A prospective two-year examination of cognitive and behavioral correlates of provoked vestibulodynia outcomes.

Note de l'éditeur : This article may not exactly replicate the final version published in the journal. It is not the copy of record. / Cet article ne constitue pas la version officielle, et peut différer de la version publiée dans la revue.

Post-polio syndrome: epidemiologic and prognostic aspects in Brazil

Objectives - To describe the clinical and epidemiological aspects of post-polio syndrome (PPS) and identify predictors of its severity. Materials and methods - 132 patients with PPS were selected at the Neuromuscular Disease Outpatient Clinic of the Federal University of Sao Paulo. Descriptive analysis was carried out and predictors of PPS severe forms were investigated using an unconditional logistic regression. Results - The average age at onset was 39.4 years. The most common symptoms were fatigue (87.1%), muscle pain (82.4%) and joint pain (72.0%); 50.4% of the cases were severe. The following were associated with PPS severity: a < 4-year period of neurological recovery (OR 2.8), permanent damage in two limbs (OR 3.6) and residence at the time of acute polio in a city with more advanced medical assistance (OR 2.5). Conclusions - Health professionals should carefully evaluate polio survivors for PPS and be aware of the implications of muscle overuse in the neurological recovery period.

Proxy-reported health-related quality of life of patients with juvenile idiopathic arthritis: Pediatric rheumatology international trials organization multinational quality of life cohort study

Objective. To investigate the proxy-reported health-related quality of life (HRQOL) and its determinants in patients with juvenile idiopathic arthritis (JIA).Methods. In this multinational, multicenter, cross-sectional study, HRQOL of patients with JIA was assessed through the Child Health Questionnaire (CHQ) and was compared with that of healthy children of similar age from the same geographic area. of joint inflammation, Childhood Health Assessment Questionnaire (CHAQ), and erythrocyte sedimentation rate.Results. A total of 6,639 participants (3,324 with JIA and 3,315 healthy) were enrolled from 32 countries. The mean SD physical and psychosocial summary scores of the CHQ were significantly lower in patients with JIA than in healthy children (physical: 44.5 +/- 10.6 versus 54.6 +/- 4.0, P < 0.0001; psychosocial: 47.6 +/- 8.7 versus 51.9 +/- 7.59 P < 0.0001), with the physical well-being domain being most impaired. Patients with persistent oligoarthritis had better HRQOL compared with other subtypes, whereas HRQOL was similar across patients with systemic arthritis, polyarthritis, and extended oligoarthritis. A CHAQ score > 1 and a pain intensity rating > 3.4 cm on a 10-cm visual analog scale were the strongest determinants of poorer HRQOL in the physical and psychosocial domains, respectively.Conclusion. We found that patients with JIA have a significant impairment of their HRQOL compared with healthy peers, particularly in the physical domain. Physical well-being was mostly affected by the level of functional impairment, whereas the intensity of pain had the greatest influence on psychosocial health.

Protocolo de exame físico para a coluna toracolombar de equinos

Thoracolumbar injuries represent a challenge to the veterinarian that seeks to eliminate the pain, reinstitute the athletic use of the horse and minimize economic losses. The percentage of lost training days due to orthopedic conditions in race horses is of 72.1% and within those conditions is back pain, whicht represents from 4.35% to 20% of the lameness cases. The present study searched to establish a protocol based on score points for the thoracolumbar physical exam, by which it is able to determine the possible affected areas and the seriousness of the injuries. Along with the physical exam, it was performed an ultrasonographic exam of the thoracolumbar region to characterize and classify the injuries found, as to accompany its evolution after treatment. It was observed a clear reduction in the physical exam score sum in all animals between the exam days being that the exam of most of the animals presented a zero score at 60 days after the treatment. Relating the evolution of the clinical exam with the ultrasonography image tests, there was a positive association between the reduction score in the severity scale and the evolution of the ultrasonographic image of the evaluated structures. Thus, it can be concluded that gradation of the physical exam showed to be efficient and allowed the monitoring of the clinical evolution, as the answer of the injuries to the suggested treatment. Besides that, the results showed that 60 days is the ideal time for the first reevaluation of the animal after the treatment.

Análise de fatores de dor intra-operatória na cirurgia ambulatorial no câncer de mama

Pós-graduação em Psicologia do Desenvolvimento e Aprendizagem - FC

Mechanical nociceptive thresholds using four probe configurations in horses

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

Tratamento cirúrgico de ameloblastoma mandibular

Ameloblastomas are benign, invasive locally and highly recurrent. It is an odontogenic tumor, characterized by the proliferation of epithelial ameloblastic in a fibrous stroma. This paper reports a case of mandibular ameloblastoma, in patients 27 years of age without pain with developments around 4 years, with about 20 mm at its greatest extent, sessile base and surface coatings full. The treatment of choice was the surgical conservative

Quantification of anandamide and 2-arachidonoylglycerol plasma levels to examine potential influences of tetrahydrocannabinol application on the endocannabinoid system in humans

The effects of tetrahydrocannabinol (THC) and endogenous cannabinoids (endocannabinoids, ECs) are both mediated by activation of the cannabinoid receptors CB1 and CB2. Exogenous activation of these receptors by THC could therefore alter EC levels. We tested this hypothesis in healthy volunteers (n = 25) who received a large intravenous dose of THC (0.10 mg/kg). Effects on the EC system were quantified by serial measurements of plasma ECs after THC administration. Eleven blood samples were drawn during the first 5 h after THC administration and two more samples after 24 and 48 h. THC, its metabolites THC-OH (biologically active) and THC-COOH (non-active), and the ECs anandamide and 2-arachidonoylglycerol (2-AG) were quantified by liquid chromatography-mass spectrometry. EC-plasma levels showed a biphasic response after THC injection reaching maximal values at 30 min. Anandamide increased slightly from 0.58 ± 0.21 ng/ml at baseline to 0.64 ± 0.24 ng/ml (p < 0.05) and 2-AG from 7.60 ± 4.30 ng/ml to 9.50 ± 5.90 ng/ml (p < 0.05). After reaching maximal concentrations, EC plasma levels decreased markedly to a nadir of 300 min after THC administration (to 0.32 ± 0.15 ng/ml for anandamide and to 5.50 ± 3.01 ng/ml for 2-AG, p < 0.05). EC plasma concentrations returned to near baseline levels until 48 h after the experiment. THC (0.76 ± 0.16 ng/ml) and THC-OH (0.36 ± 0.17 ng/ml) were still measurable at 24 h and remained detectible until 48 h after THC administration. Although the underlying mechanism is not clear, high doses of intravenous THC appear to influence endogenous cannabinoid concentrations and presumably EC-signalling.

Susceptibility of cloned K+ channels to reactive oxygen species.

Free radical-induced oxidant stress has been implicated in a number of physiological and pathophysiological states including ischemia and reperfusion-induced dysrhythmia in the heart, apoptosis of T lymphocytes, phagocytosis, and neurodegeneration. We have studied the effects of oxidant stress on the native K+ channel from T lymphocytes and on K+ channels cloned from cardiac, brain, and T-lymphocyte cells and expressed in Xenopus oocytes. The activity of three Shaker K+ channels (Kv1.3, Kv1.4, and Kv1.5), one Shaw channel (Kv3.4), and one inward rectifier K+ channel (IRK3) was drastically inhibited by photoactivation of rose bengal, a classical generator of reactive oxygen species. Other channel types (such as Shaker K+ channel Kv1.2, Shab channels Kv2.1 and Kv2.2, Shal channel Kv4.1, inward rectifiers IRK1 and ROMK1, and hIsK) were completely resistant to this treatment. On the other hand tert-butyl hydroperoxide, another generator of reactive oxygen species, removed the fast inactivation processes of Kv1.4 and Kv3.4 but did not alter other channels. Xanthine/xanthine oxidase system had no effect on all channels studied. Thus, we show that different types of K+ channels are differently modified by reactive oxygen species, an observation that might be of importance in disease states.

Elimination of potassium channel expression by antisense oligonucleotides in a pituitary cell line.

The clonal rat pituitary cell line GH4C1 expresses the genes for several voltage-dependent potassium channels including Kv1.5 and Kv1.4. Dexamethasone, a glucocorticoid agonist, induces a slowly inactivating potassium current in these cells but does not alter the amplitude of a rapidly inactivating component of potassium current. We have found that the induction of the slowly inactivating current can be blocked by an antisense phosphorothioate deoxyoligonucleotide to the Kv1.5 mRNA sequence. In contrast, antisense deoxyoligonucleotides against Kv1.4 mRNA specifically decrease the expression of the dexamethasone-insensitive rapidly inactivating current. These results demonstrate the usefulness of antisense oligonucleotides in correlating potassium currents with specific potassium channel proteins in the cell types in which they are naturally expressed.

No discrimination shock avoidance with sequential presentation of stimuli but shore crabs still reduce shock exposure

Insights into the potential for pain may be obtained from examination of behavioural responses to noxious stimuli. In particular, prolonged responses coupled with long-term motivational change and avoidance learning cannot be explained by nociceptive reflex but are consistent with the idea of pain. Here, we placed shore crabs alternately in two halves of a test area divided by an opaque partition. Each area had a dark shelter and in one repeated small electric shocks were delivered in an experimental but not in a control group. Crabs showed no specific avoidance of the shock shelter either during these trials or in a subsequent test in which both were offered simultaneously; however they often emerged from the shock shelter during a trial and thus avoided further shock. More crabs emerged in later trials and took less time to emerge than in early trials. Thus, despite the lack of discrimination learning between the two shelters they used other tactics to markedly reduce the amount of shock received. We note that a previous experiment using simultaneous presentation of two shelters demonstrated rapid discrimination and avoidance learning but the paradigm of sequential presentation appears to prevent this. Nevertheless, the data show clearly that the shock is aversive and tactics, other than discrimination learning, are used to avoid it. Thus, the behaviour is only partially consistent with the idea of pain.

Impact de la cécité sur le système nociceptif

La vision joue un rôle très important dans la prévention du danger. La douleur a aussi pour fonction de prévenir les lésions corporelles. Nous avons donc testé l’hypothèse qu’une hypersensibilité à la douleur découlerait de la cécité en guise de compensation sensorielle. En effet, une littérature exhaustive indique qu’une plasticité intermodale s’opère chez les non-voyants, ce qui module à la hausse la sensibilité de leurs sens résiduels. De plus, plusieurs études montrent que la douleur peut être modulée par la vision et par une privation visuelle temporaire. Dans une première étude, nous avons mesuré les seuils de détection thermique et les seuils de douleur chez des aveugles de naissance et des voyants à l’aide d’une thermode qui permet de chauffer ou de refroidir la peau. Les participants ont aussi eu à quantifier la douleur perçue en réponse à des stimuli laser CO2 et à répondre à des questionnaires mesurant leur attitude face à des situations douloureuses de la vie quotidienne. Les résultats obtenus montrent que les aveugles congénitaux ont des seuils de douleur plus bas et des rapports de douleur plus élevés que leurs congénères voyants. De plus, les résultats psychométriques indiquent que les non-voyants sont plus attentifs à la douleur. Dans une deuxième étude, nous avons mesuré l’impact de l'expérience visuelle sur la perception de la douleur en répliquant la première étude dans un échantillon d’aveugles tardifs. Les résultats montrent que ces derniers sont en tous points similaires aux voyants quant à leur sensibilité à la douleur. Dans une troisième étude, nous avons testé les capacités de discrimination de température des aveugles congénitaux, car la détection de changements rapides de température est cruciale pour éviter les brûlures. Il s’est avéré que les aveugles de naissance ont une discrimination de température plus fine et qu’ils sont plus sensibles à la sommation spatiale de la chaleur. Dans une quatrième étude, nous avons examiné la contribution des fibres A∂ et C au traitement nociceptif des non-voyants, car ces récepteurs signalent la première et la deuxième douleur, respectivement. Nous avons observé que les aveugles congénitaux détectent plus facilement et répondent plus rapidement aux sensations générées par l’activation des fibres C. Dans une cinquième et dernière étude, nous avons sondé les changements potentiels qu’entrainerait la perte de vision dans la modulation descendante des intrants nociceptifs en mesurant les effets de l’appréhension d’un stimulus nocif sur la perception de la douleur. Les résultats montrent que, contrairement aux voyants, les aveugles congénitaux voient leur douleur exacerbée par l’incertitude face au danger, suggérant ainsi que la modulation centrale de la douleur est facilitée chez ces derniers. En gros, ces travaux indiquent que l’absence d’expérience visuelle, plutôt que la cécité, entraine une hausse de la sensibilité nociceptive, ce qui apporte une autre dimension au modèle d’intégration multi-sensorielle de la vision et de la douleur.

Cannabinoids impact on pregnancy: effects in trophoblast cells

Cannabinoids (CBs) can be classified as: phytocannabinoids, the constituents of the Cannabis sativa plant; synthetic cannabinoids lab-synthesized and the endocannabinoids that are endogenous lipid mediators. Cannabinoid compounds activate cannabinoid receptors – CB1 and CB2. The most prevalent psychoactive phytocannabinoid is Δ9tetrahydrocannabinol (THC), but more than 60 different CBs were already identified in the plant. The best characterized endocannabinoids (eCBs) are anandamide (AEA) and 2arachidonoylglycerol (2-AG), that are involved in several physiological processes including synaptic plasticity, pain modulation, energy homeostasis and reproduction. On the other hand, some synthetic cannabinoids that were initially designed for medical research, are now used as drugs of abuse. During the period of placental development, highly dynamic processes of remodeling occur, involving proliferation, apoptosis, differentiation and invasion of trophoblasts. It is known that a tight control of eCBs levels is required for normal pregnancy progression and that eCBs are involved in trophoblast cells turnover. Therefore, by sharing activation of the same receptors, exposure to exocannabinoids either by recreational or medicinal use may lead to alterations in the eCBs levels and in the endocannabinoid system homeostasis In this work, it was studied the impact of CBs in BeWo trophoblastic cells and in primary cultures of human cytotrophoblasts. Cells were treated for 24 hours with different concentrations of THC, the synthetic cannabinoid WIN‐55,212 (WIN) and 2-AG. Treatment with THC did not affect BeWo cells viability while WIN and 2-AG caused a dose-dependent viability loss. Morphological studies together with biochemical markers indicate that 2-AG is able to induce apoptosis in cytotrophoblasts. On the other hand, morphological studies after acridine orange staining suggest that autophagy may take part in WIN-induced loss of cell viability. All cannabinoids caused a decrease in mitochondrial membrane potential (Δψm) but only 2-AG led to ROS/RNS generation, though no changes in glutathione levels were observed. In addition, ER-stress may be involved in the 2-AG induced-oxidative stress, as preliminary results point to an increase in CCAAT-enhancer-binding protein homologous protein (CHOP) expression. Besides the decrease in cell viability, alterations in cell cycle progression were observed. WIN treatment induced a cell cycle arrest in G0/G1 phase, whereas 2-AG induced a cell cycle arrest in G2/M phase. Here it is reinforced the relevance of cannabinoid signaling in fundamental processes of cell proliferation and cell death in trophoblast cells. Since cannabis-based drugs are the most consumed illicit drugs worldwide and some of the most consumed recreational drugs by pregnant women, this study may contribute to the understanding of the impact of such substances in human reproduction.

Impact de la cécité sur le système nociceptif

La vision joue un rôle très important dans la prévention du danger. La douleur a aussi pour fonction de prévenir les lésions corporelles. Nous avons donc testé l’hypothèse qu’une hypersensibilité à la douleur découlerait de la cécité en guise de compensation sensorielle. En effet, une littérature exhaustive indique qu’une plasticité intermodale s’opère chez les non-voyants, ce qui module à la hausse la sensibilité de leurs sens résiduels. De plus, plusieurs études montrent que la douleur peut être modulée par la vision et par une privation visuelle temporaire. Dans une première étude, nous avons mesuré les seuils de détection thermique et les seuils de douleur chez des aveugles de naissance et des voyants à l’aide d’une thermode qui permet de chauffer ou de refroidir la peau. Les participants ont aussi eu à quantifier la douleur perçue en réponse à des stimuli laser CO2 et à répondre à des questionnaires mesurant leur attitude face à des situations douloureuses de la vie quotidienne. Les résultats obtenus montrent que les aveugles congénitaux ont des seuils de douleur plus bas et des rapports de douleur plus élevés que leurs congénères voyants. De plus, les résultats psychométriques indiquent que les non-voyants sont plus attentifs à la douleur. Dans une deuxième étude, nous avons mesuré l’impact de l'expérience visuelle sur la perception de la douleur en répliquant la première étude dans un échantillon d’aveugles tardifs. Les résultats montrent que ces derniers sont en tous points similaires aux voyants quant à leur sensibilité à la douleur. Dans une troisième étude, nous avons testé les capacités de discrimination de température des aveugles congénitaux, car la détection de changements rapides de température est cruciale pour éviter les brûlures. Il s’est avéré que les aveugles de naissance ont une discrimination de température plus fine et qu’ils sont plus sensibles à la sommation spatiale de la chaleur. Dans une quatrième étude, nous avons examiné la contribution des fibres A∂ et C au traitement nociceptif des non-voyants, car ces récepteurs signalent la première et la deuxième douleur, respectivement. Nous avons observé que les aveugles congénitaux détectent plus facilement et répondent plus rapidement aux sensations générées par l’activation des fibres C. Dans une cinquième et dernière étude, nous avons sondé les changements potentiels qu’entrainerait la perte de vision dans la modulation descendante des intrants nociceptifs en mesurant les effets de l’appréhension d’un stimulus nocif sur la perception de la douleur. Les résultats montrent que, contrairement aux voyants, les aveugles congénitaux voient leur douleur exacerbée par l’incertitude face au danger, suggérant ainsi que la modulation centrale de la douleur est facilitée chez ces derniers. En gros, ces travaux indiquent que l’absence d’expérience visuelle, plutôt que la cécité, entraine une hausse de la sensibilité nociceptive, ce qui apporte une autre dimension au modèle d’intégration multi-sensorielle de la vision et de la douleur.

Ideación suicida y desesperanza en pacientes con cáncer

El objetivo de la presente investigación fue identificar la relación entre ideación suicida y desesperanza en 160 pacientes con cáncer. La ideación suicida se midió a través de dos ítems de una entrevista semiestructurada, la escala de ideación suicida (ISS), el ítem 9 del inventario de depresión de Beck (BDI-IA). La desesperanza se midió con la escala de desesperanza de Beck (BHS). Los resultados obtenidos indicaron una relación significativa (p=.000) entre ideación suicida y desesperanza; una prevalencia de ideación suicida en los pacientes con cáncer entre 4.4% y 13.8% y de riesgo de suicidio entre 5.6% y 30.6%; y algún grado de desesperanza en 31.9 % de los participantes. De acuerdo con lo anterior, se confirma que existe relación entre la desesperanza y la ideación suicida en pacientes oncológicos adultos. Adicionalmente, que estas variables están presentes en los pacientes y que ameritan atención en la intervención interdisciplinaria.