High levels of serum macrophage migration inhibitory factor and interleukin 10 are associated with a rapidly fatal outcome in patients with severe sepsis

SummaryObjectivesThe aim of this study was to delineate the association between high macrophage migration inhibitory factor (MIF) and interleukin 10 (IL-10) levels in the early phase of sepsis and rapidly fatal outcome.MethodsOne hundred and fifty-three adult subjects with the main diagnosis of severe sepsis (including septic shock) admitted directly from the emergency department of two tertiary medical centers and one regional teaching hospital between January 2009 and December 2011, were included prospectively. MIF and IL-10 levels were measured and outcomes were analyzed by Cox regression analysis according to the following outcomes: rapidly fatal outcome (RFO, death within 48h), late fatal outcome (LFO, death between 48h and 28 days), and survival at 28 days.ResultsAmong the three outcome groups, IL-10 levels were significantly higher in the RFO group (p < 0.001) and no significant differences were seen between the LFO and survivor groups. After Cox regression analysis, each incremental elevation of 1000 pg/ml in both IL-10 and MIF was independently associated with RFO in patients with severe sepsis. Each incremental elevation of 1000 pg/ml in IL-10 increased the RFO risk by a factor of 1.312 (95% confidence interval 1.094–1.575; p=0.003); this was the most significant factor leading to RFO in patients with severe sepsis.ConclusionsPatients with RFO exhibited simultaneously high MIF and IL-10 levels in the early phase of severe sepsis. Incremental increases in both IL-10 and MIF levels were associated with RFO in this patient group, and of the two, IL-10 was the most significant factor linked to RFO

Ramucirumab plus docetaxel versus placebo plus docetaxel in patients with locally advanced or metastatic urothelial carcinoma after platinum-based therapy (RANGE): a randomised, double-blind, phase 3 trial

Few treatments with a distinct mechanism of action are available for patients with platinum-refractory advanced or metastatic urothelial carcinoma. We assessed the efficacy and safety of treatment with docetaxel plus either ramucirumab-a human IgG1 VEGFR-2 antagonist-or placebo in this patient population

Retrospective evaluation of whole exome and genome mutation calls in 746 cancer samples

Funder: NCI U24CA211006Abstract: The Cancer Genome Atlas (TCGA) and International Cancer Genome Consortium (ICGC) curated consensus somatic mutation calls using whole exome sequencing (WES) and whole genome sequencing (WGS), respectively. Here, as part of the ICGC/TCGA Pan-Cancer Analysis of Whole Genomes (PCAWG) Consortium, which aggregated whole genome sequencing data from 2,658 cancers across 38 tumour types, we compare WES and WGS side-by-side from 746 TCGA samples, finding that ~80% of mutations overlap in covered exonic regions. We estimate that low variant allele fraction (VAF < 15%) and clonal heterogeneity contribute up to 68% of private WGS mutations and 71% of private WES mutations. We observe that ~30% of private WGS mutations trace to mutations identified by a single variant caller in WES consensus efforts. WGS captures both ~50% more variation in exonic regions and un-observed mutations in loci with variable GC-content. Together, our analysis highlights technological divergences between two reproducible somatic variant detection efforts

China’s emerging grand strategy: dominating East Asia without fighting

Since late 2002, Beijing has implemented an increasingly integrated new grand strategy. It incorporates domestic policy, foreign policy, and cross-strait policy in way of synergy to augment their combined benefits. With it, Beijing has achieved some noteworthy success in foreign affairs, despite daunting domestic dilemmas China is facing. As the country grows into a status quo power, Beijing has begun to encounter untried challenges. One of Beijing’s aspirations under this emerging national security framework, albeit officially unsaid, is to dominate East Asia and nudge out the hitherto leading US influence without a war, but instead with mainly economy and culture. China’s rapidly modernizing military capabilities, which Beijing wished to have fully prepared but preferably not used in actual combat, are intended to strengthen the effects of Beijing’s extra-military instruments. The article answers the following questions: How has the grand strategy developed? What does it contain? What assumptions is it based on? What characterizes its approaches? How has it manifested in PRC–US/Japan/Taiwan relations? What challenges has it encountered? The article ends with the table of Beijing’s post–Anti-Secession Law cross-Strait soft offensives

Physical performance among community-dwelling older people in Senawang

Introduction Older adults may remove themselves voluntarily from social activities due to health concerns and physical limitations that leads to loneliness. Additionally, loneliness is associated with poorer health among older adults. Therefore, this study aims to improve health status among community-dwelling older adults in the sub-urban area through this social participation project by creating awareness on empowering the older adults in managing their health and social life. Methods This is a community-based participatory research (CBPR) applying both quantitative and qualitative approaches. Quantitative data was obtained with a standardized data collection document and obtained during a series of health screening programs. The data was analyzed using descriptive statistics. Key results 87 older adults participated in two health screening events. The mean age was 66 ± 6.5 (SD) years, median BMI was 26.5 (IQR=6.4), mean systolic blood pressure was 141 ± 14.6 (SD) mmHg, median diastolic blood pressure was 78 (IQR=10) mmHg, median timed up and go was 10 (IQR=3) seconds, median trail-making test A was 45.8 (IQR=24.4) seconds, median trail-making test B was 115.8 (IQR=99.3) seconds. The mean hand grip strength for male was 30.76 ± 5.1 (SD) kg for right hand and 31.87 ± 24.5 (SD) kg for left hand. The mean hand grip strength for female was 18.40 ± 5.1 (SD) kg for right hand and 17.14 ± 5.0 (SD) kg for left hand. Discussion The results may represent a portion of community-dwelling older adults who are actively engage in community activities such as religious classes, weddings or events. Therefore, the results showed normal values for all physical and mental tests. However, 61% of the participants were overweight or obese and had higher mean systolic blood pressure suggesting the need for more education and awareness on health management

Risk factors for severe adenovirus infection in children during an outbreak in Singapore

Annals of the Academy of Medicine Singapore4425