Pain and quality of life in patients undergoing radiotherapy for spinal metastatic disease treatment

Background: Radiotherapy is an important tool in the control of pain in patients with spinal metastatic disease. We aimed to evaluate pain and of quality of life of patients with spinal metastatic disease undergoing radiotherapy with supportive treatment. Methods. The study enrolled 30 patients. From January 2008 to January 2010, patients selection included those treated with a 20Gy tumour dose in five fractions. Patients completed the visual analogue scale for pain assessment and the SF-36 questionnaire for quality of life assessment. Results: The most frequent primary sites were breast, multiple myeloma, prostate and lymphoma. It was found that 14 spinal metastatic disease patients (46.66%) had restricted involvement of three or fewer vertebrae, while 16 patients (53.33%) had cases involving more than three vertebrae. The data from the visual analogue scale evaluation of pain showed that the average initial score was 5.7 points, the value 30days after the end of radiotherapy was 4.60 points and the average value 6months after treatment was 4.25 points. Notably, this final value was 25.43% lower than the value from the initial analysis. With regard to the quality of life evaluation, only the values for the functional capability and social aspects categories of the questionnaire showed significant improvement. Conclusion: Radiotherapy with supportive treatment appears to be an important tool for the treatment of pain in patients with spinal metastatic disease. © 2013 Valesin Filho et al; licensee BioMed Central Ltd.

Excess androgen during perinatal life alters steroid receptor expression, apoptosis, and cell proliferation in the uteri of the offspring

Exposure to environmental chemicals may contribute to reproductive disorders, especially when it occurs in critical periods of development. The female reproductive system can be a target for androgens derived from environmental contaminants or pathological conditions. The purpose of this study was to assess the long-term effects of androgens on uterine tissue after maternal exposure limited to the time of gestation and lactation. Pregnant Wistar rats were treated with testosterone propionate (TP) at 0.05. mg/kg, 0.1. mg/kg, 0.2. mg/kg or corn oil (vehicle), s.c., from gestational day 12 until the end of lactation. The results show changes in the pattern of expression of receptors for estrogen, progesterone, and androgen at all doses tested, and decreases in both apoptosis and cell proliferation indices at 0.1 and 0.2. mg/kg. We conclude that early TP exposure, under these experimental conditions, causes changes in cellular and molecular parameters that are essential for normal uterine function in the adult. © 2013 Elsevier Inc.

Diastolic function is associated with quality of life and exercise capacity in stable heart failure patients with reduced ejection fraction

Exercise capacity and quality of life (QOL) are important outcome predictors in patients with systolic heart failure (HF), independent of left ventricular (LV) ejection fraction (LVEF). LV diastolic function has been shown to be a better predictor of aerobic exercise capacity in patients with systolic dysfunction and a New York Heart Association (NYHA) classification >II. We hypothesized that the currently used index of diastolic function E/e' is associated with exercise capacity and QOL, even in optimally treated HF patients with reduced LVEF. This prospective study included 44 consecutive patients aged 55±11 years (27 men and 17 women), with LVEF,0.50 and NYHA functional class I-III, receiving optimal pharmacological treatment and in a stable clinical condition, as shown by the absence of dyspnea exacerbation for at least 3 months. All patients had conventional transthoracic echocardiography and answered the Minnesota Living with HF Questionnaire, followed by the 6-min walk test (6MWT). In a multivariable model with 6MWT as the dependent variable, age and E/e' explained 27% of the walked distance in 6MWT (P=0.002; multivariate regression analysis). No association was found between walk distance and LVEF or mitral annulus systolic velocity. Only normalized left atrium volume, a sensitive index of diastolic function, was associated with decreased QOL. Despite the small number of patients included, this study offers evidence that diastolic function is associated with physical capacity and QOL and should be considered along with ejection fraction in patients with compensated systolic HF.

Tourism life cycle, tourism competitiveness and upgrading strategies in the Caribbean

In the 1980s Butler adapted the life cycle product model to the tourism industry and created the “Tourism Area Life Cycle (TALC) model”. The model recognizes six stages in the tourism product life cycle: exploration, investment, development, consolidation, stagnation and followed, after stagnation, by decline or revitalization of the product. These six stages can in turn be regrouped into four main stages. The Butler model has been applied to more than 30 country cases with a wide degree of success. De Albuquerque and Mc Elroy (1992) applied the TALC model to 23 small Caribbean island States in the 1990s. Following De Albuquerque and Mc Elroy, the TALC is applied to the 32 member countries of the Caribbean Tourism Organization (CTO) (except for Cancun and Cozumel) to locate their positions along their tourism life-cycle in 2007. This is done using the following indicators: the evolution of the level, market share and growth rate of stay-over arrivals; the growth rate and market share of visitor expenditures per arrival and the tourism styles of the destinations, differentiating between ongoing mass tourism and niche marketing strategies and among upscale, mid-scale and low-scale destinations. Countries have pursued three broad classes of strategies over the last 15 years in order to move upward in their tourism life cycle and enhance their tourism competitiveness. There is first a strategy that continues to rely on mass-tourism to build on the comparative advantages of “sun, sand and sea”, scale economies, all-inclusive packages and large amounts of investment to move along in Stage 2 or Stage 3 (Cuba, Dominican Republic, Puerto Rico). There is a second strategy pursued mainly by very small islands that relies on developing specific niche markets to maintain tourism competitiveness through upgrading (Anguilla, Antigua and Barbuda, British Virgin Islands and Turks and Caicos), allowing them to move from Stage 2 to Stage 3 or Stage 3 to a rejuvenation stage. There is a third strategy that uses a mix of mass-tourism, niche marketing and quality upgrading either to emerge onto the intermediate stage (Trinidad and Tobago); avoid decline (Aruba, The Bahamas) or rejuvenate (Barbados, Jamaica and the United States Virgin Islands). There have been many success stories in Caribbean tourism competitiveness and further research should aim at empirically testing the determinants of tourism competitiveness for the region as a whole.

Spatio-temporal distribution of fish larvae in relation to ontogeny and water quality in the oligohaline zone of a North Brazilian estuary

O padrão de distribuição das larvas de peixes na Baía do Guajará foi estudado através de coletas trimestrais e discutido em relação aos estágios de desenvolvimento dos indivíduos e a exposição dos mesmos aos contaminantes despejados pela Capital do Estado do Pará, Belém. A densidade e a diversidade larval foram baixas com forte dominância dos clupeídeos, engraulídeos e, em menor grau, os cianídeos. O principal período de reprodução foi definido no início do período chuvoso. Larvas de Clupeiformes em pré-flexão e flexão foram encontradas nos pontos de coletas mais afastados da cidade, enquanto aquelas em pós-flexão prevaleceram nas margens da cidade. Por outro lado, os cianídeos em pré-flexão e flexão foram capturados perto dos centros de atividade urbana, enquando aqueles em pós-flexão foram pouco abundantes. É sugerido que a baía se encontra na rota migratória dos cianídeos entre a área de desova e os berçários mais distantes. Apesar das águas no entorno da cidade de Belém mostraram sinais de contaminação, a qualidade ambiental na Baía do Guajará no momento do estudo estava apropriada para a vida das larvas de peixes. Nitrato com pH foram as variáveis que melhor explicaram a distribuição larval.

Anatomical changes and audiological profile in branchio-oto-renal syndrome: a literature review

Introduction  Branchio-oto-renal (BOR) syndrome is an autosomal-dominant genetic condition with high penetrance and variable expressivity, with an estimated prevalence of 1 in 40,000. Approximately 40% of the patients with the syndrome have mutations in the gene EYA1, located at chromosomal region 8q13.3, and 5% have mutations in the gene SIX5 in chromosome region 19q13. The phenotype of this syndrome is characterized by preauricular fistulas; structural malformations of the external, middle, and inner ears; branchial fistulas; renal disorders; cleft palate; and variable type and degree of hearing loss. Aim  Hearing loss is part of BOR syndrome phenotype. The aim of this study was to present a literature review on the anatomical aspects and audiological profile of BOR syndrome. Data Synthesis  Thirty-four studies were selected for analysis. Some aspects when specifying the phenotype of BOR syndrome are controversial, especially those issues related to the audiological profile in which there was variability on auditory standard, hearing loss progression, and type and degree of the hearing loss. Mixed loss was the most common type of hearing loss among the studies; however, there was no consensus among studies regarding the degree of the hearing loss.

Quality of life profile and correlated factors in chronic leg ulcer patients in the mid-west of São Paulo State, Brazil

BACKGROUND: Chronic leg ulcer may have an impact on patients' quality of life.OBJECTIVES:This study aimed to identify the impact of leg ulcers on patient's quality of life using the Dermatology Life Quality Index and to define the main factors correlated with this perception.METHOD:Cross-sectional, non-probabilistic sampling study. We included patients with chronic leg ulcers being treated for at least 3 months. A sociodemographic and clinical survey was conducted to assess the profile of the ulcers. We administered a screening for depressive symptoms and the Dermatology Life Quality Index. We performed a descriptive statistical analysis, chi-square test and Mann-Whitney test for categorical data, Pearson for numeric variables, and multiple regression for categorical data.RESULTS:Forty-one patients were assessed. Their mean age was 61.78 years. Venous ulcers (48.8%) were the most prevalent. Seventy-three percent of the sample perceived no impact/low impact on quality of life in the past week, and 26.8% perceived moderate/high impact. A multiple regression analysis identified the causes of lesion, pain related to the ulcers, time of onset, and severity of the depressive symptoms as the variables that had an influence on quality of life.CONCLUSIONS:The majority of the sample perceived low or no impact of the condition on the quality of the life. The variables etiology of the lesion (p<0.001), pain related to the ulcers (p=0.001), time of onset (p=0.006), and severity of the depressive symptoms (p<0.001) had an influence on the quality of life, suggesting the need for further studies with more robust designs to confirm the causal relationship between these characteristics and quality of life.

Influence of seasonal changes in daily activity and annual life cycle of Geotrigona mombuca (Hymenoptera, Apidae) in a Cerrado habitat, São Paulo, Brazil

The foraging activity of Geotrigona mombuca Smith, 1863 was studied under natural conditions aiming to verify the influence of seasonal changes on daily flight activity and annual cycle of the colony. Daily flight activity was monitored for a year based on the observation and counting of foragers leaving and entering the hive, as well as the kind of material transported and meteorological factors such as day time, temperature and relative humidity. The influence of seasonal changes was evidenced by alterations on daily rhythm of flight activity and by differences on transportation of food resources, building material and garbage. These data indicate that forager behavior is related to daily microclimate conditions and it is synchronized with the requirements of colony annual cycle, which determines an intense pollen collection in the summer. Thus, the recomposition of the intranidal population in spring and summer can be ensured, which is characterized both for a higher intensity of flight activity and increase in garbage and resin transport, as well as the swarming process in the spring. In this way, an action targeting the preservation or management of the species in a natural environment should consider that survival and reproduction of the colony depends greatly on the amount of available pollen in late winter.

Environment and dispersal paths override life strategies and residence time in determining regional patterns of invasion by alien plants

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Correlation between sleep and quality of life in cerebral palsy

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Signs, translation, and life in the Bakhtin circle and in Welby's significs

“Significs” is provisionally defined by Welby (1911: vii) as the study of the nature of significance in all its forms and relationships, of its workings in all spheres of human life and knowledge. Considering “significs” as a movement highlighting significance, Welby explores the action of signs in life; and more than the Saussurean sign composed of signifier and signified, the sign as understood by Welby refers to meaning as generated through signs in motion. This notion of “significs” empowers the study of signs when it considers the sign not in terms of the Saussurean structural representation of the union of the concept and acoustic image, but as (responsive and responsible) sign action in the world, in life. This also means to take into account the “extra-linguistic referent” (translinguistic and transdiscursive character of significs), history (space-time), subjectivity, the architecture of values connected to language, their communicative function. We believe that a dialogue can be established between Welby’s vision of significs and the notion of ideological sign proposed by Vološinov in Marxism and the Philosophy of Language, expanding the notions of “meaning” and “sense.”

Drug addictions and sexual violence in childhood and adolescence: analyzing life stories

The sexual abuse suffered in childhood and adolescence, in addition to damage to physical and psychological health of the victim, is considered as an important risk factor for alcohol and drugs addiction, development of psychopathology and psychosocial damage in adulthood. In addition to the pain and humiliation that are submitted by the abuse, children and adolescents also experience shame and guilt which require them to adopt coping strategies to endure those feelings. The use of psychoactive substances is a recognized way of dealing with the pains of living. This work, which is of narrative style, analyses and discusses, through five case reports, chemical dependency as a result of sexual abuse suffered in childhood and/or adolescence. The eight subjects in this study are male and have suffered sexual violence in this age period of life. Their ages range from 23 years to 39 years, and all are admitted to a therapeutic community in a city in the interior of Sao Paulo state, in Brazil, for treatment of chemical dependency, being met by the Department of Psychology. The reasons for the choice of the participants for treatment modality for patients are: difficult to stop using drugs, even unwilling to take it, they have easy access to it; the feeling of losing control over their lives; by successive losses as a result of drug use, and for fear that their lives had a tragic ending. With the exception of two participants, the others do not classify that as a child suffered sexual violence. However, all attribute that facilitated their entry into the world of drugs. Seven participants experienced such violence in childhood (between 7 years and 9 years) and adolescence (age 14). The attackers were people closed to the victims—in the case of two victims, their families, with the exception of one participant who was raped by a stranger. Six participants declared themselves as homosexual. Another participant does not claim to be homosexual, but presents difficulties in terms of sexuality. Two participants are HIV positive. The start of psychoactive substances use occurred during adolescence (12 years to 17 years). The participants see drugs as an anesthetic to the pain of the soul, a way to get pleasure, but they get charged expensively, as it increases the feeling of emptiness, guilt, helplessness, worthlessness and hopelessness. Although participants have sought help to deal with addiction, it is noted that throughout the life course the issue of sexual violence was not treated. It was noted that the patients have a double stigma in society: the issue of drugs addiction and the orientation of sexual desire, because the majority of participants are homosexual. The results reinforce the need for effective action geared to accommodate the victims of sexual violence and effective preventive measures to prevent children and adolescents from being abused.

Relationship between levels of neuropeptide Substance P in periodontal disease and chronic pain: a literature review

The aim of the current review was to investigate the relationship between levels of neuropeptide Substance P in periodontal disease and chronic pain. Substance P is a neuropeptide that is directly related with pain. In periodontal disease, it is expressed during the inflammatory process, and is one of the factors responsible for bone resorption. Studies have shown that Substance P levels are highest in the gingival crevicular fluid from sites with active periodontal disease and bone loss. The persistence of these substances could be sufficient to stimulate neurogenic inflammation in susceptible tissues, and cause pain. The scientific literature shows that Substance P expressed during periodontal disease can be a risk factor for patients with systemic inflammatory pathologies, such as chronic arthritis or rheumatoid arthritis. Additional research is needed to confirm the participation of this substance in the origin of some types of chronic pain.