Multiple intracranial germinomas: A case report

Les germinomes sont des tumeurs malignes dérivant des cellules primitives germinales occupant les structures de la ligne médiane au niveau cérébral telle la région pinéale et/ou sellaire. Nous rapportons un cas de localisation multiples chez un patient de 38 ans, révélé par un syndrome d’hypertension intracrânienne et une baisse de l’acuité  visuelle.L’IRM cérébrale a permis de voir les trois localisations: pinéale ; sellaire et au niveau de l’angle ponto cérébelleux droit .Les marqueurs tumoraux étaient positives. Le patient a bénéficié d’un shunt interne et a entrepris aussitôt un traitement complémentaire enchainant  chimiothérapie et radiothérapie avec une très bonne évolution clinique et radiologique.A notre connaissance aucun cas similaire n’a déjà été décrit dans la littérature africaine. Germinomas are malignant tumors arising from primitive germ cells. They may be solitary or multiple and can be situated along the midline structures or in other intracranial regions. We report on one case of multiple intracranial germinoma. A 38 year-old male patient presented with signs of increased intracranial pressure and bilateral dimunition of visual acuity. A brain MRI showed multiple lesions at the level of the pineal region, the suprasellar region and in the right pontocerebellar angle. Tumor markers were positive. He underwent radiation therapy and chemotherapy with good recovery. To the best of our knowledge no similar case was described in the African literature before

Evorus: A Crowd-powered Conversational Assistant Built to Automate Itself Over Time

Crowd-powered conversational assistants have been shown to be more robust than automated systems, but do so at the cost of higher response latency and monetary costs. A promising direction is to combine the two approaches for high quality, low latency, and low cost solutions. In this paper, we introduce Evorus, a crowd-powered conversational assistant built to automate itself over time by (i) allowing new chatbots to be easily integrated to automate more scenarios, (ii) reusing prior crowd answers, and (iii) learning to automatically approve response candidates. Our 5-month-long deployment with 80 participants and 281 conversations shows that Evorus can automate itself without compromising conversation quality. Crowd-AI architectures have long been proposed as a way to reduce cost and latency for crowd-powered systems; Evorus demonstrates how automation can be introduced successfully in a deployed system. Its architecture allows future researchers to make further innovation on the underlying automated components in the context of a deployed open domain dialog system.Comment: 10 pages. To appear in the Proceedings of the Conference on Human Factors in Computing Systems 2018 (CHI'18

L’hemangiopericytome (a propos de 8 cas)

Description L’hémangiopéricytome est une tumeur rare, mésenchymateuse, qui prend naissance au niveau des péricytes de Zimmerman. Il est souvent confondu avec le méningiome. Objectif Faire le point sur cette entité histologique souvent méconnue. Méthodes Une étude rétrospective de 8 cas d’hémangiopéricytome colligés au Service de Neurochirurgie de l’hôpital Ibn Rochd de Casablanca au Maroc, entre 2000 et 2008. Résultats Il s’agissait de 6 hommes et 2 femmes. L’âge moyen de nos patients était de 50 ans. Le délai moyen de diagnostic était de 4,75 mois. Le tableau clinique était dominé par les signes d’hypertension intracrânienne. Le bilan neuroradiologique a objectivé le caractère unique des lésions, une taille moyenne de 6,33 cm. Tous nos patient ont été traité par chirurgie avec résection subtotale dans 5 cas et totale dans le reste. Un patient a bénéficié de la radiothérapie post opératoire. L’évolution a été marquée par l’apparition d’une récidive, 3 cas de reprise évolutive et un décès. L’apparition de métastases n’a pas été notée dans notre série. Conclusion L’hémangiopéricytome se caractérise par son potentiel malin, son taux élevé de récidive et de métastase à distance. Son évolution est imprévisible nécessitant une surveillance prolongée.Mots clés : Cellules de Zimmerman, Hémangiopéricytome, Méningiom

Temporal evolution of anxiety and depression in chronic heart failure and its association with clinical outcome

Background: Although anxiety and depression have been associated with adverse outcomes in chronic heart failure (HF), data on temporal evolution of these symptoms are scarce. We aimed to investigate the association between repeatedly measured depression and anxiety symptoms and clinical outcome in chronic HF patients. Methods: In this prospective observational study, outpatients with chronic HF were included and followed-up for a maximum of 2.5 years. The hospital anxiety and depression scale (HADS) questionnaire was conducted every six months. The primary endpoint was a composite of HF hospitalization, cardiovascular death, heart transplantation and left ventricular assist device (LVAD) implantation. Cox and joint models were used to investigate the association between the HADS score and the endpoint. Results: A total of 362 patients filled out a median (25th–75th percentile) of 3 [2–4] questionnaires each. Mean ± SD age was 63 ± 13 years, 72% were men. Anxiety scores remained relatively stable leading up to the endpoint, while depression scores increased. Higher baseline depression scores were significantly associated with the endpoint (hazard ratio [HR] 1.68 and 95% confidence interval [CI] 1.19–2.36 per log(score+1), p = 0.003), while higher baseline anxiety scores did not reach statistical significance (HR [95% CI] 1.34 [0.99–1.83], p = 0.061). When repeatedly measured, both higher anxiety (HR [95% CI] 1.57[1.07–2.30], p = 0.022) and depression (HR [95% CI] 2.04 [1.39–3.06], p &lt; 0.001) scores were significantly associated with the endpoint. Conclusion: Serial measurements of depression and anxiety symptoms identify chronic HF patients with increased risk of adverse clinical outcomes. Screening for both disorders should be considered in clinical practice.</p

Mortality Prediction after the First Year of Kidney Transplantation: An Observational Study on Two European Cohorts.

After the first year post transplantation, prognostic mortality scores in kidney transplant recipients can be useful for personalizing medical management. We developed a new prognostic score based on 5 parameters and computable at 1-year post transplantation. The outcome was the time between the first anniversary of the transplantation and the patient's death with a functioning graft. Afterwards, we appraised the prognostic capacities of this score by estimating time-dependent Receiver Operating Characteristic (ROC) curves from two prospective and multicentric European cohorts: the DIVAT (Données Informatisées et VAlidées en Transplantation) cohort composed of patients transplanted between 2000 and 2012 in 6 French centers; and the STCS (Swiss Transplant Cohort Study) cohort composed of patients transplanted between 2008 and 2012 in 6 Swiss centers. We also compared the results with those of two existing scoring systems: one from Spain (Hernandez et al.) and one from the United States (the Recipient Risk Score, RRS, Baskin-Bey et al.). From the DIVAT validation cohort and for a prognostic time at 10 years, the new prognostic score (AUC = 0.78, 95%CI = [0.69, 0.85]) seemed to present significantly higher prognostic capacities than the scoring system proposed by Hernandez et al. (p = 0.04) and tended to perform better than the initial RRS (p = 0.10). By using the Swiss cohort, the RRS and the the new prognostic score had comparable prognostic capacities at 4 years (AUC = 0.77 and 0.76 respectively, p = 0.31). In addition to the current available scores related to the risk to return in dialysis, we recommend to further study the use of the score we propose or the RRS for a more efficient personalized follow-up of kidney transplant recipients

Sequencing and Characterisation of Complete Mitogenome DNA for Rasbora hobelmani (Cyprinidae) with Phylogenetic Consideration

The Kottelat rasbora Rasbora hobelmani is a small ray-finned fish categorized under the genus Rasbora in the Cyprinidae family. In this study, the complete mitogenome sequence of R. hobelmani was sequenced using two pairs of primers covering overlapping regions. The mitogenome is 16541 bp in length, housing 22 transfer RNA genes, 13 protein-coding genes, two ribosomal RNA genes and one putative control region. Identical gene organisation was spotted between this species and other Rasbora genus members. The heavy strand contains 28 genes while the light strand contains the remaining nine genes. Most protein-coding genes employ ATG as start codon, except for the COI gene, which exploits GTG instead. The central conserved sequence blocks (CSB-F, CSB-E and CSB-D), variable sequence blocks (CSB-3, CSB-2 and CSB-1) as well as the terminal associated sequence (TAS) are conserved in the control region. The maximum likelihood phylogenetic tree revealed the close phylogeny of R. hobelmani with R. sumatrana, R. aprotaenia, R. lateristriata and R. steineri with bootstrap value of at least 99%. This work acts as milestone towards future evolution and population genetics studies of this species as well as the Rasbora genus

Prognostic value of temporal patterns of global longitudinal strain in patients with chronic heart failure

BACKGROUND: We investigated whether repeatedly measured global longitudinal strain (GLS) has incremental prognostic value over repeatedly measured left ventricular ejection fraction (LVEF) and N-terminal pro B-type natriuretic peptide (NT-proBNP), and a single “baseline” GLS value, in chronic heart failure (HF) patients. METHODS: In this prospective observational study, echocardiography was performed in 173 clinically stable chronic HF patients every six months during follow up. During a median follow-up of 2.7 years, a median of 3 (25th–75th percentile:2–4) echocardiograms were obtained per patient. The endpoint was a composite of HF hospitalization, left ventricular assist device, heart transplantation, cardiovascular death. We compared hazard ratios (HRs) for the endpoint from Cox models (used to analyze the first available GLS measurements) with HRs from joint models (which links repeated measurements to the time-to-event data). RESULTS: Mean age was 58 ± 11 years, 76% were men, 81% were in New York Heart Association functional class I/II, and all had LVEF < 50% (mean ± SD: 27 ± 9%). The endpoint was reached by 53 patients. GLS was persistently decreased over time in patients with the endpoint. However, temporal GLS trajectories did not further diverge in patients with versus without the endpoint and remained stable during follow-up. Both single measurements and temporal trajectories of GLS were significantly associated with the endpoint [HR per SD change (95%CI): 2.15(1.34–3.46), 3.54 (2.01–6.20)]. In a multivariable model, repeatedly measured GLS maintained its prognostic value while repeatedly measured LVEF did not [HR per SD change (95%CI): GLS:4.38 (1.49–14.70), LVEF:1.14 (0.41–3.23)]. The association disappeared when correcting for repeatedly measured NT-proBNP. CONCLUSION: Temporal evolution of GLS was associated with adverse events, independent of LVEF but not independent of NT-proBNP. Since GLS showed decreased but stable values in patients with adverse prognosis, single measurements of GLS provide sufficient information for determining prognosis in clinical practice compared to repeated measurements, and temporal GLS patterns do not add prognostic information to NT-proBNP

Prognostic value of temporal patterns of left atrial reservoir strain in patients with heart failure with reduced ejection fraction

Background: We investigated whether repeatedly measured left atrial reservoir strain (LASr) in heart failure with reduced ejection fraction (HFrEF) patients provides incremental prognostic value over a single baseline LASr value, and whether temporal patterns of LASr provide incremental prognostic value over temporal patterns of other echocardiographic markers and NT-proBNP. Methods: In this prospective observational study, 153 patients underwent 6-monthly echocardiography, during a median follow-up of 2.5 years. Speckle tracking echocardiography was used to measure LASr. Hazard ratios (HRs) were calculated for LASr from Cox models (baseline) and joint models (repeated measurements). The primary endpoint (PEP) comprised HF hospitalization, left ventricular assist device, heart transplantation, and cardiovascular death. Results: Mean age was 58 ± 11 years, 76% were men, 82% were in NYHA class I/II, mean LASr was 20.9% ± 11.3%, and mean LVEF was 29% ± 10%. PEP was reached by 50 patients. Baseline and repeated measurements of LASr (HR per SD change (95% CI) 0.20 (0.10–0.41) and (0.13 (0.10–0.29), respectively) were both significantly associated with the PEP, independent of both baseline and repeated measurements of other echo-parameters and NT-proBNP. Although LASr was persistently lower over time in patients with PEP, temporal trajectories did not diverge in patients with versus without the PEP as the PEP approached. Conclusion: LASr was associated with adverse events in HFrEF patients, independent of baseline and repeated other echo-parameters and NT-proBNP. Temporal trajectories of LASr showed decreased but stable values in patients with the PEP, and do not provide incremental prognostic value for clinical practice compared to single measurements of LASr. Graphical abstract: [Figure not available: see fulltext.].</p