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A spatial survival analysis was performed to identify some of the factors that influence the survival of patients with COVID-19 in the states of Guerrero, México, and Chihuahua. The data that we analyzed correspond to the period from 28 February 2020 to 24 November 2021. A Cox proportional hazards frailty model and a Cox proportional hazards model were fitted. For both models, the estimation of the parameters was carried out using the Bayesian approach. According to the DIC, WAIC, and LPML criteria, the spatial model was better. The analysis showed that the spatial effect influences the survival times of patients with COVID-19. The spatial survival analysis also revealed that age, gender, and the presence of comorbidities, which vary between states, and the development of pneumonia increase the risk of death from COVID-19.
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Abstract Objective MicroRNA-29a-3p has been reported in a variety of cancers, but its role in hypopharyngeal cancer remains unclear. This study was to determine the role of microRNA-29a-3p in the occurrence and development of hypopharyngeal cancer. Methods 40 patients with hypopharyngeal cancer who underwent surgery in the Affiliated Hospital of Jining Medical University from April 2013 to November 2017 were selected for this study. The cancer tissue samples of the patients were collected, and the patients were followed up for three years. The expression of microRNA-29a-3p in tissue samples was detected by in situ hybridization with fluorescent probe, and the relationships among microRNA-29a-3p and clinicopathological factors, postoperative recurrent-metastasis, survival time were studied. Immunohistochemical was used to detect the expression of Ki67 and E-cadherin in tissue samples. Results Combined with HE staining results showed that microRNA-29a-3p expression was relatively high in non-cancer tissue cells (red blood cells and fibroblasts in tumor interstitial vessels), but was relatively low in cancer tissue and cells. According to the follow-up data of 40 patients with hypopharyngeal cancer, tumor size, T-stage, tumor differentiation, postoperative recurrent-metastasis of hypopharyngeal cancer patients were significantly negatively correlated with microRNA-29a-3p (p< 0.05). Immunohistochemica results further confirmed that microRNA-29a-3p was negatively correlated with the expression of Ki67 and E-cadherin. The survival time of patients positively related with microRNA-29a-3p expression (p< 0.05). Moreover, ROC curve analysis showed that the area under the curve of the combined detection of miRNA-29a-3p+Ki67+E-cadherin was larger than that of the single detection of the three indexes. Conclusions The expression of microRNA-29a-3p is closely related to the occurrence, development and prognosis of hypopharyngeal cancer, and it affects the proliferation and invasion. This indicates that microRNA-29a-3p serves as a therapeutic target for the occurrence and development of hypopharyngeal cancer. The evidence of study designs of this study is IV using "Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence".
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OBJECTIVE: MicroRNA-29a-3p has been reported in a variety of cancers, but its role in hypopharyngeal cancer remains unclear. This study was to determine the role of microRNA-29a-3p in the occurrence and development of hypopharyngeal cancer. METHODS: 40 patients with hypopharyngeal cancer who underwent surgery in the Affiliated Hospital of Jining Medical University from April 2013 to November 2017 were selected for this study. The cancer tissue samples of the patients were collected, and the patients were followed up for three years. The expression of microRNA-29a-3p in tissue samples was detected by in situ hybridization with fluorescent probe, and the relationships among microRNA-29a-3p and clinicopathological factors, postoperative recurrent-metastasis, survival time were studied. Immunohistochemical was used to detect the expression of Ki67 and E-cadherin in tissue samples. RESULTS: Combined with HE staining results showed that microRNA-29a-3p expression was relatively high in non-cancer tissue cells (red blood cells and fibroblasts in tumor interstitial vessels), but was relatively low in cancer tissue and cells. According to the follow-up data of 40 patients with hypopharyngeal cancer, tumor size, T-stage, tumor differentiation, postoperative recurrent-metastasis of hypopharyngeal cancer patients were significantly negatively correlated with microRNA-29a-3p (pâ¯<â¯0.05). Immunohistochemica results further confirmed that microRNA-29a-3p was negatively correlated with the expression of Ki67 and E-cadherin. The survival time of patients positively related with microRNA-29a-3p expression (pâ¯<â¯0.05). Moreover, ROC curve analysis showed that the area under the curve of the combined detection of miRNA-29a-3p+Ki67+E-cadherin was larger than that of the single detection of the three indexes. CONCLUSIONS: The expression of microRNA-29a-3p is closely related to the occurrence, development and prognosis of hypopharyngeal cancer, and it affects the proliferation and invasion. This indicates that microRNA-29a-3p serves as a therapeutic target for the occurrence and development of hypopharyngeal cancer. The evidence of study designs of this study is IV using "Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence".
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Neoplasias Hipofaríngeas , MicroRNAs , Humanos , MicroRNAs/genética , MicroRNAs/metabolismo , Neoplasias Hipofaríngeas/genética , Neoplasias Hipofaríngeas/cirurgia , Relevância Clínica , Antígeno Ki-67 , Caderinas/genéticaRESUMO
Introducción: La fibrosis quística ha dejado de ser una enfermedad pediátrica para ser una enfermedad crónica del adulto. Existen múltiples factores que condicionan la supervivencia de estos enfermos. Objetivo: Determinar la sobrevida de pacientes pediátricos con fibrosis quística hospitalizados en un centro especializado. Métodos: Estudio retrospectivo de cohorte cuyo universo lo conformaron 27 pacientes incluidos en el Registro Provincial de Fibrosis Quística de Granma, 2003-2018. Se analizaron variables: edad actual y sexo, variante genética, presencia de gérmenes, formas clínicas, y supervivencia a partir del diagnóstico y tratamiento. Se utilizó el método de Kaplan-Meier y Log-Rank Test, para un nivel de significación de 95 por ciento. Resultados: El 40,7 por ciento de los pacientes declaró tener actualmente más de 15 años, predominó el sexo masculino (63 por ciento), y la mutación F508 del en su variante genética heterocigótica (44,4 por ciento). El promedio de supervivencia resultó en 21,4 años, no existieron diferencias significativas según sexo, formas clínicas y tipos de gérmenes. Conclusiones: Los pacientes con fibrosis quística en Granma, Cuba mostraron un promedio de supervivencia de 21,4 años, inferior a lo documentado en países desarrollados. El Estado cubano garantiza recursos para la atención de estos pacientes, a pesar de las dificultades económicas del país(AU)
Introduction: Cystic fibrosis is no longer a pediatric disease but a chronic adult disease. There are multiple factors that condition the survival of these patients. Objective: To determine the survival of pediatric patients with cystic fibrosis hospitalized in a specialized center. Methods: Retrospective cohort study whose universe consisted of 27 patients included in the Granma provincial cystic fibrosis registry, 2003-2018. Variables were analyzed: current age and gender, genetic variant, presence of germs, clinical forms and survival after diagnosis and treatment. The Kaplan-Meier method and Log-Rank Test were used, for a significance level of 95 percent. Results: 40.7 percent of patients are currently over 15 years of age, male sex predominates (63 percent) and the F508del mutation in its heterozygous genetic variant (44.4 percent). The average survival is 21.4 years, there were no significant differences according to gender, clinical forms and types of germs. Conclusions: The average survival rate of patients with cystic fibrosis in Granma, Cuba, is 21.4 years, lower than that documented in developed countries. The Cuban State guarantees resources for the care of these patients, despite the country's economic difficulties(AU)
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Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Adolescente , Taxa de Sobrevida , Fibrose Cística/diagnóstico , Fibrose Cística/mortalidade , Fibrose Cística/tratamento farmacológico , Sobrevivência , Insuficiência Pancreática Exócrina/classificação , Qualidade de Vida , Estudos de Coortes , Estudo ObservacionalRESUMO
BACKGROUND: The prognostic value of preoperative fluorine-18-fluorodeoxyglucose positron-emission tomography (18F-FDG PET) scan for determining overall survival (OS) in breast cancer (BC) patients is controversial. AIM: To evaluate the OS predictive value of preoperative PET positivity after 15 years. METHODS: We performed a retrospective search of the Universitair Ziekenhuis Brussel patient database for nonmetastatic patients who underwent preoperative PET between 2002-2008. PET positivity was determined by anatomical region of interest (AROI) findings for breast and axillary, sternal, and distant sites. The prognostic role of PET was examined as a qualitative binary factor (positive vs negative status) and as a continuous variable [maximum standard uptake value (SUVmax)] in multivariate survival analyses using Cox proportional hazards models. Among the 104 identified patients who received PET, 36 were further analyzed for the SUVmax in the AROI. RESULTS: Poor OS within the 15-year study period was predicted by PET-positive status for axillary (P = 0.033), sternal (P = 0.033), and combined PET-axillary/sternal (P = 0.008) nodes. Poor disease-free survival was associated with PET-positive axillary status (P = 0.040) and combined axillary/sternal status (P = 0.023). Cox models confirmed the long-term prognostic value of combined PET-axillary/sternal status [hazard ratio (HR): 3.08, 95% confidence interval: 1.42-6.69]. SUVmax of ipsilateral breast and axilla as continuous covariates were significant predictors of long-term OS with HRs of 1.25 (P = 0.048) and 1.54 (P = 0.029), corresponding to relative increase in the risk of death of 25% and 54% per SUVmax unit, respectively. In addition, the ratio of the ipsilateral axillary SUVmax over the contralateral axillary SUVmax was the most significant OS predictor (P = 0.027), with 1.94 HR, indicating a two-fold relative increase of mortality risk. CONCLUSION: Preoperative PET is valuable for prediction of long-term survival. Ipsilateral axillary SUVmax ratio over the uninvolved side represents a new prognostic finding that warrants further investigation.
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OBJECTIVE: The objective of the study was to evaluate safety and value of radical resection for unresectable pancreatic cancer (UPC). MATERIALS AND METHODS: Clinical data were analyzed retrospectively. In unresectable group, 360° resection of the involved artery sheath, resection and reconstruction of the involved artery, resection and reconstruction of the involved vein as well as resection and reconstruction of combined organs were, respectively, performed. Operation time, intraoperative blood loss, intensive care unit (ICU) transitional treatment, pancreatic fistula, bleeding, reoperation, and survival time were analyzed for two groups. RESULTS: Operation time and intraoperative blood loss were greatly increased in the unresectable group. The incidence of intractable diarrhea and abdominal hemorrhage in the unresectable group was higher. However, the rate of ICU transitional therapy, delayed gastric emptying, and reoperation was lower. Grade C pancreatic fistula occurred in neither group. CONCLUSIONS: Surgical treatment through strict selection for patient with UPC is safe and their median survival time is similar to patient with resectable pancreatic cancer.
OBJETIVO: evaluar la seguridad y el valor de la resección radical para el cáncer de páncreas irresecable (CPU). MATERIAL Y MÉTODOS: Los datos clínicos se analizaron de forma retrospectiva. En el grupo irresecable, se realizó resección de 360° de la vaina de la arteria afectada, resección y reconstrucción de la arteria afectada, resección y reconstrucción de la vena afectada, así como resección y reconstrucción de órganos combinados, respectivamente. Se analizaron el tiempo operatorio, la pérdida de sangre intraoperatoria, el tratamiento transitorio en la UCI, la fístula pancreática, el sangrado, la reintervención y el tiempo de supervivencia para dos grupos. RESULTADOS: El tiempo de operación y la pérdida de sangre intraoperatoria aumentaron considerablemente en el grupo irresecable. La incidencia de diarrea intratable y hemorragia abdominal en el grupo irresecable fue mayor. Sin embargo, la tasa de terapia de transición en la UCI, el retraso del vaciamiento gástrico y la reintervención fueron menores. La fístula pancreática de grado C ocurrió en ninguno de los grupos. CONCLUSIONES: el tratamiento quirúrgico mediante selección estricta del paciente con CP irresecable es seguro y su mediana de supervivencia es similar a la del paciente con CPR.
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Neoplasias Pancreáticas , Humanos , Pancreatectomia , Fístula Pancreática/etiologia , Neoplasias Pancreáticas/cirurgia , Reoperação , Estudos RetrospectivosRESUMO
AIMS: Considering that healthcare systems' financial resources are limited, we aimed to analyze the number needed to treat (NNT) and cost of preventing an event (COPE) related to drug use from Supplementary Health System (SSS) perspective. METHODS: Data from KEYNOTE-189 (NCT02578680) were considered, comparing pembrolizumab + chemotherapy to chemotherapy alone. A cost-per-responder model was developed considering the 24- and 12-month time horizons for overall survival (OS) and progression-free survival (PFS) endpoints, respectively. Restricted mean survival time (RMST) and restricted mean time-on-treatment (ToT) were determined for NNT and COPE calculation. Costs were reported in American dollars (USD) and reflect those related to drug use. The analysis was conducted for the total indicated population, and an exploratory assessment was carried out for subgroups with different programmed death-ligand 1 (PD-L1) expression levels. RESULTS: Considering PFS data, the overall population NNTRMST to prevent a progression event with pembrolizumab + chemotherapy versus chemotherapy was 2.63 (95%CI: 1.90-4.02) with an estimated COPE of 251,038 USD (95%CI: 181,359-383,717) in the 12-months follow-up. Regarding OS endpoint, overall NNTRMST and COPE were 3.18 (95%CI: 2.20-5.31) and 414,163 (95%CI: 286,528-691,573) USD respectively, in the 24 months follow-up. The PFS NNT was lower with higher levels of PD-L1 expression (1.71, 3.22 and 5.53 for PD-L1 ≥ 50%, PD-L1 1%-49%, and PD-L1 < 1% groups, respectively), while there was no such apparent relationship for OS (3.23, 4.37 and 2.80 for PD-L1 ≥ 50%, PD-L1 1%-49%, and PD-L1 < 1% groups, respectively). The 95%CIs overlapped for PFS and OS NNT across the PD-L1 subgroups. CONCLUSION: The magnitude of benefit of the pembrolizumab combination used for first-line non-small cell lung cancer (NSCLC) treatment to improve survival compared to chemotherapy alone was confirmed. The exploratory analysis from the SSS perspective suggests no differences among the PDL-1 subgroups in terms of clinical benefit or economic impact.
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Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Anticorpos Monoclonais Humanizados/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Humanos , Neoplasias Pulmonares/tratamento farmacológicoRESUMO
The increasing production of biosolids in urban areas has been led to a search for alternative disposal avenues of this residue, which is rich in organic matter and nutrients. Agricultural land application of biosolids, motivated by its fertilizing power, is a widespread practice in many countries, but there are safety and regulatory concerns regarding the presence of pathogens in Class B biosolids. In addition, the scarcity of studies under tropical climate conditions raises questions that impede the agricultural use of this residue in some regions. The objective of this study was to evaluate the survival of thermotolerant coliforms over 12 months (52 weeks) after biosolids application on the surface of a Quartzipsamment neosol cultivated with Eucalyptus. Two different biosolids were studied: those generated by a biological treatment system with complete mixing aeration ponds followed by decantation ponds (Treatment A) and biosolids from a biological treatment system with conventional activated biosolids reactors (Treatment B), both delineated in randomized blocks with four replicates. After application on the forest soil, we estimated an average survival time of 54 weeks for thermotolerant coliforms present in Treatment A biosolids and 93 weeks in Treatment B biosolids. Thermotolerant coliforms persist much longer under tropical climate conditions in Brazil than in comparable studies under temperate climate conditions. This reaffirms the need to carry out studies covering the full range of moisture and temperature regimes in which biosolids are applied as fertilizer.
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Eucalyptus , Poluentes do Solo/análise , Biossólidos , Brasil , Esgotos , SoloAssuntos
Humanos , Feminino , Idoso , Pneumologia , Tumor Fibroso Solitário Pleural , Neoplasias/diagnóstico por imagemRESUMO
Environmental temperature is an abiotic factor with great influence on biological processes of living beings. Jensen's inequality states that for non-lineal processes, such as most biological phenomena, the effects of thermal fluctuations cannot be predicted from mean constant temperatures. We studied the effect of daily temperature fluctuation (DTF) on Rhodnius prolixus, a model organism in insect physiology, and an important vector of Chagas disease. We measured development time from egg to adult, fecundity, fertility, body mass reduction rate (indirect measurement of nutrient consumption rates) and survival after a single blood meal. Insects were reared at constant temperature (24⯰C), or with a DTF (17-32⯰C; mean = 24⯰C). Taking into account Jensen's inequality as well as the species tropical distribution, we predict that living in a variable thermal environment will have higher costs than inhabiting a stable one. Development time and fertility were not affected by DTF. However, fecundity was lower in females reared at DTF than at constant temperature, and males had higher body mass reduction rate and lower survival in the DTF regime, suggesting higher costs associated to fluctuating thermal environments. At a population and epidemiological level, higher energetic costs would imply an increase in nutrient consumption rate, biting frequency, and, consequently increasing disease transmission from infected insects. On the contrary, lower fecundity could be associated with a decrease in population growth. This knowledge will not only provide basic information to the field of insect ecophysiology, but also could be a useful background to develop population and disease transmission models.