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Mountzios G, Samantas E, Senghas K, Zervas E, Krisam J, Samitas K, Bozorgmehr F, Kuon J, Agelaki S, Baka S, Athanasiadis I, Gaissmaier L, Elshiaty M, Daniello L, Christopoulou A, Pentheroudakis G, Lianos E, Linardou H, Kriegsmann K, Kosmidis P, El Shafie R, Kriegsmann M, Psyrri A, Andreadis C, Fountzilas E, Heussel CP, Herth FJ, Winter H, Emmanouilides C, Oikonomopoulos G, Meister M, Muley T, Bischoff H, Saridaki Z, Razis E, Perdikouri EI, Stenzinger A, Boukovinas I, Reck M, Syrigos K, Thomas M, Christopoulos P. Association of the advanced lung cancer inflammation index (ALI) with immune checkpoint inhibitor efficacy in patients with advanced non-small-cell lung cancer. ESMO Open 2021; 6:100254. [PMID: 34481329 PMCID: PMC8417333 DOI: 10.1016/j.esmoop.2021.100254] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/08/2021] [Accepted: 08/01/2021] [Indexed: 12/26/2022] Open
Abstract
Background The advanced lung cancer inflammation index [ALI: body mass index × serum albumin/neutrophil-to-lymphocyte ratio (NLR)] reflects systemic host inflammation, and is easily reproducible. We hypothesized that ALI could assist guidance of non-small-cell lung cancer (NSCLC) treatment with immune checkpoint inhibitors (ICIs). Patients and methods This retrospective study included 672 stage IV NSCLC patients treated with programmed death-ligand 1 (PD-L1) inhibitors alone or in combination with chemotherapy in 25 centers in Greece and Germany, and a control cohort of 444 stage IV NSCLC patients treated with platinum-based chemotherapy without subsequent targeted or immunotherapy drugs. The association of clinical outcomes with biomarkers was analyzed with Cox regression models, including cross-validation by calculation of the Harrell's C-index. Results High ALI values (>18) were significantly associated with longer overall survival (OS) for patients receiving ICI monotherapy [hazard ratio (HR) = 0.402, P < 0.0001, n = 460], but not chemo-immunotherapy (HR = 0.624, P = 0.111, n = 212). Similar positive correlations for ALI were observed for objective response rate (36% versus 24%, P = 0.008) and time-on-treatment (HR = 0.52, P < 0.001), in case of ICI monotherapy only. In the control cohort of chemotherapy, the association between ALI and OS was weaker (HR = 0.694, P = 0.0002), and showed a significant interaction with the type of treatment (ICI monotherapy versus chemotherapy, P < 0.0001) upon combined analysis of the two cohorts. In multivariate analysis, ALI had a stronger predictive effect than NLR, PD-L1 tumor proportion score, lung immune prognostic index, and EPSILoN scores. Among patients with PD-L1 tumor proportion score ≥50% receiving first-line ICI monotherapy, a high ALI score >18 identified a subset with longer OS and time-on-treatment (median 35 and 16 months, respectively), similar to these under chemo-immunotherapy. Conclusions The ALI score is a powerful prognostic and predictive biomarker for patients with advanced NSCLC treated with PD-L1 inhibitors alone, but not in combination with chemotherapy. Its association with outcomes appears to be stronger than that of other widely used parameters. For PD-L1-high patients, an ALI score >18 could assist the selection of cases that do not need addition of chemotherapy. ALI is prognostic and predictive for patients with advanced NSCLC treated with immunotherapy monotherapy, but not chemo-immunotherapy. Its association with outcomes is stronger than that of other parameters (PD-L1 TPS, NLR, lung immune prognostic index, EPSILoN). For PD-L1-high patients, an ALI score >18 could assist the selection of cases that do not need addition of chemotherapy.
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Ramalingam S, de Castro G, Garassino M, Mazieres J, Sanborn R, Smit E, Spigel D, Thomas M, Velcheti V, Zhi E, Neibauer MW, Stojadinovic A, Peters S. 1360TiP First-line (1L) maintenance therapy with niraparib (nira) + pembrolizumab (pembro) vs placebo + pembro in advanced/metastatic non-small cell lung cancer (NSCLC): Phase III ZEAL-1L study. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Pillai M, Hawkins R, Jiang Y, Lorigan P, Thistlethwaite F, Thomas M, Kirillova N, Bridgeman J, Kueberuwa G, Guest R, Roberts Z. 1058P Treatment outcomes with unselected autologous tumor infiltrating lymphocytes (TILs) in patients (pts) with checkpoint inhibition–refractory advanced cutaneous melanoma. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Shah R, Blasi M, Kuon J, Christopolous P, Chung I, Stenzinger A, Kriegsmann M, Glade J, Klotz L, Eichhorn M, Wessels S, Muley T, Herth F, Bischoff H, Thomas M. 1739P Survival outcomes in patients with sarcomatoid pleural mesothelioma: A retrospective analysis from the last two decades. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Christopoulos P, Ou SH, Lin J, Berg D, Hong JL, Yin Y, Lin J, Bunn V, Lin H, Mehta M, Thomas M. 1224P Systematic review and meta-analysis of immunotherapy effectiveness for pretreated patients with non-small cell lung cancer harboring EGFR exon 20 insertions. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Griesinger F, Sebastian M, Brückl W, Hummel HD, Jaeschke B, Kern J, Schumann C, Wesseler C, Jänicke M, Fleitz A, Zacharias S, Hipper A, Groth A, Weichert W, Dörfel S, Petersen V, Schröder J, Wilke J, Eberhardt W, Thomas M. 1325P Checkpoint inhibitor monotherapy in potentially study-eligible or non-study-eligible NSCLC patients in the German CRISP registry real-world cohort (AIO-TRK-0315). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Barragan A, Thomas M, Defraene G, Michiels S, Haustermans K, Lee J, Sterpin E. PD-0818 Dose prediction with deep learning: the effect of data quality and quantity in the model’s accuracy. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07097-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Hoffmann L, Mortensen H, Berbee M, Bizzocchi N, Bütof R, Canters R, Defraene G, Ehmsen M, Freixas G, Haustermans K, Korevaar E, Makocki S, Muijs C, Nordsmark M, Thomas M, Troost E, Visser S, Weber D, Møller D. OC-0631 Proton and photon treatment planning comparison for oesophageal cancer between six European centres. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06987-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Matharsa S, Selvamani D, Thakur R, Mathew P, Thomas M, Papasavvas T. A multidisciplinary early mobility model for cardiac patients in coronary intensive care unit. Eur J Cardiovasc Nurs 2021. [DOI: 10.1093/eurjcn/zvab060.120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
This is an unfunded project
Background
Early mobilization is considered as a complex task in an intensive care unit (ICU) and patients are often on prolonged bed rest leading to physical deconditioning. Intensive care early mobility programs have been recognized to be safe and have shown positive outcomes. However, implementing early mobility program as a standard of care remains a challenge.
Coronary Intensive Care Unit (CICU) provides complex care for cardiac critically ill patients. In February 2018, the CICU multidisciplinary team (MDT) started a quality improvement project to implement early mobility program in the unit.
Purpose
This project aimed to investigate the feasibility of implementing an Early Mobility Protocol in CICU to increase the number of patients mobilized to more than 95%. Secondary objective was to explore the impact of the protocol on the mobility level of the patients at the time of discharge or transfer from the CICU.
Methods
A multidisciplinary mobility task force including Physicians, nurses, physiotherapists and respiratory therapists was formed to analyze the barriers in implementing an early mobility program. A staff survey was conducted to identify the need for a standard early mobility protocol. Root cause analysis and Pareto analysis was done. An evidence based early mobility protocol was developed and implemented. All non-mechanical ventilated patients were included in the first phase and all mechanical ventilated patients were included in the second phase of the project. A standard ICU Mobility scale (IMS) was used for scoring the mobility level of the patients. This quality improvement project is based on "Institute for Healthcare Improvement" model. Periodical staff education and training programs about early mobilization were conducted to improve staff confidence. Change ideas were implemented using multiple Plan Do Study Act cycles.
Results
The total number of patients included from 1st March 2018 till 31st December 2019 was 2356. This included both the genders. In March 2018, only 68% of non-mechanical ventilated patients were mobilized, that reached to 88% by November 2018. This gradually increased to 100% in May 2019 and is currently sustained at 100%.
In November 2019, only 50% of mechanical ventilated patients were mobilized which gradually increased to 66.66% and 75% in middle and end of December 2019. The mean IMS score at discharge or transfer from CICU was "8". From patient-family experience survey, 93.75% of patients perceived that the program was helpful in regaining mobility and 96.25% of patients felt that the program helped in regaining their autonomy.
Conclusion
The result shows that it is safe and feasible to implement an early mobility program in a Coronary Intensive Care Unit. A standardized mobility protocol can lead to efficient mobilization practice facilitating early transfers from ICUs without any complications. This could further enhance the collaboration of the MDT members leading to culture change in ICUs.
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Lai WC, Low KY, Thomas M. Pneumoperitoneum following an Endoscopic Retrograde Cholangiopancreatography (ERCP): A case report. THE MEDICAL JOURNAL OF MALAYSIA 2021; 76:594-596. [PMID: 34305128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Post Endoscopic Retrograde Cholangiopancreatography (ERCP) pneumoperitoneum is commonly associated with perforated viscus but is rarely associated with benign causes. We present a case of 29 years old lady who underwent ERCP, who was found to have benign pneumoperitoneum subsequently. She was treated conservatively and recovered without complication. Although rare, post ERCP pneumoperitoneum of benign causes should be investigated as the course of treatment and outcome differ largely.
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Whittle C, Hall ED, Dwyer S, Mavalvala N, Sudhir V, Abbott R, Ananyeva A, Austin C, Barsotti L, Betzwieser J, Blair CD, Brooks AF, Brown DD, Buikema A, Cahillane C, Driggers JC, Effler A, Fernandez-Galiana A, Fritschel P, Frolov VV, Hardwick T, Kasprzack M, Kawabe K, Kijbunchoo N, Kissel JS, Mansell GL, Matichard F, McCuller L, McRae T, Mullavey A, Pele A, Schofield RMS, Sigg D, Tse M, Vajente G, Vander-Hyde DC, Yu H, Yu H, Adams C, Adhikari RX, Appert S, Arai K, Areeda JS, Asali Y, Aston SM, Baer AM, Ball M, Ballmer SW, Banagiri S, Barker D, Bartlett J, Berger BK, Bhattacharjee D, Billingsley G, Biscans S, Blair RM, Bode N, Booker P, Bork R, Bramley A, Cannon KC, Chen X, Ciobanu AA, Clara F, Compton CM, Cooper SJ, Corley KR, Countryman ST, Covas PB, Coyne DC, Datrier LEH, Davis D, Di Fronzo C, Dooley KL, Dupej P, Etzel T, Evans M, Evans TM, Feicht J, Fulda P, Fyffe M, Giaime JA, Giardina KD, Godwin P, Goetz E, Gras S, Gray C, Gray R, Green AC, Gustafson EK, Gustafson R, Hanks J, Hanson J, Hasskew RK, Heintze MC, Helmling-Cornell AF, Holland NA, Jones JD, Kandhasamy S, Karki S, King PJ, Kumar R, Landry M, Lane BB, Lantz B, Laxen M, Lecoeuche YK, Leviton J, Liu J, Lormand M, Lundgren AP, Macas R, MacInnis M, Macleod DM, Márka S, Márka Z, Martynov DV, Mason K, Massinger TJ, McCarthy R, McClelland DE, McCormick S, McIver J, Mendell G, Merfeld K, Merilh EL, Meylahn F, Mistry T, Mittleman R, Moreno G, Mow-Lowry CM, Mozzon S, Nelson TJN, Nguyen P, Nuttall LK, Oberling J, Oram RJ, Osthelder C, Ottaway DJ, Overmier H, Palamos JR, Parker W, Payne E, Penhorwood R, Perez CJ, Pirello M, Radkins H, Ramirez KE, Richardson JW, Riles K, Robertson NA, Rollins JG, Romel CL, Romie JH, Ross MP, Ryan K, Sadecki T, Sanchez EJ, Sanchez LE, Saravanan TR, Savage RL, Schaetz D, Schnabel R, Schwartz E, Sellers D, Shaffer T, Slagmolen BJJ, Smith JR, Soni S, Sorazu B, Spencer AP, Strain KA, Sun L, Szczepańczyk MJ, Thomas M, Thomas P, Thorne KA, Toland K, Torrie CI, Traylor G, Urban AL, Valdes G, Veitch PJ, Venkateswara K, Venugopalan G, Viets AD, Vo T, Vorvick C, Wade M, Ward RL, Warner J, Weaver B, Weiss R, Willke B, Wipf CC, Xiao L, Yamamoto H, Zhang L, Zucker ME, Zweizig J. Approaching the motional ground state of a 10-kg object. Science 2021; 372:1333-1336. [PMID: 34140386 DOI: 10.1126/science.abh2634] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 05/05/2021] [Indexed: 11/02/2022]
Abstract
The motion of a mechanical object, even a human-sized object, should be governed by the rules of quantum mechanics. Coaxing them into a quantum state is, however, difficult because the thermal environment masks any quantum signature of the object's motion. The thermal environment also masks the effects of proposed modifications of quantum mechanics at large mass scales. We prepared the center-of-mass motion of a 10-kilogram mechanical oscillator in a state with an average phonon occupation of 10.8. The reduction in temperature, from room temperature to 77 nanokelvin, is commensurate with an 11 orders-of-magnitude suppression of quantum back-action by feedback and a 13 orders-of-magnitude increase in the mass of an object prepared close to its motional ground state. Our approach will enable the possibility of probing gravity on massive quantum systems.
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Abbott R, Abbott TD, Abraham S, Acernese F, Ackley K, Adams A, Adams C, Adhikari RX, Adya VB, Affeldt C, Agarwal D, Agathos M, Agatsuma K, Aggarwal N, Aguiar OD, Aiello L, Ain A, Ajith P, Akutsu T, Aleman KM, Allen G, Allocca A, Altin PA, Amato A, Anand S, Ananyeva A, Anderson SB, Anderson WG, Ando M, Angelova SV, Ansoldi S, Antelis JM, Antier S, Appert S, Arai K, Arai K, Arai Y, Araki S, Araya A, Araya MC, Areeda JS, Arène M, Aritomi N, Arnaud N, Aronson SM, Asada H, Asali Y, Ashton G, Aso Y, Aston SM, Astone P, Aubin F, Auclair P, Aufmuth P, AultONeal K, Austin C, Babak S, Badaracco F, Bader MKM, Bae S, Bae Y, Baer AM, Bagnasco S, Bai Y, Baiotti L, Baird J, Bajpai R, Ball M, Ballardin G, Ballmer SW, Bals M, Balsamo A, Baltus G, Banagiri S, Bankar D, Bankar RS, Barayoga JC, Barbieri C, Barish BC, Barker D, Barneo P, Barnum S, Barone F, Barr B, Barsotti L, Barsuglia M, Barta D, Bartlett J, Barton MA, Bartos I, Bassiri R, Basti A, Bawaj M, Bayley JC, Baylor AC, Bazzan M, Bécsy B, Bedakihale VM, Bejger M, Belahcene I, Benedetto V, Beniwal D, Benjamin MG, Bennett TF, Bentley JD, BenYaala M, Bergamin F, Berger BK, Bernuzzi S, Bersanetti D, Bertolini A, Betzwieser J, Bhandare R, Bhandari AV, Bhattacharjee D, Bhaumik S, Bidler J, Bilenko IA, Billingsley G, Birney R, Birnholtz O, Biscans S, Bischi M, Biscoveanu S, Bisht A, Biswas B, Bitossi M, Bizouard MA, Blackburn JK, Blackman J, Blair CD, Blair DG, Blair RM, Bobba F, Bode N, Boer M, Bogaert G, Boldrini M, Bondu F, Bonilla E, Bonnand R, Booker P, Boom BA, Bork R, Boschi V, Bose N, Bose S, Bossilkov V, Boudart V, Bouffanais Y, Bozzi A, Bradaschia C, Brady PR, Bramley A, Branch A, Branchesi M, Breschi M, Briant T, Briggs JH, Brillet A, Brinkmann M, Brockill P, Brooks AF, Brooks J, Brown DD, Brunett S, Bruno G, Bruntz R, Bryant J, Buikema A, Bulik T, Bulten HJ, Buonanno A, Buscicchio R, Buskulic D, Cadonati L, Caesar M, Cagnoli G, Cahillane C, Cain HW, Calderón Bustillo J, Callaghan JD, Callister TA, Calloni E, Camp JB, Canepa M, Cannavacciuolo M, Cannon KC, Cao H, Cao J, Cao Z, Capocasa E, Capote E, Carapella G, Carbognani F, Carlin JB, Carney MF, Carpinelli M, Carullo G, Carver TL, Casanueva Diaz J, Casentini C, Castaldi G, Caudill S, Cavaglià M, Cavalier F, Cavalieri R, Cella G, Cerdá-Durán P, Cesarini E, Chaibi W, Chakravarti K, Champion B, Chan CH, Chan C, Chan CL, Chan M, Chandra K, Chanial P, Chao S, Charlton P, Chase EA, Chassande-Mottin E, Chatterjee D, Chaturvedi M, Chatziioannou K, Chen A, Chen C, Chen HY, Chen J, Chen K, Chen X, Chen YB, Chen YR, Chen Z, Cheng H, Cheong CK, Cheung HY, Chia HY, Chiadini F, Chiang CY, Chierici R, Chincarini A, Chiofalo ML, Chiummo A, Cho G, Cho HS, Choate S, Choudhary RK, Choudhary S, Christensen N, Chu H, Chu Q, Chu YK, Chua S, Chung KW, Ciani G, Ciecielag P, Cieślar M, Cifaldi M, Ciobanu AA, Ciolfi R, Cipriano F, Cirone A, Clara F, Clark EN, Clark JA, Clarke L, Clearwater P, Clesse S, Cleva F, Coccia E, Cohadon PF, Cohen DE, Cohen L, Colleoni M, Collette CG, Colpi M, Compton CM, Constancio M, Conti L, Cooper SJ, Corban P, Corbitt TR, Cordero-Carrión I, Corezzi S, Corley KR, Cornish N, Corre D, Corsi A, Cortese S, Costa CA, Cotesta R, Coughlin MW, Coughlin SB, Coulon JP, Countryman ST, Cousins B, Couvares P, Covas PB, Coward DM, Cowart MJ, Coyne DC, Coyne R, Creighton JDE, Creighton TD, Criswell AW, Croquette M, Crowder SG, Cudell JR, Cullen TJ, Cumming A, Cummings R, Cuoco E, Curyło M, Canton TD, Dálya G, Dana A, DaneshgaranBajastani LM, D'Angelo B, Danilishin SL, D'Antonio S, Danzmann K, Darsow-Fromm C, Dasgupta A, Datrier LEH, Dattilo V, Dave I, Davier M, Davies GS, Davis D, Daw EJ, Dean R, Deenadayalan M, Degallaix J, De Laurentis M, Deléglise S, Del Favero V, De Lillo F, De Lillo N, Del Pozzo W, DeMarchi LM, De Matteis F, D'Emilio V, Demos N, Dent T, Depasse A, De Pietri R, De Rosa R, De Rossi C, DeSalvo R, De Simone R, Dhurandhar S, Díaz MC, Diaz-Ortiz M, Didio NA, Dietrich T, Di Fiore L, Di Fronzo C, Di Giorgio C, Di Giovanni F, Di Girolamo T, Di Lieto A, Ding B, Di Pace S, Di Palma I, Di Renzo F, Divakarla AK, Dmitriev A, Doctor Z, D'Onofrio L, Donovan F, Dooley KL, Doravari S, Dorrington I, Drago M, Driggers JC, Drori Y, Du Z, Ducoin JG, Dupej P, Durante O, D'Urso D, Duverne PA, Dwyer SE, Easter PJ, Ebersold M, Eddolls G, Edelman B, Edo TB, Edy O, Effler A, Eguchi S, Eichholz J, Eikenberry SS, Eisenmann M, Eisenstein RA, Ejlli A, Enomoto Y, Errico L, Essick RC, Estellés H, Estevez D, Etienne Z, Etzel T, Evans M, Evans TM, Ewing BE, Fafone V, Fair H, Fairhurst S, Fan X, Farah AM, Farinon S, Farr B, Farr WM, Farrow NW, Fauchon-Jones EJ, Favata M, Fays M, Fazio M, Feicht J, Fejer MM, Feng F, Fenyvesi E, Ferguson DL, Fernandez-Galiana A, Ferrante I, Ferreira TA, Fidecaro F, Figura P, Fiori I, Fishbach M, Fisher RP, Fishner JM, Fittipaldi R, Fiumara V, Flaminio R, Floden E, Flynn E, Fong H, Font JA, Fornal B, Forsyth PWF, Franke A, Frasca S, Frasconi F, Frederick C, Frei Z, Freise A, Frey R, Fritschel P, Frolov VV, Fronzé GG, Fujii Y, Fujikawa Y, Fukunaga M, Fukushima M, Fulda P, Fyffe M, Gabbard HA, Gadre BU, Gaebel SM, Gair JR, Gais J, Galaudage S, Gamba R, Ganapathy D, Ganguly A, Gao D, Gaonkar SG, Garaventa B, García-Núñez C, García-Quirós C, Garufi F, Gateley B, Gaudio S, Gayathri V, Ge G, Gemme G, Gennai A, George J, Gergely L, Gewecke P, Ghonge S, Ghosh A, Ghosh A, Ghosh S, Ghosh S, Ghosh S, Giacomazzo B, Giacoppo L, Giaime JA, Giardina KD, Gibson DR, Gier C, Giesler M, Giri P, Gissi F, Glanzer J, Gleckl AE, Godwin P, Goetz E, Goetz R, Gohlke N, Goncharov B, González G, Gopakumar A, Gosselin M, Gouaty R, Grace B, Grado A, Granata M, Granata V, Grant A, Gras S, Grassia P, Gray C, Gray R, Greco G, Green AC, Green R, Gretarsson AM, Gretarsson EM, Griffith D, Griffiths W, Griggs HL, Grignani G, Grimaldi A, Grimes E, Grimm SJ, Grote H, Grunewald S, Gruning P, Guerrero JG, Guidi GM, Guimaraes AR, Guixé G, Gulati HK, Guo HK, Guo Y, Gupta A, Gupta A, Gupta P, Gustafson EK, Gustafson R, Guzman F, Ha S, Haegel L, Hagiwara A, Haino S, Halim O, Hall ED, Hamilton EZ, Hammond G, Han WB, Haney M, Hanks J, Hanna C, Hannam MD, Hannuksela OA, Hansen H, Hansen TJ, Hanson J, Harder T, Hardwick T, Haris K, Harms J, Harry GM, Harry IW, Hartwig D, Hasegawa K, Haskell B, Hasskew RK, Haster CJ, Hattori K, Haughian K, Hayakawa H, Hayama K, Hayes FJ, Healy J, Heidmann A, Heintze MC, Heinze J, Heinzel J, Heitmann H, Hellman F, Hello P, Helmling-Cornell AF, Hemming G, Hendry M, Heng IS, Hennes E, Hennig J, Hennig MH, Hernandez Vivanco F, Heurs M, Hild S, Hill P, Himemoto Y, Hines AS, Hiranuma Y, Hirata N, Hirose E, Hochheim S, Hofman D, Hohmann JN, Holgado AM, Holland NA, Hollows IJ, Holmes ZJ, Holt K, Holz DE, Hong Z, Hopkins P, Hough J, Howell EJ, Hoy CG, Hoyland D, Hreibi A, Hsieh B, Hsu Y, Huang GZ, Huang HY, Huang P, Huang YC, Huang YJ, Huang YW, Hübner MT, Huddart AD, Huerta EA, Hughey B, Hui DCY, Hui V, Husa S, Huttner SH, Huxford R, Huynh-Dinh T, Ide S, Idzkowski B, Iess A, Ikenoue B, Imam S, Inayoshi K, Inchauspe H, Ingram C, Inoue Y, Intini G, Ioka K, Isi M, Isleif K, Ito K, Itoh Y, Iyer BR, Izumi K, JaberianHamedan V, Jacqmin T, Jadhav SJ, Jadhav SP, James AL, Jan AZ, Jani K, Janssens K, Janthalur NN, Jaranowski P, Jariwala D, Jaume R, Jenkins AC, Jeon C, Jeunon M, Jia W, Jiang J, Jin HB, Johns GR, Jones AW, Jones DI, Jones JD, Jones P, Jones R, Jonker RJG, Ju L, Jung K, Jung P, Junker J, Kaihotsu K, Kajita T, Kakizaki M, Kalaghatgi CV, Kalogera V, Kamai B, Kamiizumi M, Kanda N, Kandhasamy S, Kang G, Kanner JB, Kao Y, Kapadia SJ, Kapasi DP, Karathanasis C, Karki S, Kashyap R, Kasprzack M, Kastaun W, Katsanevas S, Katsavounidis E, Katzman W, Kaur T, Kawabe K, Kawaguchi K, Kawai N, Kawasaki T, Kéfélian F, Keitel D, Key JS, Khadka S, Khalili FY, Khan I, Khan S, Khazanov EA, Khetan N, Khursheed M, Kijbunchoo N, Kim C, Kim JC, Kim J, Kim K, Kim WS, Kim YM, Kimball C, Kimura N, King PJ, Kinley-Hanlon M, Kirchhoff R, Kissel JS, Kita N, Kitazawa H, Kleybolte 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AB, Ying M, Yokogawa K, Yokoyama J, Yokozawa T, Yoon A, Yoshioka T, Yu H, Yu H, Yuzurihara H, Zadrożny A, Zanolin M, Zeidler S, Zelenova T, Zendri JP, Zevin M, Zhan M, Zhang H, Zhang J, Zhang L, Zhang R, Zhang T, Zhao C, Zhao G, Zhao Y, Zhao Y, Zhou Z, Zhu XJ, Zhu ZH, Zucker ME, Zweizig J. Constraints on Cosmic Strings Using Data from the Third Advanced LIGO-Virgo Observing Run. PHYSICAL REVIEW LETTERS 2021; 126:241102. [PMID: 34213926 DOI: 10.1103/physrevd.97.102002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/31/2021] [Accepted: 05/23/2021] [Indexed: 05/21/2023]
Abstract
We search for gravitational-wave signals produced by cosmic strings in the Advanced LIGO and Virgo full O3 dataset. Search results are presented for gravitational waves produced by cosmic string loop features such as cusps, kinks, and, for the first time, kink-kink collisions. A template-based search for short-duration transient signals does not yield a detection. We also use the stochastic gravitational-wave background energy density upper limits derived from the O3 data to constrain the cosmic string tension Gμ as a function of the number of kinks, or the number of cusps, for two cosmic string loop distribution models. Additionally, we develop and test a third model that interpolates between these two models. Our results improve upon the previous LIGO-Virgo constraints on Gμ by 1 to 2 orders of magnitude depending on the model that is tested. In particular, for the one-loop distribution model, we set the most competitive constraints to date: Gμ≲4×10^{-15}. In the case of cosmic strings formed at the end of inflation in the context of grand unified theories, these results challenge simple inflationary models.
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R, Guzman F, Ha S, Haegel L, Hagiwara A, Haino S, Halim O, Hall ED, Hamilton EZ, Hammond G, Han WB, Haney M, Hanks J, Hanna C, Hannam MD, Hannuksela OA, Hansen H, Hansen TJ, Hanson J, Harder T, Hardwick T, Haris K, Harms J, Harry GM, Harry IW, Hartwig D, Hasegawa K, Haskell B, Hasskew RK, Haster CJ, Hattori K, Haughian K, Hayakawa H, Hayama K, Hayes FJ, Healy J, Heidmann A, Heintze MC, Heinze J, Heinzel J, Heitmann H, Hellman F, Hello P, Helmling-Cornell AF, Hemming G, Hendry M, Heng IS, Hennes E, Hennig J, Hennig MH, Hernandez Vivanco F, Heurs M, Hild S, Hill P, Himemoto Y, Hines AS, Hiranuma Y, Hirata N, Hirose E, Hochheim S, Hofman D, Hohmann JN, Holgado AM, Holland NA, Hollows IJ, Holmes ZJ, Holt K, Holz DE, Hong Z, Hopkins P, Hough J, Howell EJ, Hoy CG, Hoyland D, Hreibi A, Hsieh B, Hsu Y, Huang GZ, Huang HY, Huang P, Huang YC, Huang YJ, Huang YW, Hübner MT, Huddart AD, Huerta EA, Hughey B, Hui DCY, Hui V, Husa S, Huttner SH, Huxford R, Huynh-Dinh T, Ide S, Idzkowski B, Iess A, Ikenoue B, Imam S, Inayoshi K, Inchauspe H, Ingram C, Inoue Y, Intini G, Ioka K, Isi M, Isleif K, Ito K, Itoh Y, Iyer BR, Izumi K, JaberianHamedan V, Jacqmin T, Jadhav SJ, Jadhav SP, James AL, Jan AZ, Jani K, Janssens K, Janthalur NN, Jaranowski P, Jariwala D, Jaume R, Jenkins AC, Jeon C, Jeunon M, Jia W, Jiang J, Jin HB, Johns GR, Jones AW, Jones DI, Jones JD, Jones P, Jones R, Jonker RJG, Ju L, Jung K, Jung P, Junker J, Kaihotsu K, Kajita T, Kakizaki M, Kalaghatgi CV, Kalogera V, Kamai B, Kamiizumi M, Kanda N, Kandhasamy S, Kang G, Kanner JB, Kao Y, Kapadia SJ, Kapasi DP, Karathanasis C, Karki S, Kashyap R, Kasprzack M, Kastaun W, Katsanevas S, Katsavounidis E, Katzman W, Kaur T, Kawabe K, Kawaguchi K, Kawai N, Kawasaki T, Kéfélian F, Keitel D, Key JS, Khadka S, Khalili FY, Khan I, Khan S, Khazanov EA, Khetan N, Khursheed M, Kijbunchoo N, Kim C, Kim JC, Kim J, Kim K, Kim WS, Kim YM, Kimball C, Kimura N, King PJ, Kinley-Hanlon M, Kirchhoff R, Kissel JS, Kita N, Kitazawa H, Kleybolte L, Klimenko S, Knee AM, Knowles TD, Knyazev E, Koch P, Koekoek G, Kojima Y, Kokeyama K, Koley S, Kolitsidou P, Kolstein M, Komori K, Kondrashov V, Kong AKH, Kontos A, Koper N, Korobko M, Kotake K, Kovalam M, Kozak DB, Kozakai C, Kozu R, Kringel V, Krishnendu NV, Królak A, Kuehn G, Kuei F, Kumar A, Kumar P, Kumar R, Kumar R, Kume J, Kuns K, Kuo C, Kuo HS, Kuromiya Y, Kuroyanagi S, Kusayanagi K, Kwak K, Kwang S, Laghi D, Lalande E, Lam TL, Lamberts A, Landry M, Lane BB, Lang RN, Lange J, Lantz B, La Rosa I, Lartaux-Vollard A, Lasky PD, Laxen M, Lazzarini A, Lazzaro C, Leaci P, Leavey S, Lecoeuche YK, Lee HK, Lee HM, Lee HW, Lee J, Lee K, Lee R, Lehmann J, Lemaître A, Leon E, Leonardi M, Leroy N, Letendre N, Levin Y, Leviton JN, Li AKY, Li B, Li J, Li KL, Li TGF, Li X, Lin CY, Lin FK, Lin FL, Lin HL, Lin LCC, Linde F, Linker SD, Linley JN, Littenberg TB, Liu GC, Liu J, Liu K, Liu X, Llorens-Monteagudo M, Lo RKL, Lockwood A, Lollie ML, London LT, Longo A, Lopez D, Lorenzini M, Loriette V, Lormand M, Losurdo G, Lough JD, Lousto CO, Lovelace G, Lück H, Lumaca D, Lundgren AP, Luo LW, Macas R, MacInnis M, Macleod DM, MacMillan IAO, Macquet A, Magaña Hernandez I, Magaña-Sandoval F, Magazzù C, Magee RM, Maggiore R, Majorana E, Maksimovic I, Maliakal S, Malik A, Man N, Mandic V, Mangano V, Mango JL, Mansell GL, Manske M, Mantovani M, Marchesoni F, Marchio M, Marion F, Mark Z, Márka S, Márka Z, Markakis C, Markosyan AS, Markowitz A, Maros E, Marquina A, Marsat S, Martelli F, Martin IW, Martin RM, Martinez M, Martinez V, Martinovic K, Martynov DV, Marx EJ, Masalehdan H, Mason K, Massera E, Masserot A, Massinger TJ, Masso-Reid M, Mastrogiovanni S, Matas A, Mateu-Lucena M, Matichard F, Matiushechkina M, Mavalvala N, McCann JJ, McCarthy R, McClelland DE, McClincy P, McCormick S, McCuller L, McGhee GI, McGuire SC, McIsaac C, McIver J, McManus DJ, McRae T, McWilliams ST, Meacher D, Mehmet M, Mehta AK, Melatos A, Melchor DA, Mendell G, Menendez-Vazquez A, Menoni CS, Mercer RA, Mereni L, Merfeld K, Merilh EL, Merritt JD, Merzougui M, Meshkov S, Messenger C, Messick C, Meyers PM, Meylahn F, Mhaske A, Miani A, Miao H, Michaloliakos I, Michel C, Michimura Y, Middleton H, Milano L, Miller AL, Millhouse M, Mills JC, Milotti E, Milovich-Goff MC, Minazzoli O, Minenkov Y, Mio N, Mir LM, Mishkin A, Mishra C, Mishra T, Mistry T, Mitra S, Mitrofanov VP, Mitselmakher G, Mittleman R, Miyakawa O, Miyamoto A, Miyazaki Y, Miyo K, Miyoki S, Mo G, Mogushi K, Mohapatra SRP, Mohite SR, Molina I, Molina-Ruiz M, Mondin M, Montani M, Moore CJ, Moraru D, Morawski F, More A, Moreno C, Moreno G, Mori Y, Morisaki S, Moriwaki Y, Mours B, Mow-Lowry CM, Mozzon S, Muciaccia F, Mukherjee A, Mukherjee D, Mukherjee S, Mukherjee S, Mukund N, Mullavey A, Munch J, Muñiz EA, Murray PG, Musenich R, Nadji SL, Nagano K, Nagano S, Nakamura K, Nakano H, Nakano M, Nakashima R, Nakayama Y, Nardecchia I, Narikawa T, Naticchioni L, Nayak B, Nayak RK, Negishi R, Neil BF, Neilson J, Nelemans G, Nelson TJN, Nery M, Neunzert A, Ng KY, Ng SWS, Nguyen C, Nguyen P, Nguyen T, Nguyen Quynh L, Ni WT, Nichols SA, Nishizawa A, Nissanke S, Nocera F, Noh M, Norman M, North C, Nozaki S, Nuttall LK, Oberling J, O'Brien BD, Obuchi Y, O'Dell J, Ogaki W, Oganesyan G, Oh JJ, Oh K, Oh SH, Ohashi M, Ohishi N, Ohkawa M, Ohme F, Ohta H, Okada MA, Okutani Y, Okutomi K, Olivetto C, Oohara K, Ooi C, Oram R, O'Reilly B, Ormiston RG, Ormsby ND, Ortega LF, O'Shaughnessy R, O'Shea E, Oshino S, Ossokine S, Osthelder C, Otabe S, Ottaway DJ, Overmier H, Pace AE, Pagano G, Page MA, Pagliaroli G, Pai A, Pai SA, Palamos JR, Palashov O, Palomba C, Pan K, Panda PK, Pang H, Pang PTH, Pankow C, Pannarale F, Pant BC, Paoletti F, Paoli A, Paolone A, Parisi A, Park J, Parker W, Pascucci D, Pasqualetti A, Passaquieti R, Passuello D, Patel M, Patricelli B, Payne E, Pechsiri TC, Pedraza M, Pegoraro M, Pele A, Peña Arellano FE, Penn S, Perego A, Pereira A, Pereira T, Perez CJ, Périgois C, Perreca A, Perriès S, Petermann J, Petterson D, Pfeiffer HP, Pham KA, Phukon KS, Piccinni OJ, Pichot M, Piendibene M, Piergiovanni F, Pierini L, Pierro V, Pillant G, Pilo F, Pinard L, Pinto IM, Piotrzkowski BJ, Piotrzkowski K, Pirello M, Pitkin M, Placidi E, Plastino W, Pluchar C, Poggiani R, Polini E, Pong DYT, Ponrathnam S, Popolizio P, Porter EK, Powell J, Pracchia M, Pradier T, Prajapati AK, Prasai K, Prasanna R, Pratten G, Prestegard T, Principe M, Prodi GA, Prokhorov L, Prosposito P, Prudenzi L, Puecher A, Punturo M, Puosi F, Puppo P, Pürrer M, Qi H, Quetschke V, Quinonez PJ, Quitzow-James R, Raab FJ, Raaijmakers G, Radkins H, Radulesco N, Raffai P, Rail SX, Raja S, Rajan C, Ramirez KE, Ramirez TD, Ramos-Buades A, Rana J, Rapagnani P, Rapol UD, Ratto B, Raymond V, Raza N, Razzano M, Read J, Rees LA, Regimbau T, Rei L, Reid S, Reitze DH, Relton P, Rettegno P, Ricci F, Richardson CJ, Richardson JW, Richardson L, Ricker PM, Riemenschneider G, Riles K, Rizzo M, Robertson NA, Robie R, Robinet F, Rocchi A, Rocha JA, Rodriguez S, Rodriguez-Soto RD, Rolland L, Rollins JG, Roma VJ, Romanelli M, Romano R, Romel CL, Romero A, Romero-Shaw IM, Romie JH, Rose CA, Rosińska D, Rosofsky SG, Ross MP, Rowan S, Rowlinson SJ, Roy S, Roy S, Rozza D, Ruggi P, Ryan K, Sachdev S, Sadecki T, Sadiq J, Sago N, Saito S, Saito Y, Sakai K, Sakai Y, Sakellariadou M, Sakuno Y, Salafia OS, Salconi L, Saleem M, Salemi F, Samajdar A, Sanchez EJ, Sanchez JH, Sanchez LE, Sanchis-Gual N, Sanders JR, Sanuy A, Saravanan TR, Sarin N, Sassolas B, Satari H, Sato S, Sato T, Sauter O, Savage RL, Savant V, Sawada T, Sawant D, Sawant HL, Sayah S, Schaetzl D, Scheel M, Scheuer J, Schindler-Tyka A, Schmidt P, Schnabel R, Schneewind M, Schofield RMS, Schönbeck A, Schulte BW, Schutz BF, Schwartz E, Scott J, Scott SM, Seglar-Arroyo M, Seidel E, Sekiguchi T, Sekiguchi Y, Sellers D, Sengupta AS, Sennett N, Sentenac D, Seo EG, Sequino V, Setyawati Y, Shaffer T, Shahriar MS, Shams B, Shao L, Sharifi S, Sharma A, Sharma P, Shawhan P, Shcheblanov NS, Shen H, Shibagaki S, Shikauchi M, Shimizu R, Shimoda T, Shimode K, Shink R, Shinkai H, Shishido T, Shoda A, Shoemaker DH, Shoemaker DM, Shukla K, ShyamSundar S, Sieniawska M, Sigg D, Singer LP, Singh D, Singh N, Singha A, Sintes AM, Sipala V, Skliris V, Slagmolen BJJ, Slaven-Blair TJ, Smetana J, Smith JR, Smith RJE, Somala SN, Somiya K, Son EJ, Soni K, Soni S, Sorazu B, Sordini V, Sorrentino F, Sorrentino N, Sotani H, Soulard R, Souradeep T, Sowell E, Spagnuolo V, Spencer AP, Spera M, Srivastava AK, Srivastava V, Staats K, Stachie C, Steer DA, Steinlechner J, Steinlechner S, Stops DJ, Stover M, Strain KA, Strang LC, Stratta G, Strunk A, Sturani R, Stuver AL, Südbeck J, Sudhagar S, Sudhir V, Sugimoto R, Suh HG, Summerscales TZ, Sun H, Sun L, Sunil S, Sur A, Suresh J, Sutton PJ, Suzuki T, Suzuki T, Swinkels BL, Szczepańczyk MJ, Szewczyk P, Tacca M, Tagoshi H, Tait SC, Takahashi H, Takahashi R, Takamori A, Takano S, Takeda H, Takeda M, Talbot C, Tanaka H, Tanaka K, Tanaka K, Tanaka T, Tanaka T, Tanasijczuk AJ, Tanioka S, Tanner DB, Tao D, Tapia A, Tapia San Martin EN, Tapia San Martin EN, Tasson JD, Telada S, Tenorio R, Terkowski L, Test M, Thirugnanasambandam MP, Thomas M, Thomas P, Thompson JE, Thondapu SR, Thorne KA, Thrane E, Tiwari S, Tiwari S, Tiwari V, Toland K, Tolley AE, Tomaru T, Tomigami Y, Tomura T, Tonelli M, Torres-Forné A, Torrie CI, Tosta E Melo I, Töyrä D, Trapananti A, Travasso F, Traylor G, Tringali MC, Tripathee A, Troiano L, Trovato A, Trozzo L, Trudeau RJ, Tsai DS, Tsai D, Tsang KW, Tsang T, Tsao JS, Tse M, Tso R, Tsubono K, Tsuchida S, Tsukada L, Tsuna D, Tsutsui T, Tsuzuki T, Turconi M, Tuyenbayev D, Ubhi AS, Uchikata N, Uchiyama T, Udall RP, Ueda A, Uehara T, Ueno K, Ueshima G, Ugolini D, Unnikrishnan CS, Uraguchi F, Urban AL, Ushiba T, Usman SA, Utina AC, Vahlbruch H, Vajente G, Vajpeyi A, Valdes G, Valentini M, Valsan V, van Bakel N, van Beuzekom M, van den Brand JFJ, Van Den Broeck C, Vander-Hyde DC, van der Schaaf L, van Heijningen JV, van Putten MHPM, van Remortel N, Vardaro M, Vargas AF, Varma V, Vasúth M, Vecchio A, Vedovato G, Veitch J, Veitch PJ, Venkateswara K, Venneberg J, Venugopalan G, Verkindt D, Verma Y, Veske D, Vetrano F, Viceré A, Viets AD, Villa-Ortega V, Vinet JY, Vitale S, Vo T, Vocca H, von Reis ERG, Vorvick C, Vyatchanin SP, Wade LE, Wade M, Wagner KJ, Walet RC, Walker M, Wallace GS, Wallace L, Walsh S, Wang J, Wang JZ, Wang WH, Ward RL, Warner J, Was M, Washimi T, Washington NY, Watchi J, Weaver B, Wei L, Weinert M, Weinstein AJ, Weiss R, Weller CM, Wellmann F, Wen L, Weßels P, Westhouse JW, Wette K, Whelan JT, White DD, Whiting BF, Whittle C, Wilken D, Williams D, Williams MJ, Williamson AR, Willis JL, Willke B, Wilson DJ, Winkler W, Wipf CC, Wlodarczyk T, Woan G, Woehler J, Wofford JK, Wong ICF, Wrangel J, Wu C, Wu DS, Wu H, Wu S, Wysocki DM, Xiao L, Xu WR, Yamada T, Yamamoto H, Yamamoto K, Yamamoto K, Yamamoto T, Yamashita K, Yamazaki R, Yang FW, Yang L, Yang Y, Yang Y, Yang Z, Yap MJ, Yeeles DW, Yelikar AB, Ying M, Yokogawa K, Yokoyama J, Yokozawa T, Yoon A, Yoshioka T, Yu H, Yu H, Yuzurihara H, Zadrożny A, Zanolin M, Zeidler S, Zelenova T, Zendri JP, Zevin M, Zhan M, Zhang H, Zhang J, Zhang L, Zhang R, Zhang T, Zhao C, Zhao G, Zhao Y, Zhao Y, Zhou Z, Zhu XJ, Zhu ZH, Zucker ME, Zweizig J. Constraints on Cosmic Strings Using Data from the Third Advanced LIGO-Virgo Observing Run. PHYSICAL REVIEW LETTERS 2021; 126:241102. [PMID: 34213926 DOI: 10.1103/physrevlett.126.241102] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/31/2021] [Accepted: 05/23/2021] [Indexed: 06/13/2023]
Abstract
We search for gravitational-wave signals produced by cosmic strings in the Advanced LIGO and Virgo full O3 dataset. Search results are presented for gravitational waves produced by cosmic string loop features such as cusps, kinks, and, for the first time, kink-kink collisions. A template-based search for short-duration transient signals does not yield a detection. We also use the stochastic gravitational-wave background energy density upper limits derived from the O3 data to constrain the cosmic string tension Gμ as a function of the number of kinks, or the number of cusps, for two cosmic string loop distribution models. Additionally, we develop and test a third model that interpolates between these two models. Our results improve upon the previous LIGO-Virgo constraints on Gμ by 1 to 2 orders of magnitude depending on the model that is tested. In particular, for the one-loop distribution model, we set the most competitive constraints to date: Gμ≲4×10^{-15}. In the case of cosmic strings formed at the end of inflation in the context of grand unified theories, these results challenge simple inflationary models.
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Thomas M, Baltatzis M, Price A, Pearce L, Fox J, Vilches-Moraga A. 513 THE INFLUENCE OF FRAILTY ON OUTCOMES FOR OLDER ADULTS ADMITTED TO HOSPITAL WITH BENIGN BILIARY AND PANCREATIC DISEASE. Age Ageing 2021. [DOI: 10.1093/ageing/afab119.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
The prevalence and complications of biliary disease increase with age. We describe the prevalence of frailty in older patients hospitalised with benign biliary and pancreatic disease and establish its association with mortality and duration of hospital stay.
Methods
Prospective observational cohort study of patients aged 75 years and over admitted with a diagnosis of acute biliary disease to a surgical hospital unit between 17/09/2014 and 20/03/2017. Clinical Frailty Scale (CFS) score was recorded on admission.
Results
We included 200 patients with a median age of 82 (75–99), 60% females, 89% lived in their homes, 154 (77%) were independent for personal and 99 (49.5%) for instrumental ADLs, 95% mobilised independently, 17.5% had memory impairment and 8% low mood. Acute cholecystitis was the most common diagnosis (43%) followed by acute cholangitis (36%) and acute pancreatitis (21%). 99 patients were non-frail (NF = CFS 1–4) and 101 were frail (F = CFS ≥5). 104 patients received medical treatment only. Surgery was more common in non-frail (F 2% vs. NF 11%), percutaneous drainage more frequently carried out in frail patients (15% vs. NF 5%) and endoscopic cholangiopancreatography (ERCP) was similar in both groups (F 32%vs. NF 31%). Frailty was associated with worse clinical outcomes in F vs. NF: functional deconditioning (34% vs. 11%), increased care level (19% vs 3%), length of stay (12 vs. 7 days), 90-day (8% vs. 3%) and 1 year-mortality (48% vs. 24%).
Conclusion
Half of patients in our cohort of older adults hospitalised with acute biliary disease were frail. Higher scores of frailty are associated with increased mortality. Compared with non-frail patients, individuals living with frailty were less likely to undergo surgical treatment, spent longer in hospital and were less likely to remain alive at 12 months after hospital discharge.
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Thomas M, Cookson K, Clark R, Pearce L, Fox J, Price A. 472 A PILOT COLORECTAL AND GERIATRIC MEDICINE (CGM) CLINIC FOR OLDER, FRAIL PATIENTS REFERRED VIA A 2 WEEK WAIT PATHWAY. Age Ageing 2021. [DOI: 10.1093/ageing/afab116.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
The two week wait (2ww) colorectal referral pathway was introduced to expedite referrals where cancer is suspected, facilitating prompt diagnosis +/− intervention. Older frail patients are referred via this 2ww pathway even when invasive testing and intervention may not be appropriate. These patients may benefit more from holistic assessment than a universally surgical approach. A Colorectal and Geriatric Medicine (CGM) 2ww referral clinic was piloted, delivered by an urgent referral colorectal specialist nurse and an advanced clinical practitioner in geriatric medicine.
Method
Patients >65 years with a Clinical Frailty Scale (CFS) score of 5 or more at referral were directed to the CGM clinic. A telephone consultation was undertaken, incorporating both 2ww assessment and aspects of comprehensive geriatric assessment.
Results
42-patients were reviewed in the clinic. Mean age was 86.1 years and mean CFS 6. 12-patients underwent CT, and 2 CT virtual colonoscopy. No patients underwent endoscopic investigation and 28-patients declined any investigation. Of those who underwent investigation, no cancers were identified. 1 patient was referred on for endosocpic mucosal resection of polyps. 5-patients had severe diverticular disease, which accounted for their symptoms. Medication recommendations were made for 30-patients, some of which led to symptom cessation. Onward referrals were made to a community geriatrician, diabetes and continence teams, and palliative care specialists. 9-patients were identified as meeting criteria for advance care planning. This was commenced during the consultation and communicated back to the referring clinician for further action.
Conclusion
Older, frail patients are often not able, nor wish to undergo, invasive investigations but should not be disadvantaged or delayed in their pathway. Further work is needed to determine the most appropriate referral pathway for this group of patients. Holistic assessment that leads to improvement in symptoms and future planning may not be achievable through a solely surgical assessment.
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El Shafie RA, Seidensaal K, Bozorgmehr F, Kazdal D, Eichkorn T, Elshiaty M, Weber D, Allgäuer M, König L, Lang K, Forster T, Arians N, Rieken S, Heussel CP, Herth FJ, Thomas M, Stenzinger A, Debus J, Christopoulos P. Effect of timing, technique and molecular features on brain control with local therapies in oncogene-driven lung cancer. ESMO Open 2021; 6:100161. [PMID: 34090172 PMCID: PMC8182387 DOI: 10.1016/j.esmoop.2021.100161] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 04/24/2021] [Accepted: 04/29/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The improved efficacy of tyrosine kinase inhibitors (TKI) mandates reappraisal of local therapy (LT) for brain metastases (BM) of oncogene-driven non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS This study included all epidermal growth factor receptor-mutated (EGFR+, n = 108) and anaplastic lymphoma kinase-rearranged (ALK+, n = 33) TKI-naive NSCLC patients diagnosed with BM in the Thoraxklinik Heidelberg between 2009 and 2019. Eighty-seven patients (62%) received early LT, while 54 (38%) received delayed (n = 34; 24%) or no LT (n = 20; 14%). LT comprised stereotactic (SRT; n = 40; 34%) or whole-brain radiotherapy (WBRT; n = 77; 66%), while neurosurgical resection was carried out in 19 cases. RESULTS Median overall survival (OS) was 49.1 months for ALK+ and 19.5 months for EGFR+ patients (P = 0.001), with similar median intracranial progression-free survival (icPFS) (15.7 versus 14.0 months, respectively; P = 0.80). Despite the larger and more symptomatic BM (P < 0.001) of patients undergoing early LT, these experienced longer icPFS [hazard ratio (HR) 0.52; P = 0.024], but not OS (HR 1.63; P = 0.12), regardless of the radiotherapy technique (SRT versus WBRT) and number of lesions. High-risk oncogene variants, i.e. non-del19 EGFR mutations and 'short' EML4-ALK fusions (mainly variant 3, E6:A20), were associated with earlier intracranial progression (HR 2.97; P = 0.001). The longer icPFS with early LT was also evident in separate analyses of the EGFR+ and ALK+ subsets. CONCLUSIONS Despite preferential use for cases with poor prognostic factors, early LT prolongs the icPFS, but not OS, in TKI-treated EGFR+/ALK+ NSCLC. Considering the lack of survival benefit, and the neurocognitive effects of WBRT, patients presenting with polytopic BM may benefit from delaying radiotherapy, or from radiosurgery of multiple or selected lesions. For SRT candidates, the improved tumor control with earlier radiotherapy should be weighed against the potential toxicity and the enhanced intracranial activity of newer TKI. High-risk EGFR/ALK variants are associated with earlier intracranial failure and identify patients who could benefit from more aggressive management.
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Ahmad F, King L, Skiadas V, Thomas M. A Pictorial Review of Ankle and Foot Coalitions Focused on Primary and Secondary Findings on Plain Films, CT, and MRI. Semin Musculoskelet Radiol 2021. [DOI: 10.1055/s-0041-1731528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kamarajah S, Nepogodiev D, Bekele A, Cecconello I, Evans R, Guner A, Gossage J, Harustiak T, Hodson J, Isik A, Kidane B, Leon-Takahashi A, Mahendran H, Negoi I, Okonta K, Rosero G, Sayyed R, Singh P, Takeda F, van Hillegersberg R, Vohra R, White R, Griffiths E, Alderson D, Bundred J, Evans R, Gossage J, Griffiths E, Jefferies B, Kamarajah S, McKay S, Mohamed I, Nepogodiev D, Siaw- Acheampong K, Singh P, van Hillegersberg R, Vohra R, Wanigasooriya K, Whitehouse T, Gjata A, Moreno J, Takeda F, Kidane B, Guevara CR, Harustiak T, Bekele A, Kechagias A, Gockel I, Kennedy A, Da Roit A, Bagajevas A, Azagra J, Mahendran H, Mejía-Fernández L, Wijnhoven B, El Kafsi J, Sayyed R, Sousa M, Sampaio A, Negoi I, Blanco R, Wallner B, Schneider P, Hsu P, Isik A, Gananadha S, Wills V, Devadas M, Duong C, Talbot M, Hii M, Jacobs R, Andreollo N, Johnston B, Darling G, Isaza-Restrepo A, Rosero G, Arias- Amézquita F, Raptis D, Gaedcke J, Reim D, Izbicki J, Egberts J, Dikinis S, Kjaer D, Larsen M, Achiam M, Saarnio J, Theodorou D, Liakakos T, Korkolis D, Robb W, Collins C, Murphy T, Reynolds J, Tonini V, Migliore M, Bonavina L, Valmasoni M, Bardini R, Weindelmayer J, Terashima M, White R, Alghunaim E, Elhadi M, Leon-Takahashi A, Medina-Franco H, Lau P, Okonta K, Heisterkamp J, Rosman C, van Hillegersberg R, Beban G, Babor R, Gordon A, Rossaak J, Pal K, Qureshi A, Naqi S, Syed A, Barbosa J, Vicente C, Leite J, Freire J, Casaca R, Costa R, Scurtu R, Mogoanta S, Bolca C, Constantinoiu S, Sekhniaidze D, Bjelović M, So J, Gačevski G, Loureiro C, Pera M, Bianchi A, Moreno GM, Martín Fernández J, Trugeda Carrera M, Vallve-Bernal M, Cítores Pascual M, Elmahi S, Halldestam I, Hedberg J, Mönig S, Gutknecht S, Tez M, Guner A, Tirnaksiz M, Colak E, Sevinç B, Hindmarsh A, Khan I, Khoo D, Byrom R, Gokhale J, Wilkerson P, Jain P, Chan D, Robertson K, Iftikhar S, Skipworth R, Forshaw M, Higgs S, Gossage J, Nijjar R, Viswanath Y, Turner P, Dexter S, Boddy A, Allum W, Oglesby S, Cheong E, Beardsmore D, Vohra R, Maynard N, Berrisford R, Mercer S, Puig S, Melhado R, Kelty C, Underwood T, Dawas K, Lewis W, Al-Bahrani A, Bryce G, Thomas M, Arndt A, Palazzo F, Meguid R, Fergusson J, Beenen E, Mosse C, Salim J, Cheah S, Wright T, Cerdeira M, McQuillan P, Richardson M, Liem H, Spillane J, Yacob M, Albadawi F, Thorpe T, Dingle A, Cabalag C, Loi K, Fisher O, Ward S, Read M, Johnson M, Bassari R, Bui H, Cecconello I, Sallum R, da Rocha J, Lopes L, Tercioti V, Coelho J, Ferrer J, Buduhan G, Tan L, Srinathan S, Shea P, Yeung J, Allison F, Carroll P, Vargas-Barato F, Gonzalez F, Ortega J, Nino-Torres L, Beltrán-García T, Castilla L, Pineda M, Bastidas A, Gómez-Mayorga J, Cortés N, Cetares C, Caceres S, Duarte S, Pazdro A, Snajdauf M, Faltova H, Sevcikova M, Mortensen P, Katballe N, Ingemann T, Morten B, Kruhlikava I, Ainswort A, Stilling N, Eckardt J, Holm J, Thorsteinsson M, Siemsen M, Brandt B, Nega B, Teferra E, Tizazu A, Kauppila J, Koivukangas V, Meriläinen S, Gruetzmann R, Krautz C, Weber G, Golcher H, Emons G, Azizian A, Ebeling M, Niebisch S, Kreuser N, Albanese G, Hesse J, Volovnik L, Boecher U, Reeh M, Triantafyllou S, Schizas D, Michalinos A, Mpali E, Mpoura M, Charalabopoulos A, Manatakis D, Balalis D, Bolger J, Baban C, Mastrosimone A, McAnena O, Quinn A, Ó Súilleabháin C, Hennessy M, Ivanovski I, Khizer H, Ravi N, Donlon N, Cervellera M, Vaccari S, Bianchini S, Sartarelli L, Asti E, Bernardi D, Merigliano S, Provenzano L, Scarpa M, Saadeh L, Salmaso B, De Manzoni G, Giacopuzzi S, La Mendola R, De Pasqual C, Tsubosa Y, Niihara M, Irino T, Makuuchi R, Ishii K, Mwachiro M, Fekadu A, Odera A, Mwachiro E, AlShehab D, Ahmed H, Shebani A, Elhadi A, Elnagar F, Elnagar H, Makkai-Popa S, Wong L, Tan Y, Thannimalai S, Ho C, Pang W, Tan J, Basave H, Cortés-González R, Lagarde S, van Lanschot J, Cords C, Jansen W, Martijnse I, Matthijsen R, Bouwense S, Klarenbeek B, Verstegen M, van Workum F, Ruurda J, van der Sluis P, de Maat M, Evenett N, Johnston P, Patel R, MacCormick A, Young M, Smith B, Ekwunife C, Memon A, Shaikh K, Wajid A, Khalil N, Haris M, Mirza Z, Qudus S, Sarwar M, Shehzadi A, Raza A, Jhanzaib M, Farmanali J, Zakir Z, Shakeel O, Nasir I, Khattak S, Baig M, Noor M, Ahmed H, Naeem A, Pinho A, da Silva R, Bernardes A, Campos J, Matos H, Braga T, Monteiro C, Ramos P, Cabral F, Gomes M, Martins P, Correia A, Videira J, Ciuce C, Drasovean R, Apostu R, Ciuce C, Paitici S, Racu A, Obleaga C, Beuran M, Stoica B, Ciubotaru C, Negoita V, Cordos I, Birla R, Predescu D, Hoara P, Tomsa R, Shneider V, Agasiev M, Ganjara I, Gunjić D, Veselinović M, Babič T, Chin T, Shabbir A, Kim G, Crnjac A, Samo H, Díez del Val I, Leturio S, Ramón J, Dal Cero M, Rifá S, Rico M, Pagan Pomar A, Martinez Corcoles J, Rodicio Miravalles J, Pais S, Turienzo S, Alvarez L, Campos P, Rendo A, García S, Santos E, Martínez E, Fernández DMJ, Magadán ÁC, Concepción MV, Díaz LC, Rosat RA, Pérez SLE, Bailón CM, Tinoco CC, Choolani Bhojwani E, Sánchez D, Ahmed M, Dzhendov T, Lindberg F, Rutegård M, Sundbom M, Mickael C, Colucci N, Schnider A, Er S, Kurnaz E, Turkyilmaz S, Turkyilmaz A, Yildirim R, Baki B, Akkapulu N, Karahan O, Damburaci N, Hardwick R, Safranek P, Sujendran V, Bennett J, Afzal Z, Shrotri M, Chan B, Exarchou K, Gilbert T, Amalesh T, Mukherjee D, Mukherjee S, Wiggins T, Kennedy R, McCain S, Harris A, Dobson G, Davies N, Wilson I, Mayo D, Bennett D, Young R, Manby P, Blencowe N, Schiller M, Byrne B, Mitton D, Wong V, Elshaer A, Cowen M, Menon V, Tan L, McLaughlin E, Koshy R, Sharp C, Brewer H, Das N, Cox M, Al Khyatt W, Worku D, Iqbal R, Walls L, McGregor R, Fullarton G, Macdonald A, MacKay C, Craig C, Dwerryhouse S, Hornby S, Jaunoo S, Wadley M, Baker C, Saad M, Kelly M, Davies A, Di Maggio F, McKay S, Mistry P, Singhal R, Tucker O, Kapoulas S, Powell-Brett S, Davis P, Bromley G, Watson L, Verma R, Ward J, Shetty V, Ball C, Pursnani K, Sarela A, Sue LH, Mehta S, Hayden J, To N, Palser T, Hunter D, Supramaniam K, Butt Z, Ahmed A, Kumar S, Chaudry A, Moussa O, Kordzadeh A, Lorenzi B, Wilson M, Patil P, Noaman I, Willem J, Bouras G, Evans R, Singh M, Warrilow H, Ahmad A, Tewari N, Yanni F, Couch J, Theophilidou E, Reilly J, Singh P, van Boxel G, Akbari K, Zanotti D, Sgromo B, Sanders G, Wheatley T, Ariyarathenam A, Reece-Smith A, Humphreys L, Choh C, Carter N, Knight B, Pucher P, Athanasiou A, Mohamed I, Tan B, Abdulrahman M, Vickers J, Akhtar K, Chaparala R, Brown R, Alasmar M, Ackroyd R, Patel K, Tamhankar A, Wyman A, Walker R, Grace B, Abbassi N, Slim N, Ioannidi L, Blackshaw G, Havard T, Escofet X, Powell A, Owera A, Rashid F, Jambulingam P, Padickakudi J, Ben-Younes H, Mccormack K, Makey I, Karush M, Seder C, Liptay M, Chmielewski G, Rosato E, Berger A, Zheng R, Okolo E, Singh A, Scott C, Weyant M, Mitchell J. Mortality from esophagectomy for esophageal cancer across low, middle, and high-income countries: An international cohort study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2021; 47:1481-1488. [PMID: 33451919 DOI: 10.1016/j.ejso.2020.12.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 12/09/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND No evidence currently exists characterising global outcomes following major cancer surgery, including esophageal cancer. Therefore, this study aimed to characterise impact of high income countries (HIC) versus low and middle income countries (LMIC) on the outcomes following esophagectomy for esophageal cancer. METHOD This international multi-center prospective study across 137 hospitals in 41 countries included patients who underwent an esophagectomy for esophageal cancer, with 90-day follow-up. The main explanatory variable was country income, defined according to the World Bank Data classification. The primary outcome was 90-day postoperative mortality, and secondary outcomes were composite leaks (anastomotic leak or conduit necrosis) and major complications (Clavien-Dindo Grade III - V). Multivariable generalized estimating equation models were used to produce adjusted odds ratios (ORs) and 95% confidence intervals (CI95%). RESULTS Between April 2018 to December 2018, 2247 patients were included. Patients from HIC were more significantly older, with higher ASA grade, and more advanced tumors. Patients from LMIC had almost three-fold increase in 90-day mortality, compared to HIC (9.4% vs 3.7%, p < 0.001). On adjusted analysis, LMIC were independently associated with higher 90-day mortality (OR: 2.31, CI95%: 1.17-4.55, p = 0.015). However, LMIC were not independently associated with higher rates of anastomotic leaks (OR: 1.06, CI95%: 0.57-1.99, p = 0.9) or major complications (OR: 0.85, CI95%: 0.54-1.32, p = 0.5), compared to HIC. CONCLUSION Resections in LMIC were independently associated with higher 90-day postoperative mortality, likely reflecting a failure to rescue of these patients following esophagectomy, despite similar composite anastomotic leaks and major complication rates to HIC. These findings warrant further research, to identify potential issues and solutions to improve global outcomes following esophagectomy for cancer.
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Folkard S, Gendy R, Yao M, Latif E, Thomas M, Streeter E, Kommu S, Eddy B. Lessons learnt from 1010 consecutive robot assisted radical prostatectomies: Safe fellowship training. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01342-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Roeper J, Christopoulos P, Falk M, Heukamp L, Stenzinger A, Thomas M, Griesinger F. 139P The impact of TP53 mutations on EGFR mt+ NSCLC IV patients treated with 3rd generation TKI on 2nd line or further line therapy: Real-world data from two certified lung cancer centers in Germany. J Thorac Oncol 2021. [DOI: 10.1016/s1556-0864(21)01981-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Benton M, Thomas M, Spertus J, Andrei A, Warzecha A, Wu T, Grady K. Association of Patient Health Outcomes with Caregiver Burden after LVAD in Destination Therapy and as a Bridge to Transplant. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Christopoulos P, Grohé C, Griesinger F, Falkenstern-Ge R, Krisam J, Brückner L, Wermke M, Misch D, Hackanson B, Faehling M, Tufman A, Janning M, Schulz C, Reck M, Hong JL, Lin H, Stenzinger A, Thomas M. 153P Real-world study of NSCLC with EGFR exon 20 insertions. J Thorac Oncol 2021. [DOI: 10.1016/s1556-0864(21)01995-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sayar Z, Weatherill A, Keddie S, Sive J, Lunn M, Thomas M, D’Sa S. PO-05 Retrospective cohort observational study of venous and arterial thrombotic event rates in POEMS patients: results from the UK-based POEMS registry and mechanistic insights. Thromb Res 2021. [DOI: 10.1016/s0049-3848(21)00164-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Scherz A, Sakai H, Le X, Felip E, Veillon R, Garassino M, Raskin J, Viteri S, Mazieres J, Cortot A, Smit E, Thomas M, Conte P, Gottfried M, Britschgi C, Bruns R, Otto G, Johne A, Paik P. 157P Tepotinib in patients (pts) with MET exon 14 (METex14) skipping NSCLC: Efficacy results from all pts enrolled in VISION cohort A. J Thorac Oncol 2021. [DOI: 10.1016/s1556-0864(21)01999-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Moreno-Martinez D, Aguiar P, Auray-Blais C, Beck M, Bichet DG, Burlina A, Cole D, Elliott P, Feldt-Rasmussen U, Feriozzi S, Fletcher J, Giugliani R, Jovanovic A, Kampmann C, Langeveld M, Lidove O, Linhart A, Mauer M, Moon JC, Muir A, Nowak A, Oliveira JP, Ortiz A, Pintos-Morell G, Politei J, Rozenfeld P, Schiffmann R, Svarstad E, Talbot AS, Thomas M, Tøndel C, Warnock D, West ML, Hughes DA. Standardising clinical outcomes measures for adult clinical trials in Fabry disease: A global Delphi consensus. Mol Genet Metab 2021; 132:234-243. [PMID: 33642210 DOI: 10.1016/j.ymgme.2021.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/01/2021] [Accepted: 02/01/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Recent years have witnessed a considerable increase in clinical trials of new investigational agents for Fabry disease (FD). Several trials investigating different agents are currently in progress; however, lack of standardisation results in challenges to interpretation and comparison. To facilitate the standardisation of investigational programs, we have developed a common framework for future clinical trials in FD. METHODS AND FINDINGS A broad consensus regarding clinical outcomes and ways to measure them was obtained via the Delphi methodology. 35 FD clinical experts from 4 continents, representing 3389 FD patients, participated in 3 rounds of Delphi procedure. The aim was to reach a consensus regarding clinical trial design, best treatment comparator, clinical outcomes, measurement of those clinical outcomes and inclusion and exclusion criteria. Consensus results of this initiative included: the selection of the adaptative clinical trial as the ideal study design and agalsidase beta as ideal comparator treatment due to its longstanding use in FD. Renal and cardiac outcomes, such as glomerular filtration rate, proteinuria and left ventricular mass index, were prioritised, whereas neurological outcomes including cerebrovascular and white matter lesions were dismissed as a primary or secondary outcome measure. Besides, there was a consensus regarding the importance of patient-related outcomes such as general quality of life, pain, and gastrointestinal symptoms. Also, unity about lysoGb3 and Gb3 tissue deposits as useful surrogate markers of the disease was obtained. The group recognised that cardiac T1 mapping still has potential but requires further development before its widespread introduction in clinical trials. Finally, patients with end-stage renal disease or renal transplant should be excluded unless a particular group for them is created inside the clinical trial. CONCLUSION This consensus will help to shape the future of clinical trials in FD. We note that the FDA has, coincidentally, recently published draft guidelines on clinical trials in FD and welcome this contribution.
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