History of Seborrheic Dermatitis: Conceptual and Clinico-Pathologic Evolution.

Seborrheic dermatitis is an inflammatory and chronic disease with a high incidence and prevalence (1% to 3% in the general population, 3% to 5% in young adults, and 40% to 80% in HIV-positive individuals). Although the condition was first described in 1887, its clinical aspects and clinical forms have still not been well individualized, nor has its etiopathogenesis been fully elucidated. The disease, despite having clinical features similar to dermatitis, does not have the same histopathologic features or the same progressive clinical behavior. This contribution reviews the history of seborrheic dermatitis.

Reduced-intensity conditioning and HLA-matched haemopoietic stem-cell transplantation in patients with chronic granulomatous disease: a prospective multicentre study.

BACKGROUND: In chronic granulomatous disease allogeneic haemopoietic stem-cell transplantation (HSCT) in adolescents and young adults and patients with high-risk disease is complicated by graft-failure, graft-versus-host disease (GVHD), and transplant-related mortality. We examined the effect of a reduced-intensity conditioning regimen designed to enhance myeloid engraftment and reduce organ toxicity in these patients. METHODS: This prospective study was done at 16 centres in ten countries worldwide. Patients aged 0-40 years with chronic granulomatous disease were assessed and enrolled at the discretion of individual centres. Reduced-intensity conditioning consisted of high-dose fludarabine (30 mg/m(2) [infants <9 kg 1·2 mg/kg]; one dose per day on days -8 to -3), serotherapy (anti-thymocyte globulin [10 mg/kg, one dose per day on days -4 to -1; or thymoglobuline 2·5 mg/kg, one dose per day on days -5 to -3]; or low-dose alemtuzumab [<1 mg/kg on days -8 to -6]), and low-dose (50-72% of myeloablative dose) or targeted busulfan administration (recommended cumulative area under the curve: 45-65 mg/L × h). Busulfan was administered mainly intravenously and exceptionally orally from days -5 to -3. Intravenous busulfan was dosed according to weight-based recommendations and was administered in most centres (ten) twice daily over 4 h. Unmanipulated bone marrow or peripheral blood stem cells from HLA-matched related-donors or HLA-9/10 or HLA-10/10 matched unrelated-donors were infused. The primary endpoints were overall survival and event-free survival (EFS), probabilities of overall survival and EFS at 2 years, incidence of acute and chronic GVHD, achievement of at least 90% myeloid donor chimerism, and incidence of graft failure after at least 6 months of follow-up. FINDINGS: 56 patients (median age 12·7 years; IQR 6·8-17·3) with chronic granulomatous disease were enrolled from June 15, 2003, to Dec 15, 2012. 42 patients (75%) had high-risk features (ie, intractable infections and autoinflammation), 25 (45%) were adolescents and young adults (age 14-39 years). 21 HLA-matched related-donor and 35 HLA-matched unrelated-donor transplants were done. Median time to engraftment was 19 days (IQR 16-22) for neutrophils and 21 days (IQR 16-25) for platelets. At median follow-up of 21 months (IQR 13-35) overall survival was 93% (52 of 56) and EFS was 89% (50 of 56). The 2-year probability of overall survival was 96% (95% CI 86·46-99·09) and of EFS was 91% (79·78-96·17). Graft-failure occurred in 5% (three of 56) of patients. The cumulative incidence of acute GVHD of grade III-IV was 4% (two of 56) and of chronic graft-versus-host disease was 7% (four of 56). Stable (≥90%) myeloid donor chimerism was documented in 52 (93%) surviving patients. INTERPRETATION: This reduced-intensity conditioning regimen is safe and efficacious in high-risk patients with chronic granulomatous disease. FUNDING: None.

Recalcitrant Sterile Abscesses by Volux®: A New Therapeutic Approach.

The number of patients developing sterile abscesses because of hyaluronic acid (HA) filler procedures has increased for unknown reasons. We described this adverse reaction after filling with Juvederm Volux®, the latest innovative product in the Vycross range of technology. We presented five patients with recalcitrant sterile abscesses after filling with Juvederm Volux® who did not respond to the traditional therapy but whose lesions were resolved with the "Munhoz-Cavallieri lavage protocol" developed and recently published by the present authors. (SKINmed. 2023;21:27-33).

Rationale and Guidelines for the Use of Hyaluronidase: A Practical Guide for Complications Caused by Hyaluronic Acid.

The use of enzyme hyaluronidase to treat the complications of different brands of hyaluronic acid (HA) dermal fillers is increasing in the same proportion as the number of nonsurgical cosmetic procedures. Guidelines for diagnosing and treating complications remain controversial and are primarily based on anecdotal reports and small case series. We proposed approaching HA-related complications based on our clinical research and observations of treating more than 200 patients and providing a practical guide for the thoughtful use of hyaluronidase according to adverse events. Standardization of hyaluronidase dose and concentration is beneficial for better outcomes and future comparative analyses of the results of this treatment worldwide. The use of hyaluronidase is increasing for the reversal of the clinical manifestations of complications caused by HA fillers, although a consensus is lacking. We propose using different doses and concentrations of hyaluronidase to focus on selected anatomic areas considering properties of the product and pathogenesis of each complication.

Sterile abscess due to hyaluronic acid: A new diagnosis and a proposal for treatment-A series of eight cases.

BACKGROUND: In recent years, fillers procedures with hyaluronic acid (HA) have grown significantly. Despite HA relative safety, the number of cases of complications after injections has grown, and in many of which, we are not aware of or have little control over. AIMS: In this article, the authors describe a new adverse reaction after filling with HA injection, the sterile abscess. PATIENTS/METHODS: We present eight patients with similar clinical, laboratory, and ultrasound characteristics for sterile abscess and report a new therapeutic modality for it. RESULTS: All cases were treated with "Munhoz-Cavallieri Lavage Protocol" procedure with complete resolution. CONCLUSIONS: "Munhoz-Cavallieri Lavage Protocol" serves as a guideline in diagnosis and management of sterile abscess.

Reduction of skin-homing cytotoxic T cells (CD8+ -CLA+) in patients with vitiligo.

BACKGROUND: Vitiligo is a frequently acquired, hereditary disease, characterized by achromic macules due to the absence of melanocytes. In contrast with earlier studies, in which the main pathogenic role was attributed to anti-melanocyte antibodies, recent papers have emphasized a role for CD8(+) cytotoxic T lymphocytes in melanocyte destruction. Fifteen percent of peripheral T cell express cutaneous lymphocyte-associated antigen (CLA), responsible for skin-homing T cell. Phototherapy is used to treat patients with generalized vitiligo and it has been shown to interfere with CLA(+) T cells in other skin diseases. OBJECTIVE: To describe peripheral blood T cell subpopulations' frequency and ability to express the skin-homing molecule (CLA) in patients with non-segmental vitiligo, before and after photochemotherapy (PUVA). PATIENTS AND METHODS: Twenty-two patients with generalized and active spreading vitiligo were submitted to 30 PUVA-8MOP sessions. Lymphocyte immunophenotyping was performed by flow cytometry using anti-CD3, anti-CD8 and anti-CLA monoclonal antibodies. Fifteen healthy volunteers, sex- and age-matched, were included as a control group. RESULTS: CD8(+) -CLA(+) T cells were significantly reduced in number in untreated vitiligo patients (P=0.008) when compared with control individuals, albeit with a more intense CLA expression (P=0.028). These findings were not altered after PUVA. No significant difference was noticed in CD4/CD8 ratios nor in CD4-CLA(+) T cell numbers between vitiligo patients and controls, both before and after PUVA. CONCLUSIONS: CD8-CLA(+) T cells are reduced in peripheral blood of patients with non-segmental vitiligo. This finding may be related to the previously reported increase of CD8(+) cells in both lesions and perilesional skin of these patients.

Uma periferia, dois centros: o município de Praia Grande no contexto da formação da macrometrópole paulista no começo do século XXI / One periphery, two centers: the municipality of Praia Grande in the context of the formation of the macrometropolis of São Paulo at the beginning of the 21st century / Una periferia, dos centros: el municipio de Praia Grande en el contexto de la formación de la macrometrópolis de São Paulo a principios del siglo XXI

O presente estudo tem dois objetivos principais: discutir os impactos, consequências e respostas demográficas do processo de expansão e estruturação de grandes aglomerações urbanas, com especial enfoque no caso do município de Praia Grande/SP na Região Metropolitana da Baixada Santista (RMBS); e examinar, com mais detalhes, as nuances da mobilidade populacional e, em particular, das modalidades migratórias (e suas características), como elementos importantes da peculiar inserção regional do referido município enquanto "periferia simultânea" de duas regiões metropolitanas. A partir do uso exaustivo dos dados censitários, em especial dos Censos Demográficos de 2000 e 2010, analisam-se o crescimento e a expansão territorial de Praia Grande, enfatizando, em nível intramunicipal, o papel das distintas modalidades de migração (intrametropolitana e inter-regional). Além disso, procura-se associá-las a diferentes motivações a partir de um olhar detalhado para o perfil sociodemográfico dos fluxos estabelecidos. Como principais resultados do trabalho, observou-se que o papel de Praia Grande enquanto área de expansão metropolitana da RMBS se encontra lastreado pelos crescentes fluxos migratórios intrametropolitanos provenientes do polo regional, realidade esta que igualmente pode ser vista em outros contextos metropolitanos. No entanto, enquanto peculiaridade de seu processo de ocupação e inserção regional, parte majoritária dessa migração é originária de fora da RMBS, mais precisamente do município de São Paulo, centro de outra importante área de metropolitana, fato que contribui para caracterizar Praia Grande como uma "periferia com dois centros".

The present study has two main objectives: the first one is to discuss the impacts, consequences and demographic responses of the process of expansion and structuring of large urban agglomerations, with special focus on the case of Praia Grande/SP in the Metropolitan Area of Baixada Santista; the second one, to examine in more detail the nuances of population mobility and, in particular, migratory modalities (and their characteristics), as important elements of the peculiar regional insertion of that municipality as "simultaneous periphery" of two metropolitan areas. Based on the exhaustive use of census data, especially the Demographic Census of 2000 and 2010, this study presents an analysis of the growth and territorial expansion of Praia Grande emphasizing, at intra-municipal level, the role of the different migration modalities (intra-metropolitan and inter-regional). In addition, it seeks to associate them to different motivations from a detailed look at the sociodemographic profile of established flows. As main results of the work, it was observed that the role of Praia Grande as an area of metropolitan expansion of RMBS is supported by the growing intra-metropolitan migratory flows from the regional core, a reality that can also be observed in other metropolitan contexts. However, as a peculiarity of its process of occupation and regional insertion, a major part of this migration comes from outside the RMBS, more precisely, from the municipality of São Paulo, the center of another important metropolitan area, a fact that contributes to characterize Praia Grande as a "periphery with two centers".

El presente estúdio tiene dos objetivos principales: el primero, discutir los impactos, las consecuencias y las respuestas demográficas del proceso de expansión y estructuración de grandes aglomeraciones urbanas, con énfasis en el caso de Praia Grande (São Paulo) en la Región Metropolitana de Baixada Santista (RMBS); el segundo, examinar con más detalle los matices de la movilidad de la población y, en particular, de las modalidades migratorias (y sus características), como elementos importantes de la peculiar inserción regional del município como una "periferia simultánea" de dos regiones metropolitanas. A partir de los datos del censo, especialmente de los censos de 2000 y 2010, el estúdio presenta un análisis del crecimiento y la expansión territorial de Praia Grande con énfasis en el proceso intramunicipal, el papel de las diferentes modalidades de migración (intrametropolitana e interregional). Además, busca asociar estos movimientos a diferentes motivaciones a partir de una mirada sobre el perfil sociodemográfico de los flujos establecidos. Como resultado principal del trabajo, se observó que el papel de Praia Grande como área de expansión metropolitana de la RMBS es respaldado por el incremento de los flujos migratórios intrametropolitanos con origen en el polo regional, una realidad que también se puede ver en otros contextos metropolitanos. Sin embargo, como peculiaridad de su proceso de ocupación e inserción regional, parte significativa de esa migración se origina fuera de la RMBS, más precisamente, en la ciudad de São Paulo, cientro de otra región metropolitana (la Región Metropolitana de São Paulo), hecho que contribuye a caracterizar el municipio de Praia Grande como una "periferia de dos centros".

Immunomodulatory and anti-inflammatory effects of Kalanchoe brasiliensis.

The immunomodulatory effect of juice obtained from leaves of Kalanchoe brasiliensis (Kb) on zymosan-induced inflammation was investigated. C57B110 mice received a subcutaneous injection of 150 microg zymosan in the footpad. After 7 days, there was an increase in footpad thickness from 176 +/- 4 to 236 +/- 9 x 10(-2) mm and in blood flow in the footpad area, monitored by 99mTc, from 98 +/- 4 to 694 +/- 59 counts per minute (cpm). Zymosan induced a severe infiltration of leukocytes into the articular tissues and a 13-fold increase in the adjacent popliteal lymph node (PLN) weight. Beginning 2 days after the injection, mice were treated daily for 5 days with different concentrations of lyophilised Kb juice dissolved in water. Treatment with 480 mg/kg/day reduced footpad thickness to 193 +/- 5 x 10(-2) mm, leukocyte infiltration and blood flow to 150 +/- 18 cpm in the footpad area. PLN weight in zymosan-injected mice decreased from 6.5 +/- 0.5 to 1.5 +/- 0.4 mg, similarly to the decrease after treatment with indomethacin (3 mg/kg/day). Flow cytometric analysis of lymph node cells showed an important reduction in B cell number in Kb-treated mice. Treatment over a period of 10 days was also effective at reducing zymosan-induced inflammation, even when started 7 days after injection. These data suggest anti-inflammatory and immunosuppressive effects of K. brasiliensis that may account for its popularity in folk medicine against rheumatic diseases.

Tumor necrosis factor-alpha and the cytokine network in psoriasis.

New molecular methods of research have greatly expanded the knowledge about the role of cytokines in several diseases, including psoriasis. The work orchestrated by these peptides is essential for the communication between resident inflammatory cells (keratinocytes and endothelial cells) and infiltrating cells (neutrophils, lymphocytes, Langerhans cells). This is a complex network due to redundancy, synergism and, sometimes, the antagonism of cytokines, which prevents full understanding of the pathogenesis of the disease. Currently, it seems premature to try to establish a main actor, but TNFalpha participates in all stages of psoriatic plaque development, as we shall see.

Aglomerações urbanas e mobilidade populacional: o caso da Região Metropolitana de Campinas / Urban Agglomerations and Demographic Mobility: The Case of Campinas, Brazil / Aglomeraciones urbanas y movilidad demográfica: el caso de la región metropolitana de Campinas

Esse artigo analisa, para uma grande aglomeração urbana, a complexidade da dinâmica migratória, que se revela nas diferentes modalidades de movimentos populacionais e nas características dos indivíduos envolvidos nestes deslocamentos, assim como nos elementos estruturais que os condicionam. Baseado em dados de uma pesquisa domiciliar para a Região Metropolitana de Campinas - RMC, realizada em 2007, e nos dados do Censo Demográfico de 2010, esse estudo analisa os aspectos da mobilidade residencial (e dos indivíduos envolvidos) em várias de suas facetas, especialmente em termos das características e motivações dos atores envolvidos. Mesmo com a redução da migração externa na região, pode-se notar um significativo potencial endógeno de redistribuição da população em função de sua mobilidade dentro da RMC, muito embora, diferentemente de outras regiões metropolitanas, na de Campinas ainda se verifique que a migração externa, em grande medida, se direciona diretamente para a periferia. A análise de características demográficas e socioeconômicas dos que se movem (e não se movem) sugere a existência de coerência entre o que se esperaria observar para uma migração condicionada pelo fator econômico e o posicionamento da RMC no cenário nacional e estadual, assim como pelo processo de produção do seu espaço habitado. A seletividade dos migrantes, em geral, e dos intrametropolitanos, em particular, sugere motivações diferenciadas, das quais, embora ainda não dominante, a questão habitacional se mostra relevante. O estudo também indica que, diferentemente do que ocorria no passado, a periferia metropolitana está se diversificando e incorporando cada vez mais indivíduos e família de mais alta renda...

Abstract This paper analyzes the complexity of the migratory dynamics of a large urban agglomeration. This complexity can be seen both in the different types of movements involved and in the individual and collective characteristics of the migrants themselves, as well as in the structural elements that may affect them. Based on data from a household survey for the metropolitan area of Campinas (RMC) held in 2007 and from the 2010 Demographic Census, we examine the residential mobility characteristics in many dimensions, especially in terms of the characteristics and motivations of the actors involved. Even with the reduction of external migration into the region, we can identify the existence of a significant potential of internal population redistribution due to people mobility within the RMC. Nevertheless, unlike other metropolitan areas, external migration to a large extent still flows directly into the periphery within this region. The analysis of the demographic and socioeconomic characteristics of moving (and not moving) people suggests the existence of a coherence between what we would expect to observe for a migration conditioned by the economic factor and the RMC's positioning in the national and São Paulo state scenarios, as well as by the region´s process of production of space. The selectivity of migrants, in general, and of intrametropolitan migrants, in particular, suggests different motivations according to which, though still not dominant, the housing issue arises as a significant matter. The study also shows that, contrary to what was observed in the past, the metropolitan periphery has been diversifying and incorporating more and more high-income individuals and families...

Resumen Este artículo analiza las complexidades de las dinámicas migratorias en una gran aglomeración urbana. La complexidad se observa tanto en la variedad de movimientos y en las características individuales y colectivas de los migrantes como en los elementos estructurales que los afectan. Utilizando datos provenientes de una encuesta de hogares realizado en 2007 en la región metropolitana de Campinas (RMC) y de los Censos Demográficos, se examina varias dimensiones de la movilidad residencial en la RMC, particularmente en lo que se refiere a las características y motivaciones de los diferentes actores. Se observa también que, al contrario de lo que ocurre en otras regiones etropolitanas, la periferia de RMC sigue recibiendo flujos migratorios importantes de afuera de la región. El análisis de las características socioeconómicas y demográficas de los migrantes y no-migrantes sugiere una coherencia entre padrones migratorios, la posición ocupada por la RMC en el escenario nacional y del estado de São Paulo, y también del proceso de producción del espacio en la región. La selectividad de migrantes, incluso de los migrantes intrametropolitanos, sugiere la existencia de motivaciones diversas, entre las cuales la vivienda se constituye en elemento importante, aunque no dominante. El estudio también muestra que, al contrario de lo observado en el pasado, la periferia metropolitana está se diversificando y recibiendo un número mayor de familias y clases más abastadas...

G-CSF suppresses allergic pulmonary inflammation, downmodulating cytokine, chemokine and eosinophil production.

AIMS: Granulocyte Colony-Stimulating Factor (G-CSF), which mobilizes hemopoietic stem cells (HSC), is believed to protect HSC graft recipients from graft-versus-host disease by enhancing Th2 cytokine secretion. Accordingly, G-CSF should aggravate Th2-dependent allergic pulmonary inflammation and the associated eosinophilia. We evaluated the effects of G-CSF in a model of allergic pulmonary inflammation. MAIN METHODS: Allergic pulmonary inflammation was induced by repeated aerosol allergen challenge in ovalbumin-sensitized C57BL/6J mice. The effects of allergen challenge and of G-CSF pretreatment were evaluated by monitoring: a) eosinophilia and cytokine/chemokine content of bronchoalveolar lavage fluid, pulmonary interstitium, and blood; b) changes in airway resistance; and c) changes in bone-marrow eosinophil production. KEY FINDINGS: Contrary to expectations, G-CSF pretreatment neither induced nor enhanced allergic pulmonary inflammation. Instead, G-CSF: a) suppressed accumulation of infiltrating eosinophils in bronchoalveolar, peribronchial and perivascular spaces of challenged lungs; and b) prevented ovalbumin challenge-induced rises in airway resistance. G-CSF had multiple regulatory effects on cytokine and chemokine production: in bronchoalveolar lavage fluid, levels of IL-1 and IL-12 (p40), eotaxin and MIP-1a were decreased; in plasma, KC, a neutrophil chemoattractant, was increased, while IL-5 was decreased and eotaxin was unaffected. In bone-marrow, G-CSF: a) prevented the increase in bone-marrow eosinophil production induced by ovalbumin challenge of sensitized mice; and b) selectively stimulated neutrophil colony formation. SIGNIFICANCE: These observations challenge the view that G-CSF deviates cytokine production towards a Th2 profile in vivo, and suggest that this neutrophil-selective hemopoietin affects eosinophilic inflammation by a combination of effects on lung cytokine production and bone-marrow hemopoiesis.

Allogeneic hematopoietic stem cell transplantation in children with primary immunodeficiencies: Hospital Israelita Albert Einstein experience.

OBJECTIVE: To report the experience of a tertiary care hospital with allogeneic hematopoietic stem cell transplantation in children with primary immunodeficiencies. METHODS: Seven pediatric patients with primary immunodeficiencies (severe combined immunodeficiency: n = 2; combined immunodeficiency: n = 1; chronic granulomatous disease: n = 1; hyper-IgM syndrome: n = 2; and IPEX syndrome: n = 1) who underwent eight hematopoietic stem cell transplants in a single center, from 2007 to 2010, were studied. RESULTS: Two patients received transplants from HLA-identical siblings; the other six transplants were done with unrelated donors (bone marrow: n = 1; cord blood: n = 5). All patients had pre-existing infections before hematopoietic stem cell transplants. One patient received only anti-thymocyte globulin prior to transplant, three transplants were done with reduced intensity conditioning regimens and four transplants were done after myeloablative therapy. Two patients were not evaluated for engraftment due to early death. Three patients engrafted, two had primary graft failure and one received a second transplant with posterior engraftment. Two patients died of regimen related toxicity (hepatic sinusoidal obstruction syndrome); one patient died of progressive respiratory failure due to Parainfluenza infection present prior to transplant. Four patients are alive and well from 60 days to 14 months after transplant. CONCLUSION: Patients' status prior to transplant is the most important risk factor on the outcome of hematopoietic stem cell transplants in the treatment of these diseases. Early diagnosis and the possibility of a faster referral of these patients for treatment in reference centers may substantially improve their survival and quality of life.

Dinâmica intraurbana e redes sociais na Baixada Santista / Intra-urban dynamics and social networks in the Baixada Santista / /Dinámica intraurbana y redes sociales en la Baixada Santista

Não é de hoje que diversos estudos atribuem grande importância à redistribuição espacial da população provocada a partir de movimentos migratórios nos processos de expansão urbana. Assim, o objetivo principal deste trabalho é destacar e delimitar ainda mais o estudo desses fluxos e movimentos, a partir da noção de redes sociais. Noção já largamente utilizada desde o final da década de 1970 em estudos sobre migração internacional, mas ainda pouco apropriada nos trabalhos sobre movimentos migratórios internos, principalmente os de curta distância, tais como os intrametropolitanos. Para tanto, são utilizados os dados de uma pesquisa domiciliar, realizada em 2007, a fim de levantar e analisar informações mais específicas sobre tais redes, uma vez que estas inexistem nas usuais fontes secundárias de dados. Dessa forma, a Região Metropolitana da Baixada Santista, além de ser encarada como recorte espacial, é também tomada como objeto de estudo do projeto temático "Vulnerabilidade das Metrópoles Paulistas". A pesquisa domiciliar realizada permite, ainda, análises intramunicipais e intraurbanas a partir das chamadas zonas de vulnerabilidade.

For quite some time now studies have recognized the importance of processes of spatial redistribution of the population caused by migration flows, and the consequences of migration on urban expansion. The major concern in this paper is to highlight and further circumscribe the scope of studies on flows and movements based on the notion of social networks. This notion has been used since the late 1970s, especially in studies on international migration, but it is still rarely applied to internal migration studies, especially short distance migrations such as intra-metropolitan flows. For this purpose we conducted a study on the Baixada Santista Metropolitan Area (the urban area around the Atlantic Port of Santos, Brazil), based on data from a survey conducted in 2007. This data base gives us details on population mobility in the region and provides interesting information for analyzing factors related to the impact of social networks on migration processes. The survey enabled us to analyze the dynamics of intra-urban and intra-metropolitan mobility based on the concept of vulnerability zones.

Hace ya bastante tiempo que diversos estudios atribuyen una gran importancia a la redistribución espacial de la población provocada por movimientos migratorios en los procesos de expansión urbana. De este modo, el objetivo principal de este trabajo es destacar y delimitar todavía más el estudio de tales flujos y movimientos, a partir de la noción de redes sociales. Noción ya ampliamente utilizada desde fines de la década de 1970 en estudios sobre la migración internacional, pero aún poco apropiada en los trabajos sobre movimientos migratorios internos, principalmente los de corta distancia, tales como los intrametropolitanos. Para ello se utilizan los datos de una encuesta de hogares realizada en 2007, con el propósito de levantar y analizar información más específica sobre tales redes, una vez que ella no existe en las usuales fuentes secundarias de datos. De esta forma, la Región Metropolitana de la Baixada Santista, además de considerarse como un recorte espacial, también es tomada como objeto de estudio del proyecto temático "Vulnerabilidad de las Metrópolis Paulistas". La encuesta de hogares realizada permite asimismo realizar análisis intramunicipales e intraurbanos a partir de las llamadas zonas de vulnerabilidad.

Tumor necrosis factor-alpha and the cytokine network in psoriasis / Fator de necrose tumoral-alfa e a rede de citocinas na psoriase

New molecular methods of research have greatly expanded the knowledge about the role of cytokines in several diseases, including psoriasis. The work orchestrated by these peptides is essential for the communication between resident inflammatory cells (keratinocytes and endothelial cells) and infiltrating cells (neutrophils, lymphocytes, Langerhans cells). This is a complex network due to redundancy, synergism and, sometimes, the antagonism of cytokines, which prevents full understanding of the pathogenesis of the disease. Currently, it seems premature to try to establish a main actor, but TNFalpha participates in all stages of psoriatic plaque development, as we shall see.

A introdução de novos métodos moleculares de investigação ampliou muito o conhecimento sobre o papel das citocinas em diversas doenças, entre elas a psoríase. O trabalho orquestrado desses polipeptídeos é fundamental na comunicação entre as células inflamatórias residentes (queratinócitos e células endoteliais) e infiltrantes (neutrófilos, linfócitos, células de Langerhans). Trata-se de uma rede complexa devido à redundância, ao sinergismo e, por vezes, ao antagonismo das citocinas, o que dificulta a compreensão da fisiopatogenia da doença a partir de um mecanismo linear. No momento atual, parece precoce tentar estabelecer um regente, mas o TNF-alfa se destaca em todos os passos do desenvolvimento da placa psoriásica, como veremos a seguir.

G-CSF-treated granulocytes inhibit acute graft-versus-host disease.

It has been shown that in vivo and in vitro treatment with G-CSF induces the generation of low-density granulocytes (LDGs), which copurify with PBMCs and inhibit IFN-gamma production by human T cells. These results prompted us to postulate an immunomodulatory role for LDGs in acute graft-versus-host disease (aGVHD). Here it is shown that in the mouse experimental model, in vivo and in vitro G-CSF treatment generates LDGs capable of inhibiting 80% of T-cell IFN-gamma production. To assess the role of these LDGs in aGVHD, lethally irradiated (C57BL/6 x BALB/c) F1 hosts were reconstituted with T cell-depleted bone marrow cells plus nylon wool-purified spleen cells from G-CSF-treated (G-NWS) or -nontreated (NWS) C57BL/6 donors. Recipients of G-NWS had a 75% survival rate in contrast to a rate of 25% in the NWS recipients. The protective effect was completely abolished, and the mortality rate was 100% if donor-cell infusion was treated with anti-Gr1. Moreover, if LDGs were infused with NWS, full protection of aGVHD was observed, and no signs of disease were evidenced by mortality rate, weight loss, or histopathology of target organs. These results revealed the unexpected immunosuppressive capacity of G-CSF based on the generation of LDGs, leading to the possibility of using these cells as inhibitors of aGVHD.

Transplante alogênico de células-tronco hematopoéticas em crianças com imunodeficiências primárias: a experiência do Hospital Israelita Albert Einstein / Allogeneic hematopoietic stem cell transplantation in children with primary immunodeficiencies: Hospital Israelita Albert Einstein experience

Objective: To report the experience of a tertiary care hospital with allogeneic hematopoietic stem cell transplantation in children with primary immunodeficiencies. Methods: Seven pediatric patients with primary immunodeficiencies (severe combined immunodeficiency: n = 2; combined immunodeficiency: n = 1; chronic granulomatous disease: n = 1; hyper-IgM syndrome: n = 2; and IPEX syndrome: n = 1) who underwent eight hematopoietic stem cell transplants in a single center, from 2007 to 2010, were studied. Results: Two patients received transplants from HLA-identical siblings; the other six transplants were done with unrelated donors (bone marrow: n = 1; cord blood:n = 5). All patients had pre-existing infections before hematopoietic stem cell transplants. One patient received only anti-thymocyte globulin prior to transplant, three transplants were done with reduced intensity conditioning regimens and four transplants were done after myeloablative therapy. Two patients were not evaluated for engraftmentdue to early death. Three patients engrafted, two had primary graft failure and one received a second transplant with posterior engraftment. Two patients died of regimen related toxicity (hepatic sinusoidal obstruction syndrome); one patient died of progressive respiratory failure due to Parainfluenza infection present prior to transplant. Four patients are alive and well from 60 days to 14 months after transplant. Conclusion: Patients' status prior to transplant is the most important risk factor on the outcome of hematopoietic stem cell transplants in the treatment of these diseases. Early diagnosis and the possibility of a faster referral of these patients for treatment in reference centers may substantially improve their survival and quality of life.

Objetivo: Relatar a experiência de um hospital terciário no tratamento de pacientes pediátricos com imunodeficiências primárias com transplante de células-tronco hematopoéticas. Métodos: De 2007 a 2010, foram realizados oito transplantes em sete pacientes pediátricos com imunodeficiências primárias: imunodeficiência combinada grave (n = 2); imunodeficiência combinada (n = 1); doença granulomatosa crônica (n = 1); síndrome hiper-IgM (n = 2); síndrome IPEX (n=1). Resultados: Dois pacientes foram transplantados com medula óssea de irmãos HLA-idênticos; seis transplantes foram feitos com doadores não aparentados (medula óssea: n = 1; sangue de cordão umbilical: n = 5). Todos os pacientes haviam tido episódios de infecção grave previamente ao tratamento. Um paciente recebeu apenas globulina antitimocítica antes do transplante de células-tronco hematopoéticas, três transplantes foram feitos com quimioterapia de intensidade reduzida e quatro após quimioterapia mieloablativa. Dois pacientes morreram precocemente e não foram avaliados em relação à enxertia. Três pacientes tiveram enxertia completa, dois evoluíram com falha primária de pega, um deles recebeu um segundo transplante com pega do enxerto. Dois pacientes morreram de toxicidade do transplante (síndrome da obstrução sinusoidal hepática), um paciente morreu de insuficiência respiratória por infecção por parainfluenza já existente antes do transplante. Quatro pacientes estão vivos e bem entre 60 dias e 14 meses após o transplante. Conclusão: A condição do paciente ao transplante é o fator mais importante no sucesso do tratamento. O diagnóstico precoce dos pacientes e a possibilidade de encaminhá-los mais rapidamente para tratamento em centros de referência podem melhorar substancialmente a sobrevida e a qualidade de vida deles.

Segregação socioespacial e inserção no mercado de trabalho na Região Metropolitana de Campinas / Socio-spatial segregation and insertion in the labor market in the Metropolitan Region of Campinas, Brazil / /Segregación socioespacial e inserción en el mercado de trabajo en la Región Metropolitana de Campinas

Partindo da premissa de que o "espaço importa", o presente estudo procura contribuir para os esforços analíticos voltados a investigar o impacto da segregação, aqui entendida como a concentração no espaço de estratos socioeconômicos semelhantes, sobre a capacidade de respostas das pessoas ou famílias aos vários problemas e riscos observados nas grandes aglomerações urbanas. Mais especificamente, este artigo pretende investigar, para o caso de uma região metropolitana emergente no Brasil (Campinas, no Estado de São Paulo), se há evidências do efeito da segregação sobre distintas características da inserção dos indivíduos no mercado de trabalho. A partir dos dados do Censo Demográfico de 2000, analisa-se de que forma o desemprego, a formalidade do trabalho e a proteção social da população economicamente ativa estariam influenciados tanto pelas características sociodemográficas, incluindo status migratório e condição de mobilidade intraurbana (pendularidade), quanto por sua localização no espaço regional. Como variável espacial relativa à segregação, propõe-se uma medida baseada no Índice de Moran Local, que busca identificar áreas homogêneas em termos da composição socioeconômica de seus habitantes. Os resultados obtidos, embora não conclusivos, sugerem a importância da localização sobre a forma de inserção dos indivíduos no mercado de trabalho, o que corrobora algumas proposições teóricas levadas em conta nesse estudo.

Based on the premise that "space matters," the present study is intended as a contribution to the analytic efforts focused on investigating the impact of segregation, understood here as how the concentration in space of similar socioeconomic strata affects the ability of individuals and families to respond to the numerous problems and risks involved in large urban areas. More specifically, the article consists of an investigation into whether, for the case of an emerging metropolitan region in Brazil (Campinas, in the State of São Paulo), there are indications of the effect of segregation on the various characteristics of the inclusion of individuals in the labor market. Data from the Federal Demographic Census of 2000 show how unemployment, formality of labor, and the social protection of the economically active population are influenced both by the sociodemographic characteristics, including migratory status and condition of intraurban mobility (pendularity), and by the population's physical location in the region. As a spatial variable related to segregation, a measure is proposed on Moran's Local rate, which seeks to identify homogeneous areas in terms of the socioeconomic composition of their inhabitants. Although the results obtained are not conclusive, they do suggest the importance of location on way individuals are absorbed by the labor market. This finding corroborates several of the theoretical propositions taken into account in this study.

Partiendo de la premisa de que el "espacio es importante", el presente estudio procura aportar a los esfuerzos analíticos destinados a investigar el impacto de la segregación, que aquí se la entiende como la concentración en el espacio de estratos socioeconómicos semejantes, sobre la capacidad de respuestas de las personas o familias a los diversos problemas y riesgos observados en las grandes aglomeraciones urbanas. Más específicamente, este artículo pretende investigar, para el caso de una región metropolitana emergente en Brasil (Campinas, en el Estado de San Pablo), si hay evidencias del efecto de la segregación sobre distintas características de la inserción de los individuos en el mercado de trabajo. A partir de los datos del Censo Demográfico de 2000, se analiza de qué forma el desempleo, la formalidad del trabajo y la protección social de la población económicamente activa estarían influenciados tanto por las características sociodemográficas, incluyendo el estatus migratorio y la condición de movilidad intraurbana (pendularidad), como por su localización en el espacio regional. Como variable espacial relacionada con la segregación, se propone una medida basada en el Índice de Moran Local, que procura identificar áreas homogéneas en términos de la composición socioeconómica de sus habitantes. Los resultados obtenidos, aunque no concluyentes, sugieren la importancia de la localización sobre la forma de inserción de los individuos en el mercado de trabajo, lo cual corrobora algunas proposiciones teoréticas que se han tenido en cuenta en ese estudio.

Redução dos linfócitos T-CD8+ citotóxicos observada com a terapia Puva em paciente com vitiligo / Reduction of cytotoxic T-CD8+ lymphocytes observed during PUVA therapy in a patient with vitiligo

Na patogênese do vitiligo tem-se enfatizado o papel das células T citotóxicas. Identificadas pelo antígeno linfocitário cutâneo (CLA), essas células já foram descritas no sangue de pacientes com outras dermatoses e podem ser depletadas pela fototerapia concomitantemente à melhora clínica. Descreve-se caso de vitiligo generalizado com melhora clínica expressiva após Puva, no qual houve redução de 25% dos linfócitos T CD8+-CLA+ circulantes.

The role of cytotoxic T cells (CD8+) has been emphasized in the pathogenesis of vitiligo. This cell population, identified by a skin homing molecule (cutaneous lymphocyte associated antigen Â- CLA), has been described in patients with other dermatoses and can be reduced with phototherapy. The authors present the case of a patient with generalized vitiligo and clinical recovery after PUVA parallel to a 25% reduction in CD8+-CLA+ T cells in the peripheral blood.

Dinâmica migratória e o processo de ocupação do Centro-Oeste brasileiro: o caso de Mato Grosso / Migratory dynamics and the occupation process in central-western Brazil: the case of the State of Mato Grosso

Uma das últimas áreas de fronteira do país, o Estado de Mato Grosso é ainda hoje uma possibilidade para a população que busca alternativas para a migração. Paralelamente ao processo de "urbanização da fronteira", assiste-se em Mato Grosso outras iniciativas com impactos importantes, que dão novas especificidades ao reordenamento da população no território e também às perspectivas de continuidade de ocupação demográfica do Estado, como os assentamentos agrícolas e novas frentes pioneiras. Após ter apresentado um forte processo de ocupação até meados dos anos 80, Mato Grosso experimenta um visível arrefecimento do seu crescimento demográfico, contudo mantendo áreas ainda com relativo dinamismo. Ancorado na análise de dados dos Censos Demográficos e Agropecuários e em entrevistas realizadas no Estado, este artigo centra-se na análise das tendências migratórias e seus impactos no processo de ocupação do espaço matogrossense nos últimos vintes anos, com ênfase no comportamento de algumas áreas representativas dos principais processos em curso, buscando situá-las no contexto mais amplo de mudanças nos padrões de ocupação econômica. As análises mostram, por um lado, uma forte associação entre ambos os fenômenos, a partir do impacto das atividades extensivas (pecuária, soja, algodão) na redução das possibilidades de absorção dos migrantes no meio rural, e, por outro, os efeitos "compensadores" dos assentamentos de reforma agrária.

The State of Mato Grosso is one of the last frontier areas in Brazil, and still shows some potential for populations that continue to seek alternatives for migration. Concurrently with the process of "urbanization of the frontier," one can see other phenomena in the state that are having strong impacts on the opening up of new possibilities for realigning the population in the territory, such as small farm settlements and new pioneering projects, which would have positive impacts for the continued demographic occupation of the state. After having gone through an intense process of occupation until the mid-1980s, Mato Grosso's demographic growth slowed down considerably. At the same time, however, it also continued to show relative dynamism in general. The present article is based on analyses of data from the Demographic and Agricultural Censuses and from interviews held in Mato Grosso, and analyzes migratory trends in the state and their impacts on the process of occupation of the state in recent years. Special emphasis is given to the behavior of several areas that are representative of the most important processes now underway. The author also seeks to locate these processes of change in the patterns of economic occupation. The analyses show strong association between the two phenomena, namely, on the one hand, the impact of extensive land-use activities such as cattle raising, soybeans, and cotton in reducing the possibilities for absorbing migrants in the rural areas and, on the other, the "compensating" effects of land reform settlements.

Migração e urbanização no Brasil: alguns desafios metodológicos para análise / Migration and urbanization in Brazil: methodological challenges for analyses

A partir de um olhar demográfico, este artigo tem por objetivo apresentar algumas reflexões sobre questões relevantes para a análise de migração e urbanização, considerando os avanços e lacunas existentes e, principalmente, as possibilidades analíticas propiciadas pelo uso criativo dos Censos Demográficos brasileiros mais recentes. Pretende-se contribuir não apenas para a ampliação da agenda de estudos, mas também para uma reflexão teórico-metodológica sobre os fenômenos em questão.