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Introduction: The increasing cost of novel technologies in the oncohematology field, with increasingly flexible regulatory criteria for approval by regulatory agencies, has raised concerns among private Health Technology Assessment (HTA) bodies. The ASCO framework and ESMO-MCBS-H are validated tools designed to assess clinical benefit in oncology. Objectives: This study aims to evaluate the utility and limitations of these tools in integrating new technologies into the institutional protocol of an Oncology Network in Brazil. Material and methods: We applied the ASCO and ESMO tools validated to hematologic scenario to evaluate the clinical benefit of drugs approved by the Brazilian regulatory agency (ANVISA) for hematological malignancies in the last two-years. In addition, we assessed the quality of evidence according to the GRADE framework and the risk of bias in the ROB-2 tool. Results: Our analysis included 12 new drug approvals and five advanced therapy indications for CAR-T cells for a total of 17 assessments. Of these, five drugs were not covered by supplementary health insurance. Eight (47%) trials were phase-III, and nine (53%) were phase-II or I/II. Nine trials (53%) were randomized, and only one (6%) was blinded. Eight (47%) reported progression-free survival or event-free survival as the primary endpoint. Noteworthy, one of the trials does not have efficacy measures as a primary endpoint. The mean of ASCO score was 41.04±8.94, with only one study (6%) meeting the cut-off score of 45 for relevant clinical benefit. For the ESMO-MCBS-H, only two trials (11,7%) achieved grade 4, indicating a substantial magnitude of clinical benefit. Curiously, the only trial that passed the GRADE and ROB2 tools did not pass the ASCO or ESMO assessments. Discussion: The use of classical evidence assessments together with validated scores to assess clinical benefit in oncohematology has not led to the approval of any of the most recent approvals in hematological malignancies in Brazil. While the ESMO-MCBS-H provided assessment forms specifically designed for hematological malignancies, it is unclear how the ASCO framework is appropriate for assessing the value of treatments for blood cancers. GRADE and ROB2 are the main references for assessing the certainty of evidence and can be used by health care providers. They are recommended for use in systematic reviews and decision-making by HTA agencies such as ANVISA and NICE. However, they have rigorous criteria for evaluating trials that are sometimes unattainable in some clinical scenarios or treatment peculiarities, such as those that prevent blinded interventions. Such conditions are often found in hematological malignancies. Real-world evidence (RWE) is a supplemental source of data, especially relevant in populations that are under-represented in clinical trials, such as the Brazilian population. However, there is still room for improvement in terms of standardisation and tools for RWE quality assessment. Conclusion: Our findings highlight the current challenges of incorporating new technologies in the private Oncology Network in Brazil and the urge need for new tools to ensure confidence in the healthcare decisions in line with contemporary trends in oncohaematology.

OBJECTIVES: We propose a preventive and therapeutic assessment program for mucositis in patients with cancer based on a comprehensive review of scientific evidence. MATERIAL AND METHODS: This methodological study, designed as a non-systematic review, entails a thorough review of the scientific evidence on the management of mucositis in patients with cancer. The PICO method was used, allowing for a structured approach to explore and synthesize relevant evidence. RESULTS: Effective mucositis management requires regular assessments, dental exams, preventive strategies, and consideration of modifiable risk factors. Pharmacological therapies may be considered for severe cases, while oral antimicrobials, prophylactic antiviral and antifungal therapy can prevent infections. Topical anesthetics o?er pain relief but require careful administration. A gradual management plan, from gentle rinses to analgesics, is recommended. CONCLUSION: The suggested program may improve the identification, prevention, and management of this complication to achieve optimal management outcomes.

Abstract The European Spallation Source ERIC (ESS), currently under construction in Lund, Sweden is a facility established to deliver the highest integrated neutron flux originating from a pulsed source with the aim of supporting an initial fifteen neutron instruments for cutting edge science experiments. This in turn requires reliable monitoring at complex neutron beam lines: in particular, linearity, timing capability, adaptability of the design for various flux ranges (dynamic range) and sensitivity to neutrons within the range of 0.6-10Å are expected from the neutron beam monitors to be installed at the ESS beam lines. Additionally, operational stability and low attenuation are also desirable characteristics for such neutron beam monitoring. A prototype neutron beam monitor based on the ionisation chamber principle and a boron converter, designed by CDT CASCADE Detector Technologies GmbH and ESS, has been investigated at the BER-II research reactor of Helmholtz Zentrum Berlin (HZB). The effort to design and investigate a thermal neutron ionisation beam monitor was initiated by adapting the concept of ionisation chambers previously known elsewhere. So far all the characterised neutron beam monitors discriminate neutron hits on a discrete event basis (pulse mode), whereas the beam monitor prototype introduced in this paper estimates the total flux as a function of current (current mode). While most other neutron beam monitoring devices and detectors rely upon a signal amplifying gain stage, the ionisation chamber operates without any gain and is consequently robust against typical detector ageing effects that compromise the sensitivity over time. The initial tests were performed at the ESS V20 test beam line under realistic conditions resembling those of the future pulses of ESS. The linearity is demonstrated for 3Å pulses in the flux range of 2-3 × 105 n/s/cm2 and for white pulses (0.6-10Å) in the range of 1-5 × 106 n/s/cm2. The timing behaviour resembles the data previously recorded at the V20 beam lines. This novel implementation of a neutron sensitive ionisation chamber shows great promise for beam monitoring and diagnostics at ESS. As the ionisation beam monitor itself is an entirely passive device, it is adequately robust to be employed in areas of high irradiation where no regular servicing or maintenance can be provided.

Immunotherapy (IT) in the form of monoclonal antibodies targeting coreceptors involved in the modulation of the immune synapse represents a standard of care for patients with distinct malignancies. Over the past years, evidences supporting the clinical use of IT both in monotherapy, as well as in combinatorial regimens, grew dramatically, leading to multiple regulatory approvals. With the expanding clinical incorporation of IT, understanding the mechanisms and management of the adverse events (AE) associated with this class of drugs is of utmost importance for professionals involved in patient care. In 2017, the Brazilian Society of Clinical Oncology (SBOC) issued the initial version of the “Brazilian guidelines for the management of immune-related toxicities associated with checkpoint inhibitors”. In this article, we aimed to update general and specific aspects related to immune-related AEs associated with the use of immune-checkpoint inhibitors, including emerging evidences and updated algorithms for the most frequent clinical manifestations.

A prototype quasiparasitic thermal neutron beam monitor based on isotropic neutron scattering from a thin natural vanadium foil and standard ^{3}He proportional counters is conceptualized, designed, simulated, calibrated, and commissioned. The European Spallation Source designed to deliver the highest integrated neutron flux originating from a pulsed source is currently under construction in Lund, Sweden. The effort to investigate a vanadium-based neutron beam monitor was triggered by a list of requirements for beam monitors permanently placed in the ESS neutron beams in order to provide reliable monitoring at complex beam lines: low attenuation, linear response over a wide range of neutron fluxes, near to constant efficiency for neutron wavelengths in a range of 0.6–10 Å, calibration stability and the possibility to place the system in vacuum are all desirable characteristics. The scattering-based prototype, employing a natural vanadium foil and standard ^{3}He proportional counters, was investigated at the V17 and V20 neutron beam lines of the Helmholtz-Zentrum in Berlin, Germany, in several different geometrical configurations of the ^{3}He proportional counters around the foil. Response linearity is successfully demonstrated for foil thicknesses ranging from 0.04 mm to 3.15 mm. Attenuation lower than 1% for thermal neutrons is demonstrated for the 0.04 mm and 0.125 mm foils. The geometries used for the experiment were simulated allowing for absolute flux calibration and establishing the possible range of efficiencies for various designs of the prototype. The operational flux limits for the beam monitor prototype were established as a dependency of the background radiation and prototype geometry. The herein demonstrated prototype monitors can be employed for neutron intensities ranging from 10^{3}–10^{10} n/s.

No Brasil, o uso de vários modelos de criação intensiva e semi-extensiva desfavorece a adoção generalizada de métodos de manejo do gado bovino, principalmente do gado leiteiro. Mesmo assim, a produção leiteira pode ser melhorada a partir do uso de tecnologias que possam garantir o manejo adequado do rebanho. O objetivo deste trabalho foi desenvolver um índice de previsão de produção de leite para vacas Jersey em lactação, de genética de alta produtividade, em regime semi-estabulado, nas condições tropicais. Para a obtenção do índice, consideraram-se a temperatura e a umidade relativa do ambiente e a velocidade do ar, assim como valores de precipitação pluviométrica, temperatura do solo do pasto e a radiação solar como agentes estressores, os quais podem alterar a produção de leite. O experimento considerou dois tratamentos: A - as vacas permaneceram em sala de espera guarnecida com chuveiro e ventiladores, por um período 30 min antes da ordenha; B - as vacas não tiveram acesso a essa sala de espera (controle). Fora do período de ordenha, as vacas tiveram acesso ao pasto. Observou-se que as diferenças de médias de produção entre os tratamentos não foram estatisticamente significativas. Foram procedidas as análises para efeito de elaboração do modelo e chegou-se a um modelo factível, considerando a relação entre produção e a precipitação, assim como a temperatura máxima do solo do pasto.In Brazil the adoption of several models of cattle confinement leads to special conditions for management methods in dairy production, which can be improved by the use of technology that assures better herd management. Indexes relating environmental variables to production are applied for the prediction of milk production. The values of temperature and relative humidity, rain index, solar radiation and pasture soil temperature are generally considered potential stress agents for cows. The objective of this research was to develop an index for predicting milk production for high productivity Jersey milking cows lodged in semi confinement in tropical conditions. The experiment considered two treatments: A - the cows waited for 30 minutes prior to milking in a room with a shower associated to a fan; B - the cows did not have access to this room (control). Other than the waiting period, the cows had access to pasture. Differences in the effect of average production were not statistically significant. The analysis for studying the effect of the variables and designing the model led to a statistical model relating the variables milk production and rain index, as well as the maximum soil temperature of pasture, and milk production.

Abordaram-se, quantitativamente, parâmetros do eletrencefalograma e suas relações com idade, sexo e fatores sócio-educacionais. Foram estudadas 162 crianças de 7 a 11 anos de idade sem problemas neurológicos, psiquiátricos ou déficit cognitivo em testes psicométricos. Foram submetidas a entrevista, exame clínico-neurológico, teste de Matrizes Progressivas de Raven, Teste de Desempenho Escolar e eletrencefalograma quantitativo durante a vigília, em repouso. Observou-se, com a idade, diminuição das potências absoluta e relativa das faixas delta e teta assim como aumento da potência relativa alfa 2. Tais achados são semelhantes aos de outras populações da Europa, Ásia e América do Norte. Observou-se, ainda, que as potências absolutas delta e, especialmente, alfa foram maiores nas crianças com melhor desempenho no Teste de Desempenho Escolar, de modo independente da idade e do sexo da criança e da escolaridade materna. Não houve diferenças significativas da atividade elétrica cerebral segundo o sexo da criança e a escolaridade das mães.