Evolution of Proton Radiotherapy Brainstem Constraints on the Pediatric Proton/Photon Consortium Registry.

INTRODUCTION: Increasing concern that brainstem toxicity incidence after proton radiotherapy (PRT) might be higher than with photons led to a 2014 XXXX (XX) landmark paper identifying its risk factors and proposing more conservative dose constraints. We evaluated how practice patterns changed among the XXXX (XXXX). METHODS: This prospective multicenter cohort study gathered data from patients under age 22 enrolled on the XXXX, treated between 2002-2019 for primary posterior fossa brain tumors. After standardizing brainstem contours, we garnered dosimetry data and correlated those meeting the 2014 proton-specific brainstem constraint guidelines by treatment era, histology, and extent of surgical resection. RESULTS: A total of 467 patients with evaluable PRT plans were reviewed. Median age was 7.1 years (range: <1-21.9), 63.0% (n=296) were male, 76.0% (n=357) were white, and predominant histologies were medulloblastoma (55.0%, n=256) followed by ependymoma (27.0%, n=125). Extent of resection was mainly gross total resection (GTR) (67.0%, n=312), followed by subtotal resection (STR) or biopsy (20.0%, n=92). The XX brainstem constraint metrics most often exceeded were the goal D50% of 52.4 GyRBE (43.3%, n=202) and maximal D50% of 54 GyRBE (12.6%, n=59). The compliance rate increased after the new guidelines (2002-2014: 64.0% vs. 2015-2019: 74.6%, p=0.02), except for ependymoma (46.3% pre vs. 50.0% post guidelines, p=0.86), presenting lower compliance (48.8%) in comparison to medulloblastoma/PNET/pineoblastoma (77.7%), glioma (89.1%), and ATRT (90.9%) (p<0.001). Degree of surgical resection did not affect compliance rates (GTR/NTR 71.0% vs. STR/biopsy 72.8%, p=0.45), even within the ependymoma subset (GTR/NTR 50.5% vs. STR/biopsy 38.1%, p=0.82). CONCLUSION: Since the publication of the XX guidelines, the pediatric proton community has implemented more conservative brainstem constraints in all patients except those with ependymoma, irrespective of residual disease after surgery. Future work will evaluate if this change in practice is associated with decreased rates of brainstem toxicity.

Cervicovaginal specimen biomarkers for early detection of ovarian and endometrial cancer: A review.

BACKGROUND: In the last decade, technical innovations have resulted in the development of several minimally invasive diagnostic cancer tools. Within women at high risk of developing ovarian or endometrial cancer (EC) due to hereditary cancer syndrome, there is an urgent need for minimally invasive and patient-friendly methods to detect ovarian cancer and EC at an early stage. MATERIALS AND METHODS: We performed a systematic search of studies using DNA methylation or mutation analysis, microbiome, or proteomics performed on cervicovaginal specimens (smear, swab, or tampon) intended to detect ovarian and EC published until January 2024. RESULTS: Included studies (n = 36) showed high heterogeneity in terms of biomarkers used and outcomes, and only a few studies reported on the detection of biomarkers in high-risk subgroups. CONCLUSION: Based on the findings in this review, DNA methylation techniques seem to be the most promising for detecting ovarian and EC at early stages in the general population. Future validation of cervicovaginal DNA methylation techniques is needed to determine whether this technique might be beneficial in hereditary high-risk subgroups.

Diagnosis and management of isolated serous tubal intraepithelial carcinoma: A qualitative focus group study.

OBJECTIVE: A Serous Tubal Intraepithelial Carcinoma (STIC) without concomitant invasive carcinoma is occasionally identified and associated with a high risk of subsequent peritoneal carcinomatosis. Management needs optimisation. This study explores professionals' opinions and clinical practices regarding the diagnosis, counselling, treatment and follow-up of isolated STIC to facilitate clinical decision making and optimise the direction of future research. A secondary aim is to assess international clinical guidelines. DESIGN: Focus group study. SETTING: Four online sessions. POPULATION: International panel (n = 12 countries) of gynaecologists, gynaecologic oncologists, pathologists and medical oncologists (n = 49). METHODS: A semi-structured interview guide was used. Two independent researchers analysed transcripts by open and axial coding. Results were organised in domains. Relevant (inter)national guidelines were screened for recommendations regarding isolated STIC. MAIN OUTCOME MEASURES: Professionals' opinions and clinical practices regarding isolated STIC management. RESULTS: Regarding pathology, most professionals identified the SEE-FIM protocol as standard of care for high-risk patients, whereas variation exists in the histopathological examination of fallopian tubes in the general population. Confirmation of STIC diagnosis by a specialised pathologist was recommended. Regarding work-up and follow-up after STIC diagnosis, there was variety and discordance. Data on outcomes is limited. As for treatment, chemotherapy and PARP inhibitors were not recommended by most. Eleven guidelines provided limited recommendations. CONCLUSIONS: We identified recommendations and highlighted knowledge gaps in the diagnosis and management of isolated STIC. Moreover, recommendations in clinical guidelines are limited. There is an agreed need for international collaboration for the prospective registration of isolated STIC.

Versatile luminescence thermometry via intense green defect emission from an infrared-pumped fluorosilicate optical fiber.

An all-glass optical fiber capable of two distinct methods of optical thermometry is described. Specifically, a silica-clad, barium fluorosilicate glass core fiber, when pumped in the infrared, exhibits visibly intense green defect luminescence whose intensity and upper-state lifetime are strong functions of temperature. Intensity-based optical thermometry over the range from 25°C to 130°C is demonstrated, while a lifetime-based temperature sensitivity is shown from 25°C to 100°C. Time-domain measurements yield a relative sensitivity of 2.85% K -1 at 373 K (100°C). A proof-of-concept distributed sensor system using a commercial digital single-lens reflex camera is presented, resulting in a measured maximum relative sensitivity of 1.13% K -1 at 368 K (95°C). The sensing system described herein stands as a new blueprint for defect-based luminescence thermometry that takes advantage of pre-existing and relatively inexpensive optical components, and allows for the use of standard cameras or simply direct human observation.

Dual Exposure to E-Cigarette Vapour and Cigarette Smoke Results in Poorer Airway Cell, Monocyte, and Macrophage Function Than Single Exposure.

E-cigarette users predominantly also continue to smoke cigarettes. These Dual Users either consume e-cigarettes in locations where smoking is not allowed, but vaping is, or to reduce their consumption of cigarettes, believing it will lead to harm reduction. Whilst it is known that e-cigarette vapour is chemically less complex than cigarette smoke, it has a distinct chemical profile, and very little is known about the health impacts of exposure to both chemical profiles vs. either alone. We simultaneously exposed cells in vitro to non-toxic levels of e-cigarette vapour extract (EVE) and cigarette smoke extract (CSE) to determine their effects on 16HBE14o- airway epithelial cell metabolism and inflammatory response, as well as immune cell (THP-1 cells and monocyte-derived macrophages (MDM) from healthy volunteers) migration, phagocytosis, and inflammatory response. We observed increased toxicity, reduced metabolism (a marker of proliferation) in airway epithelial cells, and reduced monocyte migration, macrophage phagocytosis, and altered chemokine production after exposure to either CSE or EVE. These cellular responses were greater after dual exposure to CSE and EVE. The airway epithelial cells from smokers showed reduced metabolism after EVE (the Switcher model) and dual CSE and EVE exposure. When EVE and CSE were allowed to interact, the chemicals were found to be altered, and new chemicals were also found compared to the CSE and EVE profiles. Dual exposure to e-cigarette vapour and cigarette smoke led to worse functional outcomes in cells compared to either single exposure alone, adding to limited data that dual use may be more dangerous than smoking only.

A practical guide to cross-cultural and multi-sited data collection in the biological and behavioural sciences.

Researchers in the biological and behavioural sciences are increasingly conducting collaborative, multi-sited projects to address how phenomena vary across ecologies. These types of projects, however, pose additional workflow challenges beyond those typically encountered in single-sited projects. Through specific attention to cross-cultural research projects, we highlight four key aspects of multi-sited projects that must be considered during the design phase to ensure success: (1) project and team management; (2) protocol and instrument development; (3) data management and documentation; and (4) equitable and collaborative practices. Our recommendations are supported by examples from our experiences collaborating on the Evolutionary Demography of Religion project, a mixed-methods project collecting data across five countries in collaboration with research partners in each host country. To existing discourse, we contribute new recommendations around team and project management, introduce practical recommendations for exploring the validity of instruments through qualitative techniques during piloting, highlight the importance of good documentation at all steps of the project, and demonstrate how data management workflows can be strengthened through open science practices. While this project was rooted in cross-cultural human behavioural ecology and evolutionary anthropology, lessons learned from this project are applicable to multi-sited research across the biological and behavioural sciences.

Current approaches in tissue engineering-based nanotherapeutics for osteosarcoma treatment.

Osteosarcoma (OS) is a malignant bone neoplasm plagued by poor prognosis. Major treatment strategies include chemotherapy, radiotherapy, and surgery. Chemotherapy to treat OS has severe adverse effects due to systemic toxicity to healthy cells. A possible way to overcome the limitation is to utilize nanotechnology. Nanotherapeutics is an emerging approach in treating OS using nanoparticulate drug delivery systems. Surgical resection of OS leaves a critical bone defect requiring medical intervention. Recently, tissue engineered scaffolds have been reported to provide physical support to bone defects and aid multimodal treatment of OS. These scaffolds loaded with nanoparticulate delivery systems could also actively repress tumor growth and aid new bone formation. The rapid developments in nanotherapeutics and bone tissue engineering have paved the way for improved treatment efficacy for OS-related bone defects. This review focuses on current bifunctional nanomaterials-based tissue engineered (NTE) scaffolds that use novel approaches such as magnetic hyperthermia, photodynamic therapy, photothermal therapy, bioceramic and polymeric nanotherapeutics against OS. With further optimization and screening, NTE scaffolds could meet clinical applications for treating OS patients.

Integrative analysis of neuroblastoma by single-cell RNA sequencing identifies the NECTIN2-TIGIT axis as a target for immunotherapy.

Pediatric patients with high-risk neuroblastoma have poor survival rates and urgently need more effective treatment options with less side effects. Since novel and improved immunotherapies may fill this need, we dissect the immunoregulatory interactions in neuroblastoma by single-cell RNA-sequencing of 24 tumors (10 pre- and 14 post-chemotherapy, including 5 pairs) to identify strategies for optimizing immunotherapy efficacy. Neuroblastomas are infiltrated by natural killer (NK), T and B cells, and immunosuppressive myeloid populations. NK cells show reduced cytotoxicity and T cells have a dysfunctional profile. Interaction analysis reveals a vast immunoregulatory network and identifies NECTIN2-TIGIT as a crucial immune checkpoint. Combined blockade of TIGIT and PD-L1 significantly reduces neuroblastoma growth, with complete responses (CR) in vivo. Moreover, addition of TIGIT+PD-L1 blockade to standard relapse treatment in a chemotherapy-resistant Th-ALKF1174L/MYCN 129/SvJ syngeneic model induces CR. In conclusion, our integrative analysis provides promising targets and a rationale for immunotherapeutic combination strategies.

Colgajo de Mustardé como tratamiento de un carcinoma basocelular. A propósito de un caso

Introducción: El carcinoma basocelular es actualmente el cáncer de piel más frecuente, siendo su principal factor de riesgo la exposición a radiación ultravioleta. Su tratamiento es la resección quirúrgica, según riesgo de recurrencia. La reconstrucción facial posterior a la resección se enfrentará según la unidad estética de la cara, lo cual determinará la técnica quirúrgica a utilizar. Material y Método: El siguiente caso clínico aborda la resección de un carcinoma basocelular nodular morfeiforme ubicado en mejilla y ala nasal, y posterior reconstrucción mediante el uso de un Colgajo de Mustardé, con resultado exitoso. Resultados: Evolución favorable, con reseccion completa de la lesion tumoral y vitalidad del colgajo postoperatorio. Cursó con una leve desviación nasal que cedió con masaje de la cicatriz. Se puede plantear una plastía de retoque del ala nasal a futuro. Conclusión: Presentamos un caso clínico de un carcinoma basocelular facial con alto riesgo de recurrencia que fue tratado en forma segura y efectiva con un colgajo de Mustardé.

Introduction: Basal-cell carcinoma is currently the most frequent type of skin cancer, its main risk factor being exposure to ultraviolet radiation. Treatment consists of surgical resection, according to recurrence risk. Post-resection facial reconstruction should be faced according to the aesthetic unit of the face, which will determine the surgical technique. Material and Method: The following clinical case presents the resection of a morpheiform nodular basal-cell carcinoma located on the cheek and nasal wing, and subsequent reconstruction using a Mustarde flap, with successful results. Results: Favorable evolution with complete resection of the tumor lesion and postoperative vitality of the flap. The patient presented a slight nasal deviation that resolved with scar massage. A nasal wing plasty can be considered in the future. Conclusion: We present a facial basal-cell carcinoma clinical case that was safely and effectively treated with a Mustarde flap.

Evaluation of nutritional composition of flour residue of mangaba processing / Avaliação dos fatos nutricionais do processamento do resíduo da farinha de mangaba

Among several fruits, mangaba (Hancornia speciosa Gomes), it aroused the interest of producers and consumers due to its attractive sensory characteristics and health beneficial properties (high nutritional value and presence of bioactive substances), thus, this work evaluates the nutritional factors of the flour residue of mangaba processing that is despised by the food industry, and the influence of temperature on its production. The mangaba processing residue was splited in two main groups: in natura sample (control), and other for preparation of flour that was dried at 50 °C and divided into two other groups: treatment A (flour with roasts at 110 °C and 130 °C) and treatment B (flour from drying at 50 °C). The nutritional characteristics of flours were analyzed considering the chemical parameters: pH, titratable total acidity and soluble solids, in addition to the determination of moisture content, total lipids, total dietary fiber and ash, total energy value, antioxidant activity, phytochemical screening, quantification of phenolic compounds and flavonoids, as well as technological functional properties (water absorption index (WAI), water solubility index (WSI), milk absorption index (MAI) and milk solubility index (MSI) and oil absorption index (OAI). The results showed that the bioactive compounds present in the extracts do not have significant properties of acting as free radical kidnappers. The heat treatment, performed in the flour of mangaba processing residues, influenced the nutritional factors and properties of absorption and solubility, which showed statistical differences. These results show that the flour is a viable alternative for the energy enrichment of diets, contributing to the development of new products, the reduction of the disposal of these residues and consequently to the minimization of the environmental impact.

Dentre as diversas frutas a mangaba (Hancornia speciosa Gomes), despertou interesse de produtores e consumidores devido às suas características sensoriais atrativas e propriedades benéficas à saúde (elevado valor nutricional e presença de substâncias bioativas), assim, o trabalho avaliar os fatores nutricionais do resíduo da farinha de processamento de mangaba que é desprezado pela indústria alimentícia e, a influência da temperatura na sua produção. O resíduo de processamento da mangaba foi dividido em dois lotes, sendo um deles utilizado para as análises in natura (amostra controle) e o outro para a confecção da farinha que foi seca a 50 °C, e dividida em dois lotes: tratamento A (farinha com torras a 110 °C e 130 °C) e no tratamento B (farinha oriunda da secagem a 50 °C). Analisou-se as características nutricionais de farinhas considerando os parâmetros químicos: pH, acidez total titulável e sólidos solúveis, além da determinação do teor de umidade, lipídios totais, fibra alimentar total e cinzas, valor energético total, atividade antioxidante, triagem fitoquímica, quantificação de compostos fenólicos e flavonoides, bem como as propriedades funcionais tecnológicas (índice de absorção de água (IAA), índice de solubilidade em água (ISA), índice de absorção de leite (IAL) e índice de solubilidade em leite (ISL) e índice de absorção de óleo (IAO). Na análise foi inferido que os compostos bioativos presentes nos extratos não possuem propriedades significativas de agir como sequestradores de radicais livres. O tratamento térmico, realizado na farinha de resíduos de processamento de mangaba, influenciou nos dados dos fatores nutricionais e das propriedades de absorção e solubilidade, os quais apresentaram diferenças estatísticas. Estes resultados credenciam a farinha como uma alternativa viável para o enriquecimento energético de dietas, contribuindo para o desenvolvimento de [...].

Evaluation of nutritional composition of flour residue of mangaba processing

Abstract Among several fruits, mangaba (Hancornia speciosa Gomes), it aroused the interest of producers and consumers due to its attractive sensory characteristics and health beneficial properties (high nutritional value and presence of bioactive substances), thus, this work evaluates the nutritional factors of the flour residue of mangaba processing that is despised by the food industry, and the influence of temperature on its production. The mangaba processing residue was splited in two main groups: in natura sample (control), and other for preparation of flour that was dried at 50 °C and divided into two other groups: treatment A (flour with roasts at 110 °C and 130 °C) and treatment B (flour from drying at 50 °C). The nutritional characteristics of flours were analyzed considering the chemical parameters: pH, titratable total acidity and soluble solids, in addition to the determination of moisture content, total lipids, total dietary fiber and ash, total energy value, antioxidant activity, phytochemical screening, quantification of phenolic compounds and flavonoids, as well as technological functional properties (water absorption index (WAI), water solubility index (WSI), milk absorption index (MAI) and milk solubility index (MSI) and oil absorption index (OAI). The results showed that the bioactive compounds present in the extracts do not have significant properties of acting as free radical kidnappers. The heat treatment, performed in the flour of mangaba processing residues, influenced the nutritional factors and properties of absorption and solubility, which showed statistical differences. These results show that the flour is a viable alternative for the energy enrichment of diets, contributing to the development of new products, the reduction of the disposal of these residues and consequently to the minimization of the environmental impact.

Resumo Dentre as diversas frutas a mangaba (Hancornia speciosa Gomes), despertou interesse de produtores e consumidores devido às suas características sensoriais atrativas e propriedades benéficas à saúde (elevado valor nutricional e presença de substâncias bioativas), assim, o trabalho avaliar os fatores nutricionais do resíduo da farinha de processamento de mangaba que é desprezado pela indústria alimentícia e, a influência da temperatura na sua produção. O resíduo de processamento da mangaba foi dividido em dois lotes, sendo um deles utilizado para as análises in natura (amostra controle) e o outro para a confecção da farinha que foi seca a 50 °C, e dividida em dois lotes: tratamento A (farinha com torras a 110 °C e 130 °C) e no tratamento B (farinha oriunda da secagem a 50 °C). Analisou-se as características nutricionais de farinhas considerando os parâmetros químicos: pH, acidez total titulável e sólidos solúveis, além da determinação do teor de umidade, lipídios totais, fibra alimentar total e cinzas, valor energético total, atividade antioxidante, triagem fitoquímica, quantificação de compostos fenólicos e flavonoides, bem como as propriedades funcionais tecnológicas (índice de absorção de água (IAA), índice de solubilidade em água (ISA), índice de absorção de leite (IAL) e índice de solubilidade em leite (ISL) e índice de absorção de óleo (IAO). Na análise foi inferido que os compostos bioativos presentes nos extratos não possuem propriedades significativas de agir como sequestradores de radicais livres. O tratamento térmico, realizado na farinha de resíduos de processamento de mangaba, influenciou nos dados dos fatores nutricionais e das propriedades de absorção e solubilidade, os quais apresentaram diferenças estatísticas. Estes resultados credenciam a farinha como uma alternativa viável para o enriquecimento energético de dietas, contribuindo para o desenvolvimento de novos produtos, a redução do descarte desses resíduos e consequentemente para a minimização do impacto ambiental.

Evaluation of nutritional composition of flour residue of mangaba processing / Avaliação dos fatos nutricionais do processamento do resíduo da farinha de mangaba

Abstract Among several fruits, mangaba (Hancornia speciosa Gomes), it aroused the interest of producers and consumers due to its attractive sensory characteristics and health beneficial properties (high nutritional value and presence of bioactive substances), thus, this work evaluates the nutritional factors of the flour residue of mangaba processing that is despised by the food industry, and the influence of temperature on its production. The mangaba processing residue was splited in two main groups: in natura sample (control), and other for preparation of flour that was dried at 50 °C and divided into two other groups: treatment A (flour with roasts at 110 °C and 130 °C) and treatment B (flour from drying at 50 °C). The nutritional characteristics of flours were analyzed considering the chemical parameters: pH, titratable total acidity and soluble solids, in addition to the determination of moisture content, total lipids, total dietary fiber and ash, total energy value, antioxidant activity, phytochemical screening, quantification of phenolic compounds and flavonoids, as well as technological functional properties (water absorption index (WAI), water solubility index (WSI), milk absorption index (MAI) and milk solubility index (MSI) and oil absorption index (OAI). The results showed that the bioactive compounds present in the extracts do not have significant properties of acting as free radical kidnappers. The heat treatment, performed in the flour of mangaba processing residues, influenced the nutritional factors and properties of absorption and solubility, which showed statistical differences. These results show that the flour is a viable alternative for the energy enrichment of diets, contributing to the development of new products, the reduction of the disposal of these residues and consequently to the minimization of the environmental impact.

Resumo Dentre as diversas frutas a mangaba (Hancornia speciosa Gomes), despertou interesse de produtores e consumidores devido às suas características sensoriais atrativas e propriedades benéficas à saúde (elevado valor nutricional e presença de substâncias bioativas), assim, o trabalho avaliar os fatores nutricionais do resíduo da farinha de processamento de mangaba que é desprezado pela indústria alimentícia e, a influência da temperatura na sua produção. O resíduo de processamento da mangaba foi dividido em dois lotes, sendo um deles utilizado para as análises in natura (amostra controle) e o outro para a confecção da farinha que foi seca a 50 °C, e dividida em dois lotes: tratamento A (farinha com torras a 110 °C e 130 °C) e no tratamento B (farinha oriunda da secagem a 50 °C). Analisou-se as características nutricionais de farinhas considerando os parâmetros químicos: pH, acidez total titulável e sólidos solúveis, além da determinação do teor de umidade, lipídios totais, fibra alimentar total e cinzas, valor energético total, atividade antioxidante, triagem fitoquímica, quantificação de compostos fenólicos e flavonoides, bem como as propriedades funcionais tecnológicas (índice de absorção de água (IAA), índice de solubilidade em água (ISA), índice de absorção de leite (IAL) e índice de solubilidade em leite (ISL) e índice de absorção de óleo (IAO). Na análise foi inferido que os compostos bioativos presentes nos extratos não possuem propriedades significativas de agir como sequestradores de radicais livres. O tratamento térmico, realizado na farinha de resíduos de processamento de mangaba, influenciou nos dados dos fatores nutricionais e das propriedades de absorção e solubilidade, os quais apresentaram diferenças estatísticas. Estes resultados credenciam a farinha como uma alternativa viável para o enriquecimento energético de dietas, contribuindo para o desenvolvimento de novos produtos, a redução do descarte desses resíduos e consequentemente para a minimização do impacto ambiental.

Situational diagnosis of the popular use of medicinal plants in pediatrics / Diagnóstico situacional do uso popular de plantas medicinais em pediatria

Abstract This study aimed to describe the use of medicinal plants for the relief and treatment of pediatrics pathologies performed by parents of children registered in a Basic Health Unit. This is a cross-sectional, observational and analytical study that occurred from March until May 2016, with the participation of 176 individuals, using a semi-structured questionnaire as a research instrument. Descriptive statistics were applied for data analysis, using frequency distribution and chi-square test. Among all 177 indications of medicinal use of plants in childhood, considering the plant part and administration method, 61.6% converged with scientific data, 21.5% differed and 16.9% were new indications without a similar record in the literature. These results support the popular use of medicinal plants and show to need for greater awareness about the rational use of phytotherapy and stimulate scientific research, as they bring new elements about the therapeutic potential of different species.

Resumo O objetivo deste estudo foi descrever o uso de plantas medicinais para alívio e tratamento de patologias em pediatria realizado por pais de crianças cadastradas em uma Unidade Básica de Saúde. Trata-se de um estudo transversal, observacional e analítico, que ocorreu nos meses de março a maio de 2016, com a participação de 176 indivíduos, utilizando como instrumento de investigação um questionário semiestruturado. Para análise dos dados aplicou-se a estatística descritiva, com uso da distribuição de frequências e o teste do qui-quadrado. Das 177 indicações de uso medicinal de plantas na infância, considerando a parte da planta utilizada e sua forma de uso, 61,6% convergiram com os dados científicos, 21,5% divergiram e 16,9% foram novas indicações, sem registro semelhante na literatura. Esses resultados, ao mesmo tempo em que respaldam o uso popular de plantas medicinais, apontam a necessidade de maior conscientização sobre o uso racional da fitoterapia e estimulam a investigação científica, pois trazem novos elementos sobre o potencial terapêutico de diferentes espécies.

PTI y embarazo: una experiencia con rituximab / ITP and pregnancy: an experience with rituximab

El Púrpura Trombocitopénico Idiopático (PTI) es una patología asociada a una de cada 500 a 1000 gestantes. Su reconocimiento oportuno y adecuado manejo durante el embarazo, permite reducir la morbimortalidad tanto materna como fetal. Los corticoides como tratamiento de primera línea para PTI en embarazadas, es igual que en población general, con respuestas observadas entre el 5° y 7° día, alcanzando un 50 - 60% de éxito. El caso que presentamos se trata de una gestante en el 2° trimestre tardío con PTI refractario al tratamiento con corticoides, con muy bajos niveles de plaquetas y alto riesgo de hemorragia, por lo cual se decide el uso de Rituximab, un anticuerpo monoclonal (categoría C de la FDA) con escasa prescripción en el embarazo. Exponemos nuestra experiencia en este caso.

Idiopathic thrombocytopenic purpura ( ITP) is a condition associated with each 500-1000 pregnancies . Its early recognition and proper management during pregnancy, can reduce both maternal and fetal morbidity and mortality. Corticosteroids as first-line treatment for ITP in pregnant women is the same as in the general population, with responses observed between the 5th and 7th day, approximately 50-60 % of patients respond favorably. The case presented is a pregnant patient in the 2th trimester with refractory ITP treatment with corticosteroids, very low levels of platelets and high risk of bleeding so the use of Rituximab is decided, a monoclonal antibody (category C FDA) with little prescription in pregnancy. We describe our experience in this case.

Situational diagnosis of the popular use of medicinal plants in pediatrics

Abstract This study aimed to describe the use of medicinal plants for the relief and treatment of pediatrics pathologies performed by parents of children registered in a Basic Health Unit. This is a cross-sectional, observational and analytical study that occurred from March until May 2016, with the participation of 176 individuals, using a semi-structured questionnaire as a research instrument. Descriptive statistics were applied for data analysis, using frequency distribution and chi-square test. Among all 177 indications of medicinal use of plants in childhood, considering the plant part and administration method, 61.6% converged with scientific data, 21.5% differed and 16.9% were new indications without a similar record in the literature. These results support the popular use of medicinal plants and show to need for greater awareness about the rational use of phytotherapy and stimulate scientific research, as they bring new elements about the therapeutic potential of different species.

Resumo O objetivo deste estudo foi descrever o uso de plantas medicinais para alívio e tratamento de patologias em pediatria realizado por pais de crianças cadastradas em uma Unidade Básica de Saúde. Trata-se de um estudo transversal, observacional e analítico, que ocorreu nos meses de março a maio de 2016, com a participação de 176 indivíduos, utilizando como instrumento de investigação um questionário semiestruturado. Para análise dos dados aplicou-se a estatística descritiva, com uso da distribuição de frequências e o teste do qui-quadrado. Das 177 indicações de uso medicinal de plantas na infância, considerando a parte da planta utilizada e sua forma de uso, 61,6% convergiram com os dados científicos, 21,5% divergiram e 16,9% foram novas indicações, sem registro semelhante na literatura. Esses resultados, ao mesmo tempo em que respaldam o uso popular de plantas medicinais, apontam a necessidade de maior conscientização sobre o uso racional da fitoterapia e estimulam a investigação científica, pois trazem novos elementos sobre o potencial terapêutico de diferentes espécies.

DNA methylation patterns of candidate genes regulated by thymine DNA glycosylase in patients with TP53 germline mutations

Li-Fraumeni syndrome (LFS) is a rare, autosomal dominant, hereditary cancer predisposition disorder. In Brazil, the p.R337H TP53 founder mutation causes the variant form of LFS, Li-Fraumeni-like syndrome. The occurrence of cancer and age of disease onset are known to vary, even in patients carrying the same mutation, and several mechanisms such as genetic and epigenetic alterations may be involved in this variability. However, the extent of involvement of such events has not been clarified. It is well established that p53 regulates several pathways, including the thymine DNA glycosylase (TDG) pathway, which regulates the DNA methylation of several genes. This study aimed to identify the DNA methylation pattern of genes potentially related to the TDG pathway (CDKN2A, FOXA1, HOXD8, OCT4, SOX2, and SOX17) in 30 patients with germline TP53 mutations, 10 patients with wild-type TP53, and 10 healthy individuals. We also evaluated TDG expression in patients with adrenocortical tumors (ADR) with and without the p.R337H TP53 mutation. Gene methylation patterns of peripheral blood DNA samples assessed by pyrosequencing revealed no significant differences between the three groups. However, increased TDG expression was observed by quantitative reverse transcription PCR in p.R337H carriers with ADR. Considering the rarity of this phenotype and the relevance of these findings, further studies using a larger sample set are necessary to confirm our results.

Consumo, degradabilidade in situ e cinética ruminal em bovinos suplementados com diferentes proteinados / Intake, degradability in situ and ruminal kinetics in cattle supplemented with different protein supplements

Objetivou-se avaliar o efeito de combinações de diferentes fontes de nitrogênio não proteico com fontes de carboidratos como suplemento para bovinos sobre o consumo, degradabilidade in situ, taxa de passagem e cinética ruminal em bovinos. Os tratamentos consistiram nos seguintes suplementos proteinados: CSUENC = casca de soja + ureia encapsulada; CSUREIA = casca de soja + ureia; MTAMIR = milho triturado + amireia; MTURENC = milho triturado + ureia encapsulada, MTUREIA = milho triturado + ureia. Os animais foram alimentados com feno de Brachiaria brizantha cv. Marandu como fonte de volumoso. O ensaio foi conduzido em delineamento quadrado latino 5x5 (cinco suplementos, cinco animais, cinco períodos). Não houve diferenças para consumo de nutrientes (P>0,05), exceto para consumo de proteína bruta g/kgPV0,75, em que se verificou maior consumo no tratamento CSUENC. Para frações fibrosas, foram obtidas maiores ingestões de fibra em detergente neutro, fibra em detergente ácido (kg/dia; % PV; g/kgPV0,75), hemicelulose (% PV; g/kgPV0,75) quando alimentados com CSUREIA em relação àqueles com MTUREIA (P<0,05). Os tratamentos constituídos pelos diferentes proteinados não afetaram a degradabilidade in situ das frações nutricionais (P>0,05), exceto para fração potencialmente degradável da celulose. A concentração de nitrogênio amoniacal no líquido ruminal foi influenciada pela composição dos proteinados (P<0,05), sendo superior para os tratamentos MTUREIA e MTURENC em relação à CSURENC. As combinações entre diferentes fontes de nitrogênio não proteico e de carboidratos nos diferentes suplementos não modificam o consumo e a degradabilidade da forragem. Dessa forma, a escolha dos ingredientes para formulação de proteinados deve ser realizada considerando-se disponibilidade e preços desses suplementos.(AU)

The aim of this study was to evaluate the effect of combinations of different sources of non-protein nitrogen with carbohydrate sources as supplement feed to cattle on intake, in situ degradability and passage rate. Treatments consisted of the following protein supplements: CSUENC= soybean hulls + encapsulated urea; CSUREIA = soybean hulls + urea; MTAMIR = ground corn + starea; MTURENC = ground corn + encapsulated urea; MTUREIA = ground corn + urea. The animals were fed with Brachiaria brizantha cv. Marandu as roughage. The experiment was conducted in a latin square design (five supplements, five animals, five periods). The treatments did not affect the intake of nutrients (P>0.05), although a higher intake of crude protein (g/kgBW0.75) was observed by animals fed with CSUENC. A higher intake of NDF, ADF (kg/day, %BW; g/kgBW0.75) and hemicellulose (% PV; g/kgBW0.75) was observed by animals fed with CSUREIA when compared to those with MTUREIA (P<0.05). The degradability of nutritional fractions was not affected by any of the treatments (P>0.05), except for the potentially degradable cellulose. The ammoniacal nitrogen concentration in rumen fluid was influenced by the protein source (P<0.05) and was higher for MTUREIA and MTURENC treatments in relation to CSURENC. The tested combinations of different sources of non-protein nitrogen with different carbohydrates did not affect the forage intake or degradability. Therefore, the choice of the ingredients for protein supplement formulation should be made considering other factors as availability and price of these supplements.(AU)

Desafió Diagnóstico

Se presenta un caso clínico con información del cuadro, signos y síntomas con la información dada Ud. será capaz de elocurar un diagnóstico clínico.

Automatización en el laboratorio clínico / Automation in the clinical laboratory

La automatización de los laboratorios clínicos es un fenómeno que va en aumento, un proceso aplicable a todas las etapas del proceso analítico; el uso de la computación, la incorporación de autoanalizadores y otros elementos automáticos proporciona una serie de ventajas mejorando la eficiencia y la capacidad productiva en beneficio de los pacientes, de los profesionales y del propio laboratorio, reconocer el momento adecuado en que debe aplicarse la automatización así como el grado y etapas en las que se puede intervenir reporta una serie de beneficios, este cambio debe hacerse en forma planificada considerando elementos tales como los costos, la capacitación del personal y las tecnologías disponibles.

The automation of the clinical laboratories is a phenomenon that increases, a process applicable to all the stages of the analytical process, the use of the computation, the incorporation of autoanalyzers and other automatic elements provide a series of advantages improving the efficiency and the productive capacity to the benefit of the patients, of the professionals and the own laboratory, to recognize the suitable moment in which it must be applied to the automation as well as the degree and stages in which it is possible to be taken part reports a series of benefits, this change must be made in planned form considering elements such as the costs, the qualification of the personnel and the technologies available.

Teores de proteína para vacas lactantes em pastejo de capim-elefante / Protein contents for lactating dairy cows grazing elephant grass

Avaliou-se o efeito da utilização de concentrados com diferentes teores de proteína bruta (PB) para vacas em lactação sob pastejo rotacionado de capim-elefante, distribuídas em três quadrados latinos (3x3). Os tratamentos foram concentrados suplementares contendo 15,2; 18,2 ou 21,1 por cento de PB. Foram oferecidos 3kg de concentrado por vaca, duas vezes ao dia. A disponibilidade de matéria seca (MS)/ha de capim-elefante foi de 1.873kg ou de 17,4kg de MS/vaca dia-1. A MS do capim-elefante foi de 19,6 por cento, contendo 13,9 por cento de PB e 66,1 por cento de fibra detergente neutro (FDN) e 67,4 por cento de digestibilidade in vitro da MS (DIVMS). Não houve diferença (P>0,05) entre os tratamentos quanto ao consumo diário de MS da dieta total (21,5; 21,6 e 20,8kg/d), MS do capim-elefante (16,1; 16,3 e 15,5kg/d) e FDN do capim-elefante (10,7; 10,7 e 10,3kg/d). As produções de leite (17,5; 17,2 e 17,6kg/d) e os teores de gordura (3,4; 3,5 e 3,5 por cento), proteína (2,9; 2,9 e 2,9 por cento), lactose (4,4; 4,4 e 4,4 por cento) e N-ureia no leite (14,1; 14,6 e 15,8mg/dL) não diferiram (P>0,05) entre os tratamentos (respectivamente, para 15,2; 18,2 ou 21,1 por cento de PB). O teor de N-ureia no plasma foi maior (P<0,05) em vacas alimentadas com concentrado com 21,1 por cento de PB (na ordem citada: 11,5; 12,2 e 14,4mg/dL). Nas condições experimentais, o concentrado suplementar com 15,2 por cento de PB pode ser utilizado na alimentação de vacas em lactação em pastagem de capim-elefante.

To evaluate the effect of feeding concentrate with different crude protein (CP) contents, lactating dairy cows grazing elephant grass were distributed in a 3x3 latin square. Three kg/cow of concentrates (15.2, 18.2, or 21.1 percent CP) were offered twice a day. Elephant grass dry matter (DM) availability was 1,873kg/ha; with a daily offer of 17.4kg/cow. The elephant grass DM content was 19.6 percent with 13.9 percent CP, 66.1 percent neutral detergent fiber (NDF), and 67.4 percent in vitro DM digestibility. There was no difference among treatments regarding total diet DM daily intake (21.5, 21.6, and 20.8kg/cow), elephant grass DM (16.1, 16.3, and 15.5kg/cow), and elephant grass NDF (10.7, 10.7, and 10.3kg/cow). Milk yield (17.5, 17.2, and 17.6kg/d) fat (3.4, 3.5, and 3.5 percent), protein (2.9, 2.9, and 2.9 percent), lactose (4.4, 4.4, and 4.4 percent), and N-urea (14.1, 14.6, and 15.8mg/dL) did not differ among concentrates (P>0.05). Plasma N-urea was higher in cows fed concentrate with 21.1 percent CP (11.5 = 12.2<14.4mg/dL, P<0.05). According to these results, concentrate with 15.2 percent CP can be used to lactating dairy cows grazing elephant grass, without affecting milk production as compared to concentrate with 18.2 or 21.1 percent of CP.