ICE Trial Research Articles

Noteworthy in Cardiothoracic Surgery 2023.

Noteworthy in Cardiothoracic Surgery 2023 summarizes a few of the most high-impact trials and provocative trends in cardiothoracic surgery and transplantation this past year. Transplantation using organs procured from donation after circulatory death (DCD) continues to increase, and the American Society of Transplant Surgeons released recommendations on best practices in 2023. We review a summary of data on the impact of DCD on heart and lung transplantation. There has been increased interest in extracorporeal life support (ECLS), particularly after the COVID-19 pandemic, and we review the results of the highly discussed ECLS-SHOCK trial, which randomized patients in cardiogenic shock with planned revascularization to ECLS vs usual care. With improving survival outcomes in complex aortic surgery, there is a need for higher-quality evidence to guide which cooling and cerebral perfusion strategies may optimize cognitive outcomes in these patients. We review the short-term outcomes of the GOT ICE trial (Cognitive Effects of Body Temperature During Hypothermic Circulatory Arrest), a multicenter, randomized controlled trial of three different nadir temperatures, evaluating outcomes in cognition and associated changes in functional magnetic resonance imaging. Finally, both the Society of Thoracic Surgeons (STS) and the American College of Cardiology, American Heart Association, American College of Chest Physicians and Heart Rhythm Society (ACC/AHA/ACCP/HRS) updated atrial fibrillation guidelines in 2023, and we review surgically relevant updates to the guidelines and the evidence behind them.

Intercostal nerve cryoablation versus thoracic epidural analgesia for minimal invasive Nuss repair of pectus excavatum: a protocol for a randomised clinical trial (ICE trial)

IntroductionEpidural analgesia is currently considered the gold standard in postoperative pain management for the minimally invasive Nuss procedure for pectus excavatum. Alternative analgesic strategies (eg, patient-controlled analgesia and paravertebral nerve...

109P Updated long-term overall survival of older adjuvant ibandronate-treated patients with intermediate- or high-risk early breast cancer compared with additional adjuvant capecitabine treatment: The ICE randomized clinical trial

The majority of breast cancers occur in women over the age of 65, but older breast cancer patients are largely underrepresented in clinical trials. We investigated the effect of adding capecitabine to adjuvant treatment with ibandronate in elderly breast cancer patients. The multicenter phase III ICE trial enrolled women ≥65 years with early node-positive/high-risk node-negative breast cancer and a Charlson Comorbidity Index (CCI) ≤2. Patients were randomized to capecitabine 2000 mg/m2 day 1-14 q3w for 6 cycles plus ibandronate (50 mg p.o. daily or alternatively 6 mg i.v. q4w) or ibandronate alone for 2 years. We present here an update on long-term follow-up for the secondary endpoint of overall survival (OS). 1358 (96.4%) from 1409 randomized patients started treatment. 564 (83.4%) completed 6 cycles of capecitabine. 513 (77.7%) and 516 (78.8%) completed ibandronate in the capecitabine/ibandronate and ibandronate arm, respectively. Median age was 71 (range 64-88) years, 1099 (81%) were hormone receptor (HR)-positive, 705 (51.9%) node-negative, 794 (58.5%) had a CCI of 0. HR-positive patients received additional adjuvant endocrine treatment. After an updated median follow-up time of 74 (IQR 56-126) months for OS in the entire cohort, 7-year OS was 83.5% for capecitabine/ibandronate versus 80.9% for ibandronate, and 10-year OS was 73.1% for capecitabine/ibandronate versus 70.8% for ibandronate (P=0.413). Lack of effect was independent from age, nodal and HR status. Addition of capecitabine caused significantly higher skin and gastrointestinal toxicities. The adjuvant combination of capecitabine and ibandronate did not show significantly better OS than ibandronate alone in elderly breast cancer patients.

Full-Scale/Model-Scale Comparison of Podded Icebreaker’s Performance in Ice with Flexural Strength Measurement Study

_ This paper provides the results of model tests in ice to evaluate the performance of the USCG Mackinaw Icebreaker that was equipped with two podded propulsors and compares with the data obtained from the full-scale ice trials. The objective of this collaborative model test program between the NRC and USCG was to understand the capability and limitation of the model tests with podded vessels in ice. As a result, the model tests showed a good agreement with attainable speeds at selected power levels but an overestimation of the ice resistance by an average of 7% (from 10% to 25%). Further discussion of podded icebreaker performance including turning circle tests in ice is provided and future work is proposed. This paper also provides a discussion of two different flexural strength test methods, which are simple beam and cantilever beam tests. Introduction The number of icebreakers with podded propulsors has been increasing in recent years and many new icebreakers are planning to use the pods because of high maneuverability and additional benefits such as low noise and vibration, and various usages of the propeller wake. The first pod unit (1.3 MW) was installed in a utility vessel Seili in 1990. Since then, several ice-going tankers/ icebreakers have used single or multiple pod units, which had up to 16 MW power (Wilkman et al. 2018).

Application of Hydrogen Peroxide to Improve the Microbiological Stability of Food Ice Produced in Industrial Facilities

This work was aimed to produce an “active” food ice to preserve its microbiological safety over time. With this in mind, ice cubes were processed with the addition of H2O2 to water before freezing. Four food ice productions were performed at the industrial level: one control trial without the addition of H2O2 (0OX) and three experimental trials obtained by adding 4, 8, and 12 mg/L of H2O2 (4OX, 8OX, and 12OX), respectively. After production, all food ice trials were artificially contaminated with 102 CFU/100 mL of water-borne pathogenic bacteria (Escherichia coli ATCC 25922, Enteroccus faecalis ATCC 29212, and Pseudomonas aeruginosa ATCC 27853) inoculated individually. Thawed ice samples were then subjected to microbiological analyses performed by the membrane filtration method and the results indicated that only trial 12OX was able to inactivate all bacteria strains. In conclusion, the addition of 12 mg/L H2O2 represents an optimal cost-effective strategy to preserve the microbiological stability of food ice even when it is improperly handled after production.

Short-term extreme mooring loads prediction and fatigue damage evaluation for station-keeping trials in ice

Full-scale tests of station-keeping trials (SKT) in drifting ice were conducted as part of research activities undertaken by the company Equinor in the Bay of Bothnia in March 2017. In the SKT project, Magne Viking was employed as a moored supply vessel in order to measure the real-time loading during the full-scale tests. At the same time, Tor Viking was served as an ice breaker to maintain the physical ice management activities with different physical schemes i.e., the square updrift pattern, the round circle pattern, the circular updrift pattern and the linear updrift pattern. In this work, the ice resistance method is adopted to estimate the ice load during the full-scale experiment of station-keeping vessel in drifting ice. Extreme mooring loads and accumulated fatigue damage corresponding to different ice management schemes are considered based on the full-scale measurements. As a result, the ice resistance method can be directly applied to predict the (undisturbed) mooring loads for station-keeping of ships in ice without being influenced by the effect of different ice management operations. Moreover, for estimation of the statistical properties of the extreme mooring load, the block maxima method, the peaks-over-threshold method, and the ACER method are applied for each of the ice management schemes. It is observed that predictions of the extreme mooring loads by the adopted procedures deviate by around twenty percent. Regarding the efficiency of the ice management schemes, it is assessed that the circular updrift pattern provides the best result. Furthermore, the Rainflow counting procedure are applied to evaluate the fatigue damage of the mooring line for the difference ice management schemes. Regarding the degree of fatigue degradation, application of the circular updrift pattern for the purpose of ice management is seen to imply the lowest damage level.

A Randomised Controlled Trial of Ice to Reduce the Pain of Immunisation-The ICE Trial.

Background and objectives: vaccine injections are a common cause of iatrogenic pain and anxiety, contributing to non-compliance with scheduled vaccinations. With injection-related pain being recognised as a barrier to vaccination uptake in both adults and children, it is important to investigate strategies to effectively reduce immunisation pain. This prospective randomised controlled trial investigated the effects of applying an ice pack on vaccine-related pain in adults. Methods: medical students receiving the flu vaccination were randomised to receive an ice pack (intervention) or placebo cold pack (control) at the injection site for 30 s prior to needle insertion. Immediate post-vaccination pain (VAS) and adverse reactions in the proceeding 24 h were recorded. Results: pain scores between the intervention (n = 19) and control groups (n = 16) were not statistically significant (intervention: median pain VAS = 7.00, IQR = 18; control: median pain VAS = 11, IQR = 14 (p = 0.26). There were no significant differences in the number of adverse events between the two groups (site pain p = 0.18; localised swelling (p = 0.67); bruising p = 0.09; erythema p = 0.46). Discussion: ice did not reduce vaccination-related pain compared to cold packs. COVID-19 related restrictions impacted participant recruitment, rendering the study insufficiently powered to draw conclusions about the results.

Cooling during short-term heat acclimation enhances aerobic capacity but not sweat capacity

ABSTRACT To characterize the adaptive responses to short-term heat acclimation (HA) training with repeated-sprint exercises and to determine the effects of ice slurry ingestion during HA on aerobic capacity and adaptations. Seven physically active males completed two 5 consecutive day interventions in a randomized cross-over design. Participants performed approximately 80-min intermittent repeated-sprints using a cycling ergometer including break-time and half time in 36.5°C and 50%RH. Participants ingested either 1.25 g·kg body mass−1 of ice slurry (ICE: −1°C) or room temperature beverage (NOC: 36.5°C) throughout each break and 7.5 g·kg body mass−1 of the same drink during half time. Maximum oxygen uptake (O2max) test in hot conditions was completed before and after HA training. Ice slurry ingestion during short-term HA training induced significantly higher both O2max and watt at O2max following HA training. Total work done was significantly higher in HA with ICE than for the NOC trial on both day 1 and day 5. Sweating Na+ concentration in NOC trial at day 5 were significantly lower than those in the NOC trial day 1, but was not observed in ICE trial. Cooling during HA training may be an effective strategy for enhancement of aerobic capacity via the adaptations gained from a higher quantity of exercise caused by cooling, but does not improve heat loss capacity. Highlights There is the potential dilemma whether cooling during short-term training in the heat might negatively impacts the process of helping athletes adapt to hot environments. Cooling during short-term heat training may be an effective strategy to enhancement of aerobic capacity via the adaptations gained from a higher quantity of exercise caused by cooling, but does not improve heat loss capacity. The study suggests the importance to selecting cooling during the heat acclimation phase of consecutive field training according to the individual's training plan.

Investigation of ship resistance characteristics under pack ice conditions

Pack ice is a matter of considerable importance for ships and offshore structures operating in ice-covered waters. In particular, Arctic sea ice has been melting much faster recently than previously thought, with ships and offshore structures in Arctic regions and ice-covered waters being frequently exposed to pack ice conditions. Consequently, minimizing ice loads and ensuring safety under these conditions is a key consideration from a design perspective. This study aims to provide a better understanding of ship resistance characteristics and to investigate the factors that influence ship resistance when navigating pack ice fields. In the study, a preparation procedure for pack ice conditions for model testing in an ice tank is introduced, and some of the variables that can affect the ship resistance—channel width, broken ice floe size, ice concentration, and ice thickness—are considered in the experiments. The significance of each variable is discussed, and non-dimensional regression analysis is then applied to derive the relationships between the four variables and an equation for pack ice resistance prediction is established on the basis of this analysis. The reliability of the equation is verified by comparing the predicted results and the results of full-scale ice trials using the icebreaker Araon.

Effect of Maneuvering on Ice-Induced Loading on Ship Hull: Dedicated Full-Scale Tests in the Baltic Sea

Maneuvers in level ice are common operations for icebreakers and polar supply vessels. Maneuvering exposes the midship and stern area to ice interaction, influencing the magnitude and frequency of ice-induced loading in these areas. However, full-scale measurements do not typically cover the midship and stern areas, as measurements have commonly focused on the bow area. Controlled maneuvering tests were conducted during the ice trials of S.A. Agulhas II in the Baltic Sea. During these tests, ice-induced loading at different hull areas was measured simultaneously with ship control, navigation, and ice condition data. This work studied the effect of maneuvers on the characteristics and statistics of ice-induced loading at different hull areas and compared the impact to ahead operations. The study showed that the maneuvers had minor impact to the magnitude, frequency, and duration of loading at the bow and bow shoulder. On the other hand, maneuvers had a clear effect on the load magnitude and frequency at the stern shoulder. Additionally, a statistical analysis showed that the load magnitude increased as a function of load duration in all hull areas. Furthermore, the analyzed measurement data are presented and made available with the paper.

Chronic Inflammatory Demyelinating Polyneuropathy: Time to Maximal Recovery in Patients Receiving Intravenous Immunoglobulin Therapy.

The response of chronic inflammatory demyelinating polyneuropathy (CIDP) to intravenous immunoglobulins (IVIgs) treatment is well established. However, it remains unclear whether patients not responding to two IVIg treatments or those whose condition stabilizes (ICE trial) may benefit from additional doses. We aim to identify the time period required to reach maximal strength gains from IVIg treatment. Retrospective chart review of 14 patients with CIDP was performed. Change in handgrip (HG), Knee extension (KE), elbow flexion, and dorsiflexion was analyzed with a dynamometer during IVIg therapy. Strength improvements in Nm or kg, cumulative grams (g) of IVIg, and time in days required for maximal strength recovery were determined per function (± standard error of the mean). Ancillary therapy was recorded for all patients. Improvements in strength of each function were significant (p < 0.05). Earliest improvement was in HG (137.07 ± 21.23) and latest in KE (238.15 ± 38.9). Majority of patients improved by 200 days of therapy. HG required the lowest cumulative grams of IgG (561.71 ± 97.21) and KE the most (798 ± 120.7). Our study has demonstrated the effectiveness of multiple treatments with IVIg to reach significant improvement in strength. Different muscle groups manifested different time dependency, reflecting the requirement of variable amounts of IVIg. Improvement was identified on an ongoing basis, with therapy lasting between 20.2 and 37.3 weeks, requiring between 562 and 798 g of IVIg.

Intracardiac echocardiography versus fluoroscopy for endovascular and endocardial catheter navigation during cryo-ablation of the slow pathway in AVNRT patients

BackgroundA new zero-fluoroscopy technique for electrophysiology catheter navigation relying on intracardiac echocardiography (ICE) has been recently reported (Ice&ICE trial). We investigated potential differences in efficacy, safety or procedural performance between conventional fluoroscopy- and ICE-guided cryothermal ablation (CA) in symptomatic AVNRT patients.MethodsClinical and electrophysiological data of AVNRT patients included in the Ice&ICE trial (22 patients, 16 females; =zero-fluoroscopy group) were compared to those of consecutive AVNRT patients, who underwent fluoroscopy-guided CA (25 patients, 17 females; = fluoroscopy group) during the last 2 years in our institution.ResultsSlow pathway ablation or modulation was successful in all patients. Fluoroscopy time and radiation dose in the fluoroscopy group were 11.2 ± 9.0 min and 20.3 ± 16.2Gycm2, whereas no fluoroscopy was used in the opposite group (p < 0.001, respectively). EPS duration was not different between the groups (zero-fluoroscopy:101.6 ± 40.2 min, fluoroscopy:99.4 ± 37.2 min, p = n.s.). Catheter placement time was significantly shorter in the fluoroscopy group (2.2 ± 1.6 min vs. 12.0 ± 7.5 min, p < 0.05), whereas cryo-application duration (from the first cryo-mapping to the last CA) was significantly shorter in the zero-fluoroscopy group (27.5 ± 37.0 min vs. 38.1 ± 33.9 min, p < 0.05). Mean cryo-mapping and CA applications were numerically lower in the zero-fluoroscopy group (CM:7.5 ± 5.7 vs. 8.8 ± 6.2; CA:3.1 ± 1.7 vs. 3.2 ± 2.0, p = n.s.). No major adverse events occurred in both groups. After 15.0 ± 4.2 months, arrhythmia recurrence was not different between the groups (4.5% vs. 8.0%, p = n.s.).ConclusionsZero-fluoroscopy ICE-guided EP catheter navigation shows comparable efficacy and safety to fluoroscopic guidance during CA in AVNRT patients. ICE visualization of catheters and endocardial structures within the triangle of Koch shortens the cryo-application duration, though time needed for catheter placement is longer, when compared with conventional fluoroscopic guidance, which results in similar mean EPS duration with both navigation techniques.Trial registration(German Clinical Trials Register ID: DRKS00011360; Registration Date 14.12.2016)

빙해역 시운전 해석을 위한 환경조건 보정 방법 및 검증

Vessel’s ice speed performances will be verified in ice sea trial but environmental conditions of ice fields are changeable according to the weather condition of ice trial area. Speed performance has to correct in the no wind, wave and current etc. after sea trial. Especially finding ice fields which is exact the same as owner’s ice thickness and strength requirements is not easy. Therefore speed correction according to environment condition has to be done after sea trial measurements. Correction methods for ice thickness, ice strength, wave, wind and ship draft, trim, ice drift etc. are checked in ice sea trial based on literature review such as ISO standard, ITTC recommendation, journal papers and proceedings of conferences. Possibility of application for current and ice drift correction in ice field are discussed and measuring schemes and procedures of correction methods are described in this paper. All of correction schemes are calculated for ‘Araon’ which is ice breaking research vessel with Arctic and Antarctic ice field test results. Analyzed results shows that Araon is satisfied with her official ice speed performance of 3 knots with 10MW power at 1m ice thickness, 570kPa ice flexural strength.

IVIG efficacy in CIDP patients is not associated with terminal complement inhibition

Patients with acute and chronic inflammatory demyelinating neuropathies exhibit elevated serum and cerebrospinal fluid (CSF) levels of terminal complement activation products and therapeutic inhibition of complement activation is currently tested for its safety and efficacy in patients with Guillain-Barré syndrome (GBS). Here, we determined serum levels of the complement activation products C3a, C5a and the soluble terminal complement complex (sTCC) in 39 individuals with chronic inflammatory demyelinating polyneuropathy (CIDP) who participated in one of the largest ever conducted clinical trial in patients with CIDP (ICE trial) and received Intravenous Immunoglobulin (IVIG) or placebo (albumin) in 3 week intervals for up to 24 weeks. In placebo-treated patients with spontaneous disease remission, serum sTCC levels moderately decreased over time. Levels of complement activation products were, however, not modulated by IVIG and remained unchanged in patients with a beneficial response to IVIG therapy as compared to those with steady or worsened disease. These results suggest that the therapeutic efficacy of IVIG in CIDP is based on immunomodulatory mechanisms different from complement inhibition. Terminal complement activation merits further investigation as a surrogate marker for disease progression and therapeutic target in patients with CIDP.

The Impact of Cryoballoon Versus Radiofrequency Ablation for Paroxysmal Atrial Fibrillation on Healthcare Utilisation and Costs: An Economic Analysis From the FIRE AND ICE Trial – An Australian private payer perspective

Background: Secondary analyses of the FIRE AND ICE trial showed patients treated with cryoballoon experienced significantly fewer repeat ablations and cardioversion (CV) hospitalisations compared to radiofrequency (RF) catheter ablation. These in turn led to significantly lower payer costs for the cryoballoon patients compared to the radiofrequency group. Objective: To convert the secondary analysis outcomes costs from an Australian private payer perspective. Methods: Translated the hospital DRGs from the study outcomes (German, UK and US) to Australian equivalent DRGs and costs using v6.0x AR-DRG grouper and Private Hospital Data Bureau 2016–17 v6.0x National charges, respectively. Sensitivity analysis was also carried out. Results: The analysis showed the cryoballoon group used fewer post-procedure healthcare resources, including fewer repeat ablations and reinterventions compared to the RF group (205 healthcare utilisation (HCU) events vs. 268 HCU events), demonstrating favourable health economics consistent over multiple healthcare systems:$AUD510 trial savings per patient under the Australian system (p = 0.009)€640 trial savings per patient under the German system (p = 0.012)£364 trial savings per patient under the UK system (p = 0.013)$USD925 trial savings per patient under the US system (p = 0.016) Conclusion: Fewer repeat ablations and CV hospitalisations led to significantly lower payer costs for the cryoballoon patients compared to the RF group. Cryoballoon improves patient outcomes with reduced healthcare utilisation and lower healthcare system costs from an Australian private payer perspective.

Comparing radiofrequency and cryoballoon technology for the ablation of atrial fibrillation.

With the growing popularity of the cryoballoon tool for catheter ablation of atrial fibrillation, there has been discussion of whether cryothermal energy is just as or more effective than traditional radiofrequency. This review will compare both thermal energies for the treatment of atrial fibrillation. Although the FIRE and ICE trial established that cryoballoon technology is noninferior to radiofrequency ablation for the treatment of atrial fibrillation, both thermal technologies have undergone advancement. This review intends to explore recent changes in technology and catheter ablation technique to improve outcomes for patients with atrial fibrillation. Catheter ablation is standard treatment for patients with atrial fibrillation, which primarily focuses on electrical isolation of the pulmonary veins. Radiofrequency is the most common approach at present times; however, over time, new technology has developed. Most successful among these is the cryoballoon tool. Although the FIRE and ICE trial indicated radiofrequency and cryothermal energy to be approximately equal in efficacy and safety, there are advantages and disadvantages to both. This review seeks to address the value of each tool, as well as further development needed to better address atrial fibrillation while improving procedural safety.

Method for estimation of icebreaker propulsion performance in ice

Classical methods of ship propulsion estimations based on the traditionally applied system of hull and propeller interaction coefficients are not suitable for prediction of icebreaker performance in ice. This is because the wake fraction tends to assume negative values in operating conditions typical of navigation in ice. This paper suggests an alternative system of hull/propeller interaction coefficients to overcome the problem. The alternative system comprises the thrust deduction factor t and the factors allowing for hull effect on thrust iTB and hull effect on torque iQB. An alternative method of ship propulsion performance estimations is developed based on this system of coefficients to take into account all characteristics of icebreaker sailing in ice. The method was used to analyze the full-scale data obtained from sea trials of the icebreakers Vladivostok and Novorosiisk. The initial data inputs for the analysis were ship speed in ice and consumed power measured during the sea trials. The number of propeller revolutions and ice resistance were calculated. The estimated propeller revolutions were compared with the full-scale data gathered during the sea trials in ice. The ice resistance was compared with the predictions based on model tests in ice basin. It is shown that at slow speeds in ice, ranging from 0.5 to 5.0 knots, the predicted number of propeller revolutions is in good agreement with the data measured during the sea trials. Propulsion performance of the Vladivostok icebreaker in 1.5-m thick ice was estimated

Highlights From the Circulation Family of Journals.

Highlights From the Circulation Family of Journals.

Abstract LB-143: Th1/Th2 and inflammatory cytokines as biomarkers of response to ipilimumab in small cell lung cancer (SCLC) patients

Abstract Ipilimumab appears to benefit a subset of patients with SCLC but no predictive marker is available to date. Cytokines encompass a group of pleiotropic proteins secreted by immune and cancer cells with a crucial role in immune response (Th1/Th2 balance). Our study sought to evaluate the role of serum cytokine levels and changes during treatment as biomarkers of outcome with ipilimumab in SCLC. Serial serum samples (pre and on-treatment at 9 weeks) from two cohorts (C) of patients with recently diagnosed SCLC were evaluated in this study. C1, with 47 patients treated with first-line platinum/etoposide (PE) and C2, with 37 patients treated with PE plus ipilimumab (10mg/kg) within the ICE trial. By means of a fluorescent multiplex immunobead assay (Luminex Technology) we analyzed serum concentrations of Th1 (IL-2, IFN-γ), Th2 (IL-4, -5, -6, -10) and inflammatory (IL-1β, IL-8, GM-CSF, TNF-α, MIP1-α) cytokines. Optimal cut-offs were determined by the Contal and O'Quigley method. We evaluated the associations of cytokine baseline levels and on-treatment changes with patient outcomes and compare these between cohorts. Statistical analysis was carried out with Stata/MP 14 (StataCorp LLC) and Prism 6.0 (GraphPad). In the ipilimumab cohort, patients with increased baseline levels of IL-2 (&amp;gt;1.67 pg/mL) showed a median overall survival (OS) of 24.2 months (m) (9.5-not reached) vs. those with lower levels [7.9m (5.6-18.46); p=0.030]. On the contrary, those with higher levels of IL-6 (&amp;gt;3.74 pg/mL) or TNF-α (&amp;gt;9.17 pg/mL) had worse OS (9.5m vs. 18.5m; p=0.019 and 7.8 vs. 18.5m; p=0.003, respectively). Lastly, patients whose IL-8 levels decreased from baseline to the on-treatment time-point (ICE) by more than 28.3%, had a worse OS [7.9m (3.9-17) vs. 18.46m (9.5-30.5); p=0.008]. The rest of associations observed were common between both cohorts. Serum levels of Th1/Th2 and inflammatory cytokines change during treatments in SCLC patients. Having a ‘control' cohort of SCLC patients treated with chemotherapy allowed us to specifically identify differential changes induced by ipilimumab. Our study suggests that cytokines could be explored as biomarkers of sensitivity (IL-2) or resistance (IL-6 and TNF-α) to ipilimumab when combined with chemotherapy. Changes of cytokine levels during treatment might also predict benefit (IL-8). These findings warrant prospective validation. Citation Format: Max Hardy-Werbin, Pedro Rocha, Oriol Arpí, Álvaro Taus, Xavier Durán Jordà, Deborah Joseph-Pietras, Ana Rovira, Joan Albanell, Christian Ottensmeier, Edurne Arriola. Th1/Th2 and inflammatory cytokines as biomarkers of response to ipilimumab in small cell lung cancer (SCLC) patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr LB-143.

The Impact of Cryoballoon Versus Radiofrequency Ablation for Paroxysmal Atrial Fibrillation on Healthcare Utilization and Costs: An Economic Analysis From the FIRE AND ICE Trial.

In the article by Chun et al, “The Impact of Cryoballoon Versus Radiofrequency Ablation for Paroxysmal Atrial Fibrillation on Healthcare Utilization and Costs: An Economic Analysis From the FIRE AND ICE Trial” which published online July 27, 2017, and appeared in the August 2017 issue of the