bluuebunny/crossref_metadata_2025 huggingface dataset:
Causes of equine abortion, stillbirth, and perinatal mortality in Brazil
Authors: Silva Aline Aparecida da , Villalobos Eliana Monteforte Cassaro , Cunha Elenice Maria Sequetin , Lara Maria do Carmo Custódio de Souza Hunold , Nassar Alessandra Figueiredo de Castro , Piatti Rosa Maria , Castro Vanessa , Pinheiro Eliana Scarcelli , Carvalho Aline Feola de , Fava Claudia Del
Published: September 2020

ABSTRACT Abortion and complications in reproduction are important causes of economic loss in horse breeding. Studies of its causal agents can help to identify the primary pathogens or other factors involved and define appropriate measures to reduce its occurrence. This research aimed to investigate the primary causes of equine abortion, stillbirth, and perinatal mortality in regions of Brazil. Tissue from aborted fetuses, stillbirths, neonates and foals submitted to the Biological Institute of São Paulo, Brazil, from January 2010 to July 2013 were processed for viral and bacterial isolation, polymerase chain reaction (PCR), histology, and immunohistochemistry. Bacterial infection was the primary detected cause of abortion, found in 16 of the 53 animals submitted for bacterial analysis followed by viruses analysis in 2 of 105 animals, and noninfectious causes (neonatal isoerythrolysis) in 2 of 105 animals. Fungi were found in a single sample of 53 tested. The most frequent bacteria recovered were Escherichia coli, Enterobacter aerogenes, combined E. coli and Streptococcus spp., Staphylococcus spp., and Bacillus spp. The following agents were each observed in a single sample: Arcanobacterium pyogenes, Streptococcus spp., Corynebacterium spp., Actinobacillus spp., and Rhodococcus equi. The predominant identification of fecal and other opportunistic bacteria as opposed to pathogens commonly associated with equine abortion, such as Leptospira spp. and equine herpesvirus type 1 (EHV-1), suggests the need of improving hygiene management of breeding mares to prevent bacterial infection that may cause fetal loss, stillbirth, and perinatal mortality.
INTENSIDAD DE PLAGAS Y SUS ENEMIGOS NATURALES EN UNA ASOCIACIÓN DE MAÍZ Y FRÍJOL FERTILIZADOS CON DIFERENTES FORMAS DE LODO DE ALCANTARILLADO
Authors: Leite G.L.D , Silva F.W.S. , Ferreira C.S. , Guañabens R.E.M. , Lazo J.A. , Sampaio R.A. , Nogueira T.A.R. , Fonseca I.M.
Published: September 2020

RESUMEN Se evaluó la intensidad del ataque de plagas y enemigos naturales en una asociación de maíz (Zea maiz) y fríjol caupí (Vigna unguiculata), así como la incidencia de plagas en granos almacenados de los respectivos cultivos. Los tratamientos consistieron en: Suelo sin fertilización, Encalado y fertilización química, Lodo no higienizado, Lodo higienizado con extracto de neem (Azadirachta indica), Lodo tratado con cal virgen, Compuesto orgánico de lodo y Ipomoea carnea, Compuesto orgánico de lodo y I. carnea + fosfato natural al inicio del compostaje, Lodo no higienizado + fosfato natural en el campo, Lodo higienizado con neem + fosfato natural en el campo, Lodo tratado con cal virgen + fosfato natural en el campo, Compuesto orgánico de lodo y I. carnea + fosfato natural en el campo. Se realizaron observaciones semanales de plagas y enemigos naturales y los datos obtenidos se sometieron a análisis de varianza y la prueba de Scott-Knott a 5% de probabilidad. El suelo que recibió lodo de alcantarillado tratado con neem fue el que presentó el menor ataque de plagas. Otro tratamiento poco atacado por plagas fue el que recibió lodo de alcantarillado seco higienizado con extracto de neem + aplicación en el campo de fosfato natural reactivo. Por lo tanto, esos dos tratamientos son los recomendados para los productores.
ATIVIDADE DE QUITOSANAS COM DIFERENTES PESOS MOLECULARES SOBRE ALTERNARIA SOLANI
Authors: Coqueiro D.S.O. , Di Piero R.M.
Published: September 2020

RESUMO A quitosana tem demonstrado potencial antifúngico e de proteção das plantas contra fitopatógenos. O objetivo deste trabalho foi avaliar o efeito antifúngico de quitosanas sobre Alternaria solani, agente causal da pinta preta em tomateiros. Foram utilizadas três quitosanas: uma comercial (Qcom), encontrada em lojas de suplementos alimentares; uma de baixo peso molecular (Qbpm; 50-190 KDa) e outra de médio peso molecular (Qmpm; 190-310 KDa), ambas obtidas da Sigma Aldrich. As quitosanas foram depositadas sobre lâminas escavadas, para avaliar a germinação de conídios e alongamento do tubo germinativo, ou incorporadas ao meio BDA, para avaliar o crescimento micelial de A. solani. Evidenciou-se atividade antifúngica desses polissacarídeos sobre A. solani, com inibição da germinação de conídios e do crescimento micelial de 85% e 50%, respectivamente, quando utilizados em concentrações de 0,125 mg/mL e 0,5 mg/mL. O peso molecular da quitosana não influenciou a atividade antibiótica in vitro.
COMPATIBILITY OF NEUTRAL DETERGENT WITH THE ENTOMOPATHOGENIC FUNGUS METARHIZIUM ANISOPLIAE (METSCH.) SOROK.
Authors: Harterreiten-Souza E.S. , Pessoa L.G.A. , Loureiro E. de S.
Published: September 2020

ABSTRACT Entomopathogenic fungi have been widely used in pests control. The main diluent for its application in the field is water, and due to its hydrophobic character, its dispersion in the environment is complicated. Several products may be mixed to the sprays, allowing the dissolution and the dispersion of the fungus in the spray. Yet, some of these products may influence in the viability, sporulation or even in its genetic composition, changing its virulence. This paper aimed to evaluate the effect of a neutral detergent about the viability of the entomopathogenic fungus Metarhizium anisopliae. Three different concentrations of a neutral detergent (Ipê®) were used: 0.01%, 0.02%, 0.03% and an adhesive spreader (Tween 80) was used in the control. The percentage of conidia germination, the number of colony forming units (CFU), vegetative growth and the number of produced conidia were evaluated. There was no effect of the different concentrations of the neutral detergent on the germination. All detergent concentrations affected negatively in the vegetative growth of the fungus. Only the detergent at 0.01% of concentration did not affect the CFU number and the conidia production of the fungus. So, this is the only concentration classified as compatible for M. anisopliae, which may be recommended to promote the conidia dispersion of this fungus species in water.
Flora da Reserva Ducke, Amazonas, Brasil: Vitaceae
Authors: Araújo Adriane Maciel de , Liberato Maria Astrid Rocha , Amorim Bruno Sampaio , Cabral Fernanda Nunes , Rezende Cleiton Fantin , Cardozo Nállarett Marina Dávila
Published: September 2020

Resumo Este estudo apresenta o tratamento florístico das espécies de Vitaceae que ocorrem na Reserva Florestal Adolpho Ducke, Amazonas, Brasil. Coletas provenientes da Reserva Ducke foram analisadas a partir de exsicatas depositadas no herbário INPA. Foram registradas duas espécies do gênero Cissus para a reserva, Cissus erosa e C. verticillata subsp. verticillata. Apresentamos descrições das espécies, comentários taxonômicos, ilustrações, informação sobre hábitat, distribuição geográfica e uma chave de identificação para as espécies.
An efficient method for total RNA extraction from leaves of arboreal species from the Brazilian Cerrado
Authors: Rocha Geisiane Alves , Dias Vanessa Duarte , Carrer-Filho Renato , Cunha Marcos Gomes da , Dianese Érico de Campos
Published: September 2020

Abstract Considering the lack of information on RNA extraction from arboreal species, specially from the Brazilian Cerrado, the aim of this study was to test RNA extraction methods for a wide variety of native plant species from this biome. The methods tested consisted of: (i) TRIzol® reagent, (ii) TRIzol® reagent with modifications, (iii) CTAB buffer, and (iv) Modified CTAB buffer, initially for leaf samples of Xylopia aromatica and Piper arboreum. Later the procedure with the best results was used to obtain purified RNA from 17 other native species. Based on A260/A280 absorbance ratio the Modified CTAB method was the best for total RNA extraction for those woody species. Ten out of eleven species tested through RT-PCR generated fragments of the expected size from the total RNA extracted by the selected method, confirming it as the best option to obtain high-quality RNA for molecular analyses and for use in the detection of viruses infecting these tree species.
A relação entre arte e vida no longa-metragem Gabbeh, de Mohsen Makhmalbaf: a perspectiva bakhtiniana em cena
Authors: Alano Natassia D’Agostin
Published: September 2020

RESUMO Este artigo tem como objetivo realizar um ensaio-análise do longa-metragem Gabbeh (1996), do diretor iraniano Mohsen Makhmalbaf, promovendo reflexões que possam, em alguma medida, contribuir para o aprofundamento de questões que envolvem o campo da arte e da vida. As bases teórico-epistemológicas que sustentam esta análise são os estudos bakhtinianos em diálogo com a perspectiva vigotskiana. A análise parte de algumas cenas do filme e busca estabelecer uma relação entre alguns conceitos bakhtinianos - como dialogismo, cronotopo, polifonia, exotopia - e a arte cinematográfica em questão.
O corpo deslizando sentidos: o en(tre)lace discursivo do político nas fronteiras com o social
Authors: Nascimento Emanuel Angelo
Published: September 2020

RESUMO Este artigo tem como objetivo discutir a questão da materialidade significante do corpo no en(tre)lace discursivo do político imbricado nas fronteiras com o social, a partir das obras de Dan Halter. Para tanto, proponho um diálogo teórico-analítico entre a perspectiva dialógica desenvolvida pelo russo Mikhail Bakhtin e a perspectiva do materialismo-histórico, tendo como base o dispositivo teórico da Análise do Discurso francesa, a fim de analisar o objeto de estudo em questão na relação corpo, memória e discurso. Nesse sentido, ao trabalhar com a imbricação entre a materialidade verbal e não verbal, busco lançar olhar sobre duas obras do artista zimbabueano Dan Halter, considerando, desse modo, os efeitos de sentido que deslizam metafórica e metonimicamente para outros sentidos do corpo que se desdobram em diferentes imagens do sujeito, tendo em vista os processos de estruturação do conflito e da tensividade do/no social a partir dos espaços ocupados por estes corpos e atravessados que são pelo simbólico, pela ideologia e pela história.
Negligible tooth resorptions after anterior open bite treatment using skeletal anchorage with miniplates
Authors: Santos Genivaldo dos , Consolaro Alberto , Meloti Fernanda , Cardoso Mauricio de Almeida , Silva Ertty , Li An Tien , Nascimento Monikelly do Carmo Chagas
Published: September 2020

ABSTRACT Introduction: When miniplates are used as anchoring for orthodontic mechanics for anterior open bite correction by retraction of anterior teeth and posterior teeth intrusion and retraction, orthodontically induced inflammatory external apical root resorption is clinically negligible. Methods: A homogeneous sample of 32 patients was used, and the roots of the teeth were compared on CT scans performed before and after orthodontic treatment. Results: The observed root resorption was minimal, and this can be explained by the uniform distribution of forces in several teeth, simultaneously, in the set of the dental arch and in the bone that supports the teeth. Conclusion: The most important thing to prevent root resorption in orthodontic practice, besides being concerned with the intensity of the applied forces, is to be careful with its distribution along the roots of each tooth, in the dental arch and in the bone that supports the teeth.
Indication of clear aligners in the early treatment of anterior crossbite: a case series
Authors: Staderini Edoardo , Patini Romeo , Meuli Simonetta , Camodeca Andrea , Guglielmi Federica , Gallenzi Patrizia
Published: September 2020

ABSTRACT Introduction: Anterior crossbite (AC) is defined as a reverse sagittal relationship between maxillary and mandibular incisors. According to an evidence-based orthodontic triage, the treatment need of AC is indicated if any occlusal interference is forcing the mandible towards a Class III growth pattern. Removable and fixed appliances have been suggested to correct AC. Objective: The present report aims at presenting the benefits of an alternative therapy for the early treatment of anterior crossbite using clear aligners. Methods: Two cases of anterior crossbite corrected using clear aligners in 8-years-old children are presented. Results: In both cases, AC was successfully corrected within 5 months. At the end of the treatment, overjet and overbite were corrected. No major discomfort or speech impairment was noticed by the parents. Conclusions: Due to the perceived shortcomings of alternative approaches, the use of clear aligners for correcting AC in mixed dentition should be considered as a comfortable and well tolerated appliance for young patients.
Effect of surface treatments on the adhesive properties of metallic brackets on fluorotic enamel
Authors: Huilcapi Mariana , Armas-Vega Ana , Cardenas Andres Felipe Millan , Araujo Lucila Cristina Rodrigues , Ocampo Jessica Bedoya , Bandeca Matheus Coelho , Siqueira Fabiana Suelen Figuerêdo de , Loguercio Alessandro
Published: September 2020

ABSTRACT Objective: To compare the effectiveness of the pretreatment with sandblasting and deproteinization with NaOCl on bond strength (SBS), in situ conversion degree (CD) of brackets in fluorotic enamel, and enamel etching pattern. Methods: A total of 90 non-carious maxillary premolars were used. The teeth were then assigned to six experimental groups according to: enamel surface (sound and fluorotic enamel); surface treatment (Regular etch with 37% phosphoric acid [RE]; 5.2% sodium hypochlorite + phosphoric acid [NaOCl + RE]; sandblasting + phosphoric acid [sandblasting + RE]). After storage in distilled water (37°C/24h), the specimens were tested at 1 mm/min until failure (SBS). Enamel-resin cement interfaces were evaluated for CD using micro-Raman spectroscopy. The enamel-etching pattern was evaluated under a scanning electron microscope. Data from SBS and in situ CD values were analyzed using ANOVA two-away and Tukey test (α=0.05). The enamel etching pattern was evaluated only qualitatively. Results: For sound enamel, RE showed the highest SBS values, when compared to NaOCl + RE and Sandblasting + RE groups (p< 0.01). Regarding CD, only NaOCl + RE significantly compromised the mean DC, in comparison with other groups (p= 0.002). For fluorotic enamel, the Sandblasting + RE group significantly increased the mean SBS values, in comparison with RE group (p= 0.01) and no significant change was observed for CD (p> 0.52). Conclusions: The application of NaOCl or sandblasting associated to phosphoric acid improved the SBS of the brackets in fluorotic enamel without compromising the CD of the resin cement, with improving of enamel interprismatic conditioning.
A ESCOLA PÚBLICA E A SOCIEDADE DEMOCRÁTICA: A CONTRIBUIÇÃO DE ANÍSIO TEIXEIRA
Authors: Magoga Patrícia Melo , Muraro Darcísio Natal
Published: September 2020

RESUMO Este estudo objetiva refletir acerca do seguinte problema: qual é o papel da escola pública na formação da sociedade democrática? A pesquisa adota a metodologia bibliográfica, focando o estudo nas obras de Anísio Teixeira. O texto apresenta a contribuição do autor para a consolidação da escola pública brasileira. A educação proposta consiste na criação do ambiente democrático propiciado pelo ensino escolar. A sua vertente de escola nova concebe a educação como modo de vida democrático de reconstrução da experiência em torno de interesses comuns. Segundo Anísio, a escola pública é o instrumento institucional mais eficiente para a construção da sociedade democrática e, por isso, deve ser entendida e defendida necessariamente como universal, gratuita, obrigatória, laica e de qualidade.
Patient safety culture in home care service
Authors: Oliveira Patrícia Conceição , Santos Odeony Paulo dos , Villela Edlaine Faria de Moura , Barros Patrícia de Sá
Published: September 2020

Abstract OBJECTIVE Verify perceptions of the health team about patient safety culture in home care in a large city in Brazilian Midwest region. METHOD A survey study involving Safety Attitudes Questionnaire and professional profile inventory. Results: From the 37 professionals, most were female (n = 32, 86.5%), lived with their spouse (n = 25, 67.6%), worked in a statutory work regime (n = 29; 78.4%) and have only one job (n = 23; 62.2%). A higher median score for job satisfaction (80.0) and a lower score for management perception (31.8) were found. There was a negative correlation between weekly workload and teamwork (p = 0.02). Safety climate was significantly higher among consolidated (Consolidação das Leis do Trabalho - CLT) professionals in the safety climate (p = 0.001) and overall (p = 0.005) domains. Physicians had a higher perception of the safety climate domain when compared to professionals in other categories (p = 0.005). Age was positively associated to the climate in the safety (p = 0.002), working conditions (p = 0.03) and overall (p = 0.04) domains. CONCLUSION Teamwork and job satisfaction were scored as positive and management actions were considered the main weakness of the safety culture.
Treatment adherence and frailty syndrome in hypertensive older adults
Authors: Silva Luípa Michele , Souza Ana Carolina de , Fhon Jack Roberto Silva , Rodrigues Rosalina Aparecida Partezani
Published: September 2020

Abstract Objective: To analyze the association between adherence to antihypertensive treatment and frailty syndrome in hypertensive older adults. Method: A descriptive, cross-sectional study with a quantitative approach with older adults. The data collection took place between November 2017 and March 2018, evaluating sociodemographic information, adherence to antihypertensive treatment, lifestyle and frailty through the Edmonton Frail Scale. The Kruskal-Wallis test and the Chi-squared test were used for data analysis, considering a 95% confidence interval and a significance level of p<0.05. Results: There were 193 older adults who participated in the study. The average age was 80.94 (sd ± 7.17) years, with a predominance of females (72%) and widows (43.5%). The factors which were associated with adherence to treatment were diastolic blood pressure, education and the time that the older adult had smoked (p<0.05). Frailty was not associated with treatment adherence levels (p=0.095). Conclusion: There was no association between frailty scores and control of arterial hypertension; however, adequate monitoring and nursing care are essential in assessing adherence to treatment in order to reduce the aggravations of the disease and frailty syndrome development.
Estimated costs in treating sickle cell disease leg ulcer
Authors: Spira Josimare Aparecida Otoni , Borges Eline Lima , Júnior José Ferreira Pires , Monteiro Dandara Soares , Kitagawa Karolina Yukari
Published: September 2020

Abstract Objective: To identify the costs of treating leg ulcers due to sickle cell disease from the perspective of the Unified Health System. Method: An observational, descriptive, cost-effective economic assessment study conducted in a single center with ulcer patients. The data collected were extracted from the participant’s medical records and recorded in a form prepared for this purpose. The cost of the products used in ulcer treatment was provided by the Solicitation/Purchasing Section and Pharmacy Sector of the study institution. The variables studied were ulcer area, number and interval between visits, patient’s length of stay in the service, materials used in each visit, and the number of nurse appointments. Results: The sample consisted of 29 patients. The average initial area of ulcers was 14.47 cm2, 79% of the cases had complete epithelialization in an average time of 8.02 months, with an average cost of R$ 1,288.06. The average cost to reduce 1 cm2 of the lesion area was R$ 102.20. Silver activated carbon coating was the most cost-effective treatment. Conclusion: The average cost for complete healing of a sickle cell ulcer with an average area of 14.95 cm2 was R$ 1,288.06.
The cover thickness design of concrete structures subjected to chloride ingress from RBDO solution technique
Authors: Pellizzer Giovanni Pais , Leonel Edson Denner
Published: September 2020

Abstract: Diffusion is the principal transport mechanism of chloride ions into concrete pores. The chlorides trigger the reinforcements’ depassivation when its concentration at the concrete/reinforcement interface reaches the threshold level. Thus, the depassivation defines the initiation stage end and the propagation stage start. The structural safety reduces widely during the propagation stage because of the various deleterious mechanisms triggered by reinforcement’s corrosion. Therefore, the engineers should accurately predict and prevent the propagation stage start. The literature describes several models for evaluating the end of the initiation stage. However, few of them applies the Boundary Element Method (BEM) for this purpose, despite its known accuracy. Besides, enormous randomness affect the phenomenon. Thus, it is adequately handled solely in the probabilistic context. Optimisation techniques may be coupled in the problem modelling to propose adequate cover thickness values accounting for probabilities of failure. This study presents a Reliability-Based Design Optimisation (RBDO) approach for designing accurately the cover thickness of concrete structures subjected to chloride ingress. The BEM handles the diffusion modelling whereas the Monte Carlo simulation assesses the probabilities of failure. The RBDO is formulated in the context of Weighted Average Simulation Method (WASM), which requires only one assessment of the reliability analysis. It leads to a reliable and computationally efficient solution technique. The problem formulation and the implemented solution scheme are described herein. Moreover, one application is presented, in which the design results are interpreted properly.
Proposition of a simplified analytical design procedure for lattice girder slabs with shuttering in cold-formed steel lipped channel section
Authors: Favarato Lucas Fadini , Gomes André Vasconcelos Soares , Candido Daniel Carvalho de Moura , Calenzani Adenilcia Fernanda Grobério , Pires Juliana da Cruz Vianna , Ferrareto Johann Andrade
Published: September 2020

ABSTRACT This paper presents an analytical procedure to determine the resistance of a new composite ribbed lattice slab system, composed by a lipped channel cold-formed steel (CFS) profile in minor bending fastened to a lattice girder by plastic connectors, as well as light filling elements and additional rebar. Motivated by the lack of standardized procedures for such system, this paper combines slab design prescriptions to create a computational tool that estimates load capacity and required propping during construction, serving as a basis for a design catalogue. Finally, a strong limitation of unpropped construction due to the low performance of the cold-formed profile under minor axis bending was observed, being the system able to reach spans up to 1.5 m between props in general.
Anomalias congênitas na perspectiva da vigilância em saúde: compilação de uma lista com base na CID-10
Authors: Bremm João Matheus , Cardoso-dos-Santos Augusto César , Magalhães Vivyanne Santiago , Medeiros-de-Souza Ana Cláudia , Alves Ronaldo Fernandes Santos , Araujo Valdelaine Etelvina Miranda de , Macario Eduardo Marques , Oliveira Wanderson Kleber de , Schüler-Faccini Lavínia , Sanseverino Maria Teresa Vieira , França Giovanny Vinícius Araújo de
Published: September 2020

Objetivo. Propor uma lista de anomalias congênitas com códigos correspondentes na Classificação Estatística Internacional de Doenças e Problemas Relacionados à Saúde – 10a Revisão (CID-10), visando aplicação no âmbito da vigilância em saúde. Métodos. Em dezembro de 2019, realizou-se busca nas seguintes fontes de dados: CID-10; CID-11; anomalias monitoradas por três modelos de vigilância; base de informações sobre doenças raras (Orphanet). Realizou-se extração das anomalias a partir dessas fontes, processamento para correspondência com base na CID-10 e compilação mediante revisão manual. Resultados. Foram identificados 898 códigos, dos quais 619 (68,3%) constavam no capítulo XVII da CID-10. Dos 279 códigos de outros capítulos, 19 foram exclusivos da busca na CID-11, 72 dos modelos de vigilância, 79 da Orphanet e 36 da busca de termos na CID-10. Conclusão. Os códigos que constam do capítulo XVII da CID-10 não captam a totalidade das anomalias congênitas, indicando a necessidade de adoção de uma lista ampliada.
Factores asociados a la automedicación con fármacos relacionados a COVID-19 en estudiantes de ciencias de la salud de una ciudad peruana
Authors: Miñan-Tapia Armando , Conde-Escobar Aram , Calderon-Arce Dereck , Cáceres-Olazo Dalia , Peña-Rios Alexandra Johanna , Donoso-Romero Roberto Carlos
Published: September 2020

Objetivos: Determinar los factores asociados a la automedicación con fármacos relacionados con COVID-19 en estudiantes de ciencias de la salud. Material y métodos: Estudio observacional, analítico transversal, en estudiantes de ciencias de la salud de Tacna-Perú. Mediante un cuestionario virtual se recolectaron variables socioeducativas, prácticas, características de automedicación y exposición a COVID-19. El resultado fue automático en los últimos 3 meses con al menos 1 de 14 fármacos. Se calcularon las razones de prevalencia mediante los modelos lineales generalizados. Resultados:De los 718 estudiantes, el 51,3% se había automedicado. 62,2% se automedicó por presentar dos o más síntomas respiratorios siendo los fármacos más utilizados los antipiréticos, analgésicos y corticoides. Tuvieron mayor frecuencia de automedicación los estudiantes con pareja sentimental (RP: 1,33; IC95%: 1,16-1,53), de una universidad particular (RP: 1,36; IC95%: 1,10-1,69 ), que sus padres o familiares se automediquen algunas veces o siempre (RP: 2,34; IC95%: 1,58–3,47) y en los que se realizaron una prueba de tamizaje para COVID-19 (RP: 1, 47; IC95%: 1,14-1,89). Conclusiones:Encontramos una alta prevalencia de automedicación. Tuvieron mayor frecuencia de automedicación quienes tenían una pareja sentimental, proceden de una universidad particular, que sus padres o familiares se automediquen y en quienes se realizaron una prueba de tamizaje para COVID-19, lo cual podría ser utilizado para promover el uso racional de medicamentos .
A Novel Predictive Model for Idiopathic Multicentric Castleman Disease: The International Castleman Disease Consortium Study
Authors: Yu Li , Shi Menghan , Cai Qingqing , Strati Paolo , Hagemeister Fredrick , Zhai Qiongli , Li Ling , Fang Xiaosheng , Li Jianyong , Sun Ruifang , Zhang Shanxiang , Yang Hanjin , Wang Zhaoming , Qian Wenbin , Iwaki Noriko , Sato Yasuharu , Zhang Lu , Li Jian , Oksenhendler Eric , Xu-Monette Zijun Y. , Young Ken H.
Published: September 2020

Background

Patients with multicentric Castleman disease (MCD) who are negative for human immunodeficiency virus and human herpesvirus 8 are considered to have idiopathic MCD (iMCD). The clinical presentation of iMCD varies from mild constitutional symptoms to life-threatening symptoms or death. The treatment strategy varies from “watchful waiting” to high-dose chemotherapy. This diverse clinical presentation calls for a classification stratification system that takes into account the severity of the disease.

Subjects, Materials, and Methods

We analyzed the clinical, laboratory, and pathologic abnormalities and treatment outcomes of 176 patients with iMCD (median follow-up duration 12 years) from the U.S. and China to better understand the characteristics and prognostic factors of this disease. This discovery set of iMCD results was confirmed from the validation set composed of additional 197 patients with iMCD organized from The International Castleman Disease Consortium.

Results

Using these data, we proposed and validated the iMCD international prognostic index (iMCD-IPI), which includes parameters related to patient characteristics (age > 40 years), histopathologic features (plasma cell variant), and inflammatory consequences of iMCD (hepatomegaly and/or splenomegaly, hemoglobin <80 g/L, and pleural effusion). These five factors stratified patients according to their performance status and extent of organ dysfunction into three broad categories: low risk, intermediate risk, and high risk. The iMCD-IPI score accurately predicted outcomes in the discovery study cohort, and the results were confirmed on the validation study cohort.

Conclusion

This study represents the largest series of studies on patients with iMCD in the field and proposed a novel risk-stratification model for iMCD-IPI that could be used to guide risk-stratified treatment strategies in patients with iMCD.

Implications for Practice

Patients with idiopathic multicentric Castleman disease (iMCD) can benefit from care based on clinical symptoms and disease severity. This study in 176 patients with iMCD constructed an iMCD-IPI score based on five clinical factors, including age >40 years, plasmacytic variant subtype, hepatomegaly and/or splenomegaly, hemoglobin <80 g/L, and pleural effusion, and stratified patients into three risk categories: low risk, intermediate risk, and high risk. The predictive value was validated in an independent set of 197 patients with iMCD from The International Castleman Disease Consortium. The proposed novel model is valuable for predicting clinical outcome and selecting optimal therapies using clinical parameters.
Modified ypTNM Staging Classification for Gastric Cancer after Neoadjuvant Therapy: A Multi-Institutional Study
Authors: Zhong Qing , Chen Qi-Yue , Parisi Amilcare , Ma Yu-Bin , Lin Guang-Tan , Desiderio Jacopo , Yan Su , Xie Jian-Wei , Wang Jia-Bin , Hou Jun-Fang , Lin Jian-Xian , Lu Jun , Cao Long-Long , Lin Mi , Tu Ru-Hong , Huang Ze-Ning , Lin Ju-Li , Liu Zhi-Yu , Que Si-Jin , Li Ping , Zheng Chao-Hui , Huang Chang-Ming
Published: September 2020

Background

The benefits of neoadjuvant therapy for patients with locally advanced gastric cancer (GC) are increasingly recognized. The 8th edition of the American Joint Committee on Cancer (AJCC) Staging Manual first proposed ypTNM staging, but its accuracy is controversial. This study aims to develop a modified ypTNM staging.

Patients and Methods

Clinicopathological data of 1,791 patients who underwent curative-intent gastrectomy after neoadjuvant therapy in the Surveillance, Epidemiology, and End Results database, as the development cohort, were retrospectively analyzed. Modified ypTNM staging was established based on overall survival (OS). We compared the prognostic performance of the AJCC 8th edition ypTNM staging and the modified staging for patients after neoadjuvant therapy.

Results

In the development cohort, the 5-year OS for AJCC stages I, II, and III was 58.8%, 39.1%, and 21.6%, respectively, compared with 69.9%, 54.4%, 34.4%, 24.1%, and 13.6% for modified ypTNM stages IA, IB, II, IIIA, and IIIB. The modified staging had better discriminatory ability (C-index: 0.620 vs. 0.589, p < .001), predictive homogeneity (likelihood ratio chi-square: 140.71 vs. 218.66, p < .001), predictive accuracy (mean difference in Bayesian information criterion: 64.94; net reclassification index: 35.54%; integrated discrimination improvement index: 0.032; all p < .001), and model stability (time-dependent receiver operating characteristics curves) over AJCC. Decision curve analysis showed that the modified staging achieved a better net benefit than AJCC. In external validation (n = 266), the modified ypTNM staging had superior prognostic predictive power (all p < .05).

Conclusion

We have developed and validated a modified ypTNM staging through multicenter data that is superior to the AJCC 8th edition ypTNM staging, allowing more accurate assessment of the prognosis of patients with GC after neoadjuvant therapy.

Implications for Practice

The 8th edition of the American Joint Committee on Cancer (AJCC) Staging Manual first proposed ypTNM staging, but its accuracy is controversial. Based on multi-institutional data, this study developed a modified ypTNM staging, which is superior to the AJCC 8th edition ypTNM staging, allowing more accurate assessment of the prognosis of patients with gastric cancer after neoadjuvant therapy.
68Ga-DOTATATE Positron Emission Tomography-Computed Tomography Quantification Predicts Response to Somatostatin Analog Therapy in Gastroenteropancreatic Neuroendocrine Tumors
Authors: Lee Hwan , Eads Jennifer R. , Pryma Daniel A.
Published: September 2020

Background

Somatostatin analogs (SSAs) are the frontline antitumor therapy in advanced well-differentiated gastroenteropancreatic neuroendocrine tumors (GEP-NETs). A subset of patients demonstrate early disease progression on SSA therapy, yet the currently known predictors for treatment failure lack specificity to affect therapeutic decision. SSAs target tumor somatostatin receptors, the level of which can be quantitatively assessed with 68Ga-DOTATATE positron emission tomography-computed tomography (PET/CT). We investigated the ability of 68Ga-DOTATATE PET/CT to predict response to SSA therapy.

Materials and Methods

The records of 108 consecutive patients with well-differentiated grade 1–2 GEP-NETs on SSA monotherapy who received 68Ga-DOTATATE PET/CT scans were retrospectively reviewed to obtain baseline characteristics, 68Ga-DOTATATE maximum standardized uptake value (SUVmax), and progression-free survival (PFS) data. The optimal SUVmax cutoff for patient stratification was obtained with receiver operating characteristic curve analysis. PFS in the high versus low SUVmax groups was compared with Kaplan-Meier survival analysis. The effects of baseline characteristics and SUVmax on PFS were examined with univariate and multivariate Cox regression.

Results

68Ga-DOTATATE SUVmax predicted therapeutic failure with sensitivity and specificity of 39% and 98%, respectively. SUVmax of <18.35 was associated with shorter PFS, which was reproduced in the subgroup analysis of SSA-naïve patients. Low SUVmax was the only predictor of early treatment failure (hazard ratio, 6.85) in multivariate analysis, as well as in the subgroup analysis of grade 2 GEP-NETs.

Conclusion

Low SUVmax on 68Ga-DOTATATE PET/CT independently predicts early failure on SSA monotherapy in patients with well-differentiated grade 1–2 GEP-NET. Patients with lack of expected benefit from SSA therapy can be readily identified using routine 68Ga-DOTATATE PET/CT with very high specificity.

Implications for Practice

Based on 68Ga-DOTATATE positron emission tomography-computed tomography imaging, clinicians can better inform patients on the expected benefit of somatostatin analog therapy for gastroenteropancreatic neuroendocrine tumors, especially when access to the therapy is difficult, and offer proactive discussion on alternative management options.
Capacity to Provide Geriatric Specialty Care for Older Adults in Community Oncology Practices
Authors: Williams Grant R. , Weaver Kathryn E. , Lesser Glenn J. , Dressler Emily , Winkfield Karen M. , Neuman Heather B. , Kazak Anne E. , Carlos Ruth , Gansauer Lucy J. , Kamen Charles S. , Unger Joseph M. , Mohile Supriya G. , Klepin Heidi D.
Published: September 2020

Background

American Society of Clinical Oncology guidelines recommend that patients ≥65 years of age starting chemotherapy undergo a geriatric assessment (GA) to inform and guide management; however, little is known about resources available in community oncology practices to implement these guidelines and to facilitate geriatric oncology research.

Materials and Methods

Oncology practices within the National Cancer Institute Community Oncology Research Program (NCORP) were electronically surveyed in 2017 regarding the availability of specialty providers, supportive services, and practice characteristics, as part of a larger survey of cancer care delivery research capacity.

Results

Of the 943 NCORP practices, 504 (54%) responded to the survey, representing 210 practice groups. The median new cancer cases per year ≥65 years of age was 457 (interquartile range 227–939). Of respondents, only 2.0% of practices had a fellowship-trained geriatric oncologist on staff. Geriatricians were available for consultation or comanagement at 37% of sites, and of those, only 13% had availability within the oncology clinic (5% of overall). Practice size of ≥1,000 new adult cancer cases (ages ≥18) per year was associated with higher odds (1.81, confidence interval 1.02–3.23) of geriatrician availability. Other multidisciplinary care professionals that could support GA were variably available onsite: social worker (84%), nurse navigator (81%), pharmacist (77%), dietician (71%), rehabilitative medicine (57%), psychologist (42%), and psychiatrist (37%).

Conclusion

Only a third of community oncology practices have access to a geriatrician within their group and only 5% of community sites have access within the oncology clinic. Use of primarily self-administered GA tools that direct referrals to available services may be an effective implementation strategy for guideline-based care.

Implications for Practice

Only a minority of community oncology practices in the U.S. have access to geriatric specialty care. Developing models of care that use patient-reported measures and/or other geriatric screening tools to assess and guide interventions in older adults, rather than geriatric consultations, are likely the most practical methods to improve the care of this vulnerable population.
Defining a Distinct Immunotherapy Eligible Subset of Patients with Cancer of Unknown Primary Using Gene Expression Profiling with the 92-Gene Assay
Authors: Raghav Kanwal , Overman Michael , Poage Graham M. , Soifer Harris S. , Schnabel Catherine A. , Varadhachary Gauri R.
Published: September 2020

Background

Although recent advances in immunotherapy have transformed the treatment landscape for many anatomically defined cancers, these therapies are currently not approved for patients diagnosed with cancer of unknown primary (CUP). Molecular cancer classification using gene expression profiling (GEP) assays has the potential to identify tumor type and putative primary cancers and thereby may allow consideration of immune checkpoint inhibitor (ICI) therapy options for a subset of patients with CUP. Herein, we evaluated and characterized the ability of a 92-gene assay (CancerTYPE ID) to provide a molecular diagnosis and identify putative tumor types that are known to be sensitive to ICI therapies in patients with CUP or uncertain diagnosis.

Findings

A total of 24,426 cases from a large-scale research database of 92-gene assay clinical cases were classified, of which 9,350 (38%) were predicted to have an ICI-eligible tumor type. All ICIs with approved indications as of March 2020 were included in the analysis. Non-small cell lung cancer (NSCLC) was the most frequent molecular diagnosis and accounted for 33% of the ICI-eligible tumor types identified and 13% of the overall reportable results. In addition to NSCLC, the assay also frequently identified urothelial carcinomas, gastric cancer, and head and neck squamous cell carcinoma. The distributions of identified tumor types with indications for ICI therapy were similar across age and gender.

Conclusions

Results suggest that molecular profiling with the 92-gene assay identifies a subset of ICI-eligible putative primary cancers in patients with CUP. We propose a treatment strategy based on available tests, including clinicopathologic features, GEP, and ICI biomarkers of response.
Disease Flare During Temporary Interruption of Ibrutinib Therapy in Patients with Chronic Lymphocytic Leukemia
Authors: Hampel Paul J. , Call Timothy G. , Rabe Kari G. , Ding Wei , Muchtar Eli , Kenderian Saad S. , Wang Yucai , Leis Jose F. , Witzig Thomas E. , Koehler Amber B. , Fonder Amie L. , Schwager Susan M. , Van Dyke Daniel L. , Braggio Esteban , Slager Susan L. , Kay Neil E. , Parikh Sameer A.
Published: September 2020

Background

Approximately 25% of patients with chronic lymphocytic leukemia (CLL) experience a flare of disease following ibrutinib discontinuation. A critical question is whether this phenomenon may also occur when ibrutinib is temporarily held. This study aimed to determine the frequency and characteristics of disease flares in this setting and assess risk factors and clinical outcomes.

Materials and Methods

We identified all patients with CLL seen at Mayo Clinic between October 2012 and March 2019 who received ibrutinib. Temporary interruptions in treatment and associated clinical findings were ascertained.

Results

Among the 372 patients identified, 143 (38%) had at least one temporary interruption (median 1 hold, range 1–7 holds) in treatment. The median duration of interruption was 8 days (range 1–59 days) and the most common indication was periprocedural. Among the 143 patients with ≥1 hold, an associated disease flare was seen in 35 (25%) patients: mild (constitutional symptoms only) in 21 patients and severe (constitutional symptoms with exam/radiographic findings or laboratory changes) in 14 patients. Disease flare resolved with resuming ibrutinib in all patients. Predictive factors of disease flare included progressive disease at time of hold and ≥ 24 months of ibrutinib exposure. The occurrence of disease flare with an ibrutinib hold was associated with shorter event-free survival (hazard ratio 2.3; 95% confidence interval 1.3–4.1; p = .007) but not overall survival.

Conclusion

Temporary interruptions in ibrutinib treatment of patients with CLL are common, and one quarter of patients who held ibrutinib in this study experienced a disease flare. Resolution with resuming ibrutinib underscores the importance of awareness of this phenomenon for optimal management.

Implications for Practice

Ibrutinib is a very effective treatment for chronic lymphocytic leukemia (CLL) but needs to be taken continuously. Side effects, such as increased bleeding risk with procedures, require temporary interruptions in this continuous treatment. Rapid CLL progression following ibrutinib discontinuation has been increasingly recognized. This study demonstrates that similar flares in disease signs or symptoms may occur during ibrutinib holds as well. Importantly, management with restarting ibrutinib led to quick clinical improvement. Awareness of this phenomenon among clinicians is critical to avoid associated patient morbidity and premature cessation of effective treatment with ibrutinib if the flare is misidentified as true progression of disease.
Professional Medical Writer Assistance in Oncology Clinical Trials
Authors: Kouzy Ramez , Abi Jaoude Joseph , Mainwaring Walker , Lin Timothy A. , Miller Austin B. , Jethanandani Amit , Espinoza Andres F. , Verma Vivek , Fuller Clifton D. , Minsky Bruce D. , Rödel Claus , Taniguchi Cullen M. , Ludmir Ethan B.
Published: September 2020

Background

The use of professional medical writers (PMWs) has been historically low, but contemporary data regarding PMW usage are scarce. In this study, we sought to quantify PMW use in oncologic phase III randomized controlled trials (RCTs).

Methods

We performed a database query through ClinicalTrials.gov to identify cancer-specific phase III RCTs; we then identified whether a PMW was involved in writing the associated trial manuscript reporting primary endpoint results.

Results

Two-hundred sixty trials of 600 (43.3%) used a PMW. Industry-funded trials used PMWs more often than nonindustry trials (54.9% vs. 3.0%, p < .001). Increased PMW usage was further noted among trials meeting their primary endpoint (53.4% vs. 32.9%, p < .001) and trials that led to subsequent Food and Drug Administration approval (63.1% vs. 36.3%, p < .001). By treatment interventions, PMW use was highest among systemic therapy trials (50.2%). Lastly, the use of PMWs increased significantly over time (odds ratio: 1.11/year, p = .001).

Conclusion

PMW use rates are high among industry-funded trials. We urge continued and increased transparency in reporting the funding and use of PMWs.
Cladribine with Granulocyte Colony-Stimulating Factor, Cytarabine, and Aclarubicin Regimen in Refractory/Relapsed Acute Myeloid Leukemia: A Phase II Multicenter Study
Authors: Wang Hua , Wang Liang , Li Chun , Wuxiao Zhijun , Shao Ruonan , Wang Huizhong , Lu Yue
Published: September 2020

Trial Information

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Lessons Learned

Studies targeting cladribine in combination with granulocyte colony-stimulating factor, low-dose cytarabine, and aclarubicin (C-CAG) regimen in relapsed and refractory acute myeloid leukemia (R/R AML) are limited. The complete remission rate after two cycles of C-CAG regimen was 67.6%, and 1-year overall survival and disease-free survival rates were 59.7% and 72.9%, respectively. The C-CAG regimen is significantly effective against R/R AML with a low hematological toxicity and thus serves as an alternative treatment for R/R AML.

Background

The optimal salvage chemotherapy regimen for relapsed and refractory acute myeloid leukemia (R/R AML) remains uncertain. Therefore, a phase II study was conducted for the prospective evaluation of the efficacy and safety of the purine analog cladribine in combination with granulocyte colony-stimulating factor (G-CSF), low-dose cytarabine, and aclarubicin (C-CAG) regimen for patients with R/R AML.

Methods

A total of 34 patients received C-CAG regimen for salvage treatment as follows: cladribine 5 mg/m2, days 1–5; G-CSF 300 μg, days 0–9; aclarubicin 10 mg, days 3–6; cytarabine 10 mg/m2 every 12 hours, subcutaneously, days 3–9; 4 weeks per cycle. Patients were allowed to withdraw from the study if complete remission (CR) was not achieved after two courses of chemotherapy. If conditions were right, the patients achieving CR were recommended to receive allogeneic hematopoietic stem cell transplantation. Otherwise, they were treated for a total of six cycles unless disease progression or unacceptable side effects were observed or they withdrew their consent.

Results

All patients received at least two cycles of C-CAG regimen chemotherapy. After two cycles of C-CAG, 23 patients (67.6%) achieved CR, and 5 patients had partial remission (14.7%). At a median follow-up of 15 months (range, 3–38 months), the 1-year overall survival (OS) and disease-free survival (DFS) rates were 59.7% (95% confidence interval [CI], 42.6%–76.8%) and 72.9% (95% CI, 54.3%–91.5%), respectively. The most common adverse effect was myelosuppression. Nonhematological toxicities were mild, and no treatment-related deaths occurred.

Conclusion

Preliminary data indicate that the C-CAG regimen chemotherapy is significantly effective against R/R AML with a high remission rate and a low hematological toxicity. Thus, it may serve as an alternative treatment for R/R AML.