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The inflammation-related biomarker CXCR7 independently predicts patient outcome after radical prostatectomy
No full textINTRODUCTION:
The influence of inflammation on prostate tumor carcinogenesis is currently much better known than with its role in prostate cancer (CaP) progression. We evaluated the prognostic value of epigenetic (HDAC1, HDAC4, H3Ac) and inflammation-related (CXCR4, CXCR7, CXCL12) biomarkers immunoexpression, in radical prostatectomy specimens, from 2 cohorts of CaP patients with long term follow-up.
MATERIALS AND METHODS:
Formalin-fixed and paraffin-embedded radical prostatectomy specimens were obtained from the pathology archives of Prof. Doutor Fernando Fonseca Hospital, in Amadora, Portugal and Portuguese Oncology Institute of Porto, in Porto, Portugal, and tissue microarrays were assembled. It was achieved a set of 234 patients submitted to radical retropubic prostatectomy between January 2000 and December 2005. Immunohistochemistry was used for evaluation of protein expression of epigenetic and inflammation-related markers. Nuclear staining was assessed using digital image analysis. Study outcomes included disease-specific survival and disease-free survival (DFS). Statistical analysis was tabulated using SPSS version 23.0. Hazard ratios (HRs) and survival curves were estimated using Cox-regression and Kaplan-Meyer models, respectively. Statistical significance was set at P < 0.05.
RESULTS:
Complete follow-up data was available for 234 patients and median follow-up time was 164 [11-218] months. Patients with higher CXCR4 immunoexpression experienced significantly worse disease-specific survival compared to patients with low expression (HR = 1.016, 95% CI: 1.002-1.031). The same happened with CXCL12 (HR = 0.546 95% CI: 0.322-0.926) and H3Ac (HR = 1.015, 95% CI: 1.001c1.029). In what concerns to DFS, patients with higher expression of CXCR4 and CXCR7 were significantly more prone to experience disease recurrence (HR = 1.003, 95% CI: 1.000-1.005 and HR = 1.111, 95% CI:1.032-1.196, respectively). When adjusted to pTStage and WHO Grade Groups, CXCR7 maintained independent impact on DFS (HR = 1.119, 95% CI: 1.032-1.214).
CONCLUSIONS:
The interplay between inflammation and epigenetics and its impact in CaP outcome deserves further studies in the future. CXCR7 shows an independent predictor for worse DFS after radical prostatectomy, and could provide important prognostic information for patient management after radical prostatectomy.info:eu-repo/semantics/publishedVersio
Understanding a woman's heart: Lessons from 14 177 women with acute coronary syndrome
Get PDFINTRODUCTION:
Coronary artery disease is becoming the leading cause of death in women in Western society. However, the available data shows that women are still underdiagnosed and undertreated with guideline-recommended secondary prevention therapy, leading to a significantly higher rate of in-hospital complications and in-hospital mortality.
OBJECTIVE:
The main objective of this work is to assess the approach to acute coronary syndrome (ACS) in Portugal, including form of presentation, in-hospital treatment and in-hospital complications, according to gender and in three different periods.
METHODS:
We performed an observational study with retrospective analysis of all patients included between 2002 and 2019 in the Portuguese Registry of Acute Coronary Syndromes (ProACS), a voluntary, observational, prospective, continuous registry of the Portuguese Society of Cardiology and the National Center for Data Collection in Cardiology.
RESULTS:
A total of 49 113 patients (34 936 men and 14 177 women) were included. Obesity, hypertension, diabetes (p<0.001 for all) and dyslipidemia (p=0.022) were all more prevalent in women, who were more frequently admitted for non-ST segment elevation ACS (p<0.001), and more frequently presented with atypical symptoms. Women had more time until needle and until reperfusion, which is less accessible to this gender (p<0.001). During hospitalization, women had a significantly higher risk of in-hospital mortality (OR 1.94 [1.78-2.12], p<0.001), major bleeding (OR 1.53 [1.30-1.80], p<0.001), heart failure (OR 1.87 [1.78-1.97], p<0.001), atrial fibrillation (OR 1.55 [1.36-1.77], p<0.001), mechanical complications (OR 2.12 [1.78-2.53], p<0.001), cardiogenic shock (OR 1.71 [1.57-1.87], p<0.001) and stroke (OR 2.15 [1.76-2.62], p<0.001). Women were more likely to have a normal coronary angiogram or coronary lesions with <50% luminal stenosis (p<0.001 for both), and thus a final diagnosis other than ACS. Both during hospitalization and at hospital discharge, women were less likely to receive guideline-recommended secondary prevention therapy.
CONCLUSION:
In women admitted for ACS, revascularization strategies are still underused, as is guideline-recommended secondary prevention therapy, which may explain their higher incidence of in-hospital complications and higher unadjusted mortality.Introduc¸ão: A doenc¸a arterial coronária está-se a tornar a principal causa de morte no mundo
ocidental no género feminino. Contudo, os dados de que dispomos mostram que as mulheres são
ainda subdiagnosticadas e subtratadas com as terapias de prevenc¸ão secundária recomendadas,
levando a taxas significativamente mais altas de complicac¸ões intra-hospitalares e mortalidade
intra-hospitalar.
Objetivo: Avaliar a abordagem nacional às síndromas coronárias agudas, incluindo forma de
apresentac¸ão, tratamento intra-hospitalar e complicac¸ões intra-hospitalares, de acordo com o
género e em três períodos distintos.
Métodos: Estudo observacional com análise retrospetiva de todos os doentes incluídos entre
2002 e 2019 no Registo Nacional de Síndromas Coronárias Agudas (RNSCA), um registo voluntário, observacional, prospetivo e contínuo da Sociedade Portuguesa de Cardiologia e do Centro
Nacional de Colec¸ão de Dados em Cardiologia.
Resultados: Foram incluídos 49 113 doentes (34 936 homens e 14 177 mulheres). Obesidade,
hipertensão arterial, diabetes mellitus (p < 0,001 para todos) e dislipidémia (p = 0,022) foram
mais prevalentes nas mulheres, que são mais frequentemente admitidas por síndroma coronária
aguda sem supradesnivelamento do segmento ST (p < 0,001) e mais frequentemente se apresentam com sintomas atípicos. As mulheres têm tempos mais longos até agulha e até reperfusão,
esta última menos frequente neste género (p < 0,001). Durante hospitalizac¸ão, as mulheres
têm um risco significativamente maior de mortalidade intra-hospitalar (OR 1,94 [1,78;2,12], p
< 0,001), hemorragia major (OR 1,53 [1,30;1,80], p < 0,001), insuficiência cardíaca (OR 1,87
[1,78;1,97], p < 0,001), fibrilhac¸ão auricular (OR 1,55 [1,36;1,77], p < 0,001), complicac¸ões
mecânicas (OR 2,12 [1,78;2,53], p < 0,001), choque cardiogénico (OR 1,71 [1,57;1,87], p <
0,001) e acidente vascular cerebral (OR 2,15 [1,76;2,62], p < 0,001). É mais provável que as
mulheres tenham uma coronariografia normal ou lesão coronárias com estenose luminal < 50%
(p < 0,001 para ambos) e, assim, um diagnóstico final alternativo a síndroma coronária aguda.
Seja durante hospitalizac¸ão ou à alta hospitalar, é menos provável que as mulheres recebam as
terapias de prevenc¸ão secundária recomendadas.
Conclusão: Em mulheres admitidas com síndroma coronária aguda as estratégias de
revascularizac¸ão são subutilizadas, assim como as terapias de prevenc¸ão secundária recomendadas, podendo justificar a maior incidência de complicac¸ões intra-hospitalares e maior
mortalidade não ajustada.info:eu-repo/semantics/publishedVersio
Peri-operative management of a pregnant patient with hereditary angioedema submitted to a cesarean-section: case report
Get PDFO angioedema hereditário é uma doenc¸a autossômica dominante, que se manifesta
por crises súbitas, recorrentes e de gravidade variável de edema subcutâneo e submucoso, que
podem ocorrer espontaneamente ou em resposta a gatilhos. São conhecidos três tipos de angioedema hereditário. A doenc¸a é condicionada por diminuic¸ão do nível plasmático ou alterac¸ão
da capacidade funcional do inibidor de C1, com aumento da bradicinina e da permeabilidade
vascular, com consequente edema. Várias medidas devem ser tomadas no período perioperatório de forma a evitar uma crise aguda. A profilaxia deverá ser realizada durante a gravidez
antes de qualquer procedimento cirúrgico, antes de procedimentos dentários, quando existe
manuseamento da via aérea, nos doentes com episódios prévios de angioedema e quando há
alterac¸ões significativas da volemia. A literatura é escassa no que que diz respeito à associac¸ão
de angioedema hereditário e gravidez. Descrevemos um caso de sucesso de uma grávida com
angioedema hereditário tipo I submetida a cesariana.Hereditary angioedema is an autosomal dominant disorder, presenting as sudden and recurring episodes of variable severity of subcutaneous and mucosa edema that may occur spontaneously or in response to triggers. There are three knwon types of hereditary angioedema. The disorder is caused by decrease in the plasma level or change in the functional capacity of C1 inhibitor, with increase in bradykinin and in vascular permeability, and consequent edema. Several measures are required in the perioperative period in order to avoid an acute attack. Prophylaxis should be carried out throughout pregnancy before any surgical procedure, before dental procedures, upon airway handling, on patients with previous episodes of angioedema, and when there are significant changes in volemia. The literature is scarce in regard to the association between hereditary angioedema and pregnancy. We describe a successful case of a pregnant patient with type I hereditary angioedema submitted to a C-section.info:eu-repo/semantics/publishedVersio
Scrofula Caused by Multidrug-Resistant Tuberculosis
Get PDFTuberculosis (TB) is one of the top 10 causes of death worldwide. Multidrug-resistant tuberculosis (MDR-TB) occurs when at the minimum there is resistance to isoniazid and rifampin. Prevention of new infections of Mycobacterium tuberculosis and progression to TB disease is critical to reduce the burden and mortality of this disease. We present the case of a 73-year-old human immunodeficiency virus (HIV)-negative female who presented with cervical lymphadenopathy and who was diagnosed with MDR-TB.
LEARNING POINTS:
Tuberculosis is one of the most important causes of morbidity and mortality worldwide and approximately a quarter of the world's population is estimated to be latently infected by Mycobacterium tuberculosis.Multidrug-resistant tuberculosis lymphadenitis is a rare manifestation of the disease in Portugal.With the advent of multidrug-resistant tuberculosis, disease surveillance by the government should be intensified, with the aim of national and global TB control, focusing on prevention.info:eu-repo/semantics/publishedVersio
Author response to: Comment on: Safety and efficacy of non-steroidal anti-inflammatory drugs to reduce ileus after colorectal surgery.
No full textinfo:eu-repo/semantics/publishedVersio
SomosHFF (34): Newsletter do Hospital Prof. Dr. Fernando Fonseca, E.P.E.
No full textinfo:eu-repo/semantics/publishedVersio
Should We Use Papilla Morphology to Estimate the Size of the Terminal Common Bile Duct During Endoscopic Retrograde Cholangiopancreatography?
No full textObjective: A small common bile duct (CBD) diameter has been associated with complications and with a difficult biliary cannulation. Previous studies suggested that this diameter can be predicted during the endoscopic retrograde cholangiopancreatography (ERCP) simply by observing the papillary morphology. Despite this published suggestion there is no study addressing this topic. This study evaluated a possible association between the morphology of the major papilla and the diameter of the terminal CBD (t-CBD).
Methods: Observational cross-sectional study including consecutive patients with naïve papillae was referred for ERCP in two affiliated university hospitals. The transverse (p-transv) and longitudinal measures (p-long) of the papilla were obtained using a visual method. Papillae were classified into nonprominent, prominent, bulging or other. The t-CBD was measured 1 cm from the papilla using fluoroscopic images in prone/supine. Measurements were performed by two senior endoscopists and outcomes were evaluated using correlation and linear regression model.
Results: We included 245 patients with a median age of 76 years. The median p-transv for each type of papillae was as follows: nonprominent = 6 mm, prominent = 9 mm, bulging = 15 mm and other = 6 mm; P < 0.001. The median t-CBD for nonprominent = 7.62 mm, prominent = 8.34 mm, bulging = 8.60 mm and other = 8.52 mm; P = 0.40. The correlation between the transverse and longitudinal measures of papilla and the t-CBD were 0.0092 and 0.0614, respectively. In the regression model, the t-CBD diameter was not explained by papilla's size or morphology (R = 1.70%; P = 0.80).
Conclusion: The morphology of the papilla must not be used as a predictor of the diameter of the CBD as there is no correlation between these two items.info:eu-repo/semantics/publishedVersio
Zebrafish xenografts as a fast screening platform for bevacizumab cancer therapy
Get PDFCancer is the second leading cause of death in the world. Given that cancer is a highly individualized disease, predicting the best chemotherapeutic treatment for individual patients can be difficult. Ex vivo models such as mouse patient-derived xenografts (PDX) and organoids are being developed to predict patient-specific chemosensitivity profiles before treatment in the clinic. Although promising, these models have significant disadvantages including long growth times that introduce genetic and epigenetic changes to the tumor. The zebrafish xenograft assay is ideal for personalized medicine. Imaging of the small, transparent fry is unparalleled among vertebrate organisms. In addition, the speed (5-7 days) and small patient tissue requirements (100-200 cells per animal) are unique features of the zebrafish xenograft model that enable patient-specific chemosensitivity analyses.info:eu-repo/semantics/publishedVersio
Clinical management of ageing people living with HIV in Europe: the view of the care providers
No full textBACKGROUND:
Although guidelines for the management of HIV infection include recommendations for aging people living with HIV (PLWH), clinical practice of European HIV care providers may vary.
METHOD:
We performed a study using a 3-phase Delphi methodology by involving a panel of clinicians with expertise in HIV infection clinical management. The main aim of the study was to assess the care provider prospective on how HIV clinical care should be delivered to ageing PLWH. The first phase involved ten clinicians to identify HIV comorbidities of interest. The second and third phases recruited clinicians virtually via a web-based questionnaire that included 137 questions focussed on 11 comorbidities (e.g. cardiovascular disease, pulmonary disease, etc.).
RESULTS:
Results were analysed thematically and consensus (or not) among European physicians reported. Ninety-seven and 85 responses were collected in phase 2 and 3, respectively. High levels of agreement were found among clinical care providers across Europe and with the European AIDS Conference Society guidelines regarding key items of clinical management of comorbidities in ageing PLWH.
CONCLUSION:
However, we identified some important gaps, such as the lack of standardisation or implementation of the assessment of frailty or menopause, which are emerging as important factors to optimise ageing PLWH clinical care. Further studies are warranted to confirm whether intensified screening translates into HIV morbidity advances.info:eu-repo/semantics/publishedVersio