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OBJECTIVES: Immunotherapy is a new treatment in advanced lung cancer that works by modulating the immune response against malignant cells. One aspect that is challenging for radiologists in the evaluation of the response to immunotherapy is the phenomenon of pseudoprogression, in which the infiltration of inflammatory cells causes lesions to increase in size or new lesions to appear and then decrease in size or disappear. Pseudoprogression actually represents a response to treatment. We aimed to determine the frequency of pseudoprogression in patients with advanced stages of lung cancer treated with nivolumab. PATIENTS AND METHODS: We included 56 patients with advanced stages of lung cancer treated with nivolumab as a second-line or later treatment. We analyzed CT studies done while patients were undergoing nivolumab treatment. Tumor pseudoprogression was defined as an increase in the size of lesions or appearance of new lesions followed by a decrease in size or disappearance of these lesions on follow-up CT studies 4 to 8 weeks later. We did a descriptive analysis. RESULTS: In 15 patients, it was impossible to evaluate possible pseudoprogression because a second CT study was unavailable due to change of treatment or death. Tumor pseudoprogression was observed in 5 (12.2%) of the 41 patients, in most cases within 12 weeks of treatment initiation (in the fourth cycle). A second episode of pseudoprogression occurred in 2 (40%) of the 5 patients with an initial episode; the second episode occurred more than 12 weeks after treatment initiation. CONCLUSION: Tumor pseudoprogression occurred in 12.2% of patients with advanced stage lung cancer treated with nivolumab. An increase in lesion size or the appearance of new lesions must be assessed over time to avoid mistaking pseudoprogression for true progression of disease.
Assuntos
Antineoplásicos Imunológicos/uso terapêutico , Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/tratamento farmacológico , Nivolumabe/uso terapêutico , Tomografia Computadorizada por Raios X , Idoso , Carcinoma Pulmonar de Células não Pequenas/patologia , Progressão da Doença , Feminino , Humanos , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
Breast cancer is the most common cancer in women in our country and it is usually diagnosed in the early and potentially curable stages. Nevertheless, around 20-30% of patients will relapse despite appropriate locoregional and systemic therapies. A better knowledge of this disease is improving our ability to select the most appropriate therapy for each patient with a recent diagnosis of an early stage breast cancer, minimizing unnecessary toxicities and improving long-term efficacy.
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Neoplasias da Mama/patologia , Neoplasias da Mama/terapia , Guias de Prática Clínica como Assunto/normas , Ensaios Clínicos como Assunto , Terapia Combinada , Gerenciamento Clínico , Detecção Precoce de Câncer , Feminino , Humanos , Prognóstico , Sociedades MédicasAssuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias da Mama Masculina/tratamento farmacológico , Neoplasias Primárias Múltiplas/tratamento farmacológico , Neoplasias da Próstata/tratamento farmacológico , Idoso , Neoplasias da Mama Masculina/patologia , Estradiol/administração & dosagem , Estradiol/análogos & derivados , Fulvestranto , Hormônio Liberador de Gonadotropina/administração & dosagem , Hormônio Liberador de Gonadotropina/análogos & derivados , Humanos , Letrozol , Masculino , Neoplasias Primárias Múltiplas/patologia , Nitrilas/administração & dosagem , Neoplasias da Próstata/patologia , Tamoxifeno/administração & dosagem , Triazóis/administração & dosagemRESUMO
The discovery of mutated oncogenes has opened up a new era for the development of more effective treatments for non-small cell lung cancer patients (NSCLC) harbouring EGFR mutations. However, patients with EGFR-activating mutation ultimately develop acquired resistance (AR). Several studies have identified some of the mechanisms involved in the development of AR to EGFR tyrosine kinase inhibitors (TKI) that can be potential therapeutic strategies, although in up to 30% of cases, the underlying mechanism of AR are still unexplained. In this review we aim to summarize the main mechanisms of AR to EGFR TKI and some clinical strategies that can be used in the daily clinical practice to overcome this resistance and try to prolong the outcomes in this subgroup of patients.
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Antineoplásicos/farmacologia , Resistencia a Medicamentos Antineoplásicos , Receptores ErbB/genética , Inibidores de Proteínas Quinases/farmacologia , Animais , Antineoplásicos/uso terapêutico , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Carcinoma Pulmonar de Células não Pequenas/genética , Carcinoma Pulmonar de Células não Pequenas/metabolismo , Receptores ErbB/antagonistas & inibidores , Receptores ErbB/metabolismo , Amplificação de Genes , Expressão Gênica , Fator de Crescimento de Hepatócito/genética , Fator de Crescimento de Hepatócito/metabolismo , Humanos , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/metabolismo , Inibidores de Proteínas Quinases/uso terapêutico , Proteínas Proto-Oncogênicas c-met/genética , Transdução de SinaisRESUMO
PURPOSE: The primary aim of this trial was to assess the rate of pathologic complete responses (pCR) of doxorubicin/cyclophosphamide (AC) followed by bevacizumab/docetaxel (BT), as neoadjuvant therapy for breast cancer (BC). Furthermore, the association between biomarkers and the pCR was explored. METHODS: Patients with HER-negative operable stage II-III BC ≥ 2 cm were enrolled. Four cycles of AC (A 60 mg/m(2) and C 600 mg/m(2), every 3 weeks) followed by 4 cycles of BT (B 15 mg/kg and T 75 mg/m(2), every 3 weeks), were planned. A core-biopsy was performed for biological markers assessment. RESULTS: Seventy-two women were included. Forty-three (63 %) patients were hormone receptor-positive. Sixty-four (89 %) completed the planned treatment, and 66 evaluable patients underwent surgery (92 %): a pCR was achieved in 16 of them (24, 95 % CI 15-36 %). pCR was significantly higher in tumors hormone receptor-negative, and in those with Angiotensin II type 1 receptor (AGTR1) protein overexpression. The overall clinical response rate was 86 % (95 % CI 76-93 %), including 42 complete responses. No unexpected toxicities or treatment-related deaths were observed. CONCLUSION: This regimen showed a remarkable clinical and pathological activity: the suggested relation between pCR and AGTR1 overexpression should be confirmed in larger trials.
Assuntos
Inibidores da Angiogênese/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Carcinoma Ductal de Mama/tratamento farmacológico , Carcinoma Lobular/tratamento farmacológico , Receptor ErbB-2/metabolismo , Adulto , Idoso , Bevacizumab , Biomarcadores Tumorais/metabolismo , Neoplasias da Mama/metabolismo , Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/metabolismo , Carcinoma Ductal de Mama/secundário , Carcinoma Lobular/metabolismo , Carcinoma Lobular/secundário , Ciclofosfamida/administração & dosagem , Docetaxel , Doxorrubicina/administração & dosagem , Feminino , Seguimentos , Humanos , Metástase Linfática , Pessoa de Meia-Idade , Terapia Neoadjuvante , Estadiamento de Neoplasias , Cuidados Pré-Operatórios , Prognóstico , Receptores de Estrogênio/metabolismo , Receptores de Progesterona/metabolismo , Indução de Remissão , Taxoides/administração & dosagemRESUMO
The combined effects of disinfectant agents on the microbiological quality of reclaimed water produced by two full-scale water reclamation plants in Catalonia, Spain, were examined in this work. All the disinfectant treatments tested led to the absence, or near absence, of E. coli in 100 mL samples of water, with log reductions of more than 3 log u. Hypochlorite reduced the bacterial concentrations. However, ultraviolet light was more effective than hypochlorite at reducing the concentrations of bacteriophages, viruses and pathogenic protozoa such as Cryptosporidium spp. We conclude that a combination of these two disinfectant agents is effective in protecting public health, as each agent acts to a different degree against the different groups of microorganisms studied. Further studies should investigate the combined action of disinfectant agents at water reclamation plants with ultraviolet light equipment in more favourable working conditions in order to assess their capacity to inactivate microorganisms.
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Cloro/farmacologia , Desinfecção/métodos , Raios Ultravioleta , Purificação da Água/métodos , Abastecimento de Água/normas , Animais , Conservação dos Recursos Naturais/métodos , Desinfetantes/farmacologia , Escherichia coli/efeitos dos fármacos , Escherichia coli/efeitos da radiação , Eucariotos/efeitos dos fármacos , Eucariotos/efeitos da radiação , Ácido Hipocloroso/farmacologia , Reprodutibilidade dos Testes , Espanha , Vírus/efeitos dos fármacos , Vírus/efeitos da radiação , Microbiologia da Água , Abastecimento de Água/análiseRESUMO
UNLABELLED: Home enteral nutrition is a treatment carried out frequently due to advantages for patients and caregivers (lower risk of nosocomial infections and better integration in socio-familiar media) but also for the health administration because of the lower economic cost and the release of hospital beds. OBJECTIVE: To investigate patients' and caregivers' satisfaction related to tube enteral nutrition administered at home by a Service controlled and followed by the Nutritional Support Unit from the reference hospital. METHODS: One questionnaire for the patients and another for the caregivers were delivered to the patients with home enteral nutrition asking for voluntary response. Similar questionnaires were sent to hospitalized patients and their relatives or possible caregivers. RESULTS: According to the results of the questionnaires, the majority of patients and relatives were satisfied with the service received. In the cases in which the service was offered at home, the preference was to continue there and not to return to the hospital. Finally, the possibility of telephone contact and home visits were the most important factors that influenced patient satisfaction. CONCLUSION: Our results let us conclude that home enteral nutrition controlled and followed up by the Nutritional Support Unit form the hospital is a treatment well accepted both by patients and relatives.
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Cuidadores/psicologia , Nutrição Enteral/psicologia , Serviços Hospitalares de Assistência Domiciliar/organização & administração , Pacientes Internados/psicologia , Pacientes Ambulatoriais/psicologia , Satisfação do Paciente/estatística & dados numéricos , Adulto , Idoso , Família/psicologia , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Apoio NutricionalRESUMO
BACKGROUND: We reviewed radiologic features of gastrointestinal stromal tumors (GISTs) and correlated them with clinical and pathologic findings. METHODS: We investigated a series of 39 c-Kit-positive GISTs. Clinical and radiologic findings and management of these patients were recorded. RESULTS: Twenty women and 19 men (mean age 64 years) had histologically proved GIST. Tumor locations were the small bowel (n = 20), stomach (n = 14), rectum (n = 4), and omentum (n = l). Symptoms at presentation were most frequently gastrointestinal bleeding (n = 14) and abdominal pain (n = l1). Tumors were classified as very low risk (n = 2), low risk (n = 10), intermediate risk (n = 12), and high risk (n = 11). Ultrasonography, computed tomography, magnetic resonance, digital subtraction angiography, and barium series were used in the evaluation of these tumors. Most tumors were seen as well-delineated soft tissue masses with heterogeneous contrast enhancement. Necrosis, calcification, and ulceration were most commonly seen in large tumors that presented a more aggressive behavior. CONCLUSION: GISTs can arise anywhere in the gastrointestinal tract and present a great variety of clinical and radiologic features, depending mostly on size and location.
Assuntos
Tumores do Estroma Gastrointestinal/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/uso terapêutico , Sulfato de Bário , Benzamidas , Meios de Contraste , Feminino , Tumores do Estroma Gastrointestinal/patologia , Tumores do Estroma Gastrointestinal/terapia , Humanos , Mesilato de Imatinib , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos , Piperazinas/uso terapêutico , Pirimidinas/uso terapêutico , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
INTRODUCTION: Blocked blood flow in the brain of patients with sickle cell anaemia (SCA) gives rise to disorders in this organ and, occasionally, courses with no clinical symptoms. AIMS: Our objective was to determine the most common lesions in the brains of patients with SCA in the eastern region of Cuba. PATIENTS AND METHODS: We conducted a study with children and adults with SCA, who were voluntarily included in the research protocol. The 28 adult patients had no history of vaso-occlusive crises of the central nervous system, and their ages ranged from 17 to 48 years. In addition, 50 paediatric-aged patients between the ages of 2 and 17 years were evaluated. Images were obtained with the Cuban magnetic resonance imaging equipment Giroimag 01 at 0.05 T. RESULTS: Both studies showed that cortical atrophy (CA) is the most frequent brain lesion among those found in the population of patients evaluated. The study revealed 35.7% of patients with silent lesions in adults and 18% in the children. CONCLUSIONS: CA is the lesion that is most commonly seen in the population studied. The brain lesions that were found are possibly triggered by the effect of blockages in the blood flow in the brain. A population study must be conducted in order to determine the first disorders triggered by the blocked blood flow in the brains of these patients. There is also a need to evaluate the possible risk factors that favour the development of these lesions.
Assuntos
Anemia Falciforme/complicações , Encefalopatias/etiologia , Encefalopatias/patologia , Imageamento por Ressonância Magnética , Adolescente , Criança , Feminino , Humanos , MasculinoRESUMO
Hospital payment systems are being changed to mixed systems, composed of case-mix categories and structure indicators. The Health Care Financing Administration's Diagnosis-Related-Groups (HCFA's DRG-weights are used in Catalonia as Prospective Payment System (PPS)-instruments for hospital inpatient reimbursement. The Catalonian and Spanish health systems, however, are very different from the US health environment. The aim of this study is to determine whether the HCFA's DRG-weights fit the special characteristics of a European environment. To do this, cost-based weights, determined from information from the cost accounting system of two public hospitals in Barcelona, are compared with Medicare-weights. A total of 35 262 discharges representing 12 794 million pesetas are analyzed. Medicare-weights do not differ globally from cost-based-weights and the adjusted correlation weighted least squares regression between the two weight-scales is 95%. There are, however, systematic deviations in six DRG-groupings. The most important deviations are concentrated in Ambulatory Surgery categories, in DRGs in which prostheses are used, and in specialties excluded from several PPSs because of extreme variables in treatment intensity. In conclusion, Medicare-weights can be used to pay hospital output in European environment but they should be adjusted to avoid systematic deviations.
Assuntos
Grupos Diagnósticos Relacionados/economia , Hospitais Públicos/economia , Medicare/economia , Programas Nacionais de Saúde/economia , Sistema de Pagamento Prospectivo , Contabilidade , Centers for Medicare and Medicaid Services, U.S. , Alocação de Custos , Espanha , Estados UnidosRESUMO
Different carbon sources affecting growth and lipase production in Candida rugosa were studied by using batch cultures on defined medium. Carbohydrates and acids non-related to fats did not induce lipase production. The highest yields of enzyme were obtained with lipids or fatty acids as carbon sources. Tween 80 stimulated lipase biosynthesis and secretion outside the cell. Combinations of two types of substrates, carbohydrates and fatty acids, did not improve lipase production, and in some cases, their consumption was produced in a sequential pattern. Glucose presented a repressing effect on lipase production. Moreover, glucose was found to be effective in stimulating lipase secretion by cells with a high level of cell-bound lipase activity because of their previous growth in oleic acid.
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Two screening and one resistance verification trial involving 20 Prunus rootstocks were conducted under greenhouse conditions against Meloidogyne spp. and Pratylenchus vulnus. Most of the rootstocks were experimental genotypes or new commercial peach and plums of Spanish and French origin. Nearly all are interspecific hybrid rootstocks. In the first trial, the rootstocks Bruce, Cadaman, Mirac, G x N No. 15, Cachirulo x (G x N No. 9), and P. myra x peach were immune or resistant to a mixture of seven isolates of M. incognita. In the second screening trial, the hybrid plum P 2588 was a poor host to a mixture of four isolates of P. vulnus. The remaining seven rootstocks were good hosts to the root-lesion nematode. In the resistance verification trial GF-31, G x N No. 15, Torinel, AD- l 01, Monpol, Nemaguard, and Cadaman maintained a high level of resistance when tested against a mixture of 17 isolates comprising M. incognita, M. javanica, M. arenaria, M. hapla, and M. hispanica. Barrier peach suffered a partial loss of resistance not detected in previous tests.