RESUMO
The angiotensin-converting enzyme 2 (ACE2) is the receptor for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It is highly expressed in adipose tissue, possibly associated with progression to severe coronavirus disease 2019 (COVID-19) in obese subjects. We searched the Gene Expression Omnibus (GEO) and reanalyzed the GSE59034 containing microarray data from subcutaneous white adipose tissue (sWAT) biopsies from 16 women before and 2 years after RYGB, and 16 controls matched by sex, age, and BMI. After RYGB, there was a significant decrease in sWAT ACE2 gene expression (logFC=-0.4175, P=0.0015). Interestingly, after RYGB the sWAT ACE2 gene expression was significantly lower than in non-obese matched controls (LogFC=-0.32875, P=0.0014). Our data adds to the well-known benefits of RYGB, a potential protective mechanism against COVID-19.
Assuntos
COVID-19 , Derivação Gástrica , Obesidade Mórbida , Tecido Adiposo , Enzima de Conversão de Angiotensina 2 , Feminino , Expressão Gênica , Humanos , Obesidade Mórbida/cirurgia , Peptidil Dipeptidase A/genética , SARS-CoV-2RESUMO
OBJECTIVE: Diffusion-weighted magnetic resonance imaging (DWI) is part of clinical practice. The aim of this study was to evaluate the role of apparent diffusion coefficient (ADC) as a predictor of pathologic response to neoadjuvant therapy (nCRT) in patients with esophageal cancer (EC). METHODS: The MEDLINE, Embase, and Google Scholar databases were systematically searched for studies using ADC to evaluate response to neoadjuvant therapy in patients with EC. Methodological quality of the studies was evaluated with the QUADAS tool. Data from eligible studies were extracted and evaluated by two independent reviewers. Meta-analyses were performed comparing mean ADC values between responders and non-responders to nCRT in three different scenarios: baseline (BL) absolute values; percent change between intermediate (IM) values and BL; and percent change between final follow-up (FU) value and baseline BL. RESULTS: Seven studies (n = 158 patients) were included. Responders exhibited a statistically significant percent increase in ADC during nCRT (mean difference [MD] 21.06%, 95%CI = 13.04-29.09; I2 = 49%; p = 0.12). A similar increase was identified in the complete pathologic response (pCR) versus non-complete pathologic response (npCR) subgroup (MD = 25.68%, 95%CI = 18.87-32.48; I2 = 0%; p = 0.60). At the end of treatment, responders also exhibited a statistically significant percent increase in ADC (MD = 22.49%, 95%CI = 9.94-35.05; I2 = 0%; p = 0.46). BL ADC was not associated with any definition of pathologic response (MD = 0.11%, 95%CI = - 0.21-0.42; I2 = 85%; p < 0.01). CONCLUSION: These results suggest that ADC can be used as a predictor of pathologic response, with a statistically significant association between percent ADC increase during and after treatment and pCR. ADC may serve as a tool to help in guiding clinical decisions. KEY POINTS: ⢠DWI is routinely included in MRI oncological protocols. ⢠ADC can be used as a predictor of pathologic response, with a statistically significant association between percent ADC increase during and after treatment and pCR.
Assuntos
Imagem de Difusão por Ressonância Magnética/métodos , Neoplasias Esofágicas/terapia , Neoplasias Esofágicas/diagnóstico , Humanos , Terapia Neoadjuvante/métodos , Resultado do TratamentoRESUMO
BACKGROUND: Immune imbalance and inflammation have been suggested as key factors of Barrett's esophagus (BE) pathway towards adenocarcinoma. The neutrophil-lymphocyte ratio (NLR) indirectly reflects the relation between innate and adaptive immune systems and has been studied in premalignant conditions as a biomarker for cancer diagnosis. Our aim was to investigate if increasing values of NLR correlated with advancing stages of BE progression to dysplasia and neoplasia. METHODS: We retrospectively analyzed data of patients with biopsies reporting BE between 2013 and 2017 and with a complete blood count within 6 months from the endoscopy, as well as patients with esophageal adenocarcinoma (EAC). NLR was calculated as neutrophil count/lymphocyte count. Cases (n = 113) were classified as non-dysplastic BE (NDBE, n = 72), dysplastic BE (DBE, n = 11) and EAC (n = 30). RESULTS: NLR progressively increased across groups (NDBE, 1.92 ± 0.7; DBE, 2.92 ± 1.1; EAC 4.54 ± 2.9), with a significant correlation between its increasing value and the presence of dysplasia or neoplasia (r = 0.53, p < 0.001). NLR > 2.27 was able to diagnose EAC with 80% sensitivity and 71% specificity (area under the curve = 0.8). CONCLUSION: NLR correlates with advancing stages of BE progression, a finding that reinforces the role of immune imbalance in EAC carcinogenesis and suggests a possible use of this marker for risk stratification on surveillance strategies.
Assuntos
Adenocarcinoma/sangue , Adenocarcinoma/etiologia , Esôfago de Barrett/sangue , Esôfago de Barrett/patologia , Neoplasias Esofágicas/sangue , Neoplasias Esofágicas/etiologia , Linfócitos , Neutrófilos , Adenocarcinoma/patologia , Esôfago de Barrett/complicações , Estudos Transversais , Progressão da Doença , Neoplasias Esofágicas/patologia , Feminino , Humanos , Hiperplasia , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: Gastroesophageal reflux disease (GERD) impacts choice and outcomes of bariatric surgery. However, GERD diagnosis based solely on symptoms yields inaccurate results. OBJECTIVE: To determine the factors associated with a positive 24h pH-monitoring (pH-test) or esophagitis in patients with severe obesity seeking bariatric surgery. SETTING: Private practice. METHODS: 93 patients with severe obesity underwent prospective evaluation for GERD symptoms, body composition, upper gastrointestinal endoscopy, esophageal manometry and pH-test. Correlation analyses were performed. RESULTS: 50 patients (53.8%) had GERD symptoms, 49 (52.7%) had esophagitis and 33 (35.5%) had a positive pH-test. Among patients with GERD symptoms, 18% had normal pH-test and no esophagitis, while 34.9% of patients without GERD symptoms had positive pH-test, esophagitis or both. Factors independently associated with positive pH-test were esophagitis (PR:3.08, 95%CI: 1.4-6.9, Pâ¯=â¯0.006) and defective lower esophageal sphincter (PR:1.88, 95%CI: 1.09-3.21, Pâ¯=â¯0.02). Factors independently associated with esophagitis were hiatal hernia (PR: 2.46; 95%CI: 1.6-3.7, P<0.001), GERD symptoms (PR:2.09; 95%CI: 1.3-3.4, Pâ¯=â¯0.003) and positive pH-test (PR:1.82; 95%CI: 1.2-2.7, Pâ¯=â¯0.003). The combined presence of GERD symptoms and esophagitis had a low positive predictive value for a positive pH-test (57%). On the other hand, the absence of both GERD symptoms and esophagitis had a 90% predictive value for a negative pH-test. CONCLUSIONS: Investigation for GERD before bariatric surgery should consist of routine upper endoscopy and GERD symptom evaluation in all patients. Patients with GERD symptoms and no esophagitis may need a pH-test for GERD diagnosis. Prospective studies are needed to understand significance of GERD diagnosis prior to bariatric surgery.
Assuntos
Cirurgia Bariátrica , Esofagite/diagnóstico , Refluxo Gastroesofágico/diagnóstico , Obesidade Mórbida/cirurgia , Adulto , Composição Corporal , Brasil , Endoscopia do Sistema Digestório , Monitoramento do pH Esofágico , Feminino , Humanos , Masculino , Manometria , Cuidados Pré-Operatórios , Estudos ProspectivosRESUMO
BACKGROUND: Alzheimer's disease is the most common dementia in the elderly, and the potential of peripheral biochemical markers as complementary tools in the neuropsychiatric evaluation of these patients has claimed further attention. METHODS: We evaluated serum levels of S100B and neuron-specific enolase (NSE) in 54 mild, moderate and severe Alzheimer's disease (AD) patients and in 66 community-dwelling elderly. AD patients met the probable NINCDS-ADRDA criteria. Severity of dementia was ascertained by the Clinical Dementia Rating (CDR) scale, cognitive function by the Mini Mental State Examination (MMSE), and neuroimage findings with magnetic resonance imaging. Serum was obtained from all individuals and frozen at -70 degrees C until analysis. RESULTS: By comparing both groups, serum S100B levels were lower in AD group, while serum NSE levels were the same both groups. In AD patients, S100B levels were positively correlated with CDR scores (rho = 0.269; p = 0.049) and negatively correlated with MMSE scores (rho = -0.33; P = 0.048). NSE levels decreased in AD patients with higher levels of brain atrophy. CONCLUSIONS: The findings suggest that serum levels of S100B may be a marker for brain functional condition and serum NSE levels may be a marker for morphological status in AD.
Assuntos
Doença de Alzheimer/sangue , Fatores de Crescimento Neural/sangue , Fosfopiruvato Hidratase/sangue , Proteínas S100/sangue , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/complicações , Doença de Alzheimer/patologia , Encéfalo/patologia , Transtornos Cognitivos/etiologia , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Subunidade beta da Proteína Ligante de Cálcio S100 , Estatísticas não ParamétricasRESUMO
BACKGROUND: The S100B protein is considered a biochemical marker for brain injuries. However, our group demonstrated that the isolated rat heart releases S100B. In this study, we investigated the serum levels of S100B in dilated cardiomyopathy (DCM) patients to evaluate its levels in heart disease. METHODS AND RESULTS: We selected DCM patients, excluding any condition that could influence S100B serum levels. Control individuals were sex and age matched. Both groups were submitted to clinical evaluation and echocardiography. We measured the S100B and NT-proBNP serum levels (expressed as median [interquartile range]). NT-proBNP levels in patients group (1462 pg/mL [426-3591]) were higher than in controls (35 pg/mL [29-55]), P < .001. S100B serum levels were higher in patients group (0.051 microg/L [0.022-0.144]) than in controls (0.017 microg/L [0.003-0.036]), P = .009. Additionally, we found a positive correlation between S100B and NT-proBNP serum levels only in patients group (Spearman's coefficient r = 0.534; P = .013). CONCLUSIONS: Although we cannot rule out the influence of S100B from brain, the positive correlation between S100B and NT-proBNP levels in DCM patients points to the myocardium as the main source for the rise in S100B serum levels.
Assuntos
Cardiomiopatia Dilatada/sangue , Fatores de Crescimento Neural/sangue , Proteínas S100/sangue , Biomarcadores/sangue , Cardiomiopatia Dilatada/diagnóstico por imagem , Cardiomiopatia Dilatada/fisiopatologia , Progressão da Doença , Ecocardiografia , Feminino , Seguimentos , Humanos , Imunoensaio , Masculino , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Prognóstico , Precursores de Proteínas , Subunidade beta da Proteína Ligante de Cálcio S100 , Índice de Gravidade de Doença , Volume SistólicoRESUMO
S100B is an astrocytic protein assessed in cerebrospinal fluid and serum as a biochemical marker of cerebral injuries. However, increasing evidences suggest the influence of extra cerebral sources on its serum levels. Since it was reported that the injured myocardium expresses S100B, we investigated whether the isolated heart releases this protein. The rat hearts were excised and perfused by the Langendorff technique of isolated heart perfusion. After stabilization, 10 hearts (ischemic group) were submitted to 20 minutes of ischemia and 30 minutes of reperfusion, and 5 hearts (control group) were submitted to 50 minutes of perfusion. The perfusion fluid was collected at pre-ischemia, and 0, 5, 10, 15 and 30 min after ischemia (or equivalent in controls) for S100B and cardiac troponin T (a heart injury marker) assays. In the ischemic group, S100B and troponin T levels increased significantly at time 0 min: S100B values [mug/L, median (IQ25/IQ75)] increased from < or = 0.02 (< or = 0.02/0.03) to 0.38 (0.22/0.84), while troponin T values [mug/L, median (IQ25/IQ75)] increased from 0.31 (0.15/0.45) to 2.84 (2.00/3.63). Our results point to the ischemic heart as an extra cerebral source of S100B.