Effect of remote ischaemic conditioning on clinical outcomes in patients with acute myocardial infarction (CONDI-2/ERIC-PPCI): a single-blind randomised controlled trial.

BACKGROUND: Remote ischaemic conditioning with transient ischaemia and reperfusion applied to the arm has been shown to reduce myocardial infarct size in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). We investigated whether remote ischaemic conditioning could reduce the incidence of cardiac death and hospitalisation for heart failure at 12 months. METHODS: We did an international investigator-initiated, prospective, single-blind, randomised controlled trial (CONDI-2/ERIC-PPCI) at 33 centres across the UK, Denmark, Spain, and Serbia. Patients (age >18 years) with suspected STEMI and who were eligible for PPCI were randomly allocated (1:1, stratified by centre with a permuted block method) to receive standard treatment (including a sham simulated remote ischaemic conditioning intervention at UK sites only) or remote ischaemic conditioning treatment (intermittent ischaemia and reperfusion applied to the arm through four cycles of 5-min inflation and 5-min deflation of an automated cuff device) before PPCI. Investigators responsible for data collection and outcome assessment were masked to treatment allocation. The primary combined endpoint was cardiac death or hospitalisation for heart failure at 12 months in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT02342522) and is completed. FINDINGS: Between Nov 6, 2013, and March 31, 2018, 5401 patients were randomly allocated to either the control group (n=2701) or the remote ischaemic conditioning group (n=2700). After exclusion of patients upon hospital arrival or loss to follow-up, 2569 patients in the control group and 2546 in the intervention group were included in the intention-to-treat analysis. At 12 months post-PPCI, the Kaplan-Meier-estimated frequencies of cardiac death or hospitalisation for heart failure (the primary endpoint) were 220 (8·6%) patients in the control group and 239 (9·4%) in the remote ischaemic conditioning group (hazard ratio 1·10 [95% CI 0·91-1·32], p=0·32 for intervention versus control). No important unexpected adverse events or side effects of remote ischaemic conditioning were observed. INTERPRETATION: Remote ischaemic conditioning does not improve clinical outcomes (cardiac death or hospitalisation for heart failure) at 12 months in patients with STEMI undergoing PPCI. FUNDING: British Heart Foundation, University College London Hospitals/University College London Biomedical Research Centre, Danish Innovation Foundation, Novo Nordisk Foundation, TrygFonden

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

BACKGROUND: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. METHODS: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. FINDINGS: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96-1·28). INTERPRETATION: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. FUNDING: National Institute for Health Research Health Services and Delivery Research Programme

DNAfusion: an R/Bioconductor package for increased sensitivity of detecting gene fusions in liquid biopsies

Abstract Background EML4-ALK gene fusions are oncogenic drivers in non-small cell lung cancer (NSCLC), and liquid biopsies containing EML4-ALK fragments can be used to study tumor dynamics using next-generation sequencing (NGS). However, the sensitivity of EML4-ALK detection varies between pipelines and analysis tools. Results We developed an R/Bioconductor package, DNAfusion, which can be applied to BAM files generated by commercially available NGS pipelines, such as AVENIO. Forty-eight blood samples from a training cohort consisting of 41 stage IV EML4-ALK-positive NSCLC patients and seven healthy controls were used to develop DNAfusion. DNAfusion detected EML4-ALK in significantly more samples (sensitivity = 61.0%) compared to AVENIO (sensitivity = 36.6%). The newly identified EML4-ALK-positive patients were verified using droplet digital PCR. DNAfusion was subsequently validated in a blinded validation cohort comprising 24 EML4-ALK-positive and 24 EML4-ALK-negative stage IV NSCLC patients. DNAfusion detected significantly more EML4-ALK individuals in the validation cohort (sensitivity = 62.5%) compared to AVENIO (sensitivity = 29.2%). DNAfusion demonstrated a specificity of 100% in both the training and validation cohorts. Conclusion Here we present DNAfusion, which increases the sensitivity of EML4-ALK detection in liquid biopsies and can be implemented downstream of commercially available NGS pipelines. The simplistic method of operating the R package makes it easy to implement in the clinical setting, enabling wider expansion of NGS-based diagnostics

Cidadania, igualdade e diferença Citizenship, equality and diference

O artigo atenta para um aspecto específico das tendências recentes de transformação da cidadania: o avanço do reconhecimento da diferença combinado com forte regressão no plano da eqüidade. Para tanto, desenvolve-se uma análise da concepção tradicional da cidadania, das forças responsáveis pela sua desestabilização, das reações na literatura teórica perante tal desestabilização e, sobretudo, das diferentes tensões que, na edificação da cidadania moderna, caracterizaram a relação do binômio igualdade/ diferença æ tensões tematizadas de forma parcial no debate contemporâneo.<br>The article is concerned with a specific point of recent trends of change in citizenship: the progress of difference and a strong regression of equality. It makes an analysis of the traditional conception of citizenship, the forces that have turned it unstable, the theoretical reaction to it and, above all, the distinct tensions that have historically marked the relation between equality and difference, which have only partially been tackled in contemporary debate

Towards Operational Fiducial Reference Measurement (FRM) Data for the Calibration and Validation of the Sentinel-3 Surface Topography Mission over Inland Waters, Sea Ice, and Land Ice

International audienceThe Copernicus Sentinel-3 Surface Topography Mission (STM) Land Altimetry provides valuable surface elevation information over inland waters, sea ice, and land ice, thanks to its synthetic aperture radar (SAR) altimeter and its orbit that covers high-latitude polar regions. To ensure that these measurements are reliable and to maximise the return on investment, adequate validation of the geophysical retrieval methods, processing algorithms, and corrections must be performed using independent observations. The EU-ESA project St3TART (started July 2021) aims to generalise the concept of Fiducial Reference Measurements (FRMs) for the Copernicus Sentinel-3 STM. This work has gathered existing data, made new observations during field campaigns, and ensured that these observations meet the criteria of FRM standards so that they can be used to validate Sentinel-3 STM Land Altimetry products operationally. A roadmap for the operational provision of the FRM, including the definition, consolidation, and identification of the most relevant and cost-effective methods and protocols to be maintained, supported, or implemented, has been developed. The roadmap includes guidelines for SI traceability, definitions of FRM measurement procedures, processing methods, and uncertainty budget estimations

Towards Operational Fiducial Reference Measurement (FRM) Data for the Calibration and Validation of the Sentinel-3 Surface Topography Mission over Inland Waters, Sea Ice, and Land Ice

The Copernicus Sentinel-3 Surface Topography Mission (STM) Land Altimetry provides valuable surface elevation information over inland waters, sea ice, and land ice, thanks to its synthetic aperture radar (SAR) altimeter and its orbit that covers high-latitude polar regions. To ensure that these measurements are reliable and to maximise the return on investment, adequate validation of the geophysical retrieval methods, processing algorithms, and corrections must be performed using independent observations. The EU-ESA project St3TART (started July 2021) aims to generalise the concept of Fiducial Reference Measurements (FRMs) for the Copernicus Sentinel-3 STM. This work has gathered existing data, made new observations during field campaigns, and ensured that these observations meet the criteria of FRM standards so that they can be used to validate Sentinel-3 STM Land Altimetry products operationally. A roadmap for the operational provision of the FRM, including the definition, consolidation, and identification of the most relevant and cost-effective methods and protocols to be maintained, supported, or implemented, has been developed. The roadmap includes guidelines for SI traceability, definitions of FRM measurement procedures, processing methods, and uncertainty budget estimations.</p

Mutations in UPF3B, a member of the nonsense-mediated mRNA decay complex, cause syndromic and nonsyndromic mental retardation

Nonsense-mediated mRNA decay (NMD) is of universal biological significance1, 2, 3. It has emerged as an important global RNA, DNA and translation regulatory pathway4. By systematically sequencing 737 genes (annotated in the Vertebrate Genome Annotation database) on the human X chromosome in 250 families with X-linked mental retardation, we identified mutations in the UPF3 regulator of nonsense transcripts homolog B (yeast) (UPF3B) leading to protein truncations in three families: two with the Lujan-Fryns phenotype5, 6 and one with the FG phenotype7. We also identified a missense mutation in another family with nonsyndromic mental retardation. Three mutations lead to the introduction of a premature termination codon and subsequent NMD of mutant UPF3B mRNA. Protein blot analysis using lymphoblastoid cell lines from affected individuals showed an absence of the UPF3B protein in two families. The UPF3B protein is an important component of the NMD surveillance machinery8, 9. Our results directly implicate abnormalities of NMD in human disease and suggest at least partial redundancy of NMD pathways.Patrick S Tarpey, F Lucy Raymond, Lam S Nguyen, Jayson Rodriguez, Anna Hackett, Lucianne Vandeleur, Raffaella Smith, Cheryl Shoubridge, Sarah Edkins, Claire Stevens, Sarah O'Meara, Calli Tofts, Syd Barthorpe, Gemma Buck, Jennifer Cole, Kelly Halliday, Katy Hills, David Jones, Tatiana Mironenko, Janet Perry, Jennifer Varian, Sofie West, Sara Widaa, John Teague, Ed Dicks, Adam Butler, Andrew Menzies, David Richardson, Andrew Jenkinson, Rebecca Shepherd, Keiran Raine, Jenny Moon, Yin Luo, Josep Parnau, Shambhu S Bhat, Alison Gardner, Mark Corbett, Doug Brooks, Paul Thomas, Emma Parkinson-Lawrence, Mary E Porteous, John P Warner, Tracy Sanderson, Pauline Pearson, Richard J Simensen, Cindy Skinner, George Hoganson, Duane Superneau, Richard Wooster, Martin Bobrow, Gillian Turner, Roger E Stevenson, Charles E Schwartz, P Andrew Futreal, Anand K Srivastava, Michael R Stratton & Jozef Géc

Systematic review of agents for the management of gastrointestinal mucositis in cancer patients

<p>The aim of this study was to review the available literature and define clinical practice guidelines for the use of agents for the prevention and treatment of gastrointestinal mucositis.</p><p>A systematic review was conducted by the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO). The body of evidence for each intervention, in each cancer treatment setting, was assigned an evidence level. Based on the evidence level, one of the following three guideline determinations was possible: recommendation, suggestion, and no guideline possible.</p><p>A total of 251 clinical studies across 29 interventions were examined. Panel members were able to make one new evidence-based negative recommendation; two new evidence-based suggestions, and one evidence-based change from previous guidelines. Firstly, the panel recommends against the use of misoprostol suppositories for the prevention of acute radiation-induced proctitis. Secondly, the panel suggests probiotic treatment containing Lactobacillus spp., may be beneficial for prevention of chemotherapy and radiotherapy-induced diarrhea in patients with malignancies of the pelvic region. Thirdly, the panel suggests the use of hyperbaric oxygen as an effective means in treating radiation-induced proctitis. Finally, new evidence has emerged which is in conflict with our previous guideline surrounding the use of systemic glutamine, meaning that the panel is unable to form a guideline. No guideline was possible for any other agent, due to inadequate and/or conflicting evidence.</p><p>This updated review of the literature has allowed new recommendations and suggestions for clinical practice to be reached. This highlights the importance of regular updates.</p>