Prophylactic irradiation of tracts in patients with malignant pleural mesothelioma : an open-label, multicenter, phase III randomized trial

PURPOSE Prophylactic irradiation to the chest wall after diagnostic or therapeutic procedures in patients with malignant pleural mesothelioma (MPM) has been a widespread practice across Europe, although the efficacy of this treatment is uncertain. In this study, we aimed to determine the efficacy of prophylactic radiotherapy in reducing the incidence of chest wall metastases (CWM) after a procedure in MPM. METHODS After undergoing a chest wall procedure, patients with MPM were randomly assigned to receive prophylactic radiotherapy (within 42 days of the procedure) or no radiotherapy. Open thoracotomies, needle biopsies, and indwelling pleural catheters were excluded. Prophylactic radiotherapy was delivered at a dose of 21 Gy in three fractions over three consecutive working days, using a single electron field adapted to maximize coverage of the tract from skin surface to pleura. The primary outcome was the incidence of CWM within 6 months from random assignment, assessed in the intention-to-treat population. Stratification factors included epithelioid histology and intention to give chemotherapy. RESULTS Between July 30, 2012, and December 12, 2015, 375 patients were recruited from 54 centers and randomly assigned to receive prophylactic radiotherapy (n = 186) or no prophylactic radiotherapy (n = 189). Participants were well matched at baseline. No significant difference was seen in the incidence of CWM at 6 months between the prophylactic radiotherapy and no radiotherapy groups (no. [%]: 6 [3.2] v 10 [5.3], respectively; odds ratio, 0.60; 95% CI, 0.17 to 1.86; P = .44). Skin toxicity was the most common radiotherapy-related adverse event in the prophylactic radiotherapy group, with 96 patients (51.6%) receiving grade 1; 19 (10.2%), grade 2; and 1 (0.5%) grade 3 radiation dermatitis (Common Terminology Criteria for Adverse Events, version 4.0). CONCLUSION There is no role for the routine use of prophylactic irradiation to chest wall procedure sites in patients with MPM

A hybrid zone and bidirectional introgression between two catadromous species: Australian bass Macquaria novemaculeata and estuary perch Macquaria colonorum

The presence and distribution of hybrid individuals and the existence of a hybrid zone between the catadromous Australian bass Macquaria novemaculeata and estuary perch Macquaria colonorum were investigated throughout the range of both species in Australia. Bayesian analyses and genotypic simulations identified 140 putative hybrids (11.5% of the total sample) with varying levels of introgression. Most hybrids were observed in an area extending from the Snowy River to the Albert River suggesting a hybrid zone in the eastern Bass Strait region. Sixteen hybrids, however, were found outside this zone, possibly reflecting the movement of hybrid offspring between estuaries or their inadvertent release during fish stocking programmes. Biparental backcrossing was found to occur suggesting that hybrids were fertile. These results have implications for the management of the extensive stocking programme in M. novemaculeata and for understanding the potential role of habitat degradation and reduced water flow in facilitating hybridization in species with migratory life histories

Polymicrobial tenosynovitis with Pasteurella multocida and other Gram negative bacilli after a Siberian tiger bite

Mammalian bites present a considerable clinical problem because they are often associated with bacterial infections. Pasteurella multocida is a microorganism that commonly infects both canine and small feline bites. Zoonotic infections developing after large feline bites have been recognised, although their reports are limited. We describe a 35 year old man who was bitten by a Siberian tiger and who developed infectious tenosynovitis secondary to P multocida, Bergeyella (Weeksella) zoohelcum, and Gram negative bacteria most like CDC group EF-4b and comamonas species. The latter three bacteria have not been isolated previously from large feline bite wounds. Key Words: animal bite • zoonotic infection • Pasteurella multocida • Bergeyella zoohelcu

Public choice principles of redistricting

This paper uses fundamental principles of public choice, mainly the median voter theorem, to develop a simple theory of redistricting. The focus is on how closely policy outcomes correspond to majority rule. The main results are: (1) Potential policy bias in favor of nonmajority groups is structurally linked to the number of legislative seats and the population, and the structure of most states puts them very close to the theoretically maximum bias. (2) Random districting, which might seem like the essence of neutrality, does not eliminate policy bias on average. (3) Traditional principles of compact, contiguous districts that respect existing political boundaries, stressed in the Supreme Court’s Shaw v. Reno decision, minimize the chance of nonmajoritarian outcomes. Our analysis also offers a gerrymandering explanation for the positive relation between seats and spending that is usually taken as support for the “Law of 1/n.” Copyright Springer Science + Business Media B.V. 2006Redistricting, Voting rights, Median voter,

Statutory discretion and procedural control of the European Commission's executive functions

By delegating powers and designing administrative procedures, ministers of the Council, the legislators of the European Union, shape the boundaries of the EU administration. This article uses theories of executive politics to test the factors that affect the degree of statutory discretion delegated by the Council to the Commission in secondary legislation. It suggests that discretion increases with 1) the uncertainty facing legislators, 2) the convergence of preferences between the Commission and the pivotal legislator, 3) the use of qualified majority, and 4) policies that require limited involvement of national administrations. It also tests whether discretion is positively correlated with the stringency of procedural control. The article employs regression analysis and co-graduation tests on a sample of legislation and concludes that uncertainty, policy types and informal decision rules are statistically and substantively relevant in explaining discretion. Discretion is also significantly correlated with the stringency of control