RESUMO
INTRODUCTION: joint replacement is a highly effective intervention that significantly improves the patient's quality of life, relieves symptoms, restores joint function, and improves mobility and independence. The optimal pain control after total hip replacement has become an important goal of postoperative management. The purpose of this paper is to compare periarticular infiltration (PAI) and lumbar plexus nerve block (LPNB) for the management of post-operative pain in primary total hip arthroplasty because we believe that LPNB provides better analgesic management and lower opioid consumption. We evaluated the opioid usage during hospitalization and the complications derived from either technique. MATERIAL AND METHODS: we randomized 45 patients who underwent elective total hip arthroplasty between January 2019 and January 2020. Two groups were evaluated based on the association of PAI or LPNB. Both as part of a multimodal analgesic regimen. RESULTS: a total of 45 patients were evaluated (22 PAI group, 23 LPNB group). Block group required less opioid administration (p = 0.069). Most of the patients in both groups reported mild/moderate pain. The LPNB group had lower pain scale with physiotherapy. We did not have complications derived from either technique. CONCLUSION: lumbar plexus nerve block (LPNB) in patients undergoing total hip arthroplasty provides better pain management and reduced opioid consumption compared to PAI. The performance of this technique does not delay the beginning of physiotherapy and there were not any issues with the patient's recovery.
INTRODUCCIÓN: la artroplastía es una intervención altamente eficaz que mejora de manera significativa la calidad de vida del paciente, alivia los síntomas, restaura la función articular y mejora la movilidad e independencia. El control óptimo del dolor después de la artroplastía total de cadera se ha convertido en un objetivo importante del tratamiento postoperatorio. El propósito de este trabajo es comparar la infiltración periarticular (IPA) y el bloqueo nervioso del plexo lumbar (BNPL) para el manejo del dolor postoperatorio en la artroplastía total de cadera primaria, ya que creemos que la BNPL proporciona mejor manejo analgésico y menor consumo de opioides. Se evaluó el uso de opioides durante la hospitalización y las complicaciones derivadas de cada técnica. MATERIAL Y MÉTODOS: fueron aleatorizados 45 pacientes tratados con artroplastía total de cadera electiva entre Enero de 2019 y Enero de 2020 en dos grupos: IPA o BNPL. Ambos como parte de un régimen analgésico multimodal. RESULTADOS: veintidós en el grupo IPA y 23 en el grupo BNPL. El grupo de bloqueo requirió menos administración de opioides (p = 0.069). La mayoría de los pacientes de ambos grupos reportaron dolor leve/moderado. El grupo de BNPL tuvo menor escala de dolor al realizar fisioterapia. No tuvimos complicaciones derivadas de ninguna de las técnicas analgésicas. CONCLUSIÓN: el BNPL en pacientes sometidos a artroplastía total de cadera proporciona mejor manejo del dolor y una reducción del consumo de opioides en el postoperatorio en comparación con la IPA. La realización de esta técnica no retrasa el inicio de la fisioterapia y no hubo problemas con la recuperación del paciente.
Assuntos
Artroplastia de Quadril , Bloqueio Nervoso , Humanos , Analgésicos Opioides/uso terapêutico , Qualidade de Vida , Estudos Prospectivos , Método Simples-Cego , Dor , Plexo LombossacralRESUMO
Resumen: Introducción: La artroplastía es una intervención altamente eficaz que mejora de manera significativa la calidad de vida del paciente, alivia los síntomas, restaura la función articular y mejora la movilidad e independencia. El control óptimo del dolor después de la artroplastía total de cadera se ha convertido en un objetivo importante del tratamiento postoperatorio. El propósito de este trabajo es comparar la infiltración periarticular (IPA) y el bloqueo nervioso del plexo lumbar (BNPL) para el manejo del dolor postoperatorio en la artroplastía total de cadera primaria, ya que creemos que la BNPL proporciona mejor manejo analgésico y menor consumo de opioides. Se evaluó el uso de opioides durante la hospitalización y las complicaciones derivadas de cada técnica. Material y métodos: Fueron aleatorizados 45 pacientes tratados con artroplastía total de cadera electiva entre Enero de 2019 y Enero de 2020 en dos grupos: IPA o BNPL. Ambos como parte de un régimen analgésico multimodal. Resultados: Veintidós en el grupo IPA y 23 en el grupo BNPL. El grupo de bloqueo requirió menos administración de opioides (p = 0.069). La mayoría de los pacientes de ambos grupos reportaron dolor leve/moderado. El grupo de BNPL tuvo menor escala de dolor al realizar fisioterapia. No tuvimos complicaciones derivadas de ninguna de las técnicas analgésicas. Conclusión: El BNPL en pacientes sometidos a artroplastía total de cadera proporciona mejor manejo del dolor y una reducción del consumo de opioides en el postoperatorio en comparación con la IPA. La realización de esta técnica no retrasa el inicio de la fisioterapia y no hubo problemas con la recuperación del paciente.
Abstract: Introduction: Joint replacement is a highly effective intervention that significantly improves the patient's quality of life, relieves symptoms, restores joint function, and improves mobility and independence. The optimal pain control after total hip replacement has become an important goal of postoperative management. The purpose of this paper is to compare periarticular infiltration (PAI) and lumbar plexus nerve block (LPNB) for the management of post-operative pain in primary total hip arthroplasty because we believe that LPNB provides better analgesic management and lower opioid consumption. We evaluated the opioid usage during hospitalization and the complications derived from either technique. Material and methods: We randomized 45 patients who underwent elective total hip arthroplasty between January 2019 and January 2020. Two groups were evaluated based on the association of PAI or LPNB. Both as part of a multimodal analgesic regimen. Results: A total of 45 patients were evaluated (22 PAI group, 23 LPNB group). Block group required less opioid administration (p = 0.069). Most of the patients in both groups reported mild/moderate pain. The LPNB group had lower pain scale with physiotherapy. We did not have complications derived from either technique. Conclusion: Lumbar plexus nerve block (LPNB) in patients undergoing total hip arthroplasty provides better pain management and reduced opioid consumption compared to PAI. The performance of this technique does not delay the beginning of physiotherapy and there were not any issues with the patient's recovery.
RESUMO
Hepatitis E virus (HEV) genotype 3 is the most prevalent HEV genotype in Europe causing mostly asymptomatic infections in humans, but can also sporadically cause severe acute hepatitis, chronic liver disease, chronic hepatitis in immunocompromised patients and extra-hepatic manifestations. Although much is today known about the swine reservoir, no information is available on the occurrence of HEV from widely distributed deer species in Portugal. Here, we investigated the presence and characterized HEV in free-living deer in Portugal by screening stools from red deer (Cervus elaphus) (n = 95) and fallow deer (Dama dama) (n = 35) for HEV by a broad-spectrum nested RT-PCR, followed by sequencing and phylogenetic analysis. Two red deer females, sampled in central Portugal, showed to be shedding HEV (2.1%; 95% confidence interval: 0.58-7.35). Sequencing and genetic characterization showed that these two deer HEV sequences were 98.96% identical to each other, being both of HEV genotype 3 subgenotype 3e. The increasing numbers and distribution of deer in Portugal and the zoonotic features of the circulating HEV genotype 3 subgenotype 3e highlights the importance of continued surveillance directed to food-borne diseases, especially those involving wild animals and deer in particular.
Assuntos
Cervos , Vírus da Hepatite E , Hepatite E , Doenças dos Suínos , Animais , Feminino , Genótipo , Hepatite E/epidemiologia , Hepatite E/veterinária , Vírus da Hepatite E/genética , Humanos , Filogenia , Portugal/epidemiologia , SuínosRESUMO
1. The study was carried out to evaluate the effect of stocking density on performance, litter moisture, Eimeria oocyst shedding, intestinal and foot lesions in broilers.2. A total of 192 1-d-old male Cobb broilers were distributed with three different stocking densities (6, 8 or 10 chickens/m2) with outdoor access and eight replicates in a completely randomised design over two periods. Productive parameters were measured from 3 to 7 weeks of age.3. Oocyst counts (OPG) in both excreta and litter were performed at 3, 4 and 5 weeks of age. Intestinal and foot pad lesions were evaluated at 7 weeks old. The stocking density of 6 birds/m2 had the highest body weights (P < 0.05) (2129 ± 37.67, 2759 ± 50.82 and 3167 ± 75.64 g at weeks 5, 6 and 7 of age, respectively).4. Feed intake decreased with increasing stocking density at week 3 (r = -0.57), 4 (r = -0.48), 5 (r = -0.84), 6 (r = -0.68) and 7 (r = -0.65) of age (P < 0.05). Birds with stocking densities of 8 and 10/m2 consumed, respectively, up to 11% and 19.5% less feed than the lower stocking density groups.5. Stocking density affected (P < 0.05) feed conversion (1.61, 1.49 and 1.46) and litter moisture (40.88, 52.60 and 56.19%) at 3 weeks of age. Neither carcase yield nor mortality was different between densities (P > 0.05). Likewise, there was no effect of stocking density on OPG neither in excreta nor in litter, intestinal lesions, or foot pad and hock injuries (P > 0.05).6. In conclusion, the higher stocking density decreased both the feed intake and the live weight in broilers, but there were no effects in the number of Eimeria OPG in excreta or litter, neither intestinal lesions nor in foot pad injuries.
Assuntos
Galinhas , Eimeria , Criação de Animais Domésticos , Animais , Abrigo para Animais , Masculino , Clima TropicalRESUMO
Studies of the current Chilean population performed using classical genetic markers have established that the Chilean population originated primarily from the admixture of European people, particularly Spaniards, and Amerindians. A socioeconomic-ethno-genetic cline was established soon after the conquest. Spaniards born in Spain or Chile occupied the highest Socioeconomic Strata, while Amerindians belonged to the lowest. The intermediate strata consisted of people with different degrees of ethnic admixture; the larger the European admixture, the higher the Socioeconomic Level. The present study of molecular genomic markers sought to calculate the percentage of Amerindian admixture and revealed a finer distribution of this cline, as well as differences between two Amerindian groups: Aymara and Mapuche. The use of two socioeconomic classifications - Class and Socioeconomic Level - reveals important differences. Furthermore, Self-reported Ethnicity (self-assignment to an ethnic group) and Self-reported Ancestry (self-recognition of Amerindian ancestors) show variations and differing relationships between socioeconomic classifications and genomic Amerindian Admixture. These data constitute a valuable input for the formulation of public healthcare policy and show that the notions of Ethnicity, Socioeconomic Strata and Class should always be a consideration in policy development.
Assuntos
Etnicidade , Genômica , Chile , Frequência do Gene , Marcadores Genéticos , Humanos , Indígenas Sul-Americanos/genética , EspanhaRESUMO
Pancreatic ductal adenocarcinoma (PDAC) is one of the most intractable and devastating malignant tumors. Epigenetic modifications such as DNA methylation and histone modification regulate tumor initiation and progression. However, the contribution of histone variants in PDAC is unknown. Here, we demonstrated that the histone variant H2A.Z is highly expressed in PDAC cell lines and PDAC patients and that its overexpression correlates with poor prognosis. Moreover, all three H2A.Z isoforms (H2A.Z.1, H2A.Z.2.1, and H2A.Z.2.2) are highly expressed in PDAC cell lines and PDAC patients. Knockdown of these H2A.Z isoforms in PDAC cell lines induces a senescent phenotype, cell cycle arrest in phase G2/M, increased expression of cyclin-dependent kinase inhibitor CDKN2A/p16, SA-ß-galactosidase activity and interleukin 8 production. Transcriptome analysis of H2A.Z-depleted PDAC cells showed altered gene expression in fatty acid biosynthesis pathways and those that regulate cell cycle and DNA damage repair. Importantly, depletion of H2A.Z isoforms reduces the tumor size in a mouse xenograft model in vivo and sensitizes PDAC cells to gemcitabine. Overexpression of H2A.Z.1 and H2A.Z.2.1 more than H2A.Z.2.2 partially restores the oncogenic phenotype. Therefore, our data suggest that overexpression of H2A.Z isoforms enables cells to overcome the oncoprotective barrier associated with senescence, favoring PDAC tumor grow and chemoresistance. These results make H2A.Z a potential candidate as a diagnostic biomarker and therapeutic target for PDAC.
Assuntos
Adenocarcinoma/genética , Carcinoma Ductal Pancreático/genética , Inibidor p16 de Quinase Dependente de Ciclina/genética , beta-Galactosidase/genética , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/patologia , Envelhecimento/genética , Animais , Carcinoma Ductal Pancreático/tratamento farmacológico , Carcinoma Ductal Pancreático/patologia , Transformação Celular Neoplásica/genética , Dano ao DNA/efeitos dos fármacos , Metilação de DNA/genética , Reparo do DNA/efeitos dos fármacos , Desoxicitidina/análogos & derivados , Desoxicitidina/farmacologia , Resistencia a Medicamentos Antineoplásicos/genética , Epigênese Genética/genética , Xenoenxertos , Histonas/genética , Humanos , Camundongos , GencitabinaRESUMO
The unique circumstances created by the COVID-19 pandemic pose serious challenges to mood stability and emotional regulation at all ages. Although many people tend to react resiliently to stress, others appear to display emotional anxiety and depression-related symptoms. In this study, we carried out a survey (N = 10,053) during the first week of the general lockdown (quarantine) in Argentina to measure early affective reactions in Argentine adults. Respondents showed substantial anxious and depressive symptoms, with 33% and 23% of participants reporting possible depressive and anxious syndromes, respectively, with the youngest group (18 to 25 y.o.) showing the highest prevalence of symptoms. Even if prior mental health problems predisposed or aggravated the reaction, participants without prior complaints showed signs of psychological impact. Using linear regression, the most important independent variables related to depressive symptoms were the feeling of loneliness followed by daily stress. In the case of anxious states, the strongest variables were negative repetitive thinking and feeling of loneliness. Other psychological, economic, and social factors are discussed. This study is in line with previous literature that highlight the importance of the psychological impact of pandemics, but additionally demonstrates that these reactions are present at a large scale immediately after the start of quarantine with very low infectious rates as an early anticipatory adaptive reaction leading to potential negative outcomes from adjustment disorders to major disorders. In addition, the present results provide potentially relevant information about sudden environmental impacts on affective states and specific pathways for anxiety and depression to be expressed. We end by discussing implications for public policy based on considering the most vulnerable groups.
Assuntos
COVID-19 , Pandemias , Adulto , Ansiedade/epidemiologia , Argentina/epidemiologia , Controle de Doenças Transmissíveis , Depressão , Humanos , Saúde Mental , Quarentena , SARS-CoV-2 , Estresse Psicológico/epidemiologiaRESUMO
BACKGROUND: Immune checkpoint inhibitors (ICI) have been associated with several immune-related adverse events, including sarcoidosis-like reactions (SLR). SLR, which has a low prevalence but an increasing incidence, is similar to sarcoidosis in terms of histology, and clinical and radiological manifestations. The most commonly affected organs are hilar and mediastinal lymph nodes and skin. SLR is an exclusion diagnosis, so a lymph node biopsy can be useful to distinguish between tumor progression and SLR, particularly in tumors in which nodal involvement is very common. PATIENTS AND METHODS: We performed a retrospective analysis of SLR in all cancer patients receiving ICIs in our institution between January 2016 and June 2020. RESULTS: Among the 1063 treated patients, seven experienced SLR, four of whom were symptomatic (cough, skin lesions, arthralgia), with time to onset ranging from 1.5 to 6.7 months after ICI initiation. All seven patients had bilateral hilar lymphadenopathy, and granulomatous reactions in five of the six patients with lymph node biopsies. SLR improved in all patients, including four patients who continued with ICI. Three patients received corticosteroids and/or stopped ICI therapy. Four of these patients had partial responses at the time SLR was identified. CONCLUSION: Management of SLR lacks a consensus recommendation, although corticosteroids and/or stopping the ICI are generally implemented. The potential consequences of stopping anticancer treatment should be taken into consideration, particularly in the absence of clear management recommendations.
Assuntos
Toxidermias/etiologia , Inibidores de Checkpoint Imunológico/efeitos adversos , Linfadenopatia/induzido quimicamente , Neoplasias/tratamento farmacológico , Sarcoidose/induzido quimicamente , Adulto , Idoso , Feminino , Hospitais , Humanos , Inibidores de Checkpoint Imunológico/uso terapêutico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , EspanhaRESUMO
The systematic adoption of the histopathologic criteria provided by the 2016 update of the WHO classification of brain tumors has markedly increased the relative proportion of atypical and anaplastic meningiomas. These tumors exhibit a much greater recurrence rate compared to benign meningiomas, which negatively impacts survival. In recent years, the publication of numerous retrospective case series, yet no randomized controlled trials, on the impact of radiation therapy in non-benign meningioma, has yielded conflicting evidence. At present, maximum safe resection, including the dural attachment, is the preferred primary treatment modality for all types of meningiomas. Adjuvant radiotherapy is currently recommended for subtotally resected grade II and for all grade III meningiomas. However, in grade II meningiomas achieving complete resection, close radiologic and clinical observation is a feasible option. Despite the great amount of non-benign meningiomas available and eligible for trials, there is a striking lack of prospective studies testing adjuvant therapies against observation for this subset of patients. An updated and systematic literature review is provided on the effectiveness and indications of radiotherapy on grade II and III meningiomas.
Assuntos
Neoplasias Meníngeas/radioterapia , Meningioma/radioterapia , Recidiva Local de Neoplasia/radioterapia , Radioterapia Adjuvante , Humanos , Neoplasias Meníngeas/classificação , Neoplasias Meníngeas/patologia , Neoplasias Meníngeas/cirurgia , Meningioma/classificação , Meningioma/patologia , Meningioma/cirurgia , Gradação de Tumores , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Estudos Prospectivos , Organização Mundial da SaúdeRESUMO
Perfluorohexane sulfonate (PFHxS) is one of the most abundant perfluorinated compounds in the environment. Exposure to this compound has been correlated to a decrease in human fertility, although the molecular and cellular mechanisms underlying this correlation have not been described. The adverse reproductive effects of PFHxS could be based on alterations in oocyte maturation, the process rendering oocytes competent for fertilization. The aim of this study was to evaluate the effect of PFHxS on porcine oocyte viability and maturation in vitro, as well as on gap-junctional intercellular communication (GJIC) in cumulus-oocyte complexes (COCs), oocyte mitochondrial membrane potential (mΔΨ) and DNA damage in cumulus cells, as possible mechanisms of action. PFHxS caused cytotoxicity (medium lethal concentration, LC50â¯=â¯329.1⯵M) and inhibition of oocyte maturation (medium inhibitory concentration, MIC50â¯=â¯91.68⯵M). GJIC was not affected in exposed COCs. However, the mitochondrial membrane potential was significantly decreased in PFHxS-exposed oocytes at the germinal vesicle breakdown (GVBD) stage. In addition, exposure to PFHxS induced DNA damage in cumulus cells. Thus, inhibition of oocyte maturation by PFHxS could be attributed to a decreased oocyte mΔΨ at the GVBD and to DNA damage of the cumulus cells that support the oocyte.