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1.
Blood ; 139(22): 3303-3313, 2022 06 02.
Artigo em Inglês | MEDLINE | ID: mdl-35313334

RESUMO

Pediatric B-cell precursor acute lymphoblastic leukemia (BCP-ALL) outcome has improved in the last decades, but leukemic relapses are still one of the main problems of this disease. Bone morphogenetic protein 4 (BMP4) was investigated as a new candidate biomarker with potential prognostic relevance, and its pathogenic role was assessed in the development of disease. A retrospective study was performed with 115 pediatric patients with BCP-ALL, and BMP4 expression was analyzed by quantitative reverse transcription polymerase chain reaction in leukemic blasts at the time of diagnosis. BMP4 mRNA expression levels in the third (upper) quartile were associated with a higher cumulative incidence of relapse as well as a worse 5-year event-free survival and central nervous system (CNS) involvement. Importantly, this association was also evident among children classified as having a nonhigh risk of relapse. A validation cohort of 236 patients with BCP-ALL supported these data. Furthermore, high BMP4 expression promoted engraftment and rapid disease progression in an NSG mouse xenograft model with CNS involvement. Pharmacological blockade of the canonical BMP signaling pathway significantly decreased CNS infiltration and consistently resulted in amelioration of clinical parameters, including neurological score. Mechanistically, BMP4 favored chemoresistance, enhanced adhesion and migration through brain vascular endothelial cells, and promoted a proinflammatory microenvironment and CNS angiogenesis. These data provide evidence that BMP4 expression levels in leukemic cells could be a useful biomarker to identify children with poor outcomes in the low-/intermediate-risk groups of BCP-ALL and that BMP4 could be a new therapeutic target to blockade leukemic CNS disease.


Assuntos
Linfoma de Burkitt , Leucemia-Linfoma Linfoblástico de Células Precursoras B , Leucemia-Linfoma Linfoblástico de Células Precursoras , Animais , Proteína Morfogenética Óssea 4/genética , Criança , Células Endoteliais/metabolismo , Humanos , Camundongos , Leucemia-Linfoma Linfoblástico de Células Precursoras B/patologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/patologia , Recidiva , Estudos Retrospectivos , Microambiente Tumoral
2.
PLoS Comput Biol ; 19(8): e1011329, 2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-37578973

RESUMO

Although children and adolescents with acute lymphoblastic leukaemia (ALL) have high survival rates, approximately 15-20% of patients relapse. Risk of relapse is routinely estimated at diagnosis by biological factors, including flow cytometry data. This high-dimensional data is typically manually assessed by projecting it onto a subset of biomarkers. Cell density and "empty spaces" in 2D projections of the data, i.e. regions devoid of cells, are then used for qualitative assessment. Here, we use topological data analysis (TDA), which quantifies shapes, including empty spaces, in data, to analyse pre-treatment ALL datasets with known patient outcomes. We combine these fully unsupervised analyses with Machine Learning (ML) to identify significant shape characteristics and demonstrate that they accurately predict risk of relapse, particularly for patients previously classified as 'low risk'. We independently confirm the predictive power of CD10, CD20, CD38, and CD45 as biomarkers for ALL diagnosis. Based on our analyses, we propose three increasingly detailed prognostic pipelines for analysing flow cytometry data from ALL patients depending on technical and technological availability: 1. Visual inspection of specific biological features in biparametric projections of the data; 2. Computation of quantitative topological descriptors of such projections; 3. A combined analysis, using TDA and ML, in the four-parameter space defined by CD10, CD20, CD38 and CD45. Our analyses readily extend to other haematological malignancies.


Assuntos
Neoplasias Hematológicas , Leucemia-Linfoma Linfoblástico de Células Precursoras , Criança , Adolescente , Humanos , Recidiva Local de Neoplasia , Leucemia-Linfoma Linfoblástico de Células Precursoras/patologia , Citometria de Fluxo , Imunofenotipagem , Recidiva
3.
J Infect Dis ; 224(2): 229-240, 2021 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-33928374

RESUMO

BACKGROUND: Etiopathogenesis of the clinical variability of the coronavirus disease 2019 (COVID-19) remains mostly unknown. In this study, we investigate the role of killer cell immunoglobulin-like receptor (KIR)/human leukocyte antigen class-I (HLA-I) interactions in the susceptibility and severity of COVID-19. METHODS: We performed KIR and HLA-I genotyping and natural killer cell (NKc) receptors immunophenotyping in 201 symptomatic patients and 210 noninfected controls. RESULTS: The NKcs with a distinctive immunophenotype, suggestive of recent activation (KIR2DS4low CD16low CD226low CD56high TIGIThigh NKG2Ahigh), expanded in patients with severe COVID-19. This was associated with a higher frequency of the functional A-telomeric activating KIR2DS4 in severe versus mild and/or moderate patients and controls (83.7%, 55.7% and 36.2%, P < 7.7 × 10-9). In patients with mild and/or moderate infection, HLA-B*15:01 was associated with higher frequencies of activating B-telomeric KIR3DS1 compared with patients with other HLA-B*15 subtypes and noninfected controls (90.9%, 42.9%, and 47.3%; P < .002; Pc = 0.022). This strongly suggests that HLA-B*15:01 specifically presenting severe acute respiratory syndrome coronavirus 2 peptides could form a neoligand interacting with KIR3DS1. Likewise, a putative neoligand for KIR2DS4 could arise from other HLA-I molecules presenting severe acute respiratory syndrome coronavirus 2 peptides expressed on infected an/or activated lung antigen-presenting cells. CONCLUSIONS: Our results support a crucial role of NKcs in the clinical variability of COVID-19 with specific KIR/ligand interactions associated with disease severity.


Assuntos
COVID-19/genética , Predisposição Genética para Doença/genética , Receptores KIR/genética , Idoso , COVID-19/imunologia , COVID-19/patologia , Estudos Transversais , Feminino , Genótipo , Antígenos HLA/genética , Antígenos HLA/metabolismo , Humanos , Imunofenotipagem , Células Matadoras Naturais/metabolismo , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Receptores KIR/metabolismo , SARS-CoV-2 , Índice de Gravidade de Doença
4.
BMC Public Health ; 20(1): 1809, 2020 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-33246432

RESUMO

BACKGROUND: Mathematical modelling of infectious diseases is a powerful tool for the design of management policies and a fundamental part of the arsenal currently deployed to deal with the COVID-19 pandemic. METHODS: We present a compartmental model for the disease where symptomatic and asymptomatic individuals move separately. We introduced healthcare burden parameters allowing to infer possible containment and suppression strategies. In addition, the model was scaled up to describe different interconnected areas, giving the possibility to trigger regionalized measures. It was specially adjusted to Mendoza-Argentina's parameters, but is easily adaptable for elsewhere. RESULTS: Overall, the simulations we carried out were notably more effective when mitigation measures were not relaxed in between the suppressive actions. Since asymptomatics or very mildly affected patients are the vast majority, we studied the impact of detecting and isolating them. The removal of asymptomatics from the infectious pool remarkably lowered the effective reproduction number, healthcare burden and overall fatality. Furthermore, different suppression triggers regarding ICU occupancy were attempted. The best scenario was found to be the combination of ICU occupancy triggers (on: 50%, off: 30%) with the detection and isolation of asymptomatic individuals. In the ideal assumption that 45% of the asymptomatics could be detected and isolated, there would be no need for complete lockdown, and Mendoza's healthcare system would not collapse. CONCLUSIONS: Our model and its analysis inform that the detection and isolation of all infected individuals, without leaving aside the asymptomatic group is the key to surpass this pandemic.


Assuntos
Infecções Assintomáticas/epidemiologia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/prevenção & controle , Epidemias/prevenção & controle , Pandemias/prevenção & controle , Isolamento de Pacientes , Pneumonia Viral/diagnóstico , Pneumonia Viral/prevenção & controle , Argentina/epidemiologia , COVID-19 , Infecções por Coronavirus/epidemiologia , Humanos , Modelos Teóricos , Pneumonia Viral/epidemiologia
5.
Health Care Women Int ; 36(7): 851-66, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25383682

RESUMO

Domestic violence homicides and suicides are significant causes of deaths among women in India. This study examined characteristics and motives of various types of domestic violence-related homicides and suicides (n = 100) in India using newspaper reports (2011-2012). The majority of victims were found to be young women, mostly killed by burning or strangulation methods. The most frequently reported motive was dowry demands followed by a history of domestic violence or harassment and family conflict. The findings highlight the need for stronger prevention/intervention programs in India to identify and intervene with women at high risk for being killed or committing suicide.


Assuntos
Violência Doméstica/estatística & dados numéricos , Homicídio/estatística & dados numéricos , Motivação , Suicídio/estatística & dados numéricos , Adolescente , Adulto , Causas de Morte , Violência Doméstica/etnologia , Violência Doméstica/psicologia , Feminino , Homicídio/etnologia , Homicídio/psicologia , Humanos , Índia/epidemiologia , Casamento , Pessoa de Meia-Idade , Jornais como Assunto , Vigilância da População , Suicídio/etnologia , Suicídio/psicologia , Adulto Jovem
6.
Infect Dis (Lond) ; : 1-12, 2024 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-38743055

RESUMO

BACKGROUND: HIV-1-associated neurocognitive disorders (HAND) in stable patients undergoing antiretroviral therapy (ART) may result from ongoing immune dysregulation and chronic inflammation. A contributing factor may result from the unstable HLA class I allele, HLA-C*07. OBJECTIVE: To assess the genetic profile of killer-cell immunoglobulin-like receptors (KIR), human leukocyte antigens (HLA), and immune activation or senescence markers and their association with HAND in stable HIV-1 patients receiving ART. METHODS: An observational cross-sectional study was carried out with 96 patients with asymptomatic or symptomatic HAND. HLA and KIR as well as immune activation/senescence biomarkers in peripheral blood cells were assessed by SSO-Luminex typing and flow cytometry, respectively. RESULTS: HLA-C*07 is associated with symptomatic HAND. The frequency of two copies of HLA-C*07 was higher in patients with symptomatic than with asymptomatic HAND (12.0 vs. 2.2%, ρ < 0.001). The percentage of senescent CD8+CD28- T-cells was higher in patients with two copies of HLA-C*07 (ρ < 0.05). In patients with symptomatic HAND, the percentages of non-senescent CD8+CD28+ T cells were inversely proportional to the number of copies of the HLA-C*07 (ρ < 0.05). CONCLUSION: Patients with symptomatic HAND showed a higher frequency of the homozygotic unstable HLA-C*07 allotype, which could be associated with neurocognitive complications. Two copies of HLA-C*07 were associated with immune senescent T lymphocyte profiles characterized by the loss of CD28 expression.

8.
Oncoimmunology ; 10(1): 1986943, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34676148

RESUMO

NK and CD8+ T cells are the main cytolytic effectors involved in innate and adaptive tumor immune surveillance, respectively. Although their educational pathways differ, similarities in their development and function suggest that CD8+ T lymphocytes could be sensitive to NK cell licensing signals, which might influence their antitumor response. To demonstrate this hypothesis, we retrospectively evaluated the impact that NK cell licensing interactions have on the expression of CD226 on CD8+ T lymphocytes and on the survival of patients with different hematopoietic and solid cancers (n = 1,023). Prospectively, we analyzed by multiparametric flow cytometry the anti-CD3/CD28-induced proliferation and immune-receptor expression of purified CD8+ T lymphocytes from healthy donors (n = 17) with different combinations of NK cell licensing ligands. Results show that methionine/threonine (M/T) dimorphism at position -21 of the HLA-B leader peptide, but not other HLA class-I dimorphisms involved in the education of NK cells (HLA-C1/C2 or HLA-Bw4), is associated with greater survival and expression of CD226 in cancer patients, which was proportional to the number of methionines present in their genotype. CD8+ T lymphocytes from healthy donors with -21 M showed higher proliferation rates and lower expression of TIGIT after in vitro stimulation. Therefore, CD8+ T lymphocytes, like NK cells, appear to be sensitive to the -21 M/T dimorphism of HLA-B leader peptide, which results in the modulation of CD226 in vivo and the proliferation and expression of TIGIT after in vitro stimulation, all of which could be related to their immune-surveillance capacity and the survival of cancer patients.


Assuntos
Linfócitos T CD8-Positivos , Neoplasias , Antígenos de Histocompatibilidade Classe I , Humanos , Neoplasias/genética , Estudos Retrospectivos , Antígenos HLA-E
9.
Eur Urol Oncol ; 4(2): 246-255, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-31411976

RESUMO

BACKGROUND: Bladder cancer (BC) is highly immunogenic. Bacillus Calmette-Guérin (BCG) immunotherapy offers the best results in non-muscle-invasive BC (NMIBC). Natural killer cells (NKcs) play decisive roles in BCG-mediated immune response and in general cancer immune-surveillance. OBJECTIVE: To analyze killer-cell immunoglobulin-like receptors (KIRs), their human leukocyte antigen class-I (HLA-I) ligands, and the expression of DNAX Accessory Molecule-1 (DNAM-1/CD226) on peripheral blood (PB) NKcs, to identify useful predictive biomarkers in BC. DESIGN, SETTING, AND PARTICIPANTS: KIR/HLA-ligand genotypes were compared between 132 BC, 201 other solid cancers, 164 plasma cell disorders, and 615 healthy Caucasoid controls. CD226 expression was evaluated by flow cytometry. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: KIR/HLA-I interactions and CD226 expression on NKcs (CD226high or CD226low) were compared across study groups, cancer stages, treatments, and progression-free and overall survival of patients, using chi-square, analysis of variance/post hoc, Kaplan-Meier/log-rank, and regression analyses. RESULTS AND LIMITATIONS: Three immunological risk groups were identified: low risk (KIR2DL1-L2+L3-/C1C1- and KIR2DL1+L2+L3+/C1C1+), intermediate risk (rest), and high risk (KIR2DL5+/HLA-C*16+ and KIR2DL1+L2+L3-), which displayed different 10-yr progression-free rates (83.3%, 48.6%, and 0%, respectively; p<0.001) and survival rates (83.3%, 54.3%, and 6.2%, respectively; p<0.001) for muscle-invasive T2/T4, and 10-yr progression-free rates (100%, 81.6%, and 50%, respectively; p<0.05) for NMIBC-T1 treated with BCG. Immunological risk stratification had an independent prognostic value to just histological staging for survival (hazard ratio=2.93, p<0.00001, Harrell C-statistic=0.779). CD226 expression on PB NKcs improved immunological stratification in intermediate-risk T1-T4 BC patients, with survival rates of 94.1% and 66.7% for CD226high and CD226low (p<0.05), respectively. CONCLUSIONS: Immunological risk stratification will complement BC histopathology to improve risk stratification and guide the selection of personalized treatments. Understanding of the molecular mechanisms of NKc tumor immune surveillance will enable the development of future NKc-based therapies. PATIENT SUMMARY: This work describes a peripheral blood test that aids in our understanding of the immune defense mechanisms against bladder cancer, is useful for classifying patient risk, and will guide personalized treatments.


Assuntos
Neoplasias da Bexiga Urinária , Biomarcadores , Humanos , Células Matadoras Naturais , Prognóstico , Medição de Risco , Neoplasias da Bexiga Urinária/diagnóstico , Neoplasias da Bexiga Urinária/genética , Neoplasias da Bexiga Urinária/terapia
10.
Cancers (Basel) ; 12(10)2020 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-33076479

RESUMO

Killer-cell immunoglobulin-like receptors (KIR) are expressed by natural killer (NK) and effector T cells. Although KIR+ T cells accumulate in oncologic patients, their role in cancer immune response remains elusive. This study explored the role of KIR+CD8+ T cells in cancer immunosurveillance by analyzing their frequency at diagnosis in the blood of 249 patients (80 melanomas, 80 bladder cancers, and 89 ovarian cancers), their relationship with overall survival (OS) of patients, and their gene expression profiles. KIR2DL1+ CD8+ T cells expanded in the presence of HLA-C2-ligands in patients who survived, but it did not in patients who died. In contrast, presence of HLA-C1-ligands was associated with dose-dependent expansions of KIR2DL2/S2+ CD8+ T cells and with shorter OS. KIR interactions with their specific ligands profoundly impacted CD8+ T cell expression profiles, involving multiple signaling pathways, effector functions, the secretome, and consequently, the cellular microenvironment, which could impact their cancer immunosurveillance capacities. KIR2DL1/S1+ CD8+ T cells showed a gene expression signature related to efficient tumor immunosurveillance, whereas KIR2DL2/L3/S2+CD8+ T cells showed transcriptomic profiles related to suppressive anti-tumor responses. These results could be the basis for the discovery of new therapeutic targets so that the outcome of patients with cancer can be improved.

11.
Cancer Immunol Res ; 7(8): 1307-1317, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31239317

RESUMO

Therapies using NK cells (NKc) expanded/activated ex vivo or stimulated in vivo with new immunostimulatory agents offer alternative opportunities for patients with recurrent/refractory tumors, but relevant biomarkers to guide the selection of patients are required for optimum results. Overall survival of 249 solid cancer patients was evaluated in relation to the genetics and/or the expression on peripheral blood NKcs of inhibitory and activating killer-cell immunoglobulin-like receptors (iKIR and aKIR, respectively), HLA class I ligands, CD226 (also known as DNAM-1), and NKG2A. Compared with patients with higher expression, patients with low expression of CD226 on total NKcs showed shorter mean overall survival (60.7 vs. 98.0 months, P < 0.001), which was further reduced in presence of telomeric aKIRs (KIR2DS1-DS5 and/or KIR3DS1, 31.6 vs. 96.8 months, P < 0.001). KIR2DL2/S2+, KIR3DL1+, KIR2DL1+, and KIR2DL3+ NKc subsets in the presence of their cognate ligands primarily contributed to shortening patients' overall survival by increasing the sensitivity to CD226 downmodulation in aKIR-rich telomeric genotypes. In patients with high tumor burden who died during the follow-up period, aKIR-rich telomeric genotypes were associated with: (i) specific downmodulation of CD226 on educated NKcs but not on CD8+ T cells or uneducated NKcs, (ii) lower expression of CD226 and higher expression of NKG2A on aKIR+ NKcs, and (iii) lower numbers of total CD56dim NKcs. The reduced expression of CD226 on NKcs with aKIR-rich genotypes may be a biomarker indicative of NKc hyporesponsiveness in patients that could benefit from new NKc immune-stimulatory therapies.


Assuntos
Antígenos de Diferenciação de Linfócitos T/genética , Vigilância Imunológica , Células Matadoras Naturais/imunologia , Células Matadoras Naturais/metabolismo , Neoplasias/etiologia , Neoplasias/metabolismo , Receptores KIR/genética , Antígenos de Diferenciação de Linfócitos T/metabolismo , Biomarcadores , Linhagem Celular Tumoral , Citometria de Fluxo , Regulação Neoplásica da Expressão Gênica , Genótipo , Antígenos HLA/genética , Antígenos HLA/imunologia , Humanos , Ligantes , Neoplasias/patologia , Prognóstico , Ligação Proteica , Receptores KIR/metabolismo
12.
Cancer Immunol Res ; 6(12): 1537-1547, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30242020

RESUMO

Natural killer cell (NKc)-based therapies offer promising outcomes in patients with tumors, but they could improve with appropriate selection of donors and optimization of methods to expand NKcs in vitro Education through licensing interactions of inhibitory killer cell immunoglobulin-like receptors (iKIR) and NKG2A with their cognate HLA class-I ligands optimizes NKc functional competence. This work has evaluated the role of licensing interactions in NKc differentiation and the survival of cancer patients. We have analyzed KIR and KIR-ligand genes, and the expression of activating (CD16 and DNAM-1/CD226) and inhibitory (NKG2A and iKIRs) receptors on peripheral blood NKcs in 621 healthy controls and 249 solid cancer patients (80 melanoma, 80 bladder, and 89 ovarian). Licensing interactions upregulated the expression of activating CD226, reduced that of iKIR receptors, and shifted the CD226/iKIR receptor ratio on NKc membranes to activating receptors. A high tumor burden decreased CD226 expression, reduced the ratio of CD226/iKIR, and negatively affected patient survival. The progression-free survival (38.1 vs. 67.0 months, P < 0.002) and overall survival (56.3 vs. 99.6 months, P < 0.00001) were significantly shorter in patients with lower expression of CD226 on NKcs. Hence, transformed cells can downmodulate these licensing-driven receptor rearrangements as a specific mechanism to escape NKc immune surveillance. Our results suggest the importance of the CD226/iKIR receptor ratio of NKcs induced by licensing interactions as critical determinants for solid cancer immune surveillance, and may provide predictive biomarkers for patient survival that may also improve the selection of donors for NKc immunotherapy.


Assuntos
Antígenos de Diferenciação de Linfócitos T/metabolismo , Vigilância Imunológica , Células Matadoras Naturais/imunologia , Receptores KIR/metabolismo , Idoso , Antígenos de Diferenciação de Linfócitos T/imunologia , Biomarcadores Tumorais/imunologia , Estudos de Casos e Controles , Feminino , Antígenos HLA-C/genética , Humanos , Células Matadoras Naturais/metabolismo , Masculino , Melanoma/genética , Melanoma/imunologia , Melanoma/mortalidade , Pessoa de Meia-Idade , Neoplasias Ovarianas/genética , Neoplasias Ovarianas/imunologia , Neoplasias Ovarianas/mortalidade , Estudos Prospectivos , Receptores KIR/genética , Receptores KIR/imunologia , Análise de Sobrevida , Neoplasias da Bexiga Urinária/genética , Neoplasias da Bexiga Urinária/imunologia , Neoplasias da Bexiga Urinária/mortalidade
13.
Psicothema ; 29(1): 103-110, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-28126067

RESUMO

BACKGROUND: The aim of this research is to analyze Attention Deficit Hyperactivity Disorder Rating Scales IV (ADHD RS-IV) criteria validity and its clinical usefulness for the assessment of Attention Deficit Hyperactivity Disorder (ADHD) as a function of assessment method and age. METHODOLOGY: A sample was obtained from an epidemiological study (n = 1095, 6-16 years). Clinical cases of ADHD (ADHD-CL) were selected by dimensional ADHD RS-IV and later by clinical interview (DSM-IV). ADHD-CL cases were compared with four categorical results of ADHD RS-IV provided by parents (CATPA), teachers (CATPR), either parents or teachers (CATPAOPR) and both parents and teachers (CATPA&PR). Criterion validity and clinical usefulness of the answer modalities to ADHD RS-IV were studied. RESULTS: ADHD-CL rate was 6.9% in childhood, 6.2% in preadolescence and 6.9% in adolescence. Alternative methods to the clinical interview led to increased numbers of ADHD cases in all age groups analyzed, in the following sequence: CATPAOPR> CATPRO> CATPA> CATPA&PR> ADHD-CL. CATPA&PR was the procedure with the greatest validity, specificity and clinical usefulness in all three age groups, particularly in the childhood. CONCLUSIONS: Isolated use of ADHD RS-IV leads to an increase in ADHD cases compared to clinical interview, and varies depending on the procedure used.


Assuntos
Fatores Etários , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Escalas de Graduação Psiquiátrica , Avaliação de Sintomas/métodos , Adolescente , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Criança , Escolaridade , Feminino , Humanos , Entrevista Psicológica , Masculino , Pais , Prevalência , Estudos de Amostragem , Ensino
14.
Midwifery ; 41: 68-78, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27551856

RESUMO

INTRODUCTION: personalised support provided to women by health professionals is one of the prime factors attaining women's satisfaction during pregnancy and childbirth. However the multifactorial nature of 'satisfaction' makes difficult to assess it. Statistical multivariate analysis may be an effective technique to obtain in depth quantitative evidence of the importance of this factor and its interaction with the other factors involved. This technique allows us to estimate the importance of overall satisfaction in its context and suggest actions for healthcare services. METHODS: systematic review of studies that quantitatively measure the personal relationship between women and healthcare professionals (gynecologists, obstetricians, nurse, midwifes, etc.) regarding maternity care satisfaction. The literature search focused on studies carried out between 1970 and 2014 that used multivariate analyses and included the woman-caregiver relationship as a factor of their analysis. RESULTS: twenty-four studies which applied various multivariate analysis tools to different periods of maternity care (antenatal, perinatal, post partum) were selected. The studies included discrete scale scores and questionnaires from women with low-risk pregnancies. The "personal relationship" factor appeared under various names: care received, personalised treatment, professional support, amongst others. The most common multivariate techniques used to assess the percentage of variance explained and the odds ratio of each factor were principal component analysis and logistic regression. DISCUSSION: the data, variables and factor analysis suggest that continuous, personalised care provided by the usual midwife and delivered within a family or a specialised setting, generates the highest level of satisfaction. In addition, these factors foster the woman's psychological and physiological recovery, often surpassing clinical action (e.g. medicalization and hospital organization) and/or physiological determinants (e.g. pain, pathologies, etc.).


Assuntos
Mães/psicologia , Satisfação do Paciente , Relações Profissional-Paciente , Feminino , Humanos , Serviços de Saúde Materna/normas , Assistência Centrada no Paciente/métodos , Assistência Centrada no Paciente/normas , Gravidez , Inquéritos e Questionários
15.
Oncoimmunology ; 5(4): e1093721, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27141379

RESUMO

Missing self recognition makes cancer sensitive to natural killer cell (NKc) reactivity. However, this model disregards the NKc licensing effect, which highly increases NKc reactivity through interactions of inhibitory killer cell immunoglobulin-like receptors (iKIR) with their cognate HLA-I ligands. The influence of iKIR/HLA-ligand (HLA-C1/C2) licensing interactions on the susceptibility to and progression of plasma cell (PC) dyscrasias was evaluated in 164 Caucasian patients and 286 controls. Compared to controls, myeloma accumulates KIR2DL1-L2+L3- genotypes (2.8% vs. 13.2%, p < 0.01, OR = 5.29) and less diverse peripheral repertoires of NKc clones. Less diverse and weaker-affinity repertoires of iKIR2D/HLA-C licensing interactions increased myeloma susceptibility. Thus, the complete absence of conventional iKIR2D/HLA-C licensing interactions (KIR2DL1-L2+L3-/C2C2, 2.56% vs. 0.35%; p < 0.05; OR = 15.014), single-KIR2DL3+/C1+ (20.51% vs. 10.84%; p < 0.05; OR = 2.795) and single-KIR2DL2+/C1+ (12.82% vs. 4.9%; p < 0.01; OR = 5.18) interactions were over-represented in myeloma, compared to controls. Additionally, KIR2DL1-L2+L3- (20% vs. 83%, p < 0.00001) as well as KIR3DL1- (23% vs. 82%, p < 0.00001) genotypes had a dramatic negative impact on the 3-y progression-free survival (PFS), particularly in patients with low-tumor burden. Remarkably, myeloma-PCs, compared to K562 and other hematological cancers, showed substantial over-expression of HLA-I ("increasing-self" instead of missing-self), including HLA-C, and mild expression of ligands for NKc activating receptors (aRec) CD112, CD155, ULBP-1 and MICA/B, which apparently renders myeloma-PCs susceptible to lysis mainly by licensed NKc. KIR2DL1-L2+L3-/C2C2 patients (with no conventional iKIR2D/HLA-C licensing interactions) lyse K562 but barely lyse myeloma-PCs (4% vs. 15%; p < 0.05, compared to controls). These results support a model where immunosurveillance of no-missing-self cancers, e.g., myeloma, mainly depends on NKc licensing.

16.
J Microbiol Biotechnol ; 22(3): 416-21, 2012 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-22450799

RESUMO

Current influenza vaccines elicit antibodies effective against homologous strains, but new strategies are urgently needed for protection against emerging epidemic or pandemic strains. Although influenza vaccine candidates based on the viral nucleoprotein (NP) or matrix protein do not elicit sterilizing immunity, they have the advantage of inducing immunity that may cover a larger number of viral strains. In this study, recombinant NP produced in Escherichia coli was purified and formulated in combination with the adjuvant ISCOMATRIX. This formulation increased a NP-specific immunity in mice, with a Th1 profile, and may constitute a promising low-cost influenza vaccine candidate, with ability to stimulate humoral and cellular immune responses..


Assuntos
Colesterol/imunologia , Vírus da Influenza A Subtipo H1N1/imunologia , Vacinas contra Influenza/imunologia , Influenza Humana/prevenção & controle , Nucleoproteínas/imunologia , Fosfolipídeos/imunologia , Saponinas/imunologia , Proteínas Virais/imunologia , Adjuvantes Imunológicos/administração & dosagem , Animais , Anticorpos Antivirais , Colesterol/administração & dosagem , Combinação de Medicamentos , Feminino , Humanos , Imunização , Vírus da Influenza A Subtipo H1N1/genética , Vacinas contra Influenza/administração & dosagem , Vacinas contra Influenza/genética , Influenza Humana/imunologia , Influenza Humana/virologia , Camundongos , Camundongos Endogâmicos BALB C , Nucleoproteínas/administração & dosagem , Nucleoproteínas/genética , Fosfolipídeos/administração & dosagem , Proteínas Recombinantes/genética , Proteínas Recombinantes/imunologia , Saponinas/administração & dosagem , Proteínas Virais/administração & dosagem , Proteínas Virais/genética
18.
Clin Vaccine Immunol ; 16(1): 142-5, 2009 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-19020108

RESUMO

We report the first case of hemophagocytic lymphohistiocytosis (HLH) induced by the monoclonal expansion of Epstein-Barr virus (EBV)-negative NK cells. Consanguinity of the patient's parents made it necessary to discard familial HLH in the patient and her sister with identical HLA markers and demonstrate that no cause other than the expansion of NK cells, which secrete high levels of gamma interferon, was inducing HLH in this patient.


Assuntos
Herpesvirus Humano 4/isolamento & purificação , Interferon gama/metabolismo , Células Matadoras Naturais/química , Células Matadoras Naturais/virologia , Linfo-Histiocitose Hemofagocítica/patologia , Receptores KIR2DL1/análise , Feminino , Humanos , Lactente , Células Matadoras Naturais/imunologia , Linfo-Histiocitose Hemofagocítica/imunologia , Pais
19.
Acimed (Impr.) ; 13(5)sept.-oct. 2005. ilus
Artigo em Espanhol | LILACS | ID: lil-429266

RESUMO

Las vacunas representan hoy la intervención inmunológica más empleada en medicina. A pesar de ello, sólo existen vacunas para 13 de las 28 enfermedades que requieren desarrollarse con vistas a paliar situaciones de epidemia a escala mundial. Unido a esto, prevalecen mitos, difundidos por grupos no acreditados. Esta falta de información o desinformación afectan a la población y al desarrollo de nuevos proyectos en esta área. Todo ello ha contribuido al desarrollo del proyecto titulado Red Latinoamericana de Información Científico-Técnica en Vacunas (Red-CiTeVa). Dicha red se concibe con un nodo central en la Biblioteca Virtual en Vacunas y el Aula Virtual en Vacunología. Sus usuarios potenciales son los especialistas que laboran en esta área del conocimiento, los investigadores comprometidos en el descubrimiento de nuevas vacunas y gran parte del personal del sector de la salud. Para asegurar el acceso, el sitio se alojará en Infomed; ello permitirá su uso por parte de hospitales, policlínicos, bibliotecas y universidades médicas, entre otras instituciones en Cuba y Latinoamérica. La Biblioteca Virtual en Vacunas facilitará no sólo el acceso a la información sino que ofrecerá además, una serie de servicios en línea como consulta a expertos, análisis de proyectos, entre otros


Assuntos
Vacinas , Centros de Informação , Educação a Distância , Redes de Comunicação de Computadores , Sistemas On-Line
20.
Acimed (Impr.) ; 10(4)jul.-ago. 2002. ilus, tab, graf
Artigo em Espanhol | LILACS | ID: lil-354307

RESUMO

El proceso de desarrollo científico y tecnológico genera productos, servicios e información. Las organizaciones deben seleccionar, analizar y conservar la información. Una de las actividades que sigue, de forma estructurada y continua, los diferentes saberes técnicos y científicos de la organización es la vigilancia científico -tecnológica. Uno de los problemas que enfrenta esta actividad es la cantidad de datos o variables que influyen sobre la competitividad de la organización y la necesidad de emplear herramientas específicas que faciliten su análisis. Se recurre a los indicadores propios de las patentes con el objetivo de ofrecer una herramienta que permita, a las empresas, realizar una vigilancia más orientada y veraz. Se explica el lugar de las patentes en el proceso de desarrollo tecnológico, los indicadores de las patentes y las herramientas que facilitan la recopilación, procesamiento y análisis de los datos. Se aplica una metodología, MOBIS-ProSoft, a modo de ejemplo. A partir de esta aplicación práctica se identifican y muestran los niveles de actividad tecnológica, los campos tecnológicos, así como su dinámica y visibilidad. Para esto se emplearon métodos estadísticos como el escalado multidimensional y el análisis de clusters, además de la aplicación de redes neuronales artificiales (algoritmo de Kohonen del tipo SOM)


Assuntos
Estratégias de Saúde , Neisseria meningitidis , Estatística como Assunto , Redes Neurais de Computação
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