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Support Care Cancer ; 2020 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-31900618


OBJECTIVE: To evaluate the occurrence and severity of oral complications, number of radiotherapy (RT) interruptions and quality of life (QoL) in a population of head and neck cancer patients receiving a preventive oral care program (POCP) and photobiomodulation therapy (PBMT). METHODS: Prospective cohort of 61 head and neck cancer patients undergoing radiochemotherapy were monitored and submitted to a POCP that included oral hygiene and plaque control, removal of infection foci, dental restorations, periodontal therapy, fluorotherapy, oral hydration, and denture removal at night, combined with daily PBMT. Outcomes included occurrence of adverse effects such as severity of oral mucositis (OM) and oral symptoms (pain, solid and fluid dysphagia, odynophagia, dysgeusia), quality of life impacts, and interruptions of radiotherapy (RT) due to symptoms. Disease-free and overall survival rates were evaluated. RESULTS: There was a significant improvement in oral health conditions between initial assessment and the two longitudinal assessments (p < 0.05), which indicates that the POCP was effective for plaque control and reduction of gingival inflammation. All participants were free of OM at the beginning of the RT regimen and only 45.9% after the 7th session, and few patients ranked the highest score of OM. For all symptoms related to OM, there was a progressive increase of severity until the 14th RT session, which remained stable until the completion of the RT regimen. The same effect was observed for the quality of life measures. Discontinued RT due to OM occurred in only three patients (5%), and the maximum duration was 10 days. The overall survival rate was 77% and disease-free survival was 73.8%. Lower survival time was observed for patients with no response to RT (p < 0.01). CONCLUSIONS: The findings of this study suggest a positive effect of an oral preventive care program for head and neck cancer patients submitted to RT. The PBMT associated with a rigorous POCP resulted in satisfactory control of oral adverse effects, reduction of quality of life impacts, and interruption of RT regimen due to severe OM.

Diabetes Res Clin Pract ; 155: 107813, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31408665


AIMS: To assess cardiac autonomic control and its association with submaximal exercise measured using the 6-minute walk test (6MWT) in subjects with type-2 diabetes mellitus (DM2). METHODS: Cardiac autonomic control was assessed using Ewing's tests and heart rate variability (HRV) in DM2 volunteers (DG, n = 22) and sex-, age- and body mass index-matched non-diabetic controls (CG, n = 22) before, during and after 6MWT. RESULTS: Before the 6MWT, DG presented lower HRV represented by reduced SDNN [median 28.9 ms2 (IQR:18.6-35.4) vs. 45.1 (IQR:39.2-62.67), p < 0.001] and Total Power [median 785 ms2 (IQR:256-1264) vs. 1757 ms2 (IQR:1006-2912), p = 0.004]. Exercise capacity was reduced in DG [maximal predicted distance (%) = 88.4 ±â€¯6.4 vs. 95.2 ±â€¯11.0%, p = 0.018]. DG demonstrated lower global HRV during recovery and lower parasympathetic drive, represented by reduced RMSSD, during all phases of the 6MWT. Moreover, supine HR (r = -0.32), HR orthostatism (ρ = -0.40), SDNN pre-6MWT (ρ = 0.39), TP pre-6MWT (ρ = 0.38), Valsalva ratio (ρ = 0.39) and 30:15 ratio (ρ = 0.38) were all correlated with maximal walked distance. CONCLUSIONS: DM2 subjects presented abnormal HRV during and after submaximal exercise. Furthermore, autonomic control impairment in orthostatism, represented by lower global HRV (SDNN, Total power) and lower Ewing's indexes (Valsalva and 30:15 ratios), was associated with lower exercise capacity.

Sistema Nervoso Autônomo/fisiopatologia , Diabetes Mellitus Tipo 2/fisiopatologia , Teste de Esforço/métodos , Tolerância ao Exercício/fisiologia , Exercício/fisiologia , Frequência Cardíaca/fisiologia , Manobra de Valsalva/fisiologia , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
Arch Oral Biol ; 61: 8-15, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26476747


OBJECTIVE: Investigate, on a comparative basis, the expression of the adhesion molecules E-cadherin (E-cad), ß-catenin (ß-cat) and the proliferation index (Ki-67) at the invasive tumor front (ITF) in squamous cell carcinoma (SCC) and basaloid squamous cell carcinoma (BSCC). MATERIAL AND METHODS: Thirty-five SCC and 16 BSCC cases were evaluated by immunohistochemistry. Clinicopathological and survival data were also evaluated and compared. RESULTS: There was a low expression of E-cad in the cytoplasmic membrane (p=0.50) as well as in the nucleus (p=0.31) for both SCC and BSCC. A high expression of E-cad was seen in the cytoplasm for the SCC group (80%) when compared to the BSCC group (25%) (p<0.01). The expression of ß-cat was low in the cytoplasmic membrane and high in the cytoplasm in both SCC and BSCC groups. Both types of carcinoma presented low expressions of ß-cat in the nucleus (p=0.03). The Ki-67 expression was low irrespective of tumor variant. The high expression of E-cad in the cytoplasm was associated with T3/T4 tumors (p=0.04) in the SCC group and there was no significant association of E-cad, ß-cat, Ki-67 with the other clinical variables. In terms of disease-free survival and overall survival, there were no significant differences between SCC and BSCC. CONCLUSION: The E-cad-ß-cat system was found to be dysregulated in both oral SCC and oral BSCC. The Ki-67 cell proliferation index was extremely low in the cases investigated and consequently had no prognostic value.

Caderinas/metabolismo , Carcinoma de Células Escamosas/metabolismo , Antígeno Ki-67/metabolismo , Neoplasias Bucais/metabolismo , beta Catenina/metabolismo , Carcinoma de Células Escamosas/patologia , Proliferação de Células , Feminino , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Neoplasias Bucais/patologia , Fatores de Risco , Análise de Sobrevida