Volume of Disease as a Predictor for Clinical Outcomes in Patients With Melanoma Brain Metastases Treated With Stereotactic Radiosurgery and Immune Checkpoint Therapy

Purpose/ObjectivesClinical trials of anti-Programmed cell death protein 1 (PD-1) and cytotoxic T-lymphocyte-associated protein (CTLA-4) therapies have demonstrated a clinical benefit with low rates of neurologic adverse events in patients with melanoma brain metastases (MBMs). While the combined effect of these immunotherapies (ITs) and stereotactic radiosurgery (SRS) has yielded impressive results with regard to local control (LC) and overall survival (OS), it has also been associated with increased rates of radiation necrosis (RN) compared to historical series of SRS alone. We retrospectively reviewed patients treated with IT in combination with SRS to report on predictors of clinical outcomes.Materials and MethodsPatients were included if they had MBMs treated with SRS within 1 year of receiving anti-PD-1 and/or CTLA-4 therapy. Clinical outcomes including OS, LC, intracranial death (ID), and RN were correlated with type and timing of IT with SRS, radiation dose, total volume, and size and number of lesions treated.ResultsTwenty-nine patients with 171 MBMs were treated between May 2012 and May 2018. Patients had a median of 5 lesions treated (median volume of 6.5 cm3) over a median of 2 courses of SRS. The median dose was 21 Gy. Most patients were treated with ipilimumab (n = 13) or nivolumab-ipilimumab (n = 10). Most patients underwent SRS concurrently or within 3 months of receiving immunotherapy (n = 21). Two-year OS and LC were 54.4% and 85.5%, respectively. In addition, 14% of patients developed RN; however, only 4.7% of the total treated lesions developed RN. The median time to development of RN was 9.5 months. Patients with an aggregate tumor volume >6.5 cm3 were found to be at increased risk of ID (p = 0.05) and RN (p = 0.03). There was no difference in OS, ID, or RN with regard to type of IT, timing of SRS and IT, number of SRS courses, SRS dose, or number of cumulative lesions treated.ConclusionsIn our series, patients treated with SRS and IT for MBMs had excellent rates of OS and LC; however, patients with an aggregate tumor volume >6.5 cm3 were found to be at increased risk of ID and RN. Given the efficacy of combined anti-PD-1/CTLA-4 therapy for MBM management, further study of optimal selection criteria for the addition of SRS is warranted.

The sustainability of indigenous lands in Amapá state

We herein assess population growth in indigenous lands (ILs) Wajãpi, Uaçá, Galibi and Juminã in Amapá State-Brazil, which has influenced deforestation increase. We assumed the hypothesis of no association between demographic density and deforestation because population density in these areas is low. We used population growth, deaths, and deforestation data by considering a historical series (2002-2018). Demographic data have shown that Uaçá and Wajãpi ILs recorded the highest population growth. The highest demographic density was observed for Galibi ILs and the lowest one for Wajãpi ILs. The highest deforestation was observed for Uaçá ILs and the lowest one for Juminã ILs. Therefore, indigenous lands in Amapá State have an essential role in forest conservation.

Índice de Tendências Climáticas de Longo Prazo em Área Urbana na Amazônia Oriental

Esta pesquisa tem como objetivo analisar a variabilidade e a tendência de variáveis meteorológicas no longo prazo para caracterizar o clima urbano da cidade de Macapá-AP. Compreender a variabilidade dos índices climáticos em ambientes urbanos tende a mostrar possíveis interferências na qualidade de vida dos moradores locais, bem como torna possível comparar a realidade das cidades amazônicas em um contexto regional, nacional e mundial, contribuindo ao debate acadêmico. No presente caso as variáveis-chave são a temperatura do ar e a precipitação pluviométrica. A metodologia consiste nas seguintes etapas: a) coleta e consistência da série de dados por um período contínuo de 52 anos para o Estado do Amapá (1968 – 2020), b) a utilização do aplicativo RClimDex 1.1/IPCC para estimar as variações e as tendências climáticas locais utilizando-se 27 parâmetros climáticos extremos previstos pela equipe de peritos do CCI/CLIVAR e Climate Change Detection Monitoring and Indices (ETCCDMI). Os resultados obtidos acusaram treze indicadores estatísticos significativos (p<0,05), sugerindo tendência generalizada da elevação da temperatura média do ar na zona urbana da cidade. Como consequência, estes indicadores mostraram não somente uma significativa elevação das temperaturas máximas, médias e mínimas, mas também quais são os indicadores mais coerentemente associados com tendências de aquecimento temporal de cidades amazônicas, tanto para períodos diurnos quanto para períodos noturnos. Esse comportamento dos indicadores confirma a hipótese de predisposição a formação de ilha de calor em Macapá. Esta tendência mudou significativamente a partir de 2010. Index of Long Term Climate Trends in Urban Area in the Eastern AmazonA B S T R A C T This research aims to analyze the variability and trend of meteorological variables in the long term to characterize the urban climate of the city of Macapá-AP. Understanding the variability of climate indices in urban environments reveals possible interferences in the quality of life of the inhabitants, especially in urban locations. However, it has been relatively difficult to quantify trends in historical series that reliably represent climate indices relevant to the reality of Amazonian cities, both at a local and regional level. In the present case, the key variables analyzed were air temperature and rainfall. The methodology followed the following steps: a) collection and consistency of the data series over a continuous period of 52 years for the State of Amapá (1968–2020), b) using the data series by the RClimDex 1.1/IPCC application to estimate the local climate variations and trends using 27 extreme weather parameters predicted by the CCI/CLIVAR and Climate Change Detection Monitoring and Indices (ETCCDMI) team of experts. The results showed thirteen significant statistical indicators (p<0.05), suggesting a general trend towards an increase in the average air temperature in the urban area of the city. As a consequence, these indicators showed not only a significant increase in maximum, average and minimum temperatures, but also the indicators most coherently associated with temporal warming trends in Amazonian cities. So many that these effects seem to affect both the day and night periods, confirming the hypothesis of a predisposition to the formation of an urban heat island, with a significant change in this trend from 2010 onwards. Keywords: RClimDex 1.1, climate change indice, Macapá, Amapá

IFRS9 e le sfide di contesto

Under IFRS9, Financial Institutions are required to implement impairment frameworks to determine the expected losses on their credit portfolio taking into account the current (so called “point in time”) and the prospective (so called “forward looking”) economic cycle. The Covid-19 pandemic, which began in early 2020, has posed significant challenges for Financial Institutions in their ability to manage credit risk. Despite numerous guidelines given by regulators, estimating IFRS9 expected loss continues to be a considerable challenge. The challenge partly stems from the relationship between macro-economic scenarios and credit losses, the treatment of moratoriums inside the historical series for development and calibration of IFRS9 risk parameters, and the management of support measures defined at National and European levels (e.g. Next Generation EU) for the forward looking estimations.

The Effect of Isotonic Saline Nasal Lavages in Improving Symptoms in SARS-CoV-2 Infection: A Case-Control Study

Background: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) mainly colonizes nasopharynx. In upper airways acute infections, e.g., the common cold, saline nasal irrigations have a significant efficacy in reducing symptoms. The present study aimed to test the efficacy of nasal lavages in upper airways symptoms of Coronavirus Disease 2019 (COVID-19).Methods: A series of consecutive adult subjects who tested positive for SARS-CoV-2 from December 2020 to February 2021 performed daily nasal lavages with saline solution (Lavonase®—Purling, Lugo di Romagna, Italy) for 12 days, starting on the day after the SARS-CoV-2 positive swab. A control group included a historical series of patients who were infected in February-March 2020 and who did not perform lavages. An ad hoc questionnaire regarding symptoms was administered to each subjects at base-line and 10 days after diagnosis (i.e., on the same day of the control swab) in both cases and controls.Results: A total of 140 subjects were enrolled. 68 participants in the treatment group and 72 in the control group were included. 90% of respondents declared the lavages were simple to use and 70% declared they were satisfied. Symptoms of blocked nose, runny nose, or sneezing decreased by an average of 24.7% after the treatment. Blocked nose and sneezing increased in the same period of time in the control group. Ears and eyes symptoms, anosmia/ageusia symptoms, and infection duration (10.53 days in the treatment group and 10.48 days in the control group) didn't vary significantly among the two groups.Conclusion: Nasal lavages resulted to significantly decrease nasal symptoms in newly diagnosed SARS-CoV-2 patients. These devices proved to be well-tolerated and easy to be used. Further studies on a larger number of subjects are needed in order to possibly confirm these preliminary results.

CLINICAL-EPIDEMIOLOGICAL PROFILE OF PATIENTS WITH DIAGNOSIS OF ORAL CAVITY CANCER

Introduction: Cancer of the oral cavity is a malignant tumor that can occur in the lips, oral structures and region under the tongue. They are cancers that often affect male patients aged 40 years and over. Objective: To describe the clinical and epidemiological profile of patients diagnosed with oral cavity cancer from 2015 to 2019 in Montes Claros, Minas Gerais, Brazil. Methods: A descriptive study of quantitative approach was conducted through data from patients living in Montes Claros, Minas Gerais with diagnosis of oral cavity neoplasia in hospital records of the José Alencar Gomes da Silva National Cancer Institute (INCA). Results and discussion: In the historical series analyzed, 312 cases of cancer of the oral cavity were identified. Conclusion: The patients who were diagnosed with cancer in the oral cavity were mostly men aged between 50 and 69 years, the association between concomitant use of tobacco and alcoholic beverages was present in the vast majority of cases. Health professionals' efforts are needed for early diagnosis through educational actions and primary prevention.

Trends in pluviometric precipitation and climatic water balance in the hydrographic region of Paraguaçu – BA

Trend analysis of hydroclimatic data is essential in the development of water resources management, as it can envisage changes in the pattern of behaviour, helping develop strategies for adaptation in the face of imminent climate change. This study aimed to investigate possible annual and seasonal trends in rainfall and climatological water balance in the hydrographic region of Paraguaçu - BA. From the historical series of precipitation, deficiency and water surpluses, between 1989 and 2018, two analysis scenarios were conducted: the first to verify the annual and seasonal trends of each station, using the traditional Mann-Kendall (MK) methods and Sen’s estimator; and the second for each sub-region of Paraguaçu, by comparing MK with the Innovative Trend Analysis (ITA). The results of the annual series, regardless of the methodology adopted, point to negative trends in rainfall, positive trends in deficit and negative trends in water surplus. Seasonally, in the autumn and winter seasons, generally considered to be drought, there were more trends of increasing rainfall and decreasing water deficiency. A comparison between the MK and ITA models showed that both have similar results for indicating trends in the sub-regions of Paraguaçu. However, the ITA has shown a higher number of significant trends.

Database of the historical series of fisheries production in the middle Madeira River region, southwest of the Amazon, from 2001 to 2013

The Amazon is very important regarding the continental extractive fishing as it has the greatest diversity of freshwater fish in the world. Some factors can contribute to identify significant changes in fish production, such as characterization based on common names, and synonyms or classifications only at the genus level. This creates noise in different types of analyzes and mistakes in determining effective productions, as well as levels of exploitation for management. Thus, this study aims to demonstrate the variation in fish production over the years 2001 and 2013, using control data from the fishing colony "Dr. Renato Pereira Gonçalves Z-31" in the municipality of Humaitá, southern Amazonas. These data were analyzed by collaborators from the Laboratory of Ichthyology and Fisheries Management of the Madeira River Valley, at the Federal University of Amazonas. The fish landing monitoring allowed the determination of the species caught in the regional fishery and evaluated the effect of the hydrological level and the pre- and post-installation periods of the Santo Antônio and Jirau HPPs in Rondônia, on the total production. The data set showed the significant decrease in fish production between 2008 and 2013. Among the factors that explain the observed changes are the mistakes in determining the effective production due to the lack of criteria in the grouping of many species, the absence of regulations, such as the "Portaria IBAMA Nº 48" which was created only in 2007, in addition to the installation period of the HPPs on the Madeira River. It was also possible to verify the effect of seasonality through hydrological quotas on fish production, with the highest values observed in July, August and September of the years analyzed.

Brazil nuts a non-timber potential: Uncertainties and investments

The Brazil nut is one of the main non-timber forest products in Brazil, but its price fluctuations generate uncertainties and risks for both extractivists and investors. Econometric models or other simpler methods can estimate price changes and indicate the investment attractiveness of the Brazil nut. The objective of the present study was to analyze the risk-return relationship and the export price for both volatility of the Brazil nut over a 15 years period. The historical series of Brazil nut export prices, shelled and unshelled nuts, was evaluated from 2002 to 2016. The geometric growth rate and the variation coefficient indicate the return and risk respectively, associated with its price series. The price volatility of shelled and unshelled Brazil nuts was estimated with the standard deviation of the price series and with generalized models of ARCH (GARCH, EGARCH and TARCH). The shelled or unshelled Brazil nut coefficient increased over 15 years, with a low risk-return ratio. The shelled Brazil nut volatility was lower in the 2002 to 2006, 2007 to 2011 and 2012 to 2016 periods than for the unshelled nut when estimated by the standard deviation method than for the unshelled nut. The shelled Brazil nut price was higher from 2002 to 2016, with low volatility and persistent shocks. The estimate of the shelled and unshelled Brazil nut price volatility was better with the TARCH and the EGARCH models, respectively.