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3. Gerenciamento da terapia medicamentosa em pacientes com tuberculose e HIV/aids: série de casos

Author

Natália H. RESENDE, Jonathan A. SOUZA, Úrsula C. MARTINS, Adriano M. REIS, Silvana S. MIRANDA, and Wânia S. CARVALHO

Subjects
Public aspects of medicine, RA1-1270, Pharmacy and materia medica, RS1-441, Therapeutics. Pharmacology, RM1-950
Abstract

Objetivos: Descrever casos de pacientes com coinfecção tuberculose (TB) e HIV/aids acompanhados em um Hospital Referência em doenças infecciosas. Identificar, classificar e resolver os Problemas Relacionados ao uso de Medicamentos (PRM). E classificar a situação clínica e farmacoterapêutica. Métodos: Para a identificação, classificação e resolução do desfecho de PRM bem como a classificação da situação clínica e farmacoterapêutica, utilizou-se a metodologia Pharmacotherapy Workup. Trata-se um estudo observacional, descritivo, longitudinal, do tipo série de casos realizado em Hospital de Referência terciária em Belo Horizonte, seguindo as diretrizes CARE da Enhancing the QUAlity and Transparency Of health Research (EQUATOR). Foram incluídos pacientes coinfectados com TB e HIV/ aids, expostos ao tratamento preconizado pelo Ministério da Saúde, com 18 anos ou mais, de ambos os sexos, acompanhados por um período mínimo de seis meses. Resultados: Foram descritos seis casos de pacientes coinfectados com tuberculose e HIV/aids. A média de encontros com o farmacêutico foi de 6,33 (desvio padrão=0,82). Foram identificados 69 PRM, dos quais 40/69 (58,0%) relacionados à adesão, 17/69 (24,6%) à indicação, 8/69 (11,6%) à segurança e 4/69 (5,8%) à efetividade. Do total de pacientes 4/6 (66,6%) apresentaram hepatotoxicidade durante o acompanhamento. A situação clínica e farmacoterapêutica foi classificada como positiva para todos os pacientes. Conclusão: Houve alto número de PRM de adesão e indicação nos pacientes coinfectados. O monitoramento da efetividade e segurança dos tratamentos deve ser realizado, devido à maior susceptibilidade de reações adversas, como a hepatotoxicidade.

Published
2021
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4. A review of Carbon Monitoring in Wet Carbon Systems using Remote Sensing

Author

Anthony D. Campbell, Temilola Fatoyinbo, Sean P. Charles, Laura L. Bourgeau-Chavez, Joaquim Goes, Helga Gomes, Meghan Halabisky, James Holmquist, Steven Lohrenz, Catherine Mitchell, L. Monika Moskal, Han Qiu, Benjamin Poulter, Celio H. Resende De Sousa, Michael Sayers, Marc Simard, Anthony J. Stewart, Debjani Singh, Carl Trettin, Jinghui Wu, Xuesong Zhang, and David Lagomasino

Subjects
Earth Resources And Remote Sensing
Abstract

Carbon monitoring is critical for the reporting and verification of carbon stocks and change. Remote sensing is a tool increasingly used to estimate the spatial heterogeneity, extent and change of carbon stocks within and across various systems. We designate the use of the term wet carbon system to the interconnected wetlands, ocean, river and streams, lakes and ponds, and permafrost, which are carbon-dense and vital conduits for carbon throughout the terrestrial and aquatic sections of the carbon cycle. We reviewed wet carbon monitoring studies that utilize earth observation to improve our knowledge of data gaps, methods, and future research recommendations. To achieve this, we conducted a systematic review collecting 1,622 references and screening them with a combination of text matching and a panel of three experts. The search found 496 references, with an additional 78 references added by experts. Our study found considerable variability of the utilization of remote sensing and global wet carbon monitoring progress across the nine systems analyzed. The review highlighted that remote sensing is routinely used to globally map carbon in mangroves and oceans, whereas seagrass, terrestrial wetlands, tidal marshes, rivers, and permafrost would benefit from more accurate and comprehensive global maps of extent. We identified three critical gaps and twelve recommendations to continue progressing wet carbon systems and increase cross system scientific inquiry.

Published
2022
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5. Drug utilization research in coinfected patients with tuberculosis and HIV/AIDS

Author

Isabella S. LOBO, Wânia S. CARVALHO, and Natália H. RESENDE

Subjects
Public aspects of medicine, RA1-1270, Pharmacy and materia medica, RS1-441, Therapeutics. Pharmacology, RM1-950
Abstract

Objectives: This study aims to describe and classify the drugs prescribed for coinfected patients treated at a reference hospital. Methods: A retrospective cross-sectional study with analysis of information contained in a database prepared in an earlier study The Anatomical Therapeutic Chemical (ATC) classification system was used to classify the prescribed drugs. Results: Eighty-one coinfected individuals participated in the study, with a mean age of 40 years old and numerous comorbidities. A total of 147 drugs were found and, when the frequency of prescription was evaluated, the most used therapeutic groups were anti-infectious, considering the large number of opportunistic infections (OIs) presented by coinfected patients, followed by feeding tract drugs used to treat adverse drug reactions. We could observe that 73% of the evaluated population had a CD4+ T lymphocyte count

Published
2020
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8. Abstract P1-08-27: Advanced stage at diagnosis and worse clinicopathologic features in young woman with breast cancer. A sub-analysis of Brazilian population through the AMAZONA III study (GBECAM 0115)

Author

C. Mathias, Tomás Reinert, José Bines, Facundo Zaffaroni, Ruffo Freitas Junior, Sergio Daniel Simon, Geraldo Silva Queiroz, G. Borges, H Resende, RdC Costamilan, D de Andrade, Kissya Kropf da Silva, K Emerenciano, Daniela Dornelles Rosa, V Dybal, VC Cordeiro de Lima, Eduardo Cronemberger, Nicolas Lazaretti, Gustavo Werutsky, Alessandra Morelle, Y. Neron, Carlos Barrios, Maria Alice Franzoi, J Couto, Max S. Mano, P Liedke, G Zerwes Vacaro, CA Sampaio Filho, Susanne Crocamo, and B Van Evyl

Subjects
Cancer Research, Performance status, business.industry, Advanced stage, Cancer, medicine.disease, Breast cancer, Oncology, medicine, Health insurance, Brazilian population, Family history, business, Body mass index, Demography
Abstract

BACKGROUND: Breast cancer (BC) in young women is uncommon and often more aggressive. There are disparities in terms of screening coverage, diagnostic features and access to optimal treatment among young BC patients worldwide. To better understand this scenario through real world data we performed a sub-analysis of AMAZONA III study. METHODS: The AMAZONA III study (GBECAM 0115) is a prospective registry that included 2950 women newly diagnosed with invasive BC in Brazil during the period of January 2016 to March 2018 within 22 sites. Of them, 2888 patients had valid data regarding age at diagnosis and complete baseline information. For the purpose of comparisons of epidemiologic and clinicopathologic features at the time of diagnosis of BC, patients were divided in two groups: women aged ≤40 years (Group 1) and >40 years (Group 2). Quantitative variables were expressed with mean, while categorical variables were described as their count and percentage and compared using the chi-square test. RESULTS: Of 2888 women, 486 (17%) were ≤40 years of age. No differences were found between ethnicity, performance status, body mass index, personal income, health insurance and family history of cancer between the two groups. Young women had higher educational level (p Breast cancer features by age groups at diagnosis in Brazilian women.InformationGroup 1 (≤40 years)Group 2 (> 40 years)p-valueN: 2888486 (16.83%)2402 (83.17%) Stage at diagnosis p< 0.001I76 (19.2%)541 (27.8%) II156 (39.4%)816 (41.9%) III146 (36.8%)489 (25.1%) IV19 (4.6%)101 (5.2%) Tumor size p< 0.001T1114 (27.1%)749 (36.9%) T2141 (33.6%)764 (37.6%) T3101 (24.1%)282 (13.9%) T464 (15.2%)235 (11.6%) Tumor grade p < 0.001Grade 146 (10.7%)381 (17.9%) Grade 2198 (46.2%)1150 (52.0%) Grade 3185 (43.1%)641 (30.1%) Molecular Subtype p < 0.001Luminal A106 (30.6%)957 (51.3%) Luminal B - HER 2 negative55 (15.8%)212 (11.4%) Luminal B- HER 2 positive79 (22.8%)298 (16.0%) HER 2 positive27 (7.8%)135 (7.2%) Triple negative80 (23.0%)264 (14.1%) Citation Format: Franzoi MA, Rosa D, Barrios C, Bines J, Cronemberger E, Queiroz G, Cordeiro de Lima VC, Junior R, Couto J, Emerenciano K, Resende H, Crocamo S, Reinert T, Van Evyl B, Neron Y, Dybal V, Lazaretti N, Costamilan RdC, de Andrade D, Mathias C, Zerwes Vacaro G, Borges G, Silva K, Werutsky G, Morelle A, Sampaio Filho CA, Mano M, Zaffaroni F, Simon S, Liedke PE. Advanced stage at diagnosis and worse clinicopathologic features in young woman with breast cancer. A sub-analysis of Brazilian population through the AMAZONA III study (GBECAM 0115) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-08-27.

Published
2019

9. Abstract P1-08-29: Current status of clinical and pathological characteristics of breast cancer patients in Brazil: Results of the AMAZONA III study (GBECAM 0115)

Author

Vladmir Cláudio Cordeiro de Lima, CA Sampaio Filho, Susanne Crocamo, Rita de Cassia Costamilan, Ruffo Freitas-Junior, G. Borges, Max S. Mano, Kátia Luz Torres, Giovana Zerwes Vacaro, Y. Neron, Diocésio Alves Pinto de Andrade, Nicolas Lazaretti, V Dybal, C. Mathias, H Resende, G Werustky, Sergio Daniel Simon, Alessandra Morelle, K Emerenciano, Carlos Barrios, Eduardo Cronemberger, J Couto, Daniela Dornelles Rosa, José Bines, Facundo Zaffaroni, Tomás Reinert, Geraldo Silva Queiroz, and B Van Eyil

Subjects
Cancer Research, medicine.medical_specialty, business.industry, Lobular carcinoma, Cancer, medicine.disease, Continuous variable, Breast cancer, Oncology, Internal medicine, Epidemiology, Medicine, In patient, business, Triple negative, Pathological
Abstract

BACKGROUND Breast cancer (BC) is the most common tumor in women in Brazil with about 60 thousand new cases estimated per year. In low and middle-income countries, patients with BC are diagnosed with more advanced stages as compared with high-income countries. In Brazil, disparities in access to new therapies are recognized; previous data suggests worse survival of BC patients treated in the public system. The aim of AMAZONA III study (GBECAM 0115) is to describe the current status of BC care in Brazil. Here we report patients data at baseline. METHODS The AMAZONA III is a prospective BC registry that included women 18 years or older with newly diagnosed stage I to IV BC from 22 sites in Brazil in the period of January 2016 to March 2018. All patients provided written informed consent; data was collected from interview and medical charts, comprising clinical-demographic variables, initial treatment and a planned follow-up for 5 years. BC subtypes were defined by hormone receptor (HR) expression, HER2 status and grade according to von Minckwitz G. et al 2012. Here we present a descriptive analysis of the patients' baseline characteristics. Continuous variables are shown as mean (standard-deviation) and categorical variables by its absolute and relative frequencies. The study is registered in clinicaltrials.gov NCT02663973. RESULTS A total of 2950 patients were included in the study. Median age at diagnosis was 53 years old (8.4% 50 years), 58.6% were white, 34.4% had brown skin-color, 83% had children before BC diagnosis (median of 1 child/patient) and 63.1% had public health insurance. In terms of method of detection 34% were screen-detected whereas 66% were symptomatic, the last was even higher (70%) in patients in younger than 50 years. The distribution of BC stage at diagnosis was I (26.4%), II (41.6%), III (27%) and IV (5%). The most common histologies were ductal (80.9%) and lobular carcinoma (6.9%). The pathological characteristics were HR positive in 78.0%, HER-2 positive in 23.4% and grade 2 in 51%. BC subtypes were as follows: Luminal A 48%, Luminal B 12%, Luminal HER2 positive 17%, Non-luminal HER2 positive 7.3% and Triple negative 15.5%. DISCUSSION Breast cancer is diagnosed at an earlier age among Brazilian patients. The majority of patients were detected through symptomatic BC and therefore a significant proportion is still diagnosed in stages III and IV. Among other factors, these findings could have a significant impact in treatment outcomes. Further analysis of this large cohort of patients will help to identify other important elements and direct future strategies for breast cancer control. TRIAL REGISTRY: NCT02663973 KEYWORDS: Breast Cancer; Epidemiology; Treatment; Brazil Citation Format: Rosa D, Barrios C, Bines J, Werustky G, Cronemberger E, Queiroz GS, Lima VC, Freitas-Júnior R, Couto J, Emerenciano K, Resende H, Crocamo S, Reinert T, Van Eyil B, Néron Y, Dybal V, Lazaretti N, Costamilan RC, Andrade DA, Mathias C, Vacaro GZ, Borges G, Torres KL, Morelle A, Sampaio Filho CA, Mano M, Zaffaroni F, Simon S. Current status of clinical and pathological characteristics of breast cancer patients in Brazil: Results of the AMAZONA III study (GBECAM 0115) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-08-29.

Published
2019

10. High-Level Classification for Multi-Label Learning

Author

Murillo G. Carneiro and Vinicius H. Resende

Subjects
Computer science, business.industry, Process (engineering), Feature extraction, Multi label learning, 02 engineering and technology, Complex network, Semantics, Machine learning, computer.software_genre, Support vector machine, Salient, 020204 information systems, 0202 electrical engineering, electronic engineering, information engineering, Task analysis, 020201 artificial intelligence & image processing, Artificial intelligence, business, computer
Abstract

Multi-label learning (MLL) addresses the problem of learning from data items which can be associated with multiple labels simultaneously. As MLL techniques are usually derived of single-label ones, they also share common drawbacks. For example, most MLL techniques perform a low-level classification, i.e., they consider only the physical features of the input data (e.g., distance, distribution, etc) in the classification process, having troubles to detect semantic relationships among the data items, like the formation pattern for example. Recent studies have shown that learning systems based on complex networks have the ability to consider not only the physical features of the data, but also structural and topological features extracted from the network connection patterns, which is known as high-level classification. In this paper, we investigate a MLL framework which combines both low-level and high-level techniques in order to improve the predictive performance of existing MLL techniques. Experiments conducted on artificial and real-world data sets highlighted the salient features of the MLL framework and also attested its good predictive performance in comparison with widely used MLL techniques, indicating that our framework may considerable improve their predictive performance.

Published
2020

11. CLOSURE OF DUODENAL FISTULA IN 10 DAYS WITH ENDOSCOPIC VACUUM THERAPY (EVT)

Author

Carolina O. Matsubayashi, Facundo Galetti, Dth de Moura, R Tahmasebi, Ricardo H. Resende, Mel dos Santos, FS de Medeiros, Egh de Moura, Sergio E. Matuguma, and AC Madruga-Neto

Subjects
medicine.medical_specialty, business.industry, Duodenal Fistula, Closure (topology), medicine, business, Surgery
Published
2020

12. The impact of sociodemographic factors and health insurance coverage in the diagnosis and clinicopathological characteristics of breast cancer in Brazil: AMAZONA III study (GBECAM 0115)

Author

Sergio Daniel Simon, Eduardo Cronemberger, Gustavo Werutsky, Carlos Sampaio Filho, Rita de Cassia Costamilan, Y. Neron, H Resende, Ruffo Freitas-Junior, C. Mathias, Susane Crocamo, Vladmir Cláudio Cordeiro de Lima, Daniela Dornelles Rosa, Rafaela Gomes de Jesus, Giovana Zerwes Vacaro, José Bines, V Dybal, Diocésio Alves Pinto de Andrade, G. Borges, Brigitte Van Eyil, Nicolas Lazaretti, Tomás Reinert, K Emerenciano, J Couto, Carlos Barrios, Alessandra Morelle, Maira Caleffi, Facundo Zaffaroni, Geraldo Silva Queiroz, and Max S. Mano

Subjects
0301 basic medicine, Cancer Research, medicine.medical_specialty, Amazona, Breast Neoplasms, Disease, Insurance Coverage, 03 medical and health sciences, 0302 clinical medicine, Breast cancer, Internal medicine, Health care, Medicine, Animals, Humans, Prospective Studies, Stage (cooking), Prospective cohort study, Insurance, Health, business.industry, Public health, Cancer, Ductal carcinoma, medicine.disease, 030104 developmental biology, Oncology, 030220 oncology & carcinogenesis, Female, business, Brazil
Abstract

In Brazil, the available cancer registries are deficient in number and quality and, hence, little information is known regarding sociodemographic, clinicopathological characteristics, treatment patterns, and outcomes of breast cancer (BC) patients. We performed the AMAZONA III/ GBECAM 0115 study and in this analysis, we describe patients’ characteristics at diagnosis and their association with health insurance type. This is a prospective cohort study developed in 23 sites in Brazil including women with newly diagnosed invasive BC from January 2016 to March 2018. In order to compare healthcare insurance type, we considered patients who were treated under the Brazilian public health system as publicly insured, and women who had private insurance or paid for their treatment as privately insured. A total of 2950 patients were included in the study. Median age at diagnosis was 53.9 years; 63.1% were publicly insured. The majority of patients (68.6%) had stage II–III breast cancer and ductal carcinoma histology (80.9%). The most common breast cancer subtype was luminal A-like (48.0%) followed by luminal B-HER2 positive-like (17.0%) and triple-negative (15.6%). Luminal A was more frequent in private (53.7% vs. 44.2%, p

Published
2020

13. Analysis of Complex Network Measures for Multi-label Classification

Author

Murillo G. Carneiro and Vinicius H. Resende

Subjects
Multi-label classification, Artificial Intelligence, Computer science, business.industry, Data classification, Artificial intelligence, Complex network, Machine learning, computer.software_genre, business, computer, Network analysis
Abstract

Most multi-label learning (MLL) techniques perform classification by analyzing only the physical features of the data, which means they are unable to consider high-level features, such as structural and topological ones. Consequently, they have trouble to detect the semantic meaning of the data (e.g., formation pattern). To handle this problem, a high-level framework has been recently proposed to the MLL task, in which the high-level features are extracted using the analysis of complex network measures. In this paper, we extend that work by evaluating different combinations of four complex networks measures, namely clustering coefficient, assortativity, average degree and average path length. Experiments conducted over seven real-world data sets showed that the low-level techniques often can have their predictive performance improved after being combined with high-level ones, and also demonstrated that there is no a unique measure that provides the best results, i.e., different problems may ask for different network properties in order to have their high-level patterns efficiently detected.

Published
2021

14. Advanced Stage at Diagnosis and Worse Clinicopathologic Features in Young Women with Breast Cancer in Brazil: A Subanalysis of the AMAZONA III Study (GBECAM 0115)

Author

Vladmir Cláudio Cordeiro de Lima, Y. Neron, Diocésio Alves Pinto de Andrade, Nicolas Lazaretti, Daniela Dornelles Rosa, G. Borges, Alessandra Morelle, Carlos Barrios, H Resende, Susanne Crocamo, Tomás Reinert, V Dybal, José Bines, Ruffo Freitas Junior, Gustavo Werutsky, Eduardo Cronemberger, Max S. Mano, Rita de Cassia Costamillan, Carlos Alberto Sampaio Filho, J Couto, Giovana Zerwes Vacaro, K Emerenciano, Pedro E.R. Liedke, Facundo Zaffaroni, Geraldo Silva Queiroz, Maria Alice Franzoi, Brigitte Van Eyli, Sergio Daniel Simon, and C. Mathias

Subjects
Adult, Oncology, Cancer Research, medicine.medical_specialty, MEDLINE, Breast Neoplasms, lcsh:RC254-282, 03 medical and health sciences, 0302 clinical medicine, Breast cancer, Internal medicine, Original Reports, Humans, Medicine, 030212 general & internal medicine, business.industry, Advanced stage, Age Factors, Cancer, Généralités, lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens, medicine.disease, 030220 oncology & carcinogenesis, Female, Observational study, business, Brazil
Abstract

PURPOSE: Breast cancer (BC) in young women is uncommon and tends to present with more aggressive characteristics. To better understand and characterize this scenario in Brazil through real-world data, we performed a subanalysis of AMAZONA III study (ClinicalTrials.gov identifier: NCT02663973). METHODS: The AMAZONA III study (GBECAM 0115) is a prospective registry that included 2,950 women newly diagnosed with invasive BC in Brazil from January 2016 until March 2018 at 22 sites. Valid data were obtained from 2,888 patients regarding age at diagnosis and complete baseline information. To compare epidemiologic and clinicopathological features at the time of diagnosis, patients with BC were divided into two groups according to age: ≤ 40 years and > 40 years. Quantitative variables were described as means, and categorical variables were described as frequencies and percentages and compared using the Pearson's χ2 test. RESULTS: Of 2,888 women diagnosed with BC, 486 (17%) were ≤ 40 years old. Young women had higher educational level, most were employed and a significant number were married (P < .001 for all associations). Younger patients were more symptomatic at BC diagnosis (P < .001), and they also presented more frequently with stage III, T3/T4, grade 3 tumors, HER-2-positive, luminal B, and triple-negative subtypes. CONCLUSION: Brazilian women younger than age 40 years have unfavorable clinicopathological features of BC at diagnosis, with more aggressive subtypes and advanced stage when compared with older women. These differences are not explained by socioeconomic or ethnic imbalances. The causes of a higher prevalence of BC among young women in Brazil deserve additional investigation., SCOPUS: ar.j, info:eu-repo/semantics/published

Published
2019

15. Towards a High-Level Multi-label Classification from Complex Networks

Author

Murillo G. Carneiro and Vinicius H. Resende

Subjects
Multi-label classification, Computer science, business.industry, 02 engineering and technology, Complex network, Machine learning, computer.software_genre, ComputingMethodologies_PATTERNRECOGNITION, Automatic image annotation, Salient, 020204 information systems, 0202 electrical engineering, electronic engineering, information engineering, 020201 artificial intelligence & image processing, Artificial intelligence, Medical diagnosis, business, computer, Classifier (UML)
Abstract

Multi-label learning aims to solve problems in which data items can have multiple class labels assigned simultaneously, e.g., text categorization, image annotation, medical diagnosis, etc. However, as most of multi-label techniques are derived from the single-label ones, existing techniques perform the multi-label classification only based on the physical features of the data (e.g., distance, similarity or distribution), ignoring the semantic meaning of the data, such as the formation pattern. Inspired by recent advances in the use of complex networks for single-label learning, this exploratory work aims to investigate a multi-label solution able to combine existing multi-label classifiers with a high-level classifier based on complex networks measures, aiming to present a new concept of multi-label classification that, besides the physical attributes, also analyzes the topological structure of the data. Experimental results considering both artificial and real-world data sets emphasize respectively the salient features of our technique in comparison to the traditional ones and its potential to improve the predictive performance of those techniques, especially in data sets characterized by higher cardinality and density of labels, which often denote more difficult scenarios to multi-label learning.

Published
2019

16. Surveillance in inflammatory bowel disease: is chromoendoscopy the only way to go? A systematic review and meta-analysis of randomized clinical trials

Author

Wanderley Marques Bernardo, Eduardo Guimarães Hourneaux de Moura, Igor Braga Ribeiro, Paulo Sakai, Rodrigo Rocha, Ricardo H. Resende, Facundo Galetti, and Diogo Turiani Hourneaux de Moura

Subjects
medicine.medical_specialty, business.industry, Colorectal cancer, Absolute risk reduction, MEDLINE, medicine.disease, Gastroenterology, Inflammatory bowel disease, law.invention, Chromoendoscopy, 03 medical and health sciences, 0302 clinical medicine, Editorial, Randomized controlled trial, Dysplasia, law, 030220 oncology & carcinogenesis, Internal medicine, Meta-analysis, medicine, lcsh:Diseases of the digestive system. Gastroenterology, 030211 gastroenterology & hepatology, Pharmacology (medical), lcsh:RC799-869, business
Abstract

Background and study aims Ulcerative colitis (UC) and Crohn’s disease (CD) have higher risk of colorectal cancer (CRC). Guidelines recommend dysplasia surveillance with dye-spraying chromoendoscopy (DCE). The aim of this systematic review and meta-analysis was to review all randomized clinical trials (RCTs) available and compare the efficacy of different endoscopic methods of surveillance for dysplasia in patients with UC and CD. Methods Databases searched were Medline, EMBASE, Cochrane and SCIELO/LILACS. It was estimated the risk difference (RD) for dichotomous outcomes (number of patients diagnosed with one or more dysplastic lesions, total number of dysplastic lesions diagnosed and number of dysplastic lesions detected by targeted biopsies) and mean difference for continuous outcomes (procedure time). Results This study included 17 RCTs totaling 2,457 patients. There was superiority of DCE when compared to standard-definiton white light endoscopy (SD-WLE). When compared with high-definition (HD) WLE, no difference was observed in all outcomes (number of patients with dysplasia (RD 0.06; 95 % CI [–0.01, 0.13])). Comparing other techniques, no difference was observed between DCE and virtual chromoendoscopy (VCE – including narrow-band imaging [NBI], i-SCAN and flexible spectral imaging color enhancement), in all outcomes except procedure time (mean difference, 6.33 min; 95 % CI, 1.29, 11.33). DCE required a significantly longer procedure time compared with WLE (mean difference, 7.81 min; 95 % CI, 2.76, 12.86). Conclusions We found that dye-spraying chromoendoscopy detected more patients and dysplastic lesions than SD-WLE. Although no difference was observed between DCE and HD-WLE or narrow-band imaging, the main outcomes favored numerically dye-spraying chromoendoscopy, except procedure time. Regarding i-SCAN, FICE and auto-fluorescence imaging, there is still not enough evidence to support or not their recommendation.

Published
2019

17. Adverse events after biliary sphincterotomy: Does the electric current mode make a difference? A systematic review and meta-analysis of randomized controlled trials

Author

Igor Braga Ribeiro, Ricardo H. Resende, Diogo Turiani Hourneaux de Moura, Michele O. De Marco, Tomazo Franzini, Daniel T. Rezende, Wanderley Marques Bernardo, Mateus Pereira Funari, Vitor Ottoboni Brunaldi, and Eduardo Guimarães Hourneaux de Moura

Subjects
medicine.medical_specialty, Perforation (oil well), Electrosurgery, law.invention, 03 medical and health sciences, 0302 clinical medicine, Postoperative Complications, Randomized controlled trial, law, Sphincterotomy, medicine, Humans, Adverse effect, Randomized Controlled Trials as Topic, Endoscopic retrograde cholangiopancreatography, Hepatology, medicine.diagnostic_test, business.industry, Incidence (epidemiology), Incidence, Gastroenterology, medicine.disease, Surgery, Systematic review, 030220 oncology & carcinogenesis, Meta-analysis, Pancreatitis, 030211 gastroenterology & hepatology, Bile Ducts, business
Abstract

Summary Background Biliary sphincterotomy is an invasive method that allows access to the bile ducts, however, this procedure is not exempt of complications. Studies in the literature indicate that the mode of electric current used for sphincterotomy may carry different incidences of adverse events such as pancreatitis, hemorrhage, perforation, and cholangitis. Aim To evaluate the safety of different modes of electrical current during biliary sphincterotomy based on incidence of adverse events. Methods We searched articles for this systematic review in Medline, EMBASE, Central Cochrane, Lilacs, and gray literature from inception to September 2019. Data from studies describing different types of electric current were meta-analyzed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The following electric current modalities were evaluated: endocut, blend, pure cut, pure cut followed by blend, monopolar, and bipolar. Results A total of 1791 patients from 11 randomized clinical trials evaluating the following comparisons: 1. Endocut vs Blend: No statistical difference in the incidence of bleeding (7% vs 13.4%; RD: −0.11 [−0.31, 0.08], P = 0.27, I2 = 86%), pancreatitis (4.4% vs 3.5%; RD: 0.01 [−0.03, 0.04], P = 0.62, I2 = 48%) and perforation (absence of cases in both arms). 2. Endocut vs Pure cut: Higher incidence of mild bleeding (without drop in hemoglobin levels, clinical repercussion or need for endoscopic intervention) in the pure cut group (9.2% vs 28.8%; RD: −0.19 [−0.27, −0.12], P Conclusion Pure cut carries higher incidences of mild bleeding compared to endocut and blend. However, this modality might present a lower incidence of pancreatitis. The monopolar mode elicits higher rates of pancreatitis in comparison with the bipolar mode. There is no difference in incidence of cholangitis or perforation between different types of electric current. There is a lack of evidence in the literature to recommend one method over the others, therefore new studies are warranted. As there is no perfect electric current mode, the choice in clinical practice must be based on the patient risk factors.

Published
2019

18. RISK FOR TUBERCULOSIS DURING TREATMENT WITH BIOLOGICAL THERAPY: IS IT TIME FOR REVIEWING SCREENING PROTOCOL? – RESULTS FROM BRAZILIAN REGISTRY OF BIOLOGICAL THERAPIES IN RHEUMATIC DISEASES (BIOBADABRASIL)

Author

Daniel Feldman, Aline Ranzolin, A Acayaba, Gláucio Ricardo Werner de Castro, José Roberto Provenza, Markus Bredemeier, R Botelho, Jorge Miguel Miranda, Laurindo Ferreira da Rocha, Lidiane Oliveira de Carvalho, D. Titton, A Medeiros Ribeiro, Washington A. Bianchi, G. Castelar, Angela Luzia Branco Pinto Duarte, Vander Fernandes, Hellen M.S. Carvalho, André Luiz Shinji Hayata, M.L. Pinheiro, Roberto Ranza, C Macieira, Ieda Maria Magalhães Laurindo, Ivânio Alves Pereira, Manoel Barros Bertolo, Claiton Viegas Brenol, Morgana Ohira Gazzeta, Valeria Valim, Joana S. Amaral, S. Studart, Inês Guimarães da Silveira, S Schowalski, Paulo Roberto Louzada, F Sauma, B. Stadler, Adriana Maria Kakehasi, and H. Resende

Subjects
Protocol (science), medicine.medical_specialty, Biological therapies, Tuberculosis, business.industry, Medicine, business, Intensive care medicine, medicine.disease
Published
2019

19. SAT0123 RISK FOR TUBERCULOSIS DURING TREATMENT WITH BIOLOGICAL THERAPY: IS IT TIME FOR REVIEWING SCREENING PROTOCOL? – RESULTS FROM BRAZILIAN REGISTRY OF BIOLOGICAL THERAPIES IN RHEUMATIC DISEASES (BIOBADABRASIL)

Author

M. Pinheiro, José Roberto Provenza, Ieda Maria Magalhães Laurindo, Washington A. Bianchi, João Luiz de Miranda, Ana Paula Medeiros, Valeria Valim, P. Louzada, Daniel Feldman, F Sauma, R Botelho, Liana L. Carvalho, S Schowalski, Samia Araujo De Sousa Studart, Manoel Barros Bertolo, Adriana Maria Kakehasi, Claiton Viegas Brenol, B. Stadler, G. Castelar, Hellen M.S. Carvalho, D. Titton, Gláucio Ricardo Werner de Castro, Roberto Ranza, Vander Fernandes, Markus Bredemeier, H. Resende, M Gazzeta, R Acayaba, J. K. Amaral, Ivânio Alves Pereira, Lívia G. Rocha, A. Duarte, C Macieira, Inês Guimarães da Silveira, Aline Ranzolin, and André Luiz Shinji Hayata

Subjects
medicine.medical_specialty, Tuberculosis, Latent tuberculosis, business.industry, Proportional hazards model, Abatacept, Hazard ratio, medicine.disease, chemistry.chemical_compound, Tocilizumab, chemistry, Interquartile range, Internal medicine, Medicine, Prospective cohort study, business, medicine.drug
Abstract

Background: As Brazil is accountable for 33% of the tuberculosis (TB) burden in Americas, with an annual incidence of 33.5/100,000 in 2017[1], the occurrence of tuberculosis infection in patients with rheumatic diseases in use of biological therapy is a recurrent concern. Objectives: To assess incident TB among patients with rheumatic disease in use of biological therapy in a country with high incidence of TB. Methods: BiobadaBrasil is a multicentric prospective cohort study involving patients with rheumatic diseases who started the first biologic or a synthetic disease modifying anti-rheumatic drug (DMARD)[6]. This analysis includes patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis (AS) recruited from Jan 2009 to Aug 2018 and followed-up for one or multiple courses of treatment until censoring or incident TB. The primary outcome was the incidence of tuberculosis (in any organ site). The history of exposure to tuberculosis, chest Rx, screening and treatment for latent tuberculosis infection (LBTI), and use of prophylactic isoniazid were evaluated before each course of treatment. Multivariate Cox proportional hazards models (with DMARDs included as time-varying covariates) were used to estimate hazard ratios (HR) and 95% confidence intervals (CI); analyses were performed with the Survival package of R. Results: Sample: 2858 patients (female =70,2%; RA = 72%, AS=20%, and PsA = 8%). A total of 31 (1.1%) patients developed tuberculosis during treatment. One patient on abatacept and one on tocilizumab developed TB while all the others were on TNF-inhibitors(29). The median (interquartile range) exposure to the current DAMRD course was 11.1 (5.9-20) months. TB patients did not significantly differ from others regarding disease duration, sex or age. Almost half (n=14,45%) of TB patients did not present evidence of previous exposure or any screening positive test for TB; 9 (29%) TB patients had received adequate LTBI treatment (isoniazid) recently or in the past. Furthermore, 8(26%) had incomplete/inconsistent screening. The overall incidence of TB was 1.9/1000 patients/year, and was not significantly different among the diseases (1.63 for RA, 2.06, for AS, and 3.79/1000/year for PsA). In univariate analysis, exposure to anti-TNF monoclonal antibodies (HR 3.1, 95%CI 1.18-8.15, P=0.02) and presence of any marker of previous contact with TB (positive history of TB, known contact with TB, positive TST, or abnormal chest X-ray: HR 4.2 (2.1-8.5, p Conclusion: Monoclonal anti-TNF antibodies and previous exposure/diagnosis of TB are independent risk factors for developing TB in Brazil. TB cases occurred both early and lately during treatment courses, suggesting LTBI screening failures, treatment non-adherence or re-exposure. Current application and content of the protocol for screening and treatment of LTBI needs to be reviewed. References [1] WHO TB report2018.https://www.who.int/tb/publications/global_report/en/ [2] Rev Bras Reumatol Engl Ed. 2017;57Suppl 2:477-483. doi: 10.1016/j.rbre.2017.05.005. Acknowledgement: monitor P Cabral, MDs N Sacilotto, H Pereira, F Sztajnbok. Disclosure of Interests: Ana Medeiros: None declared, M Bredemeier: None declared, V Valim: None declared, M Pinheiro Consultant for: Janssen, Pfizer, Speakers bureau: Abbot,Janssen,Novartis, C Macieira: None declared, A Duarte: None declared, B Stadler: None declared, R Ranza: None declared, M Bertolo: None declared, J Miranda Speakers bureau: Pfizer, C Brenol Speakers bureau: Pfizer, Roche, Janssen, Bristol., G Castro: None declared, V Fernandes Speakers bureau: Janssen, D Titton: None declared, F Sauma: None declared, I Pereira: None declared, R Botelho: None declared, H Carvalho: None declared, A Hayata: None declared, P Louzada: None declared, A Ranzolin: None declared, S Studart: None declared, G Castelar: None declared, A Kakehasi Grant/research support from: Abbvie, UCB, JANSSEN, ROCHE, NOVARTIS, PFIZER, Consultant for: Abbvie, UCB, JANSSEN, ROCHE, NOVARTIS, PFIZER, Paid instructor for: JANSSEN, Speakers bureau: Abbvie, UCB, JANSSEN, ROCHE, NOVARTIS, PFIZER, W Bianchi: None declared, R Acayaba: None declared, I Silveira: None declared, H Resende: None declared, J Amaral: None declared, L Rocha: None declared, M Gazzeta: None declared, L Carvalho: None declared, S Schowalski: None declared, D Feldman: None declared, I Laurindo Consultant for: Abbvie, UCB, GSK, JANSSEN, LILLY, NOVARTIS, PFIZER, Paid instructor for: Abbvie, JANSSEN, Speakers bureau: Abbvie, UCB, GSK, JANSSEN, LILLY, NOVARTIS, PFIZER, ROCHE, J Provenza: None declared

Published
2019

20. Sociodemographic and clinicopathologic features of elderly breast cancer patients in Brazil: A sub-analysis of AMAZONA III study (GBCAM 0115)

Author

Nicolas Lazaretti, Ruffo Freitas-Junior, Brigitte M. Van Eyll, Susanne Crocamo Ventilari Da Costa, H Resende, José Bines, Vladmir Cláudio Cordeiro de Lima, Taiane F Rebelatto, Carla Pavei, Pedro E.R. Liedke, Daniela Dornelles Rosa, Carlos H. Barrios, Geraldo Silva Queiroz, Eduardo Cronemberger, Vanessa Dybal Bertoni, Tomás Reinert, Sergio Daniel Simon, Y. Neron, Rafaela Gomes, and Gustavo Werutsky

Subjects
Oncology, Cancer Research, medicine.medical_specialty, Invasive carcinoma, Breast cancer, business.industry, Internal medicine, medicine, business, medicine.disease
Abstract

e12603 Background: Breast cancer (BC) is the most common invasive cancer diagnosed in women worldwide. The risk of developing BC increases with age. Studies have shown that approximately up to half of BC cases occur in patients aged 65 years and older. To better understand and characterize elderly patients with BC in Brazil, we performed a sub analysis of AMAZONA III study (ClinicalTrials.gov identifier: NCT02663973). Methods: The AMAZONA III study (GBCAM 0115) is a prospective cohort study that included 2,950 women with newly diagnosed invasive BC from January 2016 to March 2018 in 23 Brazilian sites. For this sub analysis, only BC patients aged 65 years and older were included. To compare sociodemographic and clinicopathologic features we classify patients into two groups: cohort 65 to 75 years of age and cohort 75 years and older. Qualitative variables were described by absolute and relative frequencies and compared with Chi-square test. Results: Of 2,950 BC patients from AMAZONA IIII study, 602 (20.8%) were ≥ 65 years-old and were included in this sub analysis. Most patients (93.1%) had ECOG performance status 0-1, 63.4% were white. In terms of educational level, 68.6% had reported completing primary school or less. At diagnosis, 23.7% of patients had clinical stage (CS) I, 41.9% had CS II, 28.2% had CS III, and 6.2% had CS IV disease. The majority of BC were detected by symptoms and only 34.2% were detected by screening. Regarding pathological characteristics, half of cases were grade 2, 58.7% were hormone receptor positive, 25% were HER-2 positive, and 16.0% were triple negative. When evaluated by subgroup, patients from cohort 75 years and older were more frequently diagnosed at advanced clinical stages and had worse ECOG performance status at diagnosis. There was no statistically significant difference in molecular subtype, tumor grade, and mode of BC detection (Table). Conclusions: Elderly patients commonly had BC detected by symptoms. Patients from cohort 75 years and older are diagnosed more frequently with advanced disease and worse performance status than patients from cohort 65 to 75 years. Strategies to improve BC screening and educational programs among elderly patients are warranted to guarantee accessibility to early BC diagnosis.[Table: see text]

Published
2021

21. Mo1686 COMPARATION BETWEEN DIFFERENT METHODS OF SURVEILLANCE OF DYSPLASTIC LESIONS IN PATIENTS WIHT ULCERATIVE COLITIS AND CROHN'S DISEASE: SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CLINICAL TRIALS

Author

Ricardo H. Resende, Michele O. De Marco, Carlos K. Furuya, Vitor Ottoboni Brunaldi, Rogerio Kuga, Wanderlei M. Bernardo, Daniel T. Rezende, Raquel Cristina L. Mota, Eduardo G. de Moura, and Robson K. Ishida

Subjects
Crohn's disease, medicine.medical_specialty, business.industry, Gastroenterology, medicine.disease, Ulcerative colitis, law.invention, Randomized controlled trial, law, Meta-analysis, Internal medicine, medicine, Radiology, Nuclear Medicine and imaging, In patient, business
Published
2019

22. Sa1427 THE ROLE OF THE ENDOSCOPIC BALLOON DILATION OF THE MAJOR PAPILLA IN MANAGING COMMON BILE DUCT STONES: A COMPREHENSIVE SYSTEMATIC REVIEW AND META-ANALYSIS

Author

Raquel Cristina L. Mota, Wanderlei M. Bernardo, Gustavo O. Luz, Michele O. De Marco, Ricardo H. Resende, Eduardo G. de Moura, Carolina O. Matsubayashi, Tomazo Franzini, Vitor Ottoboni Brunaldi, and Daniel T. Rezende

Subjects
Major duodenal papilla, medicine.medical_specialty, medicine.anatomical_structure, Common bile duct, business.industry, Meta-analysis, Gastroenterology, medicine, Balloon dilation, Radiology, Nuclear Medicine and imaging, Radiology, business
Published
2019

23. Tu1094 THE USE OF HEMOSTATIC POWDER IN UPPER GASTROINTESTINAL BLEEDING: A SYSTEMATIC REVIEW AND META-ANALYSIS

Author

Igor Braga Ribeiro, Daniel T. Rezende, Wanderlei M. Bernardo, Sergio E. Matuguma, Christiano Sakai, Raquel Cristina L. Mota, Marcos Eduardo Lera dos Santos, Ricardo H. Resende, Sergio Barbosa Marques, Eduardo G. de Moura, Michele O. De Marco, and Vitor Ottoboni Brunaldi

Subjects
medicine.medical_specialty, business.industry, Meta-analysis, HEMOSTATIC POWDER, Internal medicine, Gastroenterology, Medicine, Radiology, Nuclear Medicine and imaging, Upper gastrointestinal bleeding, business, medicine.disease
Published
2019

24. Mo1312 PROGNOSTIC FACTORS FOR ESD OF EARLY GASTRIC CANCERS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Author

Vitor Ottoboni Brunaldi, Michele O. De Marco, Raquel Cristina L. Mota, Kendi Yamazaki, Daniel T. Rezende, Edson Ide, Ricardo H. Resende, Wanderlei M. Bernardo, Eduardo G. de Moura, Francisco Tustumi, Elisa Ryoka Baba, and Dalton Marques Chaves

Subjects
Oncology, medicine.medical_specialty, business.industry, Meta-analysis, Internal medicine, Gastroenterology, medicine, Radiology, Nuclear Medicine and imaging, business
Published
2019

25. Avaliação da Resistência de União de Pinos de Fibra de Vidro à Dentina Radicular Utilizando Diferentes Cimentos e Compósitos Preaquecidos

Author

I I N Simões, T H Resende, D R L Almeida, José Guilherme Antunes Guimarães, A.G. Penelas, and A C Martins

Abstract

Este estudo avaliou a resistência de união (RU) de pinos de fibra de vidro (PFV) à dentina radicular utilizando cimentos resinosos convencional e autoadesivo, e compósitos preaquecidos a 68 °C. Quarenta dentes bovinos foram distribuídos em quatro grupos (n10), de acordo com o agente cimentante utilizado: G1 – RelyX ARC G2 – RelyX U200 G3 – Filtek Z100 preaquecido e G4 – Filtek Bulkfill preaquecido. Os PFVs foram condicionados com H2O2 24%/1min e em seguida silanizados. Em G1, G3 e G4, os canais foram condicionados com H3PO4 37%/15s, lavados por 30s e secos com sucção a vácuo/5s e um cone de papel absorvente. Posteriormente, foi aplicado um adesivo quimicamente ativado. Em G2, os canais foram apenas lavados e secos conforme descrito anteriormente. Os agentes cimentantes foram introduzidos no interior do canal com seringa Centrix, os pinos foram inseridos e o conjunto fotoativado (1050mW/cm²/40s). Os espécimes foram seccionados e submetidos ao teste de push-out em máquina universal de ensaios. O padrão de falha ocorrido foi observado com estereomicroscópio. Os dados obtidos foram submetidos à ANOVA de dois fatores e teste de Tukey para contraste entre as médias (5%). Os valores da RU foram estatisticamente semelhantes entre os grupos. Em relação aos terços radiculares, os valores foram maiores no terço cervical que nos terços médio e apical, os quais foram semelhantes entre si. As falhas adesivas entre o agente cimentante e a dentina predominaram. Nestes termos, concluiu-se que os compósitos preaquecidos podem ser agentes cimentantes alternativos para a fixação de PFVs.Palavras-chave: Resistência de União. Pino de Fibra de Vidro. Resina Composta.

Published
2018

26. Pathology

Author

L. I. Aruin, D. S. Sarkisov, O. A. Lisenco, H. O’Connor, K. Cunnane, D. M. M. Queiroz, E. N. Mendes, G. A. Rocha, S. B. Moura, L. M. H. Resende, J. R. Cunha-Melo, A. S. T. Carvalho, L. G. V. Coelho, M. C. G. Passos, L. P. Castro, C. A. Oliveira, G. F. Lima, A. J. A. Barbosa, M. C. F. Passos, P. Castro, Gianni Testino, A. Perasso, D. Boixeda, C. Martín de Argila, T. Vila, C. Redondo, R. Cantón, C. Avila, I. Alvarez-Baleriola, L. de Rafael, E. M. Witteman, M. C. J. M. Becx, R. W. De Koning, J. C. P. Silva, A. M. M. F. Nogueira, E. Paulino, C. R. Miranda, A. Rudelli, G. Vialette, H. Sevestre, D. Capron, J. P. Ducroix, A. Smail, J. Baillet, F. Zerbib, P. L. Seurat, P. Sauvet, D. Bechade, N. Rapp, J. S. Peacock, P. Marchildon, F. Zamaniyan, J. Bond-Green, P. Liu, L. Ciota, A. Lee, N. Coltro, M. Chen, M. Alhomsi, E. Adeyemi, C. S. Goodwin, C. Rizzi, R. Maieron, L. Desinan, C. Avellini, G. L. Da Broi, C. A. Beltrami, G. Proto, F. Grimaldi, A. Proietti, C. A. Scott, S. Takasashi, H. Igarshi, N. Ishiyama, K. Nakamura, N. Masubuchi, M. Ozaki, S. Saito, T. Aoyagi, T. Itoh, I. Hirata, T. Matysiak-Budnik, E. Poniewierka, G. Gasciniak, M. Jelen, Z. Knapik, G. Gosciniak, W. M. Neri, D. Susi, I. Bovani, F. Laterza, F. Cuccurullo, A. Amorosi, P. Bechi, R. Dei, R. Mazzanti, D. A. F. Lynch, G. M. Sobala, A. Gledhill, P. Jackson, J. E. Crabtree, P. N. Foster, A. T. R. Axon, M. F. Dixon, H. I. Maaroos, P. Sipponen, M. Kekki, M. G. Di Bello, S. Raspanti, T. Vardar, F. J. Sancho, E. Olivia, S. Saiz, J. Pons Mones, Craig Hood, Milena Lesna, Ruth Alcolado, T. Knitht, S. Greaves, A. Wilson, M. Corlett, P. Webb, J. Wyatt, D. Newell, K. Hengels, D. Forman, J. B. Elder, F. Farinati, R. Cardin, F. Valiante, G. Delia Libera, M. Plebani, M. Rugge, R. Baffa, M. Guido, F. Di Mario, R. Naccarato, J. Gilvarry, E. Leen, S. Sant, E. Sweeney, C. O’ Morain, J. Schönlebe, H. Riedel, M. Prinz, L. Hahn, H. Porst, H. Lohmann, E. Orsini, J. Guerre, M. Tulliez, S. Chaussade, M. Gaudric, R. Canton, J. Sampedro, A. García-Plaza, P. Cognein, M. C. Parodi, A. Tucci, S. Gasperoni, V. Stanghellini, C. Tosetti, G. F. Paparo, O. Varoli, S. Siringo, R. Santucci, N. Monetti, G. Barbara, R. Corinaldesi, P. Dotto, F. Vianello, Ferrana M., G. A. Grasso, T. Del Bianco, G. Laino, B. Germanà, G Battaglia, C. K. Axelson, L. P. Andersen, P. B. Szecsi, K. N. Olsen, C. J. Lundborg, C. Andre, L. Descos, A. Martin, S. Cavagna, M P. Brassens-Rabbé, S. Wu, T. Wadström, F. Mégraud, G. Perdichizzi, L. Muratori, S. Pallio, M. Bottair, M. T. Fera, E. Quattrocchi, V. Caruso, T. Karttunen, T. Kerola, R. Kartttunen, S. Niemelä, T. U. Kosunen, F. Bonchviam, S. Pretolani, M. Baraldine, D. Cilla, S. Baldinelli, and G. Gasparrini

Subjects
03 medical and health sciences, Pathology, medicine.medical_specialty, 0302 clinical medicine, business.industry, medicine, 030212 general & internal medicine, General Medicine, 030204 cardiovascular system & hematology, business
Published
1992

28. Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease

Author

Ridker PM, Everett BM, Thuren T, MacFadyen JG, Chang WH, Ballantyne C, Fonseca F, Nicolau J, Koenig W, Anker SD, Kastelein JJP, Cornel JH, Pais P, Pella D, Genest J, Cifkova R, Lorenzatti A, Forster T, Kobalava Z, Vida-Simiti L, Flather M, Shimokawa H, Ogawa H, Dellborg M, Rossi PRF, Troquay RPT, Libby P, Glynn RJ, Novo S, Krum H, Varigos J, Siostrzonek P, Sinnaeve P, Gotcheva N, Yong H, Urina-Triana M, Milicic D, Vettus R, Manolis AJ, Wyss F, Sigurdsson A, Fucili A, Veze I, Petrauskiene B, Salvador L, Klemsdal TO, Medina F, Budaj A, Otasevic P, Lainscak M, Seung KB, Commerford P, Donath M, Hwang JJ, Kultursay H, Bilazarian S, East C, Forgosh L, Harris B, Ligueros M, Bohula E, Charmarthi B, Cheng S, Chou S, Danik J, McMahon G, Maron B, Ning M, Olenchock B, Pande R, Perlstein T, Pradhan A, Rost N, Singhal A, Taqueti V, Wei N, Burris H, Cioffi A, Dalseg AM, Ghosh N, Gralow J, Mayer T, Rugo H, Fowler V, Limaye AP, Cosgrove S, Levine D, Lopes R, Scott J, Hilkert R, Tamesby G, Mickel C, Manning B, Woelcke J, Tan M, Manfreda S, Ponce T, Kam J, Saini R, Banker K, Salko T, Nandy P, Tawfik R, O’Neil G, Manne S, Jirvankar P, Lal S, Nema D, Jose J, Collins R, Bailey K, Blumenthal R, Colhoun H, Gersh B, Abreu M, Actis MV, Aiub J, Aiub F, Albisu J, Alvarisqueta A, Avalos V, Barreto M, Berli MA, Blumberg C, Bocanera M, Botta C, Bowen L, Budassi N, Buhlman S, Westberg JC, Carabajal T, Caruso G, Casala J, Cendali G, Coloma G, Berra FC, Cuneo C, Degennaro N, Dellasa M, Diaz M, Dos Santos P, Espinosa V, Facello A, Facello M, Farias E, Fernandez AA, Ferrari V, Pacora FF, Flores GS, Franco M, Gabito A, Viola HG, Garcia F, Garcia Duran R, Garcia Pinna J, Glenny J, Godoy Sanchez M, Grosse A, Guzman P, Hasbani E, Hominal M, Ibañez J, Jure H, Jure D, Vico ML, Liniado G, Luciardi H, Luquez H, Maehara G, Maffei L, Majul C, Mallagray M, Marinaro S, Martinez J, Massaccesi R, De Los Milagros Had M, Azize GM, Montana O, Montenegro E, Morell Y, Muntaner J, Navarrete S, Olmedo M, Paganini M, Paz S, Perez Manghi F, Piskorz D, Polato C, Recoaro R, Romano A, Salinger M, Sanchez A, Saravia MA, Sarjanovich R, Scaro G, Schiavi LB, Soler J, Tinnirello V, Tomassi A, Valle M, Vallejo MA, Venturini C, Marcela Wenetz LM, Yossen M, Zaidman C, Zalazar L, Zangroniz P, Amerena J, Brady L, Colquhoun D, Eccleston D, Ferreira-Jardim A, French J, Jayasinghe R, Mcintosh C, Ord M, Plotz M, Purnell P, Roberts-Thomson P, Schultz C, Shanahan T, Tan R, Taverner P, Turner F, Vibert J, Vorster M, William M, Youssef G, Bergler-Klein J, Brath H, Brodmann M, Fliesser-Goerzer E, Haider K, Heeren G, Hiden C, Mandic L, Paulweber B, Ploechl A, Prenner A, Steringer-Mascherbauer R, Strohner-Kaestenbauer H, Barbato E, Bouvy C, Briké C, Charlier F, Cools F, De Knijf K, De Wolf L, Delforge M, Deweerdt N, Gits F, Goffinet C, Hermans K, Hollanders G, Mestdagh I, Pirenne B, Servaes V, Simons N, Tahon S, Theunissen E, Van Genechten G, Vervoort G, Vissers C, Vranckx P, Vrolix M, Abib E Jr, Abrantes J, Araujo Fonseca M, Barbosa E, Barroso W, Barroso A, Bodanese L, Botelho R, Costa Amorim R, Da Costa F, Da Silva A, Da Silva O Jr, Da Silva D Jr, Ferreira Dos Santos T, Dos Santos F, Dos Santos A, Duda N, Feitosa G, Felario Junior GA, Ferraz R, Filho P, Fonseca A, Wanderley FF, Freitas E, Fucci F, Marengo Garcia De Carvalho L, Hernandez M, Hettwer Magedanz E, Julião K, Kormann A, Lameira A, Lima F, Lino E, Maia L, Manenti E, Marchi AL, Fischer SM, Michalaros Y, Moraes J Jr, Moreira L, Pagnan M, Pesce F, Pinheiro L, Rassi S, Reis G, Reis H, Resende I, Roel A, Ruschel K, Saporito W, Saraiva JF, Seroqui M, Silva R, Unterkircher B, Vicente C, Vieira N, Xavier JP, Zucchetti C, Angelova I, Dimitrov G, Genova D, Gospodinov K, Goudev A, Grigorova V, Hristova K, Makedonska JJ, Katova T, Kostov K, Lazov P, Manov E, Manukov I, Manukov D, Milanova M, Kabakchieva VM, Petrov D, Petrusheva T, Pramatarova I, Raev D, Runev N, Sirakova-Taseva A, Tisheva-Gospodinova S, Todorova A, Tzekova M, Yakovova S, Yanev T, Abulencia K, Arora S, Baker A, Bata IR, Beaudry M, Belle Isle J, Bilodeau N, Boivin MC, Bolduc H, Bourgeois S, Brons S, Cantor W, Chaussé I, Chhabra A, Chouinard G, Cleveland T, Dattani D, Deslongchamps F, Diodati J, Drouin K, Duchesne L, Fontaine S, d'Amours DG, Gervais B, Gosselin G, Graham J, Grover A, Gupta A, Haldane H, Hartleib M, Hickey L, Huynh T, Johnston J, Julien VE, Lachance P, Lake J, Lamontagne C, Lauzon C, Lepage S, Maheux K, Manyari D, Martin E, McPherson C, Mehta S, Michaud N, Kouz SM, Murphy G, OKeefe D, Otis R, Ouimet F, Pandey S, Peck C, Perkins L, Richert L, Robbins K, Robinson S, Cabau JR, Ross B, Roy C, Roy M, Roy A, Rupka D, Affaki GS, Saunders K, Savard D, Soucy D, St Amour E, Thiessen S, Vertes G, Vezina M, Vincelli G, Weisnagel SJ, Zadra R, Chen J, Chen Y, Dong X, Feng Y, Feng Z, Fu G, Han B, Hao Y, He Y, He Z, Hong T, Jia Z, Jiang T, Jiang J, Jiang X, Ke Y, Li Y, Li Z, Li W, Li X, Liu P, Liu Y, Liu B, Liu S, Liu L, Lu Z, Lv Y, Ma C, Ma G, Peng L, Qing L, Ren L, Sang X, Song M, Sun Z, Wang J, Wang Y, Wei J, Wu W, Wu J, Xu H, Yan J, Yang P, Yang K, Yao Z, Yaoqing H, Yuan Z, Zhai Z, Zhang J, Zhang Y, Zhao R, Zhou H, Accini Mendoza JL, Aparicio CV, Castillo T, Chaverra I, Conrado Y, Coronel J, Cotes C, Cuentas I, Cuervo A, Dussan MA, Echeverria L, Hernandez E, Ibarra J, Isaza D, Jimenez D, Lopez P, Manzur F, Mejia I, Mendoza Y, Molina DI, Patino JM, Rodriguez D, Rodriguez LM, Rodriguez SM, Sanchez Vallejo G, Luz Serrano H, Sotomayor A, Urina M, Vesga B, Yupanqui H, Akrap B, Busic N, Ciglenecki N, Cmrecnjak J, Fucak E, Gabor M, Jeric M, Jutrisa N, Kordic K, Planinc I, Popovic Z, Radeljic V, Sesto I, Sutalo K, Tusek S, Belohlavek J, Budkova J, Busak L, Capova L, Cech V, Cermak O, Coufalova Z, Cyprian R, Dedek V, Dedkova S, Ferkl R, Hanak P, Hanustiakova A, Homza M, Horackova K, Houra M, Iveta H, Kaiserova L, Kala P, Karel I, Kellnerova I, Koleckar P, Kreckova M, Krupicka J, Lorenc Z, Machova V, Malik J, Masarikova L, Matyasek I, Mikus M, 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Boffetti P, Boley K, Bonner J, Boudreaux R, Boulanger K, Bradley A, Bramlet D, Bredlau C, Briggs S, Brousalis L, Brown S, Brown C, Buchannan C, Burke W, Burley T, Burton C, Burtt D, Byars W, Caballero-Valiente B, Carr K, Halliwell TC, Castillo J, Cei L, Cerda L, Chambers J, Chamblee T, Chattin W, Chee L, Chen YC, Cherlin R, Cheung D, Chiodi L, Christensen L, Christenson S, Cislowski D, Clavier-Firmin C, Colfer H, Colvin T, Cosgrove N, Covert C, Cox B, Cox R, Craig W, Crandall L, Crepps K, Cromer M, Cruz H, Cruz H, Cruz M, Cucher F, Damron M, Dave K, Dave B, Davis M, Davis B, Dawkins-Hughes S, Dean J, Debnam S, Defosse C, Dehning M, Dela Llana A, Dellorso M, Denham D, Desalle D, Dettmer M, Dhawan M, Diago M, Dicken T, Diederich C, Diederich M, Diehl R, Digangi D, Diller P, Dimattia M, Dodds G, Doggett J, Donahue K, Doughty L, Dragutksy B, Dreese M, Dunhurst F, Dunn D, Dutka C, Earl J, Eaton C, Eaves W, Ebeling K, Eder F, Edgerton L, Edillo C, Edwards J, Edwards T, Einhorn D, El Hafi S, Ellis M, Erickson B, Ervin W, Eskridge L, Fail P, Falcon D, Fang C, Fattal P, Fawson A, Felix L, Ferdinand K, Fien E, Fintel D, Firek C, Fitz-Patrick D, Flores E, Flores E, Flores H, Floro T, Forker A, Foster M, Foucauld J, Lehman KF, Fox B, Francoeur L, Frandsen B, Frandsen B, Frivold G, Fruchter G, Fullerton D, Gabriel J, Gacioch G, Garas S, Garcia N, Garcia Rinaldi R, Garcia-Fragoso V, Garcia-Portela M, Gelb R, George F, Ghali J, Gilbert J, Gilley J, Glancy R, Goff R, Goldberg N, Gonzales D, Gonzales V, Gonzalez E, Gorges R, Gould R, Grabeau R, Grable M, Graham JA, Graif J, Green E, Greener R, Greenway F, Grieshaber V, Griffin S, Gros C, Gudipati RVC, Guillinta P, Gupta V, Gutmann J, Gwyn M, El Hachem M, Hage F, Hageman T, Haidar A, Hakas J, Haldis T, Hall L, Hall C, Hall S, Halpern S, Hamud-Socoro A, Hardee L, Harrell W, Harrington A, Hartwell J, Hasan F, Hattler B, Haught H, Haynes E, Haywood A, Heaney L, Hecht J, Hernandez I, Herzog W, Hess E, Hill H, Hilton T, Hinderaker P, Hodnett P, Hoffman M, Hogan C, Holmes Z, Rees DH, Hotchkiss D, Huang P, Humbert J, Hutchens E, Iachini K, Ibarra M, Igbokidi O, Ilahi T, Imbrognio M, Ipp E, Iteld B, Jacques G, Jafri A, Jafry B, Jardula M, Jefferson D, Jenkins R, Johnson E, Johnson J, Jones S, Kawahara M, Kelehan S, Kelly R, Kendall T, Kereiakes D, Khan M, Khan S, Kick J, Kimmel M, King T, King A, Kirkland S, Kissel S, Kitchens D, Klein P, Klugherz B, Korban E, Koren M, Korte M, Kostis J, Kotek L, Kozak M, Kreutter F, Kusnick B, Labovitz R, Lail J, Lamance J, Lamas G, Lambert J, Lambert C, Landzberg J, Langdon J, Lavoie W, Ledger G, Lee T, Lee K, Lehman R, Leimbach W, Lennard M, Lepor N, Lester F, Levin P, Levinson L, Lewis D, Lillo J, Link L, Long C, Longaker R, Lorch G, Lucksinger G, Lynd S, Rhudy JM, Madder R, Magness K, Maheshwari A, Alan A, Malek M, Maletz L, Malhotra V, Malhotra S, Mandviwala M, Mani CK, Manuel J, Marchelletta N, Marshall L, Marsters M, Martin L, Martinez E, Mavromatis K, Maynard R, Mays M, Mays B, Mbulaiteye A, Mcalister R, Mccoy C, Mccrary D Jr, Mccullough-O'Brien H, Mcdonald M, Mcgill J, Mcgrew F, Mckenzie C, Mclaurin B, Mclellan BA, Mcneil D, Mcneill R, Mehrle A, Melbie K, Melliza T, Messina T, Meyer R, Michel K, Mikdadi G, Miller C, Miller R, Miller A, Miller G, Miller W, Mitchell J, Moats DJR, Mody F, Moffat J, Molk B, Molter D, Monroe T, Montero H, Montgomery R, Mookherjee D, Moran J, Moriarty P, Morrison J, Morton D, Moshayedi P, Mosley J, Moustafa M, Munshi K, Murray A, Mustafa J, Nadar V, Naidu R, Nalley J, Navy S, Neil L, Neutel JM, Niblack P, Nicely V, Nicolai M, Nijmeh G, Nikas A, Nikyar A, Nixon S, Norman L, Noto G, Nour K, Nugent A, Ocman B, Odegard A, Olsen S, Ortiz-Carrasquillo R, Ossino N, Paez H, Palchick B, Paliwal Y, Pannell R, Parfait V, Partridge J, Patel B, Patel R, Patel M, Patel S, Paysor C, Pena A, Pereira S, Perez M, Perez A, Perkins H, Perry B, Peters P, Phillippi C, Phillips A, Phillips A, Piacente R, Pintado M, Pish R, Pitt W, Poling T, Pomposini D, Poock J, Potts J, Poudrier R, Prior J, Pritchard C, Purighalla R, Quddusi K, Quinones J, Quinton D, Radin M, Radojcsics B, Rajput B, Rama B, Ramos M, Rauch R, Raynes K, Reber AM, Reddy J, Reeves M, Reilly K, Renaud K, Resnick H, Reyes R, Richardson M, Riethof M, Riser J, Rodero M, Rodriguez Araya E, Roper L, Rozeman P, Ruder D, Runquist L, Sack G, Saint-Jacques H, Salfity M, Sall N, Sam K, Samal A, Sanchez D, Santiago J Jr, Savignano C, Saylor R, Scheffel M, Schifferdecker B, Schindler E, Schneider P, Schneider R, Schnitzler R, Schrager B, Schwartz A, Scott R, Seals A, Shah AV, Shah A, Shatsky K, Shayani S, Shealy N, Sheets L, Shelley J, Shepard P, Shetty S, Silver K, Simon M, Singh K, Singh N, Sizemore BC, Skatrud L, Slayton C, Slimak V, Sloane G, Smallwood B, Smith P, Smith M, Smith T, Smith G, Smith B, Smith W, Smith M, Smith J, Smith J, Soca Y, Sofley C, Sopko K, Sosa-Padilla M, Sotolongo R, Sprinkle B, Srivastava S, Starzec M, Steinhoff J, Stelly L, Stinson J, Stoddard M, Stoltz S, Stone B, Stover T, Strain J, Strugatsky S, Stys T, Suleman A, Sullivan P, Tamez W, Tandon N, Teltser M, Terry PS, Terry K, Tessmar C, Thekkoott D, Thomas D, Thomas DM, Thompson E, Thompson J, Thornton A, Tjaden T, Tobias C, Topper J, Tran A, Treasure C, Trenkamp P, Trevino M, Tsou L, Tuholske C, Uy W, Vahtel M, Vaid B, Valenzuela M, Vance A, Vandam J, Vanhecke T, Vanness WC III, Vargas R, Vaz S, Vazquez Tanus J, Veerina K, Vega J, Vento A, Vijay N, Voelker F, Vogt E, Vold D, Vora K, Wade RD, Wadell C, Waksman R, Walker K, Walker K, Wallace K, Warren M, Washam M, Watson B, Webel R, Wells T, West M, Whitaker J, White J, White C, White A, White A, Wilhoit G, Wilkins M, Willingham K, Wilson S, Wilson V, Wise J, Woodall S, Woods A, Wright J, Wu J, Xu ZJ, Yarows S, Young A, Younis L, Zarate J, Zebrack J, Zhang W, Zieve F, Zineldine A, Ridker, P. M., Everett, B. M., Thuren, T., Macfadyen, J. G., Chang, W. H., Ballantyne, C., FONSECA E PIRES, CARLOS EDUARDO, Nicolau, J., Koenig, W., Anker, S. D., Kastelein, J. J. P., Cornel, J. H., Pais, P., Pella, D., Genest, J., Cifkova, R., Lorenzatti, A., Forster, T., Kobalava, Z., Vida-Simiti, L., Flather, M., Shimokawa, H., Ogawa, H., Dellborg, M., Rossi, P. R. F., Troquay, R. P. T., Libby, P., Glynn R., J, CANTOS Trial, Group, Perrone, Filardi, P, ACS - Amsterdam Cardiovascular Sciences, Vascular Medicine, ACS - Pulmonary hypertension & thrombosis, and ACS - Atherosclerosis & ischemic syndromes

Subjects
0301 basic medicine, 030204 cardiovascular system & hematology, law.invention, 0302 clinical medicine, c-reactive protein, Randomized controlled trial, law, Cardiovascular Disease, middle aged, double-blind method, antibodies, Myocardial infarction, humans, Stroke, interleukin-1beta, biology, Antibodies, Monoclonal, drug, General Medicine, Lipid, Aged, anti-inflammatory agents, monoclonal, humanized, atherosclerosis, cardiovascular diseases, dose-response relationship, female, incidence, infections, lipids, male, myocardial infarction, neutropenia, secondary prevention, stroke, Anti-Inflammatory Agent, aged, Editorial, Atherosclerosi, Monoclonal, Human, medicine.drug, medicine.medical_specialty, Neutropenia, Antibodies, Monoclonal, Humanized, Infections, Placebo, antibodies, monoclonal, dose-response relationship, drug, infection, medicine (all), 03 medical and health sciences, Internal medicine, medicine, Dose-Response Relationship, Drug, business.industry, Antiinflammatory Therapy, Canakinumab, for Atherosclerotic Disease, C-reactive protein, medicine.disease, Surgery, Canakinumab, 030104 developmental biology, biology.protein, business
Abstract

Background: Experimental and clinical data suggest that reducing inflammation without affecting lipid levels may reduce the risk of cardiovascular disease. Yet, the inflammatory hypothesis of atherothrombosis has remained unproved. Methods: We conducted a randomized, double-blind trial of canakinumab, a therapeutic monoclonal antibody targeting interleukin-1β, involving 10,061 patients with previous myocardial infarction and a high-sensitivity C-reactive protein level of 2 mg or more per liter. The trial compared three doses of canakinumab (50 mg, 150 mg, and 300 mg, administered subcutaneously every 3 months) with placebo. The primary efficacy end point was nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. RESULTS: At 48 months, the median reduction from baseline in the high-sensitivity C-reactive protein level was 26 percentage points greater in the group that received the 50-mg dose of canakinumab, 37 percentage points greater in the 150-mg group, and 41 percentage points greater in the 300-mg group than in the placebo group. Canakinumab did not reduce lipid levels from baseline. At a median follow-up of 3.7 years, the incidence rate for the primary end point was 4.50 events per 100 person-years in the placebo group, 4.11 events per 100 person-years in the 50-mg group, 3.86 events per 100 person-years in the 150-mg group, and 3.90 events per 100 person-years in the 300-mg group. The hazard ratios as compared with placebo were as follows: in the 50-mg group, 0.93 (95% confidence interval [CI], 0.80 to 1.07; P = 0.30); in the 150-mg group, 0.85 (95% CI, 0.74 to 0.98; P = 0.021); and in the 300-mg group, 0.86 (95% CI, 0.75 to 0.99; P = 0.031). The 150-mg dose, but not the other doses, met the prespecified multiplicity-adjusted threshold for statistical significance for the primary end point and the secondary end point that additionally included hospitalization for unstable angina that led to urgent revascularization (hazard ratio vs. placebo, 0.83; 95% CI, 0.73 to 0.95; P = 0.005). Canakinumab was associated with a higher incidence of fatal infection than was placebo. There was no significant difference in all-cause mortality (hazard ratio for all canakinumab doses vs. placebo, 0.94; 95% CI, 0.83 to 1.06; P = 0.31). Conclusions: Antiinflammatory therapy targeting the interleukin-1β innate immunity pathway with canakinumab at a dose of 150 mg every 3 months led to a significantly lower rate of recurrent cardiovascular events than placebo, independent of lipid-level lowering. (Funded by Novartis; CANTOS ClinicalTrials.gov number, NCT01327846.)

Published
2017

29. Aqueous PM 2.5 promotes lipid accumulation, classical macrophage polarisation and heat shock response.

Author

Corrêa Costa-Beber L, Kazmirczak Moraes R, Marques Obelar Ramos J, Meira Martins LA, Toquetto AL, Fursel Pacheco J, Resende Farias H, Gioda A, Antunes de Oliveira V, de Oliveira J, and Costa Rodrigues Guma FT

Subjects
Animals, Mice, RAW 264.7 Cells, Air Pollutants toxicity, Atherosclerosis, Lipid Metabolism drug effects, Apoptosis drug effects, Macrophage Activation drug effects, Inflammation chemically induced, Foam Cells drug effects, HSP70 Heat-Shock Proteins metabolism, Cell Proliferation drug effects, Particulate Matter toxicity, Macrophages drug effects, Macrophages metabolism, Heat-Shock Response drug effects
Abstract

Fine particulate matter (PM 2.5 ) is an air pollutant that enhances susceptibility to cardiovascular diseases. Macrophages are the first immune cells to encounter the inhaled particles and orchestrate an inflammatory response. Given their role in atherosclerosis development, we investigated whether aqueous PM 2.5 could elicit atherogenic effects by polarising macrophages to a pro-oxidative and pro-inflammatory phenotype and enhancing foam cell formation. The RAW264.7 macrophage cell line was exposed to PM 2.5 for 48 h, with PBS as the control. Aqueous PM 2.5 induced apoptosis and reduced cell proliferation. In surviving cells, we observed morphological, phagocytic, oxidative, and inflammatory features (i.e. enhanced iNOS, Integrin-1β, IL-6 expression), indicative of classical macrophage activation. We also detected an increase in total and surface HSP70 levels, suggesting macrophage activation. Further, exposure of high-cholesterol diet-fed mice to PM 2.5 resulted in aortic wall enlargement, indicating vascular lesions. Macrophages exposed to PM 2.5 and non-modified low-density lipoprotein (LDL) showed exacerbated lipid accumulation. Given the non-oxidised LDL used and the evidence linking inflammation to disrupted cholesterol negative feedback, we hypothesise that PM 2.5 -induced inflammation in macrophages enhances their susceptibility to transforming into foam cells. Finally, our results indicate that exposure to aqueous PM 2.5 promotes classical macrophage activation, marked by increased HSP70 expression and that it potentially contributes to atherosclerosis., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Published
2024
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30. Improving access to cancer clinical research in Brazil: recent advances and new opportunities. Expert opinions from the 4th CURA meeting, São Paulo, 2023.

Author

Resende H, Arai RJ, Barrios CH, Schwyter F, Teich NLS, Gomes A, Dallari AB, Bonilha LAS, Souza CMA, Francisco FR, Munhoz RR, Werutsky G, Madi M, Fernandes P, Figueiredo JM, Fedozzi F, Arruda L, Aguiar VQ, and Melo AC

Abstract

Clinical research is the cornerstone of improvements in cancer care. However, it has been conducted predominantly in high-income countries with few clinical trials available in Brazil and other low-and-middle-income countries (LMIC). Of note, less than one-third of registered clinical trials addressing some of the most commonly diagnosed cancers (breast, lung and cervical) recruited patients from LMIC in the last years. The Institute Project CURA promoted the fourth CURA meeting, discussing barriers to cancer clinical research and proposing potential solutions. A meeting was held in São Paulo, Brazil, in June 2023 with representatives from different sectors: Brazilian Health Regulatory Agency (Anvisa), National Commission of Ethics in Research (CONEP), non-governmental organisations, such as the Latin American Cooperative Oncology Group, the Brazilian Society of Clinical Oncology (SBOC), Contract Research Organisations, pharmaceutical companies and investigators. A total of 16 experts pointed out achievements as shortening the time of regulatory processes involving Anvisa and CONEP, development of staff training programs, maintenance of the National Program of Oncological Attention (PRONON), and the foundation of qualified centres in North and Northeast Brazilian regions. Participants also highlighted the need to be more competitive in the field, which requires optimising ongoing policies and implementing new strategies as decentralisation of clinical research centres, public awareness campaigns, community-centered approaches, collaborations and partnerships, expansion of physicians-directed policies, exploring the role of the steering committee. Active and consistent reporting of the initiatives might help to propagate ongoing advances, increasing Brazilian participation in clinical cancer research. Engagement of all players is crucial to maintain continuous progress with further improvements in critical points including regulatory timelines and increments in qualified human resources which aligned with new educational initiatives focused on physicians and the general population will expand access to cancer clinical trials in Brazil., Competing Interests: Heloisa Resende has received research funding from Novartis and Roche, all outside the scope of this manuscript. Gustavo Werutsky has received research funding from AstraZeneca/MedImmune, Bristol-Myers Squibb Brazil, Pfizer, Roche and Roche/Genentech, all outside the scope of this manuscript. Has consulting or advisory role at Merck. Carlos H Barrios has received research funding from AB Science, Abbvie, Abraxis BioScience, Amgen, Asana Biosciences, Astellas Pharma, AstraZeneca, Biomarin, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Clinica Atlantis, Covance, Daiichi Sankyo, Exelixis, GlaxoSmith-Kline, Halozyme, ImClone Systems, INC Research, inVentiv Health, Janssen, LEO Pharma, Lilly, Medivation, Merck, Merck KGaA, Merrimack, Millennium, Mylan, Novartis, Pfizer, PharmaMar, Polyphor, Roche/Genentech, Sanofi, Shanghai Henlius Biotech and Taiho Pharmaceutical, all outside the scope of this manuscript. Has consulting or advisory role at AstraZeneca, Boehringer Ingelheim, Eisai, GlaxoSmithKline, Libbs, Lilly, MSD Oncology, Novartis, Pfizer, Roche/Genentech and United Medical. Has stock and other ownership interests in MedSIR and Tummi. All other authors have no conflicts of interest to disclose., (© the authors; licensee ecancermedicalscience.)

Published
2024
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31. Current scenario and future perspectives of clinical research in Brazil: a national survey.

Author

Resende H, Rebelatto TF, Werutsky G, Gossling G, Aguiar VQ, Lopes GMC, de Assis BR, Arruda L, and Barrios CH

Abstract

Background: Epidemiological and clinical cancer research is essential to understanding tumour behaviour and developing new therapies in oncology. However, several countries including Brazil as well as many other regions of the world have limited participation in cancer research. Despite 625,000 new cancer cases recorded in Brazil in 2022, only 2.2% of ongoing cancer clinical trials are available in the country. We conducted an online survey to describe physician engagement with research and to identify the main barriers precluding participation in and conduct of clinical cancer research in the country., Methods: An anonymous online survey of 23 objective questions was sent by e-mail to Brazilian members of the Latin American Cooperative Oncology Group and the Brazilian Society of Clinical Oncology. The first 13 questions addressed demographic information, medical training and previous research participation. In the second part, the main barriers to engagement and participation in clinical trials in Brazil were addressed. Continuous variables were measured by median and range. Analyses were performed using SAS statistical software (version 9.4; SAS Institute, Inc. Cary, NC)., Results: 109 physicians answered the survey. Most participants were oncologists ( N = 98, 89.9%), living in capital cities ( N = 84, 77.1%), were from the Southeast region of Brazil ( N = 63, 57.8%) and worked at institutions providing exclusively private healthcare ( N = 59, 54.1%). Of the 109 respondents, 83 (76.1%) reported working in research centres (as investigators or sub-investigators). Surprisingly, 31.2% of physicians recognised they invite less than 1% of their patients to participate in clinical trials, even though 98 (89.9%) considered the participation of patients in clinical trials extremely relevant. The main barriers compromising the conduct of research in the country were the low number of available trials (48.2%) and the lack of qualified human resources to staff research sites (22.9%). Other reported barriers were the lengthy regulatory approval process (42.2%), followed by a lack of awareness of clinical research by patients resulting in low recruitment rates (24.1%). Of the 26 (23.8%) respondents not working with research, 25 (96.1%) reported interest in being involved, 31.8% have tried participating in research and 62.4% reported limited knowledge of trial procedures., Conclusion: These results suggest a clear need to further engage physicians in clinical research activities in Brazil. Patient education strategies should improve the low recruitment rates and secondarily increase the number of proposed trials in the country., Competing Interests: Heloisa Resende has received research funding from Novartis and Roche, all outside the scope of this manuscript. Taiane Francieli Rebelatto has no relationships to disclose. Gustavo Werutsky has received research funding from AstraZeneca/MedImmune, Bristol-Myers Squibb Brazil, GlaxoSmithKline, Lilly, Novartis, Pfizer, Roche and Roche/Genentech, all outside the scope of this manuscript. Has consulting or advisory role at Merck. Gustavo Gössling has received research funding from AstraZeneca/Merck and Janssen Oncology, all outside the scope of this manuscript. Vinícius Aguiar has no relationships to disclose. Guilherme Lopes has no relationships to disclose. Biazi Assis has no relationships to disclose. Lilian Arruda has no relationships to disclose. Carlos H Barrios has received research funding from AB Science, Abbvie, Abraxis BioScience, Amgen, Asana Biosciences, Astellas Pharma, AstraZeneca, Biomarin, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Clinica Atlantis, Covance, Daiichi Sankyo, Exelixis, GlaxoSmithKline, Halozyme, ImClone Systems, INC Research, inVentiv Health, Janssen, LEO Pharma, Lilly, Medivation, Merck, Merck KGaA, Merrimack, Millennium, Mylan, Novartis, Pfizer, PharmaMar, Polyphor, Roche/Genentech, Sanofi, Shanghai Henlius Biotech and Taiho Pharmaceutical, all outside the scope of this manuscript. Has consulting or advisory role at AstraZeneca, Boehringer Ingelheim, Eisai, GlaxoSmithKline, Libbs, Lilly, MSD Oncology, Novartis, Pfizer, Roche/Genentech and United Medical. Has stock and other ownership interests in MedSIR and Tummi., (© the authors; licensee ecancermedicalscience.)

Published
2023
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32. A Novel Functional Electrical Stimulation-Induced Cycling Controller Using Reinforcement Learning to Optimize Online Muscle Activation Pattern.

Author

Coelho-Magalhães T, Azevedo Coste C, and Resende-Martins H

Subjects
Humans, Bicycling physiology, Electric Stimulation, Muscle Contraction, Muscle, Skeletal physiology, Electric Stimulation Therapy methods, Spinal Cord Injuries
Abstract

This study introduces a novel controller based on a Reinforcement Learning (RL) algorithm for real-time adaptation of the stimulation pattern during FES-cycling. Core to our approach is the introduction of an RL agent that interacts with the cycling environment and learns through trial and error how to modulate the electrical charge applied to the stimulated muscle groups according to a predefined policy and while tracking a reference cadence. Instead of a static stimulation pattern to be modified by a control law, we hypothesized that a non-stationary baseline set of parameters would better adjust the amount of injected electrical charge to the time-varying characteristics of the musculature. Overground FES-assisted cycling sessions were performed by a subject with spinal cord injury (SCI AIS-A, T8). For tracking a predefined pedaling cadence, two closed-loop control laws were simultaneously used to modulate the pulse intensity of the stimulation channels responsible for evoking the muscle contractions. First, a Proportional-Integral (PI) controller was used to control the current amplitude of the stimulation channels over an initial parameter setting with predefined pulse amplitude, width and fixed frequency parameters. In parallel, an RL algorithm with a decayed-epsilon-greedy strategy was implemented to randomly explore nine different variations of pulse amplitude and width parameters over the same stimulation setting, aiming to adjust the injected electrical charge according to a predefined policy. The performance of this global control strategy was evaluated in two different RL settings and explored in two different cycling scenarios. The participant was able to pedal overground for distances over 3.5 km, and the results evidenced the RL agent learned to modify the stimulation pattern according to the predefined policy and was simultaneously able to track a predefined pedaling cadence. Despite the simplicity of our approach and the existence of more sophisticated RL algorithms, our method can be used to reduce the time needed to define stimulation patterns. Our results suggest interesting research possibilities to be explored in the future to improve cycling performance since more efficient stimulation cost dynamics can be explored and implemented for the agent to learn.

Published
2022
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33. Development of a High-Power Capacity Open Source Electrical Stimulation System to Enhance Research into FES-Assisted Devices: Validation of FES Cycling.

Author

Coelho-Magalhães T, Fachin-Martins E, Silva A, Azevedo Coste C, and Resende-Martins H

Subjects
Bicycling, Electric Stimulation, Humans, Male, Paraplegia, Electric Stimulation Therapy, Spinal Cord Injuries
Abstract

Since the first Cybathlon 2016, when twelve teams competed in the FES bike race, we have witnessed a global effort towards the development of stimulation and control strategies to improve FES-assisted devices, particularly for cycling, as a means to practice a recreational physical activity. As a result, a set of technical notes and research paved the way for many other studies and the potential behind FES-assisted cycling has been consolidated. However, engineering research needs instrumented devices to support novel developments and enable precise assessment. Therefore, some researchers struggle to develop their own FES-assisted devices or find it challenging to implement their instrumentation using commercial devices, which often limits the implementation of advanced control strategies and the possibility to connect different types of sensor. In this regard, we hypothesize that it would be advantageous for some researchers in our community to enjoy access to an entire open-source FES platform that allows different control strategies to be implemented, offers greater adaptability and power capacity than commercial devices, and can be used to assist different functional activities in addition to cycling. Hence, it appears to be of interest to make our proprietary electrical stimulation system an open-source device and to prove its capabilities by addressing all the aspects necessary to implement a FES cycling system. The high-power capacity stimulation device is based on a constant current topology that allows the creation of biphasic electrical pulses with amplitude, width, and frequency up to 150 mA, 1000 µs, and 100 Hz, respectively. A mobile application (Android) was developed to set and modify the stimulation parameters of up to eight stimulation channels. A proportional-integral controller was implemented for cadence tracking with the aim to improve the overall cycling performance. A volunteer with complete paraplegia participated in the functional testing of the system. He was able to cycle indoors for 45 min, accomplish distances of more than 5 km using a passive cycling trainer, and pedal 2400 m overground in 32 min. The results evidenced the capacity of our FES cycling system to be employed as a cycling tool for individuals with spinal cord injury. The methodological strategies used to improve FES efficiency suggest the possibility of maximizing pedaling duration through more advanced control techniques.

Published
2022
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34. Flow-cytometric analysis of membrane integrity of stallion sperm in the face of agglutination: the "zombie sperm" dilemma.

Author

Ortiz I, Felix M, Resende H, Ramírez-Agámez L, Love CC, and Hinrichs K

Subjects
Animals, Horses, Male, Cell Membrane chemistry, Cryopreservation veterinary, Flow Cytometry veterinary, Semen Preservation veterinary, Sperm Agglutination, Sperm Capacitation, Sperm Motility
Abstract

Purpose: To define the effect of sperm agglutination, associated with incubation under capacitating conditions, on accuracy of membrane assessment via flow cytometry and to develop methods to mitigate that effect., Methods: Sperm motility was measured by CASA. Sperm were stained with PI-PSA or a novel method, LD-PSA, using fixable live/dead stain and cell dissociation treatment, before flow-cytometric analysis. Using LD-PSA, acrosome reaction and plasma membrane status were determined in equine sperm treated with 10 μm A23187 for 10 min, followed by 0, 1, or 2 h incubation in capacitating conditions., Results: Using PI-PSA, measured membrane integrity (MI; live sperm) was dramatically lower than was total motility (TMOT), indicating spurious results ("zombie sperm"). Sperm aggregates were largely of motile sperm. Loss of motility after A23187 treatment was associated with disaggregation and increased MI. On disaggregation using LD-PSA, MI rose, and MI then corresponded with TMOT. In equine sperm incubated after A23187 treatment, as the percentage of live acrosome-reacted sperm increased, TMOT decreased to near 0., Conclusion: Flow cytometry assesses only individualized sperm; thus, agglutination of viable sperm alters recorded membrane integrity. As viable sperm become immotile, they individualize; therefore, factors that decrease motility, such as A23187, result in increased measured MI. Disaggregation before assessment allows more accurate determination of sperm membrane status; in this case we documented a mismatch between motility and live acrosome-reacted equine sperm that may relate to the poor repeatability of A23187 treatment for equine IVF. These findings are of profound value to future studies on sperm capacitation., (© 2021. The Author(s).)

Published
2021
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35. Factors affecting intracellular calcium influx in response to calcium ionophore A23187 in equine sperm.

Author

Sampaio B, Ortiz I, Resende H, Felix M, Varner D, and Hinrichs K

Subjects
Animals, Horses, Male, Mice, Calcimycin pharmacology, Calcium metabolism, Calcium Ionophores pharmacology, Serum Albumin, Bovine metabolism, Spermatozoa drug effects
Abstract

Background: Exposure to the calcium ionophore A23187 may present a "universal" sperm treatment for IVF, as it bypasses capacitation pathways. However, success in utilizing A23187 is variable, especially in equine spermatozoa. Notably, albumin is used during A23187 treatment but paradoxically is thought to suppress A23187 action. Essentially no critical data are available on the effects of A23187 and albumin concentrations, ratios, or addition protocols on changes in intracellular calcium ([Ca] i ) in any cell type., Objective: To determine factors that affect the action of A23187 on [Ca] i in equine and murine spermatozoa., Methods: Spermatozoa were loaded with Fluo-4 and changes in fluorescence after A23187 treatment were measured under various conditions using a microplate reader., Results: Concentrations of bovine serum albumin (BSA) and A23187, type of BSA, makeup of A23187 stock solutions (i.e., 1° stock (DMSO) or 2° stock made with medium, water or DMSO), order of addition of spermatozoa and A23187, incubation of media before sperm addition, species of spermatozoa, and time of addition of BSA all affected [Ca] i in response to A23187 treatment. In equine spermatozoa already exposed to 10 µM A23187, addition of BSA to 33 mg/ml to "quench" the A23187 did not affect [Ca] i . When this concentration of BSA was added to spermatozoa exposed to 1 µM A23187, [Ca] i in murine spermatozoa returned to baseline, however, equine spermatozoa continued to exhibit increased [Ca] i . Addition of BSA to 33 mg/ml to media containing 1 µM A23187, prior to addition of spermatozoa, completely inhibited change in [Ca] i in both murine and equine spermatozoa., Conclusion: These results represent some of the first critical data on the effects of albumin and other procedural factors on A23187-induced changes in [Ca] i in any cell type. Our findings help to explain the variability in reported response of spermatozoa to A23187 among species and among laboratories., (© 2021 American Society of Andrology and European Academy of Andrology.)

Published
2021
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36. A Novel Framework for Quantifying Accuracy and Precision of Event Detection Algorithms in FES-Cycling.

Author

Le Guillou R, Schmoll M, Sijobert B, Lobato Borges D, Fachin-Martins E, Resende H, Pissard-Gibollet R, Fattal C, and Azevedo Coste C

Subjects
Algorithms, Electric Stimulation, Gait, Humans, Electric Stimulation Therapy, Spinal Cord Injuries
Abstract

Functional electrical stimulation (FES) is a technique used in rehabilitation, allowing the recreation or facilitation of a movement or function, by electrically inducing the activation of targeted muscles. FES during cycling often uses activation patterns which are based on the crank angle of the pedals. Dynamic changes in their underlying predefined geometrical models (e.g., change in seating position) can lead to desynchronised contractions. Adaptive algorithms with a real-time interpretation of anatomical segments can avoid this and open new possibilities for the automatic design of stimulation patterns. However, their ability to accurately and precisely detect stimulation triggering events has to be evaluated in order to ensure their adaptability to real-case applications in various conditions. In this study, three algorithms (Hilbert, BSgonio, and Gait Cycle Index (GCI) Observer) were evaluated on passive cycling inertial data of six participants with spinal cord injury (SCI). For standardised comparison, a linear phase reference baseline was used to define target events (i.e., 10%, 40%, 60%, and 90% of the cycle's progress). Limits of agreement (LoA) of ±10% of the cycle's duration and Lin's concordance correlation coefficient (CCC) were used to evaluate the accuracy and precision of the algorithm's event detections. The delays in the detection were determined for each algorithm over 780 events. Analysis showed that the Hilbert and BSgonio algorithms validated the selected criteria (LoA: +5.17/-6.34% and +2.25/-2.51%, respectively), while the GCI Observer did not (LoA: +8.59/-27.89%). When evaluating control algorithms, it is paramount to define appropriate criteria in the context of the targeted practical application. To this end, normalising delays in event detection to the cycle's duration enables the use of a criterion that stays invariable to changes in cadence. Lin's CCC, comparing both linear correlation and strength of agreement between methods, also provides a reliable way of confirming comparisons between new control methods and an existing reference.

Published
2021
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37. The impact of sociodemographic factors and health insurance coverage in the diagnosis and clinicopathological characteristics of breast cancer in Brazil: AMAZONA III study (GBECAM 0115).

Author

Rosa DD, Bines J, Werutsky G, Barrios CH, Cronemberger E, Queiroz GS, de Lima VCC, Freitas-Júnior R, Couto JD, Emerenciano K, Resende H, Crocamo S, Reinert T, Van Eyil B, Nerón Y, Dybal V, Lazaretti N, de Cassia Costamilan R, de Andrade DAP, Mathias C, Vacaro GZ, Borges G, Morelle A, Caleffi M, Filho CS, Mano MS, Zaffaroni F, de Jesus RG, and Simon SD

Subjects
Animals, Brazil epidemiology, Female, Humans, Insurance Coverage, Insurance, Health, Prospective Studies, Amazona, Breast Neoplasms diagnosis, Breast Neoplasms epidemiology, Breast Neoplasms therapy
Abstract

Purpose: In Brazil, the available cancer registries are deficient in number and quality and, hence, little information is known regarding sociodemographic, clinicopathological characteristics, treatment patterns, and outcomes of breast cancer (BC) patients. We performed the AMAZONA III/ GBECAM 0115 study and in this analysis, we describe patients' characteristics at diagnosis and their association with health insurance type., Methods: This is a prospective cohort study developed in 23 sites in Brazil including women with newly diagnosed invasive BC from January 2016 to March 2018. In order to compare healthcare insurance type, we considered patients who were treated under the Brazilian public health system as publicly insured, and women who had private insurance or paid for their treatment as privately insured., Results: A total of 2950 patients were included in the study. Median age at diagnosis was 53.9 years; 63.1% were publicly insured. The majority of patients (68.6%) had stage II-III breast cancer and ductal carcinoma histology (80.9%). The most common breast cancer subtype was luminal A-like (48.0%) followed by luminal B-HER2 positive-like (17.0%) and triple-negative (15.6%). Luminal A was more frequent in private (53.7% vs. 44.2%, p < .0001) than public, whereas Luminal B HER2-positive (19.2% vs. 14.2%, p = 0.0012) and HER2-positive (8.8% vs. 5.1%, p = 0.0009) were more common in patients with public health system coverage. Only 34% of patients were diagnosed by screening exams. Privately insured patients were more frequently diagnosed with stage I disease when compared to publicly insured patients; publicly insured patients had more stage III (33.5% vs. 14.7%; p-value < 0.0001) disease than privately insured ones. Breast cancer was detected by symptoms more frequently in publicly than in privately insured patients (74.2% vs 25.8%, respectively; p-value < 0.0001)., Conclusions: Patients with public health coverage were diagnosed with symptomatic disease, later stages and more aggressive subtypes when compared to privately insured patients.

Published
2020
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38. Advanced Stage at Diagnosis and Worse Clinicopathologic Features in Young Women with Breast Cancer in Brazil: A Subanalysis of the AMAZONA III Study (GBECAM 0115).

Author

Franzoi MA, Rosa DD, Zaffaroni F, Werutsky G, Simon S, Bines J, Barrios C, Cronemberger E, Queiroz GS, Cordeiro de Lima V, Júnior RF, Couto J, Emerenciano K, Resende H, Crocamo S, Reinert T, Van Eyli B, Nerón Y, Dybal V, Lazaretti N, de Cassia Costamillan R, Pinto de Andrade DA, Mathias C, Vacaro GZ, Borges G, Morelle A, Filho CAS, Mano M, and Liedke PER

Subjects
Adult, Age Factors, Brazil, Breast Neoplasms pathology, Female, Humans, Breast Neoplasms diagnosis
Abstract

Purpose: Breast cancer (BC) in young women is uncommon and tends to present with more aggressive characteristics. To better understand and characterize this scenario in Brazil through real-world data, we performed a subanalysis of AMAZONA III study (ClinicalTrials.gov identifier: NCT02663973)., Methods: The AMAZONA III study (GBECAM 0115) is a prospective registry that included 2,950 women newly diagnosed with invasive BC in Brazil from January 2016 until March 2018 at 22 sites. Valid data were obtained from 2,888 patients regarding age at diagnosis and complete baseline information. To compare epidemiologic and clinicopathological features at the time of diagnosis, patients with BC were divided into two groups according to age: ≤ 40 years and > 40 years. Quantitative variables were described as means, and categorical variables were described as frequencies and percentages and compared using the Pearson's χ 2 test., Results: Of 2,888 women diagnosed with BC, 486 (17%) were ≤ 40 years old. Young women had higher educational level, most were employed and a significant number were married ( P < . 001 for all associations). Younger patients were more symptomatic at BC diagnosis ( P < . 001), and they also presented more frequently with stage III, T3/T4, grade 3 tumors, HER-2-positive, luminal B, and triple-negative subtypes., Conclusion: Brazilian women younger than age 40 years have unfavorable clinicopathological features of BC at diagnosis, with more aggressive subtypes and advanced stage when compared with older women. These differences are not explained by socioeconomic or ethnic imbalances. The causes of a higher prevalence of BC among young women in Brazil deserve additional investigation.

Published
2019
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39. A Skin Cancer Prevention Facial-Aging Mobile App for Secondary Schools in Brazil: Appearance-Focused Interventional Study.

Author

Brinker TJ, Heckl M, Gatzka M, Heppt MV, Resende Rodrigues H, Schneider S, Sondermann W, de Almeida E Silva C, Kirchberger MC, Klode J, Enk AH, Knispel S, von Kalle C, Stoffels I, Schadendorf D, Nakamura Y, Esser S, Assis A, and Bernardes-Souza B

Abstract

Background: The incidence of melanoma is increasing faster than any other major cancer both in Brazil and worldwide. Southeast Brazil has especially high incidences of melanoma, and early detection is low. Exposure to ultraviolet (UV) radiation is a primary risk factor for developing melanoma. Increasing attractiveness is a major motivation among adolescents for tanning. A medical student-delivered intervention that takes advantage of the broad availability of mobile phones and adolescents' interest in their appearance indicated effectiveness in a recent study from Germany. However, the effect in a high-UV index country with a high melanoma prevalence and the capability of medical students to implement such an intervention remain unknown., Objective: In this pilot study, our objective was to investigate the preliminary success and implementability of a photoaging intervention to prevent skin cancer in Brazilian adolescents., Methods: We implemented a free photoaging mobile phone app (Sunface) in 15 secondary school classes in southeast Brazil. Medical students "mirrored" the pupils' altered 3-dimensional (3D) selfies reacting to touch on tablets via a projector in front of their whole grade accompanied by a brief discussion of means of UV protection. An anonymous questionnaire capturing sociodemographic data and risk factors for melanoma measured the perceptions of the intervention on 5-point Likert scales among 356 pupils of both sexes (13-19 years old; median age 16 years) in grades 8 to 12 of 2 secondary schools in Brazil., Results: We measured more than 90% agreement in both items that measured motivation to reduce UV exposure and only 5.6% disagreement: 322 (90.5%) agreed or strongly agreed that their 3D selfie motivated them to avoid using a tanning bed, and 321 (90.2%) that it motivated them to improve their sun protection; 20 pupils (5.6%) disagreed with both items. The perceived effect on motivation was higher in female pupils in both tanning bed avoidance (n=198, 92.6% agreement in females vs n=123, 87.2% agreement in males) and increased use of sun protection (n=197, 92.1% agreement in females vs n=123, 87.2% agreement in males) and independent of age or skin type. All medical students involved filled in a process evaluation revealing that they all perceived the intervention as effective and unproblematic, and that all pupils tried the app in their presence., Conclusions: The photoaging intervention was effective in changing behavioral predictors for UV protection in Brazilian adolescents. The predictors measured indicated an even higher prospective effectiveness in southeast Brazil than in Germany (>90% agreement in Brazil vs >60% agreement in Germany to both items that measured motivation to reduce UV exposure) in accordance with the theory of planned behavior. Medical students are capable of complete implementation. A randomized controlled trial measuring prospective effects in Brazil is planned as a result of this study., (©Titus Josef Brinker, Marlene Heckl, Martina Gatzka, Markus V Heppt, Henrique Resende Rodrigues, Sven Schneider, Wiebke Sondermann, Carolina de Almeida e Silva, Michael C Kirchberger, Joachim Klode, Alexander H Enk, Sarah Knispel, Christof von Kalle, Ingo Stoffels, Dirk Schadendorf, Yasuhiro Nakamura, Stefan Esser, Aisllan Assis, Breno Bernardes-Souza. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 09.03.2018.)

Published
2018
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40. Overview of FES-Assisted Cycling Approaches and Their Benefits on Functional Rehabilitation and Muscle Atrophy.

Author

Rabelo M, de Moura Jucá RVB, Lima LAO, Resende-Martins H, Bó APL, Fattal C, Azevedo-Coste C, and Fachin-Martins E

Subjects
Bicycling, Humans, Electric Stimulation Therapy, Muscle, Skeletal physiopathology, Muscular Atrophy therapy, Spinal Cord Injuries rehabilitation
Abstract

Central nervous system diseases include brain or spinal cord impairments and may result in movement disorders almost always manifested by paralyzed muscles with preserved innervations and therefore susceptible to be activated by electrical stimulation. Functional electrical stimulation (FES)-assisted cycling is an approach mainly used for rehabilitation purposes contributing, among other effects, to restore muscle trophism. FES-assisted cycling has also been adapted for mobile devices adding a leisure and recreational benefit to the physical training. In October 2016, our teams (Freewheels and EMA-trike) took part in FES-bike discipline at the Cybathlon competition, presenting technologies that allow pilots with spinal cord injury to use their paralyzed lower limb muscles to propel a tricycle. Among the many benefits observed and reported in our study cases for the pilots during preparation period, we achieved a muscle remodeling in response to FES-assisted cycling that is discussed in this chapter. Then, we have organized some sections to explore how FES-assisted cycling could contribute to functional rehabilitation by means of changes in the skeletal muscle disuse atrophy.

Published
2018
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41. Contribution of Galvanic Vestibular Stimulation for the Diagnosis of HTLV-1-Associated Myelopathy/Tropical Spastic Paraparesis.

Author

Matos Cunha LC, Campelo Tavares M, Tierra Criollo CJ, Labanca L, Cardoso Dos Santos Couto Paz C, Resende Martins H, de Freitas Carneiro-Proietti AB, and Utsch Goncalves D

Abstract

Background and Purpose: Galvanic vestibular stimulation (GVS) is a low-cost and safe examination for testing the vestibulospinal pathway. Human T-lymphotropic virus 1 (HTLV-1)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is a slowly progressive disease that affects the vestibulospinal tract early in its course. This study compared the electromyographic (EMG) responses triggered by GVS of asymptomatic HTLV-1-infected subjects and subjects with HAM/TSP., Methods: Bipolar galvanic stimuli (400 ms and 2 mA) were applied to the mastoid processes of 39 subjects (n=120 stimulations per subject, with 60 from each lower limb). Both the short latency (SL) and medium latency (ML) components of the EMG response were recorded from the soleus muscles of 13 healthy, HTLV-1-negative adults (56±5 years, mean±SD), and 26 individuals infected with HTLV-1, of whom 13 were asymptomatic (56±8 years) and 13 had HAM/TSP (60±6 years)., Results: The SL and ML EMG components were 55±4 and 112±10 ms, respectively, in the group of healthy subjects, 61±6 and 112±10 ms and in the HTLV-1-asymptomatic group, and 67±8 and 130±3 ms in the HAM/TSP group (p=0.001). The SL component was delayed in 4/13 (31%) of the examinations in the HTLV-1-asymptomatic group, while the ML component was normal in all of them. In the HAM/TSP group, the most common alteration was the absence of waves., Conclusions: A pattern of abnormal vestibular-evoked EMG responses was found in HTLV-1-neurological disease, ranging from delayed latency among asymptomatic carriers to the absence of a response in HAM/TSP. GVS may contribute to the early diagnosis and monitoring of nontraumatic myelopathies.

Published
2013
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