Text in English / The purpose of this study was to gain a richer understanding of midlife experiences. Midlife is stereotypically viewed as a crisis and is one of the least studied, most illdefined stages in life, yet it’s one of the most significant stages. The epistemological framework for this study is post modernism, which allows for this study to document the transitions from crisis at midlife, as seen through the lens of Positive Psychology. This study was exploratory in nature and applied a qualitative ethnographic methodology. Six participants were interviewed from an ethnographic perspective, in an endeavour to allow each participant accordant ontological breadth and flexibility within their respective social and ideological contexts. The researcher’s own social context also adding nuance to the interpretation of data. This interpretation allows for the inclusion of hope, wisdom, creativity, future mindedness, courage, spirituality, responsibility and perseverance. Thematic analysis of these participants’ narratives supports the psychological research which suggests that challenges are associated with midlife. Thematic analysis revealed challenges associated with midlife such as feelings of disillusionment, regret and dissatisfaction; feelings of loneliness, rejection and isolation as well as confusion about the way forward; seeking a meaningful existence and connection as well as achievement. Some participants, however, are in denial of the existence or their experience of midlife and associated challenges, whereas others describe midlife as a transition phase — a crossroads, a wake-up call and time for reassessment Although midlife can be a difficult transitional period, Positive Psychology can help individuals identify and build the necessary resources and coping strategies to prevent a transition turning into a crisis. It was shown that most participants in this research displayed a mindset and attitude open to a Positive Psychology paradigm to accumulate the necessary resources and coping strategies to prevent a midlife transition from becoming a midlife crisis. / Psychology / M.A. (Psychology)

En dépit des taux élevés de mortalité infantile dans les populations du passé, les sujets décédés en période périnatale ont longtemps été délaissés dans les travaux anthropologiques et paléoanthropologiques. Alors que les analyses biologiques portant sur les individus adultes intègrent l’étude de la variabilité comme une composante majeure, rares sont celles permettant de replacer un individu décédé en période périnatale dans le cadre de la variabilité individuelle ou populationnelle de cette classe d’âge. Le présent travail se propose ainsi d’investir le sujet de la diversité métrique et non-métrique des sujets décédés entre 22 et 48 semaines d’aménorrhée à partir de l’étude biologique de 116 sujets de trois collections archéologiques (une kerma et deux médiévales et modernes) et d’une collection actuelle virtuelle comportant 364 individus. Un premier axe de recherche caractérise la variabilité des corpus dans ses composantes intra-individuelles, inter-individuelles, populationnelles, ainsi que du point de vue des corrélations à l’âge au décès. Un second axe de recherche vise à identifier des caractères permettant d’estimer l’état de morbidité et de vitalité à la naissance de l’individu, donnée déterminante pour le statut du sujet dans la société. Pour le premier axe, l’étude révèle des différences de conformation selon l’âge au décès et les groupes populationnels, de même que l’existence d’asymétries directionnelles et fluctuantes. Les résultats vont ensuite dans le sens d’une forte proximité biologique pour le groupe kerma, traduisant potentiellement une certaine endogamie, au contraire du groupe médiéval et moderne dont la diversité plus importante pourrait refléter des facteurs socio-géographiques ou séculaires. Le second axe de recherche a permis de souligner que la mécano-sensibilité des régions d’insertion musculaire apparaît comme un nouveau paramètre à considérer pour discerner les sujets ayant survécu à la naissance. L’étude de la collection kerma livre également la première identification en contexte archéologique d’un critère de morbidité spécifique, la côte surnuméraire cervicale. Enfin, le croisement des analyses biologiques et des données archéologiques de la nécropole 8B-51 de l’île de Saï, permet d’appréhender et de discuter les traitements funéraires dévolus à la classe d’âge périnatale au Kerma classique. / Despite the high rates of child mortality in past populations, subjects deceased in perinatal period were often neglected in bioarchaeological and paleoanthropology studies. Unlike biological analysis on adults, investigations on newborns rarely include individual or populational variability comparisons as a major component. In the present work, we will focus on metrical and non-metrical diversity of subject deceased between 22 and 48 amenorrhea weeks, based on the biological study of 116 subjects from three archaeological collections (one kerma and two medieval and modern) and one current virtual collection with 364 individuals. The first research axis characterizes the intra-individual, inter-individual and populational variability, and differences by age at death in both samples. The second line of research aims to identify criteria making it possible to estimate individual morbidity and live birth on dry bones, informations that are needed to understand the child’s position in society. Biological studies reveal for the first research axis shape differences by age at death and populations, as well as the existence of directional and fluctuating asymmetries. Results provide evidences of strong biological proximity in the kerma group, potentially indicating of endogamy. On the contrary, the diversity of the medieval and modern group appears broader and could reflect socio-geographical factors or secular trends. The second line of research reveals the mechanical sensitivity of muscular insertions as a key parameter for tracking of live-born subjects. The study of the kerma collection provides the first archaeological identification of the supernumerary cervical rib, detected as a morbidity criterion in perinatal period. Lastly, crossing of biological and archaeological data on the 8B-51 necropolis provides an interpretative framework for funerary treatments dedicated to the perinatal age group in Classic Kerma.

Made available in DSpace on 2016-04-27T18:47:21Z (GMT). No. of bitstreams: 1 GER - SILA ZUGMAN CALDERONI.pdf: 4541296 bytes, checksum: 5c4af17a5a9270efacb3e402c9cded1d (MD5) Previous issue date: 2006-10-09 / The contact with someone s old age mobilizes personal contents in middle-aged professionals dealing with the elderly, which produces effects on these professionals´ own lives. This research aimed at examining in what ways Masters in Gerontology conceive and perceive their own ageing process and future old age in the light of their personal and professional experiences. Interviews were carried out with Masters from the Post-graduate Studies Program in Social Gerontology, at PUC-SP, in the 40-60 age group and working in the area of Gerontology. Through a qualitative approach, the interviews were open and organized in a matricial reading for subsequent interpretation. This study has shown that the interviewees contact with the ageing process and the perspective of their own old age is a source of tension. Although they can already notice signs of ageing in themselves, they have not yet fully realized any limitations in their daily lives, despite half of the professionals interviewed having referred to a feeling of discomfort as a result of the awareness that they will eventually move into the aged population group themselves. Personal and professional experiences, all sorts of crises and suffering which these Masters in Gerontology have been through play a major role in the views and feelings they have towards their own ageing process. Paradoxically, they imagine themselves growing old, but without the limitations that old age brings. The knowledge acquired by the professionals interviewed associated with professional work contributed not only to reduce anguish in relation to their own future but also to produce changes in their daily practices, consequently helping improve their present life and future old age / O contato com a velhice do outro mobiliza conteúdos pessoais naqueles que se encontram na meia-idade e trabalham com idosos, o que repercute sobre suas vidas. Esta pesquisa teve como objetivo verificar como os Mestres em Gerontologia pensam e sentem o próprio processo de envelhecimento e futura velhice à luz de seu percurso pessoal e profissional. Entrevistei Mestres, titulados pelo Programa de Estudos Pós Graduados em Gerontologia Social, da PUC-SP, que atuam profissionalmente na área da Gerontologia e se situam na faixa etária entre 40 e 60 anos. Numa abordagem qualitativa, utilizei entrevistas abertas, organizadas numa leitura matricial para posterior interpretação. O estudo revelou que o contato dos entrevistados com o processo de envelhecimento e a perspectiva da própria velhice constitui-se em fonte de tensão. Reconhecem em si sinais de envelhecimento, mas ainda não percebem, em sua plenitude, restrições em seus cotidianos, embora a metade dos entrevistados já refira a sensação de incômodo em face dessa consciência. O percurso pessoal e profissional, as crises e os sofrimentos vividos, permeiam as visões e sentimentos que os Mestres em Gerontologia, na meia-idade, têm em relação ao seu próprio processo de envelhecimento e futura velhice. Paradoxalmente, sem perceber, imaginam-se idosos, até longevos, mas sem as limitações da idade avançada. Os conhecimentos adquiridos pelos estudos agregados ao trabalho profissional contribuíram para acalmar angústias em relação ao próprio futuro e modificar práticas quotidianas, tendo a função de contribuir para melhorar o presente e a futura velhice

La neurogenèse persiste à l’âge adulte dans deux régions du système nerveux central (SNC) des mammifères : la zone sous-ventriculaire (SVZ) du cerveau antérieur et la zone sous-granulaire (SGZ) de l’hippocampe. Cette neurogenèse est possible grâce à la capacité de prolifération des cellules souches présentes dans les niches de la SVZ et la SGZ, mais en vieillissant, le cerveau subit une diminution dramatique du nombre de cellules souches neurales adultes (CSNa), une diminution de la prolifération cellulaire et une altération des niches de neurogenèse. Cependant, une importante question reste sans réponse : comment la perte tardive des CSNa est temporellement reliée aux changements de l’activité de prolifération et de la structure de la principale niche de neurogenèse (la SVZ)? Afin d’avoir un aperçu sur les événements initiaux, nous avons examiné les changements des CSNa et de leur niche dans la SVZ entre le jeune âge et l’âge moyen. La niche de la SVZ des souris d’âge moyen (12 mois) subit une réduction de l’expression des marqueurs de plusieurs sous-populations de précurseurs neuraux en comparaison avec les souris jeunes adultes (2 mois). Anatomiquement, cela est associé avec des anomalies cytologiques, incluant une atrophie générale de la SVZ, une perte de la couche de cellules sousépendymaires par endroit et l’accumulation de gouttelettes lipidiques de grande taille dans l’épendyme. Fonctionnellement, ces changements sont corrélés avec une diminution de l’activité de la SVZ et une réduction du nombre de nouveaux neurones arrivant aux bulbes olfactifs. Pour déterminer si les CSNa de la SVZ ont subi des changements visibles, nous avons évalué les paramètres clés des CSNa in vivo et in vitro. La culture cellulaire montre qu’un nombre équivalent de CSNa ayant la capacité de former des neurosphères peut être isolé du cerveau du jeune adulte et d’âge moyen. Cependant, à l’âge moyen, les précurseurs neuraux semblent moins sensibles aux facteurs de croissance durant leur différenciation in vitro. Les CSNa donnent des signes de latence in vivo puisque leur capacité d’incorporation et de rétention du BrdU diminue. Ensemble, ces données démontrent que, tôt dans le processus du vieillissement, les CSNa et leur niche dans la SVZ subissent des changements significatifs, et suggèrent que la perte de CSNa liée au vieillissement est secondaire à ces événements. / Neurogenesis persists throughout the adulthood in two regions of the mammalian central nervous system (SNC): the sub-ventricular zone (SVZ) of the forebrain and the sub-granular zone (SGZ) of the hippocampus. Neurogenesis is possible due to the proliferation capacity of stem cells present within both the SVZ and SGZ niches, but with aging, the forebrain undergoes a drastic reduction in its number of adult neural stem cells (aNSCs), a decrease of cell proliferation and an alteration of the neurogenic niches. However, a key unresolved question remains: how the onset of aNSC loss is temporally related to changes of proliferating activity and to structural alterations within the principal stem cell niche (the SVZ)? To gain insights into the initial events leading to aging-associated aNSC loss, we investigated the changes occurring to aNSCs and the SVZ niche between young adulthood and middle-age. The SVZ niche of middle-aged mice (12-months-old) was found to display reduced expression of markers for multiple neural precursor sub-populations when compared to young adult mice (2-months-old). Anatomically, this was associated with significant cytological aberrations, including an overall atrophy of the SVZ, loss of sub-ependymal cells, and accumulation of large lipid droplets within the ependyma. Functionally, these changes correlated with diminished SVZ activity and reduced number of newly born neurons reaching the principal target tissue: the olfactory bulbs. To determine whether changes were evident at the level of the SVZ stem cells, we evaluated key in vitro and in vivo parameters of aNSCs. Tissue culture experiments showed that equal numbers of neurosphere-forming aNSCs could be isolated from young adult and middle-aged forebrains. However, at middle-age, neural precursors seemed to be less sensitive to growth factors during their in vitro differentiation and displayed signs of increased quiescence in vivo. Collectively, these findings demonstrate that, with early aging, aNCS and their SVZ niche go through significant changes, and suggest that aging-associated aNSC loss is secondary to these events.

Outre le recensement d’environ 1400 sarcophages, monolithes et bipartites, en Gaule du Nord, l’intérêt de cette recherche réside dans la démonstration des apports pétrographiques, technologiques, économiques et culturels de ces sépultures. Afin de travailler sur un groupe cohérent, seuls les sarcophages de production lorraine, avec une diffusion septentrionale le long de la Meuse, de la Moselle et du Rhin, ont été retenus.<p><p>\ / Doctorat en Histoire, art et archéologie / info:eu-repo/semantics/nonPublished

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L’étude présentée ici a pour but d’analyser la manière d’utiliser l’arc outrepassé, en plan et en élévation, et l’arc en retrait sur ses piliers, dans une région et dans un temps pragmatiquement défini du monde méditerranéen particulièrement riche en éléments architecturaux de ce type. L’arc en retrait n’est pas inconnu dans la recherche mais, faute d’identification précise et donc de terminologie adaptée, il a été confondu avec l’arc outrepassé sous des dénominations différentes. Faisant l’objet de diverses théories dans l’historiographie, ces deux types d’arcs ont été utilisés comme arguments majeurs dans la datation et dans la filiation stylistique des édifices dans lesquels ils se trouvent. L’objectif de cette approche consiste à confronter ces courants historiographiques, inscrivant un monument donné comme relevant du monde wisigothique, mozarabe ou carolingienne, à l’analyse des monuments in situ dans les régions catalano-roussillonnaises et languedociennes où ces formes présentent une concentration considérable. Dans ces théories tenaces, souvent assimilables à des idées reçues sans discernement, l’abbaye de Saint-Michel de Cuxa a occupé une place particulière de sorte que son attribution s’est répercutée sur de nombreux édifices, surtout des chapelles rurales, gravitant dans son orbite. Les monuments situés sur les deux versants des Pyrénées possédant ces formes en élévation ou dans la planimétrie constituent un corpus de 98 édifices. Ils ne révèlent pas seulement une certaine uniformité pour l’ensemble du territoire mais, au-delà, permettent également de définir des microrégions homogènes. L’étude de ce territoire est intégrée dans une analyse historiographique plus vaste de ces deux types d’arcs qui cherche la réponse à leur origine, à leur propagation géographique au fil de temps et présente les différentes réflexions sur la raison d’être de leur emploi. A côté des théories pragmatiques qui considèrent ces formes comme des procédés techniques offrant des avantages constructifs et des mesures techniques qui cherchent à établir une typologie séparant les arcs de différentes époques et de différentes aires géographiques, une attention particulière est apportée aux dimensions idéologiques, liturgiques et symboliques liées à ces tracés. / This study focusses, in façade and in plan, on the horseshoe arch, the hallmark of architecture in the first flowering of the Middle Ages, and on the recessed arch on piers, its more or less unrecognised contemporary. The geographical extent of the occurrence of these two types of arch has been defined by the periodic enlargement of the area where they are really concentrated: Spanish Catalonia and French Languedoc-Roussillon. Applied often to dating a building, and becoming involved as a result in a stylistic epistemology, as well as being the targets of the entrenched dogmas of a vast historiography, these pieces of evidence are here studied on the ground in their architectural context so as to juxtapose fieldwork with the theories on their deployment developed a century ago. Given the spread of developed mediaeval arches, this work endeavours to place their corpus in a wider general study which clearly cannot depend on an exhaustive survey, but which is able to suggest, nevertheless, that the realm of the Moorish arch transcends the territorial and chronological limits of Visigothic, Mozarabic, Carolingian or Islamic culture. The origin of the recessed arch on its piers, for which we propose the term «mushroom shape» displays an undeniable origin in antiquity. Its diffusion in time and space coincides with the horse-shoe throughout the vast Mediterranean ambit. The corpus of the area studied brings together 98 buildings which preserve in their structure the Moorish arch and/or the recessed arch on piers. An analysis of arch assembly, incorporated in the overall study of a building’s construction, confirms that the Moorish design or that of the recessed arch on piers concerned not only arches but was inherent in a general building process observable in the raising of the vault, or of any transverse arches or in openings, doorways or windows. The endurance of these same building procedures for centuries, for minor works such as small country chapels, as for the great abbey church of Saint- Michel de Cuxa, testifies to a conservative art associated with basic techniques.

Hiperplasia prostática benigna (HPB) é considerada a neoplasia masculina mais comum, além de ser a principal causa de sintomas do trato urinário baixo (STUB) em homens idosos. Se não tratada ou mal tratada, poderá levar o paciente a quadro de retenção urinária aguda, incontinência e infecção do trato urinário, progredindo em gravidade com a idade. Apesar do desenvolvimento de técnicas alternativas, a ressecção transuretral da próstata (RTU) continua sendo considerada o tratamento cirúrgico padrão ouro para HPB. Não obstante, a RTU pode estar associada a muitas comorbidades como, sangramento, sintomas urinários irritativos, disfunção sexual e ejaculação retrógrada. Por essa razão, o desenvolvimento de modalidades de tratamentos minimamente invasivos para o tratamento de HPB constitui um campo interessante de pesquisa clínica. Os objetivos deste estudo foram: (1) avaliar a viabilidade, a segurança e a eficácia da embolização das artérias prostáticas (EAP) nos pacientes com retenção urinária devido à HPB, (2) avaliar a porcentagem de redução volumétrica da próstata e a qualidade de vida após a EAP nos pacientes com retenção urinária devido à HPB. No presente estudo, Fase I prospective centro único, 11 pacientes portadores de retenção urinária devido à HPB foram tratados por meio da EAP entre agosto de 2009 e novembro de 2011. Exame físico, questionários de sintomas e qualidade de vida (International Prostate Symptom Score (IPSS) e Quality of Life (QoL)), dosagem do antígeno prostático específico (PSA), exames de imagens de ultrassom (US) e ressonância magnética (RM), e estudos urodinâmicos foram realizados antes e 1, 3, 6, e 12 meses depois da EAP. O tamanho da próstata variou de 30 a 90 gramas, e as embolizações foram realizadas com microesferas (Embospheres) de 300-500?m. O sucesso técnico (EAP bilateral) foi atingido em 75%, e o sucesso clínico (retirada do cateter vesical de demora e melhora dos sintomas) foi obtido em 91% (10 de 11 pacientes) dos casos. Síndrome pósembolização manifestou-se com dor leve no períneo, retropúbica e uretral. Não foram observadas complicações maiores. Ao final do primeiro ano de seguimento, sintomas eram leves com a média do IPSS de 2,8 pontos (p = 0,04), a média da QoL era de 0,4 pontos (p = 0,001), a média do PSA diminuiu de 10,1 para 4,3 ng/mL (p = 0,003), a média do volume prostático reduziu de 69,7 para 46,3 gramas (p = 0,002) e de 62 para 42,7 gramas (p = 0,004) medidos por RM e US, respectivamente, a média do pico de fluxo máximo (Qmax) aumentou de 4,2 para 10,8 mL/sec (p = 0,009), a média da pressão detrusora (Pdet) diminuiu de 85,7 para 51,5 cmH2O (p = 0,007), a média do resíduo final pós-miccional diminuiu de 160,5 para 60ml (p = 0,04) e não foi observada disfunção sexual. A EAP para o tratamento da retenção urinária causada por HPB demonstrou ser um procedimento viável, seguro e eficaz, além de poder reduzir o volume prostático em mais de 30% e melhorar os STUB e a qualidade de vida / Benign prostatic hyperplasia (BPH) is considered the most common neoplasm in men and is the main cause of lower urinary tract symptoms (LUTS) in the aging male. If left untreated or not effectively treated, can lead to acute urinary retention, incontinence, and urinary tract infections, progressing in severity with age. Despite the development of alternative techniques, transurethral resection of the prostate (TURP) is still considered the gold standard surgical treatment for BPH. However, TURP procedures can be associated with substantial morbidities such as bleeding, irritative urinary symptoms, erectile dysfunction and ejaculatory disorders. For this reason, the development of minimally invasive modalities for treatment of BPH has constituted an interesting field of research. The study objectives were: (1) to evaluate the feasibility, safety and efficacy of the prostatic artery embolization (PAE) in patients with urinary retention due to BPH, (2) to evaluate the percentage of reduction in prostate volume and quality of life after PAE in patients with urinary retention due to BPH. In the present study, a single-center prospective phase I study, 11 patients with urinary retention due to BPH were treated by PAE between August 2009 and November 2011. Physical examination, International Prostate Symptom Score (IPSS) and Quality of Life (QoL), prostate specific antigen (PSA) measurement, ultrasound (US) and magnetic resonance imaging (MRI), and urodynamic tests were performed at baseline, 1, 3, 6 and 12 months after PAE. Prostate size ranged from 30 to 90g, and embolizations were performed with 300- 500-?m Embosphere microspheres. Technical success (ie, bilateral PAE) was obtained in 75%, and clinical success (ie, catheter removal and symptom improvement) was obtained in 91% (10 of 11patients) of the cases. Postembolization syndrome manifested as mild pain in the perineum, retropúbica area, and/ or urethra. No major complications were observed. At the first year follow-up, symptoms were mild with the mean IPSS score was 2.8 points (p = 0.04), mean QoL was 0.4 points (p = 0.001), mean PSA decreased from 10.1 to 4.3 ng/mL (p = 0.003), mean prostate volume reduce from 69.7 to 46.3g (p = 0.002) and from 62 to 42.7 (p = 0.004) by MRI and US respectively, maximum urinary flow (Qmax) improved from 4.2 to 10.8 mL/sec (p = 0.009), detrusor pressure (Pdet) decreased from 85.7 to 51.5 cmH2O (p = 0.007), post-void residual decreased from 160.5 to 60ml (p = 0.04) and no erectile dysfunction was observed. PAE for the treatment of urinary retention caused by BPH demonstrated to be a feasible, safe and effective procedure. PAE can reduce the prostate volume greater than 30% and improve clinical symptoms and QoL

Hiperplasia prostática benigna (HPB) é considerada a neoplasia masculina mais comum, além de ser a principal causa de sintomas do trato urinário baixo (STUB) em homens idosos. Se não tratada ou mal tratada, poderá levar o paciente a quadro de retenção urinária aguda, incontinência e infecção do trato urinário, progredindo em gravidade com a idade. Apesar do desenvolvimento de técnicas alternativas, a ressecção transuretral da próstata (RTU) continua sendo considerada o tratamento cirúrgico padrão ouro para HPB. Não obstante, a RTU pode estar associada a muitas comorbidades como, sangramento, sintomas urinários irritativos, disfunção sexual e ejaculação retrógrada. Por essa razão, o desenvolvimento de modalidades de tratamentos minimamente invasivos para o tratamento de HPB constitui um campo interessante de pesquisa clínica. Os objetivos deste estudo foram: (1) avaliar a viabilidade, a segurança e a eficácia da embolização das artérias prostáticas (EAP) nos pacientes com retenção urinária devido à HPB, (2) avaliar a porcentagem de redução volumétrica da próstata e a qualidade de vida após a EAP nos pacientes com retenção urinária devido à HPB. No presente estudo, Fase I prospective centro único, 11 pacientes portadores de retenção urinária devido à HPB foram tratados por meio da EAP entre agosto de 2009 e novembro de 2011. Exame físico, questionários de sintomas e qualidade de vida (International Prostate Symptom Score (IPSS) e Quality of Life (QoL)), dosagem do antígeno prostático específico (PSA), exames de imagens de ultrassom (US) e ressonância magnética (RM), e estudos urodinâmicos foram realizados antes e 1, 3, 6, e 12 meses depois da EAP. O tamanho da próstata variou de 30 a 90 gramas, e as embolizações foram realizadas com microesferas (Embospheres) de 300-500?m. O sucesso técnico (EAP bilateral) foi atingido em 75%, e o sucesso clínico (retirada do cateter vesical de demora e melhora dos sintomas) foi obtido em 91% (10 de 11 pacientes) dos casos. Síndrome pósembolização manifestou-se com dor leve no períneo, retropúbica e uretral. Não foram observadas complicações maiores. Ao final do primeiro ano de seguimento, sintomas eram leves com a média do IPSS de 2,8 pontos (p = 0,04), a média da QoL era de 0,4 pontos (p = 0,001), a média do PSA diminuiu de 10,1 para 4,3 ng/mL (p = 0,003), a média do volume prostático reduziu de 69,7 para 46,3 gramas (p = 0,002) e de 62 para 42,7 gramas (p = 0,004) medidos por RM e US, respectivamente, a média do pico de fluxo máximo (Qmax) aumentou de 4,2 para 10,8 mL/sec (p = 0,009), a média da pressão detrusora (Pdet) diminuiu de 85,7 para 51,5 cmH2O (p = 0,007), a média do resíduo final pós-miccional diminuiu de 160,5 para 60ml (p = 0,04) e não foi observada disfunção sexual. A EAP para o tratamento da retenção urinária causada por HPB demonstrou ser um procedimento viável, seguro e eficaz, além de poder reduzir o volume prostático em mais de 30% e melhorar os STUB e a qualidade de vida / Benign prostatic hyperplasia (BPH) is considered the most common neoplasm in men and is the main cause of lower urinary tract symptoms (LUTS) in the aging male. If left untreated or not effectively treated, can lead to acute urinary retention, incontinence, and urinary tract infections, progressing in severity with age. Despite the development of alternative techniques, transurethral resection of the prostate (TURP) is still considered the gold standard surgical treatment for BPH. However, TURP procedures can be associated with substantial morbidities such as bleeding, irritative urinary symptoms, erectile dysfunction and ejaculatory disorders. For this reason, the development of minimally invasive modalities for treatment of BPH has constituted an interesting field of research. The study objectives were: (1) to evaluate the feasibility, safety and efficacy of the prostatic artery embolization (PAE) in patients with urinary retention due to BPH, (2) to evaluate the percentage of reduction in prostate volume and quality of life after PAE in patients with urinary retention due to BPH. In the present study, a single-center prospective phase I study, 11 patients with urinary retention due to BPH were treated by PAE between August 2009 and November 2011. Physical examination, International Prostate Symptom Score (IPSS) and Quality of Life (QoL), prostate specific antigen (PSA) measurement, ultrasound (US) and magnetic resonance imaging (MRI), and urodynamic tests were performed at baseline, 1, 3, 6 and 12 months after PAE. Prostate size ranged from 30 to 90g, and embolizations were performed with 300- 500-?m Embosphere microspheres. Technical success (ie, bilateral PAE) was obtained in 75%, and clinical success (ie, catheter removal and symptom improvement) was obtained in 91% (10 of 11patients) of the cases. Postembolization syndrome manifested as mild pain in the perineum, retropúbica area, and/ or urethra. No major complications were observed. At the first year follow-up, symptoms were mild with the mean IPSS score was 2.8 points (p = 0.04), mean QoL was 0.4 points (p = 0.001), mean PSA decreased from 10.1 to 4.3 ng/mL (p = 0.003), mean prostate volume reduce from 69.7 to 46.3g (p = 0.002) and from 62 to 42.7 (p = 0.004) by MRI and US respectively, maximum urinary flow (Qmax) improved from 4.2 to 10.8 mL/sec (p = 0.009), detrusor pressure (Pdet) decreased from 85.7 to 51.5 cmH2O (p = 0.007), post-void residual decreased from 160.5 to 60ml (p = 0.04) and no erectile dysfunction was observed. PAE for the treatment of urinary retention caused by BPH demonstrated to be a feasible, safe and effective procedure. PAE can reduce the prostate volume greater than 30% and improve clinical symptoms and QoL

This thesis provides the first rigorous history of the concept of midlife crisis. It highlights the close connections between understandings of the life course and social change. It reverses accounts of popularization by showing how an idea moved from the public sphere into academia. Above all, it uncovers the feminist origins of the concept and places this in a historically little-studied tradition of writing about middle age that rejected the gendered "double standard of aging." Constructions of middle age and life-planning were not always oppressive, but often used for feminist purposes. The idea of midlife crisis became popular in the United States with journalist Gail Sheehy's Passages (1976), a critique of Erik Erikson's male-centered model of ego development and psychoanalytic constructions of gender and identity more generally. Drawing on mid-century notions of middle life as the time of a woman's entry into the public sphere, Sheehy's midlife crisis defined the onset of middle age, for men and women, as the end of traditional gender roles. As dual-earner families replaced the male breadwinner model, Passages circulated widely, read by women and men of different generations, including social scientists. Three psychoanalytic experts-Daniel Levinson, George Vaillant, and Roger Gould-rebutted Sheehy by putting forward a male-only concept of midlife as the end of a man's family obligations; they banned women from reimagining their lives. Though this became the dominant meaning of midlife crisis, it was not universally accepted. Feminist scholars, most famously the psychologist and ethicist Carol Gilligan, drew on women's experiences to challenge the midlife crisis, turning it into a sign of emotional instability, immaturity, and egotism. Resonating with widespread understandings of mental health and social responsibility, and confirmed by large-scale surveys in the late 1990s, this relegated the midlife crisis to a chauvinist cliché. It has remained a contested concept for negotiating the balances between work and life, production and reproduction into the present day.