Results of unrelated cord blood transplantation (UCBT) in childhood acute myeloid leukemia (AML) have not been previously reported. We analyzed 95 children receiving UCB transplants for AML (20 in first complete remission [CR1], 47 in CR2, and 28 in more advanced stage). Poor prognosis cytogenetic abnormalities were identified in 29 cases. Most patients received a 1 or 2 HLA antigens-mismatched UCB transplants. The median number of collected nucleated cells (NCs) was 5.2 ؋ 10 7 / kg. Cumulative incidence (CI) of neutrophil recovery was 78% ؎ 4%, acute graftversus-host disease (GVHD) was 35% ؎ 5%, and 100-day transplantation-related mortality (TRM) was 20% ؎ 4%. In multivariable analysis, a collected NC dose higher than 5.2 ؋ 10 7 /kg was associated with a lower 100-day TRM. The 2-year CI of relapse was 29% ؎ 5% and was associated with disease status. The 2-year leukemia-free survival (LFS) was 42% ؎ 5% (59% ؎ 11% in CR1, 50% ؎ 8% in CR2, and 21% ؎ 9% for children not in CR). Children with poor prognosis cytogenetic features had similar LFS compared with other patients (44% ؎ 11% vs 40% ؎ 8%). In CR2, LFS was not influenced by the length of CR1 (53% ؎ 11% in CR1 < 9.5 months compared with 50% ؎ 12% in later relapses). We conclude that UCBT is a therapeutic option for children with very poorprognosis AML and who lack an HLAidentical sibling. IntroductionBone marrow transplantation (BMT) from an HLA-matched sibling or unrelated donor plays a major role in the treatment of children with relapsed acute myeloid leukemia (AML). [1][2][3][4][5][6] However, although there are currently more than 8 million donors registered in marrow donor registries around the world, a substantial proportion of children who lack a sibling donor will never undergo BMT from an HLA-matched unrelated donor either because such a donor cannot be found or because the time to identify a donor is too long. Moreover, for those children who received unrelated bone marrow transplants, increased HLA disparity adversely affects survival because of high risk of graft-versus-host disease (GVHD) and opportunistic infections. [7][8][9] The use of haploidentical family donors provides a potential source of hematopoietic stem cells for children who lack both a sibling and an unrelated donor. [10][11] T-cell depletion of the graft can in part overcome the risk of severe GVHD, but it substantially increases the risk of severe and prolonged posttransplantation immunodeficiency.Hematopoietic stem cells from an unrelated cord blood (UCB) transplant can restore hematopoiesis and immune function after a myeloablative conditioning regimen, even if the graft is not perfectly HLA identical to the recipient. [12][13][14][15] This important medical advance led to the establishment of large cord blood banks that made possible the use of UCB to provide transplants for patients who lack a conventional related or unrelated donor. In addition, UCB offers the advantage of significantly faster availability of banked cryopreserved UCB units compared with the availability of u...

The vaginal delivery of various drugs is well described and its relevance established in current medical practice. Alongside recent advances and achievements in the fields of pharmaceutical nanotechnology and nanomedicine, there is an increasing interest in the potential use of different nanocarriers for the delivery of old and new pharmacologically active molecules with either therapeutic or prophylactic purposes. Nanosystems of polymeric nature in particular have been investigated over the last years and their interactions with mucosal fluids and tissues, as well as genital tract biodistribution upon vaginal administration, are now better understood. While different applications have been envisioned, most of the current research is focusing in the development of nano-formulations with the potential to inhibit the vaginal transmission of HIV upon sexual intercourse. The present work focuses its discussion on the potential and perils of polymer-based nanocarriers for the vaginal administration of different pharmacologically active molecules.

This cross-sectional study evaluated the relationship between primary and secondary oral health care in Brazil. For this purpose, data from the National Program for Improving Access and Quality of Primary Care were used. Dentists from 12,403 oral health teams (OHTs) answered a structured questionnaire in 2012. The data were analyzed descriptively and by cluster analysis. Of the 12,387 (99.9%) OHTs that answered all the questions, 62.2% reported the existence of Dental Specialties Centers (DSCs) to which they could refer patients. The specialties with the highest frequencies were endodontics (68.4%), minor oral surgery (65.8%), periodontics (63.0%), radiology (46.8%), oral medicine (40.2%), orthodontics (20.5%) and implantology (6.2%). In all percentiles, the shortest wait time for secondary care was for radiology, followed by oral medicine and the other specialties. In the 50th percentile, the wait for endodontics, periodontics, minor oral surgery and orthodontics was 30 days, while for implantology, the wait was 60 days. Finally, in the 75th percentile, the wait for endodontics, orthodontics and implantology was 90 days or more. Two clusters, with different frequencies of OHT access to specialties, were identified. Cluster 1 (n = 7,913) included the OHTs with lower frequencies in all specialties except orthodontics and implantology compared with Cluster 2 (n = 4,474). Of the Brazilian regions, the South and Southeast regions had the highest frequencies for Cluster 2, with better rates for the relationship between primary and secondary care. This study suggests certain difficulties in the relationship between primary and secondary care in specific specialties in oral health, with a great number of OHTs with limited access to DSCs, in addition to different performance in terms of OHT access to DSCs across Brazilian regions.

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