Feo-hifomicose refere-se a infecções por fungos pigmentados escuros. Revisamos a casuística brasileira entre 1953 e 2010, apresentando as características clínico-epidemiológicas e diagnósticas de 17 casos. Nas quais a coloração de hematoxilina-eosina foi usada para visualizar alterações estruturais nas lesões; a coloração da prata para identificação dos microrganismos; e coloração de Fontana-Masson confirmou a melanina na parede fúngica. Os fungos cresceram sob aspecto de micélio e produziam pigmentos de melanina, que dão às colônias cor negra característica. A observação das características microscópicas dos cultivos forneceu a identificação etiológica. A feo-hifomicose está amplamente disseminada no Brasil. Entretanto, é subestimada devido a fixação das biopsias em formol, o que impede o isolamento em cultivos. / Phaeohyphomycosis refers to infection caused by darkly pigmented fungi. We reviewed the Brazilian casuistic from 1953 to 2010 and presented the clinicalepidemiologic and diagnostic features of addictional 17 cases. In the cases hematoxilin and eosin stain was used to look for structural changes of the infected lesion; Gomori’s methenamine-silver stain identified these organisms; and Fontana-Masson staining confirm the presence of melanin fungal cell wall. The organisms formed mycelial colonies and produced melanin-like pigments that give the colonies the characteristic dark color. The microscopic study of cultures identified etiology. The phaeohyphomycosis is a widespread tropical disease in Brazil. However, it is underestimated due to formalin fixation tissue specimens that oppose the prior cultures.

Feo-hifomicose refere-se a infecções por fungos pigmentados escuros. Revisamos a casuística brasileira entre 1953 e 2010, apresentando as características clínico-epidemiológicas e diagnósticas de 17 casos. Nas quais a coloração de hematoxilina-eosina foi usada para visualizar alterações estruturais nas lesões; a coloração da prata para identificação dos microrganismos; e coloração de Fontana-Masson confirmou a melanina na parede fúngica. Os fungos cresceram sob aspecto de micélio e produziam pigmentos de melanina, que dão às colônias cor negra característica. A observação das características microscópicas dos cultivos forneceu a identificação etiológica. A feo-hifomicose está amplamente disseminada no Brasil. Entretanto, é subestimada devido a fixação das biopsias em formol, o que impede o isolamento em cultivos. / Phaeohyphomycosis refers to infection caused by darkly pigmented fungi. We reviewed the Brazilian casuistic from 1953 to 2010 and presented the clinicalepidemiologic and diagnostic features of addictional 17 cases. In the cases hematoxilin and eosin stain was used to look for structural changes of the infected lesion; Gomori’s methenamine-silver stain identified these organisms; and Fontana-Masson staining confirm the presence of melanin fungal cell wall. The organisms formed mycelial colonies and produced melanin-like pigments that give the colonies the characteristic dark color. The microscopic study of cultures identified etiology. The phaeohyphomycosis is a widespread tropical disease in Brazil. However, it is underestimated due to formalin fixation tissue specimens that oppose the prior cultures.

Introdução: O processo de doação de órgãos envolve assistência aos potenciais doadores e aos seus familiares. A humanização nesse contexto requer o envolvimento dos profissionais que participam das diversas atividades desenvolvidas e, dentre eles, os enfermeiros de Unidades de Terapia Intensiva. Objetivo: Conhecer a percepção de enfermeiros de unidades de terapia intensiva sobre a humanização no processo de doação de órgãos para transplante. Método: Trata-se de um estudo exploratório, descritivo e de abordagem qualitativa. Para a coleta de dados, após a autorização da instituição e aprovação do Comitê de Ética em Pesquisa, foram entrevistados 32 enfermeiros atuantes em Unidades de Terapia Intensiva e que possuíam experiência profissional com potenciais doadores de órgãos. Para a realização das entrevistas foram utilizadas as seguintes questões norteadoras: 1.O que você entende por humanização no processo de doação de órgãos?; 2.Como acontece a humanização no processo de doação de órgãos? e 3.O que você sugere para o aprimoramento da humanização no processo? Os discursos foram analisados segundo a análise de conteúdo proposta por Bardin. Resultados: Emergiram cinco categorias: 1) Significado da humanização no processo de doação de órgãos; 2) Percepção do processo de doação de órgãos; 3) Sentimento de não inserção no processo de doação de órgãos; 4) Fatores dificultadores para humanizar o processo de doação de órgãos e 5) Sugestões para aprimorar a humanização no processo de doação de órgãos. Foi evidenciado que os participantes percebem a humanização no processo de doação de órgãos como respeito ao doador e à família, referindo que a assistência deve ser sempre humanizada, independente do paciente estar em morte encefálica ou não, e de ser um potencial doador de órgãos ou não. Os enfermeiros evidenciam, também, um sentimento de não inserção no processo, referindo uma participação rápida e pontual, o que faz com que atribuam aos profissionais da Organização de Procura de Órgãos a responsabilidade de atuar mais ativamente com as famílias dos potenciais doadores. Relatam, como fatores que dificultam a humanização no processo de doação, a inadequação do espaço físico, a falta de tempo para darem atenção à família, a dinâmica de internação do paciente e a dinâmica da unidade. Apresentam sugestões para aprimorar a humanização no processo, como: informar as pessoas sobre a temática da doação de órgãos para melhorar a compreensão e clareza do conceito de morte encefálica, estimular a discussão sobre o assunto entre as famílias e proporcionar a elas um acompanhamento psicológico. Conclusões: A humanização no processo de doação de órgãos é percebida como sendo de muita importância, mas apresenta dificuldades e contradições e requer aprimoramento, tanto no que tange à humanização da assistência ao potencial doador, quanto na inserção do enfermeiro nesse processo. / Introduction: The process of organ donation involves assisting the potential donors and their families. Humanization in this context requires the involvement of professionals who participate in the various activities that are developed and, among them, the nurses of the Intensive Care Units. Objective: To get to know the perception of nurses in intensive care units on the humanization in the donation of organs for a transplantation process. Method: This was an exploratory descriptive study of qualitative approach. The data was collected after an authorization of the institution and approved by the Research Ethics Committee. 32 respondents were nurses working in intensive care units and with professional experience with potential organ donors. For the interviews the following guiding questions were used: 1.What do you understand about the humanization of the organ donation process? 2.How does the humanization in the organ donation process happen? 3.What would you suggest to improve the humanization in the process? The reports were analyzed according to content analysis proposed by Bardin. Results: Five categories emerged: 1) Meaning of humanization in the organ donation process 2) Perception of the organ donation process 3) Feeling of non-inclusion in the organ donation process 4) Difficulty factors to humanize the process of organ donation and 5) Suggestions to improve the humanization of the organ donation process. It was shown that participants realize the importance of the humanization of organ donation in respect of the donor and family proceedings stating that the assistance must always be humane, to be independent of patient brain death or not, and being or not a potential organ donor. Nurses show a feeling of participation in the process, referring to a quick and timely participation which makes the professionals assign to the Organization of Organ Procurement the responsibility to act more actively with families of potential donors. Difficulty factors on humanization in the donation process were reported as the inadequacy of physical space, the lack of time to pay attention to the family, the dynamics of patient hospitalization and of the unit. Suggestions were made to improve the humanization of the process such as informing people about the issue of organ donation to improve understanding and clarity of the concept of brain death, stimulating discussion on the subject between families and providing psychological counseling. Conclusions: The humanization of the organ donation process is perceived as being of great importance but presents difficulties and contradictions. It requires improvement regarding the humanization of the potential donor as well as the inclusion of nurses in this process.

Organ donation is traditionally based on the notion of making a gift based on altruism. An important aspect of ‘altruistic gifting’ is commitment to a solidaristic approach to meeting transplant needs. In line with this, people are encouraged to donate their organs at death to a common pool for collective provision, or donate a live organ to another freely. Given a chronic organ shortage, proposals have been made to change this system to increase donation. Proposals include introducing some organ market or payment in the form of a reward to incentivise live or deceased donation. However, these proposals have been opposed because of the grip of ‘altruistic gift’ as the only ethically acceptable way to procure and distribute organs. To support the ethical acceptability of other systems, ‘altruistic gift’ has been subject to various criticisms. One criticism is the moral relevance of altruism: people may donate on other motives other than altruism; or, altruism is not the motive that underpins most deceased organ donations. Another criticism is the moral value of altruism: even if deceased organ donations are in general altruistic, altruism does not express communal virtues like generosity that support solidarity. A third criticism is the value of the concept of altruism when understood in the pure sense: ‘pure altruism’ fashions an unnecessary or false dichotomy – gift versus sale – in the way people can ethically relate and help each other. Consistent with or following this criticism, it has been argued that use of a financial reward to incentivise donation can be compatible with preserving donation as altruistic albeit in a ‘non-pure’ sense. ‘Altruism’ and reward can co-exist as motives for donation. This thesis concerns itself centrally with the third criticism. It argues that the concept of altruism delineates a distinctive moral ‘perspective’ of a common humanity that engenders a devotion to others’ interests. Accordingly, as I argue, ‘non-pure’ definitions of altruism are misleading as to how a financial reward can be compatible with altruism. From this, the thesis argues that introduction of a financial reward for organ donation would not preserve donation as altruistic. Based on an understanding of altruism as also a motive for ‘creative’ relationships, the thesis counters criticisms of its relevance and value to deceased organ donation under a gift model. As part of its legal analysis, the thesis considers the antithesis of ‘altruistic gift’: the idea of organs as property which places individual control on their disposition at its moral centre. It has been argued that organs should be owned as property so that individuals can sell them, or transmit them to relatives so that relatives can claim payment from donation. To provoke thought on whether organs should be owned as private property like any other, the thesis proposes an inheritance regime for organs with family as default successor.

abstract: Prior to the first successful allogeneic organ transplantation in 1954, virtually every attempt at transplanting organs in humans had resulted in death, and understanding the role of the immune mechanisms that induced graft rejection served as one of the biggest obstacles impeding its success. While the eventual achievement of organ transplantation is touted as one of the most important success stories in modern medicine, there still remains a physiological need for immunosuppression in order to make organ transplantation work. One such solution in the field of experimental regenerative medicine is interspecies blastocyst complementation, a means of growing patient-specific human organs within animals. To address the progression of immune-related constraints on organ transplantation, the first part of this thesis contains a historical analysis tracing early transplant motivations and the events that led to the discoveries broadly related to tolerance, rejection, and compatibility. Despite the advancement of those concepts over time, this early history shows that immunosuppression was one of the earliest limiting barriers to successful organ transplantation, and remains one of the most significant technical challenges. Then, the second part of this thesis determines the extent at which interspecies blastocyst complementation could satisfy modern technical limitations of organ transplantation. Demonstrated in 2010, this process involves using human progenitor cells derived from induced pluripotent stem cells (iPSCs) to manipulate an animal blastocyst genetically modified to lack one or more functional genes responsible for the development of the intended organ. Instead of directly modulating the immune response, the use of iPSCs with interspecies blastocyst complementation could theoretically eliminate the need for immunosuppression entirely based on the establishment of tolerance and elimination of rejection, while also satisfying the logistical demands imposed by the national organ shortage. Although the technology will require some further refinement, it remains a promising solution to eliminate the requirement of immunosuppression after an organ transplant. / Dissertation/Thesis / Masters Thesis Biology 2020

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京都大学 / 新制・論文博士 / 博士(医学) / 乙第13535号 / 論医博第2275号 / 新制||医||1065(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 伊達 洋至, 教授 湊谷 謙司, 教授 小林 恭 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

Bakgrund: En organtransplantation är en livräddande operation när ett organ har slutat fungera eller fungerar dåligt. En organtransplantation ändrar barnets livskvalitet men komplikationer och medicinering orsakar ofta lidande. Det är en omvälvande upplevelse för föräldrar att gå genom ett barns organtransplantation. Sjuksköterskan kan hjälpa både barn och föräldrar genom processen genom att vara lyhörd för familjens behov. Syfte: Att belysa föräldrars upplevelser av att ha ett barn som genomgått organtransplantation. Metod: Studien var en allmän litteraturstudie innehållande tio vetenskapliga artiklar vilka bearbetades med inspiration från innehållsanalys. Resultat: Tre huvudkategorier framkom: (i) upplevelser av den nya vardagen, (ii) upplevelser av relationer, (iii) upplevelser av oro inför framtiden. Konklusion: Föräldrarna upplevde att barnets organtransplantation gjorde livet lättare än innan men den sågs också som ett falskt hopp om ett bättre liv. Det sociala livet begränsades och det fanns både en negativ och positiv påverkan på föräldrarnas relationer. Föräldrarna upplevde även oro inför att inte veta vad framtiden skulle innebära. Föräldrar behöver stöd och information från sjuksköterskan för att klara av att ta hand om och vårda ett svårt sjukt barn som genomgått en organtransplantation. / Background: An organ transplant is a life-saving operation when an organ has stopped working or is working inadequate. An organ transplant changes a child's quality of life, but complications and medication can often cause suffering. It is a transformative experience for parents to go through a child's organ transplant. The nurse can help both children and parents through the process by being sensitive to the needs of the family. Aim: To shed light on parents’ experiences of having a child who has undergone an organ transplant. Method: The study is a general literature study containing ten scientific articles. The articles were processed with inspiration from content analysis. Result: Three main categories emerged: (i) experiences of the new everyday life, (ii) experiences of relationships, (iii) experiences of anxiety about the future. Conclusion: The parents felt that the child's organ transplant made life easier, but it was also seen as a false hope for a better life. The social life was limited and there were both a negative and positive impact on the parents’ relationships. The parents also experienced anxiety about not knowing what the future would entail. Parents need support and information from the nurse to cope with looking after and caring for a seriously ill child who has undergone an organ transplant.

Organ transplantation survival rates have continued to improve over the last decades, mostly due to reduction of mortality early after transplantation. The advancement of the field is facilitating a liberalization of the access to organ transplantation with more patients with higher risk profile being added to the waiting list. At the same time, the persisting organ shortage fosters strategies to rescue organs of marginal donors. In this regard, hypothermic and normothermic machine perfusion are recognized as one of the most important developments in the modern era. Owing to these developments, novel non-invasive tools for the assessment of organ quality are on the horizon. Hyperspectral imaging represents a potentially suitable method capable of evaluating tissue morphology and organ perfusion prior to transplantation. Considering the changing environment, we here discuss the hypothetical combination of organ machine perfusion and hyperspectral imaging as a prospective feasibility concept in organ transplantation.