ObjectiveThis study aimed to propose a simple, accessible and low-cost predictive clinical model to detect lung lesions due to COVID-19 infection.DesignThis prospective cohort study included COVID-19 ...survivors hospitalised between 30 March 2020 and 31 August 2020 followed-up 6 months after hospital discharge. The pulmonary function was assessed using the modified Medical Research Council (mMRC) dyspnoea scale, oximetry (SpO2), spirometry (forced vital capacity (FVC)) and chest X-ray (CXR) during an in-person consultation. Patients with abnormalities in at least one of these parameters underwent chest CT. mMRC scale, SpO2, FVC and CXR findings were used to build a machine learning model for lung lesion detection on CT.SettingA tertiary hospital in Sao Paulo, Brazil.Participants749 eligible RT-PCR-confirmed SARS-CoV-2-infected patients aged ≥18 years.Primary outcome measureA predictive clinical model for lung lesion detection on chest CT.ResultsThere were 470 patients (63%) that had at least one sign of pulmonary involvement and were eligible for CT. Almost half of them (48%) had significant pulmonary abnormalities, including ground-glass opacities, parenchymal bands, reticulation, traction bronchiectasis and architectural distortion. The machine learning model, including the results of 257 patients with complete data on mMRC, SpO2, FVC, CXR and CT, accurately detected pulmonary lesions by the joint data of CXR, mMRC scale, SpO2 and FVC (sensitivity, 0.85±0.08; specificity, 0.70±0.06; F1-score, 0.79±0.06 and area under the curve, 0.80±0.07).ConclusionA predictive clinical model based on CXR, mMRC, oximetry and spirometry data can accurately screen patients with lung lesions after SARS-CoV-2 infection. Given that these examinations are highly accessible and low cost, this protocol can be automated and implemented in different countries for early detection of COVID-19 sequelae.
Dans cet article, en nous appuyant sur les notions baudelairiennes du comique significatif et du grotesque absolu, nous nous proposons d’envisager les Cavaliers sous l’angle de l’indétermination ...entre ces deux formes. En effet, si l’une a souvent servi à appuyer une lecture politique et l’autre une lecture ritualiste de la Comédie ancienne, il nous semble qu’Aristophane joue de l’ambiguïté qui naît de cette dichotomie. Ce faisant, le poète réalise dans le hic et nunc de l’espace théâtral le topos émergent du citoyen comme spectateur passif du politique. En effet, alors qu’Aristophane affirme souvent le caractère didactique de la comédie – notamment dans sa pièce précédente, les Acharniens – et sa volonté d’ouvrir les yeux de son public, celui-ci s’installe dans l’attitude confortable du rieur extérieur, riant de ses propres défauts satirisés sur scène. Toutefois, dans les Cavaliers, le brouillage entre fiction scénique et réalité amène une fictionnalisation du public et une forme de vrai de l’illusion, plaçant ainsi la pièce sous le signe de l’équivoque plutôt que sous celui de l’univocité. Ainsi, loin de recevoir une leçon sur leur passivité en politique, les citoyens-spectateurs sont amenés à interroger cette passivité dans le temps et l’espace du théâtre et de la performance comique.
The aim of this study was to compare laparoscopic and abdominal approach in the treatment of endometrial cancer in our department.
From January 1999 to November 2002, 77 patients underwent surgery ...for stages I–III endometrial cancer. The first group of 36 patients had abdominal hysterectomy as well as salpingo-oophorectomy, with or without lymphadenectomy. The remaining 41 patients received laparoscopic assisted vaginal hysterectomy as well as salpingo-oophorectomy, with or without lymphadenectomy.
In this retrospective study, we have compared the surgical results, the short- and long-term morbidity and the outcome of the two patient groups.
Body mass index (BMI) was significantly higher in the laparoscopic group (27.3 versus 24.6;
p
=
0.009). The average time for surgery was significantly longer for the laparoscopic group (143.6
min versus 109.7
min;
p
=
0.0001), but lymphadenectomy was performed in more patients (63.4% versus 25%;
p
=
0.001).
Postoperative hospital stay was significantly longer in patients undergoing the abdominal approach (4.59 days versus 3.18 days;
p
<
0.0001). No blood transfusions were performed and the rates of complications were similar in the two groups. No differences were found in recurrence and survival rate.
In our experience, laparoscopic and abdominal surgery can achieve similar results in the treatment of endometrial cancer. In our series, even with the BMI and the number of lymphadenectomies being higher in the laparoscopic group, the rates of complications were similar in the two groups.
The aim of this study was to evaluate the predictive value of pretreatment serum hemoglobin level (Hb) together with a series of clinical and pathological variables available before neoadjuvant ...chemotherapy in locally advanced squamous cervical cancer.
The influence on response to neoadjuvant chemotherapy of a series of pretreatment clinico-pathological features: hemoglobin level at diagnosis, age, parity, menopausal status, body mass index, clinical stage, tumor diameter, and nuclear grading were analyzed on 73 patients with locally advanced cervical cancer treated with platinum-based neoadjuvant chemotherapy followed by radical surgery. The relationships between pretreatment variables and response to chemotherapy were assessed in univariate and multivariate settings. A univariate and multivariate logistic regression model was adapted to predict an “optimal” response (pathological complete response or more than 50% reduction in tumoral diameter) or “sub-optimal” response (<50% reduction in tumoral diameter).
Seventy-three patients—clinical stage: Ib2: 29 (39.7%) IIa: 22 (30.1%) IIb: 22 (30.1%)—received 3 cycles of platinum-based neoadjuvant chemotherapy followed by type III radical hysterectomy. A complete response to neoadjuvant chemotherapy was significantly associated with higher level of pretreatment hemoglobin (mean 14.0 mg/dl) compared to patients with ≥50% response (12.7 mg/dl) or <50% (11.9 mg/dl) (
P = 0.002). At multivariate analysis, Hb level was found to be the most powerful and significantly related factor to response to neoadjuvant chemotherapy. A hemoglobin threshold of 12 mg/dl was able to distinguish between patients—with ≥12 mg/dl—at higher probability to respond to neoadjuvant chemotherapy from the ones at lower probability (hemoglobin level under 12 mg/dl). Patients with a complete response to chemotherapy had a 100% survival compared to 93.1% and 53.8% for patients with responses ≥50% and <50% respectively (
P = 0.0001). Patients with a pretreatment hemoglobin level of ≥12 mg/dl showed a survival of 87% compared to 63% for patients with a lower hemoglobin level (
P = 0.008).
Pretreatment Hb level showed a prognostic and independent predictive value for response to neoadjuvant chemotherapy in locally advanced cervical cancer. In our preliminary report, performed on a limited sample, a threshold of 12 mg/dl seems to be helpful to distinguish between “optimal” and “non-optimal” response.
To correlate the arrhythmogenic effects of maternal autoantibodies with the genesis of congenital heart block, female BALB/c mice were immunized with human recombinant 48-kDa SSB/La, 60-kDa SSA/Ro, ...52-kDa SSA/Ro (52alpha), and 52beta (amino acids 169-245 deleted) as well as with murine recombinant 52-kDa SSA/Ro. Control animals received beta-galactosidase or a polypeptide encoded by pET-28 alone. Following primary immunization and two boosters, high titer responses to the respective Ags were established by ELISA, immunoblotting, and immunoprecipitation. Sera from mice immunized with either human 52alpha or 52beta immunoprecipitated murine 52Ro. mRNA and protein expression of 52Ro was demonstrated in the newborn murine heart. A spectrum of atrioventricular nodal conduction abnormalities was identified by electrocardiogram. First-degree block was detected in 7% of 27 pups born to mothers immunized with 48La, 20% of 54 pups born to 60Ro-immunized mothers, 6% of 56 pups born to 52alpha-immunized mothers, 7% of 86 pups born to 52beta-immunized mothers, and 9% of 22 pups born to mothers immunized with murine 52Ro. Advanced conduction abnormalities were only identified in offspring of 52alpha- or 52beta-immunized mice. In the 52alpha group, one pup had complete block and another had second-degree block (Wenckebach type); in the 52beta group, five pups had complete block. Maternal Abs to the primary immunogens were detected in the pups. No control had any conduction abnormalities. This Ab-specific animal model provides strong evidence for a pathogenic role of anti-SSA/Ro-SSB/La Abs, particularly 52Ro, in the development of congenital heart block. The range and frequency of conduction defects suggest that additional factors promote disease expression.
It was recently reported that sera from patients with systemic lupus erythematosus contain antibodies reactive with the second extracellular loop of the serotoninergic 5-HT4 receptor expressed in the ...human heart. This antibody response was associated with antibodies to 52kD SSA/Ro, a reactivity prevalent in mothers of children with congenital heart block (CHB). The current study was undertaken to determine whether the 5-HT4 receptor is a target of the immune response in these mothers. Initial experiments demonstrated mRNA expression of the 5-HT4 receptor in the human foetal atrium. Electrophysiologic studies established that human foetal atrial cells express functional 5-HT4 receptors. Sera from 116 mothers enrolled in the Research Registry for Neonatal Lupus, whose children have CHB, were evaluated. Ninety-nine (85%) of these maternal sera contained antibodies to SSA/Ro, 84% of which were reactive with the 52kD SSA/Ro component by immunoblot. None of the 116 sera were reactive with the peptide spanning aa165–185 of the serotoninergic receptor. Rabbit antisera which recognized this peptide did not react with 52kD SSA/Ro or peptide aa365–382 in the C terminus. Although 5-HT4 receptors are present and functional in the human foetal heart, maternal antibodies to the 5-HT4 receptor are not associated with the development of CHB.
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