Differentiated thyroid carcinoma: what the nonspecialists needs to know

ABSTRACT Differentiated thyroid carcinoma (DTC) accounts for most cases of thyroid cancer, and the heterogeneity of DTC requires that management decisions be taken by a multidisciplinary team involving endocrinologists, head and neck surgeons, nuclear medicine physicians, pathologists, radiologists, radiation oncologists, and medical oncologists. It is important for nonspecialists to recognize and refer patients with DTC who will benefit from a specialized approach. Recent advances in knowledge and changes in management of DTC call for the need to raise awareness on the part of these nonspecialist physicians, including general endocrinologists and medical oncologists at large. We provide an overview of diagnostic and therapeutic principles in DTC, especially those that bear direct implication on day-to-day management of these patients by generalists. Patients with DTC may be broadly categorized as having localized, locally persistent/recurrent, or metastatic disease. Current recommendations for DTC include a three-tiered system that classifies patients with localized disease into low, intermediate, or high risk of persistent or recurrent disease. Risk stratification should be performed at baseline and repeated on an ongoing basis, depending on clinical evolution. One of the overarching goals in the management of DTC is the need to personalize treatment by tailoring its modality and intensity according to ongoing prognostic stratification, evolving knowledge about the disease, and patient characteristics and preference. In metastatic disease that is refractory to radioactive iodine, thyroid tumors are being reclassified into molecular subtypes that better reflect their biological properties and for which molecular alterations can be targeted with specific agents

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Trinca de solidificação off-corner no lingotamento contínuo de Tarugos

Exportado OPUSMade available in DSpace on 2019-08-12T23:29:34Z (GMT). No. of bitstreams: 1 lucas_vieira_penna.pdf: 3141821 bytes, checksum: 7d431d65bea386395c1d377d3b4b3582 (MD5) Previous issue date: 4Trincas internas são o principal problema no lingotamento contínuo de tarugos. Na usina da BELGO, localizada em João Monlevade, a trinca interna, denominada offcorner é a mais comum encontrada. Este tipo de trinca ocorre com maior freqüência nos aços médio teor de carbono (percentual de carbono entre 0,25 e 0,45). O foco deste trabalho é a identificação e análise dos principais fatores que afetam a formação dastrincas off-corner em tarugos de aços médio teor de carbono.Os fatores que foram considerados neste trabalho foram: - Tipo de pó fluxante; - Intensidade do resfriamento secundário; - Tipo e conicidade da lingoteira - Intensidade da agitação eletromagnética no molde; - Vazão de água no molde; - Raio de canto da lingoteira. Através de uma técnica estatística chamada DOE (Design of experiments), experimentos foram realizados para determinar os efeitos de cada um dos fatores listados acima na formação da trinca off-corner. Baseado nos resultados destes experimentos foi possível concluir que aumentando-se a vazão da água no molde e a intensidade da agitação eletromagnética além do uso de um pó fluxante com baixa viscosidade, tem-se a a minimização da formação da trinca off-corner.Internal cracks are a major quality problem in the continuous casting of billets. At Belgos plant, located in João Monlevade, off-corner crack is the most common kind of internal crack in steel billets. This type of crack occurs more frequently in medium carbon steels (carbon content between 0.25 and 0.45%). The focus of the present investigation is the identification and analysis of the main factors that affect the formation of off-corner cracks in billets of medium carbon steels. The factors that were considered in the present work were: - type of flux powder; - intensity of secondary cooling; - type and taper of the mold tube; - intensity of the electromagnetic stirring in the mold; - water flux in the mold; - corner radius of the mold tube. By using a statistical tool named DOE (Design of Experiments), experiments were carried out to determine the effect of each one of the factors listed above on the formation of off-corner cracks. Based on the results of these experiments, it was possible to conclude that increasing the water flux in the mold, using a flux powder with low viscosity and increasing the intensity of the electromagnetic stirring the formation of off-corner cracks was minimized

Influence of the chemical composition on steel casting performance

Improving the quality of steel and the steelmaking process has been a matter of routine for metallurgical engineers and steelmaking companies in a demanding market for quality products at highly competitive price. The chemical and temperature adjustment are made during the secondary refining process, as well as the inclusion modification required to product quality, and also the demand for castability accuracy. Continuous casting process is the most used solidification casting process, in which the flow of pouring liquid metal through the submerged entry nozzle is assured by the correct temperature and the formation of liquid inclusion in the casting temperature. Thermocalc and CEQCSI were the software used in this work to assess the effect of carbon, silicon and sulphur in the castability window of the aluminium vs calcium phase diagrams. They have proved to be highly suitable and effective and the results showed that the chemical elements used directly affected the position of the castability window of carbon steel. An analysis of a 0.2%C billet sample using Scanning Electron Microscopy showed that there is a great heterogeneity of inclusions in aluminium-killed and calcium-treated steel

<i>Sporothrix brasiliensis</i> Infection Modulates Antimicrobial Peptides and Stress Management Gene Expression in the Invertebrate Biomodel <i>Galleria mellonella</i>

Sporothrix brasiliensis is the most pathogenic species, responsible for the Brazilian cat-transmitted sporotrichosis hyperendemic. In this scenario, an investigation of the pathogen–host interaction can provide relevant information for future treatment strategies. To this end, the invertebrate Galleria mellonella has proven to be a suitable alternative for evaluating the virulence of pathogenic fungi, since the insect immune system is similar to the mammalian innate immune response. The aim of this work was to investigate phenotypic and molecular aspects of the immune response of G. mellonella throughout the S. brasiliensis infection. Hemocyte density and the evolution of the fungal load were evaluated. In parallel, RT-qPCR expression analysis of genes encoding antimicrobial peptides (Gallerimycin and Galiomycin) and stress management genes (C7 Contig 15362 and C8 Contig 19101) was conducted. The fungal load and hemocyte densities increased simultaneously and proportionally to the deleterious morphological events and larvae mortality. Gallerimycin, C7 Contig 15362 and C8 Contig 19101 genes were positively regulated (p S. brasiliensis infection, characterizing a time-dependent and alternately modulated profile. Galiomycin gene expression remained unchanged. Our results contribute to the future proposal of potential alternative pathways for treating and consequently controlling S. brasiliensis zoonosis, a major public health issue in Latin America

Effect of Lung Recruitment and Titrated Positive End-Expiratory Pressure (PEEP) vs Low PEEP on Mortality in Patients With Acute Respiratory Distress Syndrome : a Randomized Clinical Trial

IMPORTANCE The effects of recruitment maneuvers and positive end-expiratory pressure (PEEP) titration on clinical outcomes in patients with acute respiratory distress syndrome (ARDS) remain uncertain. OBJECTIVE To determine if lung recruitment associated with PEEP titration according to the best respiratory-system compliance decreases 28-day mortality of patients with moderate to severe ARDS compared with a conventional low-PEEP strategy. DESIGN, SETTING, AND PARTICIPANTS Multicenter, randomized trial conducted at 120 intensive care units (ICUs) from 9 countries from November 17, 2011, through April 25, 2017, enrolling adults with moderate to severe ARDS. INTERVENTIONS An experimental strategy with a lung recruitment maneuver and PEEP titration according to the best respiratory-system compliance (n = 501experimental group) or a control strategy of low PEEP (n = 509). All patients received volume-assist control mode until weaning. MAIN OUTCOMES AND MEASURES The primary outcomewas all-cause mortality until 28 days. Secondary outcomes were length of ICU and hospital stayventilator-free days through day 28pneumothorax requiring drainage within 7 daysbarotrauma within 7 daysand ICU, in-hospital, and 6-month mortality. RESULTS A total of 1010 patients (37.5% femalemean [SD] age, 50.9 [17.4] years) were enrolled and followed up. At 28 days, 277 of 501 patients (55.3%) in the experimental group and 251 of 509 patients (49.3%) in the control group had died (hazard ratio [HR], 1.2095% CI, 1.01 to 1.42P =.041). Compared with the control group, the experimental group strategy increased 6-month mortality (65.3% vs 59.9%HR, 1.1895% CI, 1.01 to 1.38P =.04), decreased the number of mean ventilator-free days (5.3 vs 6.4difference, -1.195% CI, -2.1 to -0.1P =.03), increased the risk of pneumothorax requiring drainage (3.2% vs 1.2%difference, 2.0%95% CI, 0.0% to 4.0%P =.03), and the risk of barotrauma (5.6% vs 1.6%difference, 4.0%95% CI, 1.5% to 6.5%P =.001). There were no significant differences in the length of ICU stay, length of hospital stay, ICU mortality, and in-hospital mortality. CONCLUSIONS AND RELEVANCE In patients with moderate to severe ARDS, a strategy with lung recruitment and titrated PEEP compared with low PEEP increased 28-day all-cause mortality. These findings do not support the routine use of lung recruitment maneuver and PEEP titration in these patients. (C) 2017 American Medical Association. All rights reserved.Brazilian Ministry of HealthBrazilian Ministry of HealthHCor Res Inst, Sao Paulo, BrazilUniv Sao Paulo, Cardiopulmonary Dept, Div Pulm, Heart Inst Incor, Sao Paulo, BrazilHosp Moinhos de Vento, Porto Alegre, RS, BrazilIrmandade Santa Casa Misericordia Porto Alegre, Porto Alegre, RS, BrazilFed Univ Sao Paulo UNIFESP, Anesthesiol Pain & Intens Care Dept, Sao Paulo, BrazilUniv Sao Paulo, Dept Epidemiol, Sch Publ Hlth, Sao Paulo, BrazilHosp Maternidade Sao Vicente Paulo, Barbalha, BrazilHosp Nereu Ramos, Florianopolis, SC, BrazilHosp Unimed Vitoria, Vitoria, BrazilHosp & Prontosocorro 28 Agosto, Manaus, Amazonas, BrazilUniv Sao Paulo, Unidade Emergencia Hosp Clin FMRP, Ribeirao Preto, BrazilHosp Estadual Dr Jayme Santos Neves, Serra, BrazilFundacao Univ Fed Grande Dourados, Univ Hosp, Dourados, BrazilUniv ICESI, Fdn Valle Lili, Dept Intens Care Med, Cali, ColombiaHosp Univ Oeste Parana, Cascavel, BrazilHosp Pablo Tobon Uribe, Medellin, ColombiaHosp Clin Porto Alegre, Porto Alegre, RS, BrazilHosp Reg Hans Dieter Schmidt, Joinville, BrazilUniv Malaya, Med Ctr, Kuala Lumpur, MalaysiaJagiellonian Univ, Med Coll, Dept Intens Care & Perioperat Med, Krakow, PolandHosp Nacl Alejandro Posadas, Moron, ArgentinaFed Univ Sao Paulo UNIFESP, Anesthesiol Pain & Intens Care Dept, Sao Paulo, BrazilWeb of Scienc

LANDSLIDE HAZARD MAPPING NEAR THE ADMIRAL ÁLVARO ALBERTO NUCLEAR COMPLEX, RIO DE JANEIRO, BRAZIL.

Technological accidents can be vast in scope and require a rapid response to evacuate the affected region. Access routes to nuclear power stations are essential for the preparation of emergency plans in the event of technological disasters. The Admiral Álvaro Alberto Nuclear Power Plant (Central Nuclear Almirante Álvaro Alberto - CNAAA) in Angra dos Reis, Brazil, is located in a region with high rainfall and rugged terrain. This article presents digital image processing and geoprocessing procedures for mapping landslide-susceptible areas and landslide scars associated with the CNAAA access routes. Digital Elevation Models and their derivations were used to identify landslide-susceptible areas, and LANDSAT images were used to map the land cover. The information was superimposed, and the hazard areas and potential landslide scars were mapped. Most of the study area is medium or high risk for landslide events. Landslides scars mapping achieved over 50% of accuracy representing a potential methodology for the risk assessment and landslides monitoring in the study area. The results demonstrate that further and detailed studies must be performed in the areas in order to maintain the access roads available for eventual evacuations in a technological disaster event

Allergy Modulation by N-3 Long Chain Polyunsaturated Fatty Acids and Fat Soluble Nutrients of the Mediterranean Diet

The Mediterranean diet, containing valuable nutrients such as n-3 long chain poly-unsaturated fatty acids (LCPUFAs) and other fat-soluble micronutrients, is known for its health promoting and anti-inflammatory effects. Its valuable elements might help in the battle against the rising prevalence of non-communicable diseases (NCD), including the development of allergic diseases and other (chronic) inflammatory diseases. The fat fraction of the Mediterranean diet contains bioactive fatty acids but can also serve as a matrix to dissolve and increase the uptake of fat-soluble vitamins and phytochemicals, such as luteolin, quercetin, resveratrol and lycopene with known immunomodulatory and anti-inflammatory capacities. Especially n-3 LCPUFAs such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) derived from marine oils can target specific receptors or signaling cascades, act as eicosanoid precursors and/or alter membrane fluidity and lipid raft formation, hereby exhibiting anti-inflammatory properties. Beyond n-3 LCPUFAs, fat-soluble vitamins A, D, E, and K1/2 have the potential to affect pro-inflammatory signaling cascades by interacting with receptors or activating/inhibiting signaling proteins or phosphorylation in immune cells (DCs, T-cells, mast cells) involved in allergic sensitization or the elicitation/effector phase of allergic reactions. Moreover, fat-soluble plant-derived phytochemicals can manipulate signaling cascades, mostly by interacting with other receptors or signaling proteins compared to those modified by fat-soluble vitamins, suggesting potential additive or synergistic actions by applying a combination of these nutrients which are all part of the regular Mediterranean diet. Research concerning the effects of phytochemicals such as polyphenols has been hampered due to their poor bio-availability. However, their solubility and uptake are improved by applying them within the dietary fat matrix. Alternatively, they can be prepared for targeted delivery by means of pharmaceutical approaches such as encapsulation within liposomes or even unique nanoparticles. This review illuminates the molecular mechanisms of action and possible immunomodulatory effects of n-3 LCPUFAs and fat-soluble micronutrients from the Mediterranean diet in allergic disease development and allergic inflammation. This will enable us to further appreciate how to make use of the beneficial effects of n-3 LCPUFAs, fat-soluble vitamins and a selection of phytochemicals as active biological components in allergy prevention and/or symptom reduction

Mídia e política no Brasil: textos e agenda de pesquisa Midia and politics in Brazil: texts and research agenda

Um especialista em estudos de comunicação e um cientista político apresentam conjuntamente um panorama da pesquisa sobre as relações entre os meios de comunicação e os processos políticos no Brasil. Uma agenda de pesquisa é proposta e um elenco de textos nessa área é apresentado.<br>A specialist in communication studies and a political scientist present together a panorama of research on the relations between communication midia and political processes in Brazil A research agenda is proposed and a list of texts in this area is presented