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As parasitoses intestinais constituem um grave impasse de saúde pública no território brasileiro. Ocorrem principalmente em regiões com maior vulnerabilidade socioambiental, onde não existe saneamento básico, dificuldades de acesso ao atendimento médico e às medidas de prevenção, além de hábitos de higiene insuficientes que agravam a situação dessas parasitoses. O objetivo deste estudo consiste em proporcionar aos alunos do Ensino Fundamental da Escola Municipal Chapeuzinho Vermelho, localizada no município de Bragança-PA, uma abordagem lúdica sobre a importância da higienização das mãos para prevenção das parasitoses. Para isto, serão utilizados recursos didáticos simples e lúdicos para o ensino-aprendizagem do público-alvo, desenvolvendo atividades, brincadeiras e uma cartilha relacionada à higienização das mãos contendo jogos de tabuleiro.

O microambiente das células-tronco hematopoiéticas é responsável por coordenar diversos eventos envolvidos na produção de células sanguíneas. Essa renovação hematopoiética só é possível graças às interações e sinalizações bem ordenadas que mantém a harmonia do tecido. Nas leucemias ocorre ruptura nesses mecanismos de controle e ocorre processo de transformação leucêmica do microambiente, de forma a favorecer a manutenção neoplásica do tecido sanguíneo. O objetivo deste estudo foi expor o processo de transformação leucêmica do microambiente, no âmbito das modificações celulares e moleculares sofridas para sustentar o tumor. Trata-se de um artigo de revisão narrativa e as bases de dados Pubmed, Scielo, Cocrahne Library e MedLine foram consultadas em busca de publicações dos últimos anos sobre o tema. Os dados apresentados contribuem para o entendimento holístico acerca das leucemias. A transformação leucêmica, seja por mutações primárias nos componentes do microambiente ou pelo sequestro de suas funções normais pelas células iniciadoras de leucemia, é relevante para que ocorra a instalação, a progressão, a disseminação e a quimiorresistência tumoral. Por meio da atuação de vários componentes este microambiente sustenta as células-tronco leucêmicas e representa caminho promissor para o desenvolvimento de novas terapias antileucêmicas.

Background: Atherosclerosis is a serious health problem, and several factors contribute to its occurrence. Longitudinal and qualified monitoring of primary health care (PHC) may contribute to the management of atherosclerosis and reduction of avoidable hospital admissions. Objectives: To estimate the trend in hospitalizations for atherosclerosis and the impact of PHC coverage on its evolution from 2008 to 2018 in Brazil. Methods: An ecological time series analytical study based on the outcomes of hospital admissions for atherosclerosis in Brazil. Time in years, PHC coverage, and Family Health Strategy (FHS) services were considered independent variables. A Prais–Winsten model was used to estimate the outcome trend, and α < 0.05 was adopted. Results: We observed a mean increase of 1.81 hospitalizations for atherosclerosis per 100 000 inhabitants annually (p = 0.002) in Brazil. This growth was evidenced in the Northeast (p < 0.001), Southeast (p = 0.003), and South (p < 0.001) regions, being stable in the North (p = 0.057) and Midwest (p = 0.62) regions. Men presented twice the growth in hospitalizations from the fifth decade of life on (p < 0.01). An inversely proportional relationship was observed for PHC coverage (B = -0.71; p < 0.001) and the proportion of FHS services (B = -0.59; p < 0.001) with the rate of admissions due to atherosclerosis in Brazil. Conclusions: Although hospitalizations for atherosclerotic complications are increasing in Brazil, they present regional and individual gender and age discrepancies, as well as a mitigating effect exerted by PHC coverage.

Resumo Contexto O pé diabético é uma complicação do diabetes melito (DM), sendo a maior causa de amputação dos membros inferiores. Objetivos Avaliar a prática de medidas de autocuidado com os pés, segundo sexo e escolaridade, em pacientes portadores de DM na região nordeste no estado da Bahia. Métodos Estudo quantitativo, observacional, analítico, transversal, realizado com 88 pacientes portadores de DM, em consulta de rotina, de fevereiro a março de 2020. A coleta de dados foi executada através da aplicação de questionários socioeconômico e do autocuidado com os pés (conhecimento sobre pé diabético, hábitos de cuidado/inspeção dos pés e procura pela Unidade de Saúde na presença de alterações com a saúde dos pés). Resultados Do total, 58% dos indivíduos desconhecia o termo “pé diabético”, porém possuíam cuidados mínimos adequados com os pés, como inspecioná-los (60,2%), hidratá-los (65,9%), não andar descalço (81,8%) e cortar as unhas (92%), apesar de 90,9% não utilizar sapatos considerados adequados. Houve relação entre menor nível de escolaridade e pior desempenho nas questões referentes a andar descalço, hidratar os pés, cortar as unhas, usar calçados adequados e identificar micoses (p < 0,05), porém não houve associação da realização das medidas de autocuidado e sexo. Conclusão Os portadores de DM entrevistados não realizaram todas as medidas de autocuidado com os pés e desconheciam o termo “pé diabético”. Houve associação entre menor escolaridade e menor capacidade de realização dessas medidas, o que sugere que o letramento em saúde seria importante para melhoria desse autocuidado, contribuindo para diminuição de complicações e amputações dos pés. Abstract Background The diabetic foot is a complication of diabetes mellitus (DM) and is the most common cause of lower limb amputation. Objectives To assess foot self-care practices by sex and educational level in DM patients from the Northeast of Brazil, state of Bahia. Methods This was a quantitative, cross-sectional, observational, analytical study with 88 DM patients seen at routine consultations from February to March of 2020. Data were collected using questionnaires on socioeconomic data and self-care of feet (knowledge about the diabetic foot, habits related to care/inspection of feet, and visits to the Healthcare Center when changes to foot health are detected). Results 58% of the sample did not know the term “diabetic foot”, but a majority did perform minimum adequate foot care practices, such as inspecting feet (60.2%), moisturizing feet (65.9%), avoiding walking barefoot (81.8%), and trimming toenails (92%), although 90.9% did not wear footwear considered appropriate. There was a relationship between lower educational level and worse performance in questions relating to walking barefoot, moisturizing feet, trimming toenails, wearing appropriate footwear, and identifying mycoses (p < 0.05), but there was no association between performing self-care activities and sex. Conclusions Interviewed patientswith DM did not perform all foot self-care activities and did not know what the term “diabetic foot” means. There was an association between lower educational level and reduced capacity to perform these activities, which suggests that health literacy is important to improve self-care of feet, contributing to reduce complications and foot amputations.

Chronic graft-versus-host disease (cGvHD), an immunological complication of allogeneic cell transplantation, is the principal cause of non-relapse mortality and morbidity. Even though advances have been made in understanding the pathophysiology of this disorder, many questions remain. We sought to evaluate gene expression of transforming growth factor β (TGF-β) pathway components, through quantitative RT-PCR and PCR array, in patients with cGvHD with different disease activity. We observed an upregulation of SMAD3, BMP2, CDKN1A, IL6, and TGF-β2 genes in the clinical tolerance group, which had never developed cGvHD, or which had been withdrawn from all immunosuppressive treatments (IST) for at least 1 year. In addition, SMAD5 gene upregulation was observed in cGvHD patients undergoing IST, and ordinal regression showed a correlation between SMAD5 expression and disease severity. Our data support the evidence of the important role of TGF-β effects in the pathological process of cGvHD.

This study assesses the relationship between biopsychosocial factors and limitations in activities of daily living (ADL) in individuals with chronic kidney disease (CKD). Individual data from the National Health Survey were analyzed, with a sample size of 839 participants. The outcome was dichotomous, presenting limitations in ADL, and the factors considered were clinical and health characteristics, self-perceived behavior, contextual social support, and housing. Cox regression was applied to control the interaction between factors, using the prevalence ratio as a measure of effect and a significance level of 5%. A total of 839 individuals with CKD were reported, of which 373 (40.7%: 35.4 - 46.1%) reported having limitations in ADL. The presence of limitations in ADL was related to residing in a rural area, as well as to the absence of private health insurance, worse self-perceived health, presence of depressive symptoms, and disabilities, in addition to the use of medications and hemodialysis. Limitations in ADL in individuals with CKD are associated with biopsychosocial factors in the Brazilian population, requiring public policies that enable better therapeutic management and support for behavioral health and contextual needs.

Chronic graft-versus-host disease (cGvHD) not only remains the main cause of late mortality after allogeneic hematopoietic cell transplant, but also has the capacity of causing severe organ impairment in those who survive. The Notch, a highly conserved ligand-receptor pathway, is involved in many immunological processes, including inflammatory and regulatory responses. Recently, mouse models have shown that the blockage of canonical Notch signaling prevents GvHD.Due to the lack of data on the Notch pathway in human chronic GvHD, we sought to study the expression of NOTCH components in primary samples of patients who received allo-HCT and presented active cGvHD or a long-term clinical tolerance to cGvHD.Our results showed a significantly lower expression of NOTCH components in both groups that received allo-HCT, independently of their cGvHD status, when compared to healthy controls.Moreover, there were no differences in gene expression levels between the active cGvHD and clinically tolerant groups. To our knowledge, this is one of the first studies performed in human primary samples and our data indicate that much remains to be learned regarding NOTCH signaling as a new regulator of GvHD.

Vitamin D (1,25-dihydroxycolecalciferol) is a prohormone that has attracted the interest of researchers since studies have shown that its effects are not restricted to bone metabolism. Thus, the present review summarizes the most recent findings and discusses the usefulness of prescribing vitamin D and its analogues for treatment and prevention of cardiovascular disorders and endothelial dysfunction. The paper constitutes a narrative review of the literature, selecting articles published from 2012 to 2019. Studies have shown that vitamin D3 and its analogues have beneficial effects on endothelial function, but these results are controversial, since research with larger samples and of longer duration found no reduction in morbidity and mortality or cardiovascular risk factors after use of these substances. Given the current state of the art, there is no clear scientific basis for supplementation with vitamin D or its analogues for treatment of endothelial dysfunction or cardiovascular disease.

Orientadores: Patrícia Maria Bergamo Favaro, Sara Teresinha Olalla Saad Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas Resumo: As síndromes mielodisplásicas (SMD) são um grupo heterogêneo de doenças caracterizadas por hematopoese ineficaz e risco de progressão para leucemia mieloide aguda (LMA). SMD de baixo de risco é caracterizada por um aumento de apoptose na medula óssea e alterações clínicas com perfil autoimune, enquanto que na SMD de alto risco há uma evasão imune, baixa apoptose e danos secundários ao DNA, contribuindo para a progressão para LMA. Essas evidências, junto com os dados de terapia imunossupressora em pacientes com SMD, sugerem o papel do sistema imune na progressão desta doença. Entretanto, o papel do sistema imune não é claro, e estudos que abordem o perfil das células T são importantes para o melhor entendimento da patogênese da SMD. Formin-like 1 (FMNL1) pertence à família de proteínas formina, indispensáveis para muitos processos fundamentais actina-dependentes. FMNL1 é restritamente expressa em células derivadas de linhagem hematopoética e superexpressa em células neoplásicas hematopoéticas malignas. Recentemente, foi descrito que FMNL1 está envolvida no processo de citotoxicidade de células CD8+. Desse modo, estudar a expressão de FMNL1 tanto nos linfócitos como nas células da MO dos pacientes com SMD, poderia contribuir para o melhor entendimento do papel dessa nova proteína neste modelo de neoplasia hematológica. No presente estudo, foi observada uma diminuição significativa na contagem absoluta de linfócitos periféricos no grupo SMD, após ajuste para idade, quando comparada com o grupo de doadores saudáveis (controle). Entretanto, houve um aumento da frequência de células CD3+, resultante do aumento significativo das subpopulações de células CD3+CD4+ no grupo de alto risco e CD3+CD8+ no grupo de baixo risco, de acordo com as classificações FAB e WHO. A razão CD4:CD8 encontrou-se aumentada no grupo de alto risco comparado com o de baixo risco. Dependência transfusional foi correlacionada positivamente com a porcentagem de CD3+CD4+, enquanto que a idade dos pacientes correlacionou-se de forma negativa com a porcentagem de CD3+ e CD3+CD8+. Os níveis de expressão de FOXP3, nas células CD3+ de sangue periférico, foram significativamente menores no grupo de baixo risco quando comparado com o grupo controle, e esse padrão se repetiu para a expressão de IL10. A quantificação dos transcritos de IL10 correlacionou-se negativamente com a porcentagem de células CD3+CD8+. Em conclusão, evidenciamos que pacientes com SMD apresentaram um menor número de linfócitos, porém com a frequências das células T CD3+, CD3+CD4+ e CD3+CD8+ aumentadas. Os pacientes de baixo risco apresentaram uma diminuição da expressão de FOXP3 e de IL10, quadro característico de um microambiente apoptótico e inflamatório. Já no grupo de alto risco, a expressão de FOXP3 e de IL10 aumenta em relação ao grupo de baixo risco. É interessante ressaltar que nos pacientes com SMD houve uma correlação entre o aumento da expressão de IL10 e a diminuição das células T CD3+CD8+, sugerindo a contribuição das Tregs na progressão da doença através da produção de IL10. A análise da expressão de FMNL1 em células CD3+ de sangue periférico não denotou diferenças significativas entre os pacientes com SMD e o grupo controle. Entretanto observou-se uma correlação positiva entre a expressão de FMNL1 e o número de células CD3+CD4+ e ambos com a dependência transfusional. Quanto à expressão de FMNL1 em amostras de MO, houve uma expressão significativamente menor nos pacientes com SMD quando comparado com as células de doadores normais, além de uma correlação negativa entre FMNL1 e número de citopenias. Usando modelos de linhagens celulares hematopoéticas para a diferenciação, observou-se um aumento significativo na expressão gênica e protéica de FMNL1 durante a diferenciação megacariocítica. Esses resultados sugerem a participação de FMNL1 na ativação de linfócitos CD4+ no sangue periférico e na diferenciação hematopoética na medula óssea Abstract: Myelodysplastic syndromes (MDS) are a heterogeneous group of disorders characterized by ineffective hematopoiesis and risk of progression towards acute myeloid leukemia. Low-risk MDS is characterized by increased apoptosis in the bone marrow (BM), with a clinical autoimmune profile, whereas in high-risk MDS an immune evasion, low apoptosis and secondary DNA damage occurs, contributing to the progression of AML. This evidence, together with the data of immunosuppressive therapy in patients with MDS, suggests a role of the immune system in the progression of this disease. However, this role of the immune system is remains unclear, and studies that address the profile of T cells are important for a better understanding of the pathogenesis of MDS. Formin-like 1 (FMNL1) belongs to the family of proteins formina indispensable for many fundamental processes in actin-dependent. FMNL1 is strictly expressed in hematopoietic lineage derived cells, and overexpressed in malignant hematopoietic neoplastic cells. FMNL1 has recently been reported to be involved in the cytotoxicity of CD8+ cells. Thus, studies on the expression of FMNL1, both in lymphocytes and BM cells of MDS patients, could contribute to a better understanding of the role of this protein in this new model of hematologic malignancy. In the present study, we observed a significant decrease in absolute peripheral lymphocyte counts in the MDS group, after adjusting for age, compared with the healthy donor group (control). However, there was an increased frequency of CD3+, resulting in a significant increase of the CD3+CD4+ subpopulation in high risk and CD3+CD8+ in MDS low risk, according to FAB and WHO classifications. CD4:CD8 ratio was increased in the high risk when compared to the low risk group. Transfusion dependence was positively correlated with the percentage of CD3+CD4+, whereas the age of patients correlated negatively with the percentage of CD3+ and CD3+CD8+. The expression levels of FOXP3, in peripheral blood CD3+ cells, was significantly lower in the low risk group compared to controls and this pattern was repeated for the expression of IL10. Interestingly, IL10 transcripts correlated negatively with the percentage of CD3+CD8+. In conclusion, we found that patients with MDS had a lower lymphocyte number, however presented an increased frequency of CD3+ and CD3+CD8+ T cells. Our low risk patients showed a decreased expression of FOXP3 and IL10, characteristic of apoptotic and inflammatory microenvironment. In the high risk group, the expression of FOXP3 and IL10 was normal. Interestingly, there was a correlation between increasing expression of IL10 and reduction of CD3+CD8+ T cells in patients, suggesting the contribution of Treg in disease progression due to IL10 production. Analysis of FMNL1expression in CD3+ cells of peripheral blood showed no significant differences between patients with MDS and the control group. However, there was a positive correlation between FMNL1 expression and the number of CD3+CD4+, and both were transfusion dependence. FMNL1 expression in BM samples was significantly lower in MDS patients when compared with cells from normal donors, and there was a negative correlation between FMNL1 and number of cytopenias. Using models of hematopoietic cell lineages for differentiation, we observed an increase in gene and protein expression of FMNL1 during megakaryocytic and granulocytic differentiation. These results suggest the participation of FMNL1 in the activation of CD4+ lymphocytes in peripheral blood and bone marrow hematopoietic differentiation Mestrado Fisiopatologia Médica Mestre em Ciências

The diabetic foot is a complication of diabetes mellitus (DM) and is the most common cause of lower limb amputation.To assess foot self-care practices by sex and educational level in DM patients from the Northeast of Brazil, state of Bahia.This was a quantitative, cross-sectional, observational, analytical study with 88 DM patients seen at routine consultations from February to March of 2020. Data were collected using questionnaires on socioeconomic data and self-care of feet (knowledge about the diabetic foot, habits related to care/inspection of feet, and visits to the Healthcare Center when changes to foot health are detected).58% of the sample did not know the term "diabetic foot", but a majority did perform minimum adequate foot care practices, such as inspecting feet (60.2%), moisturizing feet (65.9%), avoiding walking barefoot (81.8%), and trimming toenails (92%), although 90.9% did not wear footwear considered appropriate. There was a relationship between lower educational level and worse performance in questions relating to walking barefoot, moisturizing feet, trimming toenails, wearing appropriate footwear, and identifying mycoses (p0.05), but there was no association between performing self-care activities and sex.

SUMMARY OBJECTIVE: The aim of this study was to highlight the differences between the cardiometabolic effects and the cardiovascular risk of physical inactivity and sedentary behavior. METHODS: A narrative bibliographic review was conducted. In the research, national and international articles were selected from the PubMed, SciELO, and LILACS databases using the descriptors “sedentary lifestyle, cardiovascular risk, physical inactivity, sedentary behavior, and cardiovascular risks.” DISCUSSION: Both physical inactivity and sedentary behavior are related to metabolic and organic changes, promoting a chronic proinflammatory state, cardiac remodeling, increased body adiposity, and skeletal muscle dysfunction. It is possibly stated that both of them result in a higher risk of developing chronic diseases, resulting in higher global and cardiovascular morbidity and mortality, with nuances in their intrinsic effects. CONCLUSIONS: It is inferred that both physical inactivity and sedentary behavior are cardiovascular risk factors that can be modified with the correct clinical approach. It is necessary to differentiate physically inactive individuals from those with a high number of sedentary behaviors. These concepts need better clinical applicability to improve the prevention of primary and secondary cardiovascular risks.

To determine agreement between the Short Test of Functional Health Literacy in Adults (S-TOFHLA) and the Short Assessment of Health Literacy for Portuguese-speaking Adults (SAHLPA-18) measurement instruments as a strategy for estimating concurrent validity.This was a cross-sectional study conducted with users of the Brazilian National Health System. An agreement approach using a weighted Kappa test for qualitative data was applied in order to test for concurrent validity.372 individuals participated. It was found that 66% and 62% of them did not have an adequate level of literacy according to SAHLPA-18 and S-TOFHLA, respectively. There was strong correlation between the instruments (p0.001; r=0.60), although the 65.3% agreement of correct answers found was considered weak (Kappa=0.35; p0.001).The SAHLPA-18 and S-TOFHLA instruments have different constructs and poor agreement. Use of different instruments is indicated in research intended to measure level of literacy, as is the development of instruments specific to health conditions that allow results close to the real context of individuals to be obtained.Determinar a concordância entre os instrumentos de mensuração short test of functional health literacy in adults (S-TOFHLA) e short assessment of health literacy for Portuguese-speaking adults (SAHLPA-18) como estratégia para estimar a validade concorrente.Estudo transversal, com usuários do Sistema Único de Saúde. Para testar a validade concorrente, aplicou-se abordagem de concordância com teste de Kappa ponderado para dados qualitativos.Participaram 372 indivíduos, dos quais 66% e 62% não apresentaram nível de letramento adequado, segundo o SAHLPA-18 e o S-TOFHLA, respectivamente. Observou-se correlação forte entre os instrumentos (p0,001; r=0,60); e a concordância de acertos encontrada, 65,3% (Kappa=0,35; p0,001), foi considerada fraca.Os instrumentos SAHLPA-18 e S-TOFHLA apresentam constructos diferentes e fraca concordância. É indicado o uso de diferentes instrumentos em pesquisas de mensuração do nível de letramento; e desenvolvimento de instrumentos específicos às condições de saúde que permitam obter resultado próximo ao real contexto dos indivíduos.Determinar la concordancia entre instrumentos de medición psicométrica short test of functional health literacy in adults (S-TOFHLA) y short assessment of health literacy for portuguese-speaking adults (SAHLPA-18) como estrategia para estimar la validez concurrente.estudio transversal realizado con usuarios del Sistema Único de Salud. Para testear la validez concurrente se aplicó un enfoque de concordancia con una prueba ponderada de Kappa para datos cualitativos.participaron 372 individuos. Se encontró que 66% y 62% de estos no tenía un nivel adecuado de letramiento según SAHLPA-18 y S-TOFHLA, respectivamente. Hubo una fuerte correlación entre los instrumentos (p0.001; r=0.60), sin embargo 65.3% de concordancia, se consideró débil (Kappa=0.35; p0.001).Los instrumentos SAHLPA-18 y S-TOFHLA tienen diferentes construcciones y escasa concordancia. En la investigación se indica el uso de diferentes instrumentos para medir el nivel de letramiento y el desarrollo de instrumentos específicos a las condiciones de salud que permitan obtener resultados cercanos al contexto real de los individuos.

SUMMARY The emergence of a new form of Coronavirus (SARS-CoV-2) exposed weaknesses of health services in several countries, with overcrowding of hospitals, and lack of supplies and professionals in combating the disease, which sometimes contributed to the installation of social, political, and economic chaos. The critical situation experienced made the subject widely publicized so that the current pandemic also deals with an information epidemic. However, the data received and transmitted require prior critical analysis of its content, although not everyone is able to make the necessary judgment before using or sharing information, partly due to the lack of adequate health knowledge. Health literacy is a broad and important topic in public health but still globally underestimated, thus considered a silent epidemic. The exponential increase in the number of confirmed cases shows the world population's inadequacy and difficulty in understanding basic prevention guidelines. The COVID-19 pandemic warns of gaps in the health literacy levels of the world population and exposes the need for a comprehensive mapping to identify the overall health literacy status in more countries.

The role of tumour microenvironment in neoplasm initiation and malignant evolution has been increasingly recognized. However, the bone marrow mesenchymal stromal cell (BMMSC) contribution to disease progression remains poorly explored. We previously reported that the expression of serine protease inhibitor kunitz‐type2 (SPINT2/HAI‐2), an inhibitor of hepatocyte growth factor (HGF) activation, is significantly lower in BMMSC from myelodysplastic syndromes (MDS) patients compared to healthy donors (HD). Thus, to investigate whether this loss of expression was due to SPINT2/HAI‐2 methylation, BMMSC from MDS and de novo acute myeloid leukaemia (de novo AML) patients were treated with 5‐Azacitidine (Aza), a DNA methyltransferase inhibitor. In MDS‐ and de novo AML‐BMMSC, Aza treatment resulted in a pronounced SPINT2/HAI‐2 levels up‐regulation. Moreover, Aza treatment of HD‐BMMSC did not improve SPINT2/HAI‐2 levels. To understand the role of SPINT2/HAI‐2 down‐regulation in BMMSC physiology, SPINT2/HAI‐2 expression was inhibited by lentivirus. SPINT2 underexpression resulted in an increased production of HGF by HS‐5 stromal cells and improved survival of CD34+ de novo AML cells. We also observed an increased adhesion of de novo AML hematopoietic cells to SPINT2/HAI‐2 silenced cells. Interestingly, BMMSC isolated from MDS and de novo AML patients had increased expression of the integrins CD49b, CD49d, and CD49e. Thus, SPINT2/HAI‐2 may contribute to functional and morphological abnormalities of the microenvironment niche and to stem/progenitor cancer cell progression. Hence, down‐regulation in SPINT2/HAI‐2 gene expression, due to methylation in MDS‐BMMSC and de novo AML‐BMMSC, provides novel insights into the pathogenic role of the leukemic bone marrow microenvironment.

The present article aims to report an experience of tutors in performing a triple jump by evaluating the methodology of Problem-Based Learning (PBL) in a group of 37 students of the second period of a medical school of the Universidade Federal do Vale do Sao Francisco - UNIVASF, campus Paulo Afonso, Bahia, Brazil.The "triple jump" occurred in a daylight period, and was divided into three tutorial groups of nine students, a group of ten students and eight tutors. The problem situation was prepared by the tutors involved and all students were previously informed about the methodology applied. The assessment was divided into three stages (1-presentation of the problem; 2- individualized study; 3- Oral Presentation). In the end of the triple jump , it was applied an evaluative questionnaire and the 27 students had consented previously to fill them out. The students who participated in this application were able to quickly identify the learning objectives (94.6%). However, a small part of the participants (about 5%) suggested modifications on the time used to complete all the steps of the “Triple Jump”.The reported experience consolidate this evaluative tool has formative character and effective way in the measuring the teaching-learning process of students in health care in PBL methodby improving their educational background. Keywords : Higher education, Problem-Based Learning, Evaluation. References : BHUTIANI, M. et al. Triple-jump assessment model for use of evidence-based medicine. MedEdPORTAL Publications., v. 12, n. ID: 10373, 2016. BLAKE, J. M. et al. Introducing progress testing in McMaster University's problem-based medical curriculum: psychometric properties and effect on learning. Acad Med, v. 71, n. 9, p. 1002-7, Sep 1996. BRASIL. Ministerio da Educacao. Conselho Nacional de Educacao. Câmara de Educacao Superior. Resolucao no 3, de 20 de junho de 2014 . . Brasilia (DF): Ministerio da Educacao; 2014. Institui Diretrizes Curriculares Nacionais do Curso de Graduacao em Medicina e da outras providencias. Disponivel em

The present article aims to report an experience of tutors in performing a triple jump by evaluating the methodology of Problem-Based Learning (PBL) in a group of 37 students of the second period of a medical school of the Federal University of Sao Francisco Valley - UNIVASF, campus Paulo Afonso, Bahia, Brazil.The "triple jump" occurred in a daylight period, and was divided into three tutorial groups of nine students, a group of ten students and eight tutors. The problem situation was prepared by the tutors involved and all students were previously informed about the methodology applied. The assessment was divided into three stages (1-presentation of the problem; 2- individualized study; 3- Oral Presentation). In the end of the triple jump , it was applied an evaluative questionnaire and the 27 students had consented previously to fill them out. The students who participated in this application were able to quickly identify the learning objectives (94.6%). However, a small part of the participants (about 5%) suggested modifications on the time used to complete all the steps of the “Triple Jump”.The reported experience consolidate this evaluative tool has formative character and effective way in the measuring the teaching-learning process of students in health care in PBL methodby improving their educational background. Keywords : Higher education, Problem-Based Learning, Evaluation. Resumo O presente artigo tem como objetivo relatar a experiencia vivenciada por tutores na realizacao de um salto triplo avaliando a metodologia de Aprendizagem Baseada em Problemas (ABP) em um grupo de 37 estudantes do segundo periodo do curso de medicina da Universidade Federal do Vale do Sao Francisco-UNIVASF, campus de Paulo Afonso, Bahia, Brasil. O “salto triplo” ocorreu em um periodo diurno, e foi dividida em tres grupos de tutoria de nove alunos, um grupo com dez alunos e oito docentes. A situacao-problema foi elaborada pelos tutores envolvidos e todos os estudantes foram previamente informados sobre a metodologia aplicada. A avaliacao foi dividida em tres etapas (1-apresentacao do caso clinico; 2-Estudo individualizado; 3-Apresentacao oral). No final do salto triplo, ainda foi aplicado um questionario avaliativo e 27 alunos consentiram em preenche-lo. Os estudantes que participaram desta aplicacao conseguiram identificar com rapidez os objetivos de aprendizagem (94,6%). No entanto, uma pequena parte dos estudantes participantes (cerca de 5%) sugeriram modificacoes quanto ao tempo estipulado para cumprimento das etapas do metodo. A experiencia relatada reforca que esta ferramenta avaliativa tem carater formativo eficaz na mensuracao do processo de ensino-aprendizagem dos estudantes na area da saude que estudam com ABP, aperfeicoando sua formacao educacional. Palavras-chave : Ensino superior. Aprendizagem baseada em problemas. Avaliacao. References : BHUTIANI, M. et al. Triple-jump assessment model for use of evidence-based medicine. MedEdPORTAL Publications., v. 12, n. ID: 10373, 2016. BLAKE, J. M. et al. Introducing progress testing in McMaster University's problem-based medical curriculum: psychometric properties and effect on learning. Acad Med, v. 71, n. 9, p. 1002-7, Sep 1996. BRASIL. Ministerio da Educacao. Conselho Nacional de Educacao. Câmara de Educacao Superior. Resolucao no 3, de 20 de junho de 2014 . . Brasilia (DF): Ministerio da Educacao; 2014. Institui Diretrizes Curriculares Nacionais do Curso de Graduacao em Medicina e da outras providencias. Disponivel em

Introduction Chronic graft versus host disease (crGvHD) pathogenesis comprises a complex immune reaction. The role of Notch pathway in regulating different cells of immune system is well recognized. Recently, Radojcic et al (Blood 2018), showed that the blocking of Dll1/Dll4–mediated Notch signals provided maximum protection if used early after transplant in a preventative fashion. Objective To analyze the correlation of the components of Notch pathway in the tolerance to GvHD of patients (pts) who received allogeneic hematopoietic cell transplant (allo-HCT). Patients and Methods This was a cross-sectional study. Samples were collected from 18 pts, and 13 health controls. We divided pts into three groups: tolerant (pts that have never developed crGvHD or who had withdrawn from all immunosuppression therapy (IST) for at least 6 months and without signs and symptoms of active crGvHD), crGvHD with IST, and crGvHD without IST. We performed quantitative PCR for the following genes; NOTCH1, NOTCH2, JAG1, JAG2, DLL1 and DLL4. Results Pts characteristics are shown in Table 1. Interestingly, when all compared with the control group, tolerant group presented a significant lower expression of NOTCH1 (-7,6 fold-change; p=0.02), NOTCH2 (-10,6 fold-change, p=0.0006), DLL1 (-5,89 fold-change; p=0.03) and JAG2(-4,11 fold-change; p=0.04, respectively). Chronic GvHD without IST and crGvHD with IST also presented a lower expression of NOTCH2 (-13,13 fold-change; p=0.02; -11,81 fold-change; p=0.03, respectively). Conclusion Our preliminary results showed that, surprisingly, the expression of key components of Notch signaling are down modulated in PBMC of pts who underwent allo-HCT, tolerant to crGVHD. Until a large cohort is evaluated, whether Notch signaling is critical for the human allogeneic lymphocytes during GVHD remains unclear.

International audience; Determining the nutritional composition of a pasture is necessary to evaluate its quality, aiming to meet the requirements of feeding animals and guarantee good performance. The quality of the forage biomass produced depends directly on the fertility and type of soil, environmental conditions, and management. In this scenario, the aim was to evaluate the chemical composition, in vitro digestibility of dry matter, and macro- and micronutrient contents of Brachiaria brizantha cv. Marandu cultivated in soils developed from basalt and sandstone in the state of Parana. A total of 120 forage samples were collected in a soil developed from basalt and 116 in soil developed from sandstone. Forage harvesting occurred in autumn and spring for basalt soil (season effect), and in spring (soil effect) for sandstone soil. Soil samples (0-20 cm) were collected in the spring season, at the same forage collection sites, to obtain a greater sample representativity regarding climate-soil-plant relationships. Forage samples were separated in leaf blade and stem + sheath, and analyses of dry matter (DM), mineral matter (MM), crude protein (CP), neutral detergent fiber (NDF), acid detergent fiber (ADF), lignin, cellulose, hemicellulose, in vitro dry matter digestibility (IVDMD), total digestible nutrients (TDN), nitrogen, and macro- and micronutrient contents were performed. In soil samples, the contents of P, K, Ca, Mg, Mn, and Zn were analyzed. There were season and soil-type effects on the chemical composition of the cultivar studied. The highest levels of protein, NDF, ADF, lignin, and cellulose were obtained in autumn. In samples from soil developed from basalt, higher levels of hemicellulose, IVDMD, and TDN were obtained in the spring. K, P, Mn, and Zn presented levels within the range recommended for the studied forage, but the values of Ca and Mg in autumn and N in the three studied periods remained below the level considered adequate. Soil nutrient contents were influenced (P < 0.05) by the soil source material, and the highest levels of K, Ca, Mg, Mn, and Zn were observed in soil developed from basalt. Forage cultivated in spring in the soil area developed from basalt, was nutritionally superior in relation to forage cultivated in the soil developed from sandstone.

Background Constitutive activation of the PI3K pathway in T cell acute lymphoblastic leukaemia (T-ALL) has been reported and in a mouse model, PI3K activation, together with MYC, cooperates in Burkitt lymphoma (BL) pathogenesis. We investigated the effects of NVP-BKM120, a potent pan-class I PI3K inhibitor, in lymphoblastic leukaemia cell lines. Methods Effects of NVP-BKM120 on cell viability, clonogenicity, apoptosis, cell cycle, cell signalling and autophagy were assessed in vitro on T-ALL (Jurkat and MOLT-4) and BL (Daudi and NAMALWA) cell lines. Results NVP-BKM120 treatment decreased cell viability and clonogenic growth in all tested cells. Moreover, the drug arrested cell cycling in association with a decrease in Cyclin B1 protein levels, and increased apoptosis. Immunoblotting analysis of cells treated with the drug revealed decreased phosphorylation, in a dose-dependent manner, of AKT, mTOR, P70S6K and 4EBP1, with stable total protein levels. Additionally, we observed a dose-dependent decrease in BAD phosphorylation, in association with augmented BAX:BCL2 ratio. Quantification of autophagy showed a dose-dependent increase in acidic vesicular organelles in all cells tested. Conclusion In summary, our present study establishes that NVP-BKM120 presents an effective antitumour activity against T-ALL and BL cell lines.