838 resultados para Pain and Suffering Damage
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Pós-graduação em Ciências Ambientais - Sorocaba
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Pós-graduação em Saúde Coletiva - FMB
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Pós-graduação em Saúde Coletiva - FMB
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Bone reconstructions are traditionally conducted with autogenous grafts harvested from intra- or extra-oral donor sites to reestablish the lost bone volume for further implant-prosthetic rehabilitation. The calvarial bone has been studied as an excellent donor site in large atrophic situations, presenting low resorption rates, as well as complications and minimal morbidity. The hospitalization time is short, with low pain levels, short functional limitations, and invisible scars. The skull microarchitecture is predominantly cortical in the presence of growth factors that demonstrate their osteogenic, osteoinductive, and osteoconductive abilities resulting in low resorption rate and high predictability when compared to the iliac crest. Dural lacerations, extra and subdural bleeding, cerebrospinal fluid leakage, and brain damage have been minimized due to the development of surgical technique. The delimitation of diploe, preserving the internal skull cortex before osteotomy at the donor made it possible to reduce accidents and complications. The aim of this paper is to show a technical and to discuss aspects of the use of calvarial bone in the reconstruction of severely atrophic maxilla for oral rehabilitation with osseointegrated implants.
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The Brown Tree Snake (Boiga irregularis) has caused ecological and economic damage to Guam, and the snake has the potential to colonize other islands in the Pacific Ocean. This study quantifies the potential economic damage if the snake were translocated, established in the state of Hawaii, and causing damage at levels similar to those on Guam. Damages modeled included costs of medical treatments due to snakebites, snake-caused power outages, and decreased tourism resulting from effects of the snake. Damage caused by presence of the Brown Tree Snake on Guam was used as a guide to estimate potential economic damage to Hawaii from both medical- and power outage–related damage. To predict tourism impact, a survey was administered to Hawaiian tourists that identified tourist responses to potential effects of the Brown Tree Snake. These results were then used in an input-output model to predict damage to the state economy. Summing these damages resulted in an estimated total potential annual damage to Hawaii of between $593 million and $2.14 billion. This economic analysis provides a range of potential damages that policy makers can use in evaluation of future prevention and control programs.
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Examination of scatological motifs in Théophile de Viau’s (1590-1626) libertine, or ‘cabaret’ poetry is important in terms of how the scatological contributes to the depiction of the Early Modern body in the French lyric.1 This essay does not examine Théophile’s portrait of the body strictly in terms of the ‘Baroque’ or the ‘neo-Classical.’ Rather, it argues that the scatological context in which he situates the body (either his, or those of others), reflects a keen sensibility of the body representative of the transition between these two eras. Théophile reinforces what Bernard Beugnot terms the body’s inherent ‘eloquence’ (17), or what Patrick Dandrey describes as an innate ‘textuality’ in what the body ‘writes’ (31), and how it discloses meaning. The poet’s scatological lyric, much of which was published in the Pamasse Satyrique of 1622, projects a different view of the body’s ‘eloquence’ by depicting a certain realism and honesty about the body as well as the pleasure and suffering it experiences. This Baroque realism, which derives from a sense of the grotesque and the salacious, finds itself in conflict with the Classical body which is frequently characterized as elegant, adorned, and ‘domesticated’ (Beugnot 25). Théophile’s private body is completely exposed, and, unlike the public body of the court, does not rely on masking and pretension to define itself. Mitchell Greenberg contends that the body in late sixteenth-century and early seventeenth-century French literature is often depicted in a chaotic manner because, ‘the French body politic was rent by tumultuous religious and social upheavals’ (62).2 While one could argue that Théophile’s portraits of a syphilis-ridden narrators are more a reflection of his personal agony rather than that of France as a whole, what emerges in Théophile is an emphasis on the movement, if not decomposition of the body.3 Given Théophile’s public persona and the satirical dimension of his work, it is difficult to imagine that the degeneration he portrays is limited only to his individual experience. On a collective level, Théophile reflects what Greenberg calls ‘a continued, if skewed apprehension of the world in both its physical and metaphysical dimensions’(62–3) typical of the era. To a large extent, the body Théophile depicts is a scatological body, one whose deterioration takes the form of waste, disease, and evacuation as represented in both the private and public domain. Of course, one could cast aside any serious reading of Théophile’s libertine verse, and virtually all of scatological literature for that matter, as an immature indulgence in the prurient. Nonetheless, it was for his dissolute behavior and his scatological poetry that Théophile was imprisoned and condemned to death. Consequently, this part of his work merits serious consideration in terms of the personal and poetic (if not occasionally political) statement it represents. With the exception of Claire Gaudiani’s outstanding critical edition of Théophile’s cabaret lyric, there exist no extensive studies of the poet’s libertine œuvre.4 Clearly however, these poems should be taken seriously with respect to their philosophical and aesthetic import. As a consequence, the objective becomes that of enhancing the reader’s understanding of the lyric contexts in which Théophile’s scatological offerings situate themselves. Structurally, the reader sees how the poet’s libertine ceuvre is just that — an integrated work in which the various components correspond to one another to set forth a number of approaches from which the texts are to be read. These points of view are not always consistent, and Théophile cannot be thought of as writing in a sequential manner along the lines of devotional Baroque poets such as Jean de La Ceppède and Jean de Sponde. However, there is a tendency not to read these poems in their vulgar totality, and to overlook the formal and substantive unity in this category of Théophile’s work. The poet’s resistance to poetic and cultural standards takes a profane, if not pornographic form because it seeks to disgust and arouse while denigrating the self, the lyric other, and the reader. Théophile’s pornography makes no distinction between the erotic and scatological. The poet conflates sex and shit because they present a double form of protest to artistic and social decency while titillating and attacking the reader’s sensibilities. Examination of the repugnant gives way to a cathartic experience which yields an understanding of, if not ironic delight in, one’s own filthy nature.
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Repetitive transcranial magnetic stimulation (rTMS) is a novel technique of non-invasive brain stimulation which has been used to treat several neuropsychiatric disorders such as major depressive disorder, chronic pain and epilepsy. Recent studies have shown that the therapeutic effects of rTMS are associated with plastic changes in local and distant neural networks. In fact, it has been suggested that rTMS induces long-term potentiation (LTP) and long-term depression (LTD) - like effects. Besides the initial positive clinical results; the effects of rTMS are stilt mixed. Therefore new toots to assess the effects of plasticity non-invasively might be useful to predict its therapeutic effects and design novel therapeutic approaches using rTMS. In this paper we propose that brain-derived neurotrophic factor (BDNF) might be such a tool. Brain-derived neurotrophic factor is a neurotrophin that plays a key role in neuronal survival and synaptic strength, which has also been studied in several neuropsychiatric disorders. There is robust evidence associating BDNF with the LTP/LTD processes, and indeed it has been proposed that BNDF might index an increase or decrease of brain activity - the `yin and yang` BDNF hypothesis. In this article, we review the initial studies combining measurements of BDNF in rTMS clinical trials and discuss the results and potential usefulness of this instrument in the field of rTMS. (C) 2008 Elsevier Ltd. All rights reserved.
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The use of patient-orientated questionnaires is of utmost importance in assessing the outcome of spine surgery. Standardisation, using a common set of outcome measures, is essential to aid comparisons across studies/in registries. The Core Outcome Measures Index (COMI) is a short, multidimensional outcome instrument validated for patients with spinal disorders. This study aimed to produce a Brazilian-Portuguese version of the COMI. A cross-cultural adaptation of the COMI into Brazilian-Portuguese was carried out using established guidelines. 104 outpatients with chronic LBP (> 3 months) were recruited from a Public Health Spine Medical Care Centre. They completed a questionnaire booklet containing the newly translated COMI, and other validated symptom-specific questionnaires: Oswestry Disability Index (ODI) and Roland Morris disability scale (RM), and a pain visual analogue scale. All patients completed a second questionnaire within 7-10 days to assess reproducibility. The COMI summary score displayed minimal floor and ceiling effects. On re-test, the responses for each individual domain of the COMI were within 1 category in 98% patients for the domain 'function', 96% for 'symptom-specific well-being', 97% for 'general quality of life', 99% for 'social disability' and 100% for 'work disability'. The intraclass correlation coefficients (ICC2,1) for COMI pain and COMI summary scores were 0.91-0.96, which compared favourably with the corresponding values for the RM (ICC, 0.99) and ODI (ICC, 0.98). The standard error of measurement for the COMI was 0.6, giving a "minimum detectable change" (MDC95%) of approximately 1.7 points i.e., the minimum change to be considered "real change" beyond measurement error. The COMI scores correlated as hypothesised (Rho, 0.4-0.8) with the other symptom-specific questionnaires. The reproducibility of the Brazilian-Portuguese version of the COMI was comparable to that of other language versions. The COMI scores correlated in the expected manner with existing but longer symptom-specific questionnaires suggesting good convergent validity for the COMI. The Brazilian-Portuguese COMI represents a valuable tool for Brazilian study-centres in future multicentre clinical studies and surgical registries.
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OBJECTIVE: The aim of this study was to assess the IgE serum levels in juvenile systemic lupus erythematosus patients and to evaluate possible associations with clinical and laboratory features, disease activity and tissue damage. METHODS: The IgE serum concentrations in 69 consecutive juvenile systemic lupus erythematosus patients were determined by nephelometry. IgG, IgM and IgA concentrations were measured by immunoturbidimetry. All patients were negative for intestinal parasites. Statistical analysis methods included the Mann-Whitney, chi-square and Fisher's exact tests, as well as the Spearman rank correlation coefficient. RESULTS: Increased IgE concentrations above 100 IU/mL were observed in 31/69 (45%) juvenile systemic lupus erythematosus patients. The mean IgE concentration was 442.0 +/- 163.4 IU/ml (range 3.5- 9936.0 IU/ml). Fifteen of the 69 patients had atopic disease, nine patients had severe sepsis and 56 patients presented with nephritis. The mean IgE level in 54 juvenile systemic lupus erythematosus patients without atopic manifestations was 271.6 +/- 699.5 IU/ml, and only nine of the 31 (29%) patients with high IgE levels had atopic disease. The IgE levels did not statistically differ with respect to the presence of atopic disease, severe sepsis, nephritis, disease activity, or tissue damage. Interestingly, IgE concentrations were inversely correlated with C4 levels ( r = -0.25, p = 0.03) and with the SLICC/ACR-DI score (r = -0.34, p = 0.005). The IgE concentration was also found to be directly correlated with IgA levels (r = 0.52, p = 0.03). CONCLUSIONS: The present study demonstrated for the first time that juvenile systemic lupus erythematosus patients have increased IgE serum levels. This increase in IgE levels was not related to allergic or parasitic diseases. Our results are in line with the hypothesis that high IgE levels can be considered a marker of immune dysregulation.
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Femtosecond lasers have been widely used in laser surgery as an instrument for contact-free tissue removal of hard dental, restorative materials, and osseous tissues, complementing conventional drilling or cutting tools. In order to obtain a laser system that provides an ablation efficiency comparable to mechanical instruments, the laser pulse rate must be maximal without causing thermal damage. The aim of this study was to compare the different morphological characteristics of the hard tissue after exposure to lasers operating in the femtosecond pulse regime. Two different kinds of samples were irradiated: dentin from human extracted teeth and bovine femur samples. Different procedures were applied, while paying special care to preserving the structures. The incubation factor S was calculated to be 0.788 +/- 0.004 for the bovine femur bone. These results indicate that the incubation effect is still substantial during the femtosecond laser ablation of hard tissues. The plasma-induced ablation has reduced side effects, i.e., we observe less thermal and mechanical damage when using a superficial femtosecond laser irradiation close to the threshold conditions. In the femtosecond regime, the morphology characteristics of the cavity were strongly influenced by the change of the effective number of pulses. (C) 2012 Society of Photo-Optical Instrumentation Engineers (SPIE). [DOI: 10.1117/1.JBO.17.4.048001]
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The dorsolateral column of the periaqueductal gray (dlPAG) integrates aversive emotional experiences and represents an important site responding to life threatening situations, such as hypoxia, cardiac pain and predator threats. Previous studies have shown that the dorsal PAG also supports fear learning; and we have currently explored how the dlPAG influences associative learning. We have first shown that N-methyl-D-aspartate (NMDA) 100 pmol injection in the dlPAG works as a valuable unconditioned stimulus (US) for the acquisition of olfactory fear conditioning (OFC) using amyl acetate odor as conditioned stimulus (CS). Next, we revisited the ascending projections of the dlPAG to the thalamus and hypothalamus to reveal potential paths that could mediate associative learning during OFC. Accordingly, the most important ascending target of the dlPAG is the hypothalamic defensive circuit, and we were able to show that pharmacological inactivation using beta-adrenoceptor blockade of the dorsal premammillary nucleus, the main exit way for the hypothalamic defensive circuit to thalamo-cortical circuits involved in fear learning, impaired the acquisition of the OFC promoted by NMDA stimulation of the dlPAG. Moreover, our tracing study revealed multiple parallel paths from the dlPAG to several thalamic targets linked to cortical-hippocampal-amygdalar circuits involved in fear learning. Overall, the results point to a major role of the dlPAG in the mediation of aversive associative learning via ascending projections to the medial hypothalamic defensive circuit, and perhaps, to other thalamic targets, as well. These results provide interesting perspectives to understand how life threatening events impact on fear learning, and should be useful to understand pathological fear memory encoding in anxiety disorders.
Physical and psychosocial risk factors for musculoskeletal disorders in Brazilian and Italian nurses
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As part of the international CUPID investigation, we compared physical and psychosocial risk factors for musculoskeletal disorders among nurses in Brazil and Italy. Using questionnaires, we collected information on musculoskeletal disorders and potential risk factors from 751 nurses employed in public hospitals. By fitting country-specific multiple logistic regression models, we investigated the association of stressful physical activities and psychosocial characteristics with site-specific and multisite pain, and associated sickness absence. We found no clear relationship between low back pain and occupational lifting, but neck and shoulder pain were more common among nurses who reported prolonged work with the arms in an elevated position. After adjustment for potential confounding variables, pain in the low back, neck and shoulder, multisite pain, and sickness absence were all associated with somatizing tendency in both countries. Our findings support a role of somatizing tendency in predisposition to musculoskeletal disorders, acting as an important mediator of the individual response to triggering exposures, such as work-load.
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Centrifugal countercurrent distribution (CCCD) in an aqueous two-phase system (TPS) is a resolute technique revealing sperm heterogeneity and for the estimation of the fertilizing potential of a given semen sample. However, separated sperm subpopulations have never been tested for their fertilizing ability yet. Here, we have compared sperm quality parameters and the fertilizing ability of sperm subpopulations separated by the CCCD process from ram semen samples maintained at 20 degrees C or cooled down to 5 degrees C. Total and progressive sperm motility was evaluated by computer-assisted analysis using a CASA system and membrane integrity was evaluated by flow cytometry by staining with CFDA/Pl. The capacitation state, staining with chlortetracycline, and apoptosis-related markers, such as phosphatidylserine (PS) translocation detected with Annexin V. and DNA damage detected by the TUNEL assay, were determined by fluorescence microscopy. Additionally, the fertilizing ability of the fractionated subpopulations was comparative assessed by zona binding assay (ZBA). CCCD analysis revealed that the number of spermatozoa displaying membrane and DNA alterations was higher in samples chilled at 5 degrees C than at 20 degrees C. which can be reflected in the displacement to the left of the CCCD profiles. The spermatozoa located in the central and right chambers (more hydrophobic) presented higher values (P<0.01) of membrane integrity, lower PS translocation (P<0.05) and DNA damage (P<0.001) than those in the left part of the profile, where apoptotic markers were significantly increased and the proportion of viable non-capacitated sperm was reduced. We have developed a new protocol to recover spermatozoa from the CCCD fractions and we proved that these differences were related with the fertilizing ability determined by ZBA, because we found that the number of spermatozoa attached per oocyte was significantly higher for spermatozoa recovered from the central and right chambers, in both types of samples. This is the first time, to our knowledge that sperm recovered from a two-phase partition procedure are used for fertilization assays. These results open up new possibilities for using specific subpopulations of sperm for artificial insemination or in vitro fertilization, not only regarding better sperm quality but also certain characteristics such as subpopulations enriched in spermatozoa bearing X or Y chromosome that we have already isolated or any other feature. (C) 2011 Elsevier B.V. All rights reserved.