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Denise Rossato Silva,1,2 Marcelo Basso Gazzana,1,2 Marli Maria Knorst1,21Department of Internal Medicine, Universidade Federal do Rio Grande do Sul, 2Department of Pulmonary Medicine, Hospital de Clínicas de Porto Alegre, Porto Alegre, BrazilBackground: Previous studies have documented that C-reactive protein (CRP) levels are increased in stable COPD patients. However, most studies have also shown that higher CRP levels are observed in patients with comorbidities like diabetes mellitus and cardiovascular disease. We aimed to investigate if CRP levels are increased in stable COPD patients, and if there is an association between CRP levels and pulmonary function tests and clinical characteristics.Methods: We conducted a case-control study in a tertiary care, university-affiliated hospital. COPD patients and controls were matched for sex and age in a 2:1 matching ratio. We included only those patients who had quit smoking. CRP levels were determined and pulmonary function tests were performed in both the groups.Results: A total of 60 COPD patients and 30 controls were included in the analysis. The study subjects had a mean age of 64.8±8.5 years in COPD group and 64.3±9.2 years in control group (P=0.214). The median of CRP levels was 3.17 mg/L (interquartile range [IQR]: 1.73–5.99 mg/L) in COPD group and 2.13 mg/L (IQR: 1.18–7.69 mg/L) in control group (P=0.370). There were 34 (56.7%) patients in COPD group and 14 (46.7%) patients in control group with CRP levels greater than 3 mg/dL (P=0.382). Using bivariate correlations, we found significant positive correlations in COPD patients between body mass index (BMI) and CRP (r=0.3, P=0.045), and between CRP and forced vital capacity (FVC, % of predicted) (r=-0.3; P=0.023). In a multivariate model, female sex and FVC (% of predicted) were associated with a CRP value greater than 3 mg/dL in the COPD group.Conclusion: The levels of CRP in the stable COPD patients were not significantly different when compared to those in the control subjects. Female sex and FVC (% predicted) were associated with CRP levels greater than 3 mg/dL in the COPD group.Keywords: case-control study, chronic obstructive pulmonary disease, C-reactive protein, comorbidity

BACKGROUND: Optimal drug dosing is important to ensure adequate response to treatment, prevent development of drug resistance and reduce drug toxicity. The aim of these clinical standards is to provide guidance on 'best practice´ for dosing and management of TB drugs.METHODS: A panel of 57 global experts in the fields of microbiology, pharmacology and TB care were identified; 51 participated in a Delphi process. A 5-point Likert scale was used to score draft standards. The final document represents the broad consensus and was approved by all participants.RESULTS: Six clinical standards were defined: Standard 1, defining the most appropriate initial dose for TB treatment; Standard 2, identifying patients who may be at risk of sub-optimal drug exposure; Standard 3, identifying patients at risk of developing drug-related toxicity and how best to manage this risk; Standard 4, identifying patients who can benefit from therapeutic drug monitoring (TDM); Standard 5, highlighting education and counselling that should be provided to people initiating TB treatment; and Standard 6, providing essential education for healthcare professionals. In addition, consensus research priorities were identified.CONCLUSION: This is the first consensus-based Clinical Standards for the dosing and management of TB drugs to guide clinicians and programme managers in planning and implementation of locally appropriate measures for optimal person-centred treatment to improve patient care.

BACKGROUND: Increasing evidence suggests that post-TB lung disease (PTLD) causes significant morbidity and mortality. The aim of these clinical standards is to provide guidance on the assessment and management of PTLD and the implementation of pulmonary rehabilitation (PR).METHODS: A panel of global experts in the field of TB care and PR was identified; 62 participated in a Delphi process. A 5-point Likert scale was used to score the initial ideas for standards and after several rounds of revision the document was approved (with 100% agreement).RESULTS: Five clinical standards were defined: Standard 1, to assess patients at the end of TB treatment for PTLD (with adaptation for children and specific settings/situations); Standard 2, to identify patients with PTLD for PR; Standard 3, tailoring the PR programme to patient needs and the local setting; Standard 4, to evaluate the effectiveness of PR; and Standard 5, to conduct education and counselling. Standard 6 addresses public health aspects of PTLD and outcomes due to PR.CONCLUSION: This is the first consensus-based set of Clinical Standards for PTLD. Our aim is to improve patient care and quality of life by guiding clinicians, programme managers and public health officers in planning and implementing adequate measures to assess and manage PTLD.

Estrutura de comunidades de árvores em florestas tropicais depende de filtros ambientais e interações abióticas, como competição e facilitação. Muitas florestas de ecótono no norte da Amazônia são intrigantemente povoadas por assembleias de árvores, caracterizadas por abundâncias distintas de uma única espécie, Peltogyne gracilipes (Leguminosae). Não está claro se este padrão isoladamente reflete filtros ambientais ou também interações antagônicas entre espécies com requisitos de habitats semelhantes. O objetivo deste estudo foi determinar a resposta da riqueza e composição de espécies aos filtros ambientais, analisando o papel de P. gracilipes na estruturação de comunidades arbóreas em áreas de floresta de ecótono do norte da Amazônia brasileira. Amostramos 129 parcelas permanentes ao longo de um gradiente hidro-edáfico. Todos os indivíduos arbóreos com diâmetro do caule ≥ 10 cm foram medidos e identificados. Regressões múltiplas foram realizadas para testar os efeitos dos filtros ambientais, e da abundância de P. gracilipes na riqueza e composição das árvores. Riqueza e composição de espécies responderam aos mesmos filtros, os quais, por sua vez, afetaram a composição das espécies direta e indiretamente, por meio da abundância de P. gracilipes. Nossos resultados indicam que tanto os filtros abióticos quanto as interações bióticas moldam as comunidades arbóreas estudadas. P. gracilipes pode ser considerada uma espécie indicadora de condições hidroedáficas, mas também é ela própria uma impulsionadora da estrutura da comunidade arbórea.

El neuromarketing como objeto de estudio en el campo de la Comunicación está ganando cada vez más atención académica en el contexto español, sobre todo en los últimos años. En este texto analizamos la evolución de este tema de investigación en las tesis doctorales durante el período 2007-2018, justo en el momento de transición de las normativas sobre estudios de postgrado a nivel nacional. A partir de una metodología de metaanálisis, de tipología mixta, se evalúan los centros científicos de producción y los autores, las configuraciones de las líneas temáticas, los conceptos y objetivos más comunes, así como el diseño metodológico en cuanto a muestras, datos, técnicas y triangulaciones dominantes. Aunque el neuromarketing continúa teniendo una presencia residual en el campo académico, el interés epistemológico que genera sigue en aumento, en particular en ámbitos de investigación fronterizos directamente vinculados con la comunicación institucional u organizacional, la comunicación de eventos y la comunicación de marca.

A two phase population balance is used to predict the polydispersed bubble flow and size distribution in a slab continuous casting mold and Submerged Entry Nozzle (SEN) system. Multiple Size Group (MUSIG) with a suitable breakage and coalescence model (Ansys CFX) was adopted to account for the polydispersed gas flow. Initial bubble size distribution as determined for two industrial refractories have been taken in consideration. A two way coupling model including the effect of the drag force and non-drag forces such as virtual mass force and turbulent dispersion force was considered. The results are compared with gas distribution in a 1:1 scale water — air mold model running under conditions of fluidynamic similarity to validate the model. The simulations have then been extended to describe the actual steel — argon flow, considering a thermal expansion factor for argon bubbles. The effect of gas distribution on the flow field of liquid inside the mold and other metallurgical aspects are discussed.

Neste artigo, analisam-se elementos que caracterizam aspectos da criação artística, mímesis, representação do imaginário e da cultura popular no gênero História em Quadrinhos (HQs) produzido por acadêmicos do Curso de Licenciatura em Educação do Campo: Códigos e Linguagens – Artes e Música da Universidade Federal do Tocantins. Metodologicamente, realizou-se uma pesquisa participante, de abordagem qualitativa. Os resultados mostram que é preciso compreender a estética do gênero HQs, sua relação com a literatura, bem como a mímesis na produção artístico-literária. E um dos caminhos para entender as representações do imaginário e da cultura popular nas HQs perpassa pela criação estética e pela literatura.

Objective. The present paper aims to investigate the role of computed tomography as an imaging technique of diagnosis in the identification of the os cordis in ovine, and also how this anatomical structure is morphotopographically characterized in macro and microscopic contexts, seeking to contribute for its functional understanding. Materials and method. The heart of a young male ovine had been donated to the Laboratory of Animal Anatomy of the Surgery Department of the FMVZ/USP, first being subject to a post-mortem examination by means of the cardiac “shedding” (transverse cross sectioning of the heart). A tomographic examination of the anatomic specimen was carried out, as well as the dissection and histological analysis of the collected sample. Results. The results indicate the presence of an osseous structure of 6.39 mm in length, located in the aortic valve of the heart, next to a ring comprised by three valve flaps, tendinous cords, and papillary muscles. The histological findings consist of fibrous connective tissue, cancellous bone tissue, and calcified hyaline cartilage wherein the cardiomyocytes are attached. Conclusions. It is concluded that computed tomography, even though seldom applied to animals of zootechnical interest, poses as an effective tool for the visualization of the os cordis in lambs.

Objetivo: Descrever reações adversas após tratamento radioterápico em pessoas com câncer atendidas em um ambulatório de radioterapia. Metodologia: Trata-se de um estudo documental por meio da coleta de dados em prontuários clínicos. Foram avaliados 436 pacientes que realizaram tratamento radioterápico em busca de episódios de reações adversas registrados nos prontuários. Foram elegíveis os pacientes maiores de 18 anos com diagnóstico de neoplasia (confirmado por laudos citopatológicos e/ou histopatológico) que realizaram cinco ou mais sessões de radioterapia entre 2015 e 2016. Resultados: 353 prontuários clínicos foram incluídos (83,6%) e 1.390 reações associadas ao tratamento radioterápico foram descritas nestes pacientes, sendo 53,2% mulheres. As reações adversas mais frequentes relacionadas à radioterapia foram dor (14%), radiodermite (9%) e falta de apetite (8%). 69% dos pacientes não apresentavam sinais ou sintomas antes do diagnóstico, sendo 25% diagnosticados com adenocarcinoma. A técnica de radioterapia mais utilizada foi a 3D (67%), com cerca de 30 frações (14%) e 5000 Gy como dose total planejada (17%). 70% dos pacientes que apresentaram reações adversas possuíam ao menos uma comorbidade. Conclusão: A radioterapia pode estar associada à diversas reações adversas, variando os sinais e sintomas nos pacientes acometidos. A prevenção e o manejo destas condições podem potencializar o tratamento, reduzindo a morbidade e a mortalidade, além de proporcionar qualidade de vida aos pacientes com câncer.

Los virus del papiloma humanos (HPVs) oncogénicos son importantes agentes en la etiología del cáncer ginecológico y actualmente han sido relacionados también a algunas lesiones carcinógenas y a algunos tipos de cánceres de boca. Con el objetivo de determinar la presencia del HPV en la queilitis fueron evaluados y considerados aptos para el estudio 29 pacientes portadores de quelitis actínica crónica y 29 pacientes en el grupo control. Se utilizó la PCR para detectar la presencia del HPV en muestras de tejido fresco, provenientes de labios enfermos. La quelitis actínica crónica (QAC) ocurrió en individuos de raza blanca, 19 hombres y 10 mujeres, con media de edad 56 años. En el análisis de las características clínicas se registraron varias alteraciones. También se evaluaron los aspectos histológicos de la QAC y se encontraron atipia en diferentes grados en todos los casos. Concluimos que todos los casos presentaron resultados negativos del aislamiento viral.

O presente artigo tem como objetivo compreender como está sendo sistematizada pelo governo federal brasileiro a denominada “Rede Nacional de Treinamento”, principalmente nos aspectos relativos à formação de jovens talentos esportivos. Para alcançar tal intento foram analisadas as fontes oficiais disponibilizadas pelo governo brasileiro A título de conclusão o trabalho aponta que a referida ação encontra-se ainda na fase de implementação, sendo hoje mais um desejo político do que uma realidade que contribua para o desenvolvimento dos jovens talentos esportivos brasileiros.

Oral squamous cell carcinoma (OSCC) shows a limited response to current systemic treatments, and this resistance could be associated with cancer stem cells (CSC). NFκB is an activated pathway in several malignancies, including head and neck cancer. Here we evaluated the role of NFκB inhibitor on the behavior of CSC derived from OSCC. Emetine was used as an NFκB inhibitor. CSC presence was assessed by tumorspheres, and the emetine IC50 was determined in this specific cell population. Also, the CSC was quantified by the enzymatic activity of aldehyde dehydrogenases (ALDH) using flow cytometry. Immunofluorescence staining for phosphorylated protein p65 was used to identify the NFκB levels of tumor cells. Finally, OSCC cells were sensitized with emetine for 24 hours followed by administration of cisplatin (IC50). The IC50 of emetine in CSC OSCC was 0.5μM. We then treated the OSCC cells with the emetine IC50, which showed a significant reduction of the ALDH population, while the NFκB pathway was inhibited. Further, emetine sensitized OSCC cells to cisplatin, resulting in a reduction of the IC50 from 3.9μM to 1.3μM for SCC9. Our results suggested that CSCs play an important role in tumor resistance to chemotherapy and highlight the disruption of these cells by the NFκB inhibition as a promisor target therapy. [ABSTRACT FROM AUTHOR]

El Síndrome de Ovario Poliquístico (SOP) es una disfunción endocrino metabólica altamente prevalente en mujeres en edad reproductiva. De etiología incierta, se manifiesta de formas muy variadas, entre las que destacan irregularidad menstrual, oligo o anovulación, hiperandrogenismo clínico, imagen ecográfica de ovario poliquístico, obesidad, insulinorresistencia e infertilidad. Por su variedad de presentación es que su definición ha requerido varios consensos y es aún hoy motivo de controversia. La infertilidad asociada al SOP obedece a diferentes mecanismos, entre los que destacan la disfunción ovulatoria, la alteración del desarrollo endometrial, la insulinorresistencia, su impacto en la esteroidogénesis ovárica y suprerrenal y, la alta frecuencia de aborto espontáneo de primer trimestre. El enfoque diagnóstico y terapéutico del SOP debe contemplar todos estos aspectos en forma integral para restablecer adecuadamente el ambiente endocrino-metábolico previo a un embarazo y tener en cuenta las potenciales repercusiones en el mediano y largo plazo para estas pacientes como dislipidemia, diabetes mellitus tipo 2, enfermedad cardiovascular y, cáncer de endometrio y mama.

Allogeneic hematopoietic stem cell transplantation (HSCT) provides curative therapy for hematological malignancies, but chronic Graft-Versus-Host Disease (cGVHD) in up to 50% of patients limits its wider use. This multi-organ disorder frequently affects the oral cavity (45-85% of cGVHD patients). Despite prevalent oral complications, the mechanism remains undefined, contributing to a lack of effective therapy, significant morbidity, compromised nutrition, and reduced quality of life. This study analyzed metabolite and immune mediator shifts in HSCT patients to unravel cGVHD pathogenesis mechanistically. Saliva and oral tissue biopsies from 14 patients who underwent matched-unrelated-donor HSCT (trial:NCT02356159) were collected pre-transplant, 6-months, and 1-year post-transplant, and at oral cGVHD onset. Longitudinal shifts in 120 metabolites were determined using gas chromatography/mass spectrometry (GC/MS). 255 critical immunoregulatory genes were analyzed using a targeted gene expression analysis (nCounter Human Inflammation v2 Panel), followed by appropriate statistical tests and correlation analyses. Of the 14 patients, 10 developed cGVHD and 4 were asymptomatic at one-year follow-up. Pro-inflammatory genes, including HLA-DRA, HLA-DRB1, CD86, TNF, FASLG, IRF1, IRF3, IRF7, and IFN-γ, were significantly increased, and a common immediate-early gene, JUN, was decreased at the onset of cGVHD. The kynurenine:tryptophan ratio decreased across the time-points in the cGVHD group, while the control group exhibited the opposite trend. In addition, several pro-inflammatory metabolites including phenylalanine, methionine, valine, and threonine were increased in the cGVHD cohort, while anti-inflammatory and homeostatic metabolites including adenosine, alpha-ketoglutarate, phosphoenolpyruvate, and N-acetyl glutamine were decreased. Interestingly, tryptophan and indolelactic acid strongly correlated with critical immunoregulator IRF7 in the cGVHD-onset lesions, underscoring the potential role of these metabolites in cGVHD. Our results from this prospective trial demonstrate the critical immune-regulatory role of Tryptophan:Kynurenine pathway in the onset of oral mucosal cGVHD. Larger studies are needed to validate these associations and further define the microbiome contribution to this immune-metabolite axis. [ABSTRACT FROM AUTHOR]