Micronized palmitoylethanolamide/trans-polydatin treatment of endometriosis-related pain: a meta-analysis

Aim. To demonstrate clinical effectiveness of micronized palmitoylethanolamide-transpolydatin combination in reducing endometriotic chronic pelvic pain. Other endometriotic- pains were also assessed. Methods. Systematic reviews of PubMed, SCIELO, Scopus, and AJOL. Randomized trials and observational studies reporting a visual analogue scale for pain or similar in endometriotic patients were reviewed. A mean improvement of visual analogue scale (or visual analogue scale-like) scores at enrollment and at a three-month follow-up was assessed and interpreted clinically. Results. Four studies of poor quality were available. In a heterogeneous sample of endometriotic patients with pain, the administration of micronized palmitoylethanolamide/ trans-polydatin (400 mg/40 mg) twice a day for three months provided a clinically relevant improvement of chronic pelvic pain and dysmenorrhea while improving deep dyspareunia to a limited degree. No clinically relevant improvement was found for dyschezia. Conclusion. More studies are warranted for assessing the drugs-related efficacy

Spinoza, B., Obras.

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Geometry in Action: A Curriculum Unit Utilizing Dynamic Geometry Software to Enhance Students’ Comprehension

The paper identifies two critical obstacles to student success in a traditional geometry classroom and examines the role dynamic geometry software can play in overcoming these obstacles

The safety profile of drotrecogin alfa (activated)

Continued safety assessment is essential for any newly approved therapy. Drotrecogin alfa (activated; DrotAA), which is approved for use in severe sepsis, has undergone clinical trials with corresponding safety analyses since 1995. However, the only comprehensive review of all trials is that reported in 2003 by Bernard and coworkers. This is an important review that focuses on the safety profile of DrotAA in all published studies (six randomized clinical trials and five national registry studies) and in previously unpublished data. DrotAA treatment is associated with an increased risk for bleeding (which in general is manageable). Nevertheless, the available evidence shows that any adverse effects of DrotAA are outweighed by its benefits in patients with severe sepsis who are at high risk for death. So far, more than 9,000 patients have been enrolled in clinical trials involving DrotAA, providing a valuable safety database. It is of note that although DrotAA does increase the risk of bleeding, this has not been associated with an overall increase in the rate of all severe adverse events

Experimental study of bitumen emulsion–cement mortars: mechanical behaviour and relation to mixtures

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Micronized palmitoylethanolamide/trans-polydatin treatment of endometriosis-related pain: a meta-analysis.

Objectives. 1. To demonstrate clinical effectiveness of micronized palmitoylethanolamide-trans-polydatin combination in reducing endometriotic chronic pelvic pain (main objective); 2. To reduce other endometriotic-associated pain; 3. To assess the effects of this treatment in patient sub-groups; 4. To demonstrate that such therapy modifies natural history of the disease. Data sources. Systematic reviews of PubMed, SCIELO, Scopus, and AJOL, without regard to time frame and other limits. Study eligibility criteria. Randomized trials and observational studies reporting a visual analogue scale for pain or similar assessments at enrollment and at least at one follow-up in endometriotic patients. Study appraisal and synthesis methods: stringent, subjective, semi-quantitative assessment of study quality in relation to data availability and results exposure; additional assessment of study availability to meet meta-analysis objectives. Quantifying of mean improvement of visual analogue scale (or visual analogue scale-like) scores at enrollment and at a three month-follow-up. Interpreting data from a clinical point of view, according to generally accepted criteria. Results. Data were collected from 4 studies of poor quality (5 effect sizes). These were unable to satisfy objectives 3 and 4, and partially answered objective 2. In a heterogeneous sample of endometriotic patients with pain, the oral administration of micronized palmitoylethanolamide/trans-polydatin (400 mg/40 mg) twice a day for three months provided a clinically relevant improvement in chronic pelvic pain and dysmenorrhea while improving deep dyspareunia to a limited degree. No clinically relevant improvement was found for dyschezia. Conclusion. The combination of micronized palmitoylethanolamide/trans-polydatin appears to be a promising treatment for chronic pelvic pain and, possibly, other acute pain in endometrioic patients. More good-quality evidence on this treatment is warranted

Peripheral arterial blood pressure monitoring adequately tracks central arterial blood pressure in critically ill patients: an observational study

INTRODUCTION: Invasive arterial blood pressure monitoring is a common practice in intensive care units (ICUs). Accuracy of invasive blood pressure monitoring is crucial in evaluating the cardiocirculatory system and adjusting drug therapy for hemodynamic support. However, the best site for catheter insertion is controversial. Lack of definitive information in critically ill patients makes it difficult to establish guidelines for daily practice in intensive care. We hypothesize that peripheral and central mean arterial blood pressures are interchangeable in critically ill patients. METHODS: This is a prospective, observational study carried out in a surgical-medical ICU in a teaching hospital. Fifty-five critically ill patients with clinical indication of invasive arterial pressure monitoring were included in the study. No interventions were made. Simultaneous measurements were registered in central (femoral) and peripheral (radial) arteries. Bias and precision between both measurements were calculated with Bland-Altman analysis for the whole group. Bias and precision were compared between patients receiving high doses of vasoactive drugs (norepinephrine or epinephrine >0.1 μg/kg/minute or dopamine >10 μg/kg/minute) and those receiving low doses (norepinephrine or epinephrine <0.1 μg/kg/minute or dopamine <10 μg/kg/minute). RESULTS: Central mean arterial pressure was 3 ± 4 mmHg higher than peripheral mean arterial pressure for the whole population and there were no differences between groups (3 ± 4 mmHg for both groups). CONCLUSION: Measurement of mean arterial blood pressure in radial or femoral arteries is clinically interchangeable. It is not mandatory to cannulate the femoral artery, even in critically ill patients receiving high doses of vasoactive drugs

Spinoza, B., Obras.

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Intrinsic innervation and dopaminergic markers after experimental denervation in rat thymus

The aim of this study was to examine rat thymus innervation using denervation techniques and to explore the related micro-anatomical localization of dopamine, D1, D2 receptors and dopamine membrane transporter (DAT). In the thymus subcapsular region, the parenchymal cholinergic fibers belong exclusively to phrenic nerve branching. No somatic phrenic nerve branching was detected in any other analysed thymus lobule regions. In rats subjected to sympathetic or parasympathetic ablation, it was observed that catecholaminergic and cholinergic nerve fibers respectively contributed to forming plexuses along vessel walls. In the subcapsular and septal region, no parenchymal nerve branching, belonging to sympathetic or parasympathetic nervous system was noted. Instead, in the deep cortical region, cortico-medullary junction (CM-j) and medulla, catecholaminergic and cholinergic nerve fibers were detected along the vessels and parenchyma. Dopamine and dopamine receptors were widely diffused in the lobular cortico-medullary junction region and in the medulla, where the final steps of thymocyte maturation and their trafficking take place. No variation in dopamine and DAT immune reaction was observed following total or partial parasympathectomy or phrenic nerve cutting. After chemical or surgical sympathectomy however, neither dopamine nor DAT immune reaction was noted again. Instead, D1 and D2 dopamine receptor expression was not affected by thymus denervation. In rats subjected to specific denervation, it was observed the direct intraparenchymal branching of the phrenic nerve and sympathetic and parasympathetic fibers into thymus parenchyma along vessels. These findings on the dopaminergic system highlight the importance of neurotransmitter receptor expression in the homeostasis of neuroimmune modulation