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The fractional flow reserve index (FFR) is currently used as a gold standard to quantify coronary stenosis's functional relevance. Due to its highly invasive nature, the development of noninvasive surrogates based on simulations has drawn much attention in recent years, emphasizing efficient strategies that enable translational research. The focus of this work is twofold. First, to assess the feasibility of using a mid-fidelity numerical strategy (transversally enriched pipe element method, TEPEM), placed between low- and high-fidelity models, for the estimation of flow-related quantities, such as FFR and wall shear stress (WSS). Low-fidelity models, as zero- or one-dimensional models, are computationally inexpensive but in detriment of poorer spatially detailed predictions. On the other hand, high-fidelity models, such as classical three-dimensional numerical approximations, can provide detailed predictions but their transition to clinical application is prohibitive due to high computational costs. As a second goal, we quantify the impact of the length of lateral branches in the blood flow through the interrogated vessel of interest to further reduce the computational burden. Both studies are addressed considering a cohort of 17 coronary geometries. A total of 20 locations were selected to estimate the FFR index for a wide range of Coronary Flow Reserve (CFR) scenarios. Numerical results suggest that the mid-fidelity TEPEM model is a reliable approach for the efficient estimation of the FFR index and WSS, with an error in the order of [Formula: see text] and [Formula: see text], respectively, when compared to the high-fidelity prediction. Moreover, such mid-fidelity models require much less computational resources, in compliance with infrastructure frequently available in the clinic, by achieving a speedup between 30 and 60 times compared to a conventional finite element approach. Also, we show that shortening peripheral branches does not introduce considerable perturbations either in the flow patterns, in the wall shear stress, or the pressure drop. Comparing the different geometric models, the error in the estimation of FFR index and WSS is reduced to less than [Formula: see text] and [Formula: see text], respectively.

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Little is known about local Criollo pig genetic resources and relationships among the various populations. In this paper, genetic diversity and relationships among 17 Criollo pig populations from 11 American countries were assessed with 24 microsatellite markers. Heterozygosities, F-statistics, and genetic distances were estimated, and multivariate, genetic structure and admixture analyses were performed. The overall means for genetic variability parameters based on the 24 microsatellite markers were the following: mean number of alleles per locus of 6.25 ± 2.3; effective number of alleles per locus of 3.33 ± 1.56; allelic richness per locus of 4.61 ± 1.37; expected and observed heterozygosity of 0.62 ± 0.04 and 0.57 ± 0.02, respectively; within-population inbreeding coefficient of 0.089; and proportion of genetic variability accounted for by differences among breeds of 0.11 ± 0.01. Genetic differences were not significantly associated with the geographical location to which breeds were assigned or their country of origin. Still, the NeighborNet dendrogram depicted the clustering by geographic origin of several South American breeds (Criollo Boliviano, Criollo of northeastern Argentina wet, and Criollo of northeastern Argentina dry), but some unexpected results were also observed, such as the grouping of breeds from countries as distant as El Salvador, Mexico, Ecuador, and Cuba. The results of genetic structure and admixture analyses indicated that the most likely number of ancestral populations was 11, and most breeds clustered separately when this was the number of predefined populations, with the exception of some closely related breeds that shared the same cluster and others that were admixed. These results indicate that Criollo pigs represent important reservoirs of pig genetic diversity useful for local development as well as for the pig industry.

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Grapevine (Vitis vinifera L.) has been cultivated in Peru since the sixteenth century to produce wine and grape brandy called "Pisco". Grapevine powdery mildew caused by Erysiphe necator (Schwein.) (formerly Uncinula necator [Schw.] Burr.; anamorph Oidium tuckeri) is currently the most important disease of grapevine in Peru. Table grape producers rely heavily on fungicide applications to manage powdery mildew infections. In Peru, the pathogen is normally found in the anamorphic state, except for one report of the teleomorphic state in 1972 (2) on wine grape varieties. In July 2011, ascomata were observed on table grapevine leaves cv. Sugraone in a commercial field near Huaral in the central coast of Peru. Abundant, mature (black) and immature (brown), globose ascocarps were visible on the abaxial leaf surfaces covered by the anamorphic state of the fungus. The chasmothecia were epiphyllous and ranged from 93.3 to 157.5 µm in diameter. The appendages were hyaline, variable in number (9 to 17), septate, with the apex helicoid when mature, and measuring 310 to 480 µm long. Each ascocarp contained four to seven subglobose asci (55.3 to 76.7 × 36.3 to 52.0 µm) with two to six (mostly three) ascospores. The ascospores were elliptical, hyaline, and measured 20.2 to 25.0 µm long by 11.1 to 17.3 µm wide. The pathogen was identified as E. necator on the basis of the host genus and morphology of the teleomorph (1). The teleomorphic state of E. necator could be a source of primary inoculum before infection by anamorphic conidia occurs, provide the basis for genetic recombination, and lead to more frequent appearance of new races. This could have serious implications for managing fungicide resistance in the pathogen population and may also result in the development of virulence to the resistance of some grape varieties tolerant to powdery mildew infections. In South America, the teleomorph of E. necator has been recently detected in Chile (3), and has caused great concern among grape producers. To our knowledge, this finding represents a first record of the presence of the ascigenous state of the pathogen on table grapes in Peru. References: (1) U. Braun. A Monograph of the Erysiphales (powdery mildews). J. Cramer, Berlin-Stuttgart, 1987. (2) S. L. Dongo and M. E. Arestegui. Fitopatologia 8:35, 1973. (3) F. Riveros et al. Aconex 83:24, 2004.

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Since 2005, symptoms of grapevine decline have been observed on 4- to 8-month-old grapevines (cvs. Red globe and Crimson) grafted onto 1103 P rootstock in Ica and Pisco valleys in southern Peru. Affected plants exhibited weak growth, interveinal chlorosis, necrosis and wilting of leaves, and death. Dark brown-to-black streaking of the xylem was seen when transverse or longitudinal cuts were made in the trunk and shoots. Symptomatic plants were collected and sections (5 cm long) were cut from the zone between the rootstock and the scion, surface sterilized for 1 min in a 1.5% sodium hypochlorite solution, and washed twice with sterile distilled water. The sections were split longitudinally, and small pieces of discolored tissues were placed onto potato dextrose agar (PDA) supplemented with oxytetracycline (500 mg liter-1). Plates were incubated at 25°C in the dark for 15 days. A Phaeoacremonium sp. was consistently isolated from necrotic tissues. Single conidial isolates were obtained and grown on PDA and malt extract agar (MEA) in the dark at 25°C for 3 weeks until colonies produced spores (3). Colonies were brown on PDA and olive brown on MEA. Conidiophores were branched, 27.5 to 67.5 (42.5) µm long, and often consisting of a single phialide. Conidia were hyaline, oblong ellipsoidal, 2.5 to 4.5 (3.6) µm long, and 1.2 to 1.9 (1.6) µm wide. On the basis of these characteristics, the isolates were identified as Phaeoacremonium parasiticum (Ajello, Georg & C.J.K Wang) W. Gams, Crous & M.J. Wingf. (teleomorph Togninia parasitica L. Mostert, W. Gams & Crous) (2,3). Identity of isolate Ppa-1 was confirmed by PCR-restriction fragment length polymorphism of the internal transcribed spacer region (Phaeoacremonium-specific primers Pm1-Pm2) with the restriction enzymes BssKI, EcoO109I, and HhaI (1). Additionally, the beta-tubulin gene fragment (primers T1 and Bt2b) of this isolate was sequenced (GenBank Accession No. FJ151015). The sequence was identical to the sequence of P. parasiticum (GenBank Accession No. AY328379). Pathogenicity tests were conducted using the isolate Ppa-1. Approximately 20 µl of a suspension containing 103 conidia ml-1 was injected into the pith of four nodes on each of 10 dormant, unrooted, 15 cm long cuttings of cv. Red Globe. Four nodes on each of 10 cuttings were used as controls and injected with an equal volume of sterile distilled water. Inoculation points were covered with Parafilm. The cuttings were planted in plastic pots and maintained at 24 ± 3°C in diffuse light, watering as needed. Within 2 months of inoculation, all P. parasicitum-inoculated cuttings exhibited shoots with very poor growth with small leaves and short internodes. In the xylem vessels, black streaks identical to symptoms observed in declining vines in the vineyard were observed. Control plants did not show any of these symptoms. The fungus was reisolated from internal tissues of symptomatic shoots of all inoculated cuttings but not from the control shoots. To our knowledge, this is the first report of P. parasiticum causing young grapevine decline in Peru. References: (1) A. Aroca and R. Raposo. Appl. Environ. Microbiol. 73:2911, 2007. (2) P. W. Crous et al. Mycology 88:786, 2006. (3) L. Mostert et al. Stud. Mycol. 54:1, 2006.

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Mango (Mangifera indica L) is one of the most important cash crops of northern Peru. Since 2003, adult mango trees (cvs. Criollo and Kent) located in Piura Province developed symptoms of dieback characterized by the death of twigs and branches in the tree canopy. Additional disease symptoms involved darkened, elongated lesions on the peduncle, causing an early maturation of the fruit, and in advanced symptoms, stem-end rot of fruits. Symptoms were frequent in the spring months (September to November) when the lesions expand rapidly. Diseased tissues from branches and fruits were collected and small pieces of necrotic tissues were surface disinfected and plated onto potato dextrose agar (PDA) with 0.5 g L-1 streptomycin sulfate. Plates were incubated at 25°C in the dark. All affected tissues consistently developed colonies with a white mycelium, moderately dense, and becoming olivaceous gray after 5 to 6 days. Pycnidia were produced on sterile mango twigs placed on the surface of potato carrot agar (PCA) after 10 days. Conidia were hyaline, guttulate, aseptate, measuring (15-) 18.5 (-22.5) × (4-) 5.2 (-7.5) µm. Conidia became olivaceous and developed one or two septa before germination. Isolates were identified as Neofusicoccum parvum (Pennycook & Samuels) Crous, Slippers, & A.J.L. Phillips (1). DNA sequences of the rDNA internal transcribed spacer region (ITS) and part of the translation elongation factor 1-alpha (EF1-α) genes were used to confirm the identification through BLAST searches in GenBank (ITS: 99% identity to Accession No. EU080928; EF1-α: 98% identity to Accession No. AY343367). Representative sequences of the studied DNA regions were deposited at GenBank (ITS: Accession No. FJ528596; EF1-α: Accession No. FJ528597). Pathogenicity tests were conducted on 18-month-old potted mango plants cv. Kent with two N. parvum strains (A4 and A5). A mycelial plug (3 cm in diameter) taken from the margin of an actively growing colony of each isolate was put in a wound made with a cork borer of the same diameter on the stem of each plant. Inoculation wounds were wrapped with Parafilm. Controls were inoculated with sterile PDA plugs. Ten replicates for each isolate were used with an equal number of control plants. Plants were maintained in a greenhouse with a temperature range of 22 to 28°C. After 4 weeks, mango plants showed necrotic stem lesions originating from the inoculation point affecting also the branches of the inoculated plants. No differences in lesion area between strains were obtained. No lesions developed in the control plants. Reisolations from necrotic tissues were successful and both isolates were morphologically identical to those used for inoculations. N. parvum was isolated from all symptomatic trees in all surveyed areas. This pathogen has already been reported on mango (2) and currently represents a serious problem in the mango-producing areas of Peru. To our knowledge, this is the first report of N. parvum affecting mango in Peru. References: (1) P. W. Crous et al. Stud. Mycol. 55:235, 2006. (2) B. Slippers et al. Mycologia 97:99, 2005.

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Mesquite (Prosopis pallida (Wildenow) Kunth) is a drought-tolerant tree widely distributed in the northern Pacific Coast of South America. This species prevents soil erosion, provides shade, conserves prairies, supports bee nutrition, and provides fruits for human and animal consumption. Since the spring of 2004, bark lesions and bleeding cankers were observed on trunks and branches of 70% of declining mesquite trees in some parks at Ica in southern Peru. Badly affected trees were killed by the disease. Isolations were made from the edge of necrotic lesions of the inner bark and roots using PARPH medium (2) and incubated at 22°C for 7 days. A Phytophthora species was consistently isolated from lesions of 10 mesquite trees, and six pure cultures (PS-87-PS-92) were obtained by transferring hyphal tips and characterized. Colonies were stellate on V8 juice agar (VJA; 2 g CaCO3, 200 ml of V8 juice, and 15 g of agar in 800 ml of distilled water), uniform to slightly radiate on corn meal agar (Oxoid Ltd., London, England), and knotty on PDA (Biokar Diagnostics, Beauvais, France). On VJA at 22°C, the average radial growth rate for the six isolates was 1.7 mm per day. Colonies grew slowly at 5 and 25°C with 0.4 and 0.7 mm per day growth rate, respectively. There was no growth at 30°C. Catenulate hyphal swellings formed on VJA and liquid media (1.5% sterile soil extract). Sporangia were persistent, ovoid to obpyriform, semipapillate with narrow exit pores (<5.0 µm in diameter), 32.3 to 39.7 × 21.0 to 27.2 µm, with a length/width ratio of 1.4:1 to 1.6:1. Sporangia were produced by cutting 5-mm disks from the advancing margin of a colony on VJA and adding disks to 10 ml of 1.5% sterile soil extract for 4 to 5 days at 22°C under fluorescent light. Isolates were homothallic with spherical oogonia, 32 to 35 µm in width with paragynous antheridia, and aplerotic oospores, 26 to 31 µm. These characteristics fit the descriptions of Phytophthora syringae (Kleb.) Kleb. (1). Sequences of the internal transcribed spacer regions on the isolates and comparison with other sequences in GenBank showed that they were identical to P. syringae (Accession No. AJ854297 from Citrus limon). In 2005, two methods were used to inoculate mesquite with two isolates. One method used two 20-mm-diameter branches of five 5-year-old mesquite trees where a 5-mm wound was made with a cork borer and a 5-mm block of the agar culture was placed under the bark and sealed with Parafilm. Another method used 10 4-month-old potted plants that received a 30-ml drench of a 104 zoospores/ml suspension per plant. Controls received clean agar blocks and a sterile water drench for 10 control pots. Two weeks after inoculation, black areas and resinosis were observed around inoculated wounds. Inoculated branches produced cankers of 4.7 to 6.8 cm2, 4 weeks after inoculations. Twenty days after inoculation of roots, wilting and root rots of seedlings occurred. No symptoms were found on the control plants. P. syringae was reisolated from the diseased branches and root rots and pure cultures were established. This test was repeated for both methods with similar results. To our knowledge, this is the first report of P. syringae in Peru and the first description of this pathogen on mesquite worldwide. References: (1) D. C. Erwin and O. K. Ribeiro. Phytophthora Diseases Worldwide. The American Phytopathological Society, St. Paul MN. 1996. (2) S. N. Jeffers and S. B. Martin. Plant Dis. 70:1038, 1986.

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OBJECTIVE: Almost half of all hospitalized patients are malnourished with low physician awareness or implementation of nutrition support. To address this problem, a 2-day immersion course in clinical nutrition for physicians was developed by the Latin American Federation of Parenteral and Enteral Nutrition (FELANPE) with support from Abbott Laboratories. The goal of Total Nutritional Therapy (TNT) is to help physicians utilize this nutrition knowledge to increase their awareness of malnutrition and implementation of nutritional therapy. Since 1997, over 8,000 physicians have completed the TNT course in 16 Latin American countries. RESEARCH METHODS & PROCEDURES: During 1999 and 2000, 675 participants responded to a survey 6 months after having completed the TNT course to determine what impact the course had on the use of nutrition assessment, nutrition support teams, or nutrition consultations in their clinical practice, and if they had participated in any nutrition association or conferences. RESULTS: The majority of physicians who completed the survey increased their use of nutrition assessment and time dedicated to nutrition therapy, and increased the number of their patients placed on nutrition therapy. CONCLUSIONS: The TNT course has been shown to be an efficient model of clinical nutrition education for general physicians. The course should be considered as part of the training of medical residents.

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Screwworm flies, Cochliomyia hominivorax (Coquerel), were fed on honey and spray dried egg product; honey, molasses, and spray dried egg product; honey and spray dried meat protein; as well as on a control diet of honey and horsemeat, which is the standard diet used for screwworm adult colony in the mass-rearing facility. In general, the weight of eggs laid by females fed on the diet of spray dried egg product was significantly higher than that laid by females fed on the standard horsemeat diet. Egg production declined when spray dried meat protein replaced the egg product. Partial replacement of honey with molasses in the egg diet did not decrease egg production, compared with the control diet. The use of spray dried egg diet has advantages over the horsemeat diet, such as storage, handling, preparation, feeding, and expense. A cost analysis suggests that replacing the horsemeat with spray dried egg product, and half of the honey with molasses, would reduce the cost of the diet by more than US $100,000 annually.

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In previous work, we found effects of prenatal exposure to diazepam (DZ) on sexual behavior of adult mice. The aim of this work was to compare sexual behavior during their reproductive span of CD-1 strain male mice exposed in utero to DZ. One group of female mice was treated with DZ (2.5 mg/kg/day; s.c.) from 6th to 17th days of gestation and a control group received saline. The spontaneous offspring male sexual activity to receptive females was tested in 3 sessions (1/week) twice, on the 6th month of age and later on the 20th. Tests were performed during the dark stage of the photoperiod and video recorded under red light. During copulating stage adult DZ-treated males showed greater incidence of interruptions of intravaginal penetration, while senile DZ-treated males had lower latencies of mount series and greater proportion of ejaculations. Both adult and senile DZ-treated males exhibited a significant larger incidence of falls and pauses during mount series with intromission. Results show a permanent effect of prenatal exposure of DZ on sexual behavior.

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Larvae of screwworm, Cochliomyia hominivorax (Coquerel), were reared on diets with varying concentrations of spray dried animal blood cells, spray dried inedible egg product, and powdered milk substitute, and compared with those reared on spray dried whole bovine blood-based diet currently used for mass rearing. Mean larval weight, pupal weight, number of pupae, adult emergence, sex ratio, longevity, fecundity, and fertility obtained from the tests with animal blood cell based diets were similar to those from tests with whole bovine blood based diet. The animal blood cell based diet has potential for use in the mass production of screwworm larvae.

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Benzodiazepines are drugs that belong to the group of minor tranquilizers. They derive from the 1-4, benzodiazepine common nucleus that was obtained by chemical synthesis and act upon the GABA receptors increasing their affinity, thus providing them with their tranquilizing, miorelaxing, and anticonvulsant properties. Due to these characteristics they have been used in a wide variety of disorders accompanied by anxiety, hyperexitability, convulsions, and muscular hypertony, as well as during pregnancy and labor. Before using them in pregnant women, the physician should consider the conditions of the product "in uterus" since, according to experimental evidences, benzodiazepines could interfere with embryonary development, mainly with those involved in central nervous system mechanisms causing tissular alterations, retardment in cellular differentiation, and behavioral disturbances. Besides, since the fetus has lower excretion rate than that of the mother, drug concentrations are greater than the therapeutic ones and fetal tolerance to the compound, administered during the last trimester, is reduced, originating abstinence or intoxication syndromes in the newborn. It is concluded that more research is needed to evaluate all the aftereffects caused by using these drugs during pregnancy.

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One hundred and twenty-five previously untreated patients bearing metastatic or advanced recurrent (inoperable) colorectal carcinoma and measurable disease were prospectively randomized. Those in arm A received 5-fluorouracil (5-FU), 1,200 mg/m2 i.v. infusion over 2 h, while those in arm B received methotrexate (MTX), 200 mg/m2 i.v. (push injection), followed 20 h later by 5-FU, 1,200 mg/m2 i.v. infusion over 2 h, plus calcium leucovorin (LV), 25 mg i.m. every 6 h for eight doses beginning 24 h after MTX administration. Cycles were repeated every 15 days. All patients receiving treatment were evaluable for toxicity and survival, and 118 patients were evaluable for response. The objective regression rate (complete plus partial response) was 12% (7 of 58) in arm A and 28% (17 of 60) in arm B (p = 0.049). No change was observed in 24% (14 of 58) in arm A and in 35% (21 of 60) in arm B (p = 0.28), while progressive disease was registered in 64% (37 of 58) and 37% (22 of 60) in arms A and B, respectively (p = 0.006). Median duration of response was 3 months in arm A and 5 months in arm B (p = 0.39). The median survival was 8.3 months in arm A and 11.2 months in arm B (p = 0.25). No statistically significant differences were found when objective regression and survival were related to site of primary tumor, performance status, and number of involved organs. There were two drug-related deaths in arm B due to severe myelosuppression followed by mucositis and sepsis. Of nonhematologic toxicities, diarrhea was more frequently observed in arm B, as were mucositis and infectious complications. Our results indicate that the sequential schedule MTX-5-FU-LV with 20-h intervals between MTX and 5-FU is superior in terms of objective regression to 5-FU alone given at the dose and schedule used in the present study. However, MTX-5-FU-LV did not have a significant impact on survival.

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The medical records of 510 patients with metastatic breast cancer were retrospectively reviewed. Seventy-seven patients with metastases confined to skeleton and 73 patients bearing visceral-only disease were identified. All patients had a disease-free interval greater than or equal to 6 months and received systemic therapy with any of the following modalities: chemotherapy, hormonotherapy, or chemohormonotherapy. The clinical features, response to treatment, and survival were analyzed and compared for both groups. Median survival of patients with osseous metastases was 28 months, while it was 13 months for those patients with a visceral pattern (p less than 0.001). Response rates to first and second line systemic therapy for both metastatic patterns showed no significant differences, suggesting a similar degree of sensitivity or resistance in both groups. Objective regression to first therapy was 45% in the group with bony disease and 41% among patients with visceral involvement; median duration of response was 16 months and 13 months, respectively. In both groups progressive disease conserved the original metastatic pattern in most patients. We conclude that although a superiority in survival was evident for the osseous metastatic pattern, for these patients efforts should be made to select the least aggressive therapy in order to avoid excessive toxicity. Further studies are needed to confirm our findings.

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Thirty-two patients with advanced non-small cell lung cancer (NSCLC) were entered in this study to evaluate the efficacy and toxicity of a chemotherapy schedule including cisplatin (C) 40 mg/m2 intravenously (i.v.) on days 1-3; vindesine (V) 3 mg/m2 i.v. on day 1, and cytarabine (ara-C) 15 mg/m2 subcutaneously every 12 hours on days 1-3 (total dose: 90 mg/m2). Cisplatin was administered simultaneously with one dose of ara-C. Cycles were repeated every 28 days. Five patients out of 28 (18%) fully evaluable for response presented partial remissions. No complete response was observed. Median survival was 8 months and median duration of response was 4 months. Hematologic toxicity was severe in 3 patients. There were no toxicity-related deaths. Other adverse reactions included nausea and vomiting, alopecia and peripheral neuropathy. We conclude that this chemotherapy combination is marginally effective against NSCLC showing in this group of patients a low number of responses of short duration without a significant impact on survival.

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The medical records of 414 patients with metastatic breast carcinoma treated between 1978 and 1986 were reviewed and 44 women were identified as having stage IV disease when the primary breast lesion was detected. Of these 44 women, 25 had metastatic disease limited to the skeleton while 19 had extraosseous lesions only. The clinical features, response to therapy, and survival were analyzed and compared for both groups. The median survival of those patients with bone-only metastases was 52 months as compared with 13 months for those with extraskeletal lesions (p = 0.0025). The response rate to first-line systemic therapy was similar for both groups (47% for bone metastases and 44% for extraosseous metastases). The median duration of response was 14 months (range, 3-55 months) for patients with bone disease and 8 months (range, 4-43 months) for those with extraskeletal lesions. We conclude that patients with metastatic breast cancer confined to the skeleton at initial diagnosis tend to follow an indolent, chronic course with prolonged survival. Therefore the increase in response rate with aggressive chemotherapy should be balanced against its higher morbidity. Further studies are needed to confirm whether the better prognosis of these patients is determined by the anatomical confinement of the disease to the skeleton or merely reflects the influence of other prognostic factors.

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La eficacia de dos esquemas quimioterápicos, sin resistencia cruzada e igualmente eficaces: adriamicina-vincristina (AV) y ciclofosfamida - methotrexate-5 - fluorouracilo = prednisona (CMFP) usados en diferentes secuencias, fue evaluada en términos de respuesta, duración, sobrevida y toxicidad. Desde diciembre de 1982 a febrero de 1984, 81 pacientes con carcinoma avanzado de mama fueron ingresadas a este estudio siendo randomizadas al azar a cada una de las ramas del estduio. Los datos del presente ensayo han sido evaluados hasta noviembre de 1985. En la rama A el tratamiento fue administrado en la secuencia inducción (AV) y mantenimiento (CMFP), mientras que en la rama B ambos esquemas (AV y CMFP) fueron alternados mensualmente. De los 41 pacientes de la rama A, 5% logró una remisión completa (RC), 49% remisión parcial (RP) y 27% progresión (P). En la rama B, de 40 pacientes tratados, 10% mostraron RC; 58% RP y no se observó progresión de enfermedad. Estos resultados no muestran diferencias significativas entre ambos esquemas, cuando se los compara en términos de regresión objetiva (RO), su duración y la sobrevida total. Sin embargo, cuando la enfermedad progresiva fue analizada se observó una diferencia estadísticamente significativa en favor de la rama B (p<0,0005). La toxicidad (hematológica y no hematológica fue similar en ambos grupos, con trastornos cardíacos más frecuentes en la rama B (AU)

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La eficacia de dos esquemas quimioterápicos, sin resistencia cruzada e igualmente eficaces: adriamicina-vincristina (AV) y ciclofosfamida - methotrexate-5 - fluorouracilo = prednisona (CMFP) usados en diferentes secuencias, fue evaluada en términos de respuesta, duración, sobrevida y toxicidad. Desde diciembre de 1982 a febrero de 1984, 81 pacientes con carcinoma avanzado de mama fueron ingresadas a este estudio siendo randomizadas al azar a cada una de las ramas del estduio. Los datos del presente ensayo han sido evaluados hasta noviembre de 1985. En la rama A el tratamiento fue administrado en la secuencia inducción (AV) y mantenimiento (CMFP), mientras que en la rama B ambos esquemas (AV y CMFP) fueron alternados mensualmente. De los 41 pacientes de la rama A, 5% logró una remisión completa (RC), 49% remisión parcial (RP) y 27% progresión (P). En la rama B, de 40 pacientes tratados, 10% mostraron RC; 58% RP y no se observó progresión de enfermedad. Estos resultados no muestran diferencias significativas entre ambos esquemas, cuando se los compara en términos de regresión objetiva (RO), su duración y la sobrevida total. Sin embargo, cuando la enfermedad progresiva fue analizada se observó una diferencia estadísticamente significativa en favor de la rama B (p<0,0005). La toxicidad (hematológica y no hematológica fue similar en ambos grupos, con trastornos cardíacos más frecuentes en la rama B

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