The European Society for Medical Oncology (ESMO) consensus conference on testicular cancer was held on 3–5 November 2016 in Paris, France. The conference included a multidisciplinary panel of 36 ...leading experts in the diagnosis and treatment of testicular cancer (34 panel members attended the conference; an additional two panel members CB and K-PD participated in all preparatory work and subsequent manuscript development). The aim of the conference was to develop detailed recommendations on topics relating to testicular cancer that are not covered in detail in the current ESMO Clinical Practice Guidelines (CPGs) and where the available level of evidence is insufficient. The main topics identified for discussion related to: (1) diagnostic work-up and patient assessment; (2) stage I disease; (3) stage II-III disease; (4) post-chemotherapy surgery, salvage chemotherapy, salvage and desperation surgery and special topics; and (5) survivorship and follow-up schemes. The experts addressed questions relating to one of the five topics within five working groups. Relevant scientific literature was reviewed in advance. Recommendations were developed by the working groups and then presented to the entire panel. A consensus vote was obtained following whole-panel discussions, and the consensus recommendations were then further developed in post-meeting discussions in written form. This manuscript presents the results of the expert panel discussions, including the consensus recommendations and a summary of evidence supporting each recommendation. All participants approved the final manuscript.
A new tool was developed for large volume sampling to facilitate marine microbiology and biogeochemical studies. It was developed for remotely operated vehicle and hydrocast deployments, and allows ...for rapid collection of multiple sample types from the water column and dynamic, variable environments such as rising hydrothermal plumes. It was used successfully during a cruise to the hydrothermal vent systems of the Mid-Cayman Rise. The Suspended Particulate Rosette V2 large volume multi-sampling system allows for the collection of 14 sample sets per deployment. Each sample set can include filtered material, whole (unfiltered) water, and filtrate. Suspended particulate can be collected on filters up to 142mm in diameter and pore sizes down to 0.2μm. Filtration is typically at flowrates of 2Lmin−1. For particulate material, filtered volume is constrained only by sampling time and filter capacity, with all sample volumes recorded by digital flowmeter. The suspended particulate filter holders can be filled with preservative and sealed immediately after sample collection. Up to 2L of whole water, filtrate, or a combination of the two, can be collected as part of each sample set. The system is constructed of plastics with titanium fasteners and nickel alloy spring loaded seals. There are no ferrous alloys in the sampling system. Individual sample lines are prefilled with filtered, deionized water prior to deployment and remain sealed unless a sample is actively being collected. This system is intended to facilitate studies concerning the relationship between marine microbiology and ocean biogeochemistry.
•We developed a novel ROV sampling tool to study dynamic, high gradient, ocean geochemical features.•It enables comprehensive collection of samples for chemistry and microbiology from within nutrient rich chemical plumes.•It enables both large volume filtration of particulate matter and whole water and filtrate collection.•It allows in situ RNA preservation of microbial samples.•It was successfully used in a study of Mid-Cayman Rise hydrothermal plume geomicrobiology.
Summary
Chronic postoperative pain is common after breast cancer surgery. Peri‐operative lidocaine infusion may prevent the development of chronic postoperative pain, but a large‐scale trial is ...required to test this hypothesis. It is unclear whether a pragmatic, multicentre trial design that is consistent with expert guidance, addresses the limitations of previous studies, and overcomes existing translational barriers is safe, effective and feasible. We conducted a double‐blind, randomised controlled pilot study in 150 patients undergoing breast cancer surgery across three hospitals in Western Australia. Patients received lidocaine, or equivalent volumes of saline, as an intravenous bolus (1.5 mg.kg‐1) and infusion (2 mg.kg‐1.h‐1) intra‐operatively, and a subcutaneous infusion (1.33 mg.kg‐1.h‐1) postoperatively for up to 12 h on a standard surgical ward, with novel safety monitoring tools in place. The co‐primary outcomes were: in‐hospital safety events; serum levels of lidocaine during intravenous and subcutaneous infusion; and annualised enrolment rates per site with long‐term data capture. In‐hospital safety events were rare, and similar in the placebo and lidocaine arms (3% vs. 1%). Median (IQR range) serum lidocaine levels during intravenous (2.16 (1.74–2.83 1.12–6.06) µg.ml‐1, n = 41) and subcutaneous (1.52 (1.28–1.83 0.64–2.85) µg.ml‐1, n = 48) infusion were comparable with previous trials reporting improved pain outcomes. Annualised enrolment approximated 50 patients per site per year, with high levels of protocol adherence and ≥ 99% capture of outcomes at 3 and 6 months. The adjusted odds ratio (95%CI) for postoperative pain at 6 months in the lidocaine arm was 0.790 (0.370–1.684). We conclude that this trial, as designed, is safe, effective and feasible in patients undergoing breast cancer surgery, and a larger‐scale trial is planned.
On Mars, seasonal martian flow features known as recurring slope lineae (RSL) are prevalent on sun-facing slopes and are associated with salts. On Earth, subsurface interactions of gypsum with ...chlorides and oxychlorine salts wreak havoc: instigating sinkholes, cave collapse, debris flows, and upheave. Here, we illustrate (i) the disruptive potential of sulfate-chloride reactions in laboratory soil crust experiments, (ii) the formation of thin films of mixed ice-liquid water “slush” at −40° to −20°C on salty Mars analog grains, (iii) how mixtures of sulfates and chlorine
salts affect their solubilities in low-temperature environments, and (iv) how these salt brines could be contributing to RSL formation on Mars. Our results demonstrate that interactions of sulfates and chlorine salts in fine-grained soils on Mars could absorb water, expand, deliquesce, cause subsidence, form crusts, disrupt surfaces, and ultimately produce landslides after dust loading on these unstable surfaces.
To enable detailed investigations of early stage hydrothermal plume formation and abiotic and biotic plume processes we developed a new oceanographic tool. The Suspended Particulate Rosette sampling ...system has been designed to collect geochemical and microbial samples from the rising portion of deep-sea hydrothermal plumes. It can be deployed on a remotely operated vehicle for sampling rising plumes, on a wire-deployed water rosette for spatially discrete sampling of non-buoyant hydrothermal plumes, or on a fixed mooring in a hydrothermal vent field for time series sampling. It has performed successfully during both its first mooring deployment at the East Pacific Rise and its first remotely-operated vehicle deployments along the Mid-Atlantic Ridge. It is currently capable of rapidly filtering 24 discrete large-water-volume samples (30–100
L per sample) for suspended particles during a single deployment (e.g. >90
L per sample at 4–7
L per minute through 1
μm pore diameter polycarbonate filters). The Suspended Particulate Rosette sampler has been designed with a long-term goal of seafloor observatory deployments, where it can be used to collect samples in response to tectonic or other events. It is compatible with
in situ optical sensors, such as laser Raman or visible reflectance spectroscopy systems, enabling
in situ particle analysis immediately after sample collection and before the particles alter or degrade.
The network theory of prolonged grief posits that causal interactions among symptoms of prolonged grief play a significant role in their coherence and persistence as a syndrome. Drawing on recent ...developments in the broader network approach to psychopathology, we argue that advancing our understanding of the causal system that gives rise to prolonged grief will require that we (a) strengthen our assessment of each component of the grief syndrome, (b) investigate intra-individual relationships among grief components as they evolve over time within individuals, (c) incorporate biological and social components into network studies of grief, and (d) generate formal theories that posit precisely how these biological, psychological, and social components interact with one another to give rise to prolonged grief disorder.
•Prolonged grief may arise from causal relations among its constituent symptoms.•Robust assessments of individual prolonged grief symptoms are needed.•Idiographic models can advance our understanding of grief syndrome.•Formalizing theories of grief will equip us to better evaluate those theories.•The network theory of grief should adopt a biopsychosocial systems perspective.
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