Success rates of re-excision after positive margins for invasive lobular carcinoma of the breast.

Rates of positive margins after surgical resection of invasive lobular carcinoma (ILC) are high (ranging from 18 to 60%), yet the efficacy of re-excision lumpReceptor subtypeectomy for clearing positive margins is unknown. Concerns about the diffuse nature of ILC may drive increased rates of completion mastectomy to treat positive margins, thus lowering breast conservation rates. We therefore determined the success rate of re-excision lumpectomy in women with ILC and positive margins after surgical resection. We identified 314 cases of stage I-III ILC treated with breast conserving surgery (BCS) at the University of California, San Francisco. Surgical procedures, pathology reports, and outcomes were analyzed using univariate and multivariate statistics and Cox-proportional hazards models. We evaluated outcomes before and after the year 2014, when new margin management consensus guidelines were published. Positive initial margins occurred in 118 (37.6%) cases. Of these, 62 (52.5%) underwent re-excision lumpectomy, which cleared the margin in 74.2%. On multivariate analysis, node negativity was significantly associated with successful re-excision (odds ratio [OR] 3.99, 95% CI 1.15-13.81, p = 0.029). After 2014, we saw fewer initial positive margins (42.7% versus 25.5%, p = 0.009), second surgeries (54.6% versus 20.2%, p < 0.001), and completion mastectomies (27.7% versus 4.5%, p < 0.001). In this large cohort of women with ILC, re-excision lumpectomy was highly successful at clearing positive margins. Additionally, positive margins and completion mastectomy rates significantly decreased over time. These findings highlight improvements in management of ILC, and suggest that completion mastectomy may not be required for those with positive margins after initial BCS

Throwing Pebbles While Waiting: An Autoethnographic Exploration of Mental Health and Colonialism

In this article, three scholars jointly investigate questions of Western colonization and mental health. While their areas of interest and experience vary, the authors discuss oppression as a common thread connecting their ideas about mental health and its medicalization. In line with Toyosaki et al. (2009), the researchers did a community autoethnography, performing written dialogue as a dynamic research method. Using a sequential model, Kelly Limes Taylor wrote about her experience, passed it on to Rita Sørly and Bengt Karlsson. Karlsson added his story to the previous writing, and he passed it on to Sørly for further addition of stories. Sørly passed the stories added to Limes Taylor, which added new reflections. Together, the three researchers explore various questions: Who determines what is normal or humane in our society, and who gets left out of those decisions? Do mental health providers make a positive difference, or are they merely legalizing new forms of oppression? What happens when one simply cannot mentally assimilate the dominant narratives that excuse oppression, environmental destruction, and/or insatiable economic practice? Through the lens of their own experience, Limes Taylor, Sørly, and Karlsson share their thoughts on these and other questions as they jointly explore ideas of mental health identity in the context of Western colonialism

Element-ary Puns

The periodic table offers a lot of information, most of which is usually not used by high school students. However, it is important for students of chemistry, biology and physics to have some background related to the elements that make up the periodic table. Several students were working with a periodic table and realized they could make studying the elements more enjoyable by making up some statements that led to the actual naming of the element. For example: If you want to catch wild horses, europium

Sustained inhibition of rat myometrial gap junctions and contractions by lindane

BACKGROUND: Gap junctions increase in size and abundance coincident with parturition, forming an intercellular communication network that permits the uterus to develop the forceful, coordinated contractions necessary for delivery of the fetus. Lindane, a pesticide used in the human and veterinary treatment of scabies and lice as well as in agricultural applications, inhibits uterine contractions in vitro, inhibits myometrial gap junctions, and has been associated with prolonged gestation length in rats. The aim of the present study was to investigate whether brief exposures to lindane would elicit sustained inhibition of rat uterine contractile activity and myometrial gap junction intercellular communication. METHODS: To examine effects on uterine contraction, longitudinal uterine strips isolated from late gestation (day 20) rats were exposed to lindane in muscle baths and monitored for changes in spontaneous phasic contractions during and after exposure to lindane. Lucifer yellow dye transfer between myometrial cells in culture was used to monitor gap junction intercellular communication. RESULTS: During a 1-h exposure, 10 micro M and 100 micro M lindane decreased peak force and frequency of uterine contraction but 1 micro M lindane did not. After removal of the exposure buffer, contraction force remained significantly depressed in uterine strips exposed to 100 micro M lindane, returning to less than 50% basal levels 5 h after cessation of lindane exposure. In cultured myometrial myocytes, significant sustained inhibition of Lucifer yellow dye transfer was observed 24 h after lindane exposures as brief as 10 min and as low as 0.1 micro M lindane. CONCLUSION: Brief in vitro exposures to lindane have long-term effects on myometrial functions that are necessary for parturition, inhibiting spontaneous phasic contractions in late gestation rat uterus and gap junction intercellular communication in myometrial cell cultures

Direitos individuais e direitos de minorias: o Estado brasileiro e o desafio da educação escolar indígena

Neste artigo, as tensões resultantes do reconhecimento de direitos de minorias dos povos indígenas brasileiros são analisadas com foco na educação escolar. Para tanto, nos apoiamos em duas vertentes do liberalismo político contemporâneo, no sentido de problematizar seus limites e possibilidades nas relações interculturais que se estabelecem na inserção de grupos indígenas no sistema de educação nacional. Nossas análises apontam que os avanços obtidos na legislação brasileira vigente são de difícil implementação, por razões que vão da precariedade de alguns sistemas de educação locais ao complexo diálogo entre a cultura majoritária e a cultura dos diferentes grupos indígenas brasileiros.Palavras-chave: Educação indígena; liberalismo político; direitos de minorias; relações interculturais

Instituto de salud mental para la región Arequipa orientado a la rehabilitación de pacientes a través de la estimulación sensorial y la interacción social en el espacio público

Las nuevas políticas nacionales en salud mental establecen un modelo de atención comunitario donde se prioriza la interacción social dentro del proceso de tratamiento y rehabilitación de pacientes mentales. Por ello, la presente investigación tiene como objetivo la elaboración de un modelo arquitectónico de un Instituto de Salud Mental para la región Arequipa que cumpla las funciones de Asistencia, Residencia, Investigación y Comunidad, que responda a las necesidades sociales y laborales que se identifican como premisas mediante el análisis – síntesis del contexto en el que se inserta el proyecto. El proyecto arquitectónico se enfoca en lograr el bienestar psicológico de los pacientes mentales para la óptima recepción de los tratamientos y terapias, y mediante el uso del espacio público plantea una estrategia para facilitar la reinserción de los pacientes dentro de la comunidad a través de la elaboración de una programación de actividades que surge a partir de las necesidades sociales del usuario que le permite interactuar con miembros de la comunidad para alcanzar su rehabilitación. Es importante entender que el espacio en el que se encuentra expuesto un individuo puede alterar su estado de ánimo y modificar su comportamiento, por consiguiente, la arquitectura que alberga pacientes mentales debe incluir estímulos positivos que ayuden con los tratamientos propuestos por los profesionales a cargo

10 Habits of Successful College Students

Student assignment: As a class, create a group poster that incorporates the following habits discussed in class: organization, study systems, choosing friends carefully, sex and relationships, careers over majors, learning over grades, health and exercise, failing courses, parting, and managing money

Site-1 protease inhibits mitochondrial respiration by controlling the TGF-β target gene Mss51

The mitochondrial response to changes in cellular energy demand is necessary for cellular adaptation and organ function. Many genes are essential in orchestrating this response, including the transforming growth factor (TGF)-β1 target gene Mss51, an inhibitor of skeletal muscle mitochondrial respiration. Although Mss51 is implicated in the pathophysiology of obesity and musculoskeletal disease, how Mss51 is regulated is not entirely understood. Site-1 protease (S1P) is a key activator of several transcription factors required for cellular adaptation. However, the role of S1P in muscle is unknown. Here, we identify S1P as a negative regulator of muscle mass and mitochondrial respiration. S1P disruption in mouse skeletal muscle reduces Mss51 expression and increases muscle mass and mitochondrial respiration. The effects of S1P deficiency on mitochondrial activity are counteracted by overexpressing Mss51, suggesting that one way S1P inhibits respiration is by regulating Mss51. These discoveries expand our understanding of TGF-β signaling and S1P function

PROTEIN WITH INCREASING LEVELS OF UREA IN THE DIET OF DAIRY COWS AT PASTURE

This study aimed to evaluate the effect of replacing dietary crude protein with increasing levels of urea on the digestive, productive and economic parameters of crossbred mid- lactation dairy cows under grazing conditions (Urochloa brizantha cv. Xaraés). Five crossbred cows (Holstein x Zebu) were distributed in a Latin square design (5 x 5) at five experimental periods of 21 days each. Replacement levels of dietary crude protein by urea were 0%, 7%, 14%, 21% and 28%. The intakes of dry matter, crude protein, neutral detergent fiber, and total digestible nutrients, as well as the coefficient of digestibility, were not affected by increasing levels of urea (p>0.05), except for the intake of non-fibrous carbohydrates that increased linearly with supplemental urea levels (p<0.05). Milk yield and   chemical composition, feed efficiency, body weight, and nitrogen use efficiency did not show a significant difference (p>0.05) for cows fed by increasing levels of urea. The financial indicators (gross margin, net margin, profitability, and rate of return) were positive, exceeding operating expenses and the total operating cost. The partial replacement of dietary crude protein by urea in mid-lactation dairy cows under grazing conditions does not interfere with the productive parameters. The results of this study demonstrate that replacing 28% of dietary crude protein by urea could be done in order to reduce feeding costs without negative impact on the performance of lactating cows grazing tropical grass pastures.Este estudo teve como objetivo avaliar o efeito da substituição da proteína bruta da dieta por níveis crescentes de ureia nos parâmetros digestivos, produtivos e econômicos de vacas leiteiras mestiças em lactação, em condições de pastejo (Urochloa brizantha cv. Xaraés). Cinco vacas mestiças Holandês x Zebu foram distribuídas em delineamento quadrado latino 5 x 5, com cinco períodos experimentais de 21 dias cada. Os níveis de reposição de proteína bruta na dieta por ureia foram de 0, 7%, 14%, 21% e 28%. A ingestão de matéria seca, proteína bruta, fibra em detergente neutro e nutrientes digestíveis totais e o coeficiente de digestibilidade, não foram afetados pelo aumento dos níveis de ureia (p>0,05), exceto pela ingestão de carboidratos não fibrosos que aumentaram linearmente com os níveis suplementares de ureia (p<0,05). A produção de leite, a sua composição química, a eficiência alimentar, o peso corporal e a eficiência no uso de nitrogênio não apresentaram diferença significativa (p>0,05) para vacas alimentadas pelo aumento dos níveis de ureia. Os indicadores financeiros (margem bruta, margem líquida, rentabilidade e taxa de retorno) foram positivos, superando as despesas operacionais e o custo operacional total. A substituição parcial da proteína bruta da dieta pela ureia em vacas leiteiras em lactação sob pastejo não interfere nos parâmetros produtivos. Os resultados deste estudo demonstram que a substituição de 28% da proteína bruta da dieta por ureia pode ser feita para reduzir os custos de alimentação sem impacto negativo no desempenho de vacas em lactação mantidas em pastagens de grama tropical