Polyethylene Glycol Epirubicin-Loaded Transcatheter Arterial Chemoembolization Procedures Utilizing a Combined Approach with 100 and 200 μm Microspheres: A Promising Alternative to Current Standards

PURPOSE:To report clinical effectiveness, toxicity profile, and prognostic factors of combined 100 μm ± 25 and 200 μm ± 50 epirubicin-loaded polyethylene glycol (PEG) microsphere drug-eluting embolic transcatheter arterial chemoembolization protocol in patients with hepatocellular carcinoma. MATERIALS AND METHODS: In this prospective, single-center, single-arm study with 18 months of follow-up, 36 consecutive patients (mean age 69.9 y ± 10.8; 26 men, 10 women; 54 naïve lesions) were treated. Embolization was initiated with 100 μm ± 25 microspheres, and if stasis (10 heart beats) was not achieved, 200 μm ± 50 microspheres were administered. Each syringe (2 mL) of PEG microsphere was loaded with 50 mg of epirubicin. Results were evaluated using Modified Response Evaluation Criteria In Solid Tumors with multidetector computed tomography/magnetic resonance imaging at 1, 3-6, 9-12, and 15-18 months. Toxicity profile was assessed by laboratory testing before and after the procedure. Complications were recorded. Postembolization syndrome (PES) was defined as onset of fever/nausea/pain after the procedure. Patient/lesion characteristics and treatment results were correlated with predicted outcome using regression analysis. Child-Pugh score was A in 86.1% of patients (31/36) and B in 13.9% (5/36). RESULTS: In 10 of 21 lesions, < 2 cm in diameter (47.5%) stasis was achieved with 100 μm ± 25 microspheres only, whereas all other lesions required adjunctive treatment with 200 μm ± 50 microspheres. Reported adverse events were grade 1 acute liver bile duct injury (3/39 cases, 7.7%) and PES (grade 2; 3/39 cases, 7.7%). Complete response (CR) at 1, 3-6, 9-12, and 15-18 months was 61.1%, 65.5%, 63.63%, and 62.5%. Objective response (CR + partial response) at 1, 3-6, 9-12, and 15-18 months was 83.3%, 65.85%, 63.63%, and 62.5%. No single factor (laboratory testing, etiology, patient status, hepatic status, tumor characteristics, administration protocol) predicted outcomes except for albumin level at baseline for CR (P < .05, odds ratio = 1.09). CONCLUSIONS: The combined microsphere sizing strategy was technically feasible and yielded promising results in terms of effectiveness and toxicity

CMS Software Distribution on the LCG and OSG Grids

The efficient exploitation of worldwide distributed storage and computing resources available in the grids require a robust, transparent and fast deployment of experiment specific software. The approach followed by the CMS experiment at CERN in order to enable Monte-Carlo simulations, data analysis and software development in an international collaboration is presented. The current status and future improvement plans are described.Comment: 4 pages, 1 figure, latex with hyperref

Third Level Trigger for the Fluorescence Telescopes of the Pierre Auger Observatory

The trigger system for the Auger fluorescence telescopes is implemented in hard- and software for an efficient selection of fluorescence light tracks induced by high-energy extensive air showers. The algorithm of the third stage uses the multiplicity signal of the hardware for fast rejection of lightning events with above 99% efficiency. In a second step direct muon hits in the camera and random triggers are rejected by analyzing the space-time correlation of the pixels. The trigger algorithm was tested with measured and simulated showers and implemented in the electronics of the fluorescence telescopes. A comparison to a prototype trigger without multiplicity shows the superiority of this approach, e.g. the false rejection rate is a factor 10 lower.Comment: 8 pages, 7 figures, to be published in NIM A; 1 typo correcte

FOOT: FragmentatiOn Of Target Experiment

The main goal of the FOOT (FragmentatiOn Of Target) experiment is the measurement of the differential cross sections as a function of energy and direction of the produced fragments in the nuclear interaction between a ion beam (proton, helium, carbon, ...) and different targets (proton, carbon, oxygen, ...). Depending on the beam energy, the purpose of the measurements is twofold: in the [150-400] MeV/u range, the data will be used to evaluate the side effects of the nuclear fragmentation in the hadrontherapy treatment, while in the [700-1000] MeV/u range it will be used to optimize the shielding of spaceships for long term space missions. The experiment has been funded by the INFN since September 2017 and it is currently in the construction phase. An overview of the detector, of the results obtained in several beam tests and of the expected performances will be presented

The FOOT (FragmentatiOn Of Target) experiment

Particle therapy uses proton and ion beams to treat deep-seated solid tumors, exploiting the favorable energy deposition profile of charged particles. Nuclear interactions with patient tissues can induce fragments production that must be taken into account in treatment planning: in proton treatments target fragmentation produces low-energy, short-range fragments depositing a non-negligible dose in the entry channel, while in heavier-ion beam treatments long-range fragments due to projectile fragmentation release dose in tissues surrounding the tumor. The FOOT experiment aims to study these processes to improve the nuclear interactions description in next generation Treatment Planning Systems softwares and hence the treatments quality. Target (16O and12C) fragmentation induced by 150–250MeV proton beams will be studied via inverse kinematics: 16O and12C beams (150–250MeV/u) collide on graphite and hydrocarbon targets to provide nuclear fragmentation cross sections on hydrogen. The projectile fragmentation of these beams will be explored as well. The FOOT detector includes a magnetic spectrometer to measure fragments momentum, a plastic scintillator for ΔE and TOF measurements and a scintillating crystal calorimeter to measure fragments kinetic energy. These measurements will be combined to accurately identify fragments charge and mass

International Consensus on Differential Diagnosis and Management of Patients With Danon Disease: JACC State-of-the-Art Review

Danon disease is a rare X-linked autophagic vacuolar cardioskeletal myopathy associated with severe heart failure that can be accompanied with extracardiac neurologic, skeletal, and ophthalmologic manifestations. It is caused by loss of function variants in the LAMP2 gene and is among the most severe and penetrant of the genetic cardiomyopathies. Most patients with Danon disease will experience symptomatic heart failure. Male individuals generally present earlier than women and die of either heart failure or arrhythmia or receive a heart transplant by the third decade of life. Herein, the authors review the differential diagnosis of Danon disease, diagnostic criteria, natural history, management recommendations, and recent advances in treatment of this increasingly recognized and extremely morbid cardiomyopathy

Hepatic follicular lymphoma in an old patient with Crohn’s disease: a rare case and review of the literature

OBJECTIVE: Crohn’s Disease (CD) has been associated with non-Hodgkin lymphoma. Follicular Lymphoma (FL) limited to the liver is extremely rare, accounting for 1% to 4.4% of all Primary Hepatic Lymphoma (PHL). CASE PRESENTATION: In 2018, an 85-years old male patient with post-operative recurrence of ileal CD referred rare episodes of fever and mild diffuse abdominal pain. Since cholecystectomy in 2001, clinical history was characterized by recurrent episodes of cholangitis and common bile duct stones. In 2018, ultrasonography and MRI showed a solid focal hepatic lesion (FHL)(4.5 cm x 2.5 cm) in the IV hepatic segment. The radiographic aspect of the lesion was unusual. Initially, focal nodular hyperplasia was suspected. Clinical history of cholangitis and radiological findings subsequently suggested a diagnosis of Hepatic Abscess (HA). A progressive enlargement of the FHL (7.3 cm x 5.8 cm) despite antibiotic treatments, led to perform a liver biopsy. Histological and immunophenotypi-cal analysis of the FHL (7.5 cm x 5.4 cm) enabled a final diagnosis of FL. The “in situ” hybridization for Epstein-Barr virus (EBER) was negative. No additional lesions related to FL were initially detected, thus suggesting a very rare case of PHL in an old patient with CD never treated with thiopurines. CONCLUSIONS: This case report highlights the need to consider a rare diagnosis of FL of the liver in patients showing a challenging focal hepatic lesion of unknown origin

Incidence of stroke in patients with hypertrophic cardiomyopathy in stable sinus rhythm during long-term monitoring.

Patients with hypertrophic cardiomyopathy (HCM) are at increased risk of stroke, but the incidence and factors associated with cardioembolic events in HCM patients without atrial fibrillation (AF) remain unresolved. We determined the incidence of stroke in patients in sinus rhythm (SR) monitored with a cardiac implantable electronic device (CIED). All consecutive patients diagnosed with HCM and referred to CIED implantation with >16 years at diagnosis and ≥ 1 year follow-up post CIED implantation were retrospectively reviewed. Severe LA dilatation was defined as ≥48 mm. Patients were stratified by rhythm as: Pre-existing AF (AF present prior to CIED); De novo AF (AF present after CIED implantation); SR: no episodes of AF. Of 1651 patients, 185 (11.2%) implanted with a CIED were included (57% men, age: 54 ± 17 years). Baseline, pre-existing AF was present in 73 (39%) patients. Ischemic stroke was reported in 19 (10.3%, 1.78%/year) patients and was similar across the three groups (2.3%/year vs 1.1%/year vs 0.6%/year in patients in SR vs pre-existing AF vs de novo AF, respectively, p = 0.235). In SR patients, a LAD≥48 mm posed the greatest risk of stroke (Hazard Ratio: 10.03,95% Confidence-Interval 2.79-16.01). At Cox multivariable analysis, after adjustment for oral anticoagulation, LA was independently associated with stroke while rhythm was not. in HCM patients with CIED long-term monitoring and no prior history of AF, stroke rates were similar in those with de novo AF or stable SR. Severe LA dilatation was a powerful risk factor, irrespective of AF