Atualmente existe uma lacuna de conhecimento referente à doação e ao transplante do tecido ósseo, já que muitas publicações concentram-se, principalmente, na temática \'doação e transplante de órgãos sólidos\'. O objetivo deste estudo foi compreender os aspectos intervenientes na efetivação da doação do tecido ósseo durante o acolhimento e a entrevista familiar, realizada pelos profissionais da Organização de Procura de Órgãos, na ótica do profissional e do familiar do potencial doador. Método: Este estudo de abordagem qualitativa, apoiado em conceitos do interacionismo simbólico, constituiu-se de familiares de doadores de órgãos e tecidos que autorizaram a doação do tecido ósseo no período de janeiro a dezembro de 2016, iniciando-se a partir de pesquisa nos prontuários da Organização de Procura de Órgãos localizada no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto/SP. Selecionaram-se todos os prontuários dos doadores de tecido ósseo, totalizando doze doadores Ainda, foram convidados a participar do estudo os quatro enfermeiros responsáveis pelo acolhimento e entrevista para solicitação dos órgãos e tecidos pertencentes à Organização de Procura dos Órgãos citada, por meio de uma entrevista gravada e realizada em seu contexto de trabalho. Foram entrevistados nove familiares e quatro enfermeiros mediante roteiro de entrevista contendo dados sociodemográficos e questões sobre a vivência de todo o processo de doação do tecido ósseo. O material foi transcrito e submetido a análise de conteúdo indutiva em três categorias temáticas: contexto onde se dá o processo de solicitação da doação, fatores que facilitaram a decisão pela doação do tecido ósseo e o resultado do processo de doação para o familiar. Observamos que os familiares, ao refletirem sobre o momento de decisão pela doação do tecido ósseo, revelaram que, apesar do desconhecimento desse tipo de doação, os aspectos que contribuíram para o consentimento foram a satisfação com o atendimento hospitalar humanizado, bem como o profissionalismo dos enfermeiros da Organização de Procura de Órgãos ao explicarem quais ossos seriam retirados e como seria reconstituído o corpo do doador; o conhecimento prévio da vontade do ente querido em ser um doador e o pensamento de estar \"fazendo o bem\". Observamos ainda que os enfermeiros, ao refletirem sobre seu papel na entrevista para solicitação da doação do tecido ósseo, revelaram que, inicialmente, o desconhecimento dos familiares quanto à possibilidade de doação do tecido ósseo, faz com que os mesmos reajam negativamente devido ao medo da deformidade do corpo. Objetivando superar esse momento difícil, os enfermeiros explicam todo o processo de captação do tecido ósseo, até a forma como seria entregue o corpo do familiar para o velório. Sugerem-se capacitações futuras à equipe de enfermeiros contribuindo para a otimização de todo o processo de doação do tecido ósseo para transplante. Acreditamos ser evidente a necessidade de educação voltada à população por meio de ações governamentais, em que futuras campanhas na divulgação da existência da doação do tecido ósseo possam promover um maior entendimento, resultando em uma reação menos traumática das pessoas no momento da solicitação do tecido ósseo / Currently there is a lack of knowledge regarding donation and transplantation of bone tissue, due many publications to focus primarily on donation and transplantation of solid organs. The aim of this study was to understand the intervening aspects on the effectiveness of bone tissue donation during approach and family interview, carried out by professionals of the Organ Procurement Organization, from perspective of professionals and potential donor relatives. Methods: It is a qualitative study, based on symbolic interactionism concepts; the sample was composed for relatives of donors of organs and tissues that authorized the donation of bone tissue in the period from January to December of 2016,.The first part was characterized for a data collection in the medical records from Organ Procurement Organization located in a Brazilian School Hospital. There were twelve donors during the selected period which medical records were selected to analyze. In addition, four nurses belonging to Organ Procurement Organization were invited to participate in study. They were responsible for the approach and interview with relatives to request organs. The data collection strategy was a structured interview which was recorded and performed in their workplace. Nine families and four nurses were interviewed using an interview script containing sociodemographic data and questions about the experience of entire process of donating bone tissue. The interviews were transcribed and submitted to analysis of inductive content in three thematic categories: the context where the donation request process happens, factors that facilitated the decision by the donation of the bone tissue and the donation process result to the relative. Results: It was observed that family members reflected on the moment of decision of bone tissue donation. They revealed that, despite the lack of knowledge about this type of donation, there were some aspects that contributed to the consent satisfaction with humanized hospital care as well as the nurses of the Organ Procurement Organization professionalism. These nurses explained which bones would be removed and how the donor\'s body would be reconstituted. Another contributed factor was the relatives prior knowledge of the being´s desire to be an organ donor and the \"doing good\" feeling. Meanwhile, the nurses interviewed revealed that initially there was family members\' lack of knowledge about the possibility of donation of the bone tissue, causes them to react negatively due to the fear of deformity of the body. The nurses explained the whole process of bone tissue withdrawal and the way which the deceased´s body would be delivered to the funeral. The aims of this approach were to overcome this difficult moment and family insecurity to make decision. Conclusions: Future nurses team training is suggested to improve all bone tissue donation for transplantation process. It is extremely important a population-oriented education through governmental actions, campaigns about bone tissue donation to promote a better understanding. It could result in less traumatic people reaction at the moment of bone tissue demand

Lau, Wai Hung. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 141-153). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts also in Chinese.

Orientador: Álvaro Francisco Bosco / Banca: Valdir Gouveia Garcia / Banca: Maria José Hitomi Nagata / Banca: Márcio Zaffalon Casati / Banca: Márcio Fernando de Moraes Grisi / Resumo: O objetivo do presente estudo foi avaliar histológica e histometricamente o padrão de cicatrização de defeitos de deiscência periodontal tratados com enxerto de tecido conjuntivo subepitelial (ETC) ou matriz dérmica acelular (MDA), cada qual comparado ao tratamento com Retalho posicionado Coronal (RPC). Foram utilizados 10 cães, divididos em dois grupo de 5. Defeitos de deiscência óssea (6x8 mm) foram criados nos caninos superiores e os grupos divididos seguindo um modelo de boca dividida de acordo com o tratamento. Em um grupo de 5 cães foi realizado o tratamento com ETC e no lado contralateral RPC e o outro grupo de 5 cães foi tratado com MDA e RPC no lado contralateral. Após 3 meses pós-operatórios os animais foram submetidos à eutanásia e os blocos processados para análise histológica e histométrica. Os parâmetros histométricos avaliados incluíram extensão de tecido epitelial (TE), nova inserção (NITC) e aposição de tecido conjuntivo (ATC), novo cemento (NC) e novo osso (NO). Os dados histométricos transformados em porcentagem, foram estatisticamente analisados pelo teste ANOVA, seguido pelo teste de Tukey... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The aim of the present study was to evaluate histologically and histometrically the healing pattern of periodontal dehiscence defects treated with Subepithelial Connective Tissue Graft (CTG) or Acellular Dermal Matrix (ADM), when compared to the Coronally Positioned Flap (CPF). Dehiscence bone defects (6x8mm) were created bilaterally in the maxillary canine area of dogs (n=10, divided in 2 groups). By means of a split mouth test design, a group of 5 dogs was randomly allocated to receive subepithelial connective tissue graft (CTG) in one of the sides and a coronally positioned flap (CPF) in the opposing side. The remaining 5 dogs had acellular dermal matrix graft (ADM) as a treatment in either one of the sides and CPF on the other side. Three months after surgery, dogs were euthanized and blocks of interest were processed. The histometric parameters for the latter included lenght of epithelial tissue (ET), new attachment (NACT) and connective tissue aposition (CTA), new cementum (NC), and new bone (NB). Histometric data were converted to percentage and statistically analyzed by ANOVA followed by Tukey test at a p<0.05. No significant difference was detected in the following parameters for both groups: ET yielding... (Complete abstract click electronic access below) / Doutor

Law Wai Keung. / Thesis (M.Sc.)--Chinese University of Hong Kong, 2002. / Includes bibliographical references (leaves 98-108). / Abstracts in English and Chinese. / Abstract --- p.v / 摘要 --- p.viii / Acknowledgement --- p.x / List of Abbreviations --- p.i / Index of tables --- p.xiv / Index of figures --- p.xv / Chapter 1. --- Introduction --- p.1 / Chapter 2. --- Literature review --- p.3 / Chapter 2.1 --- Immunosuppression in Organ Transplantation --- p.3 / Chapter 2.2 --- Mechanism of Graft Rejection --- p.4 / Chapter 2.3 --- Conventional immunosuppressive drugs --- p.4 / Chapter 2.3.1 --- Corticosteriod --- p.6 / Chapter 2.3.2 --- Azathioprine --- p.6 / Chapter 2.3.3 --- Polyclonal antilymphocyte globulin and OKT3 --- p.7 / Chapter 2.4 --- Cyclosporine A (CsA) --- p.8 / Chapter 2.4.1 --- Mechanisms of CsA --- p.8 / Chapter 2.4.2 --- Pharmacokinetics of CsA --- p.10 / Chapter 2.4.2.1 --- Absorption --- p.10 / Chapter 2.4.2.2 --- Distribution --- p.11 / Chapter 2.4.2.3 --- Metabolism and elimination --- p.11 / Chapter 2.4.2.4 --- Toxicity --- p.12 / Chapter 2.4.3 --- Therapeutic drug monitoring of CsA --- p.13 / Chapter 2.4.3.1 --- CsA trough monitoring --- p.13 / Chapter 2.4.3.2 --- Full AUC monitoring --- p.15 / Chapter 2.4.3.3 --- Limited sampling strategy --- p.16 / Chapter 2.4.3.4 --- Two-hour post dose CsA level monitoring --- p.20 / Chapter 2.4.4 --- Conventional techniques of measuring cyclosporine concentration --- p.23 / Chapter 2.4.4.1 --- High performance liquid chromatography --- p.23 / Chapter 2.4.4.2 --- Non-specific immunoassays --- p.25 / Chapter 2.4.4.3 --- Specific radioimmunoassays --- p.26 / Chapter 2.4.4.4 --- Specific fluorescent polarization immunoassay --- p.26 / Chapter 2.4.4.5 --- Enzyme multiplied immunoassay technique --- p.28 / Chapter 2.4.4.6 --- Cloned enzyme donor immunoassay --- p.29 / Chapter 2.4.4.7 --- Summary for conventional techniques --- p.29 / Chapter 2.5 --- Liquid chromatography mass spectrometry for CsA measurement --- p.30 / Chapter 2.5.1 --- Main components of MS --- p.31 / Chapter 2.5.1.1 --- Specific interfaces to LC --- p.31 / Chapter 2.5.1.2 --- Mass analyzer --- p.33 / Chapter 2.5.1.3 --- Electron multiplier --- p.36 / Chapter 2.5.2 --- Sample preparation for LC-MS/MS for CsA measurement --- p.36 / Chapter 2.5.2.1 --- Liquid-liquid extraction --- p.37 / Chapter 2.5.2.2 --- Solid phase extraction --- p.38 / Chapter 2.5.2.3 --- Column switching --- p.39 / Chapter 2.5.2.4 --- Dilute and shoot --- p.40 / Chapter 2.5.3 --- LC-MS/MS for CsA measurement --- p.40 / Chapter 2.6 --- Summary --- p.42 / Chapter 3. --- Aim of study --- p.43 / Chapter 4. --- Materials and methods --- p.44 / Chapter 4.1 --- Materials --- p.44 / Chapter 4.1.1 --- Chemicals --- p.44 / Chapter 4.1.2 --- Equipment --- p.44 / Chapter 4.1.3 --- Reagent preparation for CsA analysis --- p.45 / Chapter 4.2 --- Methods --- p.48 / Chapter 4.2.1 --- Immunoassay --- p.48 / Chapter 4.2.2 --- Operation of tandem mass spectrometer --- p.48 / Chapter 4.2.2.1 --- Optimization of cone voltage --- p.50 / Chapter 4.2.2.2 --- Optimization of collision energy --- p.50 / Chapter 4.2.3 --- Optimization of LC-MS/MS --- p.51 / Chapter 4.2.3.1 --- Deproteinization procedures of whole blood --- p.52 / Chapter 4.2.3.2 --- Optimization of mobile phase flow rate --- p.52 / Chapter 4.2.3.3 --- Optimization of source temperature --- p.53 / Chapter 4.2.3.4 --- Optimization of the drying gas flow rate --- p.53 / Chapter 4.2.4 --- Matrix interference on MS/MS response --- p.53 / Chapter 4.2.5 --- Analytical performance of CsA on LC-MS/MS --- p.54 / Chapter 4.2.5.1 --- Linearity study --- p.54 / Chapter 4.2.5.2 --- Precision performance --- p.54 / Chapter 4.2.5.3 --- Accuracy performance --- p.54 / Chapter 4.2.5.4 --- The lowest detection limit of the CsA analysis --- p.55 / Chapter 4.2.5.5 --- Correlation study of the CsA analysis --- p.55 / Chapter 4.3 --- CsA pharmacokinetic studies in Chinese patients --- p.56 / Chapter 4.3.1 --- Determining the time point of CsA correlating better with AUC --- p.56 / Chapter 4.3.1.1 --- Patient and method --- p.56 / Chapter 4.3.1.2 --- Statistical analysis --- p.57 / Chapter 4.3.2 --- "Intra-individual variability of CO, C1 and C2" --- p.57 / Chapter 4.3.2.1 --- Patient and method --- p.57 / Chapter 4.3.2.2 --- Statistical analysis --- p.57 / Chapter 5. --- Results and discussion --- p.59 / Chapter 5.1 --- Optimization of MS parameters --- p.5 9 / Chapter 5.1.1 --- Optimization of cone voltage --- p.61 / Chapter 5.1.2 --- Optimization of collision energy --- p.63 / Chapter 5.2 --- Optimization of LC-MS/MS --- p.63 / Chapter 5.2.1 --- Optimization of mobile phase flow rate --- p.63 / Chapter 5.2.2 --- Optimization of ion source temperature and drying gas flow rate --- p.67 / Chapter 5.3 --- Matrix interference on MS/MS response --- p.69 / Chapter 5.4 --- Analytical performances of CsA on LC-MS/MS method --- p.71 / Chapter 5.4.1 --- Linearity --- p.71 / Chapter 5.4.2 --- Precision performance --- p.71 / Chapter 5.4.3 --- Accuracy performance --- p.72 / Chapter 5.4.4 --- The lowest limit of detection --- p.73 / Chapter 5.4.5 --- Correlation study of the CsA analysis --- p.80 / Chapter 5.5 --- The correlation between CsA at different point and AUCo-6 --- p.84 / Chapter 5.6 --- "Intra-individual variability of CO, C1 and C2" --- p.88 / Chapter 5.7 --- Therapeutic ranges of C2 --- p.90 / Chapter 5.8 --- Practical consideration for C2 measurement by LC-MS/MS method --- p.94 / Chapter 6. --- Conclusions --- p.97 / References --- p.98

Le rejet d’allogreffe représente un obstacle majeur en transplantation rénale humaine. Le lymphocyte B (LB) joue un rôle lors de cette réaction contre le greffon, mal défini à ce jour. Notre objectif a été de caractériser et identifier son implication dans le rejet humoral chronique (cABMR) et le rejet cellulaire aigu (ACR). Dans une première partie, la caractérisation phénotypique des LB par cytométrie en flux chez ces patients a mis en évidence d’importantes différences dans la distribution des sous-populations de LB uniquement chez les patients cABMR. Chez les patients ACR, dont la distribution des LB n’est pas altérée, l’analyse de coupes de biopsies rénales a permis de mettre en évidence un infiltrat cellulaire constitué de lymphocytes B et T. Dans une seconde partie, l’activité fonctionnelle et régulatrice des LB issus de patients cABMR et ACR a été évaluée à l’aide d’un modèle in vitro de coculture entre des LB et des LT. Cette étude a révélé que les LB, issus des patients cABMR uniquement, sont dépourvus d’activités régulatrices sur la fonction des LT autologues. Cette étude a aussi mis en exergue que les LB des patients cABMR présentaient une déficience dans la sécrétion de molécules immunosuppressives telles que le TGFβ et l’indoleamine 2,3-dioxygénase (IDO). Ce défaut conduit à une incapacité à générer des lymphocytes T régulateurs. Finalement, notre étude a clairement démontré le rôle du LB dans les mécanismes physiopathologiques conduisant au rejet. Ces travaux ont donc permis de générer d’éventuelles perspectives pour définir de nouvelles stratégies thérapeutiques dans la lutte contre le rejet d’allogreffe. / Allograft rejection is one of the main obstacles in human kidney transplantation. The role of B lymphocytes in the response against the allograft is poorly understood. Our aim is to identify and clarify its involvement in chronical humoral and cellular rejection. First of all, we identify profound changes in the distribution of B lymphocytes in cABMR patients which was not the case for ACR patients. In those last ones, we were able to detect on kidney biopsies an important cellular infiltrate composed with B and T cells. In the second part of this work, the functional and regulatory functions of B cells from both groups of patients were analyzed by using an in vitro coculture model between B and T cells. It appeared that B lymphocytes isolated from cABMR patients were unable to inhibit autologous T cell activity. This study showed those cells failed to produce immunosuppressive molecules as TGFβ and indoleamine 2,3-dioxygenase (IDO) leading to a default in the generation of regulatory T cells. To conclude, this study clearly showed the roles of B cells in physiopathological mechanisms of allograft rejection and helped to define new therapeutical strategies to prevent or reduce its consequences for the patients.

Lesões da cartilagem articular podem ser tratadas por meio de cirurgia de transplante osteocondral autólogo. Esta cirurgia baseia-se na colocação de cilindros osteocondrais em áreas de lesão da cartilagem articular. O objetivo principal deste estudo foi avaliar as consequências histológicas das variações de posicionamento de enxertos osteocondrais cilíndricos: no mesmo nível e desnivelados (salientes ou profundos) em relação à superfície articular. Neste estudo, foram utilizados vinte coelhos fêmeos adultas, albinos, da raça Nova Zelândia. Defeitos cilíndricos osteocondrais de três milímetros de diâmetro e três milímetros de profundidade foram tratados por esta técnica cirúrgica. Os enxertos foram posicionados aleatoriamente em três formas: ao mesmo nível da superfície articular, profundos e salientes em relação à superfície articular. Realizou-se análise macroscópica e histológica após doze semanas de evolução. Como resultados, observamos que as avaliações macroscópicas e histológicas mostraram diferenças entre os três tipos de posicionamentos. Os enxertos posicionados ao mesmo nível da superfície articular obtiveram melhores resultados. Os resultados dos enxertos posicionados salientes à superfície articular foram melhores do que os dos enxertos posicionados profundos em relação ao nível articular / The treatment of symptomatic chondral lesions aims to restore function similar to that observed before the lesion. Autologous osteochondral transplantation is a surgical procedure that consists of filling a full-thickness articular cartilage defect with normal cartilage. The main objective of this study was to evaluate the histological consequences of the positional incompatibilities of cylindrical osteochondral grafts placed either flush with the articular surface or protruding/recessed. Two experimental groups of 10 rabbits each were randomly established regarding the positioning of the osteochondral autograft: in 1 knee, the graft was implanted either protruding or recessed with respect to the articular surface, and the graft was implanted at the level of the articular surface in the other graft. The protruding graft was placed 2 mm above the level of the articular cartilage, and the recessed graft was placed 1 mm below the level of the articular cartilage. After euthanasia, the articular cartilage was macroscopically evaluated according to the scale published by Goebel et al. and histologically evaluated by haematoxylin-eosin and safranin-O staining according to the International Cartilage Repair Society (ICRS) II classification. The evaluated parameters did not significantly differ between the protruding and recessed groups, whereas flush positioning resulted in better scores according to the Goebel et al. scale and the ICRS II classification. Recessed and protruding positioning relative to the articular surface did not produce different results

Introdução: A cirrose hepática é uma patologia crônica grave e irreversível. Ela causa debilidades variadas que afetam de forma significativa a qualidade de vida (QV), além de provocar constante vulnerabilidade emocional. O transplante é a única terapêutica capaz de reverter o estado de saúde do paciente em estágio terminal e de promover o retorno a uma vida potencialmente saudável. As taxas de sobrevida são satisfatórias e os benefícios deste tipo de cirurgia sobre a QV são demonstradas em alguns estudos. No entanto, não é raro encontrar ressalvas quanto aos ganhos em saúde mental após o transplante de fígado. Mensurar os efeitos desse tratamento sobre a vida do paciente tem sido um importante indicador para decisões e intervenções no campo da medicina, mas também para outras especialidades, entre elas, a psicologia da saúde. Objetivo: Avaliar a QV de pacientes em lista de espera e após seis meses de realizado o transplante hepático, identificar os fatores de maior influência sobre a QV e analisar a percepção do impacto do adoecimento e do transplante na vida dos doentes. Método: Participaram da pesquisa 42 pacientes que estavam em acompanhamento ambulatorial pelo Serviço de Transplante de Órgãos Abdominais do HC-FMUSP. O estudo teve um desenho prospectivo longitudinal, exploratório e descritivo, com abordagem metodológica mista (quantitativa e qualitativa). Foram aplicados dois questionários de QV (SF-36 e LDQOL), uma escala sobre autopercepção de saúde (EQ VAS) e uma entrevista em profundidade. Os dados quantitativos foram avaliados de acordo com as normas propostas por cada instrumento e submetidos à análise estatística (teste de Mann-Whitney). Para a realização da análise multivariada, foi aplicada a técnica de análise fatorial. A amostra da análise qualitativa foi composta por 10 pacientes e definida por critério de saturação. As entrevistas foram gravadas, transcritas, decompostas em categorias e submetidas à análise temática, conforme o método de análise de conteúdo proposto por Bardin. Resultados: A amostra total foi composta por 27 (64,3%) homens e 15 (35,7%) mulheres, com idade entre 21 e 70 anos. O perfil clínico dos pacientes abrangeu diferentes categorias diagnósticas, sendo a hepatite pelo vírus C a mais frequente (36,73%). Complicações graves associadas à hepatopatia apareceram em 90,47% dos casos. Os resultados obtidos por meio dos instrumentos SF-36 e LDQOL e da escala EQ VAS registraram expressiva melhora da QV após o transplante hepático, na maior parte dos domínios avaliados. Apenas os domínios \'limitações por aspectos emocionais\' (p= 0,083), do SF-36, e \'interação social\' (p= 0,087), do LDQOL, não atingiram significância estatística. A análise fatorial permitiu identificar as dimensões que mais interferiram sobre a percepção da QV, e a entrevista em profundidade possibilitou discutir, de forma mais ampla, as limitações impostas pela condição crônica da doença hepática, bem como as transformações trazidas pelo transplante. Conclusão: A melhora da qualidade de vida após o transplante foi confirmada por todos os instrumentos utilizados. Entretanto, verificou-se ressalvas quanto a melhora da qualidade da saúde psíquica do paciente transplantado, não ocorrida na mesma proporção que a expressiva reconquista do bem-estar físico / Background: Liver cirrhosis is a serious and irreversible chronic disease. It causes varied weaknesses that significantly affect quality of life (QOL), as well as causing constant emotional vulnerability. Transplantation is the only therapy capable of reversing the patient\'s state of health in the terminal stage and of promoting a return to a potentially healthy life. Survival rates are satisfactory and the benefits of this type of surgery on QOL are demonstrated in some studies. However, it is not uncommon to find caveats regarding gains in mental health after liver transplantation. Measuring the effects of this treatment on the patient\'s life has been an important indicator for decisions and interventions in the field of medicine, but also for other specialties, among them, health psychology. Aims: To assess the QOL of patients on the waiting list and after six months of liver transplantation, to identify the factors that have a greater influence on QoL and to analyze the perception of the impact of illness and transplantation on patients\' lives. Method: A total of 42 patients who underwent ambulatory follow-up by the Abdominal Organ Transplantation Service of HC-FMUSP participated in the study. The study has a prospective longitudinal, exploratory and descriptive design, with a mixed methodological approach (quantitative and qualitative). Two QOL questionnaires (SF-36 e LDQOL) were applied, one scale of self-perceived health (EQ VAS) and one in-depth interview. The quantitative data were evaluated according to the norms proposed by each instrument and submitted to statistical analysis (Mann-Whitney test). For the multivariate analysis the factorial analysis technique was applied. The sample of the qualitative analysis was composed by 10 patients and defined by saturation criterion. The interviews were recorded, transcribed, broken down into categories and submitted to thematic analysis, according to the method of content analysis proposed by Bardin. Results: The total sample consisted of 27 (64.3%) men and 15 (35.7%) women, aged between 21 and 70 years. The clinical profile of patients covered different diagnostic categories, being hepatitis C virus the most frequent (36.73%). Severe complications associated with hepatopathy appeared in 90.47% of the cases. The results obtained using the SF-36 and LDQOL instruments and the EQ VAS scale showed a significant improvement in QOL after liver transplantation in most of the evaluated domains. Only the domains \'limitations by emotional aspects\' (p = 0.083), SF-36, and \'social interaction\' (p = 0.087), LDQOL, did not reach statistical significance. Factor analysis allowed us to identify the dimensions that most interfered with the perception of QoL, and the in-depth interview made it possible to discuss, in a broader way, the limitations imposed by the chronic condition of the liver disease, as well as the transformations brought about by the transplant. Conclusions: The improvement in the quality of life after transplantation was confirmed by all the instruments used. However, there were reservations regarding the improvement in the quality of the psychic health of the transplanted patient, not occurring in the same proportion as the expressive reconquest of physical well-being

A mucosite oral, também chamada recentemente de mucosite do trato gastrointestinal, continua sendo um importante efeito colateral que pode comprometer o resultado do transplante de células tronco hematopoéticas. Ela pode ocorrer em 100% dos pacientes submetidos ao transplante alogênico de células-tronco e a maior incidência neste pode ser atribuída à administração de metotrexate. A ocorrência de mucosite ulcerativa está relacionada ao aumento dos custos hospitalares, a redução da sobrevida em 100 dias e infecção sistêmica aumentando o risco de sepse. A última década foi muito importante para a compreensão da mucosite oral, incluindo a predisposição genética dos indivíduos e alterações nas enzimas responsáveis a metabolização de quimioterápicos. Recentemente, o polimorfismo C677T no gene metilenotetrahidrofolato redutase (MTHFR) têm ganhado enfoque na relação com a incidência da mucosite. Esta enzima metaboliza o metotrexate e a ela é atribuída maior ou menor atividade levando a modificações na metabolização do fármaco. Poucos trabalhos prospectivos e caso-controle são encontrados na literatura corrente com relação ao polimorfismo C677T e a incidência da mucosite. O objetivo deste estudo foi uma análise prospectiva caso-controle da relação do polimorfismo MTHFR C677T com a incidência da mucosite. Além disso, a influência da condição de saúde bucal (presença de placa dental e inflamação gengival) com a incidência de mucosite oral foi analisada. Foram inseridos 97 pacientes divididos em 2 grupos: 35 pacientes submetidos ao transplante alogênico e 62 pacientes submetidos ao transplante autólogo. A mediana de idade foi de 41,5 anos. O regime de condicionamento consistiu de busulfano e melfalano ou regime BEAM - becenum, etoposide, citarabina e melfalano (para a Doença de Hodgkin e Linfoma não Hodgkin). A profilaxia da doença do enxerto contra o hospedeiro foi feita com ciclosporina e metotrexate, no transplante alogênico. Não foi feito resgate com ácido folínico durante a administração de metotrexato. Os resultados mostraram que o polimorfismo C677T não foi significativo no grupo de estudo em comparação com o grupo controle na previsão de incidência e severidade da mucosite oral. No entanto, a incidência e gravidade da mucosite oral foram influenciadas pela condição de saúde bucal. Em conclusão, o polimorfismo C677T da MTHFR não foi relacionado ao oral mucosite, mas o estado de saúde oral foi um fator importante no desenvolvimento da mucosite. Estes resultados reforçam a importância de um dentista na equipe multiprofissional de assistência a estes pacientes. / Oral mucositis remains an important side-effect and life-threatening complication of hematopoietic stem cell transplantation. It can occurs in 100% of patients underwenting allogeneic stem cell transplantation. The differences in incidence between allogeneic and autologous transplantation may be due to methotrexate administration in the first. Ulcerative mucositis is related to increase hospitalar costs, reduced 100-days survival and systemic infections leading to sepsis risk. The last decade was very important to the understanding of oral mucositis, including genetics changes in enzymes responsible to drug metabolization, as the C677T polymorphism in the methylenetethrahidrofolate reductase gene (MTHFR). A prospective evaluation of oral mucositis in relation to the C677T MTHFR polymorphism was done. Also, the influence of oral health condition (presence of dental plaque and gingival inflammation) with the incidence of oral mucositis was analyzed. A cohort of 97 patients (35 allogeneic-study group and 62 autologous-control group) with median age of 41.5 years was evaluated. Conditioning regimen comprised busulfan and melphalan or becenum based conditioning regimen (BEAM becenum, etoposide, cytarabin and melphalan. GVHD prophylaxis comprised cyclosporine A plus short course of methotrexate in allogeneic transplantation. No rescue with folinic acid was done in the methotrexate administration. Results showed that C677T polymorphism was not significant in the study group compared with control group in predicting incidence and severity of oral mucositis. However, the incidence and severity of oral mucositis was influenced by oral health condition. In conclusion, C677T MTHFR polymorphism was not related to oral mucositis, but oral health status was an important factor in developing mucositis. These findings reinforce the importance of a dentist in the multiprofessional team to assist these patients.

Atualmente existe uma lacuna de conhecimento referente à doação e ao transplante do tecido ósseo, já que muitas publicações concentram-se, principalmente, na temática \'doação e transplante de órgãos sólidos\'. O objetivo deste estudo foi compreender os aspectos intervenientes na efetivação da doação do tecido ósseo durante o acolhimento e a entrevista familiar, realizada pelos profissionais da Organização de Procura de Órgãos, na ótica do profissional e do familiar do potencial doador. Método: Este estudo de abordagem qualitativa, apoiado em conceitos do interacionismo simbólico, constituiu-se de familiares de doadores de órgãos e tecidos que autorizaram a doação do tecido ósseo no período de janeiro a dezembro de 2016, iniciando-se a partir de pesquisa nos prontuários da Organização de Procura de Órgãos localizada no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto/SP. Selecionaram-se todos os prontuários dos doadores de tecido ósseo, totalizando doze doadores Ainda, foram convidados a participar do estudo os quatro enfermeiros responsáveis pelo acolhimento e entrevista para solicitação dos órgãos e tecidos pertencentes à Organização de Procura dos Órgãos citada, por meio de uma entrevista gravada e realizada em seu contexto de trabalho. Foram entrevistados nove familiares e quatro enfermeiros mediante roteiro de entrevista contendo dados sociodemográficos e questões sobre a vivência de todo o processo de doação do tecido ósseo. O material foi transcrito e submetido a análise de conteúdo indutiva em três categorias temáticas: contexto onde se dá o processo de solicitação da doação, fatores que facilitaram a decisão pela doação do tecido ósseo e o resultado do processo de doação para o familiar. Observamos que os familiares, ao refletirem sobre o momento de decisão pela doação do tecido ósseo, revelaram que, apesar do desconhecimento desse tipo de doação, os aspectos que contribuíram para o consentimento foram a satisfação com o atendimento hospitalar humanizado, bem como o profissionalismo dos enfermeiros da Organização de Procura de Órgãos ao explicarem quais ossos seriam retirados e como seria reconstituído o corpo do doador; o conhecimento prévio da vontade do ente querido em ser um doador e o pensamento de estar \"fazendo o bem\". Observamos ainda que os enfermeiros, ao refletirem sobre seu papel na entrevista para solicitação da doação do tecido ósseo, revelaram que, inicialmente, o desconhecimento dos familiares quanto à possibilidade de doação do tecido ósseo, faz com que os mesmos reajam negativamente devido ao medo da deformidade do corpo. Objetivando superar esse momento difícil, os enfermeiros explicam todo o processo de captação do tecido ósseo, até a forma como seria entregue o corpo do familiar para o velório. Sugerem-se capacitações futuras à equipe de enfermeiros contribuindo para a otimização de todo o processo de doação do tecido ósseo para transplante. Acreditamos ser evidente a necessidade de educação voltada à população por meio de ações governamentais, em que futuras campanhas na divulgação da existência da doação do tecido ósseo possam promover um maior entendimento, resultando em uma reação menos traumática das pessoas no momento da solicitação do tecido ósseo / Currently there is a lack of knowledge regarding donation and transplantation of bone tissue, due many publications to focus primarily on donation and transplantation of solid organs. The aim of this study was to understand the intervening aspects on the effectiveness of bone tissue donation during approach and family interview, carried out by professionals of the Organ Procurement Organization, from perspective of professionals and potential donor relatives. Methods: It is a qualitative study, based on symbolic interactionism concepts; the sample was composed for relatives of donors of organs and tissues that authorized the donation of bone tissue in the period from January to December of 2016,.The first part was characterized for a data collection in the medical records from Organ Procurement Organization located in a Brazilian School Hospital. There were twelve donors during the selected period which medical records were selected to analyze. In addition, four nurses belonging to Organ Procurement Organization were invited to participate in study. They were responsible for the approach and interview with relatives to request organs. The data collection strategy was a structured interview which was recorded and performed in their workplace. Nine families and four nurses were interviewed using an interview script containing sociodemographic data and questions about the experience of entire process of donating bone tissue. The interviews were transcribed and submitted to analysis of inductive content in three thematic categories: the context where the donation request process happens, factors that facilitated the decision by the donation of the bone tissue and the donation process result to the relative. Results: It was observed that family members reflected on the moment of decision of bone tissue donation. They revealed that, despite the lack of knowledge about this type of donation, there were some aspects that contributed to the consent satisfaction with humanized hospital care as well as the nurses of the Organ Procurement Organization professionalism. These nurses explained which bones would be removed and how the donor\'s body would be reconstituted. Another contributed factor was the relatives prior knowledge of the being´s desire to be an organ donor and the \"doing good\" feeling. Meanwhile, the nurses interviewed revealed that initially there was family members\' lack of knowledge about the possibility of donation of the bone tissue, causes them to react negatively due to the fear of deformity of the body. The nurses explained the whole process of bone tissue withdrawal and the way which the deceased´s body would be delivered to the funeral. The aims of this approach were to overcome this difficult moment and family insecurity to make decision. Conclusions: Future nurses team training is suggested to improve all bone tissue donation for transplantation process. It is extremely important a population-oriented education through governmental actions, campaigns about bone tissue donation to promote a better understanding. It could result in less traumatic people reaction at the moment of bone tissue demand

Assessment of lung edema by gravimetrical analysis is a standard method to evaluate the severity of experimentally induced ischemia/reperfusion (IR) injury. The aim of this study was to compare gravimetrical assessment of pulmonary edema with a stereological approach which allows for qualitative and quantitative distinction between intravascular and edematous fluids by light microscopy. Eight experimental groups which differed in mode of preservation, ischemic storage and pharmacological treatments were studied in an extracorporeal rat lung model. Analysis of the pooled data showed that the wet/dry ratio values mainly reflected the amount of intra-alveolar edema (rs = 0.442; p = 0.0057) but only stereological assessment of edema formation revealed differences depending on the treatment used. Only stereological data correlated significantly with oxygen tension measured at the end of reperfusion (rs = –0.530; p = 0.0009). We conclude that gravimetry is of minor functional importance compared to assessment by stereological methods which prove to be a reliable and efficient tool for the evaluation of IR injury in the different experimental settings. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.