Lung Transplant for Interstitial Lung Diseases

Lung transplant is an important treatment modality for select cases of advanced interstitial lung disease. However, the pre- and postoperative management requires several unique considerations. The decision to transplant is based largely on clinical severity of illness and the lung allocation score. Transplant improves overall mortality across the interstitial lung diseases, though not all ILD subtypes experience equal benefit from lung transplant. Broadly speaking, there is no difference in benefit between single- and bilateral-lung transplants, though we will discuss some important clinical nuances to this decision as well. Lastly, there are a number of immunosuppression, coagulation, and malignancy risk considerations that must be carefully understood in caring for the lung transplant patient. This chapter will provide a general overview of the indications for lung transplant, risk stratification for lung transplant across the interstitial lung diseases, as well as general postoperative management details

Die Militärreform in Russland und ihre Folgen

Die Fähigkeit der russischen Streitkräfte zu effektivem, flexiblem und schnellem Eingreifen, wie es sich bei der Annexion der Krim gezeigt hat, sowie bei der Führung eines hybriden Krieges im Donbass und dem Einsatz in Syrien sind Ergebnis einer Militärreform, die von 2008 bis 2012 durchgeführt wurde. Dies wirft die Frage auf, ob die »liberale« Militärreform dem autoritären Staat einen Nutzen gebracht hat. Es ist nicht ausgeschlossen, dass Russland das Aufkommen eines »neuen Militarismus« zu erwarten hat, in dem sich moderne Modelle des Militäraufbaus mit der totalitären Ideologie einer mobilisierten Massenarmee verbinden würden. Bereits jetzt ist klar: Selbst eine »richtige« Reform in einem bestimmten Bereich, beispielsweise beim Militär, garantiert noch keineswegs eine positive Entwicklung des autoritären Regimes

CLIPTER: Looking at the Bigger Picture in Scene Text Recognition

Reading text in real-world scenarios often requires understanding the context surrounding it, especially when dealing with poor-quality text. However, current scene text recognizers are unaware of the bigger picture as they operate on cropped text images. In this study, we harness the representative capabilities of modern vision-language models, such as CLIP, to provide scene-level information to the crop-based recognizer. We achieve this by fusing a rich representation of the entire image, obtained from the vision-language model, with the recognizer word-level features via a gated cross-attention mechanism. This component gradually shifts to the context-enhanced representation, allowing for stable fine-tuning of a pretrained recognizer. We demonstrate the effectiveness of our model-agnostic framework, CLIPTER (CLIP TExt Recognition), on leading text recognition architectures and achieve state-of-the-art results across multiple benchmarks. Furthermore, our analysis highlights improved robustness to out-of-vocabulary words and enhanced generalization in low-data regimes.Comment: Accepted for publication by ICCV 202

Zwischen alter und neuer Weltordnung: die Logik der Russischen Außen- und Sicherheitspolitik

Politische Entscheidungen im System von Präsident Wladimir Putin folgen einer militärisch-technischen Logik und militärische Stärke ist ein Hauptinstrument russischer Außenpolitik. Die Modernisierung des nuklearen Potentials wird als Faustpfand in der Abschreckung vor allem gegenüber den USA gesehen, das Russland zugleich auf Augenhöhe mit dem Gegner bringt. Ebenso legitim ist für den Kreml die hybride Kriegsführung mit Desinformation, Cyber-Angriffen, Fake-News und von Russland gesteuerten Auslandsmedien

The A53T alpha-synuclein mutation increases iron-dependent aggregation and toxicity

Parkinson's disease (PD) is the most common motor disorder affecting the elderly. PD is characterized by the formation of Lewy bodies and death of dopaminergic neurons. The mechanisms underlying PD are unknown, but the discoveries that mutations in alpha-synuclein can cause familial PD and that alpha-synuclein accumulates in Lewy bodies suggest that alpha-synuclein participates in the pathophysiology of PD. Using human BE-M17 neuroblastoma cells overexpressing wild-type, A53T, or A30P alpha-synuclein, we now show that iron and free radical generators, such as dopamine or hydrogen peroxide, stimulate the production of intracellular aggregates that contain alpha-synuclein and ubiquitin. The aggregates can be identified by immunocytochemistry, electron microscopy, or the histochemical stain thioflavine S. The amount of aggregation occurring in the cells is dependent on the amount of alpha-synuclein expressed and the type of alpha-synuclein expressed, with the amount of alpha-synuclein aggregation following a rank order of A53T > A30P > wild-type > untransfected. In addition to stimulating aggregate formation, alpha-synuclein also appears to induce toxicity. BE-M17 neuroblastoma cells overexpressing alpha-synuclein show up to a fourfold increase in vulnerability to toxicity induced by iron. The vulnerability follows the same rank order as for aggregation. These data raise the possibility that alpha-synuclein acts in concert with iron and dopamine to induce formation of Lewy body pathology in PD and cell death in PD

Pre-arterialization of coronary veins prior to retroperfusion of ischemic myocardium: percutaneous closure device

BackgroundChronic coronary retroperfusion to treat myocardial ischemia has previously failed due to edema and hemorrhage of coronary veins suddenly exposed to arterial pressures. The objective of this study was to selectively adapt the coronary veins to become arterialized prior to coronary venous retroperfusion to avoid vascular edema and hemorrhage.Methods and resultsIn 32 animals (Group I = 19 and Group II = 13), the left anterior descending (LAD) artery was occluded using an ameroid occlusion model. In Group I, the great cardiac vein was blocked with suture ligation (Group IA = 11) or with occlusion device (Group IB = 8) to arterialize the venous system within 2 weeks at intermediate pressure (between arterial and venous levels) before a coronary venous bypass graft (CVBG) was implemented through a left internal mammary artery (LIMA) anastomosis. Group II only received the LAD artery occlusion and served as control. Serial echocardiograms showed recovery of left ventricular (LV) function with this adaptation-arterialization approach, with an increase in ejection fraction (EF) in Group I from 38% ± 5% after coronary occlusion to 53% ± 7% eight weeks after CVBG, whereas in Group II the EF never recovered (41% ± 2%–33% ± 7%). The remodeling of the venous system not only allowed restoration of myocardial function when CVBG was implemented but possibly promoted a novel form of “collateralization” between the native arterioles and the newly arterialized venules, which revascularized the ischemic myocardium.ConclusionsThese findings form a potential rationale for a venous arterialization-revascularization treatment for the refractory angina and the “no-option” patients using a hybrid percutaneous (closure device for arterialization)/surgical approach (CVBG) to revascularize the myocardium