Acupuncture with manual and electrical stimulation for labour pain : a longitudinal randomised controlled trial

Background: Acupuncture is commonly used to reduce pain during labour despite contradictory results. The aim of this study is to evaluate the effectiveness of acupuncture with manual stimulation and acupuncture with combined manual and electrical stimulation (electro-acupuncture) compared with standard care in reducing labour pain. Our hypothesis was that both acupuncture stimulation techniques were more effective than standard care, and that electro-acupuncture was most effective.  Methods: A longitudinal randomised controlled trial. The recruitment of participants took place at the admission to the labour ward between November 2008 and October 2011 at two Swedish hospitals. 303 nulliparous women with normal pregnancies were randomised to: 40 minutes of manual acupuncture (MA), electro-acupuncture (EA), or standard care without acupuncture (SC). Primary outcome: labour pain, assessed by Visual Analogue Scale (VAS). Secondary outcomes: relaxation, use of obstetric pain relief during labour and post-partum assessments of labour pain. The sample size calculation was based on the primary outcome and a difference of 15 mm on VAS was regarded as clinically relevant, this gave 101 in each group, including a total of 303 women.  Results: Mean estimated pain scores on VAS (SC: 69.0, MA: 66.4 and EA: 68.5), adjusted for: treatment, age, education, and time from baseline, with no interactions did not differ between the groups (SC vs MA: mean difference 2.6, 95% confidence interval [CI] -1.7-6.9 and SC vs EA: mean difference 0.6 [95% CI] -3.6-4.8). Fewer number of women in the EA group used epidural analgesia (46%) than women in the MA group (61%) and SC group (70%) (EA vs SC: odds ratio [OR] 0.35; [95% CI] 0.19-0.67).  Conclusions: Acupuncture does not reduce women's experience of labour pain, neither with manual stimulation nor with combined manual and electrical stimulation. However, fewer women in the EA group used epidural analgesia thus indicating that the effect of acupuncture with electrical stimulation may be underestimated. These findings were obtained in a context with free access to other forms of pain relief.

Acupuncture for labour pain

Background: Acupuncture involves puncturing the skin with thin sterile needles at defined acupuncture points. Previous studies are inconclusive regarding the effect of acupuncture on labour pain, but some studies have found a reduction in the use of pharmacological pain relief when acupuncture is administered. The appropriate dose of acupuncture treatment required to elicit a potential effect on labour pain has not been fully explored. The dose is determined by many different factors, including the number of needles used and the intensity of the stimulation. In Sweden, manual stimulation of the needles is common practice when acupuncture is used for labour pain, but electrical stimulation of the needles, which gives a higher dose, could possibly be more effective. The overall aim of this thesis was to evaluate the effectiveness of acupuncture with manual stimulation (MA) of the needles as well as acupuncture with a combination of manual and electrical stimulation (EA) in reducing labour pain, compared with standard care without any form of acupuncture (SC). Methods: The study was designed as a three-armed randomised controlled trial in which 303 nulliparous women with normal pregnancies were randomised to MA, EA, or SC. The primary outcome was labour pain, assessed using the Visual Analogue Scale (VAS). Secondary outcomes were relaxation during labour, use of obstetric pain relief, and associations between maternal characteristics and labour pain and use of epidural analgesia respectively. Also, labour and infant outcomes, recollection of labour pain, and maternal experiences, such as birth experience and experience of the midwife, were investigated two months after the birth. The sample size calculation was based on the potential to discover a difference of 15 mm on the VAS. Data were collected during labour before the interventions, the day after birth, and two months later. Besides using the VAS, information was collected by means of study specific protocol, questionnaires and medical records. Results: The mean VAS scores were 66.4 in the MA group, 68.5 in the EA group, and 69.0 in the SC group (mean differences: MA vs. SC 2.6 95% CI -1.7 to 6.9, and EA vs. SC 0.6 95% CI -3.6 to 4.8). Other methods of pain relief were used less frequently in the EA group, including epidural analgesia, MA 61.4%, EA 46%, and SC 69.9%. (EA vs. SC OR 0.4 95% CI 0.2 to 0.7). No statistically significant differences were found in the recollection of labour pain between the three groups two months after birth (mean VAS score: MA 69.3, EA 68.7 and SC 70.1). A few maternal characteristics were associated with labour pain (age, dysmenorrhea, and cervix dilatation), but none of the investigated characteristics predicted the outcome of the acupuncture treatment in MA or EA. Women in the EA group experienced acupuncture as being effective for labour pain to a higher extent than women who received MA, MA 44.4%, EA 67.1% (EA vs. MA OR 2.4 95% CI 1.2 to 4.8). Women in the EA group also spent less time in labour (mean 500 min) than those who received MA (mean 619 min) and SC (mean 615 min) (EA vs. MA HR 1.4 95% CI 1.0 to1.9, EA vs. SC HR 1.4, 95% CI 1.1 to 2.0), and had less blood loss than women receiving SC, (EA vs. SC OR 0.1 95% CI 0.3 to 0.7). The women’s assessment of the midwife as being supportive during labour (MA 77.2%, EA 83.5%, SC 80%), overall satisfaction with midwife care (MA 100%, EA 97.5%, SC 98.7%), and having an overall positive childbirth experience (MA 64.6%, EA 61.0%, SC 54.3%) did not differ statistically. No serious side effects of the acupuncture treatment were reported. Conclusion: Acupuncture, regardless of type of stimulation, did not differ from standard care without acupuncture in terms of reducing women’s experience of pain during labour, or their memory of pain and childbirth overall two months after the birth. However, other forms of obstetric pain relief were less frequent in women receiving a combination of manual and electrical stimulation, suggesting that this method could facilitate coping with labour pain.

Polimorfismos de inserção/deleção do gene da ECA e K121Q do gene PC-1 em pacientes com Diabete Mellito tipo 1 normoalbuminúricos : estudo com 10 anos de acompanhamento

O objetivo deste estudo foi analisar o papel do polimorfismo de I/D do gene da Enzima Conversora de Angiotensina (ECA) e o polimorfismo K121Q da PC-1 nas modificações das taxas de filtração glomerular (TFG), excreção urinária de albumina (EUA) e pressão arterial em uma coorte de pacientes diabéticos tipo 1 normoalbuminúricos (EUA<20μg/min) em um estudo com seguimento de 10,2 ± 2,0anos (6,5 a 13,3 anos). A EUA (imunoturbidimetria), TFG (técnica da injeção única de 51Cr-EDTA), HbA1c (cromatografia de troca iônica) e pressão arterial foram medidas no início do estudo e a intervalos de 1,7 ± 0,6 anos. O polimorfismo I/D e K121Q foram determinados através da PCR e restrição enzimática. Onze pacientes apresentaram o genótipo II, 13 o ID e 6 apresentaram o genótipo DD. Pacientes com o alelo D (ID/DD) desenvolveram mais freqüentemente hipertensão arterial e retinopatia diabética. Os 3 pacientes do estudo que desenvolveram nefropatia diabética apresentaram o alelo D. Nos pacientes ID/DD (n=19) ocorreu maior redução da TFG quando comparados com os pacientes II (n=11) (-0,39 ± 0,29 vs – 0,12 ± 0,37 ml/min/mês; P=0,035). A presença do alelo D, em análise de regressão múltipla linear (R2=0,15; F=4,92; P=0,035) foi o único fator associado à redução da TFG (-0,29 ± 0,34 ml/min/mês; P<0,05). Já o aumento da EUA (log EUA = 0,0275 ± 0,042 μg/min/mês; P=0,002) foi associado somente aos níveis iniciais de EUA (R2=0,17; F=5,72; P=0,024). Um aumento significativo (P<0,05) no desenvolvimento de hipertensão arterial e de novos casos de retinopatia diabética foi observado somente nos pacientes com os genótipos ID/DD. Vinte e dois pacientes apresentaram genótipo KK, 7 KQ e 1 apresentou genótipo QQ. Pacientes com os genótipos KQ/QQ apresentaram um aumento significativo (P=0,045) de novos casos de retinopatia diabética. Em conclusão a presença do alelo D nesta amostra de pacientes DM tipo 1 normoalbuminúricos e normotensos está associada com aumento na proporção de complicações microvasculares e hipertensão arterial.

Caracterização batimétrica e fisicooceanográfica do canal de acesso ao porto de Cabedelo/PB: uma análise ambiental ao derrame de óleo

The State of Paraíba is one of the most dynamic states of Brazil, strategically located in the northeast, is notable for the excellent potential for integration of different transportation modes forming the states of Rio Grande do Norte, Pernambuco and Alagoas. The dynamic that occurs with port activity causes changes in the space where it is installed. And the elements of this space are always more than suffering direct or indirect influences as the flow in the port is expanded. Therefore, this region became subject to the accidental spillage of oil, because it presents a heavy traffic of ships of various sizes that can run aground or collide with oil causing accidental events. The study of geomorphological and sedimentological compositions of seafloor becomes important as more is known about the relationships between these parameters and associated fauna, and can identify their preferred habitats. The database background, acoustically collected along the proposed study area, is a wealth of information, which were duly examined, cataloged and made available. Such information can serve as an important tool, providing a geomorphological survey of the sedimentary area studied, and come to subsidize, in a flexible, future decision making. With the study area Port of Cabedelo, Paraíba - Brazil, this research aimed to evaluate the influence of the tidal surface and background in modeling the seabed, including the acquisition of information about the location of submerged rocky bodies and the depth of these bodies may turn out to be natural traps for the trapping of oil in case of leaks, and obtain the relationship between types of bed and the hydrodynamic conditions present in the region. In this context, for this study were collected bathymetric data (depth) and physical oceanographic (height of water column, water temperature, intensity and direction of currents, waves and turbidity), meteorological (rainfall, air temperature, humidity, winds and barometric pressure) of the access channel to the Port of Cabedelo / PB and its basin evolution (where the cruise ships dock), and includes tools of remote sensing (Landsat 7 ETM +, 2001), so that images and the results are integrated into Geographic Information Systems and used in the elaboration of measures aimed at environmental protection areas under the influence of this scale facilities, serving as a grant to prepare a contingency plan in case of oil spills in the region. The main findings highlight the techniques of using hydroacoustic data acquisition together bathymetric surveys of high and low frequency. From there, five were prepared in bathymetric pattern of Directorate of Hydrography and Navigation - DHN, with the depth in meters, on a scale of 1:2500 (Channel and Basin Evolution of Access to Port of Cabedelo), where there is a large extent possible beachrocks that hinder the movement of vessels in the port area, which can cause collisions, running aground and leaking oil. From the scatter diagram of the vectors of currents, it can be seen as the tidal stream and undergoes a channeling effect caused by the bidirectional effect of the tide (ebb and flood) in the basin of the Port of Cabedelo evolution in NW-direction SE and the highest speed of the currents occurs at low tide. The characterization weather for the period from 28/02 to 04/07/2010 values was within the expected average for the region of study. The multidisciplinary integration of products (digital maps and remote sensing images), proved to be efficient for the characterization of underwater geomorphological study area, reaching the aim to discriminate and enhance submerged structures, previously not visible in the images

Resíduos de calda sulfocálcica sobre a eficiência de acaricidas no controle de Brevipalpus phoenicis

O objetivo do trabalho foi verificar a influência dos resíduos de calda sulfocálcica sobre a eficiência de acaricidas empregados no controle de Brevipalpus phoenicis. Inicialmente, o experimento foi instalado em um pomar de citros, em que foram selecionadas 10 plantas que continham frutos com verrugose. Realizou-se a aplicação de calda sulfocálcica (8g i.a. L-1 de água) em cinco plantas e as outras cinco plantas permaneceram sem aplicação de produto fitossanitário. Protegeram-se, com copos de plástico transparente de 500mL, 64 frutos nas plantas tratadas com calda e 64 frutos nas plantas não-tratadas, totalizando 128 frutos protegidos. Decorridos 30 dias da aplicação, os frutos foram colhidos e levados para o laboratório. Estes frutos foram parcialmente parafinados, deixando-se em cada fruto uma arena de 2,5cm de diâmetro com verrugose e sem parafina, delimitada com cola entomológica. em seguida, procedeu-se à aplicação sobre os frutos em Torre de Potter dos seguintes acaricidas nas concentrações expressas em mg de ingrediente ativo por litro de água: propargite a 720mg, óxido de fenbutatina a 400mg, cyhexatin a 250mg, azocyclotin a 250mg, fenpyroximate a 50mg, dicofol a 960mg e dinocap a 738mg e a testemunha sem aplicação de acaricida. Após 1, 7 e 16 dias da aplicação, transferiram-se para cada fruto 10 ácaros B. phoenicis para avaliar a mortalidade. Constatou-se que os resíduos de calda sulfocálcica não prejudicaram a eficiência dos acaricidas avaliados no controle de B. phoenicis.

Synthesis and physical properties of lipid-based poly(ester-urethane)s, I: Effect of varying polyester segment length

Four aliphatic thermoplastic poly(ester-urethane)s (PEUs) with similar molecular weights but varying polyesters molecular weight (534-1488 g/mol) were prepared from polyester diols, obtained by melt condensation of Azelaic acid and 1,9-Nonanediol, and 1,7-heptamethylene di-isocyanate (HPMDI) all sourced from vegetable oil feedstock. The thermal, and mechanical properties, and crystal structure of PEUs were investigated using DSC, TGA, DMA, tensile analysis and WAXD. For sufficiently long polyester chain, WAXD data indicated no hydrogen bonds polyethylene (PE)-like crystalline packing and for short polyester chains, small crystal domains with significant H-bonded polyamide (PA)-like packing. Crystallinity decreased with decreasing polyester molecular weights. The polymorphism of PEUs and consequently their melting characteristics were found to be largely controlled by polyester segment length. TGA of the PEUs indicated improved thermal stability with decreasing polyester chain length, suggesting a stabilization effect by urethane groups. Mechanical properties investigated by DMA and tensile analysis were found to scale predictably with the overall crystallinity of PEUs. (C) 2012 Elsevier Ltd. All rights reserved.

Controle da pinta preta dos frutos cítricos em cultivo orgânico com agentes de biocontrole e produtos alternativos

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Alginate-chitosan systems: In vitro controlled release of triamcinolone and in vivo gastrointestinal transit

The aim of this study was to develop multiparticulate therapeutic systems of alginate (AL) and chitosan (CS) containing triamcinolone (TC) to colonic drug delivery. Multiparticulate systems of AL-CS, prepared by a complex coacervation/ionotropic gelation method, were characterized for morphological and size aspects, swelling degree, encapsulation content and efficiency, in vitro release profile in different environments simulating the gastrointestinal tract (GIT) and in vivo gastrointestinal transit. The systems showed suitable morphological characteristics with particle diameters of approximately 1.6 mm. In simulated gastric environment, at pH 1.2, the capsules presented low degree of swelling and in vitro release of drug. A higher swelling degree was observed in simulated enteric environment, pH 7.5, followed by erosion. Practically all the drug was released after 6 h of in vitro assay. The in vivo analysis of gastrointestinal transit, carried out in rats, showed that the systems passed practically intact through the stomach and did not show the same profile of swelling observed in the in vitro tests. It was possible to verify the presence of capsules in the colonic region of GIT. The results indicate that AL-CS multiparticulate systems can be used as an adjuvant for the preparation of therapeutic systems to colonic delivery of drugs. (C) 2010 Elsevier Ltd. All rights reserved.

Análise química de produtos de incrustação em dutos de petróleo por espectometria de fluorescência de raios X

The quantitative chemical characterization of the inorganic fraction of scale products is very relevant in studying, monitoring and controlling corrosive processes of oil pipelines. The X-ray fluorescence spectrometry (XRF) is a very versatile analytical technique, which can be used in quantitative analysis in solid samples at low concentrations of the chemical element, in the order of few ppm. A methodology that involves sample preparation diluted in the proportion of 1:7 (one portion of the sample for seven of wax), pressed as pellets was used in the XRF calibration for chemical analysis of scale products from oil pipelines. The calibration involved the preparation of reference samples from mixtures of P.A. reagents, aiming to optimize the time consumed in the steps of sample preparation and analysis of Al, Ba, Ca, Fe, K, Mg, Mn, Na, P, S, Si, Sr and Ti, using the same pressed pellet for trace and major elements analysis

Pós-graduação stricto sensu em anestesiologia: experiência de dez anos na UNESP

JUSTIFICATIVA E OBJETIVOS: O número de Programas de Pós-Graduação em Anestesiologia stricto sensu existente no país ainda é muito pequeno. Com a finalidade de incentivar a pós-graduação em Anestesiologia no Brasil, é apresentada a experiência acumulada em dez anos de atividades do programa da Universidade Estadual Paulista (UNESP). CONTEÚDO: O Programa de Pós-Graduação em Anestesiologia stricto sensu da UNESP foi credenciado pela CAPES, desde a sua criação em 1994, nos Cursos de Mestrado e Doutorado. O Programa é desenvolvido em três Áreas de Concentração: Risco e Proteção de Órgãos e Sistemas em Anestesia e Cirurgia; Qualidade e Segurança em Anestesiologia; e Modelos Clínicos e Experimentais em Terapia Antálgica, com as suas respectivas linhas de pesquisa, em número de 14. O número de alunos regulares do Programa é compatível com o número de orientadores (12), com proporção média de três alunos por orientador. Desde o seu início até setembro de 2004, ocorreram 45 Dissertações de Mestrado e 24 de Doutorado, perfazendo 69 defesas, a maioria com bolsas e financiamentos de Órgãos de Fomento à Pesquisa. Após a conclusão do doutorado, 65% dos alunos têm atividade de docência e pesquisa em instituições públicas e privadas do ensino universitário do país. A maioria das publicações do programa tem sido realizada em revistas nacionais com Qualis A, com menor número de publicações em revistas internacionais Qualis A ou B. O programa recebeu da CAPES o conceito 4,0 numa escala de 1 a 7, em suas três últimas avaliações. CONCLUSÕES: O programa tem se desenvolvido muito bem nos 10 anos de sua existência, alcançando os principais objetivos, como a formação de professores e pesquisadores na área de Anestesiologia para as instituições universitárias do país.

Prevalence and causes of visual impairment in a Brazilian population: The Botucatu Eye Study

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

Progression of articular and extraarticular damage in oligoarticular juvenile idiopathic arthritis

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

Sub-registro de acidentes do trabalho em localidade do Estado de São Paulo, 1997

OBJETIVO: Estimar o número de acidentes do trabalho ocorridos em determinada localidade e intervalo de tempo e a extensão do sub-registro de casos. MÉTODOS: Amostraram-se 4.782 domicílios residenciais do município de Botucatu, SP, contendo 17.219 moradores, em primeiro de julho de 1997. em cada um dos domicílios, um morador adulto era entrevistado para identificar ocorrência de acidentes do trabalho nos três meses precedentes à entrevista. Nos casos positivos, os acidentados foram entrevistados. Para cálculo do intervalo de confiança utilizou-se a formula de Cochran. RESULTADOS: Confirmaram ter sofrido acidente do trabalho 76 indivíduos, estimando-se em 1.810 o número desses eventos em Botucatu no ano de 1997 e a proporção de incidência em 4,1% (IC95% 3,0%-5,3%). Dos 76 acidentados, 39 não eram cobertos pelo seguro acidente previdenciário (51,3% IC95% 41,1%-61,6%), não se enquadrando na obrigatoriedade de emissão de Comunicação de Acidente do Trabalho (funcionários públicos estatutários, autônomos, assalariados sem registro em carteira, proprietários e outros). Dentre os 37 casos com obrigatoriedade de emissão desse documento, 20 casos não possuíam (54,1% IC39,4%-68,7%). Houve maior proporção de sub-registro de casos em trabalhadores de micro, pequenas e médias empresas, do que entre grandes empresas. Apenas 22,4% (IC13,8%, 30,9%) dos acidentes do trabalho informados nas entrevistas domiciliares foram captados pelos registros previdenciários CONCLUSÕES: Os achados indicam a necessidade de melhoria de utilização de outras fontes de informação, além das Comunicações de Acidentes do Trabalho, para elaboração das estatísticas oficiais sobre acidentes do trabalho.

Endurance training improves responsiveness to insulin and modulates insulin signal transduction through the phosphatidylinositol 3-kinase/Akt-1 pathway

Background: Endurance training increases insulin-stimulated muscle glucose transport and leads to improved metabolic control in diabetic patients.Objective: To analyze the effects of endurance training on the early steps of insulin action in muscle of rats. Design: Male rats submitted to daily swimming for 6 weeks were compared with sedentary controls. At the end of the training period, anesthetized animals received an intravenous (i.v.) injection of insulin and had a fragment of their gastrocnemius muscle excised for the experiments.Methods: Associations between insulin receptor, insulin receptor substrates (IRS)-1 and -2 and phosphatidylinositol 3-kinase (PI3-kinase) were analyzed by immunoprecipitation and immunoblotting. Akt-1 serine phosphorylation and specific protein quantification were detected by immunoblotting of total extracts, and IRS-1/IRS-2-associated PI3-kinase activity were determined by thin-layer chromatography.Results: Insulin-induced phosphorylation of IRS-1 and IRS-2 increased respectively by 1.8-fold (P < 0.05) and 1.5-fold (P < 0.05), whereas their association with PI3-kinase increased by 2.3-fold (P < 0.05) and 1.9-fold (P < 0.05) in trained rats as compared with sedentary controls, respectively. The activity of PI3-kinase associated with IRS-1 and IRS-2 increased by 1.8-fold (P < 0.05) and 1.7-fold (P < 0.05) respectively, in trained rats as compared with their untrained counterparts. Serine phosphorylation of Akt-1/PKB increased 1.7-fold (P < 0.05) in trained rats in response to insulin. These findings were accompanied by increased responsiveness to insulin as demonstrated by a reduced area under the curve for insulin during an i.v. glucose tolerance test, by increased glucose disappearance rate during an insulin tolerance test, and by increased expression of glucose transporter-4.Conclusions: the increased responsiveness to insulin induced by chronic exercise in rat skeletal muscle may result, at least in part, from the modulation of the insulin signaling pathway at different molecular levels.

Hydrodechlorination of 1,2-dichloroethane by rhodium catalysts under water gas shift reaction conditions

Homogeneous catalysts prepared from rhodium trichloride in aqueous aromatic amines have been shown to reduce C-CI bonds under mild water gas shift conditions (T=100 degrees C, P-CO = 1.0 atm). In a 4-picoline/water solvent mixture, 1,2-dichloroethane is reduced to ethylene and ethane in yields compatible with the consumption of the reducing agent CO and with the formation of CO2. Variation of the catalyst solutions by using different substituted pyridines shows a pattern of catalytic activity parallel to that reported previously for H-2 production from the shift reaction, There is a moderate dependence of activity on the basicity of the aromatic amine, but a methyl group at the alpha-position exercises a strong negative steric effect. Long term studies show decrease of the activity with the time perhaps due to the build up of chloride in the medium. (C) 1999 Elsevier B.V. B.V. All rights reserved.