Anti-tumour necrosis factor discontinuation in inflammatory bowel disease patients in remission: study protocol of a prospective, multicentre, randomized clinical trial

Background: Patients with inflammatory bowel disease who achieve remission with anti-tumour necrosis factor (anti-TNF) drugs may have treatment withdrawn due to safety concerns and cost considerations, but there is a lack of prospective, controlled data investigating this strategy. The primary study aim is to compare the rates of clinical remission at 1?year in patients who discontinue anti-TNF treatment versus those who continue treatment. Methods: This is an ongoing, prospective, double-blind, multicentre, randomized, placebo-controlled study in patients with Crohn?s disease or ulcerative colitis who have achieved clinical remission for ?6?months with an anti-TNF treatment and an immunosuppressant. Patients are being randomized 1:1 to discontinue anti-TNF therapy or continue therapy. Randomization stratifies patients by the type of inflammatory bowel disease and drug (infliximab versus adalimumab) at study inclusion. The primary endpoint of the study is sustained clinical remission at 1?year. Other endpoints include endoscopic and radiological activity, patient-reported outcomes (quality of life, work productivity), safety and predictive factors for relapse. The required sample size is 194 patients. In addition to the main analysis (discontinuation versus continuation), subanalyses will include stratification by type of inflammatory bowel disease, phenotype and previous treatment. Biological samples will be obtained to identify factors predictive of relapse after treatment withdrawal. Results: Enrolment began in 2016, and the study is expected to end in 2020. Conclusions: This study will contribute prospective, controlled data on outcomes and predictors of relapse in patients with inflammatory bowel disease after withdrawal of anti-TNF agents following achievement of clinical remission. Clinical trial reference number: EudraCT 2015-001410-1

Measurement of W+W− production in association with one jet in proton–proton collisions at sqrt(s) = 8TeV with the ATLAS detector

The production of W boson pairs in association with one jet in pp collisions at View the MathML sources=8 TeV is studied using data corresponding to an integrated luminosity of 20.3 fb−1 collected by the ATLAS detector during 2012 at the CERN Large Hadron Collider. The cross section is measured in a fiducial phase-space region defined by the presence of exactly one electron and one muon, missing transverse momentum and exactly one jet with a transverse momentum above 25 GeV and a pseudorapidity of |η|<4.5|η|<4.5. The leptons are required to have opposite electric charge and to pass transverse momentum and pseudorapidity requirements. The fiducial cross section is found to be View the MathML sourceσWWfid,1-jet=136±6(stat)±14(syst)±3(lumi) fb. In combination with a previous measurement restricted to leptonic final states with no associated jets, the fiducial cross section of WW production with zero or one jet is measured to be View the MathML sourceσWWfid,≤1-jet=511±9(stat)±26(syst)±10(lumi) fb. The ratio of fiducial cross sections in final states with one and zero jets is determined to be 0.36±0.050.36±0.05. Finally, a total cross section extrapolated from the fiducial measurement of WW production with zero or one associated jet is reported. The measurements are compared to theoretical predictions and found in good agreement

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Assessment of cerebral oxygenation and hemodynamics in obstructive sleep apnea syndrome

We applied Near-Infrared Spectroscopy for the investigation of cerebral oxygenation during obstructive sleep apnea. We found a relatively large decrease in brain oxygenation during apnea and the peak of deoxygenation occurs after resumption of breathing

Signature inversion in pi h(9/2) circle times nu i(13/2) oblate band of Tl-188

High-spin Level structure of Tl-188 has been studied via Gd-157 (Cl-35,4n) fusion-evaporation reaction at beam energy of 170MeV. A rotational band built on the pi h(9/2) circle times nu i(13/2) configuration with oblate deformation has been established. Spin values have been proposed to the pi h(9/2) circle times nu i(13/2) oblate band based on the similarities between the oblate band of Tl-188 and those in odd-odd Tl190-200. With the spin assignments, the low-spin signature inversion has been revealed for the pi h(9/2) circle times nu i(13/2) oblate band of Tl-188. The low-spin signature inversion can be interpreted qualitatively in the framework of the quasi-particles plus rotor model including a J dependent p-n residual interaction

Identification of a new band and its signature inversion in Re-174

High spin states in Re-174 are investigated via the Sm-152(Al-27, 5n gamma)Re-174 reaction and gamma-gamma coincidence relationships are analysed carefully. A new band is identified due to its spectroscopic connection with the known pi 1/2(-)[541] circle times nu 1/2(-)[521] band. This band is proposed to be the ground-state band built on the pi 1/2(-)[541] circle times nu 5/2(-)[512] configuration in view of the low-lying intrinsic states in the neighbouring odd-mass nuclei. It is of particular interesting that the new band exhibits a phenomenon of low-spin signature inversion, providing a new situation for theoretical investigations

Properties of the pi h(9/2)circle times nu i(13/2) oblate band in Tl-188

High spin states in Tl-188 have been investigated via the Gd-157(Cl-35,4n) reaction at beam energy of 170 MeV. A rotational band built on the pi h(9/2) circle times nu(13/2) configuration with oblate deformation has been established. Considering the similarity between the band structure observed in odd-odd Tl nuclei, spin values have been tentatively proposed for the new band in Tl-188. The pi h(9/2) circle times nu(13/2) oblate band in Tl-188 shows low-spin signature inversion, and it can be interpreted qualitatively by the two quasiparticle plus rotor model including a J-dependent p-n residual interaction