Effects of fluoxetine on functional outcomes after acute stroke (FOCUS): a pragmatic, double-blind, randomised, controlled trial

Background Results of small trials indicate that fluoxetine might improve functional outcomes after stroke. The FOCUS trial aimed to provide a precise estimate of these effects. Methods FOCUS was a pragmatic, multicentre, parallel group, double-blind, randomised, placebo-controlled trial done at 103 hospitals in the UK. Patients were eligible if they were aged 18 years or older, had a clinical stroke diagnosis, were enrolled and randomly assigned between 2 days and 15 days after onset, and had focal neurological deficits. Patients were randomly allocated fluoxetine 20 mg or matching placebo orally once daily for 6 months via a web-based system by use of a minimisation algorithm. The primary outcome was functional status, measured with the modified Rankin Scale (mRS), at 6 months. Patients, carers, health-care staff, and the trial team were masked to treatment allocation. Functional status was assessed at 6 months and 12 months after randomisation. Patients were analysed according to their treatment allocation. This trial is registered with the ISRCTN registry, number ISRCTN83290762. Findings Between Sept 10, 2012, and March 31, 2017, 3127 patients were recruited. 1564 patients were allocated fluoxetine and 1563 allocated placebo. mRS data at 6 months were available for 1553 (99·3%) patients in each treatment group. The distribution across mRS categories at 6 months was similar in the fluoxetine and placebo groups (common odds ratio adjusted for minimisation variables 0·951 [95% CI 0·839–1·079]; p=0·439). Patients allocated fluoxetine were less likely than those allocated placebo to develop new depression by 6 months (210 [13·43%] patients vs 269 [17·21%]; difference 3·78% [95% CI 1·26–6·30]; p=0·0033), but they had more bone fractures (45 [2·88%] vs 23 [1·47%]; difference 1·41% [95% CI 0·38–2·43]; p=0·0070). There were no significant differences in any other event at 6 or 12 months. Interpretation Fluoxetine 20 mg given daily for 6 months after acute stroke does not seem to improve functional outcomes. Although the treatment reduced the occurrence of depression, it increased the frequency of bone fractures. These results do not support the routine use of fluoxetine either for the prevention of post-stroke depression or to promote recovery of function. Funding UK Stroke Association and NIHR Health Technology Assessment Programme

Searches for exclusive Higgs boson decays into D⁎γ and Z boson decays into D0γ and Ks0γ in pp collisions at √s = 13 TeV with the ATLAS detector

Searches for exclusive decays of the Higgs boson into D⁎γ and of the Z boson into D0γ and Ks0γ can probe flavour-violating Higgs boson and Z boson couplings to light quarks. Searches for these decays are performed with a pp collision data sample corresponding to an integrated luminosity of 136.3 fb−1 collected at s=13TeV between 2016–2018 with the ATLAS detector at the CERN Large Hadron Collider. In the D⁎γ and D0γ channels, the observed (expected) 95% confidence-level upper limits on the respective branching fractions are B(H→D⁎γ)<1.0(1.2)×10−3, B(Z→D0γ)<4.0(3.4)×10−6, while the corresponding results in the Ks0γ channel are B(Z→Ks0γ)<3.1(3.0)×10−6

Measurement of vector boson production cross sections and their ratios using pp collisions at √s = 13.6 TeV with the ATLAS detector

Abstract available from publisher's website

Beam-induced backgrounds measured in the ATLAS detector during local gas injection into the LHC beam vacuum

Inelastic beam-gas collisions at the Large Hadron Collider (LHC), within a few hundred metres of the ATLAS experiment, are known to give the dominant contribution to beam backgrounds. These are monitored by ATLAS with a dedicated Beam Conditions Monitor (BCM) and with the rate of fake jets in the calorimeters. These two methods are complementary since the BCM probes backgrounds just around the beam pipe while fake jets are observed at radii of up to several metres. In order to quantify the correlation between the residual gas density in the LHC beam vacuum and the experimental backgrounds recorded by ATLAS, several dedicated tests were performed during LHC Run 2. Local pressure bumps, with a gas density several orders of magnitude higher than during normal operation, were introduced at different locations. The changes of beam-related backgrounds, seen in ATLAS, are correlated with the local pressure variation. In addition the rates of beam-gas events are estimated from the pressure measurements and pressure bump profiles obtained from calculations. Using these rates, the efficiency of the ATLAS beam background monitors to detect beam-gas events is derived as a function of distance from the interaction point. These efficiencies and characteristic distributions of fake jets from the beam backgrounds are found to be in good agreement with results of beam-gas simulations performed with theFluka Monte Carlo programme

Measurements of electroweak W±Z boson pair production in association with two jets in pp collisions at √s = 13 TeV with the ATLAS detector

Measurements of integrated and differential cross-sections for electroweak W±Z production in association with two jets (W±Zjj) in proton-proton collisions are presented. The data collected by the ATLAS detector at the Large Hadron Collider from 2015 to 2018 at a centre-of-mass energy of √ s = 13 TeV are used, corresponding to an integrated luminosity of 140 fb−1 . The W±Zjj candidate events are reconstructed using leptonic decay modes of the gauge bosons. Events containing three identified leptons, either electrons or muons, and two jets are selected. Processes involving pure electroweak W±Zjj production at Born level are separated from W±Zjj production involving a strong coupling. The measured integrated fiducial cross-section of electroweak W±Zjj production per lepton flavour is σW Zjj−EW→ℓ ′ νℓℓjj = 0.368 ± 0.037 (stat.) ± 0.059 (syst.) ± 0.003 (lumi.) fb, where ℓ and ℓ ′ are either an electron or a muon. Respective cross-sections of electroweak and strong W±Zjj production are measured separately for events with exactly two jets or with more than two jets, and in three bins of the invariant mass of the two jets. The inclusive W±Zjj production cross-section, without separating electroweak and strong production, is also measured to be σW Zjj→ℓ ′ νℓℓjj = 1.462 ± 0.063 (stat.) ± 0.118 (syst.) ± 0.012 (lumi.) fb, per lepton flavour. The inclusive W±Zjj production cross-section is measured differentially for several kinematic observables. Finally, the measurements are used to constrain anomalous quartic gauge couplings by extracting 95% confidence level intervals on dimension-8 operators

IFN-α-based treatment of patients with chronic HCV show increased levels of cells with myeloid-derived suppressor cell phenotype and of IDO and NOS

<p><b>Introduction:</b> Hepatitis C virus (HCV) infection causes chronic hepatitis, which is often associated with suppressed anti-HCV immune responses. We have recently reported accumulation of myeloid-derived suppressor cells (MDSCs) and suppressed immunity in cancer patients.</p> <p><b>Aim:</b> The main aim of this study was to determine whether chronic HCV patients harbor high of MDSCs in general and in nonresponders to IFN-based therapy in particular as well as to analyze the immune suppressive molecules.</p> <p><b>Methods:</b> Peripheral blood samples withdrawn from 154 patients with chronic HCV infection and were categorized into responders and nonresponders based on viral titer upon IFN-α treatment.</p> <p><b>Results:</b> The relative and absolute numbers of MDSCs defined as Lin⁻/HLA-DR⁻/CD33⁺/CD11b⁺ increased in all HCV patients, where they were higher in nonresponders than in responders. Additionally, the levels of MDSCs after 4–6 months of treatment in responders were lower than during the course of treatment. The responders also showed higher levels of IL-2 coincided with increased numbers of dendritic cells (DCs), CD4⁺ and CD8⁺ T cells. The levels of total NOS and IDO were also higher in nonresponders as compared to responders and healthy controls, while the expression levels of CD3ζ was lower in responders as compared to nonresponders and healthy volunteers.</p> <p><b>Conclusion:</b> Chronic HCV patients harbor high numbers of MDSCs, which are higher in nonresponders than in responders. The higher numbers of MDSCs associated with increases in the suppressing factors.</p

Feasibility of reporting results of large randomised controlled trials to participants:experience from the Fluoxetine or Control under supervision (FOCUS) trial

Objectives Informing research participants of the results of studies in which they took part is viewed as an ethical imperative. However, there is little guidance in the literature about how to do this. The Fluoxetine Or Control Under Supervision trial randomised 3127 patients with a recent acute stroke to 6 months of fluoxetine or placebo and was published in the Lancet on 5 December 2018. The trial team decided to inform the participants of the results at exactly the same time as the Lancet publication, and also whether they had been allocated fluoxetine or placebo. In this report, we describe how we informed participants of the results.Design In the 6-month and 12-month follow-up questionnaires, we invited participants to provide an email address if they wished to be informed of the results of the trial. We re-opened our trial telephone helpline between 5 December 2018 and 31 March 2019.Setting UK stroke services.Participants 3127 participants were randomised. 2847 returned 6-month follow-up forms and 2703 returned 12-month follow-up forms; the remaining participants had died (380), withdrawn consent or did not respond.Results Of those returning follow-up questionnaires, a total of 1845 email addresses were provided and a further 50 people requested results to be sent by post. Results were sent to all email and postal addresses provided; 309 emails were returned unrecognised. Seventeen people replied, of whom three called the helpline and the rest responded by email.Conclusion It is feasible to disseminate results of large trials to research participants, though only around 60% of those randomised wanted to receive the results. The system we developed was efficient and required very little resource, and could be replicated by trialists in the future.Trial registration number ISRCTN83290762; Post-results

Measurements of electroweak W±Z boson pair production in association with two jets in pp collisions at s \sqrt{s} = 13 TeV with the ATLAS detector

Abstract Measurements of integrated and differential cross-sections for electroweak W±Z production in association with two jets (W±Zjj) in proton-proton collisions are presented. The data collected by the ATLAS detector at the Large Hadron Collider from 2015 to 2018 at a centre-of-mass energy of $$\sqrt{s}$$ s = 13 TeV are used, corresponding to an integrated luminosity of 140 fb−1. The W±Zjj candidate events are reconstructed using leptonic decay modes of the gauge bosons. Events containing three identified leptons, either electrons or muons, and two jets are selected. Processes involving pure electroweak W±Zjj production at Born level are separated from W±Zjj production involving a strong coupling. The measured integrated fiducial cross-section of electroweak W±Zjj production per lepton flavour is $${\sigma}_{WZjj- EW\to {\ell}^{\prime}\nu \mathcal{ll} jj}$$ σ WZjj − EW → ℓ ′ ν ll jj = 0.368 ± 0.037 (stat.) ± 0.059 (syst.) ± 0.003 (lumi.) fb, where ℓ and ℓ′ are either an electron or a muon. Respective cross-sections of electroweak and strong W±Zjj production are measured separately for events with exactly two jets or with more than two jets, and in three bins of the invariant mass of the two jets. The inclusive W±Zjj production cross-section, without separating electroweak and strong production, is also measured to be $${\sigma}_{WZjj\to {\ell}^{\prime}\nu \mathcal{ll} jj}$$ σ WZjj → ℓ ′ ν ll jj = 1.462 ± 0.063 (stat.) ± 0.118 (syst.) ± 0.012 (lumi.) fb, per lepton flavour. The inclusive W±Zjj production cross-section is measured differentially for several kinematic observables. Finally, the measurements are used to constrain anomalous quartic gauge couplings by extracting 95% confidence level intervals on dimension-8 operators.</jats:p

Searches for exclusive Higgs boson decays into D⁎γ and Z boson decays into D0γ and <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" altimg="si1.svg"><mml:msubsup><mml:mrow><mml:mi>K</mml:mi></mml:mrow><mml:mrow><mml:mi>s</mml:mi></mml:mrow><mml:mrow><mml:mn>0</mml:mn></mml:mrow></mml:msubsup><mml:mi>γ</mml:mi></mml:math> in pp collisions at <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" altimg="si2.svg"><mml:msqrt><mml:mrow><mml:mi>s</mml:mi></mml:mrow></mml:msqrt><mml:mo linebreak="goodbreak" linebreakstyle="after">=</mml:mo><mml:mn>13</mml:mn><mml:mspace width="0.25em"/><mml:mtext mathvariant="normal">TeV</mml:mtext></mml:math> with the ATLAS detector

Searches for exclusive decays of the Higgs boson into D⁎γ and of the Z boson into D0γ and Ks0γ can probe flavour-violating Higgs boson and Z boson couplings to light quarks. Searches for these decays are performed with a pp collision data sample corresponding to an integrated luminosity of 136.3 fb−1 collected at s=13TeV between 2016–2018 with the ATLAS detector at the CERN Large Hadron Collider. In the D⁎γ and D0γ channels, the observed (expected) 95% confidence-level upper limits on the respective branching fractions are B(H→D⁎γ)<1.0(1.2)×10−3, B(Z→D0γ)<4.0(3.4)×10−6, while the corresponding results in the Ks0γ channel are B(Z→Ks0γ)<3.1(3.0)×10−6