Role of Sentinel Node Biopsy in Endometrial Cancer

Lymphadenectomy, for early stages of endometrial cancer (EC), provides a low detection rate of lymphatic metastasis, without having demonstrated a therapeutic effect; so that the collection and histological analysis of the sentinel lymph node (SLN) might be an alternative to lymphadenectomy. The contribution of SLN to surgical staging represents a change in the paradigm of lymphadenectomy in EC, being an intermediate approach between not assessing the condition of the lymph nodes and complete pelvic and paraaortic dissection. Accurate identification of the main uterine drainage pathway increases the likelihood of detecting metastases during lymphatic mapping. In addition, pathological assessment by the ultrastaging of the SLN is the most important advance in the SLN biopsy (SLNB) technique. The application of the SLNB presumes a decrease in surgical and long-term morbidity, with an increase in the detection of lymphatic metastasis, mainly at the expense of detecting low tumour volume, selecting the group of patients that would benefit from a modification in adjuvant therapy. The SLNB can be established as an oncologically safe and effective method in the surgical staging of early-stage EC. Prospective studies are required to determine optimal behaviour and prognosis in the detection of low-volume metastases

Women in "The Yellow Book"

Grado en Estudios Inglese

Analisis Kinerja Simpang Patung Pahlawan Marilonga Ende

Simpang Patung Pahlawan Marilonga Ende merupakan salah satu simpang yang cukup ramai karena memiliki akses langsung ke pasar Wolowona, dan juga dilalui peregerakan lalu lintas utama dan menerus  yang melalui jalan trans Flores.Penelitian ini bertujuan untuk mengetahui seberapa besar kondisi kinerja simpang saat ini. Data yang diperlukan berupa volume lalu lintas dan kondisi lingkungan. Indikator penilaian kinerja simpang berdasarkan pedoman Manual Kapasitas Jalan Indonesia (Departemen Pekerjaan Umum, 1997).Hasil penelitian menyatakan bahwa kinerja simpang Patung Pahlawan Marilonga Ende dalam kondisi batas yang tidak ideal, nilai derajat kejenuhan (DS) sebesar 0,75, tundaan 13,4866 det/smp, dan peluang antrian (QP) 22 % - 45%. Setelah dilakukan upaya pengendalian berupa pengaturan pergerakan kendaraan dan pelarangan penggunaan aktivitas sisi jalan yang berdampak pada hambatan samping menjadi rendah. Kinerja simpang mengalami penurunan, dengan nilai derajat kejenuhan (DS) sebesar 0,31, nilai tundaan 8,1031 det/smp, dan peluang antrian (QP) 5 % - 14%.  Sehingga upaya mempertahankan kinerja simpang melalui pemasangan rambu lalu lintas berupa dilarang melawan arah, dilarang parkir, dan dilarang berhenti merupakan beberapa cara pengendalian yang bisa digunakan untuk mengatasi permasalahan pergerakan lalu lintas yang ada pada simpang Patung Pahlawan Marilonga Ende

Mapeo linfático y ultraestadificación del ganglio centinela en cáncer de endometrio

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Obstetricia y Ginecología. Fecha de lectura: 22-05-2018Esta tesis tiene embargado el acceso al texto completo hasta el 22-11-201

La radio comunitaria en función del desarrollo / Community Radio Depending on Development

El artículo aborda una reflexión teórica sobre las fortalezas y potencialidades de la radio comunitaria en los procesos de cambio social y desarrollo. Analiza los medios de comunicación comunitarios, en tanto actores sociales, que informan, educan, involucran, integran, proponen, construyen y reconstruyen nuevas realidades sociales.  Estos medios constituyen un factor esencial para favorecer la participación ciudadana en el desarrollo social, humano, y local, así como, profundas  trasformaciones a favor de una cultura integral y educativa. Además contribuyen a fortalecer la capacidad comunicativa de la comunidad para que ella misma pueda expresarse por los medios; ahí radica su gran importancia, lo que demuestra su responsabilidad social y la importancia de gestionar integralmente estos medios, sus productos, procesos y públicos. The article addresses a theoretical reflection on the strengths and potentialities of community radio in the processes of social change and development. Analyze the community media, as social actors, that inform, educate, involve, integrate, propose, construct and reconstruct new social realities. These means constitute an essential factor to favor citizen participation in social, human, and local development, as well as profound transformations in favor of an integral and educational culture. They also contribute to strengthening the communicative capacity of the community so that it can express itself through the media; there lies its great importance, which demonstrates its social responsibility and the importance of integrally managing these media, their products, processes and audiences

Conceptualización de un sistema de producción comunicativa desde un enfoque participativo en la Radio Cubana

La presente investigación propone la fundamentación de un modelo proyectivo de un sistema de producción comunicativa desde un enfoque participativo en la Radio Cubana. Expone los principales referentes teóricos-conceptuales, principios rectores, componentes constitutivos y etapas de producción radiofónica que lo sustentan. Para ello se realizó un diagnóstico sobre la producción radial cubana en nueve emisoras de alcance nacional, provincial y local. La investigación, de corte comunicológico, es empírica y aplicada, así como se empleó una perspectiva metodológica cualitativa desde un enfoque sistémico estructural. Se utilizaron como técnicas de investigación la revisión bibliográfica, el análisis documental, la entrevista en profundidad, grupos focales y grupo nominal durante la etapa de diagnóstico. Posteriormente, el sistema de producción comunicativa radiofónica con enfoque participativo que se propone se sometió a la validación por criterio de expertos para perfeccionar la versión definitiva y legitimar su pertinencia, comprensibilidad, coherencia teórica-práctica y viabilidad. Los resultados científicos que se presentan en la investigación constituyen una herramienta de consulta para las instancias que participan en la regulación, gestión, administración y producción radiofónica en Cuba. Además contribuyen al diseño de políticas de información y comunicación en medios e incrementar los niveles de participación ciudadana y otros actores claves del desarrollo en la toma de decisiones para la selección de las agendas, contenidos mediáticos y en las diferentes etapas de la producción radiofónica, así como sientan las bases para futuros Programas de Alfabetización Mediática y de Educación para la Comunicación. Entre las características del sistema propuesto destacan su carácter holístico, participativo y la reivindicación de que la información y la comunicación constituyen un derecho humano y un bien público.This research proposes the foundation of a projective model of a communicative production system from a participatory approach in Cuban Radio. It exposes the main theoretical-conceptual referents, guiding principles, constitutive components and stages of radio production that support it. For this, a diagnosis was made on the Cuban radio production in nine national, provincial and local stations. The research, of a communicological nature, is empirical and applied, just as a qualitative methodological perspective was used, from a structural systemic approach. The literature review, documentary analysis, in-depth interview, focus groups and nominal group during the diagnostic stage were used as research techniques. Subsequently, the radiophonic communicative production system with a participatory approach that was proposed was subject to validation by experts' criteria to perfect the final version and legitimize its relevance, understandability, theoretical and practical coherence and feasibility. The scientific results presented in the research constitute a consultation tool for the instances that participate in the regulation, management, administration and radio production in Cuba. They also contribute to the design of information and media communication policies and increase the levels of citizen participation and other key development actors in the decision-making process for the selection of agendas, media content and at the different stages of radio production, as well how they lay the foundations for future Media Literacy and Communication Education Programs. Among the characteristics of the proposed system are its holistic, participatory nature and the claim that information and communication constitute a human right and a public good

Comportamiento del crecimiento de dos cultivares de arroz en diferentes fechas de siembra y su influencia en el rendimiento

The study was conducted in the Scientific Technological Base Unit ( UCTB ) "in Los Palacios", in a Petroferric Ferruginous Hydromorphic Nodular Gley soil in order to determine the growth development of two rice cultivars in two sowing dates and its influence in performance, the cultivars used were INCA LP -5 and J -104 . The technology used was direct sowing and the plant breeding work was performed according to the Technical Instructions of the plantation, the experiment design was a randomized block with four replications. The dry mass (g/m2 ) was determined and the foliar area ( m2 ) in a space of 0.50 m2 and the samples were performed on the stages of active tillering, maximum tillering, flowering and grain filling , where the air part of the plant was removed, keeping them on stove for 72 hours at 70 ° C until constant weight. The foliar surface was calentaled through the product by the width and length of the active leaves by 0.7, this data was determined the media and were charted for their analysis. Agricultural yield was determined, this data was processed by means of a doble – classification variance analysis and the averages compared using the Turkey test were of 5% probability of error. As a result, it was proved that the biggest profits can be associated to an earlier growth and greater magnitude, based on the dry mass of the aerial part of plants per unit area and higher Leaf Area Index (LAI) values.El estudio se desarrolló en la Unidad Científico Tecnológica de Base (UCTB) “Los Palacios”, en un suelo Hidromórfico Gley Nodular Ferruginoso Petroférrico con el objetivo de determinar el comportamiento del crecimiento de dos cultivares de arroz en dos fechas de siembra y su influencia en el rendimiento y se utilizaron los cultivares INCA LP-5 y J-104. Se empleó la tecnología de siembra directa y las labores fitotécnicas se realizaron según el Instructivo Técnico del Cultivo, el diseño experimental fue de bloques al azar con cuatro réplicas. Se determinó la masa seca (g/m2) y la superficie foliar (m2) en un marco de 0.50 m2 y los muestreos se realizaron en las etapas de ahijamiento activo, máximo ahijamiento, floración y llenado del grano, donde se retiró la parte aérea de las plantas, manteniéndolas en estufa durante 72 horas a 70°C hasta peso constante. La superficie foliar se estimó a través del producto del ancho y del largo de las hojas activas por 0.7; a estos datos se les determinó la media y se graficaron para su análisis. Se determinó el rendimiento agrícola, datos que fueron procesados mediante un análisis de varianza de clasificación doble y las medias comparadas mediante la prueba de Tukey al 5 % de probabilidad de error. Como resultado se constató que el mayor rendimiento puedo estar asociado a un crecimiento más precoz y de mayor magnitud, atendiendo a la masa seca de la parte aérea de las plantas por unidad de superficie y a mayores valores de Índice de Área Foliar

How Frequently Benign Uterine Myomas Appear Suspicious for Sarcoma as Assessed by Transvaginal Ultrasound?

Uterine myomas may resemble uterine sarcomas in some cases. However, the rate of benign myomas appearing as sarcomas at an ultrasound examination is not known. The objective of this study is to determine the percentage of benign myomas that appear suspicious for uterine sarcoma on ultrasound examination. This is a prospective observational multicenter study (June 2019-December 2021) comprising a consecutive series of patients with histologically proven uterine myoma after hysterectomy or myomectomy who underwent transvaginal and/or transabdominal ultrasound prior to surgery. All ultrasound examinations were performed by expert examiners. MUSA criteria were used to describe the lesions (1). Suspicion of sarcoma was established when three or more sonographic features, described by Ludovisi et al. as "frequently seen in uterine sarcoma", were present (2). These features are no visible myometrium, irregular cystic areas, non-uniform echogenicity, irregular contour, "cooked" appearance, and a Doppler color score of 3-4. In addition, the examiners had to classify the lesion as suspicious based on her/his impression, independent of the number of features present. Eight hundred and ten women were included. The median maximum diameter of the myomas was 58.7 mm (range: 10.0-263.0 mm). Three hundred and forty-nine (43.1%) of the patients had more than one myoma. Using the criterion of >3 suspicious features, 40 (4.9%) of the myomas had suspicious appearance. By subjective impression, the examiners considered 40 (4.9%) cases suspicious. The cases were not exactly the same. We conclude that approximately 5% of benign uterine myomas may exhibit sonographic suspicion of sarcoma. Although it is a small percentage, it is not negligible

Challenges and Opportunities to Scale Up Cardiovascular Disease Secondary Prevention in Latin America and the Caribbean.

In the Americas, CVD represents about 38% of noncommunicable disease deaths. A roadmap for secondary prevention in Latin America and the Caribbean is warranted. Simple and practical guidelines should be developed and implemented. PAHO proposes a realistic and efficient prevention coalition plan in Latin America to fight CVD. The inclusion of the health system through health workers is highly recommended for a successful nationwide preventive program

Acute heart failure in subtropical climates: clinical characteristics, management, and outcomes in the Canary Islands versus continental Spain - the CANAR-ICA study results

Insuficiencia cardiaca aguda; Clima subtropical; Servicios de urgencias hospitalariosInsuficiència cardíaca aguda; Clima subtropical; Serveis d'urgències hospitalarisAcute heart failure; Subtropical climate; Hospital emergency servicesObjectives: To determine whether there are differences in the clinical characteristics, management, and outcome of episodes of acute heart failure (AHF) in residents of the Canary Islands, where the climate is subtropical, and episodes in continental Spain. Material and methods: Cases were identified in the registry for Epidemiology of Acute Heart Failure in Emergency Departments and categorized as in the Canary Islands or continental Spain. Data for 38 demographic, baseline, clinical, and therapeutic variables were extracted. We analyzed statistics for in-hospital and 30-day mortality, long hospital stay (more than 7 days), and a composite outcome after discharge (revisits or death within 30 days). The results for island and continental patients were compared and adjusted for between-group differences. Results: A total of 18 390 patients were studied, 697 islanders (3.8%) and 17 673 continental patients (96.2%). Comparisons showed that the islanders were younger; more often women; and more likely to have hypertension, diabetes, and a prior AHF episode. Their New York Heart Association functional class was also likely to be higher. However, their rates of dyslipidemia, valve disease, and functional dependence were lower, and they were also less likely to be on reninangiotensin system blockers. Although the severity of cardiac decompensation was similar in island and continental patients, the islanders received more intravenous treatments in the emergency department and were admitted less often. The adjusted risk of a long hospital stay was higher for the islanders (odds ratio [OR], 2.36; 95% CI, 1.52-3.02) but their risk for mortality and the composite outcome did not differ: in-hospital mortality, OR 0.97 (95% CI, 0.68-1.37); 30-day mortality, OR, 0.9 (95% CI, 0.67-1.27); and the post-discharge composite, OR, 1.19 (95% CI, 0.93-1.53). Conclusion: Baseline patient characteristics and clinical management of AHF episodes differ between the subtropical region and those in southern continental Europe. Hospitalization was required less often, but hospital stays were longer.Objetivo. Investigar si existen diferencias clínicas, asistenciales y evolutivas entre los episodios de insuficiencia cardiaca aguda (ICA) desarrollados en residentes en las Islas Canarias (CAN), de clima subtropical, y en los del territorio espa ñol continental (CON). Método. Los pacientes con ICA incluidos en el registro EAHFE se dividieron en CAN o CON. Se recogieron 38 varia bles demográficas, de estado clínico basal, clínicas y terapéuticas. Se analizó la mortalidad intrahospitalaria y a los 30 días, la hospitalización prolongada (> 7 días) y el evento combinado post-alta (reconsulta o muerte a 30 días). Se compararon los pacientes CAN y CON, ajustando los resultados por las diferencias entre grupos. Resultados. Se incluyeron 18.390 pacientes: CAN = 697 (3,8%), CON = 17.673 (96,2%). Tras el ajuste, los CAN eran más jóvenes, más frecuentemente mujeres, tenían más antecedentes de hipertensión, diabetes e ICA previa, y estaban en clase funcional más avanzada, pero tenían menos dislipemia, valvulopatías y dependencia funcional, y recibían me nos frecuentemente inhibidores del eje renina-angiotensina. Aunque la gravedad del episodio de descompensación fue similar, los CAN recibían más tratamientos endovenosos en urgencias y se hospitalizaban menos. El riesgo ajusta do de hospitalización prolongada en los CAN resultó incrementado (OR 2,36; IC 95%:1,52-3,02), pero no hubo dife rencias en la mortalidad intrahospitalaria (OR 0,97; IC 95%: 0,68-1,37), a 30 días (OR 0,9; IC 95%: 0,67-1,27) o en los eventos combinados post-alta a los 30 días (OR 1,19; IC 95%: 0,93-1,53). Conclusiones. Existen diferencias tanto en las características basales como en el manejo clínico de los episodios de insuficiencia cardiaca en los residentes de una región subtropical respecto a los de una zona meridional europea. Además, tienen menor necesidad de hospitalización, aunque estas son más prolongadas