Clinical and prognostic significance of serum transforming growth factor-beta1 levels in patients with pancreatic ductal adenocarcinoma

Pancreatic ductal adenocarcinoma (PDAC) has a poor 5-year survival rate of 5%. Biomarkers for the early detection of pancreatic cancer are urgently needed. Transforming growth factor-beta1 (TGF-β1) is elevated in the tissues and plasma of patients with PDAC. However, no studies systemically report prognostic significance of plasma TGF-β1 levels in PDAC. In the present study, we assessed the prognostic significance of serum TGF-β levels in patients with PDAC. TGF-β levels were determined in serum from 146 PDAC patients, and 58 patients with benign pancreatic conditions. Regression models were used to correlate TGF-β levels to gender, age, stage, class, and metastasis. Survival analyses were performed using multivariate Cox models. Serum levels of TGF-β1 distinguished PDAC from benign pancreatic conditions (P<0.001) and healthy control subjects (P<0.001). Serum levels of TGF-β also distinguished tumor stage (P=0.002) and lymph node metastasis (P=0.001). High serum levels of TGF-β1 were significantly correlated with reduced patient survival. Multivariate analysis revealed that TGF-β1, lymph node metastasis and tumor stage were independent factors for PDAC survival. Our results indicate that serum TGF-β1 may be used as a potential prognostic marker for PDAC.

Resultados hospitalares da intervenção coronária percutânea primária no infarto agudo do miocárdio em pacientes com mais de 80 anos / In-hospital results of primary percutaneous coronary intervention in patients above 80 years of age

INTRODUÇÃO: O aumento da expectativa de vida da população e o risco de sangramento com o uso de trombolíticos têm permitido que pacientes casa vez mais idosos com infarto agudo do miocárdio sejam tratados pela intervenção coronária percutânea (ICP) primária. Analisamos os resultados hospitalares da ICP primária em pacientes com idade >ou igual a 80 anos. Métodos: No período de janeiro de 2002 a outubro de 2008, foram realizadas 4.788 ICPs, sendo 428 ICPs primárias. Destas, 34 foram em pacientes com idade > igual a 80 anos. Resultados: O sexo feminino (47,1 por cento vs. 27,7 por cento = 0,017), a classe funcional Killip IV (11,8 por cento vs. 4,1; P = 0,002) e o fluxo coronário TIMI 2/3 pré-ICP (60 por cento vs. 44,4 por cento; P = 0,032) foram mais frequentes nos idosos. Tabagismo (44,9 por cento vs. 8 por cento; P = 0,001)e uso de inibidores...

BACKGROUND: Improvements in life expectancy of the overall population and the risk of bleeding with thrombolytics have enabled very elderly patients with acute myocardial infarction to be treated by primary percutaneous coronary intervention (PCI). We analyzed the primary PCI in-hospital results in patients > 80 years of age. METHOD: From January 2002 to October 2008, 4,788 PCIs were performed, of which 428 were primary PCIs. Of these, 34 were performed in patients > 80 years of age and 394 in patients < 80 years of age. RESULTS: Females (47.1% vs. 27.7%; P = 0.017), Killip IV functional class (11.8% vs. 4.1%; P = 0.002) and pre-procedure TIMI 2/3 flow (60% vs. 44.4%; P = 0.032) were more frequent in elderly patients. Smoking (44.9% vs. 8%; P < 0.001) and use of glycoprotein IIb/IIIa inhibitors (32.5% vs. 11.7%; P = 0.04) were prevalent in the group < 80 years of age. There were no significant differences for door-to-balloon time (117.4 ± 125.7 minutes vs. 179.3 ± 169.8 minutes; P = 0.095), use of stents (91.2% vs. 98.2%; P = 0.78), or drug-eluting stents (0 vs. 2.8%; P = 0.067) and thrombus aspiration devices (11.7% vs. 12.2%; P = 0.65). Angiographic success rate was equal between the groups (97.1% vs. 96.5%; P > 0.99), but patients > 80 years old had a higher mortality rate (11.8% vs. 2.3%; P = 0.014). Reinfarction, stroke, major vascular complications and acute renal failure were similar between groups. CONCLUSION: PCI usually presents high angiographic success and low complication rates, reinforcing its role as a method of choice for reperfusion in the acute phase of myocardial infarction. Very elderly patients (> 80 years of age) have higher mortality rates, possibly due to the greater comorbidity in this group.