Breast cancer patient-reported outcomes on level 1 and level 2 oncoplastic procedures using BREAST-Q®.

PURPOSE: In breast cancer management not only mortality and surgical morbidity measurements are important but also patient satisfaction indexes. The authors evaluated the satisfaction and health-related quality of life (HRQOL) using the breast-conserving therapy (BCT) and breast reduction (BR) modules of BREAST-Q®. METHODS: This is a cross-sectional study that analyzed breast cancer patients consecutively submitted to breast surgery between January 2011 and April 2018 using two modules of BREAST-Q®. 968 patients were contacted and 232 answers were gathered: 171 patients submitted to oncoplastic level 1 surgery answered the BCT module and 61 submitted to oncoplastic level 2 surgery answered the BR module. Clinical data were retrieved from patients' medical records. RESULTS: Among the 232 questionnaires received, the median scores for psychosocial well-being, sexual well-being and (postoperative) satisfaction with breasts for BCT and BR modules were, respectively, 77.0 and 73.5 (p = 0.17); 62.0 and 53.0 (p = 0.14); 72.0 and 66.0 (p = 0.66). The median of adverse effects of radiation in the BCT module was 87.0. The median satisfaction with outcome in the BR module was 86.0. Both groups of patients revealed high scores of satisfaction with care. For the BCT patients, satisfaction with breasts strongly correlated with sexual well-being and was moderately correlated with psychosocial and physical well-being. For the BR patients, the satisfaction with outcome strongly correlated with satisfaction with medical team and moderately correlated with the remaining scales. CONCLUSION: Both oncoplastic surgery levels yielded similar satisfaction outcomes when assessed using BCT and BR modules of BREAST-Q®.

Initial experience with targeted axillary dissection after neoadjuvant therapy in breast cancer patients.

BACKGROUND: Targeted axillary dissection (TAD) combines sentinel node biopsy (SNB) with the removal of the previously marked metastatic node. TAD is a promising concept for axillary restaging in node-positive breast cancer patients with pathological complete response (pCR) to neoadjuvant therapy (NAT). We aimed to evaluate TAD feasibility in this context. METHODS: A prospective observational study was conducted in biopsy-confirmed cN1 patients. The removal of the clipped node (CN) was guided by intraoperative ultrasound. SNB used indocyanine green and patent blue V dye. If the CN or sentinel lymph nodes (SLN) had any metastatic foci, or the TAD procedure was unsuccessful, the patient underwent axillary lymph node dissection (ALND). RESULTS: Thirty-seven patients were included. TAD and SNB identification rates were 97.3%. Every retrieved CN was also a SLN. At the individual level, SNB identification rate was 89.2% with indocyanine green and 85.5% with patent blue V dye. The CN identification rate was 81.1%, being higher when the CN was localized on the intraoperative ultrasound (84.4% vs 60.0%). Nodal pCR was achieved by 54.1% of our patients and was more frequent in HER2-positive and triple-negative tumors (p = 0.039). Nineteen patients were spared from ALND. CONCLUSION: TAD with intraoperative ultrasound-guided excision of the CN and SNB with indocyanine green and patent blue V dye is a feasible concept to identify patients without axillary residual disease after NAT, that can be spared from ALND, although the need for marking the biopsied node should be further investigated.

Perovskite-type titanate zirconate as photocatalyst for textile wastewater treatment.

Calcium titanate zirconate, Ca(Ti(1-x)Zrx)O3 (CZT), powders have been synthesised by the polymeric precursor method. The structural analysis of the CZT powders was monitored by X-ray diffraction (XRD), photoacoustic spectroscopy (PAS) and textural analysis. The photocatalytic properties were evaluated by methylene blue (MB) decomposition and real textile wastewater (RTW) combined treatment (coagulation/flocculation/photocatalysis). Chemical oxygen demand (COD) of RTW was successfully reduced from 6195 mg L-1 (untreated) to 662 mg L-1 after coagulation/flocculation with a tannin-based coagulant (Tanfloc®) and finally to 471 mg L-1 after combined treatment (coagulation/flocculation/photocatalysis) applying ultraviolet radiation and CaTiO3 as photocatalyst.

[Therapeutic implication of the azygos vein lobe in patients with pulmonary adenocarcinoma]. / Implicações terapêuticas do lobo da veia ázigos em doente com adenocarcinoma do pulmão.

The azygos vein lobe is an anatomic variant reported in 0.1 to 8% of the population and results from an anomalous development of the right lung upper lobe. In the majority of the cases, clinical implications are lacking. Since the original description of a tumor of the azygos vein lobe, in 1969, only two more cases have been reported in the literature. Behind its rarity, a tumor with such location may pose some management implications. The authors report the clinical case of a 56 years old smoker man, in whom a chest x-rays revealed a poorly defined image in the upper lobe of the right lung. Complementary studies and evaluation allowed the diagnosis of pulmonary adenocarcinoma, adherent to the azygos vein, in a patient with azygos vein lobe. The authors emphasize the fact that despite the origin of the tumor being the lung, the presence of this anatomic variant of the azygos vein played a determinant role in the surgical approach.

Pharmacokinetics of ingested fluoride: lack of effect of chemical compound.

UNLABELLED: Fluoride in drinking water may be present from natural sources or added as sodium fluoride (NaF), sodium silicofluoride (Na(2)SiF(6)) or fluorosilicic acid (H(2)SiF(6)). Results from an early study with rats suggested that, when ingested as Na(2)SiF(6), the absorption and excretion of fluoride were greater than when ingested as NaF. OBJECTIVE: The present single-blind, crossover study with 10 adults was done to determine three key pharmacokinetic parameters: the maximum plasma fluoride concentrations (C(max)), the elapsed time to reach the maximum concentrations (T(max)) and the 6-h areas under the time-plasma concentration curves (AUCs) after ingestion of 500 mL of water containing 0.67 or 5.45 mg F/L present naturally or added as NaF or H(2)SiF(6). DESIGN: Blood was collected prior to and at nine time points during 6h after ingestion of the test solutions. Plasma was analysed by electrode after HMDS-facilitated diffusion and the data were analysed for statistically significant differences using repeated measures ANOVA. RESULTS: The C(max), T(max) and AUC values after ingestion of the solutions containing natural fluoride, NaF or H(2)SiF(6) did not differ significantly at either dose level. Further, the T(max) values associated with the 0.67 and 5.45 mg/L solutions did not differ significantly indicating that the absorption, distribution and elimination rates were not affected by the dose size. CONCLUSIONS: Considered together with published reports, the present findings support the conclusion that the major features of fluoride metabolism are not affected differently by the chemical compounds commonly used to fluoridate water nor are they affected by whether the fluoride is present naturally or added artificially.

[Family planning among lower status women in Rio de Janeiro city]. / Planejamento familiar em mulheres de baixa renda no Municipio do Rio de Janeiro.

PIP: The National School of Public Health aided by WHO conducted a survey between 1984 and 1985 in 7 communities of Rio de Janeiro, Brazil, enlisting 1900 women aged 15-49 from 2019 households selected. 1783 were interviewed, yielding a response rate of 92%. 538 (30%) women were single, 7.2% of who had no sexual experience. 4.5% of the sample were widowed, divorced, or separated. Their familiarity with contraceptives was as follows: oral contraceptives, (OCs) 99.7%; female sterilization and the condom, 90%; coitus interruptus and vasectomy; 33%; the diaphragm, 27%; and natural methods; 22%. 83% of the women used OCs; less than 20% used the condom, coitus interruptus, or spermicides; and 5% had used the IUD. 8% of those 40 decided on tubal sterilization. 67% of the women in sexual unions used contraceptives vs. 35% of single women with sexual activity. Nonuse increased after age 35, while more than 50% of women 20 did not use contraceptives. Half of the sterilized women underwent the procedure before age 30 when they had 4 children. 66% of ligations were done during birth, and accompanied 63% Cesarean section. Only 28 of sterilizations were done by laparoscopy on another occasion. Misinformation about sterilization was rife, as 15% of sterilized women states that they wanted to bear a child in the future, and 11% thought that they could get pregnant. 42% of women aged 35 and over were sterilized by laparoscopy. In hospitals and clinics the average sterilized woman was 29.4 years old and had 3.5 children. Contraceptive prevalence was higher than the national average, it was comparable to the level in countries that have traditionally low fertility. The fact that OCs, the pill, and tubal ligation made up the predominant pattern of contraceptive use is the result of the inability of the health care system to provide an integrated family planning program with education about and provision of contraceptives.^ieng

[Induced abortion among low income women: dimensions of the problem]. / Aborto induzido em mulheres de baixa renda: dimensão de um problema.

This paper examines the practice of abortion, especially induced abortion among low income women. The discussion is based on survey data collected between 1984 and 1985 in seven slum communities (favelas) situated in the metropolitan area of Rio de Janeiro, Brazil. Despite restrictive law, induced abortion is extremely frequent. Among married women 21.4 per cent reported experience of induced abortion. Most abortions were performed by physicians, however the quality of care of these procedures can be questioned since almost all induced abortions are illegal there is no possible supervision by health authorities. The incidence of post-abortion complication is very high, especially for those performed by traditional midwifes or by the woman herself. More than 60 per cent of the women were not using contraception at the time of pregnancy. About, 21 per cent reported that they were using the pill. Such a high pill failure rate is inacceptable, and probably was related to incorrect use. This points to the need for a better access to family planning care within the health services. The consequences of the restrictive abortion laws in Brazil are also discussed. Restrictions that in practice prove to have little impact on the practice of induced abortion, appear to be very effective in brooding even more the social-economic inequalities.