Disertacijoje nagrinėjami Lietuvoje ir Šiaurės šalyse 1992-2012 m. ūmine limfoblastine leukemija (ŪLL) sirgusių vaikų duomenys. I tyrimas. Surinkti ir išanalizuoti 1992-2012 m. Lietuvoje gydytų ŪLL sirgusių vaikų (N=459) epidemiologija ir gydymo rezultatai, įsitraukta į tarptautinio (kartu su Šiaurės šalių vaikų onkohematologais) vaikų ŪLL gydymo protokolą. ŪLL sergančių vaikų išgyvenamumas Lietuvoje pagerėjo apie 20% ir pasiekė tarptautinį lygį. II tyrimas. Išanalizavus Šiaurės šalyse 1992-2008 m. dėl ŪLL gydytų vaikų duomenis (N=2363) nustatytos leukeminių blastų citogenetinės aberacijos ir ligonio biologiniai veiksniai, lemiantys skirtingą LS diagnozuojant ŪLL. Nustatyta, kad LS buvo reikšmingas išgyvenamumo rizikos veiksnys tiek pre-B ŪLL, tiek T-ŪLL ligoniams, kuriems pradinis LS buvo ≥100 x 109/L, tačiau tik tais atvejais, kai atsakas į gydymą buvo lėtas. III tyrimas. Populiaciniame tyrime išanalizuoti 1992-2011 m. Lietuvoje ar Šiaurės šalyse ŪLL sirgusių vaikų, kurių pradinis LS≥200 x 109/L, duomenys (N=221). Nustatyta, kad didelis leukocitų skaičius, o ne naviko lizės sindromas buvo pagrindinis ankstyvo mirtingumo rizikos veiksnys. Uždelstas specifinis ŪLL gydymas ar sumažintos pradinės chemopreparatų dozės galėjo turėti neigiamos reikšmės ankstyvų mirčių išsivystymui. Sudarytos bendros Baltijos ir Šiaurės šalių centrams skirtos rekomendacijos dėl pradinės ligonių su ŪLL ir hiperleukocitoze bei didele naviko lizės išsivystymo rizika (LS ≥100 x 109/L), gydymo taktikos... [toliau žr. visą tekstą] / The thesis is based on three studies in which data on children with acute lymhpblastic leukemia (ALL) treated in Lithuania or the Nordic countries were analyzed. Study I. Epidemiological and survival data of 459 children treated in Lithuania in 1992-2012 were analyzed. Children with ALL were included for the first time into international clinical trial that was conducted by pediatric oncologists in the Nordic countries. This resulted in survival improval of childhood ALL by 20% reaching results reported by large international childhood ALL study groups. Study II. Study of 2636 childhood ALL patients treated in the Nordic countries in 1992-2008 revealed significant differences in white blood cell (WBC) distribution both among different biological ALL subsets defined by immunophenotype or cytogenetical aberrations of leukemic blasts, and among patients of different age or gender. WBC remained as a risk factor to have a significantly poorer prognosis for patients with a WBC ≥100 x 109/L, but only among slow-responding patients. Study III. A population-based multicenter study of 221 children aged <15 y. with ALL and WBC ≥200x109/L at diagnosis treated in Lithuania and the Nordic countries were analyzed for early mortality and the impact of initial treatment strategy to survival. The Nordic/Baltic guidelines for initial treatment of ALL patients with hyperleukocytosis and a high risk for the development of tumor lysis syndrome (WBC ≥100 x 109/L) were conducted.

Hematology-instruments that analyze blood cells can at specific casesbe followed by manual counting with a hemocytometer. The plastic hemocytometer which has a fixed coverslip and is assigned for disposable use, appears to reduce the problems arising from the use of the traditional glass hemocytometer, for instance coverslip-application difficulty and dust particles. Capillary whole blood sampling may be useful for patients at the emergency department and in addition, a smaller volume of blood is taken compared to venous blood sampling. This study will focus on the platelet- and leukocyte count (PLT and WBC) in venous and capillary blood, in order to compare the plastic- and glass hemocytometers with Sysmex XN-2000 (Sysmex Corporation, Kobe, Japan), and verify if capillary whole blood sampling can be used for the measurement of these hematological parameters. 30 subjects donated both capillary- and venous blood samples and these blood samples were analyzed with glass- and plastic hemocytometers with Sysmex XN-2000 as the reference method. The study results showed high correlation between the reference method and plastic hemocytometer at low PLT but were not suitable for WBC-determination. The capillary whole blood showed high correlation to the reference method at WBC-determination, but was unusable at PLT-determination. Glass hemocytometer was closer to the reference method results than plastic hemocytometer was.

Introduction: Whole blood transfusions are indicated for the resuscitation of patients with hemorrhagic trauma. In Sweden, whole blood is stored for 14 days at 4°C. If possible, refrigerated blood is rewarmed to 37°C before transfusion to avoid hypothermia. Platelets contribute to hemostasis and can be activated with several pathways. During storage, shedding of platelet surface receptors takes place. Further research on how platelet storage in whole blood and rewarming before transfusion affect platelets is needed. Aim: The aim was to study how storage in whole blood and rewarming to 37°C affect platelet function, platelet activatability, and changes in platelet surface receptors. Method: Whole blood from two healthy donors was stored for 14 days. During these 14 days, two blood samples were taken on day 0, before and after leukocyte reducing filtration, 1, 3, 7, and 14. One of the two blood samples from each whole blood product was tested at room temperature and the other was rewarmed to 37°C. The blood samples were mixed with antibodies and platelet agonists and analyzed on a flow cytometer. The blood samples were also analyzed on a cell counter. Results: This study shows distinct changes in platelet spontaneous activation, platelet count, and platelet receptor shedding by increased storage time in cold-stored whole blood and even more with rewarming to 37°C. Conclusion: This study shows that during storage, spontaneous platelet activation and shedding of GPIb and GPIIb increases while platelet count decreases. All these factors are likely affecting the platelet function and hemostatic function negatively.

Thesis (M.Sc. (Nutrition))--North-West University, Potchefstroom Campus, 2004.

Background: Clinical studies have shown that tea consumption leads to decreased iron absorption. This finding is however, not supported by epidemiological studies, where no relationship between an increased tea consumption and a lower iron status in a population at risk of iron depletion has been found. Objectives: The main aim of this study was to compare the effects of black tea and Rooibos consumption on the iron status of primary school children in a rural setting in Potchefstroom, South Africa. Methods: One hundred and seventy five children, aged six to fifteen years, participated in this single blind, randomised, parallel intervention trial. Subjects were randomly allocated to receive two 200ml servings of either black tea or Rooibos with milk and sugar. These beverages were consumed during breaks and at the same time as the food h m the school-feeding scheme. The trial proceeded for sixteen weeks. The children received antihelminthic treatment (500mg mebendazole) at baseline. Haemoglobii haematocrit, serum iron, ferritin and transferfin were measured and total iron binding capacity and transferrin saturation were calculated. Trained fieldworkers measured dietary intakes by means of 24-hour dietary recalls and anthropometrists took anthropometric measurements. All the above mentioned data were gathered at the beginning and at the end of the intervention period. Results: Measurements indicated a study population that is malnourished in terms of anthropometrical indices and nutrient intakes. Biochemical markers of iron status also indicated that the population could be at risk of iron depletion. Changes in red blood cell count, haemoglobin, haematocrit, mean corpuscular haemoglobin (MCH), mean corpuscular volume (MCV), serum iron, transferrin, transferrin saturation, ferritin and total iron binding capacity (TIBC) did not differ significantly between the two groups. Mean red blood cell count, haematocrit, MCV, transferrin and TIBC increased significantly h m baseline to end in both groups (all p<0.0001) and MCH decreased significantly (p<.0001). Mean haemoglobin increased significantly with black tea consumption (p=0.002), although not with the consumption of Rooibos (p=0.073). Conclusion: Black tea or Rooibos consumption has similar effects on the iron status of primary school children. Iron status was not compromised by black tea in comparison with Rooibos. This questions the proposed limitation of black tea consumption as a public health strategy in order to combat iron deficiency in a population with marginal iron status. / Thesis (M.Sc. (Nutrition))--North-West University, Potchefstroom Campus, 2004.

Background: Clinical studies have shown that tea consumption leads to decreased iron absorption. This finding is however, not supported by epidemiological studies, where no relationship between an increased tea consumption and a lower iron status in a population at risk of iron depletion has been found. Objectives: The main aim of this study was to compare the effects of black tea and Rooibos consumption on the iron status of primary school children in a rural setting in Potchefstroom, South Africa. Methods: One hundred and seventy five children, aged six to fifteen years, participated in this single blind, randomised, parallel intervention trial. Subjects were randomly allocated to receive two 200ml servings of either black tea or Rooibos with milk and sugar. These beverages were consumed during breaks and at the same time as the food h m the school-feeding scheme. The trial proceeded for sixteen weeks. The children received antihelminthic treatment (500mg mebendazole) at baseline. Haemoglobii haematocrit, serum iron, ferritin and transferfin were measured and total iron binding capacity and transferrin saturation were calculated. Trained fieldworkers measured dietary intakes by means of 24-hour dietary recalls and anthropometrists took anthropometric measurements. All the above mentioned data were gathered at the beginning and at the end of the intervention period. Results: Measurements indicated a study population that is malnourished in terms of anthropometrical indices and nutrient intakes. Biochemical markers of iron status also indicated that the population could be at risk of iron depletion. Changes in red blood cell count, haemoglobin, haematocrit, mean corpuscular haemoglobin (MCH), mean corpuscular volume (MCV), serum iron, transferrin, transferrin saturation, ferritin and total iron binding capacity (TIBC) did not differ significantly between the two groups. Mean red blood cell count, haematocrit, MCV, transferrin and TIBC increased significantly h m baseline to end in both groups (all p<0.0001) and MCH decreased significantly (p<.0001). Mean haemoglobin increased significantly with black tea consumption (p=0.002), although not with the consumption of Rooibos (p=0.073). Conclusion: Black tea or Rooibos consumption has similar effects on the iron status of primary school children. Iron status was not compromised by black tea in comparison with Rooibos. This questions the proposed limitation of black tea consumption as a public health strategy in order to combat iron deficiency in a population with marginal iron status. / Thesis (M.Sc. (Nutrition))--North-West University, Potchefstroom Campus, 2004.

A contagem de células vermelhas do sangue desempenha um papel importante no diagnóstico de animais silvestres e domésticos. Apesar da existência de muitas tecnologias em diferentes contadores automatizados para análise de sangue, quando se trata do sangue de animais silvestres ainda é difícil encontrar uma solução simples e economicamente viável para múltiplas espécies. O objetivo deste estudo é desenvolver um contador automático de células vermelhas. Amostras de sangue (1 jaguatirica - Leopardus pardalis, 1 macaco - Cebus apella, 1 quati - Nasua nasua, 62 cães - Canis familiaris e 5 cavalos - Equus caballus) foram analisadas usando três métodos: 1-contagem manual, 2-contagem automática por imagem e 3-contagem semiautomática por imagem; as amostras de cães e cavalos foram analisadas por um quarto método: 4-contagem automática por impedância. As contagens dos métodos 2 e 3 foram obtidas usando o contador de células vermelhas proposto. Os resultados foram comparados usando a correlação de Pearson e gráficos com diferentes métodos como valor de referência. As contagens dos métodos 1, 2 e 3 correlacionaram muito bem com as contagens do método 4 (r ≥ 0.94). As contagens produzidas pelo método 2 apresentaram alta correlação com o método 3 (r = 0.998). Os resultados indicam que o contador proposto pode ser usado como um método de contagem automática ou semiautomática em clínicas que usam o método manual para contagem de células vermelhas do sangue de animais. / A RBC count plays an important role in the diagnostic of wild and domestic animals. Despite the many technologies available in different automated hematology analyzers, when it comes to blood of wild animals it is still difficult to find an easy and affordable solution for multiple species. This study aims to develop an automatic red blood cell counter. Blood samples (1 ocelot - Leopardus pardalis, 1 monkey - Cebus apella, 1 coati - Nasua nasua, 62 dogs - Canis familiaris and 5 horses - Equus caballus) were analyzed using three methods: 1-manual count, 2automatic count by image and 3-semi-automatic count by image; blood from dogs and horses were also analyzed by a fourth method: 4-automatic count by impedance. The counts of methods 2 and 3 were produced by the proposed red blood cell counter. Results were compared using Pearson’s correlation and plots with different methods as the criterion standard. RBC counts of methods 1, 2 and 3 correlated very well with those on the method 4 (r ≥ 0.94). RBC counts produced by method 2 were highly correlated with method 3 (r = 0.998). The results indicate that the proposed method can be used as an automatic or semi-automatic counting method in clinics that are currently using the manual method for RBC assessment.

Le carcinome de Merkel est un cancer cutané de différenciation neuroendocrine rare, mais agressif, dont le facteur étiologique principal est le polyomavirus de Merkel (MCPyV). L’objectif de ce travail a été d’identifier des marqueurs virologiques et cellulaires pronostiques ou théranostiques à l’aide d’une cohorte historicoprospective de patients ayant un carcinome de Merkel. Les patients ayant des titres élevés d’anticorps dirigés contre la protéine de capside VP1 du MCPyV ont un pronostic favorable, tandis les anticorps dirigés contre les oncoprotéines virales reflètent l’évolution tumorale. Par ailleurs, il existe une hétérogénéité d’expression des récepteurs à la somatostatine dans les carcinomes de Merkel. Ce marqueur cellulaire peut constituer un outil théranostique lors de thérapies ciblées utilisant les analogues de la somatostatine. Enfin, nos travaux actuels portent sur l’évaluation de l’immunité cellulaire chez ces patients, avec une étude ayant montré la valeur pronostique du ratio neutrophiles/lymphocytes sanguin. / Merkel Cell Carcinoma is a rare and aggressive neuroendocrine skin cancer. The Merkel cell polymavirus has been identified as the main etiological agent of such cancer. We aimed to identify viral and cellular markers relevant as prognostic and theranostic tools in patients with Merkel Cell Carcinoma. Using serological immunoassays, we observed that patients with high levels of serum antibodies against the MCPyV major capsid protein at baseline had better outcomes, whereas antibodies directed against the MCPyV oncoproteins reflected the tumor burden and course of disease. We also demonstrated that Merkel Cell Carcinoma tumors displayed a heterogeneous expression of receptors to somatostatin, which could constitute a theranostic tool for the use of targeted therapies using somatostatin analogs. Finally, current studies focus on the assessment of cellular immunity in Merkel Cell Carcinoma patients. Our results indicate that the blood neutrophil-to-lymphocyte ratio is an independent marker of mortality in Merkel Cell Carcinoma patients.

INTRODUÇÃO: Estudos experimentais suportam a evidência de leucopenia persistente desencadeada pela morte encefálica (ME). OBJETIVO: Esse estudo teve como objetivo investigar o comportamento leucocitário na medula óssea e no sangue após a morte encefálica em ratos. MÉTODOS: A morte encefálica foi induzida através da inserção e insuflação rápida de um cateter no espaço intracraniano. Ratos falso-operados (FO) foram apenas trepanados. Decorridas seis horas, as células da medula óssea, coletadas da cavidade femural, foram utilizadas para as contagens total e diferencial e analisadas por citometria de fluxo para a caracterização das subpopulações linfocitárias, a expressão de moléculas de adesão granulocíticas e apoptose/necrose (método de Anexina V/Iodeto de Propídio (PI)). RESULTADOS: Ratos com ME apresentaram uma redução de 30% no número de células da medula óssea devido à redução de linfócitos (40%) e células segmentadas (45%). As subpopulações de linfócitos na medula óssea foram semelhantes nos animais ME e FO (CD3, p=0,1; CD4, p=0,4; CD3/CD4, p=0,4; CD5, p=0,4, CD3/CD5, p=0,2; CD8, p=0,8). A expressão de L-selectina e beta2-Integrinas nos granulócitos também não diferiram entre os grupos (CD11a, p=0,9; CD11b/c, p=0,7; CD62L, p=0,1). Não existem diferenças nas porcentagens de apoptose e de necrose (Anexina V, p=0,73; PI, p=0,21; Anexina V/PI, p=0,29). CONCLUSÃO: Os dados sugerem que a redução na mobilização de células da medula óssea para o sangue, desencadeada pela morte encefálica, não se relaciona a alterações de subpopulações de linfócitos, expressão de moléculas de adesão granulocíticas, ou apoptose e necrose / INTRODUCTION: Experimental findings support the evidence of a persistent leucopenia triggered by brain death (BD). AIMS: This study aimed to investigate leukocyte behavior in bone marrow and blood after BD in rats. METHODS: BD was induced by quickly inflation of an intracranial balloon catheter. Sham operated (SH) rats were trepanned only. Six hours thereafter bone marrow cells harvested from the femoral cavity were used for total and differential counts, and analyzed by flow cytometry to characterize lymphocyte subsets, granulocyte adhesion molecules expression, and apoptosis/necrosis (annexin V/propidium iodide (PI) protocol). RESULTS: BD rats exhibited a 30% reduction in bone marrow cells due to a reduction in lymphocytes (40%) and segmented cells (45%). Bone marrow lymphocyte subsets were similar in BD and SH rats (CD3, p=0.1; CD4, p=0.4; CD3/CD4, p=0.4; CD5, p=0.4, CD3/CD5, p=0.2; CD8, p=0.8). Expression of L-selectin and ?2-integrins on granulocytes did not differ (CD11a, p=0.9; CD11b/c, p=0.7; CD62L, p=0.1). There were no differences in the percentage of apoptosis and necrosis (Annexin V, p=0.73; PI, p=0.21; Annexin V/PI, p=0.29). CONCLUSIONS: Data presented suggest that the down-regulation of the bone marrow triggered by BD is not related to changes in lymphocyte subsets, granulocyte adhesion molecules expression, or apoptosis and necrosis

INTRODUÇÃO: Estudos experimentais suportam a evidência de leucopenia persistente desencadeada pela morte encefálica (ME). OBJETIVO: Esse estudo teve como objetivo investigar o comportamento leucocitário na medula óssea e no sangue após a morte encefálica em ratos. MÉTODOS: A morte encefálica foi induzida através da inserção e insuflação rápida de um cateter no espaço intracraniano. Ratos falso-operados (FO) foram apenas trepanados. Decorridas seis horas, as células da medula óssea, coletadas da cavidade femural, foram utilizadas para as contagens total e diferencial e analisadas por citometria de fluxo para a caracterização das subpopulações linfocitárias, a expressão de moléculas de adesão granulocíticas e apoptose/necrose (método de Anexina V/Iodeto de Propídio (PI)). RESULTADOS: Ratos com ME apresentaram uma redução de 30% no número de células da medula óssea devido à redução de linfócitos (40%) e células segmentadas (45%). As subpopulações de linfócitos na medula óssea foram semelhantes nos animais ME e FO (CD3, p=0,1; CD4, p=0,4; CD3/CD4, p=0,4; CD5, p=0,4, CD3/CD5, p=0,2; CD8, p=0,8). A expressão de L-selectina e beta2-Integrinas nos granulócitos também não diferiram entre os grupos (CD11a, p=0,9; CD11b/c, p=0,7; CD62L, p=0,1). Não existem diferenças nas porcentagens de apoptose e de necrose (Anexina V, p=0,73; PI, p=0,21; Anexina V/PI, p=0,29). CONCLUSÃO: Os dados sugerem que a redução na mobilização de células da medula óssea para o sangue, desencadeada pela morte encefálica, não se relaciona a alterações de subpopulações de linfócitos, expressão de moléculas de adesão granulocíticas, ou apoptose e necrose / INTRODUCTION: Experimental findings support the evidence of a persistent leucopenia triggered by brain death (BD). AIMS: This study aimed to investigate leukocyte behavior in bone marrow and blood after BD in rats. METHODS: BD was induced by quickly inflation of an intracranial balloon catheter. Sham operated (SH) rats were trepanned only. Six hours thereafter bone marrow cells harvested from the femoral cavity were used for total and differential counts, and analyzed by flow cytometry to characterize lymphocyte subsets, granulocyte adhesion molecules expression, and apoptosis/necrosis (annexin V/propidium iodide (PI) protocol). RESULTS: BD rats exhibited a 30% reduction in bone marrow cells due to a reduction in lymphocytes (40%) and segmented cells (45%). Bone marrow lymphocyte subsets were similar in BD and SH rats (CD3, p=0.1; CD4, p=0.4; CD3/CD4, p=0.4; CD5, p=0.4, CD3/CD5, p=0.2; CD8, p=0.8). Expression of L-selectin and ?2-integrins on granulocytes did not differ (CD11a, p=0.9; CD11b/c, p=0.7; CD62L, p=0.1). There were no differences in the percentage of apoptosis and necrosis (Annexin V, p=0.73; PI, p=0.21; Annexin V/PI, p=0.29). CONCLUSIONS: Data presented suggest that the down-regulation of the bone marrow triggered by BD is not related to changes in lymphocyte subsets, granulocyte adhesion molecules expression, or apoptosis and necrosis