Acurácia da mamografia espectral com contraste para seguimento de tumor residual pós-quimioterapia neoadjuvante em pacientes com câncer de mama: um estudo de viabilidade

Objetivo: avaliar a viabilidade da utilização da mamografia espectral com meio de contraste (CESM) na avaliação do tumor residual em mulheres com câncer de mama submetidas a quimioterapia neoadjuvante. Materiais e métodos: foi avaliada a concordância entre a mensuração do tumor residual na CESM e na mamografia digital (FFDM) com os dados histopatológicos de mulheres submetidas a quimioterapia neoadjuvante entre 2011 e 2013. Após as exclusões, três radiologistas analisaram oito CESMs e FFDMs separadamente. A maior dimensão do tumor residual foi considerada para comparação com os resultados histopatológicos. Concordância e correlação da CESM e FFDM com resultados histopatológicos e a concordância interobservador foram avaliadas. Resultados: a CESM teve sensibilidade, especificidade e valores preditivos positivos e negativos maiores que a FFDM - 83,33%, 100%, 100% e 66% versus 50%, 50%, 50% e 25%, respectivamente. A CESM teve correlação boa e consistente com os achados histopatológicos (coeficiente de correlação = 0,76-0,92; coeficiente de correlação intraclasse = 0,692-0,886). A correlação entre FFDM e os achados histopatológicos não foi estatisticamente significante, com consistência questionável (coeficiente de correlação intraclasse = 0,488-0,598). A concordância entre as dimensões do estudo histopatológico foi mais estreita com a CESM do que com a FFDM. A concordância interobservador foi maior na CESM (0,94) do que na FFDM (0,88). Conclusão: a CESM é viável e pode ser utilizada para avaliação de tumor residual após quimioterapia neoadjuvante. A CESM tem boa correlação e concordância com o estudo histopatológico e excelente concordância interobservador.Objective: to assess the feasibility of contrast-enhanced spectral mammography (CESM) of the breast for assessing the size of residual tumors after neoadjuvant chemotherapy (NAC). Materials and methods: in breast cancer patients who underwent NAC between 2011 and 2013, we evaluated residual tumor measurements obtained with CESM and full-field digital mammography (FFDM). We determined the concordance between the methods, as well as their level of agreement with the pathology. Three radiologists analyzed eight CESM and FFDM measurements separately, considering the size of the residual tumor at its largest diameter and correlating it with that determined in the pathological analysis. Interobserver agreement was also evaluated. Results: the sensitivity, specificity, positive predictive value, and negative predictive value were higher for CESM than for FFDM (83.33%, 100%, 100%, and 66% vs. 50%, 50%, 50%, and 25%, respectively). The CESM measurements showed a strong, consistent correlation with the pathological findings (correlation coefficient = 0.76-0.92; intraclass correlation coefficient = 0.692-0.886). The correlation between the FFDM measurements and the pathological findings was not statistically significant, with questionable consistency (intraclass correlation coefficient = 0.488-0.598). Agreement with the pathological findings was narrower for CESM measurements than for FFDM measurements. Interobserver agreement was higher for CESM than for FFDM (0.94 vs. 0.88). Conclusion: CESM is a feasible means of evaluating residual tumor size after NAC, showing a good correlation and good agreement with pathological findings. For CESM measurements, the interobserver agreement was excellent

Constipación intestinal en pacientes admitidos en un programa de rehabilitación neurológica

OBJETIVOS: Conhecer a prevalência da constipação intestinal em pacientes admitidos para reabilitação e verificar os resultados de dois modelos de condutas instituídas para reeducação intestinal durante a internação. MÉTODOS: Estudo longitudinal, analítico, com 98 pacientes internados em enfermaria de reabilitação entre dezembro de 2009 e maio de 2010. RESULTADOS: A prevalência de constipação foi de 57,1%, não houve correlação entre as variáveis sexo, escolaridade, idade, auxílio locomoção, alteração de linguagem, atividade física, dieta e presença de constipação intestinal; a melhora na capacidade funcional foi um preditor de progresso na frequência intestinal; as condutas introduzidas apresentaram um importante papel na melhora do hábito intestinal. CONCLUSÕES: Estudos de condutas poderão fornecer subsídios no tratamento da constipação intestinal, aperfeiçoando a qualidade de vida dessas pessoas.OBJECTIVES: To determine the prevalence of constipation in patients admitted for rehabilitation and to verify the results of two intervention models for bowel retraining during hospitalization. METHODS: A longitudinal, analytical study, with 98 patients admitted to rehabilitation ward between December 2009 and May 2010. RESULTS: The prevalence of constipation was 57.1%, there was no correlation with gender, education, age, transportation assistance, language disorder, physical activity, diet and presence of constipation; the improvement in functional capacity was a predictor of progress in intestinal frequency; interventions introduced demonstrated an important role in improving bowel habits. CONCLUSIONS: Conduct studies may provide treatment options for constipation, improving the quality of life for these individuals.OBJETIVOS: Conocer la prevalencia de la constipación intestinal en pacientes admitidos para rehabilitación y verificar los resultados de dos modelos de conductas instituídas para la reeducación intestinal durante el internamiento. MÉTODOS: Estudio longitudinal, analítico, realizado con 98 pacientes internados en una unidad de rehabilitación entre diciembre del 2009 y mayo del 2010. RESULTADOS: La prevalencia de constipación fue del 57,1%, no hubo correlación entre las variables sexo, escolaridad, edad, auxilio locomoción, alteración del lenguaje, actividad física, dieta y presencia de constipación intestinal; la mejora en la capacidad funcional fue un predictor de progreso en la frecuencia intestinal; las conductas introducidas presentaron un importante papel en el mejoramiento del hábito intestinal. CONCLUSIONES: Estudios de conductas pueden ofrecer subsidios en el tratamiento de la constipación intestinal, perfeccionando la calidad de vida de esas personas

Update on middle ear barotrauma after hyperbaric oxygen therapy : insights on pathophysiology

Introduction Middle ear barotrauma is the most common side effect of hyperbaric oxygen therapy. Knowledge and understanding of its pathophysiology are crucial for an accurate diagnosis and proper decision making about treatment and prevention. Objective Describe up-to-date information on pathophysiology of middle ear barotrauma after hyperbaric oxygen therapy considering the physiology of pressure variation of the middle ear. Data Synthesis Middle ear barotrauma occurs especially during the compression phase of hyperbaric oxygen therapy. The hyperoxic environment in hyperbaric oxygen therapy leads to ventilatory dysfunction of the eustachian tube, especially in monoplace chambers, where the patients are pressurized with 100% O2, favoring middle ear barotrauma. Conclusion The eustachian tube, the tympanic cavity, and mastoid work together in a neural controlled feedback system in which various mechanisms concur for middle ear pressure regulation

Mastoid surface area-to-volume ratios in adult Brazilian individuals

As medidas de área e volume da mastoide por tomografia computadorizada não foram previamente descritas em adultos brasileiros. O conhecimento dessas medidas é muito importante para o entendimento da fisiologia da orelha média e seus estados patológicos, refletindo diretamente na pneumatização mastoídea. OBJETIVO: Verificar a existência de relação entre a área e o volume da mastoide. MÉTODO: Estudo de coorte contemporânea com corte transversal, no qual 28 pacientes foram submetidos à tomografia de mastoides. Foram reconstruídas as medidas de área e volume das mastoides por cortes seriados usando o software Image Pro Plus. RESULTADOS: Os volumes das mastoides variaram de 5,5 até 72,4 cm³. As áreas variaram de 43,9 até 525,2 cm². A área da mastoide foi uma função linear do volume. CONCLUSÃO: As medidas de área e volume da mastoide em adultos brasileiros seguem uma correlação linear, concordando com estudos realizados em outros países. As médias de área e volume encontradas foram superiores às previamente publicadas, ao contrário da média da relação área/volume, que foi inferior. Futuros estudos, com número maior de indivíduos, poderão esclarecer se a população brasileira tem ou não maiores médias de área e volume da mastoide em relação a outras populações específicas.Computed tomography-based measurements of mastoid surface area and volume have not been described for adult Brazilian individuals. These measurements add to the understanding of middle ear physiology, related diseases, and their impact on mastoid pneumatization. OBJECTIVE: To check the ratio between mastoid surface area and volume. METHOD: This contemporary cross-sectional cohort study included 28 patients submitted to CT imaging of the mastoid. Measurements of surface area and volume were made based on serial CT scans and produced with the aid of software package Image Pro Plus. RESULTS: Mastoid volumes ranged from 5.5 to 72.4 cm³. Surface areas ranged from 43.9 to 525.2 cm². Surface areas varied linearly with volumes. CONCLUSION: Mastoid surface areas and volumes of adult Brazilian subjects followed a linear correlation, as also described in studies carried out in other countries. Mean surface areas and volumes were higher than previously published, unlike surface area-to-volume ratios, which were lower. Further studies with larger populations will provide evidence as to whether Brazilian subjects have larger surface areas and volumes than other populations

Microbial community structure and dynamics in thermophilic composting viewed through metagenomics and metatranscriptomics

Composting is a promising source of new organisms and thermostable enzymes that may be helpful in environmental management and industrial processes. Here we present results of metagenomicand metatranscriptomic-based analyses of a large composting operation in the Sao Paulo Zoo Park. This composting exhibits a sustained thermophilic profile (50 degrees C to 75 degrees C), which seems to preclude fungal activity. The main novelty of our study is the combination of time-series sampling with shotgun DNA, 16S rRNA gene amplicon, and metatranscriptome high-throughput sequencing, enabling an unprecedented detailed view of microbial community structure, dynamics, and function in this ecosystem. The time-series data showed that the turning procedure has a strong impact on the compost microbiota, restoring to a certain extent the population profile seen at the beginning of the processand that lignocellulosic biomass deconstruction occurs synergistically and sequentially, with hemicellulose being degraded preferentially to cellulose and lignin. Moreover, our sequencing data allowed near-complete genome reconstruction of five bacterial species previously found in biomass-degrading environments and of a novel biodegrading bacterial species, likely a new genus in the order Bacillales. The data and analyses provided are a rich source for additional investigations of thermophilic composting microbiology.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Provost's Office for Research of the University of Sao PauloCoordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Univ Sao Paulo, Inst Quim, Dept Bioquim, Sao Paulo, BrazilUniv Sao Paulo, Programa Pos Graduacao Interunidades Bioinformat, Sao Paulo, BrazilUniv Sao Paulo, Escola Artes Ciencias & Humanidades, Sao Paulo, Brazil|Fundacao Parque Zool Sao Paulo, Sao Paulo, BrazilUniv Fed Sao Paulo, Dept Ciencias Biol, Sao Paulo, BrazilBiocomplex Inst Virginia, Blacksburg, VA USADepartamento de Ciências Biológicas, Universidade Federal de São Paulo, São Paulo, BrazilFAPESP: 2011/50870-6Web of Scienc

Metagenomic analysis of a tropical composting operation at the São Paulo Zoo Park reveals diversity of biomass degradation functions and organisms.

Composting operations are a rich source for prospection of biomass degradation enzymes. We have analyzed the microbiomes of two composting samples collected in a facility inside the Sao Paulo Zoo Park, in Brazil. All organic waste produced in the park is processed in this facility, at a rate of four tons/day. Total DNA was extracted and sequenced with Roche/454 technology, generating about 3 million reads per sample. To our knowledge this work is the first report of a composting whole-microbial community using high-throughput sequencing and analysis. The phylogenetic profiles of the two microbiomes analyzed are quite different, with a clear dominance of members of the Lactobacillus genus in one of them. We found a general agreement of the distribution of functional categories in the Zoo compost metagenomes compared with seven selected public metagenomes of biomass deconstruction environments, indicating the potential for different bacterial communities to provide alternative mechanisms for the same functional purposes. Our results indicate that biomass degradation in this composting process, including deconstruction of recalcitrant lignocellulose, is fully performed by bacterial enzymes, most likely by members of the Clostridiales and Actinomycetales orders.FAPESP 2009/52030-5RCNPqCAPE