One of the greatest advances in medicine during the past century is the introduction of organ transplantation. This therapeutic strategy designed to treat organ failure and organ dysfunction allows to prolong the survival of many patients that are faced with no other treatment option. Today, organ transplantation between genetically dissimilar individuals (allogeneic grafting) is a procedure widely used as a therapeutic alternative in cases of organ failure, hematological disease treatment, and some malignancies. Despite the potential of organ transplantation, the administration of immunosuppressive drugs required for allograft acceptance induces severe immunosuppression in transplanted patients, which leads to serious side effects such as infection with opportunistic pathogens and the occurrence of neoplasias, in addition to the known intrinsic toxicity of these drugs. To solve this setback in allotransplantation, researchers have focused on manipulating the immune response in order to create a state of tolerance rather than unspecific immunosuppression. Here, we describe the different treatments and some of the novel immunotherapeutic strategies undertaken to induce transplantation tolerance.

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Objetivo: Adaptar culturalmente o ISTAP Skin Tear Classification para a língua portuguesa no Brasil e testar a validade de conteúdo da versão adaptada. Métodos: Três fases compuseram a adaptação cultural: tradução, avaliação por comitê de juízes composto de cinco estomaterapeutas (gerando a validação de conteúdo do instrumento) e retrotradução. O projeto foi aprovado por comitê de ética em pesquisa. Resultados: Duas versões em português do instrumento foram obtidas após tradução e analisadas pelo comitê de juízes, ocorrendo discordâncias apenas em termos específicos utilizados na área, seguidas por sugestões para melhor adequação do vocabulário em saúde. Isso gerou valores baixos do índice de validade de conteúdo. No entanto, a validade de conteúdo foi confirmada após discussão das discrepâncias entre as autoras e alguns membros do comitê de juízes, bem como com uma das autoras do instrumento original, Dra. Kimberly LeBlanc, que também a atestou quando aprovou as retrotraduções dessa versão. Conclusão: Considera-se obtida a versão adaptada culturalmente do ISTAP Skin Tear Classification, com sua validade de conteúdo também atestada. Neste momento, os testes para confiabilidade inter e intraobservadores e validade concorrente estão em fase de finalização, após o que se disponibilizará o instrumento adaptado e validado para o Brasil.

The objective of this study was to evaluate interobserver reliability and the concurrent criterion validity of the adapted version of the International Skin Tear Advisory Panel (ISTAP) Skin Tear Classification System to Brazilian Portuguese. For the evaluation of interobserver reliability using the photograph database, 36 nurses classified 30 skin tears (STs) into three groups, according to its definitions (adapted version). For the evaluation through clinical application, 23 nurses classified 12 STs present in 8 thoracic and cardiovascular postoperative patients at a tertiary hospital in Sao Paulo, Brazil. For the data collection of patients, an enterostomal therapist nurse classified the ST found by simultaneously using the adapted ISTAP version and the Skin Tear Audit Research (STAR) Classification System to test the concurrent criterion validity. The average of 17.83 correct answers (SD = 5.03) resulted from 1080 photograph observations, with Fleiss κ = 0.279 (reasonable concordance level). The interobserver reliability in the clinical application resulted in a global correct answer percentage of 76.7% in 85 observations. The concurrent criterion validity was attested by the total correlation (r = 1) between ISTAP and STAR. The ISTAP classification for ST is a reliable instrument and also valid in Brazil, making it another option to be used in clinical practice.

Objective: To translate and culturally adapt the International Skin Tear Advisory Panel (ISTAP) Skin Tear Classification into the Portuguese language in Brazil and test the content validity of the adapted version. Methods: The cultural adaption comprised three phases: translation, evaluation by committee of judges composed of five stomatherapists (confirming the instrument content validity) and back-translation. Results: Two Brazilian Portuguese versions of the instrument were obtained after translation and analyzed by the committee, disagreements arose over several health related terms. This generated low values of the content validity index. However, the content validity was confirmed after discussion of discrepancies between the authors and some members of the judges’ committee, as well as with one of the authors of the original instrument, Dr. Kimberly LeBlanc, who also testified that validity when approving the back-translations of the adapted version to Brazilian Portuguese. Conclusion: The culturally adapted version of the ISTAP Skin Tear Classification is considered to have been obtained, with its content validity also attested. At that moment, the tests for inter and intraobserver reliability and concurrent validity are in the finalization phase, after which the instrument adapted and validated for Brazil will be made available.

Objective: To determine the prevalence of skin tears, and demographic and clinical factors associated with their presence in older adult residents of long-term care facilities. Method: This observational, quantitative, cross-sectional, epidemiological study was conducted with older adult residents of three long-term care facilities in São Paulo, Brazil. For data collection, four instruments were used: a questionnaire assessing sociodemographic and clinical characteristics of the residents; and the Brazilian-Portuguese versions of the Mini-Mental State Examination, Skin Tear Audit Research (STAR) Skin Tear Classification System, and the Katz Index of Independence in Activities of Daily Living. Results: A total of 69 residents took part in the study. The prevalence of skin tears was 11.6%. Skin tears were significantly associated with the presence of haematoma (odds ratio, OR=9.159; p=0.017) and actinic purpura (OR=6.265; p=0.033), which increased the odds of skin tear development nine-fold and six-fold, respectively. Conclusion: The findings agree with the international literature. Considering that this was the first epidemiological study on skin tears carried out in long-term care facilities for older adults in Brazil, its contribution lies in the systematisation of data collection and making data available on a field that has not yet been studied in this country.

Este trabajo tuvo como objetivo determinar el significado del poema “El dolor de la noche” de José María Eguren desde la perspectiva del análisis del discurso. Esta investigación corresponde al enfoque cualitativo y es de tipo descriptivo. El método que se empleó para analizar el poema fue la hermenéutica y como técnica el análisis del discurso poético que abarcó la dimensión textual, enunciativa, semiótica y pragmática. Como resultado se evidencia la tristeza y el sufrimiento causado por la pérdida de un ser querido, hallando al sujeto en un estado de soledad, expresando mensajes de remordimiento e irá por aquello que perdió y no supo vivir en su momento.

It has been demonstrated that the generation of mixed chimerism induces stable tolerance in allogeneic transplant organs. Current protocols require myeloablative or nonmyeloablative conditioning, both involving physical, pharmacological and/or cellular conditioning in order to produce general immunosuppression. Here, we have successfully developed a protocol that produces mixed chimerism using inducible allogeneic regulatory T cells (iTreg), low dose irradiation (3 Gy) and the FDA approved immunosuppressive drugs Rapamycin and Abatacept. Under experimental conditions, allogeneic iTreg treated mice produced mixed chimerism whereas, control mice lacking iTreg, rejected allogeneic bone marrow transplantation. Additionally, chimeric mice are able to accept secondary allogeneic skin transplants. Therefore we propose that generation of mixed chimerism is an improved specific therapy designed for stable alloinjert tolerance induction.