ADM1 approach to the performance optimisation and biogas H2S prediction of a large-scale anaerobic reactor fed on sugarcane vinasse.

In this paper, we present extensions to the Anaerobic Digestion Model No. 1 (ADM1) to simulate hydrogen sulphide in biogas and solids retention efficiency. The extended model was calibrated and validated against data from a large-scale covered in-ground anaerobic reactor (CIGAR), processing sugarcane vinasse. Comparative scenarios and set-ups of a CIGAR with and without a settling tank unit (settler) were simulated to investigate the reactor's performance. Biogas flow, methane content, and yield with settler were 15,983 Nm3/d, 57%, and 0.198 Nm3CH4/kgCOD, respectively, which were 9.4%, 1.8%, and 11.64%, higher than without the settler. Improvements are combination of influent flow rate 116% higher and increased solids retention time by using a settler. The optimised modelled reactor, the volume of which was reduced by 50%, was able to produce 83% more methane per volume of reactor with half the retention time. After model calibration and validation, we assessed the quality of predictions and its utility. The overall quality of predictions was assessed as high accuracy quantitative for CH4 and medium for H2S and biogas flow. A practical demonstration of ADM1 to industrial application is presented here to identify the potential optimisation and behaviour of a large-scale anaerobic reactor, reducing, consequently, expenditure, risk, and time.

Adherence of mental therapy for mental disorder patients to drug health treatment [corrected]. / Adesão do portador de transtorno mental à terapêutica medicamentosa no tratamento em saúde menta.

OBJECTIVE: To assess the adherence of mental disorder patients to drug therapy for mental health treatment and the association between demographic, socioeconomic, clinical and pharmacotherapeutic variables to treatment adherence. METHOD: A cross-sectional study conducted with mental disorder patients in two Psychosocial Care Centers in Curitiba/Paraná in 2014. Data from structured interviews and medical records were submitted to descriptive and bivariate analysis. RESULTS: 300 patients with mental disorders participated in the study. 51% of participants adhered to the drug therapy, the highest adherence was among males with no family history of mental disorder, diagnosed with schizophrenia, with disease duration of less than 1 year, who did not forget to take the medicine not even once in the previous month and who relied on family participation. Adherence was lower among the interviewees with individual income lower than one minimum wage, perception of regular and poor health, diagnosis of depression associated with another disorder, treatment time in the service over 2 years and with a history of attempted suicide. CONCLUSION: Low adherence to the drug therapy was observed. The variables associated with adherence were gender, individual income, family history of mental disorder, perception about their health, diagnosis of mental disorder, duration of illness and treatment, suicide attempt, failing to take the medication at least once in the previous month and family participation.

Hyaluronic acid covers in burn treatment: a systematic review.

OBJECTIVE: To evaluate the effectiveness of hyaluronic acid in the healing of partial thickness burns. METHOD: Systematic review of randomized controlled trials on the use of hyaluronic acid for the topical treatment of skin burns, based on recommendations of the Cochrane Handbook for Systematic Reviews of Interventions. RESULTS: Two randomized controlled trials that analyzed 143 patients with partial thickness burns and/or deep partial thickness burns were selected. They compared the application of hyaluronic acid 0.2% associated to silver sulfadiazine 1% 5g/cm2 versus silver sulfadiazine 1% 5g/cm2 alone for the outcome of complete healing. CONCLUSION: This review emphasizes the need for new well-designed randomized controlled trials to establish the therapeutic relevance of hyaluronic acid with respect to the healing of burns of partial thickness or deep partial thickness. OBJETIVO: Avaliar a efetividade do ácido hialurônico na cicatrização de queimaduras de espessura parcial. MÉTODO: Revisão sistemática de ensaios clínicos randomizados sobre a utilização de ácido hialurônico no tratamento tópico de queimaduras de pele, baseada nas recomendações do Cochrane Handbook for Systematic Reviews of Interventions. RESULTADOS: Foram recuperados dois ensaios clínicos randomizados que analisaram 143 pacientes portadores de queimaduras de espessura parcial e/ou espessura parcial profunda, comparando a aplicação de Ácido Hialurônico 0,2% associado à Sulfadiazina de Prata 1% 5g/cm2, versus Sulfadiazina de Prata 1% 5g/cm2 isolada, para o desfecho cicatrização completa. CONCLUSÃO: Esta revisão enfatiza a necessidade de novos ensaios clínicos randomizados bem delineados para estabelecimento da relevância terapêutica do ácido hialurônico no que tange à cicatrização de queimaduras de espessura parcial ou espessura parcial profunda.

A Methodology for Shielding-Gas Selection in Wire Arc Additive Manufacturing with Stainless Steel.

The main objective of this work was to propose and evaluate a methodology for shielding-gas selection in additive manufacturing assisted by wire arc additive manufacturing (WAAM) with an austenitic stainless steel as feedstock. To validate the proposed methodology, the impact of multi-component gases was valued using three different Ar-based blends recommended as shielding gas for GMA (gas metal arc) of the target material, using CMT (cold metal transfer) as the process version. This assessment considered features that potentially affect the building of the case study of thin walls, such as metal transfer regularity, deposition time, and geometrical and metallurgical characteristics. Different settings of wire-feed speeds were conceived to maintain a similar mean current (first constraint for comparison's sake) among the three gas blends. This approach implied different mean wire-feed speeds and simultaneously forced a change in the deposition speed to maintain the same amount of material deposited per unit of length (second comparison constraint). The composition of the gases affects the operational performance of the shielding gases. It was concluded that by following this methodology, shielding-gas selection decision-making is possible based on the perceived characteristics of the different commercial blends.

Synthesis of superparamagnetic Fe3O4-graphene oxide-based material for the photodegradation of clonazepam.

The global concern over water pollution caused by contaminants of emerging concern has been the subject of several studies due to the complexity of treatment. Here, the synthesis of a graphene oxide-based magnetic material (GO@Fe3O4) produced according to a modified Hummers' method followed by a hydrothermal reaction was proposed; then, its application as a photocatalyst in clonazepam photo-Fenton degradation was investigated. Several characterization analyses were performed to analyze the structure, functionalization and magnetic properties of the composite. A 23 factorial design was used for the optimization procedure to investigate the effect of [H2O2], GO@Fe3O4 dose and pH on clonazepam degradation. Adsorption experiments demonstrated that GO@Fe3O4 could not adsorb clonazepam. Photo-Fenton kinetics showed that total degradation of clonazepam was achieved within 5 min, and the experimental data were better fitted to the PFO model. A comparative study of clonazepam degradation by different processes highlighted that the heterogeneous photo-Fenton process was more efficient than homogeneous processes. The radical scavenging test showed that O 2 · - was the main active free radical in the degradation reaction, followed by hydroxyl radicals (•OH) and holes (h+) in the valence layer; accordingly, a mechanism of degradation was proposed to describe the process.

An Unusual Case of Hemophagocytic Lymphohistiocytosis Associated with Mycobacterium chimaera or Large-Cell Neuroendocrine Carcinoma.

Hemophagocytic lymphohistiocytosis (HLH) is a rare and very dangerous condition characterized by abnormal activation of the immune system, causing hemophagocytosis, inflammation, and potentially widespread organ damage. The primary (genetic) form, caused by mutations affecting lymphocyte cytotoxicity, is most commonly seen in children. Secondary HLH is commonly associated with infections, malignancies, and rheumatologic disorders. Most current information on diagnosis and treatment is based on pediatric populations. HLH is a disease that should be diagnosed and treated promptly, otherwise it is fatal. Treatment is directed at treating the triggering disorder, along with symptomatic treatment with dexamethasone and etoposide. We present a 56-year-old patient who was admitted with worsening weakness, exertional dyspnea, dry and nonproductive cough, and a 5-pound weight loss associated with loss of appetite. This is among the rare disorders that are not commonly encountered in day-to-day practice. Our differential diagnoses were broad, including infection, such as visceral leishmaniasis, atypical/tuberculous mycobacteria, histoplasmosis, Ehrlichia, Bartonella, Brucella, Adenovirus, disseminated herpes simplex virus (HSV), hematological-like Langerhans cell histiocytosis, or multicentric Castleman disease; drug reaction, such as drug rash with eosinophilia and systemic symptoms (DRESS); and metabolic disorder, including Wolman's disease (infantile lysosomal acid lipase deficiency) or Gaucher's disease. Based on our investigations as described in our case report, it was narrowed down to hemophagocytic lymphohistiocytosis and COVID-19. Two COVID-19 tests were negative. His lab abnormalities and diagnostic testing revealed hemophagocytic lymphohistiocytosis. He was empirically started on antibiotics and dexamethasone, to be continued for 2 weeks then tapered if the patient showed continued improvement. Dexamethasone was tapered over 8 weeks. He improved on just one of the Food and Drug Administration (FDA)-approved medications, proving that treatment should be tailored to the patient. In addition, in this case study, we included the background, etiology, pathogenesis, diagnosis, management, and prognosis of HLH.

Adsorption of chloroquine, propranolol, and metformin in aqueous solutions using magnetic graphene oxide nanocomposite.

The work proposes the application of a nanocomposite formed by graphene oxide and magnetite to remove chloroquine, propranolol, and metformin from water. Tests related to adsorption kinetics, equilibrium isotherms and adsorbent reuse were studied, and optimization parameters related to the initial pH of the solution and the adsorbent dosage were defined. For all pharmaceuticals, adsorption tests indicated that removal efficiency was independent of initial pH at adsorbent dosages of 0.4 g L-1 for chloroquine, 1.2 g L-1 for propranolol, and 1.6 g L-1 for metformin. Adsorption equilibrium was reached within the first few minutes, and the pseudo-second-order model represented the experimental data well. While the equilibrium data fit the Sips isotherm model at 298 K, the predicted maximum adsorption capacities for chloroquine, propranolol, and metformin were 44.01, 16.82, and 12.23 mg g-1, respectively. The magnetic nanocomposite can be reused for three consecutive cycles of adsorption-desorption for all pharmaceuticals, being a promising alternative for the removal of different classes of pharmaceuticals in water.

Hope and depression in Brazilian head and neck cancer patients during the COVID-19 pandemic.

Introduction: Head and neck cancer is characterised as traumatic, when compared to other types of cancer, due to the physical, physiological and social impact it has on the patient. Objective: To evaluate hope and severe depression in patients with head and neck cancer during the COVID-19 pandemic. Method: Quantitative, observational, and analytical; conducted in the outpatient department of the head and neck department of an oncological hospital in the city of Curitiba, Paraná, Brazil, with 60 patients with head and neck cancer being treated with chemotherapy and radiotherapy. Data collection took place between May and September 2020, with the application of three questionnaires: socio-demographic and clinical; Patient Health Questionnaire-9 (PHQ-9), to evaluate severe depression; and the Herth hope scale. Data analysis was through descriptive statistics and non-parametric Mann- Whitney, Kruskal-Wallis and Spearman correlation tests. Results: The age of participants ranged from 34 to 85 years, with 61.7% being male. The diagnosis of cancer occurred in the oral cavity (53.3%) and larynx (33.3%); 28.3% (n = 1 7) presented with a diagnosis of depression; 8.6% (n = 5) are in treatment with psychology; and 10.3% (n = 6) are in treatment with psychotropic drugs. The analysis of the association of the PHQ-9 score with sex showed a mean score of 7.7 ± 6.2, with a higher level of depression in women. The mean hope score was 41.3 ± 3.1; however, during the pandemic, 35% (n = 21) reported feelings of anguish, anxiety and fear, with the latter being predominant and in association with the PHQ-9 score showing a mean of 8.2 ± 6.2 (p = 0.123). The association of hope with the number of children was statistically significant (p = 0.034) and in the education variable with the PHQ-9 score (p = 0.019). Conclusion: The use of tools that assess both levels of hope and depression in patients undergoing chemotherapy and radiotherapy provides health professionals with support for the implementation of targeted actions to cope with the disease.

The Healthcare Failure Mode and Effect Analysis as a tool to evaluate care protocols.

OBJECTIVES: to identify, classify, and analyze modes of failure in the medication process. METHODS: evaluative research that used the Healthcare Failure Mode and Effect Analysis (HFMEA) in a service of bone marrow transplant from June to September 2018, with the participation of 35 health workers. RESULTS: 207 modes of failure were identified and classified as mistakes in verification (14%), scheduling (25.6%), administration (29%), dilution (16.4%), prescription (2.4%), and identification (12.6%). The analysis of risk showed a moderate (51.7%) and high (30.9%) need of intervention, leading to the creation of an internal quality assurance group and of continued education activities. CONCLUSIONS: the Healthcare Failure Mode and Effect Analysis showed itself to be a tool to actively identify, classify, and analyze failures in the process of medication, contributing for the proposal of actions aimed at patient safety.

Falsely positive heparin-induced thrombocytopenia antibody testing in severe hyperbilirubinemia.

Heparin-induced thrombocytopenia (HIT) is a life-threatening pathologic reaction to heparin-based products. Diagnosis of this condition can be confounded by other comorbidities or by acute illness-oftentimes presenting challenging clinical dilemmas, particularly in critically ill patients. A 67-year-old woman was admitted with liver failure and severe hyperbilirubinemia. She developed thrombocytopenia after prophylactic heparin exposure. Subsequent quantitative latex immunoturbidimetric assay (LIA) HIT antibody testing was intermediately positive. Confirmatory serotonin release assay testing subsequently returned negative. Platelet factor4-dependent P-selectin expression assay also returned negative, suggesting false positivity of the initial LIA tests. Concern was raised that hyperbilirubinemia (total bilirubin, 55.5 mg/dL) interfered with the original assay. Further testing with a separate HIT ELISA assay, which includes multiple washes and dilutions of the serum in order to effectively remove bilirubin, returned negative. Medical providers must consider the possibility of false-positive LIA testing when evaluating for HIT in the setting of severe hyperbilirubinemia.

Survival Disparities of Diffuse Large B-Cell Lymphoma in a Community-Based Inner-City Cancer Center.

BACKGROUND: Diffuse large B-cell lymphoma (DLBCL) comprises approximately 30% of all non-Hodgkin lymphomas. Multiple studies have demonstrated race-based disparities in survival among patients with DLBCL across all stages of disease, in the era both before and after rituximab. The etiology for the racial disparities in survival among patients with DLBCL is still unknown. Moreover, the Revised International Prognostic Index (R-IPI), a tool that predicts the DLBCL patients' outcome, has not yet been validated in African Americans (AA). PATIENTS AND METHODS: We conducted a cohort study of patients diagnosed with DLBCL from January 1, 2007, to December 31, 2017, from our tumor registry in a single community-based inner-city cancer center. We abstracted demographic, clinical, histopathologic, treatment, and R-IPI variables. A total of 181 patients (47.5%) with biopsy-proven DLBCL were included in the retrospective analysis. The median age was 65 years, 47% were men, 41% were AA, and 44% were white. RESULTS: The AA group had a younger median age, higher lactate dehydrogenase levels, higher frequency of B symptoms, and higher HIV infection than the non-AA group. The AA group had significantly decreased median overall survival than the non-AA group (15.7 months; 95% confidence interval, 10.3 to 23.9, vs. 93.6 months; 95% confidence interval, 61.5 to 142.6, respectively; P < .001). The survival disparities persisted after excluding patients with HIV and who did not receive chemotherapy. In addition, AA race predicts a reduced survival by univariate and multivariate analysis. CONCLUSION: AA with DLBCL may have a poorer prognosis than the non-AA population. Further studies should investigate the biology of DLBCL in the AA population.

Assessment of quality of life three years from hematopoietic stem cell transplant.

OBJECTIVE: To assess the domains of quality of life related to hematologic cancer patient health in the first three years from autologous and allogeneic hematopoietic stem cell transplantation. METHOD: A prospective cohort from September 2013 to February 2019 at a reference service in Latin America with 55 patients. The instruments Quality of Life Questionnaire Core C30 and Functional Assessment Cancer Therapy - Bone Marrow Transplantation were used. For data analysis, Generalized Linear Mixed Model was used. RESULTS: The domains global and overall quality of life presented the lowest scores in the pancytopenia phase: 59.3 and 91.4 in autologous, 55.3 and 90.3 in allogeneic. The mixed method analysis has shown that there was a significant change in scores between the phases throughout the treatment (p< 0.05). CONCLUSION: Health-related quality of life presented significant changes in the domains between the phases throughout time. Understanding these results enables nursing interventions directed at the domains which were damaged during treatment.

Adsorptive and photocatalytic activity of Fe3O4-functionalized multilayer graphene oxide in the treatment of industrial textile wastewater.

Multilayer graphene oxide (mGO) was synthesized and functionalized via co-precipitation method to produce magnetic Fe3O4-functionalized multilayer graphene oxide nanocomposite (MmGO). Photocatalytic properties of MmGO were investigated in the photodegradation of raw textile wastewater samples. Fourier-transformed infrared spectroscopy revealed Fe-O vibrations, characterized by the band shift from 636.27 to 587.25 cm-1 on MmGO. X-ray diffraction confirmed the successful oxidation of graphite by the (002) peak at 10° and indicated the presence of Fe3O4 on MmGO surface by the peaks at 2θ 35.8° (311), 42.71° (400), 54.09° (511), and 62.8° (440). There was no detection of coercivity field and remnant magnetization, evidencing a material with superparamagnetic properties. Then, the textile effluent was treated by heterogeneous photo-Fenton (HPF) reaction. A 22 factorial design was conducted to evaluate the effects of MmGO dosage and H2O2 concentration on HPF, with color and turbidity removal as response variables. The kinetic behavior of the adsorption and HPF processes was investigated separately, in which, the equilibrium was reached within 60 and 120 min, for adsorption and HPF, respectively. Pseudo-second-order model exhibited the best fit, with COD uptake capacity at equilibrium of 4094.94 mg g-1, for chemical oxygen demand. The modeling of kinetics data showed that the Chan and Chu model was the most representative for HPF, with initial removal rate of 95.52 min-1. The removal of organic matter was 76.36% greater than that reached by conventional treatment at textile mills. The presence of Fe3O4 nanoparticles attached to MmGO surface was responsible for the increase of electron mobility and the enhancement of its photocatalytic properties. Finally, MmGO presented low phytotoxic to Cucumis sativus L. with a RGI of 0.53. These results bring satisfactory perspectives regarding further employment, on large scale, of MmGO as nanocatalyst of textile pollutants.

Guided imagery relaxation in quality of life of patients undergoing hematopoietic stem cell transplantation: a quasi-experiment.

OBJECTIVE: The aim of this study was to evaluate the effects of the relaxation technique with guided imagery by means of virtual reality on health-related quality of life in patients undergoing hematopoietic stem cell transplantation. METHODS: A quasi-experiment conducted in a Bone Marrow Transplantation Service of a public hospital in southern Brazil. From October 2019 to October 2020, forty-two adult participants who underwent transplantation were included, 35 in the intervention group and seven in the control group. A guided imagery intervention, with audio guiding the relaxation associated with nature images in 360º, was performed during the hospitalization period. Data were collected on the first day of hospitalization, on the transplantation day, during the neutropenia stage, and at pre-hospital discharge. The Functional Assessment of Cancer Therapy-Bone Marrow Transplantation (FACT-BMT), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue) and Functional Assessment of Cancer Therapy-Neutropenia (FACT-N) were used to assess health-related quality of life, fatigue and neutropenia. Data were analyzed using the Generalized Linear Mixed Model for the evolution of the health-related quality of life assessments over time, considering the groups and stages. Pearson's correlation coefficient was adopted for the correlation analyses. RESULTS: Allogeneic transplantation was predominant: 28 (80%) in the intervention group and 5 (71.43%) in the control group. There were improvements in the health-related quality of life scores, although not significant. A significant difference was found among the stages (p <0.050) and a significant positive correlation (p <0.000) among the variables on general quality of life, additional concerns, fatigue and neutropenia in all stages. CONCLUSION: Patients undergoing hematopoietic stem cell transplantation suffer changes in their quality of life. Interventions based on integrative practices emerge as an option to minimize them. 
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Quality of life and changes in the social dimension of hematopoietic stem cell transplants recipients.

OBJECTIVES: to assess/correlate health-related quality of life with the social dimension of hematopoietic, autologous and allogeneic stem cell transplant patients in the three years post-transplant. METHODS: longitudinal, observational study with 55 patients, in a reference hospital in Latin America, from September 2013 to February 2019, using the Quality of Life Questionnaire-Core and Functional Assessment Cancer Therapy Bone Marrow Transplantation. RESULTS: A total of 71% underwent allogeneic transplantation. The social dimension had low averages since the baseline stage (55, 21) and low scores (56) for quality of life in pancytopenia. There was a significant positive correlation between social dimension, quality of life in pancytopenia (p<0.01) and follow-up after hospital discharge (p<0.00). There is a significant difference (p<0.00) throughout the stages, however, not in terms of the type of transplant (p>0.36/0.86). CONCLUSIONS: patients with better assessments in the social dimension have a better quality of life. Interventions focusing on the multidimensionality of the quality of life construct are necessary.

In-depth investigation of Sodium percarbonate as oxidant of PAHs from soil contaminated with diesel oil.

Sodium percarbonate (SPC, 2Na2CO3∙3H2O2), is a compound that can be used under multiple environmental applications. In this work, SPC was employed as oxidant in the treatment of soil contaminated with diesel oil. The soil samples were collected during the earthmoving stage of RNEST Oil Refinery (Petrobras), Brazil. Then, the samples were air-dried, mixed and characterized. Subsequently, raw soil was contaminated with diesel and treated by photo-Fenton reaction (H2O2/Fe2+/UV). SPC played a significant role in the generation of hydroxyl radicals under the catalytic effect of ferrous ions (Fe2+), hydrogen peroxide (H2O2) and radiation. These radicals provoked the photodegradation of polycyclic aromatic hydrocarbons (PAHs), in the soil remediation. A factorial design 33 was carried out to assess the variables which most influenced the decrease in total organic carbon (TOC). The study was performed with the following variables: initial concentration of [H2O2] and [Fe2+], between 190.0 and 950.0 mmol L-1 and 0.0-14.4 mmol L-1, respectively. UV radiation was supplied from sunlight, blacklight lamps, and system without radiation. All experiments were performed with 5.0 g of contaminated soil in 50.0 mL of solution. The initial concentration of Fe2+ showed the statistically most significant effect. The oxidation efficiency evaluated in the best condition showed a decrease from 34,765 mg kg-1 to 15,801 mg kg-1 in TOC and from 85.750 mg kg-1 to 20.770 mg kg-1 in PAHs content. Moreover, the sums of low and high molecular weight polycyclic aromatic hydrocarbons (LMW-PAHs and HMW-PAHs) were 19.537 mg kg-1 and 1.233 mg kg-1, respectively. Both values are within the limits recommended by the United Sates Environmental Protection Agency (USEPA) and evidenced the satisfactory removal of PAHs from contaminated soil, being an alternative to classic oxidation protocols.

Detoxification of sisal bagasse hydrolysate using activated carbon produced from the gasification of açaí waste.

Due to its recalcitrance and difficult disruption, biomass requires severe treatment conditions to produce bioproducts. These processes also generate substances that inhibit microbial metabolism, resulting in low conversion of sugars into bioproducts. To minimize this, in this work the sisal bagasse acid hydrolysate was detoxified using the activated carbon obtained from residues of the gasification of açaí endocarp. The adsorbent properties were analyzed, and the effects of experimental parameters related to furfural adsorption were evaluated. Then, the validation of the adsorption experiments was carried out in acid hydrolyzed liquor from sisal bagasse, the fermentation tests being performed with Saccharomyces cerevisiae. Overall, the furfural adsorption in the activated carbon was fast since most of the furfural was removed in the first minutes of the experiment. The Sips isotherm fit the experimental data best, with maximum adsorption capacity of 48.02 mg.g-1. Kinetic data fitted LDF, QDF and FD models, and diffusivity parameters were obtained. After detoxification, the activated carbon from açaí waste removed 52% of furfural, 100% of HMF and 40.4% of acetic acid with moderate loss of sugars (17%). The results confirmed that the adsorbent is effective and promising for removing furfural and other fermentation inhibitors.

Development of new cold antibodies in a patient with a history of warm autoimmune haemolytic anaemia.

A 31-year-old male presented to our facility with complaints of shortness of breath and left-sided chest pain. On record review, it was revealed that he had been seen in 2014 for an almost identical presentation and had been found to have haemolytic anaemia with warm autoantibodies. Following his acute treatment during that hospital admission, he was lost to follow-up. During his subsequent admission, 5 years later, he was found to have a systemic autoimmune disorder with a superimposed acute bacterial infection leading to a second case of haemolytic anaemia and at this time with both cold and warm antibodies present. While his diagnosis was initially difficult to make due to both derangements in expected laboratory values and the mixed pattern of the haemolytic anaemia, he was promptly treated with intravenous immune globulin and steroids and was able to make a full recovery.

Clinical Advancement and Challenges of ex vivo Expansion of Human Cord Blood Cells.

Apart from peripheral blood stem cell (PBSC), umbilical cord blood (UCB) is now a recognized source of stem cells for transplantation. UCB is an especially important source of stem cells for minority populations, which would otherwise be unable to find appropriately matched adult donors. UCB has fewer mature T lymphocytes compared with peripheral blood, thus making a UCB transplantation (UCBT) with a greater degree of HLA mismatch possible. The limited cell dose per UCB sample is however associated with delayed engraftment and a higher risk of graft failure, especially in adult recipients. This lower cell dose can be optimized by performing double unit UCBT, ex vivo UCB expansion prior to transplant and enhancement of the capabilities of the stem cells to home to the bone marrow. UCB contains naïve and immature T cells, thus posing significant challenges with increased risk of infections, graft versus host diseases (GVHD) and relapse following UCBT. Cell engineering techniques have been developed to circumnavigate the immaturity of the T cells, and include virus-specific cytotoxic T cells (VSTs), T cells transduced with disease-specific chimeric antigen receptor (CAR T cells) and regulatory T cell (Tregs) engineering. In this article, we review the advances in UCB ex vivo expansion and engineering to improve engraftment and reduce complications. As further research continues to find ways to overcome the current challenges, outcomes from UCBT will likely improve.

Hepatocellular Carcinoma Presenting With Inferior Vena Cava Tumor Thrombus Extending to the Right Atrium: A Case Report.

Hepatocellular carcinoma (HCC) is the most common primary liver tumor, and its incidence has been on the rise worldwide. It is a common cause of cancer-related death. HCC carries a poor prognosis and is challenging to manage, especially when diagnosed in advanced stages. We present a rare case of HCC in liver cirrhosis secondary to viral hepatitis C (HCV) infection, presenting with large tumor thrombus extending to the right atrium treated with lenvatinib.