Magnetic resonance imaging tumor regression shrinkage patterns after neoadjuvant chemotherapy in patients with locally advanced breast cancer: correlation with tumor biological subtypes and pathological response after therapy

The objective of this study is to analyze magnetic resonance imaging shrinkage pattern of tumor regression after neoadjuvant chemotherapy and to evaluate its relationship with biological subtypes and pathological response. We reviewed the magnetic resonance imaging studies of 51 patients with single mass-enhancing lesions (performed at time 0 and at the II and last cycles of neoadjuvant chemotherapy). Tumors were classified as Luminal A, Luminal B, HER2+, and Triple Negative based on biological and immunohistochemical analysis after core needle biopsy. We classified shrinkage pattern, based on tumor regression morphology on magnetic resonance imaging at the II cycle, as concentric, nodular, and mixed. We assigned a numeric score (0: none; 1: low; 2: medium; 3: high) to the enhancement intensity decrease. Pathological response on the surgical specimen was classified as complete (grade 5), partial (grades 4-3), and non-response (grades 1-2) according to Miller and Payne system. Fisher test was used to relate shrinkage pattern with biological subtypes and final pathological response. Seventeen patients achieved complete response, 25 partial response, and 9 non-response. A total of 13 lesions showed nodular pattern, 20 concentric, and 18 mixed. We found an association between concentric pattern and HER2+ (p < 0.001) and mixed pattern and Luminal A lesions (p < 0.001). We observed a statistical significant correlation between concentric pattern and complete response (p < 0.001) and between mixed pattern and non-response (p = 0.005). Enhancement intensity decrease 3 was associated with complete response (p < 0.001). Shrinkage pattern and enhancement intensity decrease may serve as early response indicators after neoadjuvant chemotherapy. Shrinkage pattern correlates with tumor biological subtypes

Cuidado gerencial e gerência do cuidado na interface da utilização do sistema de informação em saúde pelo enfermeiro

Resumo: Este estudo exploratório-descritivo objetiva compreender como se processa a utilização do Sistema de Informação em Saúde (SIS) pelo enfermeiro gerente no desenvolvimento da prática do cuidado. Utiliza-se como metodologia a pesquisa qualitativa. O cenário escolhido é um distrito sanitário do Município de Curitiba, no Paraná, e os dados foram coletados por meio de entrevista semi-estruturada e analisados à luz do referencial para a análise de conteúdo de Bardin (1977). Foi possível apreender que o Sistema de Informação em Saúde é fundamental nas ações que o enfermeiro gerente desenvolve como responsável por um distrito sanitário. Ele necessita de informações clínicas, epidemiológicas e gerenciais para o desenvolvimento das diversas atividades do cotidiano da sua prática profissional. Também, detectou-se que as ações gerenciais do enfermeiro em saúde coletiva apresentam dois movimentos: um mais abrangente, em que o objetivo é o desenvolvimento de ações, voltado para toda a população da área de abrangência da unidade de saúde e identificado como cuidado gerencial, e um mais focado em uma determinada parcela da população, identificado como gerência do cuidado. Este estudo mostrou sua relevância, à medida que desencadeou uma reflexão sobre a prática profissional gerencial do enfermeiro em saúde coletiva e sobre a utilização do Sistema de Informação em Saúde como instrumento essencial para a prática do cuidado

Designing for the next generation. Children urban design as a strategic method to improve the future in the cities

Nowadays, society recognizes the childhood as an important step able to generate a social value: children are the main actors of the future but it is necessary to consider the children as children and not as the next adult. Traditionally, the design for kids consider them little adults in a transition phase. The research intention is to spread a new design culture conceived expressly for children, which shall be able to communicate to them using their languages. The project is dedicated to the children - the next generation - from 3 to 11 years old. The aim of this research is to propose a methodological system to design public spaces in the cities able to orient, inform, communicate, entertain, interact, educate, and integrate all kind of children (and their parents) belonging to different cultures with one universal language.6n

Cytohistological and cytochemical features of the seeds of Malus domestica Borkh exposed to spring frosts

AbstractMalus domestica Borkh cv. Golden Delicious trees, exposed to spring frost, showed the occurrence of seeds with white (W), spotted (S) and black (B) integuments, with a different distribution, amount and damage in shedding and non-shedding fruits at several times after anthesis. While B seeds were completely degenerated, the S seeds showed hystological and cytochemical features that included a precocious embryo development stage, an embryonal cells shrinkage, an absence of reserves in the suspensor, endosperm and integuments, and a probable block of the routing of reserves, as a consequence of spring frost damages. All these features are the same occurring in seeds undergoing to natural abscission phenomenon and in the W seeds of shedding fruits observed in previous years. The S seeds damage is certainly attributable to meteorological events, because the S seeds were never found until the occurrence of the spring frosts. On the contrary, the damage in the W seeds, which do not show external symptom..

Effect of retinoic acid on human adrenal corticosteroid synthesis.

AbstractAimsRetinoic acid has recently yielded promising results in the treatment of Cushing's disease, i.e., excess cortisol secretion due to a pituitary corticotropin (ACTH)-secreting adenoma. In addition to its effect on the tumoral corticotrope cell, clinical results suggest an additional adrenal site of action. Aim of this study was to evaluate whether retinoic acid modulates cortisol synthesis and secretion by human adrenals in vitro.Main methodsPrimary cultures from 10 human adrenals specimens were incubated with 10nM, 100nM and 1μM retinoic acid with and without 10nM ACTH for 24h. Cortisol levels were measured by radioimmunoassay and CYP11A1, STAR and MC2R gene expression analyzed by real-time PCR.Key findingsRetinoic acid increased cortisol secretion (149.5±33.01%, 151.3±49.45% and 129.3±8.32% control secretion for 10nM, 100nM and 1μM respectively, p<0.05) and potentiated STAR expression (1.51±0.22, 1.56±0.15 and 1.59±0.14 fold change over baseline, for 10nM, 100nM and 1μM respectively, p<0.05). Concurrently, retinoic acid markedly blunted constitutional and ACTH-induced MC2R expression (0.66±0.11, 0.62±0.08 and 0.53±0.07 fold change over baseline, for 10nM, 100nM and 1μM respectively, p<0.05; 0.71±0.10, 0.51±0.07 and 0.51±0.08 fold change over ACTH alone, for 10nM, 100nM and 1μM respectively, p<0.05). No effect on CYP11A1 was observed.SignificanceRetinoic acid stimulates cortisol synthesis and secretion in human adrenals and at the same time markedly blunts ACTH receptor transcription. These results reveal a novel, adrenal effect of retinoic acid which may contribute to its efficacy in patients with Cushing's disease