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RESUMO Introdução: o câncer da mama é o câncer de maior incidência no sexo feminino no Brasil, representando 29,7% de todos os cânceres. Mais de dois terços das mulheres com câncer da mama apresentam expressão para receptores hormonais, estando, nestes casos, indicada a terapia hormonal com tamoxifeno, que pode representar fator de risco para o desenvolvimento do câncer do endométrio (risco relativo quatro vezes maior). Objetivo: este trabalho teve como objetivo avaliar a associação entre o uso de tamoxifeno e o desenvolvimento de distúrbios endometriais bem como eventuais outros fatores associados. Pacientes e método: Estudo de coorte retrospectivo de 364 pacientes com câncer da mama, das quais 286 utilizaram tamoxifeno e 78 não utilizaram esta hormonioterapia. Resultados: pacientes que usaram tamoxifeno tiveram um seguimento médio de 51,42 meses, semelhante àquelas sem terapia hormonal (p=0,081). Um total de 21 (7,3%) mulheres que usaram tamofixeno e nenhuma mulher sem terapia hormonal apresentaram alterações endometriais durante o seguimento (p=0,01). Nas 270 mulheres que tinham informação sobre obesidade, esta se associou significantemente com o desenvolvimento de alterações endometriais (p=0,008). A associação entre tamofixeno e alterações endometriais permaneceu significante (p=0,039) após ajustar para interação com obesidade. Conclusão: o uso de tamoxifeno no tratamento do câncer da mama esteve associado ao maior risco para desenvolvimento de alterações endometriais especialmente quando associado à obesidade.

Objective:\ud There is a need to develop and validate biomarkers for treatment response and survival in tubo-ovarian high-grade serous carcinoma (HGSC). The chemotherapy response score (CRS) stratifies patients into complete/near-complete (CRS3), partial (CRS2), and no/minimal (CRS1) response after neoadjuvant chemotherapy (NACT). Our aim was to review current evidence to determine whether the CRS is prognostic in women with tubo-ovarian HGSC treated with NACT.\ud \ud Methods:\ud We established an international collaboration to conduct a systematic review and meta-analysis, pooling individual patient data from 16 sites in 11 countries. Patients had stage IIIC/IV HGSC, 3–4 NACT cycles and >6-months follow-up. Random effects models were used to derive combined odds ratios in the pooled population to investigate associations between CRS and progression free and overall survival (PFS and OS).\ud \ud Results:\ud 877 patients were included from published and unpublished studies. Median PFS and OS were 15 months (IQR 5–65) and 28 months (IQR 7–92) respectively. CRS3 was seen in 249 patients (28%). The pooled hazard ratios (HR) for PFS and OS for CRS3 versus CRS1/CRS2 were 0·55 (95% CI, 0·45–0·66; P

Objective To develop a scoring system that guides surgical decision-making regarding the need to perform lymphadenectomy. Methods A retrospective study was performed of patients who underwent complete surgical staging of endometrial cancer between 2003 and 2014 at three centers in Brazil. Preoperative and intraoperative risk factors were used to develop a scoring system to predict lymph node metastasis. Results Among 329 patients included, 71 (21.6%) had positive lymph nodes and 259 (78.4%) had negative lymph nodes. The characteristics associated with nodal metastasis in univariate analysis included the level of cancer antigen 125 (P

Objective Small cell carcinoma of the ovary-hypercalcemic type (SCCOHT) is a rare disease with a poor prognosis. SCCOHT has recently been shown to be associated with SMARCA4 gene mutations as well as molecular and genetic similarities to malignant rhabdoid tumors (MRT). The objective of our study is to describe the clinical characteristics, treatment modalities and outcomes of 47 patients with SCCOHT. Methods We performed a retrospective analysis of 47 patients with SCCOHT evaluated at MD Anderson Cancer Center between 1990 and 2014. Medical records were reviewed for demographic information, pathologic findings, treatment regimens and outcomes. Results Median age at diagnosis was 30years (range 5–46). All patients underwent surgery with unilateral salpingo-oophorectomy (USO) performed in 26 patients (55%), and hysterectomy with bilateral salpingooophorectomy (BSO) in 21 patients (45%). Sixteen patients (34.0%) had stage I disease, six (12.8%) stage II, 23 (48.9%) stage III, and two patients (4.3%) had stage IV disease. Information on adjuvant treatment was available for 43 patients: 83.3% received chemotherapy alone, 9.5% chemotherapy followed by radiotherapy, 2.4% chemoradiation, and 4.8% did not receive any adjuvant therapy. Median follow-up was 13.2months (range, 0.1 to 210.7) with a median overall survival of 14.9months. Multi-agent chemotherapy and radiotherapy were associated with a better prognosis. Conclusion Our findings suggest that aggressive therapy including multi-agent chemotherapy and possibly radiotherapy may extend survival. Further study is needed to improve outcomes in these patients including the adoption of systemic therapies used in MRT as well as the development of novel agents targeting specific mutations.

ObjectivesOur purpose was to compare the expression of heparanase isoforms, in normal and in neoplastic endometrium. In a pioneering way, we sought to evaluate the expression of heparanase 1 (HPSE1) and heparanase 2 (HPSE2) in glandular and in stromal tissues.MethodsThis is a case-control study, conducted retrospectively in a public hospital, using paraffin blocks of endometrial tissue from patients admitted from 2002 to 2011 with and without endometrial cancer, with regard to the immunohistochemical expression of HPSE1 and HPSE2. The paraffin blocks were used for tissue microarray analysis and immunohistochemistry study in glandular and stromal tissues.ResultsIn the study period, 195 participants were enrolled, 75 with and 120 without cancer. There was no significant difference between them regarding HPSE1 expression, both in gland and in stromal tissues. Heparanase 1 expression in the glandular tissue was more frequent among those with high-grade carcinoma, compared with patients with carcinoma type I. The difference in the expression of HPSE2 was significant between groups: it was less frequent in the controls than in the patients with cancer in the glandular tissue. In the stromal tissue, HPSE2 expression was significantly higher in the controls than in the patients with cancer and different when patients of the secretory endometrium subgroup were compared with those with hypotrophic, proliferative endometriums or with architectural disorders. No significant difference was found in the heparanase expressions in patients with cancer according to prognosis factors.ConclusionsHeparanase 1 is more intensely expressed in the glandular tissue of high-grade compared with type I carcinomas. Heparanase 2 is more intensely expressed in the glandular tissue of cancer than in nonneoplastic endometrium, whereas the HPSE2 expression in the stromal tissue is higher in the nonneoplastic controls compared with the group of patients with cancer mainly in the secretory endometrium. This suggests that HPSE2 might be stimulated by progesterone, with a possible antineoplastic role, antagonist to HPSE1, to be further investigated.

Post-menopause hyperandrogenism is a condition that needs careful evaluation. Aromatase inhibitors (AI), which are important in the management of positive estrogen breast cancer, and chronic kidney disease (CKD) can puzzle the evaluation of this condition. A postmenopause female with type-2 diabetes and advanced CKD was attended due to progressive virilization, which has started after the introduction of an AI for breast cancer 5 years earlier. Clinical and radiological investigation has confirmed a pure Leydig cell tumor as source of hyperandrogenism. Re-evaluation of the breast tumor immunohistochemistry has shown positive androgen receptor expression and negative expression for estrogen, progesterone and HER-2 receptors. Even though an ovarian tumor was the source of androgen excess, we discuss that AI could exert a slight contribution to patient's virilization by reducing estradiol counterbalance. Also, although the onset of hyperandrogenic symptoms was unclear, we could not exclude that the ovarian tumor had produced enough androgens to play a role in breast tumor progression. This case report supports the literature regarding the possible association between Leydig cell tumor and androgen-receptor-positive breast cancer development. Finally, progressive hyperandrogenic symptoms in postmenopause, even under AI therapy or the presence of advanced CKD, impose a more detailed investigation.

Made available in DSpace on 2019-09-12T16:53:50Z (GMT). No. of bitstreams: 0 Previous issue date: 2012 Objective. Heparanase 2 (HPSE2) is expressed in various tissues, including the brain, intestine, prostate, breast, and endometrium. The aim of this study was to investigate the role of HPSE2 in cervical carcinogenesis, which has not been clarified to date. Materials and Methods. The immunoexpression of HPSE2 in normal and neoplastic cervical squamous epithelia was determined using a semiquantitative (SQ) method and an index of expression (IE) method, using Image Lab Software. A total of 230 cervical tissue samples were analyzed and segregated into the following diagnostic groups: normal (27.4%), cervical intraepithelial neoplasia 1 (CIN 1, 15.2%), CIN 2 (16.5%), CIN 3(15.2%), and invasive neoplasia (25.7%). The mean HPSE2 expression in the normal group was significantly lower than that of the other groups individually or combined (p < .001, for all combinations). The immunoexpression via the SQ method was significantly greater in the CIN 3 group compared with that in the CIN 1 group (p = .02). The mean immunoexpression of the high-grade squamous intraepithelial lesion groups was significantly greater than those of the normal and low-grade squamous intraepithelial lesion groups (p < .001) and lower compared with that of the invasive neoplasia group (p < .001). There were no statistically significant differences in the immunoexpression of HPSE2 among the different clinical states within the invasive neoplasia group. Conclusions. The SQ method produced a greater sensitivity and specificity than did the index of expression method. There was a progressive increase in the mean HPSE2 immunoexpression according to the severity of the cervical lesion from the low-grade squamous intraepithelial lesion group to the invasive neoplasm group, whereas the normal group displayed the lowest level of expression. This is a novel study concerning HPSE2 in the cervix and cervical cancer carcinogenesis. [Marques, Renato Moretti; Nicolau, Sergio Mancini] Univ Fed Sao Paulo, Dept Gynecol, Div Gynecol Oncol, Paulista Sch Med Prof, BR-04038032 Sao Paulo, Brazil [Marques, Renato Moretti] Universidade de Taubaté (Unitau), Dept Obstet & Gynecol [Focchi, Gustavo Rubino] Univ Fed Sao Paulo, Dept Pathol, Paulista Sch Med, BR-04038032 Sao Paulo, Brazil [Theodoro, Therese Rachell; Pinhal, Maria Aparecida] ABC, Coll Med, Dept Biochem, Sao Paulo, Brazil [Castelo, Adauto] Univ Fed Sao Paulo, Dept Med, Div Infect Dis, Paulista Sch Med, BR-04038032 Sao Paulo, Brazil

This work describes the dosimetry of a two waveguide cell system designed to expose newborn mice to electromagnetic fields associated with wireless fidelity signals in the frequency band of 2.45 GHz. The dosimetric characterisation of the exposure system was performed both numerically and experimentally. Specific measures were adopted with regard to the increase in both weight and size of the biological target during the exposure period. The specific absorption rate (SAR, W kg(-1)) for 1 W of input power vs. weight curve was assessed. The curve evidenced an SAR pattern varying from1 W kg(-1) to6 W kg(-1) during the first 5 weeks of the life of mice, with a peak resonance phenomenon at a weight around 5 g. This curve was used to set the appropriate level of input power during experimental sessions to expose the growing mice to a defined and constant dose.

La respuesta inmune a la infección por Echinococcus granulosus en el ovino ha sido poco estudiada. El objetivo del presente trabajo fue aportar información sobre la fisiopatología y la respuesta inmune a la infección experimental con E. granulosus en ovinos. Se inocularon experimentalmente ovinos con tres dosis distintas de huevos de E. granulosus, evaluándose la repuesta inmune por seguimiento mediante enzimo inmuno ensayo con tres preparaciones antigénicas (líquido hidatídico total, fracción purificada de líquido hidatídico total y fracción lipoproteica purificada) durante 500 días. Se sacrificaron animales en forma escalonada para observar macroscópica y microscópicamente el desarrollo del parásito. La respuesta inmune se detectó a partir de los 10 días y se mantuvo durante el período de observación, resultando inicialmente proporcional a la carga de huevos inoculados, y disminuyendo las diferencias con el tiempo. Se identificaron quistes fértiles a los 10 meses post inoculación y oncósferas vivas 500 días post inoculación. La respuesta de anticuerpos en el ovino a la infección por E. granulosus fue anterior a la formación de líquido hidatídico y resultó generada por la movilidad de la oncósfera. La temprana fertilidad identificada histológicamente indica que la alimentación de canes con vísceras de ovinos jóvenes puede producir ciclos de infección. La presencia de oncósferas vivas en el hígado, por su parte, aporta información sobre la patogenia de la enfermedad y permite expresar hipótesis sobre las causas de nuevas operaciones en el hombre luego de la extirpación de un quiste hidatídico lo que podría liberar el freno inmunitario sobre dichas oncósferas.The immune response to Echinococcus granulosus in sheep has not been extensively investigated. The objective of this study was to increase the information on the physiopathology of E. granulosus and the immune response elicited in sheep. Animals were experimentally inoculated with three different doses of E. granulosus eggs and the immune response was evaluated over 500 days using enzyme immunoassay with three antigenic preparations: total hydatid fluid, purified fraction of hydatid fluid and purified lipoprotein fraction. Sheep were slaughtered at different intervals to observe the macroscopic and microscopic development of the parasite. Immune response was detected at 10 days and was maintained throughout the observation period, being initially proportional to the load of inoculated eggs and then decreasing over time. Fertile cysts were identified 10 months after inoculation and live onchosphere 500 days after inoculation. Antibody response to E. granulosus in sheep preceded hydatid fluid formation and was generated by the mobility of the onchosphere. Early histological identification of fertile cysts indicates that feeding dogs with viscera of young sheep can produce cycles of infection. Furthermore, the presence of live onchosphere in the liver here found contributes to a better knowledge of the pathogenesis of this disease it could be hypothetically considered as a cause for the repeated surgeries necessary in man after the extirpation of a hydatid cyst.

Immunodiagnosis in sheep presents problems of sensitivity and specificity, limiting its applicability in surveillance systems. The objective of this study was to develop a sensitive, specific and accessible technique for diagnosing cystic echinococcosis in naturally infected sheep and to evaluate the validity of necropsy as a reference test. A total of 247 sheep were studied at slaughterhouses, confirming the parasitological diagnosis with histology. Serum was processed with enzyme immunoassay (EIA) using three antigen preparations: total hydatid liquid (LHT), purified fraction of LHT (S2B) and purified lipoprotein (B). Western Blot (WB) was used as a control. EIA proved effective for differentiating Echinococcus granulosus from larval stage of Taenia hydatigena and intestinal cestodes in all three antigen preparations. Serums from macroscopically negative sheep were reactive to EIA and positive with WB. In the whole flock, sensitivity was 89.2% for LHT, 80.0% for S2B and 86.4% for B. Sensitivity in lambs was 78.6% for LHT, 75.0% for S2B and 64.3% for B. Macroscopic diagnosis at the time of slaughter was found to have limitations as a reference test for immunodiagnosis of cystic equinococcosis in sheep, so it was necessary to include histology and WB as reference tests. LHT was the antigen preparation of greatest value and EIA proved to be a sensitive and specific technique, adequate for surveillance systems and for evaluating control programmes.

The progesterone receptor gene (PROGINS) has been identified as a risk modifier for benign and malignant gynecological diseases. The present case-control study is to evaluate the role of the PROGINS polymorphisms, as risk factor, for endometrial cancer development and to investigate the association between these genetics variants and clinical/pathologic variables of endometrial cancer. PROGINS polymorphism was examined in a total of 121 patients with endometrial cancer and 282 population-based control subjects, all located at the same area in São Paulo, SP, Brazil. The genotyping of PROGINS polymorphism was determined by polymerase chain reaction. The frequencies of PROGINS polymorphism T1/T1, T1/T2, and T2/T2 were 82.6%, 14.9%, and 2.5% in the endometrial cancer patients and 78.4%, 21.6%, and 0% in the controls, respectively. The χ2 test showed a higher incidence of the T2/T2 genotype in the endometrial cancer group subjects, these results were statistically different (P= 0.012). However, due to the fact that there were no women in the control group showing homozygosis for the allele T2, the correct evaluation of odds ratio could not be properly calculated. Regarding the clinical and pathologic findings observed within the group of patients with endometrial cancer, there was significant correlation between T1/T2 genotype and the presence of myoma (P= 0.048). No correlations were observed among the other variables. These data suggest that the PROGINS polymorphism T2/T2 genotype might be associated with an increased risk of endometrial cancer.

La vigilancia de la equinococcosis quística para detectar infestación por Echinococcus granulosus en la Provincia de Río Negro en el período 1980-2002 fue efectuada en el hombre mediante encuestas serológicas y ultrasonográficas en población joven, y en el perro por el test de arecolina. Dadas las limitaciones de esta técnica, se planteó suplantarla por el complejo copro ELISA Western Blot en heces caninas recolectadas del suelo. El objetivo del presente trabajo fue comparar las ventajas y limitaciones de las dos técnicas para medir la prevalencia de la infección en el perro, y evaluar la prevalencia actual de la infección en el hombre y en el perro. El área de trabajo comprendió 7 Departamentos endémicos con Programas de desparasitación canina sistemática (Area Programa) y 4 Departamentos no endémicos como Area Testigo. El test de arecolina se aplicó en los perros, con concurrencia voluntaria de sus propietarios (muestreo no aleatorizado). Las muestras para detección de coproantígenos fueron obtenidas de establecimientos ganaderos seleccionados en forma aleatorizada. En el hombre se determinó la prevalencia mediante tamizajes ultrasonográficos en escolares de 6 a 14 años y la incidencia por medio del sistema oficial de notificación de casos sintomáticos. Se dosificaron con arecolina 416 perros resultando 19 (5.2%) positivos en el Area Programa y ninguno positivo en el Area Testigo. Para la detección de coproantígenos se obtuvieron 748 muestras de materia fecal de 271 establecimientos ganaderos, resultando 37 muestras y 32 establecimientos (13.6%) positivos en el Area Programa y 4 muestras y 4 establecimientos (11.4%, IC: 0.3-32.3) positivos en el Área Testigo. En el Area Programa se efectuaron 7421 ecografías abdominales a escolares, detectándose 40 (0.5%) casos con imágenes compatibles con hidatidosis, mientras en el área testigo se efectuaron 1732 ecografías con 9 (0.5%) casos positivos. El test de arecolina aportó información de la prevalencia individual mientras que la detección de coproantigenos permitió mejorar la calidad de la información identificándose establecimientos donde concentrar acciones de control. El estudio permitió identificar nuevas áreas de transmisión.The surveillance of infection for Echinococcus granulosus in the Province of Rio Negro during 1980-2002 included serological and ultrasonographic screening in humans and arecoline test in dogs. In lieu of the limitations of the arecoline test the proposal was to supplant that test for the copro Elisa-copro/Western Blot complex applied to feces collected from the environment. The objective was to compare the pros and cons of the two tests and to evaluate the human and the canine infection prevalence. The working area encompassed 7 Departments with systematic canine parasiticide activities (Program Area) and 4 Departments, not endemic, as Control Area. The arecoline test was applied to the dogs in assembled groups with the voluntary participation of their owners (not randomized sampling). Samples for the detection of coproantigens were obtained from sheep farms selected at random and analyzed by the complex copro-Elisa /Western Blot. Prevalence in man was determined by screening the school population (6 to 14 years old) by ultrasound, and by means of the compulsory notification of cases from the official system. Dogs (416) were tested with arecoline, 365 of which belonged to the Program Area. Of these 19 (5.2%) resulted positive, while none of 51 dogs from the Control Area were positive. Samples (748) of feces were tested to detect coproantigens, obtaining 37 positive samples within the Program Area and 4 within the Control Area. Farms (271) from the livestock estate unit were evaluated, out of which 236 belonged to the Program Area, gave 32 (13.6%) positive results, while 4 (11.4%) of 35 from the Control Area resulted positive. Sonography tests (7421) were done in the Program Area detecting 40 (0.5%) carriers, while in the Control Area, over 1732 tests, 9 (0.5%) resulted positive. The arecoline test provides information about the dog prevalence while the detection of coproantigens in feces collected from the environment allowed to enhance the quality of the information, and the identification of environments where specific control activities focusing on risk must be concentrated. Also the study allowed to recognize new transmission areas.

A wire patch cell (WPC) operating at the uplink frequency band of GSM 1800 MHz has been designed for in vitro experiments with the aim of investigating the possible biological effects of electromagnetic radiation associated with cellular phones. The 1800 MHz WPC design is a direct descendant of the original 900 MHz WPC introduced by Laval et al. This system provides a homogeneous specific absorption rate distribution, using four 3.5 cm petri dishes simultaneously. Numerical dosimetry has been performed using a commercial code (CST Microwave Studio), in order to evaluate accurately the efficiency of the structure (in terms of W kg(-1) per 1 W input power) and the distribution in the chosen biological target. The numerical results have been confirmed by experimental measurements performed by measuring thermal increase due to a high power impulse. The efficiency of the structure is 1.25 +/- 25% W kg(-1) per 1 W input power higher than the efficiency of the 900 MHz WPC. A few adjustments have been made in order to use the WPC in a standard incubator and to avoid thermal increases related to the radio frequency exposure. This exposure system has been adopted for the experiments scheduled in the RAMP and GUARD projects (VFPE).

OBJECTIVE: To verb the cytologic predictive value of a diagnosis of atypical glandular cells of undetermined significance (AGUS) in high grade squamous intraepithelial lesions (HSIL) cases. STUDY DESIGN: In a retrospective study, 98 cases of HSIL were reviewed. All patients were referred for colposcopy and directed biopsy to confirm the cytologic diagnoses. Loop excision of the transformation zone was performed to treat clinical lesions. Sensitivity, specificity, positive and negative predictive value were evaluated. Kappa statistics and logistic regression analysis were used to evaluate the findings statistically. RESULTS: By logistic regression analysis, we found that the chance of finding squamous intraepithelial lesions involving glands in AGUS smears was 5.32 times higher than in those with no AGUS. It was 5.74 times higher in cervical intraepithelial neoplasia (CIN) 3 lesions than in CIN 2. CONCLUSION: The cytologic predictive value for HSIL involving glands is statistically significant when specific and objective criteria are used for the AGUS diagnosis.

In this work, the impact of a hydatidosis control programme for dogs on the intermediate ovine host was specifically analysed to determine the levels of prevalence achieved and the dynamics of parasite transmission, as well as to evaluate the quality of diagnostic systems in slaughterhouses. A field study was conducted in four slaughterhouses (Valcheta, Los Menucos, Jacobacci, Bariloche) that process animals coming from all the departments within the work area. The control programme for dogs entailed treating dogs with 5 mg/kg praziquantel at 2-month intervals for 20 years. Sample size was determined with a 10% error margin and a 95% significance level. Harvested viscera (liver, lungs, kidneys) were preserved in 5% formaldehyde and sent to the laboratory for diagnostic confirmation of both positive and negative specimens. The 61% initial prevalence dropped to 18.3% at the end of the 10-year period, observed differences proving significant (Chi-square=15.454, P=0.00). There were statistically significant increases in infection prevalence with age (Pearson’s Chi-square=133.61, P=0.00). Overall, 37.2% of hydatidosis cases diagnosed in slaughterhouses were considered non-hydatid by histological study. On the other hand, 1.1% of those diagnosed as healthy were found to be infected with hydatidosis. The number of hydatid cysts per animal increased with age: 0.04 in lambs and 1.22 in adults (linear regression equation, −0.0539+0.0127×age), whereas the average for the whole period was 3.7% in lambs and 20.5% in adults. Viability studies indicated that 63.8% of parasitised animals had viable cysts, out of which 53.3% were fertile. Diagnosis of infection in sheep made by means of an adjusted statistical design and with histological confirmation of the presumptive diagnosis made in slaughterhouses demonstrated the flaws of the official systems for epidemic surveillance of hydatidosis. However, there was no overall significant difference in slaughterhouse and laboratory data. Ro was 0.53 and could imply a decrease in reproductive capacity of the parasite and steady state extinction.

INTRODUCTION: Male genital infection by human papillomavirus is of particular importance since it is often asymptomatic. The patient generally presents no clinical lesion. Therefore, men represent an important reservoir of virus, playing a special role in the transmission and perpetuation of the disease. PATIENTS AND METHODS: In the present prospective clinical trial study, 190 sex partners of women with genital infection by human papillomavirus, associated or not with cervical intraepithelial neoplasia, were investigated. All patients were unaware of or denied the presence of a genital lesion. RESULTS: Cytologic examination revealed koilocytosis in 9 cases (4.7%) in the urethra and in 3 cases (1.6%) in the corona of the glans and the distal prepuce. Peniscopy with the previous use of 5% acetic acid revealed white lesions in 97.9% of the patients. Toluidine blue stained most of the lesions. At least one fragment revealed koilocytosis in the histopathologic study of 97 cases (51.05%). CONCLUSION: The three methods complement one another, allowing a more precise diagnosis of this infection in men. INTRODUÇÃO: A infecção genital masculina pelo papilomavírus humano tem especial importância, pois é, freqüentemente, assintomática. Na maioria dos casos, o indivíduo não apresenta lesão clínica. Por isso, os homens passam a ser encarados como importante reservatório do vírus, exercendo papel especial na transmissão e perpetuação da doença. PACIENTES E MÉTODOS: No presente estudo clínico do tipo prospectivo, foram avaliados 190 parceiros de mulheres com infecção genital por papilomavírus humano, associada ou não à neoplasia intra-epitelial cervical. Todos os pacientes desconheciam ou negavam a presença de lesão genital. RESULTADOS: A citologia uretral exibiu coilocitose em nove casos (4,7%) e três (1,6%) na coroa da glande e prepúcio distal. A peniscopia, após a aplicação de ácido acético a 5%, revelou lesões brancas em 97,9% dos pacientes. A solução do azul de toluidina corou a maior parte das lesões observadas, Pelo menos um fragmento revelou coilocitose quando do estudo histopatológico em 97 casos (51,05%). CONCLUSÃO: Os três métodos se complementam, permitindo diagnóstico mais preciso dessa infecção no homem.

In occupational environments, an increasing number of electromagnetic sources emitting complex magnetic field waveforms in the range of intermediate frequencies is present, requiring an accurate exposure risk assessment with both in vitro and in vivo experiments. In this article, an in vitro exposure system able to generate complex magnetic flux density B-fields, reproducing signals from actual intermediate frequency sources such as magnetic resonance imaging (MRI) scanners, for instance, is developed and validated. The system consists of a magnetic field generation system and an exposure apparatus realized with a couple of square coils. A wide homogeneity (99.9%) volume of 210 × 210 × 110 mm(3) was obtained within the coils, with the possibility of simultaneous exposure of a large number of standard Petri dishes. The system is able to process any numerical input sequence through a filtering technique aimed at compensating the coils' impedance effect. The B-field, measured in proximity to a 1.5 T MRI bore during a typical examination, was excellently reproduced (cross-correlation index of 0.99). Thus, it confirms the ability of the proposed setup to accurately simulate complex waveforms in the intermediate frequency band. Suitable field levels were also attained. Moreover, a dosimetry index based on the weighted-peak method was evaluated considering the induced E-field on a Petri dish exposed to the reproduced complex B-field. The weighted-peak index was equal to 0.028 for the induced E-field, indicating an exposure level compliant with the basic restrictions of the International Commission on Non-Ionizing Radiation Protection. Bioelectromagnetics 34:211-219, 2013. © 2012 Wiley Periodicals, Inc.

A case of mansoni schistosomiasis causing peritoneal inflammation and chronic iliac pain is reported. The patient complained of iliac pain for 6 months. Physical examination and sonographic evaluation found a tumor in the left iliac fosse. A pseudocyst was removed from the pelvic region. The histopathology confirmed the diagnosis of S. mansoni. This is a rare case of S. mansoni in the pelvic cavity.

Cystic echinococcosis (CE) is a chronic, complex and neglected disease caused by the larval stage of Echinococcus granulosus. The effects of this neglect have a stronger impact in remote rural areas whose inhabitants have no chances of being diagnosed and treated properly without leaving their jobs and travelling long distances, sometimes taking days to reach the closest referral center. Background In 1980 our group set up a control program in endemic regions with CE in rural sections of Rio Negro, Argentina. Since 1997, we have used abdominopelvic ultrasound (US) as a screening method of CE in school children and determined an algorithm of treatment. Objectives To describe the training system of general practitioners in early diagnosis and treatment of CE and to evaluate the impact of the implementation of the field program. Materials and Methods In 2000, to overcome the shortage of radiologists in the area, we set up a short training course on Focused Assessment with Sonography for Echinococcosis (FASE) for general practitioners with no previous experience with US. After the course, the trainees were able to carry out autonomous ultrasound surveys under the supervision of the course faculty. From 2000 to 2008, trainees carried out 22,793 ultrasound scans in children from 6 to 14 years of age, and diagnosed 87 (0.4%) new cases of CE. Forty-nine (56.4%) were treated with albendazole, 29 (33.3%) were monitored expectantly and 9 (10.3%) were treated with surgery. Discussion The introduction of a FASE course for general practitioners allowed for the screening of CE in a large population of individuals in remote endemic areas with persistent levels of transmission, thus overcoming the barrier of the great distance from tertiary care facilities. The ability of local practitioners to screen for CE using US saved the local residents costly travel time and missed work and proved to be an efficacious and least expensive intervention tool for both the community and health care system., Author Summary Cystic echinococcosis (CE) is an important and widespread disease that affects sheep, cattle, and humans living in areas where sheep and cattle are raised. CE is highly endemic in rural sections of Rio Negro, Argentina, where our group is based. However, it requires continuous monitoring of both populations with human disease best assessed by means of ultrasound (US) screening. This is challenging in remote rural areas due to the shortage of imaging specialists. To overcome this hurdle, we set up a two-day training program of Focused Assessment with Sonography for Echinococcosis (FASE) on CE for family medicine practitioners with no previous experience in US. After the course, they were equipped with portable US scanners and dispatched to remote rural areas in Rio Negro where they screened patients, located and staged the cysts and decided on the treatment with the help of surgeons and radiologists in local tertiary care centers. The need to travel to referral hospitals for traditional surgical interventions was therefore limited to a few cases. US was instead brought to rural areas thereby extending affordable healthcare to people who would otherwise not have access to it.

Previous studies identified the train compartment as the place where people can experience the highest exposure levels to electromagnetic fields in the radiofrequency range. Thus, in this study, a possible scenario of a train compartment has been reproduced and characterized, both numerically and experimentally, in order to assess the individual exposure. A very good agreement between the electric field values measured and simulated has been found. Results indicate that the individual exposure may increase, depending on the number of active cell phones, the coverage condition, and the position inside the compartment, while remaining well below the limits imposed by the international regulations.

Cervical cancer is a serious public health problem in women in developing countries because of absence or ineffectiveness of screening programs. Several biases to access medical care and inequity of public health system in a continental country like Brazil limit the implementation of adequate programs to appropriately prevent the cervical cancer. Therefore, the aim of this study was to evaluate the results of applying the mobile unit (MU) for cervical cancer screening. From May 2003 to May 2004, a cervical cancer screening was offered to women aged 20-69 years, residing in 19 municipal districts of the Barretos county region, in Sao Paulo. Out of the 9,560 examination available, 2,964 (31%) women underwent screening. The medium distance traveled by the MU was 45 km. The medium time spent by women in the MU for completion of the questionnaire and doing the exam was 20 minutes. It was observed that 17.0% of women screened had never had the test or had not had it repeated within the last 3 years. The negative response was more common among women aged 20 to 29 years and 60 to 69 years and among women with less schooling and lower socio-economic income (P < 0.05). MU can significantly overcome the chronic deficiency of public health system accessibility offering opportunity to these women to participate in screening programs.

An in vitro exposure system, based on a Wire Patch Cell (WPC) and operating in the whole band of the Wi-Fi signal, has been fabricated and characterized. The system enables the contemporary exposure of four 35 mm Petri dishes and can be inserted into a commercial incubator. Results of both simulations and measurements indicate a good behavior in the band. The mean efficiency, in terms of Specific Absorption Rate (SAR) in the biological sample for 1 W of input power, is higher than 0.75 (W/kg)/W. The homogeneity of the SAR distribution inside each Petri dish is above 70 % in the lowest layer of the biological solution, indicating the optimal employment of the system for the exposure of cell monolayers.

Introduction: Studies have highlighted the changes that take place in the environment between the cell and the extracellular matrix during the process of neoplastic expansion. Several papers have associated the expression of heparanase 1 with various malignant tumors. Heparanase 2 is probably related to loss of cell adhesion.Objective: the aim of this study was to evaluate the expression of heparanase 2 in epithelial neoplasia of the ovaries and in samples of normal ovarian tissue.Methods: Seventy-five ovary specimens were analyzed and divided into 3 groups: 23 malignant and 35 benign epithelial ovarian neoplasia and 17 without ovarian disease. We used 2 methodological techniques for evaluating the immunoexpression of heparanase 2. the first followed the qualitative criterion of positive or negative in relation to enzymatic expression, and the second involved computerized quantification of this expression, performed on the same slides.Results: in the quantitative analysis, we found positivity indices for heparanase 2 expression of 72.2% and 87.3% in the samples of benign and malignant neoplasias, respectively. in these,the intensity of expression and the expression index were 147.2 and 121.2. respectively, for the benign neoplasia and 134.1 and 118.0 for the malignant neoplasia. Qualitatively, its expression was strong or moderate in 44.2% of the benign and 78.2% of the malignant tumors; its expression in all of the nonneoplastic samples was negative, with the exception of one that was weakly positive.Conclusions: Heparanase 2 is involved in neoplastic proliferation, but it was not exclusively associated with the malignant process. Furthermore, there was no difference in its expression between benign and malignant ovarian epithelial neoplasia. Universidade Federal de São Paulo, Dept Gynecol, Escola Paulista Med, BR-04037005 São Paulo, Brazil Universidade Federal de São Paulo, Dept Pathol, Escola Paulista Med, BR-04037005 São Paulo, Brazil Universidade Federal de São Paulo, Dept Biochem, Escola Paulista Med, BR-04037005 São Paulo, Brazil ABC Fdn, Dept Biochem, Mol Biol Lab, Fac Med, São Paulo, Brazil Universidade Federal de São Paulo, Dept Gynecol, Escola Paulista Med, BR-04037005 São Paulo, Brazil Universidade Federal de São Paulo, Dept Pathol, Escola Paulista Med, BR-04037005 São Paulo, Brazil Universidade Federal de São Paulo, Dept Biochem, Escola Paulista Med, BR-04037005 São Paulo, Brazil Web of Science

Cystic echinococcosis is an endemic disease in the Province of Rio Negro, Argentina. Ultrasound surveys carried out in 1984 found prevalence rates of 5.6% in children between 6 and 14 years of age. Objective To describe and to evaluate the results of the strategy applied in school children by hospital services of the Province of Rio Negro with regard to diagnosis, treatment and monitoring of cystic echinococcosis and to evaluate simultaneously the results of the control program against cystic echinococcosis. Materials and methods In 1997 ultrasound was chosen to carry out population surveys and the medical treatment criteria for the detected cases were standardized. The population under study involved 5745 students in the first survey and 22,793 in subsequent studies. The detected cases were classified according to Gharbi's scheme. A treatment algorithm was defined based only on monitoring (“watch and wait”), albendazole, surgery (open or laparoscopic) or mini-invasive procedures, according to type, location and size of the cyst. Information was also obtained on cases notified to the Health System between 1980 and 2008. Results In the first survey, 70 carriers (1.2%) were detected; of these, 25 started albendazole treatment (35.7%) and only 3 (4.3%) underwent surgery. Ten years after treatment, 60.1% of 42 cases, presented Types IV and V cysts and 14.5% presented total involution of their cysts. In subsequent studies, 87 (0.4%) cases were detected, 49 of which started albendazole treatment (56.3%) and 9 underwent surgery (10.3%). The incidence rate of cystic echinococcosis cases decreased from 38 × 100,000 in 1980 to 3.7 × 100,000 in 2008. Discussion A strong decrease in cystic echinococcosis was obtained although persistent levels of transmission were maintained. The cases produced under these conditions are diagnosed by means of ultrasound surveys and are treated using a plan based on albendazole and monitoring by the Health System during a period of 10 years.

Introduction Cervical and breast cancer are the most common malignancies among women worldwide. Effective screening can facilitate early detection and dramatically reduce mortality rates. The interface between those screening patients and patients most needing screening is complex, and women in remote areas of rural counties face additional barriers that limit the effectiveness of cancer prevention programs. This study compared various methods to improve compliance with mass screening for breast and cervical cancer among women in a remote, rural region of Brazil. Methods In 2003, a mobile unit was used to perform 10,156 mammograms and Papanicolaou smear tests for women living in the Barretos County region of Sao Paulo state, Brazil (consisting of 19 neighbouring cities). To reach the women, the following community outreach strategies were used: distribution of flyers and pamphlets; media broadcasts (via radio and car loudspeakers); and community healthcare agents (CHCAs) making home visits. Results The most useful intervention appeared to be the home visits by healthcare agents or CHCAs. These agents of the Family Health Programme of the Brazilian Ministry of Health reached an average of 45.6% of those screened, with radio advertisements reaching a further 11.9%. The great majority of the screened women were illiterate or had elementary level schooling (80.9%) and were of 'poor' or 'very poor' socioeconomic class (67.2%). Conclusions Use of a mobile screening unit is a useful strategy in developing countries where local health systems have inadequate facilities for cancer screening in underserved populations. A multimodal approach to community outreach strategies, especially using CHCAs and radio advertisements, can improve the uptake of mass screening in low-income, low-educational background female populations.

The immune response to Echinococcus granulosus in sheep has not been extensively investigated. The objective of this study was to increase the information on the physiopathology of E. granulosus and the immune response elicited in sheep. Animals were experimentally inoculated with three different doses of E. granulosus eggs and the immune response was evaluated over 500 days using enzyme immunoassay with three antigenic preparations: total hydatid fluid, purified fraction of hydatid fluid and purified lipoprotein fraction. Sheep were slaughtered at different intervals to observe the macroscopic and microscopic development of the parasite. Immune response was detected at 10 days and was maintained throughout the observation period, being initially proportional to the load of inoculated eggs and then decreasing over time. Fertile cysts were identified 10 months after inoculation and live onchosphere 500 days after inoculation. Antibody response to E. granulosus in sheep preceded hydatid fluid formation and was generated by the mobility of the onchosphere. Early histological identification of fertile cysts indicates that feeding dogs with viscera of young sheep can produce cycles of infection. Furthermore, the presence of live onchosphere in the liver here found contributes to a better knowledge of the pathogenesis of this disease it could be hypothetically considered as a cause for the repeated surgeries necessary in man after the extirpation of a hydatid cyst.

Os complexos desafios socioambientais da modernidade têm levado a sociedade, as empresas e os governos a interagir, construindo um novo conhecimento interdisciplinar em direção a um desenvolvimento com a manutenção da sustentabilidade ambiental do planeta. Parte desse conhecimento devido à relação das empresas com seu ambiente, tem recebido o nome de Responsabilidade Socioambiental. O que se pretendeu nessa pesquisa foi conhecer a relação entre as práticas de gestão com responsabilidade socioambiental (RSA) e seu desempenho para o desenvolvimento sustentável (DS). Para isso, buscou-se responder à questão: qual a relação das práticas de gestão com RSA e o desempenho para o DS? Foi feita uma revisão na literatura sobre os temas relacionados e depois realizou-se uma pesquisa quantitativa descritiva multidisciplinar com 80 empresas ligadas à instituições de apoio à gestão para o Desenvolvimento Sustentável. Após realizar uma análise de correlação canônica, obteve-se os seguintes resultados: as variáveis relativas à Visão e Liderança, Planejamento e Implementação, e Controle e Relato têm importância na relação com o desempenho, porém têm maior peso as variáveis Visão e Liderança e Planejamento e Implementação. Além disso, concluiu-se que determinados princípios e diretrizes, como Declaração dos Direitos Humanos, Pacto Global, Objetivos de Desenvolvimento do Milênio, padrões de certificação, como a ISO 9001 e 14001, e ferramentas, como Produção Limpa e Ecoeficiência, têm importância similar na sua relação com o desempenho, não sendo possível determinar diferença entre elas. Também foi possível concluir, da análise de correlação canônica, que as empresas com valores do bem comum têm nível maior de prática e desempenho do que as que não tem. The socioenvironmental complex challenges of modernity have brought to society, businesses and governments to interact, building a new interdisciplinary knowledge toward a development with environmental sustainability of the planet. Part of this knowledge due to the relationship of companies with their environment, has received the name of Socioenviromental Responsibility. What if such research were intended to ascertain the relationship between management practices with socioenvironmental responsibility (SER) and its performance for Sustainable Development (SD). To do so we attempted to answer the question: what is the relationship between management practices with SER and performance for the SD? A review was made in the literature on related themes and after conducting a multidisciplinary descriptive quantitative research with 80 companies involved in the institutions supporting management for Sustainable Development an analysis was conducted of canonical correlation giving the following results: the variables on Vision and Leadership, Planning and Implementation, and Control and Reporting are important in relation to the performance, but have greater weight variables \'Vision and Leadership\' and \'Planning and Implementation. Moreover, it was concluded that certain principles and guidelines as Declaration of Human Rights, Global Compact, Millennium Development Goals and standards for certification as ISO 9001 and 14001 and tools such as Clean Production and eco-efficiency have similar importance in relation to the performance eliminating the possibility of determining the difference between them. It was also possible to conclude that companies with values of common good have a better level of practice and performance than those that do not.

The present case–control study evaluates the role of the progesterone receptor (PR) polymorphism known as PROGINS as a risk factor for ovarian cancer development and investigates the association between these genetic variants and clinical/pathologic variables of ovarian cancer. PROGINS polymorphism was examined, by polymerase chain reaction, in a total of 80 patients with ovarian cancer and 282 control subjects. The frequencies of PROGINS polymorphism T1/T1, T1/T2, and T2/T2 were 71.3, 15.0 and 13.8% in ovarian cancer patients and 78.37, 21.63 and 0% in controls, respectively. The χ2-test showed a higher incidence of the T2/T2 genotype (P = 0.001) in the ovarian cancer group. In addition, women carrying a mutated allele (T2) showed approximately 2.2 times higher risk of ovarian cancer development as compared to women who have a variant allele (odds ratio (OR) = 2.2; 95% CI = 1.80–3.54). Regarding the clinical and pathologic findings observed within the cancer group, there was a significant correlation between PROGINS polymorphism and patients with a familial history (χ2 = 6.776; P = 0.009; Fischer exact test, P = 0.01). In this regard, patients with familial antecedents have a 4.7 times higher likelihood to have at least one risk allele (T2) as compared with patients without familial antecedents (OR = 4.69; 95% CI = 1.38–15.87). No correlations were observed among the other variables. These data suggest that the PROGINS polymorphism T2/T2 genotype might be associated with an increased risk of ovarian cancer.

Small bowel metastases from primary lung cancer have rarely been reported and a single symptomatic metastasis to the small bowel is a rare occurrence. In the case reported here there was no evident additional site of metastatic disease and the diagnosis was made on the basis of morphology and immunohistochemistry analysis using CK 07, CK 20 and TTF-1 monoclonal antibodies. However, even in patients in whom the intestine is the sole metastatic site, the prognosis is dismal and most of patients die within 2 months.

Objective: The objective was to evaluate the prevalence of human papillomavirus (HPV) in the anal canal of women with cervical intraepithelial neoplasia (CIN) grade III. Study design: Two groups were compared. In group I (study group), 40 women who had undergone cervical biopsy with a histopathological result indicating CIN III were evaluated. Group II (control) consisted of 40 women with normal results from colposcopic examination and colpocytological tests. The women in group I who presented high-grade neoplasia in colpocytological tests underwent collection of material from the uterine cervix and anal canal for investigating HPV DNA using the Hybrid Capture II 1 technique. Colposcopy and cervical biopsy were then performed. If CIN III was confirmed, HPV DNA was investigated in the material collected. In group II, colpocytological tests and colposcopy were performed and, if normal, the procedure was similar to that followed for group I, except that no biopsy was performed. Results: In group I, 39 women (97.5%) were positive for HPV in the uterine cervix and 14 women (35%) in the anal canal. In group II, only four women (10%) had a positive HPV test, for both the uterine cervix and the anal canal. Conclusions: The prevalence of HPV in the anal canal of the women with CIN III was greater than in the women without CIN III. # 2008 Elsevier Ireland Ltd. All rights reserved.

The surveillance of infection for Echinococcus granulosus in the Province of Rio Negro during 1980-2002 included serological and ultrasonographic screening in humans and arecoline test in dogs. In lieu of the limitations of the arecoline test the proposal was to supplant that test for the copro ELISA-copro/Western Blot complex applied to feces collected from the environment. The objective was to compare the pros and cons of the two tests and to evaluate the human and the canine infection prevalence. The working area encompassed 7 Departments with systematic canine parasiticide activities (Program Area) and 4 Departments, not endemic, as Control Area. The arecoline test was applied to the dogs in assembled groups with the voluntary participation of their owners (not randomized sampling). Samples for the detection of coproantigens were obtained from sheep farms selected at random and analyzed by the complex copro-ELISA /Western Blot. Prevalence in man was determined by screening the school population (6 to 14 years old) by ultrasound, and by means of the compulsory notification of cases from the official system. Dogs (416) were tested with arecoline, 365 of which belonged to the Program Area. Of these 19 (5.2%) resulted positive, while none of 51 dogs from the Control Area were positive. Samples (748) of feces were tested to detect coproantigens, obtaining 37 positive samples within the Program Area and 4 within the Control Area. Farms (271) from the livestock estate unit were evaluated, out of which 236 belonged to the Program Area, gave 32 (13.6%) positive results, while 4 (11.4%) of 35 from the Control Area resulted positive. Sonography tests (7421) were done in the Program Area detecting 40 (0.5%) carriers, while in the Control Area, over 1732 tests, 9 (0.5%) resulted positive. The arecoline test provides information about the dog prevalence while the detection of coproantigens in feces collected from the environment allowed to enhance the quality of the information, and the identification of environments where specific control activities focusing on risk must be concentrated. Also the study allowed to recognize new transmission areas.

Immunodiagnosis in sheep presents problems of sensitivity and specificity, limiting its applicability in surveillance systems. The objective of this study was to develop a sensitive, specific and accessible technique for diagnosing cystic echinococcosis in naturally infected sheep and to evaluate the validity of necropsy as a reference test. A total of 247 sheep were studied at slaughterhouses, confirming the parasitological diagnosis with histology. Serum was processed with enzyme immunoassay (EIA) using three antigen preparations: total hydatid liquid (LHT), purified fraction of LHT (S2B) and purified lipoprotein (B). Western Blot (WB) was used as a control. EIA proved effective for differentiating Echinococcus granulosus from larval stage of Taenia hydatigena and intestinal cestodes in all three antigen preparations. Serums from macroscopically negative sheep were reactive to EIA and positive with WB. In the whole flock, sensitivity was 89.2% for LHT, 80.0% for S2B and 86.4% for B. Sensitivity in lambs was 78.6% for LHT, 75.0% for S2B and 64.3% for B. Macroscopic diagnosis at the time of slaughter was found to have limitations as a reference test for immunodiagnosis of cystic equinococcosis in sheep, so it was necessary to include histology and WB as reference tests. LHT was the antigen preparation of greatest value and EIA proved to be a sensitive and specific technique, adequate for surveillance systems and for evaluating control programmes.

In recent years, the widespread use of mobile phones has been accompanied by public debate about possible adverse consequences on human health. The auditory system is a major target of exposure to electromagnetic fields (EMF) emitted by cellular telephones; the aim of this study was the evaluation of possible effects of cellular phone-like emissions on the functionality of rat's cochlea. Distortion Products OtoAcoustic Emission (DPOAE) amplitude was selected as cochlea's outer hair cells (OHC) status indicator. A number of protocols, including different frequencies (the lower ones in rat's cochlea sensitivity spectrum), intensities and periods of exposure, were used; tests were carried out before, during and after the period of treatment. No significant variation due to exposure to microwaves has been evidenced.