The pan-cancer analysis of whole genomes The expansion of whole-genome sequencing studies from individual ICGC and TCGA working groups presented the opportunity to undertake a meta-analysis of genomic features across tumour types. To achieve this, the PCAWG Consortium was established. A Technical Working Group implemented the informatics analyses by aggregating the raw sequencing data from different working groups that studied individual tumour types, aligning the sequences to the human genome and delivering a set of high-quality somatic mutation calls for downstream analysis (Extended Data Fig. 1). Given the recent meta-analysis

Conclusion:Stent-graft placement is an effective option for emergency repair of descending thoracic aortic perforations.Summary: The authors evaluated 31 consecutive patients who underwent catheter-based treatment of perforating lesions of the descending aorta. Twenty-one patients received treatment of rupture of a descending thoracic aneurysm or descending thoracic aortic dissection, and 10 patients received treatment of traumatic disruption of the descending aorta. A total of 32 endographs were implanted.Endograft placement was successful in all patients. In 1 patient a second prosthesis was necessary, because of type I endoleak. The mortality rate at 30 days was 9.7%. One of 3 deaths occurred secondary to type I endoleak and aortic rupture. All 3 deaths occurred in patients with rupture of a descending thoracic aneurysm or thoracic dissection. Other complications associated with placement of the endograft were also more common in patients who received treatment of a descending thoracic aneurysm or dissection, compared with those who received treatment of traumatic transection of the descending aorta (28.6% vs 10%). The left subclavian artery was intentionally covered in 6 patients, without a major acute adverse event. No complications were noted secondary to placement of endograft struts into the aortic arch. There was no paraplegia and no further deaths or ruptures during a mean follow-up of 17 months.Comment: Clearly, endograft repair of thoracic aortic disruption is feasible with excellent short-term results in selected patients. It is still unclear the percent of patients with acute thoracic disruption who will be eligible for endograft therapy. Nevertheless, as these devices become more available, endograft therapy for acute thoracic aortic disruption will be the preferred treatment in selected patients. Randomized clinical trial of distal anastomotic interposition vein cuff and infrainguinal polytetrafluoroethylene (PTFE) bypass grafting

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Gastric cancers, with gastric adenocarcinoma (GAC) as the most common histological type, impose a considerable global health burden. Although the screening strategies for early detection have been shown to be successful in Japan and South Korea, they are either not implemented or not feasible in most of the world, leading to late diagnosis in most patients. Helicobacter pylori infection contributes to the development of many endemic GACs, and pre-emptive eradication or early treatment of this bacterial infection might provide effective primary prevention. GACs are phenotypically and genotypically heterogeneous. Localized (clinical stage I) GAC is best treated either endoscopically or with limited surgical resection, but clinical stage II or stage III tumours require multidisciplinary adjunctive approaches in addition to surgery. Although GAC is highly treatable in its early stages, advanced (clinical stage IV) GAC has a median survival of just ∼9-10 months. However, detailed molecular and immune profiling of GAC is yielding promise; early studies with immune checkpoint inhibitors suggest that GAC is amenable to immune modulation. Molecular studies have yielded a vast quantity of new information for potential exploitation. Nevertheless, advances against GACs have lagged compared with other tumours of similar incidence, and more research is necessary to overcome the obstacles to prolong survival.