RESUMEN

OBJECTIVES: To identify factors associated with poor prognoses in newborns with a prenatal diagnosis of gastroschisis in eight hospitals in Bogota, Colombia, from 2011 to 2022. METHODS: A multi-center retrospective case-control study was conducted on newborns with gastroschisis in eight hospitals in Bogota, Colombia. Poor prognosis was defined as the presence of sepsis, intestinal complications, or death. RESULTS: The study included 101 patients. Preterm newborns under 32 weeks had a poor neonatal prognosis (OR 6.78 95 % CI 0.75-319). Oligohydramnios (OR 4.95 95 % CI 1.15-21.32) and staged closure with silo (OR 3.48; 95 % CI 1.10-10.96) were risk factors for neonatal death, and intra-abdominal bowel dilation of 20-25 mm was a factor for the development of intestinal complications (OR 3.22 95 % CI 1.26-8.23). CONCLUSIONS: Intra-abdominal bowel dilation between 20 and 25 mm was associated with intestinal complications, while oligohydramnios was associated with the risk of perinatal death, requiring increased antenatal surveillance of fetal wellbeing. Management with primary reduction when technically feasible is recommended in these infants, considering that the use of silos was associated with higher mortality.

Asunto(s)

Gastrosquisis , Humanos , Recién Nacido , Colombia/epidemiología , Gastrosquisis/diagnóstico , Gastrosquisis/diagnóstico por imagen , Gastrosquisis/epidemiología , Gastrosquisis/mortalidad , Femenino , Estudios Retrospectivos , Embarazo , Estudios de Casos y Controles , Pronóstico , Masculino , Factores de Riesgo , Oligohidramnios/epidemiología , Oligohidramnios/diagnóstico , Ultrasonografía Prenatal , Adulto , Recien Nacido Prematuro

RESUMEN

PURPOSE: In this study, we investigated the circulating levels of 25-hydroxyvitamin D (25[OH]D) in Brazilian women with breast cancer in samples collected at diagnosis, and correlated these with clinicopathological parameters relevant to disease prognosis. METHODS: This study involved 147 women diagnosed with infiltrative ductal carcinoma whose peripheral blood samples were collected, to have 25(OH)D levels measured in plasma. RESULTS: Our findings indicated that circulating 25(OH)D levels at diagnosis were insufficient in patients with breast cancer. Further, 25(OH)D reduced plasmatic levels at diagnosis correlated significantly with poor prognosis parameters, including axillar positivity, chemoresistance and metastasis. Patients bearing triple-negative tumors also presented reduced 25(OH)D in plasma when compared to those who carried Luminal tumors. Our data suggest relevant correlations when 25(OH)D is reduced in plasma at diagnosis, such as advanced disease with axillar positivity, chemoresistance with advanced disease, early age at diagnosis with high histological grade and dead with axilla positivity. CONCLUSIONS: Altogether, our findings reinforce that 25(OH)D reduction can be a plausible marker of disease prognosis in breast cancer.

Asunto(s)

Axila/patología , Neoplasias de la Mama/complicaciones , Vitamina D/análogos & derivados , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/fisiopatología , Resistencia a Antineoplásicos , Femenino , Humanos , Persona de Mediana Edad , Invasividad Neoplásica , Metástasis de la Neoplasia , Pronóstico , Vitamina D/sangre

RESUMEN

AIM: To investigate the role of the transcription factor YY1 in Wilms tumor (WT). PATIENTS & METHODS: We measured YY1 expression using tissue microarray from patients with pediatric renal tumors, mainly WT and evaluated correlations with the predicted clinical evolution. YY1 expression was measured using immunohistochemical and protein expression was determined by digital pathology. RESULTS & CONCLUSION: YY1 significantly increased in WT patients. In addition, an increase in YY1 expression had a greater risk of adverse outcomes in WT patients with favorable histology. YY1 expression was higher in the blastemal component of tumors, and high nuclear expression positively correlated with metastasis. YY1 may be considered as a metastasis risk factor in WT.

Asunto(s)

Expresión Génica , Neoplasias Renales/genética , Neoplasias Renales/patología , Factor de Transcripción YY1/genética , Niño , Preescolar , Femenino , Humanos , Inmunohistoquímica , Lactante , Neoplasias Renales/mortalidad , Masculino , Clasificación del Tumor , Metástasis de la Neoplasia , Estadificación de Neoplasias , Pronóstico , Factores de Riesgo , Tumor de Wilms

RESUMEN

AIMS: In adult population, the renal cell carcinoma (RCC) is one of the most common urological malignancies. It is meaningful to research for the molecular markers which are involved in the occurrence and development of RCC. Therefore, we concentrate on illuminating the role of microRNA-154-5p in progression of RCC and explore its prognostic values. MAIN METHODS: The real-time quantitative polymerase chain reaction (RT-qPCR) was applied to determine expression level of miR-154-5p in tissues. Afterwards, the transfected cell lines ACHN and 786-O were used for the CCK-8 assay, MTT assay, wound healing assay, transwell assay and flow cytometric assay to explore the role of miR-154-5p in regulating cellular function. In addition, formalin-fixed paraffin-embedded (FFPE) renal cancer samples were used for detecting the relationship between expression level of miR-154-5p and clinical information. Furthermore, univariate and multivariate Cox proportional-hazards regression analyses, and the Kaplan-Meier survival curves were performed to evaluate the prognostic value of miR-154-5p in RCC. KEY FINDINGS: The RT-qPCR indicated that miR-154-5p is up-regulated in RCC pathologic specimens and cell lines. Results of study also demonstrated that upregulation of miR-154-5p reduced cell apoptosis and promoted cell proliferation, viability, migration as well as invasion in RCC cells. The prognosis analyses indicated that the expression level of miR-154-5p is associated with the prognosis of renal cancer, and the overall survival of patients with low expression is longer. SIGNIFICANCE: The present study revealed that the oncogene miR-154-5p regulates cellular function and acts as a molecular marker with poor prognosis in renal cell carcinoma.

Asunto(s)

Apoptosis , Carcinoma Papilar/patología , Carcinoma de Células Renales/patología , Movimiento Celular , Proliferación Celular , Neoplasias Renales/patología , MicroARNs/genética , Adulto , Anciano , Carcinoma Papilar/genética , Carcinoma Papilar/metabolismo , Carcinoma de Células Renales/genética , Carcinoma de Células Renales/metabolismo , Femenino , Regulación Neoplásica de la Expresión Génica , Humanos , Neoplasias Renales/genética , Neoplasias Renales/metabolismo , Masculino , Persona de Mediana Edad , Pronóstico , Tasa de Supervivencia , Células Tumorales Cultivadas , Adulto Joven

RESUMEN

OBJECTIVE: To determine how parents of infants in the neonatal intensive care unit with a poor or uncertain prognosis view their experience, and whether they view their choices as "worth it," regardless of outcome. STUDY DESIGN: Parents of eligible neonates at 2 institutions underwent audiotaped, semistructured interviews while their infants were still in the hospital and then again 6 months to 1 year after discharge or death. Interviews were transcribed and data were analyzed using thematic analysis. Two authors independently reviewed and coded each interview and discrepancies were resolved by consensus. RESULTS: Twenty-six families were interviewed in the initial group and 17 families were interviewed in the follow-up group. The most common themes identified included realism about death (24 families), appreciation for the infant's care team (23 families), and optimism and hope (22 families). Overall themes were very similar across both centers, and among parents of infants who died and those who survived. Themes of regret, futility, distrust of care team, and infant pain were brought up infrequently or not at all. CONCLUSIONS: No family believed that the care being provided to their infant was futile; rather, parents were grateful for the care provided to their infant, regardless of outcome. Even in the case of a poor prognosis or the death of an infant, families in our study viewed their infant's stay in the neonatal intensive care unit favorably.

Asunto(s)

Toma de Decisiones , Unidades de Cuidado Intensivo Neonatal , Padres , Relaciones Profesional-Familia , Muerte , Femenino , Humanos , Lactante , Recién Nacido , Recien Nacido Prematuro , Cuidado Intensivo Neonatal , Estudios Longitudinales , Masculino , Optimismo , Alta del Paciente , Pronóstico , Investigación Cualitativa , Riesgo , Estrés Psicológico

RESUMEN

BACKGROUND: Circulating tumor microemboli (CTM) are clusters of circulating tumor cells (CTCs), involved in metastasis, as also transforming growth factor-ß (TGF-ß). The purpose of this study was to verify their role in progression-free survival (PFS). METHODS: Blood from patients with locally advanced head and neck squamous cell carcinoma (HNSCC; n = 53) was analyzed in 2 moments. TGF-ß receptor I (TGF-ßRI) expression was evaluated by immunocytochemistry. RESULTS: Comparing CTM1 (baseline) with CTM2 (first follow-up), patients with CTM1-positive disease who became CTM2-negative were classified as favorable (PFS 20 months). Patients with unfavorable evolution (CTM1-negative/CTM2-positive), had PFS of 17.5 months. Patients always CTM-negative showed PFS of 22.4 months, those always positive, 4.7 months (P < .001). The TGF-ßRI expression in the first follow-up correlated with poor PFS (12 × 26 months; P = .007), being an independent prognostic factor (hazard ratio [HR] = 6.088; P = .033). CONCLUSION: CTM1/2, TGF-ßRI expression, and unfavorable CTM kinetics may represent poor prognosis in locally advanced HNSCC.

Asunto(s)

Carcinoma de Células Escamosas/metabolismo , Carcinoma de Células Escamosas/patología , Neoplasias de Cabeza y Cuello/metabolismo , Neoplasias de Cabeza y Cuello/patología , Células Neoplásicas Circulantes/metabolismo , Proteínas Serina-Treonina Quinasas/metabolismo , Receptores de Factores de Crecimiento Transformadores beta/metabolismo , Adulto , Anciano , Brasil , Carcinoma de Células Escamosas/mortalidad , Estudios de Cohortes , Supervivencia sin Enfermedad , Femenino , Neoplasias de Cabeza y Cuello/mortalidad , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Modelos de Riesgos Proporcionales , Receptor Tipo I de Factor de Crecimiento Transformador beta , Carcinoma de Células Escamosas de Cabeza y Cuello

RESUMEN

INTRODUCTION: Metaplastic breast carcinoma (MBC) is a rare and aggressive histologic subtype of breast cancer comprising approximately 0.5% to 5.0% of all invasive breast cancers with a poor prognosis and limited therapeutic options. PATIENTS AND METHODS: We investigated MBC at our institution to evaluate outcomes and investigate the molecular profile of our cohort to determine the presence of mutations for which there are targeted therapies. RESULTS: We found our cohort to consist mainly of the matrix-producing variant (72%) with 48% having the stereotypical estrogen receptor-negative/progesterone receptor-negative/human epidermal growth factor receptor-2-negative phenotype. While the overall survival of our cohort was an average of 1679 days (4.6 years), we had a surprising number of patients with second primaries (40%) and distant metastases (40%), yet few recurrences (12%). Molecular analysis of the tumors indicated that one gene mutation, CSFIR, was significantly associated with outcome (P = .021); however, the cohort was defined by frequent mutations in ERBB4 (36%), PIK3CA (48%), and FLT3 (60%), for which there are now targeted therapies. CONCLUSION: While surgery is the appropriate first step in the management of this aggressive malignancy, the collection of data pertaining to the use of targeted agents, although anecdotal, may provide clues to better treatment for these patients.

Asunto(s)

Biomarcadores de Tumor/genética , Neoplasias de la Mama/clasificación , Neoplasias de la Mama/patología , Carcinoma Ductal de Mama/secundario , Metaplasia/patología , Recurrencia Local de Neoplasia/patología , Neoplasias de la Mama/genética , Neoplasias de la Mama/metabolismo , Carcinoma Ductal de Mama/genética , Carcinoma Ductal de Mama/metabolismo , Carcinoma de Células Escamosas/genética , Carcinoma de Células Escamosas/metabolismo , Carcinoma de Células Escamosas/secundario , Fosfatidilinositol 3-Quinasa Clase I/genética , Femenino , Estudios de Seguimiento , Humanos , Metástasis Linfática , Metaplasia/genética , Metaplasia/metabolismo , Clasificación del Tumor , Invasividad Neoplásica , Recurrencia Local de Neoplasia/genética , Estadificación de Neoplasias , Pronóstico , Receptor ErbB-2/metabolismo , Receptor ErbB-4/genética , Receptores del Factor Estimulante de Colonias/genética , Receptores de Estrógenos/metabolismo , Receptores de Progesterona/metabolismo , Estudios Retrospectivos , Tasa de Supervivencia , Tirosina Quinasa 3 Similar a fms/genética

RESUMEN

A púrpura de Henoch-Schõnlein é uma vasculite de pequenos vasos, mais comum em crianças, com acometimento cutâneo, articular, gastrointestinal e renal. É raro o acometimento em adultos, conferindo nestes pior prognóstico. Relatamos o caso de um paciente de 54 anos com púrpura de Henoch-Schõnlein com acometimento de pele, articulação, abdominal e renal, sem resposta clínica com altas doses de prednisona, mantendo quadro de claudicação abdominal e proteinúria nefrótica.

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Henoch-Schõnlein purpura is a vasculitis of small vessels, more common in children with involvement cutaneous, articular, gastrointestinal and renal. It rarely affects adults, giving these worse prognosis. We report a patient aged 54 with Henoch-Schõnlein purpura with involvement of skin, joint, abdominal and renal, without clinical response with high doses of prednisone keeping a lameness abdominal and nephrotic proteinuria.

Asunto(s)

Humanos , Masculino , Adulto , Persona de Mediana Edad , Vasculitis por IgA/complicaciones , Vasculitis por IgA/etiología , Vasculitis por IgA/fisiopatología , Vasculitis por IgA/terapia , Diagnóstico Diferencial

RESUMEN

Hematopoietic progenitor cell transplantation from HLA-identical sibling donors cures 70-90 percent of Severe Aplastic Anemia (sAA) patients. Older age, heavy exposure to transfusions, immunosuppression treatment (IST) with a long interval from diagnosis to transplant and infection at procedure are associated with poor outcomes. We transplanted 18 patients with sAA and at least one risk factor (RF) for poor prognosis (age >35 years, >50 transfusions prior to transplant, unresponsiveness to previous IST and bacterial or fungal infection at transplant) from 2001 to 2005, using cyclophosphamide (CY - 5 patients) or busulfan plus CY (13 patients). Sixteen patients engrafted, two died with no engraftment, three patients had evidence of graft failure at days +67, +524 and +638 (two died and one was rescued with IST). Grade III/IV mucositis occurred in 39 percent but neither aGVHD nor cGVHD were observed. The Kaplan-Meier probability of survival was 75 percent at 2.14 years, with a trend favoring survival by number of RF (1 versus =2 RF) (P = 0.06). These results are comparable to recent data reported with fludarabine-based conditioning in patients with poor prognosis sAA. Due to the small sample size, prospective clinical trials with larger cohorts of patients are needed to confirm the real benefits of fludarabine-based conditioning, and also to define the best agent(s) to be associated with Fludarabine as preparative regimen for sAA patients with poor prognosis.

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Transplante de medula óssea de doador irmão HLA-idêntico pode curar 70 por cento-90 por cento dos portadores de anemia aplásica severa (AAs). Pacientes mais idosos, muito transfundidos, longamente tratados com imunossupressão (IS) e com infecções ao tempo do transplante têm pior evolução. Nós transplantamos 18 pacientes com AAs e pelo menos um dos fatores associados a pior prognóstico (idade >35 anos, >50 transfusões antes do transplante, falta de resposta à imunossupressão prévia e infecção bacteriana ou fúngica ao transplante) de 2001 a 2005, com ciclofosfamida (Cy - 5 pacientes) ou bussulfan mais Cy (13 pacientes). Dezesseis pacientes apresentaram pega do enxerto, dois morreram sem pega, três tiveram rejeição aos dias +67, +524 e +638 (dois morreram e um foi resgatado com IS). Mucosite grau III/IV ocorreu em 39 por cento e não observamos DECH aguda ou crônica. A probabilidade de sobrevida pelo método de Kaplan-Meier foi de 75 por cento aos 2,14 anos, e uma tendência a melhor sobrevida foi encontrada entre os portadores de apenas um fator de risco ao transplante (P: .06). Estes resultados são comparáveis a recentes relatos de literatura envolvendo condicionamentos baseados em fludarabina para tratar pacientes com alto risco. Devido à pequena amostra analisada, estudos clínicos prospectivos com maior número de pacientes são necessários, visando comprovar o real benefício dos condicionamentos baseados em fludarabina, definir o melhor agente a ser a ela associado e assim obter o melhor condicionamento para portadores de AAs com fatores de mau prognóstico para o transplante.

Asunto(s)

Humanos , Anemia Aplásica , Trasplante de Médula Ósea , Pronóstico , Trasplante Homólogo