Estimating 12-week death probability in patients with refractory metastatic colorectal cancer: the Colon Life nomogram.

Background: Regorafenib and TAS-102 have recently demonstrated statistically significant survival gains in patients with refractory metastatic colorectal cancer (mCRC). Life expectancy ≥12 weeks was an inclusion criterion in registrative trials, and the identification of proper clinical selection tools for the daily use of these drugs in heavily pre-treated patients is needed to improve the cost-benefit ratio. We aimed at building a nomogram able to predict death probability within 12 weeks from the date of assessment of refractory mCRC. Patients and methods: Four hundred eleven refractory mCRC patients with ECOG performance status (PS) ≤2 receiving regorafenib, TAS-102 or other treatments were used as developing set. Putative prognostic variables were selected using a random forest model and included in a binary logistic model from which the nomogram was developed. The nomogram was externally validated and its performance was evaluated by examining calibration (how close predictions were to the actual outcome) and discriminative ability (Harrell C index) both on developing (internal validation) and validating (external validation) sets. Results: Four variables were selected and included in the nomogram: PS (P < 0.0001), primary tumor resection (P = 0.027), LDH value (P = 0.0001) and peritoneal involvement (P = 0.081). In the developing set, the nomogram discriminative ability was high (C = 0.778), and was confirmed in the validating set (C = 0.778), where the overall outcome was better as a consequence of the enrichment in patients receiving regorafenib or TAS-102 (46% versus 34%; P < 0.0001). Conclusions: Our nomogram may be a useful tool to predict the probability of death within 12 weeks in patients with refractory mCRC. Based on four easy-to-collect variables, the 'Colon Life' nomogram and free app for smartphones may improve mCRC patients' selection for later-line therapies and assist researchers for the enrollment in clinical trials in this setting.

Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with T2 to T4, N0 and N1 breast cancer.

BACKGROUND: Histological status of axillary lymph nodes is an important prognostic factor in patients receiving surgery for breast cancer (BC). Sentinel lymph node (SLN) biopsy (B) has rapidly replaced axillary lymph node dissection (ALND), and is now the standard of care for axillary staging in patients with clinically node-negative (N0) operable BC. The aim of this study is to compare pretreatment lymphoscintigraphy with a post primary systemic treatment (PST) scan in order to reduce the false-negative rates for SLNB. METHODS: In this single-institution study we considered 170 consecutive T2-4 N0-1 M0 BC patients treated with anthracycline-based PST. At the time of incisional biopsy, we performed sentinel lymphatic mapping. After PST, all patients repeated lymphoscintigraphy with the same methodology. During definitive surgery we performed further sentinel lymphatic mapping, SLNB and ALND. RESULTS: The SLN was removed in 158/170 patients giving an identification rate of 92.9% (95% confidence interval (CI) = 88.0-96.3%) and a false-negative rate of 14.0% (95% CI = 6.3-25.8%). SLNB revealed a sensitivity of 86.0% (95% CI = 74.2-93.7%), an accuracy of 94.9% (95% CI = 90.3-97.8%) and a negative predictive value of 92.7% (95% CI = 86.1-96.8%). CONCLUSION: Identification rate, sensitivity and accuracy are in accordance with other studies on SLNB after PST, even after clinically negative node conversion following PST. This study confirms that diagnostic biopsy and neoadjuvant chemotherapy maintain breast lymphatic drainage unaltered.

Ants' role (Hymenoptera: Formicidae) as potential vectors of mycobacteria dispersion / Comportamento de formigas (Hymenoptera: Formicidae) como vetores potenciais de dispersão de micobactérias

Ants are found worldwide playing an important environmental role. Some species are considered as agricultural pests and potential risk to human life and public health acting as pathogens carriers. Ants as Paratrechina longicornis and Camponotus spp. have been found inside hospitals. The aim of this study was the research of mycobacteria in 138 samples of ants (137 Paratrechina longicornis and only one Camponotus spp.) which got into the laboratories of tuberculosis diagnosis. These ants were suspended in sterile saline solution and inoculated into Petragnani and Stonebrink media, incubated at 37° C until 90 days and the isolates were identified as environmental mycobacteria (1 Mycobacterium fortuitum peregrinum, 1 Mycobacterium smegmatis) and 1 Mycobacterium tuberculosis complex. These results showed that ants should also act as mechanical vectors of mycobacteria dissemination in risk environments, reinforcing their significance in public health.

As formigas têm uma distribuição mundial e representam importante papel no ecossistema. Algumas espécies são consideradas pragas para a agricultura e um risco potencial à vida humana e à saúde pública veiculando mecanicamente agentes patogênicos. Formigas como Paratrechina longicornis e Camponotus spp. têm sido encontradas em ambientes hospitalares. O foco do presente estudo foi a identificação de micobactérias em 138 amostras de formigas (137 Paratrechina longicornis e apenas uma Camponotus sp.), que tiveram acesso a áreas de laboratórios de diagnóstico de tuberculose. Essas formigas foram suspensas em solução salina estéril que foi semeada em meios de Petragnani e Stonebrink, incubadas a 37º C por até 90 dias e as estirpes de micobactérias isoladas foram identificadas pelas técnicas clássicas como micobactérias ambientais (sendo 1 Mycobacterium smegmatis, 2 Mycobacterium fortuitum peregrinum e 1 Mycobacterium tuberculosis). Esses resultados mostram que as formigas podem também se constituir vetores de dispersão de micobactérias em ambientes de risco, reforçando sua importância em saúde pública.

Transmission of tuberculosis in an endemic urban setting in Brazil.

SETTING: Two out-patient facilities in São Paulo, Brazil. OBJECTIVE: To study the transmission pattern of tuberculosis (TB) among human immunodeficiency virus (HIV) infected and uninfected persons in a setting endemic for TB. DESIGN: A prospective study comparing HIV-seropositive and -seronegative TB patients identified consecutively between 1 March 1995 and 1 April 1997. The patients were stratified according to their Mycobacterium tuberculosis isolate IS6110 RFLP patterns. Risk factors were sought for infection with an RFLP cluster pattern strain, inferred to represent recent transmission. RESULTS: Fifty-eight (38%) of 151 HIV-seropositive patients and 36 (25%) of 142 HIV-seronegative patients were infected with M. tuberculosis isolates that belonged to cluster patterns (OR 1.84, 95% CI 1.08-3.13). Multidrug-resistant (MDR) strains were isolated from 19 patients, all of whom were HIV seropositive; 12 (63%) of these, and 46 (35%) of 132 drug-susceptible isolates had cluster patterns (OR 3.20, 95% CI 1.08-9.77). CONCLUSION: In a TB-endemic urban setting in Brazil, the proportion of cases resulting from recent transmission appears to be greater among HIV-seropositive than among HIV-seronegative patients. A large proportion of MDR-TB (63%) cases was caused by strains that had cluster RFLP patterns, suggesting recent transmission of already resistant organisms. This type of knowledge regarding TB transmission may help to improve locally appropriate TB control programs.