The intermediate stage of the Barcelona Clinic Liver Cancer (BCLC) classification includes a heterogenous population of patients with hepatocellular carcinoma (HCC), and palliative treatment with ...transarterial chemoembolization is recommended for all of them. In this regard, 2 other classifications could be useful, the subclassification BCLC-B (SUB) and the classification Hong Kong Liver Cancer (HKLC).
To determine the indication of curative or palliative treatment between SUB and HKLC in BCLC-B patients.
A retrospective study in HCC patients seen between 2011 and 2016 in southern Brazil. Demographic, clinical, and laboratory data were collected. HCC staging was performed with BCLC, SUB, and HKLC.
A total of 570 patients with HCC were assessed, of whom 95 were classified as BCLC-B: 25 (26.0%) B1, 48 (50.5%) B2, 9 (9.5%) B3, and 13 (13.7%) B4. Overall median survival was 21.1 (95% confidence interval, 14.2-28.0) months. Median survival was higher for BCLC-B1 patients than in subgroups B3 (P=0.046) and B4 (P=0.001), and this was also seen for B2 versus B4 (P=0.044). Regarding the HKLC classification, a significantly higher median survival was observed for HKLC-I and HKLC-IIB in relation to the categories HKLC-IIIA (P<0.001 and 0.004, respectively) and HKLC-IIIB (P<0.001 and 0.006, respectively). When HKLC was applied, the following were identified as candidates for curative treatment: BCLC-B1, 24 (96.0%); BCLC-B2, 26 (54.2%); BCLC-B3, 0 (0%); and BCLC-B4, 3 (23.1%).
In intermediate HCC, SUB was able to identify a subset of patients with a higher overall survival. According to HKLC, 55.8% of BCLC-B patients could receive curative treatment.
Resumo: Estima-se que no Brasil existam cerca de 900 mil indígenas (0,4% da população do país) pertencentes a mais de 300 etnias diferentes. Porém, informações sobre a epidemiologia do câncer e sobre ...os medicamentos antineoplásicos utilizados no tratamento desses indivíduos são escassas. Os objetivos do presente estudo são identificar os medicamentos antineoplásicos utilizados e descrever o perfil de utilização deles na população indígena tratada no Brasil, além de descrever o perfil epidemiológico dos usuários. Foi realizado um estudo do tipo ecológico que envolveu os atendimentos ambulatoriais de quimioterapia, realizados no período de janeiro de 2014 e dezembro de 2018, em todo o Brasil. A fonte de coleta dos dados utilizada foi o Sistema de Informação Ambulatorial, do Departamento de Informática do SUS, considerando apenas as Autorizações de Procedimentos de Alta Complexidade para Quimioterapia. Foram identificadas 2.425 autorizações para procedimentos de quimioterapia destinadas ao tratamento de pacientes indígenas. Um total de 2.292 autorizações, para um total de 210 indivíduos, foram analisadas. Observou-se um aumento do número de autorizações e de indígenas em uso de quimioterapia ao longo do período, maior concentração de indivíduos residentes e em tratamento na Região Sul do país, diversidade de tipos de tumores diagnosticados (n = 63) e de esquemas terapêuticos utilizados durante o tratamento (n = 107). O presente estudo trouxe um novo panorama sobre o perfil epidemiológico dos usuários indígenas sob tratamento quimioterápico no Sistema Único de Saúde. Os achados contribuem para o preenchimento da atual lacuna de conhecimento a respeito da saúde indígena no Brasil.
Abstract: Brazil has an estimated 900,000 indigenous people (0.4% of the country’s population), belonging to more than 300 different ethnic groups. However, information is scarce on cancer epidemiology and the antineoplastic drugs used in treatment of these individuals. The study’s objectives are to identify the antineoplastic drugs used and to describe the profile of use of these drugs in the indigenous population treated in Brazil, as well as to describe the patients’ epidemiological profile. An ecological study was performed involving outpatient chemotherapy care from January 2014 to December 2018 throughout Brazil. The data source was the Outpatient Information System of the Brazilian Health Informatics Department, considering only Authorizations for High-Complexity Chemotherapy Procedures. We identified 2,425 authorizations for chemotherapy procedures for treatment of indigenous patients. Of these, 2,292 authorizations for a total of 210 individuals were analyzed. We found an increase in the number of authorizations and of indigenous persons receiving chemotherapy over the period, with a higher concentration of individuals living in and receiving treatment in the South of Brazil, plus a wide diversity in the types of diagnosed tumors (n = 63) and of treatment regimen used during the treatment (n = 107). The current study provided a new overview of the epidemiological profile of indigenous patients receiving chemotherapy in the Brazilian Unified National Health System. The findings help fill a current knowledge gap on indigenous people’s health in Brazil.
Resumen: Se estima que en Brasil existan cerca de 900 mil indígenas (0,4% de la población del país) pertenecientes a más de 300 etnias diferentes. No obstante, la información sobre la epidemiología del cáncer y medicamentos antineoplásicos utilizados en el tratamiento de esos individuos es escasa. Los objetivos del presente estudio son identificar los medicamentos antineoplásicos utilizados, y describir el perfil de utilización de esos medicamentos en la población indígena tratada en Brasil, así como describir el perfil epidemiológico de los usuarios. Se realizó un estudio de tipo ecológico, implicando la atención ambulatoria con quimioterapia, realizada en el período de enero de 2014 y diciembre de 2018 en todo Brasil. La fuente de recogida de datos utilizada fue el Sistema de Información Ambulatoria, del Departamento de Informática del SUS, considerando solamente las Autorizaciones de Procedimientos de Alta Complejidad para Quimioterapia. Se identificaron 2.425 autorizaciones para procedimientos de quimioterapia, destinadas al tratamiento de pacientes indígenas. Se analizaron 2.292 autorizaciones para un total de 210 individuos. Se observó un aumento del número de autorizaciones y de indígenas en el tratamiento de quimioterapia a lo largo del período, con una mayor concentración de individuos residentes y en tratamiento en la región sur del país, con una diversidad de tipos de tumores diagnosticados (n = 63) y de esquemas terapéuticos utilizados durante el tratamiento (n = 107). El presente estudio presentó un nuevo panorama sobre el perfil epidemiológico de los usuarios indígenas bajo tratamiento quimioterápico en el Sistema Único de Salud. Los hallazgos contribuyen a llenar la actual laguna de conocimiento con respecto a la salud indígena en Brasil.
The growth of the world's population increases the demand for fresh water, food, energy, and technology, which in turn leads to increasing amount of wastewater, produced both by domestic and ...industrial sources. These different wastewaters contain a wide variety of organic and inorganic compounds which can cause tremendous environmental problems if released untreated. Traditional treatment systems are usually expensive, energy demanding and are often still incapable of solving all challenges presented by the produced wastewaters. Microalgae are promising candidates for wastewater reclamation as they are capable of reducing the amount of nitrogen and phosphate as well as other toxic compounds including heavy metals or pharmaceuticals. Compared to the traditional systems, photosynthetic microalgae require less energy input since they use sunlight as their energy source, and at the same time lower the carbon footprint of the overall reclamation process. This mini‐review focuses on recent advances in wastewater reclamation using microalgae. The most common microalgal strains used for this purpose are described as well as the challenges of using wastewater from different origins. We also describe the impact of climate with a particular focus on a Nordic climate.
Sand fly saliva contains molecules that modify the host's hemostasis and immune responses. Nevertheless, the role played by this saliva in the induction of key elements of inflammatory responses, ...such as lipid bodies (LB, also known as lipid droplets) and eicosanoids, has been poorly investigated. LBs are cytoplasmic organelles involved in arachidonic acid metabolism that form eicosanoids in response to inflammatory stimuli. In this study, we assessed the role of salivary gland sonicate (SGS) from Lutzomyia (L.) longipalpis, a Leishmania infantum chagasi vector, in the induction of LBs and eicosanoid production by macrophages in vitro and ex vivo.
Different doses of L. longipalpis SGS were injected into peritoneal cavities of C57BL/6 mice. SGS induced increased macrophage and neutrophil recruitment into the peritoneal cavity at different time points. Sand fly saliva enhanced PGE₂ and LTB₄ production by harvested peritoneal leukocytes after ex vivo stimulation with a calcium ionophore. At three and six hours post-injection, L. longipalpis SGS induced more intense LB staining in macrophages, but not in neutrophils, compared with mice injected with saline. Moreover, macrophages harvested by peritoneal lavage and stimulated with SGS in vitro presented a dose- and time-dependent increase in LB numbers, which was correlated with increased PGE₂ production. Furthermore, COX-2 and PGE-synthase co-localized within the LBs induced by L. longipalpis saliva. PGE₂ production by macrophages induced by SGS was abrogated by treatment with NS-398, a COX-2 inhibitor. Strikingly, SGS triggered ERK-1/2 and PKC-α phosphorylation, and blockage of the ERK-1/2 and PKC-α pathways inhibited the SGS effect on PGE₂ production by macrophages.
In sum, our results show that L. longipalpis saliva induces lipid body formation and PGE₂ production by macrophages ex vivo and in vitro via the ERK-1/2 and PKC-α signaling pathways. This study provides new insights regarding the pharmacological mechanisms whereby L. longipalpis saliva influences the early steps of the host's inflammatory response.
In this paper, eight ultrahigh-voltage gain dc-dc converters are proposed. These sets of converters are derived by the association of boost cells, coupled inductor, voltage multiplier, switched ...capacitors, and LC filter cells. The nonpulsating input and output converters are evaluated in terms of: principle of operation, voltage gain, voltage and current stress, estimated power losses, and efficiency. Following full analysis prototypes built in the laboratory show experimental results verifying the theoretical analysis.
Type 1 diabetes mellitus and oral health are strictly related on a reciprocal basis, and an increased susceptibility to a wide variety of oral diseases is recognised in these patients. The aim of the ...present study was to establish a relationship between the prevalence of dental caries in Type 1 diabetic patients treated with insulin pump and that of non-diabetic patients.
An observational clinical study of analytical and cross-sectional nature was conducted. The sample consisted of 30 adults with diabetes mellitus treated with insulin pump (selected from the Coimbra Hospital and Universitary Centre) and 30 nondiabetic adults (selected from the ones accompanying the diabetic patients). One dentist evaluated all of the patients between January and May of 2015 in the Faculty of Medicine of the University of Coimbra. During the clinical evaluation a case report form adapted to the objectives of the investigation was completed. Data analysis was performed and the significance level was set at 5%.
Diabetic patients showed similar levels on the caries and plaque index to non-diabetic patients. There were no statistically significant differences between the two groups as regards oral hygiene habits and frequency of visits to the dentist. Discussão: Although diabetics' diet is less abundant in carbohydrates, which provides a smaller exposure to cariogenic food, the regularity of meals can increase the risk of caries since the critical pH for demineralization is reached frequently throughout the day. However, the existence of a chronic condition may determine a high concern for general preventive care, resulting in an overall improvement of their oral health, which could justify the results.
Type 1 diabetic patients treated with insulin pump don't have a higher prevalence of dental caries.
Cryptococcosis occurs in acquired immunodeficiency syndrome (AIDS) patients with poor compliance to antiretroviral therapy or unaware of their human immunodeficiency virus status who present severe ...immunosuppression at admission. Consequently, high mortality rates are observed due to disseminated fungal infection. This report presents clinical and postmortem data of AIDS patients with cryptococcosis in a teaching hospital in Brazil. Retrospectively, medical and necropsy records of AIDS patients with cryptococcosis clinically confirmed and/or postmortem verified were reviewed. Clinical data were compared with those of patients presenting a good outcome to evaluate disseminated fungal infection and the agreement between clinical and postmortem diagnosis. At admission, most of the 45 patients with cryptococcal meningitis who died, presented more altered consciousness (P = 0.0047), intracranial increased pressure (P = 0.047), and severe malnutrition (P = 0.0006) than the survivors. Of 29 (64.4%) patients with cryptococcal meningitis, 23 died before week 2 on antifungal therapy, and the other six during the next 3 months. The remaining 16 (35.6%) cases had other diagnoses and died soon after. At necropsy, 31 (68.9%) presented disseminated infection involving two or more organs, whereas 14 (31.1%) cases had meningeal or pulmonary localized infection. The agreement of 64.4% between clinical and postmortem diagnosis was similar to some studies. However, other reports have shown figures ranging from 34% to 95%. Currently, a progressive worldwide decrease of autopsies is worrying because the role of postmortem examination is pivotal to verify or identify the death causes, which contributes to improve the quality of clinical diagnosis and medical training.
Sugarcane productivity is severely affected by the occurrence of water deficit in the field, causing inhibition of growth and sugar production. Evaluating physiological responses of sugarcane under ...water deficit conditions is essential to understand physiological variables responsible for reaching homeostasis. Therefore, we analysed physiological traits of two sugarcane genotypes, RB835486 (Tolerant) and RB855453 (Susceptible), under water deficit conditions: well‐watered (WW‐Control), water deficit (WD) and rewatered (RW). The physiological response was evaluated using linear regression and multivariate analysis. Some characteristics such as water potential in leaves, photosynthesis, chlorophyll fluorescence, chlorophyll index, sucrose and starch contents did not show differences between the genotypes under water deficit conditions. However, the tolerant genotype showed increased reducing sugars content in the leaves, whereas the susceptible genotype had increased non‐photochemical quenching (qN). After rewatering, the susceptible sugarcane genotype showed higher electron transport rate (ETR) and efficiency of PSII (Y). Multivariate analysis revealed that non‐photochemical quenching and reducing sugars in the leaves were physiological variables responsible for reaching homestasis under water deficit conditions. Therefore, the reducing sugars concentration should be considered a physiological variable responsible for the adjustment made by the tolerant sugarcane genotype when submitted to water deficit.
Principal components analysis based on physiologic variables measured on sugarcane genotypes (RB835486, RB855453) under different water conditions: well‐watered (WW, control), water deficit (WD) and rewatered (RW). Physiological traits evaluated (n = 18): water potential pre‐dawn (Wp); chlorophyll index (Chlorophyll); CO2 assimilation (A); respiration (Rd); starch; sucrose; reducing sugars (RS); yield photochemistry (Y); photochemical quenching (qP); non‐photochemical quenching (qN). Small closed circles represent individual pots and large circles represent means of scores in the two dimensions.
The electrophysiological characterization of sesquiterpene lactones from Coriaria ruscifolia subsp. ruscifolia has been tested on hippocampal neurons. The results for glycinergic rat hippocampal ...transmission and native γ-aminobutyric acid (GABA)ergic transmission on neurons (13DIV) are remarkably different for tutin, coriamyrtin, and dihydrotutin, being tutin the most potent inhibitor and dihydrotutin the least potent one. To understand the applied mechanism of action, we discuss the structural and electronic requirements for inhibitory activity by these sesquiterpene lactones when modulating receptors of the central nervous system. The structural and electrostatic properties of these compounds were compared to those of more active metabolites like picrotoxins. The minimal energy level of these structures was calculated and then optimized at the ab initio B3LYP/DGDZVP level of theory using Gaussian 03W software. This allowed calculation of the corresponding vibrational circular dichroism spectrum of coriamyrtin which rendered the molecular absolute configuration after comparison with an experimental spectrum. These results are consistent with those from studies of other models that provide the basis for the activity on the presence of the lactone at carbons 3 and 5, the presence of the hydroxyl group at position 6, and the different electronic distributions observed in tutin and coriamyrtin. The latter has an isopropenyl moiety at carbon 4 in contrast to the dihydrotutin isopropyl group at the same position, which could explain the difference in activity between dihydrotutin and tutin or coriamyrtin. The presence of the hydroxyl group at carbon 2 is not decisive since this functionality is present in tutin, the most active compound, and in dihydrotutin, the less active one.
•Development of SMRs demands the need of characterizing boric acid concentration.•This work analyzes the viability of using ultrasound technique non-invasively.•Tests were performed relating ...different boric acid concentrations and path time.•The technique allows the analysis under very simple conditions.
This article presents a viability study about a non-invasive and a higher accurate experimental approach to measure boric acid concentration in water under a vast combination of pressure and temperature conditions. This novel approach has been developed to be used in a test facility simulating integral Pressurized Water Reactor - Small Modular Reactors (iPWR-SMRs), that is under development and will be operated by the Brazilian Nuclear Energy National Commission. Besides, the passive acting of the main systems is one of the most important requirements that characterize Generations III + and IV nuclear reactors. The integration of such systems in a unique hermetic enclosure has brought new technological challenges to the nuclear engineering. Among such challenges is the need for adequate and efficient instrumentation for assessing operating conditions and phenomena present in iPWR-SMRs. The boric acid solution has been used in conventional PWRs as an important option to core reactivity control, demanding the need to characterize boric acid concentrations in reactor vessels any time, justifying the interest of this research. However, in an iPWR-SMR, water flow (with boron) between the pressurizer and the nuclear core occurs under passive convection regime and is invariably very slow and small. This situation may require a non-invasive measurement approach. The objective of this work is to analyze the viability of using ultrasonic technique to characterize the concentration of boric acid in a liquid medium non-invasively under experimental conditions of a specific test facility. Ultrasonic tests were performed relating different boric acid concentrations with the path time of the ultrasonic wave. Factors able to mask the characterization of these concentrations by ultrasonic technique were also evaluated. The results showed that this technique allows the characterization of boric acid concentrations in liquid medium under very simple conditions, requiring further studies for complex conditions like those found in nuclear reactors.
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