Clinical experience with venlafaxine in the treatment of hot flushes in women with a history of breast cancer

OBJECTIVE: To obtain practical experience with venlafaxine for hot flushes in breast cancer patients and incorporate this in a treatment protocol. METHOD: Twenty-two women with a history of breast cancer (mean age 49.2 years, range 35-65) were referred for consideration of treatment with venlafaxine for hot flushes. Patients received extensive information on treatment with venlafaxine and were advised to self-monitor the frequency of their hot flushes. RESULTS: Eight women did not start venlafaxine because they had no postmenopausal complaints, were lost to follow-up, had too low a frequency of hot flushes, or refused treatment. Eventually 14 women started venlafaxine. Two of them did not tolerate venlafaxine, four reported some effect but stopped because of side effects, two women had no effect whatsoever. Six women observed a clear ( > 50%) reduction in their hot flush frequency that was maintained at a median follow-up of 13 months. CONCLUSION: The group of patients referred for treatment was more heterogeneous and more patients dropped out because of side effects than expected. Extensive patient education, patient selection and evaluation of the treatment effect (by self-monitoring of hot flush frequency) are mandatory to avoid useless (continuation of) treatment and to prepare patients for side effects. Under these conditions, a substantial minority of patients benefit from venlafaxine

Health-related problems and quality of life in patients with syndromic and complex craniosynostosis

Purpose: We conducted this study to gauge the health-related problems, quality of life and the performance of the Health Utility Index Mark 3 (HUI-3) in patients with syndromic and complex craniosynostosis. Patients with syndromic and complex craniosynostosis have various physical and mental problems. More insight on these problems, per syndrome, could provide guidance to improve patient treatment and follow-up. Methods: A cross-sectional, comparative study on 131 patients and their parents was performed. Health-related quality of life was measured with the HUI-3 and the Visual Analogue Scale (VAS). All data were compared to a normative Dutch population. Vision, hearing and intelligence were objectively measured. Results: The HUI-3 and the VAS were significant lower compared to the normative Dutch population. All syndromes have a high prevalence of vision and speech problems. Cognitive problems were mainly reported in patients with Apert, Crouzon and Muenke syndrome. Ambulation and dexterity problems were seen in Apert, Crouzon, Saethre-Chotzen and complex craniosynostosis. Only patients with Apert syndrome scored significantly worse on pain. The HUI-3 had a medium to strong correlation with the objectively measured outcomes. Conclusions: The overall quality of life is lower in patients with syndromic and complex craniosynostosis. To improve quality of life, more attention is needed for problems with vision and speech

Nitric oxide production and monoamine oxidase activity in cancer patients during interferon-α therapy

Both increased and decreased nitric oxide (NO) synthesis have been reported in patients treated with interferon-α (IFN-α). Animal studies showed that IFN-α administration results in increased levels of biogenic amines, subsequent activation of monoamine oxidases (MAOs), and finally in a change in NO production due to the H2O2 generated by MAOs. We examined the potential relationship between NO production in plasma and MAO-B activity in platelets of 43 cancer patients during 8 weeks of treatment with IFN-α. NO synthesis was quantitated by measuring both the ratio of citrulline and arginine (CIT/ARG-ratio) and total nitrite/nitrate (NOx) levels. Compared to baseline, MAO activity and NOx increased, while the CIT/ARG-ratio decreased. No associations were found between NOx, MAO and CIT/ARG-ratio. Only few associations were observed between changes in the biochemical parameters and changes in psychopathology induced by IFN-α, of which the association between changes in CIT and lassitude was the most consistent. The results suggest that peripheral NO production and MAO activity are unrelated to each other, and that peripheral changes in these biochemical parameters induced by IFN-α are unlikely to contribute to definite psychiatric disturbance

Prediction of portal and hepatic blood flow from intake level data in cattle

There is growing interest in developing integrated post-absorptive metabolism models for dairy 30 cattle. An integral part of linking a multi-organ post-absorptive model is the prediction of nutrient 31 fluxes between organs, and thus blood flow. It was the purpose of this paper to use a multivariate 32 meta-analysis approach to model portal blood flow (PORBF) and hepatic venous blood flow 33 (HEPBF) simultaneously, with evaluation of hepatic arterial blood flow (ARTBF; ARTBF = 34 HEPBF – PORBF) and PORBF/HEPBF (%) as calculated values. The database used to develop 35 equations consisted of 296 individual animal observations (lactating and dry dairy cows and beef 36 cattle) and 55 treatments from 17 studies, and a separate evaluation database consisted of 34 37 treatment means (lactating dairy cows and beef cattle) from 9 studies obtained from the literature. 38 Both databases had information on DMI, MEI, body weight and a basic description of the diet 39 including crude protein intake and forage proportion of the diet (FP; %). Blood flow (L/h or L/kg 40 BW0.75/h) and either DMI or MEI (g or MJ/d or g or MJ/kg BW0.75/d) with linear and quadratic 41 fits were examined. Equations were developed using cow within experiment and experiment as 42 random effects, and blood flow location as a repeated effect. Upon evaluation with the evaluation 43 database, equations based on DMI typically resulted in lower root mean square prediction errors, 44 expressed as a % of the observed mean (rMSPE%) and higher concordance correlation coefficient 45 (CCC) values than equations based on MEI. Quadratic equation terms were frequently non-46 significant, and the quadratic equations did not out-perform their linear counterparts. The best 47 performing blood flow equations were: PORBF (L/h) = 202 (± 45.6) + 83.6 (± 3.11) × DMI (kg/d) and HEPBF (L/h) = 186 (± 45.4) + 103.8 (± 3.10) × DMI (kg/d), with rMSPE% values of 17.5 and 49 16.6 and CCC values of 0.93 and 0.94, respectively. The residuals (predicted – observed) for 50 PORBF/HEPBF were significantly related to the forage % of the diet, and thus equations for 51 3 PORBF and HEPBF based on forage and concentrate DMI were developed: PORBF (L/h) = 210 52 (± 51.0) + 82.9 (± 6.43) × Forage (kg DM/d) + 82.9 (± 6.04) × Concentrate (kg DM/d), and 53 HEPBF (L/h) = 184 (± 50.6) + 92.6 (± 6.28) × Forage (kg DM/d) + 114.2 (± 5.88) × Concentrate 54 (kg DM/d), where rMSPE% values were 17.5 and 17.6 and CCC values were 0.93 and 0.94, 55 respectively. Division of DMI into forage and concentrate fractions improved the joint Bayesian 56 Information Criterion (BIC) value for PORBF and HEPBF (BIC = 6512 vs. 7303), as well as 57 slightly improved the rMSPE and CCC for ARTBF and PORBF/HEPBF. This was despite 58 minimal changes in PORBF and HEPBF predictions. Developed equations predicted blood flow 59 well, and could easily be used within a post absorptive model of nutrient metabolism. Results also 60 suggest different sensitivity of PORBF and HEPBF to the composition of DMI, and accounting 61 for this difference resulted in improved ARTBF predictions

Effect of improving diet quality by feeding supplements on methane emission in different production systems of beef cattle in Brazil.

In Brazil, the national inventories on methane emission are carried out using the Tier 2 approach published by the Intergovernmental Panel on Climate Change (IPCC). Although, IPCC recommends the use of a more specific Tier 3 approach, this is hampered by a lack of consolidated data for development, evaluation and application of such a Tier 3 approach

Emissão de metano em sistemas de produção de bovinos de corte brasileiro.

Editores técnicos: João de Mendonça Naime, Caue Ribeiro, Maria Alice Martins, Elaine Cristina Paris, Paulino Ribeiro Villas Boas, Ladislau Marcelino Rabello