Whether the route of early feeding affects outcomes of patients with severe critical illnesses is controversial. We hypothesised that outcomes were better with early first-line enteral nutrition than ...with early first-line parenteral nutrition.
In this randomised, controlled, multicentre, open-label, parallel-group study (NUTRIREA-2 trial) done at 44 French intensive-care units (ICUs), adults (18 years or older) receiving invasive mechanical ventilation and vasopressor support for shock were randomly assigned (1:1) to either parenteral nutrition or enteral nutrition, both targeting normocaloric goals (20–25 kcal/kg per day), within 24 h after intubation. Randomisation was stratified by centre using permutation blocks of variable sizes. Given that route of nutrition cannot be masked, blinding of the physicians and nurses was not feasible. Patients receiving parenteral nutrition could be switched to enteral nutrition after at least 72 h in the event of shock resolution (no vasopressor support for 24 consecutive hours and arterial lactate <2 mmol/L). The primary endpoint was mortality on day 28 after randomisation in the intention-to-treat-population. This study is registered with ClinicalTrials.gov, number NCT01802099.
After the second interim analysis, the independent Data Safety and Monitoring Board deemed that completing patient enrolment was unlikely to significantly change the results of the trial and recommended stopping patient recruitment. Between March 22, 2013, and June 30, 2015, 2410 patients were enrolled and randomly assigned; 1202 to the enteral group and 1208 to the parenteral group. By day 28, 443 (37%) of 1202 patients in the enteral group and 422 (35%) of 1208 patients in the parenteral group had died (absolute difference estimate 2·0%; 95% CI −1·9 to 5·8; p=0·33). Cumulative incidence of patients with ICU-acquired infections did not differ between the enteral group (173 14%) and the parenteral group (194 16%; hazard ratio HR 0·89 95% CI 0·72–1·09; p=0·25). Compared with the parenteral group, the enteral group had higher cumulative incidences of patients with vomiting (406 34% vs 246 20%; HR 1·89 1·62–2·20; p<0·0001), diarrhoea (432 36% vs 393 33%; 1·20 1·05–1·37; p=0·009), bowel ischaemia (19 2% vs five <1%; 3·84 1·43–10·3; p=0·007), and acute colonic pseudo-obstruction (11 1% vs three <1%; 3·7 1·03–13·2; p=0·04).
In critically ill adults with shock, early isocaloric enteral nutrition did not reduce mortality or the risk of secondary infections but was associated with a greater risk of digestive complications compared with early isocaloric parenteral nutrition.
La Roche-sur-Yon Departmental Hospital and French Ministry of Health.
While phylogeographic patterns of organisms are often interpreted through past environmental disturbances, mediated by climate changes, and geographic barriers, they may also be strongly influenced ...by species‐specific traits. To investigate the impact of such traits, we focused on two Eurasian spruce bark beetles that share a similar geographic distribution, but differ in their ecology and reproduction. Ips typographus is an aggressive tree‐killing species characterized by strong dispersal, whereas Dendroctonus micans is a discrete inbreeding species (sib mating is the rule), parasite of living trees and a poor disperser. We compared genetic variation between the two species over both beetles’ entire range in Eurasia with five independent gene fragments, to evaluate whether their intrinsic differences could have an influence over their phylogeographic patterns. We highlighted widely divergent patterns of genetic variation for the two species and argue that the difference is indeed largely compatible with their contrasting dispersal strategies and modes of reproduction. In addition, genetic structure in I. typographus divides European populations in a northern and a southern group, as was previously observed for its host plant, and suggests past allopatric divergence. A long divergence time was estimated between East Asian and other populations of both species, indicating their long‐standing presence in Eurasia, prior to the last glacial maximum. Finally, the strong population structure observed in D. micans for the mitochondrial locus provides insights into the recent colonization history of this species, from its native European range to regions where it was recently introduced.
The study aimed to evaluate inclacumab for the reduction of myocardial damage during a percutaneous coronary intervention (PCI) in patients with non-ST-segment elevation myocardial infarction.
...P-selectin is an adhesion molecule involved in interactions between endothelial cells, platelets, and leukocytes. Inclacumab is a recombinant monoclonal antibody against P-selectin, with potential anti-inflammatory, antithrombotic, and antiatherogenic properties.
Patients (N = 544) with non-ST-segment elevation myocardial infarction scheduled for coronary angiography and possible ad hoc PCI were randomized to receive 1 pre-procedural infusion of inclacumab 5 or 20 mg/kg or placebo. The primary endpoint, evaluated in patients who underwent PCI, received study medication, and had available efficacy data (n = 322), was the change in troponin I from baseline at 16 and 24 h after PCI.
There was no effect of inclacumab 5 mg/kg. Placebo-adjusted geometric mean percent changes in troponin I with inclacumab 20 mg/kg were -24.4% at 24 h (p = 0.05) and -22.4% at 16 h (p = 0.07). Peak troponin I was reduced by 23.8% (p = 0.05) and area under the curve over 24 h by 33.9% (p = 0.08). Creatine kinase-myocardial band yielded similar results, with changes of -17.4% at 24 h (p = 0.06) and -16.3% at 16 h (p = 0.09). The incidence of creatine kinase-myocardial band increases >3 times the upper limit of normal within 24 h was 18.3% and 8.9% in the placebo and inclacumab 20-mg/kg groups, respectively (p = 0.05). Placebo-adjusted changes in soluble P-selectin level were -9.5% (p = 0.25) and -22.0% (p < 0.01) with inclacumab 5 and 20 mg/kg. There was no significant difference in adverse events between groups.
Inclacumab appears to reduce myocardial damage after PCI in patients with non-ST-segment elevation myocardial infarction. (A Study of RO4905417 in Patients With Non ST-Elevation Myocardial Infarction Non-STEMI Undergoing Percutaneous Coronary Intervention; NCT01327183).
To date, it is widely accepted by the scientific community that many agricultural regions will experience more extreme temperature fluctuations. These stresses will undoubtedly impact crop ...production, particularly fruit and seed yields. In fact, pollination is considered as one of the most temperature-sensitive phases of plant development and until now, except for the time-consuming and costly processes of genetic breeding, there is no immediate alternative to address this issue. In this work, we used a multidisciplinary approach using physiological, biochemical, and molecular techniques for studying the effects of two carbohydrate-based natural activators on
in vitro
tomato pollen germination and pollen tube growth cultured
in vitro
under cold conditions. Under mild and strong cold temperatures, these two carbohydrate-based compounds significantly enhanced pollen germination and pollen tube growth. The two biostimulants did not induce significant changes in the classical molecular markers implicated in pollen tube growth. Neither the number of callose plugs nor the
CALLOSE SYNTHASE
genes expression were significantly different between the control and the biostimulated pollen tubes when pollens were cultivated under cold conditions. PECTIN METHYLESTERASE (PME) activities were also similar but a basic PME isoform was not produced or inactive in pollen grown at 8°C. Nevertheless, NADPH oxidase (
RBOH
) gene expression was correlated with a higher number of viable pollen tubes in biostimulated pollen tubes compared to the control. Our results showed that the two carbohydrate-based products were able to reduce
in vitro
the effect of cold temperatures on tomato pollen tube growth and at least for one of them to modulate reactive oxygen species production.
This Guidance describes a two‐phase approach for a fit‐for‐purpose method for the assessment of plant pest risk in the territory of the EU. Phase one consists of pest categorisation to determine ...whether the pest has the characteristics of a quarantine pest or those of a regulated non‐quarantine pest for the area of the EU. Phase two consists of pest risk assessment, which may be requested by the risk managers following the pest categorisation results. This Guidance provides a template for pest categorisation and describes in detail the use of modelling and expert knowledge elicitation to conduct a pest risk assessment. The Guidance provides support and a framework for assessors to provide quantitative estimates, together with associated uncertainties, regarding the entry, establishment, spread and impact of plant pests in the EU. The Guidance allows the effectiveness of risk reducing options (RROs) to be quantitatively assessed as an integral part of the assessment framework. A list of RROs is provided. A two‐tiered approach is proposed for the use of expert knowledge elicitation and modelling. Depending on data and resources available and the needs of risk managers, pest entry, establishment, spread and impact steps may be assessed directly, using weight of evidence and quantitative expert judgement (first tier), or they may be elaborated in substeps using quantitative models (second tier). An example of an application of the first tier approach is provided. Guidance is provided on how to derive models of appropriate complexity to conduct a second tier assessment. Each assessment is operationalised using Monte Carlo simulations that can compare scenarios for relevant factors, e.g. with or without RROs. This document provides guidance on how to compare scenarios to draw conclusions on the magnitude of pest risks and the effectiveness of RROs and on how to communicate assessment results.
This publication is linked to the following EFSA Supporting Publications article: http://onlinelibrary.wiley.com/doi/10.2903/sp.efsa.2018.EN-1440/full
‘This guidance supersedes:
a) the entire Guidance on a harmonised framework for pest risk assessment and the identification and evaluation of pest risk management options by EFSA. https://doi.org/10.2903/j.efsa.2010.1495;
b) Sections 1.8 and 1.9 of Guidance on methodology for evaluation of the effectiveness of options for reducing the risk of introduction and spread of organisms harmful to plant health in the EU territory. https://doi.org/10.2903/j.efsa.2012.2755’
Abstract
Aims
In the randomized, placebo-controlled Colchicine Cardiovascular Outcomes Trial (COLCOT) of 4745 patients enrolled within 30 days after myocardial infarction (MI), low-dose colchicine ...(0.5 mg once daily) reduced the incidence of the primary composite endpoint of cardiovascular death, resuscitated cardiac arrest, MI, stroke, or urgent hospitalization for angina leading to coronary revascularization. To assess the in-trial period and lifetime cost-effectiveness of low-dose colchicine therapy compared to placebo in post-MI patients on standard-of-care therapy.
Methods and results
A multistate Markov model was developed incorporating the primary efficacy and safety results from COLCOT, as well as healthcare costs and utilities from the Canadian healthcare system perspective. All components of the primary outcome, non-cardiovascular deaths, and pneumonia were included as health states in the model as both primary and recurrent events. In the main analysis, a deterministic approach was used to estimate the incremental cost-effectiveness ratio (ICER) for the trial period (24 months) and lifetime (20 years). Over the in-trial period, the addition of colchicine to post-MI standard-of-care treatment decreased the mean overall per-patient costs by 47%, from $502 to $265 Canadian dollar (CAD), and increased the quality-adjusted life years (QALYs) from 1.30 to 1.34. The lifetime per-patient costs were further reduced (69%) and QALYs increased with colchicine therapy (from 8.82 to 11.68). As a result, both in-trial and lifetime ICERs indicated colchicine therapy was a dominant strategy.
Conclusion
Cost-effectiveness analyses indicate that the addition of colchicine to standard-of-care therapy after MI is economically dominant and therefore generates cost savings.
Monitoring is an important component in pest management, to prevent or mitigate outbreaks of native pests and to check for quarantine organisms. Surveys often rely on trapping, especially when the ...target species respond to semiochemicals. Many traps are available for this purpose, but they are bulky in most cases, which raises transportation and deployment issues, and they are expensive, which limits the size and accuracy of any network. To overcome these difficulties, entomologists have used recycled material, such as modified plastic bottles, producing cheap and reliable traps but at the cost of recurrent handywork, not necessarily possible for all end-users (e.g., for national plant-protection organizations). These
have allowed very large surveys to be conducted, which would have been impossible with standard commercial traps, and we illustrate this approach with a few examples. Here, we present, under a
BY-SA License, the blueprint for a
, a foldable model, laser cut from a sheet of polypropylene, which can rapidly be produced in large numbers in a Fab lab or by a commercial company and could be transported and deployed in the field with very little effort. Our first field comparisons show that
are as efficient as
for some Scolytinae species and we describe two cases where they are being used for monitoring.
The cardiovascular benefits of low-dose colchicine have been demonstrated in patients with coronary disease. Its effects were evaluated in this prespecified analysis in patients with type 2 diabetes ...(T2D) from the Colchicine Cardiovascular Outcomes Trial (COLCOT).
COLCOT was a randomized, double-blinded trial of colchicine, 0.5 mg daily, versus placebo initiated within 30 days after a myocardial infarction.
There were 959 patients with T2D enrolled and monitored for a median of 22.6 months. A primary end point event occurred in 8.7% of patients in the colchicine group and in 13.1% in the placebo group (hazard ratio 0.65; 95% CI 0.44-0.96; P = 0.03). Nausea was reported in 2.7% and 0.8% in the study groups (P = 0.03), and pneumonia occurred in 2.4% and 0.4% (P = 0.008).
Among patients with T2D and a recent myocardial infarction, colchicine, 0.5 mg daily, leads to a large reduction of cardiovascular events. These results support the conduct of the COLCOT-T2D trial in primary prevention.
Key message
The
TreeTrace_Douglas
database includes images and measurements at several stages of the processing of Douglas fir logs, from sawmill logyard to machine grading and destructive testing of ...boards, and is suitable for research on quality assessment and traceability. A total of 52 long logs, 156 short logs, 208 wood discs, and 346 boards were analyzed. The image data includes RGB images of log ends and board ends, RGB images and CT slices of strips, and a set of images of the boards (RGB, laser, and X-rays) obtained with an industrial board grading machine. The measurements include wood density, growth ring widths, pith and board location in the logs, heartwood and sapwood areas, mechanical properties of each board obtained by vibratory and static testing, and visual grading of the boards. Dataset is available at
https://doi.org/10.15454/YUNEGL
and associated metadata are available at
https://metadata-afs.nancy.inra.fr/geonetwork/srv/fre/catalog.search#/metadata/d9eef6e4-f195-41f4-b6c2-2ab46adc637e
.
Abstract A breeding population of the tree-killing European spruce bark beetle Ips typographus was detected in England for the first time in 2018 and was initially assumed to have arrived with ...infested timber. To test the hypothesis that the beetles are dispersing naturally across the English channel, extensive trap networks were deployed in 2021 and 2022 to track the flight activity of the beetles from an outbreak hotspot in France and Belgium to southern England, including parallel ‘coastal’ traps on either side of the channel. Beetles were caught all along the transect, decreasing in abundance with distance from the outbreak area. Linear modelling indicates that beetles dispersed into England during 2021 and 2022, and that during a large-scale dispersal event in June 2021, beetles could have penetrated more than 160 km inland. The 2021 dispersal event initiated new incursions of the beetle in southeast England and demonstrates the extraordinary distance I. typographus may move under outbreak conditions. Our findings support the hypothesis of a damaging forest pest aerially dispersing across the barrier of the English channel and suggest that future incursions of this and other plant-associated pests may move via the same pathway.
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