Once unimaginable, fertility management is now a nationally established part of cancer care in institutions, from academic centers to community hospitals to private practices. Over the last two decades, advances in medicine and reproductive science have made it possible for men, women and children to be connected with an oncofertility specialist or offered fertility preservation soon after a cancer diagnosis. The Oncofertility Consortium's National Physicians Cooperative is a large-scale effort to engage physicians across disciplines – oncology, urology, obstetrics and gynecology, reproductive endocrinology, and behavioral health – in clinical and research activities to enable significant progress in providing fertility preservation options to children and adults. Here, we review the structure and function of the National Physicians Cooperative and identify next steps.
RESUMEN Objetivo El objetivo de este estudio fue averiguar qué factores afectan el gasto de bolsillo en servicios de salud prestados por el MINSA y los gobiernos regionales a la población en condiciones de pobreza monetaria relativa entre 2010 y 2014. Materiales y métodos Estudio transversal descriptivo econométrico con cortes anuales (2010-2014) a nivel nacional con información de encuestas de hogares. La variable dependiente fue el gasto de bolsillo en salud de las personas en situación de pobreza monetaria relativa para costear su atención médica en servicios de salud públicos. Las variables independientes fueron la afiliación al Seguro Integral de Salud (SIS), el nivel de gasto familiar per capita, el grupo de edad (0-5 años), ser mujer en edad fértil (15-49 años), ser persona adulta mayor (mayor de 60 años)), la carga familiar (cuyo indicador proxy fue el número de miembros en el hogar), y el nivel de complejidad del prestador de servicios. Resultados Sólo 5% de la población rural objeto de estudio fue atendida en centros de mayor nivel de complejidad (hospital) frente a 16% de la del medio urbano. Los medicamentos concentraron el mayor gasto de hogares: 44% en los asegurados en el SIS y 62% en los no asegurados (2014). El gasto de bolsillo en salud se asoció positivamente con no estar afiliado en el SIS, el mayor nivel de complejidad del prestador, el nivel del gasto familiar per capita y ser adulto mayor. Conclusiones La afiliación al SIS es una variable de política relevante para disminuir el gasto de bolsillo en hogares pobres. El menor gasto de bolsillo de la población rural pobre, especialmente vulnerable, está fuertemente asociado con el uso casi exclusivo de servicios provistos por prestadores del primer nivel de atención. Se necesitan políticas específicas de protección de la población adulta mayor en condiciones de pobreza. Para lograr la cobertura universal en salud, Perú necesita políticas más intensivas de protección financiera y de reestructuración de su oferta pública.
deep infiltrating disease) lesions were collected at surgery. Transcripts for BDNF, its receptors (NTRK2, NGFR, SORT1), and the estrogen receptor 1 (ESR1) were quantified by PCR. Mice (N¼30) were ovariectomized and given estradiol (E2), progesterone (P4), E2+P4, or saline for 4 days. Uterine horns were collected, protein was assessed by western blot. Human endometrial epithelial cells (CRL-1671) were treated for 24 or 48 hours with E2 (0.1nM-1mM) or P4 (10nM-100mM) in the presence of letrozole to supress endogenous aromatase. BDNF secretion was measured by ELISA. Results were compared by ANOVA.RESULTS: Transcription of SORT1, a co-receptor for BDNF secretion, was elevated in ovarian cysts compared with the endometrium of cases and controls, and deep infiltrating disease (P¼0.007). ESR1 was higher in ovarian cysts versus peritoneal foci and deep infiltrating disease (P¼0.016). In the mouse uterus, E2 increased mature BDNF 2 fold (P¼0.019), pro-BDNF 5 fold (P¼0.002), and NGFR 5 fold (P<0.001) versus other treatments. BDNF secretion by endometrial epithelial cells in culture was increased by several E2 and P4 treatments within 24 hours (P<0.05), and by all concentrations of E2 and P4 at 48 hours (P<0.05).CONCLUSION: Here we provide further evidence for the dysregulation of BDNF and its receptors in endometriosis and expose the profound effect of estrogen in their uterine regulation. We show that endometrial secretion of BDNF is controlled by E2 and P4, and its uterine expression is increased by E2. We postulate that endometriotic lesions express and release BDNF in response to hormones, and could be important in the pathophysiology and treatment of disease. Further, because of the participation of BDNF in nerve growth, proliferation, adhesion, and angiogenesis, its expression in ectopic lesions may contribute to disease progression and pain.
Abstract. Burkitt's lymphoma (BL) is a high-grade lymphoma which represents 8-10% of all tumors in individuals younger than 15 years old. It may occur as an abdominal tumor, which in rare cases may include gastric mucosa, although in most cases, the tumor is located in the ileum or cecum. Primary gastric lymphoma constitutes as low as 1.48% of all gastric cancers in children. In this study, we described a case of gastric BL in a 4-year-old child, presenting discontinuous abdominal pain, weight loss, constipation and irritability. Despite its rarity in children, this tumor should be treated aggressively and long-term survival has been reported.
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