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Introdução: No corpo humano, o conteúdo total de ácido hialurônico (AH) encontrado é de aproximadamente 15g a cada 70kg e metade encontra-se na pele mais especificamente entre a derme e epiderme. Com o passar dos anos, observa-se um declínio da sua produção endógena alterando seu volume, hidratação, sustentação e elasticidade, deixando a pele com um aspecto mais envelhecido. Objetivo: Avaliar o impacto da suplementação oral do ácido hialurônico no envelhecimento cutâneo. Material e Método: Foi realizada uma revisão bibliográfica nas principais bases de dados em saúde MEDLINE, LILACS e SCIELO, utilizando os descritores em Ciências da Saúde (DeCS): ácido hialurônico, envelhecimento cutâneo e pele, nos idiomas português e inglês, considerando os últimos 5 anos. Resultado: Foram encontrados 51 estudos, 5 foram incluídos e 46 excluídos por não atenderem os critérios de elegibilidade. Os estudos observados sugerem que a ingestão de AH via oral aumenta a hidratação e diminui as linhas de expressão, sendo um possivel tratamento na prevenção do envelhecimento da pele. Sua utilização como suplemento oral também é relativamente nova em comparação com outros nutrientes usados ​​para a pele seca e o seu envelhecimento. Conclusão: O AH possibilitou melhora na hidratação e na elasticidade da pele. Nesta revisão, a suplementação oral de diferentes doses e pesos moleculares apresentaram benefícios na saúde da pele. Entretanto, são necessários estudos clínicos randomizados para confirmar seus efeitos e estabelecer o peso molecular ideal, bem como, a dose adequada para minimizar os sinais clínicos do envelhecimento cutâneo.

Weight regain after balloon retrieval is a concern with all intra-gastric balloons (IGBs). The aim of this study was to evaluate the efficacy of liraglutide, a glucagon-like peptide-1 (GLP-1) agonist, to prevent weight regain following IGB retrieval. This was a case-matched study of patients undergoing Spatz3 adjustable IGB (Spatz FGIA, Inc. NY, USA) at three outpatient clinics in Brazil between November 2015 and January 2019. Seventy-seven patients that opted to take liraglutide following IGB retrieval (IGB-L) were matched 1:1 to 198 patients that declined the medication—IGB-Alone (IGB-A). Propensity score adjustment was performed at the time of balloon retrieval on factors known to influence the choice of liraglutide. Weight and percent body fat (%BF) was measured at baseline and 9 months after IGB retrieval. % BF is defined as the total mass of fat divided by total body mass, multiplied by 100. The primary outcome was weight regain, and the secondary outcome was change in %BF 9 months after IGB retrieval. Propensity score matching yielded 53 matched pairs. Weight regain to the starting point was not observed in either group. There was significantly less weight regain in IGB-L compared to IGB-A, − 1.15 ± 0.94 kg versus − 0.66 ± 0.99 kg (p = 0.010) 9 months after balloon retrieval. Additionally, %BF decline in IGB-L was superior to IGB-A − 10.83 ± 1.50 versus − 7.94 ± 2.02 (p

BACKGROUND The healthcare impact of obesity is enormous, and there have been calls for new approaches to containing the epidemic worldwide. Minimally invasive procedures have become more popular, with one of the most widely used being endoscopic sleeve gastroplasty (ESG). Although major adverse events after ESG are rare, some can cause considerable mortality. To our knowledge, there has been no previous report of biliary ascites after ESG. CASE SUMMARY A 48-year-old female with obesity refractory to lifestyle changes and prior gastric balloon placement underwent uncomplicated ESG and was discharged on the following day. On postoperative day 3, she developed abdominal pain, which led to an emergency department visit the following day. She was readmitted to the hospital, with poor general health status and signs of peritoneal irritation. Computed tomography imaging showed fluid in the abdominal cavity. Laparoscopy revealed biliary ascites and showed that the gallbladder was sutured to the gastric wall. The patient underwent cholecystectomy and lavage of the abdominal cavity and was admitted to the intensive care unit post-operatively. After 7 d of antibiotic therapy and 20 d of hospitalization, she was discharged. Fortunately, 6 mo later, she presented in excellent general condition and with a 20.2% weight loss. CONCLUSION ESG is a safe procedure. However, adverse events can still occur, and precautions should be taken by the endoscopist. In general, patient position, depth of tissue acquisition, location of stitch placement, and endoscopist experience are all important factors to consider to mitigate procedural risk.

BackgroundAlthough 1st-line PD-1 monotherapy has improved survival in patients with advanced NSCLC and a PD-L1 TPS ≥50%, responses occur in ~45% of patients. We have previously shown that among patients with NSCLC and PD-L1 expression of ≥50% treated with 1st-line pembrolizumab, clinical outcomes are significantly improved in those with a PD-L1 TPS of ≥90%.1 Here, we report the 3-year follow-up outcomes to 1st-line pembrolizumab in patients with a PD-L1 TPS ≥90% vs MethodsPatients with stage IV EGFR/ALK wild type NSCLC and PD-L1 TPS ≥50% who received 1st-line pembrolizumab monotherapy at Dana-Farber Cancer Institute were included. Comprehensive tumor genomic profiling was performed to examine genomic correlates of a very high PD-L1 expression on an expanded cohort of NSCLC samples.ResultsAmong 150 patients included, median age was 69 (range: 46–92), 55.3% were women, 91.9% were current smokers, and 34.0% had a KRAS mutation. At a median follow-up of 38.5 months, median progression-free (mPFS) and overall survival (mOS) in the entire cohort were 4.8 months, and 20.0 months, respectively. When compared to patients with a PD-L1 expression of 50–89% (N=81), those with PD-L1 TPS ≥90% (N=69) had a significantly longer mPFS (6.0 vs 3.9 months, HR 0.66, P=0.02), and longer mOS (27.0 vs 14.6 months, HR 0.63, P=0.03; figure 1). Kaplan-Meier estimates of the 3-year PFS and OS were 23.0% and 43.2% in the PD-L1 TPS ≥90% groups, and 8.6% and 24.0% in the PD-L1 TPS 50–89% group, respectively. A PD-L1 TPS ≥90% was confirmed to be an independent predictor of improved PFS (HR 0.58, P=0.02) and OS (HR 0.57, P=0.01) at multivariable analysis. Patients whose tumors had a PD-L1 TPS ≥90% were also significantly more likely to complete 35 cycles of therapy compared to those with PD-L1 TPS of 50–89% (17.4% vs 3.7%, PAbstract 312 Figure 1(A) Progression-free and (B) overall survival to 1st line pembrolizumab among patients with PD-L1 TPS ≥90% vs 50–89%, at a 3-year follow-up.Abstract 312 Figure 2Barplot showing the percentage of patients who completed 35 cycles of pembrolizumab monotherapy in the PD-L1 TPS ≥90% and 50–89% groupsAbstract 312 Figure 3(A) Oncoprint plot showing the top 15 genes mutated in NSCLC with PD-L1 TPS ≥90% and 50–89%. (B) Gene mutation enrichment analysis showing differentially mutated genes between NSCLCs with PD-L1 TPS ≥90% and 50–89%. ** Adjusted P value ConclusionsPembrolizumab monotherapy continues to demonstrate a meaningful long-term survival benefit at a 3-year follow-up in patients with advanced NSCLC and a PD-L1 TPS ≥90% vs 50–89%. NSCLCs with very high PD-L1 TPS have a more favorable genomic profile. These findings have implications for treatment selection and for clinical trial interpretation and design.ReferenceAguilar EJ, Ricciuti B, Gainor JF, et al. Outcomes to first-line pembrolizumab in patients with non-small-cell lung cancer and very high PD-L1 expression. Ann Oncol 2019 October 1;30(10):1653–1659

Background Sleeve gastrectomy is a well-standardized surgical treatment for obesity. However, rates of weight regain after sleeve gastrectomy in long-term follow-up are relatively high. This multicenter study is the first to evaluate the use of an endoscopic sleeve gastroplasty (ESG) technique for the management of this population. Methods This was a multicenter retrospective study, including patients with weight regain following sleeve gastrectomy who underwent ESG for weight loss. Primary outcomes included absolute weight loss, percent total weight loss (%TWL), change in body mass index (BMI), percent excess weight loss (%EWL) at 6 and 12 months, and safety profile. Clinical success was defined as achieving ≥ 25 % EWL at 1 year, ≤ 5 % serious adverse event (SAE) rate following society-recommended thresholds, and %TWL ≥ 10 %. Results 34 patients underwent ESG after sleeve gastrectomy. Technical success was 100 %. At 1 year, 82.4 % and 100 % of patients achieved ≥ 10 %TWL and ≥ 25 % EWL, respectively. Mean (SD) %TWL was 13.2 % (3.9) and 18.3 % (5.5), and %EWL was 51.9 % (19.1) and 69.9 % (29.9) at 6 months and 1 year, respectively. Mean (SD) %TWL was 14.2 % (12.5), 19.3 % (5.3), 17.5 % (5.2), and 20.4 % (3.3), and %EWL was 88.5 % (52.8), 84.4 % (22.4), 55.4 % (14.8), and 47.8 % (11.2) for BMI categories of overweight and obesity class I, II, and III, respectively, at 1 year. No predictors of success were identified in the multivariable regression analysis. No SAEs were reported. Conclusion ESG appears to be safe and effective in the management of weight regain following sleeve gastrectomy.

Obesity is a pandemic affecting approximately 700 million adults worldwide, with an additional 2 billion overweight. Endoscopic sleeve gastroplasty (ESG) is a minimally invasive endoscopic bariatric therapy that involves remodeling of the greater curvature in an effort to reduce gastric capacity and delay gastric emptying. A variety of ESG suture patterns has been reported. This study is the first to use a uniform "U" stitch pattern across all centers to simplify technical aspects of the procedure and limit cost. This also uniquely assessed outcomes in all body mass index (BMI) categories and changes in metabolic rate, lean body mass, and adipose tissue composition.This is a multicenter analysis of prospectively collected data from 7 centers including patients with overweight and obesity who underwent ESG. Primary outcomes included absolute weight loss, percent total body weight loss (%TWL), change in BMI, and percent excess weight loss (%EWL) at 6 and 12 months in overweight and obese classes I, II, and III. Secondary outcomes included adipose tissue, lean body mass reduction, and metabolic rate analyzed by bioimpedance. Additionally, immediate or delayed adverse events (AEs) were analyzed. Clinical success was defined as achieving ≥25% EWL at 1 year with ≤5% serious AE (SAE) rate following the American Society for Gastrointestinal Endoscopy (ASGE)/American Society for Metabolic and Bariatric Surgery (ASMBS) threshold.A total of 193 patients underwent ESG during the study period. All groups had10% TWL and25% EWL at 6 months of follow-up. On average, %TWL was 14.25% ± 5.26% and 15.06% ± 5.22% and the %EWL 56.15% ± 22.93% and 59.41% ± 25.69% at 6 months and 1 year of follow-up, respectively. %TWL was 8.91% ± .3%, 13.92% ± 5.76%, 16.22% ± 7.69%, and 19.01% ± .95% and %EWL 56.21% ± 2.0%, 62.03% ± 27.63%, 54.13% ± 23.46%, and 46.78% ± 2.43% for overweight and obesity classes I, II, and III, respectively, at 1 year. Male sex, age 41 years, and higher BMI were predictors of achieving a TWL ≥10% at 1-year follow-up. There was a significant reduction in adipose tissue from baseline. SAEs occurred in 1.03%, including 2 perigastric collections needing surgery.ESG appears to be feasible, safe, and effective in the treatment of patients with overweight and obesity according to ASGE/ASMBS thresholds.

The University of São Paulo Twin Panel (Painel USP de Gêmeos), based at the Institute of Psychology of the University of São Paulo, started formally in 2017. Our registry is new, but in only two years of formal existence, it comprises a volunteer sample of 4826 registered individuals (98% twins and 2% higher-order multiples), recruited at the University of São Paulo and by social media campaigns. Our main aim is to conduct and promote research with twins on psychological processes and behavior. The University of São Paulo is the largest higher education and research institution in South America, and the Painel USP de Gêmeos has great potential for fostering research on twin-related issues from a psychological perspective in Brazil and South America.

Nausea and vomiting groups x moments, Background: As the number of bariatric operations increases, there is a greater interest in knowledge, experience and skills in the operative and anesthetic management of obese people. Anesthetic recovery is an important point in the therapeutic approach and less adverse effects delaying discharge of these patients are necessary to be kept in mind by the surgical team. Aim: To compare anesthetic-analgesic techniques in the opioid-sparing era through epidural administration of local anesthetic associated with low-dose morphine vs. clonidine and analyze the impact of analgesia on the effectiveness of postoperative recovery by comparing these two techniques. Methods: Randomized, double-blind clinical trial with 66 patients candidates for Roux-en-Y gastrojejunal bypass divided into two groups: morphine group and clonidine group. Multimodal analgesia included epidural anesthesia with 0.375% ropivacaine 20 ml at the eighth thoracic vertebra with the association of morphine (morphine group) at a dose of 15 mcg / kg or clonidine (clonidine group) at a dose of 1 mcg / kg. Results: The groups were homogeneous and statistical significance was found when analyzing the difference in pain between them in the first postoperative period. The pain was higher in the clonidine group, as in this period, analgesic rescue was also better in this group. In the other times, there was no significance in the differences regarding pain and rescue. The return of intestinal motility in the morphine group was earlier in the first postoperative period. Nausea, vomiting and hospital discharge did not show significant differences between groups. Conclusion: Epidural anesthesia with low-dose morphine allowed less pain during the entire hospital stay, with a positive impact on patient recovery.

Meditation and positive psychology have been reported as promising approaches to deal with stress. This exploratory pilot study aims to evaluate the efficacy of meditation and positive psychology-based intervention on stress. Two experiments are reported, in the first one, 29 healthcare professionals were included (intervention = 14, control = 15), and the second one included 57 women managers (intervention = 27, control = 30). All participants were evaluated before and after eight weeks for levels of stress, anxiety, depression, and psychiatric symptoms. In Experiment 1, intervention group participants showed a reduction in stress levels and anxiety symptoms, and in Experiment 2, participants in the intervention group showed a decrease in stress, psychiatric symptoms, and sleep quality, when compared to the control group. A multi-component intervention based on positive psychology and meditation practices was effective at reducing stress as well as improving related stress parameters such as anxiety, psychiatric symptoms, and sleep quality.

Purpose – This study aims to identify the countries’ innovation factors that are determinant for them to achieve higher levels of development. In addition, the research identified which of these factors should be prioritized so the countries can move up in the rank of the most competitive. Design/methodology/approach – The study used the indicators of innovation and the stage of development of 137 countries proposed by the Global Competitiveness Report published by the World Economic Forum and techniques of multivariate data analysis. Findings – The results indicated that all the factors tested are determinant to lead the countries throughout their stages of development. The research highlights that the factors “Quality of scientific research institutions” and “Patent Cooperation Treaty (PCT) patent applications” should be equally prioritized for the countries’ development. Practical implications – The results suggested that the factors Capacity for Innovation, Quality of Scientific Research Institutions, Company Spending on Research and Development (R&D), University– Industry Collaboration in R&D, Government Procurement of Advanced Technology Products, Availability of Scientists and Engineers and PCT Patent Applications are decisive for positioning countries in terms of their stage of development and should be part of their public policy and enterprises’ strategic planning. Originality/value – The findings show that countries should prioritize the factors Quality of Scientific Research Institutions and PCT Patent Applications, as these factors, when acting together, predict the evolution to higher stages of development. Purpose – This study aims to identify the countries’ innovation factors that are determinant for them to achieve higher levels of development. In addition, the research identified which of these factors should be prioritized so the countries can move up in the rank of the most competitive. Design/methodology/approach – The study used the indicators of innovation and the stage of development of 137 countries proposed by the Global Competitiveness Report published by the World Economic Forum and techniques of multivariate data analysis. Findings – The results indicated that all the factors tested are determinant to lead the countries throughout their stages of development. The research highlights that the factors “Quality of scientific research institutions” and “Patent Cooperation Treaty (PCT) patent applications” should be equally prioritized for the countries’ development. Practical implications – The results suggested that the factors Capacity for Innovation, Quality of Scientific Research Institutions, Company Spending on Research and Development (R&D), University– Industry Collaboration in R&D, Government Procurement of Advanced Technology Products, Availability of Scientists and Engineers and PCT Patent Applications are decisive for positioning countries in terms of their stage of development and should be part of their public policy and enterprises’ strategic planning. Originality/value – The findings show that countries should prioritize the factors Quality of Scientific Research Institutions and PCT Patent Applications, as these factors, when acting together, predict the evolution to higher stages of development.

Screening protocols for colorectal cancer are broadly recommended and effective in reducing mortality. However, populations from different age groups can harbor distinct pathologic and molecular profiles that can also be influenced by screening and polyp resection, especially in older ages.We retrospectively analyzed tumors from stage IV colorectal cancer patients from a central pathology laboratory in Brazil that is a reference for mutational profiling countrywide. Patients were classified into age groups as follows: prescreening age (PrSA; 45 years old), screening age (SA; 45-75 years old), and postscreening age (PoSA;75 years old). Every tumor was centrally reviewed by the pathologist. Groups were compared regarding clinicopathologic features, and the presence of RAS (renin-angiotensin system) and BRAF (v-Raf murine sarcoma viral oncogene homolog B) mutations.We included 1635 patients (215 PrSA, 1213 SA, 207 PoSA). There was no difference among groups regarding sidedness (P = .65) and KRAS (Kirsten rat sarcoma viral oncogene) mutations (P = .57). Stage IV disease at diagnosis (P = .04), the presence of a signet-ring cell component (P .001), and poorly differentiated tumors (P = .02) were most common in young patients, while BRAF and NRAS (neuroblastoma RAS viral (v-ras) oncogene homolog) mutations were significantly more common among PoSA patients (P = .002 and .03, respectively). When divided by age decade, KRAS mutations seem to have a stable frequency among all ages, while the BRAF mutation rate increased with increasing age.BRAF mutations are more frequent among PoSA patients, and this seems to be a continuous trend. PrSA and PoSA patients seem to present a distinct profile from SA, including differences in molecular and pathologic aspects. These findings could impact the frequency of screening tests among different age groups.

Background Women have been assuming more responsibilities and higher positions in major companies, which exposes them to high levels of stress. Higher perceived work stress is related to higher emotional reactivity. Difficulties with emotional regulation can lead to anxiety and mood disorders, which are more prevalent in women than men. Indeed, women leaders are more likely to experience emotional fatigue than men due to excessive empathy. Our aim was to evaluate the associations between self-compassion (SC) scores to depression symptoms, perceived stress and mindfulness, as well as with brain responses to high-arousal unpleasant and pleasant pictures from the International Affective Picture System (IAPS), as measured through functional Magnetic Resonance Imaging (fMRI) in women managers. Methods Forty-six participants were selected for the study. All participants filled the Self Compassion Scale (SCS), Beck Depression Inventory (BDI), Mindful Awareness Attention Scale (MAAS) and the Perceived Stress Scale (PSS). After that they were scanned during an fMRI affective response paradigm. Correlation analysis were performed among these variables. Results Our data suggest that women with higher SC scores respond to affective stimuli with higher activation of the precuneus (a brain region related to self-referential processing), lower levels of stress and depression and show greater attention in everyday activities. Conclusion SC may be an important characteristic for women leaders because of its association with higher sensitivity to emotional stimuli and mindfulness. These skills may allow them to be more aware of others while being less susceptible for stress and depression symptoms. Electronic supplementary material The online version of this article (10.1186/s12905-018-0685-y) contains supplementary material, which is available to authorized users.

Background and study aims Obesity is a serious disease, resulting in significant morbidity and mortality. Intragastric balloons (IGBs) have been in use since the 1980s. After the insertion of an IGB, complications such as migration of the device and even severe gastric perforation can occur, requiring laparoscopic surgery. Here, we report three cases of gastric perforation after IGB insertion. In all three cases, the perforation was successfully repaired through an exclusively endoscopic approach.

Weight regain occurs in about 20% of patients after Roux-en-Y gastric bypass (RYGB). Studies have reported that in most cases this regain is associated with dilatation of the gastrojejunal anastomosis. To correct this dilatation, one of the methods used is the application of argon plasma coagulation (APC).The authors report the case of a 39-year-old woman submitted to RYGB who had weight regain. In the endoscopic evaluation, the patient presented with dilatation of the gastrojejunal anastomosis, for which treatment with APC and an adjusted diet was proposed. After 3 sessions of APC, the patient presented with a reduction of the anastomosis diameter, weight loss, and increased satiety to food, with an increased gastric emptying time evidenced by scintigraphy.APC proved to be a safe and efficacious method.O reganho de peso após bypass gástrico em Y de Roux (RYGB) ocorre em cerca de 20% dos doentes. Estudos relatam que na maioria dos casos este reganho está associado a dilatação da anastomose gastrojejunal. Para corrigir esta dilatação um dos métodos utilizados é a apli-cação de árgon plasma (APC).Os autores relatam o caso de uma mulher de 39 anos de idade, submetida a RYGB, que apresentou reganho de peso. Na avaliação en-doscópica a doente apresentava dilatação da anastomose gastrojejunal sendo proposta a realização de APC e dieta ajustada. Após 3 sessões de APC, a doente apresentou redução do diâmetro da anastomose associada a perda de peso, aumento da saciedade alimentar e aumento do tempo de esvaziamento gástrico documentado em cintigrafia.O tratamento com APC mostrou ser um méto-do seguro e eficaz.

The intragastric balloon is an excellent nonsurgical alternative for weight loss. The placement procedure is standardized but some measures are needed to guarantee its safety. Kinking of the device, twisting into the mouth, and obstruction of the tip of the catheter in the stomach are troublesome situations that may arise during the procedure. This chapter aims to demonstrate examples of difficulties during the implantation of the balloon and to suggest alternatives to solve these problems.

The mechanism of weight loss with the intra-gastric balloon (IGB) is thought to be a decrease in gastric emptying (GE); however the evidence is conflicting. Nausea, abdominal pain, and gastroesophageal reflux disease (GERD) can cause intolerance resulting in early removal. This is demoralizing for the patient and costly for the healthcare system. The ability to predict which patients will have superior weight loss and tolerance is invaluable. We sought to investigate if the IGB induced weight loss by reducing GE and the effect of the IGB on the DeMeester score. We retrospectively reviewed prospectively collected data for patients undergoing IGB placement at a single hospital. Manometry and pH studies were performed before and with the IGB in place. Weight was measured at baseline, at removal, and 6 months later. Adverse events leading to early removal were recorded. Twenty-four patients were evaluated. There was a statistically significant decrease in GE for solids with the IGB (117.92 ± 150.23 vs 281.48 ± 206.49 min; p = 0.0048), but not for liquids (54.44 ± 17.97 vs 56.08 ± 43.96 min; p = 0.7228). The lower esophageal sphincter (LES) pressure did not change significantly with placement of the IGB (17.76 ± 7.39 vs 14.74 ± 7.24 mmHg; p = 0.09). On multivariate analysis, increase in DeMeester score was associated with total body weight loss (p = 0.0125) and change in GE (p = 0.038) independently. The IGB delays GE for solids, but not for liquids, and increases the DeMeester score by a mechanism other than a loss of LES pressure.

Objective: To propose and test a scale to measure the salesperson’s integration into the product development process (PDP), considering the perspective of salespeople.Methodology: The data were collected through a survey applied to 258 salespeople from medical device industry and analyzed using exploratory and confirmatory factor analysis.Main results: The analysis of the scale’s psychometric properties was satisfactory, with good reliability and validity parameters.Contributions: The study provides an instrument for measuring salesperson’s integration into the PDP, considering the perspective of salespeople, since much of what is in the literature is based on managers and supervisors’ opinions. Also, the study can help organizations design PDPs that effectively integrate the salesperson, covering a range of meaningful information for the company, as well as helping to maintain employees with a broader view of sales activity.Relevance / originality: Lack of clarity regarding sales force integration into the PDP indicates that the salesperson may receive non-effective training, resources may be invested incorrectly, and worthy information may be lost simply because there is no understanding on the part of the salesperson that they are part of the product development process. Objetivo: Propor uma escala para mensurar a integração do vendedor ao Processo de Desenvolvimento de Produtos (PDP), considerando a perspectiva deste profissional.Metodologia: Por meio de técnicas de análise fatorial exploratória e confirmatória e estudos de validade foram analisados dados colhidos de 258 vendedores do segmento médico-hospitalar.Principais resultados: A escala desenvolvida apresentou propriedades psicométricas adequadas para a finalidade proposta, com bons parâmetros de confiabilidade e validade.Contribuições: Proposta de uma forma de mensuração da integração do vendedor ao PDP, segundo a perspectiva desse ator, uma vez que muito do que há na literatura se baseia na opinião de gerentes e supervisores. Paralelamente, o estudo poderá ajudar as organizações a projetar e implantar PDPs nos quais a integração do vendedor possa se dar de maneira efetiva, cobrindo uma gama de informações significativa para a empresa, assim como ajudá-la a manter funcionários com uma visão ampliada a respeito da atividade de vendas.Relevância / originalidade: A falta de clareza quanto à integração da força de vendas ao PDP, indica que o vendedor pode receber treinamentos que eventualmente sejam desperdiçados, recursos podem ser investidos nele incorretamente e informações muito ricas podem ser perdidas simplesmente porque não há entendimento por parte do profissional de vendas de que ele é um elemento integrante do processo.

The Hedgehog pathway (HhP) plays an important role in normal embryonic development and its abnormal function has been linked to a variety of neoplasms. Recently, the complex mechanisms involved in this pathway have been deciphered and the cross talks with other important pathways involved in carcinogenesis have been characterized. This knowledge has led to the development of targeted therapies against key components of HhP, which culminated in the approval of vismodegib for the treatment of advanced basal cell carcinoma in 2012. Since then, other compounds have been developed and evaluated in preclinical and clinical studies with interesting results. Today, several medications against components of the HhP have demonstrated clinical activity as monotherapies and in combination with cytotoxic treatment or other targeted therapies against mitogenic pathways that are linked to the HhP. This review aims to clarify the mechanism of the HhP and the complex crosstalk with others pathways involved in carcinogenesis and to discuss both the evidence associated with the growing number of medications and combined therapies addressing this pathway and future perspectives.

Purpose As cancer burden has risen worldwide, physicians, patients, and their advocates have become aware that the clinical cancer trial research paradigm is not ubiquitous. Furthermore, the number and characteristics of trials that are registered in low- and middle-income countries (LMICs) compared with that in high-income countries (HICs) are unknown. Methods We collected retrospective data on trials for breast, lung, and cervical cancer registered in ClinicalTrials.gov or with the WHO International Clinical Trial Registry Platform between 2010 and 2017. The data were then classified as trials within LMICs or HICs using definitions from the World Bank. Results Included in these analyses were 6,710 trials, of which 3,164 (47%) were breast cancer trials, 3,283 (49%) were lung cancer trials, and 263 (4%) were cervical cancer trials. There were 1,951 (29%) trials from LMICs and 4,759 (71%) trials from HICs ( P < .001). Although the proportion of phase III trials in HICs versus LMICs was similar (18% v 17%; P = .66), the number of phase I trials in LMICs was significantly lower than that of HICs (20% v 2%; P < .001). For several LMICs with the highest mortality-to-incidence ratios for breast, lung, or cervical cancer, there were no cancer trials registered in the registration data bases searched for this work. Conclusion There are differences in access to cancer clinical trials in LMICs compared with HICs. Several factors, such as excessive cost and a lack of infrastructure and expertise, may explain these differences.

Laparoscopic greater curvature plication (LGP) has recently emerged as a new bariatric procedure. This surgery provides gastric restriction without resection, which could potentially provide a lower risk alternative, with fewer complications. The real benefit of this technique in the short and long term is unknown. This systematic review aims to compare laparoscopic gastric plication and laparoscopic sleeve gastrectomy for obesity treatment. Clinical trials were identified in MEDLINE, Embase, Cochrane, LILACS, BVS, SCOPUS, and CINAHL databases. Comparison of LGP and laparoscopic sleeve gastrectomy (SG) included hospital stay, operative time, loss of hunger feeling, body mass index loss (BMIL), percentage of excess weight loss (%EWL), complications, symptoms in the postoperative period, and comorbidity remission or improvement. This systematic review search included 17,423 records. Eight studies were selected for meta-analysis. There is no difference in operative time, hospital stay, and complications. Patients in the SG group had improved loss of hunger feeling. BMIL was better in the SG group at 12 and 24 months [mean difference (MD) − 2.19, 95% confidence interval (CI) − 3.10 to − 1.28, and MD − 4.59, 95% CI − 5.55 to − 3.63, respectively]. SG showed improved %EWL compared with gastric plication in 3, 6, 12, and 24 months. However, no difference was found in %EWL long-term results (24 and 36 months). Patients who underwent LGP had more sialorrhea. SG showed better results in diabetes remission. SG showed improved weight loss when compared with LGP, with better satiety, fewer symptoms in the postoperative period, and improved diabetes remission.

Endoscopic approaches exist for targeting weight regain after Roux-en-Y gastric bypass (RYGB), including endoscopic suturing, clipping, and sclerotherapy. Argon plasma coagulation (APC) is a noncontact electrocoagulation method, and when used in RYGB patients, it has shown reduction in the diameter of the gastrojejunal anastomosis. To study the effectiveness of APC for weight regain in terms of weight loss for RYGB patients, from eight bariatric centers. A retrospective chart review was performed for 558 patients at eight bariatric centers in the USA (1) and Brazil (7) who underwent APC procedure between 31st July 2009 and 29th March 2017. APC was performed on patients who regained weight after RYGB procedure. Upon exploratory analysis of the individual BMI data, the mean BMI decreased slightly during the first 24 months and increased slightly afterwards following the APC intervention. The mean weight was 94.5 ± 18.6 kg and the mean BMI was 34.0 kg/m2 at APC. Where data were available, the mean of lowest weight was 67.0 ± 23.0 kg and the mean of lowest BMI was 24.1 kg/m2 following gastric bypass. The mean weight loss was 6.5, 7.7, and 8.3 kg at 6, 12, and 24 months, respectively, and the changes in weight over time was statistically significant (p

Os últimos anos têm sido marcados por relevantes mudanças mercadológicas. O atual ambiente competitivo sugere mudanças na forma de administrar os custos para possibilitar a continuidade da empresa no mercado. Para tanto, é importante que se tenha um controle adequado e a alocação correta de custos. Este trabalho busca identificar o método de rateio mais indicado para controlar custos em uma empresa de grande porte que atua na área de engenharia de concreto. Para os comparativos, foram utilizados dois cenários de custeio diferentes, o método ABC (Activity Based Costing) e o sistema por departamentalização. Para a realização desta pesquisa foram levantados dados quantitativos de custo da empresa, os quais foram contemplados por entrevistas com os gestores. A partir do estudo realizado foi possível a constatação de que o método ABC se adapta a empresas do ramo da construção civil, pois o sistema proporciona aos gestores melhor visualização de seus custos fornecendo informações que podem auxiliar na tomada de decisão. O método procura reduzir as distorções provocadas pelo rateio arbitrário dos custos indiretos, fazendo uma análise dos custos das atividades significativas desenvolvidas na empresa e definindo seus direcionadores. Além disso, a pesquisa forneceu à organização condições para analisar e visualizar todos os seus custos de uma maneira mais detalhada, obtendo um controle absoluto sobre seus gastos.

BackgroundAlthough the availability and use of mobile mental health apps has grown exponentially in recent years, little data are available regarding their efficacy.ObjectiveThis study aimed to evaluate the effectiveness of an app developed to promote stress management and well-being among working women compared with a control app.MethodsFemale employees at a private hospital were invited to participate in the study via mailing lists and intranet ads. A total of 653 individuals self-enrolled through the website. Eligible participants were randomized between control (n=240) and intervention (n=250) groups. The well-being mobile app provides an 8-week program with 4 classes per week (including a brief theoretical portion and a 15-min guided practice). The active control app also provided 4 assessments per week that encouraged participants to self-observe how they were feeling for 20 min. We also used the app to conduct Web-based questionnaires (10-item Perceived Stress Scale and 5-item World Health Organization Well-Being Index) and ask specific questions to assess subjective levels of stress and well-being at baseline (t1), midintervention (t4=4 weeks after t1) and postintervention (t8=8 weeks after t1). Both apps were fully automated without any human involvement. Outcomes from the control and intervention conditions at the 3 time points were analyzed using a repeated measures analysis of variance.ResultsAmong the randomized participants (n=490), 185 participants were excluded at the 4-week follow-up and another 79 at the 8-week follow-up because of noncompliance with the experimental protocol. Participants who did not complete t4 and t8 assessments were equally distributed between groups (t4: control group=34.6% [83/240] and intervention group=40.8% [102/250]; P=.16; t8: control group=29.9% [47/157] and intervention group=21.6% [32/148]; P=.10). Both groups showed a significant increase in general well-being as a function of time (F2,426=5.27; P=.006), but only the intervention group presented a significant increase in work-related well-being (F2,426=8.92; PConclusionsThe well-being mobile app was effective in reducing employee stress and improving well-being.Trial RegistrationClinicaltrials.gov NCT02637414; https://clinicaltrials.gov/ct2/show/NCT02637414.

3596 Background: Screening protocols for CRC are broadly recommended and effective in reducing mortality. However, populations from different age groups can harbor distinct pathological and molecular profiles that can also be influenced by screening and polyp resection, especially in older ages. Methods: We retrospectively analyzed tumors from stage IV CRC patients from a central pathology laboratory in Brazil that is a reference for mutational profiling countrywide. Patients were classified into age groups as the following: pre-screening (PrSA; 75yo). Every tumor has been centrally reviewed by the pathologist. Groups were compared regarding clinicopathologic features and presence of RAS and BRAF mutations. Results: We included 1244 pts (164 PrSA, 919 SA and 161 PoSA). There were no difference among groups regarding sidedness(p= .68)and KRASmutations (p=.0.97). Stage IV at diagnose (p =.001), presence of signet-ring cell component (p< .001) along with poorly differentiated tumors (p= .006) were most found on young patients, while BRAFand NRASmutations where significantly more common among PosSA (table). Conclusions: PosSA and PreSA CRCs seem to present a distinct profile from SA populations, including differences in the molecular and pathologic aspects. This could impact the frequency of screening tests among different age groups. [Table: see text]