Exploring Inflammatory Asthma Phenotypes: Proteomic Signatures in Serum and Induced Sputum.

Asthma drug responses may differ due to inflammatory mechanisms triggered by the immune cells in the pulmonary microenvironment. Thus, asthma phenotyping based on the local inflammatory profile may aid in treatment definition and the identification of new therapeutic targets. Here, we investigated protein profiles of induced sputum and serum from asthma patients classified into eosinophilic, neutrophilic, mixed granulocytic, and paucigranulocytic asthma, according to inflammatory phenotypes. Proteomic analyses were performed using an ultra-performance liquid chromatography (ultra-HPLC) system coupled to the Q Exactive Hybrid Quadrupole Orbitrap Mass Spectrometer. Fifty-two (52) proteins showed significant differences in induced sputum among the groups, while only 12 were altered in patients' sera. Five proteins in the induced sputum were able to discriminate all phenotypic groups, while four proteins in the serum could differentiate all except the neutrophilic from the paucigranulocytic inflammatory pattern. This is the first report on comparative proteomics of inflammatory asthma phenotypes in both sputum and serum samples. We have identified a potential five-biomarker panel that may be able to discriminate all four inflammatory phenotypes in sputum. These findings not only provide insights into potential therapeutic targets but also emphasize the potential for personalized treatment approaches in asthma management.

Lung cancer screening in Brazil: recommendations from the Brazilian Society of Thoracic Surgery, Brazilian Thoracic Association, and Brazilian College of Radiology and Diagnostic Imaging.

Although lung cancer (LC) is one of the most common and lethal tumors, only 15% of patients are diagnosed at an early stage. Smoking is still responsible for more than 85% of cases. Lung cancer screening (LCS) with low-dose CT (LDCT) reduces LC-related mortality by 20%, and that reduction reaches 38% when LCS by LDCT is combined with smoking cessation. In the last decade, a number of countries have adopted population-based LCS as a public health recommendation. Albeit still incipient, discussion on this topic in Brazil is becoming increasingly broad and necessary. With the aim of increasing knowledge and stimulating debate on LCS, the Brazilian Society of Thoracic Surgery, the Brazilian Thoracic Association, and the Brazilian College of Radiology and Diagnostic Imaging convened a panel of experts to prepare recommendations for LCS in Brazil. The recommendations presented here were based on a narrative review of the literature, with an emphasis on large population-based studies, systematic reviews, and the recommendations of international guidelines, and were developed after extensive discussion by the panel of experts. The following topics were reviewed: reasons for screening; general considerations about smoking; epidemiology of LC; eligibility criteria; incidental findings; granulomatous lesions; probabilistic models; minimum requirements for LDCT; volumetric acquisition; risks of screening; minimum structure and role of the multidisciplinary team; practice according to the Lung CT Screening Reporting and Data System; costs versus benefits of screening; and future perspectives for LCS.

Lung cancer screening in Brazil: recommendations from the Brazilian Society of Thoracic Surgery, Brazilian Thoracic Association, and Brazilian College of Radiology and Diagnostic Imaging / Recomendações da Sociedade Brasileira de Cirurgia Torácica, Sociedade Brasileira de Pneumologia e Tisiologia e Colégio Brasileiro de Radiologia e Diagnóstico por Imagem para o rastreamento do câncer de pulmão no Brasil

ABSTRACT Although lung cancer (LC) is one of the most common and lethal tumors, only 15% of patients are diagnosed at an early stage. Smoking is still responsible for more than 85% of cases. Lung cancer screening (LCS) with low-dose CT (LDCT) reduces LC-related mortality by 20%, and that reduction reaches 38% when LCS by LDCT is combined with smoking cessation. In the last decade, a number of countries have adopted population-based LCS as a public health recommendation. Albeit still incipient, discussion on this topic in Brazil is becoming increasingly broad and necessary. With the aim of increasing knowledge and stimulating debate on LCS, the Brazilian Society of Thoracic Surgery, the Brazilian Thoracic Association, and the Brazilian College of Radiology and Diagnostic Imaging convened a panel of experts to prepare recommendations for LCS in Brazil. The recommendations presented here were based on a narrative review of the literature, with an emphasis on large population-based studies, systematic reviews, and the recommendations of international guidelines, and were developed after extensive discussion by the panel of experts. The following topics were reviewed: reasons for screening; general considerations about smoking; epidemiology of LC; eligibility criteria; incidental findings; granulomatous lesions; probabilistic models; minimum requirements for LDCT; volumetric acquisition; risks of screening; minimum structure and role of the multidisciplinary team; practice according to the Lung CT Screening Reporting and Data System; costs versus benefits of screening; and future perspectives for LCS.

RESUMO O câncer de pulmão (CP) é uma das neoplasias mais comuns e letais no Brasil, e apenas 15% dos pacientes são diagnosticados nos estágios iniciais. O tabagismo persiste como o responsável por mais de 85% de todos os casos. O rastreamento do CP (RCP) por meio da TC de baixa dosagem de radiação (TCBD) reduz a mortalidade do CP em 20%, e, quando combinado com a cessação do tabagismo, essa redução chega a 38%. Na última década, diversos países adotaram o RCP como recomendação de saúde populacional. No Brasil, embora ainda incipiente, a discussão sobre o tema é cada vez mais ampla e necessária. Com o intuito de aumentar o conhecimento e estimular o debate sobre o RCP, a Sociedade Brasileira de Cirurgia Torácica, a Sociedade Brasileira de Pneumologia e Tisiologia e o Colégio Brasileiro de Radiologia e Diagnóstico por Imagem constituíram um painel de especialistas para elaborar as recomendações para o RCP. As recomendações aqui apresentadas foram baseadas em revisão narrativa da literatura, com ênfase em grandes estudos populacionais, em revisões sistemáticas e em recomendações de diretrizes internacionais, sendo construídas após ampla discussão pelo grupo de especialistas. Os temas revisados foram os seguintes: porque rastrear, considerações gerais sobre tabagismo, epidemiologia do CP, critérios de elegibilidade, achados incidentais, lesões granulomatosas, modelos probabilísticos, requisitos mínimos da TCBD, aquisições volumétricas, riscos do rastreamento, estrutura mínima e papel da equipe multidisciplinar, conduta segundo o Lung CT Screening Reporting and Data System (Lung-RADS), custos vs. benefícios e perspectivas do rastreamento.

Role that anorexia and weight loss play in patients with stage IV lung cancer.

OBJECTIVE: To evaluate the prevalence of anorexia and weight loss at diagnosis (pre-treatment), to identify the factors associated with pre-treatment weight loss, and to determine the prognostic role of anorexia and weight loss in the overall survival of patients with stage IV lung cancer. METHODS: This was a retrospective observational cohort study. The patients were stratified by the presence/absence of anorexia and of pre-treatment weight loss, which generated a measure composed of four categories, which were the independent variables. RESULTS: Among the 552 patients included in the study, anorexia and pre-treatment weight loss were present in 39.1% and 70.1%, respectively. After adjusting for age, male gender, and Karnofsky performance status, we found that anorexia and tumor size were significantly associated with pre-treatment weight loss. In a Cox multivariate analysis, adjusted for age, male gender and low Karnofsky performance status were found to be independent predictors of worse survival, as was concomitance of anorexia and weight loss. CONCLUSIONS: Anorexia and pre-treatment weight loss appear to be relevant problems in the follow-up of patients with advanced (stage IV) lung cancer Specific interventions are of crucial importance in individualized treatment plans, even within the context of palliative care.

Role that anorexia and weight loss play in patients with stage IV lung cancer / Papel do binômio anorexia e perda de peso em pacientes com câncer de pulmão em estádio IV

ABSTRACT Objective: To evaluate the prevalence of anorexia and weight loss at diagnosis (pre-treatment), to identify the factors associated with pre-treatment weight loss, and to determine the prognostic role of anorexia and weight loss in the overall survival of patients with stage IV lung cancer. Methods: This was a retrospective observational cohort study. The patients were stratified by the presence/absence of anorexia and of pre-treatment weight loss, which generated a measure composed of four categories, which were the independent variables. Results: Among the 552 patients included in the study, anorexia and pre-treatment weight loss were present in 39.1% and 70.1%, respectively. After adjusting for age, male gender, and Karnofsky performance status, we found that anorexia and tumor size were significantly associated with pre-treatment weight loss. In a Cox multivariate analysis, adjusted for age, male gender and low Karnofsky performance status were found to be independent predictors of worse survival, as was concomitance of anorexia and weight loss. Conclusions: Anorexia and pre-treatment weight loss appear to be relevant problems in the follow-up of patients with advanced (stage IV) lung cancer Specific interventions are of crucial importance in individualized treatment plans, even within the context of palliative care.

RESUMO Objetivo: Avaliar a prevalência de anorexia e perda de peso ao diagnóstico (pré-tratamento), os fatores associados à perda de peso pré-tratamento e o papel prognóstico da anorexia e da perda de peso na sobrevida global de pacientes com câncer de pulmão em estádio IV. Métodos: Estudo de coorte retrospectivo observacional. Os pacientes foram estratificados, dependendo da presença/ausência de anorexia e da presença/ausência de perda de peso pré-tratamento, o que gerou uma medida composta de anorexia e perda de peso de quatro níveis, que foi a variável independente. Resultados: Entre os 552 pacientes incluídos no estudo, as prevalências de anorexia e de perda de peso pré-tratamento foram de 39,1% e 70,1%, respectivamente. Após ajustar para idade, sexo masculino e índice de Karnofsky, a presença de anorexia e o tamanho do tumor foram significativamente associados à perda de peso pré-tratamento. Na análise multivariada de Cox, após ajustar para a idade, as variáveis sexo masculino, presença concomitante de anorexia e perda de peso e índice de Karnofsky reduzido foram preditores independentes de pior probabilidade de sobrevida. Conclusões: O presente estudo demonstrou que a presença de anorexia e de perda de peso pré-tratamento são problemas relevantes no seguimento de pacientes com câncer de pulmão avançado (estádio IV). Intervenções específicas são de crucial importância no plano de assistência individualizada, mesmo dentro da proposta de cuidados paliativos.

Management of lung nodules in Brazil-assessment of realities, beliefs and attitudes: a study by the Brazilian Society of Thoracic Surgery (SBCT), the Brazilian Thoracic Society (SBPT) and the Brazilian College of Radiology (CBR).

BACKGROUND: Pulmonary nodules are common; some are inconsequential while others are malignant. Management of solitary pulmonary nodule (SPN) in Brazil appears to be highly variable, potentially leading to suboptimal outcomes. Assessment of the variability and the association with the degree of availability of resources can provide a foundation for development of clinical guidelines for management of SPN specific for the Brazilian setting. METHODS: A web-based survey was developed by thoracic surgeons, pulmonologists and radiologists to evaluate SPN perception and management. This survey was sent to their respective national societies members and answers collected between August and December 2016. That included multiple choice questions regarding age, specialty, SPN management, accessibility to exams and interventional procedures characterizing public (SUS) and supplementary private working settings. RESULTS: A total of 461 questionnaires were answered. More than half of participants live in cities with over one million people. Specialties were reasonable equilibrated with 43.5% radiologists, 33.5% thoracic surgeons, 20.3% pulmonologists and 2.6% others. Most of the respondents work in both public and private sector (72.7%). Private has a similar reality compared to well-developed nations regarding exams accessibility and interventions. SUS setting has a significant variability access according to the participants. CT is only easily available in 31.9% of cases, PET-CT is easily available in 24.4%, bronchoscopy is easily available for 42.8%, transthoracic needle biopsy is only easily available in 13.9% and video-assisted thoracoscopic surgery (VATS) biopsy is not available in 19.5%. When there is a probability of malignancy of 50% or higher, 46.5% of participants would be comfortable recommending surgical biopsy. When the probability is higher than 10%, only 36.9% would be comfortable following up radiologically. CONCLUSIONS: Brazil has a very different setting for public and private patients regarding exams accessibility and management options. That might explain why participants have a higher tendency to choose interventional diagnosis and explains why current guidelines may not be applicable to developing countries reality.

Survival in a cohort of patients with lung cancer: the role of age and gender in prognosis / Sobrevida em uma coorte de pacientes com câncer de pulmão: papel da idade e do sexo no prognóstico

ABSTRACT Objective: To determine the demographic and clinical characteristics of patients with non-small cell lung cancer (NSCLC), as well as their disease course, by age group and gender. Methods: This was a retrospective cohort study of patients diagnosed with NSCLC from 2000 to 2012 and followed until July 2015 in a tertiary referral hospital in the city of São Paulo, Brazil. Based on the 25th and 75th percentiles of the age distribution, patients were stratified into three age groups: < 55 years; ≥ 55 and < 72 years; and ≥ 72 years. Survival time was evaluated during the follow-up period of the study. Functions of overall and gender-specific survival stratified by age groups (event: all-cause mortality) were calculated using the Kaplan-Meier method. Differences among survival curves were assessed via the log-rank test. Results: We included 790 patients with the following age distribution: < 55 years, 165 patients; ≥ 55 and < 72 years, 423; and ≥ 72 years, 202. In the entire sample, there were 493 men (62.4%). Adenocarcinoma was the most common histological pattern in the < 72-year age groups; 575 patients (73%) presented with advanced disease (stages IIIB-IV). The median 5-year survival was 12 months (95% CI: 4-46 months), with no significant differences among the age groups studied. Conclusions: NSCLC remains more common in men, although we found an increase in the proportion of the disease in women in the < 55-year age group. Adenocarcinoma predominated in women. In men, squamous cell carcinoma predominated in the ≥ 72-year age group. Most patients presented with advanced-stage disease at diagnosis. There were no statistical differences in survival between genders or among age groups.

RESUMO Objetivo: Analisar características demográficas e clínicas, assim como a evolução de pacientes com câncer de pulmão de células não pequenas (CPCNP) de acordo com a faixa etária e o sexo desses pacientes. Métodos: Coorte retrospectiva de pacientes diagnosticados com CPCNP entre janeiro de 2000 e julho de 2012, acompanhados até julho de 2015, em um hospital terciário de referência no município de São Paulo. Com base na distribuição de idade segundo os percentis 25 e 75, os pacientes foram estratificados em três grupos: < 55 anos; ≥ 55 e < 72 anos; e ≥ 72 anos. O tempo de sobrevida foi avaliado durante o período de acompanhamento do estudo. As funções de sobrevida geral e por sexo estratificada por faixa etária (considerando-se óbito por qualquer motivo) foram calculadas empregando-se o método de Kaplan-Meier. As diferenças entre as curvas de sobrevida foram verificadas pelo teste log-rank. Resultados: Foram incluídos 790 pacientes, com a seguinte distribuição etária: 165, 423 e 202 pacientes, respectivamente, com < 55 anos; ≥ 55 e < 72 anos; e ≥ 72 anos. Na amostra geral, havia 493 homens (62,4%). O padrão histológico mais frequente foi adenocarcinoma nos grupos com < 72 anos; 575 pacientes (73%) apresentavam doença avançada (estádios IIIB-IV). A mediana de sobrevida em 5 anos foi de 12 meses (IC95%: 4-46), sem diferenças significantes nas faixas etárias estudadas. Conclusões: O CPCNP continua sendo mais frequente em homens, apesar de ter havido um aumento de sua proporção em mulheres na faixa etária < 55 anos. O adenocarcinoma predominou nas mulheres. Nos homens, o carcinoma escamoso predominou no grupo ≥ 72 anos. A maioria dos casos apresentava-se em estádio avançado ao diagnóstico. Não foram observadas diferenças estatísticas na sobrevida entre os sexos ou as faixas etárias.

Family caregiver burden: the burden of caring for lung cancer patients according to the cancer stage and patient quality of life / Sobrecarga do cuidador familiar: a sobrecarga de cuidar de pacientes com câncer de pulmão, de acordo com o estágio do câncer e a qualidade de vida do paciente

ABSTRACT Objective: Patients with lung cancer experience different feelings and reactions, based on their family, social, cultural, and religious backgrounds, which are a source of great distress, not only for the patients but also for their family caregivers. This study aimed to evaluate the impact that lung cancer stage and quality of life (QoL) of lung cancer patients have on caregiver burden. Methods: This was a prospective cross-sectional study. Consecutive patient-caregiver dyads were selected and asked to complete the Hospital Anxiety and Depression Scale and the Medical Outcomes Study 36-item ShortForm Health Survey (SF-36). Family caregivers also completed the Caregiver Burden Scale. Group-based modeling was used in order to identify patients with early- or advanced-stage cancer (IA to IIIA vs. IIIB to IV) plus non-impaired or impaired QoL (SF36 total score > 50 vs. ≤ 50). Patient-caregiver dyads were stratified into four groups: early-stage cancer+non-impaired QoL; advanced-stage cancer+non-impaired QoL; early-stage cancer+impaired QoL; and advanced-stage cancer+impaired QoL. Results: We included 91 patient-caregiver dyads. The majority of the patients were male and heavy smokers. Family caregivers were younger and predominantly female. The burden, QoL, level of anxiety, and level of depression of caregivers were more affected by the QoL of the patients than by their lung cancer stage. The family caregivers of the patients with impaired QoL showed a higher median burden than did those of the patients with non-impaired QoL, regardless of disease stage. Conclusions: Caregiver burden is more affected by patient QoL than by lung cancer stage.

RESUMO Objetivo: Pacientes com câncer de pulmão vivenciam diferentes sentimentos e reações, dependendo de sua formação familiar, social, cultural e religiosa, que são fonte de grande sofrimento, não só para os pacientes mas também para seus cuidadores familiares. Este estudo objetivou avaliar o impacto do estágio do câncer de pulmão e da qualidade de vida (QV) dos pacientes com câncer de pulmão na sobrecarga do cuidador. Métodos: Estudo prospectivo transversal. Díades paciente-cuidador foram selecionadas consecutivamente e solicitadas a preencher a Hospital Anxiety and Depression Scale e o Medical Outcomes Study 36-item Short-Form Health Survey (SF-36). Os cuidadores familiares também preencheram a Caregiver Burden Scale. Utilizou-se a modelagem de grupos para identificar pacientes com câncer em estágio inicial ou avançado (IA a IIIA vs. IIIB a IV) mais QV não comprometida ou comprometida (pontuação total no SF36 > 50 vs. ≤ 50). As díades paciente-cuidador foram estratificadas em quatro grupos: câncer em estágio inicial+QV não comprometida; câncer em estágio avançado+QV não comprometida; câncer em estágio inicial+QV comprometida; e câncer em estágio avançado+QV comprometida. Resultados: Foram incluídas 91 díades paciente-cuidador. A maioria dos pacientes era do sexo masculino e grande fumante. Os cuidadores familiares eram mais jovens e predominantemente do sexo feminino. A sobrecarga, QV, nível de ansiedade e nível de depressão dos cuidadores foram mais afetados pela QV dos pacientes do que pelo estágio do câncer de pulmão. Os cuidadores familiares dos pacientes com QV comprometida apresentaram maior mediana de sobrecarga do que os dos pacientes com QV não comprometida, independentemente do estágio da doença. Conclusões: A sobrecarga do cuidador é mais afetada pela QV do paciente do que pelo estágio do câncer de pulmão.

Family caregiver burden: the burden of caring for lung cancer patients according to the cancer stage and patient quality of life.

OBJECTIVE:: Patients with lung cancer experience different feelings and reactions, based on their family, social, cultural, and religious backgrounds, which are a source of great distress, not only for the patients but also for their family caregivers. This study aimed to evaluate the impact that lung cancer stage and quality of life (QoL) of lung cancer patients have on caregiver burden. METHODS:: This was a prospective cross-sectional study. Consecutive patient-caregiver dyads were selected and asked to complete the Hospital Anxiety and Depression Scale and the Medical Outcomes Study 36-item ShortForm Health Survey (SF-36). Family caregivers also completed the Caregiver Burden Scale. Group-based modeling was used in order to identify patients with early- or advanced-stage cancer (IA to IIIA vs. IIIB to IV) plus non-impaired or impaired QoL (SF36 total score > 50 vs. ≤ 50). Patient-caregiver dyads were stratified into four groups: early-stage cancer+non-impaired QoL; advanced-stage cancer+non-impaired QoL; early-stage cancer+impaired QoL; and advanced-stage cancer+impaired QoL. RESULTS:: We included 91 patient-caregiver dyads. The majority of the patients were male and heavy smokers. Family caregivers were younger and predominantly female. The burden, QoL, level of anxiety, and level of depression of caregivers were more affected by the QoL of the patients than by their lung cancer stage. The family caregivers of the patients with impaired QoL showed a higher median burden than did those of the patients with non-impaired QoL, regardless of disease stage. CONCLUSIONS:: Caregiver burden is more affected by patient QoL than by lung cancer stage. OBJETIVO:: Pacientes com câncer de pulmão vivenciam diferentes sentimentos e reações, dependendo de sua formação familiar, social, cultural e religiosa, que são fonte de grande sofrimento, não só para os pacientes mas também para seus cuidadores familiares. Este estudo objetivou avaliar o impacto do estágio do câncer de pulmão e da qualidade de vida (QV) dos pacientes com câncer de pulmão na sobrecarga do cuidador. MÉTODOS:: Estudo prospectivo transversal. Díades paciente-cuidador foram selecionadas consecutivamente e solicitadas a preencher a Hospital Anxiety and Depression Scale e o Medical Outcomes Study 36-item Short-Form Health Survey (SF-36). Os cuidadores familiares também preencheram a Caregiver Burden Scale. Utilizou-se a modelagem de grupos para identificar pacientes com câncer em estágio inicial ou avançado (IA a IIIA vs. IIIB a IV) mais QV não comprometida ou comprometida (pontuação total no SF36 > 50 vs. ≤ 50). As díades paciente-cuidador foram estratificadas em quatro grupos: câncer em estágio inicial+QV não comprometida; câncer em estágio avançado+QV não comprometida; câncer em estágio inicial+QV comprometida; e câncer em estágio avançado+QV comprometida. RESULTADOS:: Foram incluídas 91 díades paciente-cuidador. A maioria dos pacientes era do sexo masculino e grande fumante. Os cuidadores familiares eram mais jovens e predominantemente do sexo feminino. A sobrecarga, QV, nível de ansiedade e nível de depressão dos cuidadores foram mais afetados pela QV dos pacientes do que pelo estágio do câncer de pulmão. Os cuidadores familiares dos pacientes com QV comprometida apresentaram maior mediana de sobrecarga do que os dos pacientes com QV não comprometida, independentemente do estágio da doença. CONCLUSÕES:: A sobrecarga do cuidador é mais afetada pela QV do paciente do que pelo estágio do câncer de pulmão.

Survival in a cohort of patients with lung cancer: the role of age and gender in prognosis.

OBJECTIVE: To determine the demographic and clinical characteristics of patients with non-small cell lung cancer (NSCLC), as well as their disease course, by age group and gender. METHODS: This was a retrospective cohort study of patients diagnosed with NSCLC from 2000 to 2012 and followed until July 2015 in a tertiary referral hospital in the city of São Paulo, Brazil. Based on the 25th and 75th percentiles of the age distribution, patients were stratified into three age groups: < 55 years; ≥ 55 and < 72 years; and ≥ 72 years. Survival time was evaluated during the follow-up period of the study. Functions of overall and gender-specific survival stratified by age groups (event: all-cause mortality) were calculated using the Kaplan-Meier method. Differences among survival curves were assessed via the log-rank test. RESULTS: We included 790 patients with the following age distribution: < 55 years, 165 patients; ≥ 55 and < 72 years, 423; and ≥ 72 years, 202. In the entire sample, there were 493 men (62.4%). Adenocarcinoma was the most common histological pattern in the < 72-year age groups; 575 patients (73%) presented with advanced disease (stages IIIB-IV). The median 5-year survival was 12 months (95% CI: 4-46 months), with no significant differences among the age groups studied. CONCLUSIONS: NSCLC remains more common in men, although we found an increase in the proportion of the disease in women in the < 55-year age group. Adenocarcinoma predominated in women. In men, squamous cell carcinoma predominated in the ≥ 72-year age group. Most patients presented with advanced-stage disease at diagnosis. There were no statistical differences in survival between genders or among age groups.

Burnout syndrome: prevalence in healthprofessionals working in the area of oncology / Síndrome de burnout: prevalência em profissionais da saúde que atuam na área de oncologia

Healthcare professionals who work in the area of caregiving are responsible for the ongoing care of patients and therefore are more vulnerable to burnout. The objective of this study is to evaluate the levels of stress in health professionals, and to analyze the quality of life, and the level of anxiety and depression among these individuals. A cross-sectional study was carried out with professionals working in the oncology unit, both men and women, over 18 years of age, who agreed to participate in the study and signed an informed consent form. Participants completed the evaluation form and completed the SF-36 Quality of Life, Hospital Anxiety and Depression Scale (HADS), and Maslach Burnout Inventory (MBI) questionnaire. We evaluated 54 professionals, predominantly female and young. When comparing quality of life and level of anxiety or depression among the different subgroups of employees, it was possible to observe that, in the dimensions of emotional exhaustion and low professional achievement, individuals with higher stress had worse quality of life and higher level of anxiety and depression. For the dimension of depersonalization, only anxiety was higher in subjects with moderate stress. This study demonstrated that many professionals have moderate or high degree of professional stress and that this was associated with greater anxiety and depression and poorer quality of life. These results may provide useful insights to improve the physical and mental health of health care professionals

Os profissionais da saúde que atuam na área de assistência são responsáveis pelo cuidado contínuo dos pacientes e, por isso, estão mais vulneráveis ao burnout. O objetivo deste estudo foi avaliar os níveis de estresse em profissionais da saúde e analisar a qualidade de vida e o nível de ansiedade e depressão entre esses indivíduos. Foi realizado estudo transversal, com profissionais que atuam na área assistencial de unidade de oncologia, de ambos os sexos, maiores de 18 anos e que aceitaram participar da pesquisa e assinaram o termo de consentimento livre e esclarecido. Os participantes preencheram ficha de avaliação e responderam ao questionário de qualidade de vida SF-36, à Escala Hospitalar de Ansiedade e Depressão (HADS) e ao Inventário de Burnout de Maslach (MBI). Foram avaliados 54 profissionais, predominando sexo feminino e faixa etária jovem. Ao comparar qualidade de vida e nível de ansiedade ou depressão entre os diferentes subgrupos de funcionários, foi possível observar que nas dimensões de exaustão emocional e baixa realização profissional os indivíduos com maior grau de estresse apresentaram pior qualidade de vida e maior nível de ansiedade e depressão. Para a dimensão de despersonalização, apenas a ansiedade se mostrou maior nos indivíduos com grau moderado de estresse. Este estudo demonstrou que muitos profissionais possuem grau moderado ou alto de estresse profissional e que isso se associou com maior ansiedade e depressão e pior qualidade de vida. Esses resultados podem fornecer conhecimentos úteis para melhorar a saúde física e mental dos profissionais da área da saúde

Who Needs to Be Allocated in ICU after Thoracic Surgery? An Observational Study.

Background. The effective use of ICU care after lung resections has not been completely studied. The aims of this study were to identify predictive factors for effective use of ICU admission after lung resection and to develop a risk composite measure to predict its effective use. Methods. 120 adult patients undergoing elective lung resection were enrolled in an observational prospective cohort study. Preoperative evaluation and intraoperative assessment were recorded. In the postoperative period, patients were stratified into two groups according to the effective and ineffective use of ICU. The use of ICU care was considered effective if a patient experienced one or more of the following: maintenance of controlled ventilation or reintubation; acute respiratory failure; hemodynamic instability or shock; and presence of intraoperative or postanesthesia complications. Results. Thirty patients met the criteria for effective use of ICU care. Logistic regression analysis identified three independent predictors of effective use of ICU care: surgery for bronchiectasis, pneumonectomy, and age ≥ 57 years. In the absence of any predictors the risk of effective need of ICU care was 6%. Risk increased to 25-30%, 66-71%, and 93% with the presence of one, two, or three predictors, respectively. Conclusion. ICU care is not routinely necessary for all patients undergoing lung resection.

A pooled analysis of nivolumab for the treatment of advanced non-small-cell lung cancer and the role of PD-L1 as a predictive biomarker.

BACKGROUND: Recent studies with nivolumab (a monoclonal antibody against programmed cell death 1 [PD-1] receptor) have shown promise non-small-cell lung cancer (NSCLC) treatment. METHODS: To review available clinical trials data in order to assess nivolumab efficacy and the role of tumoral PDL-1 expression as a biomarker. RESULTS: Nine eligible studies included 2102 patients. In the second line setting, nivolumab achieved a 1-year survival rate of 41%; and in the first line, a 1-year survival rate of 76%. For those with PD-L1 expression <1%, nivolumab showed a trend for improved survival compared with docetaxel. CONCLUSIONS: The available data reinforce nivolumab activity against NSCLC in first-line or subsequent lines. Although PD-L1 expression is related to greater response, PD-L1 negative patients had also some benefit.

The role of PD-L1 expression as a predictive biomarker in advanced non-small-cell lung cancer: a network meta-analysis.

BACKGROUND: Tumor programmed death ligand one (PD-L1) expression has been studied in several trials in non-small-cell lung cancer. METHODS: We assessed the potential role of PD-L1 expression according to Cochrane Collaboration's Guidelines. RESULTS: 13 studies with 1979 patients were included. Among 915 PD-L1 negative patients this rate was 13% (RR 2.08; 95% CI: 1.49-2.91; p < 0.01). The response rate has increased concurrent to the PD-L1 expression (Pearson's correlation, r = 0.43). PD-L1 expression was also related to better 24-weeks progression-free rate (RR 0.79; 95% CI: 0.71-0.89) and a trend toward better 1-year overall survival rate (RR 0.96; 95% CI: 0.87-1.06). CONCLUSION: Taking this data in account, PD-L1 overexpression could not be currently considered a robust biomarker to tailor the immune checkpoint inhibitors treatment.

Evaluation of lung volumes, vital capacity and respiratory muscle strength after cervical, thoracic and lumbar spinal surgery.

CONTEXT AND OBJECTIVE: Studies have shown that physiopathological changes to the respiratory system can occur following thoracic and abdominal surgery. Laminectomy is considered to be a peripheral surgical procedure, but it is possible that thoracic spinal surgery exerts a greater influence on lung function. The aim of this study was to evaluate the pulmonary volumes and maximum respiratory pressures of patients undergoing cervical, thoracic or lumbar spinal surgery. DESIGN AND SETTING: Prospective study in a tertiary-level university hospital. METHODS: Sixty-three patients undergoing laminectomy due to diagnoses of tumors or herniated discs were evaluated. Vital capacity, tidal volume, minute ventilation and maximum respiratory pressures were evaluated preoperatively and on the first and second postoperative days. Possible associations between the respiratory variables and the duration of the operation, surgical diagnosis and smoking status were investigated. RESULTS: Vital capacity and maximum inspiratory pressure presented reductions on the first postoperative day (20.9% and 91.6%, respectively) for thoracic surgery (P = 0.01), and maximum expiratory pressure showed reductions on the first postoperative day in cervical surgery patients (15.3%; P = 0.004). The incidence of pulmonary complications was 3.6%. CONCLUSIONS: There were reductions in vital capacity and maximum respiratory pressures during the postoperative period in patients undergoing laminectomy. Surgery in the thoracic region was associated with greater reductions in vital capacity and maximum inspiratory pressure, compared with cervical and lumbar surgery. Thus, surgical manipulation of the thoracic region appears to have more influence on pulmonary function and respiratory muscle action.

Evaluation of lung volumes, vital capacity and respiratory muscle strength after cervical, thoracic and lumbar spinal surgery / Avaliação dos volumes pulmonares, capacidade vital e força dos músculos respiratórios no pós-operatório de cirurgia na coluna cervical, torácica e lombar

CONTEXT AND OBJECTIVE: Studies have shown that physiopathological changes to the respiratory system can occur following thoracic and abdominal surgery. Laminectomy is considered to be a peripheral surgical procedure, but it is possible that thoracic spinal surgery exerts a greater influence on lung function. The aim of this study was to evaluate the pulmonary volumes and maximum respiratory pressures of patients undergoing cervical, thoracic or lumbar spinal surgery. DESIGN AND SETTING: Prospective study in a tertiary-level university hospital. METHODS: Sixty-three patients undergoing laminectomy due to diagnoses of tumors or herniated discs were evaluated. Vital capacity, tidal volume, minute ventilation and maximum respiratory pressures were evaluated preoperatively and on the first and second postoperative days. Possible associations between the respiratory variables and the duration of the operation, surgical diagnosis and smoking status were investigated. RESULTS: Vital capacity and maximum inspiratory pressure presented reductions on the first postoperative day (20.9% and 91.6%, respectively) for thoracic surgery (P = 0.01), and maximum expiratory pressure showed reductions on the first postoperative day in cervical surgery patients (15.3%; P = 0.004). The incidence of pulmonary complications was 3.6%. CONCLUSIONS: There were reductions in vital capacity and maximum respiratory pressures during the postoperative period in patients undergoing laminectomy. Surgery in the thoracic region was associated with greater reductions in vital capacity and maximum inspiratory pressure, compared with cervical and lumbar surgery. Thus, surgical manipulation of the thoracic region appears to have more influence on pulmonary function and respiratory muscle action.

CONTEXTO E OBJETIVO: Estudos têm demonstrado que alterações fisiopatológicas no sistema respiratório podem ocorrer após cirurgia torácica e abdominal. A laminectomia é considerada uma cirurgia periférica, mas é possível que as cirurgias de coluna torácica exerçam maior influência sobre a função pulmonar. O objetivo do estudo foi avaliar os volumes pulmonares e as pressões respiratórias máximas em pacientes submetidos a cirurgia de coluna cervical, torácica ou lombar. TIPO DE ESTUDO E LOCAL: Estudo prospectivo em hospital universitário terciário. MÉTODOS: Sessenta e três pacientes submetidos a laminectomia com diagnóstico tumor ou hérnia de disco foram avaliados. Foram avaliados, no pré-operatório, no primeiro e no segundo dias de pós-operatório, capacidade vital, volume corrente, volume por minuto e pressões respiratórias máximas. Possíveis associações entre as variáveis respiratórias e duração da cirurgia, diagnóstico cirúrgico e tabagismo foram investigadas. RESULTADOS: A capacidade vital e a pressão inspiratória máxima apresentaram redução no primeiro dia de pós-operatório (20.9% and 91.6%, respectivamente) nas cirurgias torácicas; P = 0,01), e a pressão expiratória máxima apresentou redução no primeiro dia de pós-operatório de cirurgia cervical (15.3%; P = 0,004). A incidência de complicações pulmonares foi de 3,6%. CONCLUSÕES: Houve redução da capacidade vital e das pressões respiratórias máximas no período pós-operatório em pacientes submetidos a laminectomia. A cirurgia na região torácica apresentou associação com maiores reduções na capacidade vital e na pressão inspiratória máxima em comparação com a cirurgia cervical e lombar. Assim, a manipulação cirúrgica da região torácica parece ter maior influência na função pulmonar e na ação dos músculos respiratórios.