Cryoablation for the treatment of breast cancer: immunological implications and future perspectives. Utopia or reality?

Cryoablation is a minimally invasive technique currently employed in breast cancer care, that uses freeze and thaw cycles to treat benign breast lesions, small breast cancers or focal sites of metastatic disease in patients not eligible for surgery. The final goal of this procedure is to destroy breast cancer cells using extreme cold. In addition, several studies have shown that this technique seems to have an enhancing effect on the immune response, especially by increasing the expression of tumor neoantigens specific to tumor cells, which are then attacked and destroyed. Exploiting this effect, cryoablation in combination with immunotherapy could be the key to treating early-stage breast cancers or patients who are unsuitable for surgery. According to some recent studies, there are other potential tools that could be used to enhance the therapeutic effect of cryoablation, such as FE3O4 nanoparticles or the manipulation of aquaporin expression. The aim of this narrative review is to summarize the current evidence regarding the use, indications, advantages and disadvantages of cryoablation in the treatment of breast cancer.

Phenotyping the obesities: reality or utopia?

In this thematic issue on phenotyping the obesities, prominent international experts offer an insightful and comprehensive collection of articles covering the current knowledge in the field. In order to actually capture all the polyhedral determinants of the diverse types of obesity, the granularity of the phenotypic information acquired must be expanded in the context of a personalized approach. Whilst the use of precision medicine has been successfully implemented in areas like cancer and other diseases, health care providers are more reluctant to embrace detailed phenotyping to guide diagnosis, treatment and prevention in obesity. Given its multiple complex layers, phenotyping necessarily needs to go beyond the multi-omics approach and incorporate all the diverse spheres that conform the reality of people living with obesity. Potential barriers, difficulties, roadblocks and opportunities together with their interaction in a syndemic context are analyzed. Plausible lacunae are also highlighted in addition to pointing to the need of redefining new conceptual frameworks. Therefore, this extraordinary collection of state-ofthe-art reviews provides useful information to both experienced clinicians and trainees as well as academics to steer clinical practice and research in the management of people living with obesity irrespective of practice setting or career stage.

Seeking utopia: Psychologies' waves toward decoloniality.

This paper provides a review of empirical studies published with a decolonial epistemic approach in psychology. Our goal was to better understand how decolonial approaches are being practiced empirically in psychology, with an emphasis on community-social psychology. We first discuss the context of colonization and coloniality in the research process as orienting information. We identified 17 peer-reviewed empirical articles with a decolonial approach to psychology scholarship and discerned four waves that characterize the articles: relationally-based research to transgress fixed hierarchies and unsettle power, research from the heart, sociohistorical intersectional consciousness, and desire-based future-oriented research to rehumanize and seek utopia. Community-social psychology research with a decolonial approach has the potential to remember grassroots efforts, decolonizing our world.

Tofogliflozin long-term effects on atherosclerosis progression and major clinical parameters in patients with type 2 diabetes mellitus lacking a history of cardiovascular disease: a 2-year extension study of the UTOPIA trial.

BACKGROUND: This study aimed to assess the long-term effects of tofogliflozin, a sodium-glucose cotransporter 2 (SGLT2) inhibitor, on atherosclerosis progression and major clinical parameters in patients with type 2 diabetes lacking an apparent history of cardiovascular disease. METHODS: This was a prospective observational 2-year extension study of the "Using TOfogliflozin for Possible better Intervention against Atherosclerosis for type 2 diabetes patients (UTOPIA)" trial, a 2-year randomized intervention study. The primary endpoints represented changes in the carotid intima-media thickness (IMT). Secondary endpoints included brachial-ankle pulse wave velocity (baPWV) and biomarkers for glucose metabolism, lipid metabolism, renal function, and cardiovascular risks. RESULTS: The mean IMT of the common carotid artery (IMT-CCA) significantly decreased in both the tofogliflozin (- 0.067 mm, standard error 0.009, p < 0.001) and conventional treatment groups (- 0.080 mm, SE 0.009, p < 0.001) throughout the follow-up period; however, no significant intergroup differences in the changes (0.013 mm, 95% confidence interval (CI) - 0.012 to 0.037, p = 0.32) were observed in a mixed-effects model for repeated measures. baPWV significantly increased in the conventional treatment group (82.7 ± 210.3 cm/s, p = 0.008) but not in the tofogliflozin group (- 17.5 ± 221.3 cm/s, p = 0.54), resulting in a significant intergroup difference in changes (- 100.2 cm/s, 95% CI - 182.8 to - 17.5, p = 0.018). Compared to the conventional treatment group, tofogliflozin significantly improved the hemoglobin A1c and high-density lipoprotein cholesterol levels, body mass index, abdominal circumference, and systolic blood pressure. The frequencies of total and serious adverse events did not vary significantly between the groups. CONCLUSIONS: Tofogliflozin was not associated with improved inhibition of carotid wall thickening but exerted long-term positive effects on various cardiovascular risk factors and baPWV while showing a good safety profile.

Utopia for Norwegian helicopter emergency medical services: Estimating the number of bases needed to radically bring down response times, and lives needed to be saved for cost effectiveness.

OBJECTIVES: Helicopter Emergency Medical Services (HEMS) throughout Europe are generally on scene within 10-15 minutes. In Norway, however, with its 13 HEMS bases, only 75% of the population can currently be reached within half an hour. We estimate the number of HEMS bases needed to reach the full Norwegian population within 10-15 minutes, and discuss implications regarding cost effectiveness. METHODS: Using geographic location and population characteristics from Norway's 428 municipalities as input to the Maximal Covering Location Problem-a mathematical location optimization model-we estimate the number of HEMS bases required along with accompanying personnel and healthcare costs. We estimate the minimum number of lives that would have to be saved to achieve a net social benefit of zero. RESULTS: To reach 99% or 100% of the Norwegian population by HEMS within 15 minutes 78 or 104 bases are needed, respectively. The incremental need for personnel going from 20 to 15 minutes for 99/100% of the population is 602/728, with an accompanying incremental cost of 228/276 million EURO per year. A yearly total of 280/339 additional lives would have to be saved to obtain a net social benefit of zero. Then, the HEMS-system as a whole would be cost effective although the least efficient bases still would not be. CONCLUSIONS: Reducing Norwegian HEMS response times to 10-15 minutes requires a drastic increase in the number of HEMS bases needed. Choice of ethical philosophy (utilitarianism or egalitarianism) determines when the expansion might be considered cost effective.

From Retrograde Menstruation to Endometrial Determinism and a Brave New World of "Root Treatment" of Endometriosis: Destiny or a Fanciful Utopia?

Practically unknown outside of China, the "endometrial determinism" theory was proposed to account for the apparent gap between the relatively low prevalence of endometriosis and nearly universal retrograde menstruation. Attracting uncritical advocacy, the theory culminates in a recent consensus by elite Chinese gynecologists in favor of "root treatment", intended to nip endometriosis in the bud. Correcting endometrial "defects" can gain further momentum by the presence of cancer-driver mutations such as KRAS mutations in the endometrium of women with endometriosis and the recent introduction of therapeutics aiming to rectify the effect of these mutations for cancer treatment. We provide a critical appraisal of evidence for endometrial aberrations in endometriosis and relevant experimental evidence. All available evidence of endometrial "defect" is invariably post hoc and may well be secondary to induced endometriosis. We propose that the theory of "endometrial determinism" needs to demonstrate a clear causal and a phylogenetic relationship between endometrial aberrations and endometriosis. We argue that while it is highly likely that endometriosis is a consequence of retrograde menstruation, the case that molecular aberrations as a sole or a necessary determinant remains to be proven. "Root treatment" is a worthy ambition but as of now it is close to a fanciful Utopia.

Rethinking disaster utopia: the limits of conspicuous resilience for community-based recovery and adaptation.

While some communities appear to blossom in the wake of a disaster, others are left to struggle in the ashes. This paper introduces the concept of 'conspicuous resilience' to understand how emergent community-based recovery efforts privilege some needs while marginalising others, contributing to uneven forms of recovery. Drawing on a qualitative case study of the deadly Montecito debris flow in Southern California, United States, in January 2018, an in-depth examination of emergent community-based resilience efforts is gauged next to the social construction of unmet needs. Conspicuous acts of resilience centred around gaps in social and financial support as well as desires for protection from future debris flows. In defining and addressing needs, community-based interventions mirrored existing social inequalities and uneven relationships of power, promoting a false sense of equality and security while reinforcing private interests. To address the limits of conspicuous resilience, a justice-oriented politics of disaster recovery is needed.

Is precision medicine for colorectal liver metastases still a utopia? New perspectives by modern biomarkers, radiomics, and artificial intelligence.

The management of patients with liver metastases from colorectal cancer is still debated. Several therapeutic options and treatment strategies are available for an extremely heterogeneous clinical scenario. Adequate prediction of patients' outcomes and of the effectiveness of chemotherapy and loco-regional treatments are crucial to reach a precision medicine approach. This has been an unmet need for a long time, but recent studies have opened new perspectives. New morphological biomarkers have been identified. The dynamic evaluation of the metastases across a time interval, with or without chemotherapy, provided a reliable assessment of the tumor biology. Genetics have been explored and, thanks to their strong association with prognosis, have the potential to drive treatment planning. The liver-tumor interface has been identified as one of the main determinants of tumor progression, and its components, in particular the immune infiltrate, are the focus of major research. Image mining and analyses provided new insights on tumor biology and are expected to have a relevant impact on clinical practice. Artificial intelligence is a further step forward. The present paper depicts the evolution of clinical decision-making for patients affected by colorectal liver metastases, facing modern biomarkers and innovative opportunities that will characterize the evolution of clinical research and practice in the next few years.

Avances en Psicología Social Libertaria para autogestión activa: QCA mejorada y reflexiones desde República Dominicana / Advances in Libertarian Socialist Social Psychology’s Self-management: enhanced QCA and reflections from the Dominican Republic

Profundizo en una observación participante en una comunidad libertaria que emerge como mi-noría activa en las metrópolis de República Dominicana, mediante veinte entrevistas en pro-fundidad a diez personas a principios y a finales del 2013. Reconstruyo un modelo teórico dis-tinguiendo entre el compromiso de autogestión activo del pasivo. En este adelanto, presento una explicación mejorada del resultado de interés (laautogestión activa), gracias a un diálogo entre teorías y evidencias, junto a una revisión metodológica mejorada. Para la explicación de la autogestión activa, opto por la conjugación de dos condiciones principales: 1) las multiplici-dades discursivas, el solapamiento de herramientas comunitarias del discurso autogestionario como optimizadores de la autogestión; y 2) las actitudes personales que facilitan asumir un rol protagónico en el compromiso autogestionario como sujeto. Distingo esta explicación cuando hay un compromiso autogestionario libertario más general en comparación con el compromiso específicamente anarquista. (AU)

Drawing from exploratory participant observation with libertarian socialist groups and indi-viduals emerging as active minorities in the metropolitan areas of the Dominican Republic, twenty in-depth interviews were conducted with ten participants in the beginning and the end of 2013. An advanced theoretical model was reconstructed, which distinguished itself between the persons as the commitment of active self-management, and the passive self-management commitment. This improvement is done thanks to a more profound dialogue between theories and evidence and an enhanced methodological framework. From the explanation of the active self-management we can see the combination of: 1) discursive multiplicities, the overlap of communitarian tools of discourse self-management of the cases studied as optimizers; and 2) personal attitudes that facilitate one taking a protagonist role in self-management commit-ment as a subject. These conditions are differentiated when explaining the most general lib-ertarian socialist self-management commitment separated from the specifically anarchist commitment. (AU)

No limite da cidade: diálogos entre a cidade e o quarto de despejo / On the edge of the city: dialogues between the city and the dumping room

O presente texto se compõe de reflexões realizadas a respeito do lugar dos pobres no direito à cidade capitalista, incitadas através da leitura do livro Quarto de despejo: o diário de uma favelada, de Carolina Maria de Jesus e de sua correlação com alguns autores que trazem a questão da cidade em suas obras. Ao longo de três seções, foram abordados temas como a criminalização da pobreza e a retirada dos pobres das cidades tradicionais, quando do estabelecimento da cidade enquanto mercadoria de luxo; a cidade e a para-cidade, a ilha que a cerca, onde procuramos compreender então quem tem direito a essa cidade-negócio e quem não tem; e, por fim, procuramos trazer à tona o sonho, a esperança que nos direciona ao campo de possibilidades, ao campo da vida e da restituição do urbano, onde tratamos um pouco a respeito da utopia desenhada por Lefebvre e da arte e do sensível enquanto meios de restaurar a vida nas cidades

This present is composed of reflections about the place of the poor in the right to the capitalistic city, incited by reading the book: Quarto de despejo: o diário de uma favelada, written by Carolina Maria de Jesus and its correlation to some authors who bring the issue of the city into their works. Throughout trhee sections, we approached subjects such as the criminalization of poverty and the removal of the poor from traditional cities, when the city was established as a luxury commodity; the city and the para-city, the island that surrounds it, where we tried to comprehend then who is entitled to this business-city and who is not; and, by the end, we tried to bring the dream, the hope that drives us to the possibilities field, to life field and to restitution of the urban, where we dealed a little with the utopia drawed by Lefebvre and with art and sensitive as paths to restore life in the cities

As ocupações das escolas e suas formas inéditas de revolta / School occupations and their original forms of revolt / Les occupations juvéniles et leurs formes originales de révolte / Las ocupaciones de escuelas y sus nuevas formas de revuelta

Resumo Este trabalho apresenta uma reflexão acerca da emergência de novas discursividades no campo político com o movimento de ocupações de escolas no Brasil, entre 2015 e 2016, considerando a dimensão utópica presente nessas experiências estudantis que se conjugaram a partir da posição de um não-saber. Articula-se com registros bibliográficos, fotográficos e audiovisuais, convocando o pensamento para uma conversa entre política e utopia.

Abstract This paper reflects on the emergence of new political discourses regarding students' lived experience of school occupations in Brazil, between 2015 and 2016, considering their utopic content built upon a not-knowing position. The text articulates bibliographic research, photographic and audio-visual records, inviting a debate about politics and utopia.

Résumé Cet article réfléchit à l'émergence de nouveaux discours politiques concernant les occupation juvéniles dans les écoles au Brésil, entre 2015 et 2016, en considérant leur contenu utopique construit sur une position de non-savoir. Le texte articule des recherches bibliographiques, des enregistrements photographiques et audiovisuels, invitant à un débat sur la politique et l'utopie.

Resumen Este trabajo presenta una reflexión sobre las urgencias de las nuevas discursividades en el campo político a partir del movimiento de ocupaciones de escuelas en Brasil, entre 2015 y 2016, considerando la dimensión utópica presente en estas experiencias de los estudiantes que están intercaladas a partir de la posición de un no-saber. Para ello, se utilizan bibliografía, registros fotográficos y audiovisuales, que estimulan la discusión entre política y utopía.

De uma utopia estética a uma estética utópica: a linguagem que pulsa / From aesthetic utopia to utopian aesthetics: the pulsating language / De una utopía estética a una estética utópica: el lenguaje que pulsa

Este artigo busca tensionar o significante utopia, a partir de uma articulação com a estética. Com esse intuito, dialogamos, especificamente, com a linguagem cinematográfica, assumindo a premissa de que não aplicamos a Psicanálise ao cinema, mas o cinema à Psicanálise, de modo a construir um percurso mediante o qual podemos escutar os significantes em sua equivocidade. Com a emergência de uma utopia estética, a qual ilustramos com o realismo socialista, entendemos que uma política de linguagem estrita foi colocada em cena, restringindo os jogos com os significantes e, portanto, as possibilidades discursivas. No entanto, nos emaranhados da cultura, entre fechamentos e (re)aberturas, uma estética utópica pode ganhar forma, a qual colocamos para discussão a partir do cinema de Tarkovsky, que aposta em uma linguagem cinematográfica fora dos ditames estéticos vigentes. Nesse sentido, o que está em jogo é a dimensão inventiva da linguagem, o pulsar dos significantes que convocam os sujeitos a posturas distintas.

This article seeks to underscore the 'utopia significant, based on an articulation with aesthetics. The premise is not to apply Psychoanalysis to cinema: cinema is applied to Psychoanalysis building a path through which we can listen to the signifiers in their equivocality. With the emergence of an aesthetic utopia, which we illustrate with socialist realism, we understand that a strict language policy was established, restricting games with language and, therefore, discursive possibilities. However, in the entanglements of culture, between closings and (re)openings, a utopian aesthetics can take shape, and also shape the discussion based on Tarkovsky's cinema, with his outsider cinematographic language. In this sense, what is at stake is the inventive dimension of language, the pulse of the signifiers that call the subjects to position themselves differently.

Este artículo busca tensionar el significante utopía, a partir de una articulación con la estética. Para eso, dialogamos específicamente con el lenguaje cinematográfico, asumiendo la premisa de que no aplicamos el Psicoanálisis al cine, sino el cine al Psicoanálisis, para construir un camino a través del cual podamos escuchar los significantes en su equívoco. Con el surgimiento de una utopía estética, la cual ilustramos con el realismo socialista, entendemos que una politica de lenguaje estricta fue colocada en escena, restringiendo los juegos con los significantes y, por lo tanto, las posibilidades discursivas. Sin embargo, en los enredosn de la cultura, entre cierres y (re)aperturas, puede tomar forma una estética utópica, la cual ponemos en discusión a partir del cine de Tarkovsky, que apuesta por un lenguaje cinematográfico fuera de los dictámenes estéticos actuales. En este sentido, lo que está en juego es la dimensión inventiva del lenguaje, el pulso de los significantes que convocan a los sujetos a diferentes posturas.

Farm robots: ecological utopia or dystopia?

Farm robots may lead to an ecological utopia where swarms of small robots help in overcoming the yield penalties and labor requirements associated with agroecological farming - or a dystopia with large robots cultivating monocultures. Societal discussions and policy action are needed to harness the potential of robots to serve people and the planet.

Teamwork in Cranial Base Surgery: A Feasible Task or a Utopian Dream.

In the past decade or perhaps a little earlier than that the concept of teamwork evolved among the circles of surgeons especially among those involved in complicated and time consuming surgeries. Skull base surgeries were one of those surgeries where the role of teamwork was acutely felt owing to innumerable specialties involved in the consummation of such surgeries. Although teamwork in this specialty is the need of the hour but, achieving the spirit of teamwork is not that easy and perhaps a challenging task. This manuscript tackles the much needed demand of teamwork in this arena of surgery and unveils whether such a teamwork is achievable or is just an utopian dream.

Paraguay, ¿el renacer de una utopía contagiosa? / Paraguay, the rebirth of a contagious utopia?

El artículo analiza las movilizaciones políticas en Paraguay, a partir de la década de 2000, con mayor atención a la relación entre los movimientos sociales y el gobierno de Fernando Lugo (2008 - 2012). Entre los aspectos que destaca el texto está que los movimientos sociales en Paraguay tuvieron un rol significativo desde la década del 2000. Desde la llegada de Lugo al gobierno nacional, sin embargo, se observó que las acciones de los líderes de las Centrales Sindicales comenzaron a priorizar las posiciones gubernamentales. Es decir, los partidos y agrupaciones de izquierda apuestan por el fortalecimiento de organizaciones populares, sindicatos, movimientos sociales partiendo del supuesto de que la vía administrativa podría fortalecer las organizaciones y garantizar mayores ganancias de derechos. Lo que sucedió, sin embargo, fue que los líderes fueron rápidamente cooptados por la lógica del poder estatal y la ocupación de cargos se convirtió en el objetivo principal.(AU)

The article analyzes the political mobilizations in Paraguay, starting in the 2000s, with greater attention to the relationship between social movements and the government of Fernando Lugo (2008 - 2012). Among the aspects highlighted in the text is that social movements in Paraguay had a significant role since the 2000s. Since Lugo's arrival in the national government, however, it was observed that the actions of the leaders of the Trade Union Centrals began to prioritize government positions. In other words, the parties and groups of the left are committed to strengthening popular organizations, unions, and social movements based on the assumption that the administrative route could strengthen organizations and guarantee greater gains in rights. What happened, however, was that the leaders were quickly co-opted by the logic of state power and the occupation of positions became the main objective.(AU)