Microsatellite instability in solitary and sporadic gastric cancer

Recently, the presence of microsatellite instability (MSI) has been reported in gastric cancer and associated with older age of presentation, distal tumor location, early disease staging, and better overall prognosis. Different characteristics in presentation and in tumor behavior may be explained by different genetic alterations during carcinogenesis of gastric cancer. Identification of specific genetic pathways in gastric cancer may have direct impact on prognosis and selection of treatment strategies. PATIENTS AND METHODS: All 24 patients were treated by radical surgery. Fragments of normal and tumor tissues were extracted from the specimen and stored at -80ºC before DNA purification and extraction. PCR amplification utilizing microsatellite markers was performed. Tumors presenting PCR products of abnormal sizes were considered positive for microsatellite instability (MSI+). RESULTS: Five patients (21%) had tumors that were MSI+ in at least 1 marker. In the group of patients with Lauren's intestinal-type gastric carcinoma, 3 had tumors that were MSI+ (23%), while in the group of diffuse-type gastric cancer, 2 patients had tumors that were MSI+ (19%). The mean age of presentation and the male:female ratio was similar in both groups. Tumors that were MSI+ were more frequently located in proximal portion of the stomach compared to microsatellite-stable (MSS) tumors (40% vs. 16%). Although there was a trend of patients with MSI+ tumors towards a proximal gastric tumor location, early staging, and negative lymph node metastasis, there was no statistical significance compared to those with MSS tumors (P >.1). Comparison of overall and disease-free survival between gastric tumors that were MSI+ and those that were MSS found no statistically significant differences (P >.1). CONCLUSIONS: Microsatellite instability is a frequent event in gastric carcinogenesis and shows a trend towards distinct clinical and pathological characteristics of gastric cancer.

Integrated management systems as complex adaptive systems

It is a difficult task to avoid the “smart systems” topic when discussing smart prevention and, similarly, it is a difficult task to address smart systems without focusing their ability to learn. Following the same line of thought, in the current reality, it seems a Herculean task (or an irreparable omission) to approach the topic of certified occupational health and safety management systems (OHSMS) without discussing the integrated management systems (IMSs). The available data suggest that seldom are the OHSMS operating as the single management system (MS) in a company so, any statement concerning OHSMS should mainly be interpreted from an integrated perspective. A major distinction between generic systems can be drawn between those that learn, i.e., those systems that have “memory” and those that have not. These former systems are often depicted as adaptive since they take into account past events to deal with novel, similar and future events modifying their structure to enable success in its environment. Often, these systems, present a nonlinear behavior and a huge uncertainty related to the forecasting of some events. This paper seeks to portray, for the first time as we were able to find out, the IMSs as complex adaptive systems (CASs) by listing their properties and dissecting the features that enable them to evolve and self-organize in order to, holistically, fulfil the requirements from different stakeholders and thus thrive by assuring the successful sustainability of a company. Based on the revision of literature carried out, this is the first time that IMSs are pointed out as CASs which may develop fruitful synergies both for the MSs and for CASs communities. By performing a thorough revision of literature and based on some concepts embedded in the “DNA” of the subsystems implementation standards it is intended, specifically, to identify, determine and discuss the properties of a generic IMS that should be considered to classify it as a CAS.

Analysis of integrated management systems from various perspectives

This article compiles the main topics addressed by management systems (MSs) literature concerningMSs integration by performing a systematic literature review. In this paper, it is intended to present themain limitations of non-integratedmanagement systems (IMSs), the main motivations driving an IMS implementation, the major resistances faced, the most common resultant benefits, the suitable guidelines and standards and the critical success factors. In addition, this paper addresses the issues concerning integration strategies and models, the integration levels or degrees achieved by an IMS and the audit function in an integrated context. The motivations that drive companies to integrate their management subsystems, the obstacles faced and the benefits collected may have internal or external origins. The publishing of standards guiding companies on how to integrate their management subsystems has been done mainly at a national level. There are several models that could be used in order to support companies in their management subsystems integration processes, and a sequential or an all-in strategy may be adopted. Four audit typologies can be distinguished, and the adoption of any of these typologies should consider resource availability and audit team know-how, among other features.

Integrated management systems: A model for maturity assessment

Maturity models are adopted to minimise our complexity perception over a truly complex phenomenon. In this sense, maturity models are tools that enable the assessment of the most relevant variables that impact on the outputs of a specific system. Ideally a maturity model should provide information concerning the qualitative and quantitative relationships between variables and how they affect the latent variable, that is, the maturity level. Management systems (MSs) are implemented worldwide and by an increasing number of companies. Integrated management systems (IMSs) consider the implementation of one or several MSs usually coexisting with the quality management subsystem (QMS). It is intended in this chapter to report a model based on two components that enables the assessment of the IMS maturity, considering the key process agents (KPAs) identified through a systematic literature review and the results collected from two surveys.

Arrhythmogenic cardiomyopathy of the right ventricle. Predictive value of QT interval dispersion to assess arrhythmogenic risk and sudden death

OBJECTIVE: To determine in arrhythmogenic right ventricular cardiomyopathy the value of QT interval dispersion for identifying the induction of sustained ventricular tachycardia in the electrophysiological study or the risk of sudden cardiac death. METHODS: We assessed QT interval dispersion in the 12-lead electrocardiogram of 26 patients with arrhythmogenic right ventricular cardiomyopathy. We analyzed its association with sustained ventricular tachycardia and sudden cardiac death, and in 16 controls similar in age and sex. RESULTS: (mean ± SD). QT interval dispersion: patients = 53.8±14.1ms; control group = 35.0±10.6ms, p=0.001. Patients with induction of ventricular tachycardia: 52.5±13.8ms; without induction of ventricular tachycardia: 57.5±12.8ms, p=0.420. In a mean follow-up period of 41±11 months, five sudden cardiac deaths occurred. QT interval dispersion in this group was 62.0±17.8, and in the others it was 51.9±12.8ms, p=0.852. Using a cutoff > or = 60ms to define an increase in the degree of the QT interval dispersion, we were able to identify patients at risk of sudden cardiac death with a sensitivity of 60%, a specificity of 57%, and positive and negative predictive values of 25% and 85%, respectively. CONCLUSION: Patients with arrhythmogenic right ventricular cardiomyopathy have a significant increase in the degree of QT interval dispersion when compared with the healthy population. However it, did not identify patients with induction of ventricular tachycardia in the electrophysiological study, showing a very low predictive value for defining the risk of sudden cardiac death in the population studied.

Flora oder Botanische Zeitung :welche Recensionen, Abhandlungen, Aufsätze, Neuigkeiten und Nachrichten, die Botanik betreffend, enthält /herausgegeben von der Königl. Botanischen Gesellschaft in Regensburg.

v.12:no.2 (1829)

Secular trends in a population with ischemic heart disease admitted to the Instituto do Coração in São Paulo

OBJECTIVE: To assess the clinical and demographic characteristics of a population with ischemic heart disease admitted in the final decades of the 20th century. METHODS: This study retrospectively assessed patients hospitalized with ischemic heart disease divided into the following 2 groups: acute group - 11.181 patients with acute myocardial infarction admitted from 1/1/82 to 12/31/94; and chronic group - 4.166 patients undergoing coronary artery bypass graft surgery from 1/1/84 to 12/31/94. RESULTS: In the acute group, an increase in the percentage of females (from 22.7% to 27.7%, P<0.001) and diabetic individuals (from 12.4% to 17.5%, P<0.001) was observed, as was an increase in age (from 57.4±11.5 to 59.9±12.1 years, P<0.05). In-hospital mortality was greater among females (27.8% and 15.7%, P=0.001), among diabetic individuals (24.2% and 17.8%, P=0.001), and among the elderly (60.9±15.2 and 57.7±11.8 years, P=0.0001). In the chronic group, an increase in the percentage of females (from 17.5% to 27.2%, P=0.001) was observed, as was an increase in age (from 56.3±8.6 to 60.5±9.6 years, P=0.0001). In-hospital mortality was greater among females (8.3% and 5.8%, P<0.05) and among the elderly (58.1±9.1 and 62.1±7.9 years, P=0.0001). CONCLUSION: The characteristics of the population studied with ischemic heart disease point towards a worse prognosis, due to the greater percentages of females, older patients, and diabetic patients, groups known to have greater in-hospital mortality.

Genera et species muscorum systematice disposita ; seu, adumbratio florae muscorum totius orbis terrarum /auctoribus Dr. Augusto Jæger et Fr. Sauerbeck.

v.1

Genera et species muscorum systematice disposita ; seu, adumbratio florae muscorum totius orbis terrarum /auctoribus Dr. Augusto Jæger et Fr. Sauerbeck.

v.2

Doppler tecidual como índice prognóstico em longo prazo na disfunção sistólica do ventrículo esquerdo

FUNDAMENTO: Parâmetros derivados do Doppler tecidual correlacionam-se com a pressão diastólica final do ventrículo esquerdo (VE) e podem servir como índice prognóstico na insuficiência cardíaca. OBJETIVO: Determinar se parâmetros do Doppler tecidual podem predizer eventos em longo prazo em pacientes ambulatoriais com disfunção sistólica do VE. MÉTODOS: Estudo retrospectivo envolvendo 73 pacientes (60,9±12,1 anos) que realizaram ecocardiograma Doppler entre março de 2001 e maio de 2004. O evento primário pesquisado foi morte ou hospitalização por piora da insuficiência cardíaca. RESULTADOS: O período de seguimento médio foi de 1.367±665 dias. Após análise logística multivariada "stepwise" incluindo os parâmetros ecocardiográficos, a razão entre as velocidades máximas de enchimento do VE e miocárdica no início da diástole (razão E/E'; p=0,0007) e a fração de ejeção do VE (FE; p=0,01) permaneceram como preditores do evento primário. Os pontos de corte ótimos para a previsão do evento primário para a razão E/E' (AUC 0,77; p=0,0001) e FE (AUC 0,68; p=0,006) foram, respectivamente, 12,7% e 30%. Assim, pacientes com razão E/E' > 12,7 (razão de risco=3,8, p=0,001) ou FE <30% (razão de risco=2,3, p=0,03) demonstravam pior prognóstico pela análise da curva de sobrevida. Importante salientar que 47% dos pacientes com FE acima do ponto de corte, mas razão E/E' elevada, apresentaram eventos durante o período estudado. CONCLUSÃO: Em pacientes ambulatoriais com disfunção sistólica do VE, a razão E/E' é um importante e independente indicador prognóstico em longo prazo de morte ou hospitalização. Portanto, recomenda-se incluir a medida dessa variável na avaliação rotineira desses pacientes.

Hepatology - A Clinical Textbook, Fifth Edition

Hepatology is an ever - changing field. The editors and authors of Hepatology − A Clinical Textbook have made every effort to provide information that is accurate and complete as of thedate of publication. However, in view of the rapid changes occurring in medical science, as well as the possibility of human error, this book may contain technical inaccuracies, typographical or other errors. Readers are advised to check the product information currently provided by the manufacturer of each drug to be administered to verify the recommen ded dose, the method and duration of administration, and contraindications. It is the responsibility of the treating physician who relies on experience and knowledge about the patient to determine dosages and the best treatment for the patient. The informa tion contained herein is provided "as is" and without warranty of any kind. The editors and Flying Publisher & Kamps disclaim responsibility for any errors or omissions or for results obtained from the use of information contained herein.

Aspectos ecológicos e levantamento malacológico para identificação de áreas de risco para transmissão da esquistossomose mansoni no litoral norte de Pernambuco, Brasil

Realizou-se levantamento malacológico na praia de Carne de Vaca, município de Goiana, litoral norte de Pernambuco, entre novembro de 2006 e outubro de 2007, com o objetivo de conhecer a fauna malacológica dessa localidade e verificar as condições naturais, pouco ou bastante alteradas das áreas de estudo através da aplicação de um protocolo de avaliação de diversidade de hábitats. Foram coletados 5.912 moluscos, representados por sete espécies e quatro famílias, dos quais, 5.209 exemplares de Biomphalaria glabrata (Say, 1818), 113 de Drepanotrema lucidum (Pfeiffer, 1839), 55 de Drepanotrema cimex (Moricand, 1837), 13 de Drepanotrema anatinum (Pfeiffer, 1839), 222 de Melanoides tuberculatus (Muller, 1774), 263 de Pomacea sp. e 37 de Physa marmorata Guilding, 1828. Entre os exemplares de B. glabrata coletados, 44 mostraram-se positivos para Schistosoma mansoni Sambon, 1907 e 91 mostraram-se positivos para outras larvas de trematódeos. Um exemplar de Pomacea sp. mostrou-se positivo para larva de trematódeo. Os dados obtidos, georreferenciados espacialmente, serão utilizados para a determinação das áreas de risco para a transmissão da esquistossomose na praia de Carne de Vaca, além de simulações computacionais para estudos de previsibilidade e comportamento do processo de expansão da esquistossomose no estado de Pernambuco.

PulseCath iVAC 3LTM hemodynamic performance for simple assisted flow.

The PulseCath iVAC 3L? left ventricular assist device is an option to treat transitory left heart failure or dysfunction post-cardiac surgery. Assisted blood flow should reach up to 3 l/min. In the present in vitro model exact pump flow, depending on various frequencies and afterload was examined. Optimal flow was achieved with inflation/deflation frequencies of about 70-80/min. The maximal flow rate was achieved at about 2.5 l/min with a minimal afterload of 22 mmHg. Handling of the device was easy due to the connection to a standard intra-aortic balloon pump console. With increasing afterload (up to a simulated mean systemic pressure of 66 mmHg) flow rate and cardiac support are in some extent limited.

A mathematical model to describe fat oxidation kinetics during graded exercise.

PURPOSE: The purpose of this study was to develop a mathematical model (sine model, SIN) to describe fat oxidation kinetics as a function of the relative exercise intensity [% of maximal oxygen uptake (%VO2max)] during graded exercise and to determine the exercise intensity (Fatmax) that elicits maximal fat oxidation (MFO) and the intensity at which the fat oxidation becomes negligible (Fatmin). This model included three independent variables (dilatation, symmetry, and translation) that incorporated primary expected modulations of the curve because of training level or body composition. METHODS: Thirty-two healthy volunteers (17 women and 15 men) performed a graded exercise test on a cycle ergometer, with 3-min stages and 20-W increments. Substrate oxidation rates were determined using indirect calorimetry. SIN was compared with measured values (MV) and with other methods currently used [i.e., the RER method (MRER) and third polynomial curves (P3)]. RESULTS: There was no significant difference in the fitting accuracy between SIN and P3 (P = 0.157), whereas MRER was less precise than SIN (P < 0.001). Fatmax (44 +/- 10% VO2max) and MFO (0.37 +/- 0.16 g x min(-1)) determined using SIN were significantly correlated with MV, P3, and MRER (P < 0.001). The variable of dilatation was correlated with Fatmax, Fatmin, and MFO (r = 0.79, r = 0.67, and r = 0.60, respectively, P < 0.001). CONCLUSIONS: The SIN model presents the same precision as other methods currently used in the determination of Fatmax and MFO but in addition allows calculation of Fatmin. Moreover, the three independent variables are directly related to the main expected modulations of the fat oxidation curve. SIN, therefore, seems to be an appropriate tool in analyzing fat oxidation kinetics obtained during graded exercise.