Evaluation of nuclear NF-κB, transglutaminase2, and ERCC1 as predictors of platinum resistance in testicular tumors

ABSTRACT Purpose: Testicular germ cells tumor (TGCT) are associated with a high cure rate and are treated with platinum-based chemotherapy. However, a group of testicular cancer patients may have a very unfavorable evolution and insensitivity to the main therapeutic agent chemotherapy (CT) cisplatin. The aim of this study was to evaluate the risk of recurrence and overall survival related to the expression of nuclear factor kappa-B (NF-κB), transglutaminase 2 (TG2) and excision repair cross-complementation group 1 (ERCC1) in patients with TGCT treated with platinum combinations. Patients and Methods: A retrospective study was performed with TGCT patients treated with platinum-based chemotherapy. Immunohistochemical analysis was performed and the expression was correlated with clinical and laboratory data. Results: Fifty patients were included, the mean age was 28.4 years (18 to 45), and 76% were non-seminoma. All patients were treated with standard cisplatin, etoposide and bleomycin or cisplatin, and etoposide. Patient's analyzed immunodetection for NF-κB, TG2, and ERCC1 were positive in 76%, 54% and 42%, respectively. Multivariate analysis identified that positive expressions to ERCC1 and NF-κB are independent risk factors for higher recurrence TGCT after chemotherapy (RR 2.96 and 3.16, respectively). Patients with positive expression of ERCC1 presented a poor overall survival rate for 10-year follow (p=0.001). Conclusions: The expression of ERCC1 and NF-κB give a worse prognosis for relapse, and only ERCC1 had an influence on the overall survival of TGCT patients treated with platinum-based chemotherapy. These may represent markers that predict poor clinical outcome and response to cisplatin.

Processo de perdas e morte em cuidados paliativos: paciente, família e equipe assistente / Loss and death in palliative care: patient, family and healthcare staff

Introdução: Os cuidados de pacientes cronicamente doentes, sem a perspectiva de terapias curativas, trazem consigo diversas perdas e sofrimentos. O desafio de enfrentar a terminalidade é debatido nesta revisão pelo ponto de vista do paciente, da família e da equipe assistente. O objetivo desta revisão narrativa é servir de reflexão sobre os conceitos bioéticos relacionados aos cuidados paliativos em oncologia. Métodos: Foi realizada uma revisão conceitual e narrativa da literatura nas bases de referências PubMed e SciELO, além de livros-texto referência na área de Cuidados Paliativos. Resultados: Foi realizado um sumário dos achados da literatura em relação a aspectos bioéticos relacionados a paliação; alterações do processo normal de luto; e a carga emocional e física da terminalidade no paciente, sua família e equipe assistente. Conclusão: Aceitar a condição de terminalidade é um desafio para todas as partes envolvidas no cuidado médico. Compreender os processos de luto e os sofrimentos como partes normais do cotidiano médico é fundamental para o enfrentamento da terminalidade de maneira saudável.

Introduction: The care of chronically ill patients brings different kinds of losses and suffering. The challenge of facing terminality is discussed from the point of view of the three main actors in these situations: patient, family and healthcare staff. The goals of this narrative review are: to be a reflection on the basic bioethical concepts of palliative care in the oncology setting; and to discuss the emotional and physical toll that the absence of curative treatments brings to the patient, to his family and to the staff that cares for him. Methods: Conceptual, narrative literature review using textbooks and databases PubMed and SciELO. Results: An overview of the literature is presented focusing on bioethical aspects of palliative care; disorders of the grieving process; and the emotional and physical toll of terminality on the patient, his family and healthcare staff. Conclusion: Accepting terminality is a challenge for all the actors involved with medical care. Understanding grief and suffering as normal and expected parts of the medical routine is fundamental for facing terminality in a healthy manner.

Translation and cross-cultural adaptation of the Sexual Function Questionnaire (SFQ) into Brazilian Portuguese / Tradução e adaptação transcultural do Questionário de Função Sexual (SFQ) para o português do Brasil

Abstract Introduction Sexual dysfunction is common in patients with psychotic illness. This article describes the translation and cross-cultural adaptation of the Sexual Function Questionnaire (SFQ) into Brazilian Portuguese. Methods The translation and cross-cultural adaptation followed the guidelines for adapting self-report instruments proposed by the Task Force of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Briefly, ISPOR steps include: preparation, forward translation, reconciliation, back-translation, back-translation review, harmonization, cognitive debriefing, review of cognitive debriefing and finalization, before proofreading and final version. The original authors authorized the translation and participated in the study. Results There was good agreement between translations and between the back-translation and the original English version of the SFQ. The final version was prepared with certificated evaluators in the original language and in Portuguese. Few changes were necessary to the new version in Portuguese. Conclusion The translated and adapted Brazilian Portuguese version of the SFQ is reliable and semantically equivalent to the original version. Studies on psychotropic-related sexual dysfunction may now test the validity of the instrument and can investigate sexual dysfunction in Portuguese-speaking patients.

Resumo Introdução A disfunção sexual é comum em pacientes com doença psicótica. Este artigo descreve a tradução e adaptação transcultural do Questionário de Função Sexual (SFQ) para o português do Brasil. Métodos A tradução e a adaptação transcultural seguiram as diretrizes para a adaptação de instrumentos de autorrelato propostas pela Força-Tarefa da Sociedade Internacional de Pesquisa Farmacológica e de Resultados (International Society for Pharmacoeconomics and Outcomes Research, ISPOR). As etapas da ISPOR incluem: preparação, primeiras traduções, reconciliação, retrotradução, revisão da retrotradução, harmonização, interrogatório cognitivo, revisão do interrogatório cognitivo e finalização, antes da revisão e versão final. Os autores originais autorizaram a tradução e participaram do estudo. Resultados Houve boa concordância entre as traduções e entre a retrotradução e a versão original em inglês do SFQ. A versão final foi preparada com avaliadores certificados na língua original e em português. Poucas mudanças foram necessárias para a nova versão em português. Conclusão A versão brasileira traduzida e adaptada do SFQ é confiável e semanticamente equivalente à versão original. Estudos sobre disfunção sexual relacionada a psicotrópicos podem agora testar a validade do instrumento e investigar a disfunção sexual em pacientes brasileiros.