The physiological quality of Vigna unguiculata L. seeds shows tolerance to salinity

Salinity reduces feijão-caupi production, and the search for tolerant varieties becomes important within the agricultural context, as, in addition to being used in the field, they can be used in genetic improvement. The objective was to for a identify variety that is tolerant to salinity considering the physiological quality of seeds and seedling growth. A 2 × 4 factorial scheme was used, referring to the varieties Pingo-de-ouro and Coruja, and four electrical conductivities of water (0; 3.3; 6.6 and 9.9 dS m-1). The physiological quality of seeds and the growth of seedlings were analyzed, in addition to the cumulative germination. The Pingo-de-ouro variety showed no germination, length of the shoot and root, dry mass of the shoot and root compromised up to electrical conductivity of 6 dS m-1 in relation to 0.0 dS m-1. On the other hand, the Coruja variety showed reduced germination, increased shoot and root length. The creole variety Pingo-de-ouro proved to be tolerant to salinity.

Cardiovascular multimorbidity and associated factors: the first Brazilian Registry of patients with hypertension

Background

Cardiometabolic multimorbidity (CM-MM) defined by the occurrence of at least two of morbidities (diabetes mellitus, stroke, acute myocardial infarction) is a important issue for health systems and it was associated with several health negative outcomes, especially decreasing of the life expectancy.

Purpose

To analyze the occurrence of CM-MM and associated factors among Brazilian patients with hypertension.

Methods

Cross-sectional study with participants of The First Brazilian Registry of Patients with Hypertension (BRH) from 45 sites in all regions of Brazil (n=2,646). For this study we select the individuals with ≥65 years (n=1,033) and CM-MM was defined with the presence of ≥2 of the following: diabetes mellitus, stroke, acute myocardial infarction evaluated by self related. CM-MM was analyzed according to sex, age, race, presence of others morbidities (dyslipidemia, myocardial revascularization, heart failure and chronic kidney disease), control of blood pressure, obesity, physical activity, actual smoking and alcohol consumption. The numerical variables were presented by median and interquartile range, the categorical variables by absolute and relative frequency. To verify the variables associated with the outcome, simple logistic regression was performed.

Results

CM-MM was present in 8.9% of participants. The median age was 71.6 (IQ: 67.9–76.8), female (59.7%), 65–70 years of age (39.6%), and 59.8% were white. Obesity was present in 55.8% and 48.4% of individuals have no blood pressure controlled. The occurrence of diabetes mellitus, stroke, and acute myocardial infarction was, respectively, 32.7%, 14.7% and 6.7%. A higher occurrence of CM-MM was observed in males, aged between 70 and 75 years old and with 75 years old or more, the presence of dyslipidemia; myocardial revascularization (MR); heart failure (HF) and kidney disease. The intersection size among diseases is represented in Figure 1. After multiple analysis, the following variables were associated with the presence of cardiovascular multimorbidity: male gender; age equal to or greater than 75 years and report of dyslipidemia, MR and HF.

Conclusions

The prevalence of CM-MM was high and an approach based on the clusters of cardiometabolic diseases can be a potent care strategy.

Funding Acknowledgement

Type of funding sources: None. Figure 1. Intersection size among diseases CM-MM

Crude glycerin in the supplementation of crossbred heifers in tropical pastures

Crude glycerin (CG) is a biodiesel byproduct that has been tested as an alternative feed additive for use in beef production. After being absorbed, it is used in the liver to produce glucose, an important precursor of intramuscular fat in ruminants. This study aimed to evaluate the effect of CG (439 g/kg glycerol) on the performance and meat quality of crossbred heifers finished in Urochloa brizantha cv. Marandu. Thirty-six heifers with an initial BW of 301.5 ± 23.02 kg were used. They were supplemented for 154 days with the following levels of CG: mineral mixture (without CG), 33.3, 66.6 and 99.9 g/kg CG in the DM of the supplement. Supplement or pasture DM intakes, slaughter BW and carcass traits were not influenced (P > 0.05) by increasing levels of CG. The total fat content of the meat, the vaccenic (18:1 n-7t) and conjugated linoleic acid (18:2 c9-t11) increased with the addition of CG in the diet (P < 0.05). Crude glycerin can be included up to 99.9 g/kg of the total diet without changing the performance of crossbred heifers finished in the tropical pasture.

Effects of Local Environmental and Landscape Variables on the Taxonomic and Trophic Composition of Aquatic Insects in a Rare Forest Formation of the Brazilian Amazon

In the present study, we analyzed a unique phytophysiognomy in the Amazon region, which is formed by savanna-like vegetation on iron-rich soil (known locally as canga) located within an iron-ore mining region. We used the habitat template theory to test the hypothesis that changes in the physical-chemical properties of streams and the physical structure of their habitats at in-stream and micro-basin (landscape) levels affect the taxonomic and trophic composition of immature aquatic insects. For this, we used a local environmental matrix composed of nine physical-chemical and structural habitat variables, together with the Habitat Integrity Index. We also calculated landscape metrics based on the area of the micro-basin, such as relief, slope, mean current flow, and vegetation cover. We divided the aquatic insects into five functional feeding groups based on their diet and food sources. Our results indicate that changes in the trophic level of the insects of the orders Ephemeroptera, Plecoptera, and Trichoptera are more easily observed than the taxonomic structure of communities. The loss of environmental integrity and vegetation cover were responsible for 84% of the variation observed in the composition of functional feeding groups (FFGs). Our study shows that aquatic insect communities in the canga and in the Amazon regions dominated by forest require specific in-stream and landscape conditions. These findings reinforce the need for the preservation of areas of canga vegetation, which not only have a unique levels of biological diversity, but are also targeted for the exploitation of their economically valuable natural resources.

Contribution of lung function in predicting distance covered in the 6-min walk test in obese Brazilian women

Obesity affects the respiratory system through various mechanisms, including systemic inflammation and direct mechanical hindrance due to fat deposition in the chest and abdomen. In addition, changes in the neural control of respiration and increases in thoracic blood volume can promote abnormalities in lung function. Thus, determining relationships between the distance covered in the 6-min walk test (6MWT) and demographic and lung function variables may help us better understand the mechanisms involved in reduced functional exercise capacity in obesity. To explore the determinants of the 6-min walking distance (6MWD) and evaluate the influence of lung function on the distance covered, 263 obese Brazilian women performed the 6MWT and underwent spirometry and respiratory muscle strength measurement. The mean age was 41.8±11.1 years. The mean body mass index (BMI) was 45±8 kg/m². The 6MWD showed correlations with height (r=0.319), age (r=-0.281), weight (r=-0.370), BMI (r=-0.561), forced vital capacity (FVC, r=0.443), expiratory peak flow (r=0.278), maximal inspiratory pressure (MIP, r=0.326), and maximal expiratory pressure (r=0.259), all with P<0.0001. In the stepwise forward regression analysis, BMI, FVC, age, and MIP were the independent predictive variables for 6MWD, explaining 41% of its variability. The reference equation including lung function was as follows: 6MWD (m) = 513.6 - (4.439 × BMI_kg/m2) + (1.136 × FVC_%predicted) - (1.048 × age_yrs) + (0.544 × MIP_%predicted). Thus, the inclusion of lung function in a reference equation for 6MWD contributes to a better prediction of the distance covered in this population.

P1835Application of SYNTAX score I, II and residual SYNTAX as predictors of long-term clinical outcomes after coronary artery bypass grafting

Background

The evaluation of coronary disease by SYNTAX score I (SSI) is used to grade coronary complexity. Following SSI, two other scores were developed: SYNTAX score II (SSII) and residual SYNTAX score (rSS). Nevertheless, there is still a lack of evidence about the prognostic significance of these scores among patients undergoing CABG.

Purpose

Our aim was to evaluate the relation of the SSI, SSII and rSS score with outcomes in a long-term follow-up after elective CABG.

Methods

This is a single center, registry-based study. Baseline SSI was calculated from patients undergoing CABG by interventional cardiologists. SSI results were considered as usual: <23, 23–32 and >32. SSII and rSRR were then calculated and categorized in tertiles: <21.4, 21.4–29.4 and >29.4 for SSII and 0, 1–5 and >5 for rSS. Primary outcome was a composite of overall death, myocardial infarction, additional revascularization, or stroke (MACCE).

Results

Data were obtained from 559 patients. Median follow-up was 6 years (IQR: 4.9–9.8) and 170 events were documented. The Kaplan-Meier curves (figure 1) showed significant differences of MACCE in higher SSI, SSII and rSS (p=0.039, 0.033, <0.001 respectively). After multivariate adjustment, rSS, ejection fraction (EF) and age were found to be independent predictors of MACCE (p<0.001, 0.034 and 0.006, respectively).

Figure 1

Conclusion

In this sample SSI, II and residual were associated with the occurrence of events. However, just the rSS remained an independent predictor of MACCE together with age and EF.

Pyrethroid and organophosphate pesticide resistance in field populations of horn fly in Brazil

Pesticides are used worldwide to control arthropod parasites in cattle herds. The indiscriminate and/or inappropriate use of pesticides without veterinary guidance is a reality in several countries of South America. Improper pesticide use increases the chances of contamination of food and the environment with chemical pesticides and their metabolites. Reduction of these contamination events is an increasing challenge for those involved in livestock production. The horn fly, Haematobia irritans (Linnaeus) (Diptera: Muscidae), is one of the most economically important parasites affecting cattle herds around the world. As such, horn fly control efforts are often required to promote the best productive performance of herds. Pesticide susceptibility bioassays revealed that pyrethroid resistance was widespread and reached high levels in horn fly populations in the Brazilian state of Rondônia. The knockdown resistance (kdr) sodium channel gene mutation was detected in all horn fly populations studied (n = 48), and the super kdr sodium channel gene mutation was found in all homozygous resistant kdr individuals (n = 204). Organophosphate resistance was not identified in any of the fly populations evaluated.

Redescription of Dekeyseria picta (Siluriformes; Loricariidae), a poorly known ancistrin from the Amazon and Orinoco Basins

A re-evaluation of Dekeyseria brachyura and D. pulchra found them to be junior synonyms of D. picta, the oldest species among these congeners, based on continuous intraspecific variation in morphometrics and colour pattern. Examination of material deposited at Brazilian and Venezuelan collections, including the original type specimens of Ancistrus brachyurus and A. pictus, plus samples recently collected in the Rio Negro, Amazonas, Brazil, allowed re-evaluation of the taxonomic status of D. picta and provides additional information on its distribution, habitats and reproductive strategies.

A Phase II Study of Mitomycin C, Vindesine and Cisplatin Combined with Alpha Interferon in Advanced Non-Small Cell Lung Cancer

Aims and background

MVP chemotherapy (mitomycin C, vindesine or vinblastine, cisplatin) is one of the most commonly used regimens for advanced non-small cell lung cancer (NSCLC). Experimental data suggest a synergistic cytotoxic activity of alpha-interferon (α-IFN) when combined with cisplatin, mitomycin C, and vinca alkaloids. In an effort to improve MVP chemotherapy activity, we have combined this regimen with α-IFN.

Patients and methods

Thirty-five patients with advanced NSCLC (19 stage IV) were treated with the MVP regimen (mitomycin C, 8 mg/m2; vindesine, 3 mg/m2; cisplatin, 75 mg/m2, all on day 1) plus α-2a-IFN, 3×106 U im from day 1 to 7. The cycles were repeated every 28 days.

Results

There were no complete responses and 18 partial responses, for an overall response rate of 51%. Median time to treatment failure was 6 months (range, 1-18), and median survival was 9.5 months (range, 1-32). WHO grade 3 toxicity was recorded in up to 8% of patients, flu-like syndrome was a common complaint; one toxic death occurred.

Conclusions

The combination yielded a level of response comparable to that of other cisplatin-based regimens. Larger randomized trials are needed to assess the role of α-IFN combined with chemotherapy in advanced NSCLC.

Etoposide and Mitomycin-C in Pretreated Metastatic Breast Cancer

Twenty-five patients with metastatic breast cancer in progression after prior chemotheray ± hormonotherapy were treated with etoposide 50 mg/m2 i.v. days 1 to 5 every 21 days and mitomycin-C 10 mg/m2 i.v. day 1 every 42 days. A partial response (PR) occurred in 10 patients with an overall response rate of 40 % (47 % when only the 21 patients evaluable after 3 courses or more were considered). The median duration of PR was 10.5 months (range 3-31). The soft tissue metastatic sites were the most responsive. Toxicity was mild.

Constituents from stem barks of Luehea ochrophylla Mart and evaluation of their antiparasitic, antimicrobial, and antioxidant activities

Luehea species are found in almost all Central and South American countries. The present work describes the phytochemical study, isolation, and structural characterisation of friedelin, β-friedelinol, lupeol, pseudotaraxasterol, β-sitosterol, betulinic acid, taraxasterol, (-)-epicatechin, β-sitosterol-3-O-β-d-glucopyranoside, and (+)-epicatechin-(4β→8)-epicatechin from stem barks of Luehea ochrophylla Mart. The structural identification of the isolated compounds was mainly performed by NMR analyses and comparison with the data from literature. These compounds were isolated for the first time in the genus Luehea, except β-sitosterol glucopyranoside, (-)-epicatechin, and lupeol. Hexane extract (HE) and dichloromethane (DF) and ethyl acetate (AF) fractions exhibited antiparasitic activity against amastigote (intracellular) and trypomastigote culture forms of Trypanosoma cruzi. The ethanol extract (EE), DF, and ethanol fraction (EF) exhibited considerable antifungal activity against Candida albicans. Moreover, extracts and fractions exhibited significant percentage of capture free radicals of 2,2-diphenyl-picrylhydrazyl (DPPH) when compared to the standard of ascorbic acid.

Intake, digestibility, performance, and nitrogen metabolism of feedlot-finished young bulls () fed diets containing peanut cake

This aim of this study was to evaluate the use of peanut cake as a dietary substitute for soybean meal and to determine the effects on intake, apparent digestibility, performance, and N metabolism in feedlot-finished young bulls. Thirty-two young Nellore bulls with an average initial BW of 390 ± 43.5 kg were distributed in a completely randomized design and individually housed in stalls. The young bulls were fed Tifton 85 hay and 4 concentrate mixes containing 0, 33, 66, or 100% peanut cake replacing soybean meal. The diets were formulated to be isonitrogenous, containing 150 g/kg CP, and isocaloric (65% TDN), to have a 40:60 forage:concentrate ratio, and were provided as a total mixed ration. The experiment lasted 90 d and data were collected every 28 d. Blood and urine samples were taken during the last 6 d. Intakes of DM ( = 0.005), OM ( = 0.006), CP ( = 0.002), NDF ( = 0.022), nonfiber carbohydrates ( = 0.002), and TDN ( = 0.018) linearly decreased as the dietary inclusion of peanut cake in the diet was increased. Conversely, intake and ether extract digestibility linearly increased ( < 0.035). The average daily weight gain decreased ( = 0.015) as the peanut cake levels were increased. Plasma urea N decreased (linearly; = 0.005). Peanut cake may not be used to replace soybean meal in the diet of young feedlot-finished Nellore bulls.

Influence of diets with silage from forage plants adapted to the semi-arid conditions on lamb quality and sensory attributes

Quality and sensory attributes of meat from 32 mixed-breed Santa Inês lambs fed diets composed of four silages with old man saltbush (Atriplex nummularia Lind), buffelgrass (Cenchrus ciliaris), Gliricidia (Gliricidia sepium), and Pornunça (Manihot sp.) were evaluated. Meat from lambs fed diet containing old man saltbush silage (P<0.05) showed greater values for cooking loss. Of the sensory attributes evaluated in the Longissimus lumborum muscle of the lambs, color and juiciness did not differ (P>0.05). However, the silages led to differences (P<0.05) in aroma, tenderness, and flavor values. The meat from animals fed the pornunça and Gliricidia silages was tenderer. Flavor scores were higher in meat from lambs that consumed old man saltbush silage and lower in the meat from those fed buffelgrass silage. Diets formulated with buffelgrass silage for sheep reduce meat production. Based on the results for carcass weight and meat quality, old man saltbush and pornunça are better silages for finishing sheep.

Production and quality of beef from young bulls fed diets supplemented with peanut cake

Peanut cake is a biodiesel byproduct that has been tested as an alternative feed additive for use in cattle production. This study aimed to assess the importance of dietary peanut cake inclusion for young bull growth rate, beef production, and beef quality. In total, 32 Nellore young bulls individually housed in stalls with a mean initial body weight of 390±43.5kg were distributed in a completely randomized design for the experiment. The animals were fed Tifton 85 hay and one of four concentrate mixtures with 0, 33, 66 or 100% peanut cake instead of soybean meal. There was a linear reduction (P<0.05) in the slaughter weight and hot carcass weight and a quadratic effect (P<0.05) on the beef texture. No alterations occurred in the physicochemical characteristics of the longissimus thoracis; however, changes were observed (P<0.05) in the longissimus thoracis fatty acid profile. The replacement of soybean meal with peanut cake at levels up to 100% in the diet of feedlot-finished young bulls promotes a beneficial increase in the levels of PUFAs and the following nutraceutical compounds: conjugated linoleic acid (CLA) and Ω3 and Ω6 fatty acids.

Phytochemical screening, total phenolic content and antioxidant activity of Byrsonima species

The species of the Byrsonima genus (Malpighiaceae) have been used in folk medicine to treat gastrointestinal disorders, asthma and skin infections. In this study, the total phenolic content, antioxidant activity and phytochemical screening were carried out in polar extracts of Byrsonima coccolobifolia, Byrsonima verbascifolia and Byrsonima intermedia. The presence of tannins and flavonoids in the samples and high phenols content was observed. B. coccolobifolia and B. intermedia species showed the best results of antioxidant action. It was analysed the correlation between the methods, and there was a great correlation between phenolic content and antioxidant assay, showing that the phenolic substances contribute to the antioxidant activities of these plants.

Ingestive Behavior of Heifers Supplemented with Glycerin in Substitution of Corn on Brachiaria brizantha Pasture

The objective was to evaluate the ingestive behavior of crossbred heifers finished on a Brachiaria brizantha cv. Marandu pasture receiving four levels of glycerin in their supplementation. Thirty-six crossbred heifers with average initial weight of 264.83±3.83 kg and 20 months of age were distributed into a completely randomized design with four treatments and nine replications: control (0%), 4.82%, 10.12%, and 15.56% glycerin in the dry matter. The grazing time reduced linearly (p<0.05), whereas the time spent on activities like rumination, idleness, trough and total chewing time were quadratically affected (p<0.05). Bite rate and number of bites/day were quadratically influenced (p<0.05). The number of bites/swallowed cud and the number of bites/minute, however, increased linearly (p<0.05). Although the time spent on each cud and number of chews per cud were not affected (p>0.05). The number of rumination periods reduced linearly (p<0.05), whereas the number of grazing, idle and trough periods, and the times per grazing, idle, rumination and trough periods were quadratically affected (p<0.05). The feed and rumination efficiencies of the dry matter, non-fibrous carbohydrates, pasture dry matter and concentrate were quadratically affected (p>0.05) whereas the feed efficiency of neutral detergent fiber reduced linearly (p<0.05). Addition of glycerin in substitution of corn in supplements for animals managed on pastures does not influenced feed intake, but reduces the grazing time and increases the idle time. The supplementation also improves feed and rumination efficiencies.

Ingestive behavior of lambs confined in individual and group stalls

The experiment was conducted to evaluate the ingestive behavior of lambs confined in individual and group stalls. We used thirty-four lambs in their growing phase, aged an average of three months, with mean initial live weight of 17.8±5.2 kg. They were allotted in a completely randomized design with 24 animals kept in individual stalls and 10 animals confined as a group. The experiment lasted for a total of 74 days, and the first 14 days were dedicated to the animals’ adaption to the management, facilities and diets. The data collection period lasted 60 days, divided into three 20-d periods for the behavior evaluation. The animals were subjected to five days of visual observation during the experiment period, by the quantification of 24 h a day, with evaluations on the 15th day of each period and an interim evaluation consisting of two consecutive days on the 30th and 31st day of the experiment. The animals confined as a group consumed less (p<0.05) fiber. However, the animals confined individually spent less (p<0.05) time on feeding, rumination and chewing activities and longer in idleness. Therefore, the lower capacity of lambs confined in groups to select their food negatively affects their feeding behavior.

Diets based on sugar cane treated with calcium oxide for lambs

This experiment was conducted to evaluate the intake, nutrient apparent digestibility and the effect of total collection days (two and four days) on apparent digestibility estimates for lambs fed diets containing sugar cane treated with calcium oxide (CaO). Eight Santa Inês castrated male lambs with a 16.6±1.8 kg body weight were used. The lambs were distributed in two 4×4 Latin squares, with four experimental periods of 14 d each. The animals were kept in 1.2 m² individual pens, and the intake and digestibility evaluations were performed during the last four days of each period. The diets were formulated to be isonitrogenous, containing 14% crude protein (CP), and presenting 70% sugar cane treated with 0, 0.75, 1.5 or 2.25% of CaO (as-fed basis), corrected with 1% urea, and 30% concentrate. The sugar cane with added CaO was chopped, treated, and offered to the animals after 24 h of storage. The sugar cane with CaO increased the DM, OM, CP, NDF, NDFap, TC, NFCap and TDN intake (kg/d), when compared to natural sugar cane, and produced the same intake expressed as a percentage of body weight (% BW). The NFCap digestibility of the CaO-treated sugar cane was inferior to the NFCap digestibility in natural sugar cane. There was a linear increase in the DM intake with the CaO-added sugar cane, but the DM and NDF digestibility and the TDN content decreased linearly. The chemical treatment of sugar cane with CaO increases the intake but does not improve the nutrient digestibility. Two days of total fecal collection were found to be sufficient to estimate the total apparent digestibility in lambs.

Prognosis of mucinous histology for patients with radically resected stage II and III colon cancer

BACKGROUND

Previous studies investigating the prognostic role of mucinous histology of colorectal cancer produced conflicting results. This retrospective analysis was carried out in order to explore whether mucinous adenocarcinoma (MC) is associated with a comparatively worse prognosis than that of nonmucinous adenocarcinoma (NMC) for patients undergoing curative resection for stage II and III colon cancer.

PATIENTS AND METHODS

This study involved 1025 unselected patients who underwent curative surgery for sporadic colon cancer and follow-up procedures at six different oncology departments.

RESULTS

MCs accounted for 17.4% (n=178) of tumours. Patients with MC had 5- and 8-year overall survival rates of 78.6% and 68.8%, respectively, compared with 72.3% and 63.8%, respectively, for patients with nonmucinous tumours. Multivariate analysis using the Cox proportional hazards model showed that the clinically significant prognostic factors were stage of disease and adjuvant chemotherapy. No statistically significant interaction between mucinous histology and adjuvant chemotherapy was found.

CONCLUSIONS

For patients with stage II and III colon cancer who underwent curative surgery, mucinous histology has no significant correlation with prognosis compared with NMC. This retrospective analysis suggests a comparable benefit from adjuvant chemotherapy for MC compared with NMC.

Reproductive cycle of Macrobrachium amazonicum females (Crustacea, Palaemonidae)

Macrobrachium amazonicum is considered a favorite Brazilian species of freshwater prawn for cultivation as a result of its quick development and because it is easy to maintain in captivity. The aim of this work is to describe the sexual cycle stages and determine maturation age of the female M. amazonicum, which was collected monthly from June, 2002 to May, 2003 in the Jaguaribe River, Itaiçaba, Ceará. A monthly sample of water was also collected to determine the following parameters: temperature, dissolved oxygen, pH and salinity. A monthly sample of females was selected among the individuals caught, to determine the total weight (W(T)), carapace length (L( C)) and abdomen+telson length (L(A+T)) and to register the number of non-ovigerous females (NOF) and ovigerous females (OF). Determining ovarian maturation stages of M. amazonicum was done in a laboratory by observing macroscopic characters such as coloring, size, location and appearance of ovarians examined by transparent carapace. The first maturation age was determined from the relative frequency of the total length (L(T)) of young and adult females. The environmental parameters of the Jaguaribe River did not hold any influence in the number of individuals collected. A total of 1,337 prawns were sampled, 513 males (38.4%) and 824 females (61.6%). The proportion between males and females in the studied population was of 1:1.6. Among the collected females, 492 (50.7%) did not carry eggs in their abdomens (NOF) and 332 (40.3%) carried eggs in their abdomens (OF). There was no record of intact females. Non-ovigerous females with mature ovaries were recorded throughout all the months of collection. The female ovaries were classified as immature (IM), rudimentary (RU), intermediary (IN) and mature (M). M. amazonicum females reach their first sexual maturity between 4.5 and 5.5 cm of total length.

Lymphatic, blood vessel and perineural invasion identifies early-stage high-risk radically resected gastric cancer patients

The availability of different treatment options for radically resectable gastric cancer reopened the question of treatment selection and correct definition of high-risk categories. Lymphatic, blood vessel and perineural invasion (LBVI/PNI) seem to possess the necessary potential to provide useful information for the clinical management of this disease. Seven hundred and thirty-four patients with advanced gastric cancer who underwent curative gastrectomy were analysed according to the presence of LBVI/PNI. Patients were divided into two groups: group A for patients with LBVI/PNI (189 patients 26%) and group B for patients without LBVI/PNI (545 patients, 74%). The disease-free survival (DFS) for patients in group A was 32.1 months, whereas it was not reached for patients in group B (P=0.0001); the median overall survival was 45.5 months for patients in group A, whereas it was not reached for patients in group B (P=0.0001). At multivariate analysis, the presence of LBVI/PNI appeared an independent prognostic factor for DFS and OS. Our results were confirmed in subgroup analysis, separately considering stage I and early gastric cancer patients with and without LBVI/PNI. Taken together, our findings suggest the importance of LBVI/PNI in gastric cancer as it may provide additional information for identifying patients at high risk, who may be candidates for further medical treatment after or before surgery.

Over-DI dissection may question the value of radiotherapy as a part of an adjuvant programme in high-risk radically resected gastric cancer patients

The aim of our analysis was to assess retrospectively the effect on local relapse, overall survival (OS) and disease-free survival (DFS) of a limited or an extended lymphadenectomy in radically resected gastric cancer patients. This study was performed in order to identify a subgroup of patients possibly not benefiting from a therapeutic approach such as chemoradiation therapy. We divided our patients into two groups according to lymphadenectomy type: group A for limited (<25 resected lymph nodes) and group B for extended (>25 resected lymph nodes) lymph nodes resection. A total of 418 patients were analysed: tumour stage at diagnosis was pT2–3 pN1–3 M0 in 339 patients and pT3 N0 M0 in 79 patients. Median age at diagnosis was 68 years (range 30–92 years). A total of 306 patients (73.2%) were in group A and 112 (26.8%) in group B. The median survival time (OS) for patients in groups A and B was 58.8 and 84.8 months, respectively (P=0.0371); median DFS was 28.8 months in group A and 59.9 months in group B (P=0.0027). At multivariate analysis, extension within the gastric wall, nodal involvement and the number of resected lymph nodes appeared to affect both OS and DFS. An inadequate lymph nodes resection can affect survival and result in a higher incidence of local relapse, making the latter group of patients optimal candidates for adjuvant chemoradiation.

Long-survival in responding patients with metastatic breast cancer treated with doxorubicin-docetaxel combination. A multicentre phase II trial

BACKGROUND

The doxorubicin-docetaxel combination is active in breast cancer; the aim of the present study was to evaluate the complete response rate and safety profile of the doxorubicin and docetaxel regimen as first-line chemotherapy in metastatic breast cancer patients.

PATIENTS AND METHODS

Forty-three patients entered the study. Treatment plan was: doxorubicin (50 mg/m2, i.v. bolus) followed 1 hour later by docetaxel (75 mg/m2 i.v. infusion over 1 hour), q 3 weeks, for up to six courses. The patients achieving a response or a stabilisation of disease after 6 courses were allowed to intensify the treatment with docetaxel (100 mg/m2, q 3 weeks) for up to 2 courses. G-CSF (or GM-CSF) was administered if clinically indicated.

RESULTS

Patients' median age was 57years (range 32-75) and 72% of them had visceral disease. A total of 217 doxorubicin-docetaxel courses were delivered, with 70% of patients receiving all the 6 planned cycles. Among the 40 patients assessable for response (WHO criteria), 7 (16%) achieved a complete remission and 22 (51%) a partial remission, for an overall response rate (intent-to-treat) of 67% (95% C.I. =53% to 81%). In 19 patients, the treatment was intensified with two more single-agent docetaxel cycles, without ameliorating the response. Twenty-seven patients with oestrogen receptor-positive received hormonal therapy as 'maintenance' after completing chemotherapy treatment. NCIC G3-G4 neutropenia was recorded in 58% of patients, with G/GM-CSF used in 23 (53%) patients and 91 (38%) cycles. No patients experienced severe cardiac or neurological toxicity. No toxic death occurred. With a median follow-up of 41 months among alive patients, we observed in responder patients an overall median time to progression and survival of 18 and 33 months respectively, with ten long-survivors still alive.

CONCLUSION

This study confirmed the combination doxorubicin-docetaxel as a very active regimen for metastatic breast cancer. Remarkably long survival times were observed not only in complete responders, but also in those patients who responded partially. This might be equally attributed to first-line treatment and sequential maintenance hormonal therapy.

High curative resection rate with weekly cisplatin, 5-fluorouracil, epidoxorubicin, 6S-leucovorin, glutathione, and filgastrim in patients with locally advanced, unresectable gastric cancer: a report from the Italian Group for the Study of Digestive Tract Cancer (GISCAD)

The aim of the present study was to evaluate the role of a weekly preoperative chemotherapy in locally advanced, unresectable gastric cancer. In all, 82 patients with an Eastern Oncology Cooperative Group PS <or=2 and normal cardiac function were enrolled onto the study. Surgical unresectability was confirmed in 52 patients (63%) at laparotomy, and in 30 (27%) cases by CT scan of the abdomen and endoscopic ultrasonography. Chemotherapy treatment was: cisplatin 40 mg x m(-2); 5-fluorouracil 500 mg x m(-2); epidoxorubicin 35 mg x m(-2); 6S-leucovorin 250 mg x m(-2) and glutathione 1.5 g x m(-2) (PELF). One cycle consisted of 8 weekly treatments. Response to chemotherapy was observed in 40 of 82 patients (49%): six (7%) complete and 34 (41%) partial responses, and in four (5%) cases a complete pathological response was confirmed. Of the 40 responding patients, 37 (45%) had potentially curative surgery. Grade 3/4 leucopenia and thrombocytopenia occurred in three and two patients. At a median follow-up of 48 months, 25 of the 37 resected patients (68%) were alive and 24 (65%) were disease free. The median and 4-year survival for the whole group was 17 months and 31%, respectively. The median survival was 12 months for inoperable patients and it was not reached in resected patients.

Elderly Patients with Advanced Non-Small Cell Lung Cancer

OBJECTIVES

The incidence of non-small cell lung cancer (NSCLC) is increasing among the elderly. We studied the toxicity and efficacy of a weekly schedule of gemcitabine and cisplatin in elderly patients with advanced NSCLC.

METHODS

Patients aged 70 years or above with advanced NSCLC were treated in a phase II prospective trial with gemcitabine 1,000 mg/m(2) and cisplatin 35 mg/m(2) on days 1, 8 and 15 every 28 days.

RESULTS

Forty-eight patients with a median age of 74 years (range 70-78) participated in the study. We observed 14 cases with partial response, 14 with stable disease and 16 with progressive disease, whilst 4 patients were not evaluable. By intention-to-treat analysis, partial response rate was 31.8% whilst progressive disease was 33.3%. Median survival was 9 months; 1-year survival probability was 34.4% and median time to progression was 4 months. Grade III-IV leukopenia was observed in 5/48 patients (10.4%), 20/48 patients (41.7%) had grade III-IV thrombocytopenia and 7/48 patients (14.6%) had grade III-IV anemia. One patient experienced grade III emesis and 2 patients had grade III-IV fatigue.

CONCLUSIONS

At this dose and schedule the combination of gemcitabine and cisplatin appears to be an active and well-tolerated regimen for elderly patients with advanced NSCLC.

Raltitrexed plus oxaliplatin (TOMOX) as first-line chemotherapy for metastatic colorectal cancer. A phase II study of the Italian Group for the Study of Gastrointestinal Tract Carcinomas (GISCAD)

BACKGROUND

To evaluate the safety and efficacy of the novel raltitrexed/oxaliplatin combination (TOMOX) as first-line chemotherapy for patients with advanced colorectal cancer.

MATERIALS AND METHODS

Previously untreated patients with metastatic colorectal cancer received raltitrexed 3 mg/m2 plus oxaliplatin 100 mg/m2, both intravenously, on day 1 every 3 weeks. Patients were re-evaluated after every third cycle and chemotherapy was continued up to tolerance or disease progression.

RESULTS

Fifty-eight patients from 13 Italian Group for the Study of Gastrointestinal Tract Carcinomas (GISCAD) centers were accrued from September 1999 to November 2000. According to the intention-to-treat analysis from 58 patients, the overall response rate was 50% [95% confidence interval (CI) 38% to 62%], with three complete responses and 26 partial responses. The median overall survival (44 patients currently alive) was >9 months and the median time to disease progression was 6.5 months (range 1-15 months). The main hematological toxicity was grade III/IV neutropenia, which occurred in 17% of patients, while anemia and thrombocytopenia were uncommon. Grade III/IV non-hematological toxicities were transient transaminitis (17% of patients); asthenia (16% of patients); neurotoxicity (10% of patients) and diarrhea (7% of patients). No toxic death was observed, one patient with grade IV asthenia after the first cycle refused chemotherapy.

CONCLUSIONS

The results of this study suggest that the TOMOX combination is an effective and well tolerated regimen for the treatment of advanced colorectal cancer. Its ease of administration and patient tolerance warrant further investigation as an alternative to fluoropyrimidine-based regimens with repeated and prolonged fluorouracil infusions.

Infusional 5-fluorouracil, cisplatin and mitomycin C in advanced gastric cancer: a low cost effective regimen

Recently, we reported a highly active regimen in advanced gastric cancer including a weekly administration of cisplatin, epidoxorubicin, leucovorin, 5-fluorouracil with the support of filgrastim. In order to simplify the administration and to decrease the toxicity of these drugs, mainly epidoxorubicin-induced alopecia, we designed a regimen including an infusional 5-fluorouracil schedule according to the de Gramont regimen, cisplatin and mitomycin C replacing epidoxorubicin. Forty-five patients with advanced or metastatic gastric cancer were treated with cisplatin 50 mg m(-2) i.v. on day 1, every 2 weeks, 6S-stereoisomer-leucovorin 100 mg m(-2) i.v. followed by 5-fluorouracil 400 mg m(-2) i.v. bolus and 600 mg m(-2) i.v. in a 22-h infusion, on days 1 and 2, every 2 weeks, and mitomycin C 7 mg m(-2) i.v. bolus on day 2, every 6 weeks. Grades 3-4 toxicities (National Cancer Institute-Common Toxicity Criteria) consisted mainly of neutropenia and thrombocytopenia. Five patients had a complete response and 16 had a partial response for an overall response rate of 46.7% (95% confidence interval, 32.1-61.2%). The median survival was 11 months. The combination of cisplatin, 5-fluorouracil and leucovorin according to de Gramont, and mitomycin C seems to be an active and safe regimen in the treatment of advanced gastric cancer. Because of its low cost it may be suggested for patients not enrolled into clinical trials.

Reflections of depression in acoustic measures of the patient's speech

BACKGROUND

The literature on acoustic measures of voice in depression is reviewed. Authors have separated results derived from studies of automatic speech, such as counting or reading, from free speech. Free speech requires cognitive activity such as word finding and discourse planning in addition to the motor activity of automatic speech. Also, results have been less ambiguous if homogeneous groups of agitated or retarded depressed patients were examined.

METHODS

These distinctions are applied to the results of a 12-week double-blind treatment trial that compared response to nortriptyline (25-100 mg/day) with sertraline (50-150 mg/day). Twelve male and ten female elderly depressed patients and an age-matched normal control group (n=19) were studied. Patients were divided into retarded or agitated groups on the basis of ratings. Results from measures of fluency (speech productivity and pausing) and prosody (emphasis and inflection) are described.

RESULTS

Depressed patients showed less prosody than the normal subjects. Improvement in the retarded group was reflected in briefer pauses but not longer utterances. There was a trend in the agitated group for improvement to be reflected in the utterance but not the pause measure.

CONCLUSIONS

Clinical impressions are substantially related to acoustic parameters. Temporal changes associated with depression appear to reflect the depressed state whereas prosodic features seem to reflect a depressed trait. Acoustic measures of the patient's speech may provide objective procedures to aid in the evaluation of depression. Limitations of the study are discussed.

Stress and vulnerability to posttraumatic stress disorder in children and adolescents

OBJECTIVE

This study examined the experiential factors and interacting vulnerabilities that contribute to the development of posttraumatic stress disorder (PTSD) in children and adolescents.

METHOD

Of 100 consecutive referrals to an inner-city child and adolescent psychiatry clinic, 59 had experienced a trauma that qualified as a precipitant of PTSD. For those with trauma, ages ranged from 3 to 18 years (mean=9.9, SD=4.10); 39 (66%) were males. The authors used a series of multiple regression analyses to examine the contribution of demographic characteristics, the nature of the stressor(s), and the role of preexisting clinical signs in the development of PTSD.

RESULTS

Twenty-two percent of the 59 children who had been traumatized met full criteria for PTSD, 32% had some symptoms of PTSD but did not meet full criteria, and 46% had no symptoms of PTSD. Witnessing domestic violence or being physically abused predicted severity of PTSD. Children with preexisting aggressive behavior were more likely to be victims of physical abuse.

CONCLUSIONS

Traumatic experience interacts with factors in the child and family to contribute to the development of PTSD. Trauma that threatens family integrity appears to make a strong contribution to the development of PTSD. Increased understanding of the factors contributing to PTSD may provide additional opportunities for developing effective interventions.

A model for adolescent day treatment

Milieu treatment is cited as a therapeutic aspect of inpatient, residential, and day programs for seriously disturbed adolescents. However, the literature is generally descriptive, and does not link specific treatment recommendations with theoretical conceptualizations. This population has unique developmental needs and pressures that must be taken into account for treatment to be effective. This article examines the theoretical and empirical literature and proposes an integrated model for effective day treatment for this population.