Aims: To obtain real-world data on ramucirumab use and effectiveness for the treatment of advanced gastric cancer (AGC) or gastroesophageal junction adenocarcinoma (GEJ). Methods: Observational, retrospective study carried out in 20 Spanish hospitals, in patients who started ramucirumab treatment between December 2015 and December 2018. Descriptive analysis was conducted for patient characteristics, treatment patterns and effectiveness outcomes. Results: Three hundred seventeen patients were included (93.7% treated with ramucirumab-paclitaxel and 6.3% with ramucirumab); age 62.5 (11.3) years; 66.9% male. Median progression-free survival and overall survival were 3.9 months (95% CI: 3.4-4.3) and 7.4 (95% CI: 6.4-8.9) in combination regimen and 2.0 (1.1-2.8) and 4.3 (95% CI: 1.9-7.3) in monotherapy, respectively. Conclusion: The study findings were consistent with available real-world studies and randomized clinical trials.
Adenocarcinoma/therapy , Antibodies, Monoclonal, Humanized/administration & dosage , Paclitaxel/administration & dosage , Stomach Neoplasms/therapy , Adenocarcinoma/diagnosis , Adenocarcinoma/mortality , Adenocarcinoma/pathology , Aged , Aged, 80 and over , Antibodies, Monoclonal, Humanized/adverse effects , Chemotherapy, Adjuvant/methods , Chemotherapy, Adjuvant/statistics & numerical data , Esophagogastric Junction/pathology , Esophagogastric Junction/surgery , Female , Gastrectomy , Humans , Kaplan-Meier Estimate , Male , Middle Aged , Neoadjuvant Therapy/methods , Neoadjuvant Therapy/statistics & numerical data , Paclitaxel/adverse effects , Progression-Free Survival , Retrospective Studies , Spain/epidemiology , Stomach Neoplasms/diagnosis , Stomach Neoplasms/mortality , Stomach Neoplasms/pathology , Ramucirumab
INTRODUCTION: Perioperative chemotherapy improves overall survival (OS) and disease-free survival (DFS) compared with surgery alone in patients with resectable gastric adenocarcinoma (GA) or gastro-oesophageal junction adenocarcinoma (GEJA). The addition of trastuzumab to chemotherapy improves outcomes in patients with HER2-positive advanced gastric cancer (GC), and we aimed to explore its role in the perioperative setting. MATERIAL AND METHODS: This Spanish, multicentre, open-label phase II trial evaluated the efficacy and toxicity of perioperative capecitabine, oxaliplatin and trastuzumab (XELOX-T) in patients with HER2-positive resectable GA or GEJA. The primary end-point was 18-months DFS; and secondary end-points included pathological complete response (pCR) rate, R0 resection rate, OS and toxicity (NCT01130337). RESULTS: Thirty-six patients were included. After three cycles of preoperative treatment, 14 patients (38% of the intention-to-treat population) had partial response and 18 (50%) had stable disease. Surgery was performed in 31 patients: 28 (90%) had R0 resection, three (9.6%) had a pCR and three (9.6%) died due to surgical complications. A total of 24 patients received post-operative XELOX-T, 22 of whom completed trastuzumab maintenance. Main grade III/IV toxicities included diarrhoea (33%), nausea and vomiting (8%). After a median follow-up of 24.1 months, 18-month DFS was 71% (95% confidence interval [CI], 53-83%); and an update after 102 months of follow-up showed a median OS of 79.9 months and a 60-month OS of 58% (95% CI, 40-73%). CONCLUSIONS: These data suggest that perioperative XELOX-T in patients with HER2-positive GA and GEJA is feasible and active. Further investigation in randomised studies is warranted.
Adenocarcinoma/therapy , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Capecitabine/therapeutic use , Esophageal Neoplasms/therapy , Esophagogastric Junction/drug effects , Esophagogastric Junction/surgery , Oxaliplatin/therapeutic use , Perioperative Care , Receptor, ErbB-2/antagonists & inhibitors , Stomach Neoplasms/therapy , Trastuzumab/therapeutic use , Adenocarcinoma/metabolism , Adenocarcinoma/mortality , Adenocarcinoma/pathology , Adult , Aged , Aged, 80 and over , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Capecitabine/adverse effects , Chemotherapy, Adjuvant , Disease-Free Survival , Esophageal Neoplasms/metabolism , Esophageal Neoplasms/mortality , Esophageal Neoplasms/pathology , Esophagogastric Junction/metabolism , Esophagogastric Junction/pathology , Female , Humans , Male , Middle Aged , Oxaliplatin/adverse effects , Perioperative Care/adverse effects , Perioperative Care/mortality , Receptor, ErbB-2/metabolism , Spain , Stomach Neoplasms/metabolism , Stomach Neoplasms/mortality , Stomach Neoplasms/pathology , Time Factors , Trastuzumab/adverse effects
Background: The prospective phase IV AVAMET study was undertaken to correlate response evaluation criteria in solid tumors (RECIST)-defined response rates with computed tomography-based morphological criteria (CTMC) and pathological response after liver resection of colorectal cancer metastases. Methods: Eligible patients were aged ≥18 years, with Eastern Cooperative Oncology Group (ECOG) performance status 0/1 and histologically-confirmed colon or rectal adenocarcinoma with measurable liver metastases. Preoperative treatment was bevacizumab (7.5 mg on day 1) + XELOX (oxaliplatin 130 mg/m2, capecitabine 1000 mg/m2 bid on days 1-14 q3w). After three cycles, response was evaluated by a multidisciplinary team. Patients who were progression-free and metastasectomy candidates received one cycle of XELOX before undergoing surgery 3-5 weeks later, followed by four cycles of bevacizumab + XELOX. Results: A total of 83 patients entered the study; 68 were eligible for RECIST, 67 for CTMC, and 51 for pathological response evaluation. Of these patients, 49% had a complete or partial RECIST response, 91% had an optimal or incomplete CTMC response, and 81% had a complete or major pathological response. CTMC response predicted 37 of 41 pathological responses versus 23 of 41 responses predicted using RECIST (p = 0.008). Kappa coefficients indicated a lack of correlation between the results of RECIST and morphological responses and between morphological and pathological response rates. Conclusion: CTMC may represent a better marker of pathological response to bevacizumab + XELOX than RECIST in patients with potentially-resectable CRC liver metastases.
OBJECTIVE: This study aimed to evaluate the effect of a nutritional intervention, based on the transtheoretical model, on the metabolic markers and dietary intake of individuals undergoing hemodialysis (HD). METHODS: Intervention study at a nephrology clinic includes 83 individuals undergoing HD, over a period of 4 months. The nutritional intervention based on the transtheoretical model was composed of two group meetings and three individual ones, with delivery of personalized food plans and nutritional education activities. Anthropometry, dietary intake, metabolic markers, and stage of behavior change were evaluated before and after nutritional intervention. RESULTS: There was a significant change from the stage of contemplation to the stage of action, after the intervention (P < .001). There was a significant reduction in serum concentrations of creatinine and predialysis and postdialysis urea (P < .001). Hyperphosphataemia and hyperkalemia in the group were also significantly reduced as were markers related to bone metabolism (P < .001). The markers of iron metabolism (P < .001), protein (P = .042), and globulin (P < .001) showed a significant increase. Regarding food consumption, the caloric intakes (P = .034), cholesterol (P = .034), protein, and lipid as well as intake of iron, phosphorus, potassium, copper, and vitamin C (P < .001) were significantly higher after intervention. CONCLUSIONS: The nutritional intervention based on the transtheoretical model promoted a change in the behavior of individuals undergoing HD, with an important improvement in their metabolic control. This can be explained by the significant change in the intake of calories, macronutrients, and micronutrients, as well as adequate use of phosphorus binders, indicating the crucial role of nutrition in this group.
Diet/methods , Kidney Failure, Chronic/metabolism , Nutrition Assessment , Nutrition Therapy/methods , Renal Dialysis , Transtheoretical Model , Biomarkers/metabolism , Female , Humans , Kidney Failure, Chronic/complications , Male , Metabolic Diseases/complications , Metabolic Diseases/metabolism , Middle Aged
Changes in diet of Laetacara araguaiae Ottoni and Costa, 2009 were evaluated in the Sucuriú River (Upper Paraná basin, Brazil) in an area with a small hydroelectric power plant, both before and after the formation of the reservoir, in order to answer: Did the construction of the reservoir affected the diet of this species? The results showed greater change of diet composition in the upstream section of the reservoir. It was observed that before the formation of the reservoir and the first year after, the individuals from upstream section formed a group characterized by an insectivorous diet. With the dam construction and habitat change we observed that aquatic plant material, sediment, and algae predominated in the diet. These results show the opportunistic feeding habit of L. araguaiae and contribute to the understanding of how the impoundment of rivers can influence the trophic dynamics of the ichthyofauna.
Animals , Cichlids/metabolism , Diet/veterinary , Water Reservoirs/analysis
Dysbiosis may favor the occurrence of inflammation and oxidative stress in chronic kidney disease (CKD). It has been suggested that the intake of pre/probiotics may control the progression of chronic kidney disease. Thus, the objective of this study was to systematically review the literature on the effects of pre/probiotic intake on the intestinal microbiota, control of nitrogen products, oxidative stress, and inflammation in CKD patients.The literature search was conducted on MEDLINE, LILACS, Cochrane Library of Clinical Trials, and Science Direct. After careful evaluation by the reviewers, ten potentially relevant articles were selected for this study. Based on previous studies, intake of prebiotics appears to have the following effects: increased bifidobacteria and lactobacillus counts; reduced formation of uremic toxin, p-cresol, and its serum concentrations; improved lipid profiles; reduced systemic inflammatory state and concentrations of oxidative stress markers. Similarly, consumption of probiotics can reduce blood urea and serum phosphate concentrations. Furthermore, an increase in fecal volume and intestinal Bifidobacteriumand a reduction in p-cresol serum and blood urea concentrations were observed in response to symbiotic intake. These results suggest that consumption of pre/probiotics may modulate the intestinal microbiota, and promote the growth and metabolism of anaerobic bacteria by decreasing the production of uremic solutes, further causing oxidative stress and systemic inflammation in CKD patients.
Gastrointestinal Microbiome , Inflammation/metabolism , Nitrogen/metabolism , Prebiotics , Probiotics/therapeutic use , Renal Insufficiency, Chronic/microbiology , Renal Insufficiency, Chronic/therapy , Dysbiosis , Humans , Oxidative Stress
Dysbiosis may favor the occurrence of inflammation and oxidative stress in chronic kidney disease (CKD). It has been suggested that the intake of pre/probiotics may control the progression of chronic kidney disease. Thus, the objective of this study was to systematically review the literature on the effects of pre/probiotic intake on the intestinal microbiota, control of nitrogen products, oxidative stress, and inflammation in CKD patients.The literature search was conducted on MEDLINE, LILACS, Cochrane Library of Clinical Trials, and Science Direct. After careful evaluation by the reviewers, ten potentially relevant articles were selected for this study. Based on previous studies, intake of prebiotics appears to have the following effects: increased bifidobacteria and lactobacillus counts; reduced formation of uremic toxin, p-cresol, and its serum concentrations; improved lipid profiles; reduced systemic inflammatory state and concentrations of oxidative stress markers. Similarly, consumption of probiotics can reduce blood urea and serum phosphate concentrations. Furthermore, an increase in fecal volume and intestinal Bifidobacteriumand a reduction in p-cresol serum and blood urea concentrations were observed in response to symbiotic intake. These results suggest that consumption of pre/probiotics may modulate the intestinal microbiota, and promote the growth and metabolism of anaerobic bacteria by decreasing the production of uremic solutes, further causing oxidative stress and systemic inflammation in CKD patients
La disbiosis puede favorecer la incidencia de inflamación y de estrés oxidativo en enfermedades renales crónicas. Se ha sugerido que el consumo de prebióticos y probióticos puede controlar la progresión de enfermedades renales crónicas. De este modo, el objetivo de este estudio es revisar sistemáticamente la literatura sobre los efectos del consumo de prebióticos y probióticos en la microbiota intestinal, el control de los productos de nitrógeno, el estrés oxidativo y la inflamación en enfermedades renales crónicas. La búsqueda bibliográfica fue realizada por medio de MEDLINE, LILACS, Cochrane Library of Clinical Trials y Science Direct. Diez artículos fueron incluidos en este estudio. Los prebióticos parecen aumentar las bifidobacterias y el recuento de lactobacillus, reducir la formación de toxina urémica, p-cresol y su concentración sérica; mejorar los perfiles lipídicos y reducir el estado de inflamación sistémica y la concentración de indicadores de estrés oxidativo. El consumo de probióticos puede reducir la urea en sangre y la concentración de fosfato sérico. Se verificó el aumento del volumen fecal y de las bifidobacterias intestinales y la reducción de la concentración sérica de p-cresol y de urea en sangre en respuesta a la ingesta de simbióticos. Estos resultados indican que los prebióticos y probióticos modulan la microbiota intestinal y promueven el crecimiento del metabolismo de bacterias anaerobias, disminuyendo la producción de solutos urémicos y la incidencia de estrés oxidativo e inflamación sistémica en pacientes portadores de enfermedades renales crónicas
Humans , Gastrointestinal Microbiome , Inflammation/metabolism , Nitrogen/metabolism , Prebiotics , Probiotics/therapeutic use , Renal Insufficiency, Chronic/microbiology , Renal Insufficiency, Chronic/therapy , Oxidative Stress , Dysbiosis
INTRODUCTION: Oxidative stress markers such as nitric oxide (NO) have been investigated in hemodialysis (HD). OBJECTIVE: Evaluate the association of NO variation with adiposity indicators, metabolic, inflammatory and oxidative stress markers in individuals to HD. METHODS: Cross-sectional study with 85 subjects on HD treatment (≥ 18 years). The clinical-nutritional status was evaluated through subjective global assessment modified (SGAm), anthropometric measurements and body composition. Dietary intake was evaluated using a food frequency questionnaire. Metabolic markers were obtained from medical records. Inflammatory markers (IL-6 and IL-10) and oxidative stress, (TACs), (SOD), (GST), (MDA) and NO were determined using standardized protocols. RESULTS: Those individuals with a high concentration of NO (> 4.32 µmol/L) had lower values for SGAm score (p = 0.012) and higher iron values (p = 0.050), Fe saturation (p = 0.037) and triacylglycerol (p = 0.003). The same subjects still had lower consumption of copper (p = 0.026), manganese (p = 0.035), vitamin E (p = 0.050), ω3 (p = 0.021) and ω6 (p = 0.020). In a multiple regression model, concentrations of ferritin, triacylglycerol, IL6 and SOD contributed to a 54.8% increase in NO concentrations, whereas triacylglycerol and SOD concentrations were independent factors for NO variation (p < 0.001). CONCLUSIONS: The clinical and nutritional status as well as intake of nutrients with antioxidant properties (Cu, Zn, Mn, vitamin C and ω3) appears to modulate the variation of NO in this population.
Inflammation/etiology , Nitric Oxide/metabolism , Oxidative Stress , Renal Dialysis , Renal Insufficiency, Chronic/metabolism , Renal Insufficiency, Chronic/therapy , Adiposity , Adult , Aged , Aged, 80 and over , Biomarkers , Cross-Sectional Studies , Eating , Female , Humans , Inflammation/therapy , Inflammation Mediators/metabolism , Male , Middle Aged , Young Adult
Introduction: Oxidative stress markers such as nitric oxide (NO) have been investigated in hemodialysis (HD). Objective: Evaluate the association of NO variation with adiposity indicators, metabolic, inflammatory and oxidative stress markers in individuals to HD. Methods: Cross-sectional study with 85 subjects on HD treatment (≥ 18 years). The clinical-nutritional status was evaluated through subjective global assessment modified (SGAm), anthropometric measurements and body composition. Dietary intake was evaluated using a food frequency questionnaire. Metabolic markers were obtained from medical records. Inflammatory markers (IL-6 and IL-10) and oxidative stress, (TACs), (SOD), (GST), (MDA) and NO were determined using standardized protocols. Results: Those individuals with a high concentration of NO (> 4.32 μmol/L) had lower values for SGAm score (p = 0.012) and higher iron values (p = 0.050), Fe saturation (p = 0.037) and triacylglycerol (p = 0.003). The same subjects still had lower consumption of copper (p = 0.026), manganese (p = 0.035), vitamin E (p = 0.050), ω3 (p = 0.021) and ω6 (p = 0.020). In a multiple regression model, concentrations of ferritin, triacylglycerol, IL6 and SOD contributed to a 54.8% increase in NO concentrations, whereas triacylglycerol and SOD concentrations were independent factors for NO variation (p < 0.001). Conclusions: The clinical and nutritional status as well as intake of nutrients with antioxidant properties (Cu, Zn, Mn, vitamin C and ω3) appears to modulate the variation of NO in this population (AU)
Introducción: se han investigado marcadores de estrés oxidativo como el óxido nítrico (NO) en hemodiálisis (HD). Objetivo: evaluar la asociación de la variación del NO con los indicadores de adiposidad, los marcadores metabólicos, inflamatorios y de estrés oxidativo en individuos a HD. Métodos: estudio transversal con 85 sujetos en tratamiento HD (≥ 18 años). El estado clínico-nutricional se evaluó a través de la evaluación global subjetiva modificada (SGAm), medidas antropometricas y composición corporal. La ingesta dietética se evaluó mediante un cuestionario de frecuencia alimentaria. Marcadores metabólicos se obtuvieron de los registros médicos. Se determinaron marcadores inflamatorios (IL-6 e IL-10) y estrés oxidativo (TAC), (SOD), (GST), (MDA) y NO mediante protocolos estandarizados. Resultados: los individuos con una alta concentración de NO (> 4,32 μmol/L) tuvieron valores más bajos de puntuación de SGAm (p = 0,012) y mayores valores de hierro (p = 0,050), saturación de Fe (p = 0,037) y triacilglicerol (p = 0,003). Los mismos sujetos tuvieron un menor consumo de cobre (p = 0.026), manganeso (p = 0,035), vitamina E (p = 0,050), ω3 (p = 0,021) y ω6 (p = 0,020). En un modelo de regresión múltiple, las concentraciones de ferritina, triacilglicerol, IL6 y SOD contribuyeron a un aumento de 54,8% en las concentraciones de NO, mientras que las concentraciones de triacilglicerol y SOD fueron factores independientes para la variación del NO (p < 0,001). Conclusiones: el estado clínico y nutricional así como la ingesta de nutrientes con propiedades antioxidantes (Cu, Zn, Mn, vitamina C y ω3) parecen modular la variación del NO en esta población (AU)
Humans , Renal Dialysis/adverse effects , Renal Insufficiency, Chronic/complications , Nitric Oxide/analysis , Biomarkers/analysis , Oxidative Stress/physiology , Stress, Physiological/physiology , Inflammation Mediators/analysis , Inflammation/physiopathology , Cross-Sectional Studies , Malondialdehyde/analysis , Nutrition Assessment , Nutritional Status
ABSTRACT Objective: To investigate the nutritional status variation and symptomatology of patients with celiac disease and non-celiac gluten sensitivity after specialized dietary advice Methods: This prospective study included 80 patients with celiac disease and non-celiac gluten sensitivity. Clinical, metabolic, and nutritional variables were collected from medical records, and the symptomatology was investigated by the Metabolic Screening Questionnaire. The variables were assessed on two occasions (T1 - before dietary advice and T2 - after dietary advice) with an interval of three months between T1 and T2 Results: The median age was 42 years. The prevalences of celiac disease and non-celiac gluten sensitivity were 66.2% and 33.8%, respectively. Normal weight prevailed at T1 (58.8%) and T2 (56.3%), but 30.0% of the patients at T1 and 34.9% of the patients at T2 had excess weight. The two conditions had similar symptomatology. The most frequent signs and symptoms on both occasions involved the gastrointestinal tract, followed by energy/activity and emotions. All symptoms decreased significantly after the introduction of a proper diet Conclusion: The patients were normal weight on both study occasions (T1 and T2), and the symptoms improved after dietary advice. Thus, we reinforce the importance of proper dietary management in both clinical conditions to make dietary adjustments that improve these individuals' symptomatology.
RESUMO Objetivo: Investigar a evolução do estado nutricional e a sintomatologia de pacientes com doença celíaca e sensibilidade ao glúten não celíaca após orientação dietética especializada Métodos: O estudo prospectivo foi realizado com 80 pacientes portadores da doença celíaca e de sensibilidade ao glúten não celíaca. A coleta das variáveis clínicas, metabólicas e nutricionais foi feita por análise dos prontuários, enquanto a sintomatologia foi investigada por meio de Questionário de Rastreamento Metabólico. As variáveis foram avaliadas em dois momentos (T1 - antes da orientação dietética e T2 - após orientação dietética), com intervalo de 3 meses entre T1 e T2 Resultados: A mediana de idade foi de 42 anos. A prevalência de doença celíaca e de sensibilidade ao glúten não celíaca foi de 66,2% e 33,8%, respectivamente. A eutrofia prevaleceu como estado nutricional de T1 (58,8%) e T2 (56,3%), porém 30,0% dos pacientes em T1 e 34,9% em T2 apresentaram excesso de peso. A sintomatologia foi similar entre as duas enfermidades. Os sinais e sintomas mais frequentes nos dois tempos foram os do trato digestório, seguido pelos relacionados à energia/atividade e às emoções. Todos os sintomas diminuíram significativamente após a introdução da dieta Conclusão: Os pacientes apresentaram estado nutricional de eutrofia nos dois momentos avaliados (T1 e T2) e houve redução dos sintomas após as orientações nutricionais. Dessa forma, reitera-se a importância do manejo dietético adequado para ambas as enfermidades clínicas a fim de adequar a dieta que favoreça a melhora da sintomatologia apresentada por esses indivíduos.
Humans , Male , Female , Celiac Disease , Signs and Symptoms , Food and Nutrition Education , Nutritional Status , Wheat Hypersensitivity , Diet, Gluten-Free
OBJECTIVE: The aim of this preclinical study was to compare histologically and histomorphometrically both sandblasted/acid-etched implant surfaces with or without maintained in an isotonic solution of 0.9% sodium chloride in early stages of osseointegration. MATERIAL AND METHODS: Both implant surfaces were composed of a titanium/aluminum/vanadium alloy (Ti6Al4V-ELI), but they had different surface chemistries: sandblasted/acid-etched titanium surface (FN) or sandblasted/acid-etched surface maintained in an isotonic solution of 0.9% sodium chloride (FA). The surface morphology, topography and chemistry were evaluated by scanning electron microscopy (SEM), confocal microscopy (CM) and X-ray photoelectron spectroscopy (XPS), respectively. Dynamic contact angle (DCA) was employed for wettability evaluation. One implant from each group was placed in the left tibia of twenty healthy, skeletally mature Santa Ines sheep (n = 5). Bone area (BA) and bone-to-implant contact (BIC) were performed on thin sections (30 µm) at 7, 14, 21 and 28 days after implant installation. RESULTS: Despite the roughness and morphology similarities between the groups, at the XPS evaluation, the FA group presented 2.3 times less carbon on the surface (FN: 27.3% and FA: 11.6%), sharply enhanced hydrophilicity and significantly enhanced BA and BIC at 14, 21 and 28 days of healing (P < 0.05) compared with the FN. CONCLUSION: The data suggest that the hydrophilic FA accelerates the BA apposition and BIC interface around the implants during early stages of bone formation, providing highest degree of osseointegration.
Bone-Implant Interface/pathology , Osseointegration , Tibia/surgery , Titanium , Alloys , Animals , Dental Implantation, Endosseous/methods , Dental Implants , Hydrophobic and Hydrophilic Interactions , Microscopy, Confocal , Microscopy, Electron, Scanning , Sheep , Surface Properties , Tibia/pathology
This clinical report describes how to achieve predictable outcomes for anterior teeth esthetic restorations with porcelain laminate veneers by associating the digital planning and design of the restoration with interim restorations. The previous digital smile design of the restoration eliminates the communication barrier with the patient and assists the clinician throughout patient treatment. Interim restorations (diagnostic mock-ups) further enhance communication with the patient and prevent unnecessary tooth reduction for conservative tooth preparation. Adequate communication between patient and clinician contributes to successful definitive restorations and patient satisfaction with the final esthetic outcome.
Dental Porcelain , Dental Veneers , Tooth Preparation , Dental Prosthesis Design , Esthetics, Dental , Humans
Novas escalas de cor e aparelhos eletrônicos foram desenvolvidos no intuito de melhorar e aperfeiçoar a seleção de cor. Este estudo avaliou a concordância observada durante a seleção de cor pelo método visual, utilizando as escalas de cor VITA classical A1-D4 e Linearguide 3D-Master, com a concordância apresentada pelo método digital por meio de um espectrofotômetro (VITA Easyshade Advance). O método aplicado foi o pareamento de uma amostra de cor com outra amostra do mesmo sistema de cor. Cinco amostras de cor da escala VITA classical A1-D4 e cinco amostras de cor da escala 3D-Master foram utilizadas como cores alvos para serem coincididas. Três amostras destas cores selecionadas foram posicionadas no lugar do elemento 12, 11 e 21 em dez manequins odontológicos. O critério de exclusão dos avaliadores foi a deficiência na visão cromática, avaliada através do teste de Ishihara. Os avaliadores realizaram a seleção de cor do elemento 11 em dez manequins pelo método visual. Na sequência, os mesmos avaliadores repetiram a seleção de cor por meio de um espectrofotômetro. A concordância observada utilizando a escala VITA classical foi de 66,31%, com a escala Linearguide foi de 46,84%. O espectrofotômetro obteve uma concordância observada de 90,44%. Concluiu-se que a seleção de cor por meio da espectrofotometria apresenta uma concordância maior que a seleção de cor pelo método visual (AU)
New shade guides and electronic devices were developed in order to improve shade selection. The present study has evaluated the accordance observed during shade selection carried out through visual method (using shade guides VITA classical A1-D4 e Linearguide 3D-Master) and that observed in instrumental shade selection using a spectrophotometer (VITA Easyshade Advance). Five shade tabs from the VITA classical A1-D4 system and five shade tabs from 3D-Master system were considered the golden standard. Three identical shade tabs of the selected colors were inserted into the place of teeth 12, 11 and 21 of ten articulated models and fixed in ten phantom heads. Color vision deficiency was the only exclusion criteria and evaluated using the Ishihara color vision test. The evaluators performed shade selection of element 11 in ten phantom heads through the visual method. Than the instrumental shade identification of the same teeth was performed using a spectrophotometer. Results showed that 66.31% of perfect matches for VITA classical A1-D4 and 46.84% for the Linearguide 3DMaster. The spectrophotometer obtained 90.44% of exact identifications. It was concluded that instrumental shade determination is more accurate in comparison to visual shade determination, independent of the color system used (AU)
Humans , Male , Female , Adult , Middle Aged , Color , Esthetics, Dental , Photography, Dental/methods , Spectrophotometry/methods , Brazil
BACKGROUND: Studies suggest a relationship between hypertension and outcome in bevacizumab-treated patients with metastatic colorectal cancer (mCRC). We performed a retrospective analysis of two phase II studies (BECA and BECOX) to determine if hypertension and proteinuria predict outcome in elderly patients with mCRC treated with bevacizumab. PATIENTS AND METHODS: Patients ≥ 70 years of age received either capecitabine 1250 mg/m(2) bid days 1-14 + bevacizumab 7.5 mg/kg day 1 every 21 days (BECA study) or capecitabine 1000 mg/m(2) bid days 1-14 with bevacizumab 7.5 mg/kg and oxaliplatin 130 mg/m(2) day 1 (BECOX study). The primary objective was to correlate hypertension and proteinuria with overall response rate (ORR), time to progression (TTP) and overall survival (OS). Secondary objectives included identification of risk factors associated with the development of hypertension and proteinuria and determining whether development of hypertension or proteinuria in the first 2 cycles was related to ORR, disease-control rate (DCR), TTP or OS. RESULTS: In total, 127 patients (median age 75.5 years) were included in the study. Hypertension correlated with DCR and OS; proteinuria correlated with ORR and DCR. Proteinuria or hypertension in the first 2 cycles did not correlate with efficacy. Risk factors for hypertension were female gender (odds ratio [OR] 0.241; P = 0.011) and more bevacizumab cycles (OR 1.112; P = 0.002); risk factors for proteinuria were diabetes (OR 3.869; P = 0.006) and more bevacizumab cycles (OR 1.181; P<0.0001). Multivariate analysis identified as having prognostic value: baseline lactate dehydrogenase, haemoglobin, number of metastatic lesions and DCR. CONCLUSION: This analysis of two phase II studies suggests that hypertension is significantly correlated with OS but not with ORR and TTP, whereas proteinuria is correlated with ORR but not with OS and TTP. Both hypertension and proteinuria are associated with the duration of bevacizumab treatment and do not represent an independent prognostic factor.
Antibodies, Monoclonal, Humanized/therapeutic use , Colorectal Neoplasms/complications , Colorectal Neoplasms/drug therapy , Hypertension/complications , Proteinuria/complications , Aged , Aged, 80 and over , Antineoplastic Combined Chemotherapy Protocols , Bevacizumab , Capecitabine , Clinical Trials, Phase II as Topic , Deoxycytidine/analogs & derivatives , Deoxycytidine/therapeutic use , Disease-Free Survival , Female , Fluorouracil/analogs & derivatives , Fluorouracil/therapeutic use , Humans , Male , Multivariate Analysis , Organoplatinum Compounds/therapeutic use , Oxaliplatin , Retrospective Studies , Treatment Outcome
Double tooth and talon cusp are tooth shape anomalies with rare co-occurrences in a single tooth. Double tooth is a developmental anomaly that leads to the eruption of fused teeth and may contribute to compromised esthetics, pain, caries, and tooth crowding. Talon cusp is a rare developmental extra cusp-like projection on the cingulum area that may cause functional and esthetic problems. Differential diagnosis of these anomalies may be complicated. A multidisciplinary approach for the esthetic and functional rehabilitation of double teeth is important. Various treatment methods have been described in the literature for the different types and morphological variations of double teeth. The purpose of this paper is to report the case of an unusual combination of double tooth and talon cusp on a permanent maxillary incisor and describe its esthetic and functional rehabilitation using a porcelain laminate veneer.
Dental Veneers , Esthetics, Dental , Fused Teeth/therapy , Incisor/abnormalities , Child , Dentition, Permanent , Diagnosis, Differential , Humans
Colorectal cancer (CRC) is the fourth most commonly diagnosed cancer worldwide. Recently, it has been found that about 40 % of patients with CRC have mutations in the K-RAS gene. Several clinical trials have showed that patients with metastatic colorectal cancer (mCRC) who present tumour-promoting mutations in signalling pathways involving the epidermal growth factor receptor (EGFR), which includes activating K-RAS mutations, do not respond to anti-EGFR drugs such as panitumumab and cetuximab. Hence, K-RAS status is now considered an important negative predictive factor for response to anti-EGFR drugs. Moreover, K-RAS status seems to have also a prognostic role in CRC, but this fact is somewhat controversial. Activity of antiangiogenic agents seems not to be influenced by K-RAS gene status. Tumour angiogenesis has attracted interest in attempts to improve the management of mCRC. The vascular endothelial growth factor (VEGF) pathway is fundamental to the regulation of angiogenesis, and research has focused on developing agents that selectively target it. In this way, the anti-VEGF antibody bevacizumab in combination with chemotherapy has provided important clinical benefits in terms of response rate, progression-free survival and overall survival to patients with mCRC. Efficacy data of bevacizumab in K-RAS wild-type patients seem to be comparable with the efficacy data observed with anti-EGFR therapies in a cross-trial comparison. Although there is a lack of prospective and randomized data in this setting, the combination of chemotherapy plus antiangiogenic agents could be considered as an effective alternative for the treatment of mCRC with independence of K-RAS gene status. Here, we review the available data we have in the literature of the use of antiangiogenic strategies in the treatment of mCRC nowadays.
Angiogenesis Inhibitors/therapeutic use , Colorectal Neoplasms/drug therapy , Colorectal Neoplasms/genetics , Genes, ras , Antibodies, Monoclonal, Humanized/therapeutic use , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Axitinib , Bevacizumab , Camptothecin/administration & dosage , Camptothecin/analogs & derivatives , Capecitabine , Deoxycytidine/administration & dosage , Deoxycytidine/analogs & derivatives , ErbB Receptors/metabolism , Fluorouracil/administration & dosage , Fluorouracil/analogs & derivatives , Humans , Imidazoles/administration & dosage , Indazoles/administration & dosage , Indoles/administration & dosage , Irinotecan , Niacinamide/administration & dosage , Niacinamide/analogs & derivatives , Oligonucleotides , Organoplatinum Compounds/administration & dosage , Oxaliplatin , Pharmacogenetics , Phenylurea Compounds/administration & dosage , Prognosis , Protein-Tyrosine Kinases/antagonists & inhibitors , Pyridines/administration & dosage , Pyrroles/administration & dosage , Quinazolines/administration & dosage , Receptors, Vascular Endothelial Growth Factor/therapeutic use , Recombinant Fusion Proteins/therapeutic use , Signal Transduction , Sorafenib , Sunitinib , Vascular Endothelial Growth Factor A/metabolism
AIM: To evaluate gemcitabine plus capecitabine as third-line or later-line therapy in patients with refractory advanced colorectal cancer (CRC) who maintain a good performance status (PS). PATIENTS AND METHODS: We retrospectively evaluated patients who had failed at least two lines of therapy or had contraindication to standard therapy and received gemcitabine (1,000 mg/m(2), d1 biweekly) plus capecitabine (1,700 mg/m(2)/day, d1-7 every two weeks) in a compassionate use program. RESULTS: Thirty-nine patients were enrolled. The majority (85%) had ECOG PS 1. Gemcitabine plus capecitabine was administered as third- and fourth-line in 49% and 23% of patients, respectively; and as fifth-line or later-line in 28%. A clinical benefit of 21% was found. The median progression-free survival and overall survival were 3.0 and 7.3 months, respectively. Toxicity was mild to moderate, with no reported grade 4 toxicities. CONCLUSION: Gemcitabine plus capecitabine was safe and well-tolerated. While the efficacy of this regimen was modest in terms of response, the survival data were acceptable and consistent with previous publications on this setting.
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Colorectal Neoplasms/drug therapy , Adult , Aged , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Capecitabine , Deoxycytidine/administration & dosage , Deoxycytidine/analogs & derivatives , Disease-Free Survival , Female , Fluorouracil/administration & dosage , Fluorouracil/analogs & derivatives , Humans , Male , Middle Aged , Retrospective Studies , Gemcitabine
OBJECTIVE: The aim of the project was to assess the effectiveness and safety of weekly epoetin-beta (EB) in patients with gastrointestinal cancer (GIC) subjected to concomitant chemoradiotherapy (CCTRT). METHODS: In this clinical prospective and multicentre cohort study EB was administered at a dose of 30,000 IU/ week, during CCTRT and in the four weeks thereafter, and suspended if haemoglobin (Hb) increased >2 g/dl or Hb >12-13 g/dl. Effectiveness was defi ned as Hb increase ≥1 g/dl vs. baseline. Time to response, treatment toxicity and transfusion requirements were also assessed. RESULTS: EB was effective in 75.8% of the evaluable population within a median of four weeks from EB initiation, without blood transfusions. Over 80% of all patients remained below the threshold (Hb ≤13 g/dl) and no study drug-related adverse reactions were recorded. CONCLUSION: Weekly EB proved to be effective and well tolerated by patients with GIC subjected to CCTRT.
Anemia/etiology , Antineoplastic Agents/administration & dosage , Erythropoietin/administration & dosage , Gastrointestinal Neoplasms/therapy , Adult , Aged , Aged, 80 and over , Anemia/metabolism , Antineoplastic Agents/therapeutic use , Chemoradiotherapy , Cohort Studies , Drug Administration Schedule , Erythropoietin/therapeutic use , Female , Gastrointestinal Neoplasms/complications , Hemoglobins , Humans , Male , Middle Aged , Prospective Studies , Recombinant Proteins/administration & dosage , Recombinant Proteins/therapeutic use , Treatment Outcome
PURPOSE: Anemia is common during anticancer treatment. This study aimed to evaluate the response and safety of treatment with epoetin-beta (EB) in patients with neoadjuvant therapy prior to primary digestive tract tumor surgery. PATIENTS AND METHODS: In this open-label, single-arm study, patients (n = 22) with hemoglobin (Hb) levels below 11 g/dl who received epoetin-beta 450 IU/kg (30,000 IU) weekly until the hemoglobin level reached 12 g/dl. RESULTS: After treatment with EB, a mean absolute increment of 2.6 g/dl was attained. The mean hemoglobin values during the study were pretreatment 10.1 g/dl, half-way through treatment 12.3 g/dl, 4 weeks after concomitant radiochemotherapy 12.7 g/dl, the week prior to surgery 12.5 g/dl, and after surgery 10.9 g/dl. No patient required transfusion before or after surgery. The probability or risk of postoperative complications was 27.3%, and included one rectovaginal fistula, one parastomal hernia, one case of ileus and two surgical wound infections. In this series, downstaging was observed in 81.8% of patients, and downsizing in 90.9%. Most interestingly, histopathological complete response rate was achieved by 18.2%. CONCLUSIONS: Epoetin-beta (EB) treatment in our series of patients with digestive malignancies subjected to neoadjuvant radiochemotherapy proved effective and safe, avoiding the need for transfusion during surgery.
Anemia/drug therapy , Erythropoietin/therapeutic use , Gastrointestinal Neoplasms/therapy , Hematinics/therapeutic use , Neoadjuvant Therapy/methods , Aged , Anemia/etiology , Cohort Studies , Combined Modality Therapy , Erythropoietin/adverse effects , Female , Gastrointestinal Neoplasms/pathology , Hematinics/adverse effects , Hemoglobins/metabolism , Humans , Male , Middle Aged , Postoperative Complications/etiology , Prospective Studies , Recombinant Proteins , Treatment Outcome
OBJETIVO: Analisar o consumo de frutas, verduras e legumes em mulheres, segundo fatores sócio-demográficos, econômicos e comportamentais. MÉTODOS: A amostra foi constituída de 311 mulheres de três áreas de estudo, do município de Cotia, na área metropolitana de São Paulo, selecionadas por amostragem por conglomerado em dois estágios. O consumo de frutas, verduras e legumes foi avaliado por questionário de freqüência alimentar. Os diferenciais de consumo foram estudados por análise multivariada de regressão logística. RESULTADOS: A chance de baixo consumo de frutas foi maior nas mulheres do bairro pobre, com baixa escolaridade, donas de casa e desempregadas, com baixa renda familiar e tabagistas. Os diferenciais de consumo de verduras foram associados mais à cultura alimentar do que à pobreza: as mais jovens apresentaram chances sensivelmente maiores de baixo consumo de verduras. O tabagismo e o sedentarismo associaram-se ao baixo consumo. Os legumes foram associados tanto ao nível socioeconômico, quanto à cultura alimentar. Foram pouco consumidos pelas mulheres mais jovens e, de um modo geral, por aquelas de pouca escolaridade e baixa renda familiar. Também, o etilismo e o sedentarismo aumentaram as chances de baixo consumo desses alimentos. CONCLUSÃO: O consumo de frutas, verduras e legumes apresentou diferenciais relacionados ao nível socioeconômico, à cultura alimentar e aos hábitos comportamentais.
OBJECTIVE: The objective was to analyze the consumption of fruits and vegetables by women, according to sociodemographic, economic and behavioral factors. METHODS: The sample consisted of 311 women living in three different areas of the city of Cotia, located in the metropolitan area of São Paulo city, selected by two-stage cluster sampling. Their consumption of fruits and vegetables was assessed by means of a food frequency questionnaire. Consumption differences were analyzed by multivariate logistic regression analysis. RESULTS: Unemployed women or housewives with low education level, low income and smokers living in the poor area were more likely to underconsume fruits. Consumption of leaves was more associated with eating habits than with poverty: younger women were slightly more likely to underconsume leaves. Smoking and inactivity were associated with underconsumption. Consumption of other vegetables was associated with socioeconomic levels and eating habits. Vegetables were underconsumed by younger women and by those with low education level and family income. Consumption of alcoholic beverages and inactivity also increased the likelihood of underconsuming these foods. CONCLUSION: Consumption of fruits and vegetables varied according to socioeconomic level and eating and behavior habits.
Humans , Female , Adult , Middle Aged , Eating , Socioeconomic Factors , Fruit , Vegetables , Diet Surveys
