Background
The present interdisciplinary consensus review proposes clinical considerations and recommendations for anaesthetic practice in patients undergoing gastrointestinal surgery with an ...Enhanced Recovery after Surgery (ERAS) programme.
Methods
Studies were selected with particular attention being paid to meta‐analyses, randomized controlled trials and large prospective cohort studies. For each item of the perioperative treatment pathway, available English‐language literature was examined and reviewed. The group reached a consensus recommendation after critical appraisal of the literature.
Results
This consensus statement demonstrates that anaesthesiologists control several preoperative, intraoperative and postoperative ERAS elements. Further research is needed to verify the strength of these recommendations.
Conclusions
Based on the evidence available for each element of perioperative care pathways, the Enhanced Recovery After Surgery (ERAS ®) Society presents a comprehensive consensus review, clinical considerations and recommendations for anaesthesia care in patients undergoing gastrointestinal surgery within an ERAS programme. This unified protocol facilitates involvement of anaesthesiologists in the implementation of the ERAS programmes and allows for comparison between centres and it eventually might facilitate the design of multi‐institutional prospective and adequately powered randomized trials.
The SAMI Galaxy Survey will observe 3400 galaxies with the Sydney-AAO Multi-object Integral-field spectrograph (SAMI) on the Anglo-Australian Telescope in a 3-yr survey which began in 2013. We ...present the throughput of the SAMI system, the science basis and specifications for the target selection, the survey observation plan and the combined properties of the selected galaxies. The survey includes four volume-limited galaxy samples based on cuts in a proxy for stellar mass, along with low-stellar-mass dwarf galaxies all selected from the Galaxy And Mass Assembly (GAMA) survey. The GAMA regions were selected because of the vast array of ancillary data available, including ultraviolet through to radio bands. These fields are on the celestial equator at 9, 12 and 14.5 h, and cover a total of 144 deg2 (in GAMA-I). Higher density environments are also included with the addition of eight clusters. The clusters have spectroscopy from 2-degree Field Galaxy Redshift Survey (2dFGRS) and Sloan Digital Sky Survey (SDSS) and photometry in regions covered by the SDSS and/or VLT Survey Telescope/ATLAS. The aim is to cover a broad range in stellar mass and environment, and therefore the primary survey targets cover redshifts 0.004 ... 0.095, magnitudes ... 19.4, stellar masses ..., and environments from isolated field galaxies through groups to clusters of ... (ProQuest: ... denotes formulae/symbols omitted.)
Rucaparib, a poly(ADP-ribose) polymerase inhibitor, has anticancer activity in recurrent ovarian carcinoma harbouring a BRCA mutation or high percentage of genome-wide loss of heterozygosity. In this ...trial we assessed rucaparib versus placebo after response to second-line or later platinum-based chemotherapy in patients with high-grade, recurrent, platinum-sensitive ovarian carcinoma.
In this randomised, double-blind, placebo-controlled, phase 3 trial, we recruited patients from 87 hospitals and cancer centres across 11 countries. Eligible patients were aged 18 years or older, had a platinum-sensitive, high-grade serous or endometrioid ovarian, primary peritoneal, or fallopian tube carcinoma, had received at least two previous platinum-based chemotherapy regimens, had achieved complete or partial response to their last platinum-based regimen, had a cancer antigen 125 concentration of less than the upper limit of normal, had a performance status of 0–1, and had adequate organ function. Patients were ineligible if they had symptomatic or untreated central nervous system metastases, had received anticancer therapy 14 days or fewer before starting the study, or had received previous treatment with a poly(ADP-ribose) polymerase inhibitor. We randomly allocated patients 2:1 to receive oral rucaparib 600 mg twice daily or placebo in 28 day cycles using a computer-generated sequence (block size of six, stratified by homologous recombination repair gene mutation status, progression-free interval after the penultimate platinum-based regimen, and best response to the most recent platinum-based regimen). Patients, investigators, site staff, assessors, and the funder were masked to assignments. The primary outcome was investigator-assessed progression-free survival evaluated with use of an ordered step-down procedure for three nested cohorts: patients with BRCA mutations (carcinoma associated with deleterious germline or somatic BRCA mutations), patients with homologous recombination deficiencies (BRCA mutant or BRCA wild-type and high loss of heterozygosity), and the intention-to-treat population, assessed at screening and every 12 weeks thereafter. This trial is registered with ClinicalTrials.gov, number NCT01968213; enrolment is complete.
Between April 7, 2014, and July 19, 2016, we randomly allocated 564 patients: 375 (66%) to rucaparib and 189 (34%) to placebo. Median progression-free survival in patients with a BRCA-mutant carcinoma was 16·6 months (95% CI 13·4–22·9; 130 35% patients) in the rucaparib group versus 5·4 months (3·4–6·7; 66 35% patients) in the placebo group (hazard ratio 0·23 95% CI 0·16–0·34; p<0·0001). In patients with a homologous recombination deficient carcinoma (236 63% vs 118 62%), it was 13·6 months (10·9–16·2) versus 5·4 months (5·1–5·6; 0·32 0·24–0·42; p<0·0001). In the intention-to-treat population, it was 10·8 months (8·3–11·4) versus 5·4 months (5·3–5·5; 0·36 0·30–0·45; p<0·0001). Treatment-emergent adverse events of grade 3 or higher in the safety population (372 99% patients in the rucaparib group vs 189 100% in the placebo group) were reported in 209 (56%) patients in the rucaparib group versus 28 (15%) in the placebo group, the most common of which were anaemia or decreased haemoglobin concentration (70 19% vs one 1%) and increased alanine or aspartate aminotransferase concentration (39 10% vs none).
Across all primary analysis groups, rucaparib significantly improved progression-free survival in patients with platinum-sensitive ovarian cancer who had achieved a response to platinum-based chemotherapy. ARIEL3 provides further evidence that use of a poly(ADP-ribose) polymerase inhibitor in the maintenance treatment setting versus placebo could be considered a new standard of care for women with platinum-sensitive ovarian cancer following a complete or partial response to second-line or later platinum-based chemotherapy.
Clovis Oncology.
Obesity and asthma are associated, but the mechanism(s) of the association have yet to be elucidated. The aim of this study was to assess airway inflammation in relation to obesity and plasma fatty ...acids in males and females with and without asthma. Obese (n=68) and nonobese (n=47) adults with asthma, and obese (n=16) and nonobese (n=63) healthy controls had induced sputum and venous blood samples analysed for inflammatory markers. There was a positive interaction between obesity and asthma on sputum neutrophil percentage (p=0.012) and C-reactive protein level (p=0.003). Although sputum eosinophil percentage was elevated in asthma (p=0.001), there was no effect of obesity (p=0.16). Sputum neutrophil percentage was positively associated with body mass index in females with asthma (β=1.015, 95% CI 0.258-1.772; p=0.009) and neutrophilic asthma was present in a greater proportion of obese compared with non-obese females (42.9% versus 16.2%; p=0.017). In males with asthma, sputum neutrophil percentage was positively associated with total plasma saturated fatty acids (β=0.108, 95% CI 0.036-0.180; p=0.004) and negatively with monounsaturated fatty acids (β= -0.068, 95% CI -0.131- -0.005; p=0.035). This was the first study to demonstrate an increase in neutrophilic airway inflammation in obese asthma. This relationship was significant only in females with asthma. In males, saturated and monounsaturated fatty acids were important predictors of neutrophilic airway inflammation in asthma.
We investigate the relationship between stellar and gas specific angular momentum j, stellar mass M
* and optical morphology for a sample of 488 galaxies extracted from the Sydney-AAO Multi-object ...Integral field Galaxy Survey. We find that j, measured within one effective radius, monotonically increases with M
* and that, for M
* > 109.5 M⊙, the scatter in this relation strongly correlates with optical morphology (i.e. visual classification and Sérsic index). These findings confirm that massive galaxies of all types lie on a plane relating mass, angular momentum and stellar-light distribution, and suggest that the large-scale morphology of a galaxy is regulated by its mass and dynamical state. We show that the significant scatter in the M
*-j relation is accounted for by the fact that, at fixed stellar mass, the contribution of ordered motions to the dynamical support of galaxies varies by at least a factor of 3. Indeed, the stellar spin parameter (quantified via λ
R
) correlates strongly with Sérsic and concentration indices. This correlation is particularly strong once slow rotators are removed from the sample, showing that late-type galaxies and early-type fast rotators form a continuous class of objects in terms of their kinematic properties.
The SAMI Galaxy Survey: Early Data Release Allen, J. T.; Croom, S. M.; Konstantopoulos, I. S. ...
Monthly Notices of the Royal Astronomical Society,
01/2015, Letnik:
446, Številka:
2
Journal Article
Recenzirano
Odprti dostop
We present the Early Data Release of the Sydney-AAO Multi-object Integral field spectrograph (SAMI) Galaxy Survey. The SAMI Galaxy Survey is an ongoing integral field spectroscopic survey of ~3400 ...low-redshift (z < 0.12) galaxies, covering galaxies in the field and in groups within the Galaxy And Mass Assembly (GAMA) survey regions, and a sample of galaxies in clusters. In the Early Data Release, we publicly release the fully calibrated data cubes for a representative selection of 107 galaxies drawn from the GAMA regions, along with information about these galaxies from the GAMA catalogues. All data cubes for the Early Data Release galaxies can be downloaded individually or as a set from the SAMI Galaxy Survey website. In this paper we also assess the quality of the pipeline used to reduce the SAMI data, giving metrics that quantify its performance at all stages in processing the raw data into calibrated data cubes. The pipeline gives excellent results throughout, with typical sky subtraction residuals in the continuum of 0.9-1.2 per cent, a relative flux calibration uncertainty of 4.1 per cent (systematic) plus 4.3 per cent (statistical), and atmospheric dispersion removed with an accuracy of 0.09 arcsec, less than a fifth of a spaxel.
We use data from the Sydney-AAO Multi-Object Integral Field Spectrograph Galaxy Survey and the Galaxy And Mass Assembly (GAMA) survey to investigate the spatially resolved signatures of the ...environmental quenching of star formation in galaxies. Using dust-corrected measurements of the distribution of H... emission, we measure the radial profiles of star formation in a sample of 201 star-forming galaxies covering three orders of magnitude in stellar mass (M*; 10 super( 8.1)-10 super( 10.95) M...) and in fifth nearest neighbour local environment density (...; 10 super( -1.3)-10 super( 2.1) Mpc super( -2)). We show that star formation rate gradients in galaxies are steeper in dense (log sub( 10)(.../Mpc super( 2)) > 0.5) environments by 0.58 plus or minus 0.29dexr sub( e) super( -1) in galaxies with stellar masses in the range 10 super( 10)<M*/M...<10 super( 11) and that this steepening is accompanied by a reduction in the integrated star formation rate. However, for any given stellar mass or environment density, the star formation morphology of galaxies shows large scatter. We also measure the degree to which the star formation is centrally concentrated using the unitless scale-radius ratio (r sub( 50,H...)/r sub( 50,cont)), which compares the extent of ongoing star formation to previous star formation. With this metric, we find that the fraction of galaxies with centrally concentrated star formation increases with environment density, from ~5 plus or minus 4 per cent in low-density environments (log sub( 10)(.../Mpc super( 2)) < 0.0) to 30 plus or minus 15 per cent in the highest density environments (log sub( 10)(.../Mpc super( 2)) > 1.0). These lines of evidence strongly suggest that with increasing local environment density, the star formation in galaxies is suppressed, and that this starts in their outskirts such that quenching occurs in an outside-in fashion in dense environments and is not instantaneous. (ProQuest: ... denotes formulae/symbols omitted.)
Bar-headed geese (Anser indicus) fly at up to 9,000 m elevation during their migration over the Himalayas, sustaining high metabolic rates in the severe hypoxia at these altitudes. We investigated ...the evolution of cardiac energy metabolism and O(2) transport in this species to better understand the molecular and physiological mechanisms of high-altitude adaptation. Compared with low-altitude geese (pink-footed geese and barnacle geese), bar-headed geese had larger lungs and higher capillary densities in the left ventricle of the heart, both of which should improve O(2) diffusion during hypoxia. Although myoglobin abundance and the activities of many metabolic enzymes (carnitine palmitoyltransferase, citrate synthase, 3-hydroxyacyl-coA dehydrogenase, lactate dehydrogenase, and pyruvate kinase) showed only minor variation between species, bar-headed geese had a striking alteration in the kinetics of cytochrome c oxidase (COX), the heteromeric enzyme that catalyzes O(2) reduction in oxidative phosphorylation. This was reflected by a lower maximum catalytic activity and a higher affinity for reduced cytochrome c. There were small differences between species in messenger RNA and protein expression of COX subunits 3 and 4, but these were inconsistent with the divergence in enzyme kinetics. However, the COX3 gene of bar-headed geese contained a nonsynonymous substitution at a site that is otherwise conserved across vertebrates and resulted in a major functional change of amino acid class (Trp-116 → Arg). This mutation was predicted by structural modeling to alter the interaction between COX3 and COX1. Adaptations in mitochondrial enzyme kinetics and O(2) transport capacity may therefore contribute to the exceptional ability of bar-headed geese to fly high.
Summary
Background
Obesity and asthma are associated conditions; however, the mechanisms linking the two remain unclear. Few studies have examined the effects of weight loss on inflammation and ...clinical outcomes in obese–asthma.
Objective
To compare the effects of weight loss achieved by dietary restriction, exercise or combined dietary restriction and exercise on airway inflammation and clinical outcomes in overweight and obese adults with asthma.
Methods
Participants (n = 46; 54.3% female, body mass index (mean ± SD) 33.7 ± 3.5 kg/m2) were randomized to complete a 10‐week dietary, exercise or combined dietary and exercise intervention. Dual‐energy x‐ray absorptiometry was performed, the Juniper Asthma Control Questionnaire and Juniper Asthma Quality of Life Questionnaire completed and inflammatory markers, dietary intake and physical activity measured. The trial was registered with the Australian Clinical Trials Registry: ACTRN12611000235909.
Results
Retention was 82.6%. Mean ± SD weight loss was 8.5 ± 4.2%, 1.8 ± 2.6% and 8.3 ± 4.9% after the dietary, exercise and combined interventions respectively. Asthma control improved after the dietary (mean ± SD; −0.6 ± 0.5, P ≤ 0.001) and combined interventions (−0.5 ± 0.7, P = 0.040), whereas quality of life improved after the dietary median (IQR); 0.9 (0.4, 1.3), P = 0.002, exercise 0.49 (0.03, 0.78), P = 0.037 and combined 0.5 (0.1, 1.0), P = 0.007 interventions. A 5–10% weight loss resulted in clinically important improvements to asthma control in 58%, and quality of life in 83%, of subjects. Gynoid adipose tissue reduction was associated with reduced neutrophilic airway inflammation in women β‐coefficient (95% CI); 1.75 (0.02, 3.48), P = 0.047, whereas a reduction in dietary saturated fat was associated with reduced neutrophilic airway inflammation in males (r = 0.775, P = 0.041). The exercise intervention resulted in a significant reduction to sputum eosinophils median (IQR); −1.3 (−2.0, −1.0)%, P = 0.028.
Conclusion and clinical relevance
This study suggests a weight‐loss goal of 5–10% be recommended to assist in the clinical management of overweight and obese adults with asthma. The obese–asthma phenotype may involve both innate and allergic inflammatory pathways.
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