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Pronouns often convey information about a person's social identity (e.g., gender). Consequently, pronouns have become a focal point in academic and public debates about whether pronouns should be changed to be more inclusive, such as for people whose identities do not fit current pronoun conventions (e.g., gender nonbinary individuals). Here, we make an empirical contribution to these debates by investigating which social identities lay speakers think that pronouns should encode (if any) and why. Across four studies, participants were asked to evaluate different types of real and hypothetical pronouns, including binary gender pronouns, race pronouns, and identity-neutral pronouns. We sampled speakers of two languages with different pronoun systems: English (N = 1,120) and Turkish (N = 260). English pronouns commonly denote binary gender (e.g., "he" for men), whereas Turkish pronouns are identity-neutral (e.g., "o" for anyone). Participants' reasoning about pronouns reflected both a familiarity preference (i.e., participants preferred the pronoun type used in their language) and-critically-participants' social ideologies. In both language contexts, participants' ideological beliefs that social groups are inherently distinct (essentialism) and should be hierarchal (social dominance orientation) predicted relatively greater endorsement of binary gender pronouns and race pronouns. A preregistered experimental study with an English-speaking sample showed that the relationship between ideology and pronoun endorsement is causal: Ideologies shape attitudes toward pronouns. Together, the present research contributes to linguistic and psychological theories concerning how people reason about language and informs policy-relevant questions about whether and how to implement language changes for social purposes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Idioma , Humanos , Masculino , Feminino , Adulto , Adulto Jovem , Identificação Social , PsicolinguísticaRESUMO
In principle, the fundamental concepts person, woman, and man should apply equally to people of different genders and races/ethnicities. In reality, these concepts might prioritize certain groups over others. Based on interdisciplinary theories of androcentrism, we hypothesized that (a) person is more associated with men than women (person = man) and (b) woman is more associated with women than man is with men (i.e., women are more gendered: gender = woman). We applied natural language processing tools (specifically, word embeddings) to the linguistic output of millions of individuals (specifically, the Common Crawl corpus). We found the hypothesized person = man / gender = woman bias. This bias was stronger about Hispanic and White (vs. Asian) women and men. We also uncovered parallel biases favoring White individuals in the concepts person, woman, and man. Western society prioritizes men and White individuals as people and "others" women as people with gender, with implications for equity across policy- and decision-making contexts.
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Girls and women are underrepresented in chess. Here, we explored the role of gender bias in this phenomenon. Specifically, we investigated whether parents and mentors (e.g., coaches) show bias against the female youth players in their lives. Parents and mentors (N = 286; 90.6% men) recruited through the U.S. Chess Federation reported their evaluations of and investment in youth players (N = 654). We found evidence of bias on some, but not all, measures. Most strikingly, parents and mentors thought that female youth players' highest potential chess ratings were on average lower than male players', a bias that was exacerbated among parents and mentors who believed that success in chess requires brilliance. In addition, mentors who endorsed (vs. rejected) this belief also reported that female mentees were more likely to drop out of chess due to low ability. These findings provide the first large-scale evidence of bias against youth female players and hold implications for the role of parents and mentors in other domains that, like chess, are culturally associated with intellectual ability and exhibit substantial gender imbalances (e.g., science and technology). (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Mentores , Sexismo , Adolescente , Humanos , Masculino , Feminino , Inteligência , Logro , PaisRESUMO
People with biological essentialist beliefs about social groups also tend to endorse biased beliefs about individuals in those groups, including intensified emphasis on the group, stereotypes, and prejudices. These correlations could be due to biological essentialism causing bias, and some experimental studies support this causal direction. Given this prior work, we expected to find that biological essentialism would lead to increased bias compared with a control condition and set out to extend this prior work in a new direction (regarding "value-based" essentialism). But although the manipulation affected essentialist beliefs and essentialist beliefs were correlated with group emphasis (Study 1), stereotyping (Studies 2, 3a, 3b, and 3c), prejudice (Studies 3a), there was no evidence that biological essentialism caused these outcomes (NTotal = 1,903). Given these findings, our initial research question became moot. We thus focus on reexamining the relationship between essentialism and bias.
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Recent advances have made it possible to precisely measure the extent to which any two words are used in similar contexts. In turn, this measure of similarity in linguistic context also captures the extent to which the concepts being denoted are similar. When extracted from massive corpora of text written by millions of individuals, this measure of linguistic similarity can provide insight into the collective concepts of a linguistic community, concepts that both reflect and reinforce widespread ways of thinking. Using this approach, we investigated the collective concept person/people, which forms the basis for nearly all societal decision- and policy-making. In three studies and three preregistered replications with similarity metrics extracted from a corpus of over 630 billion English words, we found that the collective concept person/people is not gender-neutral but rather prioritizes men over women-a fundamental bias in our species' collective view of itself.
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Women and men each represent about half the population, but people think of the concept person more as a man. Wardle et al. recently found that people also see face-like objects more as men than as women. This finding generates further questions on whether bias about concepts and faces might differ.
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Reconhecimento Psicológico , Feminino , Humanos , Masculino , Fatores SexuaisRESUMO
Concern that masculine generic language (e.g., man to mean humanity) perpetuates gender inequity has led several institutions to formally discourage its use. While previous experimental research indicates that generic terms like man bring more exemplars of men than women to mind, only recently have researchers begun exploring additional consequences of gendered language. Understanding the range of processes affected is of particular importance when evaluating real-world policies. Yale University recently changed the title of a leadership role from master to head. The present study (N = 341) investigated what exemplars come to mind (i.e., cognitive accessibility) while also probing memory for women and men in the leadership role both before and after Yale's language policy change. Students exposed to master generated a male exemplar more than would be expected by the incidence of men and recognized actual men in the role more accurately (d') than women in a face recognition task. Among students exposed to head, both biases were eliminated. The previous literature shows that masculine generic language brings men to mind. The present work demonstrates a similar effect but in an applied context while further documenting consequences for memory. Gender inclusive language polices have potential to reduce gender biased thinking with applied significance. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Idioma , Sexismo , Feminino , Humanos , Liderança , Masculino , Estudantes , UniversidadesRESUMO
Psychological essentialism has played an important role in social psychology, informing influential theories of stereotyping and prejudice as well as questions about wrongdoers' accountability and their ability to change. In the existing literature, essentialism is often tied to beliefs in shared biology-that is, the extent to which members of a social group are seen as having the same underlying biological features. Here we investigate the possibility of "value-based essentialism" in which people think of certain social groups in terms of an underlying essence, but that essence is understood as a value. Study 1 explored beliefs about a wide range of social groups and found that both groups with shared biology (e.g., women) and shared values (e.g., hippies) elicited similar general essentialist beliefs relative to more incidental social categories (e.g., English-speakers). In Studies 2-4, participants who read about a group either as being based in biology or in values reported higher general essentialist beliefs compared with a control condition. Because biological essences about social groups have been connected to a number of downstream consequences, we also investigated two test cases concerning value-based essentialism. In Study 3, beliefs about both shared biology and shared values increased inductive generalizations about the social group relative to control, but in Study 4, only the shared biology condition reduced blame for wrongdoing. Together these findings join with recent work to support a broader theoretical framework of essentialism about social groups that can be arrived at through multiple pathways, including, in the present case, shared values. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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BACKGROUND: Magnetic resonance imaging (MRI) assesses pulmonary hypoplasia in fetal congenital diaphragmatic hernia (CDH). Neonatal mortality may occur with CDH. OBJECTIVE: To quantify MRI parameters associated with neonatal survival in fetuses with isolated CDH. MATERIALS AND METHODS: Fetal MRI for assessing CDH included region of interest (ROI) measurements for total lung volume (TLV), herniated liver volume, herniated other organ volume and predicted lung volume. Ratios of observed lung volume and liver up volume to predicted lung volume (observed to predicted TLV, percentage of the thorax occupied by liver) were calculated and compared to neonatal outcomes. Analyses included Wilcoxon rank sum test, multivariate logistic regression and receiver operating characteristic (ROC) curves. RESULTS: Of 61 studies, the median observed to predicted TLV was 0.25 in survivors and 0.16 in non-survivors (P=0.001) with CDH. The median percentage of the thorax occupied by liver was 0.02 in survivors and 0.22 in non-survivors (P<0.001). The association of observed to predicted TLV and percentage of the thorax occupied by liver with survival for gestational age (GA) >28 weeks was greater compared to GA ≤28 weeks. The ROC analysis demonstrated an area under the curve of 0.96 (95% confidence interval 0.91-1.00) for the combined observed to predicted TLV, percentage of the thorax occupied by liver and GA. CONCLUSION: The percentage of the thorax occupied by liver and observed to predicted TLV was predictive of neonatal survival in fetuses with CDH.
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Hérnias Diafragmáticas Congênitas , Hérnias Diafragmáticas Congênitas/diagnóstico por imagem , Humanos , Lactente , Recém-Nascido , Fígado/diagnóstico por imagem , Medidas de Volume Pulmonar , Imageamento por Ressonância Magnética , Estudos RetrospectivosRESUMO
PURPOSE: To compare prevalence and severity of multi-compartment pelvic floor dysfunction between supine magnetic resonance defecography with defecation (MRD) and supine dynamic MRI during Valsalva, both with and without rectal distention. METHODS: This was an IRB-approved, HIPAA-compliant retrospective review of consecutive patients referred for MR Defecography. MRD protocol included imaging at rest, during pre-defecation Valsalva (Pre-DV), defecation (Def), and post-defecation Valsalva (Post-DV). The Post-DV images were performed after complete evacuation either during the defecation acquisition or, in cases where patient was unable to defecate during the examination, in a conventional toilet. Size of cystocele, vaginal prolapse, anorectal (AR) descent, and enterocele were measured on all acquisitions relative to the pubococcygeal line. Rectocele size was recorded in anteroposterior dimension. The presence or absence of rectal intussusception (RI) was documented. The prevalence, absolute size, and grades of prolapse, rectocele, and RI were compared between the acquisitions using pair-wise ANOVA, Friedman, Dunn pair-wise, and Cochran-Mantel-Haenszel tests. RESULTS: 30 patients were included in the final analysis. Higher prevalence of cystocele, vaginal prolapse, enterocele, AR descent grade 2 or higher, rectocele grade 2 or higher, and RI were seen on Def compared to Post-DV and Pre-DV. Cystocele, vaginal prolapse, enterocele, AR descent, and rectocele sizes were significantly larger on Def compared to Post-DV by 0.7-1.95 cm (p ≤ 0.007). Prolapse in all compartments and rectocele size were significantly larger on Def compared to Pre-DV (p < 0.0001). Cystocele, vaginal prolapse, and enterocele sizes were significantly larger on Post-DV compared to Pre-DV (p < 0.0001). There were significant differences in grading of all types of prolapse and rectocele between the various acquisitions of MRD (p < 0.0001). Cystocele, AR descent, and rectocele grades were significantly higher on Def compared to Post-DV (p range ≤ 0.0002). Grading of all types of prolapse and rectocele was significantly higher on Def compared to Pre-DV (p < 0.0001). Cystocele, vaginal prolapse, and enterocele grades were all significantly higher on Post-DV compared to Pre-DV (p ≤ 0.0007). CONCLUSION: Defecation images during supine MRD elicit higher prevalence and size of prolapse of all pelvic compartments in comparison to both pre- and post-defecation Valsalva images. Post-defecation Valsalva images show larger size of anterior and middle compartment prolapse than pre-defecation Valsalva images. Functional evaluation of pelvic floor dysfunction with MRI should include image acquisition during defecation. If Valsalva images are acquired, these should be performed after the defecation acquisition and without rectal distention.
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Defecação , Diafragma da Pelve , Defecografia , Feminino , Humanos , Imageamento por Ressonância Magnética , Diafragma da Pelve/diagnóstico por imagem , Estudos Retrospectivos , Manobra de ValsalvaRESUMO
As fetal gestational age increases, other modalities such as ultrasound have demonstrated increased levels of heterogeneity in the normal placenta. In this study, we introduce and apply ROI-based texture analysis to a retrospective fetal MRI database to characterize the second-order statistics of placenta and to evaluate the relationship between heterogeneity and gestational age. Positive correlations were observed for several Haralick texture metrics derived from fetal-brain specific T2-weighted and gravid uterus T1-weighted and T2-weighted images, confirming a quantitative increase in placental heterogeneity with gestational age. Our study shows the importance of identifying baseline MR textural changes at certain gestational ages from which placental diseased states may be compared. Specifically, when evaluating for placental invasion or insufficiency, findings should be evaluated in the context of the normal placental aging process, which occurs throughout gestation.
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Idade Gestacional , Imageamento por Ressonância Magnética , Placenta/diagnóstico por imagem , Adulto , Feminino , Humanos , Insuficiência Placentária/diagnóstico por imagem , GravidezRESUMO
Androcentrism refers to the propensity to center society around men and men's needs, priorities, and values and to relegate women to the periphery. Androcentrism also positions men as the gender-neutral standard while marking women as gender-specific. Examples of androcentrism include the use of male terms (e.g., he), images, and research participants to represent everyone. Androcentrism has been shown to have serious consequences. For example, women's health has been adversely affected by over-generalized medical research based solely on male participants. Nonetheless, relatively little is known about androcentrism's proximate psychological causes. In the present review, we propose a social cognitive perspective arguing that both social power and categorization processes are integral to understanding androcentrism. We present and evaluate three possible pathways to androcentrism deriving from (a) men being more frequently instantiated than women, (b) masculinity being more "ideal" than femininity, and/or (c) masculinity being more common than femininity.
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Cognição , Identidade de Gênero , Poder Psicológico , Comportamento Social , Feminino , Feminilidade , Humanos , Masculino , Masculinidade , Normas SociaisRESUMO
OBJECTIVE: The purpose of this study is to determine which MRI parameters of fetal head and neck masses predict high-morbidity neonatal outcomes, including ex utero intrapartum treatment (EXIT) procedure. MATERIALS AND METHODS: This retrospective study (2004-2016) included parameters of polyhydramnios (based on largest vertical pocket), mass effect on the trachea, mass midline extension, and morphologic grade and size of masses. The morbid cohort included those requiring an EXIT procedure, difficult intubation at delivery, or lethal outcome. Predictive modeling with a multivariable logistic regression and ROC analysis was then performed. RESULTS: Of 36 fetuses, five were delivered by EXIT procedures, there was one neonatal death within 12 hours after delivery, and another neonate required multiple intubation attempts. The remaining 29 fetuses were delivered at outside institutions with no interventions or neonatal morbidity. The largest vertical pocket and mass effect on the trachea were selected as independent predictors by the logistic regression. The cross-validated ROC AUC was 0.951 (95% CI, 0.8795-1). CONCLUSION: The largest vertical pocket measurement and mass effect on the trachea were the most contributory MRI parameters that predicted significant morbidity in fetuses with masses of the face and neck, along with other significant parameters. These parameters predict significant morbid neonatal outcomes, including the need for EXIT procedures.
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Doenças Fetais/diagnóstico por imagem , Neoplasias de Cabeça e Pescoço/congênito , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Diagnóstico Pré-Natal/métodos , Adulto , Feminino , Humanos , Poli-Hidrâmnios/diagnóstico por imagem , Gravidez , Resultado da Gravidez , Estudos Retrospectivos , Doenças da Traqueia/congênito , Doenças da Traqueia/diagnóstico por imagemRESUMO
RATIONALE AND OBJECTIVES: To compare quantitative multiparametric magnetic resonance imaging (mpMRI) data of symptomatic uterine fibroids being considered for MR-guided high-intensity focused ultrasound ablation with fibroid characterization based on the Funaki Classification scheme. MATERIALS AND METHODS: This was a prospective, Institutional Review Board -approved, Health Insurance Portability, and Accountability Act-compliant study. Informed consent was obtained. From December 2013 to April 2015, 48 women with symptomatic fibroids underwent screening with mpMRI protocol including sagittal/axial T2-weighted fast spin-echo, sagittal diffusion-weighted, and sagittal dynamic contrast-enhanced 3D T1-weighted gradient echo imaging on a 3T magnet. All fibroids were assigned Funaki type 1, 2, or 3 based on T2-weighted imaging. Differences in size, perfusion, and diffusion/intravoxel incoherent motion parameters among the three Funaki types were determined using linear mixed model. A logistic regression analysis was performed to select the best model in predicting type 3 fibroids. RESULTS: A total of 100 fibroids were assessed (20 type 1, 66 type 2, and 14 type 3). Apparent diffusion coefficient and D of type 3 fibroids were significantly higher than those of type 1 (P < 0.0001, P < 0.0001) and 2 fibroids (Pâ¯=â¯0.004, P < 0.0001) respectively. Transfer constant of type 3 fibroids was significantly higher than type 1 (Pâ¯=â¯0.0357), but not than type 2 (Pâ¯=â¯0.0752). A cutoff value of Dâ¯=â¯1â¯×â¯10-3 mm2/s offers an accuracy, sensitivity, and specificity of 76%, 71%, and 77%, respectively, for the diagnosis of Funaki 3 fibroids. CONCLUSION: mpMRI-derived quantitative parameters may enable a more objective selection of patients prior to MR-guided high-intensity focused ultrasound therapy.
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Tratamento por Ondas de Choque Extracorpóreas/métodos , Leiomioma , Imagem por Ressonância Magnética Intervencionista/métodos , Neoplasias Uterinas , Adulto , Imagem de Difusão por Ressonância Magnética , Feminino , Humanos , Leiomioma/patologia , Leiomioma/cirurgia , Pessoa de Meia-Idade , Imageamento por Ressonância Magnética Multiparamétrica , Estudos Prospectivos , Resultado do Tratamento , Neoplasias Uterinas/patologia , Neoplasias Uterinas/cirurgiaRESUMO
OBJECTIVE: Cervical cancer metastatic to the para-aortic lymph nodes (PALNs) carries a poor prognosis. Despite extended-field radiation therapy (EFRT), only 30% to 50% of patients will survive 3 years. We sought to examine the treatment regimens used, associated toxicities, and treatment outcomes in patients with cervical cancer metastatic to PALN. METHODS: A retrospective review was performed of all patients with cervical cancer treated at a single institution between January 1, 2007 and November 1, 2014. Included patients had PALN metastases as the most distant site of disease, and all treatment plans were designated as curative. Excluded patients had other distant disease or treatment plans considered palliative. Standard treatment consisted of EFRT with concurrent platinum-based chemotherapy. RESULTS: Fifty-one of 344 patients (14.8%) fulfilled the inclusion criteria. The median age was 48.4 years. Forty-four patients received standard EFRT; 7 also received adjuvant platinum/taxane chemotherapy. Thirty-nine of 51 (76%) of patients achieved a complete response to primary treatment. Twelve of 51 (24%) had persistent disease or progression at the completion of treatment. Of responders, 15 of 39 (38%) recurred for an overall treatment failure rate of 27 of 51 (53%). Nineteen of 27 (70%) of treatment failures occurred outside the radiated field. Adjuvant chemotherapy following EFRT was not predictive of progression-free survival or overall survival. PALN diameter ≥1 cm was a significant negative prognostic indicator for overall survival. CONCLUSIONS: Over half of patients with cervical cancer metastatic to the PALN failed extended-field chemoradiation. Most failures occurred outside the radiated field suggesting PALN involvement is a surrogate marker of systemic disease. These findings underscore the need for effective systemic therapy, especially in patients with PALN ≥1 cm in size.
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Adenocarcinoma/patologia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma de Células Escamosas/patologia , Quimiorradioterapia/mortalidade , Quimioterapia Adjuvante/mortalidade , Linfonodos/patologia , Neoplasias do Colo do Útero/patologia , Adenocarcinoma/terapia , Adulto , Idoso , Carcinoma de Células Escamosas/terapia , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Neoplasias do Colo do Útero/terapiaRESUMO
BACKGROUND AND OBJECTIVES: Age and frailty have been correlated with poor clinical outcomes in cancer. Core muscle index (CMI) and nutritional status are integral in assessing frailty. We explored the effect of pre-operative serum albumin and body composition on clinical outcomes in patients with epithelial ovarian cancer (EOC). METHODS: We identified stage III-IV EOC patients undergoing primary cytoreductive surgery from 2007 to 2015. Data were abstracted from medical records. Body composition measurements were obtained from pre-operative imaging. Psoas muscle cross-sectional area was normalized to height2 to determine CMI. Sarcopenia was defined as CMI below the population mean. The influence of sarcopenia on short-term morbidity was evaluated. Relationships among body composition measurements and albumin were assessed with Spearman correlations. Patient characteristics and body composition measurements between patients with and without sarcopenia were compared with parametric and non-parametric statistical methods. Kaplan-Meier survival curves were compared using log-rank. RESULTS: 102 women met inclusion criteria. Sarcopenia correlated with albumin (P = 0.0002). Sarcopenia was not associated with short-term morbidity or time to recurrence. Sarcopenia was associated with nearly a fourfold increased risk of death when hypoalbuminemia was present (P = 0.02). CONCLUSIONS: Pre-operative sarcopenia in combination with hypoalbuminemia was associated with significantly worse survival.
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Procedimentos Cirúrgicos de Citorredução/mortalidade , Hipoalbuminemia/complicações , Neoplasias Epiteliais e Glandulares/mortalidade , Neoplasias Ovarianas/mortalidade , Músculos Psoas/patologia , Sarcopenia/complicações , Carcinoma Epitelial do Ovário , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Neoplasias Epiteliais e Glandulares/etiologia , Neoplasias Epiteliais e Glandulares/patologia , Neoplasias Epiteliais e Glandulares/cirurgia , Neoplasias Ovarianas/etiologia , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/cirurgia , Cuidados Pré-Operatórios , Prognóstico , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
The preference for morality in others is regarded as a dominant factor in person perception. Moral traits are thought to foster liking, and immoral traits are thought to foster disliking, irrespective of the context in which they are embedded. We report the results of four studies that oppose this view. Using both explicit and implicit measures, we found that the preference for morality vs. immorality in others is conditional on the evaluator's current goals. Specifically, when immorality was conducive to participants' current goals, the preference for moral vs. immoral traits in others was eliminated or reversed. The preferences for mercifulness vs. mercilessness (experiment 1), honesty vs. dishonesty (experiment 2), sexual fidelity vs. infidelity (experiment 3), and altruism vs. selfishness (experiment 4) were all found to be conditional. These findings oppose the consensus view that people have a dominant preference for moral vs. immoral traits in others. Our findings also speak to nativist and empiricist theories of social preferences and the stability of the "social contract" underlying productive human societies.
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Objetivos , Princípios Morais , Desejabilidade Social , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Altruísmo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Motivação , Percepção , Confiança , Adulto JovemRESUMO
OBJECTIVE: The objective of this study was to evaluate acute liver injury (ALI) detected by diffusion-weighted magnetic resonance imaging (MRI) and the associated laboratory findings in women with hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome. STUDY DESIGN: This was a retrospective, observational study of women with HELLP syndrome defined by serum aspartate aminotransferase (AST) levels ≥100 U/L and thrombocytopenia with platelets ≤100,000/µL. All women underwent MRI postpartum including diffusion-weighted imaging to estimate the volume of ALI with reconstructed apparent diffusion coefficient (ADC) maps. The ADC map and the volume of ALI were compared with laboratory abnormalities by Spearman's correlation analysis. RESULTS: From March 2013 through August 2015, 16 women with HELLP syndrome underwent MRI, and of these, 14 (88%) women had areas of increased signal intensity suggestive of ALI. Their median (range) maximum AST level was 262 (140-1,958) IU/L, and at the time of MRI, AST was 103 (36-1,426) IU/L. Both of these AST levels significantly correlated with ADC map as well as the volume of ALI (both p-values <0.001). CONCLUSION: Women with HELLP syndrome frequently exhibited areas of abnormal diffusion in the liver on diffusion-weighted MRI, suggestive of ALI. The extent of liver injury was significantly correlated with serum AST.
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Aspartato Aminotransferases/sangue , Síndrome HELLP/diagnóstico por imagem , Hepatopatias/diagnóstico por imagem , Fígado/patologia , Contagem de Plaquetas , Adolescente , Adulto , Biomarcadores/sangue , Feminino , Síndrome HELLP/sangue , Humanos , Hepatopatias/sangue , Testes de Função Hepática , Imageamento por Ressonância Magnética , Período Pós-Parto , Gravidez , Estudos Retrospectivos , Adulto JovemRESUMO
INTRODUCTION: The aim of this study is to investigate the relationship between the radiation dose to pelvic and para-aortic lymph nodes, nodal response, and clinical outcomes in a resource-poor setting based on computed tomography (CT) nodal size alone. MATERIALS AND METHODS: This retrospective study from 2009 to 2015 included 46 cervical cancer patients with 133 metastatic pelvic and para-aortic lymph nodes definitively treated with chemoradiation and brachytherapy in a public hospital with limited access to positron emission tomography (PET) scans. Hence, short axis of the lymph node on CT scan was used as a measure of metastatic nodal disease, before and following radiation therapy. Inclusion criteria required the pelvic and para-aortic nodes to have the shortest axis diameter on CT scan of ≥8 mm and ≥10 mm, respectively. Based on PET resolution, a node that decreased to half of its inclusion cutoff size was considered to have a complete response (CR). Relevant clinical outcomes were documented and correlated with nodal features, nodal radiation doses, and treatment characteristics. RESULTS: After controlling for other predictive factors, increased nodal dose was associated with increased probability of CR per study definition (P = 0.005). However, there was no statistically significant association between dose and pelvic/para-aortic, distant and total recurrence (TR), and any recurrence at any location (P = 0.263, 0.785, 1.00, respectively). Patients who had no CR nodes had shorter pelvic/para-aortic recurrence-free survival (PPRFS) and TR-free survival (TRFS) than patients who had at least one CR node (P = 0.027 and 0.046, respectively). Patients with no CR nodes also had shorter PPRFS than patients who had all nodes completely respond (P < 0.05). CONCLUSIONS: Using CT-based measures, we found that increased nodal dose is associated with an increased probability of CR (as defined) and nodal CR is associated with increased PPRFS and TRFS. We were unable to determine the cutoff dose required for a CR.