Abstract In Malignant Hilar Biliary Stricture (MHBS) palliative biliary drainage is a frequent strategy, improving the quality of life, reducing pruritus, loss of appetite and relieving cholangitis. The endoscopic approach is an effective, although challenging procedure. This study aimed to evaluate technical and clinical success rates of biliary drainage by ERCP. This is a retrospective study including all patients with MHBS referred to Instituto do Cancer do Hospital de São Paulo (ICESP) submitted to biliary drainage by ERCP, between January 2010 and December 2017. Multivariable logistic regression was performed to evaluate predictors of clinical failure, as total bilirubin levels, Bismuth classification, number of hepatic sectors drained and presence of cholangitis. In total, 82 patients presenting unresectable MHBS were included in this study. 58.5% female and 41.5% male, with a mean age of 60±13 years. Bismuth classification grades II, IIIA, IIIB and IV were noted in 23.2%, 15.9%, 14.6% and 46.3%, respectively. Technical and clinical success was achieved in 92.7% and 53.7% respectively. At multivariable logistic-regression analyses, Bismuth IV strictures were related to higher clinical failure rates when compared to other strictures levels, with an Odds Ratio of 5.8 (95% CI 1.28‒20.88). In conclusion, endoscopic biliary drainage for malignant hilar biliary stricture had a high technical success but suboptimal clinical success rate. Proximal strictures (Bismuth IV) were associated with poor drainage outcomes.

RESUMO CONTEXTO: Um local comum de tumores neuroendócrinos (TNEs) é o reto. A técnica mais utilizada é a ressecção endoscópica da mucosa com injeção de solução salina. No entanto, as margens profundas costumam ser difíceis de ressecar porque a invasão da submucosa é comum. A ressecção endoscópica sob imersão d’água (RESI) é uma técnica em que o lúmen intestinal é preenchido com água em vez de ar, evitando a necessidade de elevação submucosa. OBJETIVO: Este estudo teve como objetivo avaliar a eficácia e segurança da RESI para a remoção de pequenos TNEs retais (rTNEs). MÉTODOS: Estudo retrospectivo com pacientes que realizaram RESI em dois centros. RESI foi realizada usando um colonoscópio padrão. Nenhuma injeção submucosa foi realizada. Patologistas certificados conduziram avaliação histopatológica. RESULTADOS: RESI foi realizada para pequenos rTNEs em 11 pacientes (nove mulheres) com média de idade de 55,8 anos e 11 lesões (tamanho médio de 7 mm, variando de 3-12 mm). Havia 9 (81%) pacientes com G1 rTNEs e dois pacientes com G2, sendo que todos os tumores invadiam a submucosa sendo apenas um restrito a mucosa. Nenhum caso mostrou invasão vascular ou perineural. Todas as lesões foram removidas em bloco. Nove (81%) ressecções tiveram margens livres. Dois pacientes tiveram envolvimento de margens profundas; um teve biópsias negativas por meio de vigilância endoscópica e o outro perdeu o acompanhamento. Não ocorreram perfurações ou sangramento tardios. CONCLUSÃO: A RESI parece ser uma alternativa eficaz e segura para o tratamento de pequenos rTNEs sem eventos adversos e com altas taxas de ressecção em bloco e R0. Mais estudos prospectivos são necessários para comparar as intervenções endoscópicas disponíveis e para elucidar a técnica endoscópica mais adequada para ressecção de rTNEs.

ABSTRACT BACKGROUND: A common site of neuroendocrine tumors (NETs) is the rectum. The technique most often used is endoscopic mucosal resection with saline injection. However, deep margins are often difficult to obtain because submucosal invasion is common. Underwater endoscopic mucosal resection (UEMR) is a technique in which the bowel lumen is filled with water rather than air, precluding the need for submucosal lifting. OBJECTIVE: This study aimed to evaluate the efficacy and safety of UEMR for removing small rectal neuroendocrine tumors (rNETs). METHODS: Retrospective study with patients who underwent UEMR in two centers. UEMR was performed using a standard colonoscope. No submucosal injection was performed. Board-certified pathologists conducted histopathologic assessment. RESULTS: UEMR for small rNET was performed on 11 patients (nine female) with a mean age of 55.8 years and 11 lesions (mean size 7 mm, range 3-12 mm). There were 9 (81%) patients with G1 rNET and two patients with G2, and all tumors invaded the submucosa with only one restricted to the mucosa. None case showed vascular or perineural invasion. All lesions were removed en bloc. Nine (81%) resections had free margins. Two patients had deep margin involvement; one had negative biopsies via endoscopic surveillance, and the other was lost to follow-up. No perforations or delayed bleeding occurred. CONCLUSION: UEMR appeared to be an effective and safe alternative for treatment of small rNETs without adverse events and with high en bloc and R0 resection rates. Further prospective studies are needed to compare available endoscopic interventions and to elucidate the most appropriate endoscopic technique for resection of rNETs.

OBJECTIVES: Strategic planning for coronavirus disease (COVID-19) care has dominated the agenda of medical services, which have been further restricted by the need for minimizing viral transmission. Risk is particularly relevant in relation to endoscopy procedures. This study aimed to describe a contingency plan for a tertiary academic cancer center, define a strategy to prioritize and postpone examinations, and evaluate the infection rate among healthcare workers (HCWs) in the endoscopy unit of the Cancer Institute of the State of São Paulo (ICESP). METHODS: We created a strategy to balance the risk of acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and to mitigate the effects of postponing endoscopic procedures in oncological patients. A retrospective analysis of prospectively collected data on all endoscopies between March and June 2020 compared with those during the same period in 2019 was carried out. All HCWs were interviewed to obtain clinical data and SARS-CoV-2 test results. RESULTS: During the COVID-19 outbreak, there was a reduction of 55% in endoscopy cases in total. Colonoscopy was the most affected modality. The total infection rate among all HCWs was 38%. None of the senior digestive endoscopists had COVID-19. However, all bronchoscopists had been infected. One of three fellows had a serological diagnosis of COVID-19. Two-thirds of all nurses were infected, whereas half of all technicians were infected. CONCLUSIONS: In this pandemic scenario, all endoscopy services must prioritize the procedures that will be performed. It was possible to maintain some endoscopic procedures, including those meant to provide nutritional access, tissue diagnosis, and endoscopic resection. Personal protective equipment (PPE) seems effective in preventing transmission of COVID-19 from patients to digestive endoscopists. These measures can be useful in planning, even for pandemics in the future.

RESUMO INTRODUÇÃO: A gastroenterostomia ecoguiada é um novo procedimento para paliação da obstrução maligna gastroduodenal. Nosso objetivo foi avaliar os resultados dessa técnica em nossa experiência inicial. MÉTODOS: Foram incluídos pacientes com obstrução maligna gastroduodenal de nossa instituição. O sucesso técnico foi definido como a realização adequada de uma gastroenterostomia. O sucesso clínico foi definido como boa aceitação de dieta pastosa durante a internação. Os eventos adversos e a aceitação alimentar foram avaliados um mês após o procedimento. RESULTADOS: Três pacientes foram incluídos. Os sucessos técnico e clínico foram alcançados em todos os casos. Não houve eventos adversos e a aceitação alimentar permaneceu adequada um mês após o procedimento nos pacientes incluídos. CONCLUSÃO: O EUS-GE é um tratamento promissor para pacientes com obstrução maligna gastroduodenal.

SUMMARY INTRODUCTION: EUS-guided gastroenterostomy (EUS-GE) is a novel procedure for palliation of malignant gastric outlet obstruction (GOO). Our aim was to evaluate the outcomes of this technique in our initial experience. METHODS: Patients with GOO from our institute were included. Technical success was defined as the successful creation of a gastroenterostomy. Clinical success was defined as the ability to tolerate a soft diet after the procedure. We assessed adverse events and diet tolerance 1 month after the procedure. RESULTS: Three patients were included. Technical and clinical success was achieved in all cases. There were no adverse events and good diet tolerance was observed 1 month after the procedure in the included patients. CONCLUSION: EUS-GE is a promising treatment for patients with GOO.

RESUMO CONTEXTO: A ressecção endoscópica da mucosa sob imersão d’água (REMS) surgiu como um método revolucionário que permite a ressecção de lesões colorretais sem injeção submucosa. A literatura brasileira sobre essa técnica é escassa. OBJETIVO: A finalidade deste estudo foi avaliar a eficácia e segurança da técnica REMS na remoção de lesões colorretais não pediculadas em dois centros terciários brasileiros. MÉTODOS: Este estudo prospectivo foi realizado entre junho de 2016 e maio de 2017. As lesões sem tentativa de ressecção prévia, não pediculadas e sem sinais de invasão submucosa foram ressecadas pela técnica REMS. RESULTADOS: Um total de 55 pacientes com 65 lesões foram incluídos. Todas as lesões, exceto uma, foram removidas com sucesso e completamente por REMS (taxa de sucesso de 98,5%). Durante a REMS, foram observados dois casos de sangramento (3,0%). Uma paciente apresentou dor abdominal no dia seguinte à ressecção sem pneumoperitônio. Não houve perfuração ou sangramento tardio. CONCLUSÃO: Este estudo apoia os dados existentes, indicando taxas aceitáveis de sucesso técnico e baixa incidência de eventos adversos com a REMS. Os resultados deste estudo brasileiro foram consistentes com estudos internacionais prévios.

ABSTRACT BACKGROUND: Underwater endoscopic mucosal resection (UEMR) has emerged as a revolutionary method allowing resection of colorectal lesions without submucosal injection. Brazilian literature about this technique is sparse. OBJECTIVE: The aim of this study was evaluate the efficacy and safety of UEMR technique for removing non-pedunculated colorectal lesions in two Brazilian tertiary centers. METHODS: This prospective study was conducted between June 2016 and May 2017. Naïve and non-pedunculated lesions without signs of submucosal invasion were resected using UEMR technique. RESULTS: A total of 55 patients with 65 lesions were included. All lesions, except one, were successfully and completely removed by UEMR (success rate 98.5%). During UEMR, two cases of bleeding were observed (3.0%). One patient had abdominal pain on the day after resection without pneumoperitoneum. There was no perforation or delayed bleeding. CONCLUSION: This study supports the existing data indicating acceptable rates of technical success, and low incidence of adverse events with UEMR. The results of this Brazilian study were consistent with previous abroad studies.

ABSTRACT Prostate cancer is the second most common cancer and the fifth leading cause of cancer deaths. In Brazil, it is likewise the second most common cancer among men, second only to non-melanoma skin cancers. The aim of this consensus is to align different opinions and interpretations of the medical literature in a practical and patient-oriented approach. The first Brazilian Consensus on the Treatment of Advanced Prostate Cancer was published in 2017, with the goal of reducing the heterogeneity of therapeutic conduct in Brazilian patients with metastatic prostate cancer. We acknowledge that in Brazil the incorporation of different technologies is a big challenge, especially in the Sistema Único de Saúde (SUS), which allows for the disparity in the options available to patients treated in different institutions. In order to update the recommendations and to make them objective and easily accessible, once more a panel of specialists was formed in order to discuss and elaborate a new Brazilian Consensus on Advanced Prostate Cancer. This Consensus was written through a joint initiative of the Brazilian Society of Clinical Oncology (SBOC) and the Brazilian Society of Urology (SBU) to support the clinical decisions of physicians and other health professionals involved in the care of patients with prostate cancer.

RESUMO O objetivo deste estudo foi quantificar e avaliar os componentes da heterose em híbridos de páprica para produtividade, teor de capsanteno (graus ASTA) e resistência a Phytophthora capsici, e identificar as linhagens parentais elevada capacidade geral de combinação (CGC) para serem utilizados em futuros programas de melhoramento e/ou para obter novos híbridos. Para tanto, 15 híbridos foram obtidos por cruzamentos dialélicos (excluindo os recíprocos) entre seis linhagens from Hortiagro Sementes S.A. Elas são oriundas do Peru (P1=PIM 032-03; P2=PIM 033-11; P3=PIM 034-19; P4=PIM 035-01) e dos EUA (P5=PIM 036-08; P6=PIM 037-18). Os resultados indicam que a ação génica epistática controla a heterose de produtividade de frutos frescos e secos, e o teor de capsantenos, sendo, em geral, a heterose no sentido de aumentar a produtividade. A resistência a P. capsici não teve efeito heterótico significativo, sendo explicado por dominância incompleta no sentido da Resistencia. As linhagens parentais P1 e P5 mostraram elevada CGC para os caracteres avaliados, e poderiam ser utilizadas em programas de melhoramento para obter novas linhagens melhoradas ou para a produção de híbridos com elevada produtividade.. O cruzamento P3xP5 superou à testemunha ‘Papri Queen’ em produtividade de frutos frescos (68 t ha-1), secos (10 t ha-1), graus ASTA (157) e resistência a P. capsici. A linhagem P5 assim como nos híbridos onde participou como parental foram avaliados como resistentes.

ABSTRACT The aim of this study was to quantify and assess the components of heterosis in paprika hybrids related to yield, capsanten pigment content (estimated as ASTA degrees) and resistance to Phytophthora capsici, and to identify parental lines with high general combining ability (GCA) to be used in future breeding programmes and/or to obtain new hybrids. Fifteen hybrids were obtained through a complete diallel cross (reciprocal hybrids excluded) among six proprietary paprika breeding lines from HortiAgro Sementes S.A., four of which originally introduced from Peru (P1=PIM 032-03; P2=PIM 033-11; P3=PIM 034-19; P4=PIM 035-01) and two from the U.S.A. (P5=PIM 036-08; P6=PIM 037-18). Epistatic gene action was involved in the expression of heterosis for fresh and dry yields and carotenoid pigment contents, and heterosis was predominantly in the direction of higher yields. No significant heterosis effects were detected for resistance to P. capsici, and gene action was of incomplete dominance for the resistant phenotype. The parental lines P1 and P5 showed high GCA values for all characters, and may be used in breeding programmes to obtain new improved lines or for the production of higher yielding hybrids. The most promising hybrid was P3xP5, which outperformed the standard cultivar “Papri Queen” in fresh (68 t ha-1) and dry (10 t ha-1) fruit yields and ASTA degrees (157), in addition to being resistant to P. capsici. The parental line P5, as well as the hybrids in which it participated as a parent were assessed as resistant to P. capsici.

RESUMO O objetivo deste trabalho foi desenvolver híbridos de pimentão com resistência a múltiplos patógenos e inferir sobre os componentes da heterose em híbridos obtidos a partir de linhagens presumivelmente resistentes ao Pepper yellow mosaic virus (PepYMV), Phytophthora capsici ou Meloidogyne incognita. Os trabalhos foram realizados em casa de vegetação. Foram utilizadas dez linhagens, trinta híbridos experimentais, e sete testemunhas comerciais (Konan-R, Magali-R, Martha-R, Stephany, Mallorca, Magnata Super e Criollo de Morelos-334). Em todos os experimentos, utilizou-se o delineamento em blocos casualizados, com três repetições (com parcelas de 16 plantas). Na avaliação das reações a P. capsici e ao PepYMV, foram consideradas as percentagens de plantas sem sintomas. Na avaliação das reações a M. incognita, foram calculados o índice de reprodução e o fator de reprodução do nematoide. Os efeitos gênicos aditivos foram importantes para todos os caracteres avaliados e, para percentagem de plantas resistentes a PepYMV e P. capsici, os efeitos gênicos não-aditivos foram também importantes. Os alelos que controlam resistência a PepYMV, a P. capsici e a M. incognita possuem grau de dominância próximo de 1, em valor absoluto, o que indica uma situação favorável à obtenção de híbridos com resistência múltipla a estes patógenos.

ABSTRACT The aim of this study was to develop bell pepper hybrids with resistance to multiple pathogens and make inferences in regard to components of heterosis in hybrids obtained from lines presumed to be resistant to Pepper yellow mosaic virus (PepYMV), Phytophthora capsici, or Meloidogyne incognita. The studies were carried out in a greenhouse. We used ten lines, thirty experimental hybrids, and seven controls (Konan-R, Magali-R, Martha-R, Stephany, Mallorca, Magnata Super, and Criollo de Morelos-334). For all experiments, a randomized block design was used with three replications (with plots composed of 16 plants). For evaluation of the reactions to P. capsici and to PepYMV, the percentages of asymptomatic plants were considered. For evaluation of the reactions to M. incognita, the reproduction index and the reproduction factor of the nematode were calculated. The additive gene effects were important for all the traits evaluated, and for percentage of plants resistant to PepYMV and P. capsici, the non-additive effects were also important. The alleles that control resistance to PepYMV, to P. capsici, and to M. incognita have a degree of dominance near 1, in absolute value, which indicates a favorable situation for obtaining hybrids that accumulate multiple resistance to these pathogens.

ABSTRACT Introduction Prostate cancer still represents a major cause of morbidity, and still about 20% of men with the disease are diagnosed or will progress to the advanced stage without the possibility of curative treatment. Despite the recent advances in scientific and technological knowledge and the availability of new therapies, there is still considerable heterogeneity in the therapeutic approaches for metastatic prostate cancer. Objectives This article presents a summary of the I Brazilian Consensus on Advanced Prostate Cancer, conducted by the Brazilian Society of Urology and Brazilian Society of Clinical Oncology. Materials and Methods Experts were selected by the medical societies involved. Forty issues regarding controversial issues in advanced disease were previously elaborated. The panel met for consensus, with a threshold established for 2/3 of the participants. Results and Conclusions The treatment of advanced prostate cancer is complex, due to the existence of a large number of therapies, with different response profiles and toxicities. The panel addressed recommendations on preferred choice of therapies, indicators that would justify their change, and indicated some strategies for better sequencing of treatment in order to maximize the potential for disease control with the available therapeutic arsenal. The lack of consensus on some topics clearly indicates the absence of strong evidence for some decisions.

Resumo Este artigo descreve dois casos onde a ressecção óssea associada à fibrina rica em plaquetas e leucócitos (LPRF) não resultou em resposta completa no tratamento da osteonecrose dos maxilares relacionados à medicações (MRONJ). Como observado nos casos aqui relatados, MRONJ foi recentemente descrito na literatura em pacientes que recebem a administração subcutânea de inibidores-RANK, como Denosumab ou drogas anti-angiogenicas, como Bevacizumab. Estudos recentes com resultados promissores indicam que mais pacientes serão tratados com estas terapias para evitar complicações esqueléticas devido às metástases ósseas. Portanto, este cenário pode tornar-se um desafio clínico comparável às osteonecroses dos maxilares relacionados aos bisfosfonatos na área de Cirurgia Bucomaxilofacial. Até o momento, nenhuma técnica cirúrgica foi descrita com eficiência para superar as lesões da mucosa com exposição óssea e que não cicatrizam devido a terapia com inibidores de RANK. Com base na literatura e nos achados dos casos reportados, podemos concluir que o uso do LPRF pode ser considerado no tratamento de pacientes com osteonecrose dos maxilares relacionados ao Denosumab.

Abstract This paper describes two cases in which the use of leucocyte-rich and platelet-rich fibrin (LPRF) combined with bone resection did not result in complete tissue response in the treatment of medication-related osteonecrosis of the jaw (MRONJ). It has been recently described in patients receiving subcutaneous administration of RANK-inhibitors, such as Denosumab, and anti-angiogenic drugs, such as Bevacizumab, as observed in our cases. Due to promising results in recent studies, more patients will receive these medications in order to avoid skeletal complications due to metastatic bone disease and, therefore, this scenario has a potential to become a comparable challenge to the bisphosphonate- induced jaw necrosis in the area of Oral and Maxillofacial Surgery. No convincing surgical technique has been described to overcome the non-healing mucosal lesions with exposed bone due to RANK-inhibitor therapy. Based on the findings in the literature and in both cases described herein can be concluded that the use of LPRF should be considered in the treatment of patients with DRONJ.

Contexto - A hemorragia digestiva alta implica em significativas repercussões clínicas e econômicas. O estabelecimento correto das mais recentes terapêuticas para a hemorragia digestiva alta está associado à redução na mortalidade intra-hospitalar. O uso de algoritmos para atendimento da hemorragia digestiva alta está associado com menor tempo de internação e menores custos hospitalares. Objetivos - O objetivo primário é a criação de um protocolo de atendimento da hemorragia digestiva alta, para ser utilizado em hospital terciário. Métodos - Realizada extensa revisão da literatura sobre as condutas na hemorragia digestiva alta, contidas nas bases de dados primária e secundária. Resultados - O resultado é um modelo de atendimento para os pacientes com hemorragia digestiva alta e com evidência de sangramento recente, dado por melena ou hematêmese nas ultimas 24h, que são atendidos nas salas de emergência e unidades de terapia intensiva de hospitais terciários. Neste protocolo de atendimento, desenhado de forma compacta e compreensível, fica bem evidenciado o manejo dos pacientes desde a admissão, com definição dos critérios de inclusão e exclusão, passando considerações acerca do atendimento clínico inicial, posterior direcionamento para a terapêutica endoscópica, e encaminhamento às terapias de resgate em casos de sangramento persistente ou recorrente. Destacam-se também os cuidados que devem ser tomados antes da alta hospitalar para todos os pacientes que se recuperam de um episódio de sangramento. Conclusão - A introdução de um protocolo para atendimento e tratamento de pacientes com hemorragia digestiva alta pode contribuir para uniformização de condutas médicas, diminuição no tempo de espera por medicações e serviços, no tempo de internação e nos custos hospitalares.

Background - Upper gastrointestinal bleeding implies significant clinical and economic repercussions. The correct establishment of the latest therapies for the upper gastrointestinal bleeding is associated with reduced in-hospital mortality. The use of clinical pathways for the upper gastrointestinal bleeding is associated with shorter hospital stay and lower hospital costs. Objective - The primary objective is the development of a clinical care pathway for the management of patients with upper gastrointestinal bleeding, to be used in tertiary hospital. Methods - It was conducted an extensive literature review on the management of upper gastrointestinal bleeding, contained in the primary and secondary information sources. Results - The result is a clinical care pathway for the upper gastrointestinal bleeding in patients with evidence of recent bleeding, diagnosed by melena or hematemesis in the last 12 hours, who are admitted in the emergency rooms and intensive care units of tertiary hospitals. In this compact and understandable pathway, it is well demonstrated the management since the admission, with definition of the inclusion and exclusion criteria, passing through the initial clinical treatment, posterior guidance for endoscopic therapy, and referral to rescue therapies in cases of persistent or rebleeding. It was also included the care that must be taken before hospital discharge for all patients who recover from an episode of bleeding. Conclusion - The introduction of a clinical care pathway for patients with upper gastrointestinal bleeding may contribute to standardization of medical practices, decrease in waiting time for medications and services, length of hospital stay and costs.

O objetivo deste trabalho foi determinar a presença do alelo Pvr4, que confere resistência contra o PepYMV (Pepper yellow mosaic virus), em genótipos de pimentão comunmente encontrados no mercado brasileiro, com uso de um marcador molecular codominante tipo CAPS. A resistência ao PepYMV, nos genótipos CM-334-INRA, Myr-29 e em genótipos derivados do híbrido comercial Mônica-R, foi detectada como associada à banda de 444 pb, ligada ao alelo de resistência Pvr4. As plantas resistentes homozigotas (pvr4/pvr4) mostraram uma banda de 444 pb, as suscetíveis (Pvr4+/Pvr4+) uma banda de 458 pb e as resistentes heterozigotas (Pvr4+/Pvr4) mostraram as duas bandas. No entanto, no acesso resistente CM-334-UFV, nos híbridos Magali-R e Martha-R, assim como em populações derivadas desse acesso e desses híbridos, a resistência ao PepYMV não esteve associada ao marcador CAPS. O acesso CM-334-UFV ('Criollo de Morelos-334', de Viçosa, MG) distinguiu-se do CM-334-INRA ('Criollo de Morelos-334', da França); embora ambos os acessos tenham sido resistentes ao PepYMV, apenas em CM-334-INRA foi encontrada a associação da resistência com a banda de 444 pb.

The objective of this work was to determine the presence of the Pvr4 allele, which controls the resistance to the PepYMV (Pepper yellow mosaic virus), in sweet pepper genotypes commonly available in the Brazilian market, using a CAPS codominant molecular marker. The resistance to PepYMV, in the genotypes CM-334-INRA, Myr-29, and in genotypes derived from the hybrid Mônica-R, was found to be associated with the 444 bp band linked to the resistance allele Pvr4. Homozygous resistant plants (pvr4/pvr4) showed a single band of 444 bp, the susceptible ones (Pvr4+/Pvr4+) showed a band of 458 bp, and the heterozygous resistant plants (Pvr4+/Pvr4) showed both bands. However, in the resistant accession CM-334-UFV, and in the hybrids Magali-R and Martha-R, as well as in populations derived from this accession and these hybrids, the resistance to PepYMV was not associated to the CAPS marker. The accession CM-334-UFV ('Criollo de Morelos-334' from Viçosa, MG, Brazil) was distinct from CM-334-INRA ('Criollo de Morelos-334', from France); although both accessions were resistant to PepYMV, the association of resistance with the 444 bp band was found only in CM-334-INRA.

O objetivo deste trabalho foi associar um marcador microssatélite ao alelo Ty-1 de resistência a Begomovirus em tomateiro, e avaliar a eficiência desta associação na seleção de linhagens resistentes ao vírus. Os marcadores SSR-47 e SSR-48 foram testados em linhagens isogênicas contrastantes quanto à presença do alelo Ty-1 (LA-3473, LA-3474, LA-3475). O marcador SSR-47, por ter detectado polimorfismo nas linhagens, foi o único utilizado nas etapas subsequentes da pesquisa. Detectada a associação entre o SSR-47 e o alelo Ty-1, testou-se sua eficiência na seleção de genótipos avançados de tomateiro. Para confirmar a eficiência da seleção, foi realizada a avaliação fenotípica das plantas com padrões contrastantes de bandas para SSR-47, quanto à resistência a Begomovirus. Plantas que apresentaram banda única de 191 pb foram resistentes ao Begomovirus, pelo teste de inoculação por enxertia; aquelas com banda única de 180 pb foram suscetíveis; e as plantas com bandas de 191 e 180 pb foram resistentes. A distância máxima entre o Ty-1 e o marcador SSR-47 foi de 2,7 cM. Este marcador foi efetivo em caracterizar genótipos portadores do alelo Ty-1. As respostas das plantas à infecção pelo Begomovirus, induzida via enxertia, são consistentes com as reações previstas com o uso do marcador molecular SSR-47.

The objective of this work was to associate a microsatellite marker with the Ty-1 allele that controls resistance to Begomovirus in tomatoes, and to assess the eficiency of this association in the selection of virus-resistant lines. Microsatellite markers SSR-47 and SSR-48 were tested in near isogenic tomato lines (LA-3473, LA-3474, LA-3475) with contrasting genotypes for the Ty-1 allele. The marker SSR-47 detected polymorphism in the lines, and was the only one used in the subsequent research phases. An association between the SSR-47 marker and the Ty-1 locus was detected, and its efficiency for selection of begomovirus-resistant genotypes in tomato was assessed. To confirm the selection efficiency, plants with contrasting banding patterns for the SSR-47 marker were tested for their reaction to Begomovirus. All plants with a single 191-bp band were resistant to Begomovirus, through inoculation test by grafting. Plants with a single 180-bp band were susceptible, and plants with both 191bp and 180 bp bands were resistant. The maximum distance between Ty-1 and the SSR-47 marker was 2.7 cM. This marker was efficient to identify genotypes bearing the Ty-1 allele. Plant responses to infection by Begomovirus inoculated through grafting were consistent with reactions predicted with the use of the SSR-47 marker.

RACIONAL: Ainda que se reconheça a eficiência da ecoendoscopia para o diagnóstico e até mesmo para o tratamento de várias doenças do aparelho digestivo, a sua inclusão nos algoritmos de decisão clínica em gastroenterologia tem sofrido restrições. Este fato é comprovado indiretamente através da existência de vários estudos que se preocuparam em demonstrar o impacto do exame ecoendoscópio na mudança de condutas e na redução de custos. Outra evidência, esta direta e identificável em nosso meio, é a disponibilidade bastante limitada da ecoendoscopia no Brasil. Neste sentido, quiseram-se identificar as situações clínicas em que o exame ecoendoscópico é eficiente, através de revisões sistemáticas, graduando-se o grau da evidência e a força da recomendação, realizadas pelo grupo envolvido com o método em nosso país, apresentadas e votadas na forma de consenso. MÉTODO: O grupo de médicos que realiza ecoendoscopia foi formado a partir de informações obtidas junto às sociedades de especialidades e aos fabricantes de equipamentos. A lista de tópicos e perguntas relevantes foi formulada por dois membros do consenso (FMF, CMD), discutida com e distribuída aos consensualistas 5 meses antes da reunião de consenso. Foi solicitado que se realizassem, na medida do possível, revisões sistemáticas e que as respostas fossem apresentadas para a votação com o grau de evidência e a força da recomendação. Nos 2 dias da reunião de consenso, as respostas foram apresentadas, debatidas e votadas. Quando, no mínimo, 70% dos votantes concordaram com o texto da resposta, houve consenso. O relatório final foi submetido a apreciação e aprovado por todos os consensualistas. RESULTADOS: Setenta e nove questões foram debatidas na pré-reunião do consenso, resultando 85 questões que foram então distribuídas. Nos 2 dias da reunião do consenso, 22 participantes debateram e votaram as 85 respostas. O impacto causado pelo exame ecoendoscópico foi comprovado por evidências do nível 1, gerando recomendações grau A e consenso entre os participantes nas seguintes situações: diagnóstico diferencial da lesão subepitelial do tubo digestivo e do espessamento de pregas gástricas, estádio e identificação de lesão irressecável no câncer do esôfago, sinais indiretos de carcinomatose peritonial no câncer gástrico avançado, estádio de linfoma gástrico tipo Malt e estádio do câncer de reto, diagnóstico da litíase da vesícula biliar e do colédoco, diagnóstico da pancreatite crônica, diagnóstico diferencial do nódulo sólido da pancreatite crônica, diagnóstico diferencial do cisto pancreático, resultados do tratamento endoscópico das varizes esofágicas, diagnóstico e estádio do câncer de pulmão não-pequenas células. CONCLUSÃO: Já há evidências do melhor nível na literatura médica justificando a utilização do exame ecoendoscópico em várias doenças do sistema digestório e, até mesmo, no câncer do pulmão.

BACKGROUND: In the last 20 years, several papers have focused on demonstrating the impact of endoscopic ultrasonography findings on the management of different clinical scenarios in digestive disease. This fact is an indirect evidence of the difficulty of popularization of the method. On other hand, the limited availability of endoscopic ultrasonography in Brazil is a direct evidence of this limitation. This was the rationale for the organization of a consensus meeting on endoscopic ultrasonography. It was aimed to identify the best evidence that support the use of endoscopic ultrasonography in gastroenterology. METHODS: A panel of experts on endoscopic ultrasonography was selected based on the files of the Gastroenterology and Endoscopy Societies and on the registries of endoscope manufacturers. Two members of the meeting selected the relevant topics that were transformed into questions. The topics and the questions were debated among the experts five months before the consensus meeting. The experts were asked to perform systematic reviews in order to answer the questions so it could be possible to grade the answers based on the strength of the evidence. During the two days of the meeting the answers were presented, debated and voted. Consensus was reached when a minimum of 70% of the voters were in agreement. The final consensus report was submitted to the experts' evaluation and approval. RESULTS: Seventy nine questions were debated by the experts at the pre-Consensus meeting. As the result of this debate 85 questions came out and were assigned to the members of the panel. During the Consensus meeting 22 experts debated and voted 85 answers. Consensus was reached for several clinical scenarios for which the impact of endoscopic ultrasonography findings were supported by level 1 evidences: differential diagnosis of subepithelial lesions and thickening of gastric folds, staging and diagnosis of unresectable esophageal cancer, indirect signs of peritoneal involvement of gastric cancer, MALT gastric lymphoma and rectal cancer staging, diagnosis of common bile duct and gallbladder stones, diagnosis of chronic pancreatitis and differential diagnosis of a solid mass in chronic pancreatitis, differential diagnosis of the pancreatic cyst, prediction of the results of the endoscopic treatment of esophageal varices and diagnosis and staging of non-small cell lung cancer. CONCLUSIONS: There are the highest levels of evidences that support the indication of endoscopic ultrasonography for several digestive diseases and even for non-small cell lung cancer.