Neoadjuvant radiochemotherapy in the treatment of fixed and semi-fixed rectal tumors. Analysis of results and prognostic factors

PURPOSE: To report the retrospective analysis of patients with locally advanced rectal cancer treated with neodjuvant radiochemotherapy. METHODS AND MATERIALS: From January 1994 to December 2003, 101 patients with fixed (25%) or semi-fixed (75%) rectal adenocarcinoma were treated by preoperative radiotherapy with a dose of 45Gy at the whole pelvis and 50.4Gy at primary tumor, concomitant to four weekly chemotherapies with 5-Fluorouracil (425 mg/m(2)) and Leucovorin (20 mg/m(2)). In 71 patients (70.3%) the primary tumor was located up to 6 cm from the anal verge and in 30 (29.7%) from 6.5 cm to 10 cm. Age, gender, tumor fixation, tumor distance from the anal verge, clinical response, surgical technique, and postoperative TNM stage were the prognostic factors analyzed for overall survival (OS), disease-free survival (DFS), and local control (LC) at five years. RESULTS: Median follow-up time was 38 months (range, 2–141). Complete response was observed in eight patients (7.9%), partial in 54 (53.4%) and absence in 39 (38.7%). OS, DFS and LC were 52.6%, 53.8%, and 75.9%, respectively. Distant metastasis occurred in 40 (39.6%) patients, local recurrence in 20 (19.8%) and both in 16 (15.8%). Patients with fixed tumors had lower OS (17% Vs 65.6%; p < 0.001), DFS (31.2% Vs 60.9%; p = 0.005), and LC (58% Vs 82%; p = 0.004). Patients with tumors more than 6 cm above the anal verge had better LC (93% Vs 69%; p = 0.04). The postoperative TNM stage was a significant factor for DFS (I:64.1%, II:69.6%, III:35.2%, IV:11.1%; p < 0.001) and for LC (I:75.7%, II: 92.9%, III:54.1%, IV:100%; p = 0.005). Patients with positive lymph nodes had worse OS (37.9% Vs 70.4%, p = 0.006), DFS (32% Vs 72.7%, p < 0.001) and LC (56.2% Vs 93.4%; p < 0.001). CONCLUSION: This study suggests that the neoadjuvant treatment employed was effective for local control. Fixation of the lesion and lymph nodes metastasis were the main adverse prognostic factors. Distant failures were frequent, supporting the need of new drugs for adjuvant chemotherapy

Distribuição espacial de ferro e manganês trocáveis em solos do pantanalSpatial distribution of iron and manganese exchangeable wetland soils

O ferro (Fe) e o manganês (Mn) trocáveis estão entre os elementos mais móveis na solução do solo em ambientes redutores. No Pantanal, há vários ambientes em que os solos apresentam condições redutoras sazonais ou permanentes relacionadas aos pulsos de inundação. Dentre as principais alterações que os pulsos de inundação causam nos solos, estão as mudanças nas condições de oxirredução. O Fe e o Mn estão entre os elementos mais suscetíveis a tais alterações, que influenciam diretamente a disponibilidade desses elementos para os ciclos biogeoquímicos. O objetivo deste trabalho foi estudar a variabilidade espacial dos teores de Fe e de Mn trocáveis em três áreas com superfícies geomórficas representativas da paisagemda sub-região do pantanal de Poconé (MT). Em cada área, foi delimitada uma parcela de 6.000 m2, subdividida em unidades amostrais de 10 x 10 m, onde foram realizadas coletas sistemáticas de 77 amostras de solos, nas profundidades de 0 a 20 cm e de 40 a 60 cm. Nas áreas ocorrem solos das classes: LuvissoloHáplicoem um paleodique (área 1) e Gleissolo Háplicoem duas paleoplanícies (áreas 2 e 3).Os resultados indicam grande variabilidade espacial dos teores de Fe e de Mn trocáveis e dos teores de argila. A dependência espacial dos teores de Fe e de Mn trocáveis foi considerada de alta a moderada, nas duas profundidades, evidenciando os efeitos intrínsecos causados pela posição que os solos ocupam na paisagem e a interação de fatores como a drenagem e o processo de oxirredução.Abstract Iron (Fe) and manganese (Mn) exchangeable are among the most mobile elements in soil solution in reducing environments. In Pantanal, there are several environments in which the soils have seasonal or permanent reducing conditions related to flood pulses. Among the major changes that flood pulses cause to soils are the redox conditions. Mn and Fe are among the most susceptible elements to such transformations that directly influence the availability of these elements to the biogeochemical cycles. Our objective was to study the spatial variability of the Fe and Mn exchangeable levels in three areas with geomorphic landscape surfaces representing the subregion wetland area known as Pantanal Poconé (MT). In each of the three areas it was delimited a plot of 6,000 m2, divided into sampling units of 10 m x 10 m, where systematic collection of 77 soil samples at depths 0-20 cm and 40-60 cm were performed. The classification of the soil classes in the three areas were: Haplic Luvisol in a paleodike (area 1) and Humic Haplicin two paleoplains (areas 2 and 3). The results indicate large spatial variability in the levels of Fe and Mn exchangeable and in the clay contents. The spatial dependence of the levels of Fe and Mn exchangeable was considered high to moderate at both depths, indicating the intrinsic effects caused by the position that soils occur in the landscape and in the interaction of factors such as drainage and redox process

Desmodus rotundus and Artibeus spp. bats might present distinct rabies virus lineages

In Brazil, bats have been assigned an increasing importance in public health as they are important rabies reservoirs. Phylogenetic studies have shown that rabies virus (RABV) strains from frugivorous bats Artibeus spp. are closely associated to those from the vampire bat Desmodus rotundus, but little is known about the molecular diversity of RABV in Artibeus spp. The N and G genes of RABV isolated from Artibeus spp. and cattle infected by D. rotundus were sequenced, and phylogenetic trees were constructed. The N gene nucleotides tree showed three clusters: one for D. rotundus and two for Artibeus spp. Regarding putative N amino acid-trees, two clusters were formed, one for D. rotundus and another for Artibeus spp. RABV G gene phylogeny supported the distinction between D. rotundus and Artibeus spp. strains. These results show the intricate host relationship of RABV's evolutionary history, and are invaluable for the determination of RABV infection sources. (C) 2012 Elsevier Editora Ltda. All rights reserved.CAPESCAPESCNPqCNP

Desmodus rotundus and Artibeus spp. bats might present distinct rabies virus lineages

In Brazil, bats have been assigned an increasing importance in public health as they are important rabies reservoirs. Phylogenetic studies have shown that rabies virus (RABV) strains from frugivorous bats Artibeus spp. are closely associated to those from the vampire bat Desmodus rotundus, but little is known about the molecular diversity of RABV in Artibeus spp. The N and G genes of RABV isolated from Artibeus spp. and cattle infected by D. rotundus were sequenced, and phylogenetic trees were constructed. The N gene nucleotides tree showed three clusters: one for D. rotundus and two for Artibeus spp. Regarding putative N amino acid-trees, two clusters were formed, one for D. rotundus and another for Artibeus spp. RABV G gene phylogeny supported the distinction between D. rotundus and Artibeus spp. strains. These results show the intricate host relationship of RABV's evolutionary history, and are invaluable for the determination of RABV infection sources

Desmodus rotundus and Artibeus spp. bats might present distinct rabies virus lineages

In Brazil, bats have been assigned an increasing importance in public health as they are important rabies reservoirs. Phylogenetic studies have shown that rabies virus (RABV) strains from frugivorous bats Artibeus spp. are closely associated to those from the vampire bat Desmodus rotundus, but little is known about the molecular diversity of RABV in Artibeus spp. The N and G genes of RABV isolated from Artibeus spp. and cattle infected by D. rotundus were sequenced, and phylogenetic trees were constructed. The N gene nucleotides tree showed three clusters: one for D. rotundus and two for Artibeus spp. Regarding putative N amino acid-trees, two clusters were formed, one for D. rotundus and another for Artibeus spp. RABV G gene phylogeny supported the distinction between D. rotundus and Artibeus spp. strains. These results show the intricate host relationship of RABV's evolutionary history, and are invaluable for the determination of RABV infection sources. (C) 2012 Elsevier Editora Ltda. All rights reserved.CAPESCAPESCNPqCNP

I Diretriz brasileira de cardio-oncologia pediátrica da Sociedade Brasileira de Cardiologia

Sociedade Brasileira de Oncologia PediátricaUniversidade Federal de São Paulo (UNIFESP) Instituto de Oncologia Pediátrica GRAACCUniversidade Federal de São Paulo (UNIFESP)Universidade de São Paulo Faculdade de Medicina Instituto do Coração do Hospital das ClínicasUniversidade Federal do Rio Grande do Sul Hospital de Clínicas de Porto AlegreInstituto Materno-Infantil de PernambucoHospital de Base de BrasíliaUniversidade de Pernambuco Hospital Universitário Oswaldo CruzHospital A.C. CamargoHospital do CoraçãoSociedade Brasileira de Cardiologia Departamento de Cardiopatias Congênitas e Cardiologia PediátricaInstituto Nacional de CâncerHospital Pequeno PríncipeSanta Casa de Misericórdia de São PauloInstituto do Câncer do Estado de São PauloUniversidade Federal de São Paulo (UNIFESP) Departamento de PatologiaHospital Infantil Joana de GusmãoUNIFESP, Instituto de Oncologia Pediátrica GRAACCUNIFESP, Depto. de PatologiaSciEL