Processo de enfermagem informatizado: metodologia para associação da avaliação clínica, diagnósticos, intervenções e resultados

O Processo de Enfermagem é uma tecnologia do cuidado que orienta a sequência do raciocínio clínico e melhora a qualidade do cuidado. Este artigo trata-se do relato do desenvolvimento de um Processo de Enfermagem Informatizado (PEI) para Unidade de Terapia Intensiva. O presente estudo foi desenvolvido em três principais etapas: discussão e compreensão da norma International Organization for Standard 18.104; aprofundamento teórico sobre a CIPE® 1.0; associação das informações aos diagnósticos e intervenções de Enfermagem. A base do conhecimento foi organizada segundo a CIPE® Versão 1.0. O resultado foi a reestruturação do PEI a partir da associação das avaliações clínicas aos diagnósticos e intervenções que permitem documentar a prática clínica de enfermagem, além de fornecerem apoio para a tomada de decisão. As etapas metodológicas empregadas permitiram fazer a associação entre a avaliação clínica, os diagnósticos, as intervenções e os resultados da CIPE® 1.0 com a ISO 18.104.

Phlebotomines (Diptera, Psychodidae) in the Ribeira Valley Speleological Province - 1. Parque Estadual Intervales, state of São Paulo, Brazil

The identification of the sandfly fauna and investigation of some ecological aspects of its populations in areas frequented by tourists of the PEI, an Atlantic forest reserve with many caves, were the objective of this study. Captures were undertaken monthly from January 2001 to December 2002, with automatic light traps installed in 13 ecotopes, including caves, forests, domiciliary and peridomiciliary environments, and by aspiration in armadillo burrows. Additionally, although not at regular intervals, Shannon traps were installed in forests and anthropic environments, aspirations were made on cave walls, among roots and fallen leaves, and some insects were captured while biting researchers. A total of 891 sandflies belonging to 21 species were captured. Six hundred specimens representing 19 species were captured with light traps, 215 in anthropic (2.24 insects/trap) and 385 in extra-domiciliary (1.46 insects/trap) environments. Brumptomyia troglodytes was the most abundant species (the Standardised Index of Species Abundance = 0.705). Pintomyia monticola predominated in the Shannon traps and showed anthropophilic and diurnal activity. Psathyromyia pascalei predominated in the aspirations; the largest number being in armadillo burrows. Eleven species were captured in caves; although some might be troglophiles, the majority used these ecotopes as resting places. Nyssomyia intermedia, Nyssomyia neivai and Migonemyia migonei, implicated in the transmission of cutaneous leishmaniasis in the Southeastern Brazilian region, were all found, though in such low densities as to suggest minimal risk of the disease in the PEI.

Effects of erosion and deposition on particle size distribution of deposited farmland soils on the chinese loess plateau

Particle size distribution (PSD) in the soil profile is strongly related to erosion, deposition, and physical and chemical processes. Water cycling and plant growth are also affected by PSD. Material sedimented upstream of the dam constructions formed large areas of deposited farmland (DF) soils on the Chinese Loess Plateau (CLP), which has been the site of the most severe soil erosion in the world. Two DFs without tillage on the CLP were chosen to study the combined effect of erosion and check dams on PSD. Eighty-eight layers (each 10 cm thick) of filled deposited farmland (FDF) soils and 22 layers of silting deposited farmland (SDF) soils of each studied soil profile were collected and 932 soil samples were investigated using laser granulometry. The particle sizes were stratified in both DFs based on soil properties and erosion resistance. The obtained results of clay and silt fractions showed similar horizontal distribution, indicating parallel characteristics of erosion and deposition processes. Fine sand represented the largest fraction, suggesting the preferential detachment of this fraction. The most erodible range of particle sizes was 0.25-0.5 mm, followed by 0.2-0.25 mm in the studied soil profiles. The correlation between particle size and soil water contents tended to increase with increasing water contents in FDF. Due to the abundant shallow groundwater, the relationship between particle size and soil water content in SDF was lost. Further studies on PSD in the DF area are needed to enhance the conservation management of soil and water resources in this region.

Metodologia para projeto de planejamento estratégico de informações alinhado ao planejamento estratégico: a experiência do Senac-PR

O objetivo desse artigo é descrever uma metodologia para projeto de Planejamento Estratégico de Informações (PEI) alinhado ao Planejamento Estratégico Organizacional, a partir de um estudo de caso no Serviço Nacional de Aprendizagem Comercial do Paraná, e os seus respectivos desafios e dificuldades. Os resultados e as contribuições relatam sobre a viabilidade prática do projeto PEI e os detalhes da execução de sua metodologia. A conclusão reitera a importância da metodologia do PEI, implementada e aceita como uma ferramenta para contribuir de forma efetiva nas inteligências interna, competitiva e organizacional do Senac-PR.

Improvement of productivity and polysaccharide-protein complex in Agaricus blazei

The objective of this work was to assess the productivity and polysaccharide-protein complex content of Agaricus blazei on rice straw medium, in comparison to conventional sawdust, using four casing soils. The A. blazei strain used was BCRC36814T, purchased from the Food Industry Research and Development Institute, Hsin-Chu, Taiwan. The two media were evaluated as to A. blazei productivity, harvesting time, and production costs. The experimental design used was a randomized complete block, with four replicates. Three local casing soils - Typic Paleudult (CCe), Typic Udorthent (Tq) and Oxyaquic Paleudult (TSp) - were compared to imported peat soil (PS, Saprists, Histosols), used as the control. The productivity of A. blazei using Tq and TSp soil was significantly higher. The TSp casing treatment resulted in earlier harvest by at least 14 to 27 days, when compared to the other treatments. The polysaccharide content in CCe (13.2%) and Tq soils (13.2%) did not differ significantly from the PS (13.4%) and TSp (10.6%) treatments. Local casing soils decreased the production costs of A. blazei cultivation. Composted rice straw can substitute sawdust as the culture medium for A. blazei production with increased yield.

Geoambientes do Parque Estadual do Ibitipoca, município de Lima Duarte-MG

Foram identificados, mapeados e caracterizados os geoambientes do Parque Estadual do Ibitipoca (PEI), Minas Gerais, com o objetivo de subsidiar o manejo ecológico da área. Para este fim, realizaram-se coletas de solos, em pontos georreferenciados por GPS (Global Positioning System), fotointerpretações a partir de ortofotos e uso de mapas planialtimétricos, além de intenso reconhecimento de solos no campo. Oito geoambientes foram identificados e caracterizados: (1) Patamares com Espodossolos, 2) Cristas Ravinadas, 3) Escarpas, 4) Grotas, 5) Mata Baixa com Candeia, 6) Mata Alta sobre Xisto, 7) Topos Aplainados e 8) Rampas com Vegetação Aberta. Em cada ambiente a vegetação associada é fortemente condicionada pela profundidade do solo e pelo tempo de permanência de água no sistema. Os ambientes de mata, tanto sobre xistos quanto sobre quartzitos, sofrem menor estresse hídrico, seja por melhores condições físicas do solo e maior retenção de água, seja pela presença de ambiente mais ombrófilo e úmido, como nas Grotas. Os geoambientes florestados possuem concentrações de P e K mais elevadas do que nos ambientes campestres abertos. No geoambiente de Mata Baixa com Candeia, a pobreza química do substrato parece ser o impedimento à ocorrência de uma floresta mais densa. Os Campos de Altitude ocorrem nas altitudes mais elevadas no PEI, sendo desenvolvidos sobre solos mais profundos do que sob campos rupestres, onde há freqüente exposição da rocha ou solos muito rasos.

Indicadores de sustentabilidade para conservação genética de Erythrina velutina Willd., em área de mata ciliar

Um dos grandes desafios para o sistema agropecuário é estabelecer a produção agrícola aliada à conservação dos recursos genéticos, principalmente visando à proteção de Áreas de Preservação Permanente. Nesse contexto, mulungu (Erythrina velutina Willd), entre outras espécies nativas, vem sofrendo com as pressões antrópicas nos mais diversos ecossistemas, o que causa reduções em sua base genética. Este trabalho foi realizado com o objetivo de utilizar parâmetros ecológicos e genéticos populacionais como indicadores de sustentabilidade em duas populações naturais de mulungu, situadas em áreas de floresta ciliar, no Estado de Sergipe, bem como avaliar a tendência à sustentabilidade delas, visando à conservação genética da espécie. Utilizou-se a matriz de Pressão-Estado-Impacto/Efeito-Resposta (PEI/ER) com a seleção de 13 indicadores, a partir do uso de marcadores moleculares RAPD e bioquímicos (enzimas) nas populações, de modo a apresentá-los como informações relevantes para medir o progresso quanto à sustentabilidade e conservação de mulungu. As populações estudadas apresentaram baixa tendência à sustentabilidade, necessitando de estratégias para mudança desse status.

Papilionoideae (Leguminosae) nos campos ferruginosos do Parque Estadual do Itacolomi, Minas Gerais, Brasil: florística e fenologia

Foi realizado um levantamento florístico das espécies de Papilionoideae (Leguminosae) ocorrentes nos campos ferruginosos do Parque Estadual do Itacolomi (PEI), situado nos municípios de Ouro Preto e Mariana, estado de Minas Gerais. As coletas foram feitas no período de março de 2001 a maio de 2002. Foram identificadas 20 espécies de Papilionoideae, pertencentes a 13 gêneros. Os gêneros mais representativos em número de espécies foram Desmodium (4), Crotalaria (3), Machaerium e Stylosanthes, com duas espécies cada. Os demais gêneros foram representados por apenas uma espécie cada. No estudo fenológico das espécies, foram constatadas correlações entre fatores climáticos (temperatura e precipitação) e a perda de folhas, brotação, floração e frutificação.

Reduction of the amount of intestinal secretory IgA in fulminant hepatic failure

Intestinal barrier dysfunction plays an important role in spontaneous bacterial peritonitis. In the present study, changes in the intestinal barrier with regard to levels of secretory immunoglobulin A (SIgA) and its components were studied in fulminant hepatic failure (FHF). Immunohistochemistry and double immunofluorescent staining were used to detect intestinal IgA, the secretory component (SC) and SIgA in patients with FHF (20 patients) and in an animal model with FHF (120 mice). Real-time PCR was used to detect intestinal SC mRNA in the animal model with FHF. Intestinal SIgA, IgA, and SC staining in patients with FHF was significantly weaker than in the normal control group (30 patients). Intestinal IgA and SC staining was significantly weaker in the animal model with FHF than in the control groups (normal saline: 30 mice; lipopolysaccharide: 50 mice; D-galactosamine: 50 mice; FHF: 120 mice). SC mRNA of the animal model with FHF at 2, 6, and 9 h after injection was 0.4 ± 0.02, 0.3 ± 0.01, 0.09 ± 0.01, respectively. SC mRNA of the animal model with FHF was significantly decreased compared to the normal saline group (1.0 ± 0.02) and lipopolysaccharide group (0.89 ± 0.01). The decrease in intestinal SIgA and SC induced failure of the intestinal immunologic barrier and the attenuation of gut immunity in the presence of FHF.

MMP-1/PAR-1 signal transduction axis and its prognostic impact in esophageal squamous cell carcinoma

The matrix metalloprotease-1 (MMP-1)/protease-activated receptor-1 (PAR-1) signal transduction axis plays an important role in tumorigenesis. To explore the expression and prognostic value of MMP-1 and PAR-1 in esophageal squamous cell carcinoma (ESCC), we evaluated the expression of two proteins in resected specimens from 85 patients with ESCC by immunohistochemistry. Sixty-two (72.9%) and 58 (68.2%) tumors were MMP-1- and PAR-1-positive, respectively, while no significant staining was observed in normal esophageal squamous epithelium. MMP-1 and PAR-1 overexpression was significantly associated with tumor node metastasis (TNM) stage and regional lymph node involvement. Patients with MMP-1- and PAR-1-positive tumors, respectively, had poorer disease-free survival (DFS) than those with negative ESCC (P = 0.002 and 0.003, respectively). Univariate analysis showed a significant relationship between TNM stage [hazard ratio (HR) = 2.836, 95% confidence interval (CI) = 1.866-4.308], regional lymph node involvement (HR = 2.955, 95%CI = 1.713-5.068), MMP-1 expression (HR = 2.669, 95%CI = 1.229-6.127), and PAR-1 expression (HR = 1.762, 95%CI = 1.156-2.883) and DFS. Multivariate analysis including the above four parameters identified TNM stage (HR = 2.035, 95%CI = 1.167-3.681), MMP-1 expression (HR = 2.109, 95%CI = 1.293-3.279), and PAR-1 expression (HR = 1.967, 95%CI = 1.256-2.881) as independent and significant prognostic factors for DFS. Our data suggest for the first time that MMP-1 and PAR-1 were both overexpressed in ESCC and are novel predictors of poor patient prognosis after curative resection. The MMP-1/PAR-1 signal transduction axis might be a new therapeutic target for future therapies tailored against ESCC.

Silencing HIF-1α reduces the adhesion and secretion functions of acute leukemia hBMSCs

Hypoxia inducible factor-1α (HIF-1α) is an important transcription factor, which plays a critical role in the formation of solid tumor and its microenviroment. The objective of the present study was to evaluate the expression and function of HIF-1α in human leukemia bone marrow stromal cells (BMSCs) and to identify the downstream targets of HIF-1α. HIF-1α expression was detected at both the RNA and protein levels using real-time PCR and immunohistochemistry, respectively. Vascular endothelial growth factor (VEGF) and stromal cell-derived factor-1α (SDF-1α) were detected in stromal cells by enzyme-linked immunosorbent assay. HIF-1α was blocked by constructing the lentiviral RNAi vector system and infecting the BMSCs. The Jurkat cell/BMSC co-cultured system was constructed by putting the two cells into the same suitable cultured media and conditions. Cell adhesion and secretion functions of stromal cells were evaluated after transfection with the lentiviral RNAi vector of HIF-1α. Increased HIF-1α mRNA and protein was detected in the nucleus of the acute myeloblastic and acute lymphoblastic leukemia compared with normal BMSCs. The lentiviral RANi vector for HIF-1α was successfully constructed and was applied to block the expression of HIF-1α. When HIF-1α of BMSCs was blocked, the expression of VEGF and SDF-1 secreted by stromal cells were decreased. When HIF-1α was blocked, the co-cultured Jurkat cell’s adhesion and migration functions were also decreased. Taken together, these results suggest that HIF-1α acts as an important transcription factor and can significantly affect the secretion and adhesion functions of leukemia BMSCs.

The role of Ca2+/calmodulin-dependent protein kinase II and calcineurin in TNF-α-induced myocardial hypertrophy

We investigated whether Ca2+/calmodulin-dependent kinase II (CaMKII) and calcineurin (CaN) are involved in myocardial hypertrophy induced by tumor necrosis factor α (TNF-α). The cardiomyocytes of neonatal Wistar rats (1-2 days old) were cultured and stimulated by TNF-α (100 μg/L), and Ca2+ signal transduction was blocked by several antagonists, including BAPTA (4 µM), KN-93 (0.2 µM) and cyclosporin A (CsA, 0.2 µM). Protein content, protein synthesis, cardiomyocyte volumes, [Ca2+]i transients, CaMKIIδB and CaN were evaluated by the Lowry method, [³H]-leucine incorporation, a computerized image analysis system, a Till imaging system, and Western blot analysis, respectively. TNF-α induced a significant increase in protein content in a dose-dependent manner from 10 µg/L (53.56 µg protein/well) to 100 μg/L (72.18 µg protein/well), and in a time-dependent manner from 12 h (37.42 µg protein/well) to 72 h (42.81 µg protein/well). TNF-α (100 μg/L) significantly increased the amplitude of spontaneous [Ca2+]i transients, the total protein content, cell size, and [³H]-leucine incorporation in cultured cardiomyocytes, which was abolished by 4 µM BAPTA, an intracellular Ca2+ chelator. The increases in protein content, cell size and [³H]-leucine incorporation were abolished by 0.2 µM KN-93 or 0.2 µM CsA. TNF-α increased the expression of CaMKIIδB by 35.21% and that of CaN by 22.22% compared to control. These effects were abolished by 4 µM BAPTA, which itself had no effect. These results suggest that TNF-α induces increases in [Ca2+]i, CaMKIIδB and CaN and promotes cardiac hypertrophy. Therefore, we hypothesize that the Ca2+/CaMKII- and CaN-dependent signaling pathways are involved in myocardial hypertrophy induced by TNF-α.

Overexpression of Fc receptor-like 1 associated with B-cell activation during hepatitis B virus infection

The role of B cells in the pathogenesis of hepatitis B virus (HBV) infection has not been explored in depth. In the present study, the activation status of B cells from peripheral blood of healthy controls (N = 20) and patients with acute hepatitis B (AHB, N = 15) or chronic hepatitis B (CHB, N = 30) was evaluated by measuring the expression levels of B-cell activation markers CD69 and CD86, using quantitative real-time PCR and flow cytometry. Moreover, the potential mechanism underlying B-cell activation during HBV infection was further investigated by analyzing the expression profile of FCRL1, an intrinsic activation molecule of B cells. An elevation in the levels of B-cell activation markers including CD69 and CD86 was observed in the AHB patients (44.31 ± 9.27, 27.64 ± 9.26%) compared to CHB patients (30.35 ± 11.27, 18.41 ± 6.56%, P < 0.05), which was still higher than healthy controls (12.23 ± 7.84, 8.22 ± 3.43%, P < 0.05). Furthermore, the expression of FCRL1 was found to be similar to B-cell activation markers, which was highest in AHB patients (70.15 ± 17.11%), lowest in healthy donors (36.32 ± 9.98%, P < 0.05) and half-way between these levels in patients with CHB (55.17 ± 12.03%, P < 0.05). The results were positively associated with aberrant B-cell activation. These data suggest that B cells can play a role in HBV infection, and therefore more effort should be devoted to exploring their functions.