Management of cutaneous metastases using electrochemotherapy

Background. Cutaneous metastases may cause considerable discomfort as a consequence of ulceration, oozing, bleeding and pain. Electrochemotherapy has proven to be highly effective in the treatment of cutaneous metastases. Electrochemotherapy utilises pulses of electricity to increase the permeability of the cell membrane and thereby augment the effect of chemotherapy. For the drug bleomycin, the effect is enhanced several hundred-fold, enabling once-only treatment. The primary endpoint of this study is to evaluate the efficacy of electrochemotherapy as a palliative treatment. Methods. This phase II study is a collaboration between two centres, one in Denmark and the other in the UK. Patients with cutaneous metastases of any histology were included. Bleomycin was administered intratumourally or intravenously followed by application of electric pulses to the tumour site. Results. Fifty-two patients were included. Complete and partial response rate was 68% and 18%, respectively, for cutaneous metastases <3 cm and 8% and 23%, respectively, for cutaneous metastases >3 cm. Treatment was well-tolerated by patients, including the elderly, and no serious adverse events were observed. Conclusions. ECT is an efficient and safe treatment and clinicians should not hesitate to use it even in the elderly

The cognitive role of fictionality

The question of the cognitive role of fictionality is this: what is the correct cognitive attitude to take to p, when it is fictional that p? We began by considering one answer to this question, implicit in the work of Kendall Walton, that the correct response to a fictional proposition is to imagine that proposition. However, this approach is silent in cases of fictional incompleteness, where neither p nor its negation are fictional. We argue that that Waltonians should embrace a pluralistic account of the cognitive role of fictional incompleteness: in some cases of fictional incompleteness, we are permitted to resolve the incompleteness during our engagement with the target fiction, and in other cases, we are obliged not to resolve the incompleteness. But though pluralism is accommodated by Walton's wider account of fictionality, it puts tension on his motivating idea that fictionality stands to the imagination as truth stands to belief. And so we develop a rival conception of the cognitive role of fictionality that is built around a different analogy: on this evidentialist approach, (known) fictionality stands to the imagination as evidence stands to credence

Poisoning of reintroduced red kites (Milvus milvus) in England

Programmes to reintroduce predatory birds are resource intensive and expensive, yet there are few long-term studies on the health of these reintroduced birds following release. A total of 326 red kites (Milvus milvus) were released at four sites in England between 1989 and 2006 as part of efforts to reintroduce this species to England and Scotland, resulting in the establishment of several rapidly expanding populations in the wild. Detailed post-mortem examinations were carried out on 162 individuals found dead between 1989 and 2007, involving both released and wild-fledged birds. Toxicological analysis of one or more compounds was performed on 110 of the 162 birds. Poisoning was diagnosed in 32 of these 110 kites, 19 from second-generation anticoagulant rodenticides, 9 from other pesticides and 6 from lead. Criteria for diagnosing anticoagulant rodenticide poisoning included visible haemorrhage on gross post-mortem examination and levels of anticoagulant rodenticide exceeding 100 ng/g, but levels were elevated above 100 ng/g in a further eight red kites without visible haemorrhages, suggesting poisoning may have occurred in more birds. The anticoagulant rodenticides difenacoum and bromadiolone were the most common vertebrate control agents involved during this period. Poisoning of red kites may be slowing their rate of population recovery and range expansion in England. Simple modifications of human activity, such as best practice in rodent control campaigns, tackling the illegal use of pesticides and the use of non-toxic alternatives to lead ammunition, can reduce our impact on red kites and probably other populations of predatory and scavenging species

Tapping into non-English-language science for the conservation of global biodiversity.

The widely held assumption that any important scientific information would be available in English underlies the underuse of non-English-language science across disciplines. However, non-English-language science is expected to bring unique and valuable scientific information, especially in disciplines where the evidence is patchy, and for emergent issues where synthesising available evidence is an urgent challenge. Yet such contribution of non-English-language science to scientific communities and the application of science is rarely quantified. Here, we show that non-English-language studies provide crucial evidence for informing global biodiversity conservation. By screening 419,679 peer-reviewed papers in 16 languages, we identified 1,234 non-English-language studies providing evidence on the effectiveness of biodiversity conservation interventions, compared to 4,412 English-language studies identified with the same criteria. Relevant non-English-language studies are being published at an increasing rate in 6 out of the 12 languages where there were a sufficient number of relevant studies. Incorporating non-English-language studies can expand the geographical coverage (i.e., the number of 2° × 2° grid cells with relevant studies) of English-language evidence by 12% to 25%, especially in biodiverse regions, and taxonomic coverage (i.e., the number of species covered by the relevant studies) by 5% to 32%, although they do tend to be based on less robust study designs. Our results show that synthesising non-English-language studies is key to overcoming the widespread lack of local, context-dependent evidence and facilitating evidence-based conservation globally. We urge wider disciplines to rigorously reassess the untapped potential of non-English-language science in informing decisions to address other global challenges. Please see the Supporting information files for Alternative Language Abstracts

Genetic mechanisms of critical illness in COVID-19.

Host-mediated lung inflammation is present1, and drives mortality2, in the critical illness caused by coronavirus disease 2019 (COVID-19). Host genetic variants associated with critical illness may identify mechanistic targets for therapeutic development3. Here we report the results of the GenOMICC (Genetics Of Mortality In Critical Care) genome-wide association study in 2,244 critically ill patients with COVID-19 from 208 UK intensive care units. We have identified and replicated the following new genome-wide significant associations: on chromosome 12q24.13 (rs10735079, P = 1.65 × 10-8) in a gene cluster that encodes antiviral restriction enzyme activators (OAS1, OAS2 and OAS3); on chromosome 19p13.2 (rs74956615, P = 2.3 × 10-8) near the gene that encodes tyrosine kinase 2 (TYK2); on chromosome 19p13.3 (rs2109069, P = 3.98 ×  10-12) within the gene that encodes dipeptidyl peptidase 9 (DPP9); and on chromosome 21q22.1 (rs2236757, P = 4.99 × 10-8) in the interferon receptor gene IFNAR2. We identified potential targets for repurposing of licensed medications: using Mendelian randomization, we found evidence that low expression of IFNAR2, or high expression of TYK2, are associated with life-threatening disease; and transcriptome-wide association in lung tissue revealed that high expression of the monocyte-macrophage chemotactic receptor CCR2 is associated with severe COVID-19. Our results identify robust genetic signals relating to key host antiviral defence mechanisms and mediators of inflammatory organ damage in COVID-19. Both mechanisms may be amenable to targeted treatment with existing drugs. However, large-scale randomized clinical trials will be essential before any change to clinical practice

A Multicenter, Randomized, Placebo‐Controlled Trial of Atorvastatin for the Primary Prevention of Cardiovascular Events in Patients With Rheumatoid Arthritis

Objective: Rheumatoid arthritis (RA) is associated with increased cardiovascular event (CVE) risk. The impact of statins in RA is not established. We assessed whether atorvastatin is superior to placebo for the primary prevention of CVEs in RA patients. Methods: A randomized, double‐blind, placebo‐controlled trial was designed to detect a 32% CVE risk reduction based on an estimated 1.6% per annum event rate with 80% power at P 50 years or with a disease duration of >10 years who did not have clinical atherosclerosis, diabetes, or myopathy received atorvastatin 40 mg daily or matching placebo. The primary end point was a composite of cardiovascular death, myocardial infarction, stroke, transient ischemic attack, or any arterial revascularization. Secondary and tertiary end points included plasma lipids and safety. Results: A total of 3,002 patients (mean age 61 years; 74% female) were followed up for a median of 2.51 years (interquartile range [IQR] 1.90, 3.49 years) (7,827 patient‐years). The study was terminated early due to a lower than expected event rate (0.70% per annum). Of the 1,504 patients receiving atorvastatin, 24 (1.6%) experienced a primary end point, compared with 36 (2.4%) of the 1,498 receiving placebo (hazard ratio [HR] 0.66 [95% confidence interval (95% CI) 0.39, 1.11]; P = 0.115 and adjusted HR 0.60 [95% CI 0.32, 1.15]; P = 0.127). At trial end, patients receiving atorvastatin had a mean ± SD low‐density lipoprotein (LDL) cholesterol level 0.77 ± 0.04 mmoles/liter lower than those receiving placebo (P < 0.0001). C‐reactive protein level was also significantly lower in the atorvastatin group than the placebo group (median 2.59 mg/liter [IQR 0.94, 6.08] versus 3.60 mg/liter [IQR 1.47, 7.49]; P < 0.0001). CVE risk reduction per mmole/liter reduction in LDL cholesterol was 42% (95% CI −14%, 70%). The rates of adverse events in the atorvastatin group (n = 298 [19.8%]) and placebo group (n = 292 [19.5%]) were similar. Conclusion: Atorvastatin 40 mg daily is safe and results in a significantly greater reduction of LDL cholesterol level than placebo in patients with RA. The 34% CVE risk reduction is consistent with the Cholesterol Treatment Trialists’ Collaboration meta‐analysis of statin effects in other populations

Parenting for a Digital Future – one year on

It’s been an eventful year in many ways, and a tough one for most people. Children’s lives became digital by default. Education went remote. Screen time hit the roof. Researchers had to do their research via Zoom. And parents? There’s never one answer to that question: parents are as diverse as society, and their experiences of the pandemic have surely varied hugely. For www.parenting.digital, Prof Sonia Livingstone talks about how digital parenting has changed during the past year

The Information Security Risk Estimation Engine: A Tool for Possibility Based Risk Assessment

Risk analysis methods help evaluate the costs of information security controls in relation to their benefits. Despite dramatic changes in the constellation of information security risks, the basic approach to these risk calculation methods remains unchanged. The fundamental mathematics underlying these methods is anchored to probability theory. Probability has the advantage of being widely known and conceptually simple. But it has a disadvantage in its grounding on expert estimates of frequency data because such data is often publicly unavailable. This paper proposes the use of possibility theory as an alternative grounding for information security risk calculations. Possibility theory assumes the data grounding will be estimations. The estimations include expert evaluations of both possibility and likelihood of risks. Using a design science research approach, we use possibility theory as the kernel theory in developing and evaluating a practical possibility-based risk estimation prototype. The results offer an expanded grounding to improve information security risk analysis through the use of a broader portfolio of distinct methodologies anchored to alternative mathematical theories of evidence