57 research outputs found
Plan de negocios: vinos de author ¿cuál es tú enólogo favorito?
No full textFil: Baracat, Martín Andrés. Universidad de San Andrés. Escuela de Negocios; Argentina
Laparoscopic sentinel lymph node detection after hysteroscopic injection of technetium-99 in patients with endometrial cancer
No full textBackground and Objectives: Endometrial cancer (EC) has an increasing incidence worldwide. Despite the unequivocal prognostic importance of nodal status, systematic lymphadenectomy is associated to elevated morbidity. Sentinel lymph node (SLN) biopsy is designed to avoid extensive nodal dissection and provide crucial oncologic information. The goal of this prospective study was to determine the feasibility, safety, and accuracy of laparoscopic SLN biopsy in EC obtained through hysteroscopic injection of technetium-99 (Tc-99). Methods: From January 2008 to December 2012, a total of 42 women with EC were included in the study. We injected 20 mBq of Tc-99 hysteroscopically underneath the tumor minutes before definitive surgery. Thereafter, laparoscopic SLN identification /biopsy followed by pelvic and para-aortic lymphadenectomy, hysterectomy, and bilateral salpingo-oophorectomy were executed. Results: The total number of removed nodes was 970. The detection rate of the method was 73% (31/42). Among the 70 isolated SLNs, 35% (24) were exclusively identified in the paraaortic area. Fourteen patients (45%) had SLN only in the pelvic region, whereas 11 (35%) had SLN in both pelvic and para-aortic areas and 6 women (20%) had isolated para-aortic SNL. Nodal metastases were histologically confirmed in 9 patients (22%), and SLN was identified in 7 of 9 patients (78%). Although the obtained specificity was 100% and the negative predictive value was 89%, the sensitivity was only 58% (false-negative rate of 42%). Conclusions: We could demonstrate that endoscopic SLN biopsy obtained through hysteroscopic injection of Tc-99 is a feasible and safe method. Despite the restricted number of included patients in this series, the obtained sensitivity and false-negative rates raise some questions about the real accuracy of the procedure in EC. Larger validation trials requiring quality pelvic and para-aortic lymphadenectomy are essential to correctly evaluate the method
Aspects histomorphometric in the endometrium of adult castred rats after use to estrogen, progesterone and tamoxifen
No full textNesse estudo, procurou-se avaliar, sob o ponto de vista histomorfometrico, os efeitos da reposicao com estrogenios conjugados equinos (EC) e acetato de medroxiprogesterona (AMP), isolados ou associados, e do tamoxifeno (TAM) sobre o endometrio de ratas adultas ooforectomizadas. Foram estudadas 50 ratas adultas, que apos ooforectomia bilateral, foram distribuidas, ao acaso, em cinco grupos, a saber: G I - controle (propilenoglicol); G II - tratadas com EC, 50 mg/animal/dia; G III - tratadas com AMP, 2,0 mg/animal/dia; G IV tratadas com ECI 50 mg/animal/dia, associado ao AMP., 2,0 mg/animal/dia; G V - tratadas com TAM 250 mg/animal/dia. A administracao dos medicamentos foi realizada sempre no periodo da tarde, por gavagem, durante 60 dias consecutivos. Apos esses procedimentos fragmentos endometriais foram retirados e analisados pela microscopia de luz e sistema de analise digital de imagem por computador (IMAGELAB - SOFTIUM). Baseados em nossos achados podemos concluir que houve aumento da espessura endometrial e da area glandular, nos grupos que receberam: EC (II), EC+AMP (IV) e TAM (V); nas doses e no tempo utilizados, quando comparados ao controle. E no grupo 111 (AMP), nao houve acao significante sobre o endometrioBV UNIFESP: Teses e dissertaçõe
Correction to: Impacts of bariatric surgery in health outcomes and health care costs in Brazil: Interrupted time series analysis of multi-panel data (BMC Health Services Research, (2022), 22, 1, (41), 10.1186/s12913-021-07432-x)
No full textCopyright © The Author(s) 2022. Correction to: BMC Health Serv Res 22, 41 (2022) https://doi.org/10.1186/s12913-021-07432-x. Following publication of this article [1], the corresponding author should be changed from José Antonio Orellana Turri to Nana Kwame Anokye due to a typesetting error. The original article [1] has been corrected
Abstract OT2-02-01: Brazilian randomized study - Impact of preoperative magnetic resonance in the evaluation for breast cancer conservative surgery (BREAST-MRI trial)
No full textAbstract
Background: A precise preoperative evaluation of the tumor is essential to improve breast cancer surgical management. Currently, mammography associated with ultrasound and clinical exam are the standard techniques for evaluating extension and tumor localization. However, approximately one third of the lesions in patients eligible for conservative surgical treatment are misevaluated by these methods. Breast magnetic resonance imaging (MRI) has a high sensitivity (95-100%) in detecting invasive neoplasms, and is able to detect occult tumors, multifocal and/or multicentric disease, and contralateral breast cancer more accurately than mammography and ultrasound. Until now, there are only three randomized trials assessing the role of preoperative MRI. These trials have different designs and contradictory results. Trial design: BREAST-MRI is a randomized, open label, unblinded trial designed to compare the accuracy of breast MRI in the preoperative planning of surgical treatment of breast cancer to standard protocol (clinical exam of the breast, mammography and/or breast ultrasound) and the impact of breast MRI on breast cancer outcome. Patients are randomized on a 1:1 basis, stratified for mammary density, into two groups: 1)MRI group: patients are submitted to MRI and standard protocol 2)Control group: standard protocol. First phase: patient recruitment and data collection up until surgery. Second phase: follow-up for five years or until death. Eligibility criteria: women aged 18 years or older with breast cancer stages I to III candidates for conservative surgery (CC). Specific aims: The aim of this study is to evaluate the ability of MRI in selecting patients for conservative treatment of breast cancer. Primary outcomes are: false positive rates, false negative rates, positive predictive value and negative predictive value of MRI in breast cancer CC. Secondary outcomes are: rates of positive margins on pathological examination; reoperation rates; number of conversions to mastectomy; accuracy of MRI according to mammographic density, immunohistochemical subtype and histopathology of the tumor; rates of multicentricity, multifocality and bilateralality of tumors; disease-free survival after 3 and 5 years; and cost-effectiveness of breast MRI. Statistical methods: The calculated total case number for this trial is 372, assuming a recurrence rate of 10% for CC and 1% for mastectomies. The Shapiro-Whilks test will be used to verify if distribution of the quantitative variables follows normal distribution. The baseline population will be analyzed using the t-Student test, or the Mann-Whitney test when appropriate. To test the existence of a possible association between outcomes and the categorized characteristics, chi-square and Fisher's exact test will be performed. Disease progression will be reassessed at 3 and 5 years follow-up, in order to produce a log-rank Kaplan-Meier curve of survival. Present accrual and target accrual: In June 2017, randomizations are at approximately 90% of the target sample size.
Citation Format: Dória MT, Mota BS, Reis YN, Ricci MD, Piato JRM, Ferreira VCCS, Shimizu C, Barros N, Filassi JR, Baracat EC. Brazilian randomized study - Impact of preoperative magnetic resonance in the evaluation for breast cancer conservative surgery (BREAST-MRI trial) [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT2-02-01.</jats:p
Tradução e comentário da Introdução do Livro I da Sintaxe de Apolônio Díscolo
No full textO presente trabalho contém uma tradução da introdução (primeiros trinta e seis parágrafos) do Livro I da Sintaxe de Apolônio Díscolo, precedida de uma introdução que faz breve histórico da bibliografia a respeito do autor e de três capítulos de comentário. O primeiro capítulo explicita a metodologia de tradução seguida, com destaque para o tratamento que mereceram os termos técnicos; o segundo trata de dois termos importantes na obra, taxis e thesis – o primeiro dando conta de uma ideia de ordem ou ordenação no sistema gramatical, o segundo representando tanto a imposição de nomes quanto a situação em uma ordem - e explica as escolhas para eles; o terceiro avança uma proposta de leitura para o trecho traduzido, formulada como um conjunto de preceitos ou axiomas a que o gramático adere.This work contains a translation of the introduction (i. e. the initial thirty-six paragraphs) of Book I of the Syntax of Apollonius Dyscolus, preceded by an introduction which makes a brief historical report of the bibliography about the author and by three chapters of commentary. The first chapter explains the methodology of translation, with an emphasis on the approach to technical terms; the second one deals with two important terms in the work, taxis and thesis – the first conveying and idea of order or ordering in the grammatical system, the second meaning both the imposition of names and the position in an ordering - and explains the choices for them; the third chapter proposes a general reading for the translated excerpt, formulated as a set of precepts or axioms the grammarian adheres to
A comparative analysis of EU Antidumping rules and application
No full textTrade policy in the European Union is characterized by an intensive use of Antidumping measures. In this paper we compare existing practices in the EU to WTO rules and to other WTO Members. Our comparative analysis reveals that the EU's "lesser-duty rule", which limits the magnitude of the Antidumping duty to the level of domestic injury caused by dumped imports, results in a lower average duty level in EU cases, particularly when compared to the US. In terms of the "Sunset Clause", which limits the duration of protection to 5 years, the EU presents a lower share of measures lasting beyond this limit as compared to other users of Antidumping. In recent years, the number of case initiations by the EU has decreased. There has also been a shift towards the imposition of duties and away from the use of price undertakings as a protectionist measure. In line with other WTO members, an increasing share of cases are targeted against China, where it used to be predominantly Central-European countries and Japan, as well as other low or middle income countries.Antidumping, European Union, Contingent protection, Trade policy, lesser duty rule,price undertakings, WTO
Abstract P2-12-11: Does conservative surgery treatment for locally advanced breast cancer safe after neoadjuvant treatment?
No full textAbstract
BACKGROUND:
The aim of this study was to assess the oncological efficacy of breast conserving surgery (BCS) after neoadjuvant chemotherapy in patients with local advanced breast cancer.
PATIENTS AND METHODS:
A retrospective cohort study was conducted with locally advanced breast cancer invasive (Stage IIb to III) treated at ICESP, an oncologic referral center between 2008 and 2016. Endpoints were disease free survival (DFS), local disease free survival (LDFS) and overall survival (OS). Multivariable analyses were performed using Cox proportional hazards models.
RESULTS:
530 patients were included, 26% (138) were stage IIB, 41.9% (222) IIIA, 29.6% (157) IIIB and 2.5% (13) IIIA. 88.8% (470) were invasive ductal carcinoma. The mean age was 51.5(23-95). 95.5% and 4.5% were submitted Neoadjuvant Chemotherapy and Hormone therapy, respectively. The BCS were performed in 24.5% (130) patients versus 75.5% (400) of mastectomies. The mean follow up was 36.4(0.16-80.2) months. There were no differences in local disease free-survival 59 (95%CI 58-61) versus 60 (95%CI 57-60); p=0.4 and overall survival 56.2 (95%CI 52-60) versus 59.3(95%CI 53-65); p= 0.24 for mastectomy and BCS. The disease free survival was lower at mastectomy group 51.4 (95%CI 49-53) versus 56,8 (95%CI 53-59); p=0.01. Logistic regression models were significant only for cancer stage both patterns, although the results were better for masses, particularly when kinetic assessments were included (LR 12.8; p = 0.005)
CONCLUSION:
In our population, the BCS does not affect the overall and local disease-free survival rates, which seems to be safe to perform in patients who desire to conserve the breast after neoadjuvant treatment.
Citation Format: Boufelli G, Mota BS, Franca FC, Doria MT, Maesaka JY, Ricci MD, Piato JRM, Rocha FBC, Giribela AHG, Gonçalves R, Masili-Oku S, Mano MS, Chala LF, Thompson BM, Baracat EC, Filassi JR. Does conservative surgery treatment for locally advanced breast cancer safe after neoadjuvant treatment? [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-12-11.</jats:p
From the trauma of seduction to the seduction's trauma: dialogs between Sándor Ferenczi and Jean Laplanche
No full textEsta pesquisa tem como objetivo estabelecer um diálogo entre as teorias do trauma de Sándor Ferenczi de Jean Laplanche, a fim de relacionar os pontos convergentes presentes nos autores. Para tanto, procedeu-se a uma revisão bibliográfica a fim de destacar a especificidade do pensamento de cada autor. Discorreu-se sobre a vida e obra de Ferenczi a título de efetuar um resgate do autor e pontuar os principais conceitos envolvidos em sua concepção de trauma. Depois, descreveu-se a trajetória de pesquisa de Laplanche, a qual eclodiu na renovação teórica apresentada em sua teoria da sedução generalizada. Ao final, articulou-se os principais conceitos teóricos presentes na teoria de ambos para discutir a noção de trauma oriunda destas. Destacou-se quatro pontos fundamentais sobre os quais a análise teórica foi feita: a abertura psíquica; o papel do outro na constituição subjetiva; a noção de corpo como parasitado pelas representações desligadas e a noção de après-coup como característica da temporalização do humano. Como resultado caracterizou-se dois tipos de trauma descritos pelos autores: o trauma fundamental e o trauma intromissivo. Também se certificou que para os autores o caráter exógeno da formação psíquica implica a relação com o outro originário, cujas mensagens pulsionais incidem sobre a criança, instaurando a tópica inconsciente. Assim, pode-se pensar nos aspectos éticos implicados no cuidado parental e nas possibilidades profiláticas da terapêutica psicanalítica.This research aims to establish a dialogue between the trauma theories of Sándor Ferenczi and Jean Laplanche, to enable to indicate their convergence points. Therefore, proceeded a bibliographical review to point out the specificity of each author’s thoughts. Ran through the life and work of Ferenczi to evaluate the author rescue and point out his major concepts about the trauma. Than, described Laplanche’s research, which emerges in a theorical renovation presented in the general seduction’s theory. In the end, we articulate the major concepts present in both authors to discuss the notion of trauma from them. We accentuated four conceptual axes to proceed to an theorical analysis: the psychic openning; the role for the other in the psychic constitution; the notion of body as parasited by desconnected representations and the notion of après-coup as caracateristic of human temporalization. As result, we caracterized two types of trauma as described by the authors: a fundamental trauma and the intromissive trauma. Also certificates that for these authors the psychic formation has an exogenous character implicated in the relationship with the original other, which pulsional messages affects the child, instituting the unconscious topic. So, we can think about the ethical aspects of the child’s care and the possibilities of psychoanalytical terapeutics.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES
Evaluation of artificial chylomicrons metabolism in obese and nonobese patients with polycystic ovary syndrome
No full textEste estudo teve como objetivos avaliar o metabolismo de quilomícrons utilizando a metodologia da cinética plasmática de uma emulsão de quilomícrons artificiais em pacientes com síndrome dos ovários policísticos (SOP), assim como o impacto da obesidade nesta cinética. Foram estudadas 43 mulheres adultas jovens, subdivididas em 4 grupos, sendo 8 pacientes com SOP e índice de massa corporal normal [SOP-N (IMC = 22,7 ± 1,9 Kg/m2)], e 15 com IMC >=30 kg/m2 [SOP-O (IMC = 33,8 ± 3,3 kg/m2)], pareadas com 20 mulheres controles, sendo 10 com IMC normal [Controle-N (IMC = 21 ± 1,76 kg/m2)] e 10 com IMC obeso [Controle-O (IMC = 33,7± 3,1 kg/m2)]. Quando os grupos foram comparados entre si, com relação às características antropométricas, perfil lipídico e apolipoproteínas; detectou-se diferença estatisticamente significante entre IMC (P < 0,001), circunferência abdominal (CA) (P < 0,001), colesterol total (P = 0,042), HDL-colesterol (P < 0,001), LDL-colesterol (P = 0,009), triglicérides (TG) (P < 0,001) e apolipoproteína B (P < 0,001). As médias destas variáveis foram maiores nos grupos Controle- O e SOP-O, não havendo diferenças entre eles. Com relação à apolipoproteína A1 e ácidos graxos livres não houve diferença entre os grupos. A média da apolipoproteína E foi significativamente maior no grupo Controle-N, não havendo diferença ao compararmos os outros três grupos entre si. Com relação à concentração dos hormônios, as pacientes com SOP tiveram médias significativamente maiores para a testosterona total e testosterona livre (TL) (P < 0,001, P = 0,001), respectivamente. O estradiol foi menor nas pacientes com SOP (P = 0,039), não havendo o impacto da obesidade nestas variáveis hormonais. A média da globulina ligadora dos esteróides (SHBG) foi significativamente maior no grupo Controle-N, não havendo diferença ao compararmos os outros três grupos entre si. Com relação ao modelo homeostático de resistência à insulina (HOMA-IR), houve um impacto significativo da obesidade e da SOP. A média do HOMA-IR foi significativamente maior nas mulheres obesas (Controle e SOP), e nas pacientes com SOP, ao compararmos com as controles pareadas para o IMC. Com relação à cinética plasmática de emulsão de quilomícrons artificiais, não houve diferença estatisticamente significante entre os grupos, da taxa fracional de remoção plasmática de 3H-triglicérides (TFR-TG), que avalia indiretamente a lipólise das partículas de triglicérides dos quilomícrons pela lipase lipoprotéica. Com relação à média da taxa fracional de remoção plasmática de 14C- éster de colesterol (TFR-EC), houve diferenças estatisticamente significantes, sendo as médias das pacientes com SOP menores que as médias das mulheres controles (P = 0,004), sem impacto da obesidade nesta variável. Após a análise de regressão multivariada, não se observou influência de nenhuma das variáveis estudadas na TFR-EC das pacientes com SOP. Na análise de Correlação de Pearson, observamos nas pacientes com SOP, uma correlação direta entre IMC e TG (r = 0,480; P = 0,020), IMC e HOMA-IR (r = 0,687; P < 0,001), CA e TG (r = 0,574; P = 0,004), CA e HOMA-IR (r = 0,634; P = 0,001), HDL e SHBG (r = 0,481; P = 0,020), e correlação inversa entre IMC e SHBG (r = - 0,581; P = 0,004), CA e SHBG (r = - 0,629; P = 0,001), CA e HDL (r = - 0,464; P = 0,016), SHBG e TG (r = - 0,414; P = 0,050), SHBG e HOMA-IR (r = - 0.528; P = 0,010), TL e SHBG (r = - 0.510; P = 0,013). A diminuição da recaptação de remanescentes de quilomícrons, demonstrada através da diminuição da TFR-EC, é compatível com níveis circulantes maiores destes remanescentes, assim como um tempo de permanência maior na circulação, facilitando e progredindo o processo de aterosclerose. A diminuição da TFR-EC está presente na SOP, independentemente do IMC, sendo mais um fator de risco cardiovascular nas portadoras desta síndrome.The aims of this study were to evaluate the chylomicrons metabolism using the method of plasma kinetics of an emulsion of artificial chylomicrons in patients with polycystic ovary syndrome (PCOS), as well as the impact of obesity in this kinetics. Forty-three young adult women were studied , subdivided into 4 groups: 8 of them, with PCOS and normal body mass index [ PCOS-N (BMI = 22.7 ± 1.9 kg/m2)], and 15 with BMI >=30 kg/m2 [PCOS-O (BMI = 33.8 ± 3.3 kg/m2 )] , pairwise matched with 20 controls, being 10 with normal BMI [ Control-N (BMI =21 ± 1.76 kg/m2 )] and 10 with obese BMI [Control-O (BMI = 33.7 ± 3.1 kg/m2 )]. When the groups were compared among themselves, in relation to the antropometric features, lipid profile and apolipoproteins; it was detected a statistically significant difference among BMI (P < 0.001), waist circunference (WC) (P < 0.001), total cholesterol (P = 0.042), HDL-cholesterol (P < 0.001), LDL-cholesterol (P = 0.009), triglycerides (TG) (P < 0.001) and apolipoprotein B (P < 0.001). The means of these variables were higher in the Control-O and PCOS groups and there were no differences among them. In relation to apolipoprotein A1 and to free fatty acids, there was no difference among the groups. The means of apolipoprotein E was significantly higher in the Control-N group and there was no difference when we compared the other three groups among themselves. In relation to hormone concentration, the PCOS patients had means significantly higher for total testosterone and free testosterone (P < 0.001, P = 0.001), respectively. Estradiol was lower in PCOS patients (P = 0.039), and there was no obesity impact in these hormonal variables. The means of sex hormone-binding globulin (SHBG) was significantly higher in the Control-N group, and there was no difference when we compared the other three groups among themselves. In relation to the homeostasis model assessment of insulin resistance (HOMA-IR), there was a significant impact of obesity and of PCOS. The means of HOMA-IR was significantly higher in obese women (Controls and PCOS), and in PCOS patients when compared with pairwise matched controls for BMI. In relation to the plasma kinetics of artificial chylomicrons emulsion, there was no statistically significant difference among the groups, of the plasma 3H-triglyceride fractional clearance rate (TFR-TG) , which evaluates indirectly the lipolysis of triglycerides particles of chylomicrons by the lipoprotein lipase. In relation to the means of plasma fractional clearance rate of 14C-cholesterol ester (TFR-EC), there were statistically significant differences, being the means of PCOS patients, lower than the means of controls (P = 0.004), without obesity impact in this variable. After the multivariate regression analysis, it was not observed influence of any of the variables studied in TFR-EC of PCOS patients. Using the Pearson\'s Correlation analysis, we observed in PCOS patients, a direct correlation between BMI and TG (r = 0.480; P = 0.020), BMI and HOMA-IR (r = 0.687; P < 0.001), CA and TG (r = 0.574; P = 0.004), CA and HOMA-IR (r = 0.634; P = 0.001); HDL and SHBG (r = 0.481; P = 0.020) and inverse correlation between BMI and SHBG ( r = - 0.581; P = 0.004), CA and SHBG (r = - 0.629; P = 0.001), CA and HDL (r = -0.464; P = 0.016), SHBG and TG ( r = - 0.414; P = 0.050), SHBG and HOMA-IR ( r = - 0.528; P = 0.010), TL and SHBG ( r = - 0.510; P = 0.013). The decrease of the uptake of chylomicrons remnants shown through the decrease of TFR-EC, is compatible with higher circular levels of these remnants, as well as a prolonged duration in the circulation, facilitating and proceeding to the atherosclerosis process. The decrease of TFR-EC is present in PCOS, independently of BMI, and it is one more cardiovascular risk factor for PCOS patients
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