Thrombosis, major bleeding, and survival in COVID-19 supported by VV- ECMO in the first vs second wave- multicentre observational study in the UK

BACKGROUND: Bleeding and thrombosis are major complications of veno-venous extracorporeal membrane (VV-ECMO). OBJECTIVES: To assess thrombosis, major bleeding (MB) and 180-day in patients supported by VV-ECMO between first (1st March-31st May 2020) and second (1st June 2020-30th June 2021) waves of the COVID-19 pandemic. PATIENTS/METHODS: Observational study of 309 consecutive patients (≥18years) with severe COVID-19 supported by VV-ECMO in four nationally commissioned ECMO centres, UK. RESULTS: Median age was 48 (19-75)years and 70.6% were male. Probabilities of survival, thrombosis, and MB at 180 days in the overall cohort were 62.5% (193/309), 39.8%(123/309) and 30%(93/309). In multivariate analysis, age >55 years (HR 2.29 [1.33-3.93],p=0.003) and elevated creatinine (HR 1.91 [1.19-3.08],p=0.008) were associated with increased mortality. Corrected for duration of VV-ECMO support, arterial thrombosis alone (HR 3.0 [95% CI1.5-5.9], P= 0.002) or circuit thrombosis alone (HR 3.9 [95% 2.4-6.3], P<0.001), but not venous thrombosis, increased mortality. MB during ECMO had 3-fold risk (95% CI 2.6-5.8, P<0.001) of mortality. The first wave cohort had more males (76.7% vs 64%, p=0.014), higher 180-day survival (71.1% vs 53.3% p=0.003), more venous thrombosis alone (46.4% vs 29.2%, p=0.02) and lower circuit thrombosis (9.2% vs 28.1%, p<0.001). The second wave cohort received more steroids (121/150 [80.6%] vs 86/159 [54.1%], p<0.0001) and Tocilizumab (20/150 [13.3%] vs 4/159 [2.5%] p=0.005). CONCLUSIONS: MB and thrombosis are frequent complications in patients on VV-ECMO and significantly increase mortality. Arterial thrombosis alone or circuit thrombosis alone increased mortality whilst venous thrombosis alone had no effect. MB during ECMO support increased mortality 3.9-fold

Not Just Efficiency: Insolvency Law in the EU and Its Political Dimension

Certain insolvency law rules, like creditors’ priorities and set-off rights, have a distributive impact on creditors. Distributional rules reflect the hierarchies of values and interests in each jurisdiction and, as a result, have high political relevance and pose an obstacle to reforming the EU Insolvency Regulation. This paper will show the difficulty of reform by addressing two alternative options to regulate cross-border insolvencies in the European Union. The first one is the ‘choice model’, under which companies can select the insolvency law they prefer. Although such a model would allow distressed firms to select the most efficient insolvency law, it would also displace Member States’ power to protect local constituencies. The choice model therefore produces negative externalities and raises legitimacy concerns. The opposite solution is full harmonisation of insolvency law at EU level, including distributional rules. Full harmonisation would have the advantage of internalising all externalities produced by cross-border insolvencies. However, the EU legislative process, which is still based on negotiations between states, is not apt to decide on distributive insolvency rules; additionally, if harmonisation includes such rules, it will indirectly modify national social security strategies and equilibria. This debate shows that the choice regarding power allocation over bankruptcies in the EU depends on the progress of European integration and is mainly a matter of political legitimacy, not only of efficiency

Systems medicine dissection of chr1q-amp reveals a novel PBX1-FOXM1 axis for targeted therapy in multiple myeloma

Understanding the biological and clinical impact ofcopy number aberrations (CNA)for the development of precision therapies in cancer remains anunmet challenge. Genetic amplification of chromosome 1q (chr1q-amp) is a major CNAconferring adverse prognosis in several types of cancer, including in the blood cancer multiple myeloma (MM). Although severalgenes across chr1q portend high-risk MM disease, the underpinning molecular aetiology remains elusive. Here, with reference to the 3D chromatin structure, we integrate MMpatient multi-omics datasets with genetic variables to obtain an associated clinical risk map across chr1q and to identify 103 adverse prognosis genes in chr1q-amp MM. Prominent amongst these genes, the transcription factor PBX1 is ectopically expressed by genetic amplification and epigenetic activation of its own preserved 3D regulatory domain. By binding to reprogrammed super-enhancers, PBX1 directly regulates critical oncogenic pathways and a FOXM1-dependent transcriptional programme. Together, PBX1 and FOXM1 activate a proliferative gene signature which predicts adverse prognosis across multiple types of cancer. Notably, pharmacological disruption of the PBX1-FOXM1 axis with existing agents (thiostrepton) and a novel PBX1 small-molecule inhibitor (T417) is selectively toxic against chr1q-amplified myeloma and solid tumour cells. Overall, our systems medicine approach successfully identifies CNA-driven oncogenic circuitries, links them to clinical phenotypes and proposes novel CNA-targeted therapystrategies in multiple myeloma and other types of cancer

Provably secure NTRU instances over prime cyclotomic rings

Due to its remarkable performance and potential resistance to quantum attacks, NTRUEncrypt has drawn much attention recently; it also has been standardized by IEEE. However, classical NTRUEncrypt lacks a strong security guarantee and its security still relies on heuristic arguments. At Eurocrypt 2011, Stehlé and Steinfeld first proposed a variant of NTRUEncrypt with a security reduction from standard problems on ideal lattices. This variant is restricted to the family of rings ℤ[X]/(Xn + 1) with n a power of 2 and its private keys are sampled by rejection from certain discrete Gaussian so that the public key is shown to be almost uniform. Despite the fact that partial operations, especially for RLWE, over ℤ[X]/(Xn + 1) are simple and efficient, these rings are quite scarce and different from the classical NTRU setting. In this work, we consider a variant of NTRUEncrypt over prime cyclotomic rings, i.e. ℤ[X]/(Xn-1 +…+ X + 1) with n an odd prime, and obtain IND-CPA secure results in the standard model assuming the hardness of worst-case problems on ideal lattices. In our setting, the choice of the rings is much more flexible and the scheme is closer to the original NTRU, as ℤ[X]/(Xn-1+…+X+1) is a large subring of the NTRU ring ℤ[X]/(Xn-1). Some tools for prime cyclotomic rings are also developed

Thombosis, major bleeding, and survival in COVID-19 supported by veno-venous extracorporeal membrane oxygenation in the first vs second wave: a multicenter observational study in the United Kingdom

Background Bleeding and thrombosis are major complications of veno-venous (VV) extracorporeal membrane oxygenation (ECMO). Objectives To assess thrombosis, major bleeding (MB), and 180-day survival in patients supported by VV-ECMO between the first (March 1 to May 31, 2020) and second (June 1, 2020, to June 30, 2021) waves of the COVID-19 pandemic. Methods An observational study of 309 consecutive patients (aged ≥18years) with severe COVID-19 supported by VV-ECMO was performed in 4 nationally commissioned ECMO centers in the United Kingdom. Results Median age was 48 (19-75) years, and 70.6% were male. Probabilities of survival, thrombosis, and MB at 180 days in the overall cohort were 62.5% (193/309), 39.8% (123/309), and 30% (93/309), respectively. In multivariate analysis, an age of >55 years (hazard ratio [HR], 2.29; 95% CI, 1.33-3.93; P = .003) and an elevated creatinine level (HR, 1.91; 95% CI, 1.19-3.08; P = .008) were associated with increased mortality. Correction for duration of VV-ECMO support, arterial thrombosis alone (HR, 3.0; 95% CI, 1.5-5.9; P = .002) or circuit thrombosis alone (HR, 3.9; 95% CI, 2.4-6.3; P < .001) but not venous thrombosis increased mortality. MB during ECMO had a 3-fold risk (95% CI, 2.6-5.8, P < .001) of mortality. The first wave cohort had more males (76.7% vs 64%; P = .014), higher 180-day survival (71.1% vs 53.3%; P = .003), more venous thrombosis alone (46.4% vs 29.2%; P = .02), and lower circuit thrombosis (9.2% vs 28.1%; P < .001). The second wave cohort received more steroids (121/150 [80.6%] vs 86/159 [54.1%]; P < .0001) and tocilizumab (20/150 [13.3%] vs 4/159 [2.5%]; P = .005). Conclusion MB and thrombosis are frequent complications in patients on VV-ECMO and significantly increase mortality. Arterial thrombosis alone or circuit thrombosis alone increased mortality, while venous thrombosis alone had no effect. MB during ECMO support increased mortality by 3.9-fold. Keywords: COVID-19; extracorporeal membrane oxygenation; hemorrhage; mortality; thrombosi

Foraminiferal assemblages as palaeoenvironmental bioindicators in Late Jurassic epicontinental platforms: relation with trophic conditions

Foraminiferal assemblages from the neritic environment reveal the palaeoecological impact of nutrient types in relation to shore distance and sedimentary setting. Comparatively proximal siliciclastic settings from the Boreal Domain (Brora section, Eastern Scotland) were dominated by inner−shelf primary production in the water column or in sea bottom, while in relatively seawards mixed carbonate−siliciclastic settings from the Western Tethys (Prebetic, Southern Spain), nutrients mainly derived from the inner−shelf source. In both settings, benthic foraminiferal assemblages increased in diversity and proportion of epifauna from eutrophic to oligotrophic conditions. The proximal setting example (Brora Brick Clay Mb.) corresponds to Callovian offshore shelf deposits with a high primary productivity, bottom accumulation of organic matter, and a reduced sedimentation rate for siliciclastics. Eutrophic conditions favoured some infaunal foraminifera. Lately, inner shelf to shoreface transition areas (Fascally Siltstone Mb.), show higher sedimentation rates and turbidity, reducing euphotic−zone range depths and primary production, and then deposits with a lower organic matter content (high−mesotrophic conditions). This determined less agglutinated infaunal foraminifera content and increasing calcitic and aragonitic epifauna, and calcitic opportunists (i.e., Lenticulina). The comparatively distal setting of the Oxfordian example (Prebetic) corresponds to: (i) outer−shelf areas with lower nutrient input (relative oligotrophy) and organic matter accumulation on comparatively firmer substrates (lumpy lithofacies group) showing dominance of calcitic epifaunal foraminifera, and (ii) mid−shelf areas with a higher sedimentation rate and nutrient influx (low−mesotrophic conditions) favouring potentially deep infaunal foraminifers in comparatively unconsolidated and nutrient−rich substrates controlled by instable redox boundary (marl−limestone rhythmite lithofacies).This research was carried out with the financial support of projects CGL2005−06636−C0201 and CGL2005−01316/BTE, and University of Oslo, Norway−Statoil cooperation. M.R. holds a Juan de la Cierva grant from the Ministry of Science and Technology of Spain

Automated Unbounded Analysis of Cryptographic Constructions in the Generic Group Model

We develop a new method to automatically prove security statements in the Generic Group Model as they occur in actual papers. We start by defining (i) a general language to describe security definitions, (ii) a class of logical formulas that characterize how an adversary can win, and (iii) a translation from security definitions to such formulas. We prove a Master Theorem that relates the security of the construction to the existence of a solution for the associated logical formulas. Moreover, we define a constraint solving algorithm that proves the security of a construction by proving the absence of solutions. We implement our approach in a fully automated tool, the $gga^{\infty}$ tool, and use it to verify different examples from the literature. The results improve on the tool by Barthe et al. (CRYPTO\u2714, PKC\u2715): for many constructions, $gga^{\infty}$ succeeds in proving standard (unbounded) security, whereas Barthe\u27s tool is only able to prove security for a small number of oracle queries

Beat-to-beat vectorcardiographic analysis of ventricular depolarization and repolarization in myocardial infarction

OBJECTIVES: Increased beat-to-beat variability in the QT interval has been associated with heart disease and mortality. The purpose of this study was to investigate the beat-to-beat spatial and temporal variations of ventricular depolarization and repolarization in vectorcardiogram (VCG) for characterising myocardial infarction (MI) patients. METHODS: Standard 12-lead ECGs of 84 MI patients (22 f, 63±12 yrs; 62 m, 56±10 yrs) and 69 healthy subjects (17 f, 42±18 yrs; 52 m, 40±13 yrs) were investigated. To extract the beat-to-beat QT intervals, a template-matching algorithm and the singular value decomposition method have been applied to synthesise the ECG data to VCG. Spatial and temporal variations in the QRS complex and T-wave loops were studied by investigating several descriptors (point-to-point distance variability, mean loop length, T-wave morphology dispersion, percentage of loop area, total cosine R-to-T). RESULTS: Point-to-point distance variability of QRS and T-loops (0.13±.04 vs. 0.10±0.04, p<0.0001 and 0.16±.07 vs. 0.13±.06, p<0.05) were significantly larger in the MI group than in the control group. The average T-wave morphology dispersion was significantly higher in the MI group than in the control group (62±8 vs. 38±16, p<.0001). Further, its beat-to-beat variability appeared significantly lower in the MI group than in the control group (12±5 v. 15±6u, p<0.005). Moreover, the average percentage of the T-loop area was found significantly lower in the MI group than the controls (46±17 vs. 55±15, p<.001). Finally, the average and beat-to-beat variability of total cosine R-to-T were not found statistically significant between both groups. CONCLUSIONS: Beat-to-beat assessment of VCG parameters may have diagnostic attributes that might help in identifying MI patients.Muhammad A. Hasan, Derek Abbott and Mathias Baumer

Results of a national UK physician reported survey of COVID-19 infection in patients with a myeloproliferative neoplasm

Funder: Cancer Research UK (CRUK); doi: https://doi.org/10.13039/501100000289Funder: DH | National Institute for Health Research (NIHR); doi: https://doi.org/10.13039/50110000027