Adjuvant statin therapy for oesophageal adenocarcinoma: the STAT‐ROC feasibility study

Background Statins inhibit proliferative signalling in oesophageal adenocarcinoma (OAC) and their use is associated with better survival in observational studies. The present study was undertaken to examine the feasibility of assessing adjuvant statin therapy in patients with operable OAC in a phase III RCT. Methods For this multicentre, double‐blind, parallel‐group, randomized, placebo‐controlled feasibility trial, adults with OAC (including Siewert I–II lesions) who had undergone oesophagectomy were centrally allocated (1 : 1) to simvastatin 40 mg or matching placebo by block randomization, stratified by centre. Participants, clinicians and investigators were blinded to treatment allocation. Patients received treatment for up to 1 year. Feasibility outcomes were recruitment, retention, drug absorption, adherence, safety, quality of life, generalizability and survival. Results A total of 120 patients were assessed for eligibility at four centres, of whom 32 (26·7 per cent) were randomized, 16 in each group. Seven patients withdrew. Participants allocated to simvastatin had lower low‐density lipoprotein cholesterol levels by 3 months (adjusted mean difference −0·83 (95 per cent c.i. −1·4 to −0·22) mmol/l; P = 0·009). Median adherence to medication was greater than 90 per cent between 3 and 12 months' follow‐up. Adverse events were similar between the groups. Quality‐of‐life data were complete for 98·3 per cent of questionnaire items. Cardiovascular disease, diabetes and aspirin use were more prevalent in the non‐randomized group, whereas tumour site, stage and grade were similar between groups. Survival estimates were imprecise. Conclusion This RCT supports the conduct and informs the design considerations for a future phase III trial of adjuvant statin therapy in patients with OAC. Registration number: ISRCTN98060456 (www.isrctn/com)

The political process of constructing a sustainable London Olympics sports development legacy

This study attempts to develop a research agenda for understanding the process of constructing a sustainable Olympic sports development legacy. The research uses a social constructivist perspective to examine the link between the 2012 London Olympic Games and sustainable sports development. The first part of the paper provides justification for the study of sport policy processes using a constructivist lens. This is followed by a section which critically unpacks sustainable sports development drawing on Mosse’s (1998) ideas of process-oriented research and Searle’s conceptualisation of the construction of social reality. Searle’s (1995) concepts of the assignment of function, collective intentionality, collective rules, and human capacity to cope with the environment are considered in relation to the events and discourses emerging from the legacy vision(s) associated with the 2012 London Olympic Games. The paper concludes by proposing a framework for engaging in process oriented research and highlights key elements, research questions, and methodological issues. The proposed constructivist approach can be used to inform policy, practice, and research on sustainable Olympic sports development legacy

CEM03 and LAQGSM03 - new modeling tools for nuclear applications

An improved version of the Cascade-Exciton Model (CEM) of nuclear reactions realized in the code CEM2k and the Los Alamos version of the Quark-Gluon String Model (LAQGSM) have been developed recently at LANL to describe reactions induced by particles and nuclei for a number of applications. Our CEM2k and LAQGSM merged with the GEM2 evaporation/fission code by Furihata have predictive powers comparable to other modern codes and describe many reactions better than other codes; therefore both our codes can be used as reliable event generators in transport codes for applications. During the last year, we have made a significant improvements to the intranuclear cascade parts of CEM2k and LAQGSM, and have extended LAQGSM to describe photonuclear reactions at energies to 10 GeV and higher. We have produced in this way improved versions of our codes, CEM03.01 and LAQGSM03.01. We present a brief description of our codes and show illustrative results obtained with CEM03.01 and LAQGSM03.01 for different reactions compared with predictions by other models, as well as examples of using our codes as modeling tools for nuclear applications.Comment: 12 pages, 10 figures, to be published in Journal of Physics: Conference Series: Proc. Europhysics Conf. on New Trends in Nuclear Physics Applications and Technologies (NPDC19), Pavia, Italy, September 5-9, 200

A Green Function for Metric Perturbations due to Cosmological Density Fluctuations

We study scalar perturbations to a Robertson-Walker cosmological metric in terms of a pseudo-Newtonian potential, which emerges naturally from the solution of the field equations. This potential is given in terms of a Green function for matter density fluctuations of arbitrary amplitude whose time and spatial dependence are assumed known. The results obtained span both the linearized and Newtonian limits, and do not explicitly depend on any kind of averaging procedure, but make the valid assumption that the global expansion rate is that of a Friedmann-Robertson-Walker model. In addition, we discuss the similarity to diffusive processes in the evolution of the potential, and possible applications.Comment: 19 pages, REVTeX. SU-ITP-9233, submitted to Physical Review

Thermal Diffusion and Quench Propagation in YBCO Pancake Coils Wound with ZnO-and Mylar Insulations

The thermal diffusion properties of several different kinds of YBCO insulations and the quench properties of pancake coils made using these insulations were studied. Insulations investigated include Nomex, Kapton, and Mylar, as well as insulations based on ZnO, Zn2GeO4, and ZnO-Cu. Initially, short stacks of YBCO conductors with interlayer insulation, epoxy, and a central heater strip were made and later measured for thermal conductivity in liquid nitrogen. Subsequently, three different pancake coils were made. The first two were smaller, each using one meter total of YBCO tape present as four turns around a G-10 former. One of these smaller coils used Mylar insulation co-wound with the YBCO tape, the other used YBCO tape onto which ZnO based insulation had been deposited. One larger coil was made which used 12 total meters of ZnO-insulated tape and had 45 turns. The results for all short sample and coil thermal conductivities were ~1-3 Wm-1K-1. Finally, quench propagation velocity measurements were performed on the coils (77 K, self field) by applying a DC current and then using a heater pulse to initiate a quench. Normal zone propagation velocity (NZP) values were obtained for the coils both in the radial direction and in the azimuthal direction. Radial NZP values (0.05-0.7 mm/s) were two orders of magnitude lower than axial values (~14-17 mm/s). Nevertheless, the quenches were generally seen to propagate radially within the coils, in the sense that any given layer in the coil is driven normal by the layer underneath it.Comment: 58 pages, 5 tables, 16 fig

Altered Skeletal Muscle Lipase Expression and Activity Contribute to Insulin Resistance in Humans

International audienceOBJECTIVE: Insulin resistance is associated with elevated content of skeletal muscle lipids, including triacylglycerols (TAGs) and diacylglycerols (DAGs). DAGs are by-products of lipolysis consecutive to TAG hydrolysis by adipose triglyceride lipase (ATGL) and are subsequently hydrolyzed by hormone-sensitive lipase (HSL). We hypothesized that an imbalance of ATGL relative to HSL (expression or activity) may contribute to DAG accumulation and insulin resistance. RESEARCH DESIGN AND METHODS: We first measured lipase expression in vastus lateralis biopsies of young lean (n = 9), young obese (n = 9), and obese-matched type 2 diabetic (n = 8) subjects. We next investigated in vitro in human primary myotubes the impact of altered lipase expression/activity on lipid content and insulin signaling. RESULTS: Muscle ATGL protein was negatively associated with whole-body insulin sensitivity in our population (r = -0.55, P = 0.005), whereas muscle HSL protein was reduced in obese subjects. We next showed that adenovirus-mediated ATGL overexpression in human primary myotubes induced DAG and ceramide accumulation. ATGL overexpression reduced insulin-stimulated glycogen synthesis (-30%, P < 0.05) and disrupted insulin signaling at Ser1101 of the insulin receptor substrate-1 and downstream Akt activation at Ser473. These defects were fully rescued by nonselective protein kinase C inhibition or concomitant HSL overexpression to restore a proper lipolytic balance. We show that selective HSL inhibition induces DAG accumulation and insulin resistance. CONCLUSIONS: Altogether, the data indicate that altered ATGL and HSL expression in skeletal muscle could promote DAG accumulation and disrupt insulin signaling and action. Targeting skeletal muscle lipases may constitute an interesting strategy to improve insulin sensitivity in obesity and type 2 diabetes

Definitive chemoradiation in patients with inoperable oesophageal carcinoma

We performed a retrospective study of 90 consecutive cases with inoperable carcinoma of the oesophagus treated with definitive chemoradiation at a single cancer centre between 1995 and 2002. For the last 4 years, 73 patients have received therapy according to an agreed protocol. This outpatient-based regimen involves four cycles of chemotherapy, cycles 3 and 4 given concurrently with 50 Gy external beam radiotherapy (XRT) delivered in 25 fractions over 5 weeks. Cisplatin 60 mg m-2 day-1 is given every 3 weeks together with continuous infusional 5-fluorouracil 300 mg m-2 day-1, reduced to 225 mg m-2 day-1 during the XRT. In all, 45 (50%) patients suffered one or more WHO grade 3/4 toxicity, grade 3 in 93% cases. Patients received more than 90% of the planned chemoradiation schedule. The median overall survival was 26 (15, >96) months, 51% (41, 64) and 26% (13, 52) surviving 2 and 5 years, respectively. Advanced stage, particularly T4 disease, was associated with a worse prognosis. Patients considered not suitable for surgery for reasons other than their disease, mainly co-morbidity, had a significantly better outcome, median survival 40 (26, >96) months, 2- and 5-year survivals 67% (54, 84) and 32% (13, 79), respectively (P<0.001). This schedule is a feasible, tolerable and effective treatment for patients with oesophageal cancer considered unsuitable for surgery