Resumo A agudização grave de colite ulcerosa é uma emergência médica, particularmente difícil de tratar de forma eficaz. O infliximab é uma das opções de tratamento médico de resgate após refractariedade aos corticosteróides, porém a melhor estratégia de indução ainda não está definida. Com este relato de série de casos, os autores pretendem descrever três casos de agudização grave de colite ulcerosa refratária a corticosteróides com diferentes abordagens de indução intensificada/acelerada de infliximab e rever a literatura sobre este tópico. O primeiro caso descreve uma jovem de 18 anos com agudização grave de colite ulcerosa, à apresentação da doença, com rápida progressão para megacólon tóxico, complicada também com anemia, hipoalbuminemia e coagulopatia. Após ausência de resposta a corticosteróides, foi iniciado regime acelerado e intensificado (10 mg/kg) de infliximab, concluído em 11 dias, com resposta clínica e normalização das alterações imagiológicas do cólon. Em segundo lugar, apresentamos um homem de 26 anos com colite ulcerosa esquerda conhecida há 2 anos, sob messalazina, que apresentou uma agudização moderada da doença e iniciou infliximab após resposta parcial e inconsistente aos corticosteróides. Durante o período de indução, apresen-tou desta vez um episódio de agudização grave, o que motivou uma terceira dose precoce e intensificada com boa resposta clínica. Por fim, descrevemos o caso de um homem de 78 anos com proctite ulcerosa há 12 anos apresentando agudização grave de colite ulcerosa, também com extensão proximal da doença. Após resposta insatisfatória a corticosteróides, foi iniciado infliximab em regime de indução acelerada, completado em 13 dias, com a dose padrão, obtendo remissão clínica. Os esquemas de indução de infliximab acelerados ou intensificados têm vindo a tornar-se prática clínica habitual nos casos de agudização grave de colite ulcerosa refratária a corticosteróides. As diretrizes atuais referem a possibilidade deste tipo de estratégias, não indicando qual o regime ideal por falta de evidência sólida. A literatura baseia-se principalmente em estudos retrospetivos, não randomizados, com heterogeneidade de grupos de estudo de acordo com a gravidade da doença e o efeito nas taxas de colectomia, sobretudo a longo prazo, não é claro. Estudos mais fundamentados são necessários sobre esta matéria de modo a que seja possível uma abordagem amplamente mais uniforme.

Abstract Acute severe ulcerative colitis (ASUC) is an emergent medical condition and particularly challenging to treat efficaciously. Infliximab is one of the medical salvage treatment options after corticosteroid refractoriness, but the best induction strategy is not yet defined. With this case series, the authors intend to describe three corticosteroid-refractory ASUC cases with different intensified/accelerated infliximab induction approaches and review the literature on this topic. The first case describes an 18-year-old girl with ASUC at disease onset with rapid progression to toxic megacolon, complicated also with anemia, hypoalbuminemia, and coagulopathy. After corticosteroid failure, both accelerated and intensified (10 mg/kg) infliximab regimen was completed within 11 days, with solid clinical response and colon imaging normalization. Second, we present a 26-year-old male with left-sided ulcerative colitis known for 2 years, under mesalazine, who developed a moderate flare and was started on infliximab after partial and inconsistent response to corticosteroids. During the induction period, he presented this time an ASUC episode, which motivated an early and intensified third dose with good clinical response. Finally, we describe the case of a 78-year-old man with ulcerative proctitis for 12 years presenting ASUC with proximal disease extension as well. After unsatisfactory response to corticosteroids, infliximab was initiated on an accelerated induction regimen, completed in 13 days, with the standard dose, achieving clinical remission. Accelerated or intensified infliximab induction plans are becoming current clinical practice in corticosteroid-refractory ASUC. Current guidelines refer to the possibility of this type of strategies, not determining the optimal regimen due to lack of solid evidence. Literature is mainly based on retrospective studies, not randomized, with heterogeneous groups according to disease severity, and the effect on colectomy rates, mainly on the long term, is not clear. Additional well-supported studies are needed on this subject in order to seek a more widely uniform approach.

ABSTRACT Background Despite the potential advantages of patients’ self-recordings of bowel habits in lower digestive disorders, few studies evaluate the relevance of clinical information obtained through bowel diaries in clinical practice. Objective The main objective of this study was to evaluate the role of bowel diaries as an auxiliary diagnostic tool in lower gastrointestinal disorders consultations. Methods In this cross-sectional study, at the end of their gastroenterology consultation, patients were questioned about their bowel habits and gastrointestinal symptoms. The bowel diary was then filled by the patients at home for 2 weeks. The data collected from the clinical interview and from the bowel diaries were analyzed. Results Fifty-three patients participated in the study. Patients underestimated the number of their bowel movements (BM) in the interviews compared with the bowel diaries (P=0.007). There was a poor agreement between stool consistencies described in the interviews and recorded in the diaries (k=0.281). Patients overestimated their straining during evacuation in the interviews compared with the diaries (P=0.012). Regarding the subgroups’ analysis, patients with proctological disorders described less BM in their interviews (P=0.033). Straining during evacuation was higher in the interviews of patients without proctological disorders (P=0.028) and in the interviews of more educated patients (P=0.028). Conclusion Overall, there were discrepancies between the clinical interview and the bowel diary regarding the number of BM, the stool consistency and straining. Bowel diaries are therefore a relevant instrument as a complement to the clinical interview to objectify patients’ complaints and treat functional gastrointestinal disorders more adequately.

RESUMO Contexto: Apesar das potenciais vantagens do diário intestinal como complemento à entrevista clínica, raros estudos avaliam a relevância da informação clínica obtida a partir de diários intestinais na prática clínica. Objetivo Os principais objetivos deste estudo foram avaliar o papel do diário intestinal como ferramenta diagnóstica numa consulta dedicada a patologia digestiva baixa. Métodos Foi realizado um estudo transversal, num período de 3 meses, em que no final das consultas os pacientes foram entrevistados relativamente a dados demográficos, antecedentes clínicos e hábitos e sintomas intestinais. Em seguida, foi solicitado o auto-preenchimento de um diário intestinal durante 2 semanas. Foram comparadas as respostas obtidas na entrevista clínica com os registos dos diários intestinais. Resultados: Cinquenta e três pacientes participaram no estudo. A frequência de evacuações reportada nas entrevistas clínicas e nos diários intestinais dos pacientes foi significativamente diferente (P=0,007). Verificou-se apenas uma concordância mínima entre a consistência das fezes descrita nas entrevistas e registada nos diários (κ=0,281). Em relação ao esforço evacuatório os pacientes sobrestimaram o seu esforço ao evacuar nas entrevistas (P=0,012). Adicionalmente, verificou-se que pacientes com doenças proctológicas descreveram menos evacuações nas suas entrevistas (P=0,033). A descrição do esforço durante a evacuação foi superestimada nas entrevistas de pacientes sem distúrbios proctológicos (P=0,028) e de pacientes com um nível mais elevado de educação (P=0,028). Conclusão: Globalmente verificaram-se discrepâncias entre a entrevista clínica e o diário intestinal dos pacientes em relação ao número de dejeções, à consistência das fezes e ao esforço evacuatório. Assim, esta ferramenta revelou-se uma potencial mais-valia na prática clínica diária, permitindo objetivar as queixas e consequentemente tratar os pacientes de forma mais adequada.

Abstract The aim of the present study was to investigate predictors of malocclusion in Brazilian schoolchildren eight to ten years of age based on a causal directed acyclic graph model. A cross-sectional study was conducted with 739 schoolchildren eight to ten years of age. Parents/guardians provided information on sleep disorders of the child (Sleep Disturbance Scale for Children) and family characteristics (Family Adaptability and Cohesion Evaluation Scale). The diagnosis of malocclusion was performed by four trained examiners using the Dental Aesthetic Index. Control variables were selected using a directed acyclic graph. Descriptive analysis was performed, followed by robust logistic regression analysis for complex samples (α = 5%). The following variables were associated with malocclusion in the final model: sleep disorders (OR = 2.61; 95%CI: 2.43–2.86), mouth breathing (OR = 1.04; 95%CI: 1.02–1.99), non-nutritive sucking habits (OR = 2.45; 95%CI: 2.37–4.85), and obesity (OR = 1.54; 95%CI: 1.02–2.33). Sociodemographic characteristics, family functioning, and premature tooth loss did not remain associated with malocclusion. Sleep disorders, mouth breathing, sucking habits, and obesity are predictors of malocclusion in schoolchildren eight to ten years of age.

ABSTRACT Background Sleep bruxism (BS) is defined as involuntary jaw movements characterized by grinding and clenching teeth. Objective To verify the association between chronotype, sleep quality, and self-reporting of BS in dental students. Method A cross-sectional study was conducted with 214 undergraduate dental students at a public university in northeast Brazil. The participants answered the Munich Chronotype Questionnaire for the identification of chronotype and another questionnaire regarding daily aspects to collect information about sleep quality, self-reported sleep bruxism, the use of sleeping pills, snoring, concentration during daily activities and energy upon waking. Results The prevalence of self-reported sleep bruxism was 11.0%. In the final model, the eveningness chronotype (OR = 23.00; 95% CI: 2.36-223.84, p = 0.007), habitual snoring (OR = 3.12; 95% CI: 1.31-7.39, p = 0.01) and low energy upon waking in the morning (OR = 2.37; 95% CI: 1.96-5.58, p = 0.040) were associated with self-reported sleep bruxism. Conclusion The evening chronotype, presence of snoring, and low energy when waking up in the morning influenced self-reporting of sleep bruxism among undergraduate dental students.

RESUMO Introdução O bruxismo do sono (BS) é definido como movimentos involuntários da mandíbula caracterizados por ranger e apertar os dentes. Objetivo Verificar se o cronotipo e a qualidade do sono estão associados ao autorrelato de BS em graduandos de Odontologia. Método Um estudo transversal com 214 estudantes de uma universidade pública do Nordeste do Brasil. Os participantes responderam ao Morningness-Eveningness Questionnaire para identificar os cronotipos e outro questionário sobre aspectos diários em que foram coletadas informações sobre qualidade do sono, autorrelato de bruxismo do sono, uso de pílulas para dormir, ronco, concentração nas atividades diárias, energia ao acordar. Resultados A prevalência de autorrelato do bruxismo do sono foi de 11,0%. No modelo final, o cronotipo noturno (OR = 23,00; 95% IC: 2.36-223.84, p = 0,007), o hábito de roncar (OR = 3,12; 95% IC: 1.31-7.39, p = 0,01) e o baixo nível de energia ao acordar pela manhã (OR = 2,37; 95% IC: 1.96-5.58, p = 0,04) estiveram associados com o autorrelato de BS. Conclusão O cronotipo noturno, a presença do ronco e a baixa energia ao se levantar pela manhã influenciaram o autorrelato de bruxismo do sono entre os estudantes de graduação em Odontologia.

Abstract Background: There are divergences in the literature regarding the experimental model (Wistar-WIS or Wistar Kyoto-WKY) to be used as a Spontaneously Hypertensive Rat (SHR) control. The characterization of these models in terms of cardiovascular parameters provides researchers with important tools at the time of selection and application in scientific research. Objective: The aim of this study was to evaluate the use of WIS and WKY as a Spontaneously Hypertensive Rat (SHR) control by assessing the long-term behavior of blood pressure and cardiac structure and function in these strains. Methods: To this end, WIS, WKY, and SHR underwent longitudinal experiments. Blood pressure and body mass were measured every two weeks from the 8th to the 72nd. Echocardiographic analysis was performed in all groups with 16, 48, and 72 weeks of life. After having applied the normality test, the Two-Way ANOVA of repeated measures followed by the Tukey post hoc test was used. A significance level of 5% was established. Results: The WIS group showed higher body mass (p<0.05), while the WKY and SHR presented higher body mass variation over time (p<0.05). SHR exhibited increased values of systolic, diastolic, and mean blood pressure when compared to WKY and WIS, whereas the WKY generally showed higher values than WIS (p<0.05). Regarding the cardiac function, SHR showed reduced values, while the WKY presented an early decrease when compared to WIS with aging (p<0.05). Conclusion: WIS is a more suitable normotensive control for SHR than WKY in experiments to test blood pressure and cardiac structure and function.

Abstract Introduction: The first presentation of ulcerative colitis may be an acute flare in about 15% of patients, requiring hospital admission. In acute severe steroid-refractory ulcerative colitis, cytomegalovirus (CMV) should be sought because it is a frequent cause of refractory disease. Herpes simplex colitis constitutes a rarer event in ulcerative colitis patients and it is usually associated with immunosuppression. Case Presentation: We report a case of a first presentation of ulcerative colitis complicated by CMV and herpes simplex type 2 coinfection. After a long period of systemic corticosteroids, the diagnosis of both CMV and herpes colitis was made. Despite antiviral treatment, colectomy was required due to a contained perforation. Discussion/Conclusion: This report highlights the importance of a high degree of suspicion for opportunistic infections in steroid/immunomodulator refractory ulcerative colitis, even in the first flare.

Resumo Introdução: A Colite Ulcerosa pode apresentar-se de forma aguda em até 15% dos casos, com necessidade de internamento hospitalar. Na agudização severa de Colite Ulcerosa refractária a corticoterapia deve ser excluída a infeção por Citomegalovirus (CMV), dado tratar-se de uma causa frequente de doença refractária. A colite por Herpes simplex é mais rara nos doentes com Colite Ulcerosa e associa-se frequentemente a imunossupressão. Descrição do caso: Relata-se a apresentação inaugural de Colite Ulcerosa complicada por co-infeção por CMV e herpes simplex tipo 2. Após terapêutica prolongada com corticoides sistémicos, foi diagnosticada colite tanto por CMV como Herpes simplex. Apesar de tratamento antivírico, foi necessária colectomia por perfuração cólica. Discussão/Conclusão: Este caso sublinha a importância de um alto grau de suspeição para infeções oportunistas em doentes com doença refractária a corticóide/imunomoduladores, mesmo na primeira agudização.

Abstract: This study aimed to determine the impact of the COVID-19 pandemic on sleep quality and possible sleep bruxism (SB) in children eight to ten years of age. The study hypothesis was that sleep disturbances influenced a higher occurrence of bruxism during the COVID-19 pandemic. A longitudinal study was conducted at two time points: in person prior to the COVID-19 pandemic (T1), and online during the pandemic (T2). The sample comprised 105 children. Parents/caregivers answered a questionnaire addressing sociodemographic characteristics, the use of electronic devices, reported (vs. clinical) SB, and the Sleep Disturbance Scale for Children (SDSC) at both T1 and T2. McNemar’s and Wilcoxon’s tests were used to compare SB and sleep disorders at both time points. Poisson regression analysis determined the relative risk (RR) among the variables, and the incidence of possible SB (p≤0.05). The comparison of the two time points (T1 and T2) revealed a significant increase in possible SB (p<0.01) and sleep disorders (p < 0.04). Children whose parents had a lower schooling level (RR: 2.67; 95%CI: 1.19–6.01), those with their own electronic devices (RR: 1.97; 95%CI: 1.09–2.50), and those with sleep disorders during the pandemic (RR: 1.74; 95%CI: 1.35–2.24) were at greater risk of developing SB during the pandemic. Moreover, the incidence of bruxism and sleep disorders was greater during the pandemic. The factors influencing SB incidence during the pandemic were a lower level of mothers’ schooling, greater access to electronic devices, and the occurrence of sleep disorders.

Abstract The aim of the present study was to investigate whether possible awake bruxism (AB) is associated with the use of electronic devices and the practice of sports in schoolchildren aged eight to ten years. A cross-sectional study was conducted with 739 students in public and private schools in the city of Campina Grande, Brazil. Parents/guardians answered a questionnaire addressing sociodemographic data. The children answered questions about use of electronic devices, practice of sports, and AB. Statistical analysis involved robust logistic regression for complex samples (α = 5%). The prevalence of possible AB was 14.9%. Being female (OR = 1.71, 95%CI: 1.11–2.63), being the middle child (OR = 2.19, 95%CI: 1.14–3.88), having unmarried parents (OR = 1.73, 95%CI: 1.13–2.65), daily use of a cell phone/tablet/computer (OR = 1.82, 95%CI: 1.19–2.80), use of electronic devices for two or more hours per day (OR = 1.97, 95%CI: 1.35–2.86), and playing sports in and/or out of school (OR = 1.60, 95%CI: 1.18–2.52) remained associated with possible AB in the final model. The presence of possible AB was influenced by the use of electronic devices and the practice of sports among schoolchildren aged eight to ten years.

Resumo: Introdução: A doença por coronavirus 19 (COVID-19) é uma pandemia global que afetou gravemente os serviços de saúde em todo o mundo. Durante o estado de emergência declarado em Portugal nos meses de Março e Abril de 2020, verificou-se uma redução importante na atividade médica. Este estudo teve como objetivo avaliar o impacto da COVID-19 nos Serviços de Gastroenterologia portugueses e as estratégias implementadas para fazer face a este desafio. Métodos: Tratou-se de um estudo transversal baseado num inquérito online. Um questionário pormenorizado acerca de diferentes aspetos da atividade dum Serviço de Gastroenterologia foi enviado por email para os Diretores de Serviço de Gastroenterologia dos Hospitais Distritais. Foram avaliados dois períodos: o estado de emergência e o período de recuperação entre maio e setembro. Foram registadas as respostas entre setembro e outubro 2020. Resultados: Responderam 21 Hospitais (taxa de resposta: 80,8%). Vinte e oito porcento dos inquiridos tiveram profissionais da sua unidade infectados com COVID-19. Pelo menos um elemento foi mobilizado para outro local de trabalho em 66,7% dos hospitais, maioritariamente internos de formação específica de Gastroenterologia. Durante o estado de emergência, 47,6% dos Hospitais só realizaram endoscopias urgentes/emergentes. Em 38,5%, a necessidade de racionamento de equipamento de proteção individual levou à suspensão do treino em endoscopia. Relativamente ao período de recuperação, os procedimentos não urgentes foram retomados na maioria dos centros. O mesmo se verificou para o programa de rastreio do cancro colorectal. Salienta-se que 81% dos inquiridos confirmaram que adiaram exames a pedido dos doentes por “medo de ficarem infetados”. Mantiveram-se consultas não-presenciais em 81% dos Hospitais. De modo geral, as atividades de formação dos internos foram progressivamente retomadas. Discussão/Conclusão: Este estudo oferece o retrato do impacto e consequências da primeira vaga da pandemia nos Hospitais portugueses. É importante compreender como os Serviços de Gastrenterologia nacionais lidaram com o primeiro impacto da COVID-19 e que estratégias foram implementadas de forma a melhor preparar o que se segue.

Abstract: Introduction: Coronavirus disease 2019 (COVID-19) is a global pandemic that has severely affected health care systems around the world. During the emergency state declared in Portugal in the months of March and April 2020, there was a severe reduction in medical activity in order to reduce the pressure on health systems. This study aimed to assess the impact of COVID-19 in gastroenterology departments across Portugal and the strategies developed to overcome this challenge. Methods: This was a cross-sectional study based on an online survey. A detailed questionnaire concerning different aspects of gastroenterology department activity was sent via e-mail to the heads of gastroenterology departments of Portuguese District Hospitals (Núcleo de Gastroenterologia dos Hospitais Distritais). Two periods were assessed, i.e., the emergency state and the recovery period between May and September. The responses were collected between September and October 2020. Results: A total of 21 hospitals were enrolled (80.8% response rate). Twenty-eight percent of the responders reported healthcare professionals from their unit infected with COVID-19. At least 1 member (mostly fellows) of the department was deployed to another workplace in 66.7% of the hospitals. During the emergency state, 47.6% of the hospitals only performed urgent/emergent endoscopic procedures. In 38.5% of the hospitals the need to ration personal protective equipment led to the suspension of endoscopic training. Regarding the recovery period, nonurgent procedures were restarted in almost all of the centers. The same was reported for the colorectal cancer screening program. Remarkably, 81% of the responders confirmed that they had postponed procedures at patients’ request for “fear of getting infected.” Remote consultation was maintained in 81% of the hospitals. Globally, the fellows had resumed their training. Discussion/Conclusion: This study provides a snapshot of the impact and consequences of the first wave of the COVID-19 pandemic across Portuguese hospitals. It is important to understand how the gastroenterology world dealt with the first impact of COVID-19 and what strategies were implemented in order to better prepare for what might follow.

ABSTRACT Excess body fat is a serious problem for increasing the risk of cardiovascular diseases such as obesity, compromising the health and quality of life of the population. In this sense, resistance training (RT) is type of physical exercise which improves body composition by increasing lean mass and reducing fat mass. RT in combination with nutrition (i.e. protein supplementation) is a key intervention to improve body fat metabolism and reducing obesity. Concerning protein supplementation, the β-hydroxy-β-methylbutyrate (HMB) is a metabolite of the branched-chain amino acid leucine that has demonstrated positive effects on body fat reduction. However, the effects of combining HMB supplementation with RT related to adipose tissue metabolic activity are controversial and warrant further investigation. This study analyzed the effects of HMB supplementation associated with RT on body fat concentration and lipid metabolism signaling pathways.

RESUMEN El exceso de grasa corporal es un problema grave que aumenta tu riesgo de enfermedades y problemas de salud, tales como enfermedad cardíaca, diabetes, presión arterial alta y ciertos tipos de cáncer. En este sentido, y dentro del ejercicio físico, el entrenamiento de resistencia (ER) es un tipo de entrenamiento con pesos que mejora la composición corporal aumentando la masa magra y perdiendo masa grasa. El ER asociado con la nutrición (ej. suplementación proteica) es una excelente intervención para mejorar el metabolismo de los lípidos al reducir la grasa corporal. En relación con la suplementación proteica el β-hidroxi-β-metilbutirato (HMB) es un metabolito del aminoácido de cadena ramificada esencial leucina que ha demostrado efectos positivos en la reducción de grasa corporal. Sin embargo, los efectos de la suplementación con HMB asociados con TR relacionados con la actividad metabólica del tejido adiposo son controvertidos y necesita la realización de investigaciones adicionales. Este estudio analizó los efectos de la suplementación con HMB asociados con TR en la concentración de grasa corporal y en las vías de señalización que participan en la regulación del metabolismo de los lípidos.

Abstract Obtaining low cost lignocellulolytic enzymes and efficient biomass pretreatment are key to increase the competitiveness of second-generation ethanol in comparison with fossil fuels. The enzymatic cocktail produced by the Chrysoporthe cubensis fungus as well as the mixture prepared with the cocktails of the Chrysoporthe cubensis and Penicillium pinophilum fungi have already proven to be efficient for hydrolyzing biomass pretreated with alkali. In this study, they were evaluated in saccharification of sugarcane bagasse pretreated with dilute acid or hot water at 121°C using an enzyme loading equal to 8 filter paper units per gram of biomass. The most promising results were obtained from the hydrolysis of biomass pretreated with hot water by the C. cubensis-P. pinophilum enzymes blend. In this condition, the glucose and xylose production were 25.2 g.L-1 and 4.6 g.L-1, respectively, that resulted in the conversion of 68% of glucan and 23% of xylan in only 48 hours. This study shows that the hydrothermal pretreatment is a promising alternative to improve the enzymes performance, produced by the fungi C. cubensis and P. pinophilum, in the sugarcane bagasse hydrolysis without the need of chemical compounds, generally used in the acid and alkali pretreatments. Furthermore, the hydrothermal pretreatment for 60 min allowed all cocktails applied to convert the cellulose efficiently with only 24 h of saccharification, which contributes to the energy savings employed in the process.

Introdução: O aparecimento da dissecção endoscópica da submucosa (ESD) tornou possível a resseção em bloco de lesões neoplásicas superficiais do estômago, independentemente da sua dimensão, com reduzidas taxas de complicações e recorrência. Esta técnica tem evoluído como método preferencial face à mucosectomia convencional e cirurgia, quando a metastização à distância tem risco negligenciável. No mundo ocidental a experiência nesta técnica tem evoluído de forma rápida surgindo um número crescente de séries na literatura. Este estudo tem como objetivo reportar os resultados a curto e longo prazo da ESD de lesões epiteliais gástricas realizadas por um único operador num centro Português. Metodologia: Análise retrospetiva unicêntrica dos casos de ESD de lesões epiteliais gástricas, realizadas durante um período de 5 anos, entre maio de 2012 e setembro de 2017. Resultados: Foram realizadas 114 ESDs de neoplasias epiteliais gástricas durante o período em estudo, com uma taxa de resseção em bloco de 96.5% e R0 de 87.6%. A resseção curativa confirmou-se em 83.2% dos casos. Ocorreram complicações em 13.2% dos procedimentos, incluindo hemorragia em 12 doentes (10.5%) e 1 perfuração (0.9%). Com uma mediana de follow-up de 12 meses (variação interquartil [IQR] 18), verificaram-se 6 casos de recorrência local: 4 lesões residuais e 2 recorrências em resseções R0 prévias. Observaram-se mais frequentemente lesões residuais de ESD de lesões de maiores dimensões (mediana = 40.0 mm, IQR = 26 vs. mediana = 20.0 mm, IQR = 15, p = 0.008) e com margens horizontais (HM) positivas após a resseção (50.0% vs. 0.0%, Teste exato de Fisher, p < 0.001). A incidência cumulativa de lesões gástricas metácronas aos 34 meses foi de 16.1%. Todas as novas lesões foram eficazmente tratadas por endoscopia. A sobrevivência específica aos 12 meses de follow-up foi de 100%. Conclusão: Este estudo mostra que a ESD gástrica é uma técnica eficaz e segura para o tratamento de lesões neoplásicasprecoces confirmando a maioria das séries europeias. Embora a ESD permita geralmente uma resseção em bloco as HM positivas continuam a ser um problema em alguns doentes. A vigilância endoscópica pode detetar recorrência local e novas lesões, em estádios precoces, potencialmente tratáveis por endoscopia.

Background: The emergence of endoscopic submucosal dissection (ESD) made possible en bloc resection of neoplastic gastric lesions, regardless of lesion size, with reduced rates of complications and recurrence. This technique has become the preferred method for curative resection, instead of conventional endoscopic mucosal resection and surgery, when distant metastases have negligible risk. In Western countries experience with this technique has evolved quickly, with an increasing number of case series reported in the literature. This study aims to report the short- and long-term outcomes of ESD in gastric epithelial neoplastic lesions by a single operator in a Portuguese centre. Methods: A retrospective analysis of all gastric ESDs in a tertiary specialised unit during a 5-year period, between May 2012 and September 2017, was performed. Results: A total of 114 ESDs of gastric epithelial lesions were performed during this period; 96.5% of them were removed en bloc and 87.6% with R0 resection. A curative treatment was achieved in 83.2% of the cases. Complications occurred in 13.2% of the procedures, including early and delayed bleeding in 12 patients (10.5%) and one perforation (0.9%). With a median follow-up period of 12 months (interquartile range [IQR] = 18), 6 cases of recurrence at the previous ESD site were diagnosed: 4 residual lesions and 2 local recurrences in previous R0 resections. Residual lesions occurred more often in patients with larger lesions (median = 40.0 mm, IQR = 26 vs. median = 20.0 mm, IQR = 15, p = 0.008) and with positive horizontal margins (HMs) after resection (50.0 vs. 0.0%, Fisher exact test, p < 0.001). The cumulative incidence of metachronous gastric lesions at 34 months was 16.1%. All new lesions were effectively treated using an endoscopic technique. The disease-specific survival at 12 months was 100%. Conclusion: This study showed that ESD is an effective resection technique for gastric lesions with a good safety profile, confirming other European series. Regardless, high en bloc resection positive HM is still a problem in some specimens resected by ESD. Endoscopic surveillance can detect local recurrence and new lesions during early stages, potentially treatable by endoscopy.

Resumo Fundamento: A regulação intracelular de cálcio (Ca2+) em cardiomiócitos é alterada pela hipertensão, e o exercício físico aeróbico traz benefícios para hipertensos. Objetivo: Verificar os efeitos do treinamento físico aeróbico sobre a contratilidade e a concentração intracelular de Ca2+ transitória em miócitos e a expressão do microRNA 214 no ventrículo esquerdo (VE) de ratos espontaneamente hipertensos (SHR). Métodos: SHR e ratos Wistar normotensos com 16 semanas de idade foram divididos em 4 grupos de 13 animais cada: hipertenso sedentário (HS); hipertenso treinado (HT); normotenso sedentário (NS); normotenso treinado (NT). Os animais dos grupos HT e NT foram submetidos a um programa de treinamento progressivo de corrida em esteira, 5 dias/semana, 1 hora/dia, em intensidade de 60-70% da velocidade máxima de corrida, durante 8 semanas. Adotou-se p ≤ 0,05 como nível de significância em todas as comparações. Resultados: O treinamento físico reduziu a pressão arterial sistólica nos animais hipertensos. Nos animais normotensos, o treinamento físico reduziu o tempo para 50% de relaxamento celular e o tempo para o pico de contração celular, mas aumentou o tempo para 50% de decaimento da concentração intracelular de Ca2+ transitória. Nos animais SHR, o treinamento físico aumentou a amplitude e reduziu o tempo para 50% de decaimento da concentração intracelular de Ca2+ transitória, sem alterar a contratilidade celular. O treinamento físico aumentou a expressão do miR-214 apenas nos animais hipertensos. Conclusão: O treinamento aeróbico utilizado aumenta a disponibilidade e acelera o sequestro de Ca2+ intracelular em miócitos do VE de ratos hipertensos, apesar do aumento da expressão de miR-214 e da manutenção da contratilidade celular.

Abstract Background: Regulation of intracellular calcium (Ca2+) in cardiomyocytes is altered by hypertension; and aerobic exercise brings benefits to hypertensive individuals. Objective: To verify the effects of aerobic exercise training on contractility and intracellular calcium (Ca2+) transients of cardiomyocytes and on the expression of microRNA 214 (miR-214) in the left ventricle of spontaneously hypertensive rats (SHR). Methods: SHR and normotensive Wistar rats of 16 weeks were divided into 4 groups -sedentary hypertensive (SH); trained hypertensive (TH); sedentary normotensive (SN); and trained normotensive (TN). Animals of the TH and TN groups were subjected to treadmill running program, 5 days/week, 1 hour/day at 60-70% of maximum running velocity for 8 weeks. We adopted a p ≤ 0.05 as significance level for all comparisons. Results: Exercise training reduced systolic arterial pressure in hypertensive rats. In normotensive rats, exercise training reduced the time to 50% cell relaxation and the time to peak contraction and increased the time to 50% decay of the intracellular Ca2+ transients. In SHR, exercise increased the amplitude and reduced the time to 50% decay of Ca2+ transients. Exercise training increased the expression of miR-214 in hypertensive rats only. Conclusion: The aerobic training applied in this study increased the availability of intracellular Ca2+ and accelerated the sequestration of these ions in left ventricular myocytes of hypertensive rats, despite increased expression of miR-214 and maintenance of cell contractility.