Transcranial Direct Current Stimulation Effects on Athletes' Cognitive Performance: An Exploratory Proof of Concept Trial.

Among the 2016 Olympic and Paralympic Games' unforgettable moments, one could not overlook performances by Phelps and Bolt, which challenge old premises about the maximum extension of individual supremacism in ultracompetitive modalities and the doping scandals. Different media channels resonated these two trends, with an unseen rise on discussions about traits and practices that may set ultrahigh performance athletes apart from the more ordinary ones. Yet, some key issues remain undebated. This paper aims to add to this debate, with a proof of concept trial, which investigates whether transcranial direct current stimulation (tDCS) may serve as an aid for professional athletes. Ten professional athletes of three different modalities (judo, N = 4 athletes, swimming, N = 3 athletes, and rhythmic gymnastics, N = 3 athletes) received anodal stimulation (2 mA) for 20 min on the left dorsolateral prefrontal cortex for ten consecutive weekdays. We observed a positive effect of tDCS in their cognitive performance, including a significant improvement in alternated, sustained, and divided attention and in memory scores. We also observed a decrease in Beck Depression Inventory scores (4.50 points) in this non-clinical population. These preliminary results suggest that tDCS sessions may translate into competitive advantages for professional athletes and recommend the deepening of the discussion on its ethical use in sports, which is ultimately tied to the wider debate around the risks and opportunities that neuromodulation brings to the table.

Linfoma Não Hodgkin - Resenha / Non Hodgkin's Lymphoma - Review

Background: CHOP-21 has remained the standard chemotherapy for aggressive non-Hodgkin’s lymphoma (NHL), and dose intensification is a potential strategy for improving therapeutic results. We conducted a phase III trial to determine whether dose-dense strategy involving interval shortening of CHOP (CHOP-14) is superior to CHOP-21. Patients and methods: A total of 323 previously untreated patients (aged 15-69 years) with stages II-IV aggressive NHL were randomized. The primary end point was progression-free survival (PFS). Results: Treatment compliance was comparable in both study arms. At 7-year follow-up, no substantial differences were observed in PFS and overall survival (OS) between CHOP-21 (n = 161) and CHOP-14 (n = 162) arms. Median PFS was 2.8 and 2.6 years with CHOP-21 and CHOP-14, respectively (one-sided log-rank P = 0.79). Eight-year OS and PFS rates were 56% and 42% [95% confidence interval (CI) 47% to 64% and 34% to 49%], respectively, with CHOP-21 and 55% and 38% (95% CI 47% to 63% and 31% to 46%), respectively, with CHOP-14. Subgroup analyses showed no remarkable differences in PFS or OS for patients stratified as per the International Prognostic Index or by age. Conclusion: Dose-intensification strategy involving interval shortening of CHOP did not prolong PFS in advanced, aggressive NHL.

CHOP-21 tem sido o esquema padrão para pacientes com linfoma não Hodgkin (LNH) agressivo ao longo dos últimos 30 anos. No entanto, apenas 30% a 50% dos casos são curados com este protocolo. Na tentativa de aumentar as taxas de sobrevida, vários esquemas com poliquimioterapia e intensificação de dose têm sido testados, mas sem impacto na sobrevida. Neste estudo os autores comparam CHOP-21 e CHOP-14 tendo como objetivo primário a sobrevida livre de progressão, levando-se em conta que a redução do intervalo dos ciclos poderia trazer benefícios para pacientes com LNH agressivo. Após sete anos de observação não se notou aumento na sobrevida livre de progressão e na sobrevida global com doses densas (CHOP-14). Mas apesar dos grupos estarem pareados e de não haver vantagens para nenhum dos lados, e ainda da análise de subgrupos, levando-se em conta estratificação de risco e idade, é importante ressaltar que neste estudo os pacientes foram incluídos de acordo com a classificação Working Formulation, em grau intermediário e alto, o que coloca lado a lado doenças com comportamento biológico muito diferente, inclusive misturando linfomas de linhagens distintas (B e T). Futuramente, deve-se considerar estudo comparativo entre CHOP-14 e CHOP-21 em linfomas com status biológico equivalente e padrão de agressividade semelhante.

Linfoma de sistema nervoso central com comprometimento intra e extracraniano em paciente näo imunodeprimido: relato de caso e revisäo da literatura / Central nervous system Hodgkin's limphoma with intra and extra cranial envolvent in a non immunocompromised patient. Case report and literature review

Relatamos um caso de linfoma näo Hodgkin de grandes células B em gânglios da regiäo cervical e retroperitôneo e com sítios de comprometimento extra nodal: encéfalo, calota craniana, couro cabeludo e infiltraçäo de vértebra T4. O perfil sorológico se mostrou negativo para anticorpos anti-HIV e a paciente foi tratada com seis ciclos de quimioterapia sistêmica de terceira geraçäo para linfomas agressivos (ProMACE-CytaBOM) em doses convencionais e radioterapia em encéfalo (dose total 4.000 cGY).Encontra-se em remissäo clínica e radiológica completa dez meses após o diagnóstico de linfoma. Discutimos o tratamento do linfoma primário de sistema central em pacientes näo imunodeprimidos.