RESUMEN

The G-protein-coupled receptor C-C chemokine receptor 5 (CCR5) functions as a co-receptor for the entry of HIV into immune cells. CCR5 binds promiscuously to a diverse array of ligands initiating cell signaling that includes guided migration. Although well known to be expressed on immune cells, recent studies have shown the induction of CCR5 on the surface of breast cancer epithelial cells. The function of CCR5 on breast cancer epithelial cells includes the induction of aberrant cell survival signaling and tropism towards chemo attractants. As CCR5 is not expressed on normal epithelium, the receptor provides a potential useful target for therapy. Inhibitors of CCR5 (CCR5i), either small molecules (maraviroc, vicriviroc) or humanized monoclonal antibodies (leronlimab) have shown anti-tumor and anti-metastatic properties in preclinical studies. In early clinical studies, reviewed herein, CCR5i have shown promising results and evidence for effects on both the tumor and the anti-tumor immune response. Current clinical studies have therefore included combination therapy approaches with checkpoint inhibitors.

RESUMEN

INTRODUCTION: General aviation (GA) accidents have continued to demonstrate high fatality rates. Recently, ballistic parachute recovery systems (BPRS) have been introduced as a safety feature in some GA aircraft. This study evaluates the effectiveness and associated factors of the Cirrus Airframe Parachute System (CAPS) at reducing the odds of a fatal accident in Cirrus aircraft crashes. METHODS: Publicly available Cirrus aircraft crash reports were obtained from the National Transportation Safety Board (NTSB) database for the period of January 1, 2001-December 31, 2016. Accident metrics were evaluated through univariate and multivariate analyses regarding odds of a fatal accident and use of the parachute system. RESULTS: Included in the study were 268 accidents. For CAPS nondeployed accidents, 82 of 211 (38.9%) were fatal as compared to 8 of 57 (14.0%) for CAPS deployed accidents. After controlling for all other factors, the adjusted odds ratio for a fatal accident when CAPS was not deployed was 13.1. DISCUSSION: The substantial increased odds of a fatal accident when CAPS was not deployed demonstrated the effectiveness of CAPS at providing protection of occupants during an accident. Injuries were shifted from fatal to serious or minor with the use of CAPS and postcrash fires were significantly reduced. These results suggest that BPRS could play a significant role in the next major advance in improving GA accident survival.Alaziz M, Stolfi A, Olson DM. Cirrus Airframe Parachute System and odds of a fatal accident in Cirrus aircraft crashes. Aerosp Med Hum Perform. 2017; 88(6):556-564.

Asunto(s)

RESUMEN

INTRODUCTION: This study explores the U.S. experience with waivers for insulin treatment for third-class medical certificates. From 1997 through 2014, the Federal Aviation Administration (FAA) approved an estimated 1500 waivers for insulin-treated diabetes with a total of 450 active waivers as of December 31, 2014. These pilots were involved in 25 accidents, but none were attributed to medical issues. METHODS: Data for the insulin waiver group and control group were obtained from the FAA's aeromedical certification system and matching accident data from the NTSB database. A logistic regression model comparing accidents in this group to the overall population of third-class certificate holders adjusted for gender, age, and flight times was performed. A novel technique for calculating accident rates was also employed. RESULTS: No statistically significant association between waivers for insulin treatment and accident risk was found by logistic regression. The overall accident rate for pilots possessing an insulin waiver was 7.0 per 100,000 flight hours and an estimate for all third-class pilots was also 7.0 per 100,000 flight hours. Only 8% of waivers for insulin treatment were later terminated for adverse changes related to the applicant's diabetes. Of these pilots, 8% also had coronary artery disease severe enough to require its own waiver. CONCLUSION: Taken together, these findings suggest that pilots holding special issuance waivers for insulin-treated diabetes are not detectably less safe than other airmen with third-class medical certificates and most are able to successfully comply with the FAA's stringent medical certification protocol for insulin treated diabetes.Mills WD, DeJohn CA, Alaziz M. The U.S. experience with waivers for insulin-treated pilots. Aerosp Med Hum Perform. 2017; 88(1):34-41.

Asunto(s)