The dilution evaluation as a corrective measure for interference in the white blood cell scattergram in Beckman Coulter DxH 900.

BACKGROUND: The Beckman Coulter DxH 900 is a haematological analyser capable of counting and sizing blood cells, and obtaining a complete blood cell count (CBC). This analyses different parameters of red blood cells (RBC), platelets and white blood cells/leukocytes. Some automated CBC counters present limitations due to specimen characteristics, abnormal cells or both factors. In the presence of abnormalities, the DxH 900 has a flagging system, warning the laboratory technician that something needs to be verified. In the present work, we evaluated samples from oncologic patients, presenting a population erroneously perceived as being lymphocytes. The most common explanations for this situation are RBC resistant to lysis or serum hyperbilirubinaemia. METHODS: In an attempt to solve and understand what the cause of this problem might be, we diluted our samples (1:3) and analysed the serum total bilirubin. To identify cells' abnormalities, the samples were also analysed by manual DLC counts. During the study, we also checked the different flags presented by the equipment. RESULTS: The results evidenced that the major interference was due to RBC lysis resistance, corresponding to 94.7% of the cases, while hyperbilirubinaemia was only present in 73.4%. Besides, we determined that some samples with normal bilirubin levels also presented interference, suggesting that hyperbilirubinaemia was not the main cause of the error. The most recurrent flag observed was "High event rate". CONCLUSION: The dilution solved all of the observed interferences. The results between diluted and manual counts showed a strong correlation, leading us to introduce dilution in our laboratory routine.

Biomonitoring of polycyclic aromatic hydrocarbons exposure and short-time health effects in wildland firefighters during real-life fire events.

Human biomonitoring data retrieved from real-life wildland firefighting in Europe and, also, worldwide are scarce. Thus, in this study, 176 Portuguese firefighters were biomonitored pre- and post- unsimulated wildfire combating (average:12-13 h; maximum: 55 h) to evaluate the impact on the levels of urinary polycyclic aromatic hydrocarbons hydroxylated metabolites (OHPAH; quantified by high-performance liquid chromatography with fluorescence detection) and the associated short-term health effects (symptoms, and total and differentiated white blood cells). Correlations between these variables and data retrieved from the self-reported questionnaires were also investigated. Firefighters were organized into four groups according to their exposure to wildfire emissions and their smoking habits: non-smoking non-exposed (NSNExp), non-smoking exposed (NSExp), smoking non-exposed (SNExp), and smoking and exposed (SExp). The most abundant metabolites were 1-hydroxynaphthalene and 1-hydroxyacenaphthene (1OHNaph + 1OHAce) (98-99 %), followed by 2-hydroxyfluorene (2OHFlu) (0.2-1.1 %), 1-hydroxyphenanthrene (1OHPhen) (0.2-0.4 %), and 1-hydroxypyrene (1OHPy) (0.1-0.2 %); urinary 3-hydroxybenzo(a)pyrene was not detected. The exposure to wildfire emissions significantly elevated the median concentrations of each individual and total OHPAH compounds in all groups, but this effect was more pronounced in non-smoking (1.7-4.2 times; p ≤ 0.006) than in smoking firefighters (1.3-1.6 times; p ≤ 0.03). The greatest discriminant of exposure to wildfire emissions was 1OHNaph + 1OHAce (increase of 4.2 times), while for tobacco smoke it was 2OHFlu (increase of 10 times). Post-exposure, white blood cells count significantly increased ranging from 1.4 (smokers, p = 0.025) to 3.7-fold (non-smokers, p < 0.001), which was accompanied by stronger significant correlations (0.480 < r < 0.882; p < 0.04) between individual and total OHPAH and total white blood cells (and lymphocytes > monocytes > neutrophils in non-smokers), evidencing the impact of PAH released from wildfire on immune cells. This study identifies Portuguese firefighters with high levels of biomarkers of exposure to PAH and points out the importance of adopting biomonitoring schemes, that include multiple biomarkers of exposure and biomarkers of effect, and implementing mitigations strategies.

Baseline data and associations between urinary biomarkers of polycyclic aromatic hydrocarbons, blood pressure, hemogram, and lifestyle among wildland firefighters.

Introduction: Available literature has found an association between firefighting and pathologic pathways leading to cardiorespiratory diseases, which have been linked with exposure to polycyclic aromatic hydrocarbons (PAHs). PAHs are highlighted as priority pollutants by the European Human Biomonitoring Initiative in occupational and non-occupational contexts. Methods: This cross-sectional study is the first to simultaneously characterize six creatinine-adjusted PAHs metabolites (OHPAHs) in urine, blood pressure, cardiac frequency, and hemogram parameters among wildland firefighters without occupational exposure to fire emissions (> 7 days), while exploring several variables retrieved via questionnaires. Results: Overall, baseline levels for total OHPAHs levels were 2 to 23-times superior to the general population, whereas individual metabolites remained below the general population median range (except for 1-hydroxynaphthalene+1-hydroxyacenaphtene). Exposure to gaseous pollutants and/or particulate matter during work-shift was associated with a 3.5-fold increase in total OHPAHs levels. Firefighters who smoke presented 3-times higher total concentration of OHPAHs than non-smokers (p < 0.001); non-smoker females presented 2-fold lower total OHPAHs (p = 0.049) than males. 1-hydroxypyrene was below the recommended occupational biological exposure value (2.5 µg/L), and the metabolite of carcinogenic PAH (benzo(a)pyrene) was not detected. Blood pressure was above 120/80 mmHg in 71% of subjects. Firefighters from the permanent intervention team presented significantly increased systolic pressure than those who performed other functions (p = 0.034). Tobacco consumption was significantly associated with higher basophils (p = 0.01-0.02) and hematocrit (p = 0.03). No association between OHPAHs and blood pressure was found. OHPAHs concentrations were positively correlated with monocyte, basophils, large immune cells, atypical lymphocytes, and mean corpuscular volume, which were stronger among smokers. Nevertheless, inverse associations were observed between fluorene and pyrene metabolites with neutrophils and eosinophils, respectively, in non-smokers. Hemogram was negatively affected by overworking and lower physical activity. Conclusion: This study suggests possible associations between urinary PAHs metabolites and health parameters in firefighters, that should be further assessed in larger groups.

Severe Acute Kidney Injury in Hospitalized Cancer Patients: Epidemiology and Predictive Model of Renal Replacement Therapy and In-Hospital Mortality.

BACKGROUND: Acute kidney injury (AKI) is a common complication among cancer patients, often leading to longer hospital stays, discontinuation of cancer treatment, and a poor prognosis. This study aims to provide insight into the incidence of severe AKI in this population and identify the risk factors associated with renal replacement therapy (RRT) and in-hospital mortality. METHODS: This retrospective cohort study included 3201 patients with cancer and severe AKI admitted to a Comprehensive Cancer Center between January 1995 and July 2023. Severe AKI was defined according to the KDIGO guidelines as grade ≥ 2 AKI with nephrological in-hospital follow-up. Data were analyzed in two timelines: Period A (1995-2010) and Period B (2011-2023). RESULTS: A total of 3201 patients (1% of all hospitalized cases) were included, with a mean age of 62.5 ± 17.2 years. Solid tumors represented 75% of all neoplasms, showing an increasing tendency, while hematological cancer decreased. Obstructive AKI declined, whereas the incidence of sepsis-associated, prerenal, and drug-induced AKI increased. Overall, 20% of patients required RRT, and 26.4% died during hospitalization. A predictive model for RRT (AUC 0.833 [95% CI 0.817-0.848]) identified sepsis and hematological cancer as risk factors and prerenal and obstructive AKI as protective factors. A similar model for overall in-hospital mortality (AUC 0.731 [95% CI 0.71-0.752]) revealed invasive mechanical ventilation (IMV), sepsis, and RRT as risk factors and obstructive AKI as a protective factor. The model for hemato-oncological patients' mortality (AUC 0.832 [95% CI 0.803-0.861]) included IMV, sepsis, hematopoietic stem cell transplantation, and drug-induced AKI. Mortality risk point score models were derived from these analyses. CONCLUSIONS: This study addresses the demographic and clinical features of cancer patients with severe AKI. The development of predictive models for RRT and in-hospital mortality, along with risk point scores, may play a role in the management of this population.

Unveiling hidden toxin diversity: Discovery of novel venom components through manual curation of highly expressed sequences annotated as "no hits" in Phoneutria nigriventer spider venom gland transcriptome.

Spider venoms have evolved over thousands of years, optimizing feeding and defense mechanisms. Venom components show pharmacological and biotechnological potential, rising interest in their study. However, the isolation of spider toxins for experimental evaluation poses significant challenges. To address this, transcriptomic analysis combined with computational tools has emerged as an appealing approach to characterizing spider venoms. However, many sequences remain unidentified after automatic annotation. In this study, we manually curated a subset of previously unannotated sequences from the Phoneutria nigriventer transcriptome and identified new putative venom components. Our manual analysis revealed 29 % of the analyzed sequences were potential venom components, 29 % hypothetical/uncharacterized proteins, and 17 % cellular function proteins. Only 25 % of the originally unannotated dataset remained without any identification. Most reclassified components were cysteine-rich peptides, including 23 novel putative toxins. We also found glycine-rich peptides (GRP), corroborating the previous description of GRPs in Phoneutria pertyi venom glands. Furthermore, to emphasize the recurrence of the lack of annotation in spider venom glands transcripts, we provide a survey of the percentage of unidentified sequences in several published spider venom transcriptomics studies. In conclusion, our study highlights the importance of manual curation in uncovering novel venom components and underscores the need for improved annotation strategies to fully exploit the medical and biotechnological potential of spider venoms.

Malignant phyllodes tumor of the breast in ayoung patient ­ case report

Phyllodes tumor (PT) is an uncommon form of breast tumor. It occurs most commonly in women aged 35 to 65 years. The benign form represents about 85­90% of cases and only 10­15% of PTs are malignant. Clinically and radiologically, malignant phyllodes tumor (MPT) presents as regular, well-delimited, mobile nodules that are difficult to distinguish from fibroadenomas of the breast. The most important differential diagnoses of MPT include fibroadenoma, metaplastic carcinoma, and sarcoma. The prognosis of MPT exhibits a higher frequency of local recurrence and metastatic rate with larger tumors and inadequate surgical margins. The case presented here refers to a 24-year-old female patient, with a vast tumor in the right breast, with rapid and progressive growth, associated to local pain, and histological diagnosis of MPT. Surgery was the initial treatment, followed by adjuvant chemotherapy and radiotherapy. The purpose of this article was to report an atypical case of MPT of the breast in a very young woman as well as to make a brief literature review on this infrequent and dangerous disease. (AU)

Patient perspectives on home-spirometry in interstitial lung disease: a qualitative co-designed study.

BACKGROUND: Opportunities for home-monitoring are increasing exponentially. Home- spirometry is reproducible and reliable in interstitial lung disease (ILD), yet patients' experiences are not reported. Given the morbidity and mortality associated with ILDs, maintaining health-related quality-of-life is vital. We report our findings from a codesigned, qualitative study capturing the perspectives and experiences of patients using home-spirometry in a UK regional ILD National Health Service England (NHSE) commissioned service. METHODS: Patients eligible for home-spirometry as routine clinical care, able to give consent and able to access a smart phone were invited to participate. In-depth, semistructured interviews were conducted at serial time points (baseline, 1, 3 and 6 months), recorded, transcribed and analysed thematically. RESULTS: We report on the experiences of 10 recruited patients (8 males; median age 66 years, range 50-82 years; 7 diagnosed with idiopathic pulmonary fibrosis, 3 other ILDs) who generally found spirometry convenient and easy to use, but their relationships with forced vital capacity results were complex. Main themes emerging were: (1) anticipated benefits-to identify change, trigger action and aid understanding of condition; (2) needs-clinical oversight and feedback, understanding of results, ownership, need for data and a need 'to know'; (3) emotional impact-worry, reassurance, ambivalence/conflicting feelings, reminder of health issues, indifference; (4) ease of home-spirometry-simplicity, convenience and (5) difficulties with home-spirometry-technical issues, technique, physical effort. CONCLUSION: Home-spirometry has many benefits, but in view of the potential risks to psychological well-being, must be considered on an individual basis. Informed consent and decision-making are essential and should be ongoing, acknowledging potential limitations as well as benefits. Healthcare support is vital.

Performance assessment of the MOF adsorbent MIL-101 for removal of gaseous benzene and toluene: kinetic column modeling and simulation studies of fixed-bed adsorption.

The adsorbent MIL-101, a metal-organic framework material, was synthesized, characterized, and tested for removal of relatively low concentrations of benzene and toluene adsorbates (200 ppm) from a gas phase in a continuous flow system. Breakthrough studies were modeled based on Thomas, Yoon-Nelson, Yan, Clark, Bohart-Adams, bed-depth service time, modified dose response, Wolborska, and Gompertz in the continuous fixed-bed operation. Through statistical analysis, it was determined which type of regression is most suitable for the studied models, linear or nonlinear. By comparing the values of error functions, it was possible to infer that the Thomas model is the best match for the experimental breakthrough curves for benzene (with maximum solid-phase concentration qT=126,750 mg/g) and the Gompertz model for toluene (parameter ß=0.01 min-1). Overall, when compared to the model parameters of the linear regression, those obtained through nonlinear regression show a stronger correlation with the results found experimentally. Thus, this type of regression is more suitable for the adsorption model analysis. The liquid film and intraparticle diffusion analysis was described, and it was suggested that both types of diffusion contribute to the adsorption mechanism of benzene and toluene on MIL-101. As for the isotherms, the adsorption process was better fitted by the Freundlich isotherm. The reusability of MIL-101 after six cycles was 76.5% for benzene and 62.4% for toluene, indicating that MIL-101 was a better adsorbent for the removal of benzene in comparison with toluene.

Self-regulated learning e ensino médico: revisão de literatura / Self-regulated learning and medical education: a literature review

Resumo: Introdução: A aprendizagem autorregulada (self-regulated learning - SRL) é o processo ativo que o aluno realiza para atingir seus objetivos de aprendizagem. No ensino médico, pelo fato de o ambiente clínico ser propício para o desenvolvimento da SRL, há potencial benefício na aplicação dessa ferramenta no processo de ensino-aprendizado, embora as diferenças em seus cenários de aplicação exijam uma análise mais aprofundada. Objetivo: Este artigo apresenta uma revisão da literatura sobre o histórico do desenvolvimento da SRL, sua aplicabilidade e avaliação em estudantes de Medicina por meio de escala validada, além dos fatores que a influenciam, como métodos de ensino e questões demográficas e socioculturais. Método: Realizou-se uma busca com o descritor self-regulated learning nas plataformas PubMed e SciELO e na revista Medical Education Online para artigos em inglês publicados entre 2010 e 2021. Resultado: A busca nas bases de dados resultou em 198 artigos, dos quais foram selecionados 100 para a análise crítica. Desses 100 artigos, selecionaram-se 31 que preenchiam os critérios desta revisão. Conclusão: A SRL é um conceito contemporâneo considerado pilar no processo educacional. Trata-se de ferramenta de grande valor em psicologia educacional. A aplicabilidade da SRL no contexto do ensino médico demonstra-se efetiva e traz consigo especificidades sobre a autorregulação do estudante de Medicina. Contudo, são necessários novos estudos acerca do tema, de modo a permitir o desenvolvimento de métodos instrucionais eficazes com sua utilização.

Abstract: Introduction: Self-regulated learning (SRL) is the active process that students perform to achieve their learning goals. In medical education, the development of SRL is favoured by the clinical environment, hence there is potential benefit in applying this tool in the teaching-learning process, although the differences in its application scenarios require deeper analysis. Objective: The aim of this article is to present a literature review on the development of SRL, its applicability and evaluation in medical students using a validated scale, and the factors that influence it, such as teaching methods and demographic and sociocultural issues. Method: A search was performed on the Pub-med and Scielo platforms and the online Medical Education Journal for articles in English published between 2010 and 2021 using the descriptors "Self-regulated learning". Results: The database search resulted in 198 articles, of which 100 were selected for critical analysis. Of these, 31 articles were selected based on meeting the criteria of this review. Conclusions: SRL is a contemporary educational concept and considered a pillar in the educational process. It is a valuable tool in educational psychology. Its applicability in the context of medical education proves to be effective and brings with it specificities in relation to the self-regulation of medical students. However, further studies on the subject are necessary to allow for the development of effective instructional methods to support its use.

Evaluation of clinical, pathological and epidemiological profile of patients with breast cancer in the microregion of Lavras ­ MG

Breast cancer is associated with high frequency and mortality in Brazilian women. There have been limited studies portraying the characteristics of breast cancer cases in the countryside of the state of Minas Gerais for a long period of time, a fact that will allow us to better understand the epidemiology of these tumors. This descriptive study aims to analyze the epidemiology and clinical features of patients with breast cancer treated at a public health service facility in Lavras, MG. Methods: This is a transversal study with 299 women diagnosed with breast cancer between 2002 and 2022, based on data collection from medical records and subsequent descriptive analysis. Results: There were a total of 317 cases, and 299 were eligible for the study. The mean age at diagnosis was 54.2 years, and 36.1% of the patients were under 50 years old at diagnosis. Positive family history was found in 17.0% of the patients. The diagnosis was made by clinical alteration detected on physical examination in 71.5% of cases, and lump was the most frequent type of lesion (89.0%). Invasive carcinoma was 93.1% of the cases, and the mean tumor size was 28.6 mm. The average time between first medical appointment and diagnosis was 63.2 days, and between diagnosis and beginning of treatment was 39.6 days. Conclusions: This study showed that a significant number of cases occurred in women outside the recommended age for screening in Brazil. Diagnosis was predominantly performed by clinical examination, with delays in obtaining the histological diagnosis, and the stage at diagnosis was high, and these facts were associated with the health system limitations (AU)

Acute kidney injury after allogeneic hematopoietic stem cell transplantation - Predictors and survival impact: A single center retrospective study.

INTRODUCTION AND OBJECTIVES: Acute kidney injury (AKI) is a frequent complication of hematopoietic stem cell transplantation (HSCT) and appears to be linked to increased morbidity and mortality. The aim of this study was to evaluate the incidence, etiology, predictors and survival impact of early AKI in the post-allogeneic HSCT setting. PATIENTS AND METHODS: We performed a retrospective single center study that included 155 allogeneic transplant procedures from June 2017 through September 2019. RESULTS: AKI was observed in 50 patients (32%). In multivariate analysis, age (OR 31.55, 95% CI [3.42; 290.80], p=0.002), evidence of disease at the time of transplant (OR 2.54, 95% CI [1.12; 5.75], p=0.025), cytomegalovirus reactivation (OR 5.77, 95% CI [2.43; 13.72], p<0.001) and hospital stay >35 days (OR 2.66, 95% CI [1.08; 6.52], p=0.033) were independent predictors for AKI. Increasing age (HR 1.02, 95% CI [1.00; 1.04], p=0.029), increasing length of hospital stay (HR 1.02, 95% CI [1.01; 1.03], p=0.002), matched unrelated reduced intensity conditioning HSCT (HR 1.91, 95% CI [1.10; 3.33], p=0.022), occurrence of grade III/IV acute graft-versus-host disease (HR 2.41, 95% CI [1.15; 5.03], p=0.019) and need for mechanical ventilation (HR 3.49, 95% CI [1.54; 7.92], p=0.003) predicted an inferior survival in multivariate analysis. Early AKI from any etiology was not related to worse survival. CONCLUSION: Patients submitted to HSCT are at an increased risk for AKI, which etiology is often multifactorial. Due to AKI incidence, specialized nephrologist consultation as part of the multidisciplinary team might be of benefit.

Acute Kidney Injury After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy in a Portuguese Population.

Background: Acute kidney injury (AKI) after cytoreductive surgery followed by the infusion of hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is associated with a higher rate of major complications, resulting in prolonged hospitalization and increased mortality. Our objective was to evaluate the incidence of AKI and further progression to chronic kidney disease (CKD) in patients submitted to this procedure and recognize the associated risk factors. Methods: This retrospective study collected demographic, tumor-related, intraoperative, and postoperative data from 182 patients who underwent CRS/HIPEC from January 2016 to December 2019. Renal impairment was defined according to Kidney Disease Improving Global Outcomes criteria for AKI. We conducted univariate and multiple logistic regression analyses to assess the association between variables of interest and AKI. Results: Twenty-three patients (12.6%) developed AKI. In the AKI group, the risk for developing CKD was six times higher (odds ratio (OR) 6.48, confidence interval (CI) 1.601 - 26.255). Multivariate regression identified higher risk of developing AKI in patients who underwent HIPEC with cisplatin (OR 12.21, CI 1.26 - 109.70, P = 0.025), in each additional day spent in the intensive care unit (ICU) (OR 2.42, CI 1.07 - 5.45, P = 0.033), and an association for each unit increase in estimated glomerular filtration rate (eGFR) before HIPEC (OR 0.96, CI 0.94 - 0.98, P = 0.037) and AKI development. Conclusion: Patients who are at higher risk of AKI after CRS/HIPEC include those who performed cisplatin HIPEC regimen, had poorer preoperative renal function and had longer ICU stays. Early institution of preventive measures and frequent monitoring should be considered to minimize AKI risk and its associated morbidity, such as CKD progression.

Free nipple graft: current indications and applications of a centenary breast surgery technique ­ an integrative review

Introduction: Free nipple graft is a mammaplasty technique first described about 100 years ago. Its indication, restricted to reduction mammoplasty earlier, has been expanding into areas in mastology intervention, such as transgender and oncological surgery. Aim: The aim of this study was to evaluate the efficacy and outcomes of the technique. Methods: Electronic literature search was conducted, using PubMed and LILACS databases. The search strategy consisted of the keywords, MeSH terms, and free text words and variants for the free nipple graft and its application in reduction and mammaplasty, transgender, and oncoplastic surgery. Results: A total of 397 articles were found and, after inclusion and exclusion criteria, 15 were selected. Their outcomes have been shown, despite lack of standardized scores, as well as clinical trials to postulate better scientific evidence on its use and indications, that the technique, analyzed in over 1290 patients, achieved high safety rates and reproducibility. Conclusion: Aesthetics and patients satisfaction were found positive, as recommended by the authors in different studies discussed in this article.

Linfoma cardíaco primário: o papel da multimodalidade de imagem na abordagem diagnóstica / Primary cardiac lymphoma: role of imaging multimodality in diagnosis

Massas intracardíacas constituem um desafio diagnóstico, já que os sintomas são comuns a patologias cardiovasculares ou não. Métodos ­ invasivos ou não ­ possibilitam o diagnóstico diferencial e a confirmação histológica, propiciando tratamento adequado. Para melhor compreender a importância da multimodalidade em imagem e a abordagem nos tumores cardíacos , relatamos o caso de um lifoma cardíaco primário, em que a abordagem multidisciplinar permitiu o rápido diagnóstico e seu tratamento, inclusive das intercorrências, com resposta inicial promissora, a despeito da evolução fatal durante a pandemia por SARS-CoV-2.(AU)

Intracardiac masses are a diagnostic challenge since their symptoms can be common to cardiovascular pathologies. Some methods, whether invasive or not, enable differential diagnosis, histological confirmation, and adequate treatment. To better understand the importance of imaging multimodality and the approach to managing cardiac tumors, we investigated a case of a primary cardiac lymphoma in which the multidisciplinary approach allowed rapid diagnosis and treatment, including of intercurrences, with a promising initial response despite fatal progression due to severe acute respiratory syndrome coronavirus 2 infection. (AU)

IgA nephropathy in IgG kappa multiple myeloma.

Multiple myeloma (MM) frequently affects kidney function through multiple mechanisms. Nonetheless, some patients develop kidney injury due to other causes. A 54-year-old woman was diagnosed with IgG kappa MM developed IgA nephropathy without cast nephropathy. Further studies did not show criteria for MM progression or other causes. This case highlights the need for further investigation of kidney injury in MM patients (such as toxicity of previous drugs, infectious events, or immune-mediated disorders).

Acceptance of Pharmaceutical Services by Home-Dwelling Older Patients: A Case Study in a Portuguese Community Pharmacy.

BACKGROUND: Aging-related comorbidities predispose older adults to polypharmacy and consequently an increased risk of adverse drug reactions and poor compliance. Pharmacists' interventions can have a beneficial impact on the improvement of clinical outcomes. Thus, this work aimed to assess the acceptance of Portuguese home-dwelling older adults regarding a pharmaceutical service paid by patients for medication management and pharmacotherapy follow-up. We also intended to analyze medication, characterize the medication consumption profile, and identify the main difficulties of our sample during their daily medication management. METHODS: A questionnaire on adherence and medication therapy management was applied to polymedicated patients ≥65 years old, in a community pharmacy. RESULTS: Of the 88 participants, 92.2% would be willing to pay for a pharmacotherapy management service, and 75.6% answered that they would be willing to pay for an individual medication preparation service. In addition, 45.7% of the participants were categorized as lower adherents to a medication therapeutic regimen. Our sample reported that during their daily lives, they felt difficulty: to remember to take their pills (17%), to manage so many medicines (15.9%), and to swallow the pills (9.1%). CONCLUSIONS: Polymedicated older adults are willing to pay for a service to improve the management of their medicines, suggesting that they recognize the role of pharmacists in medication management. This study provides useful information for the conceptualization of a pharmacotherapy management service that includes medication review and a pharmacotherapy follow-up.

Thrombotic microangiopathy in oncology - a review.

Thrombotic microangiopathy is a syndrome triggered by a wide spectrum of situations, some of which are specific to the Oncology setting. It is characterized by a Coombs-negative microangiopathic haemolytic anemia, thrombocytopenia and organ injury, with characteristic pathological features, resulting from platelet microvascular occlusion. TMA is rare and its cancer-related subset even more so. TMA triggered by drugs is the most common within this group, including classic chemotherapy and the latest targeted therapies. The neoplastic disease itself and hematopoietic stem-cell transplantation could also be potential triggers. Evidence-based medical guidance in the management of cancer-related TMA is scarce and the previous knowledge about primary TMA is valuable to understand the disease mechanisms and the potential treatments. Given the wide spectrum of potential causes for TMA in cancer patients, the aim of this review is to gather the vast information available. For each entity, pathophysiology, clinical features, therapeutic approaches and prognosis will be covered.

NOPCHAP1 is a PAQosome cofactor that helps loading NOP58 on RUVBL1/2 during box C/D snoRNP biogenesis.

The PAQosome is a large complex composed of the HSP90/R2TP chaperone and a prefoldin-like module. It promotes the biogenesis of cellular machineries but it is unclear how it discriminates closely related client proteins. Among the main PAQosome clients are C/D snoRNPs and in particular their core protein NOP58. Using NOP58 mutants and proteomic experiments, we identify different assembly intermediates and show that C12ORF45, which we rename NOPCHAP1, acts as a bridge between NOP58 and PAQosome. NOPCHAP1 makes direct physical interactions with the CC-NOP domain of NOP58 and domain II of RUVBL1/2 AAA+ ATPases. Interestingly, NOPCHAP1 interaction with RUVBL1/2 is disrupted upon ATP binding. Moreover, while it robustly binds both yeast and human NOP58, it makes little interactions with NOP56 and PRPF31, two other closely related CC-NOP proteins. Expression of NOP58, but not NOP56 or PRPF31, is decreased in NOPCHAP1 KO cells. We propose that NOPCHAP1 is a client-loading PAQosome cofactor that selects NOP58 to promote box C/D snoRNP assembly.

Production, physicochemical quality and antioxidant capacity of 'Niagara Rosada' grape grafted on different rootstocks / Produção, qualidade físico-química e capacidade antioxidante da uva 'Niagara Rosada' sobre diferentes porta-enxertos

The objective of this study is to evaluate the effect of rootstocks on grape production, quality and antioxidant capacity of 'Niagara Rosada' grape in two productive cycles. The work was developed in Jundiaí-SP, Brazil (26° 06' S, 46° 55' W and an average altitude of 745 m). The experimental design was in randomized blocks with subdivided plots, the plots being represented by the rootstocks and the subplots by the production cycles, with four replications, each consisting of 6 plants. The treatments consisted of a combination of 'IAC 313 Tropical', 'IAC 572 Jales', 'IAC 571-6 Jundiaí', 'IAC 766 Campinas' and '106-8 Mgt' as rootstocks and 'Niagara Rosada' as graft, and the production cycles were 2013 and 2014. The number of bunches, production and productivity of the vines, the physical characteristics of bunches, berries and stalks and the physicochemical composition of the must (soluble solids content, titratable acidity, pH and the relation soluble solids/titratable acidity) were evaluated in production cycles of 2013 and 2014). The content of chlorophylls, anthocyanins, carotenoids, flavonoids and total phenolic compounds and the antioxidant activity of grapes were also evaluated in grape berries. The rootstocks did not influence the production and physical quality of 'Niagara Rosada' grapes. As for the chemical characteristics, rootstocks only had an effect on solids content, and 'IAC 766' and '106-8 Mgt' rootstocks promoted higher values of this characteristic. Likewise, the total phenolic compounds and the antioxidant activity of the grapes were not influenced by the studied rootstocks. The vines in 2013 presented higher production and better physical characteristics of the grapes, however, the soluble solids content in this cycle was lower than in 2014.

Objetivou-se avaliar a influência de porta-enxertos na produção da videira, na qualidade e capacidade antioxidante da uva 'Niagara Rosada' em dois ciclos produtivos. O trabalho foi realizado em Jundiaí-SP, Brasil (26° 06' S, 46° 55' W e uma altitude média de 745m). O delineamento experimental foi de blocos causalizados em parcelas subdivididas, as parcelas foram representas pelos porta-enxertos e as subparcelas pelos ciclos de produção, com quatro repetições, constituídas de 6 plantas. Os tratamentos consistiram na combinação entre os porta-enxertos 'IAC 313 Tropical', 'IAC 572 Jales', 'IAC 571-6 Jundiaí', 'IAC 766 Campinas' e '106-8 Mgt' e a variedade copa 'Niagara Rosada', e os ciclos produtivos de 2013 e 2014. O número de cachos, produção e produtividade das videiras, as características físicas de cachos, bagas e engaços e a composição físico-química do mosto (teor de sólidos solúveis, acidez titulável, pH e relação sólidos solúveis/acidez titulável) foram avaliados nos ciclos de produção de 2013 e 2014. Avaliou-se ainda nas bagas das uvas o conteúdo de clorofilas, antocianinas, carotenoides, flavonoides e compostos fenólicos totais e a atividade antioxidante. Os porta-enxertos não influenciaram a produção e a qualidade física da uva 'Niagara Rosada'. Quanto as características químicas houve efeito dos porta-enxertos apenas no teor de sólidos solúveis, sendo que os porta-enxertos 'IAC 766' e '106-8 Mgt' promoveram maiores valores dessa característica. Da mesma forma, os compostos fenólicos totais e a atividade antioxidante das uvas não foram influenciados pelos porta-enxertos estudados. As videiras, em 2013 apresentaram maior produção e melhores características físicas das uvas, no entanto, o teor de sólidos solúveis nesse ciclo foi inferior ao de 2014.