TEAP home Testing - 2016

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The Fight against Sepsis
1- Sepsis is a serious and often deadly illness, yet it remains an unfamiliar threat to most of the general public, as well as one of the most challenging diseases for doctors to diagnose and treat. The condition, which begins with an aggressive immune system reaction to an infection, kills 18 million people around the world every year. Physicians, who learn about sepsis in medical school, often miss its early signs because they mimic other disorders and the illness progresses so rapidly from what looks like a mild infection to a life-threatening situation. As a result of these difficulties, doctors are often late to launch the necessary interventions, such as antibiotics to obliterate the infection. “The timing of antibiotics is a critical determinant for whether someone lives or dies,” says James O'Brien, an adviser to Sepsis Alliance. But data shows that only 50 percent of patients with septic shock get appropriate antibiotics within six hours of first being seen by a health professional.
2- Sepsis begins innocuously when the immune system performs its task of recognizing invading bacteria, viruses or fungi. Immune cells release signaling proteins called cytokines to stimulate one another and overcome the invaders—but for poorly understood reasons, the immune cells release far more cytokines and other inflammatory molecules than is typical. All the extra immune molecules surging through the bloodstream can make the blood vessels slack and permeable, reducing blood pressure and allowing the fluid component of the blood to seep into surrounding tissues. The blood components left behind clot in the smallest vessels, preventing oxygen from reaching major organs. At this point, someone with sepsis has transitioned from the earliest stage of the disease, known as systemic inflammatory response syndrome, to the later stages of severe sepsis and septic shock.
3- Because the immune system's reaction is responsible for the destructive progression of sepsis, researchers have tried using various drugs to interrupt the chemical cascade that triggers inflammation and clotting. However, treatments have been slow in coming. Failure of four potential antisepsis drugs in the past two years has discouraged researchers and advocates alike. These experimental drugs were predicted to be billion-dollar blockbusters if they had proved effective against sepsis, but instead they cost their creators millions in previous research and canceled trials. Despite the many disappointments, researchers continue to search for treatments that could halt sepsis before it becomes deadly.
4- Spectral Diagnostics in Toronto, for example, created a diagnostic blood test with a therapeutic device. The test looks for endotoxin, a molecule that is released from dying bacteria and can trigger the start of sepsis. About 50 percent of sepsis patients, often the most critically ill, have high levels of endotoxin in their blood. Blood is drawn from these patients and pumped over a filter infused with an antibiotic that binds to endotoxin, removing the molecule before the blood is returned to patients. The FDA has approved the test and the combination of diagnostic and device is currently being tested in the United States and Canada.
5- Dr. Richard Hotchkiss, who is a professor of medicine the Washington University School of Medicine has proposed a very different approach—not just to treatment but to the whole way of thinking about sepsis as well. Although current dogma explains sepsis as a sustained, excessive inflammatory response, Dr. Hotchkiss bases his approach on evidence to the contrary. According to his studies, which include examination of cells extracted from patients after death, suggest that the symptoms of sepsis persist because during the course of the illness, the immune system shifts from an overreaction to a kind of collapse—instead of doing too much, the immune system does too little. If that is correct, Dr. Hotchkiss says, then immune-stimulating compounds such as interleukin-7, which are already used in cancer treatment, could prevent deaths from sepsis.
6- With no new drugs on the horizon, some investigators urge a change in focus from discovering pharmaceutical treatments to the importance of critical care, improved long-term care and increased public awareness. They point out that while the death rate from sepsis remains high, it has decreased over time, not because of new treatments for sepsis but because doctors have in general become better at saving the lives of critically ill patients. Clinicians should pay more attention to the four fifths of sepsis patients who survive, some researchers argue. Many survivors have profound disabilities, such as amputated limbs, blindness and cognitive problems. O'Brien, the Sepsis Alliance adviser, emphasizes that public awareness encourages early recognition of sepsis, which greatly enhances the chances of recovery.
Adapted from an article by Maryn McKenna
Glossary 
Tolaunch: lançar
Slack: frouxa
Toseep: infiltrar-se
Toclot: coagular
Blockbuster: grandesucesso
Tohalt: interromper
Todraw: tirar
Tobind: ligar,vincular
Awareness: consciência, noção 
	Assinale a alternativa correta em cada uma das questões abaixo.
	
1) A qual das alternativas abaixo se refere o pronome “its” (parágrafo 1)?
e) Mild infection
	
	 
e) Desacreditar
e) Sobreviver
e) Com rapidez
e) Diminuir
	
 
15) O que pode ser inferido do trecho em questão?
Although current dogma explains sepsis as a sustained, excessive inflammatory response, Dr. Hotchkiss bases his approach on evidence to the contrary. According to his studies, which include examination of cells extracted from patients after death, suggest that the symptoms of sepsis persist because during the course of the illness, the immune system shifts from an overreaction to a kind of collapse—instead of doing too much, the immune system does too little.
a) Segundo o Dr. Hotchkiss a sepse é uma resposta inflamatória não controlada, seguindo o dogma atual.
b) A autópsia em pacientes revelou que o sistema imune tem uma reação exacerbada previamente à sepse.
c) O estudo sobre a sepse concluiu que a inflamação excessiva é uma resposta imunológica comum.
d) Dr. Hotchkiss acredita que o sistema imune em pacientes com sepse entra em colapso e trabalha pouco, após uma reação exagerada.
e) A abordagem do Dr. Hotchkiss comprova o dogma atual da sepse como uma resposta inflamatória excessiva.
	 
	 
The War on Cancer
1-“Know your enemy and know yourself and you can fight a hundred battles without disaster, Sun Tzu advises in the book “The Art of War.” As the “war on cancer” continues, researchers from Israel and the U.S. have applied that advice by suggesting that their foe should be studied for its similarities to bacteria. Specifically, the research team says cancer shows similarities to the sociality and collective survival strategies seen in bacteria, presenting potentially “a valuable model system to inspire new hypotheses and investigations useful for developing novel therapies.” Perhaps we are entering a new era of biological cyber warfare, in which we will learn to enlist bacteria in conjunction with the immune system to defeat cancer precisely on account of its ‘social intelligence,’” said the researcher Eshel Ben-Jacob, Ph.D., who focuses on the social behavior of bacteria, as well as network neuroscience and system level immunology, from Tel Aviv University.
2- Researchers presented their call for a “cyber war” on cancer in a recent paper in the Trends in Microbiology Journal. They noted that, while the understanding of cancer biology has improved over recent decades, researchers remain baffled by questions regarding the deadliest traits of malignancy: metastatic colonization, dormancy and relapse, and the rapid evolution of multiple drug and immune resistance. “Our guiding hypothesisis that cancer’s collective capabilities are key concepts for understanding tumor dynamics; one cannot successfully proceed under the assumption of uncoordinated genetic instability of individual cells,” the researchers posited. “The emerging picture is that of cancer, the primary tumor, and the metastases combined, as a multiclonal society of smart communicating cells endowed with specific traits for successful cooperative behaviors.”
3- Cancer metastasis, for example, can thus be seen as a programmed response in which the primary tumor deliberately fashions cells to colonize foreign territories: Rather than being an independent clone mutated from the primary tumor, the metastatic cells could be variant members of the society with assigned tasks. How completely the primary tumor controls the metastases is not yet known. A key reason why is because researchers have yet to establish the extent of communication within cancers. Recent research has shown, for example, that primary tumors communicate with circulating tumor cells (CTCs), though it has yet to be shown whether communication occurs from the CTCs to primary tumors.
4- “That’s a very important part of the puzzle,” Dr. Ben-Jacob said. “I assume that there should be, because if you look in biology, it’s always two-way communication.” When asked why he thinks that way, he responded, “We call the CTCs ‘spying cells’ and know thatprior to metastasis invasion, ‘spying cells’ are sent to explore the body, and return. It appears that the cells return with important information, as the process has been shown to accelerate tumor growth, angiogenesis, and stromal recruitment.” Also not yet known, Dr. Ben-Jacob said, is how malignancy traits such as metastases and cell dormancy and relapse vary from cancer to cancer. A decade of genome sequencing data has revealed that variability by showing tumors to be multiclonal, rather than monoclonal like a single-cell bacterial colony.
5- Recent research has also found that, when primary tumors are exposed to hypoxia and other types of stress, they secrete exosomes—nano-sized lipid vesicles containing pieces of RNA, DNA, or both. The exosomes are capable of inducing changes that enhance metastasis, such as changing the acidity of the environment of the tumor while increasing toxicity for immune cells. The RNA and DNA pieces can be transferred between distant cells through the exosomes, and through gap junctions between cells, and natural nanotubes connecting cells closer to each other.
6- Seventy percent of all cancers are caused by mutations for sure, but researchers just can’t tell what the driver is. Worst case might be, there isn’t a driver. The tumors are driven by some sort of a committee of minor players which together cause the disease. And that will make things more complicated for researchers, and require more research and new ways of analyzing those kinds of tumors. Until then, and especially afterward, researchers and cancer-funding advocates should give serious credence to the social-community view of the disease, as a promising research avenue likely to speed up the march toward the conquest of cancer.
Adapted from an article by Alex Philippidis
Glossário
Foe: inimigo
Deadliest: mais mortal
Relapse: reincidência
Endowed: dotada
Puzzle: quebra-cabeça
Prior to: antes de
To enhance: melhorar 
	
	Assinale a alternativa correta em cada uma das questões abaixo.
e) War on Cancer
e) parágrafo 5 ou 6
e) Prolongado
e) Extasiados
e) Cells
e) Embelezar
e) Portanto