Navegando por Palavras-chave "Survival"

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    Análise da idade e de fatores clínicos associados à mortalidade na lesão renal aguda em unidade de terapia intensiva
    (Universidade Federal de São Paulo (UNIFESP), 2017-11-30) Cruz, José Genival dos Santos [UNIFESP]; Schor, Nestor [UNIFESP]; http://lattes.cnpq.br/8276708741672261 ; http://lattes.cnpq.br/4498158647031518; Universidade Federal de São Paulo (UNIFESP)
    Introdução: O impacto da idade na mortalidade por Lesão Renal Aguda (LRA) em Unidade de Terapia Intensiva (UTI) não está estabelecido. Objetivos: Avaliar a influência da idade per si, além de outros possíveis fatores na mortalidade de idosos acometidos por LRA adquirida na UTI. Métodos: Foi realizada uma análise retrospectiva de 105 pacientes idosos (a partir de 60 anos) de janeiro 2003 a janeiro de 2007 que desenvolveram LRA pelo critério AKIN, após admissão na UTI. Inicialmente foram avaliados todos os pacientes que formaram o grupo geral (G). Em seguida, foram avaliados 04 subgrupos conforme faixas etárias: 60-69 anos (G1, n=27), 70-79 anos (G2, n=39), 80-89 anos (G3, n=28) e com ≥90 anos (G4, n=11). Uma terceira análise foi realizada entre duas faixas etárias mais idosas (<80 anos, n= 66 pacientes versus ≥ 80 anos com 39 pacientes). Resultados: Dos 105 pacientes, 57% masculinos, idade de 76±9 anos, a maioria da admissão (88%) foi por motivos clínicos. O SAPSII (Simplified Acute Physiology Score) para o grupo G foi 55±10, (p<0,04), na comparação com os subgrupos (G1, G2, G3, G4). O subgrupo G4 foi o que teve o maior SAPS II (60 ± 5) dos subgrupos (p<0, 026). A creatinina média inicial na internação foi 1,0±0,3 mg/dl. A mediana de diurese foi 900 ml e do lactato sérico foi de 18 mg/dl. Ventilação mecânica ocorreu em 77/105 (73%) dos pacientes e uso de drogas vasoativas em 90/105 (86%). Dentre as comorbidades, 76/106 (72%) eram hipertensos, 53/105 (50%) eram diabéticos, diabéticos e hipertensos juntos foram 41/105 (39%) 35/105 (33%) com doença vascular cerebral crônica e 21/105 (20%) com doença coronariana crônica. A principal etiologia da LRA foi multifatorial, seguida de isquêmica e séptica e os estágios AKIN 2 e 3 foram os mais encontrados (22% e 61% respectivamente). 86% dos sobreviventes (SV) usaram diuréticos x 95% dos não sobreviventes (NSV). Balanço hídrico positivo ocorreu em 66% dos SV e 80% dos NSV, houve necessidade de diálise em 29% dos SV e 57% dos NSV, mas sem diferença estatística significante. Mortes ocorreram em 84/105 pacientes (80%) e os fatores que influenciaram na mortalidade foram: maior classificação AKIN (p=0,016), uso de gelatina (p=0,013) e diurese < 2000ml/24h, (p<0,05). Na análise dos subgrupos, no G1, influenciaram na mortalidade, a Diferença de Íon Forte Aparente (DIFa), (p<0,04), e uso de gelatina (p<0,03); no G2, o atraso na consulta ao nefrologista (p<0,03), o SAPS II (p<0,004) e o Número de Falências Orgânicas (NFO), (p<0,01). No G4, a hipocloremia (p<0,04) e o SAPS II, este comparado ao grupo G (p<0,04) e ao G2 (p<0,026). Pacientes com LRA ≥ 80 anos (n=66) tiveram maior mortalidade que pacientes <80 anos (n=39), por análises uni, (p<0,03) e multivariada,(p<0,009). Conclusão: O estudo sugere que, além de diversos fatores clínicos, a idade isoladamente pode influenciar na mortalidade de pacientes idosos críticos com LRA em UTI.
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    Aplicação do escore balance of risk no transplante hepático
    (Universidade Federal de São Paulo (UNIFESP), 2017-12-21) Alves, Jefferson Andre da Silva [UNIFESP]; Gonzalez, Adriano Miziara [UNIFESP]; Salzedas Netto, Alcides Augusto [UNIFESP]; Meirelles Júnior, Roberto Ferreira; Alcides Augusto Salzedas Netto : http://lattes.cnpq.br/2580534578039797; Roberto Ferreira Meirelles Júnior : http://lattes.cnpq.br/2044164145880243; http://lattes.cnpq.br/6234829429056217; http://lattes.cnpq.br/1149077440256804; Universidade Federal de São Paulo (UNIFESP)
    Introduction: Balance of Risk Score (BARS), proposed by the Swiss HPB and Transplant Center, University Hospital Zurich, Switzerland, was designed to preemptively determine hepatic transplant survival . Objective: To evaluate a BARS ability to predict survival at 90 days, 1 year, 3 years and 5 years after LTx. Patients and Methods: Retrospective and observational study were performed in 866 liver transplants, in the Transplantation Program of the Hospital Israelita Albert Einstein, performed in adults (> 18 years), in the period from 01/01/2010 to 12/31/2015. Monitoring losses, splits, living donors transplants and transplants combined with other organs were excluded. BARS were calculated for each transplant performed using the variables MELD clinician, recipient age, retransplantation, need for life support, donor age and cold ischemia time (http://www.assessurgery.com/bar). Survival estimates were accompanied by 95% confidence intervals and the association between the variables of interest and the overall survival of the patients was assessed by Cox proportional hazards models. To assess a BARS 'ability to predict survival to 90 days, use ROC curves and present an estimated area under the curve (AUC), with 95% confidence intervals and p-values for the area equality test at 0.5. Result:. The AUC obtained for the 90-day period was 0.725, with a 95% CI of 0.670 to 0.781 and with a p-value of <0.001 for the equality test at 0.5. In the stratified analysis, score 18 presented the best sensitivity, considering a minimum specificity of 90%. The BARS> 18 presented survival drop from 89.7% to 60.4% in the ideal 90 days; 83.3% to 56.2% in one year; from 75.7% to 49.5% in three years and from 72.2% to 43.4% in five years. Conclusion: BARS has been shown to be reproducible and can be used as a tool to estimate survival in LTx. The achievement of LTx in patients with BARS> 18 significantly predicts a lower survival of the patient. We validate the method in Brazil.
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    Association between ABCB1 Immunohistochemical Expression and Overall Survival in Gastric Cancer Patients
    (Asian Pacific Organization Cancer Prevention, 2014-01-01) Oliveira, Juliana de [UNIFESP]; Felipe, Aledson Vitor [UNIFESP]; Artigiani Neto, Ricardo [UNIFESP]; Oshima, Celina Tizuko Fujiyama [UNIFESP]; Silva, Marcelo de Souza [UNIFESP]; Forones, Nora Manoukian [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Gastric cancer (GC) is one of the most common malignancies worldwide. the ABCB1 protein, a member of the ATP-binding cassette (ABC) transporter family, encoded by the ABCB1 gene, considerably influences the distribution of drugs across cell membranes as well as multidrug resistance (MDR) of antineoplastic drugs. in contrast to the extensive knowledge on the pharmacological action of ABCB1 protein, the correlation between the clinical-pathological data and ABCB1 protein expression in patients with GC remains unclear. the aim was to investigate association between ABCB1 expression and overall survival in GC patients. Human tumor fragments from 57 GC patients were examined by immunohistochemistry assay. We observed lower survival rate of patients with GC who were positive for ABCB1 expression (p=0.030). Based on these observations, we conclude that GC patients with positive ABCB1 protein immunohistochemical expression in their tumors suffer shorter overall survival.
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    Avaliação da expressão do vírus de Epstein-Barr e metaloproteinase 9 nas células de Hodgkin-Reed-Sternberg e correlação com os parâmetros clínicos e evolutivos em pacientes com Linfoma de Hodgkin clássico no Brasil
    (Universidade Federal de São Paulo (UNIFESP), 2010-02-24) Souza, Eni Maria de [UNIFESP]; Oliveira, José Salvador Rodrigues de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Clinical and histological features of classical Hodgkin lymphoma (cHL) are primarily due to the effects of cytokines, enzymes and chemokines produced by Hodgkin-Reed-Sternberg (HRS) cells and their surrounding inflammatory cells in response to signals triggered by etiological factors such as Epstein-Barr virus (EBV). Matrix metalloproteinase-9 (MMP-9) has been associated with poorer survival in patients with aggressive non-Hodgkin lymphomas. In EBV-related cancers the expression of viral latent membrane protein 1 (LMP1) correlates with an increased MMP-9 expression. In this study, we evaluated the prognostic relevance of MMP-9 expression and EBV status in HRS cells in patients with cHL in Brazil. Material and Methods: We selected 97 patients with cHL. Patients were included if they had: 1) > 18 years, 2) Undergone similar chemotherapy protocols, 3) Paraffin blocks available for review and for EBV and MMP-9 detection and 4) Clinical, epidemiological and laboratorial parameters available. Results: EBV was detected in 52.5% of all cases. MMP-9 expression positivity was found in 87.6% of all cases. There was no correlation between MMP-9 expression and EBV status. Response to treatment and relapse rate were independent of MMP-9 expression and EBV status. When stratified according to chemotherapy protocol used or disease stage, we still did not find any difference. MMP-9 positivity did not influence overall survival and event free survival. Conclusion: MMP-9 are expressed in the majority of HRS cells and did not correlated with EBV status or survival. The consistent MMP-9 expression in HRS cells makes this enzyme a potential target for therapy.
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    Avaliação da sobrevida segundo o estado nutricional de pacientes com câncer do aparelho digestório
    (Universidade Federal de São Paulo (UNIFESP), 2016-10-25) Barão, Katia [UNIFESP]; Forones, Nora Manoukian [UNIFESP]; http://lattes.cnpq.br/7314943504526739; http://lattes.cnpq.br/9586535240692039; Universidade Federal de São Paulo (UNIFESP)
    Objective: To evaluate survival according to the nutritional status of patients with tumors of the digestive system in remission or active, based on body mass index, the subjective global assessment produced by the patient and the phase angle, with nutritional counseling, and / or use supplements. Methods: We included patients treated from gastro-oncology outpatient nutrition team Unifesp/EPM. Patients were compared with cancer remission (Clinical Follow-up Group) or active (Cancer Group); with nutritional counseling (G1) or with nutritional supplementation and counseling (G2). All patients underwent PG-SGA, BMI and phase angle (PA). Results: 673 patients, the cancer group represented 40% of the sample. The mean age was 62.2 ± 12.4 years, with 53% of men. The CRC represented 61% gastric 19% esophageal 10% bile ducts, liver and pancreas (CBLP) 6% and 4% excluded. The stage IV was prevalent (37%), followed by stage III (24%). In the first assesment, 59% had PG-SGA B. The average PA was 5.1 ± 1.1. Patients with CBLP had the lowest median survival. Well nourished patients lived four times longer than the severely malnourished. Just PG-SGA C and PA ?5º, were confirmed as prognostic markers. G1 patients had a significant increase in the score of the PG-SGA (P <0.01) and decreased PA (p = 0.03). Conclusions: Malnutrition negatively influenced survival despite the remission of the disease. Cancer Group Patients, Anabolic or at malnutrition risk had lower survival. The relative risk of death was five times higher in severely malnourished patients and twice in patients with PA ?5º. PG-SGA has shown that most patients had moderate or severe malnutrition before starting the cancer treatment. Nutritional supplementation did not affect the survival or reverse malnutrition in advanced stage patients, but managed to contain the progressive weight loss. The group without supplementation presented clinical decrease with the reduction of PA and higher scores of PG-SGA, suggesting that supplementation may be beneficial for advanced stages patients even without reverse malnutrition
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    Belatacept-Based Regimens Versus a Cyclosporine A-Based Regimen in Kidney Transplant Recipients: 2-Year Results From the BENEFIT and BENEFIT-EXT Studies
    (Lippincott Williams & Wilkins, 2010-12-27) Larsen, Christian P.; Grinyo, Josep; Medina-Pestana, Jose [UNIFESP]; Vanrenterghem, Yves; Vincenti, Flavio; Breshahan, Barbara; Campistol, Josep M.; Florman, Sander; del Carmen Rial, Maria; Kamar, Nassim; Block, Alan; Di Russo, Gregory; Lin, Chen-Sheng; Garg, Pushkal; Charpentier, Bernard; Emory Univ; Univ Hosp Bellvitge; Universidade Federal de São Paulo (UNIFESP); Univ Hosp Leuven; Univ Calif San Francisco; Med Coll Wisconsin; Univ Barcelona; Mt Sinai Med Ctr; Inst Nefrol; CHU Rangueil; Bristol Myers Squibb Co; Univ Paris S 11
    Background. At 1 year, belatacept was associated with similar patient/graft survival, better renal function, and an improved cardiovascular/metabolic risk profile versus cyclosporine A (CsA) in the Belatacept Evaluation of Nephroprotection and Efficacy as Firstline Immunosuppression Trial (BENEFIT) and Belatacept Evaluation of Nephroprotection and Efficacy as Firstline Immunosuppression Trial-EXTended criteria donors (BENEFIT-EXT) studies. Acute rejection was more frequent with belatacept in BENEFIT. Posttransplant lymphoproliferative disorder (PTLD)-specifically central nervous system PTLD-was observed more frequently in belatacept-treated patients. This analysis assesses outcomes from BENEFIT and BENEFIT-EXT after 2 years of treatment.Methods. Patients received a more intensive (MI) or a less intensive (LI) regimen of belatacept or a CsA-based regimen.Results. Four hundred ninety-three of 666 patients(74%) in BENEFIT and 347 of 543(64%) in BENEFIT-EXT completed 2 years of treatment. the proportion of patients who survived with a functioning graft was similar across groups (BENEFIT: 94% MI, 95% LI, and 91% CsA; BENEFIT-EXT: 83% MI, 84% LI, and 83% CsA). Belatacept's renal benefits were sustained, as evidenced by a 16 to 17 mL/min (BENEFIT) and an 8 to 10 mL/min (BENEFIT-EXT) higher calculated glomerular filtration rate in the belatacept groups versus CsA. There were few new acute rejection episodes in either study between years 1 and 2. Because PTLD risk was highest in Epstein-Barr virus(EBV)(-) patients, an efficacy analysis of EBV(+) patients was performed and was consistent with the overall population results. There were two previously reported cases of PTLD in each study between years 1 and 2 in the belatacept groups. the overall balance of safety and efficacy favored the LI over the MI regimen.Conclusions. At 2 years, belatacept-based regimens sustained better renal function, similar patient/graft survival, and an improved cardiovascular/metabolic risk profile versus CsA; outcomes that were maintained in EBV (+) patients. No new safety signals emerged.
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    Biomolecular analysis of matrix proteoglycans as biomarkers in non small cell lung cancer
    (Springer, 2018) Rangel, Maristela P.; Sa, Vanessa K. de; Prieto, Tabatha; Martins, João Roberto Maciel [UNIFESP]; Olivieri, Eloisa R.; Carraro, Dirce; Takagaki, Teresa; Capelozzi, Vera Luiza
    Matrix proteoglycans (PGs) have shown promise as biomarker in malignancies. We employed agarose gel eletrophoresis, quantitative real- time reverse transcription-polymerase chain reaction and immunohistochemistry to evaluate the content of sulfated glicosaminoglycans (chondroitin sulfate and heparan sulfate) and expression of PG (biglycan, glypican, perlecan, syndecan e versican) in patient-matched normal and tumor tissues obtained from resected specimens of lung cancer. A significant increase of heparan sulfate (HS) and chondroitin sulfate (CS) concentrations was found in tumor tissue samples when compared to normal lung tissue samples. HS was also significantly increased in adenocarcinomas compared to squamous cell carcinomas. PG gene expression, with exception of syndecan, were significantly decreased in tumor tissue compared to normal lung, coinciding with significant decrease of PG protein levels in tumor cells and stroma compared to normal lung tissue (Kappa coefficient 0.41, 0.42 and 0,28, respectively). Women patients (p = 0.02), non smokers (p = 0.05), T stage (p = 0.009), N stage (p = 0.03) and adenocarcinoma (p = 0.05) were associated with improved overall survival (OS). Patients presenting tumors with low concentration of sulfated GAG and high PGs levels presented better OS compared to patients with high concentration of sulfated GAG and low expression of PGs. Cox regression model controlled by gender, tobacco history and histological type, showed that patients with high perlecan and versican expression in tumor presented respectively high probability of life (beta risk 11.64
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    Brazilian data of renal cell carcinoma in a public university hospital
    (Brazilian soc urol, 2016) Aguiar Junior, Pedro [UNIFESP]; Padua, Tiago Costa [UNIFESP]; Guimaraes, Daiane Pereira [UNIFESP]
    Purpose: Among renal malignancies, renal cell carcinoma (RCC) accounts for 85% of cases. Stage is a relevant prognostic factor
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    Carcinoma hepatocelular e as diferentes etiologias
    (Universidade Federal de São Paulo (UNIFESP), 2019-10-31) Vento, Vanessa Santos Andrade Cruz [UNIFESP]; Silva, Ivonete Sandra De Souza E [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Introduction: The main etiologies of liver disease in patients with hepatocellular carcinoma (HCC) are hepatitis B (HBV) and C (HCV) infections, alcoholic liver disease and non-alcoholic fatty liver disease. The etiology of liver disease may differ among the various characteristics of patients with HCC. Objective: To evaluate patients with HCC according to etiologies regarding clinical, laboratory and tumor characteristics and survival. Methods: cross-sectional study, through retrospective analysis of medical records of patients with HCC, attended at the liver nodule clinic of the Federal University of São Paulo, from January 2008 to December 2017. For comparative analysis according to the main etiologies of liver disease, HCC patients were grouped into group 1 (HCV vs. HCV + alcohol), group 2 (HCV vs. HBV), group 3 (viral vs. non-viral) and group 4 (alcohol vs. other etiologies). For statistical analysis Chi-square, Student's T or Mann-Whitney and Kaplan-Meier tests were applied. Results: 529 patients with HCC were studied. The main etiologies were HCV (52.5%), alcoholic liver disease (12.3%), HCV with alcohol (11.4%) and HBV (9.8%). The mean overall survival was 48 ± 3 months. In the comparative analyzes: group 1: patients with HCV + alcohol were young, men, with decompensated cirrhosis and lower ALT index, besides worse survival; group 2: HBV carriers were men, young, and less cirrhotic, with no difference in survival; group 3: non-viral etiology presented more decompensated cirrhosis, higher MELD and canalicular enzyme values, lower aminotrasfererase values, larger nodules and worse survival; group 4: patients with alcoholic liver disease were men, cirrhotic and Child B and C, with higher values of MELD and alpha-fetoprotein, but with lower value of ALT and poor survival. Conclusion: Alcohol and non-viral etiology were associated with worse liver function and lower survival compared to other etiologies in patients with HCC. Therefore, public health measures to control alcoholism are important.
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    Costs of hospitalization in preterm infants: impact of antenatal steroid therapy
    (Soc brasil pediatria, 2016) Ogata, Joice Fabiola Meneguel [UNIFESP; Fonseca, Marcelo Cunio Machado [UNIFESP]; Miyoshi, Milton Harumi [UNIFESP]; Almeida, Maria Fernanda Branco de [UNIFESP]; Guinsburg, Ruth [UNIFESP]
    Objective: To estimate the costs of hospitalization in premature infants exposed or not to antenatal corticosteroids (ACS). Method: Retrospective cohort analysis of premature infants with gestational age of 26-32 weeks without congenital malformations, born between January of 2006 and December of 2009 in a tertiary, public university hospital. Maternal and neonatal demographic data, neonatal morbidities, and hospital inpatient services during the hospitalization were collected. The costs were analyzed using the microcosting technique. Results: Of 220 patients that met the inclusion criteria, 211 (96%) charts were reviewed: 170 newborns received at least one dose of antenatal corticosteroid and 41 did not receive the antenatal medication. There was a 14-37% reduction of the different cost components in infants exposed to ACS when the entire population was analyzed, without statistical significance. Regarding premature infants who were discharged alive, there was a 24-47% reduction of the components of the hospital services costs for the ACS group, with a significant decrease in the length of stay in the neonatal intensive care unit (NICU). In very-low birth weight infants, considering only the survivors, ACS promoted a 30-50% reduction of all elements of the costs, with a 36% decrease in the total cost (p = 0.008). The survivors with gestational age < 30 weeks showed a decrease in the total cost of 38% (p = 0.008) and a 49% reduction of NICU length of stay (p = 0.011). Conclusion: ACS reduces the costs of hospitalization of premature infants who are discharged alive, especially those with very low birth weight and < 30 weeks of gestational age. (C) 2015 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.
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    Domperidone, parkinson disease and sudden cardiac death: mice and men show the way
    (Hospital clinicas, univ sao paulo, 2016) Scorza, Fulvio A. [UNIFESP]; Scorza, Carla A. [UNIFESP]; Ferraz, Henrique B. [UNIFESP]
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    Drug survival and causes of discontinuation of the first anti-TNF in ankylosing spondylitis compared with rheumatoid arthritis: analysis from BIOBADABRASIL
    (Springer, 2015-05-01) Fafa, Barbara P.; Louzada-Junior, Paulo; Titton, David C.; Zandonade, Eliana; Ranza, Roberto; Laurindo, Ieda; Pecanha, Paula; Ranzolin, Aline; Hayata, Andre L.; Duarte, Angela; Silveira, Ines G.; Costa, Izaias; Macieira, Jose C.; Guedes-Barbosa, Luiz S.; Bertolo, Manoel B.; Sauma, Maria Fatima Lobato da C.; Silva, Marilia B. G.; Freire, Marlene; Scheinberg, Morton A.; Fernandes, Vander; Bianchi, Washington; Miranda, Jose R. S.; Pinheiro, Geraldo R. C.; Carvalho, Hellen M. S.; Brenol, Claiton Viegas; Pereira, Ivanio A.; Werner de Castro, Glaucio Ricardo; Bertacini de Morais, Julio C.; Oliveira, Sheila K. F.; Abreu, Mirhelen Mendes de [UNIFESP]; Toledo, Roberto A.; Pinheiro, Marcelo M. [UNIFESP]; Vieira, Walber Pinto; Valim, Valeria; BIOBADABRASIL; Univ Fed Espirito Santo; Universidade de São Paulo (USP); Univ Fed Parana; Universidade Federal de Uberlândia (UFU); Universidade Federal de Pernambuco (UFPE); Clin Reumatol Osasco; Pontificia Univ Catolica Rio Grande Sul PUC; Universidade Federal de Mato Grosso do Sul (UFMS); Univ Fed Sergipe; Univ Fed Mato Grosso; Universidade Estadual de Campinas (UNICAMP); Fed Univ Para; Hosp Univ Evangel Curitiba; Univ Fed Triangulo Mineiro; Ctr Hosp Abreu Sodre AACD; Univ Cuiaba; Santa Casa Misericordia Rio de Janeiro; Univ Estacio Sa; Artroctr Clin Med; Universidade do Estado do Rio de Janeiro (UERJ); Hosp Base Dist Fed; Univ Fed Rio Grande do Sul; Hosp Clin Porto Alegre; Universidade Federal de Santa Catarina (UFSC); Univ Sul Santa Catarina; Universidade Federal do Rio de Janeiro (UFRJ); Universidade Federal de São Paulo (UNIFESP); Hosp Geral Fortaleza
    Treatment survival with biological therapy may be influenced by many factors, and it seems to be different among various rheumatic diseases and biological agents. the goal of the study was to compare the drug survival and the causes of discontinuation of anti-tumoral necrosis factor (anti-TNF) therapy in ankylosing spondylitis (AS) with rheumatoid arthritis (RA). Study participants were a cohort from the Brazilian Registry of Biological Therapies in Rheumatic Diseases (BIOBADABRASIL) between 2008 and 2012. the observation time was up to 4 years following the introduction of the first treatment. Gender, age, disease duration, disease activity, comorbidities, and concomitant therapies were assessed. A total of 1303 patients were included: 372 had AS and 931 had RA in which 38.7%(n=504) used infliximab (IFX), 34.9 % (n=455) used adalimumab (ADA), and 26.4 % (n=344) used etanercept (ETA). the anti-TNF drug survival of patients with AS was 63.08 months (confidence interval (CI) 60.24, 65.92) and patients with RA was 47.5 months (CI 45.65, 49.36). It was significant higher in AS (log-rank; p=0.001). Patients with RA discontinued anti-TNF more than patients with AS when adjusted to gender and corticosteroid. the adjHR (95 % CI) was 1.6 (1.14, 2.31). Female patients who were also corticosteroid users, but not of advanced age, have shown lower survival for both diseases (log-rank, p=0.001). the discontinuation rate of IFX, but not of ADA or ETA, was significantly higher in RA than in SA; HR (95 % CI) was 2.49 (1.46, 4.24). the main causes of discontinuation were ineffectiveness and adverse event in both diseases. AS patients have better drug survival adjusted to gender, age, and corticosteroid. This results appear to be related to the disease mechanism.
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    Epidemiologia e os desfechos clínicos de pacientes com carcinoma de pequenas células do ovário, tipo hipercalcêmico (SCCOHT)
    (Universidade Federal de São Paulo (UNIFESP), 2020-11-26) Callegaro Filho, Donato [UNIFESP]; Speck, Neila Maria De Gois [UNIFESP]; Universidade Federal de São Paulo
    Objective: Small cell carcinoma of the ovary-hypercalcemic type (SCCOHT) is a rare disease with a poor prognosis. SCCOHT has recently been shown to be associated with SMARCA4 gene mutations as well as molecular and genetic similarities to malignant rhabdoid tumors (MRT). The objective of our study is to describe the clinical characteristics, treatment modalities and outcomes of patients with SCCOHT. Methods: We performed a retrospective analysis of 47 patients with SCCOHT evaluated at MD Anderson Cancer Center between 1990 and 2014. Medical records were reviewed for demographic information, pathologic findings, treatment regimens and outcomes. Results: Median age at diagnosis was 30 years (range 5-46). All patients underwent surgery with unilateral salpingo-oophorectomy performed in 26 patients (55%), and hysterectomy with bilateral salpingo-oophorectomy in 21 patients (45%). Sixteen patients (34.0%) had stage I disease, six (12.8%) stage II, 23 (48.9%) stage III, and two patients (4.3%) had stage IV disease. Information on adjuvant treatment was available for 43 patients: 83.3% received chemotherapy alone, 9.5% chemotherapy followed by radiotherapy, 2.4% chemoradiation, and 4.8% did not receive any adjuvant therapy. Median follow-up was 13.2 months with a median overall survival of 14.9 months. Multi-agent chemotherapy and radiotherapy were associated with a better prognosis. On multivariate analysis, factors associated with favorable prognosis included absence of large cell component (p = 0.0003, HR = 0.19, 95% CI 0.08 to 0.47) and early stage disease (p=0.0029, HR=0.28, 95% CI 0.12 to 0.64). Median overall survival (OS) for the 12 patients with a large cell component was 8.8 months compared with 19.4 months for the 35 patients without a large cell component. Median OS for patients with early stage disease was 35.3 months compared with 10.4 months for patients with advanced stage disease. A better prognosis was also associated with the use of radiotherapy (p = 0.0365, HR = 0.26, 95% CI 0.07 to 0.92). The multiagent chemotherapy regimen of vinblastine, cisplatin, cyclophosphamide, bleomycin, doxorubicin and etoposide (VPCBAE) was associated with a decreased rate of recurrence (p = 0.0394). Conclusion: These findings shows a predominant incidence in young adults, caucasian, with large. Frequent misinterpreted as other ovarian neoplasms. Surgery was part of the initial treatment of all patients followed by complementary platinum- based chemotherapy for most patients. High recurrence rates despite treatments. Favorable prognostic factors included absence of large cell component, early stage disease, use of radiotherapy and chemotherapy with VPCBAE regimen. Further study is needed to improve outcomes in these patients including the adoption of systemic therapies used in MRT as well as the development of novel agents targeting specific mutations.
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    O exercício prévio melhora a sobrevida e atenua as repercussões miocárdicas da reperfusão tardia em ratas
    (Universidade Federal de São Paulo (UNIFESP), 2016-11-08) Veiga, Eduardo Carvalho de Arruda [UNIFESP]; Tucci, Paulo Jose Ferreira [UNIFESP]; http://lattes.cnpq.br/5187930505942303; http://lattes.cnpq.br/9762488058584769; Universidade Federal de São Paulo (UNIFESP)
    Introduction: There is acceptable evidence that exercise benefits the heart function in diseases already established in the heart. The literature is less conclusive in respect to the beneficial effects of the previous exercise training in the evolution of transient and permanent coronary occlusion. Objective: This study aimed to evaluate the effects of previous swimming in structural, functional and molecular biology of rat hearts, evaluated four weeks after permanent coronary occlusion or one hour of ischemia followed by reperfusion. Methods: Rats were subjected to swimming protocol for eight weeks and randomized between four groups: 1) sedentary infarcted (SMI; n = 12); 2) exercised infarcted (EMI: n = 12), 3) sedentary ischemia/reperfusion (SIR; n= 9) and 4) exercised ischemia/reperfusion (EIR, n = 8). Thereafter, the rats remained four weeks under observation for spontaneous evolution of secondary pathophysiology of coronary occlusion. Results (x ± sem): The Kaplan Meyer curve indicated that sedentary rats had higher mortality than the exercised. Those suffering permanent occlusion and those reperfused had MI size (% LV) not differents (SMI: 44 ± 1; EMI: 47 ± 2; SIR: 46 ± 1; EIR: 49 ± 2). Sedentary groups denoted pulmonary congestion, in contrast to exercise animals, which has no pulmonary congestion. The cardiac masses of different groups did not differ in respect to LV and RV. The hemodynamic data included: a) higher heart rate in EMI group; b) LV systolic pressure reduced in SMI animals; c) attenuation of LV end diastolic pressure increase in EIR; d) first time derivatives of positive ventricular pressure reduction in infarcted groups. In Doppler echocardiogram, there were no differences between analyzed parameters: diastolic and systolic areas, transverse fractional shortening of areas and E/A ratio. In the analysis of the papillary muscles, the maximum forces developed by reperfused groups were higher than those of the infarcted and the same result was found for the positive derivative of force. The nuclear volume of the reminiscent cardiomyocytes of exercised groups was lower than those of the sedentary groups. Collagen content, apoptosis and caspase 3 in ischemia/reperfusion groups were lower than those subjected to permanent coronary occlusion. Quantification of phosphorylated AKT1 of SMI group was lower than that of other groups; the SERCA2a/GAPDH ratios were higher in the exercised animals, as well as phosphorylated phospholamban in the groups with isquemia/reperfusion. CaATPase of the SIM group was lower than all other groups. The values of the ryanodine receptor/GAPDH of EIM were lower than all other groups. Conclusion: Prior exercise training enhanced survival, structural, functional and molecular characteristics of rats submitted to late ischemia/reperfusion. In rats submitted to definitive coronary occlusion, previous exercise promoted: lesser nuclear volume, prolonged survival, normal systolic arterial and increased phosphorylated AKT1, SERCA2 of remanent myocardial.
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    Exercise ventilatory inefficiency adds to lung function in predicting mortality in copd
    (Hindawi Publishing Corp, 2016) Neder, J. Alberto [UNIFESP]; Alharbi, Abdullah; Berton, Danilo C.; Alencar, Maria Clara N. [UNIFESP]; Arbex, Flavio F. [UNIFESP]; Hirai, Daniel M. [UNIFESP]; Webb, Katherine A.; O'Donnell, Denis E.
    Severity of resting functional impairment only partially predicts the increased risk of death in chronic obstructive pulmonary disease (COPD). Increased ventilation during exercise is associated with markers of disease progression and poor prognosis, including emphysema extension and pulmonary vascular impairment. Whether excess exercise ventilation would add to resting lung function in predicting mortality in COPD, however, is currently unknown. After an incremental cardiopulmonary exercise test, 288 patients (forced expiratory volume in one second ranging from 18% to 148% predicted) were followed for a median (interquartile range) of 57 (47) months. Increases in the lowest (nadir) ventilation to CO2 output (VCO2) ratio determined excess exercise ventilation. Seventy-seven patients (26.7%) died during follow-up: 30/77 (38.9%) deaths were due to respiratory causes. Deceased patients were older, leaner, had a greater co-morbidity burden (Charlson Index) and reported more daily life dyspnea. Moreover, they had poorer lung function and exercise tolerance (p < 0.05). A logistic regression analysis revealed that ventilation/VCO2 nadir was the only exercise variable that added to age, body mass index, Charlson Index and resting inspiratory capacity (IC)/total lung capacity (TLC) ratio to predict all-cause and respiratory mortality (p < 0.001). Kaplan-Meier analyses showed that survival time was particularly reduced when ventilation/VCO2 nadir > 34 was associated with IC/TLC 0.34 or IC/TLC 0.31 for all-cause and respiratory mortality, respectively (p < 0.001). Excess exercise ventilation is an independent prognostic marker across the spectrum of COPD severity. Physiological abnormalities beyond traditional airway dysfunction and lung mechanics are relevant in determining the course of the disease.
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    Expanding the use of expanded criteria donors in kidney transplantation
    (Springer, 2014-08-01) Assis-Borba, Luciana [UNIFESP]; Cristelli, Marina P. [UNIFESP]; Paula, Mayara I. [UNIFESP]; Franco, Marcelo F. [UNIFESP]; Tedesco-Silva, Helio [UNIFESP]; Medina-Pestana, Jose O. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Although the use of kidney allografts from expanded criteria donors (ECD) has increased in recent years, the reported discard rates are also growing. the influence of ECD characteristics on transplant outcomes is still underevaluated.This retrospective study investigated the influence of preimplantation biopsy findings and delayed graft function (DGF) on patient and graft survivals and renal function at 36 months in a cohort of 372 ECD kidney transplant recipients.Patient and graft survivals were 91.6 and 68.9 %. the incidence of biopsy-proven acute rejection was 31 %. There were no differences in patient (88.6 vs. 91.1 vs. 94.7 vs. 78.6 %, p = 0.10) or graft (78.1 vs. 72.2 vs. 60.5 vs. 62.6 %, p = 0.14) survivals and renal function (41.7 +/- A 25.6 vs. 39.9 +/- A 29.9 vs. 38.1 +/- A 30.6 vs. 37.4 +/- A 29.2 mL/min, p = 0.79) comparing ECD kidneys with mild, moderate, and severe histological changes or with no preimplantation biopsy, respectively. However, severe scored transplants had the worst death-censored graft survival (OR 3.1, 95 % CI 1.4-6.9, p = 0.007). No significant differences in patient (86.2 vs. 83.4 %, p = 0.17) or graft (73.7 vs. 65.9 %, p = 0.06) survivals and renal function (38.9 +/- A 28.6 vs. 39.9 +/- A 28.4 mL/min, p = 0.72) were observed comparing patients with or without DGF. Multivariable analysis found diabetes history as the only independent risk factor for graft loss (OR 2.1, 95 % CI 1.3-3.3, p = 0.003) or patient death (OR 3.1, 95 % CI 1.5-5.8, p < 0.001).Within the limitations of sample size and short follow-up time, in this cohort of ECD kidney transplant recipients the severity of histological changes observed in preimplantation biopsies was independently associated with graft loss.
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    Fas, FasL, and cleaved caspases 8 and 3 in glioblastomas: A tissue microarray-based study
    (Elsevier B.V., 2014-01-01) Saggioro, Fabiano Pinto; Neder, Luciano; Stávale, João Norberto [UNIFESP]; Paixão-Becker, Aline Nazareth de Paiva; Malheiros, Suzana Maria Fleury [UNIFESP]; Soares, Fernando Augusto; Pittella, José Eymard Homem; Matias, Caio César Marconato Simões; Colli, Benedicto Oscar; Carlotti Junior, Carlos Gilberto; Franco, Marcello Fabiano de [UNIFESP]; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP); Hosp Canc AC Camargo
    This investigation analyzed the immunoexpression of FasL, Fas, cleaved caspase-8, and cleaved caspase-3 in glioblastomas. Formalin-fixed and paraffin-embedded glioblastoma tissues and control brain tissues from 97 patients were analyzed by tissue microarrays and immunohistochemistry. Patients with glioblastomas that were negative or weakly stained (<50% of cells positive) for cleaved caspase-8 had worse cancer-specific overall survival (median=8.5 months) than did patients with tumors that highly expressed cleaved caspase-8 (median=11.7 months; P=0.0325), independent of clinical variables. There was no association of other markers with survival, treatment, sex, age, tumor size, and primary site. Among the tumors, there were reasonable to good positive correlations between the expression of FasL and Fas (r=0.47) and between Fas and cleaved caspase-8 (r=0.41), and there were poor positive correlations between Fas and cleaved caspase-3 (r=0.26), FasL and cleaved caspase-8 (r=0.22), and cleaved caspase-8 and -3 (r=0.31). Our results suggest that Fas-Fas-ligand signal transduction could be inhibited, especially at the stage of caspase-8 activation, thereby establishing a major mechanism for evasion of apoptosis by these tumors. the absence or low expression of cleaved caspase-8 in the tumors was a negative prognostic indicator for patient survival. (C) 2014 Elsevier GmbH. All rights reserved.
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    Fatores prognósticos clínicos e anatomopatológicos dos tumores estromais gastrointestinais (gist) de origem gástrica
    (Colégio Brasileiro de Cirurgiões, 2006-10-01) Valadão, Marcus; Lourenço, Laércio Gomes [UNIFESP]; Linhares, Eduardo; Romano, Sérgio; Kesley, Rubens; Siqueira, Deborah; INCA; Universidade Federal de São Paulo (UNIFESP); INCA Seção de Cirurgia Abdômino-Pélvica; UFRJ; INCA Serviço de Anatomia Patológica; Universidade Gama Filho; Hospital dos Servidores do Estado Serviço de Anatomia Patológica
    BACKGROUND: This study wants to identify clinical and pathologic prognostic factors of resected gastric gastrointestinal stromal tumors (GIST). METHODS: Twenty-nine patients with c-Kit positive gastric GIST who underwent surgical resection at the Brazilian National Cancer Institute (INCA) between 1983 and 2004 were reviewed retrospectively. Prognostic significance of clinical and pathological variables was investigated. The endpoints were overall survival and disease free survival. RESULTS: Median follow-up was 35 months. Five-year estimate survival rate was 53%. Univariate analysis for overall survival identified size 13.5 cm (p=0.01) and recurrence (p=0.03) as prognostic factors. Size 13.5 cm and recurrence were independent factors (p=0.01 and p=0.03 respectively) in multivariate analysis. Univariate analysis for disease free survival identified size 13.5 cm (p=0.04) and grade (p=0.04) as prognostic factors but only size 13.5 cm was an independent factor in multivariate analysis. CONCLUSION: Size 13.5 cm and recurrence were identified as independent prognostic factors for overall survival. Only size 13.5 cm was an independent prognostic factor for disease free survival.
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    Impact of Pancreatic Allograft Function on 1-Year Survival Rates After Simultaneous Pancreatic-Renal Transplant
    (Baskent Univ, 2008-12-01) Rangel, Erika Bevilaqua [UNIFESP]; Melaragno, Cláudio Santiago [UNIFESP]; Gonzalez, Adriano Miziara [UNIFESP]; Linhares, Marcelo Moura [UNIFESP]; Sá, João Roberto de [UNIFESP]; Salzedas, Alcides [UNIFESP]; Pestana, Jose Osmar Medina [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Objectives: Simultaneous pancreatic-renal transplant is an effective treatment for insulin-dependent patients with chronic renal failure. We sought to identify the main influences on pancreatic and patient survival rates after simultaneous pancreas-kidney transplants.Patients and Methods: The 1-year patient and pancreas survival rates of 150 patients who had undergone simultaneous pancreas-kidney transplant were analyzed by the Cox proportional hazards regression model and the Kaplan-Meier method. Uni- and multivariate analyses were performed in terms of transplant-, recipient-, and donor-related risk factors.Results: At 1 year, patient and pancreatic allograft survival rates were 82% and 76.7%, respectively. Delayed graft function in the kidney (P = .001, HR 5.41), acute kidney rejection (P = .016, HR 3.36), and intra-abdominal infection (P < .0001, HR 4.15) were the main factors related to 1-year patient survival. Pancreatic allograft survival at 1 year was related to intra-abdominal infection (P < .0001, OR 12.83), vascular thrombosis (P = .002, OR 40.55), acute kidney rejection (P = .027, OR 3.06), donor sodium greater than 155 mEq/L (P = .02, OR 3.27), and dopamine administration exceeding 7.6 mu g/kg/min (P = .046, OR 2.85).Conclusions: Delayed kidney allograft function and intra-abdominal infection had an important effect on both patient and pancreatic allograft survival rates.
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    Impacto do estado nutricional nos desfechos clínicos de pacientes submetidos a transplante alogênico de células progenitoras hematopoéticas
    (Universidade Federal de São Paulo (UNIFESP), 2019-01-31) Hirose, Erika Yuri [UNIFESP]; Silva, Celso Arrais Rodrigues da [UNIFESP]; Gonçalves, Matheus Vescovi [UNIFESP]; http://lattes.cnpq.br/9252089988474953; http://lattes.cnpq.br/6962573800002763; http://lattes.cnpq.br/1143162519205688; Universidade Federal de São Paulo (UNIFESP)
    Background: Malnutrition is a common finding in allogeneic hematopoietic stem cell transplantation (alloHSCT) patients, and its influence on transplant outcomes is uncertain, with conflicting results. Objetive: This study aims to compare the nutritional status of adult patients submitted to alloHSCT at admission and to evaluate the impact of nutritional status on clinical outcomes. Methods: We performed a retrospective study with 148 patients aged 18 to 75 years with hematological diseases who underwent alloHSCT between 2011 and 2017. Patients were classified according to the body mass index (BMI) and the Subjective Global Assessment (SGA). The SGA classifies patients into three groups: A (well-nourished), B (moderately malnourished) and C (severely malnourished). Results: At admission, the SGA classified 49 (33%) patients as well-nourished, 54 (37%) as moderately malnourished, and 45 (30%) as severely malnourished. The cumulative incidence (CI) of acute graft-versus-host disease (aGVHD) at 120 days was higher in severely malnourished patients (C-SGA) than in A-SGA or B- group patients, with cumulative incidence rates of 58% vs. 38%, respectively (P=0.016). C-SGA was also associated with severe aGVHD with a CI of 31% vs. a CI of 14% for combined well-nourished or moderately malnourished group (A-SGA or B-, P=0.017). Progression-free survival (PFS) and overall survival (OS) at 3 years were also significantly worse for C-SGA compared to combined A-SGA or B-: PFS rates were 61% vs. 19% (P<0.0001), respectively, and OS rates were 66% vs. 22% (P<0.0001), respectively. Conclusion: Malnutrition is common before alloHSCT, increases the risk of aGVHD and has a negative impact on survival.