Background
There are still few data on the activity and safety of cetuximab‐based salvage chemotherapy after immunotherapy (SCAI) in patients with squamous cell cancer of the head and neck (SCCHN).
...Materials and Methods
This was a retrospective study of patients with SCCHN who received cetuximab‐based SCAI after programmed cell death protein 1 or programmed cell death ligand 1(PDL1) inhibitors. Overall response rate (ORR) and disease control rate (DCR) with SCAI and with last chemotherapy before immunotherapy (LCBI) by RECIST 1.1, percentage change from baseline in target lesions (PCTL), progression‐free survival (PFS), overall survival (OS), treatment compliance, and toxicity were evaluated.
Results
Between March 2016 and November 2019, 23 patients were identified. SCAI consisted of cetuximab‐based combinations (3‐weekly cisplatin‐5FU‐cetuximab n = 2, weekly paclitaxel‐cetuximab n = 17, weekly cisplatin‐cetuximab n = 2, weekly carboplatin‐paclitaxel‐cetuximab n = 2). ORR was 56.5% (11 partial response, 2 complete response). DCR was 78.3%. Among 13 objective responders, median best PCTL was −53.5% (range, −30% to −100%). Median OS and PFS were 12 months and 6 months, respectively. In 10 patients receiving LCBI, ORR to LCBI was 40%, whereas ORR to SCAI achieved 60%. In LCBI‐treated patients, median PFS with LCBI was 8 months and median PFS and OS with SCAI were 7 months and 12 months, respectively. Reduced dose intensity of the chemotherapy and cetuximab components occurred in 82.6% and 52.2% of the patients. Grade 1 or 2 adverse events (AEs) occurred in all patients. Grade 3 or 4 AEs developed in 65%, being grade 3 in all of them except in one patient (grade 4 neutropenia). There were no treatment‐related deaths.
Conclusion
Cetuximab‐based salvage chemotherapy after PD(L)1 inhibitors associated with high response rates and deep tumor reductions with a manageable safety profile. Subsequent lines of therapy may explain the long survival achieved in our series. These results invite to design studies to elucidate the best therapeutic sequence in patients with SCCHN in the immunotherapy era.
Implications for Practice
Cetuximab‐based salvage chemotherapy (SCAI) achieved high response rates in patients with recurrent/metastatic squamous cell cancer of the head and neck (SCCHN) after progression to PD‐1/PD‐L1 inhibitors. Objective response rate was higher than and progression‐free survival was comparable to that of chemotherapy administered before immunotherapy (IO). In most patients, SCAI consisted of weekly, well‐tolerated regimens. These observations have implications for current practice because of the limited evidence to date in SCCHN and the scant therapeutic options in this disease and invite to elucidate which may be the best treatment sequence for patients with head and neck cancer in the IO era.
This study explored the safety and efficacy of salvage chemotherapy combined with cetuximab after progression to immune checkpoint inhibitors in patients with recurrent/metastatic squamous cell cancer of the head and neck.
Aim
To evaluate the attitudes towards deceased multi‐organ donation and transplantation among nurses within the critical care units of the six public tertiary transplant hospitals in Madrid, Spain.
...Background
Spain has a rate of 49 donations per million population, whereas Madrid has a lower donation rate of 34.2 per million population. Nurses generate social opinion, and their attitude can be one of the barriers against organ donation.
Method
An observational descriptive study was conducted among critical care units’ nurses. The measuring instrument was the Collaborative International Donor Project in Organ Donation and Transplantation. Data were collected from January to October 2019, and a statistical analysis was performed.
Results
A total of n = 313 questionnaires achieved a response rate of 51%. Of the intensive care unit nurses surveyed, 85% had a favourable opinion towards the donation of their organs being affected by psychosocial variables related to social variables with respect to family, religion and attitude towards the body.
Conclusion
The intensive care unit nurses of the Madrid transplant hospitals maintain a favourable attitude towards organ donation and transplantation. It is necessary to implement specialized training and periodically evaluate training in this sector. To maintain and improve the attitude towards organ donation, family discussion among health personnel should be encouraged. Religion influences the attitude of nurses and donation rates.
Implication for nursing and health policy
Intensive care nurses’ attitude towards organ donation is influenced by social variables. This study shows that the attitude is positive but improvable. These findings contribute to promote awareness of the lack of organs and the benefits of organ donation.
Introduction
Infections caused by carbapenem-resistant Enterobacterales (CRE) and carbapenem-resistant
Pseudomonas aeruginosa
, including isolates producing acquired carbapenemases, constitute a ...prevalent health problem worldwide. The primary objective of this study was to determine the distribution of the different carbapenemases among carbapenemase-producing Enterobacterales (CPE, specifically
Escherichia coli
,
Klebsiella pneumoniae
,
Enterobacter cloacae
complex, and
Klebsiella aerogenes
) and carbapenemase-producing
P. aeruginosa
(CPPA) in Spain from January 2014 to December 2018.
Methods
A national, retrospective, cross-sectional multicenter study was performed. The study included the first isolate per patient and year obtained from clinical samples and obtained for diagnosis of infection in hospitalized patients. A structured questionnaire was completed by the participating centers using the REDCap platform, and results were analyzed using IBM SPSS Statistics 29.0.0.
Results
A total of 2,704 carbapenemase-producing microorganisms were included, for which the type of carbapenemase was determined in 2692 cases: 2280 CPE (84.7%) and 412 CPPA (15.3%), most often using molecular methods and immunochromatographic assays. Globally, the most frequent types of carbapenemase in Enterobacterales and
P. aeruginosa
were OXA-48-like, alone or in combination with other enzymes (1,523 cases, 66.8%) and VIM (365 cases, 88.6%), respectively. Among Enterobacterales, carbapenemase-producing
K. pneumoniae
was reported in 1821 cases (79.9%), followed by
E. cloacae
complex in 334 cases (14.6%). In Enterobacterales, KPC is mainly present in the South and South-East regions of Spain and OXA-48-like in the rest of the country. Regarding
P. aeruginosa
, VIM is widely distributed all over the country. Globally, an increasing percentage of OXA-48-like enzymes was observed from 2014 to 2017. KPC enzymes were more frequent in 2017–2018 compared to 2014–2016.
Discussion
Data from this study help to understand the situation and evolution of the main species of CPE and CPPA in Spain, with practical implications for control and optimal treatment of infections caused by these multi-drug resistant organisms.
Energy analysis in residential buildings considers three main areas of consumption: heating, air conditioning and domestic hot water. Traditionally, the former, heating, has been the most significant ...area of consumption in Spain but, due to modern technological advances and both the national and European regulations in force, this is no longer the case. The objective of this research is to define some strong, verified consumption patterns which make it possible to compare systems with one another and evaluate their influence on the energy efficiency of new and existing buildings, thereby, making progress toward improving generation systems. Real domestic hot water consumption measurements were collected over a one-year period for more than 500 Spanish properties in five different buildings located in both public and private residential developments. Moreover, a comparative study of the indicators set out in Spanish and other European regulations was carried out, evaluating their impact on energy performance certification. Finally, the suitability of the current indicators, both in quantitative and qualitative terms, was evaluated, concluding that the unit of measurement used in the Spanish regulations is not the most appropriate, and confirming that both seasonal impact and residential development type must be considered due to their influence on domestic hot water consumption.
Celotno besedilo
Dostopno za:
BFBNIB, DOBA, GIS, IJS, IZUM, KILJ, KISLJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
To study the environmental impact of nanoparticles, the sludges of wastewater (WWTS) and water treatment (WTS) plants enriched with ZnO nanoparticles were added to agricultural soil, and the toxic ...effects of the nanoparticles were studied using a microcosm system based on the soil. The WWTS treated soils were characterised by statistically significant decreases (p<0.05) in Vicia sativa germination at the lowest (76.2%) and medium (95.2%) application rates, decreases in the fresh biomass for Triticum aestivum (19.5%), Raphanus sativus (64.1%), V. sativa (37.4%) and Eisenia fetida (33.6%) at the highest application rate and a dose-related significant increase (p<0.05) in earthworm mortality. In WTS amended soils, significant reductions (p<0.05) of the fresh biomass (17.2%) and the chlorophyll index (24.4%) for T. aestivum and the fresh biomass for R. sativus (31.4%) were only recorded at the highest application doses. In addition, the soil phosphatase enzymatic activity decreased significantly (p<0.05) in both WWTS (dose related) and WTS treatments. For water organisms, a slight inhibition of the growth of Chlorella vulgaris was observed (WWTS treated soils), along with statistically significant dose-related inhibition responses on total glutathione cell content, and statistically significant dose-related induction responses on the glutathione S-transferase enzyme activity and the reactive oxygen species generation on the RTG-2 fish cell line.
•Reductions on fresh biomass for plants were detected at the lowest application doses.•Bioconcentration factors of Cd in the earthworm exposed to ZnO nanoparticles were >1.•Soil phosphatase enzymatic activity decreased significantly in amended soils.•Oxidative stress and redox status changes were detected in the RTG-2 fish cells.
Objectives
To evaluate the current prevalence of the three clonal groups O25b:H4-B2-ST131, O15:H1-D-ST393 and CGA-D-ST69 (where ST stands for sequence type) among Escherichia coli isolates causing ...extraintestinal infections in Spain and to characterize their virulence background, 500 consecutive non-duplicate E. coli isolates causing extraintestinal infections were analysed.
Methods
The 500 isolates were collected during February 2009 from five hospitals in different Spanish regions. Phylogenetic groups, STs, serotypes, virulence genes, PFGE profiles, antimicrobial resistance and extended-spectrum β-lactamase (ESBL) enzymes were determined.
Results
The three clonal groups accounted for 19% of the 500 isolates. Furthermore, they accounted for 37% of the isolates exhibiting trimethoprim/sulfamethoxazole plus ciprofloxacin resistance, 34% of aminoglycoside-resistant isolates and 30% of multidrug-resistant isolates. Clonal group ST131 was the most prevalent, and accounted for 12% of isolates overall and for 23% of multidrug-resistant isolates. The ST131 isolates exhibited a significantly higher virulence score (mean of virulence genes 8.1) compared with the ST393 (6.0) and ST69 (5.4) isolates. The prevalence of ESBL-producing isolates was 7%. Six (10%) of the 59 ST131 isolates were positive for CTX-M-15 and one (6%) of the 16 ST393 isolates was positive for CTX-M-14, whereas none of the 22 ST69 isolates produced ESBL enzymes.
Conclusions
The three clonal groups investigated accounted for 30% of the multidrug-resistant isolates, which gives evidence of an important clonal component in the emergence of resistances among extraintestinal pathogenic E. coli. Notably, a single high virulence clonal group (O25b:H4-B2-ST131) causes approximately 1 in every 10 extraintestinal infections in Spain, representing an important public health threat. A new variant of the ST131 clonal group, which is non-ESBL-producing but trimethoprim/sulfamethoxazole resistant and with high virulence content, is reported.
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