Core warming of coronavirus disease 2019 (COVID-19) patients undergoing mechanical ventilation-A protocol for a randomized controlled pilot study

BACKGROUND: Coronavirus disease 2019 (COVID-19), caused by the virus SARS-CoV-2, is spreading rapidly across the globe, with little proven effective therapy. Fever is seen in most cases of COVID-19, at least at the initial stages of illness. Although fever is typically treated (with antipyretics or directly with ice or other mechanical means), increasing data suggest that fever is a protective adaptive response that facilitates recovery from infectious illness. OBJECTIVE: To describe a randomized controlled pilot study of core warming patients with COVID-19 undergoing mechanical ventilation. METHODS: This prospective single-site randomized controlled pilot study will enroll 20 patients undergoing mechanical ventilation for respiratory failure due to COVID-19. Patients will be randomized 1:1 to standard-of-care or to receive core warming via an esophageal heat exchanger commonly utilized in critical care and surgical patients. The primary outcome is patient viral load measured by lower respiratory tract sample. Secondary outcomes include severity of acute respiratory distress syndrome (as measured by PaO2/FiO2 ratio) 24, 48, and 72 hours after initiation of treatment, hospital and intensive care unit length of stay, duration of mechanical ventilation, and 30-day mortality. RESULTS: Resulting data will provide effect size estimates to guide a definitive multi-center randomized clinical trial. ClinicalTrials.gov registration number: NCT04426344. CONCLUSIONS: With growing data to support clinical benefits of elevated temperature in infectious illness, this study will provide data to guide further understanding of the role of active temperature management in COVID-19 treatment and provide effect size estimates to power larger studies

Core warming of coronavirus disease 2019 patients undergoing mechanical ventilation: A pilot study

Fever is a recognized protective factor in patients with sepsis, and growing data suggest beneficial effects on outcomes in sepsis with elevated temperature, with a recent pilot randomized controlled trial (RCT) showing lower mortality by warming afebrile sepsis patients in the intensive care unit (ICU). The objective of this prospective single-site RCT was to determine if core warming improves respiratory physiology of mechanically ventilated patients with coronavirus disease 2019 (COVID-19), allowing earlier weaning from ventilation, and greater overall survival. A total of 19 patients with mean age of 60.5 (±12.5) years, 37% female, mean weight 95.1 (±18.6) kg, and mean body mass index 34.5 (±5.9) kg/

Isoperimetric Inequalities in Simplicial Complexes

In graph theory there are intimate connections between the expansion properties of a graph and the spectrum of its Laplacian. In this paper we define a notion of combinatorial expansion for simplicial complexes of general dimension, and prove that similar connections exist between the combinatorial expansion of a complex, and the spectrum of the high dimensional Laplacian defined by Eckmann. In particular, we present a Cheeger-type inequality, and a high-dimensional Expander Mixing Lemma. As a corollary, using the work of Pach, we obtain a connection between spectral properties of complexes and Gromov's notion of geometric overlap. Using the work of Gunder and Wagner, we give an estimate for the combinatorial expansion and geometric overlap of random Linial-Meshulam complexes

The European Registered Toxicologist (ERT) : Current status and prospects for advancement

Acknowledgements We would like to thank the participants of the five workshops in which the issues presented in this paper were discussed and the revised guidelines prepared, as well as the EUROTOX Executive Committee and the societies of toxicology of Sweden, the Netherlands, Switzerland, Austria and France for their support which allowed the workshops to take place.Peer reviewedPostprin

Flavouring Group Evaluation 76 Revision 2 (FGE.76Rev2): Consideration of sulfur-containing heterocyclic compounds, evaluated by JECFA, structurally related to thiazoles, thiophenes, thiazoline and thienyl derivatives from chemical group 29 and miscellaneous substances from chemical group 30 evaluated by EFSA in FGE.21Rev5

The Panel on Food Additives and Flavourings (FAF) was requested to consider the JECFA evaluations of 28 flavouring substances in the Flavouring Group Evaluation 76 (FGE.76Rev2). Twenty-one of these substances have been considered in FGE.76Rev1. Seven substances could not be evaluated, because of concerns with respect to genotoxicity. New genotoxicity data have been provided for 4-methyl-5-vinylthiazole [FL-no: 15.018] and 4,5-dimethyl-2-isobutyl-3-thiazoline [FL-no: 15.032], which are representative substances of [FL-no: 15.005] and [FL-no: 15.029, 15.030, 15.130 and 15.131], respectively. The Panel concluded that the concern for genotoxicity is ruled out for [FL-no: 15.018 and 15.005]. The concerns for gene mutations and clastogenicity are ruled out for [FL-no: 15.032, 15.029, 15.030, 15.130 and 15.131]. In vitro, [FL-no: 15.032] induced micronuclei through an aneugenic mode of action. The available in vivo micronucleus study was not adequate to rule out the concern for potential aneugenicity in vivo. The Panel compared the lowest concentration resulting in aneugenicity in vitro with the use levels reported for [FL-no: 15.032]. Based on this comparison, the Panel concluded that the use of [FL-no: 15.032] at the maximum reported use levels does not raise a concern for aneugenicity. Based on structural similarity, for the remaining four substances [FL-no: 15.029, 15.030, 15.130 and 15.131], an aneugenic potential may also be anticipated. Individual genotoxicity data are needed to establish whether they have aneugenic potential. The Panel agrees with JECFA conclusions for 24 flavouring substances 'No safety concern at estimated levels of intake as flavouring substances' when based on the MSDI approach. For six substances, more reliable information on uses and use levels are needed to refine the mTAMDI estimates. For 15 substances, use levels are needed to calculate the mTAMDIs. For [FL-no: 15.109 and 15.113], information on the actual stereochemical composition is inadequate and the conclusion reached for the named substances cannot be applied to the materials of commerce

On Eigenvalues of Random Complexes

We consider higher-dimensional generalizations of the normalized Laplacian and the adjacency matrix of graphs and study their eigenvalues for the Linial-Meshulam model $X^k(n,p)$ of random $k$-dimensional simplicial complexes on $n$ vertices. We show that for $p=\Omega(\log n/n)$, the eigenvalues of these matrices are a.a.s. concentrated around two values. The main tool, which goes back to the work of Garland, are arguments that relate the eigenvalues of these matrices to those of graphs that arise as links of $(k-2)$-dimensional faces. Garland's result concerns the Laplacian; we develop an analogous result for the adjacency matrix. The same arguments apply to other models of random complexes which allow for dependencies between the choices of $k$-dimensional simplices. In the second part of the paper, we apply this to the question of possible higher-dimensional analogues of the discrete Cheeger inequality, which in the classical case of graphs relates the eigenvalues of a graph and its edge expansion. It is very natural to ask whether this generalizes to higher dimensions and, in particular, whether the higher-dimensional Laplacian spectra capture the notion of coboundary expansion - a generalization of edge expansion that arose in recent work of Linial and Meshulam and of Gromov. We show that this most straightforward version of a higher-dimensional discrete Cheeger inequality fails, in quite a strong way: For every $k\geq 2$ and $n\in \mathbb{N}$, there is a $k$-dimensional complex $Y^k_n$ on $n$ vertices that has strong spectral expansion properties (all nontrivial eigenvalues of the normalised $k$-dimensional Laplacian lie in the interval $[1-O(1/\sqrt{n}),1+O(1/\sqrt{n})]$) but whose coboundary expansion is bounded from above by $O(\log n/n)$ and so tends to zero as $n\rightarrow \infty$; moreover, $Y^k_n$ can be taken to have vanishing integer homology in dimension less than $k$.Comment: Extended full version of an extended abstract that appeared at SoCG 2012, to appear in Israel Journal of Mathematic

Scientific Guidance on the data required for the risk assessment of flavourings to be used in or on foods

Following a request from the European Commission, EFSA developed a new scientific guidance to assist applicants in the preparation of applications for the authorisation of flavourings to be used in or on foods. This guidance applies to applications for a new authorisation as well as for a modification of an existing authorisation of a food flavouring, submitted under Regulation (EC) No 1331/2008. It defines the scientific data required for the evaluation of those food flavourings for which an evaluation and approval is required according to Article 9 of Regulation (EC) No 1334/2008. This applies to flavouring substances, flavouring preparations, thermal process flavourings, flavour precursors, other flavourings and source materials, as defined in Article 3 of Regulation (EC) No 1334/2008. Information to be provided in all applications relates to: (a) the characterisation of the food flavouring, including the description of its identity, manufacturing process, chemical composition, specifications, stability and reaction and fate in foods; (b) the proposed uses and use levels and the assessment of the dietary exposure and (c) the safety data, including information on the genotoxic potential of the food flavouring, toxicological data other than genotoxicity and information on the safety for the environment. For the toxicological studies, a tiered approach is applied, for which the testing requirements, key issues and triggers are described. Applicants should generate the data requested in each section to support the safety assessment of the food flavouring. Based on the submitted data, EFSA will assess the safety of the food flavouring and conclude whether or not it presents risks to human health and to the environment, if applicable, under the proposed conditions of use

Safety of the proposed amendment of the specifications for steviol glycosides (E 960) as a food additive : Rebaudioside M produced via enzyme-catalysed bioconversion of purified stevia leaf extract

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Association of germline genetic variants with breast cancer-specific survival in patient subgroups defined by clinic-pathological variables related to tumor biology and type of systemic treatment

BACKGROUND: Given the high heterogeneity among breast tumors, associations between common germline genetic variants and survival that may exist within specific subgroups could go undetected in an unstratified set of breast cancer patients. METHODS: We performed genome-wide association analyses within 15 subgroups of breast cancer patients based on prognostic factors, including hormone receptors, tumor grade, age, and type of systemic treatment. Analyses were based on 91,686 female patients of European ancestry from the Breast Cancer Association Consortium, including 7531 breast cancer-specific deaths over a median follow-up of 8.1 years. Cox regression was used to assess associations of common germline variants with 15-year and 5-year breast cancer-specific survival. We assessed the probability of these associations being true positives via the Bayesian false discovery probability (BFDP < 0.15). RESULTS: Evidence of associations with breast cancer-specific survival was observed in three patient subgroups, with variant rs5934618 in patients with grade 3 tumors (15-year-hazard ratio (HR) [95% confidence interval (CI)] 1.32 [1.20, 1.45], P = 1.4E-08, BFDP = 0.01, per G allele); variant rs4679741 in patients with ER-positive tumors treated with endocrine therapy (15-year-HR [95% CI] 1.18 [1.11, 1.26], P = 1.6E-07, BFDP = 0.09, per G allele); variants rs1106333 (15-year-HR [95% CI] 1.68 [1.39,2.03], P = 5.6E-08, BFDP = 0.12, per A allele) and rs78754389 (5-year-HR [95% CI] 1.79 [1.46,2.20], P = 1.7E-08, BFDP = 0.07, per A allele), in patients with ER-negative tumors treated with chemotherapy. CONCLUSIONS: We found evidence of four loci associated with breast cancer-specific survival within three patient subgroups. There was limited evidence for the existence of associations in other patient subgroups. However, the power for many subgroups is limited due to the low number of events. Even so, our results suggest that the impact of common germline genetic variants on breast cancer-specific survival might be limited