-Context -Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor. Cellular proliferation and apoptosis is gaining importance for predicting prognosis in several cancers. Objective -To investigate the Ki67 and p53 immunostaining in GISTs. Methods -Specimens from 40 patients with GIST were assessed for immunohistochemical expression of Ki67 and p53. The tumors were divided according the risk of recurrence in two groups: I with high or intermediate risk and; II with low or very low risk. Results -Among the 40 patients, 21 were men, the mean age was 56 years, 16 occurred in the small intestine and 13 in the stomach, 5 in the retroperitonium, 4 in the colon or rectum and 2 in the mesenterium. Thirty two tumors were from group I and 8 from group II. Half of the patients developed recurrence, being 90% of the group I (P = 0.114). The tumor Ki67 labelling index ranged from 0.02 to 0.35 (mean level 0.12). This index was marginally higher in the group I patients with recurrence (P = 0.09) compared to the patients of the same group without recurrence. p53 staining was expressed in 65% of the GISTs. A higher frequency of p53 and Ki67 had been found in the group I tumors when compared to the other group (P = 0.022; OR = 8.00 -IC 95%: 1.32-48.65). Conclusion -The most common site was the small intestine and 80% had a malignant potential justifying the high recurrence observed. No significant correlation was found between p53 and overall outcome of the patients. In group I patients, the evaluation Ki67LI may be a marker of prognosis. The positivity of both markers is higher among the patients with worst prognosis than in the others. HEADINGS -Gastrointestinal stromal tumors. Ki-67 antigen. Tumor suppressor protein p53.
INTRODUCTIONIn the search for quality of life, humans have intensified their efforts in favour of food safety postulates in an attempt to improve the microbiological quality of foods. Mycotoxins are among the factors that compromise the quality of foods, with their ingestion causing serious damage to human and animal health.
Objective: To evaluate the copper and zinc intake and serum levels in patients with juvenile rheumatoid arthritis (JRA), considering the pauci and polyarticular types, the disease activity and duration, the number of inflamed joints and the use of corticosteroids therapy. Design: Cross-sectional study with control group. Setting: Outpatients of the pediatric rheumatology public health clinic, of the Universidade Federal de São Paulo=Escola Paulista de Medicina, Brazil. Subjects: Forty-one patients with JRA were evaluated and 23 patients' brothers, as a control group. Interventions: Copper and zinc intake evaluation by Food Register method. Copper and zinc serum levels by atomic absorption spectrophotometry. Results: The disease activity did not determine difference in copper (P ¼ 0.624) and zinc (P ¼ 0.705) intake, being predominantly below the Recommended Dietary Allowances. The serum copper in relation to control was statistically greater (P ¼ 0.018), showing that the number of inflamed joints is statistically significantly related with its variation (P ¼ 0.001). The serum zinc was not different either in relation to control (P ¼ 0.940) or to the disease characteristics. Conclusions: The evaluation of copper intake seems to be of fundamental importance. It may influence the efficiency of the organic serum response. More research is needed to indicate, with security, adequate zinc intake.
RESUMO -Considerando que, principalmente na vigência de doença inflamatória, é de grande importância um estado nutricional que propicie crescimento adequado, objetivou-se avaliar a ingestão dietética e a antropometria em crianças e adolescentes com ARJ.
Objective: to identify factors that affect the decision of prescribing opioids for intubated and ventilated neonates Method: retrospective study of intubated and ventilated newborn infants for periods longer than one hour, admitted to the NICU from January 1995 to June 1997. During this period, 203 patients fulfilled inclusion criteria and data of 176 charts were reviewed. Charts were analyzed regarding demographic data, characteristics of analgesia and respiratory support, invasive procedures performed and clinical entities diagnosed during the period of mechanical ventilation. Discriminative analysis was used to understand factors that lead to opioid use by some of these patients.Results: Ninety-seven neonates received at least one dose of opioids during the period of mechanical ventilation. None of these patients was evaluated with pain scales, and in 63% of them we could not retrieve any reason for opioid prescription in their charts. Discriminative analysis showed that the main differences between groups were birthweight, gestational age, oxygenation index at intubation, and number of arterial sticks during the first 72 hours of mechanical ventilation. The most mature and heaviest neonates with a more severe respiratory insufficiency received opioid analgesia during ventilation.Conclusion: the decision to use opioids in intubated and ventilated neonates was based on the infants' aspect and respiratory status. It did not consider the pain these patients might be suffering and it was not based on the evaluation of pain. ResumoObjetivo: identificar fatores que levaram os médicos a prescreverem opióides a recém-nascidos em ventilação mecânica.Método: estudo retrospectivo de pacientes em ventilação mecâ-nica por cânula traqueal, por mais de 1 hora, internados em UTI neonatal entre janeiro de 1995 a junho de 1997. Nesse período, 203 recém-nascidos preencheram o critério de inclusão, recuperando-se 176 prontuários. Os prontuários foram analisados quanto a dados demográficos, características da analgesia e do suporte ventilatório, procedimentos invasivos realizados e entidades mórbidas diagnosticadas durante o período de ventilação. Para entender os fatores que determinaram o uso da analgesia em parte dessa população, utilizouse a análise discriminante.Resultados: Nos 97 pacientes que receberam > 1 dose de opióides durante a ventilação, a analgesia foi iniciada, em média, até 24 horas após o início da ventilação. As escalas de avaliação da dor não foram usadas em nenhum paciente e, em 63%, não havia relato do motivo para a analgesia. A análise discriminante mostrou que as variáveis que diferenciaram os grupos submetidos ou não à analgesia foram: peso ao nascer, idade gestacional, índice de oxigenação e número de punções arteriais. Os neonatos com maior chance de receberem alguma dose de opióide durante a ventilação foram os de peso mais elevado, idade gestacional mais avançada, índice de oxigenação mais acentuado no início da ventilação e maior necessidade de gasometrias, ou seja, os bebês mais maduros e c...
The refeience curves aie widely used in real problems to evaluate whether the sample units follow, or not, an expected behavior, according to some characteristic of interest.In the medical área, for example, the reference curves, for reílecting the behavior of the healthful individuais, supply a kind of clinical cuide to interpret the information of a new patient. The construction of the reference curves envolves the estimation of the populational quantiles of respoílse variable (y) distribution, at di6erent values of pledictor vaiiable (X).With the objectivo to construct reference curves, tais work presents some nonparametric regressioii methods that fit condicional quantiles functions locally. Local quantile regression methods that are robust to outlying predictor variable values are deríved by adapting the methodology suggested in Einbeck et al. (2004) in the local âtting of the regression function.These procedurcs a.re applied to a data set related to the cardiology área, with the objective to construct reference curves for the average cardiac frequency of healthful individuais as function of their age. The obtained resulta show that the reference curves constructed by the robust methods are more appropriate in the regions in which the design is sparse.
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