Breast Cancer Subtypes Can Be Determinant in The Decision Making Process to Avoid Surgical Axillary Staging: A retrospective cohort study

Purpose: The need for performing axillary lymph-node dissection in early breast cancer when the sentinel lymph node (SLN) is positive has been questioned in recent years. The purpose of this study was to identify a lowrisk subgroup of early breast cancer patients in whom surgical axillary staging could be avoided, and to assess the probability of having a positive lymph-node (LN). Methods: We retrospectively evaluated 612 consecutive women affected by early breast cancer. We considered age, tumour size, histological grade, vascular invasion, lymphatic invasion and cancer subtype (Luminal A, Luminal B HER-2+, Luminal B HER-2-, HER-2+, and Triple Negative) as variables for univariate and multivariate analyses to assess probability of there being a positive SLN o non-sentinel lymph node (NSLN). Chi-square, Fisher’s Exact test and Student’s t tests were used to investigate the relationship between variables; whereas logit models were used to estimate and quantify the strength of the relationship among some covariates and SLN or the number of metastases. Results: A significant positive effect of vascular invasion and lymphatic invasion, and a negative effect of TN were noted. With respect to positive NSLN, size alone has a significant (positive) effect on tumour presence, but focusing on the number of metastases, also age has a (negative) significant effect. Conclusion: This work shows correlation between subtypes and the probability of having positive SLN. Patients not expressing vascular invasion, lymphatic invasion and, moreover, a triple-negative tumor subtype may be good candidates for breast conservative surgery without axillary su

breast conserving surgery in 201 very young patients 35 years

Abstract Introduction Surgical treatment of breast cancer in very young patients ( Patients and Methods We retrospectively evaluated outcome and prognostic factors of 201 consecutive patients treated with breast conservation followed by whole breast irradiation between 1997 and 2004 with special attention paid to local control. The average follow up was 72 months (range 13–133 months). Results The mean age was 32 years (Range 20–34). Invasive ductal carcinoma was found in 175 (87.1%) patients. Two (1%) patients had invasive lobular carcinoma. One-hundred and eighteen patients (58.7%) had tumors of 2 cm or smaller. Sentinel lymph node biopsy was performed in 105 (52.2%) patients. One-hundred and ten (54.7%) patients had node-negative disease, 68 (33.8%) patients had 1–3 positive nodes and 23 (11.4%) +4 positive nodes. Eighteen patients (9.0%) developed a local recurrence, 25 (12.5%) developed distant metastases and 23 patients (11.4%) died during follow up. The 5- and 10-year cumulative incidence of local events were 8.2% and 12,3% respectively. The univariate analysis did not identify any variables affecting local disease-free survival. Conclusions Breast conservation in very young patients achieves an acceptable local control rate. No prognostic factors were associated with local events

ENERGIA FOTOVOLTAICA NA AGRICULTURA FAMILIAR: UM ESTUDO DE CASO NA REGIÃO DE DOURADOS-MS:

The objective of this study was to investigate the economic feasibility of producing photovoltaic solar energy in a family property located in the city of Dourados-MS by analyzing four scenarios: (i) installation in the aerial part from own resources, (ii) installation in the aerial part through financing by Pronaf Mais Alimentos, (iii) installation in the ground through own resources and (iv) installation in the ground through financing by Pronaf Mais Alimentos. As evaluation criteria, it was used: the Net Present Value (NPV), the Internal Rate of Return (IRR), the Modified Internal Rate of Return (MIRR), the Profitability Index (PI), the Benefit/Cost Ratio (B/C), and Discounted Payback (DP). The results revealed that the four energy production scenarios are viable for the reality of the family producer. Among the analyzed scenarios, the installation in the aerial part from own resources (Scenario 1) was more economically viable.: Este estudio tuvo como objetivo investigar la viabilidad económica de la producción de energía solar fotovoltaica en una propiedad familiar en la ciudad de Dourados-MS mediante el análisis de cuatro escenarios: (i) instalación en la parte aérea con recursos propios, (ii) instalación en la parte aérea con financiamiento de Pronaf Mais Alimentos, (iii) instalación en el suelo con recursos propios y (iv) instalación en el suelo con financiamiento de Pronaf Mais Alimentos. Como criterios de evaluación se utilizaron: Valor Actual Neto (VAN), Tasa Interna de Retorno (TIR), Tasa Interna Modificada de Retorno (TIMR), Índice de Rentabilidad (IR), Relación Beneficio/Costo (B/C) y Reembolso con descuento (Rd). Los resultados revelaron que los cuatro escenarios de producción de energía son factibles para la realidad del productor familiar. Entre los escenarios analizados, la instalación en la parte aérea con recursos propios (Escenario 1) resultó más viable económicamente.Objetivou-se neste estudo investigar a viabilidade econômica da produção de energia solar fotovoltaica em uma propriedade familiar localizada no município de Dourados-MS mediante análise de quatro cenários: (i) instalação na parte aérea a partir de recursos próprios, (ii) instalação na parte aérea mediante financiamento pelo Pronaf Mais Alimentos, (iii) instalação no solo através de recursos próprios e (iv) instalação no solo mediante financiamento pelo Pronaf Mais Alimentos. Como critério de avaliação, utilizou-se: o Valor Presente Líquido (VPL), a Taxa Interna de Retorno (TIR), a Taxa Interna de Retorno Modificada (TIRM), o Índice de Lucratividade (IL), a Relação Benefício/Custo (B/C), e o Payback Descontado (PBd). Os resultados relevaram que os quatro cenários de produção de energia são viáveis para a realidade do produtor familiar. Dentre os cenários analisados, a instalação na parte aérea a partir de recursos próprios (Cenário 1) apresentou-se economicamente mais viável.Abstract: The objective of this study was to investigate the economic feasibility of producing photovoltaic solar energy in a family property located in the city of Dourados-MS by analyzing four scenarios: (i) installation in the aerial part from own resources, (ii) installation in the aerial part through financing by Pronaf Mais Alimentos, (iii) installation in the ground through own resources and (iv) installation in the ground through financing by Pronaf Mais Alimentos. As evaluation criteria, it was used: the Net Present Value (NPV), the Internal Rate of Return (IRR), the Modified Internal Rate of Return (MIRR), the Profitability Index (PI), the Benefit/Cost Ratio (B/C), and Discounted Payback (DP). The results revealed that the four energy production scenarios are viable for the reality of the family producer. Among the analyzed scenarios, the installation in the aerial part from own resources (Scenario 1) was more economically viable

Ligações intersetoriais e setores-chave da economia brasileira na década de 2000: um estudo sobre as indústrias do açúcar e do álcool

Esta pesquisa utilizou a Matriz Insumo-Produto para estimar os índices de ligação intersetorial e o Campo de Influência com intuito de analisar se as Indústrias do Açúcar e do Álcool compõem os principais setores da economia brasileira, denominados de setores-chave. Para isso, foram estimados os índices de Rasmussen-Hirschman, hipótese de “relaxamento”, índices GHS e o Campo de Influência de 2000 e 2009. Verificou-se que tanto a Indústria do Açúcar quanto a do Álcool não são consideradas setores-chave da economia, apenas a Indústria do Açúcar surgiu como setor-chave na hipótese de “relaxamento” no ano de 2000. Ademais, ambos os setores demonstraram significativas ligações na posição de demandantes de insumos dos demais setores da economia, mas tiveram poucas ligações como ofertantes de insumos. Os setores que mais se relacionam com as Indústrias do Açúcar e do Álcool são a Agricultura e Serviços (Comércio; Transporte, armazenagem e correio; Intermediação financeira e seguros; Serviços prestados às empresas; Serviços de manutenção e reparo, entre outros)

Erratum to: Oncoplastic Breast-Conserving Surgery for Tumors Larger than 2 Centimeters: Is it Oncologically Safe? A Matched-Cohort Analysis

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Avaliação de insolvência em cooperativas de crédito: uma aplicação de redes neurais artificiais e do sistema PEARLS

The present study aimed to analyze the state of insolvency of mutual cooperative credit unions in the state of Paraná, Brazil, building a mathematical model based on Artificial Neural Networks (ANN), whose main feature is the ability to process information, using factors of brain functioning such as the ability to learn, decide and adapt to changes as inspiration. The information needed to build the model was obtained from a sample of 62 mutual credit unions (31 solvent ones and 31 insolvent) by calculating the financial indicators of the PEARLS system. Algorithms of RBFNetwork, MultilayerPerceptron and MultilayerPerceptronCS neural networks, from Weka Software Package, a tool utilized in Data Mining Tool, were used to model 27, 10 and 11 indicators. The Artificial Neural Network (ANN) with MultilayerPerceptron and MultilayerPerceptronCS algorithms modeling 27 indicators showed a better performance when compared with other built networks.O presente estudo objetivou diagnosticar o estado de insolvência das cooperativas de crédito mútuo do Estado do Paraná construindo-se um modelo matemático baseado em Redes Neurais Artificiais (RNAs), cuja principal característica é sua capacidade processar informações, utilizando como inspiração fatores do funcionamento do cérebro, especificamente a sua capacidade de aprender, decidir e adaptar-se a mudanças. As informações necessárias para a construção do modelo foram obtidas de uma amostra de 62 cooperativas de crédito mútuo (31 solventes e 31 insolventes) pelo cálculo de indicadores financeiros do Sistema PEARLS. Utilizaram-se os algoritmos de redes neurais RBFNetwork, MultilayerPerceptron e MultilayerPerceptronCS, todos pertencentes ao pacote de software Weka, ferramenta utlizada em Data Mining, com modelagens para 27, 10 e 11 indicadores. A Rede Neural Artificial (RNA) com os algoritmos MultilayerPerceptron e MultilayerPerceptronCS com a modelagem para o grupo de 27 indicadores apresentou melhor desempenho em relação as demais redes construídas.&nbsp

Geração de produção, emprego e remunerações nas indústrias do açúcar e do álcool em 2000 e 2009

Esta pesquisa tem como objetivo analisar a evolução das Indústrias do Açúcar e do Álcool em termos de produção, emprego e remunerações de 2000 e 2009. Para isso, foi utilizado a metodologia da Matriz Insumo-Produto para estimar os geradores e os multiplicadores para ambos os anos de análise. Os resultados mostraram que a Indústria do Açúcar viu seus multiplicadores de produção, emprego e remunerações cair de 2000 para 2009. A Indústria do Álcool apresentou sensível aumento no multiplicador de produção devido ao ainda aquecido mercado de carros flex, mas viu cair os demais multiplicadores. A queda dos multiplicadores de emprego e remunerações foi ocasionada principalmente pela descoberta do pré-sal em 2007, que contribuiu para que o Brasil deixasse de realizar políticas voltadas para o mercado de etanol e focasse novamente no combustível fóssil.Palavras-chave: Matriz insumo-produto; indústria do açúcar; indústria do álcool.ABSTRACTThis research aims to analyze the evolution of Sugar and Alcohol Industries in terms of production, employment and remuneration in 2000 and 2009. For this, it was used the Input-Output Matrix methodology to estimate the generators and multipliers for both years of analysis. The results showed that the Sugar Industry saw its production, employment and remuneration multipliers fall of 2000 to 2009. The Alcohol Industry showed sensible increase in production multiplier due to the still heated flex car market, but saw falling the other multipliers. The fall of the employment and remuneration multipliers was mainly caused by the discovery of “pré-sal” in 2007, which contributed to the Brazil failed to make policies for the ethanol market, focusing again in fossil fuel.Keywords: Input-Output matrix; sugar industry; alcohol industry

Strategies for Breast Cancer Surgery During & After COVID-19 Pandemic

Background: In December 2019, a severe acute respiratory syndrome coronavirus 2 (SARS-COV-2), also named "COVID-19", has produced a global pandemic and has seriously affected many health systems around the world. Since the World Health Organization (WHO) declared the novel COVID-19 outbreak as a global pandemic, many international societies and groups of experts have published clinical guidelines and recommendations for surgical management of breast cancer patients in this time of crisis and issued COVID guidelines to prioritize surgery where time is critical and it cannot be deferred.Methods: In this study, we review current recommendations for breast cancer surgery during the COVID-19 pandemic and propose a plan for future waves of the current pandemic while minimizing the risk of the contagious disease and oversaturating the health systems regarding the burden of accumulating untreated disease.Results: We create a critical and constructive vision from learnt lessons for similar future situations and propose a moving forward plan during and after the COVID-19 pandemic. Conclusion: Although in many parts of world, it would appear that now we are past the peak of the COVID-19 pandemic, we still face as uncertainty as to the future course of the pandemic and the challenges of the second wave. It is important to reappraise continuously the guidance and to emphasize the need for new protocols under new norms to continue to deliver breast cancer surgery safely

Locoregional treatment of breast cancer during pregnancy.

The management of patients with breast cancer during pregnancy is very demanding and it should be better performed in highly qualified and experienced centers. Referral to institutes and physicians trained in this special clinical scenario allows reducing the risk of both overtreating and undertreating the patients. Moreover, patients can receive appropriate information regarding safety of treatments without old-fashioned taboo. The purpose of the current paper is to discuss the main issues concerning surgical management and in general locoregional treatment of patients diagnosed with breast cancer and treated during gestation, focusing on those women who chose to continue their pregnancy. We cover the issues regarding type of breast surgery, radiation therapy, immediate reconstruction during mastectomy, and management of the axilla.info:eu-repo/semantics/publishe

Sentinel lymph node biopsy in pregnant patients with breast cancer

Purpose: Sentinel lymph node biopsy (SLNB) is currently not recommended in pregnant patients with breast cancer due to radiation concerns. Methods: Twelve pregnant patients with breast cancer received low-dose (10 MBq on average) lymphoscintigraphy using 99mTc human serum albumin nanocolloids. Results: The sentinel lymph node (SLN) was identified in all patients. Of the 12 patients, 10 had pathologically negative SLN. One patient had micrometastasis in one of four SLN. One patient had metastasis in the SLN and underwent axillary clearance. From the 12 pregnancies, 11 healthy babies were born with no malformations and normal weight. One baby, whose mother underwent lymphatic mapping during the 26th week of gestation, was operated on at the age of 3 months for a ventricular septal defect and at 43 months was in good health. This malformation was suspected at the morphological US examination during week 21, well before lymphoscintigraphy, and was confirmed a posteriori by a different observer based on videotaped material. No overt axillary recurrence appeared in the patients with negative SLNs after a median follow-up of 32 months. Conclusion: Our experience supports the safety of SLNB in pregnant patients with breast cancer, when performed with a low-dose lymphoscintigraphic technique. © 2009 Springer-Verlag