El presente trabajo estudia el proceso de organización de un sistema de referencias a partir del caso de las tipologías de colectivos de vivienda en altura diseñados en la Corporación de la Vivienda ...(CORVI). Empleando un enfoque de trazado de procesos, se identifican y comparan las regularidades y variaciones de forma y programa dentro de un conjunto de 18 tipos de colectivos diseñados entre 1953 y 1975. El resultado consigna un régimen de referencias desarrollado por CORVI que, con base en elementos nominativos, formales y técnicos regulares, articula una tipología de bloques de vivienda que durante dicho período serán conocidos como colectivos. Las variaciones y adecuaciones dentro de este conjunto tipológico son constantes, pero se vuelven más extremas hacia el final de la existencia institucional de CORVI, marcando un cierre y permitiendo considerar, más allá de lo canónico, la existencia de ciclos tipológicos dentro las prácticas de la arquitectura chilena.
To study the feasibility and validity of ultrasound-guided pre-chemotherapy marking of metastatic axillary lymph nodes followed by targeted axillary dissection (TAD), in breast cancer patients ...undergoing neoadjuvant chemotherapy (NACT).
Prospective diagnostic test study conducted between January 2016 and March 2018. Patients with breast cancer and indication for NACT, cN1 or cN2 axillary staging, were included. A clip was placed in the affected lymph node prior to NACT. A sentinel lymph-node biopsy (SLNB) and a clipped lymph-node biopsy (BCLIP) were conducted, followed by axillary lymph node dissection (ALND). Location rate (LR) and negative predictive value (NPV) were evaluated, taking SLNB, BCLIP and their combination (TAD) as evaluated tests and metastatic involvement in the ALND specimen as the gold standard.
Twenty-three patients were included in the study. Sentinel lymph node could only be detected in 19 cases (LR = 80.61%), whereas BCLIP was successful in 22 (LR = 95.65%). The sentinel lymph node coincided with the marked lymph node in 14 patients (60.9%). We found a NPV for the SLNB of 0.85 (95%CI: 0.61–1.0), whereas for TAD it was 1.00 (95%CI: 0.74–1.0).
TAD is a feasible test for axillary restaging after NACT, with a higher success rate than SLNB.
to study the feasibility and value of “Targeted Axillary Dissection” (TAD) in cN1 breast cancer (BC) patients undergoing neoadjuvant chemotherapy (NACT), in order to avoid unnecessary axillary lymph ...node dissection (ALND).
Design: Prospective observational study. Inclusion criteria: Patients with histologically confirmed cN1 staging BC and treated with NACT between January 2016 and August 2019 who accomplished clinical response. Method: Fine-Needle Aspiration (FNA) positive axillary nodes were marked with a metallic clip prior to neoadjuvant treatment. All patients were summited to TAD and ALND. Analysis of data: We performed 1: a feasibility analysis of clinical, radiological and pathological variables, as well as difficulties and complications of the TAD 2; a diagnostic test study of the sentinel lymph node biopsy (SLNB), clipped lymph node biopsy (BCLIP) and their combination (TAD), using ALND as the Gold Standard.
60 patients were included. 43 patients (71.7%) had a complete clinical lymph node response to NACT. Neither limitations nor complications in clip placement were found. Intraoperative location of the clipped node was problematic in 7 cases (11.7%). The pathological complete response rate (pCR) was 30.5% (18 patients) and ypN0 staging rate was 38.3% (23 patients). Sensitivity values of each technique were: SLNB: 80.9% (95%CI: 61.8–100); BCLIP: 80.8% (95%CI: 63.7–97.8); TAD: 92.6% (95%CI: 80.9–100) with negative predictive values of: SLNB: 84.6% (95%CI: 68.8–100); BCLIP: 81.0% (95%CI: 63.7–97.8); TAD: 91.3% (95%CI: 77.6–100).
TAD is feasible and valid to rule out axillary metastatic involvement in cN1 breast cancer patients who respond to NACT.
TAD consists in SLNB and a resection of a marked lymph node during breast surgery.TAD is valid to rule out metastatic axilla in cN1 breast cancer after NACT.The main limitation of this technique is the difficulty in clip visualization by US.
The expert system for predicting the service life of buildings, fuzzy buildings service life (FBSL), is a computer application that contributes to the preventive conservation of architectural ...heritage. It establishes the process for evaluating and analysing the vulnerability and the main risks for heritage buildings, managing durability and service life according to their functionality. This paper demonstrates, after a detailed study and analysis of the two main reference standards in the field of risk management, namely the international standard ISO 31000:2009 and the European standard EN 31010:2011, that the FBSL expert system has been developed in compliance with the specifications established in these standards. This research justifies the use of this method, based on a new expert system that predicts the future service life of homogeneous heritage sites worldwide. This model manages the risk affecting these buildings and also complies with the aforementioned standards. Finally, the practical application of the FBSL expert prediction system was carried out through the study of a specific architectural heritage site.
To determine predictive factors of axillary lymph node dissection (ALND) results in breast cancer (BC) patients undergoing neoadjuvant chemotherapy (NACT), and subsequent staging using Targeted ...Axillary Dissection (TAD).
Case-control study between January 2016 and August 2019. Patients with BC, cN1 staging, marked with a metallic clip prior to NACT, and subsequently staged with TAD and ALND were included. They were divided into 2 groups: ALND patients with or without metastatic involvement (group 1 and group 2, respectively). We carried out a univariate analysis comparing clinical, radiological, surgical and pathological variables, and a logistic regression, (dependent variable: positive result of ALND; independent variables: number of suspicious lymph nodes in diagnostic ultrasound, positive hormone receptors, HER2 positive, complete clinical-radiological response to NACT, positive TAD, and biopsy of ≤2 nodes in TAD). A score for prediction of a metastatic ALND was proposed, with an internal validation study.
60 patients were included: Group 1: 33 (55.0%); Group 2: 27 (45.0%). Tumor size (Odds Ratio (OR) = 1.67; 95%CI 1.02–2.74), number of suspected nodes in ultrasound (OR = 2.20; 95%CI 1.01–4, 77), HER2 positive (OR 0.04; 95%CI 0.003–0.54), clinical-radiological response to NACT (OR = 0.07; 95%CI 0.01–0.75), and positive TAD (OR 15.48; 95%CI 1.68–142.78) were independent predictors of a positive result in ALND. We developed a “positive ALND predictive score”, with good calibration (Hosmer-Lemeshow test: p = 0.65), and discrimination (AUC = 0.93; 95% CI 0, 87–0.99), with highest Youden index (0.7) at cut-off point of 17% risk of positive ALND (sensitivity = 100%; specificity = 70%).
Tumor size, number of suspected nodes, positive HER2, response to NACT, and metastatic TAD are independent predictors of ALND. The predictive score for positive ALND would be a good indicator to safely omit ALND.
•TAD is a new technique validated in last years as an axillary re-staging technique.•There may be other factors to predict ALND status: IHC, and clinical NACT response.•Tumor size, LN number, HER2, NACT response and TAD are predictive of ALND results.•A score including said factors has good internal value to predict the ALND results.
Between 1965 and 1985, the housing strategies and implementations formulated by the Chilean State were discussed along three different political lines, establishing conceptual, formal and urban plans ...related to their perspectives. During the mandate of Eduardo Frei (1965-1970), the problems derived from migration had repercussions in the cities, and the institutions focused on solving the problems of overcrowding and encampments, but continued the implementations of “Urban Remodeling”. In the following government of Salvador Allende (1970-1973), the political crisis would worsen and there was an increase in land seizures, as a system of struggle towards the acquisition of housing. The State carried out relevant actions, revitalizing the Housing Corporations and others to solve the deficit. Finally, with the coup d'état perpetrated by Augusto Pinochet (1973), the housing problem would be compounded by the reduction of the state apparatus, so that housing actions would be mainly mediated and executed mostly by the private sector, losing the developmentalist approach sought by previous governments. The purpose of this review is to examine the application of concepts and measures, as well as the main executions in housing matters, which were distinctive to each political stage and how they facilitated or hindered the development of housing as a key agency in urban construction.
Entre 1965 y 1985, las estrategias e implementaciones habitacionales formuladas por el Estado de Chile, se discutieron desde tres líneas políticas diferentes, estableciendo planes conceptuales, formales y urbanos relativos a sus perspectivas. Durante el mandato de Eduardo Frei (1965-1970), los problemas derivados de la migración repercutieron en las urbes, y las instituciones se enfocaron en solucionar los problemas de hacinamiento y campamentos, pero continuaron las implementaciones de las “Remodelaciones Urbanas”. En el gobierno siguiente de Salvador Allende (1970-1973), la crisis política se agudizaría y existe un incremento de tomas de terreno, como sistema de lucha hacia la adquisición de la vivienda. El Estado ejecutó acciones relevantes, revitalizando las Corporaciones Habitacionales y otros para solucionar el déficit. Finalmente, con el golpe de Estado perpetrado por Augusto Pinochet (1973), al problema de la vivienda se sumaría la reducción del aparato estatal, por lo que las acciones habitacionales de serán principalmente mediadoras y ejecutadas en mayor parte por el sector privado, perdiendo el enfoque desarrollista que procuraron los gobiernos anteriores. Mediante esta revisión se pretende examinar la aplicación de conceptos y medidas, como también las principales ejecuciones en materia habitacional, que fueron distintivas a cada etapa política y de qué forma facilitaron o dificultaron el desarrollo de la vivienda como organismo clave en la construcción urbana.
Esta obra conjunta es, en primer lugar, una revisión teórica de la antropología histórica. Desde la elaborada introducción del también editor Arsenio Dacosta, se trata de una revisión sui generis, ...por su excepcionalidad, de los autores más representativos y los aspectos teóricos que iluminan con mayor riqueza la intersección de las dos disciplinas que dan título al volumen. El libro hace posible la reunión de importantes investigadores que ahondan en la temática interdisciplinar, tratando de definirla desde un plano metodológico. Se trata de un recorrido ontológico que nos sitúa ante los factores cruciales y más conflictivos de los caminos recorridos por ambas disciplinas para el florecimiento de un debate epistemológico. Desde sus propios trabajos e investigaciones, los distintos autores nos describen los métodos y prácticas que les acercan a la historia y a la antropología, con referencias y aspectos que han tratado y desarrollado a lo largo de sus respectivas trayectorias.
Perioperative antibiotic prophylaxis has proved to reduce the number of postoperative infections. In cardiac surgery, the infections in the surgical site are found to be around 0.4-4%. The most ...common bacterias causing surgical site infections in cardiac surgery are gram-positive.
Our aim in to guide the reader in the decision of choosing the most adequate Perioperative Antibiotic Prophylaxis in each patient according to their characteristics and their environment.
The most recent bibliography was reviewed searching the most common antibiotics used in perioperative Antibiotic Prophylaxis in cardiac surgery. A bibliographic search was carried out in the PubMed-MEDLINE database. A peer review was performed and a total of 4 references of more than 30 were selected.
There is no difference in the Surgical Site Infections between the use of 1st generation of Cephalosporin or Glycopeptides such as Vancomycin or Teicoplanin. On the other hand, 1st generation of Cephalosporin reduces the incidence of infections produced by Staphylococcus. Nevertheless, Glycopeptides are better at avoiding infection produced by Staphylococcus and Enterococcus resistant than Cephalosporin.
Choosing Perioperative Antibiotic Prophylaxis must be individualized according to the bacterial flora in the environment, the different characteristics of the patients, and the type of cardiac surgery. Also, a high incidence of Staphylococcus Aureus methicillin-resistant must receive prophylaxis with Vancomycin and a second antibiotic should be considered.
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