NOVAS TERAPIAS COM ALVO-MOLECULAR PARA O CÂNCER DE PULMÃO DE NÃO-PEQUENAS CÉLULAS

Cancer is the second main cause of death globally. It is overcoming by deaths related to cardiovascular diseases. Therfore, estimates pointed out that in few decades the mortality rates associated with many sort of cancer will be higher than others diseases, which desmonstrates the importance of the permanent researching aimed to discover new therapies strategies. Estimates point out that bronchial, tracheal and lung cancer commited 16 thousands of brazilians in 2016, that’s mean the second neoplasm more incident for men and the fourth for women, excluding non-melanoma cancer. The common origin of all types of neoplams is related to nuclear and enzimatic changes which are responsable by the control of normal cell cicle. However, different histologic presentations from cancer in the same anatomical site, as well specific genetic and molecular changes show up different etiologies, namely lung cancer. Although tightly linked to smoking, some cancers does not always associated to chronic exposition to waste from cigarette, such non-small cell lung cancer (NSCLC). In view of etiological and genetic particularities of NSCLC and due to the advances on imunology and genetic studies, new researches try to find out specific targets, which result as an assesment that can change the progress of the disease and, in the same time, improving both functional capacity and quality of life.O câncer é segunda principal causa de morte em todo o mundo, sendo superado apenas pelos óbitos decorrentes de doenças do sistema cardiovascular. No entanto, estimativas apontam que em poucas décadas a taxa de mortalidade decorrente dos diversos tipos de câncer será maior do que outras entidades nosológicas, o que revela a importância das constantes pesquisas em busca de novas estratégias terapêuticas. Em destaque, estima-se que o câncer de brônquio, traqueia e pulmões acometeu 16 mil brasileiros no ano de 2016, sendo a segunda neoplasia mais incidente em homens e a quarta em mulheres, excluindo-se o câncer de pele não-melanoma. A origem comum de todos os tipos de neoplasias está relacionada com alterações ao nível nuclear e enzimático que são reguladores críticos do ciclo celular normal. Apesar disso, as variantes histológicas do câncer em um mesmo sítio anatômico, bem como alterações genéticas e moleculares específicas revela a presença de diferentes etiologias no surgimento de neoplasias, nomeadamente no câncer de pulmão. Embora fortemente associado ao tabagismo, algumas apresentações tumorais nem sempre estão intimamente associadas à exposição crônica aos produtos do cigarro, com destaque para o non-small cell lung cancer (NSCLC). Tendo em vista as peculiaridades etiológicas e genéticas do NSCLC associado ao avanço das técnicas de imunohistoquímicas e estudos genéticos, novos estudos envolvendo terapias alvos-específicos tem se mostrado como uma abordagem capaz que alterar o curso da doença e, concomitantemente, aumento da capacidade funcional e melhora na qualidade de vida

CERVICAL ISTHMUS INCOMPETENCE

A Incompetência Istmo Cervical é umas das principais causas de prematuridade que a obstetrícia enfrenta. Caracterizada por uma incapacidade, inata ou adquirida, do sistema oclusivo uterino de manter os produtos da concepção até o termo, determina assim altos índices de abortamentos ou partos prematuros, classificando a gestação como alto risco. Devido à uma notória dificuldade do diagnóstico precoce desta entidade clínica, o tratamento realizado de maneira emergencial se faz necessário em alguns casos, o que é denominado como cerclagem de emergência. Procedimento cirúrgico este que quando realizado, as condições de aplicabilidade devem ser respeitadas, com os principais objetivos de garantir viabilidade da gestação e minimização de partos pré-termo. Palavras-chave: gestação alto risco; incompetência istmo cervical; cerclagem emergência. Cervical Isthmus Incompetence is one of the leading causes of prematurity in obstetrics. Characterized by an innate or acquired inability of the uterine occlusive system, to hold products from conception to term, it thus determines high rates of miscarriages or premature births, classifying pregnancy as high risk. Due to the notorious difficulty of early diagnosis of this clinical entity, emergency treatment is necessary in some cases, which is called emergency cerclage. Surgical procedure which when performed, the applicability conditions must be respected, with the main objectives of ensuring viability of pregnancy and minimization of preterm labor. Key words: high risk pregnancy; cervical isthmus incompetence; emergency cerclagem

MANEJO DO TRABALHO DE PARTO PREMATURO

INTRODUÇÃO: A prematuridade é definida como o nascimento do produto da concepção antes de 37 semanas de idade gestacional e é responsável pelas principais causas de morbidade infantil, especialmente no período neonatal. DESENVOLVIMENTO: Esse artigo revisou fontes literárias clássicas da obstetrícia e pareceres das sociedades médicas interessadas no tema e tem por finalidade trazer à luz as principais medidas farmacológicas na condução do trabalho de parto prematuro. O diagnóstico de trabalho de parto prematuro usualmente é clínico: documentação de contrações uterinas rítmicas e regulares capazes de promover a plasticidade do colo uterino (apagamento, dilatação ou ambos). A coleta detalhada da história clínica, o exame obstétrico e a pesquisa por sinais e sintomas que possam sugerir outros diagnósticos diferenciais são essenciais para o diagnóstico correto e manejo apropriado. CONCLUSÃO: Ao considerar a epidemiologia e a carga que a prematuridade exerce sobre o sistema de saúde, é de suma importância o correto diagnóstico e a datação da idade gestacional, a qual será o parâmetro para as intervenções melhor estabelecidas até o momento. Palavras-chave: trabalho de parto prematuro; diagnóstico; manejo clínico

NOVAS TERAPIAS COM ALVO-MOLECULAR PARA O CÂNCER DE PULMÃO DE NÃO-PEQUENAS CÉLULAS

Cancer is the second main cause of death globally. It is overcoming by deaths related to cardiovascular diseases. Therfore, estimates pointed out that in few decades the mortality rates associated with many sort of cancer will be higher than others diseases, which desmonstrates the importance of the permanent researching aimed to discover new therapies strategies. Estimates point out that bronchial, tracheal and lung cancer commited 16 thousands of brazilians in 2016, that’s mean the second neoplasm more incident for men and the fourth for women, excluding non-melanoma cancer. The common origin of all types of neoplams is related to nuclear and enzimatic changes which are responsable by the control of normal cell cicle. However, different histologic presentations from cancer in the same anatomical site, as well specific genetic and molecular changes show up different etiologies, namely lung cancer. Although tightly linked to smoking, some cancers does not always associated to chronic exposition to waste from cigarette, such non-small cell lung cancer (NSCLC). In view of etiological and genetic particularities of NSCLC and due to the advances on imunology and genetic studies, new researches try to find out specific targets, which result as an assesment that can change the progress of the disease and, in the same time, improving both functional capacity and quality of life.O câncer é segunda principal causa de morte em todo o mundo, sendo superado apenas pelos óbitos decorrentes de doenças do sistema cardiovascular. No entanto, estimativas apontam que em poucas décadas a taxa de mortalidade decorrente dos diversos tipos de câncer será maior do que outras entidades nosológicas, o que revela a importância das constantes pesquisas em busca de novas estratégias terapêuticas. Em destaque, estima-se que o câncer de brônquio, traqueia e pulmões acometeu 16 mil brasileiros no ano de 2016, sendo a segunda neoplasia mais incidente em homens e a quarta em mulheres, excluindo-se o câncer de pele não-melanoma. A origem comum de todos os tipos de neoplasias está relacionada com alterações ao nível nuclear e enzimático que são reguladores críticos do ciclo celular normal. Apesar disso, as variantes histológicas do câncer em um mesmo sítio anatômico, bem como alterações genéticas e moleculares específicas revela a presença de diferentes etiologias no surgimento de neoplasias, nomeadamente no câncer de pulmão. Embora fortemente associado ao tabagismo, algumas apresentações tumorais nem sempre estão intimamente associadas à exposição crônica aos produtos do cigarro, com destaque para o non-small cell lung cancer (NSCLC). Tendo em vista as peculiaridades etiológicas e genéticas do NSCLC associado ao avanço das técnicas de imunohistoquímicas e estudos genéticos, novos estudos envolvendo terapias alvos-específicos tem se mostrado como uma abordagem capaz que alterar o curso da doença e, concomitantemente, aumento da capacidade funcional e melhora na qualidade de vida

12,500+ and counting: biodiversity of the Brazilian Pampa

Knowledge on biodiversity is fundamental for conservation strategies. The Brazilian Pampa region, located in subtropical southern Brazil, is neglected in terms of conservation, and knowledge of its biodiversity is fragmented. We aim to answer the question: how many, and which, species occur in the Brazilian Pampa? In a collaborative effort, we built species lists for plants, animals, bacteria, and fungi that occur in the Brazilian Pampa. We included information on distribution patterns, main habitat types, and conservation status. Our study resulted in referenced lists totaling 12,503 species (12,854 taxa, when considering infraspecific taxonomic categories [or units]). Vascular plants amount to 3,642 species (including 165 Pteridophytes), while algae have 2,046 species (2,378 taxa) and bryophytes 316 species (318 taxa). Fungi (incl. lichenized fungi) contains 1,141 species (1,144 taxa). Animals total 5,358 species (5,372 taxa). Among the latter, vertebrates comprise 1,136 species, while invertebrates are represented by 4,222 species. Our data indicate that, according to current knowledge, the Pampa holds approximately 9% of the Brazilian biodiversity in an area of little more than 2% of Brazil’s total land. The proportion of species restricted to the Brazilian Pampa is low (with few groups as exceptions), as it is part of a larger grassland ecoregion and in a transitional climatic setting. Our study yielded considerably higher species numbers than previously known for many species groups; for some, it provides the first published compilation. Further efforts are needed to increase knowledge in the Pampa and other regions of Brazil. Considering the strategic importance of biodiversity and its conservation, appropriate government policies are needed to fund studies on biodiversity, create accessible and constantly updated biodiversity databases, and consider biodiversity in school curricula and other outreach activities

Brazilian Flora 2020: Leveraging the power of a collaborative scientific network

International audienceThe shortage of reliable primary taxonomic data limits the description of biological taxa and the understanding of biodiversity patterns and processes, complicating biogeographical, ecological, and evolutionary studies. This deficit creates a significant taxonomic impediment to biodiversity research and conservation planning. The taxonomic impediment and the biodiversity crisis are widely recognized, highlighting the urgent need for reliable taxonomic data. Over the past decade, numerous countries worldwide have devoted considerable effort to Target 1 of the Global Strategy for Plant Conservation (GSPC), which called for the preparation of a working list of all known plant species by 2010 and an online world Flora by 2020. Brazil is a megadiverse country, home to more of the world's known plant species than any other country. Despite that, Flora Brasiliensis, concluded in 1906, was the last comprehensive treatment of the Brazilian flora. The lack of accurate estimates of the number of species of algae, fungi, and plants occurring in Brazil contributes to the prevailing taxonomic impediment and delays progress towards the GSPC targets. Over the past 12 years, a legion of taxonomists motivated to meet Target 1 of the GSPC, worked together to gather and integrate knowledge on the algal, plant, and fungal diversity of Brazil. Overall, a team of about 980 taxonomists joined efforts in a highly collaborative project that used cybertaxonomy to prepare an updated Flora of Brazil, showing the power of scientific collaboration to reach ambitious goals. This paper presents an overview of the Brazilian Flora 2020 and provides taxonomic and spatial updates on the algae, fungi, and plants found in one of the world's most biodiverse countries. We further identify collection gaps and summarize future goals that extend beyond 2020. Our results show that Brazil is home to 46,975 native species of algae, fungi, and plants, of which 19,669 are endemic to the country. The data compiled to date suggests that the Atlantic Rainforest might be the most diverse Brazilian domain for all plant groups except gymnosperms, which are most diverse in the Amazon. However, scientific knowledge of Brazilian diversity is still unequally distributed, with the Atlantic Rainforest and the Cerrado being the most intensively sampled and studied biomes in the country. In times of “scientific reductionism”, with botanical and mycological sciences suffering pervasive depreciation in recent decades, the first online Flora of Brazil 2020 significantly enhanced the quality and quantity of taxonomic data available for algae, fungi, and plants from Brazil. This project also made all the information freely available online, providing a firm foundation for future research and for the management, conservation, and sustainable use of the Brazilian funga and flora

Núcleos de Ensino da Unesp: artigos 2007

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42·4% vs 44·2%; absolute difference -1·69 [-9·58 to 6·11] p=0·67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5-8] vs 6 [5-8] cm H2O; p=0·0011). ICU mortality was higher in MICs than in HICs (30·5% vs 19·9%; p=0·0004; adjusted effect 16·41% [95% CI 9·52-23·52]; p<0·0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0·80 [95% CI 0·75-0·86]; p<0·0001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status