O que faz do grupo um dispositivo analítico? Considerações de Freud e Lacan

O intuito deste artigo é retomar a discussão sobre a prática clínica com grupos a partir da psicanálise de Freud e de Lacan, tendo como horizonte ressaltar a ética do psicanalista, seus impasses e suas possibilidades de inserção em espaços coletivos, públicos ou institucionais. O recurso ao coletivo é uma característica privilegiada na atenção psicossocial e na “clínica ampliada” preconizada pelo Sistema Único de Saúde (SUS). Contudo, vê-se com frequência a diluição da perspectiva inovadora proposta no surgimento dos grupos no campo clínico e o predomínio do atendimento massificado, o que justifica esta retomada clínica. Para isto, apresentamos contrapontos entre os grupalistas no interior da psicanálise e a perspectiva lacaniana acerca da lógica coletiva e do laço social. Em seguida, retomamos alguns trabalhos de extração lacaniana em diferentes contextos coletivos e, por último, enfatizamos algumas considerações sobre a prática clínica, tendo como norte atravessar os efeitos imaginários do grupo e privilegiar o sujeito e sua singularidade.The purpose of this article is to take up the discussion on clinical practice with groups, based on the psychoanalysis of Freud and Lacan, highlighting the psychoanalyst’s ethics, its impasses and possibilities of being part of collective, public or institutional environments. The “collective” is an important aspect in psychosocial care and in the “extended medical practice (clinic)” proposed by the Unified Health System (SUS). However, innovative perspectives proposed by new groups in the field are often forgotten, in the emergence of groups in the clinical field and the predominance of mass care, which justifies our discussion. For this, we present counterpoints between the groupism concept in psychoanalysis and the Lacanian perspective on the collective logic and social bonds. Then, we return to some Lacanian works in different collective contexts and, finally, emphasize some considerations about clinical practice, in order to go beyond the imaginary effects of groups and privilege the subject and his uniqueness

Afásicos apresentam dificuldades para executar tarefas que envolvem processamento numérico e de cálculo

Objective To compare performance on EC301 battery calculation task between aphasic subjects and normal controls of the same sex, age, and education. Method Thirty-two aphasic patients who had suffered a single left hemisphere stroke were evaluated. Forty-four healthy volunteers were also selected. All subjects underwent a comprehensive arithmetic battery to assess their numerical and calculation skills. Performances on numerical processing and calculation tasks were then analyzed. Results Aphasic individuals showed changes in their ability to perform numerical processing and calculation tasks that were not observed in the healthy population. Conclusion Compared with healthy subjects of the same age and education level, individuals with aphasia had difficulty performing various tasks that involved numerical processing and calculation.Objetivo Comparar o desempenho em tarefas de cálculo através da bateria EC301 entre sujeitos afásicos e indivíduos normais pareando as variáveis sexo, idade e educação.Método Foram avaliados 32 pacientes afásicos que sofreram lesão em hemisfério esquerdo único, concomitantemente com quarenta e quatro voluntários saudáveis. Todos foram submetidos a uma bateria de aritmética abrangente para avaliar habilidades numérica e de cálculo.Resultados Os indivíduos afásicos apresentaram alterações no processamento numérico e tarefas de cálculo que não foram observadas na população saudável. Conclusão Pacientes afásicos apresentam dificuldades para executar tarefas que envolvem processamento numérico e de cálculo em comparação com indivíduos saudáveis da mesma idade e escolaridade.Universidade Várzea GrandeUniversidade Federal de São Paulo (UNIFESP)UNIFESPSciEL

Two novel classes of neuroactive fatty acid amides are substrates for mouse neuroblastoma ‘anandamide amidohydrolase’

AbstractThe endogenous cannabimimetic substance, anandamide (N-arachidonoyl-ethanolamine) and the recently isolated sleep-inducing factor, oleoyl-amide (cis-9,10-octadecenoamide), belong to two neuroactive fatty acid amide classes whose action in mammals has been shown to be controlled by enzymatic amide bond hydrolysis. Here we report the partial characterisation and purification of ‘anandamide amidohydrolase’ from membrane fractions of N18 neuroblastoma cells, and provide evidence for a further and previously unsuspected role of this enzyme. An enzymatic activity catalysing the hydrolysis of [14C]anandamide was found in both microsomal and 10,000 × g pellet fractions. The latter fractions, which displayed the highest Vmax for anandamide, were used for further characterisation of the enzyme, and were found to catalyse the hydrolysis also of [14C]oleoyl-amide, with an apparent Km of 9.0 ± 2.2 μM. [14C]anandamide- and [14C]oleoyl-amide-hydrolysing activities: (i) exhibited identical pH- and temperature-dependency profiles; (ii) were inhibited by alkylating agents; (iii) were competitively inhibited by the phospholipase A2 inhibitor arachidonyl-trifluoromethyl-ketone with the same IC50 (3 μM); (iv) were competitively inhibited by both anandamide (or other polyunsaturated fatty acid-ethanolamides) and oleoyl-amide. Proteins solubilised from 10,000 × g pellets were directly analysed by isoelectric focusing, yielding purified fractions capable of catalysing the hydrolysis of both [14C]anandamide and [14C]oleoyl-amide. These data suggest that ‘anandamide amidohydrolase’ enzymes, such as that characterised in this study, may be used by neuronal cells also to hydrolyse the novel sleep-inducing factor oleoyl-amide

Proteomic study of muscle sarcoplasmic proteins using AUT-PAGE/SDS-PAGE as two-dimensional gel electrophoresis

The conversion of muscle to meat in pig involves mainly proteolysis of myofibrillar proteins, which undergo notable changes since early stage of rigor mortis, even after 48 h post mortem. The tenderness of meat has been thoroughly investigated to understand the biochemical mechanisms, which influence texture and flavour development as well as the technological parameters and hence meat quality. Cytoplasmic proteolytic calcium dependent enzymes, named -and m-calpains, which act in the early stages of rigor mortis, significantly contribute to tenderization weakening myofibrils. These enzymes, however, act for fewdays because they are specifically inhibited by calpastatin and by pH lowering. However, when pH falls to about 5.0, proteolytic activity on muscle proteins is continued by longer acting lysosomal proteinase, cathepsins [3,7–9]. Post mortem proteolysis also causes relevant changes in sarcoplamic protein fraction, which represent the water soluble fraction (quantitatively about 30–35%) of meat total protein, and the involved proteins has already been identified by proteomic-based studies. Recent investigations have demonstrated that the most commonly found Lactobacillus species in dry fermented meats are able to hydrolyse myofibrillar and sarcoplasmic muscle proteins in vitro.The most abundant sarcoplasmic proteins, as mixture of basic polypeptides with a narrow spread range of molecular masses, represented an excellent model to test our analytical technique and to delineate its capabilities. In the present study, we compared 2D AUT-PAGE/SDSPAGE maps of water-soluble proteins extracted from fresh meat and from dry-cured ham, a non fermented product, from “Naples-type” salami, a microbiologically fermented product, and from “Coppa”, a typical semi-fermented product. Electrophoretically separated proteins have been identified by MALDI-ToF mass fingerprinting

Open and endovascular repair of juxtarenal abdominal aortic aneurysms: a systematic review

This systematic review focuses on the 30-day mortality associated with open surgery and fenestrated endografts for short-necked

GREEN INFRASTRUCTURE IN A WATER SOURCE AREA: A STUDY FOR THE BILLINGS DAM

Embora sirva ao abastecimento de água desde a década de 1950 e seja protegida por leis desde a década de 1970, a represa Billings teve seu entorno ocupado de maneira inadequada, o que comprometeu significativamente a qualidade de suas águas.  Com a “crise hídrica” de 2014-2015 tornou-se evidente a sua importância estratégica já que possui potencial para triplicar a população atendida. Para que isso se torne viável é preciso evitar que o reservatório continue sendo degrada pelo despejo de esgoto não tratado e pela carga de poluição difusa trazida pelo escoamento superficial das chuvas em áreas urbanizadas. Este trabalho investiga como a infraestrutura verde pode ajudar a conciliar a ocupação do entorno da Billings com a produção de água de boa qualidade.  Apresenta um método, diretrizes e ensaio projetual para uma sub-bacia do Ribeirão Cocaia, curso d’água afluente da Billings.Although it is used as a source of water supply since the 1950s and has been protected by legislation since the 1970s, the Billings Dam has had its surroundings inadequately occupied, which has significantly compromised the quality of its waters. With the “water crisis” during 2014-2015, its strategic importance became evident since it has the potential to triplicate the population served. For this to be feasible it is necessary to avoid that the reservoir continues being degraded by the discharge of untreated sewage and by the diffuse pollution brought by the surface runoff of the rains of urbanized areas. This article investigates how the green infrastructure can help reconcile the occupation of the Billings Dam surroundings with the production of potable water. It presents a method, guidelines and a design essay for a sub-basin of Ribeirão Cocaia, an affluent of Billings Dam

Hemodynamic depression after carotid surgery: Incidence, risk factors and outcomes

Introduction: Hemodynamic Depression (HD) characterized by hypotension and bradycardia is a complication of carotid surgery due to direct autonomic stimulation in the carotid sinus. The authors believe the incidence of HD is high and possibly related to major cardiac complications. Methods: Analysis of patient records during admissions for carotid surgery between January 2014 and December 2018 in two hospitals. HD was defined as bradycardia or hypotension in the first 24 postoperative hours. Bradycardia was defined as heart rate < 50bpm; hypotension as systolic blood pressure < 90 mmHg, continuous use of vasopressors, or a drop in SBP > 20% compared to preoperative values. Myocardial infarction, stroke, and cardiovascular death were defined as adverse events. Results: Overall, 237 carotid surgeries (178 endarterectomies, 59 angioplasties) were studied, and the global incidence of HD was 54.4% (hypotension in 50.2%, bradycardia in 11.0%, and hypotension and bradycardia in 6.8%). The independent predictors of HD were asymptomatic carotid stenosis (OR = 1.824; 95% CI 1.014–3.280; p = 0.045), endovascular surgery (OR = 3.319; 95% CI 1.675–6.576; p = 0.001) and intraoperative hypotension or bradycardia (OR = 2.144; 95% CI 1.222–3.762; p = 0.008). Hypotension requiring continuous vasopressor infusion was the only factor independently associated with adverse cardiovascular events (OR = 5.504; 95% CI 1.729–17.529; p = 0.004). Discussion/conclusion: Incidence of Hemodynamic Depression after carotid surgery is high and independently associated with surgical technique, symptomatic repercussion of the carotid stenosis, and intraoperative hypotension or bradycardia. Hypotension requiring the continuous infusion of vasopressors was independently associated with the occurrence of MACE

Experimental implantation of an arterial substitute made of silicone reinforced with polyester fabric in rabbits

OBJECTIVES: The aim of this study was to analyze silicone tubes with an internal diameter of 4 mm as a possible material for vascular prostheses. METHODS: Grafts were implanted into the infrarenal aortas of 33 rabbits. Fluoroscopic examinations were performed within 150 days after surgical implantation. Sample grafts were analyzed via electron microscopy to evaluate the eventual endothelialization of the prostheses. RESULTS: The patency rates of the prostheses were 87% (±6.7%) after 30 days, 73% (±9.3%) after 60 days and 48% (±12%) after 120 days. The material presented characteristics that support surgical implantation: good tolerance promoted by polyester tear reinforcement, ease of postoperative removal and a lack of pseudoaneurysms. However, intimal hyperplasia was a limiting factor for the patency rate. CONCLUSIONS: We concluded that polydimethylsiloxane has limited potential as an alternative material for small vascular prostheses

Meta-analysis of infrapopliteal angioplasty for chronic critical limb ischemia

BackgroundPercutaneous transluminal angioplasty has been used with increasing frequency in the treatment of infrainguinal arterial occlusive disease. This meta-analysis aimed to assess the middle-term outcomes after crural angioplasty in patients with chronic critical limb ischemia and compare results with a meta-analysis of popliteal-to-distal vein bypass graft.MethodsData were retrieved from 30 articles published from 1990 through 2006 (63% of articles published between 2000 and 2006). All studies used survival analysis, reported a 12-month cumulative rate of patency or limb salvage, and included at least 15 infrapopliteal angioplasties. The outcome measures were immediate technical success, primary and secondary patency, limb salvage, and patient survival. Data from life-tables, survival curves, and texts were used.ResultsThe pooled estimate of success was 89.0% ± 2.2% for immediate technical result. Results at 1 and 36 months were 77.4% ± 4.1% and 48.6% ± 8.0% for primary patency, 83.3% ± 1.4% and 62.9% ± 11.0% for secondary patency, 93.4% ± 2.3% and 82.4% ± 3.4% for limb salvage, and 98.3% ± 0.7% and 68.4% ± 5.5% for patient survival, respectively. Studies with >75% of the limbs with tissue loss fared worse than their respective comparative subgroup for technical success and patency but not for limb salvage or survival. No publication bias was detected.ConclusionThe technical success and subsequent durability of crural angioplasty are limited compared with bypass surgery, but the clinical benefit is acceptable because limb salvage rates are equivalent to bypass surgery. Further studies are necessary to determine the proper role of infrapopliteal angioplasty