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Metástases para a mama, a partir de tumores malignos extramamários, são raras, particularmente a partir de carcinoma de ovário. Os autores relatam dois casos de tumor metastático de ovário para mama e revisam a literatura prévia sobre esta entidade clínica pouco usual. Apesar de sua raridade, é importante diferenciar o tumor metastático do tumor primário de mama. uma vez que ambos podem diferenciar-se significativamente quanto ao prognóstico e ao tratamento. De uma maneira geral, o tumor metastático de ovário para a mama é um sinal de que a doença encontra-se disseminada, levando normalmente a uma rápida deterioração do quadro clínico e culminando com a morte do paciente. Tendo em vista que, geral mente, o tumor metastático de mama possui um prognóstico ruim, o tratamento cirúrgico radical muitas vezes é desnecessário; no entanto, o médico deve estar ciente de que a escolha do tratamento ideal pode diferir de um paciente para outro.

Background Radiological assessment of patients with chronic thromboembolic pulmonary hypertension (CTEPH) is critical to decide whether patients should be treated with pulmonary endarterectomy (PEA). Although computed tomography pulmonary angiography (CTPA) is increasingly used for decision making in CTEPH, the value of CTPA to predict surgical findings and outcome has never been explored. Methods We retrospectively reviewed 100 consecutive patients with high-quality CTPA undergoing PEA for CTEPH between May 2015 and December 2017. The most proximal level of disease in the pulmonary artery on CTPA was classified by two blinded radiologists as level 1 (main pulmonary artery), 2a (lobar pulmonary artery), 2b (origin of basal segmental pulmonary artery), 3 (segmental pulmonary artery) or 4 (predominantly subsegmental pulmonary artery). Results CTPA demonstrated level 1 in 20%, level 2a in 43%, level 2b in 11%, level 3 in 23% and level 4 in 3%. A majority of males presented with level 1 (55%) and level 2 (57%), and a majority of females (83%) with level 3 (p=0.01). Levels 3 and 4 were associated with longer duration of circulatory arrest (p=0.03) and higher frequency of Jamieson type III disease at surgery (p

Background: SCOPE is a quality improvement initiative that addresses the challenge of an aging population’s increasing care needs and the reduced capacity of primary care providers (PCPs) unaffiliated with interdisciplinary teams, to manage this population. SCOPE aims to integrate care so that patients and their families experience one care team across primary, community and hospital sectors. SCOPE’s success in offering a virtual interdisciplinary team via a centralized hub rests on grassroots co-design with PCPs and their patients. Since launching in 2012, SCOPE has grown from 30 PCPs located in one region in Toronto (Canada), to support over 300 PCPs in 4 regions. To date SCOPE has received approximately 15,000 total calls, currently averaging >400 calls/month. Half of these calls were perceived to have avoided an ED visit. The majority of SCOPE physicians (97.7%) felt they are able to access specialty care in a timely manner. Qualitative research demonstrated that PCPs felt less isolated, more confident in managing complex patients, and that their patients received more comprehensive care with more appropriate usage of healthcare resources. SCOPE was recognized in 2018 with a provincial integration award. Aims and Objectives: Demonstrate the co-design process to inform the model Reveal the infrastructure that facilitates linkages Convey an adaptable communication strategy to drive primary care integration Establish key metrics to measure successful adoption and sustainability Frame first principles for successful scale and spread of a patient-centered, provider-enhanced model Format: The SCOPE workshop will use didactic and experiential interactive learning methods to meet its objectives: Patient Narrative Video: Mr. Kandil Gudka (5 minutes) Context of co-design strategy: Dr. Pauline Pariser, Primary Care Lead, University Health Network (UHN) (6 minutes) Key elements of SCOPE Model: Acute Ambulatory Care Unit: Dr. Tara O’Brien, Medical Director, Women’s College Hospital (WCH) (7 minutes) Home and Community Care: Marni Salkovitch, Toronto Central LHIN (5 minutes) Nurse Navigation: Magdalena Rybak, UHN (5 minutes) Radiology: Dr. John Kavanagh, Chief of Radiology, WCH (7 minutes) Evaluation, Patient Outcomes and Process Measures: Dr. Pauline Pariser (5 minutes) Scale and Spread: An interactive forum using breakout groups to respond to standardized practices in building sustained relationships with PCPs and patients and what can be customized to local contexts, highlighting: patient and PCP co-design, integrated home and hospital care, and an incremental maturity model. Participants will have the opportunity to reflect how these methodologies are adaptable to their local settings (40 minutes; 25 minutes for discussion and 15 minutes report back) Facilitated by SCOPE team Closing Remarks/Questions: SCOPE team (10 minutes) Target Audience: Primary care thought leaders, hospital and community service managers, patients and consultants interested in primary care integration. Learnings/Take Away: SCOPE offers a transferable platform connecting primary care to hospital and community resources and building a community of practice SCOPE demonstrates proof of concept to successfully engage patients and providers in implementing a primary care integration strategy SCOPE provides the scaffolding to link other services as determined by local needs

Although mortality rates from cardiovascular disease in the developed world are falling, the prevalence of cardiovascular disease (CVD) is not. Each year, the number of people either being diagnosed as suffering with CVD or undergoing a surgical procedure related to it, such as percutaneous coronary intervention, continues to increase. In order to ensure that we can effectively manage these diseases in the future, it is critical that we fully understand their basic physiology and their underlying causative factors. Over recent years, the important role of the cardiac microcirculation in both acute and chronic disorders of the heart has become clear. The recruitment of inflammatory cells into the cardiac microcirculation and their subsequent activation may contribute significantly to tissue damage, adverse remodeling, and poor outcomes during recovery. However, our basic understanding of the cardiac microcirculation is hampered by an historic inability to image the microvessels of the beating heart—something we have been able to achieve in other organs for over 100 years. This stems from a couple of clear and obvious difficulties related to imaging the heart—firstly, it has significant inherent contractile motion and is affected considerably by the movement of lungs. Secondly, it is located in an anatomically challenging position for microscopy. However, recent microscopic and technological developments have allowed us to overcome some of these challenges and to begin to answer some of the basic outstanding questions in cardiac microvascular physiology, particularly in relation to inflammatory cell recruitment. In this review, we will discuss some of the historic work that took place in the latter part of last century toward cardiac intravital, before moving onto the advanced work that has been performed since. This work, which has utilized technology such as spinning-disk confocal and multiphoton microscopy, has—along with some significant advancements in algorithms and software—unlocked our ability to image the “business end” of the cardiac vascular tree. This review will provide an overview of these techniques, as well as some practical pointers toward software and other tools that may be useful for other researchers who are considering utilizing this technique themselves.

Abstract Purpose  Polysaccharides such as chondroitin play a potent role in tumor growth, tissue repair and angiogenesis. These properties make chondroitin a good candidate for novel drug delivery systems. Diammine dicarboxylic acid platinum (DDAP), a novel polymeric platinum compound, was developed by conjugating the platinum analogue to aspartate–chondroitin for drug delivery to tumor cells. DDAP improves platinum solubility which may reduce systemic toxicity and be more efficacious than cisplatin in killing tumor cells. Methods  We tested and compared the cytotoxic effects of DDAP and CDDP on the platinum-sensitive 2008 and A2780 ovarian cancer cell lines and their platinum-resistant sublines 2008.C13 and A2780cis; we also investigated DDAP’s mechanism of action. Results  In the platinum-sensitive cell lines, the cytotoxic effects of DDAP and CDDP were comparable. However, in the platinum-resistant sublines, significantly greater cell-growth inhibition was induced by DDAP than by CDDP, especially at lower doses. DDAP also induced more apoptosis than CDDP did in the 2008.C13 subline, which was partially mediated by the caspase 3-dependent pathway. In addition, lower (but not higher) doses of DDAP arrested 90% of S-phase 2008.C13 cells, which might be associated with up-regulation of p21 and maintenance of low cyclin A expression. Furthermore, greater cellular uptake of DDAP was seen in platinum-resistant than in platinum-sensitive ovarian cancer cells. Conclusions  Low-dose DDAP enhances drug delivery to platinum-resistant ovarian cancer cells and substantially inhibits their growth by inducting apoptosis and arresting cells in the S-phase, suggesting that DDAP may overcome platinum resistance in ovarian cancer. [ABSTRACT FROM AUTHOR]

BackgroundNew parents face increased risks of emotional distress and relationship dissatisfaction. Digital interventions increase support access, but few preventive programs are optimized for both parents. ObjectiveThis study aims to conduct the first randomized controlled trial on universal self-guided digital programs to support positive perinatal adjustment of both mothers and fathers. Effects of childcare information (Baby Care) and information plus an interactive program (Baby Steps Wellbeing) were compared from the third trimester baseline to 3 and 6 months subsequently. MethodsThe study recruited 388 co-parenting male-female adult couples expecting their first single child (26-38 weeks’ gestation), using web-based registration. Most (337/388, 86.8%) were obtained from prenatal hospital classes. Couples’ randomization was automated and stratified by Edinburgh Postnatal Depression Scale (EPDS) scores (50% couples scored high if either mother >7, father >5). All assessments were web-based self-reports: the EPDS and psychosocial quality of life were primary outcomes; relationship satisfaction, social support, and self-efficacy for parenting and support provision were secondary. Linear mixed models provided intention-to-treat analyses, with linear and quadratic effects for time and random intercepts for participants and couples. ResultsSelection criteria were met by 63.9% (248/388) of couples, who were all randomized. Most participants were married (400/496, 80.6%), tertiary educated (324/496, 65.3%), employed full time (407/496, 82%), and born in Australia (337/496, 67.9%). Their mean age was 32.2 years, and average gestation was 30.8 weeks. Using an EPDS cutoff score of 13, 6.9% (18/248) of men, and 16.1% (40/248) of women screened positive for depression at some time during the 6 months. Retention of both partners was 80.6% (201/248) at the 6-month assessments, and satisfaction with both programs was strong (92% ≥50). Only 37.3% (185/496) of participants accessed their program more than once, with higher rates for mothers (133/248, 53.6%) than fathers (52/248, 20.9%; P

The ability to image biological tissues is critical to our understanding of a range of systems and processes. In the case of in situ living tissue, such imaging is hampered by the innate mechanical properties of the tissue. In many cases, this provides challenges in how to process large amounts of image data which may contain aberrations from movement. Generally, current tools require the provision of reference images and are unable to maintain temporal correlations within an image set. Here, we describe a tool-Tify-which can accurately predict a numerical quality score versus human scoring and can analyse image sets in a manner that allows the maintenance of temporal relationships. The tool uses regression-based techniques to link image statistics to image quality based on user provided scores from a sample of images. Scores calculated by the software correlate strongly with the scores provided by human users. We identified that, in most cases, the software requires users to score between 20-30 frames in order to be able to accurately calculate the remaining images. Importantly, our results suggest that the software can use coefficients generated from consolidated image sets to process images without the need for additional manual scoring. Finally, the tool is able to use a frame windowing technique to identify the highest quality frame from a moving window, thus retaining macro-chronological connections between frames. In summary, Tify is able to successfully predict the quality of images in an image set based on a small number of sample scores provided by end-users. This software has the potential to improve the effectiveness of biological imaging techniques where motion artefacts, even in the presence of stabilisation, pose a significant problem.