Artificial Control of the Lower Urinary Tract by Sacral Root Stimulation

Micturition disorders are humiliating disabilities which cause major clinical, social and financial problem for a substantial part of the population. In many cases it lacks any adequate conventional solution. The clinical application of the anterior sacral root stimulation introduced by Brindley and his co-workers (1992) has been one of the most successful application of functional electrical stimulation to control the lower urinary tract. It has been used in several countries world-wide to control micturition. However, its more widespread acceptance is limited by the unsuitable recruitment characteristics of bipolar stimulating electrodes. Normal micturition requires co-ordinated bladder contraction and sphincter relaxation. The sacral roots contain large somatic motor fibres supplying the skeletal muscle of the external sphincter mixed in with small autonomic motor fibres supplying the bladder. During sacral root stimulation the larger fibres are activated more easily than the smaller ones and so, the external urethral sphincter contracts and close before the bladder is activated, making normal voiding difficult. The solution would be reverse that recruitment selection and allows bladder contraction with a relaxed sphincter. This research tests a tripolar stimulation strategy which is thought to be able to activate selectively small autonomic motors axons whilst blocking excitation in larger ones. This approach is based on initial mathematical modelling studies (Fitzpatrick, 1991). The construction of a tripolar electrode and the choice of stimulation current intensities and ratios were guided by the model predictions. The simulation results of the modelled tripolar electrode predict that the generation and propagation of action potentials in the larger axons can be anodally blocked at one end of the cuff electrode, called the blocking anode. Also, a second prediction is that is possible to regulate the intensity of the anodal current at the other side of the cuff electrode, called escape anode, in order to provide the selective blocking of the larger axons whilst allowing for the escape of action potentials in the smaller fibres. Two series of experiments were carried out to test the model predictions. The first series of experiments were developed to test the electrode and stimulation parameters, and if it is possible to achieve an anodal block at the blocking anode. Experiments performed in isolated rabbit sciatic nerve trunks, showed that the propagation of action potentials in all axons can be blocked at one end of the cuff, while unidirectional propagation of action potential still could be achieved at the escape end with tripolar stimulation. Generally, more current was needed to produce a block during the experiments than expected from the model, which can be explained because physiological circumstances during the experiments were not calculated. Block was achieved more frequently at an anodal ratio of 9:1 and trains of pulse of 0.3msec duration, confirming the model predictions. The second series of experiments were developed to test if it is possible to regulate the intensity of the anodal current at the escape anode, in order to provide the selective blocking of the larger axons whilst allowing for the escape of action potentials in the smaller fibres. Unilateral ventral sacral root stimulation was performed on adult males New Zealand white rabbits which were deeply anaesthetised with a mixture of 1-3% halothane in nitrous oxide and oxygen. Trains of pulse of 0.3msec duration lasting up to 2sec at 20Hz were delivered. Simultaneous recording of bladder and urethral pressures were made by conventional urodynamic methods. The root which produced the stronger bladder/urethral sphincter response was used throughout the experiment. The responses to stimulation of bladder, external urethral sphincter and coccygeal (skeletal) muscle, which is activated by stimulation of the same root, were compared during bipolar and tripolar stimulation. No spontaneous activity was recorded in the bladder or urethral sphincter when the animal was deeply anaesthetised. It was possible to produce activity in the lower urinary tract in 27 experiments. Average bladder pressures of 30cm H2O was developed during stimulation. Using bipolar stimulation, the lowest threshold currents were always associated with skeletomotor axons supplying muscles in the hip and in the base of the tail. Further increase in stimulus intensity recruited axons supplying the external urethral sphincter and the highest thresholds were associated with the parasympathetic axons supplying the bladder. These results confirmed the expected recruitment characteristics during conventional stimulation and were highly significant (p<0.0001). (Abstract shortened by ProQuest.)

A influência do líder na formação de equipe de alta performance: uma revisão bibliográfica

The aim was to know the main theoretical concepts about high performance teams and to analyze the role of the leader as a builder and evaluator of performance. It is based on the bibliographic method, it will show that, although the relevance of the leader is indisputable, there is no leadership model that is so much more efficient than another, but rather that the effectiveness of the leader's style depends on the stimulus used, the situation presented. , with which team profiles and in which environment. Due to business competitiveness, the formation of high performance teams and a leader capable of developing it gains prominence in the global scenario, in this way, it is essential to understand the advantages that these teams can provide to the organization, the leader and the team are essential to increase productivity, however, it is necessary that its members are committed to the goals, have a synergistic relationship and jointly apply their skills.Objetivou-se conhecer os principais conceitos teóricos sobre equipes de alta performance e analisar o papel do líder como construtor e avaliador de desempenho. Está fundamentado no método bibliográfico, vai mostrar que, embora seja indiscutível a relevância do líder, não existe um modelo de liderança que seja tão mais eficiente que outro, mas sim, que a eficácia do estilo do líder depende do estímulo utilizado, da situação apresentada, com quais perfis de equipes e em qual ambiente. Devido à competitividade empresarial, a formação de equipes de alta performance e um líder capaz de desenvolvê-la ganha destaque no cenário global, desta maneira, é fundamental compreender as vantagens que essas equipes podem proporcionar a organização, o líder e equipe são essenciais para aumentar a produtividade, porém, é necessário que seus integrantes sejam comprometidos com as metas, tenham um relacionamento sinérgico e apliquem conjuntamente suas competências

Qualidade de vida no trabalho da enfermagem: segurança, saúde e motivação

Nursing activities culminate in a final objective, which is the patient's health and recovery. Motivation for work will depend on health and safety in the environment, leading to levels of efficiency and commitment, which will result in quality of life, health safety and motivation in nursing work. This study aimed to analyze the production of knowledge about quality of life, safety, health and motivation in nursing work. A brief survey about publications in the form of articles, national and international periodical manuals, Internet, books, and magazines. A time limit between the years 2000 to 2018/2019 was considered.As atividades da enfermagem culminam num objetivo final que é a saúde e restabelecimento do paciente. A motivação para o trabalho vai depender da saúde e segurança no ambiente, acarretando níveis de eficiência e comprometimento, o que vem resultar na qualidade de vida, saúde segurança e motivação no trabalho da enfermagem. Esse estudo objetivou analisar a produção do conhecimento acerca da qualidade de vida, segurança, saúde e motivação no trabalho de enfermagem. Uma breve pesquisa a respeito das publicações na forma de artigos, manuais periódicos nacionais e internacionais, Internet, livros e revistas. Foi considerado um limite temporal entre os anos de 2000 a 2018/2019

Anticancer and anti-inflammatory activities of a standardized dichloromethane extract from piper umbellatum l. leaves

Despite the advances in anticancer drug discovery field, the worldwide cancer incidence is remarkable, highlighting the need for new therapies focusing on both cancer cell and its microenvironment. The tumor microenvironment offers multiple targets for cancer therapy, including inflammation. Nowadays, almost 75% of the anticancer agents used in chemotherapy are derived from natural products, and plants are an important source of new promising therapies. Continuing our research on Piper umbellatum species, here we describe the anticancer (in vitro antiproliferative activity and in vivo Ehrlich solid tumor model) and anti-inflammatory (carrageenan-induced paw edema and peritonitis models) activities of a standardized dichloromethane extract (SDE) from P. umbellatum leaves, containing 23.9% of 4-nerolidylcatechol. SDE showed in vitro and in vivo antiproliferative activity, reducing Ehrlich solid tumor growth by 38.7 and 52.2% when doses of 200 and 400 mg/kg, respectively, were administered daily by oral route. Daily treatments did not produce signals of toxicity. SDE also reduced paw edema and leukocyte migration on carrageenan-induced inflammation models, suggesting that the anticancer activity of SDE from Piper umbellatum leaves could involve antiproliferative and anti-inflammatory effects. These findings highlight P. umbellatum as a source of compounds against cancer and inflammation2015CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO - CNPQCOORDENAÇÃO DE APERFEIÇOAMENTO DE PESSOAL DE NÍVEL SUPERIOR - CAPES133897/2012-5sem informaçã

Perinatal characteristics and longer-term outcomes in Brazilian children with confirmed or suspected congenital Zika infection: ZIKAction Paediatric Registry

Background: Despite growing scientific knowledge of Zika virus (ZIKV) infection, questions remain regarding ZIKV infection in pregnancy and congenital ZIKV syndrome (CZS). Methods: The ZIKAction Paediatric Registry is an international registry of children with documented ZIKV exposure in utero and/or with confirmed or suspected CZS. Its aim is to characterize these children (i.e., clinical, radiological, neurodevelopmental features) and describe outcomes, longer-term sequelae and management through retrospective case note review. This analysis described the maternal and perinatal characteristics of children in the Registry’s Bahia arm, assessed their neuroimaging, ophthalmic, hearing and electroencephalography abnormalities by microcephaly classification and reported on hospitalisations. Children born in 2015-2018 and enrolled 2020-2021 in three public health facilities in Salvador were included. Results: Of 129 (57% female) children, 15 (11·6%) had laboratory-confirmed congenital ZIKV infection and 114 (88·4%) suspected CZS. At delivery, 15 (11·6%) were normocephalic, 30 (23·3%) moderately microcephalic, and 84 (65·1%) severely microcephalic. Median birth head circumference z-score was -3·51 [IQR, -4·69,-2·73]. During follow-up, all children had abnormal neuroimaging, 80·3% (94/117) abnormal electroencephalogram, 62·2% (77/120) ophthalmic abnormalities, and 27·4% (34/124) hearing impairment. Microcephaly classification was significantly associated with gestational age, and ophthalmological and electroencephalography abnormalities. Of 125 children with hospitalisation data, 52 (41·6%) had been hospitalised by most recent follow-up, at median age of 15·8 [4·0, 34·4] months; infections were the leading cause. Conclusion: Congenital ZIKV infection is an emerging disease with a varied and incompletely understood spectrum. Continued long-term follow-up is essential to understand longer-term prognosis and to inform future health and educational needs

Combating Malnutrition Among Pregnant Women, Mothers and Babies in the Rural Amazonian Forest: What can Telehealth Do?

Purpose: Malnutrition is a current public health problem and a leading cause of childhood morbidity and mortality among the indigenous population in the Amazon forest. This may be related to the nutritional transition observed among indigenous women in Brazil. This research aims to empower health professionals to promote food and nutritional education for mothers and babies living in the forest of the Brazilian state of Amazonas and its Colombian border. We describe our experience using telehealth to combat malnutrition among pregnant women, mothers and babies in the rural Amazonian forest. Methods: This is a qualitative study that included three interventions: field visits, a scoping review, and online meetings. Data collect from field visits and the scoping review were used to identify demands and incorporate themes discussed in the virtual meetings held at telehealth units. Sessions used the web conferencing platform of the state of Amazonas and were facilitated by Brazilian specialists. Locations were selected according to existence of telehealth site. Results and Conclusions: Seven telehealth sessions were held between April and December in 2018 and three in 2019, including 14 different locations equipped with telehealth points, and lasted 120 minutes each. The main findings were that telehealth services can be an instrument to establish a knowledge exchange between health professionals and indigenous people. The participation of indigenous people in social media could be an instrument to maintain their culture and to promote their healthcare, especially traditional and healthy dietary patterns

Inhibitors of the 5-lipoxygenase arachidonic acid pathway induce ATP release and ATP-dependent organic cation transport in macrophages

AbstractWe have previously described that arachidonic acid (AA)-5-lipoxygenase (5-LO) metabolism inhibitors such as NDGA and MK886, inhibit cell death by apoptosis, but not by necrosis, induced by extracellular ATP (ATPe) binding to P2X7 receptors in macrophages. ATPe binding to P2X7 also induces large cationic and anionic organic molecules uptake in these cells, a process that involves at least two distinct transport mechanisms: one for cations and another for anions. Here we show that inhibitors of the AA-5-LO pathway do not inhibit P2X7 receptors, as judged by the maintenance of the ATPe-induced uptake of fluorescent anionic dyes. In addition, we describe two new transport phenomena induced by these inhibitors in macrophages: a cation-selective uptake of fluorescent dyes and the release of ATP. The cation uptake requires secreted ATPe, but, differently from the P2X7/ATPe-induced phenomena, it is also present in macrophages derived from mice deficient in the P2X7 gene. Inhibitors of phospholipase A2 and of the AA-cyclooxygenase pathway did not induce the cation uptake. The uptake of non-organic cations was investigated by measuring the free intracellular Ca2+ concentration ([Ca2+]i) by Fura-2 fluorescence. NDGA, but not MK886, induced an increase in [Ca2+]i. Chelating Ca2+ ions in the extracellular medium suppressed the intracellular Ca2+ signal without interfering in the uptake of cationic dyes. We conclude that inhibitors of the AA-5-LO pathway do not block P2X7 receptors, trigger the release of ATP, and induce an ATP-dependent uptake of organic cations by a Ca2+- and P2X7-independent transport mechanism in macrophages

description of the methodological approach

publishersversionpublishe

NÍVEL DE SOBRECARGA E QUALIDADE DE VIDA DE CUIDADORES DE INDIVÍDUOS COM NECESSIDADES ESPECIAIS

O objetivo desse estudo foi verificar o nível de sobrecarga, a qualidade de vida e a presença de dor em cuidadores de indivíduos com necessidades especiais. Foram entrevistados 40 cuidadores (média de idade de 46,3 ± 13,35 anos) divididos em: Grupo de cuidadores de crianças e adolescentes (GCA) (n=18) e Grupo de cuidadores de adultos e idosos (GAI) (n=22). Na entrevista foram utilizados: questionário inicial para o perfil do cuidador, Questionário de Sobrecarga Burden Interview e Questionário Genérico de Qualidade de Vida SF-36. Foi verificado que 92,5% dos cuidadores eram mulheres, sendo prevalentes as mães dos indivíduos com necessidades especiais e que 50% da amostra dedicava-se em tempo integral aos cuidados. Foi verificada a presença de sobrecarga física e emocional de leve à moderada em ambos os grupos, além do acometimento da qualidade de vida, sendo que o GAI apresentou pontuações inferiores aos do GCA em todos os domínios