Effect of Preoperative Home-Based Exercise Training on Quality of Life After Lung Cancer Surgery: A Multicenter Randomized Controlled Trial.

BACKGROUND: Preoperative exercise training is recommended for improvement of clinical outcomes after lung cancer (LC) surgery. However, its effectiveness in preventing postoperative decline in quality of life (QoL) remains unknown. This study investigated the effect of preoperative home-based exercise training (PHET) on QoL after LC surgery. METHODS: Patients awaiting LC resection were randomized to PHET or a control group (CG). The PHET program combined aerobic and resistance exercise, with weekly telephone supervision. Primary outcome was QoL-assessed with the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire C30 (QLQ-C30) at baseline, before surgery, and 1 month after surgery. The secondary outcomes were hospital length of stay and physical performance. The main analysis included a factorial repeated-measures analysis of variance. Additionally, the proportion of patients experiencing clinical deterioration from baseline to post-surgery was assessed. RESULTS: The study included 41 patients (68.1 ± 9.3 years; 68.3% male) in the intention-to-treat analysis (20 PHET patients, 21 CG patients). A significant group × time interaction was observed for global QoL (p = 0.004). Between-group differences in global QoL were statistically and clinically significant before surgery (mean difference [MD], 13.5 points; 95% confidence interval [CI], 2.4-24.6; p = 0.019) and after surgery (MD, 12.4 points; 95% CI, 1.3-23.4; p = 0.029), favoring PHET. Clinical deterioration of global QoL was reported by 71.4% of the CG patients compared with 30 % of the PHET patients (p = 0.003). Between-group differences in favor of PHET were found in pain and appetite loss as well as in physical, emotional and role functions after surgery (p < 0.05). Compared with CG, PHET was superior in improving preoperative five-times sit-to-stand and postoperative exercise capacity (p < 0.05). No between-group differences in other secondary outcomes were observed. CONCLUSION: The study showed that PHET can effectively prevent the decline in QoL after LC surgery.

Antidepressant-like effect of anacardic acid in mice via the L-arginine-nitric oxide-serotonergic system.

Depression, a multifactorial neuronal disorder with high morbidity/mortality, is associated with psychological, psychosocial, hereditary, and environmental etiologies, where reactive species exert pathophysiological functions. Anacardic acid (AA), a natural compound obtained from cashew nut liquid, has several pharmacological activities, including antioxidant and anticonvulsant. The aim of the present study was to evaluate the antidepressant-like effect of AA and the involvement of serotonergic, noradrenergic, and L-arginine-nitric oxide (NO) in tail suspension and forced swim tests and, more so, to investigate its antioxidant effect in Saccharomyces cerevisiae and in male Swiss mice (n = 8). In order to identify the antidepressant mechanisms, AA (10, 25, or 50 mg/kg, p.o.) was given 30 min before clonidine (2-adrenergic receptor agonist), L-arginine (NO precursor), propranolol (ß-adrenergic receptor antagonist), and several other agonists or antagonists used. On the other hand, clonidine, noradrenoreceptor, noradrenaline, and L-arginine were used to identify the antidepressant mechanisms. Results suggest that AA exerts antidepressant-like activity, especially at higher doses, possibly by inhibiting serotonin and 5HT-1A reuptake receptors and by inhibiting NO synthetase and guanylyl cyclase enzymes. Additionally, AA exhibited antioxidant effect in S. cerevisiae. This antioxidant capacity may be linked to its antidepressant-like effect but does not interact with α- and ß-adrenoceptor receptors. In conclusion, AA may be used as a promising agent to treat depression, especially which arises from oxidative stress.

Anxiolytic effect of anacardic acids from cashew (Anacardium occidentale) nut shell in mice.

Antianxiety drugs currently in use are associated with a number of serious side effects. Present study was designed to evaluate the efficacy of anacardic acids (AAs) isolated from cashew nut (Anacardium occidentale L.) shell liquid (CNSL) to treat anxiety as well as its role in oxidative stress in mice model. Anxiolytic effect of AA was evaluated using rota-rod and a set of behavioral tests in male Swiss albino mice at the doses of 10, 25, and 50 mg/kg. Flumazenil was used to evaluate the possible involvement of GABAergic system in the mechanism of action of AA. The effect of AA on oxidative stress in mice was evaluated by determining the concentration of malondialdehyde (MDA), reduced glutathione, and catalase (CAT) activity. The detection of DNA damage of the treated animals was performed using alkaline comet test in the hippocampus and frontal cortex of the animals. The results demonstrated that AA did not produce myorelaxant and sedative effects, nor did it cause a decrease in locomotor activity. The anxiolytic effect of AA was well-evident in all tests, especially at higher dose levels (25 and 50 mg/mg). Flumazenil reversed the anxiolytic effect of AA at all doses. In addition, AA reduced oxidative stress by decreasing the concentration of MDA and increasing the levels of reduced glutathione (GSH) and CAT activity. Statistical analysis by Pearson's correlation indicated a positive correlation between anxiolytic effect of AA to its antioxidant and lipid peroxidation inhibitory activity. Furthermore, increased CAT activity and GSH concentrations in the hippocampus and frontal cortex of mice was also complementary to the reduced genotoxic damage observed in the study. In comet assay, AA did not increase in DNA damage. In conclusion, the results supported that AA possesses GABAA receptor mediated anxiolytic activity with the lack of myorelaxation and genotoxicity. © 2018 IUBMB Life, 70(5):420-431, 2018.

First chemical constituents from Cordia exaltata Lam and antimicrobial activity of two neolignans.

The phytochemical study of Cordia exaltata Lam. (Boraginaceae) led to the isolation, through chromatographic techniques, of nineteen secondary metabolites: 8,8'dimethyl-3,4,3',4'-dimethylenedioxy-7-oxo-2,7'cyclolignan (1), 8,8'-dimethyl-4,5-dimethoxy-3',4'-methylenodioxy-7-oxo-2,7'cyclolignan (2), sitosterol (3a), stigmasterol (3b), sitosterol-3-O-ß-D-glucopyranoside (4a), stigmasterol-3-O-ß-D-glucopyranoside (4b), phaeophytin A (5), 13²-hydroxyphaeophytin A (6), 17³-ethoxypheophorbide A (7), 13²-hydroxy-17³-ethoxypheophorbide A (8), m-methoxy-p-hydroxybenzaldehyde (9), (E)-7-(3,4-dihydroxyphenyl)-7-propenoic acid (10), 1-benzopyran-2-one (11), 7-hydroxy-1-benzopyran-2-one (12), 2,5-bis-(3',4'-methylenedioxiphenyl)-3,4-dimethyltetrahydrofuran (13), 3,4,5,3',5'-pentamethoxy-1'-allyl-8.O.4'-neolignan (14), 3,5,7,3',4'-pentahydroxyflavonol (15), 5,7-dihydroxy-4'-methoxyflavone (16), 5,8-dihydroxy-7,4'-dimethoxyflavone (17), kaempherol 3-O-ß-D-glucosyl-6''-α-L-ramnopyranoside (18) and kaempherol 3,7-di-O-α-L-ramnopyranoside (19). Their structures were identified by ¹H and ¹³C-NMR using one and two-dimensional techniques. In addition, the antimicrobial activity of compounds 1, 2, 13 and 14 against bacteria and fungi are reported here for the first time.

Home-Based Preoperative Exercise Training for Lung Cancer Patients Undergoing Surgery: A Feasibility Trial.

BACKGROUND: Clinical guidelines recommend prehabilitation with exercise training to optimize recovery after lung cancer surgery. However, the lack of access to facility-based exercise programs is a major barrier to routine participation. This study aimed to assess the feasibility of a home-based exercise intervention before lung cancer resection. METHODS: We conducted a prospective, two-site feasibility study, including patients scheduled for lung cancer surgery. Exercise prescription involved aerobic and resistance training with telephone-based supervision. The primary endpoint was overall feasibility (recruitment rate, retention rate, intervention adherence and acceptability). Secondary endpoints included safety and effects on health-related quality of life (HRQOL) and physical performance, evaluated at baseline, after the exercise intervention and 4-5 weeks after surgery. RESULTS: Over three months, 15 patients were eligible, and all agreed to participate (recruitment rate: 100%). A total of 14 patients completed the exercise intervention, and 12 patients were evaluated postoperatively (retention rate: 80%). The median length of the exercise intervention was 3 weeks. Patients performed an aerobic and resistance training volume higher than prescribed (median adherence rates of 104% and 111%, respectively). A total of nine adverse events occurred during the intervention (Grade 1, n = 8; Grade 2, n = 1), the most common being shoulder pain. After the exercise intervention, significant improvements were observed in the HRQOL summary score (mean difference, 2.9; 95% confidence interval [CI], from 0.9 to 4.8; p = 0.049) and the five-times sit-to-stand test score (median difference, -1.5; 95% CI, from -2.1 to -0.9; p = 0.001). After surgery, no significant effects on HRQOL and physical performance were observed. CONCLUSION: A short-term preoperative home-based exercise intervention is feasible before lung cancer resection and may enhance accessibility to prehabilitation. Clinical effectiveness should be investigated in future studies.

Mediastinal papillary thyroid carcinoma treated by video-assisted thoracic surgery - Case report.

INTRODUCTION AND IMPORTANCE: The mediastinal ectopic thyroid gland is rare and usually asymptomatic. Ectopic thyroid tissue has malignant potential, but ectopic thyroid cancers are extremely rare, particularly mediastinal thyroid cancer, with only five cases reported in the literature. CASE PRESENTATION: A 73 years-old male patient diagnosed with multinodular goitre with two FLUS cytology was summited to an uneventful total thyroidectomy. Pathology revealed 8 synchronous papillary carcinomas in both thyroid lobes. Follow-up identified persistent elevation of thyroglobulin. A cervical ultrasound and cervical and thoracic CT scan were performed, identifying a mediastinal tumour of 6 × 3 cm. Resection was performed by video-assisted thoracic surgery (VATS). Pathology identified an ectopic mediastinal thyroid with a 4 mm papillary microcarcinoma. Recovery was uneventful and the patient is currently asymptomatic. CLINICAL DISCUSSION: There is no consensus on the best treatment strategy for mediastinal ectopic thyroid, but surgical resection is advised as being the only method allowing for a complete cure. Although both thoracotomy and sternotomy approaches have been usually used for mediastinal thyroid tumours resection, the thoracoscopic approach has been used with good results in recent years. Thoracoscopy has better visualization, less morbimortality, and faster recovery. Giant masses (>10 cm) are the only limitation for VATS. CONCLUSION: Ectopic mediastinal thyroid is extremely rare, and its malignant transformation is even rarer. There is no consensus on the best treatment strategy, but surgical resection of the mediastinal thyroid is advised. VATS is a safe and feasible minimally invasive technique with good outcomes.

Insights about levels and source appointment of petroleum hydrocarbons in Brazilian semi-arid coastal: baseline status assessment for ocean decade targets.

The Ocean decade (2021-2030) for sustainable development proclaimed in 2017 by the UN, seeks to promote and conserve the sustainable use of oceans, seas, and marine resources. For this, the distribution of n-alkanes, polycyclic aromatic hydrocarbons (PAHs), and biomarkers, in sediments from the Fortaleza coastal zone (Mucuripe harbor (MH) and Inner Continental shelf (ICS)) were used to assess the impacts of anthropogenic activities in the area. The concentrations of total n-alkanes (Σ16 n-alkanes) in MH and ICS sediments varied from 35.9 to 94.9 and 17.9 to 197.3 µg g-1, respectively, while the isoprenoids phytane and pristane in MH and ICS sediments ranged from 0.1 to 1.69 ug g-1 and from 0.14 and 1.20 µg g-1, respectively. Most of the sediment samples presented carbon preference index (CPI) values close to unity, indicating that the area is submitted to petroleum-related sources. The concentrations of Σ16 PAHs in MH and ICS sediments varied from 87.0 to 562.0 and 98 to 288.0 ng g-1. This work presents the first investigation of the petroleum biomarkers hopanes and steranes in the Fortaleza coastal zone, in which ΣBiomarkers varied from 0.10 to 1.79 and 0.02 to 0.24 ug g-1 in MH and ICS sediments, respectively. The presence at stations of biomarkers also indicates petrogenic input. The diagnosis of the distribution of pollutants in the investigated zones of the Fortaleza coast suggests contamination from urban areas and oil spills and vessel traffic.

Cardiac telerehabilitation in a middle-income country: analysis of adherence, effectiveness and cost through a randomized clinical trial.

BACKGROUND: The benefits of cardiac rehabilitation (CR) are already well established; however, such intervention has been underused, mainly in low- and middle-income countries. AIM: To compare adherence, effectiveness, and cost of a home CR with the traditional CR (TCR) in a middle-income country (MIC). DESIGN: Single-blind randomized control trial. SETTING: A university hospital. POPULATION: Individuals with coronary disease that were eligible were invited to participate. A randomized sample of 51 individuals was selected, where two participants were not included by not meeting inclusion criteria. METHODS: The home-CR group participated in health education activities, carried out two supervised exercise sessions, and was instructed to carry out 58 sessions at home. Weekly telephone calls were made. The TCR group held 24 supervised exercise sessions and were instructed to carry out 36 sessions at home. RESULTS: 49 individuals (42 male, 56.37±10.35years) participated in the study, 23 in the home-CR group and 26 in the TCR group. After the intervention, adherence in the home-CR and TCR groups was 94.18% and 79.08%, respectively, with no significant difference (P=0.191). Both protocols were effective for the other variables, with no differences. The cost per patient for the service was lower in the home-CR (US$ 59.31) than in the TCR group (US$ 135.05). CONCLUSIONS: CR performed at home in an MIC demonstrated similar adherence and effectiveness compared to the TCR program, but with a lower cost for the service. The results corroborate the possibility of using home CR programs, even in MICs, after exercise risk stratification and under remote supervision. CLINICAL REHABILITATION IMPACT: Home-CR can contribute to overcome participants' barriers with compatible cost. Home-CR is effective in improving functional capacity and risk factors control. Perform risk stratification and remote supervision are essential to offer Home-CR.

Effects of Anacardic Acid Monoene on the Respiratory System of Mice Submitted to Acute Respiratory Distress Syndrome.

The acute respiratory distress syndrome caused by viral pathogens is a worldwide public health emergency. It is suggested that patients with this condition should be screened using therapies that address the need to prevent mortality. Anacardic acids found in Anacardium species have biological activities related to the antioxidant capacity of their double bonds in the lateral alkyl chain. The present study seeks to investigate the effects of anacardic acid monoene on acute respiratory distress syndrome caused by lipopolysaccharides. Experiments were carried out on mice divided into three groups: control group, acute respiratory distress-induced group, and anacardic acid monoene pretreated group, subsequently, induced to acute respiratory distress by lipopolysaccharides. Results showed that anacardic acid moeno was able to prevent changes in lung function and preserve its mechanical properties from containing inflammatory cell infiltrate, collapse of alveoli, and decreased airway resistance, suggesting that this compound may be effective in preventing the acute respiratory distress syndrome caused by viral pathogens. Supplementary Information: The online version contains supplementary material available at 10.1007/s43450-021-00151-8.

Bankart lesion repair: biomechanical and anatomical analysis of Mason-Allen and simple sutures in a swine model.

OBJECTIVE: To evaluate the labral height and pullout resistance after the repair of Bankart lesions in the glenohumeral joint of swine models, using double-loaded anchors with two suture configurations: simple and Mason-Allen. METHODS: Ten swine shoulders were used, in which Bankart lesions were created. For each specimen, the lesion was sutured randomly with Mason-Allen sutures or simple sutures. The labral height was measured before the lesion was created and after the labral repair. The specimens were submitted to a tensile test for biomechanical evaluation. RESULTS: In specimens submitted to simple suture (n = 5), the mean labral height observed before the lesion was 3.86 mm, and after suturing, 3.33 mm. In specimens submitted to Mason-Allen suture (n = 5), it was observed that the mean labral height before the lesion was 3.92 mm, and after suturing, 3.48 mm. When comparing the labral height after simple suture and Mason-Allen suture, no significant difference was observed. The pullout force at the end of the tensile test on specimens with single suture was 130 N, and in specimens with Mason-Allen suture, 128.6 N. No statistically significant differences were observed between the shoulders treated with single suture and Mason-Allen suture; p = 0.885. CONCLUSIONS: Repair of Bankart lesions with Mason-Allen suture provides increased labrum height; however, it does not increase the pullout strength.

OBJETIVO: Avaliar a altura labral e a resistência ao arrancamento do reparo da lesão de Bankart em articulação glenoumeral de suínos, com âncoras duplamente carregadas com duas configurações de sutura: simples e tipo Mason-Allen. MÉTODOS: Foram usados dez ombros suínos, nos quais foram criadas as lesões de Bankart. Para cada espécime foi feita a sutura da lesão com suturas tipo Mason-Allen e simples de forma aleatória. A altura labral foi mensurada previamente à confecção da lesão e após o reparo labral. Os espécimes foram submetidos ao ensaio de tração para avaliação biomecânica. RESULTADOS: Nos espécimes submetidos a sutura simples (n = 5), observou-se altura média previamente à confecção da lesão de 3,86 mm e após a sutura, de 3,33 mm. Nos espécimes submetidos a sutura Mason-Allen (n = 5), observou-se que a altura média previamente à confecção da lesão era de 3,92 mm e após a sutura, de 3,48 mm. Ao comparar a altura labral após a sutura simples e Mason-Allen, não foram observadas diferenças significantes. A força de arrancamento no fim do ensaio de tração nos espécimes com sutura simples foi de 130 N e nos espécimes com sutura Mason-Allen, 128,6 N. Não houve diferença estatisticamente significante entre os ombros com suturas simples e Mason-Allen, p = 0,885. CONCLUSÕES: O reparo das lesões de Bankart com sutura Mason-Allen proporciona aumento da altura do labrum, mas não eleva a força de resistência ao arrancamento.

Adherence to heart rate training zones in an exercise training program in adults with coronary artery disease

Objectives: To investigate the effect of exercise intensity on functional capacity in individuals with coronary artery disease, assess adherence to the heart rate training zone (HRTZ), and relationship between trained intensity and functional capacity. Methods: Retrospective study led with medical records of 54 outpatients with coronary artery disease in a public hospital. The prescribed intensity started at 50 ­60% of heart rate reserve, increasing monthly to 70 ­80% by the third month. Spearman's test was used to assess the correlation between improvement in distance in the incremental shuttle walk test (ISWT), exercise intensity, and rating of perceived exertion (Borg­RPE). Adherence was classified as 'below' when HRTZ was not achieved in any phase of the program, 'intermediate' when HR was within the HRTZ for one or two months, and 'above' when HR was at or higher than HRTZ two months. Improvement was tested with t-test and one-way ANOVA. Results: 51.9% of participants had an increase in ISWT of ≥70 m (p < 0.0001). In at least one month, 50.9% trained below HRTZ. Trained intensity did not go below 8.6% of the prescribed minimal threshold of HRTZ. Changes in ISWT were not significantly correlated with exercise intensity (p = 0.87) or Borg­RPE (p = 0.16). Conclusion: While a significant increase in functional capacity was found, considerable heterogeneity in changes were observed. This may, in part, be related to adherence to HRTZ with progressive exercise intensity and to the variability in exercise volume incardiovascular rehabilitation programs.

A canção de si: a música como instrumento de intervenção na clínica do traumático / The song of self: music as an instrument of intervention in trauma clinic / Le chanson de soi: la musique comme instrument d'intervention dans la clinique du traumatisme / La canción de sí mismo: la música como instrumento de intervención en la práctica clínica del trauma

Seguindo a hipótese de que o choque provocado por um acontecimento violento tem o poder de exilar o sujeito do circuito da pulsão invocante, discutimos a contribuição que uma oficina de composição de canções tem a oferecer para a transformação desse impacto traumático em narrativa. A partir da constatação de que a subtaneidade desse inesperado produz um fenômeno típico — o silenciamento do sujeito —, apostamos que nosso dispositivo de intervenção possa vir a possibilitar aos sujeitos afetados por experiências de violência e de desenraizamento, o compartilhamento e a reintegração de suas partes exiladas no momento do traumatismo. Ao final, conclui-se que o papel de passador/espectador exercido pelos próprios participantes, pelas pessoas que circulam pela instituição, ou ainda pelo próprio mediador, faz com que se autentique a voz pulsante daqueles que ali cantam, transformando-os em verdadeiros produtores de prazer.

Following the hypothesis that the shock caused by a violent event may exile the subject from the invoking drive circuit, we discuss the contribution that a songwriting workshop has to offer to transform this traumatic impact into narrative. As we realize that the suddenness of this unexpected event produces a typical phenomenon - the muting of the subject -, we found that our intervention device may allow subjects affected by violent and uprooting experiences to share and reintegrate the parts they exiled during the traumatic event. We conclude that the role of passer-by/spectator played by participants, by the people who circulate in the institution, or still by the mediator himself, makes the pulsating voice of those who sing authentic, transforming them into true producers of pleasure.

En partant de l'hypothèse que le choc provoqué par un événement violent est capable d'exiler le sujet du circuit de la pulsion invocante, nous discutons la contribution qu'un atelier de composition de chansons peut apporter à la transformation de cet impact traumatique en récit. Étant donné que la soudaineté de cet inattendu produit un phénomène typique, le mutisme du sujet, nous misons sur le fait que notre dispositif d'intervention peut permettre aux sujets affectés par des expériences de violence et de déracinement de partager et de réintégrer de ses parties exilées au moment du traumatisme. Nous concluons que le rôle de passeur/spectateur exercé par les participants, par les personnes qui circulent dans l'institution, ou encore par le médiateur, rend authentique la voix palpitante de ceux qui y chantent, les transformant en véritables producteurs de plaisir.

Siguiendo la hipótesis de que la conmoción causada por un evento violento tiene el poder de exiliar al sujeto del circuito de la pulsión invocante, discutimos la contribución de un taller de composición musical a la transformación de este impacto traumático en narrativa. A partir de la constatación de que lo repentino de este suceso inesperado produce un fenómeno típico — el silenciamiento del sujeto —, consideramos que nuestro dispositivo de intervención puede llegar a permitir que los sujetos afectados por experiencias de violencia y desarraigo compartan y reintegren las partes exiliadas en el momento del trauma. Para finalizar, se concluye que el papel de transeúnte/espectador ejercido por los propios participantes, por las personas que circulan en la institución o incluso por el propio mediador, hace que la voz pulsante de quienes cantan allí sea auténtica, transformándolos en verdaderos productores de placer.

Psicanálise com crianças online? Reflexões sobre um atendimento durante a pandemia / ¿Psicoanálisis con niños en línea? Reflexiones sobre la atención durante la pandemia / Psychoanalysis with children online? Reflections on care during the pandemic / Psychanalyse avec les enfants en ligne? Réflexions sur les soins pendant la pandémie

O presente artigo examina as vicissitudes de um atendimento clínico realizado com uma criança durante a pandemia. Trata-se de uma análise conduzida de forma online nos primeiros meses de confinamento, que exigiu do psicanalista algumas invenções táticas que pudessem viabilizar o tratamento. O estabelecimento de um ensino sobre como desenhar olhos, bem como o trabalho com fotografias em movimento (stop motion), surgiram como alternativas para o menino dominar o olhar obsceno do Outro. Ao final, a discussão sobre o modo como se dá o trabalho online nos levou à constatação de que, nele, encontramos a ocorrência de uma espécie de sutura daquilo que em teoria cinematográfica é chamado de campo e contracampo

Este artículo examina las vicisitudes de la atención clínica brindada a un niño durante la pandemia. Se trata de un análisis realizado online en los primeros meses de encierro que requirió algunos inventos psicoanalistas que pudieran hacer factible el tratamiento. El establecimiento de la enseñanza sobre cómo dibujar ojos, así como el trabajo con fotografías en movimiento (stop motion), surgieron como alternativas para que el niño dominara la mirada obscena del Otro. Al final, la discusión sobre la forma en que se desarrolla el trabajo online nos llevó a observar que en ella encontramos la ocurrencia de una especie de sutura de lo que en teoría cinematográfica se llama campo y contracampo

This article examines the vicissitudes of clinical care provided to a child during the pandemic. It is an analysis conducted online in the first few months of confinement that required some psychoanalyst from the psychoanalyst to make the treatment feasible. The establishment of teaching on how to draw eyes, as well as working with moving photographs (stop motion), emerged as alternatives for the boy to master the obscene look of the Other. At the end, the discussion on how to give online work led us to the realization that it found the occurrence of a kind of suture what in film theory is called shot and reverse shot

Cet article examine les vicissitudes des soins cliniques prodigués à un enfant pendant la pandémie. C'est une analyse menée en ligne dans les premiers mois de l'accouchement qui a nécessité des inventions psychanalystes qui pourraient rendre le traitement réalisable. La mise en place d'un enseignement sur la façon de dessiner les yeux, ainsi que le travail avec des photographies en mouvement (stop motion), ont émergé comme des alternatives pour que le garçon maîtrise le regard obscène de l'Autre. Au final, la discussion sur la manière dont s'effectue le travail en ligne nous a conduit au constat qu'on y trouve une sorte de suture de ce qu'on appelle en théorie cinématographique champ et contre-champ

Bronchial schwannoma: a singular lesion as a cause of obstructive pneumonia.

Bronchial schwannomas are very rare pulmonary lesions, but its awareness is important to reach correct diagnosis and decide proper intervention. Clinical and radiological characteristics are mainly unspecific and pathological examination usually provides the definite diagnosis. In small lesions, endoscopic approach may be sufficient, but in large lesions associated with organising pneumonia surgical intervention may be required. Prognosis is typically favourable. We describe a case of a woman, aged 66 years, with productive cough and sporadic haemoptysis, dyspnoea, anorexia, excessive sweating and weight loss with 2 months evolution. CT scan showed a soft tissue dense lesion on the left hilum with 3.75 cm with 18-Fludeoxyglucose uptake. Left upper lobectomy was performed. Gross examination revealed a polypoid mass without necrosis, histologically showing cellular dense (Antoni A) and less dense (Antoni B) areas with Verocay bodies, slightly pleomorphic spindle cells, without mitotic activity and positive for S100 protein on immunohistochemistry.

Simulação clínica para enfrentamento da COVID-19: treinamento complementar de enfermeiros / Clinical simulation to confront COVID-19: complementary training of nurses / Simulación clínica para el afrontamiento del COVID-19: formación complementaria de enfermeros

Objetivo: relatar a experiência da construção e do desenvolvimento da simulação clínica como ferramenta pedagógica para a formação complementar de enfermeiros no enfrentamento à COVID19. Método: trata-se de um estudo qualitativo, descritivo, tipo relato de experiência, de professores do curso de graduação em Enfermagem de uma universidade pública. Utilizou-se, como estratégia de ensino, a simulação clínica realizada durante um curso na qual o estudo de caso serviu como roteiro para o desenvolvimento da experiência. Resultados: notou-se que a construção do cenário realístico e o desenvolvimento da simulação clínica voltados para o atendimento ao paciente com suspeita e/ou quadro confirmado da COVID-19 foram uma estratégia de ensino que favoreceu a interação entre a teoria e a prática, possibilitando um processo de ensino seguro e de qualidade. Conclusão: conclui-se que a simulação clínica facilitou o desenvolvimento do pensamento crítico, da comunicação entre profissional e paciente, das habilidades técnicas, afetivas e psicomotoras e da capacidade de tomadas de decisão, preparando enfermeiros para o atendimento real de pacientes suspeitos e casos confirmados de COVID-19 no Amazonas.(AU)

Objective: report on the experience of building and developing clinical simulation as a pedagogical tool for the complementary training of nurses in the fight against COVID-19. Method: It is a qualitative, descriptive, experience report type study of professors from the Nursing undergraduate course of a public university. As a teaching strategy, the clinical simulation performed during a course in which the case study served as a script for the development of the experience was used. Results: it was noted that the construction of the realistic scenario and the development of clinical simulation aimed at the care of patients with suspicion and/or confirmed COVID-19 status were a teaching strategy that favored the interaction between theory and practice, enabling a safe and quality teaching process. Conclusion: it is concluded that clinical simulation facilitated the development of critical thinking, communication between professional and patient, technical, affective and psychomotor skills and decision-making capacity, preparing nurses for the actual care of suspected patients and confirmed cases of COVID-19 in Amazonas.(AU)

Objetivo: reportar la experiencia de la construcción y desarrollo de la simulación clínica como herramienta pedagógica para la formación complementaria del enfermero en el afrontamiento del COVID-19. Método: se trata de un estudio cualitativo, descriptivo, tipo relato de experiencia realizado por profesores de la carrera de licenciatura en Enfermería de una universidad pública. Como estrategia didáctica, se utilizó la simulación clínica durante un curso en el que el estudio de caso sirvió como guion para el desarrollo de la experiencia. Resultados: se observó que la construcción del escenario realista y el desarrollo de la simulación clínica orientada a asistir a pacientes con condiciones sospechosas y / o confirmadas de COVID-19 fueron una estrategia de enseñanza que favoreció la interacción entre teoría y práctica, posibilitando un proceso de enseñanza seguro y de calidad. Conclusión: se concluye que la simulación clínica facilitó el desarrollo del pensamiento crítico, la comunicación entre el profesional y el paciente, las habilidades técnicas, afectivas y psicomotoras y la capacidad de tomar decisiones, preparando enfermeros para la atención real de los pacientes sospechosos y casos confirmados del COVID-19 en Amazonas.(AU)

Desesperar, jamais: algumas reflexões sobre o trabalho clínico-psicanalítico durante a pandemia / Despair, never: some reflections on clinical-psychoanalytical work during the pandemic / Desesperación, nunca: algunas reflexiones sobre el trabajo clínicopsicoanalítico durante la pandemia / Désespérer, jamais: quelques réflexions à propos du travail clinique psychanalytique pendant la pandémie

RESUMO Apresentamos algumas reflexões sobre o trabalho clínico realizado durante a primeira fase da pandemia de covid-19 no Brasil. Constatamos que a chegada do vírus deflagrou um inesperado que nos colocou em estado de espera. A permanência nesse estado de espera remonta à des-espera, estado no qual o sujeito imerge na obscuridade de uma zona de exclusão figurada pelo intervalo entre o passado e aquilo que ele é no que projeta. Se tomarmos esse des-esperar como marca do sofrimento singular produzido pela impossibilidade de esperar a espera, constataremos que há certas especificidades a serem consideradas nos tratamentos que dirigimos neste período de pandemia. Assim, fazemos algumas considerações sobre os efeitos da fratura espaçotemporal causada pelo acontecimento-pandemia, estabelecendo ao final algumas diretrizes para o manejo do traumático que possa vir a emergir em nosso trabalho clínico neste momento delicado.

ABSTRACT The article presents some reflections on the clinical work during the first phase of the pandemic in Brazil. It is noted that the arrival of covid-19 triggered something unexpected that placed us in a waiting state. The permanence in this waiting state goes back to despair, this state in which the subject immerses himself in the obscurity of a zone of exclusion figured by the interval between the past and what he is in what he projects. If we take this "despair" as a mark of the singular suffering produced by the impossibility of waiting, we will see that there are some specificities to be considered in the treatments we direct in this period of the epidemic. Some considerations about the effects of the space-time fracture caused by the pandemic event are presented. At the end, some guidelines are established for the management of the traumatic event that may emerge in our clinical work at this delicate moment.

RESUMEN El artículo presenta algunas reflexiones sobre el trabajo clínico realizado durante la primera fase de la pandemia en el Brasil. Se observa que la llegada de la covid-19 desencadenó una situación inesperada que nos colocó en estado de espera. La permanencia en este estado de espera se remonta a la desesperación, ese estado en el que el sujeto se sumerge en la oscuridad de una zona de exclusión que figura por el intervalo entre el pasado y lo que es en lo que proyecta. Si tomamos esta "desesperación" como una marca del singular sufrimiento producido por la imposibilidad de esperar, veremos que hay algunas especificidades a considerar en los tratamientos que dirigimos en este periodo de la epidemia. Se presentan algunas consideraciones sobre los efectos de la fractura espacio-temporal causada por el evento pandémico. Al final, se establecen algunas pautas para el manejo del evento traumático que puede surgir en nuestro trabajo clínico en este delicado momento.

RÉSUMÉ Cet article présente quelques réflexions concernant le travail clinique mené pendant la première phase de la pandémie au Brésil. On constate que l'arrivée du covid-19 a provoqué une situation inattendue qui nous a mis en état d'attente. La permanence dans cet état d'attente remonte à « des-espérer ¼, cet état dans lequel le sujet immerge dans l'obscurité d'une zone d'exclusion représentée par l'écart entre le passé et cela qu'il est dans ce qu'il projette. Si nous prenons ce « des-espérer ¼ en tant que marque de la souffrance singulière produite par l'impossibilité d'attendre l'attente, nous constaterons qu'il y a des spécificités à être considérées dans les soins dont nous sommes les responsables dans ce temps d'épidémie. Ainsi, on présente quelques considérations concernant les effets de la fracture espace temporel provoqué par l'évènement pandémie, en établissant, à la fin, certaines directrices qu'envisagent le maniement du traumatique, qui puisse survenir dans notre travail clinique dans ce moment délicat.

Neurotoxicity of "ecstasy" and its metabolites in human dopaminergic differentiated SH-SY5Y cells.

"Ecstasy" (3,4-methylenedioxymethamphetamine or MDMA) is a widely abused recreational drug, reported to produce neurotoxic effects, both in laboratory animals and in humans. MDMA metabolites can be major contributors for MDMA neurotoxicity. This work studied the neurotoxicity of MDMA and its catechol metabolites, α-methyldopamine (α-MeDA) and N-methyl-α-methyldopamine (N-Me-α-MeDA) in human dopaminergic SH-SY5Y cells differentiated with retinoic acid and 12-O-tetradecanoyl-phorbol-13-acetate. Differentiation led to SH-SY5Y neurons with higher ability to accumulate dopamine and higher resistance towards dopamine neurotoxicity. MDMA catechol metabolites were neurotoxic to SH-SY5Y neurons, leading to caspase 3-independent cell death in a concentration- and time-dependent manner. MDMA did not show a concentration- and time-dependent death. Pre-treatment with the antioxidant and glutathione precursor, N-acetylcysteine (NAC), resulted in strong protection against the MDMA metabolites' neurotoxicity. Neither the superoxide radical scavenger, tiron, nor the inhibitor of the dopamine (DA) transporter, GBR 12909, prevented the metabolites' toxicity. Cells exposed to α-MeDA showed an increase in intracellular glutathione (GSH) levels, which, at the 48 h time-point, was not dependent in the activity increase of γ-glutamylcysteine synthetase (γ-GCS), revealing a possible transient effect. Importantly, pre-treatment with buthionine sulfoximine (BSO), an inhibitor of γ-GCS, prevented α-MeDA induced increase in GSH levels, but did not augment this metabolite cytotoxicity. Even so, BSO pre-treatment abolished NAC protective effects against α-MeDA neurotoxicity, which were, at least partially, due to GSH de novo synthesis. Inversely, pre-treatment of cells with BSO augmented N-Me-α-MeDA-induced neurotoxicity, but only slightly affected NAC neuroprotection. In conclusion, MDMA catechol metabolites promote differential toxic effects to differentiated dopaminergic human SH-SY5Y cells.

Bankart lesion repair: biomechanical and anatomical analysis of Mason-Allen and simple sutures in a swine model / Reparo da lesão de Bankart: análise biomecânica e anatômica das suturas tipo Mason-Allen e simples em modelo suíno

ABSTRACT Objective: To evaluate the labral height and pullout resistance after the repair of Bankart lesions in the glenohumeral joint of swine models, using double-loaded anchors with two suture configurations: simple and Mason-Allen. Methods: Ten swine shoulders were used, in which Bankart lesions were created. For each specimen, the lesion was sutured randomly with Mason-Allen sutures or simple sutures. The labral height was measured before the lesion was created and after the labral repair. The specimens were submitted to a tensile test for biomechanical evaluation. Results: In specimens submitted to simple suture (n = 5), the mean labral height observed before the lesion was 3.86 mm, and after suturing, 3.33 mm. In specimens submitted to Mason-Allen suture (n = 5), it was observed that the mean labral height before the lesion was 3.92 mm, and after suturing, 3.48 mm. When comparing the labral height after simple suture and Mason-Allen suture, no significant difference was observed. The pullout force at the end of the tensile test on specimens with single suture was 130 N, and in specimens with Mason-Allen suture, 128.6 N. No statistically significant differences were observed between the shoulders treated with single suture and Mason-Allen suture; p = 0.885. Conclusions: Repair of Bankart lesions with Mason-Allen suture provides increased labrum height; however, it does not increase the pullout strength.

RESUMO Objetivo: Avaliar a altura labral e a resistência ao arrancamento do reparo da lesão de Bankart em articulação glenoumeral de suínos, com âncoras duplamente carregadas com duas configurações de sutura: simples e tipo Mason-Allen. Métodos: Foram usados dez ombros suínos, nos quais foram criadas as lesões de Bankart. Para cada espécime foi feita a sutura da lesão com suturas tipo Mason-Allen e simples de forma aleatória. A altura labral foi mensurada previamente à confecção da lesão e após o reparo labral. Os espécimes foram submetidos ao ensaio de tração para avaliação biomecânica. Resultados: Nos espécimes submetidos a sutura simples (n = 5), observou-se altura média previamente à confecção da lesão de 3,86 mm e após a sutura, de 3,33 mm. Nos espécimes submetidos a sutura Mason-Allen (n = 5), observou-se que a altura média previamente à confecção da lesão era de 3,92 mm e após a sutura, de 3,48 mm. Ao comparar a altura labral após a sutura simples e Mason-Allen, não foram observadas diferenças significantes. A força de arrancamento no fim do ensaio de tração nos espécimes com sutura simples foi de 130 N e nos espécimes com sutura Mason-Allen, 128,6 N. Não houve diferença estatisticamente significante entre os ombros com suturas simples e Mason-Allen, p = 0,885. Conclusões: O reparo das lesões de Bankart com sutura Mason-Allen proporciona aumento da altura do labrum, mas não eleva a força de resistência ao arrancamento.

A arte da fuga: sobre a personalidade reativa e o tratamento psicanalí­tico de um adolescente em crise / The art of escape: on reactive personality and psychoanalytic treatment of an adolescent in crisis / El arte de la fuga: sobre la personalidad reactiva y el tratamiento psicoanalí­tico de un adolescente en crisis

Este trabalho apresenta uma discussão acerca de um caso clínico que interroga a ação do psicanalista perante o processo de crise de um adolescente em condição de abrigamento. O desdobramento do caso pôde, somente a posteriori, levar-nos ao estudo do funcionamento daquilo que Jacques Lacan, em seu seminário A Angústia (1962-1963), chamou de "personalidade reativa". Trata-se, segundo Lacan, não de uma espécie de sujeito, mas sim de uma zona de relação definida por ele como a do acting-out. William recorria exatamente a essa zona como único recurso diante do "não se pode dizer".

This paper presents a discussion about a clinical case that questions the psychoanalyst's action in the crisis process of an adolescent in shelter condition. Only later the case's development was able to lead us to the study of the functioning of what Jacques Lacan called "reactive personality" in his seminar Anxiety (1962-1963). According to Lacan, it is not a kind of subject, but a zone of relation defined by him as acting-out. That zone was the only resource that William had before the "cannot be said".

Este trabajo presenta una discusión acerca de un caso clínico que cuestiona la acción del psicoanalista ante el proceso de crisis de un adolescente en condición de refugio. El despliegue del caso pudo llevarnos, sólo a posteriori, al estudio del funcionamiento de lo que Jacques Lacan, en su seminario La angustia (1962-1963), llamó "personalidad reactiva". Según Lacan, no se trata de una especie de sujeto, sino de una zona de relación definida por él como acting-out. Esa zona era exactamente el único recurso que William poseía ante el "no se puede decir."