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The number of hematopoietic stem cell transplantation (HSCT) in Brazil is growing rapidly. To better understand the outcomes of HSCT in Brazil, strategies have been developed with the Center for International Blood and Marrow Transplant Research (CIBMTR), using its standardized registry structure and data sharing application. The methods adopted to establish the registry were through efforts to increase the Brazilian centers that report to CIBMTR included training courses for HSCT data managers, the officialization of a multicenter HSCT study using the CIBMTR structure and the partnership between Brazilian Society of Bone Marrow Transplantation (SBTMO) and the CIBMTR. Here we describe the history for establishing the HSCT Brazilian database using the CIBMTR back to center data and present the aggregated results since 2016. We found a significant increase in the numbers of active centers reporting to CIBMTR from 11 in 2016 to 21 in 2020 corresponding to higher numbers of transplants reported to the CIBMTR from 574 to 921 in that period. The model used to generate this national database was effective as it leverages existing infrastructure to assess the activity and outcomes of HSCT in Brazil.

Introduction: ALL is known to have a lower survival rate in adults and this can be attributed, among other aspects, to intolerance to intensive regimens. As the treatment of ALL is very complex, with many protocols available, this study proposes an analysis regarding the CALGB 8811 protocol in a tertiary health unit in Ceará Methods: In this retrospective study, 50 patients with a recent diagnosis of ALL who underwent the CALGB8811 protocol were evaluated. Disease risk criteria were based on the CALGB8811 protocol. Results: CR was obtained in 86% of patients. 12% of patients died during induction due to infectious complications. 30% of patients underwent alloSCT, 60% were on CR1. The median overall survival (OS) was 21.5 months (8.1-38.7). The 5 years OS was 25% in the transplanted patients versus 60% in the transplanted group. Achieving complete remission after induction chemotherapy and allogeneic hematopoietic stem cell transplantation were the factors associated with better long-term survival rates in uni and multivariate analysis. Conclusion: Risk factors classically associated with worse adult ALL outcome and post-induction MRD status were not outcome predictors, in addition, post-induction remission and alloSCT were factors associated with a favorable outcome.

Understanding the HSCT scenario in Brazil is challenging due to the lack of a national registry that allows the analysis of results. The partnership between the Brazilian Cellular Therapy and Bone Marrow Transplant Society (SBTMO) and the Center for International Blood and Marrow Research (CIBMTR) allowed the return of Brazilian data registered in the CIBMTR, through the Data Back to Center (DBtC), in a standardized and organized way. With this database it was possible to know the demographic data and the outcomes of transplants performed in Brazil. The spreadsheet was imported into the Power BI desktop, and functions and charts were created. Between 2008 and 2019, 7,264 transplants were reported to the CIBMTR from 24 Brazilian transplant centers. The partnership between SBTMO and CIBMTR, made the Brazilian registry possible and allowed the development of the first Brazilian Summary slides. Despite the difference in the number of cases and of follow-up time, the results in this study were similar to those presented in the US Summary Slides.

Disease recurrence is the most common cause of HCT failure in patients with AML,ALL and SMD and factors such as the presence of measurable residual disease before and after transplantation, stage of the disease before transplantation and the cytogenetic and molecular risk profile are factors associated with increased risk of recurrence.

Editorial.

The functional meaning of asymmetry in brachiopods has been a matter of discussion for over a century. Several hypotheses have been proposed to explain why these morphologies appear, the predominant idea in the literature being that it might be a non-adaptive characteristic. Here we present an in-depth study of the asymmetry present in the commissure of the rhynchonellide brachiopod Cyclothyris aff. globata from three Upper Cretaceous sections of northern Spain, with the aim to establish whether it is correlated to some kind of palaeoenvironmental factor. A new hypothesis interpreting this asymmetry as a functional feature is proposed after the results obtained from the palaeoecological and taphonomical study of the specimens. A noteworthy aspect of the asymmetry displayed by this species is that juvenile forms are fully symmetric while adult specimens are asymmetrical, but internal structures remain symmetric throughout ontogeny. In adult forms, asymmetry is expressed as the division of the shell into two vertically displaced lobes, one of which is invariably shorter than the other. Characteristically, the beak is twisted towards the shorter lobe, and in some individuals the larger lobe is seen to be completely flattened due to burial and compaction. When the occurrence of these asymmetrical forms was analyzed, it became evident that they appeared wherever the lithology was mainly marly, thus seeming to be related to the predominance of fine detrital components in the sediments (soft bottom). These features enable us to suggest that C. aff. globata lived partially buried, with one side of the shell placed inside the soft sediment. Asymmetry developed gradually as the shell grew, being evident once it attained a certain size. This hypothesis fits well with the morphological and structural features displayed by this species and, particularly with its relationship with the consistency of the substrate in which these asymmetric brachiopods lived, corresponding to an adaptation of the growing to soft and unstable bottom conditions. Although this paper does not aim to conduct a systematic review of the species, the geometric morphometric analysis performed in order to describe the asymmetry provided results that give a basis for the discussion of the taxonomic relationships between certain Upper Cretaceous asymmetric Cyclothyris species.

The relatively complete and well preserved shell of a turtle, from the middle Cenomanian of Nazare (Portugal), is studied here. It is recognized as a member of the crown group Pleurodira and, more specifically, of Bothremydidae. Pleurodira are one of the two lineages of modern turtles, their origin being in Gondwana. Pleurodira are very abundant in the uppermost Cretaceous record of Europe. However, this new finding is one of the few occurrences in the lower Upper Cretaceous of Laurasia. A single member of Bothremydidae had so far been identified in Portugal: the late Campanian-early Maastrichtian Rosasia soutoi . It was the only Cretaceous turtle identified in that country both at specific and at generic levels, being exclusive of Portugal. The taxon from Nazare is identified as Algorachelus peregrinus , this form is also present in the contemporaneous beds in Spain, and is the oldest member of Bothremydidae in Laurasia. Algorachelus peregrinus is confirmed here to be a coastal form, which facilitated its spread. The two oldest known bothremydids from Laurasia, the European A. peregrinus and the North American Paiutemys tibert , are compared for the first time. They are recognized as closely related taxa. This study provides new data allowing a more precisely characterization of the oldest so far known dispersal event of Pleurodira in Laurasia, which was performed by an African lineage of Bothremydidae that reached the east coast of the Atlantic Ocean at least in the middle Cenomanian, and the west region of that Ocean at least in the late Cenomanian.

During the early twentieth century, the Professor Modesto Bargallo developed in Spain a teaching method that promoted the active participation of the students in their training, “discovering” the Nature by themselves, through practical field trips and classroom activities. His innovative methodology allowed not only the optimal training of several classes of future teachers at the Normal School of Guadalajara, but also the discovery of four new palaeontological sites: The Silurian graptolite site of Sierra Menera, the Eocene-Oligocene vertebrate site of Huermeces, and the Miocene mammal and turtle sites of Chiloeches. The scientific legacy of Bargallo is also directly related to his relationship with two of the most important Spanish naturalist institutions: The Royal Spanish Society of Natural History (Real Sociedad Espanola de Historia Natural), in whose proceedings he published his palaeontological discoveries, and the National Museum of Natural Sciences (Museo Nacional de Ciencias Naturales), to which he donated the fossil remains that were found in those sites. Another part of his rich geological heritage remained in Spain too, after his exile to Mexico (where he continued his intense teaching and scientific work), being nowadays held at the University of Alcala, in the so-called Bargallo Historical Collection.

Introduction Several factors may interfere with the response to hematopoietic stem cell transplantation (HSCT) in myelodysplastic syndrome (MDS). Objective To evaluate the effect of cell source and type of conditioning on HSCT outcome in MDS. Methods We analyzed data from 258 MDS patients from the Latin American transplant registry in Brazil and Uruguay from 1988 to 2019. The statistics were performed on SPSS v.23.1, considering significant p Results A predominance of males (56.2%) and Caucasian individuals (84.5%) was observed. The most frequent age group was 51 to 60 years (2 -79 years) (26%). When stratified according to the Prognosis Scoring System (IPSS-R), 0.78% were classified as very low risk, 11.2% as low risk, 24% as intermediate risk, 21.3% as high risk and 4.7% as very high risk. A total of 38% of patients could not be classified according to the IPSS-R due to lack of data, such as cytogenetics. In myeloablative conditioning (MAC) (78.7%) the regimens were (bulssulfan/fludarabine, bulssulfan/cyclophosphamide, with or without total body irradiation (ICT)). Reduced intensity (RIC) (15.9%) was (bulssulfan/fludarabine, bulssulfan/cyclosphosphamide at reduced doses, with or without ICT and FluMel). The cell source was bone marrow (BM) (52.7%), peripheral blood (PB) (45.3%) and cord blood (2%). Major post-HSCT complications included acute (37.2%) and chronic (28.7%) graft versus host disease (GVHD). Regarding the possible predictors of acute, chronic GvHD and death, there was an association between type of cell source and the death outcome (p = 0.0336). Moreover, there was a significant association between acute GvHD and conditioning regimen (p = 0.0127) and cell source (p = 0.0004). There was also an association of chronic GvHD with the conditioning regimen (p Conclusion The results demonstrate the impact of conditioning and cell source on the HSCT outcome and reinforce the need for an appropriate assessment for better conduction results optimization.

It has been suggested that bridging therapy with intensive chemotherapy and/or hypomethylating agents followed by hematopoietic stem cell transplantation (HSCT) can be valuable in the treatment of patients with myelodysplastic syndromes (MDS). However, the influence of this approach on HSCT outcomes remains poorly defined. Therefore, our objective was to investigate the influence of treatment before HSCT in patients with MDS. We retrospectively analyzed data from the Latin American registry of 258 patients from 17 Latin American centers who underwent HSCT from 1988 to 2019. Our data showed that there was pre-HSCT. We detected no significant difference regarding the impact on overall survival of treated and untreated patients before HSCT. Despite these data, the type of previous treatment among treated patients showed a significant difference in overall survival. Treatment with hypomethylating agents together with pre-HSCT chemotherapy seems to result in better survival of the studied population. These data correspond to the first results obtained through cooperative work between various centers in Latin America comparing the different approaches to patients and reflecting their reality and challenges. Therefore, the selection of pretransplant bridge therapy should be analyzed and focus given primarily to those approaches that result in better survival of patients with MDS.

Limited data are available regarding contemporary multiple myeloma (MM) treatment practices in Latin America. In this retrospective cohort study, medical records were reviewed for a multinational cohort of 1103 Latin American MM patients (median age, 61 years) diagnosed in 2008-2015 who initiated first-line therapy (LOT1). Of these patients, 33·9% underwent autologous stem cell transplantation (ASCT). During follow-up, 501 (45·4%) and 129 (11·7%) patients initiated second- (LOT2) and third-line therapy (LOT3), respectively. In the LOT1 setting, from 2008 to 2015, there was a decrease in the use of thalidomide-based therapy, from 66·7% to 42·6%, and chemotherapy from, 20·2% to 5·9%, whereas use of bortezomib-based therapy or bortezomib + thalidomide increased from 10·7% to 45·5%. Bortezomib-based therapy and bortezomib + thalidomide were more commonly used in ASCT patients and in private clinics. In non-ASCT and ASCT patients, median progression-free survival (PFS) was 15·0 and 31·1 months following LOT1 and 10·9 and 9·5 months following LOT2, respectively. PFS was generally longer in patients treated with bortezomib-based or thalidomide-based therapy versus chemotherapy. These data shed light on recent trends in the management of MM in Latin America. Slower uptake of newer therapies in public clinics and poor PFS among patients with relapsed MM point to areas of unmet therapeutic need in Latin America.

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Major changes occurred in Iberia during the Late Cretaceous. First, the cessation of the previous rifting episode derived into generalized thermal subsidence in all basins, which in conjunction with warm climate and high sea-levels promoted the widest carbonate platforms ever in Iberia. Second, that post-rift interval was punctuated regionally by a series of tectonic episodes related to intraplate stresses which induced complex paleogeographic patterns, and locally by intense salt tectonics. And third, the onset of Africa-Iberia-Europe convergence, which started in Santonian times, determined the first Alpine contractional episodes in Iberia, which caused major changes in all sedimentary basins. The chapter reviews all those points in an integrated approach through the basins of Iberia.

A new Upper Cretaceous vertebrate tracksite has been discovered at Tamajon (Iberian Ranges, Guadalajara, Spain). The track level is a relatively smooth and slightly undulating sandy ferruginous crust, corresponding to an erosive surface at the base of a small meandering channel. It is incised into the underlying planar cross-bedded sandstones of coastal bars located at the middle-upper part of the Utrillas Formation (middle-upper Cenomanian). The site shows an extraordinary concentration of vertebrate tracks, among which numerous sets of two to five isolated digit impressions (“swim tracks”) and, at least, two trackways referred to crocodyliforms, and a single tridactyl footprint probably produced by a theropod dinosaur can be recognized. There are also several long traces (epichnial grooves) revealing sharp direction changes (up to 90°) which seem to be fish fin traces ( Undichna unisulca ), although crocodyliforms (tail marks) and/or fish invertebrates cannot be rejected as possible tracemakers. Some crocodyliform tracks reveal a thin raised rim, due to the displacement of the sediment by the pressure produced by the feet. Several impressions are moderately deformed by small sediment slides, only preserving their deepest part (claw marks). This is clearly indicative of a soft substrate with a high degree of plasticity and water content at the time of the track registration. Nevertheless, the sediment was hard enough to preserve manus and pes print morphologies and also possible crocodyliform tail and/or fish fin traces. Small rhizoliths can also be recognized and may belong to herbaceous wetland vegetation. The morphology of the palaeochannel, the sedimentary context and the track preservation seem to indicate that the tracks were impressed in a shallow channel located near the coast, under wet conditions and in different moments of time. This discovery represents the first occurrence of vertebrate ichnites in the Utrillas Formation, a stratigraphic unit where osteological and ichnological remains are relatively scarce, and it confirms that some crocodyliforms lived in near coast channels during the deposition of this unit.

This year, I followed a young patient who is being investigated for a probable leukemia, He said he was a gardener. I tried to explain what his diagnostic hypothesis was, but I had a distinct feeling that he hadn't quite understood the situation. I always feel this feeling of anguish, a certain impotence, because the exact understanding involves a minimum amount of knowledge that this gentleman must have about health, citizenship or even general education, which a good part of the population that we treat in public hospitals does not have. This patient who does not understand his illness very well and what effectively needs to be done for a correct diagnosis and treatment. Added to this is the difficulty of having access to new expensive drugs and, as if that were not enough, some essential drugs for the treatment of cancer, such as carmustine, used to conditioning regimen of Bone Marrow transplant, which simply disappeared from the Brazilian market and left with restrict options to treat these patients. In any case, it is not the first time that we have dealt with this reality, and many will say that there is nothing new in my report or that it used to be much worse. I agree with these two statements, but this process remains very difficult, painful and very worrying. I participated in february of a congress in the United States; there I could see the main updates in the treatments of onco-hematology and bone marrow transplantation. I presented an article and, throughout the debate, I tried to show my professional colleagues the profound differences, not to say abysmal, between our realities in Latin America and first world countries. This distance becomes increasingly larger as treatment progresses based on targeted and cellular therapies, with drugs such as immunotherapy associated with chemotherapy or the use of "smart" cells that destroy cancer, which are difficult to access. Thus, we come to the difficult trinomial that consists of cancer, poverty and lack of access. This leads us to a deep reflection on the real paths we are taking and where this modern, technological and fast society will take us all, if we do not pay attention to the need to place the individual as the priority center of all our actions.

Background Enterobacteria and multidrug-resistant non-fermenting Gram-negative bacilli present a challenge in the management of invasive infections, leading to mortality rates due to their limited therapeutic arsenal. The objective of this work was to analyze risk factors that may be associated with these infections, for a better situational mapping and assertive decision-making in a university hospital in Brazil. Methods The study was conducted between January and September 2019, with 167 patients in contact isolation at a university hospital in Brazil. Potential outcome-related variables for wide-resistance Gram-negative bacteria (BGN) infections were evaluated. Risk factors were identified from univariate statistical analysis using Fisher’s test. Results 51 (30.5%) out of 167 patients in contact isolation evolved with wide-resistance BGN infection. Risk factors in univariate analysis were age, hospital unit and previous use of invasive devices. Patients aged up to 59 years were more likely to progress to infection than those aged over 60 years (p 0.0274, OR 2.2, 95% CI 1.1-4.5). Those admitted to the oncohematology (p < 0.001, OR 32.5, Cl 9.1-116.3) and intensive care unit (p < 0.001, OR 28.0, Cl 3.5-225.9) units were more likely to develop this type of infection. The least likely were those admitted to a kidney transplant unit (p 0.0034, OR 15.33, Cl 1.8-131.0). Prior use of mechanical ventilation (p 0.0058, OR 12.2, Cl 2.0-76.1) and delayed bladder catheter (p 0.0266, OR 5.0, Cl 1.2-20.1) in patients with respiratory and urinary tract infection, respectively, were also reported as risk factors related to these infections. The gender of the patients was not significant for the study. Conclusion This study determined that variables such as age, hospitalization unit, use of mechanical ventilation and delayed bladder catheter could be considered important risk factors in triggering the infectious process by wide-resistant gram-negative bacteria. Thus, the analysis of these factors becomes a great foundation to prevent the development of multiresistant pathogens through prevention strategies, prophylaxis management and more targeted empirical therapies. Disclosures All Authors: No reported disclosures

The external and internal features, microstructure, and distributions of Coniacian rhynchonellides from the Northern Castilian Platform (Northern Spain) have been studied here. In addition, the revision of numerous European Upper Cretaceous brachiopod collections (e.g., d’Orbigny, 1842-1851; Coquand, 1860, 1862, 1879; Owen, 1962, 1988) has contributed to systematic, biostratigraphic, and palaeobiogeographic precisions. The genus Woodwardirhynchia has been identified for the first time in Spain, represented by W. pontemdiaboli sp. nov., whose range is restricted to the basal Coniacian (Forresteria petrocoriensis zone). This species is characterized by slightly dorsibiconvex shells and antidichotomous ornament with medially rather and anteriorly concave crura. The genus Cyclothyris, well characterized by its long dorsally concave crura, is also recognized. This group is represented in the lower Coniacian (Tissotioides haplophyllus zone) by C. segurai sp. nov., and in the middle and basal upper Coniacian (Gauthiericeras margae zone and lower part of the Hemitissotia turzoi zone) by C. cardiatelia sp. nov. Cyclothyris segurai is an equibiconvex rhynchonellide with a low fold ornamented with rounded ribs, while C. cardiatelia is an asymmetric species with two well-differentiated lobes in the shell, the ventral beak being twisted towards the larger lobe. The study and revision of these three species has also allowed the systematic reassignment of specimens previously classified as Rhynchonella petrocoriensis, Rhynchonella difformis var. globata, Cyclothyris claudicans, Owenirhynchia claudicans, and Cyclothyris aff. globata. The revision of the palaeobiogeographical data concerning the studied assemblages has led to the proposition of two new biochoremas, the Anglo-Paris Subprovince and the Biscay Subprovince.

Latin America is a group of countries that covers an area of approximately 19 197 000 km2. In 2016, itspopulation was estimated at more than 639 million. The prevalent languages are Spanish andPortuguese.Myelodysplastic syndromes (MDSs) are a heterogeneous group of myeloid neoplasms characterized byabnormal differentiation and maturation of myeloid cells, bone marrow failure, and genetic instability withenhanced risk of transforming to acute myeloid leukemia.The incidence rates for MDS in Europe and the United States range from 3 to 5 per 100 000 personyearsand increase markedly with age to 20 per 100 000 person-years for those older than age 70 years.Despite the absence of epidemiologic data, Latin America also has an aging population, as with otherdeveloped countries, and an increasing rate of secondary MDS from previous toxic exposure not only asa consequence of treating other malignancies but also as a result of environmental or occupationalfactors. Diagnosis and treatment remain difficult because of the high number of economic andtechnological disparities within and among Latin American countries. Fil: Crisp, Renée. Hospital Nacional "a Posadas"; Argentina Fil: Grillé, Sofía. Hospital de Clínicas; Uruguay Fil: Belli, Carolina Bárbara. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; Argentina Fil: Diaz, Lilian. Hospital de Clínicas; Uruguay Fil: Undurraga, Soledad. Hospital El Salvador; Chile Fil: Navarro, Juan. Hospital Nacional Edgardo Rebagliati Martins; Perú Fil: Vidal, Gabriela. Hospital Nacional Edgardo Rebagliati Martins; Perú Fil: Gusmao, Breno. Hospital Israelita Albert Einstein; Brasil Fil: Reyes, Jheremy. Clínica Los Nogales; Colombia Fil: Huaman Garaicoa, Fuad. Instituto Oncológico Nacional Dr. J. Tanca Marengo; Ecuador Fil: Magalhaes, Silvia. Universidade Federal Do Ceara; Brasil Fil: Barroso, Fernando. Universidade Estadual do Ceará; Brasil Fil: Ovilla, Roberto. Hospital Angeles Lomas; México Fil: Flores, Gabriela. Gobierno de Ciudad de Buenos Aires. Hospital General de Agudos "Carlos G. Durand"; Argentina Fil: Choque, Juan. Hospital de Especialidades Materno Infantil; Bolivia Fil: Distéfano, Marcos. Hospital Domingo Luciani; Venezuela Fil: Salinas Viedma, Victor. Instituto de Prevision Social; Paraguay Fil: Iastrebner, Marcelo. Sanatorio Sagrado Corazón; Argentina

Wernick’s Encephalopathy (WE) is an acute neuropsychiatric syndrome caused by thiamine deficiency post hematopoietic stem cell transplant (HSCT). WE is associated with high mortality and morbidity rates, but due to its rare occurrence, it is rarely considered in patients submitted to this procedure. Considering that, the manuscript reports the clinical characteristics and the possible factors that predisposed the occurrence of WE in a patient with non-Hodgkin’s lymphoma post-Autologous HSCT. We conclude that WE should be considered in patients submitted to autologous HSCT associated with prolonged use of TPN and malnutrition.

SUMMARY INTRODUCTION: Paroxysmal Nocturnal Haemoglobinuria (PNH) is an acquired genetic disorder characterized by complement-mediated haemolysis, thrombosis and variable cytopenias. Renal involvement may occur and causes significant morbidity to these patients. OBJECTIVE: To review the literature about pathophysiology and provide recommendations on diagnosis and management of renal involvement in PNH. METHODS: Online research in the Medline database with compilation of the most relevant 26 studies found. RESULTS: PNH may present with acute kidney injury caused by massive haemolysis, which is usually very severe. In the chronic setting, PNH may develop insidious decline in renal function caused by tubular deposits of hemosiderin, renal micro-infarcts and interstitial fibrosis. Although hematopoietic stem cell transplantation remains the only curative treatment for PNH, the drug Eculizumab, a humanized anti-C5 monoclonal antibody is capable of improving renal function, among other outcomes, by inhibiting C5 cleavage with the subsequent inhibition of the terminal complement pathway which would ultimately give rise to the assembly of the membrane attack complex. CONCLUSION: There is a lack of information in literature regarding renal involvement in PNH, albeit it is possible to state that the pathophysiological mechanisms of acute and chronic impairment differ. Despite not being a curative therapy, Eculizumab is able to ease kidney lesions in these patients.

SUMMARY Wernick's Encephalopathy (WE) is an acute neuropsychiatric syndrome caused by thiamine deficiency post hematopoietic stem cell transplant (HSCT). WE is associated with high mortality and morbidity rates, but due to its rare occurrence, it is rarely considered in patients submitted to this procedure. Considering that, the manuscript reports the clinical characteristics and the possible factors that predisposed the occurrence of WE in a patient with non-Hodgkin's lymphoma post-Autologous HSCT. We conclude that WE should be considered in patients submitted to autologous HSCT associated with prolonged use of TPN and malnutrition.

The new upper Barremian microfossil site of Vadillos-1 (Lower Cretaceous, Beteta Gorges, Cuenca province, Spain) has yielded a rich fossil assemblage consisting of numerous eggshell fragments along with diverse skeletal remains of fishes, amphibians, turtles, crocodyliforms and dinosaurs. Crocodilian eggshells constitute the main fraction of the eggshell assemblage which includes abundant material belonging to the oofamily Krokolithidae, as well as a new type of crocodilian eggshells (Neokrokolithes trigonalis oogen. et oosp. nov.) characterised by a type of ornamentation and microstructure of the basal knobs not described before. Few fragments of the oospecies cf. Mycomorphoolithus kohringi, attributed to non-eusuchian crocodylomorphs, have been also found in this site thus expanding the record of this oospecies to the upper Barremian. The eggshell assemblage has also yielded the first record of avian eggshells (Tristratioolithus minuta oogen. et oosp. nov.) from the Lower Cretaceous of Europe. Comparisons with Lower Cretaceous avian eggshells suggest its possible attribution to Enantiornithes. The tiny eggshell fragments assemblage found at Vadillos-1 site is representative of a small sized fauna. Besides, the diversity appears strongly biased with >90% of the eggshells belonging to crocodilians and approximately 9% to Aves. As established for similar outcrops, this bias may reflect differences in preservation of eggshell types or represent, at least in part, a wetland ground nesting site., Research Projects 2016/00252/001 and 2017/00155/001 of the Junta de Comunidades de Castilla-La Mancha, and CGL2015-66604 and CGL2015-68363 of the Ministerio de Economía y Competitividad (Spain).

Oysters were among the most important groups of marine invertebrates in Late Cretaceous biotas of the Tethyan Realm. During the major eustatic sea-level highstands of this interval, large areas of northern Africa and southern Europe were characterized by carbonate shelf environments with conditions favourable for the widespread dispersal of highly diverse marine ecosystems, which included many ostreid bivalves. In this palaeoecological setting, Pycnodonte (Costeina) costei (Coquand, 1869) is one of the most widespread representatives of the subfamily Pycnodonteinae, extending from Central Asia and Egypt to southern France and the Iberian Peninsula. This taxon is characterised by a strong convex left valve with an expanded posterior flange, suggesting that this species was a free-lying recliner on infralittoral soft substrates. The species is also remarkable due to its morphological plasticity, with ecophenotypes characterised by extremely variable left valve ornamentation. The assemblages of P. (C.) costei studied herein occur in middle to upper Coniacian outer-shelf facies within the northern and central sectors of the Iberian Basin (Spain), associated with transgressive and highstand system tracts. The species occurs mostly in autochthonous concentrations of several tens of individuals, cemented or oriented side by side and colonised by epizoans and borers. Endolithic sponges related to the ichnogenus Entobia were especially abundant, infesting many specimens to a great extent. These new finds in the Iberian Basin also improve the known palaeogeographic range of P. (C.) costei. Its distribution can be related to current circulation along the Tethys Ocean, firstly from its original area in Central Asia to North African shelves and then to the Iberian Basin and France, across the proto-Atlantic Lusitanian area. This dispersal model inferred by these currents also explains much of the Tethyan affinities found in the Late Cretaceous marine faunas of Iberia.

Infecção respiratória viral é causa significativa de morbi-mortalidade em paciente com doenças hematológicas. Deve ser suspeitado sempre que houver sintomas como coriza, obstrução nasal, odinofagia, tosse e dispnéia e deve-se seguir à identificação viral, quando possível. Os casos podem ser classificados como possível, provável ou confirmado. E observando-se o risco de progressão da infecção para vias aéreas inferiores, o diagnóstico deve ser precoce e as medidas terapêuticas específicas aos vírus bem como medidas de controle da infecção no ambiente hospitalar devem ser prontamente tomadas. O presente trabalho visa descrever um protocolo de manejo da infecção viral de vias respiratórias em pacientes com neoplasia hematológica dentro do Serviço de Hematologia e Transplante de medula do Hospital Universitário Walter Cantídio.

An altered mental state with or without neurologic signs have become more frequent in patients after hematopoietic stem cell transplantation (HSCT).1 The neurologic problems are different according to the stage of transplant. In the pre-engraftment period, the occurrence is associated with toxicity of high-dose chemotherapy, bacterial infections, intracranial bleeding and other drug-related neurotoxicity. During the late post-transplant phase, with the use of immunosuppressive drugs and the occurrence of GvHD, the following neurologic complications can occur: central nervous system (CNS) infections, cerebrovascular disease, metabolic encephalopathy, calcineurin inhibitor neurotoxicity with thrombotic microangiopathy or posterior reversible encephalopathy syndrome and immune-mediate disorders.

Background Myelodysplastic syndromes are heterogeneous disorders. Patients with myelodysplastic syndrome disease often have ineffective hematopoiesis, cytopenias, blood cell dysplasia in one or more cell types, and are at high risk for developing acute myeloid leukemia. In myelodysplastic syndrome, mutations of TP53 gene are usually associated with complex karyotype and confer a worse prognosis. In the present study, two mutations in this gene are presented and discussed with the clinical evolution of the patients. Case presentation The first case is a 77-year-old Brazilian woman diagnosed as having multiple lineage dysplasia myelodysplastic syndrome according to World Health Organization 2016 and classified as very low-risk by Revised International Prognostic Scoring. The second case is an 80-year-old Brazilian man also diagnosed as having multiple lineage dysplasia myelodysplastic syndrome and classified as low risk. The mutation described in the first case was already identified in some neoplasias and it is associated with a poor prognosis, but it had never been reported before in myelodysplastic syndrome. The second mutation has never been described. Conclusions This is a novel report for the scientific community and may be very helpful as we can better understand the disease and the impact of mutations through the follow-up of these patients and others in the future. Both patients are in a good clinical condition, suggesting that these mutations may not alter the clinical course of the disease or may be associated with a good prognosis, but their role in the disease must be investigated more deeply in a larger population.

Three new Lower Cretaceous vertebrate sites (Vadillos-1, Vadillos-2, El Tobar) have been recently discovered and studied in the Cuenca Province (Central Spain). They are located in deposits of “Wealden” facies belonging to the El Collado Sandstone and Clay Formation. In these outcrops, micro and macroremains corresponding to plants, invertebrates and vertebrates have been collected and subsequently assigned to macrophytes, charophytes (e.g., Atopochara trivolvis triquetra, Globator maillardii trochiliscoides, Clavator harrisii harrisii), ostracods (e.g., Cypridea gr. modesta, Cypridea cf. C. isasae, Cypridea sp. aff. C. moneta, Cypridea sp. 1, Cypridea sp. 2), molluscs (Unionoida, Viviparus sp.)fishes,amphibians, turtles (cf. Eucryptodira), crocodyliforms (Neosuchia) and dinosaurs (ankylosaurs, ornithopods, theropods). Among the vertebrate remains, scales, teeth, plates, osteoderms, phalanges, ribs, vertebrae and other incomplete bones, as well as eggshell fragments have been identified. This rich and diverse assemblage was deposited in an upper Barremian alluvial-palustrine muddy floodplain crossed by braided sandy channels.

Mixed phenotype acute leukemia is a rare subtype of leukemia that probably arises from a hematopoietic pluripotent stem cell. The co-expression of two of myeloid, B- or T-lymphoid antigens is the hallmark of this disease. Herein, the case of a 28-year-old female patient is reported who presented with hemoglobin of 5.8g/dL, white blood cell count of 138×109/L and platelet count of 12×109/L. The differential count of peripheral blood revealed 96% of blasts. Moreover, the patient presented with lymphadenopathy, splenomegaly and bone marrow infiltration by monocytoid blasts characterized as 7% positivity by Sudan Black cytochemical staining. Immunophenotyping revealed the involvement of blasts of both T- and monocytic lineages. The cytogenetic analysis showed an isolated 17p deletion. Thus, the diagnosis of T-cell/myeloid mixed phenotype acute leukemia was made with two particular rare features, that is, the monocytic differentiation and the 17p deletion as unique cytogenetic abnormalities. The possibility of concomitant expressions of T-cell and monocytic differentiation antigens in the same blast population is hard to explain using the classical model of hematopoiesis. However, recent studies have suggested that myeloid potential persists even when the lineage branches segregate toward B- and T-cells. The role of an isolated 17p deletion in the pathogenesis of this condition is unclear. At present, the patient is in complete remission after an allogeneic stem cell transplantation procedure.

“Lo Hueco” (Cuenca, Spain) is an upper Campanian–lower Maastrichtian Fossil-Lagerstatte that has provided more than 8,500 well-preserved macrofossils, including titanosaur sauropod dinosaurs. Although the facies and fossil record point to both fresh and brackish or marine water influences, a detailed study of the sulphate-bearing layers of the site through petrography, fluid inclusions, and isotopes has been undertaken to evaluate the possible marine influence. The two main sulphate units of the “Lo Hueco” site consist chiefly of bimodal micro- to meso- lenticular gypsum crystals that grew displacively in a clayey-carbonate sediment. The well-preserved lenticular gypsum crystals are primary, as demonstrated by the presence of the original twinning and the absence of hydration textures or anhydrite relicts. Primary fluid inclusions of the lenticular gypsum crystals indicate a vadose environment of formation, with salinities between 1,800 and 14,000 ppm, pointing to a brackish but non-marine environment. Furthermore, gypsum exhibits 87Sr/86Sr values between 0.708034 and 0.708120, which are higher than those from marine evaporites of Campanian–Maastrichtian age, indicating a clear influence of fresh water. Gypsum δ 34S VCDT values (18.1 to 19.0 ± 0.5 ‰) and δ 18OVSMOW values (11.0 to 15.2 ± 0.5 ‰), on the other hand, are typical isotopic values recorded in marine evaporites of this age. This apparent contradiction between fluid inclusion and Sr isotopic data is probably the result of some recycling from Upper Cretaceous evaporites. Based on all these observations, the sulphate-bearing layers are interpreted as probably formed in a near-coastal saline mudflat of a playa lake. As a whole, this study highlights the importance of combining different proxies when dealing with evaporites formed in brackish-water environments.

INTRODUCTION Secondary Acute Myeloid Leukemia (s-AML) evolves from a previous hematopoietic clonal disease such as Myelodysplastic Syndromes (MDS/AML), myeloproliferative neoplasia (NPM/AML), medullary insufficiencies - aplastic anemia - (AA/AML) or exposure to chemo or radiotherapy (t-AML). The objective of this work is to describe and highlight the demographic, pathophysiologic and clinical-therapeutic characteristics of s-AML patients compared with p-AML. METHODS This is a retrospective cohort study based on the casuistry from 34 reference centers in Latin America during a period of 10 years (JAN10'-MAY19'). Patients ≥18 years old with primary AML, excluding the promyelocytic subtype (p-AML), and s-AML were admitted. Age, gender, performance status, comorbidity, cytogenetics, mutations, AML subtypes, extramedullary compromise, treatments and overall survival (OS) were analyzed. Statistically, Graph Pad Prism version 5.00 and, SPSS version 17 were used. RESULTS One thousand eleven patients with newly diagnosed AML were recruited, 693 (68.5%) corresponded to p-AML and 318 (31.5%) to s-AML. The demographic differences between p-AML and s-AML are shown on Table 1. Subtypes of s-AML: t-AML (18.5%), MDS/AML (58.2%), NMP/AML (13.5%), AA/AML (5.7%) and others s-AML (4.1%). Global median age was 58 years (R 18-93) and male 52%. Extramedullary compromise in CNS (3.2%) and other organs (5.5%). Seven hundred ninety-three cytogenetic studies were evaluable (based on MRC classification): High (22.3%), Intermediate (68.3%) and Low Risk (9.3%). FLT3 mutation was more frequently found in p-AML. In s-AML, the multivariate study showed short overall survival associated with ECOG ≥2 (HR:2.0), white blood count ≥ 50x109/L at diagnosis (HR:1.9), poor risk karyotype (HR:1.6) and age over 60 years (HR:1.5). At least, 883 patients received treatment (Table 2). During this study period, 211 patients (21%) were transplanted; 49 (23%) were s-AML; histoidentical related donor (46%), haploidentical (39%), non-related (8%) and autologous (7%). The median survival for all AML was 11.0 months with a statistically significant difference in favor of the p-AML (Figure 1). CONCLUSION Performance status (by ECOG ≥2), age ≥60, level of leukocytes a ≥50x109/L, poor risk karyotype and s-AML subtype at diagnosis had a significant worse impact on overall survival. Most patients with s-AML came from MDS, they were older and their incidence increased as the population aged. They presented more comorbidities and worse performance status. Undoubtedly, our findings showed that s-AML is a distinct high risk subset of myeloid disorder with adverse prognosis and represents a therapeutic challenge. Disclosures No relevant conflicts of interest to declare.

Introduction The Center for International Blood & Marrow Transplant Research (CIBMTR) presents a system that makes it easier to register standardized transplantation data, as well as a business intelligence tool for the devolution of data to the transplant centers, the Qlikview app, which allows data extraction. The software might be useful for the conduction of clinical trials. Objective To evaluate overall survival (OS) and clinical characteristics of patients (pts) undergoing hematopoietic stem cell transplantation (HSCT) in Brazil while testing the usefulness and efficacy of the Qlikview app. Methods Seven Brazilian transplantation centers were asked to enter the in the CIBMTR database using their passcodes and retrieve data from all the pts undergoing HSCT between 2008 (when the Data Back to Centers, DBtC, began) and 2018 using the Qlikview. The seven spreadsheets with the whole set of clinical and demographical data were unified and analyzed using the SPSS software. OS was calculated using Kaplan Meier curves and log rank test. Results In the study period, 3994 pts received transplants in the seven centers (1546 autologous and 2448 allogeneic transplants). The set of data analyzed represented approximately 21% of the transplants performed in Brazil in the period. Among the autologous HSCTs, 1346 (87%) pts were adults and 1514 (98%) had malignant diseases (750 multiple myelomas, 292 non-Hodgkin lymphomas and 262 Hodgkin lymphomas). Among allogeneic HSCTs, 1514 (62%) were adults, 1739 (71%) had malignant diseases (603 AML, 574 ALL and 263 pts with MDS/MPN). The allogeneic source of cells was the bone marrow in 1611 (66%), 685 (28%) peripheral blood and 152 (6%) umbilical cord blood. The two-year OS for the pts with malignant diseases undergoing autologous HSCT (1202) was 79% for adult pts (1055) and 68% for children (147), while for allogeneic transplants for malignant cases (1138) it was 55%, 45% and 38% respectively for pts receiving transplants from HLA matched related (777), unrelated (287) and related donors (74) but with some HLA incompatibility (p Conclusion The Qlikview app allowed the standardized collection and analysis of data from the selected transplant centers, which may be useful for countries, such as Brazil, where a national database is not available. However, some variables were lacking in the app and should be added to improve the analyses. The data analysis has shown that pts characteristics and survival in the seven Brazilian centers are similar to the international literature.