Specificity of Four Laboratory Approaches for Cross-Sectional HIV Incidence Determination: Analysis of Samples from Adults with Known Nonrecent HIV Infection from Five African Countries

Assays to determine cross-sectional HIV incidence misclassify some individuals with nonrecent HIV infection as recently infected, overestimating HIV incidence. We analyzed factors associated with false-recent misclassification in five African countries. Samples from 2197 adults from Botswana, Kenya, South Africa, Tanzania, and Uganda who were HIV infected > 12 months were tested using the (1) BED capture enzyme immunoassay (BED), (2) avidity assay, (3) BED and avidity assays with higher assay cutoffs (BED+ avidity screen), and (4) multiassay algorithm (MAA) that includes the BED+ avidity screen, CD4 cell count, and HIV viral load. Logistic regression identified factors associated with misclassification. False-recent misclassification rates and 95% confidence intervals were BED alone: 7.6% (6.6, 8.8); avidity assay alone: 3.5% (2.7, 4.3); BED+ avidity screen: 2.2% (1.7, 2.9); and MAA: 1.2% (0.8, 1.8). The misclassification rate for the MAA was significantly lower than the rates for the other three methods (each p < 0.05). Misclassification rates were lower when the analysis was limited to subtype C-endemic countries, with the lowest rate obtained for the MAA [0.8% (0.2, 1.9)]. Factors associated with misclassification were for BED alone: country of origin, antiretroviral treatment (ART), viral load, and CD4 cell count; for avidity assay alone: country of origin; for BED+ avidity screen: country of origin and ART. No factors were associated with misclassification using the MAA. In a multivariate model, these associations remained significant with one exception: the association of ART with misclassification was completely attenuated. A MAA that included CD4 cell count and viral load had lower false-recent misclassification than the BED or avidity assays (alone or in combination). Studies are underway to compare the sensitivity of these methods for detection of recent HIV infection

Ancient DNA reveals admixture history and endogamy in the prehistoric Aegean (advance online)

The Neolithic and Bronze Ages were highly transformative periods forthe genetic history of Europe but for the Aegean—a region fundamentalto Europe’s prehistory—the biological dimensions of cultural transitionshave been elucidated only to a limited extent so far. We have analysed newlygenerated genome-wide data from 102 ancient individuals from Crete, theGreek mainland and the Aegean Islands, spanning from the Neolithic tothe Iron Age. We found that the early farmers from Crete shared the sameancestry as other contemporaneous Neolithic Aegeans. In contrast, the endof the Neolithic period and the following Early Bronze Age were marked by‘eastern’ gene flow, which was predominantly of Anatolian origin in Crete.Confirming previous findings for additional Central/Eastern Europeanancestry in the Greek mainland by the Middle Bronze Age, we additionallyshow that such genetic signatures appeared in Crete gradually from theseventeenth to twelfth centuries bc, a period when the influence of themainland over the island intensified. Biological and cultural connectednesswithin the Aegean is also supported by the finding of consanguineousendogamy practiced at high frequencies, unprecedented in the globalancient DNA record. Our results highlight the potential of archaeogenomicapproaches in the Aegean for unravelling the interplay of genetic admixture,marital and other cultural practice

Intra-fraction setup variability: IR optical localization vs. X-ray imaging in a hypofractionated patient population

<p>Abstract</p> <p>Background</p> <p>The purpose of this study is to investigate intra-fraction setup variability in hypo-fractionated cranial and body radiotherapy; this is achieved by means of integrated infrared optical localization and stereoscopic kV X-ray imaging.</p> <p>Method and Materials</p> <p>We analyzed data coming from 87 patients treated with hypo-fractionated radiotherapy at cranial and extra-cranial sites. Patient setup was realized through the ExacTrac X-ray 6D system (BrainLAB, Germany), consisting of 2 infrared TV cameras for external fiducial localization and X-ray imaging in double projection for image registration. Before irradiation, patients were pre-aligned relying on optical marker localization. Patient position was refined through the automatic matching of X-ray images to digitally reconstructed radiographs, providing 6 corrective parameters that were automatically applied using a robotic couch. Infrared patient localization and X-ray imaging were performed at the end of treatment, thus providing independent measures of intra-fraction motion.</p> <p>Results</p> <p>According to optical measurements, the size of intra-fraction motion was (<it>median ± quartile</it>) 0.3 ± 0.3 mm, 0.6 ± 0.6 mm, 0.7 ± 0.6 mm for cranial, abdominal and lung patients, respectively. X-ray image registration estimated larger intra-fraction motion, equal to 0.9 ± 0.8 mm, 1.3 ± 1.2 mm, 1.8 ± 2.2 mm, correspondingly.</p> <p>Conclusion</p> <p>Optical tracking highlighted negligible intra-fraction motion at both cranial and extra-cranial sites. The larger motion detected by X-ray image registration showed significant inter-patient variability, in contrast to infrared optical tracking measurement. Infrared localization is put forward as the optimal strategy to monitor intra-fraction motion, featuring robustness, flexibility and less invasivity with respect to X-ray based techniques.</p

The H2020-SPACE-ORIONAS project: "Lasercom-on-chip" for high-speed satellite constellation interconnectivity

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Colorectal Cancer Stage at Diagnosis Before vs During the COVID-19 Pandemic in Italy

IMPORTANCE Delays in screening programs and the reluctance of patients to seek medical attention because of the outbreak of SARS-CoV-2 could be associated with the risk of more advanced colorectal cancers at diagnosis. OBJECTIVE To evaluate whether the SARS-CoV-2 pandemic was associated with more advanced oncologic stage and change in clinical presentation for patients with colorectal cancer. DESIGN, SETTING, AND PARTICIPANTS This retrospective, multicenter cohort study included all 17 938 adult patients who underwent surgery for colorectal cancer from March 1, 2020, to December 31, 2021 (pandemic period), and from January 1, 2018, to February 29, 2020 (prepandemic period), in 81 participating centers in Italy, including tertiary centers and community hospitals. Follow-up was 30 days from surgery. EXPOSURES Any type of surgical procedure for colorectal cancer, including explorative surgery, palliative procedures, and atypical or segmental resections. MAIN OUTCOMES AND MEASURES The primary outcome was advanced stage of colorectal cancer at diagnosis. Secondary outcomes were distant metastasis, T4 stage, aggressive biology (defined as cancer with at least 1 of the following characteristics: signet ring cells, mucinous tumor, budding, lymphovascular invasion, perineural invasion, and lymphangitis), stenotic lesion, emergency surgery, and palliative surgery. The independent association between the pandemic period and the outcomes was assessed using multivariate random-effects logistic regression, with hospital as the cluster variable. RESULTS A total of 17 938 patients (10 007 men [55.8%]; mean [SD] age, 70.6 [12.2] years) underwent surgery for colorectal cancer: 7796 (43.5%) during the pandemic period and 10 142 (56.5%) during the prepandemic period. Logistic regression indicated that the pandemic period was significantly associated with an increased rate of advanced-stage colorectal cancer (odds ratio [OR], 1.07; 95%CI, 1.01-1.13; P = .03), aggressive biology (OR, 1.32; 95%CI, 1.15-1.53; P &lt; .001), and stenotic lesions (OR, 1.15; 95%CI, 1.01-1.31; P = .03). CONCLUSIONS AND RELEVANCE This cohort study suggests a significant association between the SARS-CoV-2 pandemic and the risk of a more advanced oncologic stage at diagnosis among patients undergoing surgery for colorectal cancer and might indicate a potential reduction of survival for these patients

Towards a redefinition of dissociative spectrum dimensions inside Capgras and misidentification syndromes in bipolar disorder: case series and literature review

Introduction: Misidentification phenomena and Capgras Sym- drome (CS) occur in different psychiatric (psychotic or ma- jor affective illnesses) and neurological (traumatic brain injury, epilepsy, neurosyphilis, delirium, migraine, multiple sclerosis,arteriovenous malformation, tumor, stroke and dementia) disor- ders [1]. Patients with CS report that one or more well-known persons (usually familiy members) or even the patient himself have been replaced by a “double” or impostor. This core symp- tomatology may occur within nihilistic delusions of Cotard’s Syn- drome (the delusional perceptions of physical transformation or of not being alive) and can be accompanied by intermetamorphosis, autoscopy, heautoscopy, depersonalization and derealization as well as by erotomanic or jealousy delusions [2]. The aim of this report is to redefine dissociative spectrum dimensions inside CS and misidentification syndromes in patients with Bipolar Disorder (BD).Method: Five inpatients presenting with BD and CS were assessed with the SCID-P for Axis I diagnosis. As regards psy- chopathological evaluation, the patients were also administered the Structured Clinical Interview for Derealization and Depersonaliza- tion Spectrum (SCI-DER), the Depersonalization Severity Scale (DSS) for dissociative spectrum symptoms, the Hamilton Rating Scale for Depression (HRSD) to quantify depressive features as well as the Young Mania Rating Scale (YMRS) to measure manic symptoms. The SCI-DER was developed at the Departments of Psychiatry, Neurobiology, Pharmacology, and Biotechnologies of the University of Pisa by experienced psychiatrists. It includes 49 items exploring “presence” or “absence” of lifetime spontaneous symptoms of DP organized into four domains: (1) Derealization, (2) Somatopsychic depersonalization, (3) Autopsychic depersonal- ization, and (4) Affective depersonalization. All patients received a neurological and general medicine review as well as a first-level brain imaging examination (CT and/or MRI). We conducted a systematic literature review with the principal scientific databases (PubMed, Embase, PsychInfo) using the key terms “Capgras Syndrome” and “Misidentificaition”.Discussion and Conclusion: To our knowledge in the literature there are no studies that evaluated dissociative spectrum symptoms in CS in BD. Our findings suggest that autopsychic and affective depersonalization are the effective dissociative dimensions when CS or misidentification phenomena occur within type-I BD. Disso- ciation and self-concept clarity were strongly correlated providing evidence that they may form a unitary underlying concept of ‘self- concept integration’. This particular condition of identity and self fragmentation, as well as reduction of self clarity, could be the key to shedding light on the interconnection between affective and nonaffective psychotic disorders from schizophrenia to BD, and may underscore the possible validity of the concept of the unitary psychosis (Einheitpsychose) proposed by Griesinger [3−5]. Fur- ther research is warranted to replicate our clinical and qualitative observations and, in general, quantitative studies in large samples followed up over time are needed. Methodological limitations, clinical implications and suggestions for future research directions are considered.References [1] Fishbain D.A., 1987. The frequency of Capgras delusions in psychiatric emergency service. Psychopathology 20:42−47. [2] Salvatore P., Bhuvaneswar C., Tohen M., Khalsa H.M.K., Maggini C., Baldessarini R.J., 2014. Capgras’ Syndrome in first-Episode Psychotic Disorders. Psychopathology 47(4):261−9.[3] Griesinger W., 1882. Mental pathology and therapeutics, in: Griesinger W., Book third, Forms of mental disease, New York, Hafner Pub. Co., p.144–145. [4] Reininghaus U., Priebe S., Bentall R.P., 2013. Testing the psychopa- tology of psychosis: evidence for a general psychosis dimension. Schizophr Bull 39(4):884−95. [5] Kumbier E., Herpeterz S.C., 2010. Helmut Rennert’s universal gen- esis of endogenous psychoses: the historical concept and its signif- icance for today’s discussion on unitary psychosis. Psychopathology 43(6):335−44