Orientador: Rafael Zambelli de Almeida Pinto / Resumo: Investigar a capacidade dos diferentes domínios de atividade física, mensurados por meio de instrumentos objetivo e subjetivo, em predizer desfechos clínicos em pacientes com dor lombar crônica não específica. Materiais e métodos: O delineamento do estudo foi de coorte longitudinal com um seguimento de 6 meses. A amostra consistiu de 179 participantes com dor lombar crônica não específica. Na avaliação inicial, os seguintes dados foram coletados: dados antropométricos/ demográficos; duração e intensidade da dor (Escala Numérica de Dor); incapacidade funcional (Questionário de Incapacidade de Roland Morris); medo do movimento (Escala Tampa de Cinesiofobia); depressão (Inventário de Depressão de Beck) e nível de atividade física mensurado por meio do acelerômetro (período de tempo em atividades físicas leves e em atividade física moderada/vigorosa mensurados em minutos por dia, passos por dia e counts por minutos) e por meio do questionário de Atividade Física Habitual de Baecke (atividade física ocupacional, atividade física de lazer e locomoção e exercício físico). Após 6 meses os pacientes foram avaliados em relação a intensidade da dor e incapacidade funcional. Análise de regressão linear multivariada foi utilizada para investigar a associação dos domínios de atividade física com os desfechos clínicos de dor e incapacidade. Resultados: Um total de 179 participantes com dor lombar crônica não específica foram avaliados inicialmente, sendo que 150 participantes utilizaram o a... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: To investigate the ability of different physical activity domains, measured by objective and subjective instruments, in predicting clinical outcomes in chronic non-specific low back pain. Material and methods: Study design was a longitudinal cohort with 6 months follow-up. Sample size was of 179 participants with chronic non-specific low back pain. In the first evaluation, the following data were collected: anthropometric/demographic data; pain duration and intensity (Numerical Rating Scale); functional disability (Roland Morris Disability Questionnaire); fear of movement (Tampa Scale for Kinesiophobia); depression (Beck Depression Inventory) and physical activity levels measured by accelerometer (time spend in light, moderate/ vigorous physical activity, steps per day, Counts per minutes) and by Baecke questionnaire for the evaluation of habitual physical activity (occupational physical activities, leisure and locomotion physical activities and physical exercise). After 6 months patients were evaluated according to pain intensity and functional disability. Multivariate regression analysis was used to investigate the physical activity domains association with pain and disability outcomes. Results: A total of 179 participants with chronic non-specific low back pain were initially evaluated, of those, 150 participants wore accelerometer correctly in the initial evaluation. Results showed occupational physical activity, measured by Baecke questionnaire for the evaluation of habi... (Complete abstract click electronic access below) / Mestre

of dissertation thesis Prognostic and Predictive Factors in Breast Cancer The mRNA Expression of Selected Genes in Normal and Tumor Breast Tissue Samples and Theirs Clinical Value in Breast Cancer L.Šefrhansová Background: The aim of this work was to describe and to evaluate possibilities of prognosis and prediction in breast cancer. Within the framework of this study-work we carry out a prospective clinical study. The aim of this prospective study was to detect mRNA MMP-7, p53 and TIMP-1 expression in normal and tumor breast tissue samples and to determine the clinical and prognostic significance of our results. Prognosis and prediction: The tumor size, lymph node status, presence of distant metastasis, differentiation of the tumor, perivascular invasion, mitotic activity, expression of ER, PR and HER2 receptors are the basic prognostic factors in breast cancer. Age under/above 35 years was included among independent prognostic breast cancer factors in 2005. It is approved to use uPA/PAI to assess prognosis in node negative breast cancer patients. The hormone receptor status and HER-2 receptor status are the only two predictive markers associated with the target therapy. OncotypeDX analysis could be use to predict the disease recurrence interval of patients with estrogen positive and node negative...

Introduction Malaria retinopathy is a set of visible changes in the retina which are specific to falciparum malaria. Studies to date have been mostly limited to comatose African children. Retinal changes in adults with severe malaria and severely unwell patients without malaria have been less well studied and the specificity, pathogenesis, diagnostic and prognostic value of malarial retinopathy in adults are not known. Methods A series of observational studies of retinopathy in Bangladesh, India and Malaysia were done from 2008-2012. The aims were to describe the spectrum of retinal changes in falciparum and knowlesi malaria in adults, determine their specificity for severe falciparum malaria, quantify the impact of malaria retinopathy on visual function, understand its pathogenesis and assess the potential contribution of retinopathy to confirming diagnosis of malarial coma, predicting prognosis and understanding pathogenesis of cerebral malaria. Results 495 patients were enrolled and underwent retinal photography (305 with P. falciparum malaria (112 cerebral, 68 noncerebral severe, 125 uncomplicated), 44 P. knowlesi, 43 sepsis, 41 encephalopathy and 62 healthy). Retinal whitening and white-centred haemorrhages were common and specific to severe falciparum malaria. Retinopathy was most common and severe in cerebral (88%) and fatal (91%) falciparum malaria. Moderate-severe retinopathy was 95% specific for cerebral malaria in comatose patients, and its severity correlated with depth of coma. Vessel whitening was not seen and papilloedema was rare. In noncerebral severe falciparum malaria, retinopathy predicted increased likelihood of later development of coma and death. Retinal findings in Bangladeshi children were similar to those in adults. Optic nerve sheath diameter was mildly increased and brain swelling minimal on MRI. Severity of retinopathy correlated with plasma lactate, serum bicarbonate, sequestered parasite load and red cell stiffness suggesting a central role for microvascular obstruction in the pathogenesis. Severity of retinal whitening correlated with decreased visual acuity. Conclusions Retinal changes seen in severe P. falciparum malaria in Asian adults is similar, but not identical, to that seen in African children. They have potential to help with diagnosis and prognosis of Asian adults with severe falciparum malaria. Microvascular obstruction is prominent in the pathogenesis of retinopathy and coma in adults whereas raised intracranial pressure is not.

Aproximadamente 3% das neoplasias malignas são originadas da cavidade bucal e representadas na maioria pelo carcinoma espinocelular (CEC). Estudos tem demostrado variações nas características clínico-epidemiológicas do CEC de boca de acordo com área geográfica da população estudada. A compreensão das características de uma população específica é importante por muitas razões, incluindo a compreensão da extensão do problema, fatores relacionados com seu desenvolvimento, seu diagnóstico e prognóstico. No entanto, poucos estudos têm sido relatados sobre essa lesão na população Uruguaia. O objetivo deste estudo foi avaliar o perfil demográfico, os aspectos clínicos e terapêuticos, assim como, os fatores prognósticos dos carcinomas espinocelulares de boca (CECB) diagnosticados em serviços públicos no Uruguai. Foram selecionados todos os prontuários médicos de pacientes com diagnóstico histopatológico de carcinoma espinocelular de boca primário atendidos no período de Janeiro 2000 a Dezembro de 2010 em Hospitais Públicos de Uruguai. Os prontuários foram avaliados manualmente e foram coletadas informações quanto aos dados demográficos, fatores de risco, características clínicas do tumor, tratamento e evolução. Foi confeccionado um banco de dados com as informações coletadas nos prontuários. A análise descritiva de todas as variáveis foi realizada e a existência de associação entre as variáveis independentes e os desfechos (estadiamento clínico e evolução) foi avaliada através do teste Qui-quadrado de Pearson e o teste de Fisher, o nível de significância estabelecido foi de 5%. Dentre os 200 prontuários de pacientes analisados, 79.4% eram homens com distribuição homem:mulher de 3.8:1. A média de idade foi de 60,75 anos. A análise univariada mostrou que o estadiamento clínico tem associação significativa com o tabagismo (p = 0,04), quantidade de tabaco (p = 0,018), aspecto clínico (p = 0,009), tamanho do tumor (p = 0,001) e metástases regionais (p = 0,001). Os homens portadores de CEC foram associados com o consumo de tabaco e álcool. O prognóstico desfavorável dos CECB (óbito) foi significativamente relacionado com aspecto clínico (p = 0,02), tamanho (p = 0,001), metástases regionais (p = 0,016), estadiamento clínico (p = 0,002) e tratamento (p = 0,001). A maioria dos pacientes com CECB que evoluiram a óbito (pior prognóstico), exibiram úlcera (93,9%), tamanhos avançados - T3/T4 (90,2%), metástases regionais (66%), foram classificadas no estágio III/IV (94,1%) e receberam tratamento não cirúrgico ou paliativos. Conclui-se que no Uruguai o diagnóstico do CECB é tardio e associado a baixas taxas de sobrevida. Medidas educativas e preventivas para a população assim como, investimentos em estratégias para melhorar o diagnóstico precoce devem ser uma meta neste país. / Nearly 3% of malignant neoplasms originate from the oral cavity and are mostly represented by squamous cell carcinoma (SCC). Studies have demonstrated variations in clinical and epidemiological features of oral SCC according to geographical area of the study population. Understanding the characteristics of a specific population is important for many reasons, including the comprehension of the extent of the problem, factors associated with their development, diagnosis and prognosis. However, few studies have been developed in Uruguayan population about this lesion. The aims of the present study were to evaluate the demographic, clinical and therapeutic features, as well as, the predictive factors of poor prognosis in patients with primary OSCC evaluated during a period of 10-years in public health services in Uruguay. Medical records of patients with histological diagnosis of primary OSCC treated between January 2000 and December 2010 in Uruguayan Public Hospitals were selected. Information regarding demographics, risk factors, clinical features, treatment and outcome was collected. A descriptive analysis was performed, and the existence of association between independent variables and outcomes (clinical stage and evolution) was assessed using the Pearson Chi-Square test and Fisher's test. Out of a total of 200 patients with OSCC, 79.4% were men with 3.8:1 male:female ratio. The mean age was 60.75 years. Univariate analysis showed that clinical stage have significant association with smoking (p=0,04), amount of tobacco (p=0.018), clinical aspect (p=0.009), tumor size (p=0.001) and regional metastasis (p=0.001). OSCC male patients were associated with tobacco and alcohol comsumption. Worse overall survival (poor prognosis) was significant associated with clinical aspect (p=0.02), size (p=0.001), regional metastasis (p=0.016), clinical stage (p=0.002) and treatment (p=0.001). The majority of OSCC patients with worse overall survival presented oral ulcer (93.9%), T3/T4 tumor size (90.2%), regional metastasis (66%), were classified at stage III/IV (94.1%) and received nonsurgical or palliatives treatment. We conclude that in Uruguay the diagnosis of OSCC is late associated to low survival rate. Educational and preventive measures for the population and investment in strategies to improve early diagnosis should be a goal in this country.

Introdução: As bronquiectasias não-fibrocísticas são uma doença supurativa crônica caracterizada pela dilatação anormal e irreversível de um ou mais brônquios e são a via final de uma grande variedade de doenças, embora possam não ter uma causa identificável. Elas levam ao comprometimento da função pulmonar, colonização bacteriana crônica das vias aéreas, infecções respiratórias de repetição, redução da tolerância ao exercício e piora na qualidade de vida, entre outras coisas. Existem poucos estudos na literatura que abordam os fatores relacionados ao prognóstico desses pacientes. Objetivos: O objetivo deste estudo é avaliar a taxa de mortalidade e os fatores relacionados à morbidade e à mortalidade de uma coorte de pacientes com bronquiectasias não-fibrocísticas durante um seguimento de 6 a 8 anos e testar a habilidade dos escores Bronchiectasis Severity Index (BSI) e FACED de predizer a mortalidade dos pacientes na nossa coorte. Materiais e métodos: Trata-se de um estudo prospectivo de uma coorte de 70 pacientes com bronquiectasias não-fibrocísticas que foram originalmente recrutados de Maio de 2008 a Agosto de 2010. O estudo original forneceu os dados necessários para a classificação de gravidade da doença segundo os escores BSI e FACED e todos os dados usados para esse propósito foram coletados na avaliação inicial. Após o cálculo dos escores, os pacientes foram separados em diferentes grupos de acordo com a gravidade da doença. Nós também avaliamos os prontuários de todos os pacientes para determinar o número de hospitalizações por exacerbações após a avaliação inicial, o desfecho a longo prazo para cada paciente e a causa do desfecho quando apropriado. Os desfechos foram definidos como favoráveis e desfavoráveis (sobreviventes submetidos a transplante pulmonar e óbito por todas as causas) e foram determinados até 1° de março de 2016. Resultados: Dos 70 pacientes, 27 (38,57%) haviam morrido e 1 (1,43%) sido submetido ao transplante pulmonar. Análise de sobrevivência demonstrou que o tempo médio para a ocorrência dos desfechos desfavoráveis foi de 74,67 ± 4,00 meses (IC 66,82 – 82,52). A principal causa de óbito foi a exacerbação infecciosa aguda das bronquiectasias (60,7% dos óbitos). Na nossa coorte, o modelo de risco proporcional de Cox identificou a idade (p=0,035; HR 1,04; IC 1,01 – 1,08), o VEF1 % do previsto (p=0,045; HR 0,97; IC 0,93 – 0,99) e a Pemax (p=0,016; HR 0,97; IC 0,94 – 0,99) como preditores independentes de desfechos desfavoráveis. A maior parte dos pacientes (44,3%) foi classificada como tendo doença grave pelo escore BSI e 97,2% como tendo doença leve ou moderada (48,6% cada) pelo escore FACED. De maneira geral, o escore FACED foi um melhor preditor de desfechos desfavoráveis na nossa população de pacientes (log-rank test, FACED p = 0,001 e BSI p = 0,286). A análise da curva ROC demonstrou que ambos os escores foram similares na predição de desfechos desfavoráveis (área sob a curva BSI 0,65; FACED 0,66), mas nenhum deles foi um bom preditor para essa população específica de pacientes. Conclusão: Os pacientes da nossa coorte apresentaram maior comprometimento da função pulmonar e uma taxa de mortalidade mais alta do que o previamente reportado na literatura. A principal causa de óbito foi a exacerbação infecciosa aguda da doença. A idade mais avançada, o VEF1 % do previsto e uma Pemax mais baixa foram os fatores independentemente associados aos desfechos desfavoráveis. Os escores FACED e BSI não foram bons preditores de mortalidade para este grupo de pacientes, contrastando com os dados disponíveis na literatura até o momento, portanto outros estudos incluindo um maior número de pacientes são necessários para validar o uso deles na nossa população. / Background: Non-cystic fibrosis bronchiectasis is a chronic suppurative disease characterized by an abnormal and irreversible dilation of one or more bronchi. It is the final pathway of a large number of diseases, although it can be present without an identifiable cause. It leads to impaired lung function, chronic bacterial colonization, recurrent respiratory tract infections, reduced exercise tolerance and poor quality of life, among other things. There are few studies about prognostic factors in these patients. Objectives: The goal of this study is to assess the mortality rates and the factors related to the morbidity and mortality on a cohort of patients with non cystic fibrosis bronchiectasis during a 6 to 8-year follow-up and to test the ability of the Bronchiectasis Severity Index (BSI) and FACED scores in predicting mortality in our cohort. Materials and methods: This was a prospective cohort analysis of 70 patients with non-cystic fibrosis bronchiectasis who were originally recruited from May 2008 to August 2010. The original study records provided the necessary data for the determination of the disease severity scores (BSI and FACED) and all the data used for that purpose were collected at baseline. After the calculation of the scores, patients were separated into different groups according to disease severity. We also reviewed the records of all patients to determine the number of hospitalizations for exacerbations after baseline, the long-term outcome for each patient and the cause of the outcome when appropriate. Outcomes were defined as favorable and unfavorable (survivors who underwent lung transplantation and death from all causes) and were determined as of March 1st, 2016. Results: Out of 70 patients, 27 (38.57%) had died and 1 (1.43%) had undergone lung transplantation by the end of the study. Survival analysis demonstrated that the mean time for the occurrence of an unfavorable outcome was 74.67 ± 4.00 months (CI 66.82 – 82.52). The main cause of death among non-survivors was an acute infectious exacerbation of bronchiectasis (60.7% of the deceased). In our cohort, the multivariate Cox proportional hazard model analysis identified age (p=0.035; HR 1.04; CI 1.01 – 1.08), FEV1 % of predicted (p=0.045; HR 0.97; CI 0.93 – 0.99) and MEP (p=0.016; HR 0.97; CI 0.94 – 0.99) as independent predictors of unfavorable outcomes. Most patients (44.3%) were classified as having severe disease when BSI was used and 97.2% as having a mild or moderate disease (48.6% each) when FACED was used. Overall the FACED score was better at predicting unfavorable outcomes in our population of patients (log-rank test, FACED p = 0.001 and BSI p = 0.286). AUC from the ROC analysis shows us that both scores are similar in predicting poor outcomes in our cohort (BSI 0.65; FACED 0.66), but they weren't good predictors for this specific population. Conclusion: Patients in our cohort had worst lung function and a higher mortality rate than previously reported and the main cause of death among them was an acute infectious exacerbation of bronchiectasis. Older age, lower FEV1 % of predicted and lower MEP were independently linked to the occurrence of poor outcomes. FACED and BSI scores were not accurate in predicting mortality in our cohort, contradicting the available data at the moment, so other studies including a greater number of subjects are needed to validate their use in our population.

O BNP tem sido apontado como ótimo marcador de disfunção ventricular esquerda na sala de emergência. O poder de complementar informação prognóstica aos pacientes com SCA ainda não está bem estabelecido. Analisar a contribuição do BNP no prognóstico a longo prazo de pacientes com SCASSST. A partir dos resultados obtidos, verificar a associação dos níveis séricos do BNP com o TIMI RISK escore e com a área de miocárdio sob risco isquêmico. Foram avaliados 46 pacientes consecutivos portadores de SCASSST, discriminados por troponina I positiva (valor >0,5ng/ml), admitidos no período de maio/2003 a janeiro/2004, e acompanhados por um período de seguimento de 48 meses. O estudo foi completado por 40 pacientes. A análise do BNP de admissão e após 96 horas foi realizada pelo teste não paramétrico de Wilcoxon com intervalo de confiança de 95%. Um valor de p<0,05 foi considerado significante. Utilizou-se a curva ROC para analisar a acurácia do BNP de 96 horas como preditor de morte, além de definir o ponto de corte. O teste do qui-quadrado de Pearson foi utilizado para comparar as frequências das características clínicas, eletrocardiográficas e bioquímicas. Para avaliar um possível fator de confusão entre o BNP de 96 horas, idade e desfecho, usou-se a análise de regressão logística. Houve uma elevação do BNP entre a admissão e 96 horas (mediana de 148 vs. 267 p=0,04). Ocorreram 13 óbitos no período de seguimento. Utilizando o valor de corte do BNP de 96 horas de 300pg/ml como preditor de morte, observou-se sensibilidade de 92,3%, especificidade de 77,8%, valor preditivo positivo de 66,7% e valor preditivo negativo de 95,5%. A área sob a curva ROC foi de 0,93. Diferenças significativas não foram observadas nas características clínicas, eletrocardiográficas e angiográficas entre sobreviventes e não sobreviventes. Observou-se nítida associação entre o BNP de 96 horas com a pontuação do TIMI RISK escore. Verificou-se também a relação entre o incremento do BNP, admissão e 96 horas, e a anatomia coronariana no grupo com extensa área do miocárdio sob risco isquêmico (p=0,021). A elevação do BNP após 96 horas da admissão está associada a uma população com maior área de miocárdio sob risco isquêmico. Os resultados Indicam que o maior incremento entre o BNP de admissão e após 96 horas está associado à maior gravidade e extensão de miocárdio sob risco isquêmico. Tal fato poderia explicar a relação entre BNP elevado com a pontuação do TIMI RISK escore. Análise do BNP obtido após 96 horas de evento isquêmico é uma importante ferramenta na estratificação de risco de morte a longo prazo na SCASSST. / BNP has been considered an excellent marker of left ventricular dysfunction in the emergency room. However, its ability to provide prognostic information on patients with acute coronary syndrome has not been well established. To assess the contribution of BNP to predict the long-term prognosis of patients with non-ST segment elevation myocardial infarction (NSTEMI). In addition, to assess the association of BNP serum levels with TIMI risk score and with jeopardized myocardial area. The study comprised 46 consecutive patients with NSTEMI, discriminated by positive troponin I (>0.5ng/mL), admitted from May 2003 to January 2004, and followed up for 48 months. Forty patients completed the study. The BNP levels at admission and 96 hours after that were analyzed by using the non parametric Wilcoxon test with 95% confidence interval. A p value <0.05 was considered significant. The ROC curve was used to assess the accuracy of the 96-hour BNP as a predictor of death, in addition to defining the cutoff point. The Pearson chi-square test was used to compare the frequencies of clinical, electrocardiographic, and biochemical characteristics. Logistic regression analysis was used to assess a possible confounding factor between 96-hour BNP, age, and outcome. An elevation in BNP was observed between admission and 96 hours after that (median of 148 vs. 267, respectively; p=0.04). Thirteen patients died during follow-up. By using the 96-hour BNP cutoff point of 300pg/mL as a predictor of death, the following were observed: sensitivity of 92.3%, specificity of 77.8%, positive predictive value of 66.7%, and negative predictive value of 95.5%. The area under the ROC curve was 0.93. Significant differences were not observed in clinical, electrocardiographic, and angiographic characteristics between survivors and non-survivors. A clear association of 96-hour BNP with TIMI risk score was observed. A relation between BNP increase, both at admission and after 96 hours, and coronary anatomy was observed in the group with an extensive jeopardized myocardial area (p=0.021). The increase in BNP 96 hours after admission is associated with a larger jeopardized myocardial area. The results indicate that the greater increase in BNP 96 hours after admission is associated with greater severity and extension of the jeopardized myocardium. That fact could explain the relation between increased BNP and TIMI risk score. Assessing BNP 96 hours after an ischemic event is an important tool to stratify the long-term risk of death in NSTEMI.

Made available in DSpace on 2014-06-11T19:25:36Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-02-25Bitstream added on 2014-06-13T19:12:36Z : No. of bitstreams: 1 ferrari_r_me_botfm.pdf: 1633942 bytes, checksum: 661f07a6a0fe1c72e7d870e2a8d1b28b (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Estudos mostram a evolução dos marcadores locais e sistêmicos da doença pulmonar obstrutiva crônica (DPOC) e sua associação com o prognóstico da doença. No entanto, não identificamos estudos prévios avaliando a evolução desses marcadores em pacientes brasileiros com DPOC. Além disso, a associação entre as modificações dos marcadores da doença e a qualidade de vida relacionada à saúde não está clara. O objetivo deste estudo foi verificar a evolução dos marcadores diagnósticos e prognósticos de pacientes com DPOC e a associação destes marcadores com a mortalidade, exacerbação e modificações na qualidade de vida relacionada à saúde no período de três anos. No momento basal foram avaliados 133 pacientes com DPOC leve a muito grave, 15 pacientes (11%) morreram durante o seguimento e 23 pacientes (17%) não foram reavaliados. Portanto, 95 pacientes (72%) foram submetidos às seguintes avaliações no momento basal e após três anos: espirometria, composição corporal, sensação da dispneia por meio da escala Medical Research Council (MRC) e do índice de dispneia basal (BDI), qualidade de vida por meio do Questionário do Hospital Saint George na Doença Respiratória (SGRQ), comorbidades (Índice Charlson), tolerância ao exercício (distância percorrida em seis minutos-DP6) e cálculo do Índice BODE. Após a avaliação inicial, os pacientes ou seus familiares foram contatados a cada três meses para verificar a frequência de exacerbações e óbito. A evolução dos marcadores foi feita por meio do teste T para medidas repetidas. Análise de regressão de Cox foi realizada para identificar os preditores de mortalidade. A associação dos marcadores da doença com a frequência de exacerbação foi avaliada por meio da análise de regressão de Poisson. Análise de regressão logística foi utilizada para avaliar... / Studies show the evolution of local and systemic markers of chronic obstructive pulmonary disease (COPD) and its association with the disease prognosis. However, we did not identify previous studies evaluating the evolution of these markers in Brazilian patients with COPD. In addition, the association between modifications in disease markers and health-related quality of life (HRQL) are unclear. The objective of this study was to verify the evolution of diagnostic and prognostic markers in COPD patients and the association of these markers with mortality, exacerbation and modifications in HRQL over three years. At baseline were evaluated 133 patients with mild to very severe COPD, 15 patients (11%) died and 23 patients (17%) dropped out during the follow-up period. Therefore, 95 patients (72%) underwent following the evaluations at baseline and after three years: spirometry, body composition, dyspnea perception using the Medical Research Council scale (MRC) and the baseline dyspnea index (BDI), quality of life questionnaire by Saint George's Respiratory Questionnaire (SGRQ), comorbidities (Charlson index), exercise tolerance (six-minute walk distance-6MWD) and the calculate BODE index. After the initial assessment, patients or their relatives were contacted every three months to verify the exacerbations frequency and death. The evolution of the markers was evaluated using the paired t-test. Cox regression analysis was performed to identify mortality predictors. Association of disease markers with exacerbation frequency was assessed by Poisson regression analysis. Logistic regression analysis was used to evaluate the predictors of improvement or worsening of HRQL. After three years of study, there was no change in the values of FEV1 (p=0.23) and BMI (p=0.38). There was a significant worsening... (Complete abstract click electronic access below)

Alkali-aggregate reaction (AAR) is one of the most harmful distress mechanisms affecting the performance of aging reinforced concrete structures worldwide. Although several prediction models have been developed to assess the chemical reaction, a thorough and comprehensive approach with the capabilities to correlate important parameters that affect AAR and the mechanical properties of deteriorated materials, as well as the abilities to describe the current damaged state of AAR-affected structures (diagnosis) and predict the potential of further damage (prognosis) is still lacking. Such information is essential in selecting efficient remedial/rehabilitation actions for existing structures in the field. This project aims to develop a practical, yet accurate engineering-based finite element (FE) model for assessing AAR damage and predicting the future behaviour of affected infrastructure. The model is validated through three analyses. First, its capability to accurately simulate sound concrete under mechanical loading is verified by successfully simulating different beam failure mechanisms and cracking patterns, as well as predicting the members’ full force-deflection curves. Next, AAR anisotropic expansion under different stress-state (confinement) conditions is accurately simulated and verified by correlation with laboratory tests. Lastly, an AAR-affected slender reinforced concrete structure (Robert-Bourassa/Charest overpass) is successfully simulated by performing a condition assessment based on several tests performed prior to its demolition.

Introdução: O câncer de mama é uma doença heterogênea e complexa. Carcinomas mamários triplo negativos (CMTN) são tumores com uma agressividade biológica intrínseca, resultando em um prognóstico desfavorável. O receptor de andrógeno (RA) é um dos marcadores mais estudados na atualidade em CMTN, estando associado com a gênese e desenvolvimento do câncer de mama. Objetivo: Correlacionar a expressão do RA em pacientes com CMTN com características clínicas e patológicas referentes à idade do paciente, Ki-67, grau histológico e infiltração intratumoral de linfócitos (IIL). Métodos: O estudo foi de delineamento transversal e retrospectivo, de todos os casos de CMTN registrados em uma instituição, entre janeiro de 2012 e maio de 2014. Os materiais histológicos dos tumores mamários foram submetidos ao estudo imunoistoquimico para RA, e foram correlacionados com as variáveis idade, grau histológico, IIL e Ki-67. A positividade para RA foi determinada com o anticorpo monoclonal RA 441. Quando o RA foi positivo, a expressão foi considerada fraca quando Escore-H≤150 e forte quando Escore-H>150. A análise da porcentagem de IIL foi realizada através de um corte do tumor emblocado em parafina e corado por hematoxilina e eosina (HE) e foi definida como a porcentagem de linfócitos em contato direto com células tumorais. Resultados: 34 CMTN foram analisados. A média da idade foi de 51,9 anos (variação 30-82 anos). Das 34 amostras, 23 casos (67,7%) foram RA-negativo e 11 casos (32,3%) foram RA-positivo. Dos casos positivos, a expressão foi considerada fraca em 6 casos e forte em 5 casos. A maioria dos pacientes (n=28, 82%) apresentaram tumores pouco diferenciados. A expressão média do Ki-67 foi 65% no grupo RA-negativo e 43,6% no grupo RA-positivo (p<0,05). Observou-se uma associação estatísticamente significante entre a variável idade e a expressão do RA (p<0,005), sendo a idade média de 70,8 anos no grupo RA fortemente positivo e 42,3 anos no grupo RA fracamente positivo. Não se observou associação estatística entre a expressão do RA e as variáveis grau histológico e IIL. A porcentagem média de IIL foi 38,6% no grupo RA-positivo e 39,1% no grupo RA-negativo (p=0,3). Conclusão: A expressão do RA em CMTN esteve associada a pacientes mais idosas e a tumores com menor expressão de Ki-67. A expressão do RA em pacientes com CMTN delinou 2 subgrupos com fenótipos distintos. No entanto, não houve associação entre expressão do RA com grau histológico e IIL. / Submitted by Ana Guimarães Pereira (agpereir@ucs.br) on 2016-05-18T12:33:38Z No. of bitstreams: 1 Dissertacao Maximiliano Cassilha Kneubil.pdf: 1763051 bytes, checksum: 88341a89a73f5a6646d6652ecc0d5853 (MD5) / Made available in DSpace on 2016-05-18T12:33:38Z (GMT). No. of bitstreams: 1 Dissertacao Maximiliano Cassilha Kneubil.pdf: 1763051 bytes, checksum: 88341a89a73f5a6646d6652ecc0d5853 (MD5) Previous issue date: 2016-05-18 / Background: Breast cancer is a heterogeneous and complex disease. Triple Negative Breast Cancer (TNBC) are characterized by intrinsic aggressive tumour biology resulting in poor prognosis. Androgen Receptor (AR) is one of newly emerging biomarker in TNBC and has been demonstrated to play an important role in the genesis and in the development of breast cancer. Objective: In the present study, we explored the correlation of AR expression with age, Ki-67, histological subtype, histological grade and value of Tumor-Infiltrating Lymphocytes (TIL) in TNBC. Methods: We identified consecutive invasive TNBC from a cancer registry in a single institution between January 2012 and May 2014. The biopsies were analyzed by immunohistochemistry for AR and were correlated with age, histological grade, TIL and Ki-67. AR positivity was determined with clone AR 441 antibody. When AR was positive, the expression was considered weak when H-score≤150 and strong when Hscore> 150. The analysis of percentage of TIL was performed on a single full-face HEstained tumor section and TIL were defined as the percentage of lymphocytes in direct contact with the tumor cells. Results: 34 TNBC have been analyzed to date. The mean age was 51.9 years (range 30- 82). Of the 34 TNBC samples, 23 cases (67.7%) were AR-negative and 11 cases (32.3%) were AR-positive. Of the positive cases, the expression was weak in 6 cases and strong in 5 cases. Most patients (n=28, 82%) presented poorly differentiated tumors and all patients presented invasive ductal carcinoma. The mean expression of Ki67 was 65% in AR-negative group and 43.6% in AR-positive group, respectively (p<0.05). Older age was associated with AR expression, the mean age in AR strong expression was 70.8 years (p<0.005) compared to 42.3 years in group with AR weak expression. The AR expressions was not associated with histological grade and TIL. The mean of TIL was 38.6% in the AR-positive group and 39.1% in the AR-negative group (p=0.3). Conclusion: The present analysis showed that AR expressiveness in TNBC was associated with older patients and tumors with lower expression of Ki67. The expressiveness of AR in patients with TNBC through IHC outlined 2 subgroups with distinctive phenotypes. However, the expression of RA in patients with TNBC was not associated with the percentage of TIL and histological grade.

Much cross-cultural research has been done on the topic of schizophrenia, but few studies thus far have focused on lifetime prevalence and prognosis together, grouped by world region. Additionally, there has been severe bias in which countries and regions have been studied both historically and currently. Any study that had statistics on lifetime prevalence per 1000 people and/or DALYs, from a specified country or region, was included in this thesis. Results showed that lifetime prevalence of schizophrenia does not differ among WHO regions, but DALYs and thus prognosis do differ. Several major conclusions can be drawn from these results. One is that prognosis differs even though prevalence does not. Another is that schizophrenia is not a region-specific disorder. A third is that the reason that prevalence does not differ among regions could be due to biological causes of schizophrenia being more powerful than environmental causes. A fourth is that the reasons that prognosis differs in different regions are plentiful, but can all be derived from social support and community. The implications of these conclusions can be used to better the prognosis of people with schizophrenia worldwide, but further cross-cultural research in underrepresented countries is essential.