D’Or Institute for Research and Education

Depression is a frequent neuropsychiatric symptom in dementia, yet metabolic contributors remain poorly understood. Central adiposity may be involved, but conventional anthropometric measures may inadequately capture obesity in older adults. This cross-sectional study included 601 community-dwelling individuals aged 60-91 years evaluated at a memory clinic between 2015 and 2024. Dementia was diagnosed using DSM-5 criteria for Major Neurocognitive Disorder, and depressive symptoms were assessed with the 15-item Geriatric Depression Scale. Obesity was evaluated using multiple anthropometric indices, including Body Mass Index, Waist Circumference, Waist-to-Height Ratio, A Body Shape Index, Conicity Index, Weight-Adjusted Waist Index, and Body Roundness Index (BRI). No measure was associated with depression in the overall sample. Among individuals with dementia, higher BRI was associated with increased odds of depression, with those in the highest quartile showing more than threefold greater odds. These findings suggest that BRI may better capture central adiposity relevant to depression in dementia.

Native T1 and extracellular volume (ECV) mapping have emerged as promising tools for noninvasive assessment of hepatic congestion and fibrosis; however, optimal strategies for region-of-interest (ROI) selection remain uncertain. The aim was to evaluate the level of agreement between two methods for quantifying hepatic native T1 and ECV: single wide ROI versus multiple small ROIs, in patients with repaired tetralogy of Fallot (TOF) and Fontan circulation. This agreement study prospectively enrolled outpatients with repaired TOF or Fontan circulation between 2022 and 2025. All participants underwent hepatic evaluation using a cardiac Magnetic Resonance Imaging (MRI) protocol on a 3.0-T scanner. Native and post-contrast T1 mapping were acquired using Modified Look-Locker Inversion Recovery (MOLLI) sequences. Hepatic T1 and ECV were measured using (1) one wide ROI avoiding vascular structures and (2) three small circular ROIs placed in distinct parenchymal regions. Agreement was assessed using intraclass correlation coefficients (ICC) and survival-agreement plots. A total of 61 patients was included (31 with TOF; 30 with Fontan circulation). Agreement between single-ROI and multiple-ROI strategies was excellent in TOF patients for both native T1 and ECV (ICC = 0.98), and good in patients with Fontan circulation for both parameters (ICC = 0.79). Survival-agreement analysis demonstrated that in TOF patients, all measurements differed by less than 80 ms for native T1 and less than 5% for ECV. In Fontan patients, 86% of measurements showed differences < 80 ms for native T1 and < 5% for ECV, reflecting greater hepatic heterogeneity while preserving overall concordance between ROI strategies. Hepatic native T1 and ECV measurements showed excellent agreement between single-wide and multiple-small ROI strategies in repaired TOF, supporting interchangeable use for longitudinal follow-up. In Fontan patients, concordance between methods was also good, as demonstrated by both ICC and survival-agreement analyses, indicating that either strategy remains feasible; nonetheless, the greater hepatic heterogeneity in this population warrants some caution when comparing measurements obtained with different ROI approaches.

Lung cancer (LC) incidence and mortality rates are increasing in Brazil, particularly among women. Studies indicate that sex may affect incidence, survival, and treatment response. However, overlooked or unknown risk factors may also play a role in the sex disparities observed. For instance, although smoking is a major risk factor for LC, increasing rates of LC among nonsmoking women in Brazil, and elsewhere, have been observed. Also, traditional gender roles expose women to specific environmental hazards, as they are often expected to perform domestic tasks and thus are more likely to be indoors and exposed to second-hand smoke, air pollution from cooking fuels, and radon. In addition, occupational hazards such as formaldehyde, particularly in hairdressing, disproportionately affect women. This narrative review highlights the disparities associated with LC and female sex in Brazil, and calls for more research on these overlooked risk factors.

Abstract Background: Triple-negative breast cancer (TNBC) is a heterogeneous and aggressive subtype associated with poor prognosis and limited therapeutic options. Molecular and immunological characterization of the tumor microenvironment (TME) may support the identification of prognostic biomarkers and new therapeutic targets. Objective: To evaluate, through an in silico approach, the gene expression profile and immune composition of the TNBC tumor microenvironment compared to hormone receptor-positive (HR+) and HER2-positive subtypes. Methods: We used clinical and RNA-seq data from the TCGA-BRCA dataset, comprising 1,101 breast cancer patients. Tumor samples were classified into TNBC, HR+, and HER2+ groups. Immune and stromal cell composition was estimated using the CIBERSORT and ESTIMATE algorithms. Differentially expressed genes (DEGs) were identified using the DESeq2 package. Gene co-expression network analysis was conducted using WGCNA, and overall survival was analyzed using Kaplan–Meier curves. Results: A total of 226 DEGs were identified: 206 in the TNBC vs HR+ comparison and 96 in the TNBC vs HER2+ comparison, with 76 genes shared between both. TNBC samples showed higher levels of CD8+ T cells (p &amp;lt; 0.01), activated dendritic cells, and immune scores (p &amp;lt; 0.001), but also increased T regulatory cells (p &amp;lt; 0.05) and M2 macrophages (p &amp;lt; 0.0001), suggesting a complex immune landscape with both cytotoxic and immunosuppressive elements. WGCNA identified two relevant modules: the blue module, correlated with stromal score, included DSG1, ACAN, RHCG, and KRT6C, genes linked to extracellular matrix remodeling; and the turquoise module, correlated with immune score, included CD274 (PD-L1), LAG3, IDO1, CXCL10, and GZMB, markers of immune activation and evasion. Survival analysis showed that CXCL13, CD3G, and GZMB were significantly associated with worse overall survival (p &amp;lt; 0.05). Conclusion: This integrative analysis revealed distinct gene signatures and immune patterns in TNBC, with enrichment of pathways related to inflammation, immunosuppression, and stromal remodeling. These findings suggest potential prognostic and predictive biomarkers and reinforce the TME as a relevant target for future therapeutic strategies. These results highlight promising targets for translational research and contribute to a better understanding of TNBC biological heterogeneity. Citation Format: D. L. Nunes, R. V. Gisele, V. D. Bertoni, C. A. Rocha. Transcriptomic Analysis of Differentially Expressed Genes in Triple-Negative Breast Cancer: Insights into Imune Cell Infiltration and the Tumor Microenvironment [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS3-13-14.

Abstract Background: Physical activity positively influences various aspects of cancer treatment. Among patients (pts) undergoing active therapy, it improves physical capacity, treatment tolerability, and reduces side effects. For cancer survivors, it lowers the risk of recurrence of tumors such as breast and colorectal. Despite its importance, the extent to which pts are informed about exercise recommendations remains unclear. Methods: We conducted a self-administered survey to evaluate exercise habits and knowledge among cancer pts treated between 2022 and 2024. Participants were recruited from a private oncology network (with units across Brazil) and two public cancer centers. Pts, irrespective of tumor type, disease stage, or treatment phase, completed the survey via RedCap. Results: Of the 394 pts who answered the survey, 76.4% were female. Median age was 56 years (range 23 – 92). The cohort included 52.8% self-identified white pts and 44.8% black/mixed race pts; 63.9% were treated in the private health system and 36.1% in the public. The most common primary tumors were breast (47.7%) and gastrointestinal (16.2%). While 85.9% reported receiving any exercise recommendations from physicians, only 62.5% described themselves as physically active. In addition, 30.7% stated they lacked knowledge about the type or duration of recommended exercises. Exercise guidance and adherence were lower among patients treated in public health centers, black/mixed race pts, and those with non-breast cancer (Table). Notably, 94.2% of pts without sufficient information expressed a desire to learn more about exercise. Conclusion: Although a majority of cancer pts receive general recommendations on physical activity, adherence and understanding of specific exercise guidelines remain suboptimal. Variability in exercise awareness based on health system type and race highlights disparities that must be addressed. Promoting physical activity awareness and accessibility, particularly in resource-limited settings, is crucial. Exercise should not remain a privilege for a few but rather a fundamental aspect of care accessible to all pts, regardless of their circumstances. Citation Format: R. C. Cangussu, L. Andrade, L. Testa, C. Lima, A. S. Ferreira, C. M. Moniz, S. R. Chagas, P. M. Hoff, M. Estevez-Diz, R. Colombo Bonadio. Knowledge and adherence to exercise recommendations among oncologic patients [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS1-02-10.

Glioblastoma (GBM) is an aggressive tumor with limited therapeutic options. Zika virus (ZIKV) has demonstrated activity against GBM; however, the cellular pathways behind this interaction remain unclear. We systematically reviewed open-access primary studies assessing differentially expressed genes (DEGs) in GBM models infected with wild-type or engineered ZIKV using transcriptomic approaches (inclusion criteria); reviews, restricted-access studies, commentaries, preprints, abstracts, and articles lacking data or not meeting these conditions were excluded (PROSPERO CRD420251077092). We performed a pathway analysis of reported DEGs. PubMed and Google Scholar were searched up to 5 March 2025; 139 records were identified and 5 met the eligibility criteria. Risk of bias was evaluated using an adapted ToxRTool for in vitro experiments and the SYRCLE RoB tool for in vivo models. Altogether, 4360 genes were reported as upregulated and 2072 as downregulated; 12 genes (DNAJB9, SESN2, PMAIP1, PPP1R15A, KLF4, ATF3, IFNB1, IFNL1, ANKRD33B, ZC3HAV1, OASL, and CCL5) were consistently upregulated, none were consistently downregulated. Pathway analysis of the studies providing complete DEG lists identified 23 commonly enriched pathways mostly related to interferon signaling. These findings may help guide future research in this field; nevertheless, methodological heterogeneity limits comparability, reinforcing the need for standardized protocols. Funding: ITpS, CNPq, and FAPEMIG.

Obstetric critical care encompasses the management of pregnant and postpartum women with life-threatening conditions, requiring integration of intensive care principles with pregnancy-specific physiological, ethical, and organizational considerations. Although pregnancy is a physiological state, profound maternal adaptations may mask early signs of clinical deterioration, allowing rapid progression to a critical illness condition. This review provides a comprehensive overview of the foundations of obstetric intensive care, addressing maternal-fetal physiology, recognition of severity, organ support strategies, and contemporary models of care. Key aspects discussed include cardiovascular, respiratory, renal, and hematological adaptations of pregnancy; principles of airway management and mechanical ventilation; hemodynamic support; transfusion strategies guided by viscoelastic testing; renal replacement therapy; extracorporeal support, including extracorporeal membrane oxygenation and cardiopulmonary bypass; and the safe use of diagnostic imaging involving ionizing radiation. The role of point-of-care ultrasonography, structured early warning systems, and advanced monitoring in early detection and management of clinical deterioration is emphasized. Special attention is given to maternal-fetal interactions, fetal monitoring in the intensive care unit (ICU), and complex decision-making regarding timing and mode of delivery. The review also highlights the importance of multidisciplinary and multiprofessional collaboration, ethical challenges inherent to dual-patient care, and emerging strategies to expand access to specialized care, including tele-ICU models and artificial intelligence-assisted surveillance. Across all scenarios, maternal stabilization remains the primary determinant of fetal outcome. A structured approach grounded in maternal-fetal physiology and ethical principles is essential to reduce preventable maternal and perinatal morbidity and mortality in high-complexity settings.