Роль электронейромиографии в оценке прогноза восстановления у детей с акушерским повреждением плечевого сплетения в практике специализированного центра

The aim of current publication – to present our own experience in use of electromyographic examination in prognosis for children with obstetric brachial plexus injury to practical neurologists and neurophysiologists. Review of literature shows that common approaches to electrotrophysiological diagnosis of obstetric brachial plexus injury do not exist. The aim of this study– to evaluate retrospectively electrophysiological and sonographic parameters of obstetric brachial plexus injury in children, determining the most informative variables. Since 2007 to 2014 we examined 218 children, 74 of them were operated. Electrophysiological investigation in young children have difficulties in performance.We present our algorithm of diagnostic of obstetric brachial plexus injury: 1) testing main muscles, which perform basic movementsin upper limb (needle EMG of supra- and infraspinatus muscles and cutaneous EMG of biceps muscles); 2) localization of injury (paralysis or Duchenne – Erb palsy and electrophysiological criteria of spinal cord root avulsion). We found out that the most crucial role in assessing prognosis plays an examination of motor unit potentials (MUPs) duration. Absence of MUPs within needle EMG from supraspinatus muscle and absence of interference curve from biceps muscle during first 6 months have poor prognosis. After 6 months careful, dynamic study of MUPs duration in infraspinatus muscle and co-contraction of agonist and antagonist muscles is needed. To decide whether reconstructive surgery in a patient with obstetric brachial plexus injury is necessary, surgeon must analyze clinical and instrumental data. The possibility of usage of the ultrasonogrophy in brachial plexus injury requires further investigation.Задача настоящей публикации – познакомить практических неврологов и нейрофизиологов с нашим опытом применения электронейромиографии (ЭНМГ) в оценке прогноза у детей с акушерским повреждением плечевого сплетения. Анализ отечественной и зарубежной литературы показал, что единого подхода к электрофизиологической диагностике акушерского повреждения плечевого сплетения не разработано. Цель исследования – ретроспективная оценка динамики электрофизиологических и сонографических показателей у детей с акушерским повреждением плечевого сплетения, определение наиболее информативных параметров. Всего за период с 2007 по 2014 г. нами осмотрено 218 детей, из них прооперировано 74. С учетом технических трудностей проведения электрофизиологического исследования у детей раннего возраста нами предложен следующий алгоритм: 1) оценка состояния ключевых мышц, ответственных за восстановление основных движений в верхней конечности: игольчатая ЭНМГ надостной и подостной мышц (с целью оценки состояния мышц, отвечающих за наружную ротацию плеча), накожная ЭНМГ двуглавой мышцы (сгибание руки в локтевом суставе); 2) топическая диагностика (исключение паралича и оценка электрофизиологических критериев отрыва корешка). При ретроспективной оценке электрофизиологических параметров у детей с разной степенью восстановления функции наиболее важным является оценка параметров длительности потенциалов двигательныхединиц (ПДЕ) в динамике. Прогностически неблагоприятным электрофизиологическим признаком при акушерском повреждении, по нашему мнению, служит отсутствие регистрации ПДЕ при игольчатом отведении в надостной мышце и отсутствие интерференционной кривой («биоэлектрическое молчание») с двуглавой мышцы плеча до 6 мес. После 6 мес целесообразно исследование длительности ПДЕ в подостной мышце в динамике, исследование коконтракции мышц агонистов и антагонистов. Решение о проведении реконструктивных операции хирургом принимается на основании совокупности клинико-инструментальных данных. Интересным представляется возможность использования ультразвукового исследования периферических нервов (оценка спинномозговых нервов на уровне выхода из межпозвонковых отверстий, величина невромы, сопутствующие повреждения окружающих тканей), однако эти данные требуют дальнейшего изучения

The seasonal dynamics and biting behavior of potential Anopheles vectors of Plasmodium knowlesi in Palawan, Philippines.

BACKGROUND: A small number of human cases of the zoonotic malaria Plasmodium knowlesi have been reported in Palawan Island, the Philippines. Identification of potential vector species and their bionomics is crucial for understanding human exposure risk in this setting. Here, we combined longitudinal surveillance with a trap-evaluation study to address knowledge gaps about the ecology and potential for zoonotic spillover of this macaque malaria in Palawan Island. METHODS: The abundance, diversity and biting behavior of human-biting Anopheles mosquitoes were assessed through monthly outdoor human landing catches (HLC) in three ecotypes representing different land use (forest edge, forest and agricultural area) across 8 months. Additionally, the host preference and biting activity of potential Anopheles vectors were assessed through comparison of their abundance and capture time in traps baited with humans (HLC, human-baited electrocuting net-HEN) or macaques (monkey-baited trap-MBT, monkey-baited electrocuting net-MEN). All female Anopheles mosquitoes were tested for the presence of Plasmodium parasites by PCR. RESULTS: Previously incriminated vectors Anopheles balabacensis and An. flavirostris accounted for > 95% of anophelines caught in longitudinal surveillance. However, human biting densities were relatively low (An. balabacensis: 0.34-1.20 per night, An. flavirostris: 0-2 bites per night). Biting densities of An. balabacensis were highest in the forest edge, while An. flavirostris was most abundant in the agricultural area. The abundance of An. balabacensis and An. flavirostris was significantly higher in HLC than in MBT. None of the 357 female Anopheles mosquitoes tested for Plasmodium infection were positive. CONCLUSIONS: The relatively low density and lack of malaria infection in Anopheles mosquitoes sampled here indicates that exposure to P. knowlesi in this setting is considerably lower than in neighboring countries (i.e. Malaysia), where it is now the primary cause of malaria in humans. Although anophelines had lower abundance in MBTs than in HLCs, An. balabacensis and An. flavirostris were caught by both methods, suggesting they could act as bridge vectors between humans and macaques. These species bite primarily outdoors during the early evening, confirming that insecticide-treated nets are unlikely to provide protection against P. knowlesi vectors

31st Annual Meeting and Associated Programs of the Society for Immunotherapy of Cancer (SITC 2016) : part two

Background The immunological escape of tumors represents one of the main ob- stacles to the treatment of malignancies. The blockade of PD-1 or CTLA-4 receptors represented a milestone in the history of immunotherapy. However, immune checkpoint inhibitors seem to be effective in specific cohorts of patients. It has been proposed that their efficacy relies on the presence of an immunological response. Thus, we hypothesized that disruption of the PD-L1/PD-1 axis would synergize with our oncolytic vaccine platform PeptiCRAd. Methods We used murine B16OVA in vivo tumor models and flow cytometry analysis to investigate the immunological background. Results First, we found that high-burden B16OVA tumors were refractory to combination immunotherapy. However, with a more aggressive schedule, tumors with a lower burden were more susceptible to the combination of PeptiCRAd and PD-L1 blockade. The therapy signifi- cantly increased the median survival of mice (Fig. 7). Interestingly, the reduced growth of contralaterally injected B16F10 cells sug- gested the presence of a long lasting immunological memory also against non-targeted antigens. Concerning the functional state of tumor infiltrating lymphocytes (TILs), we found that all the immune therapies would enhance the percentage of activated (PD-1pos TIM- 3neg) T lymphocytes and reduce the amount of exhausted (PD-1pos TIM-3pos) cells compared to placebo. As expected, we found that PeptiCRAd monotherapy could increase the number of antigen spe- cific CD8+ T cells compared to other treatments. However, only the combination with PD-L1 blockade could significantly increase the ra- tio between activated and exhausted pentamer positive cells (p= 0.0058), suggesting that by disrupting the PD-1/PD-L1 axis we could decrease the amount of dysfunctional antigen specific T cells. We ob- served that the anatomical location deeply influenced the state of CD4+ and CD8+ T lymphocytes. In fact, TIM-3 expression was in- creased by 2 fold on TILs compared to splenic and lymphoid T cells. In the CD8+ compartment, the expression of PD-1 on the surface seemed to be restricted to the tumor micro-environment, while CD4 + T cells had a high expression of PD-1 also in lymphoid organs. Interestingly, we found that the levels of PD-1 were significantly higher on CD8+ T cells than on CD4+ T cells into the tumor micro- environment (p < 0.0001). Conclusions In conclusion, we demonstrated that the efficacy of immune check- point inhibitors might be strongly enhanced by their combination with cancer vaccines. PeptiCRAd was able to increase the number of antigen-specific T cells and PD-L1 blockade prevented their exhaus- tion, resulting in long-lasting immunological memory and increased median survival

Robo-what?, Robo-why?, Robo-how? – A systematic literature review of robo-advice

Robo-advisors (RAs) guide investors through an automated financial advice process, recommend personalized portfolio assignments based on their risk-affinity and goals, and rebalance their portfolio automatically over time. While still a novel instantiation of FinTechs, an increased number of RA publications, especially in 2019 and 2020, shows a determined interest of research in the subject. However, no comprehensive state-of-the-art nor a set of future research directions is available. We, therefore, conduct a systematic literature review, analyzing 42 peer-reviewed articles focusing on RA. We provide descriptive statistics of the articles, including research approaches and regional focuses, and classify the literature in an Organizing Framework for RA Research with the three main themes RA Users, RA Service, and RA Competition. We summarize RA\u27s current scientific knowledge by showing important insights on each theme and the interrelation between the themes. Lastly, we provide fruitful future research directions derived from RA literature