Mechanism and Development of Thermo-Rheological Properties of Asphalts Modified by Reactive Polymer Systems.

The new class of reactive polymers is designed to modify asphalt through chemical reactions with asphalt components. The complexity of such systems and the long experience with thermoplastic elastomers as well as with some other "classical" modifiers, and to a degree that our present testing methods and even specifications revolve around these materials, might obscure the fact that we are dealing with rather different modification systems and possibly with new emerging asphalt paving technologies. Our present work attempted to compare two different reactive polymer systems with the "classical" system which uses thermoplastic elastomer. The impact of reactive polymer systems on asphalt was studied through material properties manifested by specification tests and through the development of thermo-rheological properties in linear and non-linear viscoelastic regions. As expected, the behavior of reactive polymeric systems with different chemistries also differed among themselves. The available results showed that the reactive groups of polymers react with polar components of asphalt leading to higher stiffness at elevated pavement temperatures and differing impact on low temperature properties. The data point to a significantly improved resistance to plastic deformation of pavement in the case of reactive polymers, despite the fact that elastic recovery-based specification tests failed to identify this improvement.

Carcinoma epidermoide metastásico asociado a epidermólisis ampollosa distrófica / Metastasic squamous cell carcinoma in dystrophic epidermolysis bullosa

Caso clínico: femenino de 18 años con diagnóstico de epidermolisis ampollosa distrófica (EAD) quién desarrolló una neoformación nodular sobre una úlcera crónica. Se diagnosticó carcinoma epidermoide (CE) invasor al que se realizó resección. Sin embargo, 5 meses después del tratamiento quirúrgico presentó metástasis a ganglios, pulmón e hígado con desenlace fatal. Comentarios: el CE es la causa más importante de muerte en pacientes con EAD. Suele ser agresivo y metastásico. Se recomienda una vigilancia cada 3 a 6 meses para realizar diagnóstico y tratamiento oportunos (AU)

Case report: 18-year-old female patient with dystrophic epidermolysis bullosa (DEB) who developed a tumor over a chronic ulcer. She was diagnosed with invasive squamous cell carcinoma (SCC) and underwent surgical resection. However, 5 months later she presented metastases to the lymph nodes, lung and liver with a fatal outcome. Comments: SCC is the most important cause of death in patients with DEB. It is usually aggressive and metastatic. Surveillance every 3 to 6 months is recommended for prompt diagnosis and treatment (AU)

Sorafenib-induced Facial Acneiform Eruption.

Sorafenib is a multikinase inhibitor that is used to treat hepatocellular carcinoma by inhibiting tumor cell growth and angiogenesis. Cutaneous adverse events of sorafenib are commonly reported, with alopecia and hand-foot skin reactions most frequently encountered. Acneiform eruptions represent rare adverse events that have only been reported at high doses of sorafenib. We present a patient who started low dose sorafenib for hepatocellular carcinoma and subsequently developed a fulminant facial acneiform eruption in the absence of other cutaneous adverse events. Treatment included topical clindamycin and tretinoin with some improvement. Facial acneiform eruption represents a rare consequence of sorafenib that has not previously been described at low doses. Additionally, acneiform papules in the absence of other cutaneous adverse events is unusual. The cutaneous mechanism is not well understood but may be related to indirect epidermal growth factor receptor inhibition or direct cytotoxic effects on eccrine glands. Topical treatment produces only minimal improvement in patients who continue sorafenib therapy. Discontinuation of the drug is usually unwarranted except in special circumstances.

La construcción del sujeto psíquico en el espacio analítico / The construction of the psychic subject in the analytic space / La construction du sujet psychique dans l'espace analytique

A través de un singular material clínico se ilustran los movimientos de la construcción de la dinámica intersubjetiva en sesión recorriendo los tres tiempos del trabajo psíquico de la subjetividad: la homosexualidad primaria en doble, la alteridad y la elaboración de la ausencia. El artículo recorre los tres momentos evolutivos y las posiciones objetales que se requieren para propiciar el asentamiento de la vivencia subjetiva del yo ante el otro

The article outlines the three phases of the psychic work of subjectivity drawing upon a unique clinical case study which illustrates the movements of the construction of the intersubjective dynamic in the session: primary homosexuality in double, otherness and working through absence. The article recapitulates the three evolutionary stages and object positions required for the establishment of the subjective experience of the ego in relation to the other

A travers un matériel clinique singulier s'illustrent les mouvements de la construction de la dynamique intersubjective en séance en parcourant les trois temps de travail psychique de la subjectivité: l'homosexualité primaire en double, l' altérité et l' élaboration de l' absence. L' article parcourt les trois moments évolutifs et les positions objectales qui sont requis pour promouvoir l'installation de l'expérience subjective du moi face a l'autre

El yo ideal como contraparte del ideal del yo / The ideal ego as a counterpart of the ego ideal / Le moi idéal comme contrepartie de l'idéal du moi

Partiendo de la definición de ideal del yo que aparece en Introducción del narcisismo, el autor trata de dilucidar, en la línea de Grunberger, Lagache y otros autores, la diferenciación teórica entre ideal del yo y yo ideal, indistintamente utilizados por Freud en ese texto. Cree el autor que el yo ideal es una categoría claramente diferenciada del ideal del yo, ya que comporta una vinculación muy intensa con el narcisismo primario constituyente de la subjetividad, en el cual el sujeto se halla atado a un deseo sin merma, en la medida en que la castración del narcisismo fálico donde todo es posible, no se llevó a cabo suficientemente para poder constituir una adecuada relación con los ideales del yo que poseen una función estructurante y acorde con la renuncia a la completud narcisista. El ideal del superyó, introducido por Freud en 1932 a causa de su desmesura y su grandiosidad de imposible cumplimiento arrojan al yo a un vagar entre el deseo de poderlo todo y la frustración subsiguiente ante su imposibilidad

Beginning with the definition of the ego ideal that appears in Introduction to narcissism, the author, along the lines of Grunberger, Lagache and others, attempts to elucidate the theoretical differences between "ego ideal" and "ideal ego", which Freud here uses interchangeably. The author believes that the ideal ego is clearly distinct from the ego ideal, inasmuch as it involves a strong correlation with primary narcissism as constitutive of subjectivity, in which the subject is bound to an undiminished desire. Here the castration of phallic narcissism -where everything is possible- did not adequately take place so as to establish an appropriate relationship with the ego ideals, which possess a structuring function, and in keeping with the renunciation of narcissistic completeness. The superego ideal, introduced by Freud in 1932, through its excess and its impossible-to-satisfy grandiosity, causes the ego to wander between the desire to overpower all and the subsequent frustration at its impossibility

En partant de la définition d'idéal du moi qui apparait dans Pour introduire le Narcissisme, l'auteur essaye de d'élucider, en suivant Grunberger, Lagache et d' autres auteurs, la différentiation théorique entre idéal de moi et moi idéal, indifféremment utilisés par Freud dans ce texte. L'auteur croit que le moi idéal est une catégorie clairement différenciée de l'idéal du moi, parce qu'il comporte un lien tres intense avec le narcissisme primaire constitutif de la subjectivité, dans laquelle le sujet se trouve attaché a un désir illimité, dans la mesure ou la castration du narcissisme phallique ou tout est possible n'a pas eu suffisamment lieu pour pouvoir constituer une relation adéquate avec les idéaux du moi qui possedent une fonction structurante en accord avec le renoncement a la complétude narcissique. L'idéal du surmoi, introduit par Freud en 1932 a cause de sa démesure et sa grandeur a l' exécution impossible lancent le moi a un vagabondage entre le désir de toute-puissance et la frustration ultérieure face a son impossibilité

Goethe y Freud: confluencias / Goethe and Freud: confluences

Este trabajo intenta mostrar las influencias del pensamiento metodológico de Goethe en la construcción del pensar psicoanalítico. La movilidad característica de este pensar está, a juicio del autor, profundamente impregnado del modo en que Goethe percibe el mundo partiendo de lo visible para llegar a lo invisible. El concepto de metamorfosis se encuentra íntimamente ligado a lo que en psicoanálisis conocemos como "proceso primario" y en la escucha analítica se halla emparentada con la atención intuitiva con la que Goethe enfoca la manifestación fenoménica en la naturaleza (AU)

This essay tries to show the influence of the methodologic thoughts of Goethe in the construction of the psychoanalytic way of thinking. According to the author the main feature of this thinking is deeply imbued by how Goethe sees the world: from what is visible to the invisible. The idea of metamorphosis is closely related to what is known in psychoanalysis as Primary Process. Likewise, analytic listening is linked with the intuitive attention that Goethe uses to situate the phenomena materialization within the nature (AU)

A new bilayer chitosan scaffolding as a dural substitute: experimental evaluation.

OBJECTIVE: To evaluate whether bilayer chitosan scaffolding (BChS) can provide a watertight dural closure and permit regeneration by fibroblasts in an experimental in vivo model. METHODS: In the in vitro phase, BChS was elaborated and the following characteristics were evaluated: pore size, thickness, water absorption capacity, tensile strength, strain, and toughness. In the second in vivo phase, 27 durectomized New Zealand rabbits were randomly assigned into three duraplasty groups with autologous dura, collagen matrix (CM), or BChS. In all groups, fluid leakage pressure was measured at 10, 21, or 180 days. Histology response to regeneration was evaluated through hematoxylin and eosin stain. RESULTS: BChS was standardized to obtain bilayer scaffoldings with a nonporous layer and a porous layer. The pore size was 10 µm, total thickness was 400 µm, strain was 57.8%, and tensile strength was 5.5 gr/mm(2). The physical characteristics of BChS allowed dural closure without cerebrospinal fluid (CSF) leak. There were no differences in fluid leakage pressures between the BChS, dura, and CM groups. Histologic analysis showed fibroblast migration with adequate dural regeneration. CONCLUSIONS: BChS is an ideal alternative for a watertight dural closure because it can be sutured, and it induces organized regeneration with fibroblasts without evidence of fibrosis.

[Eradication of Helicobacter pylori: triple treatment scheme plus Lactobacillus vs. triple treatment alone]. / Erradicación de helicobácter pylori: esquema triple tradicional versus mismo esquema más probiótico.

BACKGROUND: We undertook this study to determine the effectiveness of triple treatment associated with Lactobacillus casei strain Shirota against Helicobacter pylori, in comparison with triple conventional treatment without Lactobacillus. METHODS: We designed a clinical comparative randomized study that included patients of both sexes infected by Helicobacter pylori. Patients were studied with endoscopy, biopsy and serology. Control group received traditional triple treatment with clarithromycin, amoxicillin and omeprazole, and the active group received the same treatment plus Lactobacillus casei strain Shirota. With the breath test at 8 weeks we determined the eradication of Helicobacter pylori. RESULTS: In the active group we included 31 patients. After treatment, in 29 persons (94%) it was possible to eradicate the Helicobacter pylori. On the other hand, the control group was comprised of 33 patients who received only the traditional triple treatment; eradication was achieved in 25 patients (76%). Significant differences (p<0.05) were observed in favor of active group treatment. CONCLUSIONS: Traditional triple treatment plus Lactobacillus casei strain Shirota is associated with a higher frequency of eradication of Helicobacter pylori than triple treatment alone.

A double-blind randomized placebo-controlled pilot study comparing topical immunomodulating agents and corticosteroids for treatment of experimentally induced nickel contact dermatitis.

BACKGROUND: Although topical glucocorticoids are effective for most inflammatory skin disorders, their use is limited by local and systemic side effects. Tacrolimus and pimecrolimus are immunomodulators that provide clinicians with steroid-sparing options in the long-term topical treatment of allergic contact dermatitis. OBJECTIVE: To obtain pilot data regarding the relative efficacies of pimecrolimus 1% cream, tacrolimus 0.1% ointment, clobetasol propionate 0.05% ointment, and triamcinolone acetonide 0.1% ointment, as compared to control preparations (Vanicream and petrolatum), for treatment of experimentally induced nickel contact dermatitis. METHODS: Twenty-one volunteers with positive patch test reactions to nickel sulfate 5% at six sites (three on each arm) applied each study medication to one nickel site, respectively, twice daily for 14 days. Study medications were prepared in identical syringes, and the site of application was randomly assigned by a computer-generated randomization schedule. Assessments were performed at 3, 7, 10, and 14 days after randomization. RESULTS: Most reactions were coded as resolved or as almost resolved by day 14 regardless of treatment. Although most pairwise comparisons were not statistically significant, a clear trend was observed for sites treated with active drug to do better than control sites. CONCLUSION: Possible explanations for these results include contamination by neighboring medication sites, timing of assessments, and lack of repeated nickel applications.

Allergenicity and cross-reactivity of coconut oil derivatives: A double-blind randomized controlled pilot study.

BACKGROUND: Counseling of patients with cocamidopropyl betaine (CAPB) allergy is difficult because the cross-reactivity of CAPB with other coconut-derived surfactants, coconut oil, and coconut fatty acids is largely unknown. OBJECTIVE: To provide pilot data regarding the cross-reactivity and allergenicity of surfactants derived from coconut oil. METHODS: A randomized double-blind controlled pilot study of 10 control patients and 12 patients previously found to be allergic to CAPB. Eleven coconut-derived surfactants, as well as coconut oil and lauric acid, were applied in random order according to standardized patch-test procedures with readings at 48 and 92 hours. The primary outcome measure was the frequency of positive patch-test reactions to each allergen. RESULTS: Only 3 of the 12 patients with previous reactions to CAPB reacted on retesting, and all of these reactions were doubtful. Fifty-nine percent of the study patients had reactions to triethanolamine polyethylene glycol-3 (TEA-PEG-3) cocamide sulfate as compared to none of the controls (p = .005). CONCLUSIONS: Reactions to CAPB were only 25% reproducible. These results substantiate previous experience that doubtful and mild reactions to CAPB may represent irritant reactions as opposed to true allergic reactions. TEA-PEG-3 cocamide sulfate was the only agent that had a statistically significant higher rate of reactions in the study group as compared to the control group.

Optimizing reproducibility for clinical studies involving patch testing and application of topical preparations.

BACKGROUND: The reproducibility and consistency of patch-test techniques can be problematic, making controlled clinical trials of patch testing difficult. OBJECTIVE: To measure the accuracy and reproducibility of applying controlled quantities of petrolatum onto Finn Chambers. METHODS: Four dermatology nurses applied a total of 240 samples of white petrolatum, using three syringe sizes and types. Three different amounts of white petrolatum (0.02 mL, 0.05 mL, and the "usual" amount) were expressed onto previously weighed Finn Chambers, using three different syringe sizes (5 mL, 1 mL, and 0.5 mL), five times each on two separate days. RESULTS: The average weights of 0.05 mL of petrolatum expressed with each type of syringe (5 mL: 0.04252 g; 1 mL: 0.04084 g; and 0.5 mL: 0.04139 g) were not significantly different from each other in pairwise comparisons (p > .36) or from the "gold standard" expected value (0.04138 g, p > .72). The average weights of 0.02 mL of petrolatum expressed with two types of syringes (5 mL: 0.02138 g; 0.5 mL: 0.01778 g) were significantly different from each other (p = .0012), but neither differed significantly from the expected value (0.01655 g, p > .08). The variance due to the effect modifications of nurse, day, and interaction of nurse and day was statistically significant for measurements made with the 5 mL syringe but not for measurements made with the 1 mL or 0.5 mL syringe. CONCLUSION: The average amounts of petrolatum extruded from smaller syringes (0.5 mL and 1 mL) were less variable and more reproducible than those extruded from a 5 mL syringe.