963 resultados para Complex regional pain syndrome


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Nos últimos dez anos foram realizadas na parte leste da Ilha de Marajó (região dos campos naturais) pelo IDESP e NCGG, mais de 800 SEVs para fins hidrogeológicos. Na época, grande parte dessas SEVs não foram totalmente interpretadas em forma quantitativa, devido à falta de recursos técnicos para fazê-lo de forma eficiente. Agora, usando meios mais modernos para interpretação automática de SEVs, voltou-se a interpretá-las com a finalidade de apresentar uma visão regional dos principais aquíferos da área, agrupar as SEVs em famílias características, testar até que ponto essa interpretação é confiável e propor o modelamento bidimensional como técnica alternativa para interpretar as SEVs realizadas em certos locais da área em questão. Como resultado dessa interpretação, com base na teoria convencional dos meios estratificados, foram definidos três tipos de sistemas de aquíferos. 1. O primeiro, denominado de aquífero profundo, situado a profundidades maiores que 50m, estende-se por toda a região prospectada, estando provavelmente associada às camadas superiores da Formação Marajó ou às litologias altamente resistivas das camadas mais profundas do Grupo Pará. 2. O segundo, denominado de aquífero raso e de média profundidade, localiza-se na parte sul e sudeste da região a profundidades compreendidas entre 10 a 50m, e está associado às lentes arenosas do Grupo Pará. 3. O terceiro, é constituído pelos paleocanais e estruturas similares, distribuídos aleatoriamente na região a pouca profundidade. A partir do estudo detalhado das SEVs, decidiu-se classificá-las em 3 famílias características com seus respectivos tipos e apresentar mapas de localização e da espessura dos aquíferos, bem como mapas de condutância longitudinal total e resistividade média da área. Estes últimos, permitem que se divida a região dos campos da Ilha de Marajó em três zonas principais: 1. Uma, altamente resistiva, situada ao sul e sudeste, a qual coincide com os terrenos aflorantes do Grupo Pará. 2. Outra, altamente condutiva, está localizada no centro e norte, onde se encontram aleatoriamente distribuídos os paleocanais e coincide com os terrenos topograficamente mais baixos, geralmente argilosos e embebidos de água salgada, que são procedentes da erosão dos terrenos circundantes topograficamente mais altos. 3. A última é medianamente resistiva e está relacionada com os terrenos vizinhos à cidade de Chaves (noroeste da região dos campos), os quais apresentam semelhanças com os do sul e sudeste da área. Usando-se a técnica de inversão na interpretação de uma SEV característica de cada família, testou-se, através do seu tratamento estatístico, até que ponto os modelos usados na interpretação dessas SEVs (teoria convencional dos meios estratificados) seriam confiáveis. Conclui-se, então, que a alta correlação existente entre os parâmetros dos modelos assumidos (camadas horizontais, isotrópicas e homogêneas) pode-se dever à utilização de modelos geofísicos muito simples para interpretar a complexa geologia de Marajó. Tendo-se verificado que nem sempre é possível aplicar a teoria das SEVs em meios horizontalmente estratificados para interpretar SEVs obtidas em certos locais de Marajó, os quais muitas vezes apresentam bruscas variações laterais de resistividade, passou-se a demonstrar que estas variações laterais afetam profundamente os dados das SEVs, utilizando-se para isto a técnica dos elementos finitos, a qual leva em conta essa variação bidimensional das propriedades físicas do meio. Foi também possível com esta técnica, modelar uma estrutura rasa, semelhante a um paleocanal, concluindo-se que estes resultados sugerem o emprego, duma forma mais profunda, deste tipo de tratamento para os dados obtidos na região dos campos da Ilha de Marajó.

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The current article aims to update the discussion on the South American context making use of the theory of Regional Security Regional Complexes (RSC). It begins with a theoretical discussion, based on Buzan and Wæver's work. It then presents the hypothesis that, differently from what is assumed in the literature, the South American RSC is not a standard one, but a centred one, in which the centre is not a global power. An empirical analysis follows, showing that Brazil possesses the necessary resources, and has presented some cogent political initiatives, such as the creation of the Union of South American Nations (Unasur) and its Defense Council (SDC), but in other moments has been reluctant take a leadership role in South America. The analysis concludes that, regarding its configuration, the South American RSC corroborates the authors' hypothesis and that Brazil should consolidate its role at the centre of such a complex.

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Background: Investigation and discrimination of neuromuscular variables related to the complex aetiology of low back pain could contribute to clarifying the factors associated with symptoms. Objective: Analysing the discriminative power of neuromuscular variables in low back pain. Methods: This study compared muscle endurance, proprioception and isometric trunk assessments between women with low back pain (LBP, n=14) and a control group (CG, n=14). Multivariate analysis of variance and discriminant analysis of the data were performed. Results: The muscle endurance time (s) was shorter in the LBP group than in the CG (p=0.004) with values of 85.81 (37.79) and 134.25 (43.88), respectively. The peak torque (Nm/kg) for trunk extension was 2.48 (0.69) in the LBP group and 3.56 (0.88) in the GG (p=0.001); for trunk flexion, the mean torque was 1.49 (0.40) in the LBP group and 1.85 (0.39) in the CG (p=0.023). The repositioning error (degrees) before the endurance test was 2.66 (1.36) in the LBP group and 2.41 (1.46) in the CG (p=0.664), and after the endurance test, it was 2.95 (1.94) in the LBP group and 2.00 (1.16) in the CG (p=0.06). Furthermore, the variables showed discrimination between the groups (p=0.007), with 78.6% of the individuals with low back pain correctly classified in the LBP group. In turn, variables related to muscle activation showed no difference in discrimination between the groups (p=0.369). Conclusion: Based on these findings, the clinical management of low back pain should consist of both resistance and strength training, particularly in the extensor muscles.

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Sacroiliac joint (SIJ) pain is responsible for up to 40% of all cases of lumbar back pain. Objective Report the long-term efficacy of radiofrequency denervation for sacroiliac joint pain at six, twelve and eighteen months. Method Third-two adults’ patients with sacroiliac join pain diagnosis were included for a prospective study. Primary outcome measure was pain intensity on the Numeric Rating Scale (NRS). Secondary outcome measure was Patient Global Impression of Change Scale (PGIC). Results Short-term pain relief was observed, with the mean NRS pain score decreasing from 7.7 ± 1.8 at baseline to 2.8 ± 1.2 at one month and to 3.1 ± 1.9 at six months post-procedure (p < 0.001). Long-term pain relief was sustained at twelve and eighteen months post-procedure, with NRS pain remaining at 3.4 ± 2.1 and 4.0 ± 2.7, respectively. Conclusion Radiofrequency denervation of the SIJ can significantly reduce pain in selected patients with sacroiliac syndrome.

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BACKGROUND CONTEXT: The relationships between obesity and low back pain (LBP) and lumbar disc degeneration (LDD) remain unclear. It is possible that familial factors, including genetics and early environment, affect these relationships.PURPOSE: To investigate the relationship between obesity-related measures (eg, weight, body mass index [BMI]) and LBP and LDD using twin studies, where the effect of genetics and early environment can be controlled.STUDY DESIGN: A systematic review with meta-analysis.METHODS: MEDLINE, CINAHL, Scopus, Web of Science, and EMBASE databases were searched from the earliest records to August 2014. All cross-sectional and longitudinal observational twin studies identified by the search strategy were considered for inclusion. Two investigators independently assessed the eligibility, conducted the quality assessment, and extracted the data. Metaanalyses (fixed or random effects, as appropriate) were used to pool studies'estimates of association.RESULTS: In total, 11 articles met the inclusion criteria. Five studies were included in the LBP analysis and seven in the LDD analysis. For the LBP analysis, pooling of the five studies showed that the risk of having LBP for individuals with the highest levels of BMI or weight was almost twice that of people with a lower BMI (odds ratio [OR] 1.8; 95% confidence interval [CI] 1.6-2.0; I-2 = 0%). A dose-response relationship was also identified. When genetics and the effects of a shared early environment were adjusted for using a within-pair twin case-control analysis, pooling of three studies showed a reduced but statistically positive association between obesity and prevalence of LBP (OR 1.5; 95% CI 1.1-2.1; I-2 = 0%). However, the association was further diminished and not significant (OR 1.4; 95% CI 0.8-2.3; I-2 = 0%) when pooling included two studies on monozygotic twin pairs only. Seven studies met the inclusion criteria for LDD. When familial factors were not controlled for, body weight was positively associated with LDD in all five cross-sectional studies. Only two cross-sectional studies investigated the relationship between obesity-related measures and LDD accounting for familial factors, and the results were conflicting. One longitudinal study in LBP and three longitudinal studies in LDD found no increase in risk in obese individuals, whether or not familial factors were controlled for.CONCLUSIONS: Findings from this review suggest that genetics and early environment are possible mechanisms underlying the relationship between obesity and LBP; however, a direct causal link between these conditions appears to be weak. Further longitudinal studies using the twin design are needed to better understand the complex mechanisms underlying the associations between obesity, LBP, and LDD.

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The purpose of this literature review was to describe the main features of phantom eye syndrome in relation to their possible causes, symptoms, treatments, and influence of eye amputation on quality of life of anophthalmic patients. For this, a bibliographical research was performed in Pubmed database using the following terms: eye amputation, eye trauma, phantom eye syndrome, phantom pain, and quality of life, associated or not. Thirteen studies were selected, besides some relevant references contained in the selected manuscripts and other studies hallowed in the literature. Thus, 56 articles were included in this review. The phantom eye syndrome is defined as any sensation reported by the patient with anophthalmia, originated anophthalmic cavity. In phantom eye syndrome, at least one of these three symptoms has to be present: phantom vision, phantom pain, and phantom sensations. This syndrome has a direct influence on the quality of life of the patients, and psychological support is recommended before and after the amputation of the eyeball as well as aid in the treatment of the syndrome. Therefore, it is suggested that, for more effective treatment of phantom eye syndrome, drug therapy should be associated with psychological approach.

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The orofacial pain, also known by the generic term dysfunction, is highly prevalent in the general population, causing great discomfort to the patients. For this reason, there is great importance of dentist’s participation in practice and in the process of proper diagnosis of this disease, which in modern times has become increasingly important as guides the best treatment. Thus, this study was aimed to review the main causes, diagnosis, main symptoms and treatment modalities, to serve as a guide to the dentist. Moreover, it also aims to review the main etiologic factors commonly associated, as emotional stress and muscular hyperactivity, to clearly identify signs and symptoms, so the dentist is able to realize simple treatment in your particular office or recognizes complex cases that could be send for treatment to multidisciplinary teams.

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The porcine reproductive and respiratory syndrome virus (PRRSV) is an economically important pathogen of swine and is known to cause abortion and infertility in pregnant sows and respiratory distress in piglets. PRRSV contains a major glycoprotein (GP5) and three minor glycoproteins (GP2a, GP3, and GP4) on the virion envelope, all of which are required for infectious virus production. To study their interactions amongst each other and with a cellular receptor for PRRSV, CD163, I cloned each of the viral glycoproteins and CD163 in various expression vectors. My studies have shown that while the GP2a, GP3, and GP4 are co-translationally glycosylated, the GP5 is post-translationally glycosylated. By using co-immunoprecipitation (co-IP) assays, strong interaction was demonstrated between GP4 and GP5 proteins, although weak interactions among the other envelope glycoproteins were also detected. Further, GP4 was found to mediate interactions leading to formation of multiprotein glycoprotein complex. My results also show that GP2a and GP4 proteins are the only two GPs that specifically interact with the CD163 molecule and that glycosylation of these GPs is required for efficient interaction. Based on these studies, I have developed an interactome map of the viral GPs and CD163 and have proposed a model of the viral glycoprotein complex and its interaction with CD163. Studies reported here also show that glycan addition at residue 184 (N184) of GP2a, and residues N42, N50, and N131 of GP3 is essential for recovery of infectious virus. Although single site glycosylation mutants of GP4 had no effect on infectious virus production, introduction of double mutations was lethal. The loss of glycan moieties of GP2a, GP3, and GP4 proteins had no effect on host neutralizing antibody production. Overall, I conclude that the PRRSV glycoproteins are co-translationally and post-translationally glycosylated, the GP4 protein is central to mediating interglycoprotein interactions, and along with GP2a, serves as the viral attachment protein that is responsible for interactions with the viral receptor, CD163. Further, glycosylation of GP2a, GP3, and GP4 proteins is required for infectious virus production, efficient interaction with CD163, but does not play any role in neutralizing antibody response in infected animals.

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Invasive species are potential threats to biodiversity, especially if they become established and outnumber native species. In this study, a population of the non-indigenous crab Charybdis hellerii was analyzed in an estuary-bay complex on the southeastern Brazilian coast, with respect to its abundance relative to sympatric native brachyuran species, as well as the size structure, sexual maturity, sex ratio, frequency of mutilation, reproductive period, and development of the reproductive system. Crabs were sampled monthly both in the intertidal zone of rocky shores and on sublittoral soft-bottom. Nine species were recorded on the rocky shores, where C. hellerii was the second most abundant species; only three individuals of C. hellerii were collected in the sublittoral samples. This population of C. hellerii showed a unimodal size structure composed mainly of mature individuals; males were larger than females, and the sex ratio was skewed toward males (3.1:1). About 46.9% of the individuals (75 of 160 crabs) had mutilated or regenerating appendages, more frequent in males (56.8%) than in females (28.2%), which may reflect both inter- and intraspecific agonistic interactions. A continuous reproductive pattern is suggested for this population, although ovigerous females occurred unevenly during the year, with 58.82% of them being collected in winter. There was evidence of multiple spawning, since the ovigerous females with an initial egg mass showed mature ovaries as well as seminal receptacles filled with sperm. C. hellerii is well established in the estuary-bay complex, but is concentrated in intertidal and shallow subtidal rocky shores, where it may compete with and replace other species such as the portunid Cronius ruber. This study also highlights the importance of systematic monitoring studies to evaluate the effects of the introduction of non-indigenous species on ecologically similar natives.

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Arthrogryposisrenal dysfunctioncholestasis (ARC) syndrome is a rare autosomal recessive multisystem disorder caused by mutations in vacuolar protein sorting 33 homologue B (VPS33B) and VPS33B interacting protein, apicalbasolateral polarity regulator (VIPAR). Cardinal features of ARC include congenital joint contractures, renal tubular dysfunction, cholestasis, severe failure to thrive, ichthyosis, and a defect in platelet alpha-granule biogenesis. Most patients with ARC do not survive past the first year of life. We report two patients presenting with a mild ARC phenotype, now 5.5 and 3.5 years old. Both patients were compound heterozygotes with the novel VPS33B donor splice-site mutation c.1225+5G>C in common. Immunoblotting and complementary DNA analysis suggest expression of a shorter VPS33B transcript, and cell-based assays show that c.1225+5G>C VPS33B mutant retains some ability to interact with VIPAR (and thus partial wild-type function). This study provides the first evidence of genotypephenotype correlation in ARC and suggests that VPS33B c.1225+5G>C mutation predicts a mild ARC phenotype. We have established an interactive online database for ARC (https://grenada.lumc.nl/LOVD2/ARC) comprising all known variants in VPS33B and VIPAR. Also included in the database are 15 novel pathogenic variants in VPS33B and five in VIPAR. Hum Mutat 33:16561664, 2012. (c) 2012 Wiley Periodicals, Inc.

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Background The paucity of studies regarding cognitive function in patients with chronic pain, and growing evidence regarding the cognitive effects of pain and opioids on cognitive function prompted us to assess cognition via neuropsychological measurement in patients with chronic non-cancer pain treated with opioids. Methods In this cross-sectional study, 49 patients were assessed by Continuous Reaction Time, Finger Tapping, Digit Span, Trail Making Test-B and Mini-mental State Examination tests. Linear regressions were applied. Results Patients scored poorly in the Trail Making Test-B (mean?=?107.6?s, SD?=?61.0, cut-off?=?91?s); and adequately on all other tests. Several associations among independent variables and cognitive tests were observed. In the multiple regression analyses, the variables associated with statistically significant poor cognitive performance were female sex, higher age, lower annual income, lower schooling, anxiety, depression, tiredness, lower opioid dose, and more than 5?h of sleep the night before assessment (P?<?0.05). Conclusions Patients with chronic pain may have cognitive dysfunction related to some reversible factors, which can be optimized by therapeutic interventions.

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The Tamboril-Santa Quiteria Complex is an important Neoproterozoic granitic-migmatitic unit from the Ceara Central Domain that developed from ca. 650 to 610 Ma. In general the granitoids range in composition from diorite to granite with predominance (up to 85%) of granitic to monzogranitic composition with biotite as the main mafic AFM phase. Geochemical and Pb-207/Pb-206 evaporation zircon geochronology studies were applied in a group of these abundant monzogranitic rocks from the region of Novo Oriente in the southern portion of the Ceara Central Domain. In this area the granitoids are weakly peraluminous biotite granitoids and deformed biotite granitoids of high-K calc-alkaline and ferroan composition, which we interpreted as primary magmas (segregated diatexites) derived from the partial melting of crustal material. The close temporal relation of this magmatism with local eclogitic and regional high temperature metamorphism in Ceara Central Domain point out to an orogenic setting, arguably emplaced during the collisional stage. Subordinate coeval juvenile mantle incursions are also present. This crustally derived magmatism is the primary product of the continental thickening that resulted from the collision between the rocks represented by the Amazonian-West African craton (Sao Luiz cratonic fragment) to the northwest and the Paleoproterozoic-Archean basement of the Borborema Province to the southeast along the Transbrasiliano tectonic corridor. (C) 2011 Elsevier Ltd. All rights reserved.

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The authors describe on a Brazilian girl with coronal synostosis, facial asymmetry, ptosis, brachydactyly, significant learning difficulties, recurrent scalp infections with marked hair loss, and elevated serum immunoglobulin E. Standard lymphocyte karyotype showed a small additional segment in 7p21[46,XX,add(7)(p21)]. Deletion of the TWIST1 gene, detected by Multiplex Ligation Probe-dependent Amplification (MPLA) and array-CGH, was consistent with phenotype of SaethreChotzen syndrome. Array CGH also showed deletion of four other genes at 7p21.1 (SNX13, PRPS1L1, HD9C9, and FERD3L) and the deletion of six genes (CACNA2D2, C3orf18, HEMK1, CISH, MAPKAPK3, and DOCK3) at 3p21.31. Our case reinforces FERD3L as candidate gene for intellectual disability and suggested that genes located in 3p21.3 can be related to hyper IgE phenotype. (C) 2012 Wiley Periodicals, Inc.

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Borges JB, Suarez-Sipmann F, Bohm SH, Tusman G, Melo A, Maripuu E, Sandstrom M, Park M, Costa EL, Hedenstierna G, Amato M. Regional lung perfusion estimated by electrical impedance tomography in a piglet model of lung collapse. J Appl Physiol 112: 225-236, 2012. First published September 29, 2011; doi: 10.1152/japplphysiol.01090.2010.-The assessment of the regional match between alveolar ventilation and perfusion in critically ill patients requires simultaneous measurements of both parameters. Ideally, assessment of lung perfusion should be performed in real-time with an imaging technology that provides, through fast acquisition of sequential images, information about the regional dynamics or regional kinetics of an appropriate tracer. We present a novel electrical impedance tomography (EIT)-based method that quantitatively estimates regional lung perfusion based on first-pass kinetics of a bolus of hypertonic saline contrast. Pulmonary blood flow was measured in six piglets during control and unilateral or bilateral lung collapse conditions. The first-pass kinetics method showed good agreement with the estimates obtained by single-photon-emission computerized tomography (SPECT). The mean difference (SPECT minus EIT) between fractional blood flow to lung areas suffering atelectasis was -0.6%, with a SD of 2.9%. This method outperformed the estimates of lung perfusion based on impedance pulsatility. In conclusion, we describe a novel method based on EIT for estimating regional lung perfusion at the bedside. In both healthy and injured lung conditions, the distribution of pulmonary blood flow as assessed by EIT agreed well with the one obtained by SPECT. The method proposed in this study has the potential to contribute to a better understanding of the behavior of regional perfusion under different lung and therapeutic conditions.