RESUMOA Aprendizagem Baseada em Problemas (ABP), introduzida no ensino de Ciências da Saúde na McMaster University, Canadá, em 1969, é uma proposta pedagógica que consiste no ensino centrado no estudante e baseado na solução de problemas, reais ou simulados. Os alunos, para solucionar esse problema, recorrem aos conhecimentos prévios, discutem, estudam, adquirem e integram os novos conhecimentos. Essa integração, aliada à aplicação prática, facilita a retenção do conhecimento. Portanto, a ABP valoriza, além do conteúdo a ser aprendido, a forma como ocorre o aprendizado, reforçando o papel ativo do aluno neste processo, permitindo que ele aprenda como aprender. A ABP oferece diversas vantagens, como o desenvolvimento da autonomia, a interdisciplinaridade, a indissociabilidade entre teoria e práti-ca, o desenvolvimento do raciocínio crítico e de habilidades de comunicação, e a educação permanente. Porém, para a sua utilização são necessários investimentos em recursos humanos e materiais, além de um programa de capacitação de professores e alunos bem estruturado, que devem sempre ser considerados antes de sua implementação. Palavras

Background Optical coherence tomography (OCT) allows tissue histologic-like evaluation, but without tissue fixation or staining. We investigated OCT images from tissues obtained at thyroid and parathyroid surgeries to provide a preliminary assessment as to whether these images contain sufficient information for recognition and differentiation of normal neck tissues. Methods Normal tissues were obtained from patients undergoing surgical treatment. Two new-generation OCT systems, including optical frequency domain imaging (OFDI) and μOCT, were compared to representative hematoxylin-eosin histology. Results Thyroid, fat, muscle, lymph nodes, and parathyroid tissues were evaluated. Histologic-like microscopic characteristics sufficient for tissue type identification was realized using both systems for all tissue types examined. Conclusion This pilot study demonstrated that new-generation OCT systems are capable of recognizing and differentiating neck tissues encountered during thyroid and parathyroid surgeries. Further advances in OCT miniaturization and development of sterile intraoperative probe formats may allow OCT to offer an intraoperative “optical biopsy” without fixation, staining, or tissue resection.

Traqueostomia consiste na abertura da parede anterior da traqueia comunicando-a com o meio externo. Está indicada em situações onde existe obstrução da via aérea alta, acúmulo de secreção traqueal,debilidade da musculatura respiratória e intubação traqueal prolongada. Ou seja, a indicação ocorreem situações em que a dificuldade respiratória não possa ser revertida em curto espaço de tempo.

No abstract

Dietary restriction (DR) reduces adiposity and improves metabolism in patients with one or more symptoms of metabolic syndrome. Nonetheless, it remains elusive whether the benefits of DR in humans are mediated by calorie or nutrient restriction. This study was conducted to determine whether isocaloric dietary protein restriction is sufficient to confer the beneficial effects of dietary restriction in patients with metabolic syndrome. We performed a prospective, randomized controlled dietary intervention under constant nutritional and medical supervision. Twenty-one individuals diagnosed with metabolic syndrome were randomly assigned for caloric restriction (CR; n = 11, diet of 5941 ± 686 KJ per day) or isocaloric dietary protein restriction (PR; n = 10, diet of 8409 ± 2360 KJ per day) and followed for 27 days. Like CR, PR promoted weight loss due to a reduction in adiposity, which was associated with reductions in blood glucose, lipid levels, and blood pressure. More strikingly, both CR and PR improved insulin sensitivity by 62.3% and 93.2%, respectively, after treatment. Fecal microbiome diversity was not affected by the interventions. Adipose tissue bulk RNA-Seq data revealed minor changes elicited by the interventions. After PR, terms related to leukocyte proliferation were enriched among the upregulated genes. Protein restriction is sufficient to confer almost the same clinical outcomes as calorie restriction without the need for a reduction in calorie intake. The isocaloric characteristic of the PR intervention makes this approach a more attractive and less drastic dietary strategy in clinical settings and has more significant potential to be used as adjuvant therapy for people with metabolic syndrome.

Fine-needle aspiration cytology is the standard technique to diagnose thyroid pathologies. However, this method results in a high percentage of inconclusive and false negatives. The use of time-resolved fluorescence techniques to detect biochemical composition and tissue structure alterations could help to develop a portable, minimally invasive, and nondestructive method to assist during surgical procedures. This study aimed to use fluorescence lifetimes to differentiate healthy and benign tissues from malignant thyroid tissue. The thyroid tissue was excited at 298-300 nm and the fluorescence decay registered at 340 and 450 nm. We observed fluorescence lifetimes at 340 nm emission of 0.80 ± 0.26 and 3.94 ± 0.47 ns for healthy tissue; 0.90 ± 0.24 and 4.05 ± 0.46 ns for benign lesions; and 1.21 ± 0.14 and 4.63 ± 0.25 ns for malignant lesions. For 450 nm emissions, we obtain lifetimes of 0.25 ± 0.18 and 3.99 ± 0.39 ns and for healthy tissue, 0.24 ± 0.17 and 4.20 ± 0.48 ns for benign lesions, 0.33 ± 0.32 and 4.55 ± 0.55 ns for malignant lesions. Employing analysis of variance, we differentiate malignant lesions from benign and healthy tissues. In addition, we use quadratic discriminant analysis to distinguish malignant from benign and healthy tissues with an accuracy of 76.1%, sensitivity of 74.7%, and specificity of 83.3%. These results indicate that time-resolved fluorescence can assist medical evaluation of thyroid pathologies during surgeries.

Primary hyperparathyroidism can be a precocious manifestation of MEN2A. This case report highlights that asymptomatic hypercalcemia should be scrutinized in children related to patients with MEN2A who carry a mutation in the RET proto-oncogene, especially mutations in the codon 634, before the currently recommended age of 8 years.

Fine-needle aspiration cytology is the standard technique to diagnose thyroid pathologies. However, this method has a high percentage of inconclusive and false-negative results for benign and malignant lesions. Hence, it is important to search for a new method to assist medical evaluation during these surgical procedures. The use of time-resolved fluorescence techniques to detect biochemical composition and tissue structure alterations could help to develop a portable, minimally invasive, and non-destructive method to assist medical evaluation. In this study, we investigated 17 human thyroid samples by absorbance, fluorescence, excitation, and time-resolved fluorescence measurements. This initial investigation has demonstrated that thyroid fluorescence originates from many endogenous fluorophores and culminates in several bands. The fluorescence lifetimes of benign and malignant lesions were significantly different, as attested by analysis of variance using Tukey test with individual confidence level of 98.06%. Our results suggest that fluorescence lifetimes of benign and malignant lesions can potentially assist diagnosis. After further investigations, fluorescence methods could become a tool for the surgeon to identify differences between normal and pathological thyroid tissues.