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1.
Artigo em Inglês | MEDLINE | ID: mdl-32019734

RESUMO

BACKGROUND: Few data are available on the 20-year outcomes of anterior cruciate ligament (ACL) reconstruction. The purpose of this study was to assess the prevalence and risk factors of knee osteoarthritis at least 20 years after ACL reconstruction. HYPOTHESIS: Factors associated with progression to knee osteoarthritis include meniscal lesions, level of physical activity, injury-to-surgery time, body mass index, residual laxity, tunnel position and cartilage injury. MATERIAL AND METHODS: One hundred and eighty two patients were included in a multicentre retrospective study conducted in the setting of a SoFCOT symposium. Females contributed two-thirds of the study population. ACL reconstruction was performed arthroscopically in 82% of cases, and a bone-patellar tendon-bone transplant was used in 92.8% of cases. Mean age at surgery was 26±7years. Clinical outcomes were assessed based on the objective and subjective IKDC scores and on the KOOS. Radiographic evidence of osteoarthritis was classified according to the IKDC. Factors evaluated for their ability to predict progression to osteoarthritis included age, sex, body mass index, level of physical activity, injury-to-surgery time, meniscectomy, cartilage injury, tunnel position and residual laxity. RESULTS: At last follow-up, the objective IKDC score was A (normal) for 48%, B for 35%, and C or D for 17% of the knees. The mean subjective IKDC score was 82.7±13.1. Moderate-to-severe osteoarthritis was present in 29% of cases. The following risk factors for osteoarthritis were identified: medial or lateral meniscectomy, residual laxity, age >30years at surgery, and engaging in a pivoting sport. Meniscectomy was a major contributor to the development of osteoarthritis (17% of knees without vs. 46% with meniscectomy). Finally, the ACL re-tear rate was 13%. CONCLUSION: ACL reconstruction provides satisfactory knee stability. The risk of subsequent osteoarthritis depends chiefly on the status of the menisci. Residual laxity is also associated with the development of osteoarthritis. LEVEL OF EVIDENCE: IV, retrospective cohort study.

2.
Arthritis Res Ther ; 22(1): 5, 2020 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-31915059

RESUMO

OBJECTIVE: To describe successful therapeutic strategies in statin-induced anti-HMGCR myopathy. METHODS: Retrospective data from a cohort of 55 patients with statin-induced anti-HMGCR myopathy, sequentially stratified by the presence of proximal weakness, early remission, and corticosteroid and IVIG use at treatment induction, were analyzed for optimal successful induction and maintenance of remission strategies. RESULTS: A total of 14 patients achieved remission with a corticosteroid-free induction strategy (25%). In 41 patients treated with corticosteroids, only 4 patients (10%) failed an initial triple steroid/IVIG/steroid-sparing immunosuppressant (SSI) induction strategy. Delay in treatment initiation was independently associated with lower odds of successful maintenance with immunosuppressant monotherapy (OR 0.92, 95% CI 0.85 to 0.97, P = 0.015). While 22 patients (40%) presented with normal strength, only 9 had normal strength at initiation of treatment. CONCLUSION: While corticosteroid-free treatment of anti-HMGCR myopathy is now a safe option in selected cases, initial triple steroid/IVIG/SSI was very efficacious in induction. Delays in treatment initiation and, as a corollary, delays in achieving remission decrease the odds of achieving successful maintenance with an SSI alone. Avoiding such delays, most notably in patients with normal strength, may reset the natural history of anti-HMGCR myopathy from a refractory entity to a treatable disease.

3.
ChemistryOpen ; 8(11): 1328-1336, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31692837

RESUMO

The halogen bond has previously been explored as a versatile tool in crystal engineering and anion coordination chemistry, with mechanochemical synthetic techniques having been shown to provide convenient routes towards cocrystals. In an effort to expand our knowledge on the role of halogen bonding in anion coordination, here we explore a series of cocrystals formed between 3-iodoethynylpyridine and 3-iodoethynylbenzoic acid with halide salts. In total, we report the single-crystal X-ray structures of six new cocrystals prepared by mechanochemical ball milling, with all structures exhibiting C≡C-I⋅⋅⋅X- (X=Cl, Br) halogen bonds. Whereas cocrystals featuring a pyridine group favoured the formation of discrete entities, cocrystals featuring a benzoic acid group yielded an alternation of halogen and hydrogen bonds. The compounds studied herein were further characterized by 13C and 31P solid-state nuclear magnetic resonance, with the chemical shifts offering a clear and convenient method of identifying the occurrence of halogen bonding, using the crude product obtained directly from the mechanochemical ball milling. Whereas the 31P chemical shifts were quickly able to identify the occurrence of cocrystallization, 13C solid-state NMR was diagnostic of both the occurrence of halogen bonding and of hydrogen bonding.

4.
ChemistryOpen ; 8(11): 1327, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31692897

RESUMO

Invited for this month's cover picture is the group of Professor David Bryce at the University of Ottawa. The cover picture shows a stylized depiction of the mechanochemical halogen-bond induced cocrystallization of 3-iodoethynylpyridine with tetraphenylphosphonium bromide. Read the full text of their Full Paper at 10.1002/open.201900194.

5.
Am J Sports Med ; 46(12): 2842-2850, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30199646

RESUMO

BACKGROUND: Anterior cruciate ligament (ACL) reconstruction is important to prevent knee osteoarthritis. Neither of the 2 most common graft techniques-the patellar tendon (PT) or hamstring tendon (HS) graft-has demonstrated superiority in terms of the long-term osteoarthritis rate. HYPOTHESIS: Based on the International Knee Documentation Committee (IKDC) radiographic grading system, PT grafts decrease the incidence of osteoarthritis by providing better knee stability as compared with HS grafts over 12 years of follow-up. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: All adults with a first ACL rupture who underwent surgery with a PT or HS graft technique between January 2002 and December 2003 were included in the 2014 French Society of Orthopedic Surgery and Traumatology Symposium database. Baseline characteristics were collected. The primary endpoint was the occurrence of moderate to severe osteoarthritis in each group. The secondary endpoints included clinical subjective evaluations by the IKDC score and Knee injury and Osteoarthritis Outcome Score. To control the differences in baseline characteristics, the data were analyzed with propensity score matching. RESULTS: In the cohort, 541 patients from 18 centers were included: 311 PT and 230 HS ACL reconstructions. The baseline characteristics were similar after inverse probability weighting treatment (IPWT). The occurrence of osteoarthritis was similar after IPWT (19.3% for PT and 19.6% for HS, P = .94). Age at surgery >29 years and IKDC osteoarthritis stage B at the index surgery were identified as risk factors for moderate to severe osteoarthritis. Most functional outcomes were significantly higher in the HS group; however, the difference between groups remained <10 points. Of the 106 patients who needed a medial meniscectomy, the proportion of patients with moderate to severe osteoarthritis was much higher in the HS group (43.5% vs 18.3%, P = .006). However, after IPWT, the difference was not statistically significant. CONCLUSION: At 12 years of follow-up, neither graft technique was superior to the other in terms of the rate of osteoarthritis.


Assuntos
Reconstrução do Ligamento Cruzado Anterior/métodos , Tendões dos Músculos Isquiotibiais/transplante , Osteoartrite do Joelho/etiologia , Ligamento Patelar/transplante , Adulto , Reconstrução do Ligamento Cruzado Anterior/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/cirurgia , Adulto Jovem
6.
Knee Surg Sports Traumatol Arthrosc ; 26(6): 1838-1844, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28251263

RESUMO

PURPOSE: High tibial osteotomy (HTO) is used to treat young and active patients with knee osteoarthritis (OA) and varus deformity. The medial compartment OA alters the patients' gait. METHODS: A prospective study was carried out in 21 consecutive patients operated for HTO due to knee OA with varus deformity. There were 14 men and 7 women, with a median age of 51.9 years (38-64). Their gait was analyzed preoperatively and at 1 year postoperatively, and compared to a healthy control group. Clinical assessment (KOOS, WOMAC, Lysholm, and SF-36 scores) was also performed preoperatively and postoperatively. RESULTS: Patients with medial compartment OA had altered gait relative to the control population. Their walking speed was slower, step length was shorter, and single-leg stance time was shorter, while the double-leg stance time was longer (P < 0.001). Step width was not different between the two groups preoperatively (n.s.), but it was wider in the patient group postoperatively (P = 0.003). There were no differences in the patients' gait parameters before and after the osteotomy (n.s.). However, there was an improved perception of walking so that it is no longer different from controls (n.s.). The KOOS, WOMAC, Lysholm and SF-36 scores improved after HTO. The preoperative median of 7° varus (1-11) was corrected to 3° valgus (0-6). CONCLUSION: Medial compartment OA with varus deformity leads to gait modifications. HTO does not alter the time-distance parameters of gait; however, patients have improved perception of their walking ability. HTO leads to excellent results for knee function, and improves quality of life without modifying the gait pattern. LEVEL OF EVIDENCE: II.


Assuntos
Marcha/fisiologia , Genu Varum/cirurgia , Articulação do Joelho/fisiopatologia , Osteoartrite do Joelho/fisiopatologia , Osteotomia/métodos , Tíbia/cirurgia , Adulto , Feminino , Genu Varum/fisiopatologia , Humanos , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/cirurgia , Estudos Prospectivos , Qualidade de Vida
7.
Int Orthop ; 42(6): 1233-1239, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-28699021

RESUMO

PURPOSE: Cysts of the proximal tibiofibular articulation are rare and their optimal treatment remains unclear. The objective of this study was to evaluate the results and complications of the treatment of synovial ganglion cysts of the proximal tibiofibular articulation by simple excision or by excision and fusion of the proximal tibiofibular joint with a limited fibula excision. METHODS: Between January 2005 and December 2016, seven male patients with an average age of 46 years were treated for a ganglion cyst of the proximal tibiofibular articulation. Nine procedures were performed in total. Four patients underwent primary cyst excision, two underwent revision cyst excision and three underwent revision cyst excision with arthrodesis of the proximal tibiofibular joint and partial excision of the fibula (two patients underwent two procedures). RESULTS: Average follow-up was 79 months. The recurrence rate was 25% for simple cyst excision, 100% for revision cyst excision and 0% for cyst excision with arthrodesis. Average kitaoka score was 98 for simple cyst excision and 100 for cyst excision with arthrodesis (P = 0.34); resting visual analogue scores (VAS) were zero in both groups. With activity VAS was 0 for simple cyst excision and 1.6 in the arthrodesis group (P = 0.33). Two of the three arthrodesis patients went on to successful fusion. The third patient has an asymptomatic pseudarthrosis. CONCLUSION: Simple primary cyst excision has a high failure rate at 25%. Revision cyst excision without fusion failed in all cases. We therefore recommend arthrodesis with limited fibula excision.


Assuntos
Artrodese/métodos , Fíbula/cirurgia , Cistos Glanglionares/cirurgia , Articulação do Joelho/patologia , Adulto , Artrodese/efeitos adversos , Estudos de Coortes , Humanos , Articulação do Joelho/cirurgia , Estudos Longitudinais , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Recidiva , Reoperação/estatística & dados numéricos , Resultado do Tratamento , Escala Visual Analógica
8.
Int Orthop ; 42(4): 799-804, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-28831536

RESUMO

PURPOSE: The aim of this study was to analyse the clinical and radiographic results of 208 e-Motion® posterior cruciate-retaining, mobile bearing prostheses (BBraun-Aesculap, Tuttlingen, Germany) fitted using computer navigation, for knee osteoarthritis with a genu varum greater than 10°. METHODS: One hundred ninety-two patients were operated on with 208 e-Motion® prostheses fitted, between January 2006 and December 2011, using the OrthoPilot® computer navigation system. Average pre-operative IKS score was 70 ± 27 points (6-143) with a function score of 38 ± 20.5 (0-90) and a knee score of 32.5 ± 13 (0-63). Average flexion was 116.5° ± 13° (65-140°). Average pre-operative HKA angle was 166° ± 3° (154-169°). RESULTS: 2Results are available for 134 patients, with a total of 150 knees operated on (38 lost to follow-up and 20 deceased). Average follow-up was 104.5 months (60-116 months). On last follow-up, the average IKS was 180 ± 22 points (95-200) with 86.5 ± 16 points (25-100) for the function score and 93.5 ± 8 points (55-100) for the knee score. Knee flexion was 116° ± 10.5° (80-135°) and average HKA angle was 179° ± 2° (175-184°). The pre-operative objective was achieved in 90.5% of knees. CONCLUSION: The e-Motion® mobile bearing posterior cruciate-retaining prosthesis, fitted using computer navigation, offers excellent results after an average of 8.5 years follow-up. These results are at least equivalent, even superior, to those of the posterior-stabilised prostheses usually used for this type of deformity.


Assuntos
Artroplastia do Joelho/métodos , Genu Varum/cirurgia , Prótese do Joelho/efeitos adversos , Osteoartrite do Joelho/cirurgia , Cirurgia Assistida por Computador/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Joelho/instrumentação , Feminino , Seguimentos , Humanos , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Falha de Prótese , Amplitude de Movimento Articular , Resultado do Tratamento
9.
Oncotarget ; 8(25): 40152-40168, 2017 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-27374179

RESUMO

PARP inhibitors (PARPi), such as Olaparib, have shown promising results in high-grade serous (HGS) epithelial ovarian cancer (EOC) treatment. PARPi sensitivity has been mainly associated with homologous recombination (HR) deficiency, but clinical trials have shown that predicting actual patient response is complex. Here, we investigated gene expression microarray, HR functionality and Olaparib sensitivity of 18 different HGS EOC cell lines and demonstrate that PARPi sensitivity is not only associated with HR defects. Gene target validation show that down regulation of genes in the nucleotide excision repair (NER) and mismatch repair (MMR) pathways (ERCC8 and MLH1, respectively) increases PARPi response. The highest sensitivity was observed when genes in both the HR and either NER or MMR pathways were concomitantly down regulated. Using clinical samples, patients with these concurrent down regulations could be identified. Based on these results, a novel model to predict PARPi sensitivity is herein proposed. This model implies that the extreme responders identified in clinical trials have deficiencies in HR and either NER or MMR.


Assuntos
Reparo do DNA/genética , Regulação Neoplásica da Expressão Gênica/efeitos dos fármacos , Ftalazinas/farmacologia , Piperazinas/farmacologia , Transdução de Sinais/efeitos dos fármacos , Carcinoma Epitelial do Ovário , Linhagem Celular Tumoral , Feminino , Perfilação da Expressão Gênica/métodos , Humanos , Gradação de Tumores , Neoplasias Epiteliais e Glandulares/genética , Neoplasias Epiteliais e Glandulares/metabolismo , Neoplasias Epiteliais e Glandulares/patologia , Neoplasias Ovarianas/genética , Neoplasias Ovarianas/metabolismo , Neoplasias Ovarianas/patologia , Inibidores de Poli(ADP-Ribose) Polimerases/farmacologia , Interferência de RNA , Transdução de Sinais/genética
10.
Injury ; 47(6): 1282-7, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27037028

RESUMO

PURPOSE: Over the past 10 years, like many authors, we observed an increasing number of Moore I tibial plateau fractures related to alpine skiing for which the surgeon may face difficult choices regarding surgical approach and fixation means. Some authors have recently been suggesting a posterior approach associated to open reduction and osteosynthesis by a buttress plate. But in our knowledge there is no specific study on sports activity recovery after Moore I tibial fractures. The aim of this work was to assess sports activities and clinical outcomes after surgically treated Moore I tibial plateau fractures in an athletic population of skiers. METHODS: We conducted a prospective case series between 2012 and 2014. This included fifteen patients aged 39.6±7 years whom presented with a Moore I tibial plateau fracture during a skiing accident. 12 cases (80%) presented with an associated tibial spine fracture. Treatment consisted of a standard antero-medial approach, with a medial para patellar arthrotomy to allow direct visualisation of articular reduction and spinal fixation. Two or three 6.5mm long cancellous bone screws were placed antero-posteriorly so as to ensure perfect compression of the fracture site. Radiological and functional results were assessed by an independent observer (Lysholm-Tegner, UCLA, KOOS scores) at the longest follow-up. RESULTS: Mean follow-up was 18.2±6 months (12-28). An immediate postoperative anatomical reduction was achieved in all cases and remained stable in time. At last follow-up Lysholm mean score was 85±14 points (59-100), UCLA score was 7.3±1.6 (4-10) and Tegner score was 4.6±1.3 (3-6). Mean KOOS score was 77±15 (54-97). 87% of patients had resumed their skiing activity and 93% were satisfied or very satisfied from their post-operative surgical outcome. We observed no pseudarthrosis or secondary varus displacement. CONCLUSION: In our series 87% of patients had resumed back to their sporting activities. Surgical management of Moore I tibial plateau fractures by isolated antero-posterior screwing provides excellent clinical and radiological results. The anteromedial incision has a dual advantage of anatomical reduction, tibial spine fixation (in 80% of our cases) and posteromedial fragment reduction.


Assuntos
Fixação Interna de Fraturas/métodos , Fraturas Intra-Articulares/cirurgia , Luxações Articulares/cirurgia , Traumatismos do Joelho/cirurgia , Radiografia , Volta ao Esporte/estatística & dados numéricos , Esqui/lesões , Fraturas da Tíbia/cirurgia , Adulto , Placas Ósseas , Feminino , Seguimentos , Consolidação da Fratura , Humanos , Fraturas Intra-Articulares/diagnóstico por imagem , Fraturas Intra-Articulares/fisiopatologia , Traumatismos do Joelho/diagnóstico por imagem , Traumatismos do Joelho/fisiopatologia , Masculino , Estudos Prospectivos , Recuperação de Função Fisiológica , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/fisiopatologia , Resultado do Tratamento
11.
Artigo em Inglês | MEDLINE | ID: mdl-19875315

RESUMO

OBJECTIVES: This in vivo study was aimed at quantifying the electronic no-function rate of 2 electronic apex locators, ApexPointer and Novapex, and evaluating whether their operation is affected by the type of applied treatment, patient's age, and the type of tooth. STUDY DESIGN: A total of 209 root canals were included in this study. For each canal, the electronic length was determined and verified by radiography. Whenever the electronic device failed to provide a value, it was recorded as an electronic no-function. Experimental data were statistically tested with chi-squared through Statview. RESULTS: For both apex locators, the no-function rate remained around 15% and did not seem to be affected by the age of patients. A statistically significant relationship was found between no-function rate and retreatment (P < .05). The type of tooth had no influence on the no-function rate. CONCLUSIONS: Under the conditions of this assessment in vivo, the 2 apex locators proved to give no value in about 15% of the cases. Further investigations are necessary to clear up the links between no-function and retreatment or age.


Assuntos
Cavidade Pulpar/anatomia & histologia , Análise de Falha de Equipamento/métodos , Tratamento do Canal Radicular/instrumentação , Ápice Dentário/anatomia & histologia , Adolescente , Adulto , Idoso , Criança , Cavidade Pulpar/diagnóstico por imagem , Falha de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Odontometria/instrumentação , Radiografia , Reprodutibilidade dos Testes , Ápice Dentário/diagnóstico por imagem , Adulto Jovem
12.
Eur Urol ; 51(4): 980-7, 2007 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-17092632

RESUMO

OBJECTIVES: Renal cell carcinoma (RCC) is uncommon in young adults. Based on the few studies published to date, it is difficult to determine whether this tumour has a particular progression pattern. This retrospective, multicentre study analysed RCC in young patients, defined as

Assuntos
Carcinoma de Células Renais/mortalidade , Neoplasias Renais/mortalidade , Adulto , Fatores Etários , Carcinoma de Células Renais/diagnóstico , Feminino , Humanos , Neoplasias Renais/diagnóstico , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida
13.
J Phys Chem B ; 110(37): 18401-7, 2006 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-16970464

RESUMO

A new multi-scale experimental approach is proposed to continuously relate the microstructure and the macroscopic mechanical properties of plaster pastes during their settings. (1)H NMR relaxometry is used to follow continuously and not destructively, the degree of hydration and the microstructure evolution during the setting and hardening of plaster paste. Transmission of shear and compressional ultrasonic velocities enable the determination of macroscopic mechanical properties of the material during the setting. On the basis of similar behaviors of Young's modulus and NMR-population of confined water as function of the degree of hydration, we conclude that NMR gives a better understanding of the evolution of the microstructure at the origin of a better control of the macroscopic mechanical properties.

14.
J Phys Chem B ; 110(14): 7385-91, 2006 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-16599514

RESUMO

We report a comprehensive proton NMR relaxation study of the water confined in the evolving porous structure of hardened gypsum prepared with different water-to-plaster ratios (w/p) and increasing additions of crushed gypsum. This study gives some new information on the microstructure, the water distribution, and the hydration kinetics without any drying or perturbing preparation. The bi-exponential transverse magnetization decay reveals the existence of two water populations in slow exchange. However, the different behaviors of these populations during saturation and desaturation experiments show evidence of a fast exchange of each population with the surface. Two modes of organization of the microstructure of this material are identified through an original model of exchange as a function of the water-to-plaster ratio (0.4 < or = w/p < or = 0.6 and 0.7 < or = w/p < or = 1). A clear gap is shown in the exchange rate value above w/p = 0.6 that could be representative of a percolation threshold. Both the method and the theory presented can be applied more widely to other porous media with reactive surface areas.

15.
J Pain ; 6(12): 791-7, 2005 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-16326367

RESUMO

UNLABELLED: The aim of this randomized crossover study was to evaluate the impact of environmental and behavioral interventions (EBI) on behavioral, physiologic, and biologic stress response during a weighing procedure in neonates. Three groups of 15 neonates included (A) gestational age (GA), < or =32 weeks; (B) GA, 32 weeks, 1 day to 36 weeks, 6 days; and (C) GA, > or =37 weeks. Each neonate experienced 2 weighing procedures with and without EBI. Pain was evaluated by using the Neonatal Infant Pain Scale (NIPS) and the Neonatal Pain and Discomfort Scale (EDIN). Heart rate and oxygen saturation were recorded. Salivary samples were obtained for cortisol assay. Cerebral tissue oxygenation index (TOI) was recorded with near-infrared spectroscopy. A significant decrease of NIPS and EDIN was observed with EBI versus control. Mean heart rate was lower with EBI. No difference in cortisol level changes was observed. For groups A and B, a trend of increased TOI was observed with EBI. We concluded that EBI during a nursing procedure provides a decrease in pain scores in preterm and term neonates with changes in heart rate. PERSPECTIVE: This study evaluates the impact of combined environmental and behavioral interventions on pain responses in neonates during a weighing procedure. The results indicate a decrease in behavioral pain scores and in heart rate for preterm and term neonates and a trend in increased brain oxygenation depending on gestational age.


Assuntos
Terapia Comportamental/métodos , Ambiente Controlado , Neonatologia/métodos , Dor/prevenção & controle , Estresse Psicológico/prevenção & controle , Fatores Etários , Envelhecimento/fisiologia , Encéfalo/crescimento & desenvolvimento , Encéfalo/metabolismo , Estudos Cross-Over , Feminino , Frequência Cardíaca/fisiologia , Humanos , Hidrocortisona/metabolismo , Recém-Nascido , Masculino , Enfermagem/métodos , Consumo de Oxigênio/fisiologia , Dor/metabolismo , Dor/fisiopatologia , Medição da Dor , Limiar da Dor/fisiologia , Estresse Psicológico/metabolismo , Estresse Psicológico/fisiopatologia , Resultado do Tratamento
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