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O presente ensaio objetiva discorrer sobre a IA e suas implicações diante da escrita acadêmica de pós-graduandos em educação. Questiona-se: em que o avanço da IA transforma os desafios de pós-graduandos na escrita? Qual será o lugar desses sujeitos nas novas configurações da escrita acadêmica? Utilizamos centralmente os conceitos freireanos de situação-limite, atos-limite e inédito viável para explicitar a superação de limites por parte de sujeitos implicados na experiência educacional. Também dialogamos com a literatura especializada envolvendo escrita acadêmica e inteligência artificial na educação. Por fim, constatamos a complexidade da temática e reforçamos que, independentemente da forma de uso da IA na escrita acadêmica, não se deve apagar dela o sujeito e sua experiência. Tal apagamento do sujeito acarretaria uma desconfiguração completa da autoria e da educação como processo transformador e coletivo.

Most patients with muscle‐invasive bladder cancer (MIBC) are not cured with platinum chemotherapy. Up‐regulation of nuclear factor kappa light‐chain enhancer of activated B cells (NF‐κB) is a major mechanism underlying chemoresistance, suggesting that its pharmacological inhibition may increase platinum efficacy. NF‐κB signaling was investigated in two patient cohorts. The Cancer Genome Atlas (TCGA) was used to correlate NF‐κB signaling and patient survival. The efficacy of cisplatin plus the NF‐κB inhibitor dimethylaminoparthenolide (DMAPT) versus cisplatin or DMAPT alone was tested in vitro. Xenografted and immunocompetent MIBC mouse models were studied in vivo. Platinum‐naive claudin‐low MIBC showed constitutive NF‐κB signaling and this was associated with reduced disease‐specific survival in TCGA patients. Chemotherapy up‐regulated NF‐κB signaling and chemoresistance‐associated genes, including SPHK1, PLAUR, and SERPINE1. In mice, DMAPT significantly improved the efficacy of cisplatin in both models. The combination preserved body weight, renal function, and morphology, reduced muscle fatigue and IL‐6 serum levels, and did not aggravate immuno‐hematological toxicity compared with cisplatin alone. These data provide a rationale for combining NF‐κB inhibition with platinum‐based chemotherapy and conducting a clinical trial in MIBC patients.

With the proliferation and growing complexity of healthcare systems emerges the challenge of implementing scalable and interoperable solutions to seamlessly integrate heterogenous data from sources such as wearables, electronic health records, and patient reports that can provide a comprehensive and personalized view of the patient’s health. Lack of standardization hinders the coordination between systems and stakeholders, impacting continuity of care and patient outcomes. Common musculoskeletal conditions affect people of all ages and can have a significant impact on quality of life. With physical activity and rehabilitation, these conditions can be mitigated, promoting recovery and preventing recurrence. Proper management of patient data allows for clinical decision support, facilitating personalized interventions and a patient-centered approach. Fast Healthcare Interoperability Resources (FHIR) is a widely adopted standard that defines healthcare concepts with the objective of easing information exchange and enabling interoperability throughout the healthcare sector, reducing implementation complexity without losing information integrity. This article explores the literature that reviews the contemporary role of FHIR, approaching its functioning, benefits, and challenges, and presents a methodology for structuring several types of health and wellbeing data, that can be routinely collected as observations and then encapsulated in FHIR resources, to ensure interoperability across systems. These were developed considering health industry standard guidelines, technological specifications, and using the experience gained from the implementation in various study cases, within European health-related research projects, to assess its effectiveness in the exchange of patient data in existing healthcare systems towards improving musculoskeletal disorders (MSDs).

Canine cutaneous histiocytoma (CCH) represents a significant proportion of dog skin tumours, often manifesting as the most common neoplastic skin condition in young animals. Predominantly affecting dogs under four, these tumours appear primarily as solitary lesions that may regress spontaneously. This study, conducted over five years at the University of Trás-os-Montes e Alto Douro, involved a detailed histopathological and ultrastructural examination of 93 CCH cases. Histologically, these tumours showed distinct patterns of lymphoid infiltration, which contributed to their classification into four groups based on the inflammatory response and histological architecture. Most tumours displayed signs of epidermal invasion and frequent mitotic figures, with necrosis present in over half of the cases. Ultrastructurally, the neoplastic cells were characterised by pleomorphism, abundant organelles, and adherens-type junctions. This study offers significant insights into the pathophysiology and morphological characteristics of CCH, underscoring the importance of detailed histological and ultrastructural analysis in accurately diagnosing and understanding this common canine tumour.

Se em todo sistema filosófico há, pelo menos, uma ideologia social. muito mais necessariamente devemos encontrar ideias sociais na filosofia de Farias Brito, que confessava ser a sua grande preocupação a reforma da sociedade.

Temos como propósito compreender a construção e a reconstrução de discursos midiáticos por estudantes de escola pública sobre os estudos de vestibulandos no contexto da pandemia da covid-19 e analisar como o acesso de jovens da classe trabalhadora em cursos de alta seletividade social na universidade pública é divulgado na mídia. Utilizamos o modelo Codificação e Decodificação, de Stuart Hall (1973; 1980), e entrevistamos 13 estudantes do Distrito Federal. Entre as conclusões, refletimos que as mídias valorizam o mérito individual, inclusive em tempos de pandemia, enquanto silenciam as políticas públicas de acesso à educação superior. Conclui-se que a maioria dos jovens, ao reconstruir as notícias, mantém a lógica hegemônica e dominante.

Resumo A edição especial objetivou especialmente visibilizar estudos sobre a diáspora de povos lusófonos, dada a escassez de pesquisas sobre migrações que tratam de modo agregado países lusófonos, tanto na área da Demografia quanto em outras áreas, em especial a área para a qual essa edição especial foi pensada: a Administração. Compreendemos que as mobilidades contemporâneas assumem contornos cada vez mais complexos e desafiadores, o que amplia ainda mais a análise do fenômeno migratório. Assim, considerando o cenário contemporâneo, alguns pontos para reflexão nortearam essa chamada de trabalhos, quais sejam: a) os movimentos do projeto migracional em países de língua portuguesa; b) as estratégias para a inserção laboral dos sujeitos que migram para (ou de) países lusófonos; c) as migrações forçadas por guerras civis, ataques armados e/ou terroristas, e a consequente desestruturação das economias; d) as alterações climáticas e sua indução de migrações em busca de trabalho; e) as questões de gênero e suas intersecções com as questões migracionais nesses países.

ABSTRACT Objective: To evaluate the effectiveness of treatment with elexacaftor/tezacaftor/ivacaftor (ELX/TEZ/IVA) and to characterize its safety profile in cystic fibrosis (CF) patients in a real-world clinical setting. Methods: This was a prospective observational study carried out in a CF referral center in Portugal involving adult CF patients who started treatment with ELX/TEZ/IVA. Clinical characteristics of the patients were collected, and effectiveness and safety data were evaluated. Results: Of the 56 patients followed in the center at the time of the study, 28 were eligible for ELX/TEZ/IVA treatment in accordance with the Portuguese National Authority for Medicines and Health Products at the time of the study. Of these, 24 met the follow-up time requirement to be included in the clinical effectiveness analysis. The mean follow-up time was 167.3 ± 96.4 days. Adverse events were generally mild and self-limited. Significant improvements in lung function, BMI, sweat chloride concentration, and number of pulmonary exacerbations were observed. No significant differences in outcomes between F508del homozygous and heterozygous patients were found. The effectiveness of this new CFTR modulator combination also applied to patients with advanced lung disease. Conclusions: Treatment with ELX/TEZ/IVA showed effective improvement in real-world clinical practice, namely in lung function, BMI, sweat chloride concentration, and number of pulmonary exacerbations, with no safety concerns.

Breast cancer is one of the most common and well-known types of cancer among women worldwide and is the most frequent neoplasm in intact female dogs. Female dogs are considered attractive models or studying spontaneous breast cancer, whereas female rats are currently the most widely used animal models for breast cancer research in the laboratory context. Both female dogs and female rats have contributed to the advancement of scientific knowledge in this field, and, in a “One Health” approach, they have allowed broad understanding of specific biopathological pathways, influence of environmental factors and screening/discovery of candidate therapies. This review aims to clearly showcase the similarities and differences among woman, female dog and female rat concerning to anatomical, physiological and histological features of the mammary gland and breast/mammary cancer epidemiology, in order to better portray breast tumorigenesis, and to ensure appropriate conclusions and extrapolation of results among species. We also discuss the major aspects that stand out in these species. The mammary glands of female dogs and women share structural similarities, especially with respect to the lactiferous ducts and lymphatic drainage. In contrast, female rats have only one lactiferous duct per nipple. A comprehensive comparison between humans and dogs is given a special focus, as these species share several aspects in terms of breast/mammary cancer epidemiology, such as age of onset, hormonal etiology, risk factors, and the clinical course of the disease. Holistically, it is clear that each species has advantages and limitations that researchers must consider during the development of experimental designs and data analysis.

A decision support system (DSS) is a computerized information system that combines models and data to solve unstructured or semi-structured problems, with intense user involvement. DSSs have high applicability in several business areas and enable users without technical knowledge in computing to manipulate the information needed for a more assertive decision-making process. This study presents a DSS to support the decision process of installing a photovoltaic solution that considers the contracted power, the monthly expenses in electricity, and the location of the installation. The return on investment is estimated considering the annual savings in electricity and the return on investment. The findings indicate the relevance of the application to support the user in choosing the best solution and reveal that geographical location is a determining factor in the potential energy savings. Furthermore, the payback period decreases by increasing users' monthly consumption and is also potentiated by the increase in contracted power.

Librarians working in higher education want to support students in the pursuit of their academic work, based on the good use of information. To this end, they need to know the emerging pedagogical changes that they can take advantage of when designing their courses, integrating this knowledge into a more segmented, clear, and objective training offer, based on international references, published in the last decades, since the ACRL Standards, until the ACRL Framework. The attention given to these documents can prepare librarians for the necessary updating of skills, supporting innovation, and best practice achievement. This paper aims to systematise the evolution of concepts and practices of information literacy guidelines in higher education and identify their inspiration for the creation of Portuguese guidelines. An exploratory inventory of international information associations was carried out to identify information literacy guidelines. The content analysis of these guidelines allowed the identification of pedagogical trends in the performance of libraries and their professionals. The analysed contents show an interpretative evolution of the guidelines, converging in the ACRL Framework and the contents of the Portuguese recommendations for academic libraries for the period 2020-2022. It is evident that updating skills for librarians requires not only an awareness of sector trends, but also transforming them into good practice and recommendations appropriate for the national context.

Globally, educational institutes are trying to adapt modernized and effective approaches and tools to their education systems to improve the quality of their performance and achievements. However, identifying, designing, and/or developing promising mechanisms and tools that can impact class activities and the development of students’ outputs are critical success factors. Given that, the contribution of this work is to propose a methodology that can guide and usher educational institutes step by step through the implementation of a personalized package of training Toolkits in Smart Labs. In this study, the package of Toolkits refers to a set of needed tools, resources, and materials that, with integration into a Smart Lab can, on the one hand, empower teachers and instructors in designing and developing personalized training disciplines and module courses and, on the other hand, may support students (in different ways) in developing their skills. To demonstrate the applicability and usefulness of the proposed methodology, a model was first developed, representing the potential Toolkits for training and skill development. The model was then tested by instantiating a particular box that integrates some hardware to be able to connect sensors to actuators, with an eye toward implementing this system mainly in the health domain. In a real scenario, the box was used in an engineering program and its associated Smart Lab to develop students’ skills and capabilities in the areas of the Internet of Things (IoT) and Artificial Intelligence (AI). The main outcome of this work is a methodology supported by a model able to represent Smart Lab assets in order to facilitate training programs through training Toolkits.

Recent advances in machine vision technologies have provided a multitude of automatic tools for recognition and quantitative estimation of grapevine bunch features in 2D images. However, converting them into bunch weight (BuW) is still a big challenge. This paper aims to compare the explanatory power of the number of visible berries (#vBe) and the bunch area (BuA) in 2D images, in order to predict BuW. A set of 300 bunches from four grapevine cultivars were picked at harvest and imaged using a digital RGB camera. Then each bunch was manually assessed for several morphological attributes and, from each image, the #vBe was visually assessed while BuA was segmented using manual labelling combined with an image processing software. Single and multiple regression analysis between BuW and the image-based variables were performed and the obtained regression models were subsequently validated with two independent datasets. The high goodness of fit obtained for all the linear regression models indicates that either one of the image-based variables can be used as an accurate proxy of actual bunch weight and that a general model is also suitable. The comparison of the explanatory power of the two image-based attributes for predicting bunch weight showed that the models based on the predictor #vBe had a slightly lower coefficient of determination (R2) than the models based on BuA. The combination of the two image-based explanatory variables in a multiple regression model produced predictor models with similar or noticeably higher R2 than those obtained for single-predictor models. However, adding a second variable produced a higher and more generalised gain in accuracy for the simple regression models based on the predictor #vBe than for the models based on BuA. Our results recommend the use of the models based on the two image-based variables, as they were generally more accurate and robust than the single variable models. When the gains in accuracy produced by adding a second image-based feature are small, the option of using only a single predictor can be chosen; in such a case, our results indicate that BuA would be a more accurate and less cultivar-dependent option than the #vBe.

Aim of this study: to know the performance of information professionals in the fight against fake news, through the analysis of strategies in information literacy skills in an academic context. Method: a review of the literature indexed on Scopus and the Web of Science, associating fake news and information literacy in the context of higher education, was carried out. Results/Discussion: the Web of Science presents a total of 106 results and Scopus 43 results. The analysis points to the description of initiatives and projects from both higher education libraries and information professionals from the same sector, committed to the cause of fighting fake news. The literature stresses the importance of the educational factor: the training of motivated users for knowledge enhances the distinction of the truthfulness of what is stated and allows the identification of the most appropriate scenario for the production of knowledge. Better prepared individuals assume as insufficient the information made available by the Internet. In this process, libraries and librarians in higher education are important agents, as providers of learning and of updated and reliable information. It is suggested that measures be implemented by higher education institutions and information professionals to effectively combat fake news, especially in the academic context. It was concluded that knowledge can result in information, but the information does not necessarily result in knowledge – and information may not go beyond the level of opinion, so it is important to strengthen training strategies.

Aim of this study: to know the performance of information professionals in the fight against fake news, through the analysis of strategies in information literacy skills in an academic context. Method: a review of the literature indexed on Scopus and the Web of Science, associating fake news and information literacy in the context of higher education, was carried out. Results/Discussion: the Web of Science presents a total of 106 results and Scopus 43 results. The analysis points to the description of initiatives and projects from both higher education libraries and information professionals from the same sector, committed to the cause of fighting fake news. The literature stresses the importance of the educational factor: the training of motivated users for knowledge enhances the distinction of the truthfulness of what is stated and allows the identification of the most appropriate scenario for the production of knowledge. Better prepared individuals assume as insufficient the information made available by the Internet. In this process, libraries and librarians in higher education are important agents, as providers of learning and of updated and reliable information. It is suggested that measures be implemented by higher education institutions and information professionals to effectively combat fake news, especially in the academic context. It was concluded that knowledge can result in information, but the information does not necessarily result in knowledge – and information may not go beyond the level of opinion, so it is important to strengthen training strategies.

Resumo O artigo aborda o tema do plágio em livros didáticos, quando referido às pesquisas na internet e ao posicionamento dos autores. Por meio da análise de conteúdo, segundo as diretrizes de Bardin (2011), em 16 livros das coleções de Português, Ciências, Geografia e Matemática do ensino fundamental, e em entrevistas semiestruturadas com cinco autores brasileiros, concluiu-se: a inexistência de orientações sobre o plágio nesses livros analisados; a não integração da temática plágio nas diretrizes do Programa Nacional do Livro Didático; e a responsabilização da mediação dessas orientações exclusivamente a cargo dos professores.

Nesta era altamente midiatizada e com mediações de código aberto, marcada pela explosão das Tecnologias de Informação e Comunicação (TIC) em todos os contextos da vida humana, inclusive na educação, cresce também o número de problemas relacionados à cópia e ao plágio. Pesquisas internacionais alertam que os alunos estão cada vez mais cedo se especializando na técnica do “copiar e colar”. Para situar o tema do plágio, realizamos levantamento bibliográfico e exploratório da produção acadêmica entre os anos de 2010-2016. O artigo levanta a hipótese de que a falta de informação sobre os processos de pesquisa e responsabilidade na creditação autoral, nos primeiros anos de escolarização, pode ser um dos causadores do plágio e da cópia. Também indica que o estudante contemporâneo ‒ um pesquisador no ciberespaço – deve ser orientado sobre o perigo do plágio e da cópia, e que há lacunas de pesquisas sobre o assunto no ensino fundamental brasileiro, aumentando timidamente a partir do ensino superior, e, por fim, o texto apresenta algumas perspectivas de estudos e pesquisas sobre o assunto. PLAGIARISM IN EDUCATION: reflections around the international and national literature Abstract: In this highly mediatized era and with open source mediations, marked by the explosion of Information and Communication Technologies (ICT) in every aspect of human life, education included, also grows the number of problems related to copy and plagiarism. International research warns that students are become specializing in the "copy and paste" technique. In order to place the plagiarism discussion in context, was made a bibliographical and exploratory survey of academic production between the years 2010-2016. The article’s hypothesis is that the lack of information about the processes of research and responsibility in author credit in the first years of schooling, can be one of the causes of plagiarism and copying; that the contemporary student ‒ a researcher in cyberspace ‒ must be oriented about the danger of plagiarism and copying; there are gaps in research on the subject in Brazilian basic education, increasing timidly from higher education and, finally, the text presents some perspectives of studies and research on the subject. Keywords: Plagiarism. Research. Copy and paste. Internet. PLAGIO EN LA EDUCACIÓN: reflexiones en torno a la literatura internacional y nacional Resumen: En esta era altamente mediatizada y con mediaciones de código abierto, marcada por la explosión de las Tecnologías de Información y Comunicación (TIC) en todos los contextos de la vida humana, incluso en la educación, crece también el número de problemas relacionados con la copia y el plagio. Las encuestas internacionales advierten que los alumnos están cada vez más temprano se especializando en la técnica del "copiar y pegar". Para situar el tema del plagio, realizamos levantamiento bibliográfico y exploratorio de la producción académica entre los años 2010-2016. El artículo plantea la hipótesis de que la falta de información sobre los procesos de investigación y responsabilidad en la acreditación autoral en los primeros años de escolarización, puede ser uno de los causantes del plagio y de la copia; que el estudiante contemporáneo ‒ un investigador en el ciberespacio ‒ debe ser orientado sobre el peligro del plagio y de la copia; hay lagunas de investigaciones sobre el tema en la enseñanza fundamental brasileña, aumentando tímidamente a partir de la enseñanza superior y, por fin, el texto presenta algunas perspectivas de estudios e investigaciones sobre el tema. Palabras clave: Plagio. Investigación. Copiar y pegar. Internet.

Our aim was to evaluate the expression of biomarkers, CD44v6, CD147, EGFR, p53, p63, p73, p16, and podoplanin in oral leukoplakias (OL) and to assess their potential for prediction of malignant transformation (MT). We analyzed the expression of CD44v6, CD147, EGFR, p53, p63, p73, p16, and podoplanin by immunohistochemistry in 52 OL, comprised of 41 low-grade (LG) dysplasia and 11 high-grade (HG) cases. Twelve healthy normal tissues (NT) were also included. Univariate and multivariate analysis were performed to evaluate any association with MT. Variable expression among the studied markers was observed, with a significant increase of high expression from NT to LG and HG cases in CD44v6 (p = 0.002), P53 (p = 0.002), P73 (p = 0.043), and podoplanin (p < 0.001). In multivariate analysis, cases with high podoplanin score showed a significant increased risk of MT (HR of 10.148 (95% CI of 1.503–68.532; p = 0.017). Furthermore, podoplanin combined with binary dysplasia grade obtained a HR of 10.238 (95% CI of 2.06–50.889; p = 0.004). To conclude, CD44v6, p53, p73, and podoplanin showed an increasing expression along the natural history of oral carcinogenesis. Podoplanin expression independently or combined with dysplasia grade could be useful predictive markers of MT in OL.

Em 2016, a publicação das Recomendações para as Bibliotecas do Ensino Superior de Portugal procurou, numa das suas prerrogativas, a construção de uma relação de confiança e de parceria entre as bibliotecas, os seus profissionais e os investigadores. Os ganhos de competências de uns e de outros no apoio à investigação, publicação e disseminação seriam benéficos para ambos. No mesmo ano, a unidade de investigação Applied Psychology Research Center Capabilities & Inclusion (APPsyCI) incorporou, no conjunto das suas áreas de atuação, uma linha de investigação no âmbito da Ciência Aberta em articulação com a Literacia da Informação. Com este desiderato, procurou a APPsyCI implementar os pressupostos da Ciência Aberta através de diversas ações: na prossecução da gestão do repositório, na formação dos docentes e investigadores, no apoio à escolha de revistas onde publicar, na divulgação e promoção do conhecimento científico dentro dos princípios FAIR. Qual o impacto social desta linha de investigação? Associando a literacia da informação à Ciência Aberta ampliam-se horizontes e é lançada alguma luz sobre o panorama nacional em relação à inovação em investigação. A natureza transversal desta matéria resultou num conjunto de redes nacionais e de grupos de trabalho; num curso de pós-graduação de Literacia em Saúde; no primeiro ebook em língua portuguesa, editado em Portugal, sobre literacia da informação no ensino superior; em workshops, seminários e webinars sobre literacia da informação; na colaboração da tradução do Open Science Training Handbook para o idioma Português; na participação em comités e comissões científicas nacionais (APBAD, APDIS) e internacionais (ConfOA, EAHIL, ECIL, TEEM). De igual modo, os resultados deste trabalho estão a consolidar-se em vários outcomes: artigos, capítulos de livro, proceedings paper, entre outros.

O artigo aborda tanto a produção quanto os paradoxos do efeito simbólico de instituição pública de ensino médio, quando do acesso dos seus estudantes à universidade pública. A escola pauta a sua ação em exames de seleção para o ensino superior, mesmo com o ensino médio tendo outras finalidades como a preparação para o trabalho e a cidadania. O efeito esperado da escola é o efeito simbólico, derivado do poder simbólico, sendo esse último, nos termos de Bourdieu (2004), um poder de fazer coisas, poder de consagração ou de revelação e que se faz existir para os outros quando é distinguido. A partir da seleção de escola pública do Distrito Federal (DF), que obteve na imprensa a repercussão por ter estudantes que ingressaram na Universidade de Brasília (UnB), foi realizada a análise documental do Projeto Político Pedagógico da Escola, aplicação de questionário junto a 81 (oitenta e um) estudantes do ensino médio e entrevista com a direção da escola. A construção do efeito simbólico dos resultados da escola se dá em meio a paradoxos a exemplo do não envolvimento de todos os professores em preparar os estudantes aos exames de seleção; estruturalmente, em escala macro e micro, confirma a crise do ensino médio brasileiro em busca de rumos. A tendência é de que escolas busquem suas particularidades por distinção social, aprofundando a desigualdade, conservação e hierarquização na rede escolar.

Abstract Background The fate of hydrogen peroxide (H2O2) in the endoplasmic reticulum (ER) has been inferred indirectly from the activity of ER-localized thiol oxidases and peroxiredoxins, in vitro, and the consequences of their genetic manipulation, in vivo. Over the years hints have suggested that glutathione, puzzlingly abundant in the ER lumen, might have a role in reducing the heavy burden of H2O2 produced by the luminal enzymatic machinery for disulfide bond formation. However, limitations in existing organelle-targeted H2O2 probes have rendered them inert in the thiol-oxidizing ER, precluding experimental follow-up of glutathione’s role in ER H2O2 metabolism. Results Here we report on the development of TriPer, a vital optical probe sensitive to changes in the concentration of H2O2 in the thiol-oxidizing environment of the ER. Consistent with the hypothesized contribution of oxidative protein folding to H2O2 production, ER-localized TriPer detected an increase in the luminal H2O2 signal upon induction of pro-insulin (a disulfide-bonded protein of pancreatic β-cells), which was attenuated by the ectopic expression of catalase in the ER lumen. Interfering with glutathione production in the cytosol by buthionine sulfoximine (BSO) or enhancing its localized destruction by expression of the glutathione-degrading enzyme ChaC1 in the lumen of the ER further enhanced the luminal H2O2 signal and eroded β-cell viability. Conclusions A tri-cysteine system with a single peroxidatic thiol enables H2O2 detection in oxidizing milieux such as that of the ER. Tracking ER H2O2 in live pancreatic β-cells points to a role for glutathione in H2O2 turnover.

São apresentados os resultados de um estudo sobre as opiniões, necessidades e interesses dos utilizadores das bibliotecas hospitalares da zonz centro de Portugal. Esta pesquisa foi realizada com o objetivo de conhecer se os recursos e serviços das bibliotecas dos hospitais contribuem para a qualidade do atendimento prestado aos pacientes, para a prática da pesquisa e para a formação continuada dos profissionais. Para o efeito, foi realizado um inquérito a 121 utilizadores das bibliotecas de sete hospitais da zona centro de Portugal. Os resultados destacam os pontos fortes e fracos dos serviços bibliotecários, muitas vezes pouco conhecidos, e cuja avaliação varia dependendo do tipo de usuário e das iniciativas desenvolvidas pelas próprias bibliotecas.

Entendendo que a indiferença na ação pedagógica contribui para a reprodução das desigualdades no sistema de ensino, o presente artigo busca captar, a partir de entrevistas semiestruturadas, traços do habitus de professores supervisores de disciplinas do curso de Licenciatura em Pedagogia na modalidade a distância na Universidade de Brasília - UnB no âmbito do Sistema Universidade Aberta do Brasil - UAB. As orientações metodológicas de Bourdieu (2007) foram um dos elementos orientadores na análise das entrevistas, considerando ainda o uso heurístico do conceito de habitus. Conclui-se que o habitus professoral envolve esforços voluntários em busca de uma ação pedagógica diferenciada. No entanto, ele é ambíguo e condescendente frente aos limites do modelo de EaD no âmbito da UAB. Ao fim, os dados analisados permitem fornecer elementos para reorientação político-pedagógica que vise a um novo modelo de EaD nacional.

A importância das doenças oncológicas como causa de morbilidade e mortalidade está em crescimento, sendo reconhecido o seu impacto social e peso global pelos custos económicos e sociais envolvidos na sua prevenção, tratamento e reabilitação. As patologias oncológicas de cabeça e pescoço representam um dos seis tumores malignos mais prevalentes em todo o mundo, com um valor estimado de 900.000 novos casos diagnosticados anualmente em escala mundial. Estes doentes oncológicos apresentam deterioração de funções básicas que, quando percepcionadas, têm impacto negativo na sua Qualidade de Vida. Um registo oncológico adequado permite uma análise mais rigorosa dos resultados obtidos na avaliação da Qualidade de Vida Relacionada com a Saúde. Este estudo incluiu 380 doentes oncológicos de cabeça e pescoço e demonstra que as mulheres apresentam resultados de Qualidade de Vida globalmente inferiores. Salienta-se ainda a importância do diagnóstico precoce em oncologia, que se relaciona frequentemente com melhores scores e conclui-se que a localização do tumor tem impacto sobre a autopercepção de Qualidade de Vida. Os valores de Qualidade de Vida Relacionada com a Saúde devem ser interpretados à luz das variáveis sociodemográficas e clínicas, para melhor se avaliar a Patologia Oncológica de Cabeça e Pescoço numa perspectiva epidemiológica no sentido de melhor compreender o processo saúde - doença.The importance of oncology diseases as a cause of morbidity and mortality is increasing worldwide, and their social impact is being recognized due to economic and social costs involved in prevention, treatment and rehabilitation. Head and neck cancer is one of the six most prevalent neoplasms worldwide, with an estimated 900,000 new cases diagnosed annually. Regardless of tumor site, deterioration of basic functions affecting head and neck areas are perceived and affect patients' lives. Appropriate cancer registration may provide a better analysis of health-related quality of life outcomes. In this study, 380 head and neck cancer patients were evaluated. The study showed that women have lower overall Quality of Life results. It also emphasizes the importance of early diagnosis, which often relates to stages with better prognosis and better Quality of Life outcomes. The study concluded that tumor location has an impact on Quality of Life self-perception. Values of Health Related Quality of Life should be analyzed along with socio-demographic and clinical variables in order to better understand the epidemiology, pathogenesis, and prevention of Head and Neck Cancer.

The debate on economic policy has developed significantly in the past decade. The so-called Washington Consensus, which dictated most of the solutions proposed by international financial organisations, began to be questioned when a large number of emerging economies reduced their reliance on multilateral debt. The crisis of 2008 and 2009 accelerated the process of reflection on the prescriptive nature of the policy proposals advocated by monetarists, with their insistence on a uniform view as if all situations were alike. This has been termed ideology, and the ideology associated with the Washington Consensus has failed even in its methodological principles, as clearly demonstrated by the internal debate within organisations such as the International Monetary Fund or the World Bank. This article reviews the various internal arguments of the international financial organisations within the debate and provides a critique of preconstructed models involving a return to Keynesian economics. It ends with an optimistic view of the broadening and democratisation of the debate on economic policies, termed the new features of the post-Washington Consensus.

Africa has recently come to the forefront of world politics as part of the emerging South. Its increased prominence in the global discourse as a “new frontier of development” signals the recognition of its economic potential. Indeed, the continent has registered an average 5 per cent annual GDP growth rate over the past decade. However, there is more to the story than that: The rising profile of the African continent also reveals the growing role of a number of its countries in the emergence of a new South agency. It is argued that South–South cooperation is an opportunity. The discussion of the current situation in Africa understood as a continent in all its diversity including sub-Saharan Africa, but also the Maghreb and Egypt, will therefore be placed into this wider context. The renewal of a South agency witnessed over the past decade is somewhat different from the trilateral alliance of Asia–Africa–Latin America formed in the wake of decolonization. Current mega-trends demonstrate that the global South, driven by a number of regional powers, will play a vital role in shaping the twenty-first century. Understanding the complexities of this renewed agency is vital for addressing old wounds that marked the emergence of a South voice in the not-so-distant past. In jüngster Zeit ist Afrika als Teil des emerging South in den Vordergrund der Weltpolitik gerückt. Seine zunehmende Prominenz im globalen Diskurs als new frontier of development signalisiert die Anerkennung des ökonomischen Potenzials des Kontinents. Tatsächlich konnte Afrika im vergangenen Jahrzehnt eine durchschnittliche jährliche BIP-Wachstumsrate in Höhe von 5 Prozent verzeichnen. Aber es geht um mehr: Die wachsende Wahrnehmung des afrikanischen Kontinents ist Ausdruck der immer wichtigeren Rolle einiger afrikanischer Länder bei der Entstehung einer neuen South agency. Die Süd-Süd-Kooperation wird wieder als Möglichkeit erkannt. Die Diskussion der aktuellen Lage Afrikas – in all seiner Vielfalt zwischen subsaharischem Afrika, Maghreb und Ägypten – muss in diesem umfassenderen Kontext geführt werden. Die Erneuerung der South agency, die im vergangenen Jahrzehnt zu beobachten war, ist nicht gleichzusetzen mit der trilateralen Allianz Asien-Afrika-Lateinamerika in der Phase der Dekolonisation. Jüngste Megatrends signalisieren, dass der “globale Süden”, vorangetrieben von einigen Regionalmächten, bei der Gestaltung des 21. Jahrhunderts eine ganz wesentliche Rolle spielen wird. Ein Verständnis für die Komplexität dieser neuen Akteursrolle zu entwickeln, ist die Voraussetzung, wenn man alte Wunden ansprechen will, die in nicht allzu ferner Vergangenheit die Herausbildung einer Stimme des Südens begleiteten.

O controlo da asma é um factor crucial na abordagem do doente: a mais recente actualização do GINA considera que uma "asma difícil de tratar" é uma asma para investigar. O não cumprimento da terapêutica, a DPOC concomitante, o tabagismo, a rinossinusite, o refluxo gastroesofágico e a obesidade são considerados os principais motivadores da asma difícil de controlar. O presente trabalho teve por objectivo avaliar o papel do tromboembolismo pulmonar (TEP) na asma grave de difícil controlo. Foram revistos os processos clínicos de doentes asmáticos da consulta de Alergologia Respiratória do nosso Serviço, entre 2004 e 2006, com asma "persistente grave" de acordo com o GINA 2005. Foram seleccionados os que, apesar de terapêutica optimizada, apresentavam asma "não controlada" (GINA 2006) e analisadas as suas causas. Dos 254 doentes estudados, 28 (11%) preenchiam os critérios de "asma persistente grave" (idade média 44±18 anos; 86% sexo feminino); destes, 57% (n=16) tinham doença "não controlada" - 35% (n=6) por má adesão à terapêutica; 29% (n=5) por TEP (confirmado gamagraficamente); 12% (n=2) por rinossinusite grave; 6% (n=1) por síndroma hipereosinofílica; 6% (n=1) por contacto mantido com alérgenos e 6% (n=1) em estudo. Os doentes com TEP (idade média 56±9 anos; 80% sexo feminino; 80% raça branca) tiveram o diagnóstico de asma na idade adulta (média 37 anos), tendo decorrido cerca de 18 anos até ao diagnóstico de TEP. A análise dos factores predisponentes para TEP revelou: insuficiência venosa periférica (40%), HTA (40%) e deficiência de proteína C e S funcionais (20%). Todos os doentes efectuaram terapêutica anticoagulante (80% ainda mantém), referindo-se que, após o início da anticoagulação, 40% dos doentes alcançaram o controlo da doença e 40% têm, actualmente, asma "parcialmente controlada", não se tendo verificado novos internamentos por agudização da doença. Os resultados do presente trabalho apoiam a inclusão do TEP no grupo de comorbilidades possivelmente responsáveis pelo mau controlo da asma.Asthma control is a key point in patient management. GINA’s most recent report emphasises the need to investigate uncontrolled asthma, of which non-compliance with treatment, COPD, smoking, chronic sinusitis, gastroesophageal reflux disease and obesity are the usual causes. The aim of this work is to evaluate the role of pulmonary thromboembolism (PTE) in cases of difficult-to-treat asthma. We reviewed the case reports of patients with severe persistent asthma followed in our Asthma Outpatients Clinic between 2004 and 2006. We selected the ones that maintained uncontrolled disease despite an optimal therapeutical approach and investigated the causes. In this group (n=254), 28 (11%) had severe persistent asthma and their mean age was 44 ± SD18 years old. 86% were females. Of these, 57% (n=16) had uncontrolled disease: 35% (n=6) due to non-compliance with treatment; 29% (n=5) pulmonary thrombombolism (scintigraphic confirmation); 12% (n=2) severe rhinosinusitis; 6% (n=1) hypereosinophilic syndrome; 6% (n=1) persistent allergen exposure and 6% (n=1) are still being investigated. Patients with TPE (mean age 56 ± SD9 years old; 80% females; 80% Caucasians) were diagnosed with asthma as adults (mean age 37 ± SD14 years old). The mean time until the diagnosis of TPE was 18 ± SD12 years. Predisposing factors for TPE were venous insufficiency (40%), hypertension (40%) and deficit of functional protein C and S (20%). All these patients received anticoagulant therapy (80% are still medicated). It should be noted that after the beginning of anticoagulants, 40% of the patients achieved control of their asthma and 40% have partially controlled disease. There were no hospital admissions for asthma exacerbations after the beginning of anticoagulation in this group. This study supports the inclusion of TPE in the group of comorbidities to consider while investigating uncontrolled asthma.

The use of chemical compounds benefits society in a number of ways. Pesticides, for instance, enable foodstuffs to be produced in sufficient quantities to satisfy the needs of millions of people, a condition that has led to an increase in levels of life expectancy. Yet, at times, these benefits are offset by certain disadvantages, notably the toxic side effects of the chemical compounds used. Exposure to these compounds can have varying effects, ranging from instant death to a gradual process of chemical carcinogenesis. There are three stages involved in chemical carcinogenesis. These are defined as initiation, promotion and progression. Each of these stages is characterised by morphological and biochemical modifications and result from genetic and/or epigenetic alterations. These genetic modifications include: mutations in genes that control cell proliferation, cell death and DNA repair - i.e. mutations in proto-oncogenes and tumour suppressing genes. The epigenetic factors, also considered as being non-genetic in character, can also contribute to carcinogenesis via epigenetic mechanisms which silence gene expression. The control of responses to carcinogenesis through the application of several chemical, biochemical and biological techniques facilitates the identification of those basic mechanisms involved in neoplasic development. Experimental assays with laboratory animals, epidemiological studies and quick tests enable the identification of carcinogenic compounds, the dissection of many aspects of carcinogenesis, and the establishment of effective strategies to prevent the cancer which results from exposure to chemicals.A sociedade obtém numerosos benefícios da utilização de compostos químicos. A aplicação dos pesticidas, por exemplo, permitiu obter alimento em quantidade suficiente para satisfazer as necessidades alimentares de milhões de pessoas, condição relacionada com o aumento da esperança de vida. Os benefícios estão, por vezes associados a desvantagens, os efeitos resultantes da exposição a compostos químicos enquadram-se entre a morte imediata e um longo processo de carcinogênese química. A carcinogênese química inclui três etapas definidas como iniciação, promoção e progressão. Cada uma delas caracteriza-se por transformações morfológicas e bioquímicas, e resulta de alterações genéticas e/ou epigenéticas. No grupo das alterações genéticas incluem-se mutações nos genes que controlam a proliferação celular, a morte celular e a reparação do DNA - i.e. mutações nos proto-oncogenes e genes supressores de tumor. Os fatores epigenéticos, também considerados como caracteres não genéticos, podem contribuir para a carcinogênese por mecanismos de silenciamento gênico. A utilização de diferentes metodologias possibilita o reconhecimento e a compreensão dos mecanismos básicos envolvidos no desenvolvimento do cancro. Ensaios experimentais comanimais de laboratório, estudos epidemiológicos e alguns testes rápidos permitem identificar compostos carcinogênicos, analisar os eventos envolvidos na carcinogênese e estabelecer estratégias para prevenir a exposição a estes agentes.

Resumo: O controlo da asma é um factor crucial na abordagem do doente: a mais recente actualização do GINA considera que uma âasma difícil de tratarâ é uma asma para investigar. O não cumprimento da terapêutica, a DPOC concomitante, o tabagismo, a rinossinusite, o refluxo gastroesofágico e a obesidade são considerados os principais motivadores da asma difícil de controlar.O presente trabalho teve por objectivo avaliar o papel do tromboembolismo pulmonar (TEP) na asma grave de difícil controlo.Foram revistos os processos clínicos de doentes asmáticos da consulta de Alergologia Respiratória do nosso Serviço, entre 2004 e 2006, com asma âpersistente graveâ de acordo com o GINA 2005. Foram seleccionados os que, apesar de terapêutica optimizada, apresentavam asma ânão controladaâ (GINA 2006) e analisadas as suas causas. Dos 254 doentes estudados, 28 (11%) preenchiam os critérios de âasma persistente graveâ (idade média 44±18 anos; 86% sexo feminino); destes, 57% (n=16) tinham doença ânão controladaâ â 35% (n=6) por má adesão à terapêutica; 29% (n=5) por TEP (confirmado gamagra-ficamente); 12% (n=2) por rinossinusite grave; 6% (n=1) por síndroma hipereosinofílica; 6% (n=1) por contacto mantido com alérgenos e 6% (n=1) em estudo.Os doentes com TEP (idade média 56±9 anos; 80% sexo feminino; 80% raça branca) tiveram o diagnóstico de asma na idade adulta (média 37 anos), tendo decorrido cerca de 18 anos até ao diagnóstico de TEP. A análise dos factores predisponentes para TEP revelou: insuficiência venosa periférica (40%), HTA (40%) e deficiência de proteína C e S funcionais (20%).Todos os doentes efectuaram terapêutica anticoagulante (80% ainda mantém), referindo-se que, após o início da anticoagulação, 40% dos doentes alcançaram o controlo da doença e 40% têm, actualmente, asma âparcialmente controladaâ, não se tendo verificado novos internamentos por agudização da doença.Os resultados do presente trabalho apoiam a inclusão do TEP no grupo de comorbilidades possivelmente responsáveis pelo mau controlo da asma.Rev Port Pneumol 2007; XIII (6): 776-787 Abstract: Asthma control is a key point in patient management. GINAâs most recent report emphasises the need to investigate uncontrolled asthma, of which non-com-pliance with treatment, COPD, smoking, chronic sinusitis, gastroesophageal reflux disease and obesity are the usual causes.The aim of this work is to evaluate the role of pulmonary thromboembolism (PTE) in cases of difficult-to-treat asthma. We reviewed the case reports of patients with severe persistent asthma followed in our Asthma Outpatients Clinic between 2004 and 2006. We selected the ones that maintained uncontrolled disease despite an optimal therapeutical approach and investigated the causes.In this group (n=254), 28 (11%) had severe persistent asthma and their mean age was 44±SD18 years old. 86% were females. Of these, 57% (n=16) had uncontrolled disease: 35% (n=6) due to non-compliance with treatment; 29% (n=5) pulmonary thrombombolism (scintigraphic confirmation); 12% (n=2) severe rhinosinusitis; 6% (n=1) hypereosinophilic syndrome; 6% (n=1) persistent allergen exposure and 6% (n=1) are still being investigated.Patients with TPE (mean age 56±SD9 years old; 80% females; 80% Caucasians) were diagnosed with asthma as adults (mean age 37±SD14 years old). The mean time until the diagnosis of TPE was 18±SD12 years. Predisposing factors for TPE were venous insufficiency (40%), hypertension (40%) and deficit of functional protein C and S (20%).All these patients received anticoagulant therapy (80% are still medicated). It should be noted that after the beginning of anticoagulants, 40% of the patients achieved control of their asthma and 40% have partially controlled disease. There were no hospital admissions for asthma exacerbations after the beginning of anticoagulation in this group.This study supports the inclusion of TPE in the group of comorbidities to consider while investigating uncontrolled asthma.Rev Port Pneumol 2007; XIII (6): 776-787 Palavras-chave: Tromboembolismo pulmonar, asma grave, asma não controlada, Key-words: Pulmonary thromboembolism, severe asthma, difficult-to-treat asthma

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Neoadjuvant chemoradiation (CRT) followed by curative surgery still remains the standard of care for locally advanced rectal cancer (LARC). The main purpose of this multimodal treatment is to achieve a complete pathological tumor response (ypCR), with better survival. The surgery delay after CRT completion seems to increase tumor response and ypCR rate. Usually, time intervals range from 8 to 12 weeks, but the maximum tumor regression may not be seen in rectal adenocarcinomas until several months after CRT. About this issue, we report a case of a 52-year-old man with LARC treated with neoadjuvant CRT who developed, one month after RT completion, an acute myocardial infarction. The need to increase the interval between CRT and surgery for 17 weeks allowed a curative surgery without morbidity and an unexpected complete tumor response in the resected specimen (given the parameters presented in pelvic magnetic resonance imaging (MRI) performed 11 weeks after radiotherapy completion).

Human Papillomavirus cause a number of diseases most notably cervical cancer. K14-HPV16 transgenic mice expressing the HPV16 early genes in squamous epithelial cells provide a suitable experimental model for studying these diseases. MicroRNAs are small non-coding RNAs that play an important role in regulating gene expression and have been suggested to play an important role in cancer development. The role of miR-155 in cancer remains controversial and there is limited evidence linking this miRNA to HPV- associated diseases. We hypothesized that miR-155 expression modulates each tissue's susceptibility to develop HPV-associated carcinogenesis. In this study, we analyzed miR-155 expression in ear and chest skin samples from 22-26 weeks old, female K14-HPV16 transgenic (HPV16+/-) and wild-type (HPV-/-) mice. Among wild-type mice the expression of miR-155 was lower in ear skin compared with chest skin (p = 0.028). In transgenic animals, in situ carcinoma was present in all ear samples whereas chest tissues only showed epidermal hyperplasia. Furthermore, in hyperplastic chest skin samples, miR-155 expression was lower than in normal chest skin (p = 0,026). These results suggest that miR-155 expression may modulate the microenvironmental susceptibility to cancer development and that high miR155 levels may be protective against the carcinogenesis induced by HPV16.

Whipple disease (WD) is a rare systemic infection caused by Tropheryma whippelii. Neurological involvement has been recognised in 40% of patients, either as initial manifestations or during the course of the disease. We report on a 45 years-old man with WD with initial, persistent and irresistible episodes of daytime somnolence. The patient was HLA-DQB1*0602 positive (genetic marker for narcolepsy). WD diagnosis was suspected on clinical and MRI basis and confirmed by histological and immunohistochemical study of duodenal biopsy. Forty months later all clinical features improved, narcoleptic-like episodes disappeared and cerebral MRI and CSF normalised. Longitudinal neurophysiological studies revealed persistent sleep pattern abnormalities with sleep fragmentation, paucity of slow wave and of REM sleep. The disruption of the hypocretin circuitry in the hypothalamic - diencephalic region triggered by the infection was the probable cause of the hypersomnia and narcopleptic symptoms. WD should be added to the list of causes of secondary hypersomnia.A doença de Whipple (DW) é infecção sistémica rara causada pelo Tropheryma whippelii. Cerca de 40% dos doentes apresentam envolvimento neurológico, seja como manifestação inicial da doença, seja durante o seu curso. Apresentamos o caso de um homem de 45 anos com doença de DW com episódios iniciais, persistentes e irresistíveis de sonolência durante a actividade diurna. O doente era positivo para o HLA-DQB1*0602 (marcador genético de narcolepsia). A suspeita do diagnóstico de DW foi levantada com base na clínica e RM e confirmada por estudo imunocitoquímico do material de biópsia jejunal. Quarenta meses mais tarde, todas as manifestações clínicas melhoraram, os episódios narcolépticos desapareceram, e a RM e o LCR normalizaram. Os estudos neurofisiológicos seriados do sono revelaram alterações persistentes caracterizadas por fragmentação do sono, escassez de ondas lentas e sono REM. A perturbação do circuito da hipocretina na região hipotálamo-diencefálica, causada pela infecção, foi a causa provável da hipersónia num doente geneticamente susceptível. A DW deve ser incluída nas causas de hipersónia secundária.

A síndroma de Ehlers-Danlos (cutis hyperelastica), constitui uma patologia do tecido conjuntivo caracterizada por alterações da pele, ligamentos e órgãos internos. Apresenta transmissão hereditária, em geral autossómica dominante. Afecta primordialmente a síntese do colagéneo, pelo que a pele e os vasos sanguíneos se tornam extremamente elásticos e frágeis. A pele é macia, com consistência de borracha, e as equimoses surgem facilmente. As articulações são hiperextensíveis e têm mobilidade aumentada. Os autores apresentam o caso clínico de um doente de dezasseis anos, com história de hipermobilidade articular desde a infância e fractura esplénica, a quem foi feito o diagnóstico de síndroma de Ehlers-Danlos na sequência de pneumotórax espontâneo recidivante. Apresentam-se as complicações pulmonares mais frequentes desta síndroma e discute-se a importância de não esquecer as etiologias menos comuns, perante casos de pneumotórax espontâneo.Ehlers-Danlos syndrome (cutis hyperelastica), is a group of connective tissue disorders characterized by abnormalities of the skin, ligaments and internal organs. It is a hereditary syndrome, usually with autossomal dominant inheritance; that primarily affects the collagen synthesis. The skin and blood vessels are extremely fragile and elastic. The skin is soft with rubber consistency and easily bruising. There are hypermobile joints with increased extensibility. We summarize the case of a sixteen year old boy with a history of joint hypermobility since childhood and splenic fracture that was diagnosed with Ehlers-Danlos syndrome after the occurrence of recidivant spontaneous pneumothorax. We present the most common pulmonary complications of Ehlers-Danlos syndrome and discuss the importance of not forgetting the least commons etiologies of pneumothorax, in cases of spontaneous pneumothorax.

Resumo: A síndroma de Ehlers-Danlos (cutis hyperelastica), constitui uma patologia do tecido conjuntivo caracterizada por alterações da pele, ligamentos e órgãos internos.Apresenta transmissão hereditária, em geral autossómica dominante. Afecta primordialmente a síntese do colagéneo, pelo que a pele e os vasos sanguíneos se tornam extremamente elásticos e frágeis. A pele é macia, com consistência de borracha, e as equimoses surgem facilmente. As articulações são hiperextensíveis e têm mobilidade aumentada.Os autores apresentam o caso clínico de um doente de dezasseis anos, com história de hipermobilidade articular desde a infância e fractura esplénica, a quem foi feito o diagnóstico de síndroma de Ehlers-Danlos na sequência de pneumotórax espontâneo recidivante.Apresentam-se as complicações pulmonares mais frequentes desta síndroma e discute-se a importância de não esquecer as etiologias menos comuns, perante casos de pneumotórax espontâneo.Rev Port Pneumol 2006; XII (4): 471-480 Abstract: Ehlers-Danlos syndrome (cutis hyperelastica), is a group of connective tissue disorders characterized by abnormalities of the skin, ligaments and internal organs.It is a hereditary syndrome, usually with autossomal dominant inheritance; that primarily affects the collagen synthesis. The skin and blood vessels are extremely fragile and elastic. The skin is soft with rubber consistency and easily bruising. There are hypermobile joints with increased extensibility.We summarize the case of a sixteen year old boy with a history of joint hypermobility since childhood and splenic fracture that was diagnosed with Ehlers-Danlos syndrome after the occurrence of recidivant spontaneous pneumothorax.We present the most common pulmonary complications of Ehlers-Danlos syndrome and discuss the importance of not forgetting the least commons etiologies of pneumothorax, in cases of spontaneous pneumothorax.Rev Port Pneumol 2006; XII (4): 471-480 Palavras-chave: Síndroma de Ehlers-Danlos, pneumotórax, hipermobilidade articular, Key-words: Ehlers-Danlos Syndrome, pneumothorax, joint hypermobility

Bladder cancer is a significant health problem in rural areas of Africa and the Middle East where Schistosoma haematobium is prevalent, supporting an association between malignant transformation and infection by this blood fluke. Nevertheless, the molecular mechanisms linking these events are poorly understood. Bladder cancers in infected populations are generally diagnosed at a late stage since there is a lack of non-invasive diagnostic tools, hence enforcing the need for early carcinogenesis markers.Forty-three formalin-fixed paraffin-embedded bladder biopsies of S. haematobium-infected patients, consisting of bladder tumours, tumour adjacent mucosa and pre-malignant/malignant urothelial lesions, were screened for bladder cancer biomarkers. These included the oncoprotein p53, the tumour proliferation rate (Ki-67>17%), cell-surface cancer-associated glycan sialyl-Tn (sTn) and sialyl-Lewisa/x (sLea/sLex), involved in immune escape and metastasis. Bladder tumours of non-S. haematobium etiology and normal urothelium were used as controls. S. haematobium-associated benign/pre-malignant lesions present alterations in p53 and sLex that were also found in bladder tumors. Similar results were observed in non-S. haematobium associated tumours, irrespectively of their histological nature, denoting some common molecular pathways. In addition, most benign/pre-malignant lesions also expressed sLea. However, proliferative phenotypes were more prevalent in lesions adjacent to bladder tumors while sLea was characteristic of sole benign/pre-malignant lesions, suggesting it may be a biomarker of early carcionogenesis associated with the parasite. A correlation was observed between the frequency of the biomarkers in the tumor and adjacent mucosa, with the exception of Ki-67. Most S. haematobium eggs embedded in the urothelium were also positive for sLea and sLex. Reinforcing the pathologic nature of the studied biomarkers, none was observed in the healthy urothelium.This preliminary study suggests that p53 and sialylated glycans are surrogate biomarkers of bladder cancerization associated with S. haematobium, highlighting a missing link between infection and cancer development. Eggs of S. haematobium express sLea and sLex antigens in mimicry of human leukocytes glycosylation, which may play a role in the colonization and disease dissemination. These observations may help the early identification of infected patients at a higher risk of developing bladder cancer and guide the future development of non-invasive diagnostic tests.

A cohort of individuals (n = 136) with lesions as severe as atrophic chronic gastritis (ACG) was cross-sectionally evaluated for the validity assessment of pepsinogen I (PGI) and pepsinogen II (PGII) serum levels for the diagnosis of intestinal metaplasia (IM) and gastric dysplasia. PGI/PGII ratio [median (range)] was 4 (0.57.5) in patients with ACG (n = 35); 4.6 (1.9-6.8) in type I IM (n = 18); 4.2 (1.4-5.9) in type II or type III IM limited to the antrum and incisura (n = 20); 2.4 (0.4-5.6) in extensive incomplete IM (n = 38); and 1.3 (0.4-6.4) in low-grade dysplasia (n = 23) (P = .002). Using histopathologic data as a reference test, the area under the receiver operating characteristic curves (CI 95%) was 0.73 (0.64-0.82) for extensive IM, 0.72 (0.58-0.85) for the diagnosis of dysplasia, and 0.81 (0.66-0.95) for the diagnosis of high-grade dysplasia. Using a PGI/PGII ratio of ≤3 as the cutoff for dysplasia diagnosis, the sensitivity was 70% (62-78%), the specificity was 65% (57-73%), and the negative predictive value estimates were over 90%. No differences in PG levels according to age or gender were observed. Helicobacter pylori did not significantly influence validity measurement estimates. PGI/PGII serum level ratio can be used even in the management of patients with a high a priori probability for a positive test. It may be useful for the exclusion of more advanced lesions (extensive IM and neoplastic lesions).

Introdução: Feocromocitomas são tumores originários de células cromafins do sistema simpato-adrenal. As suas manifestações clínicas são múltiplas e diversificadas, função do perfil secretório variável de múltiplos compostos, incluindo catecolaminas, neuropéptidos e outros compostos vasoactivos. A Neurofibromatose 1 (D de von Recklinghausen), a mais prevalente das variantes das neurofibromatoses, é genodermatose transmitida segundo padrão mendeliano autossómico dominante. O diagnóstico de NF1 assenta em critérios diagnósticos, entre os quais as alterações cutâneas, oculares e esqueléticas são as mais relevantes, embora múltiplas neoplasias envolvendo diversos orgãos e sistemas não possam ser esquecidas ou sub-valorizadas já que é bem conhecido que o produto genético do gene alterado da NF1 – a neurofibromina – é uma proteina de supressão tumoral. Feocromocitomas ocorrem em menos de 1% dos doentes com NF1; por outro lado, apenas 5% dos casos reportados de feocromocitoma estão associados com a NF I. No entanto, entre doentes hipertensos com NF1, a prevalência de feocromocitoma pode atingir os 50%. Caso clínico: É relatado caso de eurocaucasiana de 27 A de idade, com diagnóstico de NF1 com história de 4 meses de cólicas abdominais, hiperhidrose generalizada, dispneia e hipertensão arterial paroxística. As catecolaminas e metanefrinas urinárias estavam aumentadas e a exploração topográfica levada a cabo (RMN e I-MIBG) permitiram detectar uma massa na glândula suprarrenal direita, a qual, após adrenalectomia confirmou o diagnóstico de feocromocitoma. Conclusão: O caso apresentado enfatiza a necessidade de uma abordagem multissistémica, multidisciplinar a doentes com NF1, tendo em conta as manifestações sistémicas associadas, na base de um prognóstico por vezes fechado da doença.

BackgroundSchistosomiasis is a neglected tropical disease, endemic in 76 countries, that afflicts more than 240 million people. The impact of schistosomiasis on infertility may be underestimated according to recent literature. Extracts of Schistosoma haematobium include estrogen-like metabolites termed catechol-estrogens that down regulate estrogen receptors alpha and beta in estrogen responsive cells. In addition, schistosome derived catechol-estrogens induce genotoxicity that result in estrogen-DNA adducts. These catechol estrogens and the catechol-estrogen-DNA adducts can be isolated from sera of people infected with S. haematobium. The aim of this study was to study infertility in females infected with S. haematobium and its association with the presence of schistosome-derived catechol-estrogens.Methodology/principal findingsA cross-sectional study was undertaken of female residents of a region in Bengo province, Angola, endemic for schistosomiasis haematobia. Ninety-three women and girls, aged from two (parents interviewed) to 94 years were interviewed on present and previous urinary, urogenital and gynecological symptoms and complaints. Urine was collected from the participants for egg-based parasitological assessment of schistosome infection, and for liquid chromatography diode array detection electron spray ionization mass spectrometry (LC/UV-DAD/ESI-MSn) to investigate estrogen metabolites in the urine. Novel estrogen-like metabolites, potentially of schistosome origin, were detected in the urine of participants who were positive for eggs of S. haematobium, but not detected in urines negative for S. haematobium eggs. The catechol-estrogens/ DNA adducts were significantly associated with schistosomiasis (OR 3.35; 95% CI 2.32-4.84; P≤0.001). In addition, presence of these metabolites was positively associated with infertility (OR 4.33; 95% CI 1.13-16.70; P≤0.05).Conclusions/significanceEstrogen metabolites occur widely in diverse metabolic pathways. In view of the statistically significant association between catechol-estrogens/ DNA adducts and self-reported infertility, we propose that an estrogen-DNA adduct mediated pathway in S. haematobium-induced ovarian hormonal deregulation could be involved. In addition, the catechol-estrogens/ DNA adducts described here represent potential biomarkers for schistosomiasis haematobia.

Chronic perianal fistulas are a common clinical condition. However, their evolution to adenocarcinoma is rare. We report the case of a 48-year-old man with perianal chronic fistulas, who developed two perianal ulcerated lesions near the external orifices of the fistulas, which extended proximally as a pararectal tumor. No intestinal lesion was seen at endoscopic examination. Histopathological biopsy indicated mucinous adenocarcinoma. Staging was performed by pelvic magnetic resonance imaging (MRI) and thoracoabdominal CT scan. The patient underwent a laparoscopic colostomy followed by neoadjuvant chemoradiotherapy and then laparoscopic abdominoperineal resection followed by adjuvant therapy. We have seen a favorable outcome with no recurrence at 3 years of follow-up.