Expert consensus on resection of chest wall tumors and chest wall reconstruction

Chest wall tumors are a relatively uncommon disease in clinical practice. Most of the published studies about chest wall tumors are usually single-center retrospective studies, involving few patients. Therefore, evidences regarding clinical conclusions about chest wall tumors are lacking, and some controversial issues have still to be agreed upon. In January 2019, 73 experts in thoracic surgery, plastic surgery, science, and engineering jointly released the Chinese Expert Consensus on Chest Wall Tumor Resection and Chest Wall Reconstruction (2018 edition). After that, numerous experts put forward new perspectives on some academic issues in this version of the consensus, pointing out the necessity to further discuss the points of contention. Thus, we conducted a survey through the administration of a questionnaire among 85 experts in the world. Consensus has been reached on some major points as follows. (I) Wide excision should be performed for desmoid tumor (DT) of chest wall. After excluding the distant metastasis by multi-disciplinary team, solitary sternal plasmacytoma can be treated with extensive resection and adjuvant radiotherapy. (II) Wide excision with above 2 cm margin distance should be attempted to obtain R0 resection margin for chest wall tumor unless the tumor involves vital organs or structures, including the great vessels, heart, trachea, joints, and spine. (III) For patients with chest wall tumors undergoing unplanned excision (UE) for the first time, it is necessary to carry out wide excision as soon as possible within 1-3 months following the previous surgery. (IV) Current Tumor Node Metastasis staging criteria (American Joint Committee on Cancer) of bone tumor and soft tissue sarcoma are not suitable for chest wall sarcomas. (V) It is necessary to use rigid implants for chest wall reconstruction once the maximum diameter of the chest wall defect exceeds 5 cm in adults and adolescents. (VI) For non-small cell lung cancer (NSCLC) invading the chest wall, wide excision with neoadjuvant and/or adjuvant therapy are recommended for patients with stage T3-4N0-1M0. As clear guidelines are lacking, these consensus statements on controversial issues on chest wall tumors and resection could possibly serve as further guidance in clinical practice during the upcoming years

Remdesivir in adults with severe COVID-19:a randomised, double-blind, placebo-controlled, multicentre trial

Summary Background No specific antiviral drug has been proven effective for treatment of patients with severe coronavirus disease 2019 (COVID-19). Remdesivir (GS-5734), a nucleoside analogue prodrug, has inhibitory effects on pathogenic animal and human coronaviruses, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in vitro, and inhibits Middle East respiratory syndrome coronavirus, SARS-CoV-1, and SARS-CoV-2 replication in animal models. Methods We did a randomised, double-blind, placebo-controlled, multicentre trial at ten hospitals in Hubei, China. Eligible patients were adults (aged ≥18 years) admitted to hospital with laboratory-confirmed SARS-CoV-2 infection, with an interval from symptom onset to enrolment of 12 days or less, oxygen saturation of 94% or less on room air or a ratio of arterial oxygen partial pressure to fractional inspired oxygen of 300 mm Hg or less, and radiologically confirmed pneumonia. Patients were randomly assigned in a 2:1 ratio to intravenous remdesivir (200 mg on day 1 followed by 100 mg on days 2–10 in single daily infusions) or the same volume of placebo infusions for 10 days. Patients were permitted concomitant use of lopinavir–ritonavir, interferons, and corticosteroids. The primary endpoint was time to clinical improvement up to day 28, defined as the time (in days) from randomisation to the point of a decline of two levels on a six-point ordinal scale of clinical status (from 1=discharged to 6=death) or discharged alive from hospital, whichever came first. Primary analysis was done in the intention-to-treat (ITT) population and safety analysis was done in all patients who started their assigned treatment. This trial is registered with ClinicalTrials.gov, NCT04257656. Findings Between Feb 6, 2020, and March 12, 2020, 237 patients were enrolled and randomly assigned to a treatment group (158 to remdesivir and 79 to placebo); one patient in the placebo group who withdrew after randomisation was not included in the ITT population. Remdesivir use was not associated with a difference in time to clinical improvement (hazard ratio 1·23 [95% CI 0·87–1·75]). Although not statistically significant, patients receiving remdesivir had a numerically faster time to clinical improvement than those receiving placebo among patients with symptom duration of 10 days or less (hazard ratio 1·52 [0·95–2·43]). Adverse events were reported in 102 (66%) of 155 remdesivir recipients versus 50 (64%) of 78 placebo recipients. Remdesivir was stopped early because of adverse events in 18 (12%) patients versus four (5%) patients who stopped placebo early. Interpretation In this study of adult patients admitted to hospital for severe COVID-19, remdesivir was not associated with statistically significant clinical benefits. However, the numerical reduction in time to clinical improvement in those treated earlier requires confirmation in larger studies

Beam Energy Dependence of the Third Harmonic of Azimuthal Correlations in Au+Au Collisions at RHIC

We present results from a harmonic decomposition of two-particle azimuthal correlations measured with the STAR detector in Au+Au collisions for energies ranging from $\sqrt{s_{NN}}=7.7$ GeV to 200 GeV. The third harmonic $v_3^2\{2\}=\langle \cos3(\phi_1-\phi_2)\rangle$, where $\phi_1-\phi_2$ is the angular difference in azimuth, is studied as a function of the pseudorapidity difference between particle pairs $\Delta\eta = \eta_1-\eta_2$. Non-zero {\vthree} is directly related to the previously observed large-$\Delta\eta$ narrow-$\Delta\phi$ ridge correlations and has been shown in models to be sensitive to the existence of a low viscosity Quark Gluon Plasma (QGP) phase. For sufficiently central collisions, $v_3^2\{2\}$ persist down to an energy of 7.7 GeV suggesting that QGP may be created even in these low energy collisions. In peripheral collisions at these low energies however, $v_3^2\{2\}$ is consistent with zero. When scaled by pseudorapidity density of charged particle multiplicity per participating nucleon pair, $v_3^2\{2\}$ for central collisions shows a minimum near {\snn}$=20$ GeV.Comment: 7 pages, 4 figures, for submission to Phys. Rev. Let

J/ψ\rm{J}/\psi production at low transverse momentum in p+p and d+Au collisions at sNN\sqrt{s_{NN}} = 200 GeV

We report on the measurement of $\rm{J}/\psi$ production in the dielectron channel at mid-rapidity (|y|<1) in p+p and d+Au collisions at $\sqrt{s_{NN}}$ = 200 GeV from the STAR experiment at the Relativistic Heavy Ion Collider. The transverse momentum $p_{T}$ spectra in p+p for $p_{T}$ < 4 GeV/c and d+Au collisions for $p_{T}$ < 3 GeV/c are presented. These measurements extend the STAR coverage for $\rm{J}/\psi$ production in p+p collisions to low $p_{T}$. The $$ from the measured $\rm{J}/\psi$ invariant cross section in p+p and d+Au collisions are evaluated and compared to similar measurements at other collision energies. The nuclear modification factor for $\rm{J}/\psi$ is extracted as a function of $p_{T}$ and collision centrality in d+Au and compared to model calculations using the modified nuclear Parton Distribution Function and a final-state $\rm{J}/\psi$ nuclear absorption cross section