Reconnaissance Survey of the Irish Continental Shelf/Shelf Edge - Atlantic Irish Regional Survey (AIRS) 1996: A GLORIA Survey of the Irish Continental Margin

The Atlantic Irish Regional Survey (AIRS96) sidescan sonar survey was carried out in August 1996. Covering an area of 200,000 sq.km it represented the largest reconnaissance seabed survey of the Irish Continental Shelf region. It covered both margins, together with much of the basin floor, of the Irish sector of the Rockall Trough and extended into the northern part of the Porcupine Seabight. The objectives of this project were two fold: 1. Strategic: •to undertake, for the first time a preliminary reconnaissance survey of the Irish Continental Shelf/Shelf Edge, •to establish a strategic database on Shelf/Slope Edge conditions, •to provide training and experience to Irish researchers in state of the art marine surveying equipment (GLORIA) and data processing. 2. Scientific: •to document slope stability and mass wasting features on the margins of the Rockall Trough, •to map, where possible, occurrences of deep water carbonate mounds, •to investigate the sediment erosional, transport and depositional mechanisms that have shaped the present morphology of the region. The survey revealed a range of sedimentary features across the steep (i.e. >6º slope) margins and the basin floor in the Rockall Trough. Four classes of sedimentary feature are recognised: (1) mass failure, (2) canyon systems, (3) sediment fans, and (4) sediment drifts. The western margin is characterised by large-scale downslope mass movement features. The western and central parts of the basin floor in the Rockall Trough contain the Feni Sediment Ridge, a large Miocene-Recent contourite sediment accumulation draped by large sediment waves trending sub-parallel to the dominant modern current pattern. A large-scale downslope mass failure feature is recognised across 14,000 sq.km of the northeastern margin of the Rockall Trough. Smaller slides and slumps occur along the eastern margin in association with more prevalent canyon, channel and fan systems. A cluster of carbonate mounds was imaged in the northern part of the Porcupine Seabight. These represent part of one of the most extensive suites of deep-water carbonate mounds in the Atlantic Margin and are currently the subject of a number of new EU-funded research projects. Strong northward-directed bottom currents along the eastern margin are suggested to erode, circulate and re-deposit sediment on the basin floor and on the western margin of the Rockall Trough. The main terrigenous sedimentary input was from the Irish Mainland Shelf. A broad interplay of alongslope and downslope sediment transport processes shaped the morphology of the Rockall Trough, while tectonically-driven basin subsidence, Quaternary glaciations and glacio-eustatic sea-level fluctuations also influenced the overall sedimentation pattern in the Rockall Trough.Funder: Marine Institut

Real world, multicentre patterns of treatment and survival in metastatic renal cell carcinoma with the UK Renal Oncology Collaborative (UK ROC): Is it time to look favourably on first-line immunotherapy containing combinations in all IMDC groups?

\ua9 2024 The Author(s). Cancer Medicine published by John Wiley & Sons Ltd.Introduction: Clinical trials show improved progression-free survival (PFS) and overall survival (OS) in first-line metastatic renal cell carcinoma (mRCC) patients with immunotherapy containing systemic anti-cancer therapies (SACT). However, in the favourable international metastatic renal cell cancer database consortium (IMDC) group there is no trial evidence for OS benefit despite clear PFS improvement when comparing anti-VEGF tyrosine kinase inhibitor (TKI) monotherapy and (immunotherapy and TKI) IO/TKI combinations. Objective: To assess the impact of first-line SACT choice on the clinical outcomes of PFS and OS in mRCC. To evaluate this impact of initial SACT for allcomers and the favourable IMDC group. Methods: A multicentre retrospective review of patients who started SACT for mRCC (01/01/2018–30/06/2021) at 17 UK NHS trusts. Patient demographics and IMDC group were analysed. Survival data were compared using Kaplan–Meier curves, and the statistical significance of differences in outcome between the groups was assessed with the log-rank test. Univariable and multivariable Cox proportional hazard modelling estimate the hazard ratios (HRs) for survival outcomes associated with IMDC and treatment subtype. Results: One thousand three hundred and nineteen patients were identified with a median age of 64. 294 (22.3%), 695 (52.7%) and 321 (24.3%) were IMDC group favourable, intermediate and poor, respectively. 311 (23.6%), 197 (14.9%) and 778 (59%) patients received checkpoint inhibitor and anti-CTLA4 monoclonal antibody (IO/IO), IO/TKI and TKI first-line SACT across all IMDC groups. Significant PFS improvement favouring IO/TKI versus TKI was demonstrated in allcomers HR = 0.61. In the favourable risk group, Log rank testing demonstrated a significant benefit for IO/TKI over TKI for PFS (HR = 0.60, 95% CI [0.39, 0.91]) and OS (HR = 0.42, 95% CI [0.18, 0.99]). Conclusion: In this real-world evidence cohort, we have shown OS and PFS benefit with IO/TKI versus TKI in the favourable IMDC risk group. This has not been previously reported from trial outcomes and would support use of front-line IO/TKI in mRCC favourable risk patients

The management of acute venous thromboembolism in clinical practice. Results from the European PREFER in VTE Registry

Venous thromboembolism (VTE) is a significant cause of morbidity and mortality in Europe. Data from real-world registries are necessary, as clinical trials do not represent the full spectrum of VTE patients seen in clinical practice. We aimed to document the epidemiology, management and outcomes of VTE using data from a large, observational database. PREFER in VTE was an international, non-interventional disease registry conducted between January 2013 and July 2015 in primary and secondary care across seven European countries. Consecutive patients with acute VTE were documented and followed up over 12 months. PREFER in VTE included 3,455 patients with a mean age of 60.8 ± 17.0 years. Overall, 53.0 % were male. The majority of patients were assessed in the hospital setting as inpatients or outpatients (78.5 %). The diagnosis was deep-vein thrombosis (DVT) in 59.5 % and pulmonary embolism (PE) in 40.5 %. The most common comorbidities were the various types of cardiovascular disease (excluding hypertension; 45.5 %), hypertension (42.3 %) and dyslipidaemia (21.1 %). Following the index VTE, a large proportion of patients received initial therapy with heparin (73.2 %), almost half received a vitamin K antagonist (48.7 %) and nearly a quarter received a DOAC (24.5 %). Almost a quarter of all presentations were for recurrent VTE, with >80 % of previous episodes having occurred more than 12 months prior to baseline. In conclusion, PREFER in VTE has provided contemporary insights into VTE patients and their real-world management, including their baseline characteristics, risk factors, disease history, symptoms and signs, initial therapy and outcomes

Optimisation of Perioperative Cardiovascular Management to Improve Surgical Outcome II (OPTIMISE II) trial: study protocol for a multicentre international trial of cardiac output-guided fluid therapy with low-dose inotrope infusion compared with usual care in patients undergoing major elective gastrointestinal surgery.

INTRODUCTION: Postoperative morbidity and mortality in older patients with comorbidities undergoing gastrointestinal surgery are a major burden on healthcare systems. Infections after surgery are common in such patients, prolonging hospitalisation and reducing postoperative short-term and long-term survival. Optimal management of perioperative intravenous fluids and inotropic drugs may reduce infection rates and improve outcomes from surgery. Previous small trials of cardiac-output-guided haemodynamic therapy algorithms suggested a modest reduction in postoperative morbidity. A large definitive trial is needed to confirm or refute this and inform widespread clinical practice. METHODS: The Optimisation of Perioperative Cardiovascular Management to Improve Surgical Outcome II (OPTIMISE II) trial is a multicentre, international, parallel group, open, randomised controlled trial. 2502 high-risk patients undergoing major elective gastrointestinal surgery will be randomly allocated in a 1:1 ratio using minimisation to minimally invasive cardiac output monitoring to guide protocolised administration of intravenous fluid combined with low-dose inotrope infusion, or usual care. The trial intervention will be carried out during and for 4 hours after surgery. The primary outcome is postoperative infection of Clavien-Dindo grade II or higher within 30 days of randomisation. Participants and those delivering the intervention will not be blinded to treatment allocation; however, outcome assessors will be blinded when feasible. Participant recruitment started in January 2017 and is scheduled to last 3 years, within 50 hospitals worldwide. ETHICS/DISSEMINATION: The OPTIMISE II trial has been approved by the UK National Research Ethics Service and has been approved by responsible ethics committees in all participating countries. The findings will be disseminated through publication in a widely accessible peer-reviewed scientific journal. TRIAL REGISTRATION NUMBER: ISRCTN39653756.The OPTIMISE II trial is supported by Edwards Lifesciences (Irvine, CA) and the UK National Institute for Health Research through RMP’s NIHR Professorship