Retrospective Epidemiological Analysis of Colles’ Fracture in Patients Admitted in Fernandes Távora Hospital

Background: Colles’ fracture is a type of fracture of the distal third of the radius and its most common cause is falling from patient’s own height and, epidemiologically, it is more common in the elderly. Objectives: The main objective of this study is to analyze the epidemiology of Colles’ fracture retrospectively, in patients admitted to Fernandes Távora Hospital. Materials and Methods: This retrospective study conducted at the Fernandes Távora Hospital used 1030 radiographic images of patients with wrist fractures. Results: (After a careful analysis) It was found that this type of fracture occurred with a greater frequency in age groups of 50 to 69, 60 to 69, and 40 to 49 years old, which corresponds to 59.5% of patients and the most affected sex were females (51.1%). Conclusion: The study concluded that this type of bone injury is more common in people aged 40 to 69 years old, especially in women, because of their geometry and bone composition. It is evident that Colles’ fracture impacts the life of the affected person, therefore, an adequate diagnosis and treatment having utmost importance.

Extrahepatic cholestasis associated with paracoccidioidomycosis:Challenges in the differential diagnosis of biliopancreatic neoplasia

BACKGROUND Paracoccidioidomycosis(PCM)may involve the hepatic pedicle and peripan creatic lymph nodes,cause damage to the bile duct and manifest,exceptionally,in combination with extrahepatic cholestasis(EHC),making investigation and treatment challenging.AIM To investigate the management of patients with visceral PCM admitted with EHC.METHODS All patients diagnosed with PCM treated in a public,tertiary teaching hospital between 1982 and 2020 were retrospectively evaluated.Those also identified with EHC were allocated to two groups according to the treatment approach for the purpose of comparing clinical,laboratory,and imaging findings,resources used for etiological diagnosis,treatment results,and prognosis.Statistical analyses were performed using the linear mixed-effects model(random and fixed effects),which was adjusted using the PROC MIXED procedure of the SAS®9.0 software,and Fisher’s exact test.RESULTS Of 1645 patients diagnosed with PCM,40(2.4%)had EHC.Of these,20(50.0%)lived in the rural area and 29(72.5%)were men,with a mean age of 27.1 years(3-65 years).Jaundice as first symptom and weight loss of at least 10 kg were observed in 16 patients(40.0%),and a mass in the head of the pancreas was observed in 8(20.0%).The etiological diagnosis was made by tissue collection during surgery in 4 cases(10.0%)and by endoscopic methods in 3 cases(7.5%).Twenty-seven patients(67.5%)received drug treatment alone(Group 1),whereas 13(32.5%)underwent endoscopic and/or surgical procedures in combination with drug treatment(Group 2).EHC was significantly reduced in both groups(40.7% in Group 1,with a mean time of 3 months;and 38.4% in Group 2,with a mean time of 7.5 months),with no statistically significant difference between them.EHC recurrence rates,associated mainly with treatment nonadherence,were similar in both groups:37% in Group 1 and 15.4% in Group 2.The mortality rate was 18.5% in Group 1 and 23% in Group 2,with survival estimates of 71.3% and 72.5%,respectively,with no statistically significant difference.CONCLUSION Although PCM-related EHC is rare,it needs to be included in the differential diagnosis of malignancies,as timely treatment can prevent hepatic and extrahepatic sequelae.

Association of insertion-deletions polymorphisms with colorectal cancer risk and clinical features

AIM To investigate the association between 16 insertiondeletions(INDEL) polymorphisms, colorectal cancer(CRC) risk and clinical features in an admixed population.METHODS O n e h u n d re d a n d fo r ty p a t i e n t s w i t h C R C a n d 140 cancer-free subjects were examined. Genomic DNA was extracted from peripheral blood samples. Polymorphisms and genomic ancestry distribution were assayed by Multiplex-PCR reaction, separated by capillary electrophoresis on the ABI 3130 Genetic Analyzer instrument and analyzed on Gene Mapper ID v3.2. Clinicopathological data were obtained by consulting the patients' clinical charts, intra-operative documentation, and pathology scoring.RESULTS Logistic regression analysis showed that polymorphism variations in IL4 gene was associated with increased CRC risk, while TYMS and UCP2 genes were associated with decreased risk. Reference to anatomical localization of tumor Del allele of NFKB1 and CASP8 were associated with more colon related incidents than rectosigmoid. In relation to the INDEL association with tumor node metastasis(TNM) stage risk, the Ins alleles of ACE, HLAG and TP53(6 bp INDEL) were associated with higher TNM stage. Furthermore, regarding INDEL association with relapse risk, the Ins alleles of ACE, HLAG, and UGT1A1 were associated with early relapse risk, as well as the Del allele of TYMS. Regarding INDEL association with death risk before 10 years, the Ins allele of SGSM3 and UGT1A1 were associated with death risk.CONCLUSION The INDEL variations in ACE, UCP2, TYMS, IL4, NFKB1, CASP8, TP53, HLAG, UGT1A1, and SGSM3 were associated with CRC risk and clinical features in an admixed population. These data suggest that this cancer panel might be useful as a complementary tool for better clinical management, and more studies need to be conducted to confirm these findings.

Effects on Cell Viability and on Apoptosis in Tumoral(MCF-7)and in Normal(MCF10A)Epithelial Breast Cells after Human Chorionic Gonadotropin and Derivated-Angiotensin Peptides Treatments

Angiotensin-(1 - 7) [Ang-(1 - 7)] is an endogenous heptapeptide hormone of the renin-angiotensin system that has antiproliferative properties. The aim of this work was to evaluate the anti-proliferative and pro-apoptotic properties of Ang-(1 - 7) and of Ang-(1 - 7)-substituents 9-fluorenylmethyloxycarbonyl (Fmoc) e Ang II-derivatives containing the TOAC (2,2,6,6-tetramethylpiperidine-N-oxyl-4-amino-4-carboxylic acid) in normal (MCF10A) and in tumoral (MCF7) epithelial mammary cell lines. Both cell lines received an hCG and angiotensin peptides 24-hour treatment, in combination or alone followed by cell viability, apoptosis and cell cycle assays performed by flow cytometer (GUAVA). After hCG, Ang-(1 - 7), hCG + Ang-(1 - 7) and hCG + Ang-(1 - 7)-Fmoc treatments, MCF7 displayed cell viability decrease and mid-apoptosis increase. We also observed cell viability decrease in MCF10A after Ang-(1 - 7), Ang-(1 - 7) Fmoc and hCG + AngII Toac treatments. These cells had an increase in late apoptosis and necrosis after AngII Toac, hCG + Ang-(1 - 7) and hCG + Ang-(1 - 7)-Fmoc treatments. Regarding the cell cycle analysis, we did not observed any changes in cell cycle phases. In summary, cell viability was decreased and apoptosis (initial, mid and late) was increased after hCG and/or Ang-(1 - 7) peptides treatments. These results point out hCG and Ang-(1 - 7) as effective compounds to inhibit cell proliferation, since they decrease cell viability and increase apoptosis in both normal and in tumoral breast cells, being the effect more pronounced in the tumoral cell line. Our results support the idea of investigating more closely the putative use of these compounds as novel therapeutic agents for breast cancer.

Adaptation of a Brazilian Version of the North/Northeast Region for the Brief Pain Inventory

Purpose: The adaptation of BPI-B into North/Northeast of Brazil. The purpose of this study was the translation and adaptation of the BPI to Portuguese language, as spoken in Brazil, aiming at its posterior usage to measure both intensity and interference of pain in cancer patients’ life. Methods: The BPI-B was developed from the original BPI, using back-translation and committee review. The Back Translation was compared to the original BPI, as a result, the North/Northeast Brazilian version proved to have the same goals, and is similar to other current versions, observing its psychometrics properties. The inventory presented a final sample of 475 patients, whose average age was 54.37 years old (DP = 14.56), most female (58.9%). One hundred ninety-six patients in elementary school took part. It had its objective to group multiple indicators that responded to validation, precision and parsimony criteria. The patients answered the BPI at the very moment they were diagnosed as cancer cases. All of them were above 18 years old and they were also undergoing treatment at Cancer Ambulatory in a Hospital in Ceará, Brazil. The retest was carried, after about a month of the first application. In order to verify the reliability of inventory adaptation, the exploratory factorial analysis was used as the oblique rotation axis. Results: Exploratory factor analysis confirmed two underlying dimensions, pain severity, and pain interference, with Cronbach’s α 0.833 and 0.733, respectively. Conclusion: A proposition of a north/northeast Brazilian version of BPI turned out to be adequate, gathering evidences of adaptation and internal consistency similar to already validated versions.

Angiotensin-(1-7)and Human Chorionic Gonadotropin(hCG)Modulate the Nuclear Transcription Factors or Nuclear Receptors Genes in the Tumorigenic Undifferentiated Breast Cancer Cell Line SKBR3

Breast cancer is the most common cancer among women. Angiotensin-(1 - 7) [Ang-(1 - 7)] has been correlated with cancer antiproliferative and apoptotic effects, similar properties of the human Chorionic Gonadotrofin (hCG). The aims of this work are to evaluate the role of Ang-(1 - 7) and of hCG in modulating the expression of Nuclear Receptors and Coregulators related genes in the tumorigenic breast cell line SK-BR3. Three experimental groups were created: control, hCG and hCG + Ang-(1 - 7). Cells were treated for 11 days and then had their RNA extracted. Samples were loaded into PCR Array plates containing 84 genes relate to Nuclear Receptors and Coregulators pathways. Gene expression data were used to construct canonical pathways (MetacoreTM). hCG and hCG + Ang-(1 - 7) treatments markedly modulate the expression of Nuclear Receptors and Coregulators related genes. hCG differentially expressed 17% of the genes, being 29% upregulated and 71% downregulated. Meanwhile, hCG + Ang-(1 - 7) changed the expression of 30% of the genes on the plate, among these genes 56% were upregulated and 44% downregulated. Among these differentially expressed genes, we highlight Esr1, Nr2f2, and Nr2f1, Esr1, Hdac5, and Nr4A1 (>4 fold). Finally MetaCore analysis based on Gene Ontology (GO) generated six networks for hCG and ten networks for the combined treatment. All generated networks are related to regulation of apoptosis or to Programmed Cell Death processes. In summary, our results herein demonstrate that the modulation of sexual hormones and of other nuclear factor genes expression might underlie the tumorigenic protection effect and the induction of cell differentiation caused by the hormones hCG and Ang-(1 - 7), especially in Cancer Stem Cells.

一氧化氮合成酶、环氧化酶-2、硝基酪氨酸及血管生成与软骨肉瘤预后的相关性研究

背景：免疫组织化学标记物有助于肿瘤诊断及预后评估。通过对硝基酪氨酸分析及采用一氧化氮合成酶1（NOS1）、一氧化氮合成酶2（NOS2）、一氧化氮合成酶3（NOS3）检测分析可了解一氧化氮（NO）与肿瘤的相关性。NO与超氧阴离子反应产生的过氧亚硝酸对基因有毒性作用，过氧亚硝酸传递一个硝基基团到酪氨酸的苯环上形成硝基酪氨酸。细胞内硝基酪氨酸的积累说明过氧亚硝酸持续生成。NO刺激所生成的环氧化酶-2（COX-2）与肿瘤内新生血管水平相关，研究表明新生血管影响肿瘤预后，免疫组化标记CD34可表示微血管生成，从而被用于预测肿瘤预后。本研究检测上述标记物在软骨肉瘤中的表达并分析与软骨肉瘤分级和预后的相关性。方法：101例软骨肉瘤患者肿瘤组织样本采用甲醛固定，组织样本采用免疫组织化学染色，指标为：NOS1、NOS2、NOS3、COX-2、硝基酪氨酸和CD34。5例正常软骨样本作为对照。研究分析患者特征、手术变量、肿瘤分级与这些指标的相关性。使用Kaplan—Meier多变量统计学方法分析生存曲线及生存率。结果：硝基酪氨酸、COX-2和CD34与组织学分级有明显相关性（p=0．022，p=0．014，p=0．028），但与总体预后无相关性（p=0．064，p=0．143，p=0．581）。NOS2阳性表达常预示较高的局部复发率（p=0．038）。NOS1、NOS2阳性表达预示较低的生存率（p=0．007，p〈0．001）。通过多变量分析处理，NOS2的表达被证实可作为局部复发率的独立预后判断因素；NOS1、NOS2的表达作为因变量，它们单独或复合阳性表达常与较低的总生存率有关（p=0．046，p=0．004）[危险率，3．17（95％置信区间，1．0-9．8）和5．58（95％置信区间，1．7-18．0）]。

年龄对布比卡因心脏毒性的影响

背景新生儿和幼儿对消旋布比卡因，即布比卡因的心肌毒性是否敏感一直存有争议。有的研究表明新生儿能耐受比成年人更高的血浆布比卡因浓度，而不产生严重的心肌毒性。本课题比较了大鼠不同鼠龄对消旋布比卡因和左旋布比卡因的心肌毒性的影响，并研究了上述局麻药对细胞内钙离子浓度的调节作用。方法给机械通气的2、4、6、8和16周龄的大鼠分别输注消旋布比卡因或左旋布比卡因[输注速度4mg／（kg·min）]，当监测显示心电活动停止时，所用剂量即定为该鼠龄大鼠的致死剂量。在应用外消旋布比卡因或内消旋布比卡因和不用此类局麻药时，分别以离体乳头肌颤搐测定方法研究局麻药对心肌收缩效应的影响。以裸露的心室肌纤维研究两种局麻药对细胞内钙离子浓度的调节作用。结果2周龄大鼠消旋布比卡因和左旋布比卡因的致死剂量（分别为46．0±5．2mg／kg和91．3±4．9mg／kg）均高于16周龄大鼠（分别为22．7±1．3mg／kg和22．0±2．7mg／kg）。乳头肌颤搐呈剂量相关性减低，且幼龄鼠心肌与成龄鼠心肌之间有显著性差异。在成龄鼠心肌，给予外消旋布比卡因后肌颤搐较对照减低8．6％±0．8％，而给予消旋布比卡因后肌颤搐较对照减低18．1％±2．7％（1001xm）。左旋布比卡因具有〈10μm的正性肌力效应，但仅见于2周龄大鼠。在裸露的心室肌纤维，消旋布比卡因和左旋布比卡因均能促使咖啡因（1mmol／L）激活的肌浆网释放钙离子增多，增加幅度相似，而此效应在幼龄鼠比成龄鼠更为明显。在16周龄大鼠，消旋布比卡因组咖啡因引起的反应是最大效应的53．9％±1．7％，而左旋布比卡因组为最大效应的54．1％±3．2％。在2周龄大鼠，消旋布比卡因组咖啡因引起的反应是最大效应的81．1％±3．7％，左旋布比卡因组为最大效应的78．1％±4．5％。在上两个消旋布比卡因和左旋布比卡因实验鼠龄组，收缩蛋白对钙离子的敏感性呈现同等程度的增加。肌浆网摄取钙离子并不因鼠龄或应用局麻药而发生变化。结论细胞内肌浆网钙离子调节机制的差异可能是幼龄鼠对消旋布比卡因和左旋布比卡因心肌抑制易感性减低的原因。