Relatório de estágio: intervenção em fisioterapia na sindrome da cirurgia lombar falhada

Introdução: A síndrome da cirurgia lombar falhada (SCLF) caracteriza-se pela persistência ou recidiva da dor ou aparecimento de novos sintomas após discectomia, descompressão de canal estreito ou artrodese lombares. Objectivos: O objectivo deste estudo foi descrever a abordagem em fisioterapia de um caso com Síndrome da Cirurgia Lombar Falhada e avaliar os seus efeitos na funcionalidade e sintomatologia dolorosa neste indivíduo. Metodologia: A amostra foi constituída por um sujeito com 41 anos, trabalhador da construção civil, apresentando dor lombar com irradiação para o membro inferior, após ter sido submetido a discectomia lombar e artrodese, que realizou sessões de fisioterapia convencional antes e depois da cirurgia, e que apresentava sinais compatíveis com compressão radicular. A intensidade da dor foi medida através da escala visual analógica (EVA), as amplitudes com o goniómetro universal, a funcionalidade foi avaliada utilizando o Questionário de Incapacidade Roland-Morris (RMDQ), o estado psicológico foi avaliado através da “Escala de Desânimo Associado à Dor” e do “Inventário de Convicções e Percepções Relacionadas com a Dor”. Resultados: A dor era inicialmente em média de 5,5/10 EVA, sendo de 3,4/10 EVA no final do tratamento. Quanto à funcionalidade (RMDQ) esta variou de 14/24 no início para 17/24 no final. De uma forma geral, após a aplicação de técnicas para diminuir a tensão do piriforme, técnicas neuurodinâmicas e um programa de exercícios para melhoria do controlo motor, o paciente apresentou alívio das queixas de dor na nádega esquerda e anca, aumento da amplitude de rotação medial da coxo-femoral, ausência das parestesias na face plantar do pé esquerdo e melhoria das queixas de dor na face anterior e lateral da coxa. Verificamos que houve diminuição dos índices de dor e melhorias dos níveis de funcionalidade. Conclusão: Neste estudo de caso, foi salientado o processo de raciocínio clínico desenvolvido pelo fisioterapeuta: a interpretação dos dados da história e levantamento das primeiras hipóteses e a realização dos testes no exame objectivo, permitiram estabelecer um diagnóstico funcional e elaborar um plano de intervenção através do qual o utente recuperou parcialmente a sua funcionalidade e diminuiu os seus índices de dor.

Solving Conflicting Beliefs with a Distributed Belief Revision Approach

The ability to solve conflicting beliefs is crucial for multi- agent systems where the information is dynamic, incomplete and dis- tributed over a group of autonomous agents. The proposed distributed belief revision approach consists of a distributed truth maintenance sy- stem and a set of autonomous belief revision methodologies. The agents have partial views and, frequently, hold disparate beliefs which are au- tomatically detected by system’s reason maintenance mechanism. The nature of these conflicts is dynamic and requires adequate methodolo- gies for conflict resolution. The two types of conflicting beliefs addressed in this paper are Context Dependent and Context Independent Conflicts which result, in the first case, from the assignment, by different agents, of opposite belief statuses to the same belief, and, in the latter case, from holding contradictory distinct beliefs. The belief revision methodology for solving Context Independent Con- flicts is, basically, a selection process based on the assessment of the cre- dibility of the opposing belief statuses. The belief revision methodology for solving Context Dependent Conflicts is, essentially, a search process for a consensual alternative based on a “next best” relaxation strategy.

Beliefs and Conflicts in a Real World Multi-Agent System

In a real world multiagent system, where the agents are faced with partial, incomplete and intrinsically dynamic knowledge, conflicts are inevitable. Frequently, different agents have goals or beliefs that cannot hold simultaneously. Conflict resolution methodologies have to be adopted to overcome such undesirable occurrences. In this paper we investigate the application of distributed belief revision techniques as the support for conflict resolution in the analysis of the validity of the candidate beams to be produced in the CERN particle accelerators. This CERN multiagent system contains a higher hierarchy agent, the Specialist agent, which makes use of meta-knowledge (on how the con- flicting beliefs have been produced by the other agents) in order to detect which beliefs should be abandoned. Upon solving a conflict, the Specialist instructs the involved agents to revise their beliefs accordingly. Conflicts in the problem domain are mapped into conflicting beliefs of the distributed belief revision system, where they can be handled by proven formal methods. This technique builds on well established concepts and combines them in a new way to solve important problems. We find this approach generally applicable in several domains.

Immunohistochemical molecular phenotypes of gastric cancer based on SOX2 and CDX2 predict patient outcome

Background Gastric cancer remains a serious health concern worldwide. Patients would greatly benefit from the discovery of new biomarkers that predict outcome more accurately and allow better treatment and follow-up decisions. Here, we used a retrospective, observational study to assess the expression and prognostic value of the transcription factors SOX2 and CDX2 in gastric cancer. Methods SOX2, CDX2, MUC5AC and MUC2 expression were assessed in 201 gastric tumors by immunohistochemistry. SOX2 and CDX2 expression were crossed with clinicopathological and follow-up data to determine their impact on tumor behavior and outcome. Moreover, SOX2 locus copy number status was assessed by FISH (N = 21) and Copy Number Variation Assay (N = 62). Results SOX2 was expressed in 52% of the gastric tumors and was significantly associated with male gender, T stage and N stage. Moreover, SOX2 expression predicted poorer patient survival, and the combination with CDX2 defined two molecular phenotypes, SOX2+CDX2- versus SOX2-CDX2+, that predict the worst and the best long-term patients’ outcome. These profiles combined with clinicopathological parameters stratify the prognosis of patients with intestinal and expanding tumors and in those without signs of venous invasion. Finally, SOX2 locus copy number gains were found in 93% of the samples reaching the amplification threshold in 14% and significantly associating with protein expression. Conclusions We showed, for the first time, that SOX2 combined with CDX2 expression profile in gastric cancer segregate patients into different prognostic groups, complementing the clinicopathological information. We further demonstrate a molecular mechanism for SOX2 expression in a subset of gastric cancer cases.

Audiologists’ preferences for patient-centredness: a cross-sectional questionnaire study of cross-cultural differences and similarities among professionals in Portugal, India and Iran

Objective Patient-centredness has become an important aspect of health service delivery; however, there are a limited number of studies that focus on this concept in the domain of hearing healthcare. The objective of this study was to examine and compare audiologists’ preferences for patient-centredness in Portugal, India and Iran. Design The study used a cross-sectional survey design with audiologists recruited from three different countries. Participants A total of 191 fully-completed responses were included in the analysis (55 from Portugal, 78 from India and 58 from Iran). Main outcome measure The Patient–Practitioner Orientation Scale (PPOS). Results PPOS mean scores suggest that audiologists have a preference for patient-centredness (ie, mean of 3.6 in a 5-point scale). However, marked differences were observed between specific PPOS items suggesting these preferences vary across clinical situations. A significant level of difference (p<0.001) was found between audiologists’ preferences for patient-centredness in three countries. Audiologists in Portugal had a greater preference for patient-centredness when compared to audiologists in India and Iran, although no significant differences were found in terms of age and duration of experience among these sample populations. Conclusions There are differences and similarities in audiologists’ preferences for patient-centredness among countries. These findings may have implications for the training of professionals and also for clinical practice in terms of optimising hearing healthcare across countries.