Impact of the COVID-19 Pandemic on Brazilian Head and Neck Surgery Centers

Abstract Objective The outbreak of the COVID-19 pandemic had a considerable impact on the healthcare access, treatment, and follow-up of oncologic patients. The aim of this study was to evaluate how the COVID-19 pandemic has affected consultation and follow-up demand as well as treatment volume at Brazilian Head and Neck Surgery centers. Methods An anonymous online questionnaire was used for collection of data across all Brazilian Head and Neck Surgery Centers across a 3-month period (April‒June 2021). This information included the characteristics of each center, and the perceived self-reported impact of the COVID-19 pandemic on academic activities, residency training, and the diagnosis, treatment, and follow-up of patients with Head and Neck diseases between 2019 and 2020. Results The response rate across the 40 registered Brazilian Head and Neck Surgery Centers was 47.5% (n = 19). The data showed a significant reduction in the total number of consultations (24.8%) and number of attending patients (20.2%) between 2019 and 2020. The total number of diagnostic exams (31.6%) and surgical procedures (13.0%) conducted over this period also decreased significantly. Conclusions The COVID-19 pandemic had a significant national impact on Brazilian Head and Neck Surgery Centers. Future studies should examine the long-term effects of the pandemic on cancer treatment. Level of evidence Evidence from a single descriptive study.

Componentes ético-clínicos presentes en la indicación de tratamiento en mujeres con cáncer de mama según edad de diagnóstico

Objetivo: Evaluar si existen diferencias basadas en la edad en la aproximación diagnóstica y de tratamiento del cáncer de mama. Se analizan aspectos éticos, como justicia, beneficencia y autonomía, en relación a la toma de decisiones. Material y Método: Estudio descriptivo cuantitativo y corresponde a un análisis retrospectivo de la base de datos del Centro de la Mama de Clínica Alemana de Santiago, en la que se analiza información de las mujeres de 70 años o más en relación a motivo consulta, estadio de la enfermedad al momento del diagnóstico y tratamientos recibidos y se la compara con la obtenida del grupo de mujeres menores de 70 años. Resultados: No hay diferencia en la oportunidad de la consulta, en el acceso al diagnóstico ni en el tipo de cirugía entre los dos grupos. Existen diferencias significativas en relación a la indicación de tratamientos adyuvantes como quimioterapia, radioterapia y hormonoterapia. El grupo de mujeres mayores de 70 años reciben menos terapias que las mujeres de menor edad. No existe información respecto a los motivos que expliquen esta diferencia. Discusión: Actualmente, mujeres mayores se encuentran en buenas condiciones generales, con una expectativa de vida mayor a 75 años. Es importante tratar sus enfermedades sin limitar a priori el acceso a protocolos de tratamiento, evitando la discriminación por edad. Conclusión: Se propone incorporar una evaluación geriátrica protocolizada con el objetivo de mejorar la atención de este grupo etario, preservando de esta manera los principios de justicia, beneficencia y autonomía en pacientes mayores.

Objective: To evalúate if there are differences on the diagnostic approach and breast cancer treatment based on women age. We analyze ethical aspects like justice, beneficence and autonomy in regards of decision making. Material and Method: Descriptiva and quantitative study that correspond and analysis of the Data Base of the Breast Cancer Center in Clínica Alemana de Santiago, in which we gather the information of women 70 years or more in relation to consultation motive, illness stage and treatments received, compare with the obtain in the group of women under 70 years. Results: There are no differences in the opportunity to reach consultation, access to diagnosis neither the type of surgery. There are significant differences in considering adjuvant treatment like chemotherapy, radiotherapy and hormonal therapy. The group of women with 70 years or older, receive less treatments than the younger group. There is no information that explains this differences. Discussion: In current days, women of the third and fourth age are in good general conditions and their life expectancy is over 75 years old. It is important to treat their diseases without limiting access to them only because of their age, avoiding this type of discrimination. Conclusion: it is proposed to incorporate a geriatric evaluation to improve quality of clinical attention in this age group, aiming to preserve justice, beneficence and autonomy principles in older patients.

Research progress in the application of hybrid cell membrane biomimetic nano-drug delivery system in cancer treatment / 国际生物医学工程杂志

The biomimetic strategy of using the cell membrane-coated nanoparticles can retain the physical and chemical properties of the nanoparticles and show the biological characteristics of the source cell membrane, which can further enhance the role of the nanodrug in tumor treatment. A hybrid cell membrane is the fusion of two or more different types of cell membranes. A hybrid cell membrane can endow nanoparticles with multiple biofunctions derived from the source cells compared with a single cell membrane. Hybrid cell membranes provide a foundation to stimulate extensive research into multifunctional biomimetic nano-drug delivery system (NDDS), which is expected to broaden the application of biomimetic nanotechnology in drug delivery systems. In this review paper, the types of hybrid cell membrane used to construct nano-drug delivery systems, the preparation and characterization methods, and cancer treatment research progress in recent years were reviewed.

Effect of radiotherapy on the differentiation and osteogenic activity of mesenchymal stem cells on dental implants / Efeito da radioterapia na diferenciação e atividade osteogênica de células-tronco mesenquimais em implantes dentários

Objective: to evaluate the differentiation and gene expression of transcripts related to osteogenesis in a primary culture of Mesenchymal Stem Cells (MSCs) derived from rat femurs submitted to radiotherapy and the installation of pure titanium implants. Material and Methods: fifty-four rats received titanium implants in both femurs and were divided into three groups: Control: implant surgery (C); Implant + immediate irradiation (IrI), and Implant + late irradiation (IrL). Euthanasia occurred 3, 14, and 49 days after surgery. The bone marrow MSCs from the femurs were isolated and cultivated. The cell viability, total protein content, alkaline phosphatase (ALP) activity, and the formation of mineralization nodules and cellular genotoxicity were analyzed. The gene expression of Alkaline Phosphatase (phoA), Collagen 1 (COL1), Runt-related transcription factor 2 (RUNX2), Osterix (OSX), Osteopontin (OPN), Integrin ß1(ITGB1), Bone Sialoprotein (BSP), Osteonectin (SPARC), Osteocalcin (Bglap), Transforming Growth Factor ß-type (TGF-ß), Granulocyte Macrophage Colony Stimulating Factor (GM-CSF), Interleukin-6 (IL-6), Apolipoprotein E (APOE) and Prostaglandin E2 synthase (PGE2) were evaluated by qRT- PCR. Results: ionizing radiation suppresses the gene expression of essential transcripts for bone regeneration, as well as cellular viability, as observed in the IrI and IrL groups. Conclusion: although this can lead to the loss of osseointegration and failure of the implant, the MSCs showed more activity at 49 days than at 3 and 14 days. (AU)

Objetivo: avaliar a diferenciação e expressão gênica de transcritos relacionados à osteogênese em cultura primária de MSCs derivadas de fêmures de ratos submetidos à radioterapia e instalação de implantes de titânio puro. Material e Métodos: cinquenta e quatro ratos receberam implantes de titânio em ambos os fêmures e foram divididos em três grupos: Controle: cirurgia de implante (C); Implante + irradiação imediata (IrI) e Implante + irradiação tardia (IrL). A eutanásia ocorreu 3, 14 e 49 dias após a cirurgia. As MSCs de medula óssea dos fêmures foram isoladas e cultivadas. Foram analisadas a viabilidade celular, teor de proteína total, atividade da fosfatase alcalina (ALP), formação de nódulos de mineralização e genotoxicidade celular. A expressão gênica de Fosfatase Alcalina (phoA), Colágeno 1 (COL1), fator de transcrição relacionado a Runt 2 (RUNX2), Osterix (OSX), Osteopontina (OPN), Integrina ß1 (ITGB1), Sialoproteína Óssea (BSP), Osteonectina (SPARC), Osteocalcina (Bglap), Fator de Crescimento Transformador tipo ß (TGF-ß), Fator Estimulante de Colônia de Granulócitos-Macrófagos (GM-CSF), Interleucina-6 (IL-6), Apolipoproteína E (APOE) e Prostaglandina E2 sintase (PGE2) foram avaliados por qRT-PCR. Resultados: a radiação ionizante suprime a expressão gênica de transcritos essenciais para a regeneração óssea, bem como a viabilidade celular, como observado nos grupos IrI e IrL. Conclusão:embora isso possa levar à perda da osseointegração e falha do implante, as MSCs apresentaram maior atividade aos 49 dias do que aos 3 e 14 dias (AU)

Early breast cancer: concept and therapeutic review

SUMMARY OBJECTIVE: Breast cancer treatment has evolved significantly over the years, both in terms of local and systemic approaches. Halsted's radical mastectomy gave way to modified mastectomies and to conservative surgeries, along with breast reconstruction and repair. Although the use of new drugs has directly increased the survival of patients submitted to adjuvant or neoadjuvant systemic therapies, the de-escalation of drugs may also be beneficial in numerous cases. Therefore, breast cancer treatment must be increasingly customized and assessed using a multidisciplinary approach. This study aimed to review the concept and therapy of early breast cancer. METHODS: A narrative review of the literature was carried out in the PubMed database in December 2022, where the keywords for the searches were as follows: early breast cancer, surgical treatment of breast cancer, systemic treatment of breast cancer, neoadjuvant chemotherapy in breast cancer, adjuvant treatment of luminal breast cancer, early triple negative tumor, and early positive Her-2 tumor. Articles that were historically important in the treatment of breast cancer and articles that impacted management with scientific relevance were selected for this review. DISCUSSION: As new evidence continues to update existing knowledge, breast cancer treatment is becoming increasingly personalized and must now take into account the different tumor variants and their clinical stages, the age of patients and relevant comorbidities, as well as personal expectations and desires. CONCLUSION: This literature review of current studies shows that the primary therapy for patients with early breast cancer continues to be surgery, although a customized and multidisciplinary approach is now required.

Head and Neck Cancer Survivors’ Perceptions of Cancer Treatment and Posttraumatic Growth

@#Introduction: Cancer patients’ perception on the treatment they received is vital to determine their adherence to cancer treatment, but important data on how this variable affects posttraumatic growth (PTG) experience by cancer patients is lacking. This cross-sectional study aimed to evaluate the degree of PTG among a cohort of head and neck cancer (HNC) survivors who were within first year of diagnosis and determined the association between perception of cancer treatment received (expectation and satisfaction with cancer treatment received and the feeling about the adverse effects) and PTG controlling for socio-demographic and clinical characteristics. Methods: HNC survivors were recruited from two oncology referral centres, and they were administered socio-demographic and clinical characteristics questionnaire, the Malay version of the Cancer Therapy Satisfaction Questionnaire (CTSQ) (to assess the satisfaction, expectation and feeling about the adverse effects of cancer treatment received) and the Malay version of the Posttraumatic Growth Inventory-Short Form (PTGi-SF) (to measure the degree of PTG). Results: A total of 200 HNC survivors participated in the study. The mean total PTGI-SF score was 39.5 (standard deviation [SD] = 9.3). Greater degree of positive expectation of cancer treatment and satisfaction with cancer treatment received significantly contributed to higher level of PTG, whereas feeling about side effects of treatment was not associated with PTG, after controlling for socio-demographic and clinical characteristics. Conclusion: Incorporating psychosocial interventions (such as education on cancer treatment and counselling) into the treatment regimen may facilitate development of PTG and hence, safeguard the mental well-being of HNC patients.

The prevalence of COVID-19 infection among gynecologic oncology patients receiving cancer treatment in a COVID-19 referral hospital / Philippine Journal of Obstetrics and Gynecology

Introduction@#Cancer patients are more susceptible to coronavirus disease-19 (COVID-19) infection because they are immunosuppressed by their disease or therapy, most of them have coexisting medical conditions, and they frequently visit hospitals for treatment and surveillance. @*Objective@#The objective of this study was to determine the prevalence of COVID-19 infection among gynecologic oncology patients receiving treatment in a COVID-19 referral hospital. @*Materials and Methods@#A descriptive, cross-sectional study involving 47 gynecologic cancer patients receiving treatment from June 2020 to December 2020 was performed. All patients underwent SARS-CoV-2 reverse transcription-polymerase chain reaction (RT-PCR) swab test and symptom and exposure assessment before the start of cancer treatment. Patients with negative SARS-CoV-2 RT-PCR swab test results received their planned treatment, and a repeat swab test and triage assessment were done midtreatment and after treatment. @*Results@#Five (10.6%) patients had positive baseline SARS-CoV-2 RT-PCR swab results, but all proceeded with treatment after negative results were obtained. Only 1 (2.13%) patient had a positive SARS-CoV-2 RT-PCR swab test result at midtreatment. All patients had no COVID-19-associated symptoms and none of them tested positive for COVID-19 infection posttreatment. @*Conclusion@#The prevalence of COVID-19 infection among gynecologic cancer patients receiving cancer treatment is 2.13%. All patients who had positive SARS-CoV-2 RT-PCR swab test results at baseline or midtreatment were able to continue and complete treatment. There were no severe clinical events or mortalities among those affected with COVID-19 infection.

Research progress of radiation nephropathy / 中华放射医学与防护杂志

Radiotherapy is an important treatment for malignant tumors. However, it is also one cause of damage to local normal tissues, such as radiation nephropathy, which is frequently induced during the radiotherapy of abdominal and pelvic tumors. The exact pathogenesis of radiation nephropathy is still unclear and is believed to be related mainly to factors including oxidative stress, cell aging, and gene changes presently. Moreover, there is a lack of effective treatments for radiation nephropathy. With an increase in the survival of tumor patients, radiation nephropathy has received increasing attention. This article mainly reviewed the research progress of radiation nephropathy from the aspects of pathogenesis and treatments, aiming to provide a reference for the research and clinical diagnosis and treatment of radiation nephropathy.

Lipid nanomaterials-based RNA therapy and cancer treatment

We summarize the most important advances in RNA delivery and nanomedicine. We describe lipid nanoparticle-based RNA therapeutics and the impacts on the development of novel drugs. The fundamental properties of the key RNA members are described. We introduced recent advances in the nanoparticles to deliver RNA to defined targets, with a focus on lipid nanoparticles (LNPs). We review recent advances in biomedical therapy based on RNA drug delivery and state-of-the-art RNA application platforms, including the treatment of different types of cancer. This review presents an overview of current LNPs based RNA therapies in cancer treatment and provides deep insight into the development of future nanomedicines sophisticatedly combining the unparalleled functions of RNA therapeutics and nanotechnology.

Relación entre competencia para el cuidado domiciliario y la presencia de infecciones respiratorias en niños con tratamiento oncológico en el contexto de la pandemia por COVID-19 / Relationship between competence for home care and the presence of respiratory infections in children with cancer treatment in the context of the COVID-19 pandemic / Relação entre a proficiência para dar os cuidados em casa e a presença de infecções respiratórias em crianças sob tratamento oncológico no contexto da pandemia de COVID-19

Introducción: Los cuidados domiciliarios para los niños con enfermedades neoplásicas, representan costos sociales y económicos, además de posibles riesgos de infección. Por lo que, la importancia del cuidado de los menores ante las infecciones respiratorias virales durante la infancia radica en asegurar las correctas medidas de prevención del contagio. El objetivo de este estudio fue determinar la relación existente entre la competencia para el cuidado domiciliario y la presencia de infecciones respiratorias en los niños con tratamiento oncológico. Método: Estudio de enfoque cuantitativo, diseño correlacional, de corte transversal y descriptivo. La muestra se compone de 75 díadas. La competencia del cuidado domiciliario se midió con el instrumento CUIDAR. El análisis estadístico se realizó con el programa estadístico SPSS versión 25, utilizando estadística descriptiva y estadística inferencial no paramétrica. Resultados: La prevalencia de infecciones respiratorias fue del 4% para los menores con cuidadores con un nivel alto de competencia para el cuidado domiciliario, 12% para el nivel medio y 21.3%para el nivel bajo, mostrando dependencia entre las variables de estudio(X2=14.4, gl= 2, p=0.001). Además, se determinó una asociación (r=-.439, p<.001)entre las mismas. Discusión: La competencia con un nivel alto en los cuidados domiciliarios, supone un adecuado desempeño del rol como cuidador familiar con efecto en calidad de vida de la díada cuidador familiar-persona con cáncer. Conclusiones: A mayor competencia para el cuidado, menor la prevalencia de infecciones respiratorias; existiendo una relación entre la competencia para el cuidado domiciliario y la presencia de infecciones respiratorias en los niños con tratamiento oncológico.

Introduction: Home care for children with neoplastic diseases represents social and economic costs, as well as possible risks of infection. Therefore, the importance of caring for minors in the face of viral respiratory infections during childhood lies in ensuring the correct measures to prevent contagion. The objectiveof this study was to determine the relationship between competence for home care and the presence of respiratory infections in children undergoing cancer treatment. Method: Study of quantitative approach, correlational, cross-sectional and descriptive design. The sample consists of 75 dyads. Home care competence was measured with the CARE instrument. Statistical analysis was performed with the statistical program SPSS version 25.0, using descriptive statistics and non-parametric inferential statistics. Results: The prevalence of respiratory infections was 4% for children with caregivers with a high level of home care competence, 12% for the medium level and 21.3% for the low level, showing dependence between the study variables (X2=14.4, gl= 2, p=0.001). In addition, an association (r=-.439, p<.001) was determined between them. Discussion: The competence with a high level in home care supposes an adequate performance of the role as family caregiver with effect on quality of life of the family caregiver-person with a cancer dyad. Conclusions:The higher the caregiving competence, the lower the prevalence of respiratory infections; there is a relationship between home caregiving competence and the presence of respiratory infections in children undergoing cancer treatment.

Introdução: Os cuidados domiciliares para as crianças com doenças neoplásicas representam custos sociais e econômicos, além dos possíveis riscos de infecção. Por isso, a importância de tomar conta delas no que diz respeito às infecções respiratórias virais durante sua meninice radica em segurar as medidas adequadas para prevenir o contágio. O objetivo deste estúdio foi determinar a relação entre as infecções respiratórias nas crianças sob tratamento contra o cancro e a habilitação para lhes fornecer os cuidados em casa. Método: Estúdio da abordagem quantitativa, desenho correlacional, de corte transversal e descritivo. A amostra se compõe de 75 díades. A habilitação dos cuidados em casa foi medida com o instrumento TOMAR CONTA. A análise estatística se realizou com o programa estatístico SPSS, versão 25. Foi utilizada a estatística descritiva e a estatística inferencial não paramétrica. Resultados: A prevalência de infecções respiratórias foi de 4% para as crianças que receberam os cuidados em casa com um alto nível de efetividade; 12%, quando a efetividade dos cuidados foi intermediária; e para a baixa chegou até 21,3%. Isto demonstra a correlação entre as variáveis de estudo (X2= 14,4; gl= 2; p= 0,001). Além disso, se determinou uma associação (r= -,439; p<,001) entre elas. Discussão:A aptidão adequada para fornecer os cuidados em casa aponta que o responsável pela família desempenhou bem seu papel, o que fez com que houvesse repercussões positivas na qualidade de vida da díade "cuidador familiar-pessoa com câncer". Conclusões: Quanto maior é a proficiência para dar os cuidados, menor é o impacto das infecções respiratórias. Existe uma relação entre a habilitação para os cuidados em casa e a presença de infecções respiratórias nas crianças que recebem tratamentos oncológicos

Terapia neoadyuvante total (TNT) en el manejo del cáncer de recto localmente avanzado

El manejo multimodal del cáncer de recto, localmente avanzado (LARC), se ha convertido en las últimas décadas en el estándar terapéutico de este tipo de tumores, logrando cifras de recidiva local global alrededor del 10%. Sin embargo, las tasas de sobrevida global (OS) y de sobrevida libre de enfermedad (DFS) no superan el 75% en la mayoría de las series, debido a las fallas a distancia. La investigación de nuevas terapias que logren un control efectivo de la enfermedad sistémica se ha focalizado en agregar a la radioterapia pélvica distintos esquemas de quimioterapia en la etapa preoperatoria, es decir, neoadyuvante. En esta revisión se discuten los distintos esquemas denominados genéricamente TNT (total neoadjuvant therapy), las ventajas y las limitaciones de este nuevo enfrentamiento del LARC, basado principalmente en los estudios prospectivos y aleatorizados disponibles a la fecha, con foco en los resultados en OS y DFS.

Neoadjuvant chemoradiation followed by surgery with or without adjuvant chemotherapy has remained the mainstay of treatment of locally advanced rectal cancer (LARC) for the past two decades. Although this regimen has reduced rates of local recurrence to 10% or less, rates of systemic failure are 20 to 30%, leading to a 5-year survival of 70-75%, at best. This situation has led to investigations into the use of total neoadjuvant therapy in the form of induction or consolidation chemotherapy. This review put the focus on final outcomes like overall survival and disease-free survival based on the available prospective and randomized studies about different schemes of TNT.

Choosing wisely: protocols, priorities and a postcard

Can a young doctor without training in communication skills use empathy as a compass for making ethical decisions? This narrative reflects on a young boy left alone with a paralyzed dying father after six months of ‘free’ but futile treatment. Protocols should be weighed against prognosis and priorities when the disease is incurable.

Severe Oligospermia Treatment with Testicular Sperm Using 揑CSI�

Introduction: Assisted reproductive technology has been developed significantly throughout the past few years, particularly diagnosing and treating male infertility. Many studies have been performed showing that Intracytoplasmic Sperm Injection (ICSI) is a successful method to attain clinical pregnancy and live birth through impaired spermatozoa characteristics or low sperm count, such as severe oligospermia. Severe oligospermia indicates low sperm count, which in some cases leads to azoospermia. Severe oligospermia can be caused by several factors such as genetics or medication. In search of efficient treatment for couples with Severe oligospermia, numerous retrospective and prospective researches have reported high pregnancy and live birth rates through testicular sperm for men with severe oligospermia and cryptozoospermia with or without high sperm DNA damage. The research showed that the use of testicular sperm in combination with ICSI yielded a high pregnancy rate and live births over another source of sperm, such as ejaculated sperms. Moreover, the use of ICSI in severe oligospermia has shown successful fertilization and pregnancy. Methods: In search for effective treatment for couples with severe male factor, a number of small retrospective and prospective studies have reported high pregnancy and live birth rates using testicular sperm for men with necrozoospermia, cryptozoospermia and oligozoospermia with or without elevated sperm DNA damage. Although the data suggest that there may be some benefit in performing testicular sperm retrieval (TSR)-ICSI in select groups of non-azoospermic infertile men, there are potential risks involved with TSR. Clinicians should balance these risks prior to the recommendation of TSR-ICSI on the result of a semen analysis or sperm DNA test alone. Careful evaluation and management of male factor infertility is important. The use of TSR-ICSI in the absence of specific sperm DNA defects is still experimental. Discussion: In 1992 and subsequently, several reports indicated that ICSI was a successful technique to achieve clinical pregnancy and live birth using spermatozoa with severely impaired characteristics. The initial optimism over the ability of ICSI to overcome significant sperm abnormalities was later tempered by the findings of more recent publications suggesting that some sperm deficits may not be as effectively treated with ICSI. Conclusion: Severe oligospermia indicates low sperm count, which can lead to male infertility; severe oligospermia which can be overcome through ICSI. Genetic factors like microdeletions of the Y chromosome (Yq) can cause severe oligospermia or chemotherapy molecules, affecting the sperm count directly.

Mediações pedagógicas com crianças em tratamento oncológico: um olhar para a formação inicial do bacharel em Educação Física da Universidade Federal do Espírito Santo / Pedagogical mediations with children undergoing oncologic treatment: a perspective towards a starting formation of a bachelor's degree in Physical Education at Espírito Santo Federal University / Mediaciones pedagógicas con niños en tratamiento oncológico: una mirada a la formación inicial del Licenciado en Educación Física de la Universidad Federal de Espírito Santo

Analisa as contribuições e as lacunas que a formação inicial do curso de bacharelado em Educação Física da Universidade Federal do Espírito Santo (Ufes) apresenta para a mediação pedagógica com crianças em tratamento oncológico, com ênfase nas experiências vivenciadas por um estagiário no Projeto de Extensão Brincar é o Melhor Remédio (PBMR). Trata-se de um relato de experiência que reflete sobre os processos de formação profissional em diálogo com as ementas e os objetivos de componentes curriculares do referido curso que são correlatos ao tema. Conclui-se que algumas unidades curriculares oferecem suporte teórico-metodológico para a mediação pedagógica com o público-alvo deste estudo, contudo, as concepções de infâncias e de jogos/brincadeiras podem ser ampliadas para melhor contemplar as subjetividades, as agências e as produções culturais das crianças.

The work analyzes the contributions and gaps that the initial training of the Physical Education undergraduate course at Espírito Santo Federal University (Ufes) presents for the pedagogical mediation with children undergoing oncologic care, with emphasis on the experiences lived by an intern in the Extension Project named Playing is the Best Remedy (PBMR). It is about a report of experience that reflects the processes of professional training in dialogues with menus and the curricular components goals of the referred course correlated to the theme. It is concluded that some curricular units offer theoretical-methodological support related to the pedagogical mediation with the public-target of this study, however, the conception of childhood and games/playful activities may be expanded to better contemplate the subjectivities, the agencies and the children's cultural productions.

Analiza los aportes y lagunas que presenta la formación inicial de la carrera de Licenciatura en Educación Física de la Universidad Federal de Espírito Santo (Ufes) para la mediación pedagógica con niños en tratamiento oncológico, con énfasis en las experiencias vividas por un pasante en el Proyecto de Extensión Jugar es el Mejor Remedio (PJMR). Se trata de un relato de experiencia que refleja los procesos de formación profesional en diálogo con los planes de estudio y objetivos de los componentes curriculares de la mencionada carrera afines a la temática. Se concluye que algunas unidades curriculares ofrecen soporte teórico-metodológico para la mediación pedagógica con el público objetivo de este estudio. Sin embargo, los conceptos de infancia y juego podrían ampliarse para contemplar de mejor forma las subjetividades, las agencias y las producciones culturales de los niños.

Acesso do idoso ao tratamento oncológico no estado do Rio de Janeiro - uma discussão a partir dos dados do Registro Hospitalar de Câncer dos anos 2016 e 2017 / Access of the elderly to cancer treatment in the state of Rio de Janeiro - a discussion from the Hospital Records of Cancer of the years 2016 and 2017

O presente estudo objetivou analisar o acesso do idoso ao tratamento oncológico ofertado pelo SUS no estado do Rio de Janeiro nos anos 2016 e 2017, por meio de uma análise quantitativa e qualitativa de algumas variáveis disponibilizadas no Integrador-RHC. Para a discussão, utilizou-se de consulta bibliográfica sobre os temas acesso em saúde, rede de atenção ao câncer, políticas de atenção ao controle do câncer e políticas de atenção ao idoso no Brasil, bem como foram levantados dados do Plano de Atenção Oncológica do Estado (PAOE) 2017/2021 e Plano Estadual de Saúde (PES) 2020/2023. Como resultados, obteve- se que o acesso aos serviços oncológicos é condição multifatorial, que depende tanto de aspectos sociodemográficos, como de fatores organizacionais dos serviços, sobressaindo as características da oferta e da acessibilidade geográfica como fatores determinantes para o desempenho dos serviços de saúde, capazes de favorecer o acesso dos idosos. Houve indicação de déficit na capacidade hospitalar instalada para tratamento do câncer no estado; evidências de desequilíbrio na produção de procedimentos terapêuticos entre os hospitais habilitados e subnotificação de registros de câncer no sistema do RHC pelas unidades estaduais. É necessária uma revisão do planejamento com intervenção sobre a rede, adequando as referências pactuadas e indicando possíveis regionalizações alternativas, levando em consideração os fluxos residência-local de atendimento, a acessibilidade geográfica, os custos dos deslocamentos e a malha viária existente, no caminho da construção de uma efetiva rede regionalizada de atenção oncológica, garantindo um acesso mais universal, equitativo e integral.

This study aimed to analyze the access of the elderly to the cancer treatment offered by the SUS in the State of Rio de Janeiro in the years 2016 and 2017, through a quantitative and qualitative analysis of some variables available in the Integrator-RHC. For the discussion, we used a bibliographic consultation on the themes health access, cancer care network, cancer control care policies and policies for the elderly care in Brazil, as well as data from the State Oncological Care Plan (PAOE) 2017/2021 and State Health Plan (PES) 2020/2023. As a result, it was obtained that access to cancer services is a multifactorial condition, which depends both on sociodemographic aspects and organizational factors of the services, including the characteristics of supply and geographic accessibility as determining factors for the performance of health services, capable of favoring the access of the elderly. There is an indication of a deficit in hospital capacity installed for cancer treatment in the state; evidence of imbalance in the production of therapeutic procedures among qualified hospitals and underreporting of cancer records in the RHC system by state units. It is necessary to review and adapt the planning and intervention on the service network of the SUS, reviewing the agreed references and indicating possible alternative regionalization, considering the residence-place flows of care, geographical accessibility, travel costs and the existing road network, on the way to build an effective regionalized network of oncological care, ensuring more universal, equitable and comprehensive access.

An investigation of hospitalization management and radiation protection in 131I treatment for thyroid cancer / 中国辐射卫生

Objective To investigate the status and problems of hospitalization management and radiation protection in 131I treatment for thyroid cancer, and to provide suggestions for medical institutions to implement relevant standards. Methods We investigated the status of radiation protection and management in 10 medical institutions conducting 131I treatment for thyroid cancer (6 in Shanghai, 2 in Zhejiang Province, and 2 in Jiangsu Province, China) by consulting written materials, expert interviews, and on-site inspection and testing. Results The average activity of 131I therapy for thyroid cancer in the 10 medical institutions was 110~120 mCi (4.07~4.44 GBq). All patients who received the treatment were hospitalized, with a stay of 3~7 days. Seven institutions carried out 131I dispensing, 6 of which used automatic 131I dispensing instruments. Nine institutions had an independent ventilation system in the wards, 8 of which regularly changed the filters. All the 10 institutions set special toilets and shower rooms in the wards, and had shielding facilities between sickbeds, with the lead equivalent from 0.5 mm Pb (lowest) to 10 mm Pb (highest). All the 10 institutions had intercom and monitoring facilities in the wards, 9 of which had a one-way access control system, and 4 of which had dose monitoring equipment. Nine institutions carried out surface pollution monitoring in the workplace, but none performed air pollution testing. All the 10 institutions required the radioactivity in the body of patients be less than 400 MBq before discharge, and five of them estimated the activity by measuring the dose rate at a certain distance from the body surface of patients. All the 10 institutions had radioactive sewage decay ponds, but none of them conducted regular monitoring. Rapid on-site surface pollution testing in the wards showed that highest value was 31.9 Bq/cm2. Conclusion The 10 medical institutions carried out 131I treatment for thyroid cancer basically according to the requirements of national laws, regulations, and standards, but there are still some problems in ward construction, radiation protection facilities, and patient hospitalization management, which should be further standardized.

Autophagy and cancer treatment: four functional forms of autophagy and their therapeutic applications / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

Cancer is the leading cause of death worldwide. Drugs play a pivotal role in cancer treatment, but the complex biological processes of cancer cells seriously limit the efficacy of various anticancer drugs. Autophagy, a self-degradative system that maintains cellular homeostasis, universally operates under normal and stress conditions in cancer cells. The roles of autophagy in cancer treatment are still controversial because both stimulation and inhibition of autophagy have been reported to enhance the effects of anticancer drugs. Thus, the important question arises as to whether we should try to strengthen or suppress autophagy during cancer therapy. Currently, autophagy can be divided into four main forms according to its different functions during cancer treatment: cytoprotective (cell survival), cytotoxic (cell death), cytostatic (growth arrest), and nonprotective (no contribution to cell death or survival). In addition, various cell death modes, such as apoptosis, necrosis, ferroptosis, senescence, and mitotic catastrophe, all contribute to the anticancer effects of drugs. The interaction between autophagy and these cell death modes is complex and can lead to anticancer drugs having different or even completely opposite effects on treatment. Therefore, it is important to understand the underlying contexts in which autophagy inhibition or activation will be beneficial or detrimental. That is, appropriate therapeutic strategies should be adopted in light of the different functions of autophagy. This review provides an overview of recent insights into the evolving relationship between autophagy and cancer treatment.

WSB1 regulates c-Myc expression through β-catenin signaling and forms a feedforward circuit

The dysregulation of transcription factors is widely associated with tumorigenesis. As the most well-defined transcription factor in multiple types of cancer, c-Myc can transform cells by transactivating various downstream genes. Given that there is no effective way to directly inhibit c-Myc, c-Myc targeting strategies hold great potential for cancer therapy. In this study, we found that WSB1, which has a highly positive correlation with c-Myc in 10 cancer cell lines and clinical samples, is a direct target gene of c-Myc, and can positively regulate c-Myc expression, which forms a feedforward circuit promoting cancer development. RNA sequencing results from Bel-7402 cells confirmed that WSB1 promoted c-Myc expression through the β-catenin pathway. Mechanistically, WSB1 affected β-catenin destruction complex-PPP2CA assembly and E3 ubiquitin ligase adaptor β-TRCP recruitment, which inhibited the ubiquitination of β-catenin and transactivated c-Myc. Of interest, the effect of WSB1 on c-Myc was independent of its E3 ligase activity. Moreover, overexpressing WSB1 in the Bel-7402 xenograft model could further strengthen the tumor-driven effect of c-Myc overexpression. Thus, our findings revealed a novel mechanism involved in tumorigenesis in which the WSB1/c-Myc feedforward circuit played an essential role, highlighting a potential c-Myc intervention strategy in cancer treatment.

Patogenia y tratamiento de la mucositis asociada al tratamiento de radioterapia y/o quimioterapia en pacientes con cáncer de cabeza y cuello / Pathogenesis and treatment of mucositis associated with radiotherapy and / or chemotherapy treatment in patients with head and neck cancer / Patogênese e tratamento da mucosite associada ao tratamento com radioterapia e / ou quimioterapia em pacientes com câncer de cabeça e pescoço

Resumen: La mucositis es un efecto adverso frecuente e invalidante en los pacientes oncológicos que reciben tratamiento de Radioterapia y Quimioterapia a altas dosis y muchas veces lleva a la suspensión del tratamiento. Si bien es una entidad que tiene gran relevancia en los pacientes e importante impacto económico en las instituciones de salud, no existen tratamientos claramente establecidos ni eficaces para mejorar esta condición. El objetivo de esta revisión es analizar la evidencia disponible en el tratamiento de la mucositis, y el respaldo científico e impacto que tienen conductas habitualmente tomadas en su tratamiento.

Abstract: Mucositis is a frequent and disabling adverse effect in cancer patients who received radiation therapy and chemotherapy at high doses and often discontinues treatment. Although it is an entity that has great relevance in patients and an important economic impact in health institutions, there are no clearly established or modified treatments to improve this condition. The objective of this review is to analyze the available evidence in the treatment of mucositis, and the scientific support and impact of behaviors commonly taken in its treatment.

Resumo: A mucosite é um efeito adverso frequente e incapacitante em pacientes com câncer que receberam radioterapia e quimioterapia em altas doses e muitas vezes interrompe o tratamento. Embora seja uma entidade que tenha grande relevância nos pacientes e um importante impacto econômico nas instituições de saúde, não existem tratamentos claramente estabelecidos ou modificados para melhorar essa condição. O objetivo desta revisão é analisar as evidências disponíveis no tratamento da mucosite, o suporte científico e o impacto das condutas comumente adotadas no seu tratamento.

Paraganglioma. Presentación de caso / Paraganglioma. Case presentation / Paraganglioma. Apresentação do caso

RESUMEN El Paraganglioma es un tumor poco frecuente de origen neuroectodérmico derivado del sistema nervioso autónomo. Acude a consulta paciente masculino de 52 años de edad, procedencia rural con antecedente de salud. El cual acude a la consulta, refiriendo que hace más menos 6 meses presenta un aumento de volumen en la región lateral izquierda del cuello, que fue aumentando de tamaño progresivamente, sin presentar dolor. Se le realizó biopsia incisiónal, que confirmó un Angioendotelioma papilar seromatoso; luego de la excerilisis presentó dehiscencia de la herida y aumento de tamaño de la lesión en forma de ulcerada de más menos 10cm, por lo que es remitido al Hospital Oncológico de Santiago de Cuba, centro donde se decide su inscripción para evaluar inicio de tratamiento oncoespecifico. En el examen de la lámina se diagnostica histopatológicamente un Ganglioma sugiriéndose estudio en centro de referencia nacional. Se aplicó tratamiento quirúrgico. El tratamiento de elección fue la cirugía con su embolización previa. Se recomendó seguimiento a largo plazo del paciente por el alto riesgo recurrente de enfermar.

ABSTRACT Paraganglioma is a rare tumor of neuroectodermal origin derived from the autonomic nervous system. A 52-year-old male patient, rural origin with a health history, comes to the office. The patient attended the consultation, reporting that for more than 6 months he had an increase in volume in the left lateral region of the neck, which was progressively increasing in size, without presenting pain. An incision biopsy was performed, which confirmed a seromatous papillary angioendothelioma; After excerilysis, he presented dehiscence of the wound and an increase in the size of the lesion in the form of an ulcerated lesion of more than 10cm, for which he was referred to the Oncological Hospital of Santiago de Cuba, a center where his registration was decided to evaluate the start of cancer-specific treatment . In the examination of the lamina a ganglioma is diagnosed histopathologically, suggesting study in a national reference center. Surgical treatment was applied. The treatment of choice was surgery with its prior embolization. Long-term follow-up of the patient was recommended due to the high recurrent risk of illness.

RESUMO O paraganglioma é um tumor raro de origem neuroectodérmica derivado do sistema nervoso autônomo. Paciente do sexo masculino, 52 anos, origem rural e histórico de saúde, chega ao consultório. O paciente compareceu à consulta, relatando que há mais de 6 meses apresentou aumento de volume na região lateral esquerda do pescoço, que foi aumentando de tamanho progressivamente, sem apresentar dor. Foi realizada biópsia incisional, que confirmou um angioendotelioma papilar seromatoso; Após a excerilise, apresentou deiscência da ferida e aumento do tamanho da lesão em forma de lesão ulcerada de mais de 10cm, pela qual foi encaminhado ao Hospital Oncológico de Santiago de Cuba, centro onde se decidiu seu cadastro para avaliar o início do tratamento específico do câncer . No exame da lâmina é feito o diagnóstico histopatológico de ganglioma, sugerindo estudo em centro de referência nacional. O tratamento cirúrgico foi aplicado. O tratamento de escolha foi a cirurgia com sua embolização prévia. O acompanhamento em longo prazo do paciente foi recomendado devido ao alto risco recorrente de doença.