RESUMO
PURPOSE: The prognostic value of Ki-67 in triple-negative breast cancer (TNBC) is yet unclear because the cut-off points employed differ widely and its predictive effect may vary according to age. The purpose of this study was to analyze the role of Ki-67 among patients with TNBC, and determine the optimal Ki-67 cut-off point to demonstrate its prognostic relevance associated with patient age and treatment strategy. METHODS/PATIENTS: 201 consecutive patients treated for primary TNBC from 1999 to 2014 were analyzed. Clinicopathological characteristics and outcomes were compared between patients treated with neoadjuvant or adjuvant chemotherapy. We used time-dependent receiver operating characteristic (ROC) curve and time-dependent area under the ROC curve (AUC) to evaluate the discriminative ability of Ki-67 at 3 and 5 years of follow-up. A Ki-67 cut-off point that maximized sensibility and specificity was established. Interaction effect between age and Ki-67 on disease-free survival (DFS) and overall survival (OS) was evaluated by stratified analysis. RESULTS: According to the coordinates of the ROC curves, the best cut-off point for Ki-67 was 60% (high/low). In the whole group, there was not a statistically significant association between Ki-67 and OS and DFS, using a cut-off point of 60%. In multivariate analysis (COX proportional hazards regression), for DFS high Ki-67 (> 60%) was a poor prognostic factor in patients > 40 years old and a better prognostic factor among the patients < 40 years old. CONCLUSION: Prognostic value of Ki-67 in TNBC, using a cut-off point of 60%, may vary depending on age.
Assuntos
Envelhecimento/fisiologia , Biomarcadores Tumorais/metabolismo , Antígeno Ki-67/metabolismo , Neoplasias de Mama Triplo Negativas/diagnóstico , Neoplasias de Mama Triplo Negativas/mortalidade , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/metabolismo , Biomarcadores Tumorais/análise , Quimioterapia Adjuvante/estatística & dados numéricos , Terapia Combinada/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Antígeno Ki-67/análise , Mastectomia/estatística & dados numéricos , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Análise de Sobrevida , Neoplasias de Mama Triplo Negativas/metabolismo , Neoplasias de Mama Triplo Negativas/terapiaRESUMO
PURPOSE: To evaluate the features of bone marrow (BM) biopsy involvement by lymphoma, pattern of infiltration, morphological analysis and flow cytometry were reviewed at all lymphoma patients over a period of 10 years. METHODS/PATIENTS: 413 cases were included in the study if BM biopsy slides were available. Only 356 patients had both BM trephine biopsy and flow cytometry. RESULTS: The most frequent subtype was diffuse large B cell (31.2%), followed by follicular lymphoma (18.9%). The predominant pattern was mixed (nodular-interstitial) (9.2%). Morphological marrow infiltration was found in 138 cases, and flow cytometry identified 117 cases with BM involvement. A concordance between the two methods was detected in 305 cases (85.7%). There was discordance in 51 cases (14.3%): morphology positive/FC negative in 33 cases and morphology negative/FC positive in 18. CONCLUSIONS: Flow cytometry is slightly more useful in detecting involvement when the BM is affected, but this finding is not conclusive.
Assuntos
Medula Óssea/patologia , Citometria de Fluxo/métodos , Linfoma de Células B/diagnóstico , Linfoma Folicular/diagnóstico , Linfoma Difuso de Grandes Células B/diagnóstico , Linfoma não Hodgkin/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Adulto JovemRESUMO
Group A rotaviruses are the major etiologic agents of acute gastroenteritis worldwide in children and young animals. Among its structural proteins, VP6 is the most immunogenic and is highly conserved within this group. Lactococcus lactis is a food-grade, Gram-positive, and nonpathogenic lactic acid bacteria that has already been explored as a mucosal delivery system of heterologous antigens. In this work, the nisin-controlled expression system was used to display the VP6 protein at the cell surface of L. lactis. Conditions for optimal gene expression were established by testing different nisin concentrations, cell density at induction, and incubation times after induction. Cytoplasmic and cell wall protein extracts were analyzed by Western blot and surface expression was confirmed by flow cytometry. Both analysis provided evidence that VP6 was efficiently expressed and displayed on the cell surface of L. lactis. Furthermore, the humoral response of mice immunized with recombinant L. lactis was evaluated and the displayed recombinant VP6 protein proved to be immunogenic. In conclusion, this is the first report of displaying VP6 protein on the surface of L. lactis to induce a specific immune response against rotavirus. These results provide the basis for further evaluation of this VP6-displaying L. lactis as a mucosal delivery vector in a mouse model of rotavirus infection.
Assuntos
Antígenos Virais/imunologia , Proteínas do Capsídeo/imunologia , Membrana Celular/metabolismo , Lactococcus lactis/imunologia , Animais , Citometria de Fluxo , Imunidade Humoral/imunologia , Imunização , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Proteínas Recombinantes de FusãoRESUMO
BACKGROUND: The non-invasive diagnosis of vertebral osteomyelitis is a difficult one. Studies confirm MRI as the gold standard with 92% sensitivity and 94% specificity. Scintigraphy combined with Tc99-Ga67 used to be the procedure of choice before the advent of PET with labeled glucose, which has a high sensitivity and specificity, but cannot distinguish a focus of infection from inflammation. Scintigraphy with UBI29-41 is an infection-specific study that was recently described in the literature. There are no studies showing its value in the diagnosis of vertebral osteomyelitis. OBJECTIVE: The purpose of the study is to show that the Tc99-UBI29-41 scan has 99% sensitivity for vertebral osteomyelitis. METHODS: This is a study of a diagnostic test. The case series was composed of the records of UBI scans performed at the Nuclear Medicine Department, HcHMAE. The scans were interpreted in a blind and independent fashion by 2 experienced observers. The final diagnosis was obtained with the histopathologic study or a microbiologic culture or with the clinical findings after a follow-up of at least 6 months. The sensitivity, specificity, positive and negative predictive values, and the positive and negative probability ratio were determined, always using a 95% confidence interval (CI). The sample size necessary to show 99% sensitivity with a 95% CI and a statistical power of 80% was 15 patients. The concordance with the kappa index was determined. RESULTS: Twenty-seven patients with suspected vertebral osteomyelitis were included; 15 males and 12 females, with a mean age of 50 years (SD = 16). Fourteen patients had a history of surgery and 12 had metallic implants. Nine patients had a history if spinal infiltrations. The number of patients with a positive scan was 20. The sensitivity for detecting pyogenic vertebral osteomyelitis was 100% (CI: 0.901-1) and the specificity was 87.5% (CI: 0.647-0.875). The positive predictive value was 0.95 (CI: 0.859-0.950), and the negative predictive value was 1 (CI: 0.739-1). The intra- and interobserver kappa value was 1. CONCLUSIONS: The UBI scan showed 100% sensitivity and 88% specificity for vertebral osteomyelitis. Although the role of this method in the diagnostic protocol of the patient with suspected vertebral osteomyelitis has not yet been defined, the scan was useful in this group of patients to arrive at a certain diagnosis.
Assuntos
Vértebras Lombares , Compostos de Organotecnécio , Osteomielite/diagnóstico por imagem , Fragmentos de Peptídeos , Sacro , Doenças da Coluna Vertebral/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Cintilografia , Sensibilidade e Especificidade , SupuraçãoRESUMO
In the past few years three topics in nanoscience have received great attention: catalytic activity of gold nanoparticles (AuNPs), their electron transfer properties, and magnetism. Although these properties could have much in common no report on their synergism has been published. Here we present 10-nm gold nanoparticles conveniently capped with a mixed self-assembled monolayer containing bis(dithiocarbamato)copper(II) complexes, which dismutate superoxide radical with extremely high efficiency (IC(50) = 0.074 µM). This behavior is interpreted as the result of an electron transfer (ET) process between AuNP core and the analyte when associated to copper(II). The ET process involving a charged AuNP core was detected by EPR and UV-vis spectroscopy.
Assuntos
Cobre/química , Ouro/química , Nanopartículas Metálicas/química , Compostos Organometálicos/química , Superóxidos/química , Tiocarbamatos/química , Estrutura Molecular , Tamanho da Partícula , Propriedades de SuperfícieRESUMO
To examine the epidemiology of rotaviruses in Buenos Aires, Argentina, we screened 1,212 stool samples from children with diarrhea in the southern district of Buenos Aires from 1999 to 2003. We identified 187 samples (15.4%) that were positive for group A rotavirus by use of antigen enzyme-linked immunosorbent assay. Among these specimens, 112 were available for typing: 93 (83.0%) were single-type infections, 9 (8.0%) were mixed-type infections with more than one G or P type, and 10 (8.9%) were G and/or P nontypeable. In contrast to the findings in our last study, from 1996 to 1998, genotype P[4], G2 strains were almost completely absent and P[8], G1 and P[8], G4 strains were dominant, representing more than 80% of the G and P types found. Genotypes G2 and G9 were detected in few samples, and type G3 was completely absent. We identified several uncommon genotype G12 strains, representing the first detections outside of Asia and the United States, by sequencing. Using a genotype G12-specific reverse transcription-PCR, we identified eight (6.7%) positive samples for the 1999 to 2003 period. The high degree of sequence identity between recent G12 isolates from Argentina, the United States, and Asian countries suggests a relatively recent introduction(s) of these strains into humans from a common progenitor. The Argentinean G12 strains belonged to genotype P[9], similar to most of the recently described Asian G12 strains. The finding of G12 strains in several other regions of the world raises the possibility that G12 may be emerging globally and suggests that surveillance for this strain should be conducted routinely.
Assuntos
Diarreia/epidemiologia , Epidemiologia Molecular , Infecções por Rotavirus/epidemiologia , Rotavirus/classificação , Rotavirus/genética , Antígenos Virais/genética , Argentina/epidemiologia , Proteínas do Capsídeo/genética , Criança , Pré-Escolar , Diarreia/virologia , Fezes/virologia , Genótipo , Humanos , Dados de Sequência Molecular , Vigilância da População , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Rotavirus/isolamento & purificação , Infecções por Rotavirus/virologia , Análise de Sequência de DNARESUMO
A survey was conducted for identification of human group C rotaviruses in stool specimens taken from children suffering diarrhea in suburban Buenos Aires regions. Among 90 true negative group A samples as defined by ELISA, RT-PCR and PAGE, five were positive by group C specific RT-PCR (VP7 and VP6 genes) and three of these samples exhibited the characteristic 4-3-2-2 dsRNA pattern of group C rotavirus. These results were further confirmed by electron microscopy and by ELISA for detection of group C VP6 specific antigens. Sequence analysis of the VP7 gene from one of these isolates revealed a 97.3-98.6% nucleotide identity and up to 99.1% protein homology with human group C rotavirus strains found scattered throughout the last ten years in other countries. Conversely, similar analysis performed with porcine strains showed a much lower homology degree both at the nucleotide (75.5% nucleotide identity) and amino acid level (85.5% protein homology). Detection of group C rotavirus in children with acute diarrhea in Argentina extends the identification range of this agent in the region and is consistent with previous reported data that demonstrate a global distribution of this virus.
Assuntos
Proteínas do Capsídeo , Capsídeo/genética , Diarreia/virologia , Infecções por Rotavirus/virologia , Rotavirus/classificação , Rotavirus/genética , Antígenos Virais/análise , Argentina/epidemiologia , Criança , Diarreia/epidemiologia , Eletroforese em Gel de Poliacrilamida , Genes Virais , Humanos , Microscopia Eletrônica , RNA de Cadeia Dupla/genética , RNA Viral/genética , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Rotavirus/metabolismo , Infecções por Rotavirus/epidemiologiaRESUMO
Specific and sensitive tests for the detection and typing of group A rotavirus strains are needed for a more comprehensive knowledge of the epidemiology of rotaviral infection. In this study 500 stool specimens taken from 1996 to 1998 from children with acute diarrhea in Buenos Aires were examined. Group A rotavirus was unequivocally demonstrated in 62% of the samples tested by enzyme-linked immunosorbent assay (ELISA) for detection of VP6 antigen, polyacrylamide gel electrophoresis of double-stranded RNA, and reverse transcription-PCR (RT-PCR) for amplification of the VP7:G (1, 062 bp) and VP4:P (876 bp) genes. Only five positive specimens were found by RT-PCR but not by ELISA. G and P typing was carried out by nested amplification of variable sequences of the VP7 and the VP4 genes with six G- and five P-type-specific primers (multiplex PCR). Results obtained by this method showed the prevalence of the following G and P types: G1, 39%; G2, 43%; G4, 4%; P[8], 16%; P[4], 71%. Unexpectedly, the G-P type combination most frequently found was G2P[4] (43%) rather than G1P[8] (12%), which is the most commonly found worldwide. Unusual strains of the type G1P[4] accounted for 14% of the total, while mixed infections with more than one type were found in 10% of the samples. Detection of fecal rotavirus-specific immunoglobulin M (IgM) and IgA antibodies in consecutive samples of two patients taken at daily intervals demonstrated that high levels of IgM and IgA antibodies were detected on day 1 after the onset of disease and that the samples remained positive for about 10 days, after which virus shedding was no longer observed. Multiplex PCR offers a sensitive and specific alternative to determine the prevalence of group A rotavirus G and P types and to identify the emergence of uncommon strains, whereas detection of fecal IgM and IgA antibodies represents a useful supplement to virus detection for the diagnosis of current or recently acquired infections.
Assuntos
Proteínas do Capsídeo , Capsídeo/genética , Infecções por Rotavirus/virologia , Rotavirus/classificação , Anticorpos Antivirais/análise , Antígenos Virais/análise , Argentina , Pré-Escolar , Eletroforese em Gel de Poliacrilamida , Ensaio de Imunoadsorção Enzimática , Fezes/virologia , Genoma Viral , Genótipo , Humanos , Imunoglobulina A/análise , Imunoglobulina M/análise , Lactente , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Rotavirus/genética , Rotavirus/ultraestruturaRESUMO
INTRODUCTION: Recklinghausen's disease is considered to be the autosomal dominant disorder with the highest rate of mutation after achondroplasia. It is a neuroectodermal disorder with considerable clinical effects. PATIENTS AND METHODS: We present a study of 14 patients seen for café-au-lait spots in the Clinical Genetics Department of the Hospital Infantil Sur. A detailed questionnaire and physical examination was done to obtain a clinical outline. CONCLUSION: Suspicion of this condition, together with laboratory investigations led to the conclusion that the cases were neurofibromatosis.
Assuntos
Neurofibromatose 1/diagnóstico , Adolescente , Adulto , Manchas Café com Leite/epidemiologia , Manchas Café com Leite/etiologia , Criança , Pré-Escolar , Cuba/epidemiologia , Diagnóstico por Imagem , Nanismo/epidemiologia , Nanismo/etiologia , Eletroencefalografia , Feminino , Humanos , Lactente , Deficiência Intelectual/epidemiologia , Deficiência Intelectual/etiologia , Imageamento por Ressonância Magnética , Masculino , Melanose , Neurofibromatose 1/epidemiologia , Neurofibromatose 1/patologia , Escoliose/epidemiologia , Escoliose/etiologia , Tomografia Computadorizada por Raios XRESUMO
On block hysterectomy is defined as the removal of the gravid uterus with its gestational content in situ. The described indications for the realization of this procedure are neoplastic process as the most frequent cause; septic process, persistent trophoblastic diseases, and hemorrhage due to anomalous placentation. This is a retrospective, descriptive study of twelve cases of on block hysterectomy collected from January 1989 to December 1994 at Instituto Nacional de Perinatología. An average age of 33.4 years was found. The number of pregnancies for this patients in average was found to be 4.1. The gestational age was established between 9 to 29 weeks. Four patients with a 4 or more previous miscarriage background. There were two reported cases having a multiple gestation. Among the complications found, there were three cases of hipovolemic shock and one with abcess of vaginal cupula. The average days of hospitalization was 5.3 days. We found no mortality at all in this study, and the histopathologic correlation accorded in 100% of the cases. In this five year review, 12 cases of on block hysterectomy were found, being the most frequent reason for it's realization the persistent trophoblastic diseases; severe hemorrhage in second place, and serious infection process in third. The observed complications were derived from the hemodynamic compromise of each patient. Even though on block hysterectomy is one rarely seen procedure, it most be in mind as an alternative therapeutical instance it most be carried out in third level institutions, with technology and human resources capable of solving any complication derived from this kind of surgery.
Assuntos
Histerectomia/métodos , Complicações na Gravidez/diagnóstico , Aborto Induzido , Adulto , Feminino , Idade Gestacional , Humanos , Paridade , Gravidez , Complicações na Gravidez/cirurgia , Estudos RetrospectivosRESUMO
Se presentan dos hermanos con microlitiasis alveolar pulmonar (MLA) que es una alteración rara de carácter autosómico recesivo. Se señalan las principales características de la MLA y se revisa la literatura. En un caso la biopsia pulmonar permitió el diagnóstico por la presencia de múltiples calcosferitas. Se señala la importancia del estudio familiar que descubrió una hermana con el mismo patrón radiográfico. Se presentan los datos más importantes obtenidos por imágenes radiológicas y los hallazgos histopatológicos
Assuntos
Humanos , Masculino , Adulto , Calcinose , Calcinose/diagnóstico , Pneumopatias/diagnóstico , Pneumopatias , Alvéolos Pulmonares , Alvéolos Pulmonares/fisiopatologiaRESUMO
The study of two brothers with pulmonary alveolar microlithiasis (MLA) a rare lung alteration with autosomic recessive character is presented. In one case the lung biopsy made the diagnosis by the identification of multiple calcospherites. The importance of the familiar study is stressed, as a sister with the same radiographic image was discovered this way. The literature is revised and the main data of MLA are presented; the radiologic images and histopathologic findings are commented.
Assuntos
Cálculos/genética , Alvéolos Pulmonares , Adulto , Cálculos/diagnóstico por imagem , Feminino , Humanos , Pneumopatias/diagnóstico por imagem , Pneumopatias/genética , Masculino , Linhagem , Alvéolos Pulmonares/diagnóstico por imagem , RadiografiaRESUMO
En este trabajo se presenta el estudio químico radiofarmacológico y el uso en seres humanos realizado con el "mebrofeini-Tc-99m". La finalidad del trabajo fue determinar el uso potencial de este radiofármaco en seres humanos portadores de distintas entidades clínico patológicas. Para esto, se sintetizó el producto mejorando el rendimiento de reacción, mediante una modificación en la segunda etapa del camino de síntesis, lo que condujo a elevarlo del 70 al 90%. Se determinó la cinética plasmática mediante la circulación extracorpórea realizada en ratas wistar, mientras que la hepática y renal se llevó a cabo en ratones endocriados. Todos los resultados fueron analizados mediante un procesador, obteniéndose las vidas medias plasmáticas y los máximos tiempos de captación