Margens cirúrgicas no dermatofibrossarcoma protuberans: relato de caso e revisão da literatura

Introduction: Dermatofibrosarcoma protuberans (DFSP) is a rare dermal fibrohistiocytic tumor that affects the skin, accounting for 1% of soft tissue sarcomas and representing less than0.1% of all malignancies. The main characteristic of this type of tumor is a high rate of local recurrence after surgical excision. Deciding the proper surgical margin for complete resection is a challenge. Case report: 24 year-old, shows a reddish vegetative asymptomatic tumor on the left shoulder. She has a positive family history of DFSP in the lower limb. The definitive histopathological report confirmed Dermatofibrossarcoma protuberans. Discussion: The histological feature of the tumor is the presence of tentacle type projections of neoplastic cells in the periphery extending through the subcutaneous tissue to the muscular fascia. Of course, the most important factor for local control is the achievement of free surgical margins. Excision through Mohs micrographic surgery is a great option in regions where wide excision is not desirable, as in the face. The standard margin in most pf the literature is 3 cm resected to the muscular fascia, and it can be reduced to 2 cm in places where the extensive excision impairs the conformation of the site, as in the face.Introdução: O dermatofibrossarcoma protuberante (DFSP) é um tumor fibrohistiocítico de origem dérmica raro, que acomete a pele, representando 1% dos sarcomas de partes moles e menos de 0,1% de todas malignidades. A principal característica deste tipo de tumor é a sua elevada taxa de recidiva local após excisão cirúrgica. Decidir a margem cirúrgica adequada para a ressecção completa é um desafio. Relato de caso: 24 anos, apresenta lesão tumoral vegetante avermelhada no ombro esquerdo, assintomática. Possui história familiar positiva de DFSP em membro inferior. O laudo histopatológico definitivo confirmou Dermatofibrossarcoma protuberans. Discussão: A característica histológica do tumor é a presença de projeções tipo tentáculos de células neoplásicas na periferia que se estendem através do tecido subcutâneo até a fáscia muscular. Certamente, o fator de maior importância para o controle local é a obtenção de margens cirúrgicas livres. A excisão através da cirurgia micrográfica de Mohs é uma ótima opção em regiões onde a excisão ampla não é desejável, como na face. A margem padrão estabelicida em grande parte da literatura é de 3 cm com ressecção até a fáscia muscular, podendo ser diminuida para 2 cm em locais em que a excisão ampla prejudique a conformação do local, como na fac

Universal Health Coverage in Marginalized Populations : A Qualitative Evaluation of a Health Reform Implementation in Rural Ecuador

In 2008, Ecuador underwent a major health reform with the aim of universal coverage. Little is known about the implementation of the reform and its perceived effects in rural parts of the country. The aim of this study was to explore the perceived effects of the 2008 health reform implementation, on rural primary health care services and financial access of the rural poor. A qualitative study using focus group discussions was conducted in a rural region in Ecuador, involving health staff, local health committee members, village leaders, and community health workers. Qualitative content analysis focusing on the manifest content was applied. Three categories emerged from the texts: (1) the prereform situation, which was described as difficult in terms of financial access and quality of care; (2) the reform process, which was perceived as top-down and lacking in communication by the involved actors; lack of interest among the population was reported; (3) the effects of the reform, which were mainly perceived as positive. However, testimonies about understaffing, drug shortages, and access problems for those living furthest away from the health units show that the reform has not fully achieved its intended effects. New problems are a challenging health information system and people without genuine care needs overusing the health services. The results indicate that the Ecuadorean reform has improved rural primary health care services. Still, the reform faces challenges that need continued attention to secure its current achievements and advance the health system further.Funding Agencies|Centre for General Practice and Primary Health Care, County Council of Ostergotland, Sweden; County Council of Ostergotland, Sweden</p

Potentiated Electron Transference in a-Ag2WO4 Microcrystals with Ag Nanofilaments as Microbial Agent

This study is a framework proposal for understanding the antimicrobacterial effect of both α-Ag2WO4 microcrystals (AWO) synthesized using a microwave hydrothermal (MH) method and α-Ag2WO4 microcrystals with Ag metallic nanofilaments (AWO:Ag) obtained by irradiation employing an electron beam to combat against planktonic cells of methicillin-resistant Staphylococcus aureus (MRSA). These samples were characterized by X-ray diffraction (XRD), FT-Raman spectroscopy, ultraviolet visible (UV–vis) measurements, field emission scanning electron microscopy (FE-SEM), transmission electron microscopy (TEM), and high resolution transmission electron microscopy (HRTEM). The results reveal that both AWO and AWO:Ag solutions have bacteriostatic and bactericidal effects, but the irradiated sample is more efficient; i.e., a 4-fold of the MRSA planktonic cells as compared to the nonirradiated sample was observed. In addition, first principles calculations were performed to obtain structural and electronic properties of AWO and metallic Ag, which provides strong quantitative support for an antimicrobacterial mechanism based on the enhancement of electron transfer processes between α-Ag2WO4 and Ag nanoparticles

All-sky search for short gravitational-wave bursts in the third Advanced LIGO and Advanced Virgo run

This paper presents the results of a search for generic short-duration gravitational-wave transients in data from the third observing run of Advanced LIGO and Advanced Virgo. Transients with durations of milliseconds to a few seconds in the 24–4096 Hz frequency band are targeted by the search, with no assumptions made regarding the incoming signal direction, polarization, or morphology. Gravitational waves from compact binary coalescences that have been identified by other targeted analyses are detected, but no statistically significant evidence for other gravitational wave bursts is found. Sensitivities to a variety of signals are presented. These include updated upper limits on the source rate density as a function of the characteristic frequency of the signal, which are roughly an order of magnitude better than previous upper limits. This search is sensitive to sources radiating as little as ∼10^−10 M⊙ c^2 in gravitational waves at ∼70 Hz from a distance of 10 kpc, with 50% detection efficiency at a false alarm rate of one per century. The sensitivity of this search to two plausible astrophysical sources is estimated: neutron star f modes, which may be excited by pulsar glitches, as well as selected core-collapse supernova models