Corpos Queer e a experiência da sexualidade: notas para o conhecimento da educação física

This study had the goal of make a dialogue between queer theory and the thoughts of the French philosopher Maurice Merleau-Ponty in the categories of body and sexuality. From this dialogue, other goals were designed, namely: identify possible recurrences of the experience of bodies and queer sexualities, designed under Merleau-Ponty’s perspective, to the knowledge of Physical Education and reflect on this domain of knowledge using the notions of queer epistemology and esthesia. The study had as methodology the phenomenological attitude proposed by Merleau-Ponty and use the reduction as technic of research. Trying linking these thoughts we used the cinema of the Spanish director Pedro Almodóvar as perceptive strategy, an exercise of look as possibility of reading the world and new ways of perceiving the human being. We appreciate three films, namely: All About My Mother (1999), The Skin I Live In (2011) and Bad Education (2004), which put us in touch with bodies and queer sexualities, with the body of esthesia, of the ecstasy, sensations and lived experiences, un type of art whose contours are not fixed or determinable, postulate by Merleau-Ponty. The philosopher, provide a rich conceptual view of the body and their sexual experience, extends and opens horizons of thought and reflection about queer experience, one experience indeterminate and contingent as a singular way of inhabiting the world. Those horizons opened by the philosopher and added to the queer perspective contribute to put in question the modes of knowledge production and the knowledge about body and sexuality in Physical Education. Finally, we point that this theoretical conversation give us clues to reflect about the reverberations of a queer epistemology for Physical Education usiging one type of knowledge guided by esthesia and sensitivity as marks of another scientific rationality.

Acquired Cold Urticaria: Clinical Features, Particular Phenotypes, and Disease Course in a Tertiary Care Center Cohort

BACKGROUND: Data about special phenotypes, natural course, and prognostic variables of patients with acquired cold urticaria (ACU) are scarce. OBJECTIVES: We sought to describe the clinical features and disease course of patients with ACU, with special attention paid to particular phenotypes, and to examine possible parameters that could predict the evolution of the disease. METHODS: This study was a retrospective chart review of 74 patients with ACU who visited a tertiary referral center of urticaria between 2005 and 2015. RESULTS: Fourteen patients (18.9%) presented with life-threatening reactions after cold exposure, and 21 (28.4%) showed negative results after cold stimulation tests (classified as atypical ACU). Nineteen patients (25.7%) achieved complete symptoms resolution at the end of the surveillance period and had no subsequent recurrences. Higher rates of atypical ACU along with a lower likelihood of achieving complete symptom resolution was observed in patients who had an onset of symptoms during childhood (P < .05). In patients with atypical ACU, shorter disease duration and lower doses of antihistamines required for achieving disease control were detected (P < .05). Age at disease onset, symptom severity, and cold urticaria threshold values were found to be related to disease evolution (P < .05). LIMITATIONS: This study was limited by its retrospective nature. CONCLUSIONS: The knowledge of the clinical predictors of the disease evolution along with the clinical features of ACU phenotypes would allow for the establishment of an early and proper therapeutic strategy.

Minimally invasive repair of Morgagni hernia - A multicenter case series

Children may benefit from minimally invasive surgery (MIS) in the correction of Morgagni hernia (MH). The present study aims to evaluate the outcome of MIS through a multicenter study. National institutions that use MIS in the treatment of MH were included. Demographic, clinical and operative data were analyzed. Thirteen patients with MH (6 males) were operated using similar MIS technique (percutaneous stitches) at a mean age of 22.2±18.3 months. Six patients had chromosomopathies (46%), five with Down syndrome (39%). Respiratory complaints were the most common presentation (54%). Surgery lasted 95±23min. In none of the patients was the hernia sac removed; prosthesis was never used. In the immediate post-operative period, 4 patients (36%) were admitted to intensive care unit (all with Down syndrome); all patients started enteral feeds within the first 24h. With a mean follow-up of 56±16.6 months, there were two recurrences (18%) at the same institution, one of which was repaired with an absorbable suture; both with Down syndrome. The application of MIS in the MH repair is effective even in the presence of comorbidities such as Down syndrome; the latter influences the immediate postoperative recovery and possibly the recurrence rate. Removal of hernia sac does not seem necessary. Non-absorbable sutures may be more appropriate.

Constructions of Clinical Psychology in Adult Mental Health: A Discursive Thematic Analysis

In face of the current economic-political changes facing the UK and its State institutions and of the new evidence about the impact of social inequality on human distress, this study attempts to understand the increasing practice of delivering psychological therapy by the British clinical psychology profession. A review of the critical histories of the profession in the UK identified the need for a more detailed study of the “history of the present” to reveal the discursive operations that construct professional practice. A discursive thematic analysis (DTA) based on the theoretical concepts of the late post-modern scholar Michel Foucault was used to explore public available documents produced by British clinical psychologists between 2010 and 2014. Two dominant professional discursive themes were identified: alternative and leadership. These themes were found to be supported by the discursive sub-themes of applied science, well-being, Cognitivism and therapy which align the aspiration of the profession with those of the State. The tension between the applied scientist and the therapist role - specifically the need to establish simultaneously the profession’s scientific credibility and its therapeutic abilities in order to respond to market pressures – showed recurrences of the conflicts of the early history of professionalization of clinical psychology. The positioning of clinical psychology against the use of functional psychiatric diagnosis and the challenges and opportunities identified by the opening of the NHS market to ‘any willing provider’ revealed how professional discourses operate to maintain the status quo. This study recommends that the socio-historical construction of the profession should be investigated further, in particular through the subjugated discourse identified here

Recurrent varicose veins of the lower limbs after surgery. Role of surgical technique (stripping vs. CHIVA) and surgeon’s experience

Background. Surgical treatment of varicose veins of the lower limbs resolves symptoms and improves quality of life. However, the high recurrence (20-80%) is a costly and complex issue. Patients and methods. This is a retrospective review of 1489 patients with varicose vein of the lower limbs seen at our hospital between January 1980 and December 2005. The aim is to evaluate the effect of surgical technique (stripping vs. CHIVA) and surgeon’s experience in reducing recurrences. Results. With experienced surgeons, CHIVA appears to be more effective than stripping in reducing the recurrence rate (p <0.05). However, when performed by an inexperienced surgeon the results are far worse than those achieved with stripping. Conclusion. There was a clear reduction in recurrences at 5-10 years with CHIVA than with conventional stripping. However, if performed incorrectly, results are far worse with CHIVA. In fact, good results are far more difficult to achieve with CHIVA than with stripping, which is repeatable and easy to perform.

Surgical management of symptomatic simple hepatic cysts

The authors present three cases of symptomatic, large, benign, nonparasitic hepatic cysts. The diagnosis was determined by US and CT scan, the latter enabling differential diagnosis with neoplastic or hydatid cysts. All patients were treated with open hepatic resection. In 2 cases, laparoscopy was performed to enable complete diagnosis. The authors used LigaSure™ (Covidien, USA) instrument, avoiding bleeding complications and reducing surgery time. Histological examination confirmed the diagnosis of benigntic cysts. CT follow-up at 6 months and 1 year demonstrated the efficacy of the surgery, with no recurrences.

Modified patch repair of femoral hernia after inguinal herniorrhaphy

Background and aim. It has been reported that femoral hernias are rather common after a previous repair of inguinal hernia. We herein present a modified patch repair technique for large femoral hernias that develop after a Lichtenstein operation for ipsilateral inguinal hernia. Patients and methods. The modified technique for femoral hernia was applied to three patients who had a Lichtenstein repair for inguinal hernia. All patients were male. Hernia sac is dissected completely and sent back into to the preperitoneal space. Special attention should be given to the prevascular component of the sac. It is dissected as deep as possible into the preperitoneal space over the femoral vein. The defect is quite wide in this particular type of femoral hernia following Lichtenstein repair. A prosthetic patch that matches the defect is prepared. The medial edge of the mesh is configured to correspond to the pubic corner and lacunar ligament. The lateral margin of the patch is cut to create several petals for inverting the mesh above and medial to the femoral vein to prevent prevascular herniation. The mesh is secured to inguinal ligament, ilioinguinal tract, lacunar ligament, and Cooper ligament. Few sutures are put on the pubic corner and lacunar ligament. Results. One patient was discharged after two hours, other two stayed overnight. Readmission because of seroma development was recorded in two cases where standard polypropylene meshes were used. No complication was observed in the other patient who received lightweight meshes. No early recurrences were recorded after 4, 9, and 30 months. Conclusion. Femoral recurrence after previous inguinal hernia repair seems to be a specific entity. It has a prevascular component and the hernia defect can be much larger than that of a primary femoral hernia. A patch repair with infra-inguinal approach can be a valuable alternative with low complication rate.

Incisional hernia in Day Surgery: our personal experience

Incisional hernia is one of the most common complications of laparotomy. Its repair with prosthesis has enabled a considerable improvement in the outcome, significantly reducing recurrences. This study analyses the results of open hernioplasty with mesh performed as a Day Surgery procedure in 42 patients between November 2008 and October 2010. The results were good, with low postoperative morbidity and recurrences (2.4%).

Redes de conversação como possibilidade de formação do professor tutor virtual na mediação pedagógica da educação profissional a distância

A educação a distância apoiada pelos meios de comunicação digital ampliou as possibilidades de interação, flexibilizando o processo de mediação pedagógica no tempo e no espaço. Nessa perspectiva, a educação profissional democratizou seu acesso, na qual os conhecimentos de nível técnico são customizados em um Ambiente Virtual de Aprendizagem (AVA) para serem mediados a distância. Esta tese, apresentada na forma de artigos, problematiza o processo de mediação pedagógica realizado pelo professor tutor virtual na Rede e-Tec Brasil do Instituto Federal de Educação, Ciência e Tecnologia Sul-rio-grandense (IFSul) Campus Visconde da Graça (CAVG). Nesse modelo de ensino, o professor tutor virtual é contratado para atuar, pelo período de dois anos, em todas as disciplinas curriculares de um curso técnico. Se, por um lado, isso permite-lhe conhecer a realidade de seus alunos; por outro, exige-lhe um esforço pedagógico de apropriação e mediação dos conteúdos específicos nas diversas disciplinas que integram os currículos de cada curso. A pesquisa buscou conhecer como o professor tutor virtual apropria-se dos conhecimentos específicos nos cursos técnicos para mediá-los pedagogicamente com os alunos. Apresentamos, como hipótese explicativa neste estudo, que é na convivência com o professor pesquisador que o professor tutor virtual encontra a possibilidade de se apropriar dos conhecimentos curriculares para poder mediá-los pedagogicamente com os alunos. Para sustentar teoricamente nossas proposições na experiência vivida, estabelecemos uma rede de conversação com os autores Humberto Maturana, Pierre Lévy, Lee Shulman e Maurice Tardif, por meio dos conceitos: cultura em redes de conversação; inteligência coletiva; conhecimento pedagógico do conteúdo; e formação profissional docente. Como procedimento metodológico, encontramos na técnica do Discurso do Sujeito Coletivo (DSC), de Lefèvre e Lefèvre, uma estratégia de abordagem qualitativa para analisar as recorrências encontradas nos discursos dos professores tutores virtuais. O estudo aponta que uma rede de conversação recursiva entre o professor pesquisador e o professor tutor virtual possibilita a apropriação de conhecimentos técnicos e específicos necessários ao processo de mediação pedagógica com os estudantes. Essa convivência, no caminho da constituição de um coletivo inteligente, favorece o trabalho colaborativo no ambiente da tutoria, contribuindo para profissionalizar o processo de mediação pedagógica na educação profissional a distância do IFSul CAVG. Supported by digital media, distance learning has increased the possibilities of interaction, easing the process of pedagogical mediation in time and space. From this perspective, the access to professional education has been democratized: technical knowledge is customized in a Learning Managing System and later delivered by means of mediated distance education courses. Structured in a sequence of articles, this dissertation addresses the problem of the pedagogical mediation process performed by on-line tutor teachers at Rede e-Tec Brasil of the Instituto Federal Sul- rio-grandense (IF-Sul), Campus Visconde da Graça (CAVG). This model of education establishes that on-line tutor teachers are hired to work with all the curriculum courses of a technical program for two years. If, on the hand, it allows these teachers to know the reality of their students well, on the other hand it demands them a pedagogical effort of appropriation and mediation of the specific contents guiding the various courses that comprise the curriculum of each program. This research aimed to find out how on-line tutor teachers appropriate expertise from technical programs to mediate it with their students in a pedagogical way. The explanatory hypothesis given is that by working together and sharing experience with the teacher/researcher, on-line tutor teachers will be able to appropriate of curricular knowledge and pedagogically mediate it with their students afterwards. To support our theoretical propositions, a network of conversation was established with authors like Humberto Maturana, Pierre Lévy, Lee Shulman, and Maurice Tardif through the concepts of culture in networks of conversation, collective intelligence, pedagogical content knowledge, and teacher training. As a methodological procedure, the technique of the Collective Subject Discourse (CSD), by Lefèvre and Lefèvre, was found to offer a strategy of qualitative approach to analyze the recurrences seen in the speech of on-line tutor teachers. The study shows that a recursive network of conversation between the teacher/researcher and the on-line tutor teacher enables the appropriation of specific and technical knowledge required for the process of pedagogical mediation with students. The experience of sharing a consensual professional relationship, in which one respects and accepts the other as a way of establishing a collective intelligence, encourages collaborative work in the tutoring environment, helping professionalize the process of pedagogical mediation in distance professional education at IFSul CAVG.

Giant condyloma acuminatum quickly growing. Case report

Background. Giant Condyloma Acuminatum (GCA) is a rare, slow growing, large cauliflower tumor of the penile foreskin and perianal region with benign histologic appearance but high propensity for local invasion and recurrences. GCA is associated with Human Papilloma Virus (HPV) types 6 and 11 and it also has considerable risk of neoplastic transformation into fully invasive squamous cell carcinoma into about 5 years. Objective. Because of the rarity of perianal GCA, to date there is no general agreement on the best method for treatment. We wanted to know if surgical approach only was a good method to treat our case. Case report. A 28 years old man, HIV-negative, with a 4 years history of perianal GCA quickly growing underwent full tickness local excision at least 0,7 cm margin of normal tissue with skin grafting taken from the thighs. Fecal contamination was avoided by diet and loperamide per os. At two years follow-up no recurrence was detected. Conclusion. Surgical approach with full tickness excision and immediate skin-grafting and regular follow-up demonstrated effective to treat GCA and to minimize disease recurrence.

Indications for and limits of conservative surgery in breast cancer

Improvements in diagnostic techniques and, above all, breast cancer screening campaigns - essential for early diagnosis - have enabled the objectives of conservative surgery to be pursued: disease control, no or low incidence of recurrences and an excellent esthetic result. However, to reach these objectives, it is essential to ensure a careful evaluation of the medical history of every patient, a detailed clinical examination and the correct interpretation of imaging. Particular attention should be paid to all factors influencing the choice of treatment and/or possible local recurrence: age, site, tumor volume, genetic predisposition, pregnancy, previous radiotherapy, pathological features, and surgical margins. The decision to undertake conservative treatment thus requires a multidisciplinary approach involving pathologists, surgeons and oncological radiologists, as well, of course, as the patient herself.

Minimally invasive repair of Morgagni hernia - A multicenter case series

Children may benefit from minimally invasive surgery (MIS) in the correction of Morgagni hernia (MH). The present study aims to evaluate the outcome of MIS through a multicenter study. National institutions that use MIS in the treatment of MH were included. Demographic, clinical and operative data were analyzed. Thirteen patients with MH (6 males) were operated using similar MIS technique (percutaneous stitches) at a mean age of 22.2±18.3 months. Six patients had chromosomopathies (46%), five with Down syndrome (39%). Respiratory complaints were the most common presentation (54%). Surgery lasted 95±23min. In none of the patients was the hernia sac removed; prosthesis was never used. In the immediate post-operative period, 4 patients (36%) were admitted to intensive care unit (all with Down syndrome); all patients started enteral feeds within the first 24h. With a mean follow-up of 56±16.6 months, there were two recurrences (18%) at the same institution, one of which was repaired with an absorbable suture; both with Down syndrome. The application of MIS in the MH repair is effective even in the presence of comorbidities such as Down syndrome; the latter influences the immediate postoperative recovery and possibly the recurrence rate. Removal of hernia sac does not seem necessary. Non-absorbable sutures may be more appropriate.

Evaluation of Adoptive T Cell Therapy and Oncolytic Virotherapy for Treatment of Brain Tumors

Adoptive immunotherapy and oncolytic virotherapy are two promising strategies for treating primary and metastatic malignant brain tumors. We demonstrate the ability of adoptively transferred tumor-specific T cells to rapidly mediate the clearance of established brain tumors in several mouse models. Similar to the clinical situation, tumor recurrences are frequent and result from immune editing of tumors. T cells can eliminate antigen-expressing tumor cells but are not effective against antigen loss variant (ALV) cancer cells that multiply and repopulate a tumor. We show that the level of tumor antigen present affects the success of adoptive T cell therapy. When high levels of antigen are present, tumor stromal cells such as microglia and macrophages present tumor peptide on their surface. As a result, T cells directly eliminate cancer cells and cross-presenting stromal cells and indirectly eliminate ALV cells. We were able to show the first direct evidence of tumor antigen cross-presentation by CD11b+ stromal cells in the brain using soluble, high-affinity T cell receptor monomers. Strategies that target brain tumor stroma or increase antigen shedding from tumor cells leading to increased crosspresentation by stromal cells may improve the clinical success of T cell adoptive therapies. We evaluated one potential strategy to complement adoptive T cell therapy by characterizing the oncolytic effects of myxoma virus (MYXV) in a syngeneic mouse brain tumor model of metastatic melanoma. MYXV is a rabbit poxvirus with strict species tropism for European rabbits. MYXV can also infect mouse and human cancer cell lines due to signaling defects in innate antiviral mechanisms and hyperphosphorylation of Akt. MYXV kills B16.SIY melanoma cells in vitro, and intratumoral injection of virus leads to robust, selective and transient infection of the tumor. We observed that virus treatment recruits innate immune cells iii to the tumor, induces TNFα and IFNβ production in the brain, and results in limited oncolytic effects in vivo. To overcome this, we evaluated the safety and efficacy of co-administering 2C T cells, MYXV, and neutralizing antibodies against IFNβ. Mice that received the triple combination therapy survived significantly longer with no apparent side effects, but eventually relapsed. Based on these findings, methods to enhance viral replication in the tumor and limit immune clearance of the virus will be pursued. We conclude that myxoma virus should be further explored as a vector for transient delivery of therapeutic genes to a tumor to enhance T cell responses.

Privileged Words and Sturmian Words

This dissertation has two almost unrelated themes: privileged words and Sturmian words. Privileged words are a new class of words introduced recently. A word is privileged if it is a complete first return to a shorter privileged word, the shortest privileged words being letters and the empty word. Here we give and prove almost all results on privileged words known to date. On the other hand, the study of Sturmian words is a well-established topic in combinatorics on words. In this dissertation, we focus on questions concerning repetitions in Sturmian words, reproving old results and giving new ones, and on establishing completely new research directions. The study of privileged words presented in this dissertation aims to derive their basic properties and to answer basic questions regarding them. We explore a connection between privileged words and palindromes and seek out answers to questions on context-freeness, computability, and enumeration. It turns out that the language of privileged words is not context-free, but privileged words are recognizable by a linear-time algorithm. A lower bound on the number of binary privileged words of given length is proven. The main interest, however, lies in the privileged complexity functions of the Thue-Morse word and Sturmian words. We derive recurrences for computing the privileged complexity function of the Thue-Morse word, and we prove that Sturmian words are characterized by their privileged complexity function. As a slightly separate topic, we give an overview of a certain method of automated theorem-proving and show how it can be applied to study privileged factors of automatic words. The second part of this dissertation is devoted to Sturmian words. We extensively exploit the interpretation of Sturmian words as irrational rotation words. The essential tools are continued fractions and elementary, but powerful, results of Diophantine approximation theory. With these tools at our disposal, we reprove old results on powers occurring in Sturmian words with emphasis on the fractional index of a Sturmian word. Further, we consider abelian powers and abelian repetitions and characterize the maximum exponents of abelian powers with given period occurring in a Sturmian word in terms of the continued fraction expansion of its slope. We define the notion of abelian critical exponent for Sturmian words and explore its connection to the Lagrange spectrum of irrational numbers. The results obtained are often specialized for the Fibonacci word; for instance, we show that the minimum abelian period of a factor of the Fibonacci word is a Fibonacci number. In addition, we propose a completely new research topic: the square root map. We prove that the square root map preserves the language of any Sturmian word. Moreover, we construct a family of non-Sturmian optimal squareful words whose language the square root map also preserves.This construction yields examples of aperiodic infinite words whose square roots are periodic.

Cutaneous primary B-cell lymphomas: from diagnosis to treatment

Primary cutaneous B-cell lymphomas are a heterogeneous group of mature B-cells neoplasms with tropism for the skin, whose biology and clinical course differ significantly from the equivalent nodal lymphomas. The most indolent forms comprise the primary cutaneous marginal zone and follicle center B-cell lymphomas that despite the excellent prognosis have cutaneous recurrences very commonly. The most aggressive forms include the primary cutaneous large B-cell lymphomas, consisting in two major groups: the leg type, with poor prognosis, and others, the latter representing a heterogeneous group of lymphomas from which specific entities are supposed to be individualized over time, such as intravascular large B-cell lymphomas. Treatment may include surgical excision, radiotherapy, antibiotics, corticosteroids, interferon, monoclonal antibodies and chemotherapy, depending on the type of lymphoma and on the type and location of the skin lesions. In subtypes with good prognosis is contraindicated overtreatment and in those associated with a worse prognosis the recommended therapy relies on CHOP-like regimens associated with rituximab, assisted or not with local radiotherapy. We review the primary cutaneous B-cell lymphomas, remembering the diagnostic criteria, differential diagnosis, classification, and prognostic factors and presenting the available therapies.