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Karademas EC, Roziner I, Mazzocco K, Pat-Horenczyk R, Sousa B, Oliveira-Maia AJ, Stamatakos G, Cardoso F, Frasquilho D, Kolokotroni E, Lemos R, Marzorati C, Mattson J, Pettini G, Spyropoulou E, Poikonen-Saksela P, Simos P. The mutual determination of self-efficacy to cope with cancer and cancer-related coping over time: a prospective study in women with breast cancer. Psychol Health 2023; 38:1635-1648. [PMID: 35147473 DOI: 10.1080/08870446.2022.2038157] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 09/10/2021] [Revised: 11/10/2021] [Accepted: 12/28/2021] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The aim of this study was to examine the longitudinal impact of self-efficacy to cope with cancer on the cancer-related coping reactions of breast cancer patients and vice versa. DESIGN AND MAIN OUTCOMES MEASURES Data from the BOUNCE Project (https://www.bounce-project.eu/) were used to address the hypotheses. Participants (N = 403) were enrolled in the study a few weeks after surgery or biopsy. Coping self-efficacy was assessed at baseline and six months later (M6). Cancer-related coping was assessed three (M3) and nine months (M9) after baseline. The analyses were performed using structural equation modeling with Mplus 8.6. RESULTS Baseline coping self-efficacy predicted all M3 coping reactions, while M6 coping self-efficacy also predicted changes in all but one M9 coping reaction. Moreover, one of the M3 coping reactions, that is, hopelessness/helplessness, predicted the changes in M6 coping self-efficacy. The relation between coping self-efficacy and one coping reaction (i.e. cognitive avoidance) was rather weak. Stability paths from M3 to M9 coping reactions were moderate to high. CONCLUSION The relationship between self-efficacy to cope with cancer and cancer-related coping is complex. New theoretical models are needed to more accurately describe the diverse aspects of this association.
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Affiliation(s)
- E C Karademas
- Department of Psychology, University of Crete, Rethymno, Greece
- Foundation for Research and Technology - Hellas, Heraklion, Greece
| | - I Roziner
- Department of Communication Disorders, Sackler Faculty of Medicine, University of Tel Aviv, Tel Aviv, Israel
| | - K Mazzocco
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - R Pat-Horenczyk
- School of Social Work and Social Welfare, Hebrew University of Jerusalem, Jerusalem, Israel
| | - B Sousa
- Breast Unit, Champalimaud Clinical Centre, Champalimaud Foundation, Lisboa, Portugal
| | - A J Oliveira-Maia
- Champalimaud Research and Clinical Centre, Champalimaud Centre for the Unknown, Champalimaud Foundation, Lisboa, Portugal
- NOVA Medical School, NMS, Universidade Nova de Lisboa, Lisboa, Portugal
| | - G Stamatakos
- Institute of Communication and Computer Systems, School of Electrical and Computer Engineering, National Technical University of Athens, Athens, Greece
| | - F Cardoso
- Breast Unit, Champalimaud Clinical Centre, Champalimaud Foundation, Lisboa, Portugal
| | - D Frasquilho
- Champalimaud Research and Clinical Centre, Champalimaud Centre for the Unknown, Champalimaud Foundation, Lisboa, Portugal
| | - E Kolokotroni
- Institute of Communication and Computer Systems, School of Electrical and Computer Engineering, National Technical University of Athens, Athens, Greece
| | - R Lemos
- Champalimaud Research and Clinical Centre, Champalimaud Centre for the Unknown, Champalimaud Foundation, Lisboa, Portugal
| | - C Marzorati
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - J Mattson
- Comprehensive Cancer Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - G Pettini
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - E Spyropoulou
- Department of Psychology, University of Crete, Rethymno, Greece
| | - P Poikonen-Saksela
- Comprehensive Cancer Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - P Simos
- Foundation for Research and Technology - Hellas, Heraklion, Greece
- Medical School, University of Crete, Rethymno, Greece
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Silva Neto F, Gadelha C, Silva L, Pazos N, Silva A, Silva M, Sousa B, Bernardes Dulgheroff AC, Guerra F, Magalhães da Silveira V, Oliveira M, Lima Neto R. Case Report: Ocular Sporotrichosis-A Seven-Case Series. Am J Trop Med Hyg 2023; 108:1109-1114. [PMID: 37188341 PMCID: PMC10540119 DOI: 10.4269/ajtmh.22-0501] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 12/19/2022] [Indexed: 05/17/2023] Open
Abstract
Ocular infections associated with sporotrichosis can present four clinical manifestations: granulomatous conjunctivitis, dacryocystitis, Parinaud oculoglandular syndrome, and bulbar conjunctivitis. The incidence of ocular sporotrichosis related to zoonotic transmission has significantly increased in endemic regions and is a frequently misdiagnosed cause of granulomatous conjuntivitis. Therefore, we present a series of seven cases of eye injury by Sporothrix strains, including clinical forms, therapeutic approaches, and laboratory procedures to alert health professionals who provide care to these patients.
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Affiliation(s)
- Francisco Silva Neto
- Lauro Wanderley University Hospital, Federal University of Paraíba, João Pessoa, Brazil
- Department of Infectious, Parasitic and Inflammatory Diseases, Center for Medical Sciences, Federal University of Paraíba, João Pessoa, Brazil
| | - Camila Gadelha
- Undergraduated Course in Medicine, Center for Medical Sciences, Federal University of Paraíba, João Pessoa, Brazil
| | - Larissa Silva
- Post-Graduate Program in Bioactive Synthetic Natural products, Federal University of Paraíba, João Pessoa, Brazil
| | - Natália Pazos
- Post-Graduate Program in Bioactive Synthetic Natural products, Federal University of Paraíba, João Pessoa, Brazil
| | - Alan Silva
- Technical Health School, Federal University of Paraíba, João Pessoa, Brazil
| | - Mayara Silva
- Post-Graduate Program in Fungal Biology, Federal University of Pernambuco, Recife, Brazil
| | - Bruna Sousa
- Post-Graduate Program in Fungal Biology, Federal University of Pernambuco, Recife, Brazil
| | | | - Felipe Guerra
- Post-Graduate Program in Bioactive Synthetic Natural products, Federal University of Paraíba, João Pessoa, Brazil
| | - Vera Magalhães da Silveira
- Department of Tropical Medicine, Center for Medical Sciences, Federal University of Pernambuco, Recife, Brazil
| | - Manoel Oliveira
- Instituto Oswaldo Cruz (IOC/FIOCRUZ), Rio de Janeiro, Brazil
| | - Reginaldo Lima Neto
- Post-Graduate Program in Fungal Biology, Federal University of Pernambuco, Recife, Brazil
- Department of Tropical Medicine, Center for Medical Sciences, Federal University of Pernambuco, Recife, Brazil
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3
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Karademas EC, Roziner I, Simos P, Mazzocco K, Pat-Horenczyk R, Sousa B, Oliveira-Maia AJ, Stamatakos G, Cardoso F, Kolokotroni E, Lemos R, Marzorati C, Mattson J, Greta P, Travado L, Poikonen-Saksela P. Changes over time in self-efficacy to cope with cancer and well-being in women with breast cancer: a cross-cultural study. Psychol Health 2023:1-14. [PMID: 37101374 DOI: 10.1080/08870446.2023.2202205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
OBJECTIVE This study aimed to examine whether self-efficacy to cope with cancer changes over time in patients with breast cancer and whether these potential changes are similar across patients. It also aimed to examine whether these trajectories are related to patient psychological well-being and overall quality of life. METHODS Participants (N = 404) from four countries (i.e. Finland, Israel, Italy, and Portugal) were enrolled in the study few weeks after breast surgery or biopsy. Self-efficacy to cope with cancer was assessed at baseline, six and 12 months later. Well-being indices were assessed at baseline, 12 and 18 months later. RESULTS Using Latent Class Growth Analysis, two groups of patients were identified. The majority of patients reported high levels of self-efficacy to cope, which increased over time. For almost 15% of the patients, however, self-efficacy declined over time. Diminishing levels of self-efficacy to cope predicted worse levels of well-being. The pattern of self-efficacy changes and their relationships to well-being was consistent across countries. CONCLUSION Monitoring self-efficacy to cope with cancer is probably important in order to detect alarming changes in its levels, as a declining self-efficacy to cope may serve as a signal of the need for intervention to prevent adaptation difficulties.
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Affiliation(s)
- E C Karademas
- Department of Psychology, University of Crete, and Foundation for Research and Technology, Hellas, Greece
| | - I Roziner
- Department of Communication Disorders, Sackler Faculty of Medicine, University of Tel Aviv, Israel
| | - P Simos
- Medical School, University of Crete, and Foundation for Research and Technology, Hellas, Greece
| | - K Mazzocco
- Department of Oncology and Hemato-oncology, University of Milan, & Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - R Pat-Horenczyk
- School of Social Work and Social Welfare, Hebrew University of Jerusalem, Israel
| | - B Sousa
- Breast Unit, Champalimaud Clinical Centre, Champalimaud Foundation, Lisboa, Portugal
| | - A J Oliveira-Maia
- Champalimaud Research and Clinical Centre, Champalimaud Foundation, Lisboa, Portugal
- NOVA Medical School, NMS, Universidade Nova de Lisboa, Lisboa, Portugal
| | - G Stamatakos
- Institute of Communication and Computer Systems, School of Electrical and Computer Engineering, National Technical University of Athens, Athens, Greece
| | - F Cardoso
- Breast Unit, Champalimaud Clinical Centre, Champalimaud Foundation, Lisboa, Portugal
| | - E Kolokotroni
- Institute of Communication and Computer Systems, School of Electrical and Computer Engineering, National Technical University of Athens, Athens, Greece
| | - R Lemos
- Champalimaud Research and Clinical Centre, Champalimaud Foundation, Lisboa, Portugal
- ISPA-Instituto Universitário de Ciências Psicológicas, Sociais e da Vida, Lisboa, Portugal
| | - C Marzorati
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - J Mattson
- Helsinki University Hospital Comprehensive Cancer Center, and Helsinki University, Helsinki, Finland
| | - Pettini Greta
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - L Travado
- Breast Unit, Champalimaud Clinical Centre, Champalimaud Foundation, Lisboa, Portugal
| | - P Poikonen-Saksela
- Helsinki University Hospital Comprehensive Cancer Center, and Helsinki University, Helsinki, Finland
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Bandeira S, da Trindade S, Raguenaud ME, Sousa B. TB treatment non-adherence in São Tomé and Príncipe. Public Health Action 2022; 12:195-200. [PMID: 36561905 PMCID: PMC9716817 DOI: 10.5588/pha.22.0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 10/04/2022] [Indexed: 12/04/2022] Open
Abstract
SETTING Sao Tomé and Principe (STP) is a lower middle-income country in the Gulf of Guinea that has a persistent high loss of TB patients on treatment. OBJECTIVE To investigate factors associated with patient loss to follow-up (LTFU) and to assess health worker perceptions on non-adherence. DESIGN A retrospective cohort study was conducted using data from the national database. Factors associated with LTFU were investigated using univariable and multivariable logistic regression. In-depth interviews were conducted with TB health workers to identify perceived barriers for treatment completion. RESULTS A total of 822 registered patients with drug-susceptible TB were included, of whom 82 (10.0%) were lost to follow-up. Male sex (adjusted OR [aOR] 1.7, 95% CI 1.0-3.0; P = 0.048), as well as living in the Mé-Zóchi and Caué Districts (aOR 2.60, 95% CI 1.58-4.26; P < 0.001) were associated with an increased odds of LTFU. The main barriers to treatment completion were related to lack of food, stigma, and lack of patient information and personal support. CONCLUSION The study indicates the need to address multiple issues related to LTFU during TB treatment. Enhanced efforts to personalise care, especially for information, nutrition and encouragement will better support patients in STP.
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Affiliation(s)
- S. Bandeira
- National Tuberculosis Programme of São Tomé and Príncipe, São Tomé e Príncipe
| | - S. da Trindade
- National Tuberculosis Programme of São Tomé and Príncipe, São Tomé e Príncipe
| | - M. E. Raguenaud
- WHO Special Programme for Research and Training in Tropical Diseases, Geneva, Switzerland
| | - B. Sousa
- National Tuberculosis Programme of São Tomé and Príncipe, São Tomé e Príncipe
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Rodrigues A, Sousa B, Cardoso A, Machado P. "Found in Translation": An Evolutionary Framework for Auditory-Visual Relationships. Entropy (Basel) 2022; 24:1706. [PMID: 36554111 PMCID: PMC9777780 DOI: 10.3390/e24121706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/11/2022] [Accepted: 11/14/2022] [Indexed: 06/17/2023]
Abstract
The development of computational artifacts to study cross-modal associations has been a growing research topic, as they allow new degrees of abstraction. In this context, we propose a novel approach to the computational exploration of relationships between music and abstract images, grounded by findings from cognitive sciences (emotion and perception). Due to the problem's high-level nature, we rely on evolutionary programming techniques to evolve this audio-visual dialogue. To articulate the complexity of the problem, we develop a framework with four modules: (i) vocabulary set, (ii) music generator, (iii) image generator, and (iv) evolutionary engine. We test our approach by evolving a given music set to a corresponding set of images, steered by the expression of four emotions (angry, calm, happy, sad). Then, we perform preliminary user tests to evaluate if the user's perception is consistent with the system's expression. Results suggest an agreement between the user's emotional perception of the music-image pairs and the system outcomes, favoring the integration of cognitive science knowledge. We also discuss the benefit of employing evolutionary strategies, such as genetic programming on multi-modal problems of a creative nature. Overall, this research contributes to a better understanding of the foundations of auditory-visual associations mediated by emotions and perception.
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Affiliation(s)
- Ana Rodrigues
- Department of Informatics Engineering, Centre for Informatics and Systems of the University of Coimbra, University of Coimbra, 3004-531 Coimbra, Portugal
- Intelligent Systems Associate Laboratory (LASI), University of Minho, 4800-058 Guimarães, Portugal
| | - Bruna Sousa
- Department of Informatics Engineering, Centre for Informatics and Systems of the University of Coimbra, University of Coimbra, 3004-531 Coimbra, Portugal
| | - Amílcar Cardoso
- Department of Informatics Engineering, Centre for Informatics and Systems of the University of Coimbra, University of Coimbra, 3004-531 Coimbra, Portugal
- Intelligent Systems Associate Laboratory (LASI), University of Minho, 4800-058 Guimarães, Portugal
| | - Penousal Machado
- Department of Informatics Engineering, Centre for Informatics and Systems of the University of Coimbra, University of Coimbra, 3004-531 Coimbra, Portugal
- Intelligent Systems Associate Laboratory (LASI), University of Minho, 4800-058 Guimarães, Portugal
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6
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Karademas EC, Simos P, Pat-Horenczyk R, Roziner I, Mazzocco K, Sousa B, Stamatakos G, Tsakou G, Cardoso F, Frasquilho D, Kolokotroni E, Marzorati C, Mattson J, Oliveira-Maia AJ, Perakis K, Pettini G, Vehmanen L, Poikonen-Saksela P. The Interplay Between Trait Resilience and Coping Self-efficacy in Patients with Breast Cancer: An International Study. J Clin Psychol Med Settings 2022; 30:119-128. [PMID: 35488971 DOI: 10.1007/s10880-022-09872-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2022] [Indexed: 01/22/2023]
Abstract
The role of self-efficacy to cope with breast cancer as a mediator and/or moderator in the relationship of trait resilience to quality of life and psychological symptoms was examined in this study. Data from the BOUNCE Project ( https://www.bounce-project.eu/ ) were used. Women diagnosed with and in treatment for breast cancer (N = 484), from four countries, participated in the study. Trait resilience and coping self-efficacy were assessed at baseline (soon after the beginning of systemic treatment), and outcomes (quality of life, psychological symptoms) 3 months later. Hierarchical regression, mediation, moderation, and conditional (moderated) mediation and moderation analyses were performed to examine the study hypotheses. Coping self-efficacy mediated the impact of trait resilience. In addition, higher levels of resilience in combination with higher levels of coping self-efficacy were associated with better outcomes. Country of origin had no impact on these results. Overall, it seems that coping self-efficacy is a key factor that should be taken into account for research and intervention efforts in cancer.
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Affiliation(s)
- E C Karademas
- Department of Psychology, University of Crete, and Foundation for Research and Technology - Hellas, Rethymno, Greece.
| | - P Simos
- Medical School, University of Crete, and Foundation for Research and Technology - Hellas, Heraklion, Greece
| | - R Pat-Horenczyk
- Department of Communication Disorders, Sackler Faculty of Medicine, University of Tel Aviv, Tel Aviv, Israel
| | - I Roziner
- Department of Communication Disorders, Sackler Faculty of Medicine, University of Tel Aviv, Tel Aviv, Israel
| | - K Mazzocco
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology & Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - B Sousa
- Breast Unit, Champalimaud Clinical Centre/Champalimaud Foundation, Champalimaud Research, Lisbon, Portugal
| | - G Stamatakos
- Institute of Communication and Computer Systems, School of Electrical and Computer Engineering, National Technical University of Athens, Athens, Greece
| | - G Tsakou
- SingularLogic S.A, Athens, Greece
| | - F Cardoso
- Breast Unit, Champalimaud Clinical Centre/Champalimaud Foundation, Lisbon, Portugal
| | - D Frasquilho
- Champalimaud Research and Clinical Centre, Champalimaud Centre for the Unknown, Champalimaud Foundation, Lisbon, Portugal
| | - E Kolokotroni
- Institute of Communication and Computer Systems, School of Electrical and Computer Engineering, National Technical University of Athens, Athens, Greece
| | - C Marzorati
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Milan, Italy
| | - J Mattson
- Helsinki University Hospital Comprehensive Cancer Center, Helsinki University, Helsinki, Finland
| | - A J Oliveira-Maia
- Champalimaud Research and Clinical Centre, Champalimaud Centre for the Unknown, and NOVA Medical School, NMS, Universidade Nova de Lisboa, Lisbon, Portugal
| | | | - G Pettini
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Milan, Italy
| | - L Vehmanen
- Helsinki University Hospital Comprehensive Cancer Center, Helsinki University, Helsinki, Finland
| | - P Poikonen-Saksela
- Helsinki University Hospital Comprehensive Cancer Center, Helsinki University, Helsinki, Finland
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Nunes A, Dinis A, Oliveira B, Lopes S, Freitas T, Sousa B. Adolescents eating habits: the perception of adolescents vs parents. Clin Nutr ESPEN 2021. [DOI: 10.1016/j.clnesp.2021.09.670] [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: 10/19/2022]
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Almeida S, Frasquilho D, Cotovio G, Viana F, Sousa B, Oliveira J, Mattson J, Marzorati C, Roziner I, Karademas E, Kolokotroni E, Stamatakos G, Mazzocco K, Pat-Horenczyk R, Poikonen-Saksela P, Cardoso F, Oliveira-Maia A. 132P The psychological impact of the COVID-19 pandemic on patients with early breast cancer. Ann Oncol 2021. [PMCID: PMC8106261 DOI: 10.1016/j.annonc.2021.03.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
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9
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Pinto D, Batista E, Gouveia P, Mavioso C, Correia-Anacleto J, Abreu N, Vasconcelos M, Correia M, Ribeiro J, Sousa B, Gouveia H, Ferreira A, Chumbo M, Alves C, Cardoso M, Cardoso F. Feasibility trial of lymph node marking using both clip and carbon dye in cN1 patients submitted to neo-adjuvant chemotherapy to improve accuracy of axillary surgical staging in ycN0 patients after treatment. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30845-5] [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: 10/23/2022]
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Konsoulova-Kirova A, Ribeiro J, Gouveia H, Volovat S, Sousa B, Marques R, Brito M, Pinto D, Gouveia P, Vasconcelos M, Batista E, Cardoso M, Alves C, Cardoso F. Optimal duration and effectiveness of neoadjuvant endocrine therapy in breast cancer – Retrospective series. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30681-x] [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: 10/23/2022]
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Gomes K, Sousa B, Melo K, Macedo P, Resende Z, Gonçalves E, Resende J, Luz J, Urbano E. Intercurrent management and complications related to orthognathic surgeries: case report and literature review. Int J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.ijom.2019.03.773] [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: 11/16/2022]
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12
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Gomes K, Sousa B, Melo K, Macedo P, Resende Z, Gonçalves E, Leite F, Resende J, Urbano E. Maxillofacial fibrous dysplasia: a case report and literature revew. Int J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.ijom.2019.03.283] [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: 11/15/2022]
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13
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Gomes K, Sousa B, Melo K, Macedo P, Resende Z, Gonçalves E, Resende J, Urbano E. Ameloblastoma: case study associated with literature review. Int J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.ijom.2019.03.711] [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: 10/26/2022]
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14
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Gomes K, Macedo P, Melo K, Gonçalvez E, Resende Z, Sousa B, Resende J, Urbano E, Colombini N. Recommendation of reconstruction of temporomandibular joints with prototipated total prosthesis is guarantee of resolution? case report. Int J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.ijom.2019.03.528] [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: 12/01/2022]
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15
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Sousa B. Weight loss: Changes in anthropometry and body composition. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.1525] [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: 10/28/2022]
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16
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Sousa B. Body image and adherence to the mediterranean diet in a sample of young adults. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.1524] [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: 11/17/2022]
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17
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Sousa B. Mediterranean diet, a way to reduce atherosclerosis: The adherence in a Portuguese sample. Atherosclerosis 2018. [DOI: 10.1016/j.atherosclerosis.2018.06.644] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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18
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Martins F, Castro F, Pinto ML, Silva AJ, Sousa B, Oliveira MJ, Costa ÂM. The role of the hypoxic tumor microenvironment on the macrophage-tumor cell interplay: PS124. Porto Biomed J 2017; 2:216. [PMID: 32258710 DOI: 10.1016/j.pbj.2017.07.098] [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] [Indexed: 11/25/2022] Open
Affiliation(s)
- F Martins
- Department of Biology, Faculty of Sciences, UPorto, Porto, Portugal.,i3S - Instituto de Investigação e Inovação em Saúde, UPorto, Porto, Portugal.,INEB - Institute of Biomedical Engineering, UPorto, Portugal
| | - F Castro
- i3S - Instituto de Investigação e Inovação em Saúde, UPorto, Porto, Portugal.,INEB - Institute of Biomedical Engineering, UPorto, Portugal.,ICBAS- Instituto de Ciências Biomédicas Abel Salazar, UPorto, Porto, Portugal
| | - M L Pinto
- i3S - Instituto de Investigação e Inovação em Saúde, UPorto, Porto, Portugal.,INEB - Institute of Biomedical Engineering, UPorto, Portugal.,ICBAS- Instituto de Ciências Biomédicas Abel Salazar, UPorto, Porto, Portugal
| | - A J Silva
- i3S - Instituto de Investigação e Inovação em Saúde, UPorto, Porto, Portugal.,INEB - Institute of Biomedical Engineering, UPorto, Portugal
| | - B Sousa
- i3S - Instituto de Investigação e Inovação em Saúde, UPorto, Porto, Portugal.,IPATIMUP- Institute of Molecular Pathology and Immunology of the University of Porto, Portugal
| | - M J Oliveira
- i3S - Instituto de Investigação e Inovação em Saúde, UPorto, Porto, Portugal.,INEB - Institute of Biomedical Engineering, UPorto, Portugal.,Department of Pathology and Oncology, Faculty of Medicine, UPorto, Porto, Portugal
| | - Â M Costa
- i3S - Instituto de Investigação e Inovação em Saúde, UPorto, Porto, Portugal.,INEB - Institute of Biomedical Engineering, UPorto, Portugal
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Pinto D, Gouveia P, Sousa B, Hutka M, Furlanetto J, Mariz JM, Wuerstlein R, Cardoso F. Reply to the letter to the editor 'Insertion of central venous catheters (CVCs): any changes in the past ten years' by Biffi et al. Ann Oncol 2016; 27:1351-2. [PMID: 27037295 DOI: 10.1093/annonc/mdw149] [Citation(s) in RCA: 3] [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: 11/14/2022] Open
Affiliation(s)
- D Pinto
- Champalimaud Clinical Center, Breast Unit, Lisbon, Portugal
| | - P Gouveia
- Champalimaud Clinical Center, Breast Unit, Lisbon, Portugal
| | - B Sousa
- Champalimaud Clinical Center, Breast Unit, Lisbon, Portugal
| | - M Hutka
- Champalimaud Clinical Center, Breast Unit, Lisbon, Portugal
| | - J Furlanetto
- Champalimaud Clinical Center, Breast Unit, Lisbon, Portugal
| | - J M Mariz
- Champalimaud Clinical Center, Breast Unit, Lisbon, Portugal
| | - R Wuerstlein
- Champalimaud Clinical Center, Breast Unit, Lisbon, Portugal
| | - F Cardoso
- Champalimaud Clinical Center, Breast Unit, Lisbon, Portugal
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Sousa B, Oliveira B, de Almeida M. MON-PP145: Waist-to-Height Ratio References for 6 to 10 Years-Old Children of Autonomous Region of Madeira, Portugal. Clin Nutr 2015. [DOI: 10.1016/s0261-5614(15)30577-x] [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: 11/30/2022]
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Sousa B, Furlanetto J, Hutka M, Gouveia P, Wuerstlein R, Mariz JM, Pinto D, Cardoso F. Central venous access in oncology: ESMO Clinical Practice Guidelines. Ann Oncol 2015; 26 Suppl 5:v152-68. [PMID: 26314776 DOI: 10.1093/annonc/mdv296] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
Affiliation(s)
- B Sousa
- Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal
| | | | - M Hutka
- St George's University Hospitals, NHS Foundation Trust, London, UK
| | - P Gouveia
- Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal
| | - R Wuerstlein
- CCC of LMU, Breast Center, University Hospital Munich, Munich, Germany
| | - J M Mariz
- Department of Haematology, Instituto Português de Oncologia do Porto- Francisco Gentil, Oporto, Portugal
| | - D Pinto
- Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal
| | - F Cardoso
- Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal
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Ribnikar D, Ribeiro JM, Pinto D, Sousa B, Pinto AC, Gomes E, Moser EC, Cardoso MJ, Cardoso F. Breast cancer under age 40: a different approach. Curr Treat Options Oncol 2015; 16:16. [PMID: 25796377 DOI: 10.1007/s11864-015-0334-8] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Breast cancer (BC) under age 40 is a complex disease to manage due to the additionally fertility-related factors to be taken in consideration. More than 90% of young patients with BC are symptomatic. Women<40 years are more likely to develop BC with worse clinicopathological features and more aggressive subtype. This has been frequently associated with inferior outcomes. Recently, the prognostic significance of age<40 has been shown to differ according to the BC subtype, being associated with worst recurrence-free survival (RFS) and overall survival (OS) for luminal BC. The biology of BC<40 has also been explored through analysis of large genomic data set, and specific pathways overexpressed in these tumors have been identified which can lead to the development of targeted therapy in the future. A multidisciplinary tumor board should determine the optimal locoregional and systemic management strategies for every individual patient with BC before the start of any therapy including surgery. This applies to both early (early breast cancer (EBC)) and advanced (advanced breast cancer (ABC)) disease, before the start of any therapy. Mastectomy even in young patients confers no overall survival advantage when compared to breast-conserving treatment (BCT), followed by radiotherapy. Regarding axillary approach, indications are identical to other age groups. Young age is one of the most important risk factors for local recurrence after both breast-conserving surgery (BCS) and mastectomy, associated with a higher risk of distant metastasis and death. Radiation after BCS reduces local recurrence from 19.5 to 10.2% in BC patients 40 years and younger. The indications for and the choice of systemic treatment for invasive BC (both early and advanced disease) should not be based on age alone but driven by the biological characteristics of the individual tumor (including hormone receptor status, human epidermal growth factor receptor 2 (HER-2) status, grade, and proliferative activity), disease stage, and patient's comorbidities. Recommendations regarding the use of genomic profiles such as MammaPrint, Oncotype Dx, and Genomic grade index in young women are similar to the general BC population. Especially in the metastatic setting, patient preferences should always be taken into account, as the disease is incurable. The best strategy for these patients is the inclusion into well-designed, independent, prospective randomized clinical trials. Metastatic disease should always be biopsied whenever feasible for histological confirmation and reassessment of biology. Endocrine therapy is the preferred option for hormone receptor-positive disease (HR+ve), even in presence of visceral metastases, unless there is concern or proof of endocrine resistance or there is a need for rapid disease response and/or symptom control. Recommendations for chemotherapy (CT) should not differ from those for older patients with the same characteristics of the metastatic disease and its extent. Young age by itself should not be an indication to prescribe more intensive and combination CT regimens over the sequential use of monotherapy. Poly(ADP-ribose) polymerase inhibitors (PARP inhibitors) represent an important group of promising drugs in managing patients with breast cancer susceptibility gene (BRCA)-1- or BRCA-2-associated BC. Specific age-related side effects of systemic treatment (e.g., menopausal symptoms, change in body image, bone morbidity, cognitive function impairment, fertility damage, sexual dysfunction) and the social impact of diagnosis and treatment (job discrimination, taking care for children) should also be carefully addressed when planning systemic long-lasting therapy, such as endocrine therapy. Survivorship concerns for young women are different compared to older women, including issues of fertility, preservation, and pregnancy.
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Affiliation(s)
- D Ribnikar
- Medical Oncology Department, Institute of Oncology Ljubljana, Ljubljana, Slovenia
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Affiliation(s)
| | | | - F. Cardoso
- Champalimaud Cancer Center, Breast Unit, Lisbon, Portugal
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Sousa B, Oliveira B, de Almeida M. Growth trends in boys and girls (10–17 years-old) from autonomous region of Madeira, Portugal between 1996–1998 and 2007–2009. Ann Hum Biol 2012; 39:526-9. [DOI: 10.3109/03014460.2012.713510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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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Martins D, Sousa B, Paredes J, Schmitt F. mTOR Expression in Basal-Like Breast Cancer and the Ability of Everolimus to Inhibit the Invasion Cancer Cell Capacity. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)32914-8] [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: 10/25/2022] Open
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Albergaría A, Nobre A, Vieira A, Ricardo S, Sousa B, Seruca R, Paredes J, Schmitt F. 488 TAp63 Counteracts Invasive and Stem Cell Properties Mediated by P-cadherin in Breast Cancer Cells. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)71159-0] [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: 11/29/2022]
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Pinheiro C, Sousa B, Albergaria A, Paredes J, Dufloth R, Vieira D, Schmitt F, Baltazar F. GLUT1 and CAIX expression profiles in breast cancer correlate with adverse prognostic factors and MCT1 overexpression. Histol Histopathol 2011; 26:1279-86. [PMID: 21870331 DOI: 10.14670/hh-26.1279] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The goal of the present work was to evaluate the correlation of glucose transporter 1 (GLUT1) and carbonic anhydrase IX (CAIX) with the monocarboxylate transporters 1 (MCT1) and 4 (MCT4) and their chaperone, CD147, in breast cancer. The clinico-pathological value of GLUT1 and CAIX was also evaluated. For that, we analysed the immunohistochemical expression of GLUT1 and CAIX, in a large series of invasive breast carcinoma samples (n=124), previously characterized for MCT1, MCT4 and CD147 expression. GLUT1 expression was found in 46% of the cases (57/124), while CAIX was found in 18% of the cases (22/122). Importantly, both MCT1 and CD147, but not MCT4, were associated with GLUT1 and CAIX expression. Also, GLUT1 and CAIX correlated with each other. Concerning the clinico-pathological values, GLUT1 was associated with high grade tumours, basal-like subtype, absence of progesterone receptor, presence of vimentin and high proliferative index as measured by Ki-67. Additionally, CAIX was associated with large tumour size, high histological grade, basal-like subtype, absence of estrogen and progesterone receptors and presence of basal cytokeratins and vimentin expression. Finally, patients with CAIX positive tumours had a significantly shorter disease-free survival. The association between MCT1 and both GLUT1 and CAIX may result from hypoxia-mediated metabolic adaptations, which confer a glycolytic, acid-resistant and more aggressive phenotype to cancer cells.
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Affiliation(s)
- C Pinheiro
- Life and Health Sciences Research Institute, School of Health Sciences, University of Minho, Braga, Portugal
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Sousa B, Nasim S, Cole D, Wong B, Hill K, Vandenberghe H, Ueng S, Romaschin A, Warner E. 5171 POSTER First Results From a Study Analyzing CYP2D6 Genotypes and Tamoxifen Metabolites in a Canadian Population With Endocrine Responsive Breast Cancer. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)71613-6] [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: 11/30/2022]
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Ribeiro A, Carreto L, Albergaria A, Sousa B, Ricardo S, Milanezi F, Seruca R, Santos M, Schmitt F, Paredes J. 514 Co-expression of E- and P-cadherin in breast cancer: role as an invasion suppressor or as an invasion promoter? EJC Suppl 2010. [DOI: 10.1016/s1359-6349(10)71315-x] [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: 10/19/2022] Open
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Albergaria A, Ribeiro A, Pinho S, Milanezi F, Sousa B, Oliveira C, Machado J, Seruca R, Paredes J, Schmitt F. 712 ICI 182,780 induces p-cadherin overexpression in breast cancer cells through chromatin remodelling at the promoter level: role of C/EBPbeta in CDH3 gene activation. EJC Suppl 2010. [DOI: 10.1016/s1359-6349(10)71509-3] [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: 10/19/2022] Open
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Albergaria A, Ribeiro AS, Pinho S, Milanezi F, Carneiro V, Sousa B, Sousa S, Oliveira C, Machado JC, Seruca R, Paredes J, Schmitt F. ICI 182,780 induces P-cadherin overexpression in breast cancer cells through chromatin remodelling at the promoter level: a role for C/EBP in CDH3 gene activation. Hum Mol Genet 2010; 19:2554-66. [DOI: 10.1093/hmg/ddq134] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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Faustino C, Afonso N, Sousa B, Sousa S, Couto R, Pereira D, Rodrigues H. 8042 Cisplatin plus topotecan in advanced/recurrent cervical cancer – experience from a single institution. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)71564-2] [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: 11/26/2022] Open
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Sousa M, Rodrigues A, Oliveira J, Ferreira A, Marques D, Sousa B, Sousa S, Carvalho L, Afonso N, Pereira D. 8065 Endometrial clear cell adenocarcinoma – a retrospective analysis. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)71587-3] [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] Open
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Pinto Correia A, Pinto D, Pereira D, Rodrigues H, Abreu de Sousa J, Sousa H, Sousa B, Sousa S, Lopes C, Medeiros R. 362 POSTER Pepsinogen C gene polymorphism and breast cancer: Influence on the overall survival. EJC Suppl 2007. [DOI: 10.1016/s1359-6349(07)70380-4] [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: 11/26/2022] Open
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Pereira C, Pinto D, Catarino R, Nogal A, Pereira D, Sousa B, Medeiros R. 5011 ORAL COX-2 polymorphism and susceptibility to gynaecological malignancies: –765C allele confers increased risk for ovarian cancer. EJC Suppl 2007. [DOI: 10.1016/s1359-6349(07)71183-7] [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: 11/25/2022] Open
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Coelho AP, Nogal A, Pereira D, Matos A, Sousa B, Araújo A, Catarino R, Medeiros R. Role of -2518 MCP-1 polymorphism in cervical cancer development. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.5594] [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: 11/20/2022] Open
Abstract
5594 Background: Cervical cancer (ICC) and squamous intraepitelial lesions of the cervix uteri (SIL) constitute serious health problems to women worldwide. ICC occupies the second place in the list of tumours afflicting women. Around 470,000 new cases are diagnosed annually, 80% of which in less developed countries and near half of them resulting in death of the women. MCP-1 chemokine is the main determinant of tumour associated macrophages (TAM) content in the squamous cell carcinoma of the uterine cervix. The aim of our study was the evaluation of the association between the -2518 MCP-1 polymorphism (a biallelic G/A functional polymorphism) and susceptibility to cervical intraepithelial lesions and cervical cancer development. Methods: We analyzed 898 samples of DNA, of which 420 corresponded to healthy women (control group), 130 to women with low and high-grade cervical intraepithelial lesions and 348 to women with cervical cancer. The analysis of the polymorphism and the evaluation of the corresponding genotypes were performed with the PCR-RFLP methodology. Analysis of data was performed using the computer software SPSS for windows. Results: The analysis of the genotipic frequencies of the -2518 MCP-1 genotypes indicates that women carrying genotypes with the G allele present a 29.2% protection for the development of intraepithelial lesions of the cervix uteri (OR=0.708; 95% CI: 0.503–0.998; P=0.048) and a 33.5% protection for the development of squamous cell carcinoma of the cervix uteri. It was also possible to observe an association between the waiting time to onset of cervical cancer and the polymorphism: 59 years for women carrying genotypes with the G allele (95% CI: 56–61years) and 53 years for women with the AA genotype (95% CI: 52–57 years; P=0.005). Also, women with genotypes carrying the G allele present a 2.5 fold higher risk for the progression from early stages of invasive cervical carcinoma (I/II) to clinically more advanced stages (III/IV) (OR=2.26; 95% CI: 1.09–4.67; P=0.026). Conclusions: These findings suggest a role of the -2518 MCP-1 polymorphism in the molecular mechanisms that lead to cervical cancer development and progression. No significant financial relationships to disclose.
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Affiliation(s)
- A. P. Coelho
- Portuguese Institute of Oncology, Porto, Portugal; Militar Hospital, Porto, Portugal
| | - A. Nogal
- Portuguese Institute of Oncology, Porto, Portugal; Militar Hospital, Porto, Portugal
| | - D. Pereira
- Portuguese Institute of Oncology, Porto, Portugal; Militar Hospital, Porto, Portugal
| | - A. Matos
- Portuguese Institute of Oncology, Porto, Portugal; Militar Hospital, Porto, Portugal
| | - B. Sousa
- Portuguese Institute of Oncology, Porto, Portugal; Militar Hospital, Porto, Portugal
| | - A. Araújo
- Portuguese Institute of Oncology, Porto, Portugal; Militar Hospital, Porto, Portugal
| | - R. Catarino
- Portuguese Institute of Oncology, Porto, Portugal; Militar Hospital, Porto, Portugal
| | - R. Medeiros
- Portuguese Institute of Oncology, Porto, Portugal; Militar Hospital, Porto, Portugal
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Abstract
UNLABELLED Partial trisomy 16q is a rare disorder associated with significant dysmorphism, psychomotor retardation and limited postnatal survival. A female infant with a partial trisomy 16q from a de novo translocation 11;16 is described. Clinical findings were consistent with previous reports, with the exceptions of megalocornea, partial callosal agenesis and mild bilateral occipital lobe hypoplasia. CONCLUSION Based on this clinical report, megalocornea, partial callosal agenesis and mild bilateral occipital lobe hypoplasia should perhaps be included in the list of anomalies associated with partial trisomy 16q.
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Affiliation(s)
- B Sousa
- Neonatal Intensive Care Unit, Department of Paediatrics, São João Hospital, Porto, Portugal
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