Chronic Obstructive Pulmonary Disease and Lung Cancer: Underlying Pathophysiology and New Therapeutic Modalities

Chronic obstructive pulmonary disease (COPD) and lung cancer are major lung diseases affecting millions worldwide. Both diseases have links to cigarette smoking and exert a considerable societal burden. People suffering from COPD are at higher risk of developing lung cancer than those without, and are more susceptible to poor outcomes after diagnosis and treatment. Lung cancer and COPD are closely associated, possibly sharing common traits such as an underlying genetic predisposition, epithelial and endothelial cell plasticity, dysfunctional inflammatory mechanisms including the deposition of excessive extracellular matrix, angiogenesis, susceptibility to DNA damage and cellular mutagenesis. In fact, COPD could be the driving factor for lung cancer, providing a conducive environment that propagates its evolution. In the early stages of smoking, body defences provide a combative immune/oxidative response and DNA repair mechanisms are likely to subdue these changes to a certain extent; however, in patients with COPD with lung cancer the consequences could be devastating, potentially contributing to slower postoperative recovery after lung resection and increased resistance to radiotherapy and chemotherapy. Vital to the development of new-targeted therapies is an in-depth understanding of various molecular mechanisms that are associated with both pathologies. In this comprehensive review, we provide a detailed overview of possible underlying factors that link COPD and lung cancer, and current therapeutic advances from both human and preclinical animal models that can effectively mitigate this unholy relationship

Research priorities in prehabilitation for patients undergoing cancer surgery: an international Delphi study

Background Recently, the number of prehabilitation trials has increased significantly. The identification of key research priorities is vital in guiding future research directions. Thus, the aim of this collaborative study was to define key research priorities in prehabilitation for patients undergoing cancer surgery. Methods The Delphi methodology was implemented over three rounds of surveys distributed to prehabilitation experts from across multiple specialties, tumour streams and countries via a secure online platform. In the first round, participants were asked to provide baseline demographics and to identify five top prehabilitation research priorities. In successive rounds, participants were asked to rank research priorities on a 5-point Likert scale. Consensus was considered if > 70% of participants indicated agreement on each research priority. Results A total of 165 prehabilitation experts participated, including medical doctors, physiotherapists, dieticians, nurses, and academics across four continents. The first round identified 446 research priorities, collated within 75 unique research questions. Over two successive rounds, a list of 10 research priorities reached international consensus of importance. These included the efficacy of prehabilitation on varied postoperative outcomes, benefit to specific patient groups, ideal programme composition, cost efficacy, enhancing compliance and adherence, effect during neoadjuvant therapies, and modes of delivery. Conclusions This collaborative international study identified the top 10 research priorities in prehabilitation for patients undergoing cancer surgery. The identified priorities inform research strategies, provide future directions for prehabilitation research, support resource allocation and enhance the prehabilitation evidence base in cancer patients undergoing surgery

Hb D/Talassemia beta associada à anemia crônica Hb D/ Beta thalassaemia associated with chronic anaemia

<abstract language="eng">We describe a case of Hb D/Beta thalassemia associated with chronic anemia. Hematological analyses performed in a patient with chronic anemia demonstrating microcytosis and hypochromic in his erythrocytes. Specific laboratory diagnosis performed by alkaline and acid electrophoresis, and fetal determination by alkali resistance, indicated it to be Hb D associated with beta thalassemia. Analyses carried out on his family (father, mother and brother) confirmed the suspected diagnosis. Hb D/Beta thalassemia is a very rare interaction in the Brazilian population, and its determination required specific laboratorial techniques and hematological analyses

Efeitos do apoio dos membros superiores sobre a força muscular respiratória e função pulmonar de pacientes com doença pulmonar obstrutiva crônica

Objective: To analyze the effect of arm bracing posture on respiratory muscle strength and pulmonary function in patients with Chronic Obstructive Pulmonary Disease (COPD).Methods: 20 patients with COPD (11 male; 67 +/- 8 years; BMI 24 +/- 3 Kg . m(-2)) were submitted to assessments of Maximal Inspiratory and Expiratory Pressures (MIP and MEP, respectively) and spirometry with and without arm bracing in a random order. The assessment with arm bracing was done on standing position and the height of the support was adjusted at the level of the ulnar styloid process with elbow flexion and trunk anterior inclination of 30 degrees promoting weight discharge in the upper limbs. Assessment without arm bracing was also performed on standing position, however with the arms relaxed alongside the body. The time interval between assessments was one week.Results: MIP, MEP and maximal voluntary ventilation (MW) were higher with arm bracing than without arm bracing (MIP 64 +/- 22 cmH(2)O versus 54 +/- 24 cmH(2)O, p = 0,00001; MEP 104 +/- 37 cmH(2)O versus 92 +/- 37 cmH(2)O, p = 0,00001 and MW 42 +/- 20 L/min versus 38 +/- 20 L/min, p = 0,003). Other variables did not show statistical significant difference.Conclusion: The arm bracing posture resulted in higher capacity to generate force and endurance of the respiratory muscles in patients with COPD. (C) 2009 Published by Elsevier Espana, S.L. on behalf of Sociedade Portuguesa de Pneumologia. All rights reserved

A contabilidade criativa e a deteção da fraude na perspectiva dos alunos e profissionais da área financeira

Mestrado em AuditoriaNum mundo empresarial cada vez mais competitivo, os stakeholders tornam-se, cada vez mais, vulneráveis à criação de falsas expectativas pela utilização de relato financeiro fraudulento. São os contabilistas e os auditores responsáveis pela preparação e revisão da informação financeira das empresas e, por este mesmo motivo, elementos essenciais para a prevenção e supressão da divulgação de informação financeira manipulada ou fraudulenta. Dentro das práticas de contabilidade financeira fraudulenta, para alguns defensores, é possível encontrarmos a contabilidade criativa, que ao longo dos tempos, tem suscitado distintas opiniões por vários estudiosos de áreas como a contabilidade e a auditoria, não estando a sua relação com a fraude inteiramente esclarecida. A presente dissertação investiga a opinião dos profissionais de contabilidade, dos profissionais de auditoria e dos estudantes do ensino superior da área financeira sobre a contabilidade criativa. Nomeadamente se consideram esta prática: um ato fraudulento; recorrente no dia-a-dia das empresas; questionável tendo em conta a ética e deontologia profissional e, detetável durante a revisão da informação financeira. Procurou-se ainda investigar a possibilidade de aumento de práticas de contabilidade criativa e de fraude num contexto de crise pandémica como a provocada pela COVID-19. A metodologia adotada para o estudo foi o inquérito, dirigido a profissionais e estudantes do ensino superior da área financeira em Portugal, numa amostra de 385 respondentes. Nestes moldes foi possível concluir que, de acordo com a amostra utilizada, os contabilistas, os auditores e os estudantes do ensino superior da área financeira consideram a contabilidade criativa como a utilização dos conhecimentos das normas contabilísticas para manipulação dos valores das demonstrações financeiras. A prática de contabilidade criativa é comum no quotidiano empresarial, podendo a sua prática aumentar por consequência duma crise pandémica. Apesar de definirem a contabilidade criativa como um ato lícito, os profissionais de contabilidade e de auditoria consideram que a sua prática não é aceitável e que compromete os princípios éticos e deontológicos da profissão de contabilista.In an increasingly competitive business world, stakeholders are becoming more vulnerable these days to the creation of false expectations by interpreting fraudulent financial reporting. Accountants and auditors are responsible for the preparation and review of companies' financial information, and for this very reason they are essential elements in the prevention and suppression of manipulated or fraudulent financial information. Within the practices of fraudulent financial accounting, for some proponents, we can find creative accounting. Over time, the subject of creative accounting has given rise to different opinions among various scholars in areas such as accounting and auditing, and its relationship with fraud is not entirely clear. This dissertation examines the opinion of accounting professionals, auditing professionals and higher education students in the financial area on creative accounting, namely if they consider that: creative accounting is a fraudulent act; its practice is recurrent in the daily life of companies; it compromises professional ethics and deontology; its practice is detectable in the review of financial information. It was also investigated if a pandemic crisis, as COVID-19, may promote creative accounting practices and fraud. The study was done by questionnaire and the sample of respondents was composed of Portuguese accountants, auditors, and students of higher education in the financial area, the total sample was 385 responses. It was therefore possible to conclude that accountants, auditors and higher education students in the financial area believe creative accounting refers to the use of knowledge of accounting standards to manipulate the values of financial statements. Creative accounting is common in day-to-day business and its practice may increase in a pandemic context. Although they define creative accounting as a lawful act, accounting and auditing professionals consider that its practice is not acceptable and that it compromises the ethical and deontological principles of the accountancy profession.info:eu-repo/semantics/publishedVersio

Step Counting and Energy Expenditure Estimation in Patients With Chronic Obstructive Pulmonary Disease and Healthy Elderly: Accuracy of 2 Motion Sensors

Furlanetto KC, Bisca GW, Oldemberg N. Sant'Anna TJ, Morakami FK, Camillo CA, Cavalheri V, Hernandes NA, Probst VS, Ramos EM, Brunetto AF, Pitta F. Step counting and energy expenditure estimation in patients with chronic obstructive pulmonary disease and healthy elderly: accuracy of 2 motion sensors. Arch Phys Med Rehabil 2010;91:261-7.Objective: To compare the accuracy of 2 motion sensors (a pedometer and a multisensor) in terms of step counting and estimation of energy expenditure (EE) in patients with chronic obstructive pulmonary disease (COPD) and in healthy elderly.Design: In this descriptive study, all participants wore both motion sensors while performing a treadmill walking protocol at 3 different speeds corresponding to 30%, 60%, and 100% of the average speed achieved during a six-minute walk test. As criterion methods, EE was estimated by indirect calorimetry, and steps were registered by videotape.Setting: Research laboratory at a university hospital.Participants: Patients with COPD (n=30; 17 men; mean age +/- SD, 67 +/- 8y; mean forced expiratory volume in the first second [FEV(1)] predicted +/- SD, 46% +/- 17%; mean body mass index [BMI] +/- SD, 24 +/- 4kg.m(2)) and matched healthy elderly (n=30; 15 men; mean age +/- SD, 68 +/- 7y; mean FEV(1) predicted +/- SD, 104% +/- 21%; mean BMI +/- SD, 25 +/- 3kg.m(2)).Interventions: Not applicable.Main Outcome Measure: Step counting and EE estimation during a treadmill walking protocol.Results: The pedometer was accurate for step counting and EE estimation in both patients with COPD and healthy elderly at the higher speed. However, it showed significant underestimation at the 2 slower speeds in both groups. The multisensor did not detect steps accurately at any speed, although it accurately estimated EE at all speeds in healthy elderly and at the intermediate and higher speeds in patients with COPD.Conclusions: In both patients with COPD and healthy elderly, the multisensor showed better EE estimates during most walking speeds than the pedometer. Conversely, for step counting, accuracy is observed only with the pedometer during the higher walking speed in both groups.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq