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Objective: Basic and translational research in pediatric cancer are essential to improve patient care. To critically assess the developments achieved in these areas in Latin America, we systematically reviewed information published between 2013 and 2023. Methods: Studies of basic and translational research performed by investigators in Latin America evaluating pediatric malignant solid and central nervous system tumors were retrieved from PubMed. Original articles published in English between 2013 and 2023 were included. Collaborations among Latin American authors or among Latin American authors working with researchers from other continents were also included. Studies were excluded if they focused only on adults or on basic research in tumor biology not specifically related to the tumor types analyzed in this review. Results: A total of 550 articles were retrieved, but after removal of duplicates, 514 articles were included in the analysis, the majority of which were authored by researchers affiliated with institutions in Argentina, Brazil and Mexico. These countries also had the highest number of collaborations on original articles published with authors from Europe and North America. Argentina had the highest number of collaborations on original publications, with coauthors from Brazil and Uruguay. The median impact factor of the 244 journals in which articles were published was 3.5. The most commonly studied tumors were osteosarcomas, neuroblastomas and medulloblastomas; the most commonly studied areas were molecular analysis, tumor cell biology and biomarkers. Conclusions: In Latin America, research in pediatric oncology is on the agenda, despite a notable disparity in publication rates and frequency of collaboration between countries. There is a need to strengthen scientific collaboration within Latin America and with countries from other continents to promote research and to develop novel treatment strategies that reflect the local needs of children in Latin America who have solid tumors and brain cancer.
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ABSTRACT Objective. Basic and translational research in pediatric cancer are essential to improve patient care. To critically assess the developments achieved in these areas in Latin America, we systematically reviewed information published between 2013 and 2023. Methods. Studies of basic and translational research performed by investigators in Latin America evaluating pediatric malignant solid and central nervous system tumors were retrieved from PubMed. Original articles published in English between 2013 and 2023 were included. Collaborations among Latin American authors or among Latin American authors working with researchers from other continents were also included. Studies were excluded if they focused only on adults or on basic research in tumor biology not specifically related to the tumor types analyzed in this review. Results. A total of 550 articles were retrieved, but after removal of duplicates, 514 articles were included in the analysis, the majority of which were authored by researchers affiliated with institutions in Argentina, Brazil and Mexico. These countries also had the highest number of collaborations on original articles published with authors from Europe and North America. Argentina had the highest number of collaborations on original publications, with coauthors from Brazil and Uruguay. The median impact factor of the 244 journals in which articles were published was 3.5. The most commonly studied tumors were osteosarcomas, neuroblastomas and medulloblastomas; the most commonly studied areas were molecular analysis, tumor cell biology and biomarkers. Conclusions. In Latin America, research in pediatric oncology is on the agenda, despite a notable disparity in publication rates and frequency of collaboration between countries. There is a need to strengthen scientific collaboration within Latin America and with countries from other continents to promote research and to develop novel treatment strategies that reflect the local needs of children in Latin America who have solid tumors and brain cancer.
RESUMEN Objetivo. La investigación básica y aplicada en el campo de la oncología pediátrica es fundamental para mejorar la atención al paciente. Con el objetivo de realizar una evaluación crítica de los avances logrados en este campo en América Latina, hemos realizado una revisión sistemática de la información publicada entre el 2013 y el 2023. Metodología. Se recopilaron de PubMed los artículos de investigación básica y traslacional publicados por investigadores de América Latina en los que se evaluaron tumores malignos sólidos y del sistema nervioso central en la población infantil. Se incluyeron artículos originales publicados en inglés entre el 2013 y el 2023. También se incluyeron artículos fruto de la colaboración científica entre autores e investigadores de América Latina y otros continentes. Se excluyeron aquellos estudios que se centraron solo en personas adultas o en la investigación básica en biología tumoral no relacionada específicamente con los tipos de tumores analizados en esta revisión. Resultados. Se encontraron 550 artículos en total. Después de eliminar los artículos duplicados, se incluyeron 514 artículos en la revisión, la mayoría de los cuales fueron escritos por investigadores vinculados a centros de investigación de Argentina, Brasil y México. También procedieron de estos tres países la mayor parte de los artículos originales escritos en colaboración con autores de Europa y América del Norte. Argentina tuvo el mayor número de colaboraciones en publicaciones originales, con coautores de Brasil y Uruguay. La mediana del índice de impacto de las 244 revistas en las que se publicaron los artículos fue de 3,5. Los tumores más estudiados fueron osteosarcomas, neuroblastomas y meduloblastomas. Los temas más estudiados fueron el análisis molecular, la biología de las células tumorales y los biomarcadores. Conclusiones. La investigación en oncología pediátrica forma parte de la agenda de investigación de América Latina, si bien hay una disparidad notoria en las tasas de publicación y la frecuencia de la colaboración entre países. Es necesario fortalecer la colaboración científica dentro de América Latina y con los países de otros continentes para promover la investigación y desarrollar estrategias de tratamiento novedosas que respondan a las necesidades locales de los niños y niñas de América Latina que tienen tumores sólidos o cáncer del sistema nervioso central.
RESUMO Objetivo. A pesquisa básica e translacional em câncer pediátrico é essencial para melhorar o atendimento dos pacientes. No intuito de realizar uma avaliação crítica dos avanços alcançados nessa área na América Latina, fez-se uma revisão sistemática de informações publicadas entre 2013 e 2023. Métodos. Pesquisas básicas e translacionais realizadas por pesquisadores da América Latina que avaliaram tumores sólidos malignos e tumores do sistema nervoso central em crianças foram obtidas da base de dados PubMed. Foram incluídos artigos originais publicados em inglês entre 2013 e 2023. Também foram incluídas colaborações entre autores latino-americanos ou entre autores latino-americanos que trabalham com pesquisadores de outros continentes. Estudos que tratavam apenas de adultos ou pesquisas básicas sobre biologia tumoral não especificamente relacionadas aos tipos de tumor analisados nesta revisão foram excluídos. Resultados. No total, a busca recuperou 550 artigos da base de dados. Após a remoção dos artigos duplicados, foram incluídos 514 artigos na análise, a maioria de autoria de pesquisadores de instituições da Argentina, do Brasil e do México. Esses países também tiveram o maior número de colaborações em artigos originais publicados com autores da Europa e da América do Norte. A Argentina teve o maior número de colaborações em publicações originais, com coautores do Brasil e do Uruguai. O fator de impacto mediano dos 244 periódicos nos quais os artigos foram publicados era de 3,5. Os tumores mais estudados foram osteossarcomas, neuroblastomas e meduloblastomas; as áreas mais estudadas foram análise molecular, biologia de células tumorais e biomarcadores. Conclusões. Na América Latina, a pesquisa em oncologia pediátrica está na ordem do dia, apesar de uma evidente disparidade nos índices de publicação e na frequência de colaboração entre os países. É necessário fortalecer a colaboração científica dentro da América Latina e com países de outros continentes a fim de promover a pesquisa e desenvolver novas estratégias de tratamento que reflitam as necessidades locais das crianças latino-americanas com tumores sólidos e câncer cerebral.
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Introducción: La investigación en pregrado se ha convertido en una parte integral de la formación médica, la cual ha transformado a la educación en salud y ha seguido históricamente un modelo estático con una orientación hospitalaria. Objetivo: Determinar los factores asociados al dominio correspondiente a docencia e investigación, en las mallas curriculares de las facultades de medicina humana de universidades peruanas. Métodos: Estudio de corte transversal en el cual se analizaron las mallas curriculares de las facultades de medicina humana existentes en Perú en el año 2022. Se seleccionaron asignaturas que cumplieron las características correspondientes al dominio Docencia e Investigación según lo establecido en el Documento Técnico del Ministerio de Salud. Asimismo, se evaluaron las variables tipo de universidad, ubicación, año de creación; también se recopilaron variables relacionadas con investigación: ranking SIR IBER 2022, número de publicaciones generales en Scopus, número de publicaciones en medicina en Scopus, índice H Scopus y número de investigadores. Resultados: De 40 facultades de medicina humana, la media de cursos del dominio Docencia e Investigación fue de 6,5. Se encontró que el tipo de universidad tuvo asociación significativa con la frecuencia de cursos correspondientes al dominio Docencia e Investigación, con una media de cursos en universidades privadas superior a la media reportada en universidades públicas ( = 7,5 vs. = 5,5; p = 0,023). Conclusiones: El factor asociado al dominio correspondiente Docencia e Investigación es el tipo de universidad, se encuentra una media de cursos en universidades privadas superior a lo reportado en universidades públicas.
Introduction: Undergraduate research has become an integral part of medical education which has transformed health education, and has historically followed a static model with a hospital orientation. Objective: To determine the factors associated to the domain teaching and research in the curricula of the faculties of human medicine of Peruvian universities. Methods: Cross-sectional study where the curricula of the faculties of human medicine existing in Peru by the year 2022 were analyzed. Subjects that met the characteristics corresponding to the Teaching and Research domain were selected as established in the Technical Document of the Ministry of health. Likewise, variables such as the type of university, location, year of creation were evaluated; Variables related to research were also collected, such as SIR IBER 2022 ranking, number of general publications in Scopus, number of medical publications in Scopus, Scopus H index and number of researchers. Results: Of 40 faculties of human medicine, the average number of Teaching and Research domain courses was 6,5. It was found that the type of university had a significant association with the frequency of courses corresponding to the Teaching and Research domain, with a mean number of courses in private universities higher than the mean reported in public universities ( = 7,5 vs. = 5,5; p = 0,023). Conclusions: The factor associated to the Teaching and Research domain was the type of university, it was found an average of courses in private universities higher than that reported in public universities.
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Fundamento: una vía para fortalecer el trabajo extensionista es la labor de formación vocacional y orientación profesional; actividad esta factible de ser perfeccionada a través del trabajo metodológico. Objetivo: elaborar un manual de orientaciones metodológicas para el desarrollo de actividades vocacionales vinculadas a proyectos comunitarios de salud. Métodos: se realizó una investigación panorámica cualitativa en la Universidad de Ciencias Médicas de Villa Clara, durante septiembre 2018- septiembre 2022. Se utilizaron métodos teóricos: analítico- sintético, inductivo- deductivo; y empíricos: análisis documental y la entrevista a informantes clave. El producto fue valorado por criterio de especialistas. Resultados: se diagnosticaron necesidades de orientación sobre la ejecución de proyectos de investigación comunitaria desde la labor vocacional y profesional, por falta de experiencia en esta actividad y no existir un material de apoyo de consulta para desarrollar actividades vocacionales con fines investigativos en la solución de problemas de salud en la comunidad, para lo cual se elaboró el manual de orientaciones metodológicas. Conclusiones: se elaboró un manual de orientaciones metodológicas para el desarrollo de actividades vocacionales vinculadas a proyectos comunitarios de salud que constituye un material de apoyo para desarrollar actividades vocacionales en centros escolares que contribuyan a la solución de problemas de salud en la comunidad desde la investigación científica participativa.
Background: one way to strengthen extension work is the work of vocational training and professional guidance; activity is feasible to be perfected through methodological work. Objective: to prepare a manual of methodological guidelines for the development of vocational activities linked to community health projects. Methods: a qualitative panoramic investigation was carried out at the Villa Clara University of Medical Sciences, from September 2018-September 2022. Theoretical methods were used: analytical-synthetic, inductive-deductive; and empirical: documentary analysis and interviews with key informants. The product was evaluated by specialist criteria. Results: Guidance needs were diagnosed on the execution of community research projects from vocational and professional work, due to lack of experience in this activity and there being no support material for consultation to develop vocational activities for investigative purposes in solving problems of health in the community, for which the methodological guidelines manual was prepared. Conclusions: the manual constitutes support material to develop vocational activities in schools so that they contribute to the solution of community health problems through participatory scientific research.
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Manual de Referência , Educação Vocacional , Educação Médica , Pesquisa BásicaRESUMO
This study aimed to evaluate medical and biomedical students' knowledge about legislation related to the use of animals in research (Arouca's Law), at the Federal University of São Paulo, Brazil. We received 62 responses to our online questionnaire of which 44 were considered valid. Only 25.3% of the students were aware of Arouca's Law and 15% of them had read it. The majority of the participants (54.5%) were not aware of the penalties established by this legislation and had not attended classes regarding animal bioethics (70.5%). Those who had attended courses about animal experimentation were less likely to begin their experiments without approval (p=0.03) and more likely not to use more animals than the number approved by the ethics committee (p=0.05). Overall, the results showed a lack of knowledge among students about animal bioethics legislation, and a failure on the part of the students' advisors to provide this information. The results highlight the need for more training on animal bioethics, better monitoring of compliance with the legislation and for courses on the subject for both students and advisors.
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Experimentação Animal , Faculdades de Medicina , Bem-Estar do Animal , Animais , Brasil , Humanos , EstudantesRESUMO
Scientific research and student involvement are critical to the formation of physicians, yet the number of medical researchers has decreased over time. To implement corrective strategies, the variables associated with positive research attitudes and productivity among medical students must be identified. The aim of this study was to evaluate the variables associated with students interested or involved in research. A validated questionnaire was applied to the student members of an established anatomy research group in a Mexican medical school with a six-year medical program. Data were collected and analyzed. A total of 85.5% (n = 77/90) students answered the survey with most respondents being second-year medical students. The majority of respondents indicated that the important component of conducting research was a contribution to the new knowledge (45.5%) and to the scientific community (42.9%). More than half of respondents mentioned a professor or a peer as the initial motivation to become involved in research. Lack of time was the main limitation (59.7%) to research involvement. Perceived benefits were knowledge and team work skills. Of those involved, most (85.7%) wished to continue participating in research as a complement to their clinical work. Professors and student colleagues were found to play an important motivational and recruitment role for medical research. These efforts in turn have developed into long-lasting mentor-mentee relationships. Students also anticipated that early involvement in research will positively influence the likelihood of future physicians' contribution and collaboration in research.
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Anatomia , Educação de Graduação em Medicina , Estudantes de Medicina , Anatomia/educação , Humanos , México , Faculdades de MedicinaRESUMO
Objetivo:validar método de fixação de curativos em feridas cutâneas excisionais de camundongos. Método: estudo pré-clínico. Amostra composta por animais da linhagem C57BL/6, que tiveram duas feridas excisionais confeccionadas na região dorsal. Foram avaliados diferentes métodos e produtos, amplamente aceitos na prática clínica, para fixação de curativos no modelo animal. Os desfechos avaliados foram tempo de permanência do curativo e ocorrência de eventos adversos. Resultados: atadura de crepom, fita microporosa e bandagem autoaderente apresentaram menor tempo de permanência quando comparadas ao filme de poliuretano. Esse, por sua vez, variou o tempo quando comparadas diferentes marcas (E, F, G e H) e número de voltas ao redor do corpo do animal. Com 1 volta, o tempo variou de < 24 a 36 horas. Com 2 voltas, as marcas E e G permaneceram 48 e 96 horas, respectivamente, e F e H tempo < 24 horas. Filme da marca G, cortado no tamanho 3 cm x 15 cm, dando 2 voltas no corpo do camundongo, manteve o curativo por 96 horas. A pele permaneceu íntegra, sem evento adverso. Conclusão: foi criado modelo de fixação de curativos para feridas em camundongos com produto disponível no Brasil e compatível com a estrutura copórea do animal.
Objective:validate method of fixation of dressings on excisional cutaneous wounds of mice. Method: preclinical study. Sample made up of animals of the C57BL/6 strain, which had two excision wounds made in the dorsal region. Different methods and products, widely accepted in clinical practice, for fixing dressings in the animal model were evaluated. The evaluated outcomes were the length of stay of the dressing and the occurrence of adverse events. Results: crepe bandage, microporous tape and self-adhesive bandage had a shorter residence time when compared to polyurethane film. This, in turn, varied the time when comparing different marks (E, F, G and H) and number of turns around the animal's body. With 1 lap, the time varied from <24 to 36 hours. With 2 laps, the marks E and G remained 48 and 96 hours, respectively, and F and H time <24 hours. G-brand film, cut to size 3 cm x 15 cm, giving the mouse body 2 turns, kept the dressing for 96 hours. The skin remained intact, with no adverse event. Conclusion: a dressing fixation model for wounds in mice was created with a product available in Brazil and compatible with the animal's body structure
Objetivo:validar método de fijación de apósitos en heridas cutáneas excisionales de ratones. Método: estudio preclínico. Muestra compuesta por animales del linaje C57BL/6 que tuvieron dos heridas excisionales confeccionadas en la región dorsal. Se evaluaron distintos métodos y productos, ampliamente aceptados en la práctica clínica, para fijación de apósitos en el modelo animal. Los resultados evaluados fueron tiempo de permanencia del apósito y ocurrencia de eventos adversos. Resultados: La venda de crepé, la cinta microporosa y el vendaje autoadherente presentaron menor tiempo de permanencia cuando comparados con la película de poliuretano. Esta, a su vez, varió en el tiempo cuando comparadas distintas marcas (E, F, G y H) y número de vueltas alrededor del cuerpo del animal. Con una vuelta completa, el tiempo varió de menos de 24 a 36 horas. Con dos vueltas, las marcas E y G permanecieron 48 y 96 horas, respectivamente, y F y H, tiempo igual e inferior a 24 horas. La piel permaneció íntegra, sin evento adverso. Conclusión: se creó un modelo de fijación de apósitos en ratones con un producto disponible en Brasil y compatible con la estructura del cuerpo del animal
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Bandagens , Cicatrização , Pesquisa BásicaRESUMO
OBJECTIVES/HYPOTHESIS: The objectives of this study were to evaluate laryngeal inflammation and mucosal integrity in a murine model of reflux disease and to assess the protective effects of topical agents including alginate, hyaluronic acid, and cashew gum. STUDY DESIGN: Animal study. METHODS: A surgical murine model of reflux disease was evaluated at 3 or 7 days postsurgery, and laryngeal samples were collected to measure inflammation (wet weight and myeloperoxidase [MPO]) and mucosal integrity (transepithelial resistance [TER] and mucosal permeability to fluorescein). Additional groups of animals were administered one of several topical agents (alginate, hyaluronic acid, or cashew gum) daily, and laryngeal inflammation and mucosal integrity were evaluated at 3 days postsurgery. RESULTS: At 3 days, and not 7 days postsurgery, we observed increased laryngeal wet weight and MPO, decreased laryngeal TER, and increased laryngeal mucosa permeability. Alginate partially decreased laryngeal inflammation (wet weight and not MPO) and dramatically improved laryngeal mucosal integrity. Conversely, hyaluronic acid eliminated the inflammation; however, it had no effect on laryngeal mucosal integrity impairment. Cashew gum eliminated laryngeal inflammation as well as the impairment in laryngeal mucosal integrity. CONCLUSIONS: This study shows that a surgical model of reflux disease induced laryngeal inflammation and impairment in laryngeal barrier function. These observed alterations were partially attenuated by alginate and hyaluronic acid and completely reversed by cashew gum. LEVEL OF EVIDENCE: NA Laryngoscope, 2020.
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Alginatos/administração & dosagem , Refluxo Gastroesofágico/complicações , Ácido Hialurônico/administração & dosagem , Mucosa Laríngea/efeitos dos fármacos , Mucosa Laríngea/patologia , Laringite/etiologia , Laringite/prevenção & controle , Gomas Vegetais/administração & dosagem , Anacardium , Animais , Modelos Animais de Doenças , Masculino , CamundongosRESUMO
Abstract In this commentary, the authors highlight the importance of basic research in the field of public health regarding the recent pandemic Covid-19, using tick-borne rickettsioses as an example. In addition, they alert politicians, government officials and managers of research funding agencies to increase the allocated financial resources to enhance basic research on public health in Brazil.
Resumo Neste comentário, os autores destacam a importância da pesquisa básica em saúde pública em relação à recente pandemia Covid-19, usando-se as riquetsioses transmitidas por carrapatos como exemplo. Além disso, alertam políticos, funcionários do governo e gerentes de agências de fomento à pesquisa para aumentar os recursos financeiros alocados a fim de aprimorar a pesquisa básica em saúde pública no País.
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Animais , Pneumonia Viral , Infecções por Rickettsia/epidemiologia , Carrapatos/microbiologia , Zoonoses/microbiologia , Infecções por Coronavirus , Pandemias , Brasil , Betacoronavirus , SARS-CoV-2 , COVID-19RESUMO
In this commentary, the authors highlight the importance of basic research in the field of public health regarding the recent pandemic Covid-19, using tick-borne rickettsioses as an example. In addition, they alert politicians, government officials and managers of research funding agencies to increase the allocated financial resources to enhance basic research on public health in Brazil.(AU)
Neste comentário, os autores destacam a importância da pesquisa básica em saúde pública em relação à recente pandemia Covid-19, usando-se as riquetsioses transmitidas por carrapatos como exemplo. Além disso, alertam políticos, funcionários do governo e gerentes de agências de fomento à pesquisa para aumentar os recursos financeiros alocados a fim de aprimorar a pesquisa básica em saúde pública no País.(AU)
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Pesquisa Básica , Financiamento da Pesquisa , Doenças Transmitidas por Carrapatos/veterináriaRESUMO
OBJECTIVES/HYPOTHESIS: Evaluate the effect of in vitro exposure of mice laryngeal mucosa to solutions that simulated human gastric juice and to assess the topical protective effect of cashew gum on mice laryngeal mucosal integrity in vitro. STUDY DESIGN: Animal study. METHODS: Murine (Swiss) laryngeal samples were mounted in Ussing chambers. The luminal side of biopsies was exposed to solutions of different acidity with or without pepsin and/or taurodeoxycholic acid (TDC). Transepithelial electrical resistance (TER) was continuously recorded. The topical protective effect of cashew gum solution was evaluated by precoating the biopsies before the exposure with a solution at pH 5 containing 5 mM TDC. Changes in TER and mucosal permeability to fluorescein were measured. RESULTS: Exposure of laryngeal mucosa to acidic solutions containing pepsin and TDC provoked a pH-dependent drop in TER with the maximal effect at pH 1, but still present at pH 5 (weakly acidic). The exposure of the laryngeal mucosa to a solution of pH 5 with TDC, but not with pepsin, produced a dose-dependent decrease in TER. Precoating the mucosa with cashew gum prevented the reduction of TER and increased transepithelial permeability by exposure to a solution at pH5 containing TDC. CONCLUSIONS: Weakly acidic solutions containing bile acids can produce impairment of laryngeal epithelial barrier, which may be protected by topical treatment with cashew gum. LEVEL OF EVIDENCE: NA. Laryngoscope, 128:1157-1162, 2018.
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Anacardium , Mucosa Laríngea/efeitos dos fármacos , Extratos Vegetais/farmacologia , Administração Tópica , Animais , Masculino , Camundongos , Pepsina A/farmacologia , Extratos Vegetais/administração & dosagem , Ácido Taurodesoxicólico/farmacologiaRESUMO
RESUMEN La Organización Mundial de la Salud considera que la epilepsia es una prioridad de salud pública. A las personas afectadas se les restringe con frecuencia su participación en actividades físicas y deportivas, pero los estudios clínicos han demostrado un efecto benéfico de la actividad física sobre el control de las crisis epilépticas. Se describen los hallazgos desde la perspectiva de las ciencias básicas que demuestran los mecanismos reguladores del efecto del ejercicio sobre la epileptogénesis, el control de la enfermedad y de su comorbilidad psiquiátrica. Tanto las investigaciones clínicas como las básicas indican que se debería considerar la actividad física como una estrategia terapéutica complementaria en las personas con epilepsia, la cual está disponible en todas partes del mundo y a un muy bajo costo.
SUMMARY According to the World Health Organization, epilepsy is a public health priority. Persons with this disease are frequently restricted from participating in physical activities and sports. Clinical studies have shown the beneficial effects of exercise on seizure control. Results from basic research demonstrating the mechanisms of physical activity on epileptogenesis, seizure control and psychiatric comorbidity are described. Basic and clinical research indicates that physical activity should be considered a complementary therapeutic approach for persons with epilepsy, a beneficial strategy that is available worldwide at a low cost.
RESUMO A Organização Mundial da Saúde considera que a epilepsia é uma prioridade de saúde pública. Às pessoas afetadas se lhes restringe com frequência sua participação em atividades físicas e esportivas, mas os estudos clínicos há demostrado um efeito benéfico da atividade física sobre o controle das crises epilépticas. Se descrevem as descobertas desde a perspectiva das ciências básicas que demostram os mecanismos reguladores do efeito do exercício sobre a epileptogênese, o controle da doença e de sua co-morbilidade psiquiátrica. Tanto as investigações clínicas como as básicas indicam que se deveria considerar a atividade física como uma estratégia terapêutica complementária nas pessoas com epilepsia, a qual está disponível em todas partes do mundo e a um muito baixo custo.
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Exercício Físico , Epilepsia , ConvulsõesRESUMO
Los tumores infrecuentes están definidos como cánceres pediátricos con una incidencia anual <2 casos por millón. Aunque son percibidos como raros, constituyen el 15% de todos los cánceres en menores de 20 años y 30% de todos los tumores de pacientes entre 15 y 19 años. Se han desarrollado proyectos cooperativos nacionales e internacionales pediátricos con el fin de mejorar el manejo clínico y la investigación básica en estos tumores. Revisamos los procesos desarrollados y las dificultades que se han enfrentado, como bajas tasas de registro y participación en bancos de tumores y estudios clínicos. Esta experiencia inicial ha permitido desarrollar estrategias alternativas que permitirían implementar una iniciativa similar para América Latina. La experiencia demuestra la factibilidad de cooperación multidisciplinaria a nivel nacional y sugiere que se pueden realizar estudios internacionales, que aumenten nuestro entendimiento de la biología de estos tumores, mejorando los resultados de tratamiento de niños y adolescentes con cánceres infrecuentes.
Although perceived as rare, infrequent tumors, defined as childhood solid malignancies with an annual incidence < 2/million and not considered in other clinical trials, account for 15% of all cancers in patients younger than age 20 and for 30% of all tumors in patients ages 15 to 19. National and international cooperative projects on rare paediatric tumours have been developed to improve the clinical management and basic research on these tumors. We reviewed the process developed and the problems it had to face, as low rates of registration, low levels of participation in tumor banking, and clinical trials. This initial experience has allowed to develop alternative strategies that could help to launch a latinamerican initiative. Experience demonstrates the feasibility of a national multidisciplinary cooperation and suggests that international studies can be performed, increasing our knowledge to understand the biology and improving the treatment results of young patients with rare cancers.
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Humanos , Criança , Adolescente , Doenças Raras/epidemiologia , Neoplasias/epidemiologia , Registros , Desenvolvimento de Programas , Cooperação InternacionalRESUMO
BACKGROUND: Anti-tumour necrosis factor α (TNFα) therapy effectively induces and maintains remission in Crohn's disease (CD). Up to 40% of patients, however, fail to respond to anti-TNFα. OBJECTIVE: To identify the mechanisms underlying the persistence of mucosal lesions in patients who fail to respond to anti-TNFα therapy. DESIGN: An observational study based on whole-genome transcriptional analysis was carried out using intestinal biopsy specimens from patients with CD receiving (n=12) or not (n=10) anti-TNFα therapy. The transcriptional signature of responders was compared with that of non-responders after anti-TNFα therapy. Controls with non-inflammatory bowel disease (non-IBD) (n=17) were used for comparisons. Genes of interest were validated by real-time RT-PCR in an independent cohort of patients with CD receiving (n=17) or not (n=16) anti-TNFα and non-IBD controls (n=7). RESULTS: We confirmed that response to anti-TNFα is accompanied by significant regulation of a large number of genes, including IL1B, S100A8, CXCL1, which correlated with endoscopic activity. Remarkably, patients who failed to respond to anti-TNFα showed a mixed signature, maintaining increased expression of IL1B, IL17A and S100A8, while showing significant modulation of other genes commonly upregulated in active CD, including IL6 and IL23p19. CONCLUSIONS: Our results show that anti-TNFα therapy significantly downregulates a subset of inflammatory genes even in patients who fail to achieve endoscopic remission, suggesting that these genes may not be dominant in driving inflammation in non-responders. On the other hand, we identified IL1B and IL17A as genes that remained altered in non-responders, pointing to potentially more relevant targets for modulating mucosal damage in refractory patients.
Assuntos
Doença de Crohn/tratamento farmacológico , Fármacos Gastrointestinais/uso terapêutico , Mediadores da Inflamação/metabolismo , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Adalimumab , Adulto , Idoso , Anti-Inflamatórios não Esteroides/uso terapêutico , Anticorpos Monoclonais/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Colo/metabolismo , Doença de Crohn/genética , Doença de Crohn/metabolismo , Feminino , Perfilação da Expressão Gênica/métodos , Regulação da Expressão Gênica/efeitos dos fármacos , Humanos , Infliximab , Interleucina-6/biossíntese , Interleucina-6/genética , Mucosa Intestinal/metabolismo , Masculino , Pessoa de Meia-Idade , Análise de Sequência com Séries de Oligonucleotídeos , Ativação Transcricional , Falha de Tratamento , Adulto JovemRESUMO
Transcranial direct current stimulation (tDCS) is an "old/new" noninvasive brain modulation technique that has gained increasing popularity and relevance in psychology and neuroscience. The contemporary tDCS procedure is effective and painless. It was shown to modulate motor performance and several sensory and cognitive functions. It can be used to study cortical organization and clarify brain-behavior relationships. Using tDCS for rehabilitation is a promising strategy, and numerous publications suggest that it can be used alone or combined to augment the outcomes of behavioral training and pharmacological interventions. Compared with other brain modulation techniques, it has the advantage of being noninvasive and safe, with easy and effective placebo controls. Its efficacy, low cost, and ease of use make tDCS a very convenient tool for researchers in developing countries. This review introduces tDCS to a new audience and seeks to inspire future investigations in the field. We highlight work that illustrates the main concepts and applications of tDCS as a basic research and rehabilitation tool.
Estimulação Transcraniana por Corrente Contínua (ETCC) é uma técnica de estimulação cerebral nãoinvasiva com crescente popularidade na pesquisa em psicologia e neurociências. A aplicação da ETCC é indolor, eficaz e pode afetar o desempenho motor, sensorial e cognitivo. ETCC pode ser usada para estudar a organização cortical e relações entre cérebro e comportamento. Seu uso clínico também é relevante e vários estudos sugerem que pode ser aplicada só ou como complemento a intervenções comportamentais ou farmacológicas. Quando comparada a outras técnicas de modulação cerebral a ETCC tem a vantagem de ser não-invasiva, segura e com um controle placebo eficaz. O baixo-custo, eficácia e praticidade da técnica torna a ETCC especialmente conveniente para pesquisadores em países em desenvolvimento. A revisão a seguir se propõe a apresentar a ETCC para um novo público e inspirar futuras investigações no campo. Serão apresentados trabalhos que ilustram os principais conceitos e aplicações da ETCC no campo da pesquisa básica e clínica.
La Estimulación Transcraneal con Corriente Directa (ETCD) es una técnica no invasiva de modulación del cerebro con cresciente popularidad y relevancia para la psicología y las neurociencias. El procedimiento ETCD contemporáneo es efectivo y sin dolor. ETCD puede modular el rendimiento motor y varias funciones sensoriales y cognitivas. Se puede utilizar para estudiar la organización cortical y clarificar las relaciones cerebro-conducta. Uso de ETCD para la rehabilitación es una estrategia prometedora y un número de publicaciones sugieren que puede ser utilizada sola o para impulsar los resultados de intervenciones comportamentales y farmacológicas. En comparación con otras técnicas de modulación del cerebro, tiene la ventaja de ser no invasiva y segura, con un control placebo fácil y eficaz. Su eficacia, bajo costo y facilidad de uso hacen ETCD una herramienta adequada para los investigadores en los países en desarrollo. La siguiente revisión pretende introducir ETCD a un nuevo público y inspirar futuras investigaciones en el campo. Vamos a destacar obras que ilustran los principales conceptos y aplicaciones de ETCD en la investigación básica y clínica.
Assuntos
Estimulação Magnética Transcraniana , Pesquisa , ReabilitaçãoRESUMO
Transcranial direct current stimulation (tDCS) is an "old/new" noninvasive brain modulation technique that has gained increasing popularity and relevance in psychology and neuroscience. The contemporary tDCS procedure is effective and painless. It was shown to modulate motor performance and several sensory and cognitive functions. It can be used to study cortical organization and clarify brain-behavior relationships. Using tDCS for rehabilitation is a promising strategy, and numerous publications suggest that it can be used alone or combined to augment the outcomes of behavioral training and pharmacological interventions. Compared with other brain modulation techniques, it has the advantage of being noninvasive and safe, with easy and effective placebo controls. Its efficacy, low cost, and ease of use make tDCS a very convenient tool for researchers in developing countries. This review introduces tDCS to a new audience and seeks to inspire future investigations in the field. We highlight work that illustrates the main concepts and applications of tDCS as a basic research and rehabilitation tool. (AU).
Estimulação Transcraniana por Corrente Contínua (ETCC) é uma técnica de estimulação cerebral nãoinvasiva com crescente popularidade na pesquisa em psicologia e neurociências. A aplicação da ETCC é indolor, eficaz e pode afetar o desempenho motor, sensorial e cognitivo. ETCC pode ser usada para estudar a organização cortical e relações entre cérebro e comportamento. Seu uso clínico também é relevante e vários estudos sugerem que pode ser aplicada só ou como complemento a intervenções comportamentais ou farmacológicas. Quando comparada a outras técnicas de modulação cerebral a ETCC tem a vantagem de ser não-invasiva, segura e com um controle placebo eficaz. O baixo-custo, eficácia e praticidade da técnica torna a ETCC especialmente conveniente para pesquisadores em países em desenvolvimento. A revisão a seguir se propõe a apresentar a ETCC para um novo público e inspirar futuras investigações no campo. Serão apresentados trabalhos que ilustram os principais conceitos e aplicações da ETCC no campo da pesquisa básica e clínica.(AU).
La Estimulación Transcraneal con Corriente Directa (ETCD) es una técnica no invasiva de modulación del cerebro con cresciente popularidad y relevancia para la psicología y las neurociencias. El procedimiento ETCD contemporáneo es efectivo y sin dolor. ETCD puede modular el rendimiento motor y varias funciones sensoriales y cognitivas. Se puede utilizar para estudiar la organización cortical y clarificar las relaciones cerebro-conducta. Uso de ETCD para la rehabilitación es una estrategia prometedora y un número de publicaciones sugieren que puede ser utilizada sola o para impulsar los resultados de intervenciones comportamentales y farmacológicas. En comparación con otras técnicas de modulación del cerebro, tiene la ventaja de ser no invasiva y segura, con un control placebo fácil y eficaz. Su eficacia, bajo costo y facilidad de uso hacen ETCD una herramienta adequada para los investigadores en los países en desarrollo. La siguiente revisión pretende introducir ETCD a un nuevo público y inspirar futuras investigaciones en el campo. Vamos a destacar obras que ilustran los principales conceptos y aplicaciones de ETCD en la investigación básica y clínica.(AU).