Joint pain liniments and gum lotion in the eye - A consecutive case series of mistaken identity

Purpose: Patient safety errors can arise due to similarity in packaging of medications. We aimed to describe the clinical features of patients presenting with accidental application of joint pain liniments and gum lotion in the eye due to confusion arising from similarity in packaging. Methods: This was a retrospective case series with eight consecutive patients presenting from December 2020 to August 2021 with history of accidental application of joint pain liniments or gum lotion in the eye instead of eye drops. All patients underwent visual acuity assessment and slit?lamp examination with fluorescein staining of the cornea to look for corneal involvement and was reassessed till complete resolution. Results: Of the eight patients, three were males and five were females. Seven had accidentally applied joint pain liniment, while one had applied gum lotion into the eye. Five of them had corneal involvement ranging from punctate erosions to near?total epithelial defects. Two patients needed referral to a tertiary center and hospital admission. Treatment duration ranged from 2 days to 1 month. Two patients were lost to follow?up. Conclusion: This study highlights patient safety errors arising from confusion of medication due to similar labeling and packaging of different drugs. While there was no permanent morbidity, such confusions lead to needless discomfort and waste of time, money, and effort for the patient as well as the health?care system.

Factors associated with reoperation due to bleeding and outcomes after cardiac surgery: a prospective cohort study / Factores asociados con la reintervención por sangrado y desenlaces después de cirugía cardiaca: un estudio de cohorte prospectivo / Fatores associados à reoperação por sangramento e desfechos após cirurgia cardíaca: estudo de coorte prospectivo

ABSTRACT Objective: Identify the incidence and factors associated with reoperation due to bleeding in the postoperative of a cardiac surgery, in addition to the clinical outcomes of patients. Method: Prospective cohort study, conducted in an Intensive Care Unit (ICU), with adult patients undergoing cardiac surgery. Patients diagnosed with coagulopathies were excluded. The patients were followed up from hospitalization to hospital discharge. Results: A total of 682 patients were included, and the incidence of reoperation was 3.4%. The factors associated with reoperation were history of renal failure (p = 0.005), previous use of anticoagulant (p = 0.036), higher intraoperative heart rate (p = 0.015), need for transfusion of blood component during intraoperative (p = 0.040), and higher SAPS 3 score (p < 0.001). The outcomes associated with reoperation were stroke and cardiac arrest. Conclusão: Reoperation was an event associated with greater severity, organic dysfunction, and worse clinical outcomes, but there was no difference in mortality between the groups.

RESUMEN Objetivo: Identificar la incidencia y los factores asociados con la reintervención por sangrado en el postoperatorio de cirugía cardiaca, además de los resultados clínicos de los pacientes. Método: Estudio de cohorte prospectivo, realizado en una Unidad de Cuidados Intensivos, con pacientes adultos sometidos a cirugía cardiaca. Se excluyeron a los pacientes con diagnóstico de coagulopatías. Los pacientes tuvieron un seguimiento efectuado desde el ingreso hasta el alta hospitalaria. Resultados: Se incluyeron a 682 pacientes, y la incidencia de reintervención fue del 3,4%. Los factores asociados a la reintervención fueron antecedentes de insuficiencia renal (p = 0,005), uso previo de anticoagulante (p = 0,036), mayor frecuencia cardiaca intraoperatoria (p = 0,015), necesidad de transfusión de hemocomponentes en el intraoperatorio (p = 0,040) y mayor puntaje en SAPS 3 (p < 0,001). Los desenlaces asociados con la reintervención fueron accidente cerebrovascular y paro cardiorrespiratorio. Conclusión: La reintervención fue un evento asociado con mayor gravedad, disfunción orgánica y peores desenlaces clínicos, pero no hubo diferencia en la mortalidad entre los grupos.

RESUMO Objetivo: Identificar a incidência e os fatores associados à reoperação devido sangramento no pós-operatório de cirurgia cardíaca, além dos desfechos clínicos dos pacientes. Método: Estudo de coorte prospectivo, realizado em Unidade de Terapia Intensiva (UTI), com pacientes adultos submetidos à cirurgia cardíaca. Foram excluídos pacientes com diagnóstico de coagulopatias. Os pacientes foram acompanhados desde a internação até a saída hospitalar. Resultados: Foram incluídos 682 pacientes e a incidência de reoperação foi 3,4 %. Os fatores associados à reoperação foram: histórico de insuficiência renal (p = 0,005), uso prévio de anticoagulante (p = 0,036), maior frequência cardíaca intraoperatória (p = 0,015), necessidade de transfusão de hemocomponentes no intraoperatório (p = 0,040) e maior pontuação no SAPS 3 (p < 0,001). Os desfechos associados a reoperação foram: acidente vascular encefálico e parada cardiorrespiratória. Conclusão: A reoperação foi um evento associado a maior gravidade, disfunção orgânica, e piores desfechos clínicos, porém não houve diferença de mortalidade entre os grupos.

Vida e trabalho de refugiado: a imagem como experiência do olhar a partir de uma obra de Escher / Refugee's life and work: image as experience of the look from a painting by Escher

Vida e trabalho no percurso de refugiado estão entre os mais recentes desafios contemporâneos que instigam o olhar e o pesquisar. A fim de potencializar a discussão, julgou-se pertinente atentar para a experiência do olhar frente à imagem. Tomou-se a xilogravura Dia e Noite, arte de Maurits Cornelius Escher, que alude ao movimento migratório de pássaros, por também ela provocar o olhar dadas as características que o artista lhe imprime. Como base teórica condutora da discussão, tomaram-se os conceitos de espaço liso e estriado, de Deleuze e Guattari, imbricados em referencial relativo à situação de refugiado. A conversa entre imagem e teoria ampliou o olhar para além das questões burocráticas, jurídicas e estatísticas, frequentemente associadas aos estudos acerca de refugiado, e permitiu apontar relações de continuidade e coexistência em seus modos de viver e trabalhar. Entende-se que, ao provocar a experiência do olhar, a imagem pode ser capturada, recortada, reduzida, ampliada, torcida, num esforço de sentido não necessariamente óbvio.(AU)

Life and work on the refugee journey are among the latest contemporary challenges that instigate to look and to research. In order to enhance the discussion, it was considered pertinent to pay attention to the experience of looking at the image. We took the woodcut Day and Night, art by Maurits Cornelius Escher, which alludes to the migratory movement of birds, because it also provokes the look, given the characteristics that the artist imprints on it. The concepts of smooth and striated space, by Deleuze and Guattari, imbricated in a reference regarding the refugee situation, were taken as the theoretical basis for the discussion. The conversation between image and theory broadened the look beyond bureaucratic, legal and statistical issues, often associated with studies about refugees and allowed pointing out relationships of continuity and coexistence in their ways of living and working. It is understood that, by provoking the experience of the look, the image can be captured, cut, reduced, enlarged, twisted, in an effort of meaning not necessarily obvious.(AU)

La vida y el trabajo en el curso de la vida de los refugiados son algunos de los retos contemporáneos más recientes que instigan la mirada y la investigación. Para mejorar el debate, se consideró pertinente centrarse en la experiencia de mirar la imagen. Se tomó la xilografía Día y Noche, obra de Maurits Cornelius Escher, que alude al movimiento migratorio de las aves, ya que también provoca la mirada dadas las características que el artista le imprime. Los conceptos de espacio liso y estriado, de Deleuze y Guattari, se utilizaron como base teórica para la discusión. La conversación entre la imagen y la teoría amplió la mirada más allá de las cuestiones burocráticas, legales y estadísticas que suelen asociarse a los estudios sobre los refugiados, y nos permitió señalar relaciones de continuidad y convivencia en sus formas de vivir y trabajar. Se entiende que al provocar la experiencia de la mirada, la imagen puede ser capturada, recortada, reducida, ampliada, retorcida, en un esfuerzo por dar un sentido que no es necesariamente obvio.(AU)

Management of Early Glottic Cancer Treated by CO2 Laser According to Surgical-Margin Status: A Systematic Review of the Literature

Abstract Introduction Transoral laser microsurgery (TLM) is the treatment of choice for Tis-T2 squamous cell glottic carcinomas due to its advantages compared with open surgery and radiotherapy. However, the CO2 laser beam causes changes and damage on the specimens, making the histological assessment of resection margins, the gold standard for confirming radical tumor resection, sometimes difficult. Objective To assess the different ways to manage patients depending on the status of the histopathological margin according to recent studies to detect the most commonly shared therapeutic strategy. Data Synthesis We analyzed the literature available on the PubMed and Web of Science databases, including only articles published since 2005, using specific keywords to retrieve articles whose titles and abstracts were read and analyzed independently by two authors to detect relevant studies. Therefore, we focused on disease-free survival, overall survival, local control, laryngeal preservation, and disease-specific survival. Thus, 17 studies were included in the present review; they were grouped according to the status of the histological margin, and we analyzed the different management policies described in them. This analysis showed that there is not a shared strategy, though in most studies the authors performed a second-look surgery in the cases of positive margins and a close follow-up in cases of negative ones. The main disagreement is regarding the management of close or non-valuable resection margins, since some some authors performed a second-look surgery, and others, a close follow-up. Conclusions Definitely, the most shared policy is the second-look surgery in case of positive surgical margins, and a close follow-up in case of close or non-valuable resection margins. Key Points To date, TLM is the treatment of choice for Tis-T2 squamous cell glottic carcinomas. The CO2 laser beam could impair the histological assessment of the resection margins, which is the gold standard to confirm radical tumor resection. Second-look TLM is the most performed strategy in case of positive surgical margins. Close follow-up is the most shared policy in case of close or non-valuable resection margins. In cases of negative resection margins, follow-up represents the best approach.

Complete cytoreductive surgery is the key to improving survival of colorectal cancer patients with peritoneal metastases: comment on PROPHYLOCHIP and PRODIGE 7 / 中华胃肠外科杂志

Peritoneal carcinomatosis (PC) is one of the difficult problems in the treatment of colorectal cancer (CRC). Based on several retrospective analyses of large samples and prospective randomized controlled studies (RCTs), NCCN and PSOGI recommend cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) for selected CRC patients with mild to moderate PC. There are two important controversial issues in this field: the survival benefit of second-look surgery plus HIPEC for the patients with high risk of PC, and the specific benefit of HIPEC added to CRS for patients with PC. PROPHYLOCHIP found that second-look surgery plus HIPEC in patients at high risk of PC does not result in increased survival. PRODIGE 7 showed that overall survival (OS, 41.7 months vs. 41.2 months, P=0.99) and recurrence-free survival (RFS, 13.1 months vs. 11.1 months, P=0.43) were similar between the HIPEC group and non-HIPEC group, and suggested that HIPEC is not necessary for patients who underwent complete CRS. However, due to a series of problems in the design and implementation of this trial, the conclusion has caused great controversy and has not been widely recognized. Through detailed analysis and in-depth discussion, we believe that the benefit of HIPEC could not be denied according to PRODIGE 7. CRS + HIPEC is the embodiment and model of the concept of "Solid tumor treatment is surgery-based integrated treatment". CRS is the cornerstone of therapeutic strategies with curative intent for CRC PC and complete CRS is the key to improve the prognosis. Furthermore, HIPEC is an effective supplement to CRS.

Posttraumatic progression of cartilage degeneration following anterior cruciate ligament reconstruction: A second-look arthroscopic analysis / 中国组织工程研究

BACKGROUND: Anterior cruciate ligament (ACL) reconstruction can restore the stability of knee joint, reduce the mechanical stress on meniscus and cartilage, and avoid the occurrence and development of secondary injury including traumatic arthritis. However, some studies have shown that ACL reconstruction cannot completely prevent the occurrence and development of osteoarthritis, and significant changes in osteoarthritis can be found in the long-term imaging examination after operation. Therefore, there is still controversy about the role of ACL reconstruction in preventing secondary cartilage damage and secondary osteoarthritis, and the changes in cartilage after ACL reconstruction, especially at early stage after ACL reconstruction, have not been fully elucidated. OBJECTIVE: To analyze articular cartilage changes during arthroscopic anterior cruciate ligament reconstruction and second-look arthroscopic evaluation. METHODS: From July 2015 to July 2016, 50 cases of ACL reconstruction with hamstring tendon and second-look arthroscopic exploration were analyzed retrospectively. The cartilage damage and healing between the ACL reconstruction and second-look exploration were recorded. At the same time, the influence of age on articular cartilage was analyzed. The study protocol was approved by the Ethics Committee of Foshan TCM Hospital with an approval No. 20160315. RESULTS AND CONCLUSION: No infection, graft absorption and other complications occurred in all patients. During the second-look exploration, the Lysholm score, International Knee Documentation Committee evaluation score, Tegner score and KT-1000 lateral difference were significantly improved compared with those before operation (P 0.05). During the second-look exploration, the patients with anterior cruciate ligament reconstruction who were 30 years old and above had significantly worse subpatellar, trochlear, medial femoral condyle, lateral femoral condyle and tibial lateral platform cartilage tissues than those under 30 years (P < 0.05). The results suggest that the reconstruction of ACL with autogenous hamstring tendon can achieve better stability and function of the knee joint. However, even in the early postoperative period, osteoarthritis is still progressing. Therefore, it is necessary for patients with ACL reconstruction to pay attention to the progression of osteoarthritis and the appearance of knee joint symptoms.

A língua de sinais na relação transferencial e sua dupla posição em relação à lalangue / El lenguaje de señas en la relación transferencial y su doble posición en relación con la lalangue / Sign language in the transferential relationship and its double position in relation to lalangue / La langue des signes dans la relation transférentielle et sa double position par rapport à la lalangue

Este trabalho se originou no atendimento psicanalítico de crianças com surdez e seus familiares. Considerou-se, na singularidade do encontro entre o analista e o sujeito, a língua de sinais como nó inquietante ao redor da qual o Real da transferência era percebido em seus efeitos e a posição ocupada pela criança no discurso materno evidenciava-se. Os efeitos da língua de sinais transitavam entre o incômodo, com tentativas de impedir sua circulação no discurso, e o apaziguamento, em momentos em que trazia sentido e fazia movimentar a cadeia de significantes. Para além da especificidade dos conteúdos analisados, pretende-se expor considerações quanto à língua materna dos sujeitos com surdez, articulando-a com conceitos referentes à dinâmica pulsional dos objetos a - voz e olhar. Tais objetos se apresentaram de modo singular e suas particularidades estiveram relacionadas à língua materna e ao modo como ela se colocou para os sujeitos quando ocorreu o diagnóstico da surdez. Para atingir os objetivos propostos, foram utilizados trechos dos casos clínicos analisados a fim de contribuir para o desenvolvimento das proposições e articulações teóricas.

Este trabajo se originó a partir del cuidado psicoanalítico de los niños sordos y sus familias, teniendo, en la singularidad del encuentro entre el analista y el sujeto, el lenguaje de señas como un nudo que trajo reflexiones, alrededor del cual se percibía lo Real de la transferencia en sus efectos y la posición ocupada por el niño en el discurso de la madre era evidente. Los efectos del lenguaje de señas pasaron entre la inquietud, con intentos de evitar su circulación en el discurso, y apaciguamiento, en momentos que dieron sentido y movieron la cadena de significantes. Además de la especificidad de los contenidos analizados, se presentan consideraciones con respecto a la lengua materna de los sujetos sordos, articulando conceptos relacionados con la dinámica de conducción de los objetos voz y mirada, que se presentaron de una manera única. Sus características se relacionaron con la lengua materna y con la forma cómo la lengua materna se presentó para los sujetos cuando recibieron el diagnóstico de la sordera. Para lograr los objetivos, se emplearon extractos de los casos clínicos analizados para contribuir al desarrollo de las proposiciones y articulaciones teóricas.

This work originated from the psychoanalytical care of deaf children and their families, having, in the singularity of the encounter between the analyst and the subject, the sign language as a disturbing knot, around which the Real of the transfer was perceived in its effects and the position occupied by the child in the mother's speech was evident. The effects of sign language passed between the nuisance, with attempts to prevent its circulation in the speech; and appeasement, in moments that brought meaning and moved the chain of signifiers. In addition to the specificity of the analyzed contents we intend to expose considerations regarding the mother tongue of deaf subjects, articulating concepts related to the drive dynamics of objects voice and gaze. These happened in a unique way and the particularities were related to the mother tongue and how it was placed for these subjects when deafness was diagnosed. To achieve the proposed objectives we will use some excerpts of the clinical cases analyzed, in the format of vignettes, in order to contribute to the development of the propositions and theoretical articulations.

Ce travail est né de la prise en charge psychanalytique des enfants sourds et de leurs familles. Dans la singularité de la rencontre entre l'analyste et le sujet, la langue des signes était vue comme un nœud inquiétant autour duquel le Réel du transfert était perçu dans ses effets et la place occupée par l'enfant dans le discours de la mère était évidente. Les effets du langage des signes évoluent entre l'inconfort, avec des tentatives d'empêcher sa circulation dans le discours, et l'apaisement, dans des moments où il apportait du sens et faisait bouger la chaîne des signifiants. En plus de la spécificité du contenu analysé, nous avons l'intention d'exposer des considérations concernant la langue maternelle des sujets atteints de surdité, en l'articulant avec des concepts liés à la dynamique pulsionnelle des objets à - voix et regard. Ces objets étaient présentés de manière unique et leurs particularités étaient liées à la langue maternelle et à la manière dont elle était présentée aux sujets lors du diagnostic de surdité. Pour atteindre les objectifs proposés, des extraits des cas cliniques analysés ont été utilisés afin de contribuer au développement de propositions et d'articulations théoriques.

Abdominal perineal resection surgery: case report

Colorectal cancer in known to be the most diagnosed cancer in the world, the set gold standard for the treatment of colorectal cancer is excision of the tumor via surgery. There is different type of surgeries that tend to be performed depending on the location, size and extent of the mass in order to avoid recurrence. The main aim of this paper is to discuss the abdominal perineal resection surgery together with the complications faced and criteria in managing these complications intraoperatively.

Outcomes of endobutton and rigidfix femoral fixation methods with hamstring autograft in anterior Cruciate ligament reconstruction / 中国组织工程研究

BACKGROUND: The choice of fixation is an important factor affecting the prognosis of anterior cruciate ligament reconstruction. Endobutton and Rigidfix are two kinds of femoral end suspension fixators which are widely used at present. Their advantages are high fixation strength, large contact area between tendon and bone tunnel, and conducive to tendon-bone healing. However, it is still controversial whether there are differences in clinical efficacy and bone tunnel enlargement between the two fixation methods. OBJECTIVE: To analyze the outcomes of two different femoral fixation methods (Endobutton and Rigidfix) with hamstring autograft in anterior cruciate ligament reconstruction. METHODS: A retrospective analysis was performed on the data of 270 cases which accepted the anterior cruciate ligament reconstruction and second arthroscopic look from June 2015 to December 2017. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. The patients were divided into two groups according to the method of femoral end fixation. The Endobutton femoral fixed reconstruction was performed in Endobutton group (150 cases). The Rigidfix femoral fixed reconstruction was performed in Rigidfix group (120 cases). Reconstruction of anterior cruciate ligament was done using autologous semitendinosus and gracilis tendon. All cases were fixed with Bioabsorbable Interference Screw and AO hollow nail bolt pile fixing screw at the tibial tunnel. The diameter of bone tunnel was also measured by MRI. The knee joint function recovery and stability were evaluated by Lysholm score, International Knee Documentation Committee score, Tenger score table, drawer test, Lachman test, axle shift test, and KT-1000 joint measuring instrument. Second-look arthroscopic evaluation was performed in all patients, focusing on continuity of the reconstructed anterior cruciate ligament, the synovial coverage and the prevalence of abnormal structure at 1 year after surgery. RESULTS AND CONCLUSION: (1) All patients were followed up for 14 to 44 months. (2) Tunnel widening was significantly increased in the Endobutton group than in the Rigidfix group at 1 year after surgery (P 0.05). (4) At 1 year after surgery, the range of motion of knee joint was not significantly different between the two groups (P > 0.05). (5) There was no significant difference between the two groups in drawer test, Lachman test and axle shift test (P > 0.05). The side-to-side difference of KT-1000 in the Endobutton group was (1.12±1.20) mm, while that of KT-1000 in Rigidfix group was (1.23±0.91) mm. There was no significant difference between the two groups (P > 0.05). (6) Secondary arthroscopic examination showed that there were 1 case of complete graft absorption, 11 cases of graft wear in Endobutton group, 2 cases of complete graft absorption and 15 cases of graft wear in Rigidfix group. There was no significant difference between the two groups (P > 0.05). (7) There were 59 excellent cases, 61 good cases, 30 poor cases in Endobutton group, 47 excellent cases, 49 good cases and 24 poor cases in Rigidfix group. There was no significant difference between the two groups (P > 0.05). (8) The incidence of complication was 2.6% in the Endobutton group and 6.6% in the Rigidfix group, and no significant difference was found between the two groups (P > 0.05). (9) The results suggested that Endobutton and Rigidfix had the same clinical outcome. There was no significant difference in the coverage and continuity of synovial synovial membrane between the second look grafts. However, compared with Rigidfix transverse screw system, Endobutton fixation at the femoral end is more likely to cause bone tunnel enlargement.

Assessment of the degree of awareness among post-graduate medical physicians and Pharmacists about look-alike, sound-alike drug and potential medication errors

Background: With thousands of drugs currently in the market, the potential for medication errors due to confusing drug names amongst practising physicians, pharmacists and patients is significant. The existence of confusing drug names is one of the most common causes of medication error. There are many look-alikes, sound-alike (LASA) combinations that could potentially result in medication errors. There is insufficient data about medication errors due to LASA. Hence, we conducted the present study to determine the degree of awareness regarding LASA drugs among post graduate medical physicians and Pharmacists.Methods: This study was a cross-sectional, questionnaire-based survey, conducted among 137 year post graduate medical residents of a tertiary care teaching hospital and 121 local pharmacists in an urban metropolitan Indian city.Results: There were 34% resident doctors and 17% pharmacists were aware of concept of LASA drugs. Only 46% resident doctors and 22% pharmacists had knowledge about the full form of LASA. Among resident doctors, 39% came across prescription errors due to LASA drugs. Only 69% of the pharmacists agreed that they consulted their doctors when they faced problems due to prescription errors due to similar looking and similar sounding drugs.Conclusions: Look-Alike, Sound-Alike (LASA) drugs are common source of medication errors. Our study suggests that there is lack of awareness about LASA drugs amongst resident doctors and pharmacists, which may contribute to occurrence of medication errors. Therefore, combined efforts by prescribers, pharmacists, organizations, manufacturers and patients is required to overcome medication errors due to LASA drugs.

Relato de uma experiência em Bonneuil: o olhar que dá lugar / Relato de una experiencia en Bonneuil: la mirada que da luga / Story of an experience in Bonneuil the look that gives place

Este artigo é sobre uma experiência de estágio realizada na Escola Experimental de Bonneuil-sur-Marne, fundada pela psicanalista Maud Mannoni e que acolhe crianças psicóticas, autistas ou com neuroses graves. Trata-se do relato de uma viajante sobre o seu encontro com o estrangeiro, com o estranho familiar, com a loucura e de suas tentativas de fazer laço com o outro. Foi no encontro com algumas crianças que as pontes e os pontos de contato foram criados pelo território dos orifícios pulsionais, sendo o olhar o enlaçamento primordial.

Este artículo versa sobre una experiencia de prácticas realizada en la Escuela Experimental de Bonneuil-sur-Marne, fundada por la psicoanalista Maud Mannoni y que acoge a niños psicóticos, a autistas o con neurosis graves. Se trata del relato de una viajera sobre su encuentro con el extranjero, con el extraño familiar, con la locura y sus intentos de hacer el lazo con el otro. En el encuentro con algunos niños, los puentes y los puntos de contacto fueron creados por el territorio de los orificios pulsionales, siendo la mirada el enlazado primordial.

This article is about an internship experience held at the Bonneuil-sur-Marne Experimental School, founded by the psychoanalyst Maud Mannoni and which welcomes psychotic, autistic or severely neurotic children. It is about a traveler's story and her encounter with the foreign, with the familiar stranger, with the madness and her attempts to tie in with the other. It was in the meeting with some children that the bridges and the points of contact were created by the territory of the driving holes, being the look the primordial entanglement.

Hemorrhage-prevention value of second-look endoscopy after endoscopic submucosal dissection for early gastric cancer: a meta-analysis / 中华胃肠外科杂志

Objective@#To use the meta-analysis in evaluating the hemorrhage-prevention value of second-look endoscopy after endoscopic submucosal dissection (ESD) for early gastric cancer.@*Methods@#A literature search was conducted to identify all relevant studies comparing second-look endoscopy and non-second-look endoscopy after gastric ESD. The Medline/PubMed, Ovid, Elsevier ScienceDirect, EBSCO, CNKI and VIP databases were searched systematically. Literature inclusion criteria: (1) all the patients were diagnosed as early gastric cancer receiving ESD; (2) end point of the study included postoperative bleeding rate of ESD. Exclusion criteria: (1) papers of repeated research, review, comment, guideline, etc; (2) non-control study. Meta-analysis method was used to calculate a pooled odds ratio (OR) for developing post-ESD bleeding.@*Results@#The meta-analysis showed that post-ESD bleeding was observed in 40 of 1287 patients (3.1%) without second-look endoscopy and in 40 of 968 patients (4.1%) with second- look endoscopy (OR=1.25, 95% CI: 0.79-1.98), with no significant difference between these two groups. Subgroup analysis on research method still indicated no significant difference of post-ESD bleeding between RCT group (OR=1.45,95%CI: 0.79-2.65) and non-RCT group (OR=1.02, 95%CI: 0.50-2.08) (all P>0.05).@*Conclusion@#Based on meta analysis, second-look endoscopy can not reduce the rate of postoperative bleeding of ESD. Therefore, routine second-look endoscopy after gastric ESD may not be necessary to prevent delayed postoperative bleeding of ESD.

Is Second Look Laparoscopy for Diagnosing Remaining Ovarian Cancer Appropriate Further Treatment? / 이화의대지

OBJECTIVES: The aim of our study is to compare the findings of investigative modalities and second look laparoscopy in ovarian cancer and establish the safety and accuracy of second look laparoscopy for detecting ovarian cancer. METHODS: We retrospectively reviewed 11 patients with ovarian cancer treated by a single surgeon from 2006 to 2013. These patients were diagnosed at the time of primary cytoreductive surgery and received six cycles of combination chemotherapy. Then, they underwent second look laparoscopy. They were followed up with tumor markers monthly and PET-CT and/or CT scans. RESULTS: All 11 patients had undergone primary surgery followed by six cycles of consolidation chemotherapy. Eight patients had positive pathologic findings on second look laparoscopy (72.7 %). The CA 125 level was higher in one patient (12.5%). In seven patients who had positive results on second look laparoscopy, the value was well below normal limits (87.5%). Three patients had recorded increases in fluorodeoxyglucose uptake (37.5%). The increase in standardized uptake values in specific regions in the scans corresponded to positive biopsies from those regions. Seven patients who had positive findings on second look laparoscopy were treated with consolidation chemotherapy. The 5-year survival rate was 66.67%, and the 5-year recurrence rate was 33.33%. CONCLUSION: There are limitations to the accuracy of current investigative techniques, and we must rely on clinical correlation with these modalities for each case of second look laparoscopy. It is feasible to safely perform second look laparoscopy to detect remnant ovarian cancer.

Posmodernidad, mirada y virtualidad: sujetos enredados, sujetos mirados / Posmodernity, look, and virtuality: in networking subjects, observed subjects

Resumen El presente artículo reflexivo pretende, desde una perspectiva interpretativa y crítica, realizar un acercamiento al concepto de imagen del mundo en la Posmodernidad y sus vínculos con la virtualidad y la mirada para advertir el tipo de subjetividad que se genera de estas intersecciones a partir del psicoanálisis. El texto presenta una introducción y reflexión inicial, un acápite sobre conceptos psicoanalíticos vinculados a la Posmodernidad y un acápite final sobre discusiones posibles.

Abstract From an interpretative and critical perspective, this paper seeks to make possible an approach to the image of the world concept in Postmodernism and its links with virtuality, as well as a view to warn the kind of subjectivity generated by these intersections from psychoanalysis. The text provides an introduction and an initial reflection, a section on psychoanalytic concepts related to postmodernism and a final subheading on possible discussions.

Factors Affecting the Extent of Graft Tendon Synovialization after Double-Bundle Anterior Cruciate Ligament Reconstruction: Based on Second-Look Arthroscopic Findings

BACKGROUND: We aimed to examine the factors that influence synovialization of the grafted tendon after double-bundle anterior cruciate ligament (ACL) reconstruction based on second-look arthroscopic findings. METHODS: Out of 205 knees that were treated between August 2008 and May 2016 with double-bundle ACL reconstruction using bio-absorbable cross-pins and Endobuttons for femoral tunnel fixation, we enrolled 65 knees (64 patients) that underwent second-look arthroscopy with hardware removal at 1 year postoperatively. Measured clinical outcomes included the Lysholm score and Tegner activity score that were evaluated preoperatively and during the final follow-up. We analyzed the relationship between synovial coverage and patient age, length of the preserved remnant tissue on the tibial side, type of bundle (anteromedial or posterolateral), type of graft (autograft or allograft), and time from injury to surgery. RESULTS: The area of synovial coverage showed a significant statistical correlation with patient age and the length of the preserved remnant tissue on the tibial side. The average synovial coverage was significantly better for the anteromedial bundle than for the posterolateral bundle, better for the autograft than for the allograft reconstruction, and better when treated in the acute stage than in the chronic stage. However, synovialization of grafted tendon did not correlate to clinical outcomes. CONCLUSIONS: While we were able to identify several factors influencing synovialization of the grafted tendon after double-bundle ACL reconstruction, including patient age, length of preserved remnant tissue of the torn ACL, type of bundle, type of graft, and time from injury to surgery, we found no evidence that increased synovialization improves clinical outcomes at 1 year postoperatively.

Expanding the Spectrum of Dopa-Responsive Dystonia (DRD) and Proposal for New Definition: DRD, DRD-plus, and DRD Look-alike

Previously, we defined DRD as a syndrome of selective nigrostriatal dopamine deficiency caused by genetic defects in the dopamine synthetic pathway without nigral cell loss. DRD-plus also has the same etiologic background with DRD, but DRD-plus patients have more severe features that are not seen in DRD because of the severity of the genetic defect. However, there have been many reports of dystonia responsive to dopaminergic drugs that do not fit into DRD or DRD-plus (genetic defects in the dopamine synthetic pathway without nigral cell loss). We reframed the concept of DRD/DRD-plus and proposed the concept of DRD look-alike to include the additional cases described above. Examples of dystonia that is responsive to dopaminergic drugs include the following: transportopathies (dopamine transporter deficiency; vesicular monoamine transporter 2 deficiency); SOX6 mutation resulting in a developmentally decreased number of nigral cells; degenerative disorders with progressive loss of nigral cells (juvenile Parkinson's disease; pallidopyramidal syndrome; spinocerebellar ataxia type 3), and disorders that are not known to affect the nigrostriatal dopaminergic system (DYT1; GLUT1 deficiency; myoclonus-dystonia; ataxia telangiectasia). This classification will help with an etiologic diagnosis as well as planning the work up and guiding the therapy.

La clínica psicoanalítica de la "llamada esquizofrenia": preliminares de una posible "dirección de la cura" / Psychoanalytical clinic of "so called schizophrenia": preliminary considerations for a possible direction of treatment

Sostener la clínica psicoanalítica de la "llamada esquizofrenia" es apostar fuertemente a la posibilidad de escucha del "dicho esquizofrénico". Se trata de una apuesta que busca ir más allá de lo deficitario que muchas veces sella el campo de las psicosis. Además de eso, también se trata de ir más allá de lo postulado en relación a la paranoia, delimitando un posible territorio de intervención clínica en la psicosis esquizofrénica. Es en este sentido que lo restitutivo en la "llamada esquizofrenia" será identificado y discutido. Lo que se articula a la relación del sujeto con su Otro y al desarrollo propuesto con respecto al Otro del "dicho esquizofrénico". Tales elementos, preliminares de una posible "dirección de la cura", apuntan a una particular práctica de la escucha del analista, donde la mirada y el cuerpo asumen su máxima expresión, abriendo el campo a consideraciones a respecto de la finalidad y la conclusión o término del tratamiento psicoanalítico de la "llamada esquizofrenia".

Supporting psychonalytical clinical treatment of "so-called schizophrenia" means betting strongly on the possibility of listening to "schizophrenic speech". This is a bet which seeks to reach beyond the deficit that many times seals the field of psychoses. In addition to that, it seeks to go beyond the given tenets as regards paranoia, by outlining a possible territory for clinical intervention in schizophrenic psychosis. In that sense, the restorative aspect in "so-called schizophrenia" will be identified and discussed. What is articulated concerning the subject\\\'s relationship with his or her Other and the development proposed regarding the Other in "schizophrenic speech". Such preliminary elements for a possible "direction of treatment" point towards a specific approach in the analyst\\\'s listening practice, where the look and the body adopt the height of their expression, opening the field to considerations regarding the purpose and conclusion or end point of psychoanalytical treatment of "so-called schizophrenia".

O pesquisador-cineasta e a ética dos olhares compartilhados / The researcher-filmmaker and the ethics of shared looks

O presente artigo é uma decorrência das pesquisas que venho desenvolvendo, ao longo de quase duas décadas, sobre o uso da imagem técnica em pesquisa acadêmica. O ponto de partida é a afirmação de que a utilização da câmera como mediação provoca uma intervenção singular na relação que se estabelece entre o pesquisador e os sujeitos da pesquisa. O objetivo é apresentar os princípios metodológicos que têm orientado o uso de câmera de vídeo em pesquisa acadêmica, oferecendo subsídios para a definição do ato de pesquisar como construção de uma ética e de uma estética do olhar. A filosofia da linguagem de Mikhail Bakhtin, o debate pioneiro instaurado por Walter Benjamin sobre as transformações da arte na época da reprodução técnica, o cinema documentário de Eduardo Coutinho e a obra teórica e cinematográfica de Pasolini são as principais referências.

This article is a result of the researches that I have developed over nearly two decades on the use of audiovisual camera in academic research. The starting point is the claim that the use of the camera as mediation causes an unique intervention in the relationship that is established between the researcher and the research subjects. The goal is to present the methodological principles that have guided the use of audiovisual in academic research, offering support for the definition of the act of researching as building an ethical and aesthetical look. The philosophy of Bakhtin´s language, the pioneer debate initiated by Walter Benjamin on the transformation of the art at the time of mechanical reproduction, Coutinho´s documentary film and the theoretical and cinematographic work of Pasolini are the main references.

Múltiplos cilindromas dérmicos, tratamento adequado e revisão da literatura / Multiple dermal cylindroma, appropriate treatment and literature review

Os cilindromas são tumores de apêndices cutâneos. Apresentamse normalmente na área da cabeça e pescoço. Muitas modalidades foram descritas para seu tratamento. Apresentamos aqui o caso de uma idosa que se apresentou com lesões recorrentes e que recebeu a opção de fazer uma excisão radical de todas as lesões versus a excisão das lesões sintomáticas. Ela optou por remover as lesões sintomáticas. A excisão cirúrgica das lesões sintomáticas é uma alternativa razoável para pacientes idosos.

Cylindromas are tumors of skin appendages. They present most commonly in the head and neck area. Many modalities have been described to treat them. We present a case of an elderly female who presented to us with recurrent lesions and was offered radical excision of all lesions versus excision of symptomatic lesions. She opted for the removal of symptomatic lesions. Surgical excision of symptomatic lesions is a reasonable alternative in elderly patients.

Clinical effect of second-look endoscopy in patients with early gastric cancer after ESD / 中国内镜杂志

Objective To evaluate whether second-look endoscopy could prevent endoscopic submucosal dissection complicated with delayed bleeding and to clarify what kind of lesions that need second-look endoscopy. Methods 98 patients with early gastric cancer by histological diagnosis from Oct. 2014 to Sep. 2016 were included in this study. Mucosal damage related bleeding within 24 h after ESD was considered delayed bleeding. Clinical data of patients, lesions, surgical factors, and the incidences of bleeding before and after the second endoscopy examination were retrospectively studied. Results The en bloc resection rate of 98 patients was 100.0%, and all incisal margins were negative. No gastrointestinal perforation, death or severe complications occurred. 5.1%of the patients (5/98) occurred delayed bleeding after ESD and had been successfully stopped in a second-look endoscopy, and none received operations. No delayed bleeding occurred in follow-ups of patients with negative delayed bleeding. 40.0 % of the patients (2/5) with delayed bleeding received blood transfusion. The median time of second-look endoscopy after ESD was the second day after operation (1 ~ 3 d). The median bleeding time of 5 patients with delayed bleeding after ESD was the first day after operation (1 ~ 10 d). The median duration of surgery was 75 min (60~150 min), and the prediction success rate was 94.9 %. The results of univariate analysis showed that age [(69.6 ± 7.9) vs (60.9 ± 10.1) years old, P = 0.003] and operation time [(90.0 ± 41.0) vs (66.0 ± 42.0) min, P = 0.000] were both the risk factors in delayed bleeding and non-bleeding group. Binary Logistic regression analysis showed that operation time (OR