[A new setting of opportunistic cardiovascular screening: from blood donation to preventive cardiology. Preliminary results of the Cardiorisk program]. / Un nuovo modello di screening cardiovascolare di opportunità: dalla donazione di sangue alla cardiologia preventiva. Primi risultati del programma Cardiorisk.

BACKGROUND: Cardiovascular diseases remain the leading cause of mortality and disability in developed countries. Therefore, it is necessary to increase a policy of primary prevention. The most recent European guidelines recommend the use of the absolute risk profile as a tool to identify high-risk individuals, but also underline the need for interventions on the whole population. They also mentioned the concept of opportunistic screening for cardio- and cerebrovascular risk factors. METHODS: From September 2004 to December 2008, 13 619 consecutive blood donors were evaluated to determine the absolute risk profile by using the CUORE Project score. Inclusion criteria were age between 35 and 69 years, no evidence of cardiovascular disease, 12 h fasting, and informed consent. All blood donors underwent physical examination and blood tests. The absolute risk profile system includes 8 variables: age, gender, diabetes, smoking habit, systolic blood pressure, total and HDL cholesterol, and antihypertensive therapy. The population was classified into five risk categories (<5%; 5-10%; 10-15%; 15-20%; > or =20%). The results were analyzed according to age and gender. RESULTS: The mean risk score was 2.9 +/- 3 in men and 0.8 +/- 1.04 in women. Furthermore, the proportion of subjects at low risk was high even in the most advanced age groups in both sexes, differently from the general population. In particular, in young and female subjects the risk score did not exceed 20%. The proportion of men at high risk increased in adulthood, varying between 0.5% in the 50-59 age range to 4% in subjects > or =60 years. CONCLUSIONS: Our results demonstrate the feasibility of a primary cardiovascular prevention program in a new opportunistic setting, not assessed previously. The implementation of this program is a valuable tool not only to identify high-risk subjects but also to maintain a favorable risk profile in low-risk subjects over time.

Updated definitions of healthy ranges for serum alanine aminotransferase levels.

BACKGROUND: Serum alanine aminotransferase (ALT) activity, the variable most commonly measured to assess hepatic disease, fails to identify many patients with hepatic injury. Current standards for "normal" ALT level were defined by using populations that included persons with subclinical liver disease. OBJECTIVE: To update definitions of healthy ranges for serum ALT level. DESIGN: Retrospective cohort study. SETTING: A university hospital in Milan, Italy. PARTICIPANTS: 6835 persons who were first-time blood donors from 1995 through 1999, were negative for anti-hepatitis C virus (HCV), and had no contraindications to donation and 209 persons who attempted to donate blood from 1990 through 1999 but were found to have anti-HCV antibodies. Of the latter group, 131 had HCV viremia. MEASUREMENTS: Univariate and multivariate analyses examined associations between clinical and laboratory factors and ALT levels. Healthy ranges for ALT were computed from the population at lowest risk for liver disease. Sensitivity and specificity of healthy ALT ranges were evaluated in the donors with HCV antibodies, of whom 133 had liver biopsy. RESULTS: Serum ALT activity was independently related to body mass index and to laboratory indicators of abnormal lipid or carbohydrate metabolism. Updated upper limits (for men, 500 nkat/L [30 U/L]; for women, 317 nkat/L [19 U/L]) were lower than current limits (for men, 667 nkat/L [40 U/L]; for women, 500 nkat/L [30 U/L]) and, during 6-month follow-up, showed superior sensitivity in identifying participants with HCV viremia (sensitivity, 76.3% [95 % CI, 69.1% to 83.6%] vs. 55% [CI, 46.4% to 63.5%]). The related tradeoff in specificity was acceptable (88.5% [CI, 79.2% to 94.6%] vs. 97.4% [91% to 99.7%]). The increased sensitivity targeted patients with minimal to mild histologic lesions. CONCLUSION: In patients with chronic HCV infection or nonalcoholic fatty liver disease, revision of normal limits for ALT level is advisable.

Cord blood transplantation / Transplante de sangue de cordão

The transplantation of progenitor cells has been traditionally performed with bone marrow cells and more recently from peripheral blood. From the 1980s, placental or cord blood became an alternative and there is evidence that this source offers advantages compared to peripheral blood for transplant. Some data related to cord blood and its transplantation, originally presented at the XXWI Congress of Hemotology and Hemotherapy, are related in this report.

O transplante de células progenitoras têm sido realizado habitualmente com células da medula óssea e recentemente do sangue periférico. A partir dos anos 80 o sangue de cordão passou a ser uma alternativa e existem evidências de que o mesmo apresenta vantagens quando comparado ao sangue periférico para o transplante. Neste relato, sinopse da apresentação no XXVII Congresso Brasileiro de Hematologia e Hemoterapia, apresentamos alguns dados em relação ao sangue de cordão e ao transplante.