RESUMO
Hepatocellular carcinoma (HCC) is more frequently manifesting as one of the main complications of cirrhosis of the liver, its principal risk factor. There have been modifications in its incidence over the past decade, related to an epidemiologic transition in the etiology of cirrhosis, with a decrease in the prevalence of hepatitis C and an increase in nonalcoholic fatty liver disease (NAFLD) as a cause, as well as the development of HCC in the non-cirrhotic liver due to NAFLD. Genetic markers associated with the disease have been identified, and surveillance and diagnosis have improved. Regarding treatment, surgical techniques, in both resection and transplantation, have advanced and radiologic techniques, at the curative stage of the disease, have enhanced survival in those patients. And finally, there have been radical changes in the systemic approach, with much more optimistic expectations, when compared with the options available a decade ago. Therefore, the Asociación Mexicana de Hepatología decided to carry out the Second Mexican Consensus on Hepatocellular Carcinoma, which is an updated review of the available national and international evidence on the epidemiology, risk factors, surveillance, diagnosis, and treatment of the disease, to offer the Mexican physician current information on the different topics regarding hepatocellular carcinoma. In this second part of the document, the topics related to the treatment of HCC are presented.
Assuntos
Carcinoma Hepatocelular , Neoplasias Hepáticas , Hepatopatia Gordurosa não Alcoólica , Carcinoma Hepatocelular/diagnóstico , Carcinoma Hepatocelular/epidemiologia , Carcinoma Hepatocelular/etiologia , Consenso , Humanos , Cirrose Hepática/complicações , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/epidemiologia , Neoplasias Hepáticas/etiologia , Hepatopatia Gordurosa não Alcoólica/epidemiologiaRESUMO
Hepatocellular carcinoma (HCC) is more frequently manifesting as one of the main complications of cirrhosis of the liver, its principal risk factor. There have been modifications in its incidence over the past decade, related to an epidemiologic transition in the etiology of cirrhosis, with a decrease in the prevalence of hepatitis C and an increase in nonalcoholic fatty liver disease (NAFLD) as a cause, as well as the development of HCC in the non-cirrhotic liver due to NAFLD. Genetic markers associated with the disease have been identified, and surveillance and diagnosis have improved. Regarding treatment, surgical techniques, in both resection and transplantation, have advanced and radiologic techniques, at the curative stage of the disease, have enhanced survival in those patients. And finally, there have been radical changes in the systemic approach, with much more optimistic expectations, when compared with the options available a decade ago. Therefore, the Asociación Mexicana de Hepatología decided to carry out the Second Mexican Consensus on Hepatocellular Carcinoma, which is an updated review of the available national and international evidence on the epidemiology, risk factors, surveillance, diagnosis, and treatment of the disease, to offer the Mexican physician current information on the different topics regarding hepatocellular carcinoma. In this first part of the document, the topics related to epidemiology and diagnosis are presented.
Assuntos
Carcinoma Hepatocelular , Neoplasias Hepáticas , Hepatopatia Gordurosa não Alcoólica , Carcinoma Hepatocelular/diagnóstico , Carcinoma Hepatocelular/epidemiologia , Carcinoma Hepatocelular/etiologia , Consenso , Humanos , Cirrose Hepática/complicações , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/epidemiologia , Neoplasias Hepáticas/etiologia , Hepatopatia Gordurosa não Alcoólica/epidemiologiaRESUMO
The genus Lupinus is widely distributed. Its seeds are used for animal and human food, and Lupinus possesses pharmacological potential because of its high content of quinolizidine alkaloids and flavonoids; however, there is little available information about its genotoxicity. We used the comet assay and staminal nuclei of Tradescantia (clone 4430) to evaluate the in vitro genotoxicity of 4 concentrations (0.01, 0.1, 0.5, and 1.0 mM) of alkaloid extracts of Lupinus mexicanus and Lupinus montanus, flavonoids of L. mexicanus, and commercial sparteine; nitrosodiethylamine was used as a positive control and untreated nuclei were used as a negative control. All concentrations of L. mexicanus and L. montanus showed significant genotoxic activity (P ≤ 0.05). A similar behavior was observed for flavonoid extracts of L. montanus except the 1.0 mM concentration. Sparteine showed genotoxic activity only at 0.5 mM. The order of genotoxicity of the compounds studied was as follows: L. mexicanus > L. montanus > flavonoids of L. montanus > sparteine. There is evident genotoxic activity in the compounds that were studied, particularly at lower concentrations (0.01 and 0.1 mM). Given the limited information about the genotoxicity of the compounds of L. mexicanus and L. montanus, further studies are necessary.
Assuntos
Lupinus/química , Extratos Vegetais/farmacologia , Esparteína/farmacologia , Tradescantia/efeitos dos fármacos , Alcaloides/química , Alcaloides/genética , Alcaloides/farmacologia , Ensaio Cometa , Dano ao DNA/efeitos dos fármacos , Flavonoides/química , Flavonoides/genética , Flavonoides/farmacologia , Humanos , Extratos Vegetais/química , Extratos Vegetais/genética , Quinolizidinas/química , Sementes/química , Esparteína/efeitos adversos , Esparteína/química , Tradescantia/genéticaRESUMO
INTRODUCTION: In June 2012, the presence of a severe highly pathogenic avian influenza (HPAI) outbreak produced by an influenza type A, subtype H7N3 (A/H7N3) virus was reported in Mexico, which significantly affected the region of Los Altos de Jalisco, the most important table-egg production zone in Mexico. CASE PRESENTATION: To the best of our knowledge, this is the first report describing the occurrence of infection in wild endemic birds, and particularly in the great-tailed grackle (Quiscalus mexicanus), by an HPAI A/H7N3 orthomyxovirus, during the avian influenza epizootic, which occurred in June-October 2012, in the Los Altos region of Jalisco, Mexico, a highly significant poultry area. The great-tailed grackle population has increased significantly due to intense agricultural and livestock farming expansion throughout North and Central America and northern South America, in diverse ecological systems. The great-tailed grackle's infectious/epidemiological role is unknown, as is its role as the avian influenza virus reservoir and as disseminator of other infectious diseases. CONCLUSION: Because of the huge impact that avian influenza virus has on food production, on the economic activity of the affected areas and on the public health of animal and human populations, it is necessary to further investigate the significance of a wild population existing in the vicinity of industrial poultry farms and backyard poultry operations.
RESUMO
The intergeniculate leaflet (IGL) is classically known as the area of the Thalamic Lateral Geniculate Complex providing the suprachiasmatic nucleus (SCN) non-photic information. In the present study we investigated whether this information might be related to the metabolic state of the animal. The following groups of male Wistar rats were used for analysis of neuropeptide Y (NPY) and c-Fos in the IGL and SCN. (1) Fed ad libitum. (2) Fasted for 48 h. (3) Fasted for 48 h followed by refeeding for 3 h. (4) Monosodium glutamate-lesioned and 48 h fasted. (5) Electrolytic lesion in the IGL and 48 h fasted. The results were quantified by optical densitometry. Neuronal tracers were injected in two brain areas that receive metabolic information from the periphery, the arcuate nucleus (ARC) and Nucleus of the Tractus Solitarius to investigate whether there is an anatomical relationship with the IGL. Lesion studies showed the IGL, and not the ARC, as origin of most NPY projections to the SCN. Fasting induced important changes in the NPY expression in the IGL, coinciding with similar changes of NPY/glutamate decarboxylase projections of the IGL to the SCN. These changes revealed that the IGL is involved in the transmission of metabolic information to the SCN. In fasted animals IGL lesion resulted in a significant increase of c-Fos in the SCN as compared to intact fasted animals demonstrating the inhibitory influence of the IGL to the SCN in fasting conditions. When the animal after fasting was refed, an increase of c-Fos in the SCN indicated a removal of this inhibitory input. Together these observations show that in addition to increased inhibitory IGL input during fasting, the negative metabolic condition also results in increased excitatory input to the SCN via other pathways. Consequently the present observations show that at least part of the non-photic input to the SCN, arising from the IGL contains information about metabolic conditions.
Assuntos
Corpos Geniculados/metabolismo , Neuropeptídeo Y/metabolismo , Núcleo Supraquiasmático/metabolismo , Animais , Jejum/metabolismo , Masculino , Vias Neurais/metabolismo , Distribuição Aleatória , Ratos , Ratos WistarRESUMO
Sickle cell anemia is an affection that causes chronic inflammation, with consequences for vaso-occlusion, oxidative stress and cytokine production. Genetic polymorphisms in markers involved in this process can modulate the inflammatory response, including polymorphisms -308G/A of TNFA (tumor necrosis factor alpha) and -509C/T of TGFB1 (transforming growth factor beta 1), reported to increase TNF-α and TGF-ß1 production, respectively. Changes in the cytokine balance are important risk factors for clinical events; consequently, we examined the frequencies of these polymorphisms in 240 Brazilian sickle cell anemia patients from southeast Brazil. PCR-RFLP was used to detect these polymorphisms. The -509C/T (TGFB1) polymorphism was more frequent than -308G/A (TNFA), with allelic frequency of 0.3 for the mutant allele T (TGFB) agaist 0.1 for the mutant allele A (TNFA). These allelic frequencies are similar to those known from populations with ethnicity similar to the Brazilian population. Inheritance of these polymorphisms does not seem to be associated with that of the Hb S mutation; however, this information could be useful in analyses of specific clinical characteristics of sickle cell anemia.
Assuntos
Anemia Falciforme/genética , Fator de Crescimento Transformador beta1/genética , Fator de Necrose Tumoral alfa/genética , Brasil , Frequência do Gene , Predisposição Genética para Doença , Genótipo , Hemoglobina Falciforme/genética , Humanos , Polimorfismo de Fragmento de Restrição , Polimorfismo de Nucleotídeo Único , Fator de Crescimento Transformador beta1/biossíntese , Fator de Necrose Tumoral alfa/biossínteseRESUMO
Inflammatory myofibroblastic tumors are rare lesions that have been described in virtually every organ including the gastrointestinal tract. The esophagus is an extremely unusual site for these tumors, with only a few cases described in the literature. Surgery has been the most common therapeutic approach used for the resection of these lesions. In the present case, a patient diagnosed with an inflammatory myofibroblastic tumor of the upper esophagus was reported, and it was successfully removed by endoscopy with no complications.
Assuntos
Doenças do Esôfago/cirurgia , Esofagoscopia/métodos , Granuloma de Células Plasmáticas/cirurgia , Actinas/análise , Receptores de Activinas Tipo II/análise , Eletrocirurgia/instrumentação , Eletrocirurgia/métodos , Esofagoscópios , Feminino , Humanos , Linfócitos/patologia , Pessoa de Meia-Idade , Plasmócitos/patologia , Pólipos/cirurgiaRESUMO
OBJECTIVE: To compare the bleeding patterns, satisfaction and tolerability of 3 different contraceptive in an extended regimens in the service of Family Planning of the North Central Hospital of PEMEX. MATERIAL AND METHODS: Healthy, adult women with desire of contraception for one year (N 120) were randomly assigned to receive oral contraceptive drospirenone/ethinyl E2 (group1), the norelgestromin/ethinyl E2 transdermal patch (group 2) and vaginal ring etonogestrel/ ethinyl E2 (group 3) in an extended regimen (42 consecutive days, 1 hormone-free week). Study assessments were conducted at scheduled visits at the time of initial screening, at baseline after 1, 3, 6, and 12 months. Subjects recorded menstrual associated symptoms bleeding data and completed satisfaction questionnaires. Subjects and investigators provided overall assessments of the regimens. RESULTS: Extended use of 3 different contraceptive resulted in fewer bleeding days in every group (66.6%, 55% and 58.3% P 0.0024), and less mastalgia and menstrual pain. Subjects were highly satisfied with three regimens (93.3%, 96.6% and 91.6% P 0.00421). Although not mayor adverse events were reported with this regimen, there was an increase in spotting days; it decreased with each successive cycle of therapy. Efficacy and safety were similar to those reported for traditional cycle. CONCLUSION: Extended-contraceptive regimen delays menses and reduces bleeding, a profile that may be preferred by women who seek flexibility with their contraceptive method.
Assuntos
Androstenos/farmacologia , Anticoncepcionais Orais Combinados/farmacologia , Anticoncepcionais Orais Hormonais/farmacologia , Desogestrel/farmacologia , Etinilestradiol/farmacologia , Ciclo Menstrual/efeitos dos fármacos , Norgestrel/análogos & derivados , Administração Cutânea , Adolescente , Adulto , Androstenos/administração & dosagem , Androstenos/efeitos adversos , Doenças Mamárias/induzido quimicamente , Dispositivos Anticoncepcionais Femininos , Anticoncepcionais Orais Combinados/administração & dosagem , Anticoncepcionais Orais Combinados/efeitos adversos , Anticoncepcionais Orais Hormonais/administração & dosagem , Anticoncepcionais Orais Hormonais/efeitos adversos , Desogestrel/administração & dosagem , Desogestrel/efeitos adversos , Combinação de Medicamentos , Dismenorreia/prevenção & controle , Etinilestradiol/administração & dosagem , Etinilestradiol/efeitos adversos , Feminino , Cefaleia/induzido quimicamente , Humanos , Norgestrel/administração & dosagem , Norgestrel/efeitos adversos , Norgestrel/farmacologia , Aceitação pelo Paciente de Cuidados de Saúde , Estudos Prospectivos , Fatores de Tempo , Hemorragia Uterina/induzido quimicamente , Adulto JovemRESUMO
BACKGROUND: p63 gene is a p53 homologue that encodes proteins with transactivation, DNA-binding and tetramerisation domains. The isoforms TAp63 and TAp73 transactivate p53 target genes and induce apoptosis, whereas the isoforms DeltaNp63 and DeltaNp73 lack transactivation and might have dominant-negative effects in p53 family members. p63 is expressed in germinal centre lymphocytes and can be related to the development of the lymphoma, but the prognostic significance of its expression in the survival of patients with diffuse large B-cell lymphoma (DLBCL) remains unclear. AIMS: To determine whether quantitative immunohistochemical (IHC) analysis of p63 protein expression correlates with CD10 antigen, Bcl-6 antigen and IRF4 antigen expression and to determine whether p63 is a surrogate predictor of overall survival in high-intermediate and high risk DLBCL populations. METHODS: CD10, Bcl-6 and IRF4 expression were retrospectively evaluated by IHC in 73 samples of high-intermediate and high risk DLBCL and were used to divide the lymphomas into subgroups of germinal centre B-cell-like (GCB) and activate B-cell-like (ABC) DLBCL. Similarly, p63 expression was evaluated by IHC and the results were compared with subgroups of DLBCL origin and with the survival rates for these patients. RESULTS: p63 was expressed in more than 50% of malignant cells in 11 patients and did not show correlation with subgroups of GCB-like DLBCL or ABC-like DLBCL, but p63(+) patients had better disease-free survival (DFS) than those who were negative (p = 0.01). CONCLUSIONS: p63(+) high-intermediate and high risk DLBCL patients have a better DFS than negative cases.