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The main aim is to compare oncological outcomes and patterns of recurrence of patients with early-stage endometrioid endometrial cancer according to lymphovascular space invasion (LVSI) status. The secondary objective is to determine preoperative predictors of LVSI. We performed a multicenter retrospective cohort study. A total of 3546 women diagnosed with postoperative early-stage (FIGO I-II, 2009) endometrioid endometrial cancer were included. Co-primary endpoints were disease-free survival (DFS), overall survival (OS), and pattern of recurrence. Cox proportional hazard models were used for time-to-event analysis. Univariate and multivariate logistical regression models were employed. Positive LVSI was identified in 528 patients (14.6%) and was an independent prognostic factor for DFS (HR 1.8), OS (HR 2.1) and distant recurrences (HR 2.37). Distant recurrences were more frequent in patients with positive LVSI (78.2% vs. 61.3%, p < 0.01). Deep myometrial invasion (OR 3.04), high-grade tumors (OR 2.54), cervical stroma invasion (OR 2.01), and tumor diameter ≥ 2 cm (OR 2.03) were independent predictors of LVSI. In conclusion, in these patients, LVSI is an independent risk factor for shorter DFS and OS, and distant recurrence, but not for local recurrence. Deep myometrial invasion, cervical stroma invasion, high-grade tumors, and a tumor diameter ≥ 2 cm are independent predictors of LVSI.

Objective Based on the SUCCOR study database, our primary objective was to identify the independent clinical pathological variables associated with the risk of relapse in patients with stage IB1 cervical cancer who underwent a radical hysterectomy. Our secondary goal was to design and validate a risk predictive index (RPI) for classifying patients depending on the risk of recurrence. Methods Overall, 1116 women were included from January 2013 to December 2014. We randomly divided our sample into two cohorts: discovery and validation cohorts. The test group was used to identify the independent variables associated with relapse, and with these variables, we designed our RPI. The index was applied to calculate a relapse risk score for each participant in the validation group. Results A previous cone biopsy was the most significant independent variable that lowered the rate of relapse (odds ratio [OR] 0.31, 95% confidence interval [CI] 0.17–0.60). Additionally, patients with a tumor diameter >2 cm on preoperative imaging assessment (OR 2.15, 95% CI 1.33–3.5) and operated by the minimally invasive approach (OR 1.61, 95% CI 1.00–2.57) were more likely to have a recurrence. Based on these findings, patients in the validation cohort were classified according to the RPI of low, medium, or high risk of relapse, with rates of 3.4%, 9.8%, and 21.3% observed in each group, respectively. With a median follow-up of 58 months, the 5-year disease-free survival rates were 97.2% for the low-risk group, 88.0% for the medium-risk group, and 80.5% for the high-risk group (p < 0.001). Conclusion Previous conization to radical hysterectomy was the most powerful protective variable of relapse. Our risk predictor index was validated to identify patients at risk of recurrence.

This study aimed to review the current knowledge on the utility of intraoperative fluorescence imaging in gynecologic surgery and to give evidence-based recommendations to improve the quality of care for women who undergo gynecologic surgery. A computer-based systematic review of the MEDLINE, CENTRAL, Pubmed, EMBASE, and SciSearch databases as well as institutional guidelines was performed. The time limit was set at 2000–2019. For the literature search, PRISMA guidelines were followed. A modified-Delphi method was performed in three rounds by a panel of experts to reach a consensus of conclusions and recommendations. Indocyanine green (ICG) is used primarily in gynecology for sentinel node-mapping. In endometrial and cervical cancer, ICG is a feasible, safe, time-efficient, and reliable method for lymphatic mapping, with better bilateral detection rates. Experience in vulvar cancer is more limited, with ICG used together with Tc-99 m as a dual tracer and alone in video endoscopic inguinal lymphadenectomy. In early ovarian cancer, results are still preliminary but promising. Indocyanine green fluorescence imaging also is used for ureteral assessment, allowing intraoperative ureteral visualization, to reduce the risk of ureteral injury during gynecologic surgery. For most gynecologic cancers, ICG fluorescence imaging is considered the tracer of choice for lymphatic mapping. The use of this new technology expands to a better ureteral assessment.

The objective of this study was to evaluate the efficacy of one-step nucleic acid amplification (OSNA) for the detection of sentinel lymph node (SLN) metastasis compared to standard pathological ultrastaging in patients with early-stage endometrial cancer (EC). A total of 526 SLNs from 191 patients with EC were included in the study. 379 SLNs (147 patients) were evaluated by both methods, OSNA and standard pathological ultrastaging. The central 1-mm portion of each lymph node was subjected to semi-serial sectioning at 200-μm intervals and examined by hematoxylin-eosin and immunohistochemistry with CK19; the remaining tissue was analysed by OSNA for CK19 mRNA. The OSNA assay detected metastases in 19.7% of patients (14.9% micrometastasis and 4.8% macrometastasis), whereas pathological ultrastaging detected metastasis in 8.8% of patients (3.4% micrometastasis and 5.4% macrometastasis). Using the established cut-off value for detecting SLN metastasis by OSNA in EC (250 copies/μl), the sensitivity of the OSNA assay was 92%; specificity was 82%; diagnostic accuracy was 83%, and the negative predictive value was 99%. Discordant results between both methods were recorded in 20 patients (13.6%). OSNA resulted in an upstaging in 12 patients (8.2%). OSNA could aid in the identification of patients requiring adjuvant treatment at the time of diagnosis.

Gastrointestinal tract duplications are rare congenital malformations that can affect any segment of the digestive tract. They usually occur in the first two years of life with symptoms of poor weight gain and palpable abdominal mass or may be asymptomatic until adulthood. We report the case of a 37-year-old male patient who was evaluated for epigastralgia and a history of upper gastrointestinal bleeding. High endoscopy revealed ulcerated subepithelial lesion in gastric fundus with diagnostic suspicion of gastrointestinal stromal tumor (GIST). Endoscopic ultrasound confirmed gastric mass with foci of necrosis and calcification, compatible with stromal tumor type GIST. Distal gastric resection was performed in wedge without complications. The pathology report noted gastric duplication.

The objective of this study was to evaluate the efficacy of one-step nucleic acid amplification (OSNA) for the detection of sentinel lymph node (SLN) metastasis compared to standard pathological ultrastaging in patients with early-stage endometrial cancer (EC). A total of 526 SLNs from 191 patients with EC were included in the study, and 379 SLNs (147 patients) were evaluated by both methods, OSNA and standard pathological ultrastaging. The central 1 mm portion of each lymph node was subjected to semi-serial sectioning at 200 μm intervals and examined by hematoxylin–eosin and immunohistochemistry with CK19; the remaining tissue was analyzed by OSNA for CK19 mRNA. The OSNA assay detected metastases in 19.7% of patients (14.9% micrometastasis and 4.8% macrometastasis), whereas pathological ultrastaging detected metastasis in 8.8% of patients (3.4% micrometastasis and 5.4% macrometastasis). Using the established cut-off value for detecting SLN metastasis by OSNA in EC (250 copies/μL), the sensitivity of the OSNA assay was 92%, specificity was 82%, diagnostic accuracy was 83%, and the negative predictive value was 99%. Discordant results between both methods were recorded in 20 patients (13.6%). OSNA resulted in an upstaging in 12 patients (8.2%). OSNA could aid in the identification of patients requiring adjuvant treatment at the time of diagnosis., El objetivo de este estudio fue evaluar la eficacia de la amplificación de ácido nucleico en un solo paso (OSNA) para la detección de metástasis en el ganglio linfático centinela (GC) en comparación con la ultraestadificación patológica estándar en pacientes con cáncer de endometrio (CE) en estadio temprano. Se incluyeron en el estudio un total de 526 SLN de 191 pacientes con EC, y 379 SLN (147 pacientes) fueron evaluados por ambos métodos, OSNA y ultraestadificación patológica estándar. La porción central de 1 mm de cada ganglio linfático se sometió a un seccionamiento semiserie a intervalos de 200 μm y se examinó mediante hematoxilina-eosina e inmunohistoquímica con CK19; el tejido restante fue analizado por OSNA para ARNm de CK19. El ensayo OSNA detectó metástasis en el 19,7 % de los pacientes (14,9 % micrometástasis y 4,8 % macrometástasis), mientras que la ultraestadificación patológica detectó metástasis en el 8,8 % de los pacientes (3. 4% micrometástasis y 5,4% macrometástasis). Usando el valor de corte establecido para detectar metástasis SLN por OSNA en EC (250 copias/μL), la sensibilidad del ensayo OSNA fue del 92 %, la especificidad fue del 82 %, la precisión diagnóstica fue del 83 % y el valor predictivo negativo fue del 99 % Se registraron resultados discordantes entre ambos métodos en 20 pacientes (13,6%). OSNA resultó en una sobreestadificación en 12 pacientes (8,2%). OSNA podría ayudar en la identificación de pacientes que requieren tratamiento adyuvante en el momento del diagnóstico. Se registraron resultados discordantes entre ambos métodos en 20 pacientes (13,6%). OSNA resultó en una sobreestadificación en 12 pacientes (8,2%). OSNA podría ayudar en la identificación de pacientes que requieren tratamiento adyuvante en el momento del diagnóstico. Se registraron resultados discordantes entre ambos métodos en 20 pacientes (13,6%). OSNA resultó en una sobreestadificación en 12 pacientes (8,2%). OSNA podría ayudar en la identificación de pacientes que requieren tratamiento adyuvante en el momento del diagnóstico.

Las duplicaciones del tracto gastrointestinal son malformaciones congénitas poco frecuentes que pueden afectar cualquier segmento del tubo digestivo. Suelen presentarse en los primeros dos años de vida con síntomas de pobre ganancia de peso y masa abdominal palpable o pueden ser asintomáticos hasta la adultez. Reportamos el caso de un paciente masculino de 37 años que fue evaluado por epigastralgia y antecedente de hemorragia digestiva superior. La endoscopia alta reveló lesión subepitelial en fundus gástrico ulcerada con sospecha diagnóstica de tumor del estroma gastrointestinal (GIST). El ultrasonido endoscópico confirmó masa gástrica con focos de necrosis y calcificación, compatible con tumor estromal . Se realizó resección gástrica distal en cuña sin complicaciones. El informe de patología señaló duplicación gástrica.

We present an alternating forward–backward splitting method for solving linearly constrained structured optimization problems. The algorithm takes advantage of the separable structure and possibly asymmetric regularity properties of the objective functions involved. We also describe some applications to the study of non-Newtonian fluids and image reconstruction problems. We conclude with a numerical example, and its comparison with Condat’s algorithm. An acceleration heuristic is also briefly outlined.

SUCCOR study: an international European cohort observational study comparing minimally invasive surgery versus open abdominal radical hysterectomy in patients with stage IB1 cervical cancer FREE http://orcid.org/0000-0002-1908-3251Luis Chiva1, Vanna Zanagnolo2, Denis Querleu3, Nerea Martin- Calvo4, Juan Arévalo-Serrano5, Mihai Emil Căpîlna6, Anna Fagotti7, Ali Kucukmetin8, Constantijne Mom9, Galina Chakalova10, Shamistan Aliyev11, Mario Malzoni12, http://orcid.org/0000- 0001-5809-3535Fabrice Narducci13, Octavio Arencibia14, Francesco Raspagliesi15, Tayfun Toptas16, David Cibula17, Dilyara Kaidarova18, http://orcid.org/0000-0001-6763-9720Mehmet Mutlu Meydanli19, Mariana Tavares20, Dmytro Golub21, http://orcid.org/0000-0003-3140-4772Anna Myriam Perrone22, Robert Poka23, Dimitrios Tsolakidis24, Goran Vujić25, http://orcid.org/0000-0001-8935- 0311Marcin A Jedryka26, Petra L M Zusterzeel27, Jogchum Jan Beltman28, Frederic Goffin29, Dimitrios Haidopoulos30, Herman Haller31, Robert Jach32, Iryna Yezhova33, Igor Berlev34, Margarida Bernardino35, Rasiah Bharathan36, Maximilian Lanner37, Minna M Maenpaa38, http://orcid.org/0000-0002-4403-3707Vladyslav Sukhin39, Jean-Guillaume Feron40, Robert Fruscio41, 42, Kersti Kukk43, Jordi Ponce44, Jose Angel Minguez45, http://orcid.org/0000-0002-9618- 5606Daniel Vázquez-Vicente45, Teresa Castellanos45, Enrique Chacon46 and http://orcid.org/0000-0002-9700-0853Juan Luis Alcazar47 On behalf of the SUCCOR study Group Author affiliations Abstract Background Minimally invasive surgery in cervical cancer has demonstrated in recent publications worse outcomes than open surgery. The primary objective of the SUCCOR study, a European, multicenter, retrospective, observational cohort study was to evaluate disease-free survival in patients with stage IB1 (FIGO 2009) cervical cancer undergoing open vs minimally invasive radical hysterectomy. As a secondary objective, we aimed to investigate the association between protective surgical maneuvers and the risk of relapse. Methods We obtained data from 1272 patients that underwent a radical hysterectomy by open or minimally invasive surgery for stage IB1 cervical cancer (FIGO 2009) from January 2013 to December 2014. After applying all the inclusion-exclusion criteria, we used an inverse probability weighting to construct a weighted cohort of 693 patients to compare outcomes (minimally invasive surgery vs open). The first endpoint compared disease-free survival at 4.5 years in both groups. Secondary endpoints compared overall survival among groups and the impact of the use of a uterine manipulator and protective closure of the colpotomy over the tumor in the minimally invasive surgery group. Results Mean age was 48.3 years (range ; 23–83) while the mean BMI was 25.7 kg/m2 (range ; 15–49). The risk of recurrence for patients who underwent minimally invasive surgery was twice as high as that in the open surgery group (HR, 2.07 ; 95% CI, 1.35 to 3.15 ; P=0.001). Similarly, the risk of death was 2.42-times higher than in the open surgery group (HR, 2.45 ; 95% CI, 1.30 to 4.60, P=0.005). Patients that underwent minimally invasive surgery using a uterine manipulator had a 2.76-times higher hazard of relapse (HR, 2.76 ; 95% CI, 1.75 to 4.33 ; P

La artritis infecciosa es una urgencia medica de cuyo rapido diagnostico depende el pronostico a corto y medio plazo del estado general del paciente y de la funcionalidad final de la articulacion. La articulacion esternoclavicular es una region de baja prevalencia de este tipo de artritis, aunque su frecuencia se suele concentrar en pacientes inmunosuprimidos, usuarios de drogas parenterales o tras procedimientos traumaticos. Presentamos una serie de 5 casos microbiologicamente documentados de artritis infecciosa esternoclavicular, 3 de los cuales se presentaron en pacientes inmunocompetentes, y una revision de esta peculiar enfermedad

Resumen El proposito del presente estudio es determinar la tasa de complicaciones por sangrado en pacientes anticoagulados con acenocumarol en funcion del indice normalizado internacional (INR) de coagulacion. Se realizo un estudio retrospectivo con 901 registros de pacientes a quienes se les practico una artrocentesis o infiltracion articular entre 2009 y 2013, se agruparon los registros en funcion de tener un INR superior o inferior a 2,0 (268 y 633 registros, respectivamente) y se compararon las tasas de complicaciones por sangrado. Se observo una tasa de 0,37% de complicaciones por sangrado tempranas (

Infectious arthritis is a medical emergency whose prognosis, in terms of general morbidity and the final functionality of the joint, depends on rapid diagnosis and treatment. The sternoclavicular joint is an area of low prevalence of this type of arthritis, although its frequency is often concentrated in immunosuppressed patients, users of parenteral drugs or after traumatic events. We present a series of 5 microbiologically documented cases of sternoclavicular septic arthritis, 3 of which occurred in immunocompetent patients, and a short review of this pathology.

The purpose of this study is to determine the rate of bleeding complications in patient's anticoagulated with acenocoumarol according to the international normalized ratio (INR) coagulation index. A cross-sectional study was performed with 901 charts of patients who underwent arthrocentesis or joint infiltration between 2009 and 2013; the charts were grouped on the basis of having an INR higher or lower than 2.0 (268 and 633, respectively). Comparisons were performed in terms of rates of early or late bleeding complications. A 0.37% rate of early bleeding complications (< 24hours) was observed in the group of patients with INR

Este trabalho apresenta o estudo multiescala dos lineamentos estruturais que afetam as rochas alcalinas associadas ao Domo de Lages, situado na borda Leste da Bacia do Paraná, em Santa Catarina. Foram analisadas imagens de satélite (Landsat-TM) e do projeto Shuttle Radar Topography Mission (SRTM) e realizados estudos estruturais em pedreiras de rochas alcalinas do domo. Os resultados obtidos mostram correlação entre os fotolineamentos extraídos das imagens e as falhas analisadas nas pedreiras, com destaque para as direções N-S (NNE a NNW) e E-W (ENE a ESE) e, secundariamente, NE e NW. Estas estruturas são relacionadas, em grande parte, com a reativação de descontinuidades do embasamento. As duas primeiras direções correspondem a falhas transcorrentes destral e sinistral, respectivamente. A formação destas estruturas é compatível com um campo de tensão σ1 orientado NE-SW, cuja idade situa-se entre Eocretáceo e o Terciário.

Este trabalho tem como objetivo discutir a evolução tectônica meso-cenozóica do Domo de Lages, SC, envolvendo análise das estruturas rúpteis que afetam as rochas da região, análise morfométrica e da rede de drenagem e aspectos geomorfológicos relevantes. O Domo de Lages, localizado na borda leste da Bacia do Paraná, na porção sul do estado de Santa Catarina, é caracterizado pela ocorrência de uma grande variedade de rochas alcalinas de idade neo-cretácea. Estas rochas afloram na forma de sills e diques e são intrusivas no pacote sedimentar da Bacia do Paraná, causando-lhe um soerguimento da ordem de centenas a milhares de metros. As rochas alcalinas foram afetadas por estruturas rúpteis, particularmente falhas transcorrentes e normais, denotando a presença de uma tectônica ativa durante o cenozóico. Para o entendimento do quadro evolutivo do domo, além da análise estrutural, foram elaborados diversos mapas morfométricos (hipsométrico, declividades, orientação de vertentes, superfícies de base, rugosidade, gradiente hidráulico e densidade de lineamentos e drenagens) derivados diretamente do Modelo Digital de Elevação, que por sua vez foi obtido pelo tratamento de dados SRTM (Shuttle Radar Topographic Mission) da Agência Espacial Americana (NASA). O trabalho foi complementado com a análise da rede de drenagem e de lineamentos extraídos de imagens, juntamente com a elaboração de perfis topográficos. Os resultados mostram tratar-se de uma estrutura dômica alongada com eixo maior orientado na direção NW-SE, marcada pelo alinhamento de intrusões alcalinas e basculamento dos acamamentos das rochas sedimentares que apresentam mergulho radial para fora da estrutura. A análise do relevo revelou a existência de uma superfície de aplainamento, hoje preservada na cota de 1200 m, que teria sido afetada por falhas normais de direções NW-SE e NE-SW. O modelo tectônico evolutivo elaborado para a região contempla a seguinte seqüência de eventos: atuação de esforços compressivos NE-SW no final do cretáceo, gerando falhas normais NE-SW, que afetam as rochas básicas da Formação Serra Geral e condicionam a colocação de diques alcalinos e a estruturação do domo; geração de falhas transcorrentes destrais que afetam todas as rochas da região, incluindo as rochas alcalinas, com binário orientado na direção NNE-SSW; configuração de uma superfície de aplainamento preservada na cota de 1200m, que perdurou, provavelmente, até o mioceno; distensão NE-SW e geração de falhas normais NW-SE que abatem e basculam a superfície aplainada e reorganizam a rede de drenagens; instalação de um provável evento distensivo NW-SE, responsável pela formação de falhas normais NE-SW, marcadas principalmente nos mapas morfométricos. This study was focused on the meso-cenozoic tectonic evolution of the Domo de Lages region (south Santa Catarina State, Southern Brazil), through the analysis of brittle structures affecting sedimentary and igneous rocks, morphometric parameters, drainage network and main geomorphological features. Located in the border of the Paraná sedimentary basin, the Domo de Lages is characterized by a great variety of Late Cretacic alkaline rocks, which crops out as sills and dikes cutting the Paleozoic sedimentary rocks, and are associated with an uplift of hundreds to thousands of meters. These alkaline rocks are affected by brittle structures, mainly transcurrent and normal faults, indicative of Cenozoic active tectonics. In addition to the structural analysis, several morphometric maps were developed, as an aid to enlighten the evolutionary history of the region. Maps of hypsometry, slope, aspect, isobase surfaces, surface roughness, hydraulic gradient, lineament density and drainage density were derived from SRTM (Shuttle Radar Topographic Mission) Digital Elevation Models provided by NASA, and were complemented by topographic profiles, analysis of drainage network and lineament orientation. Results show that the dome has a elongated shape with major axis oriented NW-SE, defined by alignment of intrusive bodies and tilting of sedimentary rocks bedding planes, dipping radially outwards the center of the structure. Topographic analysis revealed the existence of a planation surface, preserved at 1200m a.s.l., wich would have been affected by NW-SE and NE-SW normal faults. A tectonic evolutionary model for the region was elaborated, according the following sequence of events: in the end of Cretaceous, a compressive NE stress generates NE-SW normal faults, which affect the basic rocks of Serra Geral Formation and controls the emplacement of alkaline dikes and the uplift of the domic structure; formation of transcurrent dextral faults affecting all rocks of the area, including the alkalines, with NNE-SSW oriented binary; development of a planation surface preserved at 1200m a.s.l. which remained probably until the Miocene; NE-SW extension, creating NW-SE normal faults that lowered and tilted the levelled surface and affected the drainage network; a last extensive NW-SE event probably happened, responsible for NE-SW normal faults seen mainly in the morphometric maps.

The memory performance of 22 Multiple Sclerosis (MS) subjects and their matched controls was compared on three tasks: a perceptual memory test, a picture recognition test and a verbal recognition test. Results showed that perceptual memory does not suffer as a consequence of MS. Moreover, MS subjects are as sensitive as controls to deep semantic encoding of individual items in a picture recognition task. However, for a verbal recognition task, where a semantic encoding strategy was optional, MS subjects were less likely to report use of a strategy. Those MS subjects who did use a strategy, did more poorly on memory for verbal information than controls. The results suggest a specific inter-item semantic encoding problem in MS.