Background
Literature on severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection in cancer patients is scarce in Latin America. This population seems to have a higher risk for adverse ...outcomes. This study aims to correlate clinical characteristics with outcomes in patients with cancer.
Methods
We included all patients with cancer and confirmed SARS‐CoV‐2 infection from April 19 to December 31, 2020, at the Instituto Nacional de Cancerologia, Mexico. Clinical information was obtained from medical and epidemiological records. For the association between variables and hospitalization, invasive mechanical ventilation (IMV), and mortality, univariate and multivariate logistic regression were performed; odds ratios and 95% confidence intervals were calculated.
Results
Four hundred thirty‐three patients were included; 268 (62%) were female, the median age was 55 years. One hundred thirty‐five (31%), 131 (30%), and 93 (21%) patients had obesity, hypertension, and diabetes mellitus (DM), respectively. Three hundred forty‐one (79%) had solid cancer. One hundred seventy (39%) had advanced cancer. Two hundred (46%) patients were hospitalized. Age (p < 0.01), male gender (p = 0.03), hematological malignancies (HM) (p = 0.04) and advanced cancer (p = 0.03) increased the risk for hospital admission. Forty‐five (10%) patients required IMV. Age (p = 0.02); DM (p = 0.04); high C‐reactive protein (p < 0.01), and lactate dehydrogenase (p = 0.03) were associated with IMV. Mortality within 30 days after diagnosis was 18% (76 cases). Associated characteristics were age (p = 0.04) and low albumin (p < 0.01).
Conclusions
In this study, patients with cancer showed higher mortality, need for hospitalization, and IMV compared with other non‐cancer cohorts. We did not find an increased risk in mortality for HM. Although our cohort was younger than others previously reported, age was a strong predictor of adverse outcomes. Variables associated with IMV and death were similar to those previously described in cancer patients with COVID‐19.
In this study, we found that patients with cancer had higher mortality, need of hospitalization, and mechanical ventilation compared with other non‐cancer cohorts. Age was the most important risk factor for hospital admission, invasive mechanical ventilation, and death regardless of the type of cancer.
BACKGROUNDVaccination is the most effective intervention for reducing the burden of SARS-CoV-2-related disease; however, gaps in knowledge regarding cancer patients (CPs) immune response persist. ...OBJECTIVESTo evaluate the humoral response (anti-S antibodies) in CPs and healthcare workers (HCWs) vaccinated with two doses of BNT162b2 or AZD122 vaccines. MATERIAL AND METHODSPolyspecific anti-SARS-CoV-2 spike protein (anti-S) antibodies were quantified, and a 1:1 propensity score was used to balance baseline characteristics. Multiple logistic regressions were carried out to evaluate the effect of humoral response-related variables. RESULTSOne-hundred and twenty-seven CPs (22%) and 439 HCWs (78%) were included. Both populations developed anti-S antibodies in response to vaccination. The mRNA-based vaccine (BNT162b2) was associated with higher odds of having anti-S antibody titers ≥ 1,000 U/mL, while active cancer was related to a lower probability of developing high antibody titers. CONCLUSIONSThe BNT162b2 vaccine was associated with a higher humoral response. It is necessary for more information and vaccination strategies to be available for immunosuppressed patients in order to select the best biologics for this population based on individual characteristics.
Corneal diseases are among the main causes of blindness, with approximately 4.6 and 23 million patients worldwide suffering from bilateral and unilateral corneal blindness, respectively. The standard ...treatment for severe corneal diseases is corneal transplantation. However, relevant disadvantages, particularly in high-risk conditions, have focused the attention on the search for alternatives.
We report interim findings of a phase I-II clinical study evaluating the safety and preliminary efficacy of a tissue-engineered corneal substitute composed of a nanostructured fibrin-agarose biocompatible scaffold combined with allogeneic corneal epithelial and stromal cells (NANOULCOR). 5 subjects (5 eyes) suffering from trophic corneal ulcers refractory to conventional treatments, who combined stromal degradation or fibrosis and limbal stem cell deficiency, were included and treated with this allogeneic anterior corneal substitute.
The implant completely covered the corneal surface, and ocular surface inflammation decreased following surgery. Only four adverse reactions were registered, and none of them were severe. No detachment, ulcer relapse nor surgical re-interventions were registered after 2 years of follow-up. No signs of graft rejection, local infection or corneal neovascularization were observed either. Efficacy was measured as a significant postoperative improvement in terms of the eye complication grading scales. Anterior segment optical coherence tomography images revealed a more homogeneous and stable ocular surface, with complete scaffold degradation occurring within 3–12 weeks after surgery.
Our findings suggest that the surgical application of this allogeneic anterior human corneal substitute is feasible and safe, showing partial efficacy in the restoration of the corneal surface.
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•NANOULCOR human bioartificial corneas can be surgically implanted in human patients.•Bioartificial human corneas are highly biocompatible and free from side effects.•Preliminary signs of efficacy were found in the first cases grafted with NANOULCOR.
Objective
This study aimed to assess the efficacy and tolerability of stereotactic body radiation therapy (SBRT) for the treatment of liver metastases.
Methods
Patients with up to 5 liver metastases ...were enrolled in this prospective multicenter study and underwent SBRT. Efficacy outcomes included in-field local control (LC), progression-free survival (PFS), and overall survival (OS). Acute and late toxicities were evaluated using CTCAE v.4.0.
Results
A total of 52 patients with 105 liver metastases were treated between 2015 and 2018. The most common primary tumor was colorectal cancer (72% of cases). Liver metastases were synchronous with the primary tumor diagnosis in 24 patients (46.2%), and 21 patients (40.4%) presented with other extrahepatic oligometastases. All patients underwent intensity-modulated radiation therapy (IMRT)/volumetric-modulated arc therapy (VMAT) with image-guided radiation therapy (IGRT) and respiratory gating, and a minimum biologically effective dose (BED10Gy) of 100 Gy was delivered to all lesions. With a median follow-up of 23.1 months (range: 13.4–30.9 months) since liver SBRT, the median actuarial local progression-free survival (local-PFS) was not reached. The actuarial in-field LC rates were 84.9% and 78.4% at 24 and 48 months, respectively. The median actuarial liver-PFS and distant-PFS were 11 and 10.8 months, respectively. The actuarial median overall survival (OS) was 27.7 months from SBRT and 52.5 months from metastases diagnosis. Patients with lesion diameter ≤ 5 cm had significantly better median liver-PFS (p = 0.006) and OS (p = 0.018). No acute or late toxicities of grade ≥ 3 were observed.
Conclusions
This prospective multicenter study confirms that liver SBRT is an effective alternative for the treatment of liver metastases, demonstrating high rates of local control and survival while maintaining a low toxicity profile.
Objectives
The El Sidrón tali sample is assessed in an evolutionary framework. We aim to explore the relationship between Neandertal talus morphology and body size/shape. We test the hypothesis 1: ...talar Neandertal traits are influenced by body size, and the hypothesis 2: shape variables independent of body size correspond to inherited primitive features.
Materials and methods
We quantify 35 landmarks through 3D geometric morphometrics techniques to describe H. neanderthalensis‐H. sapiens shape variation, by Mean Shape Comparisons, Principal Component, Phenetic Clusters, Minimum spanning tree analyses and partial least square and regression of talus shape on body variables. Shape variation correlated to body size is compared to Neandertals‐Modern Humans (MH) evolutionary shape variation. The Neandertal sample is compared to early hominins.
Results
Neandertal talus presents trochlear hypertrophy, a larger equality of trochlear rims, a shorter neck, a more expanded head, curvature and an anterior location of the medial malleolar facet, an expanded and projected lateral malleolar facet and laterally expanded posterior calcaneal facet compared to MH.
Discussion
The Neandertal talocrural joint morphology is influenced by body size. The other Neandertal talus traits do not co‐vary with it or not follow the same co‐variation pattern as MH. Besides, the trochlear hypertrophy, the trochlear rims equality and the short neck could be inherited primitive features; the medial malleolar facet morphology could be an inherited primitive feature or a secondarily primitive trait; and the calcaneal posterior facet would be an autapomorphic feature of the Neandertal lineage.
Reconstructing the morphology of the Neanderthal rib cage not only provides information about the general evolution of human body shape but also aids understanding of functional anatomy and ...energetics. Despite this paleobiological importance there is still debate about the nature and extent of variations in the size and shape of the Neandertal thorax. The El Sidrón Neandertals can be used to contribute to this debate, providing new costal remains ranging from fully preserved and undistorted ribs to highly fragmented elements. Six first ribs are particularly well preserved and offer the opportunity to analyze thorax morphology in Neandertals. The aims of this paper are to present this new material, to compare the ontogenetic trajectories of the first ribs between Neandertals and modern humans, and, using geometric morphometrics, to test the hypothesis of morphological integration between the first rib and overall thorax morphology. The first ribs of the El Sidrón adult Neandertals are smaller in centroid size and tend to be less curved when compared with those of modern humans, but are similar to Kebara 2. Our results further show that the straightening of the first ribs is significantly correlated with a straightening of the ribs of the upper thorax (R = 0.66; p < 0.0001) in modern humans, suggesting modularity in the upper and lower thorax units as reported in other hominins. It also supports the hypothesis that the upper thorax of Neandertals differs in shape from modern humans with more anteriorly projecting upper ribs during inspiration. These differences could have biomechanical consequences and account for stronger muscle attachments in Neandertals. Different upper thorax shape would also imply a different spatial arrangement of the shoulder girdle and articulation with the humerus (torsion) and its connection to the upper thorax. Future research should address these inferences in the context of Neandertal overall body morphology.
The study of the Neanderthal thorax has attracted the attention of the scientific community for more than a century. It is agreed that Neanderthals have a more capacious thorax than modern humans, ...but whether this was caused by a medio-lateral or an antero-posterior expansion of the thorax is still debated, and is key to understanding breathing biomechanics and body shape in Neanderthals. The fragile nature of ribs, the metameric structure of the thorax and difficulties in quantifying thorax morphology all contribute to uncertainty regarding precise aspects of Neanderthal thoracic shape. The El Sidrón site has yielded costal remains from the upper to the lower thorax, as well as several proximal rib ends (frequently missing in the Neanderthal record), which help to shed light on Neanderthal thorax shape. We compared the El Sidrón costal elements with ribs from recent modern humans as well as with fossil modern humans and other Neanderthals through traditional morphometric methods and 3D geometric morphometrics, combined with missing data estimation and virtual reconstruction (at the 1st, 5th and 11th costal levels). Our results show that Neanderthals have larger rib heads and articular tubercles than their modern human counterparts. Neanderthal 1st ribs are smaller than in modern humans, whereas 5th and 11th ribs are considerably larger. When we articulated mean ribs (size and shape) with their corresponding vertebral elements, we observed that compared to modern humans the Neanderthal thorax is medio-laterally expanded at every level, especially at T5 and T11. Therefore, in the light of evidence from the El Sidrón costal remains, we hypothesize that the volumetric expansion of the Neanderthal thorax proposed by previous authors would mainly be produced by a medio-lateral expansion of the thorax.
El estudio del tórax Neandertal ha atraído el interés de la comunidad científica por más de un siglo. Existe acuerdo acerca de la mayor capacidad torácica en Neandertales en comparación con humanos modernos. Sin embargo, si esto es causado por una expansión antero-posterior o medio-lateral del tórax es debatido a día de hoy y es clave para el entendimiento de la biomecánica respiratoria y la morfología corporal en Neandertales. La frágil naturaleza de las costillas, la estructura metamérica del tórax y las dificultades en la cuantificación morfológica contribuyen a la incertidumbre en referencia a aspectos de la morfología torácica Neandertal. El yacimiento de El Sidrón ha proporcionado elementos costales que comprenden desde el tórax superior hasta el inferior, así como diferentes restos costales proximales (frecuentemente ausentes en el registro fósil Neandertal), los cuales pueden arrojar luz sobre esta incertidumbre. Nosotros comparamos las costillas de El Sidrón con costillas de humanos modernos actuales, así como con humanos modernos fósiles y otros Neandertales, a través de técnicas de morfometría clásica y morfometría geométrica 3D, combinadas con técnicas de estimación de datos perdidos y de reconstrucción virtual (a nivel de 1a, 5a y 11a costilla). Nuestros resultados muestran que los Neandertales presentan cabezas costales y tubérculos articulares más grandes que humanos modernos. A nivel de tamaño global de las costillas, las 1a costillas Neandertales son más pequeñas que las de humanos modernos, mientras que las 5a y 11a son considerablemente más grandes. Cuando articulamos costillas medias (forma y tamaño) con sus correspondientes elementos vertebrales, nosotros observamos que el tórax Neandertal presenta una expansión medio-lateral en los diferentes niveles estudiados con respecto a humanos modernos, aunque esto es más evidente a nivel T5 y T11. Por lo tanto, a la luz de la evidencia proporcionada por los restos costales de El Sidrón, nosotros hipotetizamos que la expansión volumétrica Neandertal propuesta por autores previos, debería ser fundamentalmente producida por una expansión medio-lateral del tórax.
Purpose
There are currently no standard definitions for assessing the severity of
Clostridioides difficile
infection (CDI) in cancer patients. We evaluated the performance of scoring systems for ...severity and analyzed risk factors for mortality in a cancer cohort.
Methods
We conducted an observational study in patients with cancer and CDI. We calculated the incidence of hospital-onset (HO-CDI) and community-onset health-care facility associated (CO-HCFA-CDI) episodes. We classified severity using five prognostic scales and calculated sensitivity, specificity, positive (PPV), and negative predictive values (NPV) for mortality and intensive care unit (ICU) admission. In addition, multivariate regression was performed to assess variables associated with mortality.
Results
The HO-CDI and CO-HCFA-CDI incidence rates were 3.7 cases/10,000 patient-days and 1.9 cases/1,000 admissions, respectively. ESCMID criteria showed the higher sensitivity (97%, 95% CI; 85–100%) and NPV (98%, 95% CI; 85–100%), while ATLAS (≥ 6 points) had the highest specificity (95%, 95% CI; 90–98%) for 30-day all-cause mortality; similar performance was observed for ICU admission. Characteristics associated with fatal outcome were neutropenia (≤ 100 cells/ml) (aOR; 3.03, 95% CI; 1.05–8.74,
p
= 0.040), male gender (aOR; 2.90, 95% CI; 1.08–7.80,
p
= 0.034), high serum creatinine (aOR; 1.71, 95% CI; 1.09–2.70,
p
= 0.020), and albumin (aOR; 0.17, 95% CI; 0.07–0.42,
p
< 0.001).
Conclusions
Some of the current scales may not be appropriate to discriminate severity in patients with cancer. The variables in this study associated with unfavorable outcomes could be evaluated in prospective studies to develop prognostic scores that identify susceptible patients, especially in immunocompromised populations.
This study was conducted to investigate the effects of dietary fructooligosaccharides (FOS) on the growth, survival rate, digestive enzyms activity, and the expression of intestinal barrier function ...genes in tropical gar (Atractosteus tropicus) larvae. A total of 960 larvae (0.030 ± 0.006 g) were fed three diets supplemented with increasing FOS concentrations (2.5, 5, and 7.5 g kg−1) and a control diet for 15 days. Results revealed that a 7.5 g kg−1 FOS supplementation improved weight gain, specific growth rate, and survival rate (p < 0.05). Furthermore, 5 g kg−1 FOS supplementation increased alkaline protease and amylase activities and induced an upregulation of the claudin-17 gene expression (p < 0.05). Meanwhile, the inclusion of 7.5 g kg−1 FOS induced the upregulation of mucin 2 (muc-2), and the tight junction genes zo-2 and claudin-3 (p < 0.05). In addition, 2.5, 5, and 7.5 g kg−1 FOS promoted the downregulation of the claudin-15 gene expression (p < 0.05). At the same time, FOS inclusion did not increase the pro-inflammatory cytokine il-8 expression. We can conclude that 7.5 g kg−1 FOS supplementation improves growth performance, survival rate, and digestive capacity, and could contribute to the reinforcement of the intestinal barrier function of Tropical gar larvae.
•SARS-CoV-2 positivity rate in hospital Non-Covid in México was 9.6%.•Men, administrative staff and employees who had relatives also working in the same hospital had higher risk of infection.•Active ...surveillance help to detect a significant number of asymptomatic infections, is necessary to reinforce preventive measures in non-medical staff to prevent nosocomial transmission.
Healthcare workers are at increased risk of SARS-CoV-2 infection. The positivity rates in hospitals that do not receive patients with COVID-19, such as the National Cancer Institute (INCan) in Mexico, and the associated factors are unknown.
To assess the incidence and factors associated with SARS-CoV-2 infection in health workers at INCan.
A cohort study of 531 workers who were followed for 6 months. RT-PCR analysis of saliva and nasopharyngeal swab samples were used in the baseline and to confirm cases during follow-up The incidence rate ratio was calculated according to the measured characteristics and the associated factors were calculated using logistic regression models.
Out of 531 workers, 9.6% tested positive for SARS-CoV-2, Being male (RR: 2.07, 95% CI: 1.1-3.8, P = .02), performing administrative tasks (RR: 1.99, 95% CI: 1.0-3.9, P = .04), and having relatives also working at INCan (RR: 3.7, 95% CI: 1.4-9.5, P < .01) were associated with higher positivity rates.
Incidence of positive cases in health workers were similar to that reported in non-COVID hospitals from other countries.
Even though active surveillance helped to detect a significant number of asymptomatic infections, it is still necessary to reinforce preventive measures in non-medical staff to prevent nosocomial transmission.
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