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1.
Prog Urol ; 32(11): 776-783, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35941009

RESUMO

BACKGROUND: A weakened pelvic floor is less efficient counteracting the increased intra-abdominal pressure during exercise. While intra-abdominal pressure is higher in Sit-up than in Curl-up, Sit-up continues to be practiced in fitness classes. This raises the question of whether it has advantages over the Curl-up for instance in reducing the interrecti distance (IRD), a goal searched by many parous women. IRD has been shown to be acutely reduced during Curl-up. OBJECTIVES: To determine if the IRD is more reduced during Sit-up than during Curl-up. METHODS: Parous women with an IRD greater than 15mm were included in the study. IRD was measured at 20mm above umbilicus with a caliper in Head-lift, Curl-up, Sit-up and Drawing-in+Curl-up. IRD was compared across the four conditions using a one-way Anova test with repeated measures and Bonferroni correction between pairwise comparisons. RESULTS: Nineteen parous women aged between 28 and 54 participated in this study. Compared to Head-lift (20.3±3.9mm), the IRD was significantly decreased during the Curl-up (12.2±3.0mm) and the Sit-up (12.1±3.6mm), but not during the Drawing-in+Curl-up (18.4±4.9mm). There was no significant difference in IRD between Curl-up and Sit-up. CONCLUSION: IRD was similarly acutely reduced during Curl-up and Sit-up. The long-term effect of Curl-up on the IRD and on the pelvic floor muscles needs to be studied. IMPACT: To reduce IRD in parous women Curl-up rather than Sit-up should be practiced. Fitness coaches should consider this information especially with classes attended by parous women, many of whom complain about pelvic floor disorders. LEVEL OF EVIDENCE: EL05.


Assuntos
Distúrbios do Assoalho Pélvico , Diafragma da Pelve , Adulto , Estudos Transversais , Exercício Físico , Feminino , Humanos , Pessoa de Meia-Idade , Ultrassonografia
2.
Eur J Nucl Med Mol Imaging ; 48(12): 3918-3924, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34018010

RESUMO

PURPOSE: A high expression of fibroblast activation protein (FAP) was observed in multiple sarcomas, indicating an enormous potential for PET/CT using 68Ga-radiolabeled inhibitors of FAP (FAPI). Therefore, this retrospective study aimed to evaluate the role of the novel hybrid imaging probe for sarcomas as a first clinical evaluation. METHODS: A cohort of 15 patients underwent 68Ga-FAPI-PET/CT for staging or restaging. The acquisition of PET scans was performed 60 min after administration of 127 to 308 MBq of the tracer. The uptake of 68Ga-FAPI in malignant tissue as well as in healthy organs was quantified by standardized uptake values SUVmean and SUVmax. RESULTS: Excellent tumor-to-background ratios (> 7) could be achieved due to low background activity and high SUVmax in primary tumors (median 7.16), local relapses (median 11.47), and metastases (median 6.29). The highest uptake was found for liposarcomas and high-grade disease (range 18.86-33.61). A high SUVmax (> 10) was observed for clinically more aggressive disease. CONCLUSION: These preliminary findings suggest a high potential for the clinical use of 68Ga-FAPI-PET/CT for patients diagnosed with sarcoma.


Assuntos
Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Sarcoma , Humanos , Ligantes , Recidiva Local de Neoplasia , Estudos Retrospectivos , Sarcoma/diagnóstico por imagem
3.
Neurobiol Dis ; 75: 177-85, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25576395

RESUMO

Electrophysiological changes in basal ganglia neurons are hypothesized to underlie motor dysfunction in Parkinson's disease (PD). Previous results in head-restrained MPTP-treated non-human primates have suggested that increased bursting within the basal ganglia and related thalamic and cortical areas may be a hallmark of pathophysiological activity. In this study, we investigated whether there is increased bursting in substantia nigra pars reticulata (SNpr) output neurons in anesthetized and awake, head-restrained unilaterally lesioned 6-OHDA mice when compared to control mice. Confirming previous studies, we show that there are significant changes in the firing rate and pattern in SNpr neuron activity under urethane anesthesia. The regular firing pattern of control urethane-anesthetized SNpr neurons was not present in the 6-OHDA-lesioned group, as the latter neurons instead became phase locked with cortical slow wave activity (SWA). Next, we examined whether such robust electrophysiological changes between groups carried over to the awake state. SNpr neurons from both groups fired at much higher frequencies in the awake state than in the anesthetized state and surprisingly showed only modest changes between awake control and 6-OHDA groups. While there were no differences in firing rate between groups in the awake state, an increase in the coefficient of variation (CV) was observed in the 6-OHDA group. Contrary to the bursting hypothesis, this increased CV was not due to changes in bursting but was instead due to a mild increase in pausing. Together, these results suggest that differences in SNpr activity between control and 6-OHDA lesioned mice may be strongly influenced by changes in network activity during different arousal and behavioral states.


Assuntos
Potenciais de Ação/fisiologia , Anestésicos/farmacologia , Neurônios/fisiologia , Transtornos Parkinsonianos/fisiopatologia , Parte Reticular da Substância Negra/fisiopatologia , Vigília/fisiologia , Potenciais de Ação/efeitos dos fármacos , Animais , Ritmo beta/efeitos dos fármacos , Dopamina/metabolismo , Camundongos Endogâmicos C57BL , Camundongos Transgênicos , Microeletrodos , Atividade Motora/fisiologia , Córtex Motor/efeitos dos fármacos , Córtex Motor/fisiopatologia , Neurônios/efeitos dos fármacos , Oxidopamina , Transtornos Parkinsonianos/patologia , Parte Reticular da Substância Negra/efeitos dos fármacos , Parte Reticular da Substância Negra/patologia , Restrição Física , Uretana/farmacologia , Vigília/efeitos dos fármacos
4.
Ann Oncol ; 25(5): 1018-25, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24585720

RESUMO

BACKGROUND: Initially, unresectable colorectal liver metastases can be resected after response to chemotherapy. While cetuximab has been shown to increase response and resection rates, the survival outcome for this conversion strategy needs further evaluation. PATIENTS AND METHODS: Patients with technically unresectable and/or ≥5 liver metastases were treated with FOLFOX/cetuximab (arm A) or FOLFIRI/cetuximab (arm B) and evaluated with regard to resectability every 2 months. Tumour response and secondary resection data have been reported previously. A final analysis of overall survival (OS) and progression-free survival (PFS) was carried out in December 2012. RESULTS: Between December 2004 and March 2008, 56 patients were randomised to arm A, 55 to arm B. The median OS was 35.7 [95% confidence interval (CI) 27.2-44.2] months [arm A: 35.8 (95% CI 28.1-43.6), arm B: 29.0 (95% CI 16.0-41.9) months, HR 1.03 (95% CI 0.66-1.61), P = 0.9]. The median PFS was 10.8 (95% CI 9.3-12.2) months [arm A: 11.2 (95% CI 7.2-15.3), arm B: 10.5 (95% CI 8.9-12.2) months, HR 1.18 (95% CI 0.79-1.74), P = 0.4]. Patients who underwent R0 resection (n = 36) achieved a better median OS [53.9 (95% CI 35.9-71.9) months] than those who did not [21.9 (95% CI 17.1-26.7) months, P < 0.001]. The median disease-free survival for R0 resected patients was 9.9 (95% CI 5.8-14.0) months, and the 5-year OS rate was 46.2% (95% CI 29.5% to 62.9%). CONCLUSIONS: This study confirms a favourable long-term survival for patients with initially sub-optimal or unresectable colorectal liver metastases who respond to conversion therapy and undergo secondary resection. Both FOLFOX/FOLFIRI plus cetuximab, appear to be appropriate regimens for 'conversion' treatment in patients with K-RAS codon 12/13/61 wild-type tumours. Thus, liver surgery can be considered curative or alternatively as an additional 'line of therapy' in those patients who are not cured. CLINICAL TRIAL NUMBER: NCT00153998, www.clinicaltrials.gov.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Camptotecina/análogos & derivados , Neoplasias Colorretais/tratamento farmacológico , Neoplasias Hepáticas/tratamento farmacológico , Idoso , Anticorpos Monoclonais Humanizados/administração & dosagem , Camptotecina/uso terapêutico , Cetuximab , Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/patologia , Intervalo Livre de Doença , Feminino , Fluoruracila/uso terapêutico , Humanos , Estimativa de Kaplan-Meier , Leucovorina/uso terapêutico , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/secundário , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Compostos Organoplatínicos/uso terapêutico , Modelos de Riscos Proporcionais , Resultado do Tratamento
5.
Br Poult Sci ; 55(5): 585-91, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25188272

RESUMO

Water used in a modern poultry processing line was tested from October 2005 to June 2006 to determine the level of bacteria in an abattoir in Germany. A total of 420 water samples were taken from 14 processing sites (PSs), at 10 times, and from three different hours of the working shift at three sampling hours (SHs) at 5:00 a.m. (SH 1), 9:00 a.m. (SH 2) and 12:00 a.m. (SH 3). Each sample was assessed for the aerobic plate count (APC) and the prevalence of Salmonella, Campylobacter, Listeria and Yersinia over 30 sampling weeks. The APC numbers of each PS from three SHs were compared, and the prevalence of Salmonella, Campylobacter, Listeria and Yersinia from each PS of three SHs was determined as well as change from the initial PS to the end of the processing line. A total of 46 water samples were positive for Salmonella, 120 positive for Campylobacter and 4 positive for Listeria. None of the water samples was found to be positive for Yersinia. During the course of the day, the APC increased. Salmonella was mostly found during SH 1 (5 a.m.) in water from all PSs. A high number of Campylobacter were observed at SH 2 (9 a.m.) and SH 3 (12 a.m.) from all PSs. The results show that water, which is still used in substantial amounts in present poultry processing technology, can serve as a carrier for Salmonella and Campylobacter. The findings indicate that birds might progressively contaminate the equipment and become contaminated via the same equipment, that water at every processing position of the line constitutes a risk and that more attention should be paid to effective water management in the processing plan.


Assuntos
Matadouros , Infecções por Campylobacter/veterinária , Galinhas , Infecções por Enterobacteriaceae/veterinária , Microbiologia de Alimentos , Listeriose/veterinária , Doenças das Aves Domésticas/epidemiologia , Microbiologia da Água , Animais , Campylobacter/isolamento & purificação , Infecções por Campylobacter/epidemiologia , Infecções por Campylobacter/microbiologia , Contagem de Colônia Microbiana/veterinária , Enterobacteriaceae/isolamento & purificação , Infecções por Enterobacteriaceae/epidemiologia , Infecções por Enterobacteriaceae/microbiologia , Manipulação de Alimentos , Alemanha/epidemiologia , Listeria/isolamento & purificação , Listeriose/epidemiologia , Listeriose/microbiologia , Doenças das Aves Domésticas/microbiologia , Prevalência , Fatores de Risco
6.
J Neurophysiol ; 110(12): 2792-805, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24068758

RESUMO

Numerous studies have suggested that alpha-synuclein plays a prominent role in both familial and idiopathic Parkinson's disease (PD). Mice in which human alpha-synuclein is overexpressed (ASO) display progressive motor deficits and many nonmotor features of PD. However, it is unclear what in vivo pathophysiological mechanisms drive these motor deficits. It is also unknown whether previously proposed pathophysiological features (i.e., increased beta oscillations, bursting, and synchronization) described in toxin-based, nigrostriatal dopamine-depletion models are also present in ASO mice. To address these issues, we first confirmed that 5- to 6-mo-old ASO mice have robust motor dysfunction, despite the absence of significant nigrostriatal dopamine degeneration. In the same animals, we then recorded simultaneous single units and local field potentials (LFPs) in the substantia nigra pars reticulata (SNpr), the main basal ganglia output nucleus, and one of its main thalamic targets, the ventromedial nucleus, as well as LFPs in the primary motor cortex in anesthetized ASO mice and their age-matched, wild-type littermates. Neural activity was examined during slow wave activity and desynchronized cortical states, as previously described in 6-hydroxydopamine-lesioned rats. In contrast to toxin-based models, we found a small decrease, rather than an increase, in beta oscillations in the desynchronized state. Similarly, synchronized burst firing of nigral neurons observed in toxin-based models was not observed in ASO mice. Instead, we found more subtle changes in pauses of SNpr firing compared with wild-type control mice. Our results suggest that the pathophysiology underlying motor dysfunction in ASO mice is distinctly different from striatal dopamine-depletion models of parkinsonism.


Assuntos
Ritmo beta , Neurônios/fisiologia , Doença de Parkinson Secundária/fisiopatologia , Doença de Parkinson/fisiopatologia , Substância Negra/fisiopatologia , Tálamo/fisiopatologia , alfa-Sinucleína/genética , Potenciais de Ação , Animais , Humanos , Masculino , Camundongos , Córtex Motor/fisiopatologia , Neurônios/metabolismo , Oxidopamina/toxicidade , Doença de Parkinson/genética , Doença de Parkinson Secundária/induzido quimicamente , Substância Negra/citologia , Substância Negra/metabolismo , Tálamo/citologia , Tálamo/metabolismo , alfa-Sinucleína/metabolismo
7.
Nano Lett ; 12(9): 4953-9, 2012 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-22935029

RESUMO

Stacking of two-dimensional electron gases (2DEGs) obtained by δ-doping of Ge and patterned by scanning probe lithography is a promising approach to realize ultrascaled 3D epitaxial circuits, where multiple layers of active electronic components are integrated both vertically and horizontally. We use atom probe tomography and magnetotransport to correlate the real space 3D atomic distribution of dopants in the crystal with the quantum correction to the conductivity observed at low temperatures, probing if closely stacked δ-layers in Ge behave as independent 2DEGs. We find that at a separation of 9 nm the stacked-2DEGs, while interacting, still maintain their individuality in terms of electron transport and show long phase coherence lengths (∼220 nm). Strong vertical electron confinement is crucial to this finding, resulting in an interlayer scattering time much longer (∼1000 × ) than the scattering time within the dopant plane.


Assuntos
Gases/química , Germânio/química , Nanoestruturas/química , Nanoestruturas/ultraestrutura , Condutividade Elétrica , Transporte de Elétrons , Campos Magnéticos , Teste de Materiais , Tamanho da Partícula , Estatística como Assunto , Temperatura
8.
ESMO Open ; 7(2): 100419, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35305400

RESUMO

BACKGROUND: The programmed death-ligand 1 inhibitor atezolizumab had shown clinical activity against several advanced malignancies. PATIENTS AND METHODS: This phase II, open-label basket study (NCT02458638) was conducted in 16 main cohorts of patients aged ≥18 years with stage III or IV solid tumors. In stage I, 12 patients were enrolled into each cohort. Treatment was atezolizumab 1200 mg intravenously every 3 weeks until loss of clinical benefit or unacceptable toxicity. The primary efficacy endpoint was the non-progression rate (NPR) at 18 weeks in treated, assessable patients. NPR ≤20% was not of interest for development as monotherapy, and NPR ≥40% was defined as the threshold of benefit/success. If ≥3 patients had non-progressive disease in stage I (interim analysis), 13 additional patients could be enrolled into stage II (final analysis). Secondary efficacy and safety endpoints were also evaluated. RESULTS: Overall, 474 patients were enrolled and treated; 433 were included in the efficacy set. Due partly to slow recruitment because of competing trials and limited efficacy at interim analyses, enrollment was stopped early, including in cohorts that passed stage I boundaries of success. NPR was >20% in five cohorts: cervical cancer {n = 27; NPR 44.4% [95% confidence interval (CI) 25.5% to 64.7%]}; follicular/papillary thyroid cancer [n = 11; 54.5% (95% CI 23.4% to 83.3%)]; thymoma [n = 13; 76.9% (95% CI: 46.2% to 95.0%)]; gastroenteropancreatic (GEP) and lung neuroendocrine tumors [NETs; n = 24; 41.7% (95% CI 22.1% to 63.4%)], and low/intermediate grade carcinoid GEP and lung NETs [n = 12; 58.3% (95% CI 27.7% to 84.8%)]. Treatment-related adverse events occurred in 55.3% of patients overall, and at grade 3, 4, and 5 in 10.3%, 1.7%, and 0.4%, respectively. CONCLUSIONS: Atezolizumab monotherapy was effective in the cervical cancer cohort. The interim benefit threshold was crossed in patients with follicular/papillary thyroid cancer, thymoma, and GEP and lung NETs, but recruitment was stopped before these signals could be confirmed in stage II. Safety was consistent with previous findings.


Assuntos
Anticorpos Monoclonais Humanizados , Neoplasias , Adolescente , Adulto , Anticorpos Monoclonais Humanizados/efeitos adversos , Feminino , Humanos , Neoplasias/tratamento farmacológico , Neoplasias/patologia , Timoma , Neoplasias do Timo , Câncer Papilífero da Tireoide , Neoplasias da Glândula Tireoide , Neoplasias do Colo do Útero
9.
ESMO Open ; 7(2): 100400, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35247870

RESUMO

BACKGROUND: Microsatellite instability (MSI)/mismatch repair deficiency (dMMR) is a key genetic feature which should be tested in every patient with colorectal cancer (CRC) according to medical guidelines. Artificial intelligence (AI) methods can detect MSI/dMMR directly in routine pathology slides, but the test performance has not been systematically investigated with predefined test thresholds. METHOD: We trained and validated AI-based MSI/dMMR detectors and evaluated predefined performance metrics using nine patient cohorts of 8343 patients across different countries and ethnicities. RESULTS: Classifiers achieved clinical-grade performance, yielding an area under the receiver operating curve (AUROC) of up to 0.96 without using any manual annotations. Subsequently, we show that the AI system can be applied as a rule-out test: by using cohort-specific thresholds, on average 52.73% of tumors in each surgical cohort [total number of MSI/dMMR = 1020, microsatellite stable (MSS)/ proficient mismatch repair (pMMR) = 7323 patients] could be identified as MSS/pMMR with a fixed sensitivity at 95%. In an additional cohort of N = 1530 (MSI/dMMR = 211, MSS/pMMR = 1319) endoscopy biopsy samples, the system achieved an AUROC of 0.89, and the cohort-specific threshold ruled out 44.12% of tumors with a fixed sensitivity at 95%. As a more robust alternative to cohort-specific thresholds, we showed that with a fixed threshold of 0.25 for all the cohorts, we can rule-out 25.51% in surgical specimens and 6.10% in biopsies. INTERPRETATION: When applied in a clinical setting, this means that the AI system can rule out MSI/dMMR in a quarter (with global thresholds) or half of all CRC patients (with local fine-tuning), thereby reducing cost and turnaround time for molecular profiling.


Assuntos
Neoplasias Colorretais , Instabilidade de Microssatélites , Inteligência Artificial , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/genética , Neoplasias Colorretais/patologia , Reparo de Erro de Pareamento de DNA/genética , Detecção Precoce de Câncer , Humanos
10.
Cancer Immunol Immunother ; 59(9): 1389-400, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20514540

RESUMO

Despite spontaneous or vaccination-induced immune responses, pancreatic cancer remains one of the most deadly immunotherapy-resistant malignancies. We sought to comprehend the spectrum of pancreatic tumor-associated antigens (pTAAs) and to assess the clinical relevance of their immunogenicity. An autologous SEREX-based screening of a cDNA library constructed from a pancreatic T3N0M0/GIII specimen belonging to a long-term survivor (36 months) revealed 18 immunogenic pTAA. RT-PCR analysis displayed broad distribution of the identified antigens among normal human tissues. PNLIPRP2 and MIA demonstrated the most distinct pancreatic cancer-specific patterns. ELISA-based screening of sera for corresponding autoantibodies revealed that although significantly increased, the immunogenicity of these molecules was not a common feature in pancreatic cancer. QRT-PCR and immunohistochemistry characterized PNLIPRP2 as a robust acinar cell-specific marker whose decreased expression mirrored the disappearance of parenchyma in the diseased organ, but was not related to the presence of PNLIPRP2 autoantibodies. Analyses of MIA-known to be preferentially expressed in malignant cells-surprisingly revealed an inverse correlation between intratumoral gene expression and the emergence of autoantibodies. MIA(high) patients were autoantibody-negative and had shorter median survival when compared with autoantibody-positive MIA(low) patients (12 vs. 34 months). The observed pTAA spectrum comprised molecules associated with acinar, stromal and malignant structures, thus presenting novel targets for tumor cell-specific therapies as well as for approaches based on the bystander effects. Applying the concept of cancer immunoediting to interpret relationships between gene expression, antitumor immune responses, and clinical outcome might better discriminate between past and ongoing immune responses, consequently enabling prognostic stratification of patients and individual adjustment of immunotherapy.


Assuntos
Adenocarcinoma/diagnóstico , Adenocarcinoma/imunologia , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/imunologia , Adenocarcinoma/sangue , Adenocarcinoma/genética , Adenocarcinoma/mortalidade , Idoso , Antígenos Glicosídicos Associados a Tumores/genética , Antígenos Glicosídicos Associados a Tumores/imunologia , Antígenos Glicosídicos Associados a Tumores/metabolismo , Autoanticorpos/sangue , Clonagem Molecular , Ensaio de Imunoadsorção Enzimática , Feminino , Biblioteca Gênica , Humanos , Imunoquímica , Lipase/genética , Lipase/imunologia , Lipase/metabolismo , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Pâncreas/metabolismo , Pâncreas/patologia , Neoplasias Pancreáticas/sangue , Neoplasias Pancreáticas/genética , Neoplasias Pancreáticas/mortalidade , Prognóstico
11.
Int J Comput Dent ; 13(3): 233-50, 2010.
Artigo em Inglês, Alemão | MEDLINE | ID: mdl-20879462

RESUMO

Treatment data from practices and specialization centers, especially in the increasingly specialized areas which university clinics do not cover, are very important for evaluating the effectiveness and efficiency of dental examination and treatment methods. In the case of paper-based documentation, the evaluation of these data usually fails because of the cost it entails. With the use of electronic medical records, this expense can be markedly lower, provided the data acquisition and storage is structured accordingly. Since access to sensitive person-related data is simplified considerably by this method, such health data are protected, especially on the European level. Other than generally assumed, this protection is not restricted solely to the confidentiality principle, but also comprises the power of disposition over the data (data protection). The result is that from a legal point of view, the treatment data cannot be readily used for scientific studies, not even by dentists and physicians who have collected the data legally during the course of their therapeutic work. The technical separation of treatment data from the personal data offers a legally acceptable solution to this problem. It must ensure that a later assignment to individual persons will not be feasible at a realistic expense ("effective anonymization"). This article describes the legal and information technology principles and their practical implementation, as illustrated by the concept of a respective compliant IT architecture for the dentaConcept CMD fact diagnostic software. Here, a special export function automatically separates the anonymized treatment data and thus facilitates multicentric studies within an institution and among dental practices.


Assuntos
Coleta de Dados , Informática Odontológica/legislação & jurisprudência , Segurança Computacional , Confidencialidade/legislação & jurisprudência , Bases de Dados Factuais/legislação & jurisprudência , Documentação , Registros Eletrônicos de Saúde/legislação & jurisprudência , União Europeia , Alemanha , Humanos , Armazenamento e Recuperação da Informação/métodos , Design de Software
12.
BMC Cancer ; 8: 349, 2008 Nov 26.
Artigo em Inglês | MEDLINE | ID: mdl-19036146

RESUMO

BACKGROUND: Disease progression of hepatocellular cancer (HCC) in patients eligible for liver transplantation (LTx) occurs in up to 50% of patients, resulting in withdrawal from the LTx waiting list. Transarterial chemoembolization (TACE) is used as bridging therapy with highly variable response rates. The oral multikinase inhibitor sorafenib significantly increases overall survival and time-to-progression in patients with advanced hepatocellular cancer. DESIGN: The HeiLivCa study is a double-blinded, controlled, prospective, randomized multi-centre phase III trial. Patients in study arm A will be treated with transarterial chemoembolization plus sorafenib 400 mg bid. Patients in study arm B will be treated with transarterial chemoembolization plus placebo. A total of 208 patients with histologically confirmed hepatocellular carcinoma or HCC diagnosed according to EASL criteria will be enrolled. An interim patients' analysis will be performed after 60 events. Evaluation of time-to-progression as primary endpoint (TTP) will be performed at 120 events. Secondary endpoints are number of patients reaching LTx, disease control rates, OS, progression free survival, quality of live, toxicity and safety. DISCUSSION: As TACE is the most widely used primary treatment of HCC before LTx and sorafenib is the only proven effective systemic treatment for advanced HCC there is a strong rational to combine both treatment modalities. This study is designed to reveal potential superiority of the combined TACE plus sorafenib treatment over TACE alone and explore a new neo-adjuvant treatment concept in HCC before LTx.


Assuntos
Antineoplásicos/uso terapêutico , Benzenossulfonatos/uso terapêutico , Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica , Neoplasias Hepáticas/terapia , Piridinas/uso terapêutico , Adulto , Carcinoma Hepatocelular/tratamento farmacológico , Terapia Combinada , Método Duplo-Cego , Feminino , Humanos , Neoplasias Hepáticas/tratamento farmacológico , Transplante de Fígado , Masculino , Niacinamida/análogos & derivados , Compostos de Fenilureia , Projetos de Pesquisa , Sorafenibe
13.
Eur J Cancer ; 90: 122-129, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29306769

RESUMO

BACKGROUND: Immune checkpoint therapy has dramatically changed treatment options in patients with metastatic melanoma. However, a relevant part of patients still does not respond to treatment. Data regarding the prognostic or predictive significance of preexisting immune responses against tumour antigens are conflicting. Retrospective data suggested a higher clinical benefit of ipilimumab in melanoma patients with preexisting NY-ESO-1-specific immunity. PATIENTS AND METHODS: Twenty-five patients with previously untreated or treated metastatic melanoma and preexisting humoural immune response against NY-ESO-1 received ipilimumab at a dose of 10 mg/kg in week 1, 4, 7, 10 followed by 3-month maintenance treatment for a maximum of 48 weeks. Primary endpoint was the disease control rate (irCR, irPR or irSD) according to immune-related response criteria (irRC). Secondary endpoints included the disease control rate according to RECIST criteria, progression-free survival and overall survival (OS). Humoural and cellular immune responses against NY-ESO-1 were analysed from blood samples. RESULTS: Disease control rate according to irRC was 52%, irPR was observed in 36% of patients. Progression-free survival according to irRC was 7.8 months, according to RECIST criteria it was 2.9 months. Median OS was 22.7 months; the corresponding 1-year survival rate was 66.8%. Treatment-related grade 3 AEs occurred in 36% with no grade 4-5 AEs. No clear association was found between the presence of NY-ESO-1-specific cellular or humoural immune responses and clinical activity. CONCLUSION: Ipilimumab demonstrated clinically relevant activity within this biomarker-defined population. NY-ESO-1 positivity, as a surrogate for a preexisting immune response against tumour antigens, might help identifying patients with a superior outcome from immune checkpoint blockade. CLINICAL TRIAL INFORMATION: NCT01216696.


Assuntos
Antígenos de Neoplasias/imunologia , Antineoplásicos Imunológicos/uso terapêutico , Ipilimumab/uso terapêutico , Melanoma/tratamento farmacológico , Melanoma/imunologia , Proteínas de Membrana/imunologia , Neoplasias Cutâneas/tratamento farmacológico , Neoplasias Cutâneas/imunologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Intervalo Livre de Doença , Feminino , Humanos , Imunidade Humoral , Masculino , Melanoma/mortalidade , Pessoa de Meia-Idade , Neoplasias Cutâneas/mortalidade , Melanoma Maligno Cutâneo
14.
Leukemia ; 31(7): 1570-1581, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-27890927

RESUMO

Despite therapeutic advances, multiple myeloma (MM) remains an incurable disease, predominantly because of the development of drug resistance. The activator protein-1 (AP-1) transcription factor family has been implicated in a multitude of physiologic processes and tumorigenesis; however, its role in MM is largely unknown. Here we demonstrate specific and rapid induction of the AP-1 family member JunB in MM cells when co-cultured with bone marrow stromal cells. Supporting a functional key role of JunB in MM pathogenesis, knockdown of JUNB significantly inhibited in vitro MM cell proliferation and survival. Consistently, induced silencing of JUNB markedly decreased tumor growth in a murine MM model of the microenvironment. Subsequent gene expression profiling revealed a role for genes associated with apoptosis, DNA replication and metabolism in driving the JunB-mediated phenotype in MM cells. Importantly, knockdown of JUNB restored the response to dexamethasone in dexamethasone-resistant MM cells. Moreover, 4-hydroxytamoxifen-induced activation of a JunB-ER fusion protein protected dexamethasone-sensitive MM cells against dexamethasone- and bortezomib-induced cytotoxicity. In summary, our results demonstrate for the first time a specific role for AP-1/JunB in MM cell proliferation, survival and drug resistance, thereby strongly supporting that this transcription factor is a promising new therapeutic target in MM.


Assuntos
Medula Óssea/patologia , Mieloma Múltiplo/patologia , Fatores de Transcrição/fisiologia , Microambiente Tumoral , Animais , Bortezomib/farmacologia , Proliferação de Células , Dexametasona/farmacologia , Resistencia a Medicamentos Antineoplásicos , Feminino , Humanos , Camundongos , Mieloma Múltiplo/tratamento farmacológico , Mieloma Múltiplo/mortalidade , NF-kappa B/fisiologia
15.
J Neurosci ; 20(8): 3006-16, 2000 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-10751453

RESUMO

Cerebellar nucleus neurons were recorded in vitro, and dynamic clamping was used to simulate inhibitory synaptic input from Purkinje cells likely to occur in vivo. Inhibitory input patterns with varying synaptic amplitudes and synchronicity were applied to determine how spike rate and spike timing can be controlled by inhibition. The excitatory input conductance was held constant to isolate the effect of dynamic inhibitory inputs on spiking. We found that the timing of individual spikes was controlled precisely by short decreases in the inhibitory conductance that were the consequence of synchronization between many inputs. The spike rate of nucleus neurons was controlled in a linear way by the rate of inhibitory inputs. The spike rate, however, also depended strongly on the amount of synchronicity present in the inhibitory inputs. An irregular spike train similar to in vivo data resulted from applied synaptic conductances when the conductance was large enough to overcome intrinsic pacemaker currents. In this situation subthreshold fluctuations in membrane potential closely followed the time course of the combined reversal potential of excitation and inhibition. This indicates that the net synaptic driving force for realistic input levels in vivo may be small and that synaptic input may operate primarily by shunting. The accurate temporal control of output spiking by inhibitory input that can be achieved in this way in the deep cerebellar nuclei may be particularly important to allow fine temporal control of movement via inhibitory output from cerebellar cortex.


Assuntos
Potenciais de Ação/fisiologia , Núcleos Cerebelares/fisiologia , Inibição Neural/fisiologia , Células de Purkinje/fisiologia , Animais , Masculino , Ratos , Ratos Sprague-Dawley
16.
J Neurosci ; 19(14): 6090-101, 1999 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-10407045

RESUMO

Previous simulations using a realistic model of a cerebellar Purkinje cell suggested that synaptic control of somatic spiking in this cell type is mediated by voltage-gated intrinsic conductances and that inhibitory rather than excitatory synaptic inputs are more influential in controlling spike timing. In this paper, we have tested these predictions physiologically using dynamic current clamping to apply model-derived synaptic conductances to Purkinje cells in vitro. As predicted by the model, this input transformed the in vitro pattern of spiking into a different spike pattern typically observed in vivo. A net inhibitory synaptic current was required to achieve such spiking, indicating the presence of strong intrinsic depolarizing currents. Spike-triggered averaging confirmed that the length of individual intervals between spikes was correlated to the amplitude of the inhibitory conductance but was not influenced by excitatory inputs. Through repeated presentation of identical stimuli, we determined that the output spike rate was very sensitive to the relative balance of excitation and inhibition in the input conductances. In contrast, the accuracy of spike timing was dependent on input amplitude and was independent of spike rate. Thus, information could be encoded in Purkinje cell spiking in a precise spike time code and a rate code at the same time. We conclude that Purkinje cell responses to synaptic input are strongly dependent on active somatic and dendritic properties and that theories of cerebellar function likely need to incorporate single-cell dynamics to a greater degree than is customary.


Assuntos
Cerebelo/fisiologia , Células de Purkinje/fisiologia , Sinapses/fisiologia , Transmissão Sináptica/fisiologia , Animais , Condutividade Elétrica , Estimulação Elétrica , Técnicas In Vitro , Potenciais da Membrana/fisiologia , Modelos Neurológicos , Técnicas de Patch-Clamp , Ratos , Fatores de Tempo
17.
J Neurosci ; 21(15): RC158, 2001 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-11459879

RESUMO

The spatial distribution of low-voltage-activated (LVA) and high-voltage-activated (HVA) barium currents was investigated in neurons of the deep cerebellar nuclei (DCN) by combining barium imaging with voltage clamp. The current-induced fluorescence signal (DeltaF/F) of the HVA current was five times higher then the LVA-induced signal at the soma, but both signals were approximately equal in size in distant dendrites. This position-dependent shift of DeltaF/F indicates a non-uniform distribution of the underlying calcium channels. The higher weight of the LVA signal in the dendrites suggests that the LVA might be of particular relevance for the dendritic integration of synaptic inputs.


Assuntos
Canais de Cálcio/metabolismo , Núcleos Cerebelares/metabolismo , Neurônios/metabolismo , Animais , Bário/metabolismo , Canais de Cálcio/classificação , Canais de Cálcio Tipo L/metabolismo , Canais de Cálcio Tipo N/metabolismo , Canais de Cálcio Tipo P/metabolismo , Canais de Cálcio Tipo R/metabolismo , Núcleos Cerebelares/citologia , Dendritos/metabolismo , Corantes Fluorescentes , Técnicas In Vitro , Líquido Intracelular/metabolismo , Técnicas de Patch-Clamp , Ratos
18.
Neuroscience ; 124(2): 305-17, 2004.
Artigo em Inglês | MEDLINE | ID: mdl-14980381

RESUMO

Granule cell activity in cerebellar cortex directly excites Purkinje cells via parallel fibers, but it also inhibits Purkinje cells via cerebellar cortical interneurons. This contribution of inhibitory interneurons to cerebellar cortical processing remains poorly understood. In the present study we examined the response properties of stellate cells in vitro to input patterns that may result from granule cell activity in vivo. We constructed input waveforms that represented the sum of inputs from all individual synapses and applied these waveforms to the soma of stellate cells during whole cell recordings in acute brain slices. The stimulus waveforms contained fluctuations in a broad range of frequencies and were applied at different amplitudes. To determine the contribution of synaptic shunting to stellate cell spike responses we applied the same input waveforms either as a simulated synaptic conductance using dynamic clamping or as a direct current injection stimulus. Only the dynamic clamp stimulus has the shunting properties of real synapses, i.e. leads to different-sized synaptic current as a function of membrane potential. We found that stellate cells spike with millisecond precision in response to fast temporal fluctuations in the total synaptic input. Transient increases in excitatory input frequency led to pronounced stellate cell spike responses, indicating that this pathway may be very responsive to even small assemblies of co-activated granule cells. This was observed regardless of whether the input waveform was applied as a conductance with dynamic clamping, or as a direct current injection. Thus the shunting properties of a conductance input did not play a major role in determining the control of precisely timed spiking. In contrast, a more tonic increase in excitatory conductance did not lead to a sustained spike response as obtained with prolonged positive current injection. However, even with tonic current injection the precision of spiking was lost, as previously observed. Overall, the synaptic response function of stellate cells suggests that this cell type may pick out transients in granule cell activity, and may generate precisely timed inhibition of Purkinje cells during behavior.


Assuntos
Potenciais de Ação/fisiologia , Cerebelo/citologia , Modelos Neurológicos , Neurônios/fisiologia , Potenciais de Ação/efeitos da radiação , Animais , Animais Recém-Nascidos , Cerebelo/fisiologia , Condutividade Elétrica , Estimulação Elétrica , Técnicas In Vitro , Masculino , Inibição Neural/fisiologia , Técnicas de Patch-Clamp/métodos , Ratos , Ratos Sprague-Dawley , Sinapses/fisiologia , Sinapses/efeitos da radiação , Fatores de Tempo
19.
J Neurosci Methods ; 32(2): 143-8, 1990 May.
Artigo em Inglês | MEDLINE | ID: mdl-2114505

RESUMO

A method is described by which a single shaft multiwire microelectrode can be fabricated efficiently. The resulting electrode can be attached to a commercial microdrive and used for single neuronal unit recording from one or more tracks in deep brain structures of anesthetized or awake animals. The electrode consists of a 30 gauge stainless steel cannula through which multiple strands of 13 micron insulated tungsten microwires are threaded. At the electrode tip the wires protrude 3-4 mm from the cannula and are cut individually at suitable offsets. The tip is stabilized and fixed to the cannula with cyanoacrylate. At the base of the electrode the wires are threaded through flexible plastic tubing that provides strain relief and are glued to individual pins of a miniature connector that plugs into a field effect transistor (FET) voltage follower. Good single unit recordings have been obtained routinely from the basal ganglia of awake, behaving monkeys with this electrode.


Assuntos
Encéfalo/fisiologia , Eletrofisiologia/instrumentação , Microeletrodos , Putamen/fisiologia , Potenciais de Ação , Animais , Haplorrinos
20.
Brain Res ; 694(1-2): 111-27, 1995 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-8974634

RESUMO

We studied changes in basal ganglia neuronal activity associated with reaching movements of the arm in two monkeys. Data were obtained from 427 single neuronal units in putamen, 199 in caudate nucleus, and 216 in globus pallidus with multiwire electrodes allowing simultaneous recordings from multiple neurons. In all structures, changes in activity related to movement occurred most often after the onset of EMG: 43% of tested neurons in the putamen, 32% in the caudate nucleus, and 38% in the globus pallidus. Less frequently, changes began before EMG activation: 20% of neurons in the putamen, 19% in caudate nucleus, and 17% in globus pallidus. In general, these changes in neuronal activity lasted longer than EMG activity associated with reaching. The proportions of neurons activated were significantly larger in the putamen than the caudate nucleus. In the pallidum, the proportions were not statistically different from either the putamen or caudate nucleus, and no significant difference was found between the internal and external pallidal segments. Significant selectivity for movements to different targets was observed in 36% of neurons in the putamen, 28% in the caudate nucleus and 9% in the globus pallidus. The lower proportion in the globus pallidus compared to the striatum was significant (P < 0.002). Clusters of activated neurons were found in the striatum, however, the timing of changes was often different for individual neurons in these clusters. A cross-correlation analysis of the activity of neurons in the clusters revealed no evidence of common inputs, suggesting that striatal neurons in close proximity with neurons showing similar changes in activity are driven by different populations of neurons. In the putamen, the anatomical locations of neurons with changes in activity related to movement execution were on average significantly more posterior and lateral than neurons with changes related to the preparation of movement described earlier. These findings support the view that the putamen and the caudate nucleus contain distinct functional areas. The present studies show that most anatomical regions in both the striatum and pallidum participate in the control of executing reaching movements.


Assuntos
Braço/fisiologia , Corpo Estriado/fisiologia , Sinais (Psicologia) , Globo Pálido/fisiologia , Movimento/fisiologia , Neurônios/fisiologia , Animais , Corpo Estriado/citologia , Eletromiografia , Eletrofisiologia , Movimentos Oculares , Feminino , Lateralidade Funcional , Globo Pálido/citologia , Macaca fascicularis , Memória , Músculos/fisiologia
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