ALCAM is a biomarker of tumor aggressiveness and worse prognosis in glottic laryngeal squamous cell carcinoma.

BACKGROUND: Laryngeal squamous cell carcinoma (LSCC) is the second most frequent head and neck tumor. Prognosis of patients with LSCC has not improved in recent decades, showing a need for the identification of prognostic biomarkers and new therapeutic targets. Recently, we showed that ALCAM overexpression was associated with glottic LSCC prognosis. OBJECTIVES AND METHODS: Aiming to validate the prognostic value of ALCAM, we evaluate the ALCAM protein levels by immunohistochemistry in 263 glottic LSCC surgically treated with neck dissection. RESULTS: ALCAM was expressed in 48.7% and overexpressed in 36.5% of glottic LSCC samples. ALCAM overexpression was associated with lymph node metastasis (p = 0.030), lymphovascular involvement (p = 0.0002), high-grade tumors (p = 0.025), and tumor relapse (p = 0.043). Multivariate survival analyses showed an overfitting between ALCAM overexpression and lymph node metastasis as a prognostic variable. CONCLUSIONS: High ALCAM expression was associated with an aggressive glottic LSCC profile.

Upper Aerodigestive Tract Squamous Cell Carcinomas Show Distinct Overall DNA Methylation Profiles and Different Molecular Mechanisms behind WNT Signaling Disruption.

Upper aerodigestive tract (UADT) tumors present different biological behavior and prognosis, suggesting specific molecular mechanisms underlying their development. However, they are rarely considered as single entities (particularly head and neck subsites) and share the most common genetic alterations. Therefore, there is a need for a better understanding of the global DNA methylation differences among UADT tumors. We performed a genome-wide DNA methylation analysis of esophageal (ESCC), laryngeal (LSCC), oral (OSCC) and oropharyngeal (OPSCC) squamous cell carcinomas, and their non-tumor counterparts. The unsupervised analysis showed that non-tumor tissues present markedly distinct DNA methylation profiles, while tumors are highly heterogeneous. Hypomethylation was more frequent in LSCC and OPSCC, while ESCC and OSCC presented mostly hypermethylation, with the latter showing a CpG island overrepresentation. Differentially methylated regions affected genes in 127 signaling pathways, with only 3.1% of these being common among different tumor subsites, but with different genes affected. The WNT signaling pathway, known to be dysregulated in different epithelial tumors, is a frequent hit for DNA methylation and gene expression alterations in ESCC and OPSCC, but mostly for genetic alterations in LSCC and OSCC. UADT tumor subsites present differences in genome-wide methylation regarding their profile, intensity, genomic regions and signaling pathways affected.

StrongKids for pediatric nutritional risk screening in Brazil: a validation study.

OBJECTIVES: To evaluate the validity and reproducibility of StrongKids as a pediatric nutritional screening tool in Brazil, which has no validated method for this purpose. METHODS: A cross-sectional study was conducted with 641 patients admitted to the pediatric care unit of a public hospital from 2014 to 2018. The concurrent validity was assessed by evaluating the sensitivity, specificity, and the positive and negative predictive values of StrongKids in detecting acute, chronic, and overall malnutrition. Predictive validity was determined by calculating the same indices to identify longer than median hospital stay, need of enteral nutrition, 30-day hospital readmission, transfer to hospitals with more complex procedures, and death. StrongKids was reapplied to a subsample to evaluate the inter-rater reproducibility. RESULTS: Prevalence of low risk was 15.6%, moderate risk was 63.7%, and high nutritional risk was 20.7%. A positive test, corresponding to the moderate or high risk category, identified all those with acute malnutrition and showed sensitivity of 89.4% (95% CI: 76.9-96.4) and 94.0% (95% CI: 86.6-98.0) for the detection of chronic and overall malnutrition, respectively. Regarding its predictive capacity, 100% of the patients who needed enteral nutrition, who were transferred, died, or were readmitted to hospital within 30 days after discharge were considered in risk by StrongKids, and the sensitivity to identify those with prolonged hospital stays was 89.2 (95% CI: 84.6-92.7). The inter-rater agreement was excellent (PABAK: 0.87). CONCLUSIONS: StrongKids had satisfactory validity and reproducibility and successfully identified nutritional deficits and predict unfavorable health outcomes. Our results support the use of StrongKids as a pediatric nutritional risk screening method in Brazil.

Rotina dos profissionais de enfermagem no trabalho com resíduos em saúde em um hospital público / Professional nursing routine in working with health wastes at a public hospital

Objetivo: analisar a rotina da equipe de enfermagem quanto à manipulação de resíduos sólidos desaúde. Método: estudo descritivo, transversal, com abordagem quantitativa. Foi aplicado um questionáriopara 17 profissionais de enfermagem distribuídos nos setores de clínica médica e cirúrgica de um hospitalpúblico. Foi realizada a caracterização da população estudada por meio da distribuição de frequências,médias, medianas, desvios-padrão, Odd ratio e intervalos de confiança (95%). O projeto foi aprovado peloComitê de Ética em Pesquisa sob CAAE – 0367.0.213.000-11. Resultados: 88% dos profissionais de enfermagemconheciam o Programa de Gerenciamento de Resíduos Sólidos de Saúde e 70% receberam treinamentos.Contrapondo as informações que apenas 11(65%) classificam e descartam corretamente os resíduos e 6(35%)usavam os Equipamentos de Proteção Individual (EPIs). Conclusão: há necessidade de sensibilizar osprofissionais de enfermagem a adotarem o uso de EPIs com o intuito de minimizar os efeitos no meioambiente e os riscos ocupacionais.