Introdução: O acesso pela via da fossa craniana média para colocação do implante coclear provou ser uma alternativa valiosa em pacientes com otite média crônica e cavidades de mastoidectomia instáveis, cócleas parcialmente ossificadas e em alguns casos de displasia do ouvido interno. Até hoje não existem pesquisas que descrevam se a inserção do feixe de eletrodos pela via da fossa média pode ser feita com um mínimo de traumatismo intracoclear, comparável ao observado nas inserções pela janela redonda. Objetivo: Avaliar o trauma intracoclear com dois modelos distintos de implante quando o feixe de eletrodos é inserido por cocleostomia na fossa craniana média em ossos temporais. Método: 20 ossos temporais retirados antes de 24 horas pós-óbito, foram implantados através do local da cocleostomia no giro basal da cóclea identificado no assoalho da fossa cerebral média. Dez peças receberam um implante reto e dez um pré-curvado, e foram fixadas em resina epóxi. Foi realizada tomografia computadorizada para determinar a colocação adequada do feixe eletrodos, profundidade de inserção e a distância entre a janela redonda e a cocleostomia. Por último, as peças foram polidas em série, tingidas e visualizadas por estereomicroscópio para avaliar a posição do feixe e trauma intracoclear. Resultados: A tomografia mostrou um posicionamento intracoclear do feixe de eletrodos nas 20 peças. No grupo dos implantes retos a média de eletrodos inserido foi 12,3 (10 a 14) e dos pré-curvados 15,1 (14 a 16) com uma diferença significativa (U=78, p=0,0001). A mediana de profundidade de inserção foi maior para o eletrodo pré-curvado (14,5mm) que para o reto (12,5mm) com diferenças estatisticamente significativas (U = 66, p = 0,021). Só uma das 20 inserções foi atraumática e 70% tiveram graus de trauma altos (grau 3 ou 4). Não foram observadas diferenças significativas do grau de trauma entre os dois tipos de feixes nem quando as inserções foram no sentido da janela redonda, comparado com o sentido do giro médio. Conclusões: A técnica cirúrgica utilizada permitiu a inserção do feixe de eletrodos na cóclea em todas as peças, porém sem garantir uma inserção na escala timpânica e com alto risco de trauma nas microestruturas da cóclea / Introduction: In recent years, a middle fossa approach has been described for the insertion of cochlear implants, and it proved to be a reliable alternative for implantation in patients with chronic supurative otitis media, unstable mastoid cavities with recurrent otorrhea, partially ossified cochlea and in some cases of inner ear dysplasia. Until now, no research has been done to describe if this approach allows for anatomic preservation and non-traumatic insertions comparable to those through the round window. Objective: To evaluate cochlear trauma when the cochlear implant electrode is inserted through a middle fossa approach by means of histologic and imaging studies in temporal bones. Methods: 20 temporal bones retrieved before 24 hours after death were implanted through a middle cranial fossa cochleostomy in the basal turn of the cochlea. Ten received a straight electrode and 10 a perimodiolar electrode. After reducing the bone size with preservation of the inner ear structures, the temporal bones were fixed, dehydrated and embedded in an epoxy resin. CT scans were performed to determine if an adequate direction of insertion was attained, the depth of insertion and the distance between the cochleostomy and the round window. At last, the samples were polished by micro-grinding technique and microscopically visualized to evaluate intracochlear trauma. Results: The CT-scan showed an adequate intracoclear position of the electrode in all the samples. In the straight electrode group the average number of inserted electrodes was 12.3 (10 to 14) against 15.1 (14- 16) for the perimodiolar (U=78, p=0.0001). The median depth of insertion was significantly larger for the perimodiolar electrode group (14.4mm vs. 12.5mm U=66, p = 0.021). Only one atraumatic insertion was achieved and 70% of the samples had important trauma (grades 3 and 4). No differences were identified for the trauma grades between the two groups of electrodes. Also, there were no differences in trauma if the cochlear implants were inserted in the direction of the basal turn of the cochlea or in the direction of the middle and apical turns. Conclusions: The surgical technique that was used allowed for a proper intracochlear insertion of the electrodes in all 20 temporal bones but it does not guarantee a correct scala tympani position and carries high trauma risk for the intracochlear microstructures

Introdução: O acesso pela via da fossa craniana média para colocação do implante coclear provou ser uma alternativa valiosa em pacientes com otite média crônica e cavidades de mastoidectomia instáveis, cócleas parcialmente ossificadas e em alguns casos de displasia do ouvido interno. Até hoje não existem pesquisas que descrevam se a inserção do feixe de eletrodos pela via da fossa média pode ser feita com um mínimo de traumatismo intracoclear, comparável ao observado nas inserções pela janela redonda. Objetivo: Avaliar o trauma intracoclear com dois modelos distintos de implante quando o feixe de eletrodos é inserido por cocleostomia na fossa craniana média em ossos temporais. Método: 20 ossos temporais retirados antes de 24 horas pós-óbito, foram implantados através do local da cocleostomia no giro basal da cóclea identificado no assoalho da fossa cerebral média. Dez peças receberam um implante reto e dez um pré-curvado, e foram fixadas em resina epóxi. Foi realizada tomografia computadorizada para determinar a colocação adequada do feixe eletrodos, profundidade de inserção e a distância entre a janela redonda e a cocleostomia. Por último, as peças foram polidas em série, tingidas e visualizadas por estereomicroscópio para avaliar a posição do feixe e trauma intracoclear. Resultados: A tomografia mostrou um posicionamento intracoclear do feixe de eletrodos nas 20 peças. No grupo dos implantes retos a média de eletrodos inserido foi 12,3 (10 a 14) e dos pré-curvados 15,1 (14 a 16) com uma diferença significativa (U=78, p=0,0001). A mediana de profundidade de inserção foi maior para o eletrodo pré-curvado (14,5mm) que para o reto (12,5mm) com diferenças estatisticamente significativas (U = 66, p = 0,021). Só uma das 20 inserções foi atraumática e 70% tiveram graus de trauma altos (grau 3 ou 4). Não foram observadas diferenças significativas do grau de trauma entre os dois tipos de feixes nem quando as inserções foram no sentido da janela redonda, comparado com o sentido do giro médio. Conclusões: A técnica cirúrgica utilizada permitiu a inserção do feixe de eletrodos na cóclea em todas as peças, porém sem garantir uma inserção na escala timpânica e com alto risco de trauma nas microestruturas da cóclea / Introduction: In recent years, a middle fossa approach has been described for the insertion of cochlear implants, and it proved to be a reliable alternative for implantation in patients with chronic supurative otitis media, unstable mastoid cavities with recurrent otorrhea, partially ossified cochlea and in some cases of inner ear dysplasia. Until now, no research has been done to describe if this approach allows for anatomic preservation and non-traumatic insertions comparable to those through the round window. Objective: To evaluate cochlear trauma when the cochlear implant electrode is inserted through a middle fossa approach by means of histologic and imaging studies in temporal bones. Methods: 20 temporal bones retrieved before 24 hours after death were implanted through a middle cranial fossa cochleostomy in the basal turn of the cochlea. Ten received a straight electrode and 10 a perimodiolar electrode. After reducing the bone size with preservation of the inner ear structures, the temporal bones were fixed, dehydrated and embedded in an epoxy resin. CT scans were performed to determine if an adequate direction of insertion was attained, the depth of insertion and the distance between the cochleostomy and the round window. At last, the samples were polished by micro-grinding technique and microscopically visualized to evaluate intracochlear trauma. Results: The CT-scan showed an adequate intracoclear position of the electrode in all the samples. In the straight electrode group the average number of inserted electrodes was 12.3 (10 to 14) against 15.1 (14- 16) for the perimodiolar (U=78, p=0.0001). The median depth of insertion was significantly larger for the perimodiolar electrode group (14.4mm vs. 12.5mm U=66, p = 0.021). Only one atraumatic insertion was achieved and 70% of the samples had important trauma (grades 3 and 4). No differences were identified for the trauma grades between the two groups of electrodes. Also, there were no differences in trauma if the cochlear implants were inserted in the direction of the basal turn of the cochlea or in the direction of the middle and apical turns. Conclusions: The surgical technique that was used allowed for a proper intracochlear insertion of the electrodes in all 20 temporal bones but it does not guarantee a correct scala tympani position and carries high trauma risk for the intracochlear microstructures

INTRODUÇÃO: A ampliação dos critérios de indicação para cirurgia do implante coclear e os benefícios da preservação da audição residual no pósoperatório estimularam o desenvolvimento de técnicas cirúrgicas atraumáticas. Minimizar os traumas intracocleares durante a inserção do feixe de eletrodos do implante coclear é um passo fundamental para este intuito. O objetivo deste trabalho é avaliar se o trauma intracoclear é diferente quando o feixe de eletrodos do implante coclear é inserido através do quadrante anterossuperior ou anteroinferior da membrana da janela redonda. MÉTODOS: Vinte e cinco ossos temporais frescos de cadáveres humanos foram submetidos à timpanomastoidectomia padrão. Após exposição adequada da membrana da janela redonda, em metade dos ossos o feixe de eletrodos do implante coclear foi inserido via quadrante anterossuperior da membrana da janela redonda, e na outra metade via quadrante anteroinferior. Os ossos temporais foram desidratados e embebidos em epóxi, com o feixe de eletrodos in situ. As peças foram serialmente polidas, tingidas e visualizadas por meio de estereomicroscópio para avaliar o trauma intracoclear causado pela inserção do feixe de eletrodos. As imagens foram fotografadas. RESULTADOS: Em treze ossos temporais o feixe de eletrodos do implante coclear foi inserido via quadrante anterossuperior da membrana da janela redonda, e em doze ossos via quadrante anteroinferior. Obteve-se 372 superfícies. As análises histológicas revelaram diferentes graus de traumas às estruturas intracocleares. Os resultados mostraram que a inserção do feixe de eletrodos via quadrante anterossuperior ou anteroinferior acarretam a mesma frequência de trauma intracoclear. CONCLUSÕES: A presença de trauma intracoclear e a severidade dos traumas ocorridos no tocante à inserção do feixe de eletrodos de implante coclear pelo quadrante anterossuperior e anteroinferior da membrana da janela redonda não apresentou diferença estatisticamente significativa. Observou-se, porém, maior facilidade para exposição cirúrgica do quadrante anterossuperior em relação ao quadrante anteroinferior / INTRODUCTION: The expansion of the indication criteria for cochlear implant surgery and the benefits of preserving residual hearing postoperatively have stimulated the development of atraumatic surgeries. Minimizing the intracochlear traumas during the electrodes insertion is a critical step for this aim. The objective of this study is to assess whether there is a difference in intracochlear trauma when the cochlear implant electrode array is inserted through the anterior-superior or anterior-inferior quadrants of the round window membrane. METHODS: Twenty-five fresh human temporal bones were submitted to standard tympanomastoidectomy. After adequate exposure of the round window membrane, in half of the bones the cochlear implant electrode array was inserted via anterior-superior quadrant of round window membrane and in the other half via anterior-inferior quadrant. The temporal bones were dehydrated and embedded in epoxy with the electrodes array in situ. The specimens were serially polished, stained and viewed through a stereomicroscope to assess the intracochlear trauma caused by insertion of the electrode array. Resulting images were documented. RESULTS: In thirteen temporal bones the cochlear implant electrode array was inserted via anterior-superior quadrant of round window membrane and in twelve bones via anterior-inferior quadrant. Three hundred and seventy two surfaces were obtained. Histological examinations revealed varying degrees of damage to the intracohlear structures. The results showed that the insertion of the electrode array via anterior-superior or anterior-inferior quadrant lead to the same frequency of intracochlear trauma. CONCLUSIONS: The presence of intracochlear trauma and severity of traumas regarding the insertion of cochlear implant electrode array via anterior-superior and via anterior-inferior quadrant of the round window membrane showed no statistically significant difference. However, it was observed that surgical exposure of anterior-superior quadrant was easier than surgical exposure of anterior-inferior quadrant

O objetivo deste estudo foi avaliar a morfologia/crescimento craniofacial e a oclusão dentária em pacientes (ambos sexos), entre 4 e 10 anos e aumento adenoamigdaliano com e sem otite média secretora (OMS). Utilizou-se análise cefalométrica e modelos de estudo dentários. Não foram observadas diferenças significativas entre os grupos estudados, em relação às medidas lineares e angulares adotadas, exceto, a medida correspondente ao comprimento do palato ósseo (ENA-ENP), que mostrou relação com a idade e a OMS. Não houve um tipo facial predominante. Observou-se discreta predominância de mordida profunda, mordida cruzada posterior e desvio da linha média em relação à OMS, porém sem significância estatística. A atresia maxilar pode estar associada à OMS, assim como sua redução pode estar relacionada ao crescimento e desenvolvimento craniofacial / The aim of this study was to evaluate the craniofacial growth/morphology and dental occlusion in 100 patients (male and female) from 4 to 10 years old and tonsils and adenoid enlargement. There were two groups: with and without otitis media with effusion (OME). We used the cephalometric analyses and dental casts. It was not observed significant differences between the two groups, in relationship to the linear and angular measurements adopted, except for the measurement corresponding to the palate bone length, which had shown correlation with age and OME. It was not found a facial pattern predominance. It was observed a discreet predominance of deep bite, posterior cross bite and midline deviation to OME, however without statistical significance. The maxillary narrowing might be associated to OME as well as its reduction may be related to the craniofacial growth and development

Introdução: A pressão crítica de fechamento da faringe (PCrit) é a pressão nasal em que há colapso da faringe. Conceitualmente a Pcrit reflete a contribuição anatômica na gênese da apnéia obstrutiva do sono (AOS). No entanto, a relação entre a PCrit e a anatomia das vias aéreas superiores (VAS) tem sido pouco estudada. A PCrit determinada durante o sono requer pesquisadores experientes durante a noite. A indução do sono com midazolam é usada na prática clínica para a realização de procedimentos ambulatoriais e poderia ser uma alternativa mais conveniente para se determinar a Pcrit. Porém, o midazolam pode provocar sedação além de simples indução do sono, reduzir a atividade muscular das VAS e aumentar a colapsabilidade quando comparado com o sono normal. Objetivos: 1. validar a determinação da PCrit durante o dia após a indução do sono com midazolam; 2. comparar a arquitetura do sono induzido com baixa dose de midazolam com o sono natural; 3. correlacionar a PCrit com a anatomia das VAS. Métodos: Homens com graus variados de sintomas sugestivos de AOS foram submetidos a polissonografia completa noturna, determinação da PCrit durante o sono natural e após a indução do sono com midazolam bem como tomografia computadorizada de cabeça e pescoço para avaliação das VAS. Resultados: Foram estudados 15 sujeitos com idade (média±DP) de 54 ± 10 anos, índice de massa corporal de 29,9 ± 3,9 kg/m2 e índice de apnéiahipopnéia (IAH) de 38 ± 22 (variação: 8-66 eventos/h). A indução do sono foi obtida em todos os sujeitos, utilizando doses mínimas de midazolam (mediana [intervalo interquartil]) (2,4 [2,0-4,4] mg). A PCrit durante o sono natural e induzido foram semelhantes (-0,82 ± 3,44 e -0,97 ± 3,21 cmH2O, P = 0,663) e se associaram (coeficiente de correlação intraclasse=0,92 (IC 95% 0,78-0,97 P<0,001). A distribuição das fases do sono durante sono natural e induzido foi similar, com excessão da fase 1 (10,5 ± 5,1% vs. 20,6 ± 8,1, respectivamente; P=0,001). A Pcrit determinada durante o sono natural e induzido se correlacionaram com o IAH (r=0,592, P=0,020 e r=0,576, P=0,025, respectivamente). Além disso tanto a Pcrit determinada por sono natural e induzido se correlacionaram com diversas variáveis tomográficas de VAS, incluindo a posição do osso hióide, ângulo da base do crânio e as áreas seccionais da velofaringe e hipofaringe (r variando de 0,577 a 0,686, P<0,05). A regressão linear múltipla revelou que o IAH foi independentemente associado com a Pcrit durante sono induzido, circunferência da cintura e idade (r2 = 0,785, P = 0,001). Conclusão: A PCrit determinada durante o dia com indução do sono é semelhante à determinada durante o sono natural e é um método alternativo promissor para determinar a PCrit. O sono induzido por doses baixas de midazolan promove um sono similar ao sono natural. A Pcrit determinada tanto durante o sono natural e induzido correlaciona-se com várias características anatômicas das VAS / Introduction: The pharyngeal critical closing pressure (Pcrit) is the nasal pressure at which the airway collapses. Pcrit is thought to reflect the anatomical contribution to the genesis of obstructive sleep apnea (OSA). However, the relationship between Pcrit and upper airway anatomy has been poorly investigated. Pcrit determined during sleep requires experienced investigators at night. Sleep induction with midazolam is frequently used in clinical practice during ambulatory procedure and could be a more convenient alternative to assess Pcrit. On the other hand, midazolam could induce sedation rather than sleep, decrease upper airway muscle activity and increase collapsibility compared with natural sleep. Objectives: 1. validate Pcrit determination during the day after sleep induction with midazolam; 2. compare the sleep architecture of induced sleep after low doses of midazolam with natural sleep; 3.correlate Pcrit with upper airway anatomy. Methods: Men with different severity of OSA symptoms underwent baseline full polysomnography, Pcrit determination during natural sleep and after sleep induction with midazolam and head and neck computed tomography. RESULTS: Fifteen men aged (mean±SD) 54±10ys, body mass index=29.9 ± 3.9 Kg/m2 and apnea hypopnea index=38±22, range: 8-66 events/h were studied. Sleep induction was obtained with minimum doses of midazolam (median[interquartile range] (2.4 [2.0-4.4] mg). Sleep phase distribution during natural and induced sleep was similar, except for stage 1 (10.5 ± 5.1% vs. 20.6 ± 8.1, respectively; P=0.001). Natural and induced sleep Pcrit were similar (-0.82 ± 3.44 and -0.97 ± 3.21 cmH2O, P=0.663) and closely associated (intraclass correlation coefficient=0.92 (95%CI 0.78-0.97, P<0.001). Natural and sleep induced Pcrit correlated with AHI (r=0.592, P=0.020; r=0.576, P=0.025, respectively). Pcrit determined both during natural and induced sleep were significantly associated with several tomographic variables, including hyoid position, cranial base angle and cross sectional areas of the velopharynx and hypopharynx (r range: 0.577 to 0.686, P<0.05). Multiple linear regression revealed that AHI was independently associated with induced sleep Pcrit, waist circumference and age (r2=0.785, P=0.001). Conclusion: Pcrit determined during the day with sleep induction is similar to natural sleep and is a promising alternative method to determine Pcrit. Sleep induction with small doses of midazolam promoted sleep similar to natural sleep. Pcrit determined both during natural and induced sleep correlates with several anatomical characteristics of the upper airway

Este estudo teve, por finalidade, estabelecer o valor da ressonância magnética em 30 doadores potenciais do lobo direito do fígado, na determinação dos seguintes fatores: esteatose hepática; anatomia biliar; anatomias arterial hepática, venosas portal e hepática, e volume hepático lobar, comparando-os, respectivamente, com os achados anatomopatológicos da biópsia hepática, da colangiografia intraoperatória, da angiografia digital e/ou com os achados cirúrgicos, e com o peso real do enxerto. A RM subestimou a infiltração gordurosa hepática; permitiu identificar a anatomia biliar, com concordância em 83% dos casos; apresentou 100% de concordância na avaliação das anatomias arterial e venosas portal e hepática, e superestimou, em pequeno grau, o volume hepático lobar / The purpose of this study was to establish the value of the magnetic resonance in 30 potential donors for right lobe living liver transplantation. The main goal was to determine the following factors: steatosis; biliar anatomy; hepatic arterial anatomy; portal and hepatic venous anatomy, and lobar liver volume, comparing them to liver biopsy results, to intraoperative colangiography, to digital angiography and/or surgical findings, and to the real graft weight, respectively. The MR has underestimated liver steatosis; it has identified biliar anatomy with 83% of agreement; it has had 100% of agreement in the evaluation of arterial and portal and hepatic venous anatomy, and it has overestimated with small degree the lobar liver volume

O adenocarcinoma prostático (ACP) é um tumor freqüente, que ocupa a segunda posição tanto em mortalidade quanto em incidência dentre as neoplasias malignas masculinas. O estadiamento local do ACP, que consiste na avaliação de extensão extracapsular (EEC) e invasão das vesículas seminais, tem importância fundamental na escolha do tratamento adequado e no prognóstico da doença, destacando-se que a prostatectomia radical é geralmente considerada o tratamento de escolha em tumores confinados à próstata. Os exames clínico-laboratoriais, e a graduação histológica de Gleason pré-operatória, não apresentam eficácia adequada no estadiamento local destes tumores, com elevadas taxas de subestadiamento. O objetivo deste trabalho foi comparar as eficácias da ultra-sonografia endorretal com power-Doppler (USD) e da ressonância magnética com bobina endorretal (RM) no estadiamento local do ACP. Quarenta e dois pacientes com diagnóstico de ACP confirmado por biópsia prostática foram prospectivamente estudados por RM, e 36 destes foram estudados também por USD, sendo os achados obtidos por estes métodos comparados com aqueles observados no estudo anátomo-patológico (AP) pós-prostatectomia radical. Na avaliação de extensão extracapsular por sextantes contíguos, os resultados de sensibilidade, especificidade, valor preditivo positivo, valor preditivo negativo e acurácia para EEC foram persistentemente superiores para a RM em relação ao USD, devendo-se salientar que tanto a RM quanto o USD apresentaram altos valores de especificidade ( > 85%), considerado o critério mais importante no sentido de se evitar diagnósticos falso-positivos. Tanto o USD quanto a RM apresentaram acurácia adequada na avaliação de invasão das vesículas seminais. No USD, foi observada associação estatisticamente significante entre abaulamento irregular do contorno prostático e presença de EEC, enquanto na RM, os critérios de abaulamento irregular do contorno prostático e principalmente presença de tecido sólido na gordura periprostática apresentaram associação estatisticamente significante com EEC. Os resultados obtidos mostraram que o emprego dos métodos de imagem no estadiamento local pode reduzir as taxas de subestadiamento clínico. Observou-se também que ambos os métodos apresentam baixa especificidade na localização tumoral, e que não houve diferença significativa na avaliação do volume prostático pelo USD, RM e AP. / Prostatic adenocarcinoma is a common tumor, corresponding to the second most common type of cancer and the second most common cause of cancer deaths among men. Local staging of prostatic cancer, which consists in the evaluation of extracapsular extension and seminal vesicle invasion, is an important factor for the prognosis and treatment of the disease, being radical prostatectomy one of the gold-standard treatment modalities for localized cancers. Rectal exam, PSA levels and pre-surgical Gleason stage are not reliable exams for local staging, with high understaging scores. The purpose of this study was the evaluation of endorectal power-Doppler ultrasound (US) and endorectal magnetic resonance imaging (MRI) for local staging of prostate cancer. Forty-two patients with biopsy-proven prostatic cancer were prospectively studied with endorectal MRI, and 36 of them were also studied with endorectal Doppler US, with the imaging results compared to the post-surgical hystopathological results.Sensitivity, specificity, positive predictive value, negative predictive value and accuracy results for extracapsular spread of disease were better for MRI than for US, however both methods obtained high ( > 85%) specificity results, which is considered the most important criteria for local staging. Accuracy for seminal vesicle invasion was adequate for both USD and MRI. At US, statistically significant correlation was observed between extracapsular extension of tumor and irregular bulging of the prostatic contour, while at MRI, statistically significant correlation was observed for irregular bulging and extraprostatic solid tissue. Our results showed that the use of imaging methods for local staging of prostatic tumors could reduce the rates of clinical understaging. Additional findings were the low specificity of both imaging methods for tumor localization, and the absence of differences between US, MRI and pathology for prostatic volume measurement.

INTRODUÇÃO: Os transtornos mentais psicóticos são condições frequentes na população em geral e estão associados à grande morbidade e elevadas taxas de comprometimento funcional, tornando-os um grave problema de saúde pública. O desenvolvimento de novos métodos de auxílio diagnóstico e prognóstico a pratica clínica psiquiátrica possibilitando que intervenções efetivas sejam feitas precocemente na história natural da doença são, dessa forma, desejáveis. A classificação de padrões neuroanatômicos é uma robusta técnica para processamento e análise de imagens médicas que permite tanto a realização de comparações voxel-a-voxel entre grupos com alta dimensionalidade de variáveis, como a classificação individualizada das imagens. OBJETIVOS: Avaliar o desempenho diagnóstico de um classificador de padrões morfológicos complexos baseado em support vector machine (SVM) na discriminação entre diferentes transtornos psicóticos no momento do primeiro episódio, utilizando-se uma abordagem epidemiológica para a seleção de casos e controles, bem como na determinação de prognóstico de 1 ano em pacientes com primeiro episódio de esquizofrenia. MÉTODOS: Uma amostra de 62 pacientes com primeiro episódio de esquizofrenia/ transtorno esquizofreniforme, 23 casos de primeiro episódio de mania psicótica (transtorno bipolar tipo I, TB-I), e 19 indivíduos com depressão maior (DM) psicótica foram estudados com ressonância magnética (RM) estrutural de 1.5T, assim como um total de 89 controles residentes na mesma região dos casos. As imagens T1 foram inicialmente registradas a uma imagem molde comum através de um método com preservação de massa, permitindo a obtenção de volumes cerebrais regionais. Um classificador neuroanatômico multivariado baseado em redução de dimensionalidade e SVM foi utilizado para identificar o melhor conjunto de características morfológicas que diferencia cada transtorno psicótico (esquizofrenia/ transtorno esquizofreniforme, TB-I e DM psicótica) de subgrupos de controles saudáveis pareados por idade, gênero e anos de escolaridade. Os resultados obtidos pelo classificador foram, então, analisados com o auxílio de uma curva ROC, e um mapa espacial de alta dimensionalidade daquelas regiões cerebrais que constituem um padrão de distribuição tecidual cerebral característico de cada transtorno psicótico em relação aos controles foi gerado. RESULTADOS: O classificador obteve uma discriminação apenas modesta entre pacientes com primeiro episódio de esquizofrenia/ transtorno esquizofreniforme e controles saudáveis, com uma medida de área sob a curva (AUC) de 0,75 e acurácia de 73,4%. O mapa espacial discriminatório resultante mostrou um padrão complexo de alterações volumétricas comprometendo regiões fronto-límbicas tanto de substância cinzenta como de substância branca cerebral bilateralmente, fascículos cerebrais associativos, terceiro ventrículo e o ventrículo lateral esquerdo. Um desempenho diagnóstico pobre foi observado nas comparações entre pacientes com TB-I e MD psicótica e controles. Além disso, o classificador baseado em SVM não conseguiu predizer satisfatoriamente o prognóstico de 1 ano (evolução de remissão versus não remissão) dos pacientes com primeiro episódio de esquizofrenia. CONCLUSÃO: Utilizando uma amostra de pacientes com psicoses afetivas e não afetivas com características clínicas semelhantes aos pacientes vistos na nossa prática psiquiátrica (comorbidade com transtornos de uso de substâncias e curso clínico variável) e selecionados através de uma abordagem epidemiológica populacional, o classificador de padrões neuroanatômicos não obteve bom desempenho diagnóstico na discriminação entre as formas esquizofreniformes e afetivas de primeiro episódio psicótico, e também não conseguiu predizer satisfatoriamente o prognóstico de 1 ano em primeiro episódio de esquizofrenia, utilizando apenas imagens estruturais de RM / INTRODUCTION: Psychotic disorders are prevalent medical conditions in the general population, and are usually associated with high morbidity and functional impairment rates, which make them a major concern for public health. The development of new methods aiming to aid diagnostic and prognostic value in clinical psychiatric practice thus allowing effective interventions at an early course of the illness are, therefore, desirable. Neuroanatomical pattern classification is a powerful technique for image processing and analysis which allows both high-dimensional voxelwise group comparisons and classification of images at an individual basis. OBJECTIVES: To evaluate the diagnostic performance of a support vector machine (SVM)-based complex morphological pattern classifier was used to discriminate different non-affective and affective psychotic disorders at the first episode using a population-based approach to recruit both cases and healthy controls, and also to predict 1-year prognosis (i.e., remitting versus non-remitting course) in a group of patients with first-episode schizophrenia. METHODS: A sample of 62 patients with first-episode schizophrenia/ schizophreniform disorder, 23 cases presenting with their first-episode of psychotic mania (bipolar I disorder, BD-I) and 19 individuals with psychotic major depressive disorder (MDD) was studied with 1.5T structural magnetic resonance imaging (MRI), as well as a pool of 89 epidemiologically recruited controls. T1-weighted images were first registered to a common template through a robust mass-preserving routine allowing regional volumetric analysis. A high-dimensional multivariate classification method based on dimensionality reduction and SVM was employed to identify the best and most parsimonious set of morphological features that discriminate each psychotic group (schizophrenia/ schizophreniform disorder, BD-I & psychotic MDD) from subgroups of age, gender and educationally-matched healthy controls. The abnormalities scores generated by the classifier were analyzed with a ROC curve analysis and a high-dimensional spatial map of the brain regions that constitute a pattern of brain tissue distribution characteristic of each of the non-affective and affective groups relative to controls was created. RESULTS: The SVM-classifier afforded modest discrimination between subjects with first-episode schizophrenia/ schizophreniform disorder and controls, with an area under the curve (AUC) value of 0.75 and overall accuracy of 73.4%. The resulting discriminative spatial map revealed a complex pattern of regional volumetric abnormalities affecting both gray and white matter fronto-limbic regions bilaterally, long associative fasciculi, besides the third and lateral ventricles. A poor diagnostic performance was observed in the pairwise comparisons between BD-I and psychotic MDD versus controls. Also, the SVM-classifier failed to predict 1-year prognosis (remitting versus non-remitting course) in the first-episode schizophrenia group. CONCLUSION: The present results suggest that at the population level and using a real world sample of affective and non-affective psychotic patients with comorbid substance use disorders and variable disease course, we failed to achieve good discrimination between schizophreniform and affective forms of first-episode psychosis, and also in predicting 1-year prognosis of first-episode schizophrenia patients, using structural images

O adenocarcinoma prostático (ACP) é um tumor freqüente, que ocupa a segunda posição tanto em mortalidade quanto em incidência dentre as neoplasias malignas masculinas. O estadiamento local do ACP, que consiste na avaliação de extensão extracapsular (EEC) e invasão das vesículas seminais, tem importância fundamental na escolha do tratamento adequado e no prognóstico da doença, destacando-se que a prostatectomia radical é geralmente considerada o tratamento de escolha em tumores confinados à próstata. Os exames clínico-laboratoriais, e a graduação histológica de Gleason pré-operatória, não apresentam eficácia adequada no estadiamento local destes tumores, com elevadas taxas de subestadiamento. O objetivo deste trabalho foi comparar as eficácias da ultra-sonografia endorretal com power-Doppler (USD) e da ressonância magnética com bobina endorretal (RM) no estadiamento local do ACP. Quarenta e dois pacientes com diagnóstico de ACP confirmado por biópsia prostática foram prospectivamente estudados por RM, e 36 destes foram estudados também por USD, sendo os achados obtidos por estes métodos comparados com aqueles observados no estudo anátomo-patológico (AP) pós-prostatectomia radical. Na avaliação de extensão extracapsular por sextantes contíguos, os resultados de sensibilidade, especificidade, valor preditivo positivo, valor preditivo negativo e acurácia para EEC foram persistentemente superiores para a RM em relação ao USD, devendo-se salientar que tanto a RM quanto o USD apresentaram altos valores de especificidade ( > 85%), considerado o critério mais importante no sentido de se evitar diagnósticos falso-positivos. Tanto o USD quanto a RM apresentaram acurácia adequada na avaliação de invasão das vesículas seminais. No USD, foi observada associação estatisticamente significante entre abaulamento irregular do contorno prostático e presença de EEC, enquanto na RM, os critérios de abaulamento irregular do contorno prostático e principalmente presença de tecido sólido na gordura periprostática apresentaram associação estatisticamente significante com EEC. Os resultados obtidos mostraram que o emprego dos métodos de imagem no estadiamento local pode reduzir as taxas de subestadiamento clínico. Observou-se também que ambos os métodos apresentam baixa especificidade na localização tumoral, e que não houve diferença significativa na avaliação do volume prostático pelo USD, RM e AP. / Prostatic adenocarcinoma is a common tumor, corresponding to the second most common type of cancer and the second most common cause of cancer deaths among men. Local staging of prostatic cancer, which consists in the evaluation of extracapsular extension and seminal vesicle invasion, is an important factor for the prognosis and treatment of the disease, being radical prostatectomy one of the gold-standard treatment modalities for localized cancers. Rectal exam, PSA levels and pre-surgical Gleason stage are not reliable exams for local staging, with high understaging scores. The purpose of this study was the evaluation of endorectal power-Doppler ultrasound (US) and endorectal magnetic resonance imaging (MRI) for local staging of prostate cancer. Forty-two patients with biopsy-proven prostatic cancer were prospectively studied with endorectal MRI, and 36 of them were also studied with endorectal Doppler US, with the imaging results compared to the post-surgical hystopathological results.Sensitivity, specificity, positive predictive value, negative predictive value and accuracy results for extracapsular spread of disease were better for MRI than for US, however both methods obtained high ( > 85%) specificity results, which is considered the most important criteria for local staging. Accuracy for seminal vesicle invasion was adequate for both USD and MRI. At US, statistically significant correlation was observed between extracapsular extension of tumor and irregular bulging of the prostatic contour, while at MRI, statistically significant correlation was observed for irregular bulging and extraprostatic solid tissue. Our results showed that the use of imaging methods for local staging of prostatic tumors could reduce the rates of clinical understaging. Additional findings were the low specificity of both imaging methods for tumor localization, and the absence of differences between US, MRI and pathology for prostatic volume measurement.

研究背景：便秘被過往的研究確認為世界各地老年人的一個常見健康問題，尤其是居住在安老院的長者。香港一項人口普查亦指出便秘也是香港老年人的一個常見健康問題。便秘對長者的生理、心理和社會功能等各方面都產生不良影響。此外，醫療體制亦因處理便秘及其衍生的健康問題而面對沉重的負擔。目前所採用的常規方案是生活模式改變及使用軟便劑，但兩者均未能有效地紓緩便秘的徵狀。由於香港老齡人口持續增長，便秘將會是一個具有潛在持續性的老年健康問題，故尋找一個能有效地紓緩便秘徵狀的方案甚為迫切。耳穴療法是一項普及的中醫療法，亦屬於互補療法。過往在中國進行的研究顯示，耳穴療法能有效地治療便秘，惟此等療效尚未被確實。耳穴療法應是一個對處理便秘具有潛在療效的治療方案。現時，香港尚未有研究評價耳穴療法對處理便秘的療效。 / 研究目的：本研究旨在評價耳穴療法的互補療效，對安老院內的長者便秘徵狀及便秘相關的健康生活品質的干預效果。 / 研究方法：本研究是一個採取混合研究法的臨床研究。先進行化研究，評價耳穴療法對安老院內長者的便秘徵狀及便秘相關的健康生活品質的互補療效；接著進行質化研究，探討面談者對接受耳穴療法的經驗及感受。量化研究是一個隨機對照及雙盲的研究。安老院內的院友被取錄為參與者後，便隨機地獲分配一個研究組別。本研究共有三個研究組別，每名組員分別接受一個預定的干預措施，包括磁珠耳貼療法 (干預組)，王不留行籽耳貼療法 (對照A組) 及耳貼療法 (對照B組)，干預措施是在七個選定的耳穴上進行耳穴療法，共維持十天。研究指標包括便秘徵狀及便秘相關的健康生活品質。此等研究指標分別在干預前 (基線資料)、十天後 (干預措施結束) 和二十天後 (干預措施結束後十天) 進行資料蒐集。統計推斷方法是採用廣義估計方程模型檢驗組間和組內在便秘徵狀及便秘相關的健康生活品質之差異。質化研究的面談者必須是完成整個研究過程的干預組組員，並在量化檢驗的便秘徵狀指標中取得最高分及最低分的各四位組員。透過個別面談，探討面談者對接受耳穴療法以處理便秘的經驗及感受。 / 研究結果：本研究共有99名參與者。祇有90名參與者接受干預措施 (干預組=31；對照A組=28；對照B組=31)，其中的81名參與者完成整個療程 (干預組=29；對照A組=25；對照B組=27)。本研究結果顯示耳穴療法在十天 (p=0.016)及二十天 (p=0.016) 的研究時期內，便秘相關的健康生活品質中的滿意度在干預組及對照A組間有顯著的差異 (十天及二十天均是p=0.016)。然而，本研究證實磁珠耳貼療法能顯著地紓緩便秘徵狀 (十天：p=0.013；二十天：p<0.001)，提升與便秘相關的健康生活品質 (十天：p=0.005；二十天：p<0.001)，並於三個研究組別中取得最大的療效。此外，質化研究結果顯示，耳穴療法確是一項安全及具認受性的療法，適用於安老院內的院友，可作為處理便秘的治療方案。 / 研究結論：本研究是香港首個通過隨機對照的臨床研究，以評價耳穴療法對處理便秘的互補療效。研究結果顯示磁珠耳貼療法對安老院內的院友具有正向的臨床價值：磁珠耳貼療法能紓緩便秘徵狀及提升便秘相關的健康生活品質；安老院內的院友認為耳穴療法是一項安全及具認受性的療法；對住在安老院內年長的中國人而言，耳穴療法是一項與其文化相關的照護方式。本研究就處理安老院內院友的便秘問題為護理專業提供了有關耳穴療法的新知，並作為日後於護理實務及護理研究方面的參考和方向。 / Background: Constipation has been identified in previous studies as a worldwide health problem among elderly people, especially those living in residential care homes (RCHs). Similarly, constipation is also reported as a common health problem among elderly people in Hong Kong in a local population survey. Constipation adversely affects the biopsychosocial well-being of elderly people. In addition, heavy burden has been imposed on the health care system in dealing with constipation and its related health problems. Constipation is currently managed by laxatives and lifestyle modification. However, constipation is not effectively relieved by these two management strategies. In Hong Kong, the aging population is seen to have an increasing trend. Constipation will then be a potentially expanding health problem among elderly people. All these data indicate an urgent need for effective alternatives to manage this health problem. Auriculotherapy is one popular treatment modality in Chinese medicine, which is also a form of complementary therapy. Previous studies conducted in Mainland China reported promising results in managing constipation with auriculotherapy, although its effectiveness was not affirmed. Auriculotherapy appears to be a promising management strategy for constipation. Until now, no study has been conducted in Hong Kong to evaluate the effectiveness of auriculotherapy in managing constipation. / Aim: The current study aims to evaluate the complementary effects of auriculotherapy in relieving constipation symptoms and in promoting disease-specific health-related quality of life (HRQOL) among elderly RCH residents. / Methods: The present study is a clinical trial that adopts the mixed-method design. A randomized placebo-controlled trial was first conducted to evaluate the complementary effects of auriculotherapy in relieving symptoms of constipation and in promoting disease-specific HRQOL in elderly RCH residents. After the completion of the randomized placebo-controlled trial, the qualitative approach was conducted to explore the participants’ experience and perceptions on the use and complementary effects of auriculotherapy with magnetic pellets in managing constipation. The randomized placebo-controlled trial was a double-blind study. The participants were recruited from elderly RCH residents and then randomly assigned to one of the three study groups. The participants received the assigned intervention, namely, auriculotherapy using auricular plaster with magnetic pellet (experimental group), auriculotherapy using auricular plaster with Semen Vaccariae (placebo-controlled group A), or auriculotherapy using only auricular plaster (placebo-controlled group B). Auriculotherapy was applied onto seven selected auricular acupoints for 10 days. Two outcome variables, namely, constipation symptoms and disease-specific HRQOL, were measured before the implementation of intervention (baseline), on Day 10 (at the completion of the intervention), and on Day 20 (at the 10th-day follow-up after the intervention). The generalized estimating equation model was adopted to evaluate the between-group and within-group differences in the complementary effects of auriculotherapy on constipation symptoms and disease-specific HRQOL. In the qualitative approach, the informants were recruited from participants of the experimental group who had successfully completed the study with mean scores in constipation symptoms at the top- or bottom-four ranking. The informants were individually interviewed to explore their experience and perceptions on the use and complementary effects of auriculotherapy in managing constipation. / Results: Ninety-nine participants were recruited in the study. Ninety participants received the intervention as assigned, and eventually, 81 participants completed the intervention. When the interaction effects of time and group were simultaneously considered, statistical significant differences were only found in the satisfaction subscale of the disease-specific HRQOL between the experimental group and placebo-controlled group A on both Day 10 (p=0.016) and Day 20 (p=0.016). For the experimental group, significant time effects were found in constipation symptoms (Day 10：p=0.013; Day 20：p<0.001) and disease-specific HRQOL (Day 10：p=0.005; Day 20：p<0.001) after receiving auriculotherapy. Most importantly, the participants who received auriculotherapy with magnetic pellets showed the greatest improvement in constipation symptoms and disease-specific HRQOL after the intervention compared with the two placebo-controlled groups. The qualitative findings further revealed that auriculotherapy is a safe, well-accepted therapy in managing constipation among elderly RCH residents. / Conclusion: The current study is the first known randomized placebo-controlled trial that evaluates the complementary effects of auriculotherapy in managing constipation in Hong Kong. The current findings indicate positive clinical value of auriculotherapy with magnetic pellets in managing constipation in elderly RCH residents. Auriculotherapy with magnetic pellets was found to provide favourable therapeutic effects in relieving constipation symptoms and in promoting disease-specific HRQOL among elderly RCH residents. This therapy is also considered by elderly people as a safe and acceptable therapy with minimal side effects. In addition, auriculotherapy is considered as a culturally relevant care modality for Chinese elderly RCH residents. The current study contributes new knowledge to nursing for future reference and directions in both nursing practice and nursing research with regard to the complementary effects of auriculotherapy in managing constipation among elderly RCH residents. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Li, Mei Kuen. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 273-305). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract and appendixes also in Chinese. / Chapter CHAPTER 1 --- INTRODUCTION / Introduction --- p.1 / Background of the study --- p.2 / Aim and significances of the study --- p.6 / Overview of the thesis --- p.6 / Chapter CHAPTER 2 --- LITERATURE REVIEW / Introduction --- p.8 / Constipation: Potentially expanding health problem in elderly population --- p.9 / Prevalence of constipation --- p.9 / Definition of constipation --- p.11 / Physiology and pathophysiology of defecation --- p.13 / Effects of constipation --- p.15 / Adverse individual health consequences --- p.15 / Economic burden in health care system --- p.18 / Contributory factors for constipation --- p.20 / Roles of nurses in managing constipation in current practice --- p.22 / Cautious use of laxatives --- p.24 / Lifestyle modification --- p.24 / Promoting dietary fiber intake --- p.25 / Encouraging oral fluid intake --- p.26 / Promoting physical activity --- p.26 / Integration of complementary therapy into nursing practice in managing constipation --- p.28 / Auriculotherapy --- p.30 / Historical overview of auriculotherapy --- p.30 / Conceptual framework of auriculotherapy --- p.31 / Approaches of auriculotherapy --- p.36 / Mechanism of auriculotherapy --- p.37 / Clinical applications of auriculotherapy in managing constipation --- p.39 / Complementary effects of auriculotherapy in managing constipation: Review of previous studies --- p.41 / Subject characteristics --- p.41 / Intervention protocol --- p.45 / Therapeutic outcome criteria and effectiveness --- p.50 / Strengths and limitations of the reviewed studies --- p.56 / Recommendations for future studies --- p.59 / Significances of the current study --- p.60 / Summary --- p.61 / Chapter CHAPTER 3 --- METHODS / Introduction --- p.63 / Overview of study design --- p.65 / Mixed-method study design --- p.66 / Quantitative approach --- p.66 / Qualitative approach --- p.68 / Research aim and objectives --- p.68 / Research aim --- p.68 / Research objectives --- p.68 / Null hypotheses --- p.69 / Operational definitions --- p.71 / Rationale of the study design --- p.73 / Rationale for adopting the mixed-method design --- p.73 / Rationale for adopting the randomized controlled trial design --- p.75 / Rationale for adopting double-blindness --- p.75 / Rationale for adopting random assignment --- p.76 / Rationale for adopting a pretest and repeated post-test design --- p.78 / Rationale for recruiting placebo-controlled groups --- p.79 / Quantitative approach --- p.81 / Sample --- p.81 / Accessible population --- p.81 / Sampling method and selection of participants --- p.82 / Sample size determination --- p.85 / Experimental intervention --- p.87 / Content of the experimental intervention --- p.87 / Integrity of experimental intervention --- p.92 / Qualification of the intervener --- p.92 / Consistency of implementation of intervention --- p.93 / Compliance of the participants to study instructions --- p.84 / Data collection --- p.95 / Study Instruments and records --- p.95 / Patient Assessment of Constipation Symptom Questionnaire (Cantonese Chinese for Hong Kong) (PAC-SYM) --- p.96 / Patient Assessment of Constipation Quality of Life Questionnaire (Cantonese Chinese for Hong Kong) (PAC-QOL) --- p.97 / Abbreviated Mental Test (Hong Kong version; AMT) --- p.98 / Physical Activity Questionnaire (Hong Kong version; PAQ) --- p.98 / Screening for eligibility of the participant --- p.99 / Demographic and Clinical Data Sheet --- p.99 / Assessment of Clinical Syndrome of Constipation --- p.99 / Assessment of oral intake of Fruits and Vegetables (AFV) --- p.100 / Bowel Movement Record (BMR) --- p.100 / Drug Administration Record (DAR) --- p.101 / Data collection procedure --- p.101 / Qualitative approach --- p.104 / Rationale for adopting criterion sampling --- p.105 / Pilot Study --- p.106 / Feasibility of the sampling method --- p.107 / Feasibility of the data collection instruments and procedure --- p.107 / Feasibility of implementation of the study intervention --- p.108 / Characteristics of the pilot sample --- p.109 / Sample size recalculation --- p.113 / Appropriateness of the interview guide --- p.114 / Recommendations for the main study --- p.115 / Data Analysis --- p.115 / Quantitative data --- p.115 / Assessment of accuracy of data entry --- p.116 / Description of sample characteristics --- p.117 / Assessment of homogeneity of the study groups --- p.117 / Detection of the intervention effect --- p.118 / Justification for choosing parametric statistical tests over non-parametric statistical tests --- p.118 / Adoption of the Generalized Estimating Equations (GEE) model --- p.119 / Rationale for adopting the GEE model --- p.119 / Choosing the appropriate link function and working correlation matrix --- p.121 / Control of possible covariates in data analysis --- p.123 / Qualitative data --- p.124 / Ethical considerations --- p.125 / Principle of respect for persons --- p.126 / Principle of beneficence --- p.127 / Principle of justice --- p.128 / Summary --- p.129 / Chapter CHAPTER 4 --- RESULTS / Introduction --- p.132 / Recruitment and characteristics of participants --- p.133 / Recruitment of participants --- p.133 / Characteristics of the participants --- p.137 / Characteristics of the study sample and homogeneity among study groups --- p.140 / Characteristics of the study sample --- p.141 / Homogeneity of the characteristics of participants who received and those who did not receive the intervention in the study --- p.145 / Homogeneity of the characteristics of participants in the experimental and the placebo-controlled groups --- p.145 / Complementary effects of auriculotherapy in managing constipation --- p.149 / Adopting the GEE model --- p.152 / Checking the missing data --- p.152 / Identifying the covariates --- p.152 / Choosing the appropriate link function --- p.153 / Choosing the appropriate working correlation matrix --- p.160 / Complementary effects of auriculotherapy on constipation symptoms and disease-specific HRQOL --- p.160 / Complementary effects of auriculotherapy on constipation symptoms --- p.161 / Constipation symptoms (PAC-SYM) --- p.161 / Subscales of constipation symptoms --- p.165 / Abdominal symptoms subscale --- p.165 / Rectal symptoms subscale --- p.168 / Stool symptoms subscale --- p.172 / Summary of the complementary effects of auriculotherapy on constipation symptoms --- p.175 / Complementary effects of auriculotherapy on disease-specific HRQOL --- p.177 / Disease-specific HRQOL (PAC-QOL) --- p.177 / Subscales of disease-specific HRQOL --- p.181 / Physical discomfort subscale --- p.181 / Psychosocial discomfort subscale --- p.185 / Worries and concerns subscale --- p.186 / Satisfaction subscale --- p.190 / Summary of the complementary effects of auriculotherapy on disease-specific HRQOL --- p.193 / Effect size calculation --- p.196 / Findings revealed from study records --- p.197 / Monitoring of the intervention dose --- p.198 / Change of bowel movement pattern --- p.198 / Change in drug administration --- p.200 / Reporting of side effects associated with auriculotherapy --- p.202 / Reporting of unexpected beneficial effects after receiving auriculotherapy --- p.202 / Qualitative findings revealed from interview --- p.203 / Recruitment of informants --- p.203 / Characteristics of the informants --- p.204 / Qualitative findings --- p.207 / Benefits of auriculotherapy in managing constipation --- p.208 / Minor discomforts associated with auriculotherapy --- p.210 / Life as usual with the use of auriculotherapy --- p.210 / Willingness to adopt and recommend auriculotherapy to others --- p.213 / Summary of the qualitative findings --- p.214 / Summary --- p.215 / Chapter CHAPTER 5 --- DISCUSSION / Introduction --- p.217 / Profile of participants --- p.217 / Demographic and clinical characteristics of the participants --- p.218 / Baselines outcome variables of the participants --- p.224 / Clinical value of auriculotherapy with magnetic pellets in managing constipation --- p.226 / Summary of the key findings --- p.226 / Complementary effects in relieving constipation symptoms and in promoting disease-specific HRQOL --- p.228 / Safe and well-accepted intervention --- p.236 / Culturally relevant care modality --- p.239 / Challenges associated with recruiting elderly participants --- p.241 / Strengths and limitations of the current study --- p.246 / Strengths of the study --- p.246 / Limitations of the study --- p.253 / Summary --- p.257 / Chapter CHAPTER 6 --- CONCLUSION / Introduction --- p.258 / Contribution of new knowledge to nursing --- p.258 / Implications for nursing practice --- p.259 / Clinical application of auriculotherapy in nursing practice --- p.261 / Strategies to promote integration of auriculotherapy into nursing practice --- p.263 / Implications for nursing research --- p.266 / Recommendations for further studies --- p.268 / Conclusion of the whole study --- p.269 / REFERENCES (ENGLISH) --- p.273 / REFERENCES (CHINESE) --- p.303