45 resultados para Referral pathways


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Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

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The prime movers behind the prehistoric colonization of Remote Oceania, and in particular the large c. 2000-year temporal gap (i.e. long pause') seen between West and East Polynesia, has long been major point of interest in the Pacific. To address these events and the processes that may have led to the known chronological disparity of these diasporas, we present results from two different, but equally powerful, analytical tools which are used to examine Polynesian seafaring capabilities and trajectories. The first is a statistical model known as Seascape, which simulates voyages, while the second uses ease of eastward travel estimates based on land distribution and wind pattern analysis. These analyses were done with the goal of determining the potential role of environmental factors in the colonization process, particularly as they relate to the long pause. We show that the eastern boundary of West Polynesia, the limit of the initial colonization pulse, is marked by a discontinuity in land distribution, where the distances travelers would have to cross in order to reach islands further to the east become significantly larger. At the same time, in West Polynesia, the frequency and intensity of winds favorable to eastward displacement decrease continuously from west to east. As far as winds are concerned, eastward travel in West Polynesia is favored in the northern and southern areas and much more difficult across the central portion. Favorable winds have a clear seasonality, and eastward displacement along the northern area is much easier under El Nino conditions. Voyaging simulations show that intentional eastward voyages departing from Tonga and Samoa, when undertaken with vessels capable of sailing efficiently against the wind, afford a viable route toward several island groups in East Polynesia, with trips starting in Samoa having a higher probability of success.

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Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

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OBJECTIVE: To evaluate treatment of Brazilian patients with gestational trophoblastic disease (GTD).STUDY DESIGN: A retrospective cohort study with analysis of medical reports performed in 10 Brazilian referral centers from January 2000 to December 2011.RESULTS: Of 5,250 patients 3 died (0.06%) at the time of uterine evacuation. Spontaneous remission of GTD (group G1) was observed in 4,103 cases, and 1,144 (21.8%) progressed to gestational trophoblastic neoplasia (GTN) (G2). In G1 2,716 (66.2%) had complete hydatidiform mole (HM) and 1,210, partial HM (29.5%); 3,772 patients (92.7%) recovered as noted in December 2012. In G2, of 1,118 patients treated, initial histopathological results of previous gestation were complete HM (77.5% [n = 886]), partial HM (8.8% [n = 100]), and choriocarcinoma (8.0% [n = 92]); 930 (81.3%) were low-risk, 200 (17.5%) were high-risk GTN, and 14 had placental site trophoblastic tumor (PSTT) (1.2%); cure was achieved in 1,078 cases (96.4%), but 26 patients (2.3%) died (4 low-risk [0.4%], 19 high-risk [9.5%], and 3 PSTT [21.4%]).CONCLUSION: The highest death rates were due to high-risk GTN and PSTT. Patients with molar pregnancy should be referred to a referral center for an early diagnosis and prompt treatment of GTN in order to reduce the morbidity and mortality found in advanced stages.

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Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

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Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

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Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

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In this study, we investigated an interaction between noradrenergic and cholinergic pathways of the medial septal area (MSA) on the control of water intake and urinary electrolyte excretion by means of injection of their respective agonists. Noradrenaline (a nonspecific α-adrenergic agonist) and clonidine (an α2-adrenergic agonist), but not phenylephrine (an α1-adrenergic agonist), induced natriuresis and kaliuresis. α-Adrenergic activation had no effect on the natriuresis and kaliuresis induced by carbachol (a cholinergic agonist) and it inhibited the antinatriuresis and antikaliuresis induced by isoproterenol (a ß-adrenergic agonist). Interactions related to volume excretion are complex. α-Adrenergic activation induced a mild diuresis and inhibited the antidiuresis induced by isoproterenol, but phenylephrine combined with carbachol induced antidiuresis. The water intake induced by carbachol was inhibited by clonidine and noradrenaline, but not phenylephrine. These results show an asymmetry in the interaction between α-adrenergic and cholinergic receptors concerning water intake and electrolyte excretion. © 1992.

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In the present experiments, we investigated a possible involvement of noradrenergic receptors of the lateral hypothalamus (LH) in the water intake and pressor response induced by cholinergic stimulation of the medial septal area (MSA) in rats. The cholinergic agonist carbachol (2 nmol) injected into the MSA induced water intake and pressor response. The injection of an α2-adrenergic agonist, clonidine (20 and 40 nmol), but not of an α1-adrenergic agonist, phenylephrine (80 and 160 nmol), into the LH inhibits the water intake induced by carbachol injected into the MSA. The injection of clonidine or phenylephrine into the LH produced no change in the MAP increase induced by carbachol injected into the MSA. The present results suggest that adrenergic pathways involving the LH are important for the water intake, but not for the pressor response, induced by cholinergic activation of the MSA. © 1994.