Prótesis colónicas en el tratamiento paliativo del cáncer colónico. Nuestra evaluación tras 10 años de experiencia / Self-expanding metal stents in the palliative treatmentof coloncancer. Results of 10 years of experience

Introducción: la colocación de prótesis metálicas autoexpansibles (PAE) por vía endoscópica surge como opción terapéutica para la obstrucción colónica neoplásica en dos situaciones: como tratamiento paliativo y como puente a la cirugía curativa. Este procedimiento evita cirugías en dos tiempos y disminuye la probabilidad de colostomía definitiva y sus complicaciones con el consecuente deterioro de la calidad de vida. Objetivo: comunicar nuestra experiencia en la colocación de PAE para el tratamiento paliativo de la obstrucción colorrectal neoplásica. Diseño: retrospectivo, longitudinal, descriptivo y observacional. Material y métodos: se incluyeron todos los pacientes a quienes el mismo grupo de endoscopistas les colocó PAE con intención paliativa por cáncer colorrectal avanzado entre agosto de 2008 y diciembre de 2019. Fueron analizadas las variables demográficas y clínicas, el éxito técnico y clínico, las complicaciones tempranas y tardías y la supervivencia. Resultados: se colocó PAE en 54 pacientes. La media de edad fue 71 años. El 85% de las lesiones se localizó en el colon izquierdo. En el 57% de los pacientes se realizó en forma ambulatoria. El éxito técnico y clínico fue del 92 y 90%, respectivamente y la supervivencia media de 209 días. La tasa de complicaciones fue del 29,6%, incluyendo un 14,8% de obstrucción y un 5,6% de migración. La mortalidad tardía atribuible al procedimiento fue del 5,6%, ocasionada por 3 perforaciones tardías: 2 abiertas y 1 microperforación con formación de absceso localizado. Conclusiones: la colocación de PAE como tratamiento paliativo de la obstrucción neoplásica colónica es factible, eficaz y segura. Permitió el manejo ambulatorio o con internación breve y la realimentación temprana, mejorando las condiciones para afrontar un eventual tratamiento quimioterápico paliativo. Las mayoría de las complicaciones fueron tardías y resueltas endoscópicamente en forma ambulatoria. (AU)

Introduction: endoscopic placement of self-expanding metal stents (SEMS) emerges as a therapeutic option for neoplastic obstruction of the colon in two situations: as palliative treatment and as a bridge to curative surgery. This procedure avoids two-stage surgeries and reduces the probability of permanent colostomy and its complications with the consequent deterioration in quality of life. Objective: to report our experience in the placement of SEMS as palliative treatment in neoplastic colorectal obstruction. Design: retrospective, longitudinal, descriptive and observational study. Methods: all patients in whom the same group of endoscopists performed SEMS placement with palliative intent for advanced colorectal cancer between August 2008 and December 2019 were analyzed. Data collected were demographic and clinical variables, technical and clinical success, early and late complications, and survival. Results: SEMS were placed in 54 patients. The average age was 71 years. Eighty-five percent were left-sided tumors. In 57% of the patients the procedure was performed on an outpatient basis. Technical and clinical success was 92 and 90%, respectively, and median survival was 209 days. The complication rate was 29.6%, including 14.8% obstruction and 5.6% migration. Late mortality attributable to the procedure was 5.6%, caused by 3 late perforations: 2 open and 1 microperforation with localized abscess formation. Conclusions: The placement of SEMS as a palliative treatment for neoplastic colonic obstruction is feasible, effective and safe. It allowed outpa-tient management or brief hospitalization and early refeeding, improving the conditions to face an eventual palliative chemotherapy treatment. Most complications were late and resolved endoscopically on an outpatient basis. (AU)

Relación entre la compatibilidad del HLA y la pérdida del injerto en trasplante renal de donante cadavérico: Un análisis por propensity score matching en Colombia / Relationship between HLA compatibility and graft loss in renal transplant from a deceased donor: An analysis by propensity score matching in Colombia

Introducción. En Colombia, solo un 24 % de los pacientes en lista recibieron un trasplante renal, la mayoría de donante cadavérico. Para la asignación de órganos se considera el HLA A-B-DR, pero la evidencia reciente sugiere que el HLA A-B no está asociado con los desenlaces del trasplante. El objetivo de este estudio fue evaluar la relevancia del HLA A-B-DR en la sobrevida del injerto de los receptores de trasplante renal. Métodos. Estudio de cohorte retrospectivo que incluyó pacientes trasplantados renales con donante cadavérico en Colombiana de Trasplantes, desde 2008 a 2023. Se aplicó un propensity score matching (PSM) para ajustar las covariables en grupos de comparación por compatibilidad y se evaluó la relación del HLA A-B-DR con la sobrevida del injerto renal por medio de la prueba de log rank y la regresión de Cox. Resultados. Se identificaron 1337 pacientes transplantados renales, de los cuales fueron mujeres un 38,7 %, con mediana de edad de 47 años y de índice de masa corporal de 23,8 kg/m2. Tras ajustar por PSM las covariables para los grupos de comparación, la compatibilidad del HLA A-B no se relacionó significativamente con la pérdida del injerto, con HR de 0,99 (IC95% 0,71-1,37) para HLA A y 0,75 (IC95% 0,55-1,02) para HLA B. Solo la compatibilidad por HLA DR fue significativa para pérdida del injerto con un HR de 0,67 (IC95% 0,46-0,98). Conclusión. Este estudio sugiere que la compatibilidad del HLA A-B no influye significativamente en la pérdida del injerto, mientras que la compatibilidad del HLA DR sí mejora la sobrevida del injerto en trasplante renal con donante cadavérico

Introduction. In Colombia, only 24% of patients on the waiting list received a renal transplant, most of them from cadaveric donors. HLA A-B-DR is considered for organ allocation, but recent evidence suggests that HLA A-B is not associated with transplant outcomes. The objective of this study was to evaluate the relevance of HLA A-B-DR on graft survival in kidney transplant recipients. Methods. Retrospective cohort study that included kidney transplant recipients with a cadaveric donor in Colombiana de Trasplantes from 2008 to 2023. A propensity score matching (PSM) was applied to adjust the covariates in comparison groups for compatibility, and the relationship of HLA A-B-DR with kidney graft survival was evaluated using the log rank test and Cox regression. Results. A total of 1337 kidney transplant patients were identified; of those, 38.7% were female, with median age of 47 years, and BMI 23.8 kg/m2. After adjusting the covariates with PSM for the comparison groups, HLA A-B matching was not significantly related to graft loss, with HR of 0.99 (95% CI 0.71-1.37) and 0.75 (95% CI 0.55-1.02), respectively. Only HLA DR matching was significant for graft loss with an HR of 0.67 (95% CI 0.46-0.98). Conclusions. This study suggests that HLA A-B matching does not significantly influence graft loss, whereas HLA DR matching does improve graft survival in renal transplantation with a cadaveric donor.

CLCA1 is Poorly Expressed in Stomach Adenocarcinoma and Correlates with Immune Infiltration / CLCA1 se Expresa Deficientemente en el Adenocarcinoma de Estómago y se Correlaciona con la Infiltración Inmune

SUMMARY: Calcium-activated chloride channel regulator 1 (CLCA1) is associated with cancer progression. The expression and immunologic function of CLCA1 in stomach adenocarcinoma (STAD) remain unclear. In this investigation, the expression of CLCA1 in STAD tissues and its involvement in the progression and immune response of STAD were examined using databases such as cBioPortal, TISIDB, and UALCAN. In order to validate the expression level of CLCA1 protein in gastric adenocarcinoma, thirty clinical tissue specimens were gathered for immunohistochemical staining. The findings indicated a downregulation of CLCA1 in STAD patients, which was correlated with race, age, cancer grade, Helicobacter pylori infection, and molecular subtype. Through the examination of survival analysis, it was identified that diminished levels of CLCA1 within gastric cancer cases were linked to decreased periods of post-progression survival (PPS), overall survival (OS), and first progression (FP) (P<0.05). The CLCA1 mutation rate was lower in STAD, but the survival rate was higher in the variant group. The correlation between the expression level of CLCA1 and the levels of immune infiltrating cells in STAD, as well as the immune activating molecules, immunosuppressive molecules, MHC molecules, chemokines, and their receptor molecules, was observed. Gene enrichment analysis revealed that CLCA1 may be involved in STAD progression through systemic lupus erythematosus (SLE), proteasome, cell cycle, pancreatic secretion, and PPAR signaling pathways. In summary, CLCA1 is anticipated to function as a prognostic marker for patients with STAD and is linked to the immunization of STAD.

El regulador 1 del canal de cloruro activado por calcio (CLCA1) está asociado con la progresión del cáncer. La expresión y la función inmunológica de CLCA1 en el adenocarcinoma de estómago (STAD) aún no están claras. En esta investigación, se examinó la expresión de CLCA1 en tejidos STAD y su participación en la progresión y respuesta inmune de STAD utilizando bases de datos como cBioPortal, TISIDB y UALCAN. Para validar el nivel de expresión de la proteína CLCA1 en el adenocarcinoma gástrico, se recolectaron treinta muestras de tejido clínico para tinción inmunohistoquímica. Los hallazgos indicaron una regulación negativa de CLCA1 en pacientes con STAD, que se correlacionó con la raza, la edad, el grado del cáncer, la infección por Helicobacter pylori y el subtipo molecular. Mediante el examen del análisis de supervivencia, se identificó que los niveles reducidos de CLCA1 en los casos de cáncer gástrico estaban relacionados con períodos reducidos de supervivencia posterior a la progresión (PPS), supervivencia general (OS) y primera progresión (FP) (P <0,05). La tasa de mutación CLCA1 fue menor en STAD, pero la tasa de supervivencia fue mayor en el grupo variante. Se observó la correlación entre el nivel de expresión de CLCA1 y los niveles de células inmunes infiltrantes en STAD, así como las moléculas activadoras inmunes, moléculas inmunosupresoras, moléculas MHC, quimiocinas y sus moléculas receptoras. El análisis de enriquecimiento genético reveló que CLCA1 puede estar involucrado en la progresión de STAD a través del lupus eritematoso sistémico (LES), el proteasoma, el ciclo celular, la secreción pancreática y las vías de señalización de PPAR. En resumen, se prevé que CLCA1 funcione como un marcador de pronóstico para pacientes con STAD y está vinculado a la inmunización de STAD.

El puntaje de Framingham ayudaría en la estratificación del riesgo de pacientes con ergometría positiva y SPECT normal / The Framingham score could help in risk stratification of patients with positive ergometry and normal SPECT

Antecedentes. El valor pronóstico de una ergometría positiva en el contexto de imágenes tomográficas de perfusión miocárdica de estrés y reposo (SPECT) normales no está bien establecido. Objetivos. Documentar la incidencia de infarto, muerte y revascularización coronaria en pacientes con una ergometría positiva de riesgo intermedio e imágenes de perfusión SPECT normales, y explorar el potencial valor del puntaje de riesgo de Framingham en la estratificación pronóstica de estos pacientes. Métodos. Cohorte retrospectiva integrada por pacientes que habían presentado síntomas o hallazgos electrocardiográficos compatibles con enfermedad arterial coronaria durante la prueba de esfuerzo, con criterios de riesgo intermedio en la puntuación de Duke y perfusión miocárdica SPECT normal. Fueron identificados a partir de la base de datos del laboratorio de cardiología nuclear del Instituto de Cardiología y Cirugía Cardiovascular de la ciudad de Posadas, Argentina. Resultados. Fueron elegibles 217 pacientes. El seguimiento fue de 3 1,5 años. La sobrevida libre de eventos (muerte,infarto de miocardio no fatal, angioplastia coronaria o cirugía de bypass de arteria coronaria) a uno, tres y cinco años fue significativamente menor (Log-rank test, p= 0,001) en el grupo con puntaje de Framingham alto o muy alto (77, 71y 59 %, respectivamente) que en el grupo de puntaje bajo o intermedio (89, 87 y 83 %). Tomando como referencia a los pacientes con riesgo bajo en el puntaje de Framingham, luego de ajustar por edad, sexo y puntaje de Duke, los pacientes categorizados en los estratos alto y muy alto riesgo del puntaje de Framingham presentaron una incidencia del evento combinado cercana al triple (hazard ratio [HR] 2,81; intervalo de confianza [IC] del 95 % 0,91 a 8,72; p= 0,07 y HR 3,61;IC 95 % 1,23 a 10,56; p= 0,019 respectivamente). Conclusiones. La estimación de riesgo con el puntaje de Framingham sería de ayuda en la estratificación pronóstica de los pacientes con ergometría positiva y SPECT normal. (AU)

Background. The prognostic value of positive exercise testing with normal SPECT myocardial perfusion imaging is not well established. Objectives. To document the incidence of infarction, death, and coronary revascularization in patients with a positive intermediate-risk exercise test and normal SPECT perfusion images and to explore the potential value of the Framingham Risk Score in the prognostic stratification of these patients. Methods. A retrospective cohort comprised patients who presented symptoms or electrocardiographic findings compatible with coronary artery disease during the stress test, with intermediate risk criteria in the Duke score and normal SPECT myocardial perfusion. They were identified from the database of the nuclear cardiology laboratory of the Instituto de Cardiología y Cirugía Cardiovascular of Posadas, Argentina. Results. 217 patients were eligible. Follow-up was 3 1.5 years. Event-free survival (death, non-fatal myocardial infarction, coronary angioplasty, or coronary artery bypass surgery) at one, three, and five years was significantly lower (Log-ranktest, p: 0.001) in the group with a score of Framingham high or very high (77, 71 and 59 %, respectively) than in the lowor intermediate score group (89, 87 and 83 %). Taking as reference the low-risk patients in the Framingham score, after adjusting for age, sex, and Duke score, the patients categorized in the high-risk and very high-risk strata showed about three times higher incidence of the combined event (hazard ratio [HR] 2.81; 95 % confidence interval [CI] 0.91 to 8.72;p=0.07 and HR 3.61; 95 % CI 1.23 to 10.56; p=0.019 respectively). Conclusions. Risk estimation with the Framingham score would be helpful in the prognostic stratification of patients with positive exercise testing and normal SPECT. (AU)

Analysis of Survival of Pediatric Patients with Leukemias and Lymphomas in the Oncological Context: Epidemiological Study in the State of São Paulo, Brazil, 2000-2022

Introduction: The time taken for screening, detection and initiation of treatment is a determining factor for therapeutic management in oncology. The availability of reliable data guides decisions for public policies and evaluates compliance with these policies. Objective:To analyze the survival and outcomes of pediatric patients with leukemia and lymphoma from 2000 to 2022. Method: Epidemiological, descriptive study, with data extracted from Fundação Oncocentro do Estado de São Paulo, according to the International Classification of Childhood Cancer (ICCC). The time elapsed between the first consultation and diagnosis was evaluated, between diagnosis and the start of oncological treatment, and the survival of these patients, calculated according to the Peto-Peto test. Results: 12,030 cases were analyzed, 6,994 in males and 7,292 with leukemia. The probability of the time between consultation and diagnosis exceeds 30 days was 49.29% for leukemias and 76.31 for lymphomas, a significant result for treatment and relapses (p < 0.001) but not in relation to sex; the time between diagnosis and treatment exceeding 60 days was 38.04% for leukemias and 71.97% for lymphomas. Not undergoing treatment was significant (p < 0.001) while waiting for diagnosis after consultation for patients with leukemia and lymphomas, except surgery, chemotherapy and radiotherapy combined. Conclusion: Despite the advances, a considerable percentage of patients wait longer than expected for diagnosis and initiation of treatment, impacting their survival rates

ntrodução: O tempo no rastreio, detecção e início do tratamento é fator determinante para o manejo terapêutico em oncologia. A disponibilidade de dados confiáveis orienta decisões para políticas públicas e avalia o cumprimento dessas políticas. Objetivo: Analisar a sobrevivência e desfechos de pacientes pediátricos com leucemias e linfomas de 2000 a 2022. Método:Estudo epidemiológico, descritivo, com dados extraídos da Fundação Oncocentro do Estado de São Paulo, segundo a Classificação Internacional de Câncer na Infância. Avaliou-se o tempo decorrido entre a primeira consulta e o diagnóstico; entre o diagnóstico e o início do tratamento oncológico; e a sobrevivência desses pacientes, calculada conforme o teste Peto-Peto. Resultados: Foram analisados 12.030 casos, com prevalência no sexo masculino 6.994; 7.292 corresponderam às leucemias. A probabilidade de o tempo entre a consulta e o diagnóstico ter sido superior a 30 dias foi de 49,29% para as leucemias e de 76,31 para os linfomas, significativo para o tratamento e recidivas (p < 0,001) e não por sexo; o tempo entre o diagnóstico e tratamento, superior a 60 dias, foi de 38,04% para as leucemias e de 71,97% para os linfomas. Não realizar tratamento foi significante (p< 0,001) na espera entre a consulta e o diagnóstico para os pacientes com leucemias; o mesmo para os linfomas, exceto para a combinação de cirurgia, quimioterapia e radioterapia. Conclusão: À despeito dos avanços obtidos, uma porcentagem considerável de pacientes aguarda um tempo maior do que o esperado para o diagnóstico e o início do tratamento, repercutindo nas taxas de sobrevivência desses pacientes

Introducción: El tiempo necesario para el screening, detección e inicio del tratamiento es un factor determinante para el manejo terapéutico en oncología. La disponibilidad de datos confiables orienta las decisiones de políticas públicas y evalúa el cumplimiento de estas políticas. Objetivo:Analizar la supervivencia y desenlaces de pacientes pediátricos con leucemia y linfoma en el período de 2000 a 2022. Método: Estudio epidemiológico, descriptivo, con datos extraídos de la Fundación Oncocentro del estado de São Paulo, según la Clasificación Internacional del Cáncer Infantil. Se evaluó el tiempo transcurrido entre la primera consulta y el diagnóstico; entre el diagnóstico y el inicio del tratamiento oncológico, y la supervivencia de estos pacientes, calculada según la prueba de Peto-Peto. Resultados: Se analizaron 12 030 casos, con una prevalencia masculina de 6994; 7292 correspondieron a leucemia. La probabilidad de que el tiempo entre consulta y diagnóstico sea mayor a 30 días fue del 49,29% para leucemias y del 76,31 para linfomas, significativa para tratamiento y recaídas (p < 0,001) y no para sexo; para el tiempo entre diagnóstico y tratamiento, superior a 60 días, fue del 38,04% para las leucemias y del 71,97% para los linfomas. No recibir tratamiento fue significativo (p < 0,001) en la espera entre la consulta y el diagnóstico en pacientes con leucemia; lo mismo para los linfomas, excepto la combinación de cirugía, quimioterapia y radioterapia. Conclusión: A pesar de los avances logrados, un porcentaje considerable de pacientes espera un tiempo más de lo esperado para el diagnóstico y el inicio del tratamiento, impactando en las tasas de supervivencia de estos pacientes.

Comprehensive Analysis of CLCA1 Expression, Immune Infiltration and Immune Checkpoints in Colon Adenocarcinoma / Análisis Completo de la Expresión de CLCA1, Infiltración Inmune y Puntos de Control Inmunológico en Colonadenocarcinoma

SUMMARY: Colon adenocarcinoma (COAD) is a prevalent disease worldwide, known for its high mortality and morbidity rates. Despite this, the extent of investigation concerning the correlation between COAD's CLCA1 expression and immune cell infiltration remains insufficient. This study seeks to examine the expression and prognosis of CLCA1 in COAD, along with its relationship to the tumor immune microenvironment. These findings will offer valuable insights for clinical practitioners and contribute to the existing knowledge in the field. In order to evaluate the prognostic significance of CLCA1 in individuals diagnosed with colorectal cancers, we conducted a comprehensive analysis using univariate and multivariate Cox regression models along with receiver operating characteristic curve (ROC) analysis. This study was performed on the patient data of COAD obtained from The Cancer Genome Atlas (TCGA) database. Nomograms were developed to anticipate CLCA1 prognostic influence. Furthermore, the CLCA1 association with tumor immune infiltration, immune checkpoints, immune checkpoint blockade (ICB) response, interaction network, and functional analysis of CLCA1-related genes was analyzed. We found that Colon adenocarcinoma tissues significantly had decreased CLCA1 expression compared to healthy tissues. Furthermore, the study revealed that the group with high expression of CLCA1 demonstrated a significantly higher overall survival rate (OS) as compared to the group with low expression. Multivariate and Univariate Cox regression analysis revealed the potential of CLCA1 as a standalone risk factor for COAD. These results were confirmed using nomograms and ROC curves. In addition, protein-protein interaction (PPI) network analysis and functional gene enrichment showed that CLCA1 may be associated with functional activities such as pancreatic secretion, estrogen signaling and cAMP signaling, as well as with specific immune cell infiltration. Therefor, as a new independent predictor and potential biomarker of COAD, CLCA1 plays a crucial role in the advancement of colon cancer.

El adenocarcinoma de colon (COAD) es una enfermedad prevalente a nivel mundial, conocida por sus altas tasas de mortalidad y morbilidad. Sin embargo, el alcance de la investigación sobre la correlación entre la expresión de CLCA1 de COAD y la infiltración de células inmunes sigue siendo insuficiente. Este estudio busca examinar la expresión y el pronóstico de CLCA1 en COAD, junto con su relación con el microambiente inmunológico del tumor. Estos hallazgos ofrecerán conocimientos valiosos para los profesionales clínicos y contribuirán al conocimiento existente en el campo. Para evaluar la importancia de pronóstico de CLCA1 en personas diagnosticadas con cáncer colorrectal, realizamos un análisis exhaustivo utilizando modelos de regresión de Cox univariados y multivariados junto con un análisis de la curva característica operativa del receptor (ROC). Este estudio se realizó con los datos de pacientes de COAD obtenidos de la base de datos The Cancer Genome Atlas (TCGA). Se desarrollaron nomogramas para anticipar la influencia pronóstica de CLCA1. Además, se analizó la asociación de CLCA1 con la infiltración inmunitaria tumoral, los puntos de control inmunitarios, la respuesta de bloqueo de los puntos de control inmunitarios (ICB), la red de interacción y el análisis funcional de genes relacionados con CLCA1. Descubrimos que los tejidos de adenocarcinoma de colon tenían una expresión significativamente menor de CLCA1 en comparación con los tejidos sanos. Además, el estudio reveló que el grupo con alta expresión de CLCA1 demostró una tasa de supervivencia general (SG) significativamente mayor en comparación con el grupo con baja expresión. El análisis de regresión de Cox multivariado y univariado reveló el potencial de CLCA1 como factor de riesgo independiente de COAD. Estos resultados se confirmaron mediante nomogramas y curvas ROC. Además, el análisis de la red de interacción proteína- proteína (PPI) y el enriquecimiento de genes funcionales mostraron que CLCA1 puede estar asociado con actividades funcionales como la secreción pancreática, la señalización de estrógenos y la señalización de AMPc, así como con la infiltración de células inmunes específicas. Por lo tanto, como nuevo predictor independiente y biomarcador potencial de COAD, CLCA1 desempeña un papel crucial en el avance del cáncer de colon.

MiR-15b-5p Promotes Growth and Metastasis of Renal Clear Cell Carcinoma / MiR-15b-5p Promueve el Crecimiento y la Metástasis del Carcinoma Renal de Células Claras

SUMMARY: We investigated the expression and clinical significance of miR-15b-5p in clear cell renal cell carcinoma (RCC) through bioinformatics analysis and experimental verification. The differentially expressed miRNAs were screened in the GEO database. Venn diagram showed that there were 5 up-regulated miRNAs (has-miR-210, has-miR-142-3p, has-miR-142-5p, has-miR-15b-5p, and has-miR-193a-3p) and only 1 down-regulated miRNA (has-miR-532-3p) that were commonly expressed between GSE189331 and GSE16441 datasets. This was further confirmed in TCGA. Further analysis showed that the has-miR-193a-3p, has-miR-142-3p, has- miR-142-5p, and has-miR-15b-5p were closely related to tumor invasion, distant metastasis and survival probability. The expression of miR-15b-5p in ccRCC tissues was significantly higher than that in adjacent normal kidney tissues (P0.05). Following inhibition of miR-15b-5p expression, RCC cells had attenuated proliferation, increased apoptosis, and attenuated migration and invasion. has-miR-15b-5p-WEE1, has-miR-15b-5p-EIF4E, has-miR-15b-5p-PPP2R1B may be three potential regulatory pathways in ccRCC. miR-15b-5p is highly expressed in cancer tissues of ccRCC patients. It may promote proliferation, inhibit apoptosis and enhance cell migration and invasion of RCC cells. The has-miR-15b-5p-WEE1, has-miR-15b-5p-EIF4E, and has-miR-15b-5p-PPP2R1B may be three potential regulatory pathways in ccRCC.

Investigamos la expresión y la importancia clínica de miR-15b-5p en el carcinoma de células renales (CCR) de células claras mediante análisis bioinformático y verificación experimental. Los miARN expresados diferencialmente se examinaron en la base de datos GEO. El diagrama de Venn mostró que había 5 miARN regulados positivamente (has-miR-210, has-miR-142-3p, has-miR-142-5p, has-miR-15b-5p y has-miR-193a-3p). ) y solo 1 miARN regulado negativamente (has-miR-532-3p) que se expresaron comúnmente entre los conjuntos de datos GSE189331 y GSE16441. Esto fue confirmado aún más en TCGA. Un análisis más detallado mostró que has-miR-193a-3p, has-miR-142-3p, has- miR-142-5p y has-miR-15b-5p estaban estrechamente relacionados con la invasión tumoral, la metástasis a distancia y la probabilidad de supervivencia. La expresión de miR-15b-5p en tejidos ccRCC fue significativamente mayor que la de los tejidos renales normales adyacentes (P 0,05). Tras la inhibición de la expresión de miR-15b-5p, las células RCC tuvieron una proliferación atenuada, un aumento de la apoptosis y una migración e invasión atenuadas. has-miR-15b-5p-WEE1, has- miR-15b-5p-EIF4E, has-miR-15b-5p-PPP2R1B pueden ser tres posibles vías reguladoras en ccRCC. miR-15b-5p se expresa altamente en tejidos cancerosos de pacientes con ccRCC. Puede promover la proliferación, inhibir la apoptosis y mejorar la migración celular y la invasión de células RCC. has-miR-15b-5p-WEE1, has- miR-15b-5p-EIF4E y has-miR-15b-5p-PPP2R1B pueden ser tres posibles vías reguladoras en ccRCC.

Supervivencia a dos años en pacientes con cáncer gástrico localmente avanzado en una institución de Popayán entre 2018 y 2020 / Two-year survival in patients with locally advanced gastric cancer at an institution in Popayán between 2018 and 2020

Introducción. El tratamiento oncológico perioperatorio en pacientes con cáncer gástrico localmente avanzado está indicado; aun así, no siempre es posible. El objetivo de este estudio fue evaluar la supervivencia de los pacientes según la administración de quimioterapia perioperatoria. Métodos. Estudio observacional, tipo cohorte ambispectivo, incluyendo pacientes con cáncer gástrico localmente avanzado quienes recibieron o no quimioterapia perioperatoria. Resultados. Se incluyeron 33 pacientes, 90,9 % pertenecían al régimen subsidiado de salud y el 78,8 % en estadio T4. El grupo que recibió quimioterapia perioperatoria, que solo tuvo 5 pacientes (15,1 %), presentó mayor supervivencia global a 2 años (100 %), seguido del grupo de quimioterapia postoperatoria (58,8 %) y del grupo sin quimioterapia, que alcanzó una supervivencia global a 2 años de 54,5 %. Discusión. La supervivencia global fue mayor en el grupo de quimioterapia perioperatoria, consonante a lo descrito a nivel internacional, aunque los pacientes se encontraban en un estadío localmente más avanzado, la mayoría con T4 y N+ según AJCC VIII edición. Conclusiones. El estadío clínico es un factor pronóstico importante y, en nuestro medio, la mayoría de los pacientes consultan en estadíos localmente más avanzados. A eso se suman las dificultades en el acceso a la atención en salud. Aun así, la quimioterapia perioperatoria mostró una supervivencia mayor en pacientes con cáncer gástrico localmente avanzado

Introduction. Perioperative cancer treatment in patients with locally advanced gastric cancer is indicated; even so, it is not always possible. The objective was to evaluate survival according to time and receipt of perioperative chemotherapy. Methods. Observational study, ambispective cohort type, including patients with locally advanced gastric cancer who received or did not receive perioperative chemotherapy. Results. Thirty-three patients were included, 90.9% belonged to the subsidized regimen and 78.8% with TNM T4. The perioperative chemotherapy group, which only had five patients (15.1%), had a higher overall survival at 2 years (100%), followed by the postoperative chemotherapy group and by the group without chemotherapy, with an overall survival at 2 years of 58.8% and 54.5%, respectively. Discussion. Overall survival was higher in the perioperative chemotherapy group, consistent with what has been described internationally, although the patients were in a more advanced stage, most being with T4 and N+ according to the AJCC VIII edition. Conclusions. The clinical stage is an important prognostic factor and in our environment, most patients consult in more advanced stages, coupled with difficulties in accessing health care. Even so, perioperative chemotherapy showed a longer survival in patients with locally advanced gastric cancer, the data should not be extrapolated since the number of patients in each group is significantly different

Sobrevida global y sobrevida libre de enfermedad a cinco y diez años en pacientes con cáncer de ovario, un estudio observacional de centro único / Overall survival and disease-free survival at five and ten years in patients with ovarian cancer, a single-center observational study

Introducción: La supervivencia del cáncer de ovario se aproxima al 50%, sin embargo, varía en función de los distintos factores pronósticos, siendo el principal la extensión de la enfermedad al diagnóstico. El objetivo del presente estudio fue establecer la supervivencia global y libre de enfermedad en un centro de referencia para el tratamiento de cáncer de ovario en Quito, Ecuador. Métodos: El presente estudio longitudinal, se realizó en el Hospital Metropolitano de Quito, de enero del 2008 a diciembre del 2018. Se incluyeron mujeres con cáncer de ovario. Se registraron variables demográficas, número de embarazos, comorbilidades, diagnóstico histológico, tiempo de evolución, tratamiento recibido, estadío de la enfermedad, progresión, recaídas, período libre de enfermedad y mortalidad. La muestra fue no probabilística. Se realiza un análisis descriptivo y un análisis de supervivencia. Resultados: Participaron 84 pacientes. La edad en 20 casos (23.8%) < 50 años, en 29 casos (34.5%) de 50 a 59 años y en 35 casos (41.7%) > 60 años. El 60.7 % con 1 a 3 embarazos, el 23.8% nunca se embarazo y el 15.5 % con > 4 embarazos, sin relación con la mortalidad. El tipo histológico más prevalente fue el carcinoma epitelial en 56 casos (66.6%). La media de tiempo de recaída fue 56.8 meses y de tiempo de sobrevida fue de 87.7 meses. La supervivencia a los 5 años fue del 62% y a los 10 años del 55%. La supervivencia fue menor en mayores de 60 años y con estadios IIB, IIC, IIIA y IIIC. Conclusión: En este estudio la mortalidad se modificó por el estadío clínico, el tiempo de evolución y la edad de las pacientes con cáncer de ovario.

Introduction: Survival from ovarian cancer is close to 50%; however, it varies depending on the different prognostic factors, the main one being the extent of the disease at diagnosis. The objective of this study was to establish overall and disease-free survival in a reference center for the treatment of ovarian cancer in Quito, Ecuador. Methods: The present longitudinal study was carried out at the Metropolitan Hospital of Quito from January 2008 to December 2018. Women with ovarian cancer were included. Demographic variables, number of pregnancies, comorbidities, histological diagnosis, evolution time, treatment received, disease stage, progression, relapses, disease-free period, and mortality were recorded. The sample was non-probabilistic. A descriptive analysis and a survival analysis are performed. Results: 84 patients participated. Age in 20 cases (23.8%) <50 years, in 29 cases (34.5%) from 50 to 59 years, and in 35 cases (41.7%) >60 years. 60.7% with 1 to 3 pregnancies, 23.8% never got pregnant, and 15.5% with > 4 pregnancies without relation to mortality. The most prevalent histological type was epithelial carcinoma in 56 cases (66.6%). The mean time to relapse was 56.8 months, and the survival time was 87.7 months. Survival at 5 years was 62%, and at 10 years, 55%. Survival was lower in those over 60 years of age and with stages IIB, IIC, IIIA, and IIIC. Conclusion: In this study, mortality was modified by the clinical stage, the time of evolution, and the age of the patients with ovarian cancer.

Relación de edad y sobrevida tras cirugía con intención curativa por cáncer gástrico en adultos: Un estudio observacional de centro único / Relationship of age and survival after surgery with curative intent for gastric cancer in adults: A single center observational study

Introducción: El cáncer gástrico constituye como una de las enfermedades de mayor morbimortalidad a nivel mundial; no obstante, la mortalidad se puede reducir con intervenciones tempranas. El objetivo del presente estudio fue determinar la relación entre la edad y la sobrevida tras cirugía con intención curativa por cáncer gástrico en pacientes atendidos en el Instituto del cáncer SOLCA, Cuenca, en el periodo 2012-2017. Métodos: El presente estudio analítico, retrospectivo fue realizado con la base de datos del Instituto del Cáncer SOLCA-Cuenca. Los datos fueron presentados en tablas de frecuencia y porcentajes. Se aplicó Chi-cuadrado (X2), análisis de Kaplan Meier y regresión de Cox, para relacionar las variables edad y años de sobrevida, considerándose estadísticamente significativo cuando P<0.05. Resultados: De los 603 pacientes con cáncer gástrico registrado durante el periodo de evaluación, el 35.3% fueron intervenidos quirúrgicamente, lográndose el seguimiento del 45.1%. Un total de 96 pacientes fueron incluidos, el 70.8% fueron intervenidos quirúrgicamente con intención curativa. En la muestra predominaba los hombres (52.9%) y el grupo etario de 70 a 79 años (30.2%). La tasa de sobrevida a los 5 años fue de 69.1% con un tiempo promedio de supervivencia de 7.24±0.49 años. La edad no se relacionó significativamente con la sobrevida de los pacientes (X2=3.15; P=0.667). Conclusión: existe una elevada tasa de sobrevida a los 5 años en los pacientes con cáncer gástrico intervenidos quirúrgicamente con intención curativa, la cual no asoció con la edad.

Introduction: Gastric cancer is one of the diseases with the highest morbidity and mortality worldwide; however, early interventions can reduce mortality. This study aimed to determine the relationship between age and survival after surgery with curative intent for gastric cancer in patients treated at the SOLCA Cancer Institute, Cuenca, in 2012-2017. Methods: The present analytical, retrospective study was carried out with the database of the SOLCA-Cuenca Cancer Institute. Data were presented in frequency and percentage tables. Chi-square (X2), Kaplan Meier analysis, and Cox regression were applied to relate the variables age and years of survival, being considered statistically significant when P<0.05. Results: Of the 603 patients with gastric cancer registered during the evaluation period, 35.3% underwent surgery, achieving a follow-up of 45.1%. A total of 96 patients were included, 70.8% underwent surgery with curative intent. The sample was dominated by men (52.9%) and the age group of 70 to 79 (30.2%). The 5-year survival rate was 69.1%, with a median survival time of 7.24±0.49 years. Age was not significantly related to patient survival (X2=3.15; P=0.667). Conclusion: there is a high 5-year survival rate in patients with gastric cancer who underwent surgery with curative intent, which was not associated with age. Keywords:

Cirugía de revascularización miocárdica: comparación de supervivencia a 10 años de la cirugía coronaria con y sin circulación extracorpórea mediante Propensity Score Matching / Ten-year survival after off-pump coronary artery bypass grafting compared with traditional bypass grafting

BACKGROUND: Long-term outcomes of Off-Pump Coronary Artery Bypass Grafting (OPCAB) as an alternative to the traditional Coronary Artery Bypass Grafting (CABG) technique with cardiopulmonary bypass (CPB) are not well defined. AIM: To compare 10-year survival of isolated OPCAB versus CABG with CPB. MATERIAL AND METHODS: Analysis of information obtained from databases, clinical records and surgical protocols of patients treated with isolated CABG between January 2006 and November 2008 at a Regional Hospital. Of 658 isolated CABG, 192 (29.2%) were OPCAB and 466 (79.9%) CPB. Propensity Score Matching (PSM) was performed to compare both groups. After PSM, two groups of 192 cases were obtained. Mortality data was obtained from the Chilean public identification service. Ten-year survival was calculated and compared with Kaplan-Meier and log-rank methods. RESULTS: Follow-up data was obtained in all cases. No statistically significant differences were found when comparing 10-year survival between OPCAB versus CPB (78.6% and 80.2% respectively, p 0.720). There was also no statistical difference in cardiovascular death free survival (90.1% with CPB versus 89.1% OPCAB, p 0.737). Survival was comparable when analyzing subgroups with diabetes mellitus, left ventricular dysfunction or chronic kidney disease, among others. CONCLUSIONS: In our series, OPBAB has a comparable 10-year survival with CABG with CPB.

Difusão da Lei Geral da Micro e Pequena Empresa em municípios paulistas / Difusión de la Ley General de las Micro y Pequeñas Empresas en los municipios de São Paulo / Diffusion of the Micro and Small Business Law in municipalities of São Paulo

Resumo Este artigo tem como objeto de análise a implantação da Lei Complementar nº 123, de 2006 (LC nº 123/2006), que instituiu o Estatuto Nacional da Microempresa e da Empresa de Pequeno Porte (MPE), por municípios paulistas. Utilizou-se o referencial teórico de difusão de políticas públicas tendo como objetivo estudar seu processo de adoção, observando os diferentes contextos e momentos de coerção previstos na legislação federal. Com base nas discussões teóricas relacionadas com o mecanismo de difusão chamado de coerção, respondeu-se a seguinte pergunta: qual é a influência do mecanismo de coerção vertical na difusão da Lei Geral da MPE nos municípios paulistas? A técnica "análise de sobrevivência" foi aplicada para identificar fatores explicativos da difusão da política, considerando variáveis de desenho institucional, políticas e partidárias, efeito vizinhança, necessidade da política, organizações/atores sociais e fatores estruturais. Os resultados demonstram que, conforme varia o desenho institucional de coerção, mudam os fatores explicativos da difusão dessa política na ponta, de modo que os aspectos locais, incluindo atores sociais, fatores regionais e questões estruturais, importam para a difusão, variando conforme o contexto coercitivo.

Resumen Este artículo analiza la implementación de la Ley General de las Micro y Pequeñas Empresas por parte de los municipios de São Paulo. Se utilizó la teoría de la difusión de políticas, con el objetivo de estudiar el proceso de adopción de esta política pública, observando los diferentes contextos y momentos de coerción previstos en la legislación federal. A partir de las discusiones teóricas relacionadas con el mecanismo de difusión denominado coerción, se respondió a la siguiente pregunta: ¿cuál es la influencia del mecanismo de coacción vertical en la difusión de la mencionada ley en los municipios de São Paulo? Se aplicó la técnica de análisis de supervivencia para identificar factores explicativos de la difusión de políticas, considerando variables institucionales, políticas y partidarias, efecto barrio, necesidad de políticas, organizaciones/actores sociales y factores estructurales. Los resultados muestran que a medida que varía el diseño institucional de coerción, los factores explicativos de la difusión de esta política al final cambian, de modo que los aspectos locales, incluidos los actores sociales, los factores regionales y los problemas estructurales importan para la difusión, variando de acuerdo con el contexto coercitivo.

Abstract This article analyzes the implementation of the General Law for Micro and Small Business by municipalities in São Paulo. The theory of policy diffusion was used to study the process of adopting this public policy in the different contexts of coercion. The article presents theoretical discussions on the diffusion mechanism "coercion" and answers the question: what is the influence of the vertical coercion mechanism in the diffusion of the General Law in the municipalities of São Paulo? The survival analysis technique was applied to identify explanatory factors of policy diffusion, considering institutional, political, and party design variables, neighborhood effect, internal needs, organizations/social actors, and structural factors. The results show that as the institutional rules of coercion vary, the explanatory factors of the diffusion change so that local aspects, including social actors, regional factors, and structural issues, matter for the diffusion, varying according to the coercive context.

Hospital volume, postoperative mortality, and costs after gastrectomy for gastric cancer in colombia: is there any association? / Volume hospitalar, mortalidade pós-operatória e custos após gastrectomia por câncer gástrico na colômbia: existe associação?

ABSTRACT BACKGROUND: There are no information in the literature associating the volume of gastrectomies with survival and costs for the health system in the treatment of patients with gastric cancer in Colombia. AIMS: The aim of this study was to analyze how gastrectomy for gastric cancer is associated with hospital volume, 30-day and 180-day postoperative mortality, and healthcare costs in Bogotá, Colombia. METHODS: A retrospective cohort study based on hospital data of all adult patients with gastric cancer who underwent gastrectomy between 2014 and 2016 using a paired propensity score. The surgical volume was identified as the average annual number of gastrectomies performed by the hospital. RESULTS: A total of 743 patients were included in the study. Hospital mortality at 30 and 180 days postoperatively was 36 (4.85%) and 127 (17.09%) patients, respectively. The average health care cost was USD 3,200. A total of 26 or more surgeries were determined to be the high surgical volume cutoff. Patients operated on in hospitals with a high surgical volume had lower 6-month mortality (HR 0.44; 95%CI 0.27-0.71; p=0.001), and no differences were found in health costs (mean difference 398.38; 95%CI-418.93-1,215.69; p=0.339). CONCLUSIONS: This study concluded that in Bogotá (Colombia), surgery in a high-volume hospital is associated with better 6-month survival and no additional costs to the health system.

RESUMO RACIONAL: Não há informações na literatura relacionando o volume de gastrectomias bem como a sobrevida e os custos para o sistema de saúde, no tratamento de pacientes com câncer gástrico na Colômbia. OBJETIVOS: analisar como a gastrectomia para câncer gástrico está associada ao volume hospitalar, mortalidade pós-operatória de 30 e 180 dias e custos de saúde em Bogotá, Colômbia. MÉTODOS: Estudo de coorte retrospectivo baseado em dados hospitalares de todos os pacientes adultos com câncer gástrico submetidos à gastrectomia entre 2014 e 2016, utilizando um escore de propensão pareado. O volume cirúrgico foi identificado como o número médio anual de gastrectomias realizadas pelo hospital. RESULTADOS: Foram incluídos no estudo 743 pacientes. A mortalidade hospitalar aos 30 e 180 dias de pós-operatório, foram respectivamente, 36 (4,85%) e 127 (17,09%) pacientes. O custo médio de saúde foi de US$ 3.200. Vinte e seis ou mais cirurgias foram determinadas como ponto de corte de alto volume cirúrgico. Pacientes operados em hospitais de alto volume cirúrgico tiveram menor mortalidade em seis meses (HR 0,44; IC95% 0,27-0,71; p=0,001) e não foram encontradas diferenças nos custos com saúde (diferença média 398,38; IC95% −418,93-1215,69; p=0,339). CONCLUSÕES: Este estudo concluiu que em Bogotá (Colômbia), a cirurgia em um hospital com alto volume cirúrgico está associada a uma melhor sobrevida de seis meses e não há custos adicionais para o sistema de saúde.

Análise de sobrevida de pacientes com câncer de cabeça e pescoço, com diagnóstico de diabetes mellitus tipo II e o efeito da metformina / Survival analysis of patients with head and neck cancer diagnosed with type II diabetes mellitus and the effect of metformin

Os dados sobre a associação entre o diabetes mellitus II e câncer de cabeça e pescoço ainda são escassos, melhorar nossa compreensão na sobrevida dos pacientes com câncer de cabeça e pescoço pode colaborar nas tomadas de decisão dos processos que envolvem o tratamento e acompanhamento. Objetivo: Avaliar o efeito da DM II, da metformina e do Indice de massa corpórea (IMC) na sobrevida de pacientes com CCP atendidos em 5 centros de referência para o câncer no Estado de São Paulo. Metodologia: Foi realizado um estudo de coorte prospectivo utilizando dados coletados no projeto GENCAP II pacientes com câncer de cabeça e pescoço acompanhados de 2011 a 2017 em cinco hospitais de referência no tratamento de câncer no Estado de SP. Foram incluídos 810 pacientes com câncer de cabeça e pescoço (CID0): cavidade oral, orofaringe, hipofaringe, laringe e cabeça e pescoço não especificados, onde 565 apresentavam o diagnóstico de diabetes mellitus II. A sobrevida global foi definida como o tempo de sobrevida dos pacientes com CCP com ou sem DM II, controlando as covariáveis sexo, idade, tabagismo, uso de álcool, localização do tumor, estadiamento (TNM) e IMC. As funções de risco (H(t)), foram estimadas a partir do modelo de regressão de Cox ajustado por sexo e idade. Taxas de risco e 95% de IC foram fornecidos. Resultados: Considerando os riscos ao longo dos 3 anos, o grupo com DM II apresentou aumento de sobrevida com (HR=0,71; IC 95%: 0,55-0,92) e p valor de <0,01. No estadiamento clínico avançado (T3, T4a, T4b) aumento de sobrevida com (HR=0,65; IC 95%: 0,47-0,88) e p valor 0,06, DM II. O grupo com IMC (>25m2kg) apresentou aumento de sobrevida com (HR=0,39; IC 95%: 0,29-0,54) com p valor de <0,001. Em relação a localização anatômica a orofaringe apresentou aumento de sobrevida com (HR=0,32; IC 95%: 0,15-0,69) p valor 0,003, no grupo com IMC (>25 m2kg) apresentou aumento de sobrevida se estendendo também em todos os estadiamentos clínicos (T1-T4b) respectivamente. Conclusão: Neste estudo os pacientes com IMC >25 m2kg apresentaram uma maior sobrevida global num período de 3 anos, quando comparados aos pacientes com CCP eutróficos ou baixo peso, sendo observado também nos estadiamentos clínicos mais avançados. (T3-T4b e N2-N3), bem como observou-se aumento de sobrevida global na presença da DM II dos pacientes com CCP, porém o efeito da metformina não pode ser avaliado pela amostra apresentar um N reduzido de pacientes usuários de metformina.

Data on the association between diabetes mellitus II and head and neck cancer are still scarce, improving our understanding of the survival of patients with head and neck cancer can collaborate in decision-making processes involving treatment and follow-up. Objective: To evaluate the effect of DM II, metformin and body mass index (BMI) on the survival of patients with HNC treated at 5 reference centers for cancer in the State of São Paulo. Methodology: A prospective cohort study was carried out using data collected in the GENCAP II project from patients with head and neck cancer followed from 2011 to 2018 in five reference hospitals in the treatment of cancer in the State of São Paulo. We included 810 patients with head and neck cancer (ICD0): oral cavity, oropharynx, hypopharynx, larynx and unspecified head and neck, where 565 had the diagnosis of diabetes mellitus II. Overall survival was defined as the survival time of patients with HNC with or without DM II, controlling for the covariates sex, age, smoking, alcohol use, tumor location, staging (TNM) and BMI. The risk functions (H(t)) were estimated from the Cox regression model adjusted for sex and age. Hazard ratios and 95% CI were provided. Results: Considering the risks over the 3 years, the group with DM II showed an increase in survival with (HR=0.71; 95% CI: 0.55-0.92) and p value of <0.01. In advanced clinical staging (T3, T4a, T4b) increased survival with (HR=0.65; 95% CI: 0.47-0.88) and p value 0.06, DM II. The BMI group (>25m2kg) showed increased survival with (HR=0.39; 95% CI: 0.29-0.54) with p value <0.001. Regarding the anatomical location, the oropharynx showed an increase in survival with (HR=0.32; CI 95%: 0.15-0.69) p value 0.003, in the group with BMI (>25 m2kg) it showed an increase in survival extending also in all clinical stages (T1-T4b) respectively. Conclusion: In this study, patients with BMI >25 m2kg had a longer overall survival over a period of 3 years, when compared to patients with eutrophic HNC or low weight, also being observed in more advanced clinical stages. (T3-T4b and N2-N3). as well as an increase in overall survival in the presence of DM II of patients with HNC, however the effect of metformin could not be evaluated due to the sample presenting a reduced N of patients using metformin.

Survival of young and elderly adults with oral squamous cell carcinoma in a population in northeastern Brazil

To compare the profile and overall survival of young adults and elderly people diagnosed with SCC. Methods: A retrospective study was carried out at a High Complexity Oncology Unit, between 2010 and 2016. A descriptive analysis, a bivariate analysis using the chi-square and Fisher's exact test and the Kaplan-Meier estimator were performed. The predictor variables were tested using the log-rank test and those with statistical significance and the literature were maintained for the Cox regression model. Results: 282 cases of SCC were recorded, with only 12.4% diagnosed in young adults. The profile was similar between groups, with the majority of cases of the disease occurring in males, smokers and alcohol consumers. The lesions predominantly located on the tongue and were diagnosed in an advanced stage of the disease, resulting in 35.7% of deaths. The median survival time was 30 months in the elderly and 31 months in young people. In the multivariate analysis, age was not statistically significant, only staging and treatment were predictors of reduced overall survival. Conclusion: Tumor staging, and treatment were prognostic factors for the disease

Comparison of prediction ability of two extended Cox models in nonlinear survival data analysis / 南方医科大学学报

OBJECTIVE@#To compare the predictive ability of two extended Cox models in nonlinear survival data analysis.@*METHODS@#Through Monte Carlo simulation and empirical study and with the conventional Cox Proportional Hazards model and Random Survival Forests as the reference models, we compared restricted cubic spline Cox model (Cox_RCS) and DeepSurv neural network Cox model (Cox_DNN) for their prediction ability in nonlinear survival data analysis. Concordance index was used to evaluate the differentiation of the prediction results (a larger concordance index indicates a better prediction ability of the model). Integrated Brier Score was used to evaluate the calibration degree of the prediction (a smaller index indicates a better prediction ability).@*RESULTS@#For data that met requirement of the proportion risk, the Cox_RCS model had the best prediction ability regardless of the sample size or deletion rate. For data that failed to meet the proportion risk, the prediction ability of Cox_DNN was optimal for a large sample size (≥500) with a low deletion (< 40%); the prediction ability of Cox_RCS was superior to those of other models in all other scenarios. For example data, the Cox_RCS model showed the best performance.@*CONCLUSION@#In analysis of nonlinear low maintenance data, Cox_RCS and Cox_DNN have their respective advantages and disadvantages in prediction. The conventional survival analysis methods are not inferior to machine learning or deep learning methods under certain conditions.

Prevalence and predictors of breastfeeding in the MINA-Brazil cohort / Prevalência e preditores do aleitamento materno na coorte MINA-Brasil

ABSTRACT OBJECTIVE: To describe the prevalence and factors associated with exclusive (EBF) and continued breastfeeding (BF) practices among Amazonian children. METHODS: Data from 1,143 mother-child pairs recorded on the Maternal and Child Health and Nutrition in Acre (MINA-Brazil) birth cohort were used. Information on EBF and BF was collected after childbirth (July 2015-June 2016) and during the follow-up visits at 1 and 6 months postpartum, 1, 2, and 5 years of age. For longitudinal analysis, the outcomes were EBF and BF duration. Probability of breastfeeding practices were estimated by Kaplan-Meier survival analysis. Associations between baseline predictors variables and outcomes among children born at term were assessed by extended Cox regression models. RESULTS: EBF frequencies (95% confidence interval [95%CI]) at 3 and 6 months of age were 33% (95%CI: 30.2-36.0) and 10.8% (95%CI: 8.9-12.9), respectively. Adjusted hazard ratio for predictors of early EBF cessation were: being a first-time mother = 1.47 (95%CI: 1.19-1.80), feeding newborns with prelacteals = 1.70 (95%CI: 1.23-2.36), pacifier use in the first week of life = 1.79 (95%CI: 1.44-2.23) or diarrhea in the first two weeks of life = 1.70 (95%CI: 1.15-2.52). Continued BF frequency was 67.9% (95%CI: 64.9-70.8), 29.3% (95%CI: 26.4-32.4), and 1.7% (95%CI: 0.9-2.8) at 1, 2 and 5 years of age, respectively. Adjusted hazard ratio for predictors of early BF cessation were: male sex = 1.23 (95%CI: 1.01-1.49), pacifier use in the first week of life = 4.66 (95%CI: 2.99-7.26), and EBF less than 3 months = 2.76 (95%CI: 1.64-4.66). CONCLUSIONS: EBF and continued BF duration among Amazonian children is considerably shorter than recommendations from the World Health Organization. Significant predictors of breastfeeding practices should be considered for evaluating local strategies to achieve optimal breastfeeding practices.

RESUMO OBJETIVO: Descrever a prevalência e os fatores associados às práticas de aleitamento materno exclusivo (AME) e continuado (AM) entre crianças amazônicas. MÉTODOS: Foram utilizados dados de 1.143 pares mãe-filho registrados na coorte de nascimento Materno-Infantil no Acre (MINA-Brasil). As informações sobre AME e AM foram coletadas após o parto (julho de 2015-junho de 2016) e durante as consultas de acompanhamento com 1 e 6 meses pós-parto e com 1, 2 e 5 anos de idade. A análise longitudinal considerou a duração do AME e AM como desfechos. A probabilidade das práticas de aleitamento materno foi estimada pela análise de sobrevida de Kaplan-Meier. As associações entre as variáveis preditoras basais e os desfechos entre crianças nascidas a termo foram avaliadas por modelos de regressão de Cox estendidos. RESULTADOS: As frequências de AME (intervalo de confiança de 95% [IC95%]) aos 3 e 6 meses de idade foram de 33% (IC95%: 30,2-36,0) e 10,8% (IC95%: 8,9-12,9), respectivamente. A razão de risco ajustada para preditores de interrupção precoce do AME foi: ser primípara = 1,47 (IC95%: 1,19-1,80), alimentar recém-nascidos com pré-lácteos = 1,70 (IC95%: 1,23-2,36), usar chupeta na primeira semana de vida = 1,79 (IC95%: 1,44-2,23) e apresentar diarreia nas duas primeiras semanas de vida = 1,70 (IC95%: 1,15-2,52). A frequência do AM continuado foi de 67,9% (IC95%: 64,9-70,8), 29,3% (IC95%: 26,4-32,4) e 1,7% (IC95%: 0,9-2,8) aos 1, 2 e 5 anos de idade, respectivamente. A razão de risco ajustada para preditores de cessação precoce do AM foi: sexo masculino = 1,23 (IC95%: 1,01-1,49), uso de chupeta na primeira semana de vida = 4,66 (IC95%: 2,99-7,26) e AME menor que 3 meses = 2,76 (IC95%: 1,64-4,66). CONCLUSÕES: A duração do AME e do AM continuado entre crianças amazônicas é consideravelmente menor do que as recomendações da Organização Mundial da Saúde. Preditores significativos das práticas de aleitamento materno devem ser considerados na avaliação das estratégias locais para alcançar práticas ideais de aleitamento materno.