Unresectable metastatic colorectal cancer in fit patients - a practical algorithm of treatment sequencing from the Brazilian Group of Gastrointestinal Tumours (GTG).

Recent advances in biomarker-driven therapies have changed the landscape of unresectable metastatic colorectal cancer (mCRC) and brought not only access issues but also difficulties for the treating physician (especially generalist oncologists) in choosing the most suitable treatment for each individual patient. This manuscript proposes an algorithm developed by The Brazilian Group of Gastrointestinal Tumours with the aim of bringing easy-to-follow steps in the management of unresectable mCRC. The algorithm is based on evidence for fit patients to facilitate therapeutic decisions in the clinical practice and assumes that there are no access and resource limitations.

Metastatic pheochromocytoma and paraganglioma: a retrospective multicentre analysis on prognostic and predictive factors to chemotherapy.

Background: Prognostic and predictive markers in metastatic pheochromocytoma and paraganglioma (mPPGL) are unknown. We aimed to evaluate epidemiology of mPPGL, and prognostic factors of overall survival (OS) and predictive markers of treatment duration with first-line chemotherapy (TD1L). Patients and methods: Retrospective multicentre study of adult patients with mPPGL treated in Latin American centres between 1982 and 2021. Results: Fifty-eight patients were included: 53.4% were female, median age at diagnosis of mPPGL was 36 years and 12.1% had a family history of PPGL. The primary site was adrenal, non-adrenal infradiaphragmatic and supradiaphragmatic in 37.9%, 34.5% and 27.6%, respectively. 65.5% had a functioning tumour and 62.1% had metachronous metastases. Positive uptakes were found in 32 (55.2%) 68Gallium positron emission tomography (PET/CT), 27 (46.6%) 2-deoxy-2-[fluorine-18]fluoro-D-glucose PET/CT and 37 (63.8%) of 131Iodine-metaiodobenzylguanidine (MIBG) tests. Twenty-three (40%) patients received first-line chemotherapy, with cyclophosphamide, vincristine and dacarbazine used in 12 (52%) of patients. At a median follow-up of 62.8 months, median TD1L was 12.8 months. Either functional exams, tumour functionality, pathological characteristics or primary tumour location were significantly associated with response or survival. Yet, negative MIBG, Ki67 ≥ 10%, infradiaphragmatic location and functional tumours were associated with numerically inferior OS. Conclusions: In patients with mPPGL, prognostic and predictive factors to chemotherapy are still unknown, but negative MIBG uptake, Ki67 ≥ 10%, infradiaphragmatic location and functional tumours were numerically linked to worse OS. Our results should be further validated in larger and independent cohorts.

Síndrome de Takotsubo como complicação de ablação septal por cateteres de radiofrequência: primeiro relato de caso / Takotsubo syndrome as a complication of septal ablation with radiofrequency catheters: first case report

Síndrome de takotsubo é uma disfunção miocárdica causada por diversos fatores, como estresse emocional, infecção por COVID, cirurgias e como descrito mais recentemente, ablação de fibrilação atrial. A ablação septal por radiofrequência é uma alternativa a miectomia cirúrgica e ablação por etanol. Em nossa instituição o uso de ablação por cateteres de radiofrequência é utilizado como primeira linha de tratamento para obstruções graves sintomáticas refratarias ao tratamento clinico. As complicações da ablação por radiofrequência incluem embolia, tamponamento pericárdico e aumento paradoxal do gradiente levando a obstrução aguda de via de saída de ventrículo esquerdo. RELATO DO CASO: mulher, 64 anos, portadora de cardiomiopatia hipertrófica obstrutiva com gradiente medioventricular de 78mmHg. Foi submetida a ablação por cateter de radiofrequência guiada por ecocardiografia conforme protocolo institucional (cateter terapêutico com ponta de 8mm até redução de gradiente >25% ou hiperrefringencia característica na região de aceleração do gradiente) com redução aguda do gradiente intraoperatório de 65 para 30mmhg. O termino do procedimento as 17:30, paciente transferida para UTI onde, as 20h apresentou pico hipertensivo durante tentativa de extubação, hematoma no sitio de punção seguida por hipotensão arterial. Realizado ecocardiografia a beira leito as 22h, demonstrando acinesia em região media e apical de VE não observadas na ecocardiografia realizada quatro horas antes. A paciente permaneceu entubada com medidas de suporte (noradrenalina e posteriormente vasopressina por 48h), com melhora progressiva da função ventricular até normalização da função ventricular ao final do terceiro dia. Pelo período prolongado de intubação a paciente desenvolveu pneumonia associada a Ventilação mecânica, evoluindo no 10 dia para óbito por possível obstrução de vias aéreas, associada a choque séptico. CONCLUSÃO: este é o primeiro relato de caso de síndrome de takotsubo como complicação de ablação septal por radiofrequência. Com o aumento das indicações do procedimento é necessário reconhecimento deste potencial complicação pela equipe de terapia intensiva.

Resolution of atrial fibrillation after radiofrequency septal ablation: case report

Atrial fibrillation is a multifactorial disease. The incidence of atrial fibrillation in cardiomyopathy is underestimated, and clinical and interventional treatment is faced with expectations of high recurrence rates. According to the new treatment guidelines for atrial fibrillation, the control of comorbidities must go hand in hand with symptom control and prevention of embolic events. Although surgical treatment of septal reduction (myectomy)has not reduced the incidence of atrial fibrillation, we do not yet know how new gradient reduction approaches may impact AF burden. Here, we have the first case report of atrial remodeling following radiofrequency septal ablation, reducing the burden of atrial fibrillation. CASE REPORT: Woman, 64 years old, with hypertrophic obstructive cardiomyopathy and paroxysmal atrial fibrillation, three symptomatic crises in the last year using amiodarone 400 mg per day and metoprolol 100 mg. Ejection Fraction 70%m septum 18 mm, LA 42mm, gradient 77 mmHg and presence of systolic anterior movement (SAM) with moderate mitral reflux. Ablation of the interventricular septum via transseptal and retro aortic routes was performed according to the protocol with gradient reduction and septal hyperrefringence. During the manipulation of the catheter in the left atrium, a new moderate pericardial effusion was observed, and it was decided not to perform concomitant pulmonary vein isolation (initial planning). Pericardial drainage and heparinization reversal were performed, with discharge from the ICU in 3 days. There was an improvement in symptoms over the first three months­and a progressive reduction of mitral insufficiency and SAM. Amiodarone was withdrawn after the third month, and there were no new arrhythmic events one year after septum ablation. At the end of one year, the echocardiogram showed no evidence of SAM or ventricular gradient, ejection fraction of 58%, septum of 12 mm and LA 36 mm. Thus, radiofrequency septal ablation allowed atrial remodeling and reduced AF burden. The long-term effects of this therapy can be beneficial when there is no symptom control with usual strategies.

Sex Differences in Aggression Are Paralleled by Differential Activation of the Brain Social Decision-Making Network in Zebrafish.

Although aggression is more prevalent in males, females also express aggressive behaviors and in specific ecological contexts females can be more aggressive than males. The aim of this work is to assess sex differences in aggression and to characterize the patterns of neuronal activation of the social-decision making network (SDMN) in response to intra-sexual aggression in both male and female zebrafish. Adult fish were exposed to social interaction with a same-sex opponent and all behavioral displays, latency, and time of resolution were quantified. After conflict resolution, brains were sampled and sex differences on functional connectivity throughout the SDMN were assessed by immunofluorescence of the neuronal activation marker pS6. Results suggest that both sexes share a similar level of motivation for aggression, but female encounters show shorter conflict resolution and a preferential use of antiparallel displays instead of overt aggression, showing a reduction of putative maladaptive effects. Although there are no sex differences in the neuronal activation in any individual brain area from the SDMN, agonistic interactions increased neuronal activity in most brain areas in both sexes. Functional connectivity was assessed using bootstrapped adjacency matrices that capture the co-activation of the SDMN nodes. Male winners increased the overall excitation and showed no changes in inhibition across the SDMN, whereas female winners and both male and female losers showed a decrease in both excitation and inhibition of the SDMN in comparison to non-interacting control fish. Moreover, network centrality analysis revealed both shared hubs, as well as sex-specific hubs, between the sexes for each social condition in the SDMN. In summary, a distinct neural activation pattern associated with social experience during fights was found for each sex, suggesting a sex-specific differential activation of the social brain as a consequence of social experience. Overall, our study adds insights into sex differences in agonistic behavior and on the neuronal architecture of intrasexual aggression in zebrafish.

The effects of a short-term meditation-based mindfulness protocol in patients receiving hemodialysis.

Mindfulness-based approaches that promote health, improve quality of life, and reduce the impact of comorbidities are key aspects in chronic diseases management. We aimed to verify the impact of a short-term meditation protocol on psychosocial and physiological parameters in chronic hemodialysis patients. We enrolled twenty-two patients, median age of 69.5 years old, into a 12-week meditation protocol that occurred during each hemodialysis session for 10-20 minutes, 3x/week, in a private tertiary hospital. We then evaluated clinical, psychological, and laboratorial parameters pre- and post-meditation. Patients exhibited a better control of serum phosphorus (-0.72 mg/dL; P = 0.002), a decrease in systolic blood pressure (-1.90 mmHg; P = 0.009), a 23% decrease in depressive symptoms (P = 0.014), and an increase of 7% in the self-compassion scale (P = 0.048) after meditation. To note, we observed an increase in 13% of the mindfulness score (P = 0.019). Our preliminary study describes the effects of a short-term meditation protocol in chronic hemodialysis setting. We observed a decrease in depressive symptoms and in blood pressure values, an improvement in self-compassion and serum phosphorous levels. In conjunction with the promising results of meditation in chronic kidney disease setting, this encouraging preliminary study supports the need for additional clinical trials.

Brazilian Group of Gastrointestinal Tumours' consensus guidelines for the management of oesophageal cancer.

Oesophageal cancer is among the ten most common types of cancer worldwide. More than 80% of the cases and deaths related to the disease occur in developing countries. Local socio-economic, epidemiologic and healthcare particularities led us to create a Brazilian guideline for the management of oesophageal and oesophagogastric junction (OGJ) carcinomas. The Brazilian Group of Gastrointestinal Tumours invited 50 physicians with different backgrounds, including radiology, pathology, endoscopy, nuclear medicine, genetics, oncological surgery, radiotherapy and clinical oncology, to collaborate. This document was prepared based on an extensive review of topics related to heredity, diagnosis, staging, pathology, endoscopy, surgery, radiation, systemic therapy (including checkpoint inhibitors) and follow-up, which was followed by presentation, discussion and voting by the panel members. It provides updated evidence-based recommendations to guide clinical management of oesophageal and OGJ carcinomas in several scenarios and clinical settings.

Nanocomposite Polymer Electrolytes of Sodium Alginate and Montmorillonite Clay.

Nanocomposite polymer electrolytes (NPEs) were synthesized using sodium alginate (Alg) and either sodium (SCa-3-Na+)- or lithium (SCa-3-Li+)-modified montmorillonite clays. The samples were characterized by structural, optical, and electrical properties. SCa-3-Na+ and SCa-3-Li+ clays' X-ray structural analyses revealed peaks at 2θ = 7.2° and 6.7° that corresponded to the interlamellar distances of 12.3 and 12.8 Å, respectively. Alg-based NPEs X-ray diffractograms showed exfoliated structures for samples with low clay percentages. The increase of clay content promoted the formation of intercalated structures. Electrochemical Impedance Spectroscopy revealed that Alg-based NPEs with 5 wt% of SCa-3-Na+ clay presented the highest conductivity of 1.96 × 10-2 S/cm2, and Alg with 10 wt% of SCa-3-Li+ showed conductivity of 1.30 × 10-2 S/cm2, both measured at 70 °C. From UV-Vis spectroscopy, it was possible to infer that increasing concentration of clay promoted a decrease of the samples' transmittance and, consequently, an increase of their reflectance.

Opportunistic and Serious Infections in Patients with Neuroendocrine Tumors Treated with Everolimus: A Multicenter Study of Real-World Patients.

INTRODUCTION: The incidence of infections is poorly studied in patients with neuroendocrine tumors (NET) treated with everolimus outside of clinical trials. We aimed to evaluate the frequency of and risk factors for opportunistic infections (Opl) or any serious infection in eligible patients. METHODS: This was a retrospective multicenter study of a Latin American cohort of consecutive patients with advanced NET treated with everolimus. Duration of everolimus, comorbidities, Charlson comorbidity score, type of prior treatment, institution, and concurrent immunosuppressive conditions were tested for possible associations with serious (grade 3-5) infections in univariate and multivariable logistic regression models. RESULTS: One hundred eleven patients from 5 centers were included. The median duration of everolimus was 8.9 months. After a median follow-up of 32.9 months, 34 patients (30.6%; 95% CI 22.2-40.1) experienced infections of any grade, with 24 (21.6%; 95% CI 14.8-30.4) having a serious infection and 7 (6.3%; 95% CI 2.6-12.6) having at least 1 OpI (Candida sp., Toxoplasma gondi, Pneumocystis sp., Herpes sp., and Cryptococcus sp.). Four patients (3.6%) died from infections, but only 2 deaths (1.8%) were deemed to be related to everolimus. The multivariable analysis identified everolimus duration (every 6-month increase; OR = 1.28; 95% CI 1.02-1.60; p = 0.03) as an independent risk factor for serious infection. CONCLUSION: Infections are more frequent in NET patients using everolimus than previously reported in clinical trials. Patients on everolimus should be closely monitored for infections, especially those receiving it for several months.

Health resource utilisation by patients with neuroendocrine tumours with or without carcinoid heart disease: a multinational study.

BACKGROUND: Carcinoid heart disease (CHD) is a rare and severe complication from carcinoid syndrome which may be associated with high health resource utilisation (HRU). We aimed to compare HRU between patients with and without CHD. METHODS: Multicentre retrospective study of 137 consecutive patients with neuroendocrine tumours (NET) and elevated urinary 5-hydroxyindoleacetic acid treated in seven large hospitals in Latin America. We used the chi-squared test for binary variables and the Mann-Whitney test for quantitative correlations. Variables were entered into a multivariable linear regression model for higher HRU. RESULTS: One-third of the patients had (45) had CHD. Patients with CHD had significantly more emergency visits and echocardiograms as compared to patients without CHD. In the bivariate models, CHD (R2 = 0.61, p = 0.01), private health system (R 2 = 0.63, p = 0.02) and simultaneous cardiovascular comorbidities (R 2 = 0.61, p = 0.04) were associated with a higher HRU. The multivariate model pointed out the accumulated effect of variables on HRU (R 2 = 0.2, p < 0.01). CONCLUSIONS: NET patients with CHD present higher HRU independently of other clinical factors or health system. Effectively treating carcinoid syndrome, and likely delaying the onset of CHD, may potentially reduce the amount of HRU by these patients.

Brazilian Group of Gastrointestinal Tumours' consensus guidelines for the management of gastric cancer.

Gastric cancer is among the ten most common types of cancer worldwide. Most cases and deaths related to the disease occur in developing countries. Local socio-economic, epidemiologic and healthcare particularities led us to create a Brazilian guideline for the management of gastric carcinomas. The Brazilian Group of Gastrointestinal Tumors (GTG) invited 50 physicians with different backgrounds, including radiology, pathology, endoscopy, nuclear medicine, genetics, oncological surgery, radiotherapy and clinical oncology, to collaborate. This document was prepared based on an extensive review of topics related to heredity, diagnosis, staging, pathology, endoscopy, surgery, radiation, systemic therapy and follow-up, which was followed by presentation, discussion, and voting by the panel members. It provides updated evidence-based recommendations to guide clinical management of gastric carcinomas in several scenarios and clinical settings.

Evidence-based recommendations for gastrointestinal cancers during the COVID-19 pandemic by the Brazilian Gastrointestinal Tumours Group.

PURPOSE: As of 2020, the world is facing the great challenge of the COVID-19 (Coronavirus disease 2019) pandemic, caused by the SARS-CoV-2 virus. While the overall mortality is low, the virus is highly virulent and may infect millions of people worldwide. This will consequently burden health systems, particularly by those individuals considered to be at high risk of severe complications from COVID-19. Such risk factors include advanced age, cardiovascular and pulmonary diseases, diabetes and cancer. However, few data on the outcomes of cancer patients infected by SARS CoV-2 exist. Therefore, there is a lack of guidance on how to manage cancer patients during the pandemic. We sought to propose specific recommendations about the management of patients with gastrointestinal malignancies. METHODS: The Brazilian Gastrointestinal Tumours Group board of directors and members sought up-to-date scientific literature on each tumour type and discussed all recommendations by virtual meetings to provide evidence-based-and sometimes, expert opinion-recommendation statements. Our objectives were to recommend evidence-based approaches to both treat and minimise the risk of COVID-19 for cancer patients, and simultaneously propose how to decrease the use of hospital resources at a time these resources need to be available to treat COVID-19 patients. RESULTS: Overall and tumour-specific recommendations were made by stage (including surgical, locoregional, radiotherapy, systemic treatments and follow-up strategies) for the most common gastrointestinal malignancies: esophagus, gastric, pancreas, bile duct, hepatocellular, colorectal, anal cancer and neuroendocrine tumours. CONCLUSIONS: Our recommendations emphasise the importance of treating cancer patients, using the best evidence available, while simultaneously taking into consideration the world-wide health resource hyperutilisation to treat non-cancer COVID-19 patients.

Cognition and brain function in elderly Tai Chi practitioners: A case-control study.

OBJECTIVE: To compare cognition and brain function in elderly Tai Chi and Water Aerobics practitioners. METHODS: Eight Tai Chi (TC) and 8 Water Aerobics (WA) practitioners matched by gender, education and age underwent neuropsychological and fMRI scan during attention (Stroop Word Color Task) and working memory (N Back) tasks. RESULTS: Groups were similar for demographic and cognitive variables. Besides anxiety (smaller in TC group), there were no differences between groups in neuropsychological variables. During the Stroop Word Color Task, TC group had smaller brain activation in the right intracalcarine cortex, lateral occipital cortex, and occipital pole, than WA. During N back, TC group presented smaller brain activation in the right frontal pole and superior frontal gyrus. CONCLUSION: Despite the small number of participants in this preliminary study, both groups had similar cognitive performance, however the Tai Chi group required less brain activation to perform the attention and memory tasks, therefore they may have a more efficient cognitive performance than Water Aerobics group.

Mixture and Exponential Arcs on Generalized Statistical Manifold.

In this paper, we investigate the mixture arc on generalized statistical manifolds. We ensure that the generalization of the mixture arc is well defined and we are able to provide a generalization of the open exponential arc and its properties. We consider the model of a φ -family of distributions to describe our general statistical model.

Greater Cortical Thickness in Elderly Female Yoga Practitioners-A Cross-Sectional Study.

Yoga, a mind-body activity that requires attentional engagement, has been associated with positive changes in brain structure and function, especially in areas related to awareness, attention, executive functions and memory. Normal aging, on the other hand, has also been associated with structural and functional brain changes, but these generally involve decreased cognitive functions. The aim of this cross-sectional study was to compare brain cortical thickness (CT) in elderly yoga practitioners and a group of age-matched healthy non-practitioners. We tested 21 older women who had practiced hatha yoga for at least 8 years and 21 women naive to yoga, meditation or any mind-body interventions who were matched to the first group in age, years of formal education and physical activity level. A T1-weighted MPRAGE sequence was acquired for each participant. Yoga practitioners showed significantly greater CT in a left prefrontal lobe cluster, which included portions of the lateral middle frontal gyrus, anterior superior frontal gyrus and dorsal superior frontal gyrus. We found greater CT in the left prefrontal cortex of healthy elderly women who trained yoga for a minimum of 8 years compared with women in the control group.

Effect of Erosion/Abrasion Challenge on the Dentin Tubule Occlusion Using Different Desensitizing Agents.

The aim of the study was to evaluate dentinal tubule occlusion, measuring the dentin permeability (Lp) and using different desensitizing agents before and after abrasive/erosive challenge. Dentin discs from 42 healthy human third molars were obtained. Minimum Lp was measured after a smear layer simulation using #600 SiC paper and maximum Lp after an immersion in 0.5 M EDTA. The specimens were treated with different desensitizers: two varnishes (Clinpro XT Varnish-CV, Fluor Protector-FP), a paste (Desensibilize Nano P-NP) and a gel (Oxa Gel-OG). The Lp of each specimen was measured immediately after the desensitizers' application. The discs were subjected to erosion/abrasion cycles for 7 days, with 0.5% citric acid solution (6x/day) and tooth brushing (3x/day). Lp was measured after the first, fourth and seventh day of the challenge. The data were analyzed by 3-way ANOVA with repeated measurements and by a Games-Howell test (α=5%). FP and CV did not show significant differences in Lp immediately after application until the 7th day (p<0.05). OG showed a significant increase in Lp after the 4th and 7th days. NP resulted in a significantly higher permeability compared to the other materials immediately after the application and after the 1st day of challenge. All the desensitizers reduced the dentin permeability immediately after application. However, only the varnishes were able to maintain the occlusive effect after the erosion/abrasion challenge.

Performance of Dental Students in Shade Matching: Impact of Training.

OBJECTIVE: The present study evaluated the effect of training on dental students' ability for matching two different shade guides. MATERIALS AND METHODS: The study was conducted in 2012. The participants were 88 male and female undergraduate dental students from Brazil and Portugal, with or without previous color education and vision refractive errors (response rate of 73.33%). They were asked to match a pair set of the shade guides Vita Classical (VC) and Vitapan 3D Master (3DM), with a 20-minutes' rest between each match. The sets were assembled over a neutral gray background and under controlled light. About 7-10 days later, all participants watched a video lecture on color education and repeated the matching procedure. The percentage of matches was calculated and submitted to statistical analysis for the variables gender, geographic region, shade guide and previous color education (Mann-Whitney tests), vision refractive errors (Kruskal-Wallis), and training (Wilcoxon signed rank). All tests were performed at a confidence level of 95%. RESULTS: Training increased the percentage of matches for all groups, except for Portuguese and hyperopic individuals (VC and 3DM) and men (3DM). Previous color education affected VC shade matching before training. Gender, refractive errors, and geographic region did not affect shade matching ability. CONCLUSIONS: Previous education and training in color positively affected shade-matching ability of dental students on shade guide pairing tests. CLINICAL SIGNIFICANCE: The subjectivity of the visual method might not be a clinical concern in daily practice. The human eye can detect small differences in color and visualize the tooth with all its complex geometry, multilayered tissues, and secondary color parameters. Therefore, any color-matching task will be judged by the patient and/or other observers with consideration to this complexity. In other words, visual assessment is paramount to the success/failure of esthetic restorative procedures. The efficiency of the visual color method may be improved by color education through the development of professional color discrimination ability. This would make the students responsible for color selection, reproduction, and evaluation and lead to increased capability over a layperson observer receiving the restorative treatment. (J Esthet Restor Dent 29:E24-E32, 2017).

Effect of Erosion/Abrasion Challenge on the Dentin Tubule Occlusion Using Different Desensitizing Agents

The aim of the study was to evaluate dentinal tubule occlusion, measuring the dentin permeability (Lp) and using different desensitizing agents before and after abrasive/erosive challenge. Dentin discs from 42 healthy human third molars were obtained. Minimum Lp was measured after a smear layer simulation using #600 SiC paper and maximum Lp after an immersion in 0.5 M EDTA. The specimens were treated with different desensitizers: two varnishes (Clinpro XT Varnish-CV, Fluor Protector-FP), a paste (Desensibilize Nano P-NP) and a gel (Oxa Gel-OG). The Lp of each specimen was measured immediately after the desensitizers’ application. The discs were subjected to erosion/abrasion cycles for 7 days, with 0.5% citric acid solution (6x/day) and tooth brushing (3x/day). Lp was measured after the first, fourth and seventh day of the challenge. The data were analyzed by 3-way ANOVA with repeated measurements and by a Games-Howell test (α=5%). FP and CV did not show significant differences in Lp immediately after application until the 7th day (p<0.05). OG showed a significant increase in Lp after the 4th and 7th days. NP resulted in a significantly higher permeability compared to the other materials immediately after the application and after the 1st day of challenge. All the desensitizers reduced the dentin permeability immediately after application. However, only the varnishes were able to maintain the occlusive effect after the erosion/abrasion challenge.

Resumo O objetivo do estudo foi avaliar a permeabilidade da dentina (Lp) usando diferentes agentes dessensibilizantes antes e depois de um desafio abrasivo/erosivo. Discos de dentina foram obtidos a partir 42 terceiros molares humanos. Lp mínima foi medida após uma simulação de smear layer usando lixa de SiC # 600 e a Lp máxima foi medida após imersão em EDTA 0,5 M. As amostras foram tratadas com diferentes dessensibilizantes: dois vernizes (Fluor Protector-FP, Clinpro XT Varnish-CV), uma pasta (Desensibilize Nano P-NP) e um gel (Oxa Gel-OG). A Lp de cada amostra foi medida imediatamente após a aplicação dos dessensibilizantes. Os discos foram submetidos a um ciclo de erosão/abrasão durante 7 dias, com uma solução de 0,5% de ácido cítrico (6x/dia) e escovação (3x/dia). Lp foi medida do primeiro ao sétimo dia do desafio. Os dados foram analisados por ANOVA a 3 critérios com medidas repetidas e teste de Games-Howell (α=5%). FP e CV demonstraram Lp semelhante imediatamente depois da aplicação até 7 dias (p<0,05). OG apresentou um aumento significativo na Lp depois do 4º e 7º dias. NP resultou numa permeabilidade significativamente mais elevada comparada com a dos outros materiais imediatamente após a aplicação e após o primeiro dia de desafio. Todos os dessensibilizantes reduziram a permeabilidade da dentina imediatamente após a aplicação. No entanto, apenas os vernizes foram capazes de manter o efeito oclusivo após o desafio da erosão/abrasão.

Guidelines for the management of neuroendocrine tumours by the Brazilian gastrointestinal tumour group.

Neuroendocrine tumours are a heterogeneous group of diseases with a significant variety of diagnostic tests and treatment modalities. Guidelines were developed by North American and European groups to recommend their best management. However, local particularities and relativisms found worldwide led us to create Brazilian guidelines. Our consensus considered the best feasible strategies in an environment involving more limited resources. We believe that our recommendations may be extended to other countries with similar economic standards.

Yoga and compassion meditation program improve quality of life and self-compassion in family caregivers of Alzheimer's disease patients: A randomized controlled trial.

AIM: To investigate the effects of the practice of yoga in combination with compassion meditation on the quality of life, attention, vitality and self-compassion of family caregivers of patients with Alzheimer's disease. METHODS: A total of 46 volunteers were randomly allocated to two groups, the yoga and compassion meditation program group (n = 25), and the control group (CG) that received no treatment (n = 21). The program lasted 8 weeks, and comprised three yoga and meditation practices per week, with each session lasting 1 h and 15 min. Quality of life, attention, vitality, and self-compassion scores were measured pre- and postintervention. RESULTS: The yoga and compassion meditation program group showed statistically significant improvements (P < 0.05) on quality of life, attention, vitality and self-compassion scores as compared with the control group, which showed no statistical significant differences at the postintervention time-point. CONCLUSIONS: The findings of the present study suggest that an 8-week yoga and compassion meditation program can improve the quality of life, vitality, attention, and self-compassion of family caregivers of Alzheimer's disease patients. Geriatr Gerontol Int 2017; 17: 85-91.