M1a prostate cancer:Results of a Dutch multidisciplinary consensus meeting

ObjectivesTo determine the consensus of a Dutch multidisciplinary expert panel on the diagnostic evaluation and treatment of de novo and recurrent metastatic prostate cancer (PCa) limited to non-regional lymph nodes (M1a) in daily clinical practice.Materials and methodsThe panel consisted of 37 Dutch specialists from disciplines involved in the management of M1a PCa (urology, medical and radiation oncology, radiology, and nuclear medicine). We used a modified Delphi method consisting of two voting rounds and a consensus meeting (video conference). Consensus (good agreement) was defined as the situation in which ≥ 75% of the panelists chose the same option.ResultsConsensus existed for 57% of the items. The panel agreed that prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA-PET/CT) is the most appropriate standard imaging modality to identify de novo (100%) and recurrent (97%) M1a PCa. Androgen deprivation therapy (ADT) combined with radiotherapy to the prostate ± the M1a lesion(s) was most frequently considered an option for de novo M1a PCa. For M1a as recurrent disease, ADT alone, deferring treatment, or local radiotherapy to the M1a lesion(s) were judged to be the most important treatment options. However, no specific indications for treatment choice in relation to disease characteristics could be formulated.ConclusionsThe Dutch consensus panel preferred PSMA-PET/CT as the standard diagnostic modality to detect M1a PCa. Although potential treatment options were identified, explicit recommendations could not be formulated. This might (partly) be explained by the absence of high-level clinical evidence in this subset of patients. Further research is, therefore, strongly encouraged

The Efficiency of Food Safety Program Expenses: The Case of Community Restaurants in the Federal District

Food is a constitutionally guaranteed right. In this context, associated with the attention that multinational agencies channel to the subject, the Community Restaurants were created, through which the State tries to provide healthy food to the low income population. In 2017, the forecast of the Federal District’s Annual Budget Law for the execution of this public policy corresponded to thirty-nine million one hundred and fifty thousand reais (R$ 39,150,000.00). This information, associated with the relevance that this policy has to the population and the media, motivated the research. Therefore, the objective of this study is to verify the efficiency of the expenditures of community restaurants in the Federal District using the Data Envelopment Analysis (DEA) method, aplied to data on committed expenditure, expenditure settled and the number of inhabitants per administrative region from the years of 2012 to 2016. The results indicated that all restaurants were efficient during the analysis period. The restaurant located in Estrutural proved the most efficient while the one located in Itapoã was the least efficient. The administrative regions with the highest number of vulnerable families do not have the most efficient restaurants. It should be emphasized that this result can be used by public managers as a means of improving the formulation of this public policy

Role of Local and/or Metastasis-directed Therapy in Patients with Hormone-sensitive M1a Prostate Cancer:A Systematic Review

CONTEXT: It remains unclear whether men with hormone-sensitive prostate cancer (PCa) metastasized to nonregional lymph nodes (M1a) benefit from prostate-directed therapy (PDT) and/or metastasis-directed therapy (MDT). OBJECTIVE: To systematically summarize the literature regarding oncological outcomes of de novo and recurrent M1a PCa patients treated with PDT and/or MDT. EVIDENCE ACQUISITION: We searched Medline (Ovid), Embase, and Scopus according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines for reports on oncological outcomes of de novo or recurrent hormone-sensitive M1a PCa patients treated with PDT (radical prostatectomy or radiotherapy) and/or MDT (nodal radiotherapy or salvage lymph node dissection) with or without androgen deprivation therapy. A descriptive data synthesis and a methodological quality assessment were performed to evaluate the impact of PDT and/or MDT on survival in M1a PCa patients. EVIDENCE SYNTHESIS: A total of 6136 articles were screened and 24 studies were included in this systematic review. In de novo M1a PCa patients, PDT was associated with improved oncological outcomes compared with no PDT. In recurrent M1a PCa, MDT could delay the need for systemic treatment in a selection of patients, but high-level evidence from prospective phase III randomized controlled trials is still awaited. CONCLUSIONS: This systematic review summarized the limited literature data on the management of M1a PCa. Subgroup analyses suggest a role for PDT plus systemic therapy in de novo M1a PCa. MDT to distant nodal metastases delayed the need for systemic therapy in recurrent disease, but robust data are lacking. The predominantly retrospective nature of the included studies and significant heterogeneity in study designs limit the strength of evidence. PATIENT SUMMARY: We reviewed the treatment of patients with prostate cancer that has spread to lymph nodes outside the pelvis without metastases in other organ systems. There is evidence that treatment of the primary prostate tumor improves outcomes in well-selected patients and that treatment targeting distant lymph node metastases can delay the start of systemic treatment.</p

Checklist of Spermatophyta of the São Paulo State, Brazil

The Phanerogamic Flora of São Paulo State project has been dedicated to create an inventory of the flora for 20 years. More than 200 collaborators are involved, mostly from the State of São Paulo, with the contributions of researchers from other states and from abroad. Since 2001, seven books with monographs of 151 families were published, dealing with 3,237 species within 722 genera. This project was the starting-point of the gathering of information about the diversity of spermatophytes of the State of São Paulo. The current checklist, at this point, presents an updated and virtually complete list of species, all certified by specialists. It also contains references to scientific collections for most of the taxa (vouchers) or to bibliography referring to the natural or subspontaneous occurrence of the species in the State. The list now contains 7,305 species distributed in 1,776 genera and in 197 spermatophyte families (according to Cronquist 1981) or 195 (according to APG III). 23% of the 31,728 species of spermatophytes listed in the Flora of Brazil occur in São Paulo State. The most representative families are Orchidaceae (797 species), Asteraceae (676 species), Fabaceae (513 species), Poaceae (500 species), Myrtaceae (304), Rubiaceae (265 species) and Melastomataceae (253 species), which, altogether, accumulate 3,308 species and constitute 45% of total species of spermatophytes in the state. The wealth of the Brazilian plant diversity, partially expressed in São Paulo, shows how important is the continuity of floristic studies in a country that is very likely to hold the largest plant diversity in the planet.O projeto Flora Fanerogâmica do Estado de São Paulo tem se dedicado a inventariar a flora paulistana há quase 20 anos. Conta com a atuação de mais de 200 colaboradores, a maioria do próprio estado, além de pesquisadores de outros estados e do exterior. Desde 2001, foram publicados sete volumes com as monografias de 151 famílias, contendo 3.237 espécies em 722 gêneros. Este projeto foi o ponto de partida para o conhecimento da diversidade das espécies de espermatófitas do estado de São Paulo. A apresentação do checklist neste momento é oportuna por constituir a produção de uma listagem das espécies com identificações certificadas pelos especialistas, além de conter a referência de uma coleção de herbário para a maior parte dos táxons (material-testemunho) ou referência à bibliografia em que a espécie é citada como ocorrente, de forma nativa ou subespontânea, no estado. Dessa forma, é aqui apresentada a listagem das espermatófitas do estado de São Paulo, com 7.305 espécies, distribuídas em 1.776 gêneros e em 197 famílias (segundo Cronquist 1981) ou então 195 (segundo o APG III). Em relação à flora do Brasil, com 31.728 espécies de espermatófitas, o estado São Paulo compartilha de 23% dessas espécies. As famílias mais representativas são Orchidaceae (797 espécies), Asteraceae (676 espécies), Fabaceae (513 espécies), Poaceae (500 espécies), Myrtaceae (304), Rubiaceae (265 espécies) e Melastomataceae (253 espécies) que, juntas, somam 3.308 espécies e constituem mais de 45% do total de espécies de espermatófitas do estado. Considerando a grande diversidade vegetal brasileira, parcialmente expressa em um estado, depreende-se a grande importância da continuidade dos estudos florísticos no Brasil, país provavelmente detentor da maior diversidade vegetal do planeta.19138

Les Poèmes Homériques et l'Histoire Grecque

 MIREAUX (Émile). — Les Poèmes Homériques et l'Histoire Grecque.  Tomo I: Homère de Chios et les routes de l'étain. Paris, Éditions  Albin Michel, 1948. In 8.°, 379 páginas, 3 mapas.(Primeiro Parágrafo do Artigo)Muito já se escreveu sobre os poemas homéricos, para tanto na antiguidade quanto nos tempos modernos, e o mesmo, certamente, sucederá no futuro, sem que jamais, talvez, possa dizer a última palavra sobre o assunt

Les Poèmes Homériques et l'Histoire Grecque

MiREAU (Émile). — Les Poèmes Homériques et l'Histoire Grecque. Tome II:  L'Iliade, I'Odissée et kes rivalités coloniales. Paris. Éditions Albin Michel, .1949. Em 8.°. 436 páginas. 4 mapas. 540 francos.(Primeiro Parágrafo do Artigo)Se há na história da literatura universal um problema que tenha preocupado os críticos de todos os tempos cuja solução pareça a muitos desesperadora é o da chamada "Questão Histórica