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Este trabalho foi desenvolvido pelo Projeto Fundão: Estatística e Probabilidade, um projeto colaborativo da Universidade Federal do Rio de Janeiro (UFRJ), composto por professores, estudantes de graduação e professores de matemática de nível escolar. A pesquisa faz parte de um estudo cujo foco é o ensino e aprendizagem de estatística e probabilidade no ensino fundamental. Nosso objetivo é o desenvolvimento profissional dos professores de matemática. Com atenção à fase inicial do letramento estatístico e com base em uma abordagem integrada, consideramos as recentes orientações normativas brasileiras determinadas pela Base Nacional Comum Curricular (BNCC) em Estatística e Probabilidade para propor sequências didáticas nos moldes da resolução de problemas de investigação estatística apresentados nas Diretrizes para Avaliação e Ensino em Educação Estatística (GAISE).

Em momentos de Emergência em Saúde Pública, o uso de tecnologias diagnósticas se dá sob condições especiais, visto a necessidade do rápido acesso. Na Emergência em Saúde Pública do vírus zika, os testes comerciais foram importantes para identificar casos e responder seus desafios. No Brasil, a comercialização de testes diagnósticos ocorre após a concessão do registro pela Agência Nacional de Vigilância Sanitária. O objetivo deste artigo foi analisar o registro dos testes comerciais para o diagnóstico da infecção pelo vírus zika no período de 2016 a 2019 no Brasil. O estudo exploratório-descritivo utilizou-se do banco de dados e de documentos do site da Agência Nacional de Vigilância Sanitária, bem como de documentos disponíveis nas páginas eletrônicas dos fabricantes detentores de registro. Quatro dimensões foram consideradas para a análise dos dados coletados: registro, testes, fabricantes e detentores de registro. Foram registrados 68 testes, sendo 91% de empresas privadas; 82% específicos para o vírus zika; 54% importados; 78% sorológicos; e 37% testes rápidos. Durante a Emergência em Saúde Pública do vírus zika, a Agência Nacional de Vigilância Sanitária priorizou o registro dos testes, sem fazer uso da Autorização de Uso Emergencial, dispositivo preconizado internacionalmente. Em 2016, o tempo médio para análise de registro foi menor e o número de exigências, maior. Não se identificou informação sobre o desempenho em 50% dos testes. A recuperação e a geração de novas evidências, durante a utilização, são os grandes desafios e mostra-se importante disponibilizar informações sobre o desempenho dos testes.

Este artigo examina a capacidade do conjunto de 40 modelos climáticos do Coupled Model Intercomparison Projects Generation 6 - CMIP6, conjunto MOD, para simular a temperatura do ar e a precipitação médias do período de janeiro de 1985 a dezembro de 2014 em cada estado do Brasil. Apesar dos vieses nas simulações, o subconjunto do CMIP6 conseguiu simular satisfatoriamente o ciclo anual e sazonal da temperatura e precipitação, bem como captar a tendência das variáveis analisadas no Brasil. Em relação a temperatura do ar à superfície, o subconjunto do CMIP6 apresentou o melhor desempenho para as Regiões Sul e Sudeste do Brasil, com destaque para os estados do Paraná, Santa Catarina e São Paulo. O melhor desempenho para a precipitação, com o subconjunto do CMIP6 foi verificado sobre a Região Centro-Oeste. Em relação às tendências de aquecimento no período de 30 anos do estudo, 1985-2014, todos estados do Brasil apresentaram tendência de aquecimento, tanto para os dados do subconjunto do CMIP6, quanto para os dados observados. A precipitação na região Norte e Sudeste, não exibiu tendências claras para o período analisado, alguns estados apresentaram aumento e outros redução da precipitação. Nas Regiões Centro-Oeste e Nordeste todos estados apresentam tendência de redução da chuva. Na Região Sul, os três estados mostram tendência de aumento na chuva tanto no observado quanto no simulado. No entanto, além das incertezas inerentes a modelagem climática e vieses detectados, este estudo é relevante para indicar o comportamento dos modelos em simular o clima presente. A avaliação apresentada neste trabalho estabeleceu níveis de confiança no uso deste subconjunto de simulações de modelos para estudos do clima futuro, conforme detalhado no texto.

Although we have witnessed remarkable progress in understanding the biological mechanisms that lead to the development of rheumatic diseases (RDs), remission is still not achieved in a substantial proportion of patients with the available pharmacological treatment. As a consequence, patients are increasingly looking for complementary adjuvant therapies, including dietary interventions. Herbs and spices have a long historical use, across various cultures worldwide, for both culinary and medicinal purposes. The interest in herbs and spices, beyond their seasoning properties, has dramatically grown in many immune-mediated diseases, including in RDs. Increasing evidence highlights their richness in bioactive molecules, such as sulfur-containing compounds, tannins, alkaloids, phenolic diterpenes, and vitamins, as well as their antioxidant, anti-inflammatory, antitumorigenic, and anticarcinogenic properties. Cinnamon, garlic, ginger, turmeric, and saffron are the most popular spices used in RDs and will be explored throughout this manuscript. With this paper, we intend to provide an updated review of the mechanisms whereby herbs and spices may be of interest in RDs, including through gut microbiota modulation, as well as summarize human studies investigating their effects in Rheumatoid Arthritis, Osteoarthritis, and Fibromyalgia.

The intensification of deforestation and the consequent fragmentation of the natural landscape in urban and periurban watersheds affect the entire eco-hydrological system, increasing the need to understand how these changes can affect their sustainability. In this sense, the present study evaluated the potential implications of forest fragmentation for the management of the Tarumã-Açu basin, based on the characterization of the structural and functional patterns of the landscape. For this, we mapped and categorized the basin’s forest fragments, based on the supervised classification (Bhattacharyya Method) of Landsat/OLI image, and, subsequently, we calculated the landscape metrics (area, density and size, edge, form, core, isolation and connectivity). The metrics showed a very fragmented landscape, especially in the region of the basin’s low course, which concentrates the smallest, most dispersed, and vulnerable fragments even in conservation units. The headwater region, on the other hand, has the largest patches, with a large amount of central area and high structural and functional connectivity, which are fundamental for the sustainability of the basin and, therefore, deserve attention and prioritization by managers. The results offer important subsidies and unpublished data that can contribute to elaboration of the basin’s management plan and for the definition of conservation and restoration strategies of the forest remnants, indicating priority areas for the implementation of these actions.

Objective Lupus nephritis is a key driver of morbidity and mortality in SLE. Detecting active nephritis on a background of pre-existing renal damage is difficult, leading to potential undertreatment and accumulating injury. An unmet need is a biomarker that distinguishes active lupus nephritis, particularly important in paediatrics where minimising invasive procedures is desirable.Methods This was a multicentre, prospective study of 113 paediatric patients with biopsy-proven lupus nephritis. Clinical data and urine were obtained every 3–4 months and patients averaged 2 years on study with seven time points. Urine was analysed for human epidermal growth factor receptor 2 (HER2), tumour necrosis factor-like weak inducer of apoptosis and vascular cell adhesion molecule-1 (VCAM-1) by ELISA. We defined active disease as either a rise in serum creatinine ≥0.3 mg/dL from baseline or a rise in renal Systemic Lupus Erythematosus Disease Activity Index score from the previous visit. These markers were also studied in patients with acute kidney injury, juvenile idiopathic arthritis (JIA), amplified pain syndrome and healthy controls.Results The rate of active disease was 56% over an average of 2 years of follow-up. HER2 and VCAM-1 were significantly elevated at time points with active disease defined by increased serum creatinine compared with time points with inactive disease or patients who never flared. All three biomarkers were associated with new-onset proteinuria and VCAM-1 was elevated at time points preceding new-onset proteinuria. These biomarkers were not increased in acute kidney injury or JIA.Conclusion All three biomarkers were associated with new onset proteinuria and increased VCAM-1 may predict impending proteinuria. These biomarkers provide potential non-invasive measures for monitoring that may be more sensitive to impending flare than conventional measures.

Objetivo: relatar a experiência da utilização das tecnologias body painting e body projection como ferramentas facilitadoras do processo ensino aprendizagem na perspectiva de docentes de Enfermagem durante o ensino do exame físico cardiovascular. Método: relato de experiência de estratégia facilitadora aplicada ao processo de ensino-aprendizagem do exame físico cardiovascular durante o curso de graduação em Enfermagem de uma universidade privada de São Paulo Brasil. Resultados: participaram da experiência 40 estudantes, dois professores, um artista plástico e dois modelos que receberam a pintura corporal. O uso das referidas tecnologias suscitou reflexões sobre a possibilidade de utilizá-las como ferramentas para o ensino de forma lúdica e eficaz, otimizando o contexto acadêmico formal. Conclusão: as ferramentas body painting e body projection, de acordo com a percepção dos docentes, facilitam o processo de ensino-aprendizagem do exame físico cardiovascular, uma vez que aproximam a teoria da prática e permitem, aos estudantes, associações visuais que superam as tradicionais barreiras de ensino-aprendizagem.

O objetivo do presente estudo foi de estimar a chance de especialização esportiva precoce em uma população escolar. Foi elaborado um questionário Sobre Especialização precoce e dados demográficos respondidos por 830 praticantes de modalidades distintas. Os participantes foram recrutados de escolas públicas e particulares. A classificação da especialização precoce foi baseada nos métodos de autoclassificação e no sistema de três pontos. A análise dos dados foi realizada através da estatística descritiva, teste qui-quadrado e análise de regressão logística multinomial. Os resultados mostraram que a chance para a especialização esportiva por tipo de escola é duas vezes mais para escola pública na categoria moderada (OR= 2,06; IC95% 1,46–2,74) e alta (OR= 1,96; IC95% 1,19–3,26) que escolas particulares. O sistema de pontos classificou os adolescentes em níveis: baixa, média e alta especialização, mostrando 61,8% (n= 495), 29,5% (n= 235), 8,7% (n= 70) respectivamente. Os participantes se classificaram como praticantes de um único (n= 405, 50,6%), ou vários esportes (n= 396, 49,4%) através do sistema de autoclassificação. Portanto, a chance de um escolar ser especializado precocemente é baixa, e a variável idade não foi determinante para influenciar na especialização dos escolares. Contudo, a especialização esportiva parece ser influenciada pelo sexo e tipo de escola.

A Odontologia Hospitalar visa à manutenção e aos cuidados prestados a pacientes sob internação hospitalar. O cirurgião-dentista é um profissional devidamente capacitado para identificação, prevenção e tratamento de alterações na cavidade bucal. A inserção do CD em ambiente hospitalar tem sido instituída mediante resoluções e leis para beneficiar quem carece desse atendimento. Sendo assim, o objetivo deste trabalho é apresentar trajetória da Odontologia Hospitalar no Brasil, verificar seu panorama atual e mostrar sobre a importância desse profissional na equipe multidisciplinar dos hospitais. As buscas foram realizadas, entre os anos de 2001 e 2019, em bases de dados bibliográficos nacionais e como complemento no manual de odontologia hospitalar, em matérias publicadas pela Agência Nacional de Vigilância Sanitária e em leis publicadas nos diários oficiais dos municípios, estados e união. Os dados mostram que muitos estados já se adequaram, do ponto de vista legal, no sentido de tornar a Odontologia Hospitalar uma realidade. No entanto, ainda falta fiscalização e profissionais ocupando todos os postos de trabalho. Logo, percebe-se que a última década foi decisiva em prol da Odontologia Hospitalar, mas ainda há muito o que se fazer para que novos avanços aconteçam.

Healthcare-associated infections are one of the major concerns worldwide. This study presents the development and the validation process of the InovSafeCare scale and aimed at identifying and measuring the ecosystem variables related to healthcare-associated infection (HCAI) prevention and control practices in European nurse students. Qualitative and quantitative approaches were used to (1) elaborate an item pool related to the educational environment, the healthcare setting environment, and the attitudes, beliefs, and performance of the nursing students regarding HCAI prevention and control and (2) analyze psychometric properties of the scale using factor analysis. The validated InovSafeCare scale was applied to undergraduate nursing students of five European Higher Education Institutions. The partial least square structural equation modeling (PLS-SEM) method with SMART-PLS3 software was used. The study sample consists of 657 nursing students, who responded a self-report inventory. From the analyzed data were identified 14 factors. The InovSafeCare scale reveals good validity and reliability of the dimensions in different European countries.

Dificuldades no atendimento odontológico das crianças, devido à necessidade de controle do comportamento e de suporte familiar adequado, além de peculiaridades relativas à anatomia dos dentes decíduos, suscitam o uso de técnicas de mínima intervenção para o controle da cárie dentária. Logo, o objetivo do presente trabalho foi realizar uma revisão bibliográfica sobre o tratamento minimamente invasivo de lesões de cárie em dentes decíduos, abordando as características, indicações e limitações de diferentes técnicas dentro desse conceito. O controle de biofilme sem selamento dentário é uma abordagem na qual nenhum tipo de material restaurador é colocado para selar as cavidades, sendo instituída a higiene bucal de modo eficiente como estratégia para paralisar as lesões de cárie. O selamento da lesão sem remoção de tecido cariado prevê a utilização de selantes resinosos ou coroas metálicas diretamente sobre as cavidades, sem remoção prévia de tecido cariado. Já a remoção seletiva de cárie seguida de restauração é a técnica mais aceita e utilizada em odontopediatria, sendo atualmente considerado o padrão ouro, em detrimento da remoção total de tecido cariado. Apesar de a mínima intervenção ser bem aceita pelas crianças, sua aceitabilidade pelos responsáveis e odontopediatras ainda é questionável. Verificou-se que todas essas técnicas se apresentam como alternativas eficazes para o tratamento minimamente invasivo em odontopediatria. Entretanto, é fundamental o entendimento, participação e comprometimento dos familiares, tendo em vista que o controle do biofilme e da dieta possuem papel fundamental para garantir o sucesso desses tratamentos.

Este trabalho busca investigar os indícios de avanços nos direitos das mulheres no pós Primavera Árabe da Tunísia, entre os anos de 2010 e 2014, através das categorias analíticas do feminismo islâmico e do pós-colonialismo. Em função da agitação político-social refletida nas grandes manifestações populares clamando por maiores liberdades, e evidenciando um hiato entre os direitos garantidos pelo texto constitucional existente no período precedente à Primavera Árabe, o de 1959, trabalha-se aqui com a hipótese de que essa oportunidade teria sido aproveitada pelas tunisianas, tendo sua luta simbolizada na nova constituição de 2014. Para tanto, observa-se os trechos constitucionais de 1959 e 2014 e avaliam-se os reflexos das lutas de gênero. Conclui-se que as mulheres obtiveram sucesso em sua luta, ao menos no sentido de terem sido garantidos, na nova constituição, seus direitos e deveres. Além disso, inferiu-se, a partir de seus ganhos, a confirmação de que o feminismo islâmico não deve ser compreendido sob a perspectiva ocidental, uma vez que cada movimento possui suas próprias reivindicações e particularidades.

ABSTRACT Objective To verify the prevalence of dental anomalies in terms of number, position and shape, and the presence of bone alterations, through analysis of panoramic radiographs. Methods This study evaluated dental anomalies and bone alterations in children aged 6 to 12 years-old, detected on panoramic radiographies recorded in the radiographic database of the Federal University of Espírito Santo between 2012 and 2016. Clinical and demographic information were registered. Dental records were retrieved to obtain the medical history involving syndromes or other diseases that may interfere with the anomalies and alterations. Chi-square and exact Fischer’s statistical tests were performed. Results There were alterations in 83 out of 301 panoramic radiographs analyzed. There were 169 anomalies or alterations (mean of 2,04±1,38 anomalies/patient), involving 201 teeth. The most prevalent anomaly was tooth impaction (26.63%), which affected the canines more frequently, followed by hypodontia (24.26%), more often found in the second premolar, and both affected mostly females. Hyperdontia and radiolucent lesions showed the same prevalence (18.93%), the most affected teeth were those of the anterosuperior region and the first mandibular molars, respectively. The least prevalent anomalies were dilaceration (7.69%), taurodontism (2.37%) and radiopaque lesions (1.18%). Bone alterations were significantly more found in mandible and in the posterior region, which confirms the prevalence in the lower molars. Conclusion Although there was no statistically significant difference regarding sex, there was a high prevalence of anomalies and alterations in our study population, which indicates the importance of its diagnosis by means of a panoramic x-ray examination.

Justificativa e Objetivo: O vírus da hepatite B tem alta prevalência mundial, com forte impacto na saúde pública, o que justifica as estratégias de vigilância e prevenção dos possíveis agravos. O risco da exposição ao vírus entre os estudantes e profissionais de saúde constitui uma grande preocupação, mostrando-se baixa a adesão desse público às medidas de biossegurança. O objetivo foi avaliar o conhecimento, imunização contra hepatite B e uso das medidas de biossegurança por estudantes da área da saúde em uma universidade no interior de Minas Gerais, Brasil. Métodos: Estudo transversal, descritivo, com aplicação de questionário, de autopreenchimento, a estudantes da área da saúde, composto por variáveis sociodemográficas e referentes ao tema biossegurança. Resultados: Dentre os 540 estudantes que participaram do estudo, 37,2% declararam não ter conhecimento sobre biossegurança, e desse total, 28,9% não foram vacinados contra a hepatite B, 32,4% dos estudantes consideraram que não estavam expostos ao vírus da hepatite B, e desses, 25,7% não eram vacinados. Ainda o estudo mostrou que 13,3% dos estudantes não usavam luvas e, destes, 41,7% não eram vacinados. Conclusão: Verificou-se que existem lacunas em relação ao conhecimento e uso das medidas de biossegurança, entre estas, a falha da imunização contra hepatite B. Neste sentido, faz-se necessária a adoção de políticas de educação permanente com inclusão sistemática do tema biossegurança e adoção de mecanismos que garantirão a imunização desses estudantes.

Objetivo: caracterizar as internações por condições sensíveis à atenção primária de um município do interior de Minas Gerais, Brasil. Método: estudo transversal, descritivo, com coleta de dados secundários de prontuários, provenientes de internações hospitalares. Foi elaborado um formulário de coleta estruturado em três blocos: sociodemográficos; relacionados à anamnese; e relacionados a internação. Foram realizadas as frequências absolutas e relativas das variáveis e utilização do Qui-quadrado de Pearson e o Exato de Fisher, considerando o nível de significância de 5%. Resultados: Foram identificados 663 prontuários, com predomínio de pacientes ≥ 60 anos (70.7%), sexo feminino (54,1%), raça/cor parda e preta (69,5%) e sem registro referente a presença ou ausência de fatores de risco (28,5%). Predominaram os diagnósticos de acidentes vasculares e insuficiência cardíaca congestiva ambos com 13,3%, pneumonia (11,0%), angina (9,5%) e doença bronco pulmonar obstrutiva crônica com 8,4% dos casos. Entre os 45 casos (6,8%) de óbito, 19 (42,2%) foram pacientes que não pertenciam à área com cobertura da equipe de Estratégia de Saúde da Família do município. Conclusão: Os resultados contribuirão para uma adequação e qualificação da gestão dos serviços de saúde e melhor planejamento dos cuidados prestados, assim como, a definição de indicadores de desempenho para atenção primária à saúde da região para que sejam controladas e reduzidas as taxas de hospitalizações evitáveis.

(1) Background: the present study aimed to evaluate the effect of different types of warm-ups on the strength and skin temperature of Paralympic powerlifting athletes. (2) Methods: the participants were 15 male Paralympic powerlifting athletes. The effects of three different types of warm-up (without warm-up (WW), traditional warm-up (TW), or stretching warm-up (SW)) were analyzed on static and dynamic strength tests as well as in the skin temperature, which was monitored by thermal imaging. (3) Results: no differences in the dynamic and static indicators of the force were shown in relation to the different types of warm-ups. No significant differences were found in relation to peak torque (p = 0.055, F = 4.560, η2p = 0.246 medium effect), and one-repetition maximum (p = 0.139, F = 3.191, η2p = 0.186, medium effect) between the different types of warm-ups. In the thermographic analysis, there was a significant difference only in the pectoral muscle clavicular portion between the TW (33.04 ± 0.71 °C) and the WW (32.51 ± 0.74 °C) (p = 0.038). The TW method also presented slightly higher values than the SW and WW in the pectoral muscles sternal portion and the deltoid anterior portion, but with p-value > 0.05. (4) Conclusions: the types of warm-ups studied do not seem to interfere with the performance of Paralympic Powerlifting athletes. However, the thermal images showed that traditional warm-up best meets the objectives expected for this preparation phase.

O presente estudo teve como objetivo identifi car o conhecimento de auxiliares e técnicos de enfermagem de Unidades Básicas de Saúde e Unidades de Saúde da Família de um distrito de Salvador/BA, Brasil, quanto ao tratamento da úlcera venosa. Trata-se de um estudo exploratório, descritivo, com abordagem qualitativa, realizado através de uma pesquisa de campo. Os dados foram coletados por meio de um questionário semiestruturado, aplicados a 6 auxiliares e 20 técnicos de enfermagem. Para a análise dos dados foi utilizada a técnica de análise de conteúdo proposta por Bardin. A temática do estudo foi dividida em cinco categorias: identifi cação da úlcera venosa; tratamentos tópicos utilizados para a úlcera venosa; processo de escolha do tratamento; recursos disponíveis na unidade para a realização do curativo; e utilização de soluções antissépticas. Os resultados demonstraram que a população do estudo não possui conhecimento científi co sufi ciente sobre a utilização dos materiais necessários para o tratamento da úlcera venosa, nem sobre quanto a identifi cação patológica. Diante disso, recomenda-se um maior investimento na educação continuada dos profi ssionais de enfermagem. Palavras-chave: Úlcera Varicosa; Auxiliares de Enfermagem; Técnicos de Enfermagem; Cuidados de Enfermagem. ABsTRAcT The present study aims to identify the knowledge of nurses’ aides and licensed practical nurses, who work in Primary Care and Family Health centres of district of Salvador/BA, Brasil, about the treatment of venous ulcer. It is a fi eld research with an exploratory, descriptive, qualitative approach. The data were collected through a semistructured questionnaire, applied to 6 nurses’ aides and 20 licensed practical nurses. Data analysis was performed according to Bardin’s content analysis. The study was divided into fi ve categories: venous ulcer identifi cation; topical treatments used for venous ulcer; the process treatment choice; resources available for dressing in the primary health centres and using of antiseptic solutions. The results showed that these professionals have not enough scientifi c knowledge about the use of necessary materials for the venous ulcers treatment and the identifi cation of it. Therefore, it is recommended greater investment in continuing education of these professionals. Keywords: Varicose Ulcer; Nurses’ Aides; Licensed Practical Nurses; Nursing Care.

Diversas abordagens cirúrgicas oncológicas estão sendo empregadas, destacando-se a Quimioterapia Intraperitoneal Hipertérmica (HIPEC) na última década no Brasil, no entanto, o acesso da população a esta técnica é limitado. O relato de experiência versa sobre os achados em pacientes oncológicos após instituição da HIPEC no programa de cirurgia citorredutora (CCR) de um hospital de atendimento público em Pernambuco. Completados três anos do programa CCR/HIPEC do Centro de Oncologia - Universidade de Pernambuco (CEON-UPE) é possível dizer que este vem sendo bem sucedido, atualmente matriculando pacientes do estado de Pernambuco e circunvizinhos que não dispõem de tal modalidade terapêutica.

O artigo trata de representações sobre a cidade de Salvador-BA no cinema brasileiro contemporâneo, com foco no espaço público da cidade, seus aspectos principais bem como suas contradições socioespaciais. O inventário de vinte e cinco filmes apresentado contribui para a linha de pesquisa das Geografias de Cinema, em estruturação no Brasil e no mundo, pois trata de análise sobre espaço público em filmes brasileiros contemporâneos, tema ainda pouco explorado no Brasil.

No Distrito Federal e em Goiás, estudos taxonômicos das Bacillariophyta são escassos. Este trabalho apresenta o levantamento taxonômico das diatomáceas pertencentes aos gêneros Actinella e Peronia do rio Descoberto e alguns de seus afluentes. As coletas foram realizadas em junho e julho de 2003 (perí­odo de seca) e janeiro e fevereiro de 2004 (perí­odo de chuva), em seis estações de amostragem. Foram identificados cinco taxa infragenéricos de Eunotiales, sendo quatro do gênero Actinella e um de Peronia. Todos os taxa registrados foram citações pioneiras para o Estado de Goiás e Distrito Federal.

Este ensaio pretende refletir sobre um projeto de pesquisa e extensão no campo de Tecnologias Sociais em Educação Alimentar e Nutricional com vistas a favorecer a ampliação da garantia da Segurança Alimentar e Nutricional e a promoção da alimentação saudável de comunidades populares. Partindo da compreensão que o empreendimento concilia marcos referenciais da educação a uma complexa trama de dimensões que conforma o fenômeno da alimentação humana, discutiremos, inicialmente, o cenário no qual o debate sobre a emergência de novas configurações de Educação Alimentar e Nutricional se desenha no campo das políticas públicas, culminando com a proposição de um marco referencial para o referido campo. Em seguida, serão apresentados os fundamentos teóricos e metodológicos que animaram a proposição do projeto. Neste quesito, o enfoque da discussão centra-se nos marcos referenciais da educação e das ciências sociais em saúde em diálogo com as ciências da nutrição. Posteriormente, descreve-se o contexto do estudo e a experiência de Educação Alimentar e Nutricional desenvolvida, ao lado de uma análise dos alcances e limites à luz dos princípios metodológicos propostos e efetivamente concretizados.

As cianobactérias são microrganismos que apresentam organização celular procariótica, como as bactérias, e atividade fotossintética muito similar das algas. São naturalmente encontradas em mananciais de água doce e podem liberar metabólitos secundários tóxicos conhecidos como cianotoxinas para o meio. Este fenômeno produz mudanças na qualidade da água, com consequências que irão refletir na Saúde Pública. No Distrito Federal, o abastecimento público de água provém de captações de água de mananciais superficiais. Nos hospitais, esta água é armazenada temporariamente em reservatórios, que poderão estar sujeitos a contaminações por motivos de higienização e/ou manutenção incorreta, fechamento inadequado, má localização ou qualidade inferior do material utilizado na sua fabricação. Neste contexto, o presente trabalho visa avaliar os reservatórios de hospitais do Distrito Federal quanto presença ou ausência de cianobactérias, no perí­odo de maio a dezembro de 2012, seguida pela identificação taxonômica nas amostras que as apresentarem.

The Pilot Transonic Wind Tunnel of Institute of Aeronautics and Space (PTT Pilot Transonic Wind Tunnel) is an important result of a tremendous effort to install a high speed wind tunnel complex (TTS acronyms for Transonic and Supersonic Tunnels, in Portuguese) at the IAE, to support Brazilian aerospace research. Its history is described below, starting from the moment the TTS project was first conceived, highlighting each successive phase, mentioning the main difficulties encountered, and the solutions chosen, up until the final installation of the Pilot facility. A brief description of the tunnel's shakedown and calibration phases is also given, together with the present campaigns and proposed activities for the near future.

Este artigo tem como objetivo desvendar como o modelo de restaurante a quilo se tornou um “espaço social alimentar” onde se revelam representações de valores da cultura brasileira e traços da nossa identidade social.

O carcinoma de células escamosas é a neoplasia epitelial maligna mais comum dos mamíferos domésticos, embora ocorram descrições em várias espécies de aves. Entre os galináceos, esse tumor é incomum e os animais afetados são na maioria adultos e idosos. A forma cutânea corresponde à mais frequente em aves. O carcinoma de células escamosas é altamente invasivo e de malignidade variável, dependendo da sua localização. Em virtude do reduzido número de relatos de neoplasias cutâneas em aves, o presente trabalho objetivou a descrição de um caso de carcinoma dérmico de células escamosas em um galo doméstico geriátrico. Um galináceo (Gallus gallus domesticus), macho, dez anos de idade, foi apresentado com um tumor cutâneo, de crescimento progressivo. O paciente foi submetido ao exame físico e diante das alterações encontradas optou-se pela excisão cirúrgica da neoformação. Submeteu-se a amostra ao exame histopatológico. Clinicamente, foi constatado um tumor cutâneo ulcerado, com crostas, limites imprecisos e aderência aos tecidos adjacentes, localizado na parte distal do membro pélvico esquerdo. A histopatologia revelou um quadro morfológico compatível com carcinoma dérmico de células escamosas, moderadamente diferenciado e infiltrativo. Transcorridos três meses do pós-cirúrgico, observou-se sinal de recidiva da neoplasia. PALAVRAS-CHAVES: Carcinoma de células escamosas, galináceo, neoplasias cutâneas.

A hiperplasia mamária felina corresponde a uma lesão dependente de substâncias progestacionais naturais ou sintéticas. Embora seja uma condição benigna, a apresentação clínica, muitas vezes, é emergencial. Assim, torna-se necessário o uso de protocolos imediatos, como o uso do aglepristone, um fármaco antiprogestágeno. O presente trabalho descreveu um caso de hiperplasia mamária felina, com terapia à base de aglepristone. Um felino, fêmea, siamês, nove meses de idade, apresentou histórico de aumento de volume mamário após administração de uma dose do contraceptivo acetato de medroxiprogesterona. De acordo com a anamnese e o exame físico, foi estabelecido o diagnóstico presuntivo de hiperplasia mamária e optou-se pelo uso do aglepristone na posologia de 10 mg/kg a cada 24 horas, durante cinco dias, via subcutânea. Todos os pares de glândulas mamárias apresentavam hiperplasia simétrica, com consistência firme-elástica. A partir do terceiro dia da administração, observou-se que as glândulas estavam flácidas, consistência mais elástica e menor volume. Transcorridos 23 dias da primeira dose, constatou-se regressão completa do tecido mamário, sendo a gata submetida à ovariossalpingo-histerectomia. O aglepristone se revelou como uma opção de tratamento eficaz e segura. PALAVRAS-CHAVES: Aglepristone, felino, glândula mamária, hiperplasia,

Glomerulonephritis remains a major cause of morbidity and mortality in systemic lupus erythematosus (SLE). We have reported that expression of HER2/ErbB2, a member of the EGFR family, is increased in kidneys of patients and mice with lupus nephritis. We therefore asked if EGFR-family inhibition could ameliorate murine lupus nephritis. We used lapatinib, an EGFR-ErbB2 dual kinase inhibitor in female lupus-prone NZBxW/F1 mice, in which lupus onset was accelerated by injecting an IFN-α-expressing adenovirus. Mice received lapatinib (75 mg/Kg) or vehicle from the beginning of the acceleration or after the mice developed severe proteinuria (>300 mg/dL). Autoantibodies, kidney disease and markers of fibrosis and wound healing were analyzed. Exposure to IFNα induced ErbB2 expression in the kidney of lupus prone mice. Lapatinib, administered before but not after renal disease onset, lowered autoantibody titers and lessened immune complex deposition in the kidney. However, lapatinib increased proteinuria, kidney fibrosis and mouse mortality. Lapatinib also inhibited an in vitro wound healing assay testing renal cells. Our results suggest that EGFR-ErbB2 dual kinase inhibitor lapatinib decreases autoimmunity but worsens renal disease in IFNα-accelerated lupus, by increasing fibrosis and inhibiting wound healing. Type I Interferons are highlighted as important regulators of HER2/ErbB2 expression in the kidney. Further studies are required to parse the beneficial aspects of EGFR inhibition on autoimmunity from its negative effects on wound healing in lupus nephritis., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Objective: Juvenile systemic sclerosis (SSc) is an orphan disease, associated with high morbidity and mortality. New treatment strategies are much needed, but clearly defining appropriate outcomes is necessary if successful therapies are to be developed. Our objective here was to propose such outcomes., Methods: This proposal is the result of 4 face-to-face consensus meetings with a 27-member multidisciplinary team of pediatric rheumatologists, adult rheumatologists, dermatologists, pediatric cardiologists, pulmonologists, gastroenterologists, a statistician, and patients. Throughout the process, we reviewed the existing adult data in this field, the more limited pediatric literature for juvenile SSc outcomes, and data from 2 juvenile SSc patient cohorts to assist in making informed, data-driven decisions. The use of items for each domain as an outcome measure in an open label 12-month clinical trial of juvenile SSc was voted and agreed upon using a nominal group technique., Results: After voting, the domains agreed on were global disease activity, skin, Raynaud's phenomenon, digital ulcers, musculoskeletal, cardiac, pulmonary, renal, and gastrointestinal involvement, and quality of life. Fourteen outcome measures had 100% agreement, 1 item had 91% agreement, and 1 item had 86% agreement. The domains of biomarkers and growth/development were moved to the research agenda., Conclusion: We reached consensus on multiple domains and items that should be assessed in an open label, 12-month clinical juvenile SSc trial as well as a research agenda for future development., (© 2023 American College of Rheumatology.)

Objectives: The main goal of this study was to characterise the frequency and phenotype of B, T follicular helper (Tfh) and T follicular regulatory (Tfr) cells in peripheral blood and the cytokine environment present in circulation in children with extended oligoarticular juvenile idiopathic arthritis (extended oligo JIA) and polyarticular JIA (poly JIA) when compared with healthy controls, children with persistent oligoarticular JIA (persistent oligo JIA) and adult JIA patients., Methods: Blood samples were collected from 105 JIA patients (children and adults) and 50 age-matched healthy individuals. The frequency and phenotype of B, Tfh and Tfr cells were evaluated by flow cytometry. Serum levels of APRIL, BAFF, IL-1β, IL-2, IL-4, IL-6, IL-10, IL-17A, IL-21, IL-22, IFN-γ, PD-1, PD-L1, sCD40L, CXCL13 and TNF were measured by multiplex bead-based immunoassay and/or ELISA in all groups included., Results: The frequency of B, Tfh and Tfr cells was similar between JIA patients and controls. Children with extended oligo JIA and poly JIA, but not persistent oligo JIA, had significantly lower frequencies of plasmablasts, regulatory T cells and higher levels of Th17-like Tfh cells in circulation when compared with controls. Furthermore, APRIL, BAFF, IL-6 and IL-17A serum levels were significantly higher in paediatric extended oligo JIA and poly JIA patients when compared with controls. These immunological alterations were not found in adult JIA patients in comparison to controls., Conclusions: Our results suggest a potential role and/or activation profile of B and Th17-like Tfh cells in the pathogenesis of extended oligo JIA and poly JIA, but not persistent oligo JIA., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.)

Although we have witnessed remarkable progress in understanding the biological mechanisms that lead to the development of rheumatic diseases (RDs), remission is still not achieved in a substantial proportion of patients with the available pharmacological treatment. As a consequence, patients are increasingly looking for complementary adjuvant therapies, including dietary interventions. Herbs and spices have a long historical use, across various cultures worldwide, for both culinary and medicinal purposes. The interest in herbs and spices, beyond their seasoning properties, has dramatically grown in many immune-mediated diseases, including in RDs. Increasing evidence highlights their richness in bioactive molecules, such as sulfur-containing compounds, tannins, alkaloids, phenolic diterpenes, and vitamins, as well as their antioxidant, anti-inflammatory, antitumorigenic, and anticarcinogenic properties. Cinnamon, garlic, ginger, turmeric, and saffron are the most popular spices used in RDs and will be explored throughout this manuscript. With this paper, we intend to provide an updated review of the mechanisms whereby herbs and spices may be of interest in RDs, including through gut microbiota modulation, as well as summarize human studies investigating their effects in Rheumatoid Arthritis, Osteoarthritis, and Fibromyalgia.

Introduction: Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare vasculitis of small and medium sized blood vessels., Case Description: Thirteen-year-old male, with history of rhinitis and asthma, who presented to the emergency room with one week of asthenia, arthralgias and myalgias and two days of fever. A diffuse petechial rash, palpable purpura and polyarthritis were detected on examination. Leukocytosis (34990/μL) with eosinophilia (66%) and elevated C-reactive protein were identified. The patient was admitted and ceftriaxone and doxycycline were started. The clinical status deteriorated in the following days. The patient developed myopericarditis, bilateral pulmonary infiltrates and pleural effusion, requiring mechanical ventilation and aminergic support. Non-clonal eosinophils were detected on the bone marrow aspiration and the skin biopsy showed leukocytoclastic vasculitis with eosinophils. Antineutrophil cytoplasmic antibodies and genetic analysis for hypereosinophilic syndrome mutations were negative. After treatment with methylprednisolone for three days a fast clinical, laboratory and radiological improvement occurred. The patient started azatiophrine and reduced steroids progressively. No relapses occurred since diagnosis five years ago., Discussion: Clinical suspicion and early treatment of EGPA are crucial to improve prognosis.

Introduction: A better understanding of hemolytic-uremic syndrome (HUS) pathophysiology significantly changed its treatment and prognosis. The aim of this study is to characterize the clinical features, severity, management, and outcomes of HUS patients., Materials and Methods: Retrospective study of HUS patients admitted to a Pediatric Nephrology Unit between 1996 and 2020. Demographic and clinical data regarding etiology, severity, treatment strategies, and patient outcome were collected., Results: Twenty-nine patients with HUS were admitted to our unit, but four were excluded. Median age at diagnosis was two years (2 months - 17 years). Clinical manifestations included diarrhea, vomiting, oliguria, hypertension, and fever. During the acute phase, 14 patients (56%) required renal replacement therapy. Infectious etiology was identified in seven patients (five Escherichia coli and two Streptococcus pneumoniae). Since 2015, 2/7 patients were diagnosed with complement pathway dysregulation HUS and there were no cases of infectious etiology detected. Six of these patients received eculizumab. The global median follow-up was 6.5 years [3 months-19.8 years]. One patient died, seven had chronic kidney disease, four of whom underwent kidney transplantation, one relapsed, and seven had no sequelae., Conclusion: These results reflect the lack of infectious outbreaks in Portugal and the improvement on etiological identification since genetic testing was introduced. The majority of patients developed sequels and mortality was similar to that of other countries. HUS patients should be managed in centers with intensive care and pediatric nephrology with capacity for diagnosis, etiological investigation, and adequate treatment. Long-term follow-up is essential.

Objective: Lupus nephritis is a key driver of morbidity and mortality in SLE. Detecting active nephritis on a background of pre-existing renal damage is difficult, leading to potential undertreatment and accumulating injury. An unmet need is a biomarker that distinguishes active lupus nephritis, particularly important in paediatrics where minimising invasive procedures is desirable., Methods: This was a multicentre, prospective study of 113 paediatric patients with biopsy-proven lupus nephritis. Clinical data and urine were obtained every 3-4 months and patients averaged 2 years on study with seven time points. Urine was analysed for human epidermal growth factor receptor 2 (HER2), tumour necrosis factor-like weak inducer of apoptosis and vascular cell adhesion molecule-1 (VCAM-1) by ELISA. We defined active disease as either a rise in serum creatinine ≥0.3 mg/dL from baseline or a rise in renal Systemic Lupus Erythematosus Disease Activity Index score from the previous visit. These markers were also studied in patients with acute kidney injury, juvenile idiopathic arthritis (JIA), amplified pain syndrome and healthy controls., Results: The rate of active disease was 56% over an average of 2 years of follow-up. HER2 and VCAM-1 were significantly elevated at time points with active disease defined by increased serum creatinine compared with time points with inactive disease or patients who never flared. All three biomarkers were associated with new-onset proteinuria and VCAM-1 was elevated at time points preceding new-onset proteinuria. These biomarkers were not increased in acute kidney injury or JIA., Conclusion: All three biomarkers were associated with new onset proteinuria and increased VCAM-1 may predict impending proteinuria. These biomarkers provide potential non-invasive measures for monitoring that may be more sensitive to impending flare than conventional measures., Competing Interests: Competing interests: LES is associate editor for Lupus Science & Medicine., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Several drugs can unmask clinically silent systemic lupus erythematosus (SLE), induce flares in patients with already known SLE diagnosis or lead to the development of lupus-like syndromes. We describe a rare case of juvenile SLE triggered by lamotrigine. A 17-year-old female, who was recently medicated with lamotrigine, presented with a 3 week history of daily fever, fatigue, odynophagia, arthralgia, myalgia, diffuse erythematous maculopapular rash, vasculitic rash of the fingers, and lips and vulvar edema. Leukopenia, lymphopenia, elevated C-reactive protein, low serum C3 and C4 levels, antinuclear, anti-double stranded DNA (anti-dsDNA) and anti-Ro (SSA) antibodies were identified. Lamotrigine was stopped and an immediate clinical improvement occurred. The patient was afebrile in less than 24h and all the other symptoms rapidly disappeared. C3 and C4 levels remained below normal ranges and anti-dsDNA antibodies persisted elevated. Treatment with hydroxychloroquine was started and the patient remained asymptomatic for two years. She later developed vasculitic rash, which responded well to treatment with steroids. A drug as a trigger for SLE should always be considered, since drug withdrawal is an important step for a favourable outcome.

Kikuchi-Fujimoto disease is usually a self-limited cause of lymphadenitis. It is a prevalent disease amongst Asian individuals, but rare in other parts of the world. It affects especially young women, with limited cases described in children. Kikuchi-Fujimoto disease is characterized by focal and tender lymphadenopathy, mostly cervical, accompanied by fever and, less commonly, systemic manifestations. This disease is seldom associated with systemic lupus erythematosus. Herein we describe the case of a previously healthy 7-year-old male patient, who presented with prolonged fever, rash, polyarthritis, cervical lymphadenopathy, hepatosplenomegaly, leucocytosis and markedly elevated inflammatory markers. No changes were seen on the echocardiogram. Antinuclear antibodies were not identified and complement levels were normal. Differential diagnosis included systemic juvenile idiopathic arthritis, infectious diseases and malignancy. Bone marrow aspiration and biopsy were normal. The cervical node biopsy was diagnostic for Kikuchi-Fujimoto disease. Oral corticosteroids were started with notorious clinical response. After one year of follow up, the patient is without medication and remains asymptomatic. This case report shows the often-convoluted course of Kikuchi-Fujimoto disease and diagnostic dilemmas clinicians face when dealing with atypical presentations.

Cardiac involvement in systemic lupus erythematosus (SLE) is well documented. The pericardium, myocardium and endocardium, as well as the coronary arteries, the valves and the conduction system can all be affected. While pericarditis is common, arrythmias are less frequently described.We present a 13-year-old male, who had fatigue, anorexia, weight loss, myalgias and arthralgias for four months. On physical examination, we identified bradycardia (heart rate 31-50 bpm), oral and nasal ulcers and polyarthritis. The laboratory results showed hemolytic anemia, hypocomplementemia, antinuclear and anti-dsDNA antibodies, hematuria and non-nephrotic proteinuria. Renal function was normal. Lupus nephritis class II was diagnosed by kidney biopsy. On the transthoracic echocardiogram we identified a minimal pericardial effusion, suggesting pericarditis, and, on the electrocardiogram, we detected sinus arrest with junctional rhythm, denoting sinus node dysfunction. The patient was diagnosed with juvenile SLE with cardiac, renal, musculoskeletal and hematologic involvement. Disease remission and cardiac rhythm control were obtained with steroids and mycophenolate mofetil. Currently, the patient is asymptomatic, with normal sinus rhythm.We described an adolescent with SLE who had sinus node dysfunction upon diagnosis. Other cases have been reported in adults but none in juvenile SLE. All SLE patients should have a thorough cardiac examination to promptly diagnose and treat the innumerous cardiac manifestations of this disease.

The current pandemic SARS-CoV-2 has required an unusual allocation of resources that can negatively impact chronically ill patients and high-complexity procedures. Across the European Reference Network on Pediatric Transplantation (ERN TransplantChild), we conducted a survey to investigate the impact of the COVID-19 outbreak on pediatric transplant activity and healthcare practices in both solid organ transplantation (SOT) and hematopoietic stem cell transplantation (HSCT). The replies of 30 professionals from 18 centers in Europe were collected. Twelve of 18 centers (67%) showed a reduction in their usual transplant activity. Additionally, outpatient visits have been modified and restricted to selected ones, and the use of telemedicine tools has increased. Additionally, a total of 14 COVID-19 pediatric transplanted patients were identified at the time of the survey, including eight transplant recipients and six candidates for transplantation. Only two moderate-severe cases were reported, both in HSCT setting. These survey results demonstrate the limitations in healthcare resources for pediatric transplantation patients during early stages of this pandemic. COVID-19 disease is a major worldwide challenge for the field of pediatric transplantation, where there will be a need for systematic data collection, encouraging regular discussions to address the long-term consequences for pediatric transplantation candidates, recipients, and their families., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Tubulointerstitial nephritis and uveitis syndrome is a rare and probably underdiagnosed condition. Renal and ocular manifestations may not occur simultaneously, making the diagnosis more difficult. Nephritis may be asymptomatic; therefore, renal function evaluation is essential for diagnosis. Urinary β2-microglobulin levels may be particularly useful. Uveitis, mostly anterior, nongranulomatous and bilateral, occurs usually after the onset of nephritis. Treatment includes corticosteroids and, eventually, other immunosuppressant agents. Renal disease is usually benign and resolves spontaneously or after treatment with systemic corticosteroids. Uveitis, however, may be chronic or recurrent. The authors described the cases of three pediatric patients diagnosed with tubulointerstitial nephritis and uveitis syndrome. The goal of this paper was to warn the medical community over the need to screen patients with uveitis for renal disease.

Tubulointerstitial nephritis and uveitis syndrome is an uncommon disease, probably underdiagnosed in clinical practice. Its aetiology and pathogenesis remain unknown. This syndrome is defined by an association of uveitis and tubulointerstitial nephritis, with no evidence of systemic disease or infection that might cause both ocular and renal inflammation. Renal and ocular manifestations may not occur simultaneously, making the diagnosis even more challenging. Treatment includes topical and oral corticosteroids. Renal involvement usually resolves spontaneously with full recovery of kidney function, however uveitis can persist or recur years after its initial presentation. We report a case of a 13-year-old girl with tubulointerstitial nephritis and uveitis syndrome., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Monogenic lupus is rare, but its study has contributed immensely to a better understanding of the pathogenesis of systemic lupus erythematosus. The first forms identified were inherited complement deficiencies, which predisposed to lupus due to impaired tolerance, and aberrant clearance of apoptotic bodies and immune complexes. In recent years, several new monogenic disorders with a lupus-like phenotype have been described. These include forms that affect nucleic acid repair, degradation and sensing (TREX1, DNASE1L3), the type I interferon (IFN) pathway (SAMHD1, RNASEH2ABC, ADAR1, IFIH1, ISG15, ACP5, TMEM173) and B cell development checkpoints (PRKCD; RAG2). Pathways informed by these newly described disorders have continued to improve our understanding of systemic lupus erythematosus., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

The aetiology of systemic lupus erythematosus (SLE) is multifactorial, and includes contributions from the environment, stochastic factors, and genetic susceptibility. Great gains have been made in understanding SLE through the use of genetic variant identification, mouse models, gene expression studies, and epigenetic analyses. Collectively, these studies support the concept that defective clearance of immune complexes and biological waste (such as apoptotic cells), neutrophil extracellular traps, nucleic acid sensing, lymphocyte signalling, and interferon production pathways are all central to loss of tolerance and tissue damage. Increased understanding of the pathogenesis of SLE is driving a renewed interest in targeted therapy, and researchers are now on the verge of developing targeted immunotherapy directed at treating either specific organ system involvement or specific subsets of patients with SLE. Accordingly, this Review places these insights within the context of our current understanding of the pathogenesis of SLE and highlights pathways that are ripe for therapeutic targeting.

Objective: To understand the roles of microRNAs (miRNAs) in proliferative lupus nephritis (LN)., Methods: A high-throughput analysis of the miRNA pattern of the kidneys of LN patients and controls was performed by molecular digital detection. Urinary miRNAs were measured by quantitative reverse transcription-polymerase chain reaction (qRT-PCR). Target gene expression in human mesangial cells was evaluated by arrays and qRT-PCR. Human epidermal growth factor receptor 2 (HER-2) was analyzed by immunohistochemistry in kidney samples from LN patients and in a murine model of lupus. Urinary levels of HER-2, monocyte chemotactic protein 1 (MCP-1), and vascular cell adhesion molecule 1 (VCAM-1) were measured by enzyme-linked immunosorbent assay., Results: Levels of the miRNAs miR-26a and miR-30b were decreased in the kidneys and urine of LN patients. In vitro these miRNAs controlled mesangial cell proliferation, and their expression was regulated by HER-2. HER-2 was overexpressed in lupus-prone NZM2410 mice and in the kidneys of patients with LN, but not in other mesangioproliferative glomerulonephritides. HER-2 was found to be up-regulated by interferon-α and interferon regulatory factor 1. Urinary HER-2 was increased in LN and reflected disease activity, and its levels correlated with those of 2 other recognized LN biomarkers, MCP-1 and VCAM-1., Conclusion: The kidney miRNA pattern is broadly altered in LN, which contributes to uncontrolled cell proliferation. Levels of the miRNAs miR-26a and miR-30b are decreased in the kidneys and urine of LN patients, and they directly regulate the cell cycle in mesangial cells. The levels of these miRNAs are controlled by HER-2, which is overexpressed in NZM2410 mice and in the kidneys and urine of LN patients. HER-2, miR-26a, and miR-30b are thus potential LN biomarkers, and blocking HER-2 may be a promising new strategy to decrease cell proliferation and damage in this disease., (© 2015, American College of Rheumatology.)

Objective: Hemophagocytes (HPCs) are activated macrophages that have engulfed other hematopoietic cells. Although HPCs are rarely identified in normal spleen tissue and bone marrow, an excess of these macrophages characterizes many cytokine storm syndromes, particularly macrophage activation syndrome and hemophagocytic lymphohistiocytosis. This study was undertaken to assess the functions of HPCs and their significance in acute inflammatory conditions., Methods: HPCs were generated in wild-type mice using repeated stimulation with Toll-like receptor 9 (TLR-9) and interleukin-10 receptor blockade. RNA was extracted from HPCs that had been isolated by lasercaptured microdissection. Transcriptional profiles of the HPCs were then compared to those of resting splenic macrophages. In addition, bone marrow samples were obtained from a diverse cohort of patients in whom excess hemophagocytosis was identified by clinical bone marrow biopsy or aspiration. The bone marrow samples were analyzed by immunohistochemistry for markers of classic (CD64) or alternative (CD163 and CD206) macrophage activation., Results: Differential gene expression and gene set enrichment analyses of murine HPCs identified upregulation of genes and gene sets associated with alternative activation of HPCs. Immunohistochemical analyses of HPCs in human bone marrow samples showed universal staining of HPCs for CD163, but rarely for CD206 or CD64., Conclusion: Laser-captured murine TLR-9– induced HPCs had a transcriptional profile similar to that of alternatively activated macrophages. In addition, HPC expression of CD163 was confirmed in a uniquely diverse cohort of patients with hemophagocytic syndromes. Collectively, these data support the hypothesis that HPCs have both immunoregulatory and clean-up functions.

Background: Gene expression studies of peripheral blood mononuclear cells from patients with systemic lupus erythematosus (SLE) have demonstrated a type I interferon signature and increased expression of inflammatory cytokine genes. Studies of patients with Aicardi Goutières syndrome, commonly cited as a single gene model for SLE, have suggested that accumulation of non-coding RNAs may drive some of the pathologic gene expression, however, no RNA sequencing studies of SLE patients have been performed. This study was designed to define altered expression of coding and non-coding RNAs and to detect globally altered RNA processing in SLE., Methods: Purified monocytes from eight healthy age/gender matched controls and nine SLE patients (with low-moderate disease activity and lack of biologic drug use or immune suppressive treatment) were studied using RNA-seq. Quantitative RT-PCR was used to validate findings. Serum levels of endotoxin were measured by ELISA., Results: We found that SLE patients had diminished expression of most endogenous retroviruses and small nucleolar RNAs, but exhibited increased expression of pri-miRNAs. Splicing patterns and polyadenylation were significantly altered. In addition, SLE monocytes expressed novel transcripts, an effect that was replicated by LPS treatment of control monocytes. We further identified increased circulating endotoxin in SLE patients., Conclusions: Monocytes from SLE patients exhibit globally dysregulated gene expression. The transcriptome is not simply altered by the transcriptional activation of a set of genes, but is qualitatively different in SLE. The identification of novel loci, inducible by LPS, suggests that chronic microbial translocation could contribute to the immunologic dysregulation in SLE, a new potential disease mechanism.

In order to describe the incidence and characteristics of major infections in juvenile-onset systemic lupus erythematosus (jSLE), we studied a cohort of 120 patients (51% Hispanic and 28% African American, 49% with renal involvement and 12% with neuropsychiatric manifestations). There were 101 major infections affecting 44 patients (37%) for an incidence of 169/1000 patient-years of follow-up. Active disease at jSLE diagnosis, renal involvement, neuropsychiatric manifestations, higher cumulative dose of prednisone, and treatment with cyclophosphamide or mycophenolate mofetil were all associated with major infection (p<0.05). By logistic regression, the combined effect of treatment with cyclophosphamide and cumulative dose of prednisone was associated with major infection (p=0.04). Two patients died, one due to cytomegalovirus infection. Major infection was associated with damage (p=0.004). In conclusion, in a large cohort of jSLE patients, major infections were common, were associated with active disease and its treatment, and resulted in noteworthy morbidity., (© 2013.)