Biological treatments in childhood asthma.

PURPOSE OF REVIEW: The aim is to update the information currently available for the use of biologics in severe asthma in children, in order to facilitate their prescription as far as possible. RECENT FINDINGS: The appearance of biologics for the treatment of severe asthma has meant a revolutionary change in the therapeutic approach to this disease. Currently, five biologics have been approved for severe asthma in children and/or adolescents by the regulatory agencies: omalizumab, mepolizumab, benralizumab, dupilumab and tezepelumab. But despite their positive results in terms of efficacy, there are still relevant points of debate that should induce caution when selecting the most appropriate biologic in a child with severe asthma. Indeed, safety is essential and, for several of the existing treatments, the availability of medium-term to long-term data in this regard is scarce. SUMMARY: The use of biologics can facilitate the therapeutic paradigm shift from pleiotropic treatments to personalized medicine. However, the choice of the most appropriate biologics remains a pending issue. On the other hand, to the extent that several of the biologics have been available for a relatively short time, the most robust evidence in terms of efficacy and safety in children is that of omalizumab.

Advances in Immunotherapy for Malignant Pleural Mesothelioma: From Emerging Strategies to Translational Insights.

MPM stands as a rare malignancy necessitating improved therapeutic strategies due to its limited treatment choices and unfavorable prognosis. The advent of immune checkpoint inhibitors has heralded a paradigm shift in the therapeutic landscape of MPM, offering promising avenues across diverse clinical scenarios. In the context of advanced stages of the disease, Immune check-point inhibitors targeting programmed cell death protein 1 (PD-1) and cytotoxic T-lymphocyte-as-sociated protein 4 (CTLA-4), have exhibited encouraging potential in clinical trials, particularly manifesting efficacy among patients exhibiting disease progression following chemotherapy regimens. Innovative combination regimens, exemplified by the concurrent administration of nivolumab and ipilimumab, have demonstrated marked improvement in survival and patient's benefits. A deeper comprehension of the intricate genetic underpinnings of MPM, encompassing key mutations such as cyclin-dependent kinase inhibitor 2A (CDKN2A), neurofibromin 2 (NF2), and BRCA1-associated protein 1 (BAP1) mutations, has elucidated novel avenues for targeted therapeutic interventions. This review accentuates the transformative capacity of immunotherapy in revolutionizing the therapeutic outlook for MPM, thereby potentially translating into augmented survival rates and offering glimpses of new approaches on the horizon. Despite the persisting challenges, the synergistic crossroads of interdisciplinary research and collaborative clinical endeavors portend a hopeful landscape for MPM treatment.

El mesotelioma pleural maligno (MPM) es una neoplasia poco frecuente que requiere una mejora de las estrategias terapéuticas debido a sus limitadas opciones de tratamiento y a su pronóstico desfavorable. La llegada de los inhibidores de los puntos de control inmunitario ha supuesto un cambio de paradigma en el panorama terapéutico del MPM, ofreciendo vías prometedoras en diversos escenarios clínicos. En el contexto de los estadios avanzados de la enfermedad, los inhibidores de puntos de control inmunitario dirigidos contra la proteína de muerte celular programada 1 (PD-1) y la proteína 4 asociada a los linfocitos T citotóxicos (CTLA-4) han mostrado un potencial alentador en los ensayos clínicos, sobre todo por su eficacia en los pacientes con progresión de la enfermedad tras los regímenes de quimioterapia. Los regímenes combinados innovadores, ejemplificados por la administración concurrente de nivolumab e ipilimumab, han demostrado una mejora significativa de la supervivencia y de los beneficios para los pacientes. Una comprensión más profunda de los complejos fundamentos genéticos del MPM, que abarca mutaciones clave como el inhibidor de la cinasa dependiente de ciclina 2A (CDKN2A), la neurofibromina 2 (NF2) y las mutaciones de la proteína 1 asociada a BRCA1 (BAP1), ha dilucidado nuevas vías para el desarrollo de intervenciones terapéuticas dirigidas. Esta revisión acentúa la capacidad transformadora de la inmunoterapia para revolucionar las perspectivas terapéuticas en el MPM, lo que podría traducirse en un aumento de las tasas de supervivencia y ofrecer nuevos enfoques terapéuticos en el horizonte próximo. A pesar de los retos persistentes, el cruce sinérgico de la investigación interdisciplinar y los esfuerzos clínicos de colaboración auguran un panorama esperanzador en el tratamiento de los MPM.

Multidisciplinary approach for locally advanced non-small cell lung cancer (NSCLC): 2023 expert consensus of the Spanish Lung Cancer Group GECP.

INTRODUCTION: Recent advances in the treatment of locally advanced NSCLC have led to changes in the standard of care for this disease. For the selection of the best approach strategy for each patient, it is necessary the homogenization of diagnostic and therapeutic interventions, as well as the promotion of the evaluation of patients by a multidisciplinary oncology team. OBJECTIVE: Development of an expert consensus document with suggestions for the approach and treatment of locally advanced NSCLC leaded by Spanish Lung Cancer Group GECP. METHODS: Between March and July 2023, a panel of 28 experts was formed. Using a mixed technique (Delphi/nominal group) under the guidance of a coordinating group, consensus was reached in 4 phases: 1. Literature review and definition of discussion topics 2. First round of voting 3. Communicating the results and second round of voting 4. Definition of conclusions in nominal group meeting. Responses were consolidated using medians and interquartile ranges. The threshold for agreement was defined as 85% of the votes. RESULTS: New and controversial situations regarding the diagnosis and management of locally advanced NSCLC were analyzed and reconciled based on evidence and clinical experience. Discussion issues included: molecular diagnosis and biomarkers, radiologic and surgical diagnosis, mediastinal staging, role of the multidisciplinary thoracic committee, neoadjuvant treatment indications, evaluation of response to neoadjuvant treatment, postoperative evaluation, and follow-up. CONCLUSIONS: Consensus clinical suggestions were generated on the most relevant scenarios such as diagnosis, staging and treatment of locally advanced lung cancer, which will serve to support decision-making in daily practice.

Outcomes of Surgery for Metachronous Second Primary Non-small Cell Lung Cancer

Objective: The optimal surgical approach for second primary metachronous lung cancer (MPLC) remains unclear. Our aim is to evaluate the morbidity and prognostic value based on the extent of surgical resection in MPLC. Methods: Retrospective study of 84 patients with a history of anatomical resection for lung cancer and MPLC surgically treated between January 2010 and December 2020. Results: The interval between the initial primary tumor and the second was 50.38±32.89 months. The second resection was contralateral in 43 patients (51.2%) and ipsilateral in 41 (48.8%). Thirty-six patients (42.9%) underwent a second anatomical resection, and in 48 patients (57.1%), it was non-anatomical. Postoperative complications were observed in 29 patients (34.5%) after the second lung resection. According to the Clavien-Dindo classification, 95.2% were mild (Clavien-Dindo I–II), and a single patient died (1.2%) in the postoperative period (Grade V). Prolonged air leak (p=0.037), postoperative arrhythmias (p=0.019) and hospital stay showed significant differences depending on the extent of surgery in ipsilateral resections. The main histological type was adenocarcinoma (47.6%) and the median tumor size was 17.74±11.74mm. The overall survival was 58.07 months (95% CI 49.29–66.85) for patients undergoing anatomical resection and 50.97 months (95% CI 43.31–58.63) for non-anatomical without significant differences (p=0.144). The disease-free survival after the second surgery was 53.75 months (95% CI 45.28–62.23) for anatomical resection and 41.34 months (95% CI 33.04–49.65) for non-anatomical group. Conclusion: Second anatomical resections provide good long-term outcomes and have been shown to provide better disease-free survival compared to non-anatomical resections in properly selected patients. (AU)

[Questions and Answers in Lung Cancer]. / Preguntas y respuestas en cáncer de pulmón.

Over the past 2 decades, scientific evidence has strongly supported the use of low-radiation dose chest computed tomography (CT) as a screening technique for lung cancer. This approach has resulted in a significant reduction in mortality rates by enabling the detection of early-stage lung cancer amenable to potentially curative treatments. Regarding diagnosis, there are also novel methods under study, such as liquid biopsy, identification of the pulmonary microbiome, and the use of artificial intelligence techniques, which will play a key role in the near future. At present, there is a growing trend towards less invasive surgical procedures, such as segmentectomy, as an alternative to lobectomy. This procedure is based on 2 recent clinical trials conducted on peripheral tumors measuring less than 2 cm. Although these approaches have demonstrated comparable survival rates, there remains controversy due to uncertainties surrounding recurrence rates and functional capacity preservation. With regard to adjuvant therapy, immunotherapy, either as a monotherapy or in conjunction with chemotherapy, has shown encouraging results in resectable stages of locally advanced lung cancer, demonstrating complete pathologic responses and improved overall survival.After surgery treatment, despite the lack of solid evidence for long-term follow-up of these patients, clinical practice recommends periodic CT scans during the early years.In conclusion, there have been significant advances in lung cancer that have improved diagnostic techniques using new technologies and screening programs. Furthermore, the treatment of lung cancer is increasingly personalized, resulting in an improvement in the survival of patients.

Outcomes of Surgery for Metachronous Second Primary Non-small Cell Lung Cancer.

OBJECTIVE: The optimal surgical approach for second primary metachronous lung cancer (MPLC) remains unclear. Our aim is to evaluate the morbidity and prognostic value based on the extent of surgical resection in MPLC. METHODS: Retrospective study of 84 patients with a history of anatomical resection for lung cancer and MPLC surgically treated between January 2010 and December 2020. RESULTS: The interval between the initial primary tumor and the second was 50.38±32.89 months. The second resection was contralateral in 43 patients (51.2%) and ipsilateral in 41 (48.8%). Thirty-six patients (42.9%) underwent a second anatomical resection, and in 48 patients (57.1%), it was non-anatomical. Postoperative complications were observed in 29 patients (34.5%) after the second lung resection. According to the Clavien-Dindo classification, 95.2% were mild (Clavien-Dindo I-II), and a single patient died (1.2%) in the postoperative period (Grade V). Prolonged air leak (p=0.037), postoperative arrhythmias (p=0.019) and hospital stay showed significant differences depending on the extent of surgery in ipsilateral resections. The main histological type was adenocarcinoma (47.6%) and the median tumor size was 17.74±11.74mm. The overall survival was 58.07 months (95% CI 49.29-66.85) for patients undergoing anatomical resection and 50.97 months (95% CI 43.31-58.63) for non-anatomical without significant differences (p=0.144). The disease-free survival after the second surgery was 53.75 months (95% CI 45.28-62.23) for anatomical resection and 41.34 months (95% CI 33.04-49.65) for non-anatomical group. CONCLUSION: Second anatomical resections provide good long-term outcomes and have been shown to provide better disease-free survival compared to non-anatomical resections in properly selected patients.

Epidemiological impacts of attenuated African swine fever virus circulating in wild boar populations.

African swine fever virus (ASFV) genotype II has been present in wild boar in the European Union since 2014. Control measures have reduced the incidence of the ASF, but highly virulent as well as attenuated ASFV strains continue to circulate. We present the intraherd epidemiological parameters of low and highly virulent ASFV in wild boar from experimental data, and for the first time, evaluate the impact of attenuated strain circulation through unique deterministic compartmental model simulations under various potential scenarios and hypotheses. Using an estimated PCR infectious threshold of TPCR = 36.4, we obtained several transmission parameters, like an Rx (experimental intraherd R0) value of 4.5. We also introduce two novel epidemiological parameters: infectious power and resistance power, which indicate the ability of animals to transmit the infection and the reduction in infectiousness after successive exposures to varying virulence strains, respectively. The presence of ASFV attenuated strains results in 4-17% of animals either remaining in a carrier state or becoming susceptible again when exposed to highly virulent ASFV for more than two years. The timing between exposures to viruses of different virulence also influences the percentage of animals that die or remain susceptible. The findings of this study can be utilized in epidemiological modelling and provide insight into important risk situations that should be considered for surveillance and future potential ASF vaccination strategies in wild boar.

Disentangling the role of virus infectiousness and awareness-based human behavior during the early phase of the COVID-19 pandemic in the European Union.

In this work, we manage to disentangle the role of virus infectiousness and awareness-based human behavior in the COVID-19 pandemic. Using Bayesian inference, we quantify the uncertainty of a state-space model whose propagator is based on an unusual SEIR-type model since it incorporates the effective population fraction as a parameter. Within the Markov Chain Monte Carlo (MCMC) algorithm, Unscented Kalman Filter (UKF) may be used to evaluate the likelihood approximately. UKF is a suitable strategy in many cases, but it is not well-suited to deal with non-negativity restrictions on the state variables. To overcome this difficulty, we modify the UKF, conveniently truncating Gaussian distributions, which allows us to deal with such restrictions. We use official infection notification records to analyze the first 22 weeks of infection spread in each of the 27 countries of the European Union (EU). It is known that such records are the primary source of information to assess the early evolution of the pandemic and, at the same time, usually suffer underreporting and backlogs. Our model explicitly accounts for uncertainty in the dynamic model parameters, the dynamic model adequacy, and the infection observation process. We argue that this modeling paradigm allows us to disentangle the role of the contact rate, the effective population fraction, and the infection observation probability across time and space with an imperfect first principles model. Our findings agree with phylogenetic evidence showing little variability in the contact rate, or virus infectiousness, across EU countries during the early phase of the pandemic, highlighting the advantage of incorporating the effective population fraction into pandemic modeling for heterogeneity in both human behavior and reporting. Finally, to evaluate the consistency of our data assimilation method, we performed a forecast that adequately fits the actual data. Statement of significance: Data-driven and model-based epidemiological studies aimed at learning the number of people infected early during a pandemic should explicitly consider the behavior-induced effective population effect. Indeed, the non-isolated, or effective, fraction of the population during the early phase of the pandemic is time-varying, and first-principles modeling with quantified uncertainty is imperative for an adequate analysis across time and space. We argue that, although good inference results may be obtained using the classical SEIR type model, the model posed in this work has allowed us to disentangle the role of virus infectiousness and awareness-based human behavior during the early phase of the COVID-19 pandemic in the European Union from official infection notification records.

Cost-effectiveness of omalizumab for the treatment of severe pediatric allergic asthma-Results of a real-life study in Spain.

BACKGROUND: Severe pediatric allergic asthma (SPAA) induces a huge economic burden in terms of direct, indirect, and intangible costs. The use of omalizumab for the treatment of these patients has produced a significant improvement in several clinical outcomes, but at the same time, the cost for the management of the disease has also increased. The aim of this report was to evaluate whether the use of omalizumab is cost-effective. METHODS: A sample of 426 children with SPAA from the ANCHORS (Asthma iN CHildren: Omalizumab in Real-life in Spain) study was used to calculate the incremental cost-effectiveness ratio (ICER) for the avoidance of moderate-to-severe exacerbations (MSE) and also for the improvement in childhood Asthma Control Test (c-ACT) or the Asthma Control Questionnaire (ACQ5). We retrospectively collected data on health encounters and drug consumption before and up to 6 years after the beginning of the treatment with omalizumab. RESULTS: The ICER per avoided MSE was €2107 after 1 year, and it consistently decreased to €656 in those followed up to 6 years. Similarly, the ICER for the minimally important difference in control tests showed a decrease from €2059 to €380 per each 0.5 points of improvement in ACQ5 and from €3141 to €2322 per each 3 points improvement in c-ACT, at years 1 and 6, respectively. CONCLUSION: The use of OMZ is a cost-effective option for most children with uncontrolled SPAA, especially those who have frequent exacerbations; the costs are progressively reduced in successive years of treatment.

Propiedades psicométricas del cuestionario de actitudes hacia la práctica de actividad físico-deportiva orientada a la salud en adolescentes peruanos / Propriedades psicométricas do Questionário de Atitudes em relação à Prática da Actividade Físico-Sportiva Orientada para a Saúde em adolescentes peruanos / Psychometric properties of the Questionnaire of Attitudes towards the Practice of Health-Oriented Physical-Sports Activity in Peruvian adolescents

Las actitudes predicen el compromiso hacia la práctica de actividad físico-deportiva. Cuanto más se conozcan, mejor será la predicción de los posibles hábitos que las personas adoptarán. Por tanto, es necesario contar con un instrumento que evidencie validez y fiabilidad, especialmente para adolescentes, ya que la adolescencia constituye una etapa fundamental en la adopción de estilos de vida saludables. El objetivo de esteestudio fue analizar las propiedades psicométricas del Cuestionario de Actitudes hacia la Práctica de Actividad Físico-Deportiva Orientada a la Salud (CAAFS) en adolescentes peruanos. Se trata de un estudio descriptivo transversal en el que participaron 1314 adolescentes de edades entre 13 y 19 años (15.59±1.05 años), conformados por 716 hombres y 598 mujeres provenientes de Lima y Callao, Perú. Mediante el software R versión 4.1.0., se efectuó la validez de constructo (Análisis Factorial Exploratorio [AFE] y el Análisis Factorial Confirmatorio [AFC]) y el cálculo de fiabilidad. Los resultados del AFE arrojaron un modelo con tres factores del CAAFS, que explica el 35 % de la varianza total. El AFC reportó un buen ajuste del modelo de tres factores del CAAFSde 19 ítems (Chi-cuadrado sobre los grados de libertad = 2.38; error de aproximacióncuadrático medio = .046; residuo cuadrático medio estandarizado = .060; índice de ajuste comparativo = .940; índice de Tuker-Lewis = .931). El coeficiente de fiabilidad Omega reportó un valor de .77. Finalmente se demostró que el CAAFS de 19 ítems evidencia validez y fiabilidad; por lo tanto, el cuestionario puede ser aplicado en adolescentes del contexto peruano. (AU)

Attitudes predict commitment to the practice of physical-sporting activity. The more they are known, the better the prediction of the possible habits that people will adopt. Therefore, it is necessary to havean instrument that shows validity and reliability, especially for adolescents, since adolescence is a fundamental stage in the adoption of healthy lifestyles. The aim of this study was to analyze the psychometric properties of the Questionnaire of Attitudes towards the Practice of Health-Oriented Physical-Sports Activity (CAAFS) in Peruvian adolescents. This was a descriptive cross-sectional study in which 1314 adolescents aged 13 to 19 years (15.59±1.05 years), made up of 716 males and 598 females from Lima and Callao, Peru, participated. Using R software version 4.1.0, construct validity (Exploratory Factor Analysis [EFA] and Confirmatory Factor Analysis [CFA]) and reliability calculation were performed. The results of the EFA yielded a three-factor modelof the CAAFS, which explains 35% of the total variance. The AFC reported a good fit of the 19-item CAAFS three-factor model (Chi-square over degrees of freedom = 2.38; root mean square error of approximation = .046; standardized root mean square residual = .060; comparative fit index = .940; Tuker-Lewis index = .931). The Omega reliability coefficient reported a value of .77. Finally, it was demonstrated that the 19-item CAAFS shows validity and reliability; therefore, the questionnaire can be applied to adolescents in the Peruvian context. (AU)

As atitudes prevêem o compromisso com a actividade física e o desporto. Quanto mais forem conhecidos, melhor será a previsão dos possíveis hábitos que as pessoas irão adoptar. Por conseguinte, é necessário ter um instrumento que demonstre validade e fiabilidade, especialmente para os adolescentes, uma vez que a adolescência é uma fase chave na adopção de estilos de vida saudáveis. O objectivo deste estudo era analisar as propriedades psicométricas do Questionário de Atitudes para a Prática da Actividade Físico-Sportiva Orientada para a Saúde (CAAFS) em adolescentes peruanos. Este foi um estudo transversal descritivo envolvendo 1314 adolescentes com idades compreendidas entre 13-19 anos (15,59±1,05 anos), compreendendo 716 homens e 598 mulheres de Lima e Callao, Peru. Utilizando o software R versão 4.1.0, foram efectuados cálculos de validade de construção (Análise Exploratória de Factores [EFA] e Análise Confirmativa de Factores [CFA]) e de fiabilidade. Os resultados da AAE produziram um modelo de três factores do CAAFS, o que explica 35% da variação total. O CFA relatou um bom ajuste do modelo de três factores CAAFS de 19 itens (Qui-quadrado sobre graus de liberdade = 2,38; erro quadrático médio de aproximação = 0,046; raiz média quadrada residual padronizada = 0,060; índice de ajuste comparativo = 0,940; índice Tuker-Lewis = 0,931). O coeficiente de fiabilidade ómega comunicou um valor de 0,77. Finalmente, foi demonstrado que o CAAFS de 19 itens mostra validade e fiabilidade; por conseguinte, o questionário pode ser aplicado aos adolescentes no contexto peruano. (AU)

Las actitudes y autoconcepto físico como condicionantes de la práctica de actividad física / Atitudes e autoconceito físico como determinantes da prática da actividade física / Attitudes and physical self-concept as determinants of physical activity practice

La práctica habitual de actividad física (AF) en la adolescencia es elemental para gozar de buena salud a lo largo de la vida; por tanto, estudiar las variables que condicionan el comportamiento de esta es de gran importancia para reforzar o modificar oportunamente la conducta a fin de garantizar una sociedad más saludable. En ese sentido, el objetivo principal este estudio fue examinar la correlación y relación entre las actitudes y el autoconcepto físico con la práctica de AF en adolescentes peruanos. Se trata de una investigación empírica de corte asociativo en el que participaron 1264 escolares con edades entre 14 y 17 años (15.51±.94), provenientes de instituciones públicas y privadas de Lima y Callao, Perú, a quienes se les aplicó un cuestionario sociodemográfico, un cuestionario de actitudes hacia la práctica de actividad físico-deportiva, un cuestionario de autoconcepto físico y un inventario de actividad física habitual. Los resultados, en primer lugar, evidenciaron que la mayor puntuación de correlación entre las variables estudiadas se dio entre actitudes y práctica de AF (.511), que fue corroborada por un tamaño del efecto grande (.25). En segundo lugar, se encontró que el 25.1 % de la variabilidad de la práctica se debe a los cambios en las actitudes y el autoconcepto físico. Además, según el análisis de regresión múltiple el modelo planteado resultó ser válido (y = - .560 + .894x1+0.94x2). Así, por un lado, se explica que por cada punto que se aumenta en actitudes (x1), la práctica de AF aumenta .894 en promedio, manteniendo constante el autoconcepto físico (x2); por otro lado, por cada punto que se aumenta en autoconcepto físico (x2), la práctica de AF aumenta .94 en promedio, manteniendo constante las actitudes (x1). En conclusión, se demuestra que las actitudes y/o el autoconcepto físico de los adolescentes condicionan la práctica de AF. (AU)

The regular practice of physical activity (PA) in adolescence is essential for good health throughout life; therefore, studying the variables that condition PA behavior is of great importance to reinforce or modify behavior in a timely manner in order to guarantee a healthier society. In this sense, the main objective of this study was to examine the correlation and relationship between attitudes and physical self-concept with PA practice in Peruvian adolescents. This is an empirical research of an associative nature in which 1264 schoolchildren aged between 14 and 17 years (15.51±.94), from public and private institutions in Lima and Callao, Peru, participated in a sociodemographic questionnaire, a questionnaire of attitudes towards the practice of physical-sports activity, a physical self-concept questionnaire and an inventory of habitual physical activity. The results, firstly, showed that the highest correlation score between the variables studied was between attitudes and PA practice (.511), which was corroborated by a large effect size (.25). Second, 25.1 % of the variability in practice was found to be due to changes in attitudes and physical self-concept. In addition, according to the multiple regression analysis, the model proposed proved to be valid (y = -.560 + .894x1+0.94x2). Thus, on the one hand, it is explained that for eachpoint that is increased in attitudes (x1), PApractice increases .894 on average, keeping physical self-concept constant (x2); on the other hand, for each point thatis increased in physical self-concept (x2), PA practice increases .94 on average, keepingattitudes constant (x1). In conclusion, it isshown that the attitudes and/or physical self-concept of adolescents condition PA practice. (AU)

A prática regular da actividade física (AF) na adolescência é essencial para uma boa saúde ao longo da vida; por conseguinte, o estudo das variáveis que condicionam o comportamento da AF é de grande importância para reforçar ou modificar o comportamento de forma atempada, a fim de assegurar uma sociedade mais saudável. Neste sentido, o principal objectivo deste estudo era examinar a correlação e relação entre as atitudes e o autoconceito físico com a prática de AP em adolescentes peruanos. Trata-se de uma investigação empírica de natureza associativa na qual participaram 1264 alunos com idades compreendidas entre os 14 e os 17 anos (15,51±,94) de instituições públicas e privadas em Lima e Callao, Peru. Foi-lhes administrado um questionário sócio-demográfico, um questionário de atitudes relativamente à prática da actividade físico-desportiva, um questionário de auto-conceito físico e um inventário da actividade física habitual. Os resultados, em primeiro lugar, mostraram que a maior pontuação de correlação entre as variáveis estudadas foi entre as atitudes e a prática de AF (.511), o que foi corroborado por uma grande dimensão de efeito (.25). Em segundo lugar, verificou-se que 25,1% da variabilidade na prática era devida a mudanças de atitudes e autoconceito físico. Além disso, de acordo com a análise de regressão múltipla, o modelo foi considerado válido (y = -.560+ .894x1+0,94x2). Assim, por um lado, explica-se que para cada ponto que é aumentado em atitudes (x1), a prática de PA aumenta .894 em média, mantendo constante o autoconceito físico (x2); por outro lado, para cada ponto que é aumentado em autoconceito físico (x2), a prática de PA aumenta .94 em média, mantendo constantes as atitudes (x1). Em conclusão, é demonstrado que as atitudes e/ou o autoconceito físico dos adolescentes condicionam a prática de AP. (AU)

Higher plasma levels of thymosin-α1 are associated with a lower waning of humoral response after COVID-19 vaccination: an eight months follow-up study in a nursing home.

BACKGROUND: Older people achieve lower levels of antibody titers than younger populations after Covid-19 vaccination and show a marked waning humoral immunity over time, likely due to the senescence of the immune system. Nevertheless, age-related predictive factors of the waning humoral immune response to the vaccine have been scarcely explored. In a cohort of residents and healthcare workers from a nursing home that had received two doses of the BNT162b2 vaccine, we measured specific anti-S antibodies one (T1), four (T4), and eight (T8) months after receiving the second dose. Thymic-related functional markers, including thymic output, relative telomere length, and plasma thymosin-α1 levels, as well as immune cellular subsets, and biochemical and inflammatory biomarkers, were determined at T1, and tested for their associations with the magnitude of the vaccine response (T1) and the durability of such response both, at the short- (T1-T4) and the long-term (T1-T8). We aimed to identify age-related factors potentially associated with the magnitude and persistence of specific anti-S immunoglobulin G (IgG)-antibodies after COVID-19 vaccination in older people. RESULTS: Participants (100% men, n = 98), were subdivided into three groups: young (< 50 years-old), middle-age (50-65 years-old), and older (≥65 years-old). Older participants achieved lower antibody titers at T1 and experienced higher decreases in both the short- and long-term. In the entire cohort, while the magnitude of the initial response was mainly associated with the levels of homocysteine [ß (95% CI); - 0.155 (- 0.241 to - 0.068); p = 0.001], the durability of such response at both, the short-term and the long-term were predicted by the levels of thymosin-α1 [- 0.168 (- 0.305 to - 0.031); p = 0.017, and - 0.123 (- 0.212 to - 0.034); p = 0.008, respectively]. CONCLUSIONS: Higher plasma levels of thymosin-α1 were associated with a lower waning of anti-S IgG antibodies along the time. Our results suggest that plasma levels of thymosin-α1 could be used as a biomarker for predicting the durability of the responses after COVID-19 vaccination, possibly allowing to personalize the administration of vaccine boosters.

Factors associated with the humoral response after three doses of COVID-19 vaccination in kidney transplant recipients.

Introduction: Kidney transplant recipients showed a weak humoral response to the mRNA COVID-19 vaccine despite receiving three cumulative doses of the vaccine. New approaches are still needed to raise protective immunity conferred by the vaccine administration within this group of high-risk patients. Methods: To analyze the humoral response and identify any predictive factors within these patients, we designed a prospective monocentric longitudinal study of Kidney transplant recipients (KTR) who received three doses of mRNA-1273 COVID-19 vaccine. Specific antibody levels were measured by chemiluminescence. Parameters related to clinical status such as kidney function, immunosuppressive therapy, inflammatory status and thymic function were analyzed as potential predictors of the humoral response. Results: Seventy-four KTR and sixteen healthy controls were included. One month after the administration of the third dose of the COVID-19 vaccine, 64.8% of KTR showed a positive humoral response. As predictive factors of seroconversion and specific antibody titer, we found that immunosuppressive therapy, worse kidney function, higher inflammatory status and age were related to a lower response in KTR while immune cell counts, thymosin-a1 plasma concentration and thymic output were related to a higher humoral response. Furthermore, baseline thymosin-a1 concentration was independently associated with the seroconversion after three vaccine doses. Discussion: In addition to the immunosuppression therapy, condition of kidney function and age before vaccination, specific immune factors could also be relevant in light of optimization of the COVID-19 vaccination protocol in KTR. Therefore, thymosin-a1, an immunomodulatory hormone, deserves further research as a potential adjuvant for the next vaccine boosters.

Presbycusis and balance disorders in the elderly. Bibliographical review of ethiopathogenic aspects, consequences on quality of life and positive effects of its treatment.

At this time, we still do not have adequate knowledge and awareness of the consequences of hearing loss in the elderly on quality of life. Similarly, there is also insufficient information on the relationship of presbycusis and balance disorders with other comorbidities. Such knowledge can contribute to improve both prevention and treatment of these pathologies, to reduce their impact on other areas such as cognition or autonomy, as well as to have more accurate information on the economic impact they generate in society and in the health system. Therefore, with this review article we aim to update the information on the type of hearing loss and balance disorders in people over 55 years of age, and their associated factors; to analyze the impact on the quality of life of these people and the one which can be generated at a personal and population level (both sociological and economic) if an early intervention in these patients is pursued.