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2.
J Surg Oncol ; 125(1): 34-37, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34897707

RESUMO

Treatment of regional lymph nodes in melanoma has been controversial for more than a century. A series of clinical trials evaluating elective lymph node dissection and then sentinel lymph node biopsy have helped define the current standard of care. These trials resulted in increasingly selective application of surgical intervention for regional lymph nodes in melanoma. First by focusing on optimal candidates for elective lymph node dissection and then by identifying patients through sentinel lymph node biopsy. The current standard of sentinel lymph node biopsy for appropriately selected patients and nodal observation for many patients, even with involved sentinel nodes is both more accurate in staging and much less morbid than what came before.


Assuntos
Ensaios Clínicos como Assunto/métodos , Linfonodos/cirurgia , Melanoma/cirurgia , Ensaios Clínicos como Assunto/história , Ensaios Clínicos Fase III como Assunto/história , Ensaios Clínicos Fase III como Assunto/métodos , História do Século XIX , História do Século XX , História do Século XXI , Humanos , Excisão de Linfonodo , Linfonodos/patologia , Metástase Linfática , Melanoma/história , Melanoma/patologia , Estudos Multicêntricos como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto/história , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Biópsia de Linfonodo Sentinela/métodos
3.
J Surg Oncol ; 125(1): 7-16, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34897706

RESUMO

Surgical trials in breast cancer have catalyzed contemporary trial design for solid organ cancers and are a prime example of surgeons taking the lead in clinical trial design. Surgeons have lead trials that have improved patient outcomes and quality of life without sacrificing oncologic safety. We have evolved from radical mastectomy to breast conservation and sentinel node biopsy. Contemporary trial design in breast cancer now focus on personalizing care based on tumor genomics.


Assuntos
Neoplasias da Mama/cirurgia , Ensaios Clínicos como Assunto/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Neoplasias da Mama/história , Neoplasias da Mama/terapia , Ensaios Clínicos como Assunto/história , Feminino , História do Século XX , História do Século XXI , Humanos , Terapia Neoadjuvante , Ensaios Clínicos Controlados Aleatórios como Assunto/história , Projetos de Pesquisa
4.
J Surg Oncol ; 125(1): 28-33, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34897715

RESUMO

Since the observation that clearance of all visible and microscopic tumors from cutaneous melanoma is critical to prevent a recurrence, wide surgical margins have been central to surgical dogma. In the last several decades, more conservative margin widths have been vigorously studied by surgical investigators to lessen wound complications, the need for reconstruction, and healthcare costs. This review summarizes surgeon-led clinical trials that define current guidelines and highlights the challenges to initiate and perform trials today.


Assuntos
Ensaios Clínicos como Assunto/métodos , Procedimentos Cirúrgicos de Citorredução/métodos , Melanoma/cirurgia , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Neoplasias Cutâneas/cirurgia , Ensaios Clínicos como Assunto/história , Ensaios Clínicos como Assunto/normas , Procedimentos Cirúrgicos de Citorredução/história , Procedimentos Cirúrgicos de Citorredução/normas , História do Século XX , História do Século XXI , Humanos , Margens de Excisão , Melanoma/história , Melanoma/patologia , Guias de Prática Clínica como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto/história , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Neoplasias Cutâneas/história , Neoplasias Cutâneas/patologia
5.
Urol Clin North Am ; 49(1): 23-38, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34776052

RESUMO

Among the various robotic devices that exist for urologic surgery, the most common are synergistic telemanipulator systems. Several have achieved clinical feasibility and have been licensed for use in humans: the standard da Vinci, Avatera, Hinotori, Revo-i, Senhance, Versius, and Surgenius. Handheld and hands-on synergistic systems are also clinically relevant for use in urologic surgeries, including minimally invasive and endoscopic approaches. Future trends of robotic innovation include an exploration of more robust haptic systems that offer kinesthetic and tactile feedback; miniaturization and microrobotics; enhanced visual feedback with greater magnification and higher fidelity detail; and autonomous robots.


Assuntos
Procedimentos Cirúrgicos Robóticos/instrumentação , Robótica/história , Procedimentos Cirúrgicos Urológicos/instrumentação , Retroalimentação , História do Século XX , História do Século XXI , Humanos , Laparoscopia , Procedimentos Cirúrgicos Robóticos/história , Terminologia como Assunto , Procedimentos Cirúrgicos Urológicos/história , Procedimentos Cirúrgicos Urológicos/métodos
6.
Med Clin North Am ; 106(1): 1-12, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34823724

RESUMO

Medicine's acceptance of addiction as a medical concept has waxed and waned over time. Addiction, as a disease, fits with modern disease definitions and scientific advances in elucidating the interactions between neurobiology and environment. Definitions of addiction need to acknowledge the complex interactions of brain circuits, genetics, environmental factors, and individual life experiences. Addiction aligns with diagnostic categories of substance use disorders that do not rely on tolerance and withdrawal as defining characteristics. Shifts in social and political views of addiction continue to propel and mirror changes in addiction treatment approaches and terminology within the medical community.


Assuntos
Comportamento Aditivo/psicologia , Assistência Integral à Saúde/métodos , Neurobiologia/métodos , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/genética , Adolescente , Analgésicos Opioides/uso terapêutico , Comportamento/ética , Comportamento Aditivo/história , Buprenorfina/uso terapêutico , Meio Ambiente , Feminino , História do Século XX , Humanos , Acontecimentos que Mudam a Vida , Masculino , Metadona/uso terapêutico , Estigma Social , Síndrome de Abstinência a Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/tratamento farmacológico , Transtornos Relacionados ao Uso de Substâncias/psicologia , Terminologia como Assunto , Pessoas Transgênero/psicologia , Adulto Jovem
7.
Med Clin North Am ; 106(1): 29-41, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34823733

RESUMO

The Half-Century long problem of addiction treatment disparities. We cannot imagine addressing disparities in addiction treatment without first acknowledging and deconstructing the etiology of this inequity. This article examines the history of addiction treatment disparities beginning with early twentieth-century drug policies. We begin by discussing structural racism, its contribution to treatment disparities, using opioid use disorder as a case study to highlight the importance of a structural competency framework in obtaining care. We conclude by discussing diversity in the workforce as an additional tool to minimizing disparities. Addiction treatment should be aimed at addressing care delivery in the context of the social, economic, and political determinants of health, which require appreciation of their historical origins to move toward equitable treatment.


Assuntos
Comportamento Aditivo/história , Mão de Obra em Saúde/ética , Disparidades em Assistência à Saúde/etnologia , /prevenção & controle , Comportamento Aditivo/etiologia , Comportamento Aditivo/terapia , Competência Cultural/educação , Diversidade Cultural , Atenção à Saúde/organização & administração , Feminino , Disparidades nos Níveis de Saúde , História do Século XX , Humanos , Legislação de Medicamentos/história , Transtornos Relacionados ao Uso de Opioides , Política , Determinantes Sociais da Saúde/ética , Fatores Socioeconômicos , /psicologia
12.
Bull Cancer ; 108(10S): S4-S17, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34920806

RESUMO

Chimeric antigen receptors (CAR)-T cells are genetically engineered T-lymphocytes redirected with a predefined specificity to any target antigen, in a non-HLA restricted manner, therefore combining antibody-type specificity with effector T-cell function. This strategy was developed some thirty years ago, after extensive work established the key role of the immune system against cancer. The first-engineered T-cell with chimeric molecule was designed in 1993 by Israeli immunologist Zelig Eshhar. Since then, several modifications took place, including the addition of co-stimulatory domain, to further improve CAR-T cell anti-tumor potency. The first clinical application of CAR-T cell was done in Rotterdam in 2005 for metastatic renal cell carcinoma and simultaneously at the National Cancer Institute (NCI) for metastatic ovarian cancer. These pioneered studies failed to demonstrate a therapeutic benefit, but warning emerged concerning their safety of use. The real clinical success came with anti-CD19 CAR-T cells, used since 2009 by Steven Rosenberg at the NCI in a patient with refractory follicular lymphoma and in 2011 by Carl June and David Porter from the University of Pennsylvania in patients with chronic lymphocytic leukemia and B-cell acute lymphoblastic leukemia. From that time, large centers in North America have embarked in several early phase and pivotal trials that have demonstrated unprecedent response rate in heavily pretreated chemo refractory patient with B-cell malignancies. Theses clinical success have led to the approval of three anti-CD19 CAR-T cells products for the management of B-cell malignancies in the United States and in Europe as of December 2020.


Assuntos
Imunoterapia Adotiva/métodos , Neoplasias/terapia , Receptores de Antígenos Quiméricos/imunologia , Linfócitos T/transplante , Especificidade de Anticorpos , Antígenos CD19/imunologia , Carcinoma de Células Renais/secundário , Carcinoma de Células Renais/terapia , Ensaios Clínicos como Assunto , Europa (Continente) , Feminino , História do Século XVIII , História do Século XIX , História do Século XX , Humanos , Imunoterapia Adotiva/história , Israel , Neoplasias Renais/patologia , Neoplasias Renais/terapia , Leucemia Linfocítica Crônica de Células B/terapia , Depleção Linfocítica/métodos , Linfócitos do Interstício Tumoral/transplante , Linfoma Folicular/terapia , Mieloma Múltiplo/terapia , Neoplasias/imunologia , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/terapia , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Linfócitos T/imunologia , Estados Unidos
13.
Proc Natl Acad Sci U S A ; 118(51)2021 12 21.
Artigo em Inglês | MEDLINE | ID: mdl-34916287

RESUMO

The surge of post-truth political argumentation suggests that we are living in a special historical period when it comes to the balance between emotion and reasoning. To explore if this is indeed the case, we analyze language in millions of books covering the period from 1850 to 2019 represented in Google nGram data. We show that the use of words associated with rationality, such as "determine" and "conclusion," rose systematically after 1850, while words related to human experience such as "feel" and "believe" declined. This pattern reversed over the past decades, paralleled by a shift from a collectivistic to an individualistic focus as reflected, among other things, by the ratio of singular to plural pronouns such as "I"/"we" and "he"/"they." Interpreting this synchronous sea change in book language remains challenging. However, as we show, the nature of this reversal occurs in fiction as well as nonfiction. Moreover, the pattern of change in the ratio between sentiment and rationality flag words since 1850 also occurs in New York Times articles, suggesting that it is not an artifact of the book corpora we analyzed. Finally, we show that word trends in books parallel trends in corresponding Google search terms, supporting the idea that changes in book language do in part reflect changes in interest. All in all, our results suggest that over the past decades, there has been a marked shift in public interest from the collective to the individual, and from rationality toward emotion.


Assuntos
Idioma , Livros/história , Emoções , História do Século XIX , História do Século XX , História do Século XXI , Humanos , Individualidade , Idioma/história , Bibliotecas Digitais/estatística & dados numéricos , Linguística/história , Linguística/tendências , Jornais como Assunto/história , Jornais como Assunto/tendências , Análise de Componente Principal
17.
PLoS One ; 16(12): e0260505, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34932567

RESUMO

Over the centuries, iconographic representations of St Anthony of Padua, one of the most revered saints in the Catholic world, have been inspired by literary sources, which described the Saint as either naturally corpulent or with a swollen abdomen due to dropsy (i.e. fluid accumulation in the body cavities). Even recent attempts to reconstruct the face of the Saint have yielded discordant results regarding his outward appearance. To address questions about the real appearance of St Anthony, we applied body mass estimation equations to the osteometric measurements taken in 1981, during the public recognition of the Saint's skeletal remains. Both the biomechanical and the morphometric approach were employed to solve some intrinsic limitations in the equations for body mass estimation from skeletal remains. The estimated body mass was used to assess the physique of the Saint with the body mass index. The outcomes of this investigation reveal interesting information about the body type of the Saint throughout his lifetime.


Assuntos
Edema/diagnóstico , Insuficiência Cardíaca/diagnóstico , Obesidade/diagnóstico , Aparência Física , Santos/história , Gordura Abdominal/fisiopatologia , Índice de Massa Corporal , Restos Mortais/anatomia & histologia , Diagnóstico , Diagnóstico Diferencial , Edema/história , Edema/fisiopatologia , Insuficiência Cardíaca/história , Insuficiência Cardíaca/fisiopatologia , História do Século XXI , História Medieval , Humanos , Itália , Obesidade/história , Obesidade/fisiopatologia , Religião e Medicina
18.
Bull Hist Med ; 95(3): 315-349, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34924436

RESUMO

This essay considers the pursuits and occupational trajectory of the Parisian anatomical modeler Marie Marguerite Biheron (1719-95), who was celebrated for her anatomical cabinet. It highlights the role of Biheron's circle of friends and supporters in nourishing her place in the anatomical world. I argue that a focus on social and affective relations, such as friendship, can enhance our understanding of the careers of female medical practitioners and medical artists like Biheron. Her case provides a useful vantage point to reconstruct how a woman, who could not rely on the support of her family nor, for most of her life, on royal patronage, could successfully engage in anatomical practice and become renowned. Casting light on early modern economies of care, Biheron's story also helps illuminate the broader significance of amicable and affective relations in the histories of medicine and natural inquiry.


Assuntos
Anatomia , Amigos , Anatomia/história , Feminino , História do Século XVIII , Humanos
20.
Int J Public Health ; 66: 603810, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34744569

RESUMO

Objectives: This study aimed to estimate the long-term trends of breast cancer incidence in Shanghai, Hong Kong, and Los Angeles (LA). Methods: Data were obtained from Cancer Incidence in Five Continents (CI5plus) database. The average annual percent change (AAPC) was conducted by joinpoint regression analysis, and the age, period and cohort effects were estimated by age-period-cohort (APC) analysis. Results: The age-standardized incidence rates (ASIRs) in LA were higher than Shanghai and Hong Kong. During 1988-2012, the ASIRs significantly decreased in white women in LA (AAPC = -0.6%, 95% CI: -0.9% to -0.4%) while increased in Shanghai (2.5%: 2.1%-2.9%) and Hong Kong (2.2%: 2.0%-2.5%). The APC analysis revealed significantly increased effects of age and period, and decreased effect of birth cohort. Conclusion: Although age and cohort effects were relatively strong, the period effect may be the key factor affecting trends of incidence, which may be caused by increasing exposures to carcinogens and risk factors. Therefore, more effective measures should be carried out promptly to protect high-risk populations such as elder women, to avoid exposures to risk factors of breast cancer.


Assuntos
Neoplasias da Mama , Idoso , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/história , China/epidemiologia , Estudos de Coortes , Feminino , História do Século XX , História do Século XXI , Hong Kong/epidemiologia , Humanos , Incidência , Los Angeles/epidemiologia , Fatores de Risco
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