136 research outputs found
Anesthesia-Related Oncological Outcomes: Beyond Volatiles and Total Intravenous Anesthesia.
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Diffusion Weighted Magnetic Resonance Imaging Radiophenotypes and Associated Molecular Pathways in Glioblastoma.
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Cuidando do recém-nascido em UTIN: convivendo com a fragilidade do viver/sobreviver à luz da complexidade
No full textDissertação (mestrado) - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Programa de Pós-Graduação em Enfermagem, Florianópolis, 2009.Este estudo trata da elaboração de um modelo que contempla o fenômeno do cuidado em Unidade de Terapia Intensiva Neonatal a partir da compreensão do ser e fazer enquanto enfermeiro neste sistema complexo. Tal compreensão aborda as transformações ocorridas desde a criação das UTINs até a atualidade, vislumbrando sua busca pela integralidade ao oferecer um cuidado sensível e compartilhado. O referencial metodológico da Teoria Fundamentada nos Dados (Grounded theory) associado ao Paradigma da Complexidade de Edgar Morin foi utilizado na análise e na construção do Modelo Teórico: CUIDANDO DO RECÉM-NASCIDO EM UTIN: Convivendo com a fragilidade do viver/sobreviver à luz da complexidade. Participaram da pesquisa 11 sujeitos, entre enfermeiros e mães com bebês internados na UTIN. Utilizou-se a entrevista aberta para coleta dos dados. A análise comparativa dos dados subsidiou o processo de codificação, amostragem, saturação teórica, ordenação e integração dos dados. Os dados foram inseridos no software NVIVO, dando seqüência na organização e agrupamento dos mesmos. A organização dos códigos foi feita de acordo com suas propriedades e, então, agrupados em códigos preliminares, subcategorias e categorias. Através das inter-relações entre categorias, emergente dos dados coletados, identificou-se a categoria central, eixo norteador do Modelo Teórico, e integradora das categorias analíticas denominada: Convivendo com a fragilidade do viver/sobreviver: cuidado altamente complexo, sensível, singular e compartilhado em torno da qual giram as demais categorias: Buscando conhecimentos e competências; Gerenciando o cuidado na UTIN e Vivenciando as singularidades na UTIN. Neste contexto, o cuidado em UTIN se fortalece como uma das áreas da Enfermagem em constante desenvolvimento, visando conciliar os avanços tecnológicos importantes para o sobreviver do bebê prematuro com abordagens que valorizam as inter-relações em seu quotidiano, de modo sistêmico. Busca atuar nas diversas esferas do cuidado complexo em saúde, desde os serviços de apoio da instituição hospitalar e seus gestores até a academia, visando evitar atuações compartimentadas e isoladas, integrando e aplicando conhecimentos científicos, com ganhos para a prática profissional. Oferecer suporte tecnológico já não basta. A pesquisa ressalta que é necessário exercitar as potencialidades já inatas dos profissionais de enfermagem e caminhar para o encontro de outras, um verdadeiro convite a novas percepções de cuidar do neonato, sua família e os membros deste sistema complexo, numa constante inquietação e adaptação para as demandas que surgem. Assim, as indagações norteadoras desta pesquisa convidam para a ampliação de novos horizontes de investigação, de forma que as possibilidades de estudos indicadas permitam o aprofundamento no âmbito das organizações de saúde e da academia.This study deals with the elaboration of a model which contemplates the phenomenon of care in a Neonatal Intensive Care Unit (NICU), based on the comprehension of the human being and human actor as a nurse in this complex system. Such comprehension encompasses the transformations which have occurred since the creation of the NICUs, discerning its search for the entirety to offer sensible and shared care. The methodological reference of the Grounded Theory associated with Edgar Morins Complexity Theory was utilized in analysis and the construction of the Theoretical Model: CARING FOR THE NEWBORN IN THE NICU: Living with the fragility of living/surviving in the light of complexity. The sample was composed of 11 subjects, including nurses and mothers with newborns in the NICU. Open interviews were used in order to collect data. Comparative data analysis subsidized the data codification, sampling, theoretical saturation, ordering, and integration processes. Data was inserted into NVIVO software, providing a sequence in data organization and grouping. Organizing the codes was done according to their properties and thus, grouped in preliminary codes, subcategories, and categories. Through the relationships in these categories which emerged from the data collected, the central category, the guiding axis of the Theoretical Model and the integrating factor of the analytical categories was identified, denominated: Living with the fragility of living/surviving: highly complex, sensitive, singular, and shared care around which are the following categories: Seeking knowledge and competencies; Managing NICU care; and Living the singularities of the NICU. In this context, NICU care is strengthened as one of the Nursing areas in constant development, seeking to conciliate important technological advances towards premature newborn survival with the approaches which systematically value day-to-day relationships. It seeks to enact in the diverse spheres of complex health care, from the support services of the hospital institution and its management to academia, searching to avoid fragmented and isolated care through integrating and applying scientific knowledge with gains for professional practice. Offering technological support is no longer enough. Research highlights that it is necessary to exercise already innate potential in nursing professionals and work towards finding others, a true invitation towards new perceptions for care for the newborn, his/her family, and the members of this complex system in a constant unrest and adaptation of demands which may arise. Thus, the guiding questions of this study invite towards the amplification of new investigative horizons, in such a manner that the possibilities for suggested studies permit more profound in the realm of health care and academic organizations
Radiomic Texture Analysis Mapping Predicts Areas of True Functional MRI Activity.
No full textIndividual analysis of functional Magnetic Resonance Imaging (fMRI) scans requires user-adjustment of the statistical threshold in order to maximize true functional activity and eliminate false positives. In this study, we propose a novel technique that uses radiomic texture analysis (TA) features associated with heterogeneity to predict areas of true functional activity. Scans of 15 right-handed healthy volunteers were analyzed using SPM8. The resulting functional maps were thresholded to optimize visualization of language areas, resulting in 116 regions of interests (ROIs). A board-certified neuroradiologist classified different ROIs into Expected (E) and Non-Expected (NE) based on their anatomical locations. TA was performed using the mean Echo-Planner Imaging (EPI) volume, and 20 rotation-invariant texture features were obtained for each ROI. Using forward stepwise logistic regression, we built a predictive model that discriminated between E and NE areas of functional activity, with a cross-validation AUC and success rate of 79.84% and 80.19% respectively (specificity/sensitivity of 78.34%/82.61%). This study found that radiomic TA of fMRI scans may allow for determination of areas of true functional activity, and thus eliminate clinician bias
A Dexamethasone-regulated Gene Signature Is Prognostic for Poor Survival in Glioblastoma Patients.
No full textBACKGROUND
Dexamethasone is reported to induce both tumor-suppressive and tumor-promoting effects. The purpose of this study was to identify the genomic impact of dexamethasone in glioblastoma stem cell (GSC) lines and its prognostic value; furthermore, to identify drugs that can counter these side effects of dexamethasone exposure.
METHODS
We utilized 3 independent GSC lines with tumorigenic potential for this study. Whole-genome expression profiling and pathway analyses were done with dexamethasone-exposed and control cells. GSCs were also co-exposed to dexamethasone and temozolomide. Risk scores were calculated for most affected genes, and their associations with survival in The Cancer Genome Atlas and Repository of Molecular Brain Neoplasia Data databases. In silico Connectivity Map analysis identified camptothecin as antagonist to dexamethasone-induced negative effects.
RESULTS
Pathway analyses predicted an activation of dexamethasone network (z-score: 2.908). Top activated canonical pathways included "role of breast cancer 1 in DNA damage response" (P=1.07E-04). GSCs were protected against temozolomide-induced apoptosis when coincubated with dexamethasone. Altered cellular functions included cell movement, cell survival, and apoptosis with z-scores of 2.815, 5.137, and -3.122, respectively. CCAAT/enhancer binding protein beta (CEBPB) was activated in a dose dependent manner specifically in slow-dividing "stem-like" cells. CEBPB was activated in dexamethasone-treated orthotopic tumors. Patients with high risk scores had significantly shorter survival. Camptothecin was validated as potential partial neutralizer of dexamethasone-induced oncogenic effects.
CONCLUSIONS
Dexamethasone exposure induces a genetic program and CEBPB expression in GSCs that adversely affects key cellular functions and response to therapeutics. High risk scores associated with these genes have negative prognostic value in patients. Our findings further suggest camptothecin as a potential neutralizer of adverse dexamethasone-mediated effects
Telemedicine for preoperative assessment during a COVID-19 pandemic: Recommendations for clinical care
No full textLimiting the spread of the disease is key to controlling the COVID-19 pandemic. This includes identifying people who have been exposed to COVID-19, minimizing patient contact, and enforcing strict hygiene measures. To prevent healthcare systems from becoming overburdened, elective and non-urgent medical procedures and treatments have been postponed, and primary health care has broadened to include virtual appointments via telemedicine. Although telemedicine precludes the physical examination of a patient, it allows collection of a range of information prior to a patient's admission, and may therefore be used in preoperative assessment. This new tool can be used to evaluate the severity and progression of the main disease, other comorbidities, and the urgency of the surgical treatment as well as preferencing anesthetic procedures. It can also be used for effective screening and triaging of patients with suspected or established COVID-19, thereby protecting other patients, clinicians and communities alike
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