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PURPOSES: This study aimed to develop and validate algorithms for automating intensity modulated radiation therapy (IMRT) planning in breast cancer patients, with a focus on patient anatomical characteristics. MATERIAL AND METHODS: We retrospectively selected 400 breast cancer patients without lymph node involvement for automated treatment planning. Automation was achieved using the Eclipse Scripting Application Programming Interface (ESAPI) integrated into the Eclipse Treatment Planning System. We employed three beam insertion geometries and three optimization strategies, resulting in 3600 plans, each delivering a 40.05 Gy dose in 15 fractions. Gantry angles in the tangent fields were selected based on a criterion involving the minimum intersection area between the Planning Target Volume (PTV) and the ipsilateral lung in the Beam's Eye View projection. ESAPI was also used to gather patient anatomical data, serving as input for Random Forest models to select the optimal plan. The Random Forest classification considered both beam insertion geometry and optimization strategy. Dosimetric data were evaluated in accordance with the Radiation Therapy Oncology Group (RTOG) 1005 protocol. RESULTS: Overall, all approaches generated high-quality plans, with approximately 94% meeting the acceptable dose criteria for organs at risk and/or target coverage as defined by RTOG guidelines. Average automated plan generation time ranged from 6 min and 37 s to 9 min and 22 s, with the mean time increasing with additional fields. The Random Forest approach did not successfully enable automatic planning strategy selection. Instead, our automated planning system allows users to choose from the tested geometry and strategy options. CONCLUSIONS: Although our attempt to correlate patient anatomical features with planning strategy using machine learning tools was unsuccessful, the resulting dosimetric outcomes proved satisfactory. Our algorithm consistently produced high-quality plans, offering significant time and efficiency advantages.
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Algoritmos , Neoplasias da Mama , Órgãos em Risco , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador , Radioterapia de Intensidade Modulada , Humanos , Planejamento da Radioterapia Assistida por Computador/métodos , Radioterapia de Intensidade Modulada/métodos , Feminino , Neoplasias da Mama/radioterapia , Órgãos em Risco/efeitos da radiação , Estudos Retrospectivos , Automação , PrognósticoRESUMO
One prominent aspect of Parkinson's disease (PD) is the presence of elevated levels of free radicals, including reactive oxygen species (ROS). Syagrus coronata (S. coronata), a palm tree, exhibits antioxidant activity attributed to its phytochemical composition, containing fatty acids, polyphenols, and flavonoids. The aim of this investigation was to examine the potential neuroprotective effects of S. coronata fixed oil against rotenone-induced toxicity using Drosophila melanogaster. Young Drosophila specimens (3-4 d old) were exposed to a diet supplemented with rotenone (50 µM) for 7 d with and without the inclusion of S. coronata fixed oil (0.2 mg/g diet). Data demonstrated that rotenone exposure resulted in significant locomotor impairment and increased mortality rates in flies. Further, rotenone administration reduced total thiol levels but elevated lipid peroxidation, iron (Fe) levels, and nitric oxide (NO) levels while decreasing the reduced capacity of mitochondria. Concomitant administration of S. coronata exhibited a protective effect against rotenone, as evidenced by a return to control levels of Fe, NO, and total thiols, lowered lipid peroxidation levels, reversed locomotor impairment, and enhanced % cell viability. Molecular docking of the oil lipidic components with antioxidant enzymes showed strong binding affinity to superoxide dismutase (SOD) and glutathione peroxidase (GPX1) enzymes. Overall, treatment with S. coronata fixed oil was found to prevent rotenone-induced movement disorders and oxidative stress in Drosophila melanogaster.
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Transtornos dos Movimentos , Rotenona , Animais , Drosophila melanogaster , Simulação de Acoplamento Molecular , Estresse Oxidativo , Antioxidantes/farmacologia , Óxido Nítrico/metabolismoRESUMO
Basketball shooting is a complex skill that requires visual routines and trained players typically evidence a specific oculomotor pattern. This study aimed to examine visual patterns in male novice youth and professional adult players while performing a jump shot. The sample included 20 basketball players grouped as under-16 youth (n = 10) and professional adult (n = 10) players. Each participant completed 50 shots at two distances (long range: 6.80 m; middle range: 4.23 m). Eye tracking glasses were used to obtain quiet eye (QE), the number of fixations, total fixation duration, duration of first and last fixation. An independent t-test was used to assess differences between groups. Shooting accuracy given by % of efficacy indicated that under-16 players attained poorer scores at both distances: long (t = -4.75, p < 0.01) and middle (t = -2.80, p < 0.012) distance. The groups also differed in QE time (long: 600 ms vs. 551 ms; middle: 572 ms vs. 504 ms) and total duration of the fixations (long: 663 ms vs. 606 ms; middle: 663 ms vs. 564 ms) in both long and middle distance shots. Significant differences also occurred in the last fixation (long distance: t = -4.301, p < 0.01; middle distance: t = -3.656, p < 0.01) with professional adult players presenting the value of, on average, 454-458 ms, while youth shooters 363-372 ms. In summary, visual strategy differed between under-16 youth and professional adult basketball players. To support their long-term sport development, it is recommended that youth basketball players focus their attention with longer final fixation before releasing the ball to improve their shot.
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The Thermoluminescent dosimeter is a solid material used as instrumentation for environmental monitoring through determining environmental equivalent dose H∗(10). This work presents the calibration methodology for TLDs LiF:Mg, Cu, P dosimeters and their application to measure H∗(10) in internal buildings occupied by inhabitants of an urban area. The calibration factor and type tests were made according to ISO 4037-3 and IEC 62387, and the uncertainty was determined. The values found are under the reference values. Therefore, the dosimeters can be applied.
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BACKGROUND: Glioblastoma is a severe brain tumor that requires aggressive treatment involving surgery, radiotherapy, and chemotherapy, offering a survival rate of only 15 months. Fortunately, recent nanotechnology progress has enabled novel approaches and, alongside ferrocenes' unique properties of cytotoxicity, sensitization, and interaction with reactive oxygen species, have brought new possibilities to complement chemotherapy in nanocarrier systems, enhancing treatment results. METHODS: In this work, we developed and characterized a temozolomide-loaded nanoemulsion and evaluated its cytotoxic potential in combination with ferrocene in the temozolomide-resistant T98G and temozolomide-sensitive U87 cell lines. The effects of the treatments were assessed through acute assays of cell viability, cell death, mitochondrial alterations, and a treatment protocol simulation based on different two-cycle regimens. RESULTS: Temozolomide nanoemulsion showed a z-average diameter of 173.37 ± 0.86 nm and a zeta potential of - 6.53 ± 1.13 mV. Physicochemical characterization revealed that temozolomide is probably associated with nanoemulsion droplets instead of being entrapped within the nanostructure, allowing a rapid drug release. In combination with ferrocene, temozolomide nanoemulsion reduced glioblastoma cell viability in both acute and two-cycle regimen assays. The combined treatment approach also reversed T98G's temozolomide-resistant profile by altering the mitochondrial membrane potential of the cells, thus increasing reactive oxygen species generation, and ultimately inducing cell death. CONCLUSIONS: Altogether, our results indicate that using nanoemulsion containing temozolomide in combination with ferrocene is an effective approach to improve glioblastoma therapy outcomes.
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Neoplasias Encefálicas , Glioblastoma , Humanos , Temozolomida/farmacologia , Temozolomida/uso terapêutico , Glioblastoma/patologia , Metalocenos/uso terapêutico , Espécies Reativas de Oxigênio/metabolismo , Linhagem Celular Tumoral , Neoplasias Encefálicas/tratamento farmacológico , Neoplasias Encefálicas/patologiaAssuntos
Infecções Oportunistas Relacionadas com a AIDS , Síndrome da Imunodeficiência Adquirida , Infecções Oportunistas , Paracoccidioidomicose , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Síndrome da Imunodeficiência Adquirida/complicações , Humanos , Paracoccidioidomicose/diagnósticoRESUMO
One of the most fundamental questions in ecology is how many species inhabit the Earth. However, due to massive logistical and financial challenges and taxonomic difficulties connected to the species concept definition, the global numbers of species, including those of important and well-studied life forms such as trees, still remain largely unknown. Here, based on global ground-sourced data, we estimate the total tree species richness at global, continental, and biome levels. Our results indicate that there are â¼73,000 tree species globally, among which â¼9,000 tree species are yet to be discovered. Roughly 40% of undiscovered tree species are in South America. Moreover, almost one-third of all tree species to be discovered may be rare, with very low populations and limited spatial distribution (likely in remote tropical lowlands and mountains). These findings highlight the vulnerability of global forest biodiversity to anthropogenic changes in land use and climate, which disproportionately threaten rare species and thus, global tree richness.
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Conservação dos Recursos Naturais , Florestas , Árvores/classificação , Planeta Terra , Árvores/crescimento & desenvolvimentoRESUMO
Sunlight-mediated disinfection in wastewater treatment ponds is widely recognised as the main role for disinfection, but pathogen removal can be limited by poor light penetration in the water column. The aim of this research is to evaluate a different and simple type of intervention for improving bacterial disinfection, by placing mid-depth transverse baffles perpendicular to the theoretical flow in an existing shallow maturation pond, aiming at increasing the opportunity for bacteria to receive radiation at the upper layers of the pond. In order to understand the hydrodynamic mechanisms and evaluate the effectiveness of the proposed intervention, a 3D Computational Fluid Dynamic (CFD) model was applied, including the transverse baffles and a particle-tracking model. This was complemented by monitoring E. coli in the pond, in the phase before and after inclusion of the transversal baffles. Overall, the transverse baffles increased disinfection efficiency by moulding/re-routing the hydrodynamic flow and increasing microorganism exposure to the sunlight.
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Desinfecção , Lagoas , Escherichia coli , Luz Solar , Eliminação de Resíduos LíquidosRESUMO
The Triplaris gardneriana Wedd. seeds extract has great therapeutic potential due to numerous biological activities such as antioxidant, antibacterial and anti-inflammatory, which are associated with phenolic content. Although this herbal preparation has shown many benefits, recently their toxicity profile has begun to be explored. In this present study, the toxic effects of T. gardneriana seeds ethanolic extract (EETg) on biological systems of different taxonomical groups and levels of complexity (from cell culture to lower vertebrates) were assessed, through a variety of viability and toxicological assays. It was found that EETg did not impair the Saccharomyces cerevisiae growth at the highest tested concentration (200 µg/mL), and no toxicant evidence was observed in Aedes aegypti larvae or in Drosophila melanogaster adult stage. Contrarily, the extract reduced the viability of undifferentiated Caco-2 cells (250 µg/mL, 40% of viable cells), but did not affect differentiated ones. The embryotoxicity in Danio rerio model showed a LC50 of 7.41 mg/L (95% confidence interval, 4.78 - 11.49 mg/L). EETg did not show signs of toxicity in the majority of the models used, but lethality and malformations in zebrafish embryos occurred. Further analyses are needed to better understand the selective toxicity mechanism of EETg on zebrafish, as well as whether the toxic effects happen in higher vertebrates.
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Polygonaceae , Peixe-Zebra , Animais , Células CACO-2 , Drosophila melanogaster , Embrião não Mamífero , Etanol , Humanos , Larva , Extratos Vegetais/toxicidade , Sementes/toxicidadeRESUMO
Mercury chloride (HgCl2) acts as a bioaccumulator capable of causing numerous neurological and physiological changes in organisms in a negative way. However, rutin has been considered a very effective antioxidant compound in the treatment of neurodegenerative diseases, as it can neutralize radicals capable of damaging neuronal cells. In this context, this study aimed to evaluate rutin as a neoprotective agent against the damage induced by HgCl2 in Drosophila melanogaster. The exposure of the flies to the agents was carried out in triplicate, and about 150 adult flies were evaluated. To assess the antioxidant action of rutin, MTT, phenanthroline, nitric oxide, total thiols and NPSH tests were carried out in the following concentrations: Control (1500 µL of distilled water), 1 mg/g of HgCl2, 0.5 mg/g of Rutin + HgCl2, 1 mg/g of Rutin + HgCl2, 2 mg/g of Rutin + HgCl2. The locomotion test was verified by negative geotaxis, the result of which showed that flies exposed to HgCl2 had difficulties in flight. The group treated with HgCl2 alone had a high mortality rate, while in combination with different concentrations of rutin, it heard a moderate reduction in the number of deaths, as well as in the negative geotaxis data in which the rutin had a positive effect. An increase in iron (II) levels was observed at the highest concentrations of rutin, while at low concentrations, rutin significantly decreased nitric oxide levels. The HgCl2 + R group (2 mg/g) showed a significant increase in the total thiols content, while for the NPSH all rutin concentrations showed a significant increase in the levels of non-protein thiols. Our results demonstrate that mercury chloride can cause oxidative stress in D. melanogaster. However, the results suggest that rutin has antioxidant and protective effects against the damage caused by HgCl2.
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Drosophila melanogaster/efeitos dos fármacos , Cloreto de Mercúrio/toxicidade , Fármacos Neuroprotetores/farmacologia , Rutina/farmacologia , Animais , Antioxidantes/farmacologia , Drosophila melanogaster/fisiologia , Ferro/metabolismo , Mitocôndrias/efeitos dos fármacos , Mitocôndrias/metabolismo , Mortalidade , Atividade Motora/efeitos dos fármacos , Atividade Motora/fisiologia , Óxido Nítrico/metabolismo , Compostos de Sulfidrila/metabolismoRESUMO
Although much has been discovered regarding the characteristics of SARS-CoV-2, its presence in aerosols and their implications in the context of the pandemic is still controversial. More research on this topic is needed to contribute to these discussions. Presented herein are the results of ongoing research to detect SARS-CoV-2 RNA in aerosol in different hospital facilities (indoor environments) and public spaces (outdoor environments) of a metropolitan center in Brazil. From May to August 2020, 62 samples were collected using active sampling method (air samplers with filters) and passive method (petri dishes) in two hospitals, with different occupancies and infrastructure for contamination control. Outdoor public spaces such as sidewalks and a bus station were also investigated. Five air samples from four facilities in a hospital tested positive for SARS-CoV-2 in suspended and sedimentable particles. SARS-CoV-2 was found in aerosols inside the Intensive Care Unit (ICU), in the protective apparel removal room, in the room containing patient mobile toilets and used clothes (room with natural ventilation) and in an external corridor adjacent to the ICU, probably coming from infected patients and/or from aerosolization of virus-laden particles on material/equipment. Our findings reinforce the hypothesis of airborne transmission of the new coronavirus, contributing to the planning of effective practices for pandemic control.
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COVID-19 , SARS-CoV-2 , Aerossóis , Brasil , Hospitais , Humanos , RNA ViralRESUMO
Introduction: Hutchinson-Guilford progeria syndrome (HGPS) is a rare genetic disease with a characteristic phenotype of premature aging in young children caused by a mutation in the LMNA gene and consequent accumulation of progerinin the cell. Aim: Describe oral manifestations of Hutchinson-Guilford progeria syndrome. Case Report: This is a case report of a six-year-old female patient with Hutchinson-Guilford Progeria syndrome. The physical examination revealed skin atrophy, lipodystrophy, hair rarefaction, prominent blood vessels of the scalp, craniofacial disproportion, perioral cyanosis and enlarged knee joints. The intraoral exam revealed limited mouth opening, mixed dentition with normal tooth anatomy and anteroinferior crowding. The eruption sequence and chronology were abnormal. The treatment plan included professional prophylaxis, the topical application of fluoride as well as both oral hygiene and dietary counselling. Monitoring the development of dentition and an early and timely dental intervention contributed to the maintenance of child's oral health. Conclusion: Early clinical and educational interventions can help patients with HGPS maintain adequate oral health status and improve their quality of life.
Introdução: A Progéria ou Síndrome de Hutchinson-Guilford (HGPS) é uma doença genética rara com um fenótipo característico de envelhecimento precoce em crianças pequenas, causado por uma mutação no gene LMNA e conseqüente acúmulo de progerina na célula. Objetivo: Descrever as manifestações orais da Síndrome de Hutchinson-Guilford. Relato do Caso: Este é um relato de caso de uma paciente de seis anos com Síndrome de Hutchinson-Guilford. O exame físico revelou atrofia da pele, lipodistrofia, rarefação dos cabelos, vasos sangüíneos proeminentes no couro cabeludo, desproporção craniofacial, cianose perioral e aumento das articulações dos joelhos. O exame intraoral revelou abertura bucal limitada, dentição mista com anatomia dentária normal e apinhamento ântero-inferior. A sequência e a cronologia de erupção estavam alteradas. O plano de tratamento incluiu profilaxia profissional, aplicação tópica de flúor, bem como orientação de higiene bucal e aconselhamento dietético. O acompanhamento do desenvolvimento da dentição e a intervenção odontológica precoce e oportuna colaboraram com a manutenção da saúde bucal da criança. Conclusão: Intervenções clínicas e educacionais precoces podem ajudar os pacientes com HGPS a manter um estado de saúde bucal adequado e melhorar sua qualidade de vida.
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Humanos , Feminino , Criança , Progéria , Saúde Bucal , Intervenção Educacional PrecoceRESUMO
BACKGROUND: Evaluate the effect of bacteria drug resistance profile on the success rates of debridement, antibiotics and implant retention. METHODS: All early acute periprosthetic infections in hip and knee arthroplasties treated with DAIR at our institution over the period from 2011 to 2015 were retrospectively analyzed. The success rate was evaluated according to the type of organism identified in culture: multidrug-sensitive (MSB), methicillin-resistant Staphylococcus aureus (MRSA), multidrug-resistant Gram-negative bacteria (MRB) and according to other risk factors for treatment failure. The data were analyzed using univariate and multivariate statistics. RESULTS: Fifty-seven patients were analyzed; there were 37 in the multidrug-sensitive bacteria (MSB) group, 11 in the methicillin-resistant Staphylococcus aureus (MRSA) group and 9 in the other multidrug-resistant Gram-negative bacteria (MRB) group. There was a statistically significant difference (p < 0.05) in the treatment failure rate among the three groups: 8.3% for the MSB group, 18.2% for the MRSA group and 55.6% for the MRB group (p = 0.005). Among the other risk factors for treatment failure, the presence of inflammatory arthritis presented a failure rate of 45.1 (p < 0.05). CONCLUSION: DAIR showed a good success rate in cases of early acute infection by multidrug-sensitive bacteria. In the presence of infection by multidrug-resistant bacteria or association with rheumatic diseases the treatment failure rate was higher and other surgical options should be considered in this specific population. The MRSA group showed intermediate results between MSB and MRB and should be carefully evaluated.
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Staphylococcus aureus Resistente à Meticilina , Infecções Relacionadas à Prótese , Antibacterianos/uso terapêutico , Desbridamento , Resistência a Medicamentos , Humanos , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/epidemiologia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Objective: Considering the limited number of studies that analyze the behavior of plant preparations in human body, this study aimed to characterize the phenolic compounds from Triplaris gardneriana extract (EETg) in terms of antioxidant and metabolic aspects, integrating in vitro, in silico and in vivo strategies.Methods: EETg was analyzed in relation to polyphenols release from the plant matrix under in vitro digestion, as well as the pharmacokinetic prediction of their major compounds by in silico simulation and understanding of its in vivo antioxidant effect in an alternative animal model.Results: About 35.22% of polyphenols from EETg proved to be accessible after enzymatic hydrolysis. A kinetics study showed that 40% of the total content of these phytochemicals was released from the extract accompanied by increased antioxidant capacity after 180 min of gastrointestinal simulation. A computational approach revealed that 7 out of 9 major phenolic compounds of EETg showed good pharmacokinetic parameters such as intestinal absorption and bioavailability score. In addition, the extract showed a protective effect on copper-induced oxidative stress in Drosophila melanogaster, evidenced by the restoration of basal levels of thiol and malondialdehyde contents. These biochemical observations were supported by the examination of histological features of D. melanogaster brain.Conclusion: It was demonstrated that the oral administration of EETg would provide phenolic compounds partially absorbable by the human gut and capable of providing health benefits associated with the inhibition of oxidative stress. Additionally, the results highlight the need to implement new approaches for the rational development of plant-based medicines.
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Drosophila melanogaster , Polygonaceae , Polifenóis/metabolismo , Animais , Antioxidantes , Estresse Oxidativo , Extratos Vegetais , Polifenóis/química , Sementes/químicaRESUMO
Resumo Apresentamos um caso de distrofia macular oculta bilateral, em paciente de 70 anos com queixa de baixa acuidade visual progressiva, sem achados fundoscópicos ou angiográficos justificáveis. Foram realizados exames de imagem do sistema nervoso central que afastaram lesões expansivas e testes eletrofisiológicos que sugeriram diagnóstico.
Abstract We report a case of bilateral occult macular dystrophy in a 70-year-old woman with progressive low visual acuity, without justifiable fundoscopic or angiographic findings. Imaging tests were done to excluding expansive lesions and electrophysiological tests that suggested the diagnosis.
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Humanos , Feminino , Idoso , Angiofluoresceinografia/métodos , Acuidade Visual , Tomografia de Coerência Óptica/métodos , Eletrofisiologia/métodos , Eletrorretinografia/métodos , Degeneração Macular/diagnóstico , Diagnóstico DiferencialRESUMO
Objetivos: identificar a prevalência da amamentação na primeira hora de vida em recém-nascidos de hospitais maternidade das cidades brasileiras. Fontes de dados: realizou se uma revisão sistemática buscando-se responder à questão: Qual é a prevalência da amamentação na primeira hora pós-parto em neonatos de hospitais maternidade das cidades brasileiras? Foram pesquisadas as bases de dados eletrônicas: Biblioteca Virtual Eletrônica (BVS): (Medline e Lilacs), Scielo Brasil e PUBMed, no período de 2007 a 2016, utilizando-se os seguintes descritores: amamentação, aleitamento materno, recém nascido, estudos epidemiológicos, prevalência, neonato, hospital maternidade. Foram identificados 133 artigos, sendo selecionados cinco deles. Resumo das conclusões: As prevalências da amamentação na primeira hora de vida de neonatos dos hospitais maternidades analisadas, variando de 16% a 56%, sendo observadas maiores proporções em hospitais em parceria com a Iniciativa Hospital Amigo da Criança.
Objectives: to identify the prevalence of breastfeeding in the first hour of life in newborns in maternity hospitals in Brazilian cities. Source of data: A systematic review was conducted in order to answer the question: What is the prevalence of breastfeeding in the first hour after delivery in neonates in maternity hospitals in Brazilian cities? We searched the electronic databases: Electronic Virtual Library (VHL): (Medline and Lilacs), Scielo Brazil and PUBMed, from 2006 to 2016, using the following descriptors: breastfeeding, newborn, epidemiological studies, prevalence, neonate, maternity hospital. A total of 133 articles were identified, of which five were selected. Summary of conclusions: the prevalence of breastfeeding in the first hour of life of newborns in the maternity hospitals analyzed ranged from 16% to 56%, with larger proportions being observed in hospitals in partnership with the BabyFriendly Hospital Initiative.
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BACKGROUND: To evaluate the in vivo and in vitro toxicity of a new formulation of liposome-encapsulated sirolimus (LES). METHODS: In vitro experiments were done using ARPE-19 and HRP cells. An MTT assay was used to determine cell metabolic activity and a TUNEL assay for detecting DNA fragmentation. In vivo experiments were conducted on New Zealand albino rabbits that received intravitreal injections of empty liposomes (EL) or different concentrations of LES. Histopathological and immunohistochemical analyses were performed on the rabbit's eyes following injection. RESULTS: Eighteen eyes of nine rabbits were used. MTT assay cell viability was 95.04% in group 1 (12.5 µL/mL LES). 92.95% in group 2 (25 µL/mL LES), 91.59% in group 3 (50 µL/mL LES), 98.09% in group 4 (12.5 µL/mL EL), 95.20% on group 5 (50 µL/mL EL), 98.53% in group 6 (50 µL/mL EL), and 2.84% on group 8 (50 µL/mL DMSO). There was no statistically significant difference among groups 1 to 7 in cell viability (p = 1.0), but the comparison of all groups with group 8 was significant (p < 0.0001). The TUNEL assay comparing two groups was not statistically significant from groups 1 to 7 (p = 1.0). The difference between groups 1 to 7 and group 8 (p < 0.0001) was significant. Histopathological changes were not found in any group. No activation of Müller cells was detected. CONCLUSION: A novel formulation of LES delivered intravitreally did not cause in vitro toxicity, as evaluated by MTT and TUNEL assays, nor in vivo toxicity as evaluated by histopathology and immunohistochemistry in rabbit eyes.
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Paraneoplastic pemphigus is a rare and severe autoimmune blistering disease characterized by mucocutaneous lesions associated with benign and malignant neoplasms. Diagnostic criteria include the presence of chronic mucositis and polymorphic cutaneous lesions with occult or confirmed neoplasia; histopathological analysis exhibiting intraepidermal acantholysis, necrotic keratinocytes, and vacuolar interface dermatitis; direct immunofluorescence with intercellular deposits (IgG and C3) and at the basement membrane zone (IgG); indirect immunofluorescence with intercellular deposition of IgG (substrates: monkey esophagus and simple, columnar, and transitional epithelium); and, autoreactivity to desmogleins 1 and 3, desmocollins 1, 2, and 3, desmoplakins I and II, envoplakin, periplakin, epiplakin, plectin, BP230, and α-2-macroglobulin-like protein 1. Neoplasias frequently related to paraneoplastic pemphigus include chronic lymphocytic leukemia, non-Hodgkin lymphoma, carcinomas, Castleman disease, thymoma, and others. Currently, there is no standardized treatment for paraneoplastic pemphigus. Systemic corticosteroids, azathioprine, mycophenolate mofetil, cyclosporine, rituximab, cyclophosphamide, plasmapheresis, and intravenous immunoglobulin have been used, with variable outcomes. Reported survival rates in 1, 2, and 5 years are 49%, 41%, and 38%, respectively.
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Síndromes Paraneoplásicas/patologia , Síndromes Paraneoplásicas/terapia , Pênfigo/patologia , Pênfigo/terapia , Autoanticorpos/imunologia , Eritema/diagnóstico , Eritema/patologia , Humanos , Doenças da Boca/diagnóstico , Doenças da Boca/patologia , Síndromes Paraneoplásicas/diagnóstico , Síndromes Paraneoplásicas/imunologia , Pênfigo/diagnóstico , Pênfigo/imunologia , Pele/patologiaRESUMO
Abstract: Paraneoplastic pemphigus is a rare and severe autoimmune blistering disease characterized by mucocutaneous lesions associated with benign and malignant neoplasms. Diagnostic criteria include the presence of chronic mucositis and polymorphic cutaneous lesions with occult or confirmed neoplasia; histopathological analysis exhibiting intraepidermal acantholysis, necrotic keratinocytes, and vacuolar interface dermatitis; direct immunofluorescence with intercellular deposits (IgG and C3) and at the basement membrane zone (IgG); indirect immunofluorescence with intercellular deposition of IgG (substrates: monkey esophagus and simple, columnar, and transitional epithelium); and, autoreactivity to desmogleins 1 and 3, desmocollins 1, 2, and 3, desmoplakins I and II, envoplakin, periplakin, epiplakin, plectin, BP230, and α-2-macroglobulin-like protein 1. Neoplasias frequently related to paraneoplastic pemphigus include chronic lymphocytic leukemia, non-Hodgkin lymphoma, carcinomas, Castleman disease, thymoma, and others. Currently, there is no standardized treatment for paraneoplastic pemphigus. Systemic corticosteroids, azathioprine, mycophenolate mofetil, cyclosporine, rituximab, cyclophosphamide, plasmapheresis, and intravenous immunoglobulin have been used, with variable outcomes. Reported survival rates in 1, 2, and 5 years are 49%, 41%, and 38%, respectively.