No description available.

Background: Colorectal cancer (CRC) is the third most common cancer in men and the second most common in women worldwide. Adenomas can be precursors to CRC, and inflammatory bowel disease (IBD) can present with the same symptoms as CRC. The majority of patients with CRC initially consult primary care. Symptoms associated with CRC are also common among primary care patients, but seldom caused by any significant disease. Reliable diagnostic aids would be helpful in deciding which patients to refer. Faecal immunochemical tests (FITs) are commonly used for this purpose in primary care in Sweden, but there is little evidence to support this use. Faecal calprotectin (FC) has been suggested as an additional test. Aim: To explore how doctors in primary care investigate patients with suspected CRC, the value of FITs, symptoms and presence of anaemia in diagnosing CRC and adenomas in primary care, and whether FC tests could contribute to diagnosis. Methods: Three studies (1-3) were carried out in Region Jämtland Härjedalen, Sweden. There was no screening programme for CRC. We used a point of care qualitative dip-stick 3-sample FIT with a cut-off of 25-50μg haemoglobin/g faeces, and a calprotectin enzyme-linked immunosorbent assay (ELISA) test with a cut-off of 100 μg/g faeces. 1: A retrospective, population-based study including all patients diagnosed with CRC or adenomas with high-grade dysplasia (HGD) during the period 2005-2009 that initially consulted primary care. Symptoms, FIT results, anaemia and time to diagnosis were retrieved from medical records. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated from FIT results at the region’s health centres 2008- 2009. (Paper I.) 2: A prospective cohort study including consecutive patients where primary care doctors requested FITs and/or FC tests, at four health centres, from 30 Jan 2013 to 31 May 2014. FITs, FC tests, haemoglobin and iron deficiency tests were analysed; patients and doctors answered questionnaires about symptoms. Patients were examined with bowel imaging or followed for two years. Findings of CRC, adenomas with HGD, adenomas with low grade dysplasia (LGD) ≥1 cm and IBD were registered. (Papers II and III.) 3: A qualitative study of interviews with eleven primary care doctors. We explored what made them suspect CRC, and their practices regarding investigation and referral with particular attention to their use of FITs. Qualitative content analysis with an inductive approach was used for the analysis. (Paper IV.) Results: 1: Paper I: Of 495 patients 323 (65.3%) started the investigation in primary care. FITs were analysed in 215. In 23 cases with CRC, FITs were negative; 15 (65.2%) had anaemia. In 33 cases with CRC, FITs were performed due to asymptomatic anaemia; 10 (30.3%) had negative FITs. The time from start of investigation, to the diagnosis of CRC or adenomas with HGD, was significantly longer for patients with negative FITs. 2: 377 patients (9 diagnosed with CRC, 10 with IBD) were included. Paper II: Concordance of positive answers about symptoms from patients and doctors was generally low. Rectal bleeding (recorded by 43.5% of patients and 25.6% of doctors) was the only symptom related to CRC and IBD. The FIT showed a better PPV than rectal bleeding for CRC and IBD. When patients recorded rectal bleeding, the FIT had a PPV of 22.6% and a NPV of 98.9% for CRC and IBD. Paper III: The best test for detecting CRC and IBD was the combination of a positive FIT and/or anaemia with a sensitivity, specificity, PPV and NPV of 100%, 61.7%, 11.7% and 100% respectively. The FC test had no additional value to the FIT alone. The sensitivity, specificity, PPV and NPV of the FIT for CRC in study 1 was estimated at 88.4%, 73.3%, 6.2% and 99.7% respectively. In study 2, corresponding figures were 88.9%, 67.4%, 6.3% and 99.6% respectively. 3: Paper IV: We identified four categories: “Careful listening – with awareness of the pit-falls”, “tests can help – the FIT can also complicate the diagnosis”, “to refer or not to refer – safety margins are necessary”, and “growing more confident – but also more humble”. All doctors had found their own way to handle FIT results in the absence of guidelines. Conclusion: The diagnostic process when suspecting CRC can be described as navigating uncertain waters with safety margins. FITs were often used by primary care doctors but with considerable variations in interpretation and handling of results. Rectal bleeding was the only symptom related to CRC and IBD, but the FIT showed a better PPV than rectal bleeding. The combination of a negative FIT and no anaemia may be useful as a rule-out test when CRC is suspected in primary care, and this potentially also applies when patients present with rectal bleeding. Further studies are needed to confirm this and to determine the optimal FIT cut-off value for this use.

Introdução: De acordo com a União Internacional Contra o Câncer um mínimo de 12 linfonodos (LN) deve ser obtido no espécime cirúrgico para o estadiamento do câncer colorretal (CCR). Estudos recentes reportaram que o uso da quimioirradioterapia neoadjuvante (QRN) pode resultar na não obtenção do número mínimo de LN na peça em 30-52% dos pacientes. Objetivo: Identificar os fatores relacionados à redução do número de LN ressecados em pacientes submetidos à neoadjuvancia e a excisão total do mesorreto. Pacientes e métodos: De janeiro de 2012 a março de 2013, 160 pacientes com câncer de reto foram submetidos à QRN (5-FU e 5040 Gys) seguida de excisão total de mesorreto com ligadura dos vasos mesentéricos inferiores nas suas raízes. Foram incluídos pacientes com estadiamento T3, T4 e/ou N+ que distavam até 10cm da borda anal e T2N0 que distavam até 7 cm da borda anal. Foram excluídos pacientes cujo tratamento com quimiorradioterapia neoadjuvante foi incompleto, ou que tiveram atrasos significativos para re-estadiamento e/ou realização da cirurgia. Todos foram estadiados através de toque retal, colonoscopia, TC de tórax e de abdome, e RM de pelve e igualmente re-estadiados 8 semanas após o término da neoadjuvância, operados e submetidos a excisão total do mesorreto. Os pacientes foram divididos em 2 grupos: A) menos de 12 LN, e B) 12 ou mais LN. Foram estudadas as possíveis variáveis relacionadas ao número de LN obtidos: sexo, idade, presença de LN acometidos, tamanho do tumor, localização da altura do tumor no reto, comprimento da peça, preservação esfincteriana, via de acesso, estadiamento inicial, grau de resposta tumoral e resposta patológica à quimiorrradioterapia neoadjuvante. Resultados: Noventa e cinco pacientes (60 masculinos) preencheram os critérios de inclusão e conseguiram ser tratados, re-estadiados e operados dentro das datas pré-estabelecidas. A média de LN ressecados foi 23,2 (3-67). Resposta patológica completa foi obtida em 18 pacientes (19%). Um mínimo de 12 LN foram obtidos em 81 pacientes (85%). Dentre os 14 doentes que obtiveram menos de 12 LN, 7 (50%) eram respostas patológicas completas. De todas as variáveis estudadas apenas resposta patológica completa na peça foi fator associado à não obtenção do número mínimo de 12 LN (p=0,002). Conclusões: Em pacientes submetidos à QRN e ETM, a resposta patológica completa foi o único fator associado a não obtenção de um mínimo de 12 de LN na peça / INTRODUCTION: According to the International Union against Cancer a minimum of 12 lymph nodes (LN) must be obtained from the surgical specimen for staging colorrectal cancer. However, recent studies reported that neoadjuvant chemoradiation may result in failure to obtain a minimum number of LN in 30-52 % of patients. OBJECTIVE: To identify factors associated with decreased number of LN resected in patients undergoing neoadjuvant therapy followed by total mesorectal excision (TEM). METHODS: From January/2012 to March/2013, 160 patients with rectal cancer underwent CRT (5 - FU and Gys 5040) followed by TEM and ligation of inferior mesenteric vessels in the roots. Patients with stage T3, T4 and/or N + within 10cm from anal verge were included. Patients with T2N0 located within 7cm from the anal verge were also included. Patients who were not able to complete the chemoradiation treatment or who presented significant delay on restaging and/or surgery were excluded from analyses. All patients were staged by digital rectal examination, colonoscopy, CT of the abdomen and chest, and MRI of the pelvis. Patients were re-staged 8 weeks after completion of neoadjuvant therapy, and submitted to total mesorectal excision right after that. Patients were stratified according to LN retrieval in two groups: A) less than 12 LN, B) 12 or more LN. Possible factors associated with the decreased number of LN were evaluated: gender, age, presence of metastatic LN, tumor size, tumor location, and length of the specimen, sphincter preservation, surgical access, initial staging, tumor regression grade and pathological response to chemoradiation. RESULTS: Ninety-five patients (60 male) met the inclusion criteria and were able to be treated, re-staged and operated within the pre-established intervals. The mean number of resected LN was 23.2 (3-67). Pathological complete response was achieved in 18 patients (19%). A minimum of 12 LN were obtained from 81 patients (85%). Half of the 14 patients with less than 12 LN presented pathologic complete response. Of all the variables studied only pathologic complete response was associated with less than 12 LN yield (p = 0.002). CONCLUSIONS: In patients submitted to chemoradiation followed by TME the complete pathological response was the only factor associated with failure to obtain a minimum of 12 LN in the specimen

Introdução: O câncer de localização colorretal é o terceiro tipo de câncer mais comumente diagnosticado no mundo. As taxas de incidências do câncer colorretal não são homogêneas, apresentando diferenças entre os países. Não há estudos brasileiros que investiguem a variação geográfica da incidência de câncer colorretal conjuntamente com indicadores socioeconômicos. Esta avaliação pode revelar diferenças locais importantes na ocorrência da doença. Objetivos: Descrever as taxas de incidência e de mortalidade do câncer colorretal no Município de São Paulo, segundo sexo e faixa etária, no período de 1997 a 2009 e realizar análise da distribuição espacial segundo distrito dos casos de câncer colorretal diagnosticados em residentes no Município de São Paulo entre 1997 e 2009. Material e Métodos: Foram analisados os novos casos de câncer colorretal diagnosticados em residentes no Município de São Paulo de 1997 a 2009. Estes dados foram fornecidos pelo Registro de Câncer de Base Populacional de São Paulo (RCBP-SP). A análise dos dados foi realizada em duas etapas: na primeira, com cárater exploratório/descritivo, os dados analíticos foram utilizados para descrever a incidência e mortalidade por câncer colorretal no período pesquisado. Na segunda etapa, os casos de câncer colorretal foram geocodificados, agrupados por distrito administrativo e estudados segundo a metodologia de análise para dados de área. Toda análise foi implementada no software R. Resultados: Com 7,7 por cento e 7,3 por cento dos casos respectivamente em homens e mulheres, câncer colorretal foi o segundo tipo de câncer mais frequente, sendo a quarta (9,0 por cento dos óbitos) e a segunda (11,0 por cento dos óbitos) causa de morte respectivamente em homens e mulheres. Do total de casos incidentes (39.250), 47,50 por cento são do sexo masculino e 52,50 por cento do sexo feminino. Destes, 4.784 (37,7 por cento ) evoluíram a óbito, sendo 48,1 por cento no sexo masculino e 51,9 por cento no sexo feminino. As taxas específicas por sexo e faixa etária de incidência aumentam fortemente com a idade, na faixa etária de 80 ou mais anos chega a 377,9 e 282,9 (por 100 mil hab.) para o sexo masculino e feminino respectivamente, sendo relativamente próximas em ambos os sexos até a idade de 49 anos e maiores para homens nas faixas etárias subsequentes. As taxas específicas por sexo e faixa etária de mortalidade, apresentam comportamento análogo, aumentam fortemente com a idade, na faixa etária de 80 ou mais anos chega a 206,9 e 159,9 (por 100 mil hab.) para o sexo masculino e feminino respectivamente. A taxa anual de incidência ajustada pela população de SEGI (1960) e modificada por DOLL et al. (1966) apresenta-se em torno de 30,0 (por 100 mil hab.) nos três primeiros anos observados (1997-1999), chega a 19,0 (por 100 mil hab.) em 2002, volta a crescer nos anos seguintes (2003-2005), chegando a 31,7 (por 100 mil hab.) e matem-se estável de 2007 a 2009. A taxa anual de mortalidade de câncer colorretal ajustada pela população crescente até 2004, chegando a 15,7 (por 100 mil hab.) e decrescem nos anos seguintes, chegando a aproximadamente 3,6 mortes por 100 mil habitantes em 2009. A média anual da taxa bruta de incidência e os indicadores socioeconômicos apresentam dependência forte dependência espacial, sendo o menor Índice I de Moran observado foi para o índice de exclusão/inclusão dos anos potenciais de vida perdidos (IEX apvp = 0,29), os demais são acima de 0,6. Os indicadores apresentam forte correlação linear com a média anual da taxa bruta de incidência. Conclusões: As distribuições da incidência e da mortalidade apresentam padrões semelhantes ao identificado mundialmente. O Município de São Paulo tem taxas equivalentes às encontradas nas regiões em transição econômica. Foi identificada forte dependência espacial na distribuição da incidência de câncer colorretal no Município de São Paulo, com a formação de clusters nas áreas centrais e periféricas. As maiores taxas são encontradas nas áreas centrais e nas periferias. A distribuição espacial da incidência de câncer colorretal apresenta forte associação com a distribuição dos indicadores de status socioeconômico no Município de São Paulo, em particular apresenta associação positiva com indicadores de renda e escolaridade. / Introduction: Colorectal cancer is the third most common diagnosed cancer worldwide. Colorectal cancer incidence rates are not homogeneous, with differences between countries. No Brazilian studies investigated the geographical variation of colorectal cancer incidence with socioeconomic indicators. This study may reveal important local differences in the occurrence of the disease. Objectives: To describe colorectal cancer incidence and mortality in São Paulo, by sex and age using 1997-2009 data and perform the spatial distribution analysis according to district colorectal cancer cases diagnosed in residents at Municipality of São Paulo between 1997 and 2009. Methods: Colorectal cancer cases diagnosed from 1997 to 2009 in São Paulo residents were analyzed. These data were provided by Population Based Cancer Registry of São Paulo (RCBP-SP). Data analysis was performed in two stages. First, analytical data were used to describe the incidence and mortality from colorectal cancer. Second, colorectal cancer cases were geocoded, grouped by administrative district and studied according data area analysis methodology. All analysis was implemented in software R. Results: 7.7 per cent and 7.3 per cent of observed cases was respectively in men and women, colorectal cancer was the second most common cancer, the fourth (9.0 per cent ) cause of death in men and the second (11.0 per cent ) cause in women. It was diagnosed 39,250 colorectal cancer new cases, 47.50 per cent in men and 52.50 per cent in women. And 4,784 (37.7 per cent ) died, with 48.1 per cent in male and 51.9 per cent in female. The specific incidence rates strongly increase with age, at the 80 years or more age reaches 377.9 and 282.9 (per 100,000 inhabitants) for male and female respectively. The mortality specific rates, have similar behavior, strongly increase with age and at the 80 years or more age reaches 206.9 and 159.9 (per 100,000 inhabitants), for males and female respectively. The annual age adjusted incidence rate was around 30.0 (per 100,000 inhab.) in the first observed years (1997-1999), arrives to 19.0 (per 100,000 inhab.) in 2002, grow back reaching 31.7 (per 100,000 inhab.) and kill stable from 2007 to 2009. The annual age colorectal cancer mortality rate grow reaching 15.7 (per 100,000 inhab.) and decrease in the following years, reaching approximately 3.6 deaths per 100,000 inhabitants in 2009. The average annual the crude incidence rate and the socio-economic indicators show strong spatial dependence, the lowest Moran´s I Index was observed for the exclusion/inclusion potential years of life lost index (IEX apvp = 0.29). The indicators show strong linear correlation with the average annual crude incidence rate. Conclusions: Distributions of incidence and mortality have similar worldwide patterns. The Municipality of São Paulo has equivalent rates founded in regions in economic transition. It was identified strong spatial dependence in the distribution of the incidence of colorectal cancer, with the formation of clusters in the central and peripheral areas of Municipality of São Paulo. The highest rates were found in the central areas and lowest were found in the suburbs. The spatial distribution of colorectal cancer incidence has a strong association with the socioeconomic status indicators distribution in Municipality of São Paulo. It was identified positive association between colorectal cancer incidence with income and education indicators.

A suinocultura moderna tem se destacado pelos altos índices produtivos alcançados. Muito disso se deve à intensa tecnificação, fazendo com que as linhagens de fêmeas suínas fossem melhoradas geneticamente tornado-as hiperprolíficas. Este aumento possibilitou uma melhor produtividade e maior ganho econômico. Entretanto, houve o surgimento de problemas relacionados à desuniformidade das leitegadas, contribuindo com uma maior variabilidade de peso dentro delas. Outro fator importante e intrínseco a este, é em relação à viabilidade e vitalidade de leitões menos favorecidos, em virtude de seu baixo peso ao nascimento e possível exposição a eventos estressantes durante o parto. Em busca de possíveis explicações sobre estes problemas gerados em termos produtivos esta tese foi desenvolvida sob a forma de uma revisão literária e dois experimentos. O Trabalho 1 teve como objetivo subsidiar teoricamente a execução tanto do segundo quanto do terceiro experimento, uma vez que foram descritos os principais fatores que afetam o peso do leitão ao nascimento. Após a compilação destes dados surgiu a idéia de realizar dois experimentos complementares a este estudo inicial. O Trabalho 2 teve como objetivo avaliar o efeito de algumas variáveis medidas em leitões logo após o nascimento em relação à sua sobrevivência durante a primeira semana de vida e desenvolvimento posterior até desmame. Foram utilizados 612 leitões oriundos de 56 fêmeas de ordem de parto 3 a 5 as quais o parto foi induzido. Logo após o nascimento foram medidos os seguintes parâmetros: Frequencia cardíaca (FC), Saturação de O2 (SatO2), glicemia; temperatura retal logo após o nascimento (TR0h) e às 24 horas após (TR24h). A ordem de nascimento, sexo, coloração de pele, integridade do cordão umbilical e a tentativa de ficar em pé também foram anotadas. Logo após a coleta destes parâmetros cada leitão foi tatuado em número seqüencial e posteriormente pesado ao nascimento, 7, 14 e 21 dias para avaliar seu desenvolvimento durante a lactação. Tanto a sobrevivência quanto o desempenho durante o crescimento dos leitões não foram afetadas pela temperatura retal ao nascimento (RT0h). Leitões que nasceram com pele cianótica e que demoraram mais que cinco minutos para se levantarem apresentaram maiores chances de mortalidade durante os três primeiros dias de vida, quando comparados a leitões que nasceram com pele normal e levaram menos de um minuto para levantar (P<0,05). Além disso, leitões que nasceram com cordão umbilical rompido tiveram também uma maior chance de mortalidade até os primeiros 3 dias de vida (P<0,05). Maiores chances de mortalidade tanto aos 3 quanto aos 7 dias de vida foram encontradas em leitões com ordem de nascimento superior ao nono leitão (>9), menor peso ao nascimento (<1275 g), baixa (24-30 mg/dl) e alta (45-162 mg/dl) glicemia, e baixa temperatura retal às 24h pós nascimento (<38,1ºC). Leitões que apresentaram baixo peso ao nascimento (<1275 g), baixa temperatura retal 24h após nascimento (<38,1ºC) e sexo feminino tiveram maiores chances de serem mais leves ao desmame (P<0,05). Dentre os vários parâmetros estudados neste experimento, pele cianótica, tentativa para se levantar, cordão umbilical rompido, elevada ordem de nascimento, baixo peso ao nascimento, baixa TR24h pós-nascimento e ambas alta e baixa glicemia foram indicadores de uma baixa habilidade na sobrevivência dos leitões durante a primeira semana de vida. Além disso, leitões do sexo feminino, com baixo peso ao nascimento e baixa temperatura retal 24h após nascimento apresentaram um menor desenvolvimento durante a fase de lactação. O Trabalho 3 teve como objetivo avaliar a associação do ganho de peso no último mês de gestação, em fêmeas alojadas em baias coletivas, com o comportamento no momento da oferta de alimento e com a uniformidade de peso da leitegada. Foram utilizadas 699 fêmeas, divididas em 3 grupos de ordem de parto (OP): OP2 (n= 137), OP 3-5 (n= 391) e OP 6-9 (n= 171). Fêmeas do grupo OP 6-9 tiveram maior número de leitões com peso inferior a 1200 g e maior coeficiente de variação (CV) do peso dos leitões (P<0,05), em comparação às fêmeas OP 2. Dentro de cada grupo de OP foram criados 3 subgrupos de percentual de ganho de peso (baixo, médio e alto). Menor peso de leitões e maior número de leitões com <1200 g foram observados no subgrupo de baixo ganho de peso em comparação ao subgrupo médio, dentro dos grupos OP 2 e OP 3-5, ou em comparação ao subgrupo alto, dentro grupo de fêmeas OP 6-9. Houve correlação positiva entre o percentual de ganho de peso na gestação e o número de vezes em que a fêmea esteve em pé no cocho (r= 0,669), o número de vezes que a fêmea bateu (r= 0,451) e correlação negativa (r= - 0,338) com o grau de arranhões na pele (P<0,0001). A variação do ganho de peso nas fêmeas mantidas em baias coletivas é influenciada pela competição no momento do arraçoamento. Fêmeas com um comportamento dominante possuem maior acesso ao alimento e, em conseqüência, maior ganho de peso. Um menor ganho de peso, no último mês de gestação, afeta negativamente o peso dos leitões ao nascimento. / Pig industry has been highlighted, recently, by the high production rates achieved. This fact is due to an intense technological improvement, which resulted in hyperprolifc dam lines. Because of that sows improved their productive performance leading to a greater economic gain. However, some reproductive problems related to the uniformity of the litter emerged contributing to a higher within birth weight variability. Another important aspect is the viability and vitality of lower birth weight piglets in relation to their extrauterine life adaptation, which could be affected. Searching for some explanation about these exposed problems this Thesis was designed in one literary review and two experiments. The first study aimed to provide a theoretical subside to the execution of both second and third studies, since it was described the factors that influence the piglet birth weight. Right after this review two new studies were designed to supply the first one. The second study aimed to verify the effect of some variables measured at birth or right after on their survival during the first week of life and growth performance until weaning. Piglets included in the analysis (n= 612) were born from 3 to 5 parity sows whose farrowing was induced. Piglets were monitored for blood oxygen saturation (SatO2), heart rate (HR), blood glucose concentration, rectal temperature at birth (RT0h) and at 24h after birth (RT24h). Birth order, sex, skin color, integrity of the umbilical cord and time elapsed from birth until the first attempts to stand were also recorded. Piglets were weighed at birth and at 7, 14 and 21 days after birth in order to evaluate their post natal development. Cumulative mortality rates were 3.3%, 5.4% and 8.7% at 3, 7 and 21 days after birth, respectively. Body temperature at birth (RT0h) did not affect (P>0.05) the survival nor the piglet growth performance. Piglets with cyanotic skin and those that took more than 5 minutes to stand showed more chances of mortality (P<0.05) compared to normal skin piglets and to piglets which stood before 1 min, respectively. Piglets with broken umbilical cord had higher odds (P<0.05) of mortality up to 3 d after birth. Higher odds (P<0.05) of mortality up to 3 and 7 d were observed in later birth order (>9), low birth weight (<1275 g), low (24- 30 mg/dl) and high (45-162 mg/dl) blood glucose concentrations, and low body temperature at 24 h (<38.1ºC). Piglets with low birth weight (<1795 g), low body temperature at 24 h (<38.6ºC) and feminine sex had higher odds of a low weight at weaning (P<0.05). Among the factors studied, cyanotic skin, delay for stand, broken umbilical cord, high birth order, low birth weight, low body temperature at 24 h after birth and both low and high blood glucose concentrations are indicators of a lower ability of piglets’ survival during the first week after birth. The growth performance until weaning is compromised in piglets with a lower birth weight, a lower body temperature at 24 h and of the feminine sex. The third one evaluated the association of weight gain during the last month of gestation with behaviour during feeding time and the uniformity of the weight of piglets at birth in group-housed sows. Sows (n= 699) were divided into three parity groups (P): P 2 (n= 137), P 3-5 (n= 391) and P 6-9 (n= 171). Higher parity sows (P 6-9) showed higher number of piglets with birth weight below 1200g and higher (P<0.05) birth weight coefficient of variation (CV) when compared with P 2 sows. Within each parity group, 3 subgroups were created according to the percentage of weight gain (Low, Medium and High) during the last month of gestation. Lower birth weight piglets and higher number of piglets with weight <1200 g (P<0.05) were observed in the subgroup of Low weight gain in comparison to Medium subgroup, within P 2 and P 3-5, and in comparison to High subgroup, within P 6-9 group. There was a positive correlation of weight gain percentage during gestation with the number of visits at the feeder (r =0.669), the number of aggressive encounters (r =0.451) and a negative correlation (r = -0.338) with the severity of skin lesions (P<0.0001). The variation in weight gain during the last month of gestation in grouphoused sows is influenced by the competition at the feeding time. Sows with a dominant behaviour have higher access to feed, hence a higher weight gain. A lower weight gain during the last month of gestation negatively affects the birth weight of piglets.

No description available.

Timely detection of prostate cancer (PCA) with prostate-specific antigens (PSA) and digital rectal examinations (DRE) are essential in optimizing incidence, minimizing prevalence, and reducing mortality rates. Given the low levels of participation in cancer screening, this study was conducted to examine the factors men consider when deciding whether to screen for PCA in Nigeria. A cross-sectional, online-based survey of 180 consenting Nigerian men 50 years old and older was carried out. Logistic regression analysis and descriptive statistics were used to analyze the data. Based on the data, there was a moderate positive association between the health belief model constructs and DRE/PSA screening intentions, which were statistically significant (p < 0.05). The results also demonstrated that there were no statistically significant associations between previous screening and age, previous screening and ethnicity, and previous screening and education among men in the sample (all p > 0.05). Of the 180 men surveyed, 29% (n = 53) had been screened for PCA before, while 76% (n = 137) reported no health insurance. Factors significantly associated with screening included income, insurance, and family history of PCA (all p < 0.05). Cancer fatalism, pain, and embarrassment were the most common barriers to screening reported. Focused interventions that help healthcare providers identify barriers quickly could improve screening outcomes. The implications for positive social change from this study include an increase in PCA screening, positive screening intentions, and a decrease in PCA mortality rate among men in Nigeria.

A adequação das opções terapêuticas para o adenocarcinoma de reto é dependente do estadiamento da lesão primária, feito por ressonância magnética (RM) dirigida. A RM é capaz de detectar fatores de mau prognóstico associados a alto risco de recidiva pélvica, selecionando pacientes que se beneficiam de tratamento neoadjuvante pré-operatório e diferenciando-os daqueles que podem ser operados após o diagnóstico, sem risco aumentado de recidiva local. No contexto de escassez de recursos e baixa disponibilidade da RM, a tomografia computadorizada (TC) poderia auxiliar nesta seleção de pacientes com fatores de mau prognóstico, agindo como um método de triagem para detecção de lesões avançadas que teriam indicação de tratamento neoadjuvante. O objetivo do presente estudo é avaliar o desempenho da TC no estadiamento local da neoplasia de reto para seleção de pacientes com fatores de mau prognóstico associados a alto risco para recidiva local. Cento e oitenta pacientes com diagnóstico histopatológico de adenocarcinoma de reto e sem tratamento prévio foram retrospectivamente analisados por dois radiologistas cegos a outros dados clínicos. As imagens de tomografia foram submetidas a reconstrução multiplanar, e a lesão primária foi analisada no eixo axial do reto, semelhante ao que é utilizado para análise por RM. Os critérios avaliados por TC foram: estadiamento T3c-d ou T4, estadiamento N2, acometimento da fáscia mesorretal, presença de invasão vascular extramural ou linfonodos pélvicos laterais acometidos. Os achados da TC foram comparados aos obtidos por RM. Os resultados mostraram que a TC foi capaz de detectar 108 de 128 pacientes com critérios de mau prognóstico, com sensibilidade de 84%, especificidade de 79%, valor preditivo positivo de 91% e valor preditivo negativo de 67%. O desempenho da TC foi superior quando avaliou tumores a mais de 5 cm da borda anal, mostrando sensibilidade de 89%, especificidade de 86%, valor preditivo positivo de 93% e valor preditivo negativo de 80%. Caso fosse utilizada para seleção dos critérios de mau prognóstico nesta população, a TC teria reduzido o número necessário de exames de RM em 52% / In order to tailor the most appropriate treatment option for rectal cancer, accurate staging is necessary. Patients with high risk of local recurrence may benefit from preoperative neoadjuvant treatment. In contrast, in patients with no risk of local recurrence, upfront surgery avoids radiation-related toxicity with good oncologic prognosis. The optimal staging strategy includes magnetic resonance imaging (MRI), which is the most accurate method of detecting lesions with high risk of local recurrence. When MRI is not available to all patients, computed tomography (CT) could possibly detect high risk features, avoiding delays without an adverse effect on primary treatment decisions. The purpose of this study is to evaluate CT staging accuracy to detect high risk of local recurrence in patients with rectal cancer. One hundred and eighty patients with biopsy-proven adenocarcinoma and no previous treatment were retrospectively studied. CT and MR images were reviewed by two blinded and independent radiologists. CT multiplanar reformatting allowed true axial images as seen by MRI. High-risk for local recurrence features were as follows: T3c-d or T4 status; N2 status; extramural venous invasion, mesorectal fascia involvement, and lateral pelvic lymph nodes. MRI was considered the reference standard. The results showed CT sensitivity of 84%, specificity of 79%, positive predictive value of 91% and negative predictive value of 67% for detection of any high risk of local recurrence feature. When tumors lying 5 cm above the anal verge were considered, CT sensitivity was 89%, specificity was 86%, positive predictive value was 93% and negative predictive value was 80%. CT staging would have reduced the need for 52% of MRI scans

Assessment of heat strain considers an individual's tolerance and indicates the risk and physiological cost of working in hot environments. This study evaluated the discrimination ability of metrics of heat strain. The null hypotheses were that (1) the metrics individually could not discriminate between acceptable and unacceptable heat strain, (2) there were no significant differences among these metrics, and (3) there were no significant differences in the applicability of the metrics due to clothing or heat stress level. The experimental design was a case crossover. Clothing and heat stress level were potential confounders. Two clothing ensembles were work clothes and vapor-barrier coveralls with hood. Two heat stress levels for a moderate metabolic rate were 5°C-WBGT and 10°C-WBGT above the Threshold Limit Value adjusted for clothing. Eight male and four female acclimated individuals (age 18-36 years) participated. Four experimental trials were randomized in sequence. The transition point, when a participant's status changed from control (acceptable heat strain) to case (unacceptable), was the first occurrence of rectal temperature equal to or greater than 38.5°C, heart rate equal to or greater than 90% of maximum, or volitional fatigue. The metrics were rectal, ear canal, oral, and disk temperatures, heart rate including moving time averages of 5, 10, 20, 30 and 45 minutes, recovery heart rate, and physiological strain index. The data at the transition point were the case data; the data 10 minutes prior to that point were the control data. Analyses used primarily receiver operating characteristic (ROC) curves, which indicated the ability to distinguish acceptable from unacceptable heat strain. Further analyses included factorial analysis of variance and exact conditional logistic regression. Based on the ROC curve analyses, the physiological metrics can distinguish between acceptable and unacceptable heat strain with average area under the curves between 0.529 and 0.861. While there were no differences among the metrics based on the 95% confidence intervals of the areas under the curve, the results were compromised by low power. Based on ANOVA and logistic regression, clothing did not influence the metrics. There were insufficient data to evaluate the role of heat stress level.

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