Treatment of pediatric myelodysplastic syndromes and juvenile myelomonocytic leukemia: the Brazilian experience in the past decade

Background: Therapy strategies for myelodysplastic syndromes (MDS) and juvenile myelomonocytic leukemia (JMML) vary considerably. Objective: To review the treatment of Brazilian children who were diagnosed with MDS or JMML in the past decade and reported to the Brazilian Cooperative Group on Pediatric Myelodysplastic syndromes (BCG-MDS-PED). Results: of 173 children reported to the BCG-MDS-PED from January 1997 to January 2003 with a suspected diagnosis of MDS or JMML, 91 had the diagnosis confirmed after central review of the bone marrow aspirate and biopsy. Information on previous treatments was available for 78 MDS/JMML patients. Treatment varied from different schedules of low-dose (14%) and standard-dose chemotherapy (50%), granulocyte-colony-stimulating factor (G-CSF 7%), interferon (5%), steroids (2%) and erythropoietin (2%) to allogeneic stem-cell transplantation (SCT) (14%). No survival advantage could be demonstrated based on Hasle's classification or based on treatment. Conclusion: This report reflects the current practice in treating Brazilian children with MDS/JMML without specific Cooperative Group guidelines. Treatment modalities were very heterogeneous. The strategies for implementing a national protocol should consider international guidelines and focus on local experience and available resources. (C) 2004 Elsevier Ltd. All rights reserved.

THE EFFECT OF RECENT DIET ON PREY ODOR DISCRIMINATION BY JUVENILE TEGU LIZARD, TUPINAMBIS-TEGUIXIN (SAURIA, TEIIDAE)

Teiid lizards are intesive foragers supposed to rely lagerly on chemoreception for prey detection, an ability that can be modified by previous feeding experiences. We investigated the ability of juvenile lizards, Tupinambis teguixin, in discriminate prey from non-prey odors as well as the effects of recent diet on these ability. Tegu lizards were able to discriminate prey odors and this ability probably is inate. The effect of recent diet was analysed through optimal foraging models and our results does not support in a broad sense the predictions made by theoretical models.

The megalopa and early juvenile stages of Calappa tortugae Rathbun, 1933 (Crustacea, Brachyura) reared in the laboratory from South Carolina neuston samples

Neuston samples collected from the Charleston Bump region off the coast of South Carolina, U.S.A., during the summers of 2002 and 2003 consistently included a decapod species of undetermined identity with a large brachyuran megalopa. Despite their resemblance to some calappids, it was impossible to make a definitive identification based solely on general morphology. Therefore, additional neuston tows were taken on the continental shelf near Charleston, during the summer of 2004 to obtain these living megalopae. These were raised successfully through five juvenile stages at the Southeastern Regional Taxonomic Center (SERTC) laboratory. The morphology of the juveniles provided evidence that they are megalopae of Calappa tortugae Rathbun, 1933. Comparisons with megalopae of Hepatus epheliticus (Linnaeus, 1763), H. pudibundus (Herbst, 1785), Calappa flammea (Herbst, 1794) and Cryptosoma balguerii (Desbonne, 1867) are presented here. This is the first complete description of the megalopa morphology of a member of the genus Calappa Weber, 1795 from the Western Atlantic, and it is helpful for taxonomic, systematic and ecological purposes.

Commensal worm traces and possible juvenile thalassinidean burrows associated with Ophiomorpha nodosa, Pleistocene, southern Brazil

The Pleistocene Chui Formation at Osorio (Rio Grande do Sul, Brazil) consists of coastal marine and eolian sands, the former containing abundant and well-preserved Ophiomorpha nodosa burrow systems. Detailed ichnological study has revealed interesting features associated with them. Small-sized Ophiomorpha, here assigned to a new ichnospecies, O. puerilis, are interpreted as possible burrows of juvenile thalassinidean crustaceans probably belonging to the same species as the producers of larger O. nodosa. Additionally, helicoidal burrows with thick, concentrically laminated linings are associated with the walls of O. nodosa. They are assigned to the new ichnospecies Cylindrichnus helix, and they are interpreted as dwellings of commensal annelid worms. The association of these three icbnospecies constitutes a fossil example of the role of thalassinideans as ecosystem engineers able to modify their environment and to create new space and resources usable by other organisms. (c) 2005 Elsevier B.V. All rights reserved.

Mispatterning in the ommatidia of Apis mellifera pupae treated with a juvenile hormone analogue

To further understand the function of morphogenetic hormones in honeybee eye differentiation, the alterations in ommatidial patterning induced by pyriproxyfen, a juvenile hormone (JH) analogue, were studied by scanning and transmission electron microscopy. Prepupae of prospective honeybee workers were treated with pyriproxyfen and the effects on ommatidial differentiation were described at the end of the pupal development. The results show that the entire ommatidia, i.e., the dioptric as well as the receptor systems, were affected by the JH analogue. The wave of ommatidial differentiation, which progresses from the posterior to the anterior region of the pupal eyes, was arrested. In treated pupae, the rhabdomeres only differentiated at the apical axis of the retinula, the secondary and tertiary pigment cells did not develop their cytoplasm protrusions, and the cone cell quartet did not pattern correctly. Simultaneously, an intense vacuolization was observed in cells forming ommatidia. In a previous study we showed that pyriproxyfen exerts an inhibition on pupal ecdysteroid secretion. In this sense, the arrested ommatidial differentiation in pyriproxyfen-treated pupae could be due to a secondary effect resulting from an alteration in pupal ecdysteroid titers. J. Morphol. 249:89-99, 2001. (C) 2001 Wiley-Liss, Inc.

Plastic debris collars on juvenile carcharhinid sharks (Rhizoprionodon lalandii) in southwest Atlantic

Three juvenile Brazilian sharpnose sharks (Rhizoprionodon lalandii) caught in gillnets in southeast Brazil, southwest Atlantic, were found with plastic debris rings around their gill or mouth region. The rings caused severe abrasion on the sharks' tissues as the animal grew, the collars probably hampering normal feeding and/or ventilation since two of the collared individuals were emaciated. The rings were identified as detachable lid parts from plastic bottles, likely thrown overboard by fishery and/or recreation boats. As several carcharhinid shark species dwells and reproduce in shallow waters, the impact of discarded plastic debris likely is greater on this shark type. (C) 2002 Elsevier B.V. Ltd. All rights reserved.

Risk factors for amenorrhea in juvenile systemic lupus erythematosus (JSLE): a Brazilian multicentre cohort study

We evaluated the prevalence and clinical associations of amenorrhea in 298 female juvenile systemic lupus erythematosus (JSLE) patients (ACR criteria) followed in 12 Brazilian Paediatric Rheumatology centres. Amenorrhea was observed in 35 patients (11.7%) with a mean duration of 7.2 +/- 3.6 months. The hormones were performed in 32/35 patients and none of them had FSH and LH levels above and estradiol below the normal range according to pubertal changes. JSLE patients with amenorrhea were younger (15.04 +/- 2.5 versus 17.8 +/- 3.1 years; P = 0.001), and had a shorter period of time between menarche and current age (3.4 +/- 2.9 versus 6.7 +/- 5.4 years; P = 0.001). Interestingly, the frequency, cumulative dose, number of pulses and duration of intravenous cyclophosphamide treatment were alike in patients with and without amenorrhea (P > 0.05). In contrast, patients with amenorrhea had significantly higher SLEDAI (P = 0.01) and SLICC/ACR-DI (P = 0.024) scores compared to those without this condition. Independent risk factors identified by multivariate analysis were higher SLEDAI (OR=1.059; CI=1.004-1.116; P=0.034) and SLICC/ACR-DI (OR=2.125; IC = 1.373-3.291; P = 0.001) scores. Our data suggest that in spite of imummosuppressive therapy, JSLE patients have an adequate ovarian follicular reserve and amenorrhea is particularly associated with disease activity and damage.

Use of ideal protein concept for precision formulation of amino acid levels in fish-meal-free diets for juvenile Nile tilapia (Oreochromis niloticus L.)

This study was undertaken in a closed system with Nile tilapia (Oreochromis niloticus) to examine the effects of total replacement of fish meal (FM) by soybean meal. Nile tilapia fingerlings with an average weight of 5.34+/-0.08 g were hand-fed one of the five isoenergetic (approximate to13.5 MJ digestible energy kg(-1)) and isoproteic (approximate to31% of digestible protein) experimental diets to satiation, six times a day during 85 days in eight replicate fibreglass tanks (six fish per tank). The control diet containing FM was substituted by soybean meal, with and without essential amino acids (lysine, methionine and threonine) or dicalcium phosphate supplementation. The supplemental amino acids were added at levels to simulate the reference amino acid profile of Nile tilapia carcass protein, based on the ideal protein concept. The results showed that soybean meal diet supplemented only with dicalcium phosphate was inferior to the control diet with FM and soybean meal diets supplemented with dicalcium phosphate and essential amino acids. Multiple essential amino acids and dicalcium phosphate incorporation in soybean meal diets was associated with performance, whole-body composition and carcass yield equal to that of the fish fed with the control diet containing FM. These data suggest that a diet with all plant protein source, supplemented with essential amino acids, based on tissue amino acid profile, can totally replace FM in a diet for Nile tilapia, without adverse effects on the growth performance, carcass yield and composition.

Proxy-reported health-related quality of life of patients with juvenile idiopathic arthritis: Pediatric rheumatology international trials organization multinational quality of life cohort study

Objective. To investigate the proxy-reported health-related quality of life (HRQOL) and its determinants in patients with juvenile idiopathic arthritis (JIA).Methods. In this multinational, multicenter, cross-sectional study, HRQOL of patients with JIA was assessed through the Child Health Questionnaire (CHQ) and was compared with that of healthy children of similar age from the same geographic area. of joint inflammation, Childhood Health Assessment Questionnaire (CHAQ), and erythrocyte sedimentation rate.Results. A total of 6,639 participants (3,324 with JIA and 3,315 healthy) were enrolled from 32 countries. The mean SD physical and psychosocial summary scores of the CHQ were significantly lower in patients with JIA than in healthy children (physical: 44.5 +/- 10.6 versus 54.6 +/- 4.0, P < 0.0001; psychosocial: 47.6 +/- 8.7 versus 51.9 +/- 7.59 P < 0.0001), with the physical well-being domain being most impaired. Patients with persistent oligoarthritis had better HRQOL compared with other subtypes, whereas HRQOL was similar across patients with systemic arthritis, polyarthritis, and extended oligoarthritis. A CHAQ score > 1 and a pain intensity rating > 3.4 cm on a 10-cm visual analog scale were the strongest determinants of poorer HRQOL in the physical and psychosocial domains, respectively.Conclusion. We found that patients with JIA have a significant impairment of their HRQOL compared with healthy peers, particularly in the physical domain. Physical well-being was mostly affected by the level of functional impairment, whereas the intensity of pain had the greatest influence on psychosocial health.

Growth and juvenile development of Uca maracoani Latreille 1802-1803 in laboratory conditions (Crustacea, Decapoda, Brachyura, Ocypodidae).

The life cycle of decapod crustaceans can be classified into three distinct morphological phases: larval, juvenile and adult. Despite its recognized importance, studies of the juvenile phase have been neglected. The present Study aimed to analyze the growth of juveniles from a single population of Uca maracoani under laboratory conditions, and also to describe the morphological differentiation of pleopods in each sex. Megalopae and juvenile crabs or U. maracoani obtained on a Mud beach at Jabaquara, Paraty, on the southern coast of the state of Rio de Janeiro (Brazil), were reared in the laboratory. The specimens were checked daily for molts and deaths. The carapace widths (CW) of intact exuviae and dead individuals were measured under a stereoscopic microscope provided with a micrometer rule. These data allowed the definition of a growth equation as well as the stages related to the beginning of pleopod development, which begins when females reach 3.0 mill CW (6th juvenile developmental stage), similar to the sizes reported for other species of the genus. In males, however, pleopods appear when the crabs reach 3.5 mm CW, equivalent to the 7th developmental stage. This difference may be related to differential growth between sexes. It also may be a consequence of laboratory rearing, or may represent an actual feature of the species.

Comparison of clinical features and drug therapies among European and Latin American patients with juvenile dermatomyositis

ObjectiveTo compare the demographic features, presenting manifestations, diagnostic investigations, disease course, and drug therapies of children with juvenile dermatomyositis (JDM) followed in Europe and Latin America.MethodsPatients were inception cohorts seen between 1980 and 2004 in 27 paediatric rheumatology centres. The following information was collected through the review of patient charts: sex; age at disease onset; date of disease onset and diagnosis; onset type; presenting clinical features; diagnostic investigations; course type; and medications received during disease course.ResultsFour hundred and ninety patients (65.5% females, mean onset age 7.0 years, mean disease duration 7.7 years) were included. Disease presentation was acute or insidious in 57.1% and 42.9% of the patients, respectively. The course type was monophasic in 41.3% of patients and chronic polycyclic or continuous in 58.6% of patients. The more common presenting manifestations were muscle weakness (84.9%), Gottron's papules (72.9%), heliotrope rash (62%), and malar rash (56.7%). Overall, the demographic and clinical features of the 2 continental cohorts were comparable. European patients received more frequently high-dose intravenous methylprednisolone, cyclosporine, cyclophosphamide, and azathioprine, while methotrexate and antimalarials medications were used more commonly by Latin American physicians.ConclusionThe demographic and clinical characteristics of JDM are similar in European and Latin American patients. We found, however, several differences in the use of medications between European and Latin American paediatric rheumatologists.