RESUMO
Introducción: El cáncer de laringe es la neoplasia maligna más común de las vías aerodigestivas superiores. La laringectomía total es el tratamiento de elección en casos avanzados, pero se asocia a una alta tasa de complicaciones. Objetivos: Conocer la prevalencia de las complicaciones posquirúrgicas de la laringectomía total y los factores asociados en pacientes con cáncer de laringe. Materiales y métodos: Estudio observacional, descriptivo, retrospectivo, de corte transversal, revisando el comportamiento de la laringectomía total y sus principales complicaciones en la Cátedra y Servicio de Otorrinolaringología del Hospital de Clínicas de la Facultad de Ciencias Médicas de la Universidad Nacional de Asunción, Paraguay, de 2015 a 2022. Se incluyeron pacientes mayores de 18 años, de ambos sexos, postoperados de laringectomía total, con diagnóstico anatomopatológico de neoplasia de laringe. Se excluyeron pacientes no operados, con fichas incompletas o que abandonaron el tratamiento. Se analizaron variables demográficas, clínicas, quirúrgicas y anatomopatológicas. Resultados: Se incluyeron 10 pacientes, todos varones, con edad media de 56,3 ± 10,2 años. El 90% presentaba hábitos tóxicos. La complicación más frecuente fue la fístula faringocutánea (70%), seguida por infección del sitio quirúrgico (10%) y sangrado posoperatorio (10%). El 71,4% de las fístulas se resolvieron con medidas conservadoras. El 30% tenía afectación supraglótica y el 57,1% de los que presentaron complicaciones recibieron radioterapia previa. Conclusión: Las complicaciones de la laringectomía total son frecuentes, principalmente la fístula faringocutánea. La afectación supraglótica y la radioterapia previa se asociaron a mayor tasa de complicaciones. Se requieren estudios prospectivos con muestras más grandes para confirmar estos hallazgos.
Introduction: Laryngeal cancer is the most common malignant neoplasm of the upper aerodigestive tract. Total laryngectomy is the treatment of choice in advanced cases, but it is associated with a high rate of complications. Objectives: To determine the prevalence of postoperative complications of total laryngectomy and associated factors in patients with laryngeal cancer. Materials and methods: Observational, descriptive, retrospective, cross-sectional study, reviewing the behavior of total laryngectomy and its main complications in the Department of Otorhinolaryngology of the Hospital de Clínicas, Faculty of Medical Sciences, National University of Asunción, Paraguay, from 2015 to 2022. Patients over 18 years of age, of both sexes, who underwent total laryngectomy, with anatomopathological diagnosis of laryngeal neoplasm were included. Non-operated patients, those with incomplete records or who abandoned treatment were excluded. Demographic, clinical, surgical and anatomopathological variables were analyzed. Results: Ten patients were included, all male, with a mean age of 56.3 ± 10.2 years. Ninety percent had toxic habits. The most frequent complication was pharyngocutaneous fistula (70%), followed by surgical site infection (10%) and postoperative bleeding (10%). Conservative measures resolved 71.4% of the fistulas. Thirty percent had supraglottic involvement and 57.1% of those who presented complications received previous radiotherapy. Conclusion: Complications of total laryngectomy are frequent, mainly pharyngocutaneous fistula. Supraglottic involvement and previous radiotherapy were associated with a higher rate of complications. Prospective studies with larger samples are required to confirm these findings.
Assuntos
Neoplasias Laríngeas/patologia , Laringectomia , Testes HematológicosRESUMO
Undiagnosed type 2 diabetes (T2D) remains a major public health concern. The global estimation of undiagnosed diabetes is about 46%, being this situation more critical in developing countries. Therefore, we proposed a non-invasive method to quantify glycated hemoglobin (HbA1c) and glucose in vivo. We developed a technique based on Raman spectroscopy, RReliefF as a feature selection method, and regression based on feed-forward artificial neural networks (FFNN). The spectra were obtained from the forearm, wrist, and index finger of 46 individuals. The use of FFNN allowed us to achieve an error in the predictive model of 0.69% for HbA1c and 30.12 mg/dL for glucose. Patients were classified according to HbA1c values into three categories: healthy, prediabetes, and T2D. The proposed method obtained a specificity and sensitivity of 87.50% and 80.77%, respectively. This work demonstrates the benefit of using artificial neural networks and feature selection techniques to enhance Raman spectra processing to determine glycated hemoglobin and glucose in patients with undiagnosed T2D.
Assuntos
Diabetes Mellitus Tipo 2 , Estado Pré-Diabético , Humanos , Hemoglobinas Glicadas , Diabetes Mellitus Tipo 2/diagnóstico , Glucose , Glicemia , Análise Espectral Raman , Redes Neurais de ComputaçãoRESUMO
This multicenter clinical study was aimed at conducting a targeted pharmacogenomic association analysis of residual on-clopidogrel platelet reactivity in 474 Caribbean Hispanic patients. Platelet reactivity was measured using the VerifyNow P2Y12 assay and clopidogrel resistance was defined as P2Y12 reaction units (PRUs) greater than or equal to 208. Genotyping was performed using the whole-genome Infinium MEGA BeadChip array. An ancestry-adjusted, weighted polygenic risk score (wPGxRS) was developed to account for the effect of multiple variants on PRU and compared between clopidogrel responders and nonresponders. The mean PRU across the study cohort was 173.8 ± 68.5 and 33.5% of patients were defined as clopidogrel resistant. Multivariate linear regression showed that 19% of PRU variability was attributed to nine independent predictors, with CYP2C19*2 (rs4244285) accounting for ~ 7% of observed PRU variation (p < 0.001). PON1 rs662, ABCB1/MDR1 rs2032582, PEAR1 rs12041331 carrier status, and the interaction between African ancestry and rs12041331 carriers also predicted PRU among the participants (p ≤ 0.05). A clear gene-dose effect was detected between PRU and CYP2C19*2 genotype, consistent with previous studies in European patient populations, as well as rs12777823. Importantly, a significant positive correlation was detected between our novel wPGxRS (4 variants) and PRU among the Hispanic patient population (rp = 0.35, p < 0.001). Moreover, the wPGxRS discriminated between nonresponders and responders (p = 0.003), indicating that this multigene-based score is a useful predictor of clopidogrel resistance among Caribbean Hispanics. Taken together, these results help close the gap of knowledge on clopidogrel pharmacogenomics and its potential clinical implementation in this under-represented population.
Assuntos
Clopidogrel/farmacologia , Hispânico ou Latino/genética , Herança Multifatorial , Farmacogenética , Inibidores da Agregação Plaquetária/farmacologia , Idoso , Feminino , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade , Índias Ocidentais/etnologiaRESUMO
Introducción: Los cultivos de café, cacao y pasturas para la ganadería son actividades agropecuarias de interés económico en Colombia. Cuando estas actividades se desarrollan bajo sistemas agroforestales (SAF) promueven la conservación e incrementan la fijación de carbono y, por ende, la mitigación del cambio climático. Objetivo: El estudio estimó el almacenamiento de carbono en la biomasa aérea, necromasa y carbono orgánico del suelo bajo SAF con cacao (SAF cacao), SAF con café (café SAF), sistemas silvopastoriles (SSP) y bosque en el municipio de Mesetas, Meta (Colombia). Métodos: Se establecieron 44 parcelas de muestreo, en donde se tomaron medidas dasométricas a individuos con un diámetro del tronco a la altura del pecho (dap) ≥ 2.5 cm (latizales, fustales y fustales grandes), cuyos valores fueron transformados a carbono con modelos de biomasa y una fracción de carbono default. En los tres sistemas agropecuarios, se contó el número de árboles de cacao, café, plantas asociadas y se identificó el tipo de uso (maderable, alimento, combustión). Resultados: El almacenamiento de carbono presentó diferencias significativas (P < 0.0001) entre usos del suelo. La mayor acumulación se encontró en bosque, con 216.6 t C ha-1, superando en 59, 72 y 73 % a SAF cacao, SSP y SAF café, respectivamente. Fabaceae, Lauraceae y Primulaceae presentaron el mayor almacenamiento de carbono. En SAF cacao, la mayor acumulación de carbono fue encontrada en especies para alimento humano; en SAF café y SSP, el mayor almacenamiento fue presentado en las especies maderables. Conclusión: Estos resultados resaltan el potencial de almacenamiento de carbono en los sistemas productivos de mayor importancia en el departamento del Meta, lo cual es importante para el diseño de estrategias que permitan integrar acciones de mitigación de emisiones de gases de efecto invernadero y promover la economía campesina local.
Introduction: Coffee, cocoa crops and pastures for livestock are agricultural activities of economic interest in Colombia. When these activities are developed under agroforestry systems (AFS), they promote conservation and increase carbon fixation and, therefore, climate change mitigation. Objective: The study estimated carbon storage in aboveground biomass, necromass and soil organic carbon under SAF with cocoa (SAF cocoa), SAF with coffee (SAF coffee), silvopastoral systems (SPS) and forest in Mesetas, Meta (Colombia). Methods: Forty-four sampling plots were established, where dasometric measurements were taken from individuals with a trunk diameter at breast height (dbh) ≥ 2.5 cm (saplings, trees and large trees), whose values were transformed to carbon with biomass models and a default carbon fraction. In the three agricultural systems, the number of cocoa and coffee trees and associated plants was counted, and the type of use (timber, food, combustion) was identified. Results: Carbon storage showed significant differences (P < 0.0001) among land uses. The highest accumulation was found in forest, with 216.6 t C ha-1, exceeding in 59, 72 and 73 % to SAF cocoa, SSP and SAF coffee, respectively. The botanical families Fabaceae, Lauraceae and Primulaceae presented the greatest carbon storage. In SAF cocoa, the greatest accumulation of carbon was found in species for human food; in SAF coffee and SSP, the greatest storage was presented by timber species. Conclusion: These results highlight the potential for carbon storage in the most important productive systems in the Meta department, which is important for designing strategies that allow for integrating actions to mitigate greenhouse gas emissions and to promote the local peasant economy.
Assuntos
Carbono/análise , Agricultura Florestal , Ciclo do Carbono/fisiologia , Colômbia , Gases de Efeito Estufa/análise , Indústria Agropecuária/análiseRESUMO
Liver cells respond to copper loading upregulating protective mechanisms. However, to date, except for liver content, there are no good indicators that identify individuals with excess liver copper. We hypothesized that administering high doses of copper to young (5.5 mg Cu · kg⻹ . d⻹) and adult (7.5 mg Cu · kg⻹ . d⻹) capuchin monkeys would induce detectable liver damage. Study groups included adult monkeys (2 females, 2 males) 3-3.5 y old at enrollment treated with copper for 36 mo (ACu); age-matched controls (1 female, 3 males) that did not receive additional copper (AC); young monkeys (2 female, 2 males) treated from birth with copper for 36 mo (YCu); and young age-matched controls (2 female, 2 males) that did not receive additional copper (YC). We periodically assessed clinical, blood biochemical, and liver histological indicators and at 36 mo the hepatic mRNA abundance of MT2a, APP, DMT1, CTR1, HGF, TGFß, and NFκΒ only in adult monkeys. After 36 mo, the liver copper concentration was 4-5 times greater in treated monkeys relative to controls. All monkeys remained healthy with normal routine serum biochemical indices and there was no evidence of liver tissue damage. Relative mRNA abundance of HGF, TGFß and NFκB was significantly greater in ACu than in AC monkeys. In conclusion, capuchin monkeys exposed to copper at doses up to 50 times the current upper level enhanced expression of genes related to inflammation and injury without clinical, blood biochemical, or histological evidence of liver damage.
Assuntos
Doença Hepática Induzida por Substâncias e Drogas/patologia , Gluconatos/administração & dosagem , Gluconatos/toxicidade , Fígado/metabolismo , Transcrição Gênica/fisiologia , Administração Oral , Envelhecimento , Animais , Biomarcadores/metabolismo , Cebus , Relação Dose-Resposta a Droga , Feminino , Gluconatos/análise , Cabelo/química , Fígado/citologia , Fígado/efeitos dos fármacos , Testes de Função Hepática , Masculino , Modelos Animais , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , Transcrição Gênica/efeitos dos fármacosRESUMO
Hurricanes have increased in strength and frequency as a result of global climate change. This research was conducted to study the spatio-temporal distribution and changes of Thalassia testudinum, the dominant species in Bahia de la Ascension (Quintana Roo, Mexico), when affected by heavy weather conditions. To complete this objective, a 2001 Landsat ETM+ image and the information from 525 sampling stations on morpho-functional and coverage of T. testudinum were used, and the seeds generated for the classification of eight benthic habitats. To quantify the changes caused by two hurricanes, we used two images, one of 1988 (Gilberto) and another of 1995 (Roxanne); other three data sets (2003, 2005 and 2007) were also used to describe the study area without major weather effects. Six categorial maps were obtained and subjected to analysis by 8 Landscape Ecology indexes, that describe the spatial characteristics, structure, function, change of the elements (matrix-patch-corridor), effects on ecosystems, connectivity, edges, shape and patch habitat fragmentation. Models indicate that T. testudinum may be classified as a continuum (matrix), since the fragments were not observed intermittently, but as a progression from minimum to maximum areas in reference to their coverage (ecological corridors). The fragments do not have a regular shape, indicating that the impacts are recent and may be due to direct effects (high-intensity hurricanes) or indirect (sediment). Fragments of type "bare soils" have a discontinuous distribution, and are considered to be the sites that have remained stable over a long timescale. While more dense coverage areas ("beds", "medium prairie" and "prairie") have low fragmentation and high connection of fragments. Features have an irregular perimeter and radial growth of formal; suggesting that the impact of meteors has no effect on the resilience of T. testudinum in this ecosystem, indicating good environmental quality to grow in this bay.
Assuntos
Tempestades Ciclônicas , Ecossistema , Monitoramento Ambiental/métodos , Hydrocharitaceae/crescimento & desenvolvimento , Região do Caribe , México , Densidade DemográficaRESUMO
Hurricane impact on Thalassia testudinum (Hydrocharitaceae) beds in the Mexican Caribbean. Hurricanes have increased in strength and frequency as a result of global climate change. This research was conducted to study the spatio-temporal distribution and changes of Thalassia testudinum, the dominant species in Bahia de la Ascension (Quintana Roo, Mexico), when affected by heavy weather conditions. To complete this objective, a 2001 Landsat ETM+ image and the information from 525 sampling stations on morpho-functional and coverage of T. testudinum were used, and the seeds generated for the classification of eight benthic habitats. To quantify the changes caused by two hurricanes, we used two images, one of 1988 (Gilberto) and another of 1995 (Roxanne); other three data sets (2003, 2005 and 2007) were also used to describe the study area without major weather effects. Six categorial maps were obtained and subjected to analysis by 8 Landscape Ecology indexes, that describe the spatial characteristics, structure, function, change of the elements (matrix-patch-corridor), effects on ecosystems, connectivity, edges, shape and patch habitat fragmentation. Models indicate that T. testudinum may be classified as a continuum (matrix), since the fragments were not observed intermittently, but as a progression from minimum to maximum areas in reference to their coverage (ecological corridors). The fragments do not have a regular shape, indicating that the impacts are recent and may be due to direct effects (high-intensity hurricanes) or indirect (sediment). Fragments of type "bare soils" have a discontinuous distribution, and are considered to be the sites that have remained stable over a long timescale. While more dense coverage areas ("beds", "medium prairie" and "prairie") have low fragmentation and high connection of fragments. Features have an irregular perimeter and radial growth of formal; suggesting that the impact of meteors has no effect on the resilience of T. testudinum in this ecosystem, indicating good environmental quality to grow in this bay. Rev. Biol. Trop. 59 (1): 385-401. Epub 2011 March 01.
Thalassia testudinum es la macrófita dominante en Bahía de la Ascensión (Quintana Roo, México), se estudió para conocer su distribución espacio- temporal y determinar si fue afectada por el paso de huracanes que se han visto incrementados en fuerza y frecuencia por el cambio climático. Partiendo de una imagen Landsat ETM+de 2001 y usando información de grandes grupos morfofuncionales y de cobertura de T. testudinum adquiridas en 525 estaciones de muestreo, se obtienen las semillas para la clasificación supervisada de los hábitats bénticos (8 clases). Con el fin de cuantificar los cambios ocasionados por dos huracanes, se usaron dos imágenes, una de 1988 (Gilberto) y 1995 (Roxanne) y tres más (2003, 2005 y 2007) para monitoreo sin efectos meteorológicos mayores; a estos 6 mapas categóricos se les aplicó un análisis de Ecología del Paisaje usando 8 índices que describen las características espaciales, de estructura, función, cambio de los elementos (matriz-mancha-corredor), efectos sobre el ecosistema, conectividad, bordes, forma del parche y fragmentación del hábitat. Los modelos indican que T. testudinum puede clasificarse como un continuo (matriz), pues los fragmentos no se observan de forma intermitente, sino como una progresión de zonas mínimas a máximas en referencia a su cobertura (corredores ecológicos). No poseen una forma regular, indicando que los impactos son recientes y pueden ser debidos a efectos directos (huracanes de alta intensidad) e indirectos (aporte de sedimentos). Los fragmentos de tipo "suelos desnudos" presentan una distribución discontinua, considerándose sitios que han permanecido estables en una larga escala de tiempo; las zonas con coberturas más densas ("camas", "praderas medias" y "praderas") presentan baja fragmentación y alta conexión de sus fragmentos. Las características de poseer un perímetro irregular y crecimiento de formal radial, sugieren que el impacto de los meteoros no tiene efecto en la capacidad de resiliencia de T. testudinum en este ecosistema, indicando el buen estado de la calidad ambiental de la bahía para su crecimiento.
Assuntos
Tempestades Ciclônicas , Ecossistema , Monitoramento Ambiental/métodos , Hydrocharitaceae/crescimento & desenvolvimento , Região do Caribe , México , Densidade DemográficaRESUMO
Prenatal undernutrition induces hypertension later in life, possibly by disturbing the hypothalamo-pituitary-adrenal axis through programming decreased expression of hypothalamic glucocorticoid receptors. We examined the systolic blood pressure, heart rate and plasma corticosterone response to intra-paraventricular dexamethasone, mifepristone and corticosterone in eutrophic and prenatally undernourished young rats. Undernutrition was induced during fetal life by restricting the diet of pregnant mothers to 10 g daily (40% of diet consumed by well-nourished controls). At day 40 of postnatal life (i) intra-paraventricular administration of dexamethasone significantly reduced at least for 24h both the systolic pressure (-11.6%), the heart rate (-20.8%) and the plasma corticosterone (-40.0%) in normal animals, while producing lower effects (-5.5, -8.7, and -22.3%, respectively) on undernourished rats; (ii) intra-paraventricular administration of the antiglucocorticoid receptor ligand mifepristone to normal rats produced opposite effects (8.2, 20.3, and 48.0% increase, respectively) to those induced by dexamethasone, being these not significant in undernourished animals; (iii) intra-paraventricular corticosterone did not exert any significant effect. Results suggest that the low sensitivity of paraventricular neurons to glucocorticoid receptor ligands observed in prenatally undernourished rats could be due to the already reported glucocorticoid receptor expression, found in the hypothalamus of undernourished animals.
Assuntos
Hipertensão/etiologia , Hipotálamo/metabolismo , Desnutrição/complicações , Fenômenos Fisiológicos da Nutrição Pré-Natal/fisiologia , Receptores de Glucocorticoides/metabolismo , Animais , Área Sob a Curva , Corticosterona/sangue , Feminino , Frequência Cardíaca/fisiologia , Hipertensão/metabolismo , Hipertensão/fisiopatologia , Sistema Hipotálamo-Hipofisário/metabolismo , Sistema Hipotálamo-Hipofisário/fisiopatologia , Hipotálamo/fisiopatologia , Masculino , Desnutrição/metabolismo , Desnutrição/fisiopatologia , Neurônios/metabolismo , Sistema Hipófise-Suprarrenal/metabolismo , Sistema Hipófise-Suprarrenal/fisiopatologia , Gravidez , Ratos , Ratos WistarRESUMO
beta-Adrenergic receptor stimulation can significantly facilitate synaptic potentiation in the hippocampus and enhance memory processes, but its effect on neocortical plastic mechanisms is less conclusive. In the present study we determined the effect of propranolol, a beta-adrenoceptor antagonist, on long-term potentiation (LTP) induced in vivo in rat occipital cortex by tetanizing stimulation of corpus callosum and observed a dose-dependent inhibition of LTP. We further administered propranolol through mini-osmotic pumps during 3 days, and observed the performance of rats in a complex operant conditioning learning paradigm and assessed the expression of brain-derived neurotrophic factor (BDNF) in the occipital cortex. Propranolol exposure depressed both the number of reinforced responses in the operant conditioning task and BDNF expression in occipital cortex. Taken together, our results suggest that propranolol impairs memory formation by inhibiting cortical LTP induction and associated BDNF expression.
Assuntos
Regulação da Expressão Gênica/fisiologia , Neocórtex/fisiologia , Plasticidade Neuronal/fisiologia , Receptores Adrenérgicos beta/metabolismo , Antagonistas Adrenérgicos beta/farmacologia , Análise de Variância , Animais , Fator Neurotrófico Derivado do Encéfalo/administração & dosagem , Fator Neurotrófico Derivado do Encéfalo/metabolismo , Condicionamento Operante/fisiologia , Corpo Caloso/fisiologia , Relação Dose-Resposta a Droga , Estimulação Elétrica/métodos , Regulação da Expressão Gênica/efeitos dos fármacos , Potenciação de Longa Duração/efeitos dos fármacos , Potenciação de Longa Duração/fisiologia , Masculino , Neocórtex/efeitos dos fármacos , Plasticidade Neuronal/efeitos dos fármacos , Propranolol/farmacologia , Ratos , Ratos Sprague-Dawley , Fatores de TempoRESUMO
Classic copper indicators are not sensitive and specific for detecting excess copper exposure when this is higher than customary but not markedly elevated. Serum copper and ceruloplasmin (Cp) are the most commonly used indicators to assess nutritional status of copper. The objective of this paper was to study the influence of estrogens on these indicators and others used to assess early effects of excess copper exposure in humans and the expression of a set of copper related proteins in a hepatic cellular model. For the studies in humans, 107 healthy participants (18-50 years) were allocated as follows: group 1 (n = 39), women assessed on day 7 of their hormonal cycle; group 2 (n = 34), women assessed on day 21 of their hormonal cycle, and group 3 (n = 34, comparison group), healthy men. Participants received 8 mg Cu/day (as copper sulfate) during 6 months. Serum Cp and Cu, Cu-Zn-superoxide dismutase activity, liver function indicators [aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma glutamyltransferase (GGT)], and serum Fe and Zn concentrations were measured monthly. In addition, the influence of estradiol on intracellular total copper content, hctr1, dmt1 and shbg mRNA abundance and hCTR1, and DMT1 expression was measured in HepG2 cells. Serum Cu, Fe, and Zn and liver aminotransferases but not Cu-Zn-superoxide dismutase varied depending on sex. Fe nutrition indicators, GGT, and ALT activities showed significant differences between the hormonal phases. Cellular experiments showed that estradiol increased cellular Cu concentration and hCTR1 and DMT1 mRNA expression and changed these proteins expression patterns. Estradiols significantly influence the responses to copper at the whole body and the cellular levels, suggesting that they help maintaining copper availability for metabolic needs.