Obstructive sleep apnea screening in different age groups: performance of the Berlin, STOP-Bang questionnaires and Epworth Sleepiness Scale.

OBJECTIVE: To evaluate the performance of the Berlin Questionnaire, the STOP-Bang Questionnaire, and the Epworth Sleepiness Scale in screening for the disease in adults of different age groups by comparing them with polysomnography. METHODS: Cross-sectional study with prospective patient allocation, in which individuals underwent a medical interview, completion of the three screening instruments, and polysomnography. Individuals were categorized into three age groups: 18-39, 40-59, and ≥60 years. The results of the screening instruments were compared to the diagnostic criteria of the International Classification of Sleep Disorders-third edition. Performance was assessed using 2×2 contingency tables, estimating sensitivity, specificity, predictive value, likelihood ratio, and accuracy. Receiver Operating Characteristic curves were also constructed and the area under the curve was estimated for each instrument by age group. RESULTS: We obtained a sample with 321 individuals suitable for analysis. The mean age was 50 years, with a predominance of females (56%). The prevalence of the disease in the overall sample was 79%, more prevalent in males in any age group and more frequent in the middle age group. The analyzes revealed that STOP-Bang performed better, both for the overall sample and for all age groups, followed by Berlin Questionnaire and Epworth Sleepiness Scale. CONCLUSION: In an outpatient setting with individuals with characteristics similar to those in this study, it seems sensible to choose the STOP-Bang as a screening tool for the disease, regardless of age group. LEVEL OF EVIDENCE ACCORDING THE GUIDE FOR AUTHORS: level 2.

Obstructive sleep apnea screening in different age groups: performance of the Berlin, STOP-Bang questionnaires and Epworth Sleepiness Scale

Abstract Objective To evaluate the performance of the Berlin Questionnaire, the STOP-Bang Questionnaire, and the Epworth Sleepiness Scale in screening for the disease in adults of different age groups by comparing them with polysomnography. Methods Cross-sectional study with prospective patient allocation, in which individuals underwent a medical interview, completion of the three screening instruments, and polysomnography. Individuals were categorized into three age groups: 18-39, 40-59, and ≥60 years. The results of the screening instruments were compared to the diagnostic criteria of the International Classification of Sleep Disorders—third edition. Performance was assessed using 2 × 2 contingency tables, estimating sensitivity, specificity, predictive value, likelihood ratio, and accuracy. Receiver Operating Characteristic curves were also constructed and the area under the curve was estimated for each instrument by age group. Results We obtained a sample with 321 individuals suitable for analysis. The mean age was 50 years, with a predominance of females (56%). The prevalence of the disease in the overall sample was 79%, more prevalent in males in any age group and more frequent in the middle age group. The analyzes revealed that STOP-Bang performed better, both for the overall sample and for all age groups, followed by Berlin Questionnaire and Epworth Sleepiness Scale. Conclusion In an outpatient setting with individuals with characteristics similar to those in this study, it seems sensible to choose the STOP-Bang as a screening tool for the disease, regardless of age group. Level of evidence according the guide for authors: level 2.

Lobesia botrana: A Biological Control Approach with a Biopesticide Based on Entomopathogenic Fungi in the Winter Season in Chile.

Lobesia botrana (Denis and Shiffermüller) (Lepidoptera: Tortricidae) is one of the main pests that affect the production and export of table grapes in Chile. Because this pest has quarantine status, the fruit must be fumigated with methyl bromide, which reduces the fruit's export competitiveness in the destination market. In the present study, to help resolve this issue, six native entomopathogenic fungi were identified through multilocus analysis, including three Beauveria pseudobassiana and three Metarhizium robertsii. These fungi were evaluated in the laboratory to control L. botrana in its pupal stage in a silk cocoon and compared against a biological control product. Formulations with additional carbon sources improved the performance of the fungi. The treatments with outstanding performance contained the fungal strains B. pseudobassiana RGM 2184 and M. robertsii RGM 678. These strains were evaluated in the field during the winter season in two different regions of the country; the strains reached maximum efficacies of 80% and 88%, respectively, at 21 days post first application. Therefore, entomopathogenic fungi can contribute to reducing pupal populations in winter, thereby decreasing the moth population in spring-summer.

PARP­1 inhibition sensitizes temozolomide­treated glioblastoma cell lines and decreases drug resistance independent of MGMT activity and PTEN proficiency.

Information on the mechanisms that are associated with tumor resistance has the potential to provide the fundamental basis for novel therapeutic strategies. In glioblastoma (GBM), predictive biomarkers of cellular responses to temozolomide (TMZ) combined with poly­ADP­ribose polymerase inhibitor (PARPi) remain largely unidentified. In this context, the influence of MGMT (O6­methylguanine DNA methyltransferase) and PTEN (phosphatase and tensin homologue deleted on chromosome ten) has been studied in addition to the occurrence of synthetic lethality involving PTEN and PARPi. The present study investigated whether PARP­1 inhibition by NU1025 may increase the cytotoxicity of TMZ­induced lesions in GBM cells, and whether these mechanisms can be influenced by MGMT and PTEN status. The impact of PTEN deficiency in repair pathways, and the effects of PARP­1 inhibition and PTEN silencing, in terms of synthetic lethality, were also assessed. NU1025 combined with TMZ effectively sensitized TMZ­resistant cells (T98G PTEN­mutated and LN18 PTEN­wild­type) and TMZ­sensitive cells (U251MG PTEN­mutated), in contrast to NU1025 alone. However, the sensitizing effects were not observed in U87MG (PTEN­mutated) cells, suggesting that specific genetic alterations may influence the response to drug treatment. The sensitizing effects occurred independently of MGMT activity, which was evaluated in O6­BG­treated cells. PTEN silencing using small interfering (si)RNA did not sensitize PTEN­proficient cells to TMZ + NU1025, or NU1025 alone, indicating an absence of synthetic lethality. The responses to TMZ + NU1025 involved antiproliferative activity, G2/M arrest, double strand breaks and the induction of apoptosis. Following 20 days of recovery after three consecutive days of TMZ treatment, TMZ­resistant cells were observed. However, when TMZ was combined with NU1025, the viability of T98G and LN18 cells was extremely decreased, indicating a lethal drug combination. Therefore, independently of MGMT proficiency and PTEN status, TMZ combined with PARPi may be a promising strategy that can be used to overcome TMZ acquired resistance in GBM cells.

Up to 15-Year Survival of Men and Women after Percutaneous Coronary Intervention Paid by the Brazilian Public Healthcare System in the State of Rio de Janeiro, 1999-2010. / Sobrevida em até 15 Anos de Homens e Mulheres após Intervenção Coronariana Percutânea Paga pelo Sistema Único de Saúde no Estado do Rio de Janeiro, 1999-2010.

BACKGROUND: Percutaneous coronary intervention (PCI) is the most frequently used invasive therapy for ischemic heart disease (IHD). Studies able to provide information about PCI's effectiveness should be conducted in a population of real-world patients. OBJECTIVES: To assess the survival rate of IHD patients treated with PCI in the state of Rio de Janeiro (RJ). METHODS: Administrative (1999-2010) and death (1999-2014) databases of dwellers aged ≥ 20 years old in the state of RJ submitted to one single PCI paid by the Brazilian public healthcare system (SUS) between 1999 and 2010 were linked. Patients were grouped as follows: 20-49 years old, 50-69 years old and ≥ 70 years old, and PCI in primary PCI, with stent and without stent placement (bare metal stent). Survival probabilities in 30 days, one year and 15 years were estimated by using the Kaplan-Meier method. Cox hazards regression models were used to compare risks among sex, age groups and types of PCI. Test results with a p-value < 0.05 were deemed statistically significant. RESULTS: Data of 19,263 patients (61 ± 11 years old, 63.6% men) were analyzed. Survival rates of men vs. women in 30 days, one year and 15 years were: 97.3% (97.0-97.6%) vs. 97.1% (96.6-97.4%), 93.6% (93.2-94.1%) vs. 93.4% (92.8-94.0%), and 55.7% (54.0-57.4%) vs. 58.1% (55.8-60.3%), respectively. The oldest age group was associated with lower survival rates in all periods. PCI with stent placement had higher survival rates than those without stent placement during a two-year follow-up. After that, both procedures had similar survival rates (HR 0.91, 95% CI 0.82-1.00). CONCLUSIONS: In a population of real-world patients, women had a higher survival rate than men within 15 years after PCI. Moreover, using a bare-metal stent failed to improve survival rates after a two-year follow-up compared to simple balloon angioplasty.

Up to 15-Year Survival of Men and Women after Percutaneous Coronary Intervention Paid by the Brazilian Public Healthcare System in the State of Rio de Janeiro, 1999-2010 / Sobrevida em até 15 Anos de Homens e Mulheres após Intervenção Coronariana Percutânea Paga pelo Sistema Único de Saúde no Estado do Rio de Janeiro, 1999-2010

Abstract Background: Percutaneous coronary intervention (PCI) is the most frequently used invasive therapy for ischemic heart disease (IHD). Studies able to provide information about PCI's effectiveness should be conducted in a population of real-world patients. Objectives: To assess the survival rate of IHD patients treated with PCI in the state of Rio de Janeiro (RJ). Methods: Administrative (1999-2010) and death (1999-2014) databases of dwellers aged ≥ 20 years old in the state of RJ submitted to one single PCI paid by the Brazilian public healthcare system (SUS) between 1999 and 2010 were linked. Patients were grouped as follows: 20-49 years old, 50-69 years old and ≥ 70 years old, and PCI in primary PCI, with stent and without stent placement (bare metal stent). Survival probabilities in 30 days, one year and 15 years were estimated by using the Kaplan-Meier method. Cox hazards regression models were used to compare risks among sex, age groups and types of PCI. Test results with a p-value < 0.05 were deemed statistically significant. Results: Data of 19,263 patients (61 ± 11 years old, 63.6% men) were analyzed. Survival rates of men vs. women in 30 days, one year and 15 years were: 97.3% (97.0-97.6%) vs. 97.1% (96.6-97.4%), 93.6% (93.2-94.1%) vs. 93.4% (92.8-94.0%), and 55.7% (54.0-57.4%) vs. 58.1% (55.8-60.3%), respectively. The oldest age group was associated with lower survival rates in all periods. PCI with stent placement had higher survival rates than those without stent placement during a two-year follow-up. After that, both procedures had similar survival rates (HR 0.91, 95% CI 0.82-1.00). Conclusions: In a population of real-world patients, women had a higher survival rate than men within 15 years after PCI. Moreover, using a bare-metal stent failed to improve survival rates after a two-year follow-up compared to simple balloon angioplasty.

Resumo Fundamento: A intervenção coronariana percutânea (ICP) é o tratamento invasivo mais frequentemente realizado na doença isquêmica do coração (DIC). Estudos capazes de prover informação sobre a sua efetividade são importantes. Objetivo: Avaliar a sobrevida em até 15 anos de pacientes submetidos a ICP no estado do Rio de Janeiro (ERJ). Métodos: Bases de dados administrativas (1999-2010) e de óbitos (1999-2014) dos residentes com idade ≥ 20 anos do ERJ submetidos a uma única ICP paga pelo Sistema Único de Saúde (SUS) entre 1999-2010 foram relacionadas. Os pacientes foram agrupados em 20-49, 50-69 ou ≥ 70 anos, e as ICP em primária (ICP-P), sem stent (ICP-SS) e com stent convencional (ICP-CS). As probabilidades de sobrevida em 30 dias, um ano e 15 anos foram estimadas pelo método de Kaplan-Meier. Modelos de regressão de risco de Cox foram utilizados para comparar riscos entre sexo, faixas etárias e tipos de ICP. Resultados dos testes com um valor de p < 0,05 foram considerados estatisticamente significativos. Resultados: Foram analisados os dados de 19.263 pacientes (61±11 anos, 63,6% homens). A sobrevida de homens vs. mulheres em 30 dias, um ano e 15 anos foram: 97,3% (97,0-97,6%) vs. 97,1% (96,6-97,4%), 93,6% (93,2-94,1%) vs. 93,4% (92,8-94,0%), e 55,7% (54,0-57,4%) vs. 58,1% (55,8-60,3%), respectivamente. Idade ≥ 70 anos foi associada à menor taxa de sobrevida em todos os períodos. A ICP-CS foi associada a uma sobrevida maior do que a ICP-SS até dois anos de acompanhamento, e após este período ambos os procedimentos apresentaram taxas de sobrevida semelhantes (HR 0,91, IC 95% 0,82-1,00). Conclusões: Mulheres apresentaram maiores taxas de sobrevida em 15 anos após ICP, e o uso de stent convencional não esteve associado a um aumento de sobrevida em longo prazo.

Anthropometric Profile, Serum Leptin, Antioxidant Vitamins, LEPR Q223R Polymorphism and Cardiovascular Risk Factors in Adolescents.

Cardiovascular disease (CVD) risk factors, such as bad eating habits, are typical in adolescence and lead to the consumption of meals that are not always sufficient in vitamins A, E, ß-carotene, excess calories and elevated serum leptin levels. The purpose of this research is to study the relationship between vitamin A deficiency (VAD), ß-carotene deficiency (ßcD), vitamin E deficiency (VED) and to explore the association of leptin receptor Q223R polymorphisms with obesity and other risk factors for CVD. Method: This observational study included 237 adolescents recruited from Adolescents Reference Center, Brazil. It was collected: socioeconomic and clinical data, laboratory and molecular samples. Results: The average age was 14.93 ± 2.18 years, 66.2 % were girls, 38.0 % had high levels of total cholesterol (TC) between 10-14 years Triceps (TSF) and subscapular skinfolds (SSF) measurements were inversely correlated with VAD. There was also an association between VAD, ßcD and high triglyceride (TG) levels. Adolescents with the RR genotype presented a trend toward higher levels of body mass index (BMI), waist circumference (WC), systolic blood pressure (SBP), TC, TG, low density lipoprotein (LDLC), leptin and low levels of high-density lipoprotein (HDL-c). Conclusion: The girls had higher levels of leptin than boys. Abdominal fat, ßcD and VED were observed in adolescents with VAD. Individuals with RR genotype have drawn attention to cardiovascular risk factors such as high rate of LDLC and reduced rate of HDLc. Thus, it is possible that individuals with this genotype may be more susceptible to the presence of cardiovascular risk factors.

Medium-term outcomes of 78,808 patients after heart valve surgery in a middle-income country: a nationwide population-based study.

BACKGROUND: Heart valve surgery outcomes are unknown in middle-income countries and thus cannot be used in health system decision making processes. This study estimated in-hospital mortality and medium and long-term survival. METHODS: This was a retrospective study of 78,806 patients who underwent heart valve surgery between 2001 and 2007 in Brazil. Two national databases were used, the Hospital Information System and the Mortality Information System. Kaplan-Meier survival analysis and log-rank tests were performed. Maximum and median follow-up was 7.7 and 2.8 years, respectively (0.002-7.707). RESULTS: Valve replacement accounted for 69.1% of procedures performed. Mitral stenosis, the most common valve injury, represented 38.9% of the total. In 94.7% of mitral stenosis patients, aetiology was rheumatic heart disease. In-hospital mortality was 7.6% and was higher for women, for patients who had undergone concomitant coronary artery bypass grafting (CABG) and for the elderly. Overall survival was 69.9% at the end of follow-up. Survival was worst among elderly, male and concomitant CABG patients (P<0.001). CONCLUSIONS: Rheumatic heart disease is still a major public health problem in Brazil. In-hospital mortality and global survival rates of patients who have undergone heart valve surgery were less satisfactory than those reported in high-income countries. The findings of this study can contribute to guiding decision making processes in middle-income countries similar to Brazil and others concerned with improving the quality of care.

E2F transcription factors associated with up-regulated genes in glioblastoma.

BACKGROUND: Glioblastoma is considered to the most common and malignant brain tumor in adults. Patients have a median survival of approximately one year from diagnosis due to poor response to therapy. OBJECTIVE: We applied bioinformatics approaches to predict transcription factors (TF) that are deregulated in glioblastoma in an attempt to point out molecular targets for therapy. METHODS: Up-regulated genes in glioblastoma selected from public microarray data were submitted to two TF association analyses. Thereafter, the expression levels of TF obtained in the overlap of analyses were assessed by RT-qPCR carried out in seven glioblastoma cell lines (T98, U251, U138, U87, U343, M059J, and M059K). RESULTS: E2F1 and E2F4 were highlighted in both TF analyses. However, only E2F1 was confirmed as significantly up-regulated in all glioblastoma cell lines in vitro. CONCLUSION: E2F1 is a potential common regulator of differentially expressed genes in glioblastoma, despite the genetic heterogeneity of tumor cells.

Tendências e Letalidade Hospitalar dos Procedimentos de Revascularização Miocárdica Pagos pelo SUS no Estado do Rio de Janeiro, 1999-2010 / Trends and Hospital Mortality in Myocardial Revascularization Procedures Covered by the Brazilian Unified Health System in Rio de Janeiro State from 1999 to 2010

As doenças isquêmicas do coração (DIC) são causas de morte relevantes no Estado do Rio de Janeiro (ERJ). A cirurgia de revascularização do miocárdio (CRVM) e a angioplastia coronariana (AC) objetivam reduzir agravos causados pelas DIC. É preciso conhecer a eficiência desses procedimentos para decisões clínica e gerenciais. Objetivo: Descrever evolução temporal e letalidade hospitalar de CRVM e AC de 1999 a 2010 no ERJ. Métodos: Estudo de dados referentes às CRVM e AC dos bancos de dados das Autorizações de Internação Hospitalar pagas pelo Sistema Único de Saúde, de 1999 a 2010 no ERJ, com informações sobre diagnóstico, idade, sexo, data e duração da internação, tipo de alta hospitalar. Foram realizadas estatísticas descritivas e regressão linear para análise de tendências. Resultados: Em 34 413 pacientes com média de idade 61±10 anos, foram realizados 38 509 procedimentos, sendo 66,3% AC e 65,4% homens. Ocorreu aumento anual de 15,8% das AC e de 3,2% das CRVM. O diagnóstico de DIC aguda foi registrado em 60,6% das internações relacionadas a AC e 57,9% das relacionadas a CRVM. As medianas de duração de internação foram de 2 dias nas AC e 10 nas CRVM. As letalidades hospitalares encontradas nas AC e nas CRVM foram de 1,8% e 6,8%, respectivamente, maiores nos indivíduos com 70 anos ou mais, nas mulheres e nas DIC agudas. Conclusão: Houve um aumento nos procedimentos de revascularização miocárdica no ERJ, principalmente nas AC com stent, divergindo de outras regiões do mundo. Além disso, a letalidade hospitalar após a AC e a CRVM foram superiores às encontradas em outros locais e em estudos controlados.

Background: Ischemic heart diseases (IHD) are important causes of deaths in the state of Rio de Janeiro (RJ). Coronary artery bypass grafting (CABG) and coronary angioplasty (CA) procedures aim to mitigate the effects of IHD. Awareness of the efficiency of these procedures is crucial for clinical and administrative decision making. Objective: To describe temporal evolution and hospital mortality of CABG and CA performed in RJ from 1999 to 2010. Methods: Study on data of CA and CABG, covered by the Brazilian Unified Health System in RJ from 1999 to 2010, obtained from the Authorization for Hospital Admission database, concerning diagnosis, age, sex, admission date and hospital internment duration, and type of hospital discharge. Trends analysis was performed by descriptive statistics and linear regression analysis. Results: In 34,413 patients with mean age of 61±10 years, 38,509 procedures were performed, 66.3% CA and 65.4% in men. There was an annual increase by 15.8% in CA and 3.2% in CABG. The diagnosis of acute IHD was recorded in 60.6% of admissions related to CA, and in 57.9% of admissions related to CABG. Median hospital stay was 2 days in CA and 10 days in CABG. Hospital mortality was 1.8% and 6.8% in CA and CABG, respectively, and was higher in patients aged 70 years or older, in women and in acute IHD. Conclusion: The number of myocardial revascularizations in RJ, especially CA with stent, has increased which differs from other regions of the world. In addition, post-CA and post-CABG hospital mortality was higher than that reported in other locations and controlled studies.

HEB silencing induces anti-proliferative effects on U87MG cells cultured as neurospheres and monolayers.

Glioblastoma multiforme (GBM) is a lethal tumor and novel strategies are required to overcome resistance. Transcription factor 12 (HEB) has been associated with neural and stem cell proliferation, is overexpressed in certain tumor types and is induced in irradiated U87MG cells. The present study aimed to determine whether HEB knockdown, with or without irradiation, may sensitize GBM cells. U87MG GBM and ACBRI­371 primary human astrocytes were cultured in monolayers or neurospheres. Cell proliferation and death, cell cycle and sub­G1 detection, and cluster of differentiation (CD) 133 immunofluorescence were analyzed by flow cytometry, whereas HEB protein expression was analyzed by immunocytochemistry and western blotting. Greater HEB protein expression was observed in U87MG neurospheres compared with ACBRI­371, and the two cell lines exhibited nuclear HEB expression. HEB silencing in cells grown in monolayers induced a significant reduction in proliferation and decreased the proportion of cells in G0/G1 phase. In addition, HEB silencing reduced (two­fold) the number of neurospheres compared with control scrambled (SCR) cells. HEB silencing combined with irradiation reduced U87MG cell proliferation when cultured in monolayers and reduced neurosphere cell number compared with the SCR irradiated group; however, not significantly. Differentiation of U87MG cells from neurospheres was reduced in HEB­silenced cells, whereas in irradiated cells the proportion of CD133+ cells was similar in HEB­silenced cells compared with the SCR control. These results suggest that HEB may contribute to the proliferation and maintenance of GBM cells. However, only limited effects were exerted by irradiation in HEB­silenced cells. HEB may be a potential target to decrease proliferation in U87MG GBM cells, grown as monolayers or neurospheres, and may provide important information for the development of novel strategies for cancer therapy.

APE1/REF-1 down-regulation enhances the cytotoxic effects of temozolomide in a resistant glioblastoma cell line.

Temozolomide (TMZ) is widely used for patients with glioblastoma (GBM); however, tumor cells frequently exhibit drug-resistance. Base excision repair (BER) has been identified as a possible mediator of TMZ resistance, and an attractive approach to sensitizing cells to chemotherapy. Human apurinic/apyrimidinic endonuclease/redox factor-1 (APE1) is an essential enzyme with a role in the BER pathway by repairing abasic sites, and it also acts as a reduction factor, maintaining transcription factors in an active reduced state. Thus, we aimed to investigate whether the down-regulation of APE1 expression by siRNA can interfere with the resistance of GBM to TMZ, being evaluated by several cellular and molecular parameters. We demonstrated that APE1 knockdown associated with TMZ treatment efficiently reduced cell proliferation and clonogenic survival of resistant cells (T98G), which appears to be a consequence of increased DNA damage, S-phase arrest, and H2AX phosphorylation, resulting in apoptosis induction. On the contrary, for those assays, the sensitization effects of APE1 silencing plus TMZ treatment did not occur in the TMZ-sensitive cell line (U87MG). Interestingly, TMZ-treatment and APE1 knockdown significantly reduced cell invasion in both cell lines, but TMZ alone did not reduce the invasion capacity of U87MG cells, as observed for T98G. We also found that VEGF expression was down-regulated by TMZ treatment in T98G cells, regardless of APE1 knockdown, but U87MG showed a different response, since APE1 silencing counteracted VEGF induction promoted by TMZ, suggesting that the APE1-redox function may play an indirect role, depending on the cell line. The present results support the contribution of BER in the GBM resistance to TMZ, with a greater effect in TMZ-resistant, compared with TMZ-sensitive cells, emphasizing that APE1 can be a promising target for modifying TMZ tolerance. Furthermore, genetic characteristics of tumor cells should be considered as critical information to select an appropriate therapeutic strategy.

Survival and Predictive Factors of Lethality in Hemodyalisis: D/I Polymorphism of The Angiotensin I-Converting Enzyme and of the Angiotensinogen M235T Genes / Sobrevida e Fatores Preditores de Letalidade em Hemodiálise: Polimorfismos D/I do Gene da Enzima Conversora da Angiotensina I e o M235T do Angiotensinogênio

Background: End-stage kidney disease patients continue to have markedly increased cardiovascular disease morbidity and mortality. Analysis of genetic factors connected with the renin-angiotensin system that influences the survival of the patients with end-stage kidney disease supports the ongoing search for improved outcomes. Objective: To assess survival and its association with the polymorphism of renin-angiotensin system genes: angiotensin I-converting enzyme insertion/deletion and angiotensinogen M235T in patients undergoing hemodialysis. Methods: Our study was designed to examine the role of renin-angiotensin system genes. It was an observational study. We analyzed 473 chronic hemodialysis patients in four dialysis units in the state of Rio de Janeiro. Survival rates were calculated by the Kaplan-Meier method and the differences between the curves were evaluated by Tarone-Ware, Peto-Prentice, and log rank tests. We also used logistic regression analysis and the multinomial model. A p value ≤ 0.05 was considered to be statistically significant. The local medical ethics committee gave their approval to this study. Results: The mean age of patients was 45.8 years old. The overall survival rate was 48% at 11 years. The major causes of death were cardiovascular diseases (34%) and infections (15%). Logistic regression analysis found statistical significance for the following variables: age (p = 0.000038), TT angiotensinogen (p = 0.08261), and family income greater than five times the minimum wage (p = 0.03089), the latter being a protective factor. Conclusions: The survival of hemodialysis patients is likely to be influenced by the TT of the angiotensinogen M235T gene. .

Fundamento: Os pacientes em hemodiálise continuam tendo um significativo aumento na morbiletalidade, especialmente a causada por doenças cardiovasculares. A análise dos fatores genéticos ligados ao sistema renina-angiotensina que influenciam na sobrevivência destes pacientes poderá ajudar na busca por melhores resultados. Objetivo: Avaliar a sobrevida em hemodialisados e sua associação com polimorfismo dos genes do sistema reninaangiotensina: deleção/inserção do gene que codifica a enzima conversora da angiotensina I e o M235T do angiotensinogênio. Métodos: Estudo observacional desenhado para ver o papel dos genes do sistema renina-angiotensina. Foram analisados 473 pacientes tratados com hemodiálise crônica em quatro unidades de diálise do Estado do Rio de Janeiro. As taxas de sobrevida foram calculadas pelo método de Kaplan-Meier e as diferenças entre as curvas avaliadas pelos testes de: Tarone-Ware, Peto-Prentice e Log-rank. Foram utilizados também modelos de regressão logística e multinomial. Um valor de p ≤ 0,05 foi considerado estatisticamente significativo. O comitê de ética aprovou este estudo. Resultados: A idade média dos pacientes foi de 45,8%. A taxa de sobrevida global foi de 48% em 11 anos. As principais causas de óbito foram: doenças do aparelho circulatório (34 %) e infecções (15%). A análise de regressão logística encontrou significância estatística para as seguintes variáveis: idade, o TT do angiotensinogênio e a renda familiar acima de cinco salários mínimos, esta última como fator de proteção (p valor: 0,000038, 0,08261 e 0,03089, respectivamente). Conclusões: Nossos dados sugerem que o risco de letalidade em pacientes em hemodiálise pode ser influenciado também pelo polimorfismo ...

Survival and predictive factors of lethality in hemodialysis: D/I polymorphism of the angiotensin I-converting enzyme and of the angiotensinogen M235T genes.

BACKGROUND: End-stage kidney disease patients continue to have markedly increased cardiovascular disease morbidity and mortality. Analysis of genetic factors connected with the renin-angiotensin system that influences the survival of the patients with end-stage kidney disease supports the ongoing search for improved outcomes. OBJECTIVE: To assess survival and its association with the polymorphism of renin-angiotensin system genes: angiotensin I-converting enzyme insertion/deletion and angiotensinogen M235T in patients undergoing hemodialysis. METHODS: Our study was designed to examine the role of renin-angiotensin system genes. It was an observational study. We analyzed 473 chronic hemodialysis patients in four dialysis units in the state of Rio de Janeiro. Survival rates were calculated by the Kaplan-Meier method and the differences between the curves were evaluated by Tarone-Ware, Peto-Prentice, and log rank tests. We also used logistic regression analysis and the multinomial model. A p value ≤ 0.05 was considered to be statistically significant. The local medical ethics committee gave their approval to this study. RESULTS: The mean age of patients was 45.8 years old. The overall survival rate was 48% at 11 years. The major causes of death were cardiovascular diseases (34%) and infections (15%). Logistic regression analysis found statistical significance for the following variables: age (p = 0.000038), TT angiotensinogen (p = 0.08261), and family income greater than five times the minimum wage (p = 0.03089), the latter being a protective factor. CONCLUSIONS: The survival of hemodialysis patients is likely to be influenced by the TT of the angiotensinogen M235T gene.

Regeneração óssea guiada em implantodontia - relato de caso / The guided bone regeneration in implant dentistry - case report

Objetivo: a utilização de métodos de regeneração te-cidual tem sido amplamente empregada na Implanto-dontia em situações clínicas com deficiências ou limi-tações anatômicas que impossibilitam a instalação de implantes osseointegrados. A evolução no desenvolvi-mento de biomateriais revolucionou essa modalidade terapêutica facilitando a resolução clínica de casos com deficiências teciduais. Sendo assim, o intuito des-te trabalho foi realizar a descrição de um caso clíni-co, abordando os métodos, as técnicas e os materiais empregados em regeneração óssea guiada aplicada à implantodontia. Relato de Caso: um caso clínico de um paciente que recebeu implante dentário do tipo cone--morse (região: 15) é descrito. Houve necessidade de utilização de biomaterial e membrana na parede vesti-bular do alvéolo. Após o período de osseointegração, realizou-se a cirurgia de reabertura e, confeccionou--se um provisório imediato. Decorridos 2 meses de acompanhamento, realizou-se a confecção da prótese definitiva, envolvendo outros elementos adjacentes. Considerações finais: A técnica de regeneração óssea guiada empregada apresentou desempenho satisfató-rio. O paciente demonstrou-se favorável no quesito de estética e função. Entretanto, mais estudos controlados e com maior período de acompanhamento são neces-sários para análises de previsibilidade.

Tumor odontogênico queratocístico - relato de caso / Odontogenic keratocyst tumor - a case report

Introdução: O Tumor Odontogênico Queratocístico (TOQ)deriva dos restos lâmina dentária com particularidades easpectos histológicos específicos, com alto índice de recidiva ecomportamento clínico agressivo. Apresenta certa predileçãopara o sexo masculino, acometendo a mandíbula de 60% a 80%dos casos, podendo estar relacionado a dente incluso de 25 a45% dos casos. Objetivo: evidenciar as características clínicas,imaginológicas e histopatológicas do TOQ, bem como discutirsobre o tratamento desta lesão. Relato de Caso: Paciente de 10anos de idade que ao procurar o ortodontista para correção demordida aberta anterior, observou-se na ortopantomografia árearadiolúcida, na região do corpo de mandíbula, associada à inclusãopatológica do pré-molar inferior. Foi realizada biópsia incisionalda lesão e o laudo histopatológico foi de tumor odontogênicoqueratocístico. Realizou-se uma tomografia computadorizadapara avaliar a extensão da lesão e sua relação com as estruturasanatômicas. Como conduta, optou-se pela extração do molarinferior decíduo e enucleação da lesão, preservando o pré-molarincluso. O mesmo segue em controle clínico-radiográfico de 18meses, após a remoção do TOQ obtendo-se a erupção do prémolarque estava envolvido na lesão. Comentários Finais: Épreciso adotar protocolos de atenção odontológica que incluemo conhecimento de diagnóstico bucal, anamnese e avaliaçãoclínica criteriosa sem esquecer a necessidade de confirmaçãohistopatológica.

Sobrevida de hemodialisados e sua associação com os polimorfismos dos genes da ECA e do angiotensinogênio / Survival rate for hemodialysis patients and association with angiotensionogen and ACE gene polymorphisms

Fundamentos: A letalidade dos pacientes em hemodiálise(HD) é alta. Apenas os fatores de risco cardiovascular tradicionais não são capazes de explicar essa elevada taxa.Objetivo: Avaliar a sobrevida e sua associação com o polimorfismo dos genes do sistema renina-angiotensina(SRA): inserção/deleção da ECA e o M235T do angiotensinogênio em pacientes em hemodiálise. Métodos: Analisaram-se inicialmente 473 pacientes tratados com HD crônica em quatro unidades de diálise do estado do Rio de Janeiro. Curvas de sobrevida foram calculadas pelo método de Kaplan-Meier e as diferenças avaliadas pelos testes de Tarone-Ware e de Peto-Prentice. Resultados: Na população de 82 pacientes, com tempo de HD até um ano que se encontrava em equilíbrio de Hardy-Weinberg, a média de idade foi 53±15 anos, sendo 55% homens. A taxa de sobrevida global foi 74% e 44%em cinco e 11 anos, respectivamente. Principais causas de óbito foram: doenças do aparelho circulatório 41%, infecções 15% e diabetes mellitus 15%. A regressão logística mostrou uma tendência (p=0,0844) de menor sobrevida para o polimorfismo TT com razão de chances de 3,931 (IC 95%: 0,128 a 1,231).Conclusões: Os dados sinalizaram uma tendência de que o risco de letalidade em pacientes em HD pode ser influenciado não só por fatores de risco cardiovascular bem conhecidos como idade e diabetes mellitus, mas também pelo polimorfismo TT do angiotensinogênio.

Background: The lethality rate for hemodialysis (HD)patients is high, which cannot be explained by traditional cardiovascular risk factors alone. Objective: To assess the survival rate and its association with the polymorphism of reninangiotensin system genes: ACE insertion/deletion and angiotensinogen M235T in HD patients. Methods: The initial analysis encompassed 473 chronic patients treated at four dialysis units in Rio de Janeiro State. The survival curves were calculated by the Kaplan-Meier method, with the differences between them evaluated by the Tarone-Ware and Peto-Prentice Tests. Results: For the population of 82 patients with up to1 year of HD in Hardy–Weinberg equilibrium, themean age was 53±15 years, of whom 55% were men.The overall survival rates were 74% and 44% at 5 and11 years respectively. The major causes of death were circulatory system diseases (41%), infections (15%)and diabetes mellitus (15%). The logistic regression models presented a trend (p=0.0844) towards a shorter survival time for the TT polymorphism with an oddsratio of 3.931 (95% CI: 0.128 to 1.231). Conclusions: The data indicate a possibility that the lethality risk of HD patients may be influenced not only by well-known cardiovascular risk factors sucha sageand diabetes mellitus, butalsob y angiotensinogen TT polymorphism.

Cytogenetic instability in childhood acute lymphoblastic leukemia survivors.

Contemporary anticancer therapies have largely improved the outcome for children with cancer, especially for Acute Lymphoblastic Leukemia (ALL). Actually, between 78% and 85% of patients achieve complete remission and are alive after 5 years of therapy completion. However, as cure rates increase, new concerns about the late effects of genotoxic treatment emerge, being the risk of developing secondary neoplasias, the most serious life-threatening rising problem. In the present paper, we describe and review the cytogenetic findings in peripheral lymphocytes from ALL survivors, and discuss aspects associated to the occurrence of increased chromosome rearrangements in this growing cohort.

Sobrevida nas reperfusões miocárdicas cirúrgicas e nas angioplastias coronarianas pagas por seguros de saúde e privados no Estado do Rio de Janeiro, 2000 a 2007 / Survival in coronary artery bypass grafts and coronary angioplasties paid privately or by health insurance in Rio de Janeiro State: 2000-2007

Fundamentos: A cirurgia de revascularização miocárdica (RVM) e a angioplastia coronariana (AC) são procedimentos comuns na prática clínica, que precisam ser continuamente avaliados. Objetivos: Estudar a sobrevida nos indivíduos submetidos à RVM ou AC no Estado do Rio de Janeiro (ERJ), pagas por seguros de saúde e privados, no período de 2000 a 2007. Métodos: Estudo utilizando bancos de dados para identificar os indivíduos submetidos aos procedimentos e aqueles que morreram, para estimar a sobrevida. As informações sobre RVM e AC provieram das Comunicações de Internação Hospitalar (CIH) e sobre óbitos das Declarações de Óbitos. Foi realizado relacionamento probabilístico entre os bancos com o programa RecLink para identificar os indivíduos que morreram após os procedimentos. Resultados: Apenas 980 procedimentos foram notificados em oito anos em 937 indivíduos residentes no ERJ. No interior do ERJ foram realizadas 32,4 por cento das RVM dos 509 indivíduos submetidos ao procedimento, enquanto as demais foram feitas em outros estados, 66,6 por cento em São Paulo (SP). Foram identificados 428 indivíduos com AC, 71,7 por cento realizadas no interior do ERJ e as demais nos outros estados, 22,8 por cento em SP. Não foi encontrada qualquer...