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Purpose of Review: Myelofibrosis (MF) includes prefibrotic primary MF (pre-PMF), overt-PMF and secondary MF (SMF). Median overall survival (OS) of pre-PMF, overt-PMF and SMF patients is around 14 years, seven and nine years, respectively. Main causes of mortality are non-clonal progression and transformation into blast phase., Recent Findings: Discoveries on the impact of the biological architecture on OS have led to the design of integrated scores to predict survival in PMF. For SMF, OS estimates should be calculated by the specific MYSEC-PM (MYelofibrosis SECondary-prognostic model). Information on the prognostic role of the molecular landscape in SMF is accumulating. Crucial treatment decisions for MF patients could be now supported by multivariable predictive algorithms. OS should become a relevant endpoint of clinical trials. Prognostic models guide prediction of OS and treatment planning in MF, therefore, their timely application is critical in the personalized approach of MF patients., (© 2024. The Author(s).)

Complement inhibitors are the mainstay of paroxysmal nocturnal hemoglobinuria (PNH) treatment. The anti-C5 monoclonal antibody eculizumab was the first treatment to improve hemolysis, thrombotic risk, and survival in PNH although at the price of a life-long intravenous fortnightly drug. Additionally, suboptimal response may occur in up to 2/3 of patients with persistent anemia due to incomplete control of intravascular hemolysis, development of upstream C3-mediated extravascular hemolysis (EVH), or concomitant bone marrow failure. Ravulizumab, a longer half-life anti-C5 developed from eculizumab, administered every 8 weeks, improved patient convenience, and reduced pharmacokinetic breakthrough hemolysis (BTH) by establishing more stable anti-C5 concentrations. More recently, several other anti-C5 compounds (crovalimab, pozelimab, tesidolumab, cemdisiran, zilucoplan, and coversin) are on study in clinical trials. Upstream inhibition of complement cascade was also explored with the anti-C3 pegcetacoplan, and with the alternative pathway inhibitors iptacopan (anti-factor B) and danicopan (anti-factor D). These drugs efficiently target EVH and are able to improve anemia and transfusion need in suboptimal responders to anti-C5. The route and schedule of administration (twice weekly subcutaneously for pegcetacoplan and twice or thrice oral daily dosing for iptacopan and danicopan, respectively) are very convenient but pose novel issues regarding adherence. Additionally, both anti-C5 and upstream inhibitors do not resolve the unmet need of pharmacodynamic BTH events due to complement amplifying conditions such as infections, traumas, and surgery. In this review, we will recapitulate PNH physiopathology, clinical presentation, and diagnosis and describe available and developing drugs that will lead to a precision medicine approach for this rare though heterogenous disease., (© 2024 The Authors. International Journal of Laboratory Hematology published by John Wiley & Sons Ltd.)

Background: Autoimmune hemolytic anemia (AIHA) may be associated with transfusion reactions and risk of alloimmunization., Objectives: To evaluate the transfusion policy and rate of alloimmunization and its clinical significance in AIHA., Methods: Data from 305 AIHA patients followed at a reference hematologic Center in Milan, Italy from 1997 to 2022 were retrospectively/prospectively collected (NCT05931718)., Results: Overall, 33% patients required transfusions with a response rate of 83% and eight transfusion reactions (7%), none hemolytic. Alloantibodies were detected in 19% of patients, being associated with higher transfusion burden (p = 0.01), lower Hb increase post-transfusion (p = 0.05), and transfusion reactions (p = 0.04). Along decades, the rate of RBC transfusions decreased from 53% to 20% and that of alloimmunization dropped from 30% to 6% likely due to the adoption of prestorage leukoreduction, the use of more restrictive Hb thresholds, and the implementation of molecular typing., Conclusions: Severe symptomatic AIHA may be safely transfused provided appropriate matching of patients and donors., (© 2023 The Authors. Journal of Internal Medicine published by John Wiley & Sons Ltd on behalf of Association for Publication of The Journal of Internal Medicine.)

Background: The boundaries between myelodysplastic syndromes (MDS) and immune-mediated cytopenias are often difficult to establish and both conditions may benefit from immunosuppressive therapy. The optimal timing and doses of immunosuppressants are largely unknown., Materials and Methods: We systematically evaluated a retrospective cohort of 79 patients with low-risk MDS tested for anti-erythrocyte or anti-platelet autoantibodies to assess their frequency and the efficacy of immunosuppression, particularly with steroids., Results: We found autoantibody positivity in 43% of cases and overt autoimmune diseases in 18%, including autoimmune hemolytic anemia, immune thromboctyopenia, and Evans syndrome. Steroid treatment improved cytopenia in about half of patients, with 26% achieving a complete recovery lasting for a median of 12 months. Better responses were observed in anemic patients with anti-erythrocyte autoantibodies than in those with anti-platelet autoantibodies, and the combination with recombinant erythropoietin (7/10) had a possible synergistic effect. Steroid doses were heterogeneous depending on the clinical intent (i.e., anti-inflammatory, immunosuppressive, anabolizing). Patients treated with a dose of 1 mg/kg day of prednisone for overt autoimmune cytopenia showed high rates of complete responses (60%)., Discussion: This observation suggests a trial with a short course (2-3 weeks) of standard steroid doses to ascertain efficacy and properly silence the autoimmune pathogenic mechanism. Steroid-related adverse events (16% of cases) should be monitored carefully in this elderly, frail population. In conclusion, features of autoimmunity are present in more than two-thirds of low-risk MDS patients and a trial with prednisone 0.5-1 mg/kg day for 2-3 weeks, with proper monitoring of adverse events, may be useful to improve cytopenias in selected cases.

Food loss and waste occur for many reasons, from crop processing to household leftovers. Even though some waste generation is unavoidable, a considerable amount is due to supply chain inefficiencies and damage during transport and handling. Packaging design and materials innovations represent real opportunities to reduce food waste within the supply chain. Besides, changes in people's lifestyles have increased the demand for high-quality, fresh, minimally processed, and ready-to-eat food products with extended shelf-life, that need to meet strict and constantly renewed food safety regulations. In this regard, accurate monitoring of food quality and spoilage is necessary to diminish both health hazards and food waste. Thus, this work provides an overview of the most recent advances in the investigation and development of food packaging materials and design with the aim to improve food chain sustainability. Enhanced barrier and surface properties as well as active materials for food conservation are reviewed. Likewise, the function, importance, current availability, and future trends of intelligent and smart packaging systems are presented, especially considering biobased sensor development by 3D printing technology. In addition, driving factors affecting fully biobased packaging design and materials development and production are discussed, considering byproducts and waste minimization and revalorization, recyclability, biodegradability, and other possible ends-of-life and their impact on product/package system sustainability.

The greater awareness of non-renewable natural resources preservation needs has led to the development of more ecological high-performance polymeric materials with new functionalities. In this regard, biobased composites are considered interesting options, especially those obtained from agro-industrial wastes and by-products. These are low-cost raw materials derived from renewable sources, which are mostly biodegradable and would otherwise typically be discarded. In this review, recent and innovative academic studies on composites obtained from biopolymers, natural fillers and active agents, as well as green-synthesized nanoparticles are presented. An in-depth discussion of biobased composites structures, properties, manufacture, and life-cycle assessment (LCA) is provided along with a wide up-to-date overview of the most recent works in the field with appropriate references. Potential uses of biobased composites from agri-food residues such as active and intelligent food packaging, agricultural inputs, tissue engineering, among others are described, considering that the specific characteristics of these materials should match the proposed application., Competing Interests: Conflict of interestThe authors declare no competing interests., (© Qatar University and Springer Nature Switzerland AG 2021.)

Blueberries are highly appreciated for their high antioxidant content but are also particularly susceptible to fungal deterioration. In this work, corn starch and chitosan, byproducts of the fishing industry, as well as active compounds obtained from citrus processing waste were used to obtain active biodegradable film packaging. Blueberries were packed in corn starch-chitosan (CS:CH) films and in active films containing lemon essential oil (LEO) or grapefruit seed extract (GSE). The effects of film packaging on the quality parameters of berries and the fungal incidence of disease during storage were studied and compared to benchmark materials. A conservation assay simulating transport and commercialization conditions was conducted. Blueberries packed in CS:CH films showed antioxidant capacity values closer to those packed in commercial PET containers ( Clamshells ), preserving 84.8% of the initial antioxidants content. Fruit packed in LEO films exhibited the greatest weight loss and rot incidence, and poor surface color. CS:CH and GSE films controlled the fruit respiration rate and weight loss, therefore they are materials with adequate barrier properties for blueberries conservation. Bags formulated with GSE showed adequate barrier properties to maintain fruit quality attributes without the incidence of rottenness, being an interesting option for blueberries exportation.

As an attempt to tackle the environmental issues derived from the use of non-degradable plastic and fertilizers overuse, such as irreversible soil pollution, this work focuses on the development of a fertilizer controlled-release, bio-based and biodegradable composite films for agricultural applications. Cassava starch and bagasse composite materials containing urea as active compound and plasticizer were prepared to achieve this purpose, analyzing their properties and stability during storage. Moreover, their biodegradation rate and urea release in soil were also assessed. Films were based on cassava starch with cassava bagasse particles as reinforcing agent and urea contents ranging from 0 to 50 wt% with respect to starch content. Urea proved to be an effective plasticizer of the matrix and films became more flexible with storage time. In addition, the material biodegradation rate in soil increased with urea content. Films with 50 wt% urea content showed a total weight loss of 57% and 95% release of the active compound after 15 days. The results indicate that this approach is adequate for the design of eco-compatible starch-based composite materials for urea dosage in soil based on cassava starch and bagasse., (Copyright © 2019 Elsevier B.V. All rights reserved.)