Double shunt technique for hybrid palliation of hypoplastic left heart syndrome: a case report

We report a technique to palliate hypoplastic left heart syndrome, with no PDA stenting, but with double polytetrafluoroethylene shunt from pulmonary artery to ascending and descending aorta by combined thoracotomies. A 30-day-old female was operated with this technique. Five months after first operation, the child was submitted to Norwood/Glenn operation. Good hemodinamic recovery and initial clinical evolution was observed. The child was extubated in 8th post operatory day and reentubated in the next day due to pulmonary infection. Despite antibiotic treatment, the child died after systemic infectious complications

Socioeconomic, Clinical, and Molecular Features of Breast Cancer Influence Overall Survival of Latin American Women

Molecular profile of breast cancer in Latin-American women was studied in five countries: Argentina, Brazil, Chile, Mexico, and Uruguay. Data about socioeconomic characteristics, risk factors, prognostic factors, and molecular subtypes were described, and the 60- month overall cumulative survival probabilities (OS) were estimated. From 2011 to 2013, 1,300 eligible Latin-American women 18 years or older, with a diagnosis of breast cancer in clinical stage II or III, and performance status ≦̸ 1 were invited to participate in a prospective cohort study. Face-to-face interviews were conducted, and clinical and outcome data, including death, were extracted from medical records. Unadjusted associations were evaluated by Chi-squared and Fisher’s exact tests and the OS by Kaplan–Meier method. Log-rank test was used to determine differences between cumulative probability curves. Multivariable adjustment was carried out by entering potential confounders in the Cox regression model. The OS at 60 months was 83.9%. Multivariable-adjusted death hazard differences were found for women living in Argentina (2.27), Chile (1.95), and Uruguay (2.42) compared with Mexican women, for older (≥60 years) (1.84) compared with younger (≤40 years) women, for basal-like subtype (5.8), luminal B (2.43), and HER2-enriched (2.52) compared with luminal A subtype, and for tumor clinical stages IIB (1.91), IIIA (3.54), and IIIB (3.94) compared with stage IIA women. OS was associated with country of residence, PAM50 intrinsic subtype, age, and tumor stage at diagnosis. While the latter is known to be influenced by access to care, including cancer screening, timely diagnosis and treatment, including access to more effective treatment protocols, it may also influence epigenetic changes that, potentially, impact molecular subtypes. Data derived from heretofore understudied populations with unique geographic ancestry and sociocultural experiences are critical to furthering our understanding of this complexity.Fil: de Almeida, Liz María. Instituto Nacional de Câncer; BrasilFil: Cortés, Sandra. Pontificia Universidad Católica de Chile; ChileFil: Vilensky, Marta. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Oncología "Ángel H. Roffo"; ArgentinaFil: Valenzuela, Olivia. Universidad de Sonora; MéxicoFil: Cortes Sanabria, Laura. Hospital de Especialidades Centro Medico Nacional Siglo XXI; MéxicoFil: de Souza, Mirian. Instituto Nacional de Câncer; BrasilFil: Barbeito, Rafael Alonso. Universidad de la República; UruguayFil: Abdelhay, Eliana. Instituto Nacional de Câncer; BrasilFil: Artagaveytia, Nora. Universidad de la Republica; UruguayFil: Daneri Navarro, Adrian. Universidad de Guadalajara; MéxicoFil: Llera, Andrea Sabina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Instituto de Investigaciones Bioquímicas de Buenos Aires. Fundación Instituto Leloir. Instituto de Investigaciones Bioquímicas de Buenos Aires; ArgentinaFil: Müller, Bettina. Instituto Nacional del Cáncer; ChileFil: Podhajcer, Osvaldo Luis. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Instituto de Investigaciones Bioquímicas de Buenos Aires. Fundación Instituto Leloir. Instituto de Investigaciones Bioquímicas de Buenos Aires; ArgentinaFil: Velazquez, Carlos. Universidad de Sonora; MéxicoFil: Alcoba, Elsa. Hospital Maria Curie; ArgentinaFil: Alonso, Isabel. Centro Hospitalario Pereira Rossell; UruguayFil: Bravo, Alicia I.. Hospital Higa Eva Perón; ArgentinaFil: Camejo, Natalia. Universidad de la República; UruguayFil: Carraro, Dirce Maria. A. C. Camargo Cancer Center; BrasilFil: Castro, Mónica. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Oncología "Ángel H. Roffo"; ArgentinaFil: Cataldi, Sandra. Instituto Nacional del Cáncer; UruguayFil: Cayota, Alfonso. Instituto Pasteur de Montevideo; UruguayFil: Cerda, Mauricio. Universidad de Chile; ChileFil: Colombo, Alicia. Universidad de Chile; ChileFil: Crocamo, Susanne. Instituto Nacional de Câncer; BrasilFil: Silva-Garcia, Aida A.. Universidad de Guadalajara; MéxicoFil: Viña, Stella. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Oncología "Ángel H. Roffo"; ArgentinaFil: Zagame, Livia. Instituto Jalisciense de Cancerología; MéxicoFil: Jones, Beth. University of Yale; Estados UnidosFil: Szklo, Moysés. University Johns Hopkins; Estados Unido

Granuloma faciale and eosinophilic angiocentric fibrosis: similar entities in different anatomic sites

Eosinophilic angiocentric fibrosis (EAF) and granuloma faciale (GF) share several histopathologic features, including eosinophil-rich inflammation, microangiitis, and progressive fibrosis. Concurrent presentation of EAF and GF suggests a pathogenetic link between them. To identify histologic findings that tell them apart and construe the pathogenetic mechanisms behind each morphologic variable, 14 immunohistochemical markers were used to study the cells subpopulations in 14 cases of GF and 3 cases of EAF. The lesions were classified according to their stage of development. The antibodies studied were: CD4, Foxp3, CD8, granzymes A and B, perforin, granulysin, CD20, CD56, CD68, ICAM-1, CD34, CD105, and 1A4. The intensity of the sclerotic response and the density of 1A4-immunostained cells were significantly higher in EAF. In both diseases, CD68 cells were the most numerous, followed by CD20, CD8, and CD4 cells. About 30% of cells expressed ICAM-1. Among cells with cytotoxic granules, granulysin-positive cells were the most frequent. Differences between GF and EAF were found to be mostly like due to anatomic site (usually skin of the face vs. sinonasal cavity) and stage of the disease development (usually earlier in cutaneous lesions because of their visibility). Innate and adaptive immunity, including B cells, T cells, and cytotoxic granules have a role in their pathogenesis.Eosinophilic angiocentric fibrosis (EAF) and granuloma faciale (GF) share several histopathologic features, including eosinophil-rich inflammation, microangiitis, and progressive fibrosis. Concurrent presentation of EAF and GF suggests a pathogenetic link253213220FAPESP - FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULOSEM INFORMAÇÃ

As ferramentas de trabalho com famílias utilizadas pelas equipes de saúde da família de Curitiba, PR The toolkit used by family health teams for working with families in Curitiba, PR

Este estudo de revisão de literatura teve por objetivo apresentar as ferramentas de trabalho utilizadas com famílias pelas equipes de saúde da família da cidade de Curitiba, Paraná, Brasil. Inicialmente, conceitua-se o trabalho com famílias, cujo propósito central está fundamentado na compreensão de sujeitos integrados ao seu contexto e dinâmica familiar, sendo possível observar o convívio e a interação entre os membros da família. Dessa forma, para além do cuidado coletivo, mesmo a atenção clínica individual pode ser estruturada em bases mais amplas, com maior resolutividade nas intervenções sobre o processo saúde-doença-cuidado. Na sequência, foram caracterizados os objetivos e as finalidades de uso das ferramentas por equipes multiprofissionais do município, tais como o Genograma ou heredograma familiar, o Ciclo de vida das famílias, o modelo F.I.R.O. e o modelo P.R.A.C.T.I.C.E. Concluiu-se que, em Curitiba, o uso das ferramentas é essencial como dispositivo no âmbito das tecnologias leves para o trabalho de cuidado em saúde das equipes de saúde. Favorece a aproximação dos trabalhadores da saúde aos problemas das pessoas na comunidade, possibilitando a coleta de evidências narrativas e a elaboração de estratégias robustas de manejo de ações e serviços em saúde.<br>This literature review study aimed to present the toolkit for working with families used by family health teams in the city of Curitiba, state of Paraná, Brazil. Initially, the work with families is conceptualized. Its central purpose is based on the understanding of subjects integrated into their context and family dynamics, being possible to observe their daily relationship and interactions. In this way, beyond the collective care, even the individual clinical attention can be structured on wider bases, with more efficient interventions on the health-disease-care process. Then, the objectives and purposes of the use of the tools (for example, Genogram, the Life Cycle of the Families, the F.I.R.O. model and the P.R.A.C.T.I.C.E. model) by multiprofessional teams of the city were characterized. It was concluded that in Curitiba, the use of the toolkit is essential as a light health technology device, as it favors the workers' approach to the people's problems in the community, enabling the collection of narrative evidences and promoting the design of robust strategies for handling health actions and services

Avaliação genética de indivíduos e progênies de cupuaçuzeiro no estado do Pará e estimativas de parâmetros genéticos Genetic evaluation of individuals and progenies of Theobroma grandiflorum in the state of Pará and estimates of genetic parameters

O presente trabalho relata a avaliação genotípica de progênies de cupuaçuzeiro, no Estado do Pará, para os caracteres número de frutos (NF) em quatro safras, intensidade de ocorrência de vassoura- de-bruxa na inflorescência (VBI) e nos frutos (VBF), e peso de vassoura-de-bruxa (PVB). Apresenta também estimativas de parâmetros genéticos que permitem inferir sobre o controle genético e nível de variabilidade genética presente no material avaliado. Todos os caracteres apresentaram considerável variabilidade genética, com coeficientes de variação genética variando de 27% a 88% no âmbito de progênie e de 38% a 123% no âmbito individual. Isto revela excelentes possibilidades para a seleção nessa população experimental híbrida. As estimativas de herdabilidade individual no sentido restrito, em uma safra, variaram de 25% a 54%, e as repetibilidades individuais para NF equivaleram a 35%. Com as quatro safras realizadas, a herdabilidade em nível individual aumentou para 48%, propiciando acurácia seletiva de 70%, para a seleção de indivíduos. O ganho em eficiência, quando se usa mais de cinco safras, é praticamente desprezível. Para NF, ganhos acima de 60% podem ser obtidos com a seleção dos cinco melhores indivíduos. Poderão ser selecionados indivíduos com produção anual de 17 frutos, valor muito superior à média geral de 10 frutos, encontrada nos plantios comerciais. Verificam-se ganhos genéticos bastante superiores quando se faz a propagação clonal dos melhores indivíduos em relação ao que se verifica quando se realiza a propagação sexuada. Para o melhor indivíduo, o ganho genético aumenta de 75.5% para 88.3%, ou seja, de 17 para quase 19 frutos por planta. Isto revela um grande potencial para a clonagem comercial de cupuaçuzeiro. Para os caracteres VBI e VBF, verificaram-se altas herdabilidades individuais no sentido restrito com valores variando entre 30% e 54%. Isto revela o excelente potencial da seleção recorrente para melhorar, gradativamente, o nível de resistência. Parece suficiente considerar na seleção apenas o número de vassouras, não sendo necessário considerar o peso. A correlação entre resistência no fruto e na inflorescência foi alta (0.84), indicando algum controle genético comum aos dois caracteres. Foram identificadas progênies superiores, simultaneamente, para produção de frutos e resistência à vassoura.<br>This paper deals with the genotypic evaluation of Theobroma grandiflorum progenies in the Pará State for the characters number of fruits (NF) in four harvests, intensity of occurrence of witch's broom disease in the inflorescences (WBI) and in the fruits (WBF) and weight of branches with witch's broom (WWB). Also, it presents estimates of genetic parameters that allow to infer on the genetic control and level of genetic variability in the appraised germplasm. All the characters presented considerable genetic variability, with coefficients of genetic variation varying from 27% to 88% at progenies level and from 38% to 123% at individual level. This reveals excellent possibilities for the selection in that hybrid experimental population. The estimates of individual narrow sense heritabilities, in a harvest, varied from 25% to 54% and the individual repeatabilities for NF was equal at 35%. With the four accomplished harvests the individual heritability increased to 48%, providing selective accuracy of 70%, for the individuals' selection. The gain in efficiency, when using more than five crops is practically worthless. For NF, genetic gains above 60% can be obtained with the selection of the best five individuals. Individuals with annual production of 17 fruits can be selected, value which is much more superior to the general average of 10 fruits, found in the commercial plantations. Superior genetic gains can be obtained with clone propagation of the best individuals in relation to the sexual propagation and for the best individual the genetic gain increases from 75.5% to 88.3%, that is to say, from 17 to almost 19 fruits per plant. This reveals a great potential for the commercial cloning of Theobroma grandiflorum. For the characters VBI and VBF high individual narrow sense heritabilities were verified with values ranging from 30% to 54%. This reveals the excellent potential of the recurrent selection to improve the resistance level. It seems enough to consider in the selection just the number of brooms, without being necessary to consider the weight. The correlation between resistance in the fruit and in the inflorescence was high (0.84) indicating some genetic control common to the two characters. Superior progenies were identified for production of fruits and resistance to the broom simultaneously

Seleção de descritores botânico-agronômicos para caracterização de germoplasma de cupuaçuzeiro Selection of morpho-agronomic descriptors for cupuaçuzeiro germplasm characterization

O objetivo deste trabalho foi selecionar descritores botânicoagronômicos quantitativos para caracterizar acessos de cupuaçuzeiro [Theobroma grandiflorum (Willd. ex Spreng.) Schum]. Foram avaliados 53 descritores associados a características de folha (14), de flor (18), de fruto (16), e descritores agronômicos (5). No descarte dos descritores, foi empregada a técnica multivariada de componentes principais, em duas etapas. Na primeira, a seleção aconteceu dentro de cada grupo. Em seguida, foi realizada análise conjunta para a seleção final. Três critérios foram adotados para descarte das variáveis. Foram descartados 34 descritores, representando redução de 64% dos inicialmente considerados. A lista mínima de descritores para o cupuaçuzeiro ficou assim composta: comprimento do pecíolo foliar, espessura do limbo foliar, largura do acume foliar, angulação das nervuras de base, comprimento do botão estriado, comprimento do pedúnculo floral, diâmetro do pedúnculo floral, diâmetro do ovário, número de óvulos, comprimento da lâmina da pétala, comprimento dos estaminóides, diâmetro transversal da semente, semente chocha, acidez, brix, pH, número de botões caídos ao solo, número de frutos imaturos caídos precocemente e número de vassouras-de-bruxa produzidas.<br>The objective of this work was to select morphological and agronomic quantitative descriptors to characterize accessions of cupuaçuzeiro [Theobroma grandiflorum (Willd. ex Spreng.) Schum]. Fifty three descriptors were evaluated, including 14 from leaves, 18 from flowers, 16 from fruits, and 5 agronomic traits. To discard redundant or non-discriminating descriptors, a two step multivariate analysis of principal components was applied. The first phase included the selection of descriptors within each group of characteristics individually (leaf; flower; fruit; agronomic). Based on the descriptors selected in this first phase, a joined analysis of principal components for the final selection was done. Three criteria for variable exclusion were adopted. Thirty four descriptors were excluded, representing a reduction of 64%. A minimal list of descriptors for cupuaçuzeiro was proposed, including leaf length, leaf thickness, leaf apex width, leaf base vein angle, flower bud length, flower peduncle length, flower peduncle diameter, ovary girth, number of ovules, flower petal lamina length, staminode length, seed width, flat seeds, acidity, brix, pH, number of fallen flowers buds, number of abscised immature pods and number of witches-brooms

Evolução da vassoura-de-bruxa e avaliação da resistência em progênies de cupuaçuzeiro Evolution of the witch's broom disease and evaluation of resistance in cupuassu progenies

Com o objetivo de conhecer a evolução da doença vassoura-de-bruxa, a taxa de segregação e estimar parâmetros genéticos, foi conduzido um experimento com 21 progênies de irmãos completos de cupuaçuzeiro, instalado em Belém, Pará. As progênies foram obtidas pelo cruzamento controlado de clones resistentes com clones resistentes, clones resistentes com clones suscetíveis e, clones suscetíveis com clones suscetíveis. Foram avaliadas também três progênies de meios-irmãos como testemunhas. Os experimentos foram avaliados ao nível de indivíduos, e as análises foram conduzidas via metodologia de modelos lineares mistos (procedimento REMl/BlUP), como delineamento em blocos incompletos desbalanceados, com tratamentos comuns entre dois experimentos. As variáveis avaliadas foram: percentagem de plantas resistentes ao ataque da doença no ramo, inflorescência, fruto imaturo e maduro, no período de 2002 a 2007. Os resultados mostraram que a emissão de vassoura vegetativa é especialmente importante entre julho e setembro. A evolução da doença evidencia que as podas fitossanitárias devem ser realizadas no final da safra, nos meses de maio/junho, e repassadas em setembro/outubro. A população estudada oferece excelente possibilidade de seleção e ganho genético, respaldada pelos elevados índices de variabilidade genética e herdabilidade dos caracteres de resistência. As progênies segregaram tanto para os sintomas de vassoura nos ramos, nas inflorescências, como nos frutos imaturos e maduros. Para o controle integrado desta doença, os resultados mostram a importância da associação de materiais genéticos resistentes ou moderadamente resistentes à vassoura-de-bruxa com as podas fitossanitárias.<br>This paper aimed to study the evolution and individual segregation of the witch's broom disease and estimate the genetic parameters in trials with 21 full sib families of Cupuaçú established in Belém, Pará. The progenies were obtained through control pollination involving resistant and susceptible parents in all three combinations. Three half-sib families were also evaluated as checks. The experiments were evaluated at individual level and all the analyses were based on the mixed model methodology (REMl/ BlUP procedure) with unbalanced incomplete blocks design and common checks across trials. The evaluated traits comprised the percentage of resistant plants concerning the disease on the branches, on the flowers and on the mature and immature fruits from 2002 to 2007. The results showed that the disease is especially important between July and September. The disease evolution showed that pruning against the disease must be conducted at the end of the productive season in May/June and also in September/October. The breeding population can be successfully improved due to the high levels of genetic variability and heritability associated to the resistance traits. There were genetic segregations for all the traits. The integrated control of the disease, associating resistant genotypes and pruning is recommended