Bone Metastases Detection in Patients with Breast Cancer: Does Bone Scintigraphy Add Information to PET/CT?

BACKGROUND: Positron emission tomography/computed tomography (PET/CT) has become in recent years a tool for breast cancer (BC) staging. However, its accuracy to detect bone metastases is classically considered inferior to bone scintigraphy (BS). The purpose of this work is to compare the effectiveness of bone metastases detection between PET/CT and BS. MATERIALS AND METHODS: Prospective study of 410 female patients treated in a Comprehensive Cancer Center between 2014 and 2020 that performed PET/CT and BS for staging purposes. The image analysis was performed by 2 senior nuclear medicine physicians. The comparison was performed based on accuracy, sensitivity, and specificity on a patient and anatomical region level and was assessed using McNemar's Test. An average ROC was calculated for the anatomical region analysis. RESULTS: PET/CT presented higher values of accuracy and sensitivity (98.0% and 93.83%), surpassing BS (95.61% and 81.48%) in detecting bone disease. There was a significant difference in favor of PET/CT (sensitivity 93.83% vs. 81.48%), however, there is no significant difference in eliminating false positives (specificity 99.09% vs. 99.09%). PET/CT presented the highest accuracy and sensitivity values for most of the bone segments, only surpassed by BS for the cranium. There was a significant difference in favor of PET/CT in the upper limb, spine, thorax (sternum) and lower limb (pelvis and sacrum), and in favor of BS in the cranium. The ROC showed that PET/CT has a higher sensitivity and consistency across the bone segments. CONCLUSION: With the correct imaging protocol, PET/CT does not require BS for patients with BC staging.

Electromiographic activity during single leg jump in adolescent athletes with chronic ankle instability: A pilot study.

Chronic ankle instability (CAI) is a common condition in athletes, which can alter the muscular activity of lower limb during jump. The objective of the study was to verify the magnitude of activation, onset timing and order of recruitment of the proximal and local muscles to the ankle of young athletes with CAI during a single leg vertical jump. Thirty-seven athletes were selected and divided into: 1) CAI group and 2) control group. An electromyographic evaluation was performed during the jump on force plate. The muscles evaluated were the proximal muscles - gluteus medius (GMed), rectus femoris (RF) and local ankle muscles - tibialis anterior (TA), peroneus longus (PL) and lateral gastrocnemius (LG). In propulsion, the CAI group showed early activation of all evaluated muscles, when compared to control group (p = 0.05). No diferences were found between groups concerning magnitude of electromyographic signal and order of muscle recruitment. During landing, an increase in magnitude of the electromyographic signal of TA in the CAI group was observed and no diferences were found between groups for onset activation and order of muscle recruitment. The results can be applied to athletes' rehabilitation through specific neuromuscular control exercises, such as reaction time and local and proximal joint stabilization to optimize muscle performance and injury incidence. Therefore, in the single leg vertical jump athletes with CAI presented higher activation of the TA in the landing and an early activation of the GMed, RF, TA, PL and LG in propulsion in relation to control group.

Bixa orellana L. by-products' fractions from an industrial process: antiproliferative activity on tumor cells and chemical profile.

This study evaluated the phytochemical characterization of Bixa orellana (BO extract) unsaponifiable extract and resulting fractions (F fraction - FF, Geranyl fraction - GF and R fraction- RF) obtained as by-products of an industrial process investigating in vitro antiproliferative activities in human tumoral cells. The main compounds identified by GC-MS for BO extract were Geranylgeraniol (61.51%); for FF: Geranylgeraniol (70.23%); for GF: Geranylgeraniol (78.92%) and for RF: ß-cubebene (27.75%). Quantifications of geranylgeraniol by GC-FID presented the percentage content: BO 27.52%; FF 38.52%; GF 51.44% and RF 1.81%. BO extract showed a significant antiproliferative activity, with GI50 up to 4 µg/mL. All fractions had a remarkably similar antiproliferative activity profile (GI50 27-47 µg/mL). Data reported herein showed an important cytostatic effect for BO extract, nevertheless this activity is not attributed exclusively to geranylgeraniol. In conclusion, this by-product becomes of great value, being a potential candidate for development of new anti-tumor ingredients.

Cisplatin, Fluorouracil in Bolus Injection, and Leucovorin in First-Line Therapy for Advanced Gastric Cancer as an Alternative to Protocols With Infusional Fluorouracil.

PURPOSE: Gastric cancer (GC) is the fourth most common cancer and the second leading cause of cancer death worldwide. Platinum agents and fluoropyrimidines are the main compounds used in the first-line setting for advanced GC. Given the activity of fluorouracil (FU) bolus, the PFL protocol, a chemotherapy regimen combining cisplatin, FU bolus, and leucovorin, was incorporated at the Brazilian National Cancer Institute, because this schedule does not require hospitalization or infusion pumps. This study aims to evaluate the outcomes of PFL in the first-line setting for patients with advanced GC. MATERIALS AND METHODS: This was a retrospective cohort study evaluating patients with advanced GC treated in the first-line setting with cisplatin 80 mg/m2 on day 1 and FU bolus 400 mg/m2 plus leucovorin 20 mg/m2 on days 1, 8, 15, and 22 every 4 weeks, from January 2008 to December 2014. RESULTS: A total of 109 patients were enrolled. The median number of cycles received per patient was four (one to 11). Complete responses were achieved in 6.4% and partial responses in 14.7%. Median progression-free survival was 6.3 months (95% CI, 5.08 to 7.58 months) and median overall survival was 8.3 months (95% CI, 6.79 to 9.87 months). Thirty-four (31.2%) patients were alive in 1 year. Grade 3 and 4 adverse events were experienced by 26.6% and 3.7% of patients, respectively, with dose reduction necessary in 9.1%. CONCLUSION: PFL is active in advanced GC and could be an alternative for FU continuous infusion protocols in institutions with limited resources and/or low budget, which is the reality in many nations all over the world.

PORTUGUESE RECOMMENDATIONS FOR THE USE OF BIOLOGICAL THERAPIES IN PATIENTS WITH PSORIATIC ARTHRITIS--2015 UPDATE.

OBJECTIVE: To update recommendations for the treatment of psoriatic arthritis with biological therapies, endorsed by the Portuguese Society of Rheumatology (SPR). METHODS: These treatment recommendations were formulated by Portuguese rheumatologists based on literature evidence and consensus opinion. At a national meeting the 16 recommendations included in this document were discussed and updated. The level of agreement among Portuguese Rheumatologists was assessed using an online survey. A draft of the full text of the recommendations was then circulated and suggestions were incorporated. A final version was again circulated before publication. RESULTS: A consensus was achieved regarding the initiation, assessment of response and switching biological therapies in patients with psoriatic arthritis (PsA). Specific recommendations were developed for several disease domains: peripheral arthritis, axial disease, enthesitis and dactylitis. CONCLUSION: These recommendations may be used for guidance in deciding which patients with PsA should be treated with biological therapies. They cover a rapidly evolving area of therapeutic intervention. As more evidence becomes available and more biological therapies are licensed, these recommendations will have to be updated.

2011 Portuguese recommendations for the use of biological therapies in patients with psoriatic arthritis.

OBJECTIVE: To develop recommendations for the treatment of psoriatic arthritis (PsA) with biological therapies, endorsed by the Portuguese Society of Rheumatology. METHODS: These treatment recommendations were formulated by Portuguese rheumatologists based on literature evidence and consensus opinion. A draft of the recommendations was first circulated to all Portuguese rheumatologists and their suggestions were incorporated in the draft. At a national meeting the recommendations were discussed and all attending rheumatologists voted on the level of agreement for each recommendation. A second draft was again circulated before publication. RESULTS: A consensus was achieved regarding the initiation, assessment of response and switching biological therapies in patients with PsA. Specific recommendations were developed for several disease domains: peripheral arthritis, axial disease, enthesitis and dactylitis. CONCLUSION: These recommendations may be used for guidance in deciding which patients with PsA should be treated with biological therapies. They cover a rapidly evolving area of therapeutic intervention. As more evidence becomes available and more biological therapies are licensed, these recommendations will have to be updated.

Isolation and identification of antioxidants from Pedilanthus tithymaloides.

A bioassay-guided methodology utilizing 2,2-diphenyl-1-picrylhydrazyl (DPPH), the trolox equivalent antioxidant capacity (TEAC), and reducing power assays, as well as an assessment of scavenging properties against O (2) (.-) , H(2)O(2), HOCl, ROO., .NO, and ONOO(-) were used to find the main antioxidant principles of Pedilanthus tithymaloides (Euphorbiaceae), a shrub used in traditional Cuban medicine. The principles were identified as kaempferol 3-O-beta-D-glucopyranoside-6''-(3-hydroxy-3-methylglutarate), quercitrin, isoquercitrin, and scopoletin. The contents of total phenolics and flavonoids were found to be 76.0 +/- 4.8 mg of gallic acid equivalents/g extract and 9.8 +/- 0.4 mg of rutin equivalents/g extract, respectively.

Antileishmanial activity of piceatannol isolated from Euphorbia lagascae seeds.

In the search for biologically active compounds from Euphorbia lagascae Spreng, an herbaceous plant native to southeast of Iberic Peninsula, a stilbene, two coumarins and two 12-deoxyphorbol diterpene esters were isolated by chromatographic methods, from the methanol extracts of its defatted seeds. The structures of these compounds were elucidated by a combination of physical and spectral data (IR, MS and high-resolution (1)H-NMR and (13)C-NMR spectroscopy utilizing COSY, HMBC, HMQC and NOESY experiments). The stilbene, piceatannol, was screened for its antileishmanial activity against promastigotes as an extracellular form of Leishmania donovani, Leishmania infantum and Leishmania major, and amastigotes of Leishmania donovani as an intracellular form. Pentostan (sodium stibogluconate), the first line clinical drug, was used as a standard reference. Piceatannol was moderately active against the extracellular forms of the three tested Leishmania species, and more active than the reference compound against the intracellular form of Leishmania donovani.

A new C9 nor-isoprenoid glucoside from Rantherium suaveolens.

The new C(9) nor-isoprenoid 3-methyl-octa-1,5-diene-7-one-3-O-beta-D-glucopyranoside, named as ranthenone glucoside (1), together with the previously known 9-hydoxylinaloyl glucoside (2), sitosterol-3beta-O-[6'-palmitoyl-beta-D-glucopyranoside] (3), scopoletin (4), fraxetin (5), and scopolin (6), were isolated from the aerial parts of Rantherium suaveolens. The structures of these compounds were elucidated by extensive spectroscopic analysis.

Ozoroalide, a new macrolide from Ozoroa insignis.

From the roots of Ozoroa insignis a new orsellinic acid named ozoroalide (1) and anacardic acid methyl ester (2) were isolated and identified on the basis of spectroscopic methods.

Antioxidant compounds from Ebenus pinnata.

Activity-guided fractionation of the methanol extract of Ebenus pinnata aerial parts led to the isolation of ombuoside (1), kaempferol 3-O-rutinoside (2), rutin (3), catechin (4), and picein (5), along with beta-sitosterol and beta-sitosterol glucoside. Compounds 1-4 showed significant antioxidant activity in the DPPH, and TEAC, reducing power assays.

Phytochemical constituents from Salsola tetrandra.

The new norisoprenoid 3beta-hydroxy-5alpha,6alpha-epoxy-beta-ionone-2alpha-O-beta-d-glucopyranoside (1) and the long-chain hydroxy fatty acids 9,12,13-trihydroxyoctadeca-10(E),15(Z)-dienoic acid (2) and 9,12,13-trihydroxyoctadeca-10(E)-dienoic acid (3) were isolated from Salsola tetrandra aerial parts, together with 3,4,5-trimethoxyphenyl-beta-d-glucopyranoside (4), 9-hydroxylinaloyl glucoside (5), taxiphyllin (6), trans-N-feruloyltyramine (7), and S-(-)-trans-N-feruloyloctopamine (8). Their structures were elucidated by extensive spectroscopic analysis and chemical methods. Compounds 6 and 8 displayed mild antibacterial activity against Staphylococcus aureus, whereas compound 6 showed the highest activity in the Artemia salina bioassay.

Tirucallane triterpenes from the roots of Ozoroa insignis.

Eight tirucallane triterpenes, methyl 3alpha,24S-dihydroxytirucalla-8,25-dien-21-oate (2), methyl 3alpha-hydroxy-24-oxotirucalla-8,25-dien-21-oate (3), methyl 3alpha-hydroxy-25,26,27-trinor-24-oxotirucall-8-en-21-oate (4), 3alpha,25-dihydroxy-24-(2-hydroxyethyl)-tirucall-8-en-21-oic acid (5), 3alpha,24S,25-trihydroxytirucall-8-en-21-oic acid (6), 3alpha,24R,25-trihydroxytirucall-8-en-21-oic acid (7), 3alpha,25-dihydroxytirucall-8-en-21-oic acid (8), and methyl 3alpha,25-dihydroxytirucall-8-en-21-oate (9), together with alpha-elemolic acid methyl ester (1), were isolated from the roots of Ozoroa insignis. Their structures were elucidated on the basis of spectroscopic evidence.

Euphoportlandols A and B, tetracylic diterpene polyesters from Euphorbia portlandica and their anti-MDR effects in cancer cells.

Two new tetracyclic diterpene polyesters, euphoportlandols A (1) and B (2), have been isolated along with 12 known tetracyclic triterpenes from an acetone extract of Euphorbia portlandica. Their structures were established as 5alpha,11alpha,14alpha,17-tetraacetoxy-3beta-benzoyloxy-6beta,15beta-dihydroxy-9-oxoseget-8(12)-ene (1) and 5alpha,11alpha,14alpha,17-tetraacetoxy-3beta-benzoyloxy-6beta,15beta-dihydroxy-9-oxosegetane (2), respectively, by spectroscopic data interpretation. Compounds 1 and 2 were evaluated for their ability to inhibit multidrug resistance in cancer cells. Both compounds were found to be inhibitors of P-glycoprotein activity.

New macrocyclic lathyrane diterpenes, from Euphorbia lagascae, as inhibitors of multidrug resistance of tumour cells.

The new macrocyclic lathyrane diterpenes latilagascenes A and B ( 1 and 2), the diacetylated derivative of 2, latilagascene C ( 3), and the known diterpenes ent-16alpha,17-dihydroxyatisan-3-one ( 4) and ent-16alpha,17-dihydroxykauran-3-one ( 5), isolated from the methanol extract of Euphorbia lagascae, were examined for their effects on the reversal of multidrug resistance (MDR) on mouse lymphoma cells. Among the active lathyrane derivatives 1 - 3, compound 2 displayed the highest inhibition of rhodamine 123 efflux of human MDR1 gene transfected mouse lymphoma cells when compared to the untreated cells or the positive control verapamil. The new compounds are the first macrocyclic lathyrane diterpenes showing oxidation at C-16, whose structures were characterized by extensive spectroscopic methods, including 2D NMR experiments ( (1)H- (1)H COSY, HMQC, HMBC and NOESY). The known phenolic compounds vanillic acid ( 6), p-salicylic acid ( 7), isofraxidin ( 8) and cleomiscosin A ( 9) were also isolated from this species.

Interleukin-6 and nitric oxide synthase expression in the vasopressin and corticotrophin-releasing factor systems of the rat hypothalamus.

Nitric oxide synthase (NOS) and interleukin-6 (IL-6) are constitutively expressed in hypothalamic cells. However, phenotypic and functional aspects of these cells remain unknown. We have studied the expression pattern of these two molecules in hypothalamic cells expressing corticotropin-releasing factor (CRF) and arginin-vasopressin (AVP), two major regulatory peptides in the hypothalamus-pituitary system, using immunofluorescence, intracerebroventricular injection of colchicine, and the study in parallel of the labeling pattern of axons in the median eminence. Within AVP cells, we distinguished two different populations: large, intensely stained AVP cells coexpressing IL-6; and large, intensely stained AVP cells coexpressing IL-6 and NOS. Within the CRF cells, we distinguished three different populations: large, intensely stained CRF cells immunonegative for AVP, NOS, and IL-6; large cells weakly stained for CRF and AVP, immunopositive for NOS and immunonegative for IL-6; and small cells intensely stained for CRF and AVP and immunonegative for IL-6 and NOS. In addition, we also found AVP cells containing IL-6 in the suprachiasmatic nucleus. These results suggest that neuronal NOS and IL-6 may be involved in different modulatory processes in hypophysiotropic and non-hypophysiotropic cells.

Anti-inflammatory and antioxidant activity of a medicinal tincture from Pedilanthus tithymaloides.

Pedilanthus tithymaloides (L.) Poit. (Euphorbiaceae) is a low tropical American shrub with a reported wide range of healing properties such as emetic, anti-inflammatory, antibiotic, antiseptic, antihemorrhagic, antiviral, antitumoral, and abortive. In the present study, a tincture from P. tithymaloides collected in Cuba was evaluated for its in vivo anti-inflammatory activity, using the rat paw oedema assay, and for its in vitro scavenging effects on reactive oxygen species (ROS) (HO*, O2*-, HOCl, ROO* and H2O2), reactive nitrogen species (RNS) (ONOO- and *NO), and DPPH* radical. The protein, free amino acid, and phenolic contents of the tincture were also determined. Pertaining to the anti-inflammatory activity, the intraperitoneal administration of the tincture inhibited carrageenan-induced rat paw oedema, whereas in the scavenging assays the tincture showed to be effective against all the assayed ROS and RNS, specially for HO* (IC50 = 345+/-77 microg/mL), O2*- (IC50 = 143+/-7 microg/mL), HOCl (IC50 = 113+/-20 microg/mL), ONOO- (IC50 = 44+/-3 microg/mL), and *NO (IC50 = 54+/-4 microg/mL), but displayed weak activity in the DPPH* assay. The protein content of the tincture was 0.70%, and twenty free amino acids were identified and quantified. The content of total phenolics was 17.4+/-0.15 mg of gallic acid equivalents (GAE)/g dry material. These results provide scientific support for the empirical use of P. tithymaloides tincture as an anti-inflammatory medicine.

Antioxidant phenolic glycosides from Moricandia arvensis.

The new phenolic glycosides quercetin 3,4'-di-O-beta-d-glucopyranoside-7-O-alpha-l-rhamnopyranoside (moricandin) (1), beta-d-glucopyranosyl 4-O-beta-d-glucopyranosylcaffeate (2), methyl 3-O-beta-d-glucopyranosyl-5-hydroxycinnamate (3), and beta-d-glucopyranosyl 4-O-beta-d-glucopyranosylbenzoate (4), together with the previously known beta-d-glucopyranosyl 4-hydroxybenzoate (5), methyl 4-O-beta-d-glucopyranosylcaffeate (6), 1-O-caffeoyl-beta-d-glucopyranoside (7), and 2-phenylethyl-beta-d-glucopyranoside (8), were isolated from the flowers of Moricandia arvensis. Their structures were elucidated by extensive spectroscopic analysis and chemical methods. Compounds 1-8 were evaluated for antioxidant activity using DPPH, TEAC, and reducing power assays, where the caffeic acid derivative 7 and the quercetin triglycoside 2 proved to possess the most potent scavenging activity.

A new sesquiterpene-coumarin ether and a new abietane diterpene and their effects as inhibitors of P-glycoprotein.

A new sesquiterpene-coumarin ether (5'beta,9'alpha,10'alpha)-7-0-(3alpha-methoxy-8'(12')-drimen-11'-yl)-scopoletin, designated driportlandin (1) and a new abietane quinoid diterpene 16-hydroxy-abieta-8,12-diene-11,14-dione, named portlanquinol (2) together with lupeol, nepehinol, wrightial, formonetin and davidigenin were isolated and characterized from the Me2CO extract of whole dried plant of Euphorbia portlandica. The structures of the new compounds were elucidated from spectral data including 2D-NMR experiments of COSY, HMQC, HMBC and NOESY. When examined for their effects on the reversal of multidrug resistance(MDR) on mouse lymphoma cells, compound 1 proved to be more active than the positive control verapamil and compound 2 was found to be toxic. This is the first report on the isolation of a sesquiterpene-coumarin and a quinoid-type diterpenoid from Euphorbia.