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1.
Chaos ; 30(4): 041102, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32357675

RESUMEN

In this work, we analyze the growth of the cumulative number of confirmed infected cases by a novel coronavirus (COVID-19) until March 27, 2020, from countries of Asia, Europe, North America, and South America. Our results show that (i) power-law growth is observed in all countries; (ii) by using the distance correlation, the power-law curves between countries are statistically highly correlated, suggesting the universality of such curves around the world; and (iii) soft quarantine strategies are inefficient to flatten the growth curves. Furthermore, we present a model and strategies that allow the government to reach the flattening of the power-law curves. We found that besides the social distancing of individuals, of well known relevance, the strategy of identifying and isolating infected individuals in a large daily rate can help to flatten the power-laws. These are the essential strategies followed in the Republic of Korea. The high correlation between the power-law curves of different countries strongly indicates that the government containment measures can be applied with success around the whole world. These measures are scathing and to be applied as soon as possible.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/transmisión , Modelos Estadísticos , Neumonía Viral/transmisión , Cuarentena/métodos , Asia/epidemiología , Betacoronavirus/crecimiento & desarrollo , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Europa (Continente)/epidemiología , Geografía Médica , Actividades Humanas , Humanos , América del Norte/epidemiología , Pandemias/prevención & control , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Prevalencia , América del Sur/epidemiología
3.
Science ; 368(6487): 136-137, 2020 04 10.
Artículo en Inglés | MEDLINE | ID: mdl-32273458
4.
Zootaxa ; 4741(1): zootaxa.4741.1.1, 2020 Feb 18.
Artículo en Inglés | MEDLINE | ID: mdl-32230226

RESUMEN

This paper presents an updated catalog of all taxa of Leiodidae (s.lat.) reported from the Neotropical Region. Keys are presented for the identification of all subfamilies, tribes, and 62 described genera. Three undescribed genera are included in the keys. A total of 600 valid named species are listed, with type localities, type depositories, synonyms, distributions, and biologies where known, and some unnamed species as recorded in the literature. Many species remain to be described. In this work we formally establish no new synonyms and no new combinations although we may indicate the existence of these; but we add new records for described species, and we make spelling corrections of scientific names, when appropriate. A brief review of distribution patterns is given. The fauna has been derived partly from some Nearctic elements that have penetrated as far south as Bolivia. A few genera in the Neotropical element have penetrated the Nearctic Region as far north as the northern U.S.A. or southeastern Canada. Most of the Neotropical genera are autochthonous. In southern South America there is a diverse Neo-Austral fauna with clear "Transantarctic" relationships to Australia and New Zealand and weakly to southern Africa. Some genera variously occur on other continents.


Asunto(s)
Escarabajos , Animales , América Latina , México , América del Sur , Indias Occidentales
5.
Zootaxa ; 4743(1): zootaxa.4743.1.7, 2020 Feb 24.
Artículo en Inglés | MEDLINE | ID: mdl-32230354

RESUMEN

Two new species of the armored spider genus Tetrablemma O. P.-Cambridge, 1873 from Colombia and Venezuela are herein described and illustrated: Tetrablemma tatacoa sp. nov. from Huila department, Colombia and T. mochima sp. nov. from Sucre state, Venezuela. These species represent the second record of the genus in the New World. Specimens of these new species were collected in pristine ecosystems, which suggests a natural Gondwanan distribution of the genus. Additionally, a distribution map of the Tetrablemma species in America is herein included.


Asunto(s)
Arañas , Distribución Animal , Animales , Ecosistema , América del Norte , América del Sur
7.
Environ Monit Assess ; 192(4): 205, 2020 Mar 02.
Artículo en Inglés | MEDLINE | ID: mdl-32124068

RESUMEN

Establishing scientifically the macro-location of a micropollutants monitoring network in tropical Andean rivers is a complex process, because information gathering is restricted by high-cost of analysis and limited availability of analytical techniques, which lead to inadequate sampling strategies that hinder the representativeness of samples. Thus, this work proposes a methodology for determining the number of representative sampling sections in a micropollutant monitoring network to characterise the ecological risk in tropical Andean torrential rivers. The proposed methodology consists of four stages: identification of the potential sampling units by Spline interpolation; calculation of the number of representative sections for a stratified sampling with an acceptable level of confidence and error; spatial allocation of the potential sampling units into sections by hierarchical cluster analysis; and representation of the spatial distribution of the sampling sections through a geographic information system (GIS). The proposed methodology is dynamic, and therefore, it can be revisited as more data are obtained in the subsequent years; it has the possibility of being applied to other inter-Andean valley rivers that interact with the tropical Andean sloppy mountains and serves as a tool for decision making by environmental authorities regarding the optimisation of the existing monitoring networks in terms of micropollutants to promote sustainable management of water resources. The proposed methodology is applied in the Upper Cauca River Basin (UCRB), which is located in southwest Colombia, South America.


Asunto(s)
Sistemas de Información Geográfica , Ríos , Contaminantes Químicos del Agua , Colombia , Monitoreo del Ambiente , América del Sur , Contaminantes Químicos del Agua/análisis
8.
Sci Data ; 7(1): 88, 2020 03 11.
Artículo en Inglés | MEDLINE | ID: mdl-32161269

RESUMEN

Genome assembly of polyploid plant genomes is a laborious task as they contain more than two copies of the genome, are often highly heterozygous with a high level of repetitive DNA. Next Generation genome sequencing data representing one Chilean and five Peruvian polyploid potato (Solanum spp.) landrace genomes was used to construct genome assemblies comprising five taxa. Third Generation sequencing data (Linked and Long-read data) was used to improve the assembly for one of the genomes. Native landraces are valuable genetic resources for traits such as disease and pest resistance, environmental tolerance and other qualities of interest such as nutrition and fiber for breeding programs. The need for conservation and enhanced understanding of genetic diversity of cultivated potato from South America is also crucial to North American and European cultivars. Here, we report draft genomes from six polyploid potato landraces representing five taxa, illustrating how Third Generation Sequencing can aid in assembling polyploid genomes.


Asunto(s)
Genoma de Planta , Solanum tuberosum/genética , Variación Genética , Secuenciación de Nucleótidos de Alto Rendimiento , Poliploidía , América del Sur
9.
Sci Data ; 7(1): 96, 2020 03 19.
Artículo en Inglés | MEDLINE | ID: mdl-32193422

RESUMEN

The Amazon Basin is an unquestionable biodiversity hotspot, containing the highest freshwater biodiversity on earth and facing off a recent increase in anthropogenic threats. The current knowledge on the spatial distribution of the freshwater fish species is greatly deficient in this basin, preventing a comprehensive understanding of this hyper-diverse ecosystem as a whole. Filling this gap was the priority of a transnational collaborative project, i.e. the AmazonFish project - https://www.amazon-fish.com/. Relying on the outputs of this project, we provide the most complete fish species distribution records covering the whole Amazon drainage. The database, including 2,406 validated freshwater native fish species, 232,936 georeferenced records, results from an extensive survey of species distribution including 590 different sources (e.g. published articles, grey literature, online biodiversity databases and scientific collections from museums and universities worldwide) and field expeditions conducted during the project. This database, delivered at both georeferenced localities (21,500 localities) and sub-drainages grains (144 units), represents a highly valuable source of information for further studies on freshwater fish biodiversity, biogeography and conservation.


Asunto(s)
Bases de Datos Factuales , Peces , Animales , Biodiversidad , Conservación de los Recursos Naturales , Agua Dulce , Ríos , América del Sur
10.
Epidemiol Infect ; 148: e41, 2020 02 26.
Artículo en Inglés | MEDLINE | ID: mdl-32100667

RESUMEN

Novel Coronavirus (2019-nCoV [SARS-COV-2]) was detected in humans during the last week of December 2019 at Wuhan city in China, and caused 24 554 cases in 27 countries and territories as of 5 February 2020. The objective of this study was to estimate the risk of transmission of 2019-nCoV through human passenger air flight from four major cities of China (Wuhan, Beijing, Shanghai and Guangzhou) to the passengers' destination countries. We extracted the weekly simulated passengers' end destination data for the period of 1-31 January 2020 from FLIRT, an online air travel dataset that uses information from 800 airlines to show the direct flight and passengers' end destination. We estimated a risk index of 2019-nCoV transmission based on the number of travellers to destination countries, weighted by the number of confirmed cases of the departed city reported by the World Health Organization (WHO). We ranked each country based on the risk index in four quantiles (4th quantile being the highest risk and 1st quantile being the lowest risk). During the period, 388 287 passengers were destined for 1297 airports in 168 countries or territories across the world. The risk index of 2019-nCoV among the countries had a very high correlation with the WHO-reported confirmed cases (0.97). According to our risk score classification, of the countries that reported at least one Coronavirus-infected pneumonia (COVID-19) case as of 5 February 2020, 24 countries were in the 4th quantile of the risk index, two in the 3rd quantile, one in the 2nd quantile and none in the 1st quantile. Outside China, countries with a higher risk of 2019-nCoV transmission are Thailand, Cambodia, Malaysia, Canada and the USA, all of which reported at least one case. In pan-Europe, UK, France, Russia, Germany and Italy; in North America, USA and Canada; in Oceania, Australia had high risk, all of them reported at least one case. In Africa and South America, the risk of transmission is very low with Ethiopia, South Africa, Egypt, Mauritius and Brazil showing a similar risk of transmission compared to the risk of any of the countries where at least one case is detected. The risk of transmission on 31 January 2020 was very high in neighbouring Asian countries, followed by Europe (UK, France, Russia and Germany), Oceania (Australia) and North America (USA and Canada). Increased public health response including early case recognition, isolation of identified case, contract tracing and targeted airport screening, public awareness and vigilance of health workers will help mitigate the force of further spread to naïve countries.


Asunto(s)
Viaje en Avión , Infecciones por Coronavirus/transmisión , Brotes de Enfermedades , Neumonía Viral/transmisión , Medición de Riesgo , África/epidemiología , Aeropuertos , Betacoronavirus , China/epidemiología , Enfermedades Transmisibles Importadas , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Humanos , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Vigilancia de la Población , América del Sur/epidemiología , Medicina del Viajero
12.
PLoS Genet ; 16(2): e1008576, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-32053607

RESUMEN

Although Plasmodium vivax parasites are the predominant cause of malaria outside of sub-Saharan Africa, they not always prioritised by elimination programmes. P. vivax is resilient and poses challenges through its ability to re-emerge from dormancy in the human liver. With observed growing drug-resistance and the increasing reports of life-threatening infections, new tools to inform elimination efforts are needed. In order to halt transmission, we need to better understand the dynamics of transmission, the movement of parasites, and the reservoirs of infection in order to design targeted interventions. The use of molecular genetics and epidemiology for tracking and studying malaria parasite populations has been applied successfully in P. falciparum species and here we sought to develop a molecular genetic tool for P. vivax. By assembling the largest set of P. vivax whole genome sequences (n = 433) spanning 17 countries, and applying a machine learning approach, we created a 71 SNP barcode with high predictive ability to identify geographic origin (91.4%). Further, due to the inclusion of markers for within population variability, the barcode may also distinguish local transmission networks. By using P. vivax data from a low-transmission setting in Malaysia, we demonstrate the potential ability to infer outbreak events. By characterising the barcoding SNP genotypes in P. vivax DNA sourced from UK travellers (n = 132) to ten malaria endemic countries predominantly not used in the barcode construction, we correctly predicted the geographic region of infection origin. Overall, the 71 SNP barcode outperforms previously published genotyping methods and when rolled-out within new portable platforms, is likely to be an invaluable tool for informing targeted interventions towards elimination of this resilient human malaria.


Asunto(s)
Brotes de Enfermedades/prevención & control , Genoma de Protozoos/genética , Técnicas de Genotipaje/métodos , Malaria Vivax/transmisión , Plasmodium vivax/genética , África Oriental , Asia , Conjuntos de Datos como Asunto , Erradicación de la Enfermedad/métodos , Marcadores Genéticos/genética , Genotipo , Geografía , Humanos , Malaria Vivax/epidemiología , Malaria Vivax/parasitología , Metadatos , Repeticiones de Microsatélite/genética , Plasmodium vivax/aislamiento & purificación , Polimorfismo de Nucleótido Simple/genética , Valor Predictivo de las Pruebas , América del Sur , Enfermedad Relacionada con los Viajes , Reino Unido , Secuenciación Completa del Genoma
14.
Nat Commun ; 11(1): 491, 2020 01 24.
Artículo en Inglés | MEDLINE | ID: mdl-31980659

RESUMEN

The causes of continental patterns in species richness continue to spur heated discussion. Hypotheses based on ambient energy have dominated the debate, but are increasingly being challenged by hypotheses that model richness as the overlap of species ranges, ultimately controlled by continental range dynamics of individual species. At the heart of this controversy lies the question of whether species richness of individual grid cells is controlled by local factors, or reflects larger-scale spatial patterns in the turnover of species' ranges. Here, we develop a new approach based on assemblage dispersion fields, formed by overlaying the geographic ranges of all species co-occurring in a grid cell. We created dispersion fields for all tetrapods of South America, and characterized the orientation and shape of dispersion fields as a vector field. The resulting maps demonstrate the existence of macro-structures in the turnover of biotic similarity at continental scale that are congruent among vertebrate classes. These structures underline the importance of continental-scale processes for species richness in individual assemblages.


Asunto(s)
Biodiversidad , Vertebrados/fisiología , Animales , Ecosistema , Geografía , Modelos Teóricos , América del Sur , Especificidad de la Especie
15.
Lancet ; 395(10217): 53-64, 2020 01 04.
Artículo en Inglés | MEDLINE | ID: mdl-31813637

RESUMEN

BACKGROUND: Ixekizumab, a high-affinity interleukin-17A (IL-17A) monoclonal antibody, has previously shown efficacy in radiographic axial spondyloarthritis (also known as ankylosing spondylitis). We aimed to evaluate the efficacy and safety of ixekizumab, an IL-17 inhibitor, in non-radiographic axial spondyloarthritis. Here, we report the primary results of COAST-X. METHODS: COAST-X was a 52-week, randomised, double-blind, placebo-controlled, parallel-group study done at 107 sites in 15 countries in Europe, Asia, North America, and South America. Eligible participants were adults (aged ≥18 years) with active axial spondyloarthritis without definite radiographic sacroiliitis (non-radiographic axial spondyloarthritis), objective signs of inflammation (via MRI or C-reactive protein), and an inadequate response or intolerance to non-steroidal anti-inflammatory drugs (NSAIDs). Patients were randomly assigned (1:1:1) to receive subcutaneous 80 mg ixekizumab every 4 weeks (Q4W) or every 2 weeks (Q2W), or placebo. Changing background medications or switching to open-label ixekizumab Q2W, or both, was allowed after week 16 at investigator discretion. Primary endpoints were Assessment of SpondyloArthritis international Society-40 (ASAS40) response (defined as an improvement of 40% or more and an absolute improvement from baseline of 2 units or more [range 0-10] in at least three of the four domains [patient global, spinal pain, function, and inflammation] without any worsening in the remaining one domain) at weeks 16 and 52. Patients who switched to open-label ixekizumab were imputed as non-responders in logistic regression analysis. This trial is registered with ClinicalTrials.gov, number NCT02757352. FINDINGS: Between Aug 2, 2016, and Jan 29, 2018, 303 patients were enrolled (105 to placebo, 96 to ixekizumab Q4W, and 102 to ixekizumab Q2W). Both primary endpoints were met: ASAS40 at week 16 (ixekizumab Q4W: 34 [35%] of 96, p=0·0094 vs placebo; ixekizumab Q2W: 41 [40%] of 102, p=0·0016; placebo: 20 [19%] of 105) and ASAS40 at week 52 (ixekizumab Q4W: 29 [30%] of 96, p=0·0045; ixekizumab Q2W: 32 [31%] of 102, p=0·0037; placebo: 14 [13%] of 105). 60 (57%) of 104 patients in the placebo group, 63 (66%) of 96 in the ixekizumab Q4W group, and 79 (77%) of 102 in the ixekizumab Q2W group had at least one treatment-emergent adverse event. The most common treatment-emergent adverse events in the ixekizumab groups were nasopharyngitis and injection site reaction. Of the treatment-emergent adverse events of special interest, there was one case of serious infection in the ixekizumab Q4W group. The frequency of serious adverse events was low (four [1%] of 302) and similar across the three groups. There were no malignancies or deaths. No new safety signals were identified. INTERPRETATION: Ixekizumab was superior to placebo for improving signs and symptoms in patients with non-radiographic axial spondyloarthritis at weeks 16 and 52. Reports of adverse events were similar to those of previous ixekizumab studies. Ixekizumab offers a potential therapeutic option for patients with non-radiographic axial spondyloarthritis who had an inadequate response or were intolerant to NSAID therapy. FUNDING: Eli Lilly and Company.


Asunto(s)
Anticuerpos Monoclonales Humanizados/administración & dosificación , Espondilitis Anquilosante/tratamiento farmacológico , Adulto , Anticuerpos Monoclonales Humanizados/efectos adversos , Asia , Método Doble Ciego , Esquema de Medicación , Europa (Continente) , Femenino , Humanos , Inyecciones Subcutáneas , Modelos Logísticos , Masculino , Persona de Mediana Edad , América del Norte , América del Sur , Resultado del Tratamiento
16.
Plant Dis ; 104(2): 493-509, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31790643

RESUMEN

Eucalyptus (Myrtaceae, Myrtales) trees are widely cultivated for commercial purposes worldwide. Calonectria leaf blight is one of the most prominent diseases associated with Eucalyptus trees grown in plantations in Asia and South America. Recently, symptoms of leaf blight, shoot blight, tree death, and seedling rot caused by Calonectria species have been observed in commercial Eucalyptus plantations and nurseries in Leizhou Peninsula, which is one of the most densely Eucalyptus-planted areas in southern China. Disease samples were collected from 10 Eucalyptus species and a number of Eucalyptus grandis, E. tereticornis, and E. urophylla hybrid genotypes that were planted on plantations at 13 sites and one experimental nursery. A total of 773 isolates of Calonectria were obtained from 683 plantation trees and nursery seedlings. Fifty-five representative isolates from all the surveyed sites and Eucalyptus species/genotypes were selected for molecular identification. These 55 isolates were identified by DNA sequence analyses based on the calmodulin (cmdA), histone H3 (his3), translation elongation factor 1-alpha (tef1), and ß-tubulin (tub2) gene regions, as well as a combination of morphological characteristics. The results indicated that these 55 isolates present one single species, Calonectria pentaseptata. Determined by sequences of cmdA, his3, tef1, and tub2 gene regions, only two genotypes were identified among the 55 representative isolates; 54 of these isolates share the same genotype, suggesting that the genetic diversity of Ca. pentaseptata collected during this study was relatively low. A growth study indicated that Ca. pentaseptata is a high-temperature species. The mating test results suggested that Ca. pentaseptata is heterothallic or lacks the ability to recombine to produce fertile progeny. Inoculation results showed that Ca. pentaseptata causes leaf blight and stem rot, resulting in tree death of the two widely planted Eucalyptus genotypes in southern China, and that the two genotypes differ significantly in their susceptibility to infection by Ca. pentaseptata. A selection program to develop Eucalyptus planting stocks with high levels of resistance to Calonectria leaf blight in China during the long-term should be urgently initiated.[Formula: see text] Copyright © 2020 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license.


Asunto(s)
Eucalyptus , Hypocreales , China , Enfermedades de las Plantas , América del Sur
17.
Plant Dis ; 104(1): 60-70, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31647693

RESUMEN

Rapid detection is key to managing emerging diseases because it allows their spread around the world to be monitored and limited. The first major wheat blast epidemics were reported in 1985 in the Brazilian state of Paraná. Following this outbreak, the disease quickly spread to neighboring regions and countries and, in 2016, the first report of wheat blast disease outside South America was released. This Asian outbreak was due to the trade of infected South American seed, demonstrating the importance of detection tests in order to avoid importing contaminated biological material into regions free from the pathogen. Genomic analysis has revealed that one particular lineage within the fungal species Pyricularia oryzae is associated with this disease: the Triticum lineage. A comparison of 81 Pyricularia genomes highlighted polymorphisms specific to the Triticum lineage, and this study developed a real-time PCR test targeting one of these polymorphisms. The test's performance was then evaluated in order to measure its analytical specificity, analytical sensitivity, and robustness. The C17 quantitative PCR test detected isolates belonging to the Triticum lineage with high sensitivity, down to 13 plasmid copies or 1 pg of genomic DNA per reaction tube. The blast-based approach developed here to study P. oryzae can be transposed to other emerging diseases.


Asunto(s)
Agricultura , Genoma Fúngico , Magnaporthe , Reacción en Cadena en Tiempo Real de la Polimerasa , Triticum , Agricultura/métodos , Genes Fúngicos/genética , Genómica , Magnaporthe/genética , Enfermedades de las Plantas/microbiología , América del Sur , Triticum/microbiología
18.
Oecologia ; 192(1): 191-200, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31768739

RESUMEN

In South America the biogeographic history has produced different biomes with different vegetation types and distinct floras. As these vegetation types may diverge in evolutionary histories, we analysed how alpha and beta phylogenetic diversity vary across them and determine the main drivers of variation in phylogenetic diversity. To this end, we compiled a list of 205 sites and 1222 tree species spread over four biomes and eight vegetation types in central South America. For each site we evaluated six measures of evolutionary alpha diversity (species richness, phylogenetic diversity sensu stricto and the standardized effect size of phylogenetic diversity, mean phylogenetic distance and mean nearest taxon distance) and beta diversity (phylogenetic Sorensen's similarity). We checked the influence of spatial and environmental variables using generalized least squares models. The greatest phylogenetic differentiation was found between west and east of central South America, mainly between the Chaco communities and the other vegetation types, suggesting that species found in this biome come from different lineages, comparing with the others vegetation types. Our results also showed a clustered phylogenetic structure for the Dry Chaco woodlands, which may be associated with harsh environmental conditions. In addition to historical process, climatic conditions are the main drivers shaping phylogenetic patterns among the distinct vegetation types. Understanding patterns of phylogenetic diversity and distribution can greatly improve conservation planning and management since it allows the conservation of unique biome characteristics.


Asunto(s)
Biodiversidad , Evolución Biológica , Ecosistema , Filogenia , América del Sur
19.
Lancet ; 395(10218): 132-141, 2020 01 11.
Artículo en Inglés | MEDLINE | ID: mdl-31836199

RESUMEN

BACKGROUND: Standard-of-care treatment for patients with newly diagnosed multiple myeloma includes combination therapies for patients who are not eligible for autologous stem-cell transplantation. At the primary analysis for progression-free survival of the phase 3 ALCYONE trial, progression-free survival was significantly longer with daratumumab in combination with bortezomib, melphalan, and prednisone (D-VMP) versus bortezomib, melphalan, and prednisone (VMP) alone in patients with transplant-ineligible, newly diagnosed multiple myeloma. Here we report updated efficacy and safety results from a prespecified, interim, overall survival analysis of ALCYONE with more than 36 months of follow-up. METHODS: ALCYONE was a multicentre, randomised, open-label, active-controlled, phase 3 trial that enrolled patients between Feb 9, 2015, and July 14, 2016, at 162 sites in 25 countries across North America, South America, Europe, and the Asia-Pacific region. Patients were eligible for inclusion if they had newly diagnosed multiple myeloma and were ineligible for high-dose chemotherapy with autologous stem-cell transplantation, because of their age (≥65 years) or because of substantial comorbidities. Patients were randomly assigned in a 1:1 ratio and by permuted block randomisation to receive D-VMP or VMP. An interactive web-based randomisation system was used. Randomisation was stratified by International Staging System disease stage, geographical region, and age. There was no masking to treatment assignments. All patients received up to nine 6-week cycles of subcutaneous bortezomib (1·3 mg/m2 of body surface area on days 1, 4, 8, 11, 22, 25, 29, and 32 of cycle one and on days 1, 8, 22, and 29 of cycles two through nine), oral melphalan (9 mg/m2 once daily on days 1 through 4 of each cycle), and oral prednisone (60 mg/m2 once daily on days 1 through 4 of each cycle). Patients in the D-VMP group also received intravenous daratumumab (16 mg/kg of bodyweight, once weekly during cycle one, once every 3 weeks in cycles two through nine, and once every 4 weeks thereafter as maintenance therapy until disease progression or unacceptable toxicity). The primary endpoint was progression-free survival, which has been reported previously. Results presented are from a prespecified interim analysis for overall survival. The primary analysis population (including for overall survival) was the intention-to-treat population of all patients who were randomly assigned to treatment. The safety population included patients who received any dose of study treatment. This trial is registered with ClinicalTrials.gov, NCT02195479. FINDINGS: 706 patients were randomly assigned to treatment groups (350 to the D-VMP group, 356 to the VMP group). At a median follow-up of 40·1 months (IQR 37·4-43·1), a significant benefit in overall survival was observed for the D-VMP group. The hazard ratio (HR) for death in the D-VMP group compared with the VMP group was 0·60 (95% CI 0·46-0·80; p=0·0003). The Kaplan-Meier estimate of the 36-month rate of overall survival was 78·0% (95% CI 73·2-82·0) in the D-VMP group and 67·9% (62·6-72·6) in the VMP group. Progression-free survival, the primary endpoint, remained significantly improved for the D-VMP group (HR 0·42 [0·34-0·51]; p<0·0001). The most frequent adverse events during maintenance daratumumab monotherapy in patients in the D-VMP group were respiratory infections (54 [19%] of 278 patients had upper respiratory tract infections; 42 [15%] had bronchitis, 34 [12%] had viral upper respiratory tract infections), cough (34 [12%]), and diarrhoea (28 [10%]). INTERPRETATION: D-VMP prolonged overall survival in patients with newly diagnosed multiple myeloma who were ineligible for stem-cell transplantation. With more than 3 years of follow-up, the D-VMP group continued to show significant improvement in progression-free survival, with no new safety concerns. FUNDING: Janssen Research & Development.


Asunto(s)
Anticuerpos Monoclonales/administración & dosificación , Bortezomib/administración & dosificación , Melfalán/administración & dosificación , Mieloma Múltiple/tratamiento farmacológico , Prednisona/administración & dosificación , Adulto , Anciano , Anciano de 80 o más Años , Anticuerpos Monoclonales/efectos adversos , Asia , Bortezomib/efectos adversos , Supervivencia sin Enfermedad , Esquema de Medicación , Quimioterapia Combinada/efectos adversos , Europa (Continente) , Femenino , Humanos , Quimioterapia de Mantención , Masculino , Melfalán/efectos adversos , Persona de Mediana Edad , Mieloma Múltiple/mortalidad , América del Norte , Prednisona/efectos adversos , América del Sur , Análisis de Supervivencia , Resultado del Tratamiento
20.
Ambio ; 49(1): 156-164, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30771206

RESUMEN

The political economy of dam development in South America is changing as a result of a resurgence in water infrastructure investments. The arrival of Chinese-funded projects in the region has altered a context traditionally dominated by multilateral development banks. Tensions are escalating around new dam projects and the environmental impact assessment process is increasingly the site of politicization around water in the region. In this perspective, we examine the most recent surge in dam development in South America, the resulting environmental and social impacts, and the mobilization of civil society and environmental groups that have developed in response to these projects. In the absence of regionally shared standards for environmental assessment and regional mechanisms to mitigate the emerging conflicts-primarily occurring between companies, states, and civil society-we argue there is a risk of a race to the bottom to finance infrastructure projects with laxer environmental and social standards.


Asunto(s)
Ambiente , Abastecimiento de Agua , Cambio Social , América del Sur , Agua
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