Two-Stage Liver Transplantation with Temporary Porto-Middle Hepatic Vein Shunt

Two-stage liver transplantation (LT) has been reported for cases of fulminant liver failure that can lead to toxic hepatic syndrome, or massive hemorrhages resulting in uncontrollable bleeding. Technically, the first stage of the procedure consists of a total hepatectomy with preservation of the recipient's inferior vena cava (IVC), followed by the creation of a temporary end-to-side porto-caval shunt (TPCS). The second stage consists of removing the TPCS and implanting a liver graft when one becomes available. We report a case of a two-stage total hepatectomy and LT in which a temporary end-to-end anastomosis between the portal vein and the middle hepatic vein (TPMHV) was performed as an alternative to the classic end-to-end TPCS. The creation of a TPMHV proved technically feasible and showed some advantages compared to the standard TPCS. In cases in which a two-stage LT with side-to-side caval reconstruction is utilized, TPMHV can be considered as a safe and effective alternative to standard TPCS

Anterior cutaneous nerve block for analgesia in anterior chest trauma: is the parasternal approach necessary?

In recent years, several techniques of regional anesthesia have been proposed to provide analgesia to the anterior thoracic cage; notably, most of these techniques require a parasternal approach. However, in this context, the potential role of a more common and well-established technique, namely the modified pectoral nerve block (known as PECS II block), has been poorly investigated. Here, we describe a case involving a patient with bilateral anterolateral multiple rib fractures associated with sternum fracture, who was successfully treated using bilateral PECS II blocks. Our experience indicates that the PECS II block can provide excellent analgesia in cases involving anterior rib and sternum fractures. Because it is easier to perform and may be safer than other parasternal techniques, the PECS II block should be considered when providing analgesia for traumatic injuries of the anterior thorax

Interethnic diversity of NAT2 polymorphisms in Brazilian admixed populations

<p>Abstract</p> <p>Background</p> <p>N-acetyltransferase type 2 (Nat2) is a phase II drug- metabolizing enzyme that plays a key role in the bioactivation of aromatic and heterocyclic amines. Its relevance in drug metabolism and disease susceptibility remains a central theme for pharmacogenetic research, mainly because of its genetic variability among human populations. In fact, the evolutionary and ethnic-specific SNPs on the <it>NAT2 </it>gene remain a focus for the potential discoveries in personalized drug therapy and genetic markers of diseases. Despite the wide characterization of <it>NAT2 </it>SNPs frequency in established ethnic groups, little data are available for highly admixed populations. In this context, five common <it>NAT2 </it>SNPs (<it>G191A</it>, <it>C481T</it>, <it>G590A</it>, <it>A803G </it>and G<it>857A</it>) were investigated in a highly admixed population comprised of Afro-Brazilians, Whites, and Amerindians in northeastern Brazil. Thus, we sought to determine whether the distribution of <it>NAT2 </it>polymorphism is different among these three ethnic groups.</p> <p>Results</p> <p>Overall, there were no statistically significant differences in the distribution of <it>NAT2 </it>polymorphism when Afro-Brazilian and White groups were compared. Even the allele frequency of <it>191A</it>, relatively common in African descendents, was not different between the Afro-Brazilian and White groups. However, allele and genotype frequencies of <it>G590A </it>were significantly higher in the Amerindian group than either in the Afro-Brazilian or White groups. Interestingly, a haplotype block between <it>G590A </it>and <it>A803G </it>was verified exclusively among Amerindians.</p> <p>Conclusions</p> <p>Our results indicate that ethnic admixture might contribute to a particular pattern of genetic diversity in the <it>NAT2 </it>gene and also offer new insights for the investigation of possible new <it>NAT2 </it>gene-environment effects in admixed populations.</p

Predictivity of clinical, laboratory and imaging findings in diagnostic definition of palpable thyroid nodules. A multicenter prospective study

Abstract PURPOSE: To assess the role of clinical, biochemical, and morphological parameters, as added to cytology, for improving pre-surgical diagnosis of palpable thyroid nodules. METHODS: Patients with a palpable thyroid nodule were eligible if surgical intervention was indicated after a positive or suspicious for malignancy FNAC (TIR 4-5 according to the 2007 Italian SIAPEC-IAP classification), or two inconclusive FNAC at a 653 months interval, or a negative FNAC associated with one or more risk factor. Reference standard was histological malignancy diagnosis. Likelihood ratios of malignancy, sensitivity, specificity, negative (NPV), and positive predictive value (PPV) were described. Multiple correspondence analysis (MCA) and logistic regression were applied. RESULTS: Cancer was found in 433/902 (48%) patients. Considering TIR4-5 only as positive cytology, specificity, and PPV were high (94 and 91%) but sensitivity and NPV were low (61 and 72%); conversely, including TIR3 among positive, sensitivity and NPV were higher (88 and 82%) while specificity and PPV decreased (52 and 63%). Ultrasonographic size 653\u2009cm was independently associated with benignity among TIR2 cases (OR of malignancy 0.37, 95% CI 0.18-0.78). In TIR3 cases the hard consistency of small nodules was associated with malignity (OR: 3.51, 95% CI 1.84-6.70, p\u2009<\u20090.001), while size alone, irrespective of consistency, was not diagnostically informative. No other significant association was found in TIR2 and TIR3. CONCLUSIONS: The combination of cytology with clinical and ultrasonographic parameters may improve diagnostic definition of palpable thyroid nodules. However, the need for innovative diagnostic tools is still high

Giovanni Sartori e la democrazia della Seconda Repubblica

Il saggio ripercorre e analizza criticamente tutti i passaggi istituzionali della cosiddetta Seconda Repubblica, ossia della peculiare democrazia maggioritaria che si imposta in Italia a partire dal 1994. Tali passaggi sono visti all'interno del pensiero di Giovanni Sartori e in particolare della sua teoria della democrazia. Tale pensiero si è manifestato sia attraverso opere scientifiche sia attraverso una continua attività pubblicistica, in particolare dalle colonne, come editorialista, del Corriere della Sera. Dall'esame di questo pensiero emerge una serrata e continua critica dei caratteri istituzionali della peculiare democrazia maggioritaria all'italiana.The essay traces and critically analyzes all the institutional steps of the so-called Italian Second Republic, that is the peculiar majoritarian democracy that is set in Italy since 1994. These steps are seen within the thoughts of Giovanni Sartori and in particular of his theory of democracy . Such thinking has manifested both through scientific works both through continuous publications, in particular from the columns, as a columnist, of the Corriere della Sera. From an examination of this thinking emerges a close and continuous criticism of the institutional character of the distinctive Italian style majoritarian democracy

A IMPORTÂNCIA DA QUALIDADE DA GESTÃO DAS DROGARIAS DE PEQUENO PORTE, TENDO EM VISTA O ATUAL PANORAMA DO VAREJO FARMACÊUTICO

Com a estabilidade econômica, proporcionada pelo plano real, observou-se o crescimento das filiais de redes de farmácias e drogarias no Brasil. Isto gerou o aumento da concorrência entre estas e as drogarias de pequeno porte, tendo como resultado a dificuldade da permanência destas neste mercado. Assim, torna-se imprescindível, ter uma gestão profissionalizada que viabilize tal permanência. Posto isso, o presente trabalho, que consiste em uma revisão sistemática da literatura, teve como objetivo compreender a importância que a qualidade da gestão de drogarias de pequeno porte tem, frente a disputa mercadológica estabelecida entre estas e as grandes redes de farmácias e drogarias, em face do crescimento vertiginoso destas últimas. Para o alcance disso foram consultadas as bases de dados Google Scholar, Scielo e CAPES, através das palavras chave: gestão, farmácias, drogarias, redes de farmácias e drogarias, drogarias de pequeno porte e gestão farmacêutica, sendo elegidos os trabalhos pertinentes publicados entre 2010 e 2018. Nesse sentido, através da análise, percebeu-se que que apesar dos desafios enfrentados por essas microempresas, para o alcance da qualidade da gestão. Esta é imprescindível por permitir a organização financeira das empresas, possibilitando a manutenção e ampliação destas. Dessa forma, conclui-se que, dada a importância da gestão, é preciso que esta seja realizada de maneira a atingir níveis de qualidade, para permitir assim, um melhor desempenho econômico

METODOLOGIAS DA GESTÃO APLICADAS A DROGARIAS E FARMÁCIAS PARA FORTALECIMENTO DESTAS NO MERCADO BRASILEIRO

A gestão consiste no ato de planejar, coordenar e organizar o processo usado para aquisição de resultados, bens ou atividades, baseado na existência de uma organização, configurando-se assim como primordial para qualquer serviço comercial e logístico. Principalmente em tempos difíceis como a época atual, em que gerenciar uma farmácia é um grande desafio. Nesse sentido, as práticas fundamentais na gestão da farmácia, como as metodologias da gestão, podem ser úteis para o enfrentamento do mercado e das suas adversidades. Assim sendo, o presente trabalho, consiste em um artigo de revisão bibliográfica e teve como objetivo principal entender a importância das metodologias da gestão aplicadas a drogarias e farmácias com o intuito de fortalecer estas no mercado brasileiro e compreender o papel que o farmacêutico pode assumir frente a gestão. Para o alcance disso, foram consultadas as bases de dados: Google Scholar, Scielo e CAPES, sendo realizada uma pesquisa, através das palavras chave: gestão de farmácias e drogarias, metodologias de gestão e mercado farmacêutico brasileiro. Nessa perspectiva, as metodologias da gestão são fundamentais para o avanço das farmácias e drogarias, no varejo farmacêutico. Isso se justifica por estas potencializarem a eficácia dos processos administrativos da empresa e permitirem a organização financeira das mesmas. Diante disso os farmacêuticos, enquanto gestores, ao fazerem uso das metodologias podem contribuir para a fortificação destas, no mercado. Posto isso, conclui-se que é de extrema importância, a adoção das metodologias da gestão em farmácias e drogaria para permitir um melhor desempenho econômico destas

Endocrine‐based treatments in clinically‐relevant subgroups of hormone receptor‐positive/HER2‐negative metastatic breast cancer: systematic review and meta‐analysis

A precise assessment of the efficacy of first‐/second‐line endocrine therapies (ET) ± target therapies (TT) in clinically‐relevant subgroups of hormone receptor‐positive (HR+)/HER2‐negative metastatic breast cancer (MBC) has not yet been conducted. To improve our current knowledge and support clinical decision‐making, we thus conducted a systematic literature search to identify all first‐/second‐line phase II/III randomized clinical trials (RCT) of currently approved or most promising ET ± TT. Then, we performed a meta‐analysis to assess progression‐free (PFS) and/or overall survival (OS) benefit in several clinically‐relevant prespecified subgroups. Thirty‐five RCT were included (17,595 patients). Pooled results show significant reductions in the risk of relapse or death of 26–41% and 12–27%, respectively, depending on the clinical subgroup. Combination strategies proved to be more effective than single‐agent ET (PFS hazard ratio (HR) range for combinations: 0.60–0.65 vs. HR range for single agent ET: 0.59–1.37; OS HR range for combinations: 0.74–0.87 vs. HR range for single agent ET: 0.68–0.98), with CDK4/6‐inhibitors(i) + ET being the most effective regimen. Single agent ET showed comparable efficacy with ET+TT combinations in nonvisceral (p = 0.63) and endocrine sensitive disease (p = 0.79), while mTORi‐based combinations proved to be a valid therapeutic option in endocrine‐resistant tumors, as well as PI3Ki + ET in PIK3CA‐mutant tumors. These results strengthen international treatment guidelines and can aid therapeutic decision‐making