Terapias no farmacológicas en el manejo del dolor en neonatos pretérmino. revisión sistemática de la literatura

Antecedentes El dolor en neonatos ha sido un problema poco explorado. Se ha propuesto el uso de las terapias no farmacológicas para su tratamiento, sin embargo existen pocas aproximaciones sistemáticas para la evaluación de su eficacia. Objetivos Determinar la eficacia de las terapias no farmacológicas en el manejo del dolor en neonatos pretérmino a través de una revisión sistemática. Metodología Se realizó una revisión sistemática de la literatura para evaluar la eficacia de las terapias no farmacológicas en el manejo del dolor en el recién nacido petérmino. La búsqueda se realizó a través de las bases de datos Embase, Cochrane, Bireme y Embase. Se identificaron estudios publicados inglés y español. Se realizó un análisis cualitativo y cuantitativo. Resultados Se incluyeron 10 ensayos clínicos. La solución de sacarosa administrada por vía oral mostró reducir la intensidad del dolor en el recién nacido. La intubación y toma de muestras facilitada por el cuidador mostró también reducir la intensidad del dolor. Conclusión Se recomienda la administración solución de sacarosa y acompañamiento del cuidador durante los procedimientos como medidas para reducir el dolor en el recién nacido pretérmino.

Apoyo social e ideación suicida en pacientes con cáncer

El diagnóstico de cáncer ha sido asociado con un alto riesgo de presentar ideación suicida en comparación con la población no oncológica, sin embargo se ha considerado al apoyo social como un factor protector para la ocurrencia de esta conducta. La presente investigación tuvo como objetivo identificar la relación entre el apoyo social percibido y la ideación suicida en 90 pacientes oncológicos adultos en Bogotá, bajo la hipótesis de que a mayor apoyo social percibido, menor presencia de ideación suicida. Se midió la variable de apoyo social a través del cuestionario Duke UNC y la ideación suicida a través de cuatro instrumentos: Escala de Ideación Suicida (SSI), Escala de Desesperanza de Beck (BHS), el ítem 9 del Inventario de Depresión de Beck (BDI-IA) y una entrevista semiestructurada. Los resultados mostraron que no existe relación entre el apoyo social percibido y la ideación suicida. Por otro lado se identificó una prevalencia de suicidio entre 5,6% y 22,77%, confirmando que el paciente con cáncer considera el suicidio y es fundamental evaluar esta variable en esta población. Se considera importante continuar con la realización de investigaciones que permitan generalizar los resultados a la población oncológica colombiana.

Diabetes gestacional como factor de riesgo para incontinencia urinaria: revisión sistemática de la literatura

La diabetes mellitus es una de las patologías frecuentes durante el embarazo, existe literatura que la ha relacionado con un mayor riesgo de aparición de incontinencia urinaria en el postparto patología que de manera clara afecta la calidad de vida de las mujeres, pero a la fecha la literatura no es concluyente. Con la presente revisión sistemática se pretendió evaluar la evidencia relacionada con la diabetes gestacional como causa de incontinencia urinaria en el postparto.

Relação entre factores ambientais causadores de stress e doença renal felina

A Doença Renal Crónica (DRC) é de natureza insidiosa, progressiva e irreversível e uma grande causa de morbilidade e mortalidade em gatos. O comportamento natural da espécie felina fica comprometido no meio doméstico, originando situações de stress que desempenham um papel importante na patogénese da doença crónica. A literatura sugere que a activação contínua do sistema nervoso simpático desencadeia uma série de processos fisiológicos que se traduzem por último no aparecimento de fibrose renal, contribuindo assim para a progressão da DRC. Esta dissertação pretende avaliar essa relação. Para tal, foram analisados questionários que permitissem avaliar as condições em que viviam uma amostra de 139 gatos e realizados painéis hematológicos e bioquímicos a uma sub-amostra para verificar as correlações existentes. Ainda que não tenha sido possível concluir que a presença de um parâmetro individual possa ser apontada como causa directa do desenvolvimento de DRC, podemos identificar um conjunto de factores ambientais causadores de stress como prováveis factores de risco para a degradação desta doença e a sua transição para fases mais avançadas. Desta forma, a implementação de estratégias de enriquecimento ambiental MEMO (Multimodal Environmental Modification) não só visa melhorar a qualidade de vida destes animais como se pode revelar uma chave de sucesso na prevenção e maneio de doenças crónicas.

Coronal mass ejections and magnetic flux buildup in the heliosphere

To test for magnetic flux buildup in the heliosphere from coronal mass ejections (CMEs), we simulate heliospheric flux as a constant background open flux with a time-varying interplanetary CME (ICME) contribution. As flux carried by ejecta can only contribute to the heliospheric flux budget while it remains closed, the ICME flux opening rate is an important factor. Two separate forms for the ICME flux opening rate are considered: (1) constant and (2) exponentially decaying with time. Coronagraph observations are used to determine the CME occurrence rates, while in situ observations are used to estimate the magnetic flux content of a typical ICME. Both static equilibrium and dynamic simulations, using the constant and exponential ICME flux opening models, require flux opening timescales of ∼50 days in order to match the observed doubling in the magnetic field intensity at 1 AU over the solar cycle. Such timescales are equivalent to a change in the ICME closed flux of only ∼7–12% between 1 and 5 AU, consistent with CSE signatures; no flux buildup results. The dynamic simulation yields a solar cycle flux variation with high variability that matches the overall variability of the observed magnetic field intensity remarkably well, including the double peak forming the Gnevyshev gap.

Role of Nrf2 in the regulation of CD36 and stress protein expression in murine macrophages - Activation by oxidatively modified LDL and 4-hydroxynonenal

CD36 is an important scavenger receptor mediating uptake of oxidized low- density lipoproteins ( oxLDLs) and plays a key role in foam cell formation and the pathogenesis of atherosclerosis. We report the first evidence that the transcription factor Nrf2 is expressed in vascular smooth muscle cells, and demonstrate that oxLDLs cause nuclear accumulation of Nrf2 in murine macrophages, resulting in the activation of genes encoding CD36 and the stress proteins A170, heme oxygenase- 1 ( HO- 1), and peroxiredoxin I ( Prx I). 4- Hydroxy- 2- nonenal ( HNE), derived from lipid peroxidation, was one of the most effective activators of Nrf2. Using Nrf2- deficient macrophages, we established that Nrf2 partially regulates CD36 expression in response to oxLDLs, HNE, or the electrophilic agent diethylmaleate. In murine aortic smooth muscle cells, expressing negligible levels of CD36, both moderately and highly oxidized LDL caused only limited Nrf2 translocation and negligible increases in A170, HO- 1, and Prx I expression. However, treatment of smooth muscle cells with HNE significantly enhanced nuclear accumulation of Nrf2 and increased A170, HO- 1, and Prx I protein levels. Because PPAR-gamma can be activated by oxLDLs and controls expression of CD36 in macrophages, our results implicate Nrf2 as a second important transcription factor involved in the induction of the scavenger receptor CD36 and antioxidant stress genes in atherosclerosis.

Free radicals, metals and antioxidants in oxidative stress-induced cancer

Oxygen-free radicals, more generally known as reactive oxygen species (ROS) along with reactive nitrogen species (RNS) are well recognised for playing a dual role as both deleterious and beneficial species. The "two-faced" character of ROS is substantiated by growing body of evidence that ROS within cells act as secondary messengers in intracellular signalling cascades, which induce and maintain the oncogenic phenotype of cancer cells, however, ROS can also induce cellular senescence and apoptosis and can therefore function as anti-tumourigenic species. The cumulative production of ROS/RNS through either endogenous or exogenous insults is termed oxidative stress and is common for many types of cancer cell that are linked with altered redox regulation of cellular signalling pathways. Oxidative stress induces a cellular redox imbalance which has been found to be present in various cancer cells compared with normal cells; the redox imbalance thus may be related to oncogenic stimulation. DNA mutation is a critical step in carcinogenesis and elevated levels of oxidative DNA lesions (8-OH-G) have been noted in various tumours, strongly implicating such damage in the etiology of cancer. It appears that the DNA damage is predominantly linked with the initiation process. This review examines the evidence for involvement of the oxidative stress in the carcinogenesis process. Attention is focused on structural, chemical and biochemical aspects of free radicals, the endogenous and exogenous sources of their generation, the metal (iron, copper, chromium, cobalt, vanadium, cadmium, arsenic, nickel)-mediated formation of free radicals (e.g. Fenton chemistry), the DNA damage (both mitochondrial and nuclear), the damage to lipids and proteins by free radicals, the phenomenon of oxidative stress, cancer and the redox environment of a cell, the mechanisms of carcinogenesis and the role of signalling cascades by ROS; in particular. ROS activation of AP-1 (activator protein) and NF-kappa B (nuclear factor kappa B) signal transduction pathways, which, in turn lead to the transcription of genes involved in cell growth regulatory pathways. The role of enzymatic (superoxide dismutase (Cu. Zn-SOD. Mn-SOD), catalase, glutathione peroxidase) and non-enzymatic antioxidants (Vitamin C, Vitamin E, carotenoids, thiol antioxidants (glutathione, thioredoxin and lipoic acid), flavonoids, selenium and others) in the process of careinogenesis as well as the antioxidant interactions with various regulatory factors, including Ref-1, NF-kappa B, AP-1 are also reviewed. 2006 Elsevier Ireland Ltd. All rights reserved.

Impact of apoE genotype on oxidative stress, inflammation and disease risk

Although in developing countries an apolipoprotein E4 (apoE4) genotype may offer an evolutionary advantage, as it has been shown to offer protection against certain infectious disease, in Westernised societies it is associated with increased morbidity and mortality, and represents a significant risk factor for cardiovascular disease, late-onset Alzheimer's disease and other chronic disorders. ApoE is an important modulator of many stages of lipoprotein metabolism and traditionally the increased risk was attributed to higher lipid levels in E4 carriers. However, more recent evidence demonstrates the multifunctional nature of the apoE protein and the fact that the impact of genotype on disease risk may be in large part due to an impact on oxidative status or the immunomodulatory/anti-inflammatory properties of apoE. An increasing number of studies in cell lines, targeted replacement rodents and human volunteers indicate higher oxidative stress and a more pro-inflammatory state associated with the F,4 allele. The impact of genotype on the antioxidant and immunomodulatory/anti-inflammatory properties of apoE is the focus of the current review. Furthermore, current information on the impact of environment (diet, exercise, smoking status, alcohol) on apoE genotype-phenotype associations are discussed with a view to identifying particular lifestyle strategies that could be adapted to counteract the 'at-risk' E4 genotype.

The activity of ribosome modulation factor during growth of Escherichia coli under acidic conditions

Expression of the gene encoding ribosome modulation factor (RMF), as measured using an rmf-lacZ gene fusion, increased with decreasing pH in exponential phase cultures of Escherichia coli. Expression was inversely proportional to the growth rate and independent of the acidifying agent used and it was concluded that expression of rmf was growth rate controlled in exponential phase under acid conditions. Increased rmf expression during exponential phase was not accompanied by the formation of ribosome dimers as occurs during stationary phase. Nor did it appear to have a significant effect on cell survival under acid stress since the vulnerability of an RMF-deficient mutant strain was similar to that of the parent strain. Ribosome degradation was increased in the mutant strain compared to the parent strain at pH 3.75. Also, the peptide elongation rate was reduced in the mutant strain but not the parent during growth under acid conditions. It is speculated that the function of RMF during stress-induced reduction in growth rate is two-fold: firstly to prevent reduced elongation efficiency by inactivating surplus ribosomes and thus limiting competition for available protein synthesis factors, and secondly to protect inactivated ribosomes from degradation.

Regulation of cell cycle and stress responses to hydrostatic pressure in fission yeast

We have investigated the cellular responses to hydrostatic pressure by using the fission yeast Schizosaccharomyces pombe as a model system. Exposure to sublethal levels of hydrostatic pressure resulted in G2 cell cycle delay. This delay resulted from Cdc2 tyrosine-15 (Y-15) phosphorylation, and it was abrogated by simultaneous disruption of the Cdc2 kinase regulators Cdc25 and Wee1. However, cell cycle delay was independent of the DNA damage, cytokinesis, and cell size checkpoints, suggesting a novel mechanism of Cdc2-Y15 phosphorylation in response to hydrostatic pressure. Spc1/Sty1 mitogen-activated protein (MAP) kinase, a conserved member of the eukaryotic stress-activated p38, mitogen-activated protein (MAP) kinase family, was rapidly activated after pressure stress, and it was required for cell cycle recovery under these conditions, in part through promoting polo kinase (Plo1) phosphorylation on serine 402. Moreover, the Spc1 MAP kinase pathway played a key role in maintaining cell viability under hydrostatic pressure stress through the bZip transcription factor, Atf1. Further analysis revealed that prestressing cells with heat increased barotolerance, suggesting adaptational cross-talk between these stress responses. These findings provide new insight into eukaryotic homeostasis after exposure to pressure stress.

Learning and memory in holocaust survivors with posttraumatic stress disorder

Background: Impairments in explicit memory have been observed in Holocaust survivors with posttraumatic stress disorder. Methods: To evaluate which memory components are preferentially affected, the California Verbal Learning Test was administered to Holocaust survivors with (n = 36) and without (n = 26) posttraumatic stress disorder, and subjects not exposed to the Holocaust (n = 40). Results: Posttraumatic stress disorder subjects showed impairments in learning and short-term and delayed retention compared to nonexposed subjects; survivors without posttraumatic stress disorder did not. Impairments in learning, but not retention, were retained after controlling fir intelligence quotient. Older age was associated with poorer learning and memory performance in the posttraumatic stress disorder group only. Conclusions: The most robust impairment observed in posttraumatic stress disorder was in verbal learning, which may be a risk factor for or consequence of chronic posttraumatic stress disorder. The negative association between performance and age may reflect accelerated cognitive decline in posttraumatic stress disorder.

Roles of the translationally controlled tumour protein (TCTP) and the double-stranded RNA-dependent protein kinase, PKR, in cellular stress responses

Translationally controlled tumour protein (TCTP) is a highly conserved protein present in all eukaryotic organisms. Various cellular functions and molecular interactions have been ascribed to this protein, many related to its growth-promoting and antiapoptotic properties. TCTP levels are highly regulated in response to various cellular stimuli and stresses. We have shown recently that the double-stranded RNA-dependent protein kinase, PKR, is involved in translational regulation of TCTP. Here we extend these studies by demonstrating that TCTP is downregulated in response to various proapoptotic treatments, in particular agents that induce Ca++ stress, in a PKR-dependent manner. This regulation requires phosphorylation of protein synthesis factor eIF2α. Since TCTP has been characterized as an antiapoptotic and Ca++-binding protein, we asked whether it is involved in protecting cells from Ca++-stress-induced apoptosis. Overexpression of TCTP partially protects cells against thapsigargin-induced apoptosis, as measured using caspase-3 activation assays, a nuclear fragmentation assay, using fluorescence-activated cell sorting analysis, and time-lapse video microscopy. TCTP also protects cells against the proapoptotic effects of tunicamycin and etoposide, but not against those of arsenite. Our results imply that cellular TCTP levels influence sensitivity to apoptosis and that PKR may exert its proapoptotic effects at least in part through downregulation of TCTP via eIF2α phosphorylation.

A specific group of genes respond to cold dehydration stress in cut Alstroemeria flowers whereas ambient dehydration stress accelerates developmental senescence expression patterns

Petal development and senescence entails a normally irreversible process. It starts with petal expansion and pigment production, and ends with nutrient remobilization and ultimately cell death. In many species this is accompanied by petal abscission. Post-harvest stress is an important factor in limiting petal longevity in cut flowers and accelerates some of the processes of senescence such as petal wilting and abscission. However, some of the effects of moderate stress in young flowers are reversible with appropriate treatments. Transcriptomic studies have shown that distinct gene sets are expressed during petal development and senescence. Despite this, the overlap in gene expression between developmental and stress-induced senescence in petals has not been fully investigated in any species. Here a custom-made cDNA microarray from Alstroemeria petals was used to investigate the overlap in gene expression between developmental changes (bud to first sign of senescence) and typical post-harvest stress treatments. Young flowers were stressed by cold or ambient temperatures without water followed by a recovery and rehydration period. Stressed flowers were still at the bud stage after stress treatments. Microarray analysis showed that ambient dehydration stress accelerates many of the changes in gene expression patterns that would normally occur during developmental senescence. However, a higher proportion of gene expression changes in response to cold stress were specific to this stimulus and not senescence related. The expression of 21 transcription factors was characterized, showing that overlapping sets of regulatory genes are activated during developmental senescence and by different stresses.

Tree species’ tolerance to water stress, salinity and fire

According to climate change predictions, water availability might change dramatically in Europe and adjacent regions. This change will undoubtedly have an adverse effect on existing tree species and affect their ability to cope with a lack or an excess of water, changes in annual precipitation patterns, soil salinity and fire disturbance. The following chapter will describe tree species and proven-ances used in European forestry practice which are the most suitable to deal with water stress, salinity and fire. Each subchapter starts with a brief description of each of the stress factors and discusses the predictions of the likelihood of their occurrence in the near future according to the climate change scenarios. Tree spe-cies and their genotypes able to cope with particular stress factor, together with indication of their use by forest managers are then introduced in greater detail.

Cortisol levels in response to starting school in children at increased risk for social phobia

Background: Research on depression has identified hyperactivity of the HPA axis as a potential contributory factor to the intergenerational transmission of affective symptoms. However, this has not yet been examined in the context of social phobia. The current study compared HPA axis activity in response to a universal social stressor (starting school) in children of 2 groups of women: one with social phobia and one with no history of anxiety (comparison group). To determine specificity of effects of maternal social phobia, a third group of children were also examined whose mothers had generalised anxiety disorder (GAD). Method: Children provided salivary cortisol samples in the morning, afternoon and at bedtime across 3 time-blocks surrounding the school start: a month before starting school (baseline), the first week at school (stress response), and the end of the first school term (stress recovery). Child behavioural inhibition at 14 months was also assessed to explore the influence of early temperament on later stress responses. Results: All children displayed an elevation in morning and afternoon cortisol from baseline during the first week at school, which remained elevated until the end of the first term. Children in the social phobia group, however, also displayed an equivalent elevation in bedtime cortisol, which was not observed for comparison children or for children of mothers with GAD. Children in the social phobia group who were classified as 'inhibited' at 14 months displayed significantly higher afternoon cortisol levels overall. Summary: A persistent stress response to school in the morning and afternoon is typical for all children, but children of mothers with social phobia also display atypical elevations in evening cortisol levels when at school - signalling long-term disruption of the circadian rhythm in HPA axis activity. This is the first study to report HPA axis disruption in children at risk of developing social phobia, and future research should aim to determine whether this represents a pathway for symptom development, taking early temperament into account.