BackgroundThe goal of this exploratory study was to develop and assess a prediction model which can potentially be used as a biomarker of breast cancer, based on anthropometric data and parameters which can be gathered in routine blood analysis.MethodsFor each of the 166 participants several clinical features were observed or measured, including age, BMI, Glucose, Insulin, HOMA, Leptin, Adiponectin, Resistin and MCP-1. Machine learning algorithms (logistic regression, random forests, support vector machines) were implemented taking in as predictors different numbers of variables. The resulting models were assessed with a Monte Carlo Cross-Validation approach to determine 95% confidence intervals for the sensitivity, specificity and AUC of the models.ResultsSupport vector machines models using Glucose, Resistin, Age and BMI as predictors allowed predicting the presence of breast cancer in women with sensitivity ranging between 82 and 88% and specificity ranging between 85 and 90%. The 95% confidence interval for the AUC was [0.87, 0.91].ConclusionsThese findings provide promising evidence that models combining age, BMI and metabolic parameters may be a powerful tool for a cheap and effective biomarker of breast cancer.Electronic supplementary materialThe online version of this article (10.1186/s12885-017-3877-1) contains supplementary material, which is available to authorized users.

Introduction. Liver diseases influence musculoskeletal functions and may negatively affect the exercise capacity of patients with cirrhosis. Aim. To test the relationship between the six-minute walk test (6MWT), maximal inspiratory pressure (MIP), and exercise capacity (VO2peak) measures and the survival rate of patients with cirrhosis. Methods. This prospective cohort study consisted of 86 patients diagnosed with cirrhosis with the following aetiology: hepatitis C virus (HCV), hepatitis B virus (HBV), and/or alcoholic cirrhosis (AC). All patients were followed up for three years and submitted to the 6MWT, pressure measurements with a compound gauge, and an exercise test (VO2peak). Results. The survival analysis showed that the individuals who covered a distance shorter than 410 m during the 6MWT had a survival rate of 55% compared with a rate of 97% for the individuals who walked more than 410 m (p = 0.0001). Individuals with MIPs below −70 cmH2O had a survival rate of 62% compared with a rate of 93% for those with MIPs above −70 cmH2O (p = 0.0001). The patients with values below 17 mL/kg had a survival rate of 55% compared with a rate of 94% for those with values above 17 mL/kg (p = 0.0001). Conclusion. The 6MWT distance, MIP, and oxygen consumption are predictors of mortality in patients with cirrhosis.

Procedimentos para lidar com o tabu da morte Procedures for dealing with the taboo of death

Introduction: Chronic liver disease results in large functional impact, causing loss of muscle mass and function with consequent reduction of functional capacity. Objective: To evaluate and compare the respiratory muscle strength and functional capacity of candidates for liver transplantation who are under Class B or C according to Child Pugh Score and to correlate these variables within each group. Methods -Cross-sectional study with a convenience sample of 35 patients divided into two groups based on the score obtained in the Child Pugh Score B (19 patients) and Child Pugh Score C (16 patients). All subjects were evaluated in a single moment, and the maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) as well as the distance walked during the 6-minute walk test (6MWT) were measured. Results: Individuals classified with Child Pugh Score B showed higher values in the MIP (-86.05 vs. 23.89 -57.94 14.14), p = 0.001, in MEP (84.16 vs. 28.26 72.00 16 1994), p = 0.142, and the distance walked in 6MWT (473.63 vs 376.13 39.00 55.276), p = 0.001. We also found a positive correlation between the values of MIP and distance walked during 6MWT in group B of the Child Pugh Score, r = 0.64 and p = 0.003. Conclusion: The progress of liver disease contributes to the onset of several complications, which together appear to contribute to the reduction of functional capacity of individuals. In our study this was evidenced by the worse performance of Child Pugh score C group. This may suggest that the wait for liver transplantation (LTx) can worsen the functional capacity of these individuals.

BACKGROUND: Hepatopulmonary syndrome (HPS) is a complication associated with cirrhosis that may contribute to worsening exercise capacity and reduced survival after liver transplantation (LT). OBJECTIVE: To evaluate exercise capacity, complications and survival after LT in patients with cirrhosis and HPS and to compare these results with the results of patients with cirrhosis without HPS. METHODS: A prospective cohort study, consisting initially of 178 patients, of whom 90 underwent LT (42 with HPS and 48 without HPS). A previous evaluation consisted of the six-minute walk test (6MWT), an exercise test and manovacuometry. Those who underwent LT were evaluated for the mechanical ventilation time (MV), noninvasive ventilation (NIV) use, and survival two years after the procedure. In the statistical analysis, we used the Kolmogorov-Smirnov test, Student’s t-test, the linear association square test, and the Kaplan-Meier survival curve. The data were analyzed with the SPSS 16.00 program and considered significant at P<0.05. RESULTS: The HPS group demonstrated a lower peak of oxygen consumption (VO2peak) (14.2±2.3 vs 17.6±2.6) P<0.001 and a shorter distance walked on the 6MWT (340.8±50.9 vs 416.5±91.4) P<0.001 before LT compared with the non-HPS group. The transplanted patients with HPS remained longer hours in MV (19.5±4.3 vs 12.5±3.3) P=0.02, required more NIV (12 vs 2) P=0.01, and had lower survival two years after the procedure (P=0.01) compared with the transplanted patients without HPS. CONCLUSION: Patients with HPS had worse exercise capacity before LT, more complications and shorter survival after this procedure than patients without HPS.