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Zangirolami-Raimundo J, Raimundo RD, Silva Noll PRE, Dos Santos WS, Leone C, Baracat EC, Sorpreso ICE, Soares Júnior JM. Postmenopausal women's cognitive function and performance of virtual reality tasks. Climacteric 2023; 26:445-454. [PMID: 36999579 DOI: 10.1080/13697137.2023.2190511] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/28/2023] [Accepted: 03/04/2023] [Indexed: 04/01/2023]
Abstract
OBJECTIVE This study aimed to assess whether prior knowledge of computer use determines performance of virtual reality tasks by postmenopausal women and whether menopausal symptoms, sociodemographic factors, lifestyle and cognition modify or interfere with their performance. METHOD This cross-sectional study included 152 postmenopausal women divided into two groups: computer users and non-users. Age, ethnicity, time of menopause, menopausal symptoms, female health status, level of physical activity and cognitive function were considered. The participants played a virtual reality game and were assessed for hits, errors, omissions and game time. The Mann-Whitney, chi-square and Fisher exact tests and multivariate linear regression analysis were used. RESULTS Postmenopausal computer users play virtual reality games (p = 0.005) better than postmenopausal non-users of computers. Vasomotor symptoms were high in women who used computers compared to those who did not (p = 0.006). Multivariate linear regression analysis found that the best-fitting predictors for the number of hits - that is, age (p = 0.039), Mini-Mental State Examination score (p = 0.006) and the headache symptom (p = 0.021) - influence the performance of virtual reality tasks. CONCLUSION Computer users performed virtual reality tasks better than non-users. Headache and age but not vasomotor symptoms negatively affected the postmenopausal women's performance.
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Affiliation(s)
- J Zangirolami-Raimundo
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
- Centro Universitário FMABC, São Paulo, Brazil
| | - R D Raimundo
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
- Centro Universitário FMABC, São Paulo, Brazil
| | - P R E Silva Noll
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - W S Dos Santos
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
- Centro Universitário FMABC, São Paulo, Brazil
| | - C Leone
- Centro Universitário FMABC, São Paulo, Brazil
| | - E C Baracat
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - I C E Sorpreso
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - J M Soares Júnior
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
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Zangirolami-Raimundo J, Noll PRES, Raimundo RD, Gonçalves GL, Urso EME, Bech GD, Frank YS, Abreu LCD, Baracat EC, Sorpreso ICE, Soares Júnior JM. Use of interventions involving virtual reality tasks during the climacteric: a systematic review. Climacteric 2022; 25:543-551. [PMID: 35771198 DOI: 10.1080/13697137.2022.2088275] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Technological advances have been impacting health care worldwide. Our study aimed to research the literature systematically to determine the impact of technological treatments versus conventional treatments on the quality of life of climacteric women. The study was registered on PROSPERO (CRD42021241638). We searched seven databases, including PRISMA, using mesh terms. After screening for eligibility, we selected five clinical trials, and applying the snowball technique we were able to include four more articles, totaling nine articles that used technology-based interventions (virtual reality games) during the climacteric. The total study population consisted of 298 climacteric women. Two studies evaluated a technology-based treatment for pelvic floor, one for urinary incontinence symptoms, three for postural balance, one for cardiorespiratory capacity, one for osteoporosis and one study for lower back pain. The studies showed that the technological treatments improved pelvic floor strength, balance, cardiorespiratory fitness and bone mineral density when compared to conventional treatments. Improvement was linked to adherence to training and a high level of satisfaction during the training sessions. Technology-based treatments appear to be a viable alternative to conventional treatments in improving the quality of health, with benefits for the cardiovascular, genitourinary and skeletal systems, and ultimately for the overall quality of life.
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Affiliation(s)
- J Zangirolami-Raimundo
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil.,Laboratório de Delineamento de Estudos e Escrita Científica, Departamento de Saúde da Coletividade, Centro Universitário FMABC, Santo André, Brazil
| | - P R E S Noll
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - R D Raimundo
- Laboratório de Delineamento de Estudos e Escrita Científica, Departamento de Saúde da Coletividade, Centro Universitário FMABC, Santo André, Brazil
| | - G L Gonçalves
- Laboratório de Delineamento de Estudos e Escrita Científica, Departamento de Saúde da Coletividade, Centro Universitário FMABC, Santo André, Brazil
| | - E Mattos E Urso
- Laboratório de Delineamento de Estudos e Escrita Científica, Departamento de Saúde da Coletividade, Centro Universitário FMABC, Santo André, Brazil
| | - G D Bech
- Laboratório de Delineamento de Estudos e Escrita Científica, Departamento de Saúde da Coletividade, Centro Universitário FMABC, Santo André, Brazil
| | - Y S Frank
- Laboratório de Delineamento de Estudos e Escrita Científica, Departamento de Saúde da Coletividade, Centro Universitário FMABC, Santo André, Brazil
| | - L C de Abreu
- Laboratório de Delineamento de Estudos e Escrita Científica, Departamento de Saúde da Coletividade, Centro Universitário FMABC, Santo André, Brazil.,Departamento de Educação Integrada em Saúde, Universidade Federal do Espírito Santo, Vitoria, Brazil
| | - E C Baracat
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - I C E Sorpreso
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - J M Soares Júnior
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
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Soares-Jr JM, Espósito Sorpreso IC, Nunes Curado JF, Ferreira Filho ES, Dos Santos Simões R, Bonfá E, Silva CA, Baracat EC. Hormone therapy effect on menopausal systemic lupus erythematosus patients: a systematic review. Climacteric 2022; 25:427-433. [PMID: 35438053 DOI: 10.1080/13697137.2022.2050205] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Systemic lupus erythematosus (SLE) primarily affects women, who may need hormone therapy (HT) in menopause. There is, however, some concern as to its efficacy and safety. This systematic review aimed to determine the effect of HT on the activity of SLE and its safety. The study was a qualitative systematic review. Research was conducted with data retrieved from Embase, MEDLINE and Cochrane databases using MESH terms up to April 2021, with no bar on date or language. Sixteen studies were selected for analysis. Most of them showed HT to be effective in the treatment of menopausal symptoms with no impact in SLE activity, but one randomized clinical trial showed an increase in the number of thrombotic events. The present systematic review demonstrated the efficacy of HT for treating the menopausal symptoms of SLE patients. The risk of flare and thrombosis seems to be very low.
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Affiliation(s)
- J M Soares-Jr
- Discipline of Gynecology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - I C Espósito Sorpreso
- Discipline of Gynecology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - J F Nunes Curado
- Discipline of Gynecology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - E S Ferreira Filho
- Discipline of Gynecology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - R Dos Santos Simões
- Discipline of Gynecology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - E Bonfá
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - C A Silva
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.,Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - E C Baracat
- Discipline of Gynecology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
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Noll PRES, Campos CAS, Leone C, Zangirolami-Raimundo J, Noll M, Baracat EC, Júnior JMS, Sorpreso ICE. Dietary intake and menopausal symptoms in postmenopausal women: a systematic review. Climacteric 2020; 24:128-138. [PMID: 33112163 DOI: 10.1080/13697137.2020.1828854] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Despite literature pointing to a relation between dietary intake and menopausal symptoms, most studies have evaluated either only supplements or only specific nutrients or foods. Therefore, this study aimed to provide a systematic review of the literature regarding the association between dietary intake and menopausal symptoms in postmenopausal women. A systematic search was conducted across PubMed/Medline, Web of Science, Scopus, and Embase to identify studies published between 2009 and 2019. We identified 3828 studies; after screening, 73 studies were reviewed and 19 of these investigated nutrient and food intake and eating patterns associated with the intensity of menopausal symptoms. Studies evaluating diet quality or dietary patterns showed an association between lower intensity of psychological symptoms, sleep disorders, and vasomotor, urogenital, and somatic symptoms and higher consumption of vegetables, whole grains, and unprocessed foods. Also, the intensity of these symptoms is associated with high-processed foods, saturated fats, and sugars. Regarding nutrient and/or specific food, the studies indicated an association between caffeine intake and type of fat intake and the intensity of menopausal symptoms. Dietary intake was found to be associated with the severity of menopausal symptoms; however, evidence for the association between dietary intake and menopausal symptoms is inconsistent and inconclusive, and is provided by a small number of studies.
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Affiliation(s)
- P R E S Noll
- Department of Obstetrics and Gynecology, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil.,Department of Public Health, Instituto Federal Goiano, Goiás, Brazil
| | - C A S Campos
- Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brazil
| | - C Leone
- Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brazil
| | - J Zangirolami-Raimundo
- Department of Obstetrics and Gynecology, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - M Noll
- Department of Public Health, Instituto Federal Goiano, Goiás, Brazil
| | - E C Baracat
- Department of Obstetrics and Gynecology, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - J M Soares Júnior
- Department of Obstetrics and Gynecology, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - I C E Sorpreso
- Department of Obstetrics and Gynecology, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
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Nogara PRB, Godoy-Santos AL, Fonseca FCP, Cesar-Netto C, Carvalho KC, Baracat EC, Maffulli N, Pontin PA, Santos MCL. Association of estrogen receptor β polymorphisms with posterior tibial tendon dysfunction. Mol Cell Biochem 2020; 471:63-69. [PMID: 32472323 DOI: 10.1007/s11010-020-03765-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 05/23/2020] [Indexed: 11/27/2022]
Abstract
Posterior tibial tendon (PTT) dysfunction is three times more common in females, and some patients may have a predisposition without a clinically evident cause, suggesting that individual characteristics play an important role in tendinopathy. The present study investigated the association of rs4986938 (+ 1730G > A; AluI RFLP) and rs1256049 (- 1082G > A; RsaI RFLP) single nucleotide polymorphisms (SNPs) of estrogen receptor-beta (ER-β) gene with PTT dysfunction. A total of 400 participants were recruited. The PTT dysfunction group: these patients underwent surgery, with PTT tendinopathy confirmed by histopathology and magnetic resonance image (MRI). The control group was composed of participants with no clinical or MRI evidence of PTT dysfunction. Each group was composed of 100 postmenopausal women, 50 premenopausal women, and 50 men. Genomic DNA was extracted from saliva samples, and genotypes were obtained by polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP). Concerning the ER-β SNP rs4986938, there were significant differences in the frequencies of alleles between test and control groups of all the cases, only postmenopausal women and only men (p < 0.0001, p = 0.0016 and p = 0.0001). Considering the PTT dysfunction group and comparing postmenopausal women versus premenopausal women adding men, the analysis showed significant differences in the allelic distribution (p = 0.0450): the allele A in postmenopausal women is a risk factor. The ER-β SNP rs1256049 did not show differences in the frequencies of alleles and genotypes between groups. The ER-β SNP rs4986938, but not ER -β SNPs rs1256049, may contribute to PTT insufficiency in the Brazilian population, with additional risk in postmenopausal women. Addition, in men the genetic factor could be more determinant.
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Affiliation(s)
- P R B Nogara
- Department of Cell Biology, University Federal of Paraná, Curitiba, PR, Brazil
| | - A L Godoy-Santos
- Department of Orthopaedics, Foot and Ankle Service, University of São Paulo, São Paulo, SP, Brazil
| | - F C P Fonseca
- Department of Orthopaedics, Foot and Ankle Service, University of São Paulo, São Paulo, SP, Brazil
| | - C Cesar-Netto
- Department of Orthopedic, Medstar Union Memorial Hospital, Baltimore, USA
| | - K C Carvalho
- Department of Gynecology, University of São Paulo, São Paulo, SP, Brazil
| | - E C Baracat
- Department of Gynecology, University of São Paulo, São Paulo, SP, Brazil
| | - N Maffulli
- Centre for Sports and Exercise Medicine Barts and The London, School of Medicine and Dentistry, London, UK
- Department of Musculoskeletal Surgery, School of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
- Institute of Science and Technology in Medicine, Keele University School of Medicine, Stoke on Trent, UK
| | - P A Pontin
- Department of Orthopaedics, Foot and Ankle Service, University of São Paulo, São Paulo, SP, Brazil
| | - M C L Santos
- Department of Cell Biology, University Federal of Paraná, Curitiba, PR, Brazil.
- Universidade Federal Do Paraná, Centro Politécnico, Rua Francisco H. Dos Santos, Jd. das Américas, Curitiba PR, 81531-990, Brazil.
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Carbonel AAF, Vieira MC, Simões RS, Lima PDA, Fuchs LFP, Girão ERC, Cicivizzo GP, Sasso GRS, de Moraes LOC, Soares Junior JM, Baracat EC, Simões MJ, Girão MJBC. Isoflavones improve collagen I and glycosaminoglycans and prevent bone loss in type 1 diabetic rats. Climacteric 2019; 23:75-83. [DOI: 10.1080/13697137.2019.1627314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- A. A. F. Carbonel
- Department of Morphology and Genetics, Paulista School of Medicine/Federal University of São Paulo – EPM/UNIFESP, São Paulo, Brazil
| | - M. C. Vieira
- Department of Gynecology, Paulista School of Medicine/Federal University of São Paulo – EPM/UNIFESP, São Paulo, Brazil
| | - R. S. Simões
- Department of Obstetrics and Gynecology, Medicine Faculty of University of São Paulo – FMUSP, São Paulo, Brazil
| | - P. D. A. Lima
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Canada
| | - L. F. P. Fuchs
- Department of Gynecology, Paulista School of Medicine/Federal University of São Paulo – EPM/UNIFESP, São Paulo, Brazil
| | - E. R. C. Girão
- Department of Gynecology, Paulista School of Medicine/Federal University of São Paulo – EPM/UNIFESP, São Paulo, Brazil
| | - G. P. Cicivizzo
- Department of Morphology and Genetics, Paulista School of Medicine/Federal University of São Paulo – EPM/UNIFESP, São Paulo, Brazil
| | - G. R. S. Sasso
- Department of Gynecology, Paulista School of Medicine/Federal University of São Paulo – EPM/UNIFESP, São Paulo, Brazil
| | - L. O. Carvalho de Moraes
- Department of Morphology and Genetics, Paulista School of Medicine/Federal University of São Paulo – EPM/UNIFESP, São Paulo, Brazil
| | - J. M. Soares Junior
- Department of Obstetrics and Gynecology, Medicine Faculty of University of São Paulo – FMUSP, São Paulo, Brazil
| | - E. C. Baracat
- Department of Obstetrics and Gynecology, Medicine Faculty of University of São Paulo – FMUSP, São Paulo, Brazil
| | - M. J. Simões
- Department of Morphology and Genetics, Paulista School of Medicine/Federal University of São Paulo – EPM/UNIFESP, São Paulo, Brazil
| | - M. J. B. C. Girão
- Department of Gynecology, Paulista School of Medicine/Federal University of São Paulo – EPM/UNIFESP, São Paulo, Brazil
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Pontin PA, Nogara PRB, Fonseca FCP, Cesar Netto C, Carvalho KC, Soares Junior JM, Baracat EC, Fernandes TD, Maffulli N, Santos MCL, Godoy-Santos AL. ERα PvuII and XbaI polymorphisms in postmenopausal women with posterior tibial tendon dysfunction: a case control study. J Orthop Surg Res 2018; 13:316. [PMID: 30537990 PMCID: PMC6290490 DOI: 10.1186/s13018-018-1020-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 11/26/2018] [Indexed: 02/05/2023] Open
Abstract
Background Posterior tibial tendon (PTT) insufficiency is considered as the main cause of adult acquired flat foot and is three times more frequent in females. High estrogen levels exert a positive effect on the overall collagen synthesis in tendons. We have previously demonstrated the association between some genetic single-nucleotide polymorphism (SNP) and tendinopathy. In the present study, we investigated the association of PvuII c454-397T>C (NCBI ID: rs2234693) and XbaI c454-351A>G (NCBI ID: rs9340799) SNPs in estrogen receptor alfa (ER-α) gene with PPT dysfunction. Methods A total of 92 female subjects with PTT dysfunction, with histopathological examination of the tendon and magnetic resonance image (MRI) evidence of tendinopathy, were compared to 92 asymptomatic females who presented an intact PPT at MRI for PvuII and XbaI SNPs in the ER-α gene. Genomic DNA was extracted from saliva and genotypes were obtained by polymerase chain reaction restriction fragment length polymorphism. Results The analysis of PvuII SNPs showed no significant differences in the frequency of alleles and genotypes between control and PTT dysfunction groups. The XbaI SNPs in the ER-α gene showed significant differences in the frequency of genotypes between control and test groups (p = 0.01; OR 95% 1.14 (0.55–2.33). Conclusions The XbaI SNP in the ERα gene may contribute to tendinopathy, and the A/A genotype could be a risk factor for PTT tendinopathy in this population. The PvuII SNP studied was not associated with PTT tendinopathy.
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Affiliation(s)
- P A Pontin
- Department of Orthopaedic and Traumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - P R B Nogara
- Department of Cell Biology, University Federal of Paraná, Curitiba, PR, Brazil
| | - F C P Fonseca
- Department of Orthopaedic and Traumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - C Cesar Netto
- Department of Orthopedic, Hospital for Special Surgery, New York, USA
| | - K C Carvalho
- Department of Gynecology, University of São Paulo, São Paulo, SP, Brazil
| | - J M Soares Junior
- Department of Gynecology, University of São Paulo, São Paulo, SP, Brazil
| | - E C Baracat
- Department of Gynecology, University of São Paulo, São Paulo, SP, Brazil
| | - T D Fernandes
- Department of Orthopaedic and Traumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - N Maffulli
- Department of Orthopaedics, School of Medicine, Surgery and Dentistry, Salerno, Italy. .,Institute of Science and Technology in Medicine, Keele University School of Medicine, Stoke-on-Trent, UK. .,Centre for Sports and Exercise Medicine, Queen Mary University of London, Mile End Road, London, E1 4NS, UK.
| | - M C L Santos
- Department of Cell Biology, University Federal of Paraná, Curitiba, PR, Brazil
| | - A L Godoy-Santos
- Department of Orthopaedic and Traumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Dória MT, Mota BS, Reis YN, Ricci MD, Piato JRM, Ferreira VCCS, Shimizu C, Barros N, Filassi JR, Baracat EC. Abstract OT2-02-01: Brazilian randomized study - Impact of preoperative magnetic resonance in the evaluation for breast cancer conservative surgery (BREAST-MRI trial). Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-ot2-02-01] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: A precise preoperative evaluation of the tumor is essential to improve breast cancer surgical management. Currently, mammography associated with ultrasound and clinical exam are the standard techniques for evaluating extension and tumor localization. However, approximately one third of the lesions in patients eligible for conservative surgical treatment are misevaluated by these methods. Breast magnetic resonance imaging (MRI) has a high sensitivity (95-100%) in detecting invasive neoplasms, and is able to detect occult tumors, multifocal and/or multicentric disease, and contralateral breast cancer more accurately than mammography and ultrasound. Until now, there are only three randomized trials assessing the role of preoperative MRI. These trials have different designs and contradictory results. Trial design: BREAST-MRI is a randomized, open label, unblinded trial designed to compare the accuracy of breast MRI in the preoperative planning of surgical treatment of breast cancer to standard protocol (clinical exam of the breast, mammography and/or breast ultrasound) and the impact of breast MRI on breast cancer outcome. Patients are randomized on a 1:1 basis, stratified for mammary density, into two groups: 1)MRI group: patients are submitted to MRI and standard protocol 2)Control group: standard protocol. First phase: patient recruitment and data collection up until surgery. Second phase: follow-up for five years or until death. Eligibility criteria: women aged 18 years or older with breast cancer stages I to III candidates for conservative surgery (CC). Specific aims: The aim of this study is to evaluate the ability of MRI in selecting patients for conservative treatment of breast cancer. Primary outcomes are: false positive rates, false negative rates, positive predictive value and negative predictive value of MRI in breast cancer CC. Secondary outcomes are: rates of positive margins on pathological examination; reoperation rates; number of conversions to mastectomy; accuracy of MRI according to mammographic density, immunohistochemical subtype and histopathology of the tumor; rates of multicentricity, multifocality and bilateralality of tumors; disease-free survival after 3 and 5 years; and cost-effectiveness of breast MRI. Statistical methods: The calculated total case number for this trial is 372, assuming a recurrence rate of 10% for CC and 1% for mastectomies. The Shapiro-Whilks test will be used to verify if distribution of the quantitative variables follows normal distribution. The baseline population will be analyzed using the t-Student test, or the Mann-Whitney test when appropriate. To test the existence of a possible association between outcomes and the categorized characteristics, chi-square and Fisher's exact test will be performed. Disease progression will be reassessed at 3 and 5 years follow-up, in order to produce a log-rank Kaplan-Meier curve of survival. Present accrual and target accrual: In June 2017, randomizations are at approximately 90% of the target sample size.
Citation Format: Dória MT, Mota BS, Reis YN, Ricci MD, Piato JRM, Ferreira VCCS, Shimizu C, Barros N, Filassi JR, Baracat EC. Brazilian randomized study - Impact of preoperative magnetic resonance in the evaluation for breast cancer conservative surgery (BREAST-MRI trial) [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT2-02-01.
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Affiliation(s)
- MT Dória
- State University of Campinas, Campinas, Sao Paulo, Brazil; University of São Paulo, Sao Paulo, Brazil
| | - BS Mota
- State University of Campinas, Campinas, Sao Paulo, Brazil; University of São Paulo, Sao Paulo, Brazil
| | - YN Reis
- State University of Campinas, Campinas, Sao Paulo, Brazil; University of São Paulo, Sao Paulo, Brazil
| | - MD Ricci
- State University of Campinas, Campinas, Sao Paulo, Brazil; University of São Paulo, Sao Paulo, Brazil
| | - JRM Piato
- State University of Campinas, Campinas, Sao Paulo, Brazil; University of São Paulo, Sao Paulo, Brazil
| | - VCCS Ferreira
- State University of Campinas, Campinas, Sao Paulo, Brazil; University of São Paulo, Sao Paulo, Brazil
| | - C Shimizu
- State University of Campinas, Campinas, Sao Paulo, Brazil; University of São Paulo, Sao Paulo, Brazil
| | - N Barros
- State University of Campinas, Campinas, Sao Paulo, Brazil; University of São Paulo, Sao Paulo, Brazil
| | - JR Filassi
- State University of Campinas, Campinas, Sao Paulo, Brazil; University of São Paulo, Sao Paulo, Brazil
| | - EC Baracat
- State University of Campinas, Campinas, Sao Paulo, Brazil; University of São Paulo, Sao Paulo, Brazil
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Boufelli G, Mota BS, Franca FC, Doria MT, Maesaka JY, Ricci MD, Piato JRM, Rocha FBC, Giribela AHG, Gonçalves R, Masili-Oku S, Mano MS, Chala LF, Thompson BM, Baracat EC, Filassi JR. Abstract P2-12-11: Does conservative surgery treatment for locally advanced breast cancer safe after neoadjuvant treatment? Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p2-12-11] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BACKGROUND:
The aim of this study was to assess the oncological efficacy of breast conserving surgery (BCS) after neoadjuvant chemotherapy in patients with local advanced breast cancer.
PATIENTS AND METHODS:
A retrospective cohort study was conducted with locally advanced breast cancer invasive (Stage IIb to III) treated at ICESP, an oncologic referral center between 2008 and 2016. Endpoints were disease free survival (DFS), local disease free survival (LDFS) and overall survival (OS). Multivariable analyses were performed using Cox proportional hazards models.
RESULTS:
530 patients were included, 26% (138) were stage IIB, 41.9% (222) IIIA, 29.6% (157) IIIB and 2.5% (13) IIIA. 88.8% (470) were invasive ductal carcinoma. The mean age was 51.5(23-95). 95.5% and 4.5% were submitted Neoadjuvant Chemotherapy and Hormone therapy, respectively. The BCS were performed in 24.5% (130) patients versus 75.5% (400) of mastectomies. The mean follow up was 36.4(0.16-80.2) months. There were no differences in local disease free-survival 59 (95%CI 58-61) versus 60 (95%CI 57-60); p=0.4 and overall survival 56.2 (95%CI 52-60) versus 59.3(95%CI 53-65); p= 0.24 for mastectomy and BCS. The disease free survival was lower at mastectomy group 51.4 (95%CI 49-53) versus 56,8 (95%CI 53-59); p=0.01. Logistic regression models were significant only for cancer stage both patterns, although the results were better for masses, particularly when kinetic assessments were included (LR 12.8; p = 0.005)
CONCLUSION:
In our population, the BCS does not affect the overall and local disease-free survival rates, which seems to be safe to perform in patients who desire to conserve the breast after neoadjuvant treatment.
Citation Format: Boufelli G, Mota BS, Franca FC, Doria MT, Maesaka JY, Ricci MD, Piato JRM, Rocha FBC, Giribela AHG, Gonçalves R, Masili-Oku S, Mano MS, Chala LF, Thompson BM, Baracat EC, Filassi JR. Does conservative surgery treatment for locally advanced breast cancer safe after neoadjuvant treatment? [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-12-11.
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Affiliation(s)
- G Boufelli
- Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - BS Mota
- Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - FC Franca
- Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - MT Doria
- Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - JY Maesaka
- Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - MD Ricci
- Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - JRM Piato
- Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - FBC Rocha
- Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - AHG Giribela
- Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - R Gonçalves
- Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - S Masili-Oku
- Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - MS Mano
- Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - LF Chala
- Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - BM Thompson
- Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - EC Baracat
- Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - JR Filassi
- Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Riccio LGC, Baracat EC, Chapron C, Batteux F, Abrão MS. The role of the B lymphocytes in endometriosis: A systematic review. J Reprod Immunol 2017; 123:29-34. [PMID: 28910679 DOI: 10.1016/j.jri.2017.09.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 08/01/2017] [Accepted: 09/06/2017] [Indexed: 01/06/2023]
Abstract
The physiopathology of endometriosis is not completely understood and its progression is associated with a local and systemic inflammatory reaction. It is important to clarify the potential role of the immune system to better understand its implication in the pathogenesis of endometriosis, which includes the study of the role of B cells and antibodies. The aim of this study was to review the literature about the role of B lymphocytes in endometriosis. A search for "endometriosis", "B cells" and "B lymphocytes" in databases resulted in 140 citations; after applying inclusion and exclusion criteria, a total of 22 studies were assessed. The analyzed samples in the studies varied and different markers and techniques were used by the authors to evaluate the direct or indirect role of B lymphocytes in endometriosis. Most studies demonstrated increased number and/or activation of B cells while seven studies found no difference and two studies showed decreased number of B cells. Increased B lymphocytes and excessive production of autoantibodies in endometriosis have been described in the literature, but their role in the development of the disease is not well understood. Moreover, the association of these factors with clinical symptoms, location and severity of the disease has not been investigated. Further studies are necessary to clarify the role of B cells in the development of endometriosis and propose new therapeutic strategies such as the use of drugs that target these cells.
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Affiliation(s)
- L G C Riccio
- School of Medicine, University of São Paulo, Endometriosis Division, Obstetrics and Gynecology Department, São Paulo, Brazil; Department of Development, Reproduction and Cancer, Institut Cochin, INSERM U1016-Batteux, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
| | - E C Baracat
- School of Medicine, University of São Paulo, Endometriosis Division, Obstetrics and Gynecology Department, São Paulo, Brazil.
| | - C Chapron
- Sorbonne Paris Cité, Faculté de Médecine, Assistance Publique - Hôpitaux de Paris (AP-HP), Groupe Hospitalier Universitaire (GHU) Ouest, Centre Hospitalier Universitaire (CHU) Cochin, Department of Gynecology Obstetrics II and Reproductive Medicine, Université Paris Descartes, Paris, France; Department of Development, Reproduction and Cancer, Institut Cochin, INSERM U1016-Batteux, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
| | - F Batteux
- Department of Development, Reproduction and Cancer, Institut Cochin, INSERM U1016-Batteux, Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Department of Immunology, Hôpital Cochin, AP-HP, Paris, France.
| | - M S Abrão
- School of Medicine, University of São Paulo, Endometriosis Division, Obstetrics and Gynecology Department, São Paulo, Brazil.
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11
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Bittencourt CA, Dos Santos Simões R, Bernardo WM, Fuchs LFP, Soares Júnior JM, Pastore AR, Baracat EC. Accuracy of saline contrast sonohysterography in detection of endometrial polyps and submucosal leiomyomas in women of reproductive age with abnormal uterine bleeding: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2017; 50:32-39. [PMID: 27862503 DOI: 10.1002/uog.17352] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [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: 05/05/2016] [Revised: 10/27/2016] [Accepted: 10/28/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To analyze the diagnostic accuracy of two- (2D) and three- (3D) dimensional saline contrast sonohysterography (SCSH) in the detection of endometrial polyps and submucosal uterine leiomyomas in women of reproductive age with abnormal uterine bleeding compared with gold standard hysteroscopy. METHODS A systematic review of diagnostic studies that compared 2D- and/or 3D-SCSH with hysteroscopy and anatomopathology was conducted according to PRISMA and SEDATE recommendations. The databases MEDLINE, EMBASE and The Cochrane Library were searched electronically using specific terms with no restriction on language or publication year. Quality assessment of included studies was performed using the QUADAS-2 tool. Meta-analysis was performed with the Meta-DiSk program and data presented as forest plots and summary receiver-operating characteristics (SROC) curves. Pooled sensitivity, specificity and positive (LR+) and negative (LR-) likelihood ratios of SCSH in the detection of uterine cavity abnormalities were calculated. RESULTS A total of 1398 citations were identified and five studies were included in the systematic review and meta-analysis. Pooled sensitivity and specificity of 2D-SCSH in detecting endometrial polyps were 93% (95% CI, 89-96%) and 81% (95% CI, 76-86%), respectively, with pooled LR+ of 5.41 (95% CI, 2.60-11.28) and LR- of 0.10 (95% CI, 0.06-0.17). In the detection of submucosal uterine leiomyomas, pooled sensitivity and specificity were 94% (95% CI, 89-97%) and 81% (95% CI, 76-86%), respectively, with pooled LR+ of 4.25 (95% CI, 2.20-8.21) and LR- of 0.11 (95% CI, 0.05-0.22). 2D-SCSH had good accuracy in detecting endometrial polyps and submucosal uterine leiomyomas, with areas under the SROC curves of 0.97 ± 0.02 and 0.97 ± 0.03, respectively. Studies that analyzed the diagnostic accuracy of 3D-SCSH could not be compared due to high heterogeneity related to menopausal status, type of technique used and primary outcome being investigation of infertility. CONCLUSIONS 2D-SCSH proved to be a highly sensitive method for detection of endometrial polyps and submucosal uterine leiomyomas, making it a potential first-line diagnostic method in the work-up for women with abnormal uterine bleeding. More studies are needed on 3D-SCSH in women of reproductive age. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- C A Bittencourt
- Disciplina de Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - R Dos Santos Simões
- Disciplina de Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - W M Bernardo
- Disciplina de Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - L F P Fuchs
- Disciplina de Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - J M Soares Júnior
- Disciplina de Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - A R Pastore
- Disciplina de Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - E C Baracat
- Disciplina de Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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12
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Robial R, Longatto-Filho A, Roteli-Martins CM, Silveira MF, Stauffert D, Ribeiro GG, Linhares IM, Tacla M, Zonta MA, Baracat EC. Frequency of Chlamydia trachomatis infection in cervical intraepithelial lesions and the status of cytological p16/Ki-67 dual-staining. Infect Agent Cancer 2017; 12:3. [PMID: 28074107 PMCID: PMC5219725 DOI: 10.1186/s13027-016-0111-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Accepted: 12/13/2016] [Indexed: 12/24/2022] Open
Abstract
Background Chlamydia trachomatis (Ct) is not a disease subject to mandatory reporting in Brazil, and the prevalence rate of this genital infection varies according to the region in which studies are conducted, as well as by the detection technique employed. Ct has been associated with persistence of Human papillomavirus (HPV) infection and the facilitation of cervical carcinoma development. We evaluated the Chlamydia trachomatis infection and its association with cytology, p16/Ki-67 dual-stained cytology and cervical intraepithelial lesions status in a screening cohort in Brazil. Methods This was a cross-sectional study of 1481 cervical samples from asymptomatic women aged 18 to 64. Samples were collected for liquid-based cytology and Ct detection by polymerase chain reaction. p16/Ki-67 double staining was performed on samples with abnormal cytology. Statistical analysis was by chi-square and likelihood-ratio tests. Odds ratio (OR) and 95% confidence intervals (95% CI) were determined. Results The frequency of Ct was 15.6% and its presence was not associated with detection of p16/Ki-67 [OR = 1.35 (0.5–3.4)]. There was also no association between abnormal cervical cytology and Ct-positivity [OR = 1.21 (0.46–3.2)]. Associations were observed between p16/Ki-67 and high-grade lesions detected by cytology and in biopsies [OR = 3.55 (1.50–8.42) and OR = 19.00 (0.6–7.2), respectively]. Conclusions The asymptomatic women in our study had a high frequency of Ct infection but this was not associated with p16/Ki-67 detection in samples with abnormal cytology. The expression of p16/Ki-67 was highest in women with high-grade CIN (p = 0.003).
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Affiliation(s)
- R Robial
- Division of Gynecologic Clinic, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - A Longatto-Filho
- Laboratory of Medical Investigation (LIM) 14, Faculty of Medicine, University of São Paulo, São Paulo, Brazil ; Molecular Oncology Research Center, Barretos Cancer Hospital, Pio XII Foundation, Barretos, Brazil ; Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal ; ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - C M Roteli-Martins
- Leonor M De Barros Hospital - Secretaria de Saúde de São Paulo, São Paulo, Brazil
| | - M F Silveira
- Federal University of Pelotas - Pelotas, Rio Grande do Sul, Brazil
| | - D Stauffert
- Federal University of Pelotas - Pelotas, Rio Grande do Sul, Brazil
| | - G G Ribeiro
- School of Pharmaceutical Sciences of Ribeirão Preto University of São Paulo, Ribeirão Preto, Brazil
| | - I M Linhares
- Division of Gynecologic Clinic, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - M Tacla
- Division of Gynecologic Clinic, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - M A Zonta
- Discipline of Infectology, Federal University of São Paulo, São Paulo, Brazil
| | - E C Baracat
- Division of Gynecologic Clinic, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Shiroma ME, Botelho NM, Damous LL, Baracat EC, Soares JM. Melatonin influence in ovary transplantation: systematic review. J Ovarian Res 2016; 9:33. [PMID: 27287621 PMCID: PMC4902985 DOI: 10.1186/s13048-016-0245-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 06/07/2016] [Indexed: 12/27/2022] Open
Abstract
Melatonin is an indolamine produced by the pineal gland and it can exert a potent antioxidant effect. Its free radical scavenger properties have been used to advantage in different organ transplants in animal experiments. Several concentrations and administration pathways have been tested and melatonin has shown encouraging beneficial results in many transplants of organs such as the liver, lungs, heart, pancreas, and kidneys. The objective of the present study was to review the scientific literature regarding the use of melatonin in ovary transplantation. A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was carried out using the Cochrane and Pubmed databases and employing the terms 'melatonin' AND 'ovary' AND 'transplantation.' After analysis, 5 articles were extracted addressing melatonin use in ovary transplants and involving 503 animals. Melatonin enhanced various graft aspects like morphology, apoptosis, immunological reaction, revascularization, oxidative stress, and survival rate. Melatonin's antioxidative and antiapoptotic properties seemingly produce positive effects on ovarian graft activity. Despite the promising results, further studies in humans need to be conducted to consolidate its use, as ovary transplantation for fertility preservation is gradually being moved from the experimental stage to a clinical setting.
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Affiliation(s)
- M E Shiroma
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255 - Cerqueira César, São Paulo, SP, 05403-000, Brazil.
| | - N M Botelho
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina, Universidade Federal do Pará, Av. Generalíssimo Deodoro, 01 - Umarizal, Belém, Pará, 66050-160, Brazil
| | - L L Damous
- Laboratory of Molecular and Structural Gynecology, Faculdade de Medicina, Universidade de São Paulo, Avenida Doutor Arnaldo, 455 - Cerqueira César, São Paulo, SP, 01246-904, Brazil
| | - E C Baracat
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255 - Cerqueira César, São Paulo, SP, 05403-000, Brazil
| | - J M Soares
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255 - Cerqueira César, São Paulo, SP, 05403-000, Brazil
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14
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Piato JR, Chala LF, Alves-Jales RD, Dória MT, Mota BS, Messias AP, Goncalves R, Mano MS, Soares JM, de Barros N, Filassi JR, Baracat EC. Abstract P4-02-04: Magnetic resonance imaging to predict nipple involvement in breast cancer patients. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p4-02-04] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction. The implementation of Nipple-Sparing Mastectomy (NSM) as a treatment option for selected cases of breast cancer has risen great interest among breast surgeons. The preservation of the nipple-areola complex (NAC) can lead to extremely favorable psychological effects in breast cancer patients treated with this type of procedure. However, to ensure the oncologic safety of this technique it is of utmost importance to evaluate the likelihood of NAC involvement pre-operatively. In this study we evaluate the contribution of Breast Magnetic Resonance Imaging (MRI) in predicting the involvement in the NAC in breast cancer patients. Materials and Methods: We studied 170 mastectomy specimens from 165 breast cancer patients (five patients had bilateral disease) affected by Ductal Carcinoma in situ (DCIS)(n=19) or Invasive Ductal Carcinoma (n=151), stages I, II or IIIA. Every patient was pre-operatively studied using a 1.5 Tesla, 4-channel in vivo dedicated surface breast coil MRI. The parameters we investigated were: type of index lesion enhancement pattern (nodular or non-nodular), size of the index lesion, enhancement between the index lesion and the NAC, enhancement of the nipple, thickening of the areola, nipple retraction and size of the nipple in comparison with the contra-lateral nipple. The retro-areolar area and papilla were evaluated in histological sections of 4μm to identify DCIS and Invasive Ductal or Lobular carcinomas. One radiologist, blinded to the result of the histological evaluation of the papillae, performed the evaluation of the MRIs. Results. In univariate analysis, type of lesion enhancement in MRI, enhancement between index lesion and the papilla, distance between the index lesion and the papilla, enhancement of the papilla and nipple retraction had a statistically significant correlation with neoplastic involvement of the NAC (p<0.05). Using multivariate analysis, among the previously mentioned parameters, enhancement between the index lesion and the NAC, and nipple retraction remained as statistically significant predictors of nipple involvement in breast cancer patients (p < 0,001 e 0,010, respectively). The Negative Predictive Value of the combination of these two variables was 89.5%. According to this model that used the combination of those two variables, the probability of neoplastic involvement of the NAC was 73.9% in the presence of enhancement between the index lesion and the papilla combined with nipple retraction; 46% in the presence of enhancement between the index lesion and the papilla without nipple retraction in the MRI; 26.9% if there is only nipple retraction in the MRI; and 9.9% in the absence of these two characteristics. The sensibility of this model composed by those 2 variables to identify neoplastic involvement of the NAC was 29.7% (CI95%: 15.9% - 47%), specificity was 97.7% (CI95%: 93,5% - 99,5%), positive predictive value was 78,6% (CI95%: 49,2% - 95,3%) and negative predictive value was 83,3% (CI95%: 76,5% - 88,8%).
Conclusion. We can conclude that the probability of the NAC being cancer-free is around 90% when there is no enhancement between the index lesion and the nipple, and there is no retraction of the nipple in the pre-operative MRI study of the breast.
Citation Format: Piato JR, Chala LF, Alves-Jales RD, Dória MT, Mota BS, Messias AP, Goncalves R, Mano MS, Soares JM, de Barros N, Filassi JR, Baracat EC. Magnetic resonance imaging to predict nipple involvement in breast cancer patients. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-02-04.
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Affiliation(s)
- JR Piato
- Discipline of Gynecology, Hospital das Clínicas, Faculty of Medicine - University of São Paulo-FMUSP, São Paulo, SP, Brazil; Institute of Radiology, Hospital das Clínicas, Faculty of Medicine - University of São Paulo-FMUSP, São Paulo, SP, Brazil; Division of Medical Oncology, Instituto do Câncer do Estado de São Paulo, Faculty of Medicine, University of São Paulo-FMUSP, São Paulo, SP, Brazil
| | - LF Chala
- Discipline of Gynecology, Hospital das Clínicas, Faculty of Medicine - University of São Paulo-FMUSP, São Paulo, SP, Brazil; Institute of Radiology, Hospital das Clínicas, Faculty of Medicine - University of São Paulo-FMUSP, São Paulo, SP, Brazil; Division of Medical Oncology, Instituto do Câncer do Estado de São Paulo, Faculty of Medicine, University of São Paulo-FMUSP, São Paulo, SP, Brazil
| | - RD Alves-Jales
- Discipline of Gynecology, Hospital das Clínicas, Faculty of Medicine - University of São Paulo-FMUSP, São Paulo, SP, Brazil; Institute of Radiology, Hospital das Clínicas, Faculty of Medicine - University of São Paulo-FMUSP, São Paulo, SP, Brazil; Division of Medical Oncology, Instituto do Câncer do Estado de São Paulo, Faculty of Medicine, University of São Paulo-FMUSP, São Paulo, SP, Brazil
| | - MT Dória
- Discipline of Gynecology, Hospital das Clínicas, Faculty of Medicine - University of São Paulo-FMUSP, São Paulo, SP, Brazil; Institute of Radiology, Hospital das Clínicas, Faculty of Medicine - University of São Paulo-FMUSP, São Paulo, SP, Brazil; Division of Medical Oncology, Instituto do Câncer do Estado de São Paulo, Faculty of Medicine, University of São Paulo-FMUSP, São Paulo, SP, Brazil
| | - BS Mota
- Discipline of Gynecology, Hospital das Clínicas, Faculty of Medicine - University of São Paulo-FMUSP, São Paulo, SP, Brazil; Institute of Radiology, Hospital das Clínicas, Faculty of Medicine - University of São Paulo-FMUSP, São Paulo, SP, Brazil; Division of Medical Oncology, Instituto do Câncer do Estado de São Paulo, Faculty of Medicine, University of São Paulo-FMUSP, São Paulo, SP, Brazil
| | - AP Messias
- Discipline of Gynecology, Hospital das Clínicas, Faculty of Medicine - University of São Paulo-FMUSP, São Paulo, SP, Brazil; Institute of Radiology, Hospital das Clínicas, Faculty of Medicine - University of São Paulo-FMUSP, São Paulo, SP, Brazil; Division of Medical Oncology, Instituto do Câncer do Estado de São Paulo, Faculty of Medicine, University of São Paulo-FMUSP, São Paulo, SP, Brazil
| | - R Goncalves
- Discipline of Gynecology, Hospital das Clínicas, Faculty of Medicine - University of São Paulo-FMUSP, São Paulo, SP, Brazil; Institute of Radiology, Hospital das Clínicas, Faculty of Medicine - University of São Paulo-FMUSP, São Paulo, SP, Brazil; Division of Medical Oncology, Instituto do Câncer do Estado de São Paulo, Faculty of Medicine, University of São Paulo-FMUSP, São Paulo, SP, Brazil
| | - MS Mano
- Discipline of Gynecology, Hospital das Clínicas, Faculty of Medicine - University of São Paulo-FMUSP, São Paulo, SP, Brazil; Institute of Radiology, Hospital das Clínicas, Faculty of Medicine - University of São Paulo-FMUSP, São Paulo, SP, Brazil; Division of Medical Oncology, Instituto do Câncer do Estado de São Paulo, Faculty of Medicine, University of São Paulo-FMUSP, São Paulo, SP, Brazil
| | - JM Soares
- Discipline of Gynecology, Hospital das Clínicas, Faculty of Medicine - University of São Paulo-FMUSP, São Paulo, SP, Brazil; Institute of Radiology, Hospital das Clínicas, Faculty of Medicine - University of São Paulo-FMUSP, São Paulo, SP, Brazil; Division of Medical Oncology, Instituto do Câncer do Estado de São Paulo, Faculty of Medicine, University of São Paulo-FMUSP, São Paulo, SP, Brazil
| | - N de Barros
- Discipline of Gynecology, Hospital das Clínicas, Faculty of Medicine - University of São Paulo-FMUSP, São Paulo, SP, Brazil; Institute of Radiology, Hospital das Clínicas, Faculty of Medicine - University of São Paulo-FMUSP, São Paulo, SP, Brazil; Division of Medical Oncology, Instituto do Câncer do Estado de São Paulo, Faculty of Medicine, University of São Paulo-FMUSP, São Paulo, SP, Brazil
| | - JR Filassi
- Discipline of Gynecology, Hospital das Clínicas, Faculty of Medicine - University of São Paulo-FMUSP, São Paulo, SP, Brazil; Institute of Radiology, Hospital das Clínicas, Faculty of Medicine - University of São Paulo-FMUSP, São Paulo, SP, Brazil; Division of Medical Oncology, Instituto do Câncer do Estado de São Paulo, Faculty of Medicine, University of São Paulo-FMUSP, São Paulo, SP, Brazil
| | - EC Baracat
- Discipline of Gynecology, Hospital das Clínicas, Faculty of Medicine - University of São Paulo-FMUSP, São Paulo, SP, Brazil; Institute of Radiology, Hospital das Clínicas, Faculty of Medicine - University of São Paulo-FMUSP, São Paulo, SP, Brazil; Division of Medical Oncology, Instituto do Câncer do Estado de São Paulo, Faculty of Medicine, University of São Paulo-FMUSP, São Paulo, SP, Brazil
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Piato JR, Aguiar FN, Mota BS, Dória MT, Alves-Jales RD, Messias AP, Goncalves R, Mano MS, Soares JM, Ricci MD, Filassi JR, Baracat EC. Abstract P3-13-09: Improved frozen section examination of the retroareolar margin for prediction of nipple involvement in breast cancer. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p3-13-09] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Development of the nipple-sparing mastectomy (NSM) technique has constituted a significant advance in the surgical treatment of selected cases of breast cancer. The most important aspect of areolar complex preservation is the exclusion of carcinoma involving the nipple. The retroareolar surgical margin is usually sampled and subjected to an intraoperative evaluation by frozen section examination in order to avoid a second procedure. However, this method is not standardized resulting in variable rates of false-negative results. Here, a new technique is proposed for the intraoperative study of the retroareolar margin. This ex vivo study was conducted by performing a simulated NSM procedure for patients undergoing total mastectomy to assess the impact of these measures on the accuracy of retroareolar frozen section examination. Materials and Methods: Between September 2012 and April 2014, we studied 158 mastectomy specimens from patients undergoing total mastectomy for breast cancer at the Cancer Institute of the State of São Paulo. Inclusion criteria were stage Tis-T3 tumors, multifocal and multicentric breast carcinoma, unicentric carcinoma not suitable to quadrantectomy. Patients submitted to neoadjuvant chemotherapy were also included. To obtain the entire sample area, the terminal retroareolar milk duct bunch was isolated. Fragments approximately 1.5 cm in length were excised and sectioned in parallel at the base of the nipple using a cold bistoury. Three transverse histological sections (4 μm each) at 200 μm intervals that included the entire isolated fragments were subjected to frozen section examination. The sections were stained with hematoxylin-eosin (H&E) and were evaluated. The remainder of each fragment was embedded in paraffin and 4 μm sections were subsequently stained with H&E and examined. Results: A total of 158 mastectomy specimens involving mammary carcinoma of no special type were examined. These included 15 (9.5%) in situ stage tumors, 36 (22.8%) stage I tumors, 71 (44.9%) stage II tumors, and 36 (22.8%) stage IIIA tumors. Paraffin examinations identified 25 retroareolar fragments compromised by carcinoma, resulting in 16.1% prevalence. Of the frozen sections examined, 2/158 (1.3%) had false-negative results and 5/158 (3.1%) had false-positive results. For the former two cases, the corresponding paraffin examinations detected low-grade carcinoma in situ and a residual cell cluster with a diameter less than 1 mm. The latter was found in a mastectomy specimen from a patient that underwent neoadjuvant chemotherapy. For the three cases involving false-positive results, the corresponding paraffin examinations revealed no atypical ductal hyperplasia present, one sclerosing intraductal papilloma and one nipple syringomatous adenoma. Statistical analysis revealed that the frozen section examinations performed had a sensitivity rate of 92.0% and a specificity rate of 96.2%. In addition, the positive predictive value (PPV) was 82.1%, the negative predictive value (NPV) was 98.4%, and the accuracy was 95.4%. Conclusion: The frozen section examination technique described here detected nipple involvement in breast cancer with greater accuracy than the frozen section usually performed by most surgeons.
Citation Format: Piato JR, Aguiar FN, Mota BS, Dória MT, Alves-Jales RD, Messias AP, Goncalves R, Mano MS, Soares JM, Ricci MD, Filassi JR, Baracat EC. Improved frozen section examination of the retroareolar margin for prediction of nipple involvement in breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-13-09.
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Affiliation(s)
- JR Piato
- Discipline of Gynecology, Hospital das Clínicas, Faculty of Medicine - University of São Paulo-FMUSP, São Paulo, SP, Brazil; Discipline of Pathology, Hospital das Clínicas, Faculty of Medicine - University of São Paulo-FMUSP, São Paulo, SP, Brazil; Division of Medical Oncology, Instituto do Câncer do Estado de São Paulo, Faculty of Medicine, Universidade de São Paulo-FMUSP, São Paulo, SP, Brazil
| | - FN Aguiar
- Discipline of Gynecology, Hospital das Clínicas, Faculty of Medicine - University of São Paulo-FMUSP, São Paulo, SP, Brazil; Discipline of Pathology, Hospital das Clínicas, Faculty of Medicine - University of São Paulo-FMUSP, São Paulo, SP, Brazil; Division of Medical Oncology, Instituto do Câncer do Estado de São Paulo, Faculty of Medicine, Universidade de São Paulo-FMUSP, São Paulo, SP, Brazil
| | - BS Mota
- Discipline of Gynecology, Hospital das Clínicas, Faculty of Medicine - University of São Paulo-FMUSP, São Paulo, SP, Brazil; Discipline of Pathology, Hospital das Clínicas, Faculty of Medicine - University of São Paulo-FMUSP, São Paulo, SP, Brazil; Division of Medical Oncology, Instituto do Câncer do Estado de São Paulo, Faculty of Medicine, Universidade de São Paulo-FMUSP, São Paulo, SP, Brazil
| | - MT Dória
- Discipline of Gynecology, Hospital das Clínicas, Faculty of Medicine - University of São Paulo-FMUSP, São Paulo, SP, Brazil; Discipline of Pathology, Hospital das Clínicas, Faculty of Medicine - University of São Paulo-FMUSP, São Paulo, SP, Brazil; Division of Medical Oncology, Instituto do Câncer do Estado de São Paulo, Faculty of Medicine, Universidade de São Paulo-FMUSP, São Paulo, SP, Brazil
| | - RD Alves-Jales
- Discipline of Gynecology, Hospital das Clínicas, Faculty of Medicine - University of São Paulo-FMUSP, São Paulo, SP, Brazil; Discipline of Pathology, Hospital das Clínicas, Faculty of Medicine - University of São Paulo-FMUSP, São Paulo, SP, Brazil; Division of Medical Oncology, Instituto do Câncer do Estado de São Paulo, Faculty of Medicine, Universidade de São Paulo-FMUSP, São Paulo, SP, Brazil
| | - AP Messias
- Discipline of Gynecology, Hospital das Clínicas, Faculty of Medicine - University of São Paulo-FMUSP, São Paulo, SP, Brazil; Discipline of Pathology, Hospital das Clínicas, Faculty of Medicine - University of São Paulo-FMUSP, São Paulo, SP, Brazil; Division of Medical Oncology, Instituto do Câncer do Estado de São Paulo, Faculty of Medicine, Universidade de São Paulo-FMUSP, São Paulo, SP, Brazil
| | - R Goncalves
- Discipline of Gynecology, Hospital das Clínicas, Faculty of Medicine - University of São Paulo-FMUSP, São Paulo, SP, Brazil; Discipline of Pathology, Hospital das Clínicas, Faculty of Medicine - University of São Paulo-FMUSP, São Paulo, SP, Brazil; Division of Medical Oncology, Instituto do Câncer do Estado de São Paulo, Faculty of Medicine, Universidade de São Paulo-FMUSP, São Paulo, SP, Brazil
| | - MS Mano
- Discipline of Gynecology, Hospital das Clínicas, Faculty of Medicine - University of São Paulo-FMUSP, São Paulo, SP, Brazil; Discipline of Pathology, Hospital das Clínicas, Faculty of Medicine - University of São Paulo-FMUSP, São Paulo, SP, Brazil; Division of Medical Oncology, Instituto do Câncer do Estado de São Paulo, Faculty of Medicine, Universidade de São Paulo-FMUSP, São Paulo, SP, Brazil
| | - JM Soares
- Discipline of Gynecology, Hospital das Clínicas, Faculty of Medicine - University of São Paulo-FMUSP, São Paulo, SP, Brazil; Discipline of Pathology, Hospital das Clínicas, Faculty of Medicine - University of São Paulo-FMUSP, São Paulo, SP, Brazil; Division of Medical Oncology, Instituto do Câncer do Estado de São Paulo, Faculty of Medicine, Universidade de São Paulo-FMUSP, São Paulo, SP, Brazil
| | - MD Ricci
- Discipline of Gynecology, Hospital das Clínicas, Faculty of Medicine - University of São Paulo-FMUSP, São Paulo, SP, Brazil; Discipline of Pathology, Hospital das Clínicas, Faculty of Medicine - University of São Paulo-FMUSP, São Paulo, SP, Brazil; Division of Medical Oncology, Instituto do Câncer do Estado de São Paulo, Faculty of Medicine, Universidade de São Paulo-FMUSP, São Paulo, SP, Brazil
| | - JR Filassi
- Discipline of Gynecology, Hospital das Clínicas, Faculty of Medicine - University of São Paulo-FMUSP, São Paulo, SP, Brazil; Discipline of Pathology, Hospital das Clínicas, Faculty of Medicine - University of São Paulo-FMUSP, São Paulo, SP, Brazil; Division of Medical Oncology, Instituto do Câncer do Estado de São Paulo, Faculty of Medicine, Universidade de São Paulo-FMUSP, São Paulo, SP, Brazil
| | - EC Baracat
- Discipline of Gynecology, Hospital das Clínicas, Faculty of Medicine - University of São Paulo-FMUSP, São Paulo, SP, Brazil; Discipline of Pathology, Hospital das Clínicas, Faculty of Medicine - University of São Paulo-FMUSP, São Paulo, SP, Brazil; Division of Medical Oncology, Instituto do Câncer do Estado de São Paulo, Faculty of Medicine, Universidade de São Paulo-FMUSP, São Paulo, SP, Brazil
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Yamakami LYS, Serafini PC, de Araujo DB, Bonfá E, Leon EP, Baracat EC, Silva CA. Clark CA, Laskin CA. Ovarian reserve in antiphospholipid syndrome: the jury is still out. Lupus 2015; 24: 773. Lupus 2015; 24:1007. [PMID: 26082466 DOI: 10.1177/0961203315591029] [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] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 05/07/2015] [Indexed: 11/17/2022]
Affiliation(s)
- L Y S Yamakami
- Department of Gynecology, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - P C Serafini
- Department of Gynecology, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - D B de Araujo
- Division of Rheumatology, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - E Bonfá
- Division of Rheumatology, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - E P Leon
- Division of Rheumatology, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - E C Baracat
- Department of Gynecology, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - C A Silva
- Division of Rheumatology, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
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Morales Piato JR, Aguiar FN, Mota BS, Ricci MD, Dória MT, Alves-Jales RD, Messias AP, Filassi JR, Baracat EC. Improved frozen section examination of the retroareolar margin for prediction of nipple involvement in breast cancer. Eur J Surg Oncol 2015; 41:986-90. [PMID: 26002985 DOI: 10.1016/j.ejso.2015.04.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 04/07/2015] [Accepted: 04/20/2015] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION In this prospective ex vivo study, we propose a new technique for the intraoperative examination of retroareolar tissue and describe both surgical excision and pathological methods. We performed a nipple-sparing mastectomy simulation in patients selected to total mastectomy, in order to evaluate the accuracy of these new technique. MATERIALS AND METHODS A total of 158 total mastectomy specimens from patients affected by ductal carcinoma in situ (n = 15) or invasive ductal carcinoma (stages I, II, or IIIA) (n = 143) were examined. To obtain the entire sample area, the terminal retroareolar milk duct bunch was isolated. Fragments approximately 1.5 cm in length were excised and sectioned in parallel at the base of the nipple using a cold bistoury. Three transverse histological sections (4 μm each) at 200 μm intervals that included the entire isolated fragments were subjected to frozen section examination. The sections were stained with hematoxylin-eosin and were evaluated. The remainder of each fragment was embedded in paraffin and 4 μm sections were subsequently stained with hematoxylin-eosin and examined. RESULTS There were two false-negative (1.3%) and five false-positive (3.1%) findings among the frozen and paraffin sections analyzed. A statistical analysis of the frozen section examinations showed a sensitivity of 92.0%, a specificity of 96.2%, a positive predictive value of 82.1%, a negative predictive value of 98.4%, and an accuracy of 95.4%. CONCLUSION The frozen section examination technique described here detected nipple involvement in breast cancer with greater accuracy than the frozen section usually performed by most surgeons.
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Affiliation(s)
- J R Morales Piato
- Discipline of Gynecology, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, FMUSP, São Paulo, Brazil
| | - F N Aguiar
- Discipline of Pathology, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, FMUSP, São Paulo, Brazil
| | - B S Mota
- Discipline of Gynecology, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, FMUSP, São Paulo, Brazil
| | - M D Ricci
- Discipline of Gynecology, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, FMUSP, São Paulo, Brazil
| | - M T Dória
- Discipline of Gynecology, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, FMUSP, São Paulo, Brazil.
| | - R D Alves-Jales
- Discipline of Gynecology, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, FMUSP, São Paulo, Brazil
| | - A P Messias
- Discipline of Gynecology, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, FMUSP, São Paulo, Brazil
| | - J R Filassi
- Discipline of Gynecology, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, FMUSP, São Paulo, Brazil
| | - E C Baracat
- Discipline of Gynecology, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, FMUSP, São Paulo, Brazil
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Azeka E, Jatene MB, Jatene IB, Horowitz ESK, Branco KC, Souza Neto JD, Miura N, Mattos S, Afiune JY, Tanaka AC, Santos CCL, Guimarães ICB, Manso PH, Pellizari RCRS, Santos MVC, Thomaz AM, Cristofani LM, Ribeiro ACL, Kulikowski LD, Sampaio MC, Pereira AC, Soares A, Soares Junior J, Oh GHY, Moreira V, Mota CCC, Afiune CMC, Pedra C, Pedra S, Pedrosa A, Guimarães V, Caneo LF, Ferreiro CF, Cavalheiro Filho C, Stefanello B, Negrão CE, Turquetto ALR, Mesquita SMF, Maeda WF, Zorzanelli L, Panajotopolos N, Siqueira AWS, Galas FRB, Hajjar LA, Benvenuti LA, Vincenzi P, Odone V, Lopes MH, Strabelli TMV, Franchi SM, Takeuti AD, Duarte MF, Leon RGP, Hermida RPM, Sorpreso ICE, Soares Junior JM, Melo NR, Baracat EC, Bortolotto MRFL, Scanavacca M, Shimoda MS, Foronda G, Romano BW, Silva DB, Omura MM, Barbeiro CPM, Vinhole ARG, Palomo JSH, Gonçalves MAB, Reis ICF, Oliveira LG, Ribeiro CC, Isosaki M, Vieira LP, Feltrim MIZ, Manoel LA, Abud KCO, Paschotto DR, Neves ILI, Senaha LE, Garcia ACCN, Cipriano SL, Santos VC, Ferraz AS, Moreira AELC, De Paulo ARSA, Duque AMPC, Trindade E, Bacal F, Auler Junior JOC, Almeida DR. [I Guidelines of heart failure and heart transplantation in the fetus, in children and adults with congenital cardiopathy, The Brazilian Society of Cardiology]. Arq Bras Cardiol 2015; 103:1-126. [PMID: 25591041 DOI: 10.5935/abc.2014s005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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19
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Dias AR, Silva E Silva A, Carvalho JP, Baracat EC, Favero G. Correction of iatrogenic injury of the obturator nerve during pelvic laparoscopic lymphadenectomy by the use of sural nerve grafts. Gynecol Oncol Rep 2014; 10:16-8. [PMID: 26075994 PMCID: PMC4434150 DOI: 10.1016/j.gore.2014.08.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [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: 04/17/2014] [Accepted: 08/03/2014] [Indexed: 11/28/2022] Open
Abstract
Intraoperative injury of the obturator nerve is not an infrequent complication of gynecological surgeries. This injury can occur in association with pelvic lymphadenectomy for uterine or cervical cancer. This manuscript demonstrates an alternative technique for the obturator nerve repair, when primary end to end anastomosis is not possible.
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Affiliation(s)
- A R Dias
- Gynecology, Instituto do Câncer do Estado de São Paulo - ICESP, São Paulo, Brazil
| | - A Silva E Silva
- Gynecology, Instituto do Câncer do Estado de São Paulo - ICESP, São Paulo, Brazil
| | - J P Carvalho
- Gynecology, Instituto do Câncer do Estado de São Paulo - ICESP, São Paulo, Brazil
| | - E C Baracat
- Gynecology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - G Favero
- Gynecology, Instituto do Câncer do Estado de São Paulo - ICESP, São Paulo, Brazil
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Pereira AKC, Garcia MT, Pinheiro W, Ejzenberg D, Soares JM, Baracat EC. What is the influence of cyclooxygenase-2 on postmenopausal endometrial polyps? Climacteric 2014; 18:498-502. [PMID: 25242379 DOI: 10.3109/13697137.2014.966240] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND The genesis of the endometrial polyp is as yet unclear. There is evidence that the polyp is related to the inflammatory process and that it interacts with the cyclooxygenase-2 (COX-2) enzyme. OBJECTIVE To review the influence of COX-2 on the postmenopausal endometrial polyp. METHODS A systematic review was made of the Medline, Embase, and Cochrane databases, covering the years of 2001-2014. The inclusion criteria were: experimental studies with immunohistological analysis of COX-2 in endometrial polyps; women; hysteroscopic and surgical evaluation; and studies with comparisons between the endometrial polyp and other tissues (normal endometrium, adjacent endometrium, and other uterine diseases). The exclusion criteria were: polyps in other organs; genetic polymorphisms; endometrial cancer exclusively; abnormal uterine bleeding unrelated to polyps. The search key words (taken from the Medical Subject Headings - MeSH) were endometrial polyp and cyclooxygenase-2. RESULTS Seven of ten articles were selected. Results showed positive COX-2 expression in the glandular epithelium of the polyps, and expression was more intense when the polyp was malignant. However, there was a study which did not find any difference between polyps and the normal endometrium, and there was another which compared polyps in menacme with postmenopausal polyps. CONCLUSION There is no consensus in the literature as to the participation of COX-2 in the development of benign and/or malignant endometrial polyps. In all of the studies, COX-2 was present in the postmenopausal polyps and with greater intensity in the malignant ones.
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Affiliation(s)
- A K C Pereira
- Disciplina de Ginecologia do Departamento de Obstetrícia e Ginecologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , Brazil
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Yamakami LYS, Serafini PC, de Araujo DB, Bonfá E, Leon EP, Baracat EC, Silva CA. Ovarian reserve in women with primary antiphospholipid syndrome. Lupus 2014; 23:862-7. [DOI: 10.1177/0961203314529468] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Accepted: 03/06/2014] [Indexed: 11/16/2022]
Abstract
Objective The objective of this paper is to evaluate ovarian reserve in primary antiphospholipid syndrome (PAPS) women and the association between ovarian reserve tests and clinical and laboratorial parameters, and anti-corpus luteum antibody (anti-CoL). Methods We screened 85 female patients between 18 to 40 years old with APS. Of these, 67 patients were excluded because of association with other autoimmune diseases ( n = 42), contraindication or unwillingness to stop hormonal contraceptive ( n = 21), current pregnancy or breastfeeding ( n = 3) and previous ovarian surgery ( n = 1). Therefore, a cross-sectional study was conducted in 18 PAPS patients and 24 healthy women. They were evaluated at early follicular phase with measurement of follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, and anti-Müllerian hormone (AMH) and sonographic antral follicle count (AFC). Serum measurement of anti-CoL was determined by immunoblot analysis. All analyses were performed after at least six months from the last intake of hormonal contraceptive and resumption of menstruation. Results The mean age was comparable in PAPS and controls (33.0 ± 5.0 vs. 30.4 ± 7.0 years; p = 0.19). Regarding ovarian reserve tests, the frequencies of low AFC (≤10) (56% vs. 22%, p = 0.04) and very low AFC (≤5) (37% vs. 9%, p = 0.04) were significantly higher in PAPS patients than controls. Trends of higher frequencies of reduced (<1.0 ng/ml), low (<0.5 ng/ml) and negligible (<0.2 ng/ml) AMH levels were found in PAPS patients ( p = 0.08, p = 0.07 and p = 0.07, respectively). FSH, LH and estradiol were similar in patients and controls. There was no association between low ovarian reserve and specific types of antiphospholipid antibodies. Anti-CoL was solely observed in PAPS patients (11% vs. 0%; p = 0.177) and was not related to ovarian reserve tests. Conclusion Women suffering from PAPS possessed reduced ovarian reserve, with prevalence greater than 50%.
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Affiliation(s)
| | | | - DB de Araujo
- Division of Rheumatology
- Department of Rheumatology, Hospital do Servidor Público Estadual de São Paulo, São Paulo, Brazil
| | | | | | | | - CA Silva
- Division of Rheumatology
- Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Borrelli GM, Carvalho KI, Kallas EG, Mechsner S, Baracat EC, Abrão MS. Chemokines in the pathogenesis of endometriosis and infertility. J Reprod Immunol 2013; 98:1-9. [PMID: 23622730 DOI: 10.1016/j.jri.2013.03.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Revised: 03/14/2013] [Accepted: 03/18/2013] [Indexed: 01/07/2023]
Abstract
Endometriosis is a chronic benign disease that affects women of reproductive age causing abdominal pain and infertility. Its pathogenesis remains obscure despite all the research conducted over the past 100 years. However, there is a consensus among the specialists that the basis of its pathophysiology would be multifactorial. Many publications have demonstrated that chemokines are somehow associated with the development of endometriosis and infertility. In this study, we reviewed all PubMed literature using MeSH terms "chemokines" and "endometriosis" as well as "chemokines" and "female infertility" to establish what we know and what we do not yet know about this relationship.
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Affiliation(s)
- G M Borrelli
- Sao Paulo University, School of Medicine, Department of Obstetrics and Gynecology, Sao Paulo, Brazil.
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Francisco AMC, Carbonel AF, Simões RS, Soares JM, Baracat EC, Haidar MA. Do extracts of oral soybean augment the trophic effect of estrogen on the rat uterus? Climacteric 2013; 16:161-8. [PMID: 22762389 DOI: 10.3109/13697137.2012.679168] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [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: 12/11/2022]
Abstract
OBJECTIVE To evaluate whether soybean extracts and estrogens present additive effects on adult rat uterus. METHODS Fifty ovariectomized rats were randomly divided into five equal groups of ten animals: Control, treated with vehicle; SE46 and SE120, treated with 46 and 120 mg/kg soybean concentrated extract (SE), respectively; EE, treated with conjugated equine estrogens (CE) 50 μg/kg; SE120 + EE, treated with 50 μg/kg (CE) plus 120 mg/kg SE. The substances were administered daily by gavage for 21 consecutive days. Thereafter the animals were weighed and killed by decapitation; trunk blood was collected for hormone determinations. Uteri were removed immediately and fixed in 10% formaldehyde, followed by dehydration, embedding in paraffin and 6-m sections staining with hematoxylin and eosin for histomorphometric analyses of myometrium and endometrium. After ANOVA analysis of the data, the study was complemented with the Tukey-Kramer test for multiple comparisons. RESULTS The concentrated extract of soybean at high concentration (SE 120 kg/mg) and estrogens proved to have a trophic effect on the uterus (endometrium and myometrium) of castrated rats. In groups SE120, EE and SE120 + EE, all morphometric parameters examined (number of glands, eosinophils, blood vessels and the glandular area) were increased. No significant addictive effects of soybean extract plus estrogens were detected in the SE120 + EE group. CONCLUSIONS Our results indicate that soy extract has a trophic effect on rat uterine structures. Treatment of ovariectomized rats with a concentrated soy extract in combination with conjugated estrogens had no addictive effect on the uterine response.
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Affiliation(s)
- A M C Francisco
- University of Vale do Sapucai - UNIVÁS, Gynecology, São Paulo, Brazil
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Neto LCDA, Soares JM, Giusa-Chiferi MG, Gonçalves WJ, Baracat EC. Expression of p53 protein in the endometrial polyp in postmenopausal women. EUR J GYNAECOL ONCOL 2013; 34:509-512. [PMID: 24601040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To evaluate p53 protein expression in the endometrial polyp and compare with adenocarcinoma and atrophic endometrium of postmenopausal women. MATERIALS AND METHODS Ninety-eight postmenopausal women were included in this study and divided into three groups related to histopathologic diagnosis: Group A--endometrial adenocarcinoma (n = 40), Group B--endometrial polyp (n = 38), and Group C--endometrial atrophy (n = 20). The length of this study was from 1990 to 2004. The endometrial samples were collected from hysteroscopic biopsy or surgery then processed for histopathologic routine. One thousand cells of each histological section were evaluated for immunohistochemical analysis using p53 antibodies. The ANOVA test was performed for the statistical analysis. RESULTS The expression of p53 in adenocarcinoma samples was the highest. The expression of polyp was positive when associated to hyperplasia without atypia. All samples of atrophic endometrial were negative. CONCLUSIONS The present data suggested that presence of hyperplasia in the endometrial polyp is factor to increase the expression of p53.
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Affiliation(s)
- L C de Albuquerque Neto
- Department of Gynecology, Federal University of São Paulo Escola Paulista de Medicina, São Paulo, Brazil.
| | - J M Soares
- Department of Obstetrics and Gynecology, Facultade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - M G Giusa-Chiferi
- Department of Gynecology, Federal University of São Paulo Escola Paulista de Medicina, São Paulo, Brazil
| | - W J Gonçalves
- Department of Gynecology, Federal University of São Paulo Escola Paulista de Medicina, São Paulo, Brazil
| | - E C Baracat
- Department of Obstetrics and Gynecology, Facultade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Condi FLF, Soares JM, Teodoro WR, Veloso AP, Parra ER, de Jesus Simoes M, Baracat EC. The effects of conjugated estrogen, raloxifene and soy extract on collagen in rat bones. Climacteric 2012; 15:441-8. [PMID: 22208761 DOI: 10.3109/13697137.2011.624213] [Citation(s) in RCA: 7] [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: 11/13/2022]
Abstract
OBJECTIVE To evaluate the action of conjugated equine estrogen, raloxifene and isolated or combined genistein-rich soy extracts on collagen fibers in the bones of oophorectomized rats. MATERIALS AND METHODS Seventy female rats received testosterone propionate (0.1 µg/g) on the 9th day after birth. At 6 months of age, the rats were administered the vehicle (propylene glycol, 0.5 ml/day), and ten of the rats were randomly chosen to comprise the non-oophorectomized control group (GI). The other 60 rats were ovariectomized and randomized into six groups of ten as follows: GII, vehicle; GIII, conjugated equine estrogen (CEE), 50 µg/kg/day; GIV, raloxifene (RAL), 0.75 mg/kg/day; GV, genistein-rich soy extract (GSE), 300 mg/kg/day; GVI, CEE + GSE, 50 µg/kg/day + 300 mg/kg/day; and GVII, CEE + RAL, 50 µg/kg/day + 0.75 mg/kg/day. Three months after surgery, the drugs were administered for 60 consecutive days. All rats were euthanized, and their left tibiae were removed for histological routine. The histological sections were stained with hematoxylin-eosin, and picrosirius for evaluating bone microarchitecture. Types I and II collagen fibers were analyzed by immunofluorescence. Data analysis was carried out with ANOVA and Tukey's test. RESULTS Collagen reduction was significant in the GIII animals when compared to the other groups (p < 0.05). There was no significant difference in the thickness of collagen fibers among the groups. There was a greater quantity of type III collagen in GVI than in the other groups. CONCLUSION Our data indicate that conjugated equine estrogen improves bone quality because it increases the quantity of type I collagen while reducing the quantity of thin collagen fibers. In addition, the combination of CEE and raloxifene or genistein-rich soy extract is not as efficient as CEE itself to improve bone quality.
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Affiliation(s)
- F L F Condi
- LIM 58, Gynecology Department, Universidade de São Paulo, São Paulo, Brazil
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Pires LA, Hegg R, Freitas FR, Tavares ER, Almeida CP, Baracat EC, Maranhão RC. Effect of neoadjuvant chemotherapy on low-density lipoprotein (LDL) receptor and LDL receptor-related protein 1 (LRP-1) receptor in locally advanced breast cancer. Braz J Med Biol Res 2012; 45:557-64. [PMID: 22570085 PMCID: PMC3854302 DOI: 10.1590/s0100-879x2012007500068] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [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: 08/06/2011] [Accepted: 03/26/2012] [Indexed: 11/22/2022] Open
Abstract
Low-density lipoprotein (LDL) receptors are overexpressed in most neoplastic cell lines and provide a mechanism for the internalization and concentration of drug-laden nanoemulsions that bind to these receptors. The aim of the present study was to determine whether the administration of standard chemotherapeutic schemes can alter the expression of LDL and LDL receptor-related protein 1 (LRP-1) receptors in breast carcinoma. Fragments of tumoral and normal breast tissue from 16 consecutive volunteer women with breast cancer in stage II or III were obtained from biopsies before the beginning of neoadjuvant chemotherapy and after chemotherapy, from fragments excised during mastectomy. Tissues were analyzed by immunohistochemistry for both receptors. Because complete response to treatment was achieved in 4 patients, only the tumors from 12 were analyzed. Before chemotherapy, there was overexpression of LDL receptor in the tumoral tissue compared to normal breast tissue in 8 of these patients. LRP-1 receptor overexpression was observed in tumors of 4 patients. After chemotherapy, expression of both receptors decreased in the tumors of 6 patients, increased in 4 and was unchanged in 2. Nonetheless, even when chemotherapy reduced receptors expression, the expression was still above normal. The fact that chemotherapy does not impair LDL receptors expression supports the use of drug carrier systems that target neoplastic cells by the LDL receptor endocytic pathway in patients on conventional chemotherapy.
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Affiliation(s)
- L A Pires
- Laboratório de Metabolismo de Lípides, Instituto do Coração, Faculdade de Medicina, Hospital das Clínicas, Universidade de São Paulo, Brasil
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Matsuoka PK, Haddad JM, Pacetta AM, Baracat EC. Intravesical treatment of painful bladder syndrome: a systematic review and meta-analysis. Int Urogynecol J 2012; 23:1147-53. [DOI: 10.1007/s00192-012-1686-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Accepted: 01/25/2012] [Indexed: 11/28/2022]
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Esposito Sorpreso IC, Laprano Vieira LH, Longoni Calió C, Abi Haidar M, Baracat EC, Soares JM. Health education intervention in early and late postmenopausal Brazilian women. Climacteric 2012; 15:573-80. [PMID: 22264078 DOI: 10.3109/13697137.2011.635915] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIM To identify aspects of health in postmenopausal Brazilian women using a health-related educational program provided by a multidisciplinary team as part of the primary care approach for early and late postmenopausal symptoms. DESIGN A prospective cohort was formed with 69 postmenopausal women; they were divided into groups corresponding to early (n = 32) and late postmenopause (n = 37) through gynecological and clinical evaluations. We administered the Kuppermann-Blatt Menopausal Index and the Women's Health Questionnaire before and after health education instructions. RESULTS The average age for the onset of menopause was 47.9 years (n = 69). Fifty women (72.5%) in this study had completed their primary education, 78.3% (n = 54) performed manual labor, and 60.9% (n = 42) showed concomitant chronic illnesses. After attending a series of health-related presentations, the mean weight of the women was reduced by 3.54% in early postmenopausal women (p < 0.001) and by 2.06% in the late postmenopausal group (p < 0.001). The mean abdominal circumference was reduced by 1.75% (p < 0.001) in the early postmenopausal group. In addition, the total score in the Kuppermann-Blatt Menopausal Index decreased by 34.38% in the early and by 33.33% in the late postmenopausal groups. According to the Women's Health Questionnaire, there was a decrease in the domain Depressive mood by 0.839 to 0.700 (p < 0.001) in the early and by 0.814 to 0.648 (p < 0.001) in the late postmenopausal groups. CONCLUSION Regardless of improving menopausal symptoms and anthropometric parameters, the effects of the multidisciplinary team activities in early postmenopausal women may be similar to those in late postmenopausal women.
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Affiliation(s)
- I C Esposito Sorpreso
- Endocrinology Gynecology Division, Gynecology Department at Federal University of São Paulo Medical School, Brazil
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Costa MP, Ferreira MC, Soares JM, Rossi AGZ, Baracat EC. Minimally invasive mastectomy: minimal incisions for better aesthetic quality of breast reconstruction. EUR J GYNAECOL ONCOL 2012; 33:155-158. [PMID: 22611954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Women with a family history of breast cancer who develop this disease are confronted with important situations regarding the increased risk for development of a second cancer in the contralateral breast. Prophylactic contralateral mastectomy (PCM) reduces by approximately 95% the risk for contralateral breast cancer. In spite of an increase in indications for PCM, the technical difficulties are many regarding the accomplishment of these procedures. The aim of this study is to describe the technique of mastectomy with preservation of the nipple-areola complex and a small incision, reducing surgical difficulties and complications attributed to this technique, thus allowing better aesthetic results in breast reconstruction. METHODS Forty-six patients with indications for PCM (28 bilateral) were submitted to minimally invasive mastectomy from March 2005 to November 2007. A small incision in the superior pole of the areola, sufficient to pass a liposuction 4 mm cannula is made. With the help of this cannula, detachment of the skin from the gland tissue is performed. Then a 3.5 to 4.5-cm long incision in the inframammary fold is made. Glandular detachment is completed using cautery in the subglandular portion and scissors in the upper breast portion cutting the restraints left by the cannula. The mammary gland tissue is removed through this incision. RESULTS Seventy-four breasts were operated on. The resected breast mass ranged from 285 g to 475 g. All 43 patients were reconstructed with prostheses. There was no necrosis of the nipple-areola complex or of the skin. CONCLUSIONS This technique is an option for cases of patients with indications for PCM.
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Affiliation(s)
- M P Costa
- Division of Plastic Surgery, Hospital das Clínicas, University of São Paulo Medical School, Brazil.
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Yamakami LYS, de Araujo DB, Silva CA, Baracat EC, de Carvalho JF. Severe hemorrhagic corpus luteum complicating anticoagulation in antiphospholipid syndrome. Lupus 2011; 20:523-526. [DOI: 10.1177/0961203310383300] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Antiphospholipid syndrome (APS) is a disorder of coagulation that causes thrombosis as well as pregnancy-related complications, occurring due to the autoimmune production of antibodies against phospholipid. Full anticoagulation is the cornerstone therapy in patients with thrombosis history, and this can lead to major bleeding. During a 3-year period, 300 primary and secondary APS patients were followed up at the Rheumatology Division of the authors’ University Hospital. Of them, 255 (85%) were women and 180 (60%) were of reproductive age. Three of them (1%) had severe hemorrhagic corpus luteum while receiving long-term anticoagulation treatment and are described in this report. All of them were taking warfarin, had elevated international normalized ratio (>4.0) and required prompt blood transfusion and emergency surgery. Therefore, we strongly recommend that all women with APS under anticoagulation should have ovulation suppressed with either intramuscular depot-medroxyprogesterone acetate or oral desogestrel.
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Affiliation(s)
- LYS Yamakami
- Division of Gynecology, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - DB de Araujo
- Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, Brazil
- Rheumatology Department, Hospital do Servidor Público Estadual de São Paulo, Brazil
| | - CA Silva
- Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, Brazil
- Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - EC Baracat
- Division of Gynecology, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - JF de Carvalho
- Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, Brazil
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Nogueira RC, Costa AMM, Silva IDCG, Carvalho CV, Maganhin C, Baracat EC, Soares JM. Influence of the CYP17 polymorphism on vasomotor symptoms in postmenopausal women: a pilot study. Climacteric 2011; 14:537-43. [DOI: 10.3109/13697137.2010.548668] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Castelo Branco de Luca A, Maggio da Fonseca A, Carvalho Lopes CM, Bagnoli VR, Soares JM, Baracat EC. Acupuncture-ameliorated menopausal symptoms: single-blind, placebo-controlled, randomized trial. Climacteric 2011; 14:140-5. [DOI: 10.3109/13697137.2010.484875] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Bonduki CE, Yokohama C, Soares JM, da Motta ELA, Girão MJBC, Baracat EC. Outcome of arterial embolization of uterine leiomyoma: case report. CLIN EXP OBSTET GYN 2011; 38:188-189. [PMID: 21793290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To describe the outcomes after uterine artery embolization treatment of leiomyoma. DESIGN Case report. SETTING Department of Gynecology - Federal University of São Paulo. PATIENT a 34-year-old woman with a diagnosis of leiomyoma for two years. INTERVENTION embolization of uterine arteries with 500 to 700-microm diameter polyvinyl alcohol particles. MAIN OUTCOME MEASURE pregnancy and delivery. RESULTS After embolization, the follow-up revealed a good clinical response with significant reduction in uterus and leiomyoma volume. Also, the patient became spontaneously pregnant, but the delivery was cesarean section due to placenta accreta.. CONCLUSION Regardless of arterial embolization results for controlling uterine bleeding, this procedure might have some consequences on pregnancy outcome.
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Affiliation(s)
- C E Bonduki
- Department of Gynecology, Federal University of São Paulo, São Paulo, Brazil.
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Urbano-Ruiz A, Soares JM, Rossi AGZ, Louback RM, Hummel FV, Baracat EC. Female pelvic pain: a case report of mucocele of the appendix. EUR J GYNAECOL ONCOL 2011; 32:672-673. [PMID: 22335033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To describe a rare case of mucocele of the appendix that simulated a cystic image by pelvic ultrasound (US). CASE A patient with pelvic pain for two months and cystic image on the right ovary by US. After laparoscopy, the image showed a mucocele of the appendix. The patient underwent right colectomy. CONCLUSION Mucocele may be a cause of pelvic pain and may simulate a cystic image on the right adnexa.
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Affiliation(s)
- A Urbano-Ruiz
- Brazilian College of Surgeons, Dr. Arnaldo Vieira de Carvalho Cancer Institute and Pérola Byington Hospital, Brazil.
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Margarido PFR, Bagnoli VR, Maggio da Fonseca A, Maciel GAR, Soares JM, D'Amico EA, Baracat EC. Transdermal estrogen therapy effects on fibrinogen levels in women with a past history of venous thromboembolism: a pilot study. CLIN EXP OBSTET GYN 2011; 38:232-235. [PMID: 21995153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To evaluate thromboelastographic parameters and fibrinogen levels in women treated with transdermal 17beta estradiol. METHODS 29 menopausal women with a history of venous thromboembolic disease were included. Nine patients composed the treatment (HT) group and 20 the control group. Coagulation was assessed by thromboelastography in samples of whole blood and platelet-poor plasma (PPP). The following thromboelastographic variables were measured: time for initial coagulation (R), blood clotting speed (K and the alpha angle), clot tensile strength (MA and G), global index of coagulation (CI) and fibrinolysis (LY30) and fibrinogen levels. RESULTS There were no differences in the other parameters comparing both groups. Fibrinogen levels showed a 13.77 +/- 19.94% reduction in the HT group and a 5.51 +/- 8.09% increase in the control group after 6 months. CONCLUSIONS Our data suggested that transdermal estrogen may not increase blood coagulability, but that it reduces fibrinogen levels in HT women.
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Affiliation(s)
- P F R Margarido
- Department of Obstetrics and Gynecology, São Paulo University, São Paulo, Brazil
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Pinheiro W, Pereira AKC, Soares JM, Baracat EC. Is the combination of mitomycin C, bleomycin and methotrexate effective as a neoadjuvant treatment for cervical cancer in women? EUR J GYNAECOL ONCOL 2011; 32:37-39. [PMID: 21446322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To determine the effectiveness of the combination of mitomycin C, bleomycin and methotrexate as a neoadjuvant treatment in preparation for surgical treatment of cervical cancer. METHODS AND MATERIALS Twenty-seven patients with carcinoma of the uterine cervix (stages exophytic IB2 and IIB-IIIB) who had not previously undergone any treatment received mitomycin C, bleomycin and methotrexate in five sessions, once every four weeks. RESULTS The objective response rate was approximately 81%, including 16 complete responses and six partial responses. Significant toxic effects were not observed. Responsive patients underwent surgery and remained without evidence of disease for the next 20 years. Unresponsive patients did not fare well and passed away within five years after treatment. CONCLUSION Our data suggest that this strategy may be effective for advanced cases, enabling patients to receive surgical treatment.
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Affiliation(s)
- W Pinheiro
- Gynecology Division of the Obstetrics and Gynecology Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil
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Sartori MGF, Feldner PC, Jarmy-Di Bella ZIK, Aquino Castro R, Baracat EC, Rodrigues de Lima G, Castello Girão MJB. Sexual steroids in urogynecology. Climacteric 2010; 14:5-14. [PMID: 20839956 DOI: 10.3109/13697137.2010.508542] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The decline in sex hormone levels that accompanies the menopause has substantial effects on the tissues of the urogenital system, leading to atrophic changes. These changes can have negative effects on sexual and urinary function. The authors evaluate the repercussion of hypoestrogenism and sexual steroids on some elements of the pelvic floor and lower urinary tract. They summarize their research work and review significant published papers. They emphasize the changes in urinary mucosae, periurethral vessels, muscular layer, connective tissue, gene expression, autonomic nervous system receptors, as well as the main clinical aspects involved.
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Affiliation(s)
- M G F Sartori
- Section of Urogynecology and Pelvic Surgery, Department of Gynecology, Universidade Federal de São Paulo, Rua dos Otonis 601 (Vila Clementino), São Paulo, Brazil
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Chian RC, Yan J, Suzuki JJ, Yu XM, Wang J, Tan SL, Kan FWK, Liu P, Qiao J, Vanderzwalmen P, Wirleitner B, Stecher A, Lejeune B, Puissant F, Vanderzwalmen S, Schwerda D, Baramsai B, Zech NH, Antinori M, Licata E, Dani G, Cerusico F, Versaci C, Antinori S, Menezes J, Sjoblom P, Brask K, Nordqvist S, Wramsby H, Rodriguez-Wallberg KA, Borgstrom B, Sheikhi M, Lundqvist ML, Hovatta O, Trapphoff T, El Hajj N, Haaf T, Eichenlaub-Ritter U, Gomes C, Alegretti JR, Rocha AM, Motta ELA, Serafini P, Hassun PA, Baracat EC, Smith GD. Session 65: Fertility Preservation 3. Hum Reprod 2010. [DOI: 10.1093/humrep/de.25.s1.65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Padua MAF, Fonseca AM, Deguti MM, Bagnoli VR, Farias AQ, Maciel GAR, Soares JM, Carilho FJ, Baracat EC. Hormone therapy in Brazilian postmenopausal women with chronic hepatitis C: a pilot study. Climacteric 2010; 13:179-86. [DOI: 10.3109/13697130902952577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Sorpreso ICE, Vieira LHL, Haidar MA, Nunes MG, Baracat EC, Soares JMJ. Multidisciplinary approach during menopausal transition and postmenopause in Brazilian women. CLIN EXP OBSTET GYN 2010; 37:283-286. [PMID: 21355458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To identify clinical, physical, life quality and nutritional aspects of Brazilian women during menopausal transition and postmenopausal periods. METHODS 115 women agreed to participate in the study. They were divided into two groups: GI--menopausal transition (n = 48) and GII--postmenopause (n = 67). The Kupperman-Blatt Menopausal Index (IMK) and Women's Health Questionnaire (WHQ), Food Frequency Questionnaire and functional capacity were used. All patients were examined and underwent clinical and gynecological examination. RESULTS There was no significant difference in IMK, WHQ and functional capacity in either group. There was a higher caloric intake, especially in sugars, in postmenopause women than in menopausal transition women. Both groups presented reduced parameters in life quality and functional capacity. CONCLUSION Our data suggests that there is no significant difference between women in menopausal transition and postmenopause, except in relation to the nutritional parameter. In both groups, the women presented low quality of life and reduced functional capacity.
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Affiliation(s)
- I C E Sorpreso
- Department of Gynecology, Discipline of Gynecological Endocrinology, Federal University of Sdo Paulo (UNIFESP) and Escola Paulista de Medicina, Paulista Medical School (EPM), São Paulo, Brazil.
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Nogueira-de-Souza NC, Guerreiro da Silva IDC, Carvalho CVD, Pulchinelli A, Haidar MA, Baracat EC, Massad-Costa AM. Effect of estrogen receptor-alpha (ESR1) gene polymorphism on high density lipoprotein levels in response to hormone replacement therapy. ACTA ACUST UNITED AC 2009; 42:1138-42. [PMID: 19936541 DOI: 10.1590/s0100-879x2009001200003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2009] [Accepted: 11/04/2009] [Indexed: 11/22/2022]
Abstract
Studies have shown that estrogen replacement therapy and estrogen plus progestin replacement therapy alter serum levels of total, LDL and HDL cholesterol levels. However, HDL cholesterol levels in women vary considerably in response to hormone replacement therapy (HRT). A significant portion of the variability of these levels has been attributed to genetic factors. Therefore, we investigated the influence of estrogen receptor-alpha (ESR1) gene polymorphisms on HDL levels in response to postmenopausal HRT. We performed a prospective cohort study on 54 postmenopausal women who had not used HRT before the study and had no significant general medical illness. HRT consisted of conjugated equine estrogen and medroxyprogesterone acetate continuously for 1 year. The lipoprotein levels were measured from blood samples taken before the start of therapy and after 1 year of HRT. ESR1 polymorphism (MspI C>T, HaeIII C>T, PvuII C>T, and XbaI A>G) frequencies were assayed by restriction fragment length polymorphism. A general linear model was used to describe the relationships between HDL levels and genotypes after adjusting for age. A significant increase in HDL levels was observed after HRT (P = 0.029). Women with the ESR1 PvuII TT genotype showed a statistically significant increase in HDL levels after HRT (P = 0.032). No association was found between other ESR1 polymorphisms and HDL levels. According to our results, the ESR1 PvuII TT genotype was associated with increased levels of HDL after 1 year of HRT.
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Affiliation(s)
- N C Nogueira-de-Souza
- Laboratório de Biologia Molecular, Departamento de Ginecologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
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Baracat EC, Barbosa IC, Giordano MG, Haidar MA, Marinho RM, Menegocci JC, Morais KM, Tomaz G, Wehba S. A randomized,open-label study of conjugated equine estrogens plus medroxyprogesterone acetate versus tibolone: effects on symptom control, bleeding pattern, lipid profile and tolerability. Climacteric 2009. [DOI: 10.1080/cmt.5.1.60.69] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Rego MF, Navarrete MALH, Facina G, Falzoni R, Silva R, Baracat EC, Nazario ACP. Analysis of human mammary fibroadenoma by Ki-67 index in the follicular and luteal phases of menstrual cycle. Cell Prolif 2009; 42:241-7. [PMID: 19317807 PMCID: PMC6496862 DOI: 10.1111/j.1365-2184.2009.00590.x] [Citation(s) in RCA: 6] [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: 03/10/2008] [Accepted: 05/26/2008] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Fibroadenoma is the most common benign mammary condition among women aged 35 or younger. Expression of Ki-67 antigen has been used to compare proliferative activity of mammary fibroadenoma epithelium in the follicular and luteal phases of the menstrual cycle. MATERIALS AND METHODS Ninety eumenorrheic women were selected for tumour excision; they were assigned to either of the two groups, according to their phase of menstrual cycle. At the end of the study, 75 patients with 87 masses were evaluated by epithelial cell Ki-67 expression, blind (no information given concerning group to which any lesion belonged). RESULTS Both groups were found to be homogeneous relative to age, menarche, body mass index, previous gestation, parity, breastfeeding, number of fibroadenomas, family history of breast cancer and tabagism. Median tumour size was 2.0 cm and no relationship between proliferative activity and nodule diameter was observed. No typical pattern was observed in the expression of Ki-67 in distinct nodules of the same patient. Average values for expression of Ki-67 (per 1000 epithelial cells) in follicular and luteal phases were 27.88 and 37.88, respectively (P = 0.116). CONCLUSION Our findings revealed that proliferative activities in the mammary fibroadenoma epithelium did not present a statistically significant difference in the follicular and luteal phases. The present study contributes to clarifying that fibroadenoma is a neoplasm and does not undergo any change in the proliferative activity during the menstrual cycle.
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Affiliation(s)
- M F Rego
- Department of Gynecology, Federal University of São Paulo, Brazil
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Padua MAF, Fonseca AM, Deguti MM, Bagnoli VR, Farias AQ, Maciel GAR, Soares JM, Carilho FJ, Baracat EC. Hormone therapy in Brazilian postmenopausal women with chronic hepatitis C: a pilot study. Climacteric 2009. [DOI: 10.1080/13697130902952577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Massad-Costa AM, Nogueira-de-Souza NC, de Carvalho CV, da Silva ID, Guindalini C, Nogueira RC, Soares JM, Haidar MA, Baracat EC. CYP17 polymorphism and hot flushes in postmenopausal women. Climacteric 2008; 11:404-8. [PMID: 18781485 DOI: 10.1080/13697130802395026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To investigate the association between the CYP17alpha gene polymorphism and hot flushes in postmenopausal women. METHODS Ninety-three non-hysterectomized, postmenopausal women were enrolled in this study. Vasomotor symptoms were assessed at the baseline visit and based on information provided by each participant. The genotypic polymorphism of CYP17alpha gene was analyzed by PCR-RFLP assay using genomic DNA isolated from peripheral blood lymphocytes. RESULTS Thirty-six women reported hot flushes of mild intensity, 25 reported hot flushes of moderate intensity and 32 of severe intensity. There was no significant difference between the severity of hot flushes and the CYP17 genotype or allele frequencies, 0.58 and 0.67 respectively. No association was found between hot flush severity and the CYP17 allele (odds ratio = 1.17, p = 0.61). CONCLUSION The results of this study suggest that the CYP17 MspAI polymorphism was not significantly associated with an increased risk of reporting hot flushes.
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Martins SB, Oliveira E, Castro RA, Sartori MG, Baracat EC, Lima GR, Girao MJ. Clinical and urodynamic evaluation in women with stress urinary incontinence treated by periurethral collagen injection. Int Braz J Urol 2008; 33:695-702; discussion 702-3. [PMID: 17980068 DOI: 10.1590/s1677-55382007000500012] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2007] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the success of treatment with periurethral collagen injections in patients suffering from stress urinary incontinence (SUI) with bladder neck hypermobility and intrinsic sphincter deficiency. MATERIALS AND METHODS Forty women suffering from (SUI) were selected and divided into GI (consisting of 13 women with SUI and bladder neck hypermobility) and GII (consisting of 27 women with SUI and intrinsic sphincter deficiency). Periurethral collagen was injected followed by a subjective evaluation (the need for urinary protectors) and an objective evaluation through urodynamic study before and after the treatment. RESULTS It was noticed that after 9 months there was a decrease in the need of urinary protectors in the two groups. It was observed through the urodynamic study that either cure or improvement was achieved in 46% in GI and 40.7% in GII. There was a significant increase in the leak pressure in GII. Moreover, there was a decrease in the volume of urine leak in the two groups, being the results in GII statistically significant. CONCLUSIONS It was concluded that the periurethral collagen injection is useful for the treatment of the SUI. The results in hypermobility are similar to those in intrinsic sphincter deficiency. In fact, it is a very simple out patient's procedure, with little side effects.
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Affiliation(s)
- S B Martins
- Department of Gynecology, Federal University of Sao Paulo, UNIFESP, Sao Paulo, SP, Brazil.
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Valente SG, Marques RH, Baracat EC, Cavalheiro EA, Naffah-Mazzacoratti MG, Amado D. Effect of hormonal replacement therapy in the hippocampus of ovariectomized epileptic female rats using the pilocarpine experimental model. Epilepsy Res 2008; 82:46-56. [PMID: 18760902 DOI: 10.1016/j.eplepsyres.2008.07.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2007] [Revised: 07/03/2008] [Accepted: 07/08/2008] [Indexed: 01/01/2023]
Abstract
Amado and Cavalheiro [Amado, D., Cavalheiro, E.A., 1998. Hormonal and gestational parameters in female rats submitted to the pilocarpine model of epilepsy. Epilepsy Res. 32, 266-274], studying the establishment of the pilocarpine epilepsy model in female rats observed that the estrous cycle was dramatically altered during the three periods of this experimental model. This work was delineated to study the function of sexual hormones in the development of the epilepsy model induced by pilocarpine in ovariectomized rats. Experimental groups were: (a) control animals during estrus phase of the estrous cycle (E) and ovariectomized female rats (OVX) treated with saline instead of pilocarpine in the same volume, (b) experimental animals, that developed status epilepticus (SE) and were studied during the chronic phase of this model: intact chronic rats (CHRON) and ovariectomized chronic rats (OVX+CHRON) and (c) ovariectomized chronic rats, that were submitted to hormonal replacement therapy treated with: medroxyprogesterone (OVX+CHRON+MPA); 17beta-estradiol (OVX+CHRON+E2), or both (OVX+CHRON+E2+MPA). All ovariectomized animals showed genital atrophy 4 days after the surgical procedure. Moreover, all animals that developed SE and survived showed spontaneous recurrent seizures during the chronic phase. Concerning to seizure frequency, animals receiving medroxyprogesterone associated with 17beta-estradiol showed decreased seizures' number. However, animals that received only medroxyprogesterone therapy also showed reduction in the number of seizures. In addition, hormonal treatment was also able to stabilize the mossy fibers sprouting process, showing the importance of these hormones in the development of the epilepsy in female rats.
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Affiliation(s)
- S G Valente
- Departamento de Neurologia e Neurocirurgia - Disciplina de Neurologia Experimental, Brazil; Departamento de Ortopedia e Traumatologia - Escola Paulista de Medicina/Universidade Federal de São Paulo, Brazil
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Andersen ML, Antunes IB, Silva A, Alvarenga TAF, Baracat EC, Tufik S. Effects of sleep loss on sleep architecture in Wistar rats: gender-specific rebound sleep. Prog Neuropsychopharmacol Biol Psychiatry 2008; 32:975-83. [PMID: 18276051 DOI: 10.1016/j.pnpbp.2008.01.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [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] [Received: 10/10/2007] [Revised: 01/08/2008] [Accepted: 01/08/2008] [Indexed: 11/30/2022]
Abstract
This study was designed to examine the influence of gender on sleep rebound architecture after a 4-day paradoxical sleep deprivation period. After a 5-day baseline sleep recording, both male and female rats in different phases of the estrus cycle were submitted to paradoxical sleep deprivation for 96 h. After this period, the sleep rebound recording was evaluated for 5 days (one estrus cycle). The findings revealed that after paradoxical sleep deprivation, sleep efficiency and paradoxical sleep returned to baseline values on the second day of the light period, for all except the proestrus group. During the dark rebound period, only the female groups presented increased sleep efficiency on the first day. Paradoxical sleep returned to baseline values on the third day, except for males and the cycling females submitted to paradoxical sleep deprivation in the diestrus phase, whose baseline values returned to normal on the second day of rebound period. Thus, the females and males displayed distinct patterns as a result of sleep disruption.
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Affiliation(s)
- M L Andersen
- Department of Psychobiology, Universidade Federal de São Paulo, Escola Paulista de Medicina (UNIFESP/EPM), R. Napoleão de Barros, 925, Vila Clementino 04024-002, São Paulo, SP, Brazil.
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Bugano DDG, Conforti-Froes N, Yamaguchi NH, Baracat EC. Genetic polymorphisms, the metabolism of estrogens and breast cancer: a review. EUR J GYNAECOL ONCOL 2008; 29:313-320. [PMID: 18714561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Breast cancer is the most common female cancer and the second cause of cancer death in women. Despite recent breakthroughs, much of the etiology of this disease is unknown and the most important risk factor, i.e., exposure to endogenous and exogenous estrogen throughout life cannot explain the heterogeneity of prognosis nor clinical features of patients. Recently, many gene polymorphisms in the metabolism of breast cancer have been described as possible neoplasm etiologic factors. This review is an attempt to summarize the current knowledge about these polymorphisms and to determine new target genes for diagnosis and treatment of the disease. Polymorphisms in the genes CYP17, CYP19, CYP1A1, CYP1A2, CYP1B1, UGT1A1, SULT1A1, 17-hydroxysteroid-dehydrogenase, COMT, GST, ESR1, and ESR2 are described.
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Affiliation(s)
- D D G Bugano
- Department of Medicine, University of São Paulo, SP, Brazil.
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