1,110 research outputs found
Brazilian gamma detection device for sentinel lymph node biopsy
OBJECTIVE: To test the effectiveness of an intra-operative gamma detection Brazilian device (IPEN) on sentinel lymph node biopsy (SLNB) procedures. METHODS: Forty melanoma or breast cancer patients with indication for undergoing SLNB were studied. Lymphoscintigraphy was done 2 to 24 hours prior to surgery. Lymphatic mapping with vital dye and gamma detection were performed intraoperatively. For gamma detection Neoprobe Âź 1500 was used followed by IPEN (equipment under test) in the first 20 patients and for the remaining half IPEN was used first to verify its ability to locate the sentinel node (SN). Measurements were taken from the radiopharmaceutical product injection site, from SN (in vivo and ex vivo) and from background. It was recorded if the SN was stained or not and if it was found easily by surgeon. RESULTS: There were 33 (82.5%) breast cancer and 7 (17.5%) melanoma patients. Ages varied from 21 to 68 year-old (median age of 46). Sex distribution was 35 (87.5%) women and 5 (12.5%) men. Sentinel node was found in all but one patient. There was no statistical difference between the reasons ex vivo/ background obtained with the measures of both equipments (p=0, 2583-ns). The SN was easily found by the surgeon with both devices. CONCLUSION: The SLNB was successfully performed using either equipment. It was possible to do SLNB with the Brazilian device developed by IPEN without prejudice for the patient.OBJETIVO: Testar a eficĂĄcia de equipamento de detecção gama intra-operatĂłria (DGI) desenvolvido pelo IPEN (Brasil), em procedimentos de biĂłpsia de linfonodo sentinela (BLS) no melanoma e no cĂąncer de mama. MĂTODOS: Foram estudados 40 pacientes portadores de melanoma ou cĂąncer de mama com indicação para realização de BLS.Todos pacientes foram submetidos Ă linfocintilografia e a BLS ocorreu entre 2 a 24 horas apĂłs a mesma. Concomitantemente Ă DGI, realizou-se o mapeamento linfĂĄtico com corante vital. Foram feitas leituras com o equipamento convencional NeoprobeÂź 1500 e com o equipamento em teste (IPEN) dos valores de captação do sĂtio de injeção do radiofĂĄrmaco, do LS in vivo e ex vivo e da captação de fundo. Foi registrado se o LS estava corado e se o cirurgiĂŁo teve facilidade para encontrĂĄ-lo. Nos primeiros 20 pacientes utilizou-se o equipamento convencional e depois o de teste; nos outros 20, utilizou-se primeiro o equipamento em teste, com objetivo de verificar se o mesmo identificava primariamente o LS. RESULTADOS: Dos quarenta pacientes, 33 eram portadores de tumor de mama e sete de melanoma cutĂąneo; variação da idade: 21 a 68 anos (mediana= 46 anos); 35 mulheres e 5 homens. Em apenas um paciente o LS nĂŁo foi encontrado, nem pela DGI nem pelo corante vital. NĂŁo houve diferença estatĂstica entre as razĂ”es ex vivo/fundo obtidas com os dois equipamentos (p=0, 2583-ns). CONCLUSĂO: Ă possĂvel realizar o procedimento de BLS com o equipamento brasileiro desenvolvido pelo IPEN, com facilidade e sem prejuĂzo para o paciente.Hospital Israelita Albert EinsteinIPENUniversidade Federal de SĂŁo Paulo (UNIFESP)Faculdade de Medicina Anhembi-MorumbiUNIFESPSciEL
Accurate simultaneous quantification of liver steatosis and iron overload in diffuse liver diseases with MRI
Purpose: To evaluate the diagnostic performances of 3 Tesla multi-echo chemical shift-encoded gradient echo magnetic resonance (MECSE-MR) imaging to simultaneously quantify liver steatosis and iron overload in a wide spectrum of diffuse liver diseases having biopsy as reference standard.
Methods: MECSE-MR-acquired images were used to calculate fat fraction and iron content in a single breath-hold in 109 adult patients. Proton density fat fraction (PDFF) was prospectively estimated using complex-based data reconstruction with multipeak fat modeling. Water R2* was used to estimate iron content. Biopsy was obtained in all cases, grading liver steatosis, siderosis, inflammation, and fibrosis. Differences in PDFF and R2* values across histopathological grades were analyzed, and ROC curves analyses evaluated the MR diagnostic performance.
Results: Calculated fat fraction measurements showed significant differences (p < 0.001) among steatosis grades, being unaffected by the presence of inflammation or fibrosis (p â„ 0.05). A strong correlation was found between fat fraction and steatosis grade (R S = 0.718, p < 0.001). Iron deposits did not affect fat fraction quantitation (p â„ 0.05), except in cases with severe iron overload (grade 4). A strong positive correlation was also observed between R2* measurements and iron grades (R S = 0.704, p < 0.001). Calculated R2* values were not different across grades of steatosis, inflammation, and fibrosis (p â„ 0.05).
Conclusion: A MECSE-MR sequence simultaneously quantifies liver steatosis and siderosis, regardless coexisting liver inflammation or fibrosis, with high accuracy in a wide spectrum of diffuse liver disorders. This sequence can be acquired within a single breath-hold and can be implemented in the routine MR evaluation of the liver.This work was partially funded by a research grant from the Teaching and Research Department of Centro Hospitalar do Porto (DEFI:309/12(213-DEFI/251-CES)) and from a Spanish Ministry of Health and Carlos III Health Institute funding grant (PI12/01262). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript
Antifungal Effect of Essential Oils
Essential oils are employed in agriculture, medicine and food industries among others, due to their antimicrobial, antiviral, insecticidal and antifungal properties. In this chapter, we will focus on the control of fungal plant pathogens with essential oils. Fungal diseases in agricultural crops and forestry alter the physiology of plants, disrupting their normal functioning, reducing their yield and sometimes causing their death. Recent studies show antifungal effects of many essential oils against plant pathogenic fungi, which make them candidates for the development of new fungicidal agents. This chapter presents a review of the most recent advances in this area, as well as the future trends in this field
Early and Middle Holocene Hunter-Gatherer Occupations in Western Amazonia: The Hidden Shell Middens
We report on previously unknown early archaeological sites in the Bolivian lowlands, demonstrating for the first time early and middle Holocene human presence in western Amazonia. Multidisciplinary research in forest islands situated in seasonally-inundated savannahs has revealed stratified shell middens produced by human foragers as early as 10,000 years ago, making them the oldest archaeological sites in the region. The absence of stone resources and partial burial by recent alluvial sediments has meant that these kinds of deposits have, until now, remained unidentified. We conducted core sampling, archaeological excavations and an interdisciplinary study of the stratigraphy and recovered materials from three shell midden mounds. Based on multiple lines of evidence, including radiocarbon dating, sedimentary proxies (elements, steroids and black carbon), micromorphology and faunal analysis, we demonstrate the anthropogenic origin and antiquity of these sites. In a tropical and geomorphologically active landscape often considered challenging both for early human occupation and for the preservation of hunter-gatherer sites, the newly discovered shell middens provide evidence for early to middle Holocene occupation and illustrate the potential for identifying and interpreting early open-air archaeological sites in western Amazonia. The existence of early hunter-gatherer sites in the Bolivian lowlands sheds new light on the region's past and offers a new context within which the late Holocene "Earthmovers" of the Llanos de Moxos could have emerged. © 2013 Lombardo et al
Male Uro-Rectal Iatrogenic Fistula Treatment in Pelvic Tumours: A National Multi-Institutional Study
Introdução: As fĂstulas uro-rectais (FUR) constituem uma complicação devastadora do tratamento de tumores pĂ©lvicos e um desafio cirĂșrgico para o cirurgiĂŁo reconstrutivo. Contudo, apesar da sua crescente incidĂȘncia associada a uma utilização cada vez mais frequente das diferentes modalidades nĂŁo-cirĂșrgicas, especialmente de radioterapia, com ou sem cirurgia, para o tratamento de tumores pĂ©lvicos, a fĂstula urorectal permanece relativamente rara. Dada a elevada improbabilidade do encerramento espontĂąneo da fĂstula uro-rectal, a correcção cirĂșrgica torna-se necessĂĄria na quase totalidade dos casos. Apesar da existĂȘncia de vĂĄrias tĂ©cnicas cirĂșrgicas, as taxas de falĂȘncia/recorrĂȘncia sĂŁo habitualmente elevadas, particularmente em fĂstulas rĂĄdicas. Descrevemos neste estudo a nossa experiĂȘncia limitada no tratamento de fĂstulas urorectais resultantes de tratamentos de tumores pĂ©lvicos (aparelho urinĂĄrio inferior e recto).
MĂ©todos: Entre Outubro de 2008 e Fevereiro de 2015, foram identificados 12 pacientes do sexo masculino com fĂstula urorectal e tratados nas nossas instituiçÔes. Foi efectuada revisĂŁo dos processos clĂnicos dos pacientes, incluindo a idade, sintomas, presença de comorbilidades, marcha diagnĂłstica, tipo e
etiologia da fĂstula, tipo de reconstrução cirĂșrgica, follow-up e resultados. Foram excluĂdos do estudo todos os pacientes com fĂstula nĂŁo-neoplĂĄsica/inflamatĂłria.
Resultados: Foram identificados e tratados 12 pacientes nas nossas instituiçÔes. Um dos pacientes, apĂłs ressecção anterior do recto, desenvolveu metĂĄstases ganglionares e hepĂĄticas 4 meses apĂłs o diagnĂłstico da fĂstula urorectal, durante tratamento mĂ©dico/antibiĂłtico de abcesso pĂ©lvico e sua resolução apĂłs drenagem e, consequentemente, foi excluĂdo do tratamento cirĂșrgico e do estudo. A idade mĂ©dia dos doentes era de 68 anos (53 â 78). Nove pacientes desenvolveram fĂstula uro-rectal apĂłs terapĂȘutica de carcinoma da prĂłstata): Dois apĂłs braquiterapia de baixa dosagem combinada com radioterapia externa; cinco apĂłs prostatectomia radical retropĂșbica (PRR), com radioterapia externa adjuvante em um; um apĂłs braquiterapia de baixa dosagem seguida de ressecção transuretral por obstrução prostĂĄtica; e um apĂłs ultra-som focalizado de alta intensidade e radioterapia externa. Em dois pacientes, a fĂstula resultou de tratamento cirĂșrgico de carcinoma rectal, associado a radioterapia externa em um deles. Foi efectuada em todos os pacientes derivação fecal com colostomia e derivação urinĂĄria, ou com cateterização suprapĂșbica, ou com cateterização uretral durante o perĂodo de espera para a reconstrução cirĂșrgica. NĂŁo houve encerramento espontĂąneo de fĂstula urorectal em nenhum paciente. Onze pacientes foram submetidos a reconstrução cirĂșrgica. Foi utilizada
abordagem exclusivamente perineal em sete doentes e abdominoperineal em quatro. Obteve-se encerramento eficaz da fĂstula em seis pacientes Ă primeira tentativa cirĂșrgica, dois doentes necessitaram
uma segunda tentativa, enquanto que em um doente foram necessĂĄrias trĂȘs tentativas cirĂșrgicas (duas delas em outras instituiçÔes) de forma a atingir um resultado com sucesso. Ocorreu falĂȘncia cirĂșrgica em dois doentes, os quais, actualmente, nĂŁo desejam qualquer tentativa reconstrutiva adicional. Estes dois doentes e um doente, em quem a reconstrução foi eficaz, permanecem ainda com colostomia. O tempo mĂ©dio de follow-
-up foi de 25,5 meses (3-75).
ConclusĂŁo: As fĂstulas uro-rectais sĂŁo uma complicação pouco frequente, mas devastadora, do tratamento dos tumores pĂ©lvicos, habitualmente associada com morbilidade debilitante e degradação da qualidade de vida. Embora a sua reconstrução cirĂșrgica possa ser extremamente difĂcil, ela Ă© possĂvel com sucesso na maioria dos casos atravĂ©s de uma abordagem perineal ou abdominoperineal agressiva e interposição de tecidos, quando indicada.info:eu-repo/semantics/publishedVersio
199â Less invasive, more effective: single puncture combined lumbar plexus and transmuscular quadratus lumborum blocks for long lasting unilateral vascular surgery procedures in fragile patients
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Galaxy evolution: black hole feedback in the luminous quasar PDS 456
The evolution of galaxies is connected to the growth of supermassive black holes in their centers. During the quasar phase, a huge luminosity is released as matter falls onto the black hole, and radiation-driven winds can transfer most of this energy back to the host galaxy. Over five different epochs, we detected the signatures of a nearly spherical stream of highly ionized gas in the broadband x-ray spectra of the luminous quasar PDS 456. This persistent wind is expelled at relativistic speeds from the inner accretion disk, and its wide aperture suggests an effective coupling with the ambient gas. The outflow's kinetic power larger than 10(46) ergs per second is enough to provide the feedback required by models of black hole and host galaxy coevolution
Sex-biased parental care and sexual size dimorphism in a provisioning arthropod
The diverse selection pressures driving the evolution of sexual size dimorphism (SSD) have long been debated. While the balance between fecundity selection and sexual selection has received much attention, explanations based on sex-specific ecology have proven harder to test. In ectotherms, females are typically larger than males, and this is frequently thought to be because size constrains female fecundity more than it constrains male mating success. However, SSD could additionally reflect maternal care strategies. Under this hypothesis, females are relatively larger where reproduction requires greater maximum maternal effort â for example where mothers transport heavy provisions to nests.
To test this hypothesis we focussed on digger wasps (Hymenoptera: Ammophilini), a relatively homogeneous group in which only females provision offspring. In some species, a single large prey item, up to 10 times the motherâs weight, must be carried to each burrow on foot; other species provide many small prey, each flown individually to the nest.
We found more pronounced female-biased SSD in species where females carry single, heavy prey. More generally, SSD was negatively correlated with numbers of prey provided per offspring. Females provisioning multiple small items had longer wings and thoraxes, probably because smaller prey are carried in flight.
Despite much theorising, few empirical studies have tested how sex-biased parental care can affect SSD. Our study reveals that such costs can be associated with the evolution of dimorphism, and this should be investigated in other clades where parental care costs differ between sexes and species
Stroke Correlates in Chagasic and Non-Chagasic Cardiomyopathies
BACKGROUND: Aging and migration have brought changes to the epidemiology and stroke has been shown to be independently associated with Chagas disease. We studied stroke correlates in cardiomyopathy patients with focus on the chagasic etiology. METHODOLOGY/PRINCIPAL FINDINGS: We performed a cross-sectional review of medical records of 790 patients with a cardiomyopathy. Patients with chagasic (329) and non-chagasic (461) cardiomyopathies were compared. There were 108 stroke cases, significantly more frequent in the Chagas group (17.3% versus 11.1%; p<0.01). Chagasic etiology (odds ratio [OR], 1.79), pacemaker (OR, 2.49), atrial fibrillation (OR, 3.03) and coronary artery disease (OR, 1.92) were stroke predictors in a multivariable analysis of the entire cohort. In a second step, the population was split into those with or without a Chagas-related cardiomyopathy. Univariable post-stratification stroke predictors in the Chagas cohort were pacemaker (OR, 2.73), and coronary artery disease (CAD) (OR, 2.58); while atrial fibrillation (OR, 2.98), age over 55 (OR, 2.92), hypertension (OR, 2.62) and coronary artery disease (OR, 1.94) did so in the non-Chagas cohort. Chagasic stroke patients presented a very high frequency of individuals without any vascular risk factors (40.4%; OR, 4.8). In a post-stratification logistic regression model, stroke remained associated with pacemaker (OR, 2.72) and coronary artery disease (OR, 2.60) in 322 chagasic patients, and with age over 55 (OR, 2.38), atrial fibrillation (OR 3.25) and hypertension (OR 2.12; pâ=â0.052) in 444 non-chagasic patients. CONCLUSIONS/SIGNIFICANCE: Chagas cardiomyopathy presented both a higher frequency of stroke and an independent association with it. There was a high frequency of strokes without any vascular risk factors in the Chagas as opposed to the non-Chagas cohort. Pacemaker rhythm and CAD were independently associated with stroke in the Chagas group while age over 55 years, hypertension and atrial fibrillation did so in the non-Chagas cardiomyopathies
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