Introdução: O melanoma mucoso de cabeça e pescoço (MMCP) é mais agressivo do que o melanoma cutâneo, marcadores prognósticos desta patologia não foram completamente esclarecidos devido a sua raridade. Em recentes estudos, algumas vias moleculares foram descritas na fisiopatologia destes tumores. Entre estas vias, existe a via da MAPK (Mitogen Activated Protein Quinase). Esta via de sinalização está envolvida no controle do crescimento celular, proliferação e migração, com um papel no desenvolvimento e progressão do melanoma. Além disso, a mutação do gene KIT foi identificada em melanomas, indicando a possibilidade de benefícios terapêuticos com o uso dos inibidores de tirosino-quinase. Objetivos: descrever a prevalência e características de mutações ativadoras do gene KIT em 28 pacientes com MMCP tratados no Instituto Nacional do Câncer-INCa; avaliar a relação entre a presença de mutação ativadora do gene KIT e evolução clínica dos pacientes tratados em relação ao estadiamento, sobrevida livre de doença e sobrevida global. Métodos: Estudo retrospectivo de coorte, foram incluídos 28 pacientes com MMCP tratados no INCA, entre 1998 e 2009. Foram analisados: estadiamento, tratamento primário, sobrevida livre de doença (SLD) e sobrevida global (SG). As curvas de sobrevida foram analisados utilizando o método de Kaplan-Meier, com software SPS 11.0. Análise KIT: O DNA foi extraído a partir de tecido incluído e fixado em parafina. O procedimento consiste de múltiplas etapas de desparafinização com xilol. Os restos celulares são precipitados por centrifugação e o DNA, no sobrenadante é utilizado nas reações de PCR (direto ou diluído). A análise mutacional do gene foi realizada utilizando-se a amplificação por PCR seguida pelo sequenciamento genômico. As análises são iniciadas pelo éxon 11, seguidas do éxon 9, 17 e 13. Resultados: Os pacientes eram predominantemente do sexo feminino (57%). A idade de apresentação variou de 27 a 85 anos. A região nasossinusal foi o sítio primário mais frequente (75%). Todos os pacientes foram submetidos a ressecção cirúrgica. Dezessete pacientes receberam radioterapia adjuvante (37%). As recorrências ocorreram em 82% dos pacientes. Presença de mutação de KIT foi encontrada em 7 casos (25%), três no éxon 9, 3 no éxon 11 e 1 no éxon 13. Fatores preditivos de recorrência foram índice mitótico (p = 0,05), invasão vascular (p = 0,043), e a disseminação perineural (p = 0,034). Não houve diferenças significativas na SLD e SG de acordo com a mutação KIT. Conclusão: A presente série incluiu 28 casos tratados. Sete casos (25%) tinham mutações ativadoras KIT. Esta descoberta sugere que existe um grupo de pacientes que poderiam se beneficiar com a terapia-alvo adequado com inibidores de tirosino-quinase / Unlike their cutaneous counterparts, head and neck mucosal malignant melanomas (HNMM) behave much more aggressively and their prognostic markers have not been fully elucidated. In recent studies, some molecular pathways have been found to be involved in the pathogenesis of melanomas. Among these, there is a proliferative MAPK pathway (\"Mitogen Activated Protein Kinase\"). This signaling pathway is involved in controlling cell growth, proliferation and migration, with a role in the development and progression of melanoma. In addition, KIT gene mutation has been identified in melanomas, indicating that there may be potential therapeutic benefits of tyrosine kinase inhibitors. Objectives: Evaluation of KIT mutation prevalence in a subset of 28 patients with HNMM treated at a single institution, establishing the relationship between different mutations and outcome (DFS and OS). The primary end-point of the study was to define the incidence of KIT mutations in HNMM, including the relationship between KIT mutations with disease-free survival (DFS) and overall survival (OS) in HNMM. Secondary end-points were correlation among therapeutic options, histopathological findings, demographic data and clinical response. Methods: This retrospective study comprised data of 28 patients with HNMM treated at Brazilian National Cancer Institute (INCA) between 2000 and 2011. Clinical analysis included patients characteristics, staging, primary and palliative treatments, disease free survival and overall survival. Progression-free survival and overall survival were analyzed using the Kaplan-Meier method, with SPS 11.0 software. KIT analysis: paraffin blocks were selected following analyses of histologic preparations, enabling DNA extraction. Different DNA concentrations were employed in PCR amplifications, based on DNA integrity. PCR amplification of exon, 9, 11, 13 and 17 was performed. . Results: Patients were predominantly females (57%). The age of presentation ranged from 27 to 85 years. The sinonasal region was the most frequent primary site (75%). All patients underwent surgical resection. Seventeen patients received adjuvant radiotherapy (37%). Recurrences occurred in 82% patients. Oncologic mutations in KIT were found in 7 (25%) of seven tumors, 3 in exon 9, 3 in exon 11 and 1 in exon 13. Predictive factors for recurrence were mitotic rate (p=0.05), vascular invasion (p=0.043), and perineural spread (p=0.034). There were no significant differences in DFS and OS according to KIT mutation. Conclusion: HNMM remains a rare disease. The present single-institution series includes 28 cases treated in single institution. Seven cases (25%) had activating KIT mutations, which is an increased prevalence of activating KIT mutations in this specific subset of mucosal melanomas. This finding suggests that there is a group of patients who might benefit with appropriate targeted therapy with kinase inhibitors

Die antioxidativen Enzyme Katalase (KAT), Glutathion-Peroxidase (GPX), Glutathion-Reduktase (GR), Superoxid-Dismutase (SOD) und Glutathion-S-Transferase (GST) sind an der intrazellulären Abwehr von oxidativem Stress beteiligt. Diverse Arbeitsgruppen fanden eine Hochregulation der antioxidativen Enzyme (AOEs) nach Exposition auf Ozon. In der vorliegenden Studie sollte an einem von Schierhorn und Mitarbeitern entwickelten Kulturmodell der nasalen Mukosa des Menschen untersucht werden, ob Aktivitätsänderungen der AOEs nach Ozonexposition in vitro zu verzeichnen sind. Zu diesem Zweck wurde die nasale Mukosa von 67 Patienten, die sich wegen nasaler Atmungsbehinderung einer Conchotomie unterzogen hatten, 24 Stunden bei 37 °C und 5% CO2 kultiviert und parallel unter den selben Bedingungen einer zusätzlichen Ozonkonzentration von 120 ppb ausgesetzt. Tendenzielle Aktivitätsänderungen durch Ozon ließen sich bei der GPX (13.8 auf 17.7 mU/mg Protein, 28% Steigerung) und der SOD (8.4 auf 9.7 U/mg Protein, 15% Steigerung) feststellen. Diese Aktivitätszunahmen wiesen jedoch keine Signifikanz auf. Aktivtätsänderungen bei KAT, GR und GST durch die Ozonexposition wurden nicht gefunden. Alter der Patienten, Geschlecht und Zigarettenrauchen nahmen den Ergebnissen dieser Studie nach keinen Einfluß auf die Regulation der AOEs nach Ozonexposition. Die Deletion der Glutathion-S-Transferase M1, die bei etwa 50% der mitteleuropäischen Bevölkerung zu finden ist, veränderte die Regulation der SOD nach in vitro Ozonexposition. Die GST-defizienten Patienten dieser Studie beantworteten die Ozonexposition mit einer signifikanten Hochregulation der SOD (p / Antioxidant enzymes as catalase (CAT), glutathione peroxidase (GPX), superoxide dismutase (SOD) and glutathione S-transferase (GST) are thought the primary cellular defense mechanism against reactive oxygen species. Ozone, a highly reactive oxidant, is known to cause respiratory symptoms at ambiental doses. A number of studies have shown the mucosa of the respiratory tract to be the first target site of ozone toxicity. Other animal studies demonstrated an upregulation of mucosal antioxidant enzymes after ozone exposition. Concerning to the antioxidant defense mechanisms of the human nasal mucosa no studies are found so far. The purpose of this study was to determine if in vitro ozone exposure of human nasal mucosa results in changes in the activity of CAT, GPX, SOD, GST and glutathione reductase (GR). Nasal mucosa from 67 patients was cultivated in a specially designed in vitro organ culture and exposed to 120 ppb ozone for 24 hours. The results were compared with the histamin release which is known to be upregulated from human nasal mucosa after ozone exposition (60-200 ppb).

Introdução: O diagnóstico etiológico da leishmaniose tegumentar baseia-se na detecção do parasito em amostras de lesão colhida por método invasivo. A detecção de DNA do parasito, através da PCR, poderia ser uma alternativa mais sensível, porém não está disponível na rotina diagnóstica e foi padronizada em amostras clínicas colhidas por métodos invasivos, tais como raspado, aspirado ou biópsia da lesão. Uma proposta para o diagnóstico de leishmaniose tegumentar seria a obtenção de material de lesão (mucosa ou cutânea) através de métodos de coleta menos invasivos e que fosse possível detectar DNA do parasito a partir de pequenas quantidades de amostra clínica. Neste trabalho avaliamos a eficácia da PCR, em amostras colhidas por método não invasivo (swab de lesão) como ferramenta para ser utilizada no diagnóstico de leishmaniose (mucosa e cutânea localizada), bem como para detecção precoce de Leishmania em mucosa de pacientes com lesão cutânea ativa e como ferramenta de avaliação de resposta terapêutica na leishmaniose mucosa. Metodologia: Entre os meses de agosto de 2013 a julho de 2015 foram selecionados 57 pacientes no ambulatório de Leishmanioses do Instituto de Infectologia Emilio Ribas, dos quais foram coletadas amostras de lesão cutânea ou mucosa através de swab e de biópsia das lesões. Em paralelo, foi realizada rotina laboratorial para diagnóstico de leishmaniose nos pacientes que apresentavam lesão ativa (anatomopatológico, pesquisa e cultura de Leishmania, sorologia e teste de Montenegro). As amostras colhidas por biópsia ou swab foram avaliadas através da reação em cadeia da polimerase tendo como alvos o minicírculo do DNA do cinetoplasto (kDNA) de Leishmania para PCR convencional e o gene da proteína de choque térmico 70Kda (Hsp70) para PCR convencional e PCR em tempo real. Resultados: A detecção de DNA de Leishmania em amostras colhidas por swab de lesões ativas foi semelhante as das amostras colhidas por biópsia das mesmas lesões. Quando comparado aos métodos comumente empregados no diagnóstico da leishmaniose tegumentar, a PCR em material colhido por swab apresentou desempenho superior. Foi demostrado que utilizando os iniciadores para o alvo kDNA obtivemos maior eficácia quando comparado com o alvo Hsp70, seja pela PCR convencional como pela PCR em tempo real (sensibilidade de 94.1%, 42.4% e 39.4%, respectivamente). Ao analisarmos amostras de pacientes já tratados para leishmaniose mucosa observamos positividade de 86% para kDNA e de 22% para Hsp70. Nas amostras de mucosa nasal íntegra e com leishmaniose cutânea ativa, coletadas com swab para detecção precoce da doença, obteve-se 92.9% de positividade com kDNA e 28.6% com Hsp70. Conclusões: Os resultados obtidos sugerem que o método de coleta de amostra biológica através do swab para o diagnóstico molecular da leishmaniose tegumentar apresenta eficácia comparada com o método de coleta por biópsia. A detecção de DNA em amostras colhidas por swab permite analisar a presença de DNA do parasito em tecido sem lesão, podendo detectar a presença de Leishmania mesmo antes de alterações clínicas estarem presentes. A monitorização da resposta terapêutica da leishmaniose mucosa pode ser feita através da detecção de DNA de Leishmania em amostras colhidas por swab / Introduction: Etiologic diagnosis of tegumentary leishmaniasis is based on the detection of the parasite in injury samples collected by invasive method. DNA detection of the parasite by PCR, could be a more sensible alternative, but is not available in routine practice and it was standardized in clinical samples by invasive methods such as scrapes, aspirate or biopsy of the lesion. A proposal for the diagnosis of tegumentary leishmaniasis lesions would obtaining material (cutaneous or mucosal) through less invasive collection methods, and it was possible to detect parasite DNA from small quantities of clinical specimen. In this study we evaluate the effectiveness of the PCR in samples collected by non-invasive method (swab injury) as a tool to be used in the diagnosis of leishmaniasis (mucosal and localized cutaneous), as well as for early detection of Leishmania in mucosa from patients with cutaneous lesions active and as an evaluation tool of therapeutic response in mucosal leishmaniasis. Methodology: Between August 2013 to July 2015 were selected 57 patients from the Leishmaniasis out clinic from the Institute of Infectious Diseases Emilio Ribas, which samples of cutaneous lesion or mucosa were collected by swab and biopsy of the lesions. In parallel, routine laboratory was carried out for the diagnosis of leishmaniasis in patients with active lesions (histopathology, search and Leishmania culture, serology and Montenegro skin test antigen). The samples taken by biopsy or swab were assessed by polymerase chain reaction having as targets the minicircle kinetoplast DNA (kDNA) of Leishmania for conventional PCR and gene heat shock protein 70kDa (Hsp70) for conventional PCR and real-time PCR. Results: Leishmania DNA detection in samples taken by swab of active lesions was similar to the samples taken by biopsy from the same lesion. When compared to the methods commonly used in the diagnosis of tegumentary leishmaniasis, PCR material collected by swab showed superior performance. It was shown that using the primers for the target kDNA obtained more effectively compared with the target Hsp70, or by conventional PCR and by real-time PCR (sensitivity 94.1%, 42.4% and 39.4%, respectively). When analyzing samples from patients already treated for mucosal leishmaniasis observed positivity of 86% to kDNA and 22% for Hsp70. Samples of nasal mucosa and active cutaneous leishmaniasis, collected by swab for early detection of disease, it obtained 92.9% positivity with kDNA and 28.6% with Hsp70. Conclusions: Our results suggest that the biological sample collection method using the swab for the molecular diagnosis of tegumentary leishmaniasis had compared efficacy with biopsy collection method. The DNA detection collected by swab samples allows to analyze the presence of DNA of the parasite in tissue without damage and can detect the presence of Leishmania even before clinical changes are present. The monitoring of therapeutic response mucosal leishmaniasis can be made by Leishmania DNA detection in samples per swab

Introdução: O diagnóstico etiológico da leishmaniose tegumentar baseia-se na detecção do parasito em amostras de lesão colhida por método invasivo. A detecção de DNA do parasito, através da PCR, poderia ser uma alternativa mais sensível, porém não está disponível na rotina diagnóstica e foi padronizada em amostras clínicas colhidas por métodos invasivos, tais como raspado, aspirado ou biópsia da lesão. Uma proposta para o diagnóstico de leishmaniose tegumentar seria a obtenção de material de lesão (mucosa ou cutânea) através de métodos de coleta menos invasivos e que fosse possível detectar DNA do parasito a partir de pequenas quantidades de amostra clínica. Neste trabalho avaliamos a eficácia da PCR, em amostras colhidas por método não invasivo (swab de lesão) como ferramenta para ser utilizada no diagnóstico de leishmaniose (mucosa e cutânea localizada), bem como para detecção precoce de Leishmania em mucosa de pacientes com lesão cutânea ativa e como ferramenta de avaliação de resposta terapêutica na leishmaniose mucosa. Metodologia: Entre os meses de agosto de 2013 a julho de 2015 foram selecionados 57 pacientes no ambulatório de Leishmanioses do Instituto de Infectologia Emilio Ribas, dos quais foram coletadas amostras de lesão cutânea ou mucosa através de swab e de biópsia das lesões. Em paralelo, foi realizada rotina laboratorial para diagnóstico de leishmaniose nos pacientes que apresentavam lesão ativa (anatomopatológico, pesquisa e cultura de Leishmania, sorologia e teste de Montenegro). As amostras colhidas por biópsia ou swab foram avaliadas através da reação em cadeia da polimerase tendo como alvos o minicírculo do DNA do cinetoplasto (kDNA) de Leishmania para PCR convencional e o gene da proteína de choque térmico 70Kda (Hsp70) para PCR convencional e PCR em tempo real. Resultados: A detecção de DNA de Leishmania em amostras colhidas por swab de lesões ativas foi semelhante as das amostras colhidas por biópsia das mesmas lesões. Quando comparado aos métodos comumente empregados no diagnóstico da leishmaniose tegumentar, a PCR em material colhido por swab apresentou desempenho superior. Foi demostrado que utilizando os iniciadores para o alvo kDNA obtivemos maior eficácia quando comparado com o alvo Hsp70, seja pela PCR convencional como pela PCR em tempo real (sensibilidade de 94.1%, 42.4% e 39.4%, respectivamente). Ao analisarmos amostras de pacientes já tratados para leishmaniose mucosa observamos positividade de 86% para kDNA e de 22% para Hsp70. Nas amostras de mucosa nasal íntegra e com leishmaniose cutânea ativa, coletadas com swab para detecção precoce da doença, obteve-se 92.9% de positividade com kDNA e 28.6% com Hsp70. Conclusões: Os resultados obtidos sugerem que o método de coleta de amostra biológica através do swab para o diagnóstico molecular da leishmaniose tegumentar apresenta eficácia comparada com o método de coleta por biópsia. A detecção de DNA em amostras colhidas por swab permite analisar a presença de DNA do parasito em tecido sem lesão, podendo detectar a presença de Leishmania mesmo antes de alterações clínicas estarem presentes. A monitorização da resposta terapêutica da leishmaniose mucosa pode ser feita através da detecção de DNA de Leishmania em amostras colhidas por swab / Introduction: Etiologic diagnosis of tegumentary leishmaniasis is based on the detection of the parasite in injury samples collected by invasive method. DNA detection of the parasite by PCR, could be a more sensible alternative, but is not available in routine practice and it was standardized in clinical samples by invasive methods such as scrapes, aspirate or biopsy of the lesion. A proposal for the diagnosis of tegumentary leishmaniasis lesions would obtaining material (cutaneous or mucosal) through less invasive collection methods, and it was possible to detect parasite DNA from small quantities of clinical specimen. In this study we evaluate the effectiveness of the PCR in samples collected by non-invasive method (swab injury) as a tool to be used in the diagnosis of leishmaniasis (mucosal and localized cutaneous), as well as for early detection of Leishmania in mucosa from patients with cutaneous lesions active and as an evaluation tool of therapeutic response in mucosal leishmaniasis. Methodology: Between August 2013 to July 2015 were selected 57 patients from the Leishmaniasis out clinic from the Institute of Infectious Diseases Emilio Ribas, which samples of cutaneous lesion or mucosa were collected by swab and biopsy of the lesions. In parallel, routine laboratory was carried out for the diagnosis of leishmaniasis in patients with active lesions (histopathology, search and Leishmania culture, serology and Montenegro skin test antigen). The samples taken by biopsy or swab were assessed by polymerase chain reaction having as targets the minicircle kinetoplast DNA (kDNA) of Leishmania for conventional PCR and gene heat shock protein 70kDa (Hsp70) for conventional PCR and real-time PCR. Results: Leishmania DNA detection in samples taken by swab of active lesions was similar to the samples taken by biopsy from the same lesion. When compared to the methods commonly used in the diagnosis of tegumentary leishmaniasis, PCR material collected by swab showed superior performance. It was shown that using the primers for the target kDNA obtained more effectively compared with the target Hsp70, or by conventional PCR and by real-time PCR (sensitivity 94.1%, 42.4% and 39.4%, respectively). When analyzing samples from patients already treated for mucosal leishmaniasis observed positivity of 86% to kDNA and 22% for Hsp70. Samples of nasal mucosa and active cutaneous leishmaniasis, collected by swab for early detection of disease, it obtained 92.9% positivity with kDNA and 28.6% with Hsp70. Conclusions: Our results suggest that the biological sample collection method using the swab for the molecular diagnosis of tegumentary leishmaniasis had compared efficacy with biopsy collection method. The DNA detection collected by swab samples allows to analyze the presence of DNA of the parasite in tissue without damage and can detect the presence of Leishmania even before clinical changes are present. The monitoring of therapeutic response mucosal leishmaniasis can be made by Leishmania DNA detection in samples per swab

<p>Drug delivery to the nasal and ocular mucosa faces several obstacles. One of these is from the effective clearance mechanisms present in the nose and eye. Polymer gels with suitable rheological properties can facilitate the absorption of poorly absorbed drugs by increasing the contact time of the drug with the mucosa. This has been attributed to the rheological and mucoadhesive properties of the gel. The main objective of this thesis was to investigate the importance of these features for the anticipated in vivo contact time, here exemplified by the ocular and nasal routes of administration.</p><p>The in situ gelling polymer gellan gum was found to have a favourable rheological and in vivo performance. When administered in the nasal cavity of rats, a gel was formed that could remain at the site of administration for up to 4 hours. In addition, the epithelial uptake and transfer of a 3 kDa fluorescein dextran was higher than for a mannitol solution. Therefore, it was concluded that a gellan gum formulation should be a promising strategy for nasal drug delivery.</p><p>The potential mucoadhesive properties of a variety of polymer gels were investigated using a rheological method and by measuring the tensile force required to detach the gel from a mucosa. With both methods the rheological properties of the gel were a determining factor for the results obtained. The rheological method was found to have several limitations. One of these was that a positive response, interpreted as mucoadhesion, was only seen with weak gels. The tensile method could, in contrast, detect strengthening of the mucus only for strong gels. However, this method reflects the in vivo performance of the gel better than the rheological method.</p><p>Finally, dielectric spectroscopy was explored as a tool for investigating the likelihood of intimate surface contact between the gel and the mucus layer. This novel approach involved determining the ease with which a charged particle can pass the gel-mucus interface layer, and may enable the study of the events at the interface closer to the molecular level, than is possible with the rheological and tensile strength methods.</p>

Drug delivery to the nasal and ocular mucosa faces several obstacles. One of these is from the effective clearance mechanisms present in the nose and eye. Polymer gels with suitable rheological properties can facilitate the absorption of poorly absorbed drugs by increasing the contact time of the drug with the mucosa. This has been attributed to the rheological and mucoadhesive properties of the gel. The main objective of this thesis was to investigate the importance of these features for the anticipated in vivo contact time, here exemplified by the ocular and nasal routes of administration. The in situ gelling polymer gellan gum was found to have a favourable rheological and in vivo performance. When administered in the nasal cavity of rats, a gel was formed that could remain at the site of administration for up to 4 hours. In addition, the epithelial uptake and transfer of a 3 kDa fluorescein dextran was higher than for a mannitol solution. Therefore, it was concluded that a gellan gum formulation should be a promising strategy for nasal drug delivery. The potential mucoadhesive properties of a variety of polymer gels were investigated using a rheological method and by measuring the tensile force required to detach the gel from a mucosa. With both methods the rheological properties of the gel were a determining factor for the results obtained. The rheological method was found to have several limitations. One of these was that a positive response, interpreted as mucoadhesion, was only seen with weak gels. The tensile method could, in contrast, detect strengthening of the mucus only for strong gels. However, this method reflects the in vivo performance of the gel better than the rheological method. Finally, dielectric spectroscopy was explored as a tool for investigating the likelihood of intimate surface contact between the gel and the mucus layer. This novel approach involved determining the ease with which a charged particle can pass the gel-mucus interface layer, and may enable the study of the events at the interface closer to the molecular level, than is possible with the rheological and tensile strength methods.

Introdução: O melanoma mucoso de cabeça e pescoço (MMCP) é mais agressivo do que o melanoma cutâneo, marcadores prognósticos desta patologia não foram completamente esclarecidos devido a sua raridade. Em recentes estudos, algumas vias moleculares foram descritas na fisiopatologia destes tumores. Entre estas vias, existe a via da MAPK (Mitogen Activated Protein Quinase). Esta via de sinalização está envolvida no controle do crescimento celular, proliferação e migração, com um papel no desenvolvimento e progressão do melanoma. Além disso, a mutação do gene KIT foi identificada em melanomas, indicando a possibilidade de benefícios terapêuticos com o uso dos inibidores de tirosino-quinase. Objetivos: descrever a prevalência e características de mutações ativadoras do gene KIT em 28 pacientes com MMCP tratados no Instituto Nacional do Câncer-INCa; avaliar a relação entre a presença de mutação ativadora do gene KIT e evolução clínica dos pacientes tratados em relação ao estadiamento, sobrevida livre de doença e sobrevida global. Métodos: Estudo retrospectivo de coorte, foram incluídos 28 pacientes com MMCP tratados no INCA, entre 1998 e 2009. Foram analisados: estadiamento, tratamento primário, sobrevida livre de doença (SLD) e sobrevida global (SG). As curvas de sobrevida foram analisados utilizando o método de Kaplan-Meier, com software SPS 11.0. Análise KIT: O DNA foi extraído a partir de tecido incluído e fixado em parafina. O procedimento consiste de múltiplas etapas de desparafinização com xilol. Os restos celulares são precipitados por centrifugação e o DNA, no sobrenadante é utilizado nas reações de PCR (direto ou diluído). A análise mutacional do gene foi realizada utilizando-se a amplificação por PCR seguida pelo sequenciamento genômico. As análises são iniciadas pelo éxon 11, seguidas do éxon 9, 17 e 13. Resultados: Os pacientes eram predominantemente do sexo feminino (57%). A idade de apresentação variou de 27 a 85 anos. A região nasossinusal foi o sítio primário mais frequente (75%). Todos os pacientes foram submetidos a ressecção cirúrgica. Dezessete pacientes receberam radioterapia adjuvante (37%). As recorrências ocorreram em 82% dos pacientes. Presença de mutação de KIT foi encontrada em 7 casos (25%), três no éxon 9, 3 no éxon 11 e 1 no éxon 13. Fatores preditivos de recorrência foram índice mitótico (p = 0,05), invasão vascular (p = 0,043), e a disseminação perineural (p = 0,034). Não houve diferenças significativas na SLD e SG de acordo com a mutação KIT. Conclusão: A presente série incluiu 28 casos tratados. Sete casos (25%) tinham mutações ativadoras KIT. Esta descoberta sugere que existe um grupo de pacientes que poderiam se beneficiar com a terapia-alvo adequado com inibidores de tirosino-quinase / Unlike their cutaneous counterparts, head and neck mucosal malignant melanomas (HNMM) behave much more aggressively and their prognostic markers have not been fully elucidated. In recent studies, some molecular pathways have been found to be involved in the pathogenesis of melanomas. Among these, there is a proliferative MAPK pathway (\"Mitogen Activated Protein Kinase\"). This signaling pathway is involved in controlling cell growth, proliferation and migration, with a role in the development and progression of melanoma. In addition, KIT gene mutation has been identified in melanomas, indicating that there may be potential therapeutic benefits of tyrosine kinase inhibitors. Objectives: Evaluation of KIT mutation prevalence in a subset of 28 patients with HNMM treated at a single institution, establishing the relationship between different mutations and outcome (DFS and OS). The primary end-point of the study was to define the incidence of KIT mutations in HNMM, including the relationship between KIT mutations with disease-free survival (DFS) and overall survival (OS) in HNMM. Secondary end-points were correlation among therapeutic options, histopathological findings, demographic data and clinical response. Methods: This retrospective study comprised data of 28 patients with HNMM treated at Brazilian National Cancer Institute (INCA) between 2000 and 2011. Clinical analysis included patients characteristics, staging, primary and palliative treatments, disease free survival and overall survival. Progression-free survival and overall survival were analyzed using the Kaplan-Meier method, with SPS 11.0 software. KIT analysis: paraffin blocks were selected following analyses of histologic preparations, enabling DNA extraction. Different DNA concentrations were employed in PCR amplifications, based on DNA integrity. PCR amplification of exon, 9, 11, 13 and 17 was performed. . Results: Patients were predominantly females (57%). The age of presentation ranged from 27 to 85 years. The sinonasal region was the most frequent primary site (75%). All patients underwent surgical resection. Seventeen patients received adjuvant radiotherapy (37%). Recurrences occurred in 82% patients. Oncologic mutations in KIT were found in 7 (25%) of seven tumors, 3 in exon 9, 3 in exon 11 and 1 in exon 13. Predictive factors for recurrence were mitotic rate (p=0.05), vascular invasion (p=0.043), and perineural spread (p=0.034). There were no significant differences in DFS and OS according to KIT mutation. Conclusion: HNMM remains a rare disease. The present single-institution series includes 28 cases treated in single institution. Seven cases (25%) had activating KIT mutations, which is an increased prevalence of activating KIT mutations in this specific subset of mucosal melanomas. This finding suggests that there is a group of patients who might benefit with appropriate targeted therapy with kinase inhibitors

Orientadores: Ester Maria Danielli Nicola, Eulália Sakano / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-25T13:39:38Z (GMT). No. of bitstreams: 1 Ortiz_Erica_D.pdf: 2854168 bytes, checksum: c4f7e3d14049e592b11a3b339481fa12 (MD5) Previous issue date: 2014 / Resumo: Introdução: Acredita-se que a imunossupressão seja única causa para maior prevalência de rinossinusites (RS) no transplantado de células tronco hematopoiéticas (TCTH) principalmente naqueles com Doença do Enxerto contra o Hospedeiro (DECH) crônica. Pacientes submetidos ao TCTH podem apresentar alterações nasossinusais, que podem se relacionar ao próprio transplante, assim como pelo regime de condicionamento ou pela DECH. Entretanto, estas alterações nasossinusais não estão bem descritas na literatura assim como a associação entre estas e a rinossinusite. Objetivo: verificar a histologia e ultraestrutura da mucosa nasossinusal com RS no TCTH com e sem DECH; e verificar a influencia da RS nas possíveis alterações histológicas nestes pacientes. Método: estudo prospectivo exploratório de coorte transversal com análise estatística de dados obtidos da avaliação de mucosa de processo unciforme de pacientes transplantados com (16) e sem DECH (8) com RS; através da microscopia eletrônica de transmissão e óptica. Comparação da recorrência das RS e alterações histológicas. Resultados: 47% (14) tiveram apenas 1 ou 2 episódios e 33%, mais de 3 episódios de rinossinusite. Apenas a presença de microvilosidades foi significativamente maior nos pacientes sem GVHD (p=0,05). Não houve diferença significativa na quantidade de cílios, ultraestrutura ciliar, metaplasia escamosa, células caliciformes, vacuolização citoplasmática, densidade do infiltrado inflamatório, linfócitos, eosinófilos e corpúsculos apoptóticos intraepiteliais, glândulas mucosas, espessura da membrana basal, edema e fibrose subepiteliais entre os grupos com e sem DECH. Houve diminuição significante de cílios conforme maior recorrência de rinossinusite (p=0,008). Conclusão: pacientes com RS e TCTH não apresentaram diferenças nas alterações histológicas nasossinusais, exceto aumento de microvilosidades naqueles sem a DECH. Os transplantados com e sem DECH apresentaram somente diminuição dos cílios conforme o aumento da recorrência de RS / Abstract: INTRODUCTION: It is believed that immunosuppression is the sole cause for the occurrence of rhinosinusitis in hematopoietic stem cell transplant (HSCT). There is a high incidence of sinusitis in recipient patients, especially in those with Chronic Graft-Versus-Host disease (GVHD). Histopathological abnormalities were described in recipients¿ sinus mucosa compared to immunocompetent patients. There were also mucosal abnormalities related to cytotoxicity in the transplanted patients with chronic GVHD but no difference in ultrastructure between HSCT patients with and without GVHD, except for increased goblet cells in patients without GVHD. The relation between the sinonasal mucosa abnormalities of patients with and without GVHD and rhinosinusitis is not well established yet. OBJECTIVE: To verify the ultrastructure of the sinonasal mucosa of HSCT with and without GVHD with rhinosinusitis to understand the cause of high sinusitis incidence in recipients with and without GVHD. METHOD: A prospective study with preliminary exploratory statistical analysis of data obtained from the evaluation of the uncinate process mucosa of patients transplanted with (16) and without GVHD (8) with rhinosinusitis by transmission electron and optical microscopy. RESULTS: Of the patients, 47% (14) had only 1 or 2 episodes, and 33% had more than 3 episodes of rhinosinusitis. Only the presence of microvilli was significantly higher in patients without GVHD. There was no significant difference in the amount of cilia, ciliary ultrastructure, squamous metaplasia, goblet cells, vacuolization, density of the inflammatory infiltrate, intraepithelial lymphocytes, eosinophils, mucous glands, apoptotic corpuscles intraepithelial basement membrane thickness, edema and subepithelial fibrosis between groups. There was a significant decrease of cilia with higher recurrence of rhinosinusitis. CONCLUSION: There was an increase in microvilli HSCT without GVHD with rhinosinusitis, and the ultrastructure and histological changes of HSCT with and without GVHD did not change with the recurrence of rhinosinusitis. However, there was a decrease of cilia in the epithelium of the sinonasal HSCT with higher recurrence of rhinosinusitis / Doutorado / Otorrinolaringologia / Doutora em Ciências Médicas

Objective: Allergic rhinitis (AR) and chronic rhinosinusitis with nasal polyps (CRSwNP) are of high importance in otorhinolaryngology. Some of their symptoms are related to changes in the nasal trigeminal sensitivity. The aim of this study was to compare nasal trigeminal sensitivity in patients with AR, CRSwNP, and healthy controls (HC). - Methods: A total of 75 individuals participated (age 19–78 years; 34 AR, 10 CRSwNP and 31 HC). Olfactory function was determined using the extended Sniffin’ Sticks test battery. Trigeminal sensitivity was assessed with CO₂ detection thresholds.Trigeminal negative mucosal potentials (NMP) and EEG-derived event-related potentials (ERP) were recorded in response to selective olfactory (phenylethyl alcohol) and trigeminal (CO₂) stimuli using high-precision air-dilution olfactometry. - Results: In comparison to HC, AR patients had lower CO₂ thresholds, also reflected in shorter peak latencies in NMP and trigeminal ERP measurements. CRSwNP patients had a decreased sensitivity for trigeminal stimuli, also reflected in prolonged trigeminal ERP latencies, and reduced olfactory function compared to HC. - Conclusion: AR patients seemed to be more sensitive to trigeminal stimuli than CRSwNP patients. Importantly, the differences could be shown on psychophysical and electrophysiological levels. The changes in trigeminal sensitivity appear to be present already at the level of the respiratory epithelium. The differences between the two groups may depend on the specific inflammatory changes accompanying each disorder, the degree of inflammatory activity, or duration of the inflammatory disorder. However, because the sample sizes are relatively small, these results need to be confirmed in the future studies with larger groups.

<p>The blood-brain barrier restricts the access of many compounds, including therapeutic agents, to the brain. Several human studies indicate that nasal administration of hydrophilic compounds, such as peptides, can bypass the blood-brain barrier. The aims of this thesis were to develop and refine models for this direct nose-to-brain transfer.</p><p>In a mouse model, [³H]-dopamine was given as a unilateral nasal dose. The resulting radioactivity in the ipsilateral olfactory bulb was significantly higher than that in the contralateral bulb and peaked at 4 h. Tape section autoradiography showed that the radioactivity was concentrated in the olfactory nerve layer and the glomerular layer of the olfactory bulb. The olfactory transfer of dopamine was also studied <i>in vitro</i>. At a lower donor concentration, the mucosal-to-serosal dopamine permeability was higher than the serosal-to-mucosal permeability, but at a higher concentration, the permeability coefficients were similar. Together, these results suggest that the olfactory transfer of dopamine has an active component.</p><p>Olfactory transfer of fluorescein-labeled dextran through the epithelium and deeper tissues was studied in a rat model, which enabled visualization of the transfer using fluorescence microscopy. Although the epithelial transfer appeared to be mainly intracellular, transfer in the following deeper tissues was extracellular. Without altering the route of uptake, a gellan gum formulation enhanced the uptake of fluorescein dextran. The enhancing effect was considered likely to be the result of an increased residence time in the nasal cavity.</p><p>In conclusion, dopamine and fluorescein-labeled dextran were identified as suitable model compounds for the study of olfactory drug transfer mechanisms and the influence of drug formulation. Two new <i>in vitro</i> models of olfactory transfer were compared. Also, a rat model, which enabled the visualization of the entire nose-to-brain transfer, was developed.</p>