A case series of cerebral toxoplasmosis in the practice of a neurological hospital

Introduction. Central nervous system is one of the main targets in patients with HIV infection. Neurological complications in AIDS are primarily caused by opportunistic brain infections including toxoplasmosis as the most common one. Patients with cerebral toxoplasmosis are often hospitalized with diagnosed strokes, tumors, or encephalitis. At that, their HIV status may be unknown and their state severity often does not allow conducting the range of required examinations. Materials and methods. We have described our experience in management of 6 patients admitted to the neurosurgery department with single toxoplasmosis foci and diagnosed brain tumors. Results. HIV infection was initially known in 3 patients only. In 2 compensated patients, the diagnosis was confirmed via Toxoplasma IgG blood test. In 2 individuals, negative serological Toxoplasma reactions were followed by neuronavigationally controlled biopsies. A patient with an extensive perifocal edema and, as a result, dislocated midline structures underwent decompressive craniectomy and mass removal. One female patient, with an unclear diagnosis, was operated for a suspected brain tumor. After additional assessments (including 4 histologies to confirm cerebral toxoplasmosis), all the patients were transferred to the infectious disease hospital for specific treatment

Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTIC‐HF: baseline characteristics and comparison with contemporary clinical trials

Aims: The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial. Here we describe the baseline characteristics of participants in GALACTIC‐HF and how these compare with other contemporary trials. Methods and Results: Adults with established HFrEF, New York Heart Association functional class (NYHA) ≥ II, EF ≤35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic‐guided dosing: 25, 37.5 or 50 mg bid). 8256 patients [male (79%), non‐white (22%), mean age 65 years] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NT‐proBNP 1971 pg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTIC‐HF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure < 100 mmHg (n = 1127), estimated glomerular filtration rate < 30 mL/min/1.73 m2 (n = 528), and treated with sacubitril‐valsartan at baseline (n = 1594). Conclusions: GALACTIC‐HF enrolled a well‐treated, high‐risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation

Особенности клинической манифестации субкомпенсированного дисбактериоза кишечника кошек при оценке эффективности его коррекции

Formation and reproduction of gut microbiome begins at birth, while change in its composition depends mainly on various genetic, nutritional and environmental factors. The article considers the features of clinical manifestation of subcompensated intestinal dysbiosis in cats in assessing the effectiveness of its treatment. The studies were carried out on the basis of Department of Veterinary Medicine, RUDN University, and the clinical work was conducted at private veterinary clinics: ‘Avettura’, ‘Epiona’, ‘In the World with Animals’. Cats were selected for the experiment as they arrived at the initial appointment at veterinary clinics. The diagnosis of suspected intestinal dysbacteriosis was made considering anamnesis, clinical examination, and microbiological tests. The severity of intestinal dysbacteriosis was assessed on the results of clinical and laboratory studies. During the research, clinical and diagnostic approaches for subcompensated intestinal dysbacteriosis in cats were improved. Furthermore, effective ways of its treatment were developed. For subcompensated intestinal dysbacteriosis, administration of ‘Lactobifadol’ probiotic, ‘Vetelakt’ prebiotic and ‘Azoksivet’ immunomodulator showed the greatest therapeutic effect, which led to an overall clinical improvement in 5.50 days. Therapeutic efficacy of B 3 regimen was also clearly evidenced by the positive changes in intestinal microbiota and hematological blood parameters during the pharmacorrection. Improvement of clinical diagnostic approaches, prognosis of intestinal dysbiosis of varying severity and treatment effectiveness in cats require will allow to study intestinal dysbiotic disorders in other animal speciesФормирование и размножение микробиома кишечника начинается с рождения, в то время как изменение его состава зависит главным образом от различных генетических, пищевых и экологических факторов. Приведены особенности клинической манифестации субкомпенсированного дисбактериоза кишечника кошек при оценке эффективности его коррекции. Исследования проведены на базе департамента ветеринарной медицины Российского университета дружбы народов, а клиническая часть работы выполнена на базе частных клиник ветеринарной медицины: «Аветтура», «Эпиона», «В мире с животными». Кошек в эксперимент подбирали по мере их поступления на первичный прием в ветклиники. Диагноз при подозрении на дисбактериоз кишечника ставили комплексно с учетом данных анамнеза, клинического осмотра, а также микробиологических исследований. Оценку степени тяжести дисбактериоза кишечника осуществляли на основании проведенных клинико-лабораторных исследований. В ходе исследования усовершенствованы клинико-диагностические подходы при субкомпенсированном дисбактериозе кишечника у кошек, а на основании этого разработаны эффективные пути его коррекции. Показано, что при субкомпенсированном дисбактериозе кишечника назначение пробиотика «Лактобифадола» в комплексе с пребиотиком «Ветелакт» и иммуномодулятором «Азоксивет» показывает наибольший терапевтический эффект, что приводит к общему клиническому улучшению уже на 5,5 сутки. О терапевтической эффективности схемы В3 наглядно свидетельствует также позитивная динамика содержимого микробиоты кишечника и гематологических показателей крови в процессе проведения фармакокоррекции. Совершенствование клинико-диагностических подходов и прогнозирование при дисбактериозе кишечника у кошек различной степени тяжести, а также оценка эффективности его коррекции создают предпосылки для дальнейшего изучения дисбиотических нарушений кишечного тракта у других видов животных

Time-resolved inner-shell photoelectron spectroscopy: From a bound molecule to an isolated atom

Due to its element and site specificity, inner-shell photoelectron spectroscopy is a widely used technique to probe the chemical structure of matter. Here, we show that time-resolved inner-shell photoelectron spectroscopy can be employed to observe ultrafast chemical reactions and the electronic response to the nuclear motion with high sensitivity. The ultraviolet dissociation of iodomethane (CH$_3$I) is investigated by ionization above the iodine $4d$ edge, using time-resolved inner-shell photoelectron and photoion spectroscopy. The dynamics observed in the photoelectron spectra appear earlier and are faster than those seen in the iodine fragments. The experimental results are interpreted using crystal-field and spin-orbit configuration interaction calculations, and demonstrate that time-resolved inner-shell photoelectron spectroscopy is a powerful tool to directly track ultrafast structural and electronic transformations in gas-phase molecules

Time-resolved inner-shell photoelectron spectroscopy: From a bound molecule to an isolated atom

Citation: Brauße, F., Goldsztejn, G., Amini, K., Boll, R., Bari, S., Bomme, C., … Rolles, D. (2018). Time-resolved inner-shell photoelectron spectroscopy: From a bound molecule to an isolated atom. Physical Review A, 97(4). https://doi.org/10.1103/PhysRevA.97.043429Due to its element and site specificity, inner-shell photoelectron spectroscopy is a widely used technique to probe the chemical structure of matter. Here, we show that time-resolved inner-shell photoelectron spectroscopy can be employed to observe ultrafast chemical reactions and the electronic response to the nuclear motion with high sensitivity. The ultraviolet dissociation of iodomethane (CH3I) is investigated by ionization above the iodine 4d edge, using time-resolved inner-shell photoelectron and photoion spectroscopy. The dynamics observed in the photoelectron spectra appear earlier and are faster than those seen in the iodine fragments. The experimental results are interpreted using crystal-field and spin-orbit configuration interaction calculations, and demonstrate that time-resolved inner-shell photoelectron spectroscopy is a powerful tool to directly track ultrafast structural and electronic transformations in gas-phase molecules

Second asymptomatic carotid surgery trial (ACST-2) : a randomised comparison of carotid artery stenting versus carotid endarterectomy

Background: Among asymptomatic patients with severe carotid artery stenosis but no recent stroke or transient cerebral ischaemia, either carotid artery stenting (CAS) or carotid endarterectomy (CEA) can restore patency and reduce long-term stroke risks. However, from recent national registry data, each option causes about 1% procedural risk of disabling stroke or death. Comparison of their long-term protective effects requires large-scale randomised evidence. Methods: ACST-2 is an international multicentre randomised trial of CAS versus CEA among asymptomatic patients with severe stenosis thought to require intervention, interpreted with all other relevant trials. Patients were eligible if they had severe unilateral or bilateral carotid artery stenosis and both doctor and patient agreed that a carotid procedure should be undertaken, but they were substantially uncertain which one to choose. Patients were randomly allocated to CAS or CEA and followed up at 1 month and then annually, for a mean 5 years. Procedural events were those within 30 days of the intervention. Intention-to-treat analyses are provided. Analyses including procedural hazards use tabular methods. Analyses and meta-analyses of non-procedural strokes use Kaplan-Meier and log-rank methods. The trial is registered with the ISRCTN registry, ISRCTN21144362. Findings: Between Jan 15, 2008, and Dec 31, 2020, 3625 patients in 130 centres were randomly allocated, 1811 to CAS and 1814 to CEA, with good compliance, good medical therapy and a mean 5 years of follow-up. Overall, 1% had disabling stroke or death procedurally (15 allocated to CAS and 18 to CEA) and 2% had non-disabling procedural stroke (48 allocated to CAS and 29 to CEA). Kaplan-Meier estimates of 5-year non-procedural stroke were 2·5% in each group for fatal or disabling stroke, and 5·3% with CAS versus 4·5% with CEA for any stroke (rate ratio [RR] 1·16, 95% CI 0·86-1·57; p=0·33). Combining RRs for any non-procedural stroke in all CAS versus CEA trials, the RR was similar in symptomatic and asymptomatic patients (overall RR 1·11, 95% CI 0·91-1·32; p=0·21). Interpretation: Serious complications are similarly uncommon after competent CAS and CEA, and the long-term effects of these two carotid artery procedures on fatal or disabling stroke are comparable

Ticagrelor in patients with diabetes and stable coronary artery disease with a history of previous percutaneous coronary intervention (THEMIS-PCI) : a phase 3, placebo-controlled, randomised trial

Background: Patients with stable coronary artery disease and diabetes with previous percutaneous coronary intervention (PCI), particularly those with previous stenting, are at high risk of ischaemic events. These patients are generally treated with aspirin. In this trial, we aimed to investigate if these patients would benefit from treatment with aspirin plus ticagrelor. Methods: The Effect of Ticagrelor on Health Outcomes in diabEtes Mellitus patients Intervention Study (THEMIS) was a phase 3 randomised, double-blinded, placebo-controlled trial, done in 1315 sites in 42 countries. Patients were eligible if 50 years or older, with type 2 diabetes, receiving anti-hyperglycaemic drugs for at least 6 months, with stable coronary artery disease, and one of three other mutually non-exclusive criteria: a history of previous PCI or of coronary artery bypass grafting, or documentation of angiographic stenosis of 50% or more in at least one coronary artery. Eligible patients were randomly assigned (1:1) to either ticagrelor or placebo, by use of an interactive voice-response or web-response system. The THEMIS-PCI trial comprised a prespecified subgroup of patients with previous PCI. The primary efficacy outcome was a composite of cardiovascular death, myocardial infarction, or stroke (measured in the intention-to-treat population). Findings: Between Feb 17, 2014, and May 24, 2016, 11 154 patients (58% of the overall THEMIS trial) with a history of previous PCI were enrolled in the THEMIS-PCI trial. Median follow-up was 3·3 years (IQR 2·8–3·8). In the previous PCI group, fewer patients receiving ticagrelor had a primary efficacy outcome event than in the placebo group (404 [7·3%] of 5558 vs 480 [8·6%] of 5596; HR 0·85 [95% CI 0·74–0·97], p=0·013). The same effect was not observed in patients without PCI (p=0·76, p interaction=0·16). The proportion of patients with cardiovascular death was similar in both treatment groups (174 [3·1%] with ticagrelor vs 183 (3·3%) with placebo; HR 0·96 [95% CI 0·78–1·18], p=0·68), as well as all-cause death (282 [5·1%] vs 323 [5·8%]; 0·88 [0·75–1·03], p=0·11). TIMI major bleeding occurred in 111 (2·0%) of 5536 patients receiving ticagrelor and 62 (1·1%) of 5564 patients receiving placebo (HR 2·03 [95% CI 1·48–2·76], p<0·0001), and fatal bleeding in 6 (0·1%) of 5536 patients with ticagrelor and 6 (0·1%) of 5564 with placebo (1·13 [0·36–3·50], p=0·83). Intracranial haemorrhage occurred in 33 (0·6%) and 31 (0·6%) patients (1·21 [0·74–1·97], p=0·45). Ticagrelor improved net clinical benefit: 519/5558 (9·3%) versus 617/5596 (11·0%), HR=0·85, 95% CI 0·75–0·95, p=0·005, in contrast to patients without PCI where it did not, p interaction=0·012. Benefit was present irrespective of time from most recent PCI. Interpretation: In patients with diabetes, stable coronary artery disease, and previous PCI, ticagrelor added to aspirin reduced cardiovascular death, myocardial infarction, and stroke, although with increased major bleeding. In that large, easily identified population, ticagrelor provided a favourable net clinical benefit (more than in patients without history of PCI). This effect shows that long-term therapy with ticagrelor in addition to aspirin should be considered in patients with diabetes and a history of PCI who have tolerated antiplatelet therapy, have high ischaemic risk, and low bleeding risk