Abstract Background The presence of Extracapsular Extension (ECE) in the Sentinel Lymph Node Biopsy (SLNB) is still a doubt in the literature. Some studies suggest that the presence of ECE may be related to a greater number of positive axillary lymph nodes which could impact Disease Free Survival (DFS) and Overall Survival (OS). This study searches for the clinical significance of the ECE. Methods Retrospective cohort comparing the presence or absence of ECE in T1-2 invasive breast cancer with positive SLNB. All cases treated surgically at the Cancer Institute of the State of São Paulo (ICESP) between 2009 and 2013 were analyzed. All patients with axillary disease in SLNB underwent AD. Outcomes Identify the association between the presence and length of ECE and additional axillary positive lymph nodes, OS and DFS between both groups. Results 128 patients with positive SLNB were included, and 65 had ECE. The mean metastasis size of 0.62 (SD = 0.59) mm at SLNB was related to the presence of ECE (p < 0.008). The presence of ECE was related to a higher mean of positive sentinel lymph nodes, 3.9 (± 4.8) vs. 2.0 (± 2.1), p = 0.001. The median length of follow-up was 115 months. The OS and DFS rates had no differences between the groups. Conclusion The presence of ECE was associated with additional positive axillary lymph nodes in this study. Therefore, the OS and DFS were similar in both groups after 10 years of follow-up. It is necessary for additional studies to define the importance of AD when SLNB with ECE.

ABSTRACT Loneliness has emerged as a public health concern. Previous research has reported its deleterious effects on physical and mental health; however, some specific psychophysiological mechanisms in healthy adults remain to be elucidated. The aim of the current study is to investigate whether self-reported social support and social touch (giving and receiving social touch), as well as resting heart rate variability (HRV), are significant negative predictors of loneliness in healthy adults. The study sample consists of 120 healthy students (50% female) with a mean age of 21.85 years old (DP= 2.21). The students were asked to complete a psychiatric screening questionnaire utilizing loneliness, social support, and social touch scales. HRV was derived from an electrocardiographic signal recorded for 15 min, with the participant relaxed in a supine position. Linear regression analyses were conducted to evaluate loneliness as a function of social support, social touch (giving or receiving touch), and resting HRV. The results show that social support (p< 0.001) and social touch, specifically receiving touch (p< 0.002), accounted for a significant proportion of the variance in loneliness. However, neither giving touch nor resting HRV was a significant predictor of loneliness. The current study highlights specific psychosocial factors in healthy adults that should be considered as promising pathways in order to reduce or work toward preventing loneliness, thus promoting better health and well-being.

ABSTRACT Sustainable Supply Chain is nowadays an increasing area of concern for both academia and industry that aims to design, plan and operate supply chains that guarantee market needs while considering not only profit objectives but also environmental and social concerns in a solution of compromise. Being supply chains complex systems the pursuing of such compromise solution calls for the use of decision tools that can support decision makers. Such tools should be based on quantitative models where Operational Research (OR) methods ought to be explored and where optimization, in particular, has a role to play. In this paper, the main characteristics of such optimization models, focusing on the design and planning of sustainable supply chains are discussed and the main issues to be considered when addressing such problems are identified. A framework, SusFrame, developed to guide practitioners and researchers in the development of optimization models for the design and planning of sustainable supply chains, is presented and applied to the solution of a set of case-studies, demonstrating the large applicability of such tool and how optimization methods can be used to help the sustainable supply chain decision process.

Abstract Introduction: intake of diets with high saturated fat may produce deleterious effects on bone mineralization. Lifestyle changes help reduce the bone loss observed in osteoporosis. Resveratrol, present in grape juice and red wine, has osteogenic and osteoinductive effects, being potentially beneficial for bone health. Objective: to evaluate the effects of red grape juice, red wine and resveratrol consumption on bone parameters in Wistar rats submitted to a high-fat diet and physical training. Method: female Wistar rats, with 90 days of age, were divided into five groups and followed up for 60 days: a) control group; b) high-fat group; c) grape juice group; d) red wine group; and e) resveratrol group. The different groups of animals performed a physical training protocol. Animal's weight and consumption were monitored weekly. After 60 days, femoral dimensions, bone mineral density (BMD) and bone mineral content (BMC) were evaluated. Results: there was no difference in body mass; however, all groups consuming the high-fat diet had higher consumption (p < 0.05). RWG presented a greater distance between the epiphyses, femoral mass and BMC (p < 0.05). RWG and RG presented greater mean diaphysis point width and BMD (p < 0.05). Conclusion: the results suggest that the bioactive compounds present in red wine and resveratrol solution together with regular exercise were able to promote beneficial effects on bone health, even when associated with a high saturated fat diet.

Resumen Introducción: el consumo de dietas ricas en grasas saturadas puede producir efectos nocivos sobre la mineralización ósea. Los cambios en el estilo de vida ayudan en la reducción de la pérdida ósea que se produce en la osteoporosis. El resveratrol, presente en el zumo de uva y el vino tinto, tiene efectos osteogénicos y osteoinductores, y es potencialmente beneficioso para la salud ósea. Objetivo: evaluar los efectos del consumo de zumo de uva roja, vino tinto y resveratrol sobre los parámetros óseos en ratas sometidas a una dieta alta en grasa y entrenamiento físico. Métodos: ratas Wistar, hembras, con 90 días, fueron divididas en cinco grupos y monitorizadas durante 60 días: a) grupo de control; b) grupo hiperlipidemia; c) grupo zumo de uva roja; d) grupo de vino tinto; y e) grupo de resveratrol. Los distintos grupos de animales fueron sometidos a un protocolo de entrenamiento físico. El peso y el consumo de los animales se monitorizaron semanalmente. Después de 60 días, se evaluaron el tamaño del fémur, la densidad mineral ósea (DMO) y el contenido mineral óseo (CMO). Resultados: no hubo diferencias en el consumo, sin embargo, todos los grupos que consumieron la dieta rica en grasas tenían un mayor consumo (p < 0,05). GV tenía una mayor distancia entre las epífisis, mayor tamaño del fémur y un mayor CMO (p < 0,05). SGS y GR tenía mayor anchura media de diáfisis y una mayor DMO (p < 0,05). Conclusión: Los resultados sugieren que los compuestos bioactivos presentes en el vino tinto y la solución de resveratrol, combinados con el ejercicio físico regular, fueron capaces de promover efectos beneficiosos sobre la salud ósea, incluso cuando se asocian con una dieta alta en grasas saturadas.

OBJETIVO:Avaliar variações no índice de massa corpórea em pacientes que estão passando por quimioterapia devido ao câncer de mama, e relacionar tais alterações com a idade da paciente e o regime de quimioterapia.MÉTODOS:Estudo de coorte retrospectivo que correlacionou variações no índice de massa corpórea pré- e pós-quimioterapia com a idade da paciente e o regime de quimioterapia. Foram excluídas as pacientes que receberam terapia hormonal prévia, seja como tamoxifeno ou inibidores da aromatase. Os dados de 196 pacientes com estágio I a III de câncer de mama foram selecionados, e elas foram tratadas por cirurgia radical ou conservadora que receberam quimioterapia adjuvante no Instituto do Câncer do Estado de São Paulo, Brasil.RESULTADOS:Antes da quimioterapia adjuvante, 67,8% das pacientes foram classificadas com sobrepeso ou obesas de acordo com seus índices de massa corpórea. Aproximadamente 66,3% (IC95% 59,7–73,0) das pacientes exibiram aumento no índice de massa corpórea após a quimioterapia adjuvante. A média de idade das pacientes foi de 56,3± 11,3 anos. Pacientes que apresentaram aumento no índice de massa corpórea eram mais jovens do que aquelas que não apresentaram aumento algum (54,7±11,1 versus 59,3±11,2 anos; p=0,007). As pacientes foram tratadas com os seguintes regimes de quimioterapia: doxorrubicina, ciclofosfamida e paclitaxel (AC-T, 129 pacientes, 65,8%); 5-fluoracil, doxorrubicina e ciclofosfamida (36 pacientes, 18,4%); ciclofosfamida, metotrexato e 5-fluoracil (16 pacientes, 8,2%); docetaxel e ciclofosfamida (7 pacientes, 3,6%) e outros regimes (8 pacientes, 4,1%). O regime AC-T mostrou uma relação significativa com o aumento do índice de massa corpórea (p<0,001 por ANOVA).CONCLUSÕES:A maioria das pacientes com câncer de mama mostrou um aumento no índice de massa corpórea pós-quimioterapia adjuvante, especialmente após o regime de quimioterapia AC-T.

PURPOSE:To evaluate variations in the body mass index in patients undergoing adjuvant chemotherapy for breast cancer, and to associate these changes with patient's age and adjuvant chemotherapy regimen.METHODS:We performed a retrospective cohort study in order to correlate any variation in the body mass index before and after adjuvant chemotherapy with patient's age and adjuvant chemotherapy regimen. Patients who received any form of prior hormone therapy, such as tamoxifen or aromatase inhibitors, were excluded. We selected data for 196 patients with stage I to III breast cancer who were treated by radical or conservative surgery and received adjuvant chemotherapy at the Cancer Institute of the State of São Paulo, Brazil.RESULTS:Before adjuvant chemotherapy, 67.8% of patients were classified as overweight or obese according to their body mass indices. Around 66.3% (95% CI 59.7–73.0) of the patients exhibited an increase in the body mass index after adjuvant chemotherapy. The average age of all patients was 56.3±11.3 years. Participants whose body mass index increased were younger than those with no increase (54.7±11.1 versus 59.3±11.2 years; p=0.007). Patients were treated with the following adjuvant chemotherapy regimens: doxorubicin, cyclophosphamide, and paclitaxel (AC-T, 129 patients, 65.8%); 5-fluoracil, doxorubicin, and cyclophosphamide (36 patients, 18.4%); cyclophosphamide, methotrexate, and 5-fluoracil (16 patients, 8.2%); docetaxel and cyclophosphamide (7 patients, 3.6%); and other regimen (8 patients, 4.1%). The AC-T regimen showed a statistically significant association with increase in the body mass index (p<0.001 by ANOVA).CONCLUSIONS:Most patients with breast cancer showed an increase in the body mass index after adjuvant chemotherapy, especially after the AC-T chemotherapy regimen.