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Nineteen cases of parathyroid carcinoma in patients with multiple endocrine neoplasia type 1 have been reported in the literature, of which 11 carry an inactivating germline mutation in the MEN1 gene. Somatic genetic abnormalities in these parathyroid carcinomas have never been detected. In this paper, we aimed to describe the clinical and molecular characterization of a parathyroid carcinoma ident ified in a patient with MEN1. A 60-year-old man was diagnosed with primary hyperparathyroidism during the postoperative period of lung carcinoid surgery. Serum calcium and parathyroid hormone levels were 15.0 mg/dL (8.4–10.2) and 472 pg/mL (12–65), respectively. The patient underwent parathyroid surgery, and histological findings were consistent with parathyroid carcinoma. Analysis of the MEN1 gene by next-generation sequencing (NGS) identified a novel germline heterozygous nonsense pathogen ic variant (c.978C>A; p.(Tyr326*)), predicted to encode a truncated protein. Genetic analysis of the parathyroid carcinoma revealed a c.307del, p.(Leu103Cysfs*16) frameshift truncating somatic MEN1 variant in the MEN1 gene, which is consistent with MEN1 tumor-suppressor role, confirming its involvement in parathyroid carcinoma etiology. Genetic analysis of CDC73, GCM2, TP53, RB1, AKT1, MTOR, PIK3CA and CCND1 genes in the parathyroid carcinoma DNA did not detect any somatic mutations. To our knowledge, this is the firs t report of a PC case presenting both germline (first-hit) and somatic (second-hit) in activation of the MEN1 gene.

Background: Treatment of advanced follicular thyroid carcinoma (FTC) is based primarily on indirect evidence obtained with multikinase inhibitors (MKI) in clinical trials in which papillary carcinomas represent the vast majority of cases. However, it should be noted that MKI have a non-negligible toxicity that may decrease the patient’s quality of life. Conventional chemotherapy with GEMOX (gemcitabine plus oxaliplatin) is an off-label therapy, which seems to have some effectiveness in advanced diffe rentiated thyroid carcinomas, with a good safety profile, although further studies are needed. Case report: We report a case of a metastatic FTC, resistant to several lines of therapy. However, with a durable response to GEMOX, the overall survival of our patient appears to have been extended significantly due to this chemotherapy. Conclusion: GEMOX may have a role in patients with thyroid cancer unresponsive to MKI.

Background: Anaplastic thyroid carcinoma (ATC) is one of the most aggressive solid tumors. ATC is frequently diagnosed at advanced stages with unresectable disease and palliative care is often indicated. Recently, several patient-tailored therapies for ATC are emerging due to advances in molecular profiling of these tumors. Entrectinib is a potent oral selective inhibitor of neutrotrophic tropomyosin receptor kinase (NTRK), ROS1, and anaplastic lymphoma kinase fusions. The experience regarding ATC and other thyroid carcinomas, particularly in the neoadjuvant setting, is minimal. Case report: We present a case of a 51-year-old female patient presenting with a bulky mass of the left thyroid lobe measuring 100 × 108 × 80 mm that was considered surgically unresectable. While waiting for next-generation sequence (NGS) profiling, lenvatinib was initiated. There was an initial clinical and imagiologic response; however, progression occurred after 12 weeks, and at this time NGS ident ified an ETV6-NTRK3 fusion and entrectinib was started. After 12 weeks, tumor diameters reduced to a minimum of 68×60×49 mm, and the patient underwent total thyroidectomy plus central lymphadenectomy. Histological diagnosis confirmed an ATC (pT4a R 2 N1a). Adjuvant radiotherapy (RT) (60 Grays) with weekly paclitaxel (45 mg/m2) was then administered followed by maintenance entrectinib 600 mg daily. Fluorodeoxyglucose positron emission tomography performed 3 months after completion of RT showed only non-specific uptake in the posterior wall of the hypopharynx and lar ynx, suggestive of inflammation. Conclusion: We report the first case of an ATC with a dramatic response to neoadjuvant therapy with entrectinib, which enabled surgical resection of an ab initio unresectable tumor.

Anaplastic thyroid carcinoma (ATC) is the most lethal subtype of thyroid cancer, with high invasive and metastatic potential, not responding to conventional treatments. Its aggressiveness may be influenced by macrophages, which are abundant cells in the tumor microenvironment. To investigate the role of macrophages in ATC aggressiveness, indirect co-cultures were established between ATC cell lines and THP-1-derived macrophages. Macrophages significantly increased both the migration and invasion of T235 cells (p < 0.01; p < 0.01), contrasting with a decrease in C3948 (p < 0.001; p < 0.05), with mild effects in T238 migration (p < 0.01) and C643 invasion (p < 0.05). Flow cytometry showed upregulation of CD80 (pro-inflammatory, anti-tumoral) and downregulation of CD163 (anti-inflammatory, pro-tumoral) in macrophages from co-culture with T235 (p < 0.05) and C3948 (p < 0.05), respectively. Accordingly, we found an upregulation of secreted pro-inflammatory mediators (e.g., GM-CSF, IL-1α; p < 0.05) in C3948–macrophage co-cultures. Proteomic analysis showed the upregulation of SPRY4, an inhibitor of the MAPK pathway, in C3948 cells from co-culture. SPRY4 silencing promoted cancer cell invasion, reverting the reduced invasion of C3948 caused by macrophages. Our findings support that macrophages play a role in ATC cell aggressiveness. SPRY4 is a possible modulator of macrophage–ATC cell communication, with a tumor suppressor role relevant for therapeutic purposes.

Introdução: O diagnóstico e o tratamento do câncer de próstata podem provocar modificações significativas na vida dos homens, alterando a sua qualidade de vida. O objetivo deste estudo foi avaliar a qualidade de vida relacionada à saúde de pacientes com câncer de próstata em tratamento de hormonioterapia e radioterapia. Materiais e Métodos: Estudo descritivo, transversal, com dados sociodemográficos, clínicos e de avaliação da qualidade de vida de 213 pacientes, obtidos por roteiro de entrevista e pelo questionário Expanded Prostate Cancer Index Composite. Utilizou-se estatística descritiva. Resultados: Houve predominância de homens acima de 50 anos, brancos, casados, com baixa escolaridade e aposentados, com diagnóstico inicial obtido pelas alterações no exame de Antígeno Prostático Específico e estadiamento II. As médias dos escores obtidos no domínio da função sexual indicaram queda na qualidade de vida, para ambos os tratamentos. Discussão: Tanto a hormonioterapia como a radioterapia podem causar algum tipo de efeito na função sexual, diretamente relacionado a um significativo impacto na qualidade de vida relacionada à saúde para muitos homens. Conclusões: Ainda que os resultados tenham sido obtidos e analisados pela primeira vez no hospital do estudo, oferecem subsídios para o conhecimento da realidade local e corroboram com os achados de outros estudos realizados em locais e realidades diferentes. Como citar este artigo: Quijada PDS, Fernandes PA, Ramos SB, Santos BMO. Qualidade de vida relacionada à saúde de pacientes com câncer de próstata. Rev Cuid. 2017; 8(3): 1826-38. http://dx.doi.org/10.15649/cuidarte.v8i3.436

The goal of this study was to identify ergonomic and psychosocial factors, and risks at informal work in the mining sector of the State of Paraíba, Brazil, from miners' perspective. A cross-sectional and descriptive study was conducted with 371 informal mining workers. They responded two questionnaires for assessing work performed in three dimensions: ergonomic factors; psychosocial factors; and occupational risks. The scores of the items of each dimension were added so that, the higher the score, the lower workers' satisfaction related to the area investigated. The results indicated that noise was common in the working environment (66%). Most workers (54.7%) pointed out that the work was too hard and that it required attention and reasoning (85.7%). The workers emphasized the lack of training for working in mining (59.3%) and few of them regarded the maintenance of the workplace as a component to prevent lumbago (32.3%). Risk of accidents was pointed out as the factor that needed increased attention in daily work (56.6%). All occupational risks were mentioned, including physical and chemical risks. There was significant correlation between age and occupational risks, indicating that the greater the age, the greater the perception of harmful agents (ρ = -0.23; p < 0.01). In the end, it was observed that, to a greater or lesser degree, all workers perceived ergonomic and psychosocial factors, and risks in informal mining. Length of service and age were the features that interfered significantly with the understanding of those factors and occupational risks.

The nature and role of the intestinal leukocytes in necrotizing enterocolitis (NEC), a severe disease affecting premature infants, remain unknown. We now show that the intestine in mouse and human NEC is rich in lymphocytes that are required for NEC development, as recombination activating gene 1-deficient ([Rag1.sup.-/-]) mice were protected from NEC and transfer of intestinal lymphocytes from NEC mice into naive mice induced intestinal inflammation. The intestinal expression of the lipopolysaccharide receptor TLR4, which is higher in the premature compared with full-term human and mouse intestine, is required for lymphocyte influx through TLR4-mediated upregulation of CCR9/CCL25 signaling. TLR4 also mediates a STAT3-dependent polarization toward increased proinflammatory [CD3.sup.+][CD4.sup.+][IL-17.sup.+] and reduced tolerogenic [Foxp3.sup.+] Treg lymphocytes (Tregs). Th17 lymphocytes were required for NEC development, as inhibition of STAT3 or IL-17 receptor signaling attenuated NEC in mice, while IL-17 release impaired enterocyte tight junctions, increased enterocyte apoptosis, and reduced enterocyte proliferation, leading to NEC. Importantly, TLR4-dependent Th17 polarization could be reversed by the enteral administration of retinoic acid, which induced Tregs and decreased NEC severity. These findings identify an important role for proinflammatory lymphocytes in NEC development via intestinal epithelial TLR4 that could be reversed through dietary modification., Introduction Necrotizing enterocolitis (NEC) is a severe inflammatory disease that affects the gastrointestinal tract of the premature infant and that causes significant morbidity and mortality in this vulnerable population (1). [...]

Objective: The aim of this study was to analyze the reticulocyte maturity indices (low, medium, and high fluorescence ratios) in iron deficient 1- to 6-year-old children, and identify the prevalence of iron deficiency anemia in this population. Methods: The present study included 39 subjects, divided into two groups: control subjects (n = 33), and subjects with iron deficiency anemia (n = 6). The results were analyzed by Student's t-test for comparison of means. Differences were considered significant when two-tailed p-value < 0.05. Results: Subjects with iron deficiency anemia presented increases in the proportion of mean (10.3 ± 4.7% vs. 6.0 ± 3.4%; p-value = 0.003), and high fluorescence reticulocytes (2.3 ± 0.87% vs. 0.9 ± 0.9%; p-value = 0.03) compared to the control group. The prevalence of anemia in this population was 15% (n = 6). Conclusion: The indices related to immaturity of reticulocytes are higher in the presence of iron deficiency, thus demonstrating a deficiency in the raw material to form hemoglobin and are, therefore, possible early markers of iron deficiency and anemia. We emphasize the need to standardize these indices for use in clinical practice and lab test results.

Objective: To identify the overall health and living conditions of diabetes patients, the main risk factors for the disease as well as the complications, difficulties, expectations andproblems relating to health service monitoring, from the perspective of “Health Field”model. Methods: Descriptive, cross-sectional study conducted with 187 diabetes patientsof both sexes, living in the urban area and enrolled at five Primary Healthcare Units of amunicipality of Minas Gerais. Data was collected during home visits, applying an interviewform created for diabetes patients, based on data from human biology, environment, lifestyle and health services’ organization, elements of the adopted model. Data was analyzed descriptively and presented as frequencies, averages and percentages. Results: Type 2 diabetes mellitus, female gender, age above 60, married status, incomplete elementary school education, and monthly income of less than three minimum wages were prevalent. Of the participants, 71 (41.5%) had abnormal glucose levels, 94 (55.1%) had blood pressure higher than recommendations and 131 (70.1%) were using oral hypoglycemic agents. Also,138 (73.8%) did not exercise on a regular basis and 133 (71.1%) were overweight or obese. Living with family was reported by 141 (75.4%) participants and 100 (53.5%) reported participating in meetings. The family was the main source of support for 96 (65.8%) of them. Conclusions: The results raised discussions on the clinical conditions, expectations and difficulties experienced by the participants, and highlighted the challenge to be faced by healthcare professionals in order to maintain the compliance of healthcare users with the long-term treatment, typical of chronic conditions such as diabetes.

O estudo, de caráter exploratório, do tipo levantamento retrospectivo, objetivou identifi car as irregularidades sanitárias nos estabelecimentos e equipamentos de assistência de alta complexidade e de interesse à saúde do município de Franca-SP, registradas no Sistema de Informação em Vigilância Sanitária, no período de agosto de 2008 a julho de 2009, como marcador de risco à saúde. Do total de 186 serviços, 59 (31,72%) apresentaram irregularidades sanitárias, categorizadas em nove eixos: documentação, estrutura física, recursos humanos, qualidade de produtos, manutenção preventiva de equipamentos, processo de esterilização, resíduos de saúde, higienização do ambiente e equipamento de proteção individual; e 164 (88,17%) apresentaram condições de baixo risco, 21 (11,29%) de médio e um serviço apresentou risco alto. Os resultados demonstram que as irregularidades sanitárias podem comprometer a qualidade do serviço ou do produto oferecido e gerar riscos à saúde dos usuários, consumidores e trabalhadores. ---------------------------------------------------------------------------------------- This study, as an exploratory one, retrospective survey-type, aimed to identify the sanitary disparities in the high complexity facilities and assistance tools and concerned to Franca – SP heath, registered in the Sanitary Surveillance Information System, in August 2008 to July 2009 as risks markers to health. From the amount of 186 services, 58 (31,72%) presented sanitary disparities, categorized into nine axes: documentation, physical frames, human resources, products qualities, tool’s preventive maintenance, sterilization process. Health waste, environment hygiene and individual protection equipments, 164 (88, 17%) presented a law risk condition, 21 (11,29%) are average, and only one presented a high risk level. Results shows that such sanitary disparities may comprise the service or the offered product quality and generate risks to the users, customers and works health.

Objetivo: Descrever o perfil epidemiológico dos 35 Portadores de Necessidades Especiais (PNE) atendidos em uma clínica odontológica. Métodos: Este é um estudo descritivo, qualitativo; documental e bservacional, cujos dados foram coletados nos prontuários e complementados junto aos cuidadores que acompanhavam o PNE. As variáveis estudadas para delineamento do perfil epidemiológico foram: idade, sexo, estado civil, procedência, diagnóstico, realização de atividade não remunerada, assistência odontológica e caracterização dos cuidadores. Resultados: Dos 35 PNE, 19 (54,3%) eram do sexo feminino; as idades variaram entre um e 45 anos, concentrando-se nas faixas entre 1 a 15 anos (57,1%). A idade, em média fica em 16 anos, com desvio padrão de 10 anos. Todos eram solteiros, 24 (68,6%) eram procedentes de cidades ligadas à IX DIR (Direção Regional de Saúde) de Barretos e 11 (31,4%) de cidades não ligadas à DIR do município. Todos possuíam diagnóstico de deficiência mental, dos quais 31,4% de diagnóstico exclusivo dessa deficiência e os demais de deficiência mental associado a outro distúrbio. Nenhum desenvolvia qualquer tipo de atividade remunerada, demonstrando uma clientela dependente economicamente da família. No período da pesquisa, 15 (42,8%) portadores estavam recebendo assistência odontológica pela primeira vez. Os que já haviam recebido assistência anterior, esta havia sido oferecida pela Associação de Pais e Amigos dos Excepcionais ou por clínicas ligadas a Faculdades de Odontologia. Os cuidadores eram exclusivamente do sexo feminino, com grau de parentesco próximo (mãe, irmã, tia). Conclusões: O estudo revela as características pessoais da clientela atendida, que enfrenta desafios de ordem econômica e social, e ressalta a contribuição que a instituição e os futuros profissionais podem oferecer aos PNE na promoção de sua da saúde bucal.

Este artigo, que tem como referência a teoria crítica, relata o resultado de uma pesquisa sobre atitudes em relação à educação inclusiva, realizada com doze professoras do 5º ano do ensino fundamental; dentre elas, seis tinham experiência de ter em sala de aula alunos com deficiência, e seis não tinham. A análise qualitativa dos dados decorrentes do levantamento realizado em seis escolas da rede municipal de Campo Grande (MS) demonstrou que, de modo geral, as professoras foram favoráveis à educação inclusiva. Contudo, ficou evidente a expressão de atitudes preconceituosas veladas ou explícitas no âmbito escolar. A formação para experiência com quem é "diferente" ainda encontra barreiras por conta do preconceito e da discriminação presentes nesta sociedade que tem como lógica uma "inclusão marginal". Em suas manifestações, apontaram dificuldades de trabalhar com alunos com deficiência intelectual severa; assinalaram que a responsabilidade de trabalhar sob a predominância da educação centrada no desempenho, com foco na inserção das pessoas no mercado de trabalho, gerava um "sentimento de impotência". Diante das contradições existentes, a educação inclusiva não deixa de evidenciar a presença das injustiças que ainda se apresentam no processo educativo. Apesar disso, foram indicados vários elementos favoráveis a essa forma de educação, que não é dissociada de movimentos sociais mais amplos.This article is based on the critical theory, and describes the result of a study on the attitudes towards inclusive education, which was conducted with twelve teachers of the 5th grade of fundamental education. Among them, six had the experience of having handicapped pupils in their classroom, and six did not. The qualitative analysis of the data resulting from the assessment carried out in six schools of the Campo Grande (MS) municipal school system demonstrated, broadly speaking, that teachers were in favor of inclusive education. However, prejudiced attitudes, veiled or explicit, were also clearly visible within the school. The formation to deal with those that are "different" still faces barriers due to prejudice and discrimination present in a society based on a logic of "marginal inclusion". In their manifestations, teachers pointed to difficulties of working with pupils with severe mental handicap; they signaled that the responsibility of working under the dominance of an education centered on performance, with focus on the insertion of students in the labor market, generated a "feeling of impotence". Faced with the existing contradictions, inclusive education does not fail to bring forward the presence of injustices that still reveal themselves in the educative process. Despite that, several elements were observed that are favorable to this form of education, which is not dissociated from wider social movements.

Este é um estudo, de caráter analítico-descritivo, que teve como objetivo descrever as alterações morfológicas da traquéia de pacientes intubados com cânulas de alto volume residual e baixa pressão no "cuff", mantidos em ventilação mecânica com pressão intra -"cuff" menor que a capilar da traquéia (20 a 30 mmHg), em função do tempo de intubação. A população constou de 23 pacientes adultos, internados em uma UTI, intubados por períodos entre 27 a 317 horas, e que foram a óbito, necessitando de necropsia para identificação da causa mortis. As alterações encontradas limitaram-se apenas à mucosa da traquéia, atingindo somente o epitélio de revestimento e a lâmina própria, e o tempo de intubação foi um fator determinante do agravamento das lesões na parede traqueal.

Tendo em vista o nosso objetivo de conhecer o quadro de colonização pelo Staphylococcus aureus em alunos de um curso de Auxiliar de Enfermagem, durante a formação profissional, realizamos a coleta de material da cavidade nasal (N) e mãos direita (Md) e esquerda (Me) de 42 alunos, em diferentes momentos da formação, relacionando as taxas com as atividades desenvolvidas durante a programação do curso. Os resultados evidenciaram uma oscilação nas taxas de colonização nos diferentes momentos e a possibilidade de transmissão recíproca do agente entre os alunos e os receptores dos cuidados prestados, considerando o tipo de contato mantido entre eles.Considerando nuestro objetivo de conocer el cuadro de colonización por Staphylococcus aureus en alumnos de un curso de auxiliar de enfermería durante su formación, realizamos la colecta de material de la cavidad nasal (N), manos derecha (Md) e izquierda (Me) de 42 alumnos, en diferentes momentos de su formación, relacionando las tasas con las actividades desarrolladas durante la programación del curso. Los resultados evidenciaron una oscilación en las tasas de colonización en los diferentes momentos y la posibilidad de transmisión mutua del agente entre los alumnos y los receptores de los cuidados, considerando el tipo de contacto mantenido entre ellos.Considering our goal of understanding the colonization by Staphylococcus aureus in students from a nursing auxiliary program, during their professional formation, we collected material from the nasal cavity (N), right (Md) and left (Me)hands from 42 students on different moments of their formation relating the levels of colonization to the activities developed during the program. Results showed an oscillation in the colonization rate in different moments and the possibility of agent reciprocal transmission between the students and the taken care receptors, considering the type of contact.

Este estudo objetiva avaliar o procedimento da limpeza de unidade do paciente assim como detectar, apontar e alertar sobre as possíveis falhas nesse processo de limpeza. Os resultados obtidos por entrevistas com os enfermeiros responsáveis pelo Serviço de Enfermagem revelam que o procedimento realizado nos hospitais em estudo não vem atendendo às normas preconizadas pela literatura o que acarreta um produto final com pouca confiabilidade do ponto de vista da desinfecção.

Este trabalho objetivou conhecer o grau de colonização pelo Staphylococcus aureus e a evolução do estado de portador são em alunos de um curso de Auxiliar de Enfermagem, durante a formação profissional. Participaram 42 alunos, dos quais foram colhidas amostras da cavidade nasal e mãos (direita e esquerda) em seis diferentes momentos da formação. Do total de alunos, 19 (45,2%) comportaram-se como portadores ocasionais, 12 (28,6%) como intermitentes, 6 (14,3%) como persistentes e 5 (11,9%) como não portadores, demonstrando que a colonização não aumentou com o decorrer do curso. Dos alunos, 24 (57,1%) referiram não terem desenvolvido atividades relacionadas à enfermagem antes e/ou durante o curso e 18 (42,9%) referiram exercê-las como atendentes.