Should we use extracorporeal photopheresis more often? Evidence from graft-versus-host disease patients monitored with Treg as a biomarker.

BACKGROUND: Chronic graft-versus-host disease (cGvHD) is a major complication after allogeneic hematopoietic cell transplantation. Extracorporeal photopheresis (ECP) is an immunotherapy treatment for cGvHD, although suitable response biomarkers are lacking. MATERIALS & METHODS: We analyzed data from six cGvHD patients undergoing ECP at a reference center from 826 to 2866 days. Circulating Tregs were enumerated, patient's clinical evolution, immunosuppression dose and adverse events (AEs) registered. RESULTS: We observed an increase in Tregs, a decrease in immunosuppression dosage and symptoms improvement. Mild AEs occurred at a very low rate. CONCLUSION: In these patients, the improvement of cGvHD, with low AEs, confirms a place for ECP as treatment. Improvements were accompanied by an increase in circulating Tregs, suggesting their role as a biomarker.

Dextran-based tube-guides for the regeneration of the rat sciatic nerve after neurotmesis injury.

In this work, dextran-based nerve tube-guides were prepared, characterized and used in a standardized animal model of neurotmesis injury. Non-porous and porous transparent tube-guides were obtained by photocrosslinking of two co-macromonomers based on dextran and poly(ε-caprolactone) (PCL). Swelling capacity of the tube-guides ranged from 40-60% with no visible constriction of their inner diameter. In vitro hydrolytic degradation tests showed that the tube-guides maintained their structural integrity up to 6 months. The in vivo performance of the tube-guides was evaluated by entubulation of the rat sciatic nerve after a neurotmesis injury, with a 10 mm-gap between the nerve stumps. The results showed that the tube-guides were able to promote the regeneration of the nerve in a similar manner to what was observed with conventional techniques (nerve graft and end-to-end suture). Stereological analysis proved that nerve regeneration occurred, and both tube-guides presented fibre diameter and g-ratio closer to healthy sciatic nerves. The histomorphometric analysis of Tibialis anterior (TA) skeletal muscle showed decreased neurogenic atrophy in the porous tube-guides treated group, presenting measurements that are similar to the uninjured control.

New perspectives on the conservative management of osteoradionecrosis of the mandible: A literature review.

Over the last decades, several therapeutic options were considered in the treatment of the osteoradionecrosis (ORN) of the mandible, including supportive measures, ultrasound therapy, corticosteroids, hyperbaric oxygen, surgical resection with reconstruction, and, more recently, drugs capable of reversing the fibroatrophic process. Once established, the ORN does not spontaneously disappear and a standard treatment has not yet been defined. The clear clinical effectiveness of hyperbaric oxygen therapy (HBOT) varies according to the literature and there are some economic/logistic issues to be considered; the triplet tocopherol/pentoxifylline/clodronate demands greater evidence from randomized clinical trials and also resilience from the patient, given the long treatment duration and its possible side effects. Controversy around the ideal treatment of the initial stage ORN of the mandible persists. More rigorous randomized prospective trials are essential. The purpose of this article was to review the relevant literature on the physiopathology of ORN of the mandible and discuss the new perspectives of its conservative treatment. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1708-1716, 2016.

Are Amyotrophic Lateral Sclerosis Caregivers at Higher Risk for Health Problems?

INTRODUCTION: Amyotrophic lateral sclerosis is a rare neurodegenerative disease affecting motor neurons. Patients present with progressive physical impairment, respiratory failure being the main cause of death. A significant portion of patients presents neurobehavioral problems as well. As severe impairment occurs, patients become highly dependent and in general, their families assume the role of primary caregivers, exposing them to stress and other potential causes of disease like insomnia, physical strain from patients' mobilization and changes on eating habits. The aim of this work is to understand if taking care of patients with amyotrophic lateral sclerosis increases disease and health problems on caregivers. MATERIAL AND METHODS: Comprehensive review of the literature published on the electronic databases PubMed and Scopus between 2010 and 2014. RESULTS: Eighteen studies met the inclusion criteria. We found that amyotrophic lateral sclerosis caregivers have higher levels of burden, depression and anxiety with lower quality of life. This is associated to age and gender of caregivers, time spent caring, patients' disability and neurobehavioral changes. Higher sense of support and spirituality on family seem to promote wellbeing. DISCUSSION: On our work, we were able to understand that several factors have influenced caregivers' quality of life and affect their health. Besides, we could understand that the outcomes studied are related between themselves and, as seen in some of the studies, related to patients' quality of life itself. Consequently, it has become essential to adopt a holistic approach of these patients and their families, fighting the deteriorating risk factors and investing on health promoters. CONCLUSION: Despite the large body of research on family caregiving for amyotrophic lateral sclerosis patients, little has changed and the outcomes measured remain almost the same before and after 2010. The work indicates that caregivers have lower levels of health than the general population. Still additional research is required, in order to better understand and characterized the changes on caregivers' health. It is nevertheless clear that health care professionals cannot ignore these health changes and need an approach focused not only on patients but also on caregivers.

Introdução: A esclerose lateral amiotrófica é uma doença neuro-degenerativa rara que afeta os neurónios motores. Os doentes apresentam-se com incapacidade motora progressiva e, por vezes, alterações neuro-comportamentais e a principal causa de morte é a falência respiratória. Com o agravamento da incapacidade funcional, os pacientes tornam-se altamente dependentes da família, que assume o papel de cuidador primário, expondo-se ao stress e outras potenciais causas de doença como insónias, o esforço físico realizado para a mobilização dos pacientes e alterações nos hábitos alimentares. O principal objetivo do nosso trabalho é perceber se cuidar de doentes com esclerose lateral amiotrófica aumenta os níveis de doença ou problemas de saúde nos cuidadores. Material e Métodos: Através de uma revisão exaustiva, analisámos a bibliografia publicada nas bases de dados eletrónicas PubMed e Scopus entre 2010 e 2015. Resultados: Verificámos que os cuidadores têm níveis mais elevados de sobrecarga, depressão e ansiedade, assim como menor qualidade de vida. Estes resultados relacionam-se com a idade e o género do cuidador e a duração dos cuidados, para além da incapacidade e das alterações neuro-comportamentais do doente. Uma elevada perceção de suporte e a espiritualidade do cuidador promovem o bem-estar. Discussão: No nosso trabalho foi-nos possível perceber que diversos factores influenciam a qualidade de vida dos cuidadores e afetam a sua saúde. Para além disso, pudemos perceber também que os diversos parâmetros avaliados estão relacionados entre si e, como visto em alguns dos estudos, relacionados com a própria qualidade de vida dos doentes. Consequentemente, tornou-se essencial adotar uma abordagem holística destes pacientes e das suas famílias, combatendo os factores prejudiciais e investindo nos promotores da saúde. Conclusão: Apesar de toda a investigação realizada sobre cuidadores de doentes com esclerose lateral amiotrófica, as variáveis analisadas antes e depois de 2010 foram praticamente as mesmas e pouco mudou nos últimos anos. Tendo sido previamente verificado que os cuidadores têm menores níveis de saúde que a população geral, ainda há muito a fazer no sentido de melhor caracterizar e compreender as alterações de saúde que ocorrem nos cuidadores de doentes com esclerose lateral amiotrófica. No entanto, desde já reforçar a ideia de que os profissionais de saúde não podem ignorar estes factos e devem focar a sua atenção nos pacientes e cuidadores.

[Leg ulcer: conservative treatment]. / Úlcera flebostática: estudo prospectivo de 202 doentes.

During 16 years 202 patients with leg ulcer have been studied prospectively. Whenever possible, cure has been obtained in ambulatory, which was the main objective. Surgery was preferentially made after the cure of the ulcer. From the 202 patients, 166 have made a prolonged follow-up. Cure in ambulatory has been obtained in 91% of the patients. We stress the importance of the direct control of all the treatment by the responsible doctor.