The influence of sex on heart failure mortality.

AIMS: Little research has investigated how sex may affect the prognosis of patients with chronic heart failure (HF). The present study was aimed at exploring sex-specific differences in prognosis in a cohort of patients with chronic HF, categorized according to severity of left ventricular dysfunction (HFrEF, HFmrEF and HFpEF), right ventricular (RV) dysfunction and ischemic (IHD) or nonischemic (no-IHD) etiology. METHODS: This retrospective analysis included 1640 HF patients of whom 24% were females, 759 patients had IHD, 1110 patients had HFrEF, 147 patients had HFmrEF and 383 patients had HFpEF. The median follow-up period was 63 months (25th-75th 27-93). RESULTS: In the no-IHD group, no statistically significant sex differences emerged regarding survival, regardless of age and severity of cardiac dysfunction. In contrast, in the IHD group, females had a significantly lower event rate than males in the age group between 65 and 79 years [hazard ratio (HR) 0.39; 95% confidence interval (CI): 0.86-0.18; P  < 0.01]; in addition, a lower event rate was observed in females compared with males among patients with HFrEF (HR 0.47; 95% CI: 0.88-0.25; P  < 0.01), among patients without RV dysfunction (HR 0.58; 95% CI: 1.02-0.33; P  = 0.048) and among patients without diabetes (HR 0.44; 95% CI: 0.84-0.23; P  < 0.01). CONCLUSION: In nonischemic patients there was no difference between males and females in terms of survival whereas in patients with ischemic etiology survival was better in females among elderly patients, in HFrEF patients, in the absence of RV dysfunction and in the absence of diabetes.

Analysis of potential for reducing emissions of greenhouse gases in municipal solid waste in Brazil, in the state and city of Rio de Janeiro.

This paper examines potential changes in solid waste policies for the reduction in GHG for the country of Brazil and one of its major states and cities, Rio de Janeiro, from 2005 to 2030. To examine these policy options, trends in solid waste quantities and associated GHG emissions are derived. Three alternative policy scenarios are evaluated in terms of effectiveness, technology, and economics and conclusions posited regarding optimal strategies for Brazil to implement. These scenarios are been building on the guidelines for national inventories of GHG emissions (IPCC, 2006) and adapted to Brazilian states and municipalities' boundaries. Based on the results, it is possible to say that the potential revenue from products of solid waste management is more than sufficient to transform the current scenario in this country into one of financial and environmental gains, where the negative impacts of climate change have created a huge opportunity to expand infrastructure for waste management.

Management challenges on small-scale gold mining activities in Brazil.

This article presents a focused study of environmental management in small-scale gold mining, called garimpo, at the Tapajós River in the Amazon basin (Brazil). Environmental management is necessary in this very important area not only for Brazil but for the general world welfare. The fact that this is a very dispersed area, with a very low economic and education level, complicates the issues. Added to these factors are legislation, administration, and control processes which are shown in their historical, technical, health, and economic aspects. Using systemic integration, the article describes how the inherent interests of each part directly or indirectly involved may be articulated to result in self-control. The same approach reveals also the potential conflicts. Some existent proposals are analyzed with regard to the extent to which they can work, given the described aspect.

Cell loss and proliferation in non-small cell lung carcinoma: correlation with histological subtype.

BACKGROUND: Cell kinetic data are important indicators of the aggressiveness of tumor and treatment response. The size of a neoplasm depends on the balance between cell proliferation and death. Thus, the analysis of the kinetics of cell proliferation and death may explain differences in the rates of tumour progression. METHODS: We studied apoptosis and proliferative indices in 95 cases of non-small cell lung carcinomas. The analysis was performed on paraffin-embedded tissue, by both MIB-1 immunocytochemical detection to establish the proliferation index and the in-situ end labelling method for the apoptosis index. The two indices were related. RESULTS: Our results showed a high proliferative index and cell loss rate in squamous cell carcinoma, and a low proliferative index and cell loss rate in adenocarcinoma, suggesting two different growth patterns. CONCLUSION: These findings could explain the different biological behaviour and treatment response of the tumours. The tendency of a cancer cell to undergo apoptosis may be especially important for the chemotherapy of malignant tumours with a low growth rate, which are typically resistant to cytostatic agents.

Myofibrosarcoma of the breast: review of the literature on myofibroblastic tumors and criteria for defining myofibroblastic differentiation.

A case of myofibrosarcoma of the breast is described. A 55-year-old woman presented with a small mammary nodule. A large recurrent lesions appeared a month later, and the patient died 11 months following initial presentation from diffuse pleuropulmonary metastases. Histologically, the primary tumor consisted mainly of spindled cells, arranged in fascicles and surrounded by varying quantities of dense hyaline collagen. The recurrent lesion had a more pleomorphic organization. In both lesions, there was positive immunostaining for vimentin, smooth-muscle actin, and fibronectin, and negative results for desmin, laminin, and type IV collagen. Electron microscopy revealed abundant rough endoplasmic reticulum, myofilaments with focal densities, and the fibronexus junctions and fibronectin fibrils characteristic of myofibroblasts. Given these cellular features and behavior, the tumor was interpreted as a malignant neoplasm showing myofibroblastic differentiation, i.e., a myofibrosarcoma. This case enlarges the group of myofibrosarcoma of breast, also with the demonstration of fibronexus and fibronectin fibrils. The paper emphasizes the criteria required for myofibroblastic differentiation and reviews lesions of the breast reported in the literature as myofibroblastic.

Divergent differentiative histogenetic lines in lung tumors: identification of histotypes with pure or mixed ultrastructural phenotype and their prognostic significance.

We performed an electron microscopic study of 50 lung tumors, previously diagnosed by light microscopy, and compared the results of the two techniques. Data analysis identified two ultrastructural phenotypes: pure and mixed. The former was characterized by a constant differentiative pattern and the latter by diverging differentiative histogenetic lines. We observed six differentiative lines as follows: squamous, glandular, neuroendocrine, villopodial, intestinal, and apocrine sudoriparous. Features of divergent differentiative lines were observed in 36 cases (64%), throughout the histotypes, sometimes with coexpression of more than one differentiation in a single case and/or cell. Adenocarcinoma was the histotype most frequently observed in pure form whereas most squamous cell carcinomas showed a mixed phenotype. This suggests that the histotype of the different lung tumors arises from a single glandular pluripotent cell, able to differentiate toward divergent differentiative lines. The clinical stage at onset and at the end of the follow-up indicates that the biologic behavior of lung tumors varies according to whether the ultrastructural phenotype is pure or mixed.

Anaplastic large cell Ki-1 lymphoma of the stomach with villopodial projections: an immunocytochemical and ultrastructural study and review of the literature.

The report describes a case of anaplastic large cell Ki-1 lymphoma of the stomach with a rapidly fatal course observed in a 28-year-old woman. By electron microscopy the neoplastic cells presented long projections of the cytoplasmic membrane arranged uniformly along all the cell circumference. The morphology and distribution of these projections were characteristic, and the term villopodial is proposed for them. A review of the literature revealed 18 cases of lymphoma and 7 cases of nonlymphoid neoplasms composed of cells with projections similar to those observed in the present case. It is suggested that such tumors be denominated villopodial lymphomas and villopodial tumors. The present case is the first anaplastic large cell Ki-1 lymphoma with villopodial projections reported in the literature.

Sistemas de indicadores de saúde e ambiente em instituições de saúde

Revisão teórica sobre aspectos conceituais e metodológicos da construção de um sistema de indicadores, visando a gestão integrada em saúde e ambiente nas instituições de pesquisa, ensino e prestação de serviços em saúde, que articule também a Biossegurança. Partiu-se do estudo de modelos internacionais de indicadores, destacando-se o modelo da Organização Mundial de Saúde, mais apropriado para este trabalho, a partir do qual foi feito o processo de coleta, organização e síntese de informações. Visa-se criar um instrumental de monitoramento e avaliação destas ações, a fim de apoiar a tomada de decisões.