Selection of colon cancer patients for neoadjuvant chemotherapy based on optimised preoperative MDCT A prospective multi-observer radiologic-pathologic agreement study

PURPOSE: Neoadjuvant chemotherapy (NACT) in potencially-resectable locally advanced colon cancer (LACC) is likely to prove superiority compared to standard treatment in the phase III FOXTROT Collaborative Group Trial. Thus, identification of LACC, defined as T3≥5 mm or T4, is fundamental and requires accurate noninvasive imaging. The value of optimized preoperative MDCT for that purpose is being assessed. METHODS AND MATERIALS: Observational, cross-sectional, prospective study including all patients with colon cancer refered to our Institution´s Radiology Department for preoperative staging between the 1st of October 2013 and the 6th of August 2014. Independent reading of optimized MDCT acquisitions using MPR was performed by 4 radiologists (3.6,15 and 20 years of experience in gastrointestinal imaging). Extramural tumour extension was graded as < 5 mm; ≥5 mm; invasion of peritoneum/fascia/adjacent organ. Surgical specimen analysis was performed by a single pathologist with 12 years of experience in gastrointestinal pathology. Radiologic-Pathologic agreement was assessed. RESULTS: 48 patients, 26 males and 22 females, with a median age of 74 years (min:45;max:89) were considered eligible. Median time to surgery was 30.5 days (min:1;max:117). Diagnostic sensitivity, specificity, positive predictive value, negative predictive value and accuracy of MDCT for the identification of LACC ranged between 0.64 and 0.82; 0.84 and 0.92; 0.5 and 0.7; 0.88 and 0.97; 0.75 and 0.88; respectively. Mean agreement between observers was 0.88 (SD:0.17) per patient. CONCLUSION: Preliminary results suggest that optimized MDCT is a specific, accurate and reproducible method for the selection of colon cancer patients who may benefit from NACT, with minimal risk of overtreatment of low-risk patients

O SERVIÇO SOCIAL EM PROCESSO DE EDUCAÇÃO PERMANENTE NA SAÚDE, GERANDO QUALIDADE DE ATENDIMENTO NO SUS

O Programa de Residência Integrada em Saúde da Escola de Saúde Pública do Rio Grande do Sul (RIS/ ESP/RS) privilegia a união de assistentes sociais de dois diferentes níveis de complexidade, com o intuito de integração entre residentes e preceptores. As discussões nos encontros demonstraram, pelo segundo ano consecutivo, que a dimensão da atuação profissional ultrapassa os muros das instituições. O núcleo de serviço social recebeu um planejamento a partir de aporte teórico com relevância ao aprimoramento cotidiano, a fim de fortalecer a visão ampliada do conceito de saúde, de acordo com Sistema Único de Saúde (Lei 8080/90), e qualificar a intervenção do assistente social no atendimento ao usuário, para potencializar o processo de trabalho a partir de discussões quanto ao cotidiano profissional.Palavras-chave: Educação. Qualificação Profissional. Processo de Trabalho. Saúde. Serviço Social

HIV-1-Transmitted Drug Resistance and Transmission Clusters in Newly Diagnosed Patients in Portugal Between 2014 and 2019

Objective: To describe and analyze transmitted drug resistance (TDR) between 2014 and 2019 in newly infected patients with HIV-1 in Portugal and to characterize its transmission networks. Methods: Clinical, socioepidemiological, and risk behavior data were collected from 820 newly diagnosed patients in Portugal between September 2014 and December 2019. The sequences obtained from drug resistance testing were used for subtyping, TDR determination, and transmission cluster (TC) analyses. Results: In Portugal, the overall prevalence of TDR between 2014 and 2019 was 11.0%. TDR presented a decreasing trend from 16.7% in 2014 to 9.2% in 2016 (p for-trend = 0.114). Multivariate analysis indicated that TDR was significantly associated with transmission route (MSM presented a lower probability of presenting TDR when compared to heterosexual contact) and with subtype (subtype C presented significantly more TDR when compared to subtype B). TC analysis corroborated that the heterosexual risk group presented a higher proportion of TDR in TCs when compared to MSMs. Among subtype A1, TDR reached 16.6% in heterosexuals, followed by 14.2% in patients infected with subtype B and 9.4% in patients infected with subtype G. Conclusion: Our molecular epidemiology approach indicates that the HIV-1 epidemic in Portugal is changing among risk group populations, with heterosexuals showing increasing levels of HIV-1 transmission and TDR. Prevention measures for this subpopulation should be reinforced.info:eu-repo/semantics/publishedVersio

The Long-Baseline Neutrino Experiment: Exploring Fundamental Symmetries of the Universe

The preponderance of matter over antimatter in the early Universe, the dynamics of the supernova bursts that produced the heavy elements necessary for life and whether protons eventually decay --- these mysteries at the forefront of particle physics and astrophysics are key to understanding the early evolution of our Universe, its current state and its eventual fate. The Long-Baseline Neutrino Experiment (LBNE) represents an extensively developed plan for a world-class experiment dedicated to addressing these questions. LBNE is conceived around three central components: (1) a new, high-intensity neutrino source generated from a megawatt-class proton accelerator at Fermi National Accelerator Laboratory, (2) a near neutrino detector just downstream of the source, and (3) a massive liquid argon time-projection chamber deployed as a far detector deep underground at the Sanford Underground Research Facility. This facility, located at the site of the former Homestake Mine in Lead, South Dakota, is approximately 1,300 km from the neutrino source at Fermilab -- a distance (baseline) that delivers optimal sensitivity to neutrino charge-parity symmetry violation and mass ordering effects. This ambitious yet cost-effective design incorporates scalability and flexibility and can accommodate a variety of upgrades and contributions. With its exceptional combination of experimental configuration, technical capabilities, and potential for transformative discoveries, LBNE promises to be a vital facility for the field of particle physics worldwide, providing physicists from around the globe with opportunities to collaborate in a twenty to thirty year program of exciting science. In this document we provide a comprehensive overview of LBNE's scientific objectives, its place in the landscape of neutrino physics worldwide, the technologies it will incorporate and the capabilities it will possess.Comment: Major update of previous version. This is the reference document for LBNE science program and current status. Chapters 1, 3, and 9 provide a comprehensive overview of LBNE's scientific objectives, its place in the landscape of neutrino physics worldwide, the technologies it will incorporate and the capabilities it will possess. 288 pages, 116 figure

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): study protocol for a randomized controlled trial

BACKGROUND: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). METHODS/DESIGN: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH2O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure 6430 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. DISCUSSION: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration metho