Effectiveness of hyaluronate-based pessaries in the treatment of vulvovaginal atrophy in postmenopausal women.

Objectives: This study aimed to assess the efficacy and safety of hyaluronic acid-based vaginal pessaries (Hydeal-D) in the treatment of vulvovaginal atrophy (VVA).Study design: The study was a pro..

A functional biological network centered on XRCC3: a new possible marker of chemoradiotherapy resistance in rectal cancer patients

Preoperative chemoradiotherapy is widely used to improve local control of disease, sphincter preservation and to improve survival in patients with locally advanced rectal cancer. Patients enrolled in the present study underwent preoperative chemoradiotherapy, followed by surgical excision. Response to chemoradiotherapy was evaluated according to Mandard's Tumor Regression Grade (TRG). TRG 3, 4 and 5 were considered as partial or no response while TRG 1 and 2 as complete response. From pretherapeutic biopsies of 84 locally advanced rectal carcinomas available for the analysis, only 42 of them showed 70% cancer cellularity at least. By determining gene expression profiles, responders and non-responders showed significantly different expression levels for 19 genes (P < 0.001). We fitted a logistic model selected with a stepwise procedure optimizing the Akaike Information Criterion (AIC) and then validated by means of leave one out cross validation (LOOCV, accuracy = 95%). Four genes were retained in the achieved model: ZNF160, XRCC3, HFM1 and ASXL2. Real time PCR confirmed that XRCC3 is overexpressed in responders group and HFM1 and ASXL2 showed a positive trend. In vitro test on colon cancer resistant/susceptible to chemoradioterapy cells, finally prove that XRCC3 deregulation is extensively involved in the chemoresistance mechanisms. Protein-protein interactions (PPI) analysis involving the predictive classifier revealed a network of 45 interacting nodes (proteins) with TRAF6 gene playing a keystone role in the network. The present study confirmed the possibility that gene expression profiling combined with integrative computational biology is useful to predict complete responses to preoperative chemoradiotherapy in patients with advanced rectal cance

A (des)valorização social do SUS e os aspectos relacionados

Introduction: The SUS - Unified Health System - enabled profound changes in the health scenario, guaranteeing access to sectors not included in the previous regime, however, although some services have a prominent position worldwide, others still face several difficulties. In this sense, this article aims to analyze the satisfaction of SUS users and explore its reflexes in the valorization of the System. Methodology: This is a narrative review study covering published articles and studies, for which searches were carried out in the PubMed databases and in the CAPES Periodicals Portal, using descriptors such as "Brazil", "Consumer Behavior", "Health Evaluation”, “Patient Preference”, “Patient Satisfaction”, “Perception”, “Satisfaction”, “SUS”, “User”, “Unified Health System”, “User Perception AND Unified Health System”, “Sistema Único de Saúde” Health AND Patient Satisfaction, “SUS AND User Perception” and “SUS AND Valuation”. Results: After analysis, it was observed that user dissatisfaction with the services provided by the SUS varies according to the region of the country, social class and perception of their own health status. In addition, 57.9% of users listed the lack of doctors as the biggest general problem. Discussion: It was possible to analyze that the Unified Health System, in part, managed to offer health services in an integral and universal way. However, despite important achievements, problems still persist such as: long waiting time for care, lack of humanization in the work of professionals, among others. Added to these problems, the lack of knowledge about the SUS contributes decisively to the devaluation on the part of the user. Conclusion: In this way, there was a general dissatisfaction of users with the system, which, along with the population's misinformation about SUS actions and the partial performance of the media, generate an impact on society's view of the health system, leading to its devaluation.Introdução: O SUS possibilitou profundas mudanças no cenário da saúde, garantindo acesso aos setores não incluídos no regime anterior. Entretanto, ainda que alguns serviços tenham posição de destaque mundial, outros ainda enfrentam diversas dificuldades. Nesse sentido, esse artigo tem como objetivo analisar a satisfação dos usuários e explorar os seus reflexos na valorização do Sistema. Metodologia: Trata-se de uma revisão narrativa abrangendo trabalhos publicados, para isso foi utilizado o PubMed e o Portal de Periódicos CAPES, com os descritores: “Brazil”, “Consumer Behavior”, “Health Evaluation”, “Patient Preference”, “Patient Satisfaction”, “Perception”, "Satisfaction", “SUS”, “User”, “Unified Health System”, “Percepção do usuário AND Sistema Único de Saúde”, “Sistema Único de Saúde AND Satisfação do paciente”, “SUS AND Percepção do usuário” e “SUS AND valorização”. O critério para inclusão desses trabalhos foi: trabalhos relacionados ao tema, em Português, Espanhol ou Inglês e com o texto completo disponível. Assim, foram selecionados 13 textos. Resultados: Após análises, observou-se que a insatisfação do usuário com os serviços do SUS varia conforme a região do país, a classe social e com a percepção sobre seu próprio estado de saúde. Além disso, 57,9% dos usuários elencaram como o maior problema geral a falta de médicos. Discussão: Foi possível analisar que o SUS, em parte, conseguiu oferecer serviços de forma integral e universal. Porém, ainda persistem problemas como: elevado tempo de espera para atendimentos e a falta de humanização. Somado a essas lacunas, o desconhecimento sobre o SUS contribui decisivamente para a desvalorização. Conclusão: Apesar de limitações como a falta de estudos mais recentes e a dificuldade metodológica, foi possível constatar uma insatisfação geral dos usuários, que atrelado à desinformação da população sobre as ações do SUS e a atuação parcial da mídia, geram um impacto na visão da sociedade sobre o sistema de saúde, levando a sua desvalorização

Technology as 'Applied Science': a Serious Misconception that Reinforces Distorted and Impoverished Views of Science

The current consideration of technology as 'applied science', this is to say, as something that comes 'after' science, justifies the lack of attention paid to technology in science education. In our paper we question this simplistic view of the science-technology relationship, historically rooted in the unequal appreciation of intellectual and manual work, and we try to show how the absence of the technological dimension in science education contributes to a na¿ ve and distorted view of science which deeply affects the necessary scientific and technological literacy of all citizens

Risk of Early Versus Later Rebleeding From Dural Arteriovenous Fistulas With Cortical Venous Drainage

Background: Cranial dural arteriovenous fistulas with cortical venous drainage are rare lesions that can present with hemorrhage. A high rate of rebleeding in the early period following hemorrhage has been reported, but published long-term rates are much lower. No study has examined how risk of rebleeding changes over time. Our objective was to quantify the relative incidence of rebleeding in the early and later periods following hemorrhage. Methods: Patients with dural arteriovenous fistula and cortical venous drainage presenting with hemorrhage were identified from the multinational CONDOR (Consortium for Dural Fistula Outcomes Research) database. Natural history follow-up was defined as time from hemorrhage to first treatment, rebleed, or last follow-up. Rebleeding in the first 2 weeks and first year were compared using incidence rate ratio and difference. Results: Of 1077 patients, 250 met the inclusion criteria and had 95 cumulative person-years natural history follow-up. The overall annualized rebleed rate was 7.3% (95% CI, 3.2-14.5). The incidence rate of rebleeding in the first 2 weeks was 0.0011 per person-day; an early rebleed risk of 1.6% in the first 14 days (95% CI, 0.3-5.1). For the remainder of the first year, the incidence rate was 0.00015 per person-day; a rebleed rate of 5.3% (CI, 1.7-12.4) over 1 year. The incidence rate ratio was 7.3 (95% CI, 1.4-37.7; P, 0.026). Conclusions: The risk of rebleeding of a dural arteriovenous fistula with cortical venous drainage presenting with hemorrhage is increased in the first 2 weeks justifying early treatment. However, the magnitude of this increase may be considerably lower than previously thought. Treatment within 5 days was associated with a low rate of rebleeding and appears an appropriate timeframe

Dural arteriovenous fistulas without cortical venous drainage:presentation, treatment, and outcomes

OBJECTIVE: Current evidence suggests that intracranial dural arteriovenous fistulas (dAVFs) without cortical venous drainage (CVD) have a benign clinical course. However, no large study has evaluated the safety and efficacy of current treatments and their impact over the natural history of dAVFs without CVD. METHODS: The authors conducted an analysis of the retrospectively collected multicenter Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR) database. Patient demographics and presenting symptoms, angiographic features of the dAVFs, and treatment outcomes of patients with Borden type I dAVFs were reviewed. Clinical and radiological follow-up information was assessed to determine rates of new intracranial hemorrhage (ICH) or nonhemorrhagic neurological deficit (NHND), worsening of venous hyperdynamic symptoms (VHSs), angiographic recurrence, and progression or spontaneous regression of dAVFs over time. RESULTS: A total of 342 patients/Borden type I dAVFs were identified. The mean patient age was 58.1 ± 15.6 years, and 62% were women. The mean follow-up time was 37.7 ± 54.3 months. Of 230 (67.3%) treated dAVFs, 178 (77%) underwent mainly endovascular embolization, 11 (4.7%) radiosurgery alone, and 4 (1.7%) open surgery as the primary modality. After the first embolization, most dAVFs (47.2%) achieved only partial reduction in early venous filling. Multiple complementary interventions increased complete obliteration rates from 37.9% after first embolization to 46.7% after two or more embolizations, and 55.2% after combined radiosurgery and open surgery. Immediate postprocedural complications occurred in 35 dAVFs (15.2%) and 6 (2.6%) with permanent sequelae. Of 127 completely obliterated dAVFs by any therapeutic modality, 2 (1.6%) showed angiographic recurrence/recanalization at a mean of 34.2 months after treatment. Progression to Borden-Shucart type II or III was documented in 2.2% of patients and subsequent development of a new dAVF in 1.6%. Partial spontaneous regression was found in 22 (21.4%) of 103 nontreated dAVFs. Multivariate Cox regression analysis demonstrated that older age, NHND, or severe venous-hyperdynamic symptoms at presentation and infratentorial location were associated with worse prognosis. Kaplan-Meier curves showed no significant difference for stable/improved symptoms survival probability in treated versus nontreated dAVFs. However, estimated survival times showed better trends for treated dAVFs compared with nontreated dAVFs (288.1 months vs 151.1 months, log-rank p = 0.28). This difference was statistically significant for treated dAVFs with 100% occlusion (394 months, log-rank p < 0.001). CONCLUSIONS: Current therapeutic modalities for management of dAVFs without CVD may provide better symptom control when complete angiographic occlusion is achieved

Exploiting Distance Technology to Foster Experimental Design as a Neglected Learning Objective in Labwork in Chemistry

This article deals with the design process of a remote laboratory for labwork in chemistry. In particular, it focuses on the mutual dependency of theoretical conjectures about learning in the experimental sciences and technological opportunities in creating learning environments. The design process involves a detailed analysis of the expert task and knowledge, e.g., spectrophotometry as a method for the determination of the concentration of a compound in a solution. In so doing, modifications in transposing tasks and knowledge to the learning situation can be monitored. The remote laboratory is described, as well as the specific features that alter the degree of fidelity of the learning situation in comparison to the expert one. It is conjectured that these alterations might represent actual benefits for learning

Recurrence after cure in cranial dural arteriovenous fistulas:a collaborative effort by the Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR)

OBJECTIVE Cranial dural arteriovenous fistulas (dAVFs) are often treated with endovascular therapy, but occasionally a multimodality approach including surgery and/or radiosurgery is utilized. Recurrence after an initial angiographic cure has been reported, with estimated rates ranging from 2% to 14.3%, but few risk factors have been identified. The objective of this study was to identify risk factors associated with recurrence of dAVF after putative cure. METHODS The Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR) data were retrospectively reviewed. All patients with angiographic cure after treatment and subsequent angiographic follow-up were included. The primary outcome was recurrence, with risk factor analysis. Secondary outcomes included clinical outcomes, morbidity, and mortality associated with recurrence. Risk factor analysis was performed comparing the group of patients who experienced recurrence with those with durable cure (regardless of multiple recurrences). Time-to-event analysis was performed using all collective recurrence events (multiple per patients in some cases). RESULTS Of the 1077 patients included in the primary CONDOR data set, 457 met inclusion criteria. A total of 32 patients (7%) experienced 34 events of recurrence at a mean of 368.7 days (median 192 days). The recurrence rate was 4.5% overall. Kaplan-Meier analysis predicted long-term recurrence rates approaching 11% at 3 years. Grade III dAVFs treated with endovascular therapy were statistically significantly more likely to experience recurrence than those treated surgically (13.3% vs 0%, p = 0.0001). Tentorial location, cortical venous drainage, and deep cerebral venous drainage were all risk factors for recurrence. Endovascular intervention and radiosurgery were associated with recurrence. Six recurrences were symptomatic, including 2 with hemorrhage, 3 with nonhemorrhagic neurological deficit, and 1 with progressive flow-related symptoms (decreased vision). CONCLUSIONS Recurrence of dAVFs after putative cure can occur after endovascular treatment. Risk factors include tentorial location, cortical venous drainage, and deep cerebral drainage. Multimodality therapy can be used to achieve cure after recurrence. A delayed long-term angiographic evaluation (at least 1 year from cure) may be warranted, especially in cases with risk factors for recurrence

Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR):rationale, design, and initial characterization of patient cohort

OBJECTIVE: Cranial dural arteriovenous fistulas (dAVFs) are rare lesions, hampering efforts to understand them and improve their care. To address this challenge, investigators with an established record of dAVF investigation formed an international, multicenter consortium aimed at better elucidating dAVF pathophysiology, imaging characteristics, natural history, and patient outcomes. This report describes the design of the Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR) and includes characterization of the 1077-patient cohort. METHODS: Potential collaborators with established interest in the field were identified via systematic review of the literature. To ensure uniformity of data collection, a quality control process was instituted. Data were retrospectively obtained. RESULTS: CONDOR comprises 14 centers in the United States, the United Kingdom, the Netherlands, and Japan that have pooled their data from 1077 dAVF patients seen between 1990 and 2017. The cohort includes 359 patients (33%) with Borden type I dAVFs, 175 (16%) with Borden type II fistulas, and 529 (49%) with Borden type III fistulas. Overall, 852 patients (79%) presented with fistula-related symptoms: 427 (40%) presented with nonaggressive symptoms such as tinnitus or orbital phenomena, 258 (24%) presented with intracranial hemorrhage, and 167 (16%) presented with nonhemorrhagic neurological deficits. A smaller proportion (224 patients, 21%), whose dAVFs were discovered incidentally, were asymptomatic. Many patients (85%, 911/1077) underwent treatment via endovascular embolization (55%, 587/1077), surgery (10%, 103/1077), radiosurgery (3%, 36/1077), or multimodal therapy (17%, 184/1077). The overall angiographic cure rate was 83% (758/911 treated), and treatment-related permanent neurological morbidity was 2% (27/1467 total procedures). The median time from diagnosis to follow-up was 380 days (IQR 120-1038.5 days). CONCLUSIONS: With more than 1000 patients, the CONDOR registry represents the largest registry of cranial dAVF patient data in the world. These unique, well-annotated data will enable multiple future analyses to be performed to better understand dAVFs and their management