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Las tumoraciones de ovario de naturaleza maligna son raras en edad pediátrica, representan el 1% de los cánceres infantiles. los tumores sólidos más frecuentes en el aparato genital femenino en niñas y adolescentes son los tumores de células germinales, que representan el 90% de los mismos. se presentan 3 casos de pacientes en edad preescolar y adolescente, con dolor abdominal y masa palpable. los hallazgos imagenológicos, asociados a la elevación de marcadores tumorales séricos determinaron el manejo quirúrgico en cada caso, con resultados anatomopatológicos malignos respectivamente: disgerminoma, tumoración mixta de células germinales y teratoma inmaduro, todos con infiltración, invasión angiolinfática y necrosis tumoral. Por lo que es importante plantear ante tumoraciones abdominopelvicas en niñas y adolescentes posible naturaleza maligna, que permita realizar un tratamiento quirúrgico y estudio anatomopatológico minucioso para un enfoque terapéutico adecuado y precoz(AU)
Ovarian tumors of a malignant nature are rare in pediatric ages, representing 1% of childhood cancers. the most frequent solid tumors in the female genital tract in girls and adolescents are germ cell tumors, which represent 90% of them. we present 3 cases of patients of school age and adolescents, who come due to abdominal pain and a palpable mass. the imaging findings, associated with the elevation of serum tumor markers, determined the surgical management in each case, with malignant pathological results, respectively: dysgerminoma, mixed germ cell tumor, and immature teratoma, all with infiltration, angiolymphatic invasion, and tumor necrosis. this is why it is essential to take into account a possible malignant nature in the presence of abdominopelvic tumors in children and adolescents, carrying out surgical treatment and a thorough pathological study being essential for an adequate and early therapeutic approach(AU)
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Humanos , Feminino , Criança , Neoplasias Ovarianas , Pediatria , Biomarcadores Tumorais , Teratoma , Diagnóstico por Imagem , Neoplasias Embrionárias de Células Germinativas , Genitália Feminina , Células GerminativasRESUMO
BACKGROUND: The importance of blockchain-based architectures for personal health record (PHR) lies in the fact that they are thought and developed to allow patients to control and at least partly collect their health data. Ideally, these systems should provide the full control of such data to the respective owner. In spite of this importance, most of the works focus more on describing how blockchain models can be used in a PHR scenario rather than whether these models are in fact feasible and robust enough to support a large number of users. OBJECTIVE: To achieve a consistent, reproducible, and comparable PHR system, we build a novel ledger-oriented architecture out of a permissioned distributed network, providing patients with a manner to securely collect, store, share, and manage their health data. We also emphasize the importance of suitable ledgers and smart contracts to operate the blockchain network as well as discuss the necessity of standardizing evaluation metrics to compare related (net)works. METHODS: We adopted the Hyperledger Fabric platform to implement our blockchain-based architecture design and the Hyperledger Caliper framework to provide a detailed assessment of our system: first, under workload, ranging from 100 to 2500 simultaneous record submissions, and second, increasing the network size from 3 to 13 peers. In both experiments, we used throughput and average latency as the primary metrics. We also created a health database, a cryptographic unit, and a server to complement the blockchain network. RESULTS: With a 3-peer network, smart contracts that write on the ledger have throughputs, measured in transactions per second (tps) in an order of magnitude close to 102 tps, while those contracts that only read have rates close to 103 tps. Smart contracts that write also have latencies, measured in seconds, in an order of magnitude close to 101 seconds, while that only read have delays close to 100 seconds. In particular, smart contracts that retrieve, list, and view history have throughputs varying, respectively, from 1100 tps to 1300 tps, 650 tps to 750 tps, and 850 tps to 950 tps, impacting the overall system response if they are equally requested under the same workload. Varying the network size and applying an equal fixed load, in turn, writing throughputs go from 102 tps to 101 tps and latencies go from 101 seconds to 102 seconds, while reading ones maintain similar values. CONCLUSIONS: To the best of our knowledge, we are the first to evaluate, using Hyperledger Caliper, the performance of a PHR blockchain architecture and the first to evaluate each smart contract separately. Nevertheless, blockchain systems achieve performances far below what the traditional distributed databases achieve, indicating that the assessment of blockchain solutions for PHR is a major concern to be addressed before putting them into a real production.
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Blockchain , Registros de Saúde Pessoal , Gerenciamento de Dados , Atenção à Saúde , HumanosRESUMO
A fast PCR-assisted impedimetric biosensor was developed for the selective detection of the clbN gene from the polyketide synthase (pks) genomic island in real Escherichia coli samples. This genomic island is responsible for the production of colibactin, a harmful genotoxin that has been associated with colorectal cancer. The experimental protocol consisted of immobilizing the designated forward primer onto an Au electrode surface to create the sensing probe, followed by PCR temperature cycling in blank, positive, and negative DNA controls. Target DNA identification was possible by monitoring changes in the system's charge transfer resistance values (Rct) before and after PCR treatment through electrochemical impedance spectroscopy (EIS) analysis. Custom-made, flexible gold electrodes were fabricated using chemical etching optical lithography. A PCR cycle study determined the optimum conditions to be at 6 cycles providing fast results while maintaining a good sensitivity. EIS data for the DNA recognition process demonstrated the successful distinction between target interaction resulting in an increase in resistance to charge transfer (Rct) percentage change of 176% for the positive DNA control vs. 21% and 20% for the negative and non-DNA-containing controls, respectively. Results showed effective fabrication of a fast, PCR-based electrochemical biosensor for the detection of pks genomic island with a calculated limit of detection of 17 ng/µL.
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Técnicas Biossensoriais/métodos , Espectroscopia Dielétrica/métodos , Escherichia coli/genética , Genoma Bacteriano , Peptídeos/genética , Policetídeo Sintases/genética , Reação em Cadeia da Polimerase/métodos , Limite de Detecção , PolicetídeosRESUMO
COVID-19 is a highly contagious disease that can cause severe pneumonia. Patients with pneumonia undergo chest X-rays (XR) to assess infiltrates that identify the infection. However, the radiographic characteristics of COVID-19 are similar to the other acute respiratory syndromes, hindering the imaging diagnosis. In this work, we proposed identifying quantitative/radiomic biomarkers for COVID-19 to support XR assessment of acute respiratory diseases. This retrospective study used different cohorts of 227 patients diagnosed with pneumonia; 49 of them had COVID-19. Automatically segmented images were characterized by 558 quantitative features, including gray-level histogram and matrices of co-occurrence, run-length, size zone, dependence, and neighboring gray-tone difference. Higher-order features were also calculated after applying square and wavelet transforms. Mann-Whitney U test assessed the diagnostic performance of the features, and the log-rank test assessed the prognostic value to predict Kaplan-Meier curves of overall and deterioration-free survival. Statistical analysis identified 51 independently validated radiomic features associated with COVID-19. Most of them were wavelet-transformed features; the highest performance was the small dependence matrix feature of "low gray-level emphasis" (area under the curve of 0.87, sensitivity of 0.85, [Formula: see text]). Six features presented short-term prognostic value to predict overall and deterioration-free survival. The features of histogram "mean absolute deviation" and size zone matrix "non-uniformity" yielded the highest differences on Kaplan-Meier curves with a hazard ratio of 3.20 ([Formula: see text]). The radiomic markers showed potential as quantitative measures correlated with the etiologic agent of acute infectious diseases and to stratify short-term risk of COVID-19 patients.
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COVID-19 , Biomarcadores , Humanos , Estudos Retrospectivos , SARS-CoV-2 , Tomografia Computadorizada por Raios XRESUMO
The gut microbiota has been implicated in a number of normal and disease biological processes. Recent studies have identified a subset of gut bacterial genes as potentially involved in inflammatory processes. In this work, we explore the sequence variability for some of these bacterial genes using a combination of deep sequencing and oligotyping, a data analysis application that identifies mutational hotspots in short stretches of DNA. The genes for pks island, tcpC and usp, all harbored by certain strains of E. coli and all implicated in inflammation, were amplified by PCR directly from stool samples and subjected to deep amplicon sequencing. For comparison, the same genes were amplified from individual bacterial clones. The amplicons for pks island and tcpC from stool samples showed minimal levels of heterogeneity comparable with the individual clones. The amplicons for usp from stool samples, by contrast, revealed the presence of five distinct oligotypes in two different regions. Of these, the oligotype GT was found to be present in the control uropathogenic clinical isolate and also detected in stool samples from individuals with colorectal cancer (CRC). Mutational hotspots were mapped onto the USP protein, revealing possible substitutions around Leu110, Glu114, and Arg115 in the middle of the pyocin domain (Gln110, Gln114, and Thr115 in most healthy samples), and also Arg218 in the middle of the nuclease domain (His218 in the uropathogenic strain). All of these results suggest that a level of variability within bacterial pro-inflammatory genes could explain differences in bacterial virulence and phenotype.
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Gut bacterial toxins are thought to contribute to the development of colorectal cancer (CRC). This study examines the presence of specific gut bacterial toxin genes in stool samples from individuals with colorectal neoplasia (adenomas and/or CRC). The presence of bacterial genes encoding genotoxic or pro-inflammatory factors (pks, tcpC, gelE, cnf-1, AMmurB, and usp) was established by PCR of stool samples from individuals from mainland US (n = 30; controls = 10, adenoma = 10, CRC = 10) and from Puerto Rico (PR) (n = 33; controls = 13; adenomas = 8; CRC = 12). Logistic regression models and multinomial logistic regression models were used to estimate the magnitude of association. Distinct bacterial gene profiles were observed in each sample cohort. In individuals with CRC, AMmurB was detected more frequently in samples from the US and gelE in samples from PR. In samples from PR, individuals with ≥2 gut bacterial toxin genes in stool had higher odds of having colorectal neoplasia (OR = 11.0, 95%: CI 1.0â»637.1): however, no significant association between bacterial genes and colorectal neoplasia was observed in the US cohort. Further analyses are warranted in a larger cohort to validate these preliminary findings, but these encouraging results highlight the importance of developing bacterial markers as tools for CRC diagnosis or risk stratification.
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Background: The human gut microbiota is a dynamic community of microorganisms that mediate important biochemical processes. Differences in the gut microbial composition have been associated with inflammatory bowel diseases (IBD) and other intestinal disorders. In this study, we quantified and compared the frequencies of eight genotoxic and/or pro-inflammatory bacterial genes found in metagenomic Whole Genome Sequences (mWGSs) of samples from individuals with IBD vs. a cohort of healthy human subjects. Methods: The eight selected gene sequences were clbN, clbB, cif, cnf-1, usp, tcpC from Escherichia coli, gelE from Enterococcus faecalis and murB from Akkermansia muciniphila. We also included the sequences for the conserved murB genes from E. coli and E. faecalis as markers for the presence of Enterobacteriaceae or Enterococci in the samples. The gene sequences were chosen based on their previously reported ability to disrupt normal cellular processes to either promote inflammation or to cause DNA damage in cultured cells or animal models, which could be linked to a role in IBD. The selected sequences were searched in three different mWGS datasets accessed through the Human Microbiome Project (HMP): a healthy cohort (N = 251), a Crohn's disease cohort (N = 60) and an ulcerative colitis cohort (N = 17). Results: Firstly, the sequences for the murB housekeeping genes from Enterobacteriaceae and Enterococci were more frequently found in the IBD cohorts (32% E. coli in IBD vs. 12% in healthy; 13% E. faecalis in IBD vs. 3% in healthy) than in the healthy cohort, confirming earlier reports of a higher presence of both of these taxa in IBD. For some of the sequences in our study, especially usp and gelE, their frequency was even more sharply increased in the IBD cohorts than in the healthy cohort, suggesting an association with IBD that is not easily explained by the increased presence of E. coli or E. faecalis in those samples. Conclusion: Our results suggest a significant association between the presence of some of these genotoxic or pro-inflammatory gene sequences and IBDs. In addition, these results illustrate the power and limitations of the HMP database in the detection of possible clinical correlations for individual bacterial genes.
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PURPOSE: Medial patellofemoral ligament (MPFL) reconstruction offers good clinical results with a very low rate of instability recurrence. However, its in vivo effect on patellar tracking is not clearly known. The aim of this study is to investigate the effects of MPFL reconstruction on patellar tracking using dynamic 320-detector-row CT. METHODS: Ten patients with patellofemoral instability referred to isolated MPFL reconstruction surgery were selected and subjected to dynamic CT before and ≥6 months after surgery. Patellar tilt angles and shift distance were analysed using computer software specifically designed for this purpose. Kujala and Tegner scores were applied, and the radiation of the CTs was recorded. Two protocols for imaging acquisition were compared: a tube potential of 80 kV and 50 mA versus a tube potential of 120 kV and 100 mA, both with a slice thickness of 0.5 mm and an acquisition duration of 10 s. RESULTS: There were no changes in patellar tracking after MPFL reconstruction. There was no instability relapse. Clinical scores improved from a mean of 51.9 (±15.6)-74.2 (±20.9) on the Kujala scale (p = 0.011) and from a median of 2 (range 0-4) to 4 (range 1-6) on the Tegner scale (p = 0.017). The imaging protocols produced a dose-length product (DLP) of 254 versus 1617 mGycm and a radiation effective estimated dose of 0.2 versus 1.3 mSv, respectively. Both protocols allowed the analysis of the studied parameters without loss of precision. CONCLUSIONS: Reconstruction of the MPFL produced no improvement in patellar tilt or shift in the population studied. The low-radiation protocol was equally effective in measuring changes in patellar tracking and is recommended. Although the procedure successfully stabilized the patella, knee surgeons should not expect patellar shift and tilt correction when performing isolated patellofemoral ligament reconstruction in patients with recurrent patellar instability. LEVEL OF EVIDENCE: IV.
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Instabilidade Articular/cirurgia , Ligamentos Articulares/cirurgia , Tomografia Computadorizada Multidetectores , Patela/diagnóstico por imagem , Patela/fisiopatologia , Luxação Patelar/cirurgia , Articulação Patelofemoral/cirurgia , Adolescente , Adulto , Feminino , Seguimentos , Humanos , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/fisiopatologia , Ligamentos Articulares/fisiopatologia , Masculino , Procedimentos Ortopédicos , Patela/cirurgia , Luxação Patelar/diagnóstico por imagem , Luxação Patelar/fisiopatologia , Articulação Patelofemoral/diagnóstico por imagem , Articulação Patelofemoral/fisiopatologia , Procedimentos de Cirurgia Plástica , Recidiva , Resultado do Tratamento , Adulto JovemRESUMO
OBJETIVOS: desenvolver solução para integração de monitores de beira de leito ao Sistema de Informações Hospitalares (SIH). MÉTODOS: Desenvolvimento e implementação de troca de mensagens no padrão Health Level 7, Admit Discharge Transfer (ADT) e Observation (OBX), utilizando a biblioteca HAPI, para cadastro do paciente e coletados parâmetros de monitoramento. Criação de base de dados para seleção e armazenamento dos parâmetros desejados. RESULTADOS: cadastro integrado com o SIH e captura em banco de dados dos parâmetros dos monitores de beira de leito além de interface de teste para visualização dos dados. CONCLUSÃO: Desenvolvido e implementado um sistema para a integração com monitores beira de leito, permitindo uma visão mais abrangente dos dados dos pacientes.
OBJECTIVES: develop solution for integration of bedside monitors to the Hospital Information System (HIS). METHODS: Development and implementation of the exchange of messages using the standard Health Level 7, Admit Discharge Transfer (ADT) and Observation (OBX), using the HAPI library in order to register the patient and to collect parameters from the monitors. It was also created a database in order to support the selection and storage of the desired parameters. RESULTS: registration integrated with HIS and saving of bedside monitors' parameters in database plus test interface for data visualization. CONCLUSION: Developed and implemented a system to integrate with bedside monitors, allowing a more comprehensive view of patient data.
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Humanos , Integração de Sistemas , Monitoramento Ambiental , Nível Sete de Saúde , Congressos como AssuntoAssuntos
Doenças Cardiovasculares/terapia , Telemedicina/normas , Síndrome Coronariana Aguda/economia , Síndrome Coronariana Aguda/epidemiologia , Síndrome Coronariana Aguda/terapia , Brasil , Doenças Cardiovasculares/economia , Doenças Cardiovasculares/epidemiologia , Humanos , Telemedicina/métodos , Telemedicina/organização & administração , Resultado do TratamentoRESUMO
The enzyme telomerase is present in about 85% of human cancers which makes it not only a good target for cancer treatment but also an excellent marker for cancer detection. Using a single stranded DNA probe specific for telomerase binding and reverse transcription tethered to an interdigital gold electrode array surface, the chromosome protection provided by the telomerase was replicated and followed by Electrochemical Impedance Spectroscopy as an unlabeled biosensor. Using this system designed in-house, easy and affordable, impedance measurements were taken while incubating at 37 °C and promoting the probe elongation. This resulted in up to 14-fold increase in the charge transfer resistance when testing a telomerase-positive nuclear extract from Jurkat cells compared to the heat-inactivated telomerase-negative nuclear extract. The electron transfer process at the Au electrodes was studied before the elongation, at different times after the elongation, and after desorption of non-specific binding.
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Although predominantly associated with health benefits, the gut microbiota has also been shown to harbor genes that promote inflammation. In this work, we report a method for the direct detection and quantification of these pro-inflammatory bacterial genes by PCR and qPCR in DNA extracted from human stool samples. PCR reactions were performed to detect (i) the pks island genes, (ii) tcpC, which is present in some strains of Escherichia coli and (iii) gelE presented in some strains of Enterococcus faecalis. Additionally, we screened for the presence of the following genes encoding cyclomodulins that disrupted mammalian cell division: (iv) cdt (which encodes the cytolethal distending toxin) and (v) cnf-1 (which encodes the cytotoxic necrotizing factor-1). Our results show that 20% of the samples (N = 41) tested positive for detectable amounts of pks island genes, whereas 10% of individuals were positive for tcpC or gelE and only one individual was found to harbor the cnf-1 gene. Of the 13 individuals that were positive for at least one of the pro-inflammatory genes, 5 were found to harbor more than one. A quantitative version of the assay, which used real-time PCR, revealed the pro-inflammatory genes to be in high copy numbers: up to 1.3 million copies per mg of feces for the pks island genes. Direct detection of specific genes in stool could prove useful toward screening for the presence of pro-inflammatory bacterial genes in individuals with inflammatory bowel diseases or colorectal cancer.
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Neste artigo é apresentada uma arquitetura para a integração do Sistema de Informação hospitalar (SIH) com uma ferramenta colaborativa. Também se descreve o desenvolvimento de seu protótipo, denominado MedCast, realizado em parceria entre o CPqD e o Instituto do Coração (InCor) - HCFMUSP. O MedCast, em sua versão atual, permite a inclusão de casos clínicos por meio de Web services e a discussão de casos com utilização de ferramentas multimídia. O protótipo demonstra que a utilização cuidadosa dessas informações permite o enriquecimento da discussão.
This article presents an architecture for the integration of the Hospital Information System (HIS) with a collaborative tool. It is also described the development of its prototype, called MedCast, as result of a partnership between CPqD and Heart Institute (InCor) - FMUSP. The MedCast, in its current version, allows the inclusion of clinical cases by means of Web services and the discussion of cases with use of multimedia tools. The prototype demonstrates that the careful use of this information is useful to enrich the discussion.
Este artículo presenta una arquitectura para la integración del Sistema de Información Hospitalario (SIH) con una herramienta de colaboración. También se describe el desarrollo de su prototipo, llamado MedCast, hecho en colaboración entre CPqD y el Instituto del Corazón (InCor) - FMUSP. El MedCast, en su versión actual, permite la inclusión de casos clínicos por medio de servicios Web y la discusión de casos con el uso de herramientas multimedia. El prototipo demuestra que el uso cuidadoso de esta información permite enriquecer el debate.
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Comportamento Cooperativo , Sistemas Computadorizados de Registros Médicos , Sistemas de Informação Hospitalar , Disseminação de Informação , Visitas de PreceptoriaRESUMO
In this work it is presented the solution adopted by the Heart Institute (InCor) of Sao Paulo for medical image distribution and visualization inside the hospital's intranet as part of the PACS system. A CORBA-based image server was developed to distribute DICOM images across the hospital together with the images' report. The solution adopted allows the decoupling of the server implementation and the client. This gives the advantage of reusing the same solution in different implementation sites. Currently, the PACS system is being used on two different hospitals each one with three different environments: development, prototype and production.
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Redes de Comunicação de Computadores/organização & administração , Sistemas de Informação Hospitalar/organização & administração , Armazenamento e Recuperação da Informação/métodos , Sistemas Computadorizados de Registros Médicos/organização & administração , Humanos , Sistemas de Informação em Radiologia/organização & administração , Integração de SistemasRESUMO
The conventional visualization of medical images is not enough for a rich and comprehensive electronic healthcare record. We believe that it is necessary to provide a viewer with more advanced capabilities than those of regular medical image viewers. In this paper, we propose an architecture that allows the use of contextual information to assist the healthcare professional in his regular tasks. The proposed architecture for the context is composed of an ontology describing the hospital and an inference engine. The result is a Java-based implementation of the architecture, named Dynamic N-dimensional Image Viewer, (ODIN in Portuguese) that is able to adapt its behavior according to the contextual information.
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Gráficos por Computador , Diagnóstico por Imagem/métodos , Sistemas Inteligentes , Interpretação de Imagem Assistida por Computador/métodos , Imageamento Tridimensional/métodos , Sistemas de Informação em Radiologia , Interface Usuário-ComputadorRESUMO
Patients usually get medical assistance in several clinics and hospitals during their lifetime, archiving vital information in a dispersed way. Clearly, a proper patient care should take into account that information in order to check for incompatibilities, avoid unnecessary exams, and get relevant clinical history. The Heart Institute (InCor) of São Paulo, Brazil, has been committed to the goal of integrating all exams and clinical information within the institution and other hospitals. Since InCor is one of the six institutes of the University of São Paulo Medical School and each institute has its own information system, exchanging information among the institutes is also a very important aspect that has been considered. In the last few years, a system for transmission, archiving, retrieval, processing, and visualization of medical images integrated with a hospital information system has been successfully created and constitutes the InCor's electronic patient record (EPR). This work describes the experience in the effort to develop a functional and comprehensive EPR, which includes laboratory exams, images (static, dynamic, and three dimensional), clinical reports, documents, and even real-time vital signals. A security policy based on a contextual role-based access control model was implemented to regulate user's access to EPR. Currently, more than 10 TB of digital imaging and communications in medicine (DICOM) images have been stored using the proposed architecture and the EPR stores daily more than 11 GB of integrated data. The proposed storage subsystem allows 6 months of visibility for rapid retrieval and more than two years for automatic retrieval using a jukebox. This paper addresses also a prototype for the integration of distributed and heterogeneous EPR.
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Cardiologia/tendências , Sistemas de Gerenciamento de Base de Dados/tendências , Sistemas de Apoio a Decisões Clínicas/tendências , Diagnóstico por Imagem/tendências , Armazenamento e Recuperação da Informação/tendências , Sistemas Computadorizados de Registros Médicos/tendências , Sistemas de Informação em Radiologia/tendências , Brasil , Atenção à Saúde/tendênciasRESUMO
Según los datos reportados por la FAO, el contenido intracelular de metionina en Saccharomyces cerevisiae, es más elevado que el de otras levaduras. Con el fín de incrementar en esta levadura la concentración interna de metionina se eligieron 3 cepas mutantes de S. cerevisiae, M2, M4 y M9, obtenidas por González Miliani (comunicación personal) por resistencia a etionina (0,1 mg/ml) y norleucina (0,33 mg/ml). Los niveles de resistencia de estas cepas a la etionina fueron incrementados hasta que se seleccionó un mutante LF-M9 et nor resistente a concentraciones de 6 mg del análogo por ml. Establecidas las condiciones óptimas de crecimiento en medio 200, este mutante fué mutagenizado con nitrosoguanidina (0,5 mg/ml) y luz ultravioleta (240 nm durante 9 minutos a d=32 cm). Los mutantes obtenidos se seleccionaron mediante réplicas en placas y ensayos microbiológicos sobre Escherichia coli 303 (Wollman, met-b1-strr).El mutante LF-M9 treo-etrnorr de S. cerevisae contiene 3 veces más metionina que la cepa S. cerevisae DSM D273-10B utilizada como control y 1.8 veces más que la cepa M9 parental. Al ser cultivado en distintos desechos agroindustriales mostró un crecimiento óptimo en un hidrolizado ácido de hojas y tallos de yuca. A nivel de fermentador de 1 litro la biomasa obtenida en ese medio fué 6.3 g de levadura (peso seco) enriquecida en metionina, por litro de extracto