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Anticoagulant rodenticides (ARs) are one of the most toxic groups of compounds currently used worldwide for rodent pest control. Toxic baits are often, directly or indirectly, ingested by non-target animals, resulting in secondary poisoning and frequently affecting apex predators. Their presence in many species of raptors is quite common, particularly scavenger species, with some of these acting as sentinels for the presence of these substances in the environment. However, there is less data on the presence of ARs in Bonelli's eagle, one of the most endangered eagle species in Spain and which is experiencing a negative population trend in Europe. This medium-sized eagle feeds predominantly on live species, and rarely consumes carrion. In this study, 17 carcasses of Bonelli's eagles from the Eastern Spain were necropsied. Both first and second generation ARs in their livers were analyzed by HPLC-MS-TOF revealing that all the eagles studied had been exposed to at least 5 ARs, out of a total of 10 ARs analyzed, with 7 being the highest number of ARs detected in a sample. Second generation ARs were the most prevalent, particularly bromadiolone and brodifacoum, with the highest concentrations in 94% of the cases. More than a third of the eagles presented a liver concentration of greater than 200 ng/g ARs, suggesting AR poisoning. The elevated presence of these compounds in Bonelli's eagles could be a new cause of mortality for this species or could explain other causes of death, such as the increased mortality in power lines, and should be taken into account for their conservation. At the same time, the presence of these compounds in the environment also represents a risk to public health, as the most frequent species in the diet of Bonelli's eagle (rabbits and partridges) are also hunted and consumed by hunters and their families.
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We evaluated feathers as a non-destructive biomonitoring tool documenting organochlorine pesticides (OCP) in liver and checked possible trends in pesticide use in two areas based on OCP concentrations in barn owls (Tyto alba). We measured the concentrations of 16 OCP in 15 primary feathers and 15 livers from barn owl carcasses collected on roadsides in Tagus Valley and Évora regions, south Portugal. Total OCP mean concentration was 8 120 ng g-1 in feathers and 178 ng g-1 in livers. All compounds were detected in feathers while in livers δ-HCH, endosulfan sulphate, p,p'-DDT and p,p'-DDD were not detected. The high ß-HCH and heptachlor concentrations in feathers most likely derived from external endogenous contamination. P,p'-DDE was the OCP with the highest hepatic concentration. Both matrices indicated an exposure to recently released heptachlor. The differing OCP concentrations between Tagus Valley and Évora seem to reflect differences in land-use and pesticide use histories of the two locations, and/or faster degradation of OCP in the Tagus area.
Assuntos
Hidrocarbonetos Clorados , Praguicidas , Estrigiformes , Animais , DDT , Diclorodifenil Dicloroetileno , Monitoramento Ambiental , Plumas/química , Heptacloro , Hidrocarbonetos Clorados/análise , Fígado/metabolismo , Praguicidas/análise , Portugal , Estrigiformes/metabolismoRESUMO
Introducción y objetivos: Se han desarrollado puntuaciones multiparamétricas para una mejor estratificación del riesgo en el síndrome de Brugada (SBr). Nuestro objetivo es validar 3 abordajes multiparamétricos (las escalas Delise, Sieira y Shanghai BrS) en una cohorte de pacientes con síndrome de Brugada y estudio electrofisiológico (EEF). Métodos: Pacientes diagnosticados de SBr y con un EEF previo entre 1998-2019 en 23 hospitales. Se utilizaron análisis mediante estadístico C y modelos de regresión de riesgos proporcionales de Cox. Resultados: Se incluyó en total a 831 pacientes con una media de edad de 42,8±13,1 años; 623 (75%) eran varones; 386 (46,5%) tenían patrón electrocardiográfico (ECG) tipo 1; 677 (81,5%) estaban asintomáticos y 319 (38,4%) tenían un desfibrilador automático implantable. Durante un seguimiento de 10,2±4,7 años, 47 (5,7%) sufrieron un evento cardiovascular. En la cohorte total, un ECG tipo 1 y síncope fueron predictivos de eventos arrítmicos. Todas las puntuaciones de riesgo se asociaron significativamente con los eventos. Las capacidades discriminatorias de las 3 escalas fueron discretas (particularmente al aplicarlas a pacientes asintomáticos). La evaluación de las puntuaciones de Delise y Sieira con diferente número de extraestímulos (1 o 2 frente a 3) no mejoró sustancialmente el índice c de predicción de eventos. Conclusiones: En el SBr, los factores de riesgo clásicos como el ECG y el síncope previo predicen eventos arrítmicos. El número de extraestímulos necesarios para inducir arritmias ventriculares influye en las capacidades predictivas del EEF. Las escalas que combinan factores de riesgo clínico con EEF ayudan a identificar las poblaciones con más riesgo, aunque sus capacidades predictivas siguen siendo discretas tanto en población general con SBr como en pacientes asintomáticos (AU)
Introduction and objectives: Multiparametric scores have been designed for better risk stratification in Brugada syndrome (BrS). We aimed to validate 3 multiparametric approaches (the Delise score, Sieira score and the Shanghai BrS Score) in a cohort with Brugada syndrome and electrophysiological study (EPS). Methods: We included patients diagnosed with BrS and previous EPS between 1998 and 2019 in 23 hospitals. C-statistic analysis and Cox proportional hazard regression models were used. Results: A total of 831 patients were included (mean age, 42.8±13.1; 623 [75%] men; 386 [46.5%] had a type 1 electrocardiogram (ECG) pattern, 677 [81.5%] were asymptomatic, and 319 [38.4%] had an implantable cardioverter-defibrillator). During a follow-up of 10.2±4.7 years, 47 (5.7%) experienced a cardiovascular event. In the global cohort, a type 1 ECG and syncope were predictive of arrhythmic events. All risk scores were significantly associated with events. The discriminatory abilities of the 3 scores were modest (particularly when these scores were evaluated in asymptomatic patients). Evaluation of the Delise and Sieira scores with different numbers of extra stimuli (1 or 2 vs 3) did not substantially improve the event prediction c-index. Conclusions: In BrS, classic risk factors such as ECG pattern and previous syncope predict arrhythmic events. The predictive capabilities of the EPS are affected by the number of extra stimuli required to induce ventricular arrhythmias. Scores combining clinical risk factors with EPS help to identify the populations at highest risk, although their predictive abilities remain modest in the general BrS population and in asymptomatic patients (AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Síndrome de Brugada/complicações , Morte Súbita/prevenção & controle , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Estudos de Coortes , Eletrocardiografia , Fatores de RiscoRESUMO
The Atacama Desert represents the highest levels of mining exploitation in Chile, which inexorably results in high levels of pollution. Raptors, and particularly scavengers, have shown their usefulness to evaluate exposure to environmental contaminants in polluted scenarios. In this study, we used primary feathers from a local avian scavenger, turkey vulture Cathartes aura, to evaluate the exposure to cadmium (Cd), lead (Pb), copper (Cu) and zinc (Zn) in two locations from the southern Atacama Desert (coastal and inland) and a third location from the bordering semiarid region, in northern Chile. All metals were detected in all analyzed samples (n = 54). Mean concentrations in Coastal Atacama were 0.68 ± 0.84 ppm for Cd; 1.97 ± 2.01 ppm for Pb; 59.11 ± 80.69 ppm for Cu; and 107.96 ± 51.00 ppm for Zn, while mean concentrations in Inland Atacama were 0.55 ± 0.42 ppm for Cd; 3.37 ± 2.61 ppm for Pb; 91.66 ± 77.74 ppm for Cu; and 214.03 ± 99.08 ppm for Zn. Mean concentrations in Coastal Coquimbo were 0.63 ± 0.69 ppm for Cd; 1.57 ± 0.92 ppm for Pb; 18.09 ± 6.12 ppm for Cu; and 149.37 ± 105.56 ppm for Zn. These differences could be explained by differences on abundance of mining settlements among areas. According to the literature, these values are very high for all metals, exceeding in some cases those values referred as responsible of health disorders in birds. We strongly recommend further research looking at potential adverse effects caused by heavy metal pollution on the health of human and wildlife populations in the southern Atacama Desert.
Assuntos
Plumas , Metais Pesados , Animais , Aves , Chile , China , Monitoramento Ambiental , Plumas/química , Humanos , Metais Pesados/análiseAssuntos
Enteropatias , Enurese Noturna , Incontinência Urinária , Adulto , Criança , Humanos , Enurese Noturna/etiologia , Enurese Noturna/terapiaRESUMO
A case affected by a seminal vesicles secondary tumor to diffuse large B-cell lymphoma is reported. Seminal vesicles neoplasms are scarce, and they can be classified into primary or secondary. The most common case is their involvement by extension of adjacent tumors, which are clinically nonspecific. In the case presented herein, the patient complained of oliguria, constipation and perineal pain, where imaging methods revealed the growth of both seminal vesicles. Pathological examination revealed infiltration of seminal vesicles by diffuse large B-cell lymphoma. In view of this clinical event, we briefly reviewed literature related to the involvement of seminal vesicles tumor.
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PURPOSE: To identify presurgical and surgical factors associated with the development of diabetes insipidus (DI) after pituitary adenoma (PA) resection through an endoscopic endonasal transsphenoidal approach. METHODS: Data from 231 patients with functioning and non-functioning PAs who underwent an endoscopic endonasal transsphenoidal approach in the last ten years. RESULTS: 231 patients with 241 pituitary surgeries were included. Eighty-five percent harbored macroadenomas and 38.1% of them were invasive. After pituitary surgery, 12.5% (n = 30) developed transient DI and 5.0% (n = 12) permanent DI. The global risk of DI was higher in patients younger than 65 years (OR = 2.94, p = 0.029), with total tumoral resection (OR = 2.86, p = 0.007) and with diaphragm opening during pituitary resection (OR = 3.63, p = 0.0003). Once postoperative DI developed, the risk of permanent DI increased in those patients with larger PA (OR = 1.07 for each mm of craniocaudal diameter, p = 0.020), especially in those greater than 30 mm (OR = 8.33, p = 0.004). Moreover, diaphragm opening during pituitary resection (OR = 28.3, p = 0.018) predicted long-term DI independently of pituitary tumor size. The risk of permanent DI increased as PA craniocaudal diameter increased (r = 0.20, p = 0.002). CONCLUSION: In patients with PAs younger than 65 years, in whom diaphragm has been opened during pituitary surgery and/or with a total tumor resection, special hydric balance monitoring should be maintained in the postoperative period due to the increased risk of developing DI. The risk of permanent DI increases as PA craniocaudal diameter increased.
Assuntos
Adenoma/cirurgia , Diabetes Insípido/patologia , Endoscopia/efeitos adversos , Procedimentos Neurocirúrgicos/efeitos adversos , Neoplasias Hipofisárias/cirurgia , Complicações Pós-Operatórias/patologia , Osso Esfenoide/cirurgia , Adenoma/patologia , Diabetes Insípido/etiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Hipofisárias/patologia , Complicações Pós-Operatórias/etiologia , Prognóstico , Estudos RetrospectivosRESUMO
We determinated Hg and Se concentrations in liver, kidney, brain, lung and muscle of five bottlenose dolphin (Tursiops truncatus), four common dolphins (Delphinus delphis) and four Risso's dolphin (Grampus griseus) stranded along the Murcia coast, Southeast Spain, in order to evaluate the risk of Hg toxicity. Hg concentrations showed similar concentrations to other individuals in the Mediterranean Sea with the same length in the same period. We observed a positive correlation of Hg and Se in liver (r = 0.948, p < 0.001) and kidney (r = 0.939; p = 0.001) and ratio the Se/Hg molar was higher than 1 in most cases. Our results suggest that the protective effects of Se against Hg toxicity occur in cetaceans. However, we detected levels of Hg described as responsible liver damage and neurotoxicological effects so other tools, as biochemical markers, should be included. Besides, more studies are needed to evaluate the risk of Hg exposure in dolphins from Murcia coastline.
Assuntos
Golfinhos/metabolismo , Monitoramento Ambiental/métodos , Rim/química , Fígado/química , Mercúrio/análise , Selênio/análise , Animais , Golfinho Nariz-de-Garrafa/metabolismo , Golfinhos Comuns/metabolismo , Mar Mediterrâneo , Especificidade de Órgãos , EspanhaRESUMO
Mercury (Hg), cadmium (Cd), lead (Pb), selenium (Se) and arsenic (As) concentrations in internal tissues of 72 striped dolphins (Stenella coeruleoalba) from Murcia Region (Mediterranean coastline) have been investigated for the first time. Hg showed the highest concentration, followed by Se, Cd, As and Pb. In general, the levels of metal found in this study were similar to those described in similar studies in the Mediterranean Sea. However, in some adult specimens, Hg liver concentrations were related with toxic effects in cetacean. A significant correlation was observed with age, likewise between Se and Hg and Cd in tissues, which agree with detoxify effect attributed to Se through inert complex formation. Molar ratio Hg:Se in liver was close to 1:1 in some specimens, which would indicate overload of the Hg-Se detoxify function and compromised health. These results could contribute to a better knowledge of the distribution of these persistent pollutants in the Mediterranean Sea.
Assuntos
Metais/análise , Stenella , Oligoelementos/análise , Poluentes Químicos da Água/análise , Fatores Etários , Animais , Arsênio/análise , Arsênio/farmacocinética , Monitoramento Ambiental/métodos , Feminino , Fígado/química , Masculino , Mar Mediterrâneo , Metais/farmacocinética , Selênio/análise , Espanha , Distribuição Tecidual , Oligoelementos/farmacocinética , Poluentes Químicos da Água/farmacocinéticaRESUMO
Introducción: Las infecciones micobacterianas fueron ya descritas en la antigüedad. En nuestro país se está produciendo un aumento en la identificación de determinadas especies de micobacterias no tuberculosas, como Mycobacterium lentiflavum. En la población pediátrica es frecuente encontrar linfadenopatías originadas por estos microorganismos, que ocasionan generalmente lesiones en la cabeza y el cuello. Caso clínico: Se presenta el caso de un lactante con lesión submaxilar derecha. Tras la realización de pruebas analíticas, radiológicas y anatomopatológicas se llegó al diagnóstico de sialoadenitis submaxilar derecha sobreinfectada. Se instauraron tratamiento sistémico antibiótico y tratamiento local de la lesión en la cara lateral del cuello, que presentaba fibrina y un exudado abundante y purulento, con diferentes productos de cura en ambiente húmedo según las necesidades requeridas. Conclusión: La lesión epitelizó a los 80 días desde su seguimiento en la unidad de asesoría en heridas. La utilización de productos que favorecen un medio ambiente húmedo se ha mostrado como una estrategia adecuada para conseguir la cicatrización de las lesiones
Introduction: Mycobacterial infections were already described in antiquity. In our country there is an increase in the identification of certain species of nontuberculous mycobacteria, such as Mycobacterium lentiflavum. In the pediatric population it is common to find lymphadenopathies caused by these microorganisms, which usually cause injuries to the head and neck. Case report: We present the case of an infant with a right submaxillary lesion. After performing analytical, radiological and anatomopathological tests, it was reached the diagnosis of overinfected right submaxillary sialoadenitis. It was established systemic antibiotic treatment and local treatment of the lesion on the lateral side of the neck, which showed fibrin and abundant and purulent exudate, with different products of moist healing environment according to the required needs. Conclusion: The lesion epithelialized after 80 days of follow-up in the wound advisory unit. The use of products that promote a moist environment has been shown as an adequate strategy to achieve the healing of the lesions
Assuntos
Humanos , Masculino , Lactente , Cicatrização , Maxila/lesões , Sialadenite/terapia , Infecções por Mycobacterium não Tuberculosas/terapia , Sialadenite/enfermagem , Antibacterianos/administração & dosagem , Azitromicina/administração & dosagem , Ciprofloxacina/administração & dosagem , Infecções por Mycobacterium não Tuberculosas/patologiaRESUMO
PURPOSE: The present work aims at evaluating intensity-modulated radiation therapy with simultaneous integrated boost (IMRT-SIB) in squamous cell carcinomas (SCC) of the larynx and hypopharynx. METHODS/PATIENTS: We performed a single institutional retrospective analysis on 116 pharyngo (29%)-laryngeal (71%) SCC patients (93% male) treated with IMRT-SIB to 66-69.96 Gy in 33 fractions between 2008 and 2016. Those who underwent surgery (54%) received adjuvant radiation of 66 Gy at 2 Gy/fraction to the surgical bed. 16 patients (14%) were treated for a local recurrence after prior surgery. High-risk lymph node regions received 59.4 Gy at 1.8 Gy/fraction and low risk regions 54.12 Gy at 1.64 Gy/fraction. The median age was 60 years and 95% of patients had an ECOG performance status 0-2. Most had advanced stage disease (III 22%, IV 74%). Chemotherapy was delivered in 74% of cases. RESULTS: Median follow-up was 32 months. Two and three-year overall survival for all patients was 87% and 82%, respectively. There were 28 (24%) locoregional recurrences and 19 (16%) distant failures. Grade 3 mucositis, dermatitis, and xerostomy were observed in 12%, 10%, and 3%, respectively. A longer IMRT-SIB overall treatment time was associated with a higher risk of mortality (HR 1.09, CI 1.01-1.17, P = 0.02). Postoperative IMRT-SIB associated with a significantly lower risk of any recurrence (HR 0.34, CI 0.18-0.64, P = 0.001) and higher local control (HR 0.06, CI 0.01-0.24, P < 0.01). Additionally, it associated with a lower risk of mucositis (P = 0.029) compared with definitive radio (chemo) therapy. CONCLUSIONS: IMRT-SIB is a safe and feasible radiation treatment technique for pharyngo-laryngeal SCC patients with a tolerable acute toxicity profile.
Assuntos
Carcinoma de Células Escamosas/radioterapia , Neoplasias Laríngeas/radioterapia , Recidiva Local de Neoplasia/mortalidade , Neoplasias Faríngeas/radioterapia , Radioterapia de Intensidade Modulada/efeitos adversos , Radioterapia de Intensidade Modulada/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/patologia , Feminino , Humanos , Neoplasias Laríngeas/patologia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Neoplasias Faríngeas/patologia , Planejamento da Radioterapia Assistida por Computador/métodos , Estudos Retrospectivos , Taxa de Sobrevida , Testes de Toxicidade , Resultado do TratamentoRESUMO
Antibiotics have been beneficial for human and animal health. However, an excessive use in livestock and a deficient management of the carcasses can lead to adverse effects in the scavengers that ingest them, especially in "supplementary feeding sites" (SFS). The aim of this study was to assess the potential risk of exposure to antibiotics for an endangered population of Cinereous vultures (Aegypius monachus) from southeastern Portugal. Hence, a multi-residue method based on QuEChERs was adapted and validated to analyse, in small volumes of tissues, the most frequent antibiotics used in livestock. The method was applied to 87 samples of liver, muscle and kidney from 7 goats and 25 sheep disposed in SFS. According to questionnaires to farmers, the animals had not been treated with antibiotics, but analyses showed residues in 29% of the samples. Antibiotics were more frequent in goats (42.9%) than in sheep (24.2%), and oxytetracycline and trimethoprim were the most common (both 13.8%). Oxytetracycline, the most common antibiotic for livestock in Portugal, showed the highest concentration (1452.68â¯ngâ¯g-1). To our knowledge, this is the first study of presence of antibiotics in carrion from SFS. The concentrations of antibiotics in carrion do not seem to pose a risk of acute intoxication for adult Cinereous vultures. However, subtle and likely chronic exposure with unknown health consequences may occur, which requires more research. Moreover, the results of this first study can be used in future studies to assess the risk for avian scavengers.
Assuntos
Antibacterianos/análise , Monitoramento Ambiental , Poluentes Ambientais/análise , Falconiformes/fisiologia , Animais , Aves , Gado , PortugalRESUMO
Mediterranean mountains are extraordinarily diverse and hold a high proportion of endemic plants, but they are particularly vulnerable to climate change, and most species distribution models project drastic changes in community composition. Retrospective studies and long-term monitoring also highlight that Mediterranean high-mountain plants are suffering severe range contractions. The aim of this work is to review the current knowledge of climate change impacts on the process of plant regeneration by seed in Mediterranean high-mountain plants, by combining available information from observational and experimental studies. We also discuss some processes that may provide resilience against changing environmental conditions and suggest some research priorities for the future. With some exceptions, there is still little evidence of the direct effects of climate change on pollination and reproductive success of Mediterranean high-mountain plants, and most works are observational and/or centred only in the post-dispersal stages (germination and establishment). The great majority of studies agree that the characteristic summer drought and the extreme heatwaves, which are projected to be more intense in the future, are the most limiting factors for the regeneration process. However, there is an urgent need for studies combining elevational gradient approaches with experimental manipulations of temperature and drought to confirm the magnitude and variability of species' responses. There is also limited knowledge about the ability of Mediterranean high-mountain plants to cope with climate change through phenotypic plasticity and local adaptation processes. This could be achieved by performing common garden and reciprocal translocation experiments with species differing in life history traits.
Assuntos
Altitude , Mudança Climática , Fenômenos Fisiológicos Vegetais , Região do Mediterrâneo , Plantas , ReproduçãoRESUMO
OBJECTIVE: The purpose of this study was to determine the late complications in critically ill patients requiring percutaneous tracheostomy (PT) using the balloon dilation technique. DESIGN: A prospective, observational cohort study was carried out. SCOPE: Two medical-surgical intensive care units (ICU). PATIENTS: All mechanically ventilated adult patients consecutively admitted to the ICU with an indication of tracheostomy. INTERVENTIONS: All patients underwent PT according to the Ciaglia Blue Dolphin® method, with endoscopic guidance. Survivors were interviewed and evaluated by fiberoptic laryngotracheoscopy and tracheal computed tomography at least 6 months after decannulation. VARIABLES: Intraoperative, postoperative and long-term complications and mortality (in-ICU, in-hospital) were recorded. RESULTS: A total of 114 patients were included. The most frequent perioperative complication was minor bleeding (n=20) and difficult cannula insertion (n=19). Two patients had severe perioperative complications (1.7%) (major bleeding and inability to complete de procedure in one case and false passage and desaturation in the other). All survivors (n=52) were evaluated 211±28 days after decannulation. None of the patients had symptoms. Fiberoptic laryngotracheoscopy and computed tomography showed severe tracheal stenosis (>50%) in 2patients (3.7%), both with a cannulation period of over 100 days. CONCLUSIONS: Percutaneous tracheostomy using the Ciaglia Blue Dolphin® technique with an endoscopic guide is a safe procedure. Severe tracheal stenosis is a late complication which although infrequent, must be taken into account due to its lack of clinical expressiveness. Evaluation should be considered in those tracheostomized critical patients who have been cannulated for a long time.
Assuntos
Traqueostomia/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Cuidados Críticos/métodos , Dilatação/instrumentação , Dilatação/métodos , Endoscopia , Feminino , Hemorragia/etiologia , Mortalidade Hospitalar , Humanos , Complicações Intraoperatórias/diagnóstico por imagem , Complicações Intraoperatórias/etiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Fatores de Tempo , Tomografia Computadorizada por Raios X , Traqueia/diagnóstico por imagem , Traqueia/lesões , Estenose Traqueal/diagnóstico por imagem , Estenose Traqueal/etiologia , Traqueostomia/métodosRESUMO
Purpose. As elective axillary dissection is loosing ground for early breast cancer (BC) patients both in terms of prognostic and therapeutic power, there is a growing interest in predicting patients with (nodal) high tumour burden (HTB), especially after a positive sentinel node biopsy (SNB) because they would really benefit from further axillary intervention either by complete lymph-node dissection or axillary radiation therapy. Methods/patients. Based on an analysis of 1254 BC patients in whom complete axillary clearance was performed, we devised a logistic regression (LR) model to predict those with HTB, as defined by the presence of three or more involved nodes with macrometastasis. This was accomplished through prior selection of every variable associated with HTB at univariate analysis. Results. Only those variables shown as significant at the multivariate analysis were finally considered, namely tumour size, lymphovascular invasion and histological grade. A probability table was then built to calculate the chances of HTB from a cross-correlation of those three variables. As a suggestion, if we were to follow the rationale previously used in the micrometastasis trials, a threshold of about 10% risk of HTB could be considered under which no further axillary treatment is warranted. Conclusions. Our LR model with its probability table can be used to define a subgroup of early BC patients suitable for axillary conservative procedures, either sparing completion lymph-node dissection or even SNB altogether (AU)
No disponible
Assuntos
Humanos , Feminino , Neoplasias da Mama/complicações , Neoplasias da Mama/epidemiologia , Axila/patologia , Modelos Logísticos , Biópsia de Linfonodo Sentinela/métodos , Carga Tumoral , Prognóstico , Excisão de Linfonodo/métodos , Sobrevida , Biópsia de Linfonodo Sentinela/estatística & dados numéricosRESUMO
PURPOSE: As elective axillary dissection is loosing ground for early breast cancer (BC) patients both in terms of prognostic and therapeutic power, there is a growing interest in predicting patients with (nodal) high tumour burden (HTB), especially after a positive sentinel node biopsy (SNB) because they would really benefit from further axillary intervention either by complete lymph-node dissection or axillary radiation therapy. METHODS/PATIENTS: Based on an analysis of 1254 BC patients in whom complete axillary clearance was performed, we devised a logistic regression (LR) model to predict those with HTB, as defined by the presence of three or more involved nodes with macrometastasis. This was accomplished through prior selection of every variable associated with HTB at univariate analysis. RESULTS: Only those variables shown as significant at the multivariate analysis were finally considered, namely tumour size, lymphovascular invasion and histological grade. A probability table was then built to calculate the chances of HTB from a cross-correlation of those three variables. As a suggestion, if we were to follow the rationale previously used in the micrometastasis trials, a threshold of about 10% risk of HTB could be considered under which no further axillary treatment is warranted. CONCLUSIONS: Our LR model with its probability table can be used to define a subgroup of early BC patients suitable for axillary conservative procedures, either sparing completion lymph-node dissection or even SNB altogether.
Assuntos
Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/secundário , Carcinoma Lobular/secundário , Modelos Logísticos , Linfonodos/patologia , Idoso , Axila , Neoplasias da Mama/cirurgia , Carcinoma Ductal de Mama/cirurgia , Carcinoma Lobular/cirurgia , Feminino , Seguimentos , Humanos , Excisão de Linfonodo , Linfonodos/cirurgia , Pessoa de Meia-Idade , Invasividade Neoplásica , Micrometástase de Neoplasia , Estadiamento de Neoplasias , Biópsia de Linfonodo Sentinela , Carga TumoralRESUMO
Plasma samples from nestlings of two top predators, White-tailed eagle (Haliaeetus albicilla) and Northern goshawk (Accipiter gentilis) from northern Norway were analysed for a wide range of per- and polyfluoroalkyl substances (PFASs). Body feathers from the White-tailed eagles were also analysed and significant associations between specific PFASs in blood plasma and body feathers were found (0.36 Assuntos
Águias/metabolismo
, Exposição Ambiental
, Poluentes Ambientais/metabolismo
, Fluorocarbonos/metabolismo
, Falcões/metabolismo
, Animais
, Águias/sangue
, Monitoramento Ambiental
, Poluentes Ambientais/sangue
, Plumas/química
, Fluorocarbonos/sangue
, Falcões/sangue
, Noruega
RESUMO
The objective of this study was to assess metal exposure in the Mediterranean Pond Turtle (Mauremys leprosa) inhabiting a watercourse in an ancient mining district polluted by different metals ("Rambla de Las Moreras", southeastern Spain) and included in the Ramsar Convention. For this purpose, mercury (Hg), lead (Pb), copper (Cu), zinc (Zn) and cadmium (Cd) were analysed in blood samples from 42 M. leprosa healthy adults (27 males and 13 females). The highest median concentrations were found for Zn, followed by Cu, Pb, Hg and Cd (366, 33, 9, 0.83 and 0.14 µg/dL, respectively). Although the literature regarding toxic metals in freshwater turtles is relatively scarce, Pb may cause deleterious effects in our population. In general, males presented higher levels than females, which could be due to maternal transfer during egg formation. The significant correlations between Cu-Cd and Cu-Hg suggest the implication of an efficient mechanism of detoxification involving metallothioneins.
Assuntos
Monitoramento Ambiental , Metais Pesados/sangue , Mineração , Tartarugas/sangue , Poluentes Químicos da Água/sangue , Animais , Cádmio/análise , Cobre/análise , Feminino , Masculino , Mercúrio/análise , Metais Pesados/análise , Lagoas/química , Espanha , Zinco/análiseRESUMO
Purpose. Roughly two-thirds of early breast cancer cases are associated with negative axillary nodes and do not benefit from axillary surgery at all. Accordingly, there is an ongoing search for non-surgical staging procedures to avoid lymph-node dissection or sentinel node biopsy (SNB). Non-invasive imaging techniques with very high sensitivity (Se) and negative predictive value (NPV) could eventually replace SNB. We aimed to establish the role of axillary US and MRI, alone or in combination, associated with ultrasound-guided fine-needle aspiration biopsy (US-FNAB) in the prediction of axillary node involvement. Methods/patients. Between January 2003 and September 2015, we included 1505 of the 1538 breast cancer patients attending our centres. All patients had been referred from a single geographical area. Axillary US, magnetic resonance imaging and ultrasound-guided fine-needle aspiration biopsy (US-FNAB) were performed if required. Results. 1533 axillary US examinations and 1351 axillary MRI studies were analyzed. For axillary US, Se, Specificity (Sp), Positive Predictive Value (PPV), and NPV were 47.5, 93.6, 82.5, and 73.8%, respectively. For axillary MRI, corresponding values were 29.8, 96.6, 84.9, and 68.4%. When both tests were combined, Sp and PPV slightly improved over individual tests alone. US-FNAB showed a 100% Sp and PPV, with a Se of 80%. Conclusion. We may confidently state that axillary US and US-FNAB have to be included in the preoperative work-up of breast cancer patients (AU)
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