Determination of glomerular filtration rate "en passant" after high doses of iohexol for computed tomography in intensive care medicine-a proof of concept.

Accurate assessment of renal function is of great clinical and scientific importance, as it is an important pharmacokinetic covariate of pivotal drugs. The iohexol clearance is nearly identical to the glomerular filtration rate, but its determination usually requires an intravenous injection and therefore bears intrinsic risks. This motivates to showcase an "en passant" approach to quantification of renal function without additional risk or blood sampling beyond routine care using real-world data. We enrolled 37 intensive care patients who received high doses of iohexol for computed tomography imaging, and quantified series of iohexol plasma concentrations by high-performance liquid chromatography (HPLC-UV). Iohexol clearance was derived by both log-linear regression and nonlinear least squares fitting and compared to glomerular filtration rate estimated by the CKD-EPI-2021 formulas. Nonlinear fitting not only turned out to be more accurate but also more robust in handling the irregularly timed data points. Concordance of iohexol clearance against estimations based on both creatinine and cystatin C showed a slightly higher bias (-3.44 mL/min/1.73 m2) compared to estimations based on creatinine alone (-0.76 mL/min/1.73 m2), but considerably narrower limits of agreement (±42.8 vs. 56 mL/min/1.73 m2) and higher Lin's correlation (0.84 vs. 0.72). In summary, we have demonstrated the feasibility and performance of the "en passant" variant of the iohexol method in intensive care medicine and described a working protocol for its application in clinical practice and pharmacologic studies.

¿Qué intervenciones se han realizado en el sistema de salud con impacto en las atenciones de morbilidad y urgencia en APS?: síntesis rápida de evidencia / What interventions have been carried out in the health system with an impact on morbidity and emergency care in PHC?: rapid evidence synthesis

ANTECEDENTES Y OBJETIVO En Chile la atención primaria de salud (APS) cuenta con un servicio de urgencia (SAPU) y los Servicios de Atención Primaria de Urgencia de Alta Resolutividad (SAR) que ofrecen atenciones de emergencia de baja complejidad durante el horario no hábil. Estos servicios se suelen utilizar como sustituto de la atención de morbilidad, significando que el beneficiario recibe solo una atención por el episodio agudo, sin considerar la continuidad de los servicios de APS. En este contexto, la División de Atención Primaria (DIVAP) solicita esta síntesis de evidencia, con el objetivo de conocer las intervenciones realizadas en el sistema de salud que tienen impacto en el número de atenciones de urgencia y morbilidad de la atención primaria. METODOLOGÍA Se formuló una estrategia de búsqueda para ser utilizada en las bases de datos MEDLINE, EMBASE y en Epistemonikos, con fecha 06 de marzo. Se incluyen documentos que contemplen intervenciones realizadas en APS, en el sistema de salud, que reporten efecto en la atención de urgencia y ambulatoria. Se excluyen intervenciones que reportan impacto en contextos hospitalarios, estudios enfocados en la percepción y razones sobre el uso de urgencias en APS. RESULTADOS Se recuperaron 13 revisiones sistemáticas -Se han propuesto diferentes modelos de organización de la atención para enfrentar la problemática de consultas fuera del horario en atención primaria. Solo 2 de estos modelos reportan resultados en el número de atención de morbilidad y fuera de horario en APS. -No se encontraron RS enfocadas en el impacto de la calidad de la atención de morbilidad ni fuera de horario en APS. -Las intervenciones identificadas que miden el impacto en atención fuera de horario en APS corresponden a educación, programas clínicos e intervenciones a nivel de sistema. -Las intervenciones que miden el impacto en la atención de morbilidad corresponden a triage en el horario de extensión de APS e intervenciones a nivel de sistema. -La mayoría de las intervenciones encontradas se centran en intervenciones o cambios en el sistema de salud realizadas durante la década de 1990 y 2000 en países europeos como Países Bajos y el Reino Unido.

¿Qué intervenciones se han realizado en el sistema de salud con impacto en las atenciones de morbilidad y urgencia en APS?: síntesis rápida de evidencia / What interventions have been implemented in the health health system with an impact on morbidity and emergency care in PHC?: rapid evidence synthesis

A nivel de atención primaria, Chile cuenta con un servicio de urgencia (SAPU) y Servicios de Atención Primaria de Urgencia de Alta Resolutividad (SAR) que ofrecen atenciones de emergencia de baja complejidad durante el horario no hábil. En muchas ocasiones, estos servicios se utilizan como sustituto de la atención de morbilidad, lo que significa que el beneficiario recibe solo una atención por el episodio agudo, sin considerar la continuidad e integralidad de los servicios de APS.

¿Cuál es el efecto de la actividad docente asistencial en establecimientos formadores en comparación con establecimientos no formadores sobre la productividad asistencial y la satisfacción usuaria?: síntesis rápida de evidencia / What is the effect of the teaching assistance activity in training establishments compared to non-training establishments on assistance productivity and non-user satisfaction?: rapid evidence synthesis

ANTECEDENTES Y OBJETIVO En Chile la relación asistencial-docente (RAD) está regulada por la norma técnica N°254. La RAD se define como un vínculo estratégico y de largo plazo, que une al Sector Público de salud con instituciones de educación superior. Ésta tiene como objetivo formar y disponer de profesionales y técnicos competentes para satisfacer las necesidades de salud de la población, beneficiando la calidad de atención que reciben los usuarios del Sistema Nacional de Salud (SNSS). En esta norma, se considera a la RAD como un eje estratégico para el sistema de salud. En este contexto el departamento de Formación, Capacitación y Educación Continua ha solicitado el desarrollo de una síntesis de evidencia, con el objetivo de conocer el efecto que tiene la formación académica sobre la productividad asistencial, y de esta manera entregar información actualizada y relevante para el proyecto de ley que regula la RAD. METODOLOGÍA Se buscaron revisiones sistemáticas que respondieron la pregunta en las bases de datos MEDLINE y EMBASE a través de OVID y en Epistemonikos, con fecha 01 de marzo. Se utiliza la metodología de la certeza de evidencia GRADE. Se incluyen estudios que evalúen la relación docente-asistencial sobre parámetros de productividad o satisfacción usuaria. Se excluyen estudios que evaluaron el efecto sobre educación al usuario, producción en investigación o percepciones de profesionales de salud, sobre el efecto de la educación virtual o de simulación y estudios de RAD exclusivo en pasantías internacionales. RESULTADOS La cantidad de revisiones sistemáticas recuperadas fueron 2, de las que se obtuvieron los siguientes resultados: - Existe alta incertidumbre de la evidencia sobre el efecto de la RAD en desenlaces de productividad o satisfacción usuaria. - De manera general, los datos sugieren que no habría diferencias importantes en la atención o satisfacción usuaria, cuando hay o no presencia de estudiantes. - La docencia asistencial es considerada fundamental para la capacitación y formación de recursos humanos en salud, tanto a nivel nacional como internacional.

Molecular Analyses of Clinical Isolates and Recombinant SARS-CoV-2 Carrying B.1 and B.1.617.2 Spike Mutations Suggest a Potential Role of Non-Spike Mutations in Infection Kinetics.

Some of the emerging severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants are less susceptible to neutralization with post-vaccine sera and monoclonal antibodies targeting the viral spike glycoprotein. This raises concerns of disease control, transmissibility, and severity. Numerous substitutions have been identified to increase viral fitness within the nucleocapsid and nonstructural proteins, in addition to spike mutations. Therefore, we sought to generate infectious viruses carrying only the variant-specific spike mutations in an identical backbone to evaluate the impact of spike and non-spike mutations in the virus life cycle. We used en passant mutagenesis to generate recombinant viruses carrying spike mutations of B.1 and B.1.617.2 variants using SARS-CoV-2- bacterial artificial chromosome (BAC). Neutralization assays using clinical sera yielded comparable results between recombinant viruses and corresponding clinical isolates. Non-spike mutations for both variants neither seemed to effect neutralization efficiencies with monoclonal antibodies nor the response to treatment with inhibitors. However, live-cell imaging and microscopy revealed differences, such as persisting syncytia and pronounced cytopathic effect formation, as well as their progression between BAC-derived viruses and clinical isolates in human lung epithelial cell lines and primary bronchial epithelial cells. Complementary RNA analyses further suggested a potential role of non-spike mutations in infection kinetics.

The microtubule cytoskeleton at the synapse.

In neurons, microtubules (MTs) provide routes for transport throughout the cell and structural support for dendrites and axons. Both stable and dynamic MTs are necessary for normal neuronal functions. Research in the last two decades has demonstrated that MTs play additional roles in synaptic structure and function in both pre- and postsynaptic elements. Here, we review current knowledge of the functions that MTs perform in excitatory and inhibitory synapses, as well as in the neuromuscular junction and other specialized synapses, and discuss the implications that this knowledge may have in neurological disease.

Large, Stable Spikes Exhibit Differential Broadening in Excitatory and Inhibitory Neocortical Boutons.

Presynaptic action potential spikes control neurotransmitter release and thus interneuronal communication. However, the properties and the dynamics of presynaptic spikes in the neocortex remain enigmatic because boutons in the neocortex are small and direct patch-clamp recordings have not been performed. Here, we report direct recordings from boutons of neocortical pyramidal neurons and interneurons. Our data reveal rapid and large presynaptic action potentials in layer 5 neurons and fast-spiking interneurons reliably propagating into axon collaterals. For in-depth analyses, we establish boutons of mature cultured neurons as models for excitatory neocortical boutons, demonstrating that the presynaptic spike amplitude is unaffected by potassium channels, homeostatic long-term plasticity, and high-frequency firing. In contrast to the stable amplitude, presynaptic spikes profoundly broaden during high-frequency firing in layer 5 pyramidal neurons, but not in fast-spiking interneurons. Thus, our data demonstrate large presynaptic spikes and fundamental differences between excitatory and inhibitory boutons in the neocortex.

Motor control pathways in the nervous system of Octopus vulgaris arm.

The octopus's arms have virtually infinite degrees of freedom, providing a unique opportunity for studying movement control in a redundant motor system. Here, we investigated the organization of the connections between the brain and arms through the cerebrobrachial tracts (CBT). To do this, we analyzed the neuronal activity associated with the contraction of a small muscle strand left connected at the middle of a long isolated CBT. Both electrical activity in the CBT and muscle contraction could be induced at low threshold values irrespective of stimulus direction and distance from the muscle strand. This suggests that axons associated with transmitting motor commands run along the CBT and innervate a large pool of motor neurons en passant. This type of innervation implies that central and peripheral motor commands involve the simultaneous recruitment of large groups of motor neurons along the arm as required, for example, in arm stiffening, and that the site of movement initiation along the arm may be determined through a unique interplay between global central commands and local sensory signals.

Dendritic Spines in Early Postnatal Fragile X Mice Are Insensitive to Novel Sensory Experience.

Autism spectrum disorders are often associated with atypical sensory processing and sensory hypersensitivity, which can lead to maladaptive behaviors, such as tactile defensiveness. Such altered sensory perception in autism spectrum disorders could arise from disruptions in experience-dependent maturation of circuits during early brain development. Here, we tested the hypothesis that synaptic structures of primary somatosensory cortex (S1) neurons in Fragile X syndrome (FXS), which is a common inherited cause of autism, are not modulated by novel sensory information during development. We used chronic in vivo two-photon microscopy to image dendritic spines and axon "en passant" boutons of layer 2/3 pyramidal neurons in S1 of male and female WT and Fmr1 KO mice, a model of FXS. We found that a brief (overnight) exposure to dramatically enhance sensory inputs in the second postnatal week led to a significant increase in spine density in WT mice, but not in Fmr1 KO mice. In contrast, axon "en passant" boutons dynamics were impervious to this novel sensory experience in mice of both genotypes. We surmise that the inability of Fmr1 KO mice to modulate postsynaptic dynamics in response to increased sensory input, at a time when sensory information processing first comes online in S1 cortex, could play a role in altered sensory processing in FXS.SIGNIFICANCE STATEMENT Very few longitudinal in vivo imaging studies have investigated synaptic structure and dynamics in early postnatal mice. Moreover, those studies tend to focus on the effects of sensory input deprivation, a process that rarely occurs during normal brain development. Early postnatal imaging experiments are critical because a variety of neurodevelopmental disorders, including those characterized by autism, could result from alterations in how circuits are shaped by incoming sensory inputs during critical periods of development. In this study, we focused on a mouse model of Fragile X syndrome and demonstrate how dendritic spines are insensitive to a brief period of novel sensory experience.

The TrkB agonist 7,8-dihydroxyflavone changes the structural dynamics of neocortical pyramidal neurons and improves object recognition in mice.

BDNF and its receptor TrkB have important roles in neurodevelopment, neural plasticity, learning, and memory. Alterations in TrkB expression have been described in different CNS disorders. Therefore, drugs interacting with TrkB, specially agonists, are promising therapeutic tools. Among them, the recently described 7,8-dihydroxyflavone (DHF), an orally bioactive compound, has been successfully tested in animal models of these diseases. Recent studies have shown the influence of this drug on the structure of pyramidal neurons, specifically on dendritic spine density. However, there is no information yet on how DHF may alter the structural dynamics of these neurons (i.e., real-time study of the addition/elimination of dendritic spines and axonal boutons). To gain knowledge on these effects of DHF, we have performed a real-time analysis of spine and axonal dynamics in pyramidal neurons of barrel cortex, using cranial windows and 2-photon microscopy during a chronic oral treatment with this drug. After confirming TrkB expression in these neurons, we found that DHF increased the gain rates of spines and axonal boutons, as well as improved object recognition memory. These results help to understand how the activation of the BDNF-TrkB system can improve basic behavioral tasks through changes in the structural dynamics of pyramidal neurons. Moreover, they highlight DHF as a promising therapeutic vector for certain brain disorders in which this system is altered.

Limited distal organelles and synaptic function in extensive monoaminergic innervation.

Organelles such as neuropeptide-containing dense-core vesicles (DCVs) and mitochondria travel down axons to supply synaptic boutons. DCV distribution among en passant boutons in small axonal arbors is mediated by circulation with bidirectional capture. However, it is not known how organelles are distributed in extensive arbors associated with mammalian dopamine neuron vulnerability, and with volume transmission and neuromodulation by monoamines and neuropeptides. Therefore, we studied presynaptic organelle distribution in Drosophila octopamine neurons that innervate ∼20 muscles with ∼1500 boutons. Unlike in smaller arbors, distal boutons in these arbors contain fewer DCVs and mitochondria, although active zones are present. Absence of vesicle circulation is evident by proximal nascent DCV delivery, limited impact of retrograde transport and older distal DCVs. Traffic studies show that DCV axonal transport and synaptic capture are not scaled for extensive innervation, thus limiting distal delivery. Activity-induced synaptic endocytosis and synaptic neuropeptide release are also reduced distally. We propose that limits in organelle transport and synaptic capture compromise distal synapse maintenance and function in extensive axonal arbors, thereby affecting development, plasticity and vulnerability to neurodegenerative disease.

Chronic benzodiazepine treatment decreases spine density in cortical pyramidal neurons.

The adult brain retains a substantial capacity for synaptic reorganization, which includes a wide range of modifications from molecular to structural plasticity. Previous reports have demonstrated that the structural remodeling of excitatory neurons seems to occur in parallel to changes in GABAergic neurotransmission. The function of neuronal inhibitory networks can be modified through GABAA receptors, which have a binding site for benzodiazepines (BZ). Although BZs are among the most prescribed drugs, is not known whether they modify the structure and connectivity of pyramidal neurons. In the present study we wish to elucidate the impact of a chronic treatment of 21 days with diazepam (2mg/kg, ip), a BZ that acts as an agonist of GABAA receptors, on the structural plasticity of pyramidal neurons in the prefrontal cortex of adult mice. We have examined the density of dendritic spines and the density of axonal en passant boutons in the cingulate cortex. Although no significant changes were observed in their anxiety levels, animals treated with diazepam showed a decrease in the density of spines in the apical dendrites of pyramidal neurons. Most GFP-expressing en passant boutons in the upper layers of the cingulate cortex had an extracortical origin and no changes in their density were detected after diazepam treatment. These results indicate that the chronic potentiation of GABAergic synapses can induce the structural remodeling of postsynaptic elements in pyramidal neurons.

Excitability tuning of axons in the central nervous system.

The axon is a long neuronal process that originates from the soma and extends towards the presynaptic terminals. The pioneering studies on the squid giant axon or the spinal cord motoneuron established that the axon conducts action potentials faithfully to the presynaptic terminals with self-regenerative processes of membrane excitation. Recent studies challenged the notion that the fundamental understandings obtained from the study of squid giant axons are readily applicable to the axons in the mammalian central nervous system (CNS). These studies revealed that the functional and structural properties of the CNS axons are much more variable than previously thought. In this review article, we summarize the recent understandings of axon physiology in the mammalian CNS due to progress in the subcellular recording techniques which allow direct recordings from the axonal membranes, with emphasis on the hippocampal mossy fibers as a representative en passant axons typical for cortical axons.

Toxicomania e suicídio sob uma visão psicanalítica / Adicción a las drogas y el suicidio bajo una visión psicoanalítica / La toxicomanie et le suicide sous une vision psychanalytique / Drug addiction and suicide under a psychoanalytic view

Para a psicanálise, qual a relação, na contemporaneidade, entre o suicídio e a toxicomania? Esse questionamento surgiu a partir de uma experiência de escuta analítica com toxicômanos. Oportunidade essa em que foram trazidas, diversas vezes, pelos usuários abusivos, suas ideações e/ou tentativas mal sucedidas de suicídio. Dessa forma, buscou-se, com este artigo, realizar um levantamento bibliográfico de cunho psicanalítico a fim de lograr uma compreensão entre a adição às drogas e o ato suicida, e as questões que possam ser comuns a ambos os assuntos. Explorou- se a obra freudiana O Mal-estar na Civilização e levantaram-se questões a respeito do gozo, desamparo e mal-estar; explorando, ainda, autores como Joel Birman e Jesús Santiago para uma compreensão da apresentação do sujeito contemporâneo. Chegou- se ao denominador comum da precariedade simbólica dos sujeitos contemporâneos devido à falência do legislador, o que resulta na dificuldade em lidar com o excesso de dimensões traumáticas às quais estão expostos na pós-modernidade. Assim, recorrem ao uso de substâncias artificiais como forma de obter uma descarga temporária e lograr um prazer "por baixo" do simbólico; ou, ainda, fazem uso de um recurso extremo, o suicídio - um ato final e infalível na solução do problema do mal-estar.(AU)

What kind of relation exists between suicide and drug addiction for psychoanalysis in the contemporaneity? The questioning came up after an experience of analytical hearing with drug addicts in which they brought several times their suicidal ideations and unsuccessful trials. In this way, this article aims to explore, through a bibliographical research, the psychoanalytical theory in order to reach a comprehension about drug addiction and the suicidal act and their common points. We explored Freud's work Civilization and its Discontents and found important concepts for the understanding of the mentioned topics - such as pleasure, helplessness, and discomfort. In addition, we discuss works of contemporaneous psychoanalysts, such as Joel Birman and Jesús Santigo, for a comprehension about the constitution of the subject in the contemporaneity. We found, as a common denominator, the subject's symbolic precariousness due to a collapse of the legislator. This subject, lacking symbolic capability, is exposed to an excess of traumatic dimensions and has difficulties dealing with it. Therefore, they appeal to artificial substances in order to achieve a temporary discharge and even obtain a pleasure that is not mediated by the symbolic. Another possibility, more extreme, rests upon the suicide, a final and unfailing act in order to solve the discomfort.(AU)

Para el Psicoanálisis, qué clase de relación existe, en la contemporaneidad, entre elsuicidio y la drogadicción? La pregunta surgió a partir de una escucha analítica con sujetos drogadictos, quienes manifestaron en varias ocasiones sus ideas suicidas y sus procesos no exitosos. De esta manera, este artículo busca explicar la teoría psicoanalítica para alcanzar una comprensión básica sobreestos temas y sus puntos en común. Se exploró la obra de Freud, La civilización y sus descontentos, y se encontraron conceptos importantes para el entendimiento de los temas mencionados, como el placer, la impotencia y el desasosiego. Adicionalmente, se revisaron obras contemporáneas de Psicoanálisis como las de Joel Birman y Jesús Santiago para comprender la constitución del sujeto en la contemporaneidad. Se encontró, como común denominador, la precariedad simbólica del sujeto debido a la caída del legislador. Este sujeto carente de capacidad simbólica es expuesto a un exceso de dimensiones traumáticas y le dificulta lidiar con éstas. Por lo tanto, el sujeto apela a sustancias artificiales para lograr una descarga temporal y obtener un placer sin la mediación de lo simbólico. Otra posibilidad más extrema yace en el suicidio, un acto final e indefectible para terminar el desasosiego.(AU)

Quelle est la relation entre le suicide et la toxicomanie dans la psychanalyse contemporaine pour? Cette question s'est posée à partir d'une expérience analytique découte avec les toxicomanes. Cette opportunité dans laquelle ils ont été amenés à plusieurs reprises par leurs agresseurs idéations et / ou tentatives infructueuses de suicide. Ainsi, nous avons cherché à accomplir avec cet article une caractéristique de la littérature psychanalytique afin de parvenir à une compréhension de la toxicomanie et de suicide, et les questions qui sont communes aux deux sujets. Explorées pour l' de Freud - le malaise dans la civilisation - et dês questions se posent au sujet de la joie, sentiment d'impuissance et d'inconfort, voire de auteurs Joel Birmans et Jesús Santiago pour une compréhension de la présentation du sujet dontemporain. Il en est résulté un dénominateur commun symbolique de la précarité des sujets contemporains en raison de l'échec de la législature, ce qui entraine une incapacité à faire face à des dimensions supplémentaires qui sont exposés à la post-modernité traumatique, et donc recourir à l'utilisation de substances artificielle comme un moyen d'obtenir une décharge, et même d'atteindre un plaisir temporaire,''en bas'' de la symbolique, ou même faire usage d'une station, dernier suicide - un acte final et une solution infaillible pour le problème du malaise.(AU)

Toxicomania e suicídio sob uma visão psicanalítica / Adicción a las drogas y el suicidio bajo una visión psicoanalítica / La toxicomanie et le suicide sous une vision psychanalytique / Drug addiction and suicide under a psychoanalytic view

Para a psicanálise, qual a relação, na contemporaneidade, entre o suicídio e a toxicomania? Esse questionamento surgiu a partir de uma experiência de escuta analítica com toxicômanos. Oportunidade essa em que foram trazidas, diversas vezes, pelos usuários abusivos, suas ideações e/ou tentativas mal sucedidas de suicídio. Dessa forma, buscou-se, com este artigo, realizar um levantamento bibliográfico de cunho psicanalítico a fim de lograr uma compreensão entre a adição às drogas e o ato suicida, e as questões que possam ser comuns a ambos os assuntos. Explorou- se a obra freudiana O Mal-estar na Civilização e levantaram-se questões a respeito do gozo, desamparo e mal-estar; explorando, ainda, autores como Joel Birman e Jesús Santiago para uma compreensão da apresentação do sujeito contemporâneo. Chegou- se ao denominador comum da precariedade simbólica dos sujeitos contemporâneos devido à falência do legislador, o que resulta na dificuldade em lidar com o excesso de dimensões traumáticas às quais estão expostos na pós-modernidade. Assim, recorrem ao uso de substâncias artificiais como forma de obter uma descarga temporária e lograr um prazer "por baixo" do simbólico; ou, ainda, fazem uso de um recurso extremo, o suicídio - um ato final e infalível na solução do problema do mal-estar.

What kind of relation exists between suicide and drug addiction for psychoanalysis in the contemporaneity? The questioning came up after an experience of analytical hearing with drug addicts in which they brought several times their suicidal ideations and unsuccessful trials. In this way, this article aims to explore, through a bibliographical research, the psychoanalytical theory in order to reach a comprehension about drug addiction and the suicidal act and their common points. We explored Freud's work Civilization and its Discontents and found important concepts for the understanding of the mentioned topics - such as pleasure, helplessness, and discomfort. In addition, we discuss works of contemporaneous psychoanalysts, such as Joel Birman and Jesús Santigo, for a comprehension about the constitution of the subject in the contemporaneity. We found, as a common denominator, the subject's symbolic precariousness due to a collapse of the legislator. This subject, lacking symbolic capability, is exposed to an excess of traumatic dimensions and has difficulties dealing with it. Therefore, they appeal to artificial substances in order to achieve a temporary discharge and even obtain a pleasure that is not mediated by the symbolic. Another possibility, more extreme, rests upon the suicide, a final and unfailing act in order to solve the discomfort.

Para el Psicoanálisis, qué clase de relación existe, en la contemporaneidad, entre elsuicidio y la drogadicción? La pregunta surgió a partir de una escucha analítica con sujetos drogadictos, quienes manifestaron en varias ocasiones sus ideas suicidas y sus procesos no exitosos. De esta manera, este artículo busca explicar la teoría psicoanalítica para alcanzar una comprensión básica sobreestos temas y sus puntos en común. Se exploró la obra de Freud, La civilización y sus descontentos, y se encontraron conceptos importantes para el entendimiento de los temas mencionados, como el placer, la impotencia y el desasosiego. Adicionalmente, se revisaron obras contemporáneas de Psicoanálisis como las de Joel Birman y Jesús Santiago para comprender la constitución del sujeto en la contemporaneidad. Se encontró, como común denominador, la precariedad simbólica del sujeto debido a la caída del legislador. Este sujeto carente de capacidad simbólica es expuesto a un exceso de dimensiones traumáticas y le dificulta lidiar con éstas. Por lo tanto, el sujeto apela a sustancias artificiales para lograr una descarga temporal y obtener un placer sin la mediación de lo simbólico. Otra posibilidad más extrema yace en el suicidio, un acto final e indefectible para terminar el desasosiego.

Quelle est la relation entre le suicide et la toxicomanie dans la psychanalyse contemporaine pour? Cette question s'est posée à partir d'une expérience analytique découte avec les toxicomanes. Cette opportunité dans laquelle ils ont été amenés à plusieurs reprises par leurs agresseurs idéations et / ou tentatives infructueuses de suicide. Ainsi, nous avons cherché à accomplir avec cet article une caractéristique de la littérature psychanalytique afin de parvenir à une compréhension de la toxicomanie et de suicide, et les questions qui sont communes aux deux sujets. Explorées pour l' de Freud - le malaise dans la civilisation - et dês questions se posent au sujet de la joie, sentiment d'impuissance et d'inconfort, voire de auteurs Joel Birmans et Jesús Santiago pour une compréhension de la présentation du sujet dontemporain. Il en est résulté un dénominateur commun symbolique de la précarité des sujets contemporains en raison de l'échec de la législature, ce qui entraine une incapacité à faire face à des dimensions supplémentaires qui sont exposés à la post-modernité traumatique, et donc recourir à l'utilisation de substances artificielle comme un moyen d'obtenir une décharge, et même d'atteindre un plaisir temporaire,''en bas'' de la symbolique, ou même faire usage d'une station, dernier suicide - un acte final et une solution infaillible pour le problème du malaise.