the onset and progression of CLL. MYD88 mutations independently associate with shorter TTT in M-CLL subgroup, identifying cases with rapid progression. Introduction: Chronic lymphocytic leukemia (CLL) is a chronic lymphoproliferative disease characterized by highly biological heterogeneity and variable clinical course. Previous researches showed that 30%-40% of patients with CLL could survive for decades of years without initial need for treatment, while some patients rapidly succumb to the progression of disease. In recent years, data on prognostic value of molecular mutations and viral infections on CLL continue accumulating. Our study was determined to define variables correlated with time-to-treatment (TTT) in Chinese with chronic lymphocytic leukemia (CLL) and use these variables to develop a prognostic score. We determined correlation of the prognostic score with survival and compared this score with those developed for persons of predominately European descent with CLL in this study.
Methods:We collected clinical, molecular, serologic and virological parameters of 334 newly diagnosed and untreated CLL patients. Utilizing Chi-square test, survival analysis, log-rank test and Cox hazard regression analysis, we checked the correlations between variables and prognosis of our patients.Results: By analyzing 334 newly diagnosed and untreated CLL patients without treatment indication, we demonstrated that Binet stage B/C, lymphocyte level, TP53 abnormality, IGHV non-mutation and evidence of HBV and EBV infection were independently associated with TTT in multivariate analyses. We used these data to construct a prognostic scoring system that divided subjects into three cohorts of low, intermediate and high risks with median TTTs of 102 months (95% confidence interval 50-154 months), 15 months (5-25 months) and 6 months (3-9 months; p-value for trend <0.001). Corresponding median OS from diagnosis were not reached, not reached and 73 months (55-91 months; p-value for trend <0.001).Conclusions: We improved current risk stratification for patients with untreated CLL using combined clinical, molecular and virological variables and defined three different risk groups with this novel stratifica-
PORTUGUESE REAL-LIFE EXPERIENCE WITH IBRUTINIB OUTSIDE CLINICAL TRIALS -A MULTICENTER ANALYSIS
Introdução: O leite materno e uma importante fonte de nutrição o mesmo possui as substâncias adequadas para suprir todas as necessidades do bebê. Além de nutritivo, o leite materno protege contra infecções, evita a desnutrição, reduz a morbidade por diarreia, infecções respiratórias, previne episódios de otite média, asma dentre outros. O aleitamento materno exclusivo deve ser preconizado até os 6 meses de vida, sendo recomenda a continuação da amamentação pelo menos até o segundo aniversário da criança. Neste contexto, a assistência do enfermeiro é de fundamental importância pois o mesmo possui as habilidades necessárias para dar suporte nessa fase tão importante. Objetivos: os objetivos deste estudo foram demonstrar as principais características do Leite Materno, os benefícios da amamentação e demonstrar o papel do enfermeiro neste contexto. Método: Esta pesquisa foi desenvolvida a partir de uma revisão integrativa da literatura. Resultados; os dados obtidos a partir desta revisão demonstraram que a assistência do enfermeiro no contexto do aleitamento materno se dá principalmente através da consulta de enfermagem, onde o mesmo presta os cuidados necessários para minimizar os possíveis prejuízos para o binômio mãe e filho, por meio de orientações e desenvolvimento de ações que visam promover e incentivar o aleitamento. Conclusão: conclui-se que o enfermeiro é um profissional impar dentro da atenção prestada, sua atua extremamente indispensável em todas as etapas envolvidas no aleitamento materno.
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