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Sporadic Abdominal Wall Desmoid type Fibromatosis: treatment paradigm after thirty two years
No full textAbstract\ud
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Background\ud
Desmoid-type fibromatosis is a benign mesenchymal neoplastic process. It exhibits an uncertain growth pattern and high recurrence rate. Previously radical surgical resection was the mainstay of treatment, but recently more surgeons are opting for conservative management with observation (“wait and see” policy). The authors intend to evaluate different therapeutic modalities and oncological outcomes for abdominal wall desmoid tumors.\ud
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Methods\ud
We performed a retrospective study of patients who underwent surgical, hormonal or chemotherapy treatment for abdominal wall desmoid tumors between 1982 to 2014 at two institutions affiliated with the University of São Paulo, Brazil.\ud
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Results\ud
In the study period, 32 patients were included. Twenty-seven patients had surgery upfront. Of those, 89% were women with a median age of 33 years. Mean tumor size was 10 cm. Pathology confirmed free margins in 92% of resections. Tumor recurrence rate was 11%, with median relapse-free survival being 24 months. Multivariate analysis showed that positive final margins (p < 0.001) and positive frozen section (p = 0.001) were independent predictors of recurrence. For the 5 patients who underwent pharmacological therapy, median age was 33 years and median tumor diameter before treatment was 13 cm. Four patients exhibited partial response by Response Evaluation Criteria in Solid Tumors (RECIST). The single patient who did not respond to RECIST underwent radiotherapy.\ud
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Conclusion\ud
Desmoid tumor treatment has been evolving over the past decade towards a more conservative approach. Pharmacological treatment may result in tumor size regression. When surgical excision is indicated, positive margins represent an important prognostic factor for local tumor recurrence
Fate of p-hydroxycinnamates and structural characteristics of residual hemicelluloses and lignin during alkaline-sulfite chemithermomechanical pretreatment of sugarcane bagasse
No full textAbstract\ud
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Background\ud
Preparing multiple products from lignocellulosic biomass feedstock enhances the profit and sustainability of future biorefineries. Grasses are suitable feedstocks for biorefineries as they permit a variety of possible by-products due to their particular chemical characteristics and morphology. Elucidating the fate of p-hydroxycinnamates (ferulates—FAs and p-coumarates—pCAs) and major structural components during bioprocessing helps to discriminate the sources of recalcitrance in grasses and paves the way for the recovery of p-hydroxycinnamates, which have multiple applications. To address these subjects, we assessed sugarcane bagasse biorefining under alkaline-sulfite chemithermomechanical (AS-CTM) pretreatment and enzymatic saccharification.\ud
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Results\ud
The mass balances of the major bagasse components were combined with 2D-NMR structural evaluation of process solids to advance our understanding of sugarcane bagasse changes during biorefining. AS-CTM pretreatment provided a high yield and thoroughly digestible substrates. The pretreated material was depleted in acetyl groups, but retained 62 and 79% of the original lignin and xylan, respectively. Forty percent of the total FAs and pCAs were also retained in pretreated material. After pretreatment and enzymatic hydrolysis, the residual solids contained mostly lignin and ester-linked pCAs, with minor amounts of FAs and non-digested polysaccharides. Saponification of the residual solids, at a higher alkali load, cleaved all the ester linkages in the pCAs; nevertheless, a significant fraction of the pCAs remained attached to the saponified solids, probably to lignin, through 4-O ether-linkages.\ud
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Conclusion\ud
AS-CTM pretreatment provided soundly digestible substrates, which retain substantial amounts of xylans and lignin. Acetyl groups were depleted, but 40% of the total FAs and pCAs remained in pretreated material. Ester-linked pCAs detected in pretreated material also resisted to the enzymatic hydrolysis step. Only a more severe saponification reaction cleaved ester linkages of pCAs from residual solids; nevertheless, pCAs remained attached to the core lignin through 4-O ether-linkages, suggesting the occurrence of an alkali-stable fraction of pCAs in sugarcane bagasse.This work was supported by FAPESP (Contract Number 14/06923-6), CNPq,\ud
and CAPES. Felipe AM Reinoso thanks CAPES for his student fellowships.\ud
JCdR, JR, and AG were funded by the Spanish Projects AGL2014-53730-R,\ud
CTQ2014-60764-JIN and AGL2017-83036-R (fnanced by Agencia Estatal de\ud
Investigación, AEI, and Fondo Europeo de Desarrollo Regional, FEDER), and the\ud
CSIC Project 2014-40E-097
How do social-economic differences in urban areas affect tuberculosis mortality in a city in the tri-border region of Brazil, Paraguay and Argentina
No full textAbstract
Background
The World Health Organization (WHO) launched the “End TB Strategy”, which aims to reduce tuberculosis (TB) mortality by 95% by 2035, Brazil has made a commitment to this, however, one challenge is achieving the goal in the border region, where the TB situation is more critical. The proposal was to analyse the spatial mortality due to TB and its socio-economic determinants in the general population, around the border areas of Brazil, Paraguay and Argentina, as well as the temporal trend in this region.
Method
This ecological study considered the cases of TB deaths of residents of Foz do Iguaçu (BR), with its units of analysis being the census sectors. The standardized mortality rate was calculated for each area. Socioeconomic variables data were obtained from the 2010 Demographic Census of the Brazilian Institute of Geography and Statistics (IBGE). The scan statistic was applied to calculate the spatial relative risk (RR), considering a 95% confidence interval (CI). Spatial dependence was analysed using the Global Bivariate Moran I and Local Bivariate Moran I (LISA) to test the relationship between the socioeconomic conditions of the urban areas and mortality from TB. Analysis of the temporal trend was also performed using the Prais-Winsten test.
Results
A total of 74 cases of TB death were identified, of which 53 (71.6%) were male and 51 (68.9%) people of white skin colour. The mortality rate ranged from 0.28 to 22.75 cases per 100,000 inhabitants. A spatial relative risk area was identified, RR = 5.07 (95% CI 1.79–14.30). Mortality was associated with: proportion of people of brown skin colour (I: 0.0440, p = 0.033), income (low income I: − 0.0611, p = 0.002; high income I: − 0.0449, p = 0.026) and density of residents (3 and 4 residents, I: 0.0537, p = 0.007; 10 or more residents, I: − 0.0390, p = 0.035). There was an increase in the mortality rate in people of brown skin colour (6.1%; 95% CI = 0.029, 0.093).
Conclusion
Death due to TB was associated with income, race resident density and social conditions. Although the TB mortality rate is stationary in the general population, it is increasing among people of brown skin colour
Alcohol-based surgical hand preparation: translating scientific evidence into clinical practice
No full textAbstract\ud
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Background\ud
Although alcohol-based surgical hand preparation offers potential advantages over the traditional surgical scrubbing technique, implementing it may be challenging due to resistance of surgeons in changing their practice. We aimed to implement alcohol-based surgical hand preparation in the hospital setting evaluating the impact of that on the quality and duration of the procedure, as well as on the prevention of surgical site infections.\ud
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Methods\ud
A quasi-experimental study conducted at a tertiary-care university hospital from April 01 to November 01, 2017. Participants were cardiac and orthopedic surgical teams (n = 56) and patients operated by them (n = 231). Intervention consisted of making alcohol-based handrub available in the operating room, convincing and training surgical teams for using it, promoting direct observation of surgical hand preparation, and providing aggregated feedback on the quality of the preparation. The primary study outcome was the quality of the surgical hand preparation, inferred by the compliance with each one of the steps predicted in the World Health Organization (WHO) technique, evaluated through direct observation. Secondary study outcome was the patient’s individual probability of developing surgical site infection in both study periods. We used the Wilcoxon for paired samples and McNemar’s test to assess the primary study outcome and we build a logistic regression model to assess the secondary outcome.\ud
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Results\ud
We observed 534 surgical hand preparation events. Among 33 participants with full data available for both study periods, we observed full compliance with all the steps predicted in the WHO technique in 0.03% (1/33) of them in the pre-intervention period and in 36.36% (12/33) of them in the intervention period (OR:12.0, 95% CI: 2. 4-59.2, p = 0.002). Compared to the pre-intervention period, the intervention reduced the duration of the preparation (4.8 min vs 2.7 min, respectively; p < 0.001). The individual risk of developing a surgical site infection did not significantly change between the pre-intervention and the intervention phase (Adjusted RR = 0.66; 95% CI 0. 16-2.70, p = 0.563).\ud
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Conclusion\ud
Our results demonstrate that, when compared to the traditional surgical scrub, alcohol-based surgical hand preparation improves the quality and reduces the duration of the preparation, being at least equally effective for the prevention of surgical site infections.The University Hospital of the Ribeirão Preto Medical School provided the\ud
ABHR for the study. Other study costs were covered by a research grant\ud
issued by the World Health Organization Implementation Research Regional\ud
Training Centre for the Americas’ Region
Influence of apocynin on cardiac remodeling in rats with streptozotocin-induced diabetes mellitus
No full textAbstract
Background
Increased reactive oxygen species (ROS) generation in diabetes mellitus (DM) is an important mechanism leading to diabetic cardiomyopathy. Apocynin, a drug isolated from the herb Picrorhiza kurroa, is considered an antioxidant agent by inhibiting NADPH oxidase activity and improving ROS scavenging. This study analyzed the influence of apocynin on cardiac remodeling in diabetic rats.
Methods
Six-month-old male Wistar rats were assigned into 4 groups: control (CTL, n = 15), control + apocynin (CTL + APO, n = 20), diabetes (DM, n = 20), and diabetes + apocynin (DM + APO, n = 20). DM was induced by streptozotocin. Seven days later, apocynin (16 mg/kg/day) or vehicle was initiated and maintained for 8 weeks. Left ventricular (LV) histological sections were used to analyze interstitial collagen fraction. NADPH oxidase activity was evaluated in LV samples. Comparisons between groups were performed by ANOVA for a 2 × 2 factorial design followed by the Bonferroni post hoc test.
Results
Body weight (BW) was lower and glycemia higher in diabetic animals. Echocardiogram showed increased left atrial diameter, LV diastolic diameter, and LV mass indexed by BW in both diabetic groups; apocynin did not affect these indices. LV systolic function was impaired in DM groups and unchanged by apocynin. Isovolumic relaxation time was increased in DM groups; transmitral E/A ratio was higher in DM + APO compared to DM. Myocardial functional evaluation through papillary muscle preparations showed impaired contractile and relaxation function in both DM groups at baseline conditions. After positive inotropic stimulation, developed tension (DT) was lower in DM than CTL. In DM + APO, DT had values between those in DM and CTL + APO and did not significantly differ from either group. Myocardial interstitial collagen fraction was higher in DM than CTL and did not differ between DM + APO and CTL + APO. Serum activity of antioxidant enzymes glutathione peroxidase, superoxide dismutase (SOD), and catalase was lower in DM than CTL; apocynin restored catalase and SOD levels in DM + APO. Myocardial NADPH oxidase activity did not differ between groups.
Conclusion
Apocynin restores serum antioxidant enzyme activity despite unchanged myocardial NADPH oxidase activity in diabetic rats
Correction to: in-transit development of color abnormalities in turkey breast meat during winter season
No full textAbstract
Due to a technical issue this article [1] was accidentally published in volume 59, the correct volume for this article is volume 60
Effect of postoperative goal-directed therapy in cancer patients undergoing high-risk surgery: a randomized clinical trial and meta-analysis
No full textAbstract\ud
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Background\ud
Perioperative goal-directed hemodynamic therapy (GDHT) has been advocated in high-risk patients undergoing noncardiac surgery to reduce postoperative morbidity and mortality. We hypothesized that using cardiac index (CI)-guided GDHT in the postoperative period for patients undergoing high-risk surgery for cancer treatment would reduce 30-day mortality and postoperative complications.\ud
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Methods\ud
A randomized, parallel-group, superiority trial was performed in a tertiary oncology hospital. All adult patients undergoing high-risk cancer surgery who required intensive care unit admission were randomly allocated to a CI-guided GDHT group or to a usual care group. In the GDHT group, postoperative therapy aimed at CI ≥ 2.5 L/min/m2 using fluids, inotropes and red blood cells during the first 8 postoperative hours. The primary outcome was a composite endpoint of 30-day all-cause mortality and severe postoperative complications during the hospital stay. A meta-analysis was also conducted including all randomized trials of postoperative GDHT published from 1966 to May 2017.\ud
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Results\ud
A total of 128 patients (64 in each group) were randomized. The primary outcome occurred in 34 patients of the GDHT group and in 28 patients of the usual care group (53.1% vs 43.8%, absolute difference 9.4 (95% CI, − 7.8 to 25.8); p = 0.3). During the 8-h intervention period more patients in the GDHT group received dobutamine when compared to the usual care group (55% vs 16%, p < 0.001). A meta-analysis of nine randomized trials showed no differences in postoperative mortality (risk ratio 0.85, 95% CI 0.59–1.23; p = 0.4; p for heterogeneity = 0.7; I2 = 0%) and in the overall complications rate (risk ratio 0.88, 95% CI 0.71–1.08; p = 0.2; p for heterogeneity = 0.07; I2 = 48%), but a reduced hospital length of stay in the GDHT group (mean difference (MD) – 1.6; 95% CI – 2.75 to − 0.46; p = 0.006; p for heterogeneity = 0.002; I2 = 74%).\ud
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Conclusions\ud
CI-guided hemodynamic therapy in the first 8 postoperative hours does not reduce 30-day mortality and severe complications during hospital stay when compared to usual care in cancer patients undergoing high-risk surgery.\ud
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Trial registration\ud
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www.clinicaltrials.gov\ud
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, \ud
NCT01946269\ud
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. Registered on 16 September 2013.The two funding sources were the University of Sao Paulo (Brazil) and\ud
Edwards LTDA (Irvine, CA, USA), which had no other role in the study
Penile cancer in Maranhão, Northeast Brazil: the highest incidence globally?
No full textAbstract\ud
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Background\ud
The objectives of this study were to determine the minimum incidence of penile cancer in the poorest Brazilian state, and to describe the epidemiologic and clinical characteristics of patients diagnosed with the disease.\ud
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Methods\ud
A retrospective study of 392 patients diagnosed with penile cancer in the three most important referral center in the state was conducted during 2004–2014.\ud
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Results\ud
The age-standardized incidence was 6.15 per 100,000 and the crude annual incidence was 1.18 per 100,000. More than half (61.1%) of the tumors were histological grades 2 and 3, and 66.4% of tumors were classified as at least stage T2. The average age of patients was 58.6 ± 15.7 years (range, 18 to 103 years), with 20.8% of patients ≤40 years of age at diagnosis. The vast majority underwent penectomy (93%). Only 41.8% underwent lymphadenectomy, 58 patients (14.8%) received chemotherapy, and 54 patients (13.8%) received radiotherapy. Stage 3/4 and vascular invasion were statically significant at disease-free survival analysis.\ud
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Conclusion\ud
The state of Maranhão has the highest incidence of penile cancer in Brazil and globally. Tumors are locally advanced and at the time of diagnosis, and there is a high frequency among young individuals. Patients have a low socioeconomic status, making it difficult to complete treatment and receive appropriate follow-up
Learning strategies scale: adaptation to Portuguese and factor structure
No full textAbstract\ud
Since learning strategies seem to be an important set of variables to explain the effectiveness of training and e-learning in organizations is here to stay, this paper aimed to analyze the factor structure and psychometric properties of a Learning Strategies Scale (LSS) and its relationship with the training transfer in an e-learning corporate context. A total of 3600 employees of a Brazilian bank participated in this study by responding to the LSS after taking part in an online course. We measured training transfer with self-evaluation and hetero-evaluation scales. Internal consistency, confirmatory factor analysis, and multiple regressions were conducted. A four-factor structure and an acceptable level of fit for the model were found. All types of learning strategies were related to training transfer in self-evaluation, and the cognitive and help-seeking strategies contributed to explain training transfer in hetero-evaluation. As a reliable and valid measure that predicts the effectiveness of training and job performance, participants should be advised about the learning strategies that produce better performance results at the workplace. Future research should use it in different contexts and samples, analyzing its relationships with other workplace variables.The research was partially funded by “Coordenação de Aperfeiçoamento de\ud
Pessoal de Nível Superior” (CAPES/Brazil)
The REAL study: a nationwide prospective study of rheumatoid arthritis in Brazil
No full textAbstract\ud
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Background\ud
There are few data on the epidemiology, clinical manifestations and management of RA in Brazil, even with the recognition of the high direct, indirect and societal costs of this disease. Herein, we report the formation of the REAL - Rheumatoid Arthritis in Real Life, the first nationally representative multicenter prospective observational study in Brazil.\ud
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Methods\ud
The REAL study was designed to include a total of 1300 evaluable patients from 13 tertiary care public health centers specialized in RA management and representative of 5 regions of Brazil. Each center was expected to enroll ~ 100 consecutively seen patients and follow them prospectively in a systematic protocol-driven fashion with scheduled visits at baseline, 6 and 12 months. Core clinical, laboratory and patient-reported outcomes measures were required to be collected at each visit.\ud
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Results\ud
A total of 1115 patients (89.4% female, mean age of 56.7 years and median disease duration of 12.7 years) were enrolled from 11 participating centers. Almost 80% of patients were of middle-low or low socioeconomic classes. The median educational time was 8 years, with 3.23% being below literacy level. The interval between symptoms and diagnosis varied from 1 to 457 months (median 12 months). Almost half of the patients were on glucocorticoids, 96.5% on DMARDs, with 35.7% on biologics. Median HAQ-DI was 0.875, ranging from 0 to 3. Median DAS28-ESR was 3.5, with 58.7% of patients presenting moderate or high disease activity.\ud
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Conclusions\ud
The first large cohort of Brazilian patients with RA in a real-life setting shows several striking differences from previously published cohorts from other countries. The long delay for diagnosis and start of DMARDs may partly explain the high frequency of erosive disease. An elevated percentage of patients on moderate or high disease activity was seen, despite of the high frequency of corticosteroid and biologics utilization. Data from this cohort may enable public health managers of developing countries better allocate the limited resources available for the care of RA patients.This work was supported by the Brazilian Society of Rheumatology (BSR). For\ud
this project, BSR received specific grant support from the following\ud
companies: Bristol-Myers Squibb Farmacêutica Ltda; Eli Lilly do Brasil Ltda;\ud
Janssen-Cilag Farmacêuticos Ltda; Laboratórios Pfizer Ltda; Produtos Roche\ud
Químicos e Farmacêuticos S.A. and UCB Biopharma Ltda. The funding body\ud
or the companies had no role in the design of the study and collection, analysis,\ud
and interpretation of data and in writing the manuscript