Depression and Cognition in Type 2 Diabetes from a Life Course Perspective

Background: Type 2 diabetes is linked to several complications which add to both physical and mental distress. Depression is a common co-morbidity of diabetes which can occur both as a cause and a consequence of type 2 diabetes. Depression has been shown to correlate with glucose regulation and treating depression might prove beneficial for glucose regulation as well as for mental well being. Another complication which might affect diabetes management is cognitive decline. Several risk factors and complications of diabetes might modify the risk for developing cognitive impairment, which is increased 1.5 times among subjects with type 2 diabetes. Type 2 diabetes, depression and impaired cognitive performance have all been linked to low birth weight. This thesis aimed to explore the effects and interactions of birth weight, depression and cognitive ability in relation to type 2 diabetes from a life course perspective. Subjects and methods: Studies I, II and V were part of the Helsinki Birth Cohort Study. 2003 subjects participated in an extensive clinical examination at an average age of 61 years. A standard glucose tolerance test (OGTT) was performed and depressive symptoms were assessed using the Beck Depression Inventory (BDI). In addition data was obtained from child welfare clinics and national registers. A subset of the cohort (n=1247) also performed a test on cognitive performance (CogState ®) at the average age of 64. Studies III and IV were randomised clinical trials where mildly depressed diabetic subjects were treated with paroxetine or placebo and the effect on metabolic parameters and quality of life was assessed. The first trial included 14 women and lasted 10 weeks, while the second trial included 43 subjects, both men and women, and lasted 6 months. Results: Type 2 diabetes was positively associated with the occurrence of depressive symptoms. Among diabetic subjects 23.6% had depressive symptoms, compared to 16.7% of subjects with normal glucose tolerance (OR = 1.77, p<0.001). Formal mediation analysis revealed that cardiovascular disease (CVD) is likely to act as a mediator in the association. Furthermore, low birth weight was found to modify the association between type 2 diabetes, CVD and depression. The association between BDI score and having type 2 diabetes or CVD was twice as strong in the subgroup with low birth weight (≤ 2500g) compared with the group with birth weight > 2500g (p for interaction 0.058). In the six months long randomised clinical trial (study IV) paroxetine had a transient beneficial effect on glycosylated haemoglobin A1c (GHbA1c) and quality of life when compared to placebo after three months of treatment. In study V we found that subjects with known diabetes had a consistently poorer level of cognitive performance than subjects with normal glucose tolerance in most of the tested cognitive domains. This effect was further amplified among those born with a small birth weight (p for interaction 0.002). Conclusions: Type 2 diabetes is associated with a higher occurrence of depressive symptoms compared to subjects with normal glucose tolerance. This association is especially strong among subjects with CVD and those born with a low birth weight. Treating depressed diabetic subjects with paroxetine has no long term effect on glucose regulation. Physicians should be aware of depression as an important co-morbidity of type 2 diabetes. Both depression and the cognitive decline often seen among diabetic subjects are increased if the subject is born with a low birth weight. Physicians should recognise low birth weight as an additional risk factor and modifier of diabetic complications.

Studies on electrical switching behavior of As-Te-Tl glasses - effect of local structure on switching type and composition dependence of switching voltages

Bulk As-Te-Tl glasses belonging to the As30Te70-xTlx (4 <= x <= 22) and As40Te60-xTlx (5 <= x <= 20) composition tie lines are studied for their I-V characteristics. Unlike other As-Te-III glasses such as As-Te-Al and As-Te-In, which exhibit threshold behavior, the present samples show memory switching. The composition dependence of switching voltages (V-t) of As-Te-Tl glasses is also different from that of As-Te-Al and As-Te-In glasses, and it is found that V-t decreases with the addition of Tl. Both the type of switching exhibited by As-Te-Tl glasses and the composition dependence of V-t, seems to be intimately connected with the nature of bonding of Tl atoms and the resultant structural network. Furthermore, the temperature and thickness dependence of switching voltages of As-Te-Tl glasses suggest an electro thermal mechanism for switching in these samples.

Generalized Burgers equations and Euler–Painlevé transcendents. III

It was proposed earlier [P. L. Sachdev, K. R. C. Nair, and V. G. Tikekar, J. Math. Phys. 27, 1506 (1986); P. L. Sachdev and K. R. C. Nair, ibid. 28, 977 (1987)] that the Euler–Painlevé equations  y(d2y/dη2)+a(dy/dη)2 +f(η)y(dy/dη)+g(η)y2+b(dy/dη) +c=0 represent generalized Burgers equations (GBE’s) in the same way as Painlevé equations represent the Korteweg–de Vries type of equations. The earlier studies were carried out in the context of GBE’s with damping and those with spherical and cylindrical symmetry. In the present paper, GBE’s with variable coefficients of viscosity and those with inhomogeneous terms are considered for their possible connection to Euler–Painlevé equations. It is found that the Euler–Painlevé equation, which represents the GBE ut+uβux=(δ/2)g(t)uxx, g(t)=(1+t)n, β>0, has solutions, which either decay or oscillate at η=±∞, only when −1

The Reaction of a Nitro-Capped Cobalt(III) Cage Complex With Base: the Crystal Structure of a Contracted Cage Complex, and the Mechanism of Its Formation

The synthesis, properties and crystal structure of the cage complex (1-hydroxy-8-methyl-3,6,10,13,15,18-hexaazabicyclo[6.6.5]nonadecane)cobalt(III) chloride hydrate ([Co(Me,OH-absar)] C13.H2O) are reported. The mechanism of the formation of this contracted cavity cage from a nitro-capped hexaazabicycloicosane type cage has been investigated. Treatment of (1-methyl-8-nitro-3,6,10,13,16,19-hexaazabicyclo[6.6.6]icosane)cobalt(III) chloride ([Co(Me,NO2-sar)] 3+) with excess base in aqueous solution leads initially to rapid (t1/2 < 1 ms) and reversible deprotonation of one coordinated secondary amine. This species undergoes a retro-Mannich type reaction and imine hydrolysis (t1/2 almost-equal-to 90 s). Quenching the reaction with acid gives rise to a pair of isomeric intermediate species which have been isolated and characterized. They have a pendant arm macrocyclic structure, resulting from the loss of a methylene unit from one of the arms of the cap. Heating either isomer in aqueous solution gives the new cage compound with the contracted cap. It is postulated that this occurs through a Nef reaction, resulting in the formation of a ketone which then condenses with the coordinated primary amine. A comparison with the corresponding bicycloicosane analogue indicates a reduced chromophoric cavity size for the contracted cage. The reduction potential of the cobalt(III)/cobalt(II) couple is 170 mV more negative for the smaller cage, and, in the electronic spectrum of the cobalt(III) complex, the d-d transitions are both shifted to higher energy, corresponding to a stronger ligand field.

Extended Huckel molecular orbital calculations on hydroxobridged heterotrinuclear cobalt(III) complexes

EHT calculations on heterotrinuclear cobalt(III) complexes of the type [Cu{(OH)(2)Co(L(4))}(2)](4+) where L(4) denotes (en)(2) or (NH3)(4), en = ethylenediamine and their component species have been carried out. The results regarding bonding and structure for the trinuclear complexes are compared with those for the monomer components such as [Co(en)(2)(OH)(2)](+), [Co(NH3)(4)(OH)(2)](+) and [Cu(OH)(4)](2-) are discussed.

Thermal analysis studies on hydroxobridged homo and hetero trinuclear cobalt(III) complexes

The synthesis and thermal analysis studies of several hydroxobridged homo and hetero trinuclear cobalt(III) complexes are reported. The complexes are of the type [M(H2O)(x) {(OH)(2)Co(en)(2)}(2)](SO4)(2). nH(2)O and [M(H2O)(x){(OH)(2)Co(NH3)(4)}(2)] (SO4)(2). nH(2)O where en denotes ethylenediamine and M =Co(II), Ni(II), Cu(II) and Zn(II) with x=0 for Cu(II), and 2 for other metal ions, and n =3, 4 or 5. The TG and DTA studies of these compounds show that one or more intermediate compounds are formed in each case before the metal oxides are produced.

Prevalence of, and antigenic variation in, serotype G10 rotaviruses and detection of serotype G3 strains in diarrheic calves: Implications for the origin of G10P11 or P11 type reassortant asymptomatic strains in newborn children in India

Previous studies have shown predominant association of G10P11 type bovine rotavirus-derived reassortant strains with asymptomatic infections in newborn children in India. To understand the epidemiological and genetic basis for the origin of these strains in humans, the relative frequencies of different serotypes among bovine rotaviruses (BRVs) isolated from southern, western and central regions of the country were determined by subgroup and serotype analysis as well as nucleotide (nt) sequence analysis of the genes encoding the outer capsid proteins VP4 and VP7. Since the human G10P11 asymptomatic neonatal strain I321 possessed NSP1 from a human rotavirus, to determine its genetic origin in the bovine strains, comparative analysis of partial gene sequences from representative G10P11 strains was also carried out. The following observations were of great epidemiological significance, (i) G10P11 strains predominated in all the three regions with frequencies ranging between 55.6% and 85.2%. In contrast to the high prevalence of G6 strains in other countries, only one G6 strain was detected in this study and G8 strains represented 5.8% of the isolates, (ii) among the G10 strains, in serotyping ELISA, four patterns of reactivity were observed that appeared to correlate with the differences in electropherotypic patterns and amino acid (aa) sequence of the VP7, (iii) surprisingly, strains belonging to serotype G3 were detected more frequently (10.7%) than those of serotypes G6 and G8 combined, while strains representing the new serotype (G15) were observed in a single farm in Bangalore, and (iv) about 3.9% of the isolates were nontypeable as they exhibited high cross-reactivity to the serotyping MAbs used in the study. Comparative analysis of the VP7 gene sequence from the prototype G3 MAb-reactive bovine strain J63 revealed greatest sequence relatedness (87.6% nt and 96.0% aa) with that of serotype G3 rhesus-monkey strain RRV. It also exhibited high sequence homology with the VP7 from several animal and animal rotavirus-related human G3 strains (Simian SA11; equine ERV316 and FI-14. canine CU-1 and K9; porcine 4F; Feline Cat2 and human HCR3, YO and AU1). Partial nucleotide sequence analysis of the NSP1 gene of J63 showed greatest nt sequence homology (95.9%) to the NSP1 gene allele of the Indian G8 strain, isolated from a diarrheic child, which is likely to have been transmitted directly from cattle and 92.6% homology to that of the bovine G8 strain A5-10 suggesting the likely origin of J63 by gene reassortment between a bovine G8 strain and a G3 animal strain. Prevalence of G10P11 strains in cattle and G10P11 or P11 type reassortant strains in asymptomatic neonates as well as detection of G8P[1] strains in diarrheic children support our hypothesis for bidirectional transmission of rotaviruses between humans and cattle and origin of novel strains catalyzed by the age-old traditions and socio-economic conditions in India.

Efficient syntheses of benzothiazepines as antagonists for the mitochondrial sodium-calcium exchanger: Potential therapeutics for type II diabetes

Type II diabetes mellitus is a chronic metabolic disorder that can lead to serious cardiovascular, renal, neurologic, and retinal complications. While several drugs are currently prescribed to treat type II diabetes, their efficacy is limited by mechanism-related side effects (weight gain, hypoglycemia, gastrointestinal distress), inadequate efficacy for use as monotherapy, and the development of tolerance to the agents. Consequently, combination therapies are frequently employed to effectively regulate blood glucose levels. We have focused on the mitochondrial sodium-calcium exchanger (mNCE) as a novel target for diabetes drug discovery. We have proposed that inhibition of the mNCE can be used to regulate calcium flux across the mitochondrial membrane, thereby enhancing mitochondrial oxidative metabolism, which in turn enhances glucose-stimulated insulin secretion (GSIS) in the pancreatic beta-cell. In this paper, we report the facile synthesis of benzothiazepines and derivatives by S-alkylation using 2-aminobenzhydrols. The syntheses of other bicyclic analogues based on benzothiazepine, benzothiazecine, benzodiazecine, and benzodiazepine templates are also described. These compounds have been evaluated for their inhibition of mNCE activity, and the results from the structure-activity relationship (SAR) studies are discussed.

Synthesis, antimicrobial, DNA-binding and photonuclease studies of Cobalt(III) and Nickel(II) Schiff base complexes

New metal complexes of the type M(nih)(L)](PF6)(n)center dot xAH(2)O and M(nih)(2)](PF6)center dot xH(2)O (where M = Co(III) or Ni(II), L = 1,10-phenanthroline (phen)/or 2,2' bipyridine (bpy), nih = 2-hydroxy-1-naphthaldehyde isonicotinoyl hydrazone, n = 2 or 1 and x = 3 or 2) have been synthesized and characterized by elemental analysis, magnetic, IR and H-1 NMR spectral data. The electronic and magnetic moment 2.97-3.07 B.M. data infers octahedral geometry for all the complexes. The IR data reveals that Schiff base (nih) form coordination bond with the metal ion through azomethine-nitrogen, phenolic-oxygen and carbonyl-oxygen in a tridentate fashion. In addition, DNA-binding properties of these six metal complexes were investigated using absorption spectroscopy, viscosity measurements and thermal denaturation methods. The results indicated that the nickel(II) complex strongly bind with calf-thymus DNA with intrinsic DNA binding constant K-b value of 4.9 x 10(4) M-1 for (3), 4.2 x 10(4) M-1 for (4), presumably via an intercalation mechanism compared to cobalt(III) complex with K-b value of 4.6 x 10(4) M-1 (1) and 4.1 x 10(4) M-1 (2). The DNA Photoclevage experiment shows that, the complexes act as effective DNA cleavage agent. (C) 2012 Elsevier B.V. All rights reserved.

Role of dicarboxylate linkers in Mn-III-salicylaldoximate based extended structures: synthesis, structures, and magnetic behavior

Four new oxo-centered Mn-III-salicylaldoximate triangle-based extended complexes (Mn6O2)-O-III(salox)(6)(EtOH)(4)(phda)](n)(saloxH(2))(n)(2H(2)O)(n) (1), (Mn6O2)-O-III(salox)(6)(MeOH)(5)(5-I-isoph)](n)(3MeOH)(n) (2), (Mn6O2)-O-III(salox)(6)(MeOH)(4)(H2O) (5-N-3-isoph)](n)(4MeOH)(n) (3) and (Mn3NaO)-Na-III(salox)(3)(MeOH)(4)(5-NO2-isoph)](n)(MeOH)(n) (H2O)(n) (4) salox=salicylaldoximate, phda=1,3-phenylenediacetate, isoph=isophthalate] have been synthesized under similar reaction conditions. Single crystal X-ray structures show that in 1, only one type of Mn-6 cluster is arranged in 1D, whereas in 2 and 3 there are two types of clusters, differing in the way the triangle units are joined and assembled. In complex4, however, the basic building structure is heteronuclear and based on Mn-3 units extended in 2D. Susceptibility measurements (dc and ac) over a wide range of temperatures and fields show that the complexes1, 2, and 3 behave as single molecule magnets (SMMs) with S=4ground state, while 4 is dominantly antiferromagnetic with a ground spin state S=2. Density functional theory calculations have been performed on model complexes to provide a qualitative theoretical interpretation for their overall magnetic behavior.

In-doped multifilled n-type skutterudites with ZT=1.8

In this paper we maximize the thermoelectric (TE) figure of merit, ZT, of n-type skutterudites, (In,Sr,Ba,Yb)(y)Co4Sb12, via three different routes: (i) find the optimum fraction of In as fourth filler (ii) check the influence of powder particle, grain, and crystallite size on the TE properties and (iii) check thermal stability. Filled n-type (Sr, Ba, Yb)(y)Co4Sb12 was mixed in three different proportions with In0.4Co4Sb12, ball milled (regular or high-energy (HB) ball milling) and hot-pressed. Particle size analyses and SEM pictures of the broken surfaces of the hot pressed samples document that only HB produces uniform particles/grains with average crystallite sizes similar to 100 nm, proven by transmission electron microscopy. X-ray Rietveld refinements combined with EDX indicate that in all cases indium entered the icosahedral voids of the skutterudite. Temperature dependent physical properties of all three regularly ball-milled samples show that increasing In-content infers an increasing electrical resistivity, increasing Seebeck coefficient but a decreasing total thermal conductivity. Although ZT (823 K) is in the same range as for the sample without In, the ZT values in the whole temperature range are higher and consequently the TE-conversion efficiency, eta is at least 10% higher. Annealing the samples at 600 degrees C for three days shows minor changes in structure and thermoelectric properties, indicating TE stability. The HB sample, due to uniformly small particles, equally sized grains and crystallites, exhibits a high power factor (4.4 mW/m K-2 at 730 K) and a very low thermal conductivity leading to an outstanding high ZT = 1.8 at 823 K (eta(max) = 17.5%). (C) 2015 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

High-coherence hybrid Si/III-V semiconductor lasers

The relentlessly increasing demand for network bandwidth, driven primarily by Internet-based services such as mobile computing, cloud storage and video-on-demand, calls for more efficient utilization of the available communication spectrum, as that afforded by the resurging DSP-powered coherent optical communications. Encoding information in the phase of the optical carrier, using multilevel phase modulationformats, and employing coherent detection at the receiver allows for enhanced spectral efficiency and thus enables increased network capacity. The distributed feedback semiconductor laser (DFB) has served as the near exclusive light source powering the fiber optic, long-haul network for over 30 years. The transition to coherent communication systems is pushing the DFB laser to the limits of its abilities. This is due to its limited temporal coherence that directly translates into the number of different phases that can be imparted to a single optical pulse and thus to the data capacity. Temporal coherence, most commonly quantified in the spectral linewidth Δν, is limited by phase noise, result of quantum-mandated spontaneous emission of photons due to random recombination of carriers in the active region of the laser.

In this work we develop a generically new type of semiconductor laser with the requisite coherence properties. We demonstrate electrically driven lasers characterized by a quantum noise-limited spectral linewidth as low as 18 kHz. This narrow linewidth is result of a fundamentally new laser design philosophy that separates the functions of photon generation and storage and is enabled by a hybrid Si/III-V integration platform. Photons generated in the active region of the III-V material are readily stored away in the low loss Si that hosts the bulk of the laser field, thereby enabling high-Q photon storage. The storage of a large number of coherent quanta acts as an optical flywheel, which by its inertia reduces the effect of the spontaneous emission-mandated phase perturbations on the laser field, while the enhanced photon lifetime effectively reduces the emission rate of incoherent quanta into the lasing mode. Narrow linewidths are obtained over a wavelength bandwidth spanning the entire optical communication C-band (1530-1575nm) at only a fraction of the input power required by conventional DFB lasers. The results presented in this thesis hold great promise for the large scale integration of lithographically tuned, high-coherence laser arrays for use in coherent communications, that will enable Tb/s-scale data capacities.

Studies of the serotonin type 3A receptor and the chemical preparation of tRNA

This thesis describes studies surrounding a ligand-gated ion channel (LGIC): the serotonin type 3A receptor (5-HT₃AR). Structure-function experiments using unnatural amino acid mutagenesis are described, as well as experiments on the methodology of unnatural amino acid mutagenesis. Chapter 1 introduces LGICs, experimental methods, and an overview of the unnatural amino acid mutagenesis.

In Chapter 2, the binding orientation of the clinically available drugs ondansetron and granisetron within 5-HT₃A is determined through a combination of unnatural amino acid mutagenesis and an inhibition based assay. A cation-π interaction is found for both ondansetron and granisetron with a specific tryptophan residue (Trp183, TrpB) of the mouse 5-HT₃AR, which establishes a binding orientation for these drugs.

In Chapter 3, further studies were performed with ondansetron and granisetron with 5-HT₃A. The primary determinant of binding for these drugs was determined to not include interactions with a specific tyrosine residue (Tyr234, TyrC2). In completing these studies, evidence supporting a cation-π interaction of a synthetic agonist, meta-chlorophenylbiguanide, was found with TyrC2.

In Chapter 4, a direct chemical acylation strategy was implemented to prepare full-length suppressor tRNA mediated by lanthanum(III) and amino acid phosphate esters. The derived aminoacyl-tRNA is shown to be translationally competent in Xenopus oocytes.

Appendix A.1 gives details of a pharmacological method for determining the equilibrium dissociation constant, K_B, of a competitive antagonist with a receptor, known as Schild analysis. Appendix A.2 describes an examination of the inhibitory activity of new chemical analogs of the 5-HT₃A antagonist ondansetron. Appendix A.3 reports an organic synthesis of an intermediate for a new unnatural amino acid. Appendix A.4 covers an additional methodological examination for the preparation of amino-acyl tRNA.

I. Foehn winds of southern California. II. Foehn wind cyclo-genesis. III. Weather conditions associated with the Akron disaster. IV. The Los Angeles storm of December 30, 1933 to January 1, 1934

I. Foehn winds of southern California.
An investigation of the hot, dry and dust laden winds occurring in the late fall and early winter in the Los Angeles Basin and attributed in the past to the influences of the desert regions to the north revealed that these currents were of a foehn nature. Their properties were found to be entirely due to dynamical heating produced in the descent from the high level areas in the interior to the lower Los Angeles Basin. Any dust associated with the phenomenon was found to be acquired from the Los Angeles area rather than transported from the desert. It was found that the frequency of occurrence of a mild type foehn of this nature during this season was sufficient to warrant its classification as a winter monsoon. This results from the topography of the Los Angeles region which allows an easy entrance to the air from the interior by virtue of the low level mountain passes north of the area. This monsoon provides the mild winter climate of southern California since temperatures associated with the foehn currents are far higher than those experienced when maritime air from the adjacent Pacific Ocean occupies the region.

II. Foehn wind cyclo-genesis.
Intense anticyclones frequently build up over the high level regions of the Great Basin and Columbia Plateau which lie between the Sierra Nevada and Cascade Mountains to the west and the Rocky Mountains to the east. The outflow from these anticyclones produce extensive foehns east of the Rockies in the comparatively low level areas of the middle west and the Canadian provinces of Alberta and Saskatchewan. Normally at this season of the year very cold polar continental air masses are present over this territory and with the occurrence of these foehns marked discontinuity surfaces arise between the warm foehn current, which is obliged to slide over a colder mass, and the Pc air to the east. Cyclones are easily produced from this phenomenon and take the form of unstable waves which propagate along the discontinuity surface between the two dissimilar masses. A continual series of such cyclones was found to occur as long as the Great Basin anticyclone is maintained with undiminished intensity.

III. Weather conditions associated with the Akron disaster.
This situation illustrates the speedy development and propagation of young disturbances in the eastern United States during the spring of the year under the influence of the conditionally unstable tropical maritime air masses which characterise the region. It also furnishes an excellent example of the superiority of air mass and frontal methods of weather prediction for aircraft operation over the older methods based upon pressure distribution.

IV. The Los Angeles storm of December 30, 1933 to January 1, 1934.
This discussion points out some of the fundamental interactions occurring between air masses of the North Pacific Ocean in connection with Pacific Coast storms and the value of topographic and aerological considerations in predicting them. Estimates of rainfall intensity and duration from analyses of this type may be made and would prove very valuable in the Los Angeles area in connection with flood control problems.

Caracterização das lesões impalpáveis (lesões III E IV), e das alterações em TP53 (p53) na detecção precoce do câncer de mama

As lesões impalpáveis da mama que muitas das vezes são assintomáticas, podem corresponder à um estágio de progressão de câncer difícil de ser detectado, durante os exames de rotina de palpação da mulher. O único método possível para a descoberta dessas lesões é através dos exames de imagem da mama, de modo geral, através da mamografia, que geralmente ocorre após os 45 anos. Devido a esses fatores, lesões impalpáveis, são frequentemente, descobertas apenas quando o estágio de desenvolvimento da doença já está avançado e as intervenções terapêuticas são menos reparadoras. Com a finalidade de iniciar a caracterização de tumores impalpáveis iniciais, objetivamos analisar o perfil genético (mutação) e epigenético (metilação de região promotora) de regiões do DNA relacionadas ao gene supressor tumoral TP53, provenientes de biópsias de mulheres residentes do Estado do Rio de Janeiro. Neste trabalho, foram investigadas 34 amostras de tecido de tumor de mama, por sequenciamento de DNA, nos exons de 5 a 8 do gene TP53. Nesta região, não foi encontrada nenhuma mutação. Este resultado pode estar relacionado ao tipo inicial de lesão, de acordo com os dados radiológicos das lesões de categorias 3 e 4 da escala BIRADS. Para verificar o estado de metilação da região promotora do gene TP53, analisamos 30 pares de amostras (sangue e tumor) de pacientes com suspeita de câncer de mama, pela técnica MSP-PCR. Nenhuma amostra tumoral apresentou alteração no estado de metilação na região promotora do gene TP53, quando comparada à amostra normal. Um motivo possível para a disparidade de resultados em relação à outros trabalhos pode ter sido a utilização da técnica. A caracterização das lesões impalpáveis apenas foi iniciada neste trabalho, no qual pudemos constatar que a mutação em TP53 pode ser um evento mais tardio. Portanto, a lesão mamária, em suas diferentes formas, continuará a ser o assunto investigado por nosso grupo, ampliando o número de amostras e alcançando melhor conexão da conduta e dos métodos clínicos já existentes, com as novas possibilidades de diagnóstico via marcadores moleculares em tumores e fluidos biológicos