Surgery in ovarian cancer - Brazilian Society of Surgical Oncology consensus.

Surgical management in epithelial ovarian cancer (EOC) has a significant impact in overall survival and progression-free survival. The Brazilian Society of Surgical Oncology (BSSO) supported a taskforce of experts to reach a consensus: experienced and specialised trained surgeons, in cancer centres, provide the best EOC surgery. Laparoscopic and/or radiological staging prognosticates the possibility of complete cytoreduction (CC0) and helps to reduce unnecessary laparotomies. Surgical techniques were reviewed. Multidisciplinary input is essential for treatment planning. Quality assurance criteria are proposed and require national consensus. Genetic testing is mandatory. This consensus states the final recommendations from BSSO for management of EOC. TWEETABLE ABSTRACT: Brazilian Society of Surgical Oncology consensus for surgery in epithelial ovarian cancer patients.

Valor nutritivo de pastagens de Coastcross-1 em consórcio com diferentes leguminosas de ciclo hibernal / Nutritive value of coastcross-1 pastures mixed to different cool season legumes

Objetivou-se com esta pesquisa avaliar três sistemas forrageiros constituídos por Coastcross-1 (CC) + 100kg de N/ha/ano + ervilhaca comum; CC + 100kg de N/ha/ano + trevo vesiculoso; e CC + 200kg de N/ha/ano. Durante o período experimental (345 dias), foram realizados treze pastejos. O delineamento experimental utilizado foi o inteiramente ao acaso, com três tratamentos (sistemas forrageiros), três repetições (piquetes) em parcelas subdividas no tempo (valores médios dos pastejos em cada estação do ano). Para avaliação, foram utilizadas vacas em lactação da raça Holandesa. Amostras de simulação de pastejo foram coletadas para análise de proteína bruta (PB), fibra em detergente neutro (FDN) e ácido (FDA), digestibilidade in situ da matéria seca (DISMS) e da matéria orgânica (DISMO) e os nutrientes digestíveis totais (NDT). Os valores médios para PB, FDN, FDA, DISMS, DISMO e NDT foram de 18,1; 16,7 e 17,6%; 57,8; 58,9 e 58,7%; 26,5; 26,5 e 26,7%; 79,6; 78,9 e 80,6%; 79,8; 79,1 e 80,6%; 72,1; 71,4 e 72,7%, respectivamente. Melhores resultados de valor nutritivo foram obtidos no inverno, em especial para o consórcio de Coastcross-1 com ervilhaca.

The aim of this research was to evaluate three grazing systems with Coastcross-1 (CC) + 100kg N/ha/year + common vetch; CC + 100kg N/ha/year + arrowleaf clover; and CC + 200kg N/ha/year. Thirteen grazing cycles were performed during the experimental period (345 days). The experimental design was completely randomized with three treatments (grazing systems), three replicates (paddocks) in completely split-plot time (average values of grazing season). Lactating Holstein cows were used in the evaluation. Forage mass and botanical composition were evaluated. Samples from the hand-plucking method were collected to analyze crude protein (CP), neutral detergent fiber (NDF) and acid (ADF), in situ digestibility of dry matter (ISDMD) and organic matter (ISOMD) and total digestible nutrients (TDN). The averages of CP, NDF, ADF, ISDMD, ISOMD and TDN were 18.1, 16.7 and 17.6 %; 57.8, 58.9 and 58.7 %; 26.5, 26.5 and 26.7 %; 79.6, 78.9 and 80.6 %; 79.8, 79.1 and 80.6 %; 72.1, 71.4 and 72.7 %, respectively. Better results for nutritive value were found during winter, especially on Coastcross-1 mixed with common vetch.

Morphologic and cytokine profile characterization of Salmonella enterica serovar typhimurium infection in calves with bovine leukocyte adhesion deficiency.

The role of neutrophils in the pathogenesis of Salmonella enterica Typhimurium-induced ruminant and human enteritis and diarrhea has yet to be characterized with in vivo models. To address this question, the in vivo bovine ligated ileal loop model of nontyphoidal salmonellosis was used in calves with the naturally occurring bovine leukocyte adhesion deficiency (BLAD) mutation whose neutrophils are unable to extravasate and infiltrate the extravascular matrix. Data obtained from 4 BLAD Holstein calves homozygous for BLAD (CD18-), 1 to 5 weeks of age, were compared with 4 controls, age-matched Holstein calves negative for BLAD (CD18+). Morphologic studies revealed that infection of CD18- calves with S Typhimurium resulted in no significant tissue infiltration by neutrophils, less tissue damage, reduced luminal fluid accumulation, and increased bacterial invasion, when compared with CD18+ calves. Ultrastructurally, lesions in enterocytes induced by S Typhimurium infection in CD18- calves--including attachment and disruption of the brush border, apical membrane ruffling formation, and cellular degeneration--were similar to the ones reported in the literature for CD18- calves. Study of cytokine gene expression by quantitative real-time polymerase chain reaction revealed that early stages of acute infection (4-8 hours postinfection) were associated with increased interleukin 8 gene expression in the absence of tissue influx of neutrophils in CD18- calves, whereas later stages of infection (12 hours postinfection) were associated with increased expression of growth-related oncogene alpha in the presence of neutrophil influx in CD18+ calves. In contrast, the proinflammatory cytokines interleukin 1beta and tumor necrosis factor alpha were poorly correlated with the presence or absence of tissue neutrophils.

Early phase morphological lesions and transcriptional responses of bovine ileum infected with Mycobacterium avium subsp. paratuberculosis.

Mycobacterium avium subsp. paratuberculosis (MAP) is the causative agent of chronic enteritis in ruminants (Johne's disease) and a possible etiopathologic agent in human Crohn's disease. The host-pathogen interaction in this chronic disease has largely depended on the randomly collected static lesions studied in subclinically or clinically infected animals. We have established and utilized the neonatal calf ligated ileal loop model to study the early temporal host changes during MAP infection. After inoculation of ligated ileal loop with MAP, samples were analyzed for bacterial invasion, histologic and ultrastructural morphologic changes, and gene expression at several times (0.5-12 hours) postinfection. Our results indicate that MAP invades the intestinal mucosa as early as 0.5 hour postinoculation. Distribution and migration of neutrophils, monocytes/macrophages, and goblet cells were confirmed by histopathology, scanning and transmission electron microscopy. Coincident with the morphologic analysis, we measured by real-time polymerase chain reaction gene expression of various cytokines/chemokines that are involved in the recruitment of mononuclear and polymorphonuclear leukocytes to the site of infection. We also detected expression of several other genes, including intestinal-trefoil factor, profilin, lactoferrin, and enteric ss-defensin, which may play significant roles in the early MAP infection. Thus, the calf ligated intestinal loop model may be used as a human disease model to understand the role of MAP in the pathogenesis of Crohn's disease.

Psychoneuroendocrine characteristics of common obesity clinical subtypes.

OBJECTIVE: To relate psychological profiles, cerebral asymmetry and the hypothalamus-pituitary-adrenal axis (HPA) reactivity to clinical characteristics of common obesity. METHODS: Sixty consecutive adult female overweight and obese patients attending the outpatient endocrine department were included in this study. Clinical evaluation specifically selected a priori the following indexes: obesity age of onset, parenthood obesity, carbohydrate craving, binge eating with purging, obesity degree (defined by the body mass index (BMI)--weight (kg)/height (m(2))), body fat distribution (defined by the abdominal--thigh ratio (A/T)) and initial weight loss after medical treatment. Psychological evaluation was performed with the Minnesota Multiphasic Personality Inventory (MMPI). In the last 30 patients, the Edinburgh Inventory of Manual Preference (EIMP) and the corticotrophin-releasing hormone (CRH) test were also performed. RESULTS: Clinical characteristics defined a priori were independent variables as evaluated by contingency table analysis. Factorial analysis of variance (ANOVA) revealed a significantly different MMPI profile, according to parental obesity, with post-hoc significantly higher scores on the hypochondriasis (Hs), paranoia (Pa), psychasthenia (Pt) and schizophrenia (Sc) scales in patients with obese parents. Obese patients presented significantly higher dichotomized manual preference indexes in relation to overweight patients. Parental obesity, binge eating behaviour with purging, body fat distribution and the dichotomized manual preference index were independent significant factors for the ACTH response in the CRH test, together explaining 41% of the response variability. Age of onset of obesity and the dichotomized manual preference index were independent and significant factors for the cortisol response, together explaining 37% of its variability. A non-normal distribution was found for the ACTH response: high- and low-responders presented significantly different MMPI profiles, with high-responders presenting higher scores on all clinical scales except masculinity/femininity (Mf). CONCLUSION: Overweight/obese subjects with parental obesity present a distinctive personality profile and a higher ACTH response in the CRH test. Cerebral asymmetry may be a relevant factor for obesity development and is associated with the HPA reactivity. HPA reactivity is a sensitive index integrating clinical, psychological and neural asymmetric factors. International Journal of Obesity (2001) 25, 24-32

[Insulin resistance and atherosclerosis]. / Insulino-resistência e aterosclerose.

The western way of life favours the development of a state of insulin resistance, in genetically predisposed subjects. In this state, greater levels of insulin are necessary so that an answer can be obtained and, consequently, hyperinsulinism occurs. Insulin has several target tissues, thus insulin resistance is associated with the dysfunction of a multiplicity of tissues, organs and systems in the body (Syndrome X). All of those dysfunctions together with hyperinsulinism can greatly enhance the risk of atherosclerotic vascular disease. In this article we review the dysfunction at several levels, including blood pressure, endothelium, lipid metabolism and fibrinolytic system and the way they can, together with hyperinsulinism, induce atherogenesis. We review some of the therapeutic options that can reduce this state of insulin resistance as well as the morbidity and mortality associated with atherosclerosis.

[Comparison of 2 artificial insemination technics. (Sperm tubal perfusion and intrauterine insemination)]. / Comparación de dos técnicas de inseminación artificial. (Perfusión tubárica de esperma e inseminación intrauterina).

In 1991 Kahn et al, described a method of intrauterine Insemination called Fallopian Tube Sperm Perfusion (FSP) using 4.0 ml for the insemination volume, unlike the classic Intrauterine Insemination (IIU) in which insemination volume is 0.5 ml. The aim of this study is to compare pregnancy rate per cycle in both technics. Between August 1993 and January 1994, 60 couples with infertility were studied, 131 ovarian stimulation cycles were done, 95 with IIU and 36 with PTE. 18 clinical pregnancies occurred, 11 with IIU and 7 with PTE, for a pregnancy rate per cycle of 11.5% for IIU and 19.4% for PTE. This result confirms the reports by Kahn. PTE represents a new possibility for the treatment of different etiology infertility.

Feedback of true heart rate during exposure in vivo. Partial replication with methodological improvement.

Ten specific phobics improved during a mean of two sessions of experimental treatment by exposure in vivo in a balanced design. Short-term results replicated those of a previous study that self-control of heart rate with the aid of biofeedback significantly reduced heart rate during treatment, but this did not hasten reduction of subjective anxiety, nor of respiratory rate or skin conductance responses. An hour's pretreatment training in self-control of heart rate with the aid of feedback did not enhance the effect. Mere instructions to lower heart rate without feedback had a significant effect during treatment, but the addition of heart rate feedback to instructions significantly augmented the decline in heart rate.

Feedback of true heart rate during exposure in vivo.

Ten women with specific chronic animal phobias were treated by graded exposure in vivo in two to four two-hour treatment sessions. Sessions were divided into four balanced half-hour epochs, half with visual feedback of true heart rate plus instructions to lower heart rate during approach to phobic stimulus. All patients improved significantly from the start to end of sessions on heart rate and on subjective anxiety. Feedback of heart rate plus instructions to lower it substantially reduced heart rate during epochs of feedback, compared to non-feedback epochs without instructions, but this effect did not generalize to skin conductance or to subjective anxiety in our short-term experiment.