CDK9 inhibition as an effective therapy for small cell lung cancer

Treatment-naïve small cell lung cancer (SCLC) is typically susceptible to standard-of-care chemotherapy consisting of cisplatin and etoposide recently combined with PD-L1 inhibitors. Yet, in most cases, SCLC patients develop resistance to first-line therapy and alternative therapies are urgently required to overcome this resistance. In this study, we tested the efficacy of dinaciclib, an FDA-orphan drug and inhibitor of the cyclin-dependent kinase (CDK) 9, among other CDKs, in SCLC. Furthermore, we report on a newly developed, highly specific CDK9 inhibitor, VC-1, with tumour-killing activity in SCLC. CDK9 inhibition displayed high killing potential in a panel of mouse and human SCLC cell lines. Mechanistically, CDK9 inhibition led to a reduction in MCL-1 and cFLIP anti-apoptotic proteins and killed cells, almost exclusively, by intrinsic apoptosis. While CDK9 inhibition did not synergise with chemotherapy, it displayed high efficacy in chemotherapy-resistant cells. In vivo, CDK9 inhibition effectively reduced tumour growth and improved survival in both autochthonous and syngeneic SCLC models. Together, this study shows that CDK9 inhibition is a promising therapeutic agent against SCLC and could be applied to chemo-refractory or resistant SCLC.

Ensembl 2024

Ensembl (https://www.ensembl.org) is a freely available genomic resource that has produced high-quality annotations, tools, and services for vertebrates and model organisms for more than two decades. In recent years, there has been a dramatic shift in the genomic landscape, with a large increase in the number and phylogenetic breadth of high-quality reference genomes, alongside major advances in the pan-genome representations of higher species. In order to support these efforts and accelerate downstream research, Ensembl continues to focus on scaling for the rapid annotation of new genome assemblies, developing new methods for comparative analysis, and expanding the depth and quality of our genome annotations. This year we have continued our expansion to support global biodiversity research, doubling the number of annotated genomes we support on our Rapid Release site to over 1700, driven by our close collaboration with biodiversity projects such as Darwin Tree of Life. We have also strengthened support for key agricultural species, including the first regulatory builds for farmed animals, and have updated key tools and resources that support the global scientific community, notably the Ensembl Variant Effect Predictor. Ensembl data, software, and tools are freely available.

Outcomes among oropharyngeal and oral cavity cancer patients treated with postoperative volumetric modulated arctherapy

Background

Presently, there are few published reports on postoperative radiation therapy for oropharyngeal and oral cavity cancers treated with IMRT/VMAT technique. This study aimed to assess the oncological outcomes of this population treated with postoperative VMAT in our institution, with a focus on loco-regional patterns of failure.

Material and methods

Between 2011 and 2019, 167 patients were included (40% of oropharyngeal cancers, and 60% of oral cavity cancers). The median age was 60 years. There was 64.2% of stage IV cancers. All patients had both T and N surgery. 34% had a R1 margin, 42% had perineural invasion. 72% had a positive neck dissection and 42% extranodal extension (ENE). All patients were treated with VMAT with simultaneous integrated boost with three dose levels: 66Gy in case of R1 margin and/or ENE, 59.4-60Gy on the tumor bed, and 54Gy on the prophylactic areas. Concomittant cisplatin was administrated concomitantly when feasible in case of R1 and/or ENE.

Results

The 1- and 2-year loco-regional control rates were 88.6% and 85.6% respectively. Higher tumor stage (T3/T4), the presence of PNI, and time from surgery >45 days were significant predictive factors of worse loco-regional control in multivariate analysis (p=0.02, p=0.04, and p=0.02). There were 17 local recurrences: 11 (64%) were considered as infield, 4 (24%) as marginal, and 2 (12%) as outfield. There were 9 regional recurrences only, 8 (89%) were considered as infield, and 1 (11%) as outfield. The 1- and 2-year disease-free survival (DFS) rates were 78.9% and 71.8% respectively. The 1- and 2-year overall survival (OS) rates were 88.6% and 80% respectively. Higher tumor stage (T3/T4) and the presence of ENE were the two prognostic factors significantly associated with worse DFS and OS in multivariate analysis.

Conclusion

Our outcomes for postoperative VMAT for oral cavity and oropharyngeal cancers are encouraging, with high rates of loco-regional control. However, the management of ENE still seems challenging.

A laser-based system to heat nuclear fuel pellets at high temperature

Annealing tests are of utmost importance in nuclear fuel research, particularly to study the thermophysical properties of the material, microstructure evolution, or the released gas as a function of temperature. As an alternative to conventional furnace or induction annealing, we report on a laser-heating experiment allowing one to heat a nuclear fuel pellet made of uranium dioxide, UO2, or potentially other nuclear fuel pellets in an isothermal and controlled manner. For that purpose, we propose to use an indirect heating method based on a two compartment tungsten crucible, one containing the sample and the other acting as a laser susceptor for efficient and homogeneous heating of the assembly. With this concept, we demonstrate the heating of UO2 samples up to 1500 °C at a maximum heating rate of 30 °C/s with the use of two 500 W lasers. The system is, however, scalable to higher heating rates or higher temperatures by increasing the laser power up to few kW. The experiment has been designed to heat a pressurized water reactor fuel pellet, but the concept could be easily applied to other sample geometries or materials.

Deciphering the segregation of proteins in high-protein dairy powders after spray-drying

High-protein dairy powders are ingredients mainly produced by spray-drying, then subjected to aging during transport and storage. They often undergo physicochemical changes at this stage, such as the development of the Maillard reaction, primarily because of their intrinsic chemical properties, but also as a result of nonoptimal storage conditions. Components present at the particle surface are the first to be targeted by moisture and other environmental disruptions. Consequently, the identification, control, and prediction of particle surface components are useful to anticipate the effect of powder aging on product quality. Here, a new diafiltration method is proposed which fractionates proteins from a binary colloidal dispersion of 80% casein micelles and 20% whey proteins, according to their presence at the surface or core of the particle. This method shows that whey proteins are strongly enriched at the particle surface, whereas casein micelles are located at the core of the particles. This protocol also allows the identification of the rehydration kinetics for each rehydrated protein layer of the particle, revealing that 2 distinct forms of swelling occur: (1) a rapid swelling and elution of whey proteins present at the particle surface, and (2) a swelling of casein micelles located below the whey proteins, associated with a slow elution of casein micelles from the particles being rehydrated.

GENCODE: reference annotation for the human and mouse genomes in 2023

GENCODE produces high quality gene and transcript annotation for the human and mouse genomes. All GENCODE annotation is supported by experimental data and serves as a reference for genome biology and clinical genomics. The GENCODE consortium generates targeted experimental data, develops bioinformatic tools and carries out analyses that, along with externally produced data and methods, support the identification and annotation of transcript structures and the determination of their function. Here, we present an update on the annotation of human and mouse genes, including developments in the tools, data, analyses and major collaborations which underpin this progress. For example, we report the creation of a set of non-canonical ORFs identified in GENCODE transcripts, the LRGASP collaboration to assess the use of long transcriptomic data to build transcript models, the progress in collaborations with RefSeq and UniProt to increase convergence in the annotation of human and mouse protein-coding genes, the propagation of GENCODE across the human pan-genome and the development of new tools to support annotation of regulatory features by GENCODE. Our annotation is accessible via Ensembl, the UCSC Genome Browser and https://www.gencodegenes.org.

The use of nitrous oxide 'cracking' technology in the labour ward: a case report and patient account

Nitrous oxide is a common choice of labour analgesia in many countries. However, its use is associated with significant cost to the environment as well as potential risks of long-term occupational exposure. Our hospital is one of a small number of healthcare providers in the United Kingdom trialling technology which catalytically destroys ('cracks') nitrous oxide to reduce greenhouse gas emissions and occupational exposure. When used in the setting of inhaled analgesia, cracking technology relies on capturing the patient's exhaled breath via a facemask or mouthpiece, a technique which requires some user skill and may be challenging for patients. In this report, we present the case of a primiparous 35-year-old consultant anaesthetist, who used nitrous oxide cracking technology with inhaled nitrous oxide analgesia (via a facemask) during labour. We present the patient's experiences and discuss the implications of using such technology on ambient nitrous oxide levels in the delivery room. Notably, despite this patient's professional expertise and familiarity with facemask use, nitrous oxide remained detectable throughout her labour, although generally at low levels. This illustrates that whilst this technology has the potential to reduce ambient nitrous oxide levels, its efficacy may vary depending on how it is used, with implications for patient education and support.

Current trends in craniofacial reconstruction

Reconstruction of the head and neck continues to pose a variety of difficult functional and aesthetic challenges to the plastic surgeon. While the surgical treatment for midfacial and skull base tumours continues to advance, the three-dimensional reconstruction predicaments continue to increase in complexity. Reconstructive strategies of the head and neck require the restoration of intricate skeletal architecture and large volumes of both internal and external soft tissue envelopes that can withstand adjuvant therapies. Vascularized bone grafts in combination with microsurgical techniques is the current trend of most reconstruction and has replaced local and pedicle flaps as the preferred modality for large defects. This article will focus on concise areas of difficulty in craniofacial reconstruction, including mandibular, midfacial, scalp and base of skull reconstruction. As our goals now move from flap survival to refinement, more complex and innovative reconstructions are executed. The problems with each modality are examined, and the frontiers of head and neck reconstruction are explored. With the potential combination of virtual surgery and tissue engineered biotechnology, we may someday be able to expand our reconstructive capabilities beyond free tissue transfer.

Ensembl 2022

Ensembl (https://www.ensembl.org) is unique in its flexible infrastructure for access to genomic data and annotation. It has been designed to efficiently deliver annotation at scale for all eukaryotic life, and it also provides deep comprehensive annotation for key species. Genomes representing a greater diversity of species are increasingly being sequenced. In response, we have focussed our recent efforts on expediting the annotation of new assemblies. Here, we report the release of the greatest annual number of newly annotated genomes in the history of Ensembl via our dedicated Ensembl Rapid Release platform (http://rapid.ensembl.org). We have also developed a new method to generate comparative analyses at scale for these assemblies and, for the first time, we have annotated non-vertebrate eukaryotes. Meanwhile, we continually improve, extend and update the annotation for our high-value reference vertebrate genomes and report the details here. We have a range of specific software tools for specific tasks, such as the Ensembl Variant Effect Predictor (VEP) and the newly developed interface for the Variant Recoder. All Ensembl data, software and tools are freely available for download and are accessible programmatically.

The Ensembl COVID-19 resource: ongoing integration of public SARS-CoV-2 data

The COVID-19 pandemic has seen unprecedented use of SARS-CoV-2 genome sequencing for epidemiological tracking and identification of emerging variants. Understanding the potential impact of these variants on the infectivity of the virus and the efficacy of emerging therapeutics and vaccines has become a cornerstone of the fight against the disease. To support the maximal use of genomic information for SARS-CoV-2 research, we launched the Ensembl COVID-19 browser; the first virus to be encompassed within the Ensembl platform. This resource incorporates a new Ensembl gene set, multiple variant sets, and annotation from several relevant resources aligned to the reference SARS-CoV-2 assembly. Since the first release in May 2020, the content has been regularly updated using our new rapid release workflow, and tools such as the Ensembl Variant Effect Predictor have been integrated. The Ensembl COVID-19 browser is freely available at https://covid-19.ensembl.org.

Peronosporaceae species causing downy mildew diseases of Poaceae, including nomenclature revisions and diagnostic resources

Downy mildew pathogens of graminicolous hosts (Poaceae) are members of eight morphologically and phylogenetically distinct genera in the Peronosporaceae (Oomycota,Peronosporales). Graminicolous downy mildews (GDMs) cause severe losses in crops such as maize, millets, sorghum, and sugarcane in many parts of the world, especially in tropical climates. In countries where the most destructive GDMs are not endemic, these organisms are often designated as high-risk foreign pathogens and subject to oversight and quarantine by regulatory officials. Thus, there is a need to reliably and accurately identify the causal organisms. This paper provides an overview of the Peronosporaceae species causing graminicolous downy mildew diseases, with a description of their impact on agriculture and the environment, along with brief summaries of the nomenclatural and taxonomic issues surrounding these taxa. Key diagnostic characters are summarized, including DNA sequence data for types and/or voucher specimens, morphological features, and new illustrations. New sequence data for cox2 and 28S rDNA markers are provided from the type specimens of three species, Peronosclerospora philippinensis, Sclerospora iseilematis, and Sclerospora northii. Thirty-nine species of graminicolous downy mildews are accepted, and seven previously invalidly published taxa are validated. Fifty-five specimens are formally designated as types, including lectotypification of 10 species, neotypification of three species, and holotype designation for Sclerophthora cryophila.

Citation: Crouch JA, Davis WJ, Shishkoff N, Castroagudín VL, Martin F, Michelmore R, Thines M (2022). Peronosporaceae species causing downy mildew diseases of Poaceae, including nomenclature revisions and diagnostic resources. Fungal Systematics and Evolution9: 43–86. doi: 10.3114/fuse.2022.09.05

Dépistage du personnel de santé exposé au SARS-CoV-2 dans un hôpital universitaire

Introduction

Dans le cadre de la pandémie mondiale au SARS-CoV-2, les personnels de santé (PS) sont professionnellement exposés à ce virus. Dans ce contexte, cette étude présente les données de surveillance de 5704 travailleurs exposés au SARS-CoV-2 d’un centre hospitalier du 17 mars au 20 avril 2020.

Matériels et méthodes

Les PS symptomatiques, les cas contacts et ceux présentant une forte anxiété ont été testés. Le diagnostic de COVID-19 a été réalisé par RT-PCR après prélèvement nasopharyngé.

Résultats

Au cours de cette période, 30,4 % (1735/5704) des PS ont bénéficié de 3057 écouvillons nasaux. Parmi ceux-ci, 8,0 % (138/1735) étaient infectés par le SRAS-CoV-2. Parmi les PS positifs au SARS-CoV-2, 21,7 % étaient asymptomatiques. Dans les unités COVID et les unités non COVID, le nombre de personnes infectées par le SARS-CoV-2 était respectivement de 5,8 % (13/223) et 8,2 % (125/1512) (p = 0,2). Parmi les PS travaillant hors des unités COVID, 6,4 % (12/188) des agents des unités pédiatriques et 8,1 % (126/1547) des agents des unités adultes ou des laboratoires étaient positifs au SARS-CoV-2 (p = 0,4). Parmi les PS des unités adultes, 6,4 % (8/125) provenaient de la médecine interne, 5,6 % (7/125) de la neurologie, 5,6 % (7/125) de la pharmacie et 5,6 % (7/125) du service médical d’urgence. Parmi les personnes atteintes du SARS-CoV2, les infirmières, les internes/médecins et les aides-soignants étaient les catégories professionnelles les plus touchées avec respectivement 30,0 % (40/138), 21,0 % (29/138) et 10,9 % (15/138). Parmi les médecins, la majorité étaient des internes (70,0 % ; 20/29). Les travailleurs de plus de 50 ans étaient moins susceptibles d’être positifs au SARS-CoV-2 (3,8 % ; 14/373) que les autres travailleurs plus jeunes (9,1 % ; 124/1362) (p < 0,001). Aucun cas grave de COVID-19 n’a été signalé dans notre population au cours de cette période.

Conclusion

Parmi les PS positifs détectés, 21,7 % (25/115) étaient asymptomatiques. Ces données soulignent l’importance du dépistage systématique des cas contacts même asymptomatiques et de l’utilisation d’équipements de protection individuelle (EPI) pour éviter la transmission. Le pourcentage des cas positifs diminuait à mesure que l’âge augmentait, en particulier après l’âge de 45 ans. Les personnels de plus de 45 ans, étant plus expérimentées et se sentant plus à risque, ont pu être mieux protégées ou affectées à des services moins à risque ou confinés à domicile. Les PS travaillant dans des unités COVID-19 n’étaient pas plus souvent infectés que ceux travaillant dans des unités non COVID-19, probablement parce qu’ils étaient plus conscients des dangers et des risques associés au SARS-CoV-2, qu’ils disposaient de plus d’équipements de protection individuelle, qu’ils les portaient de manière plus stricte et qu’ils étaient mieux informés et formés.

Thirteen-week nose-only inhalation exposures of propylene glycol aerosols in Sprague Dawley rats with a lung systems toxicology analysis

The objectives of this study were to increase PG exposure above concentrations tested by Suber et al. and use systems toxicology analysis of lung tissue to understand molecular events. Sprague Dawley rats were exposed to filtered air (sham), propylene glycol/water (PG/W; 90:10) or a propylene glycol/vegetable glycerin/water (PG/VG/W; 50:40:10) reference. The reference group was added at the high dose to observe any changes that might be associated with a carrier more in line with e-vapor products. Macroscopic examinations and terminal organ weights revealed no observations associated with exposure to PG/W or reference. Food consumption and body weights were unaffected by PG/W or reference when compared to sham. No exposure related alterations were observed in serum chemistry, hematology, coagulation, urinalysis or BALF cytology and clinical chemistry. Although clinical observations of dried red material around the nose in the high dose PG/W group were reported, histopathology showed no nasal hemorrhaging which was previously reported by Suber et al. Non-adverse PG/W and reference related findings of minimal mucous cell hyperplasia were noted in nasal cavity section II. No other exposure-related findings were noted in the primary or recovery necropsies. A systems toxicology analysis on lung tissue showed no statistically significant differentially expressed transcripts or proteins compared to the sham group. The endpoints measured from the PG/W high dose group did not differ significantly from those in the more common carrier PG/VG/W. As anticipated, exposure to PG aerosols was slightly irritating but well tolerated. Accordingly, the highest PG exposure (5 mg/L, 6 hrs/day) was regarded as the NOAEC, corresponding to a PG delivered dose of 1,152 mg/kg/day in rats.

Insight into the role of copper in the promoted photocatalytic removal of NO using Zn2-xCuxCr-CO3 layered double hydroxide

In this work the ability of Zn_2-xCu_xCr-CO₃ layered double hydroxides (LDHs) as highly efficient DeNOx photocatalysts was studied. LDHs with x = 0, 0.2 and 0.4 were prepared using a coprecipitation method. The samples were characterized by different techniques such as XRD, XPS, FT-IR, ICP-MS, TG, SBET, SEM and Diffuse reflectance (DR). The increased amount of copper ions in the LDH layers gave rise to slight changes in the structure and morphology and an important variation of the optical properties of the LDHs. The prepared ZnCuCr-CO₃ photocatalysts exhibited favourable conversion efficiency (51%) and an extraordinary selectivity (97%) for the photochemical NO abatement. The photochemical mechanism was elucidated from DOS, EPR, Femtosecond transient absorption and in-situ DRIFTS studies. The results suggested that the presence of Cu²⁺ ions in the LDH framework introduced new states in the valence band states, thus favouring the production and mobility of e^-/h⁺ charge carriers and a greater production of ⋅O₂^- and ⋅OH.

Should We Worry About Nutrition Of Adults With Minor Burns? An Audit Of Their Intakes

Small burn injuries are managed in an outpatient setting by surgeons and/or nurses. Nutrition in minor burn patients is rarely investigated. This observational study aimed to quantify their nutritional intakes, and o compare them to theoretical adequate values. Their average daily food intakes since injury were evaluated by a dietician using a ten-point visual assessment of consumed portions during the last meal (SEFI tool) and a food anamnesis. Macro- and micronutrient intakes were compared to national recommended dietary allowances (RDA) for healthy subjects: intakes <66% RDA were considered inadequate. Forty-two patients with a median age of 45 (34-56) years, BMI of 25.9 (23.5-28.9) kg/m2, and burn surface area (BSA) of 2 (1-3) % were included. Energy and protein RDA were reached in 28.6 and 71.4% of the patients, respectively. Intakes of n-3 fatty acids were inadequate in 80.9% of the patients. A SEFI <7 was associated with insufficient intakes regards both energy and proteins. Inadequate intakes of different micronutrients were frequently observed, but no risk factors could be detected. Vitamin A and C were the most impacted: 71.4% of the patients had inadequate intakes. Vitamin D intake was low: 225 (56-431) UI/d. In contrast, intakes of iron, selenium and zinc were adequate in at least 61.9% of the patients. In conclusion, this audit highlighted that a majority of macronutrient and micronutrient intakes did not reach the levels recommended by the RDA. Such data should help in designing further studies aimed at assessing the impact of optimized nutrition on outcomes.

Impact of the method chosen for the analysis of recurrences after radiotherapy for head and neck cancers: volume-based, point-based and combined methods

Intensity modulated radiation therapy for head and neck is a complex technique. Inappropriate delineation and/or dose distribution can lead to recurrences. Analysis of these recurrences should lead to improve clinical practice. For several years, different methods of analysis have been described. The purpose of this review is to describe these different methods and to discuss their advantages and limitations. The first published methods used a volume-based approach studying the entire volume of recurrence according to initial target volumes, or dose distribution. The main limitation of these methods was that the volume of recurrence studied was dependent on the delay in diagnosis of that recurrence. Subsequently, other methods used point-based approaches, conceptualizing recurrence either as a spherical expansion from a core of radioresistant cells (center of mass of recurrence volume) or using a more clinical approach, taking into account tumor expansion pathways. More recently, more precise combined methods have been described, combining the different approaches. The choice of method is decisive for conclusions on the origin of recurrence.

Colonization of Naive Roots from Populus tremula × alba Involves Successive Waves of Fungi and Bacteria with Different Trophic Abilities

Through their roots, trees interact with a highly complex community of microorganisms belonging to various trophic guilds and contributing to tree nutrition, development, and protection against stresses. Tree roots select for specific microbial species from the bulk soil communities. The root microbiome formation is a dynamic process, but little is known on how the different microorganisms colonize the roots and how the selection occurs. To decipher whether the final composition of the root microbiome is the product of several waves of colonization by different guilds of microorganisms, we planted sterile rooted cuttings of gray poplar obtained from plantlets propagated in axenic conditions in natural poplar stand soil. We analyzed the root microbiome at different time points between 2 and 50 days of culture by combining high-throughput Illumina MiSeq sequencing of the fungal ribosomal DNA internal transcribed spacer and bacterial 16S rRNA amplicons with confocal laser scanning microscopy observations. The microbial colonization of poplar roots took place in three stages, but bacteria and fungi had different dynamics. Root bacterial communities were clearly different from those in the soil after 2 days of culture. In contrast, if fungi were also already colonizing roots after 2 days, the initial communities were very close to that in the soil and were dominated by saprotrophs. They were slowly replaced by endophytes and ectomycorhizal fungi. The replacement of the most abundant fungal and bacterial community members observed in poplar roots over time suggest potential competition effect between microorganisms and/or a selection by the host.IMPORTANCE The tree root microbiome is composed of a very diverse set of bacterial and fungal communities. These microorganisms have a profound impact on tree growth, development, and protection against different types of stress. They mainly originate from the bulk soil and colonize the root system, which provides a unique nutrient-rich environment for a diverse assemblage of microbial communities. In order to better understand how the tree root microbiome is shaped over time, we observed the composition of root-associated microbial communities of naive plantlets of poplar transferred in natural soil. The composition of the final root microbiome relies on a series of colonization stages characterized by the dominance of different fungal guilds and bacterial community members over time. Our observations suggest an early stabilization of bacterial communities, whereas fungal communities are established following a more gradual pattern.

The VINON-LOCA test facility: exploring the LOCA phenomenology through an out-of-pile thermal sequence on irradiated pressurized fuel rod

Since the out-of-pile semi-integral tests performed at Studsvik in 2011 for the NRC [1] and the Halden Loss-Of-Coolant Accident (LOCA) test series IFA-650 [2], a major safety interest has raised for Fuel Fragmentation, Relocation and Dispersal (FFRD) during a LOCA sequence. In addition to the characteristics of the fuel ejected from the rod after the clad failure, the fuel behaviour before the clad failure is still to be investigated, especially its fragmentation and its possible relocation within the rod during the clad ballooning phase. Furthermore, the chronology and the sequencing of these phenomena is of particular interest.

For this purpose, the VINON-LOCA program, lying in the framework of a trilateral agreement between EDF, Framatome and CEA, is aimed at performing Out-Of-Pile heating tests on irradiated repressurized fuel rods, reproducing a typical Loss Of Coolant Accident thermal sequence. The VINON-LOCA experimental set-up is located in the so-called VERDON lab of the LECA-STAR hot cell complex. This lab was dedicated to the VERDON-ISTP program [3]. The VINON-LOCA set-up is thus largely instrumented for addressing not only these FFRD topics, but also Fission Gas Release (FGR), combining both online measurement (gamma stations, gamma camera, acoustic sensor, pressure, temperatures, flow meters, microGC…), and preand post-test characterization (gamma scanning, tomography, metrology, fuel fragments weighing and sieving, gas analyses…).

An extensive and substantial qualification campaign has been performed to validate the furnace design regarding the desired test conditions, and to qualify the instrumentation. Following some preliminary modelling and calculations, it has included tests on an out-of-cell twin mockup and tests on dummy inactive rods in the hot cell. This allowed achieving successfully the first experimental qualification test of the program end of 2019 on an irradiated UO2 fuel rodlet. A second irradiated experiment is planned with increased instrumentation capabilities, notably a 2D gamma camera for online fuel motion detection.

Crowdsourcing: A novel tool to elicit the student voice in the curriculum design process for an undergraduate diagnostic radiography degree programme

INTRODUCTION

Stakeholder participation in healthcare curriculum design is an important aspect of higher education with stakeholders including students, staff members, clinical partners, healthcare organisations, patients and members of the public. Significantly, student co-creation, of the curriculum, has become increasingly important. Yet there is limited research which addresses how to engage this group in design processes.

METHODS

This paper represents the first phase of a three stage action research spiral whereby the authors evaluated the use of a novel tool for curriculum design processes, anonymised crowdsourcing. This initial phase was open to all students enrolled on an undergraduate diagnostic radiography programme in the UK. To confirm the reliability of the crowdsource design an established eight point crowdsourcing verification tool was applied.

RESULTS

Twenty-three unique ideas were generated by participants, 40 comments made and 173 votes cast. Inductive analysis of the comments generated five themes. These included: the role of technology enhanced learning; simulation activities; patient focused curriculum; mental wealth (resilience) authentic assessment approaches. An evaluation of those who had and had not engaged highlighted areas of improvement for the administration of the second and third iterations which will include a wider pool of participants.

CONCLUSION

This study from a single programme offers lessons for others wishing to adopt and develop this approach elsewhere.

IMPLICATIONS FOR PRACTICE

Several ideas elicited by the crowdsource have been considered by the curriculum design team and will be implemented in the 2020 curriculum thus demonstrating the impact on local education practice of this research approach.

Natural History of Perianal Fistulising Lesions in Patients With Elderly-onset Crohn's Disease: A Population-based Study

INTRODUCTION

Most studies of elderly-onset Crohn's disease [CD; diagnosed in patients aged 60 or over] have described a mild course. However, data on the natural history of perianal fistulising CD [pfCD] in this population are scarce. In a population-based cohort study, we described the prevalence, natural history, and treatment of pfCD in patients with elderly-onset CD vs patients with paediatric-onset CD.

METHOD

All patients diagnosed with CD at or after the age of 60 between 1988 and 2006, were included [n = 372]. Logistic regression, Cox models, and a nested case-control method were used to identify factors associated with pfCD.

RESULTS

A total of 34 elderly patients [9% of the 372] had pfCD at diagnosis. After a median follow-up of 6 years (interquartile range [IQR]: 3; 10), 59 patients [16%] had pfCD; the same prevalence [16%] was observed in paediatric-onset patients. At last follow-up, anal incontinence was more frequent in elderly patients with pfCD than in elderly patients without pfCD [22% vs 4%, respectively; p < 10-4]. Rectal CD at diagnosis was associated with pfCD: hazard ratio (95% confidence interval [CI] = 2.8 [1.6-5.0]). Although 37% of the patients received immunosuppressants and 17% received anti-tumour necrosis factor agents, 24% [14 out of 59] had a definitive stoma at last follow-up.

CONCLUSION

During the first 6 years of disease, the prevalence of pfCD was similar in elderly and paediatric patients. Rectal involvement was associated with the appearance of pfCD in elderly-onset patients. Around a quarter of patients with elderly-onset CD will have a stoma. Our results suggest that treatment with biologics should be evaluated in these patients.

Moving Towards Common Data Elements and Core Outcome Measures in Frailty Research

With aging populations around the world, frailty is becoming more prevalent increasing the need for health systems and social systems to deliver optimal evidence based care. However, in spite of the growing number of frailty publications, high-quality evidence for decision making is often lacking. Inadequate descriptions of the populations enrolled including frailty severity and frailty conceptualization, lack of use of validated frailty assessment tools, utilization of different frailty instruments between studies, and variation in reported outcomes impairs the ability to interpret, generalize and implement the research findings. The utilization of common data elements (CDEs) and core outcome measures (COMs) in clinical trials is increasingly being adopted to address such concerns. To catalyze the development and use of CDEs and COMs for future frailty studies, the Canadian Frailty Network (www.cfn-nce.ca; CFN), a not-for-profit pan-Canadian nationally-funded research network, convened an international group of experts to examine the issue and plan the path forward. The meeting was structured to allow for an examination of current frailty evidence, ability to learn from other COMs and CDEs initiatives, discussions about specific considerations for frailty COMs and CDEs and finally the identification of the necessary steps for a COMs and CDEs consensus initiative going forward. It was agreed at the onset of the meeting that a statement based on the meeting would be published and herein we report the statement.

Use of short-lived positron emitters for in-beam and real-time β+ range monitoring in proton therapy

AIM

The purpose of this work is to evaluate the precision with which the GEANT4 toolkit simulates the production of β⁺ emitters relevant for in-beam and real-time PET in proton therapy.

BACKGROUND

An important evolution in proton therapy is the implementation of in-beam and real-time verification of the range of protons by measuring the correlation between the activity of β⁺ and dose deposition. For that purpose, it is important that the simulation of the various β⁺ emitters be sufficiently realistic, in particular for the ¹²N short-lived emitter that is required for efficient in-beam and real-time monitoring.

METHODS

The GEANT4 toolkit was used to simulate positron emitter production for a proton beam of 55 MeV in a cubic PMMA target and results are compared to experimental data.

RESULTS

The three β⁺ emitters with the highest production rates in the experimental data (¹¹C, ¹⁵O and ¹²N) are also those with the highest production rate in the simulation. Production rates differ by 8% to 174%. For the ¹²N isotope, the β⁺ spatial distribution in the simulation shows major deviations from the data. The effect of the long range (of the order of 20 mm) of the β⁺ originating from ¹²N is also shown and discussed.

CONCLUSIONS

At first order, the GEANT4 simulation of the β⁺ activity presents significant deviations from the data. The need for precise cross-section measurements versus energy below 30 MeV is of first priority in order to evaluate the feasibility of in-beam and real-time PET.

Bridging inhaled aerosol dosimetry to physiologically based pharmacokinetic modeling for toxicological assessment: nicotine delivery systems and beyond

One of the challenges for toxicological assessment of inhaled aerosols is to accurately predict their deposited and absorbed dose. Transport, evolution, and deposition of liquid aerosols are driven by complex processes dominated by convection-diffusion that depend on various factors related to physics and chemistry. These factors include the physicochemical properties of the pure substance of interest and associated mixtures, the physical and chemical properties of the aerosols generated, the interplay between different factors during transportation and deposition, and the subject-specific inhalation topography. Several inhalation-based physiologically based pharmacokinetic (PBPK) models have been developed, but the applicability of these models for aerosols has yet to be verified. Nicotine is among several substances that are often delivered via the pulmonary route, with varied kinetics depending upon the route of exposure. This was used as an opportunity to review and discuss the current knowledge and state-of-the-art tools combining aerosol dosimetry predictions with PBPK modeling efforts. A validated tool could then be used to perform for toxicological assessment of other inhaled therapeutic substances. The Science Panel from the Alliance of Risk Assessment have convened at the "Beyond Science and Decisions: From Problem Formulation to Dose-Response Assessment" workshop to evaluate modeling approaches and address derivation of exposure-internal dose estimations for inhaled aerosols containing nicotine or other substances. The discussion involved PBPK model evaluation criteria, challenges, and choices that arise in such a model design, development, and application as a computational tool for use in human toxicological assessments.

Five-year survival and prognostic factors according to histology in 6101 non-small-cell lung cancer patients

OBJECTIVE

To estimate five-year survival in non-small-cell lung cancer (NSCLC) patients according to histology and to identify independent prognostic factors by histology.

METHODS

Data were obtained during the KBP-2010-CPHG study, which included all new cases of primary lung cancer diagnosed in 2010 in 104 non-academic hospitals.

RESULTS

In all, 3199 patients had adenocarcinoma (ADC), 1852 squamous cell carcinoma (SCC), 754 large cell carcinoma (LCC). Five-year survival was 13.3% [12.1%-14.5%] for ADC, 14.3% [12.7%-16.0%] for SCC, 9.6% [7.6%-11.9%] for LCC (P<0.001). Performance status, weight loss prior to diagnosis and tumour stage were consistently significant independent prognostic factors. Age (>70 years; P=0.004), male gender (P<0.001), and smoking (P<0.001) were independent negative prognostic factors for ADC. Epidermal Growth Factor Receptor (EGFR)-mutation tests, performed in 1638 ADC patients, were positive for 186. Five-year survival was 14.7% [10.3%-21%] and 10.9% [9.4%-12.6%] for mutated and wild-type EGFR, respectively (P<0.001). EFGR mutation was an independent positive prognostic factor (HR=0.5 [0.4-0.6], P<0.001); however, the proportional hazards assumption was not fulfilled and hazards were inverted after 35 months.

CONCLUSIONS

Five-year survival in patients managed in French non-academic hospitals for primary NSCLC in 2010 remained poor (<15%), whatever the histologic type. The independent negative prognostic factors for five-year survival were: weight, particularly weight loss prior to diagnosis; smoking (active or former) at diagnosis in ADC and LCC and smoking level at diagnosis in smoker patients with SCC. The independent positive prognostic factors were young age and female gender for ADC.

[Tolerance of hypofractionated stereotactic radiotherapy for hepatic tumours]

PURPOSE

The purpose of the study was to evaluate the outcomes of stereotactic radiation therapy for primary and secondary liver tumours in Jean-Perrin cancer centre (Clermont-Ferrand, France) in terms of efficacy and safety.

MATERIALS AND METHODS

Between December 2013 and June 2016, 25 patients were included. Treatment was performed on a linear accelerator Novalis TX^®. The prescription dose was 42 to 60Gy in three to five fractions. Local control at 1 year was evaluated with modified Response Evaluation Criteria in Solid Tumours (mRECIST) and RECIST criteria. Acute and late toxicity were evaluated with Common Terminology Criteria for Adverse Events (CTCAE) v4.0 criteria.

RESULTS

Median follow-up was 10.5 months. Treatment tolerance was good with few side effects grade 3 or above, no acute toxicity and only one late toxicity. We have highlighted that hepatic artery haemorrhage was associated with the presence of a biliary prosthesis in contact with the artery (P=0.006) and in the irradiation field. There was no correlation with the dose delivered to the artery and hepatic artery haemorrhage.

CONCLUSION

Stereotactic radiation therapy for liver tumours allows a good local control with few secondary effects. Caution should be exercised when treating patients with biliary prostheses in the vicinity of the target volume because there is a risk of haemorrhage of the hepatic artery in contact with the prosthesis.

[Second- or third-line treatment with erlotinib in EGFR wild-type non-small cell lung cancer: Real-life data]

INTRODUCTION

The benefit of tyrosine kinase inhibitors for patients with an EGFR wild-type non-small cell lung cancer (NSCLC) remains controversial.

METHODS

The survival of patients with an EGFR wild-type NSCLC who received second- or third-line erlotinib treatment was assessed using real-life data that had been collected in a prospective, national, multicenter, non-interventional cohort study.

RESULTS

Data from 274 patients were analysed, 185 (68%) treated with erlotinib and 89 (32%) treated with supportive care only. The median overall survival was 4.2months (95% CI [3.5; 5.4]) with erlotinib, and 1.3months (95% CI [1.0; 1.8]) with supportive care. Survival rate at 3, 6, and 12months was 62%, 37%, and 17%, respectively, with erlotinib, versus 20%, 8%, et 3%, with exclusive supportive care. Significant predictive factors for longer overall survival were the presence of adenocarcinoma, and use of 1st line chemotherapy including either taxanes, pemetrexed or vinorelbine (P<0.05).

CONCLUSION

Erlotinib remains a valuable therapeutic option to treat inoperable locally advanced or metastatic NSCLC after failure of at least one prior chemotherapy regimen in fragile patients who are not eligible for chemotherapy.

Pregnancy outcomes following maternal venlafaxine use: A prospective observational comparative cohort study

BACKGROUND

Venlafaxine is a serotonin noradrenaline reuptake inhibitor used to treat major depressive episodes and anxiety disorders. The primary aim of this study was to investigate spontaneous abortion risks following gestational exposure.

METHODS

This prospective observational comparative cohort study utilised data collected by the UK Teratology Information Service (UKTIS) between 1995 and 2018. The study sample included 281 venlafaxine exposed pregnancies matched to antidepressant unexposed (n = 1405) and SSRI exposed (n = 843) comparator groups.

RESULTS

After correction for variation in competing outcome rates and the stage of pregnancy at reporting, no statistically significant differences in the hazard of spontaneous abortion was observed following gestational venlafaxine use compared with either antidepressant unexposed (HR 1.28, 95% CI; 0.850-1.94) or SSRI exposed (HR 1.03, 95% CI; 0.681-1.57) pregnancies.

CONCLUSIONS

No conclusive evidence is provided from this study that venlafaxine increases the risk of adverse pregnancy or fetal outcomes.