Use of Proton Pump Inhibitors Is Not Associated with Post-Dialysis Fatigue and Time of Recovery after Dialysis in Patients on Maintenance Hemodialysis.

Objectives: To define if the use of proton pump inhibitors (PPI) is associated with PDF prevalence and characteristics and with time of recovery after dialysis in patients on maintenance hemodialysis. Methods: Patients were defined as experiencing PDF if they spontaneously offered this complaint when asked the open-ended question: "Do you feel fatigued after dialysis?". Time of recovery after dialysis (TIRD) was also assessed for each patient. Each patient was invited to rate the intensity, duration and frequency of PDF from 1 to 5. We defined if patients used PPI (no PPI use or PPI use), the type of used PPI, the dose of used PPI, and the duration of the use of PPI (<1 year or ≥1 year). Results: A total of 346 patients were studied: 259 used PPI (55 used omeprazole, 63 esomeprazole, 54 pantoprazole, 87 lansoprazole, and 7 rabeprazole) and 87 did not. Two hundred and thirty-two patients declared PDF and 114 did not. The median [min-max] TIRD was 210 min [0-1440]. The prevalence of PDF in PPI users and PPI non-users was 67% and 68%, respectively (p = 0.878). The median [min-max] TIRD did not differ significantly between PPI users and PPI non-users (180 [0-1440] and 240 [0-1440], respectively; p = 0.871). Median PDF intensity, duration, frequency, and severity did not differ significantly between PPI use and no use. The prevalence of PDF was similar among the different types of PPI use and did not differ with respect to PPI non-users. Duration of PPI exposure was <1 year in 40 patients and ≥1 year in 219 patients. The prevalence of PDF did not differ between the two exposures. The correlation matrix between PPI equivalent dose, PPI treatment duration and PDF frequency, PDF characteristics, and TIRD showed whether there was statistical significance. Conclusions: The use of PPI is not associated with PDF and time of recovery after dialysis in patients on maintenance hemodialysis.

Entero-Cutaneous and Entero-Atmospheric Fistulas: Insights into Management Using Negative Pressure Wound Therapy.

Enteric fistulas are a common problem in gastrointestinal tract surgery and remain associated with significant mortality rates, due to complications such as sepsis, malnutrition, and electrolyte imbalance. The increasingly widespread use of open abdomen techniques for the initial treatment of abdominal sepsis and trauma has led to the observation of so-called entero-atmospheric fistulas. Because of their clinical complexity, the proper management of enteric fistula requires a multidisciplinary team. The main goal of the treatment is the closure of enteric fistula, but also mortality reduction and improvement of patients' quality of life are fundamental. Successful management of patients with enteric fistula requires the establishment of controlled drainage, management of sepsis, prevention of fluid and electrolyte depletion, protection of the skin, and provision of adequate nutrition. Many of these fistulas will heal spontaneously within 4 to 6 weeks of conservative management. If closure is not accomplished after this time point, surgery is indicated. Despite advances in perioperative care and nutritional support, the mortality remains in the range of 15 to 30%. In more recent years, the use of negative pressure wound therapy for the resolution of enteric fistulas improved the outcomes, so patients can be successfully treated with a non-operative approach. In this review, our intent is to highlight the most important aspects of negative pressure wound therapy in the treatment of patients with enterocutaneous or entero-atmospheric fistulas.

Potential of ash from agricultural waste as substitute of commercial FeCl3 in primary treatment of landfill leachate.

Due to the ever increasing global population, higher volumes of industrial waste discharges to landfill have caused major problems for the environment. This study investigated the performance of rice straw ash (RSA) as a natural coagulant under different conditions for the treatment of landfill leachates by coagulation-flocculation and microfiltration, with and without addition of FeCl3. The highest performing treatment conditions (RSA = 2.48 g/L, FeCl3 = 4.98 g/L, settling time = 54.75min) were achieved with the combined use of RSA and FeCl3 as coagulant and led to a sludge volume index of 41.65 mL/g, 51.27% COD removal and 76.48% total suspended solid removal. In contrast, FeCl3 alone achieved slightly better COD and total suspended solid removal rates, however it resulted in higher sludge volume index and sludge production. The combined use of RSA and FeCl3 reduced the consumption of these two coagulants by 78.76% and 46.69% respectively. Functional groups and thermal stability of the flocs showed that RSA + FeCl3 synergistically enhance the mechanisms of the coagulation-flocculation process, including adsorption by particle's bridging, charge neutralization and size of flocs. Combining the coagulants resulted in increased van der Waals forces and lower attractive forces of the inter-colloidal energy barrier in the leachate. Additionally, the highest and lowest heavy metals removal rates for treatment by microfiltration were found for Fe (92.15%) and Mg (7.63%), with a total heavy metals removal efficiency in the range of 6.08-90.78%. The findings of this study show that RSA can serve as a natural eco-friendly coagulant both alone and in combination with FeCl3 in the leachate treatment.

Evaluation of combined thermo-chemical processes for the treatment of landfill leachate using virgin and recovered FeCl3 coagulants.

Sludge resulting from treatment of municipal waste landfill leachate contains suitable cationic substances such as Fe-based recovered coagulants which, if not recovered, can cause environmental problems. The present study aimed to maximise coagulant recoverability and investigate its potential reuse for the treatment of municipal waste landfill leachate. The study focused on establishing (i) the effect of mineral acids on leaching of Fe, (ii) the % of maximum recovery of Fe coagulant, (iii) the impact of ultrasound on recovery, and (iv) effectiveness of recovered coagulant when reused in coagulation-flocculation treatment of landfill leachate. Sulfuric acid outran hydrochloric acid in performance, with the acid leaching process leading to the recovery of 70.12% of Fe (acid concentration = 3.80 M, solid-to-liquid ratio = 8%, and heating time = 5 h). Subsequently, a developed acid leaching process was tested, which results showed that the highest rate of Fe recovery occurred without ultrasound treatment, meaning the use of it could reduce the recovery rate due to the increase in the iron (III) oxide-hydroxide [Fe(OH)3] sedimentation. Comparative experiments were undertaken with the recovered and virgin coagulants. These revealed that Fe-based recovered coagulant led to the 60.21% and 91.40% removal of COD and total suspended solid respectively, while the values of the COD and total suspended solid removal with the virgin FeCl3 were 7.66% and 6.42% lower than that of Fe under optimal conditions (dosage = 9.38 g/L, pH = 8.94, settling time = 52.9 min). The present study established that Fe recovered could be exploited as an eco-friendly coagulant to replace FeCl3 in the landfill leachate treatment.

Adaptive Refurbishment for Aging in Place: Design Scenarios of Case Studies in Turin, Italy.

The "aging" world implies a rethinking of housing models, to meet the needs of the elderly for physical and mental well-being, independence, social interaction, safety, and accessibility. "Aging in place" is recognized by experts and international literature as a fundamental strategy for maintaining conditions of well-being and reducing public spending on health care. However, often the houses do not have the requirements to easily adapt to the needs that change with aging and possible downsizing of the family unit. For the elderly, maintaining their own home can become unsustainable due to problems of costs, oversizing, physical and perceptual accessibility, and safety. The contribution, taking as a case study the residential building heritage of Turin (Italy), illustrates and critically compares scenarios of adaptive recovery of homes to make them suitable for the needs of the elderly, intending to promote "aging in place" and housing adaptive refurbishment as a sustainable strategy.

Towards monitoring biodegradation of starch-based bioplastic in anaerobic condition: Finding a proper kinetic model.

Bioplastic biodegradation showed varying behavior during the process of biodegradation. The First-order and Gompertz models are the most prevalent models for monitoring biodegradation in an anaerobic digestion (AD) process, which do not suit adequately bioplastics fermentation modeling. This research aimed at studying the kinetics of methane production during AD of starch-based bioplastic by using a large library of non-linear regressions (NLRs) and an artificial neural network (ANN). Although 26 NLR models (25 were outlined in the AD literature + 1 modified by authors) have been analyzed, 9 of them were proper predictors for the whole AD process for methane production. In the end M9, which has been proposed by authors, was selected owing to the simplicity of regression as well as good statistical criteria. Moreover, MLP-ANN could outperform the NLR model and has been selected as the superior model that can define the kinetics of bioplastic AD.

Systematic review of transanal total mesorectal excision literature according to the ideal framework: The evolution never ends.

BACKGROUND: Designing studies to assess critically novel procedures can be challenging; thus, the process to achieve robust evidence is frequently problematic. The aim of this systematic review was to evaluate if literature on transanal total mesorectal excision is evolving according to the Idea, Development, Exploration, Assessment, and Long-term results framework. METHODS: Literature on transanal total mesorectal excision was searched according to the preferred reporting items for systematic reviews and meta-analyses statement, and these variables were recorded: bibliometric data, design, corresponding author's nationality, number of patients enrolled, and Idea, Development, Exploration, Assessment, and Long-term results stages (stage 0, stage 1, stage 2, stage 3, and stage 4). RESULTS: Out of 447 articles retrieved, 247 were selected (76.5% single center and 23.5% multicenter collaborations), including 35 reviews, 15 meta-analyses, 24 other publications, and 173 articles classified according to Idea, Development, Exploration, Assessment, and Long-term results stages (19 stage 0, 27 stage 1, 111 stage 2, 7 stage 3, and 9 stage 4). Overall, impact factor produced was 634.10. Reviewing corresponding authors' nationalities, 32 countries were identified, with the United States, China, and the United Kingdom the most reported; nearly all were from the Northern Hemisphere. Publication of stage 3 and 4 articles started in 2014, whereas stage 0 and 1 articles were stably published over time. The number of patients increased in correspondence with the Idea, Development, Exploration, Assessment, and Long-term results stages (case series with >51 patients, respectively, 100.0% stage 3, 77.8% stage 4, and 33.3% stage 2, P = .005). CONCLUSION: The number of stage 3 and 4 articles is still low; however, the technical innovation of transanal total mesorectal excision is a non-stop process with preclinical studies stably published over time.

Loucura e direito penal: pistas para a extinção dos manicômios judiciários / Madness and criminal law: clues to the extinction of judicial asylums

RESUMO As interfaces entre a loucura e o direito penal, com a análise das medidas de segurança diante da Lei Antimanicomial e das políticas de atenção à saúde mental no Brasil, assim como a experiência do Programa de Atenção Integral ao Louco Infrator (Paili), integram os planos de desenvolvimento deste artigo. Discutem-se aqui o tratamento penal da loucura, a natureza jurídica e os fundamentos teóricos das medidas de segurança, bases a partir das quais são formuladas pistas que se voltam para o fechamento dos manicômios judiciários.

ABSTRACT The interfaces between madness and criminal law, with the analysis of security measures under the Antimanicomial Law and the mental health care policies in Brazil, as well as the experience of the Crazy Infractor Integral Care Program (Paili), make up the development plans of this work. This article discusses the criminal treatment of madness, the legal nature and the theoretical foundations of security measures, the basis on which clues are formulated that focus on the closing of judicial asylums.

O analista está presente: performance e clínica / The analyst is present: performance and clinic

O que pode a clínica? O que pode a arte? Qual a potência presente nesses domínios? Em que ponto a arte e a clínica se transversalizam, ou seja, em que ponto comungam? Este artigo tem estas questões como direção e busca respondê-las a partir de uma aposta na abordagem transdisciplinar da clínica. Transdisciplinaridade compreendida como contágio entre diferentes disciplinas, como experimentação das interferências que um domínio pode produzir sobre outro. A performance "A artista está presente" de Marina Abramovic é tomada neste artigo como canal de expressão para a arte do encontro entre analista e paciente, encontro produtor de novas possibilidades de vida. O trabalho da artista sérvia, preocupada com o que se passa entre artista e público, nos permite problematizar o que se passa entre analista e paciente e, para tanto, desenvolvemos o conceito de Presença, certa partilha afetiva que pode se dar no encontro com o outro.(AU)

What can clinic do? What can art do? What is the power present in these areas? At what point art and clinic find a mainstream, that is, at what point do they commune? This essay has those questions as a direction and seeks to answer them based on a focus on a transdisciplinary approach to clinic. Transdisciplinarity understood as a contagion between different disciplines, as an experimentation on the interferences one domain can perform upon the other. The performance "The artist is present" of Marina Abramovic is taken in this article as an expression channel through the art of the analyst and patient encounter. A life-changing encounter. The work of this Serbian artist, worried about what goes on between the artist and the public allow us to problematize what goes on between the analyst and the patient, therefore developing the concept of the Presence, one affection share that can befall the encounter with the other.(AU)

Successful recovery from COVID-19 pneumonia after receiving baricitinib, tocilizumab, and remdesivir. A case report: Review of treatments and clinical role of computed tomography analysis.

The novel coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a pandemic, threatening global public health. In the current paper, we describe our successful treatment of one COVID-19 pneumonia patient case with high mortality risk factors. Our experience underlines the importance of the use of a multidisciplinary therapeutic approach in order to achieve a favorable clinical outcome. Further, enhancing the capability of the COVID-19 diagnosis with the use of the chest imaging modalities is discussed.

Endocrine surgery during COVID-19 pandemic: do we need an update of indications in Italy?

The ongoing spread of the coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) poses a significant threat to global health. As the coronavirus outbreak began spreading, hospitals were forced to relocate resources to treat the growing number of COVID-19 patients. As a consequence, doctors across the country canceled tens of thousands of nonurgent surgeries. However, recognizing that the COVID-19 situation may be highly variable and fluid in different communities across the country, elective surgery could be still allowed in some centers for patients included in the high-priority class. The majority of endocrine disorders requiring surgical treatment in patients identifiable as first-priority class, or needing hospitalization within 30 days, are generally represented by malignant thyroid tumors, hyperthyroidism, hyperparathyroidism, and some adrenal disorders. The need for urgent intervention is evaluated on a case-by-case basis according to the severity of the symptoms, the likelihood of progression, and global clinical judgment. On the basis of the above indications, during the last 4 weeks, we performed 18 planned surgical treatments in patients with thyroid cancer (total thyroidectomies, plus lymph node dissection if needed) or multinodular toxic goiter. In no case, postoperative ventilatory support was needed, and the average hospital stay was 3 days. The negative COVID-19 status for all the treated patients was appropriately evaluated beforehand. Nobody knows how long the current COVID-19 pandemic will be lasting. Certainly, we will be requested in the next future to incrementally offer surgical services for endocrine disorders that have been deferred for the COVID-19 pandemic.

Pulmonary embolism: a retrospective comparative study between patients with atypical vs typical clinical presentation

Background: Natural history and outcomes of patients with pulmonary embolism (PE) without typical symptoms (atypical PE) remain unclear. The aim of the study is to compare the clinical characteristics and the prognosis between typical PE and atypical PE. Methods: We retrospectively analyzed data from consecutive patients admitted to the Emergency Department (ED) because of a diagnosis of PE and classified them in two groups: typical PE and atypical PE. We defined PE to be typical in presence of almost one of the following symptoms or signs: dyspnea, chest pain, hemoptysis or signs of deep vein thrombosis. Results: Of the 191 patients with PE, 154 (81%) had typical PE and 37 (19%) had atypical PE. Patients with atypical and typical PE seemed to had similar prognostic factor such as high risk sPESI (73% vs 65%, p=0.3), right ventricular dysfunction (30% vs 26%, p=0.6) and central PE at chest CT scan (38% vs 36%, p=0.8). The rate of 30 day mortality was 7% in the typical group and 8% in the atypical group (p=0.8). The length of stay in hospital was the same in the two groups (6 days; p=0.2). Conclusions: We found that atypical and typical PE seem to be related diseases with a similar short term prognosis. Therefore, we could speculate that a missed diagnosis of PE in ED could expose the patients to a worsen prognosis. Further perspective studies are required for better investigate this diagnostic challenge.

Improving the quality of clinical research on chronic wound infection treatment: expert-based recommendations.

OBJECTIVE:: To produce recommendations for the design of reliable and informative clinical investigations in chronic wound infection. METHOD:: A multidisciplinary panel of international experts from four countries (Italy, UK, Ireland and the US) were involved in a detailed, semi-structured discussion on how to better select and describe a target population, interventions and outcomes, and which infection-related criteria to apply in order to achieve a high-quality trial. Consent among the experts was measured using the Delphi method and GRADE Working Group suggestions. The project was fully supported by AISLeC 2016 (Italian Nursing Society for Wound Care Study). RESULTS:: In total, 37 recommendations achieved substantial agreement among the experts; 10 concerned the most appropriate description and selection of a target population, four related to interventions and 15 to outcomes. A further eight statements about critical methodological points were approved. CONCLUSION:: Developing recommendations in a systematic manner through a representative group of experts could generate tools for improving the design of clinical trials in this challenging area.

An Early Tailored Approach Is the Key to Effective Rehabilitation in the Intensive Care Unit.

OBJECTIVE: To investigate the effectiveness, feasibility, and safety of an evidence-based rehabilitation care pathway in the intensive care unit (ICU) in different patient populations. DESIGN: Observational prospective cohort study, with retrospective controls. SETTING: ICUs of a university hospital. PARTICIPANTS: Patients admitted between April 1, 2015, and June 30, 2015, were compared to a retrospective cohort admitted to the same ICUs during the same 3-month period in 2014. The number of patients studied (N=285) included 152 in the prospective group and 133 in the retrospective group. INTERVENTIONS: The prospective cohort benefited of a rehabilitation care pathway based on (1) interdisciplinary teamwork; (2) early customized and goal-oriented rehabilitation; (3) daily functional monitoring and treatment revision; (4) agreed discharge policy; and (5) continuity of care. The retrospective cohort underwent usual care. MAIN OUTCOME MEASURES: Included the following: (1) proportions of patients undergoing rehabilitation team evaluation; (2) latency between patient admission to ICUs and rehabilitation team assessment; (3) proportions of patients undergoing rehabilitation treatment during ICU stay; (4) latency between the patient admission to ICUs and rehabilitation start; (5) ICU stay and total acute hospital stay; and (5) proportion of ventilator-free days out of ICU stay. RESULTS: The novel rehabilitation care pathway led to (1) an increased proportion of patients receiving rehabilitative assessment (P<.0001); (2) a decreased latency from ICU admission to both rehabilitation team assessment and rehabilitation start (P<.0001); (3) an increased proportion of patients undergoing rehabilitation (P<.0001); (4) a shorter length of stay in ICUs (P<.0001) and in hospital (P=.047); and (5) a shorter mechanical ventilation duration (P<.02). A direct relationship between rehabilitation start latency and ICU length of stay was observed. CONCLUSIONS: An early, interdisciplinary team approach, providing a customized dynamic planning of physiotherapy programs, increases ventilator-free time and reduces total hospital stay, especially in patients admitted to the ICU after general surgery. This rehabilitation care pathway can be generalized to different geopolitical scenarios, being feasible, safe and cost effective.

Heat-Transfer Method: A Thermal Analysis Technique for the Real-Time Monitoring of Staphylococcus aureus Growth in Buffered Solutions and Digestate Samples.

The identification and quantification of microorganisms in water samples are crucial to improve processes in organic waste treatment facilities. Most of the currently available tests are either labor intense or costly, and they do not allow determination of the dynamics within microbial communities in digestate samples. This study is the first report on the use of thermal analysis, specifically the heat transfer method (HTM), to monitor microbial load in aqueous systems and digestate samples. Staphylococcus aureus was used as a model organism, and different concentrations in water were measured by the HTM. It was demonstrated that there was a positive correlation between the thermal resistance and concentration of the bacterial cells. Subsequently, the influence of temperature on growth rates was studied and confirmed by plating experiments and scanning electron microscopy (SEM). These results showed the possibility to monitor the temperature-dependent growth of S. aureus using the HTM. To determine if this technique can be applied for studying complex matrices, digestate samples were collected from a number of sources and plated on nutrient agar plates. The bacterial cultures derived from single colonies were characterized and identified by sequencing of DNA regions for 16S rRNA. HTM measurements were performed in diluted or centrifuged digestate samples that were enriched with S. aureus. The results indicated that it is possible to evaluate microbial load even in samples containing other organic material. The thermal analysis method has the potential to provide a low-cost monitoring option, which is simple to use and provides real-time analysis, thus improving the existing monitoring procedures in organic waste treatment facilities.

Valorisation to biogas of macroalgal waste streams: a circular approach to bioproducts and bioenergy in Ireland.

Seaweeds (macroalgae) have been recently attracting more and more interest as a third generation feedstock for bioenergy and biofuels. However, several barriers impede the deployment of competitive seaweed-based energy. The high cost associated to seaweed farming and harvesting, as well as their seasonal availability and biochemical composition currently make macroalgae exploitation too expensive for energy production only. Recent studies have indicated a possible solution to aforementioned challenges may lay in seaweed integrated biorefinery, in which a bioenergy and/or biofuel production step ends an extractions cascade of high-value bioproducts. This results in the double benefit of producing renewable energy while adopting a zero waste approach, as fostered by recent EU societal challenges within the context of the Circular Economy development. This study investigates the biogas potential of residues from six indigenous Irish seaweed species while discussing related issues experienced during fermentation. It was found that Laminaria and Fucus spp. are the most promising seaweed species for biogas production following biorefinery extractions producing 187-195 mL CH4 gVS-1 and about 100 mL CH4 gVS-1 , respectively, exhibiting overall actual yields close to raw un-extracted seaweed.

Consensus recommendations for improvement of unmet clinical needs--the example of chronic graft-versus-host disease: a systematic review and meta-analysis.

BACKGROUND: Consensus recommendations are used to improve the methodology of research about rare disorders, but their uptake is unknown. We studied the uptake of consensus recommendations in steroid-refractory chronic graft-versus-host disease (SR-cGVHD). Although in 2006 the National Institutes of Health (NIH) cGVHD consensus project produced recommendations for clinical trials, guidelines have emphasised the scarcity of valuable evidence for all tested interventions. METHODS: We searched Medline (PubMed) between Jan 1, 1998, and Oct 1, 2013, for non-randomised studies of systemic treatment for SR-cGVHD. To measure adherence to NIH recommendations, we applied a 61 item checklist derived from the NIH consensus document. We did a meta-analysis to measure pooled effect size for overall response rate (ORR) and meta-regression analyses to measure the effect of deviations from NIH recommendations on pooled effect size. FINDINGS: We included 82 studies related to nine interventions. Conformity to NIH recommendations was evenly low across the analysed timeframe (1998-2013), and did not change significantly after publication of NIH recommendations. The pooled effect size for ORR for systemic treatment of SR-cGVHD was 0.66 (95% CI 0.62-0.70). Increased adherence to NIH recommendations in a score of items defining correct response assessment was associated with a significant reduction in ORR (-4.2%, 95% CI -6.6 to -1.9; p=0.001). We recorded no significant association between ORR and sets of items related to correct diagnostic definition of SR-cGVHD (change in ORR -3.1%, 95% CI -7.7 to 1.5), specification of primary intervention (0, -3.8 to 3.6), or concomitant treatments (-1.6%, -5.4 to 2.3). The score of items defining correct response assessment increased after publication of NIH recommendations. INTERPRETATION: Our findings show evidence of bias in the reported efficacy of treatment of SR-cGVHD. The overall effect of NIH recommendations in scientific literature is scarce; however, NIH recommendations improved assessment of response, possibly reducing the overestimation bias. Better implementation of NIH recommendations might reduce false expectations about new interventions, and thus prevent clinical studies with ineffective treatments. FUNDING: None.

Successful treatment of a Caucasian case of multifocal Castleman's disease with TAFRO syndrome with a pathophysiology targeted therapy - a case report.

BACKGROUND: Castleman-Kojima disease (TAFRO Syndrome) is characterized by Thrombocytopenia, Anasarca, myeloFibrosis, Renal dysfunction, Organomegaly, multiple lymphadenopathy and histopathology pattern of atypical Castleman's disease (CD). Only few cases of this recently identified unique variant of Multicentric CD (MCD) are described in literature, all Japanese. It therefore poses serious diagnostic and therapeutic challenges. CASE DESCRIPTION: We describe a 21 year old woman with fever, asthenia, bilateral pleural effusion, ascites, hypoalbuminemia, severe thrombocytopenia, anemia, renal failure and proteinuria, whereas microbiological tests, immune serology (except ANA) and bone marrow biopsy were all negative. A CT-scan showed multiple lymphadenopathy and tissue samplings of mediastinal lymph nodes was compatible with a mixed-type CD. The diagnosis of MCD with TAFRO syndrome was made, but after an initial improvement with high dose corticosteroid therapy, clinical and laboratory features worsened. Based upon the high serum IL-6 levels and the high number of CD20-lymphocytes in lymph nodes tissue, we started tocilizumab (partial benefit), followed by rituximab combined with CVP (cyclophosphamide, vincristine and prednisone) chemotherapy, achieving a complete response. A total of six cycles of R-CVP were administered monthly, followed by maintenance with monthly rituximab. A complete remission persists at the 12th month of follow-up. CONCLUSIONS: In patients with massive immune system activation and lymphadenopathy it is mandatory to rule out Castleman-Kojima disease. In our patient a therapy aimed at the prominent pathophysiological abnormalities has been successful so far. However, since the rarity of TAFRO Syndrome, a multicenter registry is strongly desirable for a better understanding of the disease mechanisms, hopefully leading to evidence-based therapeutic choices.

A ética da pesquisa e a perspectiva da cartografia: algumas considerações / The ethics of research and the carthografic perspective: some considerations / La ética de la pesquisa y la perspectiva de la cartografía: algunas consideraciones

A partir da conversação entre o campo da experiência e a perspectiva cartográfica, o artigo interroga a concepção transcendente e fixa da ética na pesquisa. Tendo em vista a afirmação da processualidade e do pluralismo próprio à subjetividade, pretende-se ressaltar a importância de uma orientação ética aberta e sintonizada com a singularidade dos acontecimentos envolvendo sujeitos humanos. Nesse sentido, serão priorizadas duas diretrizes de análise indicadas pela perspectiva cartográfica, a saber: a pesquisa “com”, em lugar da investigação “sobre”, e a compreensão da pesquisa como intervenção. A proposta de produção de novos conhecimentos e práticas geradas na experiência compartilhada, orientada para a invenção de novos modos de existência, permite pensar outro sentido ético que, avesso a prescrições rígidas e generalizantes, atuaria como guia face aos impasses cotidianos do campo de pesquisa em saúde mental. (AU)

A partir de la conversación entre el campo de la experiencia yla perspectiva cartográfica, el artículo cuestiona la concepción trascendente y fija de la ética en la pesquisa. En vista de la afirmación de la procesualidad y del pluralismo propio a la subjetividad, se pretende resaltar la importancia de una orientación ética abierta y sintonizada con la singularidad de los acontecimientos involucrando sujetos humanos. En ese sentido, serán priorizadas dos directrices de análisis indicadas por la perspectiva cartográfica, a saber: la pesquisa “con”, en el lugar de la investigación “acerca de”, y la compresión de la pesquisa como intervención. La propuesta de producción de nuevos conocimientos y prácticas generadas en la experiencia compartida, orientada para la invención de nuevos modos de existencia, permite pensar otro sentido ético que, avieso a prescripciones rígidas y generalizantes, actuaría como guía delante de las dificultades cotidianas del campo de pesquisa en salud mental. (AU)

From the conversations between the field of experience and the cartographic experience, the article questions the transcendent and fixed concept of research ethics. Having in view the affirmation from the processuality and the pluralism belonging to subjectivity, we intend to highlight the need for an open ethical guidance, in tune with the singularity of events involving human subjects. In this sense, and defined by the cartographic perspective, two analysis guidelines shall be prioritized, namely: the research “with”, in lieu of the investigation “on”, and the understanding of research as an intervention. The proposal for the generation of new knowledge and new practices from the shared experience, oriented towards the invention of new ways of existence, allows us to consider another ethical sense, which, averse to the strict and generalizing regulations, would act as a guide in the face of everyday dilemmas in field of mental health research. (AU)

A ética da pesquisa e a perspectiva da cartografia: algumas considerações / The ethics of research and the carthografic perspective: some considerations / La ética de la pesquisa y la perspectiva de la cartografía: algunas consideraciones

A partir da conversação entre o campo da experiência e a perspectiva cartográfica, o artigo interroga a concepção transcendente e fixa da ética na pesquisa. Tendo em vista a afirmação da processualidade e do pluralismo próprio à subjetividade, pretende-se ressaltar a importância de uma orientação ética aberta e sintonizada com a singularidade dos acontecimentos envolvendo sujeitos humanos. Nesse sentido, serão priorizadas duas diretrizes de análise indicadas pela perspectiva cartográfica, a saber: a pesquisa “com”, em lugar da investigação “sobre”, e a compreensão da pesquisa como intervenção. A proposta de produção de novos conhecimentos e práticas geradas na experiência compartilhada, orientada para a invenção de novos modos de existência, permite pensar outro sentido ético que, avesso a prescrições rígidas e generalizantes, atuaria como guia face aos impasses cotidianos do campo de pesquisa em saúde mental.

A partir de la conversación entre el campo de la experiencia yla perspectiva cartográfica, el artículo cuestiona la concepción trascendente y fija de la ética en la pesquisa. En vista de la afirmación de la procesualidad y del pluralismo propio a la subjetividad, se pretende resaltar la importancia de una orientación ética abierta y sintonizada con la singularidad de los acontecimientos involucrando sujetos humanos. En ese sentido, serán priorizadas dos directrices de análisis indicadas por la perspectiva cartográfica, a saber: la pesquisa “con”, en el lugar de la investigación “acerca de”, y la compresión de la pesquisa como intervención. La propuesta de producción de nuevos conocimientos y prácticas generadas en la experiencia compartida, orientada para la invención de nuevos modos de existencia, permite pensar otro sentido ético que, avieso a prescripciones rígidas y generalizantes, actuaría como guía delante de las dificultades cotidianas del campo de pesquisa en salud mental.

From the conversations between the field of experience and the cartographic experience, the article questions the transcendent and fixed concept of research ethics. Having in view the affirmation from the processuality and the pluralism belonging to subjectivity, we intend to highlight the need for an open ethical guidance, in tune with the singularity of events involving human subjects. In this sense, and defined by the cartographic perspective, two analysis guidelines shall be prioritized, namely: the research “with”, in lieu of the investigation “on”, and the understanding of research as an intervention. The proposal for the generation of new knowledge and new practices from the shared experience, oriented towards the invention of new ways of existence, allows us to consider another ethical sense, which, averse to the strict and generalizing regulations, would act as a guide in the face of everyday dilemmas in field of mental health research.