bluuebunny/crossref_metadata_2025 huggingface dataset:
Dynamic method for determining the permeability of a layer of high-moisture agricultural raw materials for infrared radiation
Authors:   Timirâzevskaâ selʹskohozâjstvennaâ akademiâ, Zavaliy Aleksei A.
Published: April 2023

The developed dynamic method of integral heat fl ux determination is based on the single-capacity dynamic model of the thermal state of the temperature measuring transducer (TMT), experiencing thermal infl uence of the constant infrared radiation fl ux and natural convective heat exchange of the TMT surface with the surrounding air. The model can help determine the permeability of moist agricultural raw materials. The eff ectiveness of the integral heat fl ux method was tested by studying the infrared radiation permeability of a layer of purifi ed drinking water with salinity not exceeding 1 g/l and a layer of apple pulp of the Golden-Deliches variety. The response of the temperature measuring transducer to infrared radiation was experimentally determined in series when the radiation was applied directly to the TMT and through a 3 mm thick sheet of monolithic polycarbonate. A 1 to 6 mm thick layer of water and a 1 to 10 mm thick layer of apple pulp were placed on the polycarbonate sheet in 1 mm increments. As a result of approximation of the experimental data obtained, the authors determined the maximum constant temperature value of the TMT and the time constant value of the TMT transient heating process. It was found that increasing the thickness of the water layer from 1 to 6 mm was accompanied by a decrease in the layer permeability from 0.804 to 0.629 in an exponential relationship with an exponent coeffi cient of -0.736. As the thickness of the apple layer increased from 1 to 6 mm, the permeability of the wet layer decreased from 0.780 to 0.097 according to an exponential relationship with an exponent coeffi cient of -0.399. The suffi cient heating duration for the spherical TMT was about 70 s and for the blackened fl attened TMT it did not exceed 30 s. The coeffi cients of the power-law ratio can be treated as attenuation coeffi cients in the Bouguer law for thermal radiation with energy maximum at wavelength λmax equaling 0.9 to 1.1 μm.
Demo exam as a means of improving the quality of the state fi nal assessment of automobile college graduates
Authors:   Timirâzevskaâ selʹskohozâjstvennaâ akademiâ, Kubrushko Petr F.
Published: April 2023

The results of the state final assessment (SFA) determine the further updating of the educational process. During the integration of federal state educational standards and the new WorldSkills standards in the system of secondary vocational education, a new component - a demo exam - appeared in the structure of the state fi nal assessment. It emphasizes the simulation of real working conditions to solve practical problems of professional activity in accordance with the best world standards and national practices. The article presents the features of conducting a demo exam according to the WorldSkills standards for the majors and professions of the automotive industry. The authors discuss the positive and negative characteristics of this SFA form and consider the possibility of including the independent assessment of qualifi cations (IAQ) in the SFA system. This modifi cation provides conditions for conjugating the education system and the labor market. The state fi nal assessment of the graduates of secondary vocational education institutions has revealed the need to change the content and methodology of the training process and assessment activities. As a result of integrating the traditional system of fi nal assessment with the WorldSkills standards for the training area (major) 23.02.07 “Maintenance and repair of engines, systems and assemblies of motor vehicles” in the Automotive College, the authors have developed and tested a model of the demo exam based on the independent quality assurance methodology. The model provides a comprehensive assessment of the professional competence of graduates.
COVID-19 outbreaks among crew on commercial ships at the Port of Rotterdam, the Netherlands, 2020 to 2021
Authors: Gebuis Edward , Vieyra Bruno , Slegtenhorst Rob , Wiegmans Saskia , van Dijk Bas , Veenstra Thijs , Tejland Saskia , Fanoy Ewout , de Raad Annemieke , Koopmans Marion , de Vries René , van Leeuwen-Voerman Saskia , Whelan Jane
Published: April 2023

Background

During the COVID-19 pandemic, international shipping activity was disrupted as movement of people and goods was restricted. The Port of Rotterdam, the largest port in Europe, remained operational throughout.

Aim

We describe the burden of COVID-19 among crew on sea-going vessels at the port and recommend improvements in future infectious disease event notification and response at commercial ports.

Methods

Suspected COVID-19 cases on sea-going vessels were notified to port authorities and public health (PH) authorities pre-arrival via the Maritime Declaration of Health. We linked data from port and PH information systems between 1 January 2020 and 31 July 2021, derived a notification rate (NR) of COVID-19 events per arrival, and an attack rate (AR) per vessel (confirmed cases). We compared AR by vessel type (workship/tanker/cargo/passenger), during wildtype-, alpha- and delta-dominant calendar periods.

Results

Eighty-four COVID-19 events were notified on ships, involving 622 cases. The NR among 45,030 new arrivals was 173 per 100,000 impacting 1% of vessels. Events per week peaked in April 2021 and again in July 2021, when the AR was also highest. Half of all cases were notified on workships, events occurring earlier and more frequently than on other vessels.

Conclusion

Notification of COVID-19 events on ships occurred infrequently, although case under-ascertainment was likely. Pre-agreed protocols for data-sharing between stakeholders locally and across Europe would facilitate more efficient pandemic response. Public health access to specimens for sequencing and environmental sampling would give greater insight into viral spread on ships.
"Do I look pale?" A therapist's life-changing journey
Authors: Karamatsouki Marilena
Published: April 2023

The subject of therapists facing an illness or living with a health condition that impacts their practice hasn’t been addressed much. In my research I confirmed what I have been noticing in my practice as a systemic therapist: the relational space within myself, my thoughts, emotions, memories and embodied reactions, interconnects with the relational space between client and therapist. My inner voices, what I experience, feel and think (Rober, 2010) affect the way I connect to my clients. This means that when I am fully present with my various selves in the therapy room, more of the client is in there too. Therefore, when I was diagnosed with cancer, I chose to disclose my illness to my clients. In this paper, I discuss my experience with cancer, the way it had an impact on my practice and how I found a way to include the relational space within myself facing an illness in the therapy room. The story that is included in the paper is a story from within practice that appears in my doctoral thesis (Karamatsouki, 2020).
On being a therapist, a tutor, a researcher and just another community member
Authors: Simon Gail
Published: April 2023

Writings from 2007
In 2007, I had “one of those years”. Many dreadful things happened. I hear myself think, “It could have been worse”. Nevertheless, it was a challenging year for me. And doing work which is all about supporting others with their struggles, their work, their learning was sometimes tough, frequently moving. I was aware of how I was drawing on the experiences of clients and trainees and other people I had met who had faced serious illness or death. Despite my commitment to limit imbalance of power in therapy, the experience of loss and illness created a sense of levelling that I had not anticipated. I chose to “come out” from behind that generic version of me as therapist, trainer, researcher and reveal more to people than I was used to. I’m not entirely sure how much I made a choice to do that but I did try to manage things in a professional manner. Whatever that means.
Four particular conversational clusters stood out for me that took place during that year. I wrote them at the time but I see that I have written them in the past tense. I think I needed to. Put them in the past. I was, in some ways, still in shock so writing in the past tense helped me create a timeline to locate me in another time zone known as The Present. It was a better place to be and one from which I could create another perspective.
Inching forward, lunging back. A duoethnographic poetic inquiry into practitioner experiences of health and ill health
Authors: Evans Julia , Salter Leah Karen
Published: April 2023

This contribution is, in essence, a collection of poems that the two authors wrote over a period of four weeks. The temporal element is interesting. It speaks to a commitment to “go on” (Wittgenstein, 1953) at a time of illness and recovery.
Duoethnography, as collaborative activity, invites new meaning by layering what could be seen as separate narratives and creating a dialogue between the evolving stories. This enables new meaning to evolve and intertwine. Undertaking an inquiry through poetry was an important decision. The intention being to provoke and promote creativity, to generate feelings of wellbeing at a time of depleted energy. Writing to and with each other was both an act of generosity and an act of self-preservation. Mutual support, maybe one way to frame it, but it was also outward looking, connecting with how we practice as therapists, how we are in the world, the causes we care about, all part of the awkward dance of living with health challenges.
The poems provide their own context in a way but we have wrapped prose around the main body of the paper which is written in stanza. We feel the poetry offers a window into individual, seemingly separate experiences of ill health and a developing shared narrative of “going on”. Through the writing process, it has become clear that the poetry benefitted from the scaffolding of prose, to give the reader greater insight into the structure and sense making process.
The language of inquiry speaks to what we learnt/are learning about ourselves through the process, rather than describing a research project with particular anticipated outcomes. The reflections are contained within the poems and expressed through limited words but expansive feeling.
Poetic inquiry aims to humanise research with an emphasis on lived experience and researcher reflexivity. In this case the researchers and their research material could be seen as one and the same thing, an “entanglement of matter and meaning” (Barad, 2007, p. 1). But they might also be seen as separated by time and space. Since writing the pieces, new
space has developed between illness and life unfolding, life that includes our practices as therapists. And new space has developed between the feelings we experienced at the time, the words we chose to convey them and how we feel now, looking back. Time and space may offer differing lenses, but maybe not.
The paper as a whole is an example of writing from within lived experience, written in poetic form. The form supported the authors to write their way through illness and into new territory of living with and beyond life impacting health conditions.
“HOW DID I HAPPEN TO BE HERE?” SPACE OF LOST IDENTITY IN “THREE SISTERS” BY ANTON CHEKHOV AND “THE BLACK SNOWSTORM” BY ANASTASIA BUKREEVA
Authors:   Russian State University for the Humanities, Mariakhina Elena A.
Published: April 2023

In the article, we make an attempt to study the interaction between the problematics of literary space and character’s identity in a dramaturgical work on the material of the plays “Three Sisters” by Anton Chekhov and “The Black Snowstorm” by Anastasia Bukreeva. The analysis is based on certain statements of chronotope theory developed by Mikhail Bakhtin. The paper considers the motif structure that in a certain way forms the literary space, in particular, the motifs of higher place and lower place, certain characteristics of the organization of space and time, such as isolation, “corpuscularity”, and cyclicity. An analysis is made of the complex interconnection between the place and the way of the characters’ self-determination, which is associated both with the structure of space and with the way the character perceives this space and himself within its boundaries. The nature of dramaturgy defines how the stage and off-stage spaces are organized, and the exploration of the significance of the off-stage chronotope may provide an additional perspective to navigating the character’s inner live determined by his perception of the place of acting. The purpose of this paper is to compare the approaches of the two playwrights to the existential aspects of literary space, as well as the problematics of the connection of a person’s identity with the world in which he finds himself for some reason.
CHANGING THE GENRE OF THE DIARY IN V. NABOKOV’S NOVEL “LOLITA”
Authors:   Tver State University, Shmeleva Elizaveta V.
Published: April 2023

The article analyzes how the techniques of the novel genre in the “Lolita” by V. Nabokov change the primary speech genre of the diary. The point of view category is considered as a technique of genre formation. In that case, the intimacy of the text, which the diary genre implies, is violated by the presence of not only the point of view of the notes author but also the reader’s one. The reader, which the hero-narrator assumes, determines the manner of narration. The diary of Humbert Humbert takes on the features of fiction, and even isolated from the text of the novel, it will still have signs of a secondary speech genre.
THE FEATURES OF METACYCLIZATION IN ROCK POETRY. ON THE EXAMPLE OF THE LYRICS OF THE GROUP “DDT”
Authors:   Russian State University for the Humanities, Belyaeva Natalya P.
Published: April 2023

The phenomenon of metacyclization is based on a complex system of relationships that form the lyrical cycle of works and makes it possible to realize the creative ideas of the author, potentially unresolved in poetry in other ways. The article is about the features of metacyclization in modern rock poetry on the example of the works of Y. Shevchuk, the soloist of the group “DDT”. The essence and specifics of the phenomenon in lyrics are briefly defined and the main types of its implementation are listed. The article, using specific examples from Y. Shevchuk’s poetry, considers various forms of the existence of metacycles as secondary author’s cycles and as larger-scale lyrical cycles united by theme, chronotype, etc. The means and tools used by the author to create a single composition of the cycle, the implementation of the author’s intention are characterized. The paper states that in rock poetry the compositions, the most popular or subjectively significant for the author, as a rule, are subject to secondary cyclization. It was revealed by specific examples that the context of the metacycle not only enriches the works of rock poetry with new meanings, but sometimes also transforms their text in accordance with the current author’s position one whole concept of the lyrical cycle. Numerous references to the work of Russian writers and poets, to the compositions of colleagues confirm the unity and interconnection of Yu. Shevchuk’s poetry not only with modern Russian rock, but also with Russian literature in general.
Tecnologia educacional e princípios e métodos de ensino de inglês
Authors: Fatehi Kefsan
Published: April 2023

Os instrumentos auxiliares de ensino como interface têm conseguido desempenhar bem o seu papel e seria melhor se os professores tivessem as habilidades necessárias para usar essas ferramentas. Hoje, especialistas e pensadores de todo o mundo enfatizam a importância e determinam o papel da tecnologia educacional no processo de aprendizagem e acreditam que o uso ideal de facilitadores de ensino em vez de professores terá um efeito construtivo na melhoria da qualidade da educação. Devido aos problemas do sistema educacional do nosso país no ensino de inglês e à falta de habilidades dos alunos treinados, especialmente em falar, ouvir e escrever, muitos pais tentam cobrir essa deficiência no sistema educacional recorrendo a escolas avançadas. Assim, neste artigo, decidimos examinar o papel do ensino de tecnologias assistivas na facilitação do ensino de língua inglesa em salas de aula.
SMART CITIES: AN EMPIRICAL STUDY OF DEFINITIONS
Authors: Batra Ashish , Chhabra Pankaj
Published: April 2023

This research has been done alongside the objective of set up a clear definition of smart cities that could possibly utilized globally. Despite a lot of material on smart cities that are accessible, there is no defined, widely used set of terminology that would assist in accurately defining a "Smart City".Around 115 current smart cities definitions were analysed and examined by utilizing as a guideline the themes and attributes of smart cities. These definitions have been acquired from numerous sources such as user-centric definitions, company/corporate profiles, national and international organizations (United Nations, ITU, Indian Smart Cities Mission, etc.), government initiatives, academia & research communities, standards development organizations, and trade associations. A list of thirty important terms that need to be included in a standardized definition was determined, and important indicators and categories were also established. Finally, to conclude on the basis of the given analyses, a suggested definition for the “smart city” was given by the following:An innovative city is known as a "smart city" if it adopts ICTs (“information and communication technologies”) including innovative methods to enhance wellbeing, the effectiveness of urban services and environment, while simultaneously fulfilling the social, environmental, and economic requirements of both the present as well as the future generations.This derived definition is such a definition which can be generalized for any smart city with basic fundamentals terms mentioned in it and can be adopted widely throughout the world.
America’s Hegemony Under Challenge: New Cold War Arising from the Deepening Collusion between China and Russia and their Formation of an Influence Sphere
Authors:   The Korean Association Of Area Studies, Jang Siryung , Namkoong Young
Published: April 2023

America's hegemony is severely under challenge from China and Russia. Considering the influences of the United States, China, and Russia globally, conflicts among them accelerate the instability of the current international system and inevitability increase the possibility of a new Cold War. China, second in terms of GDP after the United States, and Russia, second in military dominance, are trying to form influence spheres in which they exert main influence based on their economic and military power.
The spatial range of China and Russia's influence spheres is Eurasia and the Indo-Pacific region, with behavior being mainly political, economic, military, and security-oriented. Meanwhile, as conflict intensifies with the United States, both China and Russia are deepening their relational ties by expanding and accelerating the influence and development of the Shanghai Cooperation Organization and BRICS to achieve countervailing power against the United States. They are also trying to replace the current international leader of the United States via alternatives of their own.
As China and Russia cooperate more intimately, the United States is mobilizing various available political, economic, and diplomatic instruments. Above all, it seeks to cooperate with 'like-minded partners,' such as the Atlantic and the Pacific Alliance. As the structure of 'China and Russia's challenge to current order' and 'the deterrence of United States to block the rise of China and Russia' becomes more concrete, the world is on the verge of a New Cold War.
A (baixa) incidência da pedagogia crítico-superadora no campo científico da Educação Física
Authors: Souza Rafael Duarte de , Costa Jonatas Maia da
Published: April 2023

A (baixa) incidência da pedagogia crítico-superadora no campo científico da Educação Física
ResumoAo identificar a pedagogia crítico-superadora como partícipe de uma compreensão de educação física crítica, o artigo apresenta os resultados de um levantamento bibliográfico em importantes periódicos da educação física brasileira bem como nos anais do Congresso Brasileiro de Ciências do Esporte, em particular nos trabalhados apresentados no GTT Escola. O objetivo do estudo foi o de revelar a incidência da pedagogia crítico-superadora no campo científico da educação física. Os poucos trabalhos encontrados demonstram o quão permanece desafiador o trabalho formativo em torno de uma perspectiva de formação humana de caráter emancipatório na educação física escolar. Contudo, quando a pedagogia crítico-superadora comparece em produtos científicos, observa-se uma tendência de valorização de trabalhos de intervenção pedagógica.Palavras-chave: Educação Física Crítica. Pedagogia Crítico-Superadora. Marxismo. Escola.
The (low) incidence of critical-overcoming pedagogy in the scientific field of Physical Education
AbstractThis article presents the results of a bibliographic survey in important Brazilian physical education journals as well as in the annals of the Brazilian Congress of Sport Sciences, identifying the critical-overcoming pedagogy as a component for understanding the critical physical education thinking. The purpose of the study was to show the incidence of critical pedagogy for overcoming difficulties in the scientific field of Physical Education. The few studies founded demonstrated how challenging is to develop an educational work based on principles of human emancipation in school physical education. However, when critical pedagogy for overcoming difficulties appears in scientific papers, there is an appreciation of pedagogical intervention works.Keywords: Critical Physical Education. Critical-Overcoming Pedagogy. Marxism. School.
La (baja) incidencia de la pedagogía crítico-superadora en el campo científico de la Educación Física 
ResumenAl identificar la pedagogía crítico-superadora como partícipe de una comprensión de educación física crítica, el artículo presenta los resultados de una investigación bibliográfica en importantes revistas brasileñas de educación física, así como en los Anales del Congreso Brasileño de Ciencias del Deporte, en particular en los trabajos presentados en el GTT Escuela. El objetivo de este estudio fue revelar la incidencia de la pedagogía crítico-superadora en el campo científico de la educación física. Los pocos trabajos encontrados demuestran cuán desafiante sigue siendo el trabajo formativo en torno a una perspectiva de formación humana de carácter emancipador en la educación física escolar. Sin embargo, cuando la pedagogía crítico-superadora aparece en los productos científicos, hay una tendencia a valorar el trabajo de intervención pedagógica.Palabras clave: Educación Física Crítica. Pedagogía Crítico-Superadora. Marxismo. Escuela.
EVALUATION OF THE CLINICAL PARAMETERS OF A GROUP OF PATIENTS WITH TRIPLE-NEGATIVE BREAST TUMORS
Authors: Silva Jane Braga da , Lauria Patrícia Bittencourt Marques , Lucena Clécio Ênio Murta de , Santos Mayra de Oliveira
Published: April 2023

Objective: This study aims to evaluate the prevalence of triple-negative breast cancer (TNBC) in breast cancer patients treated at the Mastology Service of the Hospital das Clínicas – Federal University of Minas Gerais (HC-UFMG/EBSERH) and to analyze other clinical parameters in this population, such as age, clinical stage at the first consultation, and family history (FH) for cancer. To describe the systemic treatment, the surgical approach and the pattern of response after neoadjuvant chemotherapy were used. Methods: A retrospective cohort study was carried out with the analysis of 337 patients treated at the Mastology Service of HC-UFMG with TNBC. The study was approved by the National and Institutional Research Ethics Committee. Results: Of the 337 patients analyzed, 45 (13.35%) had TNBC. The median age of the patients was 51 years, the minimum age was 24 years, and the maximum age was 77 years. Clinical staging at the first consultation corresponded mostly to stage IIIA (46%), followed by 15% in stage IA and 12% in stage IIB. The positive FH for cancer in a first-degree relative was 52%. In addition to mastectomy, performed in 50% of patients, axillary lymphadenectomy was added in 70% of cases and sentinel lymph node biopsy in the remaining 30%. Of the patients who underwent conservative treatment, 50% underwent axillary lymphadenectomy and 50% underwent sentinel lymph node biopsy. Only 5% did not undergo chemotherapy (early stages). Fifty-nine percent underwent neoadjuvant chemotherapy, fulfilling the indication criteria authorized by the Unified Health System. Pathological complete response was achieved in 32% of patients. Conclusion: The incidences found in the population with TNBC assisted by the mastology service of the HC-UFMG are similar to those found in the world population. The 45 (13.35%) patients in the study with TBNC are mostly (58%) in advanced clinical stage with positive FH (52%).
SELF-PERCEPTION OF HAPPINESS IN WOMEN WITH BREAST CANCER
Authors: Magalhães Maria Cristina Figueroa , Karvat João Gabriel Vicentini , Lima Jéssica Heloise Camargo de , Pasquini Neto Ricardo
Published: April 2023

Objective: The aim of this study was to establish correlations between well-being and breast cancer (BC)-related aspects. Methods: Women with BC diagnosis (n=42) were interviewed and National Gross Happiness was assessed through an adaptation of the Second Gross National Happiness Survey Questionnaire. Cancer-related data were also assessed, such as staging, anatomopathological results, hormonal status, and surgical modality. Results: The mean age during BC diagnosis was 43.8 years. The overall happiness self-perception (HSP) score found was 8.8 out of 10. Unhappy feelings or deprived humor were reported by 61.8% of the interviewed women. Good doctor-patient relationship (DPR) during treatment was reported by 92.3% of the study population, and those who reported it had higher overall HSP scores in comparison with those who reported problems regarding their DPR. Besides, 97.6% of the interviewed women had surgical treatment, and our data showed no significant changes in the overall HSP scores among patients undergoing mastectomy and lumpectomy. Conclusion: Women with BC are prone to experience unhappiness and have deprived humor, despite having high overall HSP scores. Besides, in contrast to our original thoughts, the modality of surgical treatment did not have a significant impact on HSP scores.
PREVALENCE STUDY OF CLINICAL INDICATIONS FOR BREAST MRI
Authors: Oliveira Ilse Franco de , Diniz Camila Leal , Rahal Rosemar Macedo de Souza , Gonçalves Macks Wendhell , Ruiz Cristina Pinto Naldi , Lauar Marcelo Vilela , Almeida Paulinelly Messias de , Freitas-Junior Ruffo
Published: April 2023

Objective: This is a cross-sectional study of the clinical indications and prevalence of breast magnetic resonance scan. Methods: Data were collected retrospectively from women who had breast MRI performed at the Clínica São Marcelo and who agreed to participate in the study during the period 2020–2021. The data were extracted from the anamneses and respective medical reports of 308 women who had breast MRI scans and analyzed using the SPSS statistical software version 26.0. Results: The predominant age group was 40–49 years with a relative frequency of 34.9%, followed by 50–59 years representing 26.7%, women over 60 years with a frequency of 19.9% and 18–39 years with a relative frequency of 18.6%. Regarding clinical indications for breast MRI, breast lump presented 28.2% of indications, breast prosthesis control accounted for 11.7%, family history of cancer 11.7%, breast cancer control 9.4%, post-treatment control 8.4%, screening 6.5%, breast cancer follow-up 5.5%, dense breast 5.5%, family history of cancer and nodule 4.9%, preoperative 3.2%, asymmetry 2.3%, microcalcifications 1.3%, and breast cancer mutation 1.0%. In the Bi-Rads classification, higher percentage for Bi-Rads 2 represented 49.8% and Bi-Rads 3 with a frequency of 27%; Bi-Rads 4 represented 13.4%, Bi-Rads 6 with 5.5%, Bi-Rads 1 with 3.3%, and Bi-Rads 5 represented 1.0% of the classifications of the medical reports. Conclusion: This study showed the predominant age group of the women who attended was 40–49 years, and the most prevalent clinical indication for breast MRI was breast lump.
CLINICAL CHARACTERIZATION OF PATIENTS WITH BREAST CANCER DOING FOLLOW-UP ON A REFERENCE HOSPITAL IN THE WEST OF SANTA CATARINA STATE, BRAZIL
Authors: Duarte Maria Laura Peraça , Reichert Marilia Elis , Mânica Aline
Published: April 2023

Objective: This study aims to describe the clinical and laboratory parameters of patients with breast cancer doing follow- -up in the city of Chapecó, from 2015 to 2020. Methods: This is a quantitative, retrospective, documental, and descriptive research, which evaluated the medical charts of 64 female patients diagnosed with breast cancer from 2015 to 2020, doing follow-up in the Hospital Regional do Oeste in the city of Chapecó, Santa Catarina state, Brazil. The data were evaluated through mean (±standard deviation), total frequency, and relative frequency. This research was approved by the Unochapecó’s involving human beings’ ethics committee under the n. 52495721.8.0000.0116. Results: The average age of the analyzed patients was 52.7 years (SD±11.3 years). Regarding the carcinoma subtype, 89.06% of the patients had the ductal subtype and 10.94% had other types of carcinoma (lobular, tubular, mucinous, and papillary). Four variations of molecular subtypes were found: luminal A (n=28), luminal B (n=28), triple-negative (n=5), and HER2-enriched (n=3). Besides that, when evaluating the pathological state, it was noticed that 26.56% had compromised lymph nodes and 9.38% had metastasis. Conclusion: Although the scientific literature indicates that the most common molecular subtype is luminal A (about 60% of all breast cancers), in this study it could be verified that there is a similarity in prevalence percentages between the molecular subtypes luminal A and B. The molecular subtype luminal B has the worst prognosis, higher risk of reappearance, and lower survival rate when compared to the luminal A molecular subtype.
AXILLARY LYMPH NODE CLIP PLACEMENT AND RESECTION AT SURGERY: A SINGLE-CENTER STUDY
Authors: Carvalho Graziela Couto de , Rengel Heloisa Helena Gonçalves , Monteiro Barbara Barbosa , Venezian Larissa Scarabucci , Mello Aline Campos Oliveira , Rodrigues Fábio Francisco Oliveira
Published: April 2023

Objective: This study aims to identify the characteristics of patients who underwent axillary lymph node clipping (ALC) and determine the detection rate with sentinel node biopsy (SNB). Methods: This is a retrospective study with a review of medical records, including patients who were submitted to ALC from 2018 to 2021 and who underwent neoadjuvant chemotherapy (CH) or upfront surgery. In patients with SNB, the clipped node was marked with Technetium-99m before surgery. Results: We identified 13 patients who underwent ALC at diagnosis: 8 were submitted to SNB and 5 to axillary dissection without SNB (4 due to poor response to CH, 1 due to lobular histology with upfront surgery). The mean age was 54 years (38% <50 years). The clinical staging was: 12 with cT2cN1 — IIB and 1 with cT3cN2 — IIIA. Concerning tumor characteristics, 12 (92%) patients had ductal histology and 1 lobular; 3 patients had triple-negative disease (23%), 8 patients had luminal disease (61%), and 2 patients had triple-positive disease (15%). In 4 of the 8 patients who underwent SNB, the clip was identified in the image after surgery (2) or in the frozen section (2), and in 4 patients, no information regarding the localization of the clip was obtained in the records regarding the surgery. However, in the follow-up images, the axillary clip was not identified, presuming that it was removed. Considering the patients who did SNB, the detection rate was 50%. Conclusion: According to previous studies, ALC at the time of diagnosis is a useful tool to guide targeted axillary dissection, reducing the false-negative rate (FNR) of SNB after CH. It is important that the clip removal check is performed. Our results reflect that this verification is not always performed, which may have reduced identification rates. However, this study encourages further prospective studies to be carried out, with standardization of techniques for clip identification, improving detection rates, and reducing FNR of SNB in these patients.
ULTRASOUND-GUIDED VACUUM-ASSISTED RESECTION: REPORT OF A CASE SERIES
Authors: Alves Katyane Larissa , Rodrigues Frank Lane Braga , Pinto Sebastião Alves , Freitas-Junior Ruffo
Published: April 2023

Objective: This study aims to report a series of cases of lesions that were probably benign (ACR® BI-RADS 3) and with a low degree of suspicion (ACR® BI-RADS 4A) submitted to vacuum-assisted resection for diagnostic and therapeutic purposes. Methods: From August 2020 to January 2022, 16 patients underwent ultrasound-guided 10-gauge vacuum-assisted needle resection under local anesthesia. The biopsy needle was positioned according to the echographic view of the lesion, in order to obtain the fragments by suction. After the procedure, a titanium clip was positioned demarcating the site. Results: We performed 16 vacuum-assisted resections in lesions whose largest diameter varied between 0.4 and 2.5 cm (median=1.4 cm and standard deviation (SD)=0.66). We obtained samples whose measurements of the set of fragments varied between 2.2 and 3.6 cm (median=3.0 cm and SD=0.37). Of the 16 cases, 15 histologies were benign, predominating fibroadenomas and having 2 complex sclerosing lesions. Only 1 ductal carcinoma in situ. We had 1 case of hematoma with clinical repercussions and 1 case of increased bleeding at the skin incision site, both managed conservatively with good evolution. Conclusion: In our case series, vacuum-assisted resection allowed the investigation and, in most cases, the necessary therapy for the management of BI-RADS 3 and BI-RADS 4A lesions when the histology was benign and provided sufficient diagnostic data for the conduction of the case of carcinoma in situ, in which the conservative surgery performed maintained the same histological diagnosis. Vacuum-assisted resection can, in selected cases, replace a diagnostic and/or therapeutic surgical procedure, reducing morbidity and costs in the investigation and treatment of breast lesions, with minimal complications.
PREPECTORAL BREAST RECONSTRUCTION: A PRELIMINARY REPORT OF A CHILEAN EXPERIENCE IN 46 PATIENTS
Authors: Letzkus Jaime , Río María José del , Galté Jorge Gamboa , Bononato José Manuel Lagos , Belmar G. Alejandro , H. Andrea Sepúlveda
Published: April 2023

Prepectoral total breast reconstruction (PPTBR) has become a popular technique due to the many benefits observed in properly selected patients. Compared with the retropectoral implant position, PPTBR has the advantage of maintaining the pectoral major muscle in its anatomic original position, avoiding acute and chronic pain, maintaining better extremity strength and motion, and avoiding animation deformity and post-radiotherapy pectoral fibrosis. The basic principles of the technique can be used with a tissue expander or permanent implants. We present the preliminary report of 46 patients (51 breasts). In all, 20 out of the 46 patients had an association with radiotherapy; 18 of them received post-mastectomy radiotherapy and 2 received total breast irradiation on previous conservative treatment. The period of follow-up was 2–32 months, beginning in July 2019. The main surgical approach was using a lateral aspect of the inframammary fold incision. Depending on the new subdermal implant pocket width, in 20 patients, a synthetic mesh was placed. We only had two major complications: one who required reintervention due to radionecrosis and conversion to a dorsal flap plus a permanent implant, and the other who required a change into a retropectoral plane reconstruction due to wound dehiscence. No implant infection of grade 3–4 capsular contraction has been reported so far. The aesthetic result was excellent for most patients and the surgeon’s opinion, according to the Harris scale.
CASE REPORT: PHYSIOTHERAPY TELESERVICE IN THE IMMEDIATE POSTOPERATIVE BREAST CANCER SURGERY
Authors: Trevisan Lais de Abreu , Oliveira Barbara Valente de , Salerno Gisela Rosa Franco , Lima Rafael de Albuquerque , Antonini Marcelo
Published: April 2023

Introduction: Breast cancer is one of the most incidents and most common among women; surgical intervention is the main treatment, and physiotherapy plays an important role in the postoperative period, especially in the maintenance of range of motion and prevention/control of lymphedema. In the face of the contemporary scenario in which social isolation has been maintained due to the COVID-19 pandemic, the Federal Council of Physiotherapy and Occupational Therapy in Brazil released forms of remote care for patients who need clinical intervention. Objective: This study aims to report the experience of telecare in physiotherapy in the postoperative period of breast cancer surgery, focusing on aspects, pain, fatigue, mobility of the upper limb, and development of lymphedema. Case report: This is an experience report based on the telecare of a 61-year-old mastectomized patient, with 9 consultations, 8 in the remote format. The participant was evaluated regarding health habits, edema, sensation of pain, and tiredness using the Visual Scale of Pain (VAS), the Borg Rating of Perceived Exertion Scale, and a self-authored mastology questionnaire. In the initial evaluation, we found movement limitation (flexion-90º, extension-30º, and abduction-90º), the sensation of tightness in the scar, the sensation of a heavy limb, and dryness on the side of the surgery. In the final evaluation, we observed improvements when compared to the member opposed to surgery, in the gain of range of motion (flexion-180º, extension-45º, and abduction-180º), reduction of pain (VAS) and fatigue (BORG), and improvements in activities of daily living. Conclusion: The service in physical therapy was effective and obtained results similar to those expected in conventional face-to-face physical therapy treatments.
SENTINEL NODE BIOPSY WITH MAGTRACE® IN A HER2-POSITIVE PATIENT DIAGNOSED DURING PREGNANCY WITH COMPLETE CLINICAL RESPONSE TO NEOADJUVANT TREATMENT
Authors: Letzkus Jaime , Galté Jorge Gamboa , Río María José del , Belmar Alejandro , Bononato José Manuel Lagos , Sepúlveda Andrea
Published: April 2023

During the past decades, there has been significant progress in breast cancer diagnosis and treatment, which has led to improvement in overall and breast cancer-specific survival. It has also enabled the possibility of de-escalating the extent of surgeries. There is growing evidence that supports sentinel lymph node biopsy (SLNB) after neoadjuvant treatment, even in cases with positive lymph nodes at diagnosis. One of the key goals is the achievement of low false-negative rates for SLMB detection. Technetium-99 (Tc99) is considered the gold standard tracer worldwide. Nonetheless, access to a nuclear medicine department, the timing of Tc99 injection, operating room schedules, and administrative limitations can cause increased overall costs of care and patient discomfort. There is compelling evidence that supports the use of new tracers; one of these is the superparamagnetic iron oxide (SPIO, Magtrace®). The SPIO allows the detection of the sentinel node marking hot spots and has the advantage of dyeing the nodes with a brownish color. We present a novel experience with this tracer in a Chilean public hospital. A 33-year-old patient was diagnosed with right breast cancer during pregnancy (21 weeks). The core biopsy revealed an invasive ductal carcinoma HER2-positive, cT2N0M0 (25 mm). The patient completed neoadjuvant chemotherapy, and pregnancy interruption was scheduled at 37 weeks by cesarean section. Trastuzumab (TTZ) was initiated right after delivery and breast conservation surgery with SLNB using SPIO, and blue dye was performed thereafter. Intraoperative biopsy revealed three negative nodes, concordant with the hot spots and dyeing seen in surgery. This case shows the efficacy of neoadjuvant treatment and TTZ in HER2-positive patients with a high rate of complete clinical response. In our opinion, this new tracer is an excellent and affordable alternative to Tc99 and could avoid the use of blue dye.
IRON OVERLOAD IN A BREAST CANCER PATIENT WITH A HOMOZYGOUS MUTATION IN THE HFE HEMOSTATIC IRON REGULATOR GENE: CONSIDERATIONS REGARDING THE USE OF ADJUVANT HORMONE THERAPY
Authors: Esteban Jorge Illarramendi , Alvarellos Montserrat , Rodriguez Mercedes , Zabalza Amaya , Illarramendi José Juan
Published: April 2023

Introduction: Homozygous mutations in the HFE gene are among the causes of iron overload worldwide. Several reports suggest an increased risk of breast cancer (BC) in these patients, although there are controversial evidences on this subject. There is some discussion on the tolerance to some BC adjuvant therapies in these patients regarding aspects like the potential cardiotoxicities. Information on adjuvant hormone therapy in this setting is very limited. Case report: A 65-year- -old woman was treated with segmental resection in the left breast and selective biopsy of the sentinel node in April 2019. Pathology showed an infiltrating ductal carcinoma of 1.2 cm, grade 1, with two negative sentinel nodes. Estrogen receptor was 100%, progesterone receptor was 20%, Her2/neu was 1+, and Ki-67 was 15%. A previous diagnosis of hemochromatosis was done in October 2018 with a high transferrin saturation and a genetic analysis disclosing a homozygous C282Y mutation in the HFE gene. Regular phlebotomies every 3 months were scheduled for the treatment of the iron overload. Several points were considered for the selection of the adjuvant hormone therapy. Articular damage is a common complication of hemochromatosis. In fact, a hip prosthesis was implanted in 2018 for our patient with severe coxarthrosis. There was some risk of further articular impairment with aromatase inhibitors (AI). Furthermore, AI may have an androgenic effect, with some effect on the red cell mass. On the contrary, tamoxifen may increase the risk of porphyria crises in patients with hemochromatosis. We selected letrozole as adjuvant therapy, with good articular tolerance and fair hematological control after nearly 3 years of follow-up. Conclusion: Although homozygous HFE mutations may increase the risk of some adverse events related to BC adjuvant hormone therapy, the tolerance to letrozole in our patients has been very good, without raising further concerns.
LOCALLY ADVANCED SYNCHRONOUS BILATERAL BREAST CANCER: A RARE CASE REPORT
Authors: Belluco Rosana Zabulon Feijó , Gomes Carolina Gaze Gonçalves Fontenele , Belluco Paulo Eduardo Silva , Resende Vitória Vasconcelos de Lara , Belluco Júllia Eduarda Feijó , Vasconcelos Flávio Lúcio , Baqueiro Melissa de Andrade
Published: April 2023

Introduction: Synchronous bilateral breast cancer (SBBC) consists of the simultaneous presence of two primary tumors at diagnosis. There is no consensus on its origin, and it may be a metastasis of a primary lesion or a second independent tumor. The incidence of SBBC has been reported to be approximately 3%. The prognosis of SBBC was considered to be reserved, which is why bilateral mastectomy is the preferred approach. Case report: A 44-year-old patient with no family record of gynecological neoplasm sought care reporting bilateral breast pain and palpable nodular lesions on the breasts. On examination, a hard nodule measuring 10×12 cm was palpated on the left breast (LB) associated with ulcerated areas in the superior lateral quadrant. On the right breast (RB), a mobile nodule was palpable, measuring 8×8 cm with chocolate- -colored nipple discharge. Clinically positive axillary lymph nodes are bilateral. She had a mammogram, which showed a nodule with spiculated contours, measuring 2.5 cm in the SLQ of the LB, with apparent associated dermal retraction and multiple, grouped microcalcifications on RB-BIRADS 5. She underwent core biopsy, which resulted in invasive lobular carcinoma and dermal infiltration, with immunohistochemistry (IHC): positive PR and ER, positive HER2, Ki-67 positive in 40% on LB, and carcinoma invasive ductal, non-special type, with IHC: negative RP and RE, HER2 score 3+, and Ki-67 positive in 60% on RB. She underwent neoadjuvant chemotherapy, followed by bilateral mastectomy with sentinel lymph node biopsy. The anatomopathological (AP) study of the LB surgical specimens revealed residual ductal carcinoma in situ, free margins, and neoplasm-free lymph nodes. The RB’s AP revealed high-grade (comedocarcinoma), intermediate-grade residual intraductal carcinoma, alongside an extensive fibro hyalinized area of the stroma, foci of lobular cancerization, absence of residual invasive component, free margins, and absence of lymph node metastasis. The patient underwent adjuvant radiotherapy and hormone therapy with tamoxifen.
SPOROTRICHOSIS IN AXILLARY LYMPHADENOPATHY SIMULATING RECURRENCE OF BREAST NEOPLASM: A CASE REPORT
Authors: Alves Katyane Larissa , Rodrigues Frank Lane Braga , Pinto Sebastião Alves , Freitas-Junior Ruffo de
Published: April 2023

Introduction: Sporotrichosis is a mycosis caused by dimorphic fungi of the Sporothrix complex. It is an anthropozoonotic disease that can be transmitted to humans by contact with plants or animals, especially infected cats. Clinical presentation may vary depending on the host’s immunological condition. The diagnosis of sporotrichosis requires material obtained from lesion biopsies, which can be submitted for culture and microscopy. Case report: A 57-year-old female patient, being followed up for carcinoma in situ of the left breast, presented with ipsilateral axillary lymphadenopathy on routine examinations. She underwent ultrasound-guided core-needle biopsy of a suspicious lymph node in the left axilla, with a diagnosis of chronic granulomatous lymphadenitis containing fungal yeasts, suggestive of sporotrichosis. Treatment with systemic antifungal itraconazole was started with a good response. Discussion: Sporotrichosis is an important differential diagnosis for lymphadenopathy, associated or not with neoplasms being treated in our country. In the presented case, the patient had an oligosymptomatic presentation of sporotrichosis, probably a subacute form of the cutaneous-lymphatic presentation, initially evidenced only on evaluation with imaging methods, with a good response to systemic antifungal therapy with itraconazole, also remaining without signs of recurrence of breast cancer. Conclusion: Considering Brazil as an endemic area for sporotrichosis, the description of cases such as this one allows us to discuss and remember this differential diagnosis in clinical situations and/or in imaging examinations, even in patients undergoing follow-up for malignant neoplasms.