Long-term management of moderate-to-severe atopic dermatitis with dupilumab and concomitant topical corticosteroids (LIBERTY AD CHRONOS): a critical appraisal

Aim Blauvelt et al. (The Lancet 2017; 389: 2287-303) aimed to compare the long-term efficacy and safety of dupilumab with medium-potency topical corticosteroids (TCS) versus placebo with TCS in adults with moderate-to-severe atopic dermatitis (AD). Setting and design This multicentre randomised, double-blinded, placebo-controlled trial was conducted in hospitals, clinics and academic institutions across 161 sites in 14 countries. Study exposure Adults with moderate-to-severe AD were randomly assigned (3:1:3) to receive subcutaneous dupilumab 300mg once weekly (qw) plus TCS, dupilumab 300mg every 2 weeks (q2w) plus TCS, or placebo plus TCS until week-52. Primary outcome measures Co-primary efficacy endpoints were patients (%) achieving Investigator's Global Assessment (IGA) 0/1 and 2-points or higher improvement from baseline, and Eczema Area and Severity Index 75% improvement from baseline (EASI-75) at week-16. Results 740 patients were included in the trial: 319 were randomly assigned to dupilumab qw, 106 to dupilumab q2w and 315 to the placebo arm. At week-16, more patients in the dupilumab groups achieved the co-primary endpoints: IGA 0/1 (39% [125 patients] qw dosing, 39% [41 patients] q2w dosing vs 12% [39 patients] receiving placebo; p<0.0001) and EASI-75 (64% [204] and 69% [73] vs 23% [73]; p<0.0001). Whilst no new safety signals were identified, adverse effects (AEs) were noted in 261 (83%) in those receiving dupilumab qw plus TCS, 97 (88%) dupilumab q2w plus TCS and 266 (84%) for placebo plus TCS. Rates of conjunctivitis, injection site reactions and local herpes simplex infections were higher in the dupilumab groups compared with placebo. Conclusions Blauvelt et al. concluded that dupilumab treatment added to TCS improved AD up to week-52 compared with TCS alone, and also demonstrated acceptable safety

Do British birds conform to Bergmann's and Allen's rules? An analysis of body size variation with latitude for four species

Capsule: An analysis of body mass and wing length for four bird species shows trends broadly in line with predictions from Bergmann's and Allen's rules but with species- and sex-specific trends in terms of body size variation with latitude in Britain. Aims: To analyse body size characteristics for bird species with latitude in Britain and to test Bergmann’s and Allen’s rules (over a range of c. 740 km). Methods Body mass and wing length for four bird species (Blackbird Turdus merula, House Sparrow Passer domesticus, Robin Erithacus rubecula, and Song Thrush Turdus philomelos) were analysed using principal components regression analysis to investigate trends with latitude, longitude, or by sex and Julian day. Results: Evidence was found for latitudinal gradients in body mass for male Blackbird, female House Sparrow (both increasing in size northwards), and female Robin (decreasing in size northwards) and in wing length for female Robin and male Song Thrush (decreasing and increasing northwards, respectively). Conclusion: Trends were broadly in line with predictions from Bergmann's and Allen's rules except for Robin which had trends opposite to those expected. Differences in trends between sexes suggest a role for an interplay between natural and sexual selection with latitude that deserves further consideration

Broad‐scale patterns of the Afro‐Palaearctic landbird migration

Aim: Knowledge of broad-scale biogeographical patterns of animal migration is important for understanding ecological drivers of migratory behaviours. Here, we present a flyway-scale assessment of the spatial structure and seasonal dynamics of the Afro-Palaearctic bird migration system and explore how phenology of the environment guides long-distance migration. Location: Europe and Africa. Time period: 2009–2017. Major taxa studied: Birds. Methods: We compiled an individual-based dataset comprising 23 passerine and near-passerine species of 55 European breeding populations, in which a total of 564 individuals were tracked during migration between Europe and sub-Saharan Africa. In addition, we used remotely sensed primary productivity data (the normalized difference vegetation index) to estimate the timing of vegetation green-up in spring and senescence in autumn across Europe. First, we described how individual breeding and non-breeding sites and the migratory flyways link geographically. Second, we examined how the timing of migration along the two major Afro-Palaearctic flyways is tuned with vegetation phenology at the breeding sites. Results: We found the longitudes of individual breeding and non-breeding sites to be related in a strongly positive manner, whereas the latitudes of breeding and non-breeding sites were related negatively. In autumn, migration commenced ahead of vegetation senescence, and the timing of migration was 5–7 days earlier along the Western flyway compared with the Eastern flyway. In spring, the time of arrival at breeding sites was c. 1.5 days later for each degree northwards and 6–7 days later along the Eastern compared with the Western flyway, reflecting the later spring green-up at higher latitudes and more eastern longitudes. Main conclusions: Migration of the Afro-Palaearctic landbirds follows a longitudinally parallel leapfrog migration pattern, whereby migrants track vegetation green-up in spring but depart before vegetation senescence in autumn. The degree of continentality along migration routes and at the breeding sites of the birds influences the timing of migration on a broad scale

Population size of Oystercatchers Haematopus ostralegus wintering in Iceland

The first ever survey of Oystercatchers wintering in Iceland found around 11 000 individuals. This is an estimated 30% of the Icelandic population, including juveniles, suggesting that approximately 26 000 Icelandic Oystercatchers migrate to western Europe in the autumn. More Oystercatchers winter in Iceland than at similar latitudes elsewhere in Europe, which may reflect the remoteness and milder winter temperatures on this oceanic island

Clinical integration of fast Raman spectroscopy for Mohs micrographic surgery of basal cell carcinoma

We present the first clinical integration of a prototype device based on integrated auto-fluorescence imaging and Raman spectroscopy (Fast Raman device) for intra-operative assessment of surgical margins during Mohs micrographic surgery of basal cell carcinoma (BCC). Fresh skin specimens from 112 patients were used to optimise the tissue pre-processing and the Fast Raman algorithms to enable an analysis of complete Mohs layers within 30 minutes. The optimisation allowed >95% of the resection surface area to be investigated (including the deep and epidermal margins). The Fast Raman device was then used to analyse skin layers excised from the most relevant anatomical sites (nose, temple, eyelid, cheek, forehead, eyebrow and lip) and to detect the three main types of BCC (nodular, superficial and infiltrative). These results suggest that the Fast Raman technique is a promising tool to provide an objective diagnosis “tumour clear yes/no” during Mohs surgery of BCC. This clinical integration study is a key step towards a larger scale diagnosis test accuracy study to reliably determine the sensitivity and specificity in a clinical setting

Shorebirds as important vectors for plant dispersal in Europe

Shorebirds (Charadriiformes) undergo rapid migrations with potential for long-distance dispersal (LDD) of plants. We studied the frequency of endozoochory by shorebirds in different parts of Europe covering a broad latitudinal range and different seasons. We assessed whether plants dispersed conformed to morphological dispersal syndromes. A total of 409 excreta samples (271 faeces and 138 pellets) were collected from redshank Tringa totanus, black-winged stilt Himantopus himantopus, pied avocet Recurvirostra avosetta, northern lapwing Vanellus vanellus, Eurasian curlew Numenius arquata and black-tailed godwit Limosa limosa in south-west Spain, north-west England, southern Ireland and Iceland in 2005 and 2016, and intact seeds were extracted and identified. Godwits were sampled just before or after migratory movements between England and Iceland. The germinability of seeds was tested. Intact diaspores were recovered from all bird species and study areas, and were present in 13% of samples overall. Thirteen plant families were represented, including Charophyceae and 26 angiosperm taxa. Only four species had an ‘endozoochory syndrome’. Four alien species were recorded. Ellenberg values classified three species as aquatic and 20 as terrestrial. Overall, 89% of seeds were from terrestrial plants, and 11% from aquatic plants. Average seed length was higher in redshank pellets than in their faeces. Six species were germinated, none of which had an endozoochory syndrome. Seeds were recorded during spring and autumn migration. Plant species recorded have broad latitudinal ranges consistent with LDD via shorebirds. Crucially, morphological syndromes do not adequately predict LDD potential, and more empirical work is required to identify which plants are dispersed by shorebirds. Incorporating endozoochory by shorebirds and other migratory waterbirds into plant distribution models would allow us to better understand the natural processes that facilitated colonization of oceanic islands, or to improve predictions of how plants will respond to climate change, or how alien species spread.Peer Reviewe