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1.
Texto & contexto enferm ; 29: e20180310, Jan.-Dec. 2020.
Artigo em Inglês | LILACS, BDENF - Enfermagem | ID: biblio-1101979

RESUMO

ABSTRACT Objective: to analyze adherence to the nursing guidelines for home care of bone marrow transplant recipients from an ecosystem perspective. Method: descriptive, exploratory study with a qualitative approach, using Content Analysis for data analysis, with theoretical and philosophical ecosystem support. The interviews, carried out in bone marrow transplant services, in Brazil and Spain, were guided by an instrument developed by the researchers which contained 25 closed and ten open questions. 40 users participated who met the inclusion criteria. Data collection was carried out from July 2016 to October 2017. Results: the Orientations category emerged from the data which then gave rise to the subcategories: Interactive relational actions; and, actions and behaviors that interfered in the success of the transplant. Some users, due to excessive information at the time of discharge, were unable to assimilate or carry out the guidelines received; others, during the hospitalization phase, apprehended them and absorbed them in order to use them in the home ecosystem space after transplantation. Conclusion: part of the users followed only the guidelines that best adapted to their daily lives and, for others, after hospital discharge, they caused doubts and insecurities regarding the care to be performed at home. It is necessary for the user to identify the constituent elements of their home ecosystem and learn, through communication and information, how they interfere in post-hospital discharge care. Therefore, it is necessary to create communication and information mechanisms that enable the dynamic process between the constituent elements of the ecosystem, biotic and abiotic, so that they have interaction and sustainability and can be practiced by the user.


RESUMEN Objetivo: analizar el cumplimiento de las directrices de la enfermera para el cuidado domiciliario de los receptores de trasplante de médula ósea en una perspectiva ecosistémica. Método: descriptivo, exploratorio, con un enfoque cualitativo, utilizando el análisis de contenido para el análisis de datos, con soporte teórico y filosófico del ecosistema. Las entrevistas, realizadas en los servicios de trasplante de médula ósea, en Brasil y España, fueron guiadas por un instrumento desarrollado por los investigadores, que contenía 25 preguntas cerradas y diez abiertas. Participaron 40 usuarios que cumplieron con los criterios de inclusión. La recolección de datos se realizó entre julio de 2016 y octubre de 2017. Resultados: la categoría Orientaciones surgió de los datos y originó las subcategorías: acciones relacionales interactivas, acciones y comportamientos que interfirieron en el éxito del trasplante. Algunos usuarios, debido a la información excesiva al momento del alta, no pudieron asimilar y llevar a cabo las pautas recibidas, otros, en el curso de la fase de hospitalización, los detuvieron para absorberlos para su atención en el espacio del ecosistema del hogar en el pos trasplante. Conclusión: parte de lós usuários siguió solo las pautas que mejor se adaptaron a su vida diaria y para otros, después del alta hospitalaria, causaron dudas e inseguridades com respecto a La atención que se practica em elhogar. Es necesario que el usuario identifique los elementos constitutivos del ecosistema de su hogar y aprenda, a través de la comunicación y la información, cómo interfieren en la atención hospitalaria posterior al alta. Por lo tanto, es necesario crear mecanismos de comunicación e información que permitan el proceso dinámico entre los elementos constitutivos del ecosistema, bióticos y abióticos, para que tengan interacción y sostenibilidad y puedan ser practicados por el usuario.


RESUMO Objetivo: analisar a adesão às orientações do enfermeiro para o cuidado domiciliar do transplantado de medula óssea na perspectiva ecossistêmica. Método: descritivo, exploratório, com abordagem qualitativa, utilizando-se para a análise dos dados a Análise de Conteúdo, com apoio teórico-filosófico ecossistêmico. As entrevistas, realizadas em serviços de transplante de medula óssea, no Brasil e Espanha, foram norteadas por um instrumento elaborado pelas pesquisadoras, contendo 25 questões fechadas e dez abertas. Participaram 40 usuários que cumpriram os critérios de inclusão. A coleta de dados foi realizada de julho de 2016 a outubro de 2017. Resultados: a categoria Orientações emergiu dos dados e originou as subcategorias: Ações relacionais interativas; e, ações e comportamentos que interferiram no sucesso do transplante. Alguns usuários, por excesso de informações no momento da alta, não conseguiram assimilar e desempenhar as orientações recebidas; outros, no transcorrer da fase de internação, as apreenderam absorvê-las para o cuidado no espaço ecossistêmico domiciliar no pós-transplante. Conclusão: parte dos usuários seguiu somente as orientações que melhor se adaptaram ao seu cotidiano e, para outros, no pós-alta hospitalar, ocasionaram dúvidas e inseguranças em relação ao cuidado a ser praticado no domicílio. Faz-se necessário que o usuário identifique os elementos constituintes do seu ecossistema domiciliar e conheça, por meio da comunicação e informação, como interferem no cuidado pós alta hospitalar. Portanto, é preciso criar mecanismos de comunicação e informação que possibilitem o processo dinâmico entre os elementos constituintes do ecossistema, bióticos e abióticos, para que tenham interação e sustentabilidade e possam ser praticados pelo usuário.


Assuntos
Humanos , Adulto , Adulto Jovem , Transplante , Medula Óssea , Transplante de Medula Óssea , Transplantes , Cuidados de Enfermagem , Enfermagem , Ecossistema , Transplantados , Cooperação e Adesão ao Tratamento , Habitação
2.
Lancet Oncol ; 21(10): e477-e487, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33002443

RESUMO

The use of total body irradiation as part of conditioning regimens for acute leukaemia is progressively declining because of concerns of late toxic effects and the introduction of radiation-free regimens. Total marrow irradiation and total marrow and lymphoid irradiation represent more targeted forms of radiotherapy compared with total body irradiation that have the potential to decrease toxicity and escalate the dose to the bone marrow for high-risk patients. We review the technological basis and the clinical development of total marrow irradiation and total marrow and lymphoid irradiation, highlighting both the possible advantages as well as the current roadblocks for widespread implementation among transplantation units. The exact role of total marrow irradiation or total marrow and lymphoid irradiation in new conditioning regimens seems dependent on its technological implementation, aiming to make the whole procedure less time consuming, more streamlined, and easier to integrate into the clinical workflow. We also foresee a role for computer-assisted planning, as a way to improve planning and delivery and to incorporate total marrow irradiation and total marrow and lymphoid irradiation in multi-centric phase 2-3 trials.


Assuntos
Transplante de Medula Óssea , Medula Óssea/efeitos da radiação , Leucemia Mieloide Aguda/terapia , Irradiação Linfática , Condicionamento Pré-Transplante , Humanos , Irradiação Linfática/efeitos adversos , Doses de Radiação , Planejamento da Radioterapia Assistida por Computador , Condicionamento Pré-Transplante/efeitos adversos , Condicionamento Pré-Transplante/tendências , Resultado do Tratamento , Irradiação Corporal Total/efeitos adversos
3.
Zhongguo Shi Yan Xue Ye Xue Za Zhi ; 28(5): 1539-1544, 2020 Oct.
Artigo em Chinês | MEDLINE | ID: mdl-33067951

RESUMO

OBJECTIVE: To detect the expression level of LncRNA XLOC_109948 in bone marrow and serum of patients with acute myeloid Leukemia (AML), to verify the consistency between the expression in bone marrow and serum and to explore the role of LncRNA XLOC_109948 expression in the occurrence a development of AML. METHODS: Bone marrow and peripheral blood samples were collected from 62 patients with AML, including 36 patients with AML (AML group), 26 AML patients with complete remission (AML-CR group), and peripheral blood from 20 healthy persons (control group) were also collected. The expression level of LncRNA XLOC_109948 was detected by real-time quantitative fluorescence PCR (qRT-PCR), and the relationship between its expression and clinical characteristics was analyzed. RESULTS: The expression of LncRNA XLOC_109948 in bone marrow and serum of AML patients was higher than that of AML patients with complete remission and healthy people (P<0.001). And there was no statistically significant difference between the AML-CR group and control group (P>0.05). The expression of LncRNA XLOC_109948 significantly decreased when AML patients reached to CR, and significantly increased when the disease relapsed (P<0.05). The expression of LncRNA XLOC_109948 significantly correlated with the clinicopathologic parameters of cytogenetics (P<0.05), but not significantly correlated with sex, age, WBC count, blast in bone marrow, FAB classification and other clinical characteristics (P>0.05). CONCLUSION: The expression of LncRNA XLOC_109948 in bone marrow and serum of AML patients is high, and its expression in time and sequence is consistent between bone marrow and serum, which can reflect the occurrence, development, chemotherapy efficacy and prognosis of AML patients.


Assuntos
Leucemia Mieloide Aguda , RNA Longo não Codificante , Medula Óssea , Humanos , Leucemia Mieloide Aguda/genética , Prognóstico , RNA Longo não Codificante/genética , Indução de Remissão
4.
Zhongguo Shi Yan Xue Ye Xue Za Zhi ; 28(5): 1637-1642, 2020 Oct.
Artigo em Chinês | MEDLINE | ID: mdl-33067966

RESUMO

OBJECTIVE: To study the expression of Shh singaling related gene, including Shh, Ptch1, Smo and Gli1 in bone marrow CD34+ cells of patients with myelodysplastic syndrome(MDS) and acute myeloid leukemia with myelodysplasia-related changes(AML-MRC), and to explore their clinical significance. METHODS: The count of CD34+ cells in bone marrow was detected by flow cytometry in 53 patients with MDS and 30 patients with AML-MRC. Magnetic beads were used to separate CD34+ cells. The expression of Shh, Ptch1,Smo and Gli1 on CD34+ cells was detected by qRT-PCR, the effect of the 4 gene expression on prognosis of patients in MDS and AML-MRC group was compared, 25 patients with iron-deficiency anemia were used as controls. RESULTS: The expression levels of Shh, Smo and Gli1 of patients in MDS and AML-MRC group were significantly higher than those in control group (P<0.05), moreover increased with disease progression(P<0.05). The expression of Ptch1 was not statistically significantly different between 3 groups(P>0.05). In comparison of prognosis, the expression of Smo and Gli1 in the patients of relatively high risk groups and AML-MRC groups were significantly increased (P<0.05). The median overall survival time of patients in MDS and AML-MRC groups was 12(7.5,16.5) and 6(3.0,9.0) months (P=0.000) respectively. The median survival time of MDS and AML-MRC patients with high expression of Smo and Gli1 was significantly shorter than that of MDS and AML-MRC patients with low expression of Smo and Gli1(P<0.05). CONCLUSION: Shh signaling pathway in the patients with MDS is activated, which is involved in the progress and prognosis of MDS.


Assuntos
Leucemia Mieloide Aguda , Síndromes Mielodisplásicas , Medula Óssea , Células da Medula Óssea , Proteínas Hedgehog , Humanos , Transdução de Sinais
5.
Nat Commun ; 11(1): 4977, 2020 10 05.
Artigo em Inglês | MEDLINE | ID: mdl-33020483

RESUMO

Although thousands of breast cancer cells disseminate and home to bone marrow until primary surgery, usually less than a handful will succeed in establishing manifest metastases months to years later. To identify signals that support survival or outgrowth in patients, we profile rare bone marrow-derived disseminated cancer cells (DCCs) long before manifestation of metastasis and identify IL6/PI3K-signaling as candidate pathway for DCC activation. Surprisingly, and similar to mammary epithelial cells, DCCs lack membranous IL6 receptor expression and mechanistic dissection reveals IL6 trans-signaling to regulate a stem-like state of mammary epithelial cells via gp130. Responsiveness to IL6 trans-signals is found to be niche-dependent as bone marrow stromal and endosteal cells down-regulate gp130 in premalignant mammary epithelial cells as opposed to vascular niche cells. PIK3CA activation renders cells independent from IL6 trans-signaling. Consistent with a bottleneck function of microenvironmental DCC control, we find PIK3CA mutations highly associated with late-stage metastatic cells while being extremely rare in early DCCs. Our data suggest that the initial steps of metastasis formation are often not cancer cell-autonomous, but also depend on microenvironmental signals.


Assuntos
Interleucina-6/metabolismo , Células-Tronco Neoplásicas/metabolismo , Células-Tronco Neoplásicas/patologia , Transdução de Sinais , Medula Óssea/patologia , Mama/citologia , Neoplasias da Mama/patologia , Classe I de Fosfatidilinositol 3-Quinases/genética , Classe I de Fosfatidilinositol 3-Quinases/metabolismo , Receptor gp130 de Citocina/metabolismo , Células Epiteliais/metabolismo , Células Epiteliais/patologia , Feminino , Humanos , Interleucina-6/genética , Mutação , Metástase Neoplásica/genética , Receptores de Interleucina-6/deficiência , Receptores de Interleucina-6/metabolismo , Células Estromais/metabolismo , Microambiente Tumoral
6.
Zhongguo Shi Yan Xue Ye Xue Za Zhi ; 28(5): 1464-1467, 2020 Oct.
Artigo em Chinês | MEDLINE | ID: mdl-33067938

RESUMO

OBJECTIVE: To investigate the prognostic significance of CUEDC1 in patients with acute myeloid leukemia (non-M3). METHODS: 52 cases newly diagnosed AML (non-M3) were selected and enrolled in AML non-M3 group, at the same time, 10 cases of iron doficiency anemia were selected and enrolled in control group. The bone marrow mononuclear cells(BMMC) were isolated from bone marrow of patients, the expression level of CUEDC1 in BMMC was detected by RT-PCR, the expression level of CUEDC1 mRNA in BMMC of AML-subtype patients was compared. The AML patients were divided into low and high expression groups according to the expression level of CUEDC1 mRNA, and the complete remission rate after the first chemothrapy course was compared, and the relative expression level of CUEDC1 mRNA between the remission and the non-remission group were compared. RESULTS: CUEDC1 was expressed in BMMC of 52 newly diagnosed patients with AML (non-M3) of all subtypes, which was higher than that in control group (P<0.05), and the expression level of CUEDC1 mRNA in M5 patients was the highest (P<0.05). In CUEDC1 low expression group, induced complete remisson rate (76.2%,16/21) after the first course of treatment seemed higher than that of the high expression group(67.7%,21/31), but the difference was not statistically significant; the expression level of CUEDC1 mRNA in the remission group of patients with newly diagnosed AML(non-M3) was lower than that in the non-remission group(P<0.05). CONCLUSION: CUEDC1 is highly expressed in newly diagnosed patients with AML, among which the CUEDC1 mRNA expression level in M5 patients is the highest, the expression of CUEDC1 mRNA possibly relates to the prognosis of patients with AML.


Assuntos
Peptídeos e Proteínas de Sinalização Intracelular , Leucemia Mieloide Aguda , Medula Óssea , Humanos , Peptídeos e Proteínas de Sinalização Intracelular/genética , Ferro , Prognóstico , RNA Mensageiro/genética
7.
Medicine (Baltimore) ; 99(40): e22505, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019449

RESUMO

RATIONALE: Neuroblastoma (NB) can occur in any part of the sympathetic nervous system, and it is highly heterogeneous. Tumors that only involve bone marrow and bone lesions without solid masses have rarely been reported. PATIENT CONCERNS: A 2-year-old girl child presented with recurrent fever, accompanied by pain in both lower limbs for more than 1 month. DIAGNOSE: Bone marrow examination revealed NB cell invasion. Femoral and multiple vertebral lesions were observed by MRI, while head MRI, chest CT, abdominal CT, and pelvic CT showed no solid mass. INTERVENTIONS: The child received the standard therapy for high-risk NB. OUTCOMES: She was sensitive to the initial chemotherapy protocol. Two years later, a bone marrow examination confirmed NB recurrence. LESSONS: The prognosis of this special type of NB was not improved mainly based on common chemotherapy and local radiotherapy, and new treatment strategies should be explored.


Assuntos
Medula Óssea/patologia , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/patologia , Neuroblastoma/patologia , Exame de Medula Óssea , Neoplasias Ósseas/diagnóstico , Pré-Escolar , Feminino , Humanos , Imagem por Ressonância Magnética , Neuroblastoma/diagnóstico , Tomografia Computadorizada por Raios X
8.
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde | ID: lis-47834

RESUMO

A doação de medula óssea é importante para o tratamento de pacientes com doenças que comprometem a produção normal de células sanguíneas, como as leucemias, além de portadores de aplasia de medula óssea e síndromes de imunodeficiência congênita. Entenda como se inscrever para ser um doador voluntário e como é realizado o procedimento.


Assuntos
Doações , Medula Óssea , Doenças da Medula Óssea
9.
Arthroscopy ; 36(9): 2412-2414, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32891243

RESUMO

Cell therapies hold great promise as primary and adjuvant treatments for a range of musculoskeletal conditions. Bone marrow harvested from the iliac crest represents the gold-standard source of progenitor cells with a recognized ability to release trophic factors, modulate local immune environments, and differentiate into multiple musculoskeletal cell types in vitro. Identifying accessible locations that limit donor-site morbidity while increasing efficiency during aspiration of bone marrow is essential. There is increasing evidence to suggest that the number of progenitor cells present in bone marrow aspirated from multiple sites, including the proximal humerus and ilium, is at least equivalent to that from the iliac crest. Because many of these sources lie within the surgical field, the requirement for iliac crest harvest and the risks associated with secondary harvest sites can be mitigated. Although there is a clear need for further studies evaluating the biological attributes and clinical benefit of bone marrow aspirate concentrate in a range of clinical settings, the use of local harvesting sites is likely to reduce morbidity and improve the experience for patients.


Assuntos
Produtos Biológicos , Ílio , Artroscopia , Medula Óssea , Humanos , Úmero
10.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(9): 1130-1135, 2020 Sep 15.
Artigo em Chinês | MEDLINE | ID: mdl-32929906

RESUMO

Objective: To analyze the effectiveness of percutaneous injection of autologous concentrated bone marrow aspirate (cBMA) combined with platelet-rich plasma (PRP) in the treatment of delayed fracture healing. Methods: A prospective, randomized, controlled, single-blind case study was conducted. Between March 2016 and July 2018, 66 patients who met the inclusion and exclusion criteria for delayed fracture healing but had solid internal fixation of the fracture end were randomly divided into control group (31 cases, treated with percutaneous autogenous bone marrow blood injection) and study group (35 cases, treated with percutaneous autogenous cBMA+PRP injection). General data such as gender, age, body mass index, site of delayed fracture healing, length of bone defect at fracture end, and preoperative radiographic union score for tibia (RUST) showed no significant difference between the two groups ( P>0.05). Before injection, Kirschner wire was used in both groups to stimulate the fracture end and cause minor injury. The fracture healing time, treatment cost, and adverse reactions were recorded and compared between the two groups. Visual analogue scale (VAS) score was used to evaluate pain improvement. The tibial RUST score was extended to the tubular bone healing evaluation. Results: No infection of bone marrow puncture needle eyes occurred in both groups. In the control group, local swelling was obvious in 5 cases and pain was aggravated at 1 day after operation in 11 cases. In the study group, postoperative swelling and pain were not obvious, but 2 cases presented local swelling and pain. All of them relieved after symptomatic treatment. Patients in both groups were followed up, the follow-up time of the control group was 16-36 months (mean, 21.8 months), and the study group lasted 14-33 months (mean, 23.2 months). The amount of bone marrow blood was significantly lower in the study group than in the control group ( t=4.610, P=0.000). The degree of postoperative pain in the study group was less than that in the control group, and the treatment cost was higher than that in the control group. But the differences between the two groups in VAS score at 1 day after operation and treatment cost were not significant ( P>0.05). Fracture healing was achieved in 19 cases (61.3%) in the control group and 30 cases (85.7%) in the study group. The difference in fracture healing rate between the two groups was significant ( χ 2=5.128, P=0.024). Fracture healing time and RUST score at last follow-up were significantly better in the study group than in the control group ( P<0.05). At last follow-up, RUST scores in both groups were significantly improved when compared with those before operation ( P<0.05). Conclusion: Autogenous cBMA combined with PRP percutaneous injection can provide high concentration of BMSCs and growth factors, and can improve the fracture healing rate and shorten the fracture healing time better than autogenous bone marrow blood injection.


Assuntos
Consolidação da Fratura , Plasma Rico em Plaquetas , Medula Óssea , Fixação Interna de Fraturas , Humanos , Estudos Prospectivos , Método Simples-Cego , Resultado do Tratamento
12.
Nat Commun ; 11(1): 4798, 2020 09 23.
Artigo em Inglês | MEDLINE | ID: mdl-32968066

RESUMO

Myeloid cells are known mediators of hypertension, but their role in initiating renin-induced hypertension has not been studied. Vitamin D deficiency causes pro-inflammatory macrophage infiltration in metabolic tissues and is linked to renin-mediated hypertension. We tested the hypothesis that impaired vitamin D signaling in macrophages causes hypertension using conditional knockout of the myeloid vitamin D receptor in mice (KODMAC). These mice develop renin-dependent hypertension due to macrophage infiltration of the vasculature and direct activation of renal juxtaglomerular (JG) cell renin production. Induction of endoplasmic reticulum stress in knockout macrophages increases miR-106b-5p secretion, which stimulates JG cell renin production via repression of transcription factors E2f1 and Pde3b. Moreover, in wild-type recipient mice of KODMAC/miR106b-/- bone marrow, knockout of miR-106b-5p prevents the hypertension and JG cell renin production induced by KODMAC macrophages, suggesting myeloid-specific, miR-106b-5p-dependent effects. These findings confirm macrophage miR-106b-5p secretion from impaired vitamin D receptor signaling causes inflammation-induced hypertension.


Assuntos
Hipertensão Renal/metabolismo , Hipertensão/metabolismo , Macrófagos/metabolismo , MicroRNAs/metabolismo , Nefrite/metabolismo , Renina/metabolismo , Animais , Medula Óssea , Transplante de Medula Óssea , Modelos Animais de Doenças , Fator de Transcrição E2F1/metabolismo , Estresse do Retículo Endoplasmático , Feminino , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Células Mieloides , Receptores de Calcitriol , Vitamina D
13.
Medicine (Baltimore) ; 99(39): e22299, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32991435

RESUMO

INTRODUCTION: Hemophagocytic lymphohistiocytosis (HLH) is a condition characterized by a hyperinflammatory state and persistent macrophage activation, resulting in reactive phagocytosis of the hematopoietic elements. In children, it is usually a hereditary disorder, while in adults it is usually acquired secondary to viral infections, collagenoses, or tumors. Although accounting for 10% of hematologic malignancies, HLH is rarely associated with multiple myeloma (MM) and other plasmacytic dyscrasias. PATIENT CONCERNS: A 64-year-old Brazilian man seeked medical care with a 3-month history of intermittent fever, weight loss, night sweats, and progressive anemic symptoms. DIAGNOSIS: Total blood count showed severe bicytopenia (normocytic-normochromic anemia and thrombocytopenia), biochemical exams showed elevation of creatinine, as well as monoclonal peak in serum protein electrophoresis, high IgA dosage, and serum immunofixation with IgA kappa paraprotein. Bone marrow biopsy showed 30% of monoclonal and phenotypically anomalous plasmocytes, confirming the diagnosis of MM. Diagnosis of HLH was established by the presence of clinical and laboratory criteria: fever, splenomegaly, cytopenias, hypofibrinogenemia, hyperferritinemia, elevation of triglycerides, and several figures of erythrophagocytosis in bone marrow aspirate. INTERVENTIONS: The patient experienced pulse therapy with methylprednisolone for hemophagocytic lymphohistiocytosis, followed by initial therapy for multiple myeloma with cyclophosphamide and dexamethasone. OUTCOMES: Once the diagnosis of MM and secondary hemophagocytic syndrome was established, the patient had a rapid clinical deterioration despite the established therapeutic measures, evolving with cardiovascular failure, acute liver failure, acute disseminated intravascular coagulation, worsening renal dysfunction requiring dialysis support, respiratory dysfunction, and lowering of consciousness, characterizing rapid multiple organ dysfunction, ultimately leading to the death of the patient. INNOVATION: Here, we aimed to describe the sixth reported case of HLH associated with MM, according to cases cataloged in the PubMed database, and the first case evaluated by 18-fluordeoxyglucose positron emission tomography (18-FDG-PETCT). CONCLUSION: Our case report seeks to provide support for a better clinical and laboratory characterization of this rare paraneoplastic entity associated with MM, and aims to call the attention of hematologists and intensivists to this condition that falls within the scope of the differential diagnosis of rapid onset multiple organ failure in patients with plasmacytic neoplasms.


Assuntos
Linfo-Histiocitose Hemofagocítica/tratamento farmacológico , Linfo-Histiocitose Hemofagocítica/etiologia , Mieloma Múltiplo/complicações , Mieloma Múltiplo/tratamento farmacológico , Anemia/sangue , Anemia/etiologia , Antineoplásicos Alquilantes/administração & dosagem , Antineoplásicos Alquilantes/uso terapêutico , Medula Óssea/patologia , Brasil/epidemiologia , Ciclofosfamida/administração & dosagem , Ciclofosfamida/uso terapêutico , Dexametasona/administração & dosagem , Dexametasona/uso terapêutico , Quimioterapia Combinada , Evolução Fatal , Febre/diagnóstico , Febre/etiologia , Glucocorticoides/administração & dosagem , Glucocorticoides/uso terapêutico , Humanos , Linfo-Histiocitose Hemofagocítica/sangue , Linfo-Histiocitose Hemofagocítica/diagnóstico , Masculino , Metilprednisolona/administração & dosagem , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Mieloma Múltiplo/metabolismo , Insuficiência de Múltiplos Órgãos/complicações , Paraproteinemias/sangue , Plasmócitos/patologia , Esplenomegalia/diagnóstico , Esplenomegalia/etiologia , Trombocitopenia/sangue , Trombocitopenia/etiologia , Perda de Peso
14.
PLoS One ; 15(8): e0237155, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32866200

RESUMO

BACKGROUND: Stringent complete response (sCR) is used as a deeper response category than complete response (CR) in multiple myeloma (MM) but may be of limited value in the era of minimal residual disease (MRD) testing. METHODS: Here, we used 4-colour multiparametric flow cytometry (MFC) or next-generation sequencing (NGS) of immunoglobulin genes to analyse and compare the prognostic impact of sCR and MRD monitoring. We included 193 treated patients in two institutions achieving CR, for which both bone marrow aspirates and biopsies were available. RESULTS: We found that neither the serum free light chain ratio, clonality by immunohistochemistry (IHC) nor plasma cell bone marrow infiltration identified CR patients at distinct risk. Patients with sCR had slightly longer progression-free survival. Nevertheless, persistent clonal bone marrow disease was detectable using MFC or NGS and was associated with significantly inferior outcomes compared with MRD-negative cases. CONCLUSION: Our results confirm that sCR does not predict a different outcome and indicate that more sensitive techniques are able to identify patients with differing prognoses. We suggest that MRD categories should be implemented over sCR for the future classification of MM responses.


Assuntos
Mieloma Múltiplo/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Medula Óssea/patologia , Confiabilidade dos Dados , Feminino , Citometria de Fluxo/métodos , Seguimentos , Sequenciamento de Nucleotídeos em Larga Escala/métodos , Humanos , Cadeias Leves de Imunoglobulina/sangue , Cadeias Leves de Imunoglobulina/genética , Masculino , Pessoa de Meia-Idade , Neoplasia Residual , Plasmócitos/imunologia , Prognóstico , Intervalo Livre de Progressão , Estudos Retrospectivos
15.
Nan Fang Yi Ke Da Xue Xue Bao ; 40(8): 1134-1140, 2020 Aug 30.
Artigo em Chinês | MEDLINE | ID: mdl-32895184

RESUMO

OBJECTIVE: To explore whether thrombopoietin (TPO) can rescue megakaryopoiesis by protecting bone marrowderived endothelial progenitor cells (BM-EPCs) in patients receiving chemotherapy for hematological malignancies. METHODS: Bone marrow samples were collected from 23 patients with hematological malignancies 30 days after chemotherapy and from 10 healthy volunteers. BM-EPCs isolated from the samples were identified by staining for CD34, CD309 and CD133, and their proliferation in response to treatment with TPO was assessed using CCK8 assay. DiL-Ac-LDL uptake and FITC-UEA-I binding assay were performed to evaluate the amount of BM-EPCs from the subjects. Tube-formation and migration experiments were used for functional assessment of the BM-EPCs. The BM-EPCs with or without TPO treatment were co-cultured with human megakaryocytes, and the proliferation of the megakaryocytes was detected with flow cytometry. RESULTS: Flow cytometry indicated that the TPO-treated cells had high expressions of CD34, CD133, and CD309. CCK8 assay demonstrated that TPO treatment enhanced the proliferation of the BM-EPCs, and the optimal concentration of TPO was 100 µg/L. Double immunofluorescence assay indicated that the number of BM-EPC was significantly higher in TPO-treated group than in the control group. The TPO-treated BM-EPCs exhibited stronger tube-formation and migration abilities (P < 0.05) and more significantly enhanced the proliferation of co-cultured human megakaryocytes than the control cells (P < 0.05). CONCLUSIONS: TPO can directly stimulate megakaryopoiesis and reduce hemorrhage via protecting the function of BM-EPCs in patients following chemotherapy for hematological malignancies.


Assuntos
Medula Óssea , Neoplasias Hematológicas , Células da Medula Óssea , Células Cultivadas , Humanos , Megacariócitos , Trombopoetina
17.
Nat Commun ; 11(1): 4549, 2020 09 11.
Artigo em Inglês | MEDLINE | ID: mdl-32917889

RESUMO

Arterial macrophages have different developmental origins, but the association of macrophage ontogeny with their phenotypes and functions in adulthood is still unclear. Here, we combine macrophage fate-mapping analysis with single-cell RNA sequencing to establish their cellular identity during homeostasis, and in response to angiotensin-II (AngII)-induced arterial inflammation. Yolk sac erythro-myeloid progenitors (EMP) contribute substantially to adventitial macrophages and give rise to a defined cluster of resident immune cells with homeostatic functions that is stable in adult mice, but declines in numbers during ageing and is not replenished by bone marrow (BM)-derived macrophages. In response to AngII inflammation, increase in adventitial macrophages is driven by recruitment of BM monocytes, while EMP-derived macrophages proliferate locally and provide a distinct transcriptional response that is linked to tissue regeneration. Our findings thus contribute to the understanding of macrophage heterogeneity, and associate macrophage ontogeny with distinct functions in health and disease.


Assuntos
Artérias/citologia , Arterite/imunologia , Diferenciação Celular/fisiologia , Homeostase/fisiologia , Macrófagos/fisiologia , Envelhecimento/fisiologia , Angiotensina II/administração & dosagem , Angiotensina II/imunologia , Animais , Artérias/fisiologia , Medula Óssea/fisiologia , Transplante de Medula Óssea , Linhagem da Célula , Modelos Animais de Doenças , Feminino , Células-Tronco Hematopoéticas/fisiologia , Humanos , Masculino , Camundongos , Camundongos Transgênicos , RNA-Seq , Regeneração/fisiologia , Análise de Célula Única , Quimeras de Transplante
18.
Medicine (Baltimore) ; 99(34): e21876, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846844

RESUMO

BACKGROUND: Cancer continues to be a severe global health problem and the leading cause of death worldwide. Chemotherapy as the main treatment has various side effects, of which marrow suppression is the most common one. Acupuncture had shown clinical effects for marrow suppression after chemotherapy in many studies. However, the efficacy and safety of acupuncture therapy for marrow suppression after chemotherapy remains unclear. OBJECTIVE: This protocol aims to evaluate the efficacy and safety of acupuncture for marrow suppression after chemotherapy according to the existing randomized controlled trials. METHODS AND ANALYSIS: The randomized controlled trials on acupuncture therapy for marrow suppression after chemotherapy will be searched in the database of Embase, PubMed and Cochrane Library, Allied and Complementary Medicine Database (AMED), Chinese Biomedical Literature Database (CBM), China Science and Technology Journal Database (VIP), China National Knowledge Infrastructure (CNKI), WanFang Database (WF), and related registration platforms (WHO ICTRP, Clinical Trials, and Chinese Clinical Trial Register [ChiCTR]), Grey Literature Database from inception to 1 August 2020. The primary outcomes will be assessed using white blood cell (WBC) count, platelet count, hemoglobin count and the number of neutrophils (N). Review Manager V.5.3 software will be applied for statistical analyses. We will measure the risk of bias of the included studies with Cochrane Collaboration Risk of Bias Tool. Finally, Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) will be used to grade the overall quality of evidence. And we will use the intra-group correlation coefficient to assess the consistency of reviewers. RESULT: This systematic review and meta-analysis will put a high-quality synthesis of the efficacy and safety of acupuncture treatment in marrow suppression after chemotherapy. CONCLUSION: The conclusion of this systematic review will provide evidence to assess acupuncture therapy is an efficacy and safe intervention to treat and control marrow suppression after chemotherapy. PROSPERO REGISTRATION NUMBER: PROSPERO CRD42020163336.


Assuntos
Terapia por Acupuntura/métodos , Antineoplásicos/efeitos adversos , Células da Medula Óssea/efeitos dos fármacos , Medula Óssea/efeitos dos fármacos , Medula Óssea/patologia , Tratamento Farmacológico/métodos , Feminino , Hemoglobinas/análise , Humanos , Contagem de Leucócitos/métodos , Masculino , Neoplasias/tratamento farmacológico , Neutrófilos/citologia , Contagem de Plaquetas/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Segurança , Resultado do Tratamento
19.
Nat Commun ; 11(1): 4075, 2020 08 14.
Artigo em Inglês | MEDLINE | ID: mdl-32796847

RESUMO

Hematopoietic ageing involves declining erythropoiesis and lymphopoiesis, leading to frequent anaemia and decreased adaptive immunity. How intrinsic changes to the hematopoietic stem cells (HSCs), an altered microenvironment and systemic factors contribute to this process is not fully understood. Here we use bone marrow stromal cells as sensors of age-associated changes to the bone marrow microenvironment, and observe up-regulation of IL-6 and TGFß signalling-induced gene expression in aged bone marrow stroma. Inhibition of TGFß signalling leads to reversal of age-associated HSC platelet lineage bias, increased generation of lymphoid progenitors and rebalanced HSC lineage output in transplantation assays. In contrast, decreased erythropoiesis is not an intrinsic property of aged HSCs, but associated with decreased levels and functionality of erythroid progenitor populations, defects ameliorated by TGFß-receptor and IL-6 inhibition, respectively. These results show that both HSC-intrinsic and -extrinsic mechanisms are involved in age-associated hematopoietic decline, and identify therapeutic targets that promote their reversal.


Assuntos
Envelhecimento/metabolismo , Células-Tronco Hematopoéticas/metabolismo , Interleucina-6/metabolismo , Células-Tronco Mesenquimais/metabolismo , Fator de Crescimento Transformador beta1/metabolismo , Envelhecimento/genética , Animais , Medula Óssea , Ciclo Celular/fisiologia , Células Cultivadas , Modelos Animais de Doenças , Células Precursoras Eritroides , Eritropoese/genética , Eritropoese/fisiologia , Feminino , Perfilação da Expressão Gênica , Regulação da Expressão Gênica , Hematopoese , Interleucina-6/genética , Linfopoese/genética , Linfopoese/fisiologia , Proteínas de Membrana , Camundongos , Camundongos Endogâmicos C57BL , Células Mieloides , Transdução de Sinais , Nicho de Células-Tronco , Fator de Crescimento Transformador beta1/genética
20.
Zhongguo Shi Yan Xue Ye Xue Za Zhi ; 28(4): 1228-1233, 2020 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-32798403

RESUMO

OBJECTIVE: To investigate the expression and clinical significant of VCAN and its related molecules in patients with MM. METHODS: Ficoll density gradient centrifugation method was used to speared the bone marrow mononuclear cell in 25 cases of MM before and after treatment, the relative mRNA expression of VCAN and their related molecules (FAK, FN, MK, and HAS) in bone marrow was detected by real-time quantitative PCR, and their protein expression was determined by Western bolt. RESULTS: The expression of VCAN, FK and FN in the effective group after treatment was significantly lower than that before treatment (P<0.05), however, the expression of MK and HAS showed no statistically significantly different before and after treatment (P<0.05). The expression of VCAN of patients in non remission group was significantly higher than that in control group (P<0.05). The expression of FAK and FN of patients in no remission group was significant increased as compared with the patients in newly diagnosed group (P<0.05). The relative expression of VCAN mRNA in the patients at 3rd stage was significantly higher than those at the 1st stage (P<0.05) and control group but showed no significant difference to the patients at 2nd stage (P<0.05). The expression of VCAN and its related proteins (FAK, MK, FN) showed positively correlation in bone marrow mononuclear cells of MM patients (P<0.05). The correlation between VCAN and HAS was not statistically significant (r=0.259,P>0.05). Survival analysis showed that the relative expression of VCAN mRNA was associated with OS (P=0.049) and PFS (P=0.041) in MM patients. CONCLUSION: VCAN and its related molecules are highly expressed in MM patients; VCAN may act as potential biomarker in the development of multiple myeloma.


Assuntos
Mieloma Múltiplo , Medula Óssea , Humanos , RNA Mensageiro , Versicanas
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