RESUMO
A reconstrução de modelos avançados de pele tridimensional in vitro, que corresponda de forma mais fidedigna ao complexo microambiente da pele humana, depende da utilização de inovações tecnológicas e da adição de novos tipos celulares representativos da pele humana. Desta maneira, estes miméticos fornecem uma plataforma de alta relevância para estudos de fisiopatologia da pele, além de propiciar um sistema para a avaliação da segurança e eficácia de cosméticos e medicamentos alternativo ao uso de animais. Dessa maneira, o Capítulo I compara a performance de uma epiderme reconstruída humana (RHE) bioimpressa com a manual utilizando o teste in vitro de irritação cutânea descrito no guia OCDE número 439. Nossos resultados demonstram que ambos os modelos de pele exibiram morfologia estratificada e a função barreira epidérmica equivalente aos modelos validados. Nos testes de irritação in vitro, ambos modelos distinguiram corretamente as substâncias de referência, classificadas entre irritantes ou não-irritantes de acordo com o limiar de viabilidade de 50%. Esse resultado indica que a bioimpressora poderia ser de grande utilidade para a automação da reconstrução de modelos epidérmicos. O tecido hipodérmico possui importante papel na homeostase da pele humana. O Capítulo II aborda a reconstrução de uma pele tricamada, contendo a camada hipodérmica, além da epiderme e derme. Usando esferoides de adipócitos diferenciados in vitro, um modelo de pele tricamada em matriz de colágeno foi construído. Ao comparar este com a pele bicamada obtivemos maior expressão de loricrina e involucrina no modelo tricamada, indicando um potencial para maior função barreira, além de maior expressão de PPAR-γ. Testes de função barreira através da resistividade elétrica não demonstraram diferenças entre os modelos, mas a aplicação de SDS a 5 mg/ml por 18 horas induziu o aumento da viabilidade na pele tricamada. Além disso, após a aplicação de SDS a 2,5% para induzir uma irritação aguda, seguida de recuperação por 42h, obtivemos maior viabilidade na pele tricamada, indicando melhor recuperação pós-lesão irritativa induzida. A pele tricamada é promissora para estudos do metabolismo da pele humana e recuperação de lesões. A dermatite atópica (DA) é uma doença eczematosa de pele caracterizada por inflamação do tipo Th2 e alteração da barreira epidérmica. IL-13 e IL-4 são centrais no comprometimento da barreira epidérmica na DA. Entre os receptores de IL-13 em queratinócitos, o receptor IL-13Rα2, tem um papel controverso na alteração da barreira cutânea. O objetivo do Capítulo III foi estudar a deleção da expressão de IL-13Rα2 em RHE, que foram expostas a IL-4 e IL-13, e avaliadas conforme a expressão dos receptores e de proteínas alteradas na DA. As epidermes com knockout em IL-13Rα2 apresentaram redução da expressão de NELL2 (p<0,0021), tipicamente aumentadas na DA. Além disso, houve redução da expressão do receptor do IL-2Rγ. Assim, um possível papel de exacerbação da DA do receptor IL-13Rα2 deve ser estudado mais extensamente para ser caracterizado
The reconstruction of advanced three-dimensional in vitro skin models, which more reliably correspond to the complex microenvironment of human skin, depends on the use of technological innovations and the addition of new cell types representative of human skin.In this way, these mimetics provide a highly relevant platform for studies of skin pathophysiology, in addition to providing a system for evaluating the safety and efficacy of cosmetics and medicines alternative to animal use. In this way, Chapter I compares the performance of a bioprinted human reconstructed epidermis (RHE) with a manual one using the in vitro skin irritation test described in OECD guide number 439. Our results demonstrate that both skin models exhibited stratified morphology and the epidermal barrier function equivalent to validated models. In in vitro irritation tests, both models correctly distinguished the reference substances, classified as irritating or non-irritating according to the viability threshold of 50%. This result indicates that the bioprinter could be of great use for automating the reconstruction of epidermal models Hypodermic tissue plays an important role in the homeostasis of human skin. Chapter II addresses the reconstruction of a three-layer skin, containing the hypodermic layer, in addition to the epidermis and dermis. Using in vitro differentiated adipocyte spheroids, a trilayer skin model in collagen matrix was constructed. When comparing this with bilayer skin, we obtained greater expression of loricrin and involucrin in the trilayer model, indicating a potential for greater barrier function, in addition to greater expression of PPAR-γ . Barrier function tests using electrical resistivity did not demonstrate differences between the models, but the application of SDS at 5 mg/ml for 18 hours induced an increase in viability in the three-layer skin. Furthermore, after applying 2.5% SDS to induce acute irritation, followed by recovery for 42 hours, we obtained greater viability in the three-layer skin, indicating better recovery after induced irritant injury. Trilayer skin holds promise for studies of human skin metabolism and injury recovery. Atopic dermatitis (AD) is an eczematous skin disease characterized by Th2-type inflammation and alteration of the epidermal barrier. IL-13 and IL-4 are central to the impairment of the epidermal barrier in AD. Among the IL-13 receptors on keratinocytes, the IL-13Rα2 receptor has a controversial role in altering the skin barrier. The objective of Chapter III was to study the deletion of IL-13Rα2 expression in RHE, which were exposed to IL-4 and IL-13, and evaluated according to the expression of receptors and proteins altered in AD. Epidermis with IL-13Rα2 knockout showed reduced NELL2 expression (p<0.0021), typically increased in AD. Furthermore, there was a reduction in the expression of the IL-2Rγ receptor. Therefore, a possible AD exacerbation role of the IL-13Rα2 receptor should be studied more extensively to be characterized
Assuntos
Pele/fisiopatologia , Dermatite Atópica/patologia , Ferimentos e Lesões/fisiopatologia , Técnicas In Vitro/métodos , Preparações Farmacêuticas/análise , Colágeno/agonistas , Cosméticos/classificação , Epiderme/fisiopatologia , Inflamação/classificaçãoRESUMO
PURPOSE: Substance misuse has long been recognized as a major predisposing risk factor for traumatic injury. However, there still exists no clear scientific consensus regarding the impact of drug use on patient outcomes. Therefore, this study aims to evaluate the demographic profile, hospital-course factors, and outcomes of trauma patients based on their toxicology. METHODS: This is a non-concurrent cohort study of 3709 patients treated at the Puerto Rico Trauma Hospital during 2002-2018. The sample was divided into four groups according to their toxicology status. Statistical techniques used included Pearson's chi-square test, Spearman correlation, and negative binomial and logistic regressions. RESULTS: Admission rates for marijuana (rho = 0.87) and marijuana and cocaine positive (rho = 0.68) patients increased. Positive toxicology patients underwent surgery more often than negative testing patients (marijuana: 68.7%, cocaine: 65.6%, marijuana & cocaine: 69.8%, negative: 57.0%). Among patients with non-penetrating injuries, a positive toxicology for cocaine or marijuana was linked to a 48% and 42% increased adjusted risk of complications, 37% and 27% longer TICU LOS, and 32% and 18% longer hospital LOS, respectively. CONCLUSION: Our results show an association between positive toxicology for either marijuana, cocaine, or both with higher need for surgery. Additionally, our results show an increase in complications, TICU LOS, and hospital LOS among non-penetrating trauma patients testing positive for marijuana or cocaine. Therefore, this study provides valuable information on the clinical profile of patients with positive toxicology, suggesting they might benefit from more aggressive management.
Assuntos
Cannabis , Cocaína , Ferimentos e Lesões , Humanos , Cannabis/efeitos adversos , Cocaína/efeitos adversos , Estudos de Coortes , Fatores de Risco , Transtornos Relacionados ao Uso de Substâncias/complicações , Ferimentos e Lesões/complicações , Ferimentos e Lesões/fisiopatologiaRESUMO
The U.S. government forcibly separated more than 5,000 children from their parents between 2017 and 2018 through its "Zero Tolerance" policy. It is unknown how many of the children have since been reunited with their parents. As of August 1, 2021, however, at least 1,841 children are still separated from their parents. This study systematically examined narratives obtained as part of a medico-legal process by trained clinical experts who interviewed and evaluated parents and children who had been forcibly separated. The data analysis demonstrated that 1) parents and children shared similar pre-migration traumas and the event of forced family separation in the U.S.; 2) they reported signs and symptoms of trauma following reunification; 3) almost all individuals met criteria for DSM diagnoses, even after reunification; 4) evaluating clinicians consistently concluded that mental health treatment was indicated for both parents and children; and 5) signs of malingering were absent in all cases.
Assuntos
Refugiados/psicologia , Ferimentos e Lesões/fisiopatologia , Adulto , Criança , Separação da Família , Humanos , México , Pessoa de Meia-Idade , Pais , Adulto JovemRESUMO
OBJECTIVE: The aim of this study was to analyze the function of the palatal muscles in vivo by real-time wireless electromyography in rats. The effects of palatal wounding were also analyzed. METHODS: Microelectrodes were implanted six rats; in the masseter muscle (two-rats) for comparison, in the unwounded soft palate (two-rats) and the soft palate that received a surgical wound (two-rats). Two weeks after implantation, a wound was made in the soft palate using a 1â¯mm biopsy-punch. Electromyographic measurements and video-recordings were taken weekly to monitor train-duration and peak-amplitude during eating, grooming and drinking. RESULTS: The train-duration of the masseter muscle during eating was 0.49⯱â¯0.11â¯s (rat-1) and 0.56⯱â¯0.09â¯s (rat-2), which was higher than during grooming. In the unwounded soft palate the train-duration during eating was 0.63⯱â¯0.12â¯s (rat-1) and 0.69⯱â¯0.069â¯s (rat-2), which was higher than during grooming and drinking. The peak-amplitude for eating in the normal soft palate before surgery was 0.31⯱â¯0.001â¯mV (rat-1) and 0.33⯱â¯0.02â¯mV (rat-2). This decreased to 0.23⯱â¯0.03â¯mV and 0.25⯱â¯0.11â¯mV respectively, after surgery. For drinking the peak-amplitude was 0.30⯱â¯0.01â¯mV (rat-1) and 0.39⯱â¯0.01â¯mV (rat-2) before surgery, which decreased to 0.23⯱â¯0.09â¯mV and 0.20⯱â¯0.14â¯mV respectively, after surgery. CONCLUSION: The reduced peak-amplitude suggests impaired soft palate function after wounding. This is the first study into the in vivo function of the soft palate after surgical wounding. This model will contribute to develop strategies to improve soft palate function in patients.
Assuntos
Músculos Palatinos/fisiologia , Palato Mole/fisiologia , Ferimentos e Lesões/fisiopatologia , Animais , Eletromiografia , Músculo Masseter/fisiologia , Palato Mole/lesões , RatosRESUMO
OBJECTIVES: To evaluate changes in the quality of life of patients with chronic wounds. METHODS: Quantitative research with a cross-sectional design performed with 100 patients with chronic wounds from a university hospital and a Basic Health Unit in southern Brazil. The mean values of the domains of the instruments Wound Quality of Life (Wound-QoL) and Freiburg Life Quality Assessment Wound were compared with sociodemographic variables of age, sex and education. RESULTS: The average age of the participants was 60.98 years old; 41% (n = 41) had diabetic ulcers and 83% (n = 83) treated the wounds for more than 24 months. The total quality of life value was below the mean with 37.50/100 with (Wound-QoL) and 44.20/100 with (FLQA-Wk). The variables of gender, and educational level were not correlated with either of the two instruments used to assess the quality of life. The age variable was significantly correlated with the satisfaction item of the FLQA-Wk. CONCLUSIONS: The quality of life of patients with chronic wounds was considered poor. The age variable was correlated with the satisfaction domain, showing that the older the age, the lower the satisfaction. The use of instruments to evaluate the quality of life of patients with chronic wounds may help an effective treatment plan.
Assuntos
Pé Diabético , Indicadores Básicos de Saúde , Qualidade de Vida , Ferimentos e Lesões , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Brasil , Doença Crônica , Estudos Transversais , Pé Diabético/enfermagem , Pé Diabético/fisiopatologia , Pé Diabético/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cicatrização , Ferimentos e Lesões/enfermagem , Ferimentos e Lesões/fisiopatologia , Ferimentos e Lesões/psicologia , Adulto JovemRESUMO
Abstract Trauma is a complex pathology that requires an experienced multidisciplinary team with an inherent quick decision-making capacity, given that a few minutes could represent a matter of life or death. These management decisions not only need to be quick but also accurate to be able to prioritize and to efficiently control the injuries that may be causing impending hemodynamic collapse. In essence, this is the cornerstone of the concept of damage control trauma care. With current technological advances, physicians have at their disposition multiple diagnostic imaging tools that can aid in this prompt decision-making algorithm. This manuscript aims to perform a literature review on this subject and to share the experience on the use of whole body computed tomography as a potentially safe, effective and efficient diagnostic tool in cases of severely injured trauma patients regardless of their hemodynamic status. Our general recommendation is that, when feasible, perform a whole body computed tomography without interrupting ongoing hemostatic resuscitation in cases of severely injured trauma patients with or without signs of hemodynamic instability. The use of this technology will aid in the decision-making of the best surgical approach for these patients without incurring any delay in definitive management and/or increasing significantly their radiation exposure.
Resumen El trauma es una compleja patología que requiere un equipo experimentado y multidisciplinario con una capacidad para la toma de decisiones Oportuna ya que en unos pocos minutos pueden representar la diferencia entre la vida y la muerte. Estas decisiones deben ser precisas para ser capaces de priorizar y controlar eficientemente las lesiones que puedan estar causando el compromiso hemodinámico. En esencia, este es el punto clave del concepto de control de daños en la atención del trauma. Con los nuevos avances tecnológicos, el equipo médico tiene a disposición múltiples herramientas imagenológicas de diagnóstico. Este artículo presenta una revisión de la literatura y descripción de la experiencia local con el uso de la tomografía corporal total como una herramienta diagnostica potencialmente segura, efectiva y eficiente en casos de pacientes con trauma severo sin importar su estado hemodinámico. La recomendación general, cuando sea posible, es que se debe realizar una tomografía corporal total sin interrumpir las maniobras de resucitación hemostática en casos de pacientes severamente traumatizados con o sin signos de inestabilidad hemodinámica. El uso de esta tecnología tiene como objetivo tomar decisiones pertinentes y definir el mejor abordaje quirúrgico para el paciente sin incurrir en tardanzas en el manejo definitivo o incrementar el tiempo de exposición a la radiación.
Assuntos
Humanos , Ferimentos e Lesões/fisiopatologia , Ferimentos e Lesões/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Hemodinâmica , Ferimentos e Lesões/complicações , Escala de Gravidade do FerimentoRESUMO
Abstract Noncompressible torso hemorrhage is one of the leading causes of preventable death worldwide. An efficient and appropriate evaluation of the trauma patient with ongoing hemorrhage is essential to avoid the development of the lethal diamond (hypothermia, coagulopathy, hypocalcemia, and acidosis). Currently, the initial management strategies include permissive hypotension, hemostatic resuscitation, and damage control surgery. However, recent advances in technology have opened the doors to a wide variety of endovascular techniques that achieve these goals with minimal morbidity and limited access. An example of such advances has been the introduction of the Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA), which has received great interest among trauma surgeons around the world due to its potential and versatility in areas such as trauma, gynecology & obstetrics and gastroenterology. This article aims to describe the experience earned in the use of REBOA in noncompressible torso hemorrhage patients. Our results show that REBOA can be used as a new component in the damage control resuscitation of the severely injured trauma patient. To this end, we propose two new deployment algorithms for hemodynamically unstable noncompressible torso hemorrhage patients: one for blunt and another for penetrating trauma. We acknowledge that REBOA has its limitations, which include a steep learning curve, its inherent cost and availability. Although to reach the best outcomes with this new technology, it must be used in the right way, by the right surgeon with the right training and to the right patient.
Resumen La hemorragia no compresible del torso es una de las principales causas de muerte prevenibles alrededor del mundo. Una evaluación eficiente y apropiada del paciente traumatizado con hemorragia activa es la esencia para evitar el desarrollo del rombo de la muerte (hipotermia, coagulopatía, hipocalcemia y acidosis). Actualmente, las estrategias de manejo inicial incluyen hipotensión permisiva, resucitación hemostática y cirugía de control de daños. Sin embargo, los recientes avances tecnológicos han abierto las puertas a una amplia variedad de técnicas endovasculares que logran esos objetivos con una morbilidad mínima y un acceso limitado. Un ejemplo de estos avances ha sido la introducción del balón de resucitación de oclusión aortica; REBOA ( Resuscitative Endovascular Balloon Occlusion of the Aorta , por sus sigla en inglés ), el cual, ha tenido gran provecho entre los cirujanos de trauma alrededor del mundo debido a su potencial y versatilidad en áreas como trauma, ginecología y obstetricia, y gastroenterología. El objetivo de este artículo es describir la experiencia lograda en el uso del REBOA en pacientes con hemorragia no compresible del torso. Nuestros resultados muestran que el REBOA puede usarse como un nuevo actor en la resucitación de control de daños del paciente con trauma severo, para este fin, nosotros proponemos dos nuevos algoritmos para el manejo de pacientes hemodinámicamente inestables: uno para trauma cerrado y otro para trauma penetrante. Se reconoce que el REBOA tiene sus limitaciones, las cuales incluye un periodo de aprendizaje, su costo inherente y la disponibilidad. A pesar de esto, para lograr los mejores resultados con esta nueva tecnología, el REBOA debe ser usado en el momento correcto, por el cirujano correcto con el entrenamiento y el paciente correcto.
Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Ressuscitação/métodos , Ferimentos e Lesões/terapia , Hemorragia/terapia , Aorta , Ferimentos e Lesões/complicações , Ferimentos e Lesões/fisiopatologia , Escala de Gravidade do Ferimento , Estudos Prospectivos , Oclusão com Balão , Hemodinâmica , Hemorragia/etiologia , Hemorragia/fisiopatologiaRESUMO
BACKGROUND: To investigate the thalamic neurotransmitters and functional connections in the development of chronic constriction injury (CCI)-induced neuropathic pain. METHODS: The paw withdrawal threshold was measured by mechanical stimulation the right hind paw with the von frey hair in the rats of CCI-induced neuropathic pain. The N-acetylaspartate (NAA) and Glutamate (Glu) in thalamus were detected by magnetic resonance spectrum (MRS) process. The thalamic functional connectivity with other brain regions was scanned by functional magnetic resonance image (fMRI). RESULTS: The paw withdrawal threshold of the ipsilateral side showed a noticeable decline during the pathological process. Increased concentrations of Glu and decreased levels of NAA in the thalamus were significantly correlated with mechanical allodynia in the neuropathic pain states. The thalamic regional homogeneity (ReHo) decreased during the process of neuropathic pain. The functional connectivity among the thalamus with the insula and somatosensory cortex were significantly increased at different time points (7, 14, 21 days) after CCI surgery. CONCLUSION: Our study suggests that dynamic changes in thalamic NAA and Glu levels contribute to the thalamic functional connection hyper-excitation during CCI-induced neuropathic pain. Enhanced thalamus-insula functional connection might have a significant effect on the occurrence of neuropathic pain.
Assuntos
Neuralgia , Neurotransmissores/metabolismo , Tálamo/metabolismo , Ferimentos e Lesões/fisiopatologia , Animais , Ácido Aspártico/análogos & derivados , Ácido Aspártico/metabolismo , Constrição , Ácido Glutâmico/metabolismo , Hiperalgesia , Ratos , Tálamo/fisiopatologiaRESUMO
Epidemiological and descriptive research on malignant wounds (MWs) is scarce. The objective of this study was to identify the prevalence of MWs and analyze the characteristics and associated factors of MWs in hospitalized patients at an oncological institution. An epidemiological, cross-sectional, and descriptive study, which was derived from a larger study that collected data on the prevalence of different types of wounds in 341 adults hospitalized in a large oncological hospital, was conducted. The present study comprehensively analyzed data related to MWs. Information was obtained through participant interviews, physical examination, and medical record review. The study was approved by the ethics committee of the institution where the study was conducted. Fourteen MWs were identified in 13 patients, who were primarily married (58%) and men (75%), with a mean age of 60.5 ± 15.1 years. Malignant wounds were predominantly located in the head and neck region (43%) and classified as 1N (50%) according to the Staging of Malignant Cutaneous Wounds instrument. Malignant wounds were characterized as painful (83.3%), with significant pain present during dressing changes (93%). The presence of MWs was associated with the use of antidepressants (odds ratio [OR] = 4.95; p = .012), upper-limb edema (OR = 8.39; p = .003), and infection (OR = 12.16; p = .051). The prevalence of MWs in hospitalized patients was 3.8%. Associated clinical variables were related to the degree of disease progression. This information provides evidence of the need for research identifying and investigating nursing interventions for patients with MW to assist with pain control during dressing changes.
Assuntos
Neoplasias/complicações , Ferimentos e Lesões/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Neoplasias/fisiopatologia , Prevalência , Fatores de Risco , Cicatrização/efeitos dos fármacos , Cicatrização/fisiologia , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/fisiopatologiaRESUMO
Road or urban traffic accidents in Brazil have a large presence in external causes of mortality. The main goal of this study is to discover significant factors in the incidence of accidents on Brazilian highways based on a database with information on each person injured on federal highways in Brazil reported by the Federal Highway Police. Some factors are considered in the study as cause of the accident, type of accident, stage of the day, weather condition, highway type, highway facility, age of the victim, gender of the victim and type of vehicle. From the obtained results of chi-square tests and logistic regression models, it was observed statistical dependence (p < 0.05) of the occurrence of injured people with serious injuries and the factors cause of the accident, type of accident, day, highway type and vehicle type. Considering the dead victims, the covariates age, time of day, highway type, highway facility, gender and type of vehicle showed significance (p < 0.05). These results are of great interest for authorities to increase road enforcement, improve highway facilities and target the production of vehicles with better safety standards.