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Objetivos: Nosso objetivo é trazer nessa revisão as informações mais recentes e atualizadas sobre a abordagem cirúrgica dos nódulos de tireóide (NT). Métodos:Utilizamos as diretrizes da Associação Americana de Tireoide - American ThyroidAssociation (ATA), Consenso da Sociedade Brasileira de Endocrinologia, bibliografias prevalentes e artigos das principais bases de dados como fontes para criação desta. Resultados: Abordamos de forma objetiva e didática os principais métodos diagnósticos, além de indicações e tratamento cirúrgico, nos casos necessários, para darmos ao leitor uma ideia prática de como manejar um paciente com NT. Dentro deste contexto, a abordagem cirúrgica dessa patologiafoi o foco principal visandoque seja empregada de maneira oportuna, uma vez que esta representa uma marca divisória e definitiva no manejo desta condição. Conclusões: Diagnóstico e manejo dos NT estão sendo constantemente revisados e modificados graças aos avanços científico e epidemiológico nesta área do conhecimento. Ainda é necessário maior aprofundamento nas indicações do tratamento cirúrgico, tendo em mente o impacto que o mesmo gera na vida do paciente.

Aims: Our aim is to provide in this review the most recent information about surgical approach in thyroid nodular disease. Methods: We have used the most recent guidelines of The American Thyroid Association (ATA's) andConsenso da SociedadeBrasileira de Endocrinologia, prevalent bibliography, and articles found in relevant data bases to create this review. Results: We have approached in an objective and didactic way the methods of diagnosis, and the surgical treatment, when necessary, with the intention to give to the reader a practical idea of how to deal with patients with thyroid nodular disease. In this context, a surgical approach was the focus of this study, because it represents one of the most important and definitive divisions within management of this condition. Conclusions: Diagnosis and management of thyroid nodular diseases are constantly being revised and modified thanks to the scientific and even epidemiological advance in this area of knowledge. It yet shows that is necessary a deeper analysis about the surgical treatment, having in mind the impact that it has in the patient's life.

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RESUMO

In this work, we studied the role of surface layer (S-layer) proteins in the adaptation of Lactobacillus acidophilus ATCC 4356 to the osmotic stress generated by high salt. The amounts of the predominant and the auxiliary S-layer proteins SlpA and SlpX were strongly influenced by the growth phase and high-salt conditions (0.6 M NaCl). Changes in gene expression were also observed as the mRNAs of the slpA and slpX genes increased related to the growth phase and presence of high salt. A growth stage-dependent modification on the S-layer protein profile in response to NaCl was observed: while in control conditions, the auxiliary SlpX protein represented less than 10 % of the total S-layer protein, in high-salt conditions, it increased to almost 40 % in the stationary phase. The increase in S-layer protein synthesis in the stress condition could be a consequence of or a way to counteract the fragility of the cell wall, since a decrease in the cell wall thickness and envelope components (peptidoglycan layer and lipoteichoic acid content) was observed in L. acidophilus when compared to a non-S-layer-producing species such as Lactobacillus casei. Also, the stationary phase and growth in high-salt medium resulted in increased release of S-layer proteins to the supernatant medium. Overall, these findings suggest that pre-growth in high-salt conditions would result in an advantage for the probiotic nature of L. acidophilus ATCC 4356 as the increased amount and release of the S-layer might be appropriate for its antimicrobial capacity.

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