10 research outputs found
¿Qué hacer cuando se descubre un seudomixoma peritoneal durante la reparación de una hernia de pared abdominal?
No full textWhat Should We Do When a Peritoneal Pseudomyxoma Is Discovered During the Repair of an Abdominal Wall Hernia?
No full textRETRACTED ARTICLE: Upfront citorreduction and hyperthermic intraperitoneal chemotherapy with paclitaxel in patients with stage III-C serous epithelial ovarian cancer.
No full textAs dinâmicas político-territoriais de uma comunidade periférica no sul da América Portuguesa : a ilha de Santa Catarina e seu continente, 1680-1750
No full textDissertação (mestrado) - Universidade Federal de Santa Catarina, Centro de Filosofia e Ciências Humanas, Programa de Pós-Graduação em História, Florianópolis, 2013.Este trabalho tem como objetivo principal analisar o processo político da ocupação luso-brasileira do espaço da Ilha de Santa Catarina e do litoral próximo entre finais do século XVII e a primeira metade do XVIII. Nesse período este território ultramarino passou por inúmeras transformações que culminaram a criação da Vila do Desterro, no ano de 1726, e a instalação da capitania de Santa Catarina, em 1738. Para isso, procurou-se enfatizar aqui a trajetória social e política da elite local recém-constituída, que a partir dos seus postos de governança intermediava junto ao Estado luso o processo territorialização da fronteira sul da América portuguesa. Abstract : This work takes as its principal objective to analyze the political process of Portuguese-Brazilian occupation of the island of Santa Catarina and the nearby coat at the end of the 17th and beginning of the 18th century. During this time, this overseas Portuguese territory passed through many transformations, ending with the creation of the Vila de Desterro in 1726 and the installation of the Capitania of Santa Catarina in 1738. In order to achieve this analysis, the author emphasizes the social and political trajectory of the recently constituted local elite which, through positions of governance, worked with Lisbon to territorialize of the southern frontier of Portuguese America
Family functioning but not social capital is associated with better mental health in adolescents affected by violence and displacement by armed conflict in Colombia
No full textBACKGROUND: The effect of the Colombian armed conflict on the mental health of adolescents is still poorly understood. AIMS: Given social interventions are most likely to inform policy, we tested whether two potential intervention targets, family functioning and social capital, were associated with mental health in Colombian adolescents, and whether this was moderated by experience of violence and displacement. METHODS: We examined the cross-sectional association between family functioning, cognitive social capital, structural social capital and 12-month prevalence of Composite International Diagnostic Interview (CIDI) diagnosed psychiatric disorder, using data on 12 to 17-year-old adolescents (N = 1,754) from the 2015 National Mental Health Survey of Colombia, a nationally representative epidemiological study. We tested whether associations survived cumulative adjustment for demographic confounders, experience of non-specific violence and harm and displacement by armed conflict. RESULTS: Neither structural nor cognitive social capital were associated with better mental health. Better family functioning was associated with reduced risk of poor mental health in an unadjusted analysis (OR 0.90 [0.85–0.96]), and after cumulative adjustments for demographic confounders (OR 0.91 [0.86–0.97]), non-specific violence and harm (OR 0.91 [0.86–0.97]) and social capital variables (OR 0.91 [0.85–0.97]). In the final model, each additional point on the family APGAR scale was associated with a 9% reduced odds of any CIDI diagnosed disorder in the last 12 months. CONCLUSIONS: Better family functioning was associated with better mental health outcomes for all adolescents. This effect remained present in those affected by the armed conflict even after accounting for potential confounders
Interval Cytoreductive Surgery and Cisplatin- or Paclitaxel-Based HIPEC for Advanced Ovarian Cancer
No full textImportance: Ovarian cancer, often diagnosed at advanced stages, presents significant challenges in treatment and survival. Evaluation of different hyperthermic intraperitoneal chemotherapy (HIPEC) regimens could provide crucial insights to improve patient outcomes. Objective: To evaluate whether HIPEC with paclitaxel (HIPEC-paclitaxel) is associated with similar oncological outcomes as HIPEC with cisplatin (HIPEC-cisplatin) in patients with advanced ovarian cancer undergoing interval cytoreductive surgery (iCRS). Design, setting, and participants: This multicenter retrospective cohort study included patients with advanced ovarian cancer who received iCRS and HIPEC. Patients with primary or secondary surgical procedures or nonovarian cancers were excluded. Data came from the National Registry of Peritoneal Carcinomatosis, which includes 27 Spanish specialized peritoneal oncology centers. Cases were included from January 2012 to December 2022. The study used propensity score matching to balance the groups and ensure comparability. Exposure: HIPEC-cisplatin and HIPEC-paclitaxel, administered during iCRS. The HIPEC regimen was selected based on the standard clinical protocol for advanced ovarian cancer. Main outcomes and measures: The primary end points were overall survival (OS) and disease-free survival (DFS). The secondary end point was the rate of complications in each group. These outcomes were predefined prior to data collection. Results: A total of 846 patients (mean [SD] age, 59.04 [11.01] years) were included (325 [38.4%] in HIPEC-cisplatin group; 521 [61.6%] in HIPEC-paclitaxel group), and 199 patients in each group were propensity score matched. Among these 398 matched patients, the HIPEC-paclitaxel group had similar DFS and OS compared with the HIPEC-cisplatin group. Additionally, similar morbidity was observed. Equivalence in OS and DFS was observed during the initial 20 and 15 months of follow-up, respectively, with an equivalence margin of 0.1 respectively. Conclusions and relevance: In this cohort study of patients with advanced ovarian cancer, HIPEC-paclitaxel was associated with comparable oncologic outcomes as HIPEC-cisplatin, suggesting that it could be a viable alternative. These findings support its use, especially in patients in whom cisplatin could be contraindicated. Further studies may help refine treatment protocols and improve patient-specific outcomes
Tendencias en la gestión universitaria en los países de habla hispana en los años 2.013 a 2.023
No full textEl presente proyecto de investigación con enfoque de análisis documental titulado “Tendencias sobre gestión universitaria en los países de habla hispana en el periodo 2012 - 2022”. La autora centró su objetivo en “analizar tendencias en países de habla hispana sobre la Gestión Universitaria en el periodo 2012 -2022”. En la metodología implementada, la autora realizó una exploración en buscadores especializados como Google Académico, DIALNET, Scielo y repositorios de universidades nacionales e internaciones, artículos e informes que permitieron evidenciar la evolución de las universidades en países hispano hablantes en el período de análisis mostrando en el tránsito del tiempo los sistemas universitario y sus rumbos y con base en los resultados se desarrolló todo un análisis documental identificando las transformaciones que se han presentado en el contexto de la gestión en las instituciones de educación superior en los países analizados. Entre los principales hallazgos se encuentran que la universidad como sistema social educativo se enfrenta a los cambios que ocurren a nivel mundial y que repercute en el contexto nacional y local. La autoevaluación constante, los planes de mejora y la reingeniería como proceso, se convierten en acciones para enfrentar los cambios académicos y administrativos internos y la realidad nacional y local. La universidad como una estructura organizativa y responsable actúa en coherencia con los Objetivos de Desarrollo Sostenible y se apoya de la gestión universitaria y la Responsabilidad Social Universitaria (RSU) para lograr la misión institucional universitaria. Finalmente, el gestor universitario tiene como característica la actualización permanente, la apertura a los cambios, la comunicación bidireccional y el conocimiento de la realidad mundial, nacional y local para buscar soluciones y transformar la realizada actuando en equipo.The present research project, with a documentary analysis approach, is titled "Trends regarding University Management in Spanish-speaking Countries during the 2012-2022 period." The author focused her objective in "analyzing trends in Spanish-speaking countries regarding University Management during the 2012-2022 period." In the methodology, the author conducted an exploration using specialized search engines such as Google Scholar, DIALNET, Scielo, and repositories from national and international universities. Articles and reports were reviewed, revealing the evolution of universities in Spanish-speaking countries during the investigation period, highlighting the progression of university systems and their directions. Based on the results, a comprehensive documentary analysis was developed, identifying the transformations in higher education management within the analyzed countries. Among the main findings is that the university, as an educational social system, faces global changes that impact both the national and local contexts. Constant self-assessment, improvement plans, and reengineering processes become key actions for addressing internal academic and administrative changes and adapting to national and local realities. The university, as an organized and responsible structure, aligns with the Sustainable Development Goals (SDGs) and relies on university management and University Social Responsibility (USR) to fulfill its institutional mission. Lastly, the university manager is characterized by continuous updating, openness to change, two-way communication, and a deep understanding of global, national, and local realities, working as a team to discover solutions and drive transformationMaestríaMagíster en Ciencias de la EducaciónSedes::Cartagena::Línea de investigación desarrollo humano y contextos educativo
Relation of Lipoprotein(a) Levels to Incident Type 2 Diabetes and Modification by Alirocumab Treatment
No full textOBJECTIVE: In observational data, lower levels of lipoprotein(a) have been associated with greater prevalence of type 2 diabetes. Whether pharmacologic lowering of lipoprotein(a) influences incident type 2 diabetes is unknown. We determined the relationship of lipoprotein(a) concentration with incident type 2 diabetes and effects of treatment with alirocumab, a PCSK9 inhibitor. RESEARCH DESIGN AND METHODS: In the ODYSSEY OUTCOMES trial alirocumab was compared with placebo in patients with acute coronary syndrome. Incident diabetes was determined from laboratory, medication, and adverse event data. RESULTS: Among 13,480 patients without diabetes at baseline, 1,324 developed type 2 diabetes over a median 2.7 years. Median baseline lipoprotein(a) was 21.9 mg/dL. With placebo, 10 mg/dL lower baseline lipoprotein(a) was associated with hazard ratio 1.04 (95% CI 1.02-1.06, P < 0.001) for incident type 2 diabetes. Alirocumab reduced lipoprotein(a) by a median 23.2% with greater absolute reductions from higher baseline levels and no overall effect on incident type 2 diabetes (hazard ratio 0.95, 95% CI 0.85-1.05). At low baseline lipoprotein(a) levels, alirocumab tended to reduce incident type 2 diabetes, while at high baseline lipoprotein(a) alirocumab tended to increase incident type 2 diabetes compared with placebo (treatment-baseline lipoprotein(a) interaction P = 0.006). In the alirocumab group, a 10 mg/dL decrease in lipoprotein(a) from baseline was associated with hazard ratio 1.07 (95% CI 1.03-1.12; P = 0.0002) for incident type 2 diabetes. CONCLUSIONS: In patients with acute coronary syndrome, baseline lipoprotein(a) concentration associated inversely with incident type 2 diabetes. Alirocumab had neutral overall effect on incident type 2 diabetes. However, treatment-related reductions in lipoprotein(a), more pronounced from high baseline levels, were associated with increased risk of incident type 2 diabetes. Whether these findings pertain to other therapies that reduce lipoprotein(a) is undetermined
Lipoprotein(a) and Benefit of PCSK9 Inhibition in Patients With Nominally Controlled LDL Cholesterol
No full textInternational audienceBackground: Guidelines recommend nonstatin lipid-lowering agents in patients at very high risk for major adverse cardiovascular events (MACE) if low-density lipoprotein cholesterol (LDL-C) remains ≥70 mg/dL on maximum tolerated statin treatment. It is uncertain if this approach benefits patients with LDL-C near 70 mg/dL. Lipoprotein(a) levels may influence residual risk.Objectives: In a post hoc analysis of the ODYSSEY Outcomes (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab) trial, the authors evaluated the benefit of adding the proprotein subtilisin/kexin type 9 inhibitor alirocumab to optimized statin treatment in patients with LDL-C levels near 70 mg/dL. Effects were evaluated according to concurrent lipoprotein(a) levels.Methods: ODYSSEY Outcomes compared alirocumab with placebo in 18,924 patients with recent acute coronary syndromes receiving optimized statin treatment. In 4,351 patients (23.0%), screening or randomization LDL-C was 13.7 mg/dL or ≤13.7 mg/dL; corresponding adjusted treatment hazard ratios were 0.82 (95% CI: 0.72-0.92) and 0.89 (95% CI: 0.75-1.06), with Pinteraction = 0.43.Conclusions: In patients with recent acute coronary syndromes and LDL-C near 70 mg/dL on optimized statin therapy, proprotein subtilisin/kexin type 9 inhibition provides incremental clinical benefit only when lipoprotein(a) concentration is at least mildly elevated. (ODYSSEY Outcomes: Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab; NCT01663402)
Computationele anatomie strategieën voor karakterisering van hersenpatronen geassocieerd met de ziekte van Alzheimer
No full textilustraciones, fotografías, graficasLa enfermedad de Alzheimer (EA) es una de las fallas sistemáticas del sistema nervioso más complejas que se conocen. Los síntomas clínicos de esta enfermedad neurodegenerativa son alteraciones de la cognición y el comportamiento que pueden conducir a la aparición de un síndrome de demencia. Los mecanismos de la enfermedad que conducen a la neurodegeneración y al deterioro cognitivo en la EA aún no se conocen bien, lo que dificulta la predicción de la evolución clínica de los pacientes en las primeras fases de la EA. Actualmente, ningún biomarcador o examen es suficiente para diagnosticar la EA y los instrumentos estándar existentes no son lo suficientemente sensibles para detectar cambios sutiles, predecir el curso clínico o reconocer presentaciones atípicas de EA. Esta tesis presenta dos estrategias de anatomía computacional destinadas a identificar y cuantificar los patrones de neurodegeneración asociados a diferentes etapas clínicas a lo largo del continuo de la EA utilizando dos modalidades diferentes de imágenes de resonancia magnética. Una tercera contribución consiste en una estrategia guiada por datos para desarrollar un conjunto de puntajes específicas por dominio que resultan útiles para estimar el riesgo y predecir la progresión del deterioro cognitivo leve a la demencia. La evaluación de estas estrategias con métodos de aprendizaje automático y de inferencia estadística demuestra el potencial de las herramientas cuantitativas propuestas para ayudar al manejo y el seguimiento clínico de los pacientes y podría utilizarse para mejorar la evaluación de posibles intervenciones que puedan modificar el curso de la enfermedad. (Texto tomado de la fuente)Alzheimer's disease (AD) is one of the most complex systematic malfunctions of the nervous system that are known. The clinical symptoms of this neurodegenerative disease are alterations in cognition and behaviour that can lead to the onset of a dementia syndrome. Disease mechanisms that lead to neurodegeneration and cognitive impairment in sporadic AD are not well understood yet, making it difficult to predict the clinical progression of patients at the early stages of the AD continuum. Currently, no single biomarker or exam is sufficient to diagnose AD and existing standard instruments are not sensitive enough to detect subtle changes, predict the clinical course, and recognize heterogeneous forms of AD. This thesis presents two computational anatomy strategies aiming to identify and quantify neurodegeneration patterns associated with different clinical stages along the AD continuum using two different modalities of magnetic resonance imaging. A third contribution consists of a data-driven strategy to develop a set of domain-specific scores that result useful to estimate the risk of and predict the progression from mild cognitive impairment to dementia. Evaluation of these strategies with machine-learning and statistical inference methods demonstrate the potential of the proposed quantitative tools to help patients' clinical management and monitoring and could be used to improve the evaluation of potential disease-modifying interventions.De ziekte van Alzheimer (AD) is een van de meest complexe systemische storingen van het zenuwstelsel die bekend zijn. De klinische symptomen van deze neurodegeneratieve ziekte zijn veranderingen in cognitie en gedrag die kunnen leiden tot het ontstaan van een dementiesyndroom. De ziektemechanismen die leiden tot neurodegeneratie en cognitieve stoornissen bij sporadische AD zijn nog niet goed begrepen, waardoor het moeilijk is om de klinische progressie van patiënten in de vroege stadia van het AD continuüm te voorspellen. Momenteel is geen enkele biomarker of onderzoek voldoende om de diagnose AD te stellen en de bestaande standaardinstrumenten zijn niet gevoelig genoeg om subtiele veranderingen te detecteren, het klinische verloop te voorspellen en heterogene vormen van AD te herkennen. Dit proefschrift presenteert twee computationele anatomiestrategieën die gericht zijn op het identificeren en kwantificeren van neurodegeneratiepatronen geassocieerd met verschillende klinische stadia in het AD continuüm, gebruikmakend van twee verschillende modaliteiten van magnetische resonantie beeldvorming. Een derde bijdrage bestaat uit een data-gestuurde strategie om een reeks van domeinspecifieke scores te ontwikkelen die bruikbaar zijn om het risico in te schatten op en de progressie te voorspellen van milde cognitieve stoornissen naar dementie. Evaluatie van deze strategieën met machine-learning en statistische inferentie methoden tonen het potentieel aan van de voorgestelde kwantitatieve instrumenten om het klinisch management en de monitoring van patiënten te helpen en zouden gebruikt kunnen worden om de evaluatie van potentiële ziekte-modificerende interventies te verbeteren.DoctoradoDoctor en Ingenierí
