Preoperative serum levels of ca 72-4, cea, ca 19-9, and Alpha-fetoprotein in patients with gastric cancer

INTRODUCTION: The clinical importance of preoperative serum levels of CA 72-4, carcinoembryonic antigen (CEA), CA 19-9, and alpha-fetoprotein (AFP) was prospectively evaluated in 44 patients with gastric cancer. METHOD: The serum tumor marker levels were determined by commercial radioimmunoassay kits. Positivity for CA 72-4 (>4 U/mL), CEA (>5 ng/mL), CA 19-9 (>37 U/mL), and AFP (>10 ng/mL) were correlated according to the stage, histology, and lymph node metastasis. RESULTS AND DISCUSSION: CA 72-4 showed a higher positivity rate for gastric cancer (47.7%) than CEA (25%), CA 19-9 (25%), and AFP (0%). The combination of CA 72-4 with CEA and CA 19-9 increased the sensitivity to 61.4%. The positivity rates of CA 72-4 in patients at stages I and II (initial disease) and in patients at stages III and IV (advanced disease) were 9% and 60.6%, respectively (P < 0.005). No correlation was found between CEA and CA 19-9 levels and the stage of gastric cancer. There was a tendency of positivity for CA 72-4 to suggest lymph node involvement, but it was not significant (P = 0.075). Serum levels of tumor markers did not show a correlation with the histological types of gastric cancer. CONCLUSION: Preoperative serum levels of CA 72-4 provided a predictive value in indicating advanced gastric cancer.

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.

Umbilical mass as the sole presenting symptom of pancreatic cancer: a case report

Umbilical nodes are rare. The metastatic involvement of the region was first described in 1846. Sister Mary Joseph was the first observer to establish the correlation between carcinomas and umbilical nodes. The umbilical node may be the sole presenting sign of cancer and is usually associated with advanced disease and poor prognosis. A 64-year-old woman, previously healthy, presented vague abdominal discomfort and a hard umbilical nodule for 1 week, which was first diagnosed as an incarcerated umbilical hernia. She underwent a new clinical assessment and biopsy. After immunohistochemical analysis and computerized tomography, she was diagnosed with pancreatic cancer. The clinical staging showed advanced disease with distant metastasis. She received palliative chemotherapy. After 8 months, she was alive in poor clinical condition. Clinical suspicion should lead to a careful additional evaluation whenever an umbilical nodule presents with malignant signs.

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.

Taxonomic relevance of seed and seedling morphology in two Amazonian species of Entada (Leguminosae)

We carried out a comparative morphological study to evaluate the taxonomic value of seed and seedling traits of Entada polystachya and E. simplicata (Leguminosae, Mimosoideae, Mimoseae). Seeds of both species were collected from wild populations in Roraima State, Brazil. Our results show consistent quantitative and qualitative differences between these species regarding their seeds and seedlings. Testa fracture lines, funiculus impression, lens characters, radicle shape and length, and cotyledon lobes length, seedling morphology group, number of pinnae at first node, and hypocotyl length permit a straightforward distinction of E. polystachya from E. simplicata, supporting a recent treatment of the latter taxon as a distinct species, endemic to Roraima State, northern Amazonia, Brazil.

Flow updating: fault-tolerant aggregation for dynamic networks

Documento submetido para revisão pelos pares. A publicar em Journal of Parallel and Distributed Computing. ISSN 0743-7315

Refinement in hybridised institutions

Hybrid logics, which add to the modal description of transition structures the ability to refer to specific states, offer a generic framework to approach the specification and design of reconfigurable systems, i.e., systems with reconfiguration mechanisms governing the dynamic evolution of their execution configurations in response to both external stimuli or internal performance measures. A formal representation of such systems is through transition structures whose states correspond to the different configurations they may adopt. Therefore, each node is endowed with, for example, an algebra, or a first-order structure, to precisely characterise the semantics of the services provided in the corresponding configuration. This paper characterises equivalence and refinement for these sorts of models in a way which is independent of (or parametric on) whatever logic (propositional, equational, fuzzy, etc) is found appropriate to describe the local configurations. A Hennessy–Milner like theorem is proved for hybridised logics.

Concise server-wide causality management for eventually consistent data stores

Large scale distributed data stores rely on optimistic replication to scale and remain highly available in the face of net work partitions. Managing data without coordination results in eventually consistent data stores that allow for concurrent data updates. These systems often use anti-entropy mechanisms (like Merkle Trees) to detect and repair divergent data versions across nodes. However, in practice hash-based data structures are too expensive for large amounts of data and create too many false conflicts. Another aspect of eventual consistency is detecting write conflicts. Logical clocks are often used to track data causality, necessary to detect causally concurrent writes on the same key. However, there is a nonnegligible metadata overhead per key, which also keeps growing with time, proportional with the node churn rate. Another challenge is deleting keys while respecting causality: while the values can be deleted, perkey metadata cannot be permanently removed without coordination. Weintroduceanewcausalitymanagementframeworkforeventuallyconsistentdatastores,thatleveragesnodelogicalclocks(BitmappedVersion Vectors) and a new key logical clock (Dotted Causal Container) to provides advantages on multiple fronts: 1) a new efficient and lightweight anti-entropy mechanism; 2) greatly reduced per-key causality metadata size; 3) accurate key deletes without permanent metadata.

Permanent and temporary pacemaker implantation after orthotopic heart transplantation

PURPOSE:To determine the indication for and incidence and evolution of temporary and permanent pacemaker implantation in cardiac transplant recipients. METHODS: A retrospective review of 114 patients who underwent orthotopic heart transplantation InCor (Heart Institute USP BR) between March 1985 and May 1993. We studied the incidence of and indication for temporary pacing, the relationship between pacing and rejection, the need for pemanent pacing and the clinical follow-up. RESULTS: Fourteen of 114 (12%)heart transplant recipients required temporary pacing and 4 of 114 (3.5%) patients required permanent pacing. The indication for temporary pacing was sinus node dysfunction in 11 patients (78.5%) and atrioventricular (AV) block in 3 patients (21.4%). The indication for permanent pacemaker implantation was sinus node dysfunction in 3 patients (75%) and atrioventricular (AV) block in 1 patient (25%). We observed rejection in 3 patients (21.4%) who required temporary pacing and in 2 patients (50%) who required permanent pacing. The previous use of amiodarone was observed in 10 patients (71.4%) with temporary pacing. Seven of the 14 patients (50%) died during follow-up. CONCLUSION: Sinus node dysfunction was the principal indication for temporary and permanent pacemaker implantation in cardiac transplant recipients. The need for pacing was related to worse prognosis after cardiac transplantation.

Nonrespiratory Sinus Arrhythmia

We report here 2 cases of sinus arrhythmia considered to be a form of nonrespiratory sinus arrhythmia because they did not have variances in the RR interval sequence within the oscillations modulated by respiration. Because the patients had pulsus alternans similar that observed in bigeminy, and because they did not have signs or symptoms of heart failure, we believe the arrhythmias represent intrinsic alterations of the electric activity of the sinus node

Avaliação da expressão de mediadores imunitários em amostras de cetáceos capturados acidentalmente em Portugal Continental

Dissertação de Mestrado Integrado em Medicina Veterinária

Factores críticos de desarrollo de comunidades locales y regionales de la zona pampeana de la Provincia de Córdoba

El proyecto es la primera de tres etapas previstas para determinar factores críticos que inciden en el desarrollo local y regional integrado en la Provincia de Córdoba. Las poblaciones del interior de la Provincia de Córdoba, con exclusión de la Capital y de las principales ciudades del interior, han padecido los procesos de concentración geográfica del ingreso, la riqueza, los presupuestos oficiales y las migraciones. Muchas veces librada a su suerte, la sociedad civil de estas comunidades desarrolló y capitalizó una red de instituciones que prestan los servicios que el Estado no cubrió. Los gobiernos locales, a la vez, intentan, con éxitos limitados, detener el procesos de descapitalización social -financiera y humana de sus comunidades. Las empresas, con ciclos recurrentes de crecimiento y decrecimiento vinculados a los mercados, se debaten en la búsqueda de los escasos recursos, financieros y humanos, que les permitan consolidar un desarrollo a mediano y largo plazo. Juntos tienen, especialmente en la región pampeana de la Provincia, una nueva oportunidad de hacerlo. Según nuestra hipótesis, incidirían en estos procesos como factores críticos: 1. Aspectos exógenos que descapitalizan las comunidades como los tributarios (impuestos y gasto geográfico), financieros (colocaciones y préstamos), educativos (migración de los miembros más capacitados), sanitarios (por la concentración de las prestaciones de mayor complejidad), y de prestación de servicios públicos (por las mayores tarifas y menores prestaciones) de las empresas de capital concentrado. 2. Aspectos endógenos que producen des-economías, ineficiencias y desaprovechamiento de los recursos (humanos, productivos, tecnológicos, organizativos y financieros) locales y regionales, como: la falta de un proyecto local y/o regional común; dinámicas no participativas; insuficiencia, dispersión y desconocimiento de información clave para la planeación; diferencias personales y conflictos de roles; carencia de cadenas productivas integradas verticalmente El proyecto propone como objetivos: 1. Identificar y, en la medida de lo posible, cuantificar los factores críticos exógenos y endógenos para el desarrollo local y regional integrado; 2. elaborar sobre esta base modelos de desarrollo, proyectos interinstitucionales y propuestas de cadenas productivas que disminuyan los problemas y potencien las oportunidades de las comunidades regionales estudiadas

Regionalización provincial y asociativismo intermunicipal en Córdoba (2005-2007): balance y recomendaciones

A partir de un amplio acuerdo entre los gobiernos locales de todos los partidos políticos y el gobierno provincial, el 22 de diciembre de 2004, la Legislatura de Córdoba sancionó la Ley orgánica de regionalización provincial Nº 9206. Con el desarrollo como fin, la Ley Nº 9206 supuso dos innovaciones trascendentes: por una parte, la creación de 26 nuevas regiones a razón de una por cada departamento existente y, por la otra, el reconocimiento de Comunidades Regionales a integrarse por decisión autónoma de los municipios y comunas (gobernadas por los Intendentes municipales y Presidentes comunales de cada región). En el 2005, se integraron 212 municipios y 152 comunas (es decir el 85% del total provincial) en 23 Comunidades Regionales que, además, acordaron sus prioridades de gestión regional y un Indicador de Desarrollo Regional, mediante la asistencia técnica del Programa de Fortalecimiento Institucional de Municipios (PROFIM) de la UCC. Sobre esas bases, en el 2006; las universidades cordobesas (mediante convenios con el Gobierno provincial) asesoraron a 17 Comunidades Regionales en el diseño de políticas de desarrollo. Esta investigación problematiza la regionalización en Córdoba, analizando críticamente sus avances y demoras, desde su puesta en marcha (diciembre de 2004) hasta el recambio de autoridades (diciembre de 2007) con el propósito de recomendar correcciones.

La problemática ambiental de la Región Punilla (Provincia de Córdoba): estudio y promoción de prácticas participativas y cogestivas para su abordaje y resolución

En el marco de la regionalización de la Provincia de Córdoba, a partir de la sanción de la Ley 9206 y de la posterior consolidación de la Comunidad Regional Punilla -procesos en los cuales este equipo ha tomado parte activa a raíz de la asistencia técnica-; se percibe, a partir de la identificación por parte de los actores públicos de la problemática vinculada a la sustentabilidad ambiental como problemática prioritaria del Valle de Punilla, la oportunidad de promover la participación de la sociedad en la gestión regional. La complejidad y multidimensionalidad de la problemática socioambiental lo propicia, al tiempo que la consideración en la legislación mencionada de la participación de la sociedad civil abre una brecha entre la formalidad y la materialidad de la CRP, cuestionando las posibilidades de promover la convergencia socio-política. El proyecto busca contribuir a la generación y consolidación de espacios multiactorales de concertación que faciliten el diseño y la gestión de estrategias y políticas regionales consensuadas. La estrategia de intervención del equipo recepta buena parte de los aspectos teórico-conceptuales que sustentan las metodologías conocidas como PPGA (Planificación Participativa y Gestión Asociada. FLACSO) reconociendo sus potencialidades para el estudio y la promoción de prácticas participativas cogestivas en procesos de cambio político y social. En ese sentido, se procurará la conformación gradual de una red mixta socio-gubernamental a través de la producción de conocimientos aprovechables en tiempo real y con procesos de elaboración que garanticen la apropiación de ese conocimiento por parte de los sujetos involucrados. Así, los resultados parciales del proyecto aportarán a la dinámica constructiva de acuerdos interactorales que han de traducirse en una mayor participación social en el sistema decisorio regional y se espera que aquellos resultados parciales sean compartidos durante el desarrollo mismo del proyecto y no solamente al momento de su finalización.

Las transformaciones de la burocracia provincial en perspectiva comparada: capacidades del Estado en provincias argentinas

A partir de las políticas de descentralización llevadas adelante en Argentina desde la década de los ochenta, las provincias han adquirido una importante serie de nuevas funciones lo cual las ha obligado a ampliar y diversificar sus estructuras burocráticas y administrativas. Este proyecto busca abordar las transformaciones ocurridas durante los últimos veinte años en la organización burocrática de tres estados provinciales en Argentina. El proyecto pretende, utilizando un diseño comparado, indagar dos aspectos de la organización burocrática: el diseño organizacional institucional (leyes de Ministerios) y la división del trabajo que ello implica; y los principales procesos administrativos transversales que articulan funcionalmente las diferentes áreas de la burocracia provincial (administración financiera y recursos humanos). A partir de ello nos interesa poner en relación estas transformaciones con los cambios que va experimentando la agenda gubernamental. Suponemos, en este sentido, que los cambios organizacionales responden a cambios en dicha agenda y a la relación de fuerzas políticas que va implícita en la conformación de las mismas. De este modo, nuestra hipótesis plantea que los cambios organizaciones generados por la transformación de las agendas se manifiestan de forma más inmediata en la dimensión del diseño organizacional, mientras que los procesos administrativos transversales experimentan cambios más graduales y no necesariamente vinculados a las transformaciones de la primera dimensión. La investigación permitirá fortalecer el estudio de la administración y las organizaciones públicas, lo que representa una tarea altamente significativa (y necesaria) para el mejoramiento del sector público y las necesidades de la ciudadanía