Treatment patterns and healthcare resource utilization for triple negative breast cancer in the Brazilian private healthcare system: a database study.

In Brazil, data on the management of triple negative breast cancer (TNBC) as well as the burden of the disease in terms of health care resources utilization (HCRU) are scarce. To characterize the treatment patterns and HCRU associated with the management of Brazilian TNBC patients from the perspective of the private healthcare setting. Patients with at least one claim related to ICD-10 C50 from January 2012 until December 2017, and at least one claim for breast cancer treatment were assessed from a private claims database and classified as early and locally advanced, or metastatic. All patients with hormone and/or targeted therapy were excluded. Three thousand and four patients were identified, of which 82.8% were diagnosed in early and locally advanced stages. For early and locally advanced TNBC patients, 75.3% were treated in an adjuvant setting, mainly with anthracycline regimes. For mTNBC patients, bevacizumab regimens were the main treatment prescribed. More than 48% of mTNBC patients were switched to a second line of treatment. HCRU was higher for mTNBC patients when compared to early and locally advanced patients, with higher costs for metastatic disease management. The treatment setting has little influence on the HCRU pattern or the cost of disease management. The highest burden of disease was observed for metastatic management.

The Impact of an Inactivated Hepatitis A Vaccine with One Dose in Brazil: A Retrospective Time-Series.

BACKGROUND: In 2014, a recommended one-dose of inactivated hepatitis A vaccine was included in the Brazilian National Immunization Program targeting children 12-24 months. This decision addressed the low to intermediate endemicity status of hepatitis A across Brazil and the high rate of infection in children and adolescents between 5 and 19 years old. The aim of the study was to conduct a time-series analysis on hepatitis A incidence across age groups and to assess the hepatitis A distribution throughout Brazilian geographic regions. METHODS: An interrupted time-series analysis was performed to assess hepatitis A incidence rates before (2010-2013) and after (2015-2018) hepatitis A vaccine program implementation. The time-series analysis was stratified by age groups while a secondary analysis examined geographic distribution of hepatitis A cases. RESULTS: Overall incidence of hepatitis A decreased from 3.19/100.000 in the pre-vaccine period to 0.87/100.000 (p = 0.022) post-vaccine introduction. Incidence rate reduction was higher among children aged 1-4 years old, with an annual reduction of 67.6% in the post-vaccination period against a 7.7% annual reduction in the pre-vaccination period (p < 0.001). Between 2015 and 2018, the vaccination program prevented 14,468 hepatitis A cases. CONCLUSION: Our study highlighted the positive impact of a recommended one-dose inactivated hepatitis A vaccine for 1-4-years-old in controlling hepatitis A at national level.

Malnutrition suppresses cell cycle progression of hematopoietic progenitor cells in mice via cyclin D1 down-regulation.

OBJECTIVE: Protein malnutrition (PM) often is associated with changes in bone marrow (BM) microenvironment leading to an impaired hematopoiesis; however, the mechanism involved is poorly understood. The aim of this study was to compare the cell cycle progression of hematopoietic stem cells (HSC) and hematopoietic progenitor cells (HPC) and evaluate the cell cycle signaling in malnourished mice to assess the mechanism of cell cycle arrest. METHODS: C57Bl/6J mice were randomly assigned in control and malnourished groups receiving normoproteic and hypoproteic diets (12% and 2% protein, respectively) over a 5-wk period. Nutritional and hematologic parameters were assessed and BM immunophenotypic analysis was performed. Cell cycle of HPC (Lin(-)) and HSC (Lin(-)Sca-1(+)c-Kit(+)) were evaluated after 6 h of in vivo 5-bromo-2'-deoxyuridine (BrDU) incorporation. Cell cycle regulatory protein expression of HPC was assessed by Western blot. RESULTS: Malnourished mice showed lower levels of serum protein, albumin, glucose, insulin-like growth factor-1, insulin, and higher levels of serum corticosterone. PM also caused a reduction of BM myeloid compartment resulting in anemia and leukopenia. After 6 h of BrDU incorporation, malnourished mice showed G0-G1 arrest of HPC without changes of HSC proliferation kinetics. HPC of malnourished mice showed reduced expression of proteins that induce cell cycle (cyclin D1, cyclin E, pRb, PCNA, Cdc25a, Cdk2, and Cdk4) and increased expression of inhibitory proteins (p21 and p27) with no significant difference in p53 expression. CONCLUSION: PM suppressed cell cycle progression mainly of HPC. This occurred via cyclin D1 down-regulation and p21/p27 overexpression attesting that BM microenvironment commitment observed in PM is affecting cell interactions compromising cell proliferation.

The effect of mate tea (Ilex paraguariensis) on metabolic and inflammatory parameters in high-fat diet-fed Wistar rats.

This study investigated the effects of mate tea (Ilex paraguariensis) aqueous extract consumption on metabolic indicators and inflammatory response of peritoneal macrophages in rats fed a high-fat diet (HFD). Male Wistar rats were fed a control diet or a HFD for 12 weeks. At the end of this period, rats received, or not, daily doses of yerba maté for 4 weeks. The consumption of yerba maté promoted weight loss, attenuated the HFD-detrimental effects on adiposity and insulin sensitivity and decreased blood levels of the inflammatory biomarkers (p < 0.05). Concerning peritoneal macrophages, mate tea consumption decreased the production of interleukin (IL)-6, but did not influence the production of IL-1ß, tumour necrosis factor-α and nitric oxide; cytokine mRNA expression; or the activation of the nuclear factor-κB signalling pathway. In summary, the consumption of mate tea had no consistent effect in the inflammatory response of peritoneal macrophages, but reduced cardiometabolic risk markers.

Effects of glutamine on the nuclear factor-kappaB signaling pathway of murine peritoneal macrophages.

The aim of this study was to evaluate the effect of glutamine on the expression of proteins involved in the nuclear factor-kappaB (NF-kappaB) signaling pathway of murine peritoneal macrophages. Since glutamine is essential for the normal functioning of macrophages, it was hypothesized that in vitro glutamine supplementation would increase NF-kappaB activation. Peritoneal macrophages were pretreated with glutamine (0, 0.6, 2 and 10 mM) before incubation with lipopolysaccharide (LPS), and the effects of glutamine on the production of tumor necrosis factor-alpha and on the expression and activity of proteins involved in the NF-kappaB signaling pathway were studied by an enzyme linked immuno-sorbent assay, Western blotting, and an electrophoretic mobility shift assay. Glutamine treatment (2 and 10 mM) increased the activation of NF-kappaB in LPS-stimulated peritoneal macrophages (P < 0.05). In non-stimulated cells, glutamine treatment (2 and 10 mM) significantly reduced I kappaB-alpha protein expression (P < 0.05). Glutamine modulates NF-kappaB signaling pathway by reducing the level of I kappaB-alpha, leading to an increase in NF-kappaB within the nucleus in peritoneal macrophages.

Avaliação do ciclo celular de células tronco/progenitoras hemopoéticas da medula óssea de camundongos submetidos à desnutrição protéica / Hematopoietic stem/progenitor cell cycle evaluation from bone marrow of malnourished mice

A hemopoese é um processo dinâmico regulado pelo microambiente no qual se situa. O principal tecido hemopoético após o nascimento, a medula óssea, é constituído basicamente por substâncias solúveis, como fatores de crescimento, por uma matriz extracelular (MEC) e por células estromais, além das células hemopoéticas. Esse microambiente indutor íntegro é capaz de regular os processos de sobrevivência, proliferação e diferenciação celular, induzindo a célula a sair de um estado quiescente e entrar em ciclo celular. Contudo, na desnutrição protéica (DP) observa-se redução significativa da celularidade das células hemopoéticas, tanto no compartimento periférico quanto no central, a medula óssea. O comprometimento estrutural do microambinte medular decorrente da desnutrição pode prejudicar a sinalização de indução do ciclo celular, fato este que justificaria o quadro de pancitopenia. Portanto, no presente estudo nos propusemos avaliar o ciclo celular de células tronco/progenitoras hemopoéticas (CTPH) da medula óssea de camundongos desnutridos. Para tanto, utilizamos um modelo murino, sendo a desnutrição induzida a partir de uma ração hipoprotéica. As CTPH foram obtidas por método de depleção imunomagnética e utilizadas para a avaliação do ciclo celular a partir da incorporação de Iodeto de Propídeo (PI) e Laranja de Acridina (AO). Também, foram quantificadas proteínas regulatórias do ciclo celular por western blot e avaliada a expressão de receptores para fibronectina, VLA4 e VLA5. Paralelamente, em modelo ex vivo, avaliou-se a influência de fatores de crescimento e de uma matriz de fibronectina sobre a proliferação das CTPH. Considerando a importância das células estromais na sinalização celular, realizamos o ensaio de CFU-F para a quantificação de células estromais e dos fatores de crescimento secretados. Por fim, avaliamos a eficácia da recuperação nutricional frente às alterações no ciclo celular observadas no modelo de desnutrição...

Hematopoiesis is a dynamic process governed by the microenvironment in witch it is located. Basically, the main hematopoietic tissue, the bone marrow, is composed by soluble factors such growth factors, extracellular matrix (ECM) and stromal cells, besides the hematopoietic cells. This intact inducible microenvironment is capable to control cell survival, proliferation and differentiation, inducing cell to exit a quiescent state and enter the cell cycle. However, in protein malnutrition (PM) is observed a significant reduction of hematopoietic cells, both in peripheral and central compartments. The bone marrow structural impairment due to malnutrition could harm the cell cycle signaling, a fact that could justify the establishment of pancitopenia. Therefore, in this study we set out to assess the cell cycle of hematopoietic stem/progenitors cells (HSPC) from bone marrow of malnourished mice. We used a murine model, and malnutrition induced from a low protein diet. The HPSC were obtained by immunomagnetic depletion method and used for the evaluation of cell cycle from the incorporation of propidium iodide (PI) and Acridine Orange (AO). Also, we quantified the cell cycle regulatory proteins by western blot and evaluated the expression of receptors for fibronectin, VLA4 and VLA5. Meanwhile, in ex vivo model, we evaluated the influence of growth factors and a matrix of fibronectin on the proliferation of HSPC. Considering the importance of stromal cells in cell signaling, we performed the CFU-F assay for the quantification of stromal cells and growth factors secreted. Finally, we evaluated the efficacy of nutritional recovery in the face of cell cycle alterations observed in the model of malnutrition. Briefly, we observed an impairment in the cell cycle of HSPC of undernourished mice, with an increase in this cell population in G0/G1 phase. The proteins that induce cell cycle showed a reduced expression whereas the inhibitory proteins showed increased...

Malnourished mice display an impaired hematologic response to granulocyte colony-stimulating factor administration.

The aim of this study was to determine if protein-energy malnutrition could affect the hematologic response to granulocyte colony-stimulating factor (G-CSF). Swiss mice were fed a low-protein diet containing 4% protein, whereas control mice were fed a 20% protein-containing diet. After the malnourished group lost 20% of their original body weight, the mice were subdivided in 2 treatment groups, and hematopoietic parameters were studied. Mice were injected with either 8 microg/kg per day of G-CSF or saline twice daily for 4 days. Malnourished mice developed anemia with reticulopenia and leukopenia with depletion of granulocytes and lymphocytes. Both malnourished and control mice treated with G-CSF showed a significant increase in neutrophils; however, in the control group, this increase was more pronounced compared to the malnourished group (4.5-fold and 3.4-fold, respectively). Granulocyte colony-stimulating factor administration increased bone marrow blastic (P < .001) and granulocytic (P < .01) compartments in the controls but had no significant effect on these hematopoietic compartments in the malnourished animals (P = .08 and P = .62, respectively). We report that malnourished mice display an impaired response to G-CSF, which contributes to the decreased production of leukocytes in protein-energy malnutrition.

Protein-energy malnutrition modifies the production of interleukin-10 in response to lipopolysaccharide (LPS) in a murine model.

Malnutrition modifies resistance to infection by impairing a number of physiological processes including hematopoesis and the immune response. In this study, we examined the production of Interleukin-4 (IL-4) and IL-10 in response to lipopolysaccharide (LPS) and also evaluated the cellularity of the blood, bone marrow, and spleen in a mouse model of protein-energy malnutrition. Two-month-old male Swiss mice were subjected to protein-energy malnutrition (PEM) with a low-protein diet (4%) as compared to the control diet (20%). When the experimental group lost approximately 20% of their original body weight, the animals from both groups received 1.25 microg of LPS intravenously. The cells in the blood, bone marrow, and spleen were counted, and circulating levels of IL-4 and IL-10 were evaluated in animals stimulated with LPS. Cells from the spleen, bone marrow, and peritoneal cavity of non-inoculated animals were collected for culture to evaluate the production of IL-4 and IL-10 after stimulating these cells with 1.25 microg of LPS in vitro. Malnourished animals presented leucopenia and a severe reduction in bone marrow, spleen, and peritoneal cavity cellularity before and after stimulus with LPS. The circulating levels of IL-10 were increased in malnourished animals inoculated with LPS when compared to control animals, although the levels of IL-4 did not differ. In cells cultured with LPS, we observed high levels of IL-10 in the bone marrow cells of malnourished animals. These findings suggest that malnourished mice present a deficient immune response to LPS. These alterations may be partly responsible for the immunodeficiency observed in these malnourished mice.