58 research outputs found
Quimioterapia Primária em Carcinoma Avançado de Cabeça e Pescoço
Os autores relatam os resultados de um estudo piloto de quimioterapia primária com associação de Cisplatina e Bieomicina ambulatĂłrial no câncer avançado de cabeça e pescoço. ApĂłs 2 ciclos de quimioterapia, os pacientes foram encaminhados para radioterapia. Dos 46 pacientes que receberam inicialmente a quimioterapia, 34,7% tiveram resposta objetiva, com sobrevida estatisticamente maior em relação aos que nĂŁo responderam, mediana de 28 e 13 meses respectivamente (p = 0,0031). ApĂłs a radioterapia a taxa de resposta objetiva subiu para 63,6% com sobrevida mediana de 28 meses para os que responderam e de 8 meses para os que nĂŁo responderam (p = 0,027). A conclusĂŁo foi de que os carcinomas epidermĂłides da cabeça e pescoço sĂŁo tumores sensĂveis Ă quimioterapia como tratamento primário, justificando-se estudos prospectivos e randomizados
ResistĂŞncia a mĂşltiplas drogas: um problema da clĂnica oncolĂłgica com solução na pesquisa básica
A resistĂŞncia que as cĂ©lulas neoplásicas apresentam aos agentes quimioterápicos sempre Ă© um grande problema para o oncologista clĂnico. A descoberta da glicoproteĂna (170 Pgp) responsável pela resistĂŞncia a mĂşltiplas drogas (MDR) abriu novas perspectivas de se superar este difĂcil tipo de resistĂŞncia. Neste trabalho, apresentamos uma retrospectiva do trabalho de pesquisa realizado atĂ© a definição do modelo que hoje rege os trabalhos clĂnicos no emprego de agentes reversores da MDR
Dissecção da Axila no Tratamento do Câncer de Mama
A dissecção da axila no tratamento do câncer da mama tem sido questionada quanto aos seus objetivos. No passado prĂłximo a intenção era curativa: presentemente tem sido indicada principalmente para oferecer informação de extensĂŁo da doença (comprometimento de linfonodos por tumor) e tratamentos complementares, principalmente a quimioterapia adjuvante. Apenas alguns subgrupos de mulheres tĂŞm-se beneficiado realmente da quimioterapia adjuvante: as prĂ©-meno-pausadas com linfonodos axilares comprometidos com tumor. Uma vez decidida a dissecção axilar, ainda resta a questĂŁo de saber se deve ser radical, ou limitada a nĂveis I e II (atĂ© mĂşsculo peitoral menor). Muitos centros importantes de câncer indicam a dissecção limitada da axila, que em mĂ©dia retira cerca de 10 linfonodos, alegando que desta forma nĂŁo há risco de edema importante do braço e conseguem boa informação prognĂłstica e bom controle tumoral da axila. Aqueles que indicam a dissecção radical alegam que esta Ă© a Ăşnica forma de se obter informação real da situação axilar. Algumas pacientes podem ter linfonodos livres de tumor na parte baixa da axila, mas com tumor no ápice axilar ("skip metastasis") e a Ăşnica forma de descobri-lo seria atravĂ©s da dissecção radical. Como a dissecção radical da axila pode causar edema do braço, Ă© importante questionara real indicação da mesma. Pacientes em pĂłs-menopausa e com axila clinicamente negativa talvez pudessem ter a alternativa de nĂŁo dissecara axila de forma radical (e com isso nĂŁo correr o risco de edema do braço), sem aumentara chance de falha de tratamento. O presente artigo discute o problema da dissecção da axila no tratamento do câncer da mama e mostra dados de 148 pacientes que fizeram tratamento conservador no Centro de Oncologia Campinas, metade das quais sem dissecção da axila
Organização da assistência oncológica terciária no Estado de São Paulo: Onco-Rede
Uma ação de caráter gerencial realizada no Estado de São Paulo foi a criação da Onco-Rede (Decreto Estadual nº 32.848, em 23 de janeiro de 1991), com o objetivo de servir de instrumento para identificar e constituir formalmente uma rede de hospitais que atuasse nesta especialidade e, desta forma, facilitar e orientar a qualificação da assistência oncológica
Sloan Digital Sky Survey IV: mapping the Milky Way, nearby galaxies, and the distant universe
We describe the Sloan Digital Sky Survey IV (SDSS-IV), a project encompassing three major spectroscopic programs. The Apache Point Observatory Galactic Evolution Experiment 2 (APOGEE-2) is observing hundreds of thousands of Milky Way stars at high resolution and high signal-to-noise ratios in the near-infrared. The Mapping Nearby Galaxies at Apache Point Observatory (MaNGA) survey is obtaining spatially resolved spectroscopy for thousands of nearby galaxies (median ). The extended Baryon Oscillation Spectroscopic Survey (eBOSS) is mapping the galaxy, quasar, and neutral gas distributions between and 3.5 to constrain cosmology using baryon acoustic oscillations, redshift space distortions, and the shape of the power spectrum. Within eBOSS, we are conducting two major subprograms: the SPectroscopic IDentification of eROSITA Sources (SPIDERS), investigating X-ray AGNs and galaxies in X-ray clusters, and the Time Domain Spectroscopic Survey (TDSS), obtaining spectra of variable sources. All programs use the 2.5 m Sloan Foundation Telescope at the Apache Point Observatory; observations there began in Summer 2014. APOGEE-2 also operates a second near-infrared spectrograph at the 2.5 m du Pont Telescope at Las Campanas Observatory, with observations beginning in early 2017. Observations at both facilities are scheduled to continue through 2020. In keeping with previous SDSS policy, SDSS-IV provides regularly scheduled public data releases; the first one, Data Release 13, was made available in 2016 July
Sloan Digital Sky Survey IV : mapping the Milky Way, nearby galaxies, and the distant universe
We describe the Sloan Digital Sky Survey IV (SDSS-IV), a project encompassing three major spectroscopic programs. The Apache Point Observatory Galactic Evolution Experiment 2 (APOGEE-2) is observing hundreds of thousands of Milky Way stars at high resolution and high signal-to-noise ratios in the near-infrared. The Mapping Nearby Galaxies at Apache Point Observatory (MaNGA) survey is obtaining spatially resolved spectroscopy for thousands of nearby galaxies (median z ~ 0.03). The extended Baryon Oscillation Spectroscopic Survey (eBOSS) is mapping the galaxy, quasar, and neutral gas distributions between z ~ 0.6 and 3.5 to constrain cosmology using baryon acoustic oscillations, redshift space distortions, and the shape of the power spectrum. Within eBOSS, we are conducting two major subprograms: the SPectroscopic IDentification of eROSITA Sources (SPIDERS), investigating X-ray AGNs and galaxies in X-ray clusters, and the Time Domain Spectroscopic Survey (TDSS), obtaining spectra of variable sources. All programs use the 2.5 m Sloan Foundation Telescope at the Apache Point Observatory; observations there began in Summer 2014. APOGEE-2 also operates a second near-infrared spectrograph at the 2.5 m du Pont Telescope at Las Campanas Observatory, with observations beginning in early 2017. Observations at both facilities are scheduled to continue through 2020. In keeping with previous SDSS policy, SDSS-IV provides regularly scheduled public data releases; the first one, Data Release 13, was made available in 2016 July
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Sloan Digital Sky Survey IV: Mapping the Milky Way, Nearby Galaxies, and the Distant Universe
We describe the Sloan Digital Sky Survey IV (SDSS-IV), a project encompassing
three major spectroscopic programs. The Apache Point Observatory Galactic
Evolution Experiment 2 (APOGEE-2) is observing hundreds of thousands of Milky
Way stars at high resolution and high signal-to-noise ratio in the
near-infrared. The Mapping Nearby Galaxies at Apache Point Observatory (MaNGA)
survey is obtaining spatially-resolved spectroscopy for thousands of nearby
galaxies (median redshift of z = 0.03). The extended Baryon Oscillation
Spectroscopic Survey (eBOSS) is mapping the galaxy, quasar, and neutral gas
distributions between redshifts z = 0.6 and 3.5 to constrain cosmology using
baryon acoustic oscillations, redshift space distortions, and the shape of the
power spectrum. Within eBOSS, we are conducting two major subprograms: the
SPectroscopic IDentification of eROSITA Sources (SPIDERS), investigating X-ray
AGN and galaxies in X-ray clusters, and the Time Domain Spectroscopic Survey
(TDSS), obtaining spectra of variable sources. All programs use the 2.5-meter
Sloan Foundation Telescope at Apache Point Observatory; observations there
began in Summer 2014. APOGEE-2 also operates a second near-infrared
spectrograph at the 2.5-meter du Pont Telescope at Las Campanas Observatory,
with observations beginning in early 2017. Observations at both facilities are
scheduled to continue through 2020. In keeping with previous SDSS policy,
SDSS-IV provides regularly scheduled public data releases; the first one, Data
Release 13, was made available in July 2016
Canagliflozin and renal outcomes in type 2 diabetes and nephropathy
BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years
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