Fish By-Products: A Source of Enzymes to Generate Circular Bioactive Hydrolysates.

Fish viscera are usually discarded as waste, causing environmental problems, or as low-value by-products. This study describes a self-sufficient and zero waste approach to obtain enzymes and protein hydrolysates from fish by-products. Firstly, recovery steps of viscera enzymatic extract were applied, and the resulting raw extract was stable at a pH range of 8-9 and at temperatures between 40 and 50 °C. The application of the extracted enzymes and alcalase on fish by-products hydrolysis was also determined. The selected conditions for the enzymatic hydrolysis were 10% (E/S) for 6 h using viscera enzymatic extract and 3% (E/S) for 2 h using alcalase. Fish protein hydrolysates (FPH) proved to have a notable antioxidant capacity with similar activity, ~11 mg ascorbic acid/g dry extract (ABTS assay) and ~150 mg Trolox/g dry extract (ORAC assay). FPH were also able to inhibit the angiotensin-converting enzyme, however, alcalase hydrolysates revealed a higher antihypertensive potential, IC50 of 101 µg of protein/mL. In general, FPH obtained by both enzymes systems maintained these bioactivities after the passage throughout a simulated gastrointestinal tract. The hydrolysates also displayed important technological properties, namely oil absorption capacity (~1 g oil/g sample) and emulsifying property (~40%). Therefore, it will be conceivable to use fish by-products based on a circular economy approach to generate added value compounds for animal and human nutrition.

Survival and metabolism of hydroxycinnamic acids by Dekkera bruxellensis in monovarietal wines.

Volatile phenols in wines are responsible for unpleasant aromas, which negatively affect the quality of the wine. These compounds are produced from the metabolism of hydroxycinnamic acids, mainly by the yeasts Brettanomyces/Dekkera. Relevant data, potentially useful to support decisions on how to manage the risk of contamination of wines by Brettanomyces/Dekkera, according to the grape varieties used in the vinification, is important to the wine industry. Therefore, the aim of this work was to evaluate the survival and the metabolism of hydroxycinnamic acids by Dekkera bruxellensis in monovarietal wines. Yeast growth and survival were monitored in fifteen wines, five from each of the grape varieties Touriga Nacional, Cabernet Sauvignon and Syrah, inoculated with a strain of D. bruxellensis. Yeast culturable populations of 107 CFU mL-1 were reduced to undetectable numbers in 24 h in all wines. Plate counts of 104-106 CFU mL-1 were, however, detected after 48 h in most of Touriga Nacional and Cabernet Sauvignon wines and later in Syrah. Viability measurement by flow cytometry showed that a significant part of the populations was in a viable but non-culturable state (VBNC). The time required for the recovery of the culturable state was dependent on the wine, being longer on Syrah wines. Besides the production of ethylphenols, the metabolism of hydroxycinnamic acids by VBNC cells led to the accumulation of vinylphenols at relatively high levels, independently of the grape variety. The flow cytometry methodology showed a higher survival capacity of D. bruxellensis in Touriga Nacional wines, which corroborates with the higher amounts of volatile phenols found on this variety.

Effect of patient thickness on acute gastrointestinal toxicities following radiotherapy for prostate cancer.

BACKGROUND: There is conflicting literature regarding the effect of patient size on radiotherapy toxicities. This study aimed to determine whether there is any association between patient thickness and severity and incidence of acute GI toxicities of prostate cancer patients receiving VMAT radiotherapy. The impact of confounding factors was also examined: rectal dose, age and lymph node irradiation. MATERIALS AND METHODS: This study used a non-experimental, retrospective, descriptive and cross-sectional design. All patients who complied with the inclusion criteria (n = 96) were included. GI toxicity scores (baseline and last week of radiotherapy), rectal dose, lymph nodes irradiation and patient age at diagnosis were collected from the treatment file. Patient separations were measured from the CT-Simulator images. Statistical tests were performed to analyse the influence of these factors on acute GI toxicities. RESULTS: Patient thickness was shown to have no statistically significant effect on the incidence (p = 0.947 for antero-posterior and p = 0.839 for lateral thicknesses), and severity (p = 0.986 and 0.905, respectively) of acute GI toxicities. Severity of GI toxicities increased following radiotherapy: the Expanded Prostate Cancer Index Composite (EPIC) score increased by 2.64 from baseline (p < 0.001). The confounding factors had no statistically significant effect on toxicities (p > 0.05). CONCLUSION: As expected, most patients experienced an increase in GI toxicity following radiotherapy. No relationship was established between patient thickness and the severity or incidence of acute GI toxicities, adding to the existing body of knowledge. Therefore, all patients should receive adequate follow up, irrespective of size. Side-effect recording tools should be implemented systematically for continuous assessment of this relationship.

The impact of sociodemographic factors and health insurance coverage in the diagnosis and clinicopathological characteristics of breast cancer in Brazil: AMAZONA III study (GBECAM 0115).

PURPOSE: In Brazil, the available cancer registries are deficient in number and quality and, hence, little information is known regarding sociodemographic, clinicopathological characteristics, treatment patterns, and outcomes of breast cancer (BC) patients. We performed the AMAZONA III/ GBECAM 0115 study and in this analysis, we describe patients' characteristics at diagnosis and their association with health insurance type. METHODS: This is a prospective cohort study developed in 23 sites in Brazil including women with newly diagnosed invasive BC from January 2016 to March 2018. In order to compare healthcare insurance type, we considered patients who were treated under the Brazilian public health system as publicly insured, and women who had private insurance or paid for their treatment as privately insured. RESULTS: A total of 2950 patients were included in the study. Median age at diagnosis was 53.9 years; 63.1% were publicly insured. The majority of patients (68.6%) had stage II-III breast cancer and ductal carcinoma histology (80.9%). The most common breast cancer subtype was luminal A-like (48.0%) followed by luminal B-HER2 positive-like (17.0%) and triple-negative (15.6%). Luminal A was more frequent in private (53.7% vs. 44.2%, p < .0001) than public, whereas Luminal B HER2-positive (19.2% vs. 14.2%, p = 0.0012) and HER2-positive (8.8% vs. 5.1%, p = 0.0009) were more common in patients with public health system coverage. Only 34% of patients were diagnosed by screening exams. Privately insured patients were more frequently diagnosed with stage I disease when compared to publicly insured patients; publicly insured patients had more stage III (33.5% vs. 14.7%; p-value < 0.0001) disease than privately insured ones. Breast cancer was detected by symptoms more frequently in publicly than in privately insured patients (74.2% vs 25.8%, respectively; p-value < 0.0001). CONCLUSIONS: Patients with public health coverage were diagnosed with symptomatic disease, later stages and more aggressive subtypes when compared to privately insured patients.

Use of planar kV vs. CBCT in evaluation of setup errors in oesophagus carcinoma radiotherapy.

AIM: The aim of this study is to evaluate differences in terms of the setup errors observed using kV planar image compared to CBCT for oesophageal cancer patients. BACKGROUND: Planar kV images are quick to acquire but only allow the observation of bony structures. CBCT allows the evaluation of soft tissues, which includes the oesophagus (and tumour) and OAR, giving a more accurate verification of the positioning. MATERIALS AND METHODS: All patients were imaged with both techniques between January 2012 and March 2014 were included in the study (16 patients, 212 kV images and 116 CBCT images). Differences between the setup errors observed on the two images modalities were studied. A correlation study between TNM staging, tumour location and immobilization systems with setup errors was also done. Finally, the calculation of systematic and random errors allowed to determine the CTV-PTV margin. RESULTS: A significant discrepancy (p < 0.05) between the setup errors observed with kV and CBCT was observed in the lateral direction. No statistical correlation was found between setup errors and tumour location, immobilization system or TNM staging. The CTV-PTV margin was smaller with CBCT in the vertical (0.6 cm vs. 0.9 cm) and longitudinal (0.7 cm vs. 1 cm) directions and smaller with kV for the lateral directions (0.8 cm vs. 0.9 cm). CONCLUSIONS: The chosen modality influences the setup error observed which will influence the correction applied. Allowing a better observation of the volumes of interest, CBCT should be the modality of choice in this pathology. The CTV-PTV margins could be shrunk if CBCT is used.

Activity of lysozyme on Lactobacillus hilgardii strains isolated from Port wine.

This work evaluated the effect of lysozyme on lactobacilli isolated from Port wine. Bacterial growth experiments were conducted in MRS/TJ medium and inactivation studies were performed in phosphate buffer (KH2PO4), distilled water and wine supplemented with different concentrations of lysozyme. The response of bacteria to lysozyme was found to be highly strain dependent. Some strains of Lactobacillus hilgardii together with Lactobacillus collinoides and Lactobacillus fructivorans were found to be resistant to concentrations of lysozyme as high as 2000 mg/L. It was observed that among the L. hilgardii taxon the resistant strains possess an S-layer coat. Apparently, the strains of L. collinoides and L. fructivorans studied are also S-layer producers as suggested by the total protein profile obtained by SDS-PAGE. Thus, the hypothetical protective role of the S-layer against the action of lysozyme was investigated. From the various treatments used to remove the protein from the surface of the cells, the one employing LiCl (5 M) was the most effective. LiCl pre-treated cells exposed to lysozyme (2000 mg/L) in KH2PO4 buffer maintained its resistance. However, when cells were suspended in distilled water an increased sensitivity to lysozyme was observed. Moreover, it was found that the addition of ethanol (20% v/v) to the suspension medium (distilled water) triggered a strong inactivation effect especially on cells previously treated with LiCl (reduction of >6 CFU log cycles). The results suggest that the S-layer exerts a protective effect against lysozyme and that the cell suspension medium influences the bacteriolysis efficiency. It was also noted that ethanol enhances the inactivation effect of lysozyme.

Production of volatile phenols by Lactobacillus plantarum in wine conditions.

Some lactic acid bacteria produce volatile phenols in culture medium but this activity has not been extensively studied in wine conditions. Red and white wines were mixed with MRS medium at different ratios to study the influence of wine on the metabolism of p-coumaric and ferulic acids by Lactobacillus plantarum. In MRS broth supplemented with these precursors at 10 mg l(-1), only 4-ethylphenol was produced (1 mg l(-1)) while, in the presence of wine, 4-vinylphenol was also obtained. Both volatile phenols are produced in nearly equal amounts (1 mg l(-1)) or almost only 4-vinylphenol depending on the MRS:wine ratio. Thus, wine favours the accumulation of 4-vinylphenol. Ferulic acid was not or was weakly metabolized in the conditions studied.

Dietary Protein Quality Affects the Interplay between Gut Microbiota and Host Performance in Nile Tilapia.

Dietary protein quality plays a key role in maintaining intestinal mucosal integrity, but also modulates the growth of luminal microorganisms. This work assessed the effect of dietary protein sources on the performance, gut morphology, and microbiome in Nile tilapia. Four isonitrogenous and isolipidic diets comprising equivalent amounts of the protein supply derived from either PLANT, ANIMAL, INSECT, or BACTERIAL (bacterial biomass) sources were fed to triplicate groups of fish (IBW: 12 g) for 46 days. Fish fed the ANIMAL and BACTERIAL diets showed significantly higher weight gains than those fed the PLANT and INSECT diets (p < 0.05). Relative abundance at the phylum level showed that Bacteroidetes, Fusobacteria, and Proteobacteria were the more abundant phyla in tilapia's intestine, while Cetobacterium was the most representative genus in all treatments. Interesting patterns were observed in the correlation between amino acid intake and genus and species abundance. Metabolism prediction analysis showed that BACTERIAL amine and polyamine degradation pathways are modulated depending on diets. In conclusion, different protein sources modulate the relationship between bacteria functional pathways and amino acid intake.

RTT advanced practice and how it can change the future of radiotherapy.

The radiation therapy (RT) landscape is continuously evolving, necessitating adaptation in roles and responsibilities of radiation therapists (RTTs). Advanced Practice Radiation Therapists (APRTs) have taken on a proactive role in expanding services and assuming responsibilities within multi-professional teams. A European Society for Radiotherapy and Oncology (ESTRO) brought geographically diverse and experienced RTTs together, to discuss how advanced practice (AP) in the RTT profession should be future-proofed and create a global platform for collaboration. Challenges in achieving consensus and standardisation of APRT was identified across jurisdictions, emphasising the importance of international collaboration. Whilst highlighting the pivotal role of APRTs in driving innovation, improving patient care, and navigating the complexities of modern RT practice, this position paper presents outcomes and recommendations from the workshop. Discussions highlighted the need for standardised role definitions, education frameworks, regulatory support, and career development pathways to enable the advancement of APRT effectively. Increasing networks and collaboration is recommended to ensure APRTs can shape the future of RT.

Recommendations for the Management of Cardiomyopathy Mutation Carriers: Evidence, Doubts, and Intentions.

Cardiomyopathies may be hereditary and associated with a familial predilection. Morbidity and mortality can be caused by heart failure, sudden death, or arrhythmias. Sometimes these events are the first manifestations of cardiovascular disease. Hypertrophic cardiomyopathy and arrhythmogenic cardiomyopathy are perhaps most thoroughly studied in that context. Dilated cardiomyopathy, although most frequently of secondary etiology, has a significant familial cluster. Noncompaction of the left ventricle can sometimes be seen in healthy individuals and, in other instances, is associated with severe LV dysfunction. Genetic testing is of utmost importance, since it might allow for the identification of individuals carrying mutations predisposing them to these diseases. In addition, certain variants may benefit from tailored therapeutic regimens, and thus searching for a causal mutation can impact clinical practice and is recommended for all patients with HCM or ACM. Patients with DCM and positive family history should be included as well. Regular follow-ups are advised, even in those with negative phenotypes, because these disorders are often age dependent. During pregnancy and in the case of athletes, special consideration should be made as well. We intend to summarize the most current evidence regarding their management.

A Review of the Applicability of Current Green Practices in Healthcare Facilities.

BACKGROUND: Circular economy (CE) has raised great interest as a concept and as a development model worldwide. This concept aims to provide a substitute for the linear economic model, which was based on production and consumption, continuous growth, and resources depletion. CE allows a greener economy with sustainable development and promotes more balanced societies. The healthcare sector is a major contributor to the climate crisis, with a carbon footprint representing 4.4% of global net emissions. It is thus essential to rethink the applicability of CE in healthcare. METHODS: We conducted a scoping review guided by the Arksey and O'Malley methodological framework and utilised PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) checklist. A systematic search from MEDLINE complete, SCOPUS, and Web of Science databases published between 1992 and 2022. RESULTS: Through database searching a total of 1018 records were identified and 475 duplicates were removed. From the total search, 543 articles were screened by title/abstract according to the inclusion and exclusion criteria. After screening, 38 full-text articles were selected and assessed for eligibility. Forty-seven additional records were also identified through other sources and screened for eligibility. Other sources included: 12 articles from snowballing of previous papers; 9 articles following peer-reviewers suggestions; 19 reports from relevant organisations in CE and healthcare; two webpage, and one book. CONCLUSION: Specific areas were identified where hospitals could reduce their greenhouse gas (GHG) emissions and consequently their negative environmental impact, namely through waste management, energy, water, transportation/travel, hospital design, food optimisation, green procurement, and behaviour. Also, lack of staff awareness and knowledge of the environmental impact of healthcare, and hospitals sustainability were identified as major contributors.

A Look at the Interconnection of Dimensions of Knowledge in Physical Education Teacher Training in Chile.

The massive fragmentation of knowledge that exists in the current field of physical education enables us to research pedagogical and disciplinary aspects in the educational processes of teachers in training, as this has significant implications for future educational practices. This study proposes to assess the dimensions of knowledge (conceptual, procedural and attitudinal) that stem from the learnings that emerge in physical education teacher training in terms of the disciplinary standards proposed by the Chilean Education Ministry for the Preservice Teacher Education. The study methodology was descriptive and inferential, and the cohort was cross-sectional. A total of 750 fourth- and fifth-year students in training from 13 Chilean universities participated. Of these, 619 subjects were considered: 54.6% (338) men and 45.4% (281) women between the ages of 21 and 25. The questionnaire used for data collection was the "Questionnaire on Conceptual, Procedural and Attitudinal Learning in Preservice Teacher Education in Physical Education" (CACPA-FIDEF), prepared as part of Fondecyt project No. 11190537. The main results indicate that there are no statistically significant differences in the three dimensions in terms of students' sex and type of schooling, with p values > 0.05. In conclusion, the study observed a weak conceptual management of the discipline in future teachers, revealing once again the need to seek out didactic alternatives that enable teachers in training to understand the importance of the conceptual dimension in their learning and teaching processes.

Valorization of porcine by-products: a combined process for protein hydrolysates and hydroxyapatite production.

The meat industry generates large amounts of by-products that are costly to be treated and discarded ecologically; moreover, they could be used to extract high added-value compounds. In this work, we present an innovative combined process which allowed the parallel extraction of both organic and mineral compounds; more specifically protein hydrolysates and single-phase hydroxyapatite were obtained. The protein hydrolysates, extracted through an enzymatic hydrolysis with alcalase, showed a degree of hydrolysis of 53.3 ± 5.1%; moreover, they had a high protein content with peptides with molecular weight lower than 1.2 kDa. Their antioxidant activities, measured with ABTS and ORAC tests, were 21.1 ± 0.5 mg ascorbic acid equivalent/g of dry extract and 87.7 ± 6.3 mg Trolox equivalent/g of dry extract, respectively. Single-phase hydroxyapatite, obtained with a simple calcination at 700 °C on the residues of the hydrolysis process, showed a Ca/P ratio close to the stoichiometric one (1.65 vs. 1.67) and presented a nanometric structure. This study reports a simple and feasible process for the valorization of porcine by-products in a large-scale up generating products with potential applications for environment remediation, biomedicine, nutrition and catalysis/bioenergy.

Design of a microfluidic paper-based device for the quantification of phenolic compounds in wine samples.

In this work, the design and development of a microfluidic paper-based device (µPAD) for the quantification of total phenolic compounds (TPC) in wines is described. The developed µPAD was based upon the vertical flow concept and the colour reaction used was the known Folin-Ciocalteu reaction using gallic acid as reference phenolic compound. After studying operational parameters, namely type of paper, reagents and sample volume, a dynamic range of 5-50 mg L-1 was obtained with a limit of detection of 1.2 mg L-1. The described device proved to have good precision (relative standard deviation < 5%) and no significant interferences were observed from known compounds present in wines. Furthermore, the stability of the colour product and of the device itself were assessed; the µPAD was stable for 30 days (in the dark at room temperature) and it could be scanned up to 8 h after sample introduction. The developed µPAD pose as a simple method for TPC quantification and was successfully applied to several wine samples including sparkling and table wines with two different approaches: i) using gallic acid as reference compound with standard addition; and ii) using taniraisin with external calibration. The accuracy of the proposed µPAD method was assessed by comparison with the reference spectrophotometric method according to the International Organisation of Vine and Wine (OIV) recommendations.

Infantile hypothyroidism and its relationship with delayed tooth eruption: A case report.

Hypothyroidism is characterized as a systemic endocrine disorder that is caused by a dysfunction of the thyroid gland. This produces the thyroid hormones T3 and T4 that are responsible for carrying out the normal functions of the physical body, that is, changes in the secretion of these hormones may be related to some maladjustments in the stomatognathic system. The most common manifestations of congenital hypothyroidism, also known as cretinism, are thick lips, macroglossia, malocclusion and delayed eruption of both dentitions. This study aims to report a case of a child with hypothyroidism and a delay in the chronology of tooth eruption. Patient, female, 9 years and 8 months old, whose main complaint was a delay in the chronology of tooth eruption. On clinical examination, a marked delay in the chronology of tooth eruption was observed. Therefore, it was necessary to refer the patient to a geneticist, who ruled out any syndromic alteration. Then, the patient was referred to the endocrinologist, whose opinion was hypothyroidism. Key words:Hypothyroidism, tooth eruption, endocrine disorder, child health.

Restoration of a malformed primary incisor using digital technology in a pediatric patient with congenital Zika virus syndrome: A case report.

Zika virus congenital syndrome (ZVCS) is a congenital viral infection resulting from the transmission of the Zika virus (ZV) to the fetus during pregnancy. This report describes a clinical case involving a 20-month-old female child with ZVCS, who presented with systemic changes related to the syndrome, such as microcephaly, arthrogryposis, ocular and auditory changes, and oral changes such as delayed dental eruption, ogival (high-arched) palate, short lip frenum, and altered morphology of a superior primary incisor. For esthetic and functional rehabilitation of the oral health of this child, an indirect composite resin restoration was performed using intraoral digital scanning technology. This case presents an accurate, rapid, and comfortable restorative treatment option that might result in excellent outcomes in children with ZVCS or similar syndromes with neurological impairment.

Systematic Review on Rocuronium Continuous Infusion for Deep Neuromuscular Blockade.

BACKGROUND: Rocuronium is a muscle relaxant with increased use due to its binding relation with the reversal agent sugammadex. The purpose of this review entails the investigation of its use for the maintenance of Deep Neuromuscular Block (NMB) via continuous infusion. METHODS: Based on PRISMA systematic search guidelines, databases included PubMed, ISI Web of Science, Cochrane Library and Google Scholar. This comprehensive search addresses surgical patients under deep muscle relaxation via continuous rocuronium infusion. The main indicators were the rocuronium administration, NMB monitoring approaches and effects in order to maintain the deep level of relaxation, as well as reversal time after a standard dose of sugammadex. RESULTS: Despite the variance in approaches found in the literature, findings show the overall maintenance of deep NMB requires approximately 0.758 mg.kg-1h-1 of rocuronium (according to the PTC target of 0-10, 0-5 and 1-2, mean estimates are 0.445, 0.65 and 0.833 mg.kg-1h-1 respectively), suggesting that a lower range and a smaller maximum of PTC response require higher amount of rocuronium for its maintenance. The standard dose of sugammadex (4 mg/kg), administered at the end of the surgery takes longer [2.85 (1.17) min] than when they are administered after moderate NMB recovery [1.68 (0.47) min]. CONCLUSION: Continuous infusion for deep NMB presents inherent advantages in terms of maintenance and stability of muscle relaxation. Monitoring and rocuronium administration approaches are fundamental and intrinsically connected to provide a stable and improved maintenance of deep NMB.

Effect of phenolic acids on glucose and organic acid metabolism by lactic acid bacteria from wine.

The influence of phenolic (p-coumaric, caffeic, ferulic, gallic and protocatechuic) acids on glucose and organic acid metabolism by two strains of wine lactic acid bacteria (Oenococcus oeni VF and Lactobacillus hilgardii 5) was investigated. Cultures were grown in modified MRS medium supplemented with different phenolic acids. Cellular growth was monitored and metabolite concentrations were determined by HPLC-RI. Despite the strong inhibitory effect of most tested phenolic acids on the growth of O. oeni VF, the malolactic activity of this strain was not considerably affected by these compounds. While less affected in its growth, the capacity of L. hilgardii 5 to degrade malic acid was clearly diminished. Except for gallic acid, the addition of phenolic acids delayed the metabolism of glucose and citric acid in both strains tested. It was also found that the presence of hydroxycinnamic acids (p-coumaric, caffeic and ferulic) increased the yield of lactic and acetic acid production from glucose by O. oeni VF and not by L. hilgardii 5. The results show that important oenological characteristics of wine lactic acid bacteria, such as the malolactic activity and the production of volatile organic acids, may be differently affected by the presence of phenolic acids, depending on the bacterial species or strain.

Advanced Stage at Diagnosis and Worse Clinicopathologic Features in Young Women with Breast Cancer in Brazil: A Subanalysis of the AMAZONA III Study (GBECAM 0115).

PURPOSE: Breast cancer (BC) in young women is uncommon and tends to present with more aggressive characteristics. To better understand and characterize this scenario in Brazil through real-world data, we performed a subanalysis of AMAZONA III study (ClinicalTrials.gov identifier: NCT02663973). METHODS: The AMAZONA III study (GBECAM 0115) is a prospective registry that included 2,950 women newly diagnosed with invasive BC in Brazil from January 2016 until March 2018 at 22 sites. Valid data were obtained from 2,888 patients regarding age at diagnosis and complete baseline information. To compare epidemiologic and clinicopathological features at the time of diagnosis, patients with BC were divided into two groups according to age: ≤ 40 years and > 40 years. Quantitative variables were described as means, and categorical variables were described as frequencies and percentages and compared using the Pearson's χ2 test. RESULTS: Of 2,888 women diagnosed with BC, 486 (17%) were ≤ 40 years old. Young women had higher educational level, most were employed and a significant number were married (P < .001 for all associations). Younger patients were more symptomatic at BC diagnosis (P < .001), and they also presented more frequently with stage III, T3/T4, grade 3 tumors, HER-2-positive, luminal B, and triple-negative subtypes. CONCLUSION: Brazilian women younger than age 40 years have unfavorable clinicopathological features of BC at diagnosis, with more aggressive subtypes and advanced stage when compared with older women. These differences are not explained by socioeconomic or ethnic imbalances. The causes of a higher prevalence of BC among young women in Brazil deserve additional investigation.