Representativeness of the particulate matter pollution assessed by an official monitoring station of air quality in Santiago, Chile: projection to human health.

Santiago, capital city of Chile, presents air pollution problems for decades mainly by particulate matter, which significantly affects population health, despite national authority efforts to improve air quality. Different properties of the particulate matter (PM10, PM2.5 and PM1 fractions, particle surface and number) were measured with an optical spectrometer. The sampling was done during spring 2019 at different sites within the official representative area of Independencia monitoring station (ORMS-IS). The results of this study evidence large variations in PM mass concentration at small-scale areas within the ORMS-IS representative zone, which reports the same value for the total area. Results from PM properties such as PM1, particle number and particle surface distribution show that these properties should be incorporated in regular monitoring in order to improve the understanding of the effects of these factors on human health. The use of urban-climate canopy-layer models in a portion of the sampled area around the monitoring station demonstrates the influence of street geometry, building densities and vegetation covers on wind velocity and direction. These factors, consequently, have an effect on the potential for air pollutants concentrations. The results of this study evidence the existence of hot spots of PM pollution within the area of representativeness of the ORMS-IS. This result is relevant from the point of view of human health and contributes to improve the effectiveness of emission reduction policies.

Glycerophospholipids in Red Blood Cells Are Associated with Aerobic Performance in Young Swimmers.

This study aimed to characterize the composition of lipids in the red blood cells (RBCs) of adolescent swimmers and correlate this lipidome with the aerobic performance of the athletes. Five experimental assessments were performed by 37 adolescent swimmers. During the first session, the athletes went to the laboratory facility for venous blood sampling. The critical velocity protocol was conducted over the 4 subsequent days to measure aerobic performance (CV), comprising maximal efforts over distances of 100, 200, 400, and 800 m in a swimming pool. RBCs were obtained and extracted for analysis using the liquid chromatography-high resolution mass spectrometry untargeted approach. A total of 2146 ions were detected in the RBCs, of which 119 were identified. The enrichment pathway analysis indicated intermediary lipids in the glycerophospholipid, glycerolipid, sphingolipid, linoleic acid, and alpha-linolenic metabolisms, as well as pentose and glucuronate interconversions. A significant impact of the intermediary lipids was observed for the glycerophospholipid metabolism, including phosphatidylethanolamine (PE), phosphatidylcholine (PC), 1-acyl-sn-glycero-3-phosphocholine, sn-glycerol 3-phosphate, and phosphatidic acid. Inverse and significant associations were observed for PE 18:2/18:3 (r = -0.39; p = 0.015), PC 18:3/20:0 (r = -0.33; p = 0.041), and phosphatidic acid 18:0/0:0 (r = -0.47; p = 0.003) with aerobic performance. Swimmers who exhibited higher levels of aerobic performance also had the lowest abundance of PE, PC, and phosphatidic acid.

Fragmented Fat Transfer for Massive Weight Loss Gluteal Contouring.

SUMMARY: A recently introduced novel fragmentation technique has made it possible to convert fat tissue from apronectomy into large-scale viable lipograft, providing a glimpse of an alternative to traditional liposuction and its harvesting limitations. The purpose of this study was to assess the initial clinical evidence on fragmented fat transfer to restore volume and enhance deflated gluteal contours in a sample of massive weight loss patients. The authors retrospectively reviewed medical records of 20 women who received autologous buttock fat grafts that were harvested and fragmented following belt lipectomies and/or fleur-de-lis abdominoplasties. The average total volume subcutaneously grafted into the buttocks was 720 ml (bilateral), ranging from 500 ml to 960 ml. No local gluteal complications, such as seroma, infection, fat necrosis, or subcutaneous nodulations, were reported. Photographic observation of postoperative results over a 6- to 14-month follow-up period showed clear enhancement of body contouring in all patients, especially in those in whom fat transfer was combined with circumferential lifts. Fat fragmentation has proved useful and effective in providing great amounts of viable fat graft in a safe, simple, and reproducible technique without noticeable complications. The method eliminates the organic response to the insult of liposuction while using the entirety of formerly discarded apronectomy tissue to provide fine, transferable, autologous fat without increasing operative time. Although preliminary, the authors' clinical findings with this new technique support further studies of fragmented fat as an alternative to liposuction in gluteal fat grafting. Additional potential applications, including in wound healing and regenerative medicine, are worth exploring. . CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Plasma Amino Acids and Acylcarnitines Are Associated with the Female but Not Male Adolescent Swimmer's Performance: An Integration between Mass Spectrometry and Complex Network Approaches.

The main aim of this study was to compare the performance over different distances, the critical velocity (CV), and plasma acylcarnitines/amino acids of male and female adolescent swimmers. Moreover, we applied the complex network approach to identify which molecules are associated with athletes' performances. On the first day under a controlled environment, blood samples were collected after 12 h of overnight fasting. Performance trials (100, 200, 400, and 800-m) were randomly performed in the subsequent four days in a swimming pool, and CV was determined by linear distance versus time mathematical function. Metabolomic analyses were carried out on a triple quadrupole mass spectrometer performing electrospray ionization in the positive ionization mode. No difference was observed between the performance of male and female swimmers. Except for 200-m distance (p = 0.08), plasma tyrosine was positively and significantly associated with the female times during the trials (100-m, p = 0.04; 400-m, p = 0.04; 800-m, p = 0.02), and inversely associated with the CV (p = 0.02). The complex network approach showed that glycine (0.406), glutamine (0.400), arginine (0.335), free carnitine (0.355), tryptophan (0.289), and histidine (0.271) were the most influential nodes to reach tyrosine. These results revealed a thread that must be explored in further randomized/controlled designs, improving the knowledge surrounding nutrition and the performance of adolescent swimmers.

Urine Metabolites Enable Fast Detection of COVID-19 Using Mass Spectrometry.

The COVID-19 pandemic boosted the development of diagnostic tests to meet patient needs and provide accurate, sensitive, and fast disease detection. Despite rapid advancements, limitations related to turnaround time, varying performance metrics due to different sampling sites, illness duration, co-infections, and the need for particular reagents still exist. As an alternative diagnostic test, we present urine analysis through flow-injection-tandem mass spectrometry (FIA-MS/MS) as a powerful approach for COVID-19 diagnosis, targeting the detection of amino acids and acylcarnitines. We adapted a method that is widely used for newborn screening tests on dried blood for urine samples in order to detect metabolites related to COVID-19 infection. We analyzed samples from 246 volunteers with diagnostic confirmation via PCR. Urine samples were self-collected, diluted, and analyzed with a run time of 4 min. A Lasso statistical classifier was built using 75/25% data for training/validation sets and achieved high diagnostic performances: 97/90% sensitivity, 95/100% specificity, and 95/97.2% accuracy. Additionally, we predicted on two withheld sets composed of suspected hospitalized/symptomatic COVID-19-PCR negative patients and patients out of the optimal time-frame collection for PCR diagnosis, with promising results. Altogether, we show that the benchmarked FIA-MS/MS method is promising for COVID-19 screening and diagnosis, and is also potentially useful after the peak viral load has passed.

Fleur-de-lis Abdominoplasty and Neo-umbilicus.

Body contouring for patients with massive weight loss may demand not only lifting but also some extent of central body tightening to achieve complete tissue readjustment. Although the fleur-de-lis procedure usually achieves nice contouring results, poor visible scars, including umbilical complications, have restricted the indications for the anterior vertical approach. The purpose of this article is to present the authors' experience with the inner scar umbilical reconstruction, enhancing overall results for vertical abdominoplasties. The inner scar umbilicus is a simple, safe, and reproducible technique, presenting low complication rates with sustainable and natural results.

Most frequent errors in inhalation technique of patients with asthma treated at a tertiary care hospital.

OBJECTIVE: To demonstrate the most frequent errors in inhalation technique in patients with asthma undergoing treatment at a tertiary care hospital. METHODS: A cross-sectional study with a convenience sample of asthma patients aged 18 years or over, treated at a pulmonology outpatient clinic of a tertiary care hospital. The assessment of inhalation technique of users of the dry powder inhalers Aerolizer®, Aerocaps and Diskus®, or metered-dose inhalers was based on the manufacturer's instructions for use of each inhaler device. Patients demonstrated the inhalation technique with empty inhaler devices, and it was considered correct when all stages were performed properly, or when errors probably did not interfere with the treatment outcome. RESULTS: Among 71 participants, 43 (60.5%) performed inhalation technique incorrectly. Among metered-dose inhalers and dry powder inhalers users, inhalation technique errors were found in 84.2% and 51.9%, respectively (p=0.013). Errors were more frequent at the exhalation stage (67.4%), followed by breathing in (58.1%) and apnea (51.2%). In the group using dry powder inhalers, the most common errors occurred during exhalation and, for those using metered-dose inhalers, the most compromised stage was aspiration. CONCLUSION: Errors were more frequent among those using metered-dose inhalers compared with dry powder inhalers. Misconceptions are more common at the expiration stage among users of dry powder inhalers and in aspiration among those on metered-dose inhalers.

Inner Scar Umbilicus: New Horizons for Vertical Abdominoplasty.

BACKGROUND: It is reasonable that deflated tissue in massive weight loss patients may demand not only lifting but also some extent of central body tightening, by the fleur-de-lis procedure. Although achieving nice contouring results, poor visible scars, including umbilical complications, have restricted the indications for the anterior vertical approach. The purpose of this article is to present the authors' experience with the inner scar umbilical reconstruction, reflecting overall results in vertical abdominoplasties. METHODS: Massive weight loss patients who underwent fleur-de-lis abdominoplasties with the inner scar umbilicus were reviewed retrospectively. The original stalk was resected along with the surgical specimen, and two marked parallel skin flaps were kept and sutured against each other into the deep medial fascia, to reconstruct the umbilical base. Additional sutures were made to approximate fat tissue immediately under and above it, enhancing a deepening effect. Conventional upper and lower vertical closure helped to establish the tridimensional shape of the new navel. RESULTS: One hundred ten consecutive patients were studied, and 52 (47 percent) presented small inflammatory exudate arising from the inner suture, which resolved with conservative dry dressings. No further umbilical complications such as infection, necrosis, dehiscence, widening, or stenosis were reported, and all patients showed natural and scarless new navels with nice shapes and correct position. CONCLUSIONS: The inner scar umbilicus is a simple, safe, and reproducible technique, presenting low complication rates with sustainable and natural results. High-quality navel reconstruction favors the indication of vertical abdominoplasties, especially for post-bariatric surgery body contouring. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Exotic Eucalyptus leaves are preferred over tougher native species but affect the growth and survival of shredders in an Atlantic Forest stream (Brazil).

We evaluated the effect of leaves of native and exotic tree species on the feeding activity and performance of the larvae of Triplectides gracilis, a typical caddisfly shredder in Atlantic Forest streams. Leaves of four native species that differ in chemistry and toughness (Hoffmannia dusenii, Miconia chartacea, Myrcia lineata and Styrax pohlii) and the exotic Eucalyptus globulus were used to determine food preferences and rates of consumption, production of fine particulate organic matter (FPOM), growth and survival of shredders. We hypothesized that the consumption rates of leaves of Eucalyptus and their effects on the growth and survival of shredders could be predicted by leaf chemistry and toughness. The larvae preferred to feed on soft leaves (H. dusenii and M. chartacea) independently of the content of nutrients (N and P) and secondary compounds (total phenolics). When such leaves were absent, they preferred E. globulus and did not consume the tough leaves (M. lineata and S. pohlii). In monodietary experiments, leaf consumption and FPOM production differed among the studied leaves, and the values observed for the E. globulus treatments were intermediate between the soft and tough leaves. The larvae that fed on H. dusenii and M. chartacea grew constantly over five weeks, while those that fed on E. globulus lost biomass. Larval survival was higher on leaves of H. dusenii, M. chartacea and S. pohlii than on E. globulus and M. lineata leaves. Although E. globulus was preferred over tougher leaves, long-term consumption of leaves of the exotic species may affect the abundance of T. gracilis in the studied stream. Additionally, our results suggest that leaf toughness can be a determining factor for the behavior of shredders where low-quality leaves are abundant, as in several tropical streams.

Cluster de doenças crônicas não transmissíveis e multimorbidade em trabalhadores da atençãoprimária à saúde / Cluster of chronic non-communicable diseases and multimorbidity in primary healthcare workers

Objetivo: Investigar a agregação das DCNT e a sua associação com as características sociodemográficas e os aspectos ocupacionais dos trabalhadores da APS. Métodos: Tratou-se de um estudo epidemiológico transversal que analisou os dados parciais de uma coorte retrospectiva realizada em Vitória da Conquista (BA) e em São Geraldo da Piedade (MG) no mês de janeiro de 2022 com 105 trabalhadores da Estratégia Saúde da Família (ESF), que preencheram um questionário eletrônico específico autoaplicável. As variáveis analisadas foram: sociodemográficas, caracterização do trabalho, presença de DCNT e de multimorbidade. Foram aplicados os seguintes procedimentos estatísticos: análise descritiva, análise de cluster, teste de qui-quadrado de Pearson e regressão logística binária. Resultados:As cinco DCNT mais prevalentes foram a rinite/sinusite (30,5%), a cefaleia/enxaqueca (26,7%), o colesterol alto (26,7%), a gastrite (19,0%) e a hipertensão arterial sistêmica (19,0%). A prevalência de multimorbidade foi de 26,7% e foram encontradas 11 combinações de cluster (34,4%), sendo o maior escore na combinação das cinco doenças mais prevalentes. Foi identificada a associação entre a presença de multimorbidade e o sexo, sendo a prevalência 24% menor entre os homens, e com a escolaridade, sendo a prevalência 26% maior nos indivíduos que não possuem ensino superior. Conclusão: Foram identificadas associações entre a presença de multimorbidade e o sexo feminino, e indivíduos que não concluíram o ensino superior. Observou-se, ainda, uma associação simultânea das cinco principais DCNT deste estudo com o nível de escolaridade (AU).

Objectives: Investigate the aggregation of NCDs and their association with sociodemographic characteristics and occupational aspects in primary healthcare workers. Methods: A cross-sectional study analyzed partial data from a cohort profile conducted in Vitória da Conquista (BA) and in São Geraldo da Piedade (MG) in January 2022 with 105 workers of "Estratégia de Saúde da Família (ESF)" who answered a self-report electronic questionnaire. The variables of this research were: sociodemographic characteristics, job aspects, and the presence of NCDs and multimorbidity. Data were analyzed with descriptive statistics, cluster analysis, chi-square test, and binary logistic regression. Results: The five NCDs more prevalent were: rhinitis/sinusitis (30,5%), headache/migraine (26,7%), hypercholesterolemia (26,7%), gastritis (19,0%), and hypertension (19,0%). The prevalence of multimorbidity was 26,7%, and 11 cluster combinations were found (34,4%) since the higher score was identified in the aggregation of the five more prevalent diseases. There was an association between the presence of multimorbidity and the sex (the prevalence is 24% smaller for men) and between the presence of multimorbidity and the level of education (the prevalence is 26% higher in people without a college degree). Conclusion: The prevalence of multimorbidity was associated with the female sex and with people without a college degree. Furthermore, an association was observed between the five more prevalent NCDs in this study and the level of education (AU).

The experience of an Academic League: the positive impact on knowledge about trauma and emergency.

OBJECTIVE: to evaluate the knowledge growth of the members of the Trauma, Resuscitation and Emergency League in comparison with a nonparticipating group, with similar characteristics, at the Fluminense Federal University. METHODS: we evaluated 50 league members and 50 non-members (control group) through questionnaires applied at the beginning and end of a school year. We used a generalized linear model, with interaction effect between groups and tests (multiple comparisons with Bonferroni correction). We included the following control variables: gender, period, age, and attendance to some other course on a similar topic. RESULTS: there was an increase of 22 percentage points (p<0.001) for the group with more than 75% presence in the League compared with the eight points in the control group (p<0.05). There was no statistically significant growth for the group with less than 75% presence. CONCLUSION: the growth of knowledge was significantly higher in the group that assiduously participated in the League, which reinforces its importance in complementing the traditional content of medical courses.

Incorrect use of inhalation devices among patients with bronchial asthma. A hospital-based cross-sectional study in Rio de Janeiro, Brazil.

CONTEXT AND OBJECTIVE: Treatment of asthma implies inhalation of specific drugs to reach high concentrations in the respiratory tree and ensure low drug bioavailability and few adverse effects. This study aimed to evaluate the effectiveness of the inhalation technique among outpatients with asthma. DESIGN AND SETTING: Tertiary-care hospital-based cross-sectional study in Rio de Janeiro. METHODS: We evaluated inhalation practices in a convenience sample. A questionnaire was used to investigate sociodemographic data and assess disease control level, duration of use of the inhalation device, length of treatment and previous instructions provided by the prescribing physician. Patients demonstrated their inhalation technique using empty devices, and their technique was considered correct when all steps were appropriately performed or when errors did not interfere with the treatment outcome. RESULTS: Among the 71 participants, 53 (74.7%) had been using the same inhaler device for at least two years and 41 (57.8%) had been under treatment for two years or more. Twelve (17.1%) said that they had been taught once and 57 (81.4%) at least twice, while one (1.4%) reported not having received any guidance regarding use of inhaler devices. Eighteen patients (25.3%) presented controlled asthma and 28 (39.5%) performed the inhalation technique correctly. Incorrect technique was associated with fewer evaluations of the inhalation technique (P =0.04) and uncontrolled asthma (P = 0.01). CONCLUSIONS: Less than half of the sample performed the inhalation technique correctly. Incorrect inhalation technique was related to lower number of evaluations of the use of the inhalation device and uncontrolled asthma.

Enxerto de gordura: lipofragmentado x lipoaspirado / Fat grafting: Lipofragmentation x Liposuction

Introdução: Com o objetivo de obter lipoenxerto autógeno e injetável de tecido ressecado em dermolipectomias, este estudo propõe um novo método para colheita e processamento do tecido adiposo, através de um dispositivo fragmentador específico. O principal objetivo foi estabelecer uma análise comparativa das características de qualidade e viabilidade do novo lipofragmentado em relação ao já conhecido lipoaspirado, amplamente aceito como fonte viável de lipoenxerto. Ensaios in vivo e in vitro foram delineados para avaliar o comportamento biológico das amostras, a fim de orientar novos e possíveis estudos em humanos com aplicações clínicas. Métodos: Uma paciente pós-bariátrica que foi submetida a dermolipectomia abdominal teve sua peça cirúrgica ressecada e dividida em quatro partes que foram submetidas a Lipoaspiração e Lipofragmentação, sem e com infiltração prévia. Todas as amostras foram submetidas a centrifugação e então distribuídas para os ensaios que envolveram avaliação histológica, imunohistoquímica, citometria de fluxo, cultura celular e ainda a injeção de xenoenxerto no dorso de 10 ratos Wistar, retirados após seis semanas para avaliação de massa, volume e características histológicas. Resultados: As amostras de gordura fragmentada, seca e infiltrada, mostraram características estruturais e comportamento biológico semelhantes aos das amostras de lipoaspirado. Conclusões: A fragmentação da gordura transformou o tecido celular subcutâneo das dermolipectomias em uma nova variante de lipoenxerto injetável e viável, com características biológicas semelhantes àquelas do lipoaspirado tradicional. Embora ainda preliminares, nossos resultados embasam a realização de novas investigações buscando otimizar a técnica com vistas ao aprimoramento da enxertia gordurosa e suas possíveis aplicações na medicina regenerativa.

Introduction: Aiming to obtain autogenous and injectable lipografts from resected tissues in dermolipectomies, this study proposes a new method for harvesting and processing adipose tissue through a specific fragmenting device. The main objective was to establish a comparative analysis of the quality and viability characteristics of the new lipofragmentation technique and those of the well-known liposuction technique, widely accepted as a viable source of fat grafting. In vivo and in vitro assays were designed to evaluate the biological behavior of the samples to guide new and possible human studies with clinical applications. Methods: A post-bariatric patient who underwent abdominal dermolipectomy had her surgical specimen resected, which was divided into four parts that underwent liposuction and lipofragmentation, with and without prior infiltration. All samples were centrifuged and distributed for assays with assessments involving histological analysis, immunohistochemistry, flow cytometry, cell culture, and xenograft injection on the back of 10 Wistar rats, which was evaluated after six weeks for mass, volume, and histological features. Results: The structural characteristics and biological behaviors of fragmented, dry, and infiltrated fat samples were similar to those of liposuction samples. Conclusions: Fat fragmentation transformed the subcutaneous cellular tissue of dermolipectomies into a new, viable injectable lipograft variant, with biological characteristics similar to those of traditional liposuction. Although still preliminary, our results support further investigations to optimize the technique and improve fat grafting and its possible applications in regenerative medicine.

Most frequent errors in inhalation technique of patients with asthma treated at a tertiary care hospital / Erros mais frequentes na técnica inalatória de pacientes com asma brônquica em tratamento em hospital terciário

ABSTRACT Objective: To demonstrate the most frequent errors in inhalation technique in patients with asthma undergoing treatment at a tertiary care hospital. Methods: A cross-sectional study with a convenience sample of asthma patients aged 18 years or over, treated at a pulmonology outpatient clinic of a tertiary care hospital. The assessment of inhalation technique of users of the dry powder inhalers Aerolizer®, Aerocaps and Diskus®, or metered-dose inhalers was based on the manufacturer's instructions for use of each inhaler device. Patients demonstrated the inhalation technique with empty inhaler devices, and it was considered correct when all stages were performed properly, or when errors probably did not interfere with the treatment outcome. Results: Among 71 participants, 43 (60.5%) performed inhalation technique incorrectly. Among metered-dose inhalers and dry powder inhalers users, inhalation technique errors were found in 84.2% and 51.9%, respectively (p=0.013). Errors were more frequent at the exhalation stage (67.4%), followed by breathing in (58.1%) and apnea (51.2%). In the group using dry powder inhalers, the most common errors occurred during exhalation and, for those using metered-dose inhalers, the most compromised stage was aspiration. Conclusion: Errors were more frequent among those using metered-dose inhalers compared with dry powder inhalers. Misconceptions are more common at the expiration stage among users of dry powder inhalers and in aspiration among those on metered-dose inhalers.

RESUMO Objetivo: Demonstrar os erros mais frequentes na técnica inalatória de pacientes com asma brônquica em tratamento em hospital terciário. Métodos: Estudo transversal, com amostra de conveniência de pacientes com asma, com 18 anos ou mais, em tratamento em ambulatório de pneumologia de um hospital terciário. A avaliação da técnica inalatória dos usuários dos dispositivos de pó seco Aerolizer ®, Aerocaps® ou Diskus®, ou de aerossóis dosimetrados teve como base as orientações da bula do fabricante de cada dispositivo inalatório. Os pacientes demonstraram a técnica inalatória com dispositivos inalatórios vazios, e ela foi considerada correta quando todas as etapas foram realizadas de forma apropriada, ou quando os equívocos provavelmente não interferiam no resultado do tratamento. Resultados: Entre os 71 participantes, 43 (60,5%) realizaram a técnica inalatória de forma incorreta. Dentre os usuários de aerossóis dosimetrados e dispositivos de pó seco, ocorreram erros de técnica inalatória em 84,2% e 51,9%, respectivamente (p=0,013). Os erros foram mais frequentes na etapa da expiração (67,4%), seguidos da aspiração (58,1%) e da apneia (51,2%). No grupo que usava dispositivos de pó seco, os erros mais comuns aconteceram na expiração e, nos que utilizavam aerossóis dosimetrados, a etapa mais comprometida foi a aspiração. Conclusão: Os erros foram mais frequentes entre os que usavam aerossóis dosimetrados em comparação com dispositivos de pó seco. Os equívocos foram mais comuns na etapa da expiração entre os usuários de dispositivos de pó seco e na aspiração entre os que usavam aerossóis dosimetrados.

De que se trata ser freudiano pela psicanálise lacaniana? Os quatro conceitos fundamentais da psicanálise em Freud e Lacan / What does it mean to be freudian for lacanian psychoanalysis? The four fundamental concepts of psychoanalysis in Freud and in Lacan / ¿Qué es ser freudiano desde el psicoanálisis lacaniano? Los cuatro conceptos fundamentales del psicoanálisis en Freud y en Lacan

O artigo versa sobre os quatros conceitos considerados por Lacan como fundamentais da psicanálise: inconsciente, repetição, transferência e pulsão. Privilegia-se um Lacan menos hermético em seu retorno a Freud, comparando e discutindo o estado da arte dos fundamentos de ambos os autores e com o auxílio de alguns comentadores. O estudo propõe apontar por que estes quatro conceitos foram considerados por Lacan como fundamentais da psicanálise, e como eles foram reposicionados para uma leitura no campo da linguagem, apostando que essas discussões evidenciem as implicações da psicanálise lacaniana sobre a freudiana e vice-versa. Considera-se fundamental o retorno de Lacan a Freud, principalmente no que diz respeito à crítica e aos estudos destes quatro conceitos, a partir dos quais se acredita ser possível compreender a lógica da psicanálise e seu modus operandi.

This article deals with the four concepts considered as fundamental of psychoanalysis by Lacan: unconscious, repetition, transference and drive. It is privileged a less airtight Lacan on his return to Freud, comparing and discussing the state of the art of the elements in both authors, with the aid of some commentators. In addition, the study proposes to discuss the implications of Lacanian on the Freudian psychoanalysis, visiting theoretical and technical points repositioned by Lacan for a reading in the field of language. It is considered fundamental his return to Freud, especially with respect to the criticism and the studies of the four fundamental concepts considered by him, from whom it is believed to be possible to understand the knowledge of psychoanalysis and its modus operandi.

El artículo aborda los cuatro conceptos considerados por Lacan como fundamentales al psicoanálisis: el inconsciente, la repetición, la transferencia y la pulsión. Se busca enfocar en un Lacan menos hermético en su retorno a Freud, comparando y discutiendo el estado del arte en ambos autores y con la ayuda de algunos comentaristas. El estudio propone discutir por qué son importantes estos conceptos en Lacan, y cómo los reposicionan para una lectura en el campo del lenguaje, indicando las implicaciones del psicoanálisis lacaniano sobre el freudiano y viceversa. Se considera como importante su retorno a Freud, especialmente con respecto a la crítica y a los estudios de estos conceptos fundamentales, a partir de ellos se habla de una posibilidad de comprender como operar el conocimiento del psicoanálisis y su modus operandi.

Animal model of rapid crystalloid infusion in rats.

PURPOSE: To describe an animal model of rapid intravenous infusion with different volumes of crystalloid and discuss the clinical findings. METHODS: Fifty six male Wistar rats were used, divided randomly in seven groups (n = 8). The rats of groups 1 to 6 received lactated Ringer's solution intravenously, in the rate of 25 ml/min, with different volumes proportional to blood volume (BV). The rats of group 0 were submitted to the same procedure, but did not receive the fluid (control group). The data included respiratory rate, heart rate, saturation of peripheral oxygen (SpO(2)) in two times (before and after the infusion), and upshots (respiratory arrest and death). Dunnett's test and ANOVA were used. RESULTS: The clinical signs significantly changed in the 2, 2.5 and 3 fold BV groups. The respiratory arrest was observed in the 1.5, 2, 2.5 and 3 fold BV groups, but death was present only in 2.5 and 3 fold BV groups. CONCLUSIONS: The infusion of crystalloid in the same volume of blood volume did not cause significant variation in respiratory and heart rate, saturation of peripheral oxygen and did not induce respiratory arrest. The infusion of a volume of 3 fold blood volume was lethal to all animals.

Incorrect use of inhalation devices among patients with bronchial asthma. A hospital-based cross-sectional study in Rio de Janeiro, Brazil

ABSTRACT CONTEXT AND OBJECTIVE: Treatment of asthma implies inhalation of specific drugs to reach high concentrations in the respiratory tree and ensure low drug bioavailability and few adverse effects. This study aimed to evaluate the effectiveness of the inhalation technique among outpatients with asthma. DESIGN AND SETTING: Tertiary-care hospital-based cross-sectional study in Rio de Janeiro. METHODS: We evaluated inhalation practices in a convenience sample. A questionnaire was used to investigate sociodemographic data and assess disease control level, duration of use of the inhalation device, length of treatment and previous instructions provided by the prescribing physician. Patients demonstrated their inhalation technique using empty devices, and their technique was considered correct when all steps were appropriately performed or when errors did not interfere with the treatment outcome. RESULTS: Among the 71 participants, 53 (74.7%) had been using the same inhaler device for at least two years and 41 (57.8%) had been under treatment for two years or more. Twelve (17.1%) said that they had been taught once and 57 (81.4%) at least twice, while one (1.4%) reported not having received any guidance regarding use of inhaler devices. Eighteen patients (25.3%) presented controlled asthma and 28 (39.5%) performed the inhalation technique correctly. Incorrect technique was associated with fewer evaluations of the inhalation technique (P =0.04) and uncontrolled asthma (P = 0.01). CONCLUSIONS: Less than half of the sample performed the inhalation technique correctly. Incorrect inhalation technique was related to lower number of evaluations of the use of the inhalation device and uncontrolled asthma.

Revisitando a puboplastia pós-bariátrica / Revisiting Postbariatric Monsplasty

INTRODUÇÃO: O tratamento da região pubiana é parte integrante do reajuste corporal inferior nos pacientes pós-bariátricos, tendo em vista a fisiopatologia e o caráter generalizado das deformidades de contorno após grandes emagrecimentos. O objetivo é apresentar nossa experiência no tratamento de pacientes pós-bariátricos, exclusivamente pela marcação baixa da abdominoplastia com vetores adequados de mobilização tecidual, sem a necessidade de cicatrizes verticais ou oblíquas na região do púbis. MÉTODOS: Foram avaliados retrospectivamente prontuários médicos e registros fotográficos de pacientes submetidos a diferentes abordagens abdominais, com aplicação dos princípios descritos acima no tratamento associado da região pubiana. Incisão cutânea anterior baixa, descolamento cranial angulado em direção ao plano aponeurótico (bisel preservando gordura profunda superior), e manutenção um excedente gorduroso nos bordos superiores para a facilitar a fixação dos retalhos através do Sistema Fascial Superficial. Uma avaliação subjetiva da qualidade dos resultados foi caracterizada por observador único. RESULTADOS: Numa casuística de 126 pacientes consecutivos, a tática empregada possibilitou restabelecer a melhor posição, tônus e formato do púbis em 100% dos casos, cujos resultados foram subjetivamente classificados como bom (40%) ou ótimo (60%). As intercorrências mais frequentemente encontradas na evolução pós-operatória foram pequenas deiscências da sutura (23,8%) e seromas (19%), com boa evolução pelos curativos e punções seriadas. CONCLUSÃO: A tática cirúrgica apresentada, com posicionamento baixo da incisão anterior e aproximação dos retalhos por fixação no sistema fascial superficial e pele, possibilita o tratamento adequado da região pubiana durante as abdominoplastias pós-bariátricas, sem a necessidade de ressecções e cicatrizes adicionais.

INTRODUCTION: The treatment of the pubic region is an integral part of lower body readjustment in post-bariatric patients, considering the pathophysiology and generalized characteristics of contour deformities after a considerable weight loss. The objective is to present our experience in the treatment of post-bariatric patients, exclusively by low marking of abdominoplasty with appropriate tissue mobilization vectors, without the necessity to leave vertical or oblique scars in the pubic region. METHODS: The medical and photographic records of patients subjected to different abdominal approaches were retrospectively evaluated, applying the principles described above in the combined treatment of the pubic region. A low anterior skin incision was created, and angled cranial detachment towards the aponeurotic plane (with the bevel preserving the deep upper fat) and maintenance of excess fat on the upper edges to facilitate the fixation of the flaps through the superficial fascial system were performed. The outcomes' quality was subjectively evaluated by a single observer. RESULTS: In the case series of 126 consecutive patients, the strategy used restored the best position, tone, and shape of the pubis in 100% of the cases; the results were subjectively classified as good (40%) or very good (60%). The complications more frequently found in the post-operative period were small suture dehiscence (23.8%) and seroma formation (19%), with good evolution provided by dressings and serial punctures. CONCLUSION: The surgical strategy presented involving low positioning of the anterior incision and flap alignment in the superficial fascial system and skin by fixation allows the proper treatment of the pubic region during post-bariatric abdominoplasty procedures, without the need for additional resections and scars.