Effectiveness of sustained maximal inspiration along with transcutaneous electrical nerve stimulation in patients with malignant pleural effusion with intercostal drainage tube: a randomized controlled trial

Background: Malignant pleural effusion (MPE) is one of the most common causes of an exudative pleural effusion. It is the most common cause of a unilateral massive pleural effusion. Most MPE s are secondary to metastases to the pleura, most often from lung or breast cancer. Medical management includes aspiration of fluid with the insertion of a chest tube, which may be necessary to relieve dyspnea. Hypoventilation does occur in certain areas of the lungs because of pain and muscle guarding after intercostal drainage tube (ICD) tube placements in pleural effusion. Therefore, it is important to emphasize pain management and expansion of affected areas of the lungs and chest wall. SMI is the basic maneuver of incentive spirometry and is mainly given to prevent atelectasis and lung collapse in postoperative patients. TENS is a method of producing an electro-analgesic effect and is effective in providing post-operative pain control. Methods: The study design of the study was a randomized controlled trial. A total of 44 participants with a diagnosis of MPE with an intercostal drainage tube were included in this study. The study duration was 5 years with an intervention period of 2 weeks and the outcome measures were pulmonary functions and intercostal pain severity using the NRS Scale. Results: There was a significant improvement in pulmonary functions in the control group and a highly significant improvement in pulmonary functions in the experimental group after 2 weeks of interventions and pain severity (NRS) was significantly reduced in the experimental group only (p<0.001) Conclusions: This study concluded that sustained maximal inspiration (SMI) along with TENS significantly improves pulmonary functions and reduces pain at the site of ICD in patients with MPE.

Difusão da Lei Geral da Micro e Pequena Empresa em municípios paulistas / Difusión de la Ley General de las Micro y Pequeñas Empresas en los municipios de São Paulo / Diffusion of the Micro and Small Business Law in municipalities of São Paulo

Resumo Este artigo tem como objeto de análise a implantação da Lei Complementar nº 123, de 2006 (LC nº 123/2006), que instituiu o Estatuto Nacional da Microempresa e da Empresa de Pequeno Porte (MPE), por municípios paulistas. Utilizou-se o referencial teórico de difusão de políticas públicas tendo como objetivo estudar seu processo de adoção, observando os diferentes contextos e momentos de coerção previstos na legislação federal. Com base nas discussões teóricas relacionadas com o mecanismo de difusão chamado de coerção, respondeu-se a seguinte pergunta: qual é a influência do mecanismo de coerção vertical na difusão da Lei Geral da MPE nos municípios paulistas? A técnica "análise de sobrevivência" foi aplicada para identificar fatores explicativos da difusão da política, considerando variáveis de desenho institucional, políticas e partidárias, efeito vizinhança, necessidade da política, organizações/atores sociais e fatores estruturais. Os resultados demonstram que, conforme varia o desenho institucional de coerção, mudam os fatores explicativos da difusão dessa política na ponta, de modo que os aspectos locais, incluindo atores sociais, fatores regionais e questões estruturais, importam para a difusão, variando conforme o contexto coercitivo.

Resumen Este artículo analiza la implementación de la Ley General de las Micro y Pequeñas Empresas por parte de los municipios de São Paulo. Se utilizó la teoría de la difusión de políticas, con el objetivo de estudiar el proceso de adopción de esta política pública, observando los diferentes contextos y momentos de coerción previstos en la legislación federal. A partir de las discusiones teóricas relacionadas con el mecanismo de difusión denominado coerción, se respondió a la siguiente pregunta: ¿cuál es la influencia del mecanismo de coacción vertical en la difusión de la mencionada ley en los municipios de São Paulo? Se aplicó la técnica de análisis de supervivencia para identificar factores explicativos de la difusión de políticas, considerando variables institucionales, políticas y partidarias, efecto barrio, necesidad de políticas, organizaciones/actores sociales y factores estructurales. Los resultados muestran que a medida que varía el diseño institucional de coerción, los factores explicativos de la difusión de esta política al final cambian, de modo que los aspectos locales, incluidos los actores sociales, los factores regionales y los problemas estructurales importan para la difusión, variando de acuerdo con el contexto coercitivo.

Abstract This article analyzes the implementation of the General Law for Micro and Small Business by municipalities in São Paulo. The theory of policy diffusion was used to study the process of adopting this public policy in the different contexts of coercion. The article presents theoretical discussions on the diffusion mechanism "coercion" and answers the question: what is the influence of the vertical coercion mechanism in the diffusion of the General Law in the municipalities of São Paulo? The survival analysis technique was applied to identify explanatory factors of policy diffusion, considering institutional, political, and party design variables, neighborhood effect, internal needs, organizations/social actors, and structural factors. The results show that as the institutional rules of coercion vary, the explanatory factors of the diffusion change so that local aspects, including social actors, regional factors, and structural issues, matter for the diffusion, varying according to the coercive context.

Human microbiome and prostate cancer development: current insights into the prevention and treatment / 医学前沿

The huge communities of microorganisms that symbiotically colonize humans are recognized as significant players in health and disease. The human microbiome may influence prostate cancer development. To date, several studies have focused on the effect of prostate infections as well as the composition of the human microbiome in relation to prostate cancer risk. Current studies suggest that the microbiota of men with prostate cancer significantly differs from that of healthy men, demonstrating that certain bacteria could be associated with cancer development as well as altered responses to treatment. In healthy individuals, the microbiome plays a crucial role in the maintenance of homeostasis of body metabolism. Dysbiosis may contribute to the emergence of health problems, including malignancy through affecting systemic immune responses and creating systemic inflammation, and changing serum hormone levels. In this review, we discuss recent data about how the microbes colonizing different parts of the human body including urinary tract, gastrointestinal tract, oral cavity, and skin might affect the risk of developing prostate cancer. Furthermore, we discuss strategies to target the microbiome for risk assessment, prevention, and treatment of prostate cancer.

Efficacy of Doxycycline as Peluridising Agent in Cases of Malignant Pleural Effusion (MPE)

Objective: To determine the efficacy of doxycycline as pleuridising agent in cases of malignant pleural effusions (MPE). Subject and methods: This was a descriptive case series that was conducted at Medical and Pulmonology Department of Combined Military Hospital Lahore from January 2018 to August 2018. In this study, the cases of malignant pleural effusion assessed on history and proven by histopathology on any biopsy of either gender falling in range of 30 years or more were included. The pleural fluid was drained by appropriate size intercostal chest tube (ICT). These cases then underwent pleurodesis with Doxycycline. For pleurodesis 10 capsule of Doxycycline each carrying 100 mg in it were taken and mixed with 50 ml of normal saline. A repeat chest X-ray and USG chest was done to see for presence of fluid, complete absence of fluid was labelled as efficacious pleurodesis. Results: In this study, there were total 60 cases of malignant pleural effusion (MPE) included, out of which 35 (58.33%) were females and 25 (41.67%) females. The mean age of the subjects was 57.32 ± 7.28 years. There were 29 (48.33%) cases with CA breast, 22 (36.67%) with CA lung and 9 (15%) had the other miscellaneous malignancies. The efficacy of pleurodesis with Doxycycline was seen in 26 (43.33%) of cases. There was significant better efficacy (p=0.001) in cases that had pleural effusion less than 1 liter at presentation where it was seen in 14 (63.64%) of cases as compared to 12 (31.58%) cases that had effusion less than 1 liter. There was no significant difference in terms of duration of pleural effusion with p=0.21. Conclusion: Doxycycline is efficacious in almost half of the cases and it is significantly better in cases that had effusion less than 1 liter.

Discussion on registry study of acupuncture-moxibustion for malignant pleural effusion / 中国针灸

Malignant pleural effusion (MPE) is one of the common complications of tumor. Acupuncture-moxibustion therapy has several advantages for treatment of MPE. Acupuncture is regarded as a complex individualized intervention, and its characteristics of TCM is difficult to be reflected by strict randomized controlled trials. The registry study provides more possibilities for the data collection of individualized diagnosis and treatment under the guidance of the overall concept and syndrome differentiation, and is more suitable for data management and collection of large samples and multi-center trials in the real-world study. It has become an opportunity to carry out real-world study of acupuncture for MPE. There are many challenges in the registry study of acupuncture for MPE. However, it is of great significance to collect real-world data of acupuncture for MPE to improve the clinical effect of MPE and provide a new clinical research method for acupuncture in tumors and related complications.

Implantação e manutenção do sistema APPCC: as barreiras que desafiam as micro e pequenas empresas / Implementation and maintenance of the HACCP system: the barriers that challenge micro and small companies

Os consumidores atuais buscam cada vez mais por alimentos seguros e as indústrias vêm se empenhando em atender às expectativas deste cliente, além de se enquadrar às especificações legais. O sistema APPCC (Análise de Perigos e Pontos Críticos de Controle) tem como foco a garantia da inocuidade dos produtos, porém ainda existem diversas barreiras para a sua implantação, principalmente nas Micro e Pequenas Empresas (MPE). O objetivo deste trabalho foi revisar os conceitos básicos relativos à Segurança dos Alimentos e identificar as principais barreiras para a implantação e manutenção do sistema APPCC nas MPE. A pesquisa foi baseada em livros técnicos específicos e em publicações científicas disponibilizadas por sites de busca referenciados, como o portal de periódicos Capes, Science Direct e Scientific Eletronic Library Online (Scielo), direcionada pelas palavras chaves. Concluiu-se que as principais barreiras para a implantação do APPCC nas MPE são a falta de conhecimento técnico e de motivação por parte dos funcionários e empresários, restrições econômicas e de tempo, além da deficiência de programas governamentais que contemplem as MPE. É necessário um maior comprometimento do setor e o desenvolvimento de políticas públicas voltadas para as MPE, que facilitem a implantação do sistema APPCC, contribuindo assim para o desenvolvimento deste segmento na fabricação de alimentos seguros.

Clinical research on video-assisted thoracoscopic iodine tincture pleurodesis for treating malignant pleural effusion / 中国肿瘤临床

Objective: To observe the therapeutic effect of video-assisted thoracoscopic surgery (VATS) with iodine tincture pleurodesis on malignant pleural effusion (MPE). Methods:Clinical data from 47 MPE cases were retrospectively analyzed. Based on different treatments, the 47 cases were divided into Groups A (n. 25) and B (n. 22), which used iodine tincture and talc powder as a hard-ener, respectively. Provided that all cases were conclusively diagnosed as MPE, and the patients underwent VATS pleural biopsy and pleurodesis, Groups A and B were comparable. The authors then compared the postoperative effectiveness rates (both complete and par-tial remissions), the volume of chest drainage, the incidence of adverse reactions, and the drainage time of the chest tube between the two groups. Results:Difficulty in breathing was proven to be less severe among all cases after the operation, and none of the patients suffered from acute lung injuries. After the operation, Group A exhibited an effectiveness rate of 96.0%, whereas Group B presented a rate of 95.5%, which indicates that no significant difference was found between the two groups (P>0.05). The total incidence of adverse reactions was 32.0%in Group A and 63.6%in Group B, with a significant difference between the two (P<0.05). Conclusion:VATS io-dine tincture pleurodesis has been proven to be as therapeutically effectual as talc pleurodesis and has resulted in fewer adverse reac-tions. This finding suggests that VATS iodine tincture pleurodesis has a promising potential in clinical practice because of its definite cu-rative effect, simple management, high security, fewer adverse reactions, and reasonable cost.

Análise morfométrica e quantitativa dos neurônios do plexo mientérico do ceco de ratos submetidos a intensa carência de proteína / Análisis morfométrica y cuantitativa de las neuronas del plexo mientérico del ceco de ratas sometidos a una intensa carencia de proteína / Quantitative and morphometric analysis of myenteric neuron from the cecum of rats submitted to intensive protein deficiency

Avaliaram-se os efeitos crônicos de uma dieta severamente hipoprotéica, sobre aspectos quantitativos e morfométricos de neurônios mientéricos, NADPH-diaforase positivos do ceco de ratos jovens. Oito ratos foram divididos em dois grupos, sendo que para um dos grupos foi oferecida ração com teor protéico de 26% (controle) e, para o outro, ração com o teor protéico de 4%, mantendo-se o balanço vitamínico e mineral durante 12 semanas. Após eutanásia, o ceco de cada animal foi coletado e dissecado para confecção de preparados de membrana, os quais foram submetidos à técnica da NADPH-diaforase. Para contagem e mensuração destes neurônios, o ceco foi dividido em quatro regiões: apical mesentérica; apical antimesentérica; basal antimesentérica; próxima à ampola cecal. Não se observou alteração significativa para o peso dos animais, área do ceco e densidade populacional dos neurônios mientéricos no final do experimento. Por outro lado, em algumas regiões do ceco, os neurônios tiveram redução da área nuclear, com conseqüente redução da área do pericário

The chronicle effects of a severe hypoproteic diet on quantitative and morphometric aspects of NADPHdiaphorase-positive myenteric neurons from the cecum of young rats were assessed. Eight rats were divided into two groups. One group (control) was fed with 26%-protein chow and the other with 4%-protein chow during 12 weeks. The vitamin and mineral balance was kept. After euthanasia, the cecum of each animal was collected and dissected for the whole-mount preparation, which were submitted to NAPDH-diaphorase. The cecum was divided into four regions for counting and measurement of neurons: apical mesenteric, antimesenteric apical, basal antimesenteric, and next to the cecal ampulla. Significant alterations were not noted with respect to the weight of the animals, cecum area, and population density of myenteric neurons at the end of the experiment. On the other hand, in some regions of the cecum, the neurons presented a reduction of the nuclear area with resulting reduction of the soma area

Se evaluaron los efectos crónicos de una dieta severamente hipoprotéica, sobre aspectos cuantitativos y morfométricos de neuronas mientéricos, NADPH-diaforase positivos del ceco de ratas jóvenes. Ocho ratas fueron divididas en dos grupos, siendo que para uno de los grupos fue ofrecida ración con tenor proteico de 26% (control) y, para el otro, ración con el tenor proteico de 4%, manteniéndose el balance vitamínico y mineral durante 12 semanas. Tras eutanasia, El ceco de cada animal fue recolectado y disecado para confección de preparados de membrana, los cuales fueron sometidos a la técnica de la NADPH-diaforase. Para recuento y mensuración de estas neuronas, el ceco fue dividido en cuatro regiones: apical mesentérica, apical antimesentérica, basal antimesentérica y próxima a la ampolla cecal. No se observó alteración significativa en el peso de los animales, área del ceco y densidad poblacional de las neuronas mientéricas al final Del experimento. Por otro lado, en algunas regiones del ceco las neuronas tuvieron reducción del área nuclear, con consecuente reducción del área del pericario

Quantitative Study of the Myenteric Plexus of the Descending Colon of Young Rats Subjected to Intense Protein Deficiency / Estudio Cuantitativo del Plexo Mientérico del Colon Descendente de Ratas Jóvenes Sometidas a Intensa Deficiencia Proteica

We studied the effects of a severely hypoproteic diet on the quantitative aspects of the myenteric plexus of the descending colon of young rats. Eighteen rats were divided into two groups, one of them being fed with a chow having 26% protein (control) and the other with a chow having 4% protein, balanced for minerals and vitamins, during 12 weeks. The whole-mounts of the descending colon had their myenteric neurons stained either with Giemsa or NADPH diaphorase. The rats from the experimental group had deficits of body weight (54.23%) and area of the descending colon (48.14%); additionally, we observed that there was no alteration in the total number of neurons of the colon, but a decrease in the number of NADPH-diaphorase positive neurons (37.80%). The implications of these results concerning the priority that some cellular types may have when nutrients are less available are discussed.

Estudiamos los efectos crónicos de una dieta severamente hipoproteica sobre los aspectos cuantitativos del plexo mientérico del colon descendente de ratones jóvenes. 18 ratones fueron divididos en dos grupos, a uno de estos grupos se le dió ración con contenido proteico del 26% (control) y al otro, ración con contenido proteico del 4%. Se mantuvo el balance vitamínico y mineral, durante 12 semanas. Elaboramos los preparados de membrana del colon descendente y marcamos las neuronas del plexo mientérico con Giemsa y NADPH-diaforasa. Los ratones del grupo experimental presentaron déficit de peso corporal (54,23%) y del área del colon descendente (48,14%); además, observamos que no hubo alteración en el número total de neuronas en todo el colon; sin embargo, hubo una disminución en la marcación de neuronas NADPH-diaforasa positivas (37,80%). Los resultados son discutidos, respecto a la prioridad que ciertos tipos celulares pudiesen tener, con la menor disponibilidad de nutrientes.

Biometric and food consumption parameters of rats subjected to hypoproteic and hipercaloric diet / Parâmetros biométricos e de consumo alimentar de ratos submetidos à dieta hipoprotéica e hipercalórica / Parámetros biométricos y de consumo alimentar de ratones sometidos a la dieta hipoprotéica e hipercalórica

A carência de proteínas, causando Kwashiorkor, é o tipo de má-nutrição mais prevalente, pois fontes de alimentos protéicos, geralmente, são mais onerosas. Para estudos experimentais, o rato tem sido o principal modelo para avaliar as conseqüências de ingestão de dietas com diferentes teores protéicos, contudo ainda não estão claros os níveis de severidade dessas dietas para essa espécie. Nesse sentido, propõe-se avaliar a severidade de uma dieta hipoprotéica a 4% para ratos jovens. Para tanto, utilizaram-se 30 ratos Wistar (90 dias de idade), os quais foram divididos em dois grupos: controle (GC) e experimental (GC). O GC recebeu dieta normoprotéica, enquanto o GE recebeu dieta com 4% de teor de proteínas, ambos, durante 12 semanas. No final do experimento, avaliaram-se o peso, o crescimento, a massa gorda e massa magra dos animais. Os animais do GE não ganharam peso, tiveram retardo no crescimento, formaram menos massa gorda e menos massa muscular.

ABSTRACT: The protein lack causing Kwashiorkor is the most prevalent kind of malnutrition, because the food sources of proteins are usually more expensive. For experimental investigations, the rat has provided the primary model to evaluate the consequences of the ingestion of diets with different protein levels; however, the degrees of severity of these diets for thesespecies are still not clear. In this sense, we aimed at evaluating the severity of a 4%-hypoproteic diet on young rats. We used30 Wistar rats (90 days old), which were divided in two groups: control (CG) and experimental (EG). CG rats were fed with normoprotein chow, while EG rats were fed with a chow having 4% protein, for 12 weeks. At the end of the experiment, we evaluated the weight, growth, and fat and lean masses of the animals. The rats from EG did not gain weight, they had growth retardation, and built less fat and muscle masses.

RESUMO: A carência de proteínas, causando Kwashiorkor, é o tipo de má-nutrição mais prevalente, pois fontes de alimentos protéicos, geralmente, são mais onerosas. Para estudos experimentais, o rato tem sido o principal modelo para avaliar as conseqüências de ingestão de dietas com diferentes teores protéicos, contudo ainda não estão claros os níveis de severidade dessas dietas para essa espécie. Nesse sentido, propõe-se avaliar a severidade de uma dieta hipoprotéica a 4% para ratos jovens. Para tanto, utilizaram-se 30 ratos Wistar (90 dias de idade), os quais foram divididos em dois grupos: controle (GC) e experimental (GC). O GC recebeu dieta normoprotéica, enquanto o GE recebeu dieta com 4% de teor de proteínas, ambos, durante 12 semanas. No fi nal do experimento, avaliaram-se o peso, o crescimento, a massa gorda e massa magra dos animais. Os animais do GE não ganharam peso, tiveram retardo no crescimento, formaram menos massa gorda e menos massa muscular.

Hematologic and biochemical parameters of rats subjected to hypoproteic and hipercaloric diet / Parâmetros hematológicos e bioquímicos de ratos submetidos à dieta hipoprotéica e hipercalórica / Parámetros hematológicos y bioquímicos de ratones sometidos a la dieta hipoprotéica e hipercalórica

A má-nutrição é um problema de saúde pública que ainda assola crianças e adultos no mundo inteiro, principalmente em países em desenvolvimento. A carência de proteínas, causando Kwashiorkor, é o tipo de má-nutrição mais prevalente, pois fontes de alimentos protéicos, geralmente, são mais onerosas. Uma dieta hipoprotéica causa alterações metabólicas num animal em intensidades diretamente proporcionais ao nível de depleção de proteínas, bem como o tempo em que o indivíduo permanece sob o estado de subnutrição. Nesse sentido, propõe-se avaliar a severidade de uma dieta hipoprotéica a 4% para ratos jovens. Utilizam-se 30 ratos Wistar (90 dias de idade), divididos em grupo controle (15) e experimental (15). O GC recebeu dieta normoprotéica, enquanto o GE recebeu dieta com 4% de teor de proteínas, ambos durante 12 semanas. No final do experimento, sangue foi coletado para realização de hemograma e dosagem de atividade de fosfatase alcalina, alanina aminotrasferase, além da concentração de proteínas totais e frações, colesterol total, triglicerídeos, uréia, ácido úrico, T3, T4 e aminoácidos plasmáticos. Os animais do GE demonstraram menor atividade defosfatase alcalina no sangue, anemia microcítica normocrômica, hipoproteinemia, hipoglobulinemia, reduação na concentração plasmática de triglicerídeos, aumento da concentração plasmática de T3 e T4 e diminuição da concentração plasmática dos seguintes aminoácidos: metionina, fenilalanina, valina, leucina e isoleucina.

ABSTRACT: Malnutrition is a public health issue which still affects children and adults all over the world, especially in developing countries. Protein defi ciency causing Kwashiorkor is the most prevalent type of malnutrition, because protein-rich foods are generally expensive. A hypoproteic diet causes metabolic alterations in an animal which are directly proportional to the degree of protein depletion, as well as to the duration of the malnutrition. In this sense, we proposed to evaluate the severity of a 4%-hypoproteic diet in young rats. We used 30 Wistar rats (90 days of age), divided in control (CG, n=15) and experimental (EG, n=15) groups. CG was fed with a normoprotein chow, while EG was fed with a diet having 4% protein, for 12 weeks. At the end of the experiment, blood was collected for determination of the hemogram, activities of alkaline phosphatase and alanine aminotransferase, and concentration of total and fractional proteins, total cholesterol, triglycerides,urea, uric acid, T3, T4 and plasma aminoacids. The animals from EG had lower activity of the alkaline phosphatase enzyme in blood, normochromic microcytic anemia, hypoproteinemia, hypoglobulinemia, decreased plasma triglyceride concentration, increased plasma concentrations of T3 and T4, and decreased plasma concentrations of the following aminoacids: methionine, phenylalanine, valine, leucine and isoleucine

RESUMEN: La mala nutrición es un problema de salud pública que todavía aniquila niños y adultos en el mundo entero, principalmente en países en desarrollo. La falta de proteínas, causando Kwashiorkor, es el tipo de mala nutrición más común, pues fuentes de alimentos proteicos, generalmente, son más caras. Una dieta poco proteica causa alteraciones metabólicas en un animal en intensidades directamente proporcionales al nivel de depleción de proteínas, así como el tiempo en que el individuo queda bajo el estado de baja nutrición. En ese sentido, proponemos evaluar la severidad de una dieta de bajo contenido proteico al 4% para ratones jóvenes. Utilizamos 30 ratones Wistar (90 días de edad), divididos en grupo control (15) y experimental (15). El GC recibió dieta normoproteica, mientras el GE recibió dieta con el 4% de cantidad de proteínas, ambos durante 12 semanas. Al fi nal del experimento, sangre fue recolectado para realización del examen de la sangre y cantidad de actividad de fosfatase alcalina, alanina aminotrasferase, además de la concentración de proteínas totales y fracciones, colesterol total, triglicerídeos, urea, ácido úrico, T3, T4 y aminoácidos plasmáticos. Los animales del GE demostraron menor actividad de fosfatase alcalina en la sangre, anemia microcítica normocrómica, hipoproteinemía, hipoglobulinemia, reducción en la concentración plasmática de triglicerídeos, aumento de la plasmática de T3 y T4 y disminución de la concentración plasmática de los siguientes aminoácidos: metionina, fenilalanina, valina, leucina y isoleucina