Importância da Deformação Longitudinal na Deteção da Cardiotoxicidade Induzida por Quimioterapia e na Identificação de Padrões Específicos de Afetação Segmentar

INTRODUCTION: Serial echocardiographic assessment of left ventricular ejection fraction (LVEF) is the gold standard in screening for chemotherapy-induced cardiotoxicity (CIC). Measurement of myocardial deformation using speckle tracking enables more detailed assessment of myocardial contractility. The aim of this study was to determine the relationship between global and regional longitudinal strain and CIC. METHODS: This was a prospective study of 158 breast cancer patients undergoing chemotherapy with anthracyclines with or without adjuvant trastuzumab who underwent serial monitoring by transthoracic echocardiography with assessment of myocardial deformation. CIC was defined as a decrease in LVEF to <53%. Global longitudinal strain (GLS) was estimated using EchoPAC BT12 software on a GE Vivid E9 cardiac ultrasound system. Patients were classified according to the 2015 ASE/EACVI criteria as having impaired myocardial deformation when GLS was reduced (less negative), with a cutoff of -18%. RESULTS: During a mean follow-up of 5.4 months (1-48 months), the incidence of CIC was 18.9%. A decrease in GLS was observed during follow-up for the entire cohort (baseline GLS -20.1±3.5% vs. -18.7±3.4% at last follow-up assessment, p=0.001). A total of 97 patients (61.4%) were observed to have impaired myocardial deformation (GLS ≥18%) at some point during follow-up. This decrease was more significant in patients who eventually developed CIC (GLS -17.2±2.5%, p=0.02). On analysis of regional strain, impaired contractility was observed in the septal (6 out of 6) and anterior (2 out of 3) segments. Multivariate logistic regression showed that patients who developed impaired longitudinal strain had a 4.9-fold increased risk of developing CIC (odds ratio 4.88, confidence interval 1.32-18.0, p=0.017). CONCLUSIONS: Worsening of myocardial deformation as assessed by speckle tracking is common in breast cancer patients undergoing chemotherapy, with predominantly septal and anterior wall involvement. Impaired myocardial deformation was independently associated with increased incidence of CIC.info:eu-repo/semantics/publishedVersio

Tratamento pré-operatório do carcinoma do recto localmente avançado: Capecitabina versus Capox

Introduction: Pre-operative chemoradiotherapy is considered a standard approach for TNM stage II-III rectal cancer. The aim of this study was to investigate the effectiveness and toxicity of pre-operative chemoradiation in this setting. Methods: Between January 2007 and January 2011, patients received 5 weeks of treatment with radiotherapy 50.4/54 Gy/25 or 30 fractions with concurrent capecitabine 850 mg/m2 twice daily 5 days per week (CAP) or radiotherapy 50.4/54 Gy/25 fractions with capecitabine 850 mg/m2 twice daily 5 days per week and oxaliplatin 50 mg/m(2) once weekly (CAPOX). Histopathologic tumor regression (TRG) was determined by the amount of viable tumor versus fibrosis. Toxicity was monitored according to the Common Toxicity Criteria of the National Cancer Institute.Results: Seventy six patients were included (median age 68.3 years [range 45-88], 67% male). Median tumor distance from anal verge was 7cm (range 2-13). CAP treatment was performed in 67% and CAPOX in 33% of patients. Pathologic complete response was achieved in 13,2%. T- and N- downstaging rates were 52.6%, 65.8%, respectively. Grade 3 toxicity was documented in less than 10% of patients and no grade 4 toxicity was observed.Conclusions: This study suggests that there is no major benefit from adding oxaliplatin to preoperative chemoradiotherapy with capecitabine.Keywords: rectal cancer, chemoradiotherapy, downstaging, capecitabine, oxaliplatin Introdução: A terapêutica pré-operatória com quimioterapia e radioterapia concomitante (QRT-PO) é o tratamento de primeira-linha no carcinoma do recto localmente avançado, estadios II e III (classificação TNM). O objectivo deste estudo é o de comparar a eficácia e perfil de segurança e toxicidade de dois esquemas alternativos de quimioterapia em combinação com radioterapia: capecitabina versus capecitabina em associação com oxaliplatina. Métodos: Entre Janeiro 2007 e Janeiro 2011, foram estudados retrospectivamente setenta e seis doentes com 68,3 anos de idade mediana (limites, 45-88 anos), 68% do sexo masculino, com o diagnóstico de carcinoma do recto nos estadios II e III, com uma distância mediana à margem anal de 7 cm (3-12cm), submetidos a QRT-PO. Foram administrados dois esquemas de QRT-PO: radioterapia 50,4 Gy dose total concomitante com a capecitabina 825 mg/m2 bi-diário, dia 1-38 (esquema CAP), versus radioterapia 50,4 Gy dose total concomitante com capecitabina 825 mg/m2 bi-diário, dia 1-38 e oxaliplatina 50 mg/m2 semanal (esquema CAPOX). O grau de regressão histológica (GRH) foi determinado pela quantidade de tumor viável versus fibrose. A toxicidade foi monitorizada de acordo com os critérios de toxicidade do National Cancer Institute. Resultados: O esquema CAP foi aplicado em 67% e o esquema CAPOX em 33% dos doentes. O total de respostas completas (pRC) foi de 13,2% (GRH 4). Na avaliação histopatológica, a caracterização ypTNM documentou um downstaging de T e N em 52.6% e 65.8% dos casos, respectivamente. A toxicidade grau 3 foi reportada em menos de 10% dos casos e não foi observada toxicidade grau 4. Conclusão: Este estudo sugere não haver benefício da adição da oxaliplatina ao esquema pré-operatório com RT e capecitabina. Palavras-chave: carcinoma recto, neo-adjuvante, downstaging, capecitabina, oxaliplatina.

Taking Tiger Worm Toilets to scale: opportunities and challenges

Tiger Worm Toilets (TWTs) are a relatively recent innovation in sanitation technology, with the potential to offer affordable and safely managed on-site sanitation for underserved communities in line with Sustainable Development Goal 6. This article, authored by members of the International Worm-Based Sanitation Association (IWBSA), presents the state-of-the-art in TWT construction and operation based on frontier global experiences to-date, stemming from both knowledge from literature and the practical knowledge imparted by the authors, who were involved in the birth of this technology and are still active in the research and deployment of it today. The focus of this paper is on the implementation of TWTs to solve sanitation challenges in least-developed and lower-middle income countries specifically. The design of TWTs can be adapted to a wide range of environmental conditions including high water tables and rocky ground conditions, and in both rural and urban contexts. The challenge for TWTs therefore lies primarily in creating opportunities for scaling the uptake of this promising technology. Our article discusses the key barriers to this, identified to be broadly categorised as user preference, capacity and capability building, and governmental support–and proposes how to overcome these

Marks, Pictures and Art: Their Contribution to Revolutions in Communication

This paper addresses the question of the nature of art, how it came to be, how it fits with other communications revolutions, and the implications of the emergence of art as a means of visual communication. How did iconic imagery emerge from other mark-making among humans and their ancestors and what has been its significance? I situate visual communication as the second revolution of the six communication revolutions during human evolution: the emergence of language, iconic imagery, writing, printing, various means of communication at a distance, and the digital electronic revolution. I begin by discussing the context of deliberate production of marks in the environment, with emphasis on the relations between (1) the producer of the mark and the mark, (2) the producer of the mark and an informed observer at the time, (3) the mark and the informed observer in the absence of the producer and (4) the uninformed observer and the mark. It is fundamental that at some stage the producer intended the mark to represent something, a subject in the real or imagined world. I emphasize the importance of telling stories and singing songs in secular and ritual contexts. Out of this framework, I discuss some of the earliest objects called art in relation to their semiotic elements. I outline my arguments about how these semiotic categories were transformed in the emergence of pictures during archaeohistory. I go on to discuss how all these examples of image production connect to that which is called art in western society. I conclude by reflecting on the impact of these changes of means of communication on human cognition. Each of the revolutions involved changes in the relationships among the communicative act (sensu lato), the agent and receivers of the communication, the perception and interpretation of the communication and the persistence of it through time and ultimately across space