Sonographic correlations between intravesical prostatic protrusion and bladder outlet obstruction in patients with symptomatic benign prostatic hyperplasia in Ibadan, Nigeria

Evaluating bladder outlet obstruction (BOO) in patients with prostatic enlargement may reflect the severity of the disease and aid in predicting the treatment outcome. Objectives: To determine the sonological correlation between intravesical prostatic protrusion and bladder outlet obstruction in patients with symptomatic benign prostatic enlargement. Methods: This prospective study was conducted over one year at the Department of Radiology, University College Hospital, Ibadan. A transabdominal ultrasound scan of the urinary bladder and prostate gland was carried out on patients with prostatic enlargement and BOO. The intravesical prostatic protrusion, pre-and post-void urine volumes, prostate volume and bladder wall thickness were measured. Results: A total of 132 men aged 43 to 90 years (mean age: 63.8±8.64 years) were studied. The median size of the intravesical prostatic protrusion (IPP) was 7.25 mm (IQR: 0.00 mm; 14.9 mm). The mean prostate volume was 63.3ml±36.0ml. Most subjects (55; 41.7%) had a prostate volume above 60ml, and most patients (101, 77.2%) had bladder wall thickness less than 5mm. The mean bladder wall thickness was 4.26mm±1.54mm. There was a statistically significant correlation between IPP and pre-void urine volume and prostate volume (p = 0.002 and <0.001, respectively). Patients over 70 years had increasing IPP and post-void urine, which lacked statistical significance (p =0.15). Conclusion: The severity of bladder outlet obstruction was reflected in the pre-void urine volume, which correlated with the size of IPP

A Case Report to Study The Effective Role of Varunadi Kashaya and Dashmool Churna in the Causes of Increased Post Void Residual Urine

Post-Void Residual (PVR) volume of urine is the amount of urine retained in the bladder after a voluntary void that is measured by catheterization or non-invasively by ultrasonography. The increased value of PVR act as a diagnostic tool in a urological pathology such as a neurological disease/injury to the bladder, mechanical obstruction, infection or medication induced urinary retention. A PVR less than 50ml signifies adequate bladder emptying. The present case is of 3.1mm non-obstructing left renal calculus and Grade III prostatomegaly with increased Post Void Residual urine (91ml). Renal calculi and prostatomegaly, both are common obstructive uropathies which interferes with the normal outflow of urine. Treatment is aimed at relieving the symptoms and to treat the underlying cause as well. The treatment strategies that can be followed are catheterization, stenting, surgery, lithotripsy, hormonal therapy and antibiotic therapy. The Ayurvedic formulation, Varunadi Kashaya and Dashmool Churna are Vata kapha pacifying drugs. With its Mutrala, Deepana, Anulomana, Shothghana, Shoolghana properties, it had successfully eliminated renal calculus, decreased the prostate size and ultimately, lowered the PVR value as evidenced in USG report. There is a considerable relief in the troublesome urological symptoms- dysuria, dribbling micturition, weak urine stream, inadequate bladder emptying and abdominal pain.

Redefinition to bilayer osmotic pump tablets as subterranean river system within mini-earth via three-dimensional structure mechanism

Defining and visualizing the three-dimensional (3D) structures of pharmaceuticals provides a new and important tool to elucidate the phenomenal behavior and underlying mechanisms of drug delivery systems. The mechanism of drug release from complex structured dosage forms, such as bilayer osmotic pump tablets, has not been investigated widely for most solid 3D structures. In this study, bilayer osmotic pump tablets undergoing dissolution, as well as after dissolution in a desiccated solid state were examined, and visualized by synchrotron radiation micro-computed tomography (SR-μCT). In situ formed 3D structures at different in vitro drug release states were characterized comprehensively. A distinct movement pattern of NaCl crystals from the push layer to the drug layer was observed, beneath the semi-permeable coating in the desiccated tablet samples. The 3D structures at different dissolution time revealed that the pushing upsurge in the bilayer osmotic pump tablet was directed via peripheral "roadways". Typically, different regions of the osmotic front, infiltration region, and dormant region were classified in the push layer during the dissolution of drug from tablet samples. According to the observed 3D microstructures, a "subterranean river model" for the drug release mechanism has been defined to explain the drug release mechanism.

Changes of Brain Functional Connections in Patients with Overactive Bladder / 中国康复理论与实践

Objective:To explore the central mechanism of overactive bladder (OAB) using the resting-state functional magnetic resonance imaging (rs-fMRI). Methods:From October, 2019 to January, 2021, 13 patients with OAB aged (46.9 ±13.4) years were enrolled. Under urodynamic monitoring, rs-fMRI scans were performed in these subjects under empty bladder and strong desire to void. Matlab 2016, SPM 12 and DPABI software were used to process and analyze these obtained image data, six brain regions related to bladder control: right superior frontal gyrus (X = 3, Y=24, Z = 48), right anterior cingulate gyrus (X = 12, Y = 33, Z = 3), left postcentral gyrus (X = -18, Y = -26, Z = 48), right supplementary motor area (X = 3, Y = -12, Z = 63), left insular (X = -42, Y = -12, Z = -3) and right insular (X = 3, Y = -12, Z = 63),were extracted as the regions of interest to analyze the functional connection with the whole brain. Results:The functional connection of the right superior frontal gyrus with the right middle frontal gyrus increased, while the connection with the right cuneus decreased. The connection of the right anterior cingulate gyrus with the right superior temporal gyrus increased, while the connection with the left posterior cingulate gyrus decreased. The connection of the left postcentral gyrus with the right cuneus decreased. The functional connection of the right supplementary motor area with the left cuneus, the connection of the right insular with the medial superior frontal gyrus, and the connection of the left insular with the inferior parietal lobule increased. Conclusion:The functional connections between the brain areas related to continence and other brain regions involved in bladder control changes in patients with OAB. These changes may be one of the potential pathogenic mechanisms of OAB.

Small-world Network Features of Brain Functional Network as Strong Void Perception for Healthy Female / 中国康复理论与实践

Objective:To identify the small-world network property of brain functional network provoked by a strong desire to void in healthy women. Methods:From 2017 to 2018, 21 healthy women were enrolled, and scanned with resting-state functional magnetic resonance imaging under the empty bladder and strong desire to void, respectively. Brain connection matrix was established with Pearson's correlation analysis, and the differences in topologic properties between the two conditions were identified with paired t-test and Bonferroni correction. The small-world parameters, named clustering coefficient (Cp), characteristic path length (Lp), global efficiency (Eglob), local efficiency (Eloc) and nodal efficiency (Enodal) were calculated. Results:There were two women dropped down because of head moving. For the other 19 women, the brain connection presented a small-world network property under the both conditions. Compared with the empty bladder, Cp, Lp, and Eloc decreased, and Eglob increased under the strong desire to void (P < 0.05); while Enodal increased in left inferior frontal gyrus and superior frontal gyrus; right cingulate gyrus, middle occipital gyrus and middle temporal gyrus; and bilateral gyrus rectus and inferior parietal lobes; and decreased in bilateral fusiform gyrus, calcarine fissure and surrounding, and lingual gyrus (P < 0.05). Conclusion:Brain functional network presents a small-world network property under both empty bladder and a strong desire to void. The regulation of lower urinary tract function involves the coordination of multiple brain regions.

The efficacy and safety of intravesical electrical stimulation combined with a training for bladder motor sensory dysfunction in the treatment of neurogenic underactive bladder / 中华泌尿外科杂志

Objective:To explore the efficacy and safety of intravesical electrical stimulation (IVES) combined with a training for bladder motor and sensory dysfunction in the treatment of neurogenic underactive bladder(UAB).Methods:A prospective, single-blind, randomized controlled trial was used to study neurogenic UAB patients admitted to the China Rehabilitation Research Center from October 2019 to May 2021. Inclusive criteria included age≥18 years old, the patients who have been diagnosed as neurogenic UAB and the course of disease being more than 3 months; patients who have been undergone intermittent catheterization to empty the bladder or patients indicated for intermittent catheterization (post-void residual urine accounts for more than 40% of the functional bladder volume), voluntary signing of written informed consent, able to communicate well with researchers and comply with the requirements of the whole trial, and the patient not undergoing any treatment other than oral medication before IVES. Exclusion criteria included patients with low bladder compliance by urodynamic examination(<20 ml/cmH 2O), patients with mechanical outflow obstruction, patients with complete spinal cord injury, the patients with symptomatic urinary tract infection which was not cured, patients with hydronephrosis or bladder-ureteral reflux, patients with renal insufficiency(serum creatinine greater than 1.5 times of the upper limit of normality), patients with malignant tumors of the bladder or prostate, overactive bladder, Alzheimer's disease, brain atrophy, acute cerebrovascular disease, or cognitive impairment, patients who were pregnant or planning to be pregnant, bladder mucosa injury, patients with pacemakers or defibrillators, those who participated in other clinical trials 3 months before the study, and other circumstances that the researcher consider it is not suitable to be involved in this study. The patients were randomly divided into experimental group and control group according to the ratio of 1∶1. The experimental group used conventional transurethral insertion of bipolar catheter electrodes for IVES combined with bladder motor and sensory dysfunction training, and the control group underwent IVES with open circuit combined with bladder motor and sensory dysfunction training. The stimulation parameters of the two groups were two-way square wave, 1-30 mA intensity, 10-20 Hz frequency, 200 μs pulse width, once a day, lasting 30 minutes for each treatment, and for continuous 20 working days. The post-void residual urine, voiding efficiency, 24-hour intermittent catheterization times, first sensation of bladder filling volume and American Urological Association Symptom Index Quality of Life(AUA-SI-QOL) scores were recorded before and at the end of treatment. The adverse events during the treatment were recorded. Results:Fifty-two patients were selected and 50 patients completed the trial, including 26 patients in the experimental group and 24 patients in the control group. Before treatment, there were no significant differences in gender[16(male)/10(female)vs.13(male)/11(female), P=0.598], age [(40.7±13.5)years vs.(38.5±12.3)years, P=0.543], course of disease[0.71(0.42, 1.63)years vs.0.79(0.42, 1.50)years, P=0.695], post-void residual urine[300(193, 400)ml vs.325(178, 380)ml, P=0.724], voiding efficiency[17%(0, 47.8)% vs.21%(0, 38.0)%, P=0.960], 24-hour intermittent catheterization times[4(2, 4)vs.3(2, 4), P=0.692], first sensation volume during bladder filling[(325.8±74.3)ml vs.(307.5±75.0)ml, P=0.391] or AUA-SI-QOL scores[5(4, 5)vs.4(4, 5), P=0.313] between the experimental group and the control group. At the end of treatment, the post-void residual urine, first sensation volume during bladder filling and AUA-SI-QOL scores of the experimental group were significantly lower than those of the control group [250(40, 350)ml vs.300(200, 390)ml, P=0.034; (276.5±68.8)ml vs.(315.4±67.3)ml, P=0.049; 4(2, 4)vs.4(3, 5), P=0.024], and the voiding efficiency was significantly higher than that of the control group[33%(14.5, 84.5)% vs.18%(0, 35.8)%, P=0.041], but there was no significant difference in the number of 24-hour intermittent catheterization between the two groups [3(1, 4)vs.3(2, 4), P=0.174]. In the control group, there were no significant changes in post-void residual urine, voiding efficiency, 24-hour intermittent catheterization times, first sensation volume during bladder filling and AUA-SI-QOL scores before and after treatment [325(178, 380)ml vs.300(200, 390)ml, P=0.832; 21%(0, 38.0)% vs.18%(0, 35.8)%, P=0.943; 3(2, 4)vs.3(2, 4), P=0.239; (307.5±75.0)ml vs.(315.4±67.3)ml, P=0.257; 4(4, 5)vs.4(3, 5), P=0.157]. In the experimental group, there were significant improvements in post-void residual urine, voiding efficiency, 24-hour intermittent catheterization times, first sensation volume during bladder filling and AUA-SI-QOL scores before and after treatment [300(193, 400)ml vs.250(40, 350)ml, P<0.001; 17%(0, 47.8)% vs.33%(14.5, 84.5)%, P<0.001; 4(2, 4)vs.3(1, 4), P=0.011; (325.8±74.3)ml vs.(276.5±68.8)ml, P<0.001; 5(4, 5)vs.4(2, 4), P<0.001]. During the treatment period, 1 case of abdominal discomfort occurred in the experimental group and 1 case of urethral discomfort in the control group. After adjusting the stimulation intensity and catheter position, the discomfort disappeared without other serious adverse events. Conclusions:IVES combined with bladder motor sensory dysfunction training can not only effectively improve the bladder emptying efficiency and bladder sensation in patients with neurogenic UAB, but also be safe and easy to operate.

Mejora de las variaciones en la ecografía vesical Evaluación del volumen de orina residual posmiccional en obstrucción moderada de la salida de la vejiga / Improving Variations in Bladder Ultrasound Assessment of Post-Void Residual Urine Volume in Moderate Bladder Outlet Obstruction

Objectives: This study aimed to assess the accuracy of post-void residual (PVR) urine volume measurements in patients with moderate bladder outlet obstruction. Materials and Methods: This prospective observational study was conducted between January and December 2019. The inclusion criteria were male patients with symptoms of moderate bladder outlet obstruction. On the other hand, patients with a history of diabetes, symptoms of urinary tract infection, and positive urine for pyuria, as well as patients using medications, such as diuretics, alpha-blockers, and anticholinergic drugs, were excluded. The patients were asked to drink 1000 mL of water one to two hours before the initial ultrasound scan. Pre-void bladder capacity was measured, followed by a post-void ultrasound for residual urine volume measurement at three intervals: immediately after voiding, 15-20 minutes after the first void, and one week later with an empty bladder. Assessment of per-void capacity was carried out, based on the patient's subjective sensation of bladder fullness (a strong desire to void). Results: A total of 78 male patients, with the mean age of 60 years, were included in this study (27 cases in group I; 37 cases in group II; and 14 cases in group III). The mean PVR volume was 92 mL in the first measurement, 62 mL in the second measurement, and 60 mL in the third measurement. Significant differences were found between the first and second PVR measurements and between the first and third PVR measurements (P<0.05). However, no significant difference was found between the second and third PVR measurements (P=0.107). On the other hand, significant differences were found between groups I and II and between groups I and III (P<0.05) in the three PVR measurements. Nevertheless, there was no significant difference between groups II and III in the three PVR measurements (P=0.204, 0.56, and 0.487 for the first, second, and third PVR measurements, respectively). Conclusion: A bladder ultrasound must be performed and interpreted carefully to avoid further unnecessary medications, investigations, or procedures. We recommend a second PVR measurement in patients with bladder outlet obstruction. Also, it is suggested to conduct similar studies in different conditions to confirm our findings.

Mejora de las variaciones en la ecografía vesical Evaluación del volumen de orina residual posmiccional en obstrucción moderada de la salida de la vejiga / Improving Variations in Bladder Ultrasound Assessment of Post-Void Residual Urine Volume in Moderate Bladder Outlet Obstruction

Objectives: This study aimed to assess the accuracy of post-void residual (PVR) urine volume measurements in patients with moderate bladder outlet obstruction. Materials and Methods: This prospective observational study was conducted between January and December 2019. The inclusion criteria were male patients with symptoms of moderate bladder outlet obstruction. On the other hand, patients with a history of diabetes, symptoms of urinary tract infection, and positive urine for pyuria, as well as patients using medications, such as diuretics, alphablockers, and anticholinergic drugs, were excluded. The patients were asked to drink 1000 mL of water one to two hours before the initial ultrasound scan. Pre-void bladder capacity was measured, followed by a post-void ultrasound for residual urine volume measurement at three intervals: immediately after voiding, 15-20 minutes after the first void, and one week later with an empty bladder. Assessment of per-void capacity was carried out, based on the patient's subjective sensation of bladder fullness (a strong desire to void). Results: A total of 78 male patients, with the mean age of 60 years, were included in this study (27 cases in group I; 37 cases in group II; and 14 cases in group III). The mean PVR volume was 92 mL in the first measurement, 62 mL in the second measurement, and 60 mL in the third measurement. Significant differences were found between the first and second PVR measurements and between the first and third PVR measurements (P<0.05). However, no significant difference was found between the second and third PVR measurements (P=0.107). On the other hand, significant differences were found between groups I and II and between groups I and III (P<0.05) in the three PVR measurements. Nevertheless, there was no significant difference between groups II and III in the three PVR measurements (P=0.204, 0.56, and 0.487 for the first, second, and third PVR measurements, respectively). Conclusion: A bladder ultrasound must be performed and interpreted carefully to avoid further unnecessary medications, investigations, or procedures. We recommend a second PVR measurement in patients with bladder outlet obstruction. Also, it is suggested to conduct similar studies in different conditions to confirm our findings.

Evaluation of efficacy and safety profile of tamsulosin in benign prostatic hyperplasia

Background: To evaluate the efficacy and safety profile of alpha-1A receptor subtype specific antagonist-tamsulosin in benign prostatic hyperplasia.Methods: An open label, non-randomised, prospective, single centred study who were visiting urology department with confirmed diagnosis of benign prostatic hyperplasia (BPH) were included in the study. Thirty patients with BPH were prescribed tamsulosin and were followed up to three months. The initial or baseline data collected were identification of the patients such as international prostate symptom score (IPSS), prostate specific antigen, urine analysis, and ultrasonography of prostate including post void residual urine. The patients were followed up to 3 months to measure clinical and laboratory outcomes (IPSS score, post void residual urine, uroflow rates etc.).Results: In our study, patients receiving tamsulosin 0.4 mg once daily showed a significant improvement in post-void residual urine (PVRU), uroflow rates and IPSS score. The improvements in the above parameters were found to be statistically insignificant at first and third month of follow-up.Conclusions: In our study, tamsulosin an alpha-1A receptor subtype specific antagonist showed significant improvement in BPH symptoms and the drug was well tolerated.

O luto no complexo da mãe morta / Mourning in the dead mother complex

ABSTRACT: We review the concept of mourning, first as conceived by Freud and Klein, and how it relates with the contemporary "clinic of the void" as described by André Green. The clinic of the void is part of a series of modern manifestation of psychic malaise called "new symptoms". To illustrate, we present the case of Roxana, a Mexican woman whose psyche reflected the dynamic of the dead mother complex. Through an analysis of her interpersonal relationships and past experiences, and comparing with psychoanalytic literature, we conclude that the dead mother complex might become a common condition in our society.

Resumo: Revisamos o conceito de luto, primeiro como concebido por Freud e Klein, e como este se relaciona com a "clínica do vazio" contemporânea, como descrita por André Green. A clínica do vazio é parte de uma série de manifestações modernas do mal-estar psíquico chamado "novos sintomas". Para ilustrar, apresentamos o caso de Roxana, uma mulher mexicana cuja psique refletiu a dinâmica do complexo da mãe morta. Através de uma análise de suas relações interpessoais e experiências passadas, e comparando com a literatura psicanalítica, concluímos que o complexo da mãe morta pode se tornar uma condição comum em nossa sociedade.

Post void residue in women with pelvic organ prolapse: a prospective observational study

Background: The objective of the present study was to observe the post void residual volume (PVRV) in women with pelvic organ prolapse (POP) pre and postoperatively and to correlate stage of prolapse with lower urinary tract symptoms and quality of life in women with pelvic organ prolapse.Methods: This is a prospective observational cohort study of 100 women with symptomatic pelvic organ prolapse of stage II or greater. Patients were admitted for Vaginal hysterectomy with pelvic floor repair for pelvic organ prolapse in Gynaecology Department at Christian Medical College Hospital, Vellore, India over one year were recruited. This study was approved by the institutional review board and ethical committee of the hospital. Pre- and post-operative PVR were measured. The statistical analysis was done by using SPSS version 21 and P value < 0.05 was considered as statistically significant.Results: In this study 100 patients were recruited and 11% of women had pre-operative high post void residual volume of more than 100 ml. Stages of POP did not correlate with severity of LUTS and QOL. Pre-operative elevated PVR resolved post operatively in 91%, the P value <0.000 which was highly significant.Conclusions: 11% of women had preoperative high PVR. Stages of POP did not correlate with severity of lower urinary tract symptoms (LUTS) and quality of life(QOL). Pre-operative elevated PVR resolved post operatively in 91%, the P value < 0.000 which was highly significant. Majority of the patient with severe pelvic organ prolapse had elevated pre-op PVR which resolved post- operatively after surgical correction.

Wicking Property of Graft Material Enhanced Bone Regeneration in the Ovariectomized Rat Model

BACKGROUND: Recruitment and homing cells into graft materials from host tissue is crucial for bone regeneration. METHODS: Highly porous, multi-level structural, hydroxyapatite bone void filler (HA-BVF) have been investigated to restore critical size bone defects. The aim was to investigate a feasibility of bone regeneration of synthetic HA-BVF compared to commercial xenograft (Bio-Oss). HA-BVF of 0.7 mm in average diameter was prepared via template coating method. Groups of animals (n = 6) were divided into two with normal (Sham) or induced osteoporotic conditions (Ovx). Subsequently, subdivided into three treated with HA-BVF as an experiment or Bio-Oss as a positive control or no treatment as a negative control (defect). The new bone formation was analyzed by micro-CT and histology. RESULTS: At 4 weeks post-surgery, new bone formation was initiated from all groups. At 8 weeks post-surgery, new bone formation in the HA-BVF groups was greater than Bio-Oss groups. Extraordinarily greater bone regeneration within the Ovx-HA group than Sham-Bio-Oss or Ovx-Bio-Oss group (p<0.05). CONCLUSION: This study suggests that the immediate wicking property of HA-BVF from host tissue activates a natural healing cascade without the addition of exogeneous factors or progenitor cells. HA-BVF may be an effective alternative for repairing bone defects under both normal and osteoporotic bone conditions.

Constitución subjetiva: estructura y tiempo / Subjetive construction: structure and time

El objetivo del presente escrito consiste en investigar la constitución subjetiva desde una nueva perspectiva a fin de abordar las estructuras psicopatológicas, con miras a una terapéutica que incluya una noción de salud acorde a la ética psicoanalítica. Desarrollaremos el concepto de agujero en la estructura: proponemos que en un primer momento de la enseñanza de Lacan el agujero originario es leído en términos de falta y luego se concibe como un vacío. En este sentido, realizaremos un recorrido que nos permita argumentar qué se concibe por agujero desde el psicoanálisis y diferenciar distintos tipos de agujeros. Postulamos que el agujero, que llamaremos inicial, requerirá ser redoblado por otras operaciones tanto como para vaciarse, como para transformarse en un agujero con bordes. Para ello señalaremos la importancia de diferenciar el concepto de vacío y de agujero, y luego los tratamientos posibles de éste. Por último consideramos que la concepción que se tenga de la estructuración subjetiva tiene consecuencias en la praxis. En este recorrido nos serviremos de algunas nociones de la física para articular el concepto de estructura disipativa y desde allí pensar la orientación analítica.

The aim of this paper is to investigate the subjective constitution from a new perspective in order to approach psychopathological structures looking forward to a kind of practice that includes a notion of health consistent with psychoanalytic ethics. We will develop the concept of hole in the structure: we propose that in Lacan' s first teachings the originary hole is read in terms of lack, while in his last teachings it is conceived as a void. In this sense, we will follow a path that will allow us to argue what is the concept of hole in psychoanalysis and identify the different types of holes. We postulate that the hole, which we call originary, will need to be reinforced by other operations in order to be emptied or to become a hole with edges. And to do that, we will stress the importance of differentiating the concepts of void and hole, and then lay out the possible treatments for the latter. Finally, we consider that the concept that one may have of subjective structuring has consequences for the practice. On the course of this investigation we will use some notions of physics to articulate the concept of dissipative structure and think the analytical orientation from there.

"Saber hacer con" Efectos de un goce de época / "Know how to do with" Effects of a vintage enjoyment

Este artículo se organiza en torno a dos ejes principales: la época actual desde una mirada psicoanalítica y los efectos que ésta conlleva en la clínica contemporánea. No se puede aislar al sujeto y sus síntomas/ fenómenos del devenir de nuestras sociedades. A nivel general, el mundo actual ha puesto de relieve un amplio campo de patologías y presentaciones clínicas: cortes en el cuerpo, fanatismos, comunidades que se congregan en las redes sociales incitando a manifestaciones de violencia y autocastigo (la ballena azul), el aumento creciente de la obesidad en la población mundial, la multiplicación de conductas compulsivas en el marco del empuje al goce sin medidas, el recrudecimiento de los fenómenos de discriminación y segregación (bullying, restricciones inmigratorias, racismo). Incluso, se constata que la clínica de la psicosis también se ha visto modificada desde su presentación sintomática hasta los posibles modos de estabilización. A nivel particular, en lo que respecta a la población que es asistida en hospitales públicos, advertimos también que el contexto cultural, social y económico condicionan las presentaciones clínicas y la orientación del tratamiento, o mejor llamado desde el discurso psicoanalítico, la dirección de la cura. Asimismo, resulta fundamental mencionar que la experiencia analítica, más allá de tener presente el contexto del paciente, trabaja siempre desde la singularidad de cada caso y las soluciones que cada sujeto arma para hacer frente a su malestar. Es nuestra intención abordar dichas problemáticas a la luz de una mirada clínica.

This article is organized around two main axis: the present time from a psychoanalytic point of view and the effects that this entails in the contemporary clinic. We cannot isolate the subject and its symptoms / phenomena from our societies. Today's world has highlighted a wide range of pathologies and clinical presentations: cuts in the body, fanaticism, communities that congregate in social networks inciting violence and self-punishment (the blue whale), the increasing number of obesity in the world population, the multiplication of compulsive behaviors within the framework of the enjoyment without measures, the intensification of the phenomena of discrimination and segregation (bullying, immigration restrictions, racism) are some of the many manifestations which are currently observed. In addition, we observe that clinical psychosis has also been modified in present time from its symptomatic presentation to possible modes of stabilization. In particular, regarding population assisted in public hospitals, we also notice that the cultural, social and economic context conditions clinical presentations and orientation of treatments and the direction of the cure. It is also important to mention that analytical experience, beyond having in mind the context of the patient, always works from the singularity of each case and the solutions that each one builds to deal with their discomfort. It is our intention to face these issues in light of a clinical view.

Este artigo está organizado em dois eixos principais: a época atual desde um olhar psicanalítico e os efeitos deste na clínica contemporânea. O sujeito e seus sintomas / fenômenos/ não se pode isolar do decorrer de nossas sociedades. Em termos gerais, pode-se dizer que o mundo atual salientou um amplo campo de patologias e apresentações clínicas: cortes no corpo, fanatismos, comunidades que se juntam nas redes sociais incitando a manifestações de violência e auto punição (a baleia azul), o acréscimo da obesidade na população mundial e de condutas compulsivas no entorno que impulsiona o gozo sem medida, bem como o reaparecimento dos fenômenos de discriminação e segregação (bullying, restrições imigratórias, racismo). Verifica-se, até, que a clínica da psicose também tem sido alterada em sua apresentação o sintomática e nos possíveis modos de estabilização. No particular, relativo à população que é assistida nos hospitais públicos, revela-se também que o contexto cultural, social e econômico condicionam as apresentações clínicas e a orientação do tratamento, ou de acordo com o discurso psicanalítico, a direção da cura. De igual maneira, é fundamental mencionar q a experiência psicanalítica além de considerar o contexto do paciente, trabalha sempre desde a singularidade de cada caso e das soluções que cada sujeito cria para enfrentarse com seu mal-estar. Nosso intuito é abordar tal problemática à luz de um olhar clínico.

Falsely Elevated Postvoid Residual Urine Volume in Uterine Myoma

Precise measurement of postvoid residual (PVR) urine volume is a key factor in assessing patients with voiding dysfunction, including those with lower urinary tract problems. The safe and noninvasive ultrasound bladder scan is the preferred mode to measure PVR volume. However, this procedure has a false-positive rate up to 9%, in the presence of ovarian cysts, renal cysts, ascites, or uterine myoma with cystic degeneration. Until now, cystic lesions are known to cause false positivity in ultrasound bladder scanner. However, we encountered falsely-elevated PVR in two cases of non-cystic uterine myomas. We present these cases with detailed radiologic images and volume measurement data.

Constituição especular do desejo e sua atualização no adulto / Wish specular constitution and its up date in adult

Nesse artigo, examina-se a constituição especular do desejo da criança a partir do desejo de seus objetos primários. Assim, as representações, afetos e vazios representacionais da criança se articulam as representações, afetos e vazios representacionais de seus pais. Esse processo favorece o bloqueio na atualização do desejo do adulto. Vários fatores contribuem para isso: os vazios representacionais no desejo dos objetos primários e do sujeito, sua identificação e contra-identificação com eles, a formação do objeto idealizado e do objeto imaterial-simbólico, as alterações no sistema das representações no trauma do absoluto. Portanto, uma série de hipóteses de trabalho são propostas pela autora, para tentar entender esse fenômeno. O método clínico psicanalítico permite, afinal, que o sujeito, quando adulto, possa atualizar seu desejo no mundo. O pensamento de alguns psicanalistas favorece a reflexão da autora sobre essas questões

In this article, the specular constitution of a child's wish is related to his/her primary material wishes. In this case, the child's representations, affects and representational voids are linked to his/her parents' representations, affects and representational voids. This process favors the block in the adult's wishes' update. Several factors contribute to this: representational voids in primary objects wishes and in the subject, his/her identification and counter-identification with them, the idealized object and symbolic-immaterial object, alterations in the representational system regarding absolute trauma. Therefore, a series of work hypotheses are proposed by the author in order to understand this phenomenon. The psychoanalytical clinical method allows the patient, when adult, to update his wishes in the world. Some psychoanalysts' thoughts favor the author's reflection regarding these questions

Precompression stress and compression index depend on the property used to represent the soil deformation in the compression curve / Pressão de preconsolidação e índice de compressão dependem da propriedade usada para representar a deformação do solo na curva de compressão

ABSTRACT: During linear deformation (h) in a soil sample, the variation of the void ratio with respect to deformation (dε/dh) and the respective variation of soil bulk density (dρ/dh) are identical only for a specific value of h. Consequently, if two compression curves are drawn for the same soil sample, one using ρ and the other using ε, there are differences in both the calculated precompression stress (σp) and compression index (Ic). In this study, we highlight the causes by a mathematical analysis and an experimental investigation, quantifying the differences in σp and Ic when using ε and ρ. σp and Ic were calculated for 103 compression curves of an ultisol and 193 of an oxisol. The σp (kPa) using ρ (σpρ) was greater than when using ε (σpε), and differences were rather independent of the soil type. The relations found by linear regression relating σpρ to σpε were σpρ=0.8186σpε+34.202 for the ultisol and σpρ=0.8878σpε+34.875 for the oxisol. In contrast, the used soil property (ρ or ε) as well as soil type affected Ic. Ic calculated using ρ was greater than when using ε in almost all (96%) of the cases for the ultisol, and in only 12% of the cases for the oxisol. For a wide range of ρ, evidence from this study indicated that the use of ρ overestimates σp when compared to the use of ε.

RESUMO: À medida que uma amostra de solo sofre deformação linear (h), a variação do índice de vazios em relação à deformação (dε/dh) e da respectiva variação da densidade do solo (dρ/dh) são coincidentes somente para um único valor de h. Decorrente disso, verifica-se experimentalmente que, para a mesma amostra de solo, há diferenças, tanto na pressão de preconsolidação (σp) como no índice de compressão (Ic), se forem determinados a partir das duas curvas de compressão, uma a base da ρ e outra a base do ε. A análise matemática, seguida da investigação experimental deste estudo, evidencia as causas e quantifica as diferenças na σp e no Ic, devido ao uso do ε ou ρ. A σp e o Ic foram calculados em 103 curvas de compressão de um Argissolo e em 193 de um Latossolo. A σp (kPa) com o uso da ρ (σpρ) foi maior que a σp com o uso do ε (σpε), e as diferenças dependeram menos do tipo de solo. As relações encontradas por regressão foram σpρ=0,8186 σpε+34,202 para o Argissolo e σpρ=0,8878 σpε+34,875 para o Latossolo. Diferentemente, o Ic foi afetado pela propriedade usada (ρ ou ε) para descrever a deformação e pelo tipo de solo. O Ic calculado com o uso da ρ foi maior que quando calculado com o uso do ε em quase todos os casos (96%) no Argissolo e raramente (em 12% dos casos) no Latossolo. Para uma ampla faixa de ρ, as evidências deste estudo indicam que o uso da ρ superestima a σp em relação ao uso do ε.

3D micro-CT analysis of void formations and push-out bonding strength of resin cements used for fiber post cementation

PURPOSE: To investigate the void parameters within the resin cements used for fiber post cementation by micro-CT (µCT) and regional push-out bonding strength. MATERIALS AND METHODS: Twenty-one, single and round shaped roots were enlarged with a low-speed drill following by endodontic treatment. The roots were divided into three groups (n=7) and fiber posts were cemented with Maxcem Elite, Multilink N and Superbond C&B resin cements. Specimens were scanned using µCT scanner at resolution of 13.7 µm. The number, area, and volume of voids between dentin and post were evaluated. A method of analysis based on the post segmentation was used, and coronal, middle and apical thirds considered separately. After the µCT analysis, roots were embedded in epoxy resin and sectioned into 2 mm thick slices (63 sections in total). Push-out testing was performed with universal testing device at 0.5 mm/min cross-head speed. Data were analyzed with Kruskal–Wallis and Mann–Whitney U tests (α=.05). RESULTS: Overall, significant differences between the resin cements and the post level were observed in the void number, area, and volume (P.05). CONCLUSION: µCT proved to be a powerful non-destructive 3D analysis tool for visualizing the void parameters. Multilink N had the lowest void parameters. When efficiency of all cements was evaluated, direct relationship between the post region and push-out bonding strength was not observed.

Theoretical distribution of gutta-percha within root canals filled using cold lateral compaction based on numeric calculus / 华中科技大学学报（医学）（英德文版）

This study aimed to present a new method based on numeric calculus to provide data on the theoretical volume ratio of voids when using the cold lateral compaction technique in canals with various diameters and tapers. Twenty-one simulated mathematical root canal models were created with different tapers and sizes of apical diameter, and were filled with defined sizes of standardized accessory gutta-percha cones. The areas of each master and accessory gutta-percha cone as well as the depth of their insertion into the canals were determined mathematically in Microsoft Excel. When the first accessory gutta-percha cone had been positioned, the residual area of void was measured. The areas of the residual voids were then measured repeatedly upon insertion of additional accessary cones until no more could be inserted in the canal. The volume ratio of voids was calculated through measurement of the volume of the root canal and mass of gutta-percha cones. The theoretical volume ratio of voids was influenced by the taper of canal, the size of apical preparation and the size of accessory gutta-percha cones. Greater apical preparation size and larger taper together with the use of smaller accessory cones reduced the volume ratio of voids in the apical third. The mathematical model provided a precise method to determine the theoretical volume ratio of voids in root-filled canals when using cold lateral compaction.

Comparison of Pre-Operative and Post-Operative Post Void Residual Urine Volume in Urogenital Prolapse.

Background: Post Void Residual Urine (PVR) is a key marker for the evaluation of the efficacy of bladder emptying particularly in women with pelvic organ prolapse and lower urinary tract dysfunction. Objectives of the present study were to compare pre and postoperative post void residual urine volume and to know the relation of PVR to urinary symptoms and prolapse. Methods: 65 patients admitted with urogenital prolapse. Detailed history, general physical examination was done as per predesigned and pretested proforma. Grading for prolapse was done by POP-Q, Baden walker halfway. PVR was measured before and after operation Results: Age has shown significant relation with the raised PVR > 50 ml (p=0.007). Out of 65 cases, 11 had second, 48 had third degree and 6 had procedentia according to Baden Walker system. Urge and stress incontinence were complained by 43% and 26% of patients respectively and increased frequency and nocturia was complained by 68% and 65% of patients. Storage symptoms were not significantly associated with degree of prolapse or raised PVR. Straining to void, incomplete emptying and has to reduce to void were present in 42, 46 and 47 patients respectively and showed significant association with degree of prolapse. Except incomplete emptying other two were associated with raised PVR. Conclusion: Vaginal hysterectomy with anterior colporrhaphy was effective procedure in reducing elevated PVR in prolapse patients.