Adult life after surviving lymphoma in childhood

Introduction: Almost all pediatric lymphomas are malignant, high-grade tumors. The combined incidence of Hodgkin's disease (HD) and non-Hodgkin lymphoma (NHL) reaches 10 to 12 new cases a year per million children under the age of 16years, representing about 10% of all pediatric cancers. HD makes up to 40% and NHL 60% of pediatric lymphomas. During the last 20years, cure rates raised dramatically so that currently over 90% of children and adolescents with HD and about 80% of those with NHL can be cured. As cure can be achieved in a large majority of patients, long-term effects and quality of life of the survivors are nowadays the principal challenges to pediatric oncologists. Discussion: Like survivors from acute lymphoblastic leukemia, young adults cured from NHL may present with neurocognitive deficits, especially if treated at a young age and with cranial irradiation. Intrathecal or high-dose intravenous chemotherapy with methotrexate may induce the same problems, although in a lesser extent and severity. Large enough prospective cohort studies like the CCSS in the USA were able to show an increased risk of second malignant neoplasms, especially brain tumors in patients formerly treated with cranial irradiation. Reduced fertility can follow exposure to cyclophosphamide, especially in the male. Cardiac function must be serially evaluated over the long to very long-term because of potential cardiomyopathy after high anthracycline doses and/or mediastinal irradiation. Survivors from HD are at high risk of late complications. Radiation therapy to the neck and mediastinum (mantle field) induces a 50% risk of developing hypothyroidism and a 20% risk of developing thyroid nodules at 20years. The risk of thyroid cancer is 18 times higher the expected rate for the general population. Secondary aggressive breast cancer shows a cumulative risk of 30% at 30years after radiotherapy. Other structures affected by mediastinal irradiation are the heart (pericardial, myocardial and endocardial structures), the great arteries (fibrosis, stenosis, aneurysms) and the central portion of the lungs (diffusion troubles, restrictive pneumopathy). Cardiac toxicity can be enhanced by the concomitant therapy with adriamycin and lung toxicity by bleomycin. Radiotherapy to the paraaortic and iliacal lymph nodes can affect gonadal function both in males and females; concomitant chemotherapy with alkylating agents like cyclophosphamide and especially procarbazine have a synergistic action and can lead to premature menopause as well as infertility. Although the vast majority of survivors from pediatric lymphomas fare well, a minority present with extreme symptoms of depression and psychosomatic distress; female sex, low socio-economic status and treatment with intensive chemotherapy are important risk factors for a poor psychosocial outcome. Conclusion: It is therefore crucial, but not always easy, to inform patients and families about potential late effects and organize follow-up after the pediatric age. A well functioning network of pediatric oncologists, GP's, adult oncologists and other specialists of adult medicine must be developed in order to prevent, early detect and treat expected long-term toxicitie

Late effects in long-term survivors of ALL in childhood: experiences from the SPOG late effects study.

With the use of more intensive regimens including prophylactic CNS treatment, the prognosis of children with ALL has dramatically improved over the last three decades. The aim of this cross-sectional, nationwide study was to comprehensively assess long-term toxicity in ALL survivors, with special attention given to neuropsychological morbidity, and to look for possible differences in cognitive outcome between children having received prophylactic cranial irradiation and those not having received it. Between 1994 and 1996, long-term survivors of ALL were assessed in a multi-center setting according to a standardized protocol which included, besides usual clinical and laboratory investigations, a comprehensive endocrine work-up. Additionally, children having received anthracyclines were checked for possible late cardio-toxicity with echocardiography and ECG. Intellectual performance was evaluated with standardized neuropsychological tests (age-adapted versions of the Wechsler test). One-hundred and fifty patients were eligible for the study. The median age at diagnosis was 5 years and at evaluation 16 years, for a median follow-up of 10 years. Thirty-five patients had cranial irradiation as part of the prophylactic CNS treatment. One-hundred and forty (93%) of the 150 eligible patients were completely evaluated in terms of global long-term toxicity: 117 (83%) long-term survivors had no (n = 61) or only minimal (n = 56) late toxicity; 19 (14%) suffered from moderate impairments; 4 (3%) showed severe somatic or neuropsychological sequelae. Intellectual performance could be assessed in 147 (98%) of the 150 eligible patients. The mean global, verbal and non-verbal IQs (103, 105 and 101 respectively) of the ALL survivors as a group were comparable with those found in the general population. The results of the comparison between children having and those not having received prophylactic cranial irradiation showed: 1) significantly higher scores in chemotherapy-only treated patients, both for the global and the verbal performances; 2) significantly poorer results in specific items of the Wechsler test (short-term verbal memory, arithmetics, concentration/speed of processing) in irradiated children. These findings which show the deleterious role of cranial irradiation correlate well with many other reports found in the literature. However, they could have been influenced by the significantly longer time interval observed between therapy and evaluation in our irradiated patients. Prospective studies are needed to further characterize the potential neuropsychological hazards of chemotherapy and their evolution over time

Agroecologia: condição para a segurança alimentar

Este artigo discute o agronegócio brasileiro e de como o formato adotado de agricultura pelo governo não está garantindo a segurança alimentar. Evidencia a agroecologia e de como essa forma de agricultura permite responder estruturalmente aos graves problemas de abastecimento alimentar, aos problemas econômicos, sociais e ambientais

Paenibacillus brasilensis sp nov., a novel nitrogen-fixing species isolated from the maize rhizosphere in Brazil

Sixteen nitrogen-fixing strains isolated from the rhizosphere of maize planted in Cerrado soil, Brazil, which showed morphological and biochemical characteristics similar to the gas-forming Paenibacillus spp., were phenotypically and genetically characterized. Their identification as members of the genus Paenibacillus was confirmed by using specific primers based on the 16S rRNA gene. SDS-PAGE of whole-cell proteins, API 50CH, morphological and biochemical tests, amplified rDNA-restriction analysis (ARDRA), DNA-relatedness analyses, denaturing-gradient gel electrophoresis (DGGE) and 16S rRNA gene sequence determinations were performed to characterize the novel isolates and to compare them to strains of other nitrogen-fixing Paenibacillus spp. Phenotypic analyses showed that the 16 strains were very homogeneous and shared a high level of relatedness with Paenibacillus polymyxa and Paenibacillus peoriae. However, none of the novel isolates was able to ferment glycerol (positive test for P. polymyxa), L-arabinose or D-xylose (positive tests for P. polymyxa and P. peoriae) or utilize succinate (positive test for P. peoriae). Genetic approaches also indicated a high level of similarity among the novel isolates and P. polymyxa and P. peoriae, but the novel strains clearly could not be assigned to either of these two recognized species. On the basis of the features presented in this study, the 16 novel isolates were considered to represent members of a novel species within the genus Paenibacillus, for which the name Paenibacillus brasilensis is proposed. The type strain is PB172(T) (=ATCC BAA-413(T)=DSM 14914(T)

"A Urca é o paraíso dos cegos": mobilidade urbana, acesso à cidade e territorialização

A cidade do Rio de Janeiro, com quase 12 milhões de habitantes na região metropolitana, é a segunda maior aglomeração urbana do Brasil. O artigo propõe uma reflexão a respeito das relações sociais em espaços públicos estabelecidas nessa cidade entre pessoas cegas e outras pessoas que circulam por ruas de bairros como Centro, Copacabana ou o bairro da Urca. Ao abordar os deslocamentos e as relações sociais estabelecidas ao longo do percurso, procura-se traçar a impressão espacial e urbana de pessoas cegas e o fluxo dos seus itinerários. Como se constroem os trajetos e a ocupação espacial da cidade por pessoas cegas? Qual o uso que fazem dos transportes públicos? Quais são os cenários eleitos, os bairros frequentados e as dificuldades encontradas no caminho? Ao questionar as representações que pessoas cegas fazem dos cenários urbanos, os fatores que promovem e os fatores que restringem sua mobilidade, procura-se também desestabilizar uma compreensão do espaço urbano centrada no olhar. Busca-se incorporar na descrição dos lugares os seus aspectos vividos, os elementos, as materialidades e os sinais não-visuais que possibilitam sua apreensão.Palavras-chave: Cegueira. Corpo. Deslocamento. Cidade. Teritorialização."Urca is the paradise of the blind": urban mobility, acess to the city and territoryAbstractThe city of Rio de Janeiro, with nearly 12 million inhabitants in the metropolitan area, is the second largest urban agglomeration in Brazil. This paper proposes a reflection on the social relations in public spaces established in that city between blind people and other people moving through the streets of neighborhoods like the city center, Copacabana or Urca. Addressing the displacements and the social relations established along the route, the article seeks to trace the urban and spatial impressions of blind people and the flow of their itineraries. How the blinds build their paths and how they spatially occupy the city? What is their use of public transport? What are the elected scenarios, frequented neighborhoods and the difficulties they find in their way? By questioning the representations of urban scenes by blind people, the factors that promote and factors that restrict their mobility, we also seeks to destabilize an understanding of urban space focused on vision. We try to incorporate in the description of places their experienced aspects and the elements, materiality and non-visual signals that enable their apprehension.Keywords: Blindness. Body. Displacement. City. Territory.

Adult life after surviving lymphoma in childhood.

INTRODUCTION: Almost all pediatric lymphomas are malignant, high-grade tumors. The combined incidence of Hodgkin's disease (HD) and non-Hodgkin lymphoma (NHL) reaches 10 to 12 new cases a year per million children under the age of 16 years, representing about 10% of all pediatric cancers. HD makes up to 40% and NHL 60% of pediatric lymphomas. During the last 20 years, cure rates raised dramatically so that currently over 90% of children and adolescents with HD and about 80% of those with NHL can be cured. As cure can be achieved in a large majority of patients, long-term effects and quality of life of the survivors are nowadays the principal challenges to pediatric oncologists. DISCUSSION: Like survivors from acute lymphoblastic leukemia, young adults cured from NHL may present with neurocognitive deficits, especially if treated at a young age and with cranial irradiation. Intrathecal or high-dose intravenous chemotherapy with methotrexate may induce the same problems, although in a lesser extent and severity. Large enough prospective cohort studies like the CCSS in the USA were able to show an increased risk of second malignant neoplasms, especially brain tumors in patients formerly treated with cranial irradiation. Reduced fertility can follow exposure to cyclophosphamide, especially in the male. Cardiac function must be serially evaluated over the long to very long-term because of potential cardiomyopathy after high anthracycline doses and/or mediastinal irradiation. Survivors from HD are at high risk of late complications. Radiation therapy to the neck and mediastinum (mantle field) induces a 50% risk of developing hypothyroidism and a 20% risk of developing thyroid nodules at 20 years. The risk of thyroid cancer is 18 times higher the expected rate for the general population. Secondary aggressive breast cancer shows a cumulative risk of 30% at 30 years after radiotherapy. Other structures affected by mediastinal irradiation are the heart (pericardial, myocardial and endocardial structures), the great arteries (fibrosis, stenosis, aneurysms) and the central portion of the lungs (diffusion troubles, restrictive pneumopathy). Cardiac toxicity can be enhanced by the concomitant therapy with adriamycin and lung toxicity by bleomycin. Radiotherapy to the paraaortic and iliacal lymph nodes can affect gonadal function both in males and females; concomitant chemotherapy with alkylating agents like cyclophosphamide and especially procarbazine have a synergistic action and can lead to premature menopause as well as infertility. Although the vast majority of survivors from pediatric lymphomas fare well, a minority present with extreme symptoms of depression and psychosomatic distress; female sex, low socio-economic status and treatment with intensive chemotherapy are important risk factors for a poor psychosocial outcome. CONCLUSION: It is therefore crucial, but not always easy, to inform patients and families about potential late effects and organize follow-up after the pediatric age. A well functioning network of pediatric oncologists, GP's, adult oncologists and other specialists of adult medicine must be developed in order to prevent, early detect and treat expected long-term toxicities

A “janela da expressão”: reflexões sobre corpo, movimento e gesto nas relações entre visão e cegueira

O artigo considera os meios não discursivos que medeiam a relação entre expressividade e comunicação entre pessoas cegas e não cegas. Quais as implicações advindas de uma interação que se baseia na dupla condição de ver e não ser visto / não ver e ser visto? Qual o papel dos movimentos corporais nesta experiência comunicativa? A restrição social ao toque entre as pessoas traz implicações para a apreensão, por pessoas cegas, de uma linguagem comunicativa presente nos gestos, seja como forma de conhecimento cultural seja como recurso expressivo nas relações de interação. Abordo as consequências desse hiato a partir das possibilidades criativas que se abrem para o resgate e a construção desta linguagem corporal por intermédio da arte, a partir da participação, como parte do trabalho de campo, em oficinas de teatro com pessoas cegas e não cegas.The article considers the non-discursive means that mediate the relationship between expression and communication between blind and non-blind people. What are the implications of an interaction that is based on the double condition of seeing and not being seen / not seen and being seen? What is the role of the corporeal movements in this communicative experience? The social restriction of touch between people has implications for the apprehension, by blind people, of a communicative body language alive in gestures, either as a form of cultural knowledge or as an expressive resource in interaction relations. I discuss the consequences of this hiatus on the basis of the creative possibilities that opens up for the rescue and construction of this body language through art, with the participation, as part of fieldwork, in theater workshops with blind and non-blind persons