Response to Marabotto et al.

Biopsies have important value in assessing for nonerosive reflux disease.

The role of histology in the diagnosis of non-erosive reflux disease: A systematic review and meta-analysis.

BACKGROUND AND PURPOSE: Non-erosive reflux disease (NERD) accounts for over half of all gastroesophageal reflux cases and is characterized by reflux symptoms with pathologic acid exposure on pH monitoring but no evidence of erosions on upper endoscopy. Ambulatory pH monitoring is limited by availability and patient tolerance. The utility of performing esophageal mucosal biopsies in diagnosing NERD is unclear. We conducted a systematic review and meta-analysis to determine the sensitivity of esophageal mucosal biopsies in diagnosing NERD. METHODS: Data were obtained from Embase and Ovid MEDLINE from inception to April 2021. Studies were included if esophageal mucosal biopsies were taken and analyzed using conventional histopathologic analysis in symptomatic NERD patients. Relevant data was including histologic abnormalities and location of the biopsy. Sensitivity and specificity were calculated against healthy controls or those with functional heartburn. RESULTS: The search yielded 2871 studies, of which 10 studies met our inclusion criteria and contained raw data. Histological abnormalities included histologic sum scores, papillary elongation, basal cell hyperplasia, and dilated intraepithelial spaces. When assessing for the presence of any abnormality, biopsies taken <3 cm from the lower esophageal sphincter (LES) had a pooled sensitivity of 0.71 (95% CI 0.64-0.77) and specificity of 0.64 (95% 0.54-0.73); however, analysis of individual histologic features such as the presence of eosinophils improved the sensitivity. CONCLUSIONS: Although esophageal mucosal biopsies had poor sensitivity at diagnosing NERD, biopsies taken within 3 cm of the LES had higher sensitivity when pathologists reported upon eosinophils and dilated intraepithelial spaces.

Development of core competencies for field veterinary epidemiology training programs.

A workforce with the adequate field epidemiology knowledge, skills and abilities is the foundation of a strong and effective animal health system. Field epidemiology training is conducted in several countries to meet the increased global demand for such a workforce. However, core competencies for field veterinary epidemiology have not been identified and agreed upon globally, leading to the development of different training curricula. Having a set of agreed core competencies can harmonize field veterinary epidemiology training. The Food and Agriculture Organization of the United Nations (FAO) initiated a collective, iterative, and participative process to achieve this and organized two expert consultative workshops in 2018 to develop core competencies for field veterinary epidemiology at the frontline and intermediate levels. Based on these expert discussions, 13 competencies were identified for the frontline and intermediate levels. These competencies were organized into three domains: epidemiological surveillance and studies; field investigation, preparedness and response; and One Health, communication, ethics and professionalism. These competencies can be used to facilitate the development of field epidemiology training curricula for veterinarians, adapted to country training needs, or customized for training other close disciplines. The competencies can also be useful for mentors and employers to monitor and evaluate the progress of their mentees, or to guide the selection process during the recruitment of new staff.

Reflexões para uma inovadora visão da pessoa enquanto ser relacional / Reflections about an innovative vision towards people as relational beings / Reflexiones para una visión innovadora de la persona como ser relacional

Trata-se de uma extensa e sistemática revisão crítica sobre o livro intitulado: " Psychoanalysis, Group Analysis and Beyond - Towards a New Paradigm of the Human Being" da autoria de dois grupanalistas e psicanalistas de nacionalidade mexicana, sendo ele, argentino de nascimento, respetivamente, Juan Tubert-Oklander e Reyna Hernández-Tubert, os quais apoiados numa ampla e atualíssima bibliografia, propõem algumas novas ideias sobre como pensarmos e compreendermos as Pessoas dentro dos seus contextos familiares, sociais e políticos, enquanto seres de dupla natureza, biológica e psíquica/mental a partir de dinâmicas biopsíquicas, ora inconscientes, ora conscientes que se expressam a diferentes níveis da comunicação e da relação (intrapsíquica, interpessoal e transpessoal). Nesta coletânea de artigos publicados nos últimos 25 anos, nós encontramos propostas bastante corajosas e inovadoras todas elas escrita num elegante estilo. Os textos estão apoiados por uma sólida estrutura argumentativa e epistemológica com o propósito de pensarmos e revermos algumas das nossas " visões" sobre o que é ser-se Pessoa, propondo linhas de pensamento no sentido de desenvolver novos paradigmas conceptuais, por exemplo, como acabar com a oposição altamente problemática do que é " individual" perante do que é " coletivo" ( Tubert-Oklander, 2014).

This is an extensive and systematic critical review of the book entitled: "Psychoanalysis, Group Analysis and Beyond - Towards a New Paradigm of the Human Being" by two groups and psychoanalysts of Mexican nationality, being he, Argentinian of birth, respectively, Juan Tubert-Oklander and Reyna Hernández-Tubert, who supported in a wide and current bibliography, propose some new ideas on how to think and understand the People within their family, social and political contexts, as beings of dual nature, biological and psychic/mental from biopsychic dynamics, or unconscious, or conscious that express themselves at different levels of communication and relationship (intra-psyche, interpersonal and transpersonal). In this collection of articles published in the last 25 years, we find very bold and innovative proposals all written in an elegant style. The texts are supported by a solid argumentative and epistemological structure with the purpose of thinking and reviewing some of our " visions" about what it is to be a Person, proposing lines of thought to develop new conceptual paradigms, for example, how to end the highly problematic opposition of what is " individual" before what is " collective" ( Tubert-Oklander, 2014).

Se trata de una extensa y sistemática revisión crítica del libro titulado: "Psicoanálisis, Análisis grupal y más allá - Hacia un nuevo paradigma del ser humano" por dos grupos y psicoanalistas de nacionalidad mexicana, siendo él, argentino de nacimiento, respectivamente, Juan Tubert-Oklander y Reyna Hernández-Tubert, quienes apoyados en una amplia y actual bibliografía, proponen algunas nuevas ideas sobre cómo pensar y entender al Pueblo dentro de su contextos familiares, sociales y políticos, como seres de naturaleza dual, biológicos y psíquicos/mentales a partir de dinámicas biopsíquicas, o inconscientes, o conscientes que se expresan en diferentes niveles de comunicación y relación (intrapsiquica, interpersonal y transpersonal). En esta colección de artículos publicados en los últimos 25 años, encontramos propuestas muy audaces e innovadoras todas escritas en un estilo elegante. Los textos se apoyan en una sólida estructura argumentativa y epistemológica con el propósito de pensar y revisar algunas de nuestras " visiones" sobre lo que es ser una Persona, proponiendo líneas de pensamiento para desarrollar nuevos paradigmas conceptuales, por ejemplo, cómo terminar con la oposición altamente problemática de lo que es " individual" perante lo que es " colectivo" ( Tubert-Oklander, 2014).

Early elective versus elective sigmoid resection in diverticular disease: not only timing matters-a single institutional retrospective review of 133 patients.

PURPOSE: The optimal timing of elective surgery in patients with the colonic diverticular disease remains controversial. We aimed to analyze the timing of sigmoidectomy in patients with diverticular disease and its influence on postoperative course with respect to the classification of diverticular disease (CDD). METHODS: Patients who underwent elective laparoscopic sigmoidectomy were retrospectively enrolled and subdivided into two groups based on the time interval between the last attack and surgery: group A, early elective (≤ 6 weeks), and group B, elective (> 6 weeks). Multivariate regression models were used to identify factors which predict conversion to laparotomy, postoperative course, and length of hospital stay. RESULTS: A total of 133 patients (group A (n = 88), group B (n = 45)) were included. Basic demographic data did not differ between groups except for a higher rate of diabetes in group B (p = 0.009). The conversion rate was significantly higher in group A in comparison to group B (group A vs. group B: n = 23 (26.1%) vs. n = 3 (6.7%), p = 0.007). Logistic regression analysis revealed the timing of surgery and CDD stage as significant predictors for intraoperative conversion. Moreover, the postoperative course was influenced by high age as well as intraoperative conversion and length of hospital stay by conversion, preoperative CRP levels, and elective surgery. CONCLUSIONS: Both, timing of surgery and the disease stage, influence the conversion rates in laparoscopic sigmoidectomy for diverticular disease. Accordingly, patients with complicated acute or chronic sigmoid diverticulitis should be operated in the inflammation-free interval.

Intravenous Albumin in Patients With Cirrhosis: Evaluation of Practice Patterns and Secular Trends of Usage in Ontario 2000 to 2017.

BACKGROUND: Intravenous (IV) albumin has evidence-based indications in cirrhosis that are limited in most guidelines to spontaneous bacterial peritonitis (SBP), type 1 hepatorenal syndrome (HRS) and large volume paracentesis (LVP).This study aimed to describe the trends of IV albumin usage in patients with cirrhosis at the population level and evaluate indications for IV albumin in the hospital setting. METHODS: A retrospective study identified albumin infusions in health care data from Ontario, Canada between 2000 and 2017 in those with and without cirrhosis. Annual rates of IV albumin by cirrhosis status were calculated per 10,000 person-years (PY) and described using Poisson regression and rate ratios. Secondly, patients with cirrhosis receiving IV albumin while hospitalized at Kingston Health Sciences Centre (KHSC) in 2017 were identified and underwent detailed chart abstraction to determine the reason for IV albumin administration. RESULTS: The overall rate of provincial IV albumin usage doubled over the study period (2000: 8.4/10,000 PY versus 2017: 16.3/10,000 PY; rate ratio 1.94, 95% confidence interval 1.90 to 1.99, P <0.001). The majority of albumin was used during hospitalization (88%) and 22% was used in patients with cirrhosis. At KHSC, there were134 admissions where a patient with cirrhosis received IV albumin. Of these, 49% of prescriptions were for evidence-based indications (LVP 30%, type 1 HRS 10%, SBP 10%), whereas other indications included non-HRS renal failure, hypovolemia and sepsis. CONCLUSION: IV albumin use has doubled over two decades and is frequently used in hospitalized patients with cirrhosis with only 50% being prescribed for evidence-based indications. These results highlight the impact of cirrhosis on albumin use and highlight potential quality improvement opportunities.

New insights on human Hsp70-escort protein 1: Chaperone activity, interaction with liposomes, cellular localizations and HSPA's self-assemblies remodeling.

The 70 kDa heat shock proteins (Hsp70) are prone to self-assembly under thermal stress conditions, forming supramolecular assemblies (SMA), what may have detrimental consequences for cellular viability. In mitochondria, the cochaperone Hsp70-escort protein 1 (Hep1) maintains mitochondrial Hsp70 (mtHsp70) in a soluble and functional state, contributing to preserving proteostasis. Here we investigated the interaction between human Hep1 (hHep1) and HSPA9 (human mtHsp70) or HSPA1A (Hsp70-1A) in monomeric and thermic SMA states to unveil further information about the involved mechanisms. hHep1 was capable of blocking the formation of HSPA SMAs under a thermic treatment and stimulated HSPA ATPase activity in both monomeric and preformed SMA. The interaction of hHep1 with both monomeric and SMA HSPAs displayed a stoichiometric ratio close to 1, suggesting that hHep1 has access to most protomers within the SMA. Interestingly, hHep1 remodeled HSPA9 and HSPA1A SMAs into smaller forms. Furthermore, hHep1 was detected in the mitochondria and nucleus of cells transfected with the respective coding DNA and interacted with liposomes resembling mitochondrial membranes. Altogether, these new features reinforce that hHep1 act as a "chaperone for a chaperone", which may play a critical role in cellular proteostasis.

O nascimento e o desenvolvimento da neuro-psicanálise / The birth and development of neuro-psychoanalysis / El nacimiento y desarrollo del neuro-psicoanálisis

A Neuro-Psicanálise é uma área de investigação e estudo conceptual e epistemológico focado na reavaliação das hipóteses propostas pelo modelo psicanalítico da mente perante o recente manancial de novos dados científicos provindo de diferentes áreas de Cérebro e da sua atividade cerebral, o que tem permitindo o desenvolvimento e esclarecimento dos modelos neuro-dinâmicos relacionados com a atividade mental tanto consciente, assim como inconsciente. Os autores fizeram uma resenha sobre as circunstâncias de ordem histórica, filosófica e científica por detrás do nascimento deste movimento de diálogo entre a Psicanálise e as Neurociências Modernas, a Sociedade Internacional para a Neuro-Psicanálise, cujos fundamentos históricos estão consubstanciados na própria obra e vida de Sigmund Freud, o qual iniciou a vida profissional, como investigador em laboratórios de histologia médica, aí se interessou pelo estudo do sistema nervoso central e mais tarde iniciou atividade clínica em Neurologia. Somente a partir dos anos 50 do Seculo XX ocorreram as primeiras iniciativas precursoras para uma investigação neurocientífica moderna e foi na década de 80 que começou a surgir o manancial de dados científicos provindos de diferentes áreas de investigação neurológica, os quais permitem aventar as possibilidades de existirem eventuais correlações e correspondências entre os termos psicológicos e psicanalíticos com certas áreas e circuitos neurofisiológicos do Cérebro, assim possibilitando reabertura de um diálogo tão desejado por Freud e expresso na sua monografia intitulada: "Projecto para uma Psicologia Científica" de 1895, entre o modelo psicanalítico da Mente e os modelos neurobiológicos e neurocientíficos do Cérebro.

Neuro-Psychoanalysis is an area of conceptual and epistemological research focused on the reevaluation of hypotheses proposed by the psychoanalytic model of Mind (Psyché) facing recent and new scientific data emerging from the investigations over different Brain's areas and activities, which allows a development and clarification of new neuro-dynamic models related to both conscious and unconscious mental activity. The authors reviewed the historical, philosophical and scientific circumstances behind the birth of this movement of dialogue between Psychoanalysis and Modern Neurosciences, the International Society for Neuro-Psychoanalysis, whose historical foundations are embodied in the work and life of Sigmund Freud, who started his professional life as a researcher in medical histology laboratories and became interested in the study of the central nervous system and later on began his clinical practice in Neurology. Only at the decade of the 50s, the first precursor initiatives over modern neuroscientific research have taken place and only at the 80s emerge several sources of scientific data from different areas of neurological research which allowed the first possibilities for possible correlations and correspondences between psychological and psychoanalytic terms with certain areas and neurophysiological circuits of the Brain, thus enabling the reopening of a dialogue desired by Freud, in his monograph entitled: "Project for a Scientific Psychology" from 1895, between the psychoanalytic model of Mind and new neurobiological and neuroscientific models of the Brain.

El neuro-psicoanálisis es un área de investigación y de estudio conceptual y epistemológico centrado en la reevaluación de las hipótesis propuestas por el modelo psicoanalítico de la Mente frente a la riqueza reciente de nuevos datos científicos provenientes de diferentes áreas del Cerebro y su actividad cerebral, lo que ha permitido desarrollo y clarificación de modelos neurodinámicos relacionados tanto con la actividad mental consciente como inconsciente. Los autores revisaron las circunstancias históricas, filosóficas y científicas detrás del nacimiento de este movimiento de diálogo entre la Psicoanálisis y las Neurociencias, la Sociedad Internacional para el Neuro-Psicoanálisis, cuyos fundamentos históricos están encarnados en el trabajo y la vida de Sigmund Freud quien comenzó su vida profesional como investigador en laboratorios de histología médica e se interesó en el estudio del sistema nervioso central y más tarde comenzó la actividad clínica en Neurología. Solo a partir de los años 50 del siglo XX tuvieron lugar las primeras iniciativas precursoras para la investigación neurocientífica moderna, y fue en los años 80 que comenzó a surgir la fuente de datos científicos de diferentes áreas de la investigación neurológica, lo que permite avanzar las posibilidades de la existencia de posibles correlaciones y correspondencias entre términos psicológicos y psicoanalíticos con ciertas áreas y circuitos neurofisiológicos del cerebro, permitiendo así la reapertura de un diálogo tan deseado por Freud en su monografía titulada: "Proyecto para una psicología científica" de 1895 entre el modelo psicoanalítico de la mente y los nuevos modelos neurobiológicos y neurocientíficos del cerebro.

O que é ser um psicoterapeuta analítico de grupo /grupanalista? Reflexões teóricas e clínicas / What is it to be a group analytic psychotherapist group / group psychotherapist? Theoretical and clinical reflections / ¿Qué es ser un psicoterapeuta analítico de grupo / grupalista? Reflexiones teóricas y clínicas

O psicoterapeuta analítico de grupo ou grupanalista tem uma enorme influência nas dinâmicas do grupo e na Matriz. Apesar das características pessoais e psicológicas (emocionais e mentais) dos membros do grupo, a presença do grupanalista tem um papel particular e único o qual deriva da sua formação treino e supervisão enquanto candidato a grupanalista/psicoterapeuta de grupo. Este papel é também condicionado pelas suas características de personalidade e de carácter, enfim pelas suas capacidades afetivas/emocionais e mentais (empatia, disponibilidade interna, curiosidade, verdade, aceitação do Outro e das diferenças, etc.), quando ele se disponibiliza e interage com cada membro do grupo e com o grupo no seu todo.

A group psychotherapist or group analyst has a huge influence over the group's dynamics and Matrix. Although the group members' personal and psychological characteristics (mental and emotional), also the group analyst's presence has a particular and unique role which derives from his training, practice and supervision while candidate for group psychotherapist which is also conditioned by his characteristics of personality and character and his affective/emotional and mental skills (empathy, internal availability, curiosity, acceptance of others and their differences, etc.), when he faces and interacts with each group member or with the group-as-a-whole.

El psicoterapeuta analítico de grupo o grupanalista tiene una enorme influencia en las dinámicas del grupo e na Matrix. Apesar de las características personales y psicológicas (emocionales y mentales) de los miembros del grupo, la presencia del grupanalista tiene un papel particular y único que deriva de su formación y supervisión de entrenamiento enquanto candidato a psicoterapeuta analítico de grupo/grupanalista. Este papel también está condicionado por sus características de personalidad y carácter, por fin por sus capacidades afectivas/emocionales y mentales (empatía, disponibilidad interna, curiosidad, verdad, aceptación del otro y diferencias, etc.), cuando pone a disposición e interactúa con cada miembro del grupo y con el grupo en su totalidad.

Magnetic Resonance Imaging of the Small Bowel in Crohn's Disease: A Systematic Review and Meta-Analysis.

Introduction. Crohn's disease is most commonly found in the terminal ileum and colonic region. Magnetic resonance has become a useful modality for assessing small bowel activity. In this study, we performed a systematic review and meta-analysis on the use of MR in detecting small bowel activity as well as extramural complications in Crohn's patients. Methods. Two independent reviewers sorted through articles until October 2, 2014. We included both studies providing raw data for pooling and studies without raw data. Sensitivity, specificity, likelihood ratios, and 95% confidence intervals were calculated for each study. Results. There were 27 included studies, of which 19 were included in the pooled analysis. Pooled analysis of the 19 studies (1020 patients) with raw data revealed a sensitivity of 0.88 (95% CI 0.86 to 0.91) and specificity was 0.88 (95% CI 0.84 to 0.91). In regard to detecting stenosis, pooled sensitivity was 0.65 (95% CI 0.53 to 0.76) and specificity was 0.93 (95% CI 0.89 to 0.96). Conclusion. MR imaging provides a reliable alternative in detecting small bowel activity in patients with Crohn's disease. Its advantages include high diagnostic accuracy and no radiation exposure while its disadvantages include high cost and limited availability.

O papel dos afectos no funcionamento do aparelho menta / El papel de los afectos en el funcionamiento del aparato mental / The affects' role at the functioning of the mental apparatus

O presente trabalho versa sobre o renovado interesse pela natureza e dinâmica dos Afectos, as quais têm aumentado nas últimas décadas devido, em parte, aos novos entendimentos que as Neuro-Ciencias têm tido sobre esta questão e as suas possiveis correlações com a conceptualizacao psicanalitica. Aliás a teoria psicanalítica tem sido, desde os seus primórdios, a única teoria psicológica a considerar serem os Afectos, a par das Representaçõees, os componentes das Pulsões, factores básicos para o funcionamento do Aparelho Mental. Os Afectos são portadores de uma fonte e dinâmica próprias e eles têm sido entendidos como motivadores para a execução de desejos e de fantasias e como determinantes independentes das fantasias e dos comportamentos. Portanto faz-se uma revisão dos conceitos fundamentais e uma apresentação da evolução da conceptualizacao psicanalítica e a sua articulação com os dados revelados nos estudos neuro-científicos sobre as percepções, a consciência e as emoções.

The present paper is about the renew interest over the Affect's nature and dynamics which have been raised over the last decades partially due to the newest understandings from the neurosciences over this issue and their possible correlations with the psychoanalytical conceptualization. Therefore the psychoanalytical theory has been, since her origins, the only one psychological theory to considerer, being the Affects, in parallel with the Representations, the Drive's constituent, and the basic factors for the functioning of the Mental Apparatus. The Affects have their own source and dynamics and they have been a motivator for executing wishes and fantasies and as independent determinant of fantasies and behaviors. So the author will do a review over the basics concepts and a short presentation of the Neo-Freudian Conceptualization, linking it with the data disclosed in the neuro-scientific literature over the perceptions, the consciousness and the emotionality.

El presente articulo versa sobre el renovado interes por la naturaleza y la dinamica de los Afectos que ha aumentado en las ultimas decadas debido, en parte, al conocimiento que las neurociencias han tenido sobre esta cuestion e a las posibles correlaciones con la concepcion psicoanalitica. Presupuesto, la teoria psicoanalitica ha sido desde sus inicios la unica teoria psicologica que ha considerado, los Afectos, a la par que las representaciones, los componentes de las Pulsiones, factores basicos para el funcionamiento del aparato mental. Los Afectos son portadores de una fuente y dinamica propias y han sido entendidos como unas motivaciones para la ejecucion de deseos, fantasias y como determinantes independientes de las fantasias y de los comportamientos. Por tanto, el autor hara una revision de los conceptos fundamentales y una breve presentacion de la evolucion de la concepcion neo-freudiana articulando con los datos revelados en los estudios neurocientificos sobre percepciones, la conciencia e las emociones.

O papel dos afectos no funcionamento do aparelho menta / El papel de los afectos en el funcionamiento del aparato mental / The affects' role at the functioning of the mental apparatus

RESUMO: O presente trabalho versa sobre o renovado interesse pela natureza e dinâmica dos Afectos, as quais têm aumentado nas últimas décadas devido, em parte, aos novos entendimentos que as Neuro-Ciencias têm tido sobre esta questão e as suas possiveis correlações com a conceptualizacao psicanalitica. Aliás a teoria psicanalítica tem sido, desde os seus primórdios, a única teoria psicológica a considerar serem os Afectos, a par das Representaçõees, os componentes das Pulsões, factores básicos para o funcionamento do Aparelho Mental. Os Afectos são portadores de uma fonte e dinâmica próprias e eles têm sido entendidos como motivadores para a execução de desejos e de fantasias e como determinantes independentes das fantasias e dos comportamentos. Portanto faz-se uma revisão dos conceitos fundamentais e uma apresentação da evolução da conceptualizacao psicanalítica e a sua articulação com os dados revelados nos estudos neuro-científicos sobre as percepções, a consciência e as emoções.(AU)

ABSTRACT: The present paper is about the renew interest over the Affect's nature and dynamics which have been raised over the last decades partially due to the newest understandings from the neurosciences over this issue and their possible correlations with the psychoanalytical conceptualization. Therefore the psychoanalytical theory has been, since her origins, the only one psychological theory to considerer, being the Affects, in parallel with the Representations, the Drive's constituent, and the basic factors for the functioning of the Mental Apparatus. The Affects have their own source and dynamics and they have been a motivator for executing wishes and fantasies and as independent determinant of fantasies and behaviors. So the author will do a review over the basics concepts and a short presentation of the Neo-Freudian Conceptualization, linking it with the data disclosed in the neuro-scientific literature over the perceptions, the consciousness and the emotionality. (AU)

RESUMEN: El presente articulo versa sobre el renovado interes por la naturaleza y la dinamica de los Afectos que ha aumentado en las ultimas decadas debido, en parte, al conocimiento que las neurociencias han tenido sobre esta cuestion e a las posibles correlaciones con la concepcion psicoanalitica. Presupuesto, la teoria psicoanalitica ha sido desde sus inicios la unica teoria psicologica que ha considerado, los Afectos, a la par que las representaciones, los componentes de las Pulsiones, factores basicos para el funcionamiento del aparato mental. Los Afectos son portadores de una fuente y dinamica propias y han sido entendidos como unas motivaciones para la ejecucion de deseos, fantasias y como determinantes independientes de las fantasias y de los comportamientos. Por tanto, el autor hara una revision de los conceptos fundamentales y una breve presentacion de la evolucion de la concepcion neo-freudiana articulando con los datos revelados en los estudios neurocientificos sobre percepciones, la conciencia e las emociones. (AU)