Caracterización del asma grave no controlada en adultos mayores de 60 años

Introducción: Los pacientes mayores de 60 años suelen tener un asma más grave, menos controlada y peor función pulmonar que los jóvenes. Objetivo: Caracterizar a los pacientes mayores de 60 años con asma grave no controlada. Métodos: Se realizó un estudio observacional descriptivo, prospectivo y transversal en el Hospital Neumológico Benéfico Jurídico en el período comprendido entre enero del 2020 y enero del 2021. Resultados: Edad predominante 60-69 años (76,5 %). Mujeres (61,8 %). Antecedentes familiares de asma o alergia (64,7 %). Asma de larga evolución (85,3 %). Asma asociada a obesidad y mal control (55,9 %). Reversibilidad del VEF1 (volumen espiratorio forzado en el primer segundo) después de la aplicación del broncodilatador (26,5 %). Adherencia al tratamiento (61,8 %). El riesgo futuro de resultados adversos fue bajo en el 58,8 %, es el principal factor, el mal control actual en el 100 %. Conclusiones: El asma grave no controlada en mayores de 60 años es más frecuente en el sexo femenino, los pacientes suelen tener antecedentes familiares de asma o alergia, presentar asma de larga evolución, obesidad asociada al mal control, disminución de la reversibilidad del VEF1 con la aplicación del broncodilatador, mala adherencia al tratamiento y el mal control actual como riesgo futuro de la enfermedad.

Introduction: Patients older than 60 years tend to have more severe, less controlled asthma and worse lung function than younger people. Objective: To characterize patients older than 60 years with severe uncontrolled asthma. Methods: A descriptive, prospective and cross-sectional observational study was carried out at Benéfico Jurídico Pneumological Hospital from January 2020 to January 2021. Results: The age group 60-69 years (76.5%) predominated. Women also predominated (61.8%), as well as family history of asthma or allergy (64.7%), and long-standing asthma (85.3%). Asthma associated with obesity and poor control was 55.9%. The reversibility of the forced expiratory volume in the first second (FEV1) after the application of the bronchodilator was 26.5%. The adherence to treatment was 61.8%. The future risk of adverse results was low (58.8%), which is the main factor, the current poor control in 100%. Conclusions: Severe uncontrolled asthma in people over 60 years of age is more frequent in women, patients usually have family history of asthma or allergy, there is long-term asthma. It was observed that obesity is associated with poor control, the decreased FEV1 reversibility with the application of the bronchodilator, poor adherence to treatment and poor current control as a future risk of the disease.

FEV1 (FORCED EXPIRATORY VOLUME IN THE 1ST SECOND) REVERSIBILITY AFTER NEBULISATION WITH SABA (SHORT ACTING BETA AGONIST) AS A MARKER OF CONTROL OF ASTHMA

INTRODUCTION: Variable expiratory air flow due to bronchoconstriction, airway wall thickening and increased mucus is an obvious feature in asthma. Variable air flow obstruction is evidenced by reversibility of FEV1 following a bronchodilator inhalation. PFT (Pulmonary Function Testing) using spirometry is often used for the estimation of FEV1. Reversibility is not uniform in all cases and vary with respect to severity and control of asthma. AIMS & OBJECTIVES: 1) To determine the control of asthma in 5-15-year-old children using GINA checklist and estimate FEV1 before and after SABA nebulisation. 2) To find out the association between FEV1 reversibility and control of asthma. MATERIALS & METHODS: This cross-sectional study included 90 consecutive 5-15-year-old-children with a clinical diagnosis of asthma attending the Paediatric OPD of a teaching hospital from October-May 2021. The symptoms, signs, comorbidities, treatment, compliance and assessment of control of asthma into 2 subgroups: Well-controlled and Partly-controlled/Uncontrolled asthma, as per GINA 2020 were recorded. All were subjected to spirometry for assessment of FEV1 before and 20 minutes after nebulisation with SABA. Depending upon FEV1, they were grouped as those with >12% reversibility and <12% reversibility. Data analysed using SPSS 20.0, Paired t test for comparison of means, Chi-square test for statistical difference in proportion, and post hoc tests. The RESULTS: M:F ratio was 1.2:1, 52.2% were 10-15 years and 47.8% 5-10 years. 68.9% had partly/uncontrolled, the rest well-controlled asthma (38.1%). The difference between mean FEV1 before (67.9±10.6) and after nebulisation (80.6±9.7) was statistically significant (p<0.00*). Among those with >12 reversibility, 64.5% were in partly/uncontrolled and 35.5% in well-controlled asthma and the difference was statistically significant (p -0.013*). The CONCLUSION: finding in the study that 68.9% had partly/uncontrolled asthma is an eye-opener to optimise protocol-based treatment among children. The statistically significant difference of >12% before and after nebulisation a marker of poor control was observed in 64.5% of partly/uncontrolled asthma compared to 35.5% of well controlled asthma. Hence, the persistence of a significant degree of bronchodilator response noted in those with partly/uncontrolled asthma is recommended as an objective surrogate of poor asthma control in children who can co-operate for a PFT in order to optimise protocol-based treatment.

Short-term exposure to gossypol causes reversible reproductive toxicity and nephrotoxicity in mice / 南方医科大学学报

OBJECTIVE@#To study the toxic effects of short-term exposure to gossypol on the testis and kidney in mice and whether these effects are reversible.@*METHODS@#Twenty 7 to 8-week-old male mice were randomized into blank control group, solvent control group, gossypol treatment group and drug withdrawal group. In the former 3 groups, the mice were subjected to daily intragastric administration of 0.3 mL of purified water, 1% sodium carboxymethylcellulose solution, and 30 mg/mL gossypol solution for 14 days, respectively; In the drug withdrawal group, the mice were treated with gossypol solution in the same manner for 14 days followed by treatment with purified water for another 14 days. After the last administration, the mice were euthanized and tissue samples were collected. The testicular tissue was weighed and observed microscopically with HE and PAS staining; the kidney tissue was stained with HE and examined for mitochondrial ATPase activity.@*RESULTS@#Compared with those in the control group, the mice with gossypol exposure showed reduced testicular seminiferous epithelial cells with rounded seminiferous tubules, enlarged space between the seminiferous tubules, interstitium atrophy of the testis, and incomplete differentiation of the spermatogonia. The gossypol-treated mice also presented with complete, non-elongated spermatids, a large number of cells in the state of round spermatids, and negativity for acrosome PAS reaction; diffuse renal mesangial cell hyperplasia, increased mesangial matrix, and adhesion of the mesangium to the wall of the renal capsule were observed, with significantly shrinkage or even absence of the lumens of the renal capsules and reduced kidney mitochondrial ATPase activity. Compared with the gossypol-treated mice, the mice in the drug withdrawal group showed obvious recovery of morphologies of the testis and the kidney, acrosome PAS reaction and mitochondrial ATPase activity.@*CONCLUSIONS@#Shortterm treatment with gossypol can cause reproductive toxicity and nephrotoxicity in mice, but these toxic effects can be reversed after drug withdrawal.

Progress of reversible parkinsonism / 中华神经科杂志

Parkinsonism is a clinical syndrome caused by many reasons, mainly manifested as bradykinesia, stiffness, static tremor and postural instability. Common disease development patterns include occult onset, gradual development, and little natural remission. However, clinically there are some Parkinsonism that will improve, naturally alleviate or "cure", called reversible parkinsonism (RP). By searching the relevant literature, RP was classified into 12 different types: drugs induced, poisoning induced, infection induced, intracranial vascular induced, structural encephalopathy related, changes in intracranial pressure related, imbalance of internal environment induced, visceral diseases related, alcohol withdrawal related, surgery related, immunization and radiotherapy induced RP. This article aims to provide clinicians with more ideas for the clinical diagnosis and treatment of parkinsonism, so as to promote clinicians to make reasonable identification and diagnosis and treatment of parkinsonism as soon as possible.

Evaluación de la respuesta aguda al broncodilatador en pacientes asmáticos sobrepesos y obesos / Evaluation of the acute response to the bronchodilator in overweight and obese asthmatic patients

Introducción: La obesidad está asociada al uso frecuente de medicación de rescate y padecer asma de mayor gravedad. Los obesos asmáticos tienen menor reactividad bronquial, sin embargo, existe información limitada sobre la magnitud de la reversibilidad aguda al broncodilatador (RAB). Objetivo: Evaluar la magnitud de respuesta aguda al broncodilatador en pacientes asmáticos sobrepesos y obesos. Métodos: Se realizó un estudio descriptivo transversal con 49 pacientes asmáticos sobrepesos y obesos atendidos en consulta externa del Hospital Neumológico Benéfico Jurídico (enero 2017˗ enero 2018) y se constató mediante espirometría la respuesta aguda al broncodilatador. Resultados: Predominó la edad (40-59 años), mayor asociación de padecer asma, poca mejoría con la aplicación del broncodilatador. El sexo femenino (20-59 años) presentó mayor número que el masculino y menor reversibilidad al broncodilatador. Los pacientes con antecedentes patológicos familiares de asma o atopia representaron 73,5 por ciento del total. El 76,5 por ciento de los obesos no presentó mejoría con la aplicación del broncodilatador. Predominó la categoría de gravedad persistente moderada. Conclusiones: El sexo femenino tiene más riesgo de padecer asma y no tener mejoría al aplicar el broncodilatador. Los obesos mayores de 40 años tienen mayor riesgo de no presentar reversibilidad aguda al broncodilatador. Los antecedentes patológicos familiares de asma o atopia y personales de otras enfermedades no predisponen a menor reversibilidad aguda al broncodilatador. La gravedad del asma no influye en la reversibilidad aguda al broncodilatador(AU)

Introduction: Obesity is associated with the frequent use of rescue medication and suffering from more severe asthma. Obese asthmatics have less bronchial reactivity, however, there is limited information on the magnitude of acute bronchodilator reversibility. Objective: To assess the magnitude of the acute response to the bronchodilator in overweight and obese asthmatic patients. Methods: A cross-sectional descriptive study was carried out in 49 overweight and obese asthmatic patients seen in the outpatient clinic at Benéfico Jurídico Pneumologic Hospital from January 2017 to January 2018, and the acute response to bronchodilator was verified by spirometry. Results: Age predominated (40-59 years), greater association of suffering from asthma, and little improvement with the use of bronchodilator. The female sex (20-59 years) showed greater number than the male and less reversibility to bronchodilator. Patients with family pathological history of asthma or atopy represented 73.5 percent of the total. 76.5 percent of the obese did not show improvement with the use of bronchodilator. The category of moderate persistent severity predominated. Conclusions: The female sex has greater risk of suffering from asthma and has no improvement when applying bronchodilator. Obese individuals over 40 years of age have higher risk of not having acute reversibility to the bronchodilator. Family pathological history of asthma or atopy and personal history of other diseases do not predispose to less acute reversibility of bronchodilator. The severity of asthma does not influence acute reversibility to bronchodilator(AU)

Tratamiento de la periimplantitis. Explantación atraumática y nuevo tratamiento con implantes. Reversibilidad de la oseointegración / Treatment of peri-implantitis. Atraumatic explantation and new treatment with implants. Reversibility of osseointegration

La periimplantitis se define como la patología inflamatoria e irreversible que afecta al hueso periimplantario y le hace perder soporte y función al implante según la definición del European Workshop on Periodontology (EWOP). La prevalencia estimada de la periimplantitis es de 28 a 77%. Los diferentes protocolos de abordaje de la periimplantitis nos ofrecen diversas posibilidades: destoxificación de la superficie y regeneración, limpieza mecánica y resección del tejido inflamado, extracción del implante, entre otros. El principal problema de los tratamientos regenerativos es limpiar y desintoxicar correctamente la superficie del implante expuesto, ya que al tratarse de superficies generalmente muy rugosas, las bacterias del medio bucal las colonizan con mucha facilidad y es prácticamente imposible eliminar por completo el biofilm. El protocolo de tratamiento para la periimplantitis se basa en un algoritmo de tratamiento, en el que se retiran los implantes gravemente afectados por periimplantitis de forma atraumática, lo cual garantiza la conservación del lecho al 100% al no retirarse volumen óseo, y cuándo deben utilizarse las trefinas, pues las que se utilizan en el protocolo únicamente rompen la unión ósea de los primeros milímetros sin retirarlo. En el siguiente caso clínico mostramos el retratamiento de un caso de periimplantitis en el que se ha realizado una nueva rehabilitación implantosoportada (AU)

Periimplantitis is defined as the inflammatory and irreversible pathology that affects the peri-implantary bone and causes it to lose support and function to the implant as defined by the European Workshop on Periodontology (EWOP). The estimated prevalence of periimplantitis figures ranging from 28 to 77%. The different protocols for approaching periimplantitis offer different possibilities: detoxification of the surface and re-generation, mechanical cleaning and resection of inflamed tissue and extraction of the implant mainly. The main problem with regenerative treatments is to correctly clean and detoxify the surface of the exposed implant, since as these are generally highly rough surfaces, bacteria in the oral environment colonise them very easily and it is practically impossible to completely eliminate the biofilm. This treatment algorithm, in which implants severely affected by periimplantitis are removed atraumatically, guarantees the conservation of the bed at 100% since no bone volume is removed and trephines must be used, since those used in the protocol only break the bone union of the first few millimetres, without removing it. In the following clinical case, we show the re-treatment of a case of peri-implantitis where a new implant-supported rehabilitation has been performed (AU)

Diffusion-weighted imaging hyperintensity is reversible in large middle cerebral artery infarction following thrombectomy:a case report / 南方医科大学学报

Diffusion-weighted imaging (DWI) is currently the most sensitive technique to diagnose early ischemic stroke. DWI signal hyperintensity is usually considered to suggest irreversible infarct core, but recent studies demonstrated that DWI hyperintensity signal could be reversible on small embolic lesions. Herein we present a case in a 63-year-old male patient, who was admitted to the emergency department with altered mental status and complaint of weakness in the left arm and leg 6.8 h prior to the admission. Emergency cranial magnetic resonance imaging (MRI) and angiography (MRA) revealed occlusion of his right middle cerebral artery (MCA) and large lesions on DWI. The patient underwent intra-artery thrombectomy after evaluation in spite of the large volume of the DWI lesions up to 91.5 mL at the baseline. His right MCA was recanalized at 8.5 h from symptom onset. One week after the procedure, the patient showed reduced DWI lesion volume to 11.58 mL. In this case we observed the reversibility of a large lesion of the anterior artery circulation presenting with hyperintensity on DWI, suggesting that the clinical implication of DWI hyperintensity should be interpreted with caution, and a large volume of baseline DWI hyperintensity may not be a contraindication to thrombectomy. This conclusion, however, awaits further validation by future large-scale randomized controlled trials.

A Prospective Study on Predictive Value of Absolute Eosinophil Count for Bronchodilator Reversibility in COPD Patients

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) patients are prone to exacerbation that account for significant morbidity and mortality. According to physio-pathologic and clinical-functional viewpoints, bronchiectasis and COPD have some common characteristics, it has been observed that bronchiectasis was present in up to 50% of patients with moderate to severe COPD . This observation suggests that COPD is a risk factor for bronchiectasis. METHODOLOGY: This study was included 120 totals who were attending the OPD in the department of TB Chest. This study was conducted in the Department of TB & Respiratory Diseases, Shri Dev Suman Subharti Medical College, Dehradun. RESULT: In our study we were included 120 total number of cases, out of all cases 35.5% cases were found from eosinophilic COPD group & 62.5% were found non-eosinophilic COPD group. In eosinophilic COPD group,42 male and 3 females were found. While in non-eosinophilic COPD group ,60 male and 15 females were found. CONCLUSION: This study suggested that flow reversibility associated with this volume reversibility was more in eosinophilic COPD.

Noções de conservação e de reversibilidade lógica em crianças com transtorno de déficit de atenção/hiperatividade (TDAH) / Notions of conservation and logical reversibility in children with attention deficit hyperactivity disorder (ADHD)

O objetivo desta pesquisa foi investigar as noções de conservação e de reversibilidade lógica em crianças com Transtorno de Déficit de Atenção/Hiperatividade (TDAH). Participaram 14 crianças do sexo feminino diagnosticadas com TDAH, sendo sete com idades entre 7 e 8 anos e sete entre 10 e 11 anos. A pesquisa foi realizada em um hospital público da cidade de Vitória-ES e o instrumento utilizado foi a Prova Piagetiana de Conservação de Substância. Os dados foram coletados e analisados qualitativamente, a partir do Método Clínico Piagetiano. De acordo com Piaget, as noções de conservação de substância e de reversibilidade lógica são adquiridas por volta dos 7 anos de idade. Porém, os resultados desta pesquisa revelaram que a grande maioria das participantes, de ambas as faixas etárias, ainda não adquiriu tais noções, de forma que a etapa de transição para a aquisição das noções é a que contém o maior número de participantes. No entanto, comparando as faixas etárias, foi observado que na medida em que as crianças aumentam de idade, há também um progresso em direção à completude das noções de conservação e de reversibilidade lógica. Portanto, os resultados mostram a necessidade de promover essas noções em crianças com TDAH. Diante disso, propõem-se intervenções baseadas no incentivo das relações sociais de cooperação através do brincar e dos jogos com regras.

The objective of this research was to investigate the notions of conservation and logical reversibility of children with Attention Deficit Hyperactivity Disorder (ADHD). Participated in the study 14 female children diagnosed with ADHD, being seven children between 7 and 8 years old and seven between 10 and 11 years old. The research was conducted in a public hospital in the city of Vitória-ES and the instrument used was the Piagetian Test of Conservation of Substance. Data were collected and analyzed qualitatively based on the Piagetian Clinical Method. According to Piaget, the notions of conservation of substance and logical reversibility are acquired approximately at the age of seven. However, the results of this research revealed that the vast majority of the participants, from both age groups, have not yet acquired such notions and the transition stage for acquisition of the notions contains the largest number of participants. Comparing the age groups, it was observed that as the children grow old, there is a progress in the notions of conservation and logical reversibility. Therefore, the results show the need to promote these notions in children with ADHD. Given this fact, it is proposed interventions based on the incentive of social relations of cooperation through play and rule games, because these promote the acquisition of notions of conservation and logical reversibility.

Dynamic changes of pH2AX expression in the reversibility of mouse testicular reproductive function impaired by single heat stress / 中华男科学杂志

Objective@#To investigate the role of pH2AX in the reversibility of mouse testicular reproductive function impaired by single heat stress.@*METHODS@#Twenty-four C57 male mice were randomly divided into heat stress and control groups and immersed in water at 43℃ and 25℃, respectively, for 15 minutes. At 1, 7, and 14 days of heat exposure, all the mice were sacrificed and their testis tissues collected for determining the apoptosis of the germ cells by TUNEL and measuring the expression level of the pH2AX protein by immunohistochemistry and Western blot.@*RESULTS@#The highest percentage of apoptotic cells were found in the seminiferous tubules of the mice in the heat stress group on the 1st day of the exposure and almost no apoptosis was observed at 7 and 14 days. The pH2AX protein was expressed in the nuclei of the basement membrane of adjacent seminiferous tubules. Compared with the control group, the expression of pH2AX was significantly increased on the 1st day of exposure (0.47 ± 0.02 vs 1.61 ± 0.04, P <0.01), then decreased at 7 days (0.85 ± 0.03) in comparison with that on the 1st day (P <0.01), and again elevated at 14 days (1.72 ± 0.02) as compared with either those at 1 and 7 days (P <0.01) or that of the control (P <0.01).@*CONCLUSIONS@#Heat stress causes dynamic changes of the pH2AX expression in the testis of the mouse, which are associated with heat stress-induced proliferation and division of the testicular spermatogenic cells.

Predictive factors associated with reversibility of post-transplantation diabetes mellitus for adult: a Meta-analysis / 中华肝胆外科杂志

Objective To systematically review the predictive factors associated with reversibility of post-transplantation diabetes mellitus in adults using Meta-analysis,and to provide a theoretical basis for clinical prevention and treatment of diabetes after transplantation.Methods Pub Med,Web of Science,Cochrane Library (Issue 5,2017),CNKI,VIP and WanFang Data were searched from inception until May 2017.Two authors independently assessed the trials for inclusion and extracted the data.Discrepancies were resolved in consultation with a third reviewer.Publication biases were evaluated,and the Meta-analyses were conducted with RevMan5.3.Results A total of 7 studies were analyzed which involved 979 adults.Metaanalysis showed the following significant predictive factors:male (OR =1.73,95％ CI 1.19 to 2.50,P ＜0.05),advanced age (MD =1.73,95％ CI 0.07 to 10.39,P =0.05),high FPG before transplantation (MD=5.66,95％CI 0.11 to 11.31,P=0.05),hepatitis C virus (HCV) infection (OR=1.52,95％CI 1.08 to 2.14,P ＜ 0.05),high frequency of combination therapy with MMF (OR =0.26,95％ CI 0.11 to 0.61,P ＜ 0.05),and short time before development of PTDM (MD =-19.08,95％ CI-37.08 to -1.07,P ＜ 0.05).There was no correlation with preoperative BMI,family history of diabetes and acute rejection.Conclusion The study showed that male,advanced age,high FPG before transplantation,hepatitis C virus infection,high frequency combination therapy with MMF,short time before development of posttransplantation diabetes mellitus were the predictive factors associated with reversibility of post-transplantation diabetes mellitus.

Effects of excess maternal thyroxin on the bones of rat offspring from birth to the post-weaning period

ABSTRACT Objective To evaluate, in rat offspring, bone changes induced by excess maternal thyroxin during pregnancy and lactation, and to assess the reversibility of these changes after weaning. Material and methods Twenty Wistar rats were distributed in two groups, hyperthyroid and control, that were treated daily with L-thyroxin (50 mcg/animal) and placebo, respectively. The treatment was initiated seven days before mating and continued throughout pregnancy and lactation. From every female of each of the two groups, two offspring were euthanized after birth, two at 21 days of age (weaning), and two at 42 days of age (21 days after weaning). In newborns, the length of pelvic and thoracic limbs were measured, and in the other animals, the length and width of the femur and humerus were measured. Bones were dissected, decalcified, embedded in paraffin, and analyzed histomorphometrically. Results Excess maternal thyroxin significantly reduced the length of the pelvic limb in neonates. In 21-day-old individuals, excess maternal thyroxine reduced the length and the width of the femur and the humerus. It also increased thickness of the epiphyseal plate and the percentage of trabecular bone tissue. In 42-day-old individuals, there were no significant differences between groups in relation to the parameters evaluated in the previous periods. Conclusion Excess maternal thyroxine reduced growth in suckling rats both at birth and at weaning, and it also increased the percentage of trabecular bone tissue in 21-day-old animals. These changes, however, were reversible at 42 days, i.e., 21 days after weaning. Arch Endocrinol Metab. 2016;60(2):130-7.

Bortezomib in newly diagnosed patients with multiple myeloma: A retrospective analysis from a tertiary care center in India.

INTRODUCTION: Bortezomib is a novel proteasome inhibitor in myeloma. There is a paucity of data from India regarding the efficacy and tolerance to bortezomib. MATERIALS AND METHODS: All patients with newly diagnosed multiple myeloma from January 2008 to December 2011 treated with bortezomib as the first‑line therapy were studied in a retrospective analysis. The primary end point was the overall rate of response. Secondary end points were the progression free survival (PFS), reversibility of renal compromise and safety of bortezomib. RESULTS: Our study included 41 patients with newly diagnosed myeloma. The overall response to bortezomib was 88.5% (complete response [CR] 31.4%, very good partial response 34.2%, partial response [PR] 22.8%). A renal response (CR renal, PR renal or Minimal Response renal combined) was documented 96.2% patients with initial renal impairment. The median time to the first renal response was 21 days. 17 patients (41.4%) had severe toxicity (Grade 3 and 4). Bortezomib induced peripheral neuropathy (BIPN) was the most common toxicity seen (53.6%) and the most common cause for discontinuation of therapy. At a median follow‑up of 9 months, median PFS was not reached. DISCUSSION: The results obtained in our study are comparable with those of established studies on bortezomib. Our patient population has similar responses and renal reversibility patterns. However, they are at an increased susceptibility to BIPN, leading to discontinuation of therapy. CONCLUSION: Bortezomib as first‑line therapy has a good efficacy and safety.

Transient Splenial Lesions in the Splenium of Corpus Callosum in Seven Patients: MR Findings and Clinical Correlations

PURPOSE: The purpose of this study is to correlate the imaging findings and the clinical findings in patients with transient splenial lesions (TSL). MATERIALS AND METHODS: Total of 7 patients (M: F = 4: 3; age range 11 - 38 years, mean age 25.5 years) were studied between November 2006 and April 2011. The MRI findings and clinical findings in all patients were retrospectively reviewed. The location, MR signal intensity, restricted diffusion, enhancement pattern and reversibility from the follow up images were reviewed. Clinical features were reviewed with respect to the presented symptoms, signs, treatment and outcome. RESULTS: The lesions were located in the splenium of corpus callosum in all patients. All lesions showed high signal intensity on diffusion weighted imaging (DWI), and six patients showed restricted diffusion on the apparent diffusion coefficient (ADC) map. ADC map was not available in one patient. All lesions (n = 7) showed high signal intensity on the T2 weighted image (T2WI). Five of the patients (71.4%) with follow up images (range 7 - 34 days) showed complete resolution of focal high signal intensity on DWI, with recovery of ADC values as well as T2WI. After contrast media administration, none of the lesions showed any enhancements. All lesions with various etiologies including TB medication were developed in younger age patients and showed reversibility after the acceptable period of minimum 7 days with conservative treatment. CONCLUSION: All TSL showed nonspecific imaging findings, including restricted diffusion on DWI and ADC map on the initial images. However, reversibility of the lesions and the young age preference can be a characteristic finding of TSL with acceptable period of minimum 7 days. In addition, to keep it in mind that various etiologies including TB medication may cause TSL, is important for radiologists as well as clinicians.

Influência na retenção de coroas cimentadas sobre implantes com e sem orifício ao parafuso / Retention influence of crowns cemented on implants with and without screw access

Introdução: na Implantodontia, o mecanismo de retenção da restauração ao intermediário pode ser cimentado ou parafusado. Os cimentados apresentam difícil reversibilidade, entretanto, o uso de um orifício de acesso ao parafuso permitiria tal reversibilidade, aliando o baixo custo dos componentes à reversibilidade das próteses aparafusadas. Objetivo: o objetivo desse trabalho é avaliar a resistência à tração de próteses sobre implantes cimentadas, possuindo ou não acesso ao parafuso do intermediário. Métodos: foram confeccionados 16 corpos de prova (análogos de implantes regulares, intermediários “Tiprep” (Bionnovation, São Paulo/SP) e 16 coroas totais metálicas, sendo que 8 eram coroas convencionais para controle (G1) e outras 8 coroas foram construídas com um orifício de acesso ao parafuso, transpassando o metal, sendo o grupo experimental (G2). As coroas foram cimentadas com RelyX U100 (3M ESPE) e os espécimes do G2 tiveram a abertura de acesso ao canal restaurado com resina composta fotopolimerizável Filtek Supreme XT (3M ESPE). Os espécimes foram submetidos a teste de tração em máquina de ensaio universal 24 horas após a cimentação. Resultados: o G1 apresentou média de 191,075N; o G2 161,280N. Aplicado o teste não-paramétrico de Kolmogorov-Smirnov, a variável dependente seguiu a distribuição normal (p=0,923) e, com o teste t de Student, verificou-se não existir diferença estatisticamente significativa (p=0,353) entre os grupos. Foi considerado o nível de significância de 5%, p=0,05. Conclusões: com base nas análises, pode-se afirmar que o orifício de acesso ao parafuso não compromete ou diminui a retenção das coroas.

Introduction: In Implantology, the retention mechanism of the restoration to the intermediate can be cemented or screwed. The cemented one present difficult reversibility, however, the use of an access hole to the screw would allow such reversibility, combining the low cost of the components to the reversibility of the screwed prosthesis. Objective: The aim of this study is to evaluate the shear bond strength of prostheses on cemented implants, having or not access to the intermediate screw. Methods: Sixteen specimens were prepared (similar to regular implants, "Tiprep" intermediates (Bionnovation, São Paulo/ SP) and 16 metal crowns, of which 8 were for conventional crowns control (G1) and another 8 crowns were made with an access hole to the screw, trespassing the metal, being the experimental group (G2).The crowns were cemented with RelyX U100 (3M ESPE) and the specimens from the G2 had the opening of the channel restored with light cured composite resin Filtek Supreme XT (3M ESPE). Specimens were subjected to tensile test in a universal testing machine 24 hours after cementation. Results: G1 showed average of 191.075 N; G2 showed 161.280 N. Applied the nonparametric Kolmogorov-Smirnov test, the dependent variable followed normal distribution (p = 0.923) and, with the Student t-test, there was no difference statistically significant (p = 0.353) between groups. It was considered the level of significance of 5%, p = 0.05. Conclusions: Based on the analysis, it can be stated that the access hole to the screw does not compromise or decrease the retention of crowns.

Assessment of reversible risk factors causing acute-on-chronic renal failure.

Summary: The present study was designed to evaluate the risk factors and their degree of reversibility in cases of acute-on-chronic renal failure admitted to a tertiary care hospital over a period of one year, i.e., from November, 2006 to October, 2007. Material: In this study 100 patients of acute-on-chronic renal failure (rise in serum creatinine of 0.5 mg/dl, if baseline serum creatinine was < 3 mg/dl or rise of 1 mg/dl, if baseline was > 3 mg/dl within a one-week period) were included and various reversible risk factor(s) and the degree of reversibility of renal failure was determined. Methods: A thorough clinical evaluation and investigations of all patients was done and they were put on conservative management along with specific management of reversible factor(s) and haemodialysis, whereever needed. The observations of various parameters were recorded at presentation (baseline) and subsequently at 1 week and 2 week periods which included 24-hour urine volume, blood urea, serum creatinine, and creatinine clearance. Reversibility of these parameters was then statistically analysed. To compare the degree of reversibility, the patients were divided into 4 groups at the time of admission depending upon their GFR; group 3 with GFR 30 - 59 ml/min, group 4 with GFR 15 - 29 ml/min, group 5a with GFR 5 - 15 ml/min, and group 5b with GFR < 5 ml/min, respectively. Results: Majority of patients were found to have more than one reversible risk factor. These were hyperuricaemia (89), electrolyte imbalance (51), infection/sepsis (47), accelerated hypertension (21), volume depletion (18), urinary tract obstruction (16), and hypotension (7). A considerable degree of reversibility was detected, maximum being in volume depletion and urinary tract obstruction. Conclusions: Therefore it was concluded that patients presenting in a severe uraemic state may not be suffering from ESRD and each patient should be investigated for the presence of reversible risk factor(s) so that renal function can be restored and hence the need of renal replacement therapy can be delayed.

Related factors associated with reversal of new-onset diabetes mellitus following liver transplantation / 中华器官移植杂志

Objective To study the related factors associated with the reversal of posttransplant diabetes mellitus (PTDM) following liver transplantation. Methods The clinical data of 62patients with PTDM in 232 patients receiving liver transplantation (26. 7 %) were retrospectively analyzed and the patients were divided into two groups: patients with transient PTDM (34 cases) and those with persistent PTDM (28 cases). Pre-operative and post-operative variables, including sex,age, body mass index, family history of diabetes, hepatitis B virus infection, pretransplantation fasting plasma glucose, the immunosuppressant regime, FK506 concentration and duration of steroid usage, were analyzed retrospectively. Results The variables, including sex, age, body mass index,family history of diabetes, hepatitis B virus infection, pretransplantation fasting plasma glucose,FK506 concentration at month 1, 3 and 6 after operation, rate of cyclosporine usage and duration of steroid usage had no significant difference between the two groups (P＞0. 05). Compared with the persistent PTDM patients, the transient PTDM patients were characterized by younger age at the time of transplantation (54 ± 8 vs. 42 ± 6 years, P＜0. 05), longer time before the development of PTDM (18 ± 23 vs. 35 ± 42 days, P＜0. 05), and higher rate of mycophenolate mofetil or sirolimus usage (0vs. 8. 9 %, P＜0. 05). Based on a multivariate analysis, age at the time of transplantation was determined as the single independent predictive factor associated with reversal of PTDM following liver transplantation (odds ratio: 1. 312, 95 % confidence interval: 1. 005 - 1. 743). Conclusion Age at the time of transplantation, duration before the development of PTDM and rate of mycophenolate mofetil or sirolimus usage are associated with reversal of PTDM following liver transplantation. Among these factors, age at the time of transplantation is only the single independent predictive factor.

Communication Breakdown: Understandings of the Other and Caring for Others / Colapso da Comunicação: Compreensão dos Outros e cuidar dos outros

Robert Litman describes four remarkable cases where individuals reveal this repressed knowledge through dream analysis after the suicide of the “other.” In each case, there comes a moment of recognition of the significance of the dream such that the subject realizes culpability. And in each case, this culpability had to do with a communication breakdown that is revealed through psychoanalysis. I want to deconstruct the transference / counter-transference relationship as a symbiotic reciprocity. I do not venture forth unchanged as I transcend who I was through language with others. Language is alteration of subjectivity. I offer a criticism of certain understandings of alterity involved in psychotherapy by examining the general situation of the encounter with others through the peculiar language-event of psychotherapy. I must recognize that the threat of the alterity of the patient is also the promise of my ability to offer help. If we take seriously the transcendence of the language-event of therapy, we see that the process of altering another involves changes for all involved.

Robert Litman descreve quatro casos extraordinários em que indivíduos revelam esse conhecimento reprimido por meio da análise de sonhos após o suicídio do “outro”. Em cada caso, ocorre um momento de reconhecimento da significância do sonho tal que o sujeito se dá conta da culpabilidade. E, em cada caso, essa culpabilidade teve que ver com uma interrupção na comunicação que é revelada através da psicanálise. Quero desconstruir a relação transferência-contratransferência como uma reciprocidade simbiótica. Não ouso adiante, inalterado, quando transcendo quem eu era através da língua com outros. A língua é a alteração da subjetividade. Ofereço uma crítica de certas compreensões de alteridade envolvidas em psicoterapia pelo exame da situação geral do encontro com outros por meio do evento-língua, peculiar à psicoterapia. Devo reconhecer que a ameaça da alteridade do paciente é também a promessa da minha habilidade em oferecer ajuda. Se consideramos seriamente a transcendência do evento-língua da terapia, vemos que o processo de alteração do outro implica mudanças para todos os envolvidos.

Reversibilidad mandibular de la rigidez cadavérica por medios químicos en un modelo de rata / Reversibilidade mandibular da rigidez cadavérica por meios químicos num modelo de rato / Mandibular reversibility of the cadaverous stiffness by chemical means in a rat model

El principal problema que recae sobre el odontólogo en la toma de evidencias post mortem es la apertura bucal, limitada por el fenómeno de rigidez cadavérica el cual inicia a las 3 horas después de la muerte, siendo éste un fenómeno que persiste hasta ser destruido por los procesos autolíticos tardíos de descomposición, a partir de las 36 horas post mortem. Objetivo. Se estudió la posibilidad de acelerar la reversión de la rigidez cadavérica mandibular por medio de sustancias químicas para facilitar la apertura bucal. Materiales y métodos. Se encaminó al uso de sustancias que produzcan la alteración del pH, quelación del calcio intramuscular o proteólisis del complejo actina-miosina de los músculos masticatorios que presenten rigidez cadavérica en ratas Wistar. Resultados. Se determinó que el tiempo de establecimiento de la rigidez cadavérica mandibular en el modelo de rata, fue de 2,5 horas. A las 3,5 horas, una vez establecida la rigidez, se realizaron infiltraciones con EDTA (20 mM), NaHCO3 (50 æM), Na2CO3 (50 æM) y papaína (10 æM) encontrándose que las soluciones de NaHCO3 y Na2CO3 incrementaron significativamente (p<0,05) la velocidad de reversión (mm/h) desde las 5 h, en un 108% y un 100%, respectivamente. A partir de este ensayo se duplicó la concentración de NaHCO3 y se preparó una mezcla de NaHCO3 y Na2CO3 (1:1) sin encontrar diferencias significativas con los ensayos con NaHCO3 y Na2CO3. Conclusión. La solución de NaHCO3 (50 æM) logró revertir la apertura bucal suficiente para la toma de evidencia entre las 5- 5,5 horas...

Mandibular reversibility of the cadaverous stiffness by chemical means in a rat model. The main problem that a dentist faces when collecting postmortem evidence is the buccal opening, which is limited by the cadaverous stiffness phenomenon that begins 3 hours after death. This phenomenon persists until it is destroyed by the late autolytic processes of decomposition, after 36 hours postmortem.Objective. To analyze the feasibility of accelerating the reversion of the mandibular cadaverous stiffness by means of chemical substances to facilitate the buccal opening. Materials and methods. We assessed substances capable of altering the pH, chelatingintramuscular calcium or inducing proteolysis of the actin-myosin complex of the masticatory muscles with cadaverous stiffness in Wistar rats. Results. We found that mandibular cadaverous stiffness in Wistar rats appears after 2.5 hours of death. After 3.5 hours, once the rigidity was established, we carried out infiltrations with EDTA (20 mM), NaHCO 3 (50 µM), Na2CO3 (50 µM) and papain (10 µM).NaHCO3 and Na2CO3 solutions significantly increased (p<0.05) the reversion speed (mm/h) from hour 5, in 108% and 100%, respectively.Based on the results of this assay, we doubled the concentration of NaHCO3 and assessed a 1:1 mixture of NaHCO3 and Na2CO3 without finding significant differences with the NaHCO3 and Na2CO3 prior assays. Conclusion. NaHCO3 solution (50 µM) allows a reversal of buccal opening enough to collect evidence between 5 and 5.5 hours...

Reversibilidade mandibular da rigidez cadavérica por meios químicos num modelo de rato. O principal problema que tem o dentista na toma de evidencias post-mortem é a apertura bucal, limitada pelo fenômeno de rigidez cadavérica, o qual se inicia às 3 horas depois da morte; este fenômeno persiste hasta ser destruído pelos processos autolíticos tardios de decomposição, a partir das 36 horas post-mortem.Objetivo. Estudou-se a possibilidade de acelerar a reversão da rigidez cadavérica mandibular através de substâncias químicas para facilitara apertura bucal. Materiais e métodos. Foram empregadas substâncias que produzem alteração do pH, quelação do cálcio intramuscular ou proteólises do complexo actina-miosina dos músculos mastigatórios que apresentam rigidez cadavérica em ratos Wistar. Resultados.Estimou-se o tempo de estabelecimento da rigidez cadavérica mandibular no modelo de rato, em 2,5 horas. Às 3,5 horas, logo de estabelecida a rigidez, realizaram-se infiltrações com EDTA (20mM), NaHCO3 (50 µM), Na2CO3 (50 µM) e papaína (10 µM), encontrandoque as soluções de NaHCO3 e Na2CO3 incrementaram significativamente (p<0,05) a velocidade de reversão (mm/h) desde as 5h, num 108% e um 100%, respectivamente. A partir deste ensaio duplicou-se a concentração de NaHCO3 e preparou-se uma mistura de NaHCO3 e Na2CO3 (1:1) sem obter diferenças significativas com os ensaios com NaHCO3 e Na2CO3. Conclusão. A solução de NaHCO3 (50 µM)reverteu a apertura bucal suficientemente para a toma de evidencias entre as 5- 5,5 horas...

The Philosopher of Modern Life: Baudelaire, Merleau-Ponty, and the Art of Phenomenological Critique / O Filósofo da vida moderna: Baudelaire, Merleau-Ponty, e a Arte da Crítica Fenomenológica

I compare poet Charles Baudelaire and philosopher Maurice Merleau-Ponty as social critics of modernity from within modern society. I explore Baudelaire’s unacknowledged influence upon Merleau-Ponty as a means of re-reading Merleau-Ponty’s phenomenology. I examine Baudelaire’s poetry as well as his essay, The Painter of Modern Life. Though the essay claims to be an analysis of the significance of the painter C. Guys, I argue that it can be read as autobiographical - revealing a sense of the poet as social critic of modernity. Likewise, Merleau-Ponty’s accounts of artists reveal a great deal about his own view of the role of the philosopher as social critic. One can read Merleau-Ponty’s phenomenology as an art rather than as a science of sciences. Finally, I explore the political implications of this aesthetic-based phenomenology. I argue that there is an historical depth revealed by this phenomenological art of political judgment that would be neglected by any political science.

Comparo o poeta Charles Baudelaire e o filósofo Maurice Merleau-Ponty como críticos sociais da modernidade a partir do interior da sociedade moderna. Exploro a influência não reconhecida de Baudelaire sobre Merleau-Ponty como uma forma de reler a fenomenologia de Merleau-Ponty. Também examino a poesia de Baudelaire assim como seu ensaio “O pintor da vida moderna”. Embora o ensaio afirme ser uma análise da importância do pintor C. Guys, sustento que pode ser lido como autobiográfico - revelando uma consciência do poeta enquanto crítico social da modernidade. Da mesma maneira, as caracterizações de artistas feitas por Merleau-Ponty revelam muito sobre a sua visão do papel do filósofo como crítico social. Pode-se ler a fenomenologia de Merleau-Ponty como uma arte em vez de como uma ciência das ciências. Finalmente, exploro as implicações políticas dessa fenomenologia baseada na estética. Sustento que há uma profundidade histórica revelada por essa arte fenomenológica do julgamento político que seria negligenciada por qualquer ciência política.