Current management of the axilla in patients with clinically node-negative breast cancer: a nationwide survey of United Kingdom breast surgeons

BACKGROUND: Precise knowledge of axillary lymph node status is essential in the treatment of operable carcinoma of the breast. For many years, axillary nodal clearance (ANC) has been an integral part of the conventional management of early-stage breast cancer. During the last few decades the trend of these surgical procedures has been one of decreasing invasiveness in order to try and achieve a much lower level of morbidity. To help reach this improved level of treatment the concept of the sentinel lymph node (SLN) was utilized. Recent studies have shown that SNB can provide an accurate assessment of the axillary nodal status in clinically node negative patients, negating the need to remove the majority of the axillary contents and thus reducing morbidity. A recent meta-analysis of all the literature to date appears to reveal that the dual technique (blue dye and technetium-labelled sulfur) is the gold-standard for successful identification of the SLN in the context of early-stage breast cancer. We aim to highlight the on-going wide range of differing methods employed, and compare this to the gold-standard recommended guidelines. METHODS: A questionnaire was devised to provide a snapshot overview of the current management of the axilla in patients with clinically node-negative T1 invasive breast cancer amongst UK beast surgeons in August 2006. RESULTS: Of the 271 UK surgeons, 74 (27.3%) performed ANC as the initial management of the axilla in patients with clinically node negative T1 invasive breast cancer, 56 (20.7%) used axillary node sampling (not directed by sentinel node mapping) and a total of 141 (52.0%) used the technique of SNB, of which 50 (18.5%) used blue dye alone and 91 (33.6%) used a combination of blue dye and radioisotope. CONCLUSION: Despite the obvious advantages, our survey has revealed that the procedure is only used by 52% of British breast surgeons in this subgroup of patients (clinically node negative, tumour equal of smaller than 2 cm) most of whom have no disease within the axilla. The reasons for this include limited hospital resources and lack of surgeons training and accreditation and ARSAC license (nuclear medicine license)

Prevalência e fatores de risco para obesidade em adolescentes René Vallejo Ortiz Polyclinic. Manzanillo. 2016-2017

Obesity in adolescents in Manzanillo constitutes an incipient and complex health problem without sufficient perception of it. With the aim of determining the clinical-epidemiological aspects associated with obesity in adolescents at clinic No. 602, at the René Vallejo Ortiz polyclinic in Manzanillo, in the period from January 2016 to January 2017, a cross-sectional study was conducted or prevalence of adolescents aged between 11 to 19 years. Data processing and analysis was carried out from the information provided in the database created with the Microsoft Office Excel program, which was carried out by means of the summary study of absolute and relative frequencies. In the analysis of association between qualitative variables, Pearson's non-parametric test of independence and the odds ratio test were used. The risk factors that condition obesity include having been a macro-fetus during pregnancy (OR = 5.95), a history of obesity in the family (OR = 3.66), and a history of lipid disorders in the parents (OR = 2, 83). In order to solve the problem of obesity in adolescents, new strategies are required to control the disease, improve the health status of this population and increase the health indicators of the area in question.La obesidad en adolescentes de Manzanillo constituye un problema de salud incipiente y complejo sin suficiente percepción del mismo. Con el objetivo de determinar los aspectos clínico - epidemiológicos asociados a la obesidad en los adolescentes del consultorio No. 602, del policlínico René Vallejo Ortiz, de Manzanillo, en el período comprendido desde enero de 2016 a enero de 2017, se realizó un estudio transversal o de prevalencia de adolescentes en edades comprendidas entre 11 a 19 años. El procesamiento y análisis de datos se realizó a partir de la información suministrada en la base de datos creada con el programa Microsoft Office Excel, lo cual se realizó mediante el estudio resumido de las frecuencias absolutas y relativas. En el análisis de asociación entre variables cualitativas se empleó la prueba no paramétrica de independencia Chi cuadrado de Pearson y la prueba de razón de posibilidades. Los factores de riesgos que condicionan la obesidad incluyen haber sido macrofeto durante el embarazo (OR = 5,95), antecedente de obesidad en la familia (OR = 3,66), y antecedente de trastornos lipídicos en los progenitores (OR = 2,83). Para resolver el problema de la obesidad en adolescentes se requiriere de nuevas estrategias destinadas al control de la enfermedad, el mejoramiento del estado de salud de esta población y el ascenso de los indicadores sanitarios del área en cuestión.A obesidade em adolescentes em Manzanillo constitui um problema de saúde incipiente e complexo sem uma percepção suficiente dele. Com o objetivo de determinar os aspectos clínico-epidemiológicos associados à obesidade em adolescentes da clínica nº 602, na policlínica René Vallejo Ortiz em Manzanillo, no período de janeiro de 2016 a janeiro de 2017, foi realizado um estudo transversal ou prevalência de adolescentes com idade entre 11 e 19 anos. O processamento e análise dos dados foram realizados a partir das informações fornecidas no banco de dados criado com o programa Microsoft Office Excel, realizado por meio do estudo sumário das frequências absolutas e relativas. Na análise da associação entre variáveis qualitativas, foram utilizados o teste não paramétrico de independência e o odds ratio. Os fatores de risco que condicionam a obesidade incluem ter sido um macro-feto durante a gravidez (OR = 5,95), histórico de obesidade na família (OR = 3,66) e histórico de distúrbios lipídicos nos pais (OR = 2, 83) Para solucionar o problema da obesidade em adolescentes, novas estratégias são necessárias para controlar a doença, melhorar o estado de saúde dessa população e aumentar os indicadores de saúde da área em questão

Validación del instrumento motivaciones para la elección de la Licenciatura en Enfermería (MELE 2021)

Introducción. La motivación constituye un aspecto de vital importancia en cada persona, es la encargada de hacer que la persona realice o no determinados actos, responsable de que cada ser humano se plantee objetivos determinados en la vida y sea capaz de llegar a cumplirlos. La validez es un criterio de evaluación utilizado para determinar cuán importantes son la evidencia empírica y los fundamentos teóricos que respaldan un instrumento, examen o acción realizada; ésta junto a la fiabilidad determina la calidad que posee un instrumento; no es un rasgo dicotómico, sino de grado, lo que permite afirmar que el instrumento presenta ciertos grados de validez para ciertos usos concretos y determinadas poblaciones. Objetivo. Validar la consistencia interna del instrumento Motivaciones para la Elección de la Licenciatura en Enfermería (MELE 2021). Materiales y métodos. Estudio cuantitativo, transversal y descriptivo; participaron estudiantes que ingresaron en la cohorte generacional del segundo, cuarto y octavo semestre de la Licenciatura en Enfermería pertenecientes a la Unidad Multidisciplinaria de Tizimín del periodo escolar de Enero–Julio 2021; se aplicó un cuestionario autoadministrado de tres secciones, previamente validado en contenido mediante un juicio de expertos. Resultados. respondieron 86 estudiantes de la Unidad Multidisciplinaria Tizimín, se eliminaron ocho por no completar el instrumento; se obtuvo un alfa de Cronbach en 0.85 que determina un buen nivel de consistencia interna. Conclusiones. El instrumento posee consistencia interna, de acuerdo con los resultados obtenidos, mide la variable motivación para la elección de Licenciatura en Enfermería, objetivo para el cual fue construido

Prescripción de fármacos cardiotóxicos en pacientes con enfermedades cardiovasculares

Introducción: El uso de fármacos con potencial cardiotóxico para tratar enfermedades no cardiovasculares coexistentes resulta un agravante evitable. Objetivo: Evaluar la prescripción de 5 fármacos cardiotóxicos en pacientes con enfermedades cardiovasculares. Métodos: Se realizó un estudio descriptivo transversal (enmarcado en los estudios de utilización de medicamentos) de marzo a diciembre de 2020 en el Policlínico Santa Cruz (Artemisa, Cuba), en una población de 234 sujetos con enfermedades cardiovasculares que habían sido tratados con domperidona, azitromicina, ciprofloxacina, ibuprofeno y diclofenaco. Las variables estudiadas fueron: Sexo, edad, consumo de fármacos cardiotóxicos, motivo de indicación, enfermedades cardiovasculares, forma farmacéutica, dosis diaria, intervalo de las dosis y duración del tratamiento. Se realizó un análisis estadístico descriptivo. Resultados: Los fármacos más prescritos fueron la azitromicina (n= 63), el ibuprofeno (n= 59) y la ciprofloxacina (n= 57). Sus principales motivos de indicación fueron, respectivamente, la neumonía adquirida en la comunidad (38,1 %), las infecciones de piel y tejidos blandos (28,8 %), y las infecciones del tracto urinario (43,8 %). La principal enfermedad cardiovascular fue la hipertensión arterial. Para los 5 fármacos seleccionados se reportó su esquema terapéutico (forma farmacéutica, dosis diaria, intervalo de dosis y duración del tratamiento). Conclusiones: Aunque en todos los casos el motivo de indicación es el adecuado, los fármacos pueden sustituirse por otros de menor riesgo cardiovascular. En su mayoría, los esquemas terapéuticos son correctos, salvo en los casos de la domperidona (duración prolongada) y el diclofenaco (altas dosis)

Is soluble protein mineralisation and protease activity in soil regulated by supply or demand?

Protein represents a major input of organic matter to soil and is an important source of carbon (C) and nitrogen (N) for microorganisms. Therefore, determining which soil properties influence protein mineralisation in soil is key to understanding and modelling soil C and N cycling. However, the effect of different soil properties on protein mineralisation, and especially the interactions between soil properties, are poorly understood. We investigated how topsoil and subsoil properties affect protein mineralisation along a grassland altitudinal (catena) sequence that contained a gradient in soil type and primary productivity. We devised a schematic diagram to test the key edaphic factors that may influence protein mineralisation in soil (e.g. pH, microbial biomass, inorganic and organic N availability, enzyme activity and sorption). We then measured the mineralisation rate of 14C-labelled soluble plant-derived protein and amino acids in soil over a two-month period. Correlation analysis was used to determine the associations between rates of protein mineralisation and soil properties. Contrary to expectation, we found that protein mineralisation rate was nearly as fast as for amino acid turnover. We ascribe this rapid protein turnover to the low levels of protein used here, its soluble nature, a high degree of functional redundancy in the microbial community and microbial enzyme adaptation to their ecological niche. Unlike other key soil N processes (e.g. nitrification, denitrification), protease activity was not regulated by a small range of factors, but rather appeared to be affected by a wide range of interacting factors whose importance was dependent on altitude and soil depth [e.g. above-ground net primary productivity (NPP), soil pH, nitrate, cation exchange capacity (CEC), C:N ratio]. Based on our results, we hypothesise that differences in soil N cycling and the generation of ammonium are more related to the rate of protein supply rather than limitations in protease activity and protein turnover per se

Comunicación 5 : cuaderno de autoaprendizaje

Cuaderno de autoaprendizaje del área de Comunicación para el ciclo V. Este texto está conformado por ocho unidades, en las cuales los estudiantes encontrarán diversas actividades que los ayudarán a aprender y desarrollar sus conocimientos en el área

Drought stress and tree size determine stem CO2 efflux in a tropical forest

CO2 efflux from stems (CO2_stem) accounts for a substantial fraction of tropical forest gross primary productivity, but the climate sensitivity of this flux remains poorly understood. We present a study of tropical forest CO2_stem from 215 trees across wet and dry seasons, at the world's longest running tropical forest drought experiment site. We show a 27% increase in wet season CO2_stem in the droughted forest relative to a control forest. This was driven by increasing CO2_stem in trees 10–40 cm diameter. Furthermore, we show that drought increases the proportion of maintenance to growth respiration in trees > 20 cm diameter, including large increases in maintenance respiration in the largest droughted trees, > 40 cm diameter. However, we found no clear taxonomic influence on CO2_stem and were unable to accurately predict how drought sensitivity altered ecosystem scale CO2_stem, due to substantial uncertainty introduced by contrasting methods previously employed to scale CO2_stem fluxes. Our findings indicate that under future scenarios of elevated drought, increases in CO2_stem may augment carbon losses, weakening or potentially reversing the tropical forest carbon sink. However, due to substantial uncertainties in scaling CO2_stem fluxes, stand‐scale future estimates of changes in stem CO2 emissions remain highly uncertain.This work is a product of a UK NERC independent fellowship grant NE/N014022/1 to L.R., a UK NERC grant NE/J011002/1 to P.M. and M.M., CNPQ grant 457914/2013-0/MCTI/CNPq/FNDCT/LBA/ESECAFLOR to A.C.L.d.C., an ARC grant FT110100457 to P.M. It was previously supported by NERC NER/A/S/2002/00487, NERC GR3/11706, EU FP5-Carbonsink and EU FP7-Amazalert to P.M

Comunicación 5to. grado : cuaderno de autoaprendizaje 

Este cuaderno de autoaprendizaje ha sido preparado para ti con mucho cariño y dedicación por un equipo de profesoras y profesores. Su objetivo es brindarte la oportunidad de aprender a comunicarte a través de diversas situaciones retadoras, relacionadas con actividades socioproductivas de los diversos departamentos de nuestro país. Este cuaderno de autoaprendizaje está formado por ocho unidades. En cada una de ellas se plantean dos actividades retadoras que te permitirán dialogar, leer, escribir y expresarte sobre diversos temas. Además, encontrarás cuentos, poemas, adivinanzas, rimas, trabalenguas, canciones, afiches y otras expresiones literarias

Drought stress and tree size determine stem CO2 efflux in tropical forests

This is the author accepted manuscript. The final version is available from Wiley for New Phytologist Trust via the DOI in this record.1. CO2 efflux from stems (CO2_stem) accounts for a substantial fraction of tropical forest gross primary productivity, but the climate sensitivity of this flux remains poorly understood. 2. We present a study of tropical forest CO2_stem from 215 trees across wet and dry seasons, at the world’s longest running tropical forest drought experiment site. 3. We show a 27% increase in wet season CO2_stem in the droughted forest relative to a control forest. This was driven by increasing CO2_stem in trees 10-40 cm diameter. Furthermore, we show that drought increases the proportion of maintenance to growth respiration in trees >20 cm diameter, including large increases in maintenance respiration in the largest droughted trees, >40 cm diameter. However, we found no clear taxonomic influence on CO2_stem and were unable to accurately predict how drought sensitivity altered ecosystem scale CO2_stem, due to substantial uncertainty introduced by contrasting methods previously employed to scale CO2_stem fluxes. 4. Our findings indicate that under future scenarios of elevated drought, increases in CO2_stem may augment carbon losses, weakening or potentially reversing the tropical forest carbon sink. However, due to substantial uncertainties in scaling CO2_stem fluxes, stand-scale future estimates of changes in stem CO2 emissions remain highly uncertain.This work is a product of a UK NERC independent fellowship grant NE/N014022/1 to LR, a UK NERC grant NE/J011002/1 to PM and MM, CNPQ grant 457914/2013-0/MCTI/CNPq/FNDCT/LBA/ESECAFLOR to ACLD, an ARC grant FT110100457 to PM. It was previously supported by NERC NER/A/S/2002/00487, NERC GR3/11706, EU FP5-Carbonsink and EU FP7-Amazalert to PM. LR would also like to acknowledge the support of Dr. Robert Clement, University of Edinburgh and Dr. Timothy Hill, University of Exeter, alongside the contribution of three anonymous reviewers