Critically ill COVID-19 patients attended by anesthesiologists in northwestern Spain: a multicenter prospective observational study

BACKGROUND AND OBJECTIVES

There are limited information on outcome, complications and treatments of critically ill COVID-19 patients requiring admission to an intensive care unit (ICU). The aim of this study is to describe the clinical ICU course, treatments used, complications and outcomes, of critically ill COVID-19 patients admitted in seven ICU in Galicia region during the 2020 March-April pandemic peak.

METHODS

Between March 21 and April 19, 2020, we evaluated critically ill COVID-19 patients admitted to the ICU of Anesthesia of seven hospitals in Galicia, northwestern Spain. Outcome, complications, and treatments were monitored until May 6, 2020, the final date of follow-up.

RESULTS

A total of 97 critically ill COVID-19 patients were included. During ICU stay, mechanical ventilation became necessary in 80 (82.5%) patients, and tracheostomy in 22 (22.7%) patients. Prone position was used frequently in both intubated (67.5%) and awake (27.8%) patients. Medications consisted of antivirals agents (92.7%), corticosteroids (93.8%), tocilizumab (57.7%), and intermediate or high doses of anticoagulants (83.5%). The most frequent complications were ICU-acquired infection (52.6%), thrombosis events (16.5%), and reintubation (9.3%). After a median follow-up of 42 (34-45) days, 15 patients (15.5%) deceased, 73 patients (75.2%) had been discharged from ICU, and nine patients (9.3%) were still in the ICU.

CONCLUSIONS

A high proportion of our critically ill COVID-19 patients required mechanical ventilation, prone positioning, antiviral medication, corticosteroids, and anticoagulants. ICU complications were frequent, mainly infections and thrombotic events. We had a relatively low mortality of 15,5%.

Preclinical Efficacy of Endoglin-Targeting Antibody-Drug Conjugates for the Treatment of Ewing Sarcoma

PURPOSE

Endoglin (ENG; CD105) is a coreceptor of the TGFβ family that is highly expressed in proliferating endothelial cells. Often coopted by cancer cells, ENG can lead to neo-angiogenesis and vasculogenic mimicry in aggressive malignancies. It exists both as a transmembrane cell surface protein, where it primarily interacts with TGFβ, and as a soluble matricellular protein (sENG) when cleaved by matrix metalloproteinase 14 (MMP14). High ENG expression has been associated with poor prognosis in Ewing sarcoma, an aggressive bone cancer that primarily occurs in adolescents and young adults. However, the therapeutic value of ENG targeting has not been fully explored in this disease.

EXPERIMENTAL DESIGN

We characterized the expression pattern of transmembrane ENG, sENG, and MMP14 in preclinical and clinical samples. Subsequently, the antineoplastic potential of two novel ENG-targeting monoclonal antibody-drug conjugates (ADC), OMTX503 and OMTX703, which differed only by their drug payload (nigrin-b A chain and cytolysin, respectively), was assessed in cell lines and preclinical animal models of Ewing sarcoma.

RESULTS

Both ADCs suppressed cell proliferation in proportion to the endogenous levels of ENG observed in vitro. Moreover, the ADCs significantly delayed tumor growth in Ewing sarcoma cell line-derived xenografts and patient-derived xenografts in a dose-dependent manner.

CONCLUSIONS

Taken together, these studies demonstrate potent preclinical activity of first-in-class anti-ENG ADCs as a nascent strategy to eradicate Ewing sarcoma.

α-TCP cements prepared by syringe-foaming: Influence of Na2HPO4 and surfactant concentration

The lack of intrinsic open porosity in calcium phosphate cements slows down the resorption rate and bone ingrowth when implanted In Vivo. In this study, macroporous structures were obtained by mixing α-TCP cement with a foamed liquid phase containing different concentrations of sodium hydrogen phosphate and a nonionic surfactant. The cement paste was prepared by hand mixing in a novel system of two syringes connected by a tube. Two different liquid to powder (L/P) ratios were used to prepare the cement paste. The cement samples showed open macropores with diameters>100μm. The specimens prepared with lower L/P ratio showed smaller porosity, macroporosity and pore size distribution. The cohesion of the cement paste in liquid solutions was assessed by adding 2wt% sodium alginate to the liquid phase. This study suggests that the final macrostructure of the foamed cements can be controlled by varying the phosphate and surfactant concentrations in the liquid phase and the L/P ratio.

Cell populations in the pineal gland of the viscacha (Lagostomus maximus). Seasonal variations

Pineal samples of the viscacha, which were taken in winter and in summer, were analysed using both light and electron microscopy. The differences found between the two seasons were few in number but significant. The parenchyma showed two main cell populations. Type I cells occupied the largest volume of the pineal and showed the characteristics of typical pinealocytes. Many processes, some of which were filled with vesicles, could be seen in intimate contact with the neighbouring cells. The presence in the winter samples of "synaptic" ribbons and spherules, which were almost absent in the summer pineals, suggests a seasonal rhythm. These synaptic-like structures, as well as the abundant subsurface cisterns present in type I cells, appeared as basic differential features which allowed these cells to be distinguished from type II cells. These latter cells, which can be classified as interstitial cells, showed some other distinguishing features, such as irregular-shaped nuclei, abundant deposits of glycogen-like particles and structures of unknown function consisting of concentric cisterns surrounding a dense body. In the summer, interstitial cells displayed numerous large round bodies, which contributed to increase the cellular volume slightly. Regarding other constituents, like glial cell processes, vessels of non-fenestrated endothelium and sympathetic innervation, no qualitative differences were observed between the two seasons studied. We have presented here some morphological evidences of the circannual rhythm of the viscacha pineal, as well as ultrastructural criteria for distinguishing the main cell populations of this organ, which could be useful for studies carried out in other mammals.

Speciation study of the anti-inflammatory drug tenoxicam (Htenox) with Cu(II): X-ray crystal structure of [Cu(tenox)(2)(py)(2)].EtOH

A speciation study was carried out in aqueous solution of the anti-inflammatory drug tenoxicam (Htenox), under quasi-physiological conditions (temperature of 37 degrees C and ionic strength 0.15 M NaCl) in order to determine the acidity constants from spectrophotometric studies, the pK(a) values found being pK(1)=1.143+/-0.008 and pK(2)=4.970+/-0.004. Subsequently, the spectrophotometrical speciation of the different complexes of Cu(II) with the drug was performed under the same conditions of temperature and ionic strength, observing the formation of Cu(Htenox)(2)(2+) with log beta(212)=20.05+/-0.01, Cu(tenox)(2) with log beta(012)=13.6+/-0.1, Cu(Htenox)(2+) with log beta(111)=10.52+/-0.08, as well as Cu(tenox)(+) with log beta(011)=7.0+/-0.2, all of them in solution, and solid species Cu(tenox)(2)(s) with an estimated value of log beta(012)(s) approximately 18.7. The crystalline structure of the complex [Cu(tenox)(2)(py)(2)]. EtOH, was also determined, and it was observed that tenoxicam employs the oxygen of the amide group and the pyridyl nitrogen to bond to the cation.

Phase II study of carboplatin and 1-h intravenous etoposide and paclitaxel in a novel sequence as first-line treatment of patients with small-cell lung cancer

PURPOSE

To evaluate the efficacy and tolerability of paclitaxel, carboplatin and etoposide when administered in combination to previously-untreated small-cell lung cancer (SCLC) patients.

PATIENTS AND METHODS

Patients (n=95) with limited-stage disease (LSD; n=45) or extensive-stage disease (ESD; n=50) from 14 Spanish hospitals were entered into the study. Etoposide was administered 80 mg/m(2)/day intravenous (i.v.) on days 1, 2 and 3, paclitaxel 175 mg/m(2) i.v. on day 3 and carboplatin area-under-the-concentration-time-curve=6; i.v. on day 3, of a 3-week cycle, and repeated for up to 6 cycles.

RESULTS

The overall response (OR) rate was 74% (n=70; 32 complete, 38 partial). Although the OR in LSD and ESD patients was similar (73 vs 74%, respectively), the percentage complete response was significantly higher among the former (49 vs 20%). The main toxicities were grade 3-4 neutropenia and febrile neutropenia (62 and 18%, respectively) and there were 3 toxic deaths. Other toxicities were rare or easily manageable. Disease-free survival and overall survival rates at 1 year were 53 and 70% in LSD and 18 and 39% in ESD patients, respectively.

CONCLUSION

The results indicate that the combination of paclitaxel, etoposide and carboplatin has an anti-tumour activity in SCLC that is comparable to other combination regimens, and is well tolerated.

Primary localized nasopharyngeal amyloidosis. A case report

Primary localized amyloidosis of the nasopharynx is a rare disease. We present the case of a 13-year-old girl, to our knowledge only the second pediatric case reported in the literature. Symptoms were nasal obstruction and bleeding from the oral cavity. Physical examination revealed a mass in the nasopharynx and left side of the soft palate. The diagnosis was made by biopsy and histopathologic study of the surgical specimen. Immunohistochemical study revealed amyloid light chains (AL). The main treatment was surgical. At follow-up 9 months later, no recurrence had developed. While rare, localized amyloidosis should be considered in the differential diagnosis of nasal obstruction, epistaxis and glue ear, and must be recognized and understood by the otolaryngologist to allow appropriate diagnostic and therapeutic planning.

Split hyperfractionated accelerated radiation therapy and concomitant cisplatin for locally advanced head and neck carcinomas: a preliminary report

PURPOSE

The feasibility and activity of an intensive chemoradiotherapeutic scheme for patients with locally advanced squamous cell head and neck cancers were tested in a single institution Phase II pilot study.

METHODS AND MATERIALS

Between January 1990 and February 1992, 40 patients were entered into this trial. The treatment protocol consisted of split hyperfractionated accelerated radiation therapy (SHART), 1.6 Gy per fraction given twice per day to a total dose of 64-67.2 Gy for a total of 6 weeks with a 2-week gap, and cisplatin (20 mg/sqm/Days 1 to 5, in continuous perfusion) concomitantly.

RESULTS

All of the 40 patients are evaluable for response and survival. Toxicity was significant, but tolerable. A complete tumor response to this treatment was achieved by 37 patients (92.5%). With a minimal follow-up of 22 months (median 30 months) there have been 16 local relapses and 19 patients have died, 2 without tumor. The projected 2- and 3-year overall survival rates are 64% (confidence interval (CI) 95%, 49-79%) and 47%, respectively. The 2-year local control probability has been 56% (CI 95%, 39-73%).

CONCLUSION

This treatment obtains a high rate of complete responses with increased acute toxicity but tolerable late effects. Preliminary results are encouraging for laryngeal neoplasms. A longer follow-up is needed to evaluate the impact of this treatment on patient survival.

[Cellular and molecular differences in cleft palate susceptibility in mice]

The aim of this study was to identify possible candidate genes for the susceptibility to cleft palate. We studied hyaluronic and glycoprotein levels with morphometric and histochemical techniques, in palatine processes of 13 and 14 days old mouse embryos of strains A/Sn and C/57 BL, that are respectively susceptible and resistant to glucocorticoid and non steroid anti-inflammatory drug induced cleft palate. At 13 days, in palatine processes of the resistant strain and when these are still vertical, there was a significantly higher amount of extracellular matrix, constituted principally by hyaluronic acid. These differences disappeared at 14 days, when the processes became horizontal. The basal membrane of the medial palatine epithelium of the susceptible strain, showed interruptions due to a lower amount of glycoproteins. It is concluded that the observed differences in the amount and quality of these molecules, are a consequence of genetic differences that could determine the susceptibility to cleft palate.

[Biochemical-histological study of the effects of lithium on various organs of vizcacha (Lagostomus maximus maximus)]

Considering that the vizcacha (Lagostomus maximus maximus) is a very Lithium sensitive rodent, we planned a biochemical-histological study injecting IP doses of 1 mEq/kg/day LiCl during one month to adult vizcachas, and they were divided into three lots: Lot I the optical microscopy revealed evident renal, gonadal, hyphophyseal and adrenal damages; the biochemical analysis showed that Li significantly decreased the female serum LH levels while testosterone and estradiol levels were not affected. The male Li serum values resulted to be significantly higher than those of female animals. The damage was greater in male specimens. Lott II: the tissue recovery from the damage observed in Lot I was the following: total in hyphophysis, partial in testis, the same in kidney and was enhanced in adrenal and ovary. The Li renal clearance was determined in Lot III verifying no changes in both sexs. According to our results, Li (1 mEq/kg/day during one month) produce modifications in different tissues probably the gonadal damage may be consequence of a direct Li effect and not for a hyphophysis alteration, since in male vizcacha the LH serum level was not changed. In regard to the selective effect in the suprarenal glomerulus structure, this Li effect is produced via hyphophysis. In conclusion, the selective effect of Li on adrenal and gonada organs of this rodent is a contribution in order to warm about the possible reproduction of such effects in human beings.

[Familial hypobetalipoproteinemia: description of a heterozygous form with important biochemical alterations]

We describe a case of a patient affected of familial hypobetalipoproteinemia with marked biochemical alterations (low cholesterol and triglyceride levels) which are characteristic of the homocygote form and with no apparent clinical manifestations. The determination of Apoprotein B and the family study permitted the diagnosis of a heterocygote form.

Permeability of the pineal gland of the viscacha (Lagostomus maximus maximus) to the lanthanum hydroxide

Lanthanum hydroxide together with a fixative solution was injected into the third ventricle of the viscacha. The tracer penetrated freely into the pineal gland demonstrating an extensive network of intercommunicating intercellular spaces. Numerous gap junctions were observed indicating that they are the predominant interparenchymal contacts. The capillaries were characterized by non-fenestrated endothelial cells lining a moderate-sized perivascular space. Precipitates of lanthanum hydroxide were found in the basal membranes of the perivascular and interendothelial spaces, but not in the vascular lumina. The tracer stopped at tight junctions; these constitute a barrier between the pinealocytes and the blood compartment. Active micropinocytosis observed in the capillary walls suggest a transendothelial transport.

A light and electron microscopic study of the pineal gland of the viscacha (Lagostomus maximus maximus)

The pineal of viscacha (Lagostomus maximus maximus) is formed by two main cellular populations of pinealocytes and interstitial cells. A connective capsule surrounds the gland sending numerous septa containing blood vessels and nerves. In the specimens collected during summer the pinealocyte displays a defined contour and a clear cytoplasm with abundant ribosomes and numerous cisternae of endoplasmic reticulum. The pinealocytes observed during winter have cytological characteristics of active cells with dense and elongated mitochondria, dense bodies, and a developed Golgi complex. These seasonal glandular changes could be related to the environmental condition and mainly to the summer photoperiod. The presence of abundant nerve terminals in the perivascular spaces suggests a neural control on the blood vessels.

Biological role of the pineal. Responses to the environmental photoperiod

The pineal of vizcacha (Lagostomus maximus maximus) in specimens collected during winter, has the cytological characteristic of an active organ. In this state the animal is adapted to a prolonged dark environment and its reproductive organs are inactive. During summer, the vizcacha displays its sexual annual cycle of reproduction and the pineal is apparently inactive. These seasonal pineal changes may be related to the natural photoperiod and the gradual exposure to twilight during the long daylight summer period. This photic information may be expressed as changes in the sympathetic tone of the pineal. The vizcacha and rat's pineals may also influence on the pituitary pars intermedia secretion to respond as photoreceptors in the mechanism of adaptation to the natural photoperiod.