RESUMO

OBJECTIVES: Colorectal endoscopic submucosal dissection (ESD) is a technically complex procedure. The scissor knife mechanism may potentially provide easier and safer colorectal ESD. The aim of this meta-analysis is to evaluate the efficacy and safety of scissor-assisted vs. conventional ESD for colorectal lesions. METHODS: A search strategy was conducted in MEDLINE, Embase, and Lilacs databases from January 1990 to November 2023 according to PRISMA guidelines. Fixed and random-effects models were used for statistical analysis. Heterogeneity was assessed using I2 test. Risk of bias was assessed using the ROBINS-I and RoB-2 tools. Quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation tool. RESULTS: A total of five studies (three retrospective and two randomized controlled trials, including a total of 1575 colorectal ESD) were selected. The intraoperative perforation rate was statistically lower (risk difference [RD] -0.02; 95% confidence interval [CI] -0.04 to -0.01; P = 0.001; I2 = 0%) and the self-completion rate was statistically higher (RD 0.14; 95% CI 0.06, 0.23; P = 0.0006; I2 = 0%) in the scissor-assisted group compared with the conventional ESD group. There was no statistical difference in R0 resection rate, en bloc resection rate, mean procedure time, or delayed bleeding rate between the groups. CONCLUSION: Scissor knife-assisted ESD is as effective as conventional knife-assisted ESD for colorectal lesions with lower intraoperative perforation rate and a higher self-completion rate.

RESUMO

Experimental toxoplasmosis is an excellent model for adaptive immune response. Gamma-irradiated tachyzoites or soluble tachyzoite antigen extracts (STag) induce protection against experimental toxoplasmosis in mice. Scavenger receptors recognize irradiated proteins, promote their entry into cells, and lead to antigen presentation. CD36 is a specific scavenger receptor involved in intracellular transport of free fatty acid (FFA), cellular recycling, and intracellular trafficking in lipid rafts outside the lysosomal pathways. CD36 is also associated with an altered immune response, as CD36-/- mice presented some immune defects in the cyst-forming Toxoplasma gondii. We studied T. gondii infection in CD36-/- mice, naïve or immunized, with irradiated T. gondii STags by investigating protection, antibody production, and primed macrophage transplantation. CD36-/- mice presented no resistance against the viable RH tachyzoites, even after immunization with gamma-irradiated STags that protected wild-type mice. The animals presented poor humoral responses to both immunogens despite adequate levels of serum immunoglobulins. CD36-/- mice failed to induce protection against virulent T. gondii infection with inadequate antibody production or an innate response. Irradiated antigens failed to induce antibodies in CD36-/- mice and only produced adequate levels of immunoglobulin G when transplanted with irradiated STag-primed wild-type macrophages. The CD36 pathway is necessary for humoral response against the irradiated antigen; however, several other pathways are also involved in mounting a humoral response against any antigen. CD36 is a multipurpose molecule for FFA and lipid transport, as well as for the immune response, and gamma radiation mimics the innate response by targeting irradiated antigens of this pathway.

Assuntos

Assuntos

RESUMO

Introdução: A Organização Mundial da Saúde define como Cuidados Paliativos abordagens que melhoram a qualidade de vida dos pacientes (adultos e crianças) e de suas famílias que enfrentam problemas associados a doenças de risco de vida. Um dos principais objetivos dos Cuidados Paliativos é o alívio da dispneia. Objetivo: Esta revisão sistemática buscou encontrar na literatura evidências que indicam a efetividade das intervenções não invasivas para alívio da dispneia em fase final dos cuidados paliativos. Metodologia: Utilizou-se o guia metodológico da Cochrane Handbook. Resultados: Após a pesquisa inicial,110 artigos foram encontrados, 11 foram removidos por duplicação, 86 excluídos por não preencherem os critérios de inclusão. Após filtragem, 13 estudos foram recuperados em texto completo, e após leitura dos textos completos, 11 não corresponderam aos critérios de elegibilidade. Dois estudos foram incluídos na síntese qualitativa para avaliação da qualidade metodológica, e passaram para a síntese quantitativa. Nesta revisão sistemática, 230 pacientes incluídos foram alocados de forma aleatória para VNI (n=113) e Oxigenoterapia (n=117) seguindo uma randomização simples. Conclusão: Esta revisão sistemática apontou que as duas intervenções são métodos capazes de melhorar a dispneia dos pacientes em fase final dos Cuidados Paliativos Oncológicos, contudo a VNI mostrou ser superior à oxigenoterapia convencional e ao HFCN, principalmente nos pacientes hipercápnicos. Embora o HFCN também tenha apresentado dados significativos, seu uso ainda é controverso.

Introduction: The World Health Organization defines Palliative Care as approaches that improve the quality of life of patients (adults and children) and their families who face problems associated with lifethreatening diseases. One of the main objectives of Palliative Care is the relief of dyspnea. Objective: This systematic review sought to find evidence in the literature that indicates the effectiveness of non-invasive interventions for the relief of dyspnea in the final stage of palliative care. Methodology: The Cochrane Handbook methodological guide was used. Results: After the initial search, 110 articles were found, 11 were removed by duplication, 86 were excluded for not meeting the inclusion criteria, after filtering 13 studies were retrieved in full text, and after reading the full texts, 11 did not meet the criteria eligibility criteria. Two studies were included in the qualitative synthesis to assess methodological quality, and moved on to the quantitative synthesis. In this systematic review, 230 included patients were randomly allocated to NIV (n = 113) and oxygen therapy (n = 117) following simple randomization. Conclusion: This systematic review pointed out that the two interventions are methods capable of improving the dyspnea of patients in the final stage of Oncology Palliative Care, however NIV has been shown to be superior to conventional oxygen therapy and HFCN, especially in hypercapnic patients. Although HFCN has also presented significant data, its use is still controversial. Although supplemental oxygen therapy is widely prescribed, there is little evidence of benefit

Assuntos

RESUMO

BACKGROUND: Cohesin complex is responsible for sister chromatid cohesion. STAG1/STAG2 is part of the complex, which is regulated by PDS5B. Alterations in these genes were described in tumors. PDS5B is a negative regulator of cell proliferation. We aimed to assess molecular alterations in these genes in oral squamous cell carcinoma (OSCC) and predict their expression by the expression of 84 cell cycle genes. In addition, we investigated whether pds5b protein expression impacted ki-67 and p53 immunopositivity. METHODS: We assessed loss of heterozygosity (LOH) at STAG1 and STAG2 loci in 15 OSCC using three polymorphic markers. Associations between the immunoexpression of pds5b and ki-67 and p53 were tested in 62 samples. Differences between transcriptional levels of STAG1, STAG2, and PDS5B between OSCC and normal oral mucosa (NM) were evaluated by qPCR. An 84 cell cycle genes qPCR array was carried with OSCC samples, and STAG1, STAG2, and PDS5B were independently used as response variables in multiple linear regression models. RESULTS: Loss of heterozygosity in at least one marker was observed in three samples. pds5b, p53, and ki-67 were highly expressed, and no association was found between pds5b immunoexpression and ki-67 or p53 (P > 0.05). OSCC and NM showed similar transcriptional levels of STAG1, STAG2, and PDS5B. STAG1 and CUL3 expression seem to be related (P = 0.004). CONCLUSIONS: There is LOH at STAG1 and STAG2 loci in OSCC, but OSCC and NM showed similar transcriptional levels of STAG1, STAG2, and PDS5B. pds5b immunoexpression in OSCC was high, but it was not associated with proliferation cell index.

Assuntos

RESUMO

Background: Cold-active endo-1, 4-β-glucanase (EglC) can decrease energy costs and prevent product denaturation in biotechnological processes. However, the nature EglC from C. farmeri A1 showed very low activity (800 U/L). In an attempt to increase its expression level, C. farmeri EglC was expressed in Escherichia coli as an N-terminal fusion to protein S (ProS) from Myxococcus xanthus. Results: A novel expression vector, pET(ProS-EglC), was successfully constructed for the expression of C. farmeri EglC in E. coli. SDS-PAGE showed that the recombinant protein (ProS-EglC) was approximately 60 kDa. The activity of ProS-EglC was 12,400 U/L, which was considerably higher than that of the nature EglC (800 U/L). ProS-EglC was active at pH 6.5-pH 8.0, with optimum activity at pH 7.0. The recombinant protein was stable at pH 3.5-pH 6.5 for 30 min. The optimal temperature for activity of ProS-EglC was 30°C-40°C. It showed greater than 50% of maximum activity even at 5°C, indicating that the ProS-EglC is a cold-active enzyme. Its activity was increased by Co2+ and Fe2+, but decreased by Cd2+, Zn2+, Li+, methanol, Triton-X-100, acetonitrile, Tween 80, and SDS. Conclusions: The ProS-EglC is promising in application of various biotechnological processes because of its cold-active characterizations. This study also suggests a useful strategy for the expression of foreign proteins in E. coli using a ProS tag.

Assuntos

RESUMO

El estándar de oro en el manejo de la litiasis coraliforme es la Nefrolitotomía percutánea (NLP) asociada a la Litotricia extracorpórea (LEC), sin embargo estas técnicas de elección no están disponibles en todos los centros asistenciales de nuestro país. Considerando esto y el que la evolución natural de las Litiasis Coraliformes es a la exclusión renal, es que quisimos investigar cuanto se modifica la función renal con la Nefrolitotomía Anatrófica (NLA). Pacientes y Método: Se realizó estudio descriptivo prospectivo. Entre septiembre del 2005 y febrero del 2008, 14 pacientes fueron incluidos en protocolo, que contemplaba cintigrama DMSA pre-operatorioy un control post operatorio a los 3 meses. El promedio de edad de la serie fue de 38 años (23- 59) y esta estaba constituida por 11 mujeres y 3 varones. Todos los pacientes eran portadores de Litiasis Coraliformes Grado III ó IV, fueron estudiados con pielografía de eliminación y contaban con un clearence de creatinina normal. En todos los casos se realizó isquemia fría y se utilizó ecografía intraoperatoria. Resultados: El valor promedio del cintigrama renal DMSA preoperatorio fue de 38 por ciento (23-49).El tiempo operatorio promedio fue de 123 minutos (90-150); El tiempo promedio de isquemia fría fue de 50minutos (30-80); Se presentó un caso de lesión de vena renal, la cual se suturó satisfactoriamente; 1 paciente evolucionó con infección de herida operatoria; 1 paciente quedó con una litiasis residual de 8 mm, la cual migró al uréter distal al 8 día post operatorio, con lo cual presentó filtración de orina, que se manejó con catéter doble J y a los 21 días se resolvió realizando ureterolitotomía endoscópica. El resto de los pacientes de la serie quedó libre de litiasis. El cintigrama renal DMSA de control post op. disminuyó en un promedio de 7 puntos porcentuales (2-13). Conclusión: En nuestra serie la NLA disminuyó el porcentaje de función renal cintigráfica, pero presentó bajo porcentaje...

Percutaneous nephrolithotomy (PCNL), associated with extracorporeal lithotripsy (SWL) constitutes the gold standard in the treatment of staghorn calculi. However, these techniques are not available at all health care centres in our country. Considering that the natural course of staghorn calculi leads to renal exclusion, we decided to investigate and determine to what extent anatrophic nephrolithotomy (ANL) may modify renal function. Patients and Method: We carried out a prospective and descriptive study of 14 patients; 11 women and 3 men, mean age 38 years (range 23 to 59 years), that were treated between September 2005and February 2008. Protocol included a preoperative DMSA scintigraphy and a postoperative control at 3 months following the procedure. All patients had been diagnosed with Type III or IV stag-horn calculi, had undergone an excretory pyelogram and had normal creatinine levels. Cold ischemia within tra-operative sonography was performed in all cases. Results: Mean preoperative DMSA renal function was 38 percent (23 percent to 49 percent); average operating time was 123 minutes (90 to 150 minutes); average cold ischemic time was 50 minutes (30 to 80 minutes); a renal vein lesion occurred and was repaired satisfactorily; 1 patient developed an infection in the operative incision and 1 patient had a residual 8 mm calculi which passed into the distal ureter at the 8th postoperative day, causing urine filtration that was managed with a double J catheter and was extracted at postoperative day 21 by means of an ureteroscopy. Rest of the patients were stone free.Postoperative DMSA renal function decreased in an average of 7 percent (2 percent to 13 percent). Conclusion: In our study anatrophic nephrolithotomy (ANL) reduced the percentage of scintigraphic renal function, but generated a low incidence of complications as well as a high stone free rate. Therefore, we believe that ANL is a technique that should be performed when percutaneous renal...

Assuntos

RESUMO

Introducción: La litiasis coraliforme es una patología que de no ser tratada efectivamente lleva al daño renal progresivo e irreversible, con consecuencias que pueden ser letales. El abordaje clásico con cirugía abierta, aunque efectivo en la remoción del cálculo y sus fragmentos, está asociado a morbilidad importante. En las últimas décadas se han impuesto técnicas menos invasivas como la litotripsia extracorporea, que tiene baja morbilidad pero un rendimiento discutible como monoterapia en cálculos complejos del riñón. Presentamos nuestra experiencia en nefrolitectomía percutánea de la litiasis coraliforme, técnica que conjuga una alta efectividad con baja morbilidad. Material y Método: Se analizan en forma retrospectiva los resultados de 42 pacientes portadores de litiasis coraliforme sometidos a nefrolitectomía percutánea como tratamiento único o combinado con litotripsia extracorporea. Los pacientes se trataron en decúbito prono, con nefroscopio rígido, litotripsia endoscópica, con uno o más accesos en una o más sesiones. Todos fueron sometidos a tratamiento antibiótico previo. Entre los pacientes hubo un niño de 11 años, un paciente monorreno y una litiasis coraliforme en un riñón en herradura. Resultados: Se trataron 22 mujeres y 20 hombres de una edad promedio de 40,7 años (rango 11-74). En 27 casos el cálculo era derecho y en 15 izquierdo. En 33 casos (78,5 por ciento) se realizó un acceso único, en 9 casos (21,4 por ciento) se realizó 2 accesos y en 3 casos (7,1 por ciento) se necesitó de 3 accesos. En 9 casos hubo litiasis residual que se trató con litotripsia extracorporea y en 1 con ureteroscopía. En 40 pacientes se logró finalmente la remoción completa del cálculo y sus fragmentos (95,3 por ciento). En la serie no hubo pérdida de unidades renales ni mortalidad. Conclusiones: La cirugía percutánea de la litiasis renal es una técnica mínimamente invasiva efectiva en el tratamiento de la litiasis coraliforme asociada a una baja morbilidad.

Background: Stag horn calculi may cause irreversible renal damage. Percutaneous nephrolithotomy is a minimally invasive surgical therapy than can be useful for these calculi. Aim: To report the experience with percutaneous nephrolithotomy for stag horn calculi. Material and Methods: Retrospective analysis of medical records of patients with stag horn calculi treated with percutaneous nephrolithotomy alone or associated to extracorporeal lithotripsy. All patients were treated with a rigid nephroscope, with one or more accesses during one or more sessions. Results: Twenty two women and 20 men aged 11 to 74 years were treated. One patient had only one kidney and one calculus was located in a horse shoe shaped kidney. The calculus was located in the right side in 27 patients and in the left side in 15. A unique access was used in 33 cases (79 percent), two accesses in nine (21 percent) and three accesses in three patients (7 percent). Nine patients had a residual lithiasis that required extracorporeal lithotripsy and one required an ureteroscopy. In 40 patients (95 percent), the complete removal of the calculus and its fragments was achieved. No patient died or lost the affected kidney. Conclusions: Percutaneous nephrolithotomy is a safe and effective minimally invasive surgical treatment for stag horn calculi.

Assuntos