Symptomatic spinal cord malperfusion after stent-graft coverage of the entire descending aorta

Objective: The study aims to identify risk constellations for symptomatic spinal cord malperfusion in patients undergoing extensive stent-graft coverage of the thoracic aorta. Methods: From 1997 through 2009, 26 patients (mean age 70 years) underwent extensive stent-graft coverage of the thoracic aorta. Indications for stent-graft placement were atherosclerotic aneurysms (n=18) and penetrating atherosclerotic ulcers (PAUs) (n=8). In 16 patients, a re-routing procedure was required to gain sufficient proximal landing zone length. Cerebrospinal fluid (CSF) drainage was not routinely applied owing to the necessity of maintaining continuing anti-platelet therapy due to severe cardiovascular co-morbidities. Results: Technical success was 100%. Five patients developed symptomatic spinal cord malperfusion. All symptomatic patients had impaired spinal cord blood supply by acute or chronic occlusion of at least two major blood-supplying vascular territories of the spinal cord. Secondary CSF drainage improved neurologic symptoms in all patients without causing any anti-platelet therapy-related collateral injury. Conclusions: Extensive stent-graft coverage of the entire thoracic aorta can be performed with a high rate of success. If collateral blood supply to the spinal cord is maintained, occlusion of the intercostal arteries does not cause symptomatic malperfusion. However, if acute or chronic occlusion of the subclavian, lumbar or hypogastric arteries is present, likelihood of symptomatic malperfusion dramatically increase

Type 2 Endoleaks: The Diagnostic Performance of Non-Specialized Readers on Arterial and Venous Phase Multi-Slice CT Angiography.

PURPOSE: To define the diagnostic precision of non-specialized readers in the detection of type 2 endoleaks (T2EL) in arterial versus venous phase acquisitions, and to evaluate an approach for radiation dose reduction. METHODS: The pre-discharge and final follow-up multi-slice CT angiographies of 167 patients were retrospectively analyzed. Image data were separated into an arterial and a venous phase reading set. Two radiology residents assessed the reading sets for the presence of a T2EL, feeding vessels, and aneurysm sac size. Findings were compared with a standard of reference established by two experts in interventional radiology. The effective dose was calculated. RESULTS: Overall, experts detected 131 T2ELs, and 331 feeding vessels in 334 examinations. Persistent T2ELs causing aneurysm sac growth > 5 mm were detected in 20 patients. Radiation in arterial and venous phases contributed to a mean of 58.6% and 39.0% of the total effective dose. Findings of reader 1 and 2 showed comparable sensitivities in arterial sets of 80.9 versus 85.5 (p = 0.09), and in venous sets of 73.3 versus 79.4 (p = 0.15), respectively. Reader 1 and 2 achieved a significant higher detection rate of feeding vessels with arterial compared to venous set (p = 0.04, p < 0.01). Both readers correctly identified T2ELs with growing aneurysm sac in all cases, independent of the acquisition phase. CONCLUSION: Arterial acquisitions enable non-specialized readers an accurate detection of T2ELs, and a significant better identification of feeding vessels. Based on our results, it seems reasonable to eliminate venous phase acquisitions

Correction: Type 2 Endoleaks: The Diagnostic Performance of Non-Specialized Readers on Arterial and Venous Phase Multi-Slice CT Angiography.

[This corrects the article DOI: 10.1371/journal.pone.0149725.]

The African swine fever virus isolate Belgium 2018/1 shows high virulence in European wild boar

African swine fever (ASF) is one of the most important and complex viral diseases in domestic pigs and wild boar. Over the last decade, the disease has spread to several European and Asian countries and is now one of the major threats to profitable pig production world‐wide. One of the more recently affected western countries is Belgium. To date, only wild boar are affected in a rather defined area in the Luxembourg region close to France, Luxembourg, and Germany. While detailed sequence analyses were recently performed, biological characterization was still pending. Here, we report on the experimental inoculation of four sub‐adult wild boar to further characterize the virus and its distribution in different tissues. After oronasal inoculation with the virus strain “Belgium 2018/1”, all animals developed an acute and severe disease course with typical pathomorphological and histopathological lesions. Organs and blood samples were positive in qPCR, haemadsorption test and antigen lateral flow devices (LFD). Virus and viral genome were also detected in genitals and accessory sex glands of two boars. There were no antibodies detectable in commercial antibody ELISAs, antibody LFDs, and indirect immunoperoxidase tests. Thus, the genotype II ASF virus isolate “Belgium 2018/1” showed a highly virulent phenotype in European wild boar similar to parental viruses like Armenia 2007 and other previously characterized ASFV strains. The study also provided a large set of well characterized sample materials for test validation and assay harmonization

Daratumumab in first-line treatment of patients with light chain amyloidosis and Mayo stage IIIb improves treatment response and overall survival

Treatment of patients with Mayo stage IIIb light chain (AL) amyloidosis is still challenging, and the prognosis remains very poor. Mayo stage IIIb patients were excluded from the pivotal trial leading to the approval of daratumumab in combination with bortezomib-cyclophosphamide-dexamethasone. This retrospective, multicenter study evaluates the addition of daratumumab to first-line therapy in patients with newly diagnosed stage IIIb AL amyloidosis. In total, data from 119 consecutive patients were analyzed, 27 patients received an upfront treatment including daratumumab, 63 a bortezomibbased regimen without daratumumab, eight received therapies other than daratumumab or bortezomib and 21 pretreated patients or deceased prior to treatment were excluded. In the daratumumab group, median overall survival was not reached after a median follow-up time of 14.5 months, while it was significantly worse in the bortezomib- and the otherwise treated group (6.6 and 2.2 months, respectively) (P=0.002). Overall hematologic response rate at 2 and 6 months was better in the daratumumab group compared to the bortezomib group (59% vs. 37%, P=0.12, 67% vs. 41%, P=0.04, respectively). Landmark survival analyses revealed a significantly improved overall survival in patients with partial hematologic response or better, compared to non-responders. Cardiac response at 6 months was 46%, 21%, 0% in the daratumumab-, bortezomib- and otherwise treated groups, respectively (P=0.04). A landmark survival analysis revealed markedly improved overall survival in patients with cardiac very good partial response vs. cardiac non-responders (P=0.002). This study demonstrates for the first time the superiority of an upfront treatment with daratumumab over standard-of-care in stage IIIb AL amyloidosis

Progranulin Gene Variability and Plasma Levels in Bipolar Disorder and Schizophrenia

Basing on the assumption that frontotemporal lobar degeneration (FTLD), schizophrenia and bipolar disorder (BPD) might share common aetiological mechanisms, we analyzed genetic variation in the FTLD risk gene progranulin (GRN) in a German population of patients with schizophrenia (n = 271) or BPD (n = 237) as compared with 574 age-, gender- and ethnicity-matched controls. Furthermore, we measured plasma progranulin levels in 26 German BPD patients as well as in 61 Italian BPD patients and 29 matched controls

Cancer Biomarker Discovery: The Entropic Hallmark

Background: It is a commonly accepted belief that cancer cells modify their transcriptional state during the progression of the disease. We propose that the progression of cancer cells towards malignant phenotypes can be efficiently tracked using high-throughput technologies that follow the gradual changes observed in the gene expression profiles by employing Shannon's mathematical theory of communication. Methods based on Information Theory can then quantify the divergence of cancer cells' transcriptional profiles from those of normally appearing cells of the originating tissues. The relevance of the proposed methods can be evaluated using microarray datasets available in the public domain but the method is in principle applicable to other high-throughput methods. Methodology/Principal Findings: Using melanoma and prostate cancer datasets we illustrate how it is possible to employ Shannon Entropy and the Jensen-Shannon divergence to trace the transcriptional changes progression of the disease. We establish how the variations of these two measures correlate with established biomarkers of cancer progression. The Information Theory measures allow us to identify novel biomarkers for both progressive and relatively more sudden transcriptional changes leading to malignant phenotypes. At the same time, the methodology was able to validate a large number of genes and processes that seem to be implicated in the progression of melanoma and prostate cancer. Conclusions/Significance: We thus present a quantitative guiding rule, a new unifying hallmark of cancer: the cancer cell's transcriptome changes lead to measurable observed transitions of Normalized Shannon Entropy values (as measured by high-throughput technologies). At the same time, tumor cells increment their divergence from the normal tissue profile increasing their disorder via creation of states that we might not directly measure. This unifying hallmark allows, via the the Jensen-Shannon divergence, to identify the arrow of time of the processes from the gene expression profiles, and helps to map the phenotypical and molecular hallmarks of specific cancer subtypes. The deep mathematical basis of the approach allows us to suggest that this principle is, hopefully, of general applicability for other diseases

BEDe: A Modelling Tool for Business Ecosystems Design with ADOxx

Part 14: Knowledge Transfer and Accelerated Innovation in FoFInternational audienceIn this contribution we explore a design technique for business ecosystem applying conceptual modelling techniques as a means to conceptualize such environments and provide capabilitiesto explore and analyze its outcomes in a comprehensive manner. The motivation for thiswork is attributed to the need of methods in the field that support design, collaborations during evaluation / evolution phases of business ecosystems. The requirements are derived from areview of literature and case studies, used as input for a conceptual analysis performed. As an outcome we propose a modelling method and prototype that provides a formal representation of the concepts identified, interaction and sharing capabilities of models and enables domain-specific extension capabilities realized through metamodeling

TERAPIA NUTRICIONAL ENTERAL EM ADULTOS: NECESSIDADE ENERGÉTICA E PROTÉICA PRESCRITA VERSUS VOLUME ADMINISTRADO

A nutrição enteral deve ser indicada a pacientes com ingesta alimentar via oral insuficiente por três dias consecutivos ou pacientes impossibilitados de ingesta alimentar via oral. Entretanto, observa-se em muitos serviços que nem sempre todos os pacientes têm a prescrição de TNE adequada às suas necessidades, ou ainda, que a prescrição atende ao seu requerimento, porém, por inúmeros motivos o volume diário prescrito não é totalmente infundido. O objetivo da pesquisa foi averiguar se as prescrições dietoterápicas e o volume de dieta enteral administrado atendem ao requerimento energético e protéico de pacientes adultos hospitalizados em uso exclusivo de nutrição enteral. A técnica para seleção da amostragem utilizada foi retrospectiva, através de coleta de dados por meio da revisão do prontuário de pacientes oncológicos que utilizaram nutrição enteral no segundo semestre de 2013, foram coletados dados para amostra onde o paciente foi avaliado quanto à prescrição dietoterápica se o volume de nutrição enteral prescrito foi infundido completamente. Dos 38 prontuários analisados entre adultos (20-60) e idosos (&gt;60), 10 eram do gênero feminino e 28 do gênero masculino. A idade média foi de 61,7 anos, sendo que 63,15 % tinham 60 anos ou mais. Onde a TNE supriu apenas 70,3% das necessidades energéticas totais dos pacientes. A infusão da dieta enteral em unidades hospitalares ainda é um problema neste contexto, tendo em vista que muitos pacientes não recebem todo o seu requerimento energético e proteico, contribuindo para a desnutrição hospitalar e, piores desfechos clínicos.</jats:p