Effect of grade on disease-free survival and overall survival in FIGO stage I adenocarcinoma of the endometrium.

OBJECTIVE: To analyse the effect of differentiation on disease-free survival (DFS) and overall survival (OS) in patients with stage I adenocarcinoma of the endometrium. PATIENTS AND METHODS: From 1979 to 1995, 350 patients with FIGO stage IA-IC with well (G1), moderately (G2) or poorly (G3) differentiated tumors were treated with surgery and high dose-rate brachytherapy with or without external radiation. Median age was 65 years (39-86 years). RESULTS: The 5-year DFS was 88+/-3% for the G1 tumors, 77+/-4% for the G2 tumors, and 67+/-7% for the G3 tumors (P=0.0049). With regard to the events contributing to DFS, the 5-year cumulative percentage of local relapse was 4.6% for the G1 tumors, 9.0% for the G2 tumors, and 4.6% (P=0.027) for the G3 tumors. Cumulative percentage of metastasis was 1.4, 6.3 and 7.2% (P<0.001), respectively, whereas percentages of death were 6.0, 7.9 and 20.7% (P<0.001). The 5-year OS was 91+/-3, 83+/-4 and 76+/-7%, respectively (P=0.0018). In terms of multivariate hazard ratios (HR), the relative differences between the three differentiation groups correspond to an increase of 77% of the risk of occurrence of either of the three events considered for the DFS (HR=1.77, 95% CI [0.94-3.33]), (P=0.078) for the G2 tumors and of 163% (HR=2.63, 95% CI [1.27-5.43]), (P=0.009) for the G3 tumors with respect to the G1 tumors. The estimated relative hazards for OS are, respectively, in line with those for DFS: HR=1.51 (P=0.282) for the G2 tumors; and HR=3.37 (P=0.003) for the G3 tumors. CONCLUSION: Patients with grade 1 tumors are those least exposed to either local relapse, metastasis, or death. In contrast patients with grade 2 tumors seem to be at higher risk of metastasis, whereas patients with grade 3 tumors appear at higher risk of death. Since we have looked at the first of three competing events (local relapse, metastasis and death), this suggests that patients with grade 3 tumors probably progress to death so fast that local relapse, if any, cannot be observed.

Characteristics and outcome of 27 elbow periprosthetic joint infections: results from a 14-year cohort study of 358 elbow prostheses.

Elbow arthroplasty is increasingly performed in patients with rheumatic and post-traumatic arthritis. Data on elbow periprosthetic joint infection (PJI) are limited. We investigated the characteristics and outcome of elbow PJI in a 14-year cohort of total elbow arthroplasties in a single centre. Elbow prosthesis, which were implanted between 1994 and 2007 at Schulthess Clinic in Zurich, were retrospectively screened for infection. PJI was defined as periprosthetic purulence, the presence of sinus tract or microbial growth. A Kaplan-Meier survival method and Cox proportional hazard analysis were performed. Of 358 elbow prostheses, PJI was identified in 27 (7.5%). The median patient age (range) was 61 (39-82) years; 63% were females. Seventeen patients (63%) had a rheumatic disorder and ten (37%) had osteoarthritis. Debridement and implant retention was performed in 78%, followed by exchange or removal of the prosthesis (15%) or no surgery (7%).The relapse-free survival (95% CI) was 79% (63-95%) after 1 year and 65% (45-85%) after 2 years. The outcome after 2 years was significantly better when patients were treated according to the algorithm compared to patients who were not (100% vs. 33%, p &lt;0.05). In 21 patients treated with debridement and retention, the cure rate was also higher when the algorithm was followed (100% vs. 11%, p &lt;0.05). The findings of the present study suggest that the treatment algorithm developed for hip and knee PJI can be applied to elbow PJI. With proper patient selection and antimicrobial therapy, debridement and retention of the elbow prosthesis is associated with good treatment outcome.

Iowa Crop and Weather Report, November 27, 2011, Vol. 11. no. 39

Report produced by the The Department of Agriculture and Land Stewardship, Climatology Bureau. Iowa Secretary of Agriculture Bill Northey today commented on the Iowa Crops and Weather report released by the USDA National Agricultural Statistical Service. The report is released weekly from April through October.

Changes in protein turnover and resting energy expenditure after treatment of malaria in Gambian children.

To explore the changes in resting energy expenditure (REE) and whole body protein turnover induced by malaria, 23 children aged 6 to 14 y (23.9 +/- 1.0 kg, 1.3 +/- 0.02 m) were studied on three separate days after treatment (d 1, d 2, and 15 d later). REE was assessed by indirect calorimetry (hood), whereas whole body protein turnover was estimated using a single dose of [15N]glycine administered p.o. by measuring the isotopic enrichment of [15N]ammonia in urine over 12 h. Within the first 3.5 h after treatment, the body temperature dropped from 39.8 +/- 0.1 to 37.8 +/- 0.1 degrees C (p < 0.0001), and REE followed the same pattern, decreasing rapidly from 223 +/- 6 to 187 +/- 4 kJ/kg/d (p < 0.0001). Whole body protein synthesis and breakdown were significantly higher during the 1st day (5.65 +/- 0.38 and 6.21 +/- 0.43 g/kg/d, respectively) than at d 15 (2.95 +/- 0.17 and 2.77 +/- 0.2 g/kg/d). It is concluded that Gambian children suffering from an acute episode of malaria have an increased REE averaging 37% of the control value (d 15) and that this was associated with a substantial increase (by a factor of 2) in whole body protein turnover. A rapid normalization of the hypermetabolism and protein hypercatabolism states after treatment was observed.

Holt Oram syndrome: a registry-based study in Europe.

BACKGROUND: Holt-Oram syndrome (HOS) is an autosomal dominant disorder characterised by upper limb anomalies and congenital heart defects. We present epidemiological and clinical aspects of HOS patients using data from EUROCAT (European Surveillance of Congenital Anomalies) registries. METHODS: The study was based on data collected during 1990-2011 by 34 registries. The registries are population-based and use multiple sources of information to collect data on all types of birth using standardized definitions, methodology and coding. Diagnostic criteria for inclusion in the study were the presence of radial ray abnormalities and congenital heart disease (CHD), or the presence of either radial ray anomaly or CHD, with family history of HOS. RESULTS: A total of 73 cases of HOS were identified, including 11 (15.1%) TOPFA and 62 (84.9%) LB. Out of 73 HOS cases, 30.8% (20/65) were suspected prenatally, 55.4% (36/65) at birth, 10.7% (7/65) in the first week of life, and 3.1% (2/65) in the first year of life. The prenatal detection rate was 39.2% (20/51), with no significant change over the study period. In 55% (11/20) of prenatally detected cases, parents decided to terminate pregnancy. Thumb anomalies were reported in all cases. Agenesis/hypoplasia of radius was present in 49.2% (30/61), ulnar aplasia/hypoplasia in 24.6% (15/61) and humerus hypoplasia/phocomelia in 42.6% (26/61) of patients. Congenital heart defects (CHD) were recorded in 78.7% (48/61) of patients. Isolated septal defects were present in 54.2 (26/48), while 25% (12/48) of patients had complex/severe CHD. The mean prevalence of HOS diagnosed prenatally or in the early years of life in European registries was 0.7 per 100,000 births or 1:135,615 births. CONCLUSIONS: HOS is a rare genetic condition showing regional variation in its prevalence. It is often missed prenatally, in spite of the existence of major structural anomalies. When discovered, parents in 45% (9/20) of cases opt for the continuation of pregnancy. Although a quarter of patients have severe CHD, the overall first week survival is very good, which is important information for counselling purposes.

Association between C-reactive protein and adiposity in women.

Context: The link between C-reactive protein (CRP) and adiposity deserves to be further explored considering the controversial diabetogenic role of CRP. Objective: We explored the potential causal role of CRP on measures of adiposity. Design: We used a Mendelian randomization approach with the CRP and LEPR genes as instrumental variables in a cross-sectional Caucasian population-based study comprising 2526 men and 2836 women. Adiposity was measured using body mass index (BMI), fat and lean mass estimated by bioelectrical impedance, and waist circumference. Results: Log-transformed CRP explained by the rs7553007 SNP tagging the CRP gene was significantly associated with BMI (regression coefficient: 1.22 [0.18;2.25], P=0.02) and fat mass (2.67 [0.65;4.68], P=0.01), but not with lean mass in women, whereas no association was found in men. Log-transformed CRP explained by the rs1805096 LEPR SNP was also positively associated, although not significantly, with BMI or fat mass. The combined CRP-LEPR instrument explained 2.24% and 0.77% of CRP variance in women and in men, respectively. Log-transformed CRP explained by this combined instrument was significantly associated with BMI (0.98 [0.32;1.63], P=0.004), fat mass (2.07 [0.79;3.34], P=0.001) and waist (2.09 [0.39;3.78], P=0.01) in women, but not in men. Conclusion: Our data suggest that CRP is causally and positively related to BMI in women, and that this is mainly due to fat mass. Results on the combined CRP-LEPR instrument suggest that leptin may play a role in the causal association between CRP and adiposity in women. Results in men were not significant.

Cross-cultural adaptation, reliability, internal consistency and validation of the Spinal Function Sort (SFS) for French- and German-speaking patients with back complaints.

Introduction Functional subjective evaluation through questionnaire is fundamental, but not often realized in patients with back complaints, lacking validated tools. The Spinal Function Sort (SFS) was only validated in English. We aimed to translate, adapt and validate the French (SFS-F) and German (SFS-G) versions of the SFS. Methods Three hundred and forty-four patients, experiencing various back complaints, were recruited in a French (n = 87) and a German-speaking (n = 257) center. Construct validity was estimated via correlations with SF-36 physical and mental scales, pain intensity and hospital anxiety and depression scales (HADS). Scale homogeneities were assessed by Cronbach's α. Test-retest reliability was assessed on 65 additional patients using intraclass correlation (IC). Results For the French and German translations, respectively, α were 0.98 and 0.98; IC 0.98 (95% CI: [0.97; 1.00]) and 0.94 (0.90; 0.98). Correlations with physical functioning were 0.63 (0.48; 0.74) and 0.67 (0.59; 0.73); with physical summary 0.60 (0.44; 0.72) and 0.52 (0.43; 0.61); with pain -0.33 (-0.51; -0.13) and -0.51 (-0.60; -0.42); with mental health -0.08 (-0.29; 0.14) and 0.25 (0.13; 0.36); with mental summary 0.01 (-0.21; 0.23) and 0.28 (0.16; 0.39); with depression -0.26 (-0.45; -0.05) and -0.42 (-0.52; -0.32); with anxiety -0.17 (-0.37; -0.04) and -0.45 (-0.54; -0.35). Conclusions Reliability was excellent for both languages. Convergent validity was good with SF-36 physical scales, moderate with VAS pain. Divergent validity was low with SF-36 mental scales in both translated versions and with HADS for the SFS-F (moderate in SFS-G). Both versions seem to be valid and reliable for evaluating perceived functional capacity in patients with back complaints.

ORGANIC NITROGEN IN A TYPIC HAPLUDOX FERTILIZED WITH PIG SLURRY

The application of pig slurry may have a different effect on nitrogen dynamics in soil compared to mineral fertilization. Thus, the aim of this study was to determine the different forms of organic N in a Latossolo Vermelho distroférrico (Typic Hapludox) and their relationship to N uptake by crops in response to 10 years of annual application of pig slurry and mineral fertilizer. The treatments were application rates of 0, 25, 50, 100, and 200 m3 ha-1 of pig slurry, in addition to mineral fertilizer, organized in a randomized block design with four replications. The N contents were determined in the plant tissue and in the forms of total N and acid hydrolyzed fractions: ammonium-N, hexosamine-N, α-amino-N, amide-N, and unidentified-N. Annual application of pig slurry or mineral fertilizer increased the total-N content in the 0-10 cm depth layer. The main fractions of organic N in the soil were α-amino-N when pig slurry was applied and unidentified-N in the case of mineral fertilizers. Pig slurry increased the N fractions considered as labile: α-amino-N, ammonium-N, and amide-N. The increase in these labile organic N fractions in the soil through pig slurry application allows greater N uptake by the maize and oat crops in a no-tillage system.

ESTIMATIVA DA EROSIVIDADE DE CHUVAS NO ESTADO DO PARANÁ PELO MÉTODO DA PLUVIOMETRIA: ATUALIZAÇÃO COM DADOS DE 1986 A 2008

Três estimativas de erosividade de chuvas no Estado do Paraná foram feitas nas décadas de 1980-90, mas nenhuma outra depois. Os objetivos deste trabalho foram atualizar, numa quarta estimativa, as informações de erosividade anual das chuvas para o Paraná, com dados pluviométricos de 1986 a 2008; e gerar informações de erosividade mensal para identificar a distribuição temporal da erosividade. Foram utilizados os métodos pluviográfico e pluviométrico de determinação de erosividade. O primeiro serviu para revalidar equações prévias de correlação entre erosividade por pluviografia e por pluviometria, isso feito em três localidades; já o segundo, para calcular o coeficiente de chuva em 114 localidades, utilizando-se dados de precipitação média mensal e anual, e então a erosividade, com as equações de correlação revalidadas. Mapas de erosividade anual e mensal foram gerados por interpolações geoestatísticas. A erosividade variou entre 5.449 e 12.581 MJ mm ha-1 h-1 ano-1 e aumentou no sentido oeste, a partir da região metropolitana de Curitiba; e no sentido sul, a partir do noroeste paranaense. Isso resultou em maiores erosividades nas regiões centro-sul (Guarapuava), centro-ocidental (Campo Mourão), oeste (Cascavel) e, principalmente, sudoeste (Pato Branco). Também houve incremento de erosividade a partir da região metropolitana de Curitiba, no sentido leste, indicando o litoral como outra região crítica em termos de erosividade. A maior erosividade mensal ocorreu em janeiro (média estadual de 1394 MJ mm ha-1 h-1 mês-1), seguida por tendência de diminuição até agosto (331 MJ mm ha-1 h-1 mês-1), quando então tornou a aumentar. Porém, ocorrem dois importantes repiques de erosividade: um em maio e outro em outubro (843 e 1.173 MJ mm ha-1 h-1 mês-1, respectivamente), principalmente nas regiões sudoeste e oeste. Esses repiques coincidem com períodos de implantação de culturas de inverno ou de verão nessas regiões. Em relação à última estimativa de erosividade anual, feita em 1993, houve aumento da área delimitada pela linha isoerodente de 11.000 MJ mm ha-1 h-1 ano-1 nas regiões sudoeste e oeste e um deslocamento das linhas isoerodentes de 7.000 e 8.000 MJ mm ha-1 h-1 ano-1 para o sentido leste nas regiões norte pioneiro, centro-oriental e sudeste, sugerindo elevação da erosividade nessas regiões. Tais alterações de erosividade podem estar associadas às eventuais mudanças no clima da região, mas também ao simples fato de este estudo estar considerando maior quantidade de dados em relação aos estudos anteriores. Concluiu-se que as equações de correlação determinadas entre os métodos pluviográfico e pluviométrico, obtidas para o Paraná em trabalhos anteriores, continuam válidas; os meses críticos quanto à erosividade são janeiro, maio e outubro; e as menores erosividades ocorrem nas regiões noroeste e metropolitana do Estado.

SOIL QUALITY IN RELATION TO FOREST CONVERSION TO PERENNIAL OR ANNUAL CROPPING IN SOUTHERN BRAZIL

Many forested areas have been converted to intensive agricultural use to satisfy food, fiber, and forage production for a growing world population. There is great interest in evaluating forest conversion to cultivated land because this conversion adversely affects several soil properties. We examined soil microbial, physical, and chemical properties in an Oxisol (Latossolo Vermelho distrófico) of southern Brazil 24 years after forest conversion to a perennial crop with coffee or annual grain crops (maize and soybeans) in conventional tillage or no-tillage. One goal was to determine which soil quality parameters seemed most sensitive to change. A second goal was to test the hypothesis that no-tillage optimized preservation of soil quality indicators in annual cropping systems on converted land. Land use significantly affected microbial biomass and its activity, C and N mineralization, and aggregate stability by depth. Cultivated sites had lower microbial biomass and mineralizable C and N than a forest used as control. The forest and no-tillage sites had higher microbial biomass and mineralizable C and N than the conventional tillage site, and the metabolic quotient was 65 and 43 % lower, respectively. Multivariate analysis of soil microbial properties showed a clear separation among treatments, displaying a gradient from conventional tillage to forest. Although the soil at the coffee site was less disturbed and had a high organic C content, the microbial activity was low, probably due to greater soil acidity and Al toxicity. Under annual cropping, microbial activity in no-tillage was double that of the conventional tillage management. The greater microbial activity in forest and no-tillage sites may be attributed, at least partially, to lower soil disturbance. Reducing soil disturbance is important for soil C sequestration and microbial activity, although control of soil pH and Al toxicity are also essential to maintain the soil microbial activity high.

ORGANIC CARBON CONTENTS AND STOCKS IN PARTICLE SIZE FRACTIONS OF A TYPIC HAPLUDOX FERTILIZED WITH PIG SLURRY AND SOLUBLE FERTILIZER

The use of pig slurry (PS) as fertilizer can affect the soil quality and increase total stocks of soil organic carbon (TOC). However, the effects of PS on TOC amount and forms in the soil are not fully understood, particularly in areas under no-tillage (NT). The purpose of this study was to determine TOC contents and stocks in the particulate (POC) and mineral-associated C fractions (MAC) of an Oxisol after nine years of maize-oat rotation under NT, with annual applications of PS, soluble fertilizer and combined fertilization (pig slurry + soluble fertilizer). The experiment was initiated in 2001 in Campos Novos, Santa Catarina, with the following treatments: PS at rates of 0 (without fertilization - PS0); 25 (PS25); 50 (PS50); 100 (PS100); and 200 m3 ha-1yr-1 (PS200); fertilization with soluble fertilizer (SF); and mixed fertilization (PS + SF). The TOC content was determined in samples of six soil layers to a depth of 40 cm, and the POC and MAC contents in four layers to a depth of 20 cm. From the rate of 50 m3 ha-1yr-1 and upwards, the soil TOC content and stock increased according to the PS rates in the layers to a depth of 10 cm. The POC and MAC contents and stocks were higher in the surface layers, with a clear predominance of the second fraction, but a greater relative amplitude in the contents of the first fraction.

Liming in Agricultural Production Models with and Without the Adoption of Crop-Livestock Integration

ABSTRACT Perennial forage crops used in crop-livestock integration (CLI) are able to accumulate large amounts of straw on the soil surface in no-tillage system (NTS). In addition, they can potentially produce large amounts of soluble organic compounds that help improving the efficiency of liming in the subsurface, which favors root growth, thus reducing the risks of loss in yield during dry spells and the harmful effects of “overliming”. The aim of this study was to test the effects of liming on two models of agricultural production, with and without crop-livestock integration, for 2 years. Thus, an experiment was conducted in a Latossolo Vermelho (Oxisol) with a very clayey texture located in an agricultural area under the NTS in Bandeirantes, PR, Brazil. Liming was performed to increase base saturation (V) to 65, 75, and 90 % while one plot per block was maintained without the application of lime (control). A randomized block experimental design was adopted arranged in split-plots and four plots/block, with four replications. The soil properties evaluated were: pH in CaCl2, soil organic matter (SOM), Ca, Mg, K, Al, and P. The effects of liming were observed to a greater depth and for a long period through mobilization of ions in the soil, leading to a reduction in SOM and Al concentration and an increase in pH and the levels of Ca and Mg. In the first crop year, adoption of CLI led to an increase in the levels of K and Mg and a reduction in the levels of SOM; however, in the second crop year, the rate of decline of SOM decreased compared to the decline observed in the first crop year, and the level of K increased, whereas that of P decreased. The extent of the effects of liming in terms of depth and improvement in the root environment from the treatments were observed only partially from the changes observed in the chemical properties studied.