Concurrent hyperfractionated radiotherapy and chemotherapy for patients with limited small-cell lung cancer. Results from a single institution

BackgroundConcurrent use of chemotherapy and twice-a-day hyperfractionated radiotherapy is an efficacious scheme to control limited disease (LD) small-cell lung cancer (SCLC).AimOur main objective was to estimate initial results in overall survival for patients with LD-SCLC treated with concomitant chemotherapy and hyperfractionated thoracic radiotherapy in routine practice. Response to treatment and toxicity were also assessed.Material and MethodsForty-nine patients with confirmed LD-SCLC were treated at the Department of Radiotherapy of the Hospital General de Catalonia (Spain) from December 1999 to February 2007. The chemotherapy regimen was cisplatin (80 mg/m2) on day 1 and etoposide (100 mg/m2) on days 1, 2, and 3, every 21 day. The target dose to the tumor volume was 45 Gy. Prophylactic cranial irradiation (PCI), consisting of 30 Gy delivered in 15 fractions, was prescribed for all patients with a response rate >75% (23 of 30 patients).ResultsMedian follow-up was 12 months (range, 6–58 months) and median overall survival was 28.9 months. Two-year and 4-year survival rates were 56.4% and 30.1%, respectively. At 2 years, specific survival, local control, and systemic control were 64.2%, 88.8%, and 46.8%, respectively. Myelotoxicity and oesophagitis were the most severe toxicities.ConclusionsThe combined schedule – hyperfractionated irradiation plus concurrent chemotherapy – can be applied in routine practice in the context of early radiotherapy, which is considered standard treatment, with acceptable toxicity and similar results to those described in the literature

Overview of recent TJ-II stellarator results

The main results obtained in the TJ-II stellarator in the last two years are reported. The most important topics investigated have been modelling and validation of impurity transport, validation of gyrokinetic simulations, turbulence characterisation, effect of magnetic configuration on transport, fuelling with pellet injection, fast particles and liquid metal plasma facing components. As regards impurity transport research, a number of working lines exploring several recently discovered effects have been developed: the effect of tangential drifts on stellarator neoclassical transport, the impurity flux driven by electric fields tangent to magnetic surfaces and attempts of experimental validation with Doppler reflectometry of the variation of the radial electric field on the flux surface. Concerning gyrokinetic simulations, two validation activities have been performed, the comparison with measurements of zonal flow relaxation in pellet-induced fast transients and the comparison with experimental poloidal variation of fluctuations amplitude. The impact of radial electric fields on turbulence spreading in the edge and scrape-off layer has been also experimentally characterized using a 2D Langmuir probe array. Another remarkable piece of work has been the investigation of the radial propagation of small temperature perturbations using transfer entropy. Research on the physics and modelling of plasma core fuelling with pellet and tracer-encapsulated solid-pellet injection has produced also relevant results. Neutral beam injection driven Alfvénic activity and its possible control by electron cyclotron current drive has been examined as well in TJ-II. Finally, recent results on alternative plasma facing components based on liquid metals are also presentedThis work has been carried out within the framework of the EUROfusion Consortium and has received funding from the Euratom research and training programme 2014–2018 under Grant Agreement No. 633053. It has been partially funded by the Ministerio de Ciencia, Inovación y Universidades of Spain under projects ENE2013-48109-P, ENE2015-70142-P and FIS2017-88892-P. It has also received funds from the Spanish Government via mobility grant PRX17/00425. The authors thankfully acknowledge the computer resources at MareNostrum and the technical support provided by the Barcelona S.C. It has been supported as well by The Science and Technology Center in Ukraine (STCU), Project P-507F

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

: The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity &gt; 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI

Planeamiento Y Control Estratégico De Operaciones-II153-201702

Es un curso de especialidad en la carrera de Ingeniería Industrial EPE de carácter teórico dirigido a los estudiantes del 8° ciclo que busca desarrollar las siguientes competencias:Competencias Generales:- Pensamiento crítico.- Manejo de la información.Planeamiento y Control Estratégico de Operaciones es un curso de especialidad en la carrera de IngenieríaIndustrial de carácter teórico-práctico y dirigido a los estudiantes del sexto ciclo. Busca desarrollar lascompetencias generales de Pensamiento Crítico y Manejo de la Información y la competencia específica ABET:(g.1) Se comunica de manera clara y efectiva utilizando el lenguaje técnico de la empresa.El curso prepara a los estudiantes en el manejo apropiado de las diferentes técnicas para diseñar planearprogramar y controlar las operaciones básicas de los procesos de fabricación de bienes y servicios calculando yoptimizando el uso eficiente de los recursos de una organización bajo condiciones reales y cumpliendo con lasexigencias del mundo actual. Asimismo los estudiantes aprenden a definir estrategias alineadas a los objetivosde largo y corto plazo de la empresa actividad que les permite desempeñarse eficientemente en áreas deOperaciones a lo largo de su carrera profesionalLas operaciones al interior de la empresa se elaboran inicialmente con un plan a largo plazo que debe estar alineado con los objetivos de la empresa. Las decisiones de operaciones giran en torno a la capacidad diseño del producto y procesos. Este curso será importante y útil para tu vida profesional porque aprenderás a establecer programas que satisfagan necesidades de insumos y recursos para las operaciones planifiques el uso de dichos insumos y recursos y finalmente puedas controlar los mismos. Este tipo de decisiones te permitirán actuar como lo hace un Gerente de Operaciones

Anthropogenic emissions in South America for air quality and climate modelling

International audienceA workshop was held in Santiago, Chile, in March 2017, gathering experts in emissions from different countries in South America, Europe and the USA. Current status of emission inventories in five South American countries (Argentina, Brazil, Chile, Colombia and Peru) was presented and discussed. This information will be summarized in a document that will be used to seek international funding to generate a consistent emission inventory for each one of these South American countries. National emission inventories in South America are prepared as part of the obligations of these countries to the United Nations Framework Convention on Climate Change within the framework of their national communications. These inventories include the emissions of greenhouse gases as well as non-GHG gases subject to complementary reporting under the Convention. Several pollutants with important impact on climate change and air quality are not included in these estimates. Emission inventories developed in different Latin America (LA) countries are typically developed at national level, providing an annual total, not necessarily for all criteria pollutants and without information on spatial and temporal emission patterns. There are also inventories for a number of LA cities, particularly large urban conglomerates, but these are not necessarily consistent with the corresponding national inventories. There is need to harmonize these estimates, and to fill the gap associated with the knowledge of spatially distributed and temporally disaggregated emissions. A network was established between members of the LA Emissions Inventory Group (LAEIG) from five countries (Argentina, Brazil, Chile, Colombia and Peru) and international researchers with the aim to build a consistent and shared emission inventory in the near future for these five countries