Arsenic trioxide and all-trans retinoic acid treatment for acute promyelocytic leukaemia in all risk groups (AML17): results of a randomised, controlled, phase 3 trial

BACKGROUND: Acute promyelocytic leukaemia is a chemotherapy-sensitive subgroup of acute myeloid leukaemia characterised by the presence of the PML-RARA fusion transcript. The present standard of care, chemotherapy and all-trans retinoic acid (ATRA), results in a high proportion of patients being cured. In this study, we compare a chemotherapy-free ATRA and arsenic trioxide treatment regimen with the standard chemotherapy-based regimen (ATRA and idarubicin) in both high-risk and low-risk patients with acute promyelocytic leukaemia.

METHODS: In the randomised, controlled, multicentre, AML17 trial, eligible patients (aged ≥16 years) with acute promyelocytic leukaemia, confirmed by the presence of the PML-RARA transcript and without significant cardiac or pulmonary comorbidities or active malignancy, and who were not pregnant or breastfeeding, were enrolled from 81 UK hospitals and randomised 1:1 to receive treatment with ATRA and arsenic trioxide or ATRA and idarubicin. ATRA was given to participants in both groups in a daily divided oral dose of 45 mg/m(2) until remission, or until day 60, and then in a 2 weeks on-2 weeks off schedule. In the ATRA and idarubicin group, idarubicin was given intravenously at 12 mg/m(2) on days 2, 4, 6, and 8 of course 1, and then at 5 mg/m(2) on days 1-4 of course 2; mitoxantrone at 10 mg/m(2) on days 1-4 of course 3, and idarubicin at 12 mg/m(2) on day 1 of the final (fourth) course. In the ATRA and arsenic trioxide group, arsenic trioxide was given intravenously at 0·3 mg/kg on days 1-5 of each course, and at 0·25 mg/kg twice weekly in weeks 2-8 of course 1 and weeks 2-4 of courses 2-5. High-risk patients (those presenting with a white blood cell count >10 × 10(9) cells per L) could receive an initial dose of the immunoconjugate gemtuzumab ozogamicin (6 mg/m(2) intravenously). Neither maintenance treatment nor CNS prophylaxis was given to patients in either group. All patients were monitored by real-time quantitative PCR. Allocation was by central computer minimisation, stratified by age, performance status, and de-novo versus secondary disease. The primary endpoint was quality of life on the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 global health status. All analyses are by intention to treat. This trial is registered with the ISRCTN registry, number ISRCTN55675535.

FINDINGS: Between May 8, 2009, and Oct 3, 2013, 235 patients were enrolled and randomly assigned to ATRA and idarubicin (n=119) or ATRA and arsenic trioxide (n=116). Participants had a median age of 47 years (range 16-77; IQR 33-58) and included 57 high-risk patients. Quality of life did not differ significantly between the treatment groups (EORTC QLQ-C30 global functioning effect size 2·17 [95% CI -2·79 to 7·12; p=0·39]). Overall, 57 patients in the ATRA and idarubicin group and 40 patients in the ATRA and arsenic trioxide group reported grade 3-4 toxicities. After course 1 of treatment, grade 3-4 alopecia was reported in 23 (23%) of 98 patients in the ATRA and idarubicin group versus 5 (5%) of 95 in the ATRA and arsenic trioxide group, raised liver alanine transaminase in 11 (10%) of 108 versus 27 (25%) of 109, oral toxicity in 22 (19%) of 115 versus one (1%) of 109. After course 2 of treatment, grade 3-4 alopecia was reported in 25 (28%) of 89 patients in the ATRA and idarubicin group versus 2 (3%) of 77 in the ATRA and arsenic trioxide group; no other toxicities reached the 10% level. Patients in the ATRA and arsenic trioxide group had significantly less requirement for most aspects of supportive care than did those in the ATRA and idarubicin group.

INTERPRETATION: ATRA and arsenic trioxide is a feasible treatment in low-risk and high-risk patients with acute promyelocytic leukaemia, with a high cure rate and less relapse than, and survival not different to, ATRA and idarubicin, with a low incidence of liver toxicity. However, no improvement in quality of life was seen.

Phosphatidylethanolamines glycoxidation: products and significance

As fosfatidiletanolaminas constituem a segunda classe de fosfolípidos mais abundantes nos organismos. Elas estão presentes nas membranas biológicas e nas lipoproteínas. As alterações estruturais dos fosfolípidos, ocorrem devido ao stress oxidativo e podem manisfestar-se em alterações das suas propriedades e funções. Já são conhecidas algumas condições fisiopatológicas, nas quais os fosfolípidos oxidados estão envolvidos, por exemplo sinalização celular, resposta imunitária, apoptose e doenças relacionadas com o envelhecimento. Por esse motivo, o interesse no estudo dos fosfolípidos oxidados e suas funções tem crescido nos últimos anos. Contudo, a maioria dos estudos realizados, focam a oxidação das fosfatidilcolinas, tendo sido dedicada pouca atenção a outras classes de fosfolipídos, como as fosfatidiletanolaminas. As fosfatidiletanolaminas, podem ainda sofrer outras modificações, devido ao grupo amina livre presente na cabeça polar, como por exemplo a glicação. As fosfatidiletanolaminas glicadas já foram detectadas em condições de hiperglicemia, em pacientes diabéticos, e tem correlação com a hemoglobina glicada. Sabe-se que a glicação de biomoléculas, pode aumentar as modificações oxidativas, que por sua vez, podem ser responsáveis pelo estado inflamatório, existente na diabetes mellitus. Tanto o stress oxidativo, como a inflamação estão relacionados com a diabetes e as suas complicações. A espectrometria de massa tem sido utilizada como uma importante tecnologia na detecção e caracterização de modificações oxidativas de fosfolípidos. Assim, neste trabalho pretendeu-se estudar as modificações oxidativas induzidas em fosfatidiletanolaminas glicadas, e os seus efeitos biológicos nos monócitos e células dendríticas do sangue periférico. Pretendeu-se ainda, estudar as alterações que ocorreram nas espécies de fosfatidiletanolaminas do fígado de ratos diabéticos. Os resultados obtidos permitiram identificar vários produtos de oxidação de fosfatidiletanolaminas glicadas, nomeadamente novos produtos formados pela oxidação da cabeça polar glicada. A oxidação na cabeça polar glicada foi, ainda, confirmada pela realização de experiências com spin traps combinadas com espetrometria de massa. Posteriormente, as fosfatidiletanolaminas oxidadas, glicadas e glicoxidadas demonstraram ter efeitos pró-inflamatórios, confirmados pelo aumento da estimulação monócitos e de células dendríticas, expresso no aumento do número de células produtoras de citocinas em comparação com o estado basal. As diferentes modificações de fosfatidiletanolaminas induziram estímulos distintos nos dois tipos de células. Sendo as fosfatidiletanolaminas glicadas e as glicoxidadas, os compostos que induziram um maior estímulo. Estes resultados sugeriram que as fosfatidiletanolaminas glicadas e as glicoxidadas podem estar associadas com o estado inflamatório que decorre da hiperglicemia crónica. Ainda, a avaliação do perfil lipídico de extratos de fígado de ratos diabéticos demonstrou que a hiperglicemia induz inúmeras alterações das espécies de fosfatidiletanolaminas e das espécies de outras classes de fosfolípidos, em simultâneo com sinais de lesão hepática. Em conclusão, este trabalho demonstra a relação existente entre, a hiperglicémia, o stress oxidativo, a glicação e oxidação de fosfatidiletanolaminas e ainda a inflamação e compliações diabéticas. Portanto a contribuição da lipidómica é importante para compreender os efeitos prejudiciais da hiperglicemia não controlada, e por isso, merece ser mais explorado.

Bem-estar subjectivo e ajustamento académico em alunos do Ensino Superior

Dissertação de mest., Psicologia Clínica e da Saúde, Faculdade de Ciências Humanas e Sociais, Univ. do Algarve, 2011

Lingüística de corpus e estudos da tradução

O objectivo principal deste ensaio é discutir o interesse crescente que os Estudos da Tradução tem expressado acerca da Lingüística de Corpus e seu importante papel para a investigação do fenómeno tradutório. O ensaio apresenta os primeiros trabalhos na interface entre corpora e tradução e como a disciplina dos Estudos da Tradução de base em corpus evoluiu na última década. Uma atenção mais pontual é dada à noção de estudos em corpus de pequena dimensão e sua influência no campo das pesquisas em tradução no Brasil. Além disso, o ensaio explora como o conceito de representatividade tem recebido definições diferentes nos estudos dos fenómenos tradutórios de base em corpus.

Evaluation of the role of glutathione in the lead-induced toxicity in saccharomyces cerevisiae

The effect of intracellular reduced glutathione (GSH) in the lead stress response of Saccharomyces cerevisiae was investigated. Yeast cells exposed to Pb, for 3 h, lost the cell proliferation capacity (viability) and decreased intracellular GSH level. The Pb-induced loss of cell viability was compared among yeast cells deficient in GSH1 (∆gsh1) or GSH2 (∆gsh2) genes and wild-type (WT) cells. When exposed to Pb, ∆gsh1 and ∆gsh2 cells did not display an increased loss of viability, compared with WT cells. However, the depletion of cellular thiols, including GSH, by treatment of WT cells with iodoacetamide (an alkylating agent, which binds covalently to thiol group), increased the loss of viability in Pb-treated cells. In contrast, GSH enrichment, due to the incubation of WT cells with amino acids mixture constituting GSH (l-glutamic acid, l-cysteine and glycine), reduced the Pb-induced loss of proliferation capacity. The obtained results suggest that intracellular GSH is involved in the defence against the Pb-induced toxicity; however, at physiological concentration, GSH seems not to be sufficient to prevent the Pb-induced loss of cell viability.

Análise do mercado de serviços de regulação de frequência secundária e terciária no sistema eléctrico português

Dissertação para obtenção do grau de Mestre em Engenharia Electrotécnica Ramo Energia

Modelling an e-learning environment for learning programming languages

It is widely accepted that solving programming exercises is fundamental to learn how to program. Nevertheless, solving exercises is only effective if students receive an assessment on their work. An exercise solved wrong will consolidate a false belief, and without feedback many students will not be able to overcome their difficulties. However, creating, managing and accessing a large number of exercises, covering all the points in the curricula of a programming course, in classes with large number of students, can be a daunting task without the appropriated tools working in unison. This involves a diversity of tools, from the environments where programs are coded, to automatic program evaluators providing feedback on the attempts of students, passing through the authoring, management and sequencing of programming exercises as learning objects. We believe that the integration of these tools will have a great impact in acquiring programming skills. Our research objective is to manage and coordinate a network of eLearning systems where students can solve computer programming exercises. Networks of this kind include systems such as learning management systems (LMS), evaluation engines (EE), learning objects repositories (LOR) and exercise resolution environments (ERE). Our strategy to achieve the interoperability among these tools is based on a shared definition of programming exercise as a Learning Object (LO).

Two new power indices based on winning coalitions

Deegan and Packel (1979) and Holler (1982) proposed two power indices for simple games: the Deegan–Packel index and the Public Good Index. In the definition of these indices, only minimal winning coalitions are taken into account. Using similar arguments, we define two new power indices. These new indices are defined taking into account only those winning coalitions that do not contain null players. The results obtained with the different power indices are compared by means of two real-world examples taken from the political field.