Creatinine clearance versus serum creatinine as a risk factor in cardiac surgery

BACKGROUND: Renal impairment is one of the predictors of mortality in cardiac surgery. Usually a binarized value of serum creatinine is used to assess the renal function in risk models. Creatinine clearance can be easily estimated by the Cockcroft and Gault equation from serum creatinine, gender, age and body weight. In this work we examine whether this estimation of the glomerular filtration rate can advantageously replace the serum creatinine in the EuroSCORE preoperative risk assessment. METHODS: In a group of 8138 patients out of a total of 11878 patients, who underwent cardiac surgery in our hospital between January 1996 and July 2002, the 18 standard EuroSCORE parameters could retrospectively be determined and logistic regression analysis performed. In all patients scored, creatinine clearance was calculated according to Cockcroft and Gault. The relationship between the predicted and observed 30-days mortality was evaluated in systematically selected intervals of creatinine clearance and significance values computed by employing Monte Carlo methods. Afterwards, risk scoring was performed using a continuous or a categorical value of creatinine clearance instead of serum creatinine. The predictive ability of several risk score models and the individual contribution of their predictor variables were studied using ROC curve analysis. RESULTS: The comparison between the expected and observed 30-days mortalities, which were determined in different intervals of creatinine clearance, revealed the best threshold value of 55 ml/min. A significantly higher 30-days mortality was observed below this threshold and vice versa (both with p < 0.001). The local adaptation of the EuroSCORE is better than the standard EuroSCORE and was further improved by replacing serum creatinine (SC) by creatinine clearance (CC). Differential ROC analysis revealed that CC is superior to SC in providing predictive power within the logistic regression. Variable rank comparison identified CC as the best single variable predictor, even better than the variable age, former number 1, and SC, previously number 9 in the standard set of EuroSCORE variables. CONCLUSION: The renal function is an important determinant of mortality in heart surgery. This risk factor is not well captured in the standard EuroSCORE risk evaluation system. Our study shows that creatinine clearance, calculated according to the Cockcroft and Gault equation, should be applied to estimate the preoperative renal function instead of serum creatinine. This predictor variable replacement gains a significant improvement in the predictive accuracy of the scoring model

Voluntary organizations and society–military relations in contemporary Russia

The 2014 crisis in Ukraine has refocused attention on Russia as a European security actor. Despite showing renewed military capability, compared to the post-Soviet period, Russian society–military relations have remained the same. This relationship (between society and the security organs) provides the key context for assessing security. Analysis of everyday militarization and the role of voluntary organizations (such as DOSAAF [Dobrovol'noe obshchestvo sodeistviya armii, aviatsii i flotu] and Nashi [Molodezhnoe demokraticheskoe antifashistskoe dvizheni]) in supporting the military can provide an important insight into Russian behaviour as a security actor. These organizations generate a pro-military outlook and at the same time provide training and activities, thus contributing to military effectiveness by developing the competency of young people prior to military service as well as increasing public knowledge of military affairs. However, strong support for the military, a lack of independent information, and an absence of a shared vision on how society–military relations should be developed and also represent political challenges in terms of everyday militarization. This dynamic is important for understanding both Russia's security posture and wider security implications for Europe

Adding 6 months of androgen deprivation therapy to postoperative radiotherapy for prostate cancer: a comparison of short-course versus no androgen deprivation therapy in the RADICALS-HD randomised controlled trial

Background Previous evidence indicates that adjuvant, short-course androgen deprivation therapy (ADT) improves metastasis-free survival when given with primary radiotherapy for intermediate-risk and high-risk localised prostate cancer. However, the value of ADT with postoperative radiotherapy after radical prostatectomy is unclear. Methods RADICALS-HD was an international randomised controlled trial to test the efficacy of ADT used in combination with postoperative radiotherapy for prostate cancer. Key eligibility criteria were indication for radiotherapy after radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to radiotherapy alone (no ADT) or radiotherapy with 6 months of ADT (short-course ADT), using monthly subcutaneous gonadotropin-releasing hormone analogue injections, daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as distant metastasis arising from prostate cancer or death from any cause. Standard survival analysis methods were used, accounting for randomisation stratification factors. The trial had 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 80% to 86% (hazard ratio [HR] 0·67). Analyses followed the intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov, NCT00541047. Findings Between Nov 22, 2007, and June 29, 2015, 1480 patients (median age 66 years [IQR 61–69]) were randomly assigned to receive no ADT (n=737) or short-course ADT (n=743) in addition to postoperative radiotherapy at 121 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 9·0 years (IQR 7·1–10·1), metastasis-free survival events were reported for 268 participants (142 in the no ADT group and 126 in the short-course ADT group; HR 0·886 [95% CI 0·688–1·140], p=0·35). 10-year metastasis-free survival was 79·2% (95% CI 75·4–82·5) in the no ADT group and 80·4% (76·6–83·6) in the short-course ADT group. Toxicity of grade 3 or higher was reported for 121 (17%) of 737 participants in the no ADT group and 100 (14%) of 743 in the short-course ADT group (p=0·15), with no treatment-related deaths. Interpretation Metastatic disease is uncommon following postoperative bed radiotherapy after radical prostatectomy. Adding 6 months of ADT to this radiotherapy did not improve metastasis-free survival compared with no ADT. These findings do not support the use of short-course ADT with postoperative radiotherapy in this patient population

Duration of androgen deprivation therapy with postoperative radiotherapy for prostate cancer: a comparison of long-course versus short-course androgen deprivation therapy in the RADICALS-HD randomised trial

Background Previous evidence supports androgen deprivation therapy (ADT) with primary radiotherapy as initial treatment for intermediate-risk and high-risk localised prostate cancer. However, the use and optimal duration of ADT with postoperative radiotherapy after radical prostatectomy remains uncertain. Methods RADICALS-HD was a randomised controlled trial of ADT duration within the RADICALS protocol. Here, we report on the comparison of short-course versus long-course ADT. Key eligibility criteria were indication for radiotherapy after previous radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to add 6 months of ADT (short-course ADT) or 24 months of ADT (long-course ADT) to radiotherapy, using subcutaneous gonadotrophin-releasing hormone analogue (monthly in the short-course ADT group and 3-monthly in the long-course ADT group), daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as metastasis arising from prostate cancer or death from any cause. The comparison had more than 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 75% to 81% (hazard ratio [HR] 0·72). Standard time-to-event analyses were used. Analyses followed intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov , NCT00541047 . Findings Between Jan 30, 2008, and July 7, 2015, 1523 patients (median age 65 years, IQR 60–69) were randomly assigned to receive short-course ADT (n=761) or long-course ADT (n=762) in addition to postoperative radiotherapy at 138 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 8·9 years (7·0–10·0), 313 metastasis-free survival events were reported overall (174 in the short-course ADT group and 139 in the long-course ADT group; HR 0·773 [95% CI 0·612–0·975]; p=0·029). 10-year metastasis-free survival was 71·9% (95% CI 67·6–75·7) in the short-course ADT group and 78·1% (74·2–81·5) in the long-course ADT group. Toxicity of grade 3 or higher was reported for 105 (14%) of 753 participants in the short-course ADT group and 142 (19%) of 757 participants in the long-course ADT group (p=0·025), with no treatment-related deaths. Interpretation Compared with adding 6 months of ADT, adding 24 months of ADT improved metastasis-free survival in people receiving postoperative radiotherapy. For individuals who can accept the additional duration of adverse effects, long-course ADT should be offered with postoperative radiotherapy. Funding Cancer Research UK, UK Research and Innovation (formerly Medical Research Council), and Canadian Cancer Society

Reconstructing society-military relations in post-Soviet Russia

The thesis examines society-military relations with a focus on the contemporary Russian case. In doing this, it develops the Society-Military Interface (SMI), created by Stephen Webber and Jennifer Mathers (2006), and produces a typology of society-military relations. The SMI allows the inclusion of public and daily interactions which adds an additional layer of insight into the analysis of society-military relations. Although contemporary Russia is frequently characterised as a sub-optimal version of a democratic ideal or represents a return to the Soviet past, the thesis argues that post-Soviet Russia is militarised and that the sub-elite level of analysis can provide a meaningful insight into a Russian society-military relations. The original empirical material of the thesis is organised into four chapters examining twelve individual indicators of militarisation such as: military spending, civilian control, and everyday militarisation. The thesis seeks to offer an original contribution to the literature on civil-military relations and Russian politics, in three ways. Firstly, it explores society-military relations in terms of militarisation. Secondly, it analyses interactions beyond the experience of the West, such as mechanisms of civilian control rooted in executive power rather than legislative oversight. Thirdly, it removes the dichotomy of external armed forces and internal security services which has thus far dominated the literature. This allows the ‘military organisation’, comprised of the full range of ‘power ministries’, to be included in the analysis. As the thesis seeks to demonstrate, analysis of these institutions is crucial to understanding contemporary Russian society-military relations. These three elements challenge the approaches of the existing literature which predominantly focus on: elite level interactions (military and political); institutions controlled by the MOD (Armed Forces); and society-military relations defined in liberal-democratic terms

Elliptic anisotropy measurement of the f0_0(980) hadron in proton-lead collisions and evidence for its quark-antiquark composition

International audienceDespite the f$_0$(980) hadron having been discovered half a century ago, the question about its quark content has not been settled: it might be an ordinary quark-antiquark ($\mathrm{q\bar{q}}$) meson, a tetraquark ($\mathrm{q\bar{q}q\bar{q}}$) exotic state, a kaon-antikaon ($\mathrm{K\bar{K}}$) molecule, or a quark-antiquark-gluon ($\mathrm{q\bar{q}g}$) hybrid. This paper reports strong evidence that the f$_0$(980) state is an ordinary $\mathrm{q\bar{q}}$ meson, inferred from the scaling of elliptic anisotropies ($v_2$) with the number of constituent quarks ($n_\mathrm{q}$), as empirically established using conventional hadrons in relativistic heavy ion collisions. The f$_0$(980) state is reconstructed via its dominant decay channel f$_0$(980) $\to$$\pi^+\pi^-$, in proton-lead collisions recorded by the CMS experiment at the LHC, and its $v_2$ is measured as a function of transverse momentum ($p_\mathrm{T}$). It is found that the $n_q$ = 2 ($\mathrm{q\bar{q}}$ state) hypothesis is favored over $n_q$ = 4 ($\mathrm{q\bar{q}q\bar{q}}$ or $\mathrm{K\bar{K}}$ states) by 7.7, 6.3, or 3.1 standard deviations in the $p_\mathrm{T}$$\lt$ 10, 8, or 6 GeV/$c$ ranges, respectively, and over $n_\mathrm{q}$ = 3 ($\mathrm{q\bar{q}g}$ hybrid state) by 3.5 standard deviations in the $p_\mathrm{T}$$\lt$ 8 GeV/$c$ range. This result represents the first determination of the quark content of the f$_0$(980) state, made possible by using a novel approach, and paves the way for similar studies of other exotic hadron candidates

Search for CPCP violation in D0^0→\to KS0^0_\mathrm{S}KS0^0_\mathrm{S} decays in proton-proton collisions at s\sqrt{s} = 13 TeV

International audienceA search is reported for charge-parity D$^0$$\to$ K$^0_\mathrm{S}$K$^0_\mathrm{S}$$CP$ violation in D$^0$$\to$ K$^0_\mathrm{S}$K$^0_\mathrm{S}$ decays, using data collected in proton-proton collisions at $\sqrt{s}$ = 13 TeV recorded by the CMS experiment in 2018. The analysis uses a dedicated data set that corresponds to an integrated luminosity of 41.6 fb$^{-1}$, which consists of about 10 billion events containing a pair of ẖadrons, nearly all of which decay to charm hadrons. The flavor of the neutral D meson is determined by the pion charge in the reconstructed decays D$^{*+}$$\to$ D$^0\pi^+$ and D$^{*-}$$\to$ D$^0\pi^-$. The D$^0$$\to$ K$^0_\mathrm{S}$K$^0_\mathrm{S}$$CP$ asymmetry in D$^0$$\to$ K$^0_\mathrm{S}$K$^0_\mathrm{S}$ is measured to be $A_{CP}$( K$^0_\mathrm{S}$K$^0_\mathrm{S}$) = (6.2 $\pm$ 3.0 $\pm$ 0.2 $\pm$ 0.8)%, where the three uncertainties represent the statistical uncertainty, the systematic uncertainty, and the uncertainty in the measurement of the D$^0$ $\to$ K$^0_\mathrm{S}$K$^0_\mathrm{S}$ $CP$ asymmetry in the D$^0$ $\to$ K$^0_\mathrm{S}\pi^+\pi^-$ decay. This is the first D$^0$ $\to$ K$^0_\mathrm{S}$K$^0_\mathrm{S}$ $CP$ asymmetry measurement by CMS in the charm sector as well as the first to utilize a fully hadronic final state

Test of lepton flavor universality in B± ⁣→ ⁣K±μ+μ− {\mathrm{B}^{\pm}} \!\to\! \mathrm{K^{\pm}}\mu^{+}\mu^{-} and B± ⁣→ ⁣K±e+e− {\mathrm{B}^{\pm}} \!\to\! \mathrm{K^{\pm}}\mathrm{e}^+\mathrm{e}^- decays in proton-proton collisions at s= \sqrt{s} = 13 TeV

A test of lepton flavor universality in ${\mathrm{B}^{\pm}} \!\to\! \mathrm{K^{\pm}}\mu^{+}\mu^{-}$ and ${\mathrm{B}^{\pm}} \!\to\! \mathrm{K^{\pm}}\mathrm{e}^+\mathrm{e}^-$ decays, as well as a measurement of differential and integrated branching fractions of a nonresonant ${\mathrm{B}^{\pm}} \!\to\! \mathrm{K^{\pm}}\mu^{+}\mu^{-}$ decay are presented. The analysis is made possible by a dedicated data set of proton-proton collisions at $\sqrt{s} =$ 13 TeV recorded in 2018, by the CMS experiment at the LHC, using a special high-rate data stream designed for collecting about 10 billion unbiased b hadron decays. The ratio of the branching fractions $\mathcal{B}({\mathrm{B}^{\pm}} \!\to\! \mathrm{K^{\pm}}\mu^{+}\mu^{-})$ to $\mathcal{B}({\mathrm{B}^{\pm}} \!\to\! \mathrm{K^{\pm}}\mathrm{e}^+\mathrm{e}^-)$ is determined from the measured double ratio $R(\mathrm{K})$ of these decays to the respective branching fractions of the ${\mathrm{B}^{\pm}} \!\to\! {\mathrm{J}/\psi} \mathrm{K^{\pm}}$ with ${\mathrm{J}/\psi} \!\to\!\mu^{+}\mu^{-}$ and $\mathrm{e}^+\mathrm{e}^-$ decays, which allow for significant cancellation of systematic uncertainties. The ratio $R(\mathrm{K})$ is measured in the range 1.1 $< q^2 <$ 6.0 GeV$^2$, where $q$ is the invariant mass of the lepton pair, and is found to be $R(\mathrm{K})=$ 0.78 $^{+0.47}_{-0.23}$, in agreement with the standard model expectation $R(\mathrm{K}) \approx$ 1. This measurement is limited by the statistical precision of the electron channel. The integrated branching fraction in the same $q^2$ range, $\mathcal{B}({\mathrm{B}^{\pm}} \!\to\! \mathrm{K^{\pm}}\mu^{+}\mu^{-}) =$ (12.42 $\pm$ 0.68) $\times$ 10$^{-8}$, is consistent with the present world-average value and has a comparable precision.A test of lepton flavor universality in B$^{\pm}$$\to$ K$^{\pm}\mu^+\mu^-$ and B$^{\pm}$$\to$ K$^{\pm}$e$^+$e$^-$ decays, as well as a measurement of differential and integrated branching fractions of a nonresonant B$^{\pm}$$\to$ K$^{\pm}\mu^+\mu^-$ decay are presented. The analysis is made possible by a dedicated data set of proton-proton collisions at $\sqrt{s}$ = 13 TeV recorded in 2018, by the CMS experiment at the LHC, using a special high-rate data stream designed for collecting about 10 billion unbiased b hadron decays. The ratio of the branching fractions $\mathcal{B}$(B$^{\pm}$$\to$ K$^{\pm}\mu^+\mu^-$) to $\mathcal{B}$(B$^{\pm}$$\to$ K$^{\pm}$e$^+$e$^-$) is determined from the measured double ratio $R$(K) of these decays to the respective branching fractions of the B$^\pm$$\to$ J/$\psi$K$^\pm$ with J/$\psi$$\to$$\mu^+\mu^-$ and e$^+$e$^-$ decays, which allow for significant cancellation of systematic uncertainties. The ratio $R$(K) is measured in the range 1.1 $\lt q^2 \lt$ 6.0 GeV$^2$, where $q$ is the invariant mass of the lepton pair, and is found to be $R$(K) = 0.78$^{+0.47}_{-0.23}$, in agreement with the standard model expectation $R$(K) $\approx$ 1. This measurement is limited by the statistical precision of the electron channel. The integrated branching fraction in the same $q^2$ range, $\mathcal{B}$(B$^{\pm}$$\to$ K$^{\pm}\mu^+\mu^-$) = (12.42 $\pm$ 0.68) $\times$ 10$^{-8}$, is consistent with the present world-average value and has a comparable precision

Measurement of the inclusive cross sections for W and Z boson production in proton-proton collisions at s= \sqrt{s}= 5.02 and 13 TeV

Measurements of fiducial and total inclusive cross sections for W and Z boson production are presented in proton-proton collisions at $\sqrt{s}=$ 5.02 and 13 TeV. Electron and muon decay modes ($\ell=\mathrm{e}$ or $\mu$) are studied in the data collected with the CMS detector in 2017, in dedicated runs with reduced instantaneous luminosity. The data sets correspond to integrated luminosities of 298 $\pm$ 6 pb$^{-1}$ at 5.02 TeV and 206 $\pm$ 5 pb$^{-1}$ at 13 TeV. Measured values of the products of the total inclusive cross sections and the branching fractions at 5.02 TeV are $\sigma(\mathrm{p}\mathrm{p} \to \mathrm{W} + \mathrm{X})\mathcal{B}(\mathrm{W} \to \ell\nu) =$ 7300 $\pm$ 10 (stat) $\pm$ 60 (syst) $\pm$ 140 (lumi) pb, and $\sigma(\mathrm{p}\mathrm{p} \to \mathrm{Z} + \mathrm{X})\mathcal{B}(\mathrm{Z}\to\ell^{+}\ell^{-}) =$ 669 $\pm$ 2 (stat) $\pm$ 6 (syst) $\pm$ 13 (lumi) pb for the dilepton invariant mass in the range of 60-120 GeV. The corresponding results at 13 TeV are 20480 $\pm$ 10 (stat) $\pm$ 170 (syst) $\pm$ 470 (lumi) pb and 1952 $\pm$ 4 (stat) $\pm$ 18 (syst) $\pm$ 45 (lumi) pb. The measured values agree with cross section calculations at next-to-next-to-leading-order in perturbative quantum chromodynamics. Fiducial and total inclusive cross sections, ratios of cross sections of W$^{+}$ and W$^{-}$ production as well as inclusive W and Z boson production, and ratios of these measurements at 5.02 and 13 TeV are reported.Measurements of fiducial and total inclusive cross sections for W and Z boson production are presented in proton-proton collisions at $\sqrt{s}$ = 5.02 and 13 TeV. Electron and muon decay modes ($ell$ = e or$\mu$) are studied in the data collected with the CMS detector in 2017, in dedicated runs with reduced instantaneous luminosity. The data sets correspond to integrated luminosities of 298 $\pm$ 6 pb$^{-1}$ at 5.02 TeV and 206 $\pm$ 5 pb$^{-1}$ at 13 TeV. Measured values of the products of the total inclusive cross sections and the branching fractions at 5.02 TeV are $\sigma$(pp $\to$ W+X)$\mathcal{B}$(W $\to$$\ell\nu$) = 7300 $\pm$ 10 (stat) $\pm$ 60 (syst) $\pm$ 140 (lumi) pb, and $\sigma$(pp $\to$ Z+X)$\mathcal{B}$(Z $\to$$\ell^+\ell^-$) = 669 $\pm$ 2 (stat) $\pm$ 6 (syst) $\pm$ 13 (lumi) pb for the dilepton invariant mass in the range of 60-120 GeV. The corresponding results at 13 TeV are 20480 $\pm$ 10 (stat) $\pm$ 170 (syst) $\pm$ 470 (lumi) pb and 1952 $\pm$ 4 (stat) $\pm$ 18 (syst) $\pm$ 45 (lumi) pb. The measured values agree with cross section calculations at next-to-next-to-leading-order in perturbative quantum chromodynamics. Fiducial and total inclusive cross sections, ratios of cross sections of W$^+$ and W$^-$ production as well as inclusive W and Z boson production, and ratios of these measurements at 5.02 and 13 TeV are reported

Search for dark matter produced in association with a pair of bottom quarks in proton-proton collisions at s= \sqrt{s} = 13 TeV

A search for dark matter (DM) particles produced in association with bottom quarks is presented. The analysis uses proton-proton collision data at a center-of-mass energy of $\sqrt{s}=$ 13 TeV, corresponding to an integrated luminosity of 138 fb$^{-1}$. The search is performed in the final state with large missing transverse momentum and a pair of jets originating from bottom quarks. No significant excess of data is observed with respect to the standard model expectation. Results are interpreted in the context of a type-II two-Higgs-doublet model with an additional light pseudoscalar (2HDM+a). An upper limit is set on the mass of the lighter pseudoscalar, excluding masses up to 260 GeV at 95% confidence level. This is the first search at the LHC to probe DM produced in association with two nonresonant bottom quarks in the 2HDM+a model. Sensitivity to the parameter space with the ratio of the vacuum expectation values of the two Higgs doublets, $\tan\beta$, greater than 15 is achieved, capitalizing on the enhancement of couplings between pseudoscalars and bottom quarks with high $\tan\beta$.A search for dark matter (DM) particles produced in association with bottom quarks is presented. The analysis uses proton-proton collision data at a center-of-mass energy of $\sqrt{s}$ = 13 TeV, corresponding to an integrated luminosity of 138 fb$^{-1}$. The search is performed in the final state with large missing transverse momentum and a pair of jets originating from bottom quarks. No significant excess of data is observed with respect to the standard model expectation. Results are interpreted in the context of a type-II two-Higgs-doublet model with an additional light pseudoscalar (2HDM+a). An upper limit is set on the mass of the lighter pseudoscalar, excluding masses up to 260 GeV at 95% confidence level. This is the first search at the LHC to probe DM produced in association with two nonresonant bottom quarks in the 2HDM+a model. Sensitivity to the parameter space with the ratio of the vacuum expectation values of the two Higgs doublets, $\tan\beta$, greater than 15 is achieved, capitalizing on the enhancement of couplings between pseudoscalars and bottom quarks with high $\tan\beta$