RESUMO
Introduction: High-grade gliomas are the most common primary brain tumors in adults, and they usually have a quick fatal course. Average survival is 18 months, mainly, because of tumor resistance to Stupp protocol. Objective: To determine high-grade glioma patient survival and the effect of persuasion variables on survival. Materials and methods: We conducted a longitudinal descriptive study in which 80 untreated recently diagnosed high-grade glioma patients participated. A survey was conducted regarding their exposure to some risk factors, degree of genetic instability in peripheral blood using micronucleus quantification on binuclear lymphocytes, micronuclei in reticulocytes and sister-chromatid exchanges in lymphocytes. In the statistical analysis, this study constructed life tables, used the Kaplan-Meier, and the log-rank test, and in the multivariate analysis, a Cox proportional hazards model was constructed. Results: Eighty patients' clinical, demographic and lifestyle characteristics were analyzed, as well as their survival rates and the average survival time is 784 days (interquartile range: 928). Factors like age, exposure at work to polycyclic hydrocarbons and the number of sister-chromatid exchanges in lymphocytes in the first sampling was significantly survivalrelated in the multivariate analysis. Conclusion: We determined that only three of the analyzed variables have an important effect on survival time when it comes to high-grade glioma patients.
Introducción. Los gliomas de alto grado son los tumores cerebrales primarios más comunes en adultos y, por lo general, tienen un curso mortal rápido. La supervivencia media es de 18 meses, principalmente, como consecuencia de la resistencia del tumor al protocolo Stupp. Objetivo. Determinar la supervivencia de los pacientes con glioma de alto grado y el efecto de las variables de persuasión en la supervivencia. Materiales y métodos. Se llevó a cabo un estudio descriptivo longitudinal en el que participaron 80 pacientes con diagnóstico reciente de glioma de alto grado no tratados. Se hizo una encuesta sobre su exposición a algunos factores de riesgo, grado de inestabilidad genética en sangre periférica mediante cuantificación de micronúcleos en linfocitos binucleares, micronúcleos en reticulocitos e intercambios de cromátidas hermanas en linfocitos. En el análisis estadístico, se construyeron tablas de vida, se utilizó Kaplan-Meier y la prueba de rangos logarítmicos, y en el análisis multivariado, se construyó un modelo de riesgos proporcionales de Cox. Resultados. Se analizaron las características clínicas, demográficas y de estilo de vida de 80 pacientes, así como sus tasas de supervivencia y el tiempo medio de supervivencia fue de 784 días (rango intercuartílico: 928). Factores como la edad, la exposición laboral a hidrocarburos policíclicos y el número de intercambios de cromátidas hermanas en linfocitos en el primer muestreo se relacionaron significativamente con la supervivencia en el análisis multivariante. Conclusión. Según los resultados, el estudio determinó que solo tres de las variables analizadas tienen un efecto importante en el tiempo de supervivencia cuando se trata de pacientes con glioma de alto grado.
Assuntos
Neoplasias Encefálicas , Glioma , Humanos , Glioma/mortalidade , Glioma/patologia , Glioma/genética , Neoplasias Encefálicas/mortalidade , Neoplasias Encefálicas/patologia , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Estudos Longitudinais , Análise de Sobrevida , Fatores de Risco , Troca de Cromátide Irmã , Exposição Ocupacional/efeitos adversos , Idoso , Estimativa de Kaplan-Meier , Gradação de TumoresRESUMO
The purpose of this study was to evaluate the fatigue survival of 5Y-PSZ zirconia infiltrated with an experimental glass and bonded onto dentin analogues. Disc-shaped specimens of a 5Y-PSZ (Katana UTML Kuraray Noritake) were cemented onto dentin analogs (NEMA G10) and divided into four groups (n = 15): Zctrl Group (control, without infiltration); Zglz Group (Glaze, compression surface); Zinf-comp Group (Experimental Glass, compression surface); Zinf-tens Group (Experimental Glass, tension surface). Surface treatments were varied. Cyclic fatigue loading, oblique transillumination, stereomicroscope examination, and scanning electron microscopy were performed. Fatigue data were analyzed (failure load and number of cycles) using survival analysis (Kaplan-Meier and Log-Rank Mantel-Cox). There was no statistically significant difference in fatigue survival between the Zglz, Zctrl, and Zinf-comp groups. The Zinf-tens group presented a significantly higher failure load when compared to the other groups and exhibited a different failure mode. The experimental glass effectively infiltrated the zirconia, enhancing structural reliability, altering the failure mode, and improving load-bearing capacity over more cycles, particularly in the group where the glass was infiltrated into the tensile surface of the zirconia. Glass infiltration into 5Y-PSZ zirconia significantly enhanced structural reliability and the ability to withstand loads over an increased number of cycles. This approach has the potential to increase the durability of zirconia restorations, reducing the need for replacements and save time and resources, promoting efficiency in clinical practice.
Assuntos
Dentina , Vidro , Teste de Materiais , Zircônio , Zircônio/química , Vidro/química , Dentina/química , Humanos , Microscopia Eletrônica de Varredura , Propriedades de SuperfícieRESUMO
BACKGROUND: Graft loss increases the risk of patient death after simultaneous pancreas-kidney (SPK) transplantation. The relative risk of each graft failure is complex due to the influence of several competing events. METHODS: This retrospective, single-center study compared 4-year patient survival according to the graft status using Kaplan-Meier (KM) and Competing Risk Analysis (CRA). Patient survival was also assessed according to five eras (Era 1: 2001-2003; Era 2: 2004-2006; Era 3: 2007-2009; Era 4: 2010-2012; Era 5: 2012-2015). RESULTS: Between 2000 and 2015, 432 SPK transplants were performed. Using KM, patient survival was 86.5% for patients without graft loss (n = 333), 93.4% for patients with pancreas graft loss (n = 46), 43.7% for patients with kidney graft loss (n = 16), and 25.4% for patients with pancreas and kidney graft loss (n = 37). Patient survival was underestimated using KM versus CRA methods in patients with pancreas and kidney graft losses (25.4% vs. 36.2%), respectively. Induction with lymphocyte depleting antibodies was associated with 81% reduced risk (HR.19, 95% CI.38-.98, p = .0048), while delayed kidney function (HR 2.94, 95% CI 1.09-7.95, p = .033) and surgical complications (HR 2.94, 95% CI 1.22-7.08, p = .016) were associated with higher risk of death. Four-year patient survival increased from Era 1 to Era 5 (79% vs. 87.9%, p = .047). CONCLUSION: In this cohort of patients, kidney graft loss, with or without pancreas graft loss, was associated with higher mortality after SPK transplantation. Compared to CRA, the KM model underestimated survival only among patients with pancreas and kidney graft losses. Patient survival increased over time.
Assuntos
Diabetes Mellitus Tipo 1 , Transplante de Rim , Transplante de Pâncreas , Humanos , Diabetes Mellitus Tipo 1/cirurgia , Estudos Retrospectivos , Transplante de Pâncreas/métodos , Medição de Risco , Pâncreas , Sobrevivência de EnxertoRESUMO
BACKGROUND: Although it has been shown that cyclin dependent kinase inhibitor 2A (CDKN2A) plays a significant role in a number of malignancies, its clinicopathological value and function in small cell lung cancer (SCLC) is unclear and warrants additional research. METHODS: The clinical significance of CDKN2A expression in SCLC was examined by multiple methods, including comprehensive integration of mRNA level by high throughput data, Kaplan-Meier survival analysis for prognostic value, and validation of its protein expression using in-house immunohistochemistry. RESULTS: The expression of CDKN2A mRNA in 357 cases of SCLC was evidently higher than that in the control group (n = 525) combing the data from 20 research centers worldwide. The standardized mean difference (SMD) was 3.07, and the area under the curve (AUC) of summary receiver operating characteristic curve (sROC) was 0.97 for the overexpression of CDKN2A. ACC, COAD, KICH, KIRC, PCPG, PRAD, UCEC, UVM patients with higher CDKN2A expression had considerably worse overall survival rates than those with lower CDKN2A expression with the hazard ratio (HR) > 1. CONCLUSION: CDKN2A upregulation extensively enhances the carcinogenesis and progression of SCLC.
Assuntos
Biomarcadores Tumorais , Inibidor p16 de Quinase Dependente de Ciclina , Neoplasias Pulmonares , Carcinoma de Pequenas Células do Pulmão , Humanos , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/metabolismo , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/genética , Carcinoma de Pequenas Células do Pulmão/patologia , Carcinoma de Pequenas Células do Pulmão/metabolismo , Carcinoma de Pequenas Células do Pulmão/genética , Carcinoma de Pequenas Células do Pulmão/mortalidade , Inibidor p16 de Quinase Dependente de Ciclina/metabolismo , Prognóstico , Biomarcadores Tumorais/metabolismo , Biomarcadores Tumorais/genética , Feminino , Masculino , Estimativa de Kaplan-Meier , Curva ROC , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , Pessoa de Meia-Idade , Taxa de Sobrevida , Estudos Prospectivos , Idoso , Estudos de Casos e Controles , Relevância ClínicaRESUMO
BACKGROUND: Gallbladder carcinoma (GC) is a rare malignant tumor. Laparoscopic technology has revolutionized the reality of surgery. However, whether laparoscopic surgery is suitable for GC has not been clarified. We aimed to analyze the safety, feasibility, and oncological outcomes of laparoscopic surgery in GC. METHODS: The medical records of patients with GC treated at our hospital between January 2016 and December 2021 were retrospectively reviewed. Patients who underwent laparoscopic and open surgery were compared. Propensity score matched analysis was performed to balance the basic characteristics of the two groups. Kaplan-Meier curves were used to describe and compare the overall and disease-free survival rates between the groups. RESULTS: A total of 163 patients with GC were included. Cholelithiasis was detected in 64 (39.3%) patients. Seventy patients were matched after propensity score matching. The laparoscopic group was significantly better than the open group in terms of operation time (p < 0.001), blood loss (p = 0.002), drain time (p = 0.001), and hospital stay (p < 0.001). After a median follow-up time of 19 (12, 35) months, there was no significant difference in the cumulative overall (p = 0.650) and disease-free (p = 0.663) survival rates between the laparoscopic and open groups according to Kaplan-Meier curves. CONCLUSION: Laparoscopic surgery can reduce the operation time and blood loss, and shorten drain time and hospital stay without increasing the incidence of complications. Patients undergoing laparoscopic and open surgery have a similar prognosis. Laparoscopic surgery is worth promoting in patients with GC.
Assuntos
Neoplasias da Vesícula Biliar , Laparoscopia , Humanos , Neoplasias da Vesícula Biliar/cirurgia , Neoplasias da Vesícula Biliar/etiologia , Resultado do Tratamento , Estudos Retrospectivos , Estudos de Viabilidade , Pontuação de PropensãoRESUMO
Introducción: La pandemia de COVID-19 evidenció la importancia de los trabajadores esen-ciales de la salud. Objetivo: Estimar la ocurrencia de la infección por el virus Sars_CoV2 en funcionarios de un hospital, antes y después de implementación del programa de vacunación institucional y la fracción preventiva atribuible a la vacunación. Material y métodos: Estudio de cohorte histórica, teniendo como punto de inicio la fecha del primer funcionario diagnosticado con la Covid19 en el Hospital. Alrededor de mil traba-jadores fueron examinados, durante el periodo de estudio comprendido entre junio de 2020 y octubre 2021. Se utilizó el estadístico de Kaplan-Meier, para comparar la velocidad de infección y la fracción preventiva atribuible al programa de vacunación. Resultados. Hubo diferencias estadísticamente significativas en la reducción de casos según tipo de trabajo, los trabajadores asistenciales experimentaron una reducción del 58,1%, de 124 a 52 y la diferencia en la mediana de la velocidad de infección, antes y después, Log Rank = 127,4 gl = 1 p = 0,000; los administrativos 51,7% de 29 a 14, mediana log Rank = 34,4 gl = 1 p = 0,000, y los operativos 45,5% de 11 a 6, mediana Log Rank = 13,5 gl = 1 p = 0,000. La fracción atribuible preventiva entre los asistenciales fue 47,5% (37,454,9); 85,2% (77,788,9) en administrativos y una reducción no significativa de 43,6% (-20,7, 63,2) en operativos. Conclusiones: Los trabajadores asistenciales tienen un riesgo alto de contraer la infección por Sars_CoV2. Fue una acertada decisión vacunar a todos los trabajadores del hospital, el impacto es demostrable.
Introduction: The COVID-19 pandemic highlighted the importance of essential health care workers.Objective: To estimate the occurrence of Sars_CoV2 virus infection in hospital staff before and after implementation of the institutional vaccination program and the preventive fraction attributable to vaccination. Material and methods: Historical cohort study, having as starting point the date of the first employee diagnosed with Covid19 in the Hospital. About one thousand workers were exa-mined, during the study period from June 2020 to October 2021. The Kaplan-Meier statistic was used to compare the infection, rate and the preventive fraction attributable to the vac-cination program. Results: There were statistically significant differences in the reduction of cases according to type of work, with the assistential workers experiencing a reduction of 58.1%, from 124 to 52 and the difference in median infection rate, before and after, Log Rank = 127.4 gl = 1 p = 0.000; the administrative 51.7% from 29 to 14, median Log Rank = 34.4 gl = 1 p = 0.000, and the operatives 45.5% from 11 to 6, median Log Rank = 13.5 gl = 1 p = 0.000. The preventive attributable fraction among assistants was 47.5% (37.4-54.9); 85.2% (77.7-88.9) in adminis-trative and a non-significant reduction of 43.6% (-20.7, 63.2) in operatives.Conclusions: Healthcare workers are at high risk of contracting Sars_CoV2 infection. It was a wise decision to vaccinate all hospital workers, the impact is demonstrable.
Assuntos
Humanos , Adulto , Pessoa de Meia-Idade , Pessoal de Saúde , Vacinas contra COVID-19 , COVID-19 , Vacinas , Programas de Imunização , COVID-19/prevenção & controleRESUMO
RESUMEN La estreptococosis es una de las principales enfermedades en los peces de agua dulce que causa altas tasas de mortalidad. El objetivo de este estudio fue evaluar la respuesta en la supervivencia a la infección por Streptococcus agalactiae en tres familias de tilapia. El experimento se llevó a cabo en el Laboratorio de Enfermedades de los Peces de la Universidad Federal de Lavras. Se utilizaron peces con un peso de 93,7 ± 5,4 g de tres familias diferentes (FA, FB y FC). Se utilizaron 36 peces en cada unidad experimental, inoculados intraperitonealmente con 107 UFC/mL de Streptococcus agalactiae por peces y un grupo control por familia con 9 peces con 1 mL de caldo BHI (Infusión Cerebro Corazón) evaluados durante 15 días. No hubo mortalidad del grupo control. Se observó la presencia de exoftalmia, coloración oscura en todo el cuerpo, letargo y dilatación abdominal antes de la muerte en las tres familias evaluadas expuestas al patógeno. El estimador no paramétrico de Kaplan-Meier se utilizó para observar las curvas de supervivencia. Durante los 15 días del desafío, el tiempo promedio de supervivencia de un individuo en las familias FA, FB y FC fue de 9,4; 6,90 y 8,14 días, respectivamente. Pruebas de Log-rank y Peto & Peto para evaluar la diferencia entre las curvas de supervivencia arrojaron que no hubo diferencias significativas entre las familias evaluadas (P=0,08 y P= 0,09), respectivamente.
ABSTRACT Streptococcosis is one of the main diseases in freshwater fish that causes high mortality rates. The objective of this study was to evaluate the survival response to Streptococcus agalactiae infection in three families of tilapia. The experiment was carried out at the Laboratory of Fish Diseases of the Federal University of Lavras. Fish weighing 93.7 ± 5.4 g from three different families (FA, FB, and FC) were used. 36 fish were used in each experimental unit, intraperitoneally inoculated with 107 CFU/mL of Streptococcus agalactiae per fish and a control group per family with 9 fish with 1 mL of BHI broth (Brain Heart Infusion) evaluated for 15 days. There was no mortality in the control group. The three evaluated families exposed to the pathogen observed the presence of exophthalmia, dark coloration throughout the body, lethargy, and abdominal dilation before death. The Kaplan-Meier nonparametric estimator was used to observe the survival curves. During the 15 days of the challenge, the average survival time of an individual in the FA, FB, and FC families was 9.4, 6.90, and 8.14 days, respectively. Log-rank and Peto & Peto test to evaluate the difference between the survival curves showed no significant differences between the assessed families (P=0.08 and P= 0.09), respectively.
RESUMO
Introduction: The coronavirus disease 2019 (COVID-19) was originally identified in the city of Wuhan, China, in December 2019. Current evidence indicates that the COVID-19-causing virus is transmitted person-to-person through direct contact and droplets. Objective: To estimate Sars-CoV-2 virus infection rate in hospital employees according to their job responsibilities. Materials and methods: Retrospective cohort study to detect Sars-CoV-2 infection in hospital employees, carried out between February 2020 and October 2021. The Kaplan Meier procedure was carried out to estimate the virus infection rate based on variables such as gender, age and job description. Results: There was a difference in infection rate between young and older adult age groups (Log Rank=18.6 gl=1 p=<0.0001). A significant difference was also found between young adult and older adult groups (Log Rank=10.6 gl=1 p=0.0011). Conclusions: The older adult group showed a higher infection rate than that observed in younger age groups. These findings highlight the occupational risk of Sars-CoV-2 infection in health workers, especially in older employees. Therefore, it is necessary to maintain safety measures in order to reduce infection risks.
Introducción: La enfermedad por coronavirus 2019 se identificó originalmente en la ciudad de Wuhan, China, en diciembre de 2019. La evidencia actual indica que el virus que causa la COVID-19 se transmite de persona a persona a través del contacto directo y gotitas. Objetivo: Estimar la tasa de infección por el virus Sars-CoV-2 en empleados de hospitales según sus responsabilidades laborales. Materiales y métodos: Estudio de cohorte retrospectivo para detectar infección por Sars-CoV-2 en empleados de hospitales, realizado entre febrero 2020 y octubre 2021. Se realizó el procedimiento de Kaplan Meier para estimar la tasa de infección del virus según género, edad y descripción del trabajo. Resultados: Hubo una diferencia en la tasa de infección entre los grupos de edad de adultos jóvenes y mayores (Log Rank=18,6 gl=1 p=<0,0001). Se encontró una diferencia significativa entre grupos de adultos jóvenes y adultos mayores (Log Rank=10.6 gl=1 p=0.0011). Conclusiones: Los adultos mayores presentaron una tasa de infección superior a la observada en grupos de edades más jóvenes. Se resalta el riesgo ocupacional de infección por Sars-CoV-2 en los trabajadores de la salud, especialmente en los empleados de mayor edad. Es necesario mantener las medidas de seguridad para reducir los riesgos de infección.
Assuntos
Humanos , Masculino , Feminino , SARS-CoV-2 , Hospitais , Vírus , Saúde Ocupacional , Pessoal de Saúde , InfecçõesRESUMO
Resumo Introdução A Unidade de Assistência de Alta Complexidade em Oncologia (UNACON) permite o tratamento de leucemias agudas no Acre. Objetivo Determinar o perfil clínico-epidemiológico e a sobrevida hospitalar de leucemias agudas tratadas na UNACON/Acre entre 2007 e 2014. Método É um estudo longitudinal e retrospectivo de pacientes com leucemias agudas entre 15/06/2007 e 31/12/2014, cujos prontuários médicos forneceram dados para a análise descritiva das variáveis e posterior análise de sobrevida acumulada em 1 ano e 2 anos (método Kaplan-Meier) e comparação das curvas de sobrevida (teste de log-rank). Resultados A sobrevida para leucemias mieloides agudas (LMA) foi de 30% e 32% em 1 e 2 anos, respectivamente, com pior sobrevida para pacientes masculinos, brancos, ≥ 20 anos de idade, leucometria < 20.000 células/mm3, desidrogenase lática ≥ 600 U/dl e subtipo diferente do M3. Para leucemias linfoides agudas (LLA), a sobrevida foi de 59% e 45% em 1 e 2 anos, respectivamente, com pior sobrevida para sexo feminino, ≥ 20 anos de idade e leucometria elevada. Em pacientes abaixo de 20 anos de idade com LLA, a melhor sobrevida foi observada na faixa etária de 2 a 9 anos. Conclusão Trata-se do primeiro estudo epidemiológico de sobrevida realizado no Acre para leucemias agudas com resultados coerentes com a literatura. Contudo, novas pesquisas deverão ser realizadas.
Abstract Background The High Complexity Oncology Unit (Unidade de Assistência de Alta Complexidade em Oncologia - UNACON/Acre) allowed the treatment of acute leukemias in Acre. Objective To determine the clinical-epidemiological profile and hospital survival of acute leukemias treated at UNACON/Acre between 2007 and 2014. Method This is a longitudinal, retrospective study of patients with acute leukemias between 06/15/2007 and 12/31/2014 whose medical records provided data for descriptive analysis of the variables, and subsequent analysis of 1-year and 2-year cumulative survival (Kaplan Meier method) and comparison of survival curves (log-rank test). Results The survival for acute myeloid leukemia (AML) was 30 and 32% at 1 and 2 years, respectively, with a worse survival rate for males, white, age ≥20 years, leukometry <20,000 cells/mm3, lactic dehydrogenase ≥600 U/dl and subtype different from M3. For acute lymphoid leukemias (ALL), survival was 59 and 45% at 1 and 2 years, respectively. Female gender, age ≥20 years, and high leukometry had worse survival. For patients <20 years with ALL, better survival was observed in the age group of 2-9 years. Conclusion This is the first epidemiological study of survival in Acre for acute leukemias with results consistent with the literature. However, new studies should be performed.
RESUMO
Abstract INTRODUCTION: Understanding the mortality-associated risk factors of coronavirus disease 2019 will impact clinical decisions. METHODS: This retrospective longitudinal study included patients hospitalized for coronavirus disease in Rio de Janeiro, Brazil. The Kaplan-Meier method and multivariate Cox regression analysis were used. RESULTS: Sequential Organ Failure Assessment score of ≥2 (hazard ratio 4.614; 95% confidence interval =2.210-9.634; p<0.001) and neutrophil/lymphocyte ratio of >5 (hazard ratio=2.616; 95% confidence interval=1.303-5.252; p=0.007) were independently associated with mortality. CONCLUSIONS: Sequential Organ Failure Assessment score and neutrophil/lymphocyte ratio on admission can identify coronavirus disease patients at increased risk of death and guide subsequent clinical decisions.
Assuntos
Humanos , Infecções por Coronavirus , Brasil/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Estudos Longitudinais , BetacoronavirusRESUMO
An observational retrospective study was conducted over a 5-year period to assess survival and predictors of death in people with HIV-positive serology undergoing antiretroviral treatment with first-line regimens at the Military Hospital of Nampula, Mozambique. We collected data from 332 patient records. Kaplan-Meier boundary product estimator, log-rank, Gehan-Breslow, Tarone-Ware, time-dependent Cox models and estimates of hazard ratios (HR), with 95% confidence interval (CI) were calculated. Meantime survival for females and males was 54.8 months [95% CI 50.32-55.40] and 49.7 months [95% CI 45.89-53.53], respectively. Cox regressions indicated higher death rates significantly or potentially associated with: male sex (HR = 1.3; [95% CI 0.7-2.39]); suspected diagnosis reported only by the physician (HR = 3.6; [95% CI 1.8-7.4]); disease stages III (HR=1.2 [95% CI 0.3-3.6]) or IV (HR 1.4 [95% CI 0.4-5.8]); first TCD4+ lymphocyte count lower than 350 cells per ml (HR = 3.2; [95% CI 0.9-11.2]) or between 350-500 cells per ml (HR = 1.3; [95% CI 0.3-5.8]); or do not present cells count (HR = 3.6; [95% CI 1.2-10.2]). The above variables were significant for HIV prognosis and as predictors of death and should be considered in the clinical care of these patients.
Assuntos
Infecções por HIV , Hospitais Militares , Feminino , Infecções por HIV/mortalidade , Humanos , Estimativa de Kaplan-Meier , Masculino , Moçambique/epidemiologia , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida , Estados UnidosRESUMO
RESUMEN En el presente artículo se describe una metodología que permite tener un acercamiento a modelos probabilísticos alternativos para el análisis de supervivencia, con censura por la derecha, distintos a los que usualmente se estudian (distribución: exponencial, gamma, Weibull y log-normal), ya que es posible que los datos no se ajusten siempre con suficiente precisión por las distribuciones existentes. La metodología utilizada permite mayor flexibilidad de modelar observaciones extremas, ubicadas generalmente en la cola derecha de la distribución de los datos, lo cual admite que algunos eventos aún tengan la probabilidad de ocurrir, lo que no sucede con los modelos tradicionales y el estimador de Kaplan-Meier, el cual estima para los tiempos más prolongados, probabilidades de supervivencia aproximadamente iguales a cero. Para mostrar la utilidad de la propuesta metodológica, se consideró una aplicación con datos reales que relaciona tiempos de supervivencia de pacientes con cáncer de colon.
ABSTRACT This article describes a methodology that allows an approach to alternative right-censored probabilistic models for the analysis of survival, different to those usually studied (exponential, gamma, Weibull, and log-normal distribution) since it is possible that the data do not always fit with sufficient precision due to existing distributions. The methodology used allows for greater flexibility when modeling extreme observations, generally located in the right tail of data distribution, which admits that some events still have the probability of occurring, which is not the case with traditional models and the Kaplan-Meier estimator, which estimates for the longest times, survival probabilities approximately equal to zero. To show the usefulness of the methodological proposal, we considered an application with real data that relates survival times of patients with colon cancer (CC).
Assuntos
Humanos , Modelos Estatísticos , Neoplasias do Colo/patologia , Neoplasias/patologia , Análise de Sobrevida , Estimativa de Kaplan-MeierRESUMO
OBJECTIVE: To describe the results of the extension of surgical treatment and adjuvant chemotherapy (ACT) in incidental gallbladder cancer (CVB), in terms of postoperative morbidity (POM) and 5-year overall survival rate. METHOD: Case series of patients operated on for incidental GBC in Clínica Mayor, Temuco, Chile (2001-2016). All cases were treated by partial hepatectomy (segments IVb and V), and regional lymphadenectomy. The minimum follow-up time was 12 months. Outcome variables were MPO and 5-year overall survival rate. Other variables of interest were: infiltration depth in vesicular wall, lymph nodes and resected liver; surgical time, need for reoperation, hospital stay, follow-up and mortality. Descriptive statistics were applied as well as bivariate analysis applying Fisher's exact and t-test and non-parametrical tests for continuous variables and Kaplan Meier curves. RESULTS: The series was composed of 50 patients, whose average age was 58.6 ± 9.6 years; 68.0% of which were women. The mean surgical time and hospital stay were 224 ± 93 min (90 to 480) and 6.9 ± 2.9 days (4 to 20), respectively. POM was 28.0%. 5-year overall survival rate was 47%. There were no reoperations or mortality. CONCLUSIONS: The results verified in terms of POM and 5-year overall survival rate are similar to previously reported series.
OBJETIVO: Describir los resultados de la extensión del tratamiento quirúrgico y la quimioterapia adyuvante en el cáncer de vesícula biliar (CVB) incidental, en términos de morbilidad posoperatoria (MPO) y de supervivencia global (SVG) a 5 años. MÉTODO: Serie de casos de pacientes intervenidos por CVB incidental en Clínica Mayor, Temuco, Chile (2001-2016). Todos los casos fueron tratados mediante hepatectomía parcial de segmentos IVb y V, y linfadenectomía regional. El tiempo mínimo de seguimiento fue de 12 meses. La variables resultado fueron: MPO y la SVG a 5 años. Otras variables de interés fueron: profundidad de infiltración en la pared vesicular, de linfonodos y del hígado resecado, tiempo quirúrgico, necesidad de reintervención, estancia hospitalaria, seguimiento y mortalidad. Se aplicó estadística descriptiva, y análisis bivariados, aplicando prueba exacta de Fisher y t-test; o pruebas no paramétricas para variables continuas; y curvas de Kaplan-Meier. RESULTADOS: La serie está compuesta por 50 pacientes, con edad media de 58.6 ± 9.6 años; 68.0% de los cuales eran mujeres. La media del tiempo quirúrgico y de estancia hospitalaria fueron 224±93 minutos (90 a 480) y 6.9±2.9 días (4 a 20) respectivamente. La MPO fue 28.0%. La SVG a 5 años fue 47%. No hubo reintervenciones ni mortalidad. CONCLUSIONES: Los resultados verificados en términos de MPO y SVG a 5 años, son similares a los reportados anteriormente.
Assuntos
Neoplasias da Vesícula Biliar/tratamento farmacológico , Neoplasias da Vesícula Biliar/cirurgia , Idoso , Quimioterapia Adjuvante , Feminino , Neoplasias da Vesícula Biliar/mortalidade , Humanos , Achados Incidentais , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Taxa de Sobrevida , Resultado do TratamentoRESUMO
Aedes albopictus (Skuse 1894) is prevalent in the urban/peri-urban Port Blair, posing a public health threat, during past outbreaks of chikungunya (2006) and dengue (2010). Despite its vector potential, information on the biology is scanty. Therefore, impact of temperature on survival of immature stages, under laboratory conditions, was studied on F1 population of Andamans. Ae. albopictus larvae were exposed to static temperatures viz. 37°C, 39°C, 41°C, 43°C and 45°C, and the lethal time to cause 50% (LT50) and 90% mortality (LT90) was computed. To assess adaptive thermotolerance, larvae exposed (37°C and 39°C) were re-exposed to higher temperatures (43°C and 45°C). All larvae survived at 37°C and 39°C for the entire exposure period of 420 min, while variable mortality was observed at 41°C, 43°C and 45°C. Larvae re-exposed to 43°C and 45°C showed an increase in thermotolerance with respect to non-adapted larvae. The results are discussed in the context of survival, development and distribution.
Assuntos
Aclimatação , Aedes/fisiologia , Termotolerância , Animais , Temperatura Alta , Larva/fisiologia , Mosquitos Vetores/fisiologiaRESUMO
BACKGROUND: HIV programs are often assessed by the proportion of patients who are alive and retained in care; however some patients are categorized as lost to follow-up (LTF) and have unknown vital status. LTF is not an outcome but a mixed category of patients who have undocumented death, transfer and disengagement from care. Estimating vital status (dead versus alive) among this category is critical for survival analyses and program evaluation. METHODS: We used three methods to estimate survival in the cohort and to ascertain factors associated with death among the first cohort of HIV positive patients to receive antiretroviral therapy in Haiti: complete case (CC) (drops missing), Inverse Probability Weights (IPW) (uses tracking data) and Multiple Imputation with Chained Equations (MICE) (imputes missing data). Logistic regression was used to calculate odds ratios and 95% confidence intervals for adjusted models for death at 10 years. The logistic regression models controlled for sex, age, severe poverty (living on <$1 USD per day), Port-au-Prince residence and baseline clinical characteristics of weight, CD4, WHO stage and tuberculosis diagnosis. RESULTS: Age, severe poverty, baseline weight and WHO stage were statistically significant predictors of AIDS related mortality across all models. Gender was only statistically significant in the MICE model but had at least a 10% difference in odds ratios across all models. CONCLUSION: Each of these methods had different assumptions and differed in the number of observations included due to how missing values were addressed. We found MICE to be most robust in predicting survival status as it allowed us to impute missing data so that we had the maximum number of observations to perform regression analyses. MICE also provides a complementary alternative for estimating survival among patients with unassigned vital status. Additionally, the results were easier to interpret, less likely to be biased and provided an alternative to a problem that is often commented upon in the extant literature.
Assuntos
Interpretação Estatística de Dados , Conjuntos de Dados como Assunto , Infecções por HIV/tratamento farmacológico , Perda de Seguimento , Adulto , Antirretrovirais/uso terapêutico , Feminino , Haiti , Humanos , Modelos Logísticos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Análise de SobrevidaRESUMO
After undergoing liver transplantation, children are susceptible to oral lesions due to immunosuppressant drugs that are needed to maintain the transplant. In this context, it is important to understand how disease characteristics and age at transplantation influence the development of these lesions. Monitoring of lesions begins after transplantation and children are usually observed by a specialist in stomatology at periodic visits. Consequently, lesion development is estimated to occur between two observed times, and this is characterized as interval-censored data. However, in clinical practice, it is common to assume the moment of observation as the time of event occurrence, thereby excluding interval-censored data. Here, we discuss the impact of excluding interval-censored mechanisms in statistical analyses by using simulation studies to consider differences in sample sizes and amplitudes between observed intervals. Then, application studies are presented which use a data set from a prospective study that was conducted to investigate oral lesions in patients after liver transplantation at the A.C.Camargo Cancer Center in Brazil between 2013 and 2016 and a data set involving recurrent ovarian cancer in patients diagnosed with high-grade serous carcinoma at the A.C.Camargo Cancer Center between 2003 and 2016 (AU)
Assuntos
Humanos , Adulto Jovem , Recidiva , Neoplasias Bucais , Análise de Sobrevida , Estudos Prospectivos , Transplante de Fígado/efeitos adversos , Estimativa de Kaplan-MeierRESUMO
BACKGROUND: The first autochthonous Chikungunya virus transmission in Colombia was reported in September 2014. Three months later, every town in the Caribbean region was affected, including the bordering towns of Ovejas and Corozal, in the department of Sucre. The objective of the study was to analyze and compare the temporal dynamics of the outbreak of Chikungunya in two towns of the department of Sucre. METHODS: Households with suspicious cases with clinical symptomatology for Chikungunya were enrolled. In each house an epidemiological questionnaire was applied to collect economic and social information and methods for vector control. RESULTS: The study analyzed data collected between 09/01/2014 and 01/31/2015; 458 families in Corozal and 516 families in Ovejas were identified with Chikungunya cases. Estimated attack rates were 10,621 cases and 1640 cases per 100,000 inhabitants, in Ovejas and Corozal, respectively. The 75-day survival curve was 27.2% lower (0.632, CI = 0.614-0.651) in Ovejas than in Corozal (0.904, CI = 0.891-0.917). After 120 days, both curves showed a stable horizontal slope, close to a survival probability of 0.54, indicating the end of the epidemic period. The log-rank test (X2 = 94.6, 1fd, p-value = 0.000) showed the improved survival of Chikungunya in the town of Corozal. The relative risk between the two towns was 0.863 (CI = 0.809-0.921; p-value < 0.001). CONCLUSIONS: The dynamics of the temporal distribution of CHIKV could be influenced by socioeconomic and preventable risk factors. Poor socioeconomic conditions such as the lack and poor efficiency of water supply and waste collection services could be determining factors in the proliferation of CHIKV. The survival analysis proved to be a suitable method for studying the presentation of CHIKV and can be applied to other prevalent vector-borne diseases such as the ZIKA and Dengue.
RESUMO
This work evaluated methods of overcoming dormancy in Jatoba seeds (Hymenaea courbaril L.) by utilizing survival analysis. 75 seeds per treatment were evaluated: without treatment (T1), immersion in water at outdoor temperature for 120 h (T2) and 72 h (T3), immersion in water at 90 ºC and rest in the same water for 24 h (T4), mechanical scarification (T5) and mechanical scarification and soaking it in water for 24 h (T6). The seeds germinated per treatment were registered daily. The Kaplan-Meier method was utilized to estimate the curves of survival and median periods for the germination, the log-rank test and the Cox semiparametric model to estimate the effect of the treatments. The median periods of germination were 56 days (T4) and 33 days (T6). The seeds submitted to T4, T5 and T6 have respectively 22.5, 4.7 and 3.7 times higher capacity to germinate (shorter period for germination) than those seeds that were not submitted to overcoming dormancy.(AU)
Este trabalho avaliou métodos de superação de dormência de sementes de Jatobá (Hymenaea courbaril L.) utilizando-se análise de sobrevivência. Avaliaram-se 75 sementes por tratamento: testemunha (T1); imersão em água à temperatura ambiente durante 120 h (T2) e 72 h (T3); imersão em água a 90 ºC e repouso nesta por 24 h (T4); escarificação mecânica (T5); escarificação mecânica e imersão em água por 24 h (T6). Diariamente foram anotadas as sementes germinadas por tratamento. Empregou-se o método de Kaplan-Meier para estimar curvas de sobrevivência e tempos medianos para germinação, o teste log-rank e o modelo semiparamétrico de Cox para estimar o efeito dos tratamentos. Os tempos medianos de germinação foram 56 dias (T4) e 33 dias (T6). Sementes submetidas a T4, T5 e T6 têm, respectivamente, 22,5, 4,7 e 3,7 vezes maior capacidade de germinar (tempo para germinação mais curto) que sementes não submetidas à superação de dormência.(AU)
Assuntos
Hymenaea , Dormência de Plantas/fisiologia , Análise de Regressão , Análise de SobrevidaRESUMO
This work evaluated methods of overcoming dormancy in Jatoba seeds (Hymenaea courbaril L.) by utilizing survival analysis. 75 seeds per treatment were evaluated: without treatment (T1), immersion in water at outdoor temperature for 120 h (T2) and 72 h (T3), immersion in water at 90 ºC and rest in the same water for 24 h (T4), mechanical scarification (T5) and mechanical scarification and soaking it in water for 24 h (T6). The seeds germinated per treatment were registered daily. The Kaplan-Meier method was utilized to estimate the curves of survival and median periods for the germination, the log-rank test and the Cox semiparametric model to estimate the effect of the treatments. The median periods of germination were 56 days (T4) and 33 days (T6). The seeds submitted to T4, T5 and T6 have respectively 22.5, 4.7 and 3.7 times higher capacity to germinate (shorter period for germination) than those seeds that were not submitted to overcoming dormancy.
Este trabalho avaliou métodos de superação de dormência de sementes de Jatobá (Hymenaea courbaril L.) utilizando-se análise de sobrevivência. Avaliaram-se 75 sementes por tratamento: testemunha (T1); imersão em água à temperatura ambiente durante 120 h (T2) e 72 h (T3); imersão em água a 90 ºC e repouso nesta por 24 h (T4); escarificação mecânica (T5); escarificação mecânica e imersão em água por 24 h (T6). Diariamente foram anotadas as sementes germinadas por tratamento. Empregou-se o método de Kaplan-Meier para estimar curvas de sobrevivência e tempos medianos para germinação, o teste log-rank e o modelo semiparamétrico de Cox para estimar o efeito dos tratamentos. Os tempos medianos de germinação foram 56 dias (T4) e 33 dias (T6). Sementes submetidas a T4, T5 e T6 têm, respectivamente, 22,5, 4,7 e 3,7 vezes maior capacidade de germinar (tempo para germinação mais curto) que sementes não submetidas à superação de dormência.
Assuntos
Dormência de Plantas/fisiologia , Hymenaea , Análise de Regressão , Análise de SobrevidaRESUMO
Se realizó un estudio descriptivo, observacional, de cohorte retrospectivo, de 90 pacientes operados de cáncer colorrectal con fines curativos, que fueron asistidos en el Servicio de Coloproctología del Hospital Universitario "Dr. Ambrosio Grillo Portuondo" de Santiago de Cuba, desde enero de 1993 hasta diciembre del 2003, con vistas a determinar la supervivencia en ellos. Para la validación de los resultados se aplicó el test de Kaplan-Meier, y entre estos se destacaron el sexo femenino y los afectados mayores de 60 años de edad. También se observó que los pacientes operados por esta causa sobreviven un promedio de 5 años, con variaciones que no distan de las estadísticas mundiales, según las variables clinicoepidemiológicas seleccionadas.
A descriptive, observational study, of retrospective cohort was carried out in 90 operated patients for colorectal cancer with curative aims, who had been attended in the Coloproctology Service of "Dr. Ambrosio Grillo Portuondo" University Hospital in Santiago de Cuba, from January, 1993 to December, 2003, with the objective of determining their survival, for which the method of Kaplan-Meier estimate was applied. Among the relevant results there were the female sex and the age older than 60 years; it was also observed that the patients operated for this cause survived an average of 5 year, with variations not far from the world statistics, according to the clinical and epidemiological variables selected.