Promoção, vencimento e avaliação de desempenho do professor do ensino fundamental: o PCCR da rede municipal de ensino de Natal/RN (2004-2010)

This study is about the enhancement of the elementary school in Natal/RN, (PCCR - Law No. 058/2004), concerning to the horizontal promotion through the performance evaluation. It uses as reference the education policy on the legislative field hegemony and the managerial model. The analysis of the teacher´s valorization is based on the policy of Funds (Fundef and Fundeb) in the Brazilian social and educational agenda. The study focuses on the Career Plan, Career and Remuneration of teachers in the period (2004-2010).The study focuses on the Career Plan, Career and Remuneration of teachers in the period (2004-2010). The thesis argues for the necessity to adopt a direct relationship between career development and horizontal promotion for more others fifteen classes, no matter to any conditioning variables. In addition, the performance shall be evaluated by interval of 25 years to reach at least the provisions decided in the law, which determines the salary adjustment in 5% at every two years, as pointed at the PCCR, about teachers remuneration, and teachers qualifications. A work of a bibliographic and a documental review about the education funding with the purpose of enhancement of educational work, career concepts, and also promotion and evaluation performance as well was performed based on experts authors in this field. The survey was organized with the aim of articulating quantitative and qualitative information, analyzing data from the teacher's salary - payrolls and paychecks - also applying a questionnaire. After the implementation of the PCCR, it was found that the wage indices for horizontal promotion during the teaching career are tied to a strategy for evaluating the performance which disqualifies the teacher‟s salaries in a minimum percentage of 25% (up to 25 years) and there are also elements that disturb the promotion strategy. The national minimum wage was set in three salaries by the PSPN Lei nº11.738/2008 but it never reaches the three salaries at Natal/RN educational system.Otherwise, the elements that structure the horizontal promotion in fifteen classes, throughout the career, flout the minimum years of teaching work, long established in 25 years. In addition, changes in terms in the salary increase depend on individual efforts by professional development through titration. Concerning to the career, despite of the category approving its PCCR, neither this instrument nor the Funds Policy managed to establish regulations were able to cope effective rules for valuing the teachers in the educational district system. It is necessary to ensure, in percentage terms and financial, the real remuneration of teachers with the attainment of horizontal promotion, reviewing the elements that structure the career and the determinants of performance evaluation.

Estudo da correlação das características clínico-patológicas do câncer colorretal com a expressão imunohistoquímica de proteínas da progressão tumoral

Except the non-melanoma skin tumors, colorectal cancer is the second most common in the Southeastern Region of Brazil, the third most common in the Southern and Central Regions. It is also the forth most common in the Northern Region and it is the fifth one in the Northeastern. To assess pathological and clinical variables of colorectal Cancer is crucial to know the possible conclusions for the survival of patients and point out the characteristics in the progress of tumor, such as the profile of tumor invasion and its angiogenesis. This work focuses on analyzing clinically and pathologically some settings in colorectal cancer patients (CRC) in the city of Natal and its countryside through those variables as parameters of prognosis and determine the level of protein expression, for instance: E-cadherin (E-cad), beta- -catenin (β-cat), galectin-3 (gal-3), matrix metalloproteinases (MMP) 2 and 9 and vascular-endothelial growth factor alpha (α VEGF) in the tumor tissues. A retrospective study was done in colorectal cancer cases in the regions of Rio Grande do Norte state from 1995 to 2005, specifically in Natal city/RN/Brazil. The pathological and clinical variables, such as: age, gender, ethnicity, lifestyle, family history, the location of the primary tumor, level of differentiation, TDM staging, modified Dukes’, treatment and survival were analyzed. The pathological and clinical data were collected from medical records through a specific form and were filed on Excel. A total of 534 patients were selected from the Pathology Department file in this institution, however, 176 patients were excluded. 358 patients were included for Epidemiological analysis and its clinical and pathological correlations were selected. 180 patients were also selected for histological and immunohistochemical studies. The tumor progression of these selected proteins mentioned before were analyzed. The Paraffin blocks of these samples were treated by Microarray Tissue technique and its blades subjected to immunohistochemistry to test the intensity of these proteins in tumor tissues. The results of this analysis were correlated with clinicopathologic variables of patients. Statistical analysis using the chi-frame Pearson test and analysis of midlife by Kaplan-Meier curve was also utilized. P values < 0.05 were considered statistically significant. The average age of our sample was 58.8 years and 51.7 % were female. Alcohol consumption has increased by 1.71 time the risk of death by CCR (p = 0.034) and tobacco consumption increased 2.7 times the chance of developing tumors of high TNM stage (p = 0.001). Cancer patients had a family history of 3,833 times the chance of developing the CCR (p = 0.002). The expression of MMP-2 showed a significant association with tumors of high TNM stage (p <0.046) and mortality (p = 0.041). The α VEGF expression had statistically significant correlation with high TNM stage (p <0.009), degree of cell indifferentiation (p <0.025) and mortality (p <0.035). Expressions of E-cadherin and beta-catetina demonstrated tumor linked to high TNM stage (p = 0.0001) and Dukes› modified (p = 0.05), lesions in the rectum (p = 0.03 and p = 0.007, respectively), smoking (p = 0.05) and indifferentiation (p = 0.001). The expression of Gal-3 showed statistical significance with high TNM stage of patients (p = 0.01), smokers (p = 0.01), alcohol drinking (p = 0.03), indifferentiation (p = 0.0001) and mortality (p = 0.0001). Based on the results, therefore, we could realize that lifestyle and family history had correlation in the CCR prognosis, as well as MMP-2 expression, MMP-9, VEGF alpha, E-cadherin, Beta-catenin and Galectin-3 were important prognostic markers in tumor progression in colorectal cancer.

Os rumos do fundo público no capitalismo contemporâneo: uma análise sobre o financiamento da Política de saúde no estado do Rio Grande do Norte

This work analizes the financing of Health Policies on the state of Rio Grande Do Norte, starting at the presumption that SUS is “Bombarded” by fiscal ajustments, as a neoliberal strategy to face capital crises.The trafectory of the financing of SUS demands the comprehension of two principles which are, in essence, contradictory: the “principle of universatility”, which is caracterized by the uncompromising defence of the fundaments of the Sanitary Reform, and the “principle of containment of social costs”, articulating the macroeconomic policy that has being developed in Brazil since the 1990s and which substantiantes itself on the 2000s.This last defends the reduction of the social costs, the maintanance of primary surplus and the privatization of public social services. Considering these determinations, the objective of this research constitues in bringing a critical reflection sorrounding the financing of the Health Policies on the state of Rio Grande do Norte, on the period from 2004 to 2012.Starting from a bibliografic and documentary research, it sought out to analyze the budget planning forseen on the Budget Guideline Law (LDO) and on the Multiannual Plans (PPA), investigating the reports of the Court of Auditors of the State of RN and gathering information about expenses with health, available on the System of Information About Public Budgeting in Health (SIOPS).The Analises of the data obtained, in light of the theoretic referece chosen, reveals trends in the public budget setting for health on the State of Rio Grande do Norte, which are: a tiny share of investment expenditure on health, when compared to other expenses, the amount used in daily fees and advertising; the high expense in personnel expenses, especially for hiring medical cooperatives;the strong dependence of the state on revenue transferences from the Union; the aplication of resources in actions of other nature considered as health, in exemple of the expenditures undertaken by the budgeting unit Supplying Center S/A (CEASA) on the function of health and subfunction of prophylactic and therapeutic and on the Popular Pharmacy program. Since 2006, expenses refering to Regime Security Servers (RPPA) on the area of health also have being considered as public actions and services in health for constitutional limit ends, beyond the inconsistencies on the PPAs with the actions performed efectively.

Plasticidade dependente da experiência induzida por manipulação da matriz extracelular

The primary somatosensory cortex (S1) receives inputs from peripheral tactile receptors and plays a crucial role on many important behaviors. However, the plastic potential of this region is greatly reduced during adulthood, limiting functional recovery after injuries. This fact is due to the presence, in the brain parenchima, of structures and substances that have an inhibitory effect on plasticity, such as chondroitin sulfate proteoglicans (CSP) present in the perineuronal.nets (PNNs) surrounding a subset of neurons. Maturation of PNNs coincide with the closure of critical periods of plasticity in cortical areas, since CSP act to stabilize synaptic contacts. Removal of CSP is proven to be an effective therapeutic approach to restore plasticity and increase the odds of functional recovery after cortical lesion. In the present work, we removed CSP from the sensorimotor cortex of rats to restore plasticity and promote the compensatory morphofunctional regeneration of cortical circuits modified by removal of mystacial vibrissae during the critical period. Treatment with the CSP-digesting enzyme chondroitinase ABC proved efficient to restore plasticity in S1 circuits, as evidenced by morphological rearrangements and functional recovery.

Plasticidade dependente da experiência induzida por manipulação da matriz extracelular

The primary somatosensory cortex (S1) receives inputs from peripheral tactile receptors and plays a crucial role on many important behaviors. However, the plastic potential of this region is greatly reduced during adulthood, limiting functional recovery after injuries. This fact is due to the presence, in the brain parenchima, of structures and substances that have an inhibitory effect on plasticity, such as chondroitin sulfate proteoglicans (CSP) present in the perineuronal.nets (PNNs) surrounding a subset of neurons. Maturation of PNNs coincide with the closure of critical periods of plasticity in cortical areas, since CSP act to stabilize synaptic contacts. Removal of CSP is proven to be an effective therapeutic approach to restore plasticity and increase the odds of functional recovery after cortical lesion. In the present work, we removed CSP from the sensorimotor cortex of rats to restore plasticity and promote the compensatory morphofunctional regeneration of cortical circuits modified by removal of mystacial vibrissae during the critical period. Treatment with the CSP-digesting enzyme chondroitinase ABC proved efficient to restore plasticity in S1 circuits, as evidenced by morphological rearrangements and functional recovery.

A organização da educação no território federal do Amapá: do "ideal" ao real, do liberal ao conservador (1943-1958)

The present study on “organization education on Amapá’s Federal Territory (1943-1958)”, looked forward to answering the following questions: Was there an educational policy, in a systemic way, on the former Amapá’s federal territory? On the other hand, what were the main initiatives of the first intervenors for the education dissemination? After facing these questions, we established, as hypothesis, that the developed actions in the education’s scope on that territory back in the 40’s and 50’s were not able to implant an educational project in Amapá, since there was no preoccupation to understanding the sociocultural reality of Amapá’s population. Given this hypothesis, we analyzed the relation between the political practices developed by the first intervenor on the territory and the brazilian political scenario, from the legal-administrative nature of the federal entities and political conjuncture of the “New State” (1937-1945). To achieve that, we sought some similarities between Janary Gentil Nunes’s ways of governing and Getúlio Vargas’s political actions. To make this happen, it was necessary to check official documents out, as well as unofficial ones, especially the old articles published by “Amapá”, the local newspaper, official press tool back then, which disseminated the beliefs and values of the constituted authorities, with the purpose of “strengthen” the “modernization” ideal on the people. Such practice was based on the attempt of breaking off sociocultural economic backwardness of the territory, hiding out the reality of the Amapá’s population, marked by poverty, a high illiteracy rate and the typical tropical diseases from Amazon (Malaria). During the rupture’s process between the old and the modern, the education takes on a major role in the official speech, being used as political advertisement and as essential element to the modernization and to the development of a “new man”: now “civilized”. However, the investigation on the expansion of the elementary education in Amapá, showed us the presence of a significant number of rural schools, in contradiction to the disseminated urban modernization promise around there. In this sense, we can affirm that educational policy on Amapá’s territory failed by reasons of being based on the “transplantation” of the Federal District’s educational project, and it is important to recall that, back then, the brazilian Federal District was Rio de Janeiro. Despite the public agents had established uncountable schools on rural areas, these were not carried out from a more systemic process, this is, considering the reality of the Amazon’s "cabloco". So, we observed the existence of the separation between the modern speech and the maintenance of old oligarchic practices by that time.

As escolas polivalentes do Triângulo Mineiro e Alto Paranaíba (MG): sondagem vocacional no projeto desenvolvimentista civil-militar (1965–1976)

This study has as object eight state vocational schools located in Araguari, Araxá, Frutal, Ituiutaba, Monte Carmelo, Patos de Minas, Uberaba and Uberlândia, in Minas Gerais. The period analyzed comprises the years from 1965 to 1976, from the signature of the Agreement 512-11-610-042 beteween the Ministry of Education and Culture (MEC) and the American Agency for International Development (USAID), which started a series of other agreements, and actions ending up with the creation of the Expansion and Improvement of High Schools Program (Programa de Expansão e Melhoria do Ensino Médio - PREMEM) and, from this, the Vocational Schools. The upper limit of the study, 1976, was the year when these agreements, known as MEC/USAID agreements ceased. The Vocational Schools were characterized as vocation probing schools, directing the professional formation of the population in general, which would happen a posteriori, turning it shorter and more effective, since the labor market would demand, urgently, capable professionals for an expanding economy. The project of Vocational Schools had a national scope, and foresaw, for its unfolding, the complete substitution of State Schools for the new model, called “multi-curricula”. The theme Vocational schools was the object of my Master’s degree study, when I focused the State School Guiomar de Freitas Costa, in Uberlândia. That study raised questionings and concerns that resulted in the central problem of the thesis presented here: understanding the measure in which such schools integrated the country’s development project – mostly in the first half of the military rule – and to understand its structure, functionality and efficacyThe development of the study presented here, demanded the use of several sources: 1) specialized literature about the topics presented, i.e., the situation of national education in a temporal analysis, the political, economical and social context, research methodologies, the theory of human capital, vocational teaching, pedagogical trends and practices, agreements MEC-USAID and PREMEM; 2) national, state and county laws related to the discussion: laws of national education directives and basis, decrees and reports stating about the program of technical cooperation between Brazil and the United States of America, the Program of Expansion and Improvement of Teaching (PREMEM), formation of professors, establishment of Vocational Schools and educational planning; 3) documentation of school archives: books of minutes of Collegiate and of faculty and staff, registrar books with final scores, enrolment, visits of inspector, accounting books, punch clock records, student, professor and staff occurrences, inventory, class schedules, school year calendar, school rules, class reports, payment rolls, bills of sales, exchanged mail, personal documentation of professional personnel, documents of land acquisition, blueprints, manuals of PREMEM, didactic materials/resources used in classes, books available in the school library, structured evaluations for follow-up of school processes, pictures of events, texts prepared for special dates, and news from the official newspaper and, finally, 4) national and local press reports, especially from Folha de São Paulo, Correio de Araxá, Correio de Uberlândia and Lavoura e Comércio (Uberaba). The proposition of Vocational schools was conciliate theoretical and practical formation through an active education permeated by technological resources. The contact with knowledge and several practical activities under professional supervision, the student would identify the knowledge area that would interest him the most and his aptitude. This formation in primary school would make way for the vocation studies in high school, which became mandatory by the law 5.692/71, that reformed school education from the previous levels of elementary, middle high and high school. However, the multi-curricula proposal that would be spread to the other public schools in the country ended up succumbing to the model already established. From its ephemeral existence, maybe the Vocational Schools have not reached the more general goals in political, economic and social aspects; however, this study demonstrated that, for the people that, directly or indirectly, had contact with such schools, a legacy of vocational and quality teaching was made, so much so, that forty years after the end of that proposal, they are still remembered.

O PIBID - Programa Institucional de Bolsas de Iniciação à Docência e a crise das Licenciaturas: o caso de um Curso de Pedagogia a Distância

Tendo em vista a atual crise das licenciaturas, especialmente em termos da pouca atratividade que a formação para a docência vem apresentando em nosso contexto educacional e, considerando, ainda, as críticas sobre a fragilidade da formação inicial de professores ocorrer na modalidade a distância (no caso, o curso de Pedagogia), o PIBID - Programa Institucional de Bolsas de Iniciação à Docência surge como uma política de incentivo e valorização do magistério com o propósito de contribuir para uma formação mais sólida e articulada em termos da relação teoria-prática, especialmente pela proximidade que favorece aos alunos bolsistas, com o cotidiano escolar – este é o foco desta investigação que teve por objetivos: refletir sobre o histórico da formação docente em interface com a desvalorização do magistério que, consequentemente, levou à crise das licenciaturas e, a partir disso, analisar a proposição do PIBID como uma política pública para o enfrentamento desta crise; analisar as representações de bolsistas do PIBID, de um curso de Pedagogia a distância, sobre a experiência que estão tendo, e se ela contribui, no caso dos licenciandos, para o fortalecimento da escolha pela carreira docente; verificar as contribuições do programa para a formação dos licenciandos, dos supervisores (professores das escolas públicas parceiras) e do coordenador de área e se este oportuniza uma complementação na preparação para o exercício da docência. A pesquisa realizou uma revisão da literatura sobre a crise das licenciaturas e o contexto do aparecimento do PIBID, bem como sobre a formação de professores ocorrer na modalidade a distância, tendo como referencial teórico autores como Libâneo (1998), Gatti e Barreto (2009), Bahia e Duran (2011), Scheibe (2006), Sommer (2010), FCC (2009), Tardif (2005). Realizou, também, uma pesquisa de campo que teve como sujeitos sete bolsistas do PIBID de um curso de Pedagogia a distância (de uma instituição de ensino superior, particular, de São Paulo), sendo: quatro licenciandas, duas supervisoras e uma coordenadora de área do subprojeto. Foram aplicados dois instrumentos para a coleta de dados: um questionário para o delineamento do perfil dos sujeitos e a realização de entrevistas de aprofundamento. As reflexões realizadas a partir da revisão da literatura e das análises dos dados coletados junto aos sujeitos indicam que: em relação à proposição da formação inicial de professores a distância, esta denota maiores críticas, diferentemente da formação continuada de professores a distância, que apresenta uma maior aceitabilidade; em relação ao PIBID, os estudos vêm apontando a positividade das diversas experiências que vêm se desenvolvendo no território nacional e que denotam um trabalho articulado entre teoria e prática, bem como no resgate da identidade docente, com uma ênfase na valorização, inserção e permanência dos licenciandos nos seus cursos; as representações dos sujeitos investigados sobre a experiência que estão tendo com o PIBID apontam para: o reconhecimento de que o Programa garante, efetivamente, a reflexão e vivência entre a teoria e prática; a contribuição para a aquisição de maior segurança na relação com os alunos das escolas parceiras e também no desenvolvimento das atividades práticas; a certeza e/ou convicção de que realmente querem ser professoras.

A nasalidade no dialeto quilombola do Norte de Minas: uma análise contrastiva baseada em corpus

This research investigated the nasality of vowels in the spontaneous speech of inhabitants of the quilombola communities of Brejo dos Crioulos and Poções (MG). As a theoretical framework, we based on the assumptions of Phonetics and Phonology, in renowned scholars on the investigation of nasality (CAGLIARI, 1977; CÂMARA JR., 1984, 2013; BISOL, 2013; ABAURRE; PAGOTTO, 1996; SILVA, 2015), with subsidies of the Corpus Linguistics. Its general goal was to investigate the occurrence of nasality, in the dialect of these quilombola communities, and their linguistic behavior, considering the linguistic factors that can interfere in the phenomenon. Specifically it was aimed to a) detect the occurrence of nasalized vowels with the help of the resources that the Corpus Linguistics provides (Praat and WorldSmith Tolls); b) discriminate the different types of occurring contexts of nasalized vowels; c) make quantitative and qualitative analyzes of the nasalized vowels in the study corpus; d) describe and analyze the behavior of nasalized vowels and; e) contrast the values of F1 and F2 of the oral and nasalized vowels. It was hypothesized that the nasality happens because it is conditioned by the nasal segment following the nasalized vowel - phonological process of “assimilation” - its position as the primary stress and grammatical category. It was believed that the quilombolas communities of Brejo dos Crioulos and Poções produce nasalized vowels in their speech and this linguistic phenomenon is favored by the adjacent presence of consonants or nasal vowels. Furthermore, it was hypothesized that the values of F1 and F2 of oral and nasalized vowels in these communities are distinct. The following research questions were elaborated: (i) is the presence of nasalized vowels in the speech of these quilombola communities conditioned to the presence of a nasal sound segment? (ii) does the nasal sound segment following the nasalized vowel favor the occurrence of the nasality phenomenon? is there a difference between the values of F1 and F2 of the oral and nasalized vowels in both quilombola communities considered? To compose our corpus, 24 interviews recordings were used (12 female speakers and 12 male speakers), a total of 24 participants. It was found that the following nasal sound segment tends to condition the nasalized vowel. In general, it assimilates the lowering of the soft palate of nasal consonant segment immediately following, but there are cases of nasal vowel segment - regressive assimilation; the stressed syllable tends to favor the nasality, but it occurs in pretonic and postonic position as well; F1 and F2 values of oral and nasalized vowels in the quilombola communities of Poções and Brejo dos Crioulos are distinct: the group of Brejo dos Crioulos tends to produce the F1 of oral and nasalized vowels more lowered than the group of Poções and the F2, in a more anterior position. The nasality tends to occur in verbs and nouns, although it is not specific to a grammatical category. This research found cases of spurious nasalization, confirming previous studies. In turn, it revealed cases of lexical items with favorable context for nasalization, but with its non-occurrence. This last case, considered as the lowering of the uniform soft palate in PB, presented pronounced vowels without the soft palate lowering. That is, it was detected variation in the phenomenon of nasalization in PB. With this work, it was promoted the discussion about nasality, in order to contribute to the linguistic studies about the functioning of Brazilian Portuguese in this geographical context.

Arranjos Produtivos no setor agrícola como estratégia de desenvolvimento gradual de regiões periféricas: Um estudo de caso em Belém do Pará, na região norte do Brasil

Este artigo discute os arranjos produtivos locais em atividades relacionadas ao setor de produção agrícola como uma estratégia de desenvolvimento econômico local e de inclusão social. Trata-se de uma pesquisa qualitativa, baseada na aplicação de três trabalhos documentais desenvolvidos no Programa de Mestrado da Universidade de Taubaté, SP. Os resultados indicaram que a aplicação do conceito de arranjo produtivo no setor primário é uma prática em exercício na região estudada, e pode proporcionar desenvolvimento naquela localidade, inserindo o pequeno e médio produtor no círculo virtuoso do desenvolvimento regional. O estudo indica a necessidade de ampliar o acesso às fontes de financiamento e de formação de mão de- obra qualificada. É também necessário, em parceria com o poder público, criar mecanismos de redução da distância entre o produtor rural e o mercado consumidor, reduzindo os conflitos típicos da visão centro-periferia.

A influência do departamento de marketing: o caso OLI

Tem-se verificado alguma discussão na literatura sobre o decréscimo da importância do Marketing nas empresas. De acordo com alguns estudos, apenas 10% do tempo é dedicado ao departamento de Marketing nas suas reuniões gerais. O estudo de caso é dedicado a uma empresa portuguesa, Oliveira & Irmão, líder ibérica de produtos de instalação sanitária que atua no mercado há 60 anos. Esta empresa exporta 80% da sua produção e tornou-se reconhecida por ser uma das empresas mais inovadoras da sua àrea, contando atualmente com 40 patentes ativas. Neste estudo será analisada a influência do departamento de Marketing numa empresa com gestão familiar e onde a satisfação do cliente é o seu objetivo primário. Para compreender as alterações que se verificaram desde a implementação do Departamento de Marketing, foram realizadas quatro entrevistas aos diretores da empresa (Departamento Financeiro, Inovação, Comercial e Marketing) para compreender, através do seu ponto de vista, quais as implicações e modificações principais que sentiram. Verificou-se que apesar do departamento de Marketing ser recente na empresa este já realizou algumas alterações notórias a nível interno (comunicação interna) e a nível externo (posicionamento da marca no mercado). Contudo, um dos grandes entraves tem sido a dificuldade em participar no processo desenvolvimento de novos produtos, que até então é coordenado pelo departamento de Inovação e departamento Comercial. A autora do estudo propõe um processo em que o departamento de Marketing fornece os inputs para o desenvolvimento de novos produtos, de modo a satisfazer as necessidades dos clientes.

Osteossarcoma, quimioterapia HDMTX e reflexos laboratoriais

O osteossarcoma ou sarcoma osteogénico (OS) é o tumor maligno primário mais comum de origem óssea que ocorre em crianças e adultos jovens. Este tumor surge a partir de células mesenquimais e é histologicamente caracterizado pela presença de células fusiformes e formação aberrante de osteóide. A incidência desta neoplasia apresenta uma distribuição bimodal, com um primeiro pico na adolescência e um segundo pico a ocorrer entre a 6ª e a 7ª década de vida. A maioria dos pacientes apresenta doença localizada à data do diagnóstico, e destes, aproximadamente 15 a 20% apresentam metástases detectáveis, em especial, pulmonares. A abordagem terapêutica ao OS engloba quimioterapia pré-operatória (neoadjuvante) seguida de ressecção cirúrgica do tumor primário e de todas as metástases visíveis e de quimioterapia pós-operatória (adjuvante). Historicamente, muitos agentes foram testados e usados no tratamento do OS, mas desde os anos 90 até à actualidade, o esquema de tratamento baseia-se na utilização de três agentes: Metotrexato (MTX), Doxorrubicina (A) e Ciclofosfamida (P), podendo ou não ser incluído um 4º agente, a Ifosfamida (I) ou o Ectopósido (E). Para surtir efeito, o MTX é administrado em alta dose, habitualmente de 12g/m2, podendo ir até 20g/m2, apresentando vários efeitos adversos. Como tal, outros agentes quimioterápicos têm sido testados, assim como outros tipos de tratamento e alvos, com o intuito de melhorar a performance e a sobrevida sem recorrência. A identificação de biomarcadores que permitam o diagnóstico, prognóstico e monitorização da terapia tem sido outra das principais linhas de investigação relacionadas com o OS. O objetivo deste trabalho centra-se na revisão da importância do tratamento neoadjuvante enquanto fator prognóstico do OS, e da monitorização laboratorial na utilização do MTX por forma a evitar efeitos secundários.

Osteossarcoma, quimioterapia HDMTX e reflexos laboratoriais

O osteossarcoma ou sarcoma osteogénico (OS) é o tumor maligno primário mais comum de origem óssea que ocorre em crianças e adultos jovens. Este tumor surge a partir de células mesenquimais e é histologicamente caracterizado pela presença de células fusiformes e formação aberrante de osteóide. A incidência desta neoplasia apresenta uma distribuição bimodal, com um primeiro pico na adolescência e um segundo pico a ocorrer entre a 6ª e a 7ª década de vida. A maioria dos pacientes apresenta doença localizada à data do diagnóstico, e destes, aproximadamente 15 a 20% apresentam metástases detectáveis, em especial, pulmonares. A abordagem terapêutica ao OS engloba quimioterapia pré-operatória (neoadjuvante) seguida de ressecção cirúrgica do tumor primário e de todas as metástases visíveis e de quimioterapia pós-operatória (adjuvante). Historicamente, muitos agentes foram testados e usados no tratamento do OS, mas desde os anos 90 até à actualidade, o esquema de tratamento baseia-se na utilização de três agentes: Metotrexato (MTX), Doxorrubicina (A) e Ciclofosfamida (P), podendo ou não ser incluído um 4º agente, a Ifosfamida (I) ou o Ectopósido (E). Para surtir efeito, o MTX é administrado em alta dose, habitualmente de 12g/m2, podendo ir até 20g/m2, apresentando vários efeitos adversos. Como tal, outros agentes quimioterápicos têm sido testados, assim como outros tipos de tratamento e alvos, com o intuito de melhorar a performance e a sobrevida sem recorrência. A identificação de biomarcadores que permitam o diagnóstico, prognóstico e monitorização da terapia tem sido outra das principais linhas de investigação relacionadas com o OS. O objetivo deste trabalho centra-se na revisão da importância do tratamento neoadjuvante enquanto fator prognóstico do OS, e da monitorização laboratorial na utilização do MTX por forma a evitar efeitos secundários.