Evaluation of pain and opioid consumption in local preemptive anesthesia and the erector spine plane block in thoracoscopic surgery: A randomized clinical trial.

OBJECTIVE: assess pain and opioid consumption in patients undergoing anesthetic techniques of spinal erector plane block and local anesthetic block in video-assisted thoracic surgery in the immediate postoperative period. METHODS: ninety-two patients undergoing video assisted thoracic surgery were randomized to receive ESPB or BAL before starting the surgical procedure. Using the numerical verbal scale, the primary outcome assessed was the patient's pain in the immediate postoperative period (POI). The secondary outcome comprises the assessment of opioid consumption in the IPP by quantifying the medication used in an equianalgesic dose of morphine expressed in milligrams, in the immediate post-anesthetic recovery period, 6h, 12h, and 24h after surgery. RESULTS: the EVN scores in the LBA and ESPB group in the POI had a mean of 0,8 (±1,89) vs 0,58 (±2,02) in the post-anesthesia care room (REPAI), 1,06 (±2,00) vs 1,30 (±2,30) in 6 hours of POI, 0,84 (±1,74) vs 1,19 (±2,01) within 12 hours of POI and 0,95 (±1,88) vs 1 ( ±1,66) within 24 hours of POI, all with p>0.05. Mean opioid consumption in the BAL and ESPB groups in the POI was 12.9 (± 10.4) mg vs 14.9 (±10.2) mg, respectively, with p = 0.416. Sixteen participants in the ESPB group and seventeen in the BAL group did not use opioids during the first 24 hours of the PO analyzed. CONCLUSION: local anesthesic block and ESP block techniques showed similar results in terms of low pain scores and opioid consumption during the period evaluated.

Sertraline repositioning: an overview of its potential use as a chemotherapeutic agent after four decades of tumor reversal studies.

Sertraline hydrochloride is a first-line antidepressant with potential antineoplastic properties because of its structural similarity with other drugs capable to inhibit the translation-controlled tumor protein (TCTP), a biomolecule involved in cell proliferation. Recent studies suggest it could be repositioned for cancer treatment. In this review, we systematically map the findings that repurpose sertraline as an antitumoral agent, including the mechanisms of action that support this hypotesis. From experimental in vivo and in vitro tumor models of thirteen different types of neoplasms, three mechanisms of action are proposed: apoptosis, autophagy, and drug synergism. The antidepressant is able to inhibit TCTP, modulate chemotherapeutical resistance and exhibit proper cytotoxicity, resulting in reduced cell counting (in vitro) and shrunken tumor masses (in vivo). A mathematical equation determined possible doses to be used in human beings, supporting that sertraline could be explored in clinical trials as a TCTP-inhibitor.

Evaluation of pain and opioid consumption in local preemptive anesthesia and the erector spine plane block in thoracoscopic surgery: A randomized clinical trial / Avaliação da dor e consumo de opioides em anestesia preemptiva local e do plano eretor da espinha em cirurgia torácica videotoracoscópica: Um ensaio clínico randomizado

ABSTRACT Objective: assess pain and opioid consumption in patients undergoing anesthetic techniques of spinal erector plane block and local anesthetic block in video-assisted thoracic surgery in the immediate postoperative period. Methods: ninety-two patients undergoing video assisted thoracic surgery were randomized to receive ESPB or BAL before starting the surgical procedure. Using the numerical verbal scale, the primary outcome assessed was the patient's pain in the immediate postoperative period (POI). The secondary outcome comprises the assessment of opioid consumption in the IPP by quantifying the medication used in an equianalgesic dose of morphine expressed in milligrams, in the immediate post-anesthetic recovery period, 6h, 12h, and 24h after surgery. Results: the EVN scores in the LBA and ESPB group in the POI had a mean of 0,8 (±1,89) vs 0,58 (±2,02) in the post-anesthesia care room (REPAI), 1,06 (±2,00) vs 1,30 (±2,30) in 6 hours of POI, 0,84 (±1,74) vs 1,19 (±2,01) within 12 hours of POI and 0,95 (±1,88) vs 1 ( ±1,66) within 24 hours of POI, all with p>0.05. Mean opioid consumption in the BAL and ESPB groups in the POI was 12.9 (± 10.4) mg vs 14.9 (±10.2) mg, respectively, with p = 0.416. Sixteen participants in the ESPB group and seventeen in the BAL group did not use opioids during the first 24 hours of the PO analyzed. Conclusion: local anesthesic block and ESP block techniques showed similar results in terms of low pain scores and opioid consumption during the period evaluated.

RESUMO Objetivo: avaliar a dor e o consumo de opioides dos pacientes submetidos a técnicas anestésicas de bloqueio do plano eretor da espinha (ESPB) e bloqueio anestésico local (LBA) em cirurgia torácica vídeo assistida no período pós-operatório imediato (POI). Métodos: noventa e dois pacientes submetidos a cirurgia torácica videotoracoscópica foram randomizados aleatoriamente para receberem ESPB ou LBA antes do início do procedimento cirúrgico. O desfecho primário avaliado foi a dor do paciente no POI através da escala verbal numérica. O desfecho secundário avaliou o consumo de opioides através da quantificação da medicação usada em dose equianalgésica de morfina expressa em miligramas, no período de recuperação pós-anestésica imediata, 6h, 12h e 24h após a cirurgia. Resultados: os escores da Escala Verbal Numérica de dor (EVN) no grupo LBA e ESPB no POI, respectivamente, tiveram média de 0,8 (±1,89) vs 0,58 (±2,02) na sala de recuperação pós anestesia (REPAI), 1,06 (±2,00) vs 1,30 (±2,30) em 6 horas do POI, 0,84 (±1,74) vs 1,19 (±2,01) em 12 horas do POI e 0,95 (±1,88) vs 1 ( ±1,66) em 24 horas do POI, todos com p>0,05. O consumo médio de opioides no grupo LBA e ESPB foi de 12,9 (±10,4) mg vs 14,9 (±10.2) mg, respectivamente, com p=0.416. Dezesseis participantes do grupo ESPB e dezessete do grupo LBA não utilizaram opioides durante as primeiras 24 horas do PO. Conclusões: as técnicas de bloqueio LBA e ESPB apresentaram resultados semelhantes em termos de baixos escores de dor e consumo de opioides durante o período avaliado.

Effect of heat stress on the antioxidant defense system and erythrocyte morphology of Antarctic fishes.

This study analyzed the effect of thermal stress on erythrocytes of Notothenia rossii and Notothenia coriiceps, abundant notothenioids in Admiralty Bay, Antarctic Peninsula. In both species, the antioxidant defense system enzymes, superoxide dismutase, catalase, glutathione peroxidase, glutathione-S transferase, glutathione reductase were punctually altered (8°C for 1, 3 and 6 days) in erythrocytes, indicating that these markers are not ideal for termal stress. However, under the influence of thermal stress, morphological changes in Notothenia coriiceps erythrocytes were observed at all exposure times (1, 3 and 6 days at 8°C), and in Notothenia rossii occurred in 6 days. These results suggest that Notothenia corriceps presents a lower tolerance to thermal stress at 8°C for up to 6 days, since the cellular and nuclear alterations recorded are pathological and may be deleterious to the cells. Among the morphological markers analyzed in this work, we believe that the shape change and nuclear bubble formation may be good stress biomarkers in erythrocytes of Notothenia rossii and Notothenia coriiceps.

Reconhecimento de lesões de pele suspeitas de malignidade por médicos da atenção primária de Curitiba-PR / Identification of skin lesions suspected of malignity by primary care physitians in Curitiba-PR

Este estudo teve por objetivo analisar o desempenho de médicos atuantes na atenção primária frente ao reconhecimento de lesões suspeitas de câncer de pele. Trata-se de um estudo de campo exploratório descritivo com abordagem quantitativa. Médicos generalistas, médicos de família e residentes em Medicina de Família e Comunidade atuantes nas 66 unidades de saúde de Curitiba-PR, foram entrevistados. O conhecimento em dermatologia foi considerado mínimo para 61,5% dos participantes. A sensibilidade média (S) no reconhecimento das lesões suspeitas foi de 63,92% (IC95% 60,5-67,34). O desempenho foi considerado satisfatório na identificação do melanoma cutâneo (S=83%) e do carcinoma espinocelular (S=97%) e insatisfatório nos casos de ceratose actínica (S=54%), nevo melanocítico displásico (S=51%) e carcinoma basocelular (S=32%). Lesões de pele prevalentes podem estar sendo diagnosticadas tardiamente ou subdiagnosticadas. Salienta-se a importância de atualizações e treinamentos profissionais para aprimoramento da percepção e capacidade de reconhecimento precoce na atenção primária. (AU)

The aim of this study was to analyze the performance of primary care doctors in recognizing suspected skin cancer lesions. This is an exploratory-descriptive field study with a quantitative approach. General practitioners, family doctors, and family and community medicine residents working in the 66 health units in Curitiba-PR were interviewed. Knowledge in dermatology was considered basic for 61.5% of the participants. The mean sensitivity (S) in recognizing suspected lesions was 63.92% (CI95% 60.5-67.34). The performance was considered satisfactory in the identification of cutaneous melanoma (S=83%) and squamous cell carcinoma (S=97%) and unsatisfactory in cases of actinic keratosis (S=54%), dysplastic melanocytic nevus (S=51%) and basal cell carcinoma (S=32%). Prevalent skin lesions may be diagnosed late or underdiagnosed. The importance of professional updates and training is emphasized to improve perception and the ability to recognize early in primary care. (AU)

Chemotherapy in focus: A meta-analysis confronts immunotherapy in the treatment of advanced melanoma.

This study aimed to analyze the efficacy of the monoclonal antibodies ipilimumab, nivolumab, and pembrolizumab when compared with conventional chemotherapy in the treatment of advanced melanoma. Three authors made the search independently and five articles matched the eligibility criteria. A fourth expert confirmed their quality (κ = 1). The meta-analysis for overall survival and 12-month overall survival was impaired due to remarkably high heterogeneity (I2 = 91 % and 86 %, respectively). However, chemotherapy showed benefits on 24-months overall survival (RR = 1.60; IC95 %: 1.29, 1.98; p < 0.0001). The interruption by toxicity outcome showed no significant differences between therapies. Some studies used monoclonal antibodies in monotherapy or in combination and some groups of participants showed heterogeneity, which made the analysis difficult. Given the exorbitant costs of monoclonal antibodies in low and middle-income countries, the evidence of its benefits is limited when considering the replacement of conventional therapy with immunotherapy in public health systems.

Determinantes da violência sexual infantil no estado do Paraná - Brasil / Determinants of child sexual violence in the state of Paraná - Brasil

A violência sexual infantil configura-se como um fenômeno sociocultural, pautado em relações hierárquicas e desigualdades de gênero, étnico-raciais e geracionais. Nesta pesquisa, investigouse os determinantes da violência sexual infantil a partir dos casos notificados pelo SINAN no estado do Paraná entre 2011 e 2014, disponibilizados pelo DATASUS, por estudo descritivo, de base documental e abordagem quantitativa. No Paraná, totalizaram 2.446 casos no período. A Regional de Saúde com maior prevalência foi a de Foz do Iguaçu. Prevalece a faixa etária de 5 a 9 anos, meninas, raça negra e indígenas. Na tipologia, predominaram estupro e assédio sexual, por meio de força corporal. Os casos prevalentemente ocorreram na residência e o provável agressor era próximo da criança. Reconhecer os determinantes da violência sexual infantil é essencial para a implementação de ações de cuidado integral às vítimas.

Effect of long-term thermal challenge on the Antarctic notothenioid Notothenia rossii.

The thermal stability of the Antarctic Ocean raises questions concerning the metabolic plasticity of Antarctic notothenioids to changes in the environmental temperature. In this study, Notothenia rossii survived 90 days at 8 °C, and their condition factor level was maintained. However, their hepatosomatic (0.29×) index decreased, indicating a decrease in nutrient storage as a result of changes in the energy demands to support survival. At 8 °C, the plasma calcium, magnesium, cholesterol, and triglyceride concentrations decreased, whereas the glucose (1.91×) and albumin (1.26×) concentrations increased. The main energy substrate of the fish changed from lipids to glucose due to a marked increase in lactate dehydrogenase activity, as demonstrated by an increase in anaerobic metabolism. Moreover, malate dehydrogenase activity increased in all tissues, suggesting that fish acclimated at 8 °C exhibit enhanced gluconeogenesis. The aerobic demand increased only in the liver due to an increase (2.23×) in citrate synthase activity. Decreases in the activities of superoxide dismutase, catalase, and glutathione-S-transferase to levels that are most likely sufficient at 8 °C were observed, establishing a new physiological activity range for antioxidant defense. Our findings indicate that N. rossii has some compensatory mechanisms that enabled its long-term survival at 8 °C.

Metabolic responses in Antarctic Nototheniidae brains subjected to thermal stress.

Antarctic Nototheniidae is an attractive group for studying metabolic and physiological responses at high temperatures. The present work investigated the metabolic responses of the carbohydrate metabolism and antioxidant system to thermal stress at 8 °C (for 2-144 h) in the brains of Notothenia rossii and Notothenia coriiceps. In N. coriiceps, glycogenolysis was essential in the first hours of exposure (2 h) at 8 °C and, in addition to inhibiting glucose-6-phosphatase activity, was important for activating the pentose phosphate pathway. In N. rossii, anaerobic metabolism was reduced in the first hours of exposure (2 and 6 h) at 8 °C, followed by reduced hexokinase activity, suggesting energy regulation between neurons and astrocytes. The antioxidant system results indicated the importance of the actions of the glutathione-dependent antioxidant enzymes glutathione-S-transferase and glutathione peroxidase as well as those of catalase in N. coriiceps and the action of glutathione-S-transferase, glutathione peroxidase and glutathione reductase in N. rossii, especially during the first 12 h of thermal stress exposure. These results indicate tissue-specific patterns and species-specific responses to this stress.

Heat stress in the heart and muscle of the Antarctic fishes Notothenia rossii and Notothenia coriiceps: Carbohydrate metabolism and antioxidant defence.

Carbohydrate metabolism and the antioxidant defence system of heart and muscle of the Antarctic notothenioids Notothenia rossii and Notothenia coriiceps were evaluated in response to heat stress (8 °C) over 144 h. N. rossii heart exhibited decreased glycolysis and aerobic metabolism after up to 12 h of exposure to 8 °C, and anaerobiosis was inhibited within 24 h. However, these pathways were stimulated after 72 h at 8 °C. The consumption of glucose-6-phosphate, derived from hexokinase (HK), by glucose-6-phosphate dehydrogenase (G6PDH) decreased in N. rossii heart within 6 h at 8 °C, with a subsequent increase at 72 h. In N. rossii muscle at 8 °C, glycolysis was stimulated within 2 h by an increase in pyruvate kinase (PK), and aerobic metabolism was stimulated at 144 h, together with anaerobiosis. In N. coriiceps heart at 8 °C, glucose break down by HK decreased within 2 h and subsequently increased at 12 and 24 h. Increased glucose-6-phosphate consumption by G6PDH occurred within 6 h at 8 °C. In N. coriiceps muscle at 8 °C, glycolysis was stimulated at 2 and 6 h, with subsequent inhibition within 24 h, as indicated by HK activity. Aerobic metabolism was inhibited at 72 and 144 h at 8 °C through the inhibition of citrate synthase (CS). Heat stress caused responses were only occasional and transient in antioxidant defence system of both species in the heart and muscle, leading to increased glutathione (GSH) and decreased levels of lipoperoxidation in the heart of both species. The results obtained in this study in the heart and muscles indicate that under heat stress at 8 °C, N. rossii is more responsive than N. coriiceps with respect to carbohydrate metabolism.

Effects of heat stress on the renal and branchial carbohydrate metabolism and antioxidant system of Antarctic fish.

The objective of the present study was to assess the effect of short-term (2-144 h) heat stress (8 °C) on energy production processes and antioxidant defense systems in the kidneys and gills of Notothenia rossii and Notothenia coriiceps. Heat stress affected energy metabolism and oxidative stress parameters in a time-, tissue-, and species-dependent manner, and gills were more sensitive than kidneys to heat stress. N. rossii kidneys were able to stabilize carbohydrate metabolism after 12 h of heat stress, whereas the glycogen levels in N. coriiceps kidneys fluctuated in response to varying glucose-6-phosphatase (G6Pase) levels. The gills of N. rossii were able to stabilize their energy demand and aerobic metabolism under heat stress, whereas in the gills of N. coriiceps, changes in carbohydrate metabolic pathways depended on the exposure time: initially, anaerobiosis was activated after 6 h; the energy demand, characterized by glycogen consumption, increased after 72 h, and aerobic metabolism was activated within 144 h. With regard to the antioxidant defenses of the N. rossii kidney, it was found that levels of antioxidant enzymes were reduced during the first hours of heat stress, contributing to increased lipid peroxidation, whereas N. coriiceps kidneys did not show signs of oxidative damage. The gills of N. rossii exhibited more pronounced oxidative damage in response to heat stress than those of N. coriiceps despite the presence of increasing levels of antioxidants, likely due to tissue hypoxia.

Effect of temperature acclimation on the liver antioxidant defence system of the Antarctic nototheniids Notothenia coriiceps and Notothenia rossii.

The aim of this study was to determine whether endemic Antarctic nototheniid fish are able to adjust their liver antioxidant defence system in response to the temperature increase. The activity of the superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), glutathione-S-transferase (GST) and glutathione reductase (GR) enzymes as well as the content of non-enzymatic oxidative stress markers such as reduced glutathione (GSH), lipid peroxidation (LPO) and protein carbonyl (PC) were measured in the liver of two Antarctic fish species, Notothenia rossii and Notothenia coriiceps after 1, 3 and 6days of exposure to temperatures of 0°C and 8°C. The GST activity showed a downregulation in N. rossii after 6days of exposure to the increased temperature. The activity profiles of GST and GR in N. rossii and of GPx in N. coriiceps also changed as a consequence of heating to 8°C. The GSH content increased by heating to 8°C after 3days in N. coriiceps and after 6days in N. rossii. The content of malondialdehyde (MDA), a LPO marker, showed a negative modulation by the heating to 8°C in N. rossii after 3days of exposure to temperatures. Present results show that heating to 8°C influenced the levels and profiles of the antioxidant enzymes and defences over time in the nototheniid fish N. rossii and N. coriiceps.

Morphological and morphometric variability of the squid Lolliguncula brevis (Mollusca: Cephalopoda) in Brazilian waters: evidence for two species in the Western Atlantic?

Morphological and morphometric variability of the small-sized coastal squid Lolliguncula brevis was assessed along the largest part of its latitudinal range in the southern hemisphere, off the Brazilian coast (8º S - 27º S). A general homogeneity in form was found throughout the entire latitudinal range. In terms of body proportions, no latitudinal gradients were evident, but a few local "morphotypes" could be distinguished. The distinctive egg mass morphology, and size and form features, including a hectocotylus 20-40% longer than the opposing ventral arm and the presence of suckers on the buccal membrane, indicated that Lolliguncula from northern and southern hemispheres might comprise two different taxa.

Population structure and somatic indexes of Hypostomus cf. ancistroides (Siluriformes, Loricariidae) collected from the Bonito river, Ivaí river basin, Turvo, Paraná

This study aimed to provide information about the population structure and somatic index of Hypostomus cf. ancistroides collected from the Bonito river, located in the Ivaí river basin. The length-weight relationship was isometric for both the sexes. The length structure analysis showed that the larger individuals (from 18.1cm to 27.0cm in length) predominated, and the lowest abundances occurred at the size extremes (9.1-12cm and 27.1-30.0cm). The reproduction period occured between October and January for the females and between November and January for the males. The liver somatic index cannot be used as an indicator of the reproduction period in either of the sexes, due to no correlation between the liver somatic index and the gonad somatic index. The gonad weight exerted no influence on the monthly mean condition factor and the correlation between the condition factor and gonad somatic index was high. The condition factor could be an indicator of the reproduction period of this species.

Este estudo teve o objetivo de fornecer informações sobre a estrutura populacional e os índices somáticos de Hipostomus cf. ancistroides coletados no rio Bonito localizado na bacia do rio Ivaí. A relação comprimento-peso, para machos e para fêmeas, foi isométrica. A análise da estrutura em comprimento mostrou que há um predomínio de indivíduos maiores (entre 18.1 a 27.0 cm) sendo que as menores abundâncias ocorreram nas classes de comprimentos extremas (9.1 a 12.0 cm e 27.1 a 30.0 cm). O período reprodutivo em fêmeas ocorreu entre os meses de outubro a janeiro. Os machos possuem um período reprodutivo entre novembro e janeiro. O índice hepatossomático, para ambos os sexos, não pode ser utilizado como indicador do período reprodutivo, devido à não correlação entre o índice hepatossomático e o índice gonadossomático. O peso das gônadas não influenciou o valor médio do fator de condição e foi observada uma alta correlação entre o fator de condição e o índice gonadossomático. O fator de condição pode ser um indicador do período de reprodução desta espécie.

Population structure of Phalloceros caudimaculatus (Hensel, 1868) (Cyprinodontiformes, Poeciliidae) collected in a brook in Guarapuava, PR

The population structure of Phalloceros caudimaculatus was studied in a brook (sites A and B) existing in the CEDETEG - Guarapuava/PR. Fourteen length classes of 3 mm amplitude were defined for P. caudimaculatus. The widest length amplitude and the average and maximum sizes were observed in females. Females were significantly more predominant in the whole sample and more frequent in all length classes. The sexual proportion data, showed that the number of females was superior to that of males throughout most of the year. Young occurrence peaks were registered in November and March. Pregnant females were present from March to April, from July to August and in January, characterizing the reproductive season. At sampling site A, a higher occurrence of pregnant females and young was observed.

A estrutura populacional de Phalloceros caudimaculatus foi estudada em um riacho (pontos A e B) existente no CEDETEG - Guarapuava/PR. Para P. caudimaculatus foram encontradas 14 classes de comprimento com amplitude de 3,0mm. A maior amplitude de comprimento e os maiores tamanhos médios e máximos foram observados nas fêmeas. As fêmeas foram significativamente predominantes na amostra total e mais abundantes em todas as classes de comprimento. Pela proporção sexual pode-se detectar que o número de fêmeas é superior ao de machos a maior parte do ano. Os picos de ocorrência de jovens foram registrados nos meses de novembro e março. As fêmeas grávidas estiveram presentes nos bimestres de março-abril, julho-agosto e no mês de janeiro, caracterizando a época reprodutiva. No ponto de coleta A foi observado uma maior ocorrência de fêmeas grávidas e de jovens.