A new prognostic score supporting treatment allocation for multimodality therapy for malignant pleural mesothelioma- A review of 12 years' experience

INTRODUCTION Treatment of malignant pleural mesothelioma (MPM) remains a clinical challenge. The aim of this study was to identify selection factorsfor allocation of MPM patients to multimodal therapy based on survival data from 12 years of experience. METHODS Eligible patients had MPM of all histological subtypes with clinical stage T1-3 N0-2 M0. Induction chemotherapy consisted of cisplatin/gemcitabine (cis/gem) orcisplatin/pemetrexed (cis/pem), followed by extrapleural pneumonectomy (EPP).Multivariate analysis was performed to assess independent prognosticators for overall survival (OS). A Multimodality Prognostic Scorewasdeveloped based on clinical variablesavailable before surgery. RESULTS From May 1999 to August 2011, 186 MPM patients were intended to be treated with induction chemotherapy followed by EPP. Hematologic toxicity was significantly less frequent after cis/pemcompared to cis/gem, but no difference in response or OS between the regimens.128 patients underwent EPP with a30-day mortalityof4.7%. 52% percent of the patients received adjuvant radiotherapy. The median OSof patients undergoing EPP was significantly longer with 22months (95%CI:20-24) as compared to 11 months (9-12) for patients treated without EPP.Aprognostic score was defined considering tumor volume,histology, CRP,andresponsetochemotherapythat identified patient groupsnot benefittingfrom multimodality treatmentwhich was confirmed in an independent cohort. CONCLUSION Patients receiving induction chemotherapy followed by EPP for MPM of all histological subtypes and irrespective of nodal statusshowed a median survival of 22months. A prognostic score is proposed to help patient allocation for surgery after validation in an independent cohort

The future of Blue Carbon science

Unidad de excelencia María de Maeztu MdM-2015-0552The term Blue Carbon (BC) was first coined a decade ago to describe the disproportionately large contribution of coastal vegetated ecosystems to global carbon sequestration. The role of BC in climate change mitigation and adaptation has now reached international prominence. To help prioritise future research, we assembled leading experts in the field to agree upon the top-ten pending questions in BC science. Understanding how climate change affects carbon accumulation in mature BC ecosystems and during their restoration was a high priority. Controversial questions included the role of carbonate and macroalgae in BC cycling, and the degree to which greenhouse gases are released following disturbance of BC ecosystems. Scientists seek improved precision of the extent of BC ecosystems; techniques to determine BC provenance; understanding of the factors that influence sequestration in BC ecosystems, with the corresponding value of BC; and the management actions that are effective in enhancing this value. Overall this overview provides a comprehensive road map for the coming decades on future research in BC science

Top 100 questions for biodiversity conservation in Southeast Asia

Southeast (SE) Asia holds high regional biodiversity and endemism levels but is also one of the world's most threatened regions. Local, regional and global threats could have severe consequences for the future survival of many species and the provision of ecosystem services.In the face of myriad pressing environmental problems, we carried out a research prioritisation exercise involving 64 experts whose research relates to conservation biology and sustainability in SE Asia. Experts proposed the most pressing research questions which, if answered, would advance the goals of biodiversity conservation and sustainable development in SE Asia. We received a total of 333 questions through three rounds of elicitation, ranked them (by votes) following a workshop and grouped them into themes.The top 100 questions depict SE Asia as a region where strong pressures on biodiversity interact in complex and poorly understood ways. They point to a lack of information about multiple facets of the environment, while exposing the many threats to biodiversity and human wellbeing. The themes that emerged indicate the need to evaluate specific drivers of biodiversity loss (wildlife harvesting, agricultural expansion, climate change, infrastructure development, pollution) and even to identify which species and habitats are most at risk. They also suggest the need to study the effectiveness of practice-based solutions (protected areas, ecological restoration), the human dimension (social interventions, organisational systems and processes and, the impacts of biodiversity loss and conservation interventions on people). Finally, they highlight gaps in fundamental knowledge of ecosystem function. These 100 questions should help prioritise and coordinate research, conservation, education and outreach activities and the distribution of scarce conservation resources in SE Asia

American College of Cardiology; American Heart Association Task Force; European Society of Cardiology Committee for Practice Guidelines. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death).

The purpose this document is to update and combine the previously published recommendations into one source approved by the major cardiology organizations in the United States and Europe. We have consciously attempted to create a streamlined document, not a textbook, that would be useful specifically to locate recommendations on the evaluation and treatment of patients who have or may be at risk for ventricular arrhythmias. Thus, sections on epidemiology, mechanisms and substrates, and clinical presentations are brief, because there are no recommendations for those sections. For the other sections, the wording has been kept to a minimum, and clinical presentations have been confined to those aspects relevant to forming recommendations