Understanding nurses' awareness as to the use of therapeutic play in child care

The objective of this study was to understand how nurses become aware of the use of therapeutic play as a nursing intervention instrument. Symbolic Interactionism was the theoretical framework and Interpretive Interactionism was used as the methodological framework. Participants were seven nurses working at hospitals and outpatient pediatric units who used the therapeutic play in their practice. Four representative themes emerged: Expanding the way he/she sees the child; Becoming fascinated with a new possibility to provide care; Noticing his/her revalidated action; and Committing himself/herself to the theme development. Such themes revealed that when nurses become acquainted with therapeutic play and use it in his/her practice, they begin on a journey that allows him/her to recognize the benefits of this intervention. By doing so, nurses revalidate their actions more and more, thus valuing play as a nursing intervention tool. The authors believe that teaching about therapeutic play and integrating it to nurses' daily practice are challenges yet to be overcome.     

Recovery of pacemakers and defibrillators for analysis and device advance directives: electrophysiologists' perspectives

Background: Following high‐profile device failures, the Heart Rhythm Society emphasized the need for postmarketing surveillance by recommending that physicians return all explanted devices to the manufacturer for analysis. Methods: We conducted a national survey of electrophysiologists (EPs) regarding recovery for analysis of explanted pacemakers and implantable cardioverter defibrillators (devices), and attitudes toward device‐specific advance directives to facilitate return of devices. Online survey invitations were sent in four waves from December 2008 to June 2009 to 300 e‐mail addresses from the Heart Rhythm Society member database. Results: From 250 invitations, there were 95 responses (38%). Demographics included average age 50 years (range, 31–87); 95% male; 81% Caucasian. Only 23% reported returning all explanted devices to the manufacturers. Of all the respondents, 32% discarded >10 devices/year as medical waste, 42% stored devices in a box in the electrophysiology lab, and 10% donated at least 1 device/year to charity for reuse overseas. Sixty‐seven percent felt that it would not be helpful to have an advance directive specifying what the patient would want done with their device postmortem. Conclusions: Few EPs return all explanted devices or send interrogation reports to the manufacturers, though nearly all said it was easy to do so. A majority either dispose of explanted devices as medical waste or store them in laboratories or offices, and a small percentage donate for reuse in underserved nations or to veterinary hospitals. This study suggests a need for initiatives such as educational campaigns to increase the retrieval and return of devices, either for analysis or reuse. (PACE 2011; 659–665)     

Enteral nutrition with eicosapentaenoic acid, γ-linolenic acid and antioxidants in the early treatment of sepsis: results from a multicenter, prospective, randomized, double-blinded, controlled study: the INTERSEPT study

Introduction  

Enteral nutrition (EN) with eicosapentaenoic acid (EPA)/γ-linolenic acid (GLA) is recommended for mechanically ventilated patients with severe lung injury. EPA/GLA has anti-inflammatory benefits, as evidenced by its association with reduction in pulmonary inflammation, improvement in oxygenation and improved clinical outcomes in patients with severe forms of acute lung injury. This study was a prospective, multicenter, randomized, double-blinded, controlled trial designed to investigate whether EPA/GLA could have an effective role in the treatment of patients with early sepsis (systemic inflammatory response syndrome with confirmed or presumed infection and without any organ dysfunction) by reducing the progression of the disease to severe sepsis (sepsis associated with at least one organ failure) or septic shock (sepsis associated with hypotension despite adequate fluid resuscitation). Secondary outcomes included the development of individual organ failure, increased ICU and hospital length of stay, need for mechanical ventilation and 28-day all-cause mortality.     

A soy-based product fermented by Enterococcus faecium and Lactobacillus helveticus inhibits the development of murine breast adenocarcinoma

Purpose

Soy and its fermented products are considered functional foods. The study objective was to assess three functional food – a non-fermented soy product (NFP), fermented soy product (FSP), fermented soy product enriched with isoflavones (FI) – in terms of their ability to reduce the development of adenocarcinoma in mice, as well their ability on modulating immune system.

Methods

It was observed tumor volume and to verify correlations with the immune system it was measured levels of the cytokines IL-1β and TNF-α produced by macrophages as well as IFN-γ produced by lymphocytes using ELISA test, and nitric oxide production by macrophages using Griess reagent.

Results

All products showed immunological activity, but FSP showed the most effective tumor containment, resulting in smallest tumor volumes. FI animals expressed larger amounts of nitric oxide and IL-1β and exhibited larger tumor sizes than FSP and NFP animals.

Conclusions

The results suggested that the ingestion of FSP was most efficient in tumor containment, possibly due to a positive modulation of the immune system by when Enterococcus faecium and Lactobacillus helveticus are added to the soy product.     

Gastroprotective effects of extracts and guttiferone A isolated from Garcinia achachairu Rusby (Clusiaceae) against experimentally induced gastric lesions in mice

This study was undertaken to evaluate the gastroprotective properties of seed, leaf, and branch methanolic extracts and guttiferone A obtained from Garcinia achachairu (Clusiaceae). Mice were used in all the models, and treatments were administered orally only in pylorus-ligated model of the extracts, and drugs were administered intraduodenally. Treatment with different extracts (500?mg/kg) significantly reduced the ulcerative lesions in the ethanol/HCl-induced model; however, the seed extract was most active. When tested in different doses (50, 250, or 500?mg/kg), the seed extract of G. achaicharu showed a dose-dependent effect with a percentage of inhibition of gastric lesions of 41, 49, and 85?%, respectively. The seed extract also significantly reduced the ulcerative lesions in the indomethacin/bethanechol-induced ulcer. In this model, the percentage of inhibition of ulcer was 24, 58, and 90?%, respectively. Regarding the model of gastric secretion, a reduction of gastric juice volume and total acidity was observed, as well as an increase in gastric pH. Considering that the seed extract was the most active, it was subjected to silica gel column chromatography, leading to the isolation of guttiferone A. The isolated compound and omeprazole were evaluated in the HCl/ethanol-induced ulcer model. In this assay, both compounds at a dose of 30?mg/kg reduced the ulcerative lesions by about 75?%. These results demonstrate, for the first time, that extracts obtained from G. achachairu and guttiferone A produce gastroprotective effects, corroborating ethnomedicinal use of this plant.     

Cell cycle arrest through inhibition of tubulin polymerization by withaphysalin F,a bioactive compound isolated from <Emphasis Type="Italic">Acnistus arborescens</Emphasis>

Many compounds used in the treatment of cancer possess tubulin-interacting properties that lead to mitotic arrest. Withaphysalins are potent cytotoxic compounds that are commonly found in plants belonging to the Solanaceae family, such as Acnistus arborescens; however, the cytotoxic mechanisms or molecular targets of these compounds remain unknown. Thus, the aim of this study was to evaluate the effects of whitaphysalins on cancer cell cycle progression and tubulin interaction. In this report, we show the antiproliferative activity of withaphysalin F and its effect in arresting cells in the G₂/M phase of the cell cycle. These two effects are the result of the interference of withaphysalin F in the polymerization of microtubules. Withaphysalin F also induced DNA fragmentation, which can be related to an increase in mitochondrial membrane depolarization. These results suggest that interference of withaphysalin F in microtubule polymerization may induce cell cycle arrest in the G₂/M phase and therefore contribute to growth inhibition of tumor cells in vitro. Taken together, these studies indicate that withaphysalin F could potentially be used as an anticancer drug.     

Value of repeat ultrasound-guided fine-needle aspiration in thyroid nodule with a first benign cytologic result: impact of ultrasound to predict malignancy

This study aimed to investigate the value of repeat ultrasound-guided fine-needle aspiration (FNAC-US) in benign thyroid nodules and determine the ultrasound (US) predictors of malignancy in this group of nodules. The authors studied 35 of 143 nodules with initially benign cytological result who underwent serial re-biopsy (FNAC-US). By means of surgery, malignancy histology results were confirmed in 10 (28.5%) cases (G1) versus 25 (71.5%) benign nodules (G2). The clinical, lab, scintigraphyc, and US features were compared between the two groups to predict malignancy in thyroid nodules with initially benign cytological result. The cytological finding of 28/35 nodules were change to indeterminate cytology (Bethesda system category III or IV) at second and/or ≥third cytological study. In this group of 28 cases, 23 (82.1%) was identified until the third procedure. The interval between first and third re-biopsy was 13?months (median). There were no differences in age, gender, thyrotropin (TSH) levels, thyroid auto-antibodies, or thyroid dysfunctions. The scintigraphy showed cold nodule in 80% of G1 versus 78.9% of G2 (NS). Sonographic studies showed malignant suspected US features in G1: microcalcifications, central flow, hypoechogenicity, and border irregularity. This study suggests repeating FNAC-US in nodules with first benign cytologic result and suspicious US features of malignancy for at least two times (until the third FNAC) in about 13?months horizon.