Updates on accelerated and blast phase myeloproliferative neoplasms: Are we making progress?

Management approaches for accelerated and blast phase myeloproliferative neoplasms remain challenging for clinicians and patients alike. Despite many therapeutic advances, outcomes for those patients who are not allogeneic haematopoietic cell transplant eligible remain, in general, very poor. Estimated survival rates for such blast phase patients is frequently reported as less than 6 months. No specific immunological, genomic or clinicopathological signature currently exists that accurately predicts the risk and timing of transformation, which frequently induces a high degree of anxiety among patients and clinicians alike. Within this review article, we provide an up-to-date summary of current understanding of the underlying pathogenesis of accelerated and blast phase disease and discuss current therapeutic approaches and realistic outcomes. Finally, we discuss how the horizon may look with the introduction of more novel agents into the clinical arena.

Improving ultrasound video classification: an evaluation of novel deep learning methods in echocardiography

Echocardiography is the commonest medical ultrasound examination, but automated interpretation is challenging and hinges on correct recognition of the 'view' (imaging plane and orientation). Current state-of-the-art methods for identifying the view computationally involve 2-dimensional convolutional neural networks (CNNs), but these merely classify individual frames of a video in isolation, and ignore information describing the movement of structures throughout the cardiac cycle. Here we explore the efficacy of novel CNN architectures, including time-distributed networks and two-stream networks, which are inspired by advances in human action recognition. We demonstrate that these new architectures more than halve the error rate of traditional CNNs from 8.1% to 3.9%. These advances in accuracy may be due to these networks' ability to track the movement of specific structures such as heart valves throughout the cardiac cycle. Finally, we show the accuracies of these new state-of-the-art networks are approaching expert agreement (3.6% discordance), with a similar pattern of discordance between views.

Effects of Percutaneous Coronary Intervention on Death and Myocardial Infarction Stratified by Stable and Unstable Coronary Artery Disease: A Meta-Analysis of Randomized Controlled Trials

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In patients presenting with ST-segment–elevation myocardial infarction, percutaneous coronary intervention (PCI) reduces mortality when compared with fibrinolysis. In other forms of coronary artery disease (CAD), however, it has been controversial whether PCI reduces mortality. In this meta-analysis, we examine the benefits of PCI in (1) patients post–myocardial infarction (MI) who did not receive immediate revascularization; (2) patients who have undergone primary PCI for ST-segment–elevation myocardial infarction but have residual coronary lesions; (3) patients who have suffered a non–ST-segment–elevation acute coronary syndrome; and (4) patients with truly stable CAD with no recent infarct. This analysis includes data from the recently presented International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) and Complete versus Culprit-Only Revascularization Strategies to Treat Multivessel Disease after Early PCI for STEMI (COMPLETE) trials.

Circulating gonadotropins levels and contribution of different large antral follicles to isofolliculia in sheep

The aim of this study was first to search for isofolliculia in right and left ovaries during postnatal development of Ouled Djellel ewe lambs, a non-seasonal breed of sheep. In addition, the contribution of different sizes of large antral follicles to this phenomenon was studied, and finally the variations in both plasma FSH and LH levels during this period of life were determined. Plasma was collected from groups of four ewe lambs at 0 (<24h), 1 week, and every 2 weeks from 4 to 14 weeks of age. Thereafter, each group was slaughtered, right and left ovaries recovered, weighed and their length and width measured. One ovary was fixed in Bouin-Holland's solution and prepared for histological study. The other one was immediately frozen and cut in a cryostat and prepared for histochemical study. This latter method was used to detect the activity of alkaline phosphatase, lactate dehydrogenase, NADH(2)-tetrasolium reductase, and glucose-6-phosphate dehydrogenase enzymes. Number and size of antral follicles and their contribution to isofolliculia were determined from ovarian sections of both studies. Isofolliculia was seen in right and left ovaries of Ouled Djellel ewe lambs at 4, 6, 8, and 10 weeks of age. This phenomenon was characterized by the presence of large antral follicles almost equal in size and total enzymatic inactivity in the interstitium. Weight and dimensions of right and left ovaries increased rapidly from birth to 4 weeks of age, and then rose gradually to week 8 and then rising again to week 10, followed by a decline at 12 and 14 weeks of age. All large antral follicles contributed to isofolliculia in right and left ovaries but, the percentage of antral follicles <2mm at 4, 6, 8, and 10 weeks of age were significantly greater than the percentage of follicles > or =2 and <3mm and the contribution of follicles > or =3mm was the lowest. FSH levels increased slowly from birth to 6 weeks of age then, increased rapidly to week 10, followed by a decline at weeks 12 and 14. LH was low at birth and the level increased slowly to 8 weeks of age, followed by a further rapid increase at 10 weeks of age. All parameters studied did not show any significant differences between the right and left ovary. It was concluded that isofolliculia occurred between 4 and 10 weeks of age in left and right ovaries of Ouled Djellel ewe lambs. This phenomenon was characterized by the increase of both ovarian weights and dimensions, and of plasma FSH and LH levels. All large antral follicles > or =1mm in diameter contributed to isofolliculia but the contribution of antral follicles <2mm was greater than the contribution of antral follicles > or =2.

Relationship between follicle growth and circulating gonadotrophin levels during postnatal development of sheep

This study investigates the number and size of ovarian antral follicles in relation to plasma follicle stimulating hormones (FSH) and luteinizing hormone (LH) concentrations from birth to 26 weeks of age in ewe lambs of the Ouled Djellel breed, a non-seasonal breed of sheep. Plasma was collected from 10 ewe lambs at 14 sampling times (Week 0, i.e. <24h, Week 1 and every two weeks from Week 4 to Week 26, inclusive). At each of these stages, four ewe lambs were slaughtered, the ovaries recovered and weighed, and the number and size of the follicles determined from histological examination. The pattern for plasma FSH showed a peak at Week 10, a smaller peak at Week 18 and a very small peak at Week 24. The pattern for LH was similar until Week 24 when the largest peak occurred. Paired ovarian weight increased rapidly from birth to four weeks and then more slowly to 10 weeks, followed by a decline at 12 weeks and a gradual increase from 14 to 24 weeks of age. The number and total diameter of follicles > or =3 mm in diameter showed similar patterns of development--rising gradually from birth to Week 14, falling to Week 16 and then rising more rapidly to a peak at Week 24. Maximum follicle diameter declined from birth to Week 1, then rose rapidly to Week 4, followed by a more gradual rise to Week 14 and, thereafter, a more rapid increase to a peak of 7.23+/-0.16 mm at 24 weeks old. The number of follicles (<3 mm diameter) increased rapidly from birth to Week 10 and then declined to values similar to those at Weeks 1 and 4. First behavioural oestrus was observed at Week 24 and a corpus luteum was present on the ovary of one lamb at Week 24 and two lambs at Week 26. It was concluded that two or three peaks in plasma FSH and LH levels precede puberty and first ovulation in Ouled Djellel ewe lambs, and first ovulation occurred at 24-26 weeks of age. The increase in follicle number and size generally reflected the pattern of plasma FSH and LH levels.

[Hand injuries in the ready-made clothing industry]

We collect during 1997, 30 work accidents in the ready-wade clothe sector. These accidents have concerned 28 females and 2 males with a mean age of 21 years. Injury affect predominatly the left hand (17 patients) and the finger of pince. Severity of the lesions was variable according to the traumatic cause. In the distal fingers trauma, skin cicatrisation have been observed after 21 days and bone consolidation within 45 days.