SEALONE (Safety and Efficacy of Coronary Computed Tomography Angiography with Low Dose in Patients Visiting Emergency Room) trial: study protocol for a randomized controlled trial

Objective Chest pain is one of the most common complaints in the emergency department (ED). Cardiac computed tomography angiography (CCTA) is a frequently used tool for the early triage of patients with low- to intermediate-risk acute chest pain. We present a study protocol for a multicenter prospective randomized controlled clinical trial testing the hypothesis that a low-dose CCTA protocol using prospective electrocardiogram (ECG)-triggering and limited-scan range can provide sufficient diagnostic safety for early triage of patients with acute chest pain. Methods The trial will include 681 younger adult (aged 20 to 55) patients visiting EDs of three academic hospitals for acute chest pain or equivalent symptoms who require further evaluation to rule out acute coronary syndrome. Participants will be randomly allocated to either low-dose or conventional CCTA protocol at a 2:1 ratio. The low-dose group will undergo CCTA with prospective ECG-triggering and restricted scan range from sub-carina to heart base. The conventional protocol group will undergo CCTA with retrospective ECG-gating covering the entire chest. Patient disposition is determined based on computed tomography findings and clinical progression and all patients are followed for a month. The primary objective is to prove that the chance of experiencing any hard event within 30 days after a negative low-dose CCTA is less than 1%. The secondary objectives are comparisons of the amount of radiation exposure, ED length of stay and overall cost. Results and Conclusion Our low-dose protocol is readily applicable to current multi-detector computed tomography devices. If this study proves its safety and efficacy, dose-reduction without purchasing of expensive newer devices would be possible

Pan-cancer analysis of whole genomes

Cancer is driven by genetic change, and the advent of massively parallel sequencing has enabled systematic documentation of this variation at the whole-genome scale(1-3). Here we report the integrative analysis of 2,658 whole-cancer genomes and their matching normal tissues across 38 tumour types from the Pan-Cancer Analysis of Whole Genomes (PCAWG) Consortium of the International Cancer Genome Consortium (ICGC) and The Cancer Genome Atlas (TCGA). We describe the generation of the PCAWG resource, facilitated by international data sharing using compute clouds. On average, cancer genomes contained 4-5 driver mutations when combining coding and non-coding genomic elements; however, in around 5% of cases no drivers were identified, suggesting that cancer driver discovery is not yet complete. Chromothripsis, in which many clustered structural variants arise in a single catastrophic event, is frequently an early event in tumour evolution; in acral melanoma, for example, these events precede most somatic point mutations and affect several cancer-associated genes simultaneously. Cancers with abnormal telomere maintenance often originate from tissues with low replicative activity and show several mechanisms of preventing telomere attrition to critical levels. Common and rare germline variants affect patterns of somatic mutation, including point mutations, structural variants and somatic retrotransposition. A collection of papers from the PCAWG Consortium describes non-coding mutations that drive cancer beyond those in the TERT promoter(4); identifies new signatures of mutational processes that cause base substitutions, small insertions and deletions and structural variation(5,6); analyses timings and patterns of tumour evolution(7); describes the diverse transcriptional consequences of somatic mutation on splicing, expression levels, fusion genes and promoter activity(8,9); and evaluates a range of more-specialized features of cancer genomes(8,10-18).Peer reviewe

A Study on Service Innovation in Hospitals:Integrated Viewpoint on Medical Ethics and Customer Value

[[abstract]]In researches literatures related to hospital management in recent years, most mainly focus on the issues of medical service and management, healthcare systems, medical disputes, medical care and medical history, with few investigating the service innovation in hospitals. Therefore, with the five integrated viewpoints on medical ethics and customer value, this study aims to investigate the connotation, types and development course of the service innovation in hospitals. After summarizing and analyzing the literatures, it obtained the five viewpoints: ethical value, functional value, happy value, relationship value and situational value. Based on the largest 150 hospitals in the number of outpatient and inpatient services points and registered points, this study adopted the single-industry case-oriented qualitative research method to select a total of 60 hospitals as cases study from all 20 medical centers, and 20 largest regional hospitals and 20 local hospitals. Through secondary data collection and in-depth interviews, this study totally collected 536 innovation events to form the case database, and conducted data analysis according to type comparison, interpretation construction, time series analysis and program logic model based on using each innovation event as an analysis unit. The study findings obtained are as below: (1) 18 innovation types (which including 48 sub-types) are obtained from further analysis based on the five integrated viewpoints; (2) In terms of the hospitals’ operation and development, their service innovation takes “functional value” as core value, supplemented by “situational value” and “relationship value”. In innovation types, the medical service takes the highest proportion, followed by friendly medical environment creation, international relation, E- technology service and R& D services in sequence; (3) The hospital with larger hierarchy scale pays more attention to the sustainable development of functional value, and the hospital with smaller hierarchy pays more attention to the development of relationship value, and the innovation services respectively develop their own unique pattern due to the different regions; (4) There is an E-technology trend in the development of medical industry connects with outside relations (such as governments, cross-industries and Industry-academia, etc.); (5) The government policies and systems affect the development course of our country’s medical service innovation

Crystallization and preliminary X-ray crystallographic studies of human cyclophilin J

Human cyclophilin J is a member of the cyclophilin family and recent studies have indicated that it plays a role in the formation of liver cancers as a regulation factor or messenger. The preparation, crystallization and preliminary X-ray crystallographic studies of human cyclophilin J are reported

Crystallization and preliminary crystallographic studies of human septin 1 with site-directed mutations

The homogeneity of septin 1 has been improved by site-directed mutation of serine residues and only a small alteration in the secondary structure is observed to arise from the mutations. Crystals of the septin 1 mutant were grown and diffraction data were collected to 2.5 Å resolution