Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 5.211
Filtrar
1.
Lancet ; 397(10271): 281-292, 2021 01 23.
Artigo em Inglês | MEDLINE | ID: mdl-33485453

RESUMO

BACKGROUND: The Wee1 (WEE1hu) inhibitor adavosertib and gemcitabine have shown preclinical synergy and promising activity in early phase clinical trials. We aimed to determine the efficacy of this combination in patients with ovarian cancer. METHODS: In this double-blind, randomised, placebo-controlled, phase 2 trial, women with measurable recurrent platinum-resistant or platinum-refractory high-grade serous ovarian cancer were recruited from 11 academic centres in the USA and Canada. Women were eligible if they were aged 18 years or older, had an Eastern Cooperative Oncology Group performance status of 0-2, a life expectancy of more than 3 months, and normal organ and marrow function. Women with ovarian cancer of non-high-grade serous histology were eligible for enrolment in a non-randomised exploratory cohort. Eligible participants with high-grade serous ovarian cancer were randomly assigned (2:1), using block randomisation (block size of three and six) and no stratification, to receive intravenous gemcitabine (1000 mg/m2 on days 1, 8, and 15) with either oral adavosertib (175 mg) or identical placebo once daily on days 1, 2, 8, 9, 15, and 16, in 28-day cycles until disease progression or unacceptable toxicity. Patients and the team caring for each patient were masked to treatment assignment. The primary endpoint was progression-free survival. The safety and efficacy analysis population comprised all patients who received at least one dose of treatment. The trial is registered with ClinicalTrials.gov, NCT02151292, and is closed to accrual. FINDINGS: Between Sept 22, 2014, and May 30, 2018, 124 women were enrolled, of whom 99 had high-grade serous ovarian cancer and were randomly assigned to adavosertib plus gemcitabine (65 [66%]) or placebo plus gemcitabine (34 [34%]). 25 women with non-high-grade serous ovarian cancer were enrolled in the exploratory cohort. After randomisation, five patients with high-grade serous ovarian cancer were found to be ineligible (four in the experimental group and one in the control group) and did not receive treatment. Median age for all treated patients (n=119) was 62 years (IQR 54-67). Progression-free survival was longer with adavosertib plus gemcitabine (median 4·6 months [95% CI 3·6-6·4] with adavosertib plus gemcitabine vs 3·0 months [1·8-3·8] with placebo plus gemcitabine; hazard ratio 0·55 [95% CI 0·35-0·90]; log-rank p=0·015). The most frequent grade 3 or worse adverse events were haematological (neutropenia in 38 [62%] of 61 participants in the adavosertib plus gemcitabine group vs ten [30%] of 33 in the placebo plus gemcitabine group; thrombocytopenia in 19 [31%] of 61 in the adavosertib plus gemcitabine group vs two [6%] of 33 in the placebo plus gemcitabine group). There were no treatment-related deaths; two patients (one in each group in the high-grade serous ovarian cancer cohort) died while on study medication (from sepsis in the experimental group and from disease progression in the control group). INTERPRETATION: The observed clinical efficacy of a Wee1 inhibitor combined with gemcitabine supports ongoing assessment of DNA damage response drugs in high-grade serous ovarian cancer, a TP53-mutated tumour type with high replication stress. This therapeutic approach might be applicable to other tumour types with high replication stress; larger confirmatory studies are required. FUNDING: US National Cancer Institute Cancer Therapy Evaluation Program, Ontario Institute for Cancer Research, US Department of Defense, Princess Margaret Cancer Foundation, and AstraZeneca.


Assuntos
Antimetabólitos Antineoplásicos/uso terapêutico , Desoxicitidina/análogos & derivados , Inibidores Enzimáticos/uso terapêutico , Neoplasias Ovarianas/tratamento farmacológico , Pirazóis/uso terapêutico , Pirimidinonas/uso terapêutico , Canadá , Desoxicitidina/uso terapêutico , Método Duplo-Cego , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias Ovarianas/patologia , Sobrevida , Estados Unidos
2.
Nat Commun ; 12(1): 166, 2021 01 08.
Artigo em Inglês | MEDLINE | ID: mdl-33420005

RESUMO

Habitat alteration can influence suitability, creating ecological traps where habitat preference and fitness are mismatched. Despite their importance, ecological traps are notoriously difficult to identify and their impact on host-pathogen dynamics remains largely unexplored. Here we assess individual bat survival and habitat preferences in the midwestern United States before, during, and after the invasion of the fungal pathogen that causes white-nose syndrome. Despite strong selection pressures, most hosts continued to select habitats where disease severity was highest and survival was lowest, causing continued population declines. However, some individuals used refugia where survival was higher. Over time, a higher proportion of the total population used refugia than before pathogen arrival. Our results demonstrate that host preferences for habitats with high disease-induced mortality can create ecological traps that threaten populations, even in the presence of accessible refugia.


Assuntos
Doenças dos Animais , Quirópteros , Ecossistema , Sobrevida , Doenças dos Animais/microbiologia , Doenças dos Animais/mortalidade , Animais , Ascomicetos , Quirópteros/microbiologia , Conservação dos Recursos Naturais , Fungos/patogenicidade , Michigan , Nariz , Dinâmica Populacional , Temperatura , Wisconsin
3.
Anticancer Res ; 41(1): 317-326, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33419826

RESUMO

BACKGROUND/AIM: Several studies have reported that DM is closely associated with an increased incidence of hepatocellular carcinoma (HCC). To clarify the effects of diabetes mellitus (DM) and antidiabetic medications on the prognosis of patients with non-B non-C (NBNC) HCC following curative initial hepatectomy. PATIENTS AND METHODS: HCC patients (n=156) were divided into three groups according to the presence or absence of chronic viral hepatitis: hepatitis B virus (HBV) group, hepatitis C virus (HCV) group, and NBNC group. The clinical characteristics and survival outcomes were compared. In the NBNC group, univariate and multivariate analyses were conducted to determine prognostic factors. RESULTS: The NBNC group had a higher incidence of DM, ethanol intake, and large nodules than the other groups. Disease-free survival (DFS) was significantly worse in the NBNC group than in the HBV group. In the NBNC group, insulin treatment was an independent prognostic factor for DFS and overall survival (OS). CONCLUSION: Medications for DM that affect insulin resistance might be appropriate prognostic factors for NBNC-HCC.


Assuntos
Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/mortalidade , Diabetes Mellitus/tratamento farmacológico , Insulinas/administração & dosagem , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/mortalidade , Cuidados Pós-Operatórios , Adulto , Idoso , Carcinoma Hepatocelular/etiologia , Carcinoma Hepatocelular/cirurgia , Diabetes Mellitus/diagnóstico , Suscetibilidade a Doenças , Feminino , Hepatectomia , Humanos , Neoplasias Hepáticas/etiologia , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Prognóstico , Sobrevida
4.
Support Care Cancer ; 29(1): 223-230, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32338315

RESUMO

PURPOSE: To examine primary care physician's (PCPs) internal (confidence, training) and external (communication, receipt of survivorship care plans (SCPs)) regarding their provision of survivorship care to older breast cancer survivors METHOD: A web-based questionnaire was completed individually by PCPs about their training and areas of survivorship they address under their care. A subset of survey participants was interviewed about survivorship care for older breast cancer survivors, care coordination, and areas of improvement regarding SCPs. RESULTS: PCPs (n = 29) had an average 13.5 years in family practice. Forty-five percent surveyed as "somewhat confident" or "not confident" evaluating and managing the late effects of cancer treatment, and 25% surveyed as "somewhat confident" or "not confident" addressing the chronic comorbidities of older breast cancer survivors. More than half of PCPs surveyed that they reach out to their patients' oncologist "a little" or "none of the time" and that they receive SCPs "a little" or "none of the time." Semi-structured interviews also indicated that many PCPs did not receive a SCP from their patients' oncologists and that communication between the two providers regarding survivorship care was poor. CONCLUSION: Participants indicated that PCP confidence in providing survivorship care is lacking and that lack of training, infrequent communication with oncologists, and underutilization of SCPs may contribute to this lack of confidence. These findings provide insight into the possible need for a well-defined shared care model, which has been encouraged but not always a routine part of survivorship care in various practice settings.


Assuntos
Neoplasias da Mama/terapia , Sobreviventes de Câncer/estatística & dados numéricos , Médicos de Atenção Primária/psicologia , Atenção Primária à Saúde/métodos , Autoimagem , Adulto , Mama/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Sobrevida , Sobrevivência
5.
Rev. cuba. cir ; 59(4): e1015, oct.-dic. 2020. graf
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1149852

RESUMO

RESUMEN Introducción: La perforación del esófago constituye una de las urgencias más graves y difíciles que ha de afrontar un cirujano por las características y ubicación del órgano. El pronóstico depende sobre todo de la rapidez del diagnóstico y de la elección del tratamiento instaurado en principio. Objetivo: Presentar un caso portador del Síndrome de Boerhaave. Caso clínico: Paciente masculino en la 5ta década de vida que acudió por dolor torácico posterior a cuadro emético. Luego de estudio radiográfico se diagnosticó ruptura espontánea de esófago o síndrome de Boerhaave. Conclusiones: El enfoque terapéutico adecuado asociado al diagnóstico oportuno y precoz del síndrome garantiza mejores índices de sobrevida(AU)


ABSTRACT Introduction: Esophageal perforation is one of the most serious and difficult emergencies that a surgeon has to face due to the characteristics and location of the organ. Such prognosis depends mainly on the speed of the diagnosis and the choice of treatment established initially. Objectives: To present a case with such syndrome and to review the literature to update the therapeutic approach of this entity given its high mortality. Clinical case: Male patient in the fifth decade of life who presented for chest pain after an emetic condition. After a radiographic study, a spontaneous rupture of the esophagus or Boerhaave syndrome was diagnosed. Conclusions: The appropriate therapeutic approach associated with the early and timely diagnosis of the syndrome guarantees better survival rates(AU)


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Emergências , Perfuração Esofágica/diagnóstico por imagem , Esôfago/lesões , Ruptura Espontânea/terapia , Sobrevida
6.
Arq Gastroenterol ; 57(2): 172-177, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33206858

RESUMO

BACKGROUND: Hospital-based studies recently have shown increases in colorectal cancer survival, and better survival for women, young people, and patients diagnosed at an early disease stage. OBJECTIVE: To describe the overall survival and analyze the prognostic factors of patients treated for colorectal cancer at an oncology center. METHODS: The analysis included patients diagnosed with colon and rectal adenocarcinoma between 2000 and 2013 and identified in the Hospital Cancer Registry at A.C.Camargo Cancer Center. Overall 5-year survival was estimated using the Kaplan-Meier method, and prognostic factors were evaluated in a Cox regression model. Hazard ratios (HR) are reported with 95% confidence intervals (CI). RESULTS: Of 2,279 colorectal cancer cases analyzed, 58.4% were in the colon. The 5-year overall survival rate for colorectal cancer patients was 63.5% (65.6% and 60.6% for colonic and rectal malignancies, respectively). The risk of death was elevated for patients in the 50-74-year (HR=1.24, 95%CI =1.02-1.51) and ≥75-year (HR=3.02, 95%CI =2.42-3.78) age groups, for patients with rectal cancer (HR=1.37, 95%CI =1.11-1.69) and for those whose treatment was started >60 days after diagnosis (HR=1.22, 95%CI =1.04-1.43). The risk decreased for patients diagnosed in recent time periods (2005-2009 HR=0.76, 95%CI =0.63-0.91; 2010-2013 HR=0.69, 95%CI =0.57-0.83). CONCLUSION: Better survival of patients with colorectal cancer improves with early stage and started treatment within 60 days of diagnosis. Age over 70 years old was an independent factor predictive of a poor prognosis. The overall survival increased to all patients treated in the period 2000-2004 to 2010-2013.


Assuntos
Neoplasias do Colo/mortalidade , Neoplasias Colorretais/mortalidade , Neoplasias Retais/mortalidade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/uso terapêutico , Brasil/epidemiologia , Neoplasias do Colo/patologia , Neoplasias do Colo/terapia , Neoplasias Colorretais/patologia , Neoplasias Colorretais/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Neoplasias Retais/patologia , Neoplasias Retais/terapia , Sistema de Registros , Estudos Retrospectivos , Índice de Gravidade de Doença , Sobrevida , Análise de Sobrevida , Taxa de Sobrevida
7.
Bol Med Hosp Infant Mex ; 77(5): 234-241, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33064683

RESUMO

Background: Coronavirus disease (COVID)-19 has currently affected 8,015,502 million people worldwide with global mortality around 5%. Information in pediatric cancer patients is still limited, but it is emerging day by day. The objective of this scoping review was to analyze the available data associated with COVID-19 infection and mortality in pediatric cancer patients and to provide useful information to plan and design strategies in this group. Methods: A search was conducted, and eight articles were obtained for qualitative analysis; 110 patients were included, all from cross-sectional studies. At the time of publication, all the analyzed documents reported no deaths associated with COVID-19. Results: According to the information, COVID-19 infection appears to be less severe in the pediatric population in comparison with adults and does not appear to be a cause of mortality in patients with childhood cancer. Conclusions: Given the nature of preliminary reports and a short follow-up in cancer patients, it is necessary to have medium- and long-term follow-up studies to determine the effects of infection and modifications to the treatments of these patients.


Assuntos
Infecções por Coronavirus/epidemiologia , Neoplasias/complicações , Pneumonia Viral/epidemiologia , Adulto , Fatores Etários , Criança , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/virologia , Humanos , Pandemias , Pneumonia Viral/mortalidade , Pneumonia Viral/virologia , Índice de Gravidade de Doença , Sobrevida
8.
Rev. cir. (Impr.) ; 72(5): 482-491, oct. 2020. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1138744

RESUMO

Resumen La donación de órganos en Chile es insuficiente, con una tasa histórica de alrededor de seis donantes por millón de habitantes. Las reformas legales, mejoras organizacionales y campañas comunicacionales han permitido hacer del año 2019 el más exitoso en cuanto a donación de órganos y trasplantes. El trasplante hepático en Chile fue realizado por primera vez en el año 1969 en el Hospital Naval de Valparaíso, falleciendo el receptor precozmente. El primer trasplante exitoso fue realizado en el año 1985 en el Hospital Militar de Santiago. Desde esa fecha hasta la actualidad se han realizado 1.812 trasplantes de hígado, el 43,6% en hospitales universitarios, el 35,1% en clínicas privadas y un 21,5% en hospitales estatales. El 23,1% en la Pontificia Universidad Católica (PUC), el 20,6% en el Hospital Clínico de la Universidad de Chile (HCUCH), el 15,9% en el Hospital Luis Calvo Mackenna (HLCM), el 15,9% en Clínica Las Condes (CLC), el 14,3% en Clínica Alemana de Santiago (CA), el 5,6% en el Hospital del Salvador (HdS), 2% en Clínica Dávila (CD), 2% en el Sanatorio Alemán de Concepción (SA) y 0,9% en Clínica Santa María (CSM) De este total, 455 son en pacientes pediátricos, de ellos 63,3% en Hospital Luis Calvo Mackenna el 21,1% en la Clínica Las Condes el 7,7% en la Pontificia Universidad Católica de Chile, el 6,4% en la Clínica Alemana y 1,5% en el Sanatorio Alemán. Desde el 2015, aproximadamente el 80% de los trasplantes pediátricos se realizan en el HLCM. Sobrevidas reportadas en adultos van del 75% a 85% al año y de 75% a 92% al año en pacientes pediátricos dependiendo el período. Hay centros que nunca han reportado sus resultados. Se espera mejorar la educación en pro de una sociedad proclive en la donación, mejorar la organización de detección, mantención y procuramiento, aumentar la utilización de órganos, potenciar la utilización los de donantes cadáveres, con técnica Split o hígado dividido y, mientras no tengamos un sistema de donación que dé cuenta de las necesidades del país, mantener los programas de donante vivo. Finalmente debe motivarse a generaciones jóvenes para que se dediquen a esta importante actividad.


Organ donation in Chile is insufficient, with a historical rate of six donors per million inhabitants. Legal reforms, organizational improvements, and communications campaigns have made 2019 the most successful year in terms of organ donations and transplants. The first liver transplant in Chile was performed in 1969 at the Naval Hospital in Valparaíso. However, the patient passed away shortly after. The first successful transplant was performed in 1985 at the Militar Hospital in Santiago. As of that date to present day, 1.812 liver transplants have been performed: 43.6% of these in university hospitals, 35.1% in private clinics, and 21.5% in state hospitals. Of these, 23.1% were performed at the Pontificia Universidad Católica de Chile (PUC), 20.6% at the Universidad de Chile Clinical Hospital (HCUCH), 15.9% at the Luis Calvo Mackenna Hospital (HLCM), 15.9% at the Las Condes Clinic (CLC), 14.3% at the Alemana Clinic in Santiago (CA), 5.6% at the del Salvador Hospital (HdS), 2% at the Dávila Clinic (CD), 2% at the Alemán Sanatorium in Concepción (SA), and 0.9% at the Santa María Clinic (CSM). Of this total, 455 correspond to pediatric patients. Of these patients, 63.3% were at the Luis Calvo Mackenna Hospital, 21.1% at the Las Condes Clinic, 7.7% at the Pontificia Universidad Católica de Chile, 6.4% at the Alemana Clinic, and 1.5% at the Alemán Sanatorium. Since 2015, approximately 80% of pediatric transplants are performed at the HLCM. Reported one-year survival range from 75% to 85% in adults and 75% to 92% in pediatric patients per year, depending on the period. Some centers have never reported their results. It is expected that education of a society prone to organ donation improves, as well as improving the detection, maintenance, and procurement of potential donors, increasing the utilization of organs, enhancing the utilization of organs from deceased donors with Split technique, and, while we are building towards a donation system that responds to the needs of the nation, upholding live donor programs. Finally, younger generations are to be motivated so that they dedicate themselves to this important activity.


Assuntos
Humanos , Chile/epidemiologia , Transplante de Fígado/história , Transplantes/estatística & dados numéricos , Sobrevida , Doadores de Tecidos/estatística & dados numéricos , Obtenção de Tecidos e Órgãos/história , Obtenção de Tecidos e Órgãos/estatística & dados numéricos
9.
APMIS ; 128(12): 626-636, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32978821

RESUMO

Programmed cell death protein 1 (PD-1) is an immune checkpoint receptor which plays an important role in a patient's immune responses to microbial and cancer antigens. It is expressed in tumor-infiltrating lymphocytes (TILs) with many different malignancies. The aim of the study was to evaluate PD-1 expression and its prognostic value in tongue cancer. The data of tongue squamous cell carcinoma (TSCC) patients (N = 81) treated in Tampere University Hospital between 1999 and 2013 were used. Control data consisted of patients with non-malignant tongue mucous membrane lesions (N = 48). The formalin-fixed paraffin-embedded samples were stained immunohistochemically and scanned via digital microscope. The staining of PD-1 was examined semi-quantitatively. The density and intensity of PD-1 + cells were significantly higher in TSCC than in control samples. The expression of PD-1 correlated with better survival. The expression of PD-1 could be a potential prognostic marker in TSCC. Further research using larger sample size is needed.


Assuntos
Carcinoma de Células Escamosas/genética , Receptor de Morte Celular Programada 1/genética , Neoplasias da Língua/genética , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/genética , Biomarcadores Tumorais/metabolismo , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/patologia , Humanos , Pessoa de Meia-Idade , Prognóstico , Receptor de Morte Celular Programada 1/metabolismo , Sobrevida , Neoplasias da Língua/diagnóstico , Neoplasias da Língua/mortalidade , Neoplasias da Língua/patologia , Adulto Jovem
10.
Clinics (Sao Paulo) ; 75: e1553, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32935821

RESUMO

OBJECTIVES: To assess the patterns of failure and prognostic factors in Brazilian patients with glioblastoma multiforme (GBM) treated with radiotherapy (RT) and concurrent and adjuvant temozolomide (TMZ). METHODS: Patients with diagnosed GBM post-resection received postoperative RT. TMZ was administered concurrently at 75 mg/m2/day for 28 consecutive days and adjuvant therapy at 150-200 mg/m2/day for 5 days every 28 days. Radiographic failure was defined as any new T1-enhancing lesion or biopsy-confirmed progressive enhancement inside of the radiation field. When possible, patients with recurrence were salvaged with metronomic TMZ, either in combination with a local treatment or alone (surgery or re-irradiation). Several prognostic factors were evaluated for overall survival (OS). Univariate and multivariate analyses were performed to identify significant factors. A p-value <0.05 was considered significant. RESULTS: This study included 50 patients. The median follow-up time was 21 months. The median RT dose was 60 Gy and all patients received concomitant TMZ. During follow-up, 41 (83.6%) failures were observed, including 34 (83%) in-field, 4 (9.7%) marginal, and 3 (7.3%) distant failures. Metronomic TMZ was used as salvage treatment in 22 (44%) cases and in combination with local treatment in 12 (24%) cases. The median OS and progression-free survival times for the entire cohort were 17 and 9 months, respectively. In univariate analysis, the following factors were significant for better OS: maximal surgical resection (p=0.03), Karnofsky Performance Score (KPS)>70 at diagnosis (p=0.01), metronomic TMZ treatment (p=0.038), recursive partitioning analysis class III (p=0.03), and time to failure >9 months (p=0.0001). In multivariate analysis, the following factors remained significant for better OS: metronomic TMZ (p=0.01) and time to failure >9 months (p=0.0001). CONCLUSION: The median OS of Brazilian patients with GBM treated with RT and TMZ was satisfactory. Although TMZ therapy has become the standard of care for patients with newly diagnosed GBM, the recurrence rate is extremely high. Metronomic TMZ as salvage treatment improved survival in these patients.


Assuntos
Antineoplásicos Alquilantes/uso terapêutico , Neoplasias Encefálicas/terapia , Quimiorradioterapia/métodos , Glioblastoma/terapia , Recidiva Local de Neoplasia/epidemiologia , Temozolomida/uso terapêutico , Neoplasias Encefálicas/patologia , Brasil/epidemiologia , Quimioterapia Adjuvante , Feminino , Glioblastoma/mortalidade , Glioblastoma/patologia , Humanos , Masculino , Estudos Retrospectivos , Sobrevida , Resultado do Tratamento
11.
Value Health ; 23(7): 898-906, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32762992

RESUMO

OBJECTIVES: We evaluated how next generation sequencing (NGS) can modify care pathways in an observational impact study in France. METHODS: All patients with lung cancer, colorectal cancer, or melanoma who had NGS analyses of somatic genomic alterations done in 1 of 7 biomolecular platforms certified by the French National Cancer Institute (INCa) between 2013 and 2016 were eligible. We compared patients' pathways before and after their NGS results. Endpoints consisted of the turnaround time in obtaining results, the number of patients with at least 1 genomic alteration identified, the number of actionable alterations, the impact of the genomic multidisciplinary tumor board on care pathways, the number of changes in the treatment plan, and the survival outcome up to 1 year after NGS analyses. RESULTS: 1213 patients with a request for NGS analysis were included. NGS was performed for 1155 patients, identified at least 1 genomic alteration for 867 (75%), and provided an actionable alteration for 614 (53%). Turnaround time between analyses and results was on average 8 days (Min: 0; Max: 95) for all cancer types. Before NGS analysis, 33 of 614 patients (5%) were prescribed a targeted therapy compared with 54 of 614 patients (8%) after NGS analysis. Proposition of inclusion in clinical trials with experimental treatments increased from 5% (n = 31 of 614) before to 28% (n = 178 of 614) after NGS analysis. Patients who benefited from a genotype matched treatment after NGS analysis tended to have a better survival outcome at 1 year than patients with nonmatched treatment: 258 days (±107) compared with 234 days (±106), (P = .41). CONCLUSIONS: NGS analyses resulted in a change in patients' care pathways for 20% of patients (n = 232 of 1155).


Assuntos
Neoplasias Colorretais/genética , Sequenciamento de Nucleotídeos em Larga Escala/métodos , Neoplasias Pulmonares/genética , Melanoma/genética , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Colorretais/terapia , Feminino , França , Genômica/métodos , Acesso aos Serviços de Saúde , Humanos , Neoplasias Pulmonares/terapia , Masculino , Melanoma/terapia , Pessoa de Meia-Idade , Terapia de Alvo Molecular , Estudos Retrospectivos , Sobrevida , Fatores de Tempo , Adulto Jovem
12.
Medicine (Baltimore) ; 99(34): e21952, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846865

RESUMO

BACKGROUND: Sodium cantharidinate/vitamin B6 (SC/VB6) injection, a famous insect-derived traditional Chinese medicine preparation, has been widely applied as a promising adjunctive drug for hepatocellular carcinoma (HCC). However, its exact clinical efficacy and safety is still not well investigated. In this study, we aimed to summarize the efficacy of SC/VB6 injection on survival, liver function, immune function, and quality of life (QoL) in patients with HCC through the meta-analysis. METHODS: All available randomized controlled trials (RCTs) and high-quality prospective cohort studies that investigated the efficacy and safety of SC/VB6 for patients with HCC were searched from ten electronic databases including PubMed, Google Scholar, Cochrane Library, Excerpt Medica Database (Embase), Medline, Web of Science (WOS), Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), China Scientific Journal Database (CSJ), and Wanfang Database. Papers in Chinese or English published from January 2000 to July 2020 will be included without any restrictions.Study selection and data extraction will be performed independently by 2 researchers. The clinical outcomes including overall survival (OS), QoL, liver function, immune function, and adverse events, were systematically evaluated. Review Manager 5.3 and Stata 14.0 were used for data analysis, and the quality of the clinical trials was also evaluated. RESULTS: The results of this study will be published in a peer-reviewed journal, and provide a helpful evidence for clinicians to formulate the best postoperative adjuvant treatment strategy for HCC patients. CONCLUSION: Our study will draw an objective conclusion of the efficacy of SC/VB6 on survival, liver function, immune function, and QoL in patients with HCC. INPLASY REGISTRATION NUMBER: INPLASY202070121.


Assuntos
Cantaridina/análogos & derivados , Carcinoma Hepatocelular/tratamento farmacológico , Neoplasias Hepáticas/patologia , Vitamina B 6/farmacologia , Complexo Vitamínico B/farmacologia , Cantaridina/administração & dosagem , Cantaridina/farmacologia , Carcinoma Hepatocelular/mortalidade , Carcinoma Hepatocelular/psicologia , China/epidemiologia , Quimioterapia Combinada/métodos , Humanos , Sistema Imunitário/efeitos dos fármacos , Injeções/métodos , Fígado/efeitos dos fármacos , Medicina Tradicional Chinesa/métodos , Estudos Prospectivos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Segurança , Sobrevida , Resultado do Tratamento , Vitamina B 6/administração & dosagem , Complexo Vitamínico B/administração & dosagem
13.
Artigo em Inglês | MEDLINE | ID: mdl-32645886

RESUMO

The aim of this study was to analyze the changes in biochemical markers of oxidative stress and muscle damage, as well as psychomotor abilities during a military survival training. The study included 15 soldiers of special unit (SU), that completed 48 h military survival training combined with sleep deprivation. Before the training (P1), after 24 h (P2), and after 48 h of training (P3), blood samples were taken to measure biochemical markers. At the same time points, the measurements of divided attention and handgrip strength were conducted. Glutathione peroxidase activity decreased significantly at P3, in comparison with P1 and P2 (p < 0.0001), however, no changes were observed in other biochemical markers (i.e., lipid hydroperoxides, creatine kinase and superoxide dismutase activity) throughout the survival training (p > 0.05). The divided attention index was improved significantly at P2 and P3, as compared to P1 (p < 0.05). A tendency to change in maximum strength was found during the training period (main time effect; p = 0.08). Moreover, the strength differentiation (i.e., 50% maximum strength; 50%max) was higher at P3 than at P1 and P2 (p < 0.05). In conclusion, the 48 h survival training in the SU soldiers does not cause oxidative stress or muscle tissue damage, as well as any deterioration, and even improvement in psychomotor abilities. However, the change in strength differentiation (i.e., the production above 60%max instead of target 50%max) after the training may point to deterioration in motor control. Although it should be confirmed in further study with a more numerous group of soldiers, our findings indicate that the special unit soldiers will be able to perform, in a correct manner, specialized tasks related to their long-term activities, especially those which require divided attention. However, participation in long-term survival training, even with low workload, combined with sleep deprivation, results in a deterioration in motor control which may indicate the relevance of monitoring coordination motor abilities/skills in the training process of special unit soldiers.


Assuntos
Exercício Físico/fisiologia , Militares , Destreza Motora , Estresse Oxidativo/fisiologia , Privação do Sono , Sobrevida/fisiologia , Biomarcadores/sangue , Força da Mão/fisiologia , Humanos , Resistência Física/fisiologia
14.
Australas Psychiatry ; 28(6): 636-638, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32683892

RESUMO

OBJECTIVE: If the narrative of "coronavirus" has an underlying theme, it may perhaps for some be one of survival, whilst for others, the theme might be suffering. The recurring motif of survival has continued throughout history, yet for the first time the sum of all fears has amounted to a run on the bare essentials. This paper seeks to offer an alternative formulation of "panic buying," with references to literature, philosophy, and contemporary neurobiology. CONCLUSION: The bare essentials disappeared perhaps as part of some self-fulfilling prophecy: the supermarkets became bare because others inadvertently lead us to believe they would become bare. The contagion model of emotional propagation provides a psychological model of how "panic buying" by an individual might lead to the replication of panic in an observer. The Polyvagal Theory further informs us of how the threat posed by the pandemic primes our limbic system to perceive danger, and explains how witnessing others engaging in fight-flight responses might evoke a fearful affect in an observer. In the end, it is perhaps through Nietzsche's study of classical tragedy that we may find some meaning to the pandemic, allowing our collective lived experience to serve as a template for growth.


Assuntos
Infecções por Coronavirus/psicologia , Vítimas de Desastres/psicologia , Medo , Neurobiologia , Pânico , Pneumonia Viral/psicologia , Sobrevida/psicologia , Betacoronavirus , Ajustamento Emocional , Humanos , Pandemias , Teoria Psicológica , Psicologia Social
15.
Gac Med Mex ; 156(3): 208-216, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32539016

RESUMO

Introduction: As of March 23, 2020, suspension of non-essential activities was declared in Mexico throughout the country in order to mitigate the spread of the COVID-19 pandemic. Objective: To analyze data on the first 1,510 laboratory-confirmed cases of COVID-19 in Mexico, and to describe the geographical distribution of the disease and its transmission dynamics. Method: Description of the first COVID-19 cases with real-time RT-PCR-positive test, as well as evaluation of epidemiological measures, cumulative incidence, rate of transmission, and mortality and lethality rates during the first month of the epidemic. Results: Average age was 43 years, and 58 % were males; 44 % of initial cases were imported. Lethality in the population during the first month went from 1.08 to 3.97 per 100 cases; however, the trend is linear and similar to that observed in Europe. Conclusions: In Mexico, social distancing is being applied, but studies are still required on the dynamics of the epidemic, person-to-person transmission, incidence of subclinical infections, and patient survival.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Reação em Cadeia da Polimerase em Tempo Real/métodos , Isolamento Social , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Sobrevida , Adulto Jovem
16.
Rev. cuba. estomatol ; 57(2): e2448, abr.-jun. 2020. tab
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1126509

RESUMO

RESUMEN Introducción: La malignización de quiste dentígero a carcinoma intraóseo primario es infrecuente, poco documentada en la literatura. Corresponde del el 1 por ciento al 2,5 por ciento del total de tumores odontogénicos y es exclusiva de los huesos maxilares. Más común en hombres sobre 50 años de edad. Las características clínicas se asocian a edema, movilidad de piezas dentarias, parestesia, y la mayoría ocurre en ausencia de dolor, características que hacen difícil su diagnóstico y presentan un desafío para los patólogos. Objetivo: Revisar la prevalencia de carcinoma intraóseo primario derivados de quiste dentígero en los últimos 15 años publicados en PubMed Métodos: Se realizó una revisión de la literatura en un periodo que considera los últimos 15 años. Se consultó la base de datos PubMed utilizando los términos: "dentigerous cyst prevalence", "primary intraosseous squamous cell carcinoma", "dentigerous primary intraosseous squamous cell carcinoma". Se incluyeron artículos en inglés y español. De los 217 artículos, se suscribió a 39 para hacer el cruce de datos. Análisis e integración de los resultados: Para reconocer una enfermedad tan agresiva como el carcinoma intraóseo primario derivado de quiste dentígero hay que estudiar sus características clínicas, radiográficas y sintomatología. Su íntima relación con el quiste dentígero, el cual es el más prevalente de los quistes del desarrollo hace fundamental el profundo conocimiento de ambos. El carcinoma intraóseo primario se presenta como un desafío para los clínicos por su baja sintomatología y pobre sobrevida, con un total de 44 823 quistes odontogénicos estudiados, 9806 se diagnosticaron como quistes dentígeros, y 22 se malignizaron a carcinoma intraóseo primario, para un 0,32 por ciento del total. Conclusiones: La malignización de quiste dentígero a carcinoma intraóseo primario tiene una baja incidencia, pero se presenta silente haciendo difícil su diagnóstico precoz. Se recomienda biopsia de protocolo para cada caso de quiste dentígero y así evitar la baja sobrevida que produce el carcinoma intraóseo primario(AU)


ABSTRACT Introduction: Malignancy of dentigerous cyst into primary intraosseous carcinoma is infrequent and scantily documented in the literature. It represents 1 percent to 2.5 percent of the total odontogenic tumors and is exclusive of maxillary bones. It is more common among men aged around 50 years. Its clinical characteristics are edema, tooth mobility and paresthesia, and in most cases an absence of pain. These features hamper its diagnosis and pose a challenge to pathologists. Objective: Review the prevalence of primary intraosseous carcinoma derived from dentigerous cysts as published in PubMed in the last 15 years. Methods: A literature review was conducted of papers published in the last 15 years. The database PubMed was consulted using the following search terms: "dentigerous cyst prevalence", "primary intraosseous squamous cell carcinoma", "dentigerous primary intraosseous squamous cell carcinoma". The papers included were in English or Spanish. Of the 217 papers obtained, 39 were selected for data crossing. Data analysis and integration: Recognition of a condition as aggressive as primary intraosseous carcinoma derived from a dentigerous cyst requires examination of its clinical and radiographic characteristics as well as its symptoms. Its close relationship to dentigerous cyst, the most prevalent of developmental cysts, makes it necessary to gain an accurate and deep understanding of both. Primary intraosseous carcinoma poses a challenge to clinicians due to its low symptomatology and poor survival. Of the total 44 823 odontogenic cysts studied, 9 806 were diagnosed as dentigerous cysts and 22 maligned into primary intraosseous carcinoma, for 0.32 percent of the total. Conclusions: Malignation of a dentigerous cyst into primary intraosseous carcinoma has a low incidence and a silent presentation, which hampers its early diagnosis. Protocol biopsy is recommended for each case of dentigerous cyst to prevent the poor survival caused by primary intraosseous carcinoma(AU)


Assuntos
Humanos , Cisto Dentígero/patologia , Cistos Odontogênicos/epidemiologia , Tumores Odontogênicos/epidemiologia , Diagnóstico Precoce , Sobrevida , Literatura de Revisão como Assunto , Bases de Dados Bibliográficas
17.
Rev. colomb. cancerol ; 24(2): 72-79, abr.-jun. 2020. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1144323

RESUMO

Resumen Objetivo: Describir las características demográficas y clínicas de los pacientes con leucemia mieloide aguda (LMA) no promielocítica, y evaluar la mortalidad y la supervivencia de los niños tratados con protocolo LMA-INC 2004 (modificado de BFM 93) en la clínica de oncología pediátrica del Instituto Nacional de Cancerología, desde su instauración y por un periodo de 10 años y medio de seguimiento (mayo de 2004 a diciembre de 2014). Pacientes y método: Estudio observacional descriptivo retrospectivo de una cohorte con análisis de supervivencia de los pacientes menores de 18 años de edad con diagnóstico LMA tratados con quimioterapia intensiva sin mantenimiento ni trasplante. El análisis de supervivencia se realizó usando el método de Kaplan Meir. Resultados: Se analizaron 41 pacientes con diagnóstico de LMA excepto LMA M3, tratados con protocolo LMA-INC 2004. Se logró remisión completa en el 75,6% de los pacientes. La tasa de recaída fue de 27,4% anual y la tasa de muertes de 20,3% durante el periodo. La supervivencia general acumulada a dos años fue de 60% y a cinco años del 53,5%, con promedio de seguimiento de 4,3 años (3,2 - 5,2 años), y la supervivencia libre de recaída a cinco años fue del 42% con un tiempo promedio de seguimiento de 3,5 años (3,3 - 4,6 años). Conclusión: Los resultados muestran mejoría del 30% en la supervivencia de los pacientes con LMA como resultado de un tratamiento más intenso, que incluye la administración de altas dosis de citarabina y mitoxantrone en la consolidación y la intensificación, y que implica mejoría en los cuidados de soporte.


Abstract Objective: To describe the demographic and clinical characteristics of patients with acute myeloid leukemia; and to evaluate the mortality and survival of children treated with the LMA-INC 2004 protocol (modified from BFM 93) in a pediatric oncology clinic of the Colombian National Cancer Institute (Instituto Nacional de Cancerología de Colombia) between May 2004 and December 2014. Patients and methods: Retrospective descriptive observational study of a cohort with survival analysis of patients aged under 18 years, with a diagnosis of acute myeloid leukemia, who were treated with intensive chemotherapy without maintenance or transplantation. The survival analysis was performed using the Kaplan-Meier method. Results: We analyzed 41 patients diagnosed with myeloid leukemia, except acute myeloid leukemia type M3, who were, treated with the LMA-INC 2004 protocol. Complete remission was achieved in 75.6% of patients. The annual relapse rate was 27.4%; and the death rate 20.3%. Cumulative overall survival at 2 and 5 years was 60% and 53.5% respectively, with an average follow-up of 4.3 years (3.2 - 5.2 years); and the 5-year relapse-free survival was 42%, with an average follow-up time of 3.5 years (3.3 - 4.6 years). Conclusion: The results showed a 30% improvement in the survival of patients with acute myeloid leukemia, attributed to a more intense treatment that included the administration of high doses of cytarabine and mitoxantrone in consolidation and intensification; which implies improvement in supportive care.


Assuntos
Humanos , Criança , Pacientes , Sobrevida , Terapêutica , Leucemia Mieloide Aguda , Leucemia Mieloide , Análise de Sobrevida , Menores de Idade , Recidiva , Encaminhamento e Consulta , Assistência ao Convalescente
20.
Cien Saude Colet ; 25(5): 1575-1586, 2020 May.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32402018

RESUMO

This study aimed to evaluate the behavioral aspects and beliefs of the population of Ceará in the face of the COVID-19 pandemic. An online questionnaire was conducted on sociodemographic aspects and opinions related to the pandemic. Absolute and relative frequencies were calculated, the association between variables was performed with Chi-square, and the level of significance was 5%. The final sample had 2,259 participants, and an association was observed between females and perceiving themselves with a high risk of infection (p = 0.044) and males with non-performance of voluntary quarantine (p < 0.001). People aged 80 years and over were partially quarantined due to the flow of people at home (p < 0.001). Participants with elementary school education had a lower risk of infection than participants with a higher level of education (p < 0.001). This group includes people who did voluntary quarantine the least (p < 0.001). Participants living in the inland region of the state had less direct contact with someone tested positive for the Coronavirus (p = 0.031) and are less reclusive (p < 0.001). We can conclude that the approach to the COVID-19 pandemic varies by social aspects, such as gender, age, education, and place of residence, as well as the belief system of the population of the State of Ceará.


Assuntos
Infecções por Coronavirus , Conhecimentos, Atitudes e Prática em Saúde , Pandemias , Pneumonia Viral , Betacoronavirus , Brasil/epidemiologia , Infecções por Coronavirus/epidemiologia , Escolaridade , Feminino , Humanos , Pneumonia Viral/epidemiologia , Saúde Pública , Quarentena , Isolamento Social , Inquéritos e Questionários , Sobrevida
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...