Management of lupus nephritis: a systematic literature review informing the 2019 update of the joint EULAR and European Renal Association-European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations.

OBJECTIVES: To analyse the current evidence for the management of lupus nephritis (LN) informing the 2019 update of the EULAR/European Renal Association-European Dialysis and Transplant Association recommendations. METHODS: According to the EULAR standardised operating procedures, a PubMed systematic literature review was performed, from January 1, 2012 to December 31, 2018. Since this was an update of the 2012 recommendations, the final level of evidence (LoE) and grading of recommendations considered the total body of evidence, including literature prior to 2012. RESULTS: We identified 387 relevant articles. High-quality randomised evidence supports the use of immunosuppressive treatment for class III and class IV LN (LoE 1a), and moderate-level evidence supports the use of immunosuppressive treatment for pure class V LN with nephrotic-range proteinuria (LoE 2b). Treatment should aim for at least 25% reduction in proteinuria at 3 months, 50% at 6 months and complete renal response (<500-700 mg/day) at 12 months (LoE 2a-2b). High-quality evidence supports the use of mycophenolate mofetil/mycophenolic acid (MMF/MPA) or low-dose intravenous cyclophosphamide (CY) as initial treatment of active class III/IV LN (LoE 1a). Combination of tacrolimus with MMF/MPA and high-dose CY are alternatives in specific circumstances (LoE 1a). There is low-quality level evidence to guide optimal duration of immunosuppression in LN (LoE 3). In end-stage kidney disease, all methods of kidney replacement treatment can be used, with transplantation having the most favourable outcomes (LoE 2b). CONCLUSIONS: There is high-quality evidence to guide the initial and subsequent phases of class III/IV LN treatment, but low-to-moderate quality evidence to guide treatment of class V LN, monitoring and optimal duration of immunosuppression

Radio propagation measurements and modeling for standardization of the site general path loss model in International Telecommunications Union recommendations for 5G wireless networks

The International Telecommunications Union Radiocommunication Sector (ITU‐R) Study Group 3 identified the need for a number of radio channel models in anticipation of the World Radiocommunications Conference in 2019 when the frequency allocation for 5G will be discussed. In response to the call for propagation path loss models, members of the study group carried out measurements in the frequency bands between 0.8 GHz up to 73 GHz in urban low rise and urban high rise as well as suburban environments. The data were subsequently merged to generate site general path loss models. The paper presents an overview of the radio channel measurements, the measured environments, the data analysis and the approach for the derivation of the path loss model adopted in Recommendation ITU‐R P.1411‐10

A CO funnel in the Galactic centre: molecular counterpart of the northern Galactic chimney

We report the discovery of a velocity coherent, funnel-shaped 13CO emission feature in the Galactic centre (GC) using data from the SEDIGISM survey. The molecular cloud appears as a low-velocity structure (VLSR = [ − 3.5, + 3.5] km s−1) with an angular extent of 0.95° ×1°, extending towards positive Galactic latitudes. The structure is offset from Sgr A* towards negative Galactic longitudes; it spatially and morphologically correlates well with the northern lobe of the 430 pc radio bubble, believed to be the radio counterpart of the multiwavelength GC chimney. Spectral line observations in the frequency range of 85–116 GHz have been carried out using the IRAM 30-m telescope towards 12 positions along the funnel-shaped emission. We examine the 12C/13C isotopic ratios using various molecules and their isotopologues. The mean 12C/13C isotope ratio (30.6 ± 2.9) is consistent with the structure located within inner 3 kpc of the Galaxy and possibly in the GC. The velocity of the molecular funnel is consistent with previous radio recombination line measurements of the northern lobe of radio bubble. Our multiwavelength analysis suggests that the funnel-shaped structure extending over 100 pc above the Galactic plane is the molecular counterpart of the northern GC chimney

A CO Funnel in the Galactic Centre: Molecular Counterpart of the Northern Galactic Chimney?

We report the discovery of a velocity coherent, funnel shaped ^13CO emission feature in the Galactic centre (GC) using data from the SEDIGISM survey. The molecular cloud appears as a low velocity structure (V_LSR=[-3.5, +3.5] km/s) with an angular extent of 0.95{\deg} x 1{\deg}, extending toward positive Galactic latitudes. The structure is offset from Sgr A* toward negative Galactic longitudes and spatially and morphologically correlates well with the northern lobe of the 430 pc radio bubble, believed to be the radio counterpart of the multiwavelength GC chimney. Spectral line observations in the frequency range of 85-116 GHz have been carried out using the IRAM 30 metre telescope toward 12 positions along the funnel-shaped emission. We examine the ^12C/^13C isotopic ratios using various molecules and their isotopologues. The mean ^12C/^13C isotope ratio (30.6+-2.9) is consistent with the structure located within inner 3 kpc of the Galaxy and possibly in the GC. The velocity of the molecular funnel is consistent with previous radio recombination line measurements of the northern lobe of radio bubble. Our multiwavelength analysis suggests that the funnel shaped structure extending over 100 pc above the Galactic plane is the molecular counterpart of the northern GC chimney.Comment: Accepted for publication in A&A Letter

Image-Aligned Dynamic Liver Reconstruction Using Intra-Operative Field of Views for Minimal Invasive Surgery

Available online on 30 November 2018. Author's post-print on open access repository after an embargo period of 12 months2019-11-3

An occasional diagnosis of myasthenia gravis - a focus on thymus during cardiac surgery: a case report

<p>Abstract</p> <p>Background</p> <p>Myasthenia gravis, an uncommon autoimmune syndrome, is commonly associated with thymus abnormalities. Thymomatous myasthenia gravis is considered to have worst prognosis and thymectomy can reverse symptoms if precociously performed.</p> <p>Case report</p> <p>We describe a case of a patient who underwent mitral valve repair and was found to have an occasional thymomatous mass during the surgery. A total thymectomy was performed concomitantly to the mitral valve repair.</p> <p>Conclusion</p> <p>The diagnosis of thymomatous myasthenia gravis was confirmed postoperatively. Following the surgery this patient was strictly monitored and at 1-year follow-up a complete stable remission had been successfully achieved.</p

OFF-eNET: An optimally fused fully end-to-end network for automatic dense volumetric 3D intracranial blood vessels segmentation

Intracranial blood vessels segmentation from computed tomography angiography (CTA) volumes is a promising biomarker for diagnosis and therapeutic treatment in cerebrovascular diseases. These segmentation outputs are a fundamental requirement in the development of automated decision support systems for preoperative assessment or intraoperative guidance in neuropathology. The state-of-the-art in medical image segmentation methods are reliant on deep learning architectures based on convolutional neural networks. However, despite their popularity, there is a research gap in the current deep learning architectures optimized to address the technical challenges in blood vessel segmentation. These challenges include: (i) the extraction of concrete brain vessels close to the skull; and (ii) the precise marking of the vessel locations. We propose an Optimally Fused Fully end-to-end Network (OFF-eNET) for automatic segmentation of the volumetric 3D intracranial vascular structures. OFF-eNET comprises of three modules. In the first module, we exploit the up-skip connections to enhance information flow, and dilated convolution for detailed preservation of spatial feature map that are designed for thin blood vessels. In the second module, we employ residual mapping along with inception module for speedy network convergence and richer visual representation. For the third module, we make use of the transferred knowledge in the form of cascaded training strategy to gradually optimize the three segmentation stages (basic, complete, and enhanced) to segment thin vessels located close to the skull. All these modules are designed to be computationally efficient. Our OFF-eNET, evaluated using 70 CTA image volumes, resulted in 90.75% performance in the segmentation of intracranial blood vessels and outperformed the state-of-the-art counterparts