Modelling Bone Mineral Density in Swiss Breast Cancer Patients Treated with Letrozole, Tamoxifen and Sequences of Letrozole and Tamoxifen in the BIG 1-98 Study (SAKK 21/07).

Background: Bone health is a concern when treating early stage breast cancer patients with adjuvant aromatase inhibitors. Early detection of patients (pts) at risk of osteoporosis and fractures may be helpful for starting preventive therapies and selecting the most appropriate endocrine therapy schedule. We present statistical models describing the evolution of lumbar and hip bone mineral density (BMD) in pts treated with tamoxifen (T), letrozole (L) and sequences of T and L. Methods: Available dual-energy x-ray absorptiometry exams (DXA) of pts treated in trial BIG 1-98 were retrospectively collected from Swiss centers. Treatment arms: A) T for 5 years, B) L for 5 years, C) 2 years of T followed by 3 years of L and, D) 2 years of L followed by 3 years of T. Pts without DXA were used as a control for detecting selection biases. Patients randomized to arm A were subsequently allowed an unplanned switch from T to L. Allowing for variations between DXA machines and centres, two repeated measures models, using a covariance structure that allow for different times between DXA, were used to estimate changes in hip and lumbar BMD (g/cm2) from trial randomization. Prospectively defined covariates, considered as fixed effects in the multivariable models in an intention to treat analysis, at the time of trial randomization were: age, height, weight, hysterectomy, race, known osteoporosis, tobacco use, prior bone fracture, prior hormone replacement therapy (HRT), bisphosphonate use and previous neo-/adjuvant chemotherapy (ChT). Similarly, the T-scores for lumbar and hip BMD measurements were modeled using a per-protocol approach (allowing for treatment switch in arm A), specifically studying the effect of each therapy upon T-score percentage. Results: A total of 247 out of 546 pts had between 1 and 5 DXA; a total of 576 DXA were collected. Number of DXA measurements per arm were; arm A 133, B 137, C 141 and D 135. The median follow-up time was 5.8 years. Significant factors positively correlated with lumbar and hip BMD in the multivariate analysis were weight, previous HRT use, neo-/adjuvant ChT, hysterectomy and height. Significant negatively correlated factors in the models were osteoporosis, treatment arm (B/C/D vs. A), time since endocrine therapy start, age and smoking (current vs. never).Modeling the T-score percentage, differences from T to L were -4.199% (p = 0.036) and -4.907% (p = 0.025) for the hip and lumbar measurements respectively, before any treatment switch occurred. Conclusions: Our statistical models describe the lumbar and hip BMD evolution for pts treated with L and/or T. The results of both localisations confirm that, contrary to expectation, the sequential schedules do not seem less detrimental for the BMD than L monotherapy. The estimated difference in BMD T-score percent is at least 4% from T to L.

Estoque de carbono e nitrogênio e formas de nitrogênio mineral em um solo submetido a diferentes sistemas de manejo

O objetivo deste trabalho foi verificar alterações nos teores e no estoque de C orgânico e N total do solo, e nas suas formas nítrica e amoniacal, em sistemas de manejo implementados em área de cerrado nativo. Foram coletadas amostras no Município de Morrinhos, GO, num Latossolo Vermelho distrófico típico, textura argilosa, em cinco profundidades, nos sistemas: cerrado nativo, pastagem de Brachiaria sp., plantio direto irrigado com rotação milho-feijão, plantio direto irrigado com rotação milho-feijão e arroz-tomate, plantio convencional de longa duração e plantio convencional recente após pastagem. Não houve diferença significativa nos teores e no estoque de C e N totais do solo, embora o plantio convencional de longa duração tenha apresentado variações negativas no estoque de C em relação ao cerrado nativo até 20 cm de profundidade, ao contrário dos sistemas com menor revolvimento. O amônio predominou no cerrado nativo e na pastagem ao longo de praticamente todo o perfil, enquanto os teores de nitrato foram maiores na camada superficial dos sistemas com culturas anuais. A pastagem e o plantio direto, desde que com esquema diversificado de rotação de culturas, são promissores para aumentar os estoques de C orgânico do solo.

Is it appropriate to index glomerular filtration rate for body surface area

Purpose: Obesity is an established independent risk factor for chronic kidney disease. Thus, measurement of glomerular filtration rate (GFR) is important in this population. Traditionally, GFR has been indexed for body surface area (BSA), but this indexation may not be appropriate in obese individuals. Therefore, the objective of the study was to compare absolute GFR with GFR indexed for BSA and with GFR indexed for height. Methods and materials: The study was conducted in 66 families from the Seychelles islands that included several members with hypertension. GFR and effective renal plasma flow (ERPF) were measured using inulin and PAH clearances, respectively. Antihypertensive treatment, if used, was withheld 2 weeks before conducting the clearances. Participants with diabetes mellitus were excluded from the analysis. BSA was calculated using the Dubois formula. We assessed trend across BMI categories using a non parametric test. Results: Participants included 174 women and 127 men. The prevalence of hypertension was 61%, of which 68% were treated. The table shows that absolute GFR, GFR indexed for height, ERPF, filtration fraction were significantly higher across BMI categories. When GFR was indexed for BSA, the association between GFR and BMI categories was lost. Conclusion: Indexing GFR for BSA in overweight and obese individuals leads to a substantial underestimation of GFR. Filtration fraction, which does not depend on BSA, is higher in obese individuals, which suggests glomerular hyperfiltration. Indexing GFR for BSA therefore would mask the underlying glomerular hyperfiltration. As the number of nephrons does not increase with weight gain, absolute GFR represents a better marker of single nephron GFR and is more appropriate.

Transcranial Doppler Pulsatility Index: What it is and What it Isn't.

BACKGROUND: Transcranial Doppler (TCD) pulsatility index (PI) has traditionally been interpreted as a descriptor of distal cerebrovascular resistance (CVR). We sought to evaluate the relationship between PI and CVR in situations, where CVR increases (mild hypocapnia) and decreases (plateau waves of intracranial pressure-ICP). METHODS: Recordings from patients with head-injury undergoing monitoring of arterial blood pressure (ABP), ICP, cerebral perfusion pressure (CPP), and TCD assessed cerebral blood flow velocities (FV) were analyzed. The Gosling pulsatility index (PI) was compared between baseline and ICP plateau waves (n = 20 patients) or short term (30-60 min) hypocapnia (n = 31). In addition, a modeling study was conducted with the "spectral" PI (calculated using fundamental harmonic of FV) resulting in a theoretical formula expressing the dependence of PI on balance of cerebrovascular impedances. RESULTS: PI increased significantly (p < 0.001) while CVR decreased (p < 0.001) during plateau waves. During hypocapnia PI and CVR increased (p < 0.001). The modeling formula explained more than 65% of the variability of Gosling PI and 90% of the variability of the "spectral" PI (R = 0.81 and R = 0.95, respectively). CONCLUSION: TCD pulsatility index can be easily and quickly assessed but is usually misinterpreted as a descriptor of CVR. The mathematical model presents a complex relationship between PI and multiple haemodynamic variables.

Nutrição mineral de plantas de maxixe-do-reino

O objetivo desse estudo foi o de caracterizar as limitações nutricionais para a produção de matéria seca do maxixe-do-reino, Cyclanthera pedata (L.) Schrad. Foram realizados dois cultivos sucessivos, em vasos de 3 dm³ de solo. O delineamento experimental foi inteiramente casualizado, em treze tratamentos, com três repetições. Os tratamentos foram baseados na técnica do elemento faltante (em que se omite a calagem e cada um dos macronutrientes e micronutrientes). A produção de matéria seca da parte aérea e raiz foi reduzida pela acidez do solo e baixa disponibilidade de macronutrientes, principalmente P, Ca, Mg e S; as plantas foram pouco afetadas pela baixa disponibilidade de micronutrientes.

Produtividade e crescimento da mamoneira em resposta à adubação orgânica e mineral

O objetivo deste trabalho foi avaliar os efeitos da adubação orgânica e mineral sobre o crescimento e a produtividade da mamoneira (Ricinus communis). Avaliaram-se doses de esterco, P, K e micronutrientes, em solo de baixa fertilidade e baixa disponibilidade hídrica. Utilizou-se delineamento em blocos ao acaso, com três repetições e distribuição fatorial 3x2+4 (três doses de matéria orgânica, presença ou ausência de adubação mineral, com quatro combinações de doses de fertilizantes orgânicos e minerais e micronutrientes). Foram obtidos os seguintes valores de produtividade média: 163,7 kg ha-1, no tratamento sem adubação, e 596,9, 988,1 e 1.172,5 kg ha-1 com adubações orgânica mineral e orgânica + mineral, respectivamente. O P é o nutriente de maior importância para o aumento de produtividade e teor de óleo. A baixa disponibilidade hídrica limita a mineralização e a liberação de nutrientes do material orgânico.