Search

No livro Penser/Classer, Georges Perec nos fala de um olhar oblíquo, olhar que encontramos também no livro Memórias Inventadas, de Manoel de Barros. Na poética desses autores, essa “obliquidade” do olhar aponta para um processo de subjetivação que coloca em questão a anterioridade do sujeito face à sua escritura. O objetivo desse artigo é, a partir desse processo, estudar o deslocamento da memória como resgate do passado para o presente de sua própria inscrição.

A "morte do autor", anunciada por Roland Barthes no final dos anos sessenta, caminhou lado a lado com a "morte" do sujeito, tal como concebido pela tradição humanista. Ainda que nas últimas décadas alguns críticos tenham aludido a um "retorno ao sujeito", a dramatização da inscrição do Eu em alguns textos aponta para uma impossibilidade de resposta entre morte e ressurreição. Este artigo pretende investigar a necessidade de uma formulação teórica do que parece configurar-se como uma passagem para um regime de autoria em que a oposição mencionada não parece funcionar.

Objetivos: Monitorar o ambiente em áreas específicas de três hospitais terciários da cidade de Fortaleza – CE, buscando relatar a presença de fungos potencialmente patogênicos para pacientes e funcionários, contribuindo para uma melhor avaliação de riscos nesses hospitais. Métodos: No período de dezembro/2005 a novembro/2006, foram realizadas coletas mensais de amostras do ar de três hospitais públicos, que resultaram em 180 amostras de ar oriundas de 15 ambientes hospitalares. Os espécimes biológicos foram coletados através do método da sedimentação passiva, com exposições de placas de Petri, contendo ágar Sabouraud, suplementado com antibiótico. As placas foram incubadas por 10 dias (28°C), com a posterior identificação de todas as colônias fúngicas desenvolvidas. Resultados: Isolaram-se 10.608 colônias, pertencentes a 16 gêneros, sendo os mais frequentes Aspergillus, Penicillium, Candida, Curvularia e Trichoderma. Não se observaram relações estatisticamente significativas entre o número total de colônias e as características de cada ambiente analisado, com exceção de três ambientes. Conclusão: A diferença na concentração fúngica do ar desses hospitais possivelmente está mais relacionada com desequilíbrios das atividades humanas, tais como ambientes superpovoados e obras de construção, do que com as variações climáticas observadas no período em análise.

Objectives: To monitor the environment in specific areas of three tertiary hospitals in Fortaleza - CE, seeking to report the presence of potentially pathogenic fungi for patients and staff, contributing to a better risk assessment in these hospitals. Methods: In the period from December, 2005 to November, 2006, air samples from three public hospitals were collected monthly, which resulted in 180 air samples originated in 15 hospitals. The biological specimens were collected using the passive method of sedimentation, with exposure of Petri dishes containing Sabouraud agar supplemented with antibiotic. The dishes were incubated for 10 days (28°C) and all fungal colonies developed were subsequently identified. Results: 10,608 colonies were isolated, belonging to 16 genera, the most common being Aspergillus, Penicillium, Candida, Curvularia and Trichoderma. There were no statistically significant relationships between the total number of colonies and the characteristics of each environment studied, except for three of those. Conclusion: The difference in fungal concentrations in the air of these hospitals is possibly more related to instability of human activities, such as overpopulated settings and construction works, than to climatic variations observed in the period.

O presente trabalho descreve um simulador de escalonamento de processos de um sistema operacional multitarefa moderno que foi projetado inicialmente para avaliação acadêmica semestral. [...]

OBJETIVO: Avaliar o ganho de peso e a variação do estado nutricional dos pacientes portadores de mielomeningocele torácica após o uso da prótese vertical expansível de titânio (VEPTR) como opção para tratamento sem fusão da coluna vertebral. MÉTODOS: Estudo retrospectivo de oito pacientes (com média de idade de 5,3 anos; variando de 3,6 a 7,6 anos no momento da cirurgia inicial), portadores de mielomeningocele torácica que apresentavam escoliose, medida pelo método de Cobb, superior a 40º e cifose superior a 80º, tratados com VEPTR pelo grupo de Escoliose da AACD de São Paulo. Foram analisados os pesos, desvio-padrão em que cada paciente se encontrava na tabela idade versus peso referência da OMS e valores angulares da cifose, no pré-operatório, pós-operatório imediato e pós-operatório tardio. RESULTADOS: Houve ganho absoluto de peso em todos os pacientes, com média de 8,7 kg (variando de 3 a 20 kg). Seis pacientes (75%) apresentaram ganho de peso e aumento do valor do desvio padrão, traduzindo-se em aproximação de seu peso com relação à mediana considerada normal da curva idade versus peso referência após o início do tratamento com VEPTR. CONCLUSÃO: O ganho de peso absoluto observado não foi acompanhado de melhora do estado nutricional e não houve relação entre correção da cifose e ganho de peso.OBJETIVO: Evaluar la ganancia de peso y el cambio en el estado nutricional de los pacientes con mielomeningocele torácico después de usar la prótesis vertical expandible de titanio (VEPTR) como una opción para el tratamiento sin la fusión de la columna vertebral. MÉTODOS: Estudio retrospectivo de ocho pacientes (edad media de 5,3 años, entre 3,6 y 7,6 años en el momento de la cirugía inicial), con mielomeningocele torácico que tenían escoliosis , medida por el método de Cobb, con valores superiores a 40 º y cifosis mayores de 80 º, tratados con VEPTR en el Grupo de Escoliosis de la AACD en São Paulo. Se analizaron los pesos, las desviaciones estándar, en el que cada paciente se encontraba en la edad en comparación con tabla de edad versus peso de los valores de referencia de la OMS y también la cifosis angular en el preoperatorio y postoperatorio inmediato y tardío. RESULTADOS: Hubo un aumento de peso absoluto en todos los pacientes con una media de 8,7 kg. (rango 30-20 Kg.). Seis pacientes (75%) tuvieron un aumento de peso seguida de un aumento en el valor de la desviación estándar acercarse a la mediana de la curva edad versus peso referencia después del inicio del tratamiento con VEPTR . CONCLUSIÓN: La ganancia de peso absoluto observada no fue acompañada por mejora del estado nutricional y no había ninguna relación entre la corrección de la cifosis y aumento de peso.OBJECTIVE: To evaluate weight gain and change in nutritional status of patients with thoracic myelomeningocele after using the vertical expandable prosthetic titanium rib (VEPTR) as an option for treatment of the spine without fusion. METHODS: We conducted a retrospective study including eight patients (mean age of 5.3 years, ranging from 3.6 to 7.6 years at the time of initial surgery), with thoracic myelomeningocele presenting with scoliosis higher than 40º and kyphosis greater than 80º, measured by the Cobb method. All patients were surgically treated with VEPTR by the Scoliosis Group of the AACD in São Paulo. We analyzed patient weights and nutritional status by comparing the standard deviations in weight for age groups based on the WHO reference chart. We also analyzed the angular kyphosis at preoperative, and immediate and late post-operative periods. RESULTS: There was an absolute weight gain in all patients with a mean gain of 8.7 kg (range 3 to 20 kg). Six patients (75%) gained weight and had increased value of the standard deviation, resulting in approximation of their weight in relation to the median considered normal weight versus age reference curve after starting treatment with VEPTR. CONCLUSION: The observed absolute weight gain was not accompanied by an improvement of nutritional status and there was no relationship between kyphosis correction and weight gain.

The optimal surgical management of pancreatic neuroendocrine tumors in patients with multiple endocrine neoplasia type 1 is controversial. This study sought to compare clinicopathologic characteristics and outcomes of multiple endocrine neoplasia type 1–associated and sporadic pancreatic neuroendocrine tumors from a large multi-national database. A multi-institutional, international database of patients with surgically resected pancreatic neuroendocrine tumors was analyzed. The cohort was divided into 2 groups: those with multiple endocrine neoplasia type 1 versus those with sporadic disease. Clinicopathologic comparisons were made. Overall and disease-free survival were analyzed. Propensity score matching was used to reduce bias. Of 651 patients included, 45 (6.9%) had multiple endocrine neoplasia type 1 and 606 sporadic pancreatic neuroendocrine tumors. Multiple endocrine neoplasia type 1–associated pancreatic neuroendocrine tumors were more common in younger patients and associated with multifocal disease at the time of surgery and higher T-stage. Lymph node involvement and the presence of metastasis were similar. Total pancreatectomy rate was 5-fold higher in the multiple endocrine neoplasia type 1 cohort. Median survival did not differ (disease-free survival 126 months multiple endocrine neoplasia type 1 vs 198 months sporadic, P >.5). After matching, survival remained similar (overall survival not reached in either cohort, disease-free survival 126 months multiple endocrine neoplasia type 1 vs 198 months sporadic, P >.5). Equivalence in overall survival and disease-free survival persisted even when patients who underwent subtotal and total pancreatectomy were excluded. Multiple endocrine neoplasia type 1–associated pancreatic neuroendocrine tumors are more common in younger patients and are associated with multifocality and higher T-stage. Survival for patients with multiple endocrine neoplasia type 1–associated pancreatic neuroendocrine tumors is comparable to those with sporadic pancreatic neuroendocrine tumors, even in the absence of radical pancreatectomy. Consideration should be given to parenchymal-sparing surgery to preserve pancreatic function. [Display omitted] [ABSTRACT FROM AUTHOR]

Distal cholangiocarcinoma (dCC) is still associated with a poor overall survival (OS). This study aims to investigate the impact of novel prognostic scores in comparison with more traditional ones. Multicentric retrospective analysis of patients who underwent a pancreatoduodenectomy (PD) for dCC. An unadjusted analysis was used to identify predictors of decreased survival. Significant variables were introduced in a multivariable model that assessed OS, recurrence-free survival (RFS), early recurrence (defined as a recurrence within the first 12 months from the PD), local and distant recurrence. Prognostic scores evaluated included the TNM staging system, the lymph-node ratio (LNR), the platelet-lymphocyte ratio (PLR), the neutrophil-lymphocyte ratio (NLR) and the systemic inflammation index (SII). The study included 232 patients with resected dCC. The optimal cut-off value for LNR was 15% (LNR15). On the unadjusted analysis T stage (p = 0.012), N stage (p < 0.001), LNR15 (p < 0.001), grade (p < 0.001), perineural invasion (p < 0.001) and the R1 status of resection margin (p = 0.001) accounted for the decreased OS. No significant association between survival and PLR, NLR and SII were found. On the multivariable analysis only LNR15, perineural invasion and R1 were independent predictors of decreased RFS (p = 0.003, p = 0.021 and p = 0.009, respectively) and OS (p = 0.001, p = 0.016 and p = 0.013, respectively). Additionally, LNR15 was an independent predictor of early recurrence (p = 0.003) and both LNR15 and R1 were associated with increased local (p < 0.001 and p = 0.010) and distant recurrence (p < 0.001 and p = 0.003). LNR15 is an independent predictor of DFS, OS, early, local and distal recurrence, combined with the status of the resection margin and perineural invasion. [ABSTRACT FROM AUTHOR]

• The tumor stroma plays a key role in determining the strength of anti-tumor immunity. • The NK cells/DCs axis should be considered when exploring new immunotherapeutic strategies. • Cytokines, chemokines and certain metabolites are the major CAF-derived immunosuppressive factors against NK cells and DCs. • Combination therapies targeting stromal immunosuppression of NK cells and DCs with ICIs are a promising approach. Natural killer (NK) cells and dendritic cells (DCs) are critical mediators of anti-cancer immune responses. In addition to their individual roles, NK cells and DCs are involved in intercellular crosstalk which is essential for the initiation and coordination of adaptive immunity against cancer. However, NK cell and DC activity is often compromised in the tumor microenvironment (TME). Recently, much attention has been paid to one of the major components of the TME, the cancer-associated fibroblasts (CAFs), which not only contribute to extracellular matrix (ECM) deposition and tumor progression but also suppress immune cell functions. It is now well established that CAFs support T cell exclusion from tumor nests and regulate their cytotoxic activity. In contrast, little is currently known about their interaction with NK cells, and DCs. In this review, we describe the interaction of CAFs with NK cells and DCs, by secreting and expressing various mediators in the TME of adult solid tumors. We also provide a detailed overview of ongoing clinical studies evaluating the targeting of stromal factors alone or in combination with immunotherapy based on immune checkpoint inhibitors. Finally, we discuss currently available strategies for the selective depletion of detrimental CAFs and for a better understanding of their interaction with NK cells and DCs. [ABSTRACT FROM AUTHOR]

Whereas the usefulness of radiofrequency (RF) energy as haemostatic method in liver surgery has become well established in the last decades, its intentional application on resection margins with the aim of reducing local recurrence is still debatable. Our goal was to compare the impact of an additional application of RF energy on the top of the resection surface, namely additional margin coagulation (AMC), on local recurrence (LR) when subjected to a subcentimeter margin. We retrospectively analyzed 185 patients out of a whole cohort of 283 patients who underwent radical hepatic resection with subcentimetric margin. After propensity score adjustment, patients were classified into two balanced groups according to whether RF was applied or not. No significant differences were observed within groups in baseline characteristics after PSM adjustment. The LR rate was significantly higher in the Control than AMC Group: 12 patients (14.5%) vs. 4 patients (4.8%) (p = 0.039). The estimated 1, 3, and 5-year LR-free survival rates of patients in the Control and AMC Group were: 93.5%, 86.0%, 81.0% and 98.8%, 97.2%, 91.9%, respectively (p = 0.049). Univariate Cox analyses indicated that the use of the RF applicator was significantly associated with lower LR (HR = 0.29, 95% confidence interval 0.093–0.906, p = 0.033). The Control Group showed smaller coagulation widths than the AMC group (p < 0.001). An additional application of RF on the top of the resection surface is associated with less local hepatic recurrence than the use of conventional techniques. [ABSTRACT FROM AUTHOR]

This systematic review and meta-analysis aimed to confirm the prognostic value of lymph node ratio (LNR), and determine an optimal LNR cut-off for overall survival (OS) in patients with distal cholangiocarcinoma (DCC) undergoing curative surgery. We additionally aimed to provide a consolidated review of current evidence regarding prognostic significance of positive lymph node count (PLNC) and total lymph node count (TLNC). A systematic search of PubMed, EMBASE and Cochrane Library was conducted from inception to October 2020. Studies were included into meta-analysis if there was histological diagnosis, curative surgery, restriction to DCC and relevant LNR results. Quality assessment was performed using the Newcastle Ottawa Scale. Findings for 1228 patients were pooled across 6 studies. Meta-analysis delineated a dose-effect gradient in which higher LNR cut-offs correlated with larger pooled hazard ratios: 00.2 (HR 3.26; 95% CI 2.07–5.13; p < 0.00001) and LNR>0.4 (HR 3.59; 95% CI 2.31–5.58; p < 0.00001) when compared against a control group of LNR = 0. LNR of 0.2 (HR 2.12; 95% CI: 1.57–2.86; p < 0.0001) was found to be a significant and ideal cut-off for prognostication of poorer OS. A review of current literature reveals an ongoing debate regarding the comparative prognostic value of differing PLNC cut-offs (0/1/3 versus 0/1/4). TLNC of 10–13 is widely reported to be the minimum necessary to ensure improved long term outcomes. PLNC and LNR are strong prognostic factors for OS in DCC. An ideal LNR cut-off of 0.2 is most significantly associated with poorer OS. • Lymph node status has strong prognostic value in distal cholangiocarcinoma • Higher lymph node ratio (LNR) cut-offs are associated with poorer survival (OS) • LNR cut-off of 0.2 is significant and most ideal for prognostication of poorer OS • Total lymph node count of 10–13 is necessary to ensure improved long term outcomes • An optimal positive lymph node count cut-off (0/1/3 vs. 0/1/4) is an ongoing debate [ABSTRACT FROM AUTHOR]

BACKGROUND: In patients with COPD, limited data have been reported concerning the association between dyspnea perception and exercise tests. Moreover, the perception of dyspnea has not been analyzed in patients with the same severity of air-flow obstruction. The aim of our study was to evaluate the relationship between the degree of dyspnea and exercise capacity in subjects with COPD who had the same severity of air-flow obstruction. METHODS: We assessed dyspnea perception and maximum exercise capacity by using the modified Medical Research Council dyspnea scale (mMRC) questionnaire and by using the symptom-limited incremental cardiopulmonary exercise test, respectively. A propensity score matching was used to obtain the balance between the subjects with COPD and with an mMRC questionnaire score <2 and >2 (mMRC score) according to the severity of air-flow obstruction. RESULTS: A total of 249 ambulatory adult patients with stable COPD (mean age, 68 y) were considered in the full cohort. After propensity score analysis, 160 subjects (65% men; mean ± SD FEV1, 47.5 ± 12.8% of predicted) were included in our study cohort. The subjects with an mMRC questionnaire score ≥2 in comparison with those with an mMRC questionnaire score <2 showed lower values in oxygen uptake at peak (V... max) (P = .002) and in maximum work load (P < .001). In the regression models, the mMRC questionnaire score was able to predict oxygen uptake at peak (P < .001) and at maximum work load (P < .001). CONCLUSIONS: In subjects with COPD and with the same severity of air-flow obstruction, a high score in dyspnea was related to a poor maximum exercise capacity. Our results support the view that, in COPD, the severity of air-flow obstruction was less informative than symptoms in the combined assessment of the disease. [ABSTRACT FROM AUTHOR]