Federal University of São Paulo

About: Federal University of São Paulo is a education organization based out in São Paulo, Brazil. It is known for research contribution in the topics: Population & Medicine. The organization has 27971 authors who have published 49365 publications receiving 935536 citations. The organization is also known as: Universidade Federal de São Paulo & Universidade Federal de Sao Paulo.

A systematic review and meta-analysis of the utility of EUS for preoperative staging for gastric cancer

Abstract: Background Accurate preoperative staging is important in determining the appropriate treatment of gastric cancer. Recently, endoscopic ultrasound (EUS) has been introduced as a staging modality. However, reported test characteristics for EUS in gastric cancer vary. Our purpose in this study was to identify, synthesize, and evaluate findings from all articles on the performance of EUS in the preoperative staging of gastric cancer.

International study on microcirculatory shock occurrence in acutely Ill patients

Abstract: Objectives: Microcirculatory alterations are associated with adverse outcome in subsets of critically ill patients. The prevalence and significance of microcirculatory alterations in the general ICU population are unknown. We studied the prevalence of microcirculatory alterations in a heterogeneous ICU population and its predictive value in an integrative model of macro- and microcirculatory variables. Design: Multicenter observational point prevalence study. Setting: The Microcirculatory Shock Occurrence in Acutely ill Patients study was conducted in 36 ICUs worldwide. Patients: A heterogeneous ICU population consisting of 501 patients. Interventions: None. Measurements and Main Results: Demographic, hemodynamic, and laboratory data were collected in all ICU patients who were 18 years old or older. Sublingual Sidestream Dark Field imaging was performed to determine the prevalence of an abnormal capillary microvascular flow index ( 90 beats/min) (odds ratio, 2.71; 95% CI, 1.67-4.39; p < 0.001), mean arterial pressure (odds ratio, 0.979; 95% CI, 0.963-0.996; p = 0.013), vasopressor use (odds ratio, 1.84; 95% CI, 1.11-3.07; p = 0.019), and lactate level more than 1.5 mEq/L (odds ratio, 2.15; 95% CI, 1.28-3.62; p = 0.004) were independent risk factors for hospital mortality, but not abnormal microvascular flow index. In reference to microvascular flow index, a significant interaction was observed with tachycardia. In patients with tachycardia, the presence of an abnormal microvascular flow index was an independent, additive predictor for in-hospital mortality (odds ratio, 3.24; 95% CI, 1.30-8.06; p = 0.011). This was not true for nontachycardic patients nor for the total group of patients. Conclusions: In a heterogeneous ICU population, an abnormal microvascular flow index was present in 17% of patients. This was not associated with mortality. However, in patients with tachycardia, an abnormal microvascular flow index was independently associated with an increased risk of hospital death.

Topical tacrolimus for atopic dermatitis.

Abstract: Background Atopic dermatitis (AD) (or atopic eczema) is a chronic inflammatory skin condition that affects children and adults and has an important impact on quality of life Topical corticosteroids (TCS) are the first-line therapy for this condition; however, they can be associated with significant adverse effects when used chronically Tacrolimus ointment (in its 2 manufactured strengths of 01% and 003%) might be an alternative treatment Tacrolimus, together with pimecrolimus, are drugs called topical calcineurin inhibitors (TCIs) Objectives To assess the efficacy and safety of topical tacrolimus for moderate and severe atopic dermatitis compared with other active treatments Search methods We searched the following databases up to 3 June 2015: the Cochrane Skin Group Specialised Register, CENTRAL in the Cochrane Library (Issue 5, 2015), MEDLINE (from 1946), EMBASE (from 1974), LILACS (from 1982), and the Global Resource of Eczema Trials (GREAT database) We searched six trials registers and checked the bibliographies of included studies for further references to relevant trials We contacted specialists in the field for unpublished data A separate search for adverse effects of topical tacrolimus was undertaken in MEDLINE and EMBASE on 30 July 2013 We also scrutinised the US Food and Drug Administration (FDA) websites for adverse effects information Selection criteria All randomised controlled trials (RCTs) of participants with moderate to severe atopic dermatitis (both children and adults) using topical tacrolimus at any dose, course duration, and follow-up time compared with other active treatments Data collection and analysis Two authors independently screened and examined the full text of selected studies for compliance with eligibility criteria, risk of bias, and data extraction Our three prespecified primary outcomes were physician's assessment, participant's self-assessment of improvement, and adverse effects Our secondary outcomes included assessment of improvement of the disease by validated or objective measures, such as SCORAD (SCORing Atopic Dermatitis), the EASI (Eczema Area and Severity Index), and BSA (Body Surface Area) scores Main results We included 20 studies, with 5885 participants The variability of drug doses, outcomes, and follow-up periods made it difficult to carry out meta-analyses A single trial showed that tacrolimus 01% was better than low-potency TCS by the physician's assessment (risk ratio (RR) 309, 95% confidence interval (CI) 214 to 445, 1 study, n = 371, moderate-quality evidence) It was also marginally better than low-potency TCS on face and neck areas and moderate-potency TCS on the trunk and extremities by the physician's assessment (RR 132, 95% CI 117 to 149, 1 study, n = 972, moderate level of evidence) and for some of the secondary outcomes Compared with pimecrolimus 1%, people treated with tacrolimus were almost twice as likely to improve by the physician's assessment (RR 180, 95% CI 134 to 242, 2 studies, n = 506, moderate quality of evidence) Compared with the lower concentration of 003%, the tacrolimus 01% formulation reduced the risk of not having an improvement by 18% as evaluated by the physician's assessment (RR 082, 95% CI 072 to 092, 6 studies, n = 1640, high-quality evidence) Tacrolimus 01% compared with moderate-to-potent TCS showed no difference by the physician's assessment, and 2 secondary outcomes (1 study, 377 participants) and a marginal benefit favouring tacrolimus 01% was found by the participant's assessment (RR 121, 95% CI 113 to 129, 1 study, n = 974, low quality of evidence) and SCORAD Based on data from 2 trials, tacrolimus 003% was superior to mild TCS for the physician's assessment (RR 258, 95% CI 196 to 338, 2 studies, n = 790, moderate-quality evidence) and the participant's self-assessment (RR 164, 95% CI 141 to 190, 1 study, n = 416, moderate quality of evidence) One trial showed moderate benefit of tacrolimus 003% compared with pimecrolimus 1% on the physician's assessment (RR 142, 95% CI 102 to 198, 1 study, n = 139, low-quality evidence), but the effects were equivocal when evaluating BSA In the comparison of tacrolimus 003% with moderate-to-potent corticosteroids, no difference was found in most of the outcomes measured (including physician's and participant's assessment and also for the secondary outcomes), but in two studies, a marginal benefit favouring the corticosteroid group was found for the EASI and BSA scores Burning was more frequent in those using calcineurin inhibitors than those using corticosteroid tacrolimus 003% (RR 248, 95% CI 196 to 314, 5 studies, 1883 participants, high-quality evidence), but no difference was found for skin infections Symptoms observed were mild and transient The comparison between the two calcineurin inhibitors (pimecrolimus and tacrolimus) showed the same overall incidence of adverse events, but with a small difference in the frequency of local effects Serious adverse events were rare; occurred in both the tacrolimus and corticosteroid groups; and in most cases, were considered to be unrelated to the treatment No cases of lymphoma were noted in the included studies nor in the non-comparative studies Cases were only noted in spontaneous reports, cohorts, and case-control studies Systemic absorption was rarely detectable, only in low levels, and this decreased with time Exception is made for diseases with severe barrier defects, such as Netherton's syndrome, lamellar ichthyosis, and a few others, with case reports of a higher absorption We evaluated clinical trials; case reports; and in vivo, in vitro, and animal studies; and didn't find any evidence that topical tacrolimus could cause skin atrophy Authors' conclusions Tacrolimus 01% was better than low-potency corticosteroids, pimecrolimus 1%, and tacrolimus 003% Results were equivocal when comparing both dose formulations to moderate-to-potent corticosteroids Tacrolimus 003% was superior to mild corticosteroids and pimecrolimus Both tacrolimus formulations seemed to be safe, and no evidence was found to support the possible increased risk of malignancies or skin atrophy with their use The reliability and strength of the evidence was limited by the lack of data; thus, findings of this review should be interpreted with caution We did not evaluate costs

Abundance of MMPs and Cysteine Cathepsins in Caries-affected Dentin

Abstract: Degradation of dentin matrix components within caries dentin has been correlated with the activity of host-derived proteases, such as matrix metalloproteases (MMPs) and cysteine cathepsins (CTs). Since this relationship has not been fully established, we hypothesized that the abundance of MMPs and CTs in caries-affected dentin must be higher than in intact dentin. To test this premise, we obtained 5 slices (200 µm) from 5 intact teeth and from 5 caries-affected teeth (1 slice/tooth) and individually incubated them with primary antibodies for CT-B, CT-K, MMP-2, or MMP-9. Negative controls were incubated with pre-immune serum. Specimens were washed and re-incubated with the respective fluorescent secondary antibody. Collagen identification, attained by the autofluorescence capture technique, and protease localization were evaluated by multi-photon confocal microscopy. The images were analyzed with ZEN software, which also quantitatively measured the percentages of collagen and protease distribution in dentin compartments. The abundance of the test enzymes was markedly higher in caries-affected than in intact dentin. CT-B exhibited the highest percentage of co-localization with collagen, followed by MMP-9, MMP-2, and CT-K. The high expression of CTs and MMPs in caries-affected teeth indicates that those host-derived enzymes are intensely involved with caries progression.