Longer-term assessment of trastuzumab-related cardiac adverse events in the Herceptin Adjuvant (HERA) trial

We investigated the incidence of cardiac adverse events in patients with early breast cancer in the Herceptin Adjuvant (HERA) trial who were treated with 1 year of trastuzumab after completion of (neo)adjuvant chemotherapy.

Cardiac toxicity with anti-HER-2 therapies: what have we learned so far?

Trastuzumab, a monoclonal antibody that blocks HER-2 receptor, improves the survival of women with HER-2-positive early and advanced breast cancer when given with chemotherapy. Lapatinib, a dual tyrosine kinase inhibitor of EGFR and HER-2, is approved for the treatment of metastatic breast cancer patients after failure of prior anthracycline, taxanes and trastuzumab therapies in combination with capecitabine. Importantly, cardiac toxicity, manifested as symptomatic congestive heart failure or asymptomatic left ventricular ejection fraction decline, has been reported in some of the patients receiving these novel anti-HER-2 therapies, particularly when these drugs are used following anthracyclines, whose cardiotoxic potential has been recognized for decades. This review will focus on the incidence, natural history, underlying mechanisms, management, and areas of uncertainty regarding trastuzumab-and lapatinib-induced cardiotoxicity.

2 years versus 1 year of adjuvant trastuzumab for HER2-positive breast cancer (HERA): an open-label, randomised controlled trial

BACKGROUND Trastuzumab has established efficacy against breast cancer with overexpression or amplification of the HER2 oncogene. The standard of care is 1 year of adjuvant trastuzumab, but the optimum duration of treatment is unknown. We compared 2 years of treatment with trastuzumab with 1 year of treatment, and updated the comparison of 1 year of trastuzumab versus observation at a median follow-up of 8 years, for patients enrolled in the HERceptin Adjuvant (HERA) trial. METHODS The HERA trial is an international, multicentre, randomised, open-label, phase 3 trial comparing treatment with trastuzumab for 1 and 2 years with observation after standard neoadjuvant chemotherapy, adjuvant chemotherapy, or both in 5102 patients with HER2-positive early breast cancer. The primary endpoint was disease-free survival. The comparison of 2 years versus 1 year of trastuzumab treatment involved a landmark analysis of 3105 patients who were disease-free 12 months after randomisation to one of the trastuzumab groups, and was planned after observing at least 725 disease-free survival events. The updated intention-to-treat comparison of 1 year trastuzumab treatment versus observation alone in 3399 patients at a median follow-up of 8 years (range 0-10) is also reported. This study is registered with ClinicalTrials.gov, number NCT00045032. FINDINGS We recorded 367 events of disease-free survival in 1552 patients in the 1 year group and 367 events in 1553 patients in the 2 year group (hazard ratio [HR] 0·99, 95% CI 0·85-1·14, p=0·86). Grade 3-4 adverse events and decreases in left ventricular ejection fraction during treatment were reported more frequently in the 2 year treatment group than in the 1 year group (342 [20·4%] vs 275 [16·3%] grade 3-4 adverse events, and 120 [7·2%] vs 69 [4·1%] decreases in left ventricular ejection fraction, respectively). HRs for a comparison of 1 year of trastuzumab treatment versus observation were 0·76 (95% CI 0·67-0·86, p<0·0001) for disease-free survival and 0·76 (0·65-0·88, p=0·0005) for overall survival, despite crossover of 884 (52%) patients from the observation group to trastuzumab therapy. INTERPRETATION 2 years of adjuvant trastuzumab is not more effective than is 1 year of treatment for patients with HER2-positive early breast cancer. 1 year of treatment provides a significant disease-free and overall survival benefit compared with observation and remains the standard of care. FUNDING F Hoffmann-La Roche (Roche).

[Tisis] /

Tesis Univ. Río de Janeiro.

Memoria sobre a pesca do bacalho offerecida a companhia de pescarias Lisbonense /

Mode of access: Internet.

Arquitetura escolar Infantil modulada e flexível

For many y ears, the federal government policy is to use project for in order to speed up the work for decreasing the elementary education deficit vacancy . In Natal municipality the schoolhouses for children, from 0 to 6 years of age are denom inated Muinicipality Centre for Elementary Education. The federal government provides capital for the news edifications by the program of government named PROINFÂNCIA. This program embraces three types of projects. Type “A” must be furnished by the interes ted municipality and approved by Education and Cultura Ministry. The type “B” is standard plan with capability to 120 schoolchildren in full - time or 240 in two turns and ground plot measuring 40 x 70m and the “type C” also a standart projects to 60 schoolc hildren in full - time or 120 in two turns and ground plot measuring 35 x 45m. Sometimes , due to scarcity of bigger ground plot s is the “type C” instead of “type B”, referring to offering vacancies. In this meaning, this study intend s to present the draft - project to elementary schoolhouse, modulated and flexible, emphasizing the children needs . Therefore, it was studied concept, school architecture, construction technology, reference study and visiting to MCEE Fernanda Jales (PROINFÂNC IA “tipo B”). However, the proposal synthesizes the draft - project by module, implanting in its totality or in parts, according to its necessity and lot cha racteristic.

Acessibilidade em área comercial: um estudo do bairro do Alecrim, Natal/RN

Planejar o espaço urbano pensando na inclusão social de pessoas com deficiência significa considerar a acessibilidade como fator essencial para uma mobilidade urbana completa e segura. Esse ideal reflete-se no espaço comercial que, para ser convidativo e livre de barreiras (sejam elas físicas, tecnológicas ou atitudinais), precisa promover o direito de livre acesso a todos os cidadãos. Partindo deste entendimento, esse estudo tem como objetivo geral analisar as condições de acessibilidade da região denominada “Coração do Alecrim”, área de tradicional comércio popular em Natal. A pesquisa recorreu à abordagem multimétodos e aconteceu em três momentos: (i) avaliação técnica da área por meio da aplicação de check-list, elaborado com base na legislação específica e validado por painel de experts; (ii) elaboração de mapas com uso de Sistema de Informação Geográfica (S.I.G.), tendo como base o resultado da análise realizada na primeira etapa; (iii) aplicação de questionários e realização de entrevistas informais com usuários (visitantes, proprietários e comerciários), para coletar dados sobre sua percepção sobre o lugar, complementando a análise técnica efetuada. Resumindo as informações coletadas, foram elaboradas matrizes de descobertas, como uma junção de todas as etapas de análise. Na conclusão são apresentados pontos críticos de acessibilidade (detectados pela pesquisadora ou apontados pelos usuários) e indicadas algumas diretrizes para a intervenção no local, de modo a colaborar para futuros processos de planejamento urbano do bairro do Alecrim.

Espaço de todos ou de ninguém: análise morfológica de transformações espaciais dos Conjuntos Residenciais Parque Serrambi em Natal/ RN

This work analyses the effects of form over the emergence of new patterns of use and occupation in public spaces of housing estates designed in the 1980s and 1990s in Natal’s municipality (Brazil). We start from the premise that form acts on social process (HILLIER; HANSON, 1984), and verify how much the original spatial configuration of Parque Serrambi housing states contributed to the creation of new spatial patterns following the interventions of the people living there. The Serrambi states were built in Natal’s south based on an urbanization model following modernist’s principals and aimed to supply demands for popular dwellings. They were one of the last estates financed by the former National Dwelling Bank (BNH) and supervised by the Dwelling Cooperatives Orientation Institute (INOCOOP), materialized a spatial form different from the highrise dwelling experiences from the same period. The results were obtained through configurational analysis based on Space Syntax conceptual and methodological framework, in which space and society are viewed as interrelated. The analyses was based on represanting and quantifying spatial properties and identificatying social patterns related to the interventions. We identified that the original spatial configurations, associated to subtle changes in the states social patterns, analysed independently of non-morphological categories, gave way to the occupation patterns verrified in both Serrambi cases.

Ampliação do Setor de Aulas Teóricas IV - UFRN: proposta arquitetônica baseada no conceito da flexibilidade e adaptabilidade, utilizando os parâmetros de conforto ambiental

In recent years, the Universidade Federal do Rio Grande do Norte (UFRN) has come through an intense process of expansion, common for the Instituições Federais de Ensino Superior (IFES) - Higher Education Institutions – since the implantation of the Programa de Reestruturação e Expansão das Universidades Federais (REUNI), a program of restructuring and expansion of the federal universities. The incentives made at UFRN can be seen into the expansion of the fields of teaching, research and extension, besides hiring human resources and adaptation / expansion of physical spaces. The focus of the UFRN at the technological area through the project (REUNI) has reflected in a significant expansion of the physical structure of the Center of Technology, area where the section of classes IV remains being the main set of rooms that supports the demand of the courses in the technological area, in which highlights the lack of classrooms. In this sense, the work presented here, proposes an architectural blueprint for expanding the physical space of this sector, based in this main parameters: (i) the spatial flexibility that attends the varying numbers of students per class; (ii) the environmental comfort, using the parameters and guidelines constructive for the Bioclimatic Zone 8; (iii) the requirements contained in the rules of ABNT NBR 9050:2004, 9077:2001 and NBR NBR 15220-3:2003. The architectural proposal used the maximum template allowed by the UFRN Central Campus Master Plan, four floors, considering the existing building (area equal to 7413.95 m²) as the ground floor and the extension proposed distributed on three floors, with an area of around 2,535, 00 m² each, making up a total of 7602.65 m² of total area built

A influência do conforto luminoso na satisfação dos profissionais que atuam no ginásio do Centro de Reabilitação Infantil, Natal-RN

This study addresses the environmental quality in therapeutic spaces for children's rehabilitation. The assumption that space is active and interfere in interpersonal relationships, highlights the importance of natural light to the hospital architecture, to foster the creation of environments that encourage and assist in the recovery of patients in the rehabilitation process. Therefore, interferes with health humanization through positive actions in the physiological and emotional effects of natural light, as facilitators of the health recovery process. In Brazil hospital openings systems projects are built exclusively to follow requirements of the local construction code which do not consider the landscape, but only ventilation and heat stroke; and the luminance levels are treated just as recommendations for artificial lighting. The National Policy for Healthcare Humanization presents the environmental comfort as a priority. However, it does not guidelines for achieving it. In this context this research aims to evaluate the lighting comfort in infant therapeutic areas from the professional satisfaction, in order to identify human preferences on the variables: technical and constructive aspects, relationship with the exterior, internal visual interface and quality elements. With this purpose it was adopted as research strategy the Post-Occupancy Evaluation (Technical Functional) through a multi method approach, which included a case study in the rehabilitation gym of Children Rehabilitation Center, at Natal, Rio Grande do Norte, and a reference study at SARAH Rehabilitation Center, Fortaleza Unit at Ceará, both in Brazil northeast. The results indicate that the definition of openings systems should consider external and internal factors to the building, as the natural landscape, the immediate surroundings and activities to be performed. The POE found out the preference of the professional visual privacy in detriment to other analyzed aspects. Thus, it is expected that this study can contribute to the discussion of luminous quality and generate inputs for future projects or renovations in the Children's Rehabilitation Centers, which should not be projected as hospitals