Uma leitura teórico-clínica de uma análise: o fato clínico como operador metodológico / A theoretical-clinical reading of an analysis: the clinical fact as a methodological operator / Una lectura teórico-clinica del análisis: el hecho clínico como herramienta metodológica

O presente artigo é oriundo de pesquisa acadêmica que teve como objetivo estudar a clínica psicanalítica e seus efeitos por meio da apresentação de fragmentos de uma análise já encerrada. Para alcançar esse objetivo, utilizamos a ferramenta metodológica do fato clínico, articulando o material clínico com alguns pontos da teoria psicanalítica. Como resultado, apontamos que é possível fazer uma leitura teórico-clínica de uma experiência de análise sob a perspectiva dos movimentos discursivos, em especial do sujeito do inconsciente ($) e do objeto a, conforme apresentados na proposição dos Quatro Discursos de Lacan. Acreditamos que este estudo enfatiza a importância da especificidade da pesquisa em psicanálise em sua dimensão clínica e os possíveis efeitos produzidos por esse processo terapêutico. Dessa maneira, entendemos que a divulgação deste trabalho pode contribuir para a discussão da prática clínica entre colegas do campo psicanalítico e acadêmico, bem como para a difícil tarefa da apresentação do material clínico com a sustentação teórica necessária, a fim de fortalecermos a sempre fundamental transmissão da psicanálise.(AU)

This article comes from academic research that aimed to study the psychoanalytic clinic and its effects by presenting fragments of an analysis that has already ended. To achieve this goal, we used the methodological tool of the clinical fact, articulating the clinical material with some points of psychoanalytic theory. As a result, we point out that it is possible to make a theoretical-clinical reading of an analysis experience from the perspective of discursive movements, in particular, the subject of the unconscious ($) and of the object a, as presented in the proposition of Lacan's Four Discourses. We believe that this study emphasizes the importance of the specificity of research in psychoanalysis in its clinical dimension and the possible effects produced by this therapeutic process. In this way, we understand that the dissemination of this work can contribute to the discussion of clinical practice among colleagues in the psychoanalytic and academic fields, as well as to the difficult task of presenting clinical material with the necessary theoretical support, to strengthen the always fundamental transmission of psychoanalysis.(AU)

Este artículo surge de una investigación académica que pretendió estudiar la clínica psicoanalítica y sus efectos mediante la presentación de fragmentos de un análisis que ya terminó. Para lograr este objetivo, se utilizó la herramienta metodológica del hecho clínico articulando el material clínico con algunos puntos de la teoría psicoanalítica. El resultado permite señalar que es posible realizar una lectura teórico-clínica de una experiencia de análisis desde la perspectiva de los movimientos discursivos, en particular el sujeto del inconsciente ($) y el objeto a, como se presenta en la proposición de los cuatro discursos de Lacan. Este estudio enfatiza la importancia de la especificidad de la investigación en psicoanálisis en su dimensión clínica y los posibles efectos que produce este proceso terapéutico. De esta forma, la difusión de este trabajo puede contribuir a la discusión de la práctica clínica entre colegas del campo psicoanalítico y académico, así como a la difícil tarea de presentar material clínico con el soporte teórico necesario para fortalecer la siempre fundamental transmisión del psicoanálisis.(AU)

Analysis and clinical significance of cytochrome P 450 2C19 gene in patients with cardiovascular and cerebrovascular diseases in southern Yunnan / 中国基层医药

Objective:To analyze the distribution and clinical significance of cytochrome P 450 2C19 (CYP2C19) gene in patients with cardiovascular and cerebrovascular diseases in southern Yunnan. Methods:The data of 245 patients with cardiovascular and cerebrovascular diseases who received treatment in Southern Central Hospital of Yunnan Province between May 2019 and June 2020 were retrospectively analyzed. The distribution of CYP2C19 gene and its relationship with nationality, age, sex, blood lipids, hypertension, and diabetes were analyzed and compared between southern Yunnan and other regions.Results:The proportions of seven phenotypes of CYP2C19 gene *1/*17, *1/*1, *1/*2, *1/*3, *2/*2, *2/*3, *3/*3 in 245 patients were 2.86%, 38.37%, 39.18%, 5.31%, 9.39%, 4.08% and 0.82%, respectively. The proportions of individuals with superfast/ultrafast metabolism, fast metabolism, intermediate metabolism, and slow metabolism in 245 patients were 2.86%, 38.37%, 44.49%, and 14.29%, respectively. The frequency of polymorphisms in the CYP2C19 gene was consistent with the Hardy-Weinberg equilibrium ( P > 0.05), which was constant and representative. The Fisher test showed that the CYP2C19 gene distribution of patients with cardiovascular and cerebrovascular diseases in southern Yunnan was not greatly correlated with nationality, age, sex, underlying disease, blood lipids, and the types of cardiovascular and cerebrovascular diseases (all P > 0.05). There was a significant difference in CYP2C19 gene distribution in patients from southern Yunnan versus Dongguan, Jiangxi, Fujian, northern Sichuan, Chifeng, Xiamen, Shaanxi, and Kunming ( P < 0.001, < 0.001, 0.045, 0.008, 0.001, 0.005, < 0.001, 0.016). Conclusion:The distribution of CYP2C19 gene in patients with cardiovascular and cerebrovascular diseases in southern Yunnan is not obviously correlated with nationality, age, sex, underlying diseases, blood lipids, and the types of cardiovascular and cerebrovascular diseases. CYP2C19 gene distribution is related to regional distribution, which can guide personalized medication in different regions.

Correlation between circadian blood pressure pattern and heart rate variability and stroke severity and outcome in patients with acute ischemic stroke / 国际脑血管病杂志

Objective:To investigate the correlation between circadian blood pressure pattern and heart rate variability and stroke severity and outcome in patients with acute ischemic stroke (AIS).Methods:Patients with first-ever AIS admitted to the Affiliated Qingdao Central Hospital of Qingdao University from January 2015 to January 2021 were retrospectively included. Ambulatory blood pressure monitoring (ABPM) and ambulatory electrocardiogram (AECG) were performed after admission. The severity of stroke was assessed according to the National Institutes of Health Stroke Scale. ≤8 were defined as minor stroke, and >8 were defined as moderate to severe stroke. The modified Rankin Scale was used to evaluate the clinical outcome at 3 months after onset. ≤ 2 were defined as good outcomes, and >2 were defined as poor outcomes. Multivariate logistic regression analysis was used to determine the independent influencing factors of stroke severity and outcome. Results:A total of 516 patients with AIS were enrolled, including 328 male (63.57%), aged 59.62±6.67 years old. Among them, 266 patients (51.55%) were in the minor stroke group and 250 (48.45%) were in the moderate to severe stroke group. There were 463 patients (89.73%) were in the good outcome group and 53 (10.27%) were in the poor outcome group. Multivariate logistic regression analysis showed that hypertension (odds ratio [ OR] 5.021, 95% confidence interval [ CI] 2.635-10.923; P<0.001), atrial fibrillation ( OR 3.896, 95% CI 2.574-8.521; P<0.001), circadian blood pressure pattern (non-dipper type: OR 2.436, 95% CI 1.031-4.749, P<0.001; reverse dipper type: OR 2.654, 95% CI 1.642-5.268, P<0.001), SDNN ( OR 0.298, 95% CI 0.114-0.730; P=0.002), SDANN ( OR 0.325, 95% CI 0.200-0.679; P=0.009), rMSSD ( OR 0.437, 95% CI 0.255-0.876; P=0.016) and pNN50 ( OR 0.369, 95% CI 0.291-0.767; P=0.013) were the independent influencing factors of stroke severity. Hypertension ( OR 4.857, 95% CI 1.957-8.552; P<0.001), baseline NIHSS score ( OR 2.189, 95% CI 1.597-3.315; P<0.001), stroke severity ( OR 3.853, 95% CI 2.316-5.958; P<0.001), circadian blood pressure pattern (non-dipper type: OR 2.997, 95% CI 1.128-5.430, P<0.001; reverse dipper type: OR 3.703, 95% CI 1.478-5.902; P<0.001), SDNN ( OR0.369, 95% CI 0.215-0.779; P=0.015), SDANN ( OR 0.372, 95% CI 0.198-0.862; P=0.018), rMSSD ( OR 0.455, 95% CI 0.314-0.896; P=0.026) and pNN50 ( OR 0.448, 95% CI 0.307-0.825; P=0.021) were the independent influencing factors of poor outcomes. Conclusion:The non-dipper and reverse dipper circadian blood pressure patterns and lower heart rate variability are independently associated with stroke severity and poor outcomes in patients with AIS.

A Fact-Finding Survey on Descriptions about “What to Do When Patients Missed a Dose” in “Drug Guides for Patients” and “Kusuri-no-Shiori®” / 医薬品情報学

Objective: The guidance on “what to do when patients missed a dose” is an important item of medication instructions; however, only a small number of prescription drugs contain it. The “Drug Guide for Patients” and “Kusuri-no-Shiori” are documents designed to facilitate medication instructions for patients, having a section on “what to do when patients missed a dose.” Specific descriptions under it differ among medication instruction documents for some drugs, including those containing the same active pharmaceutical ingredients; however, the actual status of such discrepancies has not been clarified. In this study, we conducted a fact-finding survey to clarify such discrepancies using two medication instruction documents for drugs containing the same active pharmaceutical ingredients.Methods: The medication instructions of “Drug Guides for Patients” and “Kusuri-no-Shiori” for 532 active pharmaceutical ingredients used in oral drugs were included in the survey. After reading the descriptions under the “what to do when patients missed a dose” section, we divided them into six groups and determined whether the descriptions for the same ingredient in the documents fell in the same group.Results: For 186 ingredients (35.0%), we identified discrepancies between the documents. Among these, the instructions for 61 ingredients (11.5%) contained contradicting descriptions, such as “take the missed dose as soon as you remember” in one document and “always let go of the missed dose” in another document.Conclusions: A substantial number of discrepancies in descriptions about “what to do when patients missed a dose” were found between the two documents, raising concerns of confusion in medication instructions when the documents used were different. Therefore, the descriptions should be improved to resolve the discrepancies among medication instruction documents. Moreover, it is important for pharmacists or other healthcare professionals to review the descriptions thoroughly before using the document to provide appropriate medication instructions without confusion.

Wittgenstein por Lacan: considerações sobre a concepção de fato / Wittgenstein by Lacan: remarks on the conception of fact

Resumo: Examinamos a abordagem lacaniana do conceito de fato a partir de um ponto que nos parece estratégico: as considerações feitas pelo psicanalista sobre o tratamento dado por Wittgenstein a este conceito em seu Tractatus Logico-Philosophicus. Por um lado, o trabalho explora o caráter promissor que Lacan enxerga nesse tratamento (afirmando que a metalinguagem almejada pela filosofia é impossível e que não há outro acesso ao fato senão via linguagem), mas, por outro lado, as elucidações acerca desse ponto nos conduzirão às divergências que há entre filósofo e psicanalista no que concerne à verdade e ao que pode e ser dito verdadeiramente.

Abstract: We examine the Lacanian approach to the concept of fact departing from a point that we repute as being a strategic one: the psychoanalyst's considerations on Wittgenstein's treatment of this concept in the Tractatus Logico-Philosophicus. On the one hand, our work explores the promising character that Lacan finds in this treatment (claiming that the meta-language longed for by philosophy is impossible and that there is no other access to fact except via language), whereas, on the other hand, the elucidations concerning this point lead us to the differences between philosopher and psychoanalyst with regard to truth and to what can be said truthfully.

Serei Aceito? Estudo Exploratório Sobre as Vivências Emocionais do Segundo Psicoterapeuta / Will I be accepted? Exploratory study on the emotional experiences of the second therapist

Durante a graduação, os acadêmicos de Psicologia realizam estágios obrigatórios nos serviços-escola das universidades, incluindo a modalidade de atendimento em psicoterapia individual. A relação transferencial estabelecida é atravessada por emoções advindas tanto do paciente quanto do psicoterapeuta, que podem contribuir para o estabelecimento da aliança terapêutica e também para o abandono do processo terapêutico. A transferência e a contratransferência têm sido abordadas em diversas publicações, mas percebe-se uma escassez de estudos sobre as emoções dos psicoterapeutas decorrentes da troca destes durante o processo. O presente estudo visa identificar as emoções vivenciadas por psicoterapeutas-aprendizes que assumiram casos de pacientes atendidos anteriormente por outros no mesmo serviço-escola. Realizou-se uma pesquisa qualitativa, por meio da construção de fato clínico psicanalítico, a partir da análise dos relatos pós-sessões dos atendimentos em psicoterapia psicanalítica de três pacientes, atendidos por três diferentes psicoterapeutas-aprendizes, os quais foram supervisionados pela mesma docente. As emoções vivenciadas e relatadas por esses psicoterapeutas decorrentes da troca de terapeutas, foram destacadas e analisadas como fatos clínicos psicanalíticos, baseados nos pressupostos de Winnicott e seus seguidores: preocupação em relação à aceitação e medo da rejeição.

As part of undergraduate studies, psychology students perform mandatory internships at school-clinics, which include individual psychotherapy. The established transferential relationship is affected by emotions from both the patient and the psychotherapist, which may contribute either to the establishment of the therapeutic alliance or the abandonment of the therapeutic process. Transference and countertransference have been addressed in several publications, but there is a lack of studies on the emotions of the psychotherapists resulting from their exchange during the process. This study aims to identify the emotions experienced by psychotherapists in training who took over cases previously attended by other undergraduate students in the same school-clinic. A qualitative research was carried out, through the construction of a psychoanalytic clinical fact, based on the analysis of the post-session reports of three patients in psychoanalytic psychotherapy, attended by three different therapists in training, who were supervised by the same teacher. The emotions experienced and related by the psychotherapists, as a result of the change of therapists, were highlighted and analyzed as the psychoanalytic clinical facts, based on the assumptions of Winnicott and his followers: the concern about being accepted and the fear of rejection.

Prevalence and Current Management of Cardiovascular Risk Factors in Korean Adults Based on Fact Sheets

Korea is currently an aged society and is on the cusp of becoming a superaged society in a few years. The health burden of cardiovascular diseases increases with age, and the increasing prevalence of cardiovascular risk factors, such as obesity, hypertension, diabetes mellitus, and dyslipidemia, may be linked to increased population-level cardiovascular risk. In 2018, the prevalence of obesity in Korea was 35.7% (men, 45.4%; women, 26.5%) according to the Obesity Fact Sheet 2019, based on National Health Insurance Corporation medical checkup data. In 2016, the prevalence of diabetes was 14.4% in Koreans older than 30 years according to the Diabetes Fact Sheet published by the Korean Diabetes Association, based on data from the Korean National Health and Nutrition Examination Survey. The prevalence of hypertension in the total population of Korea in 2018 was 28.3% according to the Korean Hypertension Fact Sheet produced by the Korean Society of Hypertension. Lastly, the prevalence of dyslipidemia in 2018 was 40.5% according to the Dyslipidemia Fact Sheet published by the Korean Society of Lipid and Atherosclerosis. In this article, I would like to review the prevalence and current management of cardiovascular risk factors in Korea according to the fact sheets released by various associations.

Survey About Handling Telephone Consultations at a Kampo Outpatient Clinic / 日本東洋医学雑誌

We conducted a fact­finding survey about the difficulties of handling the telephone consultations at a Kampo medicine outpatient clinic. We extracted the details of consultations that could not be handled by an outpatient nurse alone from the descriptive data of the telephone responses described by the nurses in the sur­vey. We, then, identified the factors that were involved in the difficulties encountered in these consultations, and countermeasures were established and implemented. One year later, we compared and examined the status of telephone consultations between before and after the fact-­finding survey. We classified the telephone con­sultations that were difficult for the outpatient nurses to handle alone into four categories : (1) consultation about a physical disorder, (2) questions about prescribed Kampo medicines, (3) reports and questions based on the patient's own judgment, and (4) questions about treatment and hospitalization. Some of the questions about Kampo medicines included the continued use of the medicine and drug interactions, and the main topics of the survey's nurse self-­judgment reports were dose reductions and changes in Kampo medicine regimens. As a re­sult of the introduction of guidelines prepared by the nurses together with physicians at the clinics, the outpa­tient nurses became able to handle telephone consultations about frequently asked questions (FAQs). At 1 year after the survey, the number of cases of difficulties in handling telephone consultations decreased to less than half the original value, and no telephone consultations were made within 1 week after the patients' first visits to the outpatient clinic.

A corrupção na perspectiva durkheimiana: um estudo de caso da Operação Lava Jato / La corrupción en la perspectiva Durkheimiana: un estudio de caso de la Operación "Lava Jato" / Corruption in the Durkheimian perspective: a case study of the Operation Car Wash

Resumo A Operação Lava Jato vem ocupando as principais páginas de notícias como a maior operação de combate à corrupção já realizada no Brasil. A importância deste estudo reside na possibilidade de interpretar e compreender a maior investigação de crimes de corrupção no país utilizando conceitos e raciocínios durkheimianos, com vistas a contribuir para a análise do fenômeno no caso concreto e na administração pública como um todo. Verificou-se que a corrupção descoberta pela Operação Lava Jato é um fato social patológico presente na estrutura de diferentes órgãos e instituições que afeta a ordem social, decorrente de um estado de anomia no qual os indivíduos não aderem às normas sociais e morais vigentes.

Resumen En Brasil, la Operación "Lava Jato" viene ocupando las principales páginas de noticias como la mayor operación de combate a la corrupción ya realizada en el país. La importancia del estudio reside en la posibilidad de interpretar y comprender la mayor investigación de crímenes de corrupción ya realizada en Brasil, utilizando conceptos y razonamientos Durkheimianos, en la perspectiva de contribuir a la comprensión del fenómeno en el caso concreto y en toda la administración pública. Se verificó que la corrupción descubierta por la Operación "Lava Jato" es un hecho social patológico presente en la estructura de diferentes órganos e instituciones y que afecta el orden social, proveniente de un estado de anomia, en el cual los individuos no se adhieren a las normas sociales y morales vigentes.

Abstract In Brazil, Operation Car Wash has been occupying the main news pages as the largest anti-corruption operation ever carried out in the country. The importance of the study lies in the possibility of interpreting and understanding the investigations of the operation, using Durkheimian concepts and reasoning, to analyze the phenomenon focusing not only the concrete case but also looking at the whole public administration. The corruption discovered by Operation Car Wash is a pathological social fact present in the structure of different agencies and institutions. It affects the social order and is fruit of a state of anomie, in which individuals do not adhere to social norms and moral values.

Microanálisis de la comunicación verbal y no verbal en hechos clínicos psicoanalíticos / Microanalysis of verbal and nonverbal communication in psychoanalitic clinical facts

Se analizan seis fragmentos de una psicoterapia psicodinámica de larga duración, los cuales han sido definidos como "hechos clínicos" (HC). Se pretende identificar y describir algunos elementos verbales y no verbales presentes en la interacción paciente­terapeuta dentro de los segmentos pre-seleccionados del proceso.

The Experimental Assessment Of Build Up Factor And Attenuation Coefficient Of Brass Compensator Applied In Intensity-Modulated Radiation Therapy (Imrt) For 6mv Photon Beam

Introduction: Recent compensators are commonly applied in IMRT. The precise properties of applied compensators such as thickness, attenuation coefficient and build up factor are intensively important for IMRT calculations. Method: The brass compensator used for 6 MV photon beam was studied to estimate the relative effect of thickness and field size on IMRT calculations. Various field size together with several compensator thicknesses were examined. Result: The average reduction of effective attenuation coefficient (EAC), for the fields of 10×10 cm2 to 20×20 cm2, was 9.94%. By increasing the field size, EAC was decreased. The major reduction of EAC due to increasing field size was found to be 9.62%. The build up factor was increased by 2% to 21.8% respect to field size and compensator thickness. Also, the build up factor was increased by adding up the thickness. The rate of changes ranged from 24% to 48 %.Conclusion: The compensator thickness and field size are significantly important to calculate the effective attenuation coefficient and build up facto

The necessity of EGFR-targeted therapy combined with synchronized whole brain radiotherapy for non-small-cell lung cancer with mutated EGFR and brain metastasis / 中华放射肿瘤学杂志

Objective To explore the necessity of EGFR?targeted therapy combined with synchronized whole brain radiotherapy ( WBRT ) for non?small?cell lung cancer ( NSCLC ) with mutated EGFR and brain metastasis by comparing the effects on prognosis between WBRT combined with tyrosine kinase inhibitor ( TKI) and TKI alone. Methods A retrospective analysis was performed in 43 patients with EGFR mutation?positive NSCLC and brain metastasis. In those patients, 24 patients received WBRT plus TKI and 19 patients TKI alone. Results The overall response rate ( RR) and 6?month intracranial disease control rate ( CR) were significantly higher in the WBRT+TKI group than in the TKI group ( 79% vs. 37%, P=0. 002;79% vs. 63%, P=0. 008). The median intracranial progression?free survival (IPFS) time was significantly longer in the WBRT+TKI group than in the TKI group ( 23. 7 vs. 8. 3 months, P=0. 025) . The multivariate analysis indicated that the control of lung cancer, WBRT+TKI, and single brain metastasis were favorable factors for substantially longer IPFS time ( P=0. 033,0. 019,0. 019) . In 23 patients with exon 19 deletion, 12 patients received WBRT+TKI and 11 patients TKI alone;compared with the TKI group, the WBRT+TKI group had significantly higher RR and 6?month CR as well as significantly longer IPFS ( 100%vs. 35%, P=0. 000;100% vs. 55%, P=0. 008;23. 7 vs. 8. 4 months, P=0. 003). In 20 patients without exon 19 deletion, however, there were no significant differences in RR or 6?month CR between the WBRT+TKI group (n=12) and the TKI group (n=8)(64% vs. 50%, P=1. 000;58% vs. 75%, P=0. 642).The median IPFS was 14. 4 and 8. 4 months ( P=0. 864) . Conclusions WBRT combined with TKI is superior to TKI alone in the treatment of NSCLC with brain metastasis. Patients with exon 19 deletion have substantially better treatment outcomes.

A Cross sectional study of Quality of Life of Cancer patients attending Palliative Care OPD.

Abstracts: Background: In India there are 2-2.5 million estimated cancer patients at any given point of time. ‘Palliative care’ approach improves the quality of life of patients and their families facing problem associated with life-threatening illness. Quality of life (QOL) is multidimensional construct. Objectives: To assess their quality of life and factors associated with it. This is an attempt to collect baseline data to help improve palliative care services. Materials and Methods: selected patients for the study (total=108) were interviewed with the help of FACT-G Scale for Measuring the Health-related QOL (Sub scores-Physical, Social, Emotional & Functional well-being). The total scores ranged from 0-108 (0-47 poor, 48-63 average, 64-108 good). Statistical Analysis: Chi square test. Results: Out of total 108 patients, 72.22% were females. Mean age was 50.91 years (SD± 2.02). 78.70% were married, 29.63% illiterate, 43.52% belonged to Middle Socio-economic class, 89.81% had Stage 2 and 3 cancer. Mean total FACT-G scale QOL score was 54.61 (SD ±8.18). Relation between marital status and socio-economic status with total QOL score was statistically significant. Conclusions: The median of all sub-scores worsened with progress of stage of cancer. Patients with better socio-economic status and were married had better QOL scores. Counselling will improve their QOL through palliative care services.

Rapid Increase in Marrow Fat Content and Decrease in Marrow Perfusion in Lumbar Vertebra Following Bilateral Oophorectomy: An MR Imaging-Based Prospective Longitudinal Study

OBJECTIVE: Bilateral oophorectomy leads to reduced bone mineral density (BMD), and reduced BMD is associated with increased marrow fat and reduced marrow perfusion. Purpose of this study was to investigate how soon these changes occur following surgical oophorectomy. MATERIALS AND METHODS: Six patients who underwent hysterectomy and bilateral salpingo-oophorectomy were studied. At baseline, mean patient age was 49.5 years (range: 45-54 years). Third lumbar vertebral body BMD measurement using quantitative CT, marrow fat fraction (FF) using MR spectroscopy and marrow perfusion using dynamic contrast enhanced MRI were conducted immediately prior to surgery and at 3, 9, and 21 months after surgery. RESULTS: Reduced BMD, increased marrow FF, and reduced marrow perfusion occurred synchronously post-oophorectomy. There was a sharp decrease of 12.5 +/- 7.2% in BMD (n = 6), a sharp increase of 92.2 +/- 46.3% (n = 6) in FF, a sharp decrease of 23.6 +/- 3.9% in maximum contrast enhancement (n = 5), and of 45.4 +/- 7.7% for enhancement slope (n = 5) during the initial 3 months post surgery. BMD and marrow perfusion continued to decrease, and marrow FF continued to increase at a slower rate during the following 18 months. Friedman test showed a significant trend for these changes (p < 0.05). CONCLUSION: Bilateral oophorectomy leads to a rapid decrease in lumbar BMD, an increase in marrow fat content, and a decrease in marrow blood perfusion.

Prediction of Motor Recovery Using Diffusion Tensor Tractography in Supratentorial Stroke Patients With Severe Motor Involvement

OBJECTIVE: To investigate whether early stage diffusion tensor tractography (DTT) values predict motor function at 3 months after onset in supratentorial stroke patients with severe motor involvement. METHODS: A retrospective study design was used to analyze medical records and neuroimaging data of 49 supratentorial stroke patients with severe motor involvement. Diffusion tensor imaging was assessed within 3 weeks after stroke in all patients. Three-dimensional tractography of the ipsilateral corticospinal tract (CST) was performed using the fiber assignment of the continuous tracking algorithm. The two-step DTT analysis was used. The first step was classification according to ipsilateral CST visualization. The second step was a quantitative analysis of the visible-CST group parameters. Motor function was assessed at 2 weeks and at 3 months after stroke. Comparative and correlation analyses were performed between DTT-derived measures and motor assessment scores. RESULTS: Motor function of the upper extremity at 3 months after stroke was significantly higher in the visible-CST group than that in the nonvisible-CST group (p<0.05). Early stage fractional anisotropy was of DTT correlated significantly with upper extremity motor function at 3 months after stroke in the visible-CST group (p<0.05). CONCLUSION: These results demonstrate that early DTT-derived measures predict motor recovery in the upper extremity at 3 months after onset in supratentorial stroke patients with severe motor involvement.

Necrosis grasa subcutánea del recién nacido. Presentación de un caso / Subcutaneous Fat Necrosis of the Newborn. A Case Report

La necrosis grasa subcutánea del recién nacido es la inflamación del tejido adiposo que afecta a neonatos con antecedentes de dificultad respiratoria perinatal. Se caracteriza por lesiones nodulares y en placa, violáceas, firmes, móviles, localizadas en mejillas, hombros, glúteos y muslos; generalmente asintomáticas y autolimitadas. Puede complicarse con hipercalcemia. Se reporta un caso de necrosis grasa subcutánea del recién nacido en un neonato femenino, de siete días. Se enfatiza en las manifestaciones cutáneas, en el valor diagnóstico de la realización de la biopsia de piel, así como en la prevención, conocimiento y manejo de las complicaciones. Se presenta este caso por ser una complicación peculiar de la dificultad respiratoria perinatal, pocas veces sospechado por su baja incidencia.

Subcutaneous fat necrosis of the newborn is the inflammation of the adipose tissue that affects neonates with history of perinatal respiratory distress. This condition is characterized by violaceous, firm and mobile nodules and plaques located on the cheeks, shoulders, buttocks and thighs, which are generally asymptomatic and self-limited. It may be complicated by hypercalcemia. A case of subcutaneous fat necrosis of the newborn in a 7-day-old female neonate is presented. Skin manifestations, diagnostic value of the skin biopsy as well as prevention, awareness and management of complications are emphasized. This case is described as it is an uncommon complication of perinatal respiratory distress, which is rarely suspected due to its low incidence.

Qualidade de vida de mulheres tratadas de câncer de mama em uma cidade do nordeste do Brasil / Quality of life of women treated for breast cancer in a city of the northeast of Brazil

O objetivo deste estudo foi avaliar a qualidade de vida de mulheres tratadas cirurgicamente de câncer de mama no Hospital de Referência Estadual em Oncologia de São Luís (MA). A qualidade de vida foi avaliada pelo Functional Assessment of Cancer Therapy-Breast (FACT-B). As variáveis foram expressas em média e desvio padrão; e a análise estatística constou da Anova ou Kruskal Wallis e Teste t de Student ou Mann-Whitney. O nível de significância foi α < 5%. Na estatística foram usados o Stata 9.0 e o BioEstat 5.0. Participaram 197 mulheres com idade média de 53,0 ± 11,7 anos. Os valores médios do FACT-B demonstraram tendência para boa qualidade de vida, sendo o domínio Emocional o mais comprometido e a Subescala Câncer a mais favorável. O tipo de cirurgia influenciou os domínios Social, Emocional e Subescala câncer do questionário. A cirurgia não conservadora apresentou piores níveis de qualidade de vida. Viu-se relação estatística significante entre o tempo de cirurgia e os domínios Físico, Emocional e Funcional, bem como entre tempo de cirurgia e os escores do FACT-B. O tratamento adjuvante influenciou todos os domínios do FACT-B. A qualidade de vida encontrada foi relativamente boa, mas influenciada negativamente pela cirurgia não conservadora, pelo menor tempo desde a cirurgia e pelas terapias adjuvantes.

The study sought to evaluate the quality of life of women treated surgically for breast cancer at the State Oncology Hospital of Reference in São Luís in the State of Maranhão. The quality of life was assessed by the Functional Assessment of Cancer Therapy-Breast (FACT-B). The variables were expressed as mean and standard deviation, and statistical analysis consisted of the ANOVA or Kruskal Wallis test and the Student t or Mann-Whitney test. The level of significance was α < 5%. For statistical tests Stata 9.0 and BioEstat 5.0 were used. 197 women with mean age of 53.0 ± 11.7 years participated. The mean values of the FACT-B revealed a good quality of life trend, though the emotional domain was most prejudiced and the cancer sub-scale the most favorable. The type of surgery influenced the social, emotional and cancer sub-scale domain. Non-conservative surgery revealed the worst quality of life levels. A statistically significant relationship between duration of surgery and the physical, emotional and functional domains and between duration of surgery and the scores of the FACT-B was detected. Adjuvant treatment influenced all domains of FACT-B. Quality of life was relatively good, but was negatively impacted by non-conservative surgery, the shortest time between surgery and the adjuvant therapies.

Clinical epidemiologic study of upper gastrointestinal bleeding in China / 中华消化内镜杂志

Objective To investigate the etiology,characteristics of upper gastrointestinal bleeding (UGIB) in China,and to investigate the main causes of different population.Methods Literature on the causes of UGIB were retrieved and screened according to strict inclusion and exclusion standards.Results A total of 15733 UGIB patients were enrolled in the study.The most common causes of UGIB were duodenal ulcer (31.2％),gastric ulcer (15.2％),acute gastric mucosal lesions (AGML) (12.0％),cancer (11.7％),and esophageal varices (11.3％).The incidences of duodenal ulcer,gastric ulcer,AGML,esophageal varices,cancer were 32.3％,15.1％,12.1％,7.2％,and 12.5％ before 2006,and 29.7％,15.4％,11.1％,15.3％,and 10.9％ after 2006.The ratio of male to female was 3.25: 1.The most common causes of UGIB in older patients were gastric ulcer,cancer,AGML,duodenal ulcer,esophageal varices,while those in children were duodenal ulcer,gastric ulcer and AGML.Conclusion Peptic ulcers,AGML,cancer and esophageal varices were the most common causes of UGIB in China.The causes of UGIB have changed significantly in the past 5 years (P ＜0.01).

Fact-finding Survey of Nosocomial Infection Control in Hospitals in Kathmandu, Nepal—A Basis for Improvement

The purpose of this study was to investigate the actual conditions of nosocomial infection control in Kathmandu City, Nepal as a basis for the possible contribution to its improvement. The survey was conducted at 17 hospitals and the methods included a questionnaire, site visits and interviews. Nine hospitals had manuals on nosocomial infection control, and seven had an infection control committee (ICC). The number of hospitals that met the required amount of personal protective equipment preparation was as follows: gowns (13), gloves (13), surgical masks (12). Six hospitals had carried out in-service training over the past one year, but seven hospitals responded that no staff had been trained. Eight hospitals were conducting surveillance based on the results of bacteriological testing. The major problems included inadequate management of ICC, insufficient training opportunities for hospital staff, and lack of essential equipment. Moreover, increasing bacterial resistance to antibiotics was recognized as a growing issue. In comparison with the results conducted in 2003 targeting five governmental hospitals, a steady improvement was observed, but further improvements are needed in terms of the provision of high quality medical care. Particularly, dissemination of appropriate manuals, enhancement of basic techniques, and strengthening of the infection control system should be given priority.

Valores de normalidad de sensibilidad al contraste en niños entre cuatro y siete años de la localidad de Chapinero, Bogotá / Normal values of contrast sensitivity in children between four and seven years in the locality of Chapinero in Bogota

Las pruebas de sensibilidad al contraste (sc) son una poderosa herramienta para determinar la capacidad visual. Es importante conocer el desarrollo de esta función y tener parámetros precisos para el diagnóstico temprano de alteraciones. Objetivo: determinar los valores de normalidad para sc con el Functional Acuity Contrast Test (fact) en niños entre cuatro y siete años de la localidad de Chapinero en Bogotá. Materiales y métodos: estudio observacional descriptivo de corte transversal con 280 ojos. Se organizaron dos grupos: grupo 1, entre cuatro y cinco años, y grupo 2, entre seis y siete años, valorando contraste con el fact para las diferentes frecuencias espaciales. Resultados: los valores de sc se determinaron con la mediana, rango intercuartílico y prueba estadística U de Mann Whitney, lo cual reveló que no hay diferencias significativas para ninguna de las frecuencias espaciales. Los rangos de normalidad hallados para la frecuencia A se encontraron entre seis y siete; para la B entre cinco y siete; para la C entre cinco y siete; para la D entre cuatro y siete, y para la E entre cinco y siete. Al comparar los rangos para los dos grupos, se observa que no hay diferencias estadísticamente significativas en la mayoría de frecuencias. Conclusiones: los rangos y mediana para cada una de las frecuencias estaban dentro de los rangos esperados para el test; se observó que existían diferencias en el desarrollo de la sc entre los grupos A y B, con mayor amplitud en el de mayor edad.

The contrast sensitivity tests (cs) are a powerful toll for determining the vision capability. It is important to know the development of this function and have precise parameters for the early diagnosis of abnormalities. Objective: To determine normal values for sc with the Functional Acuity Contrast Test (fact) in children between four and seven years in the locality of Chapinero in Bogota. Materials and methods: An observational cross sectional study was performed with 280 eyes. They were classified into two groups: Group 1, four to five years of age, and group 2, six to seven years of age, valuing contrast with fact for the different spatial frequencies. Results: cs values were determined with the average, interquartile range and the statistical test U from Mann Whitney, which revealed no significant differences for any of the spatial frequencies. The normal range found for frequency A were between six and seven; for frequency B, between five and seven; for frequency C, between five and seven; for the frequency D, between four and seven; and for the frequency D, between five and seven. Comparing the ranges for both groups, there were no statistically significant differences in most frequencies. Conclusions: The range and average for each of the frequencies were within expected ranges for the test; it was observed that there were differences in the development of cs between groups A and B, with a wider amplitude for the oldest.