Hormone replacement therapy and the risk of breast cancer: assessment of therapy acceptance in a cohort of previously treated breast cancer patients

INTRODUCTION: In the postmenopausal period, an average of 25% of women will present symptomatic ovarian failure requiring hormonal replacement therapy. Estrogen can relieve vasomotor symptoms. Hormonal replacement therapy is generally not recommended for breast cancer patients due to the potential risk of tumor recurrence. To answer the questions about the safety of hormonal replacement therapy in this subgroup of women, it is necessary to establish the acceptance of treatment. METHODS: Between September 1998 and February 2001, a cohort of 216 breast cancer patients were asked to complete a questionnaire. All patients had completed their treatment and were informed about survival rates after breast cancer and hormonal replacement therapy. RESULTS: Among the 216 patients, 134 (62%) would refuse hormonal replacement therapy. A hundred patients were afraid of relapse (74.6%). Adjuvant tamoxifen therapy was the only statistically significant variable (70.3% versus 29.7% p=0.003). Understanding clinical stage (p= 0.045) and type of medical assistance (private versus public , p=0.033) also seemed to influence the decision. Early stage disease (p= 0.22), type of surgical procedure (radical versus conservative, p=0.67), adjuvant chemotherapy (p=0.082) or marital status (p=0.98 ) were not statistically significant in decision making. Several patients submitted to adjuvant chemotherapy (41.6%) would accept hormonal replacement therapy under medical supervision, as did most of advanced clinical stage patients (58.3%; p=0.022). CONCLUSION: There is a high level of rejection for hormonal replacement therapy among breast cancer patients when current data on tumor cure rates, and potential risks of estrogen use is available. Adverse effects of tamoxifen in the adjuvant setting may be the reason for refusal of hormonal replacement therapy .

Histopathologic and biochemical liver test abnormalities in chronic asymptomatic or oligosymptomatic alcoholics: a review

PURPOSE: To review the medical literature regarding the histopathologic and biochemical liver test abnormalities in chronic asymptomatic or oligosymptomatic alcoholics. METHODS: Review of articles in the MEDLINE and LILACS databases regarding serum levels and prevalence of alterations in aspartate-aminotransferase, alanine-aminotransferase, alkaline phosphatase, and total bilirubin, in relation to liver histopathology, with or without discrimination of types of histopathologic alteration. RESULTS: Global mean prevalence rates of aspartate-aminotransferase and alanine-aminotransferase alterations were 86.3% and 51.1%; in cases with steatosis they were 79.1% and 38.5%; and in cases of hepatitis, 90.1% and 58%. In all studies, prevalence rates of aspartate-aminotransferase alterations were significantly higher with lower variability than those of alanine-aminotransferase. Mean aspartate-aminotransferase levels were higher than 2N (N is the upper normal limit of the method employed) in all cases with hepatitis histopathology, while those of alanine-aminotransferase were 1.48N, in the same cases. Prevalence of alkaline phosphatase and total bilirubin abnormalities were 74.5% and 74.9% globally; in cases of steatosis, they were 70.9% and 67.9%; and in cases of hepatitis, 75.9% and 77.7%. Mean alkaline phosphatase levels were above the upper normal limit in all cases, but those of total bilirubin were above normal in 4 of 7 hepatitis studies. CONCLUSIONS: Prevalence of aspartate-aminotransferase alteration was consistently related to presence of histopathologic abnormalities; an enzyme level higher than 2N suggests the diagnosis of alcoholic hepatitis.

Sperm tail flexibility test: a simple test for selecting viable spermatozoa for intracytoplasmic sperm injection from semen samples without motile spermatozoa

PURPOSE: The objective was to describe the results of the injection of immotile spermatozoa with flexible tails when only immotile spermatozoa are present in the semen sample. METHODS: A retrospective study was conducted to analyze the procedure results for 10 couples who participated in our intracytoplasmic sperm injection program. The sperm tail was considered flexible when it moved up and down independently of the head movement, and it was considered inflexible when the movement occurred together (tail plus head). The fertilization and pregnancy rate were analyzed. RESULTS: The normal fertilization rate (presence of 2 pronuclei) was 30.3% (40/132), and the abnormal fertilization rate (presence of less than or more than 2 pronuclei) was 6.81% (9/132). A total of 52 embryos were obtained with 9 transfer procedures performed (pregnancy rate: 11.12%). CONCLUSIONS: The sperm tail flexibility test (STFT) is an easy and cost-effective way for selecting viable immotile spermatozoa and can be used as an alternative method for determining the viability of spermatozoa. This test seems to be a simple and risk-free method when compared to the swelling test.

Risks and benefits of hormone replacement therapy in older men

The use of testosterone in older men, known as male hormonal replacement therapy or androgen replacement therapy, has become of increasing interest to both the medical and lay communities over the past decade. Even though the knowledge of the potential benefits and risks of male Androgen Replacement Therapy has increased dramatically, there is still much that needs to be determined. Although there are a number of potential benefits of male Androgen Replacement Therapy and data concerning clinical effects of such replacement have accumulated, as yet there have not been any large multicenter randomized controlled trials of this therapy. It is the purpose of this article to review what is currently known about the possible risks and benefits of male Androgen Replacement Therapy by discussing the clinical trials to date.

Induction of experimental mammary carcinogenesis in rats with 7,12-dimethylbenz(a)anthracene

PURPOSE: To test an experimental model of chemical mammary carcinogenesis induction in rats. METHODS: Twenty young virgin Sprague-Dawley female rats, aged 47 days, received 20 mg of 7,12-dimethylbenz(a)anthracene (DMBA) intragastrically by gavage. Afterwards, at 8 and 13 weeks, their mammary glands were examined. At the end of the experiment, the animals were sacrificed, and the mammary tumors were measured and weighed. Tumor fragments were analyzed using light microscopy. RESULTS: Eight weeks after DMBA injection, 16 rats presented at least 1 breast tumor (80%). After 13 weeks, all of them (100%) developed breast carcinomas that were confirmed by histopathological analysis. CONCLUSION: This experimental animal model of chemical mammary induced carcinogenesis is feasible and can be used in further experiments on the role of tumorigenic biomodulator substances.

Produtividade sazonal da floresta e atividade de forrageamento animal em habitat de terra firme da Amazônia

Durante 13 meses (de janeiro de 1986 a janeiro de 1987), quatro trilhas, de aproximadamente 2,5 km de comprimento cada uma, cortando diferentes ambientes de mata de terra firme, foram seguidas diariamente por um mínimo de dois pesquisadores para observar animais forrageando no chão o em diferentes estratos da floresta. O local de estudo foi em porção de floresta protegida em Tucuruí, estado do Pará. Foram investigadas por observação contínua no campo as tendências sazonais de utilização de ítens de alimentos preferidos demonstrados por quelôneos: os jabutis Geochelone carbonaria, G. denticulata e a aperema Platemys platicephala; por roedores: o quatipuru Sciurus gilvigularis e a cutia Dasyprocta aguti; por cervídeos: o veado-mateiro Mazama americana e o veado fuboca Mazama guazoubira; e por primatas: o macaco-prego Cebus apella, o guariba Alouatta belzebul, o cuxiú Chiropotes satanas , o macaco-mão-de-ouro Saimiri sciureus, e o sagui preto Saguinus midas. Todos esses animais foram estudados através de observação contínua nessas trilhas de transectos, estabelecidas na mata de terra firme. As observações foram feitas pela manhã entre 06:00 e 10:00 horas e à tarde, entre 15:00 e 19 horas. O estudo demonstrou que as dietas dessas espécies animais de habitat de terra firme depende da disponibilidade de alimento na floresta na estação do ano. A importância desses ítens de alimento é demonstrada pela mudança sazonal da atividade de forrageamento, dependendo do ítem alimentar em oferta. Os jabtutis (Geochelone carbonaria e G. denticulata) alimentam-se basicamente de frutos disponíveis entre setembro e janeiro, sendo esses mesmo frutos compatilhados por cutia (Dasyprocta aguti), enquanto o macaco-prego (Cebus apella) expande sua dieta baseada em frutas, em dois picos, um entre janeiro e março, com um máximo de atividade em fevereiro, e outro pico entre julho e dezembro. Essas mesmas frutas são também compartilhadas por Chiropotes satanas. Embora o guariba (Alouatta belzebul) seja observado comendo grande porcentagem de folhas, nas estações de produção de frutos, porém, durante os dois picos anuais, (fevereiro e dezembro) tornam-se oportunisticamente frugívoros.

A practical approach to execute and test a lean startup

This paper practically applies the “Lean Startup Approach” by identifying, analyzing and executing a newly developed web-based business idea. Hypotheses were designed and tested with the construction of a minimum viable product – i.e. a landing page. In-depth interviews allowed deciding either to pivot or persevere the initial launch strategy. Overall, the aim was to collect as much valuable response as possible from customers and ultimately decide for a superior strategy while devoting the smallest amount of time and money.

Tensile properties of polymer repair materials - effect of test parameters

In this research, five types of polymer repair materials were selected for investigation of the influence of sample shape, deformation rate and test temperature on the mechanical properties determined with an uniaxial tensile test. The results showed the clear effect of measurement conditions on tensile strength, elongation and modulus of elasticity. The highest tensile strength and modulus of elasticity were exhibited by epoxy resin for the filling of concrete cracks, which achieved 1% elongation. The lowest coefficient of dispersion characterized the results of tensile test carried out using dumbbell samples at a deformation rate of 50 mm/min. The effect of temperature varied with the material type.

Assessment of overlay masonry strengthening system under in-plane monotonic and cyclic loading using the diagonal tensile test

The development of novel strengthening techniques to address the seismic vulnerability of masonry elements is gradually leading to simpler, faster and more effective strengthening strategies. In particular, the use of fabric reinforced cementitious matrix systems is considered of great potential, given the increase of ductility achieved with simple and economic strengthening procedures. To assess the effectiveness of these strengthening systems, and considering that the seismic action is involved, one important component of the structural behaviour is the in-plane cyclic response. In this work is discussed the applicability of the diagonal tensile test for the assessment of the cyclic response of strengthened masonry. The results obtained allowed to assess the contribution of the strengthening system to the increase of the load carrying capacity of masonry elements, as well as to evaluate the damage evolution and the stiffness degradation mechanisms developing under cyclic loading.

Bond of NSM FRP strengthened concrete: round robin test initiative

Despite the extensive research that has been conducted on the debonding behaviour of FRP strengthening systems, no standard methodology has been yet established on its experimental characterization. In this context, to assess the performance and reliability of small scale testing on NSM (near surface mounted) FRP strengthening systems, an experimental program was carried out on a series of nine NSM FRP strengthening systems, in the framework of an international Round Robin Testing (RRT). Eleven laboratories and seven manufacturers and suppliers participated in this extensive international exercise, which regarded both NSM and EBR FRP strengthening systems. Test results obtained for the NSM systems by the participating laboratories are discussed and compared in this paper to investigate the feasibility of the adopted single/double pulling shear test method, to investigate the mechanism of bond between NSM FRP reinforcement and concrete, and to investigate the level of variability obtained between the participating laboratories testing the same material batches. It is concluded that the tested variants in the adopted single/double shear pulling test have a significant influence, stressing the importance of the level of detail of standardized test protocols for bond verification. On overall, given the variants included in this study, the obtained variation in bond stress-slip behaviour between the laboratories remained fairly limited.

Qualitative risk assessment during polymer mortar test specimens preparation - methods comparison

Polymer binder modification with inorganic nanomaterials (NM) could be a potential and efficient solution to control matrix flammability of polymer concrete (PC) materials without sacrificing other important properties. Occupational exposures can occur all along the life cycle of a NM and “nanoproducts” from research through scale-up, product development, manufacturing, and end of life. The main objective of the present study is to analyse and compare different qualitative risk assessment methods during the production of polymer mortars (PM) with NM. The laboratory scale production process was divided in 3 main phases (pre-production, production and post-production), which allow testing the assessment methods in different situations. The risk assessment involved in the manufacturing process of PM was made by using the qualitative analyses based on: French Agency for Food, Environmental and Occupational Health & Safety method (ANSES); Control Banding Nanotool (CB Nanotool); Ecole Polytechnique Fédérale de Lausanne method (EPFL); Guidance working safely with nanomaterials and nanoproducts (GWSNN); Istituto Superiore per la Prevenzione e la Sicurezza del Lavoro, Italy method (ISPESL); Precautionary Matrix for Synthetic Nanomaterials (PMSN); and Stoffenmanager Nano. It was verified that the different methods applied also produce different final results. In phases 1 and 3 the risk assessment tends to be classified as medium-high risk, while for phase 2 the more common result is medium level. It is necessary to improve the use of qualitative methods by defining narrow criteria for the methods selection for each assessed situation, bearing in mind that the uncertainties are also a relevant factor when dealing with the risk related to nanotechnologies field.

Comparative environmental life-cycle analysis of concretes using biomass and coal fly ashes as partial cement replacement material

Nowadays, the concrete production sector is challenged by attempts to minimize the usage of raw materials and energy consumption, as well as by environmental concerns. Therefore, it is necessary to choose better options, e.g. new technologies or materials with improved life-cycle performance. One solution for using resources in an efficient manner is to close the materials' loop through the recycling of materials that result either from the end-of-life of products or from being the by-product of an industrial process. It is well known that the production of Portland cement, one of the materials most used in the construction sector, has a significant contribution to the environmental impacts, mainly related with carbon dioxide emission. Therefore, the study and utilization of by-products or wastes usable as cement replacement in concrete can supply more sustainable options, provided that these type of concrete produced has same durability and equivalent quality properties as standard concrete. This work studied the environmental benefits of incorporating different percentages of two types of fly ashes that can be used in concrete as cement replacement. These ashes are waste products of power and heat production sectors using coal or biomass as fuels. The results showed that both ashes provide a benefit for the concrete production both in terms of environmental impact minimization and a better environmental performance through an increase in cement replacement. It is possible to verify that the incorporation of fly ashes is a sustainable option for cement substitution and a possible path to improve the environmental performance of the concrete industry.

Eco-efficient self-compacting concrete with reduced Portland cement content and high volume of fly ash and metakaolin

The eco-efficient, self-compacting concrete (SCC) production, containing low levels of cement in its formulation, shall contribute for the constructions' sustainability due to the decrease in Portland cement use, to the use of industrial residue, for beyond the minimization of the energy needed for its placement and compaction. In this context, the present paper intends to assess the viability of SCC production with low cement levels by determining the fresh and hardened properties of concrete containing high levels of fly ash (FA) and also metakaolin (MK). Hence, 6 different concrete formulations were produced and tested: two reference concretes made with 300 and 500 kg/m3 of cement; the others were produced in order to evaluate the effects of high replacement levels of cement. Cement replacement by FA of 60% and by 50% of FA plus 20% of MK were tested and the addition of hydrated lime in these two types of concrete were also studied. To evaluate the self-compacting ability slump flow test, T500, J-ring, V-funnel and L-box were performed. In the hardened state the compressive strength at 3, 7, 14, 21, 28 and 90 days of age was determined. The results showed that it is possible to produce low cement content SCC by replacing high levels of cement by mineral additions, meeting the rheological requirements for self-compacting, with moderate resistances from 25 to 30 MPa after 28 days.

Towards automated test and validation of SIP solutions

IP networks are currently the major communication infrastructure used by an increasing number of applications and heterogeneous services, including voice services. In this context, the Session Initiation Protocol (SIP) is a signaling protocol widely used for controlling multimedia communication sessions such as voice or video calls over IP networks, thus performing vital functions in an extensive set of public and enter- prise solutions. However, the SIP protocol dissemination also entails some challenges, such as the complexity associated with the testing/validation processes of IMS/SIP networks. As a consequence, manual IMS/SIP testing solutions are inherently costly and time consuming tasks, being crucial to develop automated approaches in this specific area. In this perspective, this article presents an experimental approach for automated testing/validation of SIP scenarios in IMS networks. For that purpose, an automation framework is proposed allowing to replicate the configuration of SIP equipment from the pro- duction network and submit such equipment to a battery of tests in the testing network. The proposed solution allows to drastically reduce the test and validation times when compared with traditional manual approaches, also allowing to enhance testing reliability and coverage. The automation framework comprises of some freely available tools which are conveniently integrated with other specific modules implemented within the context of this work. In order to illustrate the advantages of the proposed automated framework, a real case study taken from a PT Inovação customer is presented comparing the time required to perform a manual SIP testing approach with the one time required when using the proposed auto- mated framework. The presented results clearly corroborate the advantages of using the presented framework.