RESUMO
PURPOSE: Immunosuppressed (IS) patients are at increased risk for developing Merkel cell carcinoma (MCC) with worsened outcomes compared to immunocompetent (IC) patients. We sought to determine the effects of immune status on the efficacy of adjuvant RT regarding OS for patients with stage I, II or III (localized) MCC of the head and neck. METHODS/PATIENTS: The National Cancer Database was queried for patients with resected, localized MCC of the head and neck with known immune status. Kaplan-Meier methods were used to describe OS. Log-rank tests, multivariable Cox regression models and interaction effect testing were used to compare OS by subgroup categorized by patient and treatment factors including immune status and adjuvant RT receipt. RESULTS: A total of 892 (89.6%) IC and 104 (10.4%) IS patients with MCC of the head and neck were included. Adjuvant RT was associated with improved 3-year OS rate for both IS patients (49.4% vs. 35.5%, p = 0.0467) and stage I/II IC patients (72.4% vs. 62.9%, p = 0.0092). Adjuvant RT was associated with decreased hazard of death (HR 0.77, 95% CI 0.62-0.95). Interaction effect testing did not demonstrate a difference in the efficacy of adjuvant RT on OS between IC and IS status (p = 0.157). CONCLUSIONS: In this NCDB analysis, adjuvant RT was associated with decreased hazard of death for patients with localized MCC of the head and neck regardless of immune status and should be considered for both IS and IC patients.
Assuntos
Carcinoma de Célula de Merkel/radioterapia , Neoplasias de Cabeça e Pescoço/radioterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Célula de Merkel/imunologia , Carcinoma de Célula de Merkel/mortalidade , Feminino , Neoplasias de Cabeça e Pescoço/imunologia , Neoplasias de Cabeça e Pescoço/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Radioterapia Adjuvante , Estudos RetrospectivosAssuntos
Doadores de Sangue , Antígenos HLA/imunologia , Isoanticorpos , Transfusão de Leucócitos/efeitos adversos , Síndrome do Desconforto Respiratório/prevenção & controle , Brasil , Transfusão de Eritrócitos/métodos , Europa (Continente) , Política de Saúde , Humanos , Isoanticorpos/efeitos adversos , Isoanticorpos/sangue , Japão , Leucócitos/efeitos dos fármacos , Nova Zelândia , Síndrome do Desconforto Respiratório/imunologia , Estados UnidosRESUMO
Rhodococcus equi is a well-recognized pathogen in veterinary medicine and a rare but well-documented cause of cavitary pneumonia in immunocompromised patients. Most cases of Rhodococcus equi infections in these patients involve the lungs. Otomastoiditis due to Rhodococcus equi is rare, and disseminated Rhodococcus equi with otomastoiditis has never been reported. We report a case of otomastoiditis with systemic dissemination due to Rhodococcus equi in a patient with AIDS.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS , Infecções por Actinomycetales , Mastoidite/etiologia , Otite Média Supurativa/etiologia , Rhodococcus equi , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções por Actinomycetales/tratamento farmacológico , Adulto , Antibacterianos/uso terapêutico , Seguimentos , Humanos , Masculino , Mastoidite/diagnóstico , Mastoidite/tratamento farmacológico , Otite Média Supurativa/diagnóstico , Otite Média Supurativa/tratamento farmacológico , Osso Temporal/diagnóstico por imagem , Fatores de Tempo , Tomografia Computadorizada por Raios XRESUMO
Examination of the neuromasts in the tail of the living juvenile axolotl Ambystoma mexicanum with interference contrast (Nomarski) microscopy shows that their cellular structures can be identified in considerable detail. Microscopy was performed with a 40 x water immersion objective or with a 100 x objective in a tail insertion chamber. Thus the sensory hair bundles can be seen and their orientation can be determined. Large spheres in the basal part of the sensory cells were predicted to be synaptic bodies. Subsequent examination in the transmission electron microscope of the cells observed in the light microscope confirmed this notion. Inspection during periods of several hours reveals definite movements of the synaptic bodies.
Assuntos
Ambystoma mexicanum/fisiologia , Neurônios Aferentes/fisiologia , Transmissão Sináptica/fisiologia , Cauda/anatomia & histologia , Animais , Larva , Microscopia Eletrônica , Microscopia de Contraste de Fase , Plasticidade Neuronal , Neurônios Aferentes/citologia , Neurônios Aferentes/ultraestruturaRESUMO
A study sample of 7,010 episodes of invasive Streptococcus pneumoniae disease was obtained by combining 13 existing datasets. Disease episodes due to each of 12 pneumococcal serogroups (1, 3-9, 14, 18, 19, and 23) were then compared with episodes in a constant internal control group to describe serogroup-specific variations in disease frequency by age, sex, and geographic origin. The results are presented as odds ratios (with 95% confidence intervals) derived by logistic regression, with adjustment for the major confounders, including dataset of origin. Variation in the male:female ratios between serogroups is small, suggesting that capsular characteristics are an unlikely explanation for the male preference of S. pneumoniae. Serogroups associated with higher nasopharyngeal prevalence (e.g., 19 and 24) are relatively more common in Europe and North American, while the invasive serotypes 1 and 5 are much more common in South America. The custom of reporting serogroup frequencies in two age groups, children and adults, conceals much of the variation in the age distributions across the whole span of life. The reduction of risk associated with serogroups 6, 14, 18, 19, and 23 beyond childhood follows different gradients, being most abrupt in serogroups 14 and most gradual in serogroup 18. The relative risk of disease with serotype 1 declines steadily throughout life, while with serotypes 3 and 8 it increases over middle age. Serogroups 7 and 23 are found unusually frequently in the third decade of life. Because of the wide differences in the epidemiology of individual serogroups of S. pneumoniae, it is questionable whether pneumococcal infection should continue to be classified as a single disease entity.
Assuntos
Infecções Pneumocócicas/epidemiologia , Sorotipagem/classificação , Streptococcus pneumoniae/classificação , Adolescente , Adulto , Fatores Etários , Idoso , Brasil/epidemiologia , Canadá/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Israel/epidemiologia , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Soroepidemiológicos , Fatores Sexuais , Espanha/epidemiologia , Reino Unido/epidemiologia , Estados Unidos/epidemiologia , Uruguai/epidemiologiaRESUMO
Three cases of probably therapeutically intended trepanations of cranial fractures in ancient Peru are presented and discussed.
Assuntos
Paleopatologia , Fraturas Cranianas/história , Trepanação/história , Adulto , História Antiga , Humanos , Masculino , Peru , Fraturas Cranianas/cirurgiaRESUMO
New lateral organs (neuromasts) are formed in regenerating tails of the larvae of a urodele, the axolotl (Ambystoma mexicanum), even in the absence of the lateral line nerve, as confirmed by electron microscopic examination. The non-innervated organs are similar to normal innervated organs. The hair cells are polarized in opposite directions, and despite the lack of nerve endings, contain synaptic bodies, which in normal innervated organs are found in relation to afferent boutons.