Carotid stenting: is there an operator effect? A pooled analysis from the carotid stenting trialists' collaboration.

BACKGROUND AND PURPOSE: Randomized clinical trials show higher 30-day risk of stroke or death after carotid artery stenting compared with surgery. We examined whether operator experience is associated with 30-day risk of stroke or death in the Carotid Stenting Trialists' Collaboration database. METHODS: The Carotid Stenting Trialists' Collaboration is a pooled individual patient database including all patients recruited in 3 randomized trials of stenting versus endarterectomy for symptomatic carotid stenosis (Endarterectomy Versus Angioplasty in patients with Symptomatic Severe Carotid Stenosis trial, Stent-Protected Angioplasty versus Carotid Endarterectomy trial, and International Carotid Stenting Study). Lifetime carotid artery stenting experience, lifetime experience in stenting procedures excluding the carotid, and annual number of procedures performed within the trial (in-trial volume), divided into tertiles, were used to measure operator experience. The outcome event was the occurrence of any stroke or death within 30 days of the procedure. The analysis was done per protocol. RESULTS: Among 1546 patients who underwent carotid artery stenting, 120 (7.8%) had a stroke or death within 30 days of the procedure. The 30-day risk of stroke or death did not differ according to operator lifetime carotid artery stenting experience (P=0.8) or operator lifetime stenting experience excluding the carotid (P=0.7). In contrast, the 30-day risk of stroke or death was significantly higher in patients treated by operators with low (mean ≤3.2 procedures/y; risk 10.1%; adjusted risk ratio=2.30 [1.36-3.87]) and intermediate annual in-trial volumes (3.2-5.6 procedures/y; 8.4%; adjusted risk ratio=1.93 [1.14-3.27]) compared with patients treated by high annual in-trial volume operators (>5.6 procedures/y; 5.1%). CONCLUSIONS: Carotid stenting should only be performed by operators with annual procedure volume ≥6 cases per year

Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine.

OBJECTIVE: Circulatory shock is a life-threatening syndrome resulting in multiorgan failure and a high mortality rate. The aim of this consensus is to provide support to the bedside clinician regarding the diagnosis, management and monitoring of shock. METHODS: The European Society of Intensive Care Medicine invited 12 experts to form a Task Force to update a previous consensus (Antonelli et al.: Intensive Care Med 33:575-590, 2007). The same five questions addressed in the earlier consensus were used as the outline for the literature search and review, with the aim of the Task Force to produce statements based on the available literature and evidence. These questions were: (1) What are the epidemiologic and pathophysiologic features of shock in the intensive care unit ? (2) Should we monitor preload and fluid responsiveness in shock ? (3) How and when should we monitor stroke volume or cardiac output in shock ? (4) What markers of the regional and microcirculation can be monitored, and how can cellular function be assessed in shock ? (5) What is the evidence for using hemodynamic monitoring to direct therapy in shock ? Four types of statements were used: definition, recommendation, best practice and statement of fact. RESULTS: Forty-four statements were made. The main new statements include: (1) statements on individualizing blood pressure targets; (2) statements on the assessment and prediction of fluid responsiveness; (3) statements on the use of echocardiography and hemodynamic monitoring. CONCLUSIONS: This consensus provides 44 statements that can be used at the bedside to diagnose, treat and monitor patients with shock

Massive subsurface ice formed by refreezing of ice-shelf melt ponds

Surface melt ponds form intermittently on several Antarctic ice shelves. Although implicated in ice-shelf break up, the consequences of such ponding for ice formation and ice-shelf structure have not been evaluated. Here we report the discovery of a massive subsurface ice layer, at least 16 km across, several kilometres long and tens of metres deep, located in an area of intense melting and intermittent ponding on Larsen C Ice Shelf, Antarctica. We combine borehole optical televiewer logging and radar measurements with remote sensing and firn modelling to investigate the layer, found to be ∼10 C warmer and ∼170 kg m¯³ denser than anticipated in the absence of ponding and hitherto used in models of ice-shelf fracture and flow. Surface ponding and ice layers such as the one we report are likely to form on a wider range of Antarctic ice shelves in response to climatic warming in forthcoming decades

A randomized clinical trial indicates that levamisole increases the time to relapse in children with steroid-sensitive idiopathic nephrotic syndrome

Levamisole has been considered the least toxic and least expensive steroid-sparing drug for preventing relapses of steroid-sensitive idiopathic nephrotic syndrome (SSINS). However, evidence for this is limited as previous randomized clinical trials were found to have methodological limitations. Therefore, we conducted an international multicenter, placebo-controlled, double-blind, randomized clinical trial to reassess its usefulness in prevention of relapses in children with SSINS. The efficacy and safety of one year of levamisole treatment in children with SSINS and frequent relapses were evaluated. The primary analysis cohort consisted of 99 patients from 6 countries. Between 100 days and 12 months after the start of study medication, the time to relapse (primary endpoint) was significantly increased in the levamisole compared to the placebo group (hazard ratio 0.22 [95% confidence interval 0.11-0.43]). Significantly, after 12 months of treatment, six percent of placebo patients versus 26 percent of levamisole patients were still in remission. During this period, the most frequent serious adverse event (four of 50 patients) possibly related to levamisole was asymptomatic moderate neutropenia, which was reversible spontaneously or after treatment discontinuation. Thus, in children with SSINS and frequent relapses, levamisole prolonged the time to relapse and also prevented recurrence during one year of treatment compared to prednisone alone. However, regular blood controls are necessary for safety issues

On Scottish sawflies, with results of the 14th International Sawfly Workshop, in the southern Highlands, 2010 (Hymenoptera, Symphyta).

Die Ergebnisse der Feldarbeit aus dem 14. Internationalen Sawfly Workshop werden vorgestellt. Dies fand im südlichen schottischen Hochland, überwiegend in Perthshire, statt. Einige Nachweise von Pflanzenwespen aus anderen Teilen von Schottland sind enthalten. Erstnachweise für die Britischen Inseln werden für acht tenthredinide Arten erbracht: Amauronematus mimus, Phyllocolpa alienata, P. erythropyga, P. plicalapponum, P. plicaphylicifolia, P. prussica, Pristiphora thalictri und Tenthredo ignobilis. A. mimus ist auch aus Irland nachgewiesen. Amauronematus stenogaster ist aus der Liste der Symphyta der Britischen Inseln zu entfernen. Erstmalig sind in Schottland eine Cephiden-Art (Hartigia xanthostoma) und zehn Tenthrediniden gefunden worden (Claremontia uncta, Dolerus brevicornis, Empria basalis, Empria parvula, Parna apicalis, Pristiphora decipiens, Pristiphora leucopus, Pristiphora testacea, Tenthredo mandibularis und Tenthredopsis ornata). Merkmale für die Unterscheidung einzelner Arten werden dargestellt. Der Locus typicus von Nematus herbaceae Cameron, 1876 ist geklärt. Geranium pratense ist als Wirtspflanze von Macrophya albipuncta bestätigt. Salix reticulata ist eine Wirtspflanze von Amauronematus mcluckieae. Sedum rosea kann eine Wirtspflanze von Tenthredo ignobilis sein. Allgemeine Schlussfolgerungen: hoher Artenreichtum der Pflanzenwespenfauna von Perthshire im Vergleich zu anderen Regionen in Schottland, darunter mehrere Arten, die auf den Britischen Inseln nur von dort bekannt sind; die Wichtigkeit der Erhaltung der Lebensräume von Felssimsen; große Defizite in unseren Kenntnissen bei vielen Arten, insbesondere zu Wirtspflanzen, Phänologie und Verbreitung; hoher Wert der Malaise-Falle in faunistischen Untersuchungen von Symphyta, weil das Spektrum von erfassten Taxa sich unterscheidet von dem was mit Streifnetz erfasst wird; Zusammensetzung des 'fall-out’ auf Schneeresten deutet darauf hin, dass Pflanzenwespen in einem größeren Ausmaß als bisher angenommen, aktiver Dispersion innerhalb von Landmassen unterliegen.StichwörterBritish Isles, Cephidae, Pamphiliidae, Tenthredinoidea, hosts, phenology, distribution.Results of fieldwork are presented from the 14th International Sawfly Workshop, held in the southern Highlands of Scotland, mostly in Perthshire. Some records of Symphyta from other parts of Scotland are included. First records in the British Isles are given for eight tenthredinid species: Amauronematus mimus, Phyllocolpa alienata, P. erythropyga, P. plicalapponum, P. plicaphylicifolia, P. prussica, Pristiphora thalictri and Tenthredo ignobilis. A. mimus is also recorded from Ireland. Amauronematus stenogaster is removed from the list of British Isles Symphyta. Recorded for the first time in Scotland are one cephid (Hartigia xanthostoma) and ten tenthredinids (Claremontia uncta, Dolerus brevicornis, Empria basalis, Empria parvula, Parna apicalis, Pristiphora decipiens, Pristiphora leucopus, Pristiphora testacea, Tenthredo mandibularis and Tenthredopsis ornata). Characters useful for the distinction of some species are illustrated. The type locality of Nematus herbaceae Cameron, 1876 is clarified. Geranium pratense is confirmed as a host of Macrophya albipuncta. Salix reticulata is a host of Amauronematus mcluckieae [mandatory correction of spelling of species name]. Sedum rosea may be a host of Tenthredo ignobilis. General conclusions: high species richness of Perthshire sawfly fauna compared to other regions of Scotland, including several species only known in British Isles from there; importance to conservation of rock-ledge habitats; large data deficits for many species, particularly on hosts, phenology and distribution; high value of Malaise traps in faunal survey of Symphyta, because spectrum of taxa captured differs from that recorded by hand-netting; as indicated by species and sex composition of ‘fall-out’ on snow patches, adult sawflies undertake active dispersal, within landmasses, to a greater extent than is often assumed.KeywordsBritish Isles, Cephidae, Pamphiliidae, Tenthredinoidea, hosts, phenology, distribution

Prediction Models for Clinical Outcome After a Carotid Revascularization Procedure.

Background and Purpose- Prediction models may help physicians to stratify patients with high and low risk for periprocedural complications or long-term stroke risk after carotid artery stenting or carotid endarterectomy. We aimed to evaluate external performance of previously published prediction models for short- and long-term outcome after carotid revascularization in patients with symptomatic carotid artery stenosis. Methods- From a literature review, we selected all prediction models that used only readily available patient characteristics known before procedure initiation. Follow-up data from 2184 carotid artery stenting and 2261 carotid endarterectomy patients from 4 randomized trials (EVA-3S [Endarterectomy Versus Angioplasty in Patients With Symptomatic Severe Carotid Stenosis], SPACE [Stent-Protected Angioplasty Versus Carotid Endarterectomy], ICSS [International Carotid Stenting Study], and CREST [Carotid Revascularization Endarterectomy Versus Stenting Trial]) were used to validate 23 short-term outcome models to estimate stroke or death risk ≤30 days after the procedure and the original outcome measure for which the model was developed. Additionally, we validated 7 long-term outcome models for the original outcome measure. Predictive performance of the models was assessed with C statistics and calibration plots. Results- Stroke or death ≤30 days after the procedure occurred in 158 (7.2%) patients after carotid artery stenting and in 84 (3.7%) patients after carotid endarterectomy. Most models for short-term outcome after carotid artery stenting (n=4) or carotid endarterectomy (n=19) had poor discriminative performance (C statistics ranging from 0.49-0.64) and poor calibration with small absolute risk differences between the lowest and highest risk groups and overestimation of risk in the highest risk groups. Long-term outcome models (n=7) had a slightly better performance with C statistics ranging from 0.59 to 0.67 and reasonable calibration. Conclusions- Current models did not reliably predict outcome after carotid revascularization in a trial population of patients with symptomatic carotid stenosis. In particular, prediction of short-term outcome seemed to be difficult. Further external validation of existing prediction models or development of new prediction models is needed before such models can be used to support treatment decisions in individual patients

QiSampler: evaluation of scoring schemes for high-throughput datasets using a repetitive sampling strategy on gold standards

<p>Abstract</p> <p>Background</p> <p>High-throughput biological experiments can produce a large amount of data showing little overlap with current knowledge. This may be a problem when evaluating alternative scoring mechanisms for such data according to a gold standard dataset because standard statistical tests may not be appropriate.</p> <p>Findings</p> <p>To address this problem we have implemented the QiSampler tool that uses a repetitive sampling strategy to evaluate several scoring schemes or experimental parameters for any type of high-throughput data given a gold standard. We provide two example applications of the tool: selection of the best scoring scheme for a high-throughput protein-protein interaction dataset by comparison to a dataset derived from the literature, and evaluation of functional enrichment in a set of tumour-related differentially expressed genes from a thyroid microarray dataset.</p> <p>Conclusions</p> <p>QiSampler is implemented as an open source R script and a web server, which can be accessed at <url>http://cbdm.mdc-berlin.de/tools/sampler/</url>.</p

Paraganglioma and pheochromocytoma upon maternal transmission of SDHD mutations

The SDHD gene encodes a subunit of the mitochondrial tricarboxylic acid cycle enzyme and tumor suppressor

Science Impacts of the SPHEREx All-Sky Optical to Near-Infrared Spectral Survey: Report of a Community Workshop Examining Extragalactic, Galactic, Stellar and Planetary Science

SPHEREx is a proposed SMEX mission selected for Phase A. SPHEREx will carry out the first all-sky spectral survey and provide for every 6.2" pixel a spectra between 0.75 and 4.18 $\mu$m [with R$\sim$41.4] and 4.18 and 5.00 $\mu$m [with R$\sim$135]. The SPHEREx team has proposed three specific science investigations to be carried out with this unique data set: cosmic inflation, interstellar and circumstellar ices, and the extra-galactic background light. It is readily apparent, however, that many other questions in astrophysics and planetary sciences could be addressed with the SPHEREx data. The SPHEREx team convened a community workshop in February 2016, with the intent of enlisting the aid of a larger group of scientists in defining these questions. This paper summarizes the rich and varied menu of investigations that was laid out. It includes studies of the composition of main belt and Trojan/Greek asteroids; mapping the zodiacal light with unprecedented spatial and spectral resolution; identifying and studying very low-metallicity stars; improving stellar parameters in order to better characterize transiting exoplanets; studying aliphatic and aromatic carbon-bearing molecules in the interstellar medium; mapping star formation rates in nearby galaxies; determining the redshift of clusters of galaxies; identifying high redshift quasars over the full sky; and providing a NIR spectrum for most eROSITA X-ray sources. All of these investigations, and others not listed here, can be carried out with the nominal all-sky spectra to be produced by SPHEREx. In addition, the workshop defined enhanced data products and user tools which would facilitate some of these scientific studies. Finally, the workshop noted the high degrees of synergy between SPHEREx and a number of other current or forthcoming programs, including JWST, WFIRST, Euclid, GAIA, K2/Kepler, TESS, eROSITA and LSST.Comment: Report of the First SPHEREx Community Workshop, http://spherex.caltech.edu/Workshop.html , 84 pages, 28 figure