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Mesonephric carcinoma is a rare cancer that most often arises within the cervix, and less frequently, in the ovary and endometrium. A retrospective search of our CLIA-certified and CAP-accredited reference molecular laboratory database (Foundation Medicine, Inc.) identified 20 mesonephric or mesonephric-like, cervical (n = 10), endometrial (n = 5), ovarian (n = 4) or peri-bladder (n = 1) carcinomas that had undergone comprehensive genomic profiling via next generation sequencing. Activating KRAS mutations were present in 90%, 18 of 20 cases, including G12V (n = 7), G12D (n = 6), G12A (n = 3) and G12C (n = 2). Other recurrent alterations were identified in ARID1A (25%), PIK3CA (20%), CTNNB1 (15%), TP53 (10%), MLL2 (10%) and CDKN2A (10%). One KRAS wild-type case had a GATA3 mutation as the sole alteration, while the second KRAS wild-type case had an EGFR exon 20 insertion D770_N771insSVD alteration. All tumors were negative for HPV DNA, microsatellite instability, high tumor mutational burden and homologous recombination deficiency. A circulating tumor DNA (ctDNA) liquid biopsy from peripheral blood, which was performed 6 years after original solid tumor resection in one patient with suspected lung metastasis, revealed concordance of KRAS alteration, gains of chromosomes 1q, 2, 10, 12 and 20, plus new TP53 alterations in the liquid biopsy compared to the original sample. KRAS G12 mutation is major driver of mesonephric and mesonephric-like carcinomas, with less frequent contribution by ARID1A and PIK3CA pathways in tumors of non-cervical origin. ctDNA liquid biopsy may be useful in detecting mutations in recurrent or metastatic patients, who may potentially be eligible for trials against emerging targeted therapies.

BackgroundAcute kidney injury in hospital patients is common and associated with reduced survival and higher healthcare costs. The Tackling Acute Kidney Injury (TAKI) quality improvement project aimed to reduce mortality rates in patients with acute kidney injury by implementing a multicomponent intervention comprising of an electronic alert, care bundle and education in five UK hospitals across a variety of wards. A parallel developmental evaluation using a case study approach was conducted to provide the implementation teams with insights into factors that might impact intervention implementation and fidelity. The qualitative element of the evaluation will be reported.Methods29 semi-structured interviews with implementation teams across the five hospitals were carried out to identify perceived barriers and enablers to implementation. Interviews were taped and transcribed verbatim and Framework analysis was conducted.ResultsInterviews generated four 'barriers and enablers' to implementation themes: i) practical/contextual factors, ii) skills and make-up of the TAKI implementation team, iii) design, development and implementation approach, iv) staff knowledge, attitudes, behaviours and support. Enablers included availability of specialist teams (e.g. educational teams), multi-disciplinary implementation teams with strong leadership, team-based package completion and proactive staff. Barriers were frequently the converse of facilitators.ConclusionsDespite diversity of sites, a range of common local factors-contextual, intervention-based and individual-were identified as potential barriers and enablers to fidelity, including intervention structure/design and process of/approach to implementation. Future efforts should focus on early identification and management of barriers and tailored optimisation of known enablers such as leadership and multidisciplinary teams to encourage buy-in. Improved measures of real-time intervention and implementation fidelity would further assist local teams to target their support during such quality improvement initiatives.

This study aimed to understand the relationship between an English Premier League club’s league position, average annual player wage bill and their dependence on set-pieces for goals. The relationships between these variables were studied in this research paper using Spearman’s rank correlation. The data was collected from the 2018-19 and 2019-20 English Premier League seasons from the official Premier League website, for the 20 clubs playing in the league for each corresponding season. A total of 760 matches were watched and analysed over the two seasons. The results showed that (1) there exists a significant moderate negative correlation (⍴ = -0.542 for 2018-19 and ⍴ = -0.516 for 2019-20) between a team’s final league position and their percentage of set-piece goals, and (2) a moderate negative correlation (⍴ = -0.493 for 2018-19 and ⍴ = -0.475 for 2019-20) between a team’s average weekly player wages and their percentage of set-piece goals. A high positive correlation (⍴ = 0.866 for 2018-19 and ⍴ = 0.733 for 2019-20) was also found between a club’s league position and its player wage expenditure which reinforces previous findings. This implies that teams lower in the league table tend to be more reliant on set-pieces to score goals. Similarly, teams with a lower average weekly player wage tend to be more dependent on set-pieces to score goals. Teams higher in the league table or with a greater wage bill do not necessarily score fewer goals via set-pieces but tend to score more goals from open play than lower opposition, which is why their percentage of goals scored via set-pieces is less. These results could impact managers’ tactics before games, a club’s recruitment strategies as well as the football betting industry.

In normal adult renal system, the renal artery originates from the abdominal aorta at the level of the lower border of L1 vertebrae, just below the origin of the superior mesenteric artery, one on each side. In 15-30% of the population, rare variation in origin and distribution pattern of renal artery can be seen. These variations may be attributed to anomalies in the development of the vascular system. These anomalies lead to the emergence of accessory or multiple renal arteries, causing significant variations in normal anatomical pattern. The aim of present study was to report the presence of double renal arteries on both sides, which has about 10% occurrence amongst all renal artery variations. Most commonly, double arteries are found unilaterally in approximately 30% of cases. Also, in the present case, the renal system was perfused by additional prehilar branches and polar arteries arising from either of the renal arteries. Hence, it is a rare entity. The occurrence of such variation in the vasculature of renal arteries has significant clinical implications. The knowledge of presence of aberrant or multiple renal arteries is significant for urologists, physicians, radiologists and surgeons, while performing surgeries related to kidneys, adrenal glands and associated structures.