Intraoperative ultrasound in conservative surgery for non-palpable breast cancer after neoadjuvant chemotherapy

AbstractAimsA complete clinical response after neoadjuvant chemotherapy (NACT) in breast cancer patients hinders the localization of the residual lesion and the removal of a minimum amount of breast tissue. The aim of the present work is to report our single-centre experience with intraoperative ultrasound-guided (IOUS) excision performed by surgeons in these patients.Patients and methodsFrom January 2008 to December 2012, IOUS excisions were performed on 58 patients with a previous intralesional ultrasound-detectable metallic marker and non-palpable breast cancer after NACT. The specimen margins were estimated by ultrasonography and macroscopic pathologic examination. Successful lesion removal, specimen weight, and analysis of the results as regards margins were evaluated, and the need for breast-conserving re-excision and mastectomy was considered.ResultsAfter NACT the average ultrasound/mammography and MRI diameters were 11.7 mm (0–30) and 9.1 mm (0–40) respectively. In all cases, the residual lesion or tissue around the marker was removed. The average weight of the specimens was 26.4 g (6–84), being lower in cases of complete response according to ultrasound (p < 0.05). In 4 patients (6.8%), breast-conserving re-excision was carried out, and in 3 patients (5.2%) a secondary mastectomy was performed, two of which had invasive lobular carcinoma.ConclusionsThe emplacement of a readily echodetectable metal marker before NACT makes IOUS excision feasible in an increasing number of complete clinical responses, with the excision of small amounts of breast tissue and a high percentage of conservative breast surgery. This technique requires surgeons to be trained, but has the advantage of a reduced use of other hospital services, better planning of operating theatres, and less discomfort for patients, which means that it is attractive and indeed recommendable

Theoretical and experimental study of the vibrational spectra of 1.5-dimethylcytosine

The Raman spectra of the solid 1,5-dimethylcytosine and the FTIR spectra at room and low temperatures respectively have been registered. Quantum mechanical calculations of energies, geometries and vibrational wavenumbers were carried out by using ab initio (HF) and Density Functional Theory (DFT/BLYP and B3LYP) methods with different basis sets. The best level of theory in order to reproduce the experimental wavenumbers is the BLYP method with the 6-31G* basis set. The theoretical calculations indicate the presence of four stable tautomers of 1,5-dimethylcytosine: amino-oxo; imino-oxo (a and b) and imino-hidroxy. Their geometries were optimised by using the BLYP/6-31G* method, being the amino-oxo tautomer the most stable, followed by the imino-oxo tautomer, while the imino-hidroxy one is the most unstable. The complete assignment of the observed bands in the vibrational spectra of the amino-oxo tautomer is proposed in this work. © 2007 Elsevier B.V. All rights reserved.Fil: Brandán, S.A.. Universidad Nacional de Tucumán; ArgentinaFil: Benzal, María Graciela. Universidad Nacional de Tucumán; ArgentinaFil: García Ramos, J.V.. Csic - Instituto de Estructura de la Materia (iem);Fil: Otero, J.C.. Universidad de Málaga; EspañaFil: Ben Altabef, Aida. Universidad Nacional de Tucumán; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tucumán. Instituto de Química del Noroeste. Universidad Nacional de Tucumán. Facultad de Bioquímica, Química y Farmacia. Instituto de Química del Noroeste; Argentin

Climatic and tectonic controls on carbonate deposition in syn-rift siliciclastic fluvial systems: A case of microbialites and associated facies in the Late Jurassic

This work provides new insights to assess the factors controlling carbonate deposition in the siliciclastic fluvial systems of rift basins. Sedimentological and stable-isotope data of microbialites and associated carbonate facies, along with regional geological information, are shown to reveal the influence of climate and tectonics on the occurrence and attributes of carbonate deposits in these settings. The Vega Formation – a 150 m thick Lower Kimmeridgian siliciclastic fluvial sequence in Asturias Province (northern Spain) – constitutes a candidate for this approach. This unit includes varied facies (stromatolites; rudstones, packstones and wackestones containing oncoids, intraclasts, charophytes and shell bioclasts; marlstones and polygenic calcareous conglomerates) that formed in a low-gradient fluvial–lacustrine system consisting of shallow, low-sinuosity oncoid-bearing channels and pools within marshy areas, with sporadic coarse alluvial deposition. The sedimentological attributes indicate common erosion by channel overflow and rapid lateral changes of subenvironments caused by water-discharge variations. The carbonate fluvial–lacustrine system developed near uplifted marine Jurassic rocks. The occurrence of the system was conditioned by normal faults (active during the deposition of the unit) that favoured: (i) springs of HCO3–Ca-rich water from a Rhaetian–Sinemurian carbonate rock aquifer; and (ii) carbonate deposition in areas partially isolated from the adjacent siliciclastic fluvial system. The microbialite d13C and d18O values support deposition in a hydrologically open system, fed by ambient-temperature meteoric water, with riparian vegetation. Three types of lamination in the stromatolites and oncoids reflect distinct morphological types of cyanobacterial communities. The textural pattern of lamination parallels d13C and d18O changes, suggesting short-term cycles of precipitation and temperature. A moderately to strongly contrasted seasonal and/or pluriannual precipitation regime is inferred from the cyclic d13C pattern of the lamination and from the discontinuous and asymmetrical growth of oncoids. Thus, the isotopic and sedimentological attributes of the carbonate deposits were linked to short-term climate changes associated with semi-arid conditions, consistent with the studied climatic zone

Problemas y propuestas de mejora en la atención sanitaria a los inmigrantes económicos

ResumenObjetivosAnalizar los problemas que existen en la atención sanitaria a los inmigrantes económicos en opinión de profesionales sociosanitarios, de la administración sanitaria y de inmigrantes, así como conocer y priorizar las propuestas de los profesionales para mejorar dicha atención.MétodosEstudio descriptivo de enfoque cualitativo realizado en Mallorca. Se han realizado tres grupos focales y tres grupos nominales con profesionales de atención primaria y especializada, dos entrevistas semiestructuradas a dos miembros de la administración sanitaria, uno de la Administración autonómica y otro de la Administración central, y doce entrevistas semiestructuradas a inmigrantes económicos identificados a partir de informantes clave.ResultadosEl incremento del número de inmigrantes económicos es percibido por los profesionales y por la administración con una sensación de llegada masiva. Los principales problemas identificados han sido las restricciones de acceso, el seguimiento de estos pacientes, y la falta de entrenamiento en medicina tropical. Los inmigrantes, en cambio, están más preocupados por regularizar su situación y por el acceso a la vivienda. La primera propuesta de los profesionales es su formación en medicina tropical. La Administración autonómica prioriza el acceso a los servicios sanitarios y la búsqueda activa de problemas de salud en esta población, mientras que la Administración central aboga en primer lugar por la regularización de todos los inmigrantes.ConclusionesLas principales barreras en la atención sanitaria a los inmmigrantes económicos son, en opinión de los profesionales sociosanitarios, las restricciones de acceso, el seguimiento clínico y la falta de entrenamiento en medicina tropical, y para mejorar esta situación los profesionales demandan formación. Las prioridades de las Administraciones autonómica y central no son coincidentes. Finalmente, para los inmigrantes económicos, la atención sanitaria no parece ser una prioridad.SummaryObjectivesTo analyse existing problems in health care to economic immigrants from the point of view of health and social professionals, health authorities and economic immigrants and to know which will be their proposals and priorities to improve economic immigrants’s health assistance.MethodsQualitative approach study made in Majorca island. (Spain). Three focus groups and three nominal groups with health and social workers from primary health care and hospital services were carried out as well as two partially structured interviews to health authorities, one Autonomic Authority and one Governmental Authority, and twelve partially structured interviews to economic immigrants identified trough key informants.ResultsHealth and social workers perceive the increase in the number of economic immigrants as a massive arrival. The main problems identified are: access restrictions to public helath services for economic immigrants, the follow-up of these patients and diagnostic difficulties because lack of training in tropical medicine. Health and social workers’s first proposal for improving this situation is their own training in tropical medicine. Autonomic Authority priorities are to garantiee access to public health services for all immigrants and to look actively for health problems in these population. Governmental Authority, instead, holds the legalization for all. In fact, economic immigrants are not concerned on health care because legalization and houssing problems.ConclusionsThe main barriers identified by health and social workers in health care to economic immigrants are: access restrictions, follow-up and lack of training in tropical medicine. Health and social first proposal to improve this situation is their own training in tropical medicine while Autonomic and Central Authorities’s priorities are not the same. For economic inmigrants, health assistance is not their biggest concern

Use of perborate in the bleaching of ethanolamine pulp from olive wood

In this work, we studied the influence of the bleacher concentration(2.5-5.5%), temperature (60-80 ºC) and time (60-180 min) on the reagent (perborate) consumption by dry pulp, various properties of the bleached pulp (yield, kappa number, brightness and viscosity/kappa numberratio), and some physical properties of paper sheets obtainedfrom it (tear index, burst index, stretch and breakinglength). The pulp was previously obtained by ethanolamine-soda-anthraquinone cooking of olive wood. A face-centred composite factor design was used to derive equations relating the pulp properties to the operational variables with a view to identifying the optimum operating conditions. The equations thus obtained reproduced the experimental results with errors less than 10% in all cases.The most suitable operating conditions were found to be alow temperature (60 ºC), a long time (180 min) and a highperborate concentration (5,5%). Because the pulp brightness achieved never exceeded 63% -not even under themost drastic conditions-, the process should not be used with one-step bleaching sequences

Optimising Health Emergency Resource Management from Multi-Model Databases

The health care sector is one of the most sensitive sectors in our society, and it is believed that the application of specific and detailed database creation and design techniques can improve the quality of patient care. In this sense, better management of emergency resources should be achieved. The development of a methodology to manage and integrate a set of data from multiple sources into a centralised database, which ensures a high quality emergency health service, is a challenge. The high level of interrelation between all of the variables related to patient care will allow one to analyse and make the right strategic decisions about the type of care that will be needed in the future, efficiently managing the resources involved in such care. An optimised database was designed that integrated and related all aspects that directly and indirectly affected the emergency care provided in the province of Jaén (city of Jaén, Andalusia, Spain) over the last eight years. Health, social, economic, environmental, and geographical information related to each of these emergency services was stored and related. Linear and nonlinear regression algorithms were used: support vector machine (SVM) with linear kernel and generated linear model (GLM), and the nonlinear SVM with Gaussian kernel. Predictive models of emergency demand were generated with a success rate of over 90%

Changes in the kinase activity of the insulin receptor account for an increased insulin sensitivity of mammary gland in late pregnancy

Copyright (1998) The Endocrine Society .The paper can be found at the following URL on the website http://endo.endojournals.org