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

Ripartizione della sostanza secca e dei nutrienti in piante adulte di vite nel corso della stagione vegetativa: basi per il calcolo dei reali fabbisogni

52006 POR 2nonenonePorro, D.; Clementi, S.; Zatelli, A.; Ramponi, M.; Policarpo, M.Porro, D.; Clementi, S.; Zatelli, A.; Ramponi, M.; Policarpo, M

Voluminous Myoepithelioma of the Minor Salivary Glands Involving the Base of the Tongue

Myoepithelioma is an extremely rare tumour subtype and diagnosis is based on a wide variation of cellular morphology. FNAC specimens do not always suffice for a definitive differential diagnosis which depends on histology and immunohistochemistry of the lesion. Case Presentation. A 54-year-old female came to our attention with dysphagia and dyslalia of 6-month standing. Ear, Nose, and Throat (ENT) examination revealed a voluminous mass on the right portion of the base of her tongue, where postcontrast T2-weighted Magnetic Resonance Imaging (MRI) evidenced a hyperintense lesion. The fine-needle aspiration specimen taken for cytology was not diagnostic, as a differential diagnosis between myoepithelioma and a malignant neoplasm of the salivary glands necessitates parameters that cytology alone cannot provide. Therefore, the whole lesion was excised by diode laser through a transoral approach. Histology and immunohistochemistry of the completely excised lesion confirmed a myoepithelioma

Juvenile nasopharyngeal angiofibroma: comparison between endoscopic and open operative approaches

Juvenile nasopharyngeal angiofibroma (JNA) is a rare vascular and fibrous tumor that most commonly affects males in prepuberal and adolescent age. Traditionally, these tumors have been removed, after selective embolization, with the open surgical approach (degloving), but the interest in the endoscopic resection, especially for small tumors, has increased in recent years. To present our experience of JNA management, comparing the endoscopic approach and open/combined approach

Sustainable clothing: Why conspicuous consumption and greenwashing matter

Este estudio analiza el grado en que los motivos de consumo conspicuos, la preocupación por el medio ambiente, la eficacia percibida del consumidor, la confianza en las marcas de ropa sostenible y el lavado verde percibido desencadenan la compra de ropa sostenible. El marco teórico se probó con una muestra en línea representativa de la población australiana ( N = 600). Los resultados mostraron que todos los antecedentes propuestos tienen una relación positiva con la compra de ropa sostenible, con excepción del greenwashing percibido, que disminuye la intención de compra. Además, la efectividad percibida del consumidor moderó positivamente el efecto de los motivos de consumo conspicuos en la compra. Los motivos de consumo conspicuo tenían un efecto más fuerte en la compra cuando la efectividad percibida era alta, y esta influencia se reducía para la efectividad percibida más baja. La interacción entre el consumo conspicuo y la eficacia percibida tuvo el efecto más fuerte en el modelo. Nuestros hallazgos resaltan la relevancia del consumo ostentoso como motivo para cambiar a ropa sostenible y el papel igualmente importante de la efectividad percibida del consumidor, que es una condición límite para este efecto. Los hallazgos también confirman la influencia positiva significativa de la preocupación ambiental y la confianza en la marca de ropa sostenible, mientras que el lavado verde percibido es una barrera para la adopción de ropa sostenible. Se discuten las implicaciones teóricas y prácticas de los hallazgos.This study analyzes the degree to which conspicuous consumption motives, environmental concern, perceived consumer effectiveness, trust in sustainable clothing brands, and perceived greenwashing trigger the purchase of sustainable clothing. The theoretical framework was tested with a representative online sample of the Australian population (N = 600). Results showed that all proposed antecedents have a positive relationship with the purchase of sustainable clothing, with the exception of perceived greenwashing, which decreases purchase intention. In addition, perceived consumer effectiveness positively moderated the effect of conspicuous consumption motives on purchasing. Conspicuous consumption motives had a stronger effect on purchase when perceived effectiveness was high, and this influence was reduced for lower perceived effectiveness. The interaction between conspicuous consumption and perceived efficacy had the strongest effect in the model. Our findings highlight the relevance of conspicuous consumption as a motive for switching to sustainable clothing and the likewise important role of perceived consumer effectiveness, which is a boundary condition for this effect. Findings also confirm the significant positive influence of environmental concern and trust in the sustainable clothing brand, while perceived greenwashing is a barrier to the adoption of sustainable clothing. Theoretical and practical implications of the findings are discussed

Social cynicism, greenwashing, and trust in green clothing brands

This research develops a theoretical model of the effect of social cynicism as a personality trait on trust in green clothing brands. We conducted an online survey of a representative Australian sample to test the hypothesized relationships. Our findings confirmed that social cynicism affected green brand trust negatively and that this effect can be explained by an increase in perceived greenwashing. Conspicuous consumption moderates this indirect influence. This mediated influence decreased when conspicuous consumption was more salient. Findings provide important practical insights for brand managers intending to avoid a decrease in brand trust regarding garments marketed with sustainability claims.This work was supported by funding received from La Trobe University, Australia, the Spanish Government, and European Regional Development Fund [Grant PID2021-123686OB-I00 funded by MCIN/AEI/10.13039/501100011033 and, by ERDF A way of making Europe], the Basque Government [grant IT1731-22] and FESIDE Foundation [grant 03-21]

Sustainable clothing: Why conspicuous consumption and greenwashing matter

This study analyzes the degree to which conspicuous consumption motives, environmental concern, perceived consumer effectiveness, trust in sustainable clothing brands, and perceived greenwashing trigger the purchase of sustainable clothing. The theoretical framework was tested with a representative online sample of the Australian population (N?=?600). Results showed that all proposed antecedents have a positive relationship with the purchase of sustainable clothing, with the exception of perceived greenwashing, which decreases purchase intention. In addition, perceived consumer effectiveness positively moderated the effect of conspicuous consumption motives on purchasing. Conspicuous consumption motives had a stronger effect on purchase when perceived effectiveness was high, and this influence was reduced for lower perceived effectiveness. The interaction between conspicuous consumption and perceived efficacy had the strongest effect in the model. Our findings highlight the relevance of conspicuous consumption as a motive for switching to sustainable clothing and the likewise important role of perceived consumer effectiveness, which is a boundary condition for this effect. Findings also confirm the significant positive influence of environmental concern and trust in the sustainable clothing brand, while perceived greenwashing is a barrier to the adoption of sustainable clothing. Theoretical and practical implications of the findings are discussed

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit