RESUMO
BACKGROUND: The acquisition of experience is a major concern for nurses in intensive care units. Although the emotional component of the clinical practice of these nurses has been widely studied, greater examination is required to determine how this component influences their learning and practical experience. OBJECTIVE: To discover the relationships between emotion, memory and learning and the impacts on nursing clinical practice. RESEARCH DESIGN: This is a qualitative phenomenological study. The data were collected from open, in-depth interviews. A total of 22 intensive care unit nurses participated in this research between January 2012 and December 2014. Ethical considerations: The School of Nursing Ethics Committee approved the study, which complied with ethical principles and required informed consent. FINDINGS: We found a clear relationship between emotion, memory and the acquisition of experience. This relationship grouped three dimensions: (1) satisfaction, to relieve the patient's pain or discomfort, give confidence and a sense of security to the patient, enable the presence of family members into the intensive care unit and provide family members with a realistic view of the patient's situation; (2) error experience, which nurses feel when a patient dies, when they fail to accompany a patient in his or her decision to abandon the struggle to live or when they fail to lend support to the patient's family; and (3) the feel bad-feel good paradox, which occurs when a mistake in the patient's care or handling of his or her family is repaired. CONCLUSION: Emotion is a capacity that impacts on nurses' experience and influences improvements in clinical practice. Recalling stories of satisfaction helps to reinforce good practice, while recalling stories of errors helps to identify difficulties in the profession and recognise new forms of action. The articulation of emotional competencies may support the development of nursing ethics in the intensive care unit to protect and defend their patients and improve their relationships with families in order to maximise the potential for patient care.
Assuntos
Estado Terminal/enfermagem , Emoções , Enfermeiras e Enfermeiros/psicologia , Adulto , Estado Terminal/psicologia , Feminino , Humanos , Unidades de Terapia Intensiva/organização & administração , Masculino , Cuidados de Enfermagem/ética , Cuidados de Enfermagem/psicologia , Pesquisa Qualitativa , Espanha , Recursos HumanosRESUMO
BACKGROUND AND AIMS: Several studies have suggested that polyunsaturated fatty acids, vitamins and minerals have beneficial effects on lipid profile and systemic inflammation in adults. METHODS AND RESULTS: We examined the effects of a daily intake of milk enriched with longchain polyunsaturated fatty acids, oleic acid, carbohydrates, vitamins, minerals and low in saturated fatty acids (SFAs) for 5 months, on several cardiovascular (CVD) risk biomarkers in healthy children aged 8-14 years. In a randomized double-blind placebo-controlled trial, a total of 107 children of both genders were assigned to two study groups: 1) a supplemented group (SG, n=53) who consumed 0.6 L/day of an enriched dairy product, and 2) a control group (CG, n=54) who consumed 0.6 L/day of standard whole milk. Both groups consumed the dairy drinks for 5 months, in addition to their usual diet. Serum levels of adhesion molecules as indices of vascular endothelial cell activation were assessed in both groups at 0 and 5 months as well as white blood cell counts, lipid profile, serum proteins, total serum calcium, 25-OH vitamin D, glucose, insulin and adiponectin. In the enriched dairy drink supplemented group, adhesion molecules E-selectin and ICAM-1 as well as lymphocyte levels decreased while plasma docosahexaenoic acid (DHA) and serum calcium concentrations increased. In the control group, serum total protein, transferrin, total cholesterol, HDL-cholesterol and adiponectin concentrations decreased. CONCLUSION: The consumption of a milk enriched with fish oil, oleic acid, minerals and vitamins reduced indices of endothelial cell activation in the studied group of healthy children.
Assuntos
Selectina E/sangue , Óleos de Peixe/administração & dosagem , Alimentos Fortificados , Molécula 1 de Adesão Intercelular/sangue , Leite/química , Ácido Oleico/administração & dosagem , Oligoelementos/administração & dosagem , Vitaminas/administração & dosagem , Adolescente , Análise de Variância , Animais , Doenças Cardiovasculares/prevenção & controle , Criança , Colesterol/sangue , Laticínios/análise , Método Duplo-Cego , Ácidos Graxos/administração & dosagem , Feminino , Humanos , Masculino , Fatores de RiscoRESUMO
INTRODUCTION: Renal angiomyolipoma is a frequent manifestation of Tuberous Sclerosis Complex (TSC), for which everolimus therapy has been recently established as a novel non-invasive therapeutic option. As there are limited real life and long-term data, the analysis of our experience provides added value in terms of safety and efficacy. MATERIAL AND METHODS: Descriptive analysis of our experience in patients with giant bilateral renal angiomyolipomas, in the context of TSC, treated with 10 mg oral everolimus daily, during a median of 71.5 months. We evaluated the following parameters: response rate and duration, reduction of kidney size and lesions, prevention of complications and presentation of toxicity and its cause. RESULTS: We confirm the effectiveness of treatment in 4 young patients, with multiple, bilateral angiomyolipomas of a median of 12 (5-19) cm maximum diameter, from June 2013 to date, after continuous reduction in lesion size, a decrease of 30% of the volume in 75% at six months and 50% in half of the subjects at two years, still showing drug response. Absence of complications such as bleeding or glomerular filtration rate decline in the long term, with a favorable safety profile, without interruptions and with mild-moderate, non-cumulative adverse effects, mostly within the first year of treatment. CONCLUSION: Everolimus is a safe and effective therapeutic option for renal angiomyolipoma and various manifestations of TSC, which has been reproduced in real life with six years of follow-up.
Assuntos
Angiomiolipoma , Neoplasias Renais , Lipoma , Esclerose Tuberosa , Angiomiolipoma/tratamento farmacológico , Everolimo/efeitos adversos , Humanos , Neoplasias Renais/tratamento farmacológico , Esclerose Tuberosa/tratamento farmacológicoRESUMO
INTRODUCTION AND OBJECTIVES: Nivolumab is an immunotherapy agent that has been an approved treatment for previously treated patients with advanced renal cell carcinoma (RCC). Experience in real-life settings, especially regarding immune- related adverse events, is scarce. We present our experience with reference to the safety of nivolumab in patients with metastatic RCC (mRCC) treated in 9 hospitals in Spain. MATERIAL AND METHODS: Retrospective, multicentre study of patients with mRCC treated with nivolumab between 2016 and 2018. Data on baseline socio-demographic and clinical characteristics and drug-related adverse events were collected. RESULTS: The mean age of the 26 patients included was 63.7±11.5 years; 96% were ECOG 0-1 and 78% had favourable or intermediate MSKCC risk scores; 73% had the clear cell histological subtype and 30% metastatic disease. Median follow-up was 9 months (range 1-14). All patients experienced an adverse event at different grades, with fatigue, fever and anaemia being the most common (27%). Grade 3 adverse events occurred in 23% of patients. Adverse reactions led to treatment suspension in 3 patients (11%). CONCLUSION: In the real-life clinical setting, nivolumab shows favourable outcomes, similar to those reported by other studies.
Assuntos
Antineoplásicos Imunológicos/uso terapêutico , Carcinoma de Células Renais/tratamento farmacológico , Neoplasias Renais/tratamento farmacológico , Nivolumabe/uso terapêutico , Adulto , Idoso , Antineoplásicos Imunológicos/efeitos adversos , Carcinoma de Células Renais/secundário , Feminino , Humanos , Neoplasias Renais/patologia , Masculino , Pessoa de Meia-Idade , Nivolumabe/efeitos adversos , Estudos Retrospectivos , EspanhaRESUMO
From July 4, 1999, when a liver transplantation program was started in Cuba, to December 30, 2007, we performed 125 procedures in 115 patients. The most frequent reasons for transplantation were cirrhosis caused by hepatitis C virus (29%) and alcoholic cirrhosis (17.2%). Two patients received simultaneous liver-kidney transplants. Sixty-seven patients were males, and the patient ages ranged from 12 to 74 years. The average surgical time was 6 hours, and cold ischemia time was 4 to 14 hours. The average blood consumption was 1630 mL; 2900 mL of plasma and 8 units of platelets were used in 7 cases. Immunosuppression was mainly cyclosporine, mycophenolate mofetil, and prednisone. Acute cellular rejections were treated in almost all cases with 3 doses of methylprednisolone. The most frequent complications were biliary (15%), hepatic arterial thrombosis (6%), postsurgical bleeding (8%), acute cellular rejection (20%), and ductopenic rejection (2%). The overall 1-year survival was 74.7%.
Assuntos
Transplante de Fígado/estatística & dados numéricos , Cuba , Feminino , Humanos , Imunossupressores/uso terapêutico , Hepatopatias/classificação , Hepatopatias/cirurgia , Transplante de Fígado/imunologia , Transplante de Fígado/métodos , Masculino , Complicações Pós-Operatórias/epidemiologia , Estudos RetrospectivosRESUMO
Pulsed-field gel electrophoresis (PFGE) of SmaI macrorestriction fragments of genomic DNA as well as staphylococcal cassette chromosome mec (SCCmec) typing for mecA-carrying isolates were used to study the distribution of clonal types among 177 Staphylococcus aureus clinical isolates recovered in a Spanish hospital between 2000 and 2003. Five major clonal types (P1 to P5) were identified by PFGE, with one of them (P1) comprising the majority of strains (47.5%). According to SCCmec typing, SCCmec type IVA was the most prevalent type, showing increasing prevalence in the hospital setting with respect to other pandemic clones. One SCCmec pattern was detected in different PFGE types, which demonstrates that the latter is a major discriminative typing method. Three novel SCCmec elements or variants were found, each in a different PFGE type. Oxacillin (methicillin)-resistant and -susceptible S. aureus (MRSA and MSSA, respectively) strains were detected showing identical PFGE patterns, suggesting horizontal transfer of mecA to MSSA and/or mecA deletion from MRSA. Persistence of several S. aureus clones throughout the years within the same hospital environment was also observed.
Assuntos
Proteínas de Bactérias/genética , Técnicas de Tipagem Bacteriana , Farmacorresistência Bacteriana/genética , Eletroforese em Gel de Campo Pulsado/métodos , Transferência Genética Horizontal , Staphylococcus aureus/classificação , Antibacterianos/farmacologia , Conjugação Genética , Eritromicina/farmacologia , Humanos , Resistência a Meticilina/genética , Testes de Sensibilidade Microbiana , Oxacilina/farmacologia , Proteínas de Ligação às Penicilinas , Reação em Cadeia da Polimerase , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/genéticaRESUMO
In July 1999 we began a liver transplant program that to October 2005 has included 100 liver transplants in 92 patients, eight retransplants, and two combined liver and kidney grafts. Twelve transplants were in pediatric patients, who showed a 92% survival rate in the first year. Fifty-four percent of the patients were male and 46% female. The most frequent etiologies of cirrhosis were 27% hepatitis virus C, 18% alcoholic, 13% cryptogenic, and 11% autoimmune. In 95% of the patients, we preserved the retrohepatic vena cava. The bile duct was reconstructed with a Kehr tube in 46% of patients with 31% using end-to-end suture with a tutor and 15% an end-to-end suture without a tutor. A hepaticojejunostomy was performed in 8%. The immunosuppression included cyclosporine (Neoral) or Prograf combined with mycophenolate mofetil or mycophenolate sodium and steroids. The most frequent biliary complications were local anastomosis leaks (6%) and stenosis (10%). The overall 1-year survival rate was 72%.
Assuntos
Hepatopatias/cirurgia , Transplante de Fígado/estatística & dados numéricos , Cuba , Humanos , Transplante de Rim/estatística & dados numéricos , Hepatopatias/classificação , Reoperação , Estudos Retrospectivos , Veia Cava Inferior/cirurgiaRESUMO
The effects of tetrahydrocannabinol (THC) on several parameters of macrophage function in vitro were assessed. Delta 9 THC added to cultures of normal mouse peritoneal cells in vitro affected the ability of the cells to spread on glass surfaces and also had some effect on their ability to phagocytize yeast. These effects were dose related. A concentration of 20 micrograms of THC almost completely inhibited macrophage spreading, but it also decreased viability and the total number of these cells. Doses of 10 or 5 micrograms of THC also inhibited spreading but had little effect on cell viability or number. A dose of 1.0 microgram of THC had some inhibitory effect on spreading and the lowest dose affecting spreading appeared to be about 0.05 micrograms per culture. Higher doses of THC were necessary to inhibit phagocytosis of yeast particles as determined by direct microscopic examination or use of radiolabeled yeast as the test particles. These results indicate that several readily measured functions of macrophages may be suppressed by THC.
Assuntos
Dronabinol/farmacologia , Macrófagos/efeitos dos fármacos , Fagocitose/efeitos dos fármacos , Animais , Células Cultivadas , Ativação de Macrófagos/efeitos dos fármacos , Macrófagos/citologia , Macrófagos/fisiologia , Camundongos , Camundongos Endogâmicos BALB C , Cavidade Peritoneal/citologia , Baço/citologiaRESUMO
From July 4, 1999, when a liver transplantation program was started in Cuba, to October 2003, 66 procedures had been performed in 60 patients. The most frequent reason was cirrhosis caused by hepatitis C virus (29%), and alcoholic cirrhosis (22%). Two patients received simultaneous liver-kidney transplants. Half of the patients were men. Patient ages ranged from 12 to 62 years; the average surgical time was 6 hours; and cold ischemia time was 4 to 14 hours. The average blood consumption was 2033 mL; 2900 mL of plasma and 8 units of platelets were used in 7 cases. Immunosuppression was mainly cyclosporine (Neoral), mycophenolate mofetil or azathioprine, and prednisone. Acute cellular rejections were treated in almost all cases with 3 doses of methylprednisolone. The most frequent complications were biliary (24%), hepatic arterial thrombosis (12%), post-surgical bleeding (10%), acute cellular rejection (24%), and ductopenic rejection (2%). The overall 1-year survival rate was 73.7%.
Assuntos
Transplante de Fígado , Cuba , Hepatite C/cirurgia , Humanos , Terapia de Imunossupressão/métodos , Cirrose Hepática Alcoólica/cirurgia , Transplante de Fígado/imunologia , Transplante de Fígado/métodos , Estudos RetrospectivosRESUMO
PURPOSE: The aim of the study was to determine whether creatine malate (CML) supplementation results in similar ergogenic effect in sprinters and long-distance runners. The other goal was to compare changes in body composition, physical performance and hormone levels after six-week training in athletes, divided into subgroups supplemented with creatine malate or taking placebo. RESULTS: Six-week supplementation combined with physical training induced different effects in athletes. Significantly higher increases in relative and absolute peak power and total work (p < 0.05) were found in sprinters compared to other groups. Except for growth hormone, post-exercise venous blood serum hormone levels exhibited no statistically significant differences in athletes. After CML loading period, a significant increase in growth hormone was found in the group of sprinters. CONCLUSIONS: A significant ergogenic effect was found in sprinters, which was reflected by the increase in anaerobic exercise indices and morphological indices and elevated growth hormone level, after graded exercise testing. The significant increase in the distance covered during graded test was only observed in supplemented long-distance runners, whereas no significant changes in maximal oxygen uptake, relative peak power and relative total work were noticed. This could be caused by later anaerobic threshold appearance in exercise test to exhaustion.
Assuntos
Desempenho Atlético/fisiologia , Composição Corporal/fisiologia , Creatina/administração & dosagem , Suplementos Nutricionais , Hormônios/sangue , Resistência Física/fisiologia , Corrida/fisiologia , Administração Oral , Adulto , Composição Corporal/efeitos dos fármacos , Humanos , Malatos/administração & dosagem , Masculino , Consumo de Oxigênio/efeitos dos fármacos , Consumo de Oxigênio/fisiologiaRESUMO
It is now clear that AIDS results from a complex pathogenesis where virus-induced cytopathology represents only one of the contributing factors, while the others remain elusive. For this and other reasons there is much interest in the mechanisms whereby other classically immunodepressive noncytocidal retroviruses, such as viruses of the murine Friend leukemia complex (FLC), affect the immune system. FLC-induced immunosuppression has already provided important leads to the understanding of the mechanisms whereby retroviruses immunosuppress their hosts. It is expected that further investigation of the model will prove useful in several areas of AIDS research, including the development of efficacious drug therapies.
Assuntos
Síndrome da Imunodeficiência Adquirida , Modelos Animais de Doenças , Tolerância Imunológica , Leucemia Experimental/imunologia , Síndrome da Imunodeficiência Adquirida/imunologia , Animais , Vírus da Leucemia Murina de Friend/imunologia , Humanos , Interleucinas/biossíntese , Leucemia Experimental/prevenção & controle , Leucemia Experimental/terapia , Linfócitos/imunologia , CamundongosRESUMO
In olive fruits of the cultivar Arbequina, the chlorophyll pigments decrease significantly throughout ripening, while the carotenoids decrease more gradually and discontinuously. There is no degradation of the carotenoid fraction in stages before complete ripeness. The presence of esterified xanthophylls exclusively in this variety suggests that the chloroplast pigment metabolism is different from that in other olive varieties studied previously. There are increases of specific carotenoids, violaxanthin, neoxanthin, antheraxanthin, lutein epoxide, and esterified xanthophylls between the light green and yellowish green ripening stages. Such increases are related to the detection of precursor carotenoids (phytofluene and xi-carotene) in the yellowish green stage. Chlorophyllides (a and b) and alpha-carotene have also been detected exclusively in this variety. Quantitatively, the drastic change in color between light green and yellowish green ripening stages characteristic of this variety can be explained by the considerable reduction found in the chlorophylls/carotenoids ratio. The study of the pigments present in skin and pulp has shown that the pattern of carotenoid distribution differs depending on the fruit part concerned.
Assuntos
Carotenoides/análise , Clorofila/análise , Plantas Comestíveis/química , Plantas Comestíveis/crescimento & desenvolvimentoRESUMO
The induction of hypertrophy of cardiac and skeletal muscles has been studied after treatment with two different salbutamol dosages, therapeutic and doping. Treatment of rats subjected to a physical training schedule with repeated doses (16 microg kg(-1) per day or 3 mg kg(-1) per day) of salbutamol, a specific beta-adrenergic agonist, induced a marked increase in both skeletal and heart-muscle weight, whereas total body weight did not change significantly. Adrenergic involvement of salbutamol-linked muscle hypertrophy was demonstrated by co-administration of the non-specific beta-adrenergic antagonist, propranolol (20 mg kg(-1) per day). Salbutamol-induced muscle hypertrophy was associated with an increase in serum, skeletal-muscle and heart levels of the naturally occurring polyamines putrescine, spermidine and spermine. These observations suggest the involvement of polyamines in muscle hypertrophy and the possible role of blood polyamines as exposure biomarkers in beta-adrenergic-muscle hypertrophy.
Assuntos
Agonistas Adrenérgicos beta/administração & dosagem , Albuterol/administração & dosagem , Cardiomegalia/induzido quimicamente , Músculos/química , Poliaminas/sangue , Animais , Peso Corporal/efeitos dos fármacos , Cardiomegalia/metabolismo , Cromatografia Líquida de Alta Pressão , Relação Dose-Resposta a Droga , Hipertrofia/induzido quimicamente , Masculino , Tamanho do Órgão/efeitos dos fármacos , Condicionamento Físico Animal/efeitos adversos , Poliaminas/análise , Ratos , Ratos WistarRESUMO
OBJECTIVE: To describe the results obtained in 25 males with metastatic castration-resistant prostate cancer (MCRPC) treated with abiraterone (AA). A comparative analysis of abiraterone effectiveness and safety between our results and data published in the literature was conducted. MATERIAL AND METHOD: Bi-institutional prospective analysis of 25 consecutive patients with MCRPC undergoing treatment with abiraterone, with a mean follow-up 7.9 (3-15) months was carried out. Treatment effectiveness and safety analyses regarding baseline characteristics of patients (age, prior treatments, basal PSA, performance status, pain, metastasis) were conducted. RESULTS: At 13.6 months of follow-up, the overall survival is 80% (CI 95%: 11.8-15.4). Clinical and radiological-free progression survival is 9.5 ± 1 months (CI 95%: 7.7-11.3) and biochemical response is 6.8 ± 1 months (CI 95%: 5-8.7). Only the treatment with chemotherapy impaired significantly the response time to AA [6.4 months for radiological-free progression survival (CI 95%: 4.2-8,6) and 4.3 months for biochemical-free progression survival (CI 95%: 2.6-6)]. The incidence of adverse drug events was 36%, all of them grade 1-2/4 and, in no case, suspension or reduction of the dose of AA was needed. CONCLUSIONS: The treatment with AA has been effective in our series, with a tolerability considerably higher than what other studies published.
Assuntos
Acetato de Abiraterona/uso terapêutico , Antineoplásicos/uso terapêutico , Neoplasias de Próstata Resistentes à Castração/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Intervalo Livre de Doença , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
CONTEXT: Prostate cancer treatment remains a challenge for the urologist. Medical control in locally advanced or metastatic prostate cancer is usually performed with LHRH analogues and/or antiandrogens. Different treatments have been proposed when there is biochemical and clinical progression of the disease and other new ones have changed the patients' perspective and life expectancy. OBJECTIVE: This review has aimed to establish the current role of Abiraterone Acetate in the treatment of castration-resistant prostate cancer and facilitate decision-making by the Urologist by means of a Treatment Algorithm. ACQUISITION OF THE EVIDENCE: A search of current evidence on Abiraterone treatment in patients with castration- resistant metastatic prostate cancer was performed in PubMed, mainly analyzing those studies designed as clinical trials. In addition, we reviewed and updated the role of hormone therapy and androgen receptors in prostate cancer. EVIDENCE SYNTHESIS: There are currently basically two clinical trials that demonstrate the effectiveness of Abiraterone in metastatic prostate cancer compared to placebo. The study COU-AA 302 shows a clear benefit with Abiraterone prior to chemotherapy in patients with castration-resistant prostate cancer, this making it possible to establish an algorithm for initial treatment that facilitates decision-making by the urologist. CONCLUSION: Abiraterone is a pre-chemotherapy treatment option in selected patients with castration resistant metastatic prostate cancer, although it is necessary to improve the cost and to design more multicenter clinical trials to optimize the cost/benefit ratio.
Assuntos
Acetato de Abiraterona/uso terapêutico , Algoritmos , Antineoplásicos/uso terapêutico , Neoplasias de Próstata Resistentes à Castração/tratamento farmacológico , Quimioterapia Combinada , Humanos , Masculino , Esteroide 17-alfa-Hidroxilase/antagonistas & inibidoresRESUMO
INTRODUCTION: Laparoscopic surgery is following a natural course as it decreases surgical aggression on the abdominal wall without undermining the curative and functional results. Although it is still being developed, single port surgery has meant an advance in this sense. MATERIAL AND METHODS: We present the first single port laparoscopic pyelolithectomy surgery in horseshoe kidney, using conventional rigid instruments. The case of an 18-year old patient with BMI of 19 in whom the imaging tests (urogram and computed tomography) showed a horseshoe kidney with left coralliform lithiasis and discrete calyceal ectasia is presented. The lithiasis was extracted using umbilical access with single port device and conventional rigid instruments. RESULTS: The surgery was performed without complications. Surgery time was 110 minutes and bleeding 50 cc. On incision of the urinary system, there was purulent urine extravasation that conditioned fever of 38 °C in the post-operatory period. During the intervention, a double J stent was placed via percutaneous approach. The patient was discharged on the third day of hospitalization. CONCLUSION: Single port laparoscopic access for pyelolithectomy surgery in horseshoe kidney is a reasonable alterative. The use of conventional rigid instruments facilitates the performance of this surgery with good triangulation, without conflict regarding hands and safety for the patient.
Assuntos
Rim/anormalidades , Laparoscopia/métodos , Nefrolitíase/cirurgia , Adolescente , Antifúngicos/uso terapêutico , Candidíase/complicações , Candidíase/tratamento farmacológico , Dilatação Patológica/cirurgia , Desenho de Equipamento , Feminino , Fluconazol/uso terapêutico , Humanos , Rim/patologia , Cálices Renais/patologia , Cálices Renais/cirurgia , Pelve Renal/cirurgia , Laparoscópios , Laparoscopia/instrumentação , Nefrolitíase/complicações , Nefrolitíase/diagnóstico por imagem , Fatores de Risco , Stents , Tomografia Computadorizada por Raios X , Umbigo , Infecções Urinárias/complicações , Infecções Urinárias/tratamento farmacológicoRESUMO
In modern proteomics, prediction of protein-protein interactions (PPIs) is a key research line, as these interactions take part in most essential biological processes. In this paper, a new approach is proposed to PPI data classification based on the extraction of genomic and proteomic information from well-known databases and the incorporation of semantic measures. This approach is carried out through the application of data mining techniques and provides very accurate models with high levels of sensitivity and specificity in the classification of PPIs. The well-known support vector machine paradigm is used to learn the models, which will also return a new confidence score which may help expert researchers to filter out and validate new external PPIs. One of the most-widely analyzed organisms, yeast, will be studied. We processed a very high-confidence dataset by extracting up to 26 specific features obtained from the chosen databases, half of them calculated using two new similarity measures proposed in this paper. Then, by applying a filter-wrapper algorithm for feature selection, we obtained a final set composed of the eight most relevant features for predicting PPIs, which was validated by a ROC analysis. The prediction capability of the support vector machine model using these eight features was tested through the evaluation of the predictions obtained in a set of external experimental, computational, and literature-collected datasets.
Assuntos
Genômica/métodos , Mapeamento de Interação de Proteínas/métodos , Proteômica/métodos , Máquina de Vetores de Suporte , Mineração de Dados/métodos , Bases de Dados Genéticas , Curva ROC , Reprodutibilidade dos Testes , Saccharomyces cerevisiae/genética , Saccharomyces cerevisiae/metabolismo , Sensibilidade e EspecificidadeRESUMO
The use of bortezomib in combination with other desensitization therapies like plasmapheresis, IVIG, and rituximab has allowed the decrease of antibody levels during treatment in some patients. However, all patients described here have experienced rebound effects to the same or higher levels than the ones before therapy was started. Unfortunately, no donors became available to some of these patients when their antibodies were at lower levels. Three out of the four patients presented had adverse reactions to bortezomib which include nausea, vomiting, diarrhea, myalgias and severe neuropathy. In one patient (pre-heart transplant patient #1) we noticed that some clones were selectively more susceptible to the treatment with bortezomib than others. We will continue antibody monitoring in this patient and hopefully the possibility is there, even though the overall PRA is not reduced, that certain clones will be affected and no longer produced antibody allowing these patients a wider selection of acceptable donors.
Assuntos
Ácidos Borônicos/uso terapêutico , Dessensibilização Imunológica/métodos , Transplante de Coração/imunologia , Transplante de Pulmão/imunologia , Inibidores de Proteases/uso terapêutico , Pirazinas/uso terapêutico , Adulto , Idoso , Bortezomib , Cardiomiopatias/cirurgia , Feminino , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Isoanticorpos/sangue , Isoanticorpos/efeitos dos fármacos , Masculino , Pessoa de Meia-Idade , Plasmaferese , Reação Transfusional , Listas de EsperaRESUMO
Previously, we reported that the combination of plasmapheresis (PP) and intravenous immunoglobulin (IVIg) allow sensitized patients to undergo orthotopic heart transplantation (OHT), even across a positive crossmatch. In the current study, the effect of that combination, PP+IVIg, on survival of a larger group of such recipients is investigated. The latter group (I) consisted of 35 sensitized patients who received PP+IVIG together with standard immunosuppressive drugs. Rejection was seen in 11 patients, findings strongly suggestive of a vascular (humoral) being identified in five of those cases. Four deaths occurred, two of them in the immediate post-operative period, one after almost six months, and one after almost two yr post-OHT. Follow-up range 4.5 months to 7.8 yr post-OHT (average=1.1 yr). Patient survival was analyzed after generation of a Kaplan-Meier plot. Comparison with a control OHT group (II) given standard immunosuppressive drugs only (N=276) showed enhanced survival of group I (p=0.0414 by log-rank test). We conclude that the combination of PP and IVIG (i) is associated with declines in T- and B-percent-reactive antibody and in crossmatch positivity, and (ii) is very useful in the management of the sensitized cardiac patient undergoing OHT, often allowing a successful outcome to transplantation in the face of a positive crossmatch.