Study on the anti-inflammatory and analgesic pharmacodynamics of Zhonghua Dida Pill and its effect on inflammation in arthritis model rats / 国际中医中药杂志

Objective:To investigate the anti-inflammatory and analgesic effects of Zhonghua Dieda Pills; To preliminarily explore its mechanism on adjuvant arthritis model rats.Methods:Three inflammatory models and two pain models were used to investigate the anti-inflammatory and analgesic effects of Zhonghua Dieda Pills. After establishing the adjuvant arthritis rat model, the rats were divided into normal group, model group, dexamethasone group (0.8 mg/kg), and Zhonghua Dieda Pills (2.0, 1.0, 0.5 g/kg) groups according to random number table method. Each group was given corresponding drugs once a day for 5 weeks. The toe volume was measured at 1, 3 and 5 weeks after administration, and the swelling degree was calculated; the organ indices of rats were calculated and the histopathological changes of articular cartilage were observed by HE staining; the expressions of interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α) and transforming growth factor-β (TGF-β) in joint tissues were detected by immunohistochemistry.Results:Zhonghua Dieda Pills (2.0 g/kg) group significantly reduced the swelling of foot and plantar of rats, reduced the swelling of ear of mice, and reduced the dry weight of granuloma of rats ( P<0.05); Zhonghua Dieda Pills (1.4 g/kg) group significantly reduced the number of twisting of rats, and the pain threshold after 3 h of administration was significantly higher than that of the control group ( P<0.05); Zhonghua Dieda Pills (2.0 g/kg) group significantly reduced the swelling of the foot and metatarsal of arthritic rats after 3-5 weeks of administration ( P<0.05), decreased the thymus index ( P<0.05), and reduced the expression levels of IL-1β, TNF-α and TGF-β in joint tissues ( P<0.05). Conclusion:Zhonghua Dieda Pills have confirmed anti-inflammatory and analgesic effects, which may play a therapeutic role in adjuvant arthritis model rats by reducing the levels of inflammatory factors such as IL-1β, TNF-α and TGF-β.

Double-column Die-punch fractures of distal radius treated with butterfly plate fixation via Henry approach / 中国骨伤

OBJECTIVE@#To explore clinical effect of open reduction and internal fixation with Henry's approach butterfly plate in treating double-column Die-punch fractures of distal radius.@*METHODS@#From January 2018 to June 2021, 26 patients with double-column Die-column distal radius were treated with open reduction and internal fixation through Henry's surgical approach and using distal radius volar column plate(butterfly plate), including 14 males and 12 females, aged from 20 to 75 years old with an average age of (44.2±3.4) years old. Postopertaive complications were observed, Gartland-Werley score at 12 months after opertaion was used to evaluate wrist joint function.@*RESULTS@#All 26 patients were followed up from 10 to 18 months with an average of(13.4±0.8) months. All fractures were obtained fracture union, the time ranged from 8.5 to 15.8 weeks with an average of (11.4±0.5) weeks. All incisions healed at stageⅠwithout infection, nerve injury and internal fixation failure occurred. Postoperative Gartland-Werley score at 12 months was (3.65±0.36), and 16 patients got excellent result, 8 good and 2 moderate.@*CONCLUSION@#Open reduction and internal fixation with butterfly plate for the treatment of double-column Die-punch fractures of the distal radius through volar Henry approach could obtain satisfactory clinical outcomes.

Deliberative dialogue on euthanasia in girls, boys and adolescents. Prequel to the Cabildo Ciudadano (Citizen Council) carried out in Colombia

Background: To date, there is a lack of published information on the utilization of the Deliberative dialogue methodology and the right to a dignified death in minors under 18 years of age in Colombia and Latin America. Objective: To examine the issue of children and adolescents' entitlement to a dignified death, including the criteria for exclusion, and to formulate a comprehensive plan for pediatric palliative care. A public policy document will be created with the aim of supporting the implementation of Resolution 825/2018. Methods: Participatory Action Research utilizing a Deliberative dialogue methods that has been adapted based on feminist epistemological principles. Results: The outcome of the exercise was the production of a document containing Public Policy recommendations regarding euthanasia in minors and its submission to the Ministry of Health and Social Protection of Colombia a few days prior to the release of the Resolution regulating the right to a dignified death for this population. Additionally, the conclusions of this event enabled the creation of a guide for the implementation of (Cabildos Ciudadanos) Citizen Council, in which girls, boys, and adolescents are included, trans-disciplinarity is encouraged, and feminist epistemological foundations are explored. Conclusions: The deliberative dialogue method may serve as a cost-efficient alternative to replace or complement participatory approaches utilized in the development of public health guidelines and policies.

Antecedentes: En Colombia y Latinoamérica no se cuenta con registros publicados de temas abordados desde los metodos del diálogo deliberativo frente a temas de salud sobre la población pediátrica. Objetivo: El diálogo deliberativo fue utilizado para deliberar sobre el derecho a la muerte digna en niñas, niños y adolescentes, sus criterios de exclusión, y el marco de acción de los cuidados paliativos pediátricos. Métodos: Investigación acción participativa recurriendo a la metodología Deliberative Poll. Resultados: Redacción de un documento de recomendaciones de Política Pública en torno a la eutanasia en población pediátrica y entrega del mismo al Ministerio de Salud y Protección Social de Colombia días previos a la expedición de la Resolución que reglamentó el derecho a morir con dignidad para esta población; así mismo, las conclusiones de este ejercicio posibilitaron la estructuración de una guía metodológica para la realización de Cabildos Ciudadanos en donde se integra a niñas, niños y adolescentes. Conclusiones: el diálogo deliberativo puede constituirse en una alternativa costo-eficiente para reemplazar o complementar metodologías de participación empleadas en la construcción de lineamientos y políticas públicas en salud.

Diretivas antecipadas da vontade: autonomia do paciente e segurança profissional / Advance directives: patient autonomy and professional safety / Directivas anticipadas de voluntad: autonomía del paciente y seguridad profesional

Resumo Este estudo teórico discorre sobre a bioética no sentido de promover e assegurar a dignidade do paciente de uma forma segura, que obedeça a sua tomada de decisão, seguindo normativas e protocolos que garantam o cumprimento dessa vontade, e trazendo também segurança para equipe assistencial. A ausência de consenso no meio jurídico, por falta de regulamentações que explicitem as regras para a elaboração de um modelo de diretivas de vontade, gera insegurança nos profissionais de saúde envolvidos, familiares e paciente. Para garantir esse direito, além da normatização jurídica, é necessário que os profissionais tenham pleno conhecimento do assunto, a fim de orientar e informar corretamente seus pacientes. Não basta assegurar ao indivíduo o direito de manifestar sua vontade, é preciso ainda a certeza de que esta será cumprida. Há a necessidade de ampliar discussões acerca da temática, com ênfase na realidade brasileira.

Abstract This theoretical study discusses bioethics in the sense of safely promoting and ensuring the patients' dignity, respectful of their decision making, following regulations and protocols that help fulfill this will and bring safety to the care team. The lack of clear and consensual legal regulations on how to elaborate an advance directive generates uncertainty among healthcare providers, patients and their families. Beyond legal standardization, professionals must also have full knowledge on the topic to correctly guide and inform their patients, thus guaranteeing this right. But ensuring the right to express one's will is not enough—one must be assured that such whishes will be fulfilled. Further and broader discussions on this topic anchored on the Brazilian reality are needed.

Resumen Este estudio teórico trata la bioética en el sentido de promover y garantizar la dignidad del paciente de forma segura, que acepte su toma de decisiones, siguiendo normas y protocolos que garanticen el cumplimiento de esa voluntad, además de brindar seguridad al equipo de atención. La falta de consenso en el ámbito legal respecto a normativa para la elaboración de un modelo de directivas de voluntad produce inseguridad en los profesionales de la salud involucrados, familiares y pacientes. La garantía de este derecho, además de la regulación legal, requiere que los profesionales conozcan el tema para orientar e informar correctamente a sus pacientes. No basta con garantizar al individuo el derecho a expresar su voluntad, sino que también es necesario la certeza de que esta se cumplirá. Son necesarios más estudios para ampliar las discusiones sobre el tema, con énfasis en el contexto brasileño.

Limitação terapêutica para crianças: revisão sistemática sobre final de vida / Therapeutic limitation for children: a systematic review on end-of-life / Limitación terapéutica para niños: una revisión sistemática sobre el final de la vida

Resumo Esta revisão sistemática visa identificar dificuldades enfrentadas por profissionais no manejo clínico de crianças em final de vida. Para tanto, realizou-se busca de artigos científicos nas bases de dados SciELO e LILACS por meio dos descritores "limitação de suporte terapêutico", "terminalidade" e "medidas de conforto", combinados com o descritor "crianças". Do total de 102 trabalhos completos encontrados, nove contemplaram os critérios de inclusão para a amostra do estudo. Os resultados apontam dificuldades em relação à tomada de decisões e à limitação terapêutica de pacientes infantis. Conclui-se que, quando se sentem melhor preparados para trabalhar com questões referentes ao processo de morte e morrer, os profissionais podem prestar um cuidado mais humanizado a pacientes e familiares.

Abstract This systematic review sought to identify difficulties faced by professionals in the clinical management of end-of-life child patients. Bibliographic search was conducted on the SciELO and LILACS databases using the descriptors "therapeutic limitation," "hospice care" and "comfort measures," combined with the descriptor "child." Of the 102 complete studies identified, nine met the established inclusion criteria. The results point to difficulties regarding decision making and therapeutic limitation for infant patients. In conclusion, when professionals feel better prepared to address issues related to the process of death and dying, they can provide more humanized care to patients and families.

Resumen Esta revisión sistemática tiene por objetivo identificar las dificultades que enfrentan los profesionales en el manejo clínico de los niños al final de la vida. Para ello, se realizó una búsqueda de artículos científicos en las bases de datos SciELO y LILACS utilizando las palabras clave "limitación del apoyo terapéutico", "final de la vida" y "medidas de confort", combinadas con "niños". Del total de 102 artículos completos encontrados, nueve cumplieron con los criterios de inclusión para la muestra del estudio. Los resultados apuntan a dificultades con relación a la toma de decisiones y a limitaciones terapéuticas de los pacientes pediátricos. Se concluye que los profesionales cuando se sienten más preparados para lidiar con cuestiones relacionadas con el proceso de muerte y morir pueden brindar una asistencia más humanizada a los pacientes y familias.

ATTITUDE OF DOCTORS TOWARDS EUTHANASIA

Background- Those who are pro euthanasia believe that such act eliminates the patient's pain and suffering. Right to die allows the person to die with dignity. But euthanasia may involve taking a human's life, The present study evaluates the attitude of doctors involved in care of critically ill patients towards euthanasia. Material & methods- A survey on Euthanasia was conducted amongst 100 doctors involved in the treatment of critically ill patients of various ailments at ICARE institute of Medical Sciences & Research Centre & B.C.Roy Hospital, Haldia, West Bengal, India, to ?nd out their attitude towards euthanasia. In present study, majority i.e., 64 (64%) subjects were between 31-40 years, Results- 24 (24%) subjects were between 41-50 years, 10 (10%) subjects were between 51-60 years while 2 (2%) subjects were more than 60 years. 56(28%) subjects were females while 44 (44%) subjects were males. 4 (4%) were Neurophysician, 5 (5%) were Neurosurgeon, 32 (32%) were Critical care consultant, 19 (19%) were Anesthetist, 34 (34%) were, 6 (6%) were Surgeon. 89 (89%) (81.2-94.4%, 95%CI) subjects were anti-euthanasia. In majority of circumstances, 89 (89%) subjects said they will not give euthanasia while 11 (11%) (5.6-18.8%, 95%CI) subjects said they will give euthanasia. Though the Supreme Court Conclusion- judgement has provided a major boost, it is a long way to go before it becomes a law. Also, its misuse remains a major issue.

A comparative study of metabolic parameters in diet-induced obesity model of rats

Background: The occurrence of overweight and obesity coupled with many non-communicable diseases is a major preventable cause of premature morbidity and death. Sexual dimorphism exists in neural regulation of food intake. In spite of less consumption, females are prone to deposit greater amount of fat. Aim and Objective: This study aims to compare the effect of two different diets, high-fat diet (HFD) and sucrose diet with the normal chow eating rats correlating with various biochemical parameters. Materials and Methods: A total of 36 adult rats of both genders were selected. They were divided into three groups and each group was given fat diet, sucrose diet, and normal chow diet for 10 weeks. Biochemical analysis was done at the end of 10 weeks. Results: Food intake, body weight, glucose, insulin, and total cholesterol (TC) are significantly greater in males in comparison to females. Triglycerides and G/I ratio are found to be significantly greater in females. Insulin resistance was observed in both sucrose and HFD group but TC was higher in HFD group. Conclusion: Sucrose diet and HFD produce insulin resistance and dyslipidemia and it seems to be more pronounced in males compared to females. Sucrose diet has little effect on lipid parameters.

A linear model-based dental panoramic tomography localization method / 中国辐射卫生

@#<b>Objective</b> To solve the problem of fast locating primary radiation in dental panoramic tomography apparatus by designing a linear model-based positioning die body. <b>Methods</b> By applying the mathematical principle of solving the linear equation,the two-dimensional plane coordinates were mapped to the detector plane of dental panoramic tomography apparatus, and the horizontal coordinate position was determined by determining the vertical coordinate value through X-ray imaging in the detector plane. Finally, the position of primary radiation in the detector plane was determined. <b>Results</b> The longitudinal characteristics of the image were determined by analyzing the images taken after the application of the model, and the final position of the primary radiation in the detector plane was accurate. By comparing the detection results of die body method and film method, the localization results by the die body method fell within 90% of the image center by the film method. There was no significant difference in the localization results between the two methods by Shapiro-Wilk normality test and paired-samples <i>t</i> test (<i>P</i> > 0.05). <b>Conclusion</b> For narrow-beam devices, the positioning die body designed based on the linear model method can locate the position of the primary radiation in the detector plane quickly and effectively and replace the film method.

Where do older adults die in Brazil? An analysis of two decades / Onde morrem os idosos no Brasil? Uma análise de duas décadas

Objective: To describe the characteristics of older adult deaths reported in Brazil between 1998 and 2018. Methods: This is a retrospective, descriptive study performed using secondary data from the Brazilian Ministry of Health. Results: During the analyzed period, 14 145 686 older adults died in the country, of which 40.42% were over 80 years old. The main cause of death was circulatory system disease (21.50%), and the most frequent place of death was a hospital environment (68%). The Southeast region accounted for 52.83% of the country's hospital deaths and 73.33% of those occurring in other health facilities, whereas 38.56% of the deaths that happened at home took place in the Northeast region. Conclusions: The hospital environment was the predominant place of death in all regions of the country, and the main causes of death were chronic noncommunicable diseases. Alternative care modalities emerge as a possibility of establishing accessible end-of-life care in scenarios other than the hospital.

Objetivo: Descrever as características dos óbitos de idosos no Brasil notificados entre os anos de 1998 e 2018. Metodologia: Estudo descritivo retrospectivo realizado por meio de dados secundários do Ministério da Saúde. Resultados: Durante o período analisado, morreram 14.145.686 idosos no país, destes, 40,42% tinham mais de 80 anos. A principal causa de morte foram as doenças do aparelho circulatório (21,50%), e o local de morte mais frequente foi o ambiente hospitalar (68%). Na Região Sudeste ocorreram 52,83% dos óbitos em hospitais do Brasil e 73,33% dos ocorridos em outros estabelecimentos de saúde, enquanto 38,56% das mortes em domicílio ocorreram na Região Nordeste (38,56%). Conclusões: O ambiente hospitalar foi o local de óbito predominante em todas as regiões do país, e as principais causas de óbito foram as doenças crônicas não transmissíveis. Modalidades alternativas de cuidado emergem como possibilidade de estabelecer cuidados de fim de vida acessíveis em outros cenários que não o hospitalar.

Palliative extubation: obstacles, challenges and solutions / Extubación paliativa: obstáculos, desafíos y soluciones

Abstract Life support withdrawal can be a challenging decision, but it should be considered as an option when death is inevitable or recovery to an acceptable quality of life is not possible. The process is beset by obstacles that must be overcome to finally offer patients comfort and a peaceful death. In this article, we offer a series of tools that seek to solve the challenges of palliative extubation, as well as a protocol that could facilitate the decision to withdraw life support, making palliative extubation an alternative to consider instead of artificially prolonging life at the expense of unacceptable human and economic costs.

Resumen La interrupción de la asistencia vital puede ser una decisión complicada, aun cuando se debe considerar como una opción cuando la muerte es inevitable o la recuperación a una calidad de vida aceptable no es posible. A lo largo del proceso se encuentran obstáculos que se deben sortear para finalmente ofrecer a los pacientes una muerte tranquila y confortable. En este artículo ofrecemos una serie de herramientas que buscan solucionar los desafíos de la extubación paliativa y presentamos una guía de extubación que podría facilitar la decisión de retiro del soporte vital, haciendo de la extubación paliativa una alternativa por considerar en lugar de prolongar la vida de manera artificial a expensas de un costo humano y económico inaceptable.

Vade mecum sobre o morrer e a morte / Vade mecum about dying and death / Vademécum acerca de morir y la muerte

Resumo Considerando o impacto da morte em múltiplos aspectos da coletividade humana, este artigo reflete sobre como diferentes culturas, em épocas distintas, relacionaram-se com esse tema, buscando interpretar os vários significados associados à finitude. Para tanto, o estudo parte de uma revisão bibliográfica de abordagem qualitativa. Constata-se que as civilizações que se sucederam ao longo dos séculos têm em comum uma série de barreiras para compreender e aceitar a morte. E, a despeito de novos paradigmas socioculturais, da liberdade de expressão e de toda a evolução tecnológica que caracterizam a sociedade contemporânea, a desmistificação da morte ainda requer empenho. Em sua conclusão, o texto enfatiza a necessidade de ampliar discussões e estratégias para enfrentar as questões relacionadas à finitude humana, levando em conta que novas ressignificações conceituais sempre emergem com o progresso da ciência.

Abstract Considering the impact of death on multiple aspects of human collectivity, this article reflects on how different cultures, at different times, related to this theme, seeking to interpret the various meanings associated with finitude. Therefore, the study starts with a literature review of a qualitative approach. It found that civilizations that have succeeded each other over the centuries have in common a number of barriers to understanding and accepting death. And, despite new sociocultural paradigms, freedom of expression and all the technological evolution that characterize contemporary society, the demystification of death still requires commitment. In its conclusion, the text emphasizes the need to broaden discussions and strategies to address issues related to human finitude, considering that new conceptual re-significations always emerge with the progress of science.

Resumen Considerando el impacto de la muerte en múltiples aspectos de la colectividad humana, este artículo reflexiona sobre cómo diferentes culturas, en diferentes momentos, se relacionaron con este tema, buscando interpretar los diversos significados asociados a la finitud. Por lo tanto, el estudio parte de una revisión bibliográfica de un enfoque cualitativo. Se constata que las civilizaciones que se han sucedido a lo largo de los siglos tienen en común una serie de barreras para comprender y aceptar la muerte. A pesar de los nuevos paradigmas socioculturales, la libertad de expresión y toda la evolución tecnológica que caracteriza a la sociedad contemporánea, la desmitificación de la muerte aún requiere compromiso. En su conclusión, el texto enfatiza la necesidad de ampliar las discusiones y estrategias para abordar cuestiones relacionadas con la finitud humana, teniendo en cuenta que siempre surgen nuevas resignificaciones conceptuales con el progreso de la ciencia.

Comentarios al proyecto de ley "Muerte digna y cuidados paliativos" / Remarks on the "Dignified death and palliative care" bill

The Chilean House of Representatives is discussing the bill on "Dignified death and palliative care", which regulates the so-called medical assistance in dying or euthanasia. This paper will critically analyze the different aspects of the bill, particularly concerning four main dimensions, namely, the patient's condition at the time of requesting euthanasia; the doctor-patient relationship and respect for the autonomy of both parties; the idea of medicine involved in it; and the possible therapeutic alternatives to euthanasia. This critical analysis raises the need to discuss in more depth a project that has to do with such important decisions about our lives and that implies a radical change in the way of thinking and practicing medicine.

Percepções sobre a atuação do enfermeiro às pessoas no fim de vida / PERCEPCIONES SOBRE EL PAPEL DE LAS ENFERMERAS EN LAS PERSONAS AL FINAL DE LA VIDA / Perceptions about the role of nurses in people at the end of life

Objetivo: descrever a percepção de acadêmicos de Enfermagem acerca da atuação do enfermeiro às pessoas no fim de vida. Método: estudo qualitativo, descritivo, com dados coletados em universidade privada de Curitiba. Participaram doze acadêmicos de Enfermagem, por meio de entrevista semiestruturada gravada. Após transcrição, as narrativas foram analisadas pela Teoria do Discurso do Sujeito Coletivo. Resultados: as narrativas evidenciaram: falta de preparo profissional; ausência de suporte e; ausência de gerenciamento do cuidado. Como ideal, evidenciou-se a morte sem sofrimento, em casa e perto de quem se ama; com melhor comunicação, postura e empatia; a personalização do atendimento e; o respeito ao momento da morte. Conclusão: aponta-se a importância de mais estudos e investimentos na melhor capacitação aos profissionais da enfermagem sobre o tema, potencializando suas competências e as habilidades de enfrentamento específico.

Objective: describe the perception of nursing students about the role of nurses in people at the end of life. Method: qualitative, descriptive study, with data collected at a private university in Curitiba. Twelve nursing students participated, through recorded semi-structured interviews. After transcription, the narratives analyzed using the Collective Subject Discourse Theory. Results: the narratives showed: lack of professional preparation, absence of support and absence of care management. As an ideal, death was shown without suffering, at home and close to those you love; with better communication, posture and empathy; personalization of service and; respect for the moment of death. Conclusion: it points out the importance of more studies and investments in better training for nursing professionals on the subject.

Objetivo: describir la percepción de los estudiantes de enfermería sobre el papel de las enfermeras en las personas al final de la vida. Método: estudio cualitativo y descriptivo, con datos recogidos en una universidad privada de Curitiba. Doce estudiantes de enfermería participaron, a través de entrevistas semiestructuradas grabadas. Después de la transcripción, las narrativas analizadas utilizando la Teoría del Discurso del Sujeto Colectivo. Resultados: las narraciones mostraron: falta de preparación profesional, ausencia de apoyo y ausencia de gestión de la atención. Como ideal, la muerte se mostró sin sufrimiento, en casa y cerca de los que amas; con mejor comunicación, postura y empatía; personalización del servicio y; respeto por el momento de la muerte. Conclusión: señala la importancia de más estudios e inversiones en una mejor formación para profesionales de enfermería en la materia.

Morte e morrer em tempos de COVID-19 / Death and dying in times of COVID-19

A pandemia da COVID-19 está tendo impactos em toda a sociedade humana. Muitas questões antes abordadas no plano individual pela Bioética agora tem o desafio de ter o seu enfoque ampliado para toda a sociedade. É uma grande provocação que as diversas áreas estão buscando responder adequadamente em meio a cenários desconhecidos ou incertos. A reflexão sobre os temas envolvidos nas questões da morte e do morrer são fundamentais e devem ser realizadas. (AU)

The COVID-19 pandemic is having an impact on human society as a whole. Many issues previously addressed at the individual level by bioethics now face the challenge of having their focus expanded to the society level. It is a great challenge that different areas are trying to adequately respond to in the midst of unknown or uncertain scenarios. Reflecting on the topics involved in the issues of death and dying is crucial and must be carried out. (AU)

Psicodélicos y muerte digna. Uso de sustancias psicodélicas al final de la vida / Psicodélicos e morte digna. O uso de psicodélicos no final da vida / Psychedelics and dignified death. Use of psychedelic substances at the end of life

Objetivo: repensar el potencial de los psicodélicos para la construcción de un marco psicoespiritual al final de la vida. Síntesis del contenido: con las recientes investigaciones que reconfirman el potencial de los psicodélicos para lograr experiencias místicas, estáticas y de trascendencia, los diferentes enfoques de atención al paciente moribundo se están enfrentando a una resurgente y revalidada terapia psicodélica y a un emergente paradigma psicoespiritual que procura una muerte digna, atendiendo trastornos psicológicos del final de la vida como la ansiedad, la depresión e incluso el miedo a la misma muerte. La terapia con psicodélicos favorece la construcción de un marco psicoespiritual en el moribundo, el cual está asociado a una mejor protección contra la depresión, la desesperanza, la desmoralización e incluso el deseo de una muerte acelerada. Conclusiones: entre las variables del marco de una muerte digna destaca la autonomía que tiene el moribundo para elegir qué hacer o no hacer con su cuerpo, su enfermedad o el final de su vida. Aquí se expone la necesidad de considerar el uso de psicodélicos para ayudar al moribundo a afrontar su deceso con paz, coraje y, sobre todo, dignidad.

Objetivo: repensar o potencial do uso de psicodélicos para a construção de uma estrutura psicoespiritual no final da vida. Síntese de conteúdo: com as pesquisas mais recentes que confirmam o potencial do uso de psicodélicos para atingir experiências místicas, estáticas e transcendentais, as diferentes abordagens para o cuidado do paciente moribundo trazem uma ressurgente e revalidada terapia com o uso de psicodélicos e um paradigma psicoespiritual emergente que procura uma morte digna, atendendo transtornos psicológicos no final da vida como a ansiedade, a depressão e, inclusive, o medo da própria morte. Essa terapia favorece a construção de uma estrutura psicoespiritual no paciente moribundo que está ligada a uma melhor proteção contra a depressão, a perda da esperança, a desmoralização e até o desejo de uma morte acelerada. Conclusões: entre as variáveis no contexto de uma morte digna destaca-se a autonomia do moribundo para eleger o que fazer ou não com seu corpo, com a doença e com o final da vida. Neste trabalho, é exposta a necessidade de considerar o uso de psicodélicos para ajudar o moribundo a encarar sua morte em paz, coragem e, principalmente, com dignidade.

Objective: To rethink the potential of psychedelics for the construction of a psycho-spiritual framework at the end of life. Content synthesis: With the recent studies that re-confirm the potential of psychedelics to get mystical, static and transcendent experiences, the different approaches to attention at dying patients are facing a resurgent and revalidated psychedelic therapy and an emerging psycho-spiritual paradigm that seeks a dignified death, attending psychological end-of-life disorders such as anxiety, depression and even fear of death itself. Psychedelic therapy favors the construction of a psycho-spiritual framework in the dying person, which is associated with a better protection against depression, despair, demoralization, and even the desire for an accelerated death. Conclusions: The autonomy of the dying person to choose what to do or not to do with his body, illness or the end of his life is a prominent issue among the variables in the framework of a dignified death. This work exposes the need to consider the use of psychedelics in orderto help the dying patient face their decease with peace, courage and, above all, dignity.

Shade and Irrigation Effects on Growth, Flowering, Pod Yields and Cacao Tree Survival Following 5 Years of Continuous Dry Season Irrigation

The effects of plantain shade and dry season irrigation on the growth, field survival, flowering and pod production of cacao was investigated. Treatments were a 2 by 2 factorial combinations of shade regimes (Unshaded/open sun and shaded) and irrigation intervals (5-day and 10-day intervals) arranged in a split-plot design. There was an unirrigated but shaded control. The shade regimes constituted the main plot while irrigation intervals were the sub-plot treatments. The growth, dry season survival, flowering and pod/bean yield characters of cacao were enhanced in the unshaded (open sun) compared with the shaded plants. The open sun treatment combined with 5-day irrigation produced the largest canopy development, flowering and pod production compared with shading-irrigation combinations. The shade-irrigation ameliorated microclimate and enhanced growth and development, flowering and uniform fruiting/pod production and total bean yield and reduced dry season mortality (whole tree death, branch and twig dieback). For the non-irrigated but shaded cacao, about 30% dry season mortality (branch and twig dieback) were obtained. Air temperatures within the cacao field were highest for open sun cacao followed by moderate and dense shade respectively. Flowers were more profuse for unshaded (open sun) cocoa compared with the shaded while the yield and yield components of cacao for each harvest dates and total pod and bean yields were significantly different between the unshaded and shaded cacao regimes. Trees that were irrigated at 5-day intervals produced significantly (P < 0.05) higher LAI, branching, flowers and pods compared with those irrigated at 10-day intervals. The 5-day irrigation interval significantly increased percentage of trees bearing flowers and pods, and produced larger number, and heavier pods and beans compared with the 10-day interval. The drip irrigation strategy adopted ameliorated dry season terminal drought (hydrothermal stresses) in cacao. This is a veritable tool to scale up growth, survival, establishment and flower/pod production.

Morte digna: percepção de médicos de hospital de ensino / Dignified death: the perception of doctors in a teaching hospital / Muerte digna: la percepción de los médicos de un hospital de enseñanza

Resumo Com o objetivo de identificar a percepção de morte digna de médicos de hospital de ensino, propõe-se estudo transversal, com amostra por conveniência (100 médicos), utilizando a versão reduzida da escala de percepção de morte digna. Todos os fatores do instrumento foram considerados de alta necessidade, enfatizando-se boa relação com a família (98,9%), manutenção da esperança e do prazer (97,8%) e não ser um fardo para os demais (92,3%). Mulheres priorizaram boas relações com a família e equipe; médicos com mais de 45 anos, não ser um fardo para os demais; e os sem religião, não ser um fardo e ter controle sobre o futuro. A percepção de morte digna dos médicos valorizou aspectos sociais, como afetividade e convivência, ao priorizar esses três fatores, além de demonstrar que idade, sexo e religiosidade a influenciam. Aprovação CEP-UFSC CAAE 71111317.4.0000.0121

Abstract In order to identify the perception of good death by physicians who work at a teaching hospital, a cross sectional study with a convenience sample (100 physicians) is proposed, using the reduced version of the perceived dignified death scale (Brazilian reduced version of Good Death Inventory). All factors of the instrument were considered as highly needed, emphasizing good relationship with the family (98.9%), maintenance of hope and pleasure (97.8%) and not being a burden to others (92.3%). Women prioritized good relationships with family and team; doctors over 45 years old, not being a burden to others; and those without religion, not being a burden to others and having control over the future. The perception of good death presented by physicians valued social aspects such as affectivity and acquaintanceship, by prioritizing these three factors, in addition to showing that age, sex and religiosity influence this perception. Approval CEP-UFSC CAAE 71111317.4.0000.0121

Resumen Con el objetivo de identificar la percepción de muerte digna por parte de médicos de un hospital de enseñanza, se propone un estudio transversal, con muestra de conveniencia (100 médicos), utilizando la versión reducida de la escala de percepción de muerte digna. Todos los factores del instrumento fueron considerados como de alta necesidad, con destaque para buena relación con la familia (98,9%), mantenimiento de la esperanza y placer (97,8%) y no ser una carga para los demás (92,3%). Las mujeres priorizaron buenas relaciones con la familia y el equipo; médicos con más de 45 años, no ser una carga para los demás; y los sin religión, no ser una carga para los demás y tener control sobre el futuro. La percepción de muerte digna por parte de los médicos valoró aspectos sociales como afectividad y convivencia, al priorizar estos tres factores, además de demostrar que edad, sexo y religiosidad la influencian. Aprobación CEP-UFSC CAAE 71111317.4.0000.0121

Anti-inflammatory Effect of a Goji Berry Extract (Lycium barbarum) in Rats Subjected to Inflammation by Lipopolysaccharides (LPS)

Abstract The present study aimed to evaluate the anti-inflammatory potential of a Lycium barbarum (L. barbarum) fruit extract in Wistar rats submitted to a palatable diet presenting systemic inflammation induced by lipopolysaccharides (LPS). Forty-two Wistar female rats (Rattus Novergicus) were used with 60 days old. The animals were feed for 60 days and divided in six groups (n=7): standard diet+water; standard diet+L. barbarum; palatable diet+water; palatable diet+L. barbarum; standard diet+water+LPS; standard diet+L. barbarum+LPS. A significant difference was shown between the analyzed groups concerning C-reactive protein, with the standard diet+water+LPS group presenting the highest inflammatory response in comparison to the other groups. Decreased inflammatory response was observed in the group administered a palatable diet along with the fruit extract when compared to the group that received only a palatable diet. Significant decrease in glutamic-oxaloacetic transaminase activity was observed in the standard diet+L. barbarum+LPS group compared to the standard diet+water group, as well as in the palatable diet+L. barbarum group compared to the palatable diet+water group. A significant increase in creatinine in the standard diet+water+LPS group was observed in according to the L. barbarum administration groups. The gene expression of the inflammatory markers genes in the liver showed a significant increase in TNF-α and IL-6 genes in the group treated with standard diet+L. barbarum+LPS when compared to the standard diet+LPS group. Thus, the administered L. barbarum extract displays the potential to reduce inflammatory responses induced by LPS and a palatable diet.

Eutanasia, matar y dejar morir. Desambiguación del concepto de eutanasia y consideraciones bioéticas esenciales / Euthanasia: To Kill or to Let Die. Concept Disambiguation and Essential Bioethical Considerations / Eutanásia, matar e deixar morrer. Desambiguação do conceito de eutanásia e considerações bioéticas essenciais

Resumen El propósito de este artículo es desambiguar el concepto de "eutanasia", describir las conductas que equivocadamente son asociadas a ella, y diferenciar aquellas que no son eutanasia de aquella única que sí lo es. Además, se hacen las consideraciones bioéticas mínimas en relación con los términos de "eutanasia", "matar" y "dejar morir", y se discuten en pacientes conscientes e inconscientes.

Abstract The purpose of this original paper is to clarify the term "euthanasia", describing the varied conducts wrongly associated with it and distinguishing those that are not euthanasia from the only one that certainly is. Additionally, basic bioethical considerations are presented regarding the terms "euthanasia," "killing" and "letting die," and discussed in relation to conscious and unconscious patients.

Resumo O objetivo deste artigo é desambiguar o conceito de eutanásia, descrever as condutas que, de forma equivocada, são associadas a ele e diferenciar as que não são eutanásia daquela única que realmente é. Além disso, são feitas considerações bioéticas mínimas quanto aos termos "eutanásia", "matar" e "deixar morrer", os quais são discutidos com relação a pacientes conscientes e inconscientes.