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1.
Cost Eff Resour Alloc ; 16: 55, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30410425

RESUMO

Background: The costs for treating coronary artery disease (CAD) are high worldwide. We performed a prespecified analyses of cost-effectiveness of three therapeutic strategies for multivessel CAD. Methods: From May 1995 to May 2000, a total of 611 patients were randomly assigned to coronary artery bypass graft (CABG), n = 203; percutaneous coronary intervention (PCI), n = 205; or medical treatment (MT), n = 203. This cost analysis study was based on the perspective of the Public Health Care System. Initial procedural and follow-up costs for medications, cardiology examinations, and hospitalizations for complications were calculated after randomization. Life-years and quality-adjusted life years (QALYs) were used as effectiveness measures. Incremental cost-effectiveness ratios (ICER) were obtained by using nonparametric bootstrapping methods with 5000 resamples. Results: Initial procedural costs were lower for MT. However, the subsequent 5-year cumulative costs were lower for CABG. Compared with baseline, the three treatment options produced significant improvements in QALYs. After 5 years, PCI and CABG had better QALYs results compared with MT. The ICER results favored CABG and PCI, and favored PCI over CABG in 61% of the drawings. On the other hand, sensitivity analysis showed MT as the preferred therapy compared with CABG and PCI, in the analysis considering higher costs. Conclusions: At 5-year follow-up, the three treatment options yielded improvements in quality of life, with comparable and acceptable costs. However, despite higher initial costs, the comparison of cost-effectiveness after 5 years of follow-up among the three treatments showed both interventions (CABG and PCI) to be cost-effective strategies compared with MT.Trial registration ISRCTN, ISRCTN66068876, Registered 06/10/1994, http://www.controlled-trials.com/ISRCTN66068876.

2.
Stem Cell Rev Rep ; 13(5): 686-698, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28710685

RESUMO

Amyotrophic Lateral Sclerosis (ALS) is one of the most common adult-onset motor neuron disease causing a progressive, rapid and irreversible degeneration of motor neurons in the cortex, brain stem and spinal cord. No effective treatment is available and cell therapy clinical trials are currently being tested in ALS affected patients. It is well known that in ALS patients, approximately 50% of pericytes from the spinal cord barrier are lost. In the central nervous system, pericytes act in the formation and maintenance of the blood-brain barrier, a natural defense that slows the progression of symptoms in neurodegenerative diseases. Here we evaluated, for the first time, the therapeutic effect of human pericytes in vivo in SOD1 mice and in vitro in motor neurons and other neuronal cells derived from one ALS patient. Pericytes and mesenchymal stromal cells (MSCs) were derived from the same adipose tissue sample and were administered to SOD1 mice intraperitoneally. The effect of the two treatments was compared. Treatment with pericytes extended significantly animals survival in SOD1 males, but not in females that usually have a milder phenotype with higher survival rates. No significant differences were observed in the survival of mice treated with MSCs. Gene expression analysis in brain and spinal cord of end-stage animals showed that treatment with pericytes can stimulate the host antioxidant system. Additionally, pericytes induced the expression of SOD1 and CAT in motor neurons and other neuronal cells derived from one ALS patient carrying a mutation in FUS. Overall, treatment with pericytes was more effective than treatment with MSCs. Our results encourage further investigations and suggest that pericytes may be a good option for ALS treatment in the future. Graphical Abstract ᅟ.


Assuntos
Esclerose Amiotrófica Lateral/terapia , Células-Tronco Pluripotentes Induzidas/patologia , Neurônios Motores/patologia , Pericitos/transplante , Superóxido Dismutase-1/genética , Tecido Adiposo/citologia , Tecido Adiposo/metabolismo , Esclerose Amiotrófica Lateral/genética , Esclerose Amiotrófica Lateral/mortalidade , Esclerose Amiotrófica Lateral/patologia , Animais , Barreira Hematoencefálica/metabolismo , Barreira Hematoencefálica/patologia , Tronco Encefálico/metabolismo , Tronco Encefálico/patologia , Catalase/genética , Catalase/metabolismo , Córtex Cerebral/metabolismo , Córtex Cerebral/patologia , Modelos Animais de Doenças , Feminino , Expressão Gênica , Humanos , Células-Tronco Pluripotentes Induzidas/metabolismo , Masculino , Células-Tronco Mesenquimais/citologia , Células-Tronco Mesenquimais/metabolismo , Camundongos , Camundongos Transgênicos , Neurônios Motores/metabolismo , Mutação , Pericitos/citologia , Pericitos/metabolismo , Proteína FUS de Ligação a RNA/genética , Proteína FUS de Ligação a RNA/metabolismo , Medula Espinal/metabolismo , Medula Espinal/patologia , Superóxido Dismutase-1/deficiência , Análise de Sobrevida
3.
BMC Cardiovasc Disord ; 9: 50, 2009 Nov 03.
Artigo em Inglês | MEDLINE | ID: mdl-19886995

RESUMO

BACKGROUND: Beta-2 adrenergic receptor gene polymorphisms Gln27Glu, Arg16Gly and Thr164Ile were suggested to have an effect in heart failure. We evaluated these polymorphisms relative to clinical characteristics and prognosis of alarge cohort of patients with heart failure of different etiologies. METHODS: We studied 501 patients with heart failure of different etiologies. Mean age was 58 years (standard deviation 14.4 years), 298 (60%) were men. Polymorphisms were identified by polymerase chain reaction-restriction fragment length polymorphism. RESULTS: During the mean follow-up of 12.6 months (standard deviation 10.3 months), 188 (38%) patients died. Distribution of genotypes of polymorphism Arg16Gly was different relative to body mass index (chi2 = 9.797;p = 0.04). Overall the probability of survival was not significantly predicted by genotypes of Gln27Glu, Arg16Gly, or Thr164Ile. Allele and haplotype analysis also did not disclose any significant difference regarding mortality. Exploratory analysis through classification trees pointed towards a potential association between the Gln27Glu polymorphism and mortality in older individuals. CONCLUSION: In this study sample, we were not able to demonstrate an overall influence of polymorphisms Gln27Glu and Arg16Gly of beta-2 receptor gene on prognosis. Nevertheless, Gln27Glu polymorphism may have a potential predictive value in older individuals.


Assuntos
Insuficiência Cardíaca/genética , Polimorfismo de Fragmento de Restrição , Receptores Adrenérgicos beta 2/genética , Adulto , Fatores Etários , Idoso , Índice de Massa Corporal , Feminino , Seguimentos , Frequência do Gene , Predisposição Genética para Doença , Haplótipos , Insuficiência Cardíaca/mortalidade , Humanos , Estimativa de Kaplan-Meier , Desequilíbrio de Ligação , Masculino , Pessoa de Meia-Idade , Fenótipo , Reação em Cadeia da Polimerase , Prognóstico , Modelos de Riscos Proporcionais , Medição de Risco , Fatores de Risco , Fatores de Tempo
4.
Comput Methods Programs Biomed ; 75(1): 59-65, 2004 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-15158048

RESUMO

In many clinical studies involving event history analysis, the event of interest is non-fatal and may occur more than once for each subject. Models based on the theory of counting processes have been developed to deal with such data, the recurrences being considered as transitions in a Markovian process. Under this setting, the experimental units can move between states over time, and it is possible to estimate the corresponding transition probabilities employing regression models that incorporate the influence of covariates. Despite of this, most of the softwares are concerned only in the estimation of regression parameters and do not provide transition probabilities estimates. The aim of this paper is to present a SAS macro developed to estimate the transition probabilities, considering three approaches for the regression modeling. The macro is flexible enough to allow the user to select the model to be fit providing, for a given set of covariates, plots of the estimates for the predicted transition probabilities as a function of time.


Assuntos
Modelos Estatísticos , Probabilidade , Brasil , Desenvolvimento Infantil , Pré-Escolar , Feminino , Humanos , Lactente , Falência Renal Crônica/fisiopatologia , Masculino , Recidiva , Análise de Regressão
5.
J Clin Dent ; 15(3): 76-82, 2004.
Artigo em Inglês | MEDLINE | ID: mdl-15688963

RESUMO

OBJECTIVES: The aims of this study were: 1) to compare the DIAGNOdent readings for the detection of caries on three different macroscopically sound and intact occlusal surfaces for the baseline measurement; and 2) to compare this laser device with visual and radiographic inspection. METHODOLOGY: Forty-five extracted premolars and molar human teeth were cleaned with a pumice slurry. Then 74 sites were defined and radiographs were taken from each one. Three examiners performed the examinations and took the DIAGNOdent measurements. Sensitivity and specificity were calculated for each diagnostic system, as well as intra- and inter-examiner reproducibility using Kappa tests. The cut-off point for visual and radiographic inspection was 1-2, and for the DIAGNOdent the manufacturer's instructions were followed. RESULTS: No statistical difference was found for the three predefined sound sites used for baseline measurements with DIAGNOdent. The visual inspection showed high sensitivity; radiographic inspection and DIAGNOdent measurements showed low sensitivity and high specificity. The highest intra- and inter-reproducibility was found with the DIAGNOdent. CONCLUSION: The thickness of the enamel did not have any effect on the readings with DIAGNOdent. It was concluded that in a low prevalence sample, the visual inspection provided the highest proportion of true disease identified correctly, and DIAGNOdent provided the highest proportion of non-disease identified correctly.


Assuntos
Cárie Dentária/diagnóstico , Lasers , Dente Pré-Molar/diagnóstico por imagem , Dente Pré-Molar/patologia , Cárie Dentária/diagnóstico por imagem , Esmalte Dentário/diagnóstico por imagem , Esmalte Dentário/patologia , Humanos , Dente Molar/diagnóstico por imagem , Dente Molar/patologia , Variações Dependentes do Observador , Exame Físico , Radiografia Interproximal , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Coroa do Dente/diagnóstico por imagem , Coroa do Dente/patologia
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