Identification of potential urinary protein biomarkers in colorectal cancer: a pilot study using a proteomic approach

Colorectal cancer (CRC) is among the most diagnosed malignancies worldwide, and it is also the second leading cause of cancer-related deaths. Despite recent progress in screening programs, noninvasive accurate biomarkers are still needed in the CRC field. In this study, we evaluated and compared the urinary proteomic profiles of patients with colorectal adenocarcinoma and patients without cancer, aiming to identify potential biomarker proteins. Urine samples were collected from 9 patients with CRC and 9 patients with normal colonoscopy results. Mass spectrometry (label-free LC—MS/MS) was used to characterize the proteomic profile of the groups. Ten proteins that were differentially regulated were identified between patients in the experimental group and in the control group, with statistical significance with a p value ≤ 0.05. The only protein that presented upregulation in the CRC group was beta-2-microglobulin (B2M). Subsequent studies are needed to evaluate patients through different analysis approaches to independently verify and validate these biomarker candidates in a larger cohort sample. (AU)

Results of endoscopic biliary drainage in patients with malignant hilar stricture

Abstract In Malignant Hilar Biliary Stricture (MHBS) palliative biliary drainage is a frequent strategy, improving the quality of life, reducing pruritus, loss of appetite and relieving cholangitis. The endoscopic approach is an effective, although challenging procedure. This study aimed to evaluate technical and clinical success rates of biliary drainage by ERCP. This is a retrospective study including all patients with MHBS referred to Instituto do Cancer do Hospital de São Paulo (ICESP) submitted to biliary drainage by ERCP, between January 2010 and December 2017. Multivariable logistic regression was performed to evaluate predictors of clinical failure, as total bilirubin levels, Bismuth classification, number of hepatic sectors drained and presence of cholangitis. In total, 82 patients presenting unresectable MHBS were included in this study. 58.5% female and 41.5% male, with a mean age of 60±13 years. Bismuth classification grades II, IIIA, IIIB and IV were noted in 23.2%, 15.9%, 14.6% and 46.3%, respectively. Technical and clinical success was achieved in 92.7% and 53.7% respectively. At multivariable logistic-regression analyses, Bismuth IV strictures were related to higher clinical failure rates when compared to other strictures levels, with an Odds Ratio of 5.8 (95% CI 1.28‒20.88). In conclusion, endoscopic biliary drainage for malignant hilar biliary stricture had a high technical success but suboptimal clinical success rate. Proximal strictures (Bismuth IV) were associated with poor drainage outcomes.

McKittrick-Wheelock syndrome secondary to rectal adenocarcinoma

Introduction: McKittrick-Wheelock syndrome is a rare condition that arises from a hypersecretory state secondary to large colorectal tumors, mainly villous adenomas, leading to an electrolytic disorder associated with chronic diarrhea that usually persists for years. It is a relatively unknown disease that can lead to severe complications such as acute kidney injury, severe hyponatremia, and hypokalemia. In fact, it causes death in most untreated cases. Surgical removal of the tumor is the most successful treatment, and symptoms tend to disappear after proper management. Case Report: A 62-year-old man with a 2-year history of mucoid diarrhea preceded by abdominal pain presented with acute kidney injury, hyponatremia, and hypokalemia. A digital rectal examination and sigmoidoscopy were performed, and revealed a large laterally-spreading tumor in the rectum. Further investigation showed a rectal tubulovillous adenoma with secondary McKittrick-Wheelock syndrome. An anterior resection of the rectum with a colonic J-pouch and a diverting ileostomy were performed, and the patient improved with the resolution of the renal failure and electrolyte disturbances. The histopathological analysis revealed an invasive rectal adenocarcinoma. Discussion: McKittrick-Wheelock syndrome is a condition with a low incidence that needs early intervention and proper diagnosis. It is of extreme importance that this disease is included in the differential diagnoses for chronic diarrhea associated with an electrolytic disorder. (AU)

Doses of sulfur at topdressing and organic compost supply at planting in the production, quality and content of macronutrients in lettuce seeds

The purpose of this study was to evaluate doses of sulfur applied at topdressing, with and without organic compost supply at planting, in the production, physiological quality and content of macronutrients in lettuce seeds. Ten treatments were evaluated in a 5x2 factorial scheme (five sulfur doses at topdressing x with and without application of organic compost at planting). The experimental design was a randomized block design, with four replicates. The sulfur doses applied at topdressing fertilization were 50, 100, 150 and 200 kg ha-1 of S, in addition to the control treatment (dose zero). Regarding the treatments with organic compost, the dose of 70 t ha-1 of compost (wet basis) was supplied at planting. The following characteristics were evaluated: seed production (mass and number of seeds per plant), seed quality (mass of one thousand seeds, first count of the standard germination test, germination percentage, and germination speed index) and content of macronutrients and mineral accumulation. The organic compost supply at planting increased seed production by 43% compared to the treatment without the application of organic compost, while the doses of sulfur did not affect the production of lettuce seeds. The supply of organic compost increased the accumulation of a great part of the macronutrients, except for the accumulation of calcium. The lettuce seeds quality was not affected by both the main treatments, the sulfur doses at topdressing and the organic compost supply at planting. The descending order of nutrients accumulated in the lettuce seeds was nitrogen> potassium> phosphorus> magnesium> calcium> sulfur.

Bacterial vaginosis, cervical Human Papillomavirus infection and cervical cytological abnormalities in adult women in Central Brazil: a cross-sectional study / Vaginose bacteriana, infecção cervical pelo Papilomavírus humano e anormalidades citológicas cervicais em mulheres adultas no Brasil Central: um estudo transversal

Bacterial vaginosis is the most common cause of vaginal discharge and occurs when there is an imbalance in the vaginal microbiota, predominantly composed of Lactobacillus spp. Human Papillomavirus is the most common sexually transmitted virus in the world. Persistent infection with high-risk Human Papillomavirus genotypes is the main cause of the development of cervical intraepithelial neoplasia and cervical cancer. Objective: To investigate the association between bacterial vaginosis and cervical Human Papillomavirus infection and between bacterial vaginosis and cervical cytological abnormalities in adult women. Methods: Cross-sectional study carried out in a gynecology outpatient clinic of the public health network. A total of 202 women were included in the study and underwent gynecological examination with cervical specimen collection. Cervical cytopathological examinations and bacterioscopy by the Nugent method were performed to identify bacterial vaginosis, and PCR and reverse hybridization were carried out for Human Papillomavirus detection and genotyping. Bivariate analysis was performed to investigate the association between bacterial vaginosis and cervical Human Papillomavirus infection, and between bacterial vaginosis and cervical cytological abnormalities. The odds ratio was calculated, with the respective 95% confidence intervals (95%CI) and 5% significance level (p≤0.05). Results: The prevalence of bacterial vaginosis was 33.2% (67/202), the prevalence of cervical Human Papillomavirus infection was 38.6% (78/202) and the prevalence of cervical cytological abnormalities was 6.0% (12/202). Bivariate analysis showed no significant association between bacterial vaginosis and cervical Human Papillomavirus infection (OR 0.69; 95% CI 0.37­ 1.27; p=0.23), or between bacterial vaginosis and cervical cytological abnormalities (OR 0.65; 95%CI 0.17­2.50; p=0.54). Conclusion: In this study, bacterial vaginosis did not represent a risk factor for cervical Human Papillomavirus infection or for the presence of cervical cytological abnormalities in the investigated adult women.

A vaginose bacteriana é a causa mais comum de corrimento vaginal e ocorre quando há um desequilíbrio da microbiota vaginal, composta predominantemente de Lactobacillus spp. O papilomavírus humano é o vírus sexualmente transmissível mais comum no mundo. A infecção persistente com genótipos do papilomavírus humano de alto risco é a principal causa do desenvolvimento de neoplasias intraepiteliais cervicais e câncer de colo do útero. Objetivo: Investigar a associação entre vaginose bacteriana e infecção cervical pelo papilomavírus humano e entre vaginose bacteriana e anormalidades citológicas cervicais em mulheres adultas. Métodos: Estudo de corte transversal realizado em um ambulatório de ginecologia da rede pública de saúde. O total de 202 mulheres foi incluído no estudo e submetido ao exame ginecológico com coleta de espécime cervical. Foram realizados os exames citopatológicos cervicais, a bacterioscopia pelo método de Nugent para a identificação da vaginose bacteriana e reação em cadeia da polimerase e hibridização reversa para a detecção e genotipagem do papilomavírus humano. Análise bivariada foi realizada para investigar a associação entre vaginose bacteriana e infecção cervical pelo papilomavírus humano e entre vaginose bacteriana e anormalidades citológicas cervicais. Foi calculado o odds ratio, com os respectivos intervalos de confiança de 95% (IC95%) e nível de significância de 5% (p≤0,05). Resultados: A prevalência da vaginose bacteriana foi de 33,2% (67/202), a da infecção cervical pelo papilomavírus humano foi de 38,6% (78/202) e a de anormalidades citológicas cervicais foi de 6,0% (12/202). A análise bivariada não demonstrou associação significativa entre vaginose bacteriana e infecção cervical pelo papilomavírus humano (OR 0,69; IC95% 0,37­1,27; p=0,23), nem entre vaginose bacteriana e anormalidades citológicas cervicais (OR 0,65; IC95% 0,17­2,50; p=0,54). Conclusão: Neste estudo a vaginose bacteriana não representou um fator de risco para a infecção cervical pelo papilomavírus humano e nem para presença de anormalidades citológicas cervicais nas mulheres adultas investigadas

Bacterial vaginosis and cervical human papillomavirus infection in young and adult women: a systematic review and meta-analysis

ABSTRACT OBJECTIVE To investigate the association between bacterial vaginosis and cervical human papillomavirus (HPV) infection in young and adult women. METHODS This systematic review and meta-analysis was based on the Prisma methodological guidelines. PubMed and Web of Science were searched using the following descriptors: "bacterial vaginosis and HPV", in June 2019. Articles published from 2012 to 2019 were included. Inclusion criteria were original studies that investigated the association between bacterial vaginosis and cervical HPV infection; articles published in English, Spanish or Portuguese; studies conducted in young and adult, non-pregnant, non-HIV-infected women; studies that used the Nugent criteria for the diagnosis of bacterial vaginosis and studies in which the detection of HPV used the polymerase chain reaction technique. Assembled data, odds ratio (OR) and respective 95% confidence intervals (95%CI) were estimated for the association between bacterial vaginosis and cervical HPV infection using random-effects models. A bilateral value of p < 0.05 was considered statistically significant. RESULT Six studies were selected for analysis and demonstrated association between bacterial vaginosis and cervical HPV infection (OR = 2.68; 95%CI: 1.64-4.40; p < 0.001). CONCLUSION Bacterial vaginosis was considered a risk factor for cervical HPV infection, since women with bacterial vaginosis were more likely to be infected with HPV.

AXIN2-associated adenomatous colorectal polyposis

Abstract: Introduction Most cases of colorectal cancer (CRC) occur sporadically; however, ~3% to 6% of all CRCs are related to inherited syndromes, such as Lynch syndrome and familial adenomatous polyposis (FAP). The adenomatous polyposis coli (APC) andmutY DNA glycosylase (MUTYH) germline mutations are the main genetic causes related to colorectal polyposis. Nevertheless, in many cases mutations in these genes have not been identified. The aim of the present case report is to describe a rare case of genetic colorectal polyposis associated with the axis inhibition protein 2 (AXIN2) gene. Case Report: The first colonoscopy screening of a 61-year-old male patient with no known family history of CRC revealed ~ 50 colorectal polyps. A histological evaluation of the resected polyps showed low-grade tubular adenomas. Germline genetic testing through a multigene panel for cancer predisposition syndromes revealed a pathogenic variant in the AXIN2 gene. In addition to colorectal polyposis, the patient had mild features of ectodermal dysplasia: hypodontia, scant body hair, and onychodystrophy. Discussion: The AXIN2 gene acts as a negative regulator of the Wnt/β -catenin signaling pathway, which participates in development processes and cellular homeostasis. Further studies are needed to support the surveillance recommendations for carriers of the AXIN2 pathogenic variant. (AU)

Ressecção endoscópica sob imersão d'água de pequenos tumores neuroendócrinos retais / Underwater endoscopic mucosal resection for small rectal neuroendocrine tumors

ABSTRACT BACKGROUND: A common site of neuroendocrine tumors (NETs) is the rectum. The technique most often used is endoscopic mucosal resection with saline injection. However, deep margins are often difficult to obtain because submucosal invasion is common. Underwater endoscopic mucosal resection (UEMR) is a technique in which the bowel lumen is filled with water rather than air, precluding the need for submucosal lifting. OBJECTIVE: This study aimed to evaluate the efficacy and safety of UEMR for removing small rectal neuroendocrine tumors (rNETs). METHODS: Retrospective study with patients who underwent UEMR in two centers. UEMR was performed using a standard colonoscope. No submucosal injection was performed. Board-certified pathologists conducted histopathologic assessment. RESULTS: UEMR for small rNET was performed on 11 patients (nine female) with a mean age of 55.8 years and 11 lesions (mean size 7 mm, range 3-12 mm). There were 9 (81%) patients with G1 rNET and two patients with G2, and all tumors invaded the submucosa with only one restricted to the mucosa. None case showed vascular or perineural invasion. All lesions were removed en bloc. Nine (81%) resections had free margins. Two patients had deep margin involvement; one had negative biopsies via endoscopic surveillance, and the other was lost to follow-up. No perforations or delayed bleeding occurred. CONCLUSION: UEMR appeared to be an effective and safe alternative for treatment of small rNETs without adverse events and with high en bloc and R0 resection rates. Further prospective studies are needed to compare available endoscopic interventions and to elucidate the most appropriate endoscopic technique for resection of rNETs.

RESUMO CONTEXTO: Um local comum de tumores neuroendócrinos (TNEs) é o reto. A técnica mais utilizada é a ressecção endoscópica da mucosa com injeção de solução salina. No entanto, as margens profundas costumam ser difíceis de ressecar porque a invasão da submucosa é comum. A ressecção endoscópica sob imersão d'água (RESI) é uma técnica em que o lúmen intestinal é preenchido com água em vez de ar, evitando a necessidade de elevação submucosa. OBJETIVO: Este estudo teve como objetivo avaliar a eficácia e segurança da RESI para a remoção de pequenos TNEs retais (rTNEs). MÉTODOS: Estudo retrospectivo com pacientes que realizaram RESI em dois centros. RESI foi realizada usando um colonoscópio padrão. Nenhuma injeção submucosa foi realizada. Patologistas certificados conduziram avaliação histopatológica. RESULTADOS: RESI foi realizada para pequenos rTNEs em 11 pacientes (nove mulheres) com média de idade de 55,8 anos e 11 lesões (tamanho médio de 7 mm, variando de 3-12 mm). Havia 9 (81%) pacientes com G1 rTNEs e dois pacientes com G2, sendo que todos os tumores invadiam a submucosa sendo apenas um restrito a mucosa. Nenhum caso mostrou invasão vascular ou perineural. Todas as lesões foram removidas em bloco. Nove (81%) ressecções tiveram margens livres. Dois pacientes tiveram envolvimento de margens profundas; um teve biópsias negativas por meio de vigilância endoscópica e o outro perdeu o acompanhamento. Não ocorreram perfurações ou sangramento tardios. CONCLUSÃO: A RESI parece ser uma alternativa eficaz e segura para o tratamento de pequenos rTNEs sem eventos adversos e com altas taxas de ressecção em bloco e R0. Mais estudos prospectivos são necessários para comparar as intervenções endoscópicas disponíveis e para elucidar a técnica endoscópica mais adequada para ressecção de rTNEs.

Endoscopy infection control strategy during the COVID-19 pandemic: experience from a tertiary cancer center in Brazil

OBJECTIVES: Strategic planning for coronavirus disease (COVID-19) care has dominated the agenda of medical services, which have been further restricted by the need for minimizing viral transmission. Risk is particularly relevant in relation to endoscopy procedures. This study aimed to describe a contingency plan for a tertiary academic cancer center, define a strategy to prioritize and postpone examinations, and evaluate the infection rate among healthcare workers (HCWs) in the endoscopy unit of the Cancer Institute of the State of São Paulo (ICESP). METHODS: We created a strategy to balance the risk of acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and to mitigate the effects of postponing endoscopic procedures in oncological patients. A retrospective analysis of prospectively collected data on all endoscopies between March and June 2020 compared with those during the same period in 2019 was carried out. All HCWs were interviewed to obtain clinical data and SARS-CoV-2 test results. RESULTS: During the COVID-19 outbreak, there was a reduction of 55% in endoscopy cases in total. Colonoscopy was the most affected modality. The total infection rate among all HCWs was 38%. None of the senior digestive endoscopists had COVID-19. However, all bronchoscopists had been infected. One of three fellows had a serological diagnosis of COVID-19. Two-thirds of all nurses were infected, whereas half of all technicians were infected. CONCLUSIONS: In this pandemic scenario, all endoscopy services must prioritize the procedures that will be performed. It was possible to maintain some endoscopic procedures, including those meant to provide nutritional access, tissue diagnosis, and endoscopic resection. Personal protective equipment (PPE) seems effective in preventing transmission of COVID-19 from patients to digestive endoscopists. These measures can be useful in planning, even for pandemics in the future.

Maturation and Resting of Sweet Pepper Fruits on Physiological Quality and Biochemical Response of Seeds

Abstract The post-harvest resting of the fruits can improve seed physiological quality ,once it allows the seed to complete the maturation process, so it has been a common practice in vegetable seed companies, however, there are a few studies of this technique in sweet pepper. The objective of this research was to evaluate physiological quality, and biochemical response of sweet's peppers in regarding on the stage of maturation and the post-harvest rest of the fruits. The experimental was conducted in a 4x2 factorial, being the first factor comprised four maturation stages (35, 50, 65 and 80 days after anthesis) and, the second the post-harvest management of fruits, with and without a temporary storage of seven days. Seeds were evaluated for water content, weight of thousand seeds, germination, vigor, superoxide dismutase, catalase and peroxidase activities, lipid peroxidation and hydrogen peroxide content. Fruit harvest time indicated is 80 days after anthesis (fruits 100% yellow) when seeds showed maximum germination and vigor. The post-harvest resting of the fruits was beneficial to seed physiological quality, weight of one thousand seeds and to reduce hydrogen peroxide content. Seeds of higher physiological quality showed lower superoxide dismutase and catalase enzyme activity, so they can be used as a marker of physiological quality in sweet pepper seeds.

EUS-guided gastroenterostomy: Initial experience in a brazilian tertiary center

SUMMARY INTRODUCTION: EUS-guided gastroenterostomy (EUS-GE) is a novel procedure for palliation of malignant gastric outlet obstruction (GOO). Our aim was to evaluate the outcomes of this technique in our initial experience. METHODS: Patients with GOO from our institute were included. Technical success was defined as the successful creation of a gastroenterostomy. Clinical success was defined as the ability to tolerate a soft diet after the procedure. We assessed adverse events and diet tolerance 1 month after the procedure. RESULTS: Three patients were included. Technical and clinical success was achieved in all cases. There were no adverse events and good diet tolerance was observed 1 month after the procedure in the included patients. CONCLUSION: EUS-GE is a promising treatment for patients with GOO.

RESUMO INTRODUÇÃO: A gastroenterostomia ecoguiada é um novo procedimento para paliação da obstrução maligna gastroduodenal. Nosso objetivo foi avaliar os resultados dessa técnica em nossa experiência inicial. MÉTODOS: Foram incluídos pacientes com obstrução maligna gastroduodenal de nossa instituição. O sucesso técnico foi definido como a realização adequada de uma gastroenterostomia. O sucesso clínico foi definido como boa aceitação de dieta pastosa durante a internação. Os eventos adversos e a aceitação alimentar foram avaliados um mês após o procedimento. RESULTADOS: Três pacientes foram incluídos. Os sucessos técnico e clínico foram alcançados em todos os casos. Não houve eventos adversos e a aceitação alimentar permaneceu adequada um mês após o procedimento nos pacientes incluídos. CONCLUSÃO: O EUS-GE é um tratamento promissor para pacientes com obstrução maligna gastroduodenal.

Ressecção da mucosa endoscópica sob imersão dágua para lesões colorretais não pediculadas. Um estudo prospectivo de braço único / Underwater endoscopic mucosal resection for non-pedunculated colorectal lesions. a prospective single-arm study

ABSTRACT BACKGROUND: Underwater endoscopic mucosal resection (UEMR) has emerged as a revolutionary method allowing resection of colorectal lesions without submucosal injection. Brazilian literature about this technique is sparse. OBJECTIVE: The aim of this study was evaluate the efficacy and safety of UEMR technique for removing non-pedunculated colorectal lesions in two Brazilian tertiary centers. METHODS: This prospective study was conducted between June 2016 and May 2017. Naïve and non-pedunculated lesions without signs of submucosal invasion were resected using UEMR technique. RESULTS: A total of 55 patients with 65 lesions were included. All lesions, except one, were successfully and completely removed by UEMR (success rate 98.5%). During UEMR, two cases of bleeding were observed (3.0%). One patient had abdominal pain on the day after resection without pneumoperitoneum. There was no perforation or delayed bleeding. CONCLUSION: This study supports the existing data indicating acceptable rates of technical success, and low incidence of adverse events with UEMR. The results of this Brazilian study were consistent with previous abroad studies.

RESUMO CONTEXTO: A ressecção endoscópica da mucosa sob imersão d'água (REMS) surgiu como um método revolucionário que permite a ressecção de lesões colorretais sem injeção submucosa. A literatura brasileira sobre essa técnica é escassa. OBJETIVO: A finalidade deste estudo foi avaliar a eficácia e segurança da técnica REMS na remoção de lesões colorretais não pediculadas em dois centros terciários brasileiros. MÉTODOS: Este estudo prospectivo foi realizado entre junho de 2016 e maio de 2017. As lesões sem tentativa de ressecção prévia, não pediculadas e sem sinais de invasão submucosa foram ressecadas pela técnica REMS. RESULTADOS: Um total de 55 pacientes com 65 lesões foram incluídos. Todas as lesões, exceto uma, foram removidas com sucesso e completamente por REMS (taxa de sucesso de 98,5%). Durante a REMS, foram observados dois casos de sangramento (3,0%). Uma paciente apresentou dor abdominal no dia seguinte à ressecção sem pneumoperitônio. Não houve perfuração ou sangramento tardio. CONCLUSÃO: Este estudo apoia os dados existentes, indicando taxas aceitáveis de sucesso técnico e baixa incidência de eventos adversos com a REMS. Os resultados deste estudo brasileiro foram consistentes com estudos internacionais prévios.

Endoscopic evaluation of post-fundoplication anatomy and correlation with symptomatology / Avaliação endoscópica da anatomia após fundoplicatura e correlação com sintomatologia

ABSTRACT Background: Upper digestive endoscopy is important for the evaluation of patients submitted to fundoplication, especially to elucidate postoperative symptoms. However, endoscopic assessment of fundoplication anatomy and its complications is poorly standardized among endoscopists, which leads to inadequate agreement. Aim: To assess the frequency of postoperative abnormalities of fundoplication anatomy using a modified endoscopic classification and to correlate endoscopic findings with clinical symptoms. Method: This is a prospective observational study, conducted at a single center. Patients were submitted to a questionnaire for data collection. Endoscopic assessment of fundoplication was performed according to the classification in study, which considered four anatomical parameters including the gastroesophageal junction position in frontal view (above or at the level of the pressure zone); valve position at retroflex view (intra-abdominal or migrated); valve conformation (total, partial, disrupted or twisted) and paraesophageal hernia (present or absent). Results: One hundred patients submitted to fundoplication were evaluated, 51% male (mean age: 55.6 years). Forty-three percent reported postoperative symptoms. Endoscopic abnormalities of fundoplication anatomy were reported in 46% of patients. Gastroesophageal junction above the pressure zone (slipped fundoplication), and migrated fundoplication, were significantly correlated with the occurrence of postoperative symptoms. There was no correlation between symptoms and conformation of the fundoplication (total, partial or twisted). Conclusion: This modified endoscopic classification proposal of fundoplication anatomy is reproducible and seems to correlate with symptomatology. The most frequent abnormalities observed were slipped and migrated fundoplication, and both correlated with the presence of symptoms.

RESUMO Racional: A endoscopia digestiva alta é importante ferramenta para a avaliação de pacientes submetidos à fundoplicatura, principalmente para elucidar os sintomas pós-operatórios. Entretanto, a avaliação endoscópica da sua anatomia e complicações é atualmente pouco padronizada entre os endoscopistas, o que leva à disparidade de laudos e condutas. Objetivo: Avaliar a frequência de anormalidades pós-operatórias da fundoplicatura através de uma classificação endoscópica e correlacionar os achados endoscópicos com os sintomas clínicos. Método: Este é estudo observacional prospectivo, realizado em um único centro. Os pacientes foram submetidos a um questionário para coleta de dados. A avaliação endoscópica da fundoplicatura foi realizada de acordo com a classificação em estudo, que considerou quatro parâmetros anatômicos, incluindo a posição da junção gastroesofágica em vista frontal (acima ou no nível da zona de pressão); posição da válvula na visão retroflexa (intra-abdominal ou migrada); conformação valvar (total, parcial, desgarrada ou torcida) e hérnia paraesofágica (presente ou ausente). Resultados: Foram avaliados 100 pacientes submetidos à fundoplicatura, 51% homens (idade média: 55,6 anos). Quarenta e três por cento relataram sintomas pós-operatórios. Anormalidades endoscópicas da anatomia da fundoplicatura foram relatadas em 46% dos pacientes. Junção gastroesofágica acima da zona de pressão (fundoplicatura deslizada) e fundoplicatura migrada foram significativamente correlacionadas com a ocorrência de sintomas pós-operatórios. Não houve correlação entre sintomas e conformação da fundoplicatura (total, parcial ou torcida). Conclusão: Essa classificação endoscópica modificada proposta para avaliar a anatomia da fundoplicatura é reprodutível e parece correlacionar-se com a sintomatologia. As anormalidades mais frequentes observadas foram fundoplicaturas migradas e deslizadas, e ambas se correlacionaram com a presença de sintomas.

Long-term survival analysis after endoscopic stenting as a bridge to surgery for malignant colorectal obstruction: comparison with emergency diverting colostomy

The use of colorectal self-expanding metal stents (SEMS) as bridge therapy for malignant colorectal obstruction was first reported more than 20 years ago. However, its use remains controversial. Objective: In this study, we aimed to compare the long-term survival of patients with potentially resectable malignant colorectal obstruction who had undergone colorectal SEMS placement and emergency surgery. Methods: This study was a retrospective analyses. Patients who received treatment between 2009 and 2017 were included. According to the eligibility criteria, 21 patients were included in the SEMS group and 67 patients were included in the surgical group.. Results: The majority of the patients in the SEMS group were female (57.1%), whereas the majority of those in the surgical group were male (53.7%). The median follow-up time was 60 months for both groups with the same interquartile range of 60 months. There was no difference in the overall survival rate (log rank p=0.873) and disease-free survival rate (log rank p=0.2821) in the five-year analysis. There was no difference in local recurrence rates (38.1% vs. 22.4%, p=0.14) or distant recurrence rates (33.3% vs. 50.7%, p=0.16) in the SEMS and the surgical groups. Technical and clinical success rates of endoscopic stenting were 95.3% and 85.7%, respectively. There were no immediate adverse events (AEs). Severe AEs included perforation (14.3%), silent perforation (4.7%), reobstruction (14.3%), and bleeding (14.3%). Mild AEs included pain (42.8%), tenesmus (9.5%), and incontinence (4.76%). The limitations of this study was retrospective and was conducted at a single center. Conclusions: No differences in disease-free and overall survival rates were observed in the five-year analysis of patients with resectable colorectal cancer who had undergone SEMS placement or colostomy for the treatment of malignant colorectal obstruction. Patients in the SEMS group had a higher rate of primary anastomosis and a lower rate of temporary colostomy than did those in the surgery group.

Repensando alternativas em Saúde do Trabalhador em uma perspectiva emancipatória / Rethinking alternatives in Worker's Health from an emancipatory perspective

Resumo Diante da gravidade da crise envolvendo graves retrocessos de políticas sociais em curso no Brasil, a proposta deste ensaio é pensar alternativas para futuras intervenções em Saúde do Trabalhador em uma perspectiva emancipatória. Trata-se de um convite à reflexão de novos horizontes teóricos e políticos que façam dialogar a Saúde do Trabalhador com os referenciais da abordagem pós-colonial e da proposição das Epistemologias do Sul (EdS). As EdS substanciam a obra do cientista social português Boaventura de Sousa Santos em torno de um pensamento alternativo de alternativas inspirado pelos saberes produzidos nas lutas sociais dos grupos subalternizados. Após apresentarmos uma síntese das EdS e do conceito de pensamento abissal, discutimos alguns limites e potencialidades para pensar novos horizontes teóricos, temáticos e políticos em trabalho e saúde. Em seguida refletimos sobre como os desastres industriais são emblemáticos por articular processos de exclusões radicais dentro e fora dos muros fabris. Por fim, discutimos a potência das EdS em abrir os termos do debate sobre possíveis intervenções em Saúde do Trabalhador, trazendo para o campo novos referenciais que fazem repensar, de forma ampla e radical, as agendas epistemológicas e políticas pela frente.

Abstract In view of the severity of the Brazilian crisis involving serious setbacks in social policies, the purpose of this essay is to think alternatives for future interventions in Workers' Health from an emancipatory perspective. It is an invitation to reflect on new theoretical and political horizons for discussing Workers' Health from the reference of the postcolonial approach and the proposition of the Epistemologies of the South (EdS). The EdS reflects the work of the Portuguese social scientist Boaventura de Sousa Santos around an alternative thinking of alternatives inspired by knowledge produced in social struggles of the groups that were made subaltern. After presenting a synthesis of the EdS and the concept of abyssal thinking, we discuss some limits and potentialities for thinking new theoretical, thematical and political horizons in workers´ health. Then we reflect on how industrial disasters are emblematic by articulating radical exclusion processes within and outside the factory walls. Finally, we discuss the potential of EdS to open the debate on possible interventions in Workers' Health, bringing new theoretical frameworks to the field, and enabling the broad and radical rethinking of the epistemological and political agendas to come.

Prevalência e fatores associados ao uso de álcool durante a gestação em uma maternidade de Goiás, Brasil Central / Prevalence and factors associated with alcohol use during pregnancy in a maternity hospital in Goiás, Central Brazil

Resumo O objetivo deste artigo é estimar a prevalência e os fatores associados ao uso de álcool durante a gestação. Estudo de corte transversal em uma amostra de 361 gestantes de um serviço de referência à assistência ginecológica e pré-natal. Os dados relacionados às características sociodemográficas, uso de álcool e potenciais fatores associados foram coletados por meio de entrevista face a face. Análise de regressão de Poisson com variância robusta foi utilizada para verificar os fatores associados ao desfecho analisado. O consumo de álcool na amostra estudada foi de 17,7% (IC 95%: IC 95%: 14,1-22,0%). Antecedentes de diabetes pré-gestacional ou gestacional, ideação suicida e uso de tabaco nos últimos 30 dias foi associado ao uso de álcool durante a gestação (p < 0,05). O estudo apontou alta prevalência de uso de álcool na gestação atual e a sua associação com importantes fatores. Ações como rastreio para o álcool e aconselhamentos sobre os problemas associados ao uso dessa substância principalmente no pré-natal podem contribuir para redução efetiva ou anulação do seu uso em gestantes e agravos materno-fetais relacionados.

Abstract The scope of this article is to estimate the prevalence and factors associated with alcohol use during pregnancy. It involved a cross-sectional study in a sample of 361 pregnant women in a reference service for gynecological and prenatal care. The data related to socio-demographic characteristics, alcohol use and potential associated factors were collected through face-to-face interviews. Poisson regression with robust variance was used to identify factors associated with the outcome analyzed. The consumption of alcohol in the sample was 17.7% (95% CI: 95% CI: 14.1% to 22.0%). A history of pre-gestational or gestational diabetes, suicidal ideation and tobacco use in the last 30 days was associated with alcohol use during pregnancy (p < 0.05). The study showed a high prevalence of alcohol use during the current pregnancy and its association with important factors. Actions such as screening for alcohol and advice on problems associated with the use of this substance, especially during the prenatal period, can contribute to effective reduction of alcohol use in pregnant women and related maternal and fetal injuries.

Padronização da avaliação endoscópica das fundoplicaturas e corrrelação com a sintomatologia / A standardization for endoscopic description of surgical fundoplication and correlations with symptomatology

Introdução: a endoscopia digestiva alta possui papel importante na avaliação dos pacientes submetidos à fundoplicatura, especialmente na elucidação de sintomas pós-operatórios. No entanto, é pouco padronizada e sua descrição apresenta baixa concordância entre os endoscopistas. Objetivos: padronizar a avaliação endoscópica das FPLs, identificar a frequência de anormalidades pós-operatórias e correlacionar os achados clínicos com os achados endoscópicos. Métodos: estudo prospectivo observacional, incluindo todos os pacientes submetidos à FPL, que realizaram endoscopia digestiva alta no Hospital Alemão Oswaldo Cruz no período de setembro entre 2014 e julho de 2015. Os pacientes foram submetidos a um questionário para coleta de dados e, a seguir, foi realizada classificação endoscópica das FPLs de acordo com os seguintes parâmetros: situação da TEG na visão frontal (sob zona de pressão, acima da zona de pressão ou deslizada); situação da FPL na retrovisão (intra-abdominal parcialmente ou totalmente migrada); conformação da FPL (total, parcial, desgarrada ou torcida) e hérnia paraesofágica (presente ou ausente). Resultados: foram avaliados 100 pacientes submetidos à FPL, 51% do sexo masculino, com idade média de 55,6 anos. Quarenta e três por cento (43%) referiam algum sintoma pós-operatório (regurgitação, azia, refluxo, tosse etc) e 46% apresentaram alguma anormalidade endoscópica da cirurgia. A TEG fora da zona de pressão da válvula e fundoplicatura migrada estiveram significativamente correlacionadas com a ocorrência de sintomas pós-operatórios (p < 0,001 em ambos os casos). Não houve correlação entre sintomatologia e a confirmação da fundoplicatura (se total, parcial ou desgarrada; p=0,19). Conclusão: a avaliação e a classificação endoscópica da fundoplicatura são reprodutíveis e parecem ser um bom preditor da ocorrência de sintomas. TEG acima da zona de pressão da válvula e fundoplicatura migrada estiveram correlacionadas com a recidiva dos sintomas.

Introduction: upper gastrointestinal endoscopy plays an important role in the evaluation of patients submitted to fundoplication, especially in the elucidation of postoperative symptoms. However, it is not well standardized and its description presents low agreement among the endoscopists. Objectives: to standardize endoscopic evaluation of FPLs, identify the frequency of postoperative abnormalities and correlate clinical findings with endoscopic findings. Methods: this was a prospective observational study, including all patients undergoing FPL, who underwent upper digestive endoscopy at the Alemão Oswaldo Cruz Hospital from September 2014 to July 2015. Patients were submitted to a questionnaire and then, Endoscopic classification of FPLs was performed according to the following parameters: TEG situation in frontal view (under pressure zone, above pressure zone or slipped fundoplication); FPL status in retrovision (intra-abdominal partially or totally migrated); Conformation of the FPL (total, partial, disrupted or twisted) and paraesophageal hernia (presentor absent). Results: we evaluated 100 patients submitted to FPL, 51% male, mean age of 55.6 years. Forty-three percent reported some postoperative symptoms (regurgitation, heartburn, reflux, cough, etc.) and 46% had some endoscopic surgery abnormality. TEG outside the pressure zone, and migrated fundoplication, were significantly correlated with the occurrence of postoperative symptoms (p <0.001 in both cases). There was no correlation between symptomatology and fundoplication conformation (if total, partial or twited, p= 0.19). Conclusion: the evaluation and endoscopic classification of fundoplication is reproductible and seems to be a good predictor of the occurrence of symptoms. TEG above the pressure zone and migrated fundoplication were correlated with relapse of the symptoms.

Avaliação da Dureza de Materiais Restauradores Diretos Submetidos a Diferentes Desafios Erosivos / Hardness Evaluation of Direct Restorative Materials Submitted to Different Erosive Challenges

Objetivo: Avaliar a dureza de materiais restauradores diretos submetidos a diferentes desafios erosivos in vitro. Material e método: Trata-se de um estudo experimental realizado com 12 amostras de cada material restaurador medindo 4 mm de diâmetro x 2 mm de espessura. As amostras de resinas (microparticulada e nanoparticulada) e dos cimentos de ionômero de vidro (convencional e modificado por resina) foram confeccionadas e a dureza de superfície foi determinada antes e após uma semana de desafio erosivo, sendo a troca dos meios realizada a cada 24 horas. A análise Estatística dos dados foi feita por ANOVA de 2 fatores. O Teste t pareado avaliou a comparação entre as durezas iniciais e finais. Os testes estatísticos foram realizados pelo Programa Minitab (versão 17) com o nível de significância fixado em 5%. Resultados e Conclusão: Os resultados mostram que cimento de ionômero de vidro convencional e resina nanoparticulada apresentaram maiores valores de perda de dureza. Quantos aos meios, a Coca-Cola ocasionou maior perda de dureza no Cimento de ionômero de vidro convencional e o Powerade provocou maior grau de erosão no Cimento de ionômero de vidro modificado por resina. Todos os materiais testados apresentaram redução na dureza da superfície como resultado do desafio erosivo em bebidas ácidas, sendo o cimento de ionômero de vidro convencional o material mais afetado.

Objective: To evaluate in vitro the hardness of restorative materials submitted to different erosion challenges. Material and method: This was an experimental study using 12 samples of each restorative material measuring 4 mm diameter x 2 mm thick. Resins samples (microparticulate and nanoparticulate) and glass ionomer cements (conventional and resin-modified) were prepared and the surface hardness was determined before and after a week of erosive challenge, with the media being changed at each 24 hours. The statistical analysis was performed by two-way-ANOVA. The paired t test evaluated the comparison between the initial and final hardness. Statistical tests were performed with Minitab Program (version 17) and the significance level was set at 5%. Results and Conclusion: Conventional glass ionomer cement and nanoparticulate resin had higher hardness loss values. Regarding the beverages, Coca-Cola caused higher hardness loss in the conventional glass ionomer cement and Powerade lead to a higher degree of erosion in the glass ionomer cement modified by resin. Conclusion: All materials tested showed reduction in surface hardness as a result of erosive challenge in acidic drinks. Conventional glass ionomer cement was the most affected material.

A reinvenção da deficiência: novas metáforas na natureza dos corpos / The reinvention of disability: new metaphors in the nature of bodies

O conceito de deficiência tem sido profundamente contestado nas últimas décadas, tanto política como epistemologicamente. Por um lado, está em causa o reconhecimento de que a filiação de determinadas diferenças sob a noção de deficiência constitui uma recente "invenção" da modernidade ocidental. Por outro, trata-se de pulsar as consequências dessa construção para as pessoas marcadas pelo estigma da deficiência. Estabelecendo um diálogo com importantes contribuições da teoria crítica, recrutando noções como "páticas de separação" (Michel Foucault), "materialização" (Judith Butler), "corpo múltiplo" (Annemarie Mol) e "sociologia das ausências" (Boaventura de Santos), o presente artigo procura entender como a noção de deficiência pode ser desmobilizada por leituras insurgentes das hierarquias da modernidade

The concept of disability has been profoundly challenged in the last decades, both politically and epistemologically. On the one hand, there is the recognition that affiliation of certain differences under the concept of disability is nothing but a recent "invention" of Western modernity. On the other hand, is the assumption of the consequences of that construction for the people labeled as disabled? We establish dialogue with important contributions of critical theory, addressing concepts as "dividing practices" (Michel Foucault), "materialization" (Judith Butler), "the body multiple " (Annemarie Mol) and "sociology of absences" (Boaventura de Sousa Santos), this article attempts understand how the notion of disability can be demobilized by insurgents readings of modernity and its hierarchies