Assessment of methionine plus cystine requirement of tambaqui (Colossoma macropomum) based on zootechnical performance, body composition, erythrogram, and plasmatic and hepatic metabolites.

Tambaqui (Colossoma macropomum) is a species of great cultural and economic importance in aquaculture in the Amazon region. Methionine is considered the first limiting sulfur amino acid in practical fish diets, which encourages investigating its use in diets for tambaqui. This study aimed to verify the digestible methionine plus cystine (Met + Cys) requirement in diets for tambaqui (89.52 ± 0.53 g) for 60 days. The treatments investigated were: 6.50, 7.80, 9.10, 10.40, 11.70, and 13.00 g Met + Cys kg diet-1. The estimated requirement based on final weight, weight gain, feed conversion ratio, and specific growth rate was 9.04, 8.92, 8.91, and 8.58 g Met + Cys kg diet-1, respectively, while on body protein deposition, body fat deposition, body ash deposition, and nitrogen retention efficiency was 9.29, 9.20, 9.19, and 8.72 g Met + Cys kg diet-1, respectively. Linear regression demonstrated that increased digestible Met + Cys in the diet decreased plasma total protein, globulin, and liver total protein levels. Quadratic regression showed that the highest value for liver glycogen was found with a 10.40 g Met + Cys kg diet-1. Another quadratic regression demonstrated a lower hepatic aspartate aminotransferase (AST) enzymatic activity in fish fed between 7.80 and 11.70 g Met + Cys kg diet-1. The different treatments did not influence the erythrogram. In conclusion, when considering an integrative view of the results for growth performance, whole-body deposition, and liver parameters without harming the physiological and metabolic status, we recommended choosing a diet with digestible Met + Cys between 8.58 and 9.29 g kg- 1 for tambaqui.

Are the EEG microstates correlated with motor and non-motor parameters in patients with Parkinson's disease?

OBJECTIVES: This study compared electroencephalography microstates (EEG-MS) of patients with Parkinson's disease (PD) to healthy controls and correlated EEG-MS with motor and non-motor aspects of PD. METHODS: This cross-sectional exploratory study was conducted with patients with PD (n = 10) and healthy controls (n = 10) matched by sex and age. We recorded EEG-MS using 32 channels during eyes-closed and eyes-open conditions and analyzed the four classic EEG-MS maps (A, B, C, D). Clinical information (e.g., disease duration, medications, levodopa equivalent daily dose), motor (Movement Disorder Society - Unified Parkinson Disease Rating Scale II and III, Timed Up and Go simple and dual-task, and Mini-Balance Evaluation Systems Test) and non-motor aspects (Mini-Mental State Exam [MMSE], verbal fluency, Hospital Anxiety and Depression Scale, and Parkinson's Disease Questionnaire-39 [PDQ-39]) were assessed in the PD group. Mann-Whitney U test was used to compare groups, and Spearman's correlation coefficient to analyze the correlations between coverage of EEG-MS and clinical aspects of PD. RESULTS: The PD group showed a shorter duration of EEG-MS C in the eyes-closed condition than the control group. We observed correlations (rho = 0.64 to 0.82) between EEG-MS B, C, and D and non-motor aspects of PD (MMSE, verbal fluency, PDQ-39, and levodopa equivalent daily dose). CONCLUSION: Alterations in EEG-MS and correlations between topographies and cognitive aspects, quality of life, and medication dose indicate that EEG could be used as a PD biomarker. Future studies should investigate these associations using a longitudinal design.

The Effects of Non-Invasive Brain Stimulation on Quantitative EEG in Patients With Parkinson's Disease: A Systematic Scoping Review.

Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized by motor and non-motor symptoms, aside from alterations in the electroencephalogram (EEG) already registered. Non-invasive brain stimulation (NIBS) techniques have been suggested as an alternative rehabilitative therapy, but the neurophysiological changes associated with these techniques are still unclear. We aimed to identify the nature and extent of research evidence on the effects of NIBS techniques in the cortical activity measured by EEG in patients with PD. A systematic scoping review was configured by gathering evidence on the following bases: PubMed (MEDLINE), PsycINFO, ScienceDirect, Web of Science, and cumulative index to nursing & allied health (CINAHL). We included clinical trials with patients with PD treated with NIBS and evaluated by EEG pre-intervention and post-intervention. We used the criteria of Downs and Black to evaluate the quality of the studies. Repetitive transcranial magnetic stimulation (TMS), transcranial electrical stimulation (tES), electrical vestibular stimulation, and binaural beats (BBs) are non-invasive stimulation techniques used to treat cognitive and motor impairment in PD. This systematic scoping review found that the current evidence suggests that NIBS could change quantitative EEG in patients with PD. However, considering that the quality of the studies varied from poor to excellent, the low number of studies, variability in NIBS intervention, and quantitative EEG measures, we are not yet able to use the EEG outcomes to predict the cognitive and motor treatment response after brain stimulation. Based on our findings, we recommend additional research efforts to validate EEG as a biomarker in non-invasive brain stimulation trials in PD.

BRAZILIAN SOCIETY OF HEPATOLOGY UPDATED RECOMMENDATIONS FOR DIAGNOSIS AND TREATMENT OF HEPATOCELLULAR CARCINOMA.

Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related mortality worldwide. The Brazilian Society of Hepatology (SBH) published in 2015 its first recommendations about the management of HCC. Since then, new data have emerged in the literature, prompting the governing board of SBH to sponsor a single-topic meeting in August 2018 in São Paulo. All the invited experts were asked to make a systematic review of the literature reviewing the management of HCC in subjects with cirrhosis. After the meeting, all panelists gathered together for the discussion of the topics and the elaboration of updated recommendations. The text was subsequently submitted for suggestions and approval of all members of the Brazilian Society of Hepatology through its homepage. The present manuscript is the final version of the reviewed manuscript containing the recommendations of SBH.

Atualização das recomendações da Sociedade Brasileira de Hepatologia para o diagnóstico e tratamento do carcinoma hepatocellular / Brazilian society of hepatology updated recommendations for diagnosis and treatment of hepatocellular carcinoma

ABSTRACT Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related mortality worldwide. The Brazilian Society of Hepatology (SBH) published in 2015 its first recommendations about the management of HCC. Since then, new data have emerged in the literature, prompting the governing board of SBH to sponsor a single-topic meeting in August 2018 in São Paulo. All the invited experts were asked to make a systematic review of the literature reviewing the management of HCC in subjects with cirrhosis. After the meeting, all panelists gathered together for the discussion of the topics and the elaboration of updated recommendations. The text was subsequently submitted for suggestions and approval of all members of the Brazilian Society of Hepatology through its homepage. The present manuscript is the final version of the reviewed manuscript containing the recommendations of SBH.

RESUMO O carcinoma hepatocelular (CHC) é uma das principais causas de mortalidade relacionada a câncer no Brasil e no mundo. A Sociedade Brasileira de Hepatologia (SBH) publicou em 2015 suas primeiras recomendações sobre a abordagem do CHC. Desde então, novas evidências sobre o diagnóstico e tratamento do CHC foram relatadas na literatura médica, levando a diretoria da SBH a promover uma reunião monotemática sobre câncer primário de fígado em agosto de 2018 com o intuito de atualizar as recomendações sobre o manejo da neoplasia. Um grupo de experts foi convidado para realizar uma revisão sistemática da literatura e apresentar uma atualização baseada em evidências científicas visando que pudesse nortear a prática clínica multidisciplinar do CHC. O texto resultante foi submetido a avaliação e aprovação de todos membros da SBH através de sua homepage. O documento atual é a versão final que contêm as recomendações atualizadas e revisadas da SBH.

Cuidados paliativos ao paciente com esclerose lateral amiotrófica: vivência de fisioterapeutas no âmbito hospitalar / Palliative care to patients with amyotrophic lateral sclerosis: experiences of physiotherapists in a hospital setting / Cuidados paliativos al paciente con esclerosis lateral amiotrófica: vivencia de fisioterapeutas en el ámbito hospitalario

Objetivo: Investigar a vivência de fisioterapeutas na atenção a pacientes com esclerose lateral amiotrófica (ELA) sob cuidados paliativos no âmbito hospitalar. Métodos: Estudo descritivo, exploratório, com abordagem qualitativa, realizado com fisioterapeutas das enfermarias clínica médica e cirúrgica de um hospital público do município de João Pessoa-Paraíba-Brasil, mediante entrevista semiestruturada e material empírico submetido à técnica de análise de conteúdo. Resultados: Foram entrevistados oito fisioterapeutas e, da análise dos dados, emergiram quatro categorias temáticas: I- Compreensão dos cuidados paliativos; II- Estratégias dos fisioterapeutas na promoção dos cuidados paliativos a esses pacientes; III- Interação dos fisioterapeutas com a equipe multiprofissional promovendo os cuidados paliativos na ELA; IV- Vivência dos fisioterapeutas ao assistir esses pacientes. Conclusão: Os fisioterapeutas discorreram seus argumentos com base em sua vivência profissional, destacando-se a necessidade de maiores discussões e aprofundamentos sobre a temática entre esses profissionais para articular a teoria e a prática

Objective: The study's main purpose has been to investigate the experiences of physiotherapists caring for patients with Amyotrophic Lateral Sclerosis (ALS) undergoing palliative care in a hospital setting. Methods: It is a descriptive-exploratory study with a qualitative approach, which was performed with physiotherapy professionals from the internal medicine and surgical wards of a public hospital in João Pessoa city, Paraíba State, Brazil, using a semi-structured interview and empirical material subjected to the content analysis technique. Results: After interviewing eight physiotherapists and based on data analysis, the following four thematic categories were elaborated: I- Physical therapists' understanding in regard to palliative care; II- Strategies used by physical therapists to promote palliative care for ALS patients; III- Interaction of physical therapists with the patient care team promoting palliative care for ALS patients; IV- Experience of physical therapists when assisting the patient with ALS undergoing PC. Conclusion: The physiotherapists based their arguments on their professional experience, underlining the need for further discussions and a better understanding of the subject amongst these professionals aiming to align theory with practice

Objetivo: Investigar la vivencia de fisioterapeutas en atención a los pacientes con esclerosis lateral amiotrófica (ELA) en cuidados paliativos en ámbito hospitalario. Métodos: Estudio descriptivo, exploratorio, con abordaje cualitativo, realizado con fisioterapeutas de las enfermerías clínica médica y quirúrgica de un hospital público de la ciudad de João Pessoa-Paraíba-Brasil, por medio de entrevista semiestructurada y material empírico sometido a la técnica de análisis de contenido. Resultados: Fueron entrevistados ocho fisioterapeutas y, del análisis de los datos, emergieron cuatro categorías temáticas: I- Comprensión de cuidados paliativos; II- Estrategias de fisioterapeutas en la promoción de cuidados paliativos para eses pacientes; IIIInteracción de los fisioterapeutas con el equipo multiprofesional promoviendo los cuidados paliativos en ELA; IV- Vivencia de los fisioterapeutas al asistir eses pacientes. Conclusión: los fisioterapeutas hablaron sus argumentos con base en su vivencia profesional, se destacando la necesidad de mayores discusiones y profundizaciones sobre la temática entre eses profesionales para articular teoría y práctica

Experience with Sorafenib in 3 Hospitals in Sao Paulo.

INTRODUCTION AND AIM: Sorafenib has been the standard of care for first-line treatment of advanced hepatocellular carcinoma, a complex disease that affects an extremely heterogenous population. Thereby requiring multidisciplinary individualized treatment strategies that match the disease characteristics and the patients' specific needs. MATERIAL AND METHODS: Data for 175 patients who received sorafenib for hepatocellular carcinoma in three different hospitals in Sao Paulo, Brazil over a span of nine years were retrospectively analyzed. RESULTS: The median age was 62 years. Percentages of patients with Child-Pugh A, B and C liver cirrhosis were 61%, 31% and 5%, respectively. Approximately half of the patients had Barcelona Clinic Liver Cancer stage B disease, and the other half had stage C. The median treatment duration was 253 days. Sorafenib dose was reduced to 400 mg/day in 41% of the patients due to toxicity. Overall objective response rate as per Response Evaluation Criteria in Solid Tumors and its modified version was 39%. Patients who received transarterial chemoembolization (TACE) at any point during sorafenib therapy were significantly more likely to experience an objective response. After a median follow-up of 339 days, the median overall survival was 380 days. Child-Pugh cirrhosis, tumor response and concomitant chemoembolization were independent prognostic factors for overall survival in multivariate analysis. CONCLUSION: Our results suggest that, in experienced hands, sorafenib therapy may benefit carefully selected hepatocellular carcinoma patients for whom other therapies are initially contraindicated, including those patients with Child-Pugh B liver function and those patients who are subsequently treated with concomitant TACE.

EVALUATION OF EFFICACY AND EFFECTIVENESS OF PRENATAL NUTRITIONAL CARE ON PERINATAL OUTCOME OF PREGNANT WOMEN; RIO DE JANEIRO, BRAZIL.

AIM: to evaluate the impact of a prenatal nutritional assistance proposal (PNA) for adult pregnant women. METHODS: a study of the impact of an applied nutritional intervention throughout the prenatal on perinatal outcomes - adequacy of total gestational weight gain, gestational anemia frequency and pregnancy complications in a public maternity hospital in Rio de Janeiro. The data represent three groups of adult pregnant women, during 10 years: GI (1999-2001, n = 225), GII (2005-2006, n = 208) and GIII (2007-2008, n = 394). RESULTS: in GII (reference group) it was included a detailed nutritional assessment, an individualized eating plan and an attendance of at least four scheduled appointments with a nutritionist. PNA coverage occurred in only 20.4% of GI, 100% of GII and 42.1% in GIII (p < 0.001). Women in GI had a higher proportion of inadequate total weight gain (OR 1.82, 95% CI: 1.20 -2.75), anemia (OR 2.18, 95% CI: 1.35 - 3.55) and pregnancy complications (OR 1.57, 95% CI: 1.04 - 2.36), as well as those who joined GIII, - OR 1.68 (95% CI: 1.16 - 2.44), OR 2.45 (95% CI: 1.56 - 3.84), OR 2.07 (95% CI: 1.42 - 3.00) - when compared to women in GII. CONCLUSIONS: the model tested in GII PNA demonstrated to be effective in the outcomes studied.

Objetivo: evaluar el impacto de una propuesta de asistencia nutricional prenatal (ANP) para las mujeres embarazadas adultas. Métodos: estudio del impacto de una intervención nutricional prenatal en los resultados perinatales, adecuación de la ganancia total de peso durante la gestación, frecuencia de anemia gestacional y complicaciones en el embarazo en una maternidad pública de Río de Janeiro. Los datos representan tres grupos de mujeres embarazadas adultas, durante 10 años: GI (1999-2001, n = 225), GII (2005-2006, n = 208) y GIII (2007-2008, n = 394). Resultados: en el GII (grupo de referencia) se incluyó una evaluación nutricional detallada, un plan de alimentación individualizado y una asistencia de por lo menos cuatro citas programadas con un nutricionista. La cobertura PNA se produjo en solo el 20,4% en el GI, el 100% en el GII y el 42,1% en el GIII (p < 0,001). Las mujeres del GI tenían una mayor proporción de ganancia total de peso insuficiente (OR 1,82; IC 95%: 1,20 -2,75), anemia (OR 2,18; IC 95%: 1,35-3,55) y complicaciones del embarazo (OR 1.57, IC 95%: 1,04 - 2,36), así como aquellas que se unieron al GIII, - OR 1,68 (IC 95%: 1.16 - 2.44), OR 2,45 (IC 95%: 1,56-3,84), OR 2,07 (IC 95%:1,42- 3,00), en comparación con las mujeres del GII. Conclusiones: el modelo probado en el GII PNA demostró ser eficaz según los resultados estudiados.

Evaluation of efficacy and effectiveness of prenatal nutritional care on perinatal outcome of pregnant women; Rio de Janeiro, Brazil / Evaluación de la eficacia y efectividad de la atención nutricional prenatal sobre el resultado perinatal de las mujeres embarazadas; Río De Janeiro, Brasil

Aim: to evaluate the impact of a prenatal nutritional assistance proposal (PNA) for adult pregnant women. Methods: a study of the impact of an applied nutritional intervention throughout the prenatal on perinatal outcomes - adequacy of total gestational weight gain, gestational anemia frequency and pregnancy complications in a public maternity hospital in Rio de Janeiro. The data represent three groups of adult pregnant women, during 10 years: GI (1999-2001, n = 225), GII (2005-2006, n = 208) and GIII (2007-2008, n = 394). Results: in GII (reference group) it was included a detailed nutritional assessment, an individualized eating plan and an attendance of at least four scheduled appointments with a nutritionist. PNA coverage occurred in only 20.4% of GI, 100% of GII and 42.1% in GIII (p <0.001). Women in GI had a higher proportion of inadequate total weight gain (OR 1.82, 95% CI: 1.20 -2.75), anemia (OR 2.18, 95% CI: 1.35 - 3.55) and pregnancy complications (OR 1.57, 95% CI: 1.04 - 2.36), as well as those who joined GIII, - OR 1.68 (95% CI: 1.16 - 2.44), OR 2.45 (95% CI: 1.56 - 3.84), OR 2.07 (95% CI: 1.42 - 3.00) - when compared to women in GII. Conclusions: the model tested in GII PNA demonstrated to be effective in the outcomes studied (AU)

Objetivo: evaluar el impacto de una propuesta de asistencia nutricional prenatal (ANP) para las mujeres embarazadas adultas. Métodos: estudio del impacto de una intervención nutricional prenatal en los resultados perinatales, adecuación de la ganancia total de peso durante la gestación, frecuencia de anemia gestacional y complicaciones en el embarazo en una maternidad pública de Río de Janeiro. Los datos representan tres grupos de mujeres embarazadas adultas, durante 10 años: GI (1999-2001, n = 225), GII (2005-2006, n = 208) y GIII (2007-2008, n = 394). Resultados: en el GII (grupo de referencia) se incluyó una evaluación nutricional detallada, un plan de alimentación individualizado y una asistencia de por lo menos cuatro citas programadas con un nutricionista. La cobertura PNA se produjo en solo el 20,4% en el GI, el 100% en el GII y el 42,1% en el GIII (p <0,001). Las mujeres del GI tenían una mayor proporción de ganancia total de peso insuficiente (OR 1,82; IC 95%: 1,20 -2,75), anemia (OR 2,18; IC 95%: 1,35-3,55) y complicaciones del embarazo (OR 1.57, IC 95%: 1,04 - 2,36), así como aquellas que se unieron al GIII, - OR 1,68 (IC 95%: 1.16 - 2.44), OR 2,45 (IC 95%: 1,56-3,84), OR 2,07 (IC 95%:1,42- 3,00), en comparación con las mujeres del GII. Conclusiones: el modelo probado en el GII PNA demostró ser eficaz según los resultados estudiados (AU)