Oropharyngeal colostrum immunotherapy and nutrition in preterm newborns: meta-analysis

ABSTRACT OBJECTIVE To investigated the effect of oropharyngeal colostrum immunotherapy in reducing the time required for very low birth weight preterm newborns (VLBW-PTNB: < 1,500g and < 37 weeks) to achieve full enteral nutrition. METHODS Literature search was conducted using four databases, including gray literature, with additional manual search of the references of selected articles. Eligibility criteria consisted of randomized clinical trials, without restriction regarding the date or language of the publication. Two independent reviewers performed the article selection and data extraction. The random-effects meta-analysis used a non-standard technique to assess the mean difference in days to achieve full enteral nutrition, carried out by the Stata 15 statistic program. RESULTS The systematic review comprised 10 studies, and five were selected for meta-analysis, with a population of 764 VLBW-PTNB and gestational age of birth between 25 and 32 weeks. The studies were conducted between 2011 and 2018 in North America, Asia and Africa, with only one conducted in South America. Altogether, they reported the number of days it took 708 VLBW-PTNB to achieve full enteral nutrition, with newborns treated with immunotherapy showing a shorter time in only three studies. Meta-analysis showed a mean difference of -4.26 days, (95% CI -7.44; -1.08d), with high heterogeneity (I2 = 83.1%). CONCLUSION The use of oropharyngeal colostrum immunotherapy can reduce the time for VLBW-PTNB to achieve full nutrition when compared to those who used a placebo or received routine care.

Carcinoma de células escamosas de cabeça e pescoço (HNSCC): desvendando os mistérios do microambiente tumoral / Head and neck squamous cell carcinoma (HNSCC): unmasking the tumor microenvironment

Este artigo refere-se à uma revisão sobre o carcinoma de células escamosas de cabeça e pescoço (HNSCC), o qual está envolvido em cerca de 90% dos cânceres de cabeça e pescoço,originado do revestimento escamoso da superfície das mucosas do trato aero digestivo superior,incluindo cavidade oral, faringe, laringe e trato sino nasal. Atualmente, o HNSCC apresenta-se como o sexto tipo de câncer mais comum no mundo, sendo que apenas 50% dos pacientes permanecem vivos por 5 anos, após o diagnóstico. Devido à sua distribuição acelerada e alta prevalência, este tipo de câncer tornou-se, nas últimas décadas, uma das principais ameaças para a saúde pública. Seu desenvolvimento e progressão vem ganhando um destaque especial,considerando-se as novas descobertas relacionadas à instabilidade no cerne da genômica e epigenômica, metabolômica, remodelamento celular e fatores de risco associados, principalmente com o envolvimento de infecções virais e, mais recentemente, aos aspectos imunológicos inerentes ao microambiente tumoral (TME), principalmente o perfil celular (fibroblastos associados ao câncer, linfócitos T reguladores, linfócitos e macrófagos com perfil imunossupressorTh2 e M2, respectivamente e neutrófilos associados ao tumor) e o perfil humoral (quimiocinas, citocinas imunossupressoras tais como TGF-B, IL-13, IL-10, proteínas responsáveis pela quebrada matrix extracelular–metaloproteases e fatores que contribuem para o desenvolvimento e progressão tumoral mediados pela angiogênese, tais como EGF e VEGF). Nos próximos anos, a compreensão da imunobiologia do HNSCC será paralelamente acompanhada de importantes avanços na detecção precoce de pacientes de alto risco, baseada na identificação de biomarcadores,na manipulação do sistema imune e na compreensão da farmacogenômica.

This article refers to a review about head and neck squamous cell carcinoma (HNSCC), which involves about 90% of all head and neck cancers, originated from the squamous lining of the upperaero digestive tract, including the oral cavity, pharynx, larynx and sinonasal tract. Currently, it is known as the 6th most common cancer in the world and only 50% of patients will remain alive for5 years post-diagnosis. Due to its accelerated spreading and its high occurrence, this kind of cancerhas become, in the last decades, one of the major threats to public health. Its development and progression has been gaining special attention, considering the new findings associated to the coreinstability of genetic and epigenetic, metabolomics, cellular remodeling and associated risk factors,especially with the involvement of viral infections and, more recently, to the immunological aspects inherent from the tumor microenvironment (TME) particularly cell profiles (fibroblast associated with cancer, regulatory T cells, lymphocytes, and macrophages with immuno suppressive profile Th2and M2, respectively, and neutrophils associated with tumor) and humoral profile (chemokines, immuno suppressive cytokines such as TGF-B, IL-13, IL-10, proteins responsible for the breakdown of extracellular matrix- metallo proteinase and factors that contribute to the development and tumor progression mediated by angiogenesis, such as EGF and VEGF). In the upcoming years, under standing the immunobiology of head and neck squamous cell carcinoma will be accompanied simultaneous ly by important advances in the early detection of high-risk patients, based on the identification of biomarkers,on the manipulation of the immune system and on the understanding of the pharmacogenomics.

Imunologia dos tumores / Tumors immunology

Foram analisados os mecanismos do sistema imunológico frente à transformação maligna da célula, bem como, os meios que podem ser utilizados objetivando o diagnóstico precoce dos processos neoplásicos, além dos recursos terapêuticos imunológicos que encontram-se disponíveis atualmente para o tratamento desta patologia