Percorrer por autor "Vieira, P"
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- Metabolic Profile and Cardiovascular Risk in a Population of Renal transplant recipientsPublication . Gonçalves, M; Vieira, P; Resende, L; Durães, J; Rosa, N; Teixeira, JA; Silva, GIntroduction. Cardiovascular disease is more common in renal transplant recipients (RTRs) than in the general population, and is the major cause of both graft loss and patient death in RTRs. Objectives. This study aimed to characterize the cardiovascular risk factors, calculate the 7-year risk for major adverse cardiac events and the 7-year risk for death in a population of RTRs using a cardiovascular risk calculator, and determine the main cardiovascular risk factors associated with increased prediction of major adverse cardiac event (MACE) and death. Patients. This is a retrospective review of clinical data from 121 RTRs who are in follow-up programs at our institution, and who had a functioning and stable graft for longer than 6 months. Results. Among 121 adult patients followed at our institution (59.5% males, mean age of 49.6 13.8 years, mean times for functioning grafts were 105 73.5 mo), 86.8% had hypertension, 19.8% had diabetes, 24.8% were current or former smokers, 61.9% had increased body mass index, and 71% had dyslipidemia. The 7-year risk for MACE was more than 10% in 38 (31.4%) patients with age, diabetes, and smoke being independent risk predictors. The 7-year risk for death was more than 10% in 56 (46.3%) patients with age, diabetes, blood pressure, smoking, and male gender being independent risk predictors. Conclusion. There is a high prevalence of cardiovascular risk factors in a population of RTRs, and there is increased risk for MACE and death. Accurate risk prediction is important for physician decision support and patient education, promoting improved cardiovascular health of RTRs, and thus prolonging the survival of both patients and graft.
- Practical Guidance on the Detection of NTRK Fusions in Sarcomas: Current Status and Diagnostic ChallengesPublication . Fernandes, I; Macedo, D; Gouveia, E; Ferreira, A; Lima, J; Lopez, D; Melo-Alvim, C; Carvalho, A; Tavares, P; Rodrigues-Santos, P; Cardoso, P; Magalhães, M; Vieira, P; Brito, J; Mendes, C; Rodrigues, J; Netto, E; Oliveira, V; Sousa, C; Henriques Abreu, M; Pina, F; Vasques, HSarcomas are a rare and heterogeneous group of mesenchymal malignant tumors and account for approximately 1% of all adult cancers and around 20% of all pediatric solid tumors in Europe. Technology advances have enabled a more accurate and efficient characterization of the molecular mechanisms underlying the pathogenesis of sarcoma subtypes and revealed novel and unexpected therapeutic targets with prognostic/predictive biomarkers, namely the neurotrophic tyrosine receptor kinase (NTRK) gene fusion. The NTRK fusion assessment has recently become a standard part of management for patients with unresectable locally advanced or metastatic cancers and has been identified in various tumor types. In the more prevalent adult and pediatric sarcomas, NTRK fusions are present in 1% and 20%, respectively, and in more than 90% of very rare subsets of tumors. The inhibition of TRK activity with first-generation TRK inhibitors has been found to be effective and well tolerated in adult and pediatric patients, independently of the tumor type. Overall, the therapeutic benefit to those patients compensates for the difficulties of identifying NTRK gene fusions. However, the rarity and diagnostic complexity of NTRK gene fusions raise several questions and challenges for clinicians. To address these issues, an expert panel of medical and pediatric oncologists, radiologists, surgeons, orthopedists, and pathologists reviewed the recent literature and discussed the current status and challenges, proposing a diagnostic algorithm for identifying NTRK fusion sarcomas. The aim of this article is to review the updated information on this issue and to provide the experts' recommendations and practical guidance on the optimal management of patients with soft tissue sarcomas, infantile fibrosarcoma, gastrointestinal stromal tumors, and osteosarcoma.
- Watch and wait after neoadjuvant treatment in rectal cancer: comparison of outcomes in patients with and without a complete response at first reassessment in the International Watch & Wait Database (IWWD)Publication . Temmink, SJ; Peeters, KC; Bahadoer, R; Kranenbarg, MK; Roodvoets, AG; Melenhorst, J; Burger, JW; Wolthuis, A; Renehan, AG; Figueiredo, NL; Pares, Or; Martling, A; Perez, RO; Beets, GL; van de Velde, CJ; Nilsson, PJ; Aghili, M; Keshvari, A; Nouritaromlou, MK; Ahlberg, M; Kordnejad, S; Aleinikov, A; Dulskas, A; Asoğlu, O; Tokmak, H; Barroca, RG; Caiado, AF; Rosa, IA; Breukink, SO; Coraglio, MF; Iseas, S; Creaven, B; Winter, DC; Zaborowski, A; Cunningham, C; Gregory, E; Custers, PA; Geubels, BM; DeBrun, L; D’Hoore, A; Dimofte, G; Fechner, K; Matzel, K; Fernandez, L; Herrando, AI; Vieira, P; Gaertner, WB; Madoff, RD; Gerard, JP; Jacquinot, F; Schiappa, R; Gollins, S; Gonzalez, M; Vaccaro, CA; Habr-Gama, A; São Julião, G; Holman, FA; Hompes, R; Lameris, W; Ketelaers, SH; Rutten, HJ; Leitner, K; Mazzarisi, C; Malcomson, L; O’Dwyer, ST; Saunders, M; Maroli, A; Mitchell, P; Murad-Regadas, S; Pairola, A; Pedraza, SI; Sanchez, LF; Pennings, AJ; Spinelli, A; Sun, MABackground: In rectal cancer, watch and wait for patients with a cCR after neoadjuvant treatment has an established evidence base. However, there is a lack of consensus on the definition and management of a near-cCR. This study aimed to compare outcomes in patients who achieved a cCR at first reassessment versus later reassessment. Methods: This registry study included patients from the International Watch & Wait Database. Patients were categorized as having a cCR at first reassessment or at later reassessment (that is near-cCR at first reassessment) based on MRI and endoscopy. Organ preservation, distant metastasis-free survival, and overall survival rates were calculated. Subgroup analyses were done for near-cCR groups based on the response evaluation according to modality. Results: A total of 1010 patients were identified. At first reassessment, 608 patients had a cCR; 402 had a cCR at later reassessment. Median follow-up was 2.6 years for patients with a cCR at first reassessment and 2.9 years for those with a cCR at later reassessment. The 2-year organ preservation rate was 77.8 (95 per cent c.i. 74.2 to 81.5) and 79.3 (75.1 to 83.7) per cent respectively (P = 0.499). Similarly, no differences were found between groups in distant metastasis-free survival or overall survival rate. Subgroup analyses showed a higher organ preservation rate in the group with a near-cCR categorized exclusively by MRI. Conclusion: Oncological outcomes for patients with a cCR at later reassessment are no worse than those of patients with a cCR at first reassessment.