Literatura académica sobre el tema "324.244 03"

Abstract OBJECTIVE xCures operates a direct-to-patient, real-world evidence platform according to the nationwide observational research protocol XCELSIOR (NCT03793088), which aggregates medical data in an FDA-compliant electronic database. There is a relative scarcity of published results on real-world Quality-of-Life (QoL) outcomes and resulting health state utilities for patients with Central Nervous System (CNS) cancers. We sought to use the xCures platform to help address this issue. METHODS XCELSIOR participants were invited weekly to complete the EuroQol 5-Dimension (EQ-5D-5L) QoL survey. A EuroQol-endorsed model was used to estimate health state utilities from patient surveys. Survey results, utility estimates, and clinical information were analyzed to understand the influence of common mutations in glioma on patient reported outcomes. RESULTS 30 patients (21 glioblastoma, 4 oligodendroglioma, 2 diffuse midline glioma, 2 diffuse astrocytoma, 1 Schwannoma) completed at least one EQ-5D-5L survey over the course of 9 weeks. Health state utilities were positively correlated (p< .03) with Karnofsky Performance Score (KPS). The average utility for EGFR-mutated patients (N=6) was .578 (SD=.334) while for EGFR-wildtype patients (N=7) it was .747 (SD=.227). The average utility for MGMT-methylated patients (N=13) was .816 (SD=.139) while for non-methylated patients (N=10) it was .583 (SD=.379). The average utility for IDH-mutated patients (N=9) was .789 (SD=.153) while for non-mutated patients (N=17) it was .685 (SD=.324). The average utility for patients with a 1p/19q co-deletion (N=4) was .837 (SD=.126) while for those without a co-deletion (N=8) it was .744 (SD=.244). CONCLUSION The xCures platform has enabled the study of real-world QoL outcomes for patients with CNS cancers. This is the first report studying the influence of genetic mutations on QoL collected through patient reported outcomes. Future research aims to perform similar studies with larger number of patients.

O uso empírico das plantas medicinais é uma prática mundialmente disseminada, cuja finalidade baseia-se no alívio/cura de algumas enfermidades. Objetivou-se caracterizar o perfil epidemiológico do uso domiciliar dessas plantas, pelos usuários de sete Unidades Básicas de Saúde com equipe Estratégia Saúde da Família, no município de Toledo/Paraná. Para tanto, foi aplicado um questionário a 324 pessoas. A análise dos dados mostrou que 89,50% dos entrevistados faziam uso de plantas medicinais, destes, 91,38% do sexo feminino, 42% com idade entre 21 e 40 anos, 30% sem concluir o ensino fundamental e 45,48% com renda per capita entre 01 a 03 salários mínimos. As folhas foram as partes das plantas mais utilizadas (45,10%), o modo de preparo predominante foi o chá em infusão (30,86%) e 83,64% tiveram o conhecimento de utilização das plantas repassado por familiares. Foram registradas 1.082 citações de 120 espécies de plantas, 50% destas não possuem registro na Denominação Comum Brasileira da Agência de Vigilância Sanitária; entre elas encontram-se espécies cujo conhecimento de senso comum é tão difundido que remete à incredulidade de ausência de estudos científicos para o fim citado, conferindo a falsa ideia de ausência de risco à saúde.

PURPOSE The current study investigates the frequency and outcome of secondary malignancies in patients treated for testicular cancer at Hannover University Medical School between 1970 and 1990. PATIENTS AND METHODS One thousand twenty-five patients with a median follow-up duration of 61 months (range, 12 to 240) were included in the analysis. Follow-up was complete in 1,018 patients (99%). Histology was seminoma in 324 patients (38.7%) and nonseminomatous germ cell tumor in 624 patients (61.3%). At the time of median follow-up, 814 patients (79.9%) were alive. RESULTS Fourteen patients developed a secondary neoplasm (cumulative incidence, 1.38%; 95% confidence interval [CI], 0.75 to 2.30); 13 patients had solid tumors and one had secondary lymphoblastic leukemia with a t(4; 11) translocation including band 11q23. None of 224 patients on surveillance strategy (with or without retroperitoneal lymph node dissection [RPLND]) developed a second neoplasm, compared with four of 413 patients (0.97%; 95% CI, 0 to 1.9) after cisplatin-based chemotherapy (not significant) and nine of 332 patients (2.7%; 95% CI, 0.9 to 4.5) after radiotherapy (P = .02). The cumulative incidence of a secondary neoplasia of 1.76% (95% CI, 0.97 to 2.94) in patients treated by radiotherapy and/or chemotherapy was significantly higher compared with patients on surveillance protocols (P = .03). Chemotherapy containing standard-dose etoposide did not increase the risk of occurrence of secondary neoplasms. A significantly elevated relative risk of 7.53 (range, 3.4 to 14.3) compared with the male German population was only found for patients treated by radiotherapy. CONCLUSION Compared with patients who have other curable malignant tumors, an incidence of 1.38 of secondary neoplasms after a median follow-up duration of 61 months is low. The highest risk for secondary neoplasia after treatment of testicular cancer is associated with the use of radiotherapy. Following chemotherapy, no significantly elevated risk was observed. In conclusion, the benefits of curative treatment far outweigh the risk of secondary cancer in patients with malignant germ cell tumors.

Abstract The purpose of this study was twofold: 1) to evaluate the education of osteopathic physicians who integrate osteopathic manipulative medicine in practice and attempt to find key factors that might be viewed as best practices to be adopted by colleges of osteopathic medicine (COMs), Departments of Osteopathic Manipulative Medicine (OMM), and postgraduate training programs; and 2) to evaluate if gross human anatomy was seen as valuable in OMM training. A 31-question, online survey was distributed to English-speaking members of the American Academy of Osteopathy (AAO) in the United States from July through October of 2016. Of the 438 respondents, 325 (74.3%) reported having a mentor in osteopathic manipulative medicine (OMM) or osteopathic manipulative treatment (OMT) while in school. In addition, 270 (61.6%) had dedicated time to practice OMT while in school, with 186 (42.5%) practicing supervised in a school clinic, 340 (77.6%) practicing during an undergraduate rotation, and 244 (55.7%) practicing after school hours. Many of the mentees participated in several of the above activities. Chi square test was applied to participants who are Fellows of the American Academy of Osteopathy (FAAOs). This test revealed that 24 of 26 (92.3%) of FAAOs, who responded, had a mentor, a statistically significant relationship between having an OMT/OMM mentor and becoming an FAAO (P=.03). Almost all survey participants (438 [99.5%]) had some type of gross anatomy while in medical school. The majority of respondents (321 [73.8%]) performed dissections, 81 (18.6%) had both prosection and dissections, 33 (7.6%) only had prosection, and 321 (73.8%) found that it was extremely helpful in their OMM training. In comparison, 341 respondents (78.2%) reported that gross anatomy was important to their specialty. The survey clearly demonstrated that early exposure to an OMM mentor leads to increased use of OMT and OMM and that a strong foundation in gross human anatomy was found to be useful for physicians across specialty training, including OMM.

517 Background: The relationship between toxicity from chemotherapy and clinical outcome in biliary tract cancer (BTC) is uncertain. Aim: This post hoc analysis evaluated differences by sex in the frequency of adverse events (AEs) and overall survival (OS) and its impact on progression-free survival (PFS)/recurrence-free survival (RFS) for BTC patients. Methods: Individual patient data were retrieved from ABC -01, -02, -03, -04, and BILCAP study. AEs were graded according to National Cancer Institute's Common Toxicity Criteria v 4.02 and odds ratios along with 95%CI and p-values derived from logistic regression were used to assess the effect of sex on the risk of AEs. Time to event outcomes were evaluated using Cox regression and plotted using Kaplan-Meier plots. All statistical tests were two-sided. Results: Overall 994 patients-data were examined: 86 in ABC-01, 324 in-02, 124 in -03, 13 in -04 and 447 in BILCAP. A total of 484 (49%) were males (M) and 510 (51%) were females (F). 770 patients were evaluable for AEs because a total of 224 patients in BILCAP study belonged to the observation group. Urinary tract infection (M, 1.6%; F, 5.5%), nausea (M, 50.7%; F, 69.9%), vomiting (M, 29.1%; F, 46.1%), alopecia (M, 11.3%; F, 27.3%), are dominant in F, hyperbilirubinaemia (M, 36.7%; F, 29.1%) and thrombocytopenia (M, 43.1%; F, 34.3%) and hiccups (M, 2.4%; F, 0.5%) are dominant in M at any grade. Vomiting (M, 3.5%; F, 7.0%) and fatigue (M, 4.0%; F, 8.5%) are higher in F than in M for grade 3-5. The median OS (M, 16.2 months (Mo); F, 17.5 Mo), PFS (M, 6.4 Mo; F, 6.5 Mo) and RFS (M, 20.8 Mo; F 19.4 Mo) were similar. Amongst the subgroup of patients with gallbladder, F achieved longer OS (M, 11.5 Mo; F 13.3 Mo, 0.73 (95%CI:0.54,0.99), p = 0.041) and RFS than M (M, 20.8 Mo; median PFS for F not reached, HR:0.52 (95%CI:0.27,1.02), p = 0.057). Conclusions: Females with BTC have tended to have more AEs, especially grade 3+. Although no difference was observed in OS, PFS, and RFS between males and females for the overall cohort of patients, females with gallbladder cancer had an improved OS and RFS compared with males. These findings suggest, in BTC, sex may play a role when designing clinical trials as well as in making treatment decisions.

This study was aimed to determine the feasibility level of the final disposal site (TPA) based on physical aspects in the Oransbari District according to SNI 19-3241-1994 and SNI 03-3241-1994. The method used is descriptive with field observation techniques. Measurement starts from the groundwater level using geoelectric mapping: Types of rock and distance to faults based on geological maps: slope, distance to rivers, distance to shoreline, and distance to airports based on topographic maps; rainfall data from BMKG; flooded and protected areas. Based on the results of the analysis of 10 physical parameters with the accumulated assessment (scoring) that has been done that the candidate for the location of the Final Disposal Site (TPA) is in the second interval class, with a score of 161, so that the feasibility value of the landfill location is included in the interval class 129 – 224. and categorized as “Required Enough”..

Abstract Background: The prognostic and predictive value of the PAM50 intrinsic subtypes, namely Luminal A, Luminal B, Her2, and Basal-like subtypes, is well-studied in primary as well as metastatic breast cancer settings. Prosigna has emerged as a rapid PAM50 subtype predictor based on the NanoString nCounter assay. However, assay reproducibility across various RNASeq or qRT-PCR platforms can be challenging, especially when applying the predictor on metastatic breast cancer tumors. Here, we used SpinAdapt to create an intrinsic subtype predictor that works on RNA sequencing data, and validates on multiple tumor-sites. We evaluate real-world outcomes for our intrinsic subtype predictions across various immunohistochemical (IHC) labels and metastatic sites. Methods: We trained the subtype predictor on a cohort of 2,497 breast cancer patients using the PAM50 genes, profiled using Nanostring RNA nCounter assay (GSE148426). Approximately 5,423 de-identified records of breast cancer patients sequenced using whole-exome capture RNA-seq were included in our reference dataset. The reference dataset contained samples collected from various sites including breast (n=2440), liver (n=936), lymph node (n=577), lung (n=540), and bone (n=304). For subtype classification, we first batch-corrected the external dataset to Tempus RNA-seq reference dataset using SpinAdapt, then trained a Support-Vector Classifier (SVC) on the corrected data. A 10-fold CV experiment was performed on the corrected dataset to analytically validate the intrinsic subtype predictions. We retrospectively analyzed 7,021 de-identified breast cancer patients with known hormone receptor (HR) or HER2 status and a matched RNASeq sample. The concordance between HR/HER2 status and PAM50 prediction was analyzed, and these patients were excluded from training. Real-world overall survival (rwOS) was evaluated from the time of first diagnosis. The outcomes across intrinsic subtypes were further assessed according to tumor collection site and HR/HER2 IHC status. Results: The 10-fold CV experiment on the Tempus-adapted GSE148426 dataset achieved F-1 scores of 0.97, 0.86, 0.94, and 0.87 on Basal, HER2-like, Luminal A, and Luminal B PAM50 subtypes, respectively. On the Tempus evaluation dataset, 85.3% of HR+/HER2- patients (n=4,366), 65.4% of HR-/HER2+ patients (n=240), and 75.4% of HR-/HER2- patients (n=1,930) were classified as Luminal, HER2-like, and Basal, respectively. Evaluating outcomes on Tempus patients for each PAM50 group, the rwOS for the basal group was significantly shorter than patients not predicted to be basal (n=5,845, p< 2e-90). The rwOS for the predicted PAM50 basal patients remained significantly shorter than non-basal patients even when stratified by site of metastasis: breast (n=2,405; p< 1e-27), lymph node (n=577, p< 1e-7), liver (n=936; p< 1e-25), lung (n=540, p< 1e-13), and bone (n=304, p< 1e-3). Interestingly, within both HR+/HER2- (n=3,653) and HR-/HER2- (n=1,664) IHC cohorts with available outcomes data, the predicted PAM50 basal subtype could further stratify each of these populations with basal-subtype showing significantly worse prognosis than the non-basal subtype (p< 1e-27 and p< 1e-7, respectively). Conclusions: We retrospectively analyzed Tempus multimodal RWD to validate an in-house breast intrinsic subtype predictor that is agnostic to the site of metastasis. The prognostic value of the basal subtype was significant for breast cancer patients across various sites of metastasis including lymph node, liver, lung, and bones and IHC groups. For patients in each of the HR+/HER2- and triple negative IHC groups, the intrinsic molecular subtypes provided an additional level of prognostic detail with statistical significance. These data emphasize the importance of combining molecular subtypes with IHC-based diagnostics to fully characterize clinically relevant subpopulations and risk. Citation Format: Talal Ahmed, Mark Carty, Kaveri Nadhamuni, Raphael Pelossof. Breast cancer intrinsic subtypes predict outcomes in primary and metastatic samples [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-24-03.

Caso N.º 1. Ententes: Dec.Com. 7 abril 2004, Société Air France/Alitalia Linee Aeree Italiane SpA, DO L 362 de 9 diciembre 2004 Caso N.º 2. Ententes: STJCE 29 abril 2004, C-359/01 P, British Sugar plc/Comisión Caso N.º 3. Ententes: STPI de 29 de abril de 2004, Tokai carbón Co. Ltd y otros/Comisión de las Comunidades Europeas As. T-236/01, T-239/01, T-244/01, T-245/01, T-246/01, T-251/01 y T-252/01 Caso N.º 4. Ententes: Sentencia del Tribunal de Primera Instancia 15 junio 2005, Graphites spéciaux, As. T-71/03, T-74/03, T-87/03 y T-91/03 Caso N.º 5. Ententes: STPI 8 julio 2004, Mannesmannröhren-Werke/ Comisión, T-44/00; STPI 8 julio 2004, Corus/Comisión, T-48/00; STPI 8 julio 2004, Dalmine/Comisión, T-50/00; STPI 8 julio 2004, asuntos acumulados JFE Engineering/Comisión, T-67/00, Nippon Steel/Comisión, T-68/00, JFE Steel/Comisión, T-71/00, y Sumitomo Metal Industries/ Comisión, T-78/00 Caso N.º 6. Ententes: Dec.Com. 9 diciembre 2004, Cloruro de colina, DO L 190 de 22 julio 2005. Caso N.º 7. Ententes: STJCE 28 junio 2005, Dansk Rørindustri A/S (C-189/02 P), Isoplus Fernwärmetechnik Vertriebsgesellschaft mbH y otros (C-202/02 P), KE KELIT Kunststoffwerk GmbH (C-205/02 P), LR af 1998 A/S (C-206/02 P), Brugg Rohrsysteme GmbH (C-207/02 P), LR af 1998 (Deutschland) GmbH (C-208/02 P) y ABB Asea Brown Boveri Ltd (C-213/02 P)/Comisión, Tubos de calefacción urbana (tubos preaislados), Asuntos acumulados C-189/02 P, C-202/02 P, C-205/02 P a C-208/02 P y C-213/02 P Caso N.º 8. Ententes: STPI 18 julio 2005, Scandinavian Airlines System AB/Comisión, T-241/01 Caso N.º 9. Ententes: STPI (Sala Segunda) de 27 de julio de 2005, Asuntos acumulados T-49/02 a T-51/02, Brasserie nationale SA (anteriormente Brasseries Funck-Bricher y Bofferding), Brasserie Jules Simon et Cie SCS y Brasserie Batín SNC v. Comisión de las Comunidades Europeas Caso N.º 10. Ententes: Comunicación publicada de conformidad con el artículo 27, apartado 4, del Reglamento (CE) n.º 1/2003 del Consejo, en los asuntos COMP/C2/3912-BUMA y COMP/C2/39151-SABAM (Acuerdo de Santiago-COMP/C2/38126, DO C 200 de 17 agosto 2005, pp. 11-12) Caso N.º 11. Ententes: STPI 15 septiembre 2005, DaimlerChrysler AG/ Comisión, T-325/01 Caso N.º 12. Abuso de posición dominante: Dec.Com. 24 marzo 2004, Microsoft Europe, COMP/C-3/37.792: Noción de abuso de posición dominante (la tensión entre el Derecho de la competencia y el Derecho de la propiedad intelectual) Caso N.º 13. Abuso de posición dominante: Dec. Com. 20 octubre 2004, Deutsche Post AG y RFA, COMP/38.745: Abuso de posición dominante cometido por el operador postal histórico de Alemania, por el hecho de una disposición legislativa que deberá ser modificada Caso N.º 14. Abuso de posición dominante: STPI 26 enero 2005, Piau/ Féderation Internationale de Football Association (FIFA), T-193/02, Rec., p. I-1113: Posición dominante colectiva Caso N.º 15. Abuso de posición dominante: Dec.Com. 22 junio 2005, Coca-Cola, COMP/A.39.116/B2, DO L 253 de 29 septiembre 2005: Decisión compromiso (Coca-Cola se compromete a no abusar de su posición dominante y se libra de toda sanción) Caso N.º 16. Concentraciones: Decisión de la Comisión 19 julio 2004, SONY/BMG, M. 3333 Caso N.º 17. Concentraciones: Dec.Com. 15 julio 2005, Procter & Gamble/ Gillette, M. 3732 Caso N.º 18. Concentraciones: Dec.Com. 29 julio 2005, Maersk/Ponl, M. 3829 Caso N.º 19. Concentraciones: STJCE 15 febrero 2005, Tetra Laval, C-12/03P, Rec., p. I-1113. Caso N.º 20. Concentraciones: STPI 21 septiembre 2005, EDP/Comisión, T-87/05

In this study, we aimed to directly quantify the relative contribution of Ca2+ cycling to resting metabolic rate in mouse fast-twitch (extensor digitorum longus, EDL) and slow-twitch (soleus) skeletal muscle. Resting oxygen consumption of isolated muscles (V̇o2, μl·g wet wt−1·s−1) measured polarographically at 30°C was ∼25% higher in soleus (0.61 ± .03) than in EDL (0.46 ± .03). To quantify the specific contribution of Ca2+ cycling to resting metabolic rate, cyclopiazonic acid (CPA), a highly specific inhibitor of sarco(endo)plasmic reticulum Ca2+ ATPases (SERCAs), was added to the bath at different concentrations (1, 5, 10, and 15 μM). There was a concentration-dependent effect of CPA on V̇o2, with increasing CPA concentrations up to 10 μM resulting in progressively greater reductions in muscle V̇o2. There were no differences between 10 and 15 μM CPA, indicating that 10 μM CPA induces maximal inhibition of SERCAs in isolated muscle preparations. Relative reduction in muscle V̇o2 in response to CPA was nearly identical in EDL (1 μM, 10.6 ± 3.0%; 5 μM, 33.2 ± 3.4%; 10 μM, 49.2 ± 2.9%; 15 μM, 50.9 ± 2.1%) and soleus (1 μM, 11.2 ± 1.5%; 5 μM, 37.7 ± 2.4%; 10 μM, 50.0 ± 1.3%; 15 μM, 49.9 ± 1.6%). The results indicate that ATP consumption by SERCAs is responsible for ∼50% of resting metabolic rate in both mouse fast- and slow-twitch muscles at 30°C. Thus SERCA pumps in skeletal muscle could represent an important control point for energy balance regulation and a potential target for metabolic alterations to oppose obesity.

Objective: To describe major events at follow up in octogenarian patients with atrial fibrillation (AF) according to anticoagulant treatment: direct oral anticoagulants (DOACs) versus vitamin K antagonists (VKAs). Methods: A total of 578 anticoagulated patients aged ≥80 years with AF were included in a prospective, observational, multicenter study. Basal features, embolic events (stroke and systemic embolism), severe bleedings, and all-cause mortality at follow up were investigated according to the anticoagulant treatment received. Results: Mean age was 84.0 ± 3.4 years, 56% were women. Direct oral anticoagulants were prescribed to 123 (21.3%) patients. Compared with 455 (78.7%) patients treated with VKAs, those treated with DOACs presented a lower frequency of permanent AF (52.9% vs 61.6%, P = .01), cancer history (4.9% vs 10.9%, P = .046), renal failure (21.1% vs 32.2%, P = .02), and left ventricular dysfunction (2.4% vs 8.0%, P = .03); and higher frequency of previous stroke (26.0% vs 16.6%, P = .02) and previous major bleeding (8.1% vs 3.6%, P = .03). There were no significant differences in Charlson, CHA2DS2VASc, nor HAS-BLED scores. At 3-year follow up, rates of embolic events, severe bleedings, and all-cause death (per 100 patients-year) were similar in both groups (DOACs vs VKAs): 0.34 vs 1.35 ( P = .15), 3.45 vs 4.41 ( P = .48), and 8.2 vs 11.0 ( P = .18), respectively, without significant differences after multivariate analysis (hazard ratio [HR]: 0.25, 95% confidence interval [CI]: 0.03-1.93, P = .19; HR: 0.88, 95% CI: 0.44-1.76, P = .72 and HR: 0.84, 95% CI: 0.53-1.33, P = .46, respectively). Conclusion: In this “real-world” registry, the differences in major events rates in octogenarians with AF were not statistically significant in those treated with DOACs versus VKAs.

Introdução: O dolutegravir é um antirretroviral com diversos estudos mostrando sua eficácia, segurança e tolerabilidade. Nesse cenário, o Ministério da Saúde do Brasil instituiu a nota técnica 03/2018, que recomenda a substituição (switch) de esquemas antiretrovirais em pacientes infectados pelo vírus da imunodeficiência humana, estáveis e com supressão viral, para esquemas baseados em dolutegravir. Entretanto existem fatores que podem comprometer tanto a segurança quanto a eficácia dessa estratégia. Objetivo: Avaliar a resposta virológica, a taxa de eventos adversos e descontinuações após o switch para esquemas baseados em dolutegravir. Métodos: Trata-se de um estudo transversal, observacional, de dados secundários, que incluiu pacientes positivos para o vírus da imunodeficiência humana acompanhados em um centro de referência da Bahia, Brasil, que realizaram switch para esquemas baseados em dolutegravir em 2018. Foram avaliadas as cargas virais do vírus da imunodeficiência humana, contagens de linfócitos T-CD4+, peso, entre outras variáveis, antes e após um ano do switch. Variáveis categóricas foram expressas em frequências absolutas e relativas, e as quantitativas em média e desvio padrão. Para análise de associação entre as variáveis categóricas, foi utilizado o teste de qui-quadrado, ou McNemar, e, para as quantitativas, teste t de Student ou teste t de Student pareado. Foram considerados estatisticamente significantes os valores de p<0,05 e de intervalo de confiança de 95%. Resultados: No total, 234 (97,5%) pacientes usaram dolutegravir após switch por pelo menos 24 semanas. Desses, 230 (98,3%) mantiveram carga viral indetectável após um ano e 211 (90,2%) apresentaram adesão superior a 80%. Observou-se aumento de 1,2±0,2 kg no peso e de 0,4±0,1 kg/m² no índice de massa corpórea (p<0,001) após o switch. Houve redução das taxas de desnutrição/eutrofismo e aumento das de sobrepeso/obesidade (p<0,01). Foram encontrados oito (3,4%) casos de interrupção do dolutegravir em razão de reações adversas. Conclusão: O switch para esquemas baseados em dolutegravir mostrou-se uma estratégia efetiva que manteve o sucesso virológico, com boas taxas de adesão e tolerabilidade.