Outcomes, toxicity profiles, and prognostic factors of unresectable head and neck cancer treated with chemoradiotherapy

Introduction: Head and neck cancer (HNC) is a heterogeneous group of neoplasms that can have a poor prognosis when diagnosed in advanced stages. The optimized treatment for locally advanced and unresectable lesions is mainly based on radiotherapy associated with chemotherapy (cisplatin 100mg/m²), however, at the expense of a high toxicity index. Objective: Evaluate whether chemoradiotherapy (CRT) ­ the goldstandard treatment for locally advanced head and neck cancer (HNC) ­ is effective in the study population. Methods: This is a retrospective study aimed at determining the efficacy of definitive CRT in patients with unresectable HNC treated between the 2012 and 2018 in a single institution. The following outcomes were evaluated: objective response rate (ORR), progression-free survival (PFS), overall survival (OS), and toxicity profiles. Results: Fifty-two (52) patients diagnosed with HNC between 2012 and 2018 met the inclusion criteria. The ORR was 84.6%, with 50% showing complete response. Median PFS and OS were 35.3 and 52 months, respectively. Analysis of the toxicity profiles revealed that 69.2% of the patients presented grade 3-4 toxicity. Completion of two or more cycles of cisplatin-based therapy (HR 3.57 [95% CI 1.25­10.25]; p p<0.001), grade 3-4 toxicity (HR 0.27 [95% CI 0.09-0.8] ­ p<0.02), and Charlson comorbidity index (CCI) (HR 3.23 [95% CI 1.26­8.29]; p<0.001) were significantly associated with survival. Regarding toxicity, prophylactic low-level laser therapy (HR 0.48 [95% CI 0.27­0.86]; p<0.001 for those without this practice) and body mass index (BMI) (HR 0.27 [95% CI 0.09­0.76]; p<0.01) showed statistical significance. Conclusion: CRT was effective to treat HNC in the study population, with PFS and OS comparable to those reported in larger sample studies and lower toxicity grade. Some clinical characteristics have been identified as prognostic and/or predictive factors.

Factors influencing terrestriality in primates of the Americas and Madagascar.

Among mammals, the order Primates is exceptional in having a high taxonomic richness in which the taxa are arboreal, semiterrestrial, or terrestrial. Although habitual terrestriality is pervasive among the apes and African and Asian monkeys (catarrhines), it is largely absent among monkeys of the Americas (platyrrhines), as well as galagos, lemurs, and lorises (strepsirrhines), which are mostly arboreal. Numerous ecological drivers and species-specific factors are suggested to set the conditions for an evolutionary shift from arboreality to terrestriality, and current environmental conditions may provide analogous scenarios to those transitional periods. Therefore, we investigated predominantly arboreal, diurnal primate genera from the Americas and Madagascar that lack fully terrestrial taxa, to determine whether ecological drivers (habitat canopy cover, predation risk, maximum temperature, precipitation, primate species richness, human population density, and distance to roads) or species-specific traits (body mass, group size, and degree of frugivory) associate with increased terrestriality. We collated 150,961 observation hours across 2,227 months from 47 species at 20 sites in Madagascar and 48 sites in the Americas. Multiple factors were associated with ground use in these otherwise arboreal species, including increased temperature, a decrease in canopy cover, a dietary shift away from frugivory, and larger group size. These factors mostly explain intraspecific differences in terrestriality. As humanity modifies habitats and causes climate change, our results suggest that species already inhabiting hot, sparsely canopied sites, and exhibiting more generalized diets, are more likely to shift toward greater ground use.

Sintomas depressivos e fatores associados à pessoa idosa durante a pandemia da covid-19 na cidade de São Paulo-SP / Depressive symptoms and associated factors in older people during the COVID-19 pandemic in the city of São Paulo-SP

Resumo Objetivo Determinar a presença de sintomas depressivos e seus fatores associados no idoso que vive na cidade de São Paulo durante o isolamento da pandemia da covid-19. Método Trata-se de um estudo quantitativo, descritivo e transversal realizado com 411 idosos, que vivem na cidade de São Paulo. Foram utilizados os instrumentos de perfil demográfico, Escala de Depressão Geriátrica e listagem de sintomas físicos, psicológicos e uso de substâncias. Resultados Identificou-se predomínio do sexo feminino, entre 60 e 69 anos, com companheiro, estudo superior, e sem alteração da renda. Ademais, não ter companheiro (p=0,02), sintomas psicológicos como falta de esperança (p=0,001), medo (p=0,008) e vontade de morrer (p=0,003), e sintomas físicos como tremor (p=0,003) e cansaço (p<0,001) foram associados com sintomas depressivos. Por outro lado, não usar substâncias ilegais (p=0,03) foi considerado um fator protetor à presença desses sintomas. Conclusão É necessário estar alerta a quaisquer sinais ou sintomas que possam indicar algum sofrimento mental, sugerindo-se a adoção de medidas de socialização.

Abstract Objective To determine the presence of depressive symptoms and their associated factors in the elderly living in the city of São Paulo during the isolation of the covid-19 pandemic. Method This is a quantitative, descriptive and cross-sectional study carried out with 411 elderly people living in the city of São Paulo. Demographic profile instruments, the Geriatric Depression Scale and a list of physical and psychological symptoms and substance use were used. Results There was a predominance of females, between 60 and 69 years old, with a partner, higher education, and with no change in income. In addition, not having a partner (p=0,02), psychological symptoms such as lack of hope (p=0,001), fear (p=0,008) and desire to die (p=0,003), and physical symptoms such as tremor (p=0,03) and tiredness (p<0,0001) were associated with depressive symptoms. On the other hand, not using illegal substances (p=0,03) was considered a protective factor against the presence of these symptoms. Conclusion It is necessary to be alert to any signs or symptoms that may indicate some mental suffering, suggesting the adoption of socialization measures.

Mixed-species associations in cuxiús (genus Chiropotes).

Polyspecific or mixed-species associations, where two or more species come together to forage and travel as a unit, have been reported in many primate species. These associations appear to offer a number of benefits to the species involved including increased foraging efficiency and decreased risk of predation. While several researchers have suggested that cuxiús (genus Chiropotes) form mixed-species associations, previous studies have not identified the circumstances under which cuxiús form associations or whether they form associations more often than would be expected by chance. Here we present data on the formation of mixed-species associations by four species of cuxiús at eight different sites in Brazil, Suriname, and Guyana. We analyzed data from two of the study sites, (Biological Dynamics of Forest Fragments Project (BDFFP), Brazil and the Upper Essequibo Conservation Concession (UECC), Guyana, to assess whether associations occurred more than would be expected by chance encounters and identify the factors influencing their formation. Cuxiús showed a high degree of inter-site variation in the frequency of time spent in association (ranging from 2 to 26% of observation time) and duration of associations (mean duration from 22 min to 2.5 hr). Sapajus apella was the most common association partner at most sites. At BDFFP, cuxiús formed associations more frequently but not for longer duration than expected by chance. For much of the year at UECC, associations were not more frequent or longer than chance. However, during the dry season, cuxiús formed associations with S. apella significantly more often and for longer duration than predicted by chance. Cuxiús at UECC formed associations significantly more often when in smaller subgroups and when foraging for insects, and alarm called significantly less frequently during associations. We suggest cuxiús form mixed-species associations at some sites as an adaptive strategy to decrease predation risk and/or increase foraging efficiency.