Politics and power in ultra-modernity.

This work addresses three main issues: (i) Jung's positions on the historical events that he lived through, which are mainly presented in Volume 10 of his Collected Works; (ii) a reflection from a psychological perspective on the times we are experiencing, identifying the main contemporary psychopathologies; (iii) the possibility and need for including the pathologies of our time in our psychotherapeutic work.

Ce travail s'occupe de trois sujets principaux: 1) les positions de Jung concernant les événements historiques qu'il traversa durant sa vie, et qui sont présentées principalement dans le Volume 10 des Œuvres Complètes, 2) une réflexion sur l'époque que nous vivons, du point de vue psychologique, en identifiant les psychopathologies majeures de notre époque, 3) la possibilité et la nécessité d'inclure les pathologies de notre époque dans notre travail psychothérapeutique.

El presente trabajo aborda tres temas principales: (i) La posición de Jung respecto a los eventos históricos que lo atravesaron, y que han sido principalmente presentados en el Volumen 10 de sus Obras Completas; (ii) una reflexión desde una perspectiva psicológica sobre los tiempos que estamos experimentando, identificando las principales psicopatologías contemporáneas; (iii) la posibilidad y la necesidad de incluir las patologías de nuestro tiempo en nuestro trabajo psicoterapéutico.

Este trabalho aborda três questões principais: (i) as posições de Jung sobre os eventos históricos que ele viveu, que são apresentados principalmente no Volume 10 de suas Obras Coletadas; (ii) uma reflexão a partir de uma perspectiva psicológica sobre os tempos que estamos vivenciando, identificando as principais psicopatologias contemporâneas; (iii) a possibilidade e a necessidade de incluir as patologias do nosso tempo em nosso trabalho psicoterapêutico.

Catheter-based therapy for acute pulmonary embolism: An overview of current evidence.

Systemic thrombolysis for acute pulmonary embolism reduces the risk of death and cardiovascular collapse but is associated with an increased rate of bleeding. The desire to minimize the risk of bleeding events has driven the development of catheter-based strategies for pulmonary reperfusion in pulmonary embolism. These catheter-based strategies utilize lower-dose fibrinolytic regimens or purely mechanical thromboaspiration to expedite removal of the embolus. The most comprehensive data on catheter-based techniques come from trials of ultrasound-facilitated catheter fibrinolysis. This technique relieves right ventricular pressure overload with a lower risk of major bleeding and intracranial haemorrhage than historical rates observed with systemic fibrinolysis in intermediate- to high-risk pulmonary embolism. Two aspiration thrombectomy devices recently demonstrated significant reductions in right ventricle/left ventricle ratio and a low major adverse event rate in patients with intermediate-risk pulmonary embolism. However, further research is required to determine the optimal application of ultrasound-facilitated catheter fibrinolysis and other catheter-based therapies in patients with acute pulmonary embolism.

Septal versus apical pacing sites in permanent right ventricular pacing: The multicentre prospective SEPTAL-PM study.

BACKGROUND: The optimal right ventricular pacing site for patients requiring pacemaker implantation for permanent atrioventricular block is a matter of debate. Long-term right ventricular apical pacing has been associated with left ventricular ejection fraction impairment and heart failure. Right ventricular septal pacing has been proposed as an alternative. AIM: The aim of this randomized prospective multicentre trial was to compare left ventricular remodelling and outcomes between right ventricular apical and septal pacing after mid-term follow-up. METHODS: Patients requiring pacemaker implantation for high-degree atrioventricular block were enrolled and randomized in a 1:1 fashion to receive a right ventricular apical or septal lead. RESULTS: A total of 141 patients were included, 69 in the septal group and 72 in the apical group. Both groups exhibited similar left ventricular ejection fractions after 18 months of follow-up (septal 57.1±11.9% vs. apical 57.4±13.4%), and left ventricular ejection fraction variation was similar in the two groups at the end of follow-up (septal -1.5±13.2% vs. apical 0.3±13.3%). Additionally, left ventricular volume, quality of life and 6-minute walk distance were similar in the two groups. However, patients in the septal group were more likely to be asymptomatic, with a significantly lower concentration of N-terminal prohormone of brain natriuretic peptide. Lastly, lead position did not impact 18-month survival. CONCLUSION: Pacing from the right ventricular apex does not have any detrimental effect on left ventricular systolic function compared with septal pacing over an 18-month period.

A identidade da nova direita brasileira em narrativas de seus militantes / The identity of the Brazilian New Right in its militants' discourse / L'identité de la Nouvelle Droite brésilienne dans les discours de ses militants / La identidad de la nueva derecha brasileña en las narrativas de sus militantes

Resumo Em 2013, no Brasil, emergem na cena política diversos agrupamentos políticos identificados com a direita política e unidos contra a esquerda e a permanência do Partido dos Trabalhadores no governo brasileiro. Este estudo investiga esse fenômeno no contexto da região Nordeste do Brasil. Seu objetivo é compreender como a militância de direita, em uma cidade média nordestina, organiza discursivamente uma identidade para si e para os grupos que elegem como antagonistas. Com o uso do método de análise de discurso, o estudo investiga transcrições de entrevistas realizadas com nove membros dessa militância. As categorias conservador, libertário e liberal foram usadas como posições de autoidentificação por esses militantes. O modo como descrevem essas categorias revela a pluralidade da direita, evidenciando as complexas relações e as contradições presentes no seu interior.

Abstract In 2013, Brazil saw the emergence of several political groups identified with right-wing politics and united against the left and the Worker's Party consecutive administration. This paper investigates the characteristics of this phenomenon in northeastern Brazil to understand how right-wing militancy discursively organizes its identity and that of groups it chooses as antagonists. Based on discourse analysis, the study analyzes transcripts of interviews conducted with nine members of this militancy. Categories such as conservative, liberal and libertarian were used by the interviewees as self-identifying positions. How they describe these categories reveals the plurality of the political right, highlighting its complexity and contradictions.

Résumé En 2013, le Brésil a vu l'émergence de plusieurs groupes politiques identifiée à la politique de droite et unis contre la gauche et l'administration du Parti des Travailleurs. Cet article étudie ce phénomène dans le nord-est du Brésil pour comprendre comment le militantisme de droite organise discursivement son identité et celles des groupes qu'ils choisit comme antagonistes. Basée sur l'analyse du discours, l'étude analyse les transcriptions d'entretiens menés avec neuf membres de ce militantisme. Les catégories telles que conservateur, libertaire et libéral ont été utilisées comme des positions d'autoidentification. La façon dont ils décrivent ces catégories révèle la pluralité de la droite, soulignant sa complexité et ses contradictions.

Resumen En 2013, varios grupos políticos surgieron en la escena política de Brasil identificados con la derecha política y unidos contra la izquierda y la permanencia del Partido de los Trabajadores en el gobierno brasileño. Este estudio investiga este fenómeno en el contexto de la región Nordeste de Brasil con el objetivo de comprender cómo la militancia de derecha, en una ciudad del Nordeste de tamaño mediano, organiza discursivamente una identidad para sí misma y para los grupos que eligen como antagonistas. Utilizando el método de análisis del discurso, este estudio analiza las transcripciones de entrevistas realizadas con nueve miembros de esta militancia. Las categorías conservador, liberal y libertario fueron utilizadas por los militantes como categorías de autoidentificación. La forma en que los militantes describen estas categorías revela la pluralidad de la derecha, destacando las complejas relaciones y contradicciones presentes dentro de ella.

Impact of aerobic training periodisation on global and regional right ventricular strain in coronary heart disease.

Linear aerobic training periodisation (LP) is recommended for patients with coronary heart disease (CHD). However, the effects of training periodisation on the right heart mechanics in patients with CHD have never been examined. This study aimed to explore the effects of LP and non-linear periodisation (NLP) on right heart mechanics. We prospectively randomised CHD patients to 12 weeks of aerobic training with LP or NLP. While there was a weekly increase in energy expenditure with LP, there was a steeper increase during the first 3 weeks, followed by a decrease in the fourth week with NLP. Echocardiography was performed at baseline and after the training period to assess the right ventricular free wall (RVFW) and right atrial strain. Thirty patients with CHD were included (NLP, n = 16; LP, n = 14). The traditional right and left heart parameters showed no significant time effects. There was a decrease of RVFW strain with time in both groups (+1.3 ± 0.9% with NLP, and +1.5 ± 0.8% with LP; p = 0.033). Mid-ventricular RVFW strain changed significantly with time (+2.0 ± 1.3% with NLP, and from +2.3 ± 1.2% with LP; p = 0.025). There was no time effect on the right atrial strain. In stable CHD patients, LP and NLP resulted in right ventricular strain decrements with a segment-specific pattern. This study was registered at ClinicalTrials.gov (identifier number: NCT03414996). Novelty: In stable coronary heart disease patients, both linear and non-linear aerobic training periodisation programs result in right ventricular strain decrements with time, particularly in the mid-ventricular segment. Traditional right and left heart parameters and right atrial strain showed no significant time effect in both 12 weeks aerobic training periodisation programs.

[Right ventricular function after a first episode of pulmonary embolism: Contribution of longitudinal 2D strain]. / Fonction ventriculaire droite après un premier épisode d'embolie pulmonaire : apport du strain 2D.

BACKGROUND: Analysis of right ventricular (RV) function during the acute phase of pulmonary embolism (PE) was widely reported in the literature. However, few studies analysed its function long term after the acute phase. Our aim was to evaluate the RV function long term after a first episode of PE. METHODS: In this study, we compared echocardiographic parameters of right ventricular function in 25 patients with a first episode of non-severe PE for more than six months with 25 healthy controls subject. RESULTS: In the study of RV function, we noted that the mean values of the standard parameters were significantly lower in the EP group compared to the control group but their values remained within the normal range. The global RV longitudinal strain had a mean value lower than the control group statistically significant (-21±4,8% vs. -25±2,4%; P=0,28). The longitudinal strain of the free wall of the RV was altered in the EP group, however, there was no significant difference between the EP group and the control group (-19,4±16% vs. -24±17%; P=0,28). CONCLUSION: This study has shown that there is a systolic dysfunction late after a first episode of PE and this despite the absence of the symptoms and pulmonary hypertension.

Right ventricle failure in patients treated with left ventricular assist device.

This review article aim to highlight the right ventricular function peri left ventricular assist device implantation, and to assess the incidence, physiopathology, predictors, management and prognosis, of right ventricular failure post-implant.

Pterostilbene improves cardiac function in a rat model of right heart failure through modulation of calcium handling proteins and oxidative stress.

This study explored the effect of pterostilbene (PTS) complexed with hydroxypropyl-ß-cyclodextrin (HPßCD) on right heart function, glutathione and glutaredoxin systems, and the expression of redox-sensitive proteins involved with regulation calcium levels in the experimental model of pulmonary arterial hypertension (PAH) induced by monocrotaline (MCT). After 7 days of PAH induction, rats received daily doses of the PTS:HPßCD complex (corresponding to 25, 50, or 100 mg·kg-1 of PTS) or vehicle (control group, CTR0) (an aqueous solution containing HPßCD; CTR0 and MCT0 (MCT group that did not receive PTS treatment)) via oral administration for 2 weeks. The results showed that the PTS:HPßCD complex increased the content of reduced glutathione and the activity of glutathione-S-transferase and glutaredoxin in the right ventricle (RV) of MCT-treated rats in a dose-dependent manner. Additionally, at higher doses, it also prevented the reduction of stroke volume and cardiac output, prevented myocardial performance index (MPI) increase, reduced lipoperoxidation, reduced total phospholamban, and increased the expression of sarcoplasmic reticulum calcium ATPase in the RV of MCT-treated rats. These results demonstrate that the PTS:HPßCD complex has a dose-dependent antioxidant mechanism that results in improved cardiac function in experimental right heart failure. Our results open a field of possibilities to PTS administration as new therapeutic approach to conventional therapy for right ventricular dysfunction. Novelty Pterostilbene complexed with hydroxypropyl-ß-cyclodextrin could be a new therapeutic approach. Pterostilbene complexed with hydroxypropyl-ß-cyclodextrin reestablishes redox homeostasis through glutathione metabolism modulation, leading to an improved MPI in pulmonary arterial hypertension-provoked right heart failure.

[Management of right ventricular failure in pulmonary vascular diseases]. / Prise en charge de l'insuffisance ventriculaire droite aiguë compliquant les maladies vasculaires pulmonaires.

Right ventricular failure (RVF) is a common cause of admission to the intensive care unit and its presence is a major prognostic factor in acute pulmonary embolism (PE) and chronic pulmonary hypertension (PH). RVF results from an incapacity of the RV to adapt to an increase in afterload so it can become critical in acute PE and chronic PH. The presence of RVF in cases of acute PE with haemodynamic instability is an indication for thrombolytic therapy. RVF represents the most common cause of death in chronic PH. Factors triggering RV failure in PH, such as infection, PE, arrhythmias, or unplanned withdrawal of pulmonary arterial hypertension (PAH)-targeted therapy, have to be considered and treated if identified. However, RVF may also represent progression to end-stage disease. The management of RVF in patients with PH requires expertise and consists of optimization of fluid balance (with diuretics), cardiac output (with inotropic support such as dobutamine), perfusion pressure (with norepinephrine), and reduction of RV afterload with PAH-targeted therapies. Extracorporeal life support, lung transplantation or heart-lung transplantation should be considered in cases of refractory RVF in eligible patients.

Right ventricular outflow tract prestenting with AndraStent XXL before percutaneous pulmonary valve implantation.

BACKGROUND: The indications for percutaneous pulmonary valve implantation (PPVI) have been extended to include large dysfunctional right ventricular outflow tracts (RVOTs). Prestenting of the RVOT is commonly performed before PPVI in order to ensure a stable landing zone. The AndraStent XXL (AndraMed GmbH, Reutlingen, Germany), a cobalt-chromium stent with semi-open cell design, has unique mechanical properties in this indication but is no longer available in France. AIMS: To assess the efficiency of AndraStent XXL before PPVI. METHODS: In this retrospective multicentre cohort study, 86 AndraStents XXL were implanted in 77 patients in 6 centres. RESULTS: PPVI was indicated mainly for pulmonary regurgitation (75.3%) in native or patched RVOT (88.3%). The stents were manually mounted on balloon catheters and delivered through sheaths using a conventional femoral approach. PPVI was performed successfully in 97.4% of patients after successful prestenting, generally during the same procedure (77.9%). There were no deaths associated with stent implantation, and four patients experienced five complications, mainly stent embolization, including one requiring surgery. Neither stent fracture nor dysfunction were observed in any patient during a mean follow-up of 19.2±8.7months. Stent analysis showed an excellent maximal stent expansion (97.1%) regardless of balloon size. A 22.3%±3.4 stent shortening with a 30mm balloon was observed. CONCLUSIONS: Implantation of large cobalt-chromium AndraStent XXL stents is efficient for prestenting before PPVI.

[Transcatheter aortic valve implantation and conduction disturbances]. / Implantation percutanée de valve aortique et troubles conductifs.

Transcatheter aortic valve implantation (TAVI) is currently becoming the treatment of choice for patients with calcific aortic stenosis. Despite several technical improvements, the incidence of conduction disturbances has not diminished and remains TAVI's major complication. These disturbances include the occurrence of left bundle branch block and/or high-grade atrioventricular block often requiring pacemaker implantation. The proximity of the aortic valve to the conduction system (conduction pathways) accounts for the occurrence of these complications. Several factors have been identified as carrying a high risk of conduction disturbances like the presence of pre-existing right bundle branch block, the type of valve implanted, the volume of aortic and mitral calcifications, the size of the annulus and the depth of valve implantation. Left bundle branch block is the most frequent post TAVI conduction disturbance. Whereas the therapeutic strategy for persistent complete atrioventricular block is simple, it becomes complex in the presence of fluctuating changes in PR interval and left bundle branch block duration. The QRS width threshold value (150-160 ms) indicative of the need for pacemaker implantation is still being debated. Although there are currently no recommendations regarding the management of these conduction disturbances, the extension of TAVI indications to patient at low surgical risk calls for a standardization of our practice. However, a decision algorithm was recently proposed by a group of experts composed of interventional cardiologists, electrophysiologists and cardiac surgeons. There are still uncertainties about the appropriate timing of pacemaker implantation and the management of new onset left bundle branch block.

Characteristics and prognosis of patients with significant tricuspid regurgitation.

BACKGROUND: Severe tricuspid regurgitation (TR) usually remains asymptomatic for a long period, and the diagnosis is often delayed until an advanced stage of right heart failure (RHF). Only a minority of patients are referred for surgery. AIM: To describe the characteristics and prognosis of patients with significant TR, according to aetiology. METHOD: Two-hundred and eight consecutive patients with moderate-to-severe (grade III) or severe (grade IV) TR were included from echocardiography reports between 2013 and 2017. Median follow-up was 18 (6-38) months. RESULTS: Patients (mean age 75 years; 46.6% men) were divided into four groups according to TR aetiology: group 1, primary TR (14.9%); group 2, TR secondary to left heart disease with a history of left heart valve surgery (24.5%); group 3, TR secondary to left heart or pulmonary disease with no history of left valvular surgery (26.5%); and group 4, idiopathic TR (34.1%). During follow-up, 61 patients (29.3%) experienced at least one episode of RHF decompensation requiring hospitalization. Only 11 patients (5.3%) underwent tricuspid valve surgery during follow-up. The 4-year survival was much lower than the expected survival of age- and sex-matched individuals in the general population (56±4% vs. 74%). After adjustment for outcome predictors, patients with idiopathic TR had a higher risk of mortality (adjusted hazard ratio 1.83, 95% confidence interval 1.05-3.21; P=0.034) compared with other groups. CONCLUSIONS: Moderate-to-severe or severe TR is associated with a high risk of hospitalization for RHF and death at 4 years, and a low rate of surgery. Idiopathic TR is associated with worse outcome than other aetiologies.

[Isolated right aortic arch: prenatal diagnosis characteristics, pregnancy outcomes and systematic review]. / Crosse aortique droite isolée : caractéristiques du diagnostic anténatal, issues de grossesses et revue de la littérature.

OBJECTIVE: To investigate prenatal diagnosis characteristics and pregnancy outcomes associated with isolated right aortic arch (RAA). METHODS: A retrospective study including fetuses with isolated RAA, managed between January 2010 and February 2018. Cases were identified from the ultrasound databases of the expert pediatric cardiologists, who made the aforementioned diagnosis. All fetuses were examined by a fetal medicine imaging expert to exclude any extracardiac abnormality. A systematic review was performed to assess the prenatal diagnosis and outcomes of fetuses with isolated RAA. RESULTS: Fifty-six fetuses were diagnosed with an isolated RAA. An isolated double aortic arch (DAA) was diagnosed in one fetus. Mean gestational age at diagnosis was 24 weeks. The sex ratio (boy/girl) was 0.89. No significant abnormality was detected in invasive tests (karyotype and FISH or microarray). Only one fetus was misdiagnosed with isolated RAA. He was the only symptomatic (stridor) newborn baby and was later diagnosed with DAA. Four studies were included in our systematic review representing 115 cases of isolated RAA. One significant chromosomal abnormality was detected: a 22q11 deletion in a newborn baby who had a postnatal finding of a soft palate cleft. There was one major obstetric complication: an intrauterine fetal demise at 41 gestational weeks. CONCLUSION: Diagnosis of isolated RAA can be challenging. Invasive tests are to be discussed. The diagnosis of isolated RAA should not change obstetric monitoring. Nevertheless, an echocardiography should be performed systematically in these new newborn babies within their first month of life.

The challenging right inferior pulmonary vein: A systematic approach for successful cryoballoon ablation.

BACKGROUND: Pulmonary vein isolation (PVI) using cryoballoon ablation is widely used for rhythm control in patients with paroxysmal atrial fibrillation. This technique has a steep learning curve, and PVI can be achieved quickly in most patients. However, the right inferior pulmonary vein (RIPV) is often challenging to occlude and isolate. AIM: We aimed to analyse the efficacy of RIPV ablation using a systematic approach. METHODS: Consecutive patients referred for cryoballoon ablation of paroxysmal atrial fibrillation were enrolled prospectively. A systematic approach was used for RIPV cryoablation. The primary endpoint was acute RIPV isolation during initial freeze. RESULTS: A total of 214 patients were included. RIPV isolation during initial freeze occurred in 179 patients (82.2%). Real-time PVI could be observed in 72 patients (33.6%), whereas cryoballoon stability required pushing the Achieve™ catheter inside the RIPVs in the remaining patients. The rate of unsuccessful or aborted first freeze as a result of insufficient minimal temperature was significantly higher in patients with real-time pulmonary vein potential recording (16.7% vs. 6.3%; P=0.031). To overcome this issue and obtain both stability and real-time PVI, a dedicated "whip technique" was developed. Twelve patients (5.6%) required a redo ablation; only two of these had a reconnected RIPV. CONCLUSIONS: A systematic approach to RIPV cryoablation can lead to a high rate of first freeze application. Operators should not struggle to visualize pulmonary vein potentials before ablation, as this may decrease cryoapplication efficacy. Thus, stability should be preferred over real-time PVI for RIPV ablation. Both stability and real-time PVI can be obtained using a "whip technique".

Significado e melancolia: a poesia da existência / Meaning and melancholia: the poetry of existence / Sentido y melancolía: la poesía de la existencia / Sens et mélancolie: la poésie de l'existence

Em um mundo onde a direita política ganha cada vez mais espaço, o psicanalista americano Christopher Bollas se coloca a pensar nas razões psíquicas desse movimento surpreendente. Para ele vivemos um problema psicopolítico, no qual a psicanálise tem a contribuir, inclusive emprestando léxico analítico ao contexto político. Explorando essa história psicopolítica desde o início do século XX, o autor propõe pontos de vista e padrões de pensamento que tentam contribuir na explicação do momento atual. Para ele, não mais somos oprimidos por um superego forte, mas, sim, por egos fracos e inoperantes, adaptativos às necessidades da sociedade. Nesse contexto, o splitting da personalidade, a projeção e a melancolia ganham espaço nas mentes e na política.

In a world where the political right gains more and more ground, the American psychoanalyst Christopher Bollas thinks about the psychic reasons of this surprising movement. Bollas believes we are experiencing a psycho-political problem, in which psychoanalysis has to contribute, including lending some analytical lexicon to the political context. Exploring this psycho-political history from the beginning of the twentieth century on, he offers points of view and thought patterns in order to contribute to a deeper explanation of the present moment. Bollas considers that we are no longer oppressed by a strong superego, but by weak and inoperative egos, adaptive to the needs of society. In this context, the splitting of personality, the projection and the melancholy gain space in people's minds and in politics.

En un mundo donde la derecha política gana cada vez más espacio, el psicoanalista americano Christopher Bollas se pone a pensar en las razones psíquicas de ese movimiento sorprendente. Para él vivimos un problema psicopolítico, en el que el psicoanálisis tiene que aportar, incluso prestando léxico analítico al contexto político. Explorando esta historia psicopolítica desde principios del siglo XX, propone puntos de vista y patrones de pensamiento que intentan contribuir en la explicación del momento actual. Para él, ya no somos oprimidos por un superyó fuerte, sino por egos débiles e inoperantes, adaptativos a las necesidades de la sociedad. En ese contexto, el splitting de la personalidad, la proyección y la melancolía ganan espacio en las mentes y en la política.

RÉSUMÉ Dans un monde où la droite politique prend de plus en plus de place, le psychanalyste américain Christopher Bollas se met à penser aux raisons psychiques de ce mouvement surprenant. Pour lui, nous vivons un problème psycho-politique, auquel la psychanalyse peut porter sa contribution, y compris par l'emprunt du lexique analytique au contexte politique. En exploitant cette histoire psycho-politique depuis les débuts du xxe siècle, il propose des points de vue et des modèles de pensée qui cherchent à contribuer à l'explication du moment actuel. Pour lui, nous ne sommes pas opprimés par un surmoi fort, mais par des moi faibles et inopérants, adaptatifs aux besoins de la société. Dans ce contexte, le splitting de la personnalité, la projection et la mélancolie prennent place dans les esprits et dans la politique.

[The 'Dangerous' ECG]. / Das «gefährliche¼ EKG.

The 'Dangerous' ECG Abstract. This review aims to draw the attention of physicians confronted with cardiac emergencies to some specific ECG pathomorphologies in acute coronary syndrome and pulmonary embolism, as well as to malignant arrhythmias in hyperkalemia, drug-induced QTc prolongation, WPW, and arrhythmogenic right ventricular cardiomyopathy. If they are not detected the resultant failure to treat or incorrect treatment can have serious consequences for the patient and the doctor (liability consequences).

[Evaluation of the management of low-risk pulmonary embolism diagnosed in an emergency department. HoPE study (Home treatment of Pulmonary Embolism)]. / Évaluation de la prise en charge des embolies pulmonaires à bas risque diagnostiquée aux urgences. Étude HoPE (Home Treatment of Pulmonary Embolism).

INTRODUCTION: Risk stratification allows outpatient management of low-risk pulmonary embolism (PE). Here, we carry out an evaluation of the professional practices on the emergency management of low-risk PE, after selection with the sPESI score. MATERIAL AND METHOD: All patients admitted to the emergency department of Chambéry hospital, with a final diagnosis of PE are analyzed. The PE of score sPESI at 0 are included, in the absence of contraindications. Ninety-day follow-up is done. The objective is to evaluate the proportion of ambulatory care for low-risk patients. RESULTS: Eighty PE were diagnosed in 2016, 28 with sPESI score at 0 and 3 patients excluded. Of the 25 inclusions, 6 patients had signs of right ventricular dysfunction and were therefore hospitalized. The remaining 19 were eligible for outpatient care but only 8 of them stayed less than 24hours in the hospital. DISCUSSION: The sPESI score is a decision support tool for outpatient management but should not be used alone. The search for right ventricular dysfunction seems important here.

[Pathophysiology of right ventricular hemodynamics]. / Physiopathologie hémodynamique du ventricule droit.

The right ventricle (RV) plays a key role in the maintenance of an adequate cardiac output whatever the demand, and thus contributes to the optimization of the ventilation/perfusion ratio. The RV has a thin wall and it buffers the physiological increases in systemic venous return without causing a deleterious rise in right atrial pressure (RAP). The RV is coupled to the pulmonary circulation which is a low pressure, low resistance, high compliance system. In the healthy subject at rest, the contribution of the RV to right heart systolic function is surpassed by the contribution of both left ventricular contraction and the respiratory pump. RV systolic function plays a contributory role during exercise and in patients with pulmonary hypertension. The RV compensates better for volume overload than for pressure overload and is more capable of sustaining chronic increases in load than acute ones. An impaired RV-pulmonary artery coupling leads to a major mismatch between RV function and arterial load ("afterload mismatch") and is associated progressively with a low cardiac output and a high RAP. Right ventricular dysfunction is involved in the pathophysiology of both cardiovascular and pulmonary diseases, and may partly explain the deleterious haemodynamic consequences of mechanical ventilation.

Predictores psicosociales que subyacen al pensamiento político: un estudio en dos poblaciones universitarias costarricenses / Psychosocial underpinnings predicting the political thought: a study on two Costa Rican universities / Preditores psicossociais subjacentes ao pensamento político: um estudo em duas populações universitárias da Costa Rica / Indicateurs psychosociaux qui soustendent la pensée politique: une étude réalisée au sein de deux communautés universitaires costariciennes

El objetivo de la investigación es determinar la relación existente entre las actitudes en cuanto a la libertad económica y el Autoritarismo como dos variables dependientes respecto a las variables independientes a) nivel de dominancia social, b) la atribución de la pobreza, c) el nivel de religiosidad individual y d) la percepción de la naturaleza humana. Las variables dependientes que pretenden representar el pensar político se encuentran representadas por dos variables escalares; una de actitudes hacia la libertad económica representando la tradicional "izquierda - derecha" y otra de Autoritarismo. El estudio fue llevado a cabo con una muestra de 196 estudiantes de dos universidades costarricenses, una pública y una privada especializada en ciencias de la salud. Entre los resultados más importantes se obtuvo una relación entre la orientación a la dominancia social y autoritarismo, además de relaciones significativas en cuanto a la religiosidad con a) el autoritarismo, b) libertad económica (derecha económica) y c) la percepción positiva de la naturaleza humana.

The aim is to determine the existing relation between attitudes towards economical freedom and Authoritarianism as two dependent variables in comparison to the independent variables a) level of Social Dominance Orientation (SDO), b) poverty attribution, c) the individual religiosity level and d) the perception on human nature. The dependent variables represent the political thinking which is represented by two variables; economical freedom representing the traditional "left - right" conception regarding the economical aspect, and an authoritarianism scale. 196 college students from two Costa Rican universities were surveyed; a public and a private one specialized in health sciences. Among the most important results, a significant relation was found between Social Dominance Orientation and Authoritarianism, as well as between religiousness and a) Authoritarianism, b) Economic freedom (right-wing), and c) a positive perception on human nature.

O objetivo da pesquisa foi determinar a relação entre as variáveis dependentes atitudes para com a liberdade econômica e autoritarismo com as variáveis independentes: a) nível de dominância social, b) atribuição de pobreza, c) nível de religiosidade individual e d) percepção da natureza humana. As variáveis dependentes que pretendem representar o pensamento político foram representadas por duas variáveis escalares, uma de atitudes em relação à liberdade econômica que representa a tradicional "esquerda - direita" e outra de autoritarismo. O estudo foi realizado com uma amostra de 196 estudantes de duas universidades de Costa Rica, uma pública e uma privada especializada em ciências da saúde. Destacam-se como resultados a relação entre a orientação em relação à dominância social e o autoritarismo, além de relações significativas entre a religiosidade e as variáveis: a) autoritarismo, b) libertade econômica (direita econômica) y c) a percepção positiva naturaza humana.

L'objectif de la recherche est de déterminer la relation existante des attitudes face à la liberté économique et l'Autoritarisme, comme deux variables dépendantes, par rapport aux variables indépendantes : a) le niveau de dominance sociale, b) l'attribution de la pauvreté, c) le niveau de religiosité individuelle et d) la perception de la nature humaine. Les variables dépendantes que prétend représenter la pensée politique, sont représentées par deux variables scalaires; l'une, d'attitudes envers la liberté économique représentant la traditionnelle "gauche - droite" et, l'autre, de l'Autoritarisme. L'étude a été élaborée sur un échantillonnage de 196 étudiants issus de deux universités costariciennes, une université publique et une université privée, spécialisée en sciences de la santé. Parmi les résultats les plus importants se trouve une relation entre l'orientation de dominance sociale et autoritarisme, et de relations significatives quant à la religiosité avec a) l'autoritarisme, b) la liberté économique (droite économique) et la perception positive de la nature humaine.