Gestação de Substituição em Portugal: Orientações para a prática clínica

Introdução: A aprovação na Assembleia da República, em dezembro de 2021, da lei aplicável à Gestação de Substituição, suscita a reflexão acerca dos aspetos práticos em que o regime se concretizará e das orientações necessárias para os profissionais de saúde envolvidos. Por esse motivo, foram definidos como objetivos: analisar um conjunto de recomendações para a prática clínica no âmbito da Gestação de Substituição em países com experiência no procedimento e promover uma discussão com peritos na área da Procriação Medicamente Assistida. Material e Métodos: Foi realizada uma análise documental das publicações e documentos oficiais sobre o tema que serviu de base para o estudo de desenho qualitativo baseado em grupos focais com diferentes profissionais -médicos e psicólogos- com experiência em Procriação Medicamente Assistida. A discussão foi concretizada através de sessões via Zoom®, realizadas separadamente com os dois grupos focais. Resultados: Na discussão os peritos fizeram as suas apreciações e propostas de melhoria em relação à versão inicial do documento resultante da análise documental. Conclusão: Obteve-se uma versão consolidada do conjunto de orientações para os profissionais de saúde com as dimensões a avaliar e acompanhar junto da gestante e parte beneficiária na Gestação de Substituição.

Introducción : La aprobación por el Parlamento portugués, en diciembre de 2021, de la ley aplicable a la Gestación Subrogada, plantea la reflexión sobre los aspectos prácticos en los que se implementará el esquema y las directrices necesarias para los profesionales de la salud involucrados. Por este motivo, se definieron los siguientes objetivos: analizar un conjunto de recomendaciones para la práctica clínica en el ámbito de la gestación subrogada en países con experiencia en el procedimiento y promover un debate con expertos en el campo de la Reproducción Médicamente Asistida. Material y Métodos : Se realizó un análisis documental de publicaciones y documentos oficiales sobre el tema, que sirvió de base para el estudio de diseño cualitativo basado en focus group con diferentes profesionales -médicos y psicólogos- con experiencia en Reproducción Médicamente Asistida. La discusión se realizó a través de sesiones via Zoom®, celebradas por separado con los dos focus group. Resultados : En la discusión, los expertos realizaron sus apreciaciones y propuestas de mejora respecto a la versión inicial del documento resultante del análisis documental. Conclusión : Se obtuvo una versión consolidada del conjunto de directrices para los profesionales de la salud con las dimensiones para evaluar y dar seguimiento a la madre sustituta y a los beneficiarios en la Gestación Subrogada.

Introduction: The approval by the Portuguese Parliament, in December 2021, of the law applicable to Surrogate Pregnancy, raises reflection on the practical aspects in which the scheme will be implemented and the necessary guidelines for health professionals involved. For this reason, the following objectives were defined: to analyze a set of recommendations for clinical practice in surrogacy in countries with experience in the procedure and to promote a discussion with experts in Medically Assisted Reproduction. Material and Methods: A documental analysis of publications and official documents on the theme was conducted. This served as a basis for the qualitative design study based on focus groups with different professionals -physicians, and psychologists- with experience in Medically Assisted Reproduction. The discussion was realized through sessions via Zoom®, held separately with the two focus groups. Results : In the debate, the experts made their appreciation and proposals for improvement concerning the initial version of the document resulting from the document analysis. Conclusion : A consolidated version of the set of guidelines for health professionals was obtained with the dimensions to evaluate and follow up with the surrogate and beneficiaries in Surrogacy.

Resultados del aislamiento eléctrico de las venas pulmonares en pacientes menores y mayores de 70 años / Outcomes of pulmonary vein electrical isolation in patients younger than and older than 70 years

Resumen Introducción y objetivos: Comparar las características clínicas y los resultados de cohortes contemporáneas de pacientes menores y mayores de 70 años que han sido sometidos a ablación de fibrilación auricular (FA) mediante catéter. Métodos: Se llevó a cabo un estudio de cohortes retrospectivo en pacientes sometidos a ablación con catéter debido a la presencia de FA refractaria. Se realizó un seguimiento mínimo de 12 meses por paciente. Resultados: En el estudio se incluyeron un total de 239 pacientes sometidos a ablación de FA, de los cuales 171 (71,5%) pertenecían al grupo de edad < 70 años y 68 (28,5%) al grupo de edad > 70 años. La edad promedio de la población estudiada fue de 62,4 años (desviación estándar [DE] = 10,87). El grupo < 70 años presentó una edad promedio de 58,03 años (DE = 9,71), mientras que el grupo > 70 años tuvo una edad promedio de 73,4 años (DE = 3,05). Además, se observó una mayor prevalencia de FA paroxística en el grupo de pacientes menores de 70 años, mientras que en el grupo de pacientes mayores de 70 años se encontró una mayor prevalencia de FA persistente. Estas diferencias fueron estadísticamente significativas en ambos casos. Las tasas de recurrencia después del primer procedimiento de ablación fueron similares entre los dos grupos (21,43% en el grupo menor de 70 años frente a 23,53% en el grupo mayor de 70 años, p = 0,79). No se encontraron diferencias significativas en cuanto a complicaciones. El grupo menor de 70 años experimentó 18 complicaciones, mientras que el grupo mayor de 70 años tuvo 5 complicaciones, con un valor de p de 0,472. Conclusión: Los pacientes mayores de 70 años sometidos al primer procedimiento de ablación de FA por catéter presentan resultados clínicos similares a los pacientes menores de 70 años.

Abstract Introduction and objectives: The objective of this study is to compare the clinical characteristics and outcomes of contemporary cohorts of patients undergoing catheter ablation for atrial fibrillation (AF), stratified by age (< 70 years and ≥ 70 years). Methods: This retrospective cohort study included patients who underwent catheter ablation for refractory AF. The minimum follow-up duration per patient was 12 months. Results: A total of 239 patients were included in the study, with 171 (71.5%) in the < 70 years group and 68 (28.5%) in the ≥ 70 years group. The mean age of the study population was 62.4 years (SD 10.87). The < 70 years group had a mean age of 58.03 years (SD 9.71), while the ≥ 70 years group had a mean age of 73.4 years (SD 3.05). Furthermore, a higher proportion of paroxysmal AF was observed in patients < 70 years, whereas a higher proportion of persistent AF was found in patients ≥ 70 years. These differences were statistically significant. The recurrence rates after the initial ablation procedure were similar between the two groups (21.43% in the < 70 years group vs. 23.53% in the ≥ 70 years group, p = 0.79). Additionally, there were no significant differences in terms of complications. The < 70 years group experienced 18 complications, while the ≥ 70 years group had 5 complications (p = 0.472). Conclusion: The findings of this study suggest that patients aged 70 years and older who undergo their first catheter ablation procedure for AF demonstrate similar clinical outcomes compared to patients younger than 70 years.

Processamento de linguagem natural não supervisionado na identificação de pacientes suspeitos de infecção por COVID-19 / Procesamiento del lenguaje natural no supervisado para identificar a los pacientes sospechosos de infección por COVID-19 / Unsupervised natural language processing in the identification of patients with suspected COVID-19 infection

Os pacientes com síndrome pós-COVID-19 se beneficiam de programas de promoção de saúde e sua rápida identificação é importante para a utilização custo efetiva desses programas. Técnicas tradicionais de identificação têm fraco desempenho, especialmente em pandemias. Portanto, foi realizado um estudo observacional descritivo utilizando 105.008 autorizações prévias pagas por operadora privada de saúde com aplicação de método não supervisionado de processamento de linguagem natural por modelagem de tópicos para identificação de pacientes suspeitos de infecção por COVID-19. Foram gerados seis modelos: três utilizando o algoritmo BERTopic e três modelos Word2Vec. O modelo BERTopic cria automaticamente grupos de doenças. Já no modelo Word2Vec, para definição dos tópicos relacionados a COVID-19, foi necessária análise manual dos 100 primeiros casos de cada tópico. O modelo BERTopic com mais de 1.000 autorizações por tópico sem tratamento de palavras selecionou pacientes mais graves - custo médio por autorizações prévias pagas de BRL 10.206 e gasto total de BRL 20,3 milhões (5,4%) em 1.987 autorizações prévias (1,9%). Teve 70% de acerto comparado à análise humana e 20% de casos com potencial interesse, todos passíveis de análise para inclusão em programa de promoção à saúde. Teve perda importante de casos quando comparado ao modelo tradicional de pesquisa com linguagem estruturada e identificou outros grupos de doenças - ortopédicas, mentais e câncer. O modelo BERTopic serviu como método exploratório a ser utilizado na rotulagem de casos e posterior aplicação em modelos supervisionados. A identificação automática de outras doenças levanta questionamentos éticos sobre o tratamento de informações em saúde por aprendizado de máquina.

Los pacientes con síndrome pos-COVID-19 pueden beneficiarse de los programas de promoción de la salud. Su rápida identificación es importante para el uso efectivo de estos programas. Las técnicas de identificación tradicionales no tienen un buen desempeño, especialmente en pandemias. Se realizó un estudio observacional descriptivo, con el uso de 105.008 autorizaciones previas pagadas por un operador de salud privado mediante la aplicación de un método no supervisado de procesamiento del lenguaje natural mediante modelado temático para identificar a los pacientes sospechosos de estar infectados por COVID-19. Se generaron 6 modelos: 3 con el uso del algoritmo BERTopic y 3 modelos Word2Vec. El modelo BERTopic crea automáticamente grupos de enfermedades. En el modelo Word2Vec para definir temas relacionados con la COVID-19, fue necesario el análisis manual de los primeros 100 casos de cada tema. El modelo BERTopic con más de 1.000 autorizaciones por tema sin tratamiento de palabras seleccionó a pacientes más graves: costo promedio por autorizaciones previas pagada de BRL 10.206 y gasto total de BRL 20,3 millones (5,4%) en 1.987 autorizaciones previas (1,9%). Además, contó con el 70% de aciertos en comparación con el análisis humano y el 20% de los casos con potencial interés, todos los cuales pueden analizarse para su inclusión en un programa de promoción de la salud. Hubo una pérdida significativa de casos en comparación con el modelo tradicional de investigación con lenguaje estructurado y se identificó otros grupos de enfermedades: ortopédicas, mentales y cáncer. El modelo BERTopic sirvió como un método exploratorio para ser utilizado en el etiquetado de casos y su posterior aplicación en modelos supervisados. La identificación automática de otras enfermedades plantea preguntas éticas sobre el tratamiento de la información de salud mediante el aprendizaje de máquina.

Patients with post-COVID-19 syndrome benefit from health promotion programs. Their rapid identification is important for the cost-effective use of these programs. Traditional identification techniques perform poorly especially in pandemics. A descriptive observational study was carried out using 105,008 prior authorizations paid by a private health care provider with the application of an unsupervised natural language processing method by topic modeling to identify patients suspected of being infected by COVID-19. A total of 6 models were generated: 3 using the BERTopic algorithm and 3 Word2Vec models. The BERTopic model automatically creates disease groups. In the Word2Vec model, manual analysis of the first 100 cases of each topic was necessary to define the topics related to COVID-19. The BERTopic model with more than 1,000 authorizations per topic without word treatment selected more severe patients - average cost per prior authorizations paid of BRL 10,206 and total expenditure of BRL 20.3 million (5.4%) in 1,987 prior authorizations (1.9%). It had 70% accuracy compared to human analysis and 20% of cases with potential interest, all subject to analysis for inclusion in a health promotion program. It had an important loss of cases when compared to the traditional research model with structured language and identified other groups of diseases - orthopedic, mental and cancer. The BERTopic model served as an exploratory method to be used in case labeling and subsequent application in supervised models. The automatic identification of other diseases raises ethical questions about the treatment of health information by machine learning.

Genetic parameter and genetic trend estimates for reproductive traits in Wistar rats / [Estimativas de parâmetros genéticos e tendências genéticas de características reprodutivas em ratos Wistar]

The aim of this study was to estimate genetic parameters and genetic trends for reproductive traits in Wistar rats. A total of 1,167 data records from 283 females over six generations of monogamous mating pairs was used. Heritability and genetic correlation were estimated through Bayesian inference and genetic trends were calculated by linear regression of breeding values over generations. Heritability estimates for litter size at birth (LS), calving interval (CI), pup mortality (PM) and maternal cannibalism (CAN) presented low magnitude, ranging from 0.01 to 0.13. CAN presented high and positive genetic correlation with LS and PM (0.77 and 0.78, respectively). On the other hand, all the other estimated genetic correlations were not significant. Genetic trend was positive for LS (+0.0900 pups per generation), and negative for PM and CAN (-1.0085 and -0.5217 pups per generation, respectively). For CI the genetic trend was not significant. It is recommended to increase selection intensity on dams in this Wistar rat population in order to accelerate the genetic progress.(AU)

O objetivo deste estudo foi estimar os parâmetros genéticos e as tendências genéticas de características reprodutivas em ratos Wistar. Foram analisados 1.167 registros coletados em 283 fêmeas ao longo de seis gerações de pares de acasalamentos monogâmicos. Herdabilidade e correlação genética foram estimadas por meio de inferência bayesiana, e as tendências genéticas foram calculadas pela regressão linear dos valores genéticos em função das gerações. As estimativas de herdabilidades para as características número de filhotes nascidos (LS), intervalo de parto (CI), mortalidade de filhotes (PM) e canibalismo materno (CAN) foram de baixa magnitude (0,01 a 0,13). CAN apresentou correlação genética alta e positiva com LS e PM, 0,77 e 0,78, respectivamente. As demais correlações genéticas estimadas foram não significativas. A tendência genética foi positiva para LS (+0,0900 filhote por geração) e negativa para PM e CAN (-1,0085 e -0,5217 filhote por geração, respectivamente). A tendência genética não foi significativa para CI. Recomenda-se aumentar a intensidade de seleção nas fêmeas nessa população de ratos Wistar, a,fim de acelerar o progresso genético.(AU)

Early Prediction of Coagulopathy in Acquired Bleeding Disorders - Revisited Using Rotational Thromboelastometry

Introduction: Acquired bleeding disorders are a major causeof mortality, both in the developed and developing countries.An acute haemorrhage should be managed immediately withblood products, factor concentrates or anti-fibrinolytics.Investigations to detect coagulopathies typically includebaseline screening tests like prothrombin time, activatedpartial thromboplastin time, platelet count and fibrinogenlevel. These tests have a long turn around time whichfrequently lead to a blinded approach towards blood productsupport leading to under or over transfusion. In contrast,rotational thromboelastometry (ROTEM) which assesseshaemostasis from the start of clot formation to fibrinolysisgives earliest results within ten minutes. This study wasdone to establish a correlation between ROTEM parametersand standard coagulation profile in the context of acquiredbleeding disorders.Material and Methods: A total of 138 subjects - 70 patientswho presented with acquired bleeding disorders and 68 subjectsdiagnosed to be normal on the basis of a complete coagulationwork up were included as the cases and controls respectively.All samples were subjected to standard coagulation profileand ROTEM analysis which included Clotting Time, ClotFormation Time, Alpha Angle, Maximum Clot Firmness andMaximum Lysis.Results: The Maximum Clot Firmness had a very goodco relation with serum fibrinogen levels (k value - 0.807;p<0.000; Sensitivity - 88%; Specificity - 92%), and goodcorrelation with platelet count (k value - 0.793; p< 0.000;Sensitivity - 86%, Specificity-92%), whereas Clot FormationTime showed moderate correlation with aPTT. Clotting timehad a poor correlation with prothrombin time and activatedpartial thromboplastin time.Conclusion: The achievement of haemostasis is a crucialfactor for determining patient outcomes in acquired bleedingdisorders. The gold standard test to diagnose coagulopathy is thestandard coagulation profile. Rotational thromboelastometrycorrelates well with standard coagulation parameters. Thistest which is performed on whole blood showed interpretableresults within 10 minutes, whereas standard coagulationprofile required an average of 45 – 75 minutes. In view of thegood correlation to the standard coagulation profile, it appearsthat Rotational Thromboelastometry results can be safely usedto implement early transfusion therapy for haemorrhage.

Criterios de selección de marca comercial de implantes dentales más usados por especialistas / Brand selection criteria for specialists most used dental implants

RESUMEN: Objetivo: Determinar los criterios de selección más usados al elegir una marca comercial de implantes dentales según odontólogos especialistas. Material y método: Se identificaron los parámetros para escoger una marca de implantes, estos se clasificaron en técnicos y mercadológicos, ordenándose en un cuestionario de tipo cerrado, valorándose por medio de escala psicométrica Likert del 1 al 5, además se incluyó una pregunta abierta. Se tomó una muestra por conveniencia de veinte odontólogos especialistas con experiencia al menos en tres marcas de implantes. Para el análisis estadístico descriptivo se usó Microsoft Excel 2011 versión para Mac, utilizando medidas de tendencia central como la Media Aritmética y Moda. Los parámetros técnicos se clasificaron de 1a hasta 1i, mercadológicos del 2a hasta el 2f y los sugeridos de p1 a p7. Resultados: La variabilidad en pilares de retención protésica, disponibilidad adecuada de los productos ofertados por la empresa y la compatibilidad de los aditamentos entre marcas comerciales, fueron los factores más relevantes considerados por especialistas a la hora de elegir un determinado sistema de implante. Conclusión: Las razones que más influyen en la elección de un sistema de implante son la variedad y disponibilidad de productos junto a la compatibilidad entre marcas.

ABSTRACT: Objective: The aim of this study is to determine the most used selection criteria when choosing a commercial brand of dental implant according to specialist. Material and methods: We identified the parameters to choose an implant brand, these were classified as technical and marketing, ordered in a closed questionnaire, assessed by means of a Likert psychometric scale from 1 to 5, plus an open question was included. A convenience sample of twenty specialists with experience in at least three implant brands. For the descriptive statistical analysis, Microsoft Excel 2011 version for Mac was used, using measures of central tendency such as Arithmetic Media and Fashion. For this same purpose, the technical parameters were classified from 1a to 1i, marketing parameters from 2a to 2f and suggested parameters from p1 to p7. Results: The variability in prosthetic retention pillars, adequate availability of the products offered by the company and the compatibility of the abutments between trademarks, were the most relevant factors considered by specialists when choosing a specific implant system. Conclusion: The arguments that most influence the choice of an implant system are variety and availability of products, as well as the compatibility between brands.

Selection criteria for liver transplantation recipients of hepatocellular carcinoma / 中华肝脏病杂志

Liver transplantation is by far the most thorough and effective treatment for liver cancer. However, there is still much controversy about how to select receptors in an effective and equitable manner under the shortage of liver donor. The "Milan Standard" is the most widely used screening standard for liver transplantation recipients in the world. In recent years, many patients with Trans Milan criteria (such as Hangzhou standard) can achieve transplant survival similar to that of Milan patients after transplantation. This article describes the research progress of liver transplantation recipients’ selection criteria in hepatocellular carcinoma.

Review and prospect of clinical study on liver transplantation of hepatocellular carcinoma / 中华肝脏病杂志

The focus of clinical research on liver transplantation of hepatocellular carcinoma over past decade is as follows: (1) the appropriate indications, so that the limited liver resources can be used more fairly and reasonably. A number of new indications standards have been proposed and validated. Our country scholar puts forward the standard norms, which could benefit more liver cancer patients from liver transplant. (2) To explore the appropriate immunosuppressive regimen in the control of rejection while preventing and reducing tumor recurrence rate after transplantation. At present, there is not enough clinical trial data to conclude, but for patients with high recurrence risk, it is recommended to minimize the dosage of calmodulin inhibitors and convert them to mTOR inhibitors after liver transplantation. In recent years, the rapid development of cancer precision medicine and immunotherapy technology has provided new opportunities for the study of liver transplantation in liver cancer.

La selección de árbitros desde la perspectiva de directores de revistas biomédicas cubanas / Selection of peer reviewers according to the Cuban medical journal editors´ perspective

Valorar los criterios utilizados por los directores de revistas biomédicas cubanas para la selección de sus árbitros. Métodos: Se realizó una investigación descriptiva entre septiembre del año 2013 y diciembre de 2014. Se aplicó y se validó un cuestionario enviado por vía electrónica a 21 directores escogidos por muestreo de conveniencia y disponibilidad para participar. La muestra la constituyeron 14 directores. Se exploraron variables relacionadas con el proceso de arbitraje y la selección de los árbitros. Los datos se ingresaron en una base de datos creada al efecto con el programa SPSS versión 15.0. en español. Los resultados se expresaron en valores absolutos y porcentajes. Resultados: El prestigio científico fue el criterio de selección marcado por 13 (85,7 por ciento) directores. La característica señalada como indispensable por todos los directores fue la actualización del árbitro en el tema a evaluar. En segundo lugar mencionaron el compromiso de ser ético y responsable, la objetividad en el dictamen, y el gestionar la información pertinente; esta última condición fue muy valorada. Entre las habilidades indispensables en un árbitro, 8 directores declararon que fueran capaces de detectar errores graves de forma y de contenido y problemas metodológicos que afecten la calidad del texto. Conclusiones: Los criterios adoptados por los directores para la selección de árbitros denotan una orientación objetiva. No obstante, deben establecerse pautas concretas que establezcan las condiciones y habilidades indispensables para el buen desempeño de un árbitro. Esto facilitaría la gestión de selección de estos expertos(AU)

To assess the criteria used by the Cuban medical journal editors for the selection of peer reviewers. Methods: A descriptive research study was conducted from September 2013 to December 2014. A questionnaire was administered and validated, which was sent by e-mail to 21 editors selected through convenience sampling and willingness to participate in the study. The sample was 14 editors. Several variables related to review process and selection of reviewers were explored. Data were entered into a database created for this purpose with the SPSS 15.0 version software in Spanish. The results were given in absolute figures and percentages. Results: The scientific prestige was the selection criterion stated by 13 (85.7 percent) editors. The characteristic that all the editors pointed out as indispensable was update in terms of evaluation by the reviewer. In the second place, they listed the commitment to ethics and responsibility, objective reporting and relevant information management, the latter was highly assessed by the participants. Among the indispensable skills of a reviewer, eight editors stated that they should be able to detect serious mistakes in form and content and the methodological problems affecting the quality of text. Conclusions: The criteria of editors for the selection of peer reviewers show an objective orientation. However, specific guidelines should be set to state the indispensable skills and conditions for good performance of reviewers, which would facilitate the process of selection of these experts(AU)

Research progress of liver transplantation for primary hepatocellular carcinoma / 中华消化外科杂志

Primary hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide and has a relatively high mortality rate.Liver transplantation has become an effective treatment for HCCs,but tumor recurrences after liver transplantation and donor shortages are the major limitations.The Milan criterion was the first standard and has been widely applied to liver transplantation of HCCs.Then,there are new emerging standards,namely University of California,San Francisco criterion (UCSF),Hangzhou and Shanghai criteria.Meanwhile,the comparison among these criteria laid the foundation for early prediction and prevention of post-transplantation tumor recurrence.In this review,clinical effect prediction and tumor recurrence after liver transplantation are also heated issues.

Advances in liver transplantation for patients with liver failure / 中华肝脏病杂志

Liver transplantation is the most effective salvage treatment for advanced liver failure, but its clinical application is limited by a shortage of liver donor, strict technology admittance, and complex and diverse issues in liver damage control before transplantation. We need to better understand the indications for liver transplantation in liver failure patients, select surgical timing correctly, and develop proper surgical regimens, in order to improve the rescue and cure rate of such patients. In addition, great achievements have been made in living-donor liver transplantation, auxiliary liver transplantation, and ABO-incompatible liver transplantation, which should be taken seriously in clinical practice.

Admission To Medical Colleges- Predictive Validity Of Selection Criteria.

Background & objective: Appropriate selection criteria for admission to medical college is a fundamental prerequisite where number of aspirants seeking admission to medical college has increased. The selection criteria used by medical colleges has been changing from time to time and not uniform all over India. Hence it is important to validate the selection criteria by observing performance of students during medical course. The study aims to find predictive value of entrance test & science score obtained at HSC level on the performance of medical students in I MBBS University Examination. Methods: The study included marks obtained in science subjects at HSC level, Entrance and I MBBS University examination for four consecutive batches(2009 to 2012). Correlation between all three variables was found using spearman rank correlation. Results: Performance in I MBBS examination showed no correlation with Entrance score but correlated significantly with science scores at HSC level (p<0.001). Also on Linear Regression Analysis, only HSC score showed strong positive correlation with First MBBS score(p<0.001). Interpretation & conclusion: This study indicates that Entrance test needs revision. Either the test should be modified or several selection tools like giving additional weightage to science score at HSC level should be combined, so as to select the optimum standard students.

Liver transplantation for advanced hepatocellular carcinoma

There has been ongoing debate that the Milan criteria may be too strict that a significant number of patients who could benefit from liver transplantation (LT) might have been excluded. Based on this idea, various studies have been conducted to further expand the Milan criteria and give more HCC patients a chance of cure. In deceased donor LT (DDLT) setting, expansion of the criteria is relatively tempered because the results of LT for HCC should be comparable to those of patients with non-malignant indications. On the other hand, in living donor LT (LDLT) situation, liver grafts are not public resources. The acceptable target outcomes for LDLT might be much lower than those for DDLT. Patients with biologically favorable tumors might have excellent survivals after LT despite morphological advanced HCCs. Therefore, the significance and utility of biological tumor parameters for selecting suitable LT candidates have been increased to predict HCC recurrence after LT. Although there is no consensus regarding the use of prognostic biomarkers in LT selection criteria for HCC, the combination of conventional morphological parameters and new promising biomarkers could help us refine and expand the LT criteria for HCC in the near future.

Contrasting morphology and training background in waterpolo teams of different competitive levels / Comparação de indicadores morfológicos e do tempo de treino semanal em equipes de pólo aquático de diferentes níveis competitivos / Comparación de indicadores morfológicos y de tiempo de entrenamiento semanal en equipos de waterpolo de diferentes niveles competitivos

We aimed to describe and compare the general morphological, somatotype and training background characteristics of Iberian waterpolo players (22 Portuguese and 22 Spanish National Teams players) considering their playing positions. The International Working Group of Kinanthropometry guidelines was herein followed, and a somatochart was obtained through specific software (Somatotype, Calculation and Analysis. (c)2001 SWEAT technologies). Spanish players train more hours per week (22.8 ±9.5 vs.12.2 ±5.6), are taller (187.4 cm ±6.6 vs.180.3 cm ±5.1), heavier (89.2 kg ±11.6 vs.79.1 kg ±10.0), show higher arm span (195.7 cm ±8.5 vs.185.2 cm ±7.4) and muscle mass percentage (49.0% ± 1.8 vs.46.0% ±6.0), and tend to be more mesomorphic (5.19 ±1.27 vs.4.26 ±1.32) than the Portuguese players. Concerning field positions, Spanish center forward players train more hours per week than the Portuguese (20.2 ±9.1 vs.12.2 ±3.8) and show higher arm span (204.4 cm ±7.3 vs.184.0 cm ±6.5). Spanish goal keepers and outside players show higher muscle mass percentage (49.8% ±1.5 vs.42.2% ±5.2 and 49.4% ±1.5 vs.45.5% ±4.6, respectively) than the Portuguese players. These evidences should be taken into account for the improvement of waterpolo sport...

"Comparação de indicadores morfológicos e do tempo de treino semanal em equipes de pólo aquático de diferentes níveis competitivos." O presente estudo objetivou descrever e comparar a morfologia geral, o somatótipo e horas de treino de jogadores Ibéricos de selecções nacionais de polo aquático (22 portugueses e 22 espanhóis) e compará-los quanto às posições de jogo. Utilizou-se um software específico para o desenho da somatocarta (Somatotype, Calculation and Analysis,(c)2001 SWEAT technologies). Os jogadores espanhóis, quando comparados com os portugueses, treinam mais horas por semana (22,8 ±9,5 vs.12,2 ±5,6), são mais altos (187,4 cm ±6,6 vs.180,3 cm ±5,1), mais pesados (89,2 kg ±11,6 vs.79,1 kg ±10,0), apresentam maior envergadura (195,7 cm ±8,5 vs. 185,2 cm ±7,4), percentagem de massa muscular (49,0% ±1,8 vs. 46,0% ±6,0) e tendem a ser mais mesomorfos (5,19 ±1,27 vs. 4,26 ±1,32) do que os jogadores portugueses. Quanto às posições de jogo, os pivôs espanhóis treinam mais horas por semana (20,2 ±9,1 vs.12,2 ±3,8) e apresentam maior envergadura (204,4 cm ±7,3 vs.184,0 cm ±6,5) que os portugueses. Ainda, respectivamente, os goleiros e os jogadores laterais espanhóis apresentam percentagens mais elevadas de massa muscular (49,8% ±1,5 vs.42,2% ±5,2 e 49,4% ±1,5 vs.45,5% ±4,6) do que os portugueses. Estas evidências devem ser consideradas para a melhoria do polo aquático...

"Comparación de indicadores morfológicos y de tiempo de entrenamiento semanal en equipos de waterpolo de diferentes niveles competitivos" El objetivo del estudio fue describir y comparar la morfología general, somatotipo y horas de entrenamiento de jugadores Ibéricos de selecciones nacionales de waterpolo (22 portugueses y 22 españoles) y comparar sus diferencias entre posiciones de juego. Los parámetros evaluados fueron seleccionados en la literatura. La somatocarta fue construida con un software específico (Somatotype, Calculation and Analysis, (c)2001 SWEAT technologies). Los jugadores españoles entrenan más horas por semana (22,8 ±9,5 vs.12,2 ±5,6), tienen más altura (187,4cm ± 6,6 vs.180,3 cm ±5.1), más peso (89,2 kg ±11,6 vs.79,1 kg ±10,0), más envergadura (195,7 cm ±8,5 vs. 185,2 cm ±7,4), porcentaje de masa muscular (49,0% ±1,8 vs. 46,0% ±6,0) y tienden a presentar valores más altos de mesomorfia (5,19 ±1,27 vs. 4,26 ±1,32) que los jugadores portugueses. Con respecto a las posiciones de juego, los boyas Españoles superan los portugueses en las horas de entrenamiento semanal (20,2 ±9,1 vs.12,2 ±3,8) y presentan más envergadura (204,4 cm ±7,3 vs.184,0 cm ±6,5). Los porteros y jugadores periféricos españoles tienen más masa muscular que los jugadores portugueses (49,8% ±1,5 vs. 42,2% ±5,2 e 49,4% ±1,5 vs.45,5% ±4,6), respectivamente. Estas evidencias deberán ser consideradas para la mejora del waterpolo...

Survey Analysis of Medical Staff at Blood Centers on the Perspectives of the Current Donor Selection Criteria / 대한수혈학회지

BACKGROUND: The donor selection criteria should ensure the safety of both the donors and the recipients of blood products. However, modifications may help promote more blood donors in keeping with the rapidly aging Korean population. Our goal was to gather opinions of the medical staff at blood centers on the current donor selection criteria. METHODS: A survey was sent out via email to 55 medical staff at hospital blood banks, the Korean Red Cross and Hanmaeum blood centers. The survey included 14~16 questions regarding age, weight, donation volume, donation interval and frequency, hemoglobin, blood pressure, pulse rate, and the level of alanine aminotransferase (ALT). RESULTS: Survey responses from 38 out of 55 (69.1%) medical staff were analyzed. The donor selection criteria that showed significantly higher acceptable rates included the upper age limit (71%, P=0.009) and whole blood donation frequency and intervals (68%, P=0.023). The ALT level showed the highest unacceptable rate (84%, P<0.0001) and other criteria with significantly higher unacceptable rates included donor weight (68%, P=0.023) and donation volume (76%, P=0.001). Responses from medical staff at supply blood banks and hospital blood banks showed a significant difference regarding the use of parent/guardian consent forms in blood donors that were 16 years or younger (75% versus 41%, respectively; P=0.0368). CONCLUSION: This study outlines the perspectives of medical staff at blood centers regarding the current donor selection criteria. According to the survey, the ALT level, donor weight, and donation volume should be considered for revision. These results can be referenced in the future when proposing modifications to the donor selection criteria.

Modelos de dimensão finita para a estimação de parâmetros genéticos para a produção de leite de primeiras lactações de vacas da raça Holandesa / Finite dimension models to estimate genetic parameters for first lactation milk yields of Holstein cows

Foram estimados parâmetros genéticos para produção de leite acumulada até 305 dias (P305) e produção de leite no dia do controle (PLDC) de 50.171 controles mensais de 9.281 primeiras lactações de vacas da raça Holandesa. A P305 e as PLDC foram analisadas por meio de modelo animal uni e bicaracterísticas. Para a P305 o modelo incluiu como aleatório, o efeito genético e como efeitos fixos o grupo de contemporâneos e a covariável idade da vaca ao parto. Para as PLDC foi usado o mesmo modelo descrito para a P305, incluindo como covariável o número de dias em lactação. Os componentes de variância foram estimados pelo Método da Máxima Verossimilhança Restrita. As estimativas de herdabilidade (h²) para as PLDC oscilaram entre 0,07 e 0,19 em análises unicaracterísticas e, de 0,12 a 0,22 nas bicaracterísticas. Para a P305, as h² resultantes das análises uni-característica e bicaracterística foram 0,26 e 0,27, respectivamente. As correlações genéticas das PLDC com a P305 foram todas positivas e elevadas, variando de 0,63 a 1,00. As correlações genéticas entre as PLDC variaram de 0,30 a 1,00. A seleção para a P305 parece ser o melhor critério de seleção a ser adotado, uma vez que proporciona maiores ganhos genéticos para as produções de leite em, praticamente, todos os controles da lactação.

Genetic parameters for 50,171 first lactation test-day milk yields and 305 day milk yield (Y305) of 9,281 Holstein cows were estimated, applying uni and bi-trait animal models. The model for Y305 included the additive genetic effect as random and the fixed effects of contemporary group and age of cow at calving as covariable. For TDMY the same animal model described for Y305 was used, including days in milk as covariable. Variance components were estimated by Restricted Maximum Likelihood. Heritability estimates obtained for TDMY ranged from 0.07 to 0.19 and from 0.12 to 0.22 by uni-trait and bi-trait analysis, respectively. Heritability for Y305 was 0.26 by uni-trait and 0.27 by bi-trait analysis. The genetic correlations between TDMY and Y305 were all positive and high, ranging from 0.63 to 1.00. The genetic correlations between TDMY ranged from 0.30 to 1.00. Selection for Y305 seems to be the best selection criterion to be adopted, since it provides larger genetic gain for milk productions in, practically, all test days.

Hepatocellular Carcinoma and Liver Transplantation / 대한이식학회지

In a study by Mazzaferro et al, the patient with Milan criteria had excellent survival and disease free survival rate of 85 % and 92% respectively, at 4 years after liver transplantation and this criteria have been widely used as the guideline for the selection of candidates for liver transplantation in many transplantation center. Milan criteria will exclude a large portion of patients from liver transplantation and some studies suggested an expansion of the selection criteria without affecting outcome. The University of California, San Francisco (UCSF) group proposed an expansion of the selection criteria according to tumors characteristics, while preserving excellent survival after liver transplantation. The limitation of clinical staging system based soley on the results of the pretransplantation imaging technique, inaccurate and understaging identified as meeting standard criteria. when applied to pretransplantation evaluation, the expansion criteria are associated with lower survival rate and disease free survival rate. In contrast to long waiting time and high dropout rate in cadaver transplantation, living donor liver transplantation (LDLT) appear the alternative method and LDLT is chosen by the balance of the risk and benefit for donor and recipients. The most centers demonstrated favorable results in patients chosen by extended selection criteria. Most centers in Korea had a concensus on exclusion of extrahepatic metastasis and major vascular invasion in principle. The broadest criteria such as exclusion of major vessel invasion which expanded the patients by about 20%, result in the 3 years of 86.8%, not significant different from Milan criteria. With the aim of reducing dropout rates on the waiting list, locoregional therapy can be offered to patient at risk for tumor progression. While favorable results in terms of local tumor necrosis and improved survival rate were observed in some centers, others made poor efficacy. Whether liver transplantation or liver resection is the optional initial treatment for early tumor in compansated liver cirrhosis depends on the survival rate. The similar result in both treatment modality and the shortage of cadaver donor liver graft, Most center recommand the liver resection as the first line therapy. Resection first and salvage transplantation for recurrent tumor or liver failure has been shown to be a feasible strategy in the most patients.

Selection Criteria and Utilization of Health Information on the Internet by Consumers / 대한의료정보학회지

This study was conducted to investigate selection criteria of health information and utilization pattern of health information on the Web by the consumers. Data were collected through off-line and on-line surveys. The off-line survey was conducted with 64 white color office workers in seven companies. The on-line survey was conducted on JoongAng Ilbo 'Healthcare' and KIHASA 'Healthguide' Web sites and 216 participated in the survey. To compare the selection criteria of the consumers with that of health informatics experts, an e-mail survey was done with twenty-six health informatics experts. Selection criteria of health information rated by consumers were in order of accuracy of content, scope and depth of content, privacy and confidentiality, and readability. Experts ranked in order of accuracy of content, purpose of sites, scope and depth of content, and readability. Seventy eight percent of consumers used the Internet once a month to search health information, 60.4% visited health-related Web sites via Internet search. The majority (85%) visited 2-5 different Web sites when they searched for health information. Eighty three percent of consumers regarded the health information on Internet as reliable. Ninety percent of consumers said that the health information on Internet was useful. Consumers used the Internet 'to find disease-related information' (86.1%), 'to find information on exercise and nutrition' (77.9%), 'to get an on-line advice' (42.5%), and 'to buy products or medicine for health' (18.9%). The results of the present study suggested what the health informatics experts should consider when they provide health information on the Internet and what consumers demand when they filter quality health information.

A Study on the Status of Utilization and Criteria for Selection of Medical Care Facilities of Elementary School Children

PURPOSE: The aim of this study is to find out the distribution of illness, patterns of medical care utilization and factors determining medical care utilization in elementary school children. METHODS: We performed the questionnaires in Gwangju city on 2,036 children of two elementary schools from June 1 to June 30, 1998. RESULTS: The prevalence rate of illness was 32.3%. The distribution of illness was respiratory disease(64.7%), gastrointestinal disease(12.8%), injury & poisoning. The rate of persons having received medical treatment when they were sick, was 89.8%. The selection distribution among various medical facilities was pediatric hospital(46.7%), otolaryngologic hospital(19.8%), pharmacy (13.2%) and internal medicine in the decreasing frequency sequence. The major factors influencing the selection of medical facility were geographic accessibility and good results. The most common reason for the first visit to the pediatric hospital was geographic accessibility. The most common reason for a visit and to otolaryngologic hospital was a good result. The most frequently utilized medical facility for respiratory symptoms and gastrointestinal symptoms was pediatric hospital. The persons influencing the selection of medical facility in the children were mother(73.3%), father(10.8%), doctor and others in decreasing sequence. The persons answering the questionaire thought that the optimal age of pediatric care was from 0 to 12 years(47.8%), to 10 years(22.4%) and to 15 years(18.5%) in decreasing rate. CONCLUSION: Other departments instead of pediatrics have treated children. Children have particular growth and development process, which is different to those of adults. So, it is necessary to choose special medical care and adequate medical facilities for children.

A Study on Success Factors of Buyer-Supplier Relationship in Elementary School Lunch : From the buyer's viewpoint

The purpose of this study is to clarify success factors for desirable relationship between buyer and supplier in elementary school. Therefore, the survey questionnaire consisted of general background, past success, success difference, buyer-supplier relationship characteristics(trust, supporting status, communication behavior, conflict resolution techniques, supplier selection process). The subjects were 66 dieticians of elementary school in Inchon. The statistical analysis of data was completed using SPSS program. The results were summarized as follows : Average total cost/day per one person 1,156Won. The number of suppliers per one school were 6. 92.3% of the subjects were in favor of private contract, regarding contract methods of purchasing food materials. For the past success, degree of satisfaction about past their supplier showed 3.49 score. The present success difference was shown higher than the past success. There was significant correlation between the past success and the present success difference. Trust about suppliers showed 3.40score. Supplying companies hardly support for buying school. Among information quality(timely, accurate, adequate, complete, credible), timely and complete showed lower score than the other kind of elements. Among the buyer-supplier relationship characteristic elements, only trust correlated with satisfaction about suppliers significantly. Among the conflict resolution techniques, joint problem solving and persuasive attempts were often made use of by subjects. The supplier selection criteria were shown quality(7.47), supplier's capabilities(6.46), management plan(6.00), price(5.73), scale(5.48), assets(5.27), considers delivery(4.76) and technology(2.39). As results, trust was needed for the desirable relationship between buyers and suppliers. This study has some limitations. The data in this study were collected from only buyer. It is more desired to acquire data from suppliers also.