ologic high grade which confers poor prognosis and reduced chances for good overall survival outcome.

To evaluate the incidence of pulmonary metastases in the preoperative work-up of patients with primary vulvar squamous cell carcinoma (SCC).

Retrospective cohort study.

Tertiary referral centre.

Patients treated for primary vulvar SCC from 2000 to 2018.

The pre-operative chest imaging of 452 consecutively treated patients was documented with a minimal follow-up period of 2years.

Incidence of pulmonary metastases, frequency of chest imaging and subsequent coincidental findings.

In total, 80.8% of patients underwent pre-operative chest imaging. Seven patients (1.9%), with a median tumour size of 80mm, presented with pulmonary metastases. UPR inhibitor None of the patients with early stage disease and tumour size <40mm who underwent radical local excision (RLE) with sentinel node (SN)-procedure, was diagnosed with pulmonary metastasis. Chest imaging was performed by radiography (58.9%) and computerised tomography (CT) (41.1%). Coincidental findings were reported in 40.7% of patients who underwent CT, compared with 15.8% of patients undergoing radiography, resulting in additional diagnostics in 14.7 and 19.7% and being of limited consequence for outcome in 2.9 and 3.3%, respectively.

The incidence of pulmonary metastases in patients with primary vulvar SCC is extremely low, and none in patients with early stage disease undergoing the SN procedure. Chest imaging was performed in the majority of patients and was associated with frequent coincidental findings leading to clinically irrelevant diagnostic procedures. Therefore, we recommend omitting chest imaging in patients with early stage disease and tumours<40mm, considering chest CT only in patients with large tumours and/or advanced stage disease.

The incidence of pulmonary metastases is 1.9%, none in early stage disease planned for SN. Omitting chest imaging in this group is advised.

The incidence of pulmonary metastases is 1.9%, none in early stage disease planned for SN. Omitting chest imaging in this group is advised.

The aim of this study was to investigate the relationship between diabetes mellitus (DM) and left atrial (LA) remodelling in a group of patients with heart failure and reduced ejection fraction (HFrEF), and their combined impact on cardiac events (CE).

This study included 136 consecutive HFrEF patients (65±11years), 36 had DM, and 86 had increased LA stiffness (LASt). All patients underwent complete conventional and tissue Doppler echocardiographic measurements were made including LA volumes and function. LASt was calculated using the formula LASt=E/e’ ratio / PALS.

At 55±37months follow-up, free survival from CE was 69% in patients without DM and 44.4% in those with DM (p<.0001). The CE free survival was lower in patients with increased LASt compared to normal LASt, (50 versus. 80%, p<.001), irrespective of the presence of DM (27 versus. 71%, p<.001).The best cut-off value of LASt for predicting CE in the group as a whole was≥0.82% [81% sensitivity, 72% specificity and AUC 0.82 (p<.001)]. LASt≥0.82% also predicted CE in no DM patients [78% sensitivity, 71% specificity and AUC 0.80 (p<.001)] and was a stronger predictor in DM patients [85% sensitivity, 71% specificity and AUC=0.847 (p<.001)].

High LA stiffness is associated with poor clinical outcome in patients with HFrEF. Diabetes has an additional incremental value in determining clinical outcome in those patients.

High LA stiffness is associated with poor clinical outcome in patients with HFrEF. Diabetes has an additional incremental value in determining clinical outcome in those patients.

Bacillus thuringiensis (Bt) is a Gram-positive bacterium that synthesizes specific protein toxins, which can be exploited for control of various insect pests, including Diatraea saccharalis, a lepidopteran that severely damages sugarcane crops. Although studies have described the effects of Bt in the larval phases of D. saccharalis, few have examined its effect on insect eggs. Herein, we studied the entomopathogenic potential of Bacillus thuringiensis serovar Aizawai GC-91 (Bta) during D. saccharalis embryo development with the aim of understanding the entomopathogenic mechanism and developing new biological control techniques for target insects.

Bta concentrations of 5, 10 and 20 g L

demonstrated the strongest bioactivity, reducing D. saccharalis egg viability by 28.69%, 33.91% and 34.98%, respectively. The lethal concentrations (LCs) were estimated as LC

= 28.07 g L

(CI 95% = 1.89-2.38) and LC

= 65.36 g L

(CI 95% = 4.19-5.26). Alterations in egg coloration, melanization and granule accumulation were observed at 24 h, persisting until 144 h. The embryo digestive systems were severely damaged, including narrowing of the intestinal lumen, vesiculations and degenerated cells, causing embryonic death.

The toxicity caused by Bta in D. saccharalis embryos demonstrated its potential as a biological control agent and as a sustainable alternative for integrated management of D. saccharalis infestation. © 2020 Society of Chemical Industry.

The toxicity caused by Bta in D. saccharalis embryos demonstrated its potential as a biological control agent and as a sustainable alternative for integrated management of D. saccharalis infestation. © 2020 Society of Chemical Industry.Choosing the most appropriate patient-reported outcome measure (PROM) for a clinical study is essential in order to achieve trustworthy results. This choice will depend on (a) the objective of the study and hence the research question; (b) the choice of a theoretical framework, such as the World Health Organization’s International Classification of Functioning, Disability, and Health (ICF); (c) whether there currently is a PROM that possesses high content validity and high construct validity for the specific patient group and objective, and if not; (d) the decision on whether to use a suboptimal PROM or develop and validate a new PROM. This paper presents the steps that should be followed in order to assess the relevance of PROMs and suggests ways to enhance the choice depending on the goal of the study.