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Dias M, Pinto LF, Pinto MV, Gervais R, Accioli P, Amorim G, Guedes M, Gomes CP, Pedrosa RC, Waddington-Cruz M. Real-life experience with inotersen at CEPARM, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro. Arq Neuropsiquiatr 2024; 82:1-7. [PMID: 38579737 PMCID: PMC10997406 DOI: 10.1055/s-0044-1781463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/03/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND Hereditary transthyretin amyloidosis (ATTRv) is an inherited, progressive, and fatal disease still largely underdiagnosed. Mutations in the transthyretin (TTR) gene cause the TTR protein to destabilize, misfold, aggregate, and deposit in body tissues, which makes ATTRv a disease with heterogeneous clinical phenotype. OBJECTIVE To describe the long-term efficacy and safety of inotersen therapy in patients with ATTRv peripheral neuropathy (ATTRv-PN). METHODS Patients who completed the NEURO-TTR pivotal study and the NEURO-TTR OLE open-label extension study migrated to the present study and were followed-up for at least 18 more months to an average of 67 months and up to 76 months since day 1 of the inotersen therapy (D1-first dose of inotersen). Disease progression was evaluated by standard measures. RESULTS Ten ATTRv-PN patients with Val30Met mutation were included. The mean disease duration on D1 was of 3 years, and the mean age of the patients was of 46.8 years. During an additional 18-month follow up, neurological function, based on the Neuropathy Impairment Score and the Polyneuropathy Disability Score, functionality aspects (Karnofsky Performance Status), and nutritional and cardiac aspects were maintained. No new safety signs have been noted. CONCLUSION The treatment with inotersen was effective and well tolerated for the average of 67 months and up to 76 months. Our results are consistent with those of larger phase-III trials.
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Affiliation(s)
- Moises Dias
- Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Serviço de Nefrologia, Rio de Janeiro RJ, Brazil.
- Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Centro de Estudos em Paramiloidose Antônio Rodrigues de Mello (CEPARM), Rio de Janeiro RJ, Brazil.
| | - Luiz Felipe Pinto
- Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Centro de Estudos em Paramiloidose Antônio Rodrigues de Mello (CEPARM), Rio de Janeiro RJ, Brazil.
| | - Marcus Vinícius Pinto
- Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Centro de Estudos em Paramiloidose Antônio Rodrigues de Mello (CEPARM), Rio de Janeiro RJ, Brazil.
- Mayo Clinic, Department of Neurology, Rochester MN, United States.
| | - Renata Gervais
- Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Serviço de Nefrologia, Rio de Janeiro RJ, Brazil.
- Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Centro de Estudos em Paramiloidose Antônio Rodrigues de Mello (CEPARM), Rio de Janeiro RJ, Brazil.
| | - Paula Accioli
- Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Centro de Estudos em Paramiloidose Antônio Rodrigues de Mello (CEPARM), Rio de Janeiro RJ, Brazil.
| | - Gabriela Amorim
- Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Centro de Estudos em Paramiloidose Antônio Rodrigues de Mello (CEPARM), Rio de Janeiro RJ, Brazil.
| | - Mariana Guedes
- Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Centro de Estudos em Paramiloidose Antônio Rodrigues de Mello (CEPARM), Rio de Janeiro RJ, Brazil.
| | - Carlos Perez Gomes
- Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Serviço de Nefrologia, Rio de Janeiro RJ, Brazil.
- Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Centro de Estudos em Paramiloidose Antônio Rodrigues de Mello (CEPARM), Rio de Janeiro RJ, Brazil.
| | - Roberto Coury Pedrosa
- Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Centro de Estudos em Paramiloidose Antônio Rodrigues de Mello (CEPARM), Rio de Janeiro RJ, Brazil.
- Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Instituto de Cardiologia Edson Saad, Rio de Janeiro RJ, Brazil.
| | - Márcia Waddington-Cruz
- Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Programa de Pós-graduação/Centro de Estudos em Paramiloidose Antônio Rodrigues de Mello (CEPARM), Rio de Janeiro RJ, Brazil.
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Pichone A, Juvencio EL, Crespo B, Gomes CP, Mendes RDS, Godinho MR, Ladeira ACF, Leite, Jr M, Guimarães JAM. Patellar and quadriceps tendon rupture are associated with hip fracture in hemodialysis patients with severe hyperparathyroidism. JBMR Plus 2024; 8:ziae008. [PMID: 38505521 PMCID: PMC10945730 DOI: 10.1093/jbmrpl/ziae008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 12/22/2023] [Accepted: 01/04/2024] [Indexed: 03/21/2024] Open
Abstract
Spontaneous rupture of the patellar (PTR) and quadriceps (QTR) tendon is infrequent. Systemic diseases such as diabetes mellitus, CKD, and secondary hyperparathyroidism (SHPT) are risk factors. The present cohort study aimed to evaluate risk factors associated with tendon rupture in hemodialysis (HD) patients with SHPT, as well as outcomes including surgical complications, re-ruptures, and fracture. Baseline clinical, laboratorial data, and radiographs were analyzed. Patients were followed up from March 2012 to March 2020. One-hundred thirty-one patients (≥18 yr of age, on HD ≥ 6 mo, with SHPT) were included. Incidence rates of PTR and QTR were 2.3 and 1.7/10000 HD patients/yr, respectively. The mean age of patients with tendon rupture was 44.0 ± 11.2 yr. These patients exhibited higher serum levels of phosphorus (6.3 ± 1.5 mg/dL vs 5.6 ± 1.1 mg/dL; P = .005), PTH (2025.7 ± 667.6 pg/mL vs 1728.4 ± 684.8 pg/mL; P = .035), and C-reactive-protein (35.4 ± 32.9 mg/dL vs 17 ± 24.5 mg/dL; P = .002) compared to the group without tendon rupture. The mean follow-up was 56.7 ± 27.1 mo. No patient required a new surgical approach or experienced re-rupture. Of all patients, 31% experienced hip fracture: 50% in the group with rupture (29.5 ± 17.4 mo after the tendon rupture) vs 26% without tendon rupture (P = .015). After adjustment, the hazard ratio for hip fracture was 2.87 (95% CI, 1.27-6.49; P = .012). Patients with SHPT and high levels of phosphorus, PTH, and inflammatory markers were at greater risk for tendon rupture. Surgical complication rates were low. However, results suggest that tendon rupture of knee extensor mechanism in HD patient with SHPT should be regarded as a "red flag" for future hip fracture.
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Affiliation(s)
- Alinie Pichone
- Department of Nephrology, Knee Surgery and Research, National Institute of Traumatology and Orthopedics Jamil Haddad, Rio de Janeiro, RJ 20940-070, Brazil
- Department of Nephrology, University Hospital Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, RJ 21941-617, Brazil
| | - Elicivaldo Lima Juvencio
- Department of Nephrology, University Hospital Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, RJ 21941-617, Brazil
| | - Bernardo Crespo
- Department of Nephrology, Knee Surgery and Research, National Institute of Traumatology and Orthopedics Jamil Haddad, Rio de Janeiro, RJ 20940-070, Brazil
- Department of Nephrology, University Hospital Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, RJ 21941-617, Brazil
| | - Carlos Perez Gomes
- Department of Nephrology, University Hospital Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, RJ 21941-617, Brazil
| | - Renata de Souza Mendes
- Department of Nephrology, Knee Surgery and Research, National Institute of Traumatology and Orthopedics Jamil Haddad, Rio de Janeiro, RJ 20940-070, Brazil
- Department of Nephrology, University Hospital Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, RJ 21941-617, Brazil
| | - Marise Rocha Godinho
- Department of Nephrology, Knee Surgery and Research, National Institute of Traumatology and Orthopedics Jamil Haddad, Rio de Janeiro, RJ 20940-070, Brazil
| | - Aline Cordeiro Fernandes Ladeira
- Department of Nephrology, Knee Surgery and Research, National Institute of Traumatology and Orthopedics Jamil Haddad, Rio de Janeiro, RJ 20940-070, Brazil
| | - Maurilo Leite, Jr
- Department of Nephrology, University Hospital Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, RJ 21941-617, Brazil
| | - João Antônio Matheus Guimarães
- Department of Nephrology, Knee Surgery and Research, National Institute of Traumatology and Orthopedics Jamil Haddad, Rio de Janeiro, RJ 20940-070, Brazil
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Santa Rosa RG, Polonine S, Pichone A, Gomes CP, Lima LFC, de Paula Paranhos Neto F, de Mendonça LMC, Farias MLF, Madeira M. Chronic hypoparathyroidism is associated with increased cortical bone density evaluated using high-resolution peripheral quantitative computed tomography. Endocrine 2023; 82:673-680. [PMID: 37624475 DOI: 10.1007/s12020-023-03495-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 08/15/2023] [Indexed: 08/26/2023]
Abstract
PURPOSE This cross-sectional study aimed to assess bone mineral density (BMD), bone microarchitecture and fracture prevalence in women with chronic postsurgical hypoparathyroidism (hypoPT). METHODS Twenty-seven women with postsurgical hypoPT and 44 age-matched healthy women were included. Dual-energy X-ray absorptiometry was used to evaluate areal BMD and vertebral fracture assessment. High-resolution peripheral quantitative computed tomography assessed microarchitecture and volumetric BMD at the distal radius and tibia. Biochemical parameters, including fibroblast growth factor 23, C-terminal cross-linking telopeptide of type I collagen (ICTP), and procollagen type I N-terminal propeptide (P1NP), were also measured. Previous low-impact fractures were assessed and the 10-year fracture risk was estimated using the FRAX tool for the Brazilian population. RESULTS No participant had prevalent clinical fractures, and both groups showed low risk for major and hip based on FRAX tool, but two hypoPT patients had moderate to severe morphometric vertebral fractures. Women with hypoPT had increased aBMD in the lumbar spine, femoral neck and total hip (p < 0.05) and higher cortical vBMD in the radius (p = 0.020) and tibia (p < 0.001). Trabecular bone was not affected. Both P1NP and ICTP suggested low bone turnover rates, but no significant correlation was observed between bone density or microstructure and any of the biochemical parameters. CONCLUSIONS The prevalence of fragility fractures was low in HypoPT women and compatible with low fracture risk estimated by the FRAX tool. Patients had a higher aBMD and cortical vBMD than those of healthy control women, but the association with decreased bone turnover remains unclear.
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Affiliation(s)
- Renata Gervais Santa Rosa
- Endocrinology Division, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
- Nephrology Division, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Simone Polonine
- Endocrinology Division, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Alinie Pichone
- Nephrology Division, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Carlos Perez Gomes
- Nephrology Division, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | | | | | - Miguel Madeira
- Endocrinology Division, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Burla MM, Gomes CP, Calvi I, Oliveira ESC, Hora DAB, Mao RD, de Figueiredo SMP, Lu R. Management and outcomes of obturator hernias: a systematic review and meta-analysis. Hernia 2023:10.1007/s10029-023-02808-w. [PMID: 37270718 DOI: 10.1007/s10029-023-02808-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/21/2023] [Indexed: 06/05/2023]
Abstract
PURPOSE Obturator Hernia (OH) is a rare type of abdominal wall hernia. It usually occurs in elderly women with late symptomatic presentation, increasing mortality rates. Surgery is the standard of care for OH, and laparotomy with simple suture closure of the defect is commonly used. Given the rarity of this disease, large studies are lacking, and data to drive management are still limited. This systematic review and meta-analysis aimed to describe current surgical options for OHs, with a focus on comparing the effectiveness and safety of mesh use with primary repair. METHODS PubMed, EMBASE, and Cochrane were searched for studies comparing mesh and non-mesh repair for OH. Postoperative outcomes were assessed by pooled analysis and meta-analysis. Statistical analysis was performed using RevMan 5.4. RESULTS One thousand seven hundred and sixty studies were screened and sixty-seven were thoroughly reviewed. We included 13 observational studies with 351 patients surgically treated for OH with mesh or non-mesh repair. One hundred and twenty (34.2%) patients underwent mesh repair and two hundred and thirty-one (65.81%) underwent non-mesh repair. A total of 145 (41.3%) underwent bowel resection, with the majority having a non-mesh repair performed. Hernia recurrence was significantly higher in patients who underwent hernia repair without mesh (RR 0.31; 95% CI 0.11-0.94; p = 0.04). There were no differences in mortality (RR 0.64; 95% CI 0.25-1.62; p = 0.34; I2 = 0%) or complication rates (RR 0.59; 95% CI 0.28-1.25; p = 0.17; I2 = 50%) between both groups. CONCLUSION Mesh repair in OH was associated with lower recurrence rates without an increase in postoperative complications. While mesh in clean cases is more likely to offer benefits, an overall recommendation regarding its use in OH repair cannot be made due to potential bias across studies. Given that many OH patients are frail and present emergently, the decision to use mesh is complex and should consider the patient's clinical status, comorbidities, and degree of intraoperative contamination.
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Affiliation(s)
- M M Burla
- Department of Medicine, Estacio de Sa Vista Carioca University, RJ, Rio de Janeiro, Brazil.
| | - C P Gomes
- Department of Obstetrics and Gynecology, Maimonides Medical Center, New York, NY, USA
| | - I Calvi
- Department of Medicine, Immanuel Kant Baltic Federal University, Kaliningrad, KGD, Russian Federation
| | - E S C Oliveira
- Department of Medicine, University of Brasilia, Brasilia, DF, Brazil
| | - D A B Hora
- Department of Medicine, Federal University of Amazonas, Manaus, AM, Brazil
| | - R D Mao
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - S M P de Figueiredo
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - R Lu
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
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Miyawaki IA, Gomes CP, Moreira VCS, Marques IR, Souza IAF, Silva CHA, Loyola JER, Huh K, Mcdowell M, Padrao EMH. The single-syringe versus the double-syringe techniques of adenosine administration for supraventricular tachycardia: a systematic review and meta-analysis. Eur Heart J 2023. [DOI: 10.1093/eurheartj/ehac779.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Intravenous double-syringe technique (DST) of adenosine administration consists of an intravenous bolus of adenosine via three-way stopcock followed by an immediate 10-20ml sodium chloride 0.9% flush and is the recommended first-line treatment for stable supraventricular tachycardia (SVT). However, an alternative single-syringe technique (SST) method for adenosine administration has been described. This consists of diluting adenosine with sodium chloride 0.9% to a total volume of 15-20ml and was recently found to be potentially beneficial in several studies.
Purpose
We aimed to perform a meta-analysis of the SST versus the DST of adenosine administration as treatments for SVT.
Methods
We systematically searched EMBASE, PubMed, Cochrane, and ClinicalTrials.gov databases for randomised controlled trials (RCTs) and non-randomised studies of intervention (NRSIs) comparing the DST to SST adenosine administration in patients with SVT. The risk of bias was assessed by RoB-2 for RCTs and ROBINS-I for NRSIs. Outcomes included termination rate, termination rate at first dose, total administered dose, adverse effects, and discharge rate.
Results
We included four studies (three RCTs and one NRSI) with a total of 180 (60.55% female) patients, of whom 100 (55.55%) underwent the SST of adenosine administration. The three RCTs were considered of some concerns due to no pre-specified analysis in all studies and deviation from the intended intervention in one study. The NRSI was considered to carry a serious risk of bias by no analysis method that controlled for confounding, the possible influence of the outcome measure by knowledge of the intervention received, and no pre-specified analysis. No significant difference was found between treatment groups regarding termination rate (p = 0.22, Fig 1a), termination rate restricted to RCTs (p = 0.49, Fig 1b), total administered dose (p = 0.29, Fig 2a) and discharge rate (p = 0.1, Fig 2b). Termination rate at first dose (OR 2.87; CI 1.11-7.41; p = 0.03; I² = 0%, Fig 1c) was significantly increased in patients who received the SST. Major adverse effects were observed in only one study, with one patient suffering extravasation and phlebitis in the DST group.
Conclusion
To our knowledge, this is the first meta-analysis studying SST versus conventional DST for the management of SVT. This study suggests that the SST may be as safe as DST, equally effective for SVT termination, or even potentially more effective with the first dose. The SST would represent a simpler and more rapid approach, obviating the need for syringe switching or three-way stopcock, and reducing the margin of error in adenosine administration. To our knowledge, this is the highest quality evidence to date. Our results demonstrate that the current evidence is sufficient to support both SST and DST. However, favouring one technique over the other is not feasible given the limited sample size.
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Affiliation(s)
- I A Miyawaki
- Federal University of Parana , Curitiba , Brazil
| | - C P Gomes
- Federal University Santa Maria , Santa Maria , Brazil
| | - V C S Moreira
- Albert Einstein Israelite Hospital , Sao Paulo , Brazil
| | - I R Marques
- Universitat Internacional de Catalunya , Barcelona , Spain
| | - I A F Souza
- Petropolis Medical School , Petropolis , Brazil
| | - C H A Silva
- Federal University of Rio Grande do Norte , Natal , Brazil
| | - J E R Loyola
- Santa Casa de Misericórdia de Sao Paulo , Sao Paulo , Brazil
| | - K Huh
- University of Connecticut , Internal Medicine , Storrs , United States of America
| | - M Mcdowell
- University of Illinois at Chicago , Chicago , United States of America
| | - E M H Padrao
- University of Connecticut , Internal Medicine , Storrs , United States of America
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Polonine S, de Santa Rosa RG, Farias MLF, Garcia MI, Gomes CP, Gottlieb I, Madeira M. Hyperphosphatemia is associated with cardiac valve calcification in chronic hypoparathyroidism. J Endocrinol Invest 2022; 45:1359-1366. [PMID: 35235195 DOI: 10.1007/s40618-022-01770-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 02/16/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE To evaluate the association between metabolic abnormalities and cardiovascular risk factors in patients with chronic hypoparathyroidism (HPP). PATIENTS AND METHODS Patients 18 years and older, glomerular filtration > 30 mL/min/1.73 m2 and no documented coronary artery disease were selected. Serum calcium, phosphorus, glucose, lipids, PTH, 25(OH)D and FGF23 were measured. Cardiovascular risk was estimated by the European Society of Cardiology (ESC) calculator. Transthoracic echocardiogram and carotid ultrasound were performed to detect carotid plaques (CP), carotid intima-media thickness (IMT), cardiac valve calcification (CVC), and left ventricular hypertrophy (LVH). RESULTS Thirty-seven patients (94.6% female), aged 56.0 ± 13.5 years and HPP duration 7.0 (4.0; 11.3) years, were included. Fifteen were classified as low cardiovascular risk, 9 as intermediate risk, 9 as high risk and none as very high risk. The prevalence of CP, CVC and LVH was 24.3%, 24.3% and 13.5%, respectively. IMT values were within normal ranges in all cohort. FGF23 were not associated with CP, IMT, CVC or LVH. After logistic regression, phosphorus was the only significant metabolic variable impacting CVC in univariate analysis (OR 2.795; 95% CI 1.132-6.905; p = 0.026), as well as in the multivariate analysis (OR 3.572; 95% CI 1.094-11.665; p = 0.035). Analysis by ROC curve showed serum phosphorus > 5.05 mg/dL (AUC 0.748; CI 0.584-0.877; p = 0.05) as the best cutoff point associated with valve heart calcification (sensitivity 78%; negative predictive value 91.3%). CONCLUSION Hyperphosphatemia was associated with CVC in HPP patients. Further studies are needed to investigate whether the control of hyperphosphatemia may reduce cardiovascular risk in this population.
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Affiliation(s)
- S Polonine
- Division of Endocrinology, Clementino Fraga Filho Hospital, UFRJ, Avenida Professor Rodolpho Paulo Rocco 255, Rio de Janeiro, RJ, 21941-913, Brazil.
| | - R G de Santa Rosa
- Division of Nephrology, Clementino Fraga Filho Hospital, UFRJ, Avenida Professor Rodolpho Paulo Rocco 255, Rio de Janeiro, RJ, 21941-913, Brazil
| | - M L F Farias
- Division of Endocrinology, Clementino Fraga Filho Hospital, UFRJ, Avenida Professor Rodolpho Paulo Rocco 255, Rio de Janeiro, RJ, 21941-913, Brazil
| | - M I Garcia
- Division of Cardiology, Clementino Fraga Filho Hospital, UFRJ, Avenida Professor Rodolpho Paulo Rocco 255, Rio de Janeiro, RJ, 21941-913, Brazil
| | - C P Gomes
- Division of Nephrology, Clementino Fraga Filho Hospital, UFRJ, Avenida Professor Rodolpho Paulo Rocco 255, Rio de Janeiro, RJ, 21941-913, Brazil
| | - I Gottlieb
- Casa de Saúde São José, Rua Macedo Sobrinho 21, Rio de Janeiro, RJ, 22271-080, Brazil
| | - M Madeira
- Division of Endocrinology, Clementino Fraga Filho Hospital, UFRJ, Avenida Professor Rodolpho Paulo Rocco 255, Rio de Janeiro, RJ, 21941-913, Brazil
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Pichone A, Gomes CP, Lima LFC, Moreira CA, Paranhos-Neto FDP, Madeira M, Lopes RT, Farias MLF, Leite Jr. M. Assessment of trabecular and cortical parameters using high-resolution peripheral quantitative computed tomography, histomorphometry and microCT of iliac crest bone core in hemodialysis patients. Bone Rep 2022; 16:101173. [PMID: 35198659 PMCID: PMC8850668 DOI: 10.1016/j.bonr.2022.101173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/03/2022] [Accepted: 02/04/2022] [Indexed: 11/28/2022] Open
Abstract
Patients with end-stage renal disease develop changes in bone quality and quantity, which can be assessed using different methods. This study aimed to compare and to correlate bone parameters obtained in vivo using high-resolution peripheral quantitative computed tomography (HR-pQCT) with those obtained by bone biopsy using histomorphometry and microcomputed tomography (microCT) analysis of the iliac crest core, and to evaluate if HR-pQCT is helpful in aiding with categorization of those with high turnover. Twenty hemodialysis patients, 13 females (7 postmenopausal), underwent bone biopsy from 2018 to 2020. The mean age was 48.5 ± 10.6 years, and the mean hemodialysis vintage was 15 years. Histomorphometry identified mineralization defects, low turnover, and high turnover in 65%, 45%, and 35% of the patients, respectively. The highest values of trabecular bone volume (BV/TV) were obtained by histomorphometry, while the highest values of cortical thickness (Ct.Th) were obtained by HR-pQCT at the distal tibia. Moderate correlations were found between BV/TV values obtained by microCT of the bone core and HR-pQCT at the distal radius (r = 0.531, p = 0.016) and at the distal tibia (r = 0.536, p = 0.015). BV/TV values obtained from the bone core by histomorphometry and microCT were also significantly correlated (r = 0.475, p = 0.04). Regarding Ct.Th, there was a strong correlation between the radius and tibia HR-pQCT (r = 0.800, p < 0.001), between bone core microCT and the distal radius HR-pQCT (r = 0.610, p < 0.01), as between histomorphometry and microCT (r = 0.899, p < 0.01). In groups classified by bone turnover, patients with high turnover presented lower BV/TV, Tb.N, Tb.Th, and Ct.Th than those with low turnover in peripheral sites using HR-pQCT. By this method, it was possible to identify low turnover from tibia BV/TV > 12,4% plus Tb.Sp ≤ 0.667 mm (AUC 0.810, 95% CI 0.575 to 0.948) and high turnover from total bone mineral density (BMD) ≤ 154.2 mg HA/cm3 (AUC 0.860, 95% CI 0.633 to 0.982, p < 0.001) and cortical BMD ≤ 691.6 mg HA/cm3 (AUC 0.840, 95% CI 0.609 to 0.963, p < 0.001). In conclusion, HR-pQCT had significant correlation with iliac crest bone in BV/TV and Ct.Th, which are known to provide bone strength. This method is quick and non-invasive and may be helpful in categorizing those with high versus low turnover in hemodialysis patients. Bone structure in hemodialysis patients can be assessed using different methods. There was correlation of BV/TV and Ct.Th between histomorphometry and bone core microCT. BV/TV and Ct.Th values obtained by radius HR-pQCT and bone core microCT were correlated. High turnover patients had lower BV/TV, Tb.N, Tb.Th, and Ct.Th by HR-pQCT. HR-pQCT was able to discriminate low and high turnover in hemodialysis patients.
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Affiliation(s)
- Alinie Pichone
- Division of Nephrology, HUCFF, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Corresponding author at: Hospital Universitario Clementino Fraga Filho – Universidade Federal do Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco, 255/Serviço de nefrologia - sétimo andar, Rio de Janeiro, RJ 21941-617, Brazil.
| | - Carlos Perez Gomes
- Division of Nephrology, HUCFF, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Luis Felipe Cardoso Lima
- Laboratory of Nuclear Instrumentation, COPPE, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Carolina Aguiar Moreira
- Division of Endocrinology (SEMPR), Internal Medicine Department of Federal University of Parana & Academic Research Center of Pro Renal Institute, Curitiba, Brazil
| | | | - Miguel Madeira
- Division of Endocrinology, HUCFF, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ricardo Tadeu Lopes
- Laboratory of Nuclear Instrumentation, COPPE, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Maurilo Leite Jr.
- Division of Nephrology, HUCFF, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Pichone A, Campos G, Leite M, Gomes CP. High ankle-brachial index predicts cardiovascular events and mortality in hemodialysis patients with severe secondary hyperparathyroidism. ACTA ACUST UNITED AC 2021; 43:478-485. [PMID: 33979425 PMCID: PMC8940110 DOI: 10.1590/2175-8239-jbn-2020-0218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 03/23/2021] [Indexed: 11/22/2022]
Abstract
Introduction: Vascular calcification related to severe secondary hyperparathyroidism (SHPT) is an important cause of cardiovascular and bone complications, leading to high morbidity and mortality in patients with chronic kidney disease (CKD) undergoing hemodialysis (HD). The present study aimed to analyze whether ankle-brachial index (ABI), a non-invasive diagnostic tool, is able to predict cardiovascular outcomes in this population. Methods: We selected 88 adult patients on HD for at least 6 months, with serum iPTH>1,000pg/mL. We collected clinical data, biochemical and hormonal parameters, and ABI (sonar-Doppler). Calcification was assessed by lateral radiography of the abdomen and by simple vascular calcification score (SVCS). This cohort was monitored prospectively between 2012 and 2019 for cardiovascular outcomes (death, myocardial infarction (MI), stroke, and calciphylaxis) to estimate the accuracy of ABI in this setting. Results: The baseline values were: iPTH: 1770±689pg/mL, P: 5.8±1.2 mg/dL, corrected Ca: 9.7±0.8mg/dL, 25(OH)vit D: 25.1±10.9ng/mL. Sixty-five percent of patients had ABI>1.3 (ranging from 0.6 to 3.2); 66% had SVCS≥3, and 45% aortic calcification (Kauppila≥8). The prospective evaluation (51.6±24.0 months), provided the following cardiovascular outcomes: 11% of deaths, 17% of nonfatal MI, one stroke, and 3% of calciphylaxis. After adjustments, patients with ABI≥1.6 had 8.9-fold higher risk of cardiovascular events (p=0.035), and ABI≥1.8 had 12.2-fold higher risk of cardiovascular mortality (p=0.019). Conclusion: The presence of vascular calcifications and arterial stiffness was highly prevalent in our population. We suggest that ABI, a simple and cost-effective diagnostic tool, could be used at an outpatient basis to predict cardiovascular events in patients with severe SHPT undergoing HD.
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Affiliation(s)
- Alinie Pichone
- Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Divisão de Nefrologia, Rio de Janeiro, RJ, Brasil
| | - Gabriela Campos
- Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Divisão de Nefrologia, Rio de Janeiro, RJ, Brasil
| | - Maurilo Leite
- Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Divisão de Nefrologia, Rio de Janeiro, RJ, Brasil
| | - Carlos Perez Gomes
- Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Divisão de Nefrologia, Rio de Janeiro, RJ, Brasil
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da Silva MD, de Santa Rosa RG, Gomes CP, Cardoso Berensztejn A, Pinto MV, Pinto LF, Cruz MW. Albumin/creatinine (uACR) and protein/creatinine (uPCR) ratios in spot urine samples can be used to evaluate albuminuria and proteinuria in hereditary transthyretin amyloidosis patients. Amyloid 2019; 26:41-42. [PMID: 31343291 DOI: 10.1080/13506129.2019.1582506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Moisés Dias da Silva
- a Department of Neurology, CEPARM, Federal University of Rio de Janeiro (UFRJ) , Rio de Janeiro , Brazil.,b Department of Nephrology, Federal University of Rio de Janeiro (UFRJ) , Rio de Janeiro , Brazil
| | - Renata Gervais de Santa Rosa
- a Department of Neurology, CEPARM, Federal University of Rio de Janeiro (UFRJ) , Rio de Janeiro , Brazil.,b Department of Nephrology, Federal University of Rio de Janeiro (UFRJ) , Rio de Janeiro , Brazil
| | - Carlos Perez Gomes
- b Department of Nephrology, Federal University of Rio de Janeiro (UFRJ) , Rio de Janeiro , Brazil
| | - Amanda Cardoso Berensztejn
- a Department of Neurology, CEPARM, Federal University of Rio de Janeiro (UFRJ) , Rio de Janeiro , Brazil
| | - Marcus Vinicius Pinto
- a Department of Neurology, CEPARM, Federal University of Rio de Janeiro (UFRJ) , Rio de Janeiro , Brazil
| | - Luiz Felipe Pinto
- a Department of Neurology, CEPARM, Federal University of Rio de Janeiro (UFRJ) , Rio de Janeiro , Brazil
| | - Marcia Waddington Cruz
- a Department of Neurology, CEPARM, Federal University of Rio de Janeiro (UFRJ) , Rio de Janeiro , Brazil
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Guio BM, Gomes CP, Costa FBD, Oliveira ADSD, Duarte MT, Leite M. Beneficial effects of intradialytic cardiopulmonary rehabilitation. J Bras Nefrol 2017; 39:275-282. [PMID: 29044337 DOI: 10.5935/0101-2800.20170051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 10/19/2016] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Patients on hemodialysis (HD) present high mortality from cardiovascular complications and high morbidity, including decreasing functional capacity and quality of life. OBJECTIVE To analyze clinical and laboratory responses of patients in HD to intradialytic cardiopulmonary rehabilitation on an outpatient basis. METHODS We evaluated 14 patients in a prospective study for 8 months using cardiopulmonary rehabilitation protocol (CRehab) consisted of intradialytic aerobic exercise with a cycle ergometer. We analyzed heart rate (HR), systolic (SBP) and diastolic blood pressure (DBP), peripheral oxygen saturation (SpO2) and modified Borg scale. We evaluated cardiac function by echocardiogram, functional capacity by six minutes walk test (6MWT), and quality of life by SF-36 survey, before and after CRehab. Biochemical data and KT/Vsp were collected form medical records. RESULTS During CRehab, the results of HR, SBP, DBP, SpO2 and Borg scale showed no significant changes. 6MWT test showed progressive increase in the distance covered (p < 0.001) as well as a reduction in the scale of Borg post-6MWT (p = 0.009). There was no significant change in any biochemical data or in KT/Vsp. There was increase in left ventricular ejection from 65.7 ± 10.2% to 73.6 ± 10.1% (p = 0.028) and in left ventricular diastolic diameter (p = 0.027). According to SF-36 survey, patients showed improvement in three areas: physical role functioning (p = 0.012), bodily pain (p = 0.007) and vitality (p = 0.009). CONCLUSION The intradialytic CRehab applied in this population was safe and allowed objective improvement of functional capacity and exercise tolerance, subjective improvement in the perception of effort, significant increase in cardiac function and better quality of life in different domains.
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Lima GAC, de Paula Paranhos-Neto F, Silva LC, de Mendonça LMC, Delgado AG, Leite M, Gomes CP, Farias MLF. Bone Density Is Directly Associated With Glomerular Filtration and Metabolic Acidosis but Do Not Predict Fragility Fractures in Men With Moderate Chronic Kidney Disease. J Clin Densitom 2016; 19:146-53. [PMID: 24709549 DOI: 10.1016/j.jocd.2014.01.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Accepted: 01/22/2014] [Indexed: 01/10/2023]
Abstract
Hyperparathyroidism, vitamin D deficiency, increased fibroblast growth factor-23 (FGF-23), and metabolic acidosis promote bone fragility in chronic kidney disease (CKD). Although useful in predicting fracture risk in the general population, the role of dual-energy X-ray absorptiometry (DXA) in CKD remains uncertain. This cross-sectional study included 51 men aged 50-75 yr with moderate CKD. The stage 4 CKD patients had higher levels of parathyroid hormone (p<0.001), FGF-23 (p=0.029), and lowest 25-hydroxyvitamin D (p=0.016), bicarbonate (p<0.001), total femur (p=0.003), and femoral neck (p=0.011) T-scores compared with stage 3 CKD patients. Total femur and femoral neck T-scores were directly correlated with serum bicarbonate (p=0.003, r=0.447 and p=0.005, r=0.427, respectively) and estimated glomerular filtration rate (p=0.024, r=0.325 and p=0.003, r=0.313, respectively) but were not significantly associated with parathyroid hormone, 25-hydroxyvitamin D, or FGF-23. Only 3.9% of the participants had osteoporosis on DXA scan, whereas 31.4% reported a low-impact fracture. Our data point to a pivotal role of metabolic acidosis for bone impairment and to the inadequacy of DXA to evaluate bone fragility in CKD patients.
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Affiliation(s)
- Guilherme Alcantara Cunha Lima
- Division of Endocrinology, Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil.
| | - Francisco de Paula Paranhos-Neto
- Division of Endocrinology, Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil
| | - Luciana Colonese Silva
- Division of Endocrinology, Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil
| | - Laura Maria Carvalho de Mendonça
- Division of Rheumatology, Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil
| | - Alvimar Gonçalves Delgado
- Division of Nephrology, Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil
| | - Maurilo Leite
- Division of Nephrology, Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil
| | - Carlos Perez Gomes
- Division of Nephrology, Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil
| | - Maria Lucia Fleiuss Farias
- Division of Endocrinology, Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil
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Lima GAC, Paranhos Neto FDP, Pereira GRM, Gomes CP, Farias MLF. Osteoporosis management in patient with renal function impairment. ACTA ACUST UNITED AC 2014; 58:530-9. [DOI: 10.1590/0004-2730000003360] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 05/24/2014] [Indexed: 01/23/2023]
Abstract
Aging is associated with decreases in bone quality and in glomerular filtration. Consequently, osteoporosis and chronic kidney disease (CKD) are common comorbid conditions in the elderly, and often coexist. Biochemical abnormalities in the homeostasis of calcium and phosphorus begin early in CKD, leading to an increase in fracture risk and cardiovascular complications since early stages of the disease. The ability of DXA (dual energy X-ray absorptiometry) to diagnose osteoporosis and to predict fractures in this population remains unclear. The management of the disease is also controversial: calcium and vitamin D, although recommended, must be prescribed with caution, considering vascular calcification risk and the development of adynamic bone disease. Furthermore, safety and effectiveness of osteoporosis drugs are not established in patients with CKD. Thus, risks and benefits of antiosteoporosis treatment must be considered individually.
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Gomes CP, Leão-Ferreira LR, Pinheiro AAS, Gomes-Quintana E, Wengert M, Lopes AG, Caruso-Neves C. Crosstalk between the signaling pathways triggered by angiotensin II and adenosine in the renal proximal tubules: implications for modulation of Na(+)-ATPase activity. Peptides 2008; 29:2033-8. [PMID: 18682265 DOI: 10.1016/j.peptides.2008.07.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2008] [Revised: 07/03/2008] [Accepted: 07/07/2008] [Indexed: 11/26/2022]
Abstract
We have previously demonstrated that adenosine (Ado) reverses the stimulatory effect of angiotensin II (Ang II) on Na(+)-ATPase activity via the A(2A) receptor. In this work, the molecular mechanism involved in Ado-induced shutdown in the signaling pathway triggered by 10(-8)M Ang II was investigated. It was observed that: (1) both 10(-12)M PMA (a PKC activator) and 5x10(-8)M U73122 (an inhibitor of PI-PLCbeta) prevent the reversion effect induced by 10(-6)M Ado (only observed in the presence of 10(-6)M DPCPX (an A(1) receptor antagonist)) on Ang II-stimulated Na(+)-ATPase and PKC activities; (2) Ang II-stimulated PKC activity was reversed by 10(-6)M forskolin (an adenylyl cyclase activator) or 10(-8)M PKA inhibitory peptide and 10(-8)M DMPX (an A(2) receptor-selective antagonist). Considering that PMA prevents the inhibitory effect of Ado on Ang II-stimulated Na(+)-ATPase and PKC activities, it is likely that the PMA-induced effect, i.e. PKC activation, is downstream of the target for Ado-induced reversion of Ang II stimulation of Na(+)-ATPase activity. We investigated the hypothesis that PI-PLCbeta could be the target for Ado-induced PKA activation. Our data demonstrate that Ang II-stimulated PI-PLCbeta activity was reversed by Ado or 10(-7)M cAMP; the reversibility of the Ado-induced effect was prevented by either DMPX or PKA inhibitory peptide. These data demonstrate that Ado-induced PKA activation reduces Ang II-induced stimulation of PI-PLCbeta.
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Affiliation(s)
- C P Gomes
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, CCS Bloco G, 21949-900 Rio de Janeiro, RJ, Brazil
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Gomes CP, Andrade LALA. PTEN and p53 expression in primary ovarian carcinomas: immunohistochemical study and discussion of pathogenetic mechanisms. Int J Gynecol Cancer 2006; 16 Suppl 1:254-8. [PMID: 16515600 DOI: 10.1111/j.1525-1438.2006.00306.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Proapoptotic molecules have been studied in epithelial ovarian neoplasms as possible indicators of the pathogenetic pathways, as targets for new therapeutic approaches, and as prognostic markers. PTEN and p53 are proteins that have many different regulatory functions, including apoptosis. We have studied their immunohistochemical expression in 70 cases of primary ovarian carcinomas (26 serous, 27 endometrioid, and 17 mucinous) and compared the results with morphologic parameters (histologic grade, subtype) and clinical data (age, stage, tumor size). Statistical analyses showed a significantly higher expression of p53 in histologically high-grade tumors (grades 2 and 3), mainly of the serous subtype. A statistical tendency of higher expression of p53 in older patients (P= 0.08) was also observed. The loss of expression of PTEN was significantly more frequent in grade 1 endometrioid adenocarcinomas. These markers did not show association with volume or stage of the tumor. p53 is associated with serous carcinoma, loss of differentiation, and older patients, whereas PTEN inactivation is an early event in carcinogenesis of the endometrioid subtype, as observed in type I endometrial carcinoma. Our results are in keeping with different pathogenetic pathways in subtypes of ovarian carcinoma, prompting the search for new strategies of prevention and treatment.
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Affiliation(s)
- C P Gomes
- Department of Anatomic Pathology, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, Brazil
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Gomes CP, Leão-Ferreira LR, Caruso-Neves C, Lopes AG. Adenosine reverses the stimulatory effect of angiotensin II on the renal Na+-ATPase activity through the A2 receptor. ACTA ACUST UNITED AC 2005; 129:9-15. [PMID: 15927692 DOI: 10.1016/j.regpep.2005.01.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2004] [Accepted: 01/07/2005] [Indexed: 11/30/2022]
Abstract
In the present paper, we report the modulation of the Angiotensin II (Ang II)-stimulated Na+-ATPase activity of the proximal tubule basolateral membrane by adenosine (Ado). Preincubation of isolated basolateral membrane with 10(-8)M Ang II increases the Na+-ATPase activity from 7.5+/-0.3 (control) to 14.6+/-0.9 nmol Pi x mg(-1)x min(-1)nmol Pi x mg(-1) x min(-1) (p<0.05). Incubation of Ang II-stimulated enzyme with 10(-6)M Ado, in the presence of the A1 receptor antagonist DPCPX (10(-6)M), completely reverses the Ang II-induced effect bringing the Na+-ATPase activity to the basal level. The following evidences demonstrate involvement of the A2 receptor/Gs protein/adenylyl cyclase/PKA signaling pathway in the inhibitory effect induced by Ado on the Ang II-stimulated Na+-ATPase activity in the presence of the DPCPX: 1) the inhibitory effect of Ado is abolished by the A2 receptor selective antagonist DMPX (10(-8)M); 2) the effect induced by Ado is blocked by 10(-8)M GDPbetaS and mimicked by 10(-9)M cholera toxin and 10(-8)M GTPgammaS; 3) the stimulatory effect of Ang II is reduced by 10(-6)M forskolin, an activator of adenylyl cyclase, or 10(-6)M cAMP; 4) Ado stimulates PKA activity; 5) the inhibitory effect induced by this nucleoside is reversed by the PKA inhibitor peptide.
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Affiliation(s)
- C P Gomes
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro,CCS Bloco G, 21949-900, Rio de Janeiro, RJ, Brazil
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Abstract
CONTEXT AND OBJECTIVE Few studies have focused on bone disease in patients with chronic kidney disease under conservative treatment. The objective was to evaluate bone disease in patients with chronic kidney disease. DESIGN AND SETTING Case series, at the Nephrology Division, Hospital Universitário Pedro Ernesto. METHODS 131 patients with creatinine clearance from 10 to 60 ml/min/1.73 m(2) were followed up for at least one year. Serum creatinine, albumin, calcium, phosphorus, alkaline phosphatase, total CO2 (tCO2), intact parathyroid hormone (iPTH), and alkaline phosphatase were measured. Creatinine clearance was calculated from 24-hour urine creatinine measurements and protein ingestion estimates from urea assays. RESULTS Patients presenting creatinine clearance < 30 ml/min/1.73 m(2) had higher iPTH values, but normal serum levels for calcium, phosphorus, alkaline phosphatase and tCO2. Patients presenting iPTH values of twice the normal upper limit (144 pg/ml) showed lower tCO2 values. Bone alkaline phosphatase was evaluated in 37 patients with creatinine clearance < 30 ml/min/1.73 m(2), showing correlation with alkaline phosphatase but not with parathyroid hormone. Bone biopsy on nine patients with creatinine clearance < 30 ml/min/1.73 m(2) and iPTH > 144 pg/ml showed osteitis fibrosa (4), mild lesion (4) and high turnover (1). CONCLUSION The present data suggest the importance of early control for iPTH and metabolic acidosis, among patients under conservative management for chronic kidney disease, in order to prevent complications related to bone disease.
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Affiliation(s)
- Carlos Perez Gomes
- Nephrology Division, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rua Soares Cabral 71, Laranjeiras Rio de Janeiro, (RJ), Brazil, CEP 22240-070
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Kusamura S, Derchain S, Alvarenga M, Gomes CP, Syrjänen KJ, Andrade LALA. Expression of p53, c-erbB-2, Ki-67, and CD34 in granulosa cell tumor of the ovary. Int J Gynecol Cancer 2003; 13:450-7. [PMID: 12911721 DOI: 10.1046/j.1525-1438.2003.13327.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The purpose of this study is to investigate the expression of p53, c-erbB-2, Ki-67, and angiogenic activity and their correlation with the clinicopathologic characteristics in a series of granulosa cell tumors of the ovary (GCTO). Eighteen GCTO cases assisted at the Department of Obstetrics and Gynecology, School of Medical Science, UNICAMP, after diagnostic confirmation by three pathologists, were submitted to immunohistochemistry for assessment of p53, c-erbB-2, Ki-67, and CD34 expressions. The mean tumor size was 13 cm (range: 4-30 cm). Six (33%) cases presented with extraovarian disease. Thirteen (72%) cases presented some solid diffuse or sarcomatoid pattern and six (33%) moderate or strong atypia. Fourteen cases presented </=2 mitoses/10 HPF. Thirteen cases were focally positive for Ki-67. The mean Ki-67 proliferative index was 1.0%. One case presented positive expression for mutant p53 but all cases were negative for c-erbB-2 expression. The mean microvascular density was 28.9/mm2 (range: 0-50). No significant correlations could be established between the biologic markers and clinicopathologic variables. GCTO showed a markedly low rate of immunohistochemical staining for p53 or c-erbB-2 overexpression/amplification, as well as low proliferative and angiogenic activities. Further studies are urgently needed to elaborate the factors responsible for the highly unpredictable clinical course of GCTO.
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Affiliation(s)
- S Kusamura
- Department of Obstetrics and Gynecology, School of Medical Science, Universidade Estadual de Campinas (UNICAMP), Campinas, Brazil
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