Nonsmall cell lung cancer: evaluation of 737 consecutive patients in a single institution

OBJECTIVE: To analyze surgical and pathological parameters and outcome and prognostic factors of patients with nonsmall cell lung cancer (NSCLC) who were admitted to a single institution, as well as to correlate these findings to the current staging system. METHOD: Seven hundred and thirty seven patients were diagnosed with NSCLC and admitted to Hospital do Cancer A. C. Camargo from 1990 to 2000. All patients were included in a continuous prospective database, and their data was analyzed. Following staging, a multidisciplinary team decision on adequate management was established. Variables included in this analysis were age, gender, histology, Karnofsky index, weight loss, clinical stage, surgical stage, chemotherapy, radiotherapy, and survival rates. RESULTS: 75.5% of patients were males. The distribution of histologic type was squamous cell carcinoma 51.8%, adenocarcinoma 43.1%, and undifferentiated large cell carcinoma 5.1%. Most patients (73%) presented significant weight loss and a Karnofsky index of 80%. Clinical staging was IA 3.8%, IB 9.2%, IIA 1.4%, IIB 8.1%, IIIA 20.9%, IIIB 22.4%, IV 30.9%. Complete tumor resection was performed in 24.6% of all patients. Surgical stage distribution was IA 25.3%, IB 1.4%, IIB 17.1%, IIIA 16.1%, IIIB 20.3%, IV 11.5%. Chemotherapy and radiotherapy were considered therapeutic options in 43% and 72%, respectively. The overall 5-year survival rate of nonsmall cell lung cancer patients in our study was 28%. Median survival was 18.9 months. CONCLUSIONS: Patients with NSCLC who were admitted to our institution presented with histopathologic and clinical characteristics that were similar to previously published series in cancer hospitals. The best prognosis was associated with complete tumor resection with lymph node dissection, which is only achievable in earlier clinical stages.

The use and limitations of ultrasonography in the diagnosis of liver morbidity attributable to Schistosoma mansoni infection in community-based surveys

The objective of this population-based study was to estimate the liver morbidity attributable to Schistosoma mansoni infection by ultrasonography adopting the proposed standard protocols of the Cairo Meeting on Ultrasonography, 1991. We examined 2384 individuals representing 20 of the households of the rural population of the Ismailia Governorate, East of Delta, Egypt. Prevalence of S. mansoni and S. haematobium infections were 40.3 and 1.7 respectively. Portal tract thickening (PTT) grade 1, 2 and 3 considered diagnostic of schistosomal liver morbidity was detected in 35.1, 1.3 and 0.2 individuals respectively. Generally, ultrasonographically-detected pathological changes increased with age, but correlated with intensity of infection only in age group 20-59 years. Comparing individuals with and without S. mansoni infections in an endemic and a non-endemic community indicated no significant difference between the former and the latter in either case. In conclusion: ultrasonography had a limited value in estimating schistosomal liver morbidity in our population-based study where early grades of liver morbidly were prevalent. The criteria of diagnosing grade I portal fibrosis need to be revised as well as the staging system proposed by the Cairo Meeting on ultrasonography in schistosomiasis.

The importance of PET/CT in the evaluation of patients with Ewing tumors

AbstractThe effective evaluation for the treatment of patients with Ewing tumors depends on the accuracy in the determination of the primary tumor extent and the presence of metastatic disease. Currently, no universally accepted staging system is available to assess Ewing tumors. The present study aimed at discussing the use of PET/CT as a tool for staging, restaging and assessment of therapeutic response in patients with Ewing tumors. In spite of some limitations of PET/CT as compared with anatomical imaging methods, its relevance in the assessment of these patients is related to the capacity of the method to provide further physiological information, which often generates important clinical implications. Currently, the assessment of patients with Ewing tumor should comprise a study with PET/CT combined with other anatomical imaging modalities, such as radiography, computed tomography and magnetic resonance imaging.

Budget impact from the incorporation of positron emission tomography – computed tomography for staging lung cancers

OBJECTIVE To estimate the budget impact from the incorporation of positron emission tomography (PET) in mediastinal and distant staging of non-small cell lung cancer.METHODS The estimates were calculated by the epidemiological method for years 2014 to 2018. Nation-wide data were used about the incidence; data on distribution of the disease´s prevalence and on the technologies’ accuracy were from the literature; data regarding involved costs were taken from a micro-costing study and from Brazilian Unified Health System (SUS) database. Two strategies for using PET were analyzed: the offer to all newly-diagnosed patients, and the restricted offer to the ones who had negative results in previous computed tomography (CT) exams. Univariate and extreme scenarios sensitivity analyses were conducted to evaluate the influence from sources of uncertainties in the parameters used.RESULTS The incorporation of PET-CT in SUS would imply the need for additional resources of 158.1 BRL (98.2 USD) million for the restricted offer and 202.7 BRL (125.9 USD) million for the inclusive offer in five years, with a difference of 44.6 BRL (27.7 USD) million between the two offer strategies within that period. In absolute terms, the total budget impact from its incorporation in SUS, in five years, would be 555 BRL (345 USD) and 600 BRL (372.8 USD) million, respectively. The costs from the PET-CT procedure were the most influential parameter in the results. In the most optimistic scenario, the additional budget impact would be reduced to 86.9 BRL (54 USD) and 103.8 BRL (64.5 USD) million, considering PET-CT for negative CT and PET-CT for all, respectively.CONCLUSIONS The incorporation of PET in the clinical staging of non-small cell lung cancer seems to be financially feasible considering the high budget of the Brazilian Ministry of Health. The potential reduction in the number of unnecessary surgeries may cause the available resources to be more efficiently allocated.

Climate governance in an international system under conservative hegemony: the role of major powers

In the last five years, climate change has been established as a central civilizational driver of our time. As a result of this development, the most diversified social processes - as well as the fields of science which study them - have had their dynamics altered. In International Relations, this double challenge could be explained as follows: 1) in empirical terms, climate change imposes a deepening of cooperation levels on the international community, considering the global common character of the atmosphere; and 2) to International Relations as a discipline, climate change demands from the scientific community a conceptual review of the categories designed to approach the development of global climate governance. The goal of this article is to discuss in both conceptual and empirical terms the structure of global climate change governance, through an exploratory research, aiming at identifying the key elements that allow understanding its dynamics. To do so, we rely on the concept of climate powers. This discussion is grounded in the following framework: we now live in an international system under conservative hegemony that is unable to properly respond to the problems of interdependence, among which - and mainly -, the climate issue.

Between system maker and privileges taker: the role of China in the Greater Mekong Sub-region

Utilizing China's leadership projects in the Great Mekong Sub-Region (GMS) as a case study, this paper aims to investigate whether China qualifies as an international leader. This work argues that its geographic position and economic rise allow China to be a "system maker and privilege taker," which is a dual role forming in economic-political relations in the GMS in the last ten years. China is among major driving forces to set up an economic zone in GMS. Growing Chinese regional power is intimately related to the creation of various hubs connecting regional transportation, communication and energy systems that foster the economic development of this region. However, China also proves dark sides of rising powers which take advantage of their privileges to gain benefits. As a "system maker" with its own position and capability, China has notably benefited from building hydropower systems. More importantly, while China is pursuing its benefits and privileges, its hydropower projects have caused some negative effects for the ecosystem in the region. The inflation of dam constructions in both China and GMS countries is raising concerns about using natural resources of the Mekong River. Our concluding part addresses the pressing need to start a serious discussion on the balance between national interests and regional solidarity within the formulation of Chinese foreign policy in GMS.

Environmental issues and international relations, a new global (dis)order - the role of International Relations in promoting a concerted international system

Is it possible to talk about the rise of a new global (dis)order founded on the challenges posed by environmental issues? Through the review of the state of the art on the subject, this article analyzes the growing importance of the environment, and natural resources in particular, in international relations; and aims to raise awareness among International Relations scholars to the potential positive impact of the development of the discipline in integration with global environmental change studies.

Evaluation of respiratory parameters in minimally processed lettuce grown under organic or conventional system

The increased preference for minimally processed vegetables has been attributed to the health benefits associated with fresh produce and the demand for ready-to-eat salads. In this paper, lettuce (Lactuca sativa L.) was evaluated for the effects of different cropping systems on the respiratory properties. Lettuce was packaged in low density polyethylene bags and stored in a refrigerator at 4 ºC. The concentration of carbon dioxide and oxygen inside the package was monitored during the storage at zero, three, six, eight, ten and twelve days by gas chromatography. Dry matter variation was measured gravimetrically up to day fourteen of storage. Values of respiratory rate for conventional lettuce increased from day 1 to 3 and remained low, while respiratory rate of the organic lettuce increased three-fold up to day 8, stabilizing at a high level. Variation in dry matter during storage also resulted from differences between the two cultivation systems. The highest content of dry matter was achieved by organic lettuce.

Lime and fertilizer recommendation system for coconut trees

Fertilizer recommendation to most agricultural crops is based on response curves. Such curves are constructed from field experimental data, obtained for a particular condition and may not be reliable to be applied to other regions. The aim of this study was to develop a Lime and Fertilizer Recommendation System for Coconut Crop based on the nutritional balance. The System considers the expected productivity and plant nutrient use efficiency to estimate nutrient demand, and effective rooting layer, soil nutrient availability, as well as any other nutrient input to estimate the nutrient supply. Comparing the nutrient demand with the nutrient supply the System defines the nutrient balance. If the balance for a given nutrient is negative, lime and, or, fertilization is recommended. On the other hand, if the balance is positive, no lime or fertilizer is needed. For coconut trees, the fertilization regime is divided in three stages: fertilization at the planting spot, band fertilization and fertilization at the production phase. The data set for the development of the System for coconut trees was obtained from the literature. The recommendations generated by the System were compared to those derived from recommendation tables used for coconut crop in Brazil. The main differences between the two procedures were for the P rate applied in the planting hole, which was higher in the proposed System because the tables do not pay heed to the pit volume, whereas the N and K rates were lower. The crop demand for K is very high, and the rates recommended by the System are superior to the table recommendations for the formation and initial production stage. The fertilizer recommendations by the System are higher for the phase of coconut tree growth as compared to the production phase, because greater amount of biomass is produced in the first phase.

Influence of the N/K ratio on the production and quality of cucumber in hydroponic system

The objective of this work was to evaluate the quality of fruits and the nutritional status of cucumber CV. Aodai cultivated in nutrient solutions with different N:K ratios. The hydroponic cultivation was initially performed, during the vegetative growth, in nutrient solution with 1:2.0 mmol L-1 N:K, and, later, during fruit setting, in four different nutrient solutions with N:K (w/w) at the ratios 1:1.4, 1:1.7, 1:2.0 and 1:2.5. An additional treatment with a nutrient solution containing the ratio 1:2.2 (w/w) N:K during the vegetative growth and N:K 1:1.4 (w/w) during fruit setting, both with 10% ammonium (NH4+) was included. The treatments were arranged in a randomized design with six replicates. Irrigation was carried out with deionized water until seed germination, and then with nutrient solution until 30 days after germination, when plants were transplanted. Plants in the hydroponic growing beds were irrigated with the solutions for vegetative growth, and, after 21 days, the solutions were replaced by solutions for fruit setting. At 45 and 60 days after transplanting, the fresh weight, length, diameter, volume and firmness of the fruit were evaluated, and, at 45 days after transplanting, the macronutrient concentrations in the leaves were determined. The use of different N:K ratios during fruit setting influenced the cucumber production. The ratio of 1.0:1.7 N: K (w/w), with 10% of N in the form of ammonia, is recommended for the whole cycle.

Morphology and stability of aggregates of an Oxisol according to tillage system and gypsum application

Morphological characterization and aggregate stability is an important factor in evaluating management systems. The aim of this paper is to evaluate the stability and morphology of the aggregates of a dystrophic Oxisol managed with no-tillage and conventional tillage with and without the residual action of gypsum. The experimental design was randomized blocks arranged in split-split plot, where the treatments were two soil management systems (plots) with 0 and 2000 kg ha-1 of gypsum (subplots) and five depths (0-0.05, 0.05-0.10, 0.10-0.15, 0.15-0.20 and 0.20-0.30 m) as the subsubplots, with four replications. The aggregate morphology was determined through images and later evaluated by the Quantporo software. Stability was determined by the wet method. The results showed that the no-tillage system, with or without gypsum residual effect, provided the aggregates with the largest geometric diameters. The combination of no-tillage system and the gypsum residual effect provided rougher aggregates.

In vitro growth and leaf anatomy of Cattleya walkeriana (Gardner, 1839) grown in natural ventilation system

Natural ventilation system facilitates gaseous exchanges in in vitro plants promoting changes in the leaf tissue, which can be evaluated through the leaf anatomy, and it allows a cultivation closer to the photoautrophic micropropagation. The objective of this work was to evaluate the effects on in vitro growth and on the leaf anatomy of Cattleya walkeriana grown in natural and conventional ventilation system with different concentrations of sucrose (0; 15; 30 and 45 L-1) combined with different cultivation systems (conventional micropropagation and natural ventilation system). The culture medium was composed of MS salts, solidified with 7 g L-1 of agar and pH adjusted to 5.8. Forty milliliters of culture medium were distributed in 250 mL flasks, autoclaved at 120 ºC for 20 minutes. The greater plant growth, as well as the greater thickness of the mesophyll was observed with the use of 20 g L-1 sucrose in natural ventilation system. Plants grown in natural ventilation system showed a thicker leaf mesophyll, which is directly related to photoautotrophic crops. The natural ventilation system induced more elliptical stomata and probably more functional formats.

Soil chemical properties affected by cover crops under no-tillage system

The use of cover crops in no-tillage systems (NTS) can significantly improve the soil's fertility. Thus, a study was performed to evaluate changes in chemical properties of soil caused by cover crops in a no-tillage system. The field experiment consisted of the following crop rotation: cover crops/rice/cover crops/rice. The experimental design was in randomized blocks with three replications. Treatments consisted of four cover crops (Brachiaria brizantha(Hochst. ex A. Rich.) Stapf. cv. Marandu, Brachiaria ruziziensis R. Germ. and C.M. Evrard, Panicum maximum Jacq. cv. Colonião, and Pennisetum glaucum(L.) R. Br. cv. BN-2) and fallow (control treatment). Soil samples were collected at the beginning of the summer crop in Oct 2007, Oct 2008 and Oct 2009 at 0-5 cm soil depth. The use of cover crops provided for a significant increase in the level of nutrients, soil organic matter, cation exchange capacity, and base saturation in the soil. Soil fertility improved from the first to second year with the growing of cover crops. The soil under cover crops P. glaucum, B. ruziziensis, and B. brizantha showed higher fertility than the area under fallow.

Weed suppression by green manure in an agroecological system

ABSTRACT Green manure promotes efficient suppression of weeds, but green manure species can exhibit distinct behaviors, depending on the environmental conditions. This study aimed to evaluate the potential of soil mulching and weed suppression by spring/summer green manure species grown in the spring/summer season, at different growth stages and after management (cut), for 90 days during the cassava crop cycle. The study was carried out in the 2010/2011 season, in a system managed under agroecological principles. The treatments consisted of different green manure species and arrangements: Crotalaria juncea, Cajanus cajan, Canavalia brasiliensis, Canavalia ensiformis, Pennisetum americanum, Crotalaria juncea and Pennisetum americanum intercropped; Mucuna aterrima, Sorghum bicolor, a mixture of all the green manures in study and a control plot under fallow. The experiment was arranged in a randomized block design with four replications. The evaluations of the soil cover either by the green manures or weeds were performed at 45, 90 and 105 days after the emergence of the green manures. The cassava crop was planted under reduced tillage system at 11 days after the cut of the green manures. The percentage of soil covered by weeds and the dry matter produced were evaluated at 30, 60 and 90 days after planting. The results showed that the green manures had a suppressive effect on weeds during their life cycle, as well as during the first months after its management (cut), composing the mulch.