Tiago Bezerra de Sá de Sousa Nogueira

Objetivo: Avaliar a eficácia do uso de biomarcadores plasmáticos no diagnóstico precoce do Alzheimer. Metodologia: O presente estudo trata-se de uma revisão integrativa da literatura, em que foram realizadas buscas, no período de outubro de 2019, por publicações nas base de dados U.S. National Library of Medicine and the National Institutes Health (PubMed) e na Scientific Electronic Library Online (SciELO) nos últimos 5 anos. Os descritores empregados para a seleção dos estudos, obtidos junto aos Descritores em Ciências da Saúde (DeCS), foram: Alzheimer AND Biomarcadores plasmáticos AND Diagnóstico precoce. Resultados: Foram selecionados 19 artigos após aplicados os critérios de inclusão e exclusão. Após a categorização e análise das publicações, foi identificado que 100% (n=19) dos artigos foram publicados em inglês, 36,8% (n=7) foram publicados em 2018 e 42,10% (n=8) abordavam a temática dos biomarcadores proteicos. Conclusão: Os biomarcadores plasmáticos são eficazes no diagnóstico precoce do Alzheimer, possibilitando um tratamento antecipado e mais eficiente no retardo da progressão dos sintomas. O uso combinado dos biomarcadores pode representar a melhor abordagem de rastreio, uma vez que teriam uma alta acurácia.

Neoadjuvant radiotherapy (RT) and chemotherapy are applied to large, high-grade extremity soft tissue sarcomas to treat metastatic disease earlier and sterilize margins to perform R0 surgery. However, preoperative RT increases wound complication rates (rWC), delaying adjuvant chemotherapy or preventing it from being administered altogether. Hypofractionated neoadjuvant RT can be offered in this situation, concomitant to chemotherapy, allowing patients to receive chemotherapy as a preoperative treatment in less time with an acceptable rWC. The objectives of this protocol are to maintain low rates of morbidity and mortality compared to literature data, improving survival rates and avoiding poor responders from receiving unnecessary adjuvant chemotherapy. This noncontrolled, single-arm, phase 2 clinical trial recruited patients aged over 18 years with high-grade soft tissue sarcomas in the girdles or extremities. Three neoadjuvant chemotherapy (ifosfamide and doxorubicin) cycles were administered with 5 days of hypofractionated RT (25 Gy in 5 fractions) in the second cycle of doxorubicin only. Viable cell counts in the surgical specimen were measured, and patients in whom this value was less than 30% continued to receive an additional 3 full chemotherapy cycles as adjuvant treatment. Primary endpoint will be disease-specific survival measured by the evaluation of local and distant recurrence after neoadjuvant treatment. The secondary endpoints will be wound complication and amputation rates and chemotherapy toxicity. We also will record the viable cell rates after the schema and correlate this with survival. As seems with other solid tumors, hypofractionated RT has comparable efficacy and safety as conventional fractionation. This modality of treatment combined with chemotherapy could increase the pathological response rates and improve the outcomes of select patients. ClinicalTrials.gov NCT02812654; https://clinicaltrials.gov/ct2/show/NCT02812654 (Archived by WebCite at http://www.webcitation.org/6qC3puBOy).