The VLT-FLAMES Tarantula Survey: XIX. B-type supergiants: Atmospheric parameters and nitrogen abundances to investigate the role of binarity and the width of the main sequence

Context: Model atmosphere analyses have been previously undertaken for both Galactic and extragalactic B-type supergiants. By contrast, little attention has been given to a comparison of the properties of single supergiants and those that are members of multiple systems. 

Aims: Atmospheric parameters and nitrogen abundances have been estimated for all the B-type supergiants identified in the VLT-FLAMES Tarantula survey. These include both single targets and binary candidates. The results have been analysed to investigate the role of binarity in the evolutionary history of supergiants. 

Methods: tlusty non-local thermodynamic equilibrium (LTE) model atmosphere calculations have been used to determine atmospheric parameters and nitrogen abundances for 34 single and 18 binary supergiants. Effective temperatures were deduced using the silicon balance technique, complemented by the helium ionisation in the hotter spectra. Surface gravities were estimated using Balmer line profiles and microturbulent velocities deduced using the silicon spectrum. Nitrogen abundances or upper limits were estimated from the Nii spectrum. The effects of a flux contribution from an unseen secondary were considered for the binary sample. Results. We present the first systematic study of the incidence of binarity for a sample of B-type supergiants across the theoretical terminal age main sequence (TAMS). To account for the distribution of effective temperatures of the B-type supergiants it may be necessary to extend the TAMS to lower temperatures. This is also consistent with the derived distribution of mass discrepancies, projected rotational velocities and nitrogen abundances, provided that stars cooler than this temperature are post-red supergiant objects. For all the supergiants in the Tarantula and in a previous FLAMES survey, the majority have small projected rotational velocities. The distribution peaks at about 50 km s^-1 with 65% in the range 30 km s^-1 ≤ ν_e sin i ≤ 60 km s^-1. About ten per cent have larger ve sin i (≥100 km s^-1), but surprisingly these show little or no nitrogen enhancement. All the cooler supergiants have low projected rotational velocities of ≤70 km s^-1 and high nitrogen abundance estimates, implying that either bi-stability braking or evolution on a blue loop may be important. Additionally, there is a lack of cooler binaries, possibly reflecting the small sample sizes. Single-star evolutionary models, which include rotation, can account for all of the nitrogen enhancement in both the single and binary samples. The detailed distribution of nitrogen abundances in the single and binary samples may be different, possibly reflecting differences in their evolutionary history. 

Conclusions: The first comparative study of single and binary B-type supergiants has revealed that the main sequence may be significantly wider than previously assumed, extending to T_eff = 20 000 K. Some marginal differences in single and binary atmospheric parameters and abundances have been identified, possibly implying non-standard evolution for some of the sample. This sample as a whole has implications for several aspects of our understanding of the evolutionary status of blue supergiants.

Incomplete DJH rearrangements of the IgH gene are frequent in multiple myeloma patients: immunobiological characteristics and clinical implications.

DH-JH rearrangements of the Ig heavy-chain gene (IGH) occur early during B-cell development. Consequently, they are detected in precursor-B-cell acute lymphoblastic leukemias both at diagnosis and relapse. Incomplete DJH rearrangements have also been occasionally reported in mature B-cell lymphoproliferative disorders, but their frequency and immunobiological characteristics have not been studied in detail. We have investigated the frequency and characteristics of incomplete DJH as well as complete VDJH rearrangements in a series of 84 untreated multiple myeloma (MM) patients. The overall detection rate of clonality by amplifying VDJH and DJH rearrangements using family-specific primers was 94%. Interestingly, we found a high frequency (60%) of DJH rearrangements in this group. As expected from an immunological point of view, the vast majority of DJH rearrangements (88%) were unmutated. To the best of our knowledge, this is the first systematic study describing the incidence of incomplete DJH rearrangements in a series of unselected MM patients. These results strongly support the use of DJH rearrangements as PCR targets for clonality studies and, particularly, for quantification of minimal residual disease by real-time quantitative PCR using consensus JH probes in MM patients. The finding of hypermutation in a small proportion of incomplete DJH rearrangements (six out of 50) suggests important biological implications concerning the process of somatic hypermutation. Moreover, our data offer a new insight in the regulatory development model of IGH rearrangements.

Systematic evaluation of patient-reported outcome (PRO) protocol content and reporting in UK cancer clinical trials: the EPiC study protocol

Introduction Emerging evidence suggests that patient-reported outcome (PRO)-specific information may be omitted in trial protocols and that PRO results are poorly reported, limiting the use of PRO data to inform cancer care. This study aims to evaluate the standards of PRO-specific content in UK cancer trial protocols and their arising publications and to highlight examples of best-practice PRO protocol content and reporting where they occur. The objective of this study is to determine if these early findings are generalisable to UK cancer trials, and if so, how best we can bring about future improvements in clinical trials methodology to enhance the way PROs are assessed, managed and reported. Hypothesis: Trials in which the primary end point is based on a PRO will have more complete PRO protocol and publication components than trials in which PROs are secondary end points.

Methods and analysis Completed National Institute for Health Research (NIHR) Portfolio Cancer clinical trials (all cancer specialities/age-groups) will be included if they contain a primary/secondary PRO end point. The NIHR portfolio includes cancer trials, supported by a range of funders, adjudged as high-quality clinical research studies. The sample will be drawn from studies completed between 31 December 2000 and 1 March 2014 (n=1141) to allow sufficient time for completion of the final trial report and publication. Two reviewers will then review the protocols and arising publications of included trials to: (1) determine the completeness of their PRO-specific protocol content; (2) determine the proportion and completeness of PRO reporting in UK Cancer trials and (3) model factors associated with PRO protocol and reporting completeness and with PRO reporting proportion.

Ethics and dissemination The study was approved by the ethics committee at University of Birmingham (ERN_15-0311). Trial findings will be disseminated via presentations at local, national and international conferences, peer-reviewed journals and social media including the CPROR twitter account and UOB departmental website (http://www.birmingham.ac.uk/cpro0r).

Statin use and survival in colorectal cancer: Results from a population-based cohort study and an updated systematic review and meta-analysis

BACKGROUND: The aim of this study was to investigate the association between statin use and survival in a population-based colorectal cancer (CRC) cohort and perform an updated meta-analysis to quantify the magnitude of any association.

METHODS: A cohort of 8391 patients with newly diagnosed Dukes' A-C CRC (2009-2012) was identified from the Scottish Cancer Registry. This cohort was linked to the Prescribing Information System and the National Records of Scotland Death Records (until January 2015) to identify 1064 colorectal cancer-specific deaths. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for cancer-specific mortality by statin use were calculated using time dependent Cox regression models. The systematic review included relevant studies published before January 2016. Meta-analysis techniques were used to derive combined HRs for associations between statin use and cancer-specific and overall mortality.

RESULTS: In the Scottish cohort, statin use before diagnosis (HR=0.84, 95% CI 0.75-0.94), but not after (HR=0.90, 95% CI 0.77-1.05), was associated with significantly improved cancer-specific mortality. The systematic review identified 15 relevant studies. In the meta-analysis, there was consistent (I(2)=0%,heterogeneity P=0.57) evidence of a reduction in cancer-specific mortality with statin use before diagnosis in 6 studies (n=86,622, pooled HR=0.82, 95% CI 0.79-0.86) but this association was less apparent and more heterogeneous (I(2)=67%,heterogeneity P=0.03) with statin use after diagnosis in 4 studies (n=19,152, pooled HR=0.84, 95% CI 0.68-1.04).

CONCLUSION: In a Scottish CRC cohort and updated meta-analysis there was some evidence that statin use was associated with improved survival. However, these associations were weak in magnitude and, particularly for post-diagnosis use, varied markedly between studies.