Competências de Comunicação Clínica: Objetivos de Ensino-Aprendizagem para um Currículo Nuclear nas Áreas da Saúde

RESUMO Este ensaio destaca a importância das competências de comunicação clínica (CCC) nas ciências da saúde. Estas competências podem ser ensinadas, aprendidas e avaliadas, e vários estudos evidenciam para as vantagens de uma formação específica nesta área, potenciando a relação que os profissionais da área da saúde estabelecem com os pacientes, cuidadores informais e equipas de saúde, com resultados melhorados nos indicadores de saúde e cuidados mais humanizados. Confrontados com dificuldades na integração de programas específicos de comunicação nos curricula, assim como um défice no processo de avaliação e feedback estruturado, é crucial um investimento na formação pedagógica e no desenvolvimento curricular. Conscientes da escassez de trabalhos sistemáticos que apontam para um consenso sobre as competências e objetivos de ensino-aprendizagem das CCC, o sub-grupo Core Curriculum do comité de ensino (tEACH) da Associação Europeia de Comunicação em Saúde (EACH) desenvolveu e alcançou um consenso para um currículo nuclear nas diferentes áreas da saúde. Neste contexto, surgiu o Health Professions Core Communication Curriculum – HPCCC, que pode servir como referencial flexível de acordo com as necessidades específicas e contribuir para uma maior sistematização das iniciativas de CCC em saúde em língua portuguesa.

Use of nuclear technique in samples for agricultural purposes

The concern related to environment is growing. Due to this, it is needed to determine chemical elements in a large range of concentration. The neutron activation technique (NAA) determines the elemental composition by the measurement of artificial radioactivity in a sample that was submitted to a neutron flux. NAA is a sensitive and accurate technique with low detection limits. An example of application of NAA was the measurement of concentrations of rare earth elements (REE) in waste samples of phosphogypsum (PG) and cerrado soil samples (clayey and sandy soils). Additionally, a soil reference material of the International Atomic Energy Agency (IAEA) was also analyzed. The REE concentration in PG samples was two times higher than those found in national fertilizers, (total of 4,000 mg kg-1 ), 154 times greater than the values found in the sandy soil (26 mg kg-1 ) and 14 times greater than the in clayey soil (280 mg kg-1 ). The experimental results for the reference material were inside the uncertainty of the certified values pointing out the accuracy of the method (95%). The determination of La, Ce, Pr, Nd, Pm, Sm, Eu, Tb, Dy, Ho, Er, Tm, Yb and Lu in the samples and reference material confirmed the versatility of the technique on REE determination in soil and phosphogypsum samples that are matrices for agricultural interest.

Alterações na expressão do antígeno nuclear de proliferação celular e dos receptores de estrogênio e de progesterona provocadas pela quimioterapia primária no carcinoma de mama

OBJETIVO: averiguar as alterações induzidas pela quimioterapia primária no fenótipo celular. MÉTODOS: avaliamos a expressão do antígeno nuclear de proliferação celular (PCNA) e dos receptores de estrogênio (RE) e de progesterona (RP) em 17 tumores de mama no estádio clínico II, obtidos antes e após a terapia antiblástica, por método imuno-histoquímico. Os valores foram relacionados com o estado menstrual, com a resposta clínica tumoral e com o comprometimento axilar. RESULTADOS: houve redução significante na porcentagem de células coradas pelo anti-PCNA antes (tempo A) e após (tempo B) a quimioterapia (p=0,041). Observamos também resultados significantes ao compararmos os índices médios de PCNA com o grau histológico GII/GIII [tempo A=63,1 e tempo B=38,7 (p=0,049)] e nos casos em que houve resposta clínica [tempo A=53,1 e tempo B=34,4 (p=0,011)]. Não observamos relação significante entre os índices de PCNA com o estado menstrual e o axilar. Houve redução significante do RE após a quimioterapia nas pacientes pré-menopausadas [tempo A=60,3 e tempo B=24,1 (p=0,027)] e naquelas que apresentaram resposta clínica ao tratamento [tempo A=59,1 e tempo B=37,9 (p=0,030)]. Observamos aumento significante do RP após a quimioterapia nas pacientes pós-menopausadas [tempo A=35,3 e tempo B=58,3 (p=0,023)]. Não encontramos relação entre os receptores hormonais e o comprometimento axilar. CONCLUSÕES: a diminuição dos índices de PCNA nos tumores de alto grau histológico, do RE nas pacientes pré-menopausadas e de ambos, PCNA e RE, nos tumores com redução clínica após a quimioterapia nos mostra que ela atuou sobre as células em proliferação e que o PCNA pode ser utilizado como parâmetro de resposta a este tratamento.

Carcinoma ductal in situ associado a carcinoma invasivo na mesma mama: análise do grau nuclear e da expressão das proteínas p53 e C-erbB-2 e dos receptores de estrógeno

OBJETIVOS: avaliar a variação do grau nuclear e da expressão das proteínas p53 e c-erbB-2 e dos receptores de estrógeno (RE) no carcinoma ductal in situ (CDIS) e no carcinoma invasivo, presentes na mesma mama. MÉTODOS: estudo descritivo retrospectivo com 38 mulheres com CDIS associado a carcinoma invasivo da mama. Foi avaliado o grau nuclear e o realizado estudo imunohistoquímico para expressão das proteínas p53 e c-erbB-2 e para os RE. Os casos considerados positivos para a expressão das proteínas e dos RE foram aqueles com contagem de células positivas igual ou superior a 10%. A concordância entre estas variáveis no componente in situ e invasivo foi avaliada pelo coeficiente kappa (k), interpretado de acordo com os critérios de Landis e Koch. O teste de MacNemar foi usado para testar diferenças entre os dois grupos. RESULTADOS: a concordância entre o grau nuclear e a expressão dos RE nos componentes in situ e invasivo foi de 0,89 para ambos, quase perfeita. A concordância para a expressão da proteína c-erbB-2 também foi considerada quase perfeita, com coeficiente de 0,84. Já a concordância entre a expressão da proteína p53 no componente in situ e no invasivo foi de 1,0, considerada perfeita. Não houve diferenças significativas entre o grau nuclear e as expressões das proteínas e dos RE nos componentes in situ e invasivo na mesma mama. CONCLUSÕES: existe concordância alta do grau nuclear e da expressão das proteínas p53 e c-erbB-2 no CDIS e no carcinoma invasivo presentes na mesma mama.

Diagnóstico pré-natal de gêmeos unidos com uso da ressonância nuclear magnética: relato de dois casos

A gemelaridade imperfeita é entidade bastante rara e de grande interesse para fetólogos e obstetras em geral. Sua incidência estimada varia de 1:50.000 a 1:200.000 nascimentos. Seu diagnóstico precoce se faz necessário, tendo em vista sua importância para o prognóstico da gestação, correta determinação da via de parto e o planejamento pós-natal. Os dois casos relatados são de gêmeos unidos diagnosticados no pré-natal através da ultra-sonografia e ressonância nuclear magnética, para estudo do compartilhamento dos órgãos e melhor definição das relações anatômicas. O primeiro par gemelar foi cefalópago, ou seja, unidos pela cabeça, tórax e abdome, com duas pelves e oito membros. O segundo foi toracópago, ou seja, unidos pelo tórax e abdome superior. A ressonância magnética pouco contribuiu para o diagnóstico de gêmeos unidos. Entretanto, se mostrou de grande auxílio na descrição dos órgãos compartilhados entre os fetos, contribuindo na definição do prognóstico fetal.

Comparison of nuclear grade and immunohistochemical features in situ and invasive components of ductal carcinoma of breast

PURPOSE:To compare the prognostic and predictive features between in situ and invasive components of ductal breast carcinomas. METHODS:We selected 146 consecutive breast samples with ductal carcinoma in situ (DCIS) associated with adjacent invasive breast carcinoma (IBC). We evaluated nuclear grade and immunohistochemical expression of estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), cytokeratin 5/6 (CK5/6), and epidermal growth factor receptor (EGFR) in both components, in situ and invasive, and the Ki-67 percentage of cells in the invasive part. The DCIS and IBC were classified in molecular surrogate types determined by the immunohistochemical profile as luminal (RE/PR-positive/ HER2-negative), triple-positive (RE/RP/HER2-positive), HER2-enriched (ER/PR-negative/HER2-positive), and triple-negative (RE/RP/HER2-negative). Discrimination between luminal A and luminal B was not performed due to statistical purposes. Correlations between the categories in the two groups were made using the Spearman correlation method. RESULTS:There was a significant correlation between nuclear grade (p<0.0001), expression of RE/RP (p<0.0001), overexpression of HER2 (p<0.0001), expression of EGFR (p<0.0001), and molecular profile (p<0.0001) between components in situ and IBC. CK 5/6 showed different distribution in DCIS and IBC, presenting a significant association with the triple-negative phenotype in IBC, but a negative association among DCIS. CONCLUSIONS: Our results suggest that classical prognostic and predictive features of IBC are already determined in the preinvasive stage of the disease. However the role of CK5/6 in invasive carcinoma may be different from the precursor lesions.

Nuclear and mitochondrial DNA markers in traceability of retail beef samples

Several characteristics are important in a traceability system of animal products, such as age at slaughter, breed composition, besides information of the productive chain. In general, the certification agent records information about the animals and the system which it came from, although cannot guarantee that the slaughtering, meat processing and distribution are error proof. Besides, there is a differential price, at least at the international market, based on sex and breed composition of the animals. Genetic markers allow identification of characteristics controlled in the beef cattle traceability program, as sex and breed composition, in order to correctly identify and appraise the final product for the consumer. The hypothesis of this study was that the majority beef samples retailed in the local market originate from female with a great participation of zebu breeds. Therefore, the objective of this work was to characterize retail beef samples with DNA markers that identify cattle sex and breed composition. Within 10 beef shops localized in Pirassununga, SP, Brazil, 61 samples were collected, all were genotyped as harboring Bos taurus mitochondrial DNA and 18 were positive for the Y chromosome amplification (male). For the marker sat1711b-Msp I the frequency of the allele A was 0.278 and for the marker Lhr-Hha I the frequency of the allele T was 0.417. The results of sat1711b-Msp I and Lhr-Hha I allelic frequencies are suggestive that the proportion of indicus genome compared with the taurine genome in the market meat is smaller than the observed in the Nellore breed. The procedure described in this study identified sex and subspecies characteristics of beef meat samples, with potential application in meat products certification in special as an auxiliary tool in beef cattle traceability programs.

Concanavalin A-reactive nuclear matrix glycoprotein

The binding capacity of concanavalin A (Con A) to condensed euchromatin and heterochromatin was investigated in chicken erythrocyte nuclei (CEN), mouse liver cells, Zea mays mays meristematic cells and Drosophila melanogaster polytene chromosomes after 4 N HCl hydrolysis to determine whether binding was preferentially occurring in bands and heterochromatin. Dry mass (DM) variation was investigated in CEN by interference microscopy. Feulgen and Con A reactions were employed for all materials to correlate the loci of the two reactions. Quantifications and topological verifications were carried out by video image analysis (high performance cytometry). It was observed that 4 N HCl hydrolysis caused an important DM loss in CEN leaving a level corresponding to the average DNA DM content. In this material, Con A binding was restricted to the nuclear envelope, which reinforces the idea of the absence of a nuclear matrix in these cells. The other cell types exhibited a correspondence of Feulgen-positive and Con A-reactive areas. The Con A reaction was highly positive in the condensed chromatin areas and heterochromatin. This fact led us to speculate that Con A-positive proteins may play a role in the chromatin condensation mechanism, endowing this structure with physico-chemical stability towards acid hydrolysis and contributing to its rheological properties.

Image analysis and definition of nuclear phenotypes

Some basic topics concerned with the extraction of textural and geometric information from cell nucleus images as well as description and characterization of chromatin supraorganization and consequent classification of nuclear phenotypes are presented.

Patch-clamp detection of macromolecular translocation along nuclear pores

The present paper reviews the application of patch-clamp principles to the detection and measurement of macromolecular translocation along the nuclear pores. We demonstrate that the tight-seal 'gigaseal' between the pipette tip and the nuclear membrane is possible in the presence of fully operational nuclear pores. We show that the ability to form a gigaseal in nucleus-attached configurations does not mean that only the activity of channels from the outer membrane of the nuclear envelope can be detected. Instead, we show that, in the presence of fully operational nuclear pores, it is likely that the large-conductance ion channel activity recorded derives from the nuclear pores. We conclude the technical section with the suggestion that the best way to demonstrate that the nuclear pores are responsible for ion channel activity is by showing with fluorescence microscopy the nuclear translocation of ions and small molecules and the exclusion of the same from the cisterna enclosed by the two membranes of the envelope. Since transcription factors and mRNAs, two major groups of nuclear macromolecules, use nuclear pores to enter and exit the nucleus and play essential roles in the control of gene activity and expression, this review should be useful to cell and molecular biologists interested in understanding how patch-clamp can be used to quantitate the translocation of such macromolecules into and out of the nucleus

Association of hepatic nuclear factor-4 in the apolipoprotein B promoter: a preliminary report

Previous studies have examined the arrangement of regulatory elements along the apolipoprotein B (apoB) promoter region (-3067 to +940) and a promoter fragment extending from nucleotides -150 to +124 has been demonstrated to be essential for transcriptional activation of the apoB gene in hepatic and intestinal cells. It has also been shown that transcriptional activation of apoB requires a synergistic interaction between hepatic nuclear factor-4 (HNF-4) and CCAAT/enhancer-binding protein a (C/EBPa) transcription factors. Here, we have examined the hypothesis that HNF-4 factor binding to DNA may induce a DNA helix bend, thus facilitating the communication with a C/EBPa factor located one helix turn from this HNF-4 factor in the apoB promoter. A gel electrophoretic mobility shift assay using wild type double-stranded oligonucleotides or modified wild type duplex oligonucleotides with 10 nucleotides inserted between HNF-4 and C/EBPa factor motifs showed similar retarded complexes, indicating that HNF-4 and C/EBPa factors interact independently of the distance between binding sites. However, when only one base, a thymidine, was inserted at the -71 position of the apoB promoter, the complex shift was completely abolished. In conclusion, these results regarding the study of the mechanisms involving the interaction between HNF-4 and C/EBPa factors in the apoB promoter suggest that the perfect 5'-CCCTTTGGA-3' motif is needed in order to facilitate the interaction between the two factors.