Reduced-intensity-conditioned allogeneic stem cell transplantation (SCT) remains a potentially curative approach for patients with relapsed/refractory Hodgkin lymphoma (HL) after an autologous stem cell transplantation. In the absence of an HLA-identical donor, haploidentical SCT (haplo-SCT) with post-transplantation cyclophosphamide (PT-Cy) has been evaluated with favorable preliminary results. We evaluated 24 patients who underwent haplo-SCT for relapsed/refractory HL. The conditioning regimen consisted of cyclophosphamide, fludarabine, and total body irradiation. Graft-versus-host disease (GVHD) prophylaxis consisted of a calcineurin inhibitor, mycophenolate mofetil, and PT-Cy (50 mg/kg/day for 2 days) for all patients. After a median follow-up of 2 years, the cumulative incidence (CI) of nonrelapse mortality was 26% and the CI of grades II to IV acute GVHD and chronic GVHD were 17% and 24%, respectively. Estimation of progression-free and overall survival at 2 years were 54% and 66%%, respectively. Haplo-SCT is a valuable option for relapsed/refractory HL patients after a failed autologous SCT, with favorable survival and relatively low risk of GVHD.

Introdução: A osteoartrite (OA) é uma doença degenerativa caracterizada por perda da cartilagem articular e sintomas de diminuição da propriocepção, força muscular e dor. A bandagem parece ser um bom recurso para diminuir a dor na OA e pode influenciar no controle postural. Objetivos: Verificar se o uso de bandagem infrapatelar influencia a oscilação corporal e a dor em indivíduos com OA de joelho. Métodos: Dez indivíduos com OA de joelho realizaram apoio unipodal nas condições com e sem bandagem. Os dados do centro de pressão (CP) foram obtidos pela plataforma de força e analisados pela área da elipse de confiança e a dor foi avaliada pela Escala Visual Analógica. Resultados: Tanto o deslocamento do CP quanto a dor não resultaram em diferença significativa entre as condições com e sem bandagem. Conclusão: A bandagem não aliviou a dor e não alterou o controle postural de indivíduos com OA de joelho.

Frailty can be defined as a biologic syndrome that results from decline in multiple systems leading to vulnerability, with poorer capacity of the organism to maintain homeostasis facing stressing events. Physical symptoms of frailty involve unintentional weight loss, decreased physical activity level, exhaustion, muscle weakness, impaired balance and gait. Together, these symptoms can compromise independence in activities of daily living. Physical Therapy can improve muscle strength, balance, gait and cardiorespiratory aptitude of frail elderly, but remains unclear what is the best intervention strategy: unimodal or multimodal interventions, with combined exercises. This systematic review aimed: (1) to compare the efficacy of unimodal and multimodal Physical Therapy interventions; (2) to analyze its effects on clinical outcomes and (3) to elucidate what is the best modality of exercise and its combination in order to improve physical symptoms and independence in frail elderly. Searches were conducted in PubMed, Medline, PEDro, Lilacs and Scielo databases. We obtained 2,579 studies and 17 were included in analysis. Studies analyzed the following clinical outcomes: mobility, muscle strength, balance, falls and fear of falling, quality of life and functional capacity. We conclude that both unimodal and multimodal interventions have potential to promote beneficial effects, but the analyzed studies have important methodological issues that negatively affect their quality. Although the beneficial effects of both interventions, the quality of studies analyzed does not allow us to generalize these effects. We suggest that new clinical trials should be conducted with a stronger methodology and according to current guidelines for randomized clinical trials.

ARTIGO ORIGINAL | ORIGINAL ARTICLE RESUMODiminuição da Amplitude de Movimento (ADM) de tornozelo e redução da força de dorsiflexores em decorrência do processo de envelhecimento são alterações conhecidas e que estão associadas com o aumento do risco de tropeços e quedas. Foi nosso objetivo avaliar a ADM de tornozelo em idosos da comunidade durante a marcha habitual e em duas condições de tarefas simultâneas (funcional e cognitiva). Trinta e dois idosos da comunidade (66.8±4.7 anos), de ambos os sexos, não caidores, que apresentavam marcha sem dispositivo de auxilio, participaram do estudo. A dorsiflexão e flexão plantar de tornozelo foram avaliadas em três situações: marcha habitual, marcha com tarefa funcional e marcha com tarefa cognitiva, utilizando 8 câmeras Qualisys Pro-reflex Oqus 300®. Análises de variância (ANOVA) foram aplicadas e comparações foram feitas por Newman-Keuls no programa SPSS (versão 16.0) adotando nível de significância de 5% (p 0.05). Não houve diferenças entre as diferentes tarefas (p> 0.05) para a ADM de dorsiflexão e flexão plantar dos idosos, porém, durante a marcha habitual a ADM de dorsiflexão foi menor se comparada aos valores de referência descritos na literatura. A realização de tarefas associadas à marcha não alterou a ADM de tornozelo em idosos da comunidade não caidores, entretanto, são necessários mais estudos que abordem idosos que tiveram quedas prévias. Palavras-chave: dorsiflexão, envelhecimento, equilíbrio postural, flexão plantar. ABSTRACTDecreased range of motion (ROM) of the ankle and dorsiflexor strength due to the aging process has been associated with increased risk of trips and falls. However, the impact of dual-task on the ankle ROM in elderly is not clear. It was our objective to evaluate the ankle ROM in community elderly during usual gait and two simultaneous task conditions (functional and cognitive). Thirty-two community elderly (66.8 ± 4.7 years) of both sexes, non-fallers, who had independent walking were recruited. The dorsiflexion and plantar flexion of the ankle were assessed in three situations: usual gait, gait with functional task and gait with cognitive task, using 8 cameras Qualisys Pro-reflex Oqus 300®. Analysis of variance (ANOVA) were applied and comparisons were made by Newman-Keuls using SPSS (version 16.0) adopting a significance level of 5% (p 0.05). There were no differences among tasks (p> 0.05) in the dorsiflexion and plantar flexion in the elderly, however, during the usual gait the dorsiflexion ROM of the elderly was lower than the normative values described in literature. The performance of tasks during walking have no influence on ankle ROM in non-fallers community-elderly. However, more studies including older adults who have previously fallen are necessary.

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TXThalassemia, a hemoglobinopathy which is common in Asian descendants, in its severe forms, has a poor prognosis. Allogeneic stem cell transplantation (allo-SCT) in severe thalassemia patients is an only way to cure the disease, however available HLA-matched donors for the patients were hardly identified. We recently reported an alternative strategy, pre-transplant immunosuppression (PTIS), combination of fludarabine (Flu) and dexamethasone (Dxm), would immunosuppress the patients to facilitate engraftment when followed by a reduced-toxicity conditioning (RTC) regimen, antithymocyte globulin (ATG), Flu and IV busulfan (Bu), to prepare high risk thalassemia patients for allo-SCT. We explored the use of an alternative, mismatched related ("haplo-"), donor in thalassemia patients. We enrolled severe thalassemia patients including a high risk group, so called class 3 Lucarelli classification, aged more than 7 years old and had a liver size more than 5 cms below the costal margin. All patients received two courses of PTIS, 40 mg/m 2 /day of IV Flu and 25 mg/m 2 /day of IV Dxm on day -68 to -64 and day -40 to -36, followed by RTC regimen, 1.5 mg/kg/ day of ATG on day -12 to -10, 35 mg/m 2 /day of Flu on day -8 to -3 and 130 mg/m 2 /day of Bu on day -8 to -5, was administered followed by unmanipulated peripheral blood stem cell (PBSC) from haploidentical donors. Graft-versus-host disease (GVHD) prophylaxis consisted of 50 mg/kg/day of cyclophosphamide (PTCy) on day +3 and +4 and tacrolimus or sirolimus was started together with a short course of mycophenolate mofetil. Twenty five patients received haplo-SCT at the median age of 10 (2-20) years. Twenty one patients had beta-thalassemia/hemoglobin E while the rest of patients had homozygous beta-thalassemia. Twelve patients had class 3 disease, their median age at the time of haplo-SCT was 14 (10-20) years. One of the patients had haplo-SCT as a second transplant after a matched-related allo-HSCT complicated with primary graft failure with autologous reconstitution. Sixteen patients received PBSC from the mother while the rest received from the father, the median CD34+ cell dose at 11.6 (4.0-19.0) x 10 6 cells/kg of body weight of recipients. The median time of neutrophil engraftment and platelet engraftment were 14 (11-18) and 30 (20-45) days, respectively. Two patients who suffered from primary graft failure had anti-HLA antibodies. Nine patients developed grade II acute GVHD, while four patients developed mild reversible veno-occlusive disease. Only three patients developed limited chronic GVHD. One patient died of GVHD complications. The 2-year overall and thalassemia-free survival rates are 93% and 88%, respectively, at the median follow up time was 11 (6-30) months. We concluded our new program, PTIS followed by RTC regimen and PTCy-based GVHD prophylaxis, had rapid and durable engraftment, yet a low risk of serious GVHD in the severe thalassemia patients.Background: Allogeneic Hematopoietic Cell Transplantation (HCT) is currently the only treatment modality to res...

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