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1.
Liver Transpl ; 2020 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-32078242

RESUMO

Portal vein thrombosis (PVT) is a common complication in patients with cirrhosis awaiting a liver transplantation (LT), with the incidence ranging from 2% to 26%. Risk factors associated with this complication are male sex; previous treatment for portal hypertension (sclerotherapy, transjugular intrahepatic portosystemic shunt [TIPS], shunt surgery, previous splenectomy); Child-Pugh class C and alcoholic liver disease.

2.
J Crohns Colitis ; 2020 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-32080712

RESUMO

BACKGROUND AND AIMS: Gadolinium-enhanced sequences are not included in the simplified Magnetic Resonance Index of Activity (sMARIA), but in the derivation of this index readers had access to these sequences. The current study aimed to validate the sMARIA without gadolinium-enhanced sequences for assessing disease activity, severity, and response to treatment in patients with Crohn's disease. PATIENTS AND METHODS: We prospectively included patients with active Crohn's disease and at least one segment with severe inflammation (ulcers) at ileocolonoscopy who required treatment with biological drugs. Patients were evaluated by both MRE and ileocolonoscopy at baseline and 46 weeks after initiation of medical treatment. We compared the quantification of disease activity and response to treatment with sMARIA versus with ileocolonoscopy (CDEIS), considered the gold standard. RESULTS: Data from both MRE and ileocolonoscopy 46 weeks after treatment initiation were available for 39 of the 50 patients. As in the derivation study, the optimal cutoffs were sMARIA≥1 for predicting active disease (area under the curve [AUC] 0.92) and sMARIA≥2 for predicting the presence of ulcers at ileocolonoscopy (AUC 0.93). In evaluating the response to treatment, the sMARIA detected endoscopic ulcer healing at the segment level (sMARIA<2) with 89.5% sensitivity and 87.5% specificity. The sMARIA decreased significantly (p<0.001) in segments achieving endoscopic ulcer healing, but did not change (p=0.222) in segments with persistent ulceration.

3.
Curr Microbiol ; 2020 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-31982966

RESUMO

Two bacterial strains were isolated from the hepatopancreas of a cultured shrimp (Penaeus vannamei) in Sinaloa, México. Their partial 16S rRNA gene sequences clustered within those of the genus Photobacterium, showing high similarity to the type strains of Photobacterium angustum and Photobacterium leiognathi, were 87.1% and 97.5%, respectively. Multilocus sequence analysis using eight housekeeping genes (ftsZ, gapA, gyrB, mreB, pyrH, recA, rpoA, topA and 16S rRNA) and phylogenetic analysis with 139 single-copy genes showed that the new strains form an independent branch whole genome sequencing and genomic analyses (average nucleotide identity, average amino acid identity, and in silico DNA-DNA hybridization) produced values well below the thresholds for species delineation with all methods tested. In addition, a phenotypic characterization was performed to support the description and differentiation of the novel strains from related taxa. The results obtained demonstrate that the two strains represent a novel species for which the name Photobacterium lucens sp. nov. is proposed.

4.
Int J Cancer ; 2020 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-31953839

RESUMO

Endometrial cancer (EC) is the most common gynecologic malignancy in developed countries. Although most patients are diagnosed at early stages, 15-20% will relapse despite local treatment. Presently, there are no reliable markers to identify patients with worse outcomes who may benefit from adjuvant treatments, such as chemotherapy, and liquid biopsies may be of use in this setting. Peritoneal lavages are systematically performed during endometrial surgery but little data are available about their potential as liquid biopsies. We analyzed KRAS and PIK3CA mutations in paired surgical biopsies, blood and cytology-negative peritoneal lavages in a cohort of 50 EC patients. Surgical biopsies were submitted to next-generation sequencing (NGS) while circulating-free DNA (cfDNA) purified from plasma and peritoneal lavages was analyzed for KRAS and PIK3CA hotspot mutations using a sensitive quantitative polymerase chain reaction (PCR) assay. NGS of biopsies revealed KRAS, PIK3CA or concomitant KRAS + PIK3CA mutations in 33/50 (66%) EC patients. Of those, 19 cases carried hotspot mutations. Quantitative PCR revealed KRAS and/or PIK3CA mutations in the lavages of 9/19 (47.4%) hotspot EC patients. In contrast, only 2/19 (10.5%) blood samples from hotspot EC patients were positive. Mutations found in cfDNA consistently matched those in paired biopsies. One of the two patients positive in plasma and lavage died in less than 6 months. In conclusion, mutational analysis in peritoneal lavages and blood from early stage EC is feasible. Further studies are warranted to determine if it might help to identify patients with worse prognosis. Human genes discussed: KRAS, KRAS proto-oncogene, GTPase; PIK3CA, phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha.

5.
Pap. psicol ; 40(3): 226-232, sept.-dic. 2019.
Artigo em Espanhol | IBECS-Express | ID: ibc-ET2-4129

RESUMO

La génesis de la complementariedad se explica desde complejos sistemas neuronales entre los que se encuentran las neuronas espejo. Esta red es mucho más que un espejo ya que, en su interacción con otras áreas cerebrales, posibilita configurar relaciones simétricas y asimétricas. Las primeras, son a partir de la mímica, incidental o intencional, que se despliegan conductas basadas en la mínima diferencia respecto de las percibidas, como también, al contagio emocional y a la empatía. Las segundas, son a partir de la inhibición de la mímica que controla las respuestas motoras de este sistema sensoriomotor. En cada caso se detallan las áreas y circuitos cerebrales involucrados. La originalidad se alcanza al entrelazar los diferentes subsistemas de acción neuronal con los tipos de relación que conforman la complementariedad. Asimismo, se afirma que todas las relaciones son complementarias desde un metanivel relacional. Además, estas conclusiones son plasmadas en la praxis de la psicoterapia sistémica, para reflexionar sobre el sustrato neurobiológico de las relaciones disfuncionales de los pacientes, como también, sobre las diferentes posiciones relacionales que puede adoptar el experto de manera estratégica


The genesis of complementarity is explained based on complex neuronal systems among which are mirror neurons. This network is much more than just a mirror because, in its interaction with other brain areas, it makes it possible to configure symmetric and asymmetric relationships. The former stem from incidental or intentional mimicry behaviors based on the minimum difference with respect to the displayed and perceived actions, as well as emotional contagion and empathy. Asymmetric relationships, however, are based on the inhibition of mimicry, which controls the motor responses of the sensorimotor system. We present the brain areas and circuits involved in each case. In this paper, the originality is achieved by interlacing the different subsystems of neuronal action with the types of relationships that make up the complementarity. It is confirmed that all relationships are complementary from a relational meta-level perspective. In addition, these conclusions are shown through the practice of systemic psychotherapy, in order to reflect on the neurobiological substratum of patients' dysfunctional relationships, as well, on the different relational positions that the expert can strategically adopt

6.
Leukemia ; 2019 Nov 26.
Artigo em Inglês | MEDLINE | ID: mdl-31772299

RESUMO

Timed degradation of the cyclin-dependent kinase inhibitor p27Kip1 by the E3 ubiquitin ligase F-box protein SKP2 is critical for T-cell progression into cell cycle, coordinating proliferation and differentiation processes. SKP2 expression is regulated by mitogenic stimuli and by Notch signaling, a key pathway in T-cell development and in T-cell acute lymphoblastic leukemia (T-ALL); however, it is not known whether SKP2 plays a role in the development of T-ALL. Here, we determined that SKP2 function is relevant for T-ALL leukemogenesis, whereas is dispensable for T-cell development. Targeted inhibition of SKP2 by genetic deletion or pharmacological blockade markedly inhibited proliferation of human T-ALL cells in vitro and antagonized disease in vivo in murine and xenograft leukemia models, with little effect on normal tissues. We also demonstrate a novel feed forward feedback loop by which Notch and IL-7 signaling cooperatively converge on SKP2 induction and cell cycle activation. These studies show that the Notch/SKP2/p27Kip1 pathway plays a unique role in T-ALL development and provide a proof-of-concept for the use of SKP2 as a new therapeutic target in T-cell acute lymphoblastic leukemia (T-ALL).

8.
Int Psychogeriatr ; : 1-12, 2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31455461

RESUMO

OBJECTIVES: To use a Machine Learning (ML) approach to compare Neuropsychiatric Symptoms (NPS) in participants of a longitudinal study who developed dementia and those who did not. DESIGN: Mann-Whitney U and ML analysis. Nine ML algorithms were evaluated using a 10-fold stratified validation procedure. Performance metrics (accuracy, recall, F-1 score, and Cohen's kappa) were computed for each algorithm, and graphic metrics (ROC and precision-recall curves) and features analysis were computed for the best-performing algorithm. SETTING: Primary care health centers. PARTICIPANTS: 128 participants: 78 cognitively unimpaired and 50 with MCI. MEASUREMENTS: Diagnosis at baseline, months from the baseline assessment until the 3rd follow-up or development of dementia, gender, age, Charlson Comorbidity Index, Neuropsychiatric Inventory-Questionnaire (NPI-Q) individual items, NPI-Q total severity, and total stress score and Geriatric Depression Scale-15 items (GDS-15) total score. RESULTS: 30 participants developed dementia, while 98 did not. Most of the participants who developed dementia were diagnosed at baseline with amnestic multidomain MCI. The Random Forest Plot model provided the metrics that best predicted conversion to dementia (e.g. accuracy=.88, F1=.67, and Cohen's kappa=.63). The algorithm indicated the importance of the metrics, in the following (decreasing) order: months from first assessment, age, the diagnostic group at baseline, total NPI-Q severity score, total NPI-Q stress score, and GDS-15 total score. CONCLUSIONS: ML is a valuable technique for detecting the risk of conversion to dementia in MCI patients. Some NPS proxies, including NPI-Q total severity score, NPI-Q total stress score, and GDS-15 total score, were deemed as the most important variables for predicting conversion, adding further support to the hypothesis that some NPS are associated with a higher risk of dementia in MCI.

11.
Int J Med Inform ; 127: 52-62, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31128832

RESUMO

INTRODUCTION: Alzheimer's disease is a degenerative brain disease and the most common cause of dementia. Today, 47 million people live with dementia worldwide. This number is projected to increase to more than 131 million by 2050, as populations age. Therefore, the World Health Organization considers serious cognitive deterioration a public health priority. OBJECTIVES: Advanced cognitive evaluation mechanisms are needed to help make an early diagnosis. These new mechanisms should overcome the limitations of current neuropsychological tests, including delayed detection; being perceived as intrusive; being non-ecological; being dependent on confounding factors; or their administration being expensive, among others. A promising novel approach consists of the introduction of serious games based on virtual reality and machine learning able to assess cognitive traits relevant to the diagnosis of mild cognitive impairment and Alzheimer's disease. METHODS: As a result of a preliminary pilot experiment, promising evidence was obtained about the predictive power of this solution. However, for these new serious games to be effective, evidence has to be gathered on the player experience by senior adults, avoiding the limitations of traditional tests at the same time. This study addresses these aspects with the participation of 74 senior users and 15 test administrators. RESULTS: Main findings confirm the usability and playability of Panoramix, a game battery designed according to the principles discussed above, its technological acceptability and its accessibility. For example, in relation to acceptability, the game battery was scored 4.39 in a 5-point scale, while its average usability score was 4.45 regardless of socio-cultural level or previous experience with digital technologies. In addition, health professionals confirm both, usability and playability, levels with an average score of 6.5 in a 7-point scale. Participants' willingness of using this kind of systems for cognitive evaluation was also confirmed. CONCLUSION: Promising results obtained pave the way for additional work to confirm the diagnostic validity according to clinical standards of these new cognitive assessment tools.


Assuntos
Disfunção Cognitiva , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer , Transtornos Cognitivos , Feminino , Humanos , Aprendizado de Máquina , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Jogos de Vídeo
12.
Nat Commun ; 10(1): 1812, 2019 04 18.
Artigo em Inglês | MEDLINE | ID: mdl-31000705

RESUMO

Non-small cell lung cancer (NSCLC) tumors harboring mutations in EGFR ultimately relapse to therapy with EGFR tyrosine kinase inhibitors (EGFR TKIs). Here, we show that resistant cells without the p.T790M or other acquired mutations are sensitive to the Aurora B (AURKB) inhibitors barasertib and S49076. Phospho-histone H3 (pH3), a major product of AURKB, is increased in most resistant cells and treatment with AURKB inhibitors reduces the levels of pH3, triggering G1/S arrest and polyploidy. Senescence is subsequently induced in cells with acquired mutations while, in their absence, polyploidy is followed by cell death. Finally, in NSCLC patients, pH3 levels are increased after progression on EGFR TKIs and high pH3 baseline correlates with shorter survival. Our results reveal that AURKB activation is associated with acquired resistance to EGFR TKIs, and that AURKB constitutes a potential target in NSCLC progressing to anti-EGFR therapy and not carrying resistance mutations.


Assuntos
Antineoplásicos/farmacologia , Aurora Quinase B/metabolismo , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Neoplasias Pulmonares/tratamento farmacológico , Inibidores de Proteínas Quinases/farmacologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Antineoplásicos/uso terapêutico , Aurora Quinase B/antagonistas & inibidores , Aurora Quinase B/genética , Carcinoma Pulmonar de Células não Pequenas/genética , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Carcinoma Pulmonar de Células não Pequenas/patologia , Linhagem Celular Tumoral , Proliferação de Células/efeitos dos fármacos , Progressão da Doença , Resistencia a Medicamentos Antineoplásicos/genética , Receptores ErbB/antagonistas & inibidores , Receptores ErbB/genética , Feminino , Pontos de Checagem da Fase G1 do Ciclo Celular/efeitos dos fármacos , Histonas/metabolismo , Humanos , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/patologia , Masculino , Camundongos , Pessoa de Meia-Idade , Organofosfatos/farmacologia , Organofosfatos/uso terapêutico , Fosforilação/efeitos dos fármacos , Poliploidia , Inibidores de Proteínas Quinases/uso terapêutico , Quinazolinas/farmacologia , Quinazolinas/uso terapêutico , RNA Interferente Pequeno/metabolismo , Análise de Sobrevida , Resultado do Tratamento , Ensaios Antitumorais Modelo de Xenoenxerto
13.
Am J Clin Pathol ; 151(6): 622-627, 2019 05 03.
Artigo em Inglês | MEDLINE | ID: mdl-30989227

RESUMO

OBJECTIVES: Concern exists regarding overdiagnosis of Clostridium difficile infection (CDI) via molecular modalities. We determined effects of a preanalytic order intervention on laboratory and CDI prevention measures in a multihospital system. METHODS: Intervals before and following implementation of a CDI electronic order alert (relative to appropriate testing scenario) were assessed for C difficile test volume and positivity rate, hospital-onset CDI frequency, and hospital-onset C difficile standardized infection ratio (SIR). C difficile detection occurred by PCR throughout the study. RESULTS: During the first half of 2015, testing volume was 1,578, with 88 hospital-onset CDIs. Following implementation, 18.9% and 56.8% reductions in volume and hospital-onset CDIs were realized, respectively, in the first half of 2017. Regression analysis revealed decreasing trends in PCR volume, positivity rate, hospital-onset CDI frequency, and SIR in larger facilities. CONCLUSIONS: Preanalytic considerations affect not only the microbiology laboratory but also hospital infection prevention in the context of CDI.

14.
Gastroenterology ; 157(2): 432-439.e1, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30953614

RESUMO

BACKGROUND & AIMS: The magnetic resonance index of activity (MARIA) for Crohn's disease (CD) is used to assess the activity of luminal CD. However, it has a number of practical limitations. We aimed to develop and validate a simplified MARIA to more easily and quickly assess CD activity and response to therapy. PATIENTS AND METHODS: We performed a retrospective analysis of magnetic resonance imaging data from 98 participants in 2 studies. We used logistic regression analysis to identify magnetic resonance imaging parameters independently associated with CD endoscopic index of severity (CDEIS) scores (the reference standard). We validated the responsiveness and reliability of the simplified MARIA in an independent cohort of 37 patients who underwent magnetic resonance imaging and endoscopy before and after a therapeutic intervention. RESULTS: Logistic regression analysis showed that dichotomous qualitative assessment of wall thickening (>3 mm), presence of mural edema, perienteric fat stranding, and ulcers were independently associated with CDEIS scores; we used these factors to create a simplified MARIA. Simplified MARIA scores greater than 1 identified segments with active CD with 90% sensitivity and 81% specificity (area under the curve 0.91; 95% confidence interval 0.88-0.94). Simplified MARIA scores of 2 or more detected severe lesions (ulcers) with 85% sensitivity and 92% specificity (area under the curve 0.94; 95% confidence interval 0.91-0.96). For each patient, there was a high level of correlation between simplified MARIA scores and CDEIS scores (r = 0.83) and simplified MARIA scores and original MARIA scores (and r = 0.93) (P < .001). The simplified MARIA score accurately detected changes in lesion severity in response to therapy and was as reliable as endoscopy for the assessment of mucosal healing. CONCLUSION: We developed and validated a simplified MARIA for easier and faster assessment of CD activity and severity. This index identifies patients with a response to therapy with a high level of accuracy. These findings require confirmation in independent, multireader studies.


Assuntos
Doença de Crohn/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Colo/diagnóstico por imagem , Colo/patologia , Colonoscopia , Doença de Crohn/patologia , Doença de Crohn/terapia , Humanos , Mucosa Intestinal/diagnóstico por imagem , Mucosa Intestinal/patologia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento
15.
J Matern Fetal Neonatal Med ; : 1-8, 2019 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-30836798

RESUMO

BACKGROUND: Variability in clinical practice may influence morbidity and mortality in extremely preterm infants. We aimed to know if there are differences in survival and survival without bronchopulmonary dysplasia (BPD) in extremely preterm infants in Spanish tertiary hospitals and the potential associated factors. METHODS: Fifteen hospitals from the SEN1500 network were studied. The overall rate of survival without BPD was 61.4%. Hospitals with extreme results were grouped for comparison (Group 1; N = 2480 versus Group 2; N = 2367). A bivariate analysis of the characteristics of patients and perinatal interventions was carried out and the probability of survival without BPD was studied by Cox regression. RESULTS: Survival (79.0 versus 72.9%; p < .001) and survival without BPD (72.5 versus 49.1%; p < .001) were greater in Group 1. Higher gestational age, birth weight, and female sex were associated with better outcomes. Oxygen administration (aHR: 0.868 [95%CI: 0.782, 0.964]; p=.008) and intubation (aHR: 0.767 [95%CI: 0.701, 0.839]; p < .001) in delivery room were associated with lower survival without BPD. The occurrence of patent ductus arteriosus (PDA), sepsis and/or necrotizing enterocolitis (NEC) was independently associated with worse outcomes. After adjusting for confounders, the probabilities of survival without BPD were significantly higher among patients in Group 1: aHR: 1.557 [95% CI: 1.458, 1.662]; p < .001. CONCLUSIONS: Among the studied hospitals, we found great variability in clinical practice and in the rates of survival and survival without BPD. A more conservative approach to the use of oxygen and respiratory support seems to be related to an increase in survival without BPD. Complications such as PDA, sepsis, and/or NEC decrease survival without BPD. Other variables not included in the present study could be relevant and deserve further study.

16.
Int J Geriatr Psychiatry ; 34(7): 941-949, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30854737

RESUMO

OBJECTIVES: The overall aim of the present study was to explore the role of cognitive reserve (CR) in the conversion from mild cognitive impairment (MCI) to dementia. We used traditional and machine learning (ML) techniques to compare converter and nonconverter participants. We also discuss the predictive value of CR proxies in relation to the ML model performance. METHODS: In total, 169 participants completed the longitudinal study. Participants were divided into a control group and three MCI subgroups, according to the Petersen criteria for diagnosis. Information about the participants was compared using nine ML classification techniques. Seven relevant performance metrics were computed in order to evaluate the accuracy of prediction regarding converter and nonconverter participants. RESULTS: ML algorithms applied to socio-demographic, basic health, and CR proxy data enabled prediction of conversion to dementia. The best performing models were the gradient boosting classifier (accuracy (ACC) = 0.93; F1 = 0.86, and Cohen κ = 0.82) and random forest classifier (ACC = 0.92; F1 = 0.79, and Cohen κ = 0.71). Use of ML techniques corroborated the protective role of CR as a mediator of conversion to dementia, whereby participants with more years of education and higher vocabulary scores survived longer without developing dementia. CONCLUSIONS: We used ML approaches to explore the role of CR in conversion from MCI to dementia. The findings indicate the potential value of ML algorithms for detecting risk of conversion to dementia in cognitive aging and CR studies. Further research is required to develop an ML-based procedure that can be used to make robust predictions.

17.
Pediatr. aten. prim ; 21(81): 65-68, ene.-mar. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-184536

RESUMO

El síndrome de dumping o síndrome de vaciado gástrico rápido se define como el conjunto de manifestaciones digestivas y sistémicas que surgen como resultado de un vaciamiento rápido de gran cantidad de líquidos, alimentos osmóticamente activos y sólidos. Puede ser precoz o tardío. Su etiología es multifactorial. La mayoría de los casos aparecen como secuela de una cirugía gástrica (vagotomía y piloroplastia, gastroyeyunostomía, funduplicatura de Nissen), aunque se han descrito formas idiopáticas, y casos que aparecen en un contexto de disfunción autonómica generalizada. Se presenta un caso clínico de un adolescente sano con un síndrome de dumping precoz, de evolución favorable tras un tratamiento dietético correcto


Dumping syndrome or rapid gastric emptying syndrome is defined as the set of digestive and systemic manifestations that arise as a result of a rapid emptying of large amounts of liquids, osmotically active and solid foods. It can be early or late. Its etiology is multifactorial. Most cases appear as a sequel to gastric surgery (vagotomy and pyloroplasty, gastrojejunostomy, Nissen fundoplication), although idiopathic forms have been described, and cases that appear in a context of generalized autonomic dysfunction. We present a clinical case of a healthy adolescent with an early dumping syndrome, proper evolution after correct dietary measures


Assuntos
Humanos , Masculino , Criança , Síndrome de Esvaziamento Rápido/diagnóstico , Tratamento de Emergência/métodos , Síndrome de Esvaziamento Rápido/dietoterapia , Gastrectomia/efeitos adversos , Fatores de Risco , Motilidade Gastrointestinal/fisiologia
18.
Br J Haematol ; 185(3): 480-491, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30793290

RESUMO

The use of immunochemotherapy has improved the outcome of follicular lymphoma (FL). Recently, complete response at 30 months (CR30) has been suggested as a surrogate for progression-free survival. This study aimed to analyse the life expectancy of FL patients according to their status at 30 months from the start of treatment in comparison with the sex and age-matched Spanish general population (relative survival; RS). The training series comprised 263 patients consecutively diagnosed with FL in a 10-year period who needed therapy and were treated with rituximab-containing regimens. An independent cohort of 693 FL patients from the Grupo Español de Linfomas y Trasplante Autólogo de Médula Ósea (GELTAMO) group was used for validation. In the training cohort, 188 patients were in CR30, with a 10-year overall survival (OS) of 53% and 87% for non-CR30 and CR30 patients, respectively. Ten-year RS was 73% and 100%, showing no decrease in life expectancy for CR30 patients. Multivariate analysis indicated that the FL International Prognostic Index was the most important variable predicting OS in the CR30 group. The impact of CR30 status on RS was validated in the independent GELTAMO series. In conclusion, FL patients treated with immunochemotherapy who were in CR at 30 months showed similar survival to a sex- and age-matched Spanish general population.

19.
J. pediatr. (Rio J.) ; 95(1): 41-47, Jan.-Feb. 2019. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-984647

RESUMO

Abstract Objective: To know the distribution of births of very low birth weight infants by day of the week, and whether this distribution affects the morbidity and mortality in this group of patients. Methods: This was a retrospective analysis of data collected prospectively in the Spanish SEN1500 network (2002-2011). Outborn infants, patients with major congenital anomalies, and those who died in the delivery room were excluded. Births were grouped into "weekdays" and "weekends." A multivariate logistic regression analysis was conducted to evaluate the independent effect of the birth moment on outcomes, and Cox regression for survival. Results: Out of a total of 27,205 very low birth weight infants born at and/or admitted to the participating centers, 22,961 (84.4%) met inclusion criteria. A reduction of 24% in the number of births was observed during the "weekends" compared with "weekdays". In the raw analysis, patients born on weekends exhibited higher morbidity and mortality (mortality rate: 14.2% vs. 16.5%, p < 0.001), but differences were no longer significant after adjusting for confounding factors. Conclusions: The present results suggest that current care practices reduce the proportion of births during the weekends and tend to cluster some high-risk births during this period, increasing crude morbidity and mortality. However, after adjusting for confounding factors, the differences disappear, suggesting that overall care coverage in these centers is appropriate.


Resumo Objetivo: Conhecer a distribuição dos partos de neonatos com muito baixo peso ao nascer durante a semana e se essa distribuição afeta a morbidez e a mortalidade nesse grupo de pacientes. Método: Esta é uma análise retrospectiva de dados coletados prospectivamente na rede espanhola SEN1500 (2002-2011). Foram excluídos neonatos nascidos em outro local, pacientes com grandes anomalias congênitas e pacientes falecidos na sala de parto. Os partos foram agrupados em "Dias úteis" e "Final de semana". Foi realizada uma análise de regressão logística multivariada para avaliar o efeito independente do parto sobre os resultados e uma regressão de Cox para avaliar a sobrevida. Resultados: Do total de 27.205 neonatos com muito baixo peso ao nascer nascidos e/ou internados nos centros participantes, 22.961 (84,4%) atenderam aos critérios de inclusão. Houve uma redução de 24% no número de partos no "Final de semana" em comparação com os "Dias úteis". Na análise bruta, os pacientes nascidos em finais de semana apresentaram maior morbidez e mortalidade (Taxa de mortalidade: 14,2% em comparação a 16,5%, p < 0,001), porém as diferenças não eram mais significativas após o ajuste aos fatores de confusão. Conclusões: Nossos resultados sugerem que as práticas atuais de atendimento reduzem a proporção de partos em finais de semana e tendem a agrupar alguns partos de alto risco nesse período, aumentando a morbidez e mortalidade brutas. Contudo, após o ajuste aos fatores de risco, as diferenças desaparecem, sugerindo que a cobertura de atendimento geral em nossos centros é adequada.

20.
J Pediatr (Rio J) ; 95(1): 41-47, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29197224

RESUMO

OBJECTIVE: To know the distribution of births of very low birth weight infants by day of the week, and whether this distribution affects the morbidity and mortality in this group of patients. METHODS: This was a retrospective analysis of data collected prospectively in the Spanish SEN1500 network (2002-2011). Outborn infants, patients with major congenital anomalies, and those who died in the delivery room were excluded. Births were grouped into "weekdays" and "weekends." A multivariate logistic regression analysis was conducted to evaluate the independent effect of the birth moment on outcomes, and Cox regression for survival. RESULTS: Out of a total of 27,205 very low birth weight infants born at and/or admitted to the participating centers, 22,961 (84.4%) met inclusion criteria. A reduction of 24% in the number of births was observed during the "weekends" compared with "weekdays". In the raw analysis, patients born on weekends exhibited higher morbidity and mortality (mortality rate: 14.2% vs. 16.5%, p<0.001), but differences were no longer significant after adjusting for confounding factors. CONCLUSIONS: The present results suggest that current care practices reduce the proportion of births during the weekends and tend to cluster some high-risk births during this period, increasing crude morbidity and mortality. However, after adjusting for confounding factors, the differences disappear, suggesting that overall care coverage in these centers is appropriate.


Assuntos
Mortalidade Infantil , Recém-Nascido de muito Baixo Peso , Morbidade , Fatores de Tempo , Brasil/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Fatores de Risco , Fatores Socioeconômicos
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