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a incid&#234;ncia de CECC aumentou proporcionalmente nos &#250;ltimos anos&#44; resultando em morbidade&#44; mortalidade e &#244;nus econ&#244;mico significantes no longo prazo para os pacientes&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">3&#8211;5</span></a> Portanto&#44; uma compreens&#227;o mais profunda da patog&#234;nese do CECC &#233; crucial para melhorar o diagn&#243;stico e a efic&#225;cia do tratamento&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">6</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">As sirtu&#237;nas&#44; que pertencem &#224; fam&#237;lia das histonas desacetilases&#44; est&#227;o envolvidas em v&#225;rias fun&#231;&#245;es celulares&#44; como envelhecimento&#44; resposta ao estresse&#44; metabolismo e homeostase energ&#233;tica&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">7&#8211;9</span></a> As sirtu&#237;nas de mam&#237;feros consistem em sete membros da fam&#237;lia &#40;SIRT1&#8208;7&#41;&#44; que exibem diferentes localiza&#231;&#227;o subcelular&#44; atividades catal&#237;ticas e fun&#231;&#245;es biol&#243;gicas&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">10</span></a> A SIRT6&#44; localizada principalmente no n&#250;cleo&#44; funciona como desacetilase dependente de NAD&#43; e ADP&#8208;ribosiltransferase altamente conservadas&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">11&#44;12</span></a> A SIRT6 tem sido implicada em diabetes&#44; doen&#231;as cardiovasculares&#44; envelhecimento e c&#226;ncer&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">13&#8211;16</span></a> Evid&#234;ncias emergentes sugerem forte liga&#231;&#227;o entre SIRT6 e o in&#237;cio e progress&#227;o do mieloma m&#250;ltiplo &#40;MM&#41; e v&#225;rios outros tipos de neoplasias&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">17&#44;18</span></a> Seu duplo papel de suprimir ou promover o c&#226;ncer foi observado em diferentes tipos de c&#226;ncer&#44; potencialmente influenciado por vias de sinaliza&#231;&#227;o e contextos tecido&#8208;espec&#237;ficos&#46;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">19&#44;20</span></a> Entretanto&#44; o impacto preciso da SIRT6 no CECC permanece em grande parte indefinido&#46; A hip&#243;tese dos autores &#233; que a SIRT6 desempenha papel fundamental na patog&#234;nese e progress&#227;o do CECC&#44; justificando avalia&#231;&#227;o de seus padr&#245;es de express&#227;o&#44; mecanismos funcionais e potenciais implica&#231;&#245;es cl&#237;nicas&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Materiais e m&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Materiais</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Reagentes</span><p id="par0015" class="elsevierStylePara elsevierViewall">Foram utilizados os seguintes reagentes&#58; linhagem celular de carcinoma espinocelular cut&#226;neo humano A431 &#40;obtida de Zhongqiao Xinzhou&#44; Xangai&#41; e linhagem celular SCL&#8208;1 &#40;Enzyme Research&#44; Xangai&#41;&#59; a linhagem de queratin&#243;citos humanos normais imortalizados HaCaT &#40;Shanghai Fuheng Biotechnology Co&#46;&#44; Ltd&#46;&#41;&#59; leite desnatado&#44; clorof&#243;rmio e isopropanol &#40;adquirido da Shanghai Shenggong Co&#46;&#44; Ltd&#46;&#41;&#59; anticorpos prim&#225;rios contra SIRT6 e &#946;&#8208;tubulina&#44; anticorpos secund&#225;rios contra imunoglobulina IgG de camundongo &#40;adquiridos de Abcam&#44; EUA&#41;&#59; anticorpo monoclonal de N&#8208;caderina anti&#8208;humano de camundongo e anticorpo monoclonal de vimentina anti&#8208;humano de camundongo &#40;Proteintech&#44; Wuhan&#41;&#59; soro bovino fetal e meio DMEM com alto teor de glicose &#40;adquirido de Gibco&#44; EUA&#41;&#59; <span class="elsevierStyleItalic">kit</span> de an&#225;lise BCA&#44; cristal violeta e lipofectamina 2000 &#40;adquiridos de Biyuntian Biotechnology Co&#46;&#44; Ltd&#46;&#41;&#59; membrana de fluoreto de polivinilideno &#40;PVDF&#59; adquirida de Millipore&#44; EUA&#41;&#59; reagente trizol&#44; <span class="elsevierStyleItalic">kit</span> de tecido puro para prepara&#231;&#227;o de RNA&#44; <span class="elsevierStyleItalic">kit</span> de s&#237;ntese PrimeScript RT e <span class="elsevierStyleItalic">kit</span> SYBR Green qRT&#8208;PCR Master Mix &#40;adquiridos de Thermo&#44; EUA&#41;&#59; <span class="elsevierStyleItalic">kit</span> de ensaio CCK&#8208;8 &#40;Proteintech&#44; Wuhan&#41;&#59; gel de matriz e c&#226;maras <span class="elsevierStyleItalic">transwell</span> de 8<span class="elsevierStyleHsp" style=""></span>&#956;m &#40;Corning&#44; EUA&#41;&#46; Todos os <span class="elsevierStyleItalic">primers</span> foram sintetizados pela Shanghai Shenggong Co&#46;&#44; Ltd&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Amostras de tecido</span><p id="par0020" class="elsevierStylePara elsevierViewall">Blocos de tecido de 70 pacientes com CECC&#44; de 25 pacientes com doen&#231;a de Bowen &#40;DB&#41; e de 60 pacientes com ceratose act&#237;nica &#40;CA&#41; foram coletados de janeiro de 2017 a dezembro de 2022&#46; Al&#233;m disso&#44; 20 amostras de pele normal de cirurgia pl&#225;stica foram coletadas como controles normais&#46; Foram coletadas amostras frescas de CECC e de pele normal &#40;TN&#41;&#44; 20 de cada&#46; Al&#233;m disso&#44; nenhum dos pacientes deste estudo recebeu qualquer tratamento antes da cirurgia&#44; incluindo quimioterapia ou radioterapia&#46; Todos os pacientes participantes do estudo forneceram consentimento informado&#44; e este estudo foi aprovado pelo Comit&#234; de &#201;tica do hospital &#40;n&#250;mero de aprova&#231;&#227;o&#58; 2021KT085&#41;&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">M&#233;todos</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Imuno&#8208;histoqu&#237;mica para an&#225;lise de express&#227;o da prote&#237;na</span><p id="par0025" class="elsevierStylePara elsevierViewall">Amostras de tecido de CECC foram desparafinizadas e tratadas com per&#243;xido de hidrog&#234;nio por 5 minutos para inibir a atividade da peroxidase end&#243;gena&#46; Foi adicionada solu&#231;&#227;o bloqueadora de soro de cabra&#44; e a recupera&#231;&#227;o antig&#234;nica foi realizada com solu&#231;&#227;o de citrato&#46; Amostras de tecido de CECC foram incubadas com anticorpo anti&#8208;SIRT6 de camundongo &#40;1&#58;200&#41; durante a noite a 4<span class="elsevierStyleHsp" style=""></span>&#176;C&#46; Ap&#243;s duas lavagens com PBS por 3 minutos cada&#44; as amostras foram incubadas com IgG de cabra anticamundongo conjugado com HRP &#40;1&#58;2000&#41; por 1&#44;5 hora &#224; temperatura ambiente&#46; Ap&#243;s duas lavagens com PBS durante 3 minutos cada&#44; o anticorpo prim&#225;rio foi detectado utilizando um <span class="elsevierStyleItalic">kit</span> de substrato de diaminobenzidina &#40;DAB&#41;&#46; Imagens de marca&#231;&#227;o imuno&#8208;histoqu&#237;mica foram observadas ao microsc&#243;pio e v&#225;rios campos foram selecionados aleatoriamente para observa&#231;&#227;o em grande aumento&#46; Os resultados da marca&#231;&#227;o imuno&#8208;histoqu&#237;mica foram interpretados usando um m&#233;todo de escore semiquantitativo comumente utilizado<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">21</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Cultura de c&#233;lulas</span><p id="par0030" class="elsevierStylePara elsevierViewall">As linhagens celulares utilizadas neste estudo inclu&#237;ram a linhagem celular de carcinoma espinocelular da pele humana &#40;A431&#44; SCL&#8208;1&#41; e a linhagem de queratin&#243;citos normais humanos imortalizados HaCaT&#46; O meio utilizado para c&#233;lulas A431&#44; SCL&#8208;1 e HaCaT foi meio DMEM com alto teor de glicose&#46; Todas as c&#233;lulas foram cultivadas a 37<span class="elsevierStyleHsp" style=""></span>&#176;C com 5&#37; de CO<span class="elsevierStyleInf">2</span> e 10&#37; de soro bovino fetal no meio&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Western blot</span><p id="par0035" class="elsevierStylePara elsevierViewall">A lise celular foi realizada utilizando tamp&#227;o RIPA&#44; e a prote&#237;na foi extra&#237;da em gelo&#46; A concentra&#231;&#227;o de prote&#237;na foi determinada utilizando um <span class="elsevierStyleItalic">kit</span> de ensaio BCA&#46; Amostras de prote&#237;na de cada grupo foram carregadas em gel a 12&#44;5&#37; e submetidas &#224; eletroforese a 80<span class="elsevierStyleHsp" style=""></span>V por 30 minutos&#44; seguida de 110<span class="elsevierStyleHsp" style=""></span>V por 1 hora&#46; A transfer&#234;ncia para membrana PVDF foi realizada a 100<span class="elsevierStyleHsp" style=""></span>V em banho de gelo por 1&#44;5 hora&#46; A membrana foi ent&#227;o bloqueada com leite desnatado a 5&#37; durante 2 horas&#44; seguida de incuba&#231;&#227;o com anticorpo prim&#225;rio a 4<span class="elsevierStyleHsp" style=""></span>&#176;C durante a noite e incuba&#231;&#227;o com anticorpo secund&#225;rio por 2 horas&#46; Os anticorpos secund&#225;rios utilizados foram HRP de cabra anticamundongo &#40;dilui&#231;&#227;o 1&#58;1000&#41; e HRP de cabra anticoelho &#40;dilui&#231;&#227;o 1&#58;1000&#41;&#46; Por fim&#44; as imagens foram capturadas e armazenadas utilizando sistema de imagem por quimiluminesc&#234;ncia Bio&#8208;Rad&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Rea&#231;&#227;o em cadeia da polimerase via transcriptase reversa quantitativa &#40;qRT&#8208;PCR&#41;</span><p id="par0040" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Pellets</span> celulares foram coletados e tratados com reagente trizol para lise&#44; seguido de extra&#231;&#227;o com clorof&#243;rmio&#47;isopropanol para separar e precipitar RNA&#46; O RNA total foi posteriormente extra&#237;do por precipita&#231;&#227;o com etanol&#46; A transcri&#231;&#227;o reversa de 1<span class="elsevierStyleHsp" style=""></span>&#956;g de RNA em cDNA foi realizada utilizando o <span class="elsevierStyleItalic">kit</span> de s&#237;ntese PrimeScript RT&#46; A qRT&#8208;PCR foi realizada utilizando o <span class="elsevierStyleItalic">kit</span> SYBR Green qRT&#8208;PCR Master Mix&#44; com U6 sendo utilizado como refer&#234;ncia interna&#46; As sequ&#234;ncias de <span class="elsevierStyleItalic">primers</span> est&#227;o listadas na <a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Infec&#231;&#227;o celular e triagem</span><p id="par0045" class="elsevierStylePara elsevierViewall">O shSIRT6 lentiviral e o controle shNC foram fornecidos por Youxi Weinan Biotechnology Company &#40;Sanming&#44; China&#41;&#46; Os lentiv&#237;rus foram envelopados usando um sistema de plasm&#237;deo triplo&#46; O shRNA foi inserido no vetor de express&#227;o g&#234;nica induz&#237;vel por doxiciclina &#40;DOX&#41; Tet&#8208;pLKO&#46;1&#8208;puro&#46; Ap&#243;s transfec&#231;&#227;o durante 36 horas&#44; os lentiv&#237;rus foram colhidos&#46; C&#233;lulas A431 e c&#233;lulas SCL&#8208;1 foram infectadas com os lentiv&#237;rus por 24 horas e linhagens celulares transduzidas est&#225;veis foram selecionadas usando puromicina &#40;0&#44;8<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;mL para c&#233;lulas A431&#59; 0&#44;4<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;mL para c&#233;lulas SCL&#8208;1&#41;&#46; A express&#227;o g&#234;nica foi induzida com 1<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;mL de DOX e c&#233;lulas transfectadas com vetor vazio serviram como c&#233;lulas de controle normal &#40;CN&#41;&#46; As c&#233;lulas foram divididas em quatro grupos&#58; grupo CN&#44; grupo CN&#43;DOX&#44; grupo shSIRT6 e grupo shSIRT6&#43;DOX&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Ensaio Cell Counting Kit&#8208;8 &#40;CCK&#8208;8&#41; para prolifera&#231;&#227;o celular</span><p id="par0050" class="elsevierStylePara elsevierViewall">As c&#233;lulas foram semeadas a 2&#46;000 c&#233;lulas&#47;100<span class="elsevierStyleHsp" style=""></span>&#956;L em placa de 96 po&#231;os com quatro po&#231;os replicados por grupo&#46; A placa foi incubada a 37<span class="elsevierStyleHsp" style=""></span>&#176;C com 5&#37; de CO<span class="elsevierStyleInf">2</span> e umidade saturada at&#233; as c&#233;lulas atingirem 80&#37; de conflu&#234;ncia&#46; Cada grupo de c&#233;lulas foi tratado de maneira diferente e incubado por mais 24 horas nas mesmas condi&#231;&#245;es&#46; O meio de cultura original em cada po&#231;o foi descartado e foram adicionados 100<span class="elsevierStyleHsp" style=""></span>&#956;L de meio de cultura contendo 10&#37; de CCK&#8208;8&#46; A placa foi incubada em incubadora de c&#233;lulas por 1 hora e a absorb&#226;ncia a 450<span class="elsevierStyleHsp" style=""></span>nm foi medida utilizando leitor de microplacas&#46; Os valores de absorb&#226;ncia &#40;OD&#41; foram medidos ap&#243;s 12&#44; 24&#44; 48 e 72 horas para avaliar a prolifera&#231;&#227;o celular&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105"><span class="elsevierStyleItalic">Ensaio</span> Transwell</span><p id="par0055" class="elsevierStylePara elsevierViewall">Transwell revestido com Matrigel foi utilizado para realizar ensaios de invas&#227;o e migra&#231;&#227;o celular para cada grupo&#46; Foram adicionados 50<span class="elsevierStyleHsp" style=""></span>&#956;L de Matrigel &#40;2<span class="elsevierStyleHsp" style=""></span>mg&#47;mL&#41; &#224; c&#226;mara superior de <span class="elsevierStyleItalic">transwell</span> e incubados a 37<span class="elsevierStyleHsp" style=""></span>&#176;C por 30 minutos&#46; Em seguida&#44; 4 &#215; 10<span class="elsevierStyleSup">3</span> c&#233;lulas foram semeadas em meio DMEM isento de soro&#46; A c&#226;mara inferior foi preenchida com 600<span class="elsevierStyleHsp" style=""></span>&#956;L de meio contendo 10&#37; de soro fetal bovino como quimioatraente&#46; Ap&#243;s incuba&#231;&#227;o por 24 horas&#44; as c&#233;lulas n&#227;o invasoras foram removidas com um cotonete&#46; As c&#233;lulas invadidas na membrana inferior foram fixadas com paraformalde&#237;do a 4&#37; por 30 minutos &#224; temperatura ambiente e coradas com cristal violeta a 0&#44;1&#37; por 20 minutos&#46; As c&#233;lulas invadidas e migradas foram fotografadas e contadas ao microsc&#243;pio &#40;Carl Zeiss&#44; Alemanha&#41;&#46; Tr&#234;s campos aleat&#243;rios foram selecionados para contagem de c&#233;lulas e a m&#233;dia foi calculada&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110"><span class="elsevierStyleItalic">Ensaio</span> cell scratch</span><p id="par0060" class="elsevierStylePara elsevierViewall">As c&#233;lulas da fase logar&#237;tmica foram colhidas&#44; centrifugadas e ressuspensas em meio de cultura&#46; As c&#233;lulas foram contadas e cada grupo de c&#233;lulas foi semeado em uma placa de seis po&#231;os &#40;6&#44;0 &#215; 10<span class="elsevierStyleSup">5</span> c&#233;lulas&#47;po&#231;o&#41; para cultura&#46; Quando a conflu&#234;ncia celular atingiu aproximadamente 95&#37; no dia seguinte&#44; um arranh&#227;o foi feito no centro de cada po&#231;o usando uma ponta de pipeta de 200<span class="elsevierStyleHsp" style=""></span>&#956;L&#46; Ap&#243;s lavagem com PBS&#44; foi adicionado meio de cultura fresco&#46; A imagem da hora 0 foi obtida utilizando um microsc&#243;pio &#243;ptico invertido e as c&#233;lulas foram adicionalmente incubadas&#46; As imagens foram obtidas ap&#243;s 24 e 48 horas&#46; A taxa de cicatriza&#231;&#227;o foi calculada usando o <span class="elsevierStyleItalic">software</span> ImageJ&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">An&#225;lise de citometria de fluxo de apoptose celular usando colora&#231;&#227;o dupla de anexina V&#47;iodeto de prop&#237;dio &#40;IP&#41;</span><p id="par0065" class="elsevierStylePara elsevierViewall">O sobrenadante da cultura foi coletado de cada grupo de c&#233;lulas e as c&#233;lulas foram lavadas com PBS&#44; tripsinizadas e coletadas&#46; As c&#233;lulas foram duplamente coradas utilizando o Annexin V&#8208;FITC Apoptosis Detection Kit&#46; A colora&#231;&#227;o foi realizada em c&#226;mara escura &#224; temperatura ambiente por 10 minutos&#46; A citometria de fluxo foi utilizada para an&#225;lise quantitativa e a taxa de apoptose foi calculada&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">An&#225;lise do ciclo celular</span><p id="par0070" class="elsevierStylePara elsevierViewall">As linhagens celulares de CECC humanos A431 e SCL&#8208;1 foram mantidas em meio de cultura DMEM suplementado com 5&#37; de FBS em placa de cultura de 10<span class="elsevierStyleHsp" style=""></span>cm&#46; Ap&#243;s tratamento nas condi&#231;&#245;es especificadas&#44; as c&#233;lulas foram coletadas e suspensas em PBS e fixadas em etanol frio a 70&#37; durante a noite a 4<span class="elsevierStyleHsp" style=""></span>&#176;C&#46; As c&#233;lulas foram ent&#227;o incubadas com 50<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;mL de iodeto de prop&#237;dio &#40;IP&#41; e 100<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;mL de RNase A &#40;1&#58;1&#41; por 20 minutos em temperatura ambiente no escuro&#46; Por fim&#44; o sinal de colora&#231;&#227;o das c&#233;lulas CECC foi avaliado utilizando o cit&#244;metro de fluxo FACSCalibur&#8482; &#40;BD Biosciences&#44; Franklin Lakes&#44; New Jersey&#44; EUA&#41;&#44; e a distribui&#231;&#227;o das porcentagens do ciclo celular foi analisada utilizando o <span class="elsevierStyleItalic">software</span> Cell Quest vers&#227;o 3&#46;3 &#40;BD Biosciences&#41; de acordo com as instru&#231;&#245;es do fabricante&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">An&#225;lise estat&#237;stica</span><p id="par0075" class="elsevierStylePara elsevierViewall">A an&#225;lise estat&#237;stica foi realizada utilizando o <span class="elsevierStyleItalic">software</span> SPSS 23&#46;0&#46; Os dados quantitativos foram expressos como m&#233;dia &#177; desvio padr&#227;o&#46; O teste de Qui&#8208;Quadrado foi utilizado para comparar dados categ&#243;ricos e an&#225;lise de vari&#226;ncia &#40;ANOVA&#41; foi utilizada para comparar taxas positivas entre m&#250;ltiplos grupos&#46; Testes <span class="elsevierStyleItalic">t</span> de amostras independentes foram usados para compara&#231;&#245;es pareadas&#46; O valor de p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05 foi considerado estatisticamente significante&#46;</p></span></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Resultados</span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Express&#227;o elevada de SIRT6 em tecidos de QA&#44; DB e CECC em compara&#231;&#227;o com tecido cut&#226;neo normal</span><p id="par0080" class="elsevierStylePara elsevierViewall">A express&#227;o de SIRT6 em diferentes tecidos foi analisada por marca&#231;&#227;o imuno&#8208;histoqu&#237;mica&#46; Os resultados revelaram que a express&#227;o da prote&#237;na SIRT6 era predominantemente observada no n&#250;cleo celular&#44; exibindo uma gama de tonalidades desde amarelo claro at&#233; colora&#231;&#227;o marrom&#8208;acastanhada&#44; enquanto nenhuma express&#227;o significante foi observada no citoplasma &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1A</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Uma avalia&#231;&#227;o quantitativa dos n&#237;veis de express&#227;o foi realizada utilizando sistema de escore semiquantitativo&#46; Os resultados demonstraram a seguinte distribui&#231;&#227;o nos tecidos examinados&#58; em 20 amostras de tecido cut&#226;neo normal &#40;TN&#41;&#44; n&#227;o houve express&#227;o de SIRT6 fortemente positiva&#44; positiva&#44; fracamente positiva ou negativa&#59; em 60 amostras de tecido de QA&#44; a distribui&#231;&#227;o foi de tr&#234;s amostras&#44; 31 amostras&#44; 22 amostras e quatro amostras&#44; respectivamente&#59; em 25 amostras de tecido de DB&#44; a distribui&#231;&#227;o foi de nove amostras&#44; 14 amostras&#44; duas amostras e 0 amostras&#44; respectivamente&#59; e entre 70 amostras de tecido de CECC&#44; houve 46 amostras&#44; 18 amostras&#44; seis amostras e 0 amostras&#44; respectivamente &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1B</a>&#41;&#46; As taxas de express&#227;o elevada de SIRT6 nos tecidos de TN&#44; QA&#44; DB e CECC foram 0&#37;&#44; 56&#44;67&#37;&#44; 92&#44;00&#37; e 91&#44;43&#37;&#44; respectivamente &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46; Compara&#231;&#245;es pareadas revelaram maior express&#227;o estatisticamente significante de SIRT6 em tecidos de QA&#44; DB e CECC em compara&#231;&#227;o com TN &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#44; enquanto n&#227;o houve diferen&#231;a estatisticamente significante na express&#227;o de SIRT6 entre tecidos de DB e CECC&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Correla&#231;&#227;o entre express&#227;o de SIRT6 e par&#226;metros cl&#237;nico&#8208;patol&#243;gicos em pacientes com CECC</span><p id="par0090" class="elsevierStylePara elsevierViewall">A an&#225;lise da correla&#231;&#227;o entre a express&#227;o de SIRT6 e par&#226;metros cl&#237;nico&#8208;patol&#243;gicos em pacientes com CECC revelou que a elevada express&#227;o de SIRT6 estava associada a tecido neopl&#225;sico localizado em &#225;reas expostas ao sol &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41; e maior grau na classifica&#231;&#227;o Broders &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; Entretanto&#44; n&#227;o foram observadas correla&#231;&#245;es significantes entre a express&#227;o de SIRT6 e dados cl&#237;nico&#8208;patol&#243;gicos&#44; como g&#234;nero&#44; idade&#44; dura&#231;&#227;o da doen&#231;a&#44; profundidade de invas&#227;o e di&#226;metro do tumor &#40;p<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; A <a class="elsevierStyleCrossRef" href="#tbl0020">tabela 4</a> mostra detalhes adicionais&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Alta express&#227;o de SIRT6 em c&#233;lulas e tecidos CECC e supress&#227;o da prolifera&#231;&#227;o de c&#233;lulas de CECC por silenciamento de SIRT6</span><p id="par0095" class="elsevierStylePara elsevierViewall">Pela an&#225;lise WB e qRT&#8208;PCR&#44; observou&#8208;se que o n&#237;vel de express&#227;o da prote&#237;na SIRT6 foi maior nas linhagens celulares de CECC &#40;A431&#44; SCL&#8208;1&#41; em compara&#231;&#227;o aos queratin&#243;citos humanos imortalizados &#40;HaCaT&#59; <a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2A</a>&#41;&#46; Do mesmo modo&#44; o n&#237;vel de express&#227;o de mRNA de SIRT6 foi maior nas c&#233;lulas A431 e SCL&#8208;1 do que nas c&#233;lulas HaCaT&#46; A an&#225;lise qRT&#8208;PCR de 20 pares de CECC e tecidos adjacentes normais confirmou a alta express&#227;o de SIRT6 em tecidos de CECC &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2B</a>&#41;&#44; consistente com os resultados da an&#225;lise imuno&#8208;histoqu&#237;mica&#46; Para investigar melhor o papel funcional da SIRT6 no CECC&#44; linhagens celulares de CECC com silenciamento do gene <span class="elsevierStyleItalic">SIRT6</span> foram estabelecidas por transdu&#231;&#227;o lentiviral&#46; Controle negativo &#40;CN&#41;&#44; grupo CN&#43;DOX e grupo controle shSIRT6 foram inclu&#237;dos como CN&#46; A efici&#234;ncia do silenciamento de SIRT6 em c&#233;lulas A431 e SCL&#8208;1 foi validada por an&#225;lise de <span class="elsevierStyleItalic">Western blot</span> &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2C</a>&#41; e qRT&#8208;PCR &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2D</a>&#41;&#44; demonstrando regula&#231;&#227;o negativa da prote&#237;na SIRT6 e express&#227;o de mRNA no grupo shSIRT6 em compara&#231;&#227;o com o grupo controle&#46; Experimentos subsequentes foram realizados utilizando linhagens celulares silenciadas e grupos controle&#46; Os resultados do ensaio CCK&#8208;8 mostraram que o silenciamento de SIRT6 inibiu significantemente a prolifera&#231;&#227;o de c&#233;lulas A431 e SCL&#8208;1 &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2E</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Inibi&#231;&#227;o da migra&#231;&#227;o e invas&#227;o de c&#233;lulas CECC por silenciamento de SIRT6</span><p id="par0100" class="elsevierStylePara elsevierViewall">Os efeitos de SIRT6 na migra&#231;&#227;o e invas&#227;o de c&#233;lulas CECC foram investigados posteriormente utilizando o ensaio <span class="elsevierStyleItalic">Transwell</span> e o ensaio <span class="elsevierStyleItalic">scratch</span>&#46; Os resultados mostraram que&#44; em compara&#231;&#227;o com os grupos controle &#40;CN&#44; CN &#43; DOX e controle shSIRT6&#41;&#44; o grupo silenciado shSIRT6 &#43; DOX exibiu migra&#231;&#227;o e invas&#227;o celular reduzidas &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3A</a>&#41; e taxa de cicatriza&#231;&#227;o de feridas reduzida &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3B</a>&#41; em c&#233;lulas A431 e SCL&#8208;1&#46; Esses resultados indicam que o silenciamento de SIRT6 inibe significantemente as capacidades de migra&#231;&#227;o e invas&#227;o das c&#233;lulas de CECC&#46; A an&#225;lise de <span class="elsevierStyleItalic">Western blot</span> foi realizada para detectar a express&#227;o de marcadores de transi&#231;&#227;o epitelial&#8208;mesenquimal &#40;TEM&#41; em c&#233;lulas de CECC&#46; Em compara&#231;&#227;o com os grupos de controle &#40;controle CN&#44; CN &#43; DOX e shSIRT6&#41;&#44; o grupo shSIRT6 &#43; DOX de c&#233;lulas A431 e SCL&#8208;1 apresentou express&#227;o regulada negativamente dos marcadores mesenquimais N&#8208;caderina e vimentina &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3C</a>&#41;&#46; Esses resultados indicam que o silenciamento de SIRT6 promove a express&#227;o dos marcadores de transi&#231;&#227;o epitelial&#8208;mesenquimal N&#8208;caderina e vimentina em c&#233;lulas CECC&#44; sugerindo que a inibi&#231;&#227;o da migra&#231;&#227;o e invas&#227;o de c&#233;lulas CECC por silenciamento de SIRT6 possa estar associada &#224; supress&#227;o do processo TEM&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0115" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">O silenciamento da SIRT6 aumenta a apoptose e induz a parada do ciclo celular na fase G0&#47;G1 em c&#233;lulas de CECC</span><p id="par0105" class="elsevierStylePara elsevierViewall">Utilizando citometria de fluxo&#44; foi investigado tamb&#233;m o efeito da SIRT6 na apoptose e na progress&#227;o do ciclo celular em c&#233;lulas de CECC&#46; Os resultados mostram que os grupos de c&#233;lulas A431 e SCL&#8208;1 tratados com shSIRT6 &#43; DOX exibem taxas apopt&#243;ticas aumentadas &#40;<a class="elsevierStyleCrossRef" href="#fig0020">fig&#46; 4A</a>&#41; e bloqueio na fase G0&#47;G1 do ciclo celular &#40;<a class="elsevierStyleCrossRef" href="#fig0020">fig&#46; 4B</a>&#41;&#44; indicando que a regula&#231;&#227;o negativa de SIRT6 pode aumentar a apoptose e induzir a parada do ciclo celular na fase G0&#47;G1 em c&#233;lulas de CECC&#46; Para avaliar a express&#227;o de marcadores relacionados &#224; apoptose &#40;Bax&#44; BCL&#8208;2&#44; caspase&#8208;3 clivada&#41; e marcadores relacionados ao ciclo celular &#40;CyclinD1&#44; CDK4&#41; em c&#233;lulas de CECC&#44; foi realizada an&#225;lise por <span class="elsevierStyleItalic">Western blot</span>&#46; Em compara&#231;&#227;o com os grupos de controle CN&#44; CN &#43; DOX e shSIRT6&#44; os grupos de c&#233;lulas A431 e SCL&#8208;1 tratados com shSIRT6 &#43; DOX exibiram n&#237;veis aumentados de express&#227;o da prote&#237;na Bax&#44; BCL&#8208;2 e caspase&#8208;3 clivada&#44; enquanto os n&#237;veis de prote&#237;na CyclinD1 e CDK4 estavam diminu&#237;dos &#40;<a class="elsevierStyleCrossRef" href="#fig0020">fig&#46; 4C</a>&#41;&#46; Esses resultados indicam que a regula&#231;&#227;o negativa da SIRT6 promove a apoptose e induz a parada do ciclo celular na fase G0&#47;G1 em c&#233;lulas de CECC&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span></span></span><span id="sec0120" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Discuss&#227;o</span><p id="par0110" class="elsevierStylePara elsevierViewall">O CECC &#233; neoplasia maligna proliferativa originada das c&#233;lulas queratinizadas dos anexos ou da epiderme&#46; Embora a maioria dos CECC possa ser erradicada com sucesso por meio de excis&#227;o cir&#250;rgica&#44; aproximadamente 14&#37; a 15&#37; dos pacientes com CECC prim&#225;rio ainda apresentam infiltra&#231;&#227;o subcl&#237;nica&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">22</span></a> O crescimento invasivo do CECC pode romper a membrana basal da epiderme e invadir a derme mais profunda&#44; anexos da pele&#44; vasos sangu&#237;neos&#44; vasos linf&#225;ticos&#44; nervos etc&#46;&#44; levando ao desenvolvimento do CECC de alto risco&#46; Apesar dos avan&#231;os significantes nas op&#231;&#245;es de tratamento&#44; como cirurgia de Mohs&#44; cetuximabe e panitumumabe&#44; que melhoraram muito o progn&#243;stico dos pacientes com CECC&#44; o progn&#243;stico para CECC de alto e muito alto risco permanece ruim&#44; com taxas de recorr&#234;ncia em cinco anos variando de 30&#37; a 50&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">23</span></a> Portanto&#44; &#233; necess&#225;rio explorar ainda mais os mecanismos subjacentes &#224; ocorr&#234;ncia e progress&#227;o do CECC e identificar mais alvos terap&#234;uticos&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">A SIRT6 est&#225; desregulada em v&#225;rios tipos de c&#226;ncer&#44; e seu papel na tumorig&#234;nese depende do tipo e do contexto do tumor&#46; A express&#227;o de SIRT6 &#233; regulada positivamente no c&#226;ncer de mama&#44; c&#226;ncer de p&#226;ncreas&#44; melanoma prim&#225;rio e carcinoma de pulm&#227;o de c&#233;lulas n&#227;o pequenas&#44;<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">24&#44;25</span></a> sugerindo papel pr&#243;&#8208;oncog&#234;nico nesses tipos de c&#226;ncer&#46; Por outro lado&#44; a SIRT6 &#233; regulada negativamente em tecidos de c&#226;ncer de ov&#225;rio&#44; e sua baixa express&#227;o est&#225; intimamente associada &#224; infiltra&#231;&#227;o neopl&#225;sica e met&#225;stases&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">26</span></a> Estudos demonstraram que a SIRT6 inibe o crescimento do c&#226;ncer g&#225;strico ao suprimir o transdutor de sinal&#47;JAK2 e o ativador da via da transcri&#231;&#227;o&#8208;3&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">27</span></a> Al&#233;m disso&#44; foi relatado que SIRT6 pode suprimir a ocorr&#234;ncia e o desenvolvimento de c&#226;ncer pancre&#225;tico&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">28</span></a> Portanto&#44; a SIRT6 tamb&#233;m desempenha um papel na inibi&#231;&#227;o do in&#237;cio e desenvolvimento de neoplasias malignas&#44; com forte heterogeneidade em diferentes tipos de tumores&#46; Os resultados deste estudo mostram que a express&#227;o de SIRT6 est&#225; aumentada em tecidos tumorais de CECC em compara&#231;&#227;o com tecidos cut&#226;neos normais&#44; sugerindo que a alta express&#227;o de SIRT6 possa estar envolvida na ocorr&#234;ncia e desenvolvimento do CECC&#46; O n&#237;vel de express&#227;o da prote&#237;na SIRT6 no CECC &#233; maior do que na les&#227;o pr&#233;&#8208;cancerosa de CA e tecido cut&#226;neo normal&#44; sugerindo que a SIRT6 possa desempenhar papel importante na progress&#227;o do tecido cut&#226;neo normal para les&#245;es pr&#233;&#8208;cancerosas e posteriormente para carcinoma espinocelular cut&#226;neo&#46; No entanto&#44; a express&#227;o de SIRT6 foi ligeiramente maior na DB do que no tecido de CECC&#44; o que pode estar relacionado ao n&#250;mero limitado de amostras de tecido de DB&#46; A alta express&#227;o de SIRT6 em tecidos de CECC est&#225; associada &#224; localiza&#231;&#227;o do tecido neopl&#225;sico em &#225;reas expostas ao sol e ao estadiamento de Broders&#44; mas n&#227;o ao g&#234;nero&#44; idade&#44; di&#226;metro do tumor etc&#46;&#44; consistente com achados em melanoma e carcinoma de pulm&#227;o de c&#233;lulas n&#227;o pequenas&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">29</span></a> Al&#233;m disso&#44; descobriu&#8208;se que a SIRT6 &#233; altamente expressa em c&#233;lulas de CECC e que o silenciamento da SIRT6 inibe a capacidade de prolifera&#231;&#227;o&#44; migra&#231;&#227;o e invas&#227;o das c&#233;lulas de CECC&#46; A invas&#227;o e a migra&#231;&#227;o s&#227;o caracter&#237;sticas cr&#237;ticas das neoplasias malignas&#44; e o silenciamento da SIRT6 reduziu significantemente a prolifera&#231;&#227;o&#44; migra&#231;&#227;o e invas&#227;o de c&#233;lulas de CECC&#44; fornecendo evid&#234;ncias do papel da SIRT6 no crescimento e motilidade das c&#233;lulas de CECC&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">O silenciamento de SIRT6 induz a apoptose celular e inibe a transi&#231;&#227;o do ciclo celular G1&#47;S&#46; A apoptose celular &#233; processo complexo que envolve m&#250;ltiplas vias de sinaliza&#231;&#227;o&#44; e a regula&#231;&#227;o positiva de prote&#237;nas relacionadas &#224; apoptose &#40;incluindo Bax&#44; BCL&#8208;2&#44; caspase&#8208;3 clivada&#41; ap&#243;s o silenciamento de SIRT6 confirma seu envolvimento na regula&#231;&#227;o da apoptose do CECC&#46; Tamb&#233;m foi observado que o silenciamento de SIRT6 leva &#224; parada do ciclo celular G0&#47;G1&#44; como demonstrado pela an&#225;lise do ciclo celular&#46; Al&#233;m disso&#44; a regula&#231;&#227;o negativa de ciclina D1 e CDK4&#44; que codificam prote&#237;nas que regulam o ciclo celular&#44; est&#225; associada &#224; progress&#227;o do tumor&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">30</span></a> A ciclina D1 &#233; prote&#237;na&#8208;chave na regula&#231;&#227;o do ciclo celular e &#233; suficiente para impulsionar a progress&#227;o desse ciclo&#46;<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">31&#44;32</span></a> Este estudo demonstra o envolvimento da SIRT6 na regula&#231;&#227;o da apoptose e do ciclo celular em c&#233;lulas de CECC&#44; influenciando assim os n&#237;veis de express&#227;o de apoptose e prote&#237;nas relacionadas ao ciclo celular&#46; Com base nisso&#44; especula&#8208;se que a SIRT6 possa estar envolvida no comportamento biol&#243;gico das c&#233;lulas do CECC como uma mol&#233;cula funcional&#46; Entretanto&#44; existem v&#225;rias limita&#231;&#245;es neste estudo&#46; Primeiro&#44; as amostras cl&#237;nicas de tecidos do estudo s&#227;o limitadas&#59; estudos futuros devem aumentar o tamanho da amostragem e utilizar m&#250;ltiplos m&#233;todos experimentais para esclarecer ainda mais o padr&#227;o de express&#227;o de SIRT6&#46; Em segundo lugar&#44; em virtude da complexidade da regula&#231;&#227;o e desenvolvimento tumoral&#44; os mecanismos espec&#237;ficos ainda est&#227;o sujeitos a investiga&#231;&#227;o adicional&#44; e experimentos subsequentes <span class="elsevierStyleItalic">in vivo</span> devem ser realizados para explorar o impacto da SIRT6 no comportamento biol&#243;gico do CECC&#46; Al&#233;m disso&#44; as neoplasias s&#227;o doen&#231;as complexas com elevada heterogeneidade&#44; e sua ocorr&#234;ncia e desenvolvimento n&#227;o s&#227;o determinados por um &#250;nico fator independente&#46; Portanto&#44; a identifica&#231;&#227;o no CECC de mol&#233;culas que possam interagir sinergicamente ou antagonicamente com a SIRT6 continua sendo um foco para pesquisas futuras&#46;</p></span><span id="sec0125" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Conclus&#227;o</span><p id="par0125" class="elsevierStylePara elsevierViewall">Este estudo descobriu que a SIRT6 &#233; altamente expressa no CECC&#44; o que pode desempenhar papel como fator cancer&#237;geno&#44; fornecendo certa base te&#243;rica para tratamentos futuros&#46;</p></span><span id="sec0130" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Suporte financeiro</span><p id="par0130" class="elsevierStylePara elsevierViewall">Este trabalho recebeu suporte financeiro da Nantong Municipal Health Commission &#40;MB2021019&#41;&#44; Basic Research Project of Nantong Science e Technology Bureau &#40;JCZ2022021&#41;&#44; e Natural Science Foundation of Jiangsu Province &#40;BK20211108&#41;&#46;</p></span><span id="sec0135" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0175">Contribui&#231;&#227;o dos autores</span><p id="par0135" class="elsevierStylePara elsevierViewall">Chen Sai&#58; Concep&#231;&#227;o e planejamento do estudo&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; an&#225;lise estat&#237;stica&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; revis&#227;o cr&#237;tica do manuscrito&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Chen Hongxia&#58; Obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; an&#225;lise estat&#237;stica&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; revis&#227;o cr&#237;tica do manuscrito&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Wang Xu&#58; Obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; an&#225;lise estat&#237;stica&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; revis&#227;o cr&#237;tica do manuscrito&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Zhang Dongmei&#58; Participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; revis&#227;o cr&#237;tica da literatura&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Zhang Li&#58; Obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; revis&#227;o cr&#237;tica da literatura&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Jiawei Cheng&#58; Obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; revis&#227;o cr&#237;tica da literatura&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Zhang Qi&#58; Obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; revis&#227;o cr&#237;tica da literatura&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Zhixiang Hua&#58; Participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; revis&#227;o cr&#237;tica da literatura&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Miao Xu&#58; Participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; revis&#227;o cr&#237;tica da literatura&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Shi Jian&#58; Participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; an&#225;lise estat&#237;stica&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; revis&#227;o cr&#237;tica do manuscrito&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p></span><span id="sec0140" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0180">Conflito de interesses</span><p id="par0185" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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    "fechaRecibido" => "2023-06-17"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Fundamentos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">O carcinoma espinocelular cut&#226;neo &#40;CECC&#41; &#233; um dos tipos de c&#226;ncer de pele mais comuns em todo o mundo&#46; Portanto&#44; a identifica&#231;&#227;o de biomarcadores associados &#224; progress&#227;o do CECC poderia auxiliar na detec&#231;&#227;o precoce do carcinoma espinocelular de alto risco e no desenvolvimento de novas estrat&#233;gias terap&#234;uticas&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Este estudo teve como objetivo investigar os padr&#245;es de express&#227;o da prote&#237;na <span class="elsevierStyleItalic">silent mating type information regulation 2 homolog 6</span> &#40;SIRT6&#41; em CECC e seu significado cl&#237;nico&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">O n&#237;vel de express&#227;o da prote&#237;na SIRT6 nos tecidos foi detectado por imuno&#8208;histoqu&#237;mica&#44; e a correla&#231;&#227;o entre a express&#227;o da SIRT6 e par&#226;metros clinicopatol&#243;gicos em pacientes com CECC foi analisada&#46; A express&#227;o relativa de SIRT6 na linhagem celular de CECC e em amostras de tecido cut&#226;neo foi determinada por <span class="elsevierStyleItalic">western blotting</span> e PCR&#46; O efeito do silenciamento da SIRT6 na prolifera&#231;&#227;o celular foi avaliado utilizando o <span class="elsevierStyleItalic">kit</span>&#8208;8 de contagem de c&#233;lulas&#46; A cicatriza&#231;&#227;o de feridas&#44; o m&#233;todo <span class="elsevierStyleItalic">transwell</span> e a citometria de fluxo foram utilizados para investigar a migra&#231;&#227;o&#44; invas&#227;o e distribui&#231;&#227;o&#47;apoptose do ciclo celular de c&#233;lulas de CECC ap&#243;s o silenciamento da SIRT6&#44; respectivamente&#46; <span class="elsevierStyleItalic">Western blot</span> foi utilizado para detectar a express&#227;o de transi&#231;&#227;o epitelial&#8208;mesenquimal &#40;TEM&#41;&#44; ciclo&#44; apoptose e outras prote&#237;nas relacionadas&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A alta express&#227;o de SIRT6 foi correlacionada com a localiza&#231;&#227;o do tecido neopl&#225;sico e o estadiamento de Broder em pacientes com CECC&#46; O silenciamento da SIRT6 inibiu a prolifera&#231;&#227;o&#44; migra&#231;&#227;o&#44; invas&#227;o e TEM de c&#233;lulas de CECC e promoveu sua apoptose&#59; as c&#233;lulas foram bloqueadas na fase G1&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Limita&#231;&#245;es do estudo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Nenhum experimento com animais foi realizado para verificar adicionalmente os resultados&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclus&#227;o</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A redu&#231;&#227;o da express&#227;o de SIRT6 pode inibir a ocorr&#234;ncia e o desenvolvimento de CECC&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Como citar este artigo&#58; Chen S&#44; Chen H&#44; Wang X&#44; Zhang D&#44; Zhang L&#44; Cheng J&#44; et al&#46; Expression analysis and biological regulation of silencing regulatory protein&#160;6 &#40;SIRT6&#41; in cutaneous squamous cell carcinoma&#46; An Bras Dermatol&#46; 2024&#59;99&#58;535&#8211;45&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Trabalho realizado no Nantong First People&#39;s Hospital&#44; Nantong&#44; China&#46;</p>"
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          "pt" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">O silenciamento de SIRT6 pode aumentar a apoptose e a parada do ciclo celular na fase G0&#47;G1 das c&#233;lulas de CECC&#46; &#40;A&#8208;B&#41; A an&#225;lise de citometria de fluxo mostrou a taxa de apoptose e a distribui&#231;&#227;o do ciclo celular de c&#233;lulas A431 e SCL&#8208;1 transfectadas com shSIRT6&#43;DOX e NC&#44; NC&#43;DOX e shSIRT6 no grupo controle&#46; A taxa de apoptose foi medida por citometria de fluxo&#46; O quadrante superior direito representava c&#233;lulas apopt&#243;ticas tardias&#44; e o quadrante inferior direito representava c&#233;lulas apopt&#243;ticas precoces&#46; A taxa de apoptose<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>raz&#227;o apopt&#243;tica tardia &#43; raz&#227;o apopt&#243;tica precoce&#46; &#40;C&#41; <span class="elsevierStyleItalic">Western blots</span> mostraram prote&#237;nas relacionadas &#224; apoptose &#40;Bax&#44; BCL&#8208;2&#44; Cleaved&#8208;caspase3&#41; e ciclinas &#40;ciclinaD1 e CDK4&#41; em c&#233;lulas A431 e SCL&#8208;1 transfectadas com shSIRT6&#43;DOX e controle NC&#44; NC&#43;DOX&#44; shSIRT6 Flat&#44; &#42;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#44; &#42;&#42;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#46;</p>"
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            "rol" => "short"
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            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Indica&#231;&#227;o de avalia&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Gradua&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Escore&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Contagem celular positiva</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#37;&#8764;25&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#37;&#8764;50&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&#37;&#8764;75&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">76&#37;&#8764;100&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Intensidade da marca&#231;&#227;o</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sem marca&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Amarelo claro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Claybank</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Castanho&#8208;claro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Intensidade de express&#227;o &#40;contagem de c&#233;lulas positivas &#215; intensidade de marca&#231;&#227;o&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Baixa express&#227;o</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Negativa &#40;&#8722;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#8764;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fracamente positiva &#40;&#43;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#8764;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alta express&#227;o</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Positiva &#40;&#43;&#43;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#8764;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fortemente positiva &#40;&#43;&#43;&#43;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#8764;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab3563619.png"
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        "descripcion" => array:1 [
          "pt" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Resultados da marca&#231;&#227;o para SIRT6 avaliados utilizando m&#233;todo de escore semiquantitativo de 12 pontos</p>"
        ]
      ]
      5 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Tabela 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Tabela "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Gene&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sequ&#234;ncia de <span class="elsevierStyleItalic">primer</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SIRT6</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F&#58;5&#8242;&#8208; TGGCAGTCTTCCAGTGTGGTGT&#8208;3&#8242;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">R&#58;5&#8242;&#8208; CGCTCTCAAAGGTGGTGTCGAA&#8208;3&#8242;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">U6</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F&#58;5&#8242;&#8208; CTCGCTTCGGCAGCACA &#8208;3&#8242;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">R&#58; 5&#8242;&#8208; AACGCTTCACGAATTTGCGT&#8208;3&#8242;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                0 => "xTab3563617.png"
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          "pt" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Sequ&#234;ncias de <span class="elsevierStyleItalic">primers</span> usadas na PCR quantitativa de fluoresc&#234;ncia em tempo real</p>"
        ]
      ]
      6 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Tabela 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
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            "identificador" => "at3"
            "detalle" => "Tabela "
            "rol" => "short"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">TN&#44; tecido cut&#226;neo normal&#59; CA&#44; ceratose act&#237;nica&#59; DB&#44; doen&#231;a de Bowen&#59; CECC&#44; carcinoma espinocelular cut&#226;neo&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Grupo</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Express&#227;o of SIRT6</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Taxa de alta express&#227;o</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Baixa express&#227;o &#40;&#8722;&#8764;&#43;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Alta express&#227;o &#40;&#43;&#43;&#8764;&#43;&#43;&#43;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&#44;67&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">DB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">92&#44;00&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CECC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">91&#44;43&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3563616.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Diferen&#231;as na express&#227;o de SIRT6 em tecidos TN&#44; CA&#44; DB e CECC</p>"
        ]
      ]
      7 => array:8 [
        "identificador" => "tbl0020"
        "etiqueta" => "Tabela 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at4"
            "detalle" => "Tabela "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Caracter&#237;sticas cl&#237;nicas</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N&#250;mero de casos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Baixa express&#227;o &#40;&#8722;&#8764;&#43;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Alta express&#227;o &#40;&#43;&#43;&#8764;&#43;&#43;&#43;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&#8208;valor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">G&#234;nero</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Masculino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;433&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Feminino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Idade</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8804; 70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;207&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#62;<span class="elsevierStyleHsp" style=""></span>70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Posi&#231;&#227;o</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Exposi&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;032&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sem exposi&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tempo de doen&#231;a</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>2 anos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;405&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8805; 2 anos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Profundidade de invas&#227;o</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8804; 3mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;128&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#62;<span class="elsevierStyleHsp" style=""></span>3mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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          "pt" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Rela&#231;&#227;o entre a express&#227;o de SIRT6 e caracter&#237;sticas cl&#237;nicas de pacientes com CECC</p>"
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                            4 => "C&#46;C&#46; Wu"
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Artigo original
Análise da expressão e regulação biológica da proteína reguladora silenciadora 6 (SIRT6) no carcinoma espinocelular cutâneo
Sai Chena, Hongxia Chena, Xu Wanga, Dongmei Zhangb,c, Li Zhanga, Jiawei Chenga, Qi Zhanga, Zhixiang Huaa, Xu Miaoa, Jian Shia,
Corresponding author
jsntmcsj@163.com

Autor para correspondência.
a Departamento de Dermatologia, Affiliated Hospital 2 of Nantong University, República Popular da China
b Jiangsu Provincial Medical Key Discipline (Laboratório) Unidade de Cultivo de Imunologia, Nantong First People's Hospital, República Popular da China
c Medical Research Center, Affiliated Hospital 2 of Nantong University, República Popular da China
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          "pt" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Inibi&#231;&#227;o da migra&#231;&#227;o e invas&#227;o de c&#233;lulas de CECC por silenciamento de SIRT6&#46; &#40;A&#41; Resultados do ensaio Transwell e an&#225;lise estat&#237;stica representando os efeitos da SIRT6 na migra&#231;&#227;o e invas&#227;o celular em c&#233;lulas A431 e SCL&#8208;1&#46; Compara&#231;&#227;o do n&#250;mero de c&#233;lulas migradas e invadidas nos grupos SIRT6&#43;DOX&#44; NC&#44; NC&#43;DOX e grupo controle shSIRT6&#46; &#40;B&#41; Resultados do ensaio <span class="elsevierStyleItalic">scratch</span> e an&#225;lise estat&#237;stica demonstrando os efeitos da SIRT6 na taxa de migra&#231;&#227;o celular em c&#233;lulas A431 e SCL&#8208;1&#46; Compara&#231;&#227;o da taxa de migra&#231;&#227;o em 24 e 48 horas nos grupos SIRT6&#43;DOX&#44; NC&#44; NC&#43;DOX e grupo shSIRT6&#46; &#40;C&#41; Resultados da an&#225;lise de <span class="elsevierStyleItalic">Western blot</span> e an&#225;lise estat&#237;stica representando os efeitos da SIRT6 na express&#227;o de marcadores de transi&#231;&#227;o epitelial&#8208;mesenquimal &#40;EMT&#41; em c&#233;lulas de CECC&#46; Compara&#231;&#227;o dos n&#237;veis de express&#227;o dos marcadores mesenquimais N&#8208;caderina e vimentina em c&#233;lulas A431 e SCL&#8208;1&#46; Nota&#58; &#42;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#44; &#42;&#42;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Introdu&#231;&#227;o</span><p id="par0005" class="elsevierStylePara elsevierViewall">O carcinoma espinocelular cut&#226;neo &#40;CECC&#41; est&#225; consolidado como o segundo c&#226;ncer de pele n&#227;o melanoma mais comum&#44; com incid&#234;ncia crescente variando de 20&#37; a 50&#37; de todos os tipos de c&#226;ncer de pele&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">1</span></a> A progress&#227;o do CECC &#233; determinada por uma combina&#231;&#227;o de suscetibilidade gen&#233;tica e fatores de risco ambientais&#44; incluindo exposi&#231;&#227;o &#224; radia&#231;&#227;o ultravioleta&#44; agentes cancer&#237;genos e medicamentos imunossupressores&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">2</span></a> Apesar do risco relativamente baixo de met&#225;stases e da sobrevida favor&#225;vel em longo prazo ap&#243;s o tratamento&#44; a incid&#234;ncia de CECC aumentou proporcionalmente nos &#250;ltimos anos&#44; resultando em morbidade&#44; mortalidade e &#244;nus econ&#244;mico significantes no longo prazo para os pacientes&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">3&#8211;5</span></a> Portanto&#44; uma compreens&#227;o mais profunda da patog&#234;nese do CECC &#233; crucial para melhorar o diagn&#243;stico e a efic&#225;cia do tratamento&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">6</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">As sirtu&#237;nas&#44; que pertencem &#224; fam&#237;lia das histonas desacetilases&#44; est&#227;o envolvidas em v&#225;rias fun&#231;&#245;es celulares&#44; como envelhecimento&#44; resposta ao estresse&#44; metabolismo e homeostase energ&#233;tica&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">7&#8211;9</span></a> As sirtu&#237;nas de mam&#237;feros consistem em sete membros da fam&#237;lia &#40;SIRT1&#8208;7&#41;&#44; que exibem diferentes localiza&#231;&#227;o subcelular&#44; atividades catal&#237;ticas e fun&#231;&#245;es biol&#243;gicas&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">10</span></a> A SIRT6&#44; localizada principalmente no n&#250;cleo&#44; funciona como desacetilase dependente de NAD&#43; e ADP&#8208;ribosiltransferase altamente conservadas&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">11&#44;12</span></a> A SIRT6 tem sido implicada em diabetes&#44; doen&#231;as cardiovasculares&#44; envelhecimento e c&#226;ncer&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">13&#8211;16</span></a> Evid&#234;ncias emergentes sugerem forte liga&#231;&#227;o entre SIRT6 e o in&#237;cio e progress&#227;o do mieloma m&#250;ltiplo &#40;MM&#41; e v&#225;rios outros tipos de neoplasias&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">17&#44;18</span></a> Seu duplo papel de suprimir ou promover o c&#226;ncer foi observado em diferentes tipos de c&#226;ncer&#44; potencialmente influenciado por vias de sinaliza&#231;&#227;o e contextos tecido&#8208;espec&#237;ficos&#46;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">19&#44;20</span></a> Entretanto&#44; o impacto preciso da SIRT6 no CECC permanece em grande parte indefinido&#46; A hip&#243;tese dos autores &#233; que a SIRT6 desempenha papel fundamental na patog&#234;nese e progress&#227;o do CECC&#44; justificando avalia&#231;&#227;o de seus padr&#245;es de express&#227;o&#44; mecanismos funcionais e potenciais implica&#231;&#245;es cl&#237;nicas&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Materiais e m&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Materiais</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Reagentes</span><p id="par0015" class="elsevierStylePara elsevierViewall">Foram utilizados os seguintes reagentes&#58; linhagem celular de carcinoma espinocelular cut&#226;neo humano A431 &#40;obtida de Zhongqiao Xinzhou&#44; Xangai&#41; e linhagem celular SCL&#8208;1 &#40;Enzyme Research&#44; Xangai&#41;&#59; a linhagem de queratin&#243;citos humanos normais imortalizados HaCaT &#40;Shanghai Fuheng Biotechnology Co&#46;&#44; Ltd&#46;&#41;&#59; leite desnatado&#44; clorof&#243;rmio e isopropanol &#40;adquirido da Shanghai Shenggong Co&#46;&#44; Ltd&#46;&#41;&#59; anticorpos prim&#225;rios contra SIRT6 e &#946;&#8208;tubulina&#44; anticorpos secund&#225;rios contra imunoglobulina IgG de camundongo &#40;adquiridos de Abcam&#44; EUA&#41;&#59; anticorpo monoclonal de N&#8208;caderina anti&#8208;humano de camundongo e anticorpo monoclonal de vimentina anti&#8208;humano de camundongo &#40;Proteintech&#44; Wuhan&#41;&#59; soro bovino fetal e meio DMEM com alto teor de glicose &#40;adquirido de Gibco&#44; EUA&#41;&#59; <span class="elsevierStyleItalic">kit</span> de an&#225;lise BCA&#44; cristal violeta e lipofectamina 2000 &#40;adquiridos de Biyuntian Biotechnology Co&#46;&#44; Ltd&#46;&#41;&#59; membrana de fluoreto de polivinilideno &#40;PVDF&#59; adquirida de Millipore&#44; EUA&#41;&#59; reagente trizol&#44; <span class="elsevierStyleItalic">kit</span> de tecido puro para prepara&#231;&#227;o de RNA&#44; <span class="elsevierStyleItalic">kit</span> de s&#237;ntese PrimeScript RT e <span class="elsevierStyleItalic">kit</span> SYBR Green qRT&#8208;PCR Master Mix &#40;adquiridos de Thermo&#44; EUA&#41;&#59; <span class="elsevierStyleItalic">kit</span> de ensaio CCK&#8208;8 &#40;Proteintech&#44; Wuhan&#41;&#59; gel de matriz e c&#226;maras <span class="elsevierStyleItalic">transwell</span> de 8<span class="elsevierStyleHsp" style=""></span>&#956;m &#40;Corning&#44; EUA&#41;&#46; Todos os <span class="elsevierStyleItalic">primers</span> foram sintetizados pela Shanghai Shenggong Co&#46;&#44; Ltd&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Amostras de tecido</span><p id="par0020" class="elsevierStylePara elsevierViewall">Blocos de tecido de 70 pacientes com CECC&#44; de 25 pacientes com doen&#231;a de Bowen &#40;DB&#41; e de 60 pacientes com ceratose act&#237;nica &#40;CA&#41; foram coletados de janeiro de 2017 a dezembro de 2022&#46; Al&#233;m disso&#44; 20 amostras de pele normal de cirurgia pl&#225;stica foram coletadas como controles normais&#46; Foram coletadas amostras frescas de CECC e de pele normal &#40;TN&#41;&#44; 20 de cada&#46; Al&#233;m disso&#44; nenhum dos pacientes deste estudo recebeu qualquer tratamento antes da cirurgia&#44; incluindo quimioterapia ou radioterapia&#46; Todos os pacientes participantes do estudo forneceram consentimento informado&#44; e este estudo foi aprovado pelo Comit&#234; de &#201;tica do hospital &#40;n&#250;mero de aprova&#231;&#227;o&#58; 2021KT085&#41;&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">M&#233;todos</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Imuno&#8208;histoqu&#237;mica para an&#225;lise de express&#227;o da prote&#237;na</span><p id="par0025" class="elsevierStylePara elsevierViewall">Amostras de tecido de CECC foram desparafinizadas e tratadas com per&#243;xido de hidrog&#234;nio por 5 minutos para inibir a atividade da peroxidase end&#243;gena&#46; Foi adicionada solu&#231;&#227;o bloqueadora de soro de cabra&#44; e a recupera&#231;&#227;o antig&#234;nica foi realizada com solu&#231;&#227;o de citrato&#46; Amostras de tecido de CECC foram incubadas com anticorpo anti&#8208;SIRT6 de camundongo &#40;1&#58;200&#41; durante a noite a 4<span class="elsevierStyleHsp" style=""></span>&#176;C&#46; Ap&#243;s duas lavagens com PBS por 3 minutos cada&#44; as amostras foram incubadas com IgG de cabra anticamundongo conjugado com HRP &#40;1&#58;2000&#41; por 1&#44;5 hora &#224; temperatura ambiente&#46; Ap&#243;s duas lavagens com PBS durante 3 minutos cada&#44; o anticorpo prim&#225;rio foi detectado utilizando um <span class="elsevierStyleItalic">kit</span> de substrato de diaminobenzidina &#40;DAB&#41;&#46; Imagens de marca&#231;&#227;o imuno&#8208;histoqu&#237;mica foram observadas ao microsc&#243;pio e v&#225;rios campos foram selecionados aleatoriamente para observa&#231;&#227;o em grande aumento&#46; Os resultados da marca&#231;&#227;o imuno&#8208;histoqu&#237;mica foram interpretados usando um m&#233;todo de escore semiquantitativo comumente utilizado<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">21</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Cultura de c&#233;lulas</span><p id="par0030" class="elsevierStylePara elsevierViewall">As linhagens celulares utilizadas neste estudo inclu&#237;ram a linhagem celular de carcinoma espinocelular da pele humana &#40;A431&#44; SCL&#8208;1&#41; e a linhagem de queratin&#243;citos normais humanos imortalizados HaCaT&#46; O meio utilizado para c&#233;lulas A431&#44; SCL&#8208;1 e HaCaT foi meio DMEM com alto teor de glicose&#46; Todas as c&#233;lulas foram cultivadas a 37<span class="elsevierStyleHsp" style=""></span>&#176;C com 5&#37; de CO<span class="elsevierStyleInf">2</span> e 10&#37; de soro bovino fetal no meio&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Western blot</span><p id="par0035" class="elsevierStylePara elsevierViewall">A lise celular foi realizada utilizando tamp&#227;o RIPA&#44; e a prote&#237;na foi extra&#237;da em gelo&#46; A concentra&#231;&#227;o de prote&#237;na foi determinada utilizando um <span class="elsevierStyleItalic">kit</span> de ensaio BCA&#46; Amostras de prote&#237;na de cada grupo foram carregadas em gel a 12&#44;5&#37; e submetidas &#224; eletroforese a 80<span class="elsevierStyleHsp" style=""></span>V por 30 minutos&#44; seguida de 110<span class="elsevierStyleHsp" style=""></span>V por 1 hora&#46; A transfer&#234;ncia para membrana PVDF foi realizada a 100<span class="elsevierStyleHsp" style=""></span>V em banho de gelo por 1&#44;5 hora&#46; A membrana foi ent&#227;o bloqueada com leite desnatado a 5&#37; durante 2 horas&#44; seguida de incuba&#231;&#227;o com anticorpo prim&#225;rio a 4<span class="elsevierStyleHsp" style=""></span>&#176;C durante a noite e incuba&#231;&#227;o com anticorpo secund&#225;rio por 2 horas&#46; Os anticorpos secund&#225;rios utilizados foram HRP de cabra anticamundongo &#40;dilui&#231;&#227;o 1&#58;1000&#41; e HRP de cabra anticoelho &#40;dilui&#231;&#227;o 1&#58;1000&#41;&#46; Por fim&#44; as imagens foram capturadas e armazenadas utilizando sistema de imagem por quimiluminesc&#234;ncia Bio&#8208;Rad&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Rea&#231;&#227;o em cadeia da polimerase via transcriptase reversa quantitativa &#40;qRT&#8208;PCR&#41;</span><p id="par0040" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Pellets</span> celulares foram coletados e tratados com reagente trizol para lise&#44; seguido de extra&#231;&#227;o com clorof&#243;rmio&#47;isopropanol para separar e precipitar RNA&#46; O RNA total foi posteriormente extra&#237;do por precipita&#231;&#227;o com etanol&#46; A transcri&#231;&#227;o reversa de 1<span class="elsevierStyleHsp" style=""></span>&#956;g de RNA em cDNA foi realizada utilizando o <span class="elsevierStyleItalic">kit</span> de s&#237;ntese PrimeScript RT&#46; A qRT&#8208;PCR foi realizada utilizando o <span class="elsevierStyleItalic">kit</span> SYBR Green qRT&#8208;PCR Master Mix&#44; com U6 sendo utilizado como refer&#234;ncia interna&#46; As sequ&#234;ncias de <span class="elsevierStyleItalic">primers</span> est&#227;o listadas na <a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Infec&#231;&#227;o celular e triagem</span><p id="par0045" class="elsevierStylePara elsevierViewall">O shSIRT6 lentiviral e o controle shNC foram fornecidos por Youxi Weinan Biotechnology Company &#40;Sanming&#44; China&#41;&#46; Os lentiv&#237;rus foram envelopados usando um sistema de plasm&#237;deo triplo&#46; O shRNA foi inserido no vetor de express&#227;o g&#234;nica induz&#237;vel por doxiciclina &#40;DOX&#41; Tet&#8208;pLKO&#46;1&#8208;puro&#46; Ap&#243;s transfec&#231;&#227;o durante 36 horas&#44; os lentiv&#237;rus foram colhidos&#46; C&#233;lulas A431 e c&#233;lulas SCL&#8208;1 foram infectadas com os lentiv&#237;rus por 24 horas e linhagens celulares transduzidas est&#225;veis foram selecionadas usando puromicina &#40;0&#44;8<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;mL para c&#233;lulas A431&#59; 0&#44;4<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;mL para c&#233;lulas SCL&#8208;1&#41;&#46; A express&#227;o g&#234;nica foi induzida com 1<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;mL de DOX e c&#233;lulas transfectadas com vetor vazio serviram como c&#233;lulas de controle normal &#40;CN&#41;&#46; As c&#233;lulas foram divididas em quatro grupos&#58; grupo CN&#44; grupo CN&#43;DOX&#44; grupo shSIRT6 e grupo shSIRT6&#43;DOX&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Ensaio Cell Counting Kit&#8208;8 &#40;CCK&#8208;8&#41; para prolifera&#231;&#227;o celular</span><p id="par0050" class="elsevierStylePara elsevierViewall">As c&#233;lulas foram semeadas a 2&#46;000 c&#233;lulas&#47;100<span class="elsevierStyleHsp" style=""></span>&#956;L em placa de 96 po&#231;os com quatro po&#231;os replicados por grupo&#46; A placa foi incubada a 37<span class="elsevierStyleHsp" style=""></span>&#176;C com 5&#37; de CO<span class="elsevierStyleInf">2</span> e umidade saturada at&#233; as c&#233;lulas atingirem 80&#37; de conflu&#234;ncia&#46; Cada grupo de c&#233;lulas foi tratado de maneira diferente e incubado por mais 24 horas nas mesmas condi&#231;&#245;es&#46; O meio de cultura original em cada po&#231;o foi descartado e foram adicionados 100<span class="elsevierStyleHsp" style=""></span>&#956;L de meio de cultura contendo 10&#37; de CCK&#8208;8&#46; A placa foi incubada em incubadora de c&#233;lulas por 1 hora e a absorb&#226;ncia a 450<span class="elsevierStyleHsp" style=""></span>nm foi medida utilizando leitor de microplacas&#46; Os valores de absorb&#226;ncia &#40;OD&#41; foram medidos ap&#243;s 12&#44; 24&#44; 48 e 72 horas para avaliar a prolifera&#231;&#227;o celular&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105"><span class="elsevierStyleItalic">Ensaio</span> Transwell</span><p id="par0055" class="elsevierStylePara elsevierViewall">Transwell revestido com Matrigel foi utilizado para realizar ensaios de invas&#227;o e migra&#231;&#227;o celular para cada grupo&#46; Foram adicionados 50<span class="elsevierStyleHsp" style=""></span>&#956;L de Matrigel &#40;2<span class="elsevierStyleHsp" style=""></span>mg&#47;mL&#41; &#224; c&#226;mara superior de <span class="elsevierStyleItalic">transwell</span> e incubados a 37<span class="elsevierStyleHsp" style=""></span>&#176;C por 30 minutos&#46; Em seguida&#44; 4 &#215; 10<span class="elsevierStyleSup">3</span> c&#233;lulas foram semeadas em meio DMEM isento de soro&#46; A c&#226;mara inferior foi preenchida com 600<span class="elsevierStyleHsp" style=""></span>&#956;L de meio contendo 10&#37; de soro fetal bovino como quimioatraente&#46; Ap&#243;s incuba&#231;&#227;o por 24 horas&#44; as c&#233;lulas n&#227;o invasoras foram removidas com um cotonete&#46; As c&#233;lulas invadidas na membrana inferior foram fixadas com paraformalde&#237;do a 4&#37; por 30 minutos &#224; temperatura ambiente e coradas com cristal violeta a 0&#44;1&#37; por 20 minutos&#46; As c&#233;lulas invadidas e migradas foram fotografadas e contadas ao microsc&#243;pio &#40;Carl Zeiss&#44; Alemanha&#41;&#46; Tr&#234;s campos aleat&#243;rios foram selecionados para contagem de c&#233;lulas e a m&#233;dia foi calculada&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110"><span class="elsevierStyleItalic">Ensaio</span> cell scratch</span><p id="par0060" class="elsevierStylePara elsevierViewall">As c&#233;lulas da fase logar&#237;tmica foram colhidas&#44; centrifugadas e ressuspensas em meio de cultura&#46; As c&#233;lulas foram contadas e cada grupo de c&#233;lulas foi semeado em uma placa de seis po&#231;os &#40;6&#44;0 &#215; 10<span class="elsevierStyleSup">5</span> c&#233;lulas&#47;po&#231;o&#41; para cultura&#46; Quando a conflu&#234;ncia celular atingiu aproximadamente 95&#37; no dia seguinte&#44; um arranh&#227;o foi feito no centro de cada po&#231;o usando uma ponta de pipeta de 200<span class="elsevierStyleHsp" style=""></span>&#956;L&#46; Ap&#243;s lavagem com PBS&#44; foi adicionado meio de cultura fresco&#46; A imagem da hora 0 foi obtida utilizando um microsc&#243;pio &#243;ptico invertido e as c&#233;lulas foram adicionalmente incubadas&#46; As imagens foram obtidas ap&#243;s 24 e 48 horas&#46; A taxa de cicatriza&#231;&#227;o foi calculada usando o <span class="elsevierStyleItalic">software</span> ImageJ&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">An&#225;lise de citometria de fluxo de apoptose celular usando colora&#231;&#227;o dupla de anexina V&#47;iodeto de prop&#237;dio &#40;IP&#41;</span><p id="par0065" class="elsevierStylePara elsevierViewall">O sobrenadante da cultura foi coletado de cada grupo de c&#233;lulas e as c&#233;lulas foram lavadas com PBS&#44; tripsinizadas e coletadas&#46; As c&#233;lulas foram duplamente coradas utilizando o Annexin V&#8208;FITC Apoptosis Detection Kit&#46; A colora&#231;&#227;o foi realizada em c&#226;mara escura &#224; temperatura ambiente por 10 minutos&#46; A citometria de fluxo foi utilizada para an&#225;lise quantitativa e a taxa de apoptose foi calculada&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">An&#225;lise do ciclo celular</span><p id="par0070" class="elsevierStylePara elsevierViewall">As linhagens celulares de CECC humanos A431 e SCL&#8208;1 foram mantidas em meio de cultura DMEM suplementado com 5&#37; de FBS em placa de cultura de 10<span class="elsevierStyleHsp" style=""></span>cm&#46; Ap&#243;s tratamento nas condi&#231;&#245;es especificadas&#44; as c&#233;lulas foram coletadas e suspensas em PBS e fixadas em etanol frio a 70&#37; durante a noite a 4<span class="elsevierStyleHsp" style=""></span>&#176;C&#46; As c&#233;lulas foram ent&#227;o incubadas com 50<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;mL de iodeto de prop&#237;dio &#40;IP&#41; e 100<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;mL de RNase A &#40;1&#58;1&#41; por 20 minutos em temperatura ambiente no escuro&#46; Por fim&#44; o sinal de colora&#231;&#227;o das c&#233;lulas CECC foi avaliado utilizando o cit&#244;metro de fluxo FACSCalibur&#8482; &#40;BD Biosciences&#44; Franklin Lakes&#44; New Jersey&#44; EUA&#41;&#44; e a distribui&#231;&#227;o das porcentagens do ciclo celular foi analisada utilizando o <span class="elsevierStyleItalic">software</span> Cell Quest vers&#227;o 3&#46;3 &#40;BD Biosciences&#41; de acordo com as instru&#231;&#245;es do fabricante&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">An&#225;lise estat&#237;stica</span><p id="par0075" class="elsevierStylePara elsevierViewall">A an&#225;lise estat&#237;stica foi realizada utilizando o <span class="elsevierStyleItalic">software</span> SPSS 23&#46;0&#46; Os dados quantitativos foram expressos como m&#233;dia &#177; desvio padr&#227;o&#46; O teste de Qui&#8208;Quadrado foi utilizado para comparar dados categ&#243;ricos e an&#225;lise de vari&#226;ncia &#40;ANOVA&#41; foi utilizada para comparar taxas positivas entre m&#250;ltiplos grupos&#46; Testes <span class="elsevierStyleItalic">t</span> de amostras independentes foram usados para compara&#231;&#245;es pareadas&#46; O valor de p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05 foi considerado estatisticamente significante&#46;</p></span></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Resultados</span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Express&#227;o elevada de SIRT6 em tecidos de QA&#44; DB e CECC em compara&#231;&#227;o com tecido cut&#226;neo normal</span><p id="par0080" class="elsevierStylePara elsevierViewall">A express&#227;o de SIRT6 em diferentes tecidos foi analisada por marca&#231;&#227;o imuno&#8208;histoqu&#237;mica&#46; Os resultados revelaram que a express&#227;o da prote&#237;na SIRT6 era predominantemente observada no n&#250;cleo celular&#44; exibindo uma gama de tonalidades desde amarelo claro at&#233; colora&#231;&#227;o marrom&#8208;acastanhada&#44; enquanto nenhuma express&#227;o significante foi observada no citoplasma &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1A</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Uma avalia&#231;&#227;o quantitativa dos n&#237;veis de express&#227;o foi realizada utilizando sistema de escore semiquantitativo&#46; Os resultados demonstraram a seguinte distribui&#231;&#227;o nos tecidos examinados&#58; em 20 amostras de tecido cut&#226;neo normal &#40;TN&#41;&#44; n&#227;o houve express&#227;o de SIRT6 fortemente positiva&#44; positiva&#44; fracamente positiva ou negativa&#59; em 60 amostras de tecido de QA&#44; a distribui&#231;&#227;o foi de tr&#234;s amostras&#44; 31 amostras&#44; 22 amostras e quatro amostras&#44; respectivamente&#59; em 25 amostras de tecido de DB&#44; a distribui&#231;&#227;o foi de nove amostras&#44; 14 amostras&#44; duas amostras e 0 amostras&#44; respectivamente&#59; e entre 70 amostras de tecido de CECC&#44; houve 46 amostras&#44; 18 amostras&#44; seis amostras e 0 amostras&#44; respectivamente &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1B</a>&#41;&#46; As taxas de express&#227;o elevada de SIRT6 nos tecidos de TN&#44; QA&#44; DB e CECC foram 0&#37;&#44; 56&#44;67&#37;&#44; 92&#44;00&#37; e 91&#44;43&#37;&#44; respectivamente &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46; Compara&#231;&#245;es pareadas revelaram maior express&#227;o estatisticamente significante de SIRT6 em tecidos de QA&#44; DB e CECC em compara&#231;&#227;o com TN &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#44; enquanto n&#227;o houve diferen&#231;a estatisticamente significante na express&#227;o de SIRT6 entre tecidos de DB e CECC&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Correla&#231;&#227;o entre express&#227;o de SIRT6 e par&#226;metros cl&#237;nico&#8208;patol&#243;gicos em pacientes com CECC</span><p id="par0090" class="elsevierStylePara elsevierViewall">A an&#225;lise da correla&#231;&#227;o entre a express&#227;o de SIRT6 e par&#226;metros cl&#237;nico&#8208;patol&#243;gicos em pacientes com CECC revelou que a elevada express&#227;o de SIRT6 estava associada a tecido neopl&#225;sico localizado em &#225;reas expostas ao sol &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41; e maior grau na classifica&#231;&#227;o Broders &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; Entretanto&#44; n&#227;o foram observadas correla&#231;&#245;es significantes entre a express&#227;o de SIRT6 e dados cl&#237;nico&#8208;patol&#243;gicos&#44; como g&#234;nero&#44; idade&#44; dura&#231;&#227;o da doen&#231;a&#44; profundidade de invas&#227;o e di&#226;metro do tumor &#40;p<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; A <a class="elsevierStyleCrossRef" href="#tbl0020">tabela 4</a> mostra detalhes adicionais&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Alta express&#227;o de SIRT6 em c&#233;lulas e tecidos CECC e supress&#227;o da prolifera&#231;&#227;o de c&#233;lulas de CECC por silenciamento de SIRT6</span><p id="par0095" class="elsevierStylePara elsevierViewall">Pela an&#225;lise WB e qRT&#8208;PCR&#44; observou&#8208;se que o n&#237;vel de express&#227;o da prote&#237;na SIRT6 foi maior nas linhagens celulares de CECC &#40;A431&#44; SCL&#8208;1&#41; em compara&#231;&#227;o aos queratin&#243;citos humanos imortalizados &#40;HaCaT&#59; <a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2A</a>&#41;&#46; Do mesmo modo&#44; o n&#237;vel de express&#227;o de mRNA de SIRT6 foi maior nas c&#233;lulas A431 e SCL&#8208;1 do que nas c&#233;lulas HaCaT&#46; A an&#225;lise qRT&#8208;PCR de 20 pares de CECC e tecidos adjacentes normais confirmou a alta express&#227;o de SIRT6 em tecidos de CECC &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2B</a>&#41;&#44; consistente com os resultados da an&#225;lise imuno&#8208;histoqu&#237;mica&#46; Para investigar melhor o papel funcional da SIRT6 no CECC&#44; linhagens celulares de CECC com silenciamento do gene <span class="elsevierStyleItalic">SIRT6</span> foram estabelecidas por transdu&#231;&#227;o lentiviral&#46; Controle negativo &#40;CN&#41;&#44; grupo CN&#43;DOX e grupo controle shSIRT6 foram inclu&#237;dos como CN&#46; A efici&#234;ncia do silenciamento de SIRT6 em c&#233;lulas A431 e SCL&#8208;1 foi validada por an&#225;lise de <span class="elsevierStyleItalic">Western blot</span> &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2C</a>&#41; e qRT&#8208;PCR &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2D</a>&#41;&#44; demonstrando regula&#231;&#227;o negativa da prote&#237;na SIRT6 e express&#227;o de mRNA no grupo shSIRT6 em compara&#231;&#227;o com o grupo controle&#46; Experimentos subsequentes foram realizados utilizando linhagens celulares silenciadas e grupos controle&#46; Os resultados do ensaio CCK&#8208;8 mostraram que o silenciamento de SIRT6 inibiu significantemente a prolifera&#231;&#227;o de c&#233;lulas A431 e SCL&#8208;1 &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2E</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Inibi&#231;&#227;o da migra&#231;&#227;o e invas&#227;o de c&#233;lulas CECC por silenciamento de SIRT6</span><p id="par0100" class="elsevierStylePara elsevierViewall">Os efeitos de SIRT6 na migra&#231;&#227;o e invas&#227;o de c&#233;lulas CECC foram investigados posteriormente utilizando o ensaio <span class="elsevierStyleItalic">Transwell</span> e o ensaio <span class="elsevierStyleItalic">scratch</span>&#46; Os resultados mostraram que&#44; em compara&#231;&#227;o com os grupos controle &#40;CN&#44; CN &#43; DOX e controle shSIRT6&#41;&#44; o grupo silenciado shSIRT6 &#43; DOX exibiu migra&#231;&#227;o e invas&#227;o celular reduzidas &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3A</a>&#41; e taxa de cicatriza&#231;&#227;o de feridas reduzida &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3B</a>&#41; em c&#233;lulas A431 e SCL&#8208;1&#46; Esses resultados indicam que o silenciamento de SIRT6 inibe significantemente as capacidades de migra&#231;&#227;o e invas&#227;o das c&#233;lulas de CECC&#46; A an&#225;lise de <span class="elsevierStyleItalic">Western blot</span> foi realizada para detectar a express&#227;o de marcadores de transi&#231;&#227;o epitelial&#8208;mesenquimal &#40;TEM&#41; em c&#233;lulas de CECC&#46; Em compara&#231;&#227;o com os grupos de controle &#40;controle CN&#44; CN &#43; DOX e shSIRT6&#41;&#44; o grupo shSIRT6 &#43; DOX de c&#233;lulas A431 e SCL&#8208;1 apresentou express&#227;o regulada negativamente dos marcadores mesenquimais N&#8208;caderina e vimentina &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3C</a>&#41;&#46; Esses resultados indicam que o silenciamento de SIRT6 promove a express&#227;o dos marcadores de transi&#231;&#227;o epitelial&#8208;mesenquimal N&#8208;caderina e vimentina em c&#233;lulas CECC&#44; sugerindo que a inibi&#231;&#227;o da migra&#231;&#227;o e invas&#227;o de c&#233;lulas CECC por silenciamento de SIRT6 possa estar associada &#224; supress&#227;o do processo TEM&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0115" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">O silenciamento da SIRT6 aumenta a apoptose e induz a parada do ciclo celular na fase G0&#47;G1 em c&#233;lulas de CECC</span><p id="par0105" class="elsevierStylePara elsevierViewall">Utilizando citometria de fluxo&#44; foi investigado tamb&#233;m o efeito da SIRT6 na apoptose e na progress&#227;o do ciclo celular em c&#233;lulas de CECC&#46; Os resultados mostram que os grupos de c&#233;lulas A431 e SCL&#8208;1 tratados com shSIRT6 &#43; DOX exibem taxas apopt&#243;ticas aumentadas &#40;<a class="elsevierStyleCrossRef" href="#fig0020">fig&#46; 4A</a>&#41; e bloqueio na fase G0&#47;G1 do ciclo celular &#40;<a class="elsevierStyleCrossRef" href="#fig0020">fig&#46; 4B</a>&#41;&#44; indicando que a regula&#231;&#227;o negativa de SIRT6 pode aumentar a apoptose e induzir a parada do ciclo celular na fase G0&#47;G1 em c&#233;lulas de CECC&#46; Para avaliar a express&#227;o de marcadores relacionados &#224; apoptose &#40;Bax&#44; BCL&#8208;2&#44; caspase&#8208;3 clivada&#41; e marcadores relacionados ao ciclo celular &#40;CyclinD1&#44; CDK4&#41; em c&#233;lulas de CECC&#44; foi realizada an&#225;lise por <span class="elsevierStyleItalic">Western blot</span>&#46; Em compara&#231;&#227;o com os grupos de controle CN&#44; CN &#43; DOX e shSIRT6&#44; os grupos de c&#233;lulas A431 e SCL&#8208;1 tratados com shSIRT6 &#43; DOX exibiram n&#237;veis aumentados de express&#227;o da prote&#237;na Bax&#44; BCL&#8208;2 e caspase&#8208;3 clivada&#44; enquanto os n&#237;veis de prote&#237;na CyclinD1 e CDK4 estavam diminu&#237;dos &#40;<a class="elsevierStyleCrossRef" href="#fig0020">fig&#46; 4C</a>&#41;&#46; Esses resultados indicam que a regula&#231;&#227;o negativa da SIRT6 promove a apoptose e induz a parada do ciclo celular na fase G0&#47;G1 em c&#233;lulas de CECC&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span></span></span><span id="sec0120" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Discuss&#227;o</span><p id="par0110" class="elsevierStylePara elsevierViewall">O CECC &#233; neoplasia maligna proliferativa originada das c&#233;lulas queratinizadas dos anexos ou da epiderme&#46; Embora a maioria dos CECC possa ser erradicada com sucesso por meio de excis&#227;o cir&#250;rgica&#44; aproximadamente 14&#37; a 15&#37; dos pacientes com CECC prim&#225;rio ainda apresentam infiltra&#231;&#227;o subcl&#237;nica&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">22</span></a> O crescimento invasivo do CECC pode romper a membrana basal da epiderme e invadir a derme mais profunda&#44; anexos da pele&#44; vasos sangu&#237;neos&#44; vasos linf&#225;ticos&#44; nervos etc&#46;&#44; levando ao desenvolvimento do CECC de alto risco&#46; Apesar dos avan&#231;os significantes nas op&#231;&#245;es de tratamento&#44; como cirurgia de Mohs&#44; cetuximabe e panitumumabe&#44; que melhoraram muito o progn&#243;stico dos pacientes com CECC&#44; o progn&#243;stico para CECC de alto e muito alto risco permanece ruim&#44; com taxas de recorr&#234;ncia em cinco anos variando de 30&#37; a 50&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">23</span></a> Portanto&#44; &#233; necess&#225;rio explorar ainda mais os mecanismos subjacentes &#224; ocorr&#234;ncia e progress&#227;o do CECC e identificar mais alvos terap&#234;uticos&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">A SIRT6 est&#225; desregulada em v&#225;rios tipos de c&#226;ncer&#44; e seu papel na tumorig&#234;nese depende do tipo e do contexto do tumor&#46; A express&#227;o de SIRT6 &#233; regulada positivamente no c&#226;ncer de mama&#44; c&#226;ncer de p&#226;ncreas&#44; melanoma prim&#225;rio e carcinoma de pulm&#227;o de c&#233;lulas n&#227;o pequenas&#44;<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">24&#44;25</span></a> sugerindo papel pr&#243;&#8208;oncog&#234;nico nesses tipos de c&#226;ncer&#46; Por outro lado&#44; a SIRT6 &#233; regulada negativamente em tecidos de c&#226;ncer de ov&#225;rio&#44; e sua baixa express&#227;o est&#225; intimamente associada &#224; infiltra&#231;&#227;o neopl&#225;sica e met&#225;stases&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">26</span></a> Estudos demonstraram que a SIRT6 inibe o crescimento do c&#226;ncer g&#225;strico ao suprimir o transdutor de sinal&#47;JAK2 e o ativador da via da transcri&#231;&#227;o&#8208;3&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">27</span></a> Al&#233;m disso&#44; foi relatado que SIRT6 pode suprimir a ocorr&#234;ncia e o desenvolvimento de c&#226;ncer pancre&#225;tico&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">28</span></a> Portanto&#44; a SIRT6 tamb&#233;m desempenha um papel na inibi&#231;&#227;o do in&#237;cio e desenvolvimento de neoplasias malignas&#44; com forte heterogeneidade em diferentes tipos de tumores&#46; Os resultados deste estudo mostram que a express&#227;o de SIRT6 est&#225; aumentada em tecidos tumorais de CECC em compara&#231;&#227;o com tecidos cut&#226;neos normais&#44; sugerindo que a alta express&#227;o de SIRT6 possa estar envolvida na ocorr&#234;ncia e desenvolvimento do CECC&#46; O n&#237;vel de express&#227;o da prote&#237;na SIRT6 no CECC &#233; maior do que na les&#227;o pr&#233;&#8208;cancerosa de CA e tecido cut&#226;neo normal&#44; sugerindo que a SIRT6 possa desempenhar papel importante na progress&#227;o do tecido cut&#226;neo normal para les&#245;es pr&#233;&#8208;cancerosas e posteriormente para carcinoma espinocelular cut&#226;neo&#46; No entanto&#44; a express&#227;o de SIRT6 foi ligeiramente maior na DB do que no tecido de CECC&#44; o que pode estar relacionado ao n&#250;mero limitado de amostras de tecido de DB&#46; A alta express&#227;o de SIRT6 em tecidos de CECC est&#225; associada &#224; localiza&#231;&#227;o do tecido neopl&#225;sico em &#225;reas expostas ao sol e ao estadiamento de Broders&#44; mas n&#227;o ao g&#234;nero&#44; idade&#44; di&#226;metro do tumor etc&#46;&#44; consistente com achados em melanoma e carcinoma de pulm&#227;o de c&#233;lulas n&#227;o pequenas&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">29</span></a> Al&#233;m disso&#44; descobriu&#8208;se que a SIRT6 &#233; altamente expressa em c&#233;lulas de CECC e que o silenciamento da SIRT6 inibe a capacidade de prolifera&#231;&#227;o&#44; migra&#231;&#227;o e invas&#227;o das c&#233;lulas de CECC&#46; A invas&#227;o e a migra&#231;&#227;o s&#227;o caracter&#237;sticas cr&#237;ticas das neoplasias malignas&#44; e o silenciamento da SIRT6 reduziu significantemente a prolifera&#231;&#227;o&#44; migra&#231;&#227;o e invas&#227;o de c&#233;lulas de CECC&#44; fornecendo evid&#234;ncias do papel da SIRT6 no crescimento e motilidade das c&#233;lulas de CECC&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">O silenciamento de SIRT6 induz a apoptose celular e inibe a transi&#231;&#227;o do ciclo celular G1&#47;S&#46; A apoptose celular &#233; processo complexo que envolve m&#250;ltiplas vias de sinaliza&#231;&#227;o&#44; e a regula&#231;&#227;o positiva de prote&#237;nas relacionadas &#224; apoptose &#40;incluindo Bax&#44; BCL&#8208;2&#44; caspase&#8208;3 clivada&#41; ap&#243;s o silenciamento de SIRT6 confirma seu envolvimento na regula&#231;&#227;o da apoptose do CECC&#46; Tamb&#233;m foi observado que o silenciamento de SIRT6 leva &#224; parada do ciclo celular G0&#47;G1&#44; como demonstrado pela an&#225;lise do ciclo celular&#46; Al&#233;m disso&#44; a regula&#231;&#227;o negativa de ciclina D1 e CDK4&#44; que codificam prote&#237;nas que regulam o ciclo celular&#44; est&#225; associada &#224; progress&#227;o do tumor&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">30</span></a> A ciclina D1 &#233; prote&#237;na&#8208;chave na regula&#231;&#227;o do ciclo celular e &#233; suficiente para impulsionar a progress&#227;o desse ciclo&#46;<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">31&#44;32</span></a> Este estudo demonstra o envolvimento da SIRT6 na regula&#231;&#227;o da apoptose e do ciclo celular em c&#233;lulas de CECC&#44; influenciando assim os n&#237;veis de express&#227;o de apoptose e prote&#237;nas relacionadas ao ciclo celular&#46; Com base nisso&#44; especula&#8208;se que a SIRT6 possa estar envolvida no comportamento biol&#243;gico das c&#233;lulas do CECC como uma mol&#233;cula funcional&#46; Entretanto&#44; existem v&#225;rias limita&#231;&#245;es neste estudo&#46; Primeiro&#44; as amostras cl&#237;nicas de tecidos do estudo s&#227;o limitadas&#59; estudos futuros devem aumentar o tamanho da amostragem e utilizar m&#250;ltiplos m&#233;todos experimentais para esclarecer ainda mais o padr&#227;o de express&#227;o de SIRT6&#46; Em segundo lugar&#44; em virtude da complexidade da regula&#231;&#227;o e desenvolvimento tumoral&#44; os mecanismos espec&#237;ficos ainda est&#227;o sujeitos a investiga&#231;&#227;o adicional&#44; e experimentos subsequentes <span class="elsevierStyleItalic">in vivo</span> devem ser realizados para explorar o impacto da SIRT6 no comportamento biol&#243;gico do CECC&#46; Al&#233;m disso&#44; as neoplasias s&#227;o doen&#231;as complexas com elevada heterogeneidade&#44; e sua ocorr&#234;ncia e desenvolvimento n&#227;o s&#227;o determinados por um &#250;nico fator independente&#46; Portanto&#44; a identifica&#231;&#227;o no CECC de mol&#233;culas que possam interagir sinergicamente ou antagonicamente com a SIRT6 continua sendo um foco para pesquisas futuras&#46;</p></span><span id="sec0125" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Conclus&#227;o</span><p id="par0125" class="elsevierStylePara elsevierViewall">Este estudo descobriu que a SIRT6 &#233; altamente expressa no CECC&#44; o que pode desempenhar papel como fator cancer&#237;geno&#44; fornecendo certa base te&#243;rica para tratamentos futuros&#46;</p></span><span id="sec0130" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Suporte financeiro</span><p id="par0130" class="elsevierStylePara elsevierViewall">Este trabalho recebeu suporte financeiro da Nantong Municipal Health Commission &#40;MB2021019&#41;&#44; Basic Research Project of Nantong Science e Technology Bureau &#40;JCZ2022021&#41;&#44; e Natural Science Foundation of Jiangsu Province &#40;BK20211108&#41;&#46;</p></span><span id="sec0135" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0175">Contribui&#231;&#227;o dos autores</span><p id="par0135" class="elsevierStylePara elsevierViewall">Chen Sai&#58; Concep&#231;&#227;o e planejamento do estudo&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; an&#225;lise estat&#237;stica&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; revis&#227;o cr&#237;tica do manuscrito&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Chen Hongxia&#58; Obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; an&#225;lise estat&#237;stica&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; revis&#227;o cr&#237;tica do manuscrito&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Wang Xu&#58; Obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; an&#225;lise estat&#237;stica&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; revis&#227;o cr&#237;tica do manuscrito&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Zhang Dongmei&#58; Participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; revis&#227;o cr&#237;tica da literatura&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Zhang Li&#58; Obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; revis&#227;o cr&#237;tica da literatura&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Jiawei Cheng&#58; Obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; revis&#227;o cr&#237;tica da literatura&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Zhang Qi&#58; Obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; revis&#227;o cr&#237;tica da literatura&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Zhixiang Hua&#58; Participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; revis&#227;o cr&#237;tica da literatura&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Miao Xu&#58; Participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; revis&#227;o cr&#237;tica da literatura&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Shi Jian&#58; Participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; an&#225;lise estat&#237;stica&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; revis&#227;o cr&#237;tica do manuscrito&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p></span><span id="sec0140" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0180">Conflito de interesses</span><p id="par0185" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Fundamentos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">O carcinoma espinocelular cut&#226;neo &#40;CECC&#41; &#233; um dos tipos de c&#226;ncer de pele mais comuns em todo o mundo&#46; Portanto&#44; a identifica&#231;&#227;o de biomarcadores associados &#224; progress&#227;o do CECC poderia auxiliar na detec&#231;&#227;o precoce do carcinoma espinocelular de alto risco e no desenvolvimento de novas estrat&#233;gias terap&#234;uticas&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Este estudo teve como objetivo investigar os padr&#245;es de express&#227;o da prote&#237;na <span class="elsevierStyleItalic">silent mating type information regulation 2 homolog 6</span> &#40;SIRT6&#41; em CECC e seu significado cl&#237;nico&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">O n&#237;vel de express&#227;o da prote&#237;na SIRT6 nos tecidos foi detectado por imuno&#8208;histoqu&#237;mica&#44; e a correla&#231;&#227;o entre a express&#227;o da SIRT6 e par&#226;metros clinicopatol&#243;gicos em pacientes com CECC foi analisada&#46; A express&#227;o relativa de SIRT6 na linhagem celular de CECC e em amostras de tecido cut&#226;neo foi determinada por <span class="elsevierStyleItalic">western blotting</span> e PCR&#46; O efeito do silenciamento da SIRT6 na prolifera&#231;&#227;o celular foi avaliado utilizando o <span class="elsevierStyleItalic">kit</span>&#8208;8 de contagem de c&#233;lulas&#46; A cicatriza&#231;&#227;o de feridas&#44; o m&#233;todo <span class="elsevierStyleItalic">transwell</span> e a citometria de fluxo foram utilizados para investigar a migra&#231;&#227;o&#44; invas&#227;o e distribui&#231;&#227;o&#47;apoptose do ciclo celular de c&#233;lulas de CECC ap&#243;s o silenciamento da SIRT6&#44; respectivamente&#46; <span class="elsevierStyleItalic">Western blot</span> foi utilizado para detectar a express&#227;o de transi&#231;&#227;o epitelial&#8208;mesenquimal &#40;TEM&#41;&#44; ciclo&#44; apoptose e outras prote&#237;nas relacionadas&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A alta express&#227;o de SIRT6 foi correlacionada com a localiza&#231;&#227;o do tecido neopl&#225;sico e o estadiamento de Broder em pacientes com CECC&#46; O silenciamento da SIRT6 inibiu a prolifera&#231;&#227;o&#44; migra&#231;&#227;o&#44; invas&#227;o e TEM de c&#233;lulas de CECC e promoveu sua apoptose&#59; as c&#233;lulas foram bloqueadas na fase G1&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Limita&#231;&#245;es do estudo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Nenhum experimento com animais foi realizado para verificar adicionalmente os resultados&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclus&#227;o</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A redu&#231;&#227;o da express&#227;o de SIRT6 pode inibir a ocorr&#234;ncia e o desenvolvimento de CECC&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Como citar este artigo&#58; Chen S&#44; Chen H&#44; Wang X&#44; Zhang D&#44; Zhang L&#44; Cheng J&#44; et al&#46; Expression analysis and biological regulation of silencing regulatory protein&#160;6 &#40;SIRT6&#41; in cutaneous squamous cell carcinoma&#46; An Bras Dermatol&#46; 2024&#59;99&#58;535&#8211;45&#46;</p>"
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            "Ancho" => 2763
            "Tamanyo" => 874185
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          "pt" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Inibi&#231;&#227;o da migra&#231;&#227;o e invas&#227;o de c&#233;lulas de CECC por silenciamento de SIRT6&#46; &#40;A&#41; Resultados do ensaio Transwell e an&#225;lise estat&#237;stica representando os efeitos da SIRT6 na migra&#231;&#227;o e invas&#227;o celular em c&#233;lulas A431 e SCL&#8208;1&#46; Compara&#231;&#227;o do n&#250;mero de c&#233;lulas migradas e invadidas nos grupos SIRT6&#43;DOX&#44; NC&#44; NC&#43;DOX e grupo controle shSIRT6&#46; &#40;B&#41; Resultados do ensaio <span class="elsevierStyleItalic">scratch</span> e an&#225;lise estat&#237;stica demonstrando os efeitos da SIRT6 na taxa de migra&#231;&#227;o celular em c&#233;lulas A431 e SCL&#8208;1&#46; Compara&#231;&#227;o da taxa de migra&#231;&#227;o em 24 e 48 horas nos grupos SIRT6&#43;DOX&#44; NC&#44; NC&#43;DOX e grupo shSIRT6&#46; &#40;C&#41; Resultados da an&#225;lise de <span class="elsevierStyleItalic">Western blot</span> e an&#225;lise estat&#237;stica representando os efeitos da SIRT6 na express&#227;o de marcadores de transi&#231;&#227;o epitelial&#8208;mesenquimal &#40;EMT&#41; em c&#233;lulas de CECC&#46; Compara&#231;&#227;o dos n&#237;veis de express&#227;o dos marcadores mesenquimais N&#8208;caderina e vimentina em c&#233;lulas A431 e SCL&#8208;1&#46; Nota&#58; &#42;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#44; &#42;&#42;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#46;</p>"
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        "etiqueta" => "Figura 4"
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        "descripcion" => array:1 [
          "pt" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">O silenciamento de SIRT6 pode aumentar a apoptose e a parada do ciclo celular na fase G0&#47;G1 das c&#233;lulas de CECC&#46; &#40;A&#8208;B&#41; A an&#225;lise de citometria de fluxo mostrou a taxa de apoptose e a distribui&#231;&#227;o do ciclo celular de c&#233;lulas A431 e SCL&#8208;1 transfectadas com shSIRT6&#43;DOX e NC&#44; NC&#43;DOX e shSIRT6 no grupo controle&#46; A taxa de apoptose foi medida por citometria de fluxo&#46; O quadrante superior direito representava c&#233;lulas apopt&#243;ticas tardias&#44; e o quadrante inferior direito representava c&#233;lulas apopt&#243;ticas precoces&#46; A taxa de apoptose<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>raz&#227;o apopt&#243;tica tardia &#43; raz&#227;o apopt&#243;tica precoce&#46; &#40;C&#41; <span class="elsevierStyleItalic">Western blots</span> mostraram prote&#237;nas relacionadas &#224; apoptose &#40;Bax&#44; BCL&#8208;2&#44; Cleaved&#8208;caspase3&#41; e ciclinas &#40;ciclinaD1 e CDK4&#41; em c&#233;lulas A431 e SCL&#8208;1 transfectadas com shSIRT6&#43;DOX e controle NC&#44; NC&#43;DOX&#44; shSIRT6 Flat&#44; &#42;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#44; &#42;&#42;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#46;</p>"
        ]
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        "etiqueta" => "Tabela 1"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Indica&#231;&#227;o de avalia&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Gradua&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Escore&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Contagem celular positiva</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#37;&#8764;25&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#37;&#8764;50&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&#37;&#8764;75&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">76&#37;&#8764;100&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Intensidade da marca&#231;&#227;o</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sem marca&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Amarelo claro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Claybank</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Castanho&#8208;claro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Intensidade de express&#227;o &#40;contagem de c&#233;lulas positivas &#215; intensidade de marca&#231;&#227;o&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Baixa express&#227;o</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Negativa &#40;&#8722;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#8764;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fracamente positiva &#40;&#43;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#8764;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alta express&#227;o</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Positiva &#40;&#43;&#43;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#8764;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fortemente positiva &#40;&#43;&#43;&#43;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#8764;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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        "descripcion" => array:1 [
          "pt" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Resultados da marca&#231;&#227;o para SIRT6 avaliados utilizando m&#233;todo de escore semiquantitativo de 12 pontos</p>"
        ]
      ]
      5 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Tabela 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Tabela "
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Gene&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sequ&#234;ncia de <span class="elsevierStyleItalic">primer</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SIRT6</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F&#58;5&#8242;&#8208; TGGCAGTCTTCCAGTGTGGTGT&#8208;3&#8242;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">R&#58;5&#8242;&#8208; CGCTCTCAAAGGTGGTGTCGAA&#8208;3&#8242;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">U6</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">F&#58;5&#8242;&#8208; CTCGCTTCGGCAGCACA &#8208;3&#8242;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">R&#58; 5&#8242;&#8208; AACGCTTCACGAATTTGCGT&#8208;3&#8242;&nbsp;\t\t\t\t\t\t\n
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">TN&#44; tecido cut&#226;neo normal&#59; CA&#44; ceratose act&#237;nica&#59; DB&#44; doen&#231;a de Bowen&#59; CECC&#44; carcinoma espinocelular cut&#226;neo&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
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                  \t\t\t\t  " rowspan="2" align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Grupo</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Express&#227;o of SIRT6</th><th class="td" title="\n
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                  \t\t\t\t  " rowspan="2" align="left" valign="\n
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                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Taxa de alta express&#227;o</th></tr><tr title="table-row"><th class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Baixa express&#227;o &#40;&#8722;&#8764;&#43;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Alta express&#227;o &#40;&#43;&#43;&#8764;&#43;&#43;&#43;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">TN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">CA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&#44;67&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">DB&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">92&#44;00&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CECC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">91&#44;43&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "pt" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Diferen&#231;as na express&#227;o de SIRT6 em tecidos TN&#44; CA&#44; DB e CECC</p>"
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              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Caracter&#237;sticas cl&#237;nicas</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N&#250;mero de casos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Baixa express&#227;o &#40;&#8722;&#8764;&#43;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Alta express&#227;o &#40;&#43;&#43;&#8764;&#43;&#43;&#43;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&#8208;valor&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;433&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Feminino&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
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                  \t\t\t\t">Posi&#231;&#227;o</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Exposi&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;032&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sem exposi&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tempo de doen&#231;a</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>2 anos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">39&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;405&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">&#8805; 2 anos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " rowspan="2" align="left" valign="\n
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                  \t\t\t\t">Profundidade de invas&#227;o</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8804; 3mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;128&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">&#62;<span class="elsevierStyleHsp" style=""></span>3mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " rowspan="2" align="left" valign="\n
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                  \t\t\t\t">Di&#226;metro</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8804; 2cm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;316&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">2cm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
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                  \t\t\t\t">Classifica&#231;&#227;o de Broders</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">I&#8208;II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;012&#42;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">III&#8208;IV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  """
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        "descripcion" => array:1 [
          "pt" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Rela&#231;&#227;o entre a express&#227;o de SIRT6 e caracter&#237;sticas cl&#237;nicas de pacientes com CECC</p>"
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      "titulo" => "Refer&#234;ncias"
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        0 => array:2 [
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            0 => array:3 [
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cutaneous squamous cell carcinoma"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46; Waldman"
                            1 => "C&#46; Schmults"
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                    0 => array:2 [
                      "doi" => "10.1016/j.hoc.2018.08.001"
                      "Revista" => array:6 [
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                        "volumen" => "33"
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                        "paginaFinal" => "12"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30497667"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk factors for cutaneous squamous cell carcinoma recurrence&#44; metastasis&#44; and disease&#8208;specific death&#58; a systematic review and meta&#8208;analysis"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
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                            2 => "L&#46;J&#46; Prokop"
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                      "doi" => "10.1001/jamadermatol.2015.4994"
                      "Revista" => array:6 [
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26762219"
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                  "contribucion" => array:1 [
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                          "etal" => false
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                            0 => "P&#46;K&#46; Goon"
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                    0 => array:2 [
                      "doi" => "10.2340/00015555-2310"
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Derm Venereol&#46;"
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                        "paginaFinal" => "821"
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                          0 => array:2 [
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                            0 => "V&#46; Varra"
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                            3 => "N&#46;P&#46; Joshi"
                            4 => "J&#46; Geiger"
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                    0 => array:2 [
                      "doi" => "10.21873/anticanres.12923"
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                      "doi" => "10.1016/j.jaad.2012.11.037"
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                          "etal" => true
                          "autores" => array:6 [
                            0 => "I&#46;P&#46; Chen"
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                            2 => "I&#46; Spassova"
                            3 => "S&#46; Henning"
                            4 => "L&#46; Kubat"
                            5 => "K&#46; Fan"
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                    0 => array:2 [
                      "doi" => "10.1007/s00432-020-03358-9"
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                        "tituloSerie" => "J Cancer Res Clin Oncol&#46;"
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                        "link" => array:1 [
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                          "etal" => true
                          "autores" => array:6 [
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                            4 => "Y&#46;T&#46; Tai"
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                    0 => array:2 [
                      "doi" => "10.1182/blood-2015-06-649970"
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                    0 => array:2 [
                      "doi" => "10.1016/j.tibs.2013.12.002"
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                        "tituloSerie" => "Trends Biochem Sci&#46;"
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Article information
ISSN: 26662752
Original language: Portuguese
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