Prognostic factors and combined use of tocilizumab and corticosteroids in a Spanish cohort of elderly COVID-19 patients.

Coronavirus disease 2019 (COVID-19) infection in elderly patients is more aggressive and treatments have shown limited efficacy. Our objective is to describe the clinical course and to analyze the prognostic factors associated with a higher risk of mortality of a cohort of patients older than 80 years. In addition, we assess the efficacy of immunosuppressive treatments in this population. We analyzed the data from 163 patients older than 80 years admitted to our institution for COVID-19, during March and April 2020. A Lasso regression model and subsequent multivariate Cox regression were performed to select variables predictive of death. We evaluated the efficacy of immunomodulatory therapy in three cohorts using adjusted survival analysis. The mortality rate was 43%. The mean age was 85.2 years. The disease was considered severe in 76.1% of the cases. Lasso regression and multivariate Cox regression indicated that factors correlated with hospital mortality were: age (hazard ratio [HR] 1.12, 95% confidence interval [CI]: 1.03-1.22), alcohol consumption (HR 3.15, 95% CI: 1.27-7.84), CRP > 10 mg/dL (HR 2.67, 95% CI: 1.36-5.24), and oxygen support with Venturi Mask (HR 6.37, 95% CI: 2.18-18.62) or reservoir (HR 7.87, 95% CI: 3.37-18.38). Previous treatment with antiplatelets was the only protective factor (HR 0.47, 95% CI: 0.23-0.96). In the adjusted treatment efficacy analysis, we found benefit in the combined use of tocilizumab (TCZ) and corticosteroids (CS) (HR 0.09, 95% CI: 0.01-0.74) compared to standard treatment, with no benefit of CS alone (HR 0.95, 95% CI: 0.53-1.71). Hospitalized elderly patients suffer from a severe and often fatal form of COVID-19 disease. In this regard, several parameters might identify high-risk patients upon admission. Combined use of TCZ and CS could improve survival.

Accelerating the crystallization kinetics of linear polylactides by adding cyclic poly (L-lactide): Nucleation, plasticization and topological effects.

Polylactide is one of the most versatile biopolymers, but its slow crystallization limits its temperature usage range. Hence finding ways to enhance it is crucial to widen its applications. Linear and cyclic poly (L-lactide) (l-PLLA and c-PLLA) of similarly low molecular weights (MW) were synthesized by ring-opening polymerization of L-lactide, and ring-expansion methodology, respectively. Two types of blends were prepared by solution mixing: (a) l-PLLA/c-PLLA, at extreme compositions (rich in linear or in cyclic chains), and (b) blends of each of these low MW materials with a commercial high MW linear PLA. The crystallization of the different blends was evaluated by polarized light optical microscopy and differential scanning calorimetry. It was found, for the first time, that in the l-PLLA rich blends, small amounts of c-PLLA (i.e., 5 and 10 wt%) increase the nucleation density, nucleation rate (1/τ0), spherulitic growth rate (G), and overall crystallization rate (1/τ50%), when compared to neat l-PLLA, due to a synergistic effect (i.e., nucleation plus plasticization). In contrast, the opposite effect was found in the c-PLLA rich blends. The addition of small amounts of l-PLLA to a matrix of c-PLLA chains causes a decrease in the nucleation density, 1/τ0, G, and 1/τ50% values, due to threading effects between cyclic and linear chains. Small amounts of l-PLLA and c-PLLA enhance the crystallization ability of a commercial high MW linear PLA without affecting its melting temperature. The l-PLLA only acts as a plasticizer for the PLA matrix, whereas c-PLLA has a synergistic effect in accelerating the crystallization of PLA that goes beyond simple plasticization. The addition of small amounts of c-PLLA affects not only PLA crystal growth but also its nucleation due to the unique cyclic chains topology.