Fertility Response to the COVID-19 Pandemic in Developed Countries – On Pre-pandemic Fertility Forecasts

The COVID-19 pandemic has affected all areas of our lives. Among other outcomes, the academic literature and popular media both discuss the potential effects of the pandemic on fertility. As fertility is an important determinant of population development and population forecasts are important for policy decisions and planning, we need to address to which extent fertility forecasts performed before the pandemic still apply. Using Monte Carlo forecasting based on principal components of fertility rates, we quantify the effects of the pandemic on fertility for 22 countries and discuss whether forecasts made prior to the pandemic need adjustment based on more recent data. Among the studied countries, 14 countries show no significant effect of the pandemic at all, while six countries have significantly lowered numbers of births in comparison to counterfactual trajectories that assume that past trends will hold. These countries are primarily in the Mediterranean and East Asia. For Finland and South Korea, there is statistical evidence for increased fertility in the early phases of the pandemic. In all cases with statistically significant fertility differentials caused by the pandemic, reproductive behavior normalized quickly. Therefore, we find no evidence for long-term effects of the pandemic on fertility, leading to the conclusion that pre-pandemic fertility forecasts still apply

Diagnostic delay does not influence survival of pancreatic cancer patients

Background: Most pancreatic ductal adenocarcinoma patients present with advanced disease. Whether it is possible to increase survival by earlier diagnosis is unclear. Objective: The purpose of this study was to investigate the association between presenting complaints and risk factors for pancreatic cancer with diagnostic delay, stage and survival. Methods: This was a single-centre retrospective cohort study. Consecutive patients were interviewed and data on demographics, medical history, risk factors and complaints leading to pancreatic ductal adenocarcinoma diagnosis and disease stage were recorded. Diagnostic delay was considered as time between first complaint and diagnosis. Patients received appropriate treatments and their outcome was recorded in a dedicated database. The Chi-square test for comparison of categorical variables and the Mann–Whitney test for continuous variables were employed with Bonferroni corrections. Correlation between continuous variables was evaluated by means of the Spearman correlation coefficient. Survival analysis was performed with the Kaplan–Meier method and a log-rank test. Results: The median diagnostic delay for 477 pancreatic ductal adenocarcinoma patients was two months (interquartile range 1–5), being significantly shorter for patients presenting with jaundice compared with those with pain, weight loss, diabetes (p < 0.001). The global rate of metastatic disease at diagnosis was 40%, being only 22% in those presenting with jaundice. The median diagnostic delay, however, was not significantly different among disease stages but was significantly longer in patients with a body mass index>25 kg/m2. The median survival time was seven months. Factors associated with worse survival at the multivariable analysis were older age (hazard ratio 1.02 per year), metastatic disease (hazard ratio 2.12) and pain as presenting complaint (hazard ratio 1.32), while diagnostic delay was not. Conclusion: While some complaints are associated with a shorter diagnostic delay and less advanced disease stage, we could not demonstrate that delay is associated with survival, possibly suggesting that prevention rather than early recognition is important to tackle pancreatic cancer lethality

Modelo de valoración de riesgo en ambulancias terrestres

Fil: Vanella, O. R. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas, Físicas y Naturales. Laboratorio de Investigación Aplicada y Desarrollo; Argentina.Fil: Ugozzoli Rojas, L. R. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas, Físicas y Naturales. Laboratorio de Investigación Aplicada y Desarrollo; Argentina.Fil: Bruni, R. G. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas, Físicas y Naturales. Laboratorio de Investigación Aplicada y Desarrollo; Argentina.Fil: Faillaci, S. M. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas, Físicas y Naturales. Centro de Vinculación Biogestión; Argentina.En el sistema de salud, las ambulancias son un elemento crítico, destinado a brindar un servicio simultáneo de atención médica y traslado, ya que la atención que se les puede brindar a los pacientes transportados en los primeros 10 minutos, esun factor determinante que puede aumentar el porcentaje de supervivencia de las víctimas. Por ello, deben garantizarse las condiciones de seguridad y el adecuado funcionamiento de las unidades, así como también de todos sus componentes, en el transcurso de su vida útil. Si bien existen métodos de verificación de la seguridad de estos vehículos [1] y su aparatos electromédicos [2], no se advierten hasta el momento propuestas de metodologías que permitan a los fabricantes de ambulancias identificar peligros o estimar y evaluar los riesgos asociados a ellos,durante las etapas de diseño y fabricación. Este trabajo presenta un modelo de valoración de riesgos en ambulancias terrestres, ejemplos de su aplicación en las etapas de diseño de estos vehículos y un resumen de los resultados obtenidos al emplearlo.http://www.bioingenieria.edu.ar/eventos/claib2014/Fil: Vanella, O. R. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas, Físicas y Naturales. Laboratorio de Investigación Aplicada y Desarrollo; Argentina.Fil: Ugozzoli Rojas, L. R. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas, Físicas y Naturales. Laboratorio de Investigación Aplicada y Desarrollo; Argentina.Fil: Bruni, R. G. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas, Físicas y Naturales. Laboratorio de Investigación Aplicada y Desarrollo; Argentina.Fil: Faillaci, S. M. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas, Físicas y Naturales. Centro de Vinculación Biogestión; Argentina.Otras Ingeniería Eléctrica, Ingeniería Electrónica e Ingeniería de la Informació

Use of small scale electrical resistivity tomography to identify soil-root interactions during deficit irrigation

Plant roots activity affect the exchanges of mass and energy between the soil and atmosphere. However, it is challenging to monitor the activity of the root-zone because roots are not visible from the soil surface, and root systems undergo spatial and temporal variations in response to internal and external conditions. Therefore, measurements of the activity of root systems are interesting to ecohydrologists in general, and are especially important for specific applications, such as irrigation water management. This study demonstrates the use of small scale three-dimensional (3-D) electrical resistivity tomography (ERT) to monitor the root-zone of orange trees irrigated by two different regimes: (i) full rate, in which 100% of the crop evapotranspiration (ETc) is provided; and (ii) partial root-zone drying (PRD), in which 50% of ETc is supplied to alternate sides of the tree. We performed time-lapse 3-D ERT measurements on these trees from 5 June to 24 September 2015, and compared the long-term and short-term changes before, during, and after irrigation events. Given the small changes in soil temperature and pore water electrical conductivity, we interpreted changes of soil electrical resistivity from 3-D ERT data as proxies for changes in soil water content. The ERT results are consistent with measurements of transpiration flux and soil temperature. The changes in electrical resistivity obtained from ERT measurements in this case study indicate that root water uptake (RWU) processes occur at the 0.1 m scale, and highlight the impact of different irrigation schemes. (C) 2017 Elsevier B.V. All rights reserved

Impact of cemiplimab treatment duration on clinical outcomes in advanced cutaneous squamous cell carcinoma

: Treatment duration with checkpoint inhibitors must be optimized to prevent unjustified toxicity, but evidence for the management of cutaneous squamous cell carcinoma is lacking. A retrospective study was performed to evaluate the survival of patients with cutaneous squamous cell carcinoma (CSCC) who discontinued cemiplimab due to different causes and without progression. Among 95 patients with CSCC who received cemiplimab, 22 (23%) patients discontinued immunotherapy due to causes other than progression, such as comorbidities, toxicity, complete response or lack of compliance (group that discontinued before censoring [DBC]), then 73 patients had standard treatment scheduled (STS). The overall survival was 25.2 months (95% CI: 8.9-29.4) in STS group and 28.3 months (95% CI: 12.7-28.3) in the DBC group; deaths for all causes were 11/22 (50%) in the DBC group and 34/73 (46.6%) in the STS group (p = 0.32). 10/22 (45.4%) subjects died due to CSCC in the DBC after discontinuation and 34/73 (46.6%) in the STS group, and the difference between groups was not significant (p = 0.230). Duration of treatment was significantly lower in subjects with stable disease versus those with complete or partial response (16.9, 30.6 and 34.9 months, respectively; p = 0.004). Among the 22 STS patients, 12 received cemiplimab for less than 12 months (10 [83%] died) and 10 for at least 12 months (1 [10%] died). Our observation, finding no outcome difference between DBC and STS groups, suggests that ICI treatment after one year might expose patients to further treatment related events without efficacy advantages

Gene-expression signature predicts autoimmune toxicity in metastatic melanoma

Objectives To identify predictive gene-expression signatures for immune-related adverse events (irAEs) in patients with melanoma treated with anti-PD-1 inhibitors, in the adjuvant therapy (AT) and first-line therapy (FLT). Methods This retrospective study analyzed baseline whole-blood gene expression profile from 161 patients with resected stage III or unresectable stage III-IV melanoma treated with anti-PD-1 inhibitors. RNA was extracted from baseline peripheral blood samples and profiled using the NanoString nCounter PanCancer IO 360 panel. Gene-expression signatures were identified and validated using cross-validated sparse partial least squares modeling and principal component analysis, then correlated with toxicity occurrence. Results A total of 223 and 186 irAEs were observed in the AT and FLT groups, respectively, including arthralgia, colitis, and headache. Distinct gene-expression signatures significantly predicted toxicity occurrence, with variation across therapy settings. Arthralgia was predicted by immune-related and apoptotic gene signatures (eg, SMAD5, FASLG in FLT; ICOS, TGFB2 in AT), while colitis was linked to inflammatory and adhesion-related pathways. In the AT group, headache was associated with genes involved in interferon and adhesion signaling. Across both cohorts, specific signatures predicted overall irAE risk and timing. No events were observed in patients with low-risk signatures over the follow-up period. In the FLT cohort, arthralgia and cutaneous toxicities were positively associated with ORR, while arthralgia, asthenia, colitis, fatigue, and skin-related toxicities correlated with improved disease control rate. No significant association between irAEs and relapse risk was observed in the adjuvant cohort. Conclusions Whole-blood gene-expression profiling enables early identification of patients at high risk for irAEs during anti-PD-1 therapy. These predictive biomarkers may guide personalized toxicity monitoring in melanoma treatment

Real Life Clinical Management and Survival in Advanced Cutaneous Melanoma: The Italian Clinical National Melanoma Registry Experience

Background: Cutaneous melanoma (CM) is one of the most aggressive types of skin cancer. Currently, innovative approaches such as target therapies and immunotherapies have been introduced in clinical practice. Data of clinical trials and real life studies that evaluate the outcomes of these therapeutic associations are necessary to establish their clinical utility. The aim of this study is to investigate the types of oncological treatments employed in the real-life clinical management of patients with advanced CM in several Italian centers, which are part of the Clinical National Melanoma Registry (CNMR). Methods: Melanoma-specific survival and overall survival were calculated. Multivariate Cox regression models were used to estimate the hazard ratios adjusting for confounders and other prognostic factors. Results: The median follow-up time was 36 months (range 1.2-185.1). 787 CM were included in the analysis with completed information about therapies. All types of immunotherapy showed a significant improved survival compared with all other therapies (p=0.001). 75% was the highest reduction of death reached by anti-PD-1 (HR=0.25), globally immunotherapy was significantly associated with improved survival, either for anti-CTLA4 monotherapy or combined with anti-PD-1 (HR=0.47 and 0.26, respectively) and BRAFI+MEKI (HR=0.62). Conclusions: The nivolumab/pembrolizumab in combination of ipilimumab and the addition of ant-MEK to the BRAFi can be considered the best therapies to improve survival in a real-world-population. The CNMR can complement clinical registries with the intent of improving cancer management and standardizing cancer treatment

Ostomy closure rate during COVID-19 pandemic. An Italian multicentre observational study

During the corona virus disease 2019 (COVID-19) pandemic, most of the surgical procedures were performed for emergencies or oncologic reasons to the detriment of the remaining elective procedures for benign conditions. Ileostomy or colostomy creation are sequelae of oncologic or emergency colorectal surgery, but their closure does not fall within the definition of oncologic or emergency surgery. The aim of this retrospective multicentre observational study is to report the impact of COVID-19 pandemic on the ostomy closure rate in Italy. Data regarding ileostomy and colostomy creation and closure from 24 Italian centres, during the study period (March 2020–February 2021) and during the control period (March 2019–February 2020) were collected. Three hospitals (12.5%) were COVID free. The number of colostomies and ileostomies created and closed in the same period was lower (-18.8% and-30%, respectively) in the study period in comparison to the control period (p = 0.1915 and p = 0.0001, respectively), such as the ostomies closed in the analysed periods but created before (colostomy-36.2% and ileostomy-7.4%, p = 0.2211 and p = 0.1319, respectively). Overall, a 19.5% reduction in ostomies closed occurred in the study period. Based on the present study, a reduction in ostomy closure rate occurred in Italy between March 2020 and February 2021. During the pandemic, the need to change the clinical practice probably prolonged deterioration of quality of life in patients with ostomies, increasing number of stomas that will never be closed, and related management costs, even if these issues have not been investigated in this study

ASFISSIA PERINATALE:VALUTAZIONE CLINICO-EPIDEMIOLOGICA IN UN CAMPIONE DI NEONATI DI ≥ 34 SEG

Asfissia, late preterm, a termin

Outcomes of lumen apposing metal stent placement in patients with surgically altered anatomy: Multicenter international experience.

Background and study aims Although outcomes of lumen-apposing metal stents (LAMS) placement in native anatomy have been reported, data on LAMS placement in surgically altered anatomy (SAA) are sparse. We aimed to assess outcomes of LAMS placement in patients with SAA for different indications. Patients and methods This was an international, multicenter, retrospective, observational study at 25 tertiary care centers through November 2023. Consecutive patients with SAA who underwent LAMS placement were included. The primary outcome was technical success defined as correct placement of LAMS. Secondary outcomes were clinical success and safety. Results Two hundred and seventy patients (125 males; average age 61 ± 15 years) underwent LAMS placement with SAA. Procedures included EUS-directed transgastric ERCP (EDGE) and EUS-directed transenteric ERCP (EDEE) (n = 82), EUS-guided entero-enterostomy (n = 81), EUS-guided biliary drainage (n = 57), EUS-guided drainage of peri-pancreatic fluid collections (n = 48), and EUS-guided pancreaticogastrostomy (n = 2). Most cases utilized AXIOS stents (n = 255) compared with SPAXUS stents (n = 15). Overall, technical success was 98%, clinical success was 97%, and the adverse event (AE) rate was 12%. Using AGREE classification, five events were rated as Grade II, 21 events as Grade IIIa, and six events as IIIb. No difference in AEs were noted among stent types ( P = 0.52). Conclusions This study shows that placement of LAMS is associated with high technical and clinical success rates in patients with SAA. However, the rate of AEs is noteworthy, and thus, these procedures should be performed by expert endoscopists at tertiary centers