Protocolo de avaliação para apraxia de fala adquirida / Assessment protocol for acquired apraxia of speech

RESUMO Objetivo Elaborar um protocolo de avaliação do planejamento motor da fala com estímulos fonologicamente balanceados para o português brasileiro e que contemple todas as variáveis necessárias para este diagnóstico. Método Foram realizadas três etapas: Na primeira, construíram-se listas de palavras cujo critério principal foram os padrões silábicos e acentuais. Do levantamento realizado na Etapa 1, procedeu-se à seleção dos vocábulos que compuseram a primeira versão do protocolo na Etapa 2, reunidas em duas tarefas: de repetição e de Leitura em Voz Alta (LVA). Em seguida, investigou-se a ocorrência das palavras usando a base de dados do Corpus Brasileiro (PUC-SP) - Linguateca. Na etapa 3 realizou-se a análise estatística para verificar se as listas de repetição e de LVA estavam equilibradas quanto à ocorrência das palavras. Assim, as listas foram distribuídas em quartis e foram analisadas de forma descritiva e bivariada. O nível de significância utilizado foi de 5%. Resultados Após a realização de todas as etapas, foi possível obter as palavras que compuseram as listas das tarefas de repetição e de LVA. Finalmente, foram então acrescidas ao protocolo as demais tarefas consideradas essenciais para a avaliação da apraxia como as taxas diadococinéticas e a prancha para a emissão oral espontânea. Conclusão O protocolo desenvolvido contém as tarefas consideradas padrão para a avaliação da apraxia de fala pela literatura internacional, o que torna esse instrumento importante para o diagnóstico desse distúrbio em falantes do português brasileiro.

ABSTRACT Purpose To develop an assessment protocol for speech motor planning with phonologically balanced stimuli for Brazilian Portuguese, including all necessary variables for this diagnosis. Methods Three stages were carried out: In the first, word lists were built with the main criterion being syllabic and accentual patterns. From the survey conducted in Stage 1, the words that composed the first version of the protocol lists in Stage 2 were selected, and grouped into two fundamental tasks for diagnosing acquired apraxia of speech (AOS): repetition and Reading Aloud (RA). In Stage 3, the occurrence of words was investigated using the Brazilian Corpus (PUC-SP) - Linguateca database, and a statistical analysis was performed to verify if the repetition and RA lists were balanced in terms of the occurrences. Thus, the lists were distributed in quartiles and submitted to both descriptive and bivariate analyses. A significance level of 5% (p<0.05) was adopted. Results After completion of all stages, the words that composed the lists of the repetition and RA tasks were obtained. Finally, other tasks considered essential for the assessment of AOS, such as diadochokinetic rates and the board for spontaneous oral emission, were then added to the protocol. Conclusion The developed protocol contains the tasks considered standard for the assessment of AOS according to the international literature, which makes this instrument important for diagnosing this disorder in speakers of Brazilian Portuguese.

Assessment and indicators of kinematic behavior and perceived fatigability

SUMMARY OBJECTIVE: The objective of this study was to investigate the relationship between upper limb kinetics and perceived fatigability in elderly individuals during an upper limb position sustained isometric task. METHODS: A total of 31 elderly participants, 16 men (72.94±4.49 years) and 15 women (72.27±6.05 years), performed a upper limb position sustained isometric task. Upper-limb acceleration was measured using an inertial measurement unit. Perceived fatigability was measured using the Borg CR10 scale. RESULTS: Higher mean acceleration in the x-axis throughout the activity was associated with higher final perceived fatigability scores. Moderate correlations were observed between perceived fatigability variation and mean acceleration cutoffs in all axes during the second half of the activity. In women, significant correlations were found between all perceived fatigability cutoffs and mean acceleration in the y- and x-axes. However, in men, the relationships between perceived fatigability variation and mean acceleration were more extensive and stronger. CONCLUSION: The acceleration pattern of the upper limb is linked to perceived fatigability scores and variation, with differences between sexes. Monitoring upper limb acceleration using a single inertial measurement unit can be a useful and straightforward method for identifying individuals who may be at risk of experiencing high perceived fatigability or task failure.

Depressive symptoms and self-rated health among Brazilian older adults: baseline data from the ELSI-Brazil study

Objective: To investigate whether having a higher number of depressive symptoms is associated with negative self-rated health (SRH) even in the absence of illness. Methods: This is a secondary analysis of baseline data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil), conducted in 2015-2016, using a national sample of 9,412 people aged 50 or over. SRH was dichotomized into poor or very poor and very good or excellent, good, or average. Depressive symptoms were assessed through the eight-item Center for Epidemiologic Studies Depression Scale (CES-D8). Sociodemographic variables, information about unhealthy behaviors, and the number of chronic conditions were also analyzed. Results: Having depressive symptoms was strongly associated with poor or very poor SRH both in the unadjusted and adjusted analyses. The magnitude of the association was reduced when the number of chronic illnesses was included in the multivariate analysis, along with the other sociodemographic variables and unhealthy behaviors (OR 1.35, 95%CI 1.31-1.39). Conclusion: Having depressive symptoms may contribute towards having a poorer perception of health, even in the absence of health conditions. SRH is a multidimensional construct that can accurately reflect a person's state of general mental health.

Percepción temporal de síntomas de disfagia en una cohorte de pacientes con disfagia orofaríngea neurogénica

Introducción: La disfagia resulta de varios mecanismos fisiopatológicos donde sus síntomas no son estáticos ni homogéneos en las personas, especialmente cuando existe disfagia orofaríngea neurogénica. Objetivo: Conocer la percepción y comportamiento en el tiempo de síntomas de disfagia mediante el instrumento Eating Assessment Tool-10 (EAT-10) en pacientes con disfagia orofaríngea neurogénica, con el fin de visualizar la dinámica clínica de esta forma de disfagia. Metodología: Estudio observacional tipo cohorte en pacientes con disfagia orofaríngea neurogénica de causas neurológicas y neuromusculares, con seguimiento a tres y seis meses y diligenciamiento del EAT-10 al momento basal, tercer y sexto mes. Resultados: Un total de 90 personas con evaluación basal, de las cuales el 56,7 % (51/90) lograron seguimiento al tercer mes y 25,6 % (23/90) al sexto mes. Los síntomas de disfagia con mayor autopercepción en los tres momentos fueron la dificultad para tragar sólidos, sensación de comida pegada en garganta y tos al comer. La odinofagia no fue un síntoma habitualmente percibido. La puntuación total del EAT-10 estuvo entre 16,61 ± 9 y 18,1 ± 9,5 puntos en general. En pacientes con seguimiento completo se observó variación en la autopercepción para tragar líquidos y pastillas. Se observó variación del puntaje al ajustarlo por recepción de terapias. Discusión: Las enfermedades neurológicas y neuromusculares impactan directamente la deglución con gravedad entre leve a profunda, donde la autopercepción de síntomas deglutorios es dinámica, pero con síntomas cardinales de disfagia orofaríngea en el tiempo. Conclusiones: El reconocimiento y seguimiento de síntomas de disfagia deben ser aspectos usuales en la atención de pacientes con enfermedades neurológicas y neuromusculares.

Introduction: Dysphagia results from several pathophysiological mechanisms where its symptoms are not static or homogeneous in people, especially when there is neurogenic oropharyngeal dysphagia. Objective: To know the perception and behavior over time of symptoms of dysphagia using the Eating Assessment Tool-10 (EAT-10) in patients with neurogenic oropharyngeal dysphagia to visualize the clinical dynamics of this form of dysphagia. Methodology: Observational cohort study in patients with neurogenic oropharyngeal dysphagia of neurological and neuromuscular causes with, follow-up at three and six months, and completion of the EAT-10 at baseline, third and sixth month. Results: A total of 90 people with baseline evaluation were included, of whom 56.7% (51/90) achieved follow-up at the third month and 25.6% (23/90) at the sixth month. Symptoms of dysphagia with greater self-perception at all three moments were difficulty swallowing solids, sensation of food stuck in the throat and coughing when eating. Odynophagia was not a commonly perceived symptom. The total score of the EAT-10 was between 16.61±9 and 18.1±9.5 points in general. In patients with complete follow-up, variation in self-perception of swallowing liquids and pills was observed. Variation of the score when adjusting for the reception of therapies. Discussion: Neurological and neuromuscular diseases directly impact swallowing with mild to profound severity, where self-perception of swallowing symptoms is dynamic, but with cardinal symptoms of oropharyngeal dysphagia over time. Conclusions: The recognition and monitoring of dysphagia symptoms should be usual aspects in the care of patients with neurological and neuromuscular diseases.

Lecturas sobre la anorexia desde el psicoanálisis: una revisión sistemática / Readings on anorexia from psychoanalysis: a systematic review

Resumen Este trabajo propone realizar una revisión sistemática sobre las diferentes lecturas sobre la anorexia para describir las propuestas de abordaje en el psicoanálisis y sus perspectivas metodológicas. La revisión sistemática, según la Declaración PRISMA, se lleva a cabo en julio de 2022 y se seleccionan quince artículos científicos provenientes de siete bases de datos (REDIB, SCIELO, Dialnet, REDALYC, DOAJ, SNRD y Portal Regional en Salud Organización Panamericana de la Salud) que refieren a publicaciones en español entre 2022-2012 tomando como referencias las propuestas de la clínica psicoanalítica sobre la anorexia, en donde se concluye sobre las similitudes y diferencias en los abordajes de la temática desde el psicoanálisis sobre la consideración de la anorexia tanto a nivel teórico como clínico-terapéutico. Se podría pensar a la anorexia de hoy en día como la respuesta de algunos jóvenes histéricos a este imperativo: el sujeto insiste en afirmar su división subjetiva, rechazando al objeto que pretende colmarla. Se afana en albergar la nada, espacio del deseo puro.

Abstract This work proposes to carry out a systematic review on the different readings on anorexia to describe the proposals of approach in psychoanalysis and its methodological perspectives. The systematic review, according to the PRISMA Declaration, will be carried out in July 2022 and fifteen scientific articles will be selected from seven databases (REDIB, SCIELO, Dialnet, REDALYC, DOAJ, SNRD and Portal Regional en Salud Organización Panamericana de la Salud) that refer to publications in Spanish between 2022-2012 taking as references the proposals of the psychoanalytic clinic on anorexia, where it is concluded about the similarities and differences in the approaches to the subject from psychoanalysis on the consideration of anorexia both at a theoretical and clinical-therapeutic level. Today's anorexia could be thought of as the response of some hysterical young people to this imperative: the subject insists on affirming his subjective division, rejecting the object that tries to fill it. It strives to house nothingness, the space of pure desire.

Resultados de una evaluación y seguimiento online de problemas de salud mental en universitarios chilenos / Results of an online mental health problems screening and follow-up with Chilean university students

Resumen Este estudio examina la detección y posterior seguimiento online de problemas de salud mental en estudiantes universitarios y expone los resultados de ambos procesos. Para ello, se aplicó a través de la plataforma de la universidad a 1 707 estudiantes una batería de cuestionarios destinados a detectar desesperanza y riesgo de suicidio, síntomas depresivos y ansiosos, estrés, trastornos de la conducta alimentaria y apoyo social percibido. Una vez aplicados los instrumentos, los estudiantes recibían una retroalimentación acerca de sus niveles de síntomas e información acerca de redes y establecimientos para buscar ayuda y recibir atención en los casos requeridos. A mediados del año siguiente, se realizó una encuesta de seguimiento a 577 de los estudiantes que previamente habían respondido todos los cuestionarios. Los resultados de la batería de cuestionarios aplicados indican altos índices de problemas de salud mental, con diferencias estadísticamente significativas según sexo, siendo las mujeres quienes presentan mayor prevalencia. Estos resultados concuerdan con diversos estudios que muestran altos porcentajes de síntomas de problemas de salud mental en los universitarios. A su vez, el posterior seguimiento permitió evidenciar que el feedback entregado activó la búsqueda de ayuda, y se obtuvieron correlaciones positivas entre sentirse mejor y haber buscado un tratamiento de salud mental o haber pedido ayuda a los amigos o a la familia. El uso de tecnologías de la información en la detección y prevención de salud mental tendría un alcance positivo y resultó ser una herramienta útil, accesible y cercana para los jóvenes.

Abstract The exponential increase in higher education students and the new university profile that incorporates more vulnerable social groups are associated with an increase in mental health problems in this population. Likewise, the complex stage of the life cycle in which these young people find themselves and the stress of the transition between adolescence and adulthood are other risk factors for the development of mental health problems. The emergence of mental health problems in this group could then be due to a confluence of factors, also facilitating risk behaviors. National and international researches have reported the worrying rates of mental health disorders in university students, mainly in relation to the presence of depression, anxiety, stress, alcohol or drug use, eating disorders, and suicidal ideation. These disorders tend to be aggravated, because the university population is prone not to seek help. The stigma of presenting mental health problems, skepticism about treatments, not wanting to worry the closest family and the few economic resources or not having a health plan, lead to not seeking help or do this late. Studies have found that more than half of students who need mental health and support services are not receiving them. On the other hand, a high percentage seeks help late, which implies that the disorders are accentuated or become chronic, which makes subsequent treatment and improvement difficult, even becoming a public health problem due to the high economic and professional demand that these treatments require.

Esboços para uma teoria do sujeito: com Badiou e a psicanálise / Outlines for a theory of the subject: with Badiou and psychoanalysis / Essais pour une théorie du sujet: avec Badiou et la psychanalyse

Partindo-se do pressuposto de que, com Descartes, a questão que subjaz na constituição da modernidade é o que seria o sujeito, este texto se propõe a explorar desdobramentos sobre essa questão tendo como referência teorizações de Alain Badiou e algumas concepções básicas que aprendemos a ler na psicanálise. Ele procura demonstrar os impasses que encontramos ao tentarmos estabelecer formalizações sobre o sujeito, impasses esses que estariam na constituição do homem moderno. Trabalha também interseções e implicações dessas formalizações paradoxais com conceitos igualmente caros à psicanálise, como os de sintoma, corpo e verdade, assim como ressonâncias que poderíamos desdobrar entre a tipologia formal do sujeito proposta por Badiou e formalizações sobre esse tema que poderíamos depreender da leitura das obras de Freud e Lacan.

Based on the assumption that with Descartes the question that underlies the constitution of modernity is what the subject would be, this text proposes to explore developments on this issue with Alain Badiou's theorizations as a reference and some basic concepts that we learn to read in psychoanalysis. He tries to demonstrate the impasses that we find when we try to establish formalizations about the subject, impasses that would be in the constitution of modern humans. It also works on the intersections and implications of these paradoxical formalizations with concepts equally dear to psychoanalysis such as symptom, body, and truth, as well as resonances that we could unfold between the formal typology of the subject proposed by Badiou and formalizations on this theme that we could infer from reading the works by Freud and Lacan.

Sur la base de l'hypothèse que, avec Descartes, la question qui sous-tend la constitution de la modernité est ce qui serait le sujet, ce texte propose d'explorer les développements sur cette question ayant pour référence des théorisations d'Alain Badiou et quelques concepts de base que nous apprenons à lire en psychanalyse. Il essaie de démontrer les impasses que nous trouvons lorsque nous essayons d'établir des formalisations sur le sujet, des impasses qui seraient dans la constitution de l'homme moderne. Il travaille également sur les intersections et implications de ces formalisations paradoxales avec des concepts tout aussi chers à la psychanalyse, tels que les symptômes, le corps et la vérité, ainsi que les résonances que nous pourrions déployer entre la typologie formelle du sujet proposée par Badiou et les formalisations sur ce thème que nous pourrions déduire de la lecture des travaux de Freud et de Lacan.

O sintoma da criança: a criança como sintoma dos pais / Le symptôme de l'enfant: l'enfant comme symptôme des parents / The symptom of the child: the child as a symptom of the parents

A questão que introduz este artigo diz respeito à constituição do sintoma da criança e como este é atravessado pelo discurso dos pais. Na bagagem adquirida na clínica foi possível observar como as manifestações do inconsciente aparecem nos detalhes no discurso do indivíduo. Tem-se como intuito marcar a importância das funções paterna e materna na constituição da criança e, quando essas não operam, a desordem que podem causar no psiquismo infantil. Busca-se sensibilizar a noção de que a desorganização psíquica dos pais tem repercussão no processo de subjetivação dos filhos. Nota-se a impossibilidade de separar a criança dos pais no processo analítico, uma vez que ela ainda não se diferenciou enquanto sujeito. Convém não desconsiderar a resposta da criança. Há algo que é dela, que diz respeito à sua singularidade e que não podemos deixar de lado. A função parental tem como responsabilidade a imposição de limites, a orientação para a lógica da hierarquia, e não do igualitarismo, em que pai e filho têm os mesmos direitos e deveres. Entretanto, lidamos hoje com uma sociedade que desacredita da potência desse aparelho regulador e, por consequência, podemos observar um excesso de gozo. O que se colhe disso são crianças que têm que lidar com a falta da falta que a castração impõe a todos

La question qui introduit cet article concerrne la constitution du symptôme de l'enfant et comme elle est traversée par le discours des parents. Avec l'expérience acquise en clinique, cela a été possible d'observer comment les manifestations de l'inconscient apparaissent dans les détails du discours de l'individu. Il a l'intention de souligner l'importance des fonctions paternelle et maternelle dans la constitution de l'enfant et quand celles-ci n'opèrent pas, elles peuvent causer le désordre dans le psychisme infantile. Nous cherchons à sensibiliser la notion que la désorganisation psychique des parents a une répercussion dans le procès de subjectivation des fils. On peut noter l'impossibilité de séparer l'enfant des parents dans le procès analytique, une fois qu'il ne s'est pas différencié en tant que sujet. Il convient de déconsidérer que la réponse de l'enfant. Il y a quelque chose qui est à lui, qui concerne sa singularité et que nous pouvons laisser de côté. Cependant, nous faisons face aujourd'hui à une société qui ne croit pas à la puissance de cet appareil régulateur et, par conséquence, nous pouvons observer un excès de jouissance. Ce que nous en recueillons ce sont des enfants qui doivent gérer avec le manque du manque que la castration impose à tous.

The question that introduces this article concerns the constitution of the child's symptom and how it is traversed by the discourse of the parents. In the baggage acquired through clinical practice, it was possible to observe how manifestations of the unconscious appear in the details of the individual's speech. The aim is to emphasize the importance of both paternal and maternal functions in the constitution of the child, and when these functions do not operate, the disorder they can cause in the child's psyche. The intention is to raise awareness of the notion that the psychic disorganization of the parents has repercussions on the process of subjectivation of the children. It is noted the impossibility to separate the child from the parents in the analytic process, as the child has not yet differentiated itself as a subject. It is worth not disregarding the child's response. There is something that belongs to the child, related to their uniqueness, that we cannot overlook. The parental function bears the responsibility of imposing limits, guiding towards the logic of hierarchy, rather than egalitarianism, where the parent and the child have the same rights and duties. However, today we deal with a society that disbelieves in the potency of this regulatory apparatus, and consequently, we can observe an excess of jouissance. What is gathered from this is that we have children who must cope with the lack of absence that castration imposeson everyone

Efficacy and Safety of Stomatab Capsules® in Improving Oral Health in Recurrent Aphthous Stomatitis: An Open-labeled Clinical Study

Background: Recurrent aphthous stomatitis (RAS) is a common ulcerative disease of the oral mucosa, which is difficult to treat. In Ayurveda, several medicinal plants have been evaluated for their anti-inflammatory and antioxidant effects in many oral diseases as an alternative for modern medicines. Method: A study with open-label, non-comparative single-arm design was conducted to evaluate the efficacy of “Stomatab” capsules in improving oral health in 30 subjects with RAS. The secondary objectives were to assess the improvement in oral health and tolerability of the herbal formulation. Subjects were instructed to take one capsule thrice daily after meals for 14 days. Patients were evaluated at three assessment points: screening and baseline (Visit 1, Day 0) with follow-ups done at Visit 2 (Day 5 ± 2) and Visit 3 at the end of the study (Day 14 ± 2). Results: There was a significant reduction in the mean ulcer size from 3.66 ± 1.27 mm (V1) to 0.64 ± 0.78 (V3). The mean number of ulcers reduced from 1.97 ± 0.72 (V1) to 0.90 ± 0.66 (V3). Significant improvement in ulcer-related symptoms of pain (Ruja), burning sensation (Daha) and redness (Raktavarnata) was noted. The total ulcer symptom scores decreased from 7.67 ± 2.38 (V1) to 0.63 ± 0.56 (V3). No side effects were reported by the study participants. Conclusion: These results show that the polyherbal formulation “Stomatab” capsule is safe and effective for the treatment of RAS.

Assessment of the efficacy of olopatadine 0.1% in the treatment of vernal keratoconjunctivitis in terms of clinical improvement based on total ocular symptom score and ocular surface disease index

Purpose: The main objective of this study is to explore the efficacy of olopatadine 0.1% treatment in the resolution of symptoms of vernal keratoconjunctivitis (VKC) among the Indian population. Methods: This single?center, prospective cohort study involved 234 patients with VKC. Patients were treated with olopatadine 0.1%, twice daily for a period of 12 weeks and then followed up in 1st week, 4th week, 3rd month, and 6th month. The extent of relief in the symptoms of VKC was measured using total ocular symptom score (TOSS) and ocular surface disease index (OSDI). Results: In the present study, the dropout rate was 5.6%. Total of 136 males and 85 females with a mean age of 37.68 ± 11.35 years completed the study. TOSS score reduced from 58.85 to 5.06 and the OSDI score reduced from 75.41 to 11.2 with statistical significance (P < 0.01) from 1st week to 6th week after olopatadine 0.1% treatment. The data showed relief in subjective symptoms of itching, tearing, and redness, and relief in discomfort in functions related to ocular grittiness, visuals like reading, and environmental like tolerability in dry conditions. Further, olopatadine 0.1% was effective in both males and females, and patients across ages 18–70 years. Conclusion: Based on TOSS and OSDI scores, the findings of this study validate safety and tolerability as revealed by low adverse effects and moderate efficacy of olopatadine 0.1% in reducing VKC symptoms in a broader age group (18–70 years) of both genders.

An Open-label Prospective Noncomparative Clinical Study to Evaluate the Efficacy and Safety of Beliv: An Ayurvedic Medicine in Improving Liver Function

An open-label prospective noncomparative study was conducted to examine the efficacy and safety of Beliv tablet, a polyherbal Ayurvedic medicine, in 30 adult patients suffering from liver disorders. Two tablets were administered daily for 56 days. Patients were evaluated at Day 0, Day 21, Day 42 and at Day 56. The primary end point of the study was a change in liver function test parameters measured by the levels of serum glutamic-oxaloacetic transaminase (SGOT), serum glutamic-pyruvic transaminase (SGPT) and total bilirubin at all assessment points. Results showed a significant reduction in the serum levels of SGOT, SGPT and total bilirubin from baseline to 21 days, 42 days and 56 days. The total icterus symptom score was also significantly reduced from 5.17 ± 2.26 (baseline) to 2.6 ± 1.48, 1.37 ± 1.13 and 0.77 ± 0.73 at Days 21, 42 and 56, respectively. The Subjective Global Assessment (SGA) decreased significantly from 3.33 ± 1.16 (Day 21) to 2.33 ± 1.16 and 1.80 ± 0.76 at Days 42 and 56, respectively. The Physician Global Assessment (PGA) score was also significantly reduced from 3.0 ± 1.02 (Day 21) to 2.07 ± 0.83 and 1.70 ± 0.79 at Days 42 and 56, respectively. A significant reduction in serum creatinine level was observed at Day 56. No adverse effects or serious adverse effects were observed during the study period. The study concluded that Beliv tablet was highly effective for the treatment of liver disorders, as evidenced by the reduction in serum levels of SGOT, SGPT, total bilirubin, icterus symptoms and PGA and SGA scores. No treatment-related side effects were reported by any of the study participants suggesting that it was safe for clinical use in humans for the treatment of liver disorders.

Avaliação de sintomas da pessoa com câncer avançado / Assessment of symptoms in people with advanced cancer

Resumo: Trata-se de um estudo de natureza quantitativa, observacional, descritivo com delineamento longitudinal, com o objetivo de avaliar os sintomas apresentados pela pessoa com câncer avançado, assistida em um serviço de oncologia. Aprovado pelo Comitê de Ética em Pesquisa com seres humanos do Complexo Hospital de Clínicas da Universidade Federal do Paraná. O local do estudo foi um hospital de referência em atendimento a pacientes oncológicos na cidade de Curitiba, Paraná. Participaram do estudo 23 adultos portadores de câncer em estadiamento III e IV. A coleta de dados ocorreu de fevereiro a julho de 2022. A etapa inicial foi presencial, houve a identificação dos participantes quanto ao perfil sociodemográfico e clínico, bem como, a avaliação dos sintomas com a Escala de Avaliação de Sintomas de Edmonton (ESAS). O seguimento do estudo se deu majoritariamente por telefone, uma vez por semana, com a ESAS. Foram avaliados os sintomas dor, cansaço, sonolência, náusea, apetite, falta de ar, depressão, ansiedade e bem-estar. Os participantes atribuíram valores de 0 a 10 de acordo com a intensidade que cada sintoma apresentava no momento da avaliação. Os dados obtidos foram analisados por meio do software GraphPad Prism 5.0. Para a análise descritiva de dados dos sintomas foi usado a análise de variância (ANOVA) de duas vias, considerando p<0,05 como estatisticamente significativo. A ANOVA de 2 vias é baseada em dois fatores. O fator linha equivale às diferenças entre as respostas dos itens, e o fator coluna, equivale às variações das respostas em um mesmo item. Quanto ao perfil sociodemográfico, os participantes tinham média de idade de 53,3 anos, 78,3% do sexo feminino, e 82,6% procedentes de Curitiba. Acerca do perfil clínico, as neoplasias de mama representaram 30,8% dos diagnósticos, seguido por adenocarcinoma de cólon e reto 17,4% e carcinoma espinocelular de colo uterino 13%. Entre os sintomas avaliados, o de maior intensidade média foi o cansaço (5,53) e, a náusea, apresentou a menor média (1,76). Referente à décima questão da ESAS (Outro problema?), a constipação intestinal foi a mais presente, relatada em 13,8% das 247 avaliações. Constatou-se que os sintomas em pessoas com câncer avançado se manifestam de maneira concomitante, e que existe um processo de inter-relação importante entre sintomas físicos e psicológicos. O instrumento ESAS foi eficiente para as avaliações de sintomas, sendo facilmente compreendido pelos participantes, de aplicação rápida, e ainda, forneceu dados objetivos. Espera-se que este estudo contribua para o aprimoramento da avaliação e manejo dos sintomas, proporcionando melhora da qualidade de vida aos pacientes com câncer avançado e seus familiares.

Abstract: This is a quantitative, observational, descriptive study with a longitudinal design, with the objective of evaluating the symptoms presented by people with advanced cancer assisted in an oncology service. Approved by the Ethics Committee for Research with Human Subjects of the Clinics Hospital Complex of the Federal University of Paraná. The study location was a hospital that is a reference in treating cancer patients in the city of Curitiba, Paraná. Twenty-three adults with stage III and IV cancer participated in the study. Data was collected from February to July 2022. The first stage was faceto- face, where participants were identified according to their sociodemographic and clinical profile, and their symptoms were assessed using the Edmonton Symptom Assessment Scale (ESAS). The follow-up of the study took place mostly by phone, once a week, with ESAS. The symptoms pain, fatigue, drowsiness, nausea, appetite, shortness of breath, depression, anxiety, and well-being were assessed. Participants assigned values from 0 to 10 according to how intense each symptom was at the time of the assessment. The data obtained were analyzed using GraphPad Prism 5.0 software. For the descriptive analysis of symptom data, two-way analysis of variance (ANOVA) was used, considering p<0.05 as statistically significant. The 2-way ANOVA is based on two factors. The row factor equals the differences between item responses, and the column factor, equals the variations in responses within the same item. As for the sociodemographic profile, the participants had a mean age of 53.3 years, 78.3% were female, and 82.6% were from Curitiba. About the clinical profile, breast neoplasms accounted for 30.8% of the diagnoses, followed by colon and rectal adenocarcinoma 17.4% and cervical squamous cell carcinoma 13%. Among the symptoms evaluated, the one with the highest average intensity was tiredness (5.53), and nausea had the lowest average (1.76). Regarding the tenth question of the ESAS (Other problem?), constipation was the most present, reported in 13.8% of the 247 evaluations. It has been found that symptoms in people with advanced cancer occur concomitantly, and that there is an important interrelationship process between physical and psychological symptoms. The ESAS instrument was efficient for symptom assessments, being easily understood by the participants, quick to apply, and also providing objective data. It is hoped that this study will contribute to the improvement of symptom assessment and management, providing improved quality of life for patients with advanced cancer and their families.

A prospective study to evaluate the efficacy and adverse effects of alpha-blockers in the management of benign prostatic hyperplasia

Background: Benign prostatic hyperplasia (BPH) is the most common cause for the lower urinary tract symptoms in men. The conservative management of BPH comprises of alpha blockers, especially selective alpha 1 adrenergic blockers for symptomatic relief. Aims and Objectives: We aimed to evaluate the efficacy and adverse effects of alpha blockers in managing BPH. Materials and Methods: After getting approval from the Institutional Human Ethics Committee and consent from subjects, this prospective, randomized, and controlled trial was conducted. In this study, patients under inclusion criteria were divided into two groups. Group I received silodosin 8 mg once daily for 8 weeks. Group II received tamsulosin 0.4 mg once daily for 8 weeks. Primary outcome measure was reduction in international prostate symptom score (IPSS). Adverse events during study period were recorded. Results: A total of 90 patients were enrolled in this study. Ten patients were excluded and remaining 80 patients were divided as 40 in Group I (Silodosin) and 40 in Group II (Tamsulosin), patients were followed up for 8 weeks. As primary outcome, the IPSS at 8th week was significantly <0 week, that is, baseline in both the groups. The comparison of IPSS within Group I and Group II at 0 week and 8th week was significant (P < 0.05). The quality of life comparison within Group I and Group II at 0 week and 8th week was significant (P < 0.05). Both the drugs were well tolerated. Retrograde ejaculation and diarrhea were noted with silodosin (Group I), dizziness and orthostatic hypotension were noted with Tamsulosin (Group II). Conclusion: The obtained results showed that both silodosin and tamsulosin produced significant improvement in IPSS and quality of Life in BPH patients. In silodosin group, retrograde ejaculation and diarrhea were notable adverse effects and in tamsulosin group, dizziness and orthostatic hypotension were noted.

Value of allergen nasal provocation test in assessment of the efficacy of house dust mites specific immunotherapy / 临床耳鼻咽喉头颈外科杂志

Objective:To investigate the value of nasal provocation test（NPT） in evaluating the efficacy of allergen immunotherapy（AIT） in patients with dust mite induced allergic rhinitis（AR）. Methods:A total of 83 patients with dust mite induced AR with/without asthma were included. Symptom score（SS）, daily medication score（DMS）, combined symptom and medication score（CSMS）, rhinoconjunctivitis quality of life questionnaire（RQLQ）, NPT and skin prick test（SPT） were assessed before and after 1 year AIT. Results:There were statistical differences in SS（P<0.000 1）, DMS（P<0.000 1）, CSMS（P<0.000 1）, and RQLQ（P<0.000 1） after 1 year of AIT compared with pre-treatment. The effective rate of CSMS was 73.49%, and the effective rate of NPT was 42.17%. CSMS was consistent with NPT in efficacy assessment（Kappa=0.437, P<0.001）; while in 54 patients with pre-treatment NPT concentrations other than the original concentration, CMSM and NPT showed better consistence（Kappa=0.895, P<0.001）. Among the 48 patients with ineffective NPT assessment in the first year, 25 patients completed the second-year follow-up, and 12 patients（48.00%） showed effective in NPT. However, 10 out of 12 patients（83.33%） with NPT concentration other than original solution pre-treatment showed effective NPT at the second year. Conclusion:NPT can be used as one of the indicators for efficacy evaluation for dust mite induced AR patients, especially for patients with positive NPT induced at lower concentrations before treatment.

Evaluation of subjective scale in allergen nasal provocation test / 临床耳鼻咽喉头颈外科杂志

Objective:To compare the clinical value of visual analogue scale （VAS）, Lebel scale and total nasal symptom scores （TNSS） in evaluating nasal allergen provocation test （NAPT）. Methods:A total of 151 patients suspected of allergic rhinitis admitted to the Department of Otolaryngology-Head and Neck Surgery of our hospital from April 2020 to September 2020 were included, of which 76 were positive for house dust mites and 75 were negative for allergens. Nasal airway resistance（NAR） was measured by active anterior nasal manometry. Nasal symptoms were evaluated by VAS, Lebel and TNSS. House dust mite allergen was used for NAPT by spray method. An increase≥40% in NAR was used as the gold standard for objective evaluation of NAPT. ROC curves of VAS, Lebel and TNSS were drawn to compare the evaluation effectiveness of different subjective evaluation methods, and the optimal critical point of each ROC curve was obtained. Results:With NAR increased by ≥40% as the gold standard, the area under ROC curve of VAS was 0.884, and the sensitivity and specificity were 97.75% and 80.65%, respectively. The area under ROC curve of Lebel was 0.773, and the sensitivity and specificity were 68.54% and 75.81%, respectively. The area under ROC curve of TNSS was 0.792, and the sensitivity and specificity were 68.54% and 79.03%, respectively. There was no significant difference between Lebel and TNSS（P>0.05）. The VAS differed significantly from Lebel and TNSS（P<0.05）. The Kappa values of VAS, Lebel, TNSS and NAR were 0.803, 0.432 and 0.459, respectively. Conclusion:The VAS, Lebel, TNSS subjective scale and NAR are consistent in evaluating the efficacy of NAPT, with the VAS assessment showing highest consistency with NAR. As objective assessment instruments are not widely used in China, subjective assessment method could be adopted to evaluate the efficacy of NAPT in clinical practice, and VAS scale is recommended as a priority.

The application progress on diagnostic scales of laryngopharyngeal reflux disease / 临床耳鼻咽喉头颈外科杂志

At present, objective methods for diagnosing laryngopharyngeal reflux disease(LPRD) are not minimally invasive, effective, and economical. Diagnostic scales are widely used worldwide due to the advantages of inexpensive, noninvasive, and easy to operate. The reflux symptom index(RSI) and the reflux finding score(RFS) are preferred to use in clinical diagnosis. However, many controversies have appeared in the application of RSI and RFS in recent years, causing many troubles to clinical diagnosis. Therefore, this review briefly discusses the problems of RSI and RFS in clinical applications to provide reference for diagnosing LPRD accurately.

Exploring biological connotation of blood stasis syndrome of rheumatoid arthritis and establishment of improved animal models based on syndrome-symptom mapping / 药学学报

Blood stasis syndrome is one of the core clinical syndrome of rheumatoid arthritis (RA), but the biological connotation of this syndrome is not clear, and there is a lack of disease improved animal models that match the characteristics of this disease and syndrome. The aim of this study was to screen the candidate biomarker gene set of blood stasis syndrome of RA, reveal the biological connotation of this syndrome, and explore and evaluate the preparation method of the improved animal model based on the characteristics of "disease-syndrome-symptom". The study was approved by the ethics committee of Guang'anmen Hospital, Chinese Academy of Traditional Chinese Medicine (No. 2019-073-KY-01) and the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine (No. TYLL2021[K]018), and the study subjects gave their informed consent. Animal welfare and experimental procedures followed the regulations of the Experimental Animal Ethics Committee of the Chinese Academy of Traditional Chinese Medicine (No. IBTCMCACMS21-2207-01). The whole blood samples were collected clinically from RA patients with blood stasis syndrome (3 cases) or other syndromes (7 types, 3 cases/type), and healthy volunteers (4 cases), and then transcriptome sequencing, KEGG, gene set enrichment analysis (GSEA) and weighted correlation network analysis (WGCNA) analysis were performed. 126 pivotal genes were screened, and their functional annotation results were significantly enriched in "immune-inflammation" related pathways and lipid metabolism regulation (sphingolipids, ether lipid metabolism and steroid biosynthesis). Syndrome-symptom mapping of hub gene set to the TCM primary and secondary symptoms, Western phenotypic symptoms and pathological links showed that joint tingling, abnormal joint morphology, petechiae and abnormal blood circulation are representative of blood stasis syndrome of RA. The results of the improved animal model showed that the rats in the collagen-induced arthritis + adrenaline hydrochloride (CIA+Adr) 3 model group had increased blood rheology, coagulation, platelet function and endothelial function abnormalities compared with the CIA-alone model group, suggesting that the rats with blood stasis syndrome of RA may be in a state of "blood stasis". The results of the study can help to advance the objective study of the evidence of blood stasis syndrome in RA, and provide new ideas for the establishment of an animal model that reflects the clinical characteristics of the disease and syndrome.

CiteSpace-based visualization analysis of domestic and foreign research on somatic symptom disorder / 四川精神卫生

BackgroundThe etiology and pathogenesis of somatic symptom disorder are complicated， for which no effective treatment currently exists， posing a critical impact on their quality of life. ObjectiveTo analyze the current situation and development trend in domestic and foreign research on somatic symptom disorder from 2011 to 2021， and to better understand the research frontiers and hot spots in this field. MethodsOn 31 August 2022， literature on somatic symptom disorder published from January 1， 2011 to January 1， 2023 were searched in China National knowledge Infrastructure （CNKI）， Wanfang Data Knowledge Service Platform， Web of Science and PubMed， and a total of 15 035 articles were included， then the visualization analysis of the number of publications and keywords was conducted based on Microsoft Excel and CiteSpace software. ResultsIn the field of somatic symptoms disorder research from 2011 to 2021， the number of annual publications demonstrated an overall upward trend in foreign studies， and displayed a slow downward trend in domestic studies. The keyword co-occurrence network analysis revealed that the top five high-frequency keywords were "mental health" "depressive disorder" "depression" "anxiety" and "somatic symptom" in domestic studies， and were "symptom" "prevalence" "depression" "disorder" and "quality of life" in foreign studies. The burst analysis suggested that the burst terms in past five years were "somatic symptom" "syndrome" and "quality of life" in domestic studies， and were "major depressive disorder" and "outcome" in foreign studies. The clustering analysis yielded 8 clusters in domestic studies and 4 clusters in foreign studies， reflecting in the related disease， prevention and treatment protocols and epidemiological characteristics of somatic symptom disorder. ConclusionIn recent years， the publications and academic concerns regarding the research on somatic symptom disorder show an upward trend in foreign studies and are relatively inadequate in domestic studies， and both the domestic and foreign studies have been focused on the influencing factors of somatic symptom disorder. ［Funded by the Medical Health Science and Technology Project of Zhejiang Provincial （number， 2020PY064）； Medical Health Science and Technology Project of Hangzhou （number， 0020190783）］

Challenges and strategies in depression research / 四川精神卫生

Depression constitutes the most common mental disorder with high prevalence rate， and is the leading contributor to the global burden of disease. Many factors are found to influence the development of depression， whereas either reliable biomarkers for the early diagnosis or diagnostic criteria for subtype classification currently exist for depression. Therefore， this paper gives a detailed discussion on the current status and existing challenges of depression research in the context of brain imaging， psychoneuroimmunology and electroencephalography， thus providing a new perspective for research directions and future strategies related to depression.

Sleep status and influencing factors among higher vocational college students / 四川精神卫生

BackgroundSleep disorder can adversely affect human physical and mental health， with important implications for socioeconomic development. And higher vocational college students are subject to various pressures and stimuli exerted by academic studies， job seeking and family socioeconomic status， which may contribute to the onset insomnia symptom or sleep disorder. ObjectiveTo discuss the sleep status and influencing factors among higher vocational college students， and to provide references for improving their sleep status. MethodsIn January and February， 2022， a stratified random sampling method was utilized to enroll 3 300 students from five higher vocational colleges in Wenjiang district of Chengdu city. All the participants were assessed using Insomnia Severity Index （ISI）， Patient Health Questionnaire Depression Scale-9 item （PHQ-9） and Generalized Anxiety Disorder Scale-7 （GAD-7）. Pearson correlation analysis was conducted to test the correlation of ISI with PHQ-9 and GAD-7 scores， and the Logistic regression analysis was performed to identify the influencing factors of insomnia symptom in higher vocational college students. ResultInsomnia symptom was detected in 81.90% （2 497 / 3 300） of higher vocational college students. The detection rate of insomnia symptom among vocational college students yielded statistical difference in terms of gender， family socioeconomic status， being an only child or having siblings， degree of psychological pressure exerted by academic studies or job seeking， amount of hours spent on Internet per day， frequency of physical exercise， and the presence or absence of anxiety symptom and depression symptom （χ2=21.032， 22.172， 8.983， 75.939， 36.781， 32.350， 54.512， 86.561， P<0.01 or 0.05）. Among higher vocational college students， ISI score was positively correlated with GAD-7 and PHQ-9 scores （r=0.620， 0.714， P<0.01）， and GAD-7 score was positively correlated with PHQ-9 score （r=0.824， P<0.01）. Gender， family socioeconomic status， degree of psychological pressure exerted by academic studies or job seeking， amount of hours spent on Internet per day， frequency of physical exercise， and the presence or absence of anxiety symptom and depression symptom were effective factors in predicting the insomnia symptom in higher vocational college students （P<0.01 or 0.05）. ConclusionFemale gender， average and below average family socioeconomic status， moderate-to-severe degree of psychological pressure exerted by academic studies or job seeking， spending 2~5 h， 5~7 h or >7 h on Internet per day， inadequate physical exercise and presence of depressive symptom are the risk factors for insomnia symptom in higher vocational college students.［Funded by Sichuan Provincial Primary Health Development Research Center in 2022， North Sichuan Medical College （number， SWFZ22-C-89）］