RESUMEN
This study aimed to perform a systematic review and meta-analysis to analyze the results obtained clinically for bar-clip versus stud-retainers in overdentures. Three databases (PubMed Central, MEDLINE, and BvSalud) were used beyond a manual search. The study followed strictly the inclusion and exclusion criteria, considering the PICO strategy. For the risk of bias and quality assessment of studies, in the case of RCT, there were six domains of analysis, and for non-RCT studies, the Modified Newcastle-Ottawa Scale was performed. A meta-analysis was developed using the available data for marginal bone loss (MBL) and survival rate. 25 studies were included. The stud-retentor had the lowest implant SR (87.6%) and the greatest MBL (1.96 mm). For the bar-clip system, the mean survival rate was 95.91%, with only 4 studies included for this system, and the mean MBL was 1.13 mm. Only 3 studies directly compared both systems quantitatively, showing a significantly greater MBL toward the stud-retention group. The results may not allow determination of the best system for overdenture (stud retentor or bar-clip). Therefore, most of the studies suggested the stud-retentor as a more preferable system due to better distribution of forces, biological peri-implant behavior, low-cost, and ease for removal facilitating the sanitization and/or repair.
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Implantes Dentales , Prótesis de Recubrimiento , Prótesis Dental de Soporte Implantado , Retención de Dentadura , Mandíbula , Instrumentos QuirúrgicosRESUMEN
The aim of this systematic review and meta-analysis was to evaluate studies comparing implant survival rates, marginal bone loss (MBL), and mechanical and biological complication rates between narrow-diameter implants (NDIs) and regular-diameter implants (RDIs) used for oral rehabilitation in the anterior region. The review was conducted according to the PRISMA checklist. Two independent reviewers performed a comprehensive search of the PubMed/MEDLINE, Embase, Scopus, and Cochrane Library databases for studies published until May 2020. A total of 843 implants (484 NDIs and 359 RDIs) were included. No significant difference in implant survival rate (risk difference (RD) 0.01, 95% confidence interval (CI) -0.01 to 0.03; P=0.34), MBL (standardised mean difference -0.51mm, 95% CI -1.29 to 0.26mm; P=0.19), mechanical complications (RD 0.01, 95% CI -0.02 to 0.04; P=0.40), or biological complications (RD 0.01, 95% CI -0.09 to 0.11; P=0.85) was found between the implant groups. Within the limitations of this study, it is concluded that NDIs are an effective alternative to RDIs due to similar survival rates, MBL, and mechanical and biological complication rates. However, future studies are highly encouraged due to the small number of interventional studies on this topic.
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Pérdida de Hueso Alveolar , Implantes Dentales , Implantación Dental Endoósea , Diseño de Prótesis Dental , Prótesis Dental de Soporte Implantado , Fracaso de la Restauración Dental , HumanosRESUMEN
Fifteen New Zealand adult rabbits were randomly allocated into three groups: Sham-operated (group A), Ischemia and Reperfusion (group B) and Carolina Rinse Solution (CRS) (group C). Groups B and C were subjected to one hour of ischemia and two hours of reperfusion. In group C, ten minutes before reperfusion, the bowel lumen was filled with CRS, and the segment immersed in CRS. Necrosis and loss of integrity of the villi were visible in groups B and C. Edema of the submucosa and circular muscle was observed in all groups. Hemorrhage was observed in different layers for groups B and C, but group C showed more severe hemorrhage in different layers during reperfusion. All groups showed polymorphonuclear leukocyte infiltration on the base of the mucosa, submucosa, and longitudinal muscle, in addition to polymorphonuclear leukocytes margination in the mucosal and submucosal vessels. Necrosis of enterocytes, muscles, crypts of Lieberkühn and myenteric plexus was observed in groups B and C during reperfusion. Topical and intraluminal Carolina Rinse Solution did not attenuate the effects of ischemia and reperfusion in the small intestine of rabbits.(AU)
Quinze coelhos da raça Nova Zelândia foram alocados em três grupos: instrumentado (grupo A), isquemia e reperfusão (grupo B) e solução de Carolina rinse (CRS) (grupo C). Os grupos B e C foram submetidos a uma hora de isquemia e a duas horas de reperfusão. No grupo C, 10 minutos antes da reperfusão, o segmento isolado foi imerso e teve seu lúmen preenchido com CRS. Os grupos B e C apresentaram necrose e perda progressiva da integridade das vilosidades. Foi observado edema na submucosa e na camada muscular circular em todos os grupos. Nos grupos B e C, foi observada hemorragia em diferentes camadas, mas, no grupo C, a hemorragia foi mais intensa durante a reperfusão. Todos os grupos apresentaram infiltrado de PMN na base da mucosa, na submucosa e na camada muscular longitudinal e marginação de PMN nos vasos da mucosa e da submucosa. Durante a reperfusão, foi observada necrose dos enterócitos, das camadas musculares, das criptas de Lieberkühn e do plexo mioentérico nos grupos B e C. O uso tópico e intraluminal de CRS não atenuou os efeitos da isquemia e da reperfusão no intestino delgado de coelhos.(AU)
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Animales , Conejos , Reperfusión/veterinaria , Alopurinol/administración & dosificación , Deferoxamina/administración & dosificación , Glutatión/administración & dosificación , Isquemia/veterinaria , Yeyuno/cirugíaRESUMEN
AIM: To evaluate the bond strength and adhesive interface between several resin cements and root dentine immediately and 6 months after radiotherapy. METHODOLOGY: Sixty maxillary canines were selected and randomly assigned to two groups (n = 30): one group was not irradiated and the other one was subjected to a cumulative radiation dose of 60 Gy. The teeth were sectioned to obtain roots 16 mm long and the canals were prepared with the Reciproc system (R50) and filled using a lateral condensation technique with an epoxy resin sealer. Each group was divided into three subgroups (n = 10) according to the resin cement used for fibreglass fibre post cementation: RelyX-U200, Panavia-F2.0 and RelyX ARC. The posts were cemented in accordance with the manufacturer's recommendations. Three 1-mm-thick dentine slices were then obtained from each root third. The first two slices in the crown-apex direction of each third were selected for the push-out test. The failure mode after debonding was determined with a stereo microscope. The third slice from each root third was selected for scanning electron microscopy (SEM) analyses to examine the resin cement-dentine interface with 100, 1000, 2000 and 4000× magnification. Bond strength data were analysed by anova and Tukey's test (α = 0.05). RESULTS: Significantly lower bond strength (P < 0.0001) was obtained after irradiation compared to nonirradiated teeth. RelyX-U200 cemented fibre posts had the higher bond strength (15.17 ± 5.89) compared with RelyX ARC (P < 0.001) and Panavia-F2.0 (P < 0.001). The evaluation after 6 months revealed lower bond strength values compared to the immediate values (P < 0.001) for irradiated and nonirradiated teeth. Cohesive failures occurred in the irradiated dentine. SEM revealed fractures, microfractures and fewer collagen fibres in irradiated root dentine. RelyX-U200 and Panavia-F2.0 were associated with a juxtaposed interface of the cement with the radicular dentine in irradiated and nonirradiated teeth, and for RelyX ARC, hybrid layer formation and tags were observed in both irradiated and nonirradiated teeth. CONCLUSION: Radiation was associated with a decrease in the push-out bond strength and with lower resin cement/root dentine interface adaptation. Self-adhesive resin cement was a better alternative for fibre post cementation in teeth subjected to radiation therapy. The bond strength decreased after 6 months.
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Recubrimiento Dental Adhesivo , Dentina/efectos de los fármacos , Radioterapia/métodos , Cementos de Resina/química , Cementos de Resina/efectos de la radiación , Raíz del Diente/efectos de los fármacos , Bisfenol A Glicidil Metacrilato/química , Bisfenol A Glicidil Metacrilato/efectos de la radiación , Cementación/métodos , Cementos Dentales/química , Cementos Dentales/efectos de la radiación , Materiales Dentales/química , Materiales Dentales/efectos de la radiación , Análisis del Estrés Dental , Resinas Epoxi/química , Resinas Epoxi/efectos de la radiación , Vidrio , Cementos de Ionómero Vítreo/química , Cementos de Ionómero Vítreo/efectos de la radiación , Humanos , Ensayo de Materiales , Polietilenglicoles/química , Polietilenglicoles/efectos de la radiación , Ácidos Polimetacrílicos/química , Ácidos Polimetacrílicos/efectos de la radiación , Técnica de Perno Muñón , Materiales de Obturación del Conducto Radicular/química , Materiales de Obturación del Conducto Radicular/efectos de la radiación , Resistencia al Corte , Estrés Mecánico , Propiedades de SuperficieRESUMEN
This study presents the characterization of an X-ray irradiator through dosimetric tests, which confirms the actual dose rate that small animals and cells will be exposed to during radiobiological experiments. We evaluated the linearity, consistency, repeatability, and dose distribution in the positions in which the animals or cells are placed during irradiation. In addition, we evaluated the performance of the X-ray tube (voltage and tube operating current), the radiometric survey (leakage radiation) and safety devices. The irradiator default setting was established as 160 kV and 25 mA. Tests showed that the dose rate was linear overtime (R2=1) and remained stable for long (constant) and short (repeatability) intervals between readings. The mean dose rate inside the animal cages was 1.27±0.06 Gy/min with a uniform beam of 95.40% (above the minimum threshold guaranteed by the manufacturer). The mean dose rate inside the cell plates was 0.92±0.19 Gy/min. The dose rate dependence with tube voltage and current presented a quadratic and linear relationship, respectively. There was no observed mechanical failure during evaluation of the irradiator safety devices and the radiometric survey obtained a maximum ambient equivalent dose rate of 0.26 mSv/h, which exempts it from the radiological protection requirements of the International Atomic Energy Agency. The irradiator characterization enables us to perform radiobiological experiments, and assists or even replaces traditional therapy equipment (e.g., linear accelerators) for cells and small animal irradiation, especially in early research stages.
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Dosis de Radiación , Radiometría/instrumentación , Animales , Calibración , Diseño de Equipo , Aceleradores de Partículas , Radiometría/métodos , Rayos XRESUMEN
PURPOSE: Tumor expansion is dependent on neovascularization, a process that requires sustained new vessel formation. Although the critical role of angiogenesis by endothelial sprouting in this process, controversy still prevails on whether angiogenesis involving bone marrow-derived endothelial cells, does contribute to this process. This study aims to evaluate the recruitment of bone marrow-derived cells by the melanoma tumor, including endothelial cells, and if they contribute to angiogenesis. METHODS: A chimeric mouse model of GFP bone marrow was used to induce melanoma tumors derived from murine B16-F10 cell line. These tumors were evaluated for the presence of myeloid cells (CD11b), T lymphocytes (CD3, CD4 and CD8) and endothelial cells (VEGFR2 and CD31) derived from bone marrow. RESULTS: Mice transplanted with GFP+ cells showed significant bone marrow chimerism (90.9 ± 0.87 %) when compared to the GFP transgenic mice (90.66 ± 2.1 %, p = 0.83) demonstrating successful engraftment of donor bone marrow stem/progenitor cells. Analysis of the murine melanoma tumor showed the presence of donor cells in the tumors (3.5 ± 1.7 %) and interestingly, these cells represent endothelial cells (CD31+ cells; 11.5 ± 6.85 %) and myeloid cells (CD11b+ cells; 80 ± 21 %), but also tumor-infiltrating lymphocytes (CD8+ T cells, 13.31 ± 0.2 %; CD4+ T-cells, 2.1 ± 1.2 %). Examination of the tumor endothelium by confocal microscopy suggests the presence of donor CD31+/GFP+ cells in the wall of some blood vessels. CONCLUSION: This study demonstrates that bone marrow-derived cells are recruited by the murine melanoma tumor, with myeloid cells and CD4 and CD8 T lymphocytes migrating as antitumor immune response, and endothelial cells participating of the tumor blood vessels formation.
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Médula Ósea/patología , Endotelio Vascular/patología , Linfocitos Infiltrantes de Tumor/patología , Melanoma Experimental/irrigación sanguínea , Melanoma Experimental/patología , Neovascularización Patológica , Animales , Médula Ósea/metabolismo , Trasplante de Médula Ósea , Endotelio Vascular/metabolismo , Proteínas Fluorescentes Verdes/metabolismo , Humanos , Melanoma Experimental/metabolismo , Ratones , Ratones Endogámicos C57BL , Ratones TransgénicosRESUMEN
AIM: To evaluate the influence of radiation on root canal sealer push-out bond strength to dentine and sealer/dentine interface in teeth filled with AH Plus (Dentsply Ind. Com. Ltda, Petrópolis, RJ, Brazil) and MTA Fillapex (Angelus Ind. Prod. Odontológicos S/A, Londrina, PR, Brazil). METHODOLOGY: Thirty-two maxillary canines were selected and randomly assigned to 2 groups (n = 16): one group was not irradiated, and the other was subjected to a cumulative radiation dose of 60 Gy. Root canals were prepared with the Reciproc system (VDW GmbH, Munich, Germany), and each group was divided into 2 subgroups (n = 8) according to the sealer - AH Plus or MTA Fillapex - using the single-cone filling technique. Then, 1-mm-thick dentine slices were obtained from each root third for the push-out test to evaluate sealer bond strength to dentine and for scanning electron microscopy (SEM) to examine the sealer/dentine interface. Failure mode after debonding was determined with a stereomicroscope at ×25 magnification. Bond strength data were analysed by two-way anova with a split-plot design and post hoc Tukey's test (α = 0.05). RESULTS: Significantly lower bond strength (P < 0.0001) was obtained after irradiation (0.71 ± 0.20 versus 0.97 ± 0.29 MPa) and in specimens filled with MTA Fillapex (0.70 ± 0.18 MPa) compared with AH Plus (1.00 ± 0.27 MPa). Percentage of adhesive failures increased after radiation in all root thirds in the teeth filled with AH Plus. SEM revealed more gap-containing regions and fewer tags at the sealer/dentine interface in irradiated specimens, with more tag formation and fewer gaps with AH Plus sealer. CONCLUSIONS: Radiation was associated with a decrease in the push-out bond strength of sealers to intraradicular dentine and formation of more gaps and fewer tags at the sealer/dentine interface regardless of the sealer.
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Compuestos de Aluminio/efectos de la radiación , Compuestos de Calcio/efectos de la radiación , Dentina/efectos de la radiación , Resinas Epoxi/efectos de la radiación , Óxidos/efectos de la radiación , Materiales de Obturación del Conducto Radicular/efectos de la radiación , Silicatos/efectos de la radiación , Diente Canino , Recubrimiento Dental Adhesivo , Fracaso de la Restauración Dental , Análisis del Estrés Dental , Fraccionamiento de la Dosis de Radiación , Combinación de Medicamentos , Neoplasias de Cabeza y Cuello/radioterapia , Humanos , Ensayo de Materiales , MaxilarRESUMEN
Radiotherapy is one of the main approaches to cure prostate cancer, and its success depends on the accuracy of dose planning. A complicating factor is the presence of a metallic prosthesis in the femur and pelvis, which is becoming more common in elderly populations. The goal of this work was to perform dose measurements to check the accuracy of radiotherapy treatment planning under these complicated conditions. To accomplish this, a scale phantom of an adult pelvic region was used with alanine dosimeters inserted in the prostate region. This phantom was irradiated according to the planned treatment under the following three conditions: with two metallic prostheses in the region of the femur head, with only one prosthesis, and without any prostheses. The combined relative standard uncertainty of dose measurement by electron spin resonance (ESR)/alanine was 5.05%, whereas the combined relative standard uncertainty of the applied dose was 3.35%, resulting in a combined relative standard uncertainty of the whole process of 6.06%. The ESR dosimetry indicated that there was no difference (P>0.05, ANOVA) in dosage between the planned dose and treatments. The results are in the range of the planned dose, within the combined relative uncertainty, demonstrating that the treatment-planning system compensates for the effects caused by the presence of femur and hip metal prostheses.
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Adulto , Humanos , Masculino , Citocinas/sangre , Infecciones por VIH/sangre , Linfoma Relacionado con SIDA/sangre , Linfoma de Células B/sangre , Linfoma de Células B/virología , Biomarcadores de Tumor/sangre , Bisexualidad , Estudios de Casos y Controles , Infecciones por VIH/inmunología , Homosexualidad , Inflamación/sangre , Inflamación/inmunología , Inflamación/virología , Activación de Linfocitos , Linfoma Relacionado con SIDA/inmunología , Linfoma de Células B/inmunología , Análisis MultivarianteRESUMEN
Radiotherapy is one of the main approaches to cure prostate cancer, and its success depends on the accuracy of dose planning. A complicating factor is the presence of a metallic prosthesis in the femur and pelvis, which is becoming more common in elderly populations. The goal of this work was to perform dose measurements to check the accuracy of radiotherapy treatment planning under these complicated conditions. To accomplish this, a scale phantom of an adult pelvic region was used with alanine dosimeters inserted in the prostate region. This phantom was irradiated according to the planned treatment under the following three conditions: with two metallic prostheses in the region of the femur head, with only one prosthesis, and without any prostheses. The combined relative standard uncertainty of dose measurement by electron spin resonance (ESR)/alanine was 5.05%, whereas the combined relative standard uncertainty of the applied dose was 3.35%, resulting in a combined relative standard uncertainty of the whole process of 6.06%. The ESR dosimetry indicated that there was no difference (P>0.05, ANOVA) in dosage between the planned dose and treatments. The results are in the range of the planned dose, within the combined relative uncertainty, demonstrating that the treatment-planning system compensates for the effects caused by the presence of femur and hip metal prostheses.
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Espectroscopía de Resonancia por Spin del Electrón/instrumentación , Prótesis de Cadera , Neoplasias de la Próstata/radioterapia , Dosis de Radiación , Adulto , Calibración , Espectroscopía de Resonancia por Spin del Electrón/métodos , Humanos , Masculino , Modelos Anatómicos , Fantasmas de Imagen , Dosificación Radioterapéutica , Reproducibilidad de los Resultados , IncertidumbreRESUMEN
We examined the expression of anti-apoptotic genes (XIAP and Bcl-2) and apoptotic genes (cytochrome c, caspase-9, Apaf-1) in tissue samples of patients with superficial bladder cancer. Thirty-two bladder cancer tissue samples (8 papillary urothelial neoplasm of low malignant potential, 10 low-grade, and 14 high-grade) and 8 normal bladder tissue samples from necropsy were used for the study of gene expression by real-time PCR analysis. Analysis of the expression of apoptotic gene constituents of an apoptosome demonstrated an increase in Apaf-1 expression in the three tumor grades when compared with the control (P < 0.01, P < 0.05, and P < 0.01), low expression of caspase-9 in all groups (P < 0.05), and an increase in cytochrome c expression in all tumor grades in relation to the control, although without statistically significant difference. The expression of anti-apoptotic genes revealed an increase in XIAP expression in all tumor grades in relation to the control, although without statistically significant difference, and low expression of Bcl-2 in all tumor grades and the control (P < 0.05). The results proved that there is low evidence of apoptotic activity by the intrinsic pathway, demonstrated by the low expression of caspase-9 and considerable increase in XIAP expression, which may render these genes potential therapeutic targets in bladder cancer treatment.
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Apoptosis/genética , Regulación Neoplásica de la Expresión Génica , Transducción de Señal , Neoplasias de la Vejiga Urinaria/genética , Neoplasias de la Vejiga Urinaria/metabolismo , Factor Apoptótico 1 Activador de Proteasas/genética , Factor Apoptótico 1 Activador de Proteasas/metabolismo , Caspasa 9/genética , Caspasa 9/metabolismo , Citocromos c/genética , Citocromos c/metabolismo , Perfilación de la Expresión Génica , Humanos , Proteínas Proto-Oncogénicas c-bcl-2/genética , Proteínas Proto-Oncogénicas c-bcl-2/metabolismo , Reacción en Cadena en Tiempo Real de la PolimerasaRESUMEN
Despite advances in neurosurgery and aggressive treatment with temozolomide (TMZ) and radiation, the overall survival of patients with glioblastoma (GBM) remains poor. Vast evidence has indicated that the nuclear factor NF- κ B is constitutively activated in cancer cells, playing key roles in growth and survival. Recently, Dehydroxymethylepoxyquinomicin (DHMEQ) has shown to be a selective NF- κ B inhibitor with antiproliferative properties in GBM. In the present study, the ability of DHMEQ to surmount tumor's invasive nature and therapy resistance were further explored. Corroborating results showed that DHMEQ impaired cell growth in dose- and time-dependent manners with G2/M arrest when compared with control. Clonogenicity was also significantly diminished with increased apoptosis, though necrotic cell death was also observed at comparable levels. Notably, migration and invasion were inhibited accordingly with lowered expression of invasion-related genes. Moreover, concurrent combination with TMZ synergistically inhibited cell growth in all cell lines, as determined by proliferation and caspase-3 activation assays, though in those that express O(6)-methylguanine-DNA methyltransferase, the synergistic effects were schedule dependent. Pretreatment with DHMEQ equally sensitized cells to ionizing radiation. Taken together, our results strengthen the potential usefulness of DHMEQ in future therapeutic strategies for tumors that do not respond to conventional approaches.
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Gliomas are the most common and malignant primary brain tumors in humans. Studies have shown that classes of kaurene diterpene have anti-tumor activity related to their ability to induce apoptosis. We investigated the response of the human glioblastoma cell line U87 to treatment with ent-kaur-16-en-19-oic acid (kaurenoic acid, KA). We analyzed cell survival and the induction of apoptosis using flow cytometry and annexin V staining. Additionally, the expression of anti-apoptotic (c-FLIP and miR-21) and apoptotic (Fas, caspase-3 and caspase-8) genes was analyzed by relative quantification (real-time PCR) of mRNA levels in U87 cells that were either untreated or treated with KA (30, 50, or 70â µM) for 24, 48, and 72â h. U87 cells treated with KA demonstrated reduced viability, and an increase in annexin V- and annexin V/PI-positive cells was observed. The percentage of apoptotic cells was 9% for control cells, 26% for cells submitted to 48â h of treatment with 50â µM KA, and 31% for cells submitted to 48â h of treatment with 70â µM KA. Similarly, in U87 cells treated with KA for 48â h, we observed an increase in the expression of apoptotic genes (caspase-8, -3) and a decrease in the expression of anti-apoptotic genes (miR-21 and c-FLIP). KA possesses several interesting properties and induces apoptosis through a unique mechanism. Further experiments will be necessary to determine if KA may be used as a lead compound for the development of new chemotherapeutic drugs for the treatment of primary brain tumors.
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Apoptosis/efectos de los fármacos , Supervivencia Celular/efectos de los fármacos , Diterpenos/farmacología , Glioblastoma/tratamiento farmacológico , Mikania/química , Caspasa 3/efectos de los fármacos , Caspasa 8/efectos de los fármacos , Línea Celular Tumoral , Diterpenos/aislamiento & purificación , Proteína Ligando Fas , Citometría de Flujo , Glioblastoma/enzimología , Glioblastoma/patología , Humanos , Reacción en Cadena en Tiempo Real de la Polimerasa , Transducción de Señal , Factores de TiempoRESUMEN
Gliomas are the most common and malignant primary brain tumors in humans. Studies have shown that classes of kaurene diterpene have anti-tumor activity related to their ability to induce apoptosis. We investigated the response of the human glioblastoma cell line U87 to treatment with ent-kaur-16-en-19-oic acid (kaurenoic acid, KA). We analyzed cell survival and the induction of apoptosis using flow cytometry and annexin V staining. Additionally, the expression of anti-apoptotic (c-FLIP and miR-21) and apoptotic (Fas, caspase-3 and caspase-8) genes was analyzed by relative quantification (real-time PCR) of mRNA levels in U87 cells that were either untreated or treated with KA (30, 50, or 70 µM) for 24, 48, and 72 h. U87 cells treated with KA demonstrated reduced viability, and an increase in annexin V- and annexin V/PI-positive cells was observed. The percentage of apoptotic cells was 9% for control cells, 26% for cells submitted to 48 h of treatment with 50 µM KA, and 31% for cells submitted to 48 h of treatment with 70 µM KA. Similarly, in U87 cells treated with KA for 48 h, we observed an increase in the expression of apoptotic genes (caspase-8, -3) and a decrease in the expression of anti-apoptotic genes (miR-21 and c-FLIP). KA possesses several interesting properties and induces apoptosis through a unique mechanism. Further experiments will be necessary to determine if KA may be used as a lead compound for the development of new chemotherapeutic drugs for the treatment of primary brain tumors.
Asunto(s)
Humanos , Apoptosis/efectos de los fármacos , Supervivencia Celular/efectos de los fármacos , Diterpenos/farmacología , Glioblastoma/tratamiento farmacológico , Mikania/química , Línea Celular Tumoral , /efectos de los fármacos , /efectos de los fármacos , Diterpenos/aislamiento & purificación , Proteína Ligando Fas , Citometría de Flujo , Glioblastoma/enzimología , Glioblastoma/patología , Reacción en Cadena en Tiempo Real de la Polimerasa , Transducción de Señal , Factores de TiempoRESUMEN
Trastuzumab is an important biological agent in the treatment of HER2-positive breast cancer, with effects on response rates, progression-free survival, overall survival and quality of life. Although this drug is well tolerated in terms of adverse effects, trastuzumab-associated myocardiotoxicity has been described to have an incidence of 0.6-4.5% and in rare cases, the drug can trigger severe congestive heart failure with progression to death or even mimic acute coronary syndrome with complete left bundle branch blockade. In this paper is reported a case of trastuzumab-associated myocardiotoxicity manifesting as acute coronary syndrome in a 69-year-old female. The patient is currently undergoing a conservative clinical treatment that restricts overexertion.The majority of clinical studies report trastuzumab-induced cardiotoxicity as a rare event, and, when present, characterized by mild to moderate clinical signs, the ease of reversibility with pharmacological measures and the temporary discontinuation of the medication. Conversely, it is vital for the oncologist/cardiologist to consider the possibility that trastuzumab-induced cardiotoxicity may manifest itself as a severe clinical case, mimicking acute coronary syndrome, justifying careful risk stratification and adequate cardiac monitoring, especially in high-risk patients.
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We studied the incidence of cervical Chlamydia trachomatis (CT) in 65 adolescents aged between 14 and 19 years and 65 adults aged 20 years or more. All subject were more than three months advanced in a normal pregnancy. Two samples for cytology were obtained from each patient, one ecto- and endocervical, with Ayre's spatula and cytobrush, and one only endocervical with cytobrush. The first one was examined after Papanicolaou staining and the second one was examined with the easily performed immunofluorescence reaction to CT (IF)--Microtrak, SYVA. Twenty seven adolescent patients (41.5%) and fourteen adults (21.5%) had a positive IF test for CT; the rate in adolescents was significantly higher (P < 0.01) than in adults. The Papanicolaou (Pap) stained slides, examined blind for evidence of CT infection showed a sensitivity of 70.7%, a specificity of 95.5% and positive and negative predictive values of 87.8% and 87.6% respectively. Seven adolescents showed cytological signs of Papillomavirus (HPV) infection, and six of them were also CT positive; five had signs of HPV infection and 4 of them were CT positive.