Correlation of mixed lymphocyte culture with chronic graft-versus-host disease following allogeneic stem cell transplantation

The purpose of the present study was to evaluate the mixed lymphocyte culture as a predictive assay of acute and chronic graft-versus-host disease (GVHD). We studied 153 patients who received a first bone marrow transplantation from human leukocyte antigen-identical siblings. Acute GVHD was observed in 26 of 128 (20.3%) patients evaluated and chronic GVHD occurred in 60 of 114 (52.6%). One-way mixed lymphocyte culture (MLC) assays were performed by the standard method. MLC results are reported as the relative response (RR) from donor against patient cells. The responses ranged from -47.0 to 40.7%, with a median of 0.5%. The Kaplan-Meier probability of developing GVHD was determined for patients with positive and negative MLC. There was no significant difference in incidence of acute GVHD between the groups studied. However, the incidence of chronic GVHD was higher in recipients with RR >4.5% than in those with RR 4.5%), 2.9 for those who received peripheral blood progenitor cells as a graft, and 2.2 for patients who developed previous acute GVHD. MLC was not useful for predicting acute GVHD, but MLC with RR >4.5% associated with other risk factors could predict the development of chronic GVHD, being of help for the prevention and/or treatment of this late complication.56757

The availability of full match sibling donors and feasibility of allogeneic bone marrow transplantation in Brazil

The feasibility of allogeneic bone marrow transplantation (alloBMT) in a developing country has not yet been demonstrated. Many adverse factors including social and economic limitations may reduce the overall results of this complex and expensive procedure. Our objective was to characterize the most important clinical, social and economic features of candidates for transplantation and their potential donors as well as the influence of these factors on overall survival in a retrospective and exploratory analysis at a university hospital. From July 1993 to July 2001, candidates for BMT were referred to the Bone Marrow Transplantation Unit by Hematology and Oncology Centers from several regions of Brazil. A total of 1138 patients were referred to us as candidates for alloBMT. Median age was 25 years (range: 2 months-60 years), 684 (60.1%) were males and 454 (39.9%) were females. The clinical indications were severe aplastic anemia and hematological malignancies. From the total of 1138 patients, 923 had HLA-typing; 497/923 (53.8%) candidates had full match donors; 352/1138 (30.8%) were eligible for alloBMT. Only 235 of 352 (66.7%) were transplanted. Schooling was 1st to 8th grade for 123/235 (52.3%); monthly family income ranged from US$60 (7$400 (36%). Overall survival for patients with chronic myeloid leukemia, severe aplastic anemia and acute myeloid leukemia was 58, 60 and 30%, respectively. Thus, overall survival rates for the most frequent hematological diseases were similar to those reported in the International Registry, except for acute myeloid leukemia. This descriptive and exploratory analysis suggests the feasibility of alloBMT in a developing country like Brazil.31532

Study protocol for the multicentre cohorts of Zika virus infection in pregnant women, infants, and acute clinical cases in Latin America and the Caribbean: The ZIKAlliance consortium

Background: The European Commission (EC) Horizon 2020 (H2020)-funded ZIKAlliance Consortium designed a multicentre study including pregnant women (PW), children (CH) and natural history (NH) cohorts. Clinical sites were selected over a wide geographic range within Latin America and the Caribbean, taking into account the dynamic course of the ZIKV epidemic. Methods: Recruitment to the PW cohort will take place in antenatal care clinics. PW will be enrolled regardless of symptoms and followed over the course of pregnancy, approximately every 4 weeks. PW will be revisited at delivery (or after miscarriage/abortion) to assess birth outcomes, including microcephaly and other congenital abnormalities according to the evolving definition of congenital Zika syndrome (CZS). After birth, children will be followed for 2 years in the CH cohort. Follow-up visits are scheduled at ages 1-3, 4-6, 12, and 24 months to assess neurocognitive and developmental milestones. In addition, a NH cohort for the characterization of symptomatic rash/fever illness was designed, including follow-up to capture persisting health problems. Blood, urine, and other biological materials will be collected, and tested for ZIKV and other relevant arboviral diseases (dengue, chikungunya, yellow fever) using RT-PCR or serological methods. A virtual, decentralized biobank will be created. Reciprocal clinical monitoring has been established between partner sites. Substudies of ZIKV seroprevalence, transmissio

CURSO DIÁRIO E SAZONAL DO POTENCIAL HÍDRICO FOLIAR DE MOGNO EM SISTEMAAGROFLORESTAL1

Este trabalho objetivou avaliar o curso diário e sazonal do potencial hídrico foliar de mogno (Swietenia macrophylla King) (Meliaceae) em sistema agroflorestal (SAF). O experimento foi realizado em árvores de S. macrophylla plantadas num sistema agroflorestal instalado no Campo Experimental da Embrapa Amazônia Ocidental, Manaus, AM. Avaliou-se o potencial hídrico foliar (Ψf) dos cursos diário e sazonal nos anos 2004 e 2005, por meio da utilização de bomba de pressão tipo Scholander. Os resultados indicaram que os valores do Ψf de S. macrophylla, de modo geral, foram superiores no início da manhã e no final da tarde, com redução acentuada ao meio-dia, e que, em relação à sazonalidade de precipitação, as menores taxas foram reportadas para a época menos chuvosa, variando de -26 bar em 2004 para -31bar em 2005. Verificou-se que o potencial hídrico de Swietenia macrophylla em sistema agroflorestal sofreu reduções significativas em razão dos baixos índices pluviométricos entre junho e outubro de 2005

The availability of full match sibling donors and feasibility of allogeneic bone marrow transplantation in Brazil

The feasibility of allogeneic bone marrow transplantation (alloBMT) in a developing country has not yet been demonstrated. Many adverse factors including social and economic limitations may reduce the overall results of this complex and expensive procedure. Our objective was to characterize the most important clinical, social and economic features of candidates for transplantation and their potential donors as well as the influence of these factors on overall survival in a retrospective and exploratory analysis at a university hospital. From July 1993 to July 2001, candidates for BMT were referred to the Bone Marrow Transplantation Unit by Hematology and Oncology Centers from several regions of Brazil. A total of 1138 patients were referred to us as candidates for alloBMT. Median age was 25 years (range: 2 months-60 years), 684 (60.1%) were males and 454 (39.9%) were females. The clinical indications were severe aplastic anemia and hematological malignancies. From the total of 1138 patients, 923 had HLA-typing; 497/923 (53.8%) candidates had full match donors; 352/1138 (30.8%) were eligible for alloBMT. Only 235 of 352 (66.7%) were transplanted. Schooling was 1st to 8th grade for 123/235 (52.3%); monthly family income ranged from US$60 (7$400 (36%). Overall survival for patients with chronic myeloid leukemia, severe aplastic anemia and acute myeloid leukemia was 58, 60 and 30%, respectively. Thus, overall survival rates for the most frequent hematological diseases were similar to those reported in the International Registry, except for acute myeloid leukemia. This descriptive and exploratory analysis suggests the feasibility of alloBMT in a developing country like Brazil

Descriptive Analysis Of And Overall Survival After Surgical Treatment Of Lung Metastases [análise Descritiva E Sobrevida Global Do Tratamento Cirúrgico Das Metástases Pulmonares]

Objective: To describe demographic characteristics, surgical results, postoperative complications, and overall survival rates in surgically treated patients with lung metastases. Methods: This was a retrospective analysis of 119 patients who underwent a total of 154 lung metastasis resections between 1997 and 2011. Results: Among the 119 patients, 68 (57.1%) were male and 108 (90.8%) were White. The median age was 52 years (range, 15-75 years). In this sample, 63 patients (52.9%) presented with comorbidities, the most common being systemic arterial hypertension (69.8%) and diabetes (19.0%). Primary colorectal tumors (47.9%) and musculoskeletal tumors (21.8%) were the main sites of origin of the metastases. Approximately 24% of the patients underwent more than one resection of the lesions, and 71% had adjuvant treatment prior to metastasectomy. The rate of lung metastasis recurrence was 19.3%, and the median disease-free interval was 23 months. The main surgical access used was thoracotomy (78%), and the most common approach was wedge resection with segmentectomy (51%). The rate of postoperative complications was 22%, and perioperative mortality was 1.9%. The overall survival rates at 12, 36, 60, and 120 months were 96%, 77%, 56%, and 39%, respectively. A Cox analysis confirmed that complications within the first 30 postoperative days were associated with poor prognosis (hazard ratio = 1.81; 95% CI: 1.09-3.06; p = 0.02). Conclusions: Surgical treatment of lung metastases is safe and effective, with good overall survival, especially in patients with fewer metastases.396650658Aberg, T., Malmberg, K.A., Nilsson, B., Nöu, E., The effect of metastasectomy: Fact or fiction? (1980) Ann Thorac Surg., 30 (4), pp. 378-384. , http://dx.doi.org/10.1016/S0003-4975(10)61278-7Weinlechner, J.D., Tumorenan der brustwand und derenbehand-lung (Resektion der rippen, eroffnung der brusthohle, partielleentfernun der lunge) (1882) Wiener Med Wschr., 20, pp. 589-591Ehrenhaft, J.L., Pulmonary resections for metastatic lesions (1951) AMA Arch Surg., 63 (3), pp. 326-336. , http://dx.doi.org/10.1001/archsurg.1951.01250040332007, PMid:14868186Fujisawa, T., Yamaguchi, Y., Saitoh, Y., Sekine, Y., Iizasa, T., Mitsunaga, S., Factors influencing survival following pulmonary resection for metastatic colorectal carcinoma (1996) Tohoku J Exp Med., 180 (2), pp. 153-160. , http://dx.doi.org/10.1620/tjem.180.153, PMid:9111764Dellai, R.C.A., Chojniak, R., Marques, E., Younes, R.N., Detecção de nódulos pulmonares por tomografia computadorizada em pacientes com metástases pulmonares submetidos à cirurgia (1994) J Pneumol., 20 (SUPPL. 3), p. 28Thomford, N.R., Woolner, L.B., Clagett, O.T., The surgical treatment of metastatic tumors in the lungs (1965) J Thorac Cardiovasc Surg., 49, pp. 357-363. , PMid:14265951Morales-Blanhir, J.E., Palafox Vidal, C.D., Rosas Romero Mde, J., García Castro, M.M., Londono Villegas, A., Zamboni, M., Six-minute walk test: A valuable tool for assessing pulmonary impairment (2011) J Bras Pneumol., 37 (1), pp. 110-117. , http://dx.doi.org/10.1590/S1806-37132011000100016, PMid:21390439Younes, R.N., Haddad, F., Ferreira, F., Gross, J.L., Surgical removal of pulmonary metastasis: Prospective study in 182 patients [Article in Portuguese] (1998) Rev Assoc Med Bras., 44 (3), pp. 218-225. , PMid:9755551Moore, K.H., McCaughan, B.C., Surgical resection for pulmonary metastases from colorectal cancer (2001) ANZ J Surg., 71 (3), pp. 143-146. , http://dx.doi.org/10.1046/j.1440-1622.2001.02057.xPfannschmidt, J., Muley, T., Hoffmann, H., Dienemann, H., Prognostic factors and survival after complete resection of pulmonary metastases from colorectal carcinoma: Experiences in 167 patients (2003) J Thorac Cardiovasc Surg., 126 (3), pp. 732-739. , http://dx.doi.org/10.1016/S0022-5223(03)00587-7Rena, O., Casadio, C., Viano, F., Cristofori, R., Ruffini, E., Filosso, P.L., Pulmonary resection for metastases from colorectal cancer: Factors influencing prognosis. Twenty-year experience (2002) Eur J Cardiothorac Surg., 21 (5), pp. 906-912. , http://dx.doi.org/10.1016/S1010-7940(02)00088-XSaito, Y., Omiya, H., Kohno, K., Kobayashi, T., Itoi, K., Teramachi, M., Pulmonary metastasectomy for 165 patients with colorectal carcinoma: A prognostic assessment (2002) J Thorac Cardiovasc Surg., 124 (5), pp. 1007-1013. , http://dx.doi.org/10.1067/mtc.2002.125165, PMid:12407386Toscano, E., (1991) Tratamento cirúrgico das metástases nodulares do pulmão, , [thesis] Rio de Janeiro: Universidade Federal FluminenseRama, N., Monteiro, A., Bernardo, J.E., Eugénio, L., Antunes, M.J., Lung metastases from colorectal cancer: Surgical resection and prognostic factors (2009) Eur J Cardiothorac Surg., 35 (3), pp. 444-449. , http://dx.doi.org/10.1016/j.ejcts.2008.10.047, PMid:19136273Pfannschmidt, J., Dienemann, H., Hoffmann, H., Surgical resection of pulmonary metastases from colorectal cancer: A systematic review of published series (2007) Ann Thorac Surg., 84 (1), pp. 324-338. , http://dx.doi.org/10.1016/j.athoracsur.2007.02.093, PMid:17588454Ike, H., Shimada, H., Ohki, S., Togo, S., Yamaguchi, S., Ichikawa, Y., Results of aggressive resection of lung metastases from colorectal carcinoma detected by intensive follow-up (2002) Dis Colon Rectum., 45 (4), pp. 468-473. , http://dx.doi.org/10.1007/s10350-004-6222-0, discussion 473-5 PMid:12006927Inoue, M., Ohta, M., Iuchi, K., Matsumura, A., Ideguchi, K., Yasumitsu, T., Benefits of surgery for patients with pulmonary metastases from colorectal carcinoma (2004) Ann Thorac Surg., 78 (1), pp. 238-244. , http://dx.doi.org/10.1016/j.athoracsur.2004.02.017, PMid:15223436Monteiro, A., Arce, N., Bernardo, J., Eugénio, L., Antunes, M.J., Surgical resection of lung metastases from epithelial tumors (2004) Ann Thorac Surg., 77 (2), pp. 431-437. , http://dx.doi.org/10.1016/j.athoracsur.2003.06.012, PMid:14759411Groeger, A.M., Kandioler, M.R., Mueller, M.R., End, A., Eckersberger, F., Wolner, E., Survival after surgical treatment of recurrent pulmonary metastases (1997) Eur J Cardiothorac Surg., 12, pp. 703-705. , http://dx.doi.org/10.1016/S1010-7940(97)00239-XMauro Rossi, B., Lopes, A., Paulo Kowalski, L., de Oliveira Regazzini, R.C., Prognostic factors in 291 patients with pulmonary metastases submitted to thoracotomy (1995) Sao Paulo Med J., 113 (3), pp. 910-916. , http://dx.doi.org/10.1590/S1516-31801995000300005, PMid:8728726Kanemitsu, Y., Kato, T., Hirai, T., Yasui, K., Preoperative probability model for predicting overall survival after resection of pulmonary metastases from colorectal cancer (2004) Br J Surg., 91 (1), pp. 112-120. , http://dx.doi.org/10.1002/bjs.4370, PMid:14716804Lee, W.S., Yun, S.H., Chun, H.K., Lee, W.Y., Yun, H.R., Kim, J., Pulmonary resection for metastases from colorectal cancer: Prognostic factors and survival (2007) Int J Colorectal Dis., 22 (6), pp. 699-704. , http://dx.doi.org/10.1007/s00384-006-0218-2, PMid:1710910

Descriptive analysis of and overall survival after surgical treatment of lung metastases

To describe demographic characteristics, surgical results, postoperative complications, and overall survival rates in surgically treated patients with lung metastases. Methods: This was a retrospective analysis of 119 patients who underwent a total of 154 lung metastasis resections between 1997 and 2011. Results: Among the 119 patients, 68 (57.1%) were male and 108 (90.8%) were White. The median age was 52 years (range, 15-75 years). In this sample, 63 patients (52.9%) presented with comorbidities, the most common being systemic arterial hypertension (69.8%) and diabetes (19.0%). Primary colorectal tumors (47.9%) and musculoskeletal tumors (21.8%) were the main sites of origin of the metastases. Approximately 24% of the patients underwent more than one resection of the lesions, and 71% had adjuvant treatment prior to metastasectomy. The rate of lung metastasis recurrence was 19.3%, and the median disease-free interval was 23 months. The main surgical access used was thoracotomy (78%), and the most common approach was wedge resection with segmentectomy (51%). The rate of postoperative complications was 22%, and perioperative mortality was 1.9%. The overall survival rates at 12, 36, 60, and 120 months were 96%, 77%, 56%, and 39%, respectively. A Cox analysis confirmed that complications within the first 30 postoperative days were associated with poor prognosis (hazard ratio = 1.81; 95% Cl: 1.09-3.06; p = 0.02). Conclusions: Surgical treatment of lung metastases is safe and effective, with good overall survival, especially in patients with fewer metastases396650658Descrever características demográficas, resultados operatórios, complicações pós-operatórias e taxa de sobrevida global em pacientes com metástases pulmonares tratados cirurgicamente. Análise retrospectiva de 119 pacientes submetidos a um total de 154 cirurgias de ressecção de metástase pulmonar entre 1997 e 2011. Resultados: Do total de 119 pacientes, 68 (57,1%) eram do sexo masculino, e 108 (90,8%) eram brancos. A mediana de idade foi de 52 anos (variação, 15-75 anos). Nessa amostra, 63 pacientes (52,9%) apresentaram comorbidades, sendo as mais frequentes hipertensão arterial sistêmica (69,8%) e diabetes (19,0%). Tumores primários colorretais (47,9%) e musculoesqueléticos (21,8%) foram os principais sítios de origem das metástases. Aproximadamente 24% dos pacientes foram submetidos a mais de uma ressecção das lesões, e 71% fizeram tratamento adjuvante prévio à metastasectomia. A taxa de recidiva de metástase pulmonar foi de 19,3%. A mediana do intervalo livre de doença foi de 23 meses. A principal via de acesso usada foi toracotomia (78%), e o tipo de ressecção mais frequente foi em cunha e segmentectomia (51%). O índice de complicações pós-operatórias foi de 22% e o de mortalidade perioperatória foi de 1,9%. As taxas de sobrevida global em 12, 36, 60 e 120 meses foram, respectivamente, de 96%, 77%, 56% e 39%. A análise de Cox confirmou que complicações nos primeiros 30 dias pós-operatórios associaram-se a pior prognóstico (hazard ratio = 1,81; IC95%: 1,09-3,06; p = 0,02). Conclusões: O tratamento cirúrgico das metástases pulmonares oriundas de diferentes sítios tumorais é efetivo e seguro, com boa sobrevida global, especialmente nos casos com um menor número de lesões pulmonare

The availability of full match sibling donors and feasibility of allogeneic bone marrow transplantation in Brazil

The feasibility of allogeneic bone marrow transplantation (alloBMT) in a developing country has not yet been demonstrated. Many adverse factors including social and economic limitations may reduce the overall results of this complex and expensive procedure. Our objective was to characterize the most important clinical, social and economic features of candidates for transplantation and their potential donors as well as the influence of these factors on overall survival in a retrospective and exploratory analysis at a university hospital. From July 1993 to July 2001, candidates for BMT were referred to the Bone Marrow Transplantation Unit by Hematology and Oncology Centers from several regions of Brazil. A total of 1138 patients were referred to us as candidates for alloBMT. Median age was 25 years (range: 2 months-60 years), 684 (60.1%) were males and 454 (39.9%) were females. The clinical indications were severe aplastic anemia and hematological malignancies. From the total of 1138 patients, 923 had HLA-typing; 497/923 (53.8%) candidates had full match donors; 352/1138 (30.8%) were eligible for alloBMT. Only 235 of 352 (66.7%) were transplanted. Schooling was 1st to 8th grade for 123/235 (52.3%); monthly family income ranged from US$60 (7$400 (36%). Overall survival for patients with chronic myeloid leukemia, severe aplastic anemia and acute myeloid leukemia was 58, 60 and 30%, respectively. Thus, overall survival rates for the most frequent hematological diseases were similar to those reported in the International Registry, except for acute myeloid leukemia. This descriptive and exploratory analysis suggests the feasibility of alloBMT in a developing country like Brazil