Search

Diante do alto índice de criminalidade no Brasil, objetiva-se analisar os fatores sociais do crime, a implementação eficaz dos direitos sociais como um instrumento de prevenção criminal e a seletividade punitiva. Para tanto, por meio de um método dedutivo, amparado em técnica de revisão bibliográfica e análise estatística, realiza-se uma análise da criminalidade do ponto de vista teórico e jurídico, da qual pode-se observar que a efetivação dos direitos sociais requer maiores esforços por parte do Estado, a fim de evitar a incidência da seletividade punitiva, elevada taxa de criminalidade e reclusão e promover o bem-estar social de que trata o Estado Democrático de Direito.

IntroductionThe role of fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in early breast cancer treated with preoperative systemic therapy (PST) is not yet established in clinical practice. PET parameters have aroused great interest in the recent years, as non-invasive dynamic biological markers for predicting response to PST.MethodsIn this retrospective study, we included 141 patients with stage II-III breast cancer who underwent surgery after PST. Using ROC analysis, we set optimal cutoff of FDG-PET/CT parameters predictive for pathological complete response (pCR). We investigated the correlation between FDG-PET/CT parameters and pCR, median disease-free survival (DFS), and median overall survival (mOS).ResultsAt multivariable analysis, baseline SUVmax (high vs low: OR 9.00, CI 1.85 – 61.9, p=0.012) and Delta SUVmax (high vs low: OR 9.64, CI 1.84, 69.2, p=0.012) were significantly associated with pCR rates. Interestingly, we found that a combined analysis of the metabolic parameter Delta SUVmax with the volume-based parameter Delta MTV, may help to identify patients with pCR, especially in the subgroup of hormone receptor positive breast cancer. Delta SUVmax was also an independent predictive marker for both mDFS (high vs low: HR 0.17, 95%CI 0.05-0.58, p=0.004) and mOS (high vs. low: HR 0.19, 95%CI 0.04-0.95, p=0.029).DiscussionOur results suggest that Delta SUVmax may predict survival of early BC patients treated with PST.

Surgery for breast cancer has changed in the last few decades in favor of more conservative approaches, without compromising loco‐regional control and survival. Common immediate complications fol ‐lowing breast surgery are hematoma, seroma, and wound infection.1Traditionally, surgeons have implemented the use of closed‐suction drains in this setting with the aim of preventing these complications, which can cause discomfort, morbidity, increased follow‐up visits,and possible delay in the beginning of adjuvant therapies.2 On the other hand, potential benefits of performing breast procedures without using a drain have been increasingly considered.3 There is lack of modern and official guidelines on use of drains in breast sur ‐gery, with no consensus regarding their management and the appro‐priate use of antibiotics in this setting. Almost all reports agree withthe use of drains after breast procedures, especially if they are asso‐ciated with reconstruction or axillar lymph node dissection (ALND), but an extreme variability is reported regarding practice patterns.4A national survey regarding the management of drains afterbreast cancer surgery was sent by email on January 2018 to all Breast Centers (BC) registered with Senonetwork Italia. Data col ‐lected by the administrative office of Senonetwork were de‐iden‐tified and exported for statistical analysis. A Steering Committeecomposed of general surgeons and plastic surgeons was appointedto coordinate the survey, which consisted of 22 multiple choicequestions, designed to inquire about surgeons' demographics, use of drains after breast procedures with and without reconstructionand/or ALND, antibiotic use and to characterize drain managementin their clinical practice.

This study addresses the influence of climate seasonal variations on the slide safety factor on a granite residual soil slope based on the principles of the mechanics of unsaturated soils. The base study for this paper was carried out on SC-401, a highway located in the city of Florianopolis, a coastal region in the state of Santa Catarina in southern Brazil. The region suffered a landslide in 2008, which stopped traffic on this highway. In the slope that borders this highway, a borehole was drilled to a depth of 2 m. Samples of granite residual soil taken from this borehole were used for the characterization tests. The soil suction profiles of this location were continuously monitored by granular matrix suction sensors connected to a data acquisition system. Near this study site, a pluviometer was installed which allowed the monitoring of hourly rainfall. The suction profile rate over time with the shear strength parameters of the soil from the study site were used as input data in Rocscience’s Slide software. In this way, the variation of the sliding safety factor of the slope over time was obtained. The maximum suction value, depending on the rainfall regime in the study region, was 270 kPa. The values of the safety factors, considering the soil suction profile, varied from 1.29 to 1.51, while for saturated condition, the critical value was 1.28.

Environmental health literacy (EHL) includes knowledge of health effects due to environmental exposure and skills to protect health from environmental risks. This study investigated some aspects about EHL of the Italian adult population. Data were collected through questionnaires (n = 672) and analysed through multivariable logistic regression models. Results showed that participants with incomplete/insufficient self-perceived knowledge of health effects due to environmental risks verified less information about this topic (adjOR = 0.38 (CI95% 0.25–0.59)/0.09 (0.04–0.21); p < 0.001/

[This corrects the article DOI: 10.1371/journal.pone.0201812.].

The aim of this study was to verify the carryover of aflatoxin B1 from feed to lambari fish. Aflatoxins (AF) were incorporated into feed, checking the levels by HPLC. Treatments were: Control, feed without toxin; A, feed + 10 µg AFB1 kg–1; B, feed + 20 µg AFB1 kg–1; and C, feed + 50 µg AFB1 kg–1. Juveniles of lambari fish were placed in 12 aquariums at a density of 50 fish/m2. Fish were fed twice a day with extruded feed, at 5% of animal biomass. The unit sample was constituted by a pool of 10 fish. AFs B1, B2, G1, G2 and M1 were quantified by HPLC in fish muscle and liver after 30, 60, 90 and 120 days of experiment. There was accumulation of AFs is fish liver and muscle, mainly after 90 days. Fish from treatment C had higher levels of AFB1 in muscle when compared with the others, and AFB1 in muscle at 120 days was similar to the levels in feed. Therefore, when lambari fish is exposed on a daily and long-term basis to AFs in feed, the regulation limits for AFs in animal feed do not guarantee safet...

Um dos grandes desafios na engenharia é a implantação de obras sobre solos com baixa resistência, o solo mole, por exemplo, possui uma característica de baixa resistência, e, por estar sujeito a prolongados recalques merece um estudo criterioso. Esta pesquisa tem como objetivo analisar a estabilidade de um aterro sobre um trecho de solo mole e, a partir disto indicar medidas para o aumento do fator de segurança do aterro sobre o qual será construído uma rodovia, e, propor melhorias nas condições do solo em relação ao aceleramento de recalque. Primeiramente, com dados dos parâmetros de resistência fornecidos de um perfil de solo mole, foi possível verificar o fator de segurança através do software Slide. Percebeu-se que o solo do aterro, nas condições normais e sem tratamento, obteve um fator de segurança de 0,70, ou seja, menor do que o aceitável em norma, desse modo foi necessária a colocação de bermas de equilíbrio de 12 metros de largura e 1,5 metros de altura e a aplicação de geogrelhas com capacidade de 400 kPa, aumentando o fator de segurança para 1,3. Com relação a análise de recalque verificou-se a necessidade de acelerá-lo, a solução se deu pela colocação de 155.028 metros de drenos em um trecho de 350 metros de rodovia.

We performed lymphoscintigraphy on 31 patients (newborns and children) affected by congenital lymphatic dysplasia according to our previously published protocol. Congenital lymphatic dysplasia may present with various degrees of clinical severity, ranging from nonimmune hydrops fetalis with visceral effusions to lymphedema alone. We recommend that lymphoscintigraphy should be strongly considered in all patients with signs of lymphatic dysplasia, including those with minimal and initial signs of lymphatic impairment, in order to obtain a very early diagnosis and to start treatment. Lymphoscintigraphy is safe and useful in the diagnosis of lymphatic dysplasia in the newborn and children. Moreover, it is well tolerated by patients and well accepted by their parents.

Differences in hormone receptor and HER-2 status between primary tumour and corresponding relapse could have a substantial impact on clinical management of patients. The aim of this study was to evaluate change in expression of hormone receptors and HER-2 status between primary tumour and corresponding local recurrence or distant metastasis. We analysed 140 primary tumours and related recurrent or metastatic samples. Hormone receptors status was evaluated by immunohistochemistry, while HER-2 status by immunohistochemistry and silver in situ hybridisation. A change in HER-2 was rare; 3.7% of cases by immunohistochemistry and only 0.7% by silver in situ hybridisation analysis. A change in estrogen and progesterone receptors was seen in 6.4% and 21.4% of cases, respectively. Estrogen receptor change was not affected by adjuvant therapy, whereas progesterone receptor was influenced by adjuvant chemotherapy associated to hormone therapy (P = 0.0005). A change in progesterone receptor was more frequent in distant metastases than in local recurrences (P = 0.03). In the setting of estrogen receptor positive tumours, patients with progesterone receptor loss in local recurrence had a statistically significant lower median metastasis free survival compared to others patients; progesterone receptor positive, 112 months; progesterone receptor negative, 24 months (P = 0.005). A change between primary tumour and corresponding relapse is frequent for progesterone receptor, infrequent for estrogen receptor and rare for HER-2. In cases with changes in HER-2, it is worthwhile reassessing HER-2 status with both immunohistochemistry and in situ hybridisation analysis. Progesterone receptor loss seems to be influenced by therapy and to correlate with a worse prognosis.

Volume guarantee ventilation (VGV) is an optional ventilation mode which has become the most widely and extensively studied in the last 10 years in premature infants. Nonetheless, theoretical expected endpoints are intriguing and even though VGV has not yet become 'the' standard ventilation mode, a great deal of information has been acquired and stored. In our experience, VGV during the course of respiratory distress syndrome is useful and can be considered a standard ventilation mode. Weaning occurs in real time as described earlier, and synchronized intermittent positive pressure ventilation and pressure support ventilation (PSV) seem to be the preferred combined modes. Management during the acute phase requires more care since several sudden changes take place in both the lung mechanics and clinical behavior. The software is designed to protect the lung, and subsequently, sudden changes in lung compliance following iatrogenic procedures such as surfactant administration are powerfully counteracted. VGV has been extensively studied and the proposed algorithm has been found to function as planned. Although the 'superiority' of one method over another cannot be demonstrated, the use of new technologies require 'a staff learning curve' and homogeneity of treatment, while at the same time other factors, such as patient heterogeneity or illness phase, should be taken into due account.

Objective—To compare the eVectiveness of the Infant Flow Driver (IFD) with single prong nasal continuous positive airway pressure (nCPAP) in preterm neonates aVected by respiratory distress syndrome. Design—Randomised controlled study. Patients—Between September 1997 and March 1999, 36 preterm infants who were eligible for CPAP treatment were randomly selected for either nCPAP or IFD and studied prospectively for changes in oxygen requirement and/or respiratory rate. The requirement for mechanical ventilation, complications of treatment, and eVects on mid-term outcome were also evaluated. Results—Use of the IFD had a significantly beneficial eVect on both oxygen requirement and respiratory rate (p < 0.0001) when compared with nCPAP. Moreover,O2 requirement and respiratory rate were significantly decreased by four hours (p < 0.001 and p < 0.03 respectively). The probability of remaining supplementary oxygen free over the first 48 hours of treatment was significantly higher in patients treated with the IFD than with nCPAP (p < 0.02). IFD treated patients had a higher success (weaning) rate (94% v 72 %) and shorter duration of treatment (49.3 (31) v 56 (29.7) hours respectively; mean (SD)), although the diVerence was not significant. Conclusions—IFD appears to be a feasible device for managing respiratory distress syndrome in preterm infants, and benefits may be had with regard to oxygen requirement and respiratory rate when compared with nCPAP. The trend towards reduced requirement for mechanical ventilation, shorter clinical recovery time,and shorter duration of treatment requires further evaluation in a multicentre randomised clinical trial. (Arch Dis Child Fetal Neonatal Ed 2001;85:F86‐F90)

This study reviews nine new families with branchio-oto-renal (BOR) syndrome (Online Mendelian Inheritance in Man [OMIM] 113650). Diagnosis was made by studying 10 index cases, and then 22 other previously undetected patients were diagnosed within the nine families. The syndrome consists of conductive, sensorineural, or mixed hearing loss; preauricular pits; structural defects of the outer, middle, or inner ear; renal anomalies; lateral cervical fistulas, cysts, or sinuses; and/or nasolacrimal duct stenosis or fistulas. In our study, all patients first diagnosed in each familial group were recognized on the basis of severe renal anomalies associated with at least one of these symptoms. Our study showed that BOR syndrome is a misdiagnosed disorder, usually recognized in the presence of severe renal failure but often not diagnosed, especially in the adult in the presence of other isolated clinical signs, such as mild branchial or urological anomalies. We stress the meticulous search we performed for renal anomalies and/or hearing loss in all subjects showing minimal signs of branchial defects. BOR syndrome should be suspected in all cases of isolated urological anomalies, even if no other signs of the syndrome are present. After BOR syndrome has been diagnosed in a patient, all family members should be examined for the presence of the syndrome, even if there are only minimal stigmata of the disease.

A multicentrer series of 350 intraductal breast cancers (DCIS) is reported. Mammography was the most sensitive test but suspicion arose only at palpation in 13% of cases whereas in 10% of cases biopsy was recommended for a benign lesion and DCIS was an unexpected finding. Mammography, physical examination and cytology must be combined to achieve optimal sensitivity. Systematic biopsy of apparently benign masses would increase DCIS detection rates but the cost-effectiveness of such a policy is questionable. A trend of conservative surgery was evident over time (from 1968-79, 28%; 1985-1989, 50%) but breast irradiation followed only in one fourth of the cases. The local recurrence rate was significantly higher in cases of limited surgery (with or without irradiation) with respect to mastectomy (1.2 vs 0.2 × 100 patient-years at risk). Most recurrences (7 of 8) in the conserved breast were infiltrating, but no recurrence was seen in subclinical DCIS cases. Three patients died of breast cancer after local recurrence in the conserved breast (2 cases) or mastectomy scar (1 case). Eligibility for conservative surgery of DCIS needs to be carefully discussed to avoid under-treatment. Contralateral breast cancer was recorded in 44 cases and the incidence of further metachronous cancer to the other breast was ten times higher than expected in normal breasts. Four patients died of contralateral breast cancer, free of ipsilateral recurrence. A careful follow-up of the contralateral breast in DCIS cases looks as important as surveillance of the conserved breast.

Retrospective analysis of 17 cases of phyllodes tumor with a follow-up of almost 1 year revealed no close correlation between histological pattern and clinical course, since local relapse occurs even after histological findings of benign lesion in the primary tumor. Phyllodes and fibroadenoma patterns are often associated in the same patient and extensive surgery is not recommended owing to the fact that recurrences are observed both after subcutaneous mastectomy and after simple resection. We conclude that local control of the disease by wedge resection and strict follow-up may be the most rational approach.

Summary— The plasma level profile of SA and SUA after a single oral dose of ASA was studied in 8 children with juvenile rheumatoid arthritis, aged 3.5–15.0 years. Pharmacokinetic parameters were on average similar to those reported in the literature for adult subjects, although a somewhat larger intersubject variability was found.

The authors consider their experience in male breast cancer. Making a review of the literature they point out the risk factors and the prognosis of this disease.

We report male monozygotic twins who presented with neonatal diabetes mellitus (NDM) within an autoimmune context. They were born to unrelated healthy parents after 36 weeks of uncomplicated pregnancy. Family history was unremarkable. The clinical history of the patients was almost identical; both twins were admitted on the 12th and 25th days of life, respectively, because of poor feeding, dehydration, lethargy, metabolic acidosis, severe watery diarrhea, and persistent hyperglycemia (>17 mmol/1). It was very difficult to stabilize diabetes on the conventional subcutaneous insulin schedule, so intravenous treatment was started in both patients. High levels of thyroid-stimulating hormone were found by routine screening tests, …

The purpose of treatment of hepatic glycogen storage disease (GSD) is to prevent fasting hypoglycaemia and its clinical and metabolic consequences: growth retardation, hepatomegaly, metabolic acidosis, hyperuricaemia and hyperlipidaemia. This problem is particularly severe for patients with GSD type I (McKusick 23220) and for young patients with GSD type III (McKusick 23240). In recent years frequent day feedings associated with continuous intragastric infusion have been proposed as the treatment of choice (Burr et al., 1979; Fernandes et al., 1984b; Greene et al., 1980). Gastric drip night feeding is effective, but serious complications such as symptomatic hypoglycaemia and acidosis resulting from acute gastroenteritis, vomiting and delays in feeding are reported (Greene et al., 1980). The regimen requires monitoring by infusion pump and specific training for parents; furthermore, some patients have psychological problems in accepting it.

The Authors describe a case of asymptomatic retroperitoneal teratoma discovered on a routine examination in a six year-old male. Diagnosis was made pre-operatively on the base of CT scan imaging. Surgery allowed radical excision of the teratoma, which turned to be a totally benign entity.