Trauma e psicopatologia na dor somatoforme

Objectivo: Esta investigação pretendeu averiguar as experiências traumáticas e o seu impacto em doentes com perturbação de dor somatoforme e investigar a associação entre tipos de trauma e localizações da dor. Como objectivos secundários, quisemos perceber se a depressão e outros sintomas psicopatológicos estariam ligados a este quadro de dor, se a intensidade da dor era diferente pelo sexo e pelo tipo de diagnóstico de dor somatoforme e, finalmente, se o sexo tinha influência sobre o tipo de diagnóstico. Método: Para a confirmação do diagnóstico de dor somatoforme, recorremos a uma entrevista estruturada, a versão actualizada da Mini International Neuropsychiatric Interview (M.I.N.I.), a M.I.N.I. Plus. Para registar objectivamente a localização anatómica da dor utilizámos a nossa adaptação do Pain Drawing Instrument, que denominámos de Mapa Corporal da Dor (MCD). Para avaliar as experiências traumáticas usámos o Traumatic Experiencies Checklist (TEC). Para avaliar os sintomas depressivos e os sintomas psicopatológicos, aplicámos o Beck Depression Inventory (BDI) e o Brief Symptom Inventory (BSI) respectivamente. A nossa amostra ficou constituída por um grupo de doentes com dor somatoforme (n = 30) e um grupo de comparação que incluiu doentes sem patologia de dor (n = 30). As idades ficaram compreendidas entre os 26 e os 68 anos. Resultados: Os doentes com dor somatoforme têm significativamente mais experiências traumáticas emocionais, de abuso sexual e de ameaça corporal do que os doentes sem dor. Essas experiências foram todas registadas com impacto máximo. A localização da dor correlaciona-se moderadamente com o local do trauma no corpo. Os doentes do grupo com dor têm valores elevados na depressão e a diferença das pontuações médias entre os dois grupos é altamente significativa. O grupo de doentes com dor apresenta valores significativamente mais elevados em todos os sintomas psicopatológicos. Observamos ainda que a intensidade da dor nas mulheres é significativamente mais alta do que nos homens. Não encontramos diferenças na intensidade da dor quando comparamos os dois diagnósticos de dor somatoforme. Verificámos que o sexo feminino prediz o tipo de diagnóstico de dor. Conclusão: Ficou clara a relação entre trauma e dor somatoforme, no entanto os nossos resultados devem ser vistos como preliminares e replicados em amostras maiores e representativas

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Measurement of Λ\Lambda transverse polarization in e+e−e^{+}e^{-} collisions at s=3.68−3.71\sqrt{s}= 3.68-3.71 GeV

With data samples collected with the BESIII detector at seven energy points at $\sqrt{s}= 3.68 - 3.71$ GeV, corresponding to an integrated luminosity of 333 pb$^{-1}$, we present a study of the $\Lambda$ transverse polarization in the $e^+e^-\to\Lambda\bar\Lambda$ reaction. The significance of polarization by combining the seven energy points is found to be 2.6$\sigma$ including the systematic uncertainty, which implies a non-zero phase between the transition amplitudes of the $\Lambda\bar\Lambda$ helicity states. The modulus ratio and the relative phase of EM-$psionic$ form factors combined with all energy points are measured to be $R^{\Psi} =$ 0.71$^{+0.10}_{-0.10}$ $\pm$ 0.03 and $\Delta\Phi^{\Psi}$ = (23$^{+8.8}_{-8.0}$ $\pm$ 1.6$)^\circ$, where the first uncertainties are statistical and the second systematic.Comment: 19 pages, 4 figures, 3 tables, consistent with the publication in JHEP10(2023)08

Guidelines for the use and interpretation of assays for monitoring autophagy (4th edition)1.

In 2008, we published the first set of guidelines for standardizing research in autophagy. Since then, this topic has received increasing attention, and many scientists have entered the field. Our knowledge base and relevant new technologies have also been expanding. Thus, it is important to formulate on a regular basis updated guidelines for monitoring autophagy in different organisms. Despite numerous reviews, there continues to be confusion regarding acceptable methods to evaluate autophagy, especially in multicellular eukaryotes. Here, we present a set of guidelines for investigators to select and interpret methods to examine autophagy and related processes, and for reviewers to provide realistic and reasonable critiques of reports that are focused on these processes. These guidelines are not meant to be a dogmatic set of rules, because the appropriateness of any assay largely depends on the question being asked and the system being used. Moreover, no individual assay is perfect for every situation, calling for the use of multiple techniques to properly monitor autophagy in each experimental setting. Finally, several core components of the autophagy machinery have been implicated in distinct autophagic processes (canonical and noncanonical autophagy), implying that genetic approaches to block autophagy should rely on targeting two or more autophagy-related genes that ideally participate in distinct steps of the pathway. Along similar lines, because multiple proteins involved in autophagy also regulate other cellular pathways including apoptosis, not all of them can be used as a specific marker for bona fide autophagic responses. Here, we critically discuss current methods of assessing autophagy and the information they can, or cannot, provide. Our ultimate goal is to encourage intellectual and technical innovation in the field

Performance Analysis and Optimization Design of a Dual-Mode Reconfigurable Ankle Joint Parallel Rehabilitation Mechanism

In this study, a dual-mode reconfigurable parallel ankle joint rehabilitation mechanism is proposed to meet the needs of patients in different ankle rehabilitation stages. This mechanism can switch between the 1T2R (where R represents rotation and T represents translation) and 2T1R motion modes. The screw theory and the modified G-K formula were used to analyze and verify the degree of freedom of the mechanism. The non-parasitic motion characteristics were analyzed by examining the topological structure of the mechanism. An inverse kinematics model was established using the closed-loop vector method, and the mechanism’s singularity was analyzed based on the Jacobian matrix. The Jacobian matrix and the numerical method were used to compare and analyze the workspace index, the rotational dexterity index and the load capacity performance index before and after the introduction of branched chains with actuation redundancy. A particle swarm optimization algorithm was used to optimize the geometric dimensional parameters of the mechanism. The results show that the mechanism exhibits the characteristics of a parallel mechanism without parasitic motion in the two motion modes. Using branched chains with actuation redundancy can significantly improve the rotational dexterity and load capacity performance index, without affecting the workspace index. Compared to the original mechanism, the kinematic performance of the optimized mechanism is significantly improved. It is concluded that the proposed mechanism can meet the needs of ankle joint activity training in the 1T2R motion mode and the needs of ankle joint proprioception training in the 2T1R motion mode, which can better meet the needs of patients in different rehabilitation stages

Modelling and analysis of natural language controlled robotic systems

© IFAC. Controlling a robotic system through natural language commands can provide great convenience for human users. Many researchers have investigated on high-level planning for natural language controlled robotic systems. Most of the methods designed the planning as open-loop processes and therefore cannot well handle unexpected events for realistic applications. In this paper, a closed-loop method is proposed for task-planning to overcome unexpected events occurred during implementation of assigned tasks. The designed system is modeled and theoretically proved to be able to stabilize the robotic system under unexpected events. Experimental results demonstrate effectiveness and advantages of the proposed method.Link_to_subscribed_fulltex