RESUMO
Assuntos
Consumo de Bebidas Alcoólicas , Antituberculosos , Infecções por HIV , Isoniazida , Tuberculose Latente , Humanos , Isoniazida/administração & dosagem , Antituberculosos/administração & dosagem , Antituberculosos/efeitos adversos , Uganda/epidemiologia , Tuberculose Latente/tratamento farmacológico , Masculino , Infecções por HIV/tratamento farmacológico , Feminino , Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/epidemiologia , Adulto , Cadeias de Markov , Teste Tuberculínico , Tuberculose/prevenção & controle , Tuberculose/epidemiologia , Doença Hepática Induzida por Substâncias e Drogas/prevenção & controle , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Doença Hepática Induzida por Substâncias e Drogas/epidemiologia , Adulto Jovem , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Personalized postoperative management of patients with pituitary adenomas requires an early risk stratification system. METHODS: We reviewed 501 cases operated between 10/27/2011 and 5/5/2016 by a single neurosurgeon. We determined biochemical remission and tumor resection at 3 months, and biochemical recurrence, tumor recurrence, radiation and reoperation during follow-up. We considered age, gender, tumor diameter, cavernous sinus invasion (CSI) by MRI, diagnostic category (clinical, biochemical and immunohistochemical), and proliferation markers in a Cox proportional hazards model. We built predictive models with the significant parameters and used Kaplan-Meier survival curves for time-dependent analyses. RESULTS: The 501 cases comprised 141 functional and 360 nonfunctional adenomas. Tumor diameter, CSI, and ki-67 index predicted long-term events. Model 1 (CSI, diameter ≥ 2.9 cm and ki-67 > 3%) identified 18 (3.6%) adenomas and predicted persistent hypersecretory syndrome and residual tumor with 98.7% specificity (OR 8.6; CI 3.0-24.7). Model 2 (ki-67 > 3% and CSI) identified 48 (9.6%) adenomas and had 93.1% specificity (OR 3.3; CI 1.8-6.0). Model 3 (ki-67 > 3%, mitoses and p53, former "atypical" adenoma) identified 26 (5.2%) adenomas and had 96.0% specificity (OR 2.3; CI 1.0-5.0). Model 1 best predicted the long-term event-free survival and was strengthened when Knosp 3-4 CSI grades were used. Model 2 better identified the smaller adenomas at risk. Among the WHO 2017 special PA subtypes, patients with silent corticotroph adenoma had a lower event-free survival than ACTH-negative nonfunctional adenomas. CONCLUSION: Use of CSI, ki-67 and tumor diameter in prediction models facilitates tailored surveillance and management of patients with pituitary adenomas.
Assuntos
Adenoma/cirurgia , Neoplasias Hipofisárias/cirurgia , Adenoma/mortalidade , Adulto , Intervalo Livre de Doença , Feminino , Humanos , Estimativa de Kaplan-Meier , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Neoplasias Hipofisárias/mortalidade , Modelos de Riscos ProporcionaisRESUMO
A search for optimal methods of planning cosmonaut's training is currently guided by the concept of the leading role of support afferentation in hypogravity-induced changes of locomotion. Support afferentation is dependent on the strength of support reactions (SR); in this connection, the investigation was aimed at analysis of the vertical component of maximal SR at identical speeds of different types of locomotion on motorized and nonmotorized treadmill in I g and micro-g. Minimal vertical components of maximal SR were, measured during walk on the motorized treadmill. Maximal vertical components of maximal SR were measured during run on the nonmotorized treadmill. This was observed regularly on ISS treadmill BD-2 outfitted with vibroisolation and a special training suit to produce axial loading. On the ground, the relationship was less regular. Considerable differences of individual locomotion strategies and maximal SR values imply that SR is a factor that must be taken into account when planning individual training programs for rnosmonaut on long-duration missions.