864 resultados para remission and recurrent


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Tumor response to antineoplastic drugs is not always predictable. This is also true for bladder carcinoma, a highly recurrent neoplasia. Currently, the combination of cisplatin and gemcitabine is well accepted as a standard protocol for treating bladder carcinoma. However, in some cases, this treatment protocol causes harmful side effects. Therefore, we investigated the roles of the genes TP53, RASSF1A (a tumor suppressor gene) and hMLH1 (a gene involved in the mismatch repair pathway) in cell susceptibility to cisplatin/gemcitabine treatment. Two bladder transitional carcinoma cell (TCC) lines, RT4 (wild-type TP53) and 5637 (mutated TP53), were used in this study. First, we evaluated whether the genotoxic potential of cisplatin/gemcitabine was dependent on TP53 status. Then, we evaluated whether the two antineoplastic drugs modulated RASSF1A and hMLH1 expression in the two cell lines. Increased DNA damage was observed in both cell lines after treatment with cisplatin or gemcitabine and with the two drugs simultaneously, as depicted by the comet assay. A lack of RASSF1A expression and hypermethylation of its promoter were observed before and after treatment in both cell lines. On the other hand, hMLH1 downregulation, unrelated to methylation status, was observed in RT4 cells after treatment with cisplatin or with cisplatin and gemcitabine simultaneously (wild-type TP53); in 5637 cells, hMLH1 was upregulated only after treatment with gemcitabine. In conclusion, the three treatment protocols were genotoxic, independent of TP53 status. However, cisplatin was the most effective, causing the highest level of DNA damage in both wild-type and mutated TP53 cells. Gemcitabine was the least genotoxic agent in both cell lines. Furthermore, no relationship was observed between the amount of DNA damage and the level of hMLH1 and RASSF1A expression. Therefore, other alternative pathways might be involved in cisplatin and gemcitabine genotoxicity in these two bladder cancer cell lines.

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Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

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Brazilian Campos grasslands are ecosystems under high frequency of disturbance by grazing and fires. Absence of such disturbances may lead to shrub encroachment and loss of plant diversity. Vegetation regeneration after disturbance in these grasslands occurs mostly by resprouting from belowground structures. We analyzed the importance of bud bank and belowground bud bearing organs in Campos grasslands. We hypothesize that the longer the intervals between disturbances are, the smaller the size of the bud bank is. Additionally, diversity and frequency of belowground organs should also decrease in areas without disturbance for many years. We sampled 20 soil cores from areas under different types of disturbance: grazed, exclusion from disturbance for two, six, 15 and 30 years. Belowground biomass was sorted for different growth forms and types of bud bearing organs. We found a decrease in bud bank size with longer disturbance intervals. Forbs showed the most drastic decrease in bud bank size in the absence of disturbance, which indicates that they are very sensitive to changes in disturbance regimes. Xylopodia (woody gemmiferous belowground organs with hypocotyl-root origin) were typical for areas under influence of recurrent fires. The diversity of belowground bud bearing structures decreased in the absence of disturbance. Longer intervals between disturbance events, resulting in decrease of bud bank size and heterogeneity of belowground organs may lead to the decline and even disappearance of species that relay on resprouting from the bud bank upon disturbance. (C) 2014 Elsevier GmbH. All rights reserved.

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A 35-year-old African Brazilian patient had sickle cell anemia complicated with recurrent vasoocclusive (VOC) crises and refractory painful leg ulcers for 16 years. The ulcers started over both medial malleoli and expanded gradually. The ulcer on the left leg spread from the foot to the knee circumferentially and was refractory to all forms of therapy within the frame work of multi-disciplinary care. The patient agreed to a below the knee amputation of the left leg. He felt much better after the amputation but developed severe neuropathic phantom pain that was well controlled medically. He could differentiate the sickle cell anemia and ulcer pain from the neuropathic pain. About 6 months after the amputation he had dengue fever with fatal outcome. This is the first report of treatment of refractory sickle cell anemia leg ulcer with amputation and probably the first report of a Brazilian patient with sickle cell anemia and dengue fever.

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Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

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Hepatic encephalopathy (HE) is a cognitive disturbance characterized by neuropsychiatric alterations. It occurs in acute and chronic hepatic disease and also in patients with portosystemic shunts. The presence of these portosystemic shunts allows the passage of nitrogenous substances from the intestines through systemic veins without liver depuration. Therefore, the embolization of these shunts has been performed to control HE manifestations, but the presence of portal vein thrombosis is considered a contraindication. In this presentation we show a cirrhotic patient with severe HE and portal vein thrombosis who was submitted to embolization of a large portosystemic shunt. Case report: a 57 years-old cirrhotic patient who had been hospitalized many times for persistent HE and hepatic coma, even without precipitant factors. She had a wide portosystemic shunt and also portal vein thrombosis. The abdominal angiography confirmed the splenorenal shunt and showed other shunts. The larger shunt was embolized through placement of microcoils, and the patient had no recurrence of overt HE. There was a little increase of esophageal and gastric varices, but no endoscopic treatment was needed. Since portosystemic shunts are frequent causes of recurrent HE in cirrhotic patients, portal vein thrombosis should be considered a relative contraindication to perform a shunt embolization. However, in particular cases with many shunts and severe HE, we found that one of these shunts can be safely embolized and this procedure can be sufficient to obtain a good HE recovery. In conclusion, we reported a case of persistent HE due to a wide portosystemic shunt associated with portal vein thrombosis. As the patient had other shunts, she was successfully treated by embolization of the larger shunt. (C) 2014 Baishideng Publishing Group Inc. All rights reserved.

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Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

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The ambivalent image of the sea is recurrent in Bojunga Nunes’s work. It receives a lot of symbolic meanings in her production, being sometimes a positive and sometimes a negative element. Thus, the sea is used in a utopic way, as a place for pleasure and leisure, and in a dystopic way, as scenery of a rite of passage, which includes the pain and suffering, part of the rite of passage that characterizes the bildungsromans. So, if in some texts the sea assumes a utopic character, being a place of snuggle, security, the ideal to reach, in others it is represented as dystopic, a place of distress, asphyxia and death. In this text we will study the hypothesis that, even in its dark symbolic meaning, in the author’s work the sea is an element of reflection and revelation. Thereby, it assumes metaphorically a sense of magnification of the reader’s expectative, being an element of emancipation. The objective of this text is to present a reflection on the sea’s symbolism on the mentioned texts and its importance for the reader’s formation.

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Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)