Patient-centered Outcomes in Breast Cancer: Description of EQ-5D-5L and EORTC-QLQ-BR23 Measurements in Real-world Data and Their Association With Survival.

AIMS: In recent years, major improvements in breast cancer treatments have led to a significant increase in survival. Despite that, this population's quality of life (QoL) information is lacking, especially real-world data. MATERIALS AND METHODS: This was a prospective, multicentre, observational study of female breast cancer patients, without prior systemic treatment, treated between 2012 and 2019 in private health care in Brazil. QoL was assessed by two questionnaires, the EQ-5D-5L and the EORTC-QLQ-BR23. Additional data were retrospectively collected. RESULTS: The study comprised 1372 patients, most with early-stage disease (80.2% stages 0-II). At a median follow-up of 25.6 months, the estimated 3-year overall survival was 93.6%. Patients with locally advanced and metastatic breast cancer had the lowest visual analogue scale scores and the highest symptom burden in all dimensions of EQ-5D-5L, but with the most significant improvement after treatment. With the EORTC-QLQ-BR23 questionnaire, patients undergoing lumpectomy had a better perception of body image. Axillary dissection led to greater arm symptoms after 12 months, radiotherapy enhanced breast symptoms and patients treated with chemotherapy had significant worsening in the effects of systemic therapy compared with endocrine or HER2 therapy. Staging and immunohistochemical subtype correlated with survival and with several QoL parameters, but overall survival was not independently affected by patient-reported outcomes in this cohort. CONCLUSION: Our results show that early diagnosis and access to treatments with fewer side-effects, such as endocrine or targeted therapy, and less aggressive surgeries are the best strategies to achieve a better QoL for breast cancer patients.

Higher values of triglycerides:HDL-cholesterol ratio hallmark disease severity in children and adolescents with sickle cell anemia.

Dyslipidemia has been described in sickle cell anemia (SCA) but its association with increased disease severity is unknown. Here, we examined 55 children and adolescents with SCA as well as 41 healthy controls to test the association between the lipid profiles in peripheral blood and markers of hemolysis, inflammation, endothelial function, and SCA-related clinical outcomes. SCA patients exhibited lower levels of total cholesterol (P<0.001), low-density lipoprotein cholesterol (LDL-c) (P<0.001), and high-density lipoprotein cholesterol (HDL-c) (P<0.001), while displaying higher triglyceride (TG) levels and TG/HDL-c ratio values (P<0.001). TG/HDL-c values were positively correlated with lactate dehydrogenase (P=0.047), leukocyte count (P=0.006), and blood flow velocity in the right (P=0.02) and left (P=0.05) cerebral artery, while being negatively correlated with hemoglobin levels (P<0.04). Acute chest syndrome (ACS) and vaso-occlusive events (VOE) were more frequent in SCA patients exhibiting higher TG/HDL-c values (odds ratio: 3.77, P=0.027). Multivariate logistic regression analysis confirmed independent associations between elevated TG/HDL-c values and SCA. Thus, children and adolescents with SCA exhibited a lipid profile associated with hemolysis and inflammatory parameters, with increased risk of ACS and VOE. TG/HDL-c is a potential biomarker of severity of disease.

Reaction on "Ocular ultrasound versus MRI in the detection of extrascleral extension in a patient with choroidal melanoma".

BACKGROUND: In the recently published article entitled "Ocular ultrasound versus MRI in the detection of extrascleral extension in a patient with choroidal melanoma" Jacobsen et al. describe a case in which a hyper-intense extra-ocular lesion on MRI was erroneously diagnosed as an extrascleral extension of the tumor. Based upon this the authors conclude "the superiority of ocular ultrasound in the diagnostic management of extra scleral extension in choroidal melanoma". In our view, there are numerous flaws in the investigation that cast doubt on this message. MAIN: First of all, this is quite a bold statement when only one patient has been evaluated. Secondly, the manuscript only presents a post-contrast T1-weighted image, whereas multiple MRI-sequences need to be included to determine if a hyperintense region is an extrascleral invasion. Moreover, no modern MRI-techniques such Dynamic Contrast Enhanced (DCE) or Diffusion Weighted Imaging (DWI) have been included in the evaluation of this patient, making it hard to use this single case to compare the efficacy of MRI and Ultrasound. The presented data do, however, give clear clues that the hyperintense lesion is likely to be inflammatory. CONCLUSION: Although the study falls short in providing a comprehensive comparison between current MRI techniques and ultrasound, it does show that the evaluation of ocular MR-images should be made in a multi-disciplinary setting involving both ophthalmologist and radiologists, since the field of ocular MRI is continuously progressing.

Higher values of triglycerides: HDL-cholesterol ratio hallmark disease severity in children and adolescents with sickle cell anemia

Dyslipidemia has been described in sickle cell anemia (SCA) but its association with increased disease severity is unknown. Here, we examined 55 children and adolescents with SCA as well as 41 healthy controls to test the association between the lipid profiles in peripheral blood and markers of hemolysis, inflammation, endothelial function, and SCA-related clinical outcomes. SCA patients exhibited lower levels of total cholesterol (P<0.001), low-density lipoprotein cholesterol (LDL-c) (P<0.001), and high-density lipoprotein cholesterol (HDL-c) (P<0.001), while displaying higher triglyceride (TG) levels and TG/HDL-c ratio values (P<0.001). TG/HDL-c values were positively correlated with lactate dehydrogenase (P=0.047), leukocyte count (P=0.006), and blood flow velocity in the right (P=0.02) and left (P=0.05) cerebral artery, while being negatively correlated with hemoglobin levels (P<0.04). Acute chest syndrome (ACS) and vaso-occlusive events (VOE) were more frequent in SCA patients exhibiting higher TG/HDL-c values (odds ratio: 3.77, P=0.027). Multivariate logistic regression analysis confirmed independent associations between elevated TG/HDL-c values and SCA. Thus, children and adolescents with SCA exhibited a lipid profile associated with hemolysis and inflammatory parameters, with increased risk of ACS and VOE. TG/HDL-c is a potential biomarker of severity of disease.

CT and MR Imaging in the Diagnosis of Scleritis.

Scleritis is a rare, underdiagnosed vision-threatening condition that can occur isolated or in association with other orbital abnormalities. The etiology of scleritis is mainly inflammatory noninfectious, either idiopathic or in the context of systemic disease. Ultrasonography remains the criterion standard in diagnostic imaging of this condition but might prove insufficient, and studies on the diagnostic value of CT and MR imaging are lacking. We retrospectively analyzed 11 cases of scleritis in which CT and/or MR imaging were performed during the active phase of disease and assessed the diagnostic utility of these techniques. The most important imaging findings of scleritis were scleral enhancement, scleral thickening, and focal periscleral cellulitis. MR imaging is the recommended imaging technique, though posterior scleritis also can be accurately diagnosed on CT. It is important for the radiologist to be acquainted with these findings because being able to diagnose scleritis is of clinical significance and might be vision-saving.

Divergência genética entre genótipos de frangos tipo caipira / Genetic divergence between genotypes of alternative strain of broiler chickens

Objetivou-se com este trabalho verificar a divergência genética entre sete genótipos de frangos tipo caipira da linhagem Redbro utilizando as características de desempenho por meio de técnicas de análise multivariada. Foram utilizados 840 pintos de um dia, machos, distribuídos em delineamento inteiramente ao acaso, dos seguintes genótipos: Caboclo, Carijó, Colorpak, Gigante Negro, Pesadão Vermelho, Pescoço Pelado e Tricolor. Após a consistência dos dados, foram avaliadas as seguintes variáveis: ganho em peso médio diário, consumo de ração médio diário e conversão alimentar, para os períodos: 1 a 28, 1 a 56, 1 a 70 e 1 a 84 dias de idade; peso corporal ao nascimento, aos 28, 56, 70 e aos 84 dias de idade. O desempenho dos genótipos foi avaliado por meio da análise de variância multivariada e da função discriminante linear de Fisher, usando os testes do maior autovalor de Roy e da união-interseção de Roy para as comparações múltiplas. O estudo da divergência genética foi feito por meio da análise por variáveis canônicas e pelo método de otimização de Tocher. Os genótipos Caboclo e Gigante Negro apresentaram médias canônicas diferentes dos demais genótipos. As duas primeiras variáveis canônicas explicaram 97,41% da variação entre os genótipos. A divergência genética entre os genótipos avaliados permitiu a formação de quatro grupos com os seguintes genótipos: grupo 1 - Colorpak; grupo 2 - Pesadão Vermelho e Pescoço Pelado; grupo 3 - Carijó e Tricolor; e grupo 4 - Caboclo e Gigante Negro.

The aim of this study was to evaluate the genetic divergence among seven genotypes of alternative strain of broiler chickens of the Redbro strain using the performance characteristics using multivariate analysis. We used 840 day old male chicks, distributed in a completely randomized design, with the following genotypes: Caboclo, Carijó, Colorpak, Gigante Negro, Pesadão Vermelho, Pescoço Pelado and Tricolor. After the consistency of the data, the following variables were analyzed: average daily gain, average daily feed intake and feed conversion for the periods: 1 to 28, 1 to 56, 1 to 70 and 1 to 84 days of age, body weight at birth, at 28, 56, 70 and at 84 days old. The performance of genotypes was assessed by multivariate analysis of variance and Fisher's linear discriminant function, using the tests of the largest eigenvalue of Roy and the Roy union-intersection for multiple comparisons. The study of genetic diversity was done by canonical variate analysis and the method of Tocher. The genotypes Caboclo and Gigante Negro had different canonical averages from the other genotypes. The first two canonical variables accounted for 97.41% of the variation among genotypes. The genetic divergence between the genotypes allowed the formation of four groups with the following genotypes: group 1 - Colorpak, group 2 - Pesadão Vermelho and Pescoço Pelado; group 3 - Carijó and Tricolor, and group 4 - Caboclo and Gigante Negro.

Avaliação genética de caprinos da raça Saanen nascidos no Brasil de 1979 a 2009 / Genetic evaluation of Saanen goats born in Brazil from 1979 to 2009

O objetivo deste trabalho foi estimar herdabilidades, correlações genéticas e fenotípicas e tendências genéticas das características morfológicas e de tipo de caprinos da raça Saanen nascidos no Brasil de 1979 a 2009. Dados de 1243 caprinos, 197 machos e 1046 fêmeas, foram utilizados para estimar parâmetros genéticos e tendência das características: perímetro torácico, comprimento corporal, altura na cernelha, altura, largura e comprimento da garupa, bem como as principais características que definem o padrão racial e a aptidão do animal (paleta e linha superior, membros e pés, tipo leiteiro, capacidade de corpo, úbere, ligamento traseiro e dianteiro, textura do úbere, tetos e nota). Os componentes de variância foram estimados pelo método da máxima verossimilhança restrita em análise multicaracterística. A tendência genética foi obtida por meio da regressão dos valores genéticos médios por ano de nascimento. As estimativas de herdabilidade das características morfofuncionais variaram de 0,08 a 0,45, as correlações genéticas de -0,58 a 0,89 e fenotípicas de -0,11 a 0,87. A tendência foi de um leve declínio ao longo dos anos para a maior parte das características avaliadas, o que evidencia a existência de variabilidade genética aditiva entre os animais, mas demonstra que a seleção praticada tem sido pouco efetiva...

The aim of this study was to estimate heritability, genetic and phenotypic correlations and genetic trends of morphological characteristics and type of Saanen goats born in Brazil from 1979 to 2009. Data from 1243 goats, 197 males and 1046 females were used to estimate genetic parameters and trends for the following traits: girth, body length, wither height, height, width and rump length, and the main traits that define the breed standard and ability of the animal (shoulder and topline, limbs and feet, dairy type, body capacity, mammary gland, linking front and rear, texture of the udder, teats and note). Variance components were estimated by Restricted Maximum Likelihood multi-trait analysis. Genetic trends were obtained by regression of mean breeding values by year of birth. The heritability estimates of morphological and functional traits ranged from 0.08 to 0.45, the genetic correlations from -0.58 to 0.89 and phenotypes from -0.11 to 0.87. The trend was a slight decline over the years for most traits, which shows the existence of additive genetic variability among animals, but it demonstrates that the selection practiced has been ineffective...

A time-compressed simulated geomagnetic storm influences the nest-exiting flight angles of the stingless bee Tetragonisca angustula.

Insects have been used as models for understanding animal orientation. It is well accepted that social insects such as honeybees and ants use different natural cues in their orientation mechanism. A magnetic sensitivity was suggested for the stingless bee Schwarziana quadripunctata, based on the observation of a surprising effect of a geomagnetic storm on the nest-exiting flight angles. Stimulated by this result, in this paper, the effects of a time-compressed simulated geomagnetic storm (TC-SGS) on the nest-exiting flight angles of another stingless bee, Tetragonisca angustula, are presented. Under an applied SGS, either on the horizontal or vertical component of the geomagnetic field, both nest-exiting flight angles, dip and azimuth, are statistically different from those under geomagnetic conditions. The angular dependence of ferromagnetic resonance (FMR) spectra of whole stingless bees shows the presence of organized magnetic nanoparticles in their bodies, which indicates this material as a possible magnetic detector.

Unfolding neutron spectra obtained from BS-TLD system using genetic algorithm.

Due to the variability of neutron spectrum within the same environment, it is essential that the spectral distribution as a function of energy should be characterized. The precise information allows radiological quantities establishment related to that spectrum, but it is necessary that a spectrometric system covers a large interval of energy and an unfolding process is appropriate. This paper proposes use of a technique of Artificial Intelligence (AI) called genetic algorithm (GA), which uses bio-inspired mathematical models with the implementation of a specific matrix to unfolding data obtained from a combination of TLDs embedded in a BS system to characterize the neutron spectrum as a function of energy. The results obtained with this method were in accordance with reference spectra, thus enabling this technique to unfold neutron spectra with the BS-TLD system.

Comparative anatomical study of the forearm extensor muscles of Cebus libidinosus (Rylands et al., 2000; Primates, Cebidae), modern humans, and other primates, with comments on primate evolution, phylogeny, and manipulatory behavior.

Despite its abundance in Latin America, and its remarkable ability to use tools, there are only a few myological studies on the capuchin monkey, Cebus libidinosus. In the present study, we dissected the forearm extensor muscles of six adult males and two adult females of this species. We describe these muscles and compare them with those of other primates dissected by us and by other authors. The forearm extensor muscles of Cebus monkeys are, in general, more similar to those of other platyrrhines than to distantly related taxa that use tools, such as chimpanzees and modern humans, with three main exceptions: contrary to most other platyrrhines, (1) in Cebus, chimpanzees and modern humans the extensor pollicis longus usually inserts onto Digit I, and not onto Digits I and II; (2) in Cebus the abductor pollicis longus has two separate tendons, as is the case in chimpanzees, and in modern humans (where one of these tendons is associated with a distinct belly, forming the muscle extensor pollicis brevis); (3) in Cebus, and in modern humans and chimpanzees, the extensor pollicis longus is not deeply blended with the extensor indicis. Therefore, the Cebus monkeys provide an illustrative example of how phylogenetic constrains and ecological adaptations have been combined to develop a specific myological configuration that, associated with their sophisticated neurological organization, allow them to easily navigate in their arboreal habitats and, at the same time, to finely manipulate objects in order to search for food and to prepare this food for ingestion.

Effects of glycerol and sorbitol on the thermal dependence of the lysis of human erythrocytes by ethanol.

In this work, the effects of 1 mol/L glycerol or sorbitol on the thermal dependence (27-47 degrees C) of the lysis of human erythrocytes by ethanol in saline solution (0.154 mol/L NaCl) have been evaluated. Lysis was monitored by measurement of the absorbance at 540 nm. Ethanol produced either lysis or protection against lysis depending on the conditions. These antagonistic effects are attributed to the existence of expanded (R) and compacted (T) erythrocytes, present under conditions of low and high osmolarity, respectively. The transitions of lysis of the R state and formation and lysis of the T state were all found to be sigmoidally defined. The ethanol concentration at the midpoint of the lysis transition of the R state (D(50R)) was found to decrease with increasing temperature and osmolarity. In the presence of glycerol or sorbitol, an increase in temperature led to smaller decreases in D(50R) and osmotic protection against lysis. The ethanol concentration at the midpoint of formation (S(50T)) and lysis (D(50T)) of the T state also decreased with increasing temperature and osmolarity. Lysis of R state erythrocytes is determined by the chaotropic action of ethanol, but the formation and lysis of T state erythrocytes are determined by osmotic pressure effects.

Less postoperative nausea and vomiting after propofol + remifentanil versus propofol + fentanyl anaesthesia during plastic surgery.

BACKGROUND: The effect of different opioids on postoperative nausea and vomiting (PONV) has not been conclusively determined yet, thus the aim of this study was to compare the incidence of PONV in propofol-anaesthetized patients receiving either fentanyl or remifentanil as opioid supplement. METHODS: Sixty ASA physical status I and II patients scheduled for plastic surgery gave their written informed consent for this prospective, randomized, double-blind study. Anaesthesia was induced with propofol, rocuronium and fentanyl (n = 30; 2 microg kg(-1)) or remifentanil (n = 30; 1 microg kg(-1)). After tracheal intubation, anaesthesia was maintained with propofol, oxygen in air and an infusion of the opioid studied, which was modified according to clinical criteria. Baseline postoperative analgesia was achieved with intravenous propacetamol + metamizol. Intravenous morphine was given if visual analogic scale (VAS) for pain was > or = 4 (scale 0-10) and metoclopramide was administered if a patient presented > or = 2 PONV episodes (nausea or vomiting) in less than 30 min. Postoperatively (2, 12 and 24 h), we registered VAS, rescue morphine consumption, number of patients with episodes of PONV and number of patients requiring metoclopramide. P < 0.05 was considered significant. RESULTS: There were no significant differences between groups in the demographic parameters, ASA physical status, propofol dose, VAS, and rescue morphine requirements. Fourteen patients in the fentanyl group and four in the remifentanil group presented PONV episodes 2-12 h postoperative hours' interval; (P < 0.05). Ten patients in the fentanyl group and four in the remifentanil group presented vomiting episodes in the same period (P < 0.05); and eight patients in the fentanyl group and one in the remifentanil group required metoclopramide; (P < 0.05). The number of postoperative PONV episodes were low, both in the 0-2-h period (n = 2 vs. n = 1, fentanyl and remifentanil, respectively) and in the 12-24-h period (n = 3 vs. n = 1). CONCLUSION: Propofol + fentanyl anaesthesia resulted in a higher incidence of PONV and requirements of antiemetic drugs in the period between 2 and 12 postoperative hours compared with propofol + remifentanil, in patients undergoing plastic surgery.

Quantitative and descriptive analysis of the meniscotibial ligament in human corpses

The meniscotibial ligaments (LMT) of humans are capsular fibers with proximal origin in the lateral border of the menisci and distal insertion in the lateral border of the tibial condyle, also called coronary ligament of the knee. However, few studies describe the presence, course and anatomical variations of this ligament. Our objective was to evaluate the LMT through quantitative and descriptive methods. Eighty-five knees were examined(42 right knees [RK] and 43 left knees [LK]), dissected, evaluated, catalogued and photographed by four examiners. Twenty knees (23.53%) presented LMT, 6 (30%) in RK and 14 (70%) in LK. In two RKs, the LMT presented proximal insertion in the medial menisci and distal insertion in medial tibial condyle; in the other ones, the LMT presented proximal insertion in the lateral menisci and distal insertion in the lateral tibial condyle. In the LK, four LMT presented proximal insertion in the medial menisci and distal insertion in the medial tibial condyle, while the other ones presented proximal insertion in the lateral menisci and distal insertionin the lateral tibial condyle. One LMT in the LK presented proximal and distal insertion in both menisci and tibial condyle. The analysis of human corpses in our study suggests that the presence of the LMT is much more common in the LK than in the RK, with more frequent insertion in the proximal region of the lateral menisci and distal insertion in the lateral tibial condyle.

[Fentanyl or remifentanil to potentiate a single dose of rocuronium in patients anesthetized with propofol with evaluation by accelerometry]. / Potenciación de una dosis única de rocuronio por fentanilo o remifentanilo en pacientes anestesiados con propofol. Evaluación por acelerometría.

OBJECTIVE: To compare the increase in potency of a single dose of rocuronium during anesthesia with propofol combined with either fentanyl or remifentanil. PATIENTS AND METHODS: Forty patients scheduled for plastic surgery were distributed in 2 groups of 20 according to the opioid drug assigned: fentanyl or remifentanil. Induction with propofol was accomplished by computer-controlled infusion, with response measured in the adductor pollicis muscle. After calibration, a dose of 0.6 mg/Kg of rocuronium was infused. Anesthesia was maintained with propofol, oxygen in air, and an equipotent dose of either fentanyl or remifentanil, which was modified to maintain heart rate and systolic arterial pressure within 30% above or below baseline levels. Patient characteristics recorded were age, sex, height, weight, ASA class, type of surgery, and the propofol and opioid doses consumed. Intubation conditions and time to onset of action of rocuronium (T1), of recovery of the first response in a train of four (RT1), and of recovery of 25% of the first response or clinical duration. RESULTS: The groups were statistically similar in terms of demographic variables, type of surgery, propofol and opioid consumption, intubation conditions, and rocuronium T1 and RT1. Clinical duration of anesthesia was longer (p<0.05) in the remifentanil group (33.1 +/- 10 minutes) than in the fentanyl group (27.1 +/- 7.4 minutes). CONCLUSIONS: Remifentanil administered in combination with propofol for anesthesia does not affect time of onset of a single dose of 0.6 mg/Kg dose of rocuronium, but clinical duration of anesthesia is longer with remifentanil and propofol than with the fentanyl and propofol combination. The surgical and intubation conditions achieved with both combinations are adequate and similar.

[Prolonged neuromuscular block after a single dose of vecuronium in a patient with undiagnosed polyneuropathy and steroid myopathy]. / Bloqueo neuromuscular prolongado tras dosis única de vecuronio en un paciente con polineuropatía y miopatía esteroide no diagnosticadas.

We report the case of a patient who had been receiving long-term corticoid therapy with undiagnosed polyneuropathy and steroid-related myopathy before experiencing prolonged neuromuscular blockade (lasting longer than 4 hours) after administration of a single dose of 0.08 mg/kg of vecuronium. Neuromuscular function was monitored by accelerometry with four-stimuli series. Many of the circumstances present in this case -such as prior administration of succinylcholine, the use of an inhaled anesthetic, kidney insufficiency and cyclosporin therapy- have been associated with increased duration of blockade induced by neuromuscular blockers, although durations reported have been shorter than that experienced by our patient. After electromyography and muscle biopsy, polyneuropathy and steroid-related myopathy were diagnosed. We conclude that neuromuscular blockers should be administered with extreme caution to patients with polyneuropathy and those undergoing long-term corticoid therapy, in order to prevent prolonged neuromuscular blockade.

[Epidural abscess secondary to the implantation of a thoracic catheter]. / Absceso epidural secundario a la implantación de un catéter torácico.

Spinal compression related to the formation of an epidural abscess after epidural blockade is a rare but serious complication. We report the case of a male patient in whom a thoracic epidural catheter was implanted to provide analgesia after trauma involving fracture ribs. The patient developed an epidural abscess within one week of implantation. Delay in diagnosis led to persistent neurogenic bladder symptoms in spite of aggressive treatment. We review causal factors, mechanisms of formation, pathogenesis, diagnosis and management, as well as possible relation between injury and abscess formation. We also emphasize the importance of adequate vigilance as well as rapid diagnosis and adoption of therapeutic measures in order to avoid permanent sequelae such as paresis, sensory deficits or mechanical sphincter dysfunction.

Compartment syndrome with severe rhabdomyolysis in the postoperative period following major vascular surgery.

We report a case of compartment syndrome with marked rhabdomyolysis in the immediate postoperative period following major vascular surgery. Early and aggressive treatment, based on intravenous fluids, sodium bicarbonate, mannitol and fasciotomy, resulted in satisfactory management of the patient and prevented the onset of severe complications, such as acute renal failure in a patient who presented several factors that predisposed him to this disorder.