Determination of policyclic aromatic compounds, (PAH, nitro-PAH and oxy-PAH) in soot collected from a diesel engine operating with different fuels.

A qualitative and quantitative analysis of polycyclic aromatic compounds (PACs; polycyclic aromatic hydrocarbons (PAHs), oxygenated and nitrated polycyclic aromatic hydrocarbons (OPAHs and NPAHs)) present in the soluble organic fraction (SOF) of different soot samples has been carried out to determine the effect of soot-generation conditions on their composition and health effects. The soot samples were generated using a diesel engine bench powered by diesel (DS) and biodiesel (BS) fuels under different combustion conditions. To optimize the procedure, a surrogate soot (Printex-U) and a certified reference material (SRM1650b) were also tested. Different extraction methods were used to extract the PAHs, OPAHs and NPAHs, and the Soxhlet technique using pyridine:acetic acid 1 % was found to be the most suitable procedure to extract the highest concentration (ng mg-1) and more types of PAHs and OPAHs from the soot. The results show that the PACs identified, and their concentrations, depend on the formation and collection conditions. The predominant compounds in all soot samples studied were fluorene (Flo), phenanthrene (Phe), fluoranthene (Fla), pyrene (Pyr), 9-fluorenone (9Flo) and 9,10-anthraquinone (9,10Anq). As such, the presence of these PACs in the atmosphere of urban and rural areas can mainly be attributed to the emissions from diesel vehicles. The percentage of OPAHs with respect to total PACs was highest in the soot generated from a biofuel. These oxidized compounds favor regeneration of the diesel particulate filter (DPF). The results also indicate that the carcinogenicity of the soot depends on the combustion conditions and type of fuel.

Post-transplant patients with COVID-19 associated acute respiratory distress syndrome, a role for Tociluzumab: A case series.

COVID-19 is the disease caused by SARS-CoV-2 that portends both a relatively high mortality rate as well as high rate of intensive care admission amongst all age groups; however effective therapy remains poorly characterized. Post-transplant patients are especially high risk and underrepresented in the literature. In these patients, cytokine release may play a significant role in the development of acute respiratory distress syndrome, raising the hypothesis that interleukin-6 inhibitors such as tocilizumab may be of benefit. Here, we describe two high-risk post-transplant patients who were treated with single-dose tocilizumab after intubation for moderate acute respiratory distress syndrome secondary to confirmed COVID-19 infection. Both patients recovered rapidly and were successfully extubated and discharged from the hospital without need for supplemental oxygen shortly thereafter, and their clinical improvement correlated with response in interleukin-6 levels. Tocilizumab appears to hold promise for critically ill COVID-19 patients who require mechanical ventilation when given shortly after intubation.

Utilidad y eficiencia de la teledermatoscopia en el manejo del cáncer de piel en atención primaria / Usefulness and efficiency of teledermoscopy in skin cancer management in primary care

OBJETIVO: Evaluar la utilidad de la teledermatoscopia como método de diagnóstico y de triaje de las lesiones sospechosas de cáncer cutáneo entre atención primaria y dermatología. Analizar la reducción en el número de derivaciones y estimar el ahorro conseguido. MATERIALES Y MÉTODOS: Estudio de concordancia sobre una serie de casos no aleatorizada. Estudio observacional descriptivo. Teleconsultas remitidas desde 2 centros de salud (urbano y rural) al servicio de dermatología de referencia en Córdoba (España) entre enero de 2017 y abril de 2019. Se recogieron los diagnósticos propuestos por atención primaria antes y después de utilizar dermatoscopia y el diagnóstico del/la dermatólogo/a y otras variables epidemiológicas. Se realizaron análisis descriptivo y estudio de concordancia. RESULTADOS: Se efectuaron 395 teleconsultas. El coeficiente de concordancia κ entre los diagnósticos de ambos especialistas sin utilizar dermatoscopia fue de 0,486. Si se emplea esta técnica la concordancia fue de 0,641. Se produjo una reducción del 58% de derivaciones, un ahorro de 2.475€ en transporte en ambulancia y una reducción del absentismo laboral de 550h de trabajo. Los diagnósticos más comunes fueron queratosis seborreica (20%; n=79) y carcinoma basocelular (15,2%; n=60). CONCLUSIONES: La incorporación de la dermatoscopia aumenta la concordancia diagnóstica, siendo un sistema útil para priorizar pacientes y liberar la demanda de atención hospitalaria con el consecuente ahorro de recursos, y evitando desplazamientos innecesarios a nuestros pacientes

OBJECTIVE: To evaluate the usefulness of teledermoscopy as a diagnostic and triage method for suspected skin cancer lesions between Primary Care and Dermatology. To analyse the reduction in the number of referrals and estimate the savings achieved. MATERIAL AND METHODS: Concordance study on a non-randomised case series. Descriptive observational study of teleconsultations sent from two Health Centres (urban and rural) to the reference Dermatology service in Cordoba (Spain) between January 2017 and April 2019. The diagnoses proposed by Primary Care before and after the use of dermatoscopy, and the diagnosis of the Dermatologist, along with other epidemiological variables were collected. Descriptive analysis and concordance study were performed. RESULTS: A total of 395 teleconsultations were made. The coefficient of agreement between the diagnoses of both specialists without using dermoscopy was 0.486. Using this technique the concordance was 0.641. A reduction in the number of referrals to Dermatology was 58%. A savings of 2,475€ in transfers by ambulance and 550 working hours were made. The most common diagnoses were basal cell carcinoma (20%; n=79) and seborrheic keratosis (15.2%; n=60). CONCLUSIONS: The addition of dermoscopy increases diagnosis concordance. Teledermatology is a useful system for patient triage and for decreasing the demand for hospital care, with an inherent resources saving

[Usefulness and efficiency of teledermoscopy in skin cancer management in primary care]. / Utilidad y eficiencia de la teledermatoscopia en el manejo del cáncer de piel en atención primaria.

OBJECTIVE: To evaluate the usefulness of teledermoscopy as a diagnostic and triage method for suspected skin cancer lesions between Primary Care and Dermatology. To analyse the reduction in the number of referrals and estimate the savings achieved. MATERIAL AND METHODS: Concordance study on a non-randomised case series. Descriptive observational study of teleconsultations sent from two Health Centres (urban and rural) to the reference Dermatology service in Cordoba (Spain) between January 2017 and April 2019. The diagnoses proposed by Primary Care before and after the use of dermatoscopy, and the diagnosis of the Dermatologist, along with other epidemiological variables were collected. Descriptive analysis and concordance study were performed. RESULTS: A total of 395 teleconsultations were made. The coefficient of agreement between the diagnoses of both specialists without using dermoscopy was 0.486. Using this technique the concordance was 0.641. A reduction in the number of referrals to Dermatology was 58%. A savings of 2,475€ in transfers by ambulance and 550 working hours were made. The most common diagnoses were basal cell carcinoma (20%; n=79) and seborrheic keratosis (15.2%; n=60). CONCLUSIONS: The addition of dermoscopy increases diagnosis concordance. Teledermatology is a useful system for patient triage and for decreasing the demand for hospital care, with an inherent resources saving.

Analysis and Tendencies of Metals and POPs in a Sediment Core from the Alvarado Lagoon System (ALS), Veracruz, Mexico.

This study focused on dating of a sediment core from the Alvarado Lagoon System, Veracruz, Mexico, calculating the sedimentation rate by using 210Pb to determine the tendency towards pollution by polycyclic aromatic hydrocarbons, organochlorides, the metals Cd, Cr, Cu, Hg, Ni, Pb, and V, and organic matter content. The activity of total Pb and supported Pb in the samples was 83.1 and 29.5 Bq kg-1, respectively, whereas the average estimated sedimentation rate was 0.48 ± 0.09 cm per year-1. The organic matter values exhibited linear behavior throughout the historical profile, with values under 2.5%. Metal concentrations followed the order V > Cr > Ni > Cu > Pb > Hg > Cd. Variations found in Cr, Ni, Pb, and V concentrations are basically due to three meteorological phenomena that hit the region: hurricanes Gladys, Hilda, and Janet in September of 1955. V, Ni, and Hg input comes from anthropogenic and lithogenic sources. The presence of individual polycyclic aromatic hydrocarbons showed no ascending accumulation pattern over time, nor did it show any significant statistical correlation to OM. As for the organochlorine pesticides, 63.61% of the total sum of these compounds were from the ciclodienics family. Concentration of p,p'-DDT was observed only in the earliest profile, from 1929.

Análisis de 51.996 opiniones online sobre profesionales sanitarios en una web comercial / An analysis of 51.996 online opinions in a commercial rating website

No disponible

Síndrome de Münchausen por poder en otorrinolaringología / Münchausen syndrome by proxy in otorhinolaryngology

El síndrome de Münchausen por poder es una forma de maltrato infantil, con graves consecuencias para el niño afectado. El diagnóstico de esta afección constituye un desafío para los médicos por su heterogeneidad en los síntomas y signos de presentación. Variadas manifestaciones otorrinolaringológicas están descritas en esta patología. En este artículo se presenta un caso clínico de otitis media crónica con otorragia en un paciente de 2 años, donde se logró establecer el diagnóstico de síndrome de Münchausen por poder a través de la identificación de elementos incongruentes en la historia clínica y finalmente por la detección in fraganti de la agresión por parte de la madre. En esta revisión se concluye que es necesario un alto índice de sospecha para identificar esta patología, la que debe ser una preocupación habitual del equipo de salud para evitar asi consecuencias graves en estos pacientes, tales como secuelas psiquiátricas o incluso la muerte.

Münchausen's syndrome by proxy is a form of child abuse with severe consequences for the affected child. The diagnosis of this condition is a challenge for physicians due to the heterogeneity of the presentation symptoms. A lot of otorhinolaryngological manifestations have been described in this syndrome. We present a case of a 2 year old patient with chronic otitis media and otorrhagia, where we could establish the diagnosis of Münchausen's syndrome by proxy through the identifications of incongruent elements on the clinical history and finally the direct visualization of mother's aggression. In this should be a common concern for health workers to avoid severe consequences in these patients like psychiatric diseases or even death.

First Report of Pepper vein yellows virus Infecting Sweet Pepper in Spain.

In November 2012, unusual symptoms were observed in plants of sweet pepper (Capsicum annuum L.) grown in commercial greenhouses of Almería Province, southeastern Spain. Symptoms included interveinal yellowing, upward leaf curling, and internode shortening, and were more evident in the upper part of the plant. Abnormal ripening of fruits was observed in symptomatic plants, with fruits remaining orange in the red varieties and yellow in the orange varieties, thus reducing their marketability. During December 2012 and January 2013, severe outbreaks of this disease syndrome occurred, with many greenhouses exhibiting almost 100% incidence. The symptoms observed were similar to those reported for isolates of Pepper vein yellows virus (PeVYV, genus Polerovirus, family Luteoviridae) (previously also named Pepper yellow leaf curl virus [PYLCV] and Pepper yellows virus [PYV]) (2,4). Twenty five symptomatic leaf and/or fruit samples (some of them supplied by Zeraim Ibérica, S.A.), each from a different greenhouse, were analyzed and all reacted positively in double-antibody sandwich-ELISA with an antiserum against the polerovirus Cucurbit aphid-borne yellows virus (CABYV) (Sediag, Longvic, France), known to cross-react with PeVYV (2). Total RNA was extracted by TRIsure reagent (Bioline, London, United Kingdom) from symptomatic leaves and analyzed by reverse transcription (RT)-PCR with primers Pol-G-F (5'-GAYTGCTCYGGYTTYGACTGGAG-3') and Pol-G-R (5'-GATYTTATAYTCATGGTAGGCCTTGAG-3') designed for universal detection of poleroviruses by amplifying the RNA-dependent RNA polymerase (RdRp) and coat protein (CP) partial genes (3). DNA fragments of the expected size (1.1 kbp) were amplified supporting a polerovirus infection in all the analyzed samples. The PCR product obtained from one sample (Almería-1) was extracted from agarose gel with a QIAquick gel extraction kit (Qiagen, Hilden, Germany), cloned in pGEM-T Easy vector (Promega, Madison, WI), and one clone was sequenced (Macrogen Inc., Seoul, South Korea). The PCR products amplified from three other samples (2-13, 7-13, and 8-13) were directly sequenced. The nucleotide identity between the amplified fragments (GenBank Accession Nos. KC769487, KC839992 to 94), calculated after alignment with ClustalW, was 99.7 to 100%. The highest nucleotide identity of the Spanish sequences was with a PeVYV isolate from Turkey (FN600344, named as PYV) (98.5 to 98.7%). The spread of PeVYV in Spain is additional evidence of the emergence of this virus as a global threat for pepper crops after its first detection in Japan in 1995 and recent reports from the Mediterranean Basin (1,2). References: (1) N. Buzkan et al. Arch. Virol. 158:881, 2013. (2) A. Dombrovsky et al. Phytoparasitica 38:477, 2010. (3) D. Knierim et al. Plant Pathol. 59:991, 2010. (4) R. Murakami et al. Arch. Virol. 156:921, 2011.

Application of cluster analysis to surface ozone, NO2 and SO2 daily patterns in an industrial area in Central-Southern Spain measured with a DOAS system.

The daily variations of surface ozone, NO2 and SO2 have been investigated in a heavily industrialised area in the centre of the Iberian Peninsula (Puertollano) using hourly values recorded during two years (2008-2009) with an active LP-DOAS system. The meteorological conditions and air masses have been studied using the HYSPLIT model. The maximum hourly levels of these air pollutants exceeded 100 ppb for ozone, 150 ppb for SO2 and 210 ppb for NO2. However, mean values for ozone, NO2 and SO2 were of 49, 10 and 3 ppb respectively. Daily-monthly evolutions (defined as daily evolutions for different months) have been analysed in order to know the general daily behaviour of these species. Air pollution problems have been identified using the thresholds defined in the European Directive 2008. The limits to protect human health (human health protection limitations) have been exceeded during the study period. In order to find a set of representative daily cycles for each pollutant at different air quality regimes, a K-mean cluster technique has been applied. Five and four optimal cluster numbers have been obtained for the daily patterns of ozone and SO2 respectively. In addition, we studied the daily variation of the temperature, relative and specific humidity and wind speed associated with each air pollutant daily pattern. Ozone daily patterns showed typical daily variations with one exception of a cluster which presents a peak in the early morning. For SO2, the first two clusters present a low mixing ratio, however cluster 3 and 4 are less frequent but with higher levels. The more frequent air pollutant daily patterns do not exceed the threshold defined in the Directive. Nevertheless, clusters with lower frequency (representing between 5 and 7% of days) exceed the thresholds and could be considered as air pollution events.

[Eosinophilic cholecystitis: a case report.]. / Colecistitis eosinofílica. Presentación de un caso.

Eosinophilic cholecystitis is a rare disease with clinical presentation similar to acute cholecystitis. The diagnosis is based on typical symptoms of acute cholecystitis with presence of more than 90% eosinophilic infiltration within the gallbladder wall. The case of a 27-year-old woman with periodic epigastric pain during ten years is presented. Routine and Boyden s technique biliary ultrasounds were normal. Hepatobiliary scintigraphy showed delayed gallbladder empty and patient underwent endoscopic sphinterotomy. Laparoscopic cholecystectomy was performed with uneventful postoperative course. Histopathologic examination of the gallblader demonstrated infiltration with eosinophils, consistent with acute eosinophilic cholecystitis.

Absceso como forma de presentación del carcinoma epidermoide primario de mama en una lactante. Revisión a propósito de un caso clínico / No disponible

Existen pocos casos descritos de absceso mamario comoforma de presentación del carcinoma epidermoide primario dela mama, y, menos aún, de carcinoma epidermoide de lamama durante la gestación. Generalmente, se considera queel potencial maligno del carcinoma epidermoide de mama esmayor que el de otras variedades anatomopatológicas de tumormamario así como también se le atribuye una mayoragresividad al cáncer de mama que aparece en la pacientegestante con respecto al que aparece fuera del periodo gestacional.Presentamos el caso de una paciente lactante diagnosticadade carcinoma epidermoide y llevamos a cabo una revisión delas características de esta variedad de neoplasia así como delas opciones de tratamiento que se han propuesto durante losúltimos años en relación a la misma(AU)

Few cases of breast primary squamous cell carcinoma(SCC) presenting as breast abscess have been reported and itis also less frequent the development of SCC during gestationalperiod. Malignant potential is generally considered to behigh in cases of SCC subtypes of breast cancer. On the otherside, breast cancer during lactation tends to behave aggressivelythan breast cancer in non- gestational patients.A case of SCC of the breast in a lactating woman is reported.We have reviewed literature for presenting features of thiskind of tumor and therapy options that have been suggestedduring last years(AU)

Night-time atmospheric fate of acrolein and crotonaldehyde.

The absolute rate coefficients for the gas-phase reaction of the NO3 radical with acrolein and crotonaldehyde have been measured overthe temperature range 249-330 K, using a discharge flow system and monitoring the NO3 radical by laser induced fluorescence (LIF). The obtained rate coefficients at 298 K for NO3 reactions with acrolein and crotonaldehyde were (3.30 +/- 0.39) x 10(-15) cm3 molecule(-1) s(-1) for acrolein and (1.35 +/- 0.04) x 10(-14) cm3 molecule(-1) s(-1) for crotonaldehyde, and the proposed Arrhenius expressions are k(T) = (1.72 +/- 0.5) x 10(-13) exp[(-1190 +/- 43)/T] and k(T) = (5.02 +/- 0.7) x 10(-13) exp[(-1076 +/- 47)/T], respectively, in units of cm3 molecule(-1) s(-1). In addition, the products and mechanisms were investigated using an environmental chamber/FTIR absorption system. Formaldehyde, CO, and acryloylperoxy nitrate were identified as the main products for the acrolein reaction with molar yields of 31.6 +/- 2.0, 20.9 +/- 1.9, and 47 +/- 3, respectively. In the crotonaldehyde reaction the main products detected were crotonylperoxy nitrate and CO with yields of 93.6 +/- 4.3 and 8.3 +/- 1.1, respectively. On the basis of the rate constant measured, the activation energy calculated, and the identified products, abstraction of the aldehydic H seems to be the main degradation pathway at room temperature for the reaction of acrolein with NO3. For crotonaldehyde, the mechanism is unclear on the basis of the experimental results. The atmospheric implications of the reactions in question are also discussed.

Peripheral leukocyte response to oncological radiotherapy: expression of heat shock proteins.

PURPOSE: To study Heat Shock Proteins (HSP) expression in patients subjected to radiotherapy and their potential use as biomarkers for radiation tolerance. An evaluation is also made of whether irradiated volume is critical to the outcome of normal tissue injury using polymorphonuclear neutrophils as biosensors, and whether HSP antibodies (Ab) may be involved in post-radiotherapy disease. MATERIAL AND METHODS: Twelve patients receiving the same total dose of radiotherapy, but in three different volumes, and four healthy volunteers used as controls were analysed. hsp27 and 70i mRNA were determined by Reverse Transcription-Polymerase Chain Reaction (RT-PCR) and Southern-blot, HSP by flow cytometry, and HSP-Ab by Enzyme-linked Immnoadsorbent Assay (ELISA). The clinical protocol included radiation related toxicity based on clinical and analytical scales. RESULTS: Radiotherapy caused hsp downregulation, maximum in patients with the largest irradiated volumes, and a decrease in intracellular HSP content. Patients with greatest intraleukocyte HSP levels before treatment suffered more severe radiation morbidity. Patients with endocrine neoplasms presented the highest HSP-Ab titers. CONCLUSIONS: Radiotherapy downregulates hsp27 and 70i, which would enhance radiosensitivity. HSP content prior to treatment is suggested as a prognostic biomarker for radiation tolerance, with circulating leukocytes as biosensors. HSP-Ab may be biomarkers of tumor disease, but do not seem to be involved in the morbidity of acute post-radiotherapy disease, which is closely related to the volumes irradiated.

Peripheral blood mobilization of different lymphocyte and dendritic cell subsets with the use of intermediate doses of G-CSF in patients with non-Hodgkin's lymphoma and multiple myeloma.

Between June 2003 and November 2004, we collected mobilized peripheral blood units from 29 patients with non-Hodgkin's lymphoma and multiple myeloma for autologous peripheral blood stem cell transplantation. They received granulocyte colony-stimulating factor (G-CSF) (16 micro g/kg/day) for a total of 5 days. Immediately before and 3 h after the fourth and fifth dose of G-CSF, we performed flow cytometry analysis to quantify: T cells (CD3+CD4+, CD3+CD8+), B cells (CD19+), NK cells (CD3-CD16+CD56+), NKT cells (CD3+CD16+CD56+), type 1 dendritic cells (DC1) (lin-HLA-DR+CD11c+), type 2 dendritic cells (DC2) (lin-HLA-DR+CD123+), regulatory T cells (Tregs) (CD4+CD25+), and activated T cells (CD3+HLA-DR+). All cell subsets were mobilized after G-CSF treatment with the exception of B, NK, and NKT lymphocytes. The median number of Treg cells before and after G-CSF was statistically different (29+/-14.9x10(6)/l vs 70.1+/-46.1x10(6)/l, P<0.02). DCs were mobilized significantly with a 5.9-fold increase in DC2 (15.1+/-30.3x10(6)/l vs 89.8+/-81.0x10(6)/l, P<0.02) and a 2.6-fold increase for DC1 (41+/-42.5x10(6)/l vs 109.5+/-58.0x10(6)/l, P<0.04). Patients received a mean of 3.1+/-1.2x10(7)/kg NK cells, 1.3+/-0.9x10(7)/kg NKT cells, 0.41+/-0.29x10(7)/kg DC1, 0.2+/-0.22x10(7)/kg DC2, and 1.8+/-1.9x10(7)/kg Tregs. In conclusion, intermediate doses of G-CSF induce mobilization of different lymphocyte subsets, with the exception of B, NK, and NKT cells. The mobilization of certain suppressive populations (DC2 and Treg) could be in theory deleterious, at least in patients with cancer.

Clinical relevance of NK, NKT, and dendritic cell dose in patients receiving G-CSF-mobilized peripheral blood allogeneic stem cell transplantation.

To analyze the relationship between the cellular composition of peripheral blood allografts and clinical outcome, we performed a prospective study in 45 adult patients who underwent allogeneic peripheral blood hematopoietic stem cell transplantation (HSCT) from a histocompatibility leukocyte antigen identical sibling donor for different hematological malignancies. The dose of CD34+, CD3+, CD4+, CD8+, and CD19+ lymphocytes, natural killer (NK) cells, natural killer T (NKT) cells, type 1 and type 2 dendritic cells (DC1 and DC2), as well as regulatory T (Treg) lymphocytes was analyzed. All patients were conditioned with busulphan and cyclophosphamide (BuCy2) +/- VP-16 and received a short course of methotrexate and cyclosporin-A as graft-versus-host disease (GVHD) prophylaxis. Acute GVHD (aGVHD) was present in 9 of 43 (21%) patients, and chronic GVHD (cGVHD) developed in 18 of 39 (46%) patients. There was a significantly higher incidence of aGVHD in patients receiving more than 6x10(6)/kg CD34+ cells. In univariate analysis, variables associated with better survival were as follows: a dose of less than 1.5x10(7)/kg NKT cells and less than 1.7x10(6)/kg DC2 for disease-free survival (DFS), and a dose of less than 3x10(7)/kg NK cells, less than 1.5x10(7)/kg NKT cells, less than 3x10(6)/kg DC1, and less than 1.7x10(6)/kg DC2 for overall survival (OS). In the Cox regression analysis, the dose of NKT cells was the only variable associated with better DFS, while the doses of NK, NKT, and CD34+ cells (less than 8x10(6)/kg) were associated with better OS. In conclusion, different circulating cell populations, other than CD34+ cells, are also of relevance in predicting the clinical outcome after allogeneic peripheral blood HSCT.

CD4+ CD25+ lymphocyte and dendritic cell mobilization with intermediate doses of recombinant human granulocyte colony-stimulating factor in healthy donors.

We prospectively conducted a quantitative and phenotypic analysis of T, B, natural killer (NK), NKT, type 1 and 2 dendritic cells (DC), and regulatory T cells, before and after mobilization with intermediate doses of granulocyte colony-stimulating factor (G-CSF) (16 microg/kg per day). Between November, 2003, and December, 2004, we collected stem cells from 25 HLA identical sibling donors for allogeneic hematopoietic stem cell transplantation. Before mobilization and 3 h after the fourth and fifth doses of G-CSF, blood samples were taken for blood counts and flow cytometry. The median number of regulatory T cells before and after G-CSF was statistically different (69 +/- 41 x 10(6)/L versus 161 +/- 159 x 10(6)/L, p < 0.01). We observed a 1.7-fold increase in NK and NKT cells (p < 0.009 and p < 0.02, respectively). DC were mobilized with a 11.5-fold increase in type 2 (p < 0.004) and a 8.5-fold increase in type 1 DC (p < 0.003). The patients received a mean of: 2.2 x 10(7)/kg +/- 1.4 x 10(7)/kg of NK cells, 0.95 x 10(7)/kg +/- 0.81 x 107/kg of NKT cells, 0.43 x 107/kg +/- 0.53 x 10(7)/kg of type 1 DC, 0.3 v 10(7)/kg +/- 0.45 x 10(7)/kg of type 2 DC and 1.4 x 10(7)/kg +/- 1.2 x 10(7)/kg of regulatory T cells. Using intermediate doses of G-CSF, we have demonstrated the mobilization of different lymphocyte subsets, in particular regulatory T cells and DC, which can be expanded later and used in the treatment of cancer and autoimmune diseases.

Allogeneic peripheral blood stem cell transplantation using reduced intensity versus myeloablative conditioning regimens for the treatment of leukemia.

Reduced intensity conditioning (RIC) have allowed the application of transplantation to older patients and to patients with underlying medical problems. Between October, 1999, and June, 2003, 61 patients with acute leukemia or chronic myeloid leukemia received allogeneic peripheral blood hematopoietic stem cell transplantation (HSCT) from HLA-identical siblings. Thirty-four were conditioned with myeloablative protocols and twenty-seven with RIC regimens. The patients in the myeloablative group were younger (29 vs. 37 years; p < 0.0003), most of them were transplanted in complete remission (74% vs. 59%; p < 0.03), had a shorter interval between diagnosis and HSCT (12 vs. 21 months; p < 0.02) and a greater proportion belonged to standard-risk prognosis (68% vs. 48%; p < 0.1). The median times to neutrophil, platelet and red blood cell engraftment for the myeloablative and RIC groups were 14 versus 11 days (p < 0.009), 17 versus 9 days (p < 0.0001), and 19 versus 12 days (p < 0.007), respectively. Transfusion requirements were lower in the RIC group. Severe mucositis was present in 32% and 7%, respectively (p < 0.01). The proportion of patients having acute graft versus-disease (GVHD), chronic GVHD, and infections was the same, as well as early and late mortality, disease-free survival, and overall survival. Analyzing all the patients together, three factors significantly influenced overall survival: standard risk patients, complete remission at transplant, and the absence of severe acute GVHD. In conclusion, our data suggest that even in high-risk patients, RIC transplantation seems to be as useful as ablative HSCT.