ABSTRACT
Background: Inflammation and neutrophils play a central role in severe Covid-19 disease. In previous data, we showed that the FLARE score, combining both tumor and Covid-19-induced proinflammatory status (proinflamstatus), predicts early mortality in cancer patients (pts) with Covid-19 infection. We aimed to assess the impact of this score in a larger cohort and characterize the immunophenotype (IF) of circulating neutrophils. Methods: Multicenter retrospective cohort (RC) of pts with cancer and Covid-19 infection across 14 international centers. Circulating inflammatory markers were collected at two timepoints: baseline (-15 to -45d before Covid-19 diagnosis) and Covid-19 diagnosis. Tumor-induced proinflam-status was defined by high dNLR (neutrophils/(leucocytes-neutrophils)> 3) at baseline. Covid-19-induced proinflam-status was defined by +100% increase of dNLR between both timepoints. We built the FLARE score combining both Tumor and Infection-induced inflammation: T+/I+ (poor), if both proinflam-status;T+/I- (T-only), if inflammation only due to tumor;T-/I+ (I-only), if inflammation only due to Covid;T-/I- (favorable), if no proinflam-status. The IF of circulating neutrophils by flow cytometry was determined in a unicenter prospective cohort (PC) of pts with cancer during Covid-19 infection and in healthy volunteers (HV). Primary endpoint was 30-day mortality. Results: 524 pts were enrolled in the RC with a median follow- up of 84d (95%CI 78-90). Median age was 69 (range 35-98), 52% were male and 78% had baseline PS <1.Thoracic cancers were the most common (26%). 70% had active disease, 51% advanced stage and 57% were under systemic therapy. dNLR was high in 25% at baseline vs 55% at Covid-19 diagnosis. The median dNLR increase between both timepoints was +70% (IQR: 0-349%);42% had +100% increase of dNLR. Pts distribution and mortality across FLARE groups is resumed in the Table. Overall mortality rate was 26%. In multivariate analysis, including gender, stage and PS, the FLARE poor group was independently associated with 30-day mortality [OR 5.27;1.37-20.3]. 44 pts were enrolled in the PC. Median circulating neutrophils were higher in pts with cancer (n=10, 56.7% [IQR: 39-78.4%]) vs HV (n=6, 35.8% [IQR: 25.6-21%]), and particularly higher in pts with cancer and severe Covid-19 infection (n=7, 88.6% [IQR: 80.9-94%] (p=0.003). A more comprehensive characterization of the IF of circulating neutrophils, including Lox1/CD62/CD64, will be presented at ASCO. Conclusions: The FLARE score, combining tumor and Covid-19-induced proinflam-status, can identify the population at higher risk for mortality. A better characterization of circulating neutrophils may help improve the prediction of Covid-19 outcomes in pts with cancer. (Table Presented).
ABSTRACT
Due to COVID-19, more students are transitioning to online classrooms. This poses a problem for STEM educators as students are limited in their ability to learn about the scientific process or scientific thinking through hands-on experimentation. Additionally, outreach programs that are designed to increase interest and participation in STEM face a challenge of not being able to enter the physical classroom for activities. To address these needs, a program was developed to create self-contained experimental kits that could be shipped to students' homes. This allows students to gain the same outreach experience that they might have had in the classroom without leaving the safety of their home. Additionally, it removes the burden on parents of having to purchase outreach materials. The contents of the kits were designed with the following constraints: 1) experiments must be easy to complete with minimal instructions, 2) there must be a limited mess and 3) they must be easily and inexpensively shipped. With these constraints, four experiments were developed: analyzing the pH of household acids and bases using a red cabbage indicator (chemical engineering), building a popsicle-stick bridge (civil engineering), creating a drinking-straw prosthetic hand (biomedical engineering), and assembling an automatic LED night light (electrical engineering). The instructional guides to the kits include background information about the STEM topic, methods for completing the experiment, tables for data collection, and/or analysis questions about the data. To ensure the clarity of the instructions, recommendations were taken from a non-target audience to refine the materials. The kits were piloted on college-aged peers who have varying degrees of expertise in the subjects. Peers were asked to assess the clarity of the activity, provide feedback on the quality of the experiment, and complete questions for the pretest and posttest on the topic matter covered in the instructional guides. Results from this study will be used to refine the outreach kits prior to implementation with K-12 students. While originally designed to address the limitations in place due to COVID-19, this project can expand the outreach program to areas where in-person programs can be challenging. With considerate development, expansion to Appalachian regions can provide students with more exposure to STEM, while also allowing them to interact with engineering students from the University of Kentucky. © American Society for Engineering Education, 2021
ABSTRACT
Background: The impact of coronavirus disease 2019 (COVID-19) on cancer patients is still unknown. We aimed to describe the clinical characteristics and 28-day mortality among patients with solid cancers (SC) and COVID-19. Methods: This single-center retrospective study included all adult patients with SC and RT-PCR confirmed COVID-19 between March 12, 2020 and April 30, 2020. Both oncological and COVID-19-related clinical data were collected. COVID-19 severity was defined according to Chinese CDC criteria. In-hospital and 28-day mortality were estimated. Multivariate analysis was adjusted for age, sex and COVID-19 severity. Results: We included 58 (2.7%) of 2130 patients with COVID-19 diagnosed in our hospital;37 (63.8%) were males. Median age was 68.5 years (IQR, 61-75). Main comorbidities were hypertension (28 [48.3%]) and overweight/obesity (23 [39.7%]). Most common SC were prostate (12 [20.7%]), lung (10 [17.2%]) and breast (10 [17.2%]). Overall, 48 (82.8%) patients had previous ECOG PS of 0-1;26 (44.8%) were stage IV and 32 (57.1%) were undergoing cancer treatment. Fifty-six (96.5%) patients were admitted. Most frequent COVID-19 symptoms were fever (40 [69.0%]), cough (35 [62.5%]) and dyspnea (27 [48.2%]). Hydroxychloroquine and azithromycin were used in 40 (69.0%) and 38 (65.5%) patients, respectively;only 3 (5.2%) patients received tocilizumab. Eighteen patients (32.1%) had severe/critical COVID-19. Major complications were respiratory failure (33 [57.9%]), sepsis (14 [24.6%]) and acute kidney injury (13 [22.4%]). Four (6.9%) patients were admitted to ICU. In-hospital and 28-day mortality were 17.2% (10/58) and 24.1% (14/58), respectively. In the multivariate analysis, only dyspnea at diagnosis (hazard ratio [HR]: 6.71, 95% CI 1.40-32.25, p=0.017) and ECOG PS of 2-3 (HR: 4.17;95% CI: 1.13-15.30, p=0.031) were independent risk factors for 28-day mortality. Conclusions: In our patients with SC and COVID-19, 32.1% had a severe/critical disease and 24.1% died within 28 days from diagnosis. Dyspnea at diagnosis and previous ECOG PS of 2-3 were the major predictors for 28-day mortality. Cancer treatment and stage were not associated with mortality. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: M. Majem: Honoraria (self), Research grant/Funding (self): BMS;Honoraria (self), Non-remunerated activity/ies: MSD;Honoraria (self), Non-remunerated activity/ies: BOEHRINGER INGELHEIM;Honoraria (self), Non-remunerated activity/ies: ASTRA ZENENCA;Honoraria (self), Non-remunerated activity/ies: KYOWA KYRIN;Honoraria (self): PIERRE FABRE. All other authors have declared no conflicts of interest.