Purpose To evaluate prospectively the engraftment rate, factors influencing engraftment, and predictability of clinical outcome of low-passage xenografts from patients with resectable pancreatic ductal adenocarcinoma (PDA) and to establish a bank of PDA xenografts. Experimental Design Patients with resectable PDA scheduled for resection at the Johns Hopkins Hospital were eligible. Representative pieces of tumor were implanted in nude mice. The status of the SMAD4 gene and content of tumor-generating cells were determined by immunohistochemistry (IHC). Gene expression was performed using U133 Plus 2.0 array. Patients were followed for progression and survival. Results 94 patients with PDA were resected, 69 tumors implanted in nude mice, and 42 (61%) engrafted. Engrafted carcinomas were more often SMAD4 mutant, had a metastatic gene expression signature and worse prognosis. Tumors from patients resistant to gemcitabine were enriched in stroma-related gene pathways. Tumors sensitive to gemcitabine were enriched in cell cycle and pyrimidine gene pathways. The time progression for patients who received treatment with gemcitabine for metastatic disease (n=7) was double in patients with xenografts sensitive to gemcitabine. Conclusion A successful xenograft was generated in 61% of patients attempted, generating a pool of 42 PDA xenografts with significant biological information and annotated clinical data. Patients with PDA and SMAD4 inactivation have a better engraftment rate. Engraftment is a poor prognosis factor, and engrafted tumors have a metastatic gene expression signature. Tumors from gemcitabine-resistant patients were enriched in stromal pathways.

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RESUMOObjetivos: identificar características dos serviços de atenção domiciliar brasileiros. Método: revisão integrativa, que buscou artigos científicos publicados entre janeiro de 2012 a maio de 2017, nas bases de BDENF, LILACS e na biblioteca virtual SciELO. A avaliação dos estudos foi feita pela leitura dos resumos dos artigos que respondessem como é o cenário da assistência domiciliar no Brasil e os resultados foram apresentados em forma de tabela e sínteses. Resultados: a amostra foi composta por nove artigos dos quais foram possíveis identificar três categorias temáticas – “os grupos populacionais prevalentes na assistência domiciliar”, “o perfil dos profissionais e dos cuidadores familiares inseridos nesse contexto” e “características do serviço de atenção domiciliar”. Conclusão: a atenção domiciliar é um eficaz meio de desospitalização e redução de custo e humanização do cuidado, porém, de acesso escasso aos usuários da rede pública de saúde. Descritores: Serviços de assistência domiciliar; Serviços hospitalares de assistência domiciliar; Assistência domiciliar; Saúde Pública; Educação em Saúde; Assistência Integral à Saúde.ABSTRACTObjectives: to identify characteristics of Brazilian home care services. Method: integrative review, which sought scientific articles published between January 2012 and May 2017, in the databases of BDENF, LILACS and the virtual library SciELO. The evaluation of the studies was done by reading the summaries of the articles that answered the scenario of home care in Brazil and the results were presented in a table and summaries. Results: the sample consisted of nine articles of which it was possible to identify three thematic categories - "population groups prevalent in home care", "the profile of professionals and family caregivers inserted in this context" and "characteristics of the home care service". Conclusion: home care is an effective means of dehospitalization and reduction of the cost and humanization of care, however, of scarce access to the users of the public health system. Descriptors: Home care services; Home care hospital services; Home assistance; Public health; Health Education; Comprehensive Health Care.RESUMENObjetivos: identificar las características de los servicios de atención domiciliaria brasileñas. Método: revisión integrativa, que buscó artículos científicos publicados entre enero de 2012 a mayo de 2017, en las bases de BDENF, LILACS y en la biblioteca virtual SciELO. La evaluación de los estudios fue realizada por la lectura de los resúmenes de los artículos que respondieran como es el escenario de la asistencia domiciliaria en Brasil y los resultados se presentaron en forma de tabla y síntesis de los resultados. Resultados: la muestra fue compuesta por nueve artículos de los cuales fueron posibles identificar tres categorías temáticas - “los grupos poblacionales prevalentes de la asistencia domiciliaria”, “el perfil de los profesionales y de los cuidadores familiares insertados en este contexto” y “las características del servicio de atención domiciliaria”. Conclusión: la atención domiciliaria es un eficaz medio de desospitalización y reducción de costo y humanización del cuidado, pero, de acceso escaso a los usuarios de la red pública de salud. Descriptores: Servicios de asistencia domiciliaria; Servicios hospitalarios de asistencia domiciliaria; Asistencia domiciliaria. Salud pública; Educación en Salud; Asistencia Integral a la Salud.

BACKGROUND: Rheumatoid arthritis (RA) is a chronic disease with higher prevalence among women aged between 30 and 50 years and general prevalence of 1% worldwide. Interventions promoting improvement of quality of life for individuals with RA are required. Tai Chi appears to be a low-cost alternative, with studies showing positive results from this technique. However, regarding aspects of RA such as pain and sensitivity, studies remain inconclusive. OBJECTIVES: To compare the effectiveness of the Tai Chi method for treating patients diagnosed with rheumatoid arthritis, among systematic reviews. DESIGN AND SETTING: Overview of systematic reviews with Cochrane and non-Cochrane methodology. METHODS: Systematic reviews involving quasi-randomized and randomized clinical trials (RCTs) on use of Tai Chi, with no restrictions regarding the date and language of publication, were included. RESULTS: Three systematic reviews were included. The effects of Tai Chi associated with education and stretching exercises versus education and stretching were evaluated in these reviews. They showed that improvements in the variables of mood, depression and functional index were associated with use of Tai Chi. CONCLUSIONS: The findings suggest that clinical improvement was achieved, although not statistically significant with regard to pain and disease pattern, as assessed using the ACR20 measurement. Improvements relating to disability and quality of life were also seen. There was a low level of evidence and therefore caution in data analysis is recommended. The three studies included showed poor reliability for providing an accurate and complete summary of use of Tai Chi among people diagnosed with rheumatoid arthritis. PROSPERO: CRD42019125501.

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The present article aims to evaluate the outcomes of enteral nutrition for people with advanced dementia. A systematic review was conducted by searching The Cochrane Library, MEDLINE, EMBASE, PROQUEST and LILACS for articles that were published from 2008 to 2013. Prospective and retrospective studies involving a control group were searched. Data were independently extracted and assessed by one reviewer and checked by a second. Searched outcomes included survival, clinical and nutritional parameters and complications. In total, nine controlled studies were identified from several parts of the world: Israel, Italy, Japan, the United States and Brazil. Most of the studies did not report any outcome of harm with enteral nutrition use in dementia patients compared with patients without dementia. A study with a higher follow-up period demonstrated improvements in albumin, weight and chronic inflammation parameters. It is not possible to affirm that tube feeding is harmful for dementia patients. Thus, an adequate follow-up by a multidisciplinary team may lower complications associated with this therapy and thus improve survival.

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A desnutrição tem sido algo muito comum em crianças e adolescentes submetidos a tratamentos oncológicos. Trata-se de uma doença causada pela falta de nutrientes, gerando um déficit e ocasionando uma série de danos ao organismo, podendo até levar à morte caso não tratada. Devido aos seus efeitos adversos, a nutrição, com a terapia nutricional, possui um papel importantíssimo na manutenção e melhora do estado nutricional desses pacientes. O presente estudo teve como objetivo principal alertar a respeito da incidência da desnutrição em pacientes oncológicos e da importância da terapia nutricional nesse momento. Tratou-se de um estudo observacional, do tipo transversal descritivo. A coleta de dados foi feita por meio da aplicação de um questionário online com pais ou responsáveis de crianças e/ou adolescentes na faixa etária de 7 a 19 anos, onde foram obtidas informações como dados antropométricos, tipo de tratamento em realização e os sintomas apresentados. Essas informações resultaram em uma prevalência de neoplasias no público masculino, com média de idade de 12,5 anos, pacientes, em sua maioria, de quimioterapia e radioterapia. Houve perda de peso considerável, em 92,9% dos participantes da pesquisa, devido aos diversos sintomas gastrointestinais e orais apresentados e com isso, percebeu-se a importância da terapia nutricional nesse tratamento, com o intuito de minimizar o declínio no estado nutricional do paciente.