Research Progress on Ventricular Arrhythmia Ablation Therapy via Coronary Venous System / 中国循环杂志

Ablation of ventricular arrhythmia originating from the epicardial and intramural sites tends to be challenging in clinical practice.As the reflux system of cardiac blood flow,tributaries of the coronary venous system widely covers the surface and the myocardium tissue of the heart,which could serve as alternative access route for auxiliary mapping and ablation.This review updated the research progress on the novel ablation methods via the coronary venous system.

India-China's Strategic-Contest for Supremacy in Central Asia

There has long been a relationship between India, China, and Central Asia (Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan). The Silk Route served as this triad's conduit to Europe and other western countries historically as well. The major declarations made during the first fictitious India-Central Asia conference under Prime Minister Modi and the competition for the same from his Chinese counterpart show how important Central Asia is to both India and China even now. Even though Central Asian countries and both China and India are members of the S.C.O., there is still a geopolitical struggle and a tremendous game going on. India and China's engagements are still influenced by Afghanistan in distinct ways. This research will discuss the historical and contemporary patterns of Indian and Chinese interactions in Central Asia. By obtaining access to the world's supply systems via Central Asia, it would also draw attention to the struggle for supremacy. As both India and China have enormous production facilities, the huge and untapped market and the availability of raw resources will eventually strengthen these interactions

A escalada neoconservadora e a agenda antigênero: o caso da participação do Brasil na Cúpula Demográfica de Budapeste / Neoconservative escalation and the anti-gender agenda: the case of Brazil's participation in the Budapest Demographic Summit / Escalada neoconservadora y agenda antigénero: el caso de la participación de Brasil en la Cumbre Demográfica de Budapest

Este artigo busca analisar o significado da participação do Brasil na III Cúpula Demográfica de Budapeste. Esse encontro é derivado de uma série de eventos que ocorrem desde 2015, a partir da ascensão do governo de extrema-direita de Viktor Orbán. Com o objetivo de pensar o enfrentamento ao declínio populacional, a partir de estratégias anti-imigração e pró-família, o evento vem se posicionando como um contraponto às conferências da ONU. Enquanto percurso metodológico, partimos de pesquisa on-line e documental no site dos organizadores da cúpula e do governo brasileiro para, posteriormente, utilizarmos a análise crítica do discurso (ACD) para o pronunciamento da ministra Damares Alves durante o evento, com reflexão a partir dos estudos feministas pós-estruturalistas. O que se apura é uma inflexão do Brasil à agenda neoconservadora e antigênero, se associando a países de extrema-direita, fundamentalistas e contrários à defesa de direitos humanos. O discurso proferido instrumentaliza noções demográficas para camuflar suas perspectivas ideológicas em relação ao gênero, emprestando ares de discurso científico aos ataques aos direitos sexuais e reprodutivos e às noções de família não tradicionais.

This article seeks to analyze the significance of Brazil's participation in the 3rd Budapest Demographic Summit. This meeting follows a series of events that have taken place since 2015, through the rise of Viktor Orbán's extreme right-wing administration. Seeking to tackle population decline, based on anti-immigration and pro-family strategies, the event has been positioning itself as a counterpoint to the UN Conferences. To that end, we began an online and documentary research on the website of Summit organizers and the Brazilian government, followed by a Critical Discourse Analysis (ACD) of the speech by Minister Damares Alves during the event, with reflections from post-structuralist feminist studies. A clear inflection to the global neoconservative and anti-gender agenda is observed in Brazil through the association with far-right countries, opposed to the defense of Human Rights, and fundamentalists. The speech included instrumentalized demographic notions used to camouflage ideological perspectives in relation to gender and launch attacks on sexual and reproductive rights and to non-traditional notions of family disguised as scientific discourse.

Este artículo busca analizar el significado de la participación de Brasil en la III Cumbre Demográfica de Budapest. Esta reunión deriva de una serie de eventos que han tenido lugar desde 2015, con el surgimiento del gobierno de extrema derecha de Viktor Orbán. Con el objetivo de pensar en enfrentar el declive de la población, basado en estrategias antiinmigración y profamilia, el evento se ha posicionado como un contrapunto a las conferencias de la ONU. Como camino metodológico, comenzamos con una investigación documental y en línea en el sitio web de los organizadores de la cumbre y del gobierno brasileño, para luego utilizar el análisis crítico del discurso para la declaración de la ministra Damares Alves durante el evento, con la reflexión de los estudios feministas posestructuralistas. Lo que está claro es una inflexión de Brasil hacia la agenda global neoconservadora y antigénero, para la que se asocia con países de extrema derecha, fundamentalistas y opuestos a la defensa de los derechos humanos. El discurso analizado instrumentaliza las nociones demográficas para camuflar sus perspectivas ideológicas en relación con el género, y les da un aire de discurso científico a los ataques a los derechos sexuales y reproductivos y a las nociones no tradicionales de familia.

Highlights from the International Summit on Intellectual Disability and Dementia: implications for Brazil / Síntese da Cúpula Internacional sobre Deficiência Intelectual e Demência: implicações para o Brasil

ABSTRACT In October of 2016, an interdisciplinary group representing North and South American and European countries met in Glasgow, Scotland, to scrutinize universal issues regarding adults with intellectual disability (ID) affected by dementia and to produce recommendations and guidelines for public policy, practice, and further research. The aim of this paper is to apprise relevant outcomes of the Summit targeting Brazilian researchers, clinicians, and nongovernmental organizations in the field of ageing and dementia that are committed to developing the Brazilian national dementia plan. Three core themes were covered by the Summit: i) human rights and personal resources, ii) personalized services and caregiver support, and iii) advocacy and public impact. The exploration of the themes highlighted variations across countries, and revealed consensual views on matters such as international networks, guidance for practices, and advocacy on behalf of both people with ID affected by dementia, and their families. The authors outline the challenges Brazil must confront regarding ageing and dementia and proffer recommendations to address the needs of adults with ID affected by dementia within this scenario; both of which would help in developing the Brazilian national dementia plan.

RESUMO Em outubro de 2016, um grupo interdisciplinar representando países da América do Norte e do Sul, bem como Europeus reuniu-se em Glasgow, na Escócia, para examinar questões relativas aos adultos com deficiência intelectual (DI) afetados por demência e para produzir recomendações e diretrizes referentes às políticas públicas, práticas e pesquisa. O objetivo deste artigo é informar os resultados relevantes da Cúpula aos pesquisadores, clínicos e organizações não-governamentais brasileiras que atuam no campo do envelhecimento e da demência, e estão envolvidos no desenvolvimento do plano nacional de demência. Três temas centrais foram discutidos na Cúpula: i) Direitos humanos e recursos pessoais, ii) Serviços personalizados e apoio aos cuidadores, e iii) Advocacia e impacto público. A exploração dos temas destacou as variações entre os países e revelou visões consensuais em questões como redes internacionais, orientação para práticas e defesa de direitos em nome de pessoas com DI afetadas por demência e suas famílias. Os autores descrevem os desafios que o Brasil deve enfrentar em relação ao envelhecimento e à demência e apresentam recomendações para atender às necessidades de adultos com DI afetados por demência nesse cenário; ambos aspectos contribuem para o desenvolvimento do plano nacional de demência.

Primary Total Hip Arthroplasty Using Summit® Stems in Korean: Minimum Four-year Follow-up / 대한고관절학회지

PURPOSE: The aim of this study was to assess the mid-term results of primary cementless total hip arthroplasty (THA) using Summit® stems. MATERIALS AND METHODS: One hundred twenty-eight arthroplasties in 121 patients who were performed THA from December 2004 to March 2013, were reviewed retrospectively a minimum of 4 years follow-up (mean age, 60.3 years; mean postoperative follow up period, 86.3 months). For a clinical evaluation, the Harris hip score (HHS) was used to assess outcome. Radiographic evaluation was done through spot welds, subsidence, stress shielding, canal filling. RESULTS: The mean HHS was 69.8 points preoperatively, and it improved significantly to 96.3 points at the final follow-up. Postoperatively, 10 patients experienced thigh pain and 7 patients showed a moderate limping gait. There was not only early stem subsidence but there was no more subsidence at last follow up. One hundred eighteen hips showed radiographic signs of stem bone ingrowth, and 10 hips showed fibrous ingrowth at the last follow-up. Stress shielding occurred in 85 hips and third degree stress shielding was observed in 6 hips. Complication arose in 10 hips due to dislocation. Although revisions due to recurrent dislocations led to acetabular component revision in one hip, no revisions arose due to isolated aseptic loosening of the femoral component. CONCLUSION: The clinical and radiological mid-term results of primary THA using Summit® stems revealed solid initial fixation and bone ingrowth stable fixation. Considering the satisfactory clinical results, Summit® stems may be a good treatment option in Korean patients who were required hip arthroplasty

Radiofrequency Ablation of Recurrent Ventricular Premature Complex Originating from near Left Ventricular Summit Guided by Intracardiac Echocardiography

A 40-year-old man presented with frequent ventricular premature complexes (VPCs) and left ventricular systolic dysfunction. He underwent radiofrequency (RF) ablation using a 3-dimensional mapping system; the ablation was performed from both the right and left outflow tract septa. Improvement in symptoms and left ventricular systolic function was noted, but VPCs recurred one month after the procedure, and 24-hour Holter monitoring revealed a VPC burden of 26%. Direct visualization of the anatomical details, catheter contact, and transmural lesion formation by intracardiac echocardiography allowed for successful performance of a redo RF ablation with higher power and longer duration at the previous ablation sites.

Pseudomembranous Colitis: Do We Need A Screening.

In the last few decades, increasing use of antibiotics has dramatically increased incidences of antibiotic associated diarrhea. An unopposed homing of Clostridium difficile in ICU and wards put forward new challenges for physicians. Development of diarrhea during or just after hospital stay especially in old patients is a typical clinical presentation of C. difficile diarrhea. Cytotoxin assay from tissue culture is a gold standard diagnostic test but its poor availability, high cost, time bound results and rapidly development of life-threatening complications made us to think of a screening test. Demonstration of pathognomonic summit lesions and pseudomembrane with colonoscopy or sigmoidoscopy is relatively inexpensive, easily available and diagnosis is prompt. Our experience in few patients with colonoscopy makes us to recommend it as a screening test for all clinically suspected patients. Till today, it is refuted as first-line investigation because of good number of false negative results but demonstration of pathognomonic lesions even in few patients saves the life with minimal expenditure and least time wastage before initiation of definitive treatment.

Comparative Analysis of Two Cementless Stems in Total Hip Arthroplasties in Patients with Osteonecrosis of Femoral Head: Summit(R) Stem and Bencox(R) Stem

PURPOSE: We compared the clinical and radiological outcomes of total hip arthroplasty (THR) using Summit and Bencox stems. MATERIALS AND METHODS: The patients who underwent cementless total hip arthroplasty were recruited with a satisfactory condition of a minimum three years of follow-ups after THR. Those patients were divided into two groups, those with Summit stems and those with Bencox stems. Summit stems were in 36 patients(40 hips), and Bencox stems in 36 patients(48 hips). Summit and Bencox stems had 78 months and 42.2 months as a mean follow-up, respectively. The clinical and radiological evaluations of femoral components were performed. RESULTS: There was no difference in clinical results between the two groups. Under the radiological findings, there were no osteolytic changes or loosening. Osseointegration was detected at an average of 6.4 months(3-12 months) in the Bencox stem on the distal portion of the femoral stem, and cortical hypertrophy was detected on 6 hips with a Summit stem. CONCLUSION: The clinical and radiological evaluations in both systems showed excellent outcomes at the three year follow-ups, and there was no statistical difference on the clinical and radiological results between the two groups. Thigh pain and cortical hypertrophy were not detected in the Bencox stem, and that wound would be caused by surface treatment methods of the femoral stem, and morphological differences.

From Port-of-Spain Summit to United Nations High Level Meeting: CARICOM and the global non-communicable disease agenda / Desde la Cumbre de Puerto España a la Reunión de Alto Nivel de las Naciones Unidas: CARICOM y la agenda global de ENC

The English-speaking Caribbean has the highest per capita burden of chronic non-communicable diseases (CNCDs) in the region of the Americas. Building on a long history of cooperation in health among the Caribbean Community (CARICOM) and past successes in eliminating/reducing communicable diseases through collective action, non-communicable diseases (NCDs) have now been targeted. CARICOM convened a "first-in-the-world" summit of Heads of Government to address NCDs, which generated the Port-of-Spain NCD Summit Declaration, "Uniting to Stop The Epidemic of Chronic Non-communicable Diseases". This 15-point declaration calls on all of government, civil society and the private sector to jointly tackle the common risk factors for the major chronic diseases, and improve the care of such diseases. Implementation of this declaration has been mixed, being most successful where there were regional supports, and in countries with populations > 250 000 reflecting country capacity. CARICOM has elevated this approach to the global level through successful advocacy for a United Nations High Level Meeting on NCDs to be convened in September 2011. Jamaica will be one of two co-facilitators of this meeting, a reflection of the role of CARICOM countries in advancing the NCD agenda at the global level. CARICOM Heads of Government should attend this meeting, showcase the implementation of the NCD Summit Declaration in the Caribbean, commit to enhancing systems and resources, endorse and implement the commitments made and identify and support leadership for sustained action and accountability for these initiatives.

El Caribe anglófono tiene la carga per cápita más alta de enfermedades no comunicables crónicas (ENCs) en la región de las Américas. Como continuación de una larga historia de cooperación en materias de salud en la Comunidad caribeña (CARICOM) y éxitos pasados en la eliminación/reducción de las enfermedades comunicativas a través de acciones colectivas, las ENCs se han colocado ahora en el centro de la atención. CARICOM convocó a la primera cumbre mundial de Jefes de Gobierno para abordar el problema de las ENCs, y en la cual se produjo la declaración de la Cumbre de Puerto Príncipe sobre ENC: "Unidos para detener la epidemia de las enfermedades no comunicables crónicas". Esta declaración de 15 puntos, hace un llamado a todos los gobiernos, la sociedad civil y el sector privado, a abordar el problema de los factores de riesgo comunes de las principales enfermedades crónicas. La implementación de esta declaración de lucha contra las ENCs ha tomado diversas formas, y ha tenido mayor éxito allí donde ha habido apoyo regional, y en los países con poblaciones > 250 000 reflejo de la capacidad del país. CARICOM ha elevado este enfoque a nivel global abogando exitosamente por una Reunión de Alto Nivel de las Naciones Unidas sobre ENCs a celebrarse en septiembre de 2011. Jamaica ocupará una de las dos presidencias de esta reunión, lo cual refleja el papel de los países del CARICOM en el progreso de la agenda de ENC a nivel global. Los Jefes de Gobierno de CARICOM deben asistir a esta reunión, mostrar la implementación de la Declaración de la Cumbre sobre ENC, comprometerse a mejorar los sistemas y recursos, refrendar e implementar los compromisos hechos, e identificar y apoyar el liderazgo a fin de lograr una acción sostenida y responsabilidad ante estas iniciativas.

Cementless Total Hip Arthroplasty using Ceramic-on-ceramic Summit(R) System: 3 years follow up

PURPOSE: To prospectively evaluate the 3 years follow up clinical and radiographic results of uncemented total hip arthroplasty using the Summit(R) system with ceramic-on-ceramic articulation. MATERIALS AND METHODS: From January 2001 to December 2001, thirty-one primary total hip arthroplasties were performed on thirty-one patients using the Summit(R) system. The mean follow-up period was 3.3 years. The preoperative diagnoses were degenerative osteoarthritis in 18 cases, avascular necrosis in 10 cases, and a femoral neck fracture in 3 cases. The mean age at surgery was 67.4 years. The clinical results were evaluated using the Harris hip score. The radiographic evaluation was performed to determine the stability of the components, the prevalence of osteolysis and the amount of wear. RESULTS: The mean Harris hip score improved from 64.7 points preoperatively to 90.4 points at the most recent follow-up. The complications included two cases of dislocation, three cases of limping gait lasting for 1 year after surgery. Fixation by bone ingrowth was noted in all cases and there was no case of migration of the acetabular cup and osteolysis. There was no case in the varus position, sinking down, or a loosening of the femoral stem. On the final observation after surgery, the range of hip joint motion showed flexion of 120.7degreeson average (110degrees~150degrees), extension of 5degrees(0degrees~10degrees), internal rotation of 20.3degrees(15degrees~25degrees), external rotation of 33.7degrees(20degrees~40degrees), abduction of 29.4degrees(20degrees~40degrees), and adduction of 19.5degrees(15degrees~25degrees). CONCLUSION: Uncemented total hip arthroplasty using the Summit(R) system with ceramic-on-ceramic articulation showed excellent clinical and radiographic results in the range of motion and function.

Retrospectiva da cúpla de edimburgo: subsídios para a educação médica

Resumo: Um critério transcendente da qualidade da educação médica é a formação de profissionais competentes e aptos a responder às necessidades de saúde da sociedade como um todo. Nessa perspectiva, o artigo sintetiza os subsídios resultantes da Cúpula Mundial sobre educação médica, em Edimburgo -1993. Esses elementos são relacionados aos desafios correntes e a quatro estratégias globais de reorientação, as quais têm em comum tal critério de qualidade.

Summary: A transcendent criterium of quality in medical education is the training of competent professionals who are responsive to the health need of society as a whole. In this respect, the article synthesizes the propositions that resulted from the World Summit on Medical Education at Edinburgh. It relates such propositions with the current challenges facing the medical schools ant the global strategies for reorientation of medical education that have such a quality criterium in common.