ABSTRACT
Abstract Autophagy is an evolutionary process preserved in eukaryotes, which removes harmful components and maintains cell homeostasis in response to a variety of extracellular stimuli. It is involved in both physiological and pathological conditions, including cancer. The role of autophagy in the treatment of cancer is described as a "double-edged sword", which reflects its involvement in tumor suppression, survival and subsequent proliferation of tumor cells. Recent advances are useful for planning appropriate adjustments to inhibit or promote autophagy in order to obtain therapeutic efficacy in cancer patients. The objectives of this review are to clarify the role of autophagy in cancer and to highlight the need for more research in the field.
Resumen La autofagia es un proceso conservado evolutivamente en eucariotas que elimina componentes dañinos y mantiene la homeostasis celular en respuesta a una serie de estímulos extracelulares. Está implicada tanto en condiciones fisiológicas como patológicas, incluyendo el cáncer. El papel de la autofagia en el tratamiento del cáncer se describe como un "arma de doble filo", un término que refleja su participación en la supresión tumoral, la supervivencia y la proliferación de células tumorales. Los avances recientes ayudan a proyectar los ajustes apropiados en la inhibición o la promoción de la autofagia con el objetivo de conferir eficacia terapéutica en los pacientes con cáncer. Esta revisión tiene como objetivo aclarar los roles de la autofagia en el cáncer y destacar la necesidad de una mayor investigación en el campo.
ABSTRACT
Background:The incidence of bacteremia has increased over the last decade due to the aging of the population and the wide implementation of invasive nosocomial procedures and wide-spectrum antimicrobial treatments. Aim: To assess the epidemiology of hospital and ambulatory bacteremias in a public hospital in Santiago. Material and Methods: A prospective longitudinal cohort study of laboratory-confirmed adult patients with bacteremia was undertaken at a public hospital in Santiago, between June 1, 2007 and April 30, 2008. Demographic, clinical, and laboratory data was collected into a standardized study-specific form. Results: In the study period, 253 cases of true bacteremia were identified, with an incidence of 11 per 1,000 patient discharges (63.6% nosocomial, 36.7% fatal). Only 2/3 of the cohort was alive at day 28 of hospitalization. Variables associated with mortality were age with a hazard ratio (HR) of 2.31; (95% confidence intervals (CI) 1.42- 3.77); female gender (HR, 1.70; 95% CI 1.06- 2.71); shock (HR, 3.24; 95%CI 2.01-5.22); and C reactive protein (HR, 2.10; 95% CI 1.17- 3.78). The variable associated with lower mortality was surgery (HR, 0.43; 95% CI 0.25-0.75). Selective empiric treatment did not improve survival. Conclusions: Besides age and gender, survival can be influenced by modifiable variables such as presence of shock and surgical intervention, which may provide an opportunity to improve outcomes.