Predictors of mortality in patients with COVID-19 by flow cytometry.

Despite the great impact of severe acute respiratory syndrome caused by coronavirus 2 (SARS-CoV-2), we still lack techniques that allow us to anticipate the natural history of the disease in order to avoid or shorten the clinical period of the disease. The values of nine cytokines were measured in COVID-19+ patients admitted to the Hospital Universitario Reina Sofía (HURS) using flow cytometry. The cytokines measured are IL-1ß, IL-6, MCP-1, IP-10, IL-10, IL-8, IL-12, IFN-γ and TNF-α. Given the absence of previous studies on cytokine values in healthy patients using the flow cytometry technique, and the low availability of resources in the first waves of COVID-19, a control group was lacking, all resources were employed for monitoring sick patients. However, this study has revealed a greater increase in two specific cytokines, which are also found to be higher than the rest in healthy patients: MCP-1 and IP-10, which are mainly responsible for cytokine storm and post-disease thrombosis.

Relaxation of Vibrationally Excited OH Radical by SO.

Molecular energy transfer in gas-phase collisions is of large interest in kinetics models. Vibrational excitation and deactivation processes can be concurrent with chemical reaction and/or sources of nascent excited species. In the present work, a full-dimension quasi-classical trajectory study of the vibrational deactivation of OH(v' = 1,5) in collisions with SO is presented. A global potential energy surface for the ground electronic state of HSO2, previously reported, is used to represent the interatomic interactions. The specific initial-state OH deactivation cross section and the corresponding SO activation cross sections are reported. Models for the maximum impact parameter and excitation function are discussed, while some details on the energy transfer mechanisms are also given. Specific initial-state deactivation thermal rate coefficients and vibrational average deactivation thermal rate coefficients are also presented and compared to previous results in the literature.

Conservative surgery, external radiotherapy, and HDR brachytherapy in a single fraction of 7 Gy in early breast cancer: long-term toxicity and esthetic assessment.

INTRODUCTION: The essential issue in conservative treatment is the quality in breast preservation. When risk factors for local relapse exist, a tumour bed boost is required, but the boost choice remains controversial. Prospectively, we studied long-term toxicity, cosmetic outcome and prognostic factors. MATERIALS AND METHODS: After conservative treatment, 115 patients received a single dose of 7 Gy HDR-brachytherapy (HDR-BT) boost between June 1996 and December 2005. Late toxicity was assessed using the LENT-SOMA scale. For esthetic assessment, a subjective scale was used for patients and a modified Fehlauer scale for physicians. Mean age was 56.6 years. Invasive ductal carcinoma (78 %) and lumpectomy (60 %) were predominantly reported. 48 % received chemotherapy (CT). RESULTS: Regarding toxicity, 39 % of patients reported breast pain, 75 % fibrosis, 56 % telangiectasias, 19 % lymphoedema, and 51 % retraction/atrophy. Concerning management, 22 % of patients with pain and 45 % with lymphoedema were treated. The esthetic result was found satisfactory by 96 % of the patients and 85 % of the physicians. Fibrosis was influenced by CT and a larger irradiated volume and telangiectasias by a greater implant volume. CONCLUSIONS: HDR-BT boost shows good cosmetic effects with acceptable toxicity. Patients overestimate the esthetic outcome. LENT/SOMA is useful to assess chronic toxicity.

Early-stage breast cancer conservative treatment: high-dose-rate brachytherapy boost in a single fraction of 700 cGy to the tumour bed.

BACKGROUND AND PURPOSE: Conservative treatment represents the current therapy for early-stage breast cancer. When risk factors for local relapse exist, a tumour bed boost is required. Retrospectively, we evaluated the prognostic factors influencing local recurrence (LR), overall survival (OS) and disease-free survival (DFS). MATERIAL AND METHODS: After conservative treatment, 210 patients received a single-dose HDR brachytherapy (HDRBT) boost between June 1996 and December 2005. Mean age was 57 years; 75% had invasive ductal carcinoma. The most frequent surgery was lumpectomy (55.7%); 39.4% were G3, 18.6% intraductal component >25% and only 22% had negative margins. RESULTS: With a mean follow-up of 85 months, at 5 and 10 years the OS was 93% and 88%, DFS 92% and 89%, and LR 3.6% and 5.3%, respectively. For LR, the risk factors were carcinoma in situ, N+ and involved margins, whereas for metastasis, the risk factors were T2 tumours, stage III, N+ and the presence of local recurrence. CONCLUSIONS: HDR-BT boost in one fraction is an effective, simple and safe method for reducing LR. The outpatient setting and shorter treatment duration represent undeniable advantages.

Once-weekly dose of epoetinum alfa in cancer patients with anemia receiving radiotherapy

Introduction. Anaemia is present in 30%-90% of all patients with cancer, and its origin is multifactorial. Human recombinant erythropoietin has been shown to be useful in treating anemia in patients with cancer. The aim of this study was to evaluate the effectiveness of treatment of anaemia with epoetin alfa (EPO) given as a single weekly dose, and its repercussions on quality of life (QoL). Materials and methods. From January to October 2002, a total of 139 patients referred to our service for radiotherapy (RT) had anemia and received treatment with EPO as a single weekly dose of 40,000 IU subcutaneously, with oral iron supplement. If haemoglobin (Hb) values after 1 month of treatment did not increase by >=1 g/dl, the dose was increased to 60,000 IU/week. Treatment with EPO ended when Hb values reached >=14 g/dl or one month after the end of RT regardless of Hb values. QoL was evaluated with the Functional Assessment of Cancer Therapy-Anaemia subscale (FACT-An) and the Cancer Linear Analogue Scale (CLAS). Results. Mean Hb at the start of treatment with EPO was 11.49 ± 1.08 g/dl, and the mean value at the end of treatment was 14.52 ± 1.41 g/dl (p < 0.001). The mean increase in Hb was 2.97 ± 1.65 g/dl. Mean duration of treatment was 7.13 ± 2.91 weeks. In 11 patients (7.9%) the dose was increased after 4 weeks. In 84 patients (60.4%) EPO treatment was implemented before the commencing of RT. Mean Hb values in this group was 11.34 ± 1.11 g/dl at the start of EPO treatment, 12.69 ± 1.56 g/dl at the start of RT, 13.96 ± 1.54 g/dl at the end of RT and 14.68 ± 1.3 g/dl at the end of EPO treatment (p < 0.001). In 55 patients (39.6%) anaemia developed during RT and, therefore, EPO treatment was implemented after commencing of RT. In this group the mean Hb values were 12.29 ± 1.6 g/dl at the start of RT, 11.72 ± 1.01 g/dl at the start of EPO treatment, 13.97 ± 1.53 g/dl at the end of RT and 14.28 ± 1.54 g/dl at the end of EPO treatment (p < 0.001). Hemoglobin levels at the start of EPO were lower in patients who commenced EPO before RT (p < 0.05). In 60 patients who received combined RT and chemotherapy, mean Hb values were 11.42 ± 1.16 g/dl at the start of EPO and 13.98 ± 1.55 g/dl at the end of EPO (p < 0.005). In 75 patients who had received RT alone, the mean Hb values was 11.53 ± 1.05 g/dl at the start of EPO and 14.98 ± 1.17 g/dl at the end of treatment (p < 0.001). Patients treated with RT alone had higher Hb levels at the end of RT and at the end of EPO treatment than did patients who had received combined treatment (p < 0.005). The duration of EPO treatment was shorter in the group treated with RT alone than in the combined treatment group (6.41 ± 2.99 weeks versus 7.96 ± 2.67 weeks; p < 0.005). No significant differences were observed in FACT-An and CLAS scores at the beginning and the end of the study. Conclusions. Treatment with epoetin alfa as a single weekly dose significantly increased Hb levels in patients with cancer who were undergoing radiotherapy. The response was greater in patients treated with radiotherapy alone than in those receiving combined therapy. The duration of EPO treatment was shorter in the group treated with radiotherapy alone than in the combined treatment group

Early stage breast cancer conserving treatment: high dose rate brachytherapy boost to the tumour bed.

INTRODUCTION: The dose administered to the tumour bed is a risk-factor for local recurrence in localised breast cancer following breast-conserving surgery. MATERIALS AND METHODS: All patients (n=94) received 50 Gy external beam radiotherapy and one application of 700 cGy at 85% isodose with high dose rate brachytherapy. RESULTS: Of the cases, 84% were infiltrating ductal carcinoma; 31.2% were G3; 28% were intraductal component > 25%; 54% had margin < 1 cm or unknown. With a mean follow-up of 65 months (range: 36-107 months), the overall actuarial survival at 5 and 8 years was 93.2% and 84.2%, respectively; disease-free survival was 88.3% and 84.6%, respectively; local control was 92.2% and 88.75%, respectively. Local recurrence rate was 5.3%, and distant dissemination rate was 8.5%. Among the risk-factors analysed, only the presence of 4 or more lymph node involvement implied a higher risk for local recurrence (p =0.0001). For distant dissemination, the risk-factors were: 4 or more lymph nodes involved (p = 0.0001),G3 (p =0.029), tumour >3 cm (p = 0.001), irradiation volume with external beam radiotherapy (p =0.0001), and presence of local recurrence (p = 0.001). CONCLUSION: High dose rate brachytherapy is an effective method for reducing local recurrence, and increasing local control.

Early stage breast cancer conserving treatment: high dose rate brachytherapy boost to the tumour bed

Introduction. The dose administered to the tumour bed is a risk-factor for local recurrence in localised breast cancer following breast-conserving surgery. Materials and Methods. All patients (n=94) received 50 Gy external beam radiotherapy and one application of 700 cGy at 85% isodose with high dose rate brachytherapy. Results. Of the cases, 84% were infiltrating ductal carcinoma; 31.2% were G3; 28% were intraductal component > 25%; 54% had margin 3 cm (p = 0.001), irradiation volume with external beam radiotherapy (p = 0.0001), and presence of local recurrence (p = 0.001). Conclusion. High dose rate brachytherapy is an effective method for reducing local recurrence, and increasing local control

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Thalassemias and their dental implications.

Thalassemias constitute a form of anemia that pose clear problems in relation to dental treatment. Dental professionals must be aware of the treatment adaptations required in patients with severe forms of beta-thalassemia. Until medical research is able to afford a definitive solution to these diseases (thereby greatly simplifying the dental management of such patients), effort will continue to center on the improvement of available therapeutic modalities, with the aim of obtaining effective and inexpensive oral chelators and drugs that either individually or in combination allow increases in fetal hemoglobin levels. Undoubtedly, the use of such measures together with serial blood transfusions has made it possible for an ever increasing number of patients with beta-thalassemia to reach adult age, where the provision of integral rather than merely palliative dental treatment must be seriously considered. At present, the clinical orofacial manifestations caused by the erythroid mass expanding the facial bones - resulting in dental malocclusions and protrusions tend to be less intense as a result of early medical treatment. In the future, gene therapy may be expected to allow a normal facial appearance thanks to complete healing of the patient.

Las talasemias y sus implicaciones odontológicas / Thalassenias and their dental implications

Las talasemias son un tipo de anemias con clara problemática a la hora de realizar un tratamiento dental. Debemos conocer cómo adaptar nuestros tratamientos dentales a las formas graves de las beta talasemias. Mientras que las investigaciones médicas se orientan a conseguir tratamientos definitivos que solucionen y no que traten la enfermedad, momento en el cual el tratamiento odontológico será muy sencillo, debemos de conocer los intentos en mejorar los tratamientos actuales, los cuales se encaminan a conseguir quelantes orales eficaces y baratos así como fármacos que en forma individualizada o combinada consigan aumentar los niveles de hemoglobina fetal. El hecho incuestionable es que la utilización de las medidas anteriores junto a las transfusiones seriadas han permitido alcanzar cada vez a más pacientes con beta talasemia, la edad adulta en donde la solicitud de tratamientos odontológicos que no sean exclusivamente paliativos, sino integrales, deben de ser muy seriamente considerados. Actualmente los signos clínicos orales-faciales motivados por la masa eritroide que expansiona los huesos faciales causando protusiones y maloclusiones dentales suelen estar disminuidos en intensidad por los tratamientos médicos tempranos. En el futuro la terapia génica conseguirá un aspecto facial normal por la curación completa del paciente (AU)