International development of a patient-centered core outcome set for assessing health-related quality of life in metastatic breast cancer patients.

PURPOSE: For patients living with metastatic breast cancer (MBC), achieving best possible health-related quality of life, along with maximizing survival, is vital. Yet, we have no systemic way to determine if we achieve these goals. A Core Outcome Set (COS) that allows standardized measurement of outcomes important to patients, but also promotes discussing these outcomes during clinical encounters, is long overdue. METHODS: An international expert group (EG) of patient advocates, researchers, medical specialists, nurse specialists, and pharmaceutical industry representatives (n = 17) reviewed a list of relevant outcomes retrieved from the literature. A broader group (n = 141: patients/patient advocates (n = 45), health care professionals/researchers (n = 64), pharmaceutical industry representatives (n = 28), and health authority representatives (n = 4)) participated in a modified Delphi procedure, scoring the relevance of outcomes in two survey rounds. The EG finalized the COS in a consensus meeting. RESULTS: The final MBC COS includes 101 variables about: (1) health-related quality of life (HRQoL, n = 26) and adverse events (n = 24); (2) baseline patient characteristics (n = 9); and (3) clinical variables (n = 42). Many outcome that cover aspects of HRQoL relevant to MBC patients are included, e.g. daily functioning (including ability to work), psychosocial/emotional functioning, sexual functioning, and relationship with the medical team. CONCLUSION: The COS developed in this study contains important administrative data, clinical records, and clinician-reported measures that captures the impact of cancer. The COS is important for standardization of clinical research and implementation in daily practice and has received accreditation by the International Consortium for Health Outcomes Measurement (ICHOM).

Clinical and Metabolic Improvement after Bariatric Surgery in Older Adults: A 6-Year Follow-Up.

AIM: Our aim in this study was to assess the clinical and metabolic impact of bariatric surgery in older adults. METHODS: This analytical, observational, longitudinal study was carried out with individuals aged 60 years and older who underwent bariatric surgery after 55 years of age at a specialist center for obesity management located in the Federal District of Brazil. Post-surgery changes in the following parameters from baseline: total body weight, excess weight lost, body mass index (BMI), number of medications, number of comorbidities, and weight regain. Mean values of the variables of interest before and after surgery were compared using the nonparametric Wilcoxon test, Poisson regression and multiple linear regression to test the effect of different variables. RESULTS: Overall, 74 subjects were assessed (78.3% female, mean age 65.8 ± 3.9 years). The mean time from bariatric surgery to assessment was 75.7 months. The mean weight and BMI in the overall sample at baseline was 101.9 ± 17.1 kg and 39.8 ± 4.9 kg/m², respectively. After the procedure, mean weight and BMI were reduced to 75.9 ± 12.9 kg and 29.4 ± 4.1 kg/m², respectively. Reductions were also achieved in mean number of medications used (P<0.001), number of comorbidities (P<0.001), triglyceride levels (P=0.007), and glycated hemoglobin (P=0.02). The mean HDL level increased significantly (P=0.008). CONCLUSION: In this sample, bariatric surgery was not only useful to manage obesity, but also reduced the number of comorbidities and medications used, and was associated with improvement in clinical and laboratory parameters.

Consumo, degradabilidade in situ e cinética ruminal em bovinos suplementados com diferentes proteinados / Intake, degradability in situ and ruminal kinetics in cattle supplemented with different protein supplements

Objetivou-se avaliar o efeito de combinações de diferentes fontes de nitrogênio não proteico com fontes de carboidratos como suplemento para bovinos sobre o consumo, degradabilidade in situ, taxa de passagem e cinética ruminal em bovinos. Os tratamentos consistiram nos seguintes suplementos proteinados: CSUENC = casca de soja + ureia encapsulada; CSUREIA = casca de soja + ureia; MTAMIR = milho triturado + amireia; MTURENC = milho triturado + ureia encapsulada, MTUREIA = milho triturado + ureia. Os animais foram alimentados com feno de Brachiaria brizantha cv. Marandu como fonte de volumoso. O ensaio foi conduzido em delineamento quadrado latino 5x5 (cinco suplementos, cinco animais, cinco períodos). Não houve diferenças para consumo de nutrientes (P>0,05), exceto para consumo de proteína bruta g/kgPV0,75, em que se verificou maior consumo no tratamento CSUENC. Para frações fibrosas, foram obtidas maiores ingestões de fibra em detergente neutro, fibra em detergente ácido (kg/dia; % PV; g/kgPV0,75), hemicelulose (% PV; g/kgPV0,75) quando alimentados com CSUREIA em relação àqueles com MTUREIA (P<0,05). Os tratamentos constituídos pelos diferentes proteinados não afetaram a degradabilidade in situ das frações nutricionais (P>0,05), exceto para fração potencialmente degradável da celulose. A concentração de nitrogênio amoniacal no líquido ruminal foi influenciada pela composição dos proteinados (P<0,05), sendo superior para os tratamentos MTUREIA e MTURENC em relação à CSURENC. As combinações entre diferentes fontes de nitrogênio não proteico e de carboidratos nos diferentes suplementos não modificam o consumo e a degradabilidade da forragem. Dessa forma, a escolha dos ingredientes para formulação de proteinados deve ser realizada considerando-se disponibilidade e preços desses suplementos.(AU)

The aim of this study was to evaluate the effect of combinations of different sources of non-protein nitrogen with carbohydrate sources as supplement feed to cattle on intake, in situ degradability and passage rate. Treatments consisted of the following protein supplements: CSUENC= soybean hulls + encapsulated urea; CSUREIA = soybean hulls + urea; MTAMIR = ground corn + starea; MTURENC = ground corn + encapsulated urea; MTUREIA = ground corn + urea. The animals were fed with Brachiaria brizantha cv. Marandu as roughage. The experiment was conducted in a latin square design (five supplements, five animals, five periods). The treatments did not affect the intake of nutrients (P>0.05), although a higher intake of crude protein (g/kgBW0.75) was observed by animals fed with CSUENC. A higher intake of NDF, ADF (kg/day, %BW; g/kgBW0.75) and hemicellulose (% PV; g/kgBW0.75) was observed by animals fed with CSUREIA when compared to those with MTUREIA (P<0.05). The degradability of nutritional fractions was not affected by any of the treatments (P>0.05), except for the potentially degradable cellulose. The ammoniacal nitrogen concentration in rumen fluid was influenced by the protein source (P<0.05) and was higher for MTUREIA and MTURENC treatments in relation to CSURENC. The tested combinations of different sources of non-protein nitrogen with different carbohydrates did not affect the forage intake or degradability. Therefore, the choice of the ingredients for protein supplement formulation should be made considering other factors as availability and price of these supplements.(AU)

Growth inhibition and antioxidative response of wood decay fungi exposed to plant extracts of Casearia species.

UNLABELLED: Ligninolytic fungi take part in critical processes in ecosystems such as nutrient recycling; however, some fungal species can be pathogenic to forest and urban trees and deteriorate wood products. The tropical flora is an important source of antimicrobial compounds environmentally safer than traditional wood preservatives. Therefore, this study aimed to evaluate the inhibitory activity of ethanol plant extracts of Casearia sylvestris and Casearia decandra on the white-rot wood decay basidiomycetes Trametes villosa and Pycnoporus sanguineus. In addition, the effect of the extracts on the fungal antioxidative metabolism was studied. Among the different substances present in the extracts, the phytochemical analyses identified a clerodane diterpenoid (C. sylvestris) and cinnamic acid, hydroquinone and ß-sitosterol (C. decandra). The extracts inhibited the fungi up to 70% and caused hyphal morphology changes. The extracts triggered oxidative stress process as indicated by the increased levels of the antioxidant enzymes catalase and glutathione reductase. Therefore, the Casearia extracts are a potential source of natural biocides to control wood decay fungi, and one of the mechanisms of action is the oxidative stress. SIGNIFICANCE AND IMPACT OF THE STUDY: The Casearia plant extracts exhibited important antifungal activity on wood decay fungi and triggered oxidative stress process, an inhibitory mechanism rarely studied in filamentous fungi exposed to plant extracts. Therefore, a starting point was provided for the development of natural compounds-based products as an alternative to chemical fungicides. In addition, subsidies were given to further studies in order to elucidate in more detail how compounds present in extracts of native tropical plants affect the physiology of fungi.

Analysis of the morphology and distribution of argentaffin, argyrophil and insulin-immunoreactive endocrine cells in the small intestine of the adult opossum Didelphis aurita (Wied-Neuwied, 1826).

The aim of this study was to identify and quantify the argyrophil, argentaffin and insulin-immunoreactive cells (IIC) in the small intestine of the opossum Didelphis aurita. Seven adult male specimens of opossums were investigated. The animals were captured, and their blood insulin levels were determined. After euthanasia, fragments of the small intestine were processed for light microscopy and transmission electron microscopy, and submitted to histochemistry and immunohistochemistry for identification of argyrophil and argentaffin endocrine cells, and IIC. Argyrophil and argentaffin cells were identified in the intestinal villi and Liberkühn crypts, whereas IIC were present exclusively in the crypts. Ultrastructure of the IIC revealed cytoplasmic granules of different sizes and electron densities. The numbers of IIC per mm(2) in the duodenum and jejunum were higher than in the ileum (p<0.05). The animals had low levels of blood insulin (2.8 ± 0.78 µIU/ml). There was no correlation between insulin levels and the number of IIC in the small intestine. The IIC presented secretory granules, elongated and variable morphology. It is believed that insulin secretion by the IIC may influence the proliferation of cells in the Liberkühn crypts, and local glucose homeostasis, primarily in animals with low serum insulin levels, such as the opossum.

Purification and characterization of xylanases from Aspergillus giganteus.

A strain of Aspergillus giganteus cultivated in a medium with xylan produced two xylanases (xylanase I and II) which were purified to homogeneity. Their molar mass, estimated by SDS-PAGE, were 21 and 24 kDa, respectively. Both enzymes are glycoproteins with 50 degrees C temperature optimum; optimum pH was 6.0-6.5 for xylanase I and 6.0 for xylanase II. At 50 degrees C xylanase I exhibited higher thermostability than xylanase II. Hg2+, Cu2+ and SDS were strong inhibitors, 1,4-dithiothreitol stimulated the reaction of both enzymes. Both xylanases are xylan-specific; kinetic parameters indicated higher efficiency in the hydrolysis of oat spelts xylan. In hydrolysis of this substrate, xylotriose, xylotetraose and larger xylooligosaccharides were released and hence the enzymes were classified as endoxylanases.

Seizures in Chédiak-Higashi syndrome. Case report.

Chédiak-Higashi syndrome is a rare hematological disease characterized by increased fusion of cytoplasmatic granules. Neurological symptoms occur in approximately half of the patients. We describe the clinical, eletrophysiological, hematological and radiological findings in a girl who had Chédiak-Higashi syndrome and seizures.

Inhibition of mitogen-activated proliferation of human lymphocytes in vitro by high concentrations of glutamine

We invetigated the influence of hogh concentrations of glutamine and aspargine on in vitro cellular growth of lymphocytes stimulated with phytohaemaglutinin (PHA), concanavalin A (Con A) and pokeweed mitogen (PWM), a recognized test of cellular immunocompetence. Human peripheral lymphocytes were cultured in flat-bottomed 96-well microplates at 37§ C for 96 (PHA and Con A) or 144 hours (PWM) in the presence of a mitogen at different concentrations and either glutamine or asparagine supplemented at doses of 2, 4 or 8 mM. Lymphocyte reactivity, meas ured by the incorporation of tritiated thymidine into cellular DNA, was compared to identical cultures in the absence of supplemented amino acids (controls). We found that glutamine in doses of 2 mM and higher inhibited lymphocyte proliferation of mitogen-stimulated human lymphocyes, whereas asparagine caused no effect. These results demonstrate that, although necessary for cellular division in moderate amounts, glutamine in high concentrations has the reverse effect

The influence of amino acids on mitogen-activated proliferation of human lymphocytes in vitro.

Recurrent infections are common features in patients affected by various aminoacidopathies. Since these disorders are biochemically characterized by tissue accumulation of amino acids, it is possible that these compounds may act as immunosuppressants. We therefore investigated the influence of 21 amino acids on in vitro cellular growth of lymphocytes stimulated with phytohaemagglutinin (PHA), concanavalin A (Con A) and pokeweed mitogen (PWM), a recognized test of cellular immunocompetence. Human peripheral lymphocytes were cultured in flat-bottomed 96-well microplates at 37 degrees C for 96 (PHA and Con A) or 144 h (PWM) in the presence of one mitogen at different concentrations and of one amino acid added at doses of 2, 4 or 8 mM. Cell reactivity was measured by the incorporation of tritiated thymidine into cellular DNA and compared to that of identical cultures with no amino acids added (controls). We found that among the 21 amino acids tested, cysteine stimulated lymphocyte growth, whereas glutamate, tryptophan, phenylalanine and glutamine caused significant inhibition. These results may reflect an immunomodulatory role for some amino acids.

[Cognitive deficit assessment in asymptomatic HIV-infected females]. / Avaliacao de deficit cognitivo em portadores assintomaticas do virus da imunodeficiencia humana.

PIP: A sample of 16 asymptomatic female HIV carriers (in CDC stages I and II) infected heterosexually and a sample of 26 seronegative women hospitalized in Porto Alegre were studied in order to determine the nervous system manifestations of HIV infection. They answered the computerized version of the Wisconsin Card Sorting Test (WCST) to ascertain how the frontal lobe and the frontotemporal connection were functioning. There was a significant difference between cases and controls (p = 0.0132) with respect to the level of education. The cases performed worse in all measured parameters than the controls (p = 0.0060). The cases made a higher number of total errors (p = 0.00060), a higher percentage of perseverative errors (p = 0.00148) and nonperseverative errors (p = 0.0133). In order to find out whether a possible confounder was at play in the educational level, a stratified analysis was carried out. There was a significant difference between them regarding the total number of errors at the third grade educational level. Differences also appeared at the third grade level with regard to perseverative errors. There was also a significant difference between the two groups in the total number of errors (p 0.05) and perseverative errors (p 0.01) at the level of university education. Multivariate analysis (ANOVA) indicated that age did not alter either the percentage of errors or the number of perseverative responses. The level of education was of importance, but diagnosis was more important to the effect that it was significant in the multivariate equation. With respect to nonperseverative errors, which was altered by the level of education, this factor was isolated as the most important one which maintained significance in this type of analysis. This pilot project should be expanded in the future by applying neuropsychometric tests and depression and anxiety scales in order to confirm the validity of this evaluation.^ieng

Inactivation of membrane-bound (Na+ +K+)-ATPase of Yoshida sarcoma cells and cobra venom cytotoxin complex with the glycolipid components of the enzyme system.

The molecular mechanisms involved in the inactivation of (Na+ + K+)-stimulated ATPase of Yoshida sarcoma cells by a cytotoxic protein (P6) from cobra venom have been examined. The overall data obtained using purified (Na+ + K+)-stimulated ATPase of Yoshida sarcoma cells suggest that cytotoxin P6 combines with phosphatidyl serine and a glycolipid which are closely associated with (Na+ + K+)-stimulated ATPase which in turn may lead to the inactivation of the enzyme in this cell system.