ABSTRACT Differentiated thyroid carcinoma (DTC) accounts for most cases of thyroid cancer, and the heterogeneity of DTC requires that management decisions be taken by a multidisciplinary team involving endocrinologists, head and neck surgeons, nuclear medicine physicians, pathologists, radiologists, radiation oncologists, and medical oncologists. It is important for nonspecialists to recognize and refer patients with DTC who will benefit from a specialized approach. Recent advances in knowledge and changes in management of DTC call for the need to raise awareness on the part of these nonspecialist physicians, including general endocrinologists and medical oncologists at large. We provide an overview of diagnostic and therapeutic principles in DTC, especially those that bear direct implication on day-to-day management of these patients by generalists. Patients with DTC may be broadly categorized as having localized, locally persistent/recurrent, or metastatic disease. Current recommendations for DTC include a three-tiered system that classifies patients with localized disease into low, intermediate, or high risk of persistent or recurrent disease. Risk stratification should be performed at baseline and repeated on an ongoing basis, depending on clinical evolution. One of the overarching goals in the management of DTC is the need to personalize treatment by tailoring its modality and intensity according to ongoing prognostic stratification, evolving knowledge about the disease, and patient characteristics and preference. In metastatic disease that is refractory to radioactive iodine, thyroid tumors are being reclassified into molecular subtypes that better reflect their biological properties and for which molecular alterations can be targeted with specific agents. (DTC cancer surgeons physicians pathologists radiologists approach large daytoday day generalists persistentrecurrent persistent/recurrent threetiered three tiered low intermediate basis evolution preference iodine agents

RESUMO O presente estudo caracteriza o afluente, o efluente e a eficiência de remoção de 56 estações de tratamento de esgoto (ETEs) em operação no Rio Grande do Sul, Brasil. A análise abrange os principais processos de tratamento de esgoto utilizados no país: fossa séptica e filtro anaeróbio, lodo ativado com reator sequencial em batelada e com aeração estendida, reator UASB e filtro biológico, lagoas anaeróbias e facultativas, e a combinação de lagoas anaeróbias, facultativas e de maturação. Os parâmetros avaliados foram demanda bioquímica de oxigênio (DBO), demanda química de oxigênio (DQO), nitrogênio amoniacal (NNH3), fósforo, sólidos suspensos totais (SST) e Escherichia coli. As concentrações afluentes de DBO, DQO e SST (intervalos médios respectivos de 38–189, 203–416 e 75–242 mg∙L−1) foram inferiores às reportadas em outros estudos no Brasil, indicando que as ETEs analisadas operam com um afluente mais diluído. O efluente também apresentou concentrações abaixo dos valores de referência, embora essas diferenças não tenham sido tão acentuadas quanto no afluente. Em geral, não foram observadas discrepâncias significativas entre as eficiências de remoção obtidas e outras estimativas da literatura, exceto para SST, com valores inferiores de remoção. Fossas sépticas obtiveram menor eficiência na remoção de DBO, DQO e SST, enquanto sistemas de lodo ativado foram melhores na remoção de fósforo. Este estudo representa o primeiro conjunto de dados abrangente sobre o desempenho de ETEs na região Sul do Brasil, identificando áreas potenciais para aprimoramento e contribuindo para uma melhor gestão desses sistemas. 5 (ETEs Brasil país anaeróbio estendida biológico maturação DBO , (DBO) DQO, (DQO) NNH3, NNH3 NNH (NNH3) fósforo (SST coli intervalos 38189 38 189 38–189 203416 203 416 203–41 75242 75 242 75–24 mg∙L−1 mgL1 mgL mg L 1 diluído referência geral literatura (DBO (DQO (NNH3 3818 3 18 38–18 20341 20 41 203–4 7524 7 24 75–2 mg∙L− (NNH 381 38–1 2034 2 4 203– 752 75– mg∙L 38–

ABSTRACT This study assesses the influent and effluent characteristics and the removal efficiency of 56 wastewater treatment plants (WWTPs) operating in Brazil’s southern region, in the Rio Grande do Sul state. The analysis encompasses the main secondary wastewater treatment processes used in the country, such as septic tank and anaerobic filter, activated sludge with sequencing batch reactor and with extended aeration, upflow anaerobic sludge blanket reactor followed by trickling filter, anaerobic and facultative ponds, and the combination of anaerobic, facultative, and maturation ponds. The parameters evaluated were biochemical oxygen demand (BOD), chemical oxygen demand (COD), ammoniacal nitrogen (NNH3), total phosphorus (TP), total suspended solids (TSS), and Escherichia coli. The influent concentrations of BOD, COD, and TSS were considerably lower than other values reported in studies in Brazil, indicating that the analyzed WWTPs operate with a diluted influent, with respective average ranges of 38–189, 203–416, and 75–242 mg∙L−1. The effluent concentrations were also lower than the reference values, although the differences were not as pronounced as in the influent. No significant distinctions were observed between the removal efficiencies obtained and other results in the literature, except for TSS, which had a weaker performance. Concerning the technologies, lower performance was observed for BOD, COD, and TSS removal in the septic tank and higher removal rates of TP for the activated sludge systems. This study represents the first comprehensive dataset on the performance of WWTPs in Brazil’s southern region, contributing to the understanding of wastewater management practices in the country by indicating potential points for improvement. 5 (WWTPs Brazils Brazil s region state filter aeration ponds BOD , (BOD) COD (COD) NNH3, NNH3 NNH (NNH3) TP, (TP) (TSS) coli 38189 38 189 38–189 203416 203 416 203–416 75242 75 242 75–24 mgL1 mgL mg L 1 mg∙L−1 literature technologies systems improvement (BOD (COD (NNH3 (TP (TSS 3818 3 18 38–18 20341 20 41 203–41 7524 7 24 75–2 mg∙L− (NNH 381 38–1 2034 2 4 203–4 752 75– mg∙L 38– 203–