Effectiveness of a palliative care outpatient programme in improving cancer-related symptoms among ambulatory Brazilian patients.

The focuses of palliative care are to provide symptom relief and improve quality of life through an interdisciplinary approach. Previous studies conducted to evaluate the effectiveness of palliative care in reducing symptom distress among outpatients confirmed the importance of the palliative care approach. To our knowledge, there is no published information from Brazil regarding the impact of a palliative care outpatient programme in reducing symptom distress. Symptom scores from 232 patients were measured using Edmonton Symptom Assessment System scales in two consecutive consults. Changes in symptoms at follow-up visit were analysed using Wilcoxon signed-rank paired test. The symptom subtraction indices (SSI) (follow-up scores minus baseline scores) were calculated and then analysed with Spearman's correlation. Edmonton Symptom Assessment System median scores at follow-up visits were statistically significant reduced in all symptoms evaluated. All the SSI positively correlated with well-being-SSI. Other important SSI correlations were: fatigue-SSI and anxiety-SSI, and fatigue-SSI and dyspnoea-SSI. Our palliative care outpatient programme was able to provide a significant improvement in the symptoms evaluated. The well-being-SSI was positively correlated with all the SSI, verifying that the control of symptoms in palliative care is essential for the patient well-being. Adequate/inadequate control of specifically symptoms seems to indirectly improve/worsen other symptoms.

Absence of transforming growth factor-beta type II receptor is associated with poorer prognosis in HER2-negative breast tumours.

BACKGROUND: The clinical relevance of transforming growth factor-beta (TGF-beta)-signalling pathway in breast carcinomas (BCs) remained elusive. This study aimed to evaluate the prognostic value of TGF-beta1 and transforming growth factor-beta type II receptor (TGF-betaRII) expression levels in tumour cells and their association with the established biomarkers in BC. PATIENTS AND METHODS: In 324 BC from patients with long-term follow-up, the TGF-beta1 and TGF-betaRII transcript and protein expression levels were assessed. RESULTS: TGF-beta1 and TGF-betaRII down-expression was significantly associated with BC. Negative TGF-beta1 and TGF-betaRII protein status was associated with the development of distant metastasis (P = 0.003 and P = 0.029, respectively). In multivariate analysis, TGF-beta1-positive tumours were associated with increased disease-free survival (DFS) [hazard ratio (HR) = 0.489, P = 0.003]. TGF-betaRII positivity was an independent prognostic factor for DFS (HR = 0.439, P = 0.001) and overall survival (OS) (HR = 0.409, P = 0.003) in human epidermal growth factor receptor-2 (HER2)-negative patients. Absence of TGF-beta1 and TGF-betaRII proteins in breast tumour cells was significantly associated with metastasis development. CONCLUSIONS: To the best of our knowledge, this is the first report indicating the relevance of HER2 status in discriminating TGF-betaRII as a prognostic marker for DFS and OS in human BC. These data indicate that TGF-betaRII protein analysis in tumour cells could be introduced in clinical practice as additional prognostic biomarker in HER2-negative BC.

Aspectos do metabolismo energético e protéico em idosos / Aspects of energy and protein metabolism in the elderly

The nutritional condition of elderly persons has close relations with their immunologic status and general health. There is no agreement regarding the recommended dietary allowances of energy and of the various nutrients inthe elderly population. Also, studies on this field were carried out in developed Countries, with possibly different cultural, social, and even climatic conditions if compared with Brazil. This paper revises some aspects of the energy and protein metabolism in elderly persons and highlights the necessity for new research lines about the nutritional status and the adequacy of the caloric and protein intake of our aged population in order to enable the development of rational nutritional interventions

El estado nutricional de lo adultos mayores influye en su sistema inmunológico y la salud. No existe un consenso acerca de las necesidades calóricas y de nutrientes para esta población. La mayor parte de los estudios de estas variables fueron realizados en países desarrollados, con condiciones culturales, sociales y hasta climáticas, bastante diferentes del Brasil. Se revisaron algunos aspectos del metabolismo enegético y proteico de los adultos mayores, señalando los estudios necesários para uma evaluación del estado nutricional, que permitan el ajuste correcto de estos parámetros en la dieta de los adultos mayores, elementos indispensables para la planificación de intervenciones nutricionales racionales

O estado nutricional dos idosos é relacionado com o seu estado imunológico e saúde geral. Não existe consenso sobre as necessidades calóricas e dos diversos nutrientes na população idosa. Também, a maioria dos estudos acerca destas variáveis foram realizados em países desenvolvidos, com cultura, condições sociais e mesmo climáticas diferentes daquelas do Brasil. O presente artigo revisa alguns aspectos do metabolismo energético e protéico em idosos, destacando a necessidade da realização de pesquisas para a avaliação do estado nutricional e da adequação calórica e protéica da dieta habitual da nossa população idosa, essenciais para o planejamento de intervenções nutricionais racionais

Transplantation of islets of Langerhans in diabetic rats.

In the present work, homogeneous isolated pancreatic islet-cells were transplanted to diabetic rats with the aim of verifying if the transplanted tissue could survive and reduce the plasma glucose concentration on the alloxan-induced diabetic receptors. For the isolation of the pancreatic islets, pancreas was incubated in collagenase solution for about 13 +/- 3 minutes, followed by centrifugation in Ficoll gradients. The islets, 3 000 to 5 000, were transplanted to alloxan diabetic recipients, in a territory, preferentially with portal-hepatic drainage (mesentery and spleen). Sixty per cent of the recipients exhibited a fall of the plasma glucose concentration, up to 70%, while in the control animals, the diabetes persisted. The islets were found in the recipients mesentery up to 10 days after transplantation, and all of them showed heavily granulated (aldehyde fuchsin positive) beta cells. After this time, islets were not found. These results indicate that islets can survive and attenuate diabetes in alloxan-treated rats, and that, probably, the number of islets transplanted as well as the receiving areas play an important role.

Transplantation of islets of Langerhans in diabetic rats.

In the present work, homogeneous isolated pancreatic islet-cells were transplanted to diabetic rats with the aim of verifying if the transplanted tissue could survive and reduce the plasma glucose concentration on the alloxan-induced diabetic receptors. For the isolation of the pancreatic islets, pancreas was incubated in collagenase solution for about 13 +/- 3 minutes, followed by centrifugation in Ficoll gradients. The islets, 3 000 to 5 000, were transplanted to alloxan diabetic recipients, in a territory, preferentially with portal-hepatic drainage (mesentery and spleen). Sixty per cent of the recipients exhibited a fall of the plasma glucose concentration, up to 70

, while in the control animals, the diabetes persisted. The islets were found in the recipients mesentery up to 10 days after transplantation, and all of them showed heavily granulated (aldehyde fuchsin positive) beta cells. After this time, islets were not found. These results indicate that islets can survive and attenuate diabetes in alloxan-treated rats, and that, probably, the number of islets transplanted as well as the receiving areas play an important role.

Transplantation of islets of Langerhans in diabetic rats

In the present work, homogeneous isolated pancreatic islet-cells were transplanted to diabetic rats with the aim of verifying if the transplanted tissue could survive and reduce the plasma glucose concentration on the alloxan-induced diabetic receptors. For the isolation of the pancreatic islets, pancreas was incubated in collagenase solution for about 13 +/- 3 minutes, followed by centrifugation in Ficoll gradients. The islets, 3 000 to 5 000, were transplanted to alloxan diabetic recipients, in a territory, preferentially with portal-hepatic drainage (mesentery and spleen). Sixty per cent of the recipients exhibited a fall of the plasma glucose concentration, up to 70

, while in the control animals, the diabetes persisted. The islets were found in the recipients mesentery up to 10 days after transplantation, and all of them showed heavily granulated (aldehyde fuchsin positive) beta cells. After this time, islets were not found. These results indicate that islets can survive and attenuate diabetes in alloxan-treated rats, and that, probably, the number of islets transplanted as well as the receiving areas play an important role.

[Right ventricle--pulmonary artery diastolic blood flow (author's transl)]. / Fluxo diastólico ventrículo direito--artéria pulmonar

The authors show the possibility of the establishment of blood flow from the right ventricle to the pulmonary artery during the period of ventricular diastole, through experimental models mimetizing hemodynamic patterns described in the literature for certain cardiopathies. These models consisted of experimental hypodiastoly, associated or not with right ventricle hyposystoly. The detection of the existence or not of blood flow in the several phases of the cardiac cycle, was made recording the variations of the electrical impedance of the blood.

[Pre-systolic deflexion in pressure recordings of the right ventricle and pulmonary artery (author's transl)]. / Deflexão pré-sistólica nos registros pressóricos do ventrículo direito e da artéria pulmonar

The authors demonstrated experimentally that the origin of the pre-systolic deflexion, previously observed by many investigators in pressure recordings of the right ventricle and the pulmonary artery, is due to the effective atrial contraction, which, besides the pressure change, produces a blood flow from the ventricle towards the artery. This flow must possibly exert an important role in the maintenance of the cardiac output when a failure of the right ventricle is established.

[An impedance measuring technique for blood flow qualitative recording]. / Técnica impedanciométrica de detecção de fluxo sanguíneo.

An impedance measuring technique was developed for blood flow qualitative recordings in laboratory animals. Basically, it consists in the administration of an indicator solution (0,1 ml, NaCl 20%) which, mixing with the blood, provokes a decrease in its electrical resistance, in such way that the passage of this mixture (concentrated saline/blood) through a bipolar receptor electrode, resistively balanced by the electrical impedance of blood alone, will be detected as a sudden resistance fall. The results so far show that it is an adequate technique for blood flow qualitative studies, since, despite its simplicity, provides consistent and unequivocal recordings which, performed simultaneously with those of other circulatory events, may become a helpful tool for their understanding.