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OBJECTIVE: Stereotactic radiosurgery (SRS) is used for the treatment of residual/recurrent nonfunctional pituitary adenoma (NFPA). The aim of this study was to evaluate the factors related to long-term tumor control and delayed endocrinopathies following SRS. METHODS: This retrospective, multicenter study included patients with recurrent/residual NFPA treated with single-fraction SRS; they were then divided into two arms. The first arm included patients with at least 5 years of radiographic follow-up and all patients with local tumor progression. The second arm included patients with at least 5 years of endocrinological follow-up and all patients who developed endocrinopathy. Study endpoints were tumor control and new or worsening hypopituitarism after SRS and were analyzed using Cox regression and Kaplan-Meier methodology. RESULTS: There were 360 patients in the tumor control arm (median age 52.7 [IQR 42.9-61] years, 193 [53.6%] males) and 351 patients in the hypopituitarism arm (median age 52.5 [IQR 43-61] years, 186 [53.0%] males). The median follow-up in the tumor control evaluation group was 7.95 (IQR 5.7-10.5) years. Tumor control rates at 5, 8, 10, and 15 years were 93% (95% CI 90%-95%), 87% (95% CI 83%-91%), 86% (95% CI 82%-90%), and 69% (95% CI 59%-81%), respectively. The median follow-up in the endocrinopathy evaluation group was 8 (IQR 5.9-10.7) years. Pituitary function preservation rates at 5, 8, 10, and 15 years were 83% (95% CI 80%-87%), 81% (95% CI 77%-85%), 78% (95% CI 74%-83%), and 71% (95% CI 63%-79%), respectively. A margin dose > 15 Gy (HR 0.8, 95% CI 0.7-0.9; p < 0.001) and a delay from last resection to SRS > 1 year (HR 0.9, 95% CI 0.7-0.9; p = 0.04) were significant factors related to tumor control in multivariable analysis. A maximum dose to the pituitary stalk ≤ 10 Gy (HR 1.1, 95% CI 1.09-1.2; p < 0.001) was associated with pituitary function preservation. New visual deficits after SRS occurred in 7 (1.94%) patients in the tumor control group and 8 (2.3%) patients in the endocrinopathy group. Other new cranial nerve deficits post-SRS occurred in 4 of 160 patients with data in the tumor control group and 3 of 140 patients with data in the endocrinopathy group. CONCLUSIONS: SRS affords favorable and durable tumor control for the vast majority of NFPAs. Post-SRS hypopituitarism occurs in a minority of patients, but this risk increases with time and warrants long-term follow-up.
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BACKGROUND: Higher risk of secondary brain tumor, carotid stenosis and stroke has been reported after conventional sella irradiation for pituitary neuroendocrine tumors (PitNET). Stereotactic radiosurgery (SRS), which is a more focused approach, is now increasingly used instead. The aim was to assess the risk of secondary brain tumor, carotid stenosis/occlusion and stroke after SRS. METHODS: In this multicentric retrospective study, 2,254 patients with PitNET were studied, 1,377 in the exposed group and 877 in the control group. RESULTS: There were 9,840.1 patient-years at risk for the SRS and 5,266.5 for the control group. The 15-year cumulative probability of secondary intracranial tumor was 2.3% (95%CI:0.5%, 4.1%) for SRS and 3.7% (95%CI:0%, 8.7%) for the control group (p=0.6), with an incidence rate of 1.32 per 1,000 and 0.95 per 1,000, respectively. SRS was not associated with increased risk of tumorigenesis when stratified by age (HR: 1.59 [95%CI: 0.57, 4.47], p=0.38). The 15-year probability of new carotid stenosis/occlusion was 0.9% (95%CI: 0.2, 1.6) in the SRS and 2% (95%CI: 0, 4.4) in the control group (p=0.8). The 15-year probability of stroke was 2.6% (95%CI: 0.6%, 4.6%) in the SRS and 11.1% (95%CI: 6%, 15.9%) in the control group (p<0.001). In cox multivariate analysis stratified by age, SRS (HR 1.85[95%CI:0.64, 5.35], p=0.26) was not associated with risk of new stroke. CONCLUSION: No increased risk of long-term secondary brain tumor, new stenosis or occlusion and stroke was demonstrated in SRS group compared to control in this study with imaging surveillance.
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Dengue virus (DENV) is currently causing epidemics of unprecedented scope in endemic settings and expanding to new geographical areas. It is therefore critical to track this virus using genomic surveillance. However, the complex patterns of viral genomic diversity make it challenging to use the existing genotype classification system. Here we propose adding two sub-genotypic levels of virus classification, named major and minor lineages. These lineages have high thresholds for phylogenetic distance and clade size, rendering them stable between phylogenetic studies. We present an assignment tool to show that the proposed lineages are useful for regional, national and sub-national discussions of relevant DENV diversity. Moreover, the proposed lineages are robust to classification using partial genome sequences. We provide a standardized neutral descriptor of DENV diversity with which we can identify and track lineages of potential epidemiological and/or clinical importance. Information about our lineage system, including methods to assign lineages to sequence data and propose new lineages, can be found at: dengue-lineages.org.
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Este estudo investigou os fatores associados à satisfação com a vida de 654 idosos usuários de Unidades Básicas de Saúde de Maringá, Paraná. Foi utilizado um questionário sociodemográfico, o International Physical Activity Questionnaire (IPAQ) e a Escala de Satisfação com a Vida. A análise dos dados foi realizada por meio dos testes de Kruskal-Wallis, Mann-Whitney e correlação de Spearman (p < 0,05). Verificou-se que os idosos com menor poder aquisitivo que se perceberam com saúde ruim e tomam medicamentos regularmente são menos satisfeitos com a vida do que seus pares. Os idosos fisicamente ativos se mostraram mais satisfeitos com a vida do que os sedentários/irregularmente ativos. A satisfação com a vida se associou com os dias de caminhada por semana (r = 0,15). Conclui-se que a renda familiar, a percepção de saúde, o uso de medicamentos e a atividade física são fatores intervenientes na satisfação com a vida.
This study investigated the associated factors involved in life satisfaction of 654 elderly users of Basic Health Units of Maringá, Paraná. A sociodemographic questionnaire was used, the International Physical Activity Questionnaire (IPAQ) and the Life Satisfaction Scale. Data analysis was performed using the Kruskal-Wallis, Mann-Whitney, and Spearman correlation tests (p < 0.05). Older people with lower purchasing power who were perceived with poor health and who take medications regularly are less satisfied with life than their peers (p < 0.05). The physically active elderly were more satisfied with life than the sedentary/irregularly active (p = 0.004). Satisfaction with life correlated with walking days per week (r = 0.15). It is concluded that family income, health perception, medication use, and physical activity are factors that intervene in life satisfaction.
Este estudio investigó los factores asociados con la satisfacción con la vida de 654 ancianos usuarios de Unidades Básicas de Salud de Maringá, Paraná. Se utilizó un cuestionario sociodemográfico, el International Physical Activity Questionnaire (IPAQ) y la Escala de Satisfacción con la vida. El análisis de los datos fue realizado por medio de las pruebas de Kruskal-Wallis, Mann-Whitney y correlación de Spearman (p < 0,05). Se verificó que los ancianos con menor poder adquisitivo que se percibieron con mala salud y que toman medicamentos regularmente son menos satisfechos con la vida que sus pares. Los ancianos físicamente activos se mostraron más satisfechos con la vida que los sedentarios/irregularmente activos. La satisfacción con la vida se asoció con los días de caminata por semana (r = 0,15). Se concluye que la renta familiar, la percepción de salud, el uso de medicamentos y la actividad física son factores intervinientes en la satisfacción con la vida.