Primary chemotherapy versus primary surgery for newly diagnosed advanced ovarian cancer (CHORUS): an open-label, randomised, controlled, non-inferiority trial.

BACKGROUND: The international standard of care for women with suspected advanced ovarian cancer is surgical debulking followed by platinum-based chemotherapy. We aimed to establish whether use of platinum-based primary chemotherapy followed by delayed surgery was an effective and safe alternative treatment regimen. METHODS: In this phase 3, non-inferiority, randomised, controlled trial (CHORUS) undertaken in 87 hospitals in the UK and New Zealand, we enrolled women with suspected stage III or IV ovarian cancer. We randomly assigned women (1:1) either to undergo primary surgery followed by six cycles of chemotherapy, or to three cycles of primary chemotherapy, then surgery, followed by three more cycles of completion chemotherapy. Each 3-week cycle consisted of carboplatin AUC5 or AUC6 plus paclitaxel 175 mg/m(2), or an alternative carboplatin combination regimen, or carboplatin monotherapy. We did the random assignment by use of a minimisation method with a random element, and stratified participants according to the randomising centre, largest radiological tumour size, clinical stage, and prespecified chemotherapy regimen. Patients and investigators were not masked to group assignment. The primary outcome measure was overall survival. Primary analyses were done in the intention-to-treat population. To establish non-inferiority, the upper bound of a one-sided 90% CI for the hazard ratio (HR) had to be less than 1.18. This trial is registered, number ISRCTN74802813, and is closed to new participants. FINDINGS: Between March 1, 2004, and Aug 30, 2010, we randomly assigned 552 women to treatment. Of the 550 women who were eligible, 276 were assigned to primary surgery and 274 to primary chemotherapy. All were included in the intention-to-treat analysis; 251 assigned to primary surgery and 253 to primary chemotherapy were included in the per-protocol analysis. As of May 31, 2014, 451 deaths had occurred: 231 in the primary-surgery group versus 220 in the primary-chemotherapy group. Median overall survival was 22.6 months in the primary-surgery group versus 24.1 months in primary chemotherapy. The HR for death was 0.87 in favour of primary chemotherapy, with the upper bound of the one-sided 90% CI 0.98 (95% CI 0.72-1.05). Grade 3 or 4 postoperative adverse events and deaths within 28 days after surgery were more common in the primary-surgery group than in the primary-chemotherapy group (60 [24%] of 252 women vs 30 [14%] of 209, p=0.0007, and 14 women [6%] vs 1 woman [<1%], p=0.001). The most common grade 3 or 4 postoperative adverse event was haemorrhage in both groups (8 women [3%] in the primary-surgery group vs 14 [6%] in the primary-chemotherapy group). 110 (49%) of 225 women receiving primary surgery and 102 (40%) of 253 receiving primary chemotherapy had a grade 3 or 4 chemotherapy related toxic effect (p=0.0654), mostly uncomplicated neutropenia (20% and 16%, respectively). One fatal toxic effect, neutropenic sepsis, occurred in the primary-chemotherapy group. INTERPRETATION: In women with stage III or IV ovarian cancer, survival with primary chemotherapy is non-inferior to primary surgery. In this study population, giving primary chemotherapy before surgery is an acceptable standard of care for women with advanced ovarian cancer. FUNDING: Cancer Research UK and the Royal College of Obstetricians and Gynaecologists.

Parental body mass index and maternal gestational weight gain associations with offspring body composition in young women from the Nutritionists' Health Study.

Objective: Intrauterine environment can induce fetal metabolic programming that predisposes to adiposity-related chronic diseases in its lifespan. We examined the associations of parental nutritional status and gestational weight gain with offspring body composition in early adulthood. Methods: This is cross-sectional analysis of female participants of the NutriHS who were submitted to questionnaires, clinical examinations and body composition assessed by DXA. Association of preconception parental BMI and maternal gestational weight gain (exposures) with body composition measurements (outcomes) were analyzed using multiple linear models adjusted for Directed Acyclic Graphs-based covariables (maternal and paternal educational level, maternal age, and tobacco, alcohol and/or drugs use). The sample included 124 women (median 28 (24-31) years) with a mean BMI of 25.4 ± 4.7 kg/m2. Results: No association between previous paternal BMI and offspring's body composition was detected. In the fully adjusted linear regression model, maternal BMI was associated with offspring's total lean mass (ß = 0.66, p = 0.001), appendicular skeletal muscle mass index (ASMI) (ß = 0.11, p = 0.003) and fat mass index (FMI) (ß = 0.03, p = 0.039). Gestational weight gain was associated with increased offspring's BMI (OR 1.12 [95% CI 1.02-1.20], p = 0.01). The linear regression model adjusted for maternal age and maternal and paternal education levels showed associations of gestational weight gain with offspring's ASMI (ß = 0.42, p = 0.046), FMI (ß = 0.22, p = 0.005) and android-to-gynoid fat ratio (ß = 0.09, p = 0.035). Conclusion: Our findings suggest that preconception maternal BMI could influence lean mass and general adiposity of young adult female offspring and that gestational weight gain could be useful for predicting centrally distributed adiposity.

Maternal and paternal obesity are associated with offspring obestatin levels in the Nutritionists' Health Study.

OBJECTIVES: The aim of this study was to examine whether paternal and maternal body mass indexes (BMIs) were independently associated with obestatin and visfatin levels in adult offspring. METHODS: This cross-sectional analysis included 124 women who participated in the Nutritionists' Health Study (NutriHS) at baseline. Early life events, anthropometry, dual-energy x-ray absorptiometry-determined body composition and blood sample were obtained. Associations of parental BMI with outcomes (obestatin and visfatin) were tested by multiple linear regression, using minimal sufficient adjustments recommended by Directed Acyclic Graph. Participants' mean BMI was 25 ± 5 kg/m2 and 74% were metabolically healthy. Median obestatin and visfatin levels were 56.4 pg/mL (42-72) and 17.7 ng/mL (14-21.8), respectively. Eleven percent of mothers and 39% of fathers were overweight/obese. RESULTS: Daughters born from overweight/obese mothers had higher BMI than those born from normal weight women (P = 0.003). In adjusted regression model, offspring obestatin levels were associated with maternal BMI (ß = -0.03; P = 0.045) and paternal BMI (ß = -0.02; P = 0.048) independently of maternal and paternal education, maternal age, and maternal use of tobacco, alcohol, and/or drugs. No association was detected with visfatin levels. CONCLUSION: Inverse associations of maternal and paternal BMIs with offspring obestatin concentrations in women could suggest a utility of this biomarker of energy regulation determined in early adulthood. Whether obestatin could be an indicator of protection against obesity-related disorders in the life course requires investigation in studies designed to test such hypothesis.

Parental body mass index and maternal gestational weight gain associations with offspring body composition in young women from the Nutritionists' Health Study

ABSTRACT Objective: Intrauterine environment can induce fetal metabolic programming that predisposes to adiposity-related chronic diseases in its lifespan. We examined the associations of parental nutritional status and gestational weight gain with offspring body composition in early adulthood. Materials and methods: This is cross-sectional analysis of female participants of the NutriHS who were submitted to questionnaires, clinical examinations and body composition assessed by DXA. Association of pre-conception parental BMI and maternal gestational weight gain (exposures) with body composition measurements (outcomes) were analyzed using multiple linear models adjusted for Directed Acyclic Graphs-based covariables (maternal and paternal educational level, maternal age, and tobacco, alcohol and/or drugs use). The sample included 124 women (median 28 (24-31) years) with a mean BMI of 25.4 ± 4.7 kg/m2. Results: No association between previous paternal BMI and offspring's body composition was detected. In the fully adjusted linear regression model, maternal BMI was associated with offspring's total lean mass (β = 0.66, p = 0.001), appendicular skeletal muscle mass index (ASMI) (β = 0.11, p = 0.003) and fat mass index (FMI) (β = 0.03, p = 0.039). Gestational weight gain was associated with increased offspring's BMI (OR 1.12 [95% CI 1.02-1.20], p = 0.01). The linear regression model adjusted for maternal age and maternal and paternal education levels showed associations of gestational weight gain with offspring's ASMI (β = 0.42, p = 0.046), FMI (β = 0.22, p = 0.005) and android-to-gynoid fat ratio (β = 0.09, p = 0.035). Conclusion: Our findings suggest that preconception maternal BMI could influence lean mass and general adiposity of young adult female offspring and that gestational weight gain could be useful for predicting centrally distributed adiposity.

ERICA: consumption of trans fats and saturated fats associated with dyslipidemia in obese and overweight adolescents / ERICA: consumo de grasas trans y grasas saturadas asociado a la dislipidemia en adolescentes con sobrepeso y obesidad

The study aimed to associate the consumption of trans and saturated fats with dyslipidemia in overweight and obese adolescents who participated in the Study of Cardiovascular Risks in Adolescents (ERICA) from February 2013 to November 2014. Anthropometry, food consumption data, and the lipidogram of 9,538 overweight Brazilian adolescents from macro-regions and Teresina were used in the study. We found an association between saturated fats and HDL-c in Teresina and in the Northeastern macro-region (p-value= 0.002 and p-value= 0.033, respectively), showing that adolescents in Teresina who consumed less than 10% of saturated fats were 2.04-fold more likely to have desirable HDL-c (OR= 2.04), while northeastern adolescents were 0.625 less likely to have desirable HDL-c (OR= 0.625). In Teresina, there was an association between saturated fat consumption and total cholesterol (p-value= 0.045), showing that adolescents consuming less than 10% of saturated fats had a 0.543- fold lower odds of having desirable total cholesterol levels (OR= 0.543). Lipid profile was not associated with consumption of trans fats, but with the consumption of saturated fats. It is important to monitor the lipid profile of adolescents, especially in the presence of overweight.

El objective fue asociar el consumo de grasas trans y saturadas y dislipidemia en adolescentes con sobrepeso y obesidad que participaron en el Estudio de Riesgos Cardiovasculares en Adolescentes (ERICA), en el período de febrero de 2013 a noviembre de 2014. Se utilizaron datos antropométricos, consumo alimentario y lipidograma de 9.538 adolescentes, residentes en Brasil, macrorregiones y Teresina. En Teresina y Macroregión Nordeste, hubo asociación entre el consumo de grasa saturada y HDL-c (p-valor= 0,002 y p-valor= 0,033), respectivamente, mostrando que, adolescentes teresinenses con consumo menor que 10% la grasa saturada tiene 2,04 veces más probabilidades de tener HDL-c deseables (OR= 2,04); mientras que los nordestinos que consumen menos del 10% de grasa saturada tienen 0,625 veces la probabilidad de tener HDL-c deseables (OR= 0,625). En Teresina, hubo asociación entre el consumo de grasa saturada y colesterol total (p-valor= 0,045), mostrando que adolescentes con consumo menor que 10% de grasa saturada tienen 0,543 veces la probabilidad de tener colesterol total deseable (OR= 0,543). El perfil lipídico no se asoció al consumo de grasa trans, sino al consumo de grasa saturada. Es importante realizar monitorización del perfil lipídico de adolescentes, especialmente en presencia del sobrepeso.

Enteroparasitosis in patients attended by the health public service: epidemiology and spatial distribution / Enteroparasitoses em pacientes atendidos pelo serviço público de saúde: epidemiologia e distribuição espacial

Aims: This research aims to determine the epidemiology and the spatial distribution of intestinal parasitosis in the city of Teresina, Brazil. Methods: A cross-sectional study was carried out based on the data of parasitological fecal exams performed in the Laboratory Raul Bacelar between January, 2014 and July, 2017. In addition to the prevalence of intestinal parasitosis and polyparasitism, we verified the association of these diseases with gender, zone and period of the year by means of the chi-squared test, whereas the relation with age was analyzed by the Mann-Kendall tests and multiple comparisons of age classes. The spatial distribution was performed using the QGIS georeferencing software. Results: The prevalence of enteroparasitosis in Teresina was 17.8% with Ascaris lumbricoides being the most common species. The prevalence of individuals with polyparasitism was 3.1%, in which an association between the species Entamoeba coli and Entamoeba histolytica/dispar was found. There was no relation between intestinal parasitosis with gender, but we verified that individuals in rural areas were more susceptible to these diseases. The species Ascaris lumbricoides and Entamoeba histolytica/dispar occured more frequently in the first and second semester, respectively. We observed that there was an apparent tendency to increase cases of Entamoeba histolytica/dispar and reduction of cases of Giardia sp. according to aging. Mapping intestinal parasitosis showed us that there was a prevalence between 1 and 20% in most of Teresina's neighborhoods, and Ascariasis embodies at least 40% of cases of enteroparasitosis in these neighborhoods. Conclusions: Investments in basic sanitation and new epidemiological investigations must be carried out to control intestinal parasitosis in Teresina, emphasizing that children and the elderly should be considered priority groups in these programs

Objetivo: Determinar a epidemiologia e a distribuição espacial das parasitoses intestinais no município de Teresina, Brasil. Métodos: Foi realizado um estudo transversal com base nos resultados dos exames parasitológicos de fezes executados no laboratório Raul Bacelar, entre janeiro de 2014 e julho de 2017. Além da prevalência de parasitoses intestinais e de poliparasitismo, verificou-se a associação destas doenças com sexo, zona e período do ano, por meio do teste do qui-quadrado, enquanto a relação com a idade foi analisada pelos testes de Mann-Kendall e comparações múltiplas de faixas etárias. A distribuição espacial foi realizada utilizando o software de georreferenciamento QGIS. Resultados: A prevalência de enteroparasitoses em Teresina foi de 17,8%, sendo Ascaris lumbricoides a espécie mais comum. A prevalência de indivíduos com poliparasitismo foi de 3,1%, na qual foi encontrada uma associação entre as espécies Entamoeba coli e Entamoeba histolytica/dispar. Não houve relação entre parasitoses intestinais e sexo, mas verificou-se que indivíduos na zona rural foram mais suscetíveis a essas doenças. As espécies Ascaris lumbricoides e Entamoeba histolytica/dispar ocorreram com maior frequência, respectivamente, no primeiro e no segundo semestre. Observou-se que houve aparente tendência de aumento de casos de E. histolytica/dispar e de redução de casos de Giardia sp. de acordo com o envelhecimento. O mapeamento das parasitoses intestinais demostrou que houve uma prevalência entre 1 e 20% na maioria dos bairros de Teresina, e a ascaridíase representou pelo menos 40% dos casos de enteroparasitose nesses bairros. Conclusões: Investimentos em saneamento básico e novas investigações epidemiológicas devem ser realizados para o controle das parasitoses intestinais em Teresina, enfatizando que crianças e idosos devem ser considerados grupos prioritários nessas ações.

Endometrial metastasis of colorectal cancer with coincident endometrial adenocarcinoma.

Metastasis to the uterine corpus is uncommon and secondary colorectal tumours of the endometrium are rare. We describe a uterine tumour with components of both primary endometrial and metastatic colorectal carcinomata. In this case, a 72-year-old obese woman presented with a 2-week history of postmenopausal bleeding per vaginum and weight loss. She had an abdominoperineal resection 3 years previously for a Dukes stage B rectal carcinoma. A transvaginal ultrasonography showed a thickened endometrium. Histology immunophenotyping showed a CK7+, CK20+, CA125- and CEA+ colorectal metastasis (a profile consistent with her previous cancer) associated with a primary CK7+, CK20-, CA125+ and CEA- endometroid endometrial adenocarcinoma. We conclude this represents endometrial metastasis of colorectal carcinoma with coincident primary endometrial adenocarcinoma. We speculate as to whether the endometrial carcinoma arose de novo or was induced by the colorectal metastasis, or whether the primary endometrial tumour provided a fertile site for the colorectal metastasis.

Análise da aplicabilidade de sistema mini-VANT comercial no diagnóstico da geração de resíduos de desastres no Brasil / Analysis of the applicability of commercial mini-VANT system in the diagnosis of disaster waste generation in Brazil

A necessidade de minimizar os impactos causados por desastres, e pelos resíduos sólidos neles gerados, motivaram o desenvolvimento da gestão de resíduos de desastres em todo o mundo. Plataformas de sensoriamento remoto orbital e aeronaves tripuladas vêm sendo empregadas no auxílio à gestão de desastres e de seus resíduo, ainda que de forma restrita a casos mais extremos. O desenvolvimento tecnológico dos veículos aéreos não tripulados (VANTs), em especial os modelos civis comerciais de baixo custo, e a formulação da legislação que trata do seu uso, tem viabilizado sua aplicação em distintas áreas, dentre elas o mapeamento de precisão. A fim de analisar a aplicabilidade dessas plataformas de auxilio ao diagnóstico da geração de resíduos de desastres, foram selecionados dois conjuntos fotografias previamente obtidos com um VANT comercial quadrirotor. Em seguida, foi realizado o processamento desses dados no PhotoScan, visando a geração de mapas informativos. Buscou-se analisar a capacidade de identificação, quantificação e caracterização dos resíduos sólidos dispostos nas áreas mapeadas. Aspectos legais, econômicos e técnicos associados ao uso da ferramenta foram contemplados, afim de melhor fundamentar a aplicabilidade em questão. Os resultados indicaram relevante potencial de identificação e quantificação dos resíduos encontrados, e algumas limitações na capacidade de caracterizá-los. A atual legislação, e os aspectos econômicos e técnicos levantados favorecem a utilização de mini-VANT comercial para o uso proposto, ainda que de forma limitada à desastres onde a extensão afetada não seja demasiadamente extensa. A observância às boas praticas na escolha do equipamento, no planejamento e execução de vôo são fundamentais para a geração de mapas informativos contendo o posicionamento, o volume estimado e a composição estimada dos montes de resíduos encontrados

The need to minimize the impacts caused by disasters, and the solid waste generated, motivated the development of methods and practices for the management of disaster residues all over the world. Orbital remote sensing platforms and manned aircraft have been used in the management of disasters and their residues, even though it restricts them to the most extreme cases. The technological development of unmanned aerial vehicles (UAVs), especially low-cost commercial civil models, and the formulation of legislation that deals with their use, has made their application viable in different areas, including precision mapping. In order to analyze the applicability of these platforms in aid of the diagnosis of disaster waste generation, two sets of photographs previously obtained with an "off the shelf" UAV were selected. Then, the processing of these data in PhotoScan was carried out, aiming at the generation of informative maps. It was sought to analyze the capacity of identification, quantification and characterization of the solid residues disposed in the mapped areas. Legal, economic and technical aspects associated to the use of the tool were contemplated, in order to better base the applicability on the question. The results indicated relevant potential of identification and quantification of the residues found, and some limitations in their capacity of characterization. The current legislation, and the economic and technical aspects raised favor the use of commercial mini-VANT for the proposed use, even though in a limited way to disasters where the affected extension is not too extensive. The observance of good practices in the choice of equipment, in the planning and execution of its execution are fundamental for the generation of informative maps containing the positioning, the estimated volume and the estimated composition of the amounts of residues found