Dependência crônica de ventilação pulmonar mecânica na assistência pediátrica: um debate necessário para o SUS Chronic dependence on mechanical pulmonary ventilation in pediatric care: a necessary debate for Brazil's Unified Health System

Pessoas com dependência prolongada de ventilação pulmonar mecânica necessitam de cuidados permanentes e de equipamentos, que podem alongar muito a permanência hospitalar, determinando uma dificuldade de acesso para pacientes com agravos agudos, assim como transtornos pessoais com limitação da qualidade de vida de seus familiares ou cuidadores, devido aos longos períodos de internação. Esta revisão crítica de publicações sobre dependência de ventilação pulmonar mecânica em crianças e adolescentes objetivou disponibilizar informações organizadas de modo sistemático, a fim de subsidiar o debate sobre o tema, considerando que as mudanças de perfil epidemiológico e o crescente acesso tecnológico determinam necessidades como leitos de terapia intensiva e complexa assistência domiciliar para pacientes crônicos, ainda com limites de oferta e regulação no sistema público de saúde brasileiro.<br>People with prolonged dependence on mechanical ventilation require permanent care and the use of equipment that can result in longer term hospital internment. This can lead to difficulty of access for patients with acute injuries, as well as personal difficulties and stress with reduced quality of life for their families or caregivers due to such longer hospital internment. This critical review of publications dealing with dependence on mechanical ventilation among children and adolescents aimed at making information organized in a systematic manner available in order to support discussion on the subject. It should be borne in mind that changes in epidemiological profile and growing technological access determine needs such as intensive therapy hospital beds and complex home care for chronic patients, which still have limits of supply and regulatory restrictions in the Brazilian public health syste

Myelomeningocele: the management of the associated hydrocephalus

The pathogenesis of the hydrocephalus associated with myelomeningocele (MMC) has been the subject of an extensive number of studies. The contemporary reduction of the incidence of the Chiari II malformation and of the associated active hydrocephalus after closure of the spinal defect in utero is in line with previous studies suggesting a prominent role of the posterior cranial fossa abnormalities, where even the increased venous pressure might be at least mostly a consequence of the constriction of the posterior cranial fossa structures. Pure absorptive abnormalities however coexist, the main ones documented to be abnormal cisternal spaces and peculiar cerebrospinal fluid chemical features

Dissipative solitons for mode-locked lasers

International audienceDissipative solitons are localized formations of an electromagnetic field that are balanced through an energy exchange with the environment in presence of nonlinearity, dispersion and/or diffraction. Their growing use in the area of passively mode-locked lasers is remarkable: the concept of a dissipative soliton provides an excellent framework for understanding complex pulse dynamics and stimulates innovative cavity designs. Reciprocally, the field of mode-locked lasers serves as an ideal playground for testing the concept of dissipative solitons and revealing their unusual dynamics. This Review provides basic definitions of dissipative solitons, summarizes their implications for the design of high-energy mode-locked fibre laser cavities, highlights striking emerging dynamics such as dissipative soliton molecules, pulsations, explosions and rain, and finally provides an outlook for dissipative light bullets