Venous thrombosis in immunocompetent patients with acute cytomegalovirus infection: a complication that may be underestimated

In the present study, we retrospectively studied clinical and laboratory findings associated with cytomegalovirus (CMV) infection in immunocompetent patients. We focused on severe CMV infection. Among 38 patients, five had a severe form of infection: one had meningitis, one had symptomatic thrombocytopenia and three had venous thromboses with pulmonary embolism, a rarely described complication. CMV-induced thrombosis has been reported in immunocompromised patients such as transplant recipients and patients with AIDS. Recent case reports have also described thrombotic phenomena in immunocompetent patients with CMV infection. Our study suggests that venous thrombosis during acute CMV infection is an underestimated complication

Optimization of flow shop scheduling through a hybrid genetic algorithm for manufacturing companies

A task scheduling problem is a process of assigning tasks to a limited set of resources available in a time interval, where certain criteria are optimized. In this way, the sequencing of tasks is directly associated with the executability and optimality of a preset plan and can be found in a wide range of applications, such as: programming flight dispatch at airports, programming production lines in a factory, programming of surgeries in a hospital, repair of equipment or machinery in a workshop, among others. The objective of this study is to analyze the effect of the inclusion of several restrictions that negatively influence the production programming in a real manufacturing environment. For this purpose, an efficient Genetic Algorithm combined with a Local Search of Variable Neighborhood for problems of n tasks and m machines is introduced, minimizing the time of total completion of the tasks. The computational experiments carried out on a set of problem instances with different sizes of complexity show that the proposed hybrid metaheuristics achieves high quality solutions compared to the reported optimal cases

Does Quantification of Carotid Plaque Surface Irregularities Better Detect Symptomatic Plaques Compared to the Subjective Classification?

Objectives To evaluate the interobserver agreement of color Doppler ultrasound (CDUS) and contrast‐enhanced ultrasound (CEUS) for quantification of carotid plaque surface irregularities and to correlate objective and subjective measures with stroke occurrence. Methods This work was an observational study involving 54 patients with 62 internal carotid artery or carotid bulb plaques (31 symptomatic) undergoing CDUS and CEUS between February 2016 and February 2018, with retrospective interpretation of prospectively acquired data. Plaques were included if causing moderate (50%–69%) or severe (70%–99%) stenosis based on velocity criteria, and their surface was classified as smooth, irregular, or ulcerated based on CEUS. The surface irregularities were quantified in the form of a surface irregularity index by 2 observers, based on CDUS and CEUS. The surface irregularity index was evaluated for interobserver agreement with CDUS and CEUS and correlated with the occurrence of stroke, as was the subjective characterization of the plaque surface. Results Color Doppler ultrasound and CEUS showed good interobserver agreement (intraclass correlation coefficients, 0.979 and 0.952, respectively). Plaques were characterized as smooth in 30.6% of cases, irregular in 50%, and ulcerated in 19.4%. The subjective classification of the plaque surface did not correlate with stroke occurrence (P > .05, χ2). Surface irregularity index values were significantly higher for symptomatic plaques with both CDUS and CEUS (P < .05). Conclusions Color Doppler ultrasound and CEUS can quantify carotid plaque surface irregularities with good interobserver agreement. The resulting quantitative measure was significantly higher in symptomatic plaques, whereas the subjective characterization of plaque surface failed to differ between symptomatic and asymptomatic plaques

An ultrasonographic multiparametric carotid plaque risk index associated with cerebrovascular symptomatology: A study comparing color Doppler imaging and contrast-enhanced ultrasonography

BACKGROUND AND PURPOSE: Various ultrasonographic features of carortid plaques have been associated with the occurence of stroke, highlighting the need for multi-parametric assessment of plaque’s vulnerability. Our aim was to compare ultrasonographic multiparametric indices using color Doppler imaging and contrast-enhanced sonography between symptomatic and asymptomatic carotid plaques. MATERIALS AND METHODS: This was a cross-sectional observational study recruiting 54 patients (72.2% male; median age, 61 years) undergoing sonography and contrast-enhanced sonography. Patients were included if a moderately or severely stenotic internal carotid artery plaque was detected, with the plaque being considered symptomatic if it was ipsilateral to a stroke occuring within the last 6 months. A vulnerability index, previously described by Kanber et al, combined the degree of stenosis, gray-scale median, and a quantitative measure of surface irregularities (surface irregularity index) derived from color Doppler imaging and contrast-enhanced ultrasonography, resulting in 2 vulnerability indices, depending on the surface irregularity index used. Mann-Whitney U and t tests were used to compare variables between groups, and receiver operating characteristic curves were used to compare diagnostic accuracy. RESULTS: Sixty-two plaques were analyzed (50% symptomatic), with a mean degree of stenosis of 68.9%. Symptomatic plaques had a significantly higher degree of stenosis (mean, 74.7% versus 63.1%; P .001), a lower gray-scale median (13 versus 38; P .001), and a higher Kanber vulnerability index based both on color Doppler imaging (median, 61.4 versus 16.5; P .001) and contrast-enhanced ultrasonography (median, 88.6 versus 25.2; P .001). The area under the curve for the detection of symptomatic plaques was 0.772 for the degree of stenosis alone, 0.783 for the vulnerability index–color Doppler imaging, and 0.802 for the vulnerability index–contrast-enhanced ultrasonography, though no statistical significance was achieved. CONCLUSIONS: Symptomatic plaques had a higher degree of stenosis, lower gray-scale median values, and higher values of the Kanber vulnerability index using both color Doppler imaging and contrast-enhanced ultrasonography for plaque surface delineation. © 2019 American Society of Neuroradiology. All rights reserved