Changes over time in self-efficacy to cope with cancer and well-being in women with breast cancer: a cross-cultural study.

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.

The Interplay Between Trait Resilience and Coping Self-efficacy in Patients with Breast Cancer: An International Study.

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.

The mutual determination of self-efficacy to cope with cancer and cancer-related coping over time: a prospective study in women with breast cancer.

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.

Trabecular bone score in women with differentiated thyroid cancer on long-term TSH-suppressive therapy.

INTRODUCTION: Thyrotropin stimulating hormone (TSH) suppression in patients with differentiated thyroid cancer (DTC) aims to decrease the growth and proliferation of thyroid cancer cells. However, the effect of TSH-suppressive therapy on bone microarchitecture remains undefined. METHODS: Cross-sectional study including 43 women with DTC undergoing TSH-suppressive therapy (sTSH) compared to 20 women also on levothyroxine (LT4) therapy but with TSH in the low-normal range (nTSH) since the thyroid surgery. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry (DXA), and trabecular bone score (TBS) was evaluated using the TBS iNsigth software. Fracture risk assessed by FRAX, with and without TBS, was calculated. The relationship between suppressive therapy-related parameters and bone parameters was investigated. RESULTS: The TBS mean values were not significantly different in the sTSH and nTSH groups (1.273 ± 0.12 vs 1.307 ± 0.14, p = 0.7197). In both groups, postmenopausal women had degraded microarchitecture (TBS 1.216 ± 0.11 vs 1.213 ± 0.09, p = 0.9333), while premenopausal women had normal microarchitecture (1.328 ± 0.11 vs 1.401 ± 0.12, p = 0.195). The percentage of all postmenopausal women with degraded TBS was 54.7%, while the percentage of osteoporosis diagnoses was 16.1%. The TBS-adjusted FRAX-probability of fracture was similar in sTSH and nTSH groups. Body mass index (BMI) and menopausal status were the only variables associated with TBS and BMD. CONCLUSION: Trabecular microarchitecture assessed by TBS was similar between women on long-term suppressive therapy in DTC and those on LT4 replacement therapy aiming at a TSH level within the low-normal reference range. Low TBS values were observed in postmenopausal women of both groups, suggesting that not only suppressed TSH levels but also a low-normal TSH is associated with deteriorated bone microarchitecture in postmenopausal women following total thyroidectomy.

Multiresistance and virulence factors of Staphylococcus aureus isolated from pigs / [Multirresistência e fatores de virulência de Staphylococcus aureus isolados de suínos]

The emergence of livestock-associated methicillin-resistant Staphylococcus aureus strains (LA-MRSA) and the potential role of pigs in the evolution of these strains has led to increased interest in research of these microorganisms. However, this has contributed to a lack of research in the isolation and characterization of methicillin-susceptible S. aureus strains (MSSA). In this study, the prevalence of S. aureus in pigs in the nursery and finishing stages were analyzed. The susceptibility profiles to antibiotics, tolerance to heavy metals, and biofilm production of the isolates were evaluated using phenotypic and genotypic techniques. A total of 1,250 colonies suggestive of Staphylococcus spp. were isolated from 128 pigs, of which 63.6% (n = 795) belonged to this microbial genus. Sixty-seven colonies isolated from 34 animals (26.5%) were confirmed as S. aureus (8.4%). No strains resistant to copper, zinc, or methicillin were detected; however, all strains presented a resistance profile to at least three different classes of antimicrobials and 21 produced biofilms. These data are of concern, as they indicate the need for increased surveillance in the use of antimicrobials as well as reinforce the importance of studies on MSSA strains.(AU)

A emergência de cepas de Staphylococcus aureus resistentes à meticilina associadas à pecuária (LA-MRSA) e o papel potencial dos suínos na evolução dessas cepas têm levado ao aumento do interesse na pesquisa desses microrganismos. No entanto, isso tem contribuído para a falta de estudos sobre o isolamento e a caracterização de cepas de S. aureus sensíveis à meticilina (MSSA). Neste estudo, foi analisada a prevalência de S. aureus em suínos nas fases de creche e terminação. Os perfis de suscetibilidade aos antibióticos, a tolerância a metais pesados e a produção de biofilme dos isolados foram avaliados por meio de técnicas fenotípicas e genotípicas. Um total de 1.250 colônias sugestivas de Staphylococcus spp. foi isolado de 128 suínos, das quais 63,6% (n = 795) pertenciam a esse gênero microbiano. Sessenta e sete colônias isoladas de 34 animais (26,5%) foram confirmadas como S. aureus (8,4%). Nenhuma cepa resistente ao cobre, ao zinco ou à meticilina foi detectada; entretanto, todas as cepas apresentaram perfil de resistência a pelo menos três classes diferentes de antimicrobianos e 21 produziam biofilme. Esses dados são preocupantes, pois indicam a necessidade de maior vigilância no uso de antimicrobianos, bem como reforçam a importância de estudos com cepas de MSSA.(AU)

Características estruturais e produção de forragem do capim-piatã submetido a regimes de desfolhação intermitente / [Structural characteristics and forage production of piata grass submitted to intermittent defoliation management]

Objetivou-se avaliar as características estruturais e a produção de forragem do capim-piatã submetido à combinação de duas frequências de corte (95% e máxima interceptação de luz pelo dossel forrageiro, ILmax) e duas alturas pós-corte (15 e 20cm), no período de janeiro de 2012 a março de 2013. O delineamento utilizado foi em blocos ao acaso, com três repetições, em esquema fatorial 2x2, totalizando 12 unidades experimentais de 14m2 cada. Foram avaliadas as seguintes variáveis-respostas: altura do dossel no pré-corte, intervalo de corte, índice de área foliar pré e pós-corte, taxa de produção de forragem e as percentagens de colmo, folha e forragem morta na forragem produzida. A altura pré-corte decresceu durante o experimento (de 65,81 para 34,03cm), sendo a menor altura observada no dossel sob alta frequência de desfolhação (95% de IL). A taxa de produção de forragem foi maior nas épocas favoráveis ao crescimento da gramínea forrageira. As percentagens de folha, colmo e forragem morta foram semelhantes entre as frequências de corte. Assim, o capim-piatã sob manejo de desfolhação intermitente pode ser colhido com qualquer combinação de frequências de corte de 95% e ou máxima interceptação de luz, e alturas pós-corte de 15 ou 20cm.(AU)

The objective of this study was to evaluate the structural characteristics and forage production of the piatã grass submitted to the combination of two cutting frequencies (95% and maximum interception of light by the forage canopy, ILmax) and two post cutting heights (15 and 20cm) in the period from January 2012 to March 2013. The design was a randomized complete block with three replications, in a 2x2 factorial scheme, totaling 12 experimental units of 14m2 each. The following variables were evaluated: pre-cut canopy height, cut interval, pre and post-cut leaf area index, forage yield rate, and percentage of stem, leaf and dead forage in the forage produced. The pre-cut height decreased during the experiment (from 65.81 to 34.03cm), with the lowest height observed in the canopy under high frequency of defoliation (95% IL). The rate of forage production was higher in the seasons favorable to forage grass growth. The percentages of leaf, stem and dead fodder were similar between cut-off frequencies. Thus, piatã grass under intermittent defoliation management can be harvested with any combination of 95% and maximum light interception cut frequencies, and post cutting heights of 15 or 20cm.(AU)

Supplementation with different non-fiber carbohydrate sources in dairy cow diets with high or low rumen-undegradable protein content / Suplementação com diferentes fontes de carboidratos não fibrosos em dietas para vacas leiteiras com alto ou baixo teor de proteína não degradável no rúmen

The objective for this study was to evaluate the supplementation with different non-fibrous carbohydrate (NFC) sources for grazing dairy cows in diets with high or low concentrations of rumen undegradable protein (RUP). Twelve multiparous cows averaging 30kg/d of milk production and 45±23 days in milk in a 4x4 Latin square design with 2 × 2 factorial arrangement were used. The difference in NFC content of the diets was achieved using ground corn (GC) or dried citrus pulp (DCP). Dietary RUP was altered by the partial replacement of soybean meal (LRUP) by roasted whole soybean and corn gluten meal (HRUP). Greater dry matter intake (DMI) was observed in DCP treatments compared to GC treatments (19.2 and 17.7kg/day of DM, respectively). Milk fat concentration was lower for LRUP treatments (3.4%) when compared to HRUP (3.6%). The milk protein concentration was greater for GC treatments (2.9%) in relation to DCP treatments (2.8%). Lower milk ureic nitrogen was observed when DCP diets were fed compared to those with GC (17.8 and 21.2mg/dL, respectively). The use of DCP as CNF source increased dry matter intake as well as milk fat concentration, although no differences in milk production were observed for RUP level.(AU)

Objetivou-se avaliar a suplementação com diferentes fontes de carboidratos não fibrosos (CNF) em vacas manejadas a pasto em dietas com alta ou baixa concentração de proteína não degradável no rúmen (PNDR). Doze vacas multíparas com média de 30kg leite/ dia e 45±23 dias em lactação foram utilizadas em delineamento quadrado latino 4x4 com arranjo fatorial 2 × 2. As fontes de CNF foram milho moído (MM) e polpa cítrica seca (PC). A PNDR da dieta foi alterada pela substituição parcial do farelo de soja da dieta de baixa PNDR (BPNDR) por grão de soja tostado e farelo de glúten de milho dieta de alta PNDR (APNDR). Foi observado maior consumo de matéria seca (CMS) nos tratamentos com PC quando comparado aos tratamentos com MM (19,2 e 17,7kg / dia de MS, respectivamente). O teor de gordura do leite foi menor para os tratamentos com BPNDR (3,4%) em comparação aos tratamentos com APNDR (3,6%). O teor de proteína do leite foi maior nos tratamentos com MM (2,9%) em relação aos tratamentos com PC (2,8%). Foram observados menores teores de nitrogênio ureico no leite dos animais alimentados com PC em relação aos com MM (17,8 e 21,2mg / dL, respectivamente). O uso de PC como fonte de CNF aumentou o consumo de matéria seca, bem como o teor de gordura do leite, embora não tenham sido observadas diferenças na produção de leite relacionada a alteração nos teores de PNDR.(AU)

Perfilhamento do capim-piatã submetido a regimes de desfolhação intermitente / Tillering of piatã grass subject intermittent cutting

Objetivou-se avaliar o perfilhamento da Brachiaria brizantha cv. Piatã, como base para identificação das frequências e alturas pós-corte mais adequadas para essa gramínea forrageira. Em um esquema fatorial 2 x 2, foram estudadas combinações entre duas frequências de corte (95% e máxima interceptação de luz, ILmax) e duas alturas pós-corte (15 e 20cm). O delineamento foi em blocos ao acaso, com três repetições, totalizando 12 unidades experimentais de 14m2 cada. Foram avaliadas as taxas de aparecimento (TApP) e de mortalidade (TMoP) de perfilhos, o índice de estabilidade (IE) e a densidade populacional de perfilhos. A maior TApP no dossel sob IL de 95% ocorreu no Verão 1, em comparação às demais épocas. Nos dosséis manejados com ILmax, a TApP foi superior no Verão 1 e no Outono, quando comparados às outras épocas. No Verão 1 e no Final da Primavera e Verão 2, houve as maiores TMoP para as duas frequências de corte avaliadas. No Outono, a TMoP também foi alta no dossel cortado com ILmáx. O IE foi menor durante o Verão 1 no dossel sob ILmax e com 15cm de resíduo (0,995). Porém, nas demais épocas, os valores de índice de estabilidade foram maiores que uma unidade e não foram influenciados pela frequência e altura pós-corte. A densidade populacional de perfilhos foi menor no Verão 1, em comparação às demais épocas. O capim-piatã pode ser desfolhado com qualquer combinação entre as interceptações de luz, 95% e ILmax, e alturas pós-corte, 15 ou 20cm, sem prejudicar a persistência do pasto.(AU)

The aim of this study was to evaluate the tillering of Brachiaria brizantha cv. Piatã, as a basis for identifying the frequencies and post-cutting heights most suitable for this grass. In a 2 x 2 factorial scheme, combinations between two cut frequencies (95% and maximum light interception, IL max ) and two post-cut heights (15 and 20cm) were studied. The experimental design was in randomized blocks with 3 replicates, totaling 12 experimental units of 14m 2 each. Rates of appearance (TAR) and mortality (TMR) of tillers, the stability index and the population density of tillers were evaluated. The highest TAR in the canopy under 95% IL occurred in Summer 1, in comparison to the other seasons. In the canopies managed with IL max , TAR was higher in summer 1 and in autumn, when compared to other seasons. In summer 1 and at the end of spring and summer 2, there were the highest TMR for the two cutoff frequencies evaluated. In autumn, TMR was also high in the canopy cut with IL max . IE was lower during summer 1 in the canopy under IL max and 15cm of residue (0.995). However, at other times, stability index values were greater than one unit and were not influenced by post-cut frequency and height. The population density of tillers was lower in Summer 1, when compared to the other seasons. The piata grass may be defoliated with any combination of light intercepts, 95% and ILmax, and post-cut heights, 15 or 20cm, without impairing the persistence of pasture.(AU)

Produção de forragem e potencial de utilização do capim faixa-branca submetido a frequências de desfolhação / Production of forage potential of utilization of digit grass subjected to high defoliation frequencies

O objetivo deste trabalho foi avaliar a produção de forragem e o potencial de utilização do capim faixa-branca submetido a frequências de desfolhação. Os tratamentos foram constituídos de quatro frequências de desfolhação: muito alta (25cm), alta (35cm), média (45cm) e baixa (55cm), avaliados em duas épocas do ano (maior e menor insolação), entre 2015 e 2016. Utilizou-se o delineamento em blocos ao acaso, com quatro repetições e medidas repetidas no tempo. A produção diária de folhas foi menor na frequência muito alta em relação às outras frequências. A redução das frequências de desfolhação aumentou a produção diária de colmo, senescência diária de folhas, produção total diária e acúmulo líquido diário de forragem e diminuiu o potencial de utilização da forragem. No período de maior insolação, a produção diária de colmos, o acúmulo líquido diário de forragem e o potencial de utilização de forragem foram maiores e a senescência diária de folhas foi menor. A frequência de desfolhação muito alta não proporcionou um bom desenvolvimento da planta, enquanto a frequência baixa apresentou elevada produção de colmos. As frequências de desfolhação alta e média são mais indicadas para a desfolhação do capim faixa-branca, promovendo uma melhor proporção de folhas em relação a colmos.(AU)

The objective of this study was to evaluate the production of forage and the potential of utilization of digit grass subjected to four defoliation frequencies: very high (25cm), high (35cm), medium (45cm), and low (55cm), evaluated at two times of the year (higher and lower insolation), from January 2015 to January 2016. A randomized-block design with four replicates was adopted and measures repeated over time. The daily production of leaves was lower at the very high frequency in relation to the other frequencies. The reduction in defoliation frequency increased the daily production of stems, the daily leaf senescence, the total daily forage production, and the daily forage accumulation, and decreased the potential of forage utilization. At the time of higher insolation, the daily production of stems, the daily forage accumulation, the potential of utilization of forage were higher, and the daily leaf senescence was lower. The very high frequency of defoliation did not provide a good development of the plan, while the lower frequency displayed a high production of stems. The high and medium frequencies of defoliation are more indicated to the defoliation of digit grass, enabling a better proportion of leaves in relation to stems.(AU)

A single administration of human adipose tissue-derived mesenchymal stromal cells (MSC) induces durable and sustained long-term regulation of inflammatory response in experimental colitis.

Current therapies for inflammatory bowel diseases (IBD) are aimed at controlling the exacerbated response in the gut, but no treatment is fully effective for many refractory patients. Mesenchymal stromal cells (MSC) are multi-potent cells with regulatory immunosuppressive activity that may control inflammatory diseases. In this study, we investigated the short- and especially the long-term protective effects of MSC on experimental colitis. We show that MSC elicited protection to acute intestinal inflammation with gain of weight, improvement in the clinical disease score and expressive reduction in the mortality rate of treated mice. MSC changed the population of neutrophils, eosinophils and augmented the frequency of CD4 T lymphocytes in the gut-draining lymph nodes, together with reduced accumulation of these cells in the colon intraepithelial compartment. Interestingly, there were increased levels of programmed death 1 (PD-1) and glucocorticoid-induced tumour necrosis factor receptor family-related receptor (GITR) in the spleen regulatory T cells of mice that received MSC treatment, which also presented a reversal in the pattern of immune response in the gut, with diminished inflammatory, T helper type 1 (Th1) and Th17 profile, in contrast to augmented Th2 responses. Most strikingly, this balanced response elicited by a single administration of MSC during the acute colitis persisted long-term, with restored goblet cells, eosinophils and maintenance of elevated gut interleukin (IL)-4, besides increased CD4+ CD25+ PD-1+ cells in the spleen and reduced Th17 response in mesenteric lymph nodes (MLN) of treated mice on day 60. Taken together, our findings provided a significant contribution to translational immunology by pointing human adipose tissue-derived MSC as a novel therapeutic approach with long-term beneficial regulatory effects in experimental colitis.

Evolución cicatricial de herida lacerante con exposición ósea en equino. Reporte de caso / Healing evolution of lacerating wound with bone exposure in horse. Case report

RESUMEN Este manuscrito reporta un caso de laceración amplia con gran pérdida de piel en la porción dorso-medial del miembro pélvico derecho, con exposición parcial del metatarso y del tendón del músculo extensor digital común en una yegua de la raza Cuarto de Milla con 8 meses de edad. Se prescribió un tratamiento a base de antibióticos y anti-inflamatorios, con intervención de la herida en días alternados previa tranquilización con clorhidrato de detomidina. La contaminación inicial, asociada al tamaño y magnitud de la lesión, contribuyeron para que la herida demorase 170 días para cicatrizar. El uso repetido y prolongado de detomidina no causo alteraciones cardiovasculares en la paciente.

ABSTRACT This article reports a case of a large laceration with great loss of skin at the dorsal medial portion of the right pelvic member, with partial exposure of the metatarsal and the long extensor tendon of the fingers in a 8-month-old Quare Horse mare. A treatment was prescribed based on antibiotics and anti-inflammatory drugs, with an intervention of the wound on alternate days after tranquilization with detomidine. The initial contamination, associated with the size and magnitude of the injury, contributed to a delay of 170 days for the wound to heal. Repeated and prolonged use of detomidine did not cause any cardiovascular changes.

Withanolides from leaves of cultivated Acnistus arborescens.

Seven withanolides, including four previously unknown, were isolated from the acetone and ethanol extracts of cultivated specimens of Acnistus arborescens. These four compounds were identified as rel-(18R,22R)-5ß,6ß:18ß,20-diepoxy-3ß,18α-dimethoxy-4ß-hydroxy-1-oxowith-24-enolide, rel-(20R,22R)-5ß,6ß-epoxy-4ß,16α,20-trihydroxy-1-oxowitha-2,24dienolide, rel-(20R,22R)-16α-acetoxy-6α-chloro-4ß,5ß,20-trihydroxy-1-oxowitha-2,24-dienolide and rel-(20R,22R)-16α-acetoxy-20-hydroxy-1-oxowitha-2,5,24-trienolide. Their structures were elucidated by interpretation of spectroscopic data (1D and 2D NMR), HRESIMS experiments and comparison with published data for similar compounds. Cytotoxicity of the isolated compounds was evaluated against a panel of four tumor cell lines (HL-60, HCT-116, SF-268 and PANC-1). Withanolide D was the most active, with an IC50 value in the range of 0.3-1.7 µM, rel-(18R,22R)-5ß,6ß:18ß,20-diepoxy-3ß,18α-dimethoxy-4ß-hydroxy-1-oxowith-24-enolide and rel-(20R,22R)-5ß,6ß-epoxy-4ß,16α,20-trihydroxy-1-oxowitha-2,24dienolide were moderately active, while all the others were non-cytotoxic.

Single-walled carbon nanotubes functionalized with sodium hyaluronate enhance bone mineralization

The aim of this study was to evaluate the effects of sodium hyaluronate (HY), single-walled carbon nanotubes (SWCNTs) and HY-functionalized SWCNTs (HY-SWCNTs) on the behavior of primary osteoblasts, as well as to investigate the deposition of inorganic crystals on titanium surfaces coated with these biocomposites. Primary osteoblasts were obtained from the calvarial bones of male newborn Wistar rats (5 rats for each cell extraction). We assessed cell viability using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide assay and by double-staining with propidium iodide and Hoechst. We also assessed the formation of mineralized bone nodules by von Kossa staining, the mRNA expression of bone repair proteins, and the deposition of inorganic crystals on titanium surfaces coated with HY, SWCNTs, or HY-SWCNTs. The results showed that treatment with these biocomposites did not alter the viability of primary osteoblasts. Furthermore, deposition of mineralized bone nodules was significantly increased by cells treated with HY and HY-SWCNTs. This can be partly explained by an increase in the mRNA expression of type I and III collagen, osteocalcin, and bone morphogenetic proteins 2 and 4. Additionally, the titanium surface treated with HY-SWCNTs showed a significant increase in the deposition of inorganic crystals. Thus, our data indicate that HY, SWCNTs, and HY-SWCNTs are potentially useful for the development of new strategies for bone tissue engineering.

Efeito da adição de teores crescentes de ureia na cana-de-açúcar em dietas de vacas em lactação sobre a produção e composição do leite e viabilidade econômica / The effect of increasing urea in sugarcane diet of lactating cows on milk production and composition and its economic viability

Avaliou-se o efeito da adição de teores crescentes de ureia (0,0; 0,5 e 1,0%) na matéria natural da cana-de-açúcar sobre a produção e composição do leite, eficiência alimentar e viabilidade econômica. Foram utilizadas 18 vacas em lactação, com produção média inicial de 21,3±0,8kg/dia de leite e com 83±7 dias em lactação, distribuídas em delineamento ensaio de reversão do tipo switch-back, 3x3. As dietas experimentais foram constituídas de cana-de-açúcar como volumoso único e concentrado, na relação de 50:50 (base MS). Não houve efeito da suplementação dos diferentes teores de ureia sobre a produção e composição do leite. Contudo, a eficiência alimentar (produção de leite/consumo de matéria seca) foi melhor nas dietas em que se utilizou ureia, sendo 1,14; 1,17 e 1,17, respectivamente, para as dietas com 0,0; 0,5 e 1,0% de ureia (P<0,05). Considerando-se apenas o custo alimentar, todas as dietas apresentaram saldo positivo, sendo que a dieta com 1,0% de ureia apresentou o melhor saldo.(AU)

We studied the effect of increasing 0.0, 0.5 and 1.0% urea in natural sugar cane on cow milk production and composition, food productivity and economic viability. Eighteen lactating cows were studied, they had avarage milk production of 21.3±0.8kg/day and were 83±7 days in lactation in a switch-back, 3 x 3 design. The experimental diets consisted of a unique concentrated sugar cane portion with the 50:50 relation (MS base). The results showed no effect of different urea concentrations on the milk production or composition. However, food productivity (milk production/dry matter consumption) was 1.14; 1.17, and 1.17 respectively on urea diets of 0.0; 0.5 and 1.0% (P<0.05). Considering only the alimentary cost, all diets had a positive balance, and the 1.0% urea concentration was the best.(AU)

Breast cancer under age 40: a different approach.

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.

Age-period-cohort effects in the incidence of hip fractures: political and economic events are coincident with changes in risk.

UNLABELLED: An age-period cohort model was fitted to analyse time effects on hip fracture incidence rates by sex (Portugal, 2000-2008). Rates increased exponentially with age (age effect). Incidence rates decreased after 2004 for women and were random for men (period effect). New but comprehensive fluctuations in risk were coincident with major political/economic changes (cohort effect). INTRODUCTION: Healthcare improvements have allowed prevention but have also increased life expectancy, resulting in more people being at risk. Our aim was to analyse the separate effects of age, period and cohort on incidence rates by sex in Portugal, 2000-2008. METHODS: From the National Hospital Discharge Register, we selected admissions (aged ≥ 49 years) with hip fractures (ICD9-CM, codes 820.x) caused by low/moderate trauma (falls from standing height or less), readmissions and bone cancer cases. We calculated person-years at risk using population data from Statistics Portugal. To identify period and cohort effects for all ages, we used an age-period-cohort model (1-year intervals) followed by generalised additive models with a negative binomial distribution of the observed incidence rates of hip fractures. RESULTS: There were 77,083 hospital admissions (77.4 % women). Incidence rates increased exponentially with age for both sexes (age effect). Incidence rates fell after 2004 for women and were random for men (period effect). There was a general cohort effect similar in both sexes; risk of hip fracture altered from an increasing trend for those born before 1930 to a decreasing trend following that year. Risk alterations (not statistically significant) coincident with major political and economic change in the history of Portugal were observed around birth cohorts 1920 (stable-increasing), 1940 (decreasing-increasing) and 1950 (increasing-decreasing only among women). CONCLUSIONS: Hip fracture risk was higher for those born during major economically/politically unstable periods. Although bone quality reflects lifetime exposure, conditions at birth may determine future risk for hip fractures.