CD38 expression level and pattern of expression remains a reliable and robust marker of progressive disease in chronic lymphocytic leukemia

Chronic lymphocytic leukemia (CLL) follows a variable clinical course which is difficult to predict at diagnosis. We assessed somatic mutation (SHM) status, CD38 and ZAP-70 expression in 87 patients (49 male, 38 female) with stage A CLL and known cytogenetic profile to compare their role in predicting disease progression, which was assessed by the treatment free interval (TFI) from diagnosis. Sixty (69%) patients were SHM+, 24 (28%) were CD38+ and ten (12%) were ZAP-70+. The median TFI for: (i) SHM + versus SHM- patients was 124 versus 26 months; hazard ratio (HR) = 3.6 [95% confidence interval (CI) = 1.8 - 7.3; P = 0.001]: (ii) CD38- versus CD38+ patients was 120 versus 34 months; HR = 2.4 (95% CI = 1.4 - 5.3; P = 0.02); and (iii) ZAP70- versus ZAP70+ was 120 versus 16 months; HR = 3.4 (95% CI = 1.4 - 8.7; P = 0.01). SHM status and CD38 retained prognostic significance on multivariate analysis whereas ZAP-70 did not. We conclude that ZAP-70 analysis does not provide additional prognostic information in this group of patients.

Treatment of relapse after allogeneic bone marrow transplantation with reduced intensity conditioning (FLAG +/- Ida) and second allogeneic stem cell transplant

Acute leukaemias in relapse after allogeneic stem cell transplantation (SCT) respond poorly to donor leucocyte infusions (DLI) compared with chronic myeloid leukaemia (CML), at least in part because of faster disease kinetics. Fludarabine-containing 'non-myeloablative' chemotherapy followed by further allo SCT may offer more rapid and effective disease control. We report 14 patients with relapse after allo SCT for acute leukaemia [seven acute myeloid leukaemia (AML), five acute lymphoblastic leukaemia (ALL)] or refractory anaemia with excess blasts in transformation (RAEB-t, n = 2) treated with fludarabine, high-dose cytosine arabinoside (ara-C) and granulocyte colony-simulating factor (G-CSF) with (n = 10) or without (n = 2) idarubicin (FLAG +/- Ida) or DaunoXome (FLAG-X) (n = 2) and second allo SCT from the original donor. Donors were fully human leucocyte antigen (HLA) -matched in 13 cases with a single class A mismatch in one. Actuarial overall survival was 60% and disease-free survival was 26% at 58 months. Remissions after the second SCT were longer than those after the first bone marrow transplantation (BMT) in eight of the 13 assessable patients to date. Haematopoietic recovery was rapid. Transplants were well tolerated with no treatment-related deaths. The major complication was graft-versus-host disease (GvHD, acute >/= grade II-2 cases, chronic - eight cases, two limited, six extensive) although there have been no deaths attributable to this. FLAG +/- Ida and second allo SCT is a safe and useful approach and may be more effective than DLI in the treatment of acute leukaemias relapsing after conventional allo SCT.

Transfusões sanguíneas em cães e gatos: indicações e reações transfusionais

O presente relatório teve como base o estágio curricular no Hospital Veterinário Central, sob a orientação da Professora Cristina Queiroga, e coorientação do Dr. Nuno Paixão. Na primeira parte deste documento são relatadas as atividades desenvolvidas durante o estágio curricular, abrangendo várias áreas de especialidade clínica, em medicina de animais de companhia. A segunda parte do documento consiste numa revisão bibliográfica sobre transfusões sanguíneas, onde são abordados vários pontos, seguida da apresentação e discussão de um estudo sobre as transfusões sanguíneas realizadas no Hospital Veterinário Central, no período de 1 de janeiro de 2012 a 28 de fevereiro de 2013. O estudo tem como objetivos a avaliação da variação do hematócrito, frequência cardíaca e respiratória, coloração das mucosas, temperatura retal, pressões sanguíneas e atitude, em intervalos de tempo estipulados. Outro objetivo do presente estudo, é determinar a prevalência de reações transfusionais adversas e a taxa de sobrevivência dos animais submetidos a transfusão, e avaliar, através de testes estatísticos, se existe associação entre as várias variáveis em estudo; ### ABSTRACT: Blood transfusions in dogs and cats: indications and transfusion reactions This report is based on the internship accomplished in Hospital Veterinário Central, under the orientation of Dr. Cristina Queiroga and co-orientation of Dr. Nuno Paixão. The first part of this report describes the activities undertaken during a traineeship in several areas of clinical specialty, in small animal medicine. The second part of this document consists of a literature review on blood transfusions, which addresses several points, followed by a presentation and discussion of a study of blood transfusions performed at Hospital Veterinário Central, during the period of 1 January 2012 and 28 February 2013. The study aims at assessing the changes in hematocrit, heart and respiratory rate, mucous membrane coloration, retal temperature, blood pressures and attitude, at prescribed time intervals. Another objective of the present study is to determine the prevalence of adverse transfusion reactions and the survival rate of animals subjected to transfusion, and evaluate, through statistical tests, whether an association exists between the different variables under study.

Characterization of bioactive compounds of dealcoholized wine: valuation of distillation process

O vinho tinto é uma importante fonte de compostos fenólicos com atividade antioxidante e que estão relacionados com a prevenção de doenças cardiovasculares e cancro. Estes compostos são um sub-produto do processo de destilação vínica utilizado para produzir aguardente necessária para a produção de Vinho do Porto. Esta tese tem como objetivo valorizar os compostos fenólicos resultantes das destilarias de vinho, através do estudo da sua composição, das interações com o material polimérico do vinho, da sua estabilidade durante o armazenamento e avaliação dos seus potenciais efeitos biológicos in vitro. Isto irá permitir definir aplicações para estes compostos como ingredientes alimentares com propriedades funcionais. Dois vinhos tintos (RW1 e RW2) foram utilizados como fonte de compostos fenólicos. A fim de estudar estes compostos, cada vinho foi evaporado à pressão atmosférica, permitindo obter o respetivo vinho desalcolizado (DW1 e DW2). Os polissacarídeos e compostos fenólicos presentes nos vinhos desalcolizados foram fracionados por extração em fase sólida utilizando cartuchos C18 sep-pak. A fração hidrofóbica, rica em compostos fenólicos, foi separada em frações ricas em ácidos fenólicos, em procianidinas e em antocianinas, as quais foram usadas para avaliar a sua contribuição para a atividade antioxidante total e caracterização fenólica detalhada dos DW. Foram obtidas quantidades comparáveis de compostos fenólicos totais (1.3 g/L para RW1 e DW1, e 3.1 para RW2 e DW2), de taninos (1.2 g/L para RW1 e DW1 e 1.6 para RW2 e DW2) e de antocianinas (0.24 g/L para RW1 e DW1 e 0.41 para RW2 e DW2) para os vinhos e para os respetivos vinhos desalcolizados. A determinação da atividade antioxidante de RW e DW pelos métodos do DPPH e ABTS também originou valores semelhantes, permitindo inferir que o processo de destilação realizado não promoveu uma perda relevante de compostos fenólicos. A atividade antioxidante total de vinho deveu-se essencialmente à fração rica em antocianinas. Os dois DW foram dialisados para se obter o material polimérico dos vinhos (WPM1 e WPM2). O WPM1 e WPM2 apresentavam 1.1 e 1.3 g/L de material sólido, respetivamente. O WPM (WPM1 e WPM2) era composto por polissacarídeos (31 e 36%), proteínas (10 e 12%) e também por compostos fenólicos (32 e 43%). A análise de açúcares mostrou que as manoproteínas e as arabinogalactanas eram os principais polissacarídeos presentes. A extração do WPM com metanol deu origem a um material insolúvel em metanol (PMi) e a uma fração solúvel em metanol, que continuava a conter hidratos de carbono e compostos fenólicos, mostrando uma forte interação entre estes compostos. Para determinar a energia de ativação (Ea) da libertação dos compostos fenólicos de fracções de material polimérico do vinho, foram realizadas diálises do DW, WPM e PMi, utilizando-se quatro concentrações diferentes, a cinco temperaturas (5-40 °C). O valor da Ea foi 25 para o WPM e 61 kJ/mol para o PMi, mostrando que os compostos fenólicos do vinho podem estar associados de forma diferente à matriz polimérica e que uma fração pode estar, ainda, fortemente associada a esta matriz. A fim de avaliar a possível existência de interações seletivas com os compostos fenólicos, o WPM foi fracionado, permitindo a obtenção de uma fração rica em manoproteínas (MP), através de uma cromatografia de afinidade com concanavalina A e 3 frações ricas em arabinogalactanas (AG0, AG1 e AG2) obtidas por cromatografia de troca aniónica. Foi avaliada a difusão de nove antocianinas monoméricas através de uma membrana de diálise, em presença do WPM, e das frações ricas em MP e em AG. A diálise dos compostos fenólicos livres do vinho foi realizada como ensaio em branco. Todas as frações poliméricas mostraram capacidade para reter as antocianinas, embora em diferente extensão. Foi observada uma capacidade de retenção maior para as antocianinas acilglucosiladas do que para as antocianinas glucosiladas. A fração rica em AG teve uma maior contribuição para a capacidade de retenção das antocianinas pelo material polimérico vinho do que a fração rica em MP, principalmente quando as antocianinas estavam acetiladas. Com o objetivo de estudar formas para preservar, a longo prazo, as propriedades antioxidantes dos compostos fenólicos, o extrato de compostos fenólicos (PCE), em pó, foi armazenado em diferentes condições de luz e atmosfera, à temperatura ambiente durante 1 ano. Observou-se que o PCE armazenado no escuro, dentro de um exsicador sob atmosfera de azoto, preservou 95% da atividade antioxidante inicial. Também foram avaliadas as melhores condições para preservar as antocianinas quando em solução, armazenadas a duas temperaturas (5 e 30 ºC) durante 3 meses. A adição de 0.5 g/L de uma fração rica em polissacarídeos a um vinho armazenado a 30 ºC promoveu a proteção das antocianinas, especialmente das antocianinas cumaroiladas. Os potenciais efeitos biológicos dos compostos fenólicos foram avaliados em diferentes sistemas celulares in vitro utilizando as seguintes frações: WPM, WPS (polissacarídeos do vinho), WPC (compostos fenólicos do vinho), PA-E (fração rica em ácidos fenólicos), PR-E (fração rica em procianidinas) e APP-E (fração rica em antocianinas e procianidinas poliméricas). Foi observada uma maior viabilidade celular quando as células do carcinoma do cólon HT-29 foram expostas a dois agentes oxidantes (radiação UV e H2O2) em presença das frações PR-E e APP-E. Além disso, os extratos WPS, WPC, PR-E e APP-E mostraram propriedades anti-inflamatórias, avaliadas pela inibição da produção de NO por células de macrófagos RAW264.7, sendo o extrato APP-E (0.19 mg/mL) o que exibiu a maior capacidade anti-inflamatória. A fim de elucidar as propriedades antioxidantes dos extratos do vinho em células humanas, os glóbulos vermelhos (RBC) foram selecionados como um modelo metabolicamente simples. Os extratos WPM, WPS, WPC, PR-E, e APP-E mostraram efeito anti-hemolítico para a hemólise dos RBC provocada pelo peróxido de hidrogénio (H2O2) e pelo di-hidrocloreto de 2,2'-azo-bis(2-diaminopropano) (AAPH). Os resultados obtidos permitem concluir que o processo de desalcoolização dos vinhos à pressão atmosférica, preservou as principais características antioxidantes dos compostos fenólicos. Estes compostos podem contribuir para a defesa das células contra agentes oxidantes, nomeadamente por terem um potencial de atividades anti-inflamatória e anti-hemolítica, promovendo a viabilidade celular. A interação dos compostos fenólicos do vinho com o material polimérico permite inferir uma dosagem contínua e gradual das antocianinas vinho tinto após a sua ingestão, contribuindo para um período mais longo da sua exposição e, como consequência, dos seus potenciais benefícios para a saúde.

Long-term seasonal changes in the abundance of Dendrodoris nudibranchs: a five-year survey

Dissertação de mestrado, Biologia Marinha, Faculdade de Ciências e Tecnologia, Universidade do Algarve, 2015

Diversifying medical imaging of breast lesions

Dissertação de mestrado, Engenharia Informática, Faculdade de Ciências e Tecnologia, Universidade do Algarve, 2015

Sarcosine oxidase composite screen-printed electrode for sarcosine determination in biological samples

XIX Meeting of the Portuguese Electrochemical Society - XVI Iberic Meeting of Electrochemistry

Resultados clínicos de doentes referenciados a Centro Oncológico

Os tumores da cabeça e pescoço (TCP) associam-se a elevada morbilidade e mortalidade. A referenciação atempada assume particular importância na evolução clínica. No intuito de avaliar a evolução dos doentes observados em consulta de Otorrinolaringologia “Oncológica”, procedeu-se a um estudo dos doentes com TCP referenciados ao Instituto Português de Oncologia (IPO) de Lisboa no ano 2008. Dos 454 doentes observados, a maioria era do sexo masculino (86%) com idade média 60 anos. Os tumores mais comuns foram laríngeos (36%), a maioria (69%) em estadio avançado. A cirurgia foi o tratamento primário em 60%. O intervalo médio de tempo entre primeira consulta e tratamento foi 75 dias, e a sobrevida global aos 2 anos 66%. A maioria dos doentes apresentava tumores avançados aquando da referenciação, o que comprometeu a sobrevida e o controlo locorregional, apesar do início rápido dos tratamentos. Políticas de saúde pública deveriam ser implementadas para melhoria da educação para a saúde, prevenção e referenciação destes doentes.

The Hybrid Approach for Palliation of Hypoplastic Left Heart Syndrome: Intermediate Results of a Single-Center Experience

INTRODUCTION: Hypoplastic left heart syndrome (HLHS) is a major cause of cardiac death during the first week of life. The hybrid approach is a reliable, reproducible treatment option for patients with HLHS. Herein we report our results using this approach, focusing on its efficacy, safety and late outcome. METHODS: We reviewed prospectively collected data on patients treated for HLHS using a hybrid approach between July 2007 and September 2014. RESULTS: Nine patients had a stage 1 hybrid procedure, with seven undergoing a comprehensive stage 2 procedure. One patient completed the Fontan procedure. Five patients underwent balloon atrial septostomy after the hybrid procedure; in three patients, a stent was placed across the atrial septum. There were three deaths: two early after the hybrid procedure and one early after stage two palliation. Overall survival was 66%. CONCLUSIONS: In our single-center series, the hybrid approach for HLHS yields intermediate results comparable to those of the Norwood strategy. The existence of dedicated teams for the diagnosis and management of these patients, preferably in high-volume centers, is of major importance in this condition.

Liver Depurative Techniques: A Single Liver Transplantation Center Experience

In a liver transplant (LT) center, treatments with Prometheus were evaluated. The main outcome considered was 1 and 6 months survival. Methods. During the study period, 74 patients underwent treatment with Prometheus; 64 were enrolled,with a mean age of 51 13 years; 47men underwent 212 treatments (mean, 3.02 per patient). The parameters evaluated were age, sex, laboratorial (liver enzymes, ammonia) and clinical (model for end-stage liver disease and Child-Turcotte-Pugh score) data. Results. Death was verified in 23 patients (35.9%) during the hospitalization period, 20 patients (31.3%) were submitted to liver transplantation, and 21 were discharged. LT was performed in 4 patients with acute liver failure (ALF, 23.7%), in 7 patients with acute on chronic liver failure (AoCLF, 43.7%), and in 6 patients with liver disease after LT (30%). Seven patients who underwent LT died (35%). In the multivariate analysis, older age (P ¼ .015), higher international normalized ratio (INR) (P ¼ .019), and acute liver failure (P ¼ .039) were independently associated with an adverse 1-month clinical outcome. On the other hand, older age (P ¼ .011) and acute kidney injury (P ¼ .031) at presentation were both related to worse 6-month outcome. For patients with ALF and AoCLF we did not observe the same differences. Conclusions. In this cohort, older age was the most important parameter defining 1- and 6-month survival, although higher INR and presence of ALF were important for 1-month survival and AKI for 6-month survival. No difference was observed between patients who underwent LT or did not have LT.

Primary localized rectal/pararectal gastrointestinal stromal tumors: results of surgical and multimodal therapy from the French Sarcoma group.

BACKGROUND: Rectal and pararectal gastrointestinal stromal tumors (GISTs) are rare. The optimal management strategy for primary localized GISTs remains poorly defined. METHODS: We conducted a retrospective analysis of 41 patients with localized rectal or pararectal GISTs treated between 1991 and 2011 in 13 French Sarcoma Group centers. RESULTS: Of 12 patients who received preoperative imatinib therapy for a median duration of 7 (2-12) months, 8 experienced a partial response, 3 had stable disease, and 1 had a complete response. Thirty and 11 patients underwent function-sparing conservative surgery and abdominoperineal resection, respectively. Tumor resections were mostly R0 and R1 in 35 patients. Tumor rupture occurred in 12 patients. Eleven patients received postoperative imatinib with a median follow-up of 59 (2.4-186) months. The median time to disease relapse was 36 (9.8-62) months. The 5-year overall survival rate was 86.5%. Twenty patients developed local recurrence after surgery alone, two developed recurrence after resection combined with preoperative and/or postoperative imatinib, and eight developed metastases. In univariate analysis, the mitotic index (≤5) and tumor size (≤5 cm) were associated with a significantly decreased risk of local relapse. Perioperative imatinib was associated with a significantly reduced risk of overall relapse and local relapse. CONCLUSIONS: Perioperative imatinib therapy was associated with improved disease-free survival. Preoperative imatinib was effective. Tumor shrinkage has a clear benefit for local excision in terms of feasibility and function preservation. Given the complexity of rectal GISTs, referral of patients with this rare disease to expert centers to undergo a multidisciplinary approach is recommended.

Which screening strategy using BMD measurements would be most cost effective for hip fracture prevention in elderly women? A decision analysis based on a Markov model.

INTRODUCTION: Hip fractures are responsible for excessive mortality, decreasing the 5-year survival rate by about 20%. From an economic perspective, they represent a major source of expense, with direct costs in hospitalization, rehabilitation, and institutionalization. The incidence rate sharply increases after the age of 70, but it can be reduced in women aged 70-80 years by therapeutic interventions. Recent analyses suggest that the most efficient strategy is to implement such interventions in women at the age of 70 years. As several guidelines recommend bone mineral density (BMD) screening of postmenopausal women with clinical risk factors, our objective was to assess the cost-effectiveness of two screening strategies applied to elderly women aged 70 years and older. METHODS: A cost-effectiveness analysis was performed using decision-tree analysis and a Markov model. Two alternative strategies, one measuring BMD of all women, and one measuring BMD only of those having at least one risk factor, were compared with the reference strategy "no screening". Cost-effectiveness ratios were measured as cost per year gained without hip fracture. Most probabilities were based on data observed in EPIDOS, SEMOF and OFELY cohorts. RESULTS: In this model, which is mostly based on observed data, the strategy "screen all" was more cost effective than "screen women at risk." For one woman screened at the age of 70 and followed for 10 years, the incremental (additional) cost-effectiveness ratio of these two strategies compared with the reference was 4,235 euros and 8,290 euros, respectively. CONCLUSION: The results of this model, under the assumptions described in the paper, suggest that in women aged 70-80 years, screening all women with dual-energy X-ray absorptiometry (DXA) would be more effective than no screening or screening only women with at least one risk factor. Cost-effectiveness studies based on decision-analysis trees maybe useful tools for helping decision makers, and further models based on different assumptions should be performed to improve the level of evidence on cost-effectiveness ratios of the usual screening strategies for osteoporosis.

Polysomy 8 defines a clinico-cytogenetic entity representing a subset of myeloid hematologic malignancies associated with a poor prognosis: report on a cohort of 12 patients and review of 105 published cases.

Tetrasomy, pentasomy, and hexasomy 8 (polysomy 8) are relatively rare compared to trisomy 8. Here we report on a series of 12 patients with acute myeloid leukemia (AML), myelodysplastic syndrome (MDS), or myeloproliferative disorder (MPD) associated with polysomy 8 as detected by conventional cytogenetics and fluorescence in situ hybridization (FISH). In an attempt to better characterize the clinical and hematological profile of this cytogenetic entity, our data were combined with those of 105 published patients. Tetrasomy 8 was the most common presentation of polysomy 8. In 60.7% of patients, polysomy 8 occurred as part of complex changes (16.2% with 11q23 rearrangements). No cryptic MLL rearrangements were found in cases in which polysomy 8 was the only karyotypic change. Our study demonstrates the existence of a polysomy 8 syndrome, which represents a subtype of AML, MDS, and MPD characterized by a high incidence of secondary diseases, myelomonocytic or monocytic involvement in AML and poor overall survival (6 months). Age significantly reduced median survival, but associated cytogenetic abnormalities did not modify it. Cytogenetic results further demonstrate an in vitro preferential growth of the cells with a high level of aneuploidy suggesting a selective advantage for polysomy 8 cells.

Vincristine and intestinal pseudo-obstruction in children: report of 5 cases, literature review, and suggested management.

Summary: Intestinal pseudo-obstruction is a rare complication resulting from a variety of disorders. Symptoms include abdominal pain, nausea, vomiting, diarrhea, constipation, and malnutrition. Vincristine-related pseudo-obstruction has been reported in the literature, but its description in children and recommendations for management are lacking. A review of the literature revealed 21 reported pediatric cases of vincristine-related pseudo-obstruction. Most have, however, been attributed to a drug interaction with itraconazole, accidental vincristine overdose, or liver failure. Potential genetic causes are rarely addressed. We present here 5 cases of pseudo-obstruction related to vincristine without any identifiable predisposing factors, and a suggested algorithm for management

Ten years of lung transplantation in Switzerland: results of the Swiss Lung Transplant Registry.

Lung transplantation has evolved from an experimental procedure to a viable therapeutic option in many countries. In Switzerland, the first lung transplant was performed in November 1992, more than ten years after the first successful procedure world-wide. Thenceforward, a prospective national lung transplant registry was established, principally to enable quality control. The data of all patients transplanted in the two Swiss Lung Transplant centres Zurich University Hospital and Centre de Romandie (Geneva-Lausanne) were analysed. In 10 years 242 lung transplants have been performed. Underlying lung diseases were cystic fibrosis including bronchiectasis (32%), emphysema (32%), parenchymal disorders (19%), pulmonary hypertension (11%) and lymphangioleiomyomatosis (3%). There were only 3% redo procedures. The 1, 5 and 9 year survival rates were 77% (95% CI 72-82), 64% (95% CI 57-71) and 56% (95% CI 45-67), respectively. The 5 year survival rate of patients transplanted since 1998 was 72% (95% CI 64-80). Multivariate Cox regression analysis revealed that survival was significantly better in this group compared to those transplanted before 1998 (HR 0.44, 0.26-0.75). Patients aged 60 years and older (HR 5.67, 95% CI 2.50-12.89) and those with pulmonary hypertension (HR 2.01, 95% CI 1.10-3.65) had a significantly worse prognosis The most frequent causes of death were infections (29%), bronchiolitis obliterans syndrome (25%) and multiple organ failure (14%). The 10-year Swiss experience of lung transplantation compares favourably with the international data. The best results are obtained in cystic fibrosis, pulmonary emphysema and parenchymal disorders.