Mucinous carcinoma of the breast is a type of well-differentiated adenocarcinoma, a rare subtype of infiltrating ductal carcinoma. It represents approximately 2% of all invasive breast carcinomas. ...The mean age of presentation is 65 years, with an incidence of 1% in women younger than 35 years. Depending on the mucin content of the carcinoma, they are described as pure or mixed; the distinction between the 2 is important for prognosis and treatment. The treatment of special types of breast cancer is still controversial due to the limited amount of evidence, however, the main treatment for breast cancer is still surgery. We present a case of a 29-year-old patient with mucinous carcinoma of the breast with a delay in its management, but with a favorable postoperative result.
Abstract
Objective
The immediate referral of patients with risk factors for placenta accreta spectrum (PAS) to specialized centers is recommended, thus favoring an early diagnosis and an ...interdisciplinary management. However, diagnostic errors are frequent, even in referral centers (RCs). We sought to evaluate the performance of the prenatal diagnosis for PAS in a Latin American hospital.
Methods
A retrospective descriptive study including patients referred due to the suspicion of PAS was conducted. Data from the prenatal imaging studies were compared with the final diagnoses (intraoperative and/or histological).
Results
A total of 162 patients were included in the present study. The median gestational age at the time of the first PAS suspicious ultrasound was 29 weeks, but patients arrived at the PAS RC at 34 weeks. The frequency of false-positive results at referring hospitals was 68.5%. Sixty-nine patients underwent surgery based on the suspicion of PAS at 35 weeks, and there was a 28.9% false-positive rate at the RC. In 93 patients, the diagnosis of PAS was ruled out at the RC, with a 2.1% false-negative frequency.
Conclusion
The prenatal diagnosis of PAS is better at the RC. However, even in these centers, false-positive results are common; therefore, the intraoperative confirmation of the diagnosis of PAS is essential.
Flexible quantity contract has been widely used as a coordination mechanism in decentralized supply chains. Its application it allows to determinate purchase and sale quantities and variability ...limits in order to reduce the losses risk and improves the supply chain overall profit. However, this one is not focused on the income distribution, because this kind of contract seeks to improve the overall profit through agreements in the supplier-buyer relationship, without analyzing the behavior of revenues. This article proposes a hybrid method including the asymmetrical Shapley value as a contract model complement. The proposed model is validated in the case of study in a small farmer citrus supply chain with three echelons: producer, intermediary and retailer. Supply chain is decentralized, uncoordinated and intermediary is a dominant player. The model of application allows to obtain optimal transfer quantities between echelons to get the maximum global profits together with an equitable profits distribution using Shapley value. Subsequently, profit is translated in terms of income, both general and for each echelon in the supply chain. It is concluded that it is possible from the game theory approach, to balance the dominant positions between echelons to improve the distribution of income between each one of them.
El contrato de cantidad flexible ha sido utilizado ampliamente como mecanismo de coordinación en cadenas de suministro descentralizadas. Su aplicación permite determinar las cantidades de compra y venta y los límites de variabilidad que reducen el riesgo de pérdidas y mejora la utilidad global de la cadena. Sin embargo, existe un vacío en cuanto la distribución de ingresos, debido a que este tipo de contratos busca mejorar la utilidad global a través de acuerdos en la relación proveedor-comprador, sin analizar el comportamiento de los ingresos. Este artículo propone un método hibrido que incluye el uso del valor de Shapley asimétrico como complemento al modelo de contrato. El modelo propuesto se valida en el caso de estudio de una cadena de suministro citrícola de pequeños productores de tres eslabones: productor, intermediario y detallista; la cadena es descentralizada, está descoordinada y presenta al intermediario como jugador dominante. A partir de la aplicación del modelo se determinan las cantidades óptimas de transferencia entre los eslabones que permiten la ganancia global máxima junto con una distribución equitativa de la utilidad utilizando el valor de Shapley. Posteriormente la utilidad se traduce en términos de ingreso, tanto global como para cada eslabón de la cadena. Se concluye que es posible desde el enfoque de teoría de juegos, equilibrar las posiciones de dominancia entre los eslabones de la y mejorar la distribución de los ingresos entre cada uno de ellos.
Objective: The pregnant oral health is nowdays a very important issue of socialcultural and academic matter due to chances that can be seen. The oral health is essential for the well-being of ...pregnant woman. The objective was: To determinate the bucodental status of pregnantwomen in Armenia City. Methods: It was made a observational descriptive study, at the city of Armenia,Quindio. We take the pregnant who assisted to pre-birth control at the city’s services of health. We include 186 pregnants who could meet the selection characteristic and wish to be part of the research. Results: Age average was 22 years, mostly 58.3% From quindio. 65.9% have been at the dentist during the pregnancy. In the clinical examination we found that 34.5% of pregnants showed soft tissue injuries, 94.05% tooth decay and 70.2% periodontal disease. Conclusions: Oral health is pregnants is modificad with prevalences of disease such as tooth decay, the mother did not go for dental care during their pregnancy. Key words: Pregnant. Oral health. Periodontal disease.
Abdominal and thoracic aortic aneurysms (AAAs, TAAs) remain a major cause of deaths worldwide, in part due to the lack of reliable prognostic markers or early warning signs. Sox6 has been found to ...regulate renin controlling blood pressure. We hypothesized that Sox6 may serve as an important regulator of the mechanisms contributing to hypertension-induced aortic aneurysms. Phenotype and laboratory-wide association scans in a clinical cohort found that SOX6 gene expression is associated with aortic aneurysm in subjects of European ancestry. Sox6 and tumor necrosis factor alpha (TNF-α) expression were upregulated in aortic tissues from patients affected by either AAA or TAA. In Sox6 knockout mice with angiotensin-II-induced AAA, we found that Sox6 plays critical role in the development and progression of AAA. Our data support a regulatory role of SOX6 in the development of hypertension-induced AAA, suggesting that Sox6 may be a therapeutic target for the treatment of aortic aneurysms.
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•Using electronic health records and biobank samples, we found that the transcription factor SOX6 is associated with abdominal and thoracic aortic aneurysm and its expression is upregulated in tissue from patients affected by those diseases•Laboratory-wide association study (LabWAS) provides several clinical laboratory measurements associated with aortic aneurysm diagnosis that may be potential biomarkers for the disease•Knocking out Sox6 from the smooth muscle cells of mice attenuated hypertension-induced abdominal aortic aneurysm. These transgenic mice may be useful tools to elucidate the mechanisms associated with abdominal aortic aneurysm
Medical science; Cardiovascular medicine; Molecular Genetics
Introducción. El análisis de las situaciones de salud, en el acto del cuidado de la enfermería, requiere de conocimientos, pues es el marco conceptual y la guía de esta labor. Aunque el cuidado ...integral de la salud, según Watson, depende del compromiso moral del enfermero de preservar la dignidad humana; son frecuentes los informes que muestran una mala percepción de la prestación de servicios de salud. En los informes, se indica que el 36% de los encuestados tienen una mala o muy mala percepción de la calidad de la atención médica. El objetivo es reflexionar sobre las circunstancias que influyen en la calidad de la atención médica percibida por los colombianos. Temas de reflexión. Se abordará el tema desde los patrones de conocimiento de la enfermería: el empírico, el estético, el ético, el sociocultural y el personal. Discusión. Las condiciones que influyen en la percepción de la calidad de la atención médica se agrupan en dos conceptos del metaparadigma de la enfermería. El primero es el entorno, en el que existen barreras de oferta y demanda, como la tecnificación, la infraestructura y los recursos del sistema de salud. El segundo es el cuidado, en el que la condición laboral tiene incidencia, ya que los profesionales de enfermería sienten culpabilidad, agotamiento y estrés, y comprometen la buena percepción del cuidado médico y el sentido de trascendencia profesional. Conclusiones. El acto del cuidado de la enfermería está rodeado de situaciones poco favorables, dadas las barreras en el sistema de salud colombiano, que comprometen la labor del enfermero. Por lo tanto, es necesario reflexionar y desarrollar conceptos relacionados con los patrones de conocimiento de la disciplina, que inciden en la formación de los nuevos profesionales. Esto, con el fin de cumplir a cabalidad el deber ser y el hacer de la enfermería en Colombia. Duque-Castro JA, Ortiz- Urbano J, Rengifo-Arias DM. Entorno y cuidado: circunstancias que influyen en la calidad de la atención percibida por los colombianos. MedUNAB. 2018;21(2):60-68. doi:10.29375/01237047.2799
Traditionally, the relationship between the body and the right has been approached from the positive instance of the law. To that extent, the body becomes a surface on which penalizes the crime ...evident truths. Contrary to this perspective, this article aims to rethink the importance of expanding the dialogue with other knowledge law so that opens a thoughtful way to interpret their exercise and introduce another way of studying the body and the complexities around same weave.
The aim of this study was to evaluate the effect of a proposal of moderate-intensity group exercise (EGMI) program on blood pressure (BP) and functional capacity (VO2peak) in hypertensive ...post-menopausal women. Thirty female volunteers (63.36±1.06 y; 158.6±5.50 cm; 70.97±9.44 kg; 28.21±2.60 kg·m-2) were randomly assigned to an EGMI group (n=15) and a control (n=15, CG), which maintained its activities of daily life, for 12 weeks. Systolic (SBP), diastolic blood pressure (DBP) and VO2peak, estimated using the six-minute walk test, were evaluated before and after the intervention. Significant change in SBP was found in the EGMI group (mean change 95% CI, p-value, Cohen’s d; -9.2 -3.95, -14.44 mmHg, p=0.002, d=-0.7), while no changes were found in CG. DBP was unchanged in the EGMI group but increased significantly in the CG (10.0 3.72, 16.27 mmHg, p=0.004, d=1.1). A significant increase in estimated VO2peak was observed in EGMI (3.87 2.91, 4.82 ml∙kg-1∙min-1, p<0.001, d=1.2), with no difference in CG. There were significant differences between the groups in SBP and estimated VO2peak (p≤0.05). Our proposal of EGMI reduces SBP and improves functional capacity in hypertensive post-menopausal women over 60 years old.
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