Validation of the Berlin Grading System for moyamoya angiopathy with the use of [15O]H2O PET

The Berlin Grading System assesses clinical severity of moyamoya angiopathy (MMA) by combining MRI, DSA, and cerebrovascular reserve capacity (CVRC). Our aim was to validate this grading system using [15O]H2O PET for CVRC. We retrospectively identified bilateral MMA patients who underwent [15O]H2O PET examination and were treated surgically at our department. Each hemisphere was classified using the Suzuki and Berlin Grading System. Preoperative symptoms and perioperative ischemias were collected, and a logistic regression analysis was performed. A total of 100 hemispheres in 50 MMA patients (36 women, 14 men) were included. Using the Berlin Grading System, 2 (2.8%) of 71 symptomatic hemispheres were categorized as grade I, 14 (19.7%) as grade II, and 55 (77.5%) as grade III. The 29 asymptomatic hemispheres were characterized as grade I in 7 (24.1%) hemispheres, grade II in 12 (41.4%), and grade III in 10 (34.5%) hemispheres. Berlin grades were independent factors for identifying hemispheres as symptomatic and higher grades correlated with increasing proportion of symptomatic hemispheres (p < 0.01). The Suzuki grading did not correlate with preoperative symptoms (p = 0.26). Perioperative ischemic complications occurred in 8 of 88 operated hemispheres. Overall, complications did not occur in any of the grade I hemispheres, but in 9.1% (n = 2 of 22) and 9.8% (n = 6 of 61) of grade II and III hemispheres, respectively. In this study, we validated the Berlin Grading System with the use of [15O]H2O PET for CVRC as it could stratify preoperative symptomatology. Furthermore, we highlighted its relevance for predicting perioperative ischemic complications.

Palliative Cytoreductive Surgery With or Without Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis: Is It Safe and Effective?

INTRODUCTION

Palliation is a controversial indication for cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Patients with peritoneal carcinomatosis (PC) are living longer, and the roles of palliative CRS and HIPEC are increasingly challenged. The purpose of this study is to evaluate indications, morbidity, and symptom improvement from CRS/HIPEC in advanced PC.

METHODS

A retrospective review of patients undergoing CRS and/or HIPEC with a palliative intent at a single institution from February 2008 to February 2018 was performed. Main end points included symptom improvement, symptom-free interval, and overall survival.

RESULTS

Two hundred and seventy seven patients were referred for CRS/HIPEC during the study period and 17 underwent 20 palliative procedures. Appendiceal (n = 6) and colorectal cancers (n = 6) were the most common malignancies. Ascites (n = 8) and bowel obstruction (n = 8) were the most common indications for intervention. The postoperative complication rate was 50% and major complication rate was 20%. Partial symptom improvement or resolution of symptoms was achieved in 18 (90%) cases. A durable symptom control at 90 d was achieved in 13 (65%) cases. The median time to symptom recurrence was 5.1 mo (interquartile range: 2-11.4), and the median overall survival was 11.6 mo (interquartile range: 3.8-28.5).

CONCLUSIONS

Palliative CRS and/or HIPEC achieve symptom improvement in patients with advanced PC. Risk assessment and expected time to recovery from surgery remain paramount for patient selection.

Logical Hidden Markov Models

Logical hidden Markov models (LOHMMs) upgrade traditional hidden Markov models to deal with sequences of structured symbols in the form of logical atoms, rather than flat characters. This note formally introduces LOHMMs and presents solutions to the three central inference problems for LOHMMs: evaluation, most likely hidden state sequence and parameter estimation. The resulting representation and algorithms are experimentally evaluated on problems from the domain of bioinformatics.

Towards discovering structural signatures of protein folds based on logical hidden Markov models

With the growing number of determined protein structures and the availability of classification schemes, it becomes increasingly important to develop computer methods that automatically extract structural signatures for classes of proteins. In this paper, we introduce and apply a new Machine Learning technique, Logical Hidden Markov Models (LOHMMs), to the task of finding structural signatures of folds according to the classification scheme SCOP. Our results indicate that LOHMMs are applicable to this task and possess several advantages over other approaches.

Osseous sequestration in cattle: 110 cases (1987-1997)

OBJECTIVE

To determine risk factors for development of sequestra in cattle and identify factors associated with a successful outcome.

DESIGN

Retrospective study.

ANIMALS

110 cattle.

PROCEDURE

Medical records of cattle treated at veterinary teaching hospitals in North America were reviewed. To determine risk factors for osseous sequestration, breed, age, and sex of cattle with osseous sequestration were compared with breed, age, and sex of all other cattle admitted during the study period.

RESULTS

110 cattle were included in the study. Three had 2 sequestra; thus, 113 lesions were identified. Most sequestra were associated with the bones of the extremities, most commonly the third metacarpal or third metatarsal bone. Ninety-two animals were treated surgically (i.e., sequestrectomy), 7 were treated medically, 3 were initially treated medically and were then treated surgically, and 8 were not treated. Follow-up information was available for 65 animals treated surgically and 6 animals treated medically. Fifty-one (78%) animals treated surgically and 5 animals treated medically had a successful outcome. Cattle that were 6 months to 2 years old had a significantly increased risk of developing a sequestrum, compared with cattle < 6 months old. Cattle in which sequestrectomy was performed with the aid of local anesthesia were significantly more likely to undergo 2 or more surgical procedures than were cattle in which sequestrectomy was performed with the aid of general anesthesia.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggest that sequestrectomy will result in a successful outcome for most cattle with osseous sequestration.

Microbiologic effect of bovine cerebrospinal fluid and azithromycin against Neisseria meningitidis, Streptococcus pneumoniae, and Haemophilus influenzae

Minimum inhibitory concentrations (MICs) and minimum bactericidal concentrations (MBCs) of azithromycin against reference strains of Streptococcus pneumoniae ATCC 49619, Neisseria meningitidis ATCC 13090, and Haemophilus influenzae ATCC 49247 were determined by the macrodilution broth method with and without 10% bovine cerebrospinal fluid (CSF) supplementation. The MICs and MBCs were within one to two dilutions for N. meningitidis and S. pneumoniae, and no difference was observed for H. influenzae. Time-kill curves demonstrated enhanced killing by azithromycin when 10% bovine CSF was added to media for N. meningitidis. The minimum azithromycin concentration for a greater than 3 log10 reduction in inoculum with bovine CSF was 0.03 microg/ml and without CSF was 0.12 microg/ml, a 3-fold difference. Killing was not significantly different for either H. influenzae nor S. pneumoniae.

An evaluation of four types of freshwater model ecosystem for assessing the hazard of pesticides

Experimental results are reported on four types of freshwater model ecosystem after administration of a single dose of chlorpyrifos. The fate, and primary and secondary effects of chlorpyrifos were compared between the model ecosystems, and were evaluated in the light of the predictive value of the current ecotoxicological hazard assessment procedure for pesticides. 'Slootbox', a fate model used in the ecotoxicological risk assessment of pesticides in the Netherlands, overestimated chlorpyrifos concentrations. The primary effects of chlorpyrifos can be predicted accurately on the basis of single species laboratory toxicity data. The population effects observed in the microecosystems, microcosms, and mesocosms were consistent between all experiments and with the single species tests. Community metabolism, as a functional endpoint, was less sensitive than the structural parameters measured. Secondary effects, both for structural and functional endpoints, varied between the micro- and mesocosm experiments. At the present 'state of the art' in ecotoxicology, no a priori prediction of secondary effects in natural ecosystems will generally be possible. 0.1 times the lowest acute L(E)C50 for chlorpyrifos, as measured in the current ecotoxicological hazard assessment procedure, matched the NOECmesocosm for a single dose of chlorpyrifos. Recovery of populations affected by insecticide stress was found to depend on factors such as life cycle characteristics and ecological infrastructure, in addition to the toxicant concentration. The onset of (potential) recovery is likely to start at an approximate concentration of the EC10(48 h).

Prognostic value of anion gap calculation in cattle with abomasal volvulus: 58 cases (1980-1985)

Values for anion gap, serum chloride, and base excess were tabulated for 58 dairy cows with abomasal volvulus. Test values for survivors (n = 40) and nonsurvivors (n = 18) were compared. Surviving cattle were released for production or salvage. Nonsurviving cows died or were euthanatized. Accuracy of preoperative anion gap, serum chloride, and base excess values in predicting outcome was evaluated by calculating the sensitivity, specificity, predictive value, and negative predictive value of these at assigned cutoff values. Anion gaps greater than or equal to 30 mEq/L were indicative of a poor prognosis. At this value, the sensitivity (0.889), specificity (0.925), predictive value (0.842), negative predictive value (0.949), and efficiency (0.914) were higher than when serum chloride concentration less than or equal to 84 mEq/L or base excess value less than or equal to 0 were used to denote poor prognosis. We concluded that preoperative anion gap calculation could reliably predict the outcome of cows with abomasal volvulus and was more accurate than either serum chloride concentration or base excess value.