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Lourenco G, Carvalho B, Pellegrino R, Khater L, Chone C, Costa F, Lima C. 8521 POSTER Novel Candidate Genetic Polymorphisms Identified in Genome-wide Association Study for Base of Tongue Squamous Cell Carcinoma Susceptibility. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)72163-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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102
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Dyer RA, James MF, Butwick AJ, Carvalho B. The Proseal laryngeal mask airway and elective caesarean section. Anaesth Intensive Care 2011; 39:760-762. [PMID: 21823396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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103
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Brosens RPM, Belt EJTH, Haan JC, Buffart TE, Carvalho B, Grabsch H, Quirke P, Cuesta MA, Engel AF, Ylstra B, Meijer GA. Deletion of chromosome 4q predicts outcome in stage II colon cancer patients. Cell Oncol (Dordr) 2011; 34:215-23. [PMID: 21717218 PMCID: PMC3149118 DOI: 10.1007/s13402-011-0042-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2010] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Around 30% of all stage II colon cancer patients will relapse and die of their disease. At present no objective parameters to identify high-risk stage II colon cancer patients, who will benefit from adjuvant chemotherapy, have been established. With traditional histopathological features definition of high-risk stage II colon cancer patients is inaccurate. Therefore more objective and robust markers for prediction of relapse are needed. DNA copy number aberrations have proven to be robust prognostic markers, but have not yet been investigated for this specific group of patients. The aim of the present study was to identify chromosomal aberrations that can predict relapse of tumor in patients with stage II colon cancer. MATERIALS AND METHODS DNA was isolated from 40 formaldehyde fixed paraffin embedded stage II colon cancer samples with extensive clinicopathological data. Samples were hybridized using Comparative Genomic Hybridization (CGH) arrays to determine DNA copy number changes and microsatellite stability was determined by PCR. To analyze differences between stage II colon cancer patients with and without relapse of tumor a Wilcoxon rank-sum test was implemented with multiple testing correction. RESULTS Stage II colon cancers of patients who had relapse of disease showed significantly more losses on chromosomes 4, 5, 15q, 17q and 18q. In the microsatellite stable (MSS) subgroup (n = 28), only loss of chromosome 4q22.1-4q35.2 was significantly associated with disease relapse (P < 0.05, FDR < 0.15). No differences in clinicopathological characteristics between patients with and without relapse were observed. CONCLUSION In the present series of MSS stage II colon cancer patients losses on 4q22.1-4q35.2 were associated with worse outcome and these genomic alterations may aid in selecting patients for adjuvant therapy.
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Rodrigues JA, Barros AS, Carvalho B, Brandão T, Gil AM. Probing beer aging chemistry by nuclear magnetic resonance and multivariate analysis. Anal Chim Acta 2011; 702:178-87. [PMID: 21839195 DOI: 10.1016/j.aca.2011.06.042] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Revised: 06/14/2011] [Accepted: 06/21/2011] [Indexed: 02/06/2023]
Abstract
This paper describes the use of nuclear magnetic resonance (NMR) spectroscopy, in tandem with multivariate analysis (MVA), for monitoring the chemical changes occurring in a lager beer exposed to forced aging (at 45°C for up to 18 days). To evaluate the resulting compositional variations, both principal component analysis (PCA) and partial least squares-discriminant analysis (PLS-DA) were applied to the NMR spectra of beer recorded as a function of aging and a clear aging trend was observed. Inspection of PLS-DA loadings and peak integration enabled the changing compounds to be identified, revealing the importance of well known markers such as 5-hydroxymethylfurfural (5-HMF) as well as a range of other relevant compounds: amino acids, higher alcohols, organic acids, dextrins and some still unassigned spin systems. In addition, the multivariate analysis method of 2D correlation analysis was applied to the NMR data enabling the relevant compound variations to be confirmed and inter-compound correlations to be assessed, some reflecting common metabolic/chemical pathways and, therefore, offering improved insight into the chemical aspects of beer aging.
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Butwick AJ, Hilton G, Riley ET, Carvalho B. Non-invasive measurement of hemoglobin during cesarean hysterectomy: a case series. Int J Obstet Anesth 2011; 20:240-5. [PMID: 21640577 DOI: 10.1016/j.ijoa.2011.03.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2010] [Revised: 02/13/2011] [Accepted: 03/29/2011] [Indexed: 11/26/2022]
Abstract
Obstetric patients diagnosed with abnormal placentation (placenta accreta, increta or percreta) are at increased risk of major postpartum hemorrhage and cesarean hysterectomy. Obstetric anesthesiologists are primarily involved in intraoperative transfusion management in these cases. Hemoglobin assessment is invaluable for assisting transfusion decision-making during the acute period of obstetric hemorrhage. However, laboratory and point-of-care tests of hemoglobin concentration are time-dependent and intermittent, and do not provide a real-time assessment of change during the acute phase of blood loss. A new non-invasive hemoglobin monitor has been introduced recently, which provides real-time measurement of hemoglobin values (SpHb) using multi-wavelength pulse co-oximetry. We present a review of five patients with suspected abnormal placentation who received SpHb monitoring during cesarean hysterectomy at our institution. We discuss the potential clinical utility of non-invasive hemoglobin monitoring for pregnant patients at high risk of obstetric hemorrhage, and the potential role of SpHb in guiding transfusion therapy.
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Carvalho B, Pereira P, Santos Silva P, Silva J, Pinto M, Vaz R. [Lumbar tuberculous spondylodiscitis: a minimally invasive surgical approach]. ACTA REUMATOLOGICA PORTUGUESA 2011; 36:57-60. [PMID: 21483281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Tuberculous spondylodiscitis is the most frequent and severe manifestation of extra-pulmonary tuberculosis, accounting for 40 to 50 percent of the cases with osteoarticular involvement. Although antituberculous drugs remain the cornerstone of therapy, surgical treatment still has an important role in the management of some situations. Classical approaches of radical debridement have been gradually replaced by minimally invasive surgical procedures. CASE REPORT The authors describe a case of an 86-year-old male, diagnosed with a L2-L3 tuberculous spondylodiscitis complicated by an anterior epidural abscess, bilateral psoas muscle abscesses and meningoencephalitis. The patient underwent surgery by minimally invasive posterior paramedian approaches with tubular retractors. A L2-L3 discectomy, drainage of the abscesses and L2-L3 percutaneous transpedicular fixation were performed. The procedure and postoperative period were uneventful and the patient had a favourable outcome. DISCUSSION A minimally invasive posterior approach allows adequate access to the spinal canal for neural decompression in cases of spinal infection. Combined with percutaneous internal fixation the procedure prevents the loss of vertebral alignment and facilitates an early mobilization of the patient.
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Sultan P, Qadan M, Pushpanathan E, Carvalho B. A practical guide to undertaking out of programme experience in the United States of America. Br J Hosp Med (Lond) 2010; 71:M158-9. [PMID: 20944517 DOI: 10.12968/hmed.2010.71.sup10.78984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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108
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Butwick A, Carvalho B. Neuraxial anesthesia in obstetric patients receiving anticoagulant and antithrombotic drugs. Int J Obstet Anesth 2010; 19:193-201. [DOI: 10.1016/j.ijoa.2009.06.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2009] [Accepted: 06/25/2009] [Indexed: 10/19/2022]
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109
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Carvalho B, Marques CJ, Carvalho D, Barros A, Carvalho F. Novel human pathological mutations. Gene symbol: CYP21A2. Disease: adrenal hyperplasia. Hum Genet 2010; 127:482-483. [PMID: 21488305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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110
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Butwick A, Coleman L, Cohen S, Riley E, Carvalho B. Minimum effective bolus dose of oxytocin during elective Caesarean delivery. Br J Anaesth 2010; 104:338-43. [DOI: 10.1093/bja/aeq004] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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111
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Gouveia R, Bonfim C, Ginani V, Zecchin V, Carlesse F, Carvalho C, Schmitz J, Marconcini J, Porto D, Duarte A, Ribeiro L, Félix O, Simões P, Silva A, Petrilli A, Carvalho B, Pinto M, Seber A. Hematopoietic Stem Cell Transplantation For Patients With Severe Combined Immunodeficiency And Disseminated Bacillus Calmette-Guérin Infections. Biol Blood Marrow Transplant 2010. [DOI: 10.1016/j.bbmt.2009.12.325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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112
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Machado AP, Ramalho C, Portugal R, Brandão O, Carvalho B, Carvalho F, Matias A, Montenegro N. Concordance for bilateral congenital diaphragmatic hernia in a monozygotic dichorionic twin pair - first clinical report. Fetal Diagn Ther 2010; 27:106-9. [PMID: 20110658 DOI: 10.1159/000279752] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2009] [Accepted: 11/09/2009] [Indexed: 11/19/2022]
Abstract
The authors present a clinical case of concordance for bilateral congenital diaphragmatic hernia in a monozygotic twin pair diagnosed in the early second trimester.
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113
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Carvalho B, Coleman L, Saxena A, Fuller A, Riley E. Analgesic requirements and postoperative recovery after scheduled compared to unplanned cesarean delivery: a retrospective chart review. Int J Obstet Anesth 2010; 19:10-5. [DOI: 10.1016/j.ijoa.2009.02.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2008] [Revised: 02/08/2009] [Accepted: 02/09/2009] [Indexed: 11/29/2022]
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114
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Brosens RPM, Belt EJTH, Haan JC, Buffart TE, Carvalho B, Grabsch H, Quirke P, Cuesta MA, Engel AF, Ylstra B, Meijer GA. Deletion of chromosome 4q predicts outcome in stage II colon cancer patients. Anal Cell Pathol (Amst) 2010; 33:95-104. [PMID: 20966546 PMCID: PMC4605565 DOI: 10.3233/acp-clo-2010-0531] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND Around 30% of all stage II colon cancer patients will relapse and die of their disease. At present no objective parameters to identify high-risk stage II colon cancer patients, who will benefit from adjuvant chemotherapy, have been established. With traditional histopathological features definition of high-risk stage II colon cancer patients is inaccurate. Therefore more objective and robust markers for prediction of relapse are needed. DNA copy number aberrations have proven to be robust prognostic markers, but have not yet been investigated for this specific group of patients. The aim of the present study was to identify chromosomal aberrations that can predict relapse of tumor in patients with stage II colon cancer. MATERIALS AND METHODS DNA was isolated from 40 formaldehyde fixed paraffin embedded stage II colon cancer samples with extensive clinicopathological data. Samples were hybridized using Comparative Genomic Hybridization (CGH) arrays to determine DNA copy number changes and microsatellite stability was determined by PCR. To analyze differences between stage II colon cancer patients with and without relapse of tumor a Wilcoxon rank-sum test was implemented with multiple testing correction. RESULTS Stage II colon cancers of patients who had relapse of disease showed significantly more losses on chromosomes 4, 5, 15q, 17q and 18q. In the microsatellite stable (MSS) subgroup (n=28), only loss of chromosome 4q22.1-4q35.2 was significantly associated with disease relapse (p<0.05, FDR<0.15). No differences in clinicopathological characteristics between patients with and without relapse were observed. CONCLUSION In the present series of MSS stage II colon cancer patients losses on 4q22.1-4q35.2 were associated with worse outcome and these genomic alterations may aid in selecting patients for adjuvant therapy.
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Vega J, Murari A, Carvalho B, de Arcas G, Felton R, Riva M, Ruiz M, Svensson J. New developments at JET in diagnostics, real-time control, data acquisition and information retrieval with potential application to ITER. FUSION ENGINEERING AND DESIGN 2009. [DOI: 10.1016/j.fusengdes.2009.02.055] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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116
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Gonçalves H, Martínez-Solano I, Pereira RJ, Carvalho B, García-París M, Ferrand N. High levels of population subdivision in a morphologically conserved Mediterranean toad (Alytes cisternasii) result from recent, multiple refugia: evidence from mtDNA, microsatellites and nuclear genealogies. Mol Ecol 2009; 18:5143-60. [PMID: 19912538 DOI: 10.1111/j.1365-294x.2009.04426.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Pleistocene glaciations often resulted in differentiation of taxa in southern European peninsulas, producing the high levels of endemism characteristic of these regions (e.g. the Iberian Peninsula). Despite their small ranges, endemic species often exhibit high levels of intraspecific differentiation as a result of a complex evolutionary history dominated by successive cycles of fragmentation, expansion and subsequent admixture of populations. Most evidence so far has come from the study of species with an Atlantic distribution in northwestern Iberia, and taxa restricted to Mediterranean-type habitats remain poorly studied. The Iberian Midwife toad (Alytes cisternasii) is a morphologically conserved species endemic to southwestern and central Iberia and a typical inhabitant of Mediterranean habitats. Applying highly variable genetic markers from both mitochondrial and nuclear genomes to samples collected across the species' range, we found evidence of high population subdivision within A. cisternasii. Mitochondrial haplotypes and microsatellites show geographically concordant patterns of genetic diversity, suggesting population fragmentation into several refugia during Pleistocene glaciations followed by subsequent events of geographical and demographic expansions with secondary contact. In addition, the absence of variation at the nuclear beta-fibint7 and Ppp3caint4 gene fragments suggests that populations of A. cisternasii have been recurrently affected by episodes of extinction and recolonization, and that documented patterns of population subdivision are the outcome of recent and multiple refugia. We discuss the evolutionary history of the species with particular interest in the increasing relevance of Mediterranean refugia for the survival of genetically differentiated populations during the Pleistocene glaciations as revealed by studies in co-distributed taxa.
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Marques CJ, Pignatelli D, Carvalho B, Barceló J, Almeida AC, Fernandes S, Witchel SF, Sousa M, Oliveira MJ, Freitas P, Fontoura M, Carvalho D, Barros A, Carvalho F. Mutational Characterization of Steroid 21-Hydroxylase Gene in Portuguese patients with Congenital Adrenal Hyperplasia. Exp Clin Endocrinol Diabetes 2009; 118:505-12. [DOI: 10.1055/s-0029-1237363] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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118
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Diosdado B, van de Wiel MA, Terhaar Sive Droste JS, Mongera S, Postma C, Meijerink WJHJ, Carvalho B, Meijer GA. MiR-17-92 cluster is associated with 13q gain and c-myc expression during colorectal adenoma to adenocarcinoma progression. Br J Cancer 2009; 101:707-14. [PMID: 19672269 PMCID: PMC2736819 DOI: 10.1038/sj.bjc.6605037] [Citation(s) in RCA: 207] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: MicroRNAs are small non-coding RNA molecules, which regulate central mechanisms of tumorigenesis. In colorectal tumours, the combination of gain of 8q and 13q is one of the major factors associated with colorectal adenoma to adenocarcinoma progression. Functional studies on the miR-17-92 cluster localised on 13q31 have shown that its transcription is activated by c-myc, located on 8q, and that it has oncogenic activities. We investigated the contribution of the miR-17-92 cluster during colorectal adenoma to adenocarcinoma progression. Methods: Expression levels of the miR-17-92 cluster were determined in 55 colorectal tumours and in 10 controls by real-time RT–PCR. Messenger RNA c-myc expression was also determined by real-time RT–PCR in 48 tumours with array comparative genomic hybridisation (aCGH) data available. Results: From the six members of the miR-17-92 cluster, all except miR-18a, showed significant increased expression in colorectal tumours with miR-17-92 locus gain compared with tumours without miR-17-92 locus gain. Unsupervised cluster analysis clustered the tumours based on the presence of miR-17-92 locus gain. Significant correlation between the expression of c-myc and the six miRNAs was also found. Conclusion: Increased expression of miR-17-92 cluster during colorectal adenoma to adenocarcinoma progression is associated to DNA copy number gain of miR17-92 locus on 13q31 and c-myc expression.
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Valentim A, Vaz F, Carvalho B, Nunes J. 647 TRANSDERMAL BUPRENORPHINE FOR POSTOPERATIVE PAIN MANAGEMENT IN A PATIENT ON METHADONE MAINTENANCE THERAPY — CASE REPORT. Eur J Pain 2009. [DOI: 10.1016/s1090-3801(09)60650-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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120
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Postma C, Koopman M, Buffart TE, Eijk PP, Carvalho B, Peters GJ, Ylstra B, van Krieken JH, Punt CJA, Meijer GA. DNA copy number profiles of primary tumors as predictors of response to chemotherapy in advanced colorectal cancer. Ann Oncol 2009; 20:1048-56. [PMID: 19150955 DOI: 10.1093/annonc/mdn738] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is biologically a heterogeneous disease, which may affect response to drug therapy. We investigated the correlation of genome-wide DNA copy number profiles of primary tumors with response to systemic chemotherapy in advanced CRC. PATIENTS AND METHODS DNA was isolated from formaldehyde-fixed paraffin-embedded primary tumors of 32 patients with advanced CRC, which were selected based on either a good response (n = 16) or a poor response (n = 16) to first-line combination therapy with capecitabine and irinotecan. High-resolution DNA copy number profiles were obtained by means of 30 K oligonucleotide-based array comparative genomic hybridization (aCGH). RESULTS Unsupervised hierarchical cluster analysis of the aCGH data revealed two clusters of 19 and 13 tumors, respectively, and cluster membership showed a significant correlation with response status (P < 0.03). The nonresponders had fewer chromosomal alterations compared with the responders, in particular less losses were found (P < 0.03). Most prominent differences between the two groups were losses of regions 18p11.32-q11.2 (P < 0.02) and 18q12.1-q23 (P < 0.03), which were more frequently observed in responders. CONCLUSIONS Differences in DNA copy number profiles of primary CRCs are associated with response to systemic combination chemotherapy with capecitabine and irinotecan. Responders overall had more chromosomal alterations, especially loss of chromosome 18.
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121
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Carvalho B, Postma C, Mongera S, Hopmans E, Diskin S, van de Wiel MA, van Criekinge W, Thas O, Matthäi A, Cuesta MA, Terhaar Sive Droste JS, Craanen M, Schröck E, Ylstra B, Meijer GA. Multiple putative oncogenes at the chromosome 20q amplicon contribute to colorectal adenoma to carcinoma progression. Gut 2009; 58:79-89. [PMID: 18829976 DOI: 10.1136/gut.2007.143065] [Citation(s) in RCA: 181] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This study aimed to identify the oncogenes at 20q involved in colorectal adenoma to carcinoma progression by measuring the effect of 20q gain on mRNA expression of genes in this amplicon. METHODS Segmentation of DNA copy number changes on 20q was performed by array CGH (comparative genomic hybridisation) in 34 non-progressed colorectal adenomas, 41 progressed adenomas (ie, adenomas that present a focus of cancer) and 33 adenocarcinomas. Moreover, a robust analysis of altered expression of genes in these segments was performed by microarray analysis in 37 adenomas and 31 adenocarcinomas. Protein expression was evaluated by immunohistochemistry on tissue microarrays. RESULTS The genes C20orf24, AURKA, RNPC1, TH1L, ADRM1, C20orf20 and TCFL5, mapping at 20q, were significantly overexpressed in carcinomas compared with adenomas as a consequence of copy number gain of 20q. CONCLUSION This approach revealed C20orf24, AURKA, RNPC1, TH1L, ADRM1, C20orf20 and TCFL5 genes to be important in chromosomal instability-related adenoma to carcinoma progression. These genes therefore may serve as highly specific biomarkers for colorectal cancer with potential clinical applications.
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Coleman L, Carvalho B, Lipman S, Schmiesing C, Riley E. Accidental intrathecal sufentanil overdose during combined spinal-epidural analgesia for labor. Int J Obstet Anesth 2009; 18:78-80. [DOI: 10.1016/j.ijoa.2008.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Revised: 09/04/2008] [Accepted: 10/02/2008] [Indexed: 10/21/2022]
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123
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Carvalho B, Butwick A, Saxena A, Macario A. In reply. Int J Obstet Anesth 2009. [DOI: 10.1016/j.ijoa.2008.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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124
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Carvalho B, Saxena A, Butwick A, Macario A. Vaginal twin delivery: a survey and review of location, anesthesia coverage and interventions. Int J Obstet Anesth 2008; 17:212-6. [PMID: 17881218 DOI: 10.1016/j.ijoa.2007.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2007] [Accepted: 04/01/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Twin pregnancies are associated with increased perinatal morbidity and mortality. No consensus exists whether vaginal twin delivery should take place in the labor room or operating room, or whether anesthesiologists should be present. We surveyed members of the California Society of Anesthesiologists (CSA) to review management of vaginal twin delivery, and examined anesthetic intervention retrospectively at our institution. METHODS 230 CSA members were asked to complete an online survey on location of vaginal twin delivery in their institution and whether they were required to be present throughout. We then retrospectively reviewed charts of vaginal twin deliveries at our institution over a 36-month period to analyze frequency and type of anesthetic intervention. RESULTS The online survey response rate was 58%; 64% of responders reported that vaginal twin deliveries were performed in the operating room and 55% that an anesthesiologist was present. There was a strong association between anesthesiologist's presence and delivery in the operating room (OR 7; 95% CI 3-20). We reviewed 81 charts of women who underwent vaginal twin delivery. The median (range) time that the anesthesiologist was present for each delivery was 60 (20-380) min. Of women undergoing vaginal twin delivery, 27% required anesthetic intervention during the second stage of labor with 6% having emergency cesarean delivery. CONCLUSION There is a lack of consensus regarding the appropriate location for vaginal twin delivery and the role of anesthesiologists. A significant percentage of women undergoing vaginal twin delivery in our institution received anesthetic intervention in the immediate delivery period.
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Pereira R, Sousa J, Fernandes A, Patrício F, Carvalho B, Neto A, Varandas C, Gorini G, Tardocchi M, Gin D, Shevelev A. ATCA data acquisition system for gamma-ray spectrometry. FUSION ENGINEERING AND DESIGN 2008. [DOI: 10.1016/j.fusengdes.2007.10.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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