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The southeast region of Brazil experienced in austral summer 2014 a major drought event leading to a number of impacts in water availability for human consumption, agricultural irrigation and hydropower production. This study aims to perform a diagnostic analysis of the observed climate conditions during this event, including an inspection of the occurred precipitation anomalies in the context of previous years, and an investigation of possible relationships with sea surface temperatures and atmospheric circulation patterns. The sea surface temperature analysis revealed that the southwestern South Atlantic Ocean region near the coast of southeast Brazil showed strong negative association with precipitation over southeast Brazil, indicating that increased sea temperatures in this ocean region are consistent with reduced precipitation as observed in summer 2014. The circulation analysis revealed prevailing anti-cyclonic anomalies at lower levels (850 hPa) with northerly anomalies to the west of southeast Brazil, channeling moisture from the Amazon towards Paraguay, northern Argentina and southern Brazil, and drier than normal air from the South Atlantic Ocean towards the southeast region of Brazil. This circulation pattern was found to be part of a large-scale teleconnection wave train linked with the subsidence branch of the Walker circulation in the tropical east Pacific, which in turn was generated by an anomalous tropical heat source in north/northeastern Australia. A regional Hadley circulation with an ascending branch to the south of the subsidence branch of the Walker circulation in the tropical east Pacific was identified as an important component connecting the tropical and extratropical circulation. The ascending branch of this Hadley circulation in the south Pacific coincided with an identified Rossby wave source region, which contributed to establishing the extratropical component of the large-scale wave train connecting the south Pacific and the Atlantic region surrounding southeast Brazil. This connection between the Pacific and the Atlantic was confirmed with Rossby ray tracing analyses. The local circulation response was associated to downward air motion (subsidence) over Southeast Brazil, contributing to the expressive negative precipitation anomalies observed during summer 2014, and leading to a major drought event in the historical context. The analysis of atmospheric and oceanic patterns of this event helped defining a schematic framework leading to the observed drought conditions in southeast Brazil, including the involved teleconnections, blocking high pressure, radiative and humidity transport effects.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection results in a wide range of outcomes characterized by a high heterogeneity in both symptomatology and susceptibility to the disease. In such a perspective, COVID-19 may be considered as a multifactorial disease featured by the interaction between the environment, which is the virus itself, and the genetic profile of the host. Our analysis aimed at investigating the transmission dynamics of SARS-CoV-2 within families whose members responded in different ways to the infection, although the exposure was common to the entire group and occurred before the availability of any vaccine. The goal was to understand how the genetic background of each subject can influence the viral infection outcome and hence the above-mentioned clinical variability. We performed a segregation analysis in 19 Italian families with a designed custom panel of 42 genes involved in immunity and virus entry and which have also been shown to be related to SARS-CoV-2 host response. We carried out both a familial segregation analysis and a global statistical analysis. In the former we identified eighteen risk variants co-segregating with a COVID-positive status and six variants with a possible protective effect. In addition, sixteen variants showed a trend of association to a severe phenotype. Together with common SNPs, we detected private rare variants that may also provide insight into the observed clinical COVID-19 heterogeneity. The global statistical analysis confirmed statistically significant positive associations between SARS-CoV-2 individual response and some specific gene variants identified in familial analysis. In conclusion our data confirm that the clinical expression of COVID-19 is markedly influenced by the host genetic profile both with a mendelian transmission pattern and a polygenic architecture.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection results in a wide range of outcomes characterized by a high heterogeneity in both symptomatology and susceptibility to the disease. In such a perspective, COVID-19 may be considered as a multifactorial disease featured by the interaction between the environment, which is the virus itself, and the genetic profile of the host. Our analysis aimed at investigating the transmission dynamics of SARS-CoV-2 within families whose members responded in different ways to the infection, although the exposure was common to the entire group and occurred before the availability of any vaccine. The goal was to understand how the genetic background of each subject can influence the viral infection outcome and hence the above-mentioned clinical variability. We performed a segregation analysis in 19 Italian families with a designed custom panel of 42 genes involved in immunity and virus entry and which have also been shown to be related to SARS-CoV-2 host response. We carried out both a familial segregation analysis and a global statistical analysis. In the former we identified eighteen risk variants co-segregating with a COVID-positive status and six variants with a possible protective effect. In addition, sixteen variants showed a trend of association to a severe phenotype. Together with common SNPs, we detected private rare variants that may also provide insight into the observed clinical COVID-19 heterogeneity. The global statistical analysis confirmed statistically significant positive associations between SARS-CoV-2 individual response and some specific gene variants identified in familial analysis. In conclusion our data confirm that the clinical expression of COVID-19 is markedly influenced by the host genetic profile both with a mendelian transmission pattern and a polygenic architecture.

Achieving successful hematopoietic stem cell transplantation (HSCT) relies on two fundamental pillars: effective mobilization and efficient collection through apheresis to attain the optimal graft dose. These cornerstones pave the way for enhanced patient outcomes. The primary challenges encountered by the clinical unit and collection facility within a transplant program encompass augmenting mobilization efficiency to optimize the harvest of target cell populations, implementing robust monitoring and predictive strategies for mobilization, streamlining the apheresis procedure to minimize collection duration while ensuring adequate yield, prioritizing patient comfort by reducing the overall collection time, guaranteeing the quality and purity of stem cell products to optimize graft function and transplant success, and facilitating seamless coordination between diverse entities involved in the HSCT process. In this review, we aim to address key questions and provide insights into the critical aspects of mobilizing and collecting hematopoietic stem cells for transplantation purposes.

The Atlantic Intertropical Convergence Zone (A-ITCZ) exhibits variations on several time-scales and plays a crucial role in precipitation regimes of northern South America and western Africa. Here we investigate the variability of the A-ITCZ on intraseasonal time-scales during austral summer (November–March) and winter (May–September) based on a multivariate index that describes the main atmospheric features of the A-ITCZ and retains its variability on interannual, semiannual, and intraseasonal time-scales. This index is the time coefficient of the first combined empirical orthogonal function mode of anomalies (annual cycle removed) of precipitation, and zonal and meridional wind components at 850 hPa from the climate forecast system reanalysis (1979–2010). We examine associations between the intraseasonal variability of the A-ITCZ and the activity of the Madden–Julian oscillation (MJO). We show that during austral summer intraseasonal variability of the A-ITCZ is associated with a Rossby wave train in the Northern Hemisphere. In austral winter this variability is associated with the propagation of a Rossby wave in the Southern Hemisphere consistent with the Pacific-South American pattern. Moreover, we show that intense A-ITCZ events on intraseasonal time-scales are more frequent during the phase of MJO characterized by convection over western Pacific and suppression over the Indian Ocean. These teleconnection patterns induce anomalies in the trade winds and upper level divergence over the equatorial Atlantic that modulate the intensity of the A-ITCZ.

Southeastern Brazil is the most populated and economically developed region of this country. Its climate consists of two distinct seasons: the dry season, extending from April to September, the precipitation is significantly reduced in comparison to that of the wet season, which extends from October to March. However, during nine days of the 2016 dry season, successive convective systems were associated with atypical precipitation events, tornadoes and at least one microburst over the southern part of this region. These events led to flooding, damages to buildings, shortages of electricity and water in several places, many injuries, and two documented deaths. The present study investigates the synoptic and dynamical features related to these anomalous events. The convective systems were embedded in an unstable environment with intense low-level jet flow and strong wind shear and were supported by a sequence of extratropical cyclones occurring over the Southwest Atlantic Ocean. These features were intensified by the Madden–Julian oscillation (MJO) in its phase 8 and by intense negative values of the Pacific South America (PSA) 2 mode.

A 46-year-old woman with IgA-λ myeloma in partial remission, after a tandem autologous hematopoietic stem cells transplantation, complained of progressive lower back pain associated with paraplegia and neurological bladder 6 months after the second transplant. A lumbar puncture revealed atypical malignant plasma cells in the cerebral spinal fluid associated with multiple foci of altered signal intensity of brain and spinal cord demonstrated by magnetic resonance. Considering the lack of efficacious chemotherapies for neurological myeloma, an experimental systemic treatment with topotecan, temozolamide, and dexamethasone associated with concurrent radiotherapy of brain and spinal cord was initiated. During this treatment, the patient rapidly improved with disappearance of back pain, paresthesia, and urinary incontinence lasting 5 months, before dying of progressive disease. The proposed systemic chemotherapy associated with concurrent radiotherapy may have an antitumor activity against MM with CNS involvement.

Background A multitude of options are traditionally used for the treatment of acne scars; however, newer treatment modalities are emerging to decrease the propensity for post-inflammatory hyperpigmentation and upregulate new collagen production. The aim of this study was to evaluate the efficacy of nanofat and platelet-rich plasma (PRP) infiltration alone and combined with fractional CO 2 laser resurfacing to improve atrophic scars of the face. Methods From March 2014 to June 2015, 30 patients with atrophic acne scars on the cheeks were selected for this study. Patients were evaluated pre- and postoperatively by physical examination, photographs and ultrasound with a 22-MHz probe to measure subcutaneous tissue thickness. All patients were treated with infiltration of nanofat plus PRP. The production of PRP was achieved using the RegenLab THT tube ® method. In 15 randomly chosen patients, a fractional CO 2 laser resurfacing at 15 W was also performed right after the infiltration. An Italian version of the FACE-Q postoperative module was administered to analyze each patient’s satisfaction and aesthetic perception of the result. Results The average preoperative thickness of subcutaneous tissue of patients from group A was 0.532 cm, while the average preoperative thickness of subcutaneous tissue of patients from group B was 0.737 cm. The average postoperative thickness of subcutaneous tissue was 1.201 cm in group A and 1.367 cm in group B. The improvement of thickness of subcutaneous tissue was 0.668 cm in group A and 0.63 cm in group B. We applied a t test on unpaired data, comparing the difference in thickness obtained with the treatment in both group A and in group B, with a p value =0.7289 (not significant). All patients in both groups had a treatment benefit, confirmed with FACE-Q postoperative module, but without a significant difference between the two groups. Conclusions Subcutaneous infiltration with nanofat and PRP seems to be effective to improve atrophic scars, either alone or combined with fractional CO 2 laser resurfacing. The FACE-Q module confirmed the impact of treatment of facial acne scars in social life and relationships. Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The Gruppo Romano Mielodisplasie (GROM) conducted a retrospective study in 543 patients with myelodysplastic syndromes (MDS) to evaluate the safety and efficacy of erythropoiesis-stimulating agents (ESAs) in “real-life” clinical practice. The 40.000-UI/week erythropoietin (EPO)-alpha and 30.000-UI/week EPO-beta starting dose were defined “standard,” and 80,000 UI/week EPO-alpha and 60.000 UI/week EPO-beta were defined “high.” Response was defined according to International Working Group (IWG) 2006 criteria. At ESA’s start, median age was 74.2 years (interquartile range (IR) 67.8–79.5) and median hemoglobin was 8.9 g/dl (IR 8.2–9.6). Median time from diagnosis to ESAs start was 3.8 months (IR 0.8–13.2). ESA starting dose was “standard” in 361 patients (66.5 %) and “high” in 182 patients (33.5 %). Erythroid response was observed in 82/185 (44.3 %) transfusion dependent (TD) patients as compared with 226/329 (68.6 %) transfusion independent (TI) ones ( p  < 0.001). At multivariate analysis, in TD patients, only endogenous EPO levels <50 mU/l were significant ( p  = 0.046), whereas in TI patients, high-dose ESAs ( p  < 0.001), abnormal creatinine levels (0.009), and endogenous EPO levels <50 mU/l ( p  = 0.014) were predictors of response. Responders showed a higher 5-year overall survival (OS) (57.8 vs. 32.2 %, p  < 0.001) and leukemia-free survival (76.0 vs. 49.8 %, p  < 0.001). At multivariable analysis for OS, response to ESA, low International Prognostic Scoring System (IPSS), no transfusion need, and female sex showed an independent favorable prognostic role. Our results confirm that treatment with ESAs is effective in a real-life MDS setting, particularly at high dose and in TI patients. Prospective studies are needed to define the optimal starting dose.

A multitude of options are traditionally used for the treatment of acne scars; however, newer treatment modalities are emerging to decrease the propensity for post-inflammatory hyperpigmentation and upregulate new collagen production. The aim of this study was to evaluate the efficacy of nanofat and platelet-rich plasma (PRP) infiltration alone and combined with fractional CO laser resurfacing to improve atrophic scars of the face. From March 2014 to June 2015, 30 patients with atrophic acne scars on the cheeks were selected for this study. Patients were evaluated pre- and postoperatively by physical examination, photographs and ultrasound with a 22-MHz probe to measure subcutaneous tissue thickness. All patients were treated with infiltration of nanofat plus PRP. The production of PRP was achieved using the RegenLab THT tube method. In 15 randomly chosen patients, a fractional CO laser resurfacing at 15 W was also performed right after the infiltration. An Italian version of the FACE-Q postoperative module was administered to analyze each patient's satisfaction and aesthetic perception of the result. The average preoperative thickness of subcutaneous tissue of patients from group A was 0.532 cm, while the average preoperative thickness of subcutaneous tissue of patients from group B was 0.737 cm. The average postoperative thickness of subcutaneous tissue was 1.201 cm in group A and 1.367 cm in group B. The improvement of thickness of subcutaneous tissue was 0.668 cm in group A and 0.63 cm in group B. We applied a t test on unpaired data, comparing the difference in thickness obtained with the treatment in both group A and in group B, with a p value =0.7289 (not significant). All patients in both groups had a treatment benefit, confirmed with FACE-Q postoperative module, but without a significant difference between the two groups. Subcutaneous infiltration with nanofat and PRP seems to be effective to improve atrophic scars, either alone or combined with fractional CO laser resurfacing. The FACE-Q module confirmed the impact of treatment of facial acne scars in social life and relationships. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .