Dolor crónico tras la cirugía de mama: incidencia, factores de riesgo e impacto en la calidad de vida / Chronic pain after breast surgery: Incidence, risk factors and impact on quality of life

Introducción y objetivos: El cáncer de mama es la neoplasia más frecuentemente diagnosticada y el dolor crónico postoperatorio (DCPO) es un problema relacionado con la terapia crecientemente reconocido. Evaluamos la incidencia del DCPO, sus características, factores asociados e impacto en la calidad de vida (CdV) del paciente.Materiales y métodosSe realizó un estudio prospectivo observacional de 6meses en pacientes tratados mediante cirugía de mama en un hospital universitario terciario. Los datos se recopilaron utilizando diversos cuestionarios: Pain Catastrophizing Scale, Brief Pain Inventory-Short Form, Douleur Neuropathique 4, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire y Breast Cancer Module.ResultadosUn total de 112 pacientes completaron el estudio, de los cuales aproximadamente un tercio (34,8%) desarrollaron DCPO y casi todos ellos dolor neuropático potencial. El DCPO interfirió con la vida diaria de los pacientes y redujo su CdV. La diabetes (p=0,028), la catastrofización (p=0,042) y la gravedad del dolor posoperatorio agudo (p<0,001) se asociaron a DCPO.ConclusionesEste estudio amplía nuestra comprensión sobre el DCPO y muestra el impacto de este síndrome. Los profesionales sanitarios deben ser conscientes del DCPO, y tomar medidas para prevenirlo y tratarlo, proporcionando a los pacientes la información suficiente. (AU)

Introduction and objectives: Breast cancer is the most frequently diagnosed malignancy, and chronic pain after breast surgery (CPBS) is an increasingly recognized therapy-related problem. We evaluated CPBS incidence, characteristics, associated factors, and impact on patient quality of life (QoL).Materials and methodsSix-month observational prospective study in patients undergoing breast surgery in a tertiary university hospital. Data were collected using several questionnaires: Pain Catastrophizing Scale, Brief Pain Inventory-Short Form, Douleur Neuropathique 4 Questionnaire, and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire and its Breast Cancer Module.ResultsA total of 112 patients completed the study. Approximately, one third (34.8%) developed CPBS, almost all with potentially neuropathic pain. CPBS interfered with patients’ daily life and reduced their QoL. Diabetes (p=.028), catastrophizing (p=.042), and acute postoperative pain severity (p<.001) were associated with CPBS.ConclusionsThis study broadens our understanding of CPBS and shows the impact of this syndrome. Healthcare workers need to be aware of CPBS and take steps to prevent and treat it, and provide patients with adequate information. (AU)

Chronic pain after breast surgery: incidence, risk factors and impact on quality of life.

INTRODUCTION AND OBJECTIVES: Breast cancer is the most frequently diagnosed malignancy, and chronic pain after breast surgery (CPBS) is an increasingly recognized therapy-related problem. We evaluated CPBS incidence, characteristics, associated factors, and impact on patient quality of life (QoL). MATERIALS AND METHODS: Six-month observational prospective study conducted in patients undergoing breast surgery in a tertiary university hospital. Data were collected using several questionnaires: Pain Catastrophizing Scale, Brief Pain Inventory-Short Form, Douleur Neuropathique 4 Questionnaire, and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire and its Breast Cancer Module. RESULTS: A total of 112 patients completed the study. Approximately, one third (34.8%) developed CPBS, and almost all with potentially neuropathic pain. CPBS interfered with patients' daily life and reduced their QoL. Diabetes (p = 0.028), catastrophizing (p = 0.042), and acute postoperative pain severity (p < 0.001) were associated with CPBS. CONCLUSIONS: This study broadens our understanding of CPBS and shows the impact of this syndrome. Healthcare workers need to be aware of CPBS and take steps to prevent and treat it, and provide patients with adequate information.

Optical gap energy study of poly(thienylene-2,5-dialkoxyphenylene) in solid-state films.

Optical gap energy (Egap) in luminescent π-conjugated polymers presents several difficulties in its determination, particularly when using CW conventional optical spectroscopy, absorption and emission. This happens due to several physicochemical parameter's dependence. Among others, the molecular conformation, intramolecular interactions, structural defects, polymer processability and solvent interaction stand out. In addition, there is a distribution of conjugated segments along the polymeric main chains that differentiate optical absorption transition from emission processes. In other words, these processes do not necessarily occur in the same conjugated segment owing to the very efficient ratios of energy transfer or charge migration in these materials. In this work we present a systematic study of the determination of Egap for the polymer poly(thienylene-2,5-dialkoxyphenylene). We present a comparison between the solution and solid-state film, clearly showing the presence of a polymer-polymer interaction as aggregate species. The goal of this paper is to isolate and aggregate the contribution determination of each species through systematic analysis of optical spectra, as well as to obtain, even on film, the Egap of the isolated polymer which is very similar to the polymer solution at about 2.37 eV. The intersection theory and the voltammetry methods corroborate the experiment and the discussion of the results obtained.

Individual differences in behaviour and gut bacteria are associated in collared peccary (Mammalia, Tayassuidae).

AIMS: We tested the hypothesis that the behaviour of an individual is associated with the diversity of its gut bacteria, using the collared peccary (Pecari tajacu) as a model. METHODS AND RESULTS: In all, 24 adult male collared peccaries received either low- (n = 12) or high-fibre diet (n = 12) to induce contrasting gut fermentation profiles. They were submitted to three short-term challenges, allowing us to rate the animals in a coping-style dimension named 'calmness'. At the end of the experimental period, we collected samples of peccaries' forestomach contents to characterize bacterial diversity. We found a significant positive association between individual 'calmness' z-scores and the bacterial evenness index in gut bacteria (and a similar trend with the Simpson's diversity index), suggesting a more homogeneous bacterial community of calmer individuals. We also found a positive association between fibres digestibility and gut bacterial diversity in the peccaries' forestomach, but no effect of the dietary fibre level. CONCLUSIONS: Gut bacteria evenness increases with 'calmness' z-scores, suggesting a more homogeneous bacterial community of calmer individuals, compared with the more heterogeneous of the most distressed ones. Our results also suggest associations between the digestibility of ADF with the gut bacterial diversity indices and with the relative abundance of the Actinobacteria phylum. SIGNIFICANCE AND IMPACT OF THE STUDY: Our data showed that the hosts' individual behavioural differences are potentially aligned with gut bacterial diversity. The behaviour-microbiota link is correlated with host feed efficiency and, ultimately, may have implications for animal health and welfare of farm animals.

Individual differences in behavior affect total tract fiber digestibility: the example of collared peccary.

Differences in how individuals cope with stressful conditions (e.g. novel/unfamiliar environment, social isolation and increases in human contact) can explain the variability in data collection from nutrient digestibility trials. We used the collared peccary (Pecari tajacu), which is under process of domestication and shows high individual behavioral distinctiveness in reactions toward humans, to test the hypothesis that behavioral differences play a role in nutrient digestibility. We assessed the individual behavioral traits of 24 adult male collared peccaries using both the 'behavioral coding' and the 'subjective ratings' approaches. For the behavioral coding assessment, we recorded the hourly frequency of behaviors potentially indicative of stress during the 30-day habituation period to the experimental housing conditions. The subjective ratings were performed based on the individuals' reactions to three short-term challenge tests (novel environment, novel object and threat from a capture net) over a period of 56 days. During the last 26 days, the collared peccaries were fed diets either high (n = 12) or low (n = 12) in dietary fiber levels, and we determined the total tract apparent digestibility of nutrients. The individual subjective ratings showed consistency in the correlated measures of 'relaxedness', 'quietness' and 'satisfaction' across the three challenge tests, which were combined to produce z score ratings of one derived variable ('calmness'). Individual frequency of BPIS/h and calmness scores were negatively correlated and both predicted the total tract digestibility of acid detergent fiber (ADF), which ranged from 0.41 to 0.79. The greater the calmness z scores (i.e. calmer individuals), the greater the total tract digestibility of ADF. In contrast, the higher the frequency of BPIS/h, the lower the total tract digestibility of ADF. Therefore, our results provide evidence that by selecting calmer collared peccaries, there will be an increase in their capacity to digest dietary fiber.

Measurement properties from the Brazilian Portuguese version of the QUIP-RS.

Parkinson's disease (PD) has numerous motor and non-motor symptoms. Among non-motor manifestations impulse control disorders (ICDs) stand out. ICDs include compulsions for gambling, shopping, eating, and sexual behavior, and "related disorders" such as hobbyism, simple motor activities, and dopamine dysregulation syndrome. There is no rating scale translated and adapted transculturally into Brazilian Portuguese language. Therefore, we cross-culturally adapted and investigated the measurement properties of the Brazilian version of the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease-Rating Scale (QUIP-RS). Fifty-three patients participated in the study. Inter-evaluator and test-retest (patient and health professional) reliabilities (intraclass correlation coefficient) were all excellent (0.93, 0.93, and 0.99). The internal consistency was high (α = 0.92). The Minimal detectable change (MDC) value was 5.8 (patient) and 2.3 (health professional) points. There was a floor, but no ceiling, effect. In summary, the Brazilian version of the QUIP-RS has high reliability and content validity.

Investigation of charge ratio variation in mRNA - DEAE-dextran polyplex delivery systems.

mRNA pharmaceuticals represent a new class of therapeutics, with applications, in cancer vaccination, tumour therapy and protein substitution. Formulations are required to deliver messenger RNA (mRNA) to the target sites where induction of genetic transfection following receptor mediated cell uptake & translation is required. In the current study, the cationic polysaccharide diethylaminoethylen (DEAE) - Dextran was selected as a model system carrier for the investigation of polyplex nanoparticle formation together with mRNA as a function of the molar ratio of the components. The structure of the mRNA/Dextran colloids was investigated as a function of the polymer-to-mRNA ratio and correlated with the biological activity determined by cellular transfection with luciferase coding mRNA. Dynamic light scattering (DLS), small angle x-ray scattering (SAXS), and small angle neutron scattering (SANS) with deuterium contrast variation were used to achieve structural insight into the systems. Similarly to previously investigated lipid based systems, colloidally stable particles with confined size were obtained with either excess of positive or negative charge. Highest activity was obtained with positive charge excess. From the scattering experiments information on the internal organization inside the polymer/mRNA systems was derived. Indication for the presence of structural elements in the length scale of ten to 20 nm were found in the excess of dextran, which could be due to either excess or particulate polymer. Information on the molecular organization of the mRNA nanoparticle products may provide a valuable basis for defining critical quality attributes of drug products for pharmaceutical application.

Haploidentical stem cell transplantation in a boy with chronic granulomatous disease

Chronic granulomatous disease is a primary immunodeficiency caused by mutations in any one of the five components of the NADPH oxidase in phagocytic leucocytes. This causes impaired microbial killing, which leads to severe life-threatening bacterial and fungal infections. Currently, allogenic hematopoietic stem cell transplantation (HSCT) is the only curative treatment for chronic granulomatous disease, although gene therapy may provide a new therapeutic option for the treatment of patients with CGD. Haploidentical HSCT provides a potentially curative treatment option for patients who lack a suitably HLA-matched donor, but only a few cases have been reported in the literature. Herein, we report a boy with X-linked chronic granulomatous disease treated successfully by haploidentical HSCT with post-transplant cyclophosphamide using a treosulfan-based conditioning regimen

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Haploidentical stem cell transplantation in a boy with chronic granulomatous disease.

Chronic granulomatous disease is a primary immunodeficiency caused by mutations in any one of the five components of the NADPH oxidase in phagocytic leucocytes. This causes impaired microbial killing, which leads to severe life-threatening bacterial and fungal infections. Currently, allogenic hematopoietic stem cell transplantation (HSCT) is the only curative treatment for chronic granulomatous disease, although gene therapy may provide a new therapeutic option for the treatment of patients with CGD. Haploidentical HSCT provides a potentially curative treatment option for patients who lack a suitably HLA-matched donor, but only a few cases have been reported in the literature. Herein, we report a boy with X-linked chronic granulomatous disease treated successfully by haploidentical HSCT with post-transplant cyclophosphamide using a treosulfan-based conditioning regimen.

Evaluation of the safety and satisfaction of rheumatic patients with accelerated infliximab infusion.

INTRODUCTION: Infliximab infusion generally occurs in 2-4 h. Recent studies have suggested the possibility of accelerated infusion (1 h) of this drug. OBJECTIVE: To evaluate the safety of accelerated infliximab infusion in patients with rheumatic diseases. In addition, patient satisfaction was also assessed. METHODS: A prospective, single-center, non-randomized study with 34 patients with rheumatic diseases was conducted from July to November 2016. Patients with the following were excluded: history of allergic reaction to biologics, asthma or severe atopy. All patients previously received a 2- to 3-h infliximab infusion. The infusion rate was accelerated to 1 h, and premedication was excluded. The infusion was monitored in all patients. RESULTS: A total of 34 patients were included in the study [rheumatoid arthritis (n = 16), ankylosing spondylitis (n = 15), psoriatic arthritis (n = 2) and enteropathic arthropathy (n = 1)], with an average age of 48.7 ± 18.6 years; 55.5% of the patients were female, and 29.4% were white. The duration of disease was 9.5 ± 9.2 years, and the duration of infliximab use was 38.9 ± 27.6 months, with a mean dose per infusion of 414.2 ± 158.1 (range, 200-800) mg. The mean infliximab infusion time prior to the study was 2.2 ± 0.4 h. A total of 6 (17.6%) patients received premedication. The premedication was suspended. There were no adverse effects during or after infusion. Ninety-seven percent of the patients and 100% of the health workers were satisfied with the accelerated infusion. CONCLUSION: Our data support the safe use of accelerated infliximab infusion in rheumatic patients, with high satisfaction among patients and health workers.

The challenges of asymmetric mating - the influence of male and female size on the reproductive output of Acanthochondria cornuta (Chondracanthidae).

The reproductive strategy of Acanthochondria cornuta, a parasitic copepod with dwarf, hyperparasitic males, is described in detail. The potential impact of male parasitism on the reproductive output was evaluated by determining the size of each sex and the female's fecundity, egg size and total reproductive effort for each pair/trio throughout the four seasons of the year. Marked seasonal differences were observed in female size and reproductive output, suggesting two distinct generations, but no differences were observed for male size. No statistically significant correlations were observed between male size and any measure of reproductive effort, but females with larger males had lower fecundity. A trade-off between egg number and egg size was recorded. Overall, the reproductive effort in A. cornuta seems to be determined mostly by female size, and larger females do not hold smaller males.

A new designed π conjugated molecule for stable single walled carbon nanotube dispersion in aqueous medium.

A molecule with a π conjugated backbone built from aromatic thiophene and dialkoxyphenylene units and substituted imidazolium groups (TPO) is designed to obtain ultra-stable single walled carbon nanotube (SWCNT) dispersion in aqueous medium. The proposed mechanism of non-covalent interaction is accompanied by individualization of SWCNT and comprises of dominant nondisruptive π-π and cation-π interaction between them and the TPO conjugated oligomer. The individualization of SWCNT and dispersibility and stability of the ultra-stable suspensions were estimated using high resolution transmission electron microscopy, UV-Visible-NIR absorption spectroscopy, Raman spectroscopy, photoluminescence and zeta potential measurement. Nuclear magnetic resonance data provides direct evidence toward possible cation-π interaction.

Validation of the Geriatric Oral Health Assessment Index in complete denture wearers.

To perform a validation of the Geriatric Oral Health Assessment Index (GOHAI) for complete denture wearers and present a proposal for estimation of perceived oral health. This is a cross-sectional study with non-probabilistic sampling. A total of 211 subjects with a mean age of 62·5 (s.d. = 11·4) years participated, being 169 female. The GOHAI was applied in a personal interview. The construct/convergent/discriminant validity was tested using structural equation modelling. Confirmatory factor analysis was used to verify the fit of three proposals of the GOHAI: three-factor, one-factor and second-order hierarchical models. The stability of the models was evaluated in independent samples. The three-factor model presented an inadequate fit, and items 3, 4 and 9 were removed. The new structure presented an acceptable fit and strong invariance in independent samples. The convergent, discriminant validity and internal consistency were below adequate. The one-factor model presented an adequate fit to the sample. Convergent validity was compromised. A strong invariance of the one-factor model was observed. To calculate the overall scores of the GOHAI factors (three-factor model) or of the oral health perception (one-factor model), a matrix of regression weights for each item in the model was presented as a suggestion. We found an adequate fit of the both structures of the GOHAI for denture wearers, but the three-factor structure was more parsimonious. We suggested considering the weights of the regression model to calculate the overall score of perceived oral health or of its factors in different samples.

Efeitos de uma intervenção analítico-comportamental com casal de namorados / Effects of a behavior analytic intervention with lovers

Estudar o relacionamento conjugal e a avaliação da efetividade de intervenções com casais pode promover as habilidades de comunicação, afeto e resolução de problemas. Pesquisas com casais de namorados na literatura são incipientes e acredita-se que ampliar tais comportamentos pode ajudar esses casais. O presente estudo de caso avalia uma intervenção (quatro sessões de avaliação e dez sessões de grupo) com um casal de namorados num delineamento de sujeito único, considerando medidas de linha de base, pré-teste, pós-teste e seguimento, combinado com medidas processuais de expectativa e satisfação com o procedimento conduzido. Os resultados demonstram satisfação com o tratamento, generalização para outros relacionamentos e melhoria do relacionamento em comunicação, afeto e resolução de problemas. Discute-se implicações para a prevenção e futuras pesquisas

The study of the marital relationship and of the evaluation of the effectiveness of interventions with couples can promote communication skills, affection and problem solving. Researches with dating couples are incipient on the literature, and it is believed that extending such behaviors can help those couples. The present case study evaluates an intervention (four evaluation sessions and ten sessions of group) with dating couples, in the design of a single subject, considering measures baseline, pretest, posttest and follow-up, combined with procedural measures of expectation and satisfaction with the procedure conducted. The results show satisfaction with treatment, generalization to other relationships and improvement of the relationship as communication, affection and problem solving. Implications are discussed for future prevention and researches

Efeitos de uma intervenção analítico-comportamental com casal de namorados / Effects of a behavior analytic intervention with lovers

Estudar o relacionamento conjugal e a avaliação da efetividade de intervenções com casais pode promover as habilidades de comunicação, afeto e resolução de problemas. Pesquisas com casais de namorados na literatura são incipientes e acredita-se que ampliar tais comportamentos pode ajudar esses casais. O presente estudo de caso avalia uma intervenção (quatro sessões de avaliação e dez sessões de grupo) com um casal de namorados num delineamento de sujeito único, considerando medidas de linha de base, pré-teste, pós-teste e seguimento, combinado com medidas processuais de expectativa e satisfação com o procedimento conduzido. Os resultados demonstram satisfação com o tratamento, generalização para outros relacionamentos e melhoria do relacionamento em comunicação, afeto e resolução de problemas. Discute-se implicações para a prevenção e futuras pesquisas (AU)

Cierre parcial del ductus arterioso intraútero asociado a consumo materno de flavonoides / Partial closure of the intrauterine arteriosus ductus resulting from a maternal consumption of flavonoids

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Effects of TachoSil and 5-fluorouracil on colonic anastomotic healing.

BACKGROUND: The administration of intraperitoneal (IP) 5-fluorouracil (5-FU) during the early postoperative period after cytoreductive surgery can decrease local cancer recurrence but may also cause impairment of the anastomotic healing. This study examined the effects of the use of this therapy and of the anastomotic sealing with TachoSil, a fibrin-thrombin coated sealant (FTCS), on the healing of colon anastomoses. MATERIALS AND METHODS: Forty male rats were divided into four groups (1-4, 10 rats each) that underwent transection and anastomosis of the left colon. The anastomoses were covered with FTCS in groups 2 and 4. Saline solution (2 mL/d-groups 1 and 2) or 5-FU (20 mg/kg/d; groups 3 and 4) was administered IP once daily for 3 d. Bursting pressure (BP) was recorded, and the anastomoses were examined macroscopically and graded histologically. RESULTS: The relative weight loss was significantly higher in group 3 than in the other groups (P = 0.0004). Anastomotic dehiscence, postoperative adhesion formation, perianastomotic collections, and preanastomotic dilatation did not differ significantly among groups. BP was significantly lower in group 3 compared with all other groups (P = 0.001). Neoangiogenesis was significantly lower in group 3 compared with groups 1 and 2 (P = 0.05). Fibroblastic activity was significantly higher in group 1 compared with group 3 (P = 0.035). Inflammatory cell infiltration and collagen deposition did not differ significantly among groups. CONCLUSIONS: Our results shown that the early postoperative IP chemotherapy with 5-FU impaired the healing of colon anastomoses. However, anastomotic sealing with FTCS reversed some of the negative effects of this therapy.

The effects of unrelated offspring whistle calls on capybaras (Hydrochoerus hydrochaeris).

Parent-offspring vocal communication, such as the isolation call, is one of the essential adaptations in mammals that adjust parental responsiveness. Thus, our aim was to test the hypothesis that the function of the capybara infants' whistle is to attract conspecifics. We designed a playback experiment to investigate the reaction of 20 adult capybaras (seven males and 13 females) to pups' whistle calls - recorded from unrelated offspring - or to bird song, as control. The adult capybaras promptly responded to playback of unrelated pup whistles, while ignoring the bird vocalisation. The adult capybaras took, on average, 2.6 ± 2.5 seconds (s) to show a response to the whistles, with no differences between males and females. However, females look longer (17.0 ± 12.9 s) than males (3.0 ± 7.2 s) toward the sound source when playing the pups' whistle playback. The females also tended to approach the playback source, while males showed just a momentary interruption of ongoing behaviour (feeding). Our results suggest that capybara pups' whistles function as the isolation call in this species, but gender influences the intensity of the response.