Giant Ruptured Common Iliac Artery Infected Aneurysm

INTRODUCTION

Saccular mycotic aorto-iliac aneurysms are extremely rare and when presented with ruptured, they are an important life- threatening condition.

METHODS

We present a 52 years old male transferred from another Hospital and admitted to the emergency room with a ruptured iliac artery aneurysm.

RESULTS

He complained of persistent fever and abdominal discomfort that swiftly established as hemorrhagic shock. Imagiological study with angioCT revealed a ruptured left common iliac artery saccular aneurysm with 90mm. The patient was instantaneously and successfully submitted to endoaneurismorraphy, common and external iliac artery ligation and construction of an extra anatomic bypass, right to left femoro-femoral bypass. Blood culture revealed a Streptococcus anginosus and the patient received appropriate targeted antibiotics. Post-operative period was uneventful and the patient discharged ten days after admission. He has now eleven months of follow up with no intercurrences.

CONCLUSION

Long term antibiotics along with aggressive surgical debridement of the infected tissue and vascular revascularization with an extra anatomic bypass remain the most definitive solution while endovascular aneurysm repair may generally constitute a bridge life-saving procedure in mycotic infected aneurysms. Even though surgical approach carries a relative risk of perioperative morbidity it is a feasible and durable solution for extreme situations like the one here described.

Percutaneous Treatment Pseudo-Aneurism of the Hand in Hemophilic Patient

INTRODUCTION

Pseudo aneurysms of the hand are infrequent lesions, usually associated with perforating trauma. The diagnosis is based on clinical suspicion and image confirmation of a pulsatile swelling. Various treatment modalities are currently described in the literature.

METHODS

Presentation of a clinical case and discussion of the treatment strategy instituted.

RESULTS

Clinical case: Man, 35 years old, with hemophilia A. History of perforating trauma of the palmar face of the right hand 3 weeks ago, having been sutured in the local hospital. Since then he notices a pulsatile swelling in the palm of the hand associated with paresthesias and decreased sensitivity in the index finger. A pseudo-aneurysm with 2x3cm was observed, partially thrombosed, and with probable origin in the palmar arch or in the common digital artery. He underwent angiography demonstrating the patency of the palmar arch but without perfusion of the pseudo-aneurysm, and the control dupplex scan showed complete thrombosis of the false aneurysm. After 2 months of follow-up, the dupplex scan was repeated and repermeabilization of the pseudo-aneurysm was verified. The patient was then treated with percutaneous Doppler-guided thrombin injection. Immediate thrombosis of the lesion was found, with no evidence of ischemic complications. He remained asymptomatic under clinical surveillance.

CONCLUSION

For small pseudo-aneurysm conservative non- -interventional treatment with external compression may be effective. Conventional surgical treatment with simple ligation or arterial reconstruction may be indicated in larger pseudo-aneurysm. Recently, endovascular techniques such as coil embolization have also been described. Hemophilia A is a genetic disease of recessive hereditary transmission linked to the X chromosome, with deficiency of factor VIII of the coagulation cascade, which manifests with increased risk of hemorrhage. In this particular case, given the risk of hemorrhage, we chose minimally invasive percutaneous treatment, with clinical and imagological success and no complications. Percutaneous treatment by ecodoppler- guided injection of thrombin is an effective and safe treatment, particularly in pseudo-aneurysm associated with surgical risk factors.

Repatriation Data: More than two million species occurrence records added to the Brazilian Biodiversity Information Facility Repository (SiBBr)

Background

Primary biodiversity data records, available on-line, are essential for conservation planning. Of the mega diversity countries, Brazil have reached a high level of scientific research in describing their biodiversity. However, there still remain significant limitations in recovering, collating and organizing available information on Brazil's biological diversity and its distribution. Since the colonial period, biological material were often collected and transferred to other countries, which were characterized, stored and maintained. As a result, natural history museums worldwide possess large amounts of primary biodiversity data originally from Brazil which are then published on-line in the international Global Biodiversity Information Facility (GBIF) infrastructure. Aiming to recover these data, the Brazilian Biodiversity Information System (SiBBr) developed an automatic repatriation tool capable of retrieving all records registered in Brazil but published outside Brazilian territory in an automated manner.

New information

Thus, 2,459,366 records were added to SiBBr’s Repository in one day. Europe and the United States hold about 80% of all records. The data set covers all life kingdoms. Animalia is the most represented group with 3 main phylum's: Chordata, Arthropoda and Mollusca, within more than 40% of all records. Plantae also comprises a large portion of the records with angiosperms having the major number of entries.

Predictive Factors of Acute Rejection in Low Immunologic Risk Kidney Transplant Recipients Receiving Basiliximab

INTRODUCTION

The optimal immunosuppressive induction therapy in kidney transplant recipients with low immunologic risk of acute rejection (AR) is still controversial. The use of basiliximab (BSX) has led to a significant decrease of AR with a low side effect profile.

OBJECTIVE

This study sought to evaluate predictive risk factors for AR in low immunologic risk patients subjected to immunosuppressive induction therapy with BSX.

METHODS

We reviewed all low immunologic risk patients (panel reactive antibody [PRA] level <50%, who had undergone a first deceased-donor transplant) subjected to immunosuppressive induction therapy with BSX, calcineurin inhibitor, mycophenolate mofetil, and prednisolone (n = 346). AR was defined as any rejection occurring until 12 months posttransplantation. Predictive risk factors for AR were evaluated by logistic regression and, to find the best cut-off of PRA related to a higher incidence of AR, receiver-operator characteristic (ROC) curve analysis was performed.

RESULTS

The rate of AR was 7.8%. Multivariate logistic regression analysis identified age at the time of transplantation (P = .040) and PRA level (P = .001) as independent risk factors for AR. ROC curve analysis confirmed that PRA >10% was related to an increased incidence of AR (19.2% vs 6.0%, P = .005).

CONCLUSIONS

A higher incidence of AR was observed in low immunologic risk kidney transplant patients with a PRA level >10%. These data support the use of more intensive immunosuppressive induction therapy in patients with low immunologic risk and a PRA level >10%.

The Ciliary Transition Zone: Finding the Pieces and Assembling the Gate

Eukaryotic cilia are organelles that project from the surface of cells to fulfill motility and sensory functions. In vertebrates, the functions of both motile and immotile cilia are critical for embryonic development and adult tissue homeostasis. Importantly, a multitude of human diseases is caused by abnormal cilia biogenesis and functions which rely on the compartmentalization of the cilium and the maintenance of its protein composition. The transition zone (TZ) is a specialized ciliary domain present at the base of the cilium and is part of a gate that controls protein entry and exit from this organelle. The relevance of the TZ is highlighted by the fact that several of its components are coded by ciliopathy genes. Here we review recent developments in the study of TZ proteomes, the mapping of individual components to the TZ structure and the establishment of the TZ as a lipid gate.

Assessing suicide risk with the Clinical Interview for Psychotic Disorders (CIPD): Preliminary reliability and validity of the Suicide Risk Scale for Psychosis (SRS-P)

Background

Suicide risk is an important variable to consider both in assessment and throughout the therapeutic process in psychotic disorders. The SRS-P is an 18-item scale computed from the patient and clinician-rated scores obtained in the CIPD. The scale comprises lifetime assessment of depressed mood, anhedonia and its current interference and severity, current and past feelings of hopelessness, suicidal ideation, ‘voices’ about suicide, and suicide-related behaviors.

Aims

To assess reliability and convergent validity of the SRS-P in a sample of participants with psychosis.

Methods

The sample comprised 22 participants (68.2% male), single (72.7%), between 19 and 47 years old (M = 31.05; SD = 7.088), with 4–17 years of education (M = 11.77; SD = 3.176), employed (50%). The most prevalent diagnosis was schizophrenia (68.2%) and the participants had a mean of 1.90 hospitalizations (SD = 2.548). The mean age of illness onset was 23.57 years (SD = 5.555). The participants were assessed with the CIPD, Depression, Anxiety and Stress Scales-21, Forms of Self-Criticism and Reassurance Scale, Self-Compassion Scale, Other as Shamer Scale and the Empowerment with Psychotic Symptoms Scales.

Results

The SRS-P has shown good reliability (α = .87) and validity in relation to depressive symptoms (r = .67; P = .001), anxiety (r = .74; P < .001), stress (r = .59; P = .004), inadequate self (r = .43; P = .046), hated self (r = .54; P = .009), reassured self (r = –.65; P = .001), self-compassion (r = –.63; P = .002), shame (r = .46; P = .033) and empowerment regarding positive symptoms (r = –.54; P = .015).

Conclusions

The SRS-P presented adequate reliability and convergent-divergent validity. Further studies are planned in order to test the factorial structure of the scale and confirm the presented results in a larger sample.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

The reality of domestic violence in the US

According to the United States department of justice, domestic violence is defined as “a pattern of abusive behaviours in any relationship that are used by one partner to gain or maintain power and control over another intimate partner”. It involves a pattern of coercive behaviour in intimate relationships whereby the behaviour is controlled through humiliation, intimidation, fear, and often intentional physical, emotional or sexual injury. Domestic violence crosses all ethnic, socioeconomic and age groups, and is also prevalent in same sex relationships.

Over six million children are severely assaulted by family members every year in the United States; a man beats a woman every twelve seconds; women who leave their batterer are at 75% greater risk of being killed by their batterer than those who stay; and one third of police time is spending on answering domestic violence calls.

In domestic violence situations the intervention is frequently in crisis, where the victims “fight” for survival, and it is necessary to give proper answers according to the victim's needs. The professionals that work directly with domestic violence assume that there is a strong bond connecting the domestic violence with mental health. In the United States 90% of domestic violence survivors report extreme emotional distress; 47.5% report having been diagnosed with post-traumatic stress disorder; 14.7% report anxiety; 20% depression. Mental illnesses are frequently observed in domestic violence survivors.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Empowerment With Psychotic Symptoms Scale (EWPSS): Exploratory Study of the Scale's Psychometric Properties

Background

Empowerment has been defined as the ability to act autonomously, the willingness to take risks and being aware of responsibility. The importance of this construct in psychosis has been emphasized by recovery models. An integrant part of the Clinical Interview for Psychotic Disorders (CIPD), the EWPSS is a visual analog scale in which the participants assess their sense of empowerment regarding symptoms (delusions, hallucinations, negative symptoms and disorganization). EWPSS focuses on personal empowerment (self-worth and self-efficacy) as it could apply to symptoms.

Aims

To preliminarily assess the psychometric properties of the EWPSS in a sample of participants with psychosis.

Methods

The sample comprised 22 participants (68.2% male), 72.7% single, 50% employed, between 19 and 47 years old (M = 31.05; SD = 7.088), with 4–17 years of education (M = 11.77; SD = 3.176). The most prevalent diagnosis was schizophrenia (68.2%) and the participants had a mean of 1.90 hospitalizations (SD = 2.548). The participants were assessed with the CIPD (EWPSS) and Depression, Anxiety and Stress Scales-21.

Results

EWPSS has shown acceptable reliability for all dimensions (with alphas ranging between .54 and .78). Empowerment with delusions was associated with the other dimensions, excepting for empowerment with negative symptoms (which in turn was not associated significantly with any dimension). Empowerment regarding hallucinations and with disorganization were only associated with empowerment with delusions, which was also associated with anxiety symptoms (r = –.52, P = .016).

Conclusions

The EWPSS presented adequate reliability and validity. Further studies intended to explore the factorial structure of the EWPSS are under development.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

miRNA profiling of human naive CD4 T cells links miR-34c-5p to cell activation and HIV replication

Cell activation is a vital step for T-cell memory/effector differentiation as well as for productive HIV infection. To identify novel regulators of this process, we used next-generation sequencing to profile changes in microRNA expression occurring in purified human naive CD4 T cells in response to TCR stimulation and/or HIV infection. Our results demonstrate, for the first time, the transcriptional up-regulation of miR-34c-5p in response to TCR stimulation in naive CD4 T cells. The induction of this miR was further consistently found to be reduced by both HIV-1 and HIV-2 infections. Overexpression of miR-34c-5p led to changes in the expression of several genes involved in TCR signaling and cell activation, confirming its role as a novel regulator of naive CD4 T-cell activation. We additionally show that miR-34c-5p promotes HIV-1 replication, suggesting that its down-regulation during HIV infection may be part of an anti-viral host response.

Neuropsychiatric Systemic Lupus Erythematosus Involvement: Towards a Tailored Approach to Our Patients?

Neuropsychiatric involvement in systemic lupus erythematosus (NPSLE) is a complex condition that remains poorly understood, and includes heterogeneous manifestations involving both the central and peripheral nervous system, with disabling effects. There are several models to improve NPSLE diagnosis when a neurological syndrome is present. In the last couple of years, the growing knowledge of the role of cytokines and antibodies in NPSLE, as well as the development of new functional imaging techniques, has brought some insights into the physiopathology of the disease, but their validation for clinical use remains undetermined. Furthermore, besides the classic clinical approach, a new tool for screening the 19 NPSLE syndromes has also been developed. Regarding NPSLE therapeutics, there is still no evidence-based treatment approach, but some data support the safety of biological medication when classic treatment fails. Despite the tendency to reclassify SLE patients in clinical and immunological subsets, we hope that these data will inspire medical professionals to approach NPSLE in a manner more tailored to the individual patient.

Nonlinear compensation with DBP aided by a memory polynomial

Using digital backpropagation (DBP) based on the split step Fourier method (SSFM) aided by a memory polynomial (MP) model, we demonstrate an improved DBP approach for fiber nonlinearity compensation. The proposed technique (DBP-SSFM&MP) is numerically validated and its performance and complexity are compared against the benchmark DBP-SSFM, considering a single-channel 336 Gb/s PM-64QAM transmission system. We demonstrate that the proposed technique allows to maintain the performance achieved by DBP-SSFM, while decreasing the required number of iterations, by over 60%. For a transmission length of 1600 km we obtain a complexity reduction gain of 50.7% in terms of real multiplications in comparison with the standard DBP-SSFM.

Hyperacute Rejection in a Kidney Transplant With Negative Crossmatch: A Case Report

Hyperacute rejection (HAR) is a rare event that can be prevented by crossmatch tests that detect anti-human leukocyte antigen antibodies against the donor. We present the case of a 43-year-old man who underwent a deceased-donor kidney transplantation with a negative complement-dependent cytotoxicity and a negative flow cytometry crossmatch. Luminex technology detected anti-DQ donor-specific antibodies (DSA) with a mean fluorescence intensity of 11,000. A single plasmapheresis session was carried out, followed by immunosuppression with immunoglobulin, antithymocyte globulin, tacrolimus, and methylprednisolone. Minutes after graft reperfusion, in the presence of clinical evidence of HAR, the patient underwent nephrectomy. The investigation for the presence of anti-major histocompatibility complex class I-related chain A and anti-endothelial antibodies was negative. This case reinforces the importance of DSA, and more specifically, of anti-DQ DSA in the allogeneic response when detected by solid-phase tests, even with a negative crossmatch, assuming they can be responsible for HAR.

CIB1 and CIB2 are HIV-1 helper factors involved in viral entry

HIV-1 relies on the host-cell machinery to accomplish its replication cycle, and characterization of these helper factors contributes to a better understanding of HIV-host interactions and can identify potential novel antiviral targets. Here we explored the contribution of CIB2, previously identified by RNAi screening as a potential helper factor, and its homolog, CIB1. Knockdown of either CIB1 or CIB2 strongly impaired viral replication in Jurkat cells and in primary CD4+ T-lymphocytes, identifying these proteins as non-redundant helper factors. Knockdown of CIB1 and CIB2 impaired envelope-mediated viral entry for both for X4- and R5-tropic HIV-1, and both cell-free and cell-associated entry pathways were affected. In contrast, the level of CIB1 and CIB2 expression did not influence cell viability, cell proliferation, receptor-independent viral binding to the cell surface, or later steps in the viral replication cycle. CIB1 and CIB2 knockdown was found to reduce the expression of surface molecules implicated in HIV-1 infection, including CXCR4, CCR5 and integrin α4β7, suggesting at least one mechanism through which these proteins promote viral infection. Thus, this study identifies CIB1 and CIB2 as host helper factors for HIV-1 replication that are required for optimal receptor-mediated viral entry.

Biosimilar monoclonal antibodies: preclinical and clinical development aspects

Biological drugs and their originated biosimilars are large, highly complex molecules derived from living cells or organisms. Traditional medicines, by contrast, are usually simple molecules of low molecular weight, synthesised by chemical means. The distinct complexities and methods of manufacture create an important difference between biosimilars and conventional generic drugs: while chemical generics can be fully characterised as identical to the originator product, biosimilars cannot. In addition, biological therapies are inherently variable, creating unavoidable differences between even subsequent batches of the same product. An expiring patent does not necessarily mean that the manufacturing process of the originator product becomes available to the biosimilar developers (for instance, the relevant cell line clone and growth medium). Therefore, it cannot be guaranteed that biosimilar products are identical to their reference product on a molecular level. This difference has important implications for the regulation and licensing of biosimilars. While conventional generic drugs require only a limited comparison and demonstration of identical chemical structure to the reference product, biosimilars require far more rigorous testing. In general, there must be a thorough comparison of structural and functional characteristics between biosimilar and originator drug. Stepwise nonclinical in vitro and in vivo approaches are recommended to evaluate the similarity of both drugs and any identified micro-heterogeneities must then be assessed for their impact on safety and clinical performance. Subsequently, clinical pharmacokinetic (PK) studies need to be performed in order to demonstrate a similar PK profile, prior to conducting clinical efficacy trials.

Sperm whale codas may encode individuality as well as clan identity

Sperm whales produce codas for communication that can be grouped into different types according to their temporal patterns. Codas have led researchers to propose that sperm whales belong to distinct cultural clans, but it is presently unclear if they also convey individual information. Coda clicks comprise a series of pulses and the delay between pulses is a function of organ size, and therefore body size, and so is one potential source of individual information. Another potential individual-specific parameter could be the inter-click intervals within codas. To test whether these parameters provide reliable individual cues, stereo-hydrophone acoustic tags (Dtags) were attached to five sperm whales of the Azores, recording a total of 802 codas. A discriminant function analysis was used to distinguish 288 5 Regular codas from four of the sperm whales and 183 3 Regular codas from two sperm whales. The results suggest that codas have consistent individual features in their inter-click intervals and inter-pulse intervals which may contribute to individual identification. Additionally, two whales produced different coda types in distinct foraging dive phases. Codas may therefore be used by sperm whales to convey information of identity as well as activity within a social group to a larger extent than previously assumed.

Assessment of Change in Psychoanalysis: Another Way of Using the Change After Psychotherapy Scales

A systematic method is presented whereby material from a full course of psychoanalytic treatment is analyzed to assess changes and identify patterns of change. Through an analysis of session notes, changes were assessed using the CHange After Psychotherapy scales (CHAP; Sandell 1987a), which evaluate changes in five rating variables (symptoms, adaptive capacity, insight, basic conflicts, and extratherapeutic factors). Change incidents were identified in nearly every session. Early in the analysis, relatively more change incidents related to insight were found than were found for the other types of change. By contrast, in the third year and part of the fourth year, relatively more change incidents related to basic conflicts and adaptive capacity were found. While changes related to symptoms occurred throughout the course of treatment, such changes were never more frequent than other types of change. A content analysis of the change incidents allowed a determination of when in the treatment the patient's main conflicts (identified clinically) were overcome. A crossing of quantitative data with clinical and qualitative data allowed a better understanding of the patterns of change.