Bladder acellular matrix graft: in vivo functional properties of the regenerated rat bladder.

The purpose of this study was to determine whether the rat urinary bladder augmented by an acellular matrix graft can restore the bladder's low-pressure reservoir function and preserve normal micturition. After partial cystectomy (> 50%) and grafting with the bladder acellular matrix graft (BAMG), storage and voiding functions were monitored in 20 rats by means of a specially designed "micturition cage," leak-point cystography, and cystometry. After 4 months, sections (n = 6) were examined histologically to evaluate regeneration of bladder wall components within the BAMG. Bladder capacity and compliance increased progressively and were significantly higher in the grafted animals than in controls (partial cystectomy only), and volumes per void were significantly higher than in either control or normal animals. At 4 months, the regenerated urothelium, smooth muscle, blood vessels and nerves within the BAMG were qualitatively identical to normal bladder wall. Augmentation cystoplasty with the homologous BAMG leads to morphologic and functional rat bladder regeneration, thus enhancing low-pressure reservoir function and preserving normal micturition

“A Good Death” - Palliative Surgery in Trisomy 18

A trissomia 18 caracteriza-se por múltiplas anomalias, incluindo doença cardíaca em 60 a 90% dos casos e elevada mortalidade. O mau prognóstico global, conduz habitualmente a uma politica de “cuidados mínimos” mas, paliar, é também nestas situações, um imperativo ético. Descreve-se o caso de uma recém-nascida sem diagnóstico pré natal, mas com confirmação por cariotipo, com cardiopatia, que condicionou insuficiência cardíaca congestiva e angústia respiratória crescente, inviabilizando alta hospitalar, como era desejo da família. Após consenso entre os pais e o corpo clínico responsável, foi decidida intervenção cirúrgica cardíaca paliativa, que possibilitou melhoria clínica e alta para o domicílio. Os autores defendem que a cirurgia cardíaca pode ser uma atitude a considerar em casos de trissomia 18, pois pode aliviar o sofrimento

Patients’ use of information about medicine side effects in relation to experiences of suspected adverse drug reactions

Background Adverse drug reactions (ADRs) are common, and information about medicines is increasingly widely available to the public. However, relatively little work has explored how people use medicines information to help them assess symptoms that may be suspected ADRs. Objective Our objective was to determine how patients use patient information leaflets (PILs) or other medicines information sources and whether information use differs depending on experiences of suspected ADRs. Method This was a cross-sectional survey conducted in six National Health Service (NHS) hospitals in North West England involving medical in-patients taking at least two regular medicines prior to admission. The survey was administered via a questionnaire and covered use of the PIL and other medicines information sources, perceived knowledge about medicines risks/ADRs, experiences of suspected ADRs, plus demographic information. Results Of the 1,218 respondents to the survey, 18.8 % never read the PIL, whilst 6.5 % only do so if something unexpected happens. Educational level was related to perceived knowledge about medicines risks, but not to reading the PIL or seeking further information about medicines risks. Over half the respondents (56.0 %) never sought more information about possible side effects of medicines. A total of 57.2 % claimed they had experienced a suspected ADR. Of these 85.9 % were either very sure or fairly sure this was a reaction to a medicine. Over half of those experiencing a suspected ADR (53.8 %) had read the PIL, of whom 36.2 % did so before the suspected ADR occurred, the remainder afterwards. Reading the PIL helped 84.8 % of these respondents to decide they had experienced an ADR. Educational level, general knowledge of medicines risks and number of regular medicines used all increased the likelihood of experiencing an ADR. Conclusion More patients should be encouraged to read the PIL supplied with medicines. The results support the view that most patients feel knowledgeable about medicines risks and suspected ADRs and value information about side effects, but that reading about side effects in PILs or other medicines information sources does not lead to experiences of suspected ADRs

Screening a variable germplasm collection of Cucumis melo L. for seedling resistance to Macrophomina phaseolina

[EN] We evaluate the seedling resistance to charcoal rot caused by Macrophomina phaseolina in ninety-seven Cucumis melo accessions, from different geographical origins and five F1 generations, derived from crosses of five accessions selected for their resistance. Artificial inoculations with the toothpick method, previously reported to be useful for predicting shoot resistance, were performed, and plants were scored using a scale of disease severity. The average disease severity was calculated for each accession and was used to cluster the accession in five reaction classes. The screening revealed that sources of natural resistance to this fungus are limited. However, seedlings of seven accessions of different botanic groups displayed a resistant response to the stem inoculation, one cantaloup from Israel, one conomon accession from Korea, two wild agrestis and one acidulus from Africa, and two dudaim accessions from Middle East. The response of the F1 progenies varied from susceptibility to high resistance, the latter in progenies from the two agrestis wild types. These results suggest differences in the genetic basis of the resistance in the different selected sources. The resistant accessions are suggested to be screened under field conditions to confirm the level of resistance at adult plant stage and under stressful conditions.This work has been partially funded by the Project No 294/13 of the Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior CAPES (Brazil). M. M. Q. Ambrosio and A. C. A. Dantas thank CAPES for their research fellowships. B.Pico thanks the Programa Hispano-Brasileno de Cooperacion Universitaria HBP2012-008 and PHBP14/00021 and to the MINECO project AGL2014-53398-C2-2-R.Ambrosio, MM.; Dantas, AC.; Martinez Perez, EM.; Medeiros, AC.; Sousa Nunes, GHD.; Picó Sirvent, MB. (2015). Screening a variable germplasm collection of Cucumis melo L. for seedling resistance to Macrophomina phaseolina. Euphytica. 206(2):287-300. https://doi.org/10.1007/s10681-015-1452-xS2873002062Aegerter BJ, Gordon TR, Davis RM (2000) Occurrence and pathogenicity of fungi associated with melon root rot and vine decline in California. Plant Dis 84:224–230Almeida AMR, Abdelnoor RV, Arias CAA, Carvalho VP, Jacoud Filho DS, Marin SRR, Benato LC, Pinto MC, Carvalho CGP (2003) Genotypic diversity among Brazilian isolates of Macrophomina phaseolina revealed by RAPD. Fitopatol Bras 28:279–285Almeida AMRA, Seixas CDSS, Farias JRBF, Oliveira MCN, Franchini JC, Debiasi H, Costa JM, Gaudêncio CA (2014) Macrophomina phaseolina em soja. Embrapa Soja, Londrina, p 30pAmbrósio MMQ, Bueno CJ, Padovani CR, Souza NL (2009) Sobrevivência de fungos fitopatogênicos habitantes do solo, em microcosmo, simulando solarização com prévia incorporação de materiais orgânicos. Summa Phytopathol 35(1):20–25Andrade DEGT, Michereff SJ, Biondi CM, Nascimento CWA, Sales R Jr (2005) Frequência de fungos associados ao colapso do meloeiro e relação com características físicas, químicas e microbiológicas dos solos. Summa Phytopathol 31(4):327–333Bedendo IP (2011) Podridões de raiz e de colo. In: Amorin L, Rezende JAM, Bergamin Filho A (eds) Manual de Fitopatologia: Princípios e conceitos. Agronômica Ceres, São Paulo, pp 443–448Bramel-Cox PJ, Stein IS, Rodgers DM, Claflin LE (1988) Inheritance of resistance to Macrophomina phaseolina (Tassi) Goid. and Fusarium moniliforme Sheldom in Sorghum. Crop Sci 28(1):37–40Bruton BD, Miller E (1997) Occurrence of vine decline diseases of melons in Honduras. Plant Dis 81(6):696Bruton BD, Jeger MD, Reuveni R (1987) Macrophomina phaseolina infection and vine decline in cantaloupe in relation to planting date, soil environment, and maturation. Plant Dis 71(3):259–263Burger Y, Katzir N, Tzuri G, Portnoy V, Saar U, Shriber S, Perl-Treves R, Cohen R (2003) Variation in the response of melon genotypes to Fusarium oxysporum f. sp. melonis race 1 determined by inoculation tests and molecular markers. Plant Pathol 52:204–211Chamorro M, Miranda L, Domínguez P, Medina JJ, Soria C, Romero F, López Aranda JM, De los Santos B (2015) Evaluation of biosolarization for the control of charcoal rot disease (Macrophomina phaseolina) in strawberry. Crop Prot 67:279–286Cohen R (1993) A leaf disk assay for detection of resistance of melons to Sphaerotheca fuliginea race 1. Plant Dis 77(5):513–517Cohen R, Katzir N, Schreiber S, Greenberg R (1996) Occurrence of Shaerotheca fuliginea Race 3 on Cucurbits in Israel. Plant Dis 80:334Cohen R, Omari N, Porat A, Edelstein M (2012) Management of Macrophomina wilt in melons using grafting or fungicide soil application: pathological, horticultural and economical aspects. Crop Prot 35:58–63Cohen R, Tyutyunik J, Fallik E, Oka Y, Tadmor Y, Edelstein M (2014) Phytopathological evaluation of exotic watermelon germplasm as a basic for rootstock breeding. Sci Hortic 165:203–210Dantas AMM, Ambrósio MMQ, Nascimento SRC, Senhor RF, Cézar MA, Lima JSS (2013) Incorporation of plant materials in the control of root pathogens in mushmelon. Revista Agro@ambiente on-line 7(3):338–344Davis RM, Turini TA, Aegerter BJ, Stapleton JJ (2009) Cucurbits charcoal rot, pathogen: Macrophomina phaseolina. UC IPM online. http://www.totoagriculture.org/PDFs/PlantDiseasesPests/1026.pdf . Accessed 25 Feb 2015Dias RCS, Picó B, Espinos A, Nuez F (2004) Resistance to melón vine decline derived from Cucumis melo ssp. agrestis: genetic analysis of root structure and root response. Plant Breed 123:66–72Diourte M, Starr JL, Jegger MJ, Stack JP, Rosenow DT (1995) Charcoal rot (Macrophomina phaseolina) resistance and the effect of water stress on disease development in Sorghum. Plant Pathol 44:196–202Esteras C, Pascual B, Nuez F, Picó MB (2009) Use of ecotilling to identify natural allelic variants of melon candidate genes involved in fuit ripening. 8th Plant Genomics European Meeting (Plant GEM 8) Istambul, 213Esteras C, Formisano G, Roig C, Díaz A, Blanca J, Garcia-Mas J, Gómez-Guillamón ML, López-Sesé AI, Lázaro A, Monforte AJ, Picó B (2013) SNP genotyping in melons: genetic variation, population structure, and linkage disequilibrium. Theor Appl Genet 126(5):1285–1303. doi: 10.1007/s00122-013-2053-5Fang X, Phillips D, Li H, Sivasithamparama K, Barbettia MJ (2011) Comparisons of virulence of pathogens associated with crown and root diseases of strawberry in Western Australia with special reference to the effect of temperature. Sci Hortic 131(22):39–48Food and Agriculture Organization (2014) Faostat. http://faostat.fao.org/site/567/default.aspx#ancor . Accessed 11 Nov 2011García-Jiménez J, Martínez-Ferrer G, Armengol J, Velazquez MT, Orts M, Juárez M, Ortega A, Jordá MC, Alfaro A (1993) Agentes asociados al colapso del melón en distintas zonas españolas. Bol San Veg Plagas 19:401–423Grezes-Besset B, Lucante N, Kelechian V, Dargent R, Muller H (1996) Evaluation of castor bean resistance to sclerotial wilt disease caused by Macrophomina phaseolina. Plant Dis 80(8):842–846Hutcheson SW (1998) Current concepts of active defense in plants. Annu Rev Phytopathol 36:59–90Iglesias A, Picó B, Nuez F (2000) A temporal genetic analysis of disease resistance genes resistance to melon vine decline derived from Cucumis melo var. agrestis. Plant Breed 119:329–334Islam MS, Haque MS, Islam MM, Emdad EM, Halim A, Hossen QMM, Hossain MZ, Ahmed B, Rahim S, Rahman MS, Alam MM, Hou S, Wan X, Saito JÁ, Alam M (2012) Tools to kill: genome of one of the most destructive plant pathogenic fungi Macrophomina phaseolina. BMC Genomic 13(493):1–16Jacob CJ, Krarup C, Díaz A, Latorre BA (2013) A severe outbreak of charcoal rot in cantaloupe melon caused by Macrophomina phaseolina in Chile. Plant Dis 97(1):141Kaur S, Dhillon GS, Brar SK, Vallad GE, Chand R, Chauhan VB (2012) Emerging phytopathogen Macrophomina phaseolina: biology, economic importance and current diagnostic trends. Crit Rev Microbiol 38(1):136–151Keeling A (1982) Seedling test for resistance to soybean stem canker caused by diaporthe phaseolorum var. caulivora. Phytopathology 72(7):807–809Khan SN (2007) Macrophomina phaseolina as causal agent for charcoal rot of sunflower. Mycopath 5(2):111–118Khan SH, Shuaib M (2007) Identification of sources of resistance in Mung bean (Vigna radiata L.) against Charcoal Rot Macrophomina phaseolina (Tassi) Goid. Afr Crop Sci 8:2101–2102Krikun J, Orion D, Nachmias A, Reuveni R (1982) The role of soilborne pathogens under conditions of intensive agricultura. Phytoparasitica 10(4):247–258Mahmoudi SB, Ghashghaie S (2013) Reaction of sugar beet S1 lines and cultivars to different isolates of Macrophomina phaseolina and Rhizoctonia solani AG-2-2IIIB. Euphytica 190:39–445. doi: 10.1007/s10681-012-0832-8Mertely J, Seijo T, Peres N (2005) First report of Macrophomina phaseolina causing a crown rot of strawberry in Florida. Plant Dis 89(4):434Mughogho LK, Pande S (1984) Charcoal Rot of Sorghum. In: Mughogho LK, Rosenberg G (eds) Sorghum root and stalk rots, a critical review: proceedings of the consultative group discussion on research needs and strategies for control of sorghum root and stalk rot diseases. Icrisat, Bellagio, pp 11–24Nischwitz C, Olsen M, Rasmussen S (2004) Effect of irrigation type on inoculum density of Macrophomina phaseolina in melon fields in Arizona. J Phytopathol 152(3):133–137Noling JW, Becker JO (1994) The challenge of research and extension to define and implement alternatives to methyl bromide. J Nematol 26(4S):573–586Pitrat M (2008) Melon. In: Prohens J, Nuez F (eds) Handbook of plant breeding. Springer, New York, pp 283–315Purkayastha S, Kaur B, Dilbaghi N, Chaudhury A (2006) Characterization of Macrophomina phaseolina, the charcoal rot pathogen of cluster bean, using conventional techniques and PCR-based molecular markers. Plant Pathol 55:106–116. doi: 10.1111/j.1365-3059.2005.01317.xRadwan O, Rouhana LV, Hartman GL, Korban SS (2014) Genetic mechanisms of host-pathogen interactions for charcoal rot in soybean. Plant Mol Biol Report 32(3):617–629Ravf BA, Ahmad I (1998) Studies on correlation of seed infection to field incidence of Alternaria alternate and Macrophomina phaseolina in Sunflower. 13th Iranian Plant Protection Congress-Karaj, p 113Roustaee A, Reyhan MK, Jafari M (2011) Study of interaction between salinity and charcoal rot diseases of melon (Macrophomina phaseolina) in Semnan and Garmsar. Desert 16(2):175–218Salari M, Panjehkeh N, Nasirpoor Z, Abkhoo J (2012) Reaction of melón (Cucumis melo L.) cultivars to soil-borne plant pathogenic fungi in Iran. Afr J Biotecnol 11(87):15324–15329Sales R Jr, Oliveira OF, Medeiros EV, Guimarães IM, Correia KC, Michereff SJ (2012) Ervas daninhas como hospedeiras alternativas de patógenos causadores do colapso do meloeiro. Rev Ciênc Agron 43(1):195–198Sas Institute (2000) Sas/Stat user´s guide: statistics, version 8.01, v. 2, 4. SAS Institute, Inc, CaryScandiani MM, Ruberti DS, Giorda LM, Pioli RN, Luque AG, Bottai H, Ivancovich JJ, Aoki T, O´Donnell K (2011) Comparison of inoculation methods for characterizing relative aggressiveness of two soybean sudden-death syndrome pathogens, Fusarium virguliforme and F. tucumaniae. Trop Plant Pathol 36(3):133–140Scott AJ, Knott MA (1974) Cluster analysis method for grouping means in the analysis of variance. Biometrics 30(3):507–512Sebastian P, Schaefer H, Telford IRH, Renner SS (2010) Cucumber (Cucumis sativus) and melon (C. melo) have numerous wild relatives in Asia and Australia, and the sister species of melon is from Australia. Proc Natl Acad Sci 107:14269–14273Sharmishtha P, Bhavneet K, Neeraj D, Ashok C (2006) Evaluation of cluster bean genotypes for resistance to charcoal rot caused by Macrophomina phaseolina using different host inoculation methods pages. J Crop Improv 15(1):67–79Shekhar M, Sharma RC, Singh L, Dutta R (2006) Morphological and pathogenic variability of Macrophomina phaseolina (Tassi.) Goid Incitant of charcoal rot of maize in India. Indian Phytopath 59(3):294–298Stapleton JJ (2000) Soil solarization in various agricultural production systems. Crop Prot 19:837–841Twizeyimana M, Hill CB, Pawlowski M, Paul C, Hartman GL (2012) A cut-stem inoculation technique to evaluate soybean for resistance to Macrophomina phaseolina. Plant Dis 96(8):1210–1215Watson A, Napier T (2009) Disease of cucurbit vegetables. Primefact 832:1–6Wolukau JN, Zhou XH, Li Y, Zhang Y, Chen J (2007) Resistance to gummy stem blight in melon (Cucumis melo L.) germplasm and inheritance of resistance from plant introductions 157076, 420145, and 323498. HortScience 42(2):215–221Wrather JA, Anderson TR, Arsyad DM, Tan Y, Ploper LD, Porta-Puglia A, Ram HH, Yorinori JT (2001) Soybean disease loss estimates for the top ten soybean-producing countries in 1998. Can J Plant Pathol 23:115–12

COVID-19 in a Pediatric Cohort—Retrospective Review of Chest Computer Tomography Findings

Background: Radiological features of the novel 2019 coronavirus disease (COVID-19) have been mainly described in adults. Available literature states that imaging findings in children are similar but less pronounced. The aim of this study is to describe and illustrate the chest computer tomography (CT) features of pediatric COVID-19. Results: This retrospective study was based on the review of all the chest CTs performed in pediatric patients with confirmed COVID-19 disease between March 8th and May 26th 2020 (n = 24). The presence of comorbidities and coinfection was assessed, as well as timing of CT examination in relation to the onset of symptoms. CT findings were categorized as typical, indeterminate, atypical, and negative for COVID-19 according to International Expert Consensus Statement on Chest Imaging in Pediatric COVID-19 Patient Management. This study found that CT findings were abnormal in 17 (71%) patients, with 5 (21%), 9 (38%), and 3 (13%) patients considered to have typical, indeterminate, and atypical findings, respectively. The most common CT patterns were multiple ground-glass opacities (58%), followed by consolidations (50%). Six patients showed predominantly peripheral distribution of parenchymal abnormalities. A halo sign was identified in 3 patients and a perilobular pattern was identified in one of the cases with typical findings. Conclusions: Chest CT findings in children infected with SARS-CoV-2 can be subtle or absent. Besides recognizing typical findings, radiologists should be able to identify features that favor different or concomitant diagnosis.info:eu-repo/semantics/publishedVersio

Thermal behavior of hard-axis magnetization in noninteracting particles with uniaxial anisotropy

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Experimental evidence is presented to support predictions made by an analytical model describing the temperature-dependent behavior of an assembly of noninteracting magnetic nanoparticles with uniaxial anisotropy under an external field. When the applied field is smaller than the anisotropy field of the particles and is oriented perpendicular to the easy axis, a maximum of the magnetization occurs at finite temperature. The theory shows good agreement with measurements of an array of CoCrPt nanoislands with uniaxial anisotropy. Deviations are discussed taking into account the thermal dependencies of the saturation magnetization and the anisotropy of the magnetic material.9520PIIC-DGIP-USMFondecyt Chile [1070224]Millennium Science Initiative ChileFundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)CONICYTNational Science Foundation [DMR 02-13282]Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Fondecyt Chile [1070224]National Science Foundation [DMR 02-13282

The Dynamics of Nestedness Predicts the Evolution of Industrial Ecosystems

In economic systems, the mix of products that countries make or export has been shown to be a strong leading indicator of economic growth. Hence, methods to characterize and predict the structure of the network connecting countries to the products that they export are relevant for understanding the dynamics of economic development. Here we study the presence and absence of industries at the global and national levels and show that these networks are significantly nested. This means that the less filled rows and columns of these networks' adjacency matrices tend to be subsets of the fuller rows and columns. Moreover, we show that nestedness remains relatively stable as the matrices become more filled over time and that this occurs because of a bias for industries that deviate from the networks' nestedness to disappear, and a bias for the missing industries that reduce nestedness to appear. This makes the appearance and disappearance of individual industries in each location predictable. We interpret the high level of nestedness observed in these networks in the context of the neutral model of development introduced by Hidalgo and Hausmann (2009). We show that, for the observed fills, the model can reproduce the high level of nestedness observed in these networks only when we assume a high level of heterogeneity in the distribution of capabilities available in countries and required by products. In the context of the neutral model, this implies that the high level of nestedness observed in these economic networks emerges as a combination of both, the complementarity of inputs and heterogeneity in the number of capabilities available in countries and required by products. The stability of nestedness in industrial ecosystems, and the predictability implied by it, demonstrates the importance of the study of network properties in the evolution of economic networks.Comment: 26 page

Issues potentially affecting quality of life arising from long-term medicines use: a qualitative study

Background Polypharmacy is increasing and managing large number of medicines may create a burden for patients. Many patients have negative views of medicines and their use can adversely affect quality of life. No studies have specifically explored the impact of general long-term medicines use on quality of life. Objective To determine the issues which patients taking long-term medicines consider affect their day-to-day lives, including quality of life. Setting Four primary care general practices in North West England Methods Face-to-face interviews with adults living at home, prescribed four or more regular medicines for at least 1 year. Interviewees were identified from primary care medical records and purposively selected to ensure different types of medicines use. Interviews were recorded, transcribed and analysed thematically. Results Twenty-one interviews were conducted and analysed. Patients used an average of 7.8 medicines, 51 % were preventive, 40 % for symptom relief and 9 % treatment. Eight themes emerged: relationships with health professionals, practicalities, information, efficacy, side effects, attitudes, impact and control. Ability to discuss medicines with health professionals varied and many views were coloured by negative experiences, mainly with doctors. All interviewees had developed routines for using multiple medicines, some requiring considerable effort. Few felt able to exert control over medicines routines specified by health professionals. Over half sought additional information about medicines whereas others avoided this, trusting in doctors to guide their medicines use. Patients recognised their inability to assess efficacy for many medicines, notably those used for prophylaxis. All were concerned about possible side effects and some had poor experiences of discussing concerns with doctors. Medicines led to restrictions on social activities and personal life to the extent that, for some, life can revolve around medicines. Conclusion There is a multiplicity and complexity of issues surrounding medicines use, which impact on day-to-day lives for patients with long-term conditions. While most patients adapt to long-term medicines use, others did so at some cost to their quality of life

Combination of gefitinib and methotrexate to treat tubal ectopic pregnancy (GEM3): a multicentre, randomised, double-blind, placebo-controlled trial

BACKGROUND: Tubal ectopic pregnancies can cause substantial morbidity or even death. Current treatment is with methotrexate or surgery. Methotrexate treatment fails in approximately 30% of women who subsequently require rescue surgery. Gefitinib, an epidermal growth factor receptor inhibitor, might improve the effects of methotrexate. We assessed the efficacy of oral gefitinib with methotrexate, versus methotrexate alone, to treat tubal ectopic pregnancy. METHODS: We performed a multicentre, randomised, double-blind, placebo-controlled trial across 50 UK hospitals. Participants diagnosed with tubal ectopic pregnancy were administered a single dose of intramuscular methotrexate (50 mg/m2) and randomised (1:1 ratio) to 7 days of additional oral gefitinib (250 mg daily) or placebo. The primary outcome, analysed by intention to treat, was surgical intervention to resolve the ectopic pregnancy. Secondary outcomes included time to resolution of ectopic pregnancy and serious adverse events. This trial is registered at the ISRCTN registry, ISCRTN 67795930. FINDINGS: Between Nov 2, 2016, and Oct 6, 2021, 328 participants were allocated to methotrexate and gefitinib (n=165) or methotrexate and placebo (n=163). Three participants in the placebo group withdrew. Surgical intervention occurred in 50 (30%) of 165 participants in the gefitinib group and in 47 (29%) of 160 participants in the placebo group (adjusted risk ratio 1·15, 95% CI 0·85 to 1·58; adjusted risk difference -0·01, 95% CI -0·10 to 0·09; p=0·37). Without surgical intervention, median time to resolution was 28·0 days in the gefitinib group and 28·0 days in the placebo group (subdistribution hazard ratio 1·03, 95% CI 0·75 to 1·40). Serious adverse events occurred in five (3%) of 165 participants in the gefitinib group and in six (4%) of 162 participants in the placebo group. Diarrhoea and rash were more common in the gefitinib group. INTERPRETATION: In women with a tubal ectopic pregnancy, adding oral gefitinib to parenteral methotrexate does not offer clinical benefit over methotrexate and increases minor adverse reactions. FUNDING: National Institute of Health Research