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BACKGROUND While endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) is considered a preferred technique for tissue sampling for solid lesions, fine needle biopsy (FNB) has recently been developed. AIM To compare the accuracy of FNB vs FNA in determining the diagnosis of solid lesions. METHODS A retrospective, multi-center study of EUS-guided tissue sampling using FNA vs FNB needles. Measured outcomes included diagnostic test characteristics (i.e., sensitivity, specificity, accuracy), use of rapid on-site evaluation (ROSE), and adverse events. Subgroup analyses were performed by type of lesion and diagnostic yield with or without ROSE. A multivariable logistic regression was also performed. RESULTS A total of 1168 patients with solid lesions (n = 468 FNA; n = 700 FNB) underwent EUS-guided sampling. Mean age was 65.02 ± 12.13 years. Overall, sensitivity, specificity and accuracy were superior for FNB vs FNA (84.70% vs 74.53%; 99.29% vs 96.62%; and 87.62% vs 81.55%, respectively; P < 0.001). On subgroup analyses, sensitivity, specificity, and accuracy of FNB alone were similar to FNA + ROSE [(81.66% vs 86.45%; P = 0.142), (100% vs 100%; P = 1.00) and (88.40% vs 85.43%; P = 0.320]. There were no difference in diagnostic yield of FNB alone vs FNB + ROSE (P > 0.05). Multivariate analysis showed no significant predictor for better accuracy. On subgroup analyses, FNB was superior to FNA for non-pancreatic lesions; however, there was no difference between the techniques among pancreatic lesions. One adverse event was reported in each group. CONCLUSION FNB is superior to FNA with equivalent diagnostic test characteristics compared to FNA + ROSE in the diagnosis of non-pancreatic solid lesions. Our results suggest that EUS-FNB may eliminate the need of ROSE and should be employed as a first-line method in the diagnosis of solid lesions.

Este artigo explora as relações entre psicanálise e fotografia a partir do Serviço Fotográfico da Salpêtrière, onde Freud realizou, em 1886, um estágio de pesquisa com Jean-Martin Charcot. À luz do trabalho de Georges Didi-Huberman, o objetivo deste artigo é mostrar de que maneira a fotografia pode se prestar a uma investigação psicanalítica. A começar pela Salpêtrière, com toda sua importância na história da psicanálise, cuja relevância fica ainda mais evidente quando a ênfase recai sobre sua célebre iconografia fotográfica. Resumos This paper focuses on the relationships between psychoanalysis and photography, stemming from the Photographic Service of the Salpêtrière, where Freud did a research internship in 1886 with Jean-Martin Charcot. Drawing significantly on the work of Georges Didi-Huberman, the purpose of this paper is to show how photography might be useful to a psychoanalytic investigation – starting with Salpêtrière, with all its importance in the history of psychoanalysis, which relevance becomes particularly evident when we consider the Salpêtrière´s photographic iconography. Cet article porte sur les relations entre la psychanalyse et la photographie à partir du Service de photographie de la Salpêtrière, où Freud a effectué un stage de recherche en 1886 avec Jean-Martin Charcot. À la lumière du travail de Georges Didi-Huberman, le but de cet article est de montrer comment la photographie peut se prêter à une investigation psychanalytique, en commençant par la Salpêtrière, dont l’importance pour l’histoire de la psychanalyse devient encore plus évidente lorsqu’on prend en considération sa célèbre iconographie photographique. Este artículo explora las relaciones entre el psicoanálisis y la fotografía a partir del Servicio Fotográfico de la Salpêtrière, lugar en el que Freud realizó, en 1886, una pasantía de investigación con Jean-Martin Charcot. A la luz del trabajo de Georges Didi-Huberman, el propósito de este artículo es mostrar cómo la fotografía puede prestarse a una investigación psicoanalítica, comenzando por la Salpêtrière, con toda su importancia en la historia de psicoanálisis, cuya relevancia se hace más evidente cuando se hace hincapié en su célebre Iconografía Fotográfica.

O trauma, como co(rpo)memoração, será abordado, neste trabalho, na perspectiva psicanalítica, com base nos desdobramentos que se manifestam em “atos” no corpo que tomam o lugar da elaboração psíquica. Perspectiva na qual a repetição se apresenta sob a modalidade da fixação a um gozo “além” e da regressão como uma espécie de memória que evita o encontro com o novo e retorna a traços de memória deixados no corpo. Para tanto, será tomado como referência o pesadelo vivido e narrado pela ativista Eve Ensler, no relato de cunho testemunhal, em seu livro No corpo do mundo: um livro de memórias (2014). Ensler fala da relação profundamente íntima e dolorosa que tem com seu corpo e como esta mudou ao longo de sua vida, depois de conviver com mulheres que tinham experimentado a violência e o sofrimento da violação de seus corpos. Resumos This paper discusses trauma as an in-body memory based on ramifications that are manifested as “acts” in the body, and which replace psychic elaborations. In thispsychoanalytic perspective, repetition is manifested as fixation to a joissance “beyond” and as regression as a kind of memory that avoids the new and looks to traces of past memory left in the body. To this end, the nightmare lived and narrated by activist Eve Ensler in her book In the body of the world: A memoir (2014), will be used as reference. Ensler speaks of the deeply intimate and painful relationship she has with her body and how it changed throughout her life, after spending time with women victims of sexual violence. Cet article traite du traumatisme, comme co(rps)mmémoration basée sur des déroulements qui se manifestent comme des “actes” dans le corps, et qui remplacent les élaborations psychiques. Dans cette perspective psychanalytique, la répétition se manifeste comme une fixation à une jouissance “au-delà” et comme une régression en tant que type de mémoire qui évite la rencontre avec le nouveau et renvoie à des traces de mémoire laissées sur le corps. À cette fin, le cauchemar vécu et raconté par l’activiste Eve Ensler dans son livre Dans le corps du monde: une mémoire (2014), sera utilisé comme référence. Ensler y parle du rapport profondément intime et douloureux qu’elle entretient avec son corps et de la façon dont elle a évolué au cours de sa vie, après avoir vécu avec des femmes victimes des violences sexuelles. El trauma, como forma de c(uerp)onmemoración, será abordado, en este trabajo, desde la perspectiva psicoanalítica, a partir de los desdoblamientos que se manifiestan en “actos” en el cuerpo que ocupan el lugar de la elaboración psíquica. Una perspectiva en la que la repetición se presenta bajo la modalidad de fijación a un goce “más allá” y de regresión como una especie de memoria que evita el encuentro con lo nuevo y vuelve a las huellas de la memoria dejados en el cuerpo. Para ello, se tomará como referencia la pesadilla vivida y narrada por la activista Eve Ensler, en el relato testimonial de su libro De Pronto, Mi Cuerpo: Una Memoria (2015). Ensler habla de la relación profundamente íntima y dolorosa que mantiene con su cuerpo y de cómo ésta ha cambiado a lo largo de su vida, tras convivir con mujeres que habían experimentado la violencia y el sufrimiento de la violación de sus cuerpos.

Highlights • Diagnosis and management of benign hepatobiliary diseases are often challenging. • SpyGlass cholangioscopy has enhanced the diagnosis of biliary diseases. • A multidisciplinary approach can ensure diagnosis and treatment of patients with hepatobiliary diseases. • Association of laparoscopic hepaticojejunostomy to SpyGlass cholangioscopy is a safe and minimal invasive procedure., Introduction Careful evaluation of intrahepatic injury of biliary tract diseases is crucial to assure proper management and estimate disease prognosis. Hepatholithiasis is a rare condition that can be associated to cholestatic liver diseases. Additional tools to improve diagnosis and patient care are of great interest specially if associated to decreased morbidity. Recently the spread of single-operator platforms of cholangioscopy brought this procedure back to scene. Our aim was to identify safety, feasibility and utility of SpyGlass cholangioscopy of biliary tract during laparoscopic hepaticojejunostomy. Presentation of case A 53 years-old man with hepatolithiasis associated to choledolithiasis under treatment with ursodeoxycholic acid and fenofibrate for 8 months, was submitted to laparoscopic hepaticojejunostomy with cholangioscopy for biliary duct evaluation. Spyscope was inserted through a right lateral laparoscopic trocar entering the common bile duct. Examination of intra-hepatic bile ducts showed injury of right biliary. Few microcalculi were visualized. Left biliary ducts presented normal mucosa. Histopathological examination showed a chronic inflammatory process. During the procedure contrasted radiologic images were performed to assure Spyscope location. Following cholangioscopy evaluation, a Roux-en-Y hepaticojejunostomy was performed. To enlarge hepatic duct, a small longitudinal incision was made, and a PDS-5.0 running suture was used for bilioenteric anastomosis. Patient was discharged on postoperative day 6, with drain removal on day 20. Conclusion SpyGlass cholangioscopy during laparoscopic hepaticojejunostomy is feasible leading to minimal additional invasion of the surgical. In this case the method was performed safely, providing detailed examination of injured biliary ducts, adding elements to determine disease prognosis and patient care.

A conferência apresenta duas partes. Na primeira, tematiza a estrutura do conflito psíquico a partir das categorias lacanianas real, simbólico e imaginário. Na segunda, aborda a presença da guerra na vida cotidiana através da manifestação esportiva do futebol visto como a sublimação das pulsões destrutivas. Palavras-chave: psicanálise, conflito, guerra, sublimação, futebol.

Background and study aims Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) is traditionally considered a first-line strategy for diagnosing pancreatic lesions; however, given less than ideal accuracy rates, fine-needle biopsy (FNB) has been recently developed to yield histological tissue. The aim of this study was to compare diagnostic yield and safety between EUS-FNA and EUS-FNB in sampling of pancreatic masses. Patients and methods This was a multicenter retrospective study to evaluate efficacy and safety of EUS-FNA and EUS-FNB for pancreatic lesions. Baseline characteristics including sensitivity, specificity, and accuracy, were evaluated. Rapid on-site evaluation (ROSE) diagnostic adequacy, cell-block accuracy, and adverse events were analyzed. Subgroup analyses comparing FNA versus FNB route of tissue acquisition and comparison between methods with or without ROSE were performed. Multivariable logistic regression was also performed. Results A total of 574 patients (n = 194 FNA, n = 380 FNB) were included. Overall sensitivity, specificity, and accuracy of FNB versus FNA were similar [(89.09 % versus 85.62 %; P = 0.229), (98.04 % versus 96.88 %; P = 0.387), and 90.29 % versus 87.50 %; P = 0.307)]. Number of passes for ROSE adequacy and cell-block accuracy were comparable for FNA versus FNB [(3.06 ± 1.62 versus 3.04 ± 1.88; P = 0.11) and (3.08 ± 1.63 versus 3.35 ± 2.02; P = 0.137)]. FNA + ROSE was superior to FNA alone regarding sensitivity and accuracy [91.96 % versus 70.83 %; P Conclusion EUS-FNB allowed for more consistent cell-block evaluation as compared to EUS-FNA. EUS-FNA + ROSE was found to have a similar sensitivity to EUS-FNB alone suggesting a reduced need for ROSE as part of the standard algorithm of pancreatic sampling. While FNB alone produced similar diagnostic findings to EUS-FNA + ROSE, FNB + ROSE still was noted to increase diagnostic yield. This finding may favor a unique role for FNB + ROSE, suggesting it may be useful in cases when previous EUS-guided sampling may have been indeterminate.

Este artigo propõe um sistema para a geração e validação de diplomas e certificados onde os documentos sejam confiáveis e facilmente verificáveis. Para isso foi utilizada a rede blockchain pública da Ethereum aliada com uma rede de arquivos distribuída usando o protocolo InterPlanetary File System e ferramentas de código aberto. O modelo mostra que a realização do sistema é viável, englobando propriedades de sistemas off-chain e on-chain para a arquitetura proposta.

O presente trabalho objetiva discorrer sobre como a psicanálise considera o processo de constituição do sujeito, tomando como base o grafo do desejo estabelecido por Jacques Lacan no final da década de 50 como modelo que coloca em correlação o processo de constituição subjetiva e os processos encontrados em uma análise. Será realizada uma investigação sobre a subversão da ordem instintual quando se é constituído pelo significante. Para isso, considerou-se necessário abordar o decurso das primeiras relações da criança com o outro, tratando das relações do sujeito mítico da necessidade, do atravessamento da demanda, e do seu mais além, o desejo. The present work aims to discuss how psychoanalysis considers the process of constitution of the subject, based on graph of desire established by Jacques Lacan at the end of the 50s as the model that puts in correlation the process of subjective constitution and the process found within the psychoanalytic clinic. An investigation will be carried out on the subversion of the instinctive order when the subject is constituted by the signifier. For this, it was considered necessary to address the course of the child’s first relations with the other, addressing the relationships of the mythical subject of need, the crossing of demand, and its beyond, the desire. El presente trabajo tiene como objetivo discutir cómo el psicoanálisis considera el proceso de constitución del sujeto, basado en el grafo del deseo establecido por Jacques Lacan a fines de los años 50, como un modelo que correlaciona el proceso de constitución subjetiva y los procesos encontrados en la clínica psicoanalítica. Se realizará una investigación sobre la subversión del instinto cuando la constitución ocurre a través del significante. Para esto, se consideró necesario abordar el curso de las primeras relaciones del niño con el otro, abordando las relaciones del sujeto mítico de la necesidad, del cruce de la demanda, y del tú más allá, el deseo. Le présent travail cherche à discuter de la manière dont la psychanalyse considère le processus de constitution du sujet, basé sur le graphe du désir établi par Jacques Lacan à la fin des années 1950 comme modèle qui met en corrélation le processus de constitution du sujet et les processus trouvés dans la clinique psychanalytique. Une enquete sera menée sur la subversion de l’instinct quand il est constitué par le signifiant. Pour cela, il a été jugé nécessaire d’aborder le cours des premières relations de l’enfant avec l’autre, traitant des relations du sujet mytique de la nécessité, du croisement de la demande, et voire au-delà, le désir.

O presente trabalho objetiva discorrer sobre como a psicanálise considera o processo de constituição do sujeito, tomando como base o grafo do desejo estabelecido por Jacques Lacan no final da década de 50 como modelo que coloca em correlação o processo de constituição subjetiva e os processos encontrados em uma análise. Será realizada uma investigação sobre a subversão da ordem instintual quando se é constituído pelo significante. Para isso, considerou-se necessário abordar o decurso das primeiras relações da criança com o outro, tratando das relações do sujeito mítico da necessidade, do atravessamento da demanda, e do seu mais além, o desejo.

Embora a homossexualidade não esteja mais no rol das psicopatologias, em muitos países ainda é considerada crime, passível de punição que chega à pena de morte. O avanço na conquista dos direitos homoafetivos trouxe, na mesma medida, o aumento do ultraconservadorismo, expresso em violência. Para Freud, a homossexualidade é tão enigmática quanto a heterossexualidade, mas a crença na complementaridade sexual - impossível para a psicanálise - talvez seja um fator que leve muitos transexuais a buscar harmonizar sexo e gênero. Autoidentificados como homossexuais antes de se dizerem transexuais, a escuta desses sujeitos revela que a adequação do corpo transexual pode estar a serviço da homofobia cultural e internalizada do próprio homossexual. Seria a demanda transexual de corresponder o corpo à alma uma tentativa subreptícia de negação da homossexualidade na contemporaneidade?

The conference has two parts. The first one is about the structure of the psychic conflict understood with the lacanian categoriesreal, symbolic, imaginary. The second focuses the presence of war in daily life approaching soccer as the sublimation of destructive drives. A conferência apresenta duas partes. Na primeira, tematiza a estrutura do conflito psíquico a partir das categorias lacanianas real,simbólico e imaginário. Na segunda, aborda a presença da guerra na vida cotidiana através da manifestação esportiva do futebol visto como a sublimação das pulsões destrutivas.

Este artigo pretende refletir sobre as falas dos sujeitos em tratamento psicanalítico durante a pandemia de COVID-19 pelo novo coronavírus (SARS-CoV-2) e, para tanto, elegeu alguns significantes que se impuseram à escuta dos psicanalistas ao longo do tempo. This article aims to reflect on the discourses of subjects who are undergoing psychoanalytic treatment during the COVID-19 pandemic caused by the new coronavirus (SARS-CoV-2). To achieve that goal, we selected some signifiers which imposed themselves to the therapists’ listening over time. Cet article entend réfléchir sur les discours des sujets sous traitement psychanalytique lors de la pandémie de COVID-19 par le nouveau coronavirus (SARS-CoV-2) et, à cet effet, a élu certains signifiants qui se sont imposés à l’écoute des thérapeutes au fil du temps. Este artículo pretende reflexionar sobre el discurso de los sujetos en tratamiento psicoanalítico durante la pandemia de COVID-19, ocasionado por el nuevo coronavirus (SARS-CoV-2) y, para ello, se eligieron algunos significantes que se impusieron a lo largo del tiempo a la escucha de los terapeutas.

Este artigo pretende refletir sobre as falas dos sujeitos em tratamento psicanalítico durante a pandemia de COVID-19 pelo novo coronavírus (SARS-CoV-2) e, para tanto, elegeu alguns significantes que se impuseram à escuta dos psicanalistas ao longo do tempo.

Endoscopic sleeve gastroplasty (ESG) has emerged as a promising technique in endoscopic bariatric and metabolic therapies (EBMTs). We aimed to perform a systematic review and meta-analysis to provide an update on its efficacy and safety. This is a systematic review and meta-analysis was performed following the PRISMA guidelines. MEDLINE, Cochrane, EMBASE, and LILACS were searched to identify the studies related to ESG. Eleven studies with a total of 2170 patients were included. The average BMI pre-ESG was 35.78 kg/m2. Pooled mean %TWL observed at 6, 12, and 18 months was 15.3%, 16.1%, and 16.8% respectively. Pooled mean %EWL at 6, 12, and 18 months was 55.8%, 60%, and 73% respectively. No procedure-related mortality was reported. ESG is a safe and effective procedure for primary obesity therapy with promising short- and mid-term results.

The Fog of Things (FoT) proposes a paradigm which uses the Fog Computing concept to deploy Internet of Things (IoT) applications. The FoT exploits the processing, storage, and network capacity of local resources, allowing for the integration of different devices in a seamless IoT architecture, and it defines the components which compose the FoT paradigm describing their characteristics. This chapter presents the FoT paradigm and relates it to IoT architecture describing the main characteristics and concepts from the sensor and actuator communication to gateways, and local and cloud servers. Lastly, this chapter presents SOFT-IoT platform as a concrete implementation of FoT, which uses microservice infrastructure distributed along devices in the IoT system.