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Crohn's disease (CD) is a chronic inflammatory bowel disease that can affect any part of the gastrointestinal tract. The etiology of CD is unknown; however, genetic, epigenetic, environmental, and lifestyle factors could play an essential role in the onset and establishment of the disease. CD results from immune dysregulation due to loss of the healthy symbiotic relationship between host and intestinal flora and or its antigens. It affects both sexes equally with a male to female ratio of 1.0, and its onset can occur at any age, but the diagnosis is most commonly observed in the range of 20 to 40 years of age. CD diminishes quality of life, interferes with social activities, traumatizes due to the stigma of incontinence, fistulae, strictures, and colostomies, and in severe cases, affects survival when compared to the general population. Symptoms fluctuate between periods of remission and activity in which complications such as fistulas, strictures, and the need for bowel resection, surgery, and colostomy implantation make up the most severe aspects of the disease. CD can be progressive and the complications recurrent despite treatment with anti-inflammatory drugs, corticosteroids, immunosuppressants, and biological agents. However, over time many patients become refractory without treatment alternatives, and in this scenario, hematopoietic stem cell transplantation (HSCT) has emerged as a potential treatment option. The rationale for the use of HSCT for CD is anchored in animal studies and human clinical trials where HSCT could reset a patient's immune system by eliminating disease-causing effector cells and upon immune recovery increase regulatory and suppressive immune cells. Autologous HSCT using a non-myeloablative regimen of cyclophosphamide and anti-thymocyte globulin without CD34+ selection has been to date the most common transplant conditioning regimen adopted. In this review we will address the current situation regarding CD treatment with HSCT and emphasize the medical, ethical, and legal aspects that permeate the procedure in Brazil.

Introducción: La hemorragia intracerebral remota es una complicación neuroquirúrgica poco frecuente, ocurre en el 18% de los procedimientos intracraneales y aún menos en la cirugía de columna. Presentación de caso clínico: Un hombre de 89 años con un hematoma subdural derecho, que se sometió a un drenaje por craneotomía, en la tomografía de control presentó un hematoma intraparenquimatoso occipito temporal izquierdo y hemorragia intraventricular. Conclusión: Algunas teorías que han tratado de explicar las causas de la hemorragia intracerebral remota, el síndrome de hiperperfusión, la hipertensión, la angiopatía amiloide, el infarto venoso o el uso de anticoagulantes orales.

Background Decompressive craniectomy (DC) after traumatic brain injury (TBI) is a common surgical procedure. Cranioplasty (CP) is undertaken as a routine secondary operation following DC. In neurosurgical trauma centers, patients who require CPs compete with other patients who require emergency neurosurgical intervention and they are not given enough priority. Methods A retrospective study was conducted of patients who had undergone autologous bone CP after DC for TBI over three years in a 3rd level trauma center in Mexico. All families were administered a questionnaire to assess how the patient judged the cosmetic result of CP. Results A total of 29 patients agreed to participate in this study. 25 patients (86.2%) were satisfied with the aesthetic result and 4 patients (13.8%) were no satisfied with their CP. 4 cases (13.8%) reported medical complications related to CP. Unsatisfied patients complained most likely about the dented aesthetic look, with a moderate negative correlation between this and cosmetic outcome (ρ = −0.483, P = 0.001). Patient age (ρ = 0.194, P = 0.314) and defect size (ρ = 0.156, P = 0.419) was not related to the assessment of the aesthetic result. A strong negative correlation between postoperative infection and the grade of satisfaction (ρ = −0.710, P = 0.001) was also observed. Conclusions Based on our results, overall most of the patients were satisfied with their CP with an acceptable complication rate.

ANTECEDENTES Los abordajes quirurgicos de la region selar han sido un reto para los neurocirujanos. Con la introduccion de la tecnica endoscopica se ha minimizado el trauma quirurgico, pero esta tecnica no se encuentra exenta de complicaciones. OBJETIVO Describir nuestra experiencia institucional en pacientes sometidos a reseccion de macroadenomas hipofisarios por via microquirurgica endonasal transesfenoidal asistida por endoscopia con enfasis en las complicaciones resultantes. METODO Revisamos los expedientes electronicos de 17 pacientes sometidos a dicho procedimiento de manera consecutiva entre 2017 y 2018, y recabamos variables como edad, sexo, clasificacion imagenologica, tiempo de diagnostico al momento de la cirugia, complicaciones posoperatorias y recurrencia. RESULTADOS La edad promedio de los pacientes fue de 45.23 anos y el 70.59% eran mujeres. Radiologicamente predomino el grado 2 Knosp (47.05%). La complicacion principal fue diabetes insipida transitoria (23.52%), seguida por la fistula de liquido cefalorraquideo (11.76%). CONCLUSIONES El manejo microquirurgico asistido por endoscopia ha demostrado ser un recurso valioso para tratar macroadenomas hipofisarios, pero presenta grados variables de complicaciones, por lo cual se requiere la adquisicion de habilidades para el uso del endoscopio, la planeacion preoperatoria adecuada y el manejo conjunto multidisciplinario con el fin de evitarlas. BACKGROUND Surgical approaches to the sellar region have been a challenge for the neurosurgeon. With the introduction of the endoscopic technique, surgical trauma has been minimized, however it is not free of complications. OBJECTIVE To describe our institutional experience in patients undergoing resection of pituitary macroadenomas by endoscopic-assisted microsurgical approach, with emphasis on the resulting complications. METHOD We reviewed the electronic files of 17 patients who underwent this procedure consecutively between 2017 and 2018, collecting variables such as age, sex, imaging classification, time of diagnosis at the time of surgery, postoperative complications and recurrence. RESULTS The average age of the patients was 45.23 years, with 70.59% women. Radiologically, grade 2 Knosp predominated (47.05%). The main complication was transient diabetes insipidus (23.52%) followed by cerebrospinal fluid fistula (11.76%). CONCLUSIONS The endoscopic-assisted microsurgical approach has proven to be a valuable resource for treating pituitary macroadenomas, however it presents variable degrees of complications, which requires the acquisition of skills for the use of the endoscope, adequate preoperative planning, and multidisciplinary joint management in order to avoid them.

El presente artículo plantea la asignación óptima de recursos de los canales de radio disponibles en las redes celulares para la transmisión de datos desde los medidores inteligentes de energía eléctrica hacia los sistemas de gestión de información. El modelo planteado identifica y contabiliza a los abonados del sector eléctrico en un área geográfica; mediante el algoritmo de clusterización kmeans se ubican las radios bases celulares, las mismas que brindan comunicaciones a los dispositivos dentro de su radio de cobertura. Los canales de comunicación disponibles para la transmisión de datos son optimizados usando el algoritmo de Greedy, el mismo regula el tiempo en que los medidores inteligentes deben enviar su data a través de los canales de comunicación en desuso.

Autoimmune diseases are an important field for the development of bone marrow transplantation, or hematopoietic stem cell transplantation. In Europe alone, almost 3000 procedures have been registered so far. The Brazilian Society for Bone Marrow Transplantation (Sociedade Brasileira de Transplantes de Medula Óssea) organized consensus meetings for the Autoimmune Diseases Group, to review the available literature on hematopoietic stem cell transplantation for autoimmune diseases, aiming to gather data that support the procedure for these patients. Three autoimmune diseases for which there are evidence-based indications for hematopoietic stem cell transplantation are multiple sclerosis, systemic sclerosis and Crohn's disease. The professional stem cell transplant societies in America, Europe and Brazil (Sociedade Brasileira de Transplantes de Medula Óssea) currently consider hematopoietic stem cell transplantation as a therapeutic modality for these three autoimmune diseases. This article reviews the evidence available.

Background: In December 2019, in Wuhan, a new virus emerged, causing severe acute respiratory syndrome (SARS) secondary to infection by a type of coronavirus, causing coronavirus disease (COVID-19) The pandemic caused by the new coronavirus has had implications in the central nervous system COVID-19 is known to be characterized by coagulation activation and endothelial dysfunction, causing ischemic and hemorrhagic vascular syndromes Case Description: A 27-year-old male patient case with progressive decrease in visual acuity, associated with respiratory symptoms and intense headache Multilobar infiltrate with a reticulonodular pattern is evident on chest CT scan Brain CT scan with pituitary macroadenoma apoplexy was shown SARS-Cov2 was confirmed, and respiratory support initiated However, the patient died shortly afterward, secondary to pulmonary complications Conclusion: The angiotensin-converting enzyme (ACE) II receptor is expressed in circumventricular organs and in cerebrovascular endothelial cells, which play a role in vascular autoregulation and cerebral blood flow For this reason, is rational the hypothesize that brain ACE II could be involved in COVID-19 infection Underlying mechanisms require further elucidation in the future [ABSTRACT FROM AUTHOR] Copyright of Surgical Neurology International is the property of Scientific Scholar LLC and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission However, users may print, download, or email articles for individual use This abstract may be abridged No warranty is given about the accuracy of the copy Users should refer to the original published version of the material for the full abstract (Copyright applies to all Abstracts )

Crohn's disease (CD) is an inflammatory bowel disease that can affect any site of the digestive system. It occurs due to an immunological imbalance and is responsible for intestinal mucosal lesions and complications such as fistulas and stenoses. Treatment aims to stabilize the disease, reducing the symptoms and healing intestinal lesions. Surgical procedures are common in patients. Cell therapy was initially used to treat this disease in patients who also suffered from lymphoma and leukemia and were considered to be good candidates for autologous and allogeneic transplantation. After transplantation, an improvement was also observed in their CD. In 2003, the procedure began to be used to treat the disease itself, and several case series and randomized studies have been published since then; this approach currently comprises a new option in the treatment of CD. However, considerable doubt along with significant gaps in our knowledge continue to exist in relation to cell therapy for CD. Cell therapy is currently restricted to the autologous modality of hematopoietic stem cell transplantation and, experimentally, to mesenchymal stromal cells to directly treat lesions of the anal mucosa. This article presents the supporting claims for transplantation as well as aspects related to the mobilization regime, conditioning and perspectives of cell therapy.

Background Hematopoietic stem cell transplantation (HSCT) can be used in the treatment of patients with refractory Crohn's disease (CD) when no alternative treatment is available. However, HSCT increases the risk of infections, in particular during the aplasia of mobilization and conditioning. Moreover, intestinal stomas in CD augment the risk of morbidity in immunocompromised patients and under aplastic conditions. The objective of this report was to describe the results of the first year after HSCT in a CD patient with an intestinal stoma. Methods The patient was assessed in respect to disease symptoms and endoscopic findings before the procedure and 30, 90, 180, and 365 days after HSCT. Results No complications were observed during mobilization and conditioning with sufficient CD34+ cells being harvested in just one apheresis session. Toxicity was restricted to the hematological series. Scores of all the CD indexes and the quality of life of the patient improved. However, two of three endoscopic scores remained unchanged even though improvements were found in the appearance of the lesions. Conclusion HSCT may be an alternative treatment for refractory CD in patients with an intestinal stoma, and a priori, carefully selected patients with stomas should not be excluded as candidates for this procedure.

Objective The incidence of adverse events in myeloablative transplant protocols is high in refractory Crohn’s disease; this study used low doses of cyclophosphamide. Fourteen patients were submitted to non-myeloablative autologous hematopoietic stem cell transplantation. Results The average number of days of anemia (hemoglobin 9/L) in the mobilization phase was 1.7 ± 1.5 while it was 7.6 ± 1.4 in the conditioning phase. When comparing the conditioning and mobilization phases, there was an increased number days of leukopenia (white blood cells 9/L), lymphocytopenia (lymphocytes 9/L) and thrombocytopenia (platelets 9/L). Crohn’s Disease Activity Index values before the transplant ranged from 155 to 450.5 (mean 281.2 ± 79.0) and at 30 days after the procedures they ranged from 45.4 to 177 (mean 95.8 ± 35.4). Moreover, the procedure improved in overall quality of life of patients. Non-myeloablative autologous hematopoietic stem cell transplantation with lower doses of cyclophosphamide leads to lower rates of hematological toxicity and adverse events compared to protocols described in the literature. Trial registration NCT 03000296: Date 9 December 2016

Background: Retroclival hematomas are rare and occur mostly in the pediatric population. They are variously attributed to trauma, apoplexy, and vascular lesions. With motor vehicle accidents (MVAs), the mechanism of traumatic injury is forced flexion and extension. There may also be associated cervical spinal and/or clivus fractures warranting fusion. Case Description: A 35-year-old male sustained a traumatic brain injury after a fall of 5 m at work. His Glasgow coma scale (GCS) on admission was 13 (M6V3O4). He had no cranial nerve deficits. The brain computed tomography (CT) showed a retroclival subdural hematoma that extended to the C2 level. Conclusions: Most retroclival hematomas are attributed to MVAs, and cranial CT and magnetic resonance studies typically demonstrate a combination of posterior fossa hemorrhage with retroclival hematomas (intra or extradural). Patients with retroclival hematomas but high GCS scores on admission usually have better prognoses following traumatic brain injuries attributed to MVA. Notable however is the frequent association with additional cervical and/or craniocervical injuries (e.g. such as odontoid fracture) that may warrant surgery/fusión.

PURPOSE To report a case of a patient with ischemic retinopathy associated with Crohn's disease. CASE REPORT This report presents a case of a 28-year-old female patient with Crohn's disease and sudden decrease of visual acuity in the right eye. Fluorescein angiography, optical coherence tomography, and multifocal electroretinography confirmed the clinical features of ischemic retinopathy. After systemic corticosteroid treatment, the patient developed epiretinal membrane without significant improvement in visual acuity. DISCUSSION The patient presented with ischemic retinopathy associated with Crohn's disease with deficiency of central visual acuity. Periodic examination by a retina specialist is recommended for patients being treated for Crohn's disease.

BackgroundTreatment with high doses chemotherapy followed by autologous haematopoietic stem cell transplantation is promising for refractory Crohn’s disease patients with no therapeutic option and at imminent risk of further surgeries.ObjectivesTo evaluate the feasibility and efficacy of haematopoietic progenitor cell mobilization in a group of Crohn’s disease patients preparing for autologous unselected haematopoietic stem cell transplantation in a single institution. This is the first study to evaluate mobilization for Crohn’s disease.MethodsPatients were selected according to criteria of the European Bone Marrow Transplant Society.ResultsAll patients mobilized with the mean number of haematopoietic progenitor cells obtained and infused being 16.17 × 106/CD34+/kg. Most patients required only one leukapheresis session to reach the ideal number of cells. Grafting occurred around ten days after cells infusion. Complications and adverse events during the mobilization period were rare with only one patient presenting sepsis as a relevant event in the period.Most patients 20 (70%) had anaemia from the beginning of the mobilization but only 11 (37.9%) received packed red blood cell transfusions.ConclusionMobilization in patients with Crohn’s disease is effective and it seems they are good mobilizers.

This article presents an optimal deployment of wireless sensor network taking into account the use of spectrum electromagnetic, data link layer, physical layer and the energy consumption used to transmit information in smart homes. For the analysis a surface has been defined in which smart devices have been deployed randomly in order to ensure that all the devices perform an optimal routing, reaching the gateway through the creation of a wireless sensor network. Different technologies of wireless communication were analyzed in order to calculate the size of the information and fill fields of the data link layer to determine the real size that transport the physical layer. This information is using to optimize the time of use of channel, distances, energy consumption and requirements of bandwidth by each technology.

Background Endoscopy has gained a crucial role in high specialty neurosurgery during the last decades. At present, there are well-defined flexible neuroendoscopic procedures to treat ventricular and subarachnoid space pathologies. Neurocysticercosis is recognized as a common cause of neurologic disease in developing countries and the United States. Surgical intervention, especially cerebrospinal fluid diversion, is the key for management of hydrocephalus. In 2002, a consensus suggested that ventricular forms should be treated with endoscopy as the first option. Case description Here, we present the case of a 51-year-old right-handed male, from Estado de Mexico. Two days before admission he experienced holocraneal headache 7/10 on the visual analogue scale which was intermittent, with no response to any medication, sudden worsening of pain to 10/10, nausea, and vomit. On physical examination, he presented with 14 points in the Glasgow coma scale (M6, O4, V4), pupils were 3 mm, there was adequate light-reflex response, and bilateral papilledema. The cranial nerves did not have other pathological responses, extremities had adequate strength of 5/5, and normal reflexes (++/++) were noted. Neuroimaging studies showed dilatation of the four ventricles as well as a cystic lesion in the fourth ventricle. Surgical position was Concorde, and the approach through a suboccipital burr hole was planned preoperatively with craneometric points. A rigid Karl Storz Hopkins II® endoscope was inserted directly through the cerebellum and the cystic lesion was extracted entirely. Conclusion This article presents a useful technique with low morbidity and mortality. Further investigation is needed, especially in our Mexico, where neuroendoscopical techniques are still in the development phase.

Made available in DSpace on 2015-12-07T15:31:04Z (GMT). No. of bitstreams: 0 Previous issue date: 2014. Added 1 bitstream(s) on 2021-07-15T15:00:50Z : No. of bitstreams: 1 S1516-84842014000400264.pdf: 193801 bytes, checksum: 9795657b458ed2fcb50b4e59be9f5a53 (MD5) Autologous hematopoietic stem cell transplantation is a conduct used to treat some hematologic diseases and to consolidate the treatment of others. In the field of nursing, the few published scientific studies on nursing care and early hospital discharge of transplant patients are deficient. Knowledge about the diseases treated using hematopoietic stem cell transplantation, providing guidance to patients and caregivers and patient monitoring are important nursing activities in this process. Guidance may contribute to long-term goals through patients' short-term needs. To analyze the results of early hospital discharge on the treatment of patients submitted to autologous transplantation and the influence of nursing care on this conduct. A retrospective, quantitative, descriptive and transversal study was conducted. The hospital records of 112 consecutive patients submitted to autologous transplantation in the period from January to December 2009 were revisited. Of these, 12 patients, who remained in hospital for more than ten days after transplantation, were excluded from the study. The medical records of 100 patients with a median age of 48.5 years (19-69 years) were analyzed. All patients were mobilized and hematopoietic stem cells were collected by leukapheresis. The most common conditioning regimes were BU12Mel100 and BEAM 400. Toxicity during conditioning was easily managed in the outpatient clinic. Gastrointestinal toxicity, mostly Grades I and II, was seen in 69% of the patients, 62% of patients had diarrhea, 61% of the patients had nausea and vomiting and 58% had Grade I and II mucositis. Ten patients required hospitalization due to the conditioning regimen. Febrile neutropenia was seen in 58% of patients. Two patients died before Day +60 due to infections, one with aplasia. The median times to granulocyte and platelet engraftment were 12 days and 15 days, respectively, with median red blood cell and platelet transfusions until discharge of three and four units, respectively. Twenty-three patients required rehospitalization before being discharged from the outpatient clinic. The median time to granulocyte engraftment was 12 days and during the aplasia phase few patients were hospitalized or suffered infections. The toxicity of the conditioning was the leading cause of rehospitalization. The nursing staff participated by providing guidance to patients and during the mobilization, transplant and outpatient follow-up phases, thus helping to successfully manage toxicity. Universidade de São Paulo (USP), São Paulo, SP, Brazil. Universidade de São Paulo (USP), São Paulo, SP, Brazil; Universidade Nove de Julho (Uninove), São Paulo, SP, Brazil. Hospital Inglês, São Paulo, SP, Brazil. Associação Portuguesa de Beneficência, São José do Rio Preto, SP, Brazil. Universidade do Estado de São Paulo (UNESP), São José do Rio Preto, SP, Brazil. Universidade de São Paulo (USP), São Paulo, SP, Brazil; Hospital Inglês, São Paulo, SP, Brazil. Electronic address: fldulley@usp.br. Universidade do Estado de São Paulo (UNESP), São José do Rio Preto, SP, Brazil.

PURPOSE: To evaluate the variability of subjective corneal topography map classification between different experienced examiners and the impact of changing from an absolute to a normative scale on the classifications. METHODS: Preoperative axial curvature maps using Scheimpflug imaging obtained with the Pentacam HR (Oculus Optikgeräte, Wetzlar, Germany) and clinical parameters were sent to 11 corneal topography specialists for subjective classification according to the Ectasia Risk Scoring System. The study population included two groups: 11 eyes that developed ectasia after LASIK and 14 eyes that had successful and stable LASIK outcomes. Each case was first reviewed using the absolute scale masked to the patient group. After 3 months, the same cases were represented using a normative scale and reviewed again by the same examiners for new classifications masked to the patient group. RESULTS: Using the absolute scale, 17 of 25 (68%) cases had variations on the classifications from 0 to 4 for the same eye across examiners, and the overall agreement with the mode was 60%. Using the normative scale, the classifications from 11 of 25 (44%) cases varied from 0 to 4 for the same eye across examiners, and the overall agreement with the mode was 61%. Eight examiners (73%) reported statistically higher scores ( P < .05) when using the normative scale. Considering all 550 topographic analyses (25 cases, 11 examiners, and two scales), the same classification from the two scales was reported for 121 case pairs (44%). CONCLUSION: There was significant inter-observer variability in the subjective classifications using the same scale, and significant intra-observer variability between scales. Changing from an absolute to a normative scale increased the scores on the classifications by the same examiner, but significant inter-observer variability in the subjective interpretation of the maps still persisted. [ J Refract Surg. 2013;29(11):770–775.]

Made available in DSpace on 2018-12-11T17:36:35Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-02-01. Added 1 bitstream(s) on 2021-07-15T15:22:28Z : No. of bitstreams: 1 S2359-39972018000100021.pdf: 166618 bytes, checksum: c6efd9bc253878c7d54e958992f693f1 (MD5) Objectives: This study aimed to evaluate the frequencies of the angiotensin converting enzyme (ACE) gene insertion/deletion (I/D) and methylenetetrahydrofolate reductase (MTHFR) gene C677T polymorphisms in obese patients with and without type 2 diabetes mellitus (T2DM). Subjects and methods: These polymorphisms were analyzed by polymerase chain reaction in 125 patients with obesity, 47 (T2DM) and 78 (Control Group). Results: No significant difference was found on comparing the T2DM and Control Groups in respect to the genotypic frequencies of the polymorphisms - (II: 13.3% vs. 12.0%; ID: 37.8% vs. 37.3; DD: 48.9% vs. 50.7%; CC: 36.2% vs. 39.0%; CT: 46.8% vs. 49.3%; TT: 17.0% vs. 11.7%), and alleles (I: 32.2% vs. 30.7%; D: 67.8% vs. 69.3%; C: 59.6% vs. 63.6%; T: 40.4% vs. 36.4%) and their synergisms in the pathophysiology of T2DM. On analyzing the T2DM Group, there were no significant differences in the presence of complications. In this population of Brazilian obese patients, no correlation was found between the ACE and MTHFR polymorphisms in the development of T2DM. Conclusion: Analyzing only the group with diabetes, there was also no relationship between these polymorphisms and comorbidities. Departamento de Biologia Universidade Estadual Paulista “Júlio de Mesquita Filho” (Unesp) Associação Portuguesa de Beneficência Faculdade de Medicina União das Faculdades dos Grandes Lagos (Unilago) Departamento de Biologia Universidade Estadual Paulista “Júlio de Mesquita Filho” (Unesp)

EnglishThe Autologous Stem Cell Transplantation International Crohn Disease (ASTIC) trial by Dr Hawkey and colleagues1 was interpreted as a failure of autologous hematopoietic stem cell transplantation (HSCT) compared with standard care. However, the ASTIC trial used a complex multifaceted primary end point that included all of the following: Crohn disease activity index less than 150; no active treatment; and endoscopic and radiologic remission. This end point has not been used in any prior study. The data from such a small cohort of patients would have been interpreted as encouraging if the authors had used some of their secondary outcomes as the primary end point, for example, Crohn disease activity index change from baseline (P = .04) or simple endoscopic score of Crohn disease change from baseline (P = .03). EnglishThe ASTIC trial was designed to investigate the possibility, suggested by a number of case reports, that long-term, drug-free cure of Crohn disease could be achieved through autologous HSCT.1 The lack of statistical significance of the primary end point showed that this experience is rare. However, we agree with Dr Burt and colleagues that the extent of improvement in secondary end points suggests possible therapeutic efficacy, albeit falling short of cure.

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T18:40:42Z No. of bitstreams: 1 S1516-84842012000600010.pdf: 614468 bytes, checksum: d64149a3b77faf179f01947b8ae973b3 (MD5) Made available in DSpace on 2013-08-22T18:40:42Z (GMT). No. of bitstreams: 1 S1516-84842012000600010.pdf: 614468 bytes, checksum: d64149a3b77faf179f01947b8ae973b3 (MD5) Previous issue date: 2012-01-01 Made available in DSpace on 2013-09-30T19:26:40Z (GMT). No. of bitstreams: 2 S1516-84842012000600010.pdf: 614468 bytes, checksum: d64149a3b77faf179f01947b8ae973b3 (MD5) S1516-84842012000600010.pdf.txt: 23597 bytes, checksum: 385ab2b19f8173d4c4c2ebe0bf5d0940 (MD5) Previous issue date: 2012-01-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T14:00:43Z No. of bitstreams: 2 S1516-84842012000600010.pdf: 614468 bytes, checksum: d64149a3b77faf179f01947b8ae973b3 (MD5) S1516-84842012000600010.pdf.txt: 23597 bytes, checksum: 385ab2b19f8173d4c4c2ebe0bf5d0940 (MD5) Made available in DSpace on 2014-05-20T14:00:43Z (GMT). No. of bitstreams: 2 S1516-84842012000600010.pdf: 614468 bytes, checksum: d64149a3b77faf179f01947b8ae973b3 (MD5) S1516-84842012000600010.pdf.txt: 23597 bytes, checksum: 385ab2b19f8173d4c4c2ebe0bf5d0940 (MD5) Previous issue date: 2012-01-01 Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) OBJECTIVE: The oxidative stress in 20 sickle cell anemia patients taking hydroxyurea and 13 sickle cell anemia patients who did not take hydroxyurea was compared with a control group of 96 individuals without any hemoglobinopathy. METHODS: Oxidative stress was assessed by thiobarbituric acid reactive species production, the Trolox-equivalent antioxidant capacity and plasma glutathione levels. RESULTS: Thiobarbituric acid reactive species values were higher in patients without specific medication, followed by patients taking hydroxyurea and the Control Group (p < 0.0001). The antioxidant capacity was higher in patients taking hydroxyurea and lower in the Control Group (p = 0.0002 for Trolox-equivalent antioxidant capacity and p < 0.0292 for plasma glutathione). Thiobarbituric acid reactive species levels were correlated with higher hemoglobin S levels (r = 0.55; p = 0.0040) and lower hemoglobin F concentrations(r = -0.52; p = 0.0067). on the other hand, plasma glutathione levels were negatively correlated with hemoglobin S levels (r = -0.49; p = 0.0111) and positively associated with hemoglobin F values (r = 0.56; p = 0.0031). CONCLUSION: Sickle cell anemia patients have high oxidative stress and, conversely, increased antioxidant activity. The increase in hemoglobin F levels provided by hydroxyurea and its antioxidant action may explain the reduction in lipid peroxidation and increased antioxidant defenses in these individuals. Universidade Estadual Paulista Instituto de Hematologia Arthur de Siqueira Cavalcanti Santa Casa de São Paulo Faculdade de Ciências Médicas Universidade de São Paulo Universidade Estadual Paulista

Currently, there are many unproven or insufficiently proven cell-based treatments commercially available for hopeful individuals seeking cures for a variety of conditions. Typically, these so-called “therapies” are currently being advertised, sold and administered to patients, although they fail to achieve recognized biological/medical standards of proof for safety or efficacy. In addition, they are often expensive and offered outside the cover of routine clinical care for treatments, outside the realm of conventional clinical trials supervised and monitored by regulatory agencies. This paper summarizes a position document to be published by the International Society for Cellular Therapy (ISCT) as an open manuscript intended for professionals and patient associations. Avoiding a systematic overview of the relevant peer-reviewed literature and investigations, its purpose is to examine multiple aspects of unproven cell therapy interventions including definitions, manufacturing issues, regulations, economic factors and communication. With this document, the ISCT intends to promote a cooperative approach to facilitate the development of safe and effective therapies while minimizing and balancing risks for patients to ultimately establish a coalition of stakeholders that fulfill the vision of a broad, pro-patient cell therapy alliance...

Over the years, as editors of Revista Brasileira de Hematologia e Hemoterapia (RBHH), we have faced different issues. The irst of these, an observation that sometimes became a question, is about the purpose of the journal. To answer this question it is necessary to return to the journal’s origins in the 1980s. In those dificult times of discretion, Brazil was different and the Sociedade Brasileira de Hematologia e Hematologia (SBHH) was going through a period of restructuring and controversy about the role of hemotherapy in the country. In a irm and decisive action, remunerated blood donation was banned in Brazil. The SBHH had published a monthly newsletter since 1973 which aimed to promote the activities of the Executive Board of the society and informing everyone about what was going on in hematology and transfusion medicine across the country. At a time when there was little information, when for most it was dificult to access scientiic journals, it was said that for some corners of the country, this was the only accessible communication about hematology and transfusion medicine. An international congress of hematology was hosted by the city of Buenos Aires, Argentina, in 1984 when the Board of the SBHH, in a daring act involving four or ive people, modiied the format of the newsletter and launched instead a prototype of the scientiic journal that circulated during the event. At that point the primary objective and heresy of the creators was to move forward and to mark a scientiic position, a criticism that the SBHH received, in addition to attracting young people

Besides the known effects on sleep disorders, studies show that melatonin, a hormone produced mainly by the pineal gland, plays a key role in energy expenditure, food intake, glucose metabolism in adipocytes and regulating the secretion of various cytokines involved in weight control and appetite, such as leptin. In vitro and in vivo, both in animals and in humans, they demonstrate the potential benefits of melatonin supplementation on various diseases, including the metabolic disorders. This work aims to review the physiology of this hormone, its association with diseases such as obesity and diabetes, the benefits of supplementation of this hormone and the importance of research in the area for scientific evidence about the substance of this type. On the other hand, some countries, like Brazil, has regulated the marketing of this product which reduces the clinical research and the benefits that melatonin could bring to several patients.

Introduction Retinitis pigmentosa (RP) is a severe neurodegenerative disease of the retina that can lead to blindness. Even without treatment, a clinical study with the use of stem cells is currently underway and the results are being evaluated. In the present report we assess the vision-related quality of life in patients with RP submitted to intravitreal use of bone marrow-derived stem cells. Method The study included 20 patients with RP submitted to intravitreal use of bone marrow-derived stem cells. We evaluate the vision-related quality of life (VRQOL) of patients using the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25). Patients were scheduled to answer the questionnaire before treatment and 3 and 12 months after treatment. Results All patients completed the survey as scheduled. There was a statistically significant improvement (P

Relatamos o caso de um paciente masculino de 49 anos, portador de oclusão embólica de todas as artérias da perna esquerda. Após múltiplas e fracassadas tentativas de revascularização e, também, simpatectomia lombar em outros serviços, chegou a nós com indicação de amputação no nível de perna. Propusemos o implante de células-tronco autógenas de medula óssea na panturrilha. Obteve-se um excelente resultado, com a supressão da dor em repouso, melhora da hipotermia e palidez, elevação do índice tornozelo/braço, da velocidade sistólica de pico, dos índices cintilográficos e angiográficos e sensível melhora na granulação no local da amputação do quarto e quinto pododáctilo.

Nos últimos anos, vários agentes citoprotetores têm sido desenvolvidos para proteger células normais dos efeitos tóxicos da quimioterapia e radioterapia. O agente citoprotetor ideal seria aquele capaz de permitir a intensificação da dose dos quimioterápicos; proteger um amplo espectro de órgãos e tecidos quando do tratamento com diversos fármacos quimioterápicos; conferir proteção específica aos tecidos normais; preservar o efeito anti-tumoral e ter pequena e/ou controlável toxicidade e efeitos colaterais. Um citoprotetor deve ser administrado antes da quimioterapia citotóxica, ao contrário dos fatores estimuladores de colônia e do Leucovorin, que são administrados após quimioterapia como resgate à medula óssea e estimular a sua recuperação. Do ponto de vista prático existem três agentes citoprotetores: dois citoprotetores quimio-específicos (Dexrazoxane e Mesna) e um citoprotetor de amplo espectro (Amifostina). Os autores discutem as principais propriedades e utilidades destas drogas utilizadas em Onco Hematologia. In recent years, cytoprotective agents have been developed to protect normal cells from the toxic effects of chemotherapy and radiotherapy. The ideal cytoprotectant is that which is able to allow intensification of chemotherapy; protects a broad spectrum of normal tissues and organs when used with a variety of chemotherapeutic agents; confers specific protection for normal tissues; preserves anti tumour activity and has little or manageable toxicity of its own. A cytoprotectant is administered prior to cytotoxic therapy, in contrast to the colony stimulant factors and Leucovorin, which are administered after chemotherapy to rescue the bone marrow and stimulate haematological recovery. Currently there are three cytoprotectors: two chemotherapy-specific (Dexrazoxane and Mesna) and one broad-spectrum (Amifostine). The authors discuss the main properties and usefulness of these drugs in Oncohematology.

Health surveillance for hazardous situations due to chemical exposure, in particular those which are carcinogenic, requires sensitive monitoring tests. Although experimental studies have shown the genotoxic and carcinogenic effect of several organochlorides, the lack of epidemiologic studies prevents their classification as carcinogenic to human beings. In this context, genotoxicity tests of short duration in human cells gain importance. The relation between the clastogenic effects (chromosome breaks) and cancer induction is already known to the scientific literature. The micronucleus test has been proposed as a good indicator of clastogenesis. In the present study, we evaluated, by means of the micronucleus test, 41 workers of a chemical industry in the state of Sao Paulo, southeast region of Brazil, who had been exposed to a mixture of chlorinated solvents (carbon tetrachloride, perchloroethylene, and hexachlorobenzene) and 28 workers who had not been exposed. Peripheral lymphocytes stimulated by phytohemagglutinin and with cytokinesis blocked by cytochalasin B were used. The results showed that the exposed workers presented a statistically significant higher frequency of micronuclei than the group which had not been exposed.

Body iron disorders have been reported after myeloablative conditioning in patients undergoing hematopoietic stem cell transplantation (HSCT). There is a concern that labile plasma iron (LPI), the redox-active form of iron, can be involved in the occurrence of toxicity and other complications commonly observed in the early post-HSCT period. In order to better understand the LPI kinetics and its determinants and implications, we undertook sequential LPI determinations before and after conditioning until engraftment in 25 auto-HSCT patients. Increased LPI was present in only 5 patients before starting conditioning. Shortly after conditioning, LPI levels were increased in 23 patients, with peak at day 0, returning to normal range upon engraftment in 21 patients. Overall, LPI levels correlated weakly with serum ferritin and more strongly with transferrin saturation; however, both parameters were apparently not applicable as surrogate markers for increased LPI. Although this was a small cohort, logistic regression suggested that baseline LPI levels could predict occurrence of grade III or IV toxicity. In conclusion, LPI kinetics is influenced by aplasia following conditioning and engraftment. Measuring LPI before starting conditioning can offer an opportunity to predict toxicity and, perhaps, the need for chelation therapy.

Cell therapy, known in the media and among laypeople as stem cell treatment, has been under debate on several totally different fronts. The main confusion, which still persists even though it has been about for many years, is related to the use of embryonic stem cells in experimental and pre-clinical studies; today this occurs in most countries(1,2) but great difficulties exist in Brazil until now(3). This issue was debated extensively for four years in the Brazilian society and in 2008 the Supreme Court legalized studies using human embryonic stem cells. Subsequently, this measure allowed the first line of human embryonic stem cells to be obtained in Brazil(4). Notwithstanding the controversial source of the embryo, in its strict sense cell therapy is a medical procedure that is not new as it goes back centuries to the time when human and even animal blood first began to be used for therapeutic purposes. Landsteiner's discovery of the ABO blood group system in 1900, complemented by the Rh blood group system, paved the way for the incorporation of transfusion medicine in the medical practice(5). Cell replacement therapy using red blood cells and blood components enabled the treatment of many diseases and allowed a leap in surgical techniques including solid organ transplants. The fear of nuclear war and its foreseeable immediate and long-term consequences on human beings helped the progression of research which aimed to minimize the effects with the evolution of reparative cell therapy using bone marrow transplants, which are now called hematopoietic stem cell transplantation (HSCT). This procedure is today common practice. Hereditary and acquired hematologic diseases including onco-hematology, autoimmune and immunodeficiency diseases are on the list of indications for HSCT with this list still expanding(6). At the start of this millennium, the studies and results of cell therapy in degenerative and chronic diseases, the emergence of the concepts of cellular plasticity(7-9), transdifferentiation and fusion(10-12), and the description of the paracrine effect of cells(13), opened new perspectives for research in regenerative therapy using different sources of cells including the bone marrow, peripheral blood and umbilical cord blood. So began the era of regenerative cell therapy, a movement that has caught the imagination of the scientific, academic and lay communities with the idea of new approaches to treat incurable diseases and common diseases that lack good therapeutic options(14). Auspicious results have been described using several experimental models including in myocardial infarction after the use of cell therapy in a small sample of patients(15). The number of publications on the use of stem cells has been expanding geometrically and so publications in all areas of medicine are becoming commonplace. The same has occurred in respect to heart disease in Brazil and after the publication of promising results in Chagasic cardiomyopathy(16), a large double-blind, randomized clinical trial was designed involving 1200 patients with diverse heart diseases(17,18). Subsequently, after 2005 government resources are being allocated to research projects; the National Network of Cell Therapy was created resulting in the establishment of several cell therapy Centers (Figure 1)(19). Investment by the Brazilian Government in the area of cell therapy is shown in Table 1. Figure 1 Number of new cell therapy centers by state established after the creation of the National Network of Cell Therapy. Adapted from Mendez-Otero et al.(19) Table 1 Funding Research for Stem Cell Therapy in Brazil Despite these advances, several questions remain unanswered and the pressure of the community continues in light of the positive results that have been observed in different diseases(20-25). These results do not go unnoticed in the electronic communication age; they quickly become common knowledge. This issue was reviewed and discussed in presentations on the theme during the congress of the Sociedade Brasileira de Transplante de Medula Ossea recently held in Sao Paulo. Among the topics presented, the potential of using mesenchymal stem cells (MST) was debated with their possible use in patients with graft-versus-host disease (GVHD) being stressed. This common adverse reaction after allogeneic HSCT is frequently difficult to control and so the use of MST is indicated in these situations. In Brazil the use of MST is restricted to patients enrolled in clinical trials, which makes it difficult for centers around the country, that are both competent and technically prepared, to offer this type of therapy to a larger number of patients(26). The compassionate use of MST in these cases, when necessary, is based on the data available in the medical literature. This topic has been discussed by Medical and Research Ethics Committees with great repercussions; as in countless other situations involving clinical or surgical procedures, cell therapy cannot be postponed at the expense of the patients' health. In Brazil there is a legal inadequacy in respect to compassionate treatment. And do not forget that the patients cannot wait(23,26-28). Cell therapy has flourished in respect to heart diseases in experimental studies on acute myocardial infarction. Soon clinical trials and case reports related to other heart diseases proved the benefits of the procedure. However ten years after the first reports there are still uncertainties about cell therapy(29,30). Doubts related to cell therapy also extrapolate to the clinical parameters employed in previous studies. These include the use of the left ventricle ejection fraction as a clinical outcome as in many studies. Even without improvements in this parameter being observed, increases in survival and quality of life in many patients subjected to this procedure were demonstrated. The review presented at the congress makes us reflect on the interpretation of results obtained using cell therapy in heart disease. The benefits of the use of cell therapy in the treatment of autoimmune, central nervous system and ophthalmological diseases and for orthopedic complications among others were also demonstrated during the scientific event thereby proving the importance of cell therapy as a new modality of therapy. In conclusion, cell therapy has proven to be safe and effective in many situations, in particular in peripheral arterial diseases when there is a risk of amputation(23). This latter example makes us reflect on the current status of the treatment of diverse diseases in which cell therapy may play a leading or supporting role. This procedure remains crucial to relieve the suffering and benefit patients for whom there is no therapeutic option.

Made available in DSpace on 2015-04-27T11:55:53Z (GMT). No. of bitstreams: 0 Previous issue date: 2013Bitstream added on 2015-04-27T12:08:30Z : No. of bitstreams: 1 ISSN2157-7633-2013-S6-08-01-05.pdf: 1119303 bytes, checksum: 83bb37f4d554521491781bf36209bf60 (MD5) The idiopathic dilated cardiomyopathy (IDC) is one of the major public health problems in the western world. Patients with IDC in functional class IV (New York Health Association - NYHA), even after therapeutic optimization, have high mortality. Stem cell therapy has emerged as a potential therapeutic option for cell death-related heart diseases and several positive effects were assigned to cell therapy in cardiomyopathy. The aim of this study was identify short-term result of cell transplantation in idiopathic dilated cardiomyopathy patients (IDC) who were treated by transplantation of autologous bone marrow mononuclear cells (BMMC). Intracoronary injections of autologous BMMC were performed in eight patients with severe ventricle dysfunction (mean of left ventricle ejection fraction – LEVF=20.03%), cardiac mass muscle around 156.2 g and NYHA between III and IV grades, other 8 IDC patients received placebo. The IDCs were followed - up for one and two years, by magnetic resonance imaging (MRI). The results after one year showed significant improvement in LVEF (mean=181.4) and muscle mass increasing (mean=181.4 g), after two years the LVEF continued improving, reaching a mean of 32.69% and the cardiac muscle mass kept stable (mean=179.4 g). Excepted for one patient, all the other had improvement in the NYHA functional class. The placebo group did not show any improvement. We believe that BMMC implant may be a beneficial therapeutic option for IDC patients. Universidade Estadual Paulista Júlio de Mesquita Filho, Departamento de Ciência da Computação e Estatística, Instituto de Biociências Letras e Ciências Exatas de São José do Rio Preto, Sao Jose do Rio Preto, RUA Cristovão Colombo, 2265, Jardim Nazareth, CEP 15054-000, SP, Brasil Universidade Estadual Paulista Júlio de Mesquita Filho, Departamento de Ciência da Computação e Estatística, Instituto de Biociências Letras e Ciências Exatas de São José do Rio Preto

OBJECTIVES: The aim of this retrospective study was to investigate the results of T-cell large granular lymphocytic leukemia treatment with fludarabine by assessing the complete hematologic response, the complete molecular response, progression-free survival, and overall survival. METHODS: We evaluated the records of six patients with T-cell large granular lymphocytic leukemia who were treated with fludarabine as a first-, second-, or third-line therapy, at a dose of 40 mg/m², for three to five days per month and 6 to 8 cycles. RESULTS: Of the six patients investigated with T-cell large granular lymphocytic leukemia who were treated with fludarabine, five (83.3%) were female, and their median age was 36.5 years (range 18 to 73). The median lymphocyte level was 3.4x10(9)/L (0.5 to 8.9). All patients exhibited a monoclonal T-cell receptor gamma gene rearrangement at diagnosis. Two (33.3%) patients received fludarabine as first-line treatment, two (33.3%) for refractory disease, one (16.6%) for relapsed disease after the suspension of methotrexate treatment dueto liver toxicity, and one (16.6%) due to dyspesia. A complete hematologic response was achieved in all cases, and a complete molecular response was achieved in five out six cases (83.3%). During a mean follow-up period of 12 months, both the progression-free survival and overall survival rates were 100%. CONCLUSION: T-cell large granular lymphocytic leukemia demonstrated a high rate of complete hematologic and molecular response to fludarabine, with excellent compliance and tolerability rates. To confirm our results in this rare disease, we believe that fludarabine should be tested in clinical trials as a first-line treatment for T-cell large granular lymphocytic leukemia.

In today's world of profound changes and new paradigms, journals from emerging countries face both new and old challenges. In a recent publication, Meneghini(1) points out the differences in the commercial rationale between developed and emerging countries and discusses the dominance of international journals and the difficulties scientists from non-English speaking countries have to get published in these periodicals. He says that in order to publish their work in international journals, authors need to overcome barriers that include poorly written English and the generally lower and more variable quality of scientific production.

The third seminar, coordinated by SciELO and Fapesp, on the evaluation of the performance of Brazilian journals took place in September in Sao Paulo. With the editors of most of the Brazilian journals linked to SciELO and Fapesp attending, the contribution of these two institutions was demonstrated in the event, as was the promising results observed since the first meeting held three years ago. It was reported that there has been an increase in the number of journals published in English. In the SciELO database, for example, the proportion increased from 33% to 66% over three years and the progress of Brazil in the indexation of journals in the JCR/ISI/Thomson Reuters has been very expressive. The increase in Brazilian scientific production with indexation of journals in the World of Science (WOS) of Thomson Reuters since 2005 is shown in Figures 1 & 2(1). Figure 1 2005-2010: Countries that added over 40 titles to Web of Science Figure 2 2005-2010: Clinical medicine - countries with greatest increase in coverage For the first time in the area of health sciences, Brazilian journals have an Impact Factor (IF) higher than two and there is an increasing number of journals with IFs higher than one or that are close to this value. In the event, the Editor-in-Chief of the journal Frontiers in Ecology and the Environment, Sue Silver gave a speech on the theme "Scientific journals: raising profiles, prospects and Impact Factors". With her experience with the implantation of the journal The Lancet Oncology, Sue Silver listed the different measures that enabled her as editor of Frontiers in Ecology and the Environment to index the journal in the WOS in 2003 and to attain an IF of 3.32 by 2005; the current IF is 9.113. This IF is very high for medical journals. The magic formula to achieve this, as described by the Editor-in-Chief, is simply based on a professional organization of the journal, work and dedication at all levels of the editorial process and attaining a high-level of consultancy in the editorial, internal and marketing boards with the goal of deploying a judicious evaluation of the high-level scientific contributions that will be published. Sue Silver cited strategies on how to attract good authors and thus good papers for publication in the Frontiers in Ecology and the Environment. With this, the articles started to be cited and as a result there was an exponential increase in the IF as previously mentioned. This apparently trivial measure (that is difficult for some scientific institutions to understand) put Frontiers in Ecology and the Environment in second place of all journals in the area of environmental sciences worldwide. The Ecology Society of American that publishes the pleasant modern looking 'Frontiers in Ecology and the Environment' also publishes several other journals available both in print and on electronic media including with the use of new tools to access issues such as iPad. Subsequently, in the SciELO/Fapesp meeting, several editors commented on their experiences and it became perfectly clear that indexation by JCR/ISI/Thomson Reuters and obtaining an IF is the Holy Grail of publishing, of scientific production and of the evaluation of researchers, especially in Brazil(2). However, several publications have shown that the IF is not a good instrument to evaluate researchers and even the editor of Science has shown strong doubts in relation to this bibliometric index(2-5). With all the hype mixed with the excessive patriotism of a large country and of an emerging country expressed in the event, the Revista Brasileira de Hematologia e Hemoterapia has learned and followed the strategies of specialty journals that are less favored by funding agencies and by CAPES(7). Even with the difficulties of a scientific journal that relies on its own finances, it is necessary to learn from the lessons of this and previous events: to overcome barriers, organize the journal's structure, to prepare a fearless and dedicated editorial staff, to expand the editorial board with international members, to start to publish in English and after two years in Lilacs, ExtraMed Scopus and SciELO become indexed in PubMed thereby giving definitive and international visibility to articles(8-11). We consider this moment in the history of the journal to be an extremely special, but emblematic, one as achieving indexation in PubMed should just be considered another step in the evolution of the journal, a step that gives a greater degree of responsibility to the hematology and transfusion medicine community as a whole. We have an obligation to maintain the scientific journal and modernize it in order to adapt it for the culture shock that has already arrived with developments in electronic media and new manners to access and divulge journals. We are only at the start.

At the close of the year and of Volume 33 of the Revista Brasileira de Hematologia e Hemoterapia (RBHH) several significant changes deserve reflection and considerations. The first change this year was that the journal was printed in English. There was almost unanimous agreement about this decision. Even so, one or two colleagues contacted me and said they believed that this measure was inapt and even unpatriotic. This theme has been debated for some time, even among journal editors at events of the Associacao Brasileira de Editores Cientificos (ABEC). Since 2002, in its instructions for authors, the RBHH has stated that it is a bilingual journal; papers in Portuguese or English would be published and so the choice of language has always depended on the author. The times have changed and in recent years the country changed with greater participation in the global scientific market as was reported in previous issues.(1) Concurrently the academic pressure for authors' visibility has increased and the Qualis scientific journal classification system of the Coordenacao de Apoio aos Profissionais do Ensino Superior (CAPES) implanted four years ago was a fatal blow for many national journals and authors, alike.(2,3) Editorial staff felt that their work was devalued and the authors were discouraged because their contributions were given low scores with a direct impact on the productivity factor of professors and researchers. Since then the quest for visibility has become a mantra of all editors and the pursuit of the internationalization of journals has become a national goal. At this point ABEC and the Associacao Medica Brasileira (AMB) issued clear signals that it is essential to implement changes. Among which is the internationalization of the editorial board, with the participation of foreign "experts" in journals; this is one of the main demands for journals to become indexed to the Institute for Scientific Information Web of Knowledge/Journal Citation Reports (ISI/JCR) and PubMed/Medline electronic databases. And at this time both printed and electronic journals need to be edited in English. Thus, recent publications and events such as those of the Fundacao de Amparo a Pesquisas do Estado de Sao Paulo (FAPESP) and of the Scientific Electronic Library Online (SciELO) have been stimulating journals to publish in English on the grounds that English should be considered technical, frank and the most important or even the only international language. FAPESP recommends, albeit inexplicitly, that English be used for national publications if the objective is to reach international audiences. Publish, be read and cited or perish. This is the key. So today, on filling out disclosure documents, such as requests for financial support for the journal there is always the question of whether the journal is published in English. So the RBHH started to be printed in English, and because of this it was indexed in PubMed Central (PMC) of the National Institutes of Health, an auspicious achievement in 2011. Volume 33 will be indexed in PMC in full thereby providing international visibility to all authors. Another accomplishment this year was a 20% increase in submissions, a fact that comforts us as it shows that the changes have been accepted not only in respect to our attempts at internationalization but also in respect to measures implemented on the quality of print and the scientific rigor used in the evaluation of submissions. So, in line with policies of the Associacao Brasileira de Hematologia e Hemoterapia (ABHH) and affiliated societies [Sociedade Brasileira de Transplante de Medula Ossea (SBTMO), Associacao Italo-Brasileira de Hematologia (AIBE) and Sociedade Brasileira de Oncologia Pediatrica (SOBOPE)] the RBHH is becoming internationalized and fulfilling its role as representative of the Brazilian hematology community with the aim of becoming an alternative for the international scientific communities.

The last issue emphasized the changes taking place in the Revista Brasileira de Hematologia e Hemoterapia (RBHH) and discussed the reasons that the Associacao Brasileira de Hematologia e Hemoterapia (ABHH) and her two sister societies decided to internationalize the journal.(1-3) It was pointed out that one of the primary reasons for this was the new Qualis classification by the Brazilian further education council (Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior - Capes). In several articles, editors of many Brazilian journals voiced their unanimous disagreement at the use of just the Thomson-Reuters impact factor in the preparation of this new classification.(4,5) The impact factor has long been used inappropriately to assess the productivity of individual researchers and professors and consequently in academic decisions related to promotion. Thus, several reports exorcise the Thomson-Reuters impact factor and recommend that other indices, such as those of SCImago and SciELO, should also be used in the classification of scientific journals.(6,7) This is justified and so the objective of the Brazilian editors was to valorize national production and Brazilian journals. In June, Crossref Quarterly, the e-letter of one of the institutions that attribute Digital Object Identifiers (DOIs) to scientific publications on the internet, reported on the Brazilian evolution over the last two years in respect to the number of requests for DOIs.(8) Crossref cites Brazil because of the recent increase in membership; the RBHH is one of these new members. Another article from the Royal Society entitled "Knowledge, Networks and Nations: Global scientific collaboration in the 21st century" identifies the new emerging countries of great scientific power led by China and including Brazil and also throws light on the growing scientific production of countries that are not normally mentioned such as Iran, Turkey and Tunisia.(9) China is now the second highest producer of scholarship articles worldwide and the fourth in medicine.(10) Eleven years ago it was the nineteenth in the ranking of SCImago in medicine, that is, behind Brazil which was the seventeenth (Table 1). China's contribution has accompanied its intense economic progress that has been observed over the last fifteen years. Table 1 Scientific publications in medicine - 1996 to 2010(10) Albeit not so evident, a similar evolution has happened number giving a larger slice of the share in these years (Figure 1). Today, both in general publications and in medicine, we are in the thirteenth position according to the SCImago Journal Rank (SJR - Table 1). Figure 1 Evolution of scientific production in Brazil between 1996 and 2010(10) And how is the production of Hematology? Table 2 is the cumulated publications from 1996 to 2010. In 2009 and 2010 there was intense and comparable production in Italy, the UK and Germany; these countries produced the highest number of articles after the USA. Between 1999 and 2009 China climbed from the twenty-fifth place to the seventh place giving it an aggregate position of thirteenth in 2010 (Table 2). Table 2 Scientific publications in hematology – 1996 to 2010(10) In the same period, Brazil moved from twenty-fourth to fourteenth position and its aggregate position for 1996 to 2010 is eighteenth. This is important but it is even more significant if we look at the production of Brazil in 2010 when it is in the twelfth position and not so far behind countries such as Australia and Spain (Table 3). Table 3 Scientific publications in hematology – 2010(10) However we can improve as is clear on comparing the percentage of production in hematology in respect to the overall production of documents in Medicine. Table 4 is a simple comparison of evolution of randomly chosen years of the countries that lead aggregate ranking in Hematology as well as China and Brazil. What is observed is that every year the percentage contribution of the USA and Italy in the field of hematology compared to its overall scientific production in medicine is higher than China and Brazil which shows we can and should improve. Table 4 Percentage of publications in hematology compared to the overall scientific publications in medicine of each country in 1999, 2004, 2009, cumulative of 2006 and 2009 and the year of highest productivity(10) At this point we should emphasize that the RBHH has an important role in the evolution of hematology in Brazil; it is publishing most of the citable and cited documents which make up the score of the ranking of the SJR. These data can be challenged or considered irrelevant, but should be viewed as a stimulus; an encouragement to continue with changes to transform the Revista Brasileira de Hematologia e Hemoterapia.

The last issue of the Revista Brasileira de Hematologia e Hemoterapia (RBHH) - Journal of Hematology and Hemotherapy - was the result of a sequence of events that began after the emergence of the new Qualis classification established by the Coordenacao de Aperfeicoamento de Pessoal do Ensino Superior (CAPES) of the Brazilian Government that ranks scientific journals.(1) All journals were reclassified using just the Impact Factor (IF) of Thompson Reuters; those that were not indexed to the Institute for Scientific Information (ISI/JCR) were discriminated against and demoted as second class publications. This had a great impact on the Brazilian academic scene as individual productivity is now measured by the new classification criteria and the IF started to have a great bearing in determining the quality of post graduate programs in the country which are based on the publications of university professors. The implementation of this measure caused reactions with several meetings being organized supported by the Brazilian Medical Association (AMA) and the Brazilian Association of Scientific Editors (ABEC). These meetings debated the decisions of CAPES and resulted in several joint publications that were printed in many national scientific journals.(2,3) Additionally, with the aim of stressing the true value of Brazilian journals, the use of other parameters to classify journals were discussed in the debates. One suggestion was to adopt the indices of SCImago Journal Rank (SJR) and SciELO.(4) The reason why CAPES should adopt these other two indices is related to the fact that the use of the IF alone is not recommendable and because, as was shown by the Editor-in-Chief of the journal Clinics, the IF and these two other indices overlap; if this combination were used by CAPES, some journals, including the Revista Brasileira de Hematologia e Hemoterapia, would be reclassified from B4 to B2.(4) Figure 1 and Table 1 show the correlation between the ISI/JCR and SCImago impact factors and a list of 138 journals excluded by the Qualis criteria including the RBHH. Figure 1 Correlation between Journal Citation Reports (ISI - Thompson) and SCImago (2009) impact factors for the 64 Brazilian journals indexed in both and with values greater than zero. The identity between the metrics is practically absolute. The angular coefficient ... Table 1 The SCImago Impact Factor of 138 Brazilian Journals excluded in the recent Qualis classification (Simulation using 2009 figures) The RBHH supports the adoption of these three parameters to evaluate Brazilian journals. The new Qualis classification of CAPES took us at the journal, out of our comfort zone. By early 2010, the recently sworn in board of directors of the Associacao Brasileira de Hematologia e Hemoterapia (ABHH), through its scientific department, met with the Editorial Policy Council attended by prestigious hematologists from around the country with the aim of discussing the future of the journal. The ten years of uninterrupted publications of the RBHH which had substituted the Bulletin of the Sociedade Brasileira de Hematologia e Hemoterapia (published since 1973) as the official vehicle of scientific communications of Brazilian Hematology, was evaluated under a critical eye and two alternatives were considered; to stop to print altogether or to invest with the objective of making the RBHH an internationally respected journal. The few advocates who wanted to stop to print justified this based on the limited international representation which is correct if you take into account that the RBHH is not indexed to the most prestigious international databases and when you compared it to other medical journals with high impact factors. However, the decision of ABHH was to honor the existing journal and to invest in it based on the apparently simplistic view of one participant in the discussions who questioned: "why destroy it? It is easier to improve what we already have." And so the meeting ended. Since then the ABHH has increased its support - a description of most of the steps taken at the journal was presented in an editorial in the last issue;(5) the most important changes were the professionalization of the journal and the creation of the Internal Editorial Committee. As a result, the first issue of volume 33 has a more elaborate layout, but even more importantly, it was more painstakingly checked to improve the content and overall quality. On observing the profile of the excluded journals in SCImago, including the RBHH, we see that there is a large number of publications in regular issues and special supplements every year that are quotable (original and review articles), but that the high number reduces the impact factors of both SCImago and SciELO. This meant that measures needed to be taken with improving the quality of the journal becoming our true goal. Thus, decisions were taken, not only in respect to preparing publishing, online submission and review manuals that are currently being developed, but also to improve the publicity of the journal with the goal of including the RBHH in international databases for it to be an active participant in the development of hematology and transfusion therapy.

BACKGROUND: Hodgkin's lymphoma has high rates of cure, but in 15% to 20% of general patients and between 35% and 40% of those in advanced stages, the disease will progress or will relapse after initial treatment. For this group, hematopoietic stem cell transplantation is considered one option of salvage therapy. OBJECTIVES: To evaluate a group of 106 patients with Hodgkin's lymphoma, who suffered relapse or who were refractory to treatment, submitted to autologous hematopoietic stem cell transplantation in a single transplant center. METHODS: A retrospective study was performed with data collected from patient charts. The analysis involved 106 classical Hodgkin's lymphoma patients who were consecutively submitted to high-dose chemotherapy followed by autologous transplants in a single institution from April 1993 to December 2006. RESULTS: The overall survival rates of this population at five and ten years were 86% and 70%, respectively. The disease-free survival was approximately 60% at five years. Four patients died of procedure-related causes but relapse of classical Hodgkin's lymphoma after transplant was the most frequent cause of death. Univariate analysis shows that sensitivity to pre-transplant treatment and hemoglobin < 10 g/dL at diagnosis had an impact on patient survival. Unlike other studies, B-type symptoms did not seem to affect overall survival. Lactic dehydrogenase and serum albumin concentrations analyzed at diagnosis did not influence patient survival either. CONCLUSION: Autologous hematopoietic stem cell transplantation is an effective treatment strategy for early and late relapse in classical Hodgkin's lymphoma for cases that were responsive to pre-transplant chemotherapy. Refractory to treatment is a sign of worse prognosis. Additionally, a hemoglobin concentration below 10 g/dL at diagnosis of Hodgkin's lymphoma has a negative impact on the survival of patients after transplant. As far as we know this relationship has not been previously reported.

Made available in DSpace on 2013-09-27T14:53:53Z (GMT). No. of bitstreams: 1 WOS000208709800007.pdf: 531167 bytes, checksum: 8b937e39a1c7e78e8c4d0ed2acbb1a4e (MD5) Previous issue date: 2011-01-01 Made available in DSpace on 2013-09-30T19:24:06Z (GMT). No. of bitstreams: 1 WOS000208709800007.pdf: 531167 bytes, checksum: 8b937e39a1c7e78e8c4d0ed2acbb1a4e (MD5) Previous issue date: 2011-01-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T15:34:27Z No. of bitstreams: 1 WOS000208709800007.pdf: 531167 bytes, checksum: 8b937e39a1c7e78e8c4d0ed2acbb1a4e (MD5) Made available in DSpace on 2014-05-20T15:34:27Z (GMT). No. of bitstreams: 1 WOS000208709800007.pdf: 531167 bytes, checksum: 8b937e39a1c7e78e8c4d0ed2acbb1a4e (MD5) Previous issue date: 2011-01-01 Cardiovascular Disease Institute (IMC, Sao Jose do Rio Preto, SP, Brazil) Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Within the chronic obstructive pulmonary disease (COPD) spectrum, lung emphysema presents, as a primarily histopathologic feature, the destruction of pulmonary parenchyma and, accordingly, an increase in the airflow obstruction distal to the terminal bronchiole. Notwithstanding the significant advances in prevention and treatment of symptoms, no effective or curative therapy has been accomplished. In this context, cellular therapy with stem cells (SCs) arises as a new therapeutic approach, with a wide application potential. The -purpose of this study is to evaluate the safety of SCs infusion procedure in patients with advanced COPD (stage IV dyspnea). After selection, patients underwent clinical examination and received granulocyte colony-stimulating factor, immediately prior to the bone marrow harvest. The bone marrow mononuclear cells (BMMC) were isolated and infused into a peripheral vein. The 12-month follow-up showed a significant improvement in the quality of life, as well as a clinical stable condition, which suggest a change in the natural process of the disease. Therefore, the proposed methodology in this study for BMMC cell therapy in sufferers of advanced COPD was demonstrated to be free of significant adverse effects. Although a larger sample and a greater follow-up period are needed, it is possible to infer that BMMC cell therapy introduces an unprecedented change in the course or in the natural history of emphysema, inhibiting or slowing the progression of disease. This clinical trial was registered with ClinicalTrials.gov (NCT01110252) and was approved by the Brazilian National Committee of Ethics in Research (registration no. 14764, CONEP report 233/2009). Univ Estadual Paulista UNESP, Assis, SP, Brazil Cardiovasc Dis Inst IMC, Sao Jose do Rio Preto, SP, Brazil USP IPT I, Interunits Biotechnol Post Grad Program, São Paulo, Brazil Univ Estadual Paulista UNESP, Assis, SP, Brazil

Foram apresentadas as alterações hematológicas do sangue periférico e da medula óssea em pacientes expostos cronicamente ao benzeno. Foram descritos a biotransformação metabólica e os possíveis mecanismos envolvidos neste tipo de toxicidade. Os dados hematológicos do sangue periférico são mostrados e avaliados em sua importância, sendo a macrocitose e a linfocitopenia sinais precoces de toxicidade ao benzeno. As alterações da medula óssea observadas são demonstradas pelos métodos complementares citológico e histológico. A anormalidade histológica de maior importância foi a hipocelularidade global devida principalmente ao setor granulocítico. Foi observado também aumento do percentual de eosinófilos, de mastócitos e de atipias no setor megacariocítico. Foram observadas alterações de caráter inflamatório e ressaltada a presença de sinais de dismielopoiese. Foram enfatizadas a necessidade da valorização das alterações hematológicas do sangue periférico e a visão critica e global desse importante problema de saúde pública.

The Guidelines Project of the Associacao Medica Brasileira (AMB) and of the Conselho Federal de Medicina (CFM) began in 2000 with specialist societies participating in the preparation of the texts. The guidelines are based on research and contain solid advice on the diagnosis, therapy, and prevention of diseases. Grounded in evidence-based medicine, they seek to answer specific or crucial questions regarding the disease. A review of the literature is performed and, using pre-established criteria, studies on the disease are selected and graded according to their characteristics and type. Randomized clinical trials and meta-analyses have the highest value (A). Second in importance are observational and clinical studies (B), then case reports and case series (C), and finally, publications of consensuses and opinions (D). Due to the methodology employed, current systematic reviews are clearly more relevant when compared to those written in the past. Historically, reviews were much more based on personal opinions and subject to the author's interest, that is, more concerned with the individual point of view and based on personal experience.1 The Associacao Brasileira de Hematologia, Hemoterapia e Terapia Celular (ABHH) began to participate effectively in the development of the guidelines of the AMB in 2009, with contributions by several experts as shown in Table 1; previously, the collection was limited, with fewer themes. After 2012, guidelines on several diseases were completed and published in the Revista Brasileira de Hematologia e Hemoterapia (RBHH); chronic myelogenous leukemia,2 multiple myeloma,3 and diagnosis4 and treatment of immune thrombocytopenic purpura.5 It is also important to quote other systematic reviews published in the RBHH, such as preventive practices in longterm hematopoietic stem cell transplantation survivors, with the participation of experts from several different countries.6 The consensus of the Sociedade Brasileira de Transplante de Medula Ossea (SBTMO) produced the famous 'Pink Book'; this was rounded out with two publications on transplantation in acute myeloid leukemia7 and autoimmune diseases.8 Table 1 Guidelines published on hematological diseases. Acute promyelocytic leukemia (APL) has well-defined clinical, cytogenetic, and morphological characteristics; it encompasses 10% to 15% of all myeloid-type leukemias. Its molecular bases are well defined, with different variations influencing the treatment of patients.9 The results, as reported by the International Consortium on APL, established the treatment strategies and the conduct for the disease in developing countries.10,11 The guidelines for the diagnosis and treatment of APL12 are published in this issue of the RBHH, the first in 2014, thereby adding to those already published. Hopefully, this will stimulate other experts to continue this hard work, aiming to contribute to medical practice and to solidify the knowledge on the diagnoses and treatment of hematologic diseases.

Portadores de leucemia linfoide cronica (LLC) apresentam curso clinico indolente e prolongado que devem ser diferenciados daqueles que tem doenca de evolucao agressiva e fatal. Pacientes mais jovens e com criterios de alto risco podem se beneficiar com tratamento mais agressivo como o transplante de celulas-tronco hemopoeticas (TCTH). O transplante autologo apresenta casos com remissao citogenetica e molecular, baixa taxa de mortalidade, mas nao demonstram plato nas curvas de sobrevivencia e alta taxa de recaidas. Os transplantes alogenicos com regime mieloablativos tem altos indices de toxicidade e mortalidade, mas evidenciam o efeito enxerto versus leucemia, que aumenta a possibilidade de cura destes individuos. Assim, a opcao dos transplantes alogenicos esta dirigida para os transplantes com regime de condicionamento nao mieloablativo, que pode ser aplicado inclusive a pacientes mais idosos ou portadores de comorbidades, e manter o potencial efeito GVL. A identificacao dos pacientes que podem ser beneficiados por esses procedimentos, caracterizar e apontar os novos marcadores prognosticos permanece objeto de muitos estudos clinicos e foi o objetivo do grupo responsavel em discutir as diretrizes do TCTH no consenso da Sociedade Brasileira de Transplante de Medula Ossea - SBTMO. Assim, consideramos que o TCTH para a leucemia linfoide cronica (LLC) deve seguir, para sua indicacao, os criterios do European Group for Blood and Marrow Transplantation (EBMT) e, quando houver disponibilidade de um doador aparentado, a opcao deve ser do TCTH alogenico com regime nao mieloablativo. O TCTH alogenico nao aparentado e o autologo devem ser considerados como opcao secundaria de indisponibilidade de doador, situacoes especiais e ensaios clinicos.

Neste relato os autores apresentam informações sobre os instrumentos bibliométricos e a sua importância na aferição da qualidade dos periódicos científicos, pesquisadores e docentes. Apresentam em particular a história e a implantação do fator de impacto do Institute for Scientific Information, existente desde 1955. São apresentados e discutidos as críticas referentes à inadequação do fator de impacto para avaliação da produção científica, uso indevido e estratégias editoriais de manipulação deste índice bibliométrico.É apresentada a nova classificação Capes para os periódicos, baseada em vários critérios e no Fator de Impacto, em especial, e a sua influência na vida acadêmica e científica nacional. Conclui que, apesar de todos os óbices e discussões, o Fator de Impacto do Institute for Scientific Information ainda é uma ferramenta útil e, isoladamente, a única existente para avaliar os periódicos científicos e a produtividade intelectual. In this report, the authors present information on bibliometric instruments and their importance in measuring the quality of scientific journals and researchers. They present the history and deployment of the impact factor by the Institute for Scientific Information that exists since 1955. Criticism regarding the inadequacy of the impact factor in the evaluation of scientific publications, its misuse and editorial handling strategies of this bibliometric index are presented and discussed. The new Capes classification for journals, based on various criteria and in particular the impact factor, is presented as is its influence on national scientific and academic life. The authors conclude that, despite all obstacles and discussions, the impact factor of the Institute for Scientific Information is still a useful tool and is the only one available to assess, in isolation, scientific and intellectual productivity.