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INTRODUÇÃO:O linfedema é uma condição crônica caracterizada por acúmulo anormal de líquido intersticial rico em proteína, como consequência de uma disfunção congênita (primária) ou adquirida (secundária). A neoplasia maligna é a etiologia mais frequente de linfedemas secundários. O manejo do linfedema é desafiador, uma vez que não existe uma abordagem padronizada.OBJETIVO:Sendo assim, o objetivo deste estudo é avaliar as diferentes estratégias terapêuticas disponíveis, dando ênfase no linfedema em pacientes oncológicos.MÉTODOS:Trata-se de uma revisão integrativa de estudos coletados nas bases MEDLINE, LILACS e EMBASE; por meio dos termos: “Breast Cancer Lymphedema”; “Lymphatic Diseases”; “Lymphedema”; “Neoplasms”; “Non-Filarial Lymphedema”; e “Therapeutics”. Foram incluídos estudos com dados relevantes sobre a temática abordada, artigos redigidos apenas na língua inglesa e estudos disponíveis na íntegra.RESULTADOS E DISCUSSÃO:Um centro multidisciplinar especializado em linfedema oferece o melhor tratamento para pacientes oncológicos. A abordagem inclui elevação da extremidade afetada, cuidados com a pele e compressão através do uso de malhas estáticas ou dispositivos pneumáticos. A cirurgia é considerada apenas em último caso, após a falha da terapia conservadora e em pacientes com morbidade significativa. Pacientes com linfedema apresentam risco aumentado de infecções e devem manter a pele hidratada e realizar banhos frequentes. O exercício físico não é contra indicado e pode melhorar a condição ao aumentar o fluxo linfático. A terapia física complexa combina cuidados com a pele, bandagens, exercícios e drenagem linfática manual. O laser de baixa potência tem mostrado resultados promissores na redução do volume do membro afetado. Além disso, é importante fornecer apoio psicossocial aos pacientes, pois o linfedema pode afetar negativamente a qualidade de vida.CONCLUSÃO:Em suma, o tratamento multidisciplinar do linfedema em pacientes oncológicos envolve elevação, cuidados com a pele, compressão, terapia física complexa e, em último caso, cirurgia. No entanto, vale ressaltar que o tratamento deste estado edematoso não leva a uma cura definitiva, mas sim a uma melhora significativa na qualidade de vida dos portadores.

Background The standard of practice when a superficial lesion was identified during upper GI endoscopy is to take an endoscopic forceps biopsy (EFB) of the lesion. The histopathologic findings then will determine the management plan. Endoscopic submucosal dissection (ESD) enables en-bloc resection for early neoplasms of the gastrointestinal tract and provides an adequate specimen that permits a more reliable histopathologic assessment. The objective of this study was to determine the rate of histopathologic discrepancy between EFB and specimens resected by ESD, and to identify the predisposing risk factors for this discordance. Materials and methods This is a retrospective study, enrolling patients with superficial gastric neoplasms that underwent EFB followed by ESD. We divided cases to concordant or discordant group according to the histopathologic diagnosis of EFB and ESD specimens. We also analyzed the features that may have influenced the occurrence of histopathologic discordance and the association between discordant samples of adenocarcinoma and neoplastic invasion to deeper layers. Results A total of 115 gastric ESD procedures were performed with 84 patients meeting the inclusion criteria. Histopathologic discordance between EFB and ESD specimens were observed in 35.8% of cases (30/84 lesions). The univariant-bivariant analysis and multivariate logistic regression analysis showed that histologic discordance was closely related to the size of the lesions (P=0.028). Conclusion Histopathologic discrepancy between EFB and ESD specimens may occur in approximately one-third of cases, particularly for lesions over 20 mm, which may lead to crucial delays in gastric cancer precise diagnosis and treatment.

Background and study aims The adherence to and knowledge of physicians about colorectal cancer (CRC) screening and surveillance guidelines is still suboptimal, threatening the effectiveness of CRC screening. This study assessed the usefulness of a mobile decision support system (MDSS) to improve physician ability to recommend proper timing of and intervals for CRC screening and surveillance. Patients and methods This was a binational, single-blinded, randomized clinical trial including gastroenterologists and colorectal surgeons from Argentina and Uruguay. The specialists were invited to respond to a questionnaire with 10 CRC screening and surveillance clinical scenarios, randomized into two groups, with and without access to a dedicated app (CaPtyVa). The main outcome measure was the proportion of physicians correctly solving at least 60 % of the clinical cases according to local guidelines. Results A total of 213 physicians were included. The proportion of physicians responding correctly at least 60 % of the vignettes was higher in the app group as compared to the control group (90 % versus 56 %) (relative risk [RR] 1.6 95 % confidence interval [CI] 1.34–1.91). The performance was also higher in the app group for both vignette categories: CRC screening (93 % vs 75 % RR 1.24, 95 %CI 1.01–1.40) and surveillance (85 % vs 47 % RR 1.81 95 %CI 1.46–2.22), respectively. Physicians considered the app easy to use and of great utility in daily practice. Conclusions A MDSS was shown to be a useful tool that improved specialist performance in solving CRC screening and surveillance clinical scenarios. Its implementation in daily practice may facilitate the adherence of physicians to CRC screening and surveillance guidelines.

Resumen: Introducción y objetivos: La disección endoscópica de submucosa (ESD) en el tratamiento de las neoplasias superficiales del tracto gastrointestinal es uno de los más grandes avances en endoscopia terapéutica en la actualidad. En América Latina aún no se utiliza de manera rutinaria debido a la alta complejidad técnica. El objetivo de este estudio es presentar la experiencia con ESD en neoplasias gástricas superficiales desarrollada en Brasil a partir del entrenamiento con expertos japoneses. Material y métodos: Estudio retrospectivo de un banco de datos recolectado prospectivamente, que incluyó a todos los pacientes sometidos a ESD por neoplasias superficiales de estómago desde junio del 2008 hasta junio del 2019 en dos centros endoscópicos de referencia en Brasil, calculando las tasas de resección en bloque, completa y curativa, así como también la tasa de recurrencia local y eventos adversos. Resultados: En el periodo descrito se incluyeron 103 procedimientos de ESD para neoplasias superficiales gástricas, de las cuales 80 (77.6%) fueron neoplasias gástricas malignas tempranas o lesiones premalignas (adenocarcinoma: 52.5%, displasia de alto grado: 27.5%, displasia de bajo grado: 16.3% y tumores neuroendocrinos: 3.8%). Las tasas globales de resección en bloque y completa para las neoplasias gástricas superficiales fueron del 96.3% y 92.5%, respectivamente, mientras que la tasa de resección curativa con base en los criterios expandidos fue del 76%. Conclusiones: La ESD para el tratamiento de lesiones neoplásicas gástricas superficiales es una modalidad terapéutica efectiva y segura en Latinoamérica, presentando resultados similares a los mostrados en los estudios japoneses más representativos. Abstract: Introduction and aims: Endoscopic submucosal dissection (ESD) in the treatment of superficial neoplasias of the gastrointestinal tract is currently one of the greatest advances in therapeutic endoscopy. Due to its high technical complexity, it is not yet a routine procedure in Latin America. The aim of the present study was to present the experience in Brazil with ESD in superficial gastric neoplasias, based on training received from Japanese experts. Materials and methods: A retrospective study was conducted, in which information was prospectively collected from a database that included all patients that underwent ESD due to superficial gastric neoplasias at two endoscopy referral centers in Brazil, within the time frame of June 2008 to June 2019. En bloc, complete, and curative resection rates were calculated, along with the local recurrence rate and adverse events. Results: A total of 103 ESDs for superficial gastric neoplasias were performed during the study period. Eighty of those patients (77.6%) presented with early malignant gastric neoplasias or premalignant lesions (adenocarcinoma: 52.5%, high-grade dysplasia: 27.5%, low-grade dysplasia: 16.3%, and neuroendocrine tumors: 3.8%). Overall en bloc and complete resection rates for the superficial gastric neoplasias were 96.3% and 92.5%, respectively, whereas the curative resection rate based on expanded criteria was 76%. Conclusions: ESD for the treatment of superficial gastric neoplasias is a safe and effective therapeutic modality in Latin America, with results similar to those shown in the most representative Japanese studies.

Introduction and aims: Endoscopic submucosal dissection (ESD) in the treatment of superficial neoplasias of the gastrointestinal tract is currently one of the greatest advances in therapeutic endoscopy. Due to its high technical complexity, it is not yet a routine procedure in Latin America. The aim of the present study was to present the experience in Brazil with ESD in superficial gastric neoplasias, based on training received from Japanese experts. Materials and methods: A retrospective study was conducted, in which information was prospectively collected from a database that included all patients that underwent ESD due to superficial gastric neoplasias at two endoscopy referral centers in Brazil, within the time frame of June 2008 to June 2019. En bloc, complete, and curative resection rates were calculated, along with the local recurrence rate and adverse events. Results: A total of 103 ESDs for superficial gastric neoplasias were performed during the study period. Eighty of those patients (77.6%) presented with early malignant gastric neoplasias or premalignant lesions (adenocarcinoma: 52.5%, high-grade dysplasia: 27.5%, low-grade dysplasia: 16.3%, and neuroendocrine tumors: 3.8%). Overall en bloc and complete resection rates for the superficial gastric neoplasias were 96.3% and 92.5%, respectively, whereas the curative resection rate based on expanded criteria was 76%. Conclusions: ESD for the treatment of superficial gastric neoplasias is a safe and effective therapeutic modality in Latin America, with results similar to those shown in the most representative Japanese studies. Resumen: Introduccion y objetivos: La disección endoscópica de submucosa (ESD) en el tratamiento de las neoplasias superficiales del tracto gastrointestinal es uno de los más grandes avances en endoscopia terapéutica en la actualidad. En América Latina aún no se utiliza de manera rutinaria debido a la alta complejidad técnica. El objetivo de este estudio es presentar la experiencia con ESD en neoplasias gástricas superficiales desarrollada en Brasil a partir del entrenamiento con expertos japoneses. Material y metodos: Estudio retrospectivo de un banco de datos recolectado prospectivamente, que incluyo a todos los pacientes sometidos a ESD por neoplasias superficiales de estómago desde Junio del 2008 hasta Junio del 2019 en dos centros endoscópicos de referencia en Brasil. Calculando las tasas de resección en bloque, completa y curativa, así como también la tasa de recurrencia local y eventos adversos. Resultados: En el periodo descrito se incluyeron 103 procedimientos de ESD para neoplasias superficiales gástricas, de las cuales 80 (77.6%) fueron neoplasias gástricas malignas tempranas o lesiones premalignas (adenocarcinoma: 52.5%, displasia de alto grado: 27.5%, displasia de bajo grado: 16.3% y tumores neuroendocrinos: 3.8%). Las tasas globales de resección en bloque y completa para las neoplasias gástricas superficiales fueron del 96.3% y 92.5%, respectivamente, mientras que la tasa de resección curativa con base en los criterios expandidos fue del 76%. Conclusiones: La ESD para el tratamiento de lesiones neoplásicas gástricas superficiales es una modalidad terapéutica efectiva y segura en Latinoamérica, presentando resultados similares a los mostrados en los estudios japoneses más representativos.

BACKGROUND: Endoscopic submucosal dissection (ESD) of esophageal superficial neoplasm is associated with a high en bloc R0 resection rate and low recurrence. OBJECTIVE: We aim to compare the performance and clinical outcomes of ESD via ESD after circumferential incision (ESD-C) versus submucosal tunneling (ESD-T). METHODS: Single-center retrospective analysis of all consecutive patients who underwent ESD for superficial esophageal cancer, between 2009 and 2018. ESD-T was defined as the technique of making the mucosal incisions followed by submucosal tunneling in the oral to anal direction. ESD-C consisted of completing a circumferential incision followed by ESD. Main study outcomes included en bloc and R0 resection rates. Secondary outcomes included procedural characteristics, curative resection rate, local recurrence and adverse events. RESULTS: A total of 65 procedures (23 ESD-T and 42 ESD-C) were performed for ESCC (40; 61.5%) and BE-neoplasia (25; 38.5%). There were no statistically significant differences between patients who underwent ESD-T versus ESD-C in en bloc (91.3% vs 100%, P=0.12), R0 (65.2% vs 78.6%, P=0.24), curative resection rates (65.2% vs 73.8%, P=0.47) and mean procedure time (118.7 min with vs 102.4 min, P=0.35). Adverse events for ESD-T and ESD-C were as follows: bleeding (0 versus 2.4%; P=0.53), perforation (4.3% vs 0; P=0.61), esophageal stricture (8.7% versus 9.5%; P=0.31). Local recurrence was encountered in 8.7% after ESD-T and 2.4% after ESD-C (P=0.28) at a mean follow-up of 8 and 2.75 years, respectively (P=0.001). CONCLUSION: ESD-T and ESD-C appear to be equally effective with similar safety profiles for the management of superficial esophageal neoplasms. RESUMO CONTEXTO: A dissecção endoscópica submucosa (DES) no tratamento da neoplasia superficial do esôfago está associada a uma alta taxa de ressecção R0 em bloco e baixa taxa de recorrência. OBJETIVO: O objetivo deste estudo é comparar o desempenho e os resultados clínicos da DES com incisão circunferencial (DES-C) versus com DES com túnel submucoso (DES-TS). MÉTODOS: Estudo retrospectivo de banco de dados coletados prospectivamente de um centro especializado em DES, investigando pacientes consecutivos submetidos à DES por câncer de esôfago superficial, entre 2009 e 2018. DES-TS foi definida como a técnica de realizar primeiro incisões na mucosa seguida de tunelamento submucoso no sentido oral para anal. DES-C consistiu em completar uma incisão circunferencial seguida da dissecção submucosa. As principais variáveis do estudo incluíram taxas de ressecção em bloco e R0. Os resultados secundários incluíram características do procedimento, taxa de ressecção curativa, recorrência local e eventos adversos. RESULTADOS: Um total de 65 procedimentos (23 DES-TS e 42 DES-C) foram realizados para CCE de esôfago (40; 61,5%) e neoplasia associada ao EB (25; 38,5%). Não houve diferenças estatisticamente significativas entre os pacientes submetidos a DES-TS versus DES-C nas taxas de ressecção em bloco (91,3% vs 100%, P=0,12), R0 (65,2% vs 78,6%, P=0,24), taxas de ressecção curativa (65,2% vs 73,8%, P=0,47) e tempo médio do procedimento (118,7 min com vs 102,4 min, P=0,35). Os eventos adversos para DES-TS e DES-C foram os seguintes: sangramento (0 vs 2,4%; P=0,53), perfuração (4,3% vs 0; P=0,61), estenose esofágica (8,7% vs 9,5%; P=0,31). A recorrência local foi encontrada em 8,7% após DES-TS e 2,4% após DES-C (P=0,28) em um seguimento médio de 8 e 2,75 anos, respectivamente (P=0,001). CONCLUSÃO: DES-TS e DES-C demostram ser igualmente eficazes com perfil de segurança semelhante para o tratamento das neoplasias superficiais do esôfago.

Due to the advent of distributed energy resources at distribution level, utility companies face new challenges in terms of voltage control. Existing works in the literature have proposed the use of demand side management (DSM) to provide ancillary services to the grid. Some works explored the use of thermal inertia of buildings to tackle the frequency regulation problem. Existing DSM strategies ignore the potential service loads can provide for the Volt/Var control (VVC) problem. The ability of smart buildings to provide reactive power support to the grid has not been exploited to date. In this paper, we present a finite control state model predictive control strategy for VVC in distribution networks. The robustness of this strategy is validated on a modified IEEE 13 bus system.

Background and study aims Esophageal squamous cell carcinoma (ESCC) is the most common secondary tumor in patients with head and neck squamous cell cancer (HNSCC). Currently, endoscopic submucosal dissection (ESD) is the preferred approach to manage superficial ESCC, however, it remains to be elucidated whether patients with HNSCC and early ESCC managed by ESD have different outcomes. Patients and methods We retrospectively analyzed esophageal ESD for early ESCC from September 2009 to September 2017 and the following variables: demographics, tumor and specimen size, Paris classification, location, en bloc and R0 resection rates, overall survival (OS) and adverse events (AEs). To reduce selection bias, propensity score matching was applied to compare the results. Results Eighty-nine ESDs were performed in 81 consecutive patients (47 with HNSCC and 34 without HNSCC). Patients with HNSCC who developed superficial ESCC were found to be younger and to refer a more frequent history of alcohol ingestion and smoking. There was no difference in lesion size, number of lesions, procedure time, en bloc resection rate, R0 resection rate, local recurrence and adverse event rate between the two groups. The histological depth of invasion for patients with HNSCC was significantly shallower before (P = 0.016) and after (P = 0.047) matching. The overall survival rate was similar in both groups. Conclusions Patients with HNSCC have earlier detection of ESCC, probably due to endoscopic screening. Previous history of chemoradiation and surgery for HNSCC does not affect procedure time, AEs and OS.

Background & Aims: Despite the significant advances made in the diagnosis and treatment of Barrett's esophagus (BE), there is still a need for standardized definitions, appropriate recognition of endoscopic landmarks, and consistent use of classification systems. Current controversies in basic definitions of BE and the relative lack of anatomic knowledge are significant barriers to uniform documentation. We aimed to provide consensus-driven recommendations for uniform reporting and global application. Methods: The World Endoscopy Organization Barrett's Esophagus Committee appointed leaders to develop an evidence-based Delphi study. A working group of 6 members identified and formulated 23 statements, and 30 internationally recognized experts from 18 countries participated in 3 rounds of voting. We defined consensus as agreement by ≥80% of experts for each statement and used the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) tool to assess the quality of evidence and the strength of recommendations. Results: After 3 rounds of voting, experts achieved consensus on 6 endoscopic landmarks (palisade vessels, gastroesophageal junction, squamocolumnar junction, lesion location, extraluminal compressions, and quadrant orientation), 13 definitions (BE, hiatus hernia, squamous islands, columnar islands, Barrett's endoscopic therapy, endoscopic resection, endoscopic ablation, systematic inspection, complete eradication of intestinal metaplasia, complete eradication of dysplasia, residual disease, recurrent disease, and failure of endoscopic therapy), and 4 classification systems (Prague, Los Angeles, Paris, and Barrett's International NBI Group). In round 1, 18 statements (78%) reached consensus, with 12 (67%) receiving strong agreement from more than half of the experts. In round 2, 4 of the remaining statements (80%) reached consensus, with 1 statement receiving strong agreement from 50% of the experts. In the third round, a consensus was reached on the remaining statement. Conclusions: We developed evidence-based, consensus-driven statements on endoscopic landmarks, definitions, and classifications of BE. These recommendations may facilitate global uniform reporting in BE.

Volt/VAR control (VVC) techniques may be used for purposes such as technical loss reduction, voltage profile improvement, and conservation voltage reduction. The advent of distributed energy resources (DERs) at distribution and consumer levels imposes imperative VVC challenges for the distribution network operator. Innovative approaches have been proposed to use the inherent thermal inertia of buildings to provide ancillary services to the grid to tackle the problems posed by increasing trend of volatile DERs. Numerous state-of-the-art VVC strategies utilize traditional VVC devices and smart inverters to deal with voltage violations in active distribution networks (DNs) with increased DER penetration. However, they have not considered the potential service buildings can provide to mitigate this problem. The ability of smart buildings to provide reactive power support to the grid has not been exploited to date. Hitherto, the effect of the modulation of loads’ reactive power consumption on the grid's voltage profile has not been studied. In this article, a distributed model-predictive control strategy for VVC in the DN by utilizing smart buildings is presented. The robustness of this strategy is validated on a modified IEEE 13-bus system.

The increase in electric energy tariffs in conjunction with social and cultural aspects often leads electric energy consumers to tamper with electric energy meters, as a means to decrease the reading for consumed energy at their respective residencies. One form of meter tampering that is very difficult to detect is the removal of the neutral conductor, which goes on to produce an effect where the meter registers a consumption that is lower than the real consumption. The identification of this fraud is difficult due to the fact that the readings are scheduled, and as such the fraudulent consumer needs only to reconnect the neutral conductor at the time of the meter reading. This article presents a device developed for identifying and registering this type of theft, thus making it more difficult to practice. Laboratory tests and simulations have shown that the lower the power factor of an installation in low voltage, lower will be the reading registered on the meter when this type of fraud arises. This newly developed device has shown itself to be robust, with a low cost as well as efficient in performing to its proposed intent.

Esophagogastroduodenoscopy is a preoperative examination commonly required for candidates to bariatric surgery (BS). Overweight individuals have a greater risk of cardiorespiratory complications during endoscopy under sedation. This study aimed to investigate the feasibility, tolerance, and cardiovascular stress of transnasal endoscopy (TNE) without sedation in obese patients eligible for BS. This prospective study enrolled obese adult patients with indication for BS that consented to undergo unsedated preoperative TNE. All examinations were carried out in an outpatient center. The outcomes assessed were endoscopic findings, procedural success, patients’ tolerance according to a visual analogic scale, cardiovascular stress estimated by double product (i.e., systolic blood pressure × heart rate) and adverse events. Statistical analyses were used to compare each patient’s double product among different examination periods. Ninety-four patients (77.6% female) completed the study, with an average body mass index (BMI) of 53 kg/m2 (range, 35–73.4 kg/m2). There were 63 super-obese individuals (67%), with BMI > 50 kg/m2. In 93 patients (98.9%), unsedated TNE was successfully completed up to the second part of the duodenum. TNE failed in one patient. Tolerance was rated as excellent or good in 95.7%. Minimal cardiovascular stress was noted in obese individuals, whereas the double product remained stable throughout the procedure in super-obese patients. Three patients (3.2%) had self-limited epistaxis. Unsedated TNE for preoperative endoscopic evaluation of obese patients is feasible, safe, and well tolerated and should be preferentially considered when examining super-obese patients.

High penetration levels of in Distributed Energy Resources (DERs) as low-inertia renewable energy sources into smart grids imposes imperative Volt-VAR Control (VVC) as well as stability challenges for Distribution Network (DN) operation. Although numerous approaches harness traditional VVC devices to compensate for voltage violations, synthetic inertia and control of energy storage systems exist to improve transient stability with an increase of DERs. While ample strategies tackle these two problems separately, the ability of smart buildings to provide active and reactive power support simultaneously to the grid has not yet been fully exploited. In this work, the effect of the modulation of loads' apparent power consumption on the grid's frequency and voltage profile have been explored. A Distributed Model Predictive Control (DMPC) strategy is presented for voltage and frequency control in the DN provided by smart buildings. The robustness of this strategy is validated on a modified IEEE 13 bus system.

Background Underwater endoscopic mucosal resection (UEMR) without submucosal injection has been described as an alternative technique to the endoscopic resection of adenomas and colorectal serrated lesions. We aimed to assess the feasibility, safety, and efficacy of UEMR in a Brazilian setting. Methods This was a prospective observational study of consecutive patients who underwent UEMR between January and July 2019, in a single tertiary care center. Inclusion criteria were lesions without endoscopic stigmata of deep submucosal invasion in patients referred for endoscopic resection of colorectal adenomas, and serrated lesions detected in a previous colonoscopy. The following features were assessed: complete resection rate, en bloc resection rate, resection time, adverse events, and resection infeasibility. Results A total of 36 patients underwent UEMR for 51 colorectal lesions. The mean/median lesion size was 16.24/13 mm and the mean/median resection time was 16.97/9.19 min. Histopathology revealed the following: tubular adenoma (43.1%), tubulovillous adenoma (13.7%), serrated lesions (41.2%), and intramucosal adenocarcinoma (2%). Complete resection was achieved in 86.3% of cases; 52.9% of the lesions were removed en bloc, while 47.1% were resected in a piecemeal fashion. UEMR was feasible in 96.1% of cases and failed on 2 occasions, requiring conversion to standard endoscopic mucosal resection. Minor intraoperative bleeding occurred in 5 patients (9.8%) and only 1 presented with delayed bleeding (2%), all controlled endoscopically. Conclusion UEMR for removal of adenomas and colorectal serrated lesions was demonstrated to be feasible, safe and effective.

CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior Este trabalho apresenta um estudo realizado sobre a reconfiguração de um sistema de distribuição de energia elétrica, com o objetivo de mitigar suas perdas técnicas, ou seja, perdas por efeito Joule. Foram considerados os efeitos da introdução de geração distribuída por meio de placas fotovoltaicas e, também, o uso de armazenadores de energia objetivando a redução das perdas técnicas. Para alcançar este objetivo, de maneira a disponibilizar ao final da pesquisa uma ferramenta útil e aplicável, utilizaram- se recursos oriundos de técnicas de inteligência artificial, tais como as Redes Neurais Artificiais e a Otimização por Enxame de Partículas. As Redes Neurais Artificiais foram empregadas de modo a fazer uma estimação da potência gerada pelas placas fotovoltaicas. Foram obtidos e tratados dados climáticos com projeção de um horizonte definido os quais permitiram realizar estimação do potencial de geração de energia elétrica. Através do estudo das revisões bibliográficas e simulações, foi escolhida a arquitetura de rede NARX. Foi feito também um estudo de dimensionamento a longo prazo de armazenadores de energia para a minimização das perdas técnicas em redes de distribuição. Foram feitas análises combinatórias para a reconfiguração da rede de distribuição com testes de factibilidades, de acordo com a teoria dos grafos. O fluxo de carga foi implementado por meio do método de Newton-Raphson trifásico. Por meio da Otimização por Enxame de Partículas Binário (BPSO) foram testadas as configurações otimizadas de rede para a minimização de perdas técnicas. A linguagem de programação utilizada, para o desenvolvimento de todos os algoritmos propostos, foi a disponível no software MATLAB®. A topologia de rede analisada, é a do sistema do IEEE 37 barras (modificado). This work presents a study about the reconfiguration of electrical distribution systems, with aim to minimize its technical losses, or be it, Joule effect losses. The effect of Photovoltaics penetration and energy storage were considered herein. To achieve this objective, in a way to at the end of this research left available a useful and applicable tool, resources from Artificial Intelligence techniques were used, such as Artificial Neural Networks and Particle Swarm Optimization. The Artificial Neural Networks were used to estimate the generated power by means of Photovoltaics. Weather data were obtained and standardized with the projection for a defined horizon which allowed the estimation of the potential generated power. By means of bibliographic studies e simulation, the NARX architecture was chosen. A battery energy storage long-term scale study was performed to minimize technical losses on distribution grids. Combinatory analysis were performed to reconfigure the distribution grid with factbility tests, according to graph theory. The power flow was implemented by means of the three-phase Newton-Raphson method. With Particle Swarm Optimization, the optimized configurations of the grid were tested for the network losses minimization. The computer language used, for all of the proposed algorithms, was the available on MATLAB® software. The grid topology analyzed is that from IEEE 37 buses (modified). Tese (Doutorado)

BACKGROUND: Endoscopic submucosal dissection (ESD) enables en bloc excision of superficial neoplasms. Although ESD is widely practiced in Eastern countries like Japan, South Korea and China, its use in the West is supposed to be still limited to few tertiary centers. OBJECTIVE: This study aimed to investigate the clinical practice of ESD in Brazil by means of an electronic questionnaire elaborated by the Brazilian Society of Digestive Endoscopy (SOBED). METHODS: In October 2019, 3512 endoscopist members of SOBED were invited to respond to an electronic survey containing 40 questions divided into four topics: operator profile; clinical experience with ESD; adverse events and training. Informed consent was requested to all participants. The investigators reviewed all responses and considered valid if more than 50% of the questions were answered and additional information, when requested, was provided. RESULTS: A total of 155 (4.4%) qualified responses entered the study. ESD has been practiced in 22 of 26 Federation States and majority of respondents (32.2%) have 10 to 20 years of practice. ESD has been performed more frequently in private hospitals (101 individuals, 66.9%) and private ambulatory centers (41 individuals, 27.1%). ESD was performed mainly in the stomach (72%), followed by the rectum (57%) and 80% of the individuals reported less than 25 operations. Twenty-four (15.4 %) individuals reported perforation and 4 (2.5%) of them reported postoperative deaths. Approximately a quarter of responders denied hands-on training in models or visit to training centers. CONCLUSION: ESD appears to be practiced throughout the country, not only in tertiary or academic institutions and mainly in private practice. Most operators received limited training and still are at the beginning of their learning curve. The reported adverse events and mortality rates appear to be higher than Eastern reports.

Background and study aims In March 2020, the World Health Organization declared coronavirus disease of 2019 (COVID-19) as a pandemic, mobilizing all countries to contain the disease spread. Activity in endoscopy centers globally was severely affected. We conducted a national survey aiming to assess the impact of the COVID-19 outbreak on endoscopic clinical practice in Brazil. Methods In April 2020, 3,719 associate members of SOBED (Brazilian Society of Digestive Endoscopy) were invited to respond to an electronic survey. An Internet link was established to provide access to the online questionnaire with 40 questions regarding personal profile, endoscopy unit logistics and schedule, availability and use of personal protective equipment (PPE), financial impact, and exposure to COVID-19. Results A total of 2,131 individuals (67 %) accessed the questionnaire and 1155 responses were received. After review, 980 responses were considered valid. According to almost 90 % of respondents, endoscopy activity was restricted to urgent procedures, in both public and private hospitals. All respondents increased PPE use after the outbreak, however, institutions provided adequate PPE to only 278 responders (28.7 %). Significant income loss was universally reported. A total of 10 practitioners (1 %) reported COVID-19 infection and attributed the contamination to endoscopic procedures. Conclusions Based on this nationwide survey with almost 1,000 respondents, the COVID-19 pandemic substantially reduced the activity of endoscopy units in private and public settings. The pandemic increased awareness of PPE use, but its availability was not universal and 1 % of the respondents became infected with COVID-19, allegedly due to exposure during endoscopic procedures.

Endoscopic clipping has become a common practice among endoscopists. Several models are available, most frequently being introduced via the working channel of the endoscope (through-the-scope); however, larger clips can also be mounted onto the distal tip of the endoscope (over-the-scope). The main indications for endoclip placement include providing effective mechanical hemostasis for bleeding lesions and allowing endoscopic closure of gastrointestinal perforations. Endoclips can also be used prophylactically after endoscopic resection; however, this practice is still controversial. This review discusses the main indications for endoscopic clipping in the esophagus, stomach, duodenum and colon to manage acute bleeding lesions, and the criteria to be used in the prevention of delayed post-polypectomy bleeding.

In light of recent changes to electric energy sector regulations, themselves motivated through technological advances, an increase has been noted not only in the economic viability but also in the difficulties faced by the Brazilian hydroelectric system. These new regulations allow residential consumers to become micro and mini-generators; this scenario institutes an overall change to the behavior of the energy distribution system (DS). The loads now tend toward a bidirectional flow, producing change in the energy profile, this occurs mainly during the day due to photovoltaic penetration. In this context, one notes the introduction of Electrical Energy Storages (EES), which has as its prime objective to aid distribution systems in their control of these new variables. The goal behind this article is to analyze the use of EES through reducing medium-term technical losses in electrical energy distribution systems. In order to reach this goal, a technical analysis was performed that tested 4 case studies, considering variable demand, with distributed and concentrated EES. The analyses show that the use of EES over the medium-term can significantly avoid technical losses to the electrical energy distribution system.

RESUMO Introducao No infarto agudo do miocardio com supradesnivelamento do segmento ST, a necessidade de recanalizacao precoce da arteria culpada, associada as dificuldades de acesso da populacao em geral aos servicos medicos que realizam esta modalidade de tratamento, contribui para o aumento da mortalidade nesse perfil de paciente. Diante do exposto, encontra-se o racional de implementacao do projeto denominado LATIN, acronimo para Latin America Telemedicine Infarct Network, em areas caracterizadas por concentracao demografica densa e dificuldades de acesso a saude. [...]

Background and study aims A post-endoscopic submucosal dissection (ESD) scar is expected to look homogeneous, however, some patients develop benign polypoid nodule scar (PNS). Incidence of PNS is unknown, yet these scars have direct clinical implications because they may render evaluation of post-ESD neoplastic recurrence difficult. Therefore, we reviewed the clinical experience of 5 ESD referral centers and evaluated their PNS incidence and clinical management. Patients and methods This was a retrospective multicenter case series enrolling patients that underwent R0, curative gastric ESD from 2003 to 2015 in 5 academic centers. PNS was defined as ESD site nodularity with hyperplastic or regenerative tissue histology. Results A total of 2275 patients underwent gastric ESD with endoscopy control and 28 patients (18 men/10 women) developed PNS for overall incidence of 1.2 %. Incidence of PNS ranged from 0.15 % to 11.4 % between centers. All patients that developed PNS had primary neoplastic lesions located in the distal stomach. Considering only lesions situated in the antrum (n = 912), incidence of PNS was 3.1 %. After mean follow-up of 43 months (range 6 – 192), no malignant recurrence in the PNS has been identified. In five patients (17.8 %) PNS disappeared after a mean of 18 months. Conclusion PNS occurs exclusively after ESD in the distal stomach in approximately 3.1 % of patients. Although PNS appearance can be concerning, no malignant recurrence was observed after curative R0 resection. Therefore, PNS should be viewed as a benign alteration that does not require any type of intervention, other than endoscopic surveillance.

The incidence of esophageal cancer is steadily increasing worldwide. Outcome is poor, given that the majority of cases are diagnosed at advanced disease stages. However, when detected at early stages, esophageal tumors can be curatively treated through less invasive methods, resulting in a 5-year survival rate above 90%. Therefore, it is essential to identify the high-risk population and recommend those patients undergo screening using high-resolution endoscopy, adding the resources of chromoendoscopy with Lugol solution (or digital chromoendoscopy) and magnification. Such systematized examination makes it possible to recognize early-stage esophageal neoplasia and propose endoscopic submucosal dissection as treatment. In that procedure, the tumor is resected en bloc , resulting in lower morbidity and mortality, compared with previous standard treatment, including early-stage esophagectomy. The present article is a review of the latest advances in the management of superficial esophageal tumors through endoscopic submucosal dissection.

Resumen: La incidencia del cáncer de esófago viene aumentando progresivamente a nivel mundial. Su pronóstico es pobre ya que en su mayoría el diagnóstico se realiza en estadios avanzados. Sin embargo, cuando es detectado en estadio precoz, las neoplasias esofágicas pueden ser tratadas de forma curativa y por métodos menos invasivos, resultando en una sobrevida de más del 90% en 5 años. Por lo tanto, es clave identificar la población de alto riesgo del cáncer esofágico y recomendarles endoscopia de alta resolución de cribado, agregando recursos de cromoendoscopia con lugol (o digital) y magnificación. Este examen sistematizado permite reconocer la neoplasia esofágica en estadio temprano, donde se puede proponer tratamiento endoscópico mediante la disección endoscópica submucosa (DES) realizándose la resección en bloque de la lesión tumoral con disminución de la morbimortalidad en comparación con el tratamiento estándar previo, incluso en estadios tempranos como lo era la esofagectomía. El objetivo de este artículo es revisar los últimos avances en el manejo de las neoplasias esofágicas superficiales a través de la DES. Abstract: The incidence of esophageal cancer is steadily increasing worldwide. Outcome is poor, given that the majority of cases are diagnosed at advanced disease stages. However, when detected at early stages, esophageal tumors can be curatively treated through less invasive methods, resulting in a 5-year survival rate above 90%. Therefore, it is essential to identify the high-risk population and recommend those patients undergo screening using high-resolution endoscopy, adding the resources of chromoendoscopy with Lugol’s solution (or digital chromoendoscopy) and magnification. Such systematized examination makes it possible to recognize early-stage esophageal neoplasia and propose endoscopic submucosal dissection as treatment. In that procedure, the tumor is resected en bloc, resulting in lower morbidity and mortality, compared with previous standard treatment, including early-stage esophagectomy. The present article is a review of the latest advances in the management of superficial esophageal tumors through endoscopic submucosal dissection. Palabras clave: Cáncer de esófago temprano, Carcinoma de células escamosas, Disección endoscópica submucosa, Resección de mucosa endoscópica, Keywords: Early esophageal cancer, Squamous cell carcinoma, Endoscopic submucosal dissection, Endoscopic mucosal resection

This study presents a voltage regulator that is specific to three-phase self-excited induction generators (SEIG). The voltage regulator proposed in this paper uses a PID controller that adjusts the pulse width of a PWM signal for the firing of the bidirectional switches, which provides the switching function of an inductive load that consumes reactive energy, thus controlling the terminal voltage of the SEIG. The paper presents the results obtained by means of computer simulation and experiments. In order to demonstrate the operation of this regulator, the tests present a critical operational condition, the triggering of a dynamic load, where SEIG of 3 hp supplies the direct start-up of a 1 hp induction motor. Even under this worse condition scenario, the regulator manages to recuperate the terminal voltage of the generator to a permitted voltage regulation value (1.02 pu).