Indexing and retrieval of free-form surfaces using self-organizing maps

This thesis describes the use of Self-Organizing Maps in combination with unique curvature based feature combinations and various training data sets as a clustering function to describe free-form surfaces. Our descriptor was successfully used as the basis of techniques that segmented, indexed and retrieved free-form surfaces represented as triangulated meshes

A core outcome set for localised prostate cancer effectiveness trials

Objective: To develop a core outcome set (COS) applicable for effectiveness trials of all interventions for localised prostate cancer. Background: Many treatments exist for localised prostate cancer, although it is unclear which offers the optimal therapeutic ratio. This is confounded by inconsistencies in the selection, definition, measurement and reporting of outcomes in clinical trials. Subjects and methods: A list of 79 outcomes was derived from a systematic review of published localised prostate cancer effectiveness studies and semi-structured interviews with 15 prostate cancer patients. A two-stage consensus process involving 118 patients and 56 international healthcare professionals (HCPs) (cancer specialist nurses, urological surgeons and oncologists) was undertaken, consisting of a three-round Delphi survey followed by a face-to-face consensus panel meeting of 13 HCPs and 8 patients. Results: The final COS included 19 outcomes. Twelve apply to all interventions: death from prostate cancer, death from any cause, local disease recurrence, distant disease recurrence/metastases, disease progression, need for salvage therapy, overall quality of life, stress urinary incontinence, urinary function, bowel function, faecal incontinence, sexual function. Seven were intervention-specific: perioperative deaths (surgery), positive surgical margin (surgery), thromboembolic disease (surgery), bothersome or symptomatic urethral or anastomotic stricture (surgery), need for curative treatment (active surveillance), treatment failure (ablative therapy), and side effects of hormonal therapy (hormone therapy). The UK-centric participants may limit the generalisability to other countries, but trialists should reason why the COS would not be applicable. The default position should not be that a COS developed in one country will automatically not be applicable elsewhere. Conclusion: We have established a COS for trials of effectiveness in localised prostate cancer, applicable across all interventions which should be measured in all localised prostate cancer effectiveness trials

Onasemnogene abeparvovec in spinal muscular atrophy: an Australian experience of safety and efficacy

First published: 16 February 2022Objective: To provide a greater understanding of the tolerability, safety and clinical outcomes of onasemnogene abeparvovec in real-world practice, in a broad population of infants with spinal muscular atrophy (SMA). Methods: A prospective cohort study of children with SMA treated with onasemnogene abeparvovec at Sydney Children's Hospital Network, Australia was conducted from August 2019 to November 2021. Safety outcomes included clinical and laboratory evaluations. Efficacy assessments included World Health Organisation (WHO) motor milestones, oral and swallowing abilities, and requirements for respiratory support. The implementation of a model of care for onasemnogene abeparvovec administration in health practice is described. Results: 21 children were treated (age range, 0.65–24 months; body weight range, 2.5–12.5 kg) and 19/21 (90.4%) had previous nusinersen. Transient treatment-related side effects occurred in all children; vomiting (100%), transaminitis (57%) and thrombocytopaenia (33%). Incidence of moderate/severe transaminitis was significantly greater in infants weighing ≥8 kg compared with <8 kg (p < 0.05). Duration of prednisolone following treatment was prolonged (mean 87.5 days, range 57–274 days). 16/21 (76%) children gained at least one WHO motor milestone. Stabilisation or improvement in bulbar or respiratory function was observed in 20/21 (95.2%) patients. Implementation challenges were mitigated by developing standard operating procedures and facilitating exchange of knowledge. Interpretation: This study provides real-world evidence to inform treatment decisions and guide therapeutic expectations for onasemnogene abeparvovec and combination therapy for SMA in health practice, especially for children weighing ≥8 kg receiving higher vector loads. Proactive clinical and laboratory surveillance is essential to facilitate individualised management of risks.Arlene M. D’Silva, Sandra Holland, Didu Kariyawasam, Karen Herbert, Peter Barclay, Anita Cairns, Suzanna C. MacLennan, Monique M. Ryan, Hugo Sampaio, Nicholas Smith, Ian R. Woodcock, Eppie M. Yiu, Ian E. Alexander and Michelle A. Farra

A BURST-BAUS consensus document for best practice in the conduct of scrotal exploration for suspected testicular torsion : the Finding consensus for orchIdopeXy In Torsion (FIX-IT) study

Acknowledgements The authors would like to thank Jacqueline Emkes and Rachel Jury for their contribution to our protocol development with respect to patient and public involvement. Similarly, the authors would like to thank Dr Matthew Coward, Department of Urology, University of North Carolina, and Dr Selcuk Sarikaya, Department of Urology, University of Ankara, for their international perspectives and input to our study protocol. We would like to acknowledge the BAUS Trustees for allowing this collaboration. Unrelated to this work, The BURST Research Collaborative would like to acknowledge funding from the BJUI, the Urology Foundation, Ferring Pharmaceuticals Ltd, Rosetrees Trust and Action Bladder Cancer UK. Veeru Kasivisvanathan is an Academic Clinical Lecturer funded by the United Kingdom National Institute for Health Research (NIHR). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. PubMed Indexed Collaborative Authors: Matthew Coward, Selcuk Sarikaya, Jacqueline Emkes, Rachel Jury. Research Funding Department of Health National Institute for Health Research National Institute for Health Research Rosetrees Trust Ferring Pharmaceuticals Urology Foundation University of North CarolinaPeer reviewedPublisher PD

A dynamic T cell–limited checkpoint regulates affinity-dependent B cell entry into the germinal center

Entry into the germinal center requires antigen-bearing B cells to compete for cognate T cell help at the T–B border

Interplay between faults and lava flows in construction of the upper oceanic crust : the East Pacific Rise crest 9°25′–9°58′N

Author Posting. © American Geophysical Union, 2007. This article is posted here by permission of American Geophysical Union for personal use, not for redistribution. The definitive version was published in Geochemistry Geophysics Geosystems 8 (2007): Q06005, doi:10.1029/2006GC001399.The distribution of faults and fault characteristics along the East Pacific Rise (EPR) crest between 9°25′N and 9°58′N were studied using high-resolution side-scan sonar data and near-bottom bathymetric profiles. The resulting analysis shows important variations in the density of deformational features and tectonic strain estimates at young seafloor relative to older, sediment-covered seafloor of the same spreading age. We estimate that the expression of tectonic deformation and associated strain on “old” seafloor is ~5 times greater than that on “young” seafloor, owing to the frequent fault burial by recent lava flows. Thus the unseen, volcanically overprinted tectonic deformation may contribute from 30% to 100% of the ~300 m of subsidence required to fully build up the extrusive pile (Layer 2A). Many longer lava flows (greater than ~1 km) dam against inward facing fault scarps. This limits their length at distances of 1–2 km, which are coincident with where the extrusive layer acquires its full thickness. More than 2% of plate separation at the EPR is accommodated by brittle deformation, which consists mainly of inward facing faults (~70%). Faulting at the EPR crest occurs within the narrow, ~4 km wide upper crust that behaves as a brittle lid overlying the axial magma chamber. Deformation at greater distances off axis (up to 40 km) is accommodated by flexure of the lithosphere due to thermal subsidence, resulting in ~50% inward facing faults accommodating ~50% of the strain. On the basis of observed burial of faults by lava flows and damming of flows by fault scarps, we find that the development of Layer 2A is strongly controlled by low-relief growth faults that form at the ridge crest and its upper flanks. In turn, those faults have a profound impact on how lava flows are distributed along and across the ridge crest.The field and laboratory studies were supported by NSF grants OCE-9819261 (to H.S., M.A.T., and D.J.F.), OCE-0525863 (D.J.F. and S.A.S.), OCE-0138088 (M.P.), WHOI Vetlesen Foundation Funds (J.E., D.J.F., and S.A.S.). Additional support by INSU/CNRS to J.E. is also acknowledged

Dipeptidyl peptidase-1 inhibition in patients hospitalised with COVID-19:a multicentre, double-blind, randomised, parallel-group, placebo-controlled trial

This study was funded by an investigator-initiated research grant from Insmed (Bridgewater, NJ, USA). The authors acknowledge the funding and logistical support from the UK National Institute for Health and Care Research.Background: Neutrophil serine proteases are involved in the pathogenesis of COVID-19 and increased serine protease activity has been reported in severe and fatal infection. We investigated whether brensocatib, an inhibitor of dipeptidyl peptidase-1 (DPP-1; an enzyme responsible for the activation of neutrophil serine proteases), would improve outcomes in patients hospitalised with COVID-19. Methods: In a multicentre, double-blind, randomised, parallel-group, placebo-controlled trial, across 14 hospitals in the UK, patients aged 16 years and older who were hospitalised with COVID-19 and had at least one risk factor for severe disease were randomly assigned 1:1, within 96 h of hospital admission, to once-daily brensocatib 25 mg or placebo orally for 28 days. Patients were randomly assigned via a central web-based randomisation system (TruST). Randomisation was stratified by site and age (65 years or ≥65 years), and within each stratum, blocks were of random sizes of two, four, or six patients. Participants in both groups continued to receive other therapies required to manage their condition. Participants, study staff, and investigators were masked to the study assignment. The primary outcome was the 7-point WHO ordinal scale for clinical status at day 29 after random assignment. The intention-to-treat population included all patients who were randomly assigned and met the enrolment criteria. The safety population included all participants who received at least one dose of study medication. This study was registered with the ISRCTN registry, ISRCTN30564012. Findings: Between June 5, 2020, and Jan 25, 2021, 406 patients were randomly assigned to brensocatib or placebo; 192 (47·3%) to the brensocatib group and 214 (52·7%) to the placebo group. Two participants were excluded after being randomly assigned in the brensocatib group (214 patients included in the placebo group and 190 included in the brensocatib group in the intention-to-treat population). Primary outcome data was unavailable for six patients (three in the brensocatib group and three in the placebo group). Patients in the brensocatib group had worse clinical status at day 29 after being randomly assigned than those in the placebo group (adjusted odds ratio 0·72 [95% CI 0·57-0·92]). Prespecified subgroup analyses of the primary outcome supported the primary results. 185 participants reported at least one adverse event; 99 (46%) in the placebo group and 86 (45%) in the brensocatib group. The most common adverse events were gastrointestinal disorders and infections. One death in the placebo group was judged as possibly related to study drug. Interpretation: Brensocatib treatment did not improve clinical status at day 29 in patients hospitalised with COVID-19.Publisher PDFPeer reviewe

Geochemistry of lavas from the 2005–2006 eruption at the East Pacific Rise, 9°46′N–9°56′N : implications for ridge crest plumbing and decadal changes in magma chamber compositions

Author Posting. © American Geophysical Union, 2010. This article is posted here by permission of American Geophysical Union for personal use, not for redistribution. The definitive version was published in Geochemistry Geophysics Geosystems 11 (2010): Q05T09, doi:10.1029/2009GC002977.Detailed mapping, sampling, and geochemical analyses of lava flows erupted from an ∼18 km long section of the northern East Pacific Rise (EPR) from 9°46′N to 9°56′N during 2005–2006 provide unique data pertaining to the short-term thermochemical changes in a mid-ocean ridge magmatic system. The 2005–2006 lavas are typical normal mid-oceanic ridge basalt with strongly depleted incompatible trace element patterns with marked negative Sr and Eu/Eu* anomalies and are slightly more evolved than lavas erupted in 1991–1992 at the same location on the EPR. Spatial geochemical differences show that lavas from the northern and southern limits of the 2005–2006 eruption are more evolved than those erupted in the central portion of the fissure system. Similar spatial patterns observed in 1991–1992 lavas suggest geochemical gradients are preserved over decadal time scales. Products of northern axial and off-axis fissure eruptions are consistent with the eruption of cooler, more fractionated lavas that also record a parental melt component not observed in the main suite of 2005–2006 lavas. Radiogenic isotopic ratios for 2005–2006 lavas fall within larger isotopic fields defined for young axial lavas from 9°N to 10°N EPR, including those from the 1991–1992 eruption. Geochemical data from the 2005–2006 eruption are consistent with an invariable mantle source over the spatial extent of the eruption and petrogenetic processes (e.g., fractional crystallization and magma mixing) operating within the crystal mush zone and axial magma chamber (AMC) before and during the 13 year repose period. Geochemical modeling suggests that the 2005–2006 lavas represent differentiated residual liquids from the 1991–1992 eruption that were modified by melts added from deeper within the crust and that the eruption was not initiated by the injection of hotter, more primitive basalt directly into the AMC. Rather, the eruption was driven by AMC pressurization from persistent or episodic addition of more evolved magma from the crystal mush zone into the overlying subridge AMC during the period between the two eruptions. Heat balance calculations of a hydrothermally cooled AMC support this model and show that continual addition of melt from the mush zone was required to maintain a sizable AMC over this time interval.This work has been supported by NSF grants OCE‐0525863 and OCE‐0732366 (D. J. Fornari and S. A. Soule), OCE‐0636469 (K. H. Rubin), and OCE‐ 0138088 (M. R. Perfit), as well as postdoctoral fellowship funds from the University of Florida

Natural and Vaccine-Mediated Immunity to Salmonella Typhimurium is Impaired by the Helminth Nippostrongylus brasiliensis

The impact of exposure to multiple pathogens concurrently or consecutively on immune function is unclear. Here, immune responses induced by combinations of the bacterium Salmonella Typhimurium (STm) and the helminth Nippostrongylus brasiliensis (Nb), which causes a murine hookworm infection and an experimental porin protein vaccine against STm, were examined. Mice infected with both STm and Nb induced similar numbers of Th1 and Th2 lymphocytes compared with singly infected mice, as determined by flow cytometry, although lower levels of secreted Th2, but not Th1 cytokines were detected by ELISA after re-stimulation of splenocytes. Furthermore, the density of FoxP3+ T cells in the T zone of co-infected mice was lower compared to mice that only received Nb, but was greater than those that received STm. This reflected the intermediate levels of IL-10 detected from splenocytes. Co-infection compromised clearance of both pathogens, with worms still detectable in mice weeks after they were cleared in the control group. Despite altered control of bacterial and helminth colonization in co-infected mice, robust extrafollicular Th1 and Th2-reflecting immunoglobulin-switching profiles were detected, with IgG2a, IgG1 and IgE plasma cells all detected in parallel. Whilst extrafollicular antibody responses were maintained in the first weeks after co-infection, the GC response was less than that in mice infected with Nb only. Nb infection resulted in some abrogation of the longer-term development of anti-STm IgG responses. This suggested that prior Nb infection may modulate the induction of protective antibody responses to vaccination. To assess this we immunized mice with porins, which confer protection in an antibody-dependent manner, before challenging with STm. Mice that had resolved a Nb infection prior to immunization induced less anti-porin IgG and had compromised protection against infection. These findings demonstrate that co-infection can radically alter the development of protective immunity during natural infection and in response to immunization

Development of a glycoconjugate vaccine to prevent invasive Salmonella Typhimurium infections in sub-Saharan Africa

Invasive infections associated with non-typhoidal Salmonella (NTS) serovars Enteritidis (SE), Typhimurium (STm) and monophasic variant 1,4,[5],12:i:- are a major health problem in infants and young children in sub-Saharan Africa, and currently, there are no approved human NTS vaccines. NTS O-polysaccharides and flagellin proteins are protective antigens in animal models of invasive NTS infection. Conjugates of SE core and O-polysaccharide (COPS) chemically linked to SE flagellin have enhanced the anti-COPS immune response and protected mice against fatal challenge with a Malian SE blood isolate. We report herein the development of a STm glycoconjugate vaccine comprised of STm COPS conjugated to the homologous serovar phase 1 flagellin protein (FliC) with assessment of the role of COPS O-acetyls for functional immunity. Sun-type COPS conjugates linked through the polysaccharide reducing end to FliC were more immunogenic and protective in mice challenged with a Malian STm blood isolate than multipoint lattice conjugates (>95% vaccine efficacy [VE] versus 30-43% VE). Immunization with de-O-acetylated STm-COPS conjugated to CRM197 provided significant but reduced protection against STm challenge compared to mice immunized with native STm-COPS:CRM197 (63-74% VE versus 100% VE). Although OPS O-acetyls were highly immunogenic, post-vaccination sera that contained various O-acetyl epitope-specific antibody profiles displayed similar in vitro bactericidal activity when equivalent titers of anti-COPS IgG were assayed. In-silico molecular modeling further indicated that STm OPS forms a single dominant conformation, irrespective of O-acetylation, in which O-acetyls extend outward and are highly solvent exposed. These preclinical results establish important quality attributes for an STm vaccine that could be co-formulated with an SE-COPS:FliC glycoconjugate as a bivalent NTS vaccine for use in sub-Saharan Africa