Besitzt die Bestimmung tumorvolumen-assoziierter Parameter oder die Anzahl der Tumorherde eine prognostische Aussagekraft nach radikaler Prostatektomie?

Über den prognostischen Nutzen der Bestimmung tumorvolumen-assoziierter Parameter und der Anzahl der Tumorherde nach radikaler Prostatektomie wird kontrovers diskutiert. Die Bestimmung der tumorvolumen-assoziierten Parameter und der Anzahl der Tumorherde von 758 Prostatektomiepräparaten erfolgte mit Hilfe eines visuellen Schätzverfahrens. In der univariaten Analyse korrelierten alle tumorvolumen-assoziierten Parameter und die Anzahl der Tumorherde mit dem Auftreten eines Prostatakarzinomrezidivs. In der multivariaten Analyse erbrachte lediglich die Bestimmung des Tumorprozentanteils einen unabhängigen prognostischen Nutzen. Die Bestimmung der tumorvolumen-assoziierten Parameter und der Anzahl der Tumorherde besitzt eine prognostische Aussagekraft für das Auftreten eines Rezidivs nach radikaler Prostatektomie

CMDX©-based single source information system for simplified quality management and clinical research in prostate cancer

Background: Histopathological evaluation of prostatectomy specimens is crucial to decision-making and prediction of patient outcomes in prostate cancer (PCa). Topographical information regarding PCa extension and positive surgical margins (PSM) is essential for clinical routines, quality assessment, and research. However, local hospital information systems (HIS) often do not support the documentation of such information. Therefore, we investigated the feasibility of integrating a cMDX-based pathology report including topographical information into the clinical routine with the aims of obtaining data, performing analysis and generating heat maps in a timely manner, while avoiding data redundancy. Methods: We analyzed the workflow of the histopathological evaluation documentation process. We then developed a concept for a pathology report based on a cMDX data model facilitating the topographical documentation of PCa and PSM; the cMDX SSIS is implemented within the HIS of University Hospital Muenster. We then generated a heat map of PCa extension and PSM using the data. Data quality was assessed by measuring the data completeness of reports for all cases, as well as the source-to-database error. We also conducted a prospective study to compare our proposed method with recent retrospective and paper-based studies according to the time required for data analysis. Results: We identified 30 input fields that were applied to the cMDX-based data model and the electronic report was integrated into the clinical workflow. Between 2010 and 2011, a total of 259 reports were generated with 100% data completeness and a source-to-database error of 10.3 per 10,000 fields. These reports were directly reused for data analysis, and a heat map based on the data was generated. PCa was mostly localized in the peripheral zone of the prostate. The mean relative tumor volume was 16.6%. The most PSM were localized in the apical region of the prostate. In the retrospective study, 1623 paper-based reports were transferred to cMDX reports; this process took 15 ± 2 minutes per report. In a paper-based study, the analysis data preparation required 45 ± 5 minutes per report. Conclusions: cMDX SSIS can be integrated into the local HIS and provides clinical routine data and timely heat maps for quality assessment and research purposes.

Clinical map document based on XML (cMDX): document architecture with mapping feature for reporting and analysing prostate cancer in radical prostatectomy specimens

<p>Abstract</p> <p>Background</p> <p>The pathology report of radical prostatectomy specimens plays an important role in clinical decisions and the prognostic evaluation in Prostate Cancer (PCa). The anatomical schema is a helpful tool to document PCa extension for clinical and research purposes. To achieve electronic documentation and analysis, an appropriate documentation model for anatomical schemas is needed. For this purpose we developed cMDX.</p> <p>Methods</p> <p>The document architecture of cMDX was designed according to Open Packaging Conventions by separating the whole data into template data and patient data. Analogue custom XML elements were considered to harmonize the graphical representation (e.g. tumour extension) with the textual data (e.g. histological patterns). The graphical documentation was based on the four-layer visualization model that forms the interaction between different custom XML elements. Sensible personal data were encrypted with a 256-bit cryptographic algorithm to avoid misuse. In order to assess the clinical value, we retrospectively analysed the tumour extension in 255 patients after radical prostatectomy.</p> <p>Results</p> <p>The pathology report with cMDX can represent pathological findings of the prostate in schematic styles. Such reports can be integrated into the hospital information system. "cMDX" documents can be converted into different data formats like text, graphics and PDF. Supplementary tools like cMDX Editor and an analyser tool were implemented. The graphical analysis of 255 prostatectomy specimens showed that PCa were mostly localized in the peripheral zone (Mean: 73% ± 25). 54% of PCa showed a multifocal growth pattern.</p> <p>Conclusions</p> <p>cMDX can be used for routine histopathological reporting of radical prostatectomy specimens and provide data for scientific analysis.</p

Resistindo ao desenvolvimento neocolonial: a luta do povo de Andalgalá contra projetos megamineiros

A América Latina vem experimentando uma nova era de declarada fé dos governos no mito do desenvolvimento, em articulação com a expansão de políticas extrativistas exportadoras em um contexto de renovada dependência. A face mais dramática do extrativismo na região tem sido a crescente presença de corporações mineiras transnacionais apoiadas por governos nacionais e regionais e por instituições internacionais financeiras e de apoio ao desenvolvimento, e intensamente resistidas por movimentos sociais populares. Neste artigo apresentamos o caso de Andalgalá (uma pequena cidade na Província de Catamarca, na Argentina) e as lutas do povo contra corporações mineiras transnacionais e seus aliados. Na tradição da Filosofia da Libertação e do método ana-dialético de Dussel, nos engajamos com o que tem sido denominado "comunidades argentinas do NÃO", expressando sua oposição a formas neocoloniais de desenvolvimento e gestão. Neste artigo estamos especificamente interessados em compreender como dois dispositivos gerencialistas usados pelas corporações mineiras, responsabilidade social corporativa (RSC) e pactos de governança, impactam a luta do povo. Acima de tudo, este artigo oferece instantâneos de batalhas na linha de frente do extrativismo. Esperamos ter dado voz àquelas pessoas que normalmente não são ouvidas, criando um espaço para suas visões sobre um tipo diferente de desenvolvimento.</jats:p

El laberinto de la autonomía indígena en el Ecuador: las circunscripciones territoriales indígenas en la Amazonía Central, 2010-2012

¿Cuáles son los avatares y desencuentros presentes en el proceso de constitución de las Circunscripciones Territoriales Indígenas (CTIs) en relación a la vigencia del derecho a la autodeterminación y autogestión territorial de las nacionalidades indígenas en el Ecuador? Para responder a dicha interrogante, el artículo considera el reconocimiento al derecho a la autonomía y autodeterminación de las nacionalidades y pueblos indígenas en Ecuador. Posteriormente, analiza el alcance de los procedimientos establecidos tanto en la Constitución Política como en el Código Orgánico de Ordenamiento Territorial y Descentralización (COOTAD), y su alcance potencial en generar un nuevo tipo de institucionalidad y una nueva organización territorial en el marco de la definición del Estado plurinacional Ecuatoriano. Esta contribución analiza además el proceso derivado de una hoja de ruta acordada entre el Estado y las nacionalidades amazónicas en el periodo comprendido entre 2010 y 2012, y analiza las diferentes acciones desplegadas desde entonces, enfatizando en los avances y contradicciones, tanto a lo interno del movimiento indígena como en su relación con otras instancias estatales centrales y locales. Se examinan los desencuentros y tensiones a lo interno del aparato Estatal y los sectores mestizos, que no se plantean ningún reparo al momento de obstaculizar los avances del proceso. El artículo analiza el desafío de crear las CTIs en el territorio de los Kichwa de las provincias de Napo y Orellana y en los territorios Kichwa y Achuar en la provincia de Pastaza, en la Amazonía central. Finalmente, el texto puntualiza críticamente algunas de las perspectivas y dilemas que dicho proceso plantea al futuro de la relación Estado-nacionalidades indígenas y al proceso de construcción del Estado plurinacional e intercultural en Ecuador