The mechanisms underlying the pronociceptive effect of paradoxical sleep deprivation (PSD) are not known. In this study, we asked whether PSD increases tonic nociception in the formalin test, decreases the antinociceptive effect of morphine administered into the periaqueductal gray matter (PAG), and disrupts endogenous descending pain modulation. PSD for either 24 or 48 h significantly increased formalin-induced nociception and decreased mechanical nociceptive paw withdrawal threshold. The maximal antinociceptive effect induced by morphine (0.9-9 nmol, intra-PAG) was significantly decreased by PSD. The administration of a low dose of the GABAA receptor antagonist, bicuculline (30-300 pmol, intra-PAG), decreased nociception in control rats, but not in paradoxical-sleep-deprived ones. Furthermore, the administration of the cholecystokinin (CCK) 2 receptor antagonist, YM022 (0.5-2 pmol) in the rostral ventral medulla (RVM), decreased nociception in paradoxical-sleep-deprived rats but not in control ones. While a dose of the CCK 2 receptor agonist, CCK-8 (8-24 pmol intra-RVM), increased nociception in control rats, but not in paradoxical-sleep-deprived ones. In addition, the injection of lidocaine (QX-314, 2%, intra-RVM) decreased nociception in sleep-deprived rats, but not in control rats, while the lesion of the dorsolateral funiculus prevented the pronociceptive effect of PSD. Finally, PSD significantly increased c-Fos expression in the RVM. Therefore, PSD increases pain independently of its duration or of the characteristic of the nociceptive stimulus and decreases morphine analgesia at the PAG. PSD appears to increase pain by decreasing descending pain inhibitory activity and by increasing descending pain facilitatory activity.

In Brazil, cancer treatment may be covered by both private health insurance and the Unified Health System (SUS). The latter was created by Law nº 8,080 of September 19 th , 1990, with the aim of ensuring comprehensive, universal and free access to health care for the entire population of the country. However, although patients have access to treatment, the disease affects other

As important as perceiving pain is the ability to modulate this perception in some contextual salient situations. The periaqueductal gray (PAG) is perhaps the most important site of endogenous pain modulation; however, little is known about dopaminergic mechanisms underlying PAG-mediated antinociception. In this study, we used a pharmacological approach to evaluate this subject. We found that µ-opioid receptor-induced antinociception (DAMGO, 0.3 μg) from PAG was blocked by the coadministration of either D1-like or D2-like dopaminergic antagonists (SCH23390, 2, 4, and 6 μg or raclopride, 2 and 4 μg, respectively) both in the tail-flick and in the mechanical paw-withdrawal test. A selective D2-like receptor agonist (piribedil, 6 and 12 μg into the PAG) induced antinociception in the mechanical paw-withdrawal test, but not in the tail-flick test. This effect was blocked by the coadministration of its selective antagonist (raclopride 4 μg), as well as by either a GABAA agonist (muscimol, 0.1 μg) or an opioid receptor antagonist (naloxone, 0.5 μg). A selective D1-like receptor agonist (SKF38393, 1, 5, and 10 μg into the PAG) induced a poor and transient antinociceptive effect, but when combined with piribedil, a potentiated antinociceptive effect emerged. None of these treatments affected locomotion in the open-field test. These findings suggest that µ-opioid antinociception from the PAG depends on dopamine acting on both D1-like and D2-like receptors. Selective activation of PAG D2-like receptors induces antinociception mediated by supraspinal mechanisms dependent on inhibition of GABAA and activation of opioid neurotransmission.

Objective: To assess the quality of life of patients with advanced cancer in palliative therapy and in palliative care. Materials and Methods: Quantitative, observational, cross-sectional, and analytic study conducted in a teaching hospital in Paraná, Brazil, from January to June 2018, with 126 patients: 107 in palliative therapy; 19 in exclusive palliative care. The questionnaires for data collection were: Quality of Life Questionnaire-Core 15-Palliative, Functional Assessment of Chronic Illness Therapy-Palliative Care 14, and Edmonton Symptom Assessment System. The Spearman non-parametric coefficient test was used for the analysis. Results: The overall quality of life in palliative therapy and in palliative care was, respectively, 71.54/59.65; when correlating the total score of quality of life of the Quality of Life Questionnaire-Core 15-Palliative with the Functional Assessment of Chronic Illness Therapy-Palliative Care 14 (p = 0.001), and the Edmonton Symptom Assessment System (p = 0.001), significant difference of better quality of life was observed in the palliative therapy. Conclusion: Patients in palliative therapy have good overall quality of life, while the palliative care group reports regular quality of life. The symptoms were milder in the palliative therapy and more intense and with greater significance in palliative care; hence, knowing the compromise of quality of life will help professionals in planning interventions with transdisciplinary approach for patients and for their families.

Objective: to evaluate the criterion validity and reliability of the Portuguese-Brazilian version of the Wound Quality of Life. Methods: methodological research with 100 participants. For criterion and reliability validation, the items in the Wound Quality of Life questionnaires were correlated with the Freiburg Life Quality Assessment Wound - Wound Version, using the Spearman correlation test and Cronbach’s alpha. Results: the validity of concurrent criteria had a strong magnitude (0.85) when correlated with the Freiburg Life Quality Assessment Wound; the internal consistency had a Cronbach’s alpha of 0.84. Conclusion: the validated questionnaire has good psychometric properties, is brief, easy to apply and reliable for assessing the quality of life of patients with wounds that are difficult to heal.

Objective: To assess the domains of quality of life related to hematologic cancer patient health in the first three years from autologous and allogeneic hematopoietic stem cell transplantation. Method: A prospective cohort from September 2013 to February 2019 at a reference service in Latin America with 55 patients. The instruments Quality of Life Questionnaire Core C30 and Functional Assessment Cancer Therapy – Bone Marrow Transplantation were used. For data analysis, Generalized Linear Mixed Model was used. Results: The domains global and overall quality of life presented the lowest scores in the pancytopenia phase: 59.3 and 91.4 in autologous, 55.3 and 90.3 in allogeneic. The mixed method analysis has shown that there was a significant change in scores between the phases throughout the treatment (p< 0.05). Conclusion: Health-related quality of life presented significant changes in the domains between the phases throughout time. Understanding these results enables nursing interventions directed at the domains which were damaged during treatment.

Objetivo:  avaliar os domínios que comprometem a qualidade de vida de pacientes com câncer avançado em tratamento quimioterápico paliativo e cuidado paliativo. Método: Trata-se de uma scoping review realizada de março a maio de 2018, nas bases de dados CINAHL, LILACS, PubMed, Cuiden e na literatura cinzenta (Google Scholar e referências encontradas nos artigos analisados), utilizando os descritores “palliative care”,“quality of life”,“emotionalcare”, “functional care”,“sexual care”, “physical care”,“social care”,“comfort care”,“spiritual care”,“palliative chemotherapy” e “cancer advanced”. Foi realizada avaliação da qualidade metodológica por meio do instrumento STROBE para estudos observacionais e o CONSORT para os ensaios clínicos. Resultados: Os nove artigos encontrados e analisados são internacionais, publicados entre 2012 e 2016, com boa qualidade metodológica. Os domínios identificados foram os físicos, sociais e emocionais; o internamento hospitalar e local de óbito são fatores que também comprometeram a qualidade de vida. Conclusão: os pacientes em quimioterapia paliativa possuem baixa qualidade de vida. Porém, a presença de familiar e o acompanhamento concomitante com o serviço de cuidados paliativos melhoram essa situação. A avaliação dos pacientes, com enfoque nestes domínios, permite à Enfermagem adotar estratégias para melhoraria da qualidade de vida.

Objetivou-se correlacionar as preocupações adicionais e o desempenho pessoal com a qualidade de vida geral/global dos pacientes adultos com câncer hematológico, hospitalizados para o transplante de células-tronco hematopoiéticas autólogo e alogênico.Estudo longitudinal, observacional e analítico, realizado em hospital público do sul do Brasil com 55 pacientes. A coleta de dados foi realizada entre setembro de 2013 e novembro de 2015. Foram utilizados os questionários sociodemográfico e clínico, Quality of Life Questionnarie Core-30 e o Functional Assessment of Câncer Therapy – Bone Marrow Transplant. Os dados foram avaliados com o auxílio do software Statística 7.0. A média de idade para o transplante autólogo foi de 45 anos, com predomínio do diagnóstico de mieloma múltiplo; para o alogênico foi de 31 anos com predomínio da leucemia. A qualidade de vida geral/global, o desempenho pessoal e as preocupações adicionais caracterizadas pela imagem corporal, fadiga, sexualidade e apetite apresentaram médias significativamente menores no período de pancitopenia em relação ao basal, com gradativa melhora no período pré-alta hospitalar. Conclui-se que o transplante é uma terapêutica com potencial papel de cura, no entanto, acarreta em impactos negativos nos domínios da qualidade de vida, desempenho pessoal, preocupações adicionais e na experiência de vida dos receptores.