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Next-generation sequencing (NGS) has been implemented in clinical oncology for diagnosis, prognosis, and therapeutic guidance. Among the various NGS applications in molecular oncology, we focused on the following topics: laboratory standards for targeted gene panels (somatic mutations) and therapeutic guidance based on NGS of lung cancer and rare cancers, namely sarcomas and cancers of unknown primary. Multiple quality control checkpoints should be addressed in the pre-analytical phase for good quality and interpretation of the NGS results. It includes tumor size and cellularity, tissue processing and decalcification, tumor fraction, tumor viability, fixatives, and staining. Communication between clinicians and laboratory support is also essential. In lung cancer, all patients with non-squamous non-small cell lung cancer should be tested with a NGS panel, and it should include not only genes with approved targeted therapies (ALK, BRAF, EGFR, MET, NTRK, RET, and ROS1) but also genes with potentially actionable genomic alterations (HER2 and KRAS). Since there is a lack of extensive knowledge regarding the use of NGS in rare tumors performing comprehensive genomic profiling, NGS panels to better manage the disease are recommended. Moreover, other patients with other incurable solid tumors may benefit from being included in biomarker-driven clinical trials. Multidisciplinary tumor boards with the participation of experts with the ability to integrate genomic profiling data are essential to tailor the best strategy for each patient. Considering that there are no national guidelines, this article aims to guide laboratory and clinical practice for the use of NGS in the context of lung cancer, rare tumors, and cancer of unknown primary in Portugal.

Neste texto, apresenta-se um estudo sobre o impacto que o ensino explícito e sistemático do processo de escrita e dos seus subprocessos: a planificação, a textualização, a revisão e a edição tem na qualidade de textos expositivos produzidos por alunos de 4.º ano de escolaridade, em Portugal. Foi desenvolvida uma intervenção no sentido de ensinar explicitamente estes subprocessos, aplicados aos textos expositivos. O desenho investigativo contemplou um diagnóstico da situação através da realização de um pré-teste; uma intervenção didática, visando implementar um conjunto de sequências didáticas em que a dimensão processual da escrita era objeto de ensino explícito; e, por último, a realização de um pós-teste para avaliar o impacto da intervenção na qualidade dos textos. Constata-se que, a partir de uma análise mista dos pré e pós-testes, houve uma progressão do grupo experimental, no que se refere à interiorização da dimensão processual da escrita e à qualidade dos textos. Palavras-chave: escrita; dimensão processual da escrita; texto expositivo.

Angiosarcoma is a rare malignant vascular tumor. Pulmonary involvement is usually attributable to metastasis from other primary sites, primary pulmonary angiosarcoma therefore being quite uncommon. We report a case of angiosarcoma with pulmonary involvement, probably primary to the lung, which had gone untreated for more than two years. We describe this rare neoplasm and its growth, as well as the extensive local invasion and hematogenous metastasis at presentation. We also discuss its poor prognosis.

O cancro do pulmão é a causa mais comum de morte por doença oncológica. Os doentes com diagnóstico de neoplasia - qualquer que seja a localização - têm risco acrescido de desenvolver um segundo tumor. Pretendeu-se caracterizar uma população com neoplasia do pulmão e o diagnóstico síncrono ou metácrono de tumor primário com outra localização. Foi feito um estudo retrospectivo, referente ao período de 2000-2007, analisando-se os processos clínicos de doentes seguidos na Unidade de Pneumologia Oncológica do nosso hospital em que estavam referenciadas duas neoplasias. Dos doentes seguidos na Unidade (n=1046) no período referido, 4,2% (n=44) tinham evidência de duas neoplasias. A maioria (88,6%) dos doentes eram homens, com idade média elevada (70,1±10 anos). Oitenta e seis por cento (n=38) tinham hábitos tabágicos e 65,4% dos doentes com registo de história familiar de neoplasia (n=26) tinham história familiar relevante (n=17). A doença oncológica manifestou-se em primeiro lugar na próstata, cólon, cabeça e pescoço ou bexiga. O cancro do pulmão foi em geral a segunda neoplasia. O intervalo de tempo médio entre a primeira e a segunda neoplasia foi de 62,9±64,9 meses (max: 240, min: 0), sendo que geralmente a segunda neoplasia foi detectada em estádio avançado. A sobrevivência média foi de 8,6±8,24 meses (max: 32; min: 1), permanecendo vivos quatro doentes. Os presentes dados levam-nos a sugerir vigilância clínica prolongada em doentes com diagnóstico prévio de cancro. Sugerimos um algoritmo que possibilite vigiar melhor estes doentes e estudo prospectivo para verificar se existem marcadores moleculares nesta população.Lung cancer is the leading form of cancer death worldwide. Cancer patients are at a high risk of developing a second cancer. The present study attempts to determine the characteristics of a population with lung cancer diagnosed with another cancer. We analysed records of patients from the Department of Lung Oncology of our hospital from 2000 to 2007 who were identified as having two or more tumours. We found 4.2% (n=44) multiple cancers among the registered cases (n=1046), 88.6% males, (high) mean age 70.1±10 years old. About 86% (n=38) of the patients were smokers or ex -smokers. From the patients with record of family history, 65.4% (n=17) had relevant family history of cancer. The majority of the first malignancy diagnosed was prostate, colon, head and neck and bladder. Lung cancer was essentially the second malignancy. The mean time lag between the two diagnoses was 62.9±64.9 months (max. 240, min. 0), with the second cancer usually detected at an advanced stage. The mean survival of patients who had a second primary lung cancer was 8.6±8.24 months (max. 32, min. 1), with four patients still surviving. Lung cancer was essentially the second malignancy. The mean time lag between the two diagnoses was 62.9±64.9 months (max. 240, min. 0), with the second cancer usually detected at an advanced stage. The mean survival of patients who had a second primary lung cancer was 8.6±8.24 months (max. 32, min. 1), with four patients still surviving.

Resumo: Descreve-se o caso clínico de um doente do sexo masculino com uma massa mediastínica de crescimento lento. Após terem-se efectuado vários exames complementares, foi através de cirurgia que se confirmou o diagnóstico de fibrose idiopática do mediastino. A remoção parcial da massa permitiu uma estabilização transitória das suas dimensões. Cerca de quatro anos depois, verificou-se um crescimento marcado com repercurssões importantes, através da inevitável compressão de estruturas vitais, que conduziram a hipertensão pulmonar grave. A fibrose idiopática do mediastino é uma entidade extremamente rara, estando descritas associações a outras patologias, mais frequentemente às auto-imunes, mas apresenta sempre um curso fatal quando não é possível a cirurgia.Rev Port Pneumol 2005; XI (2): 155-163 Abstract: We herein report a case of a male patient, who presented a mediastinal mass that had a slow growth over the years. After surgery, that made the diagnosis of idiopathic mediastinal fibrosis, the growth stabilized. Four years latter it was observed a substantial increase which lead to the inevitable compression of vital structures which, in turn, led to pulmonary hypertension. Idiopathic mediastinal fibrosis is an extremely rare pathology. There are same cases in which it is associated with other pathologies but has always a fatal prognosis when surgery is not an option.Rev Port Pneumol 2005; XI (2): 155-163 Palavras-chave: Fibrose do mediastino, síndroma da veia cava superior, hipertensão pulmonar, mediastinite fibrosante, Key words: Mediastinal fibrosis, superior vena cava syndrome, pulmonary hypertension, fibrosis mediastinites

This paper provides an analysis of the literature on transnational education to identify the key challenges and success factors for the sustainable operation of transnational higher education (TNE) programmes as perceived by key stakeholders. Probing the stakeholders' perspectives and applying a systematic approach, this study analyses 227 English-written articles retrieved from the Web of Science database published from 2000 to 2021. Key challenges identified include difficulties in managing the TNE programmes, ensuring quality assurance, adapting the curricula to the local contexts, accommodating offshore students' learning styles, creating studying environments for TNE students equivalent to those in the home institutions, ensuring preparedness of the academic staff, and facilitating the knowledge transfer in the host countries. The analysis also highlights six factors for the sustainable development of TNE programmes, including the effectiveness of the operations, the internationalization of the curricula, the transnational experience of the students, the development of the transnational staff, the existence of a proper regulatory framework in the host countries, and the development of a global systematic data collection for quality assurance. In addition, the evidence collected suggests that while the transition from domestic into a foreign programme can be rewarding, it demands appropriate planning and implementation.

Cancer is the second most important cause of death in Portugal, following cardiovascular diseases (CVD), and shows a constant progressive increase in the proportional share of total deaths. In Portugal, as in most countries, the health care budget is under constant cost-containment pressures. In this context it is necessary to verify if enough resources have been allocated to the disease in terms of health care expenditure. The main objective of this study is to estimate the cost of cancer care in Portugal and to compare it to similar data in Europe and the United States of America (USA), to the cost of CVD. The secondary objective is to evaluate the cost of pharmaceuticals used in the treatment of cancer in Portugal, both in relation to total pharmaceutical expenditure and to other therapeutic areas.Three main sources of information were used: comprehensive literature review, primary and secondary data sources, and a modified Delphi Panel, which was used to fill in gaps in the information derived from the data sources and the literatura review. The burden of cancer was measured through the Disability-adjusted life-year (DALY) and, in order to determine the costs of cancer, detailed information on the costs of medical visits and of inpatient episodes based on Diagnosis Related Groups (DRG), in 2006, was used. To estimate the total cost of cancer, we used a combination of top down (breaking global expenditure data to specific levels) and bottom up methodology (based on the sum of different components).Based on 2006 data on direct medical care expenditures in Portugal, we found that 565 million euro were spent on cancer in comparison to 1 320 million on CVD representing 3.91% and 9.14% of total cost on health respectively. When we break down total expenditure on drugs by therapeutic area we find that CVD drugs represent about 21.6% of total drug costs in Portugal and cancer drugs represent about 5.6% of the total. Oncology drugs represent 32% of the total expenditure on cancer, while CVD drugs represent 54% of the total expenditure on CVD. In comparison, in terms of BoD in Portugal, 18.6% of DALY's were associated with CVD and 15.3% with cancer.Considering the burden of disease (BoD) of CVD and cancer in Portugal, we can state that the expenditure allocated to cancer is significantly lower than expected. Using the criterion of expenditure according to need, we observed that there is an imbalance of expense/BoD in oncology indicating that cancer seems to be underfunded in Portugal. Even considering that this shouldn't be the only criterion to determine the volume of expense in a certain therapeutic area, the differential observed in this study is sufficiently high to deserve attention from the decision-makers.

Resumo: Os agentes inibidores dos receptores de membrana tirosina cinase como o EGFR tem sido um alvo atractivo, visto que o EGFR está sobreexpresso em cerca de 80% dos CPNPC. O erlotinib em monoterapia após falência de pelo menos um esquema de quimio-terapia prévia prolonga a sobrevivência e melhora a qualidade de vida, embora com modesta taxa de resposta. As mulheres, não fumadores, adenocarcinomas e asiáticos estão associados a melhor resposta. É neste grupo de doentes que mais frequentemente se encontra a mutação do EGFR. Os autores descrevem dois casos, com importante controlo sintomático e aumento do tempo para a progressão independente-mente do tipo de resposta à terapêutica (estabilização ou resposta parcial).Rev Port Pneumol 2008; XIV (Supl 3): S53-S60 Abstract: Agents that inhibit the activity of cell membrane receptor tyrosine kinases, such as the human epidermal growth factor receptor (EGFR) have been an attractive target because EGFR is expressed by 80% of NSCLC. Erlotinib as monotherapy in the treatment of NSCLC after failure of at least one prior chemotherapy regimen, prolonged survival and improved quality of life, although modest response rate. Women, Asiens, patients with Adenocarcinoma and never smokers, were more likely than other patients to have a response to erlotinib. This is the group of patients that most commonly have an EGFR mutation. The authors describe two cases, with important control of symptoms and increased time to progression, independently o response rate (stable disease or partial response).Rev Port Pneumol 2008; XIV (Supl 3): S53-S60 Palavras-chave: Carcinoma pulmonar de não pequenas células, terapêutica, inibidores do EGFR, erlotinib, Key-words: Non-small cell lung cancer, treatment, EGFR inhibitors, erlotinib

Resumo: O cancro do pulmão, em particular o carcinoma pulmonar de não pequenas células (CPNPC), permanece a principal causa de morte por neoplasia em todo o mundo, com taxas de sobrevivência

The Brazilian Institute of Geography and Statistics (IBGE) is, with INEGI in Mexico are the only ones in the world to claim the "geography". But is it a scientific guarantee for researchers who implement local census data? The large number of territorial categories of official statistics of present-day Brazil reveals a great wealth of data, provided they are not considered as a "turnkey" material for research.From a pre-statistical European model inherited from the colonial period to the rationality of the state, then to the liberal and post-modern context that spread in the globalized world, the IBGE categories reveal the paradoxes due to the superposition of different points of view on how to characterize the urban space. This translates into difficulties in understanding and using aggregated population data on official spatial and urban categories. The avatars of the current situation are symptomatic of the paradigm of complexity that increasingly influences the quantitative approach in the social sciences and more generally reflects a break between citizens, policies and the logic of experts. Based on an in-depth analysis of territorial categories produced by the IBGE, the article uses these sources to understand the criteria that prevail in the divisions of space and in the definition of the urban space by the institution in order to assess the interest and limitations of using these sources of information. This analysis should allow a better understanding and better use of the rich dataset spread by the national statistical services.