The impact of lesion location and lesion size on poststroke infection frequency

In cutaneous leishmaniasis (CL), parasites reside in the dermis, creating an opportunity for local drug administration potentially reducing adverse effects and improving treatment adherence compared to current therapies. Polymeric film-forming systems (FFSs) are directly applied to the skin and form a thin film as the solvent evaporates. In contrast to conventional topical dosage forms, FFSs strongly adhere to the skin, favouring sustained drug delivery to the affected site, reducing the need for frequent applications, and enhancing patient compliance. This study reports the first investigation of the use of film-forming systems for the delivery of DNDI-0690, a nitroimidazole compound with potent activity against CL-causing Leishmania species. A total of seven polymers with or without plasticiser were evaluated for drying time, stickiness, film-flexibility, and cosmetic attributes; three FFSs yielded a positive evaluation for all test parameters. The impact of each of these FFSs on the permeation of the model skin permeant hydrocortisone (hydrocortisone, 1% (w/v) across the Strat-M membrane was evaluated, and the formulations resulting in the highest and lowest permeation flux (Klucel LF with triethyl citrate and Eudragit RS with dibutyl sebacate, respectively) were selected as the FFS vehicle for DNDI-0690. The release and skin distribution of the drug upon application to Leishmania-infected and uninfected BALB/c mouse skin were examined using Franz diffusion cells followed by an evaluation of the efficacy of both DNDI-0690 FFSs (1% (w/v)) in an experimental CL model. Whereas the Eudragit film resulted in a higher permeation of DNDI-0690, the Klucel film was able to deposit four times more drug into the skin, where the parasite resides. Of the FFSs formulations, only the Eudragit system resulted in a reduced parasite load, but not reduced lesion size, when compared to the vehicle only control. Whereas drug delivery into the skin was successfully modulated using different FFS systems, the FFS systems selected were not effective for the topical application of DNDI-0690. The convenience and aesthetic of FFS systems alongside their ability to modulate drug delivery to and into the skin merit further investigation using other promising antileishmanial drugs.

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Elastic Modulus and Elasticity Ratio of Malignant Breast Lesions with Shear Wave Ultrasound Elastography: Variations with Different Region of Interest and Lesion Size

Diagnostics ◽

10.3390/diagnostics11061015 ◽

2021 ◽

Vol 11 (6) ◽

pp. 1015

Author(s):

Antonio Bulum ◽

Gordana Ivanac ◽

Eugen Divjak ◽

Iva Biondić Špoljar ◽

Martina Džoić Dominković ◽

...

Keyword(s):

Elastic Modulus ◽

Shear Wave ◽

Large Diameter ◽

Small Diameter ◽

Shear Wave Elastography ◽

Lesion Size ◽

Ultrasound Elastography ◽

Breast Lesions ◽

Malignant Breast ◽

The Impact

Shear wave elastography (SWE) is a type of ultrasound elastography with which the elastic properties of breast tissues can be quantitatively assessed. The purpose of this study was to determine the impact of different regions of interest (ROI) and lesion size on the performance of SWE in differentiating malignant breast lesions. The study included 150 female patients with histopathologically confirmed malignant breast lesions. Minimal (Emin), mean (Emean), maximal (Emax) elastic modulus and elasticity ratio (e-ratio) values were measured using a circular ROI size of 2, 4 and 6 mm diameters and the lesions were divided into large (diameter ≥ 15 mm) and small (diameter < 15 mm). Highest Emin, Emean and e-ratio values and lowest variability were observed when using the 2 mm ROI. Emax values did not differ between different ROI sizes. Larger lesions had significantly higher Emean and Emax values, but there was no difference in e-ratio values between lesions of different sizes. In conclusion, when measuring the Emin, Emean and e-ratio of malignant breast lesions using SWE the smallest possible ROI size should be used regardless of lesion size. ROI size has no impact on Emax values while lesion size has no impact on e-ratio values.

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Methods for the Quantification of Resistance of Apple Genotypes to European Fruit Tree Canker Caused by Neonectria ditissima

Plant Disease ◽

10.1094/pdis-04-17-0576-re ◽

2017 ◽

Vol 101 (12) ◽

pp. 2012-2019 ◽

Cited By ~ 2

Author(s):

M. Wenneker ◽

P. W. Goedhart ◽

P. van der Steeg ◽

W. E. van de Weg ◽

H. J. Schouten

Keyword(s):

Statistical Significance ◽

Lesion Size ◽

Fruit Tree ◽

Infection Frequency ◽

Pome Fruit ◽

Start Date ◽

Apple Cultivars ◽

Lesion Growth ◽

Two Parameters ◽

Parallel Tests

European fruit tree canker, caused by Neonectria ditissima, is an important disease of pome fruit worldwide. Apple cultivars differ in their levels of susceptibility to N. ditissima. In order to design an effective plant resistance test, we examined the effectiveness of two resistance parameters: infection frequency and lesion growth. Both parameters were evaluated in parallel tests using 10 apple cultivars in three experimental years, applying seminatural infection of leaf scars (infection frequency) or inoculation of artificial wounds (lesion growth). We compared six parameters for lesion growth, of which a new parameter, lesion growth rate (LGR), appeared to be the best with respect to reproducibility and statistical significance. LGR is defined as the slope of the regression of lesion size versus time. The slope was estimated for each lesion, employing a common start date and a lesion-specific end date determined by the girdling of the lesion. The two parameters (infection frequency and LGR) were examined in separate experiments and in three successive years, and provided complementary information and resulted in reproducible conclusions on the relative resistance levels to N. ditissima of the tested cultivars. The presented methods can be used to develop strategies for the control of European fruit tree canker (e.g., in the breeding of new apple cultivars with high levels of resistance to N. ditissima).

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Impact of a dedicated multidisciplinary meeting on the management of superficial cancers of the digestive tract

Endoscopy International Open ◽

10.1055/a-0658-1350 ◽

2018 ◽

Vol 06 (12) ◽

pp. E1470-E1476 ◽

Cited By ~ 2

Author(s):

Solène Dermine ◽

Maximilien Barret ◽

Caroline Prieux ◽

Sophie Ribière ◽

Sarah Leblanc ◽

...

Keyword(s):

Digestive Tract ◽

Endoscopic Resection ◽

Gastrointestinal Endoscopy ◽

Lesion Size ◽

Concordance Rate ◽

Resection Rate ◽

Tertiary Referral Center ◽

Multidisciplinary Meeting ◽

The Mean ◽

The Impact

Abstract Background The recent development of endoscopic resection for superficial gastrointestinal cancers could justify the need for a dedicated oncological multidisciplinary meeting (MDM). The aim of our study was to evaluate the impact of the dedicated MDM on the management of superficial cancers of the digestive tract. Methods A dedicated MDM was developed at our tertiary referral center. A retrospective review of the MDM conclusions for all patients referred from March 2015 to March 2017 was performed. Outcomes measurements were the outcomes of endoscopic resection, and the concordance rate between the MDM recommendations, European Society of Gastrointestinal Endoscopy (ESGE) guidelines, and final patient management. Results In total, 153 patients with a median age of 69 years were included. Half of the patients had major comorbidities. The mean lesion size was 25 mm, and R0 and curative resection rate were 73.9 % and 56.9 %, respectively. Forty-three patients had an indication for surgery after endoscopic resection. The concordance rate between ESGE guidelines and MDM recommendation was 92.2 %, and 12 patients did not receive the treatment recommended due to comorbidities. Conclusion A MDM dedicated to superficial tumors helped tailor the ESGE guidelines to each patient in order to avoid unnecessary surgery.

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Dynamics of language reorganization after left temporo-parietal and frontal stroke

Brain ◽

10.1093/brain/awaa023 ◽

2020 ◽

Vol 143 (3) ◽

pp. 844-861 ◽

Cited By ~ 14

Author(s):

Anika Stockert ◽

Max Wawrzyniak ◽

Julian Klingbeil ◽

Katrin Wrede ◽

Dorothee Kümmerer ◽

...

Keyword(s):

Functional Mri ◽

Chronic Phase ◽

Global Network ◽

Lesion Location ◽

Post Stroke ◽

Language Functions ◽

Language Recovery ◽

Patient Groups ◽

The Impact ◽

General Networks

Abstract The loss and recovery of language functions are still incompletely understood. This longitudinal functional MRI study investigated the neural mechanisms underlying language recovery in patients with post-stroke aphasia putting particular emphasis on the impact of lesion site. To identify patterns of language-related activation, an auditory functional MRI sentence comprehension paradigm was administered to patients with circumscribed lesions of either left frontal (n = 17) or temporo-parietal (n = 17) cortex. Patients were examined repeatedly during the acute (≤1 week, t1), subacute (1–2 weeks, t2) and chronic phase (>6 months, t3) post-stroke; healthy age-matched control subjects (n = 17) were tested once. The separation into two patient groups with circumscribed lesions allowed for a direct comparison of the contributions of distinct lesion-dependent network components to language reorganization between both groups. We hypothesized that activation of left hemisphere spared and perilesional cortex as well as lesion-homologue cortex in the right hemisphere varies between patient groups and across time. In addition, we expected that domain-general networks serving cognitive control independently contribute to language recovery. First, we found a global network disturbance in the acute phase that is characterized by reduced functional MRI language activation including areas distant to the lesion (i.e. diaschisis) and subsequent subacute network reactivation (i.e. resolution of diaschisis). These phenomena were driven by temporo-parietal lesions. Second, we identified a lesion-independent sequential activation pattern with increased activity of perilesional cortex and bilateral domain-general networks in the subacute phase followed by reorganization of left temporal language areas in the chronic phase. Third, we observed involvement of lesion-homologue cortex only in patients with frontal but not temporo-parietal lesions. Fourth, irrespective of lesion location, language reorganization predominantly occurred in pre-existing networks showing comparable activation in healthy controls. Finally, we detected different relationships of performance and activation in language and domain-general networks demonstrating the functional relevance for language recovery. Our findings highlight that the dynamics of language reorganization clearly depend on lesion location and hence open new perspectives for neurobiologically motivated strategies of language rehabilitation, such as individually-tailored targeted application of neuro-stimulation.

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Seasonal Variation in Host Susceptibility to Fusarium Canker in Young Almond Trees

Plant Disease ◽

10.1094/pdis-06-19-1292-re ◽

2020 ◽

Vol 104 (3) ◽

pp. 772-779

Author(s):

Abigail J. Stack ◽

Meera Madra ◽

Thomas R. Gordon ◽

Richard M. Bostock

Keyword(s):

Cold Storage ◽

Fusarium Species ◽

Lesion Size ◽

Host Susceptibility ◽

Seasonal Effect ◽

Canker Disease ◽

Almond Trees ◽

Bare Root ◽

The Impact

Loss of water that reduces the relative water content (RWC) of bark can occur during processing, cold storage, and planting of bare-root stone fruit trees. In California nurseries and newly planted orchards, this stress can predispose young almond trees (Prunus dulcis) to a canker disease caused primarily by Fusarium species. While reduced bark RWC contributes to disease development, anecdotal observations suggest a seasonal effect on host physiology may also influence disease severity. We evaluated the effect of season and the impact of drying and reduced RWC on susceptibility of almond branch segments excised from orchard trees (cv. Nonpareil) to Fusarium acuminatum, Fusarium avenaceum, Fusarium brachygibbosum, and Fusarium californicum sp. nov. With lesion size as the criterion, excised inoculated branch segments were most susceptible in spring, of intermediate susceptibility during winter dormancy, and least susceptible during summer and fall. Consistent with an earlier study, branches with RWC between 80 and 85% yielded lesions that were significantly larger than lesions from branches with bark that was above or below that range. However, the effect of reduced bark moisture on lesion size was only apparent in the spring. These results affirm the importance of avoiding conditions that diminish moisture status in bare-root almond trees in Fusarium canker disease management, especially during transport and planting operations in the spring, a period of high physiological vulnerability. California nurseries apply fungicides to bare-root trees prior to cold storage to reduce “mold” growth. Of eight fungicides currently registered for use on almond trees, fludioxonil (Scholar), fluopyram/trifloxystrobin (Luna Sensation), and fluxapyroxad/pyraclostrobin (Merivon) were most inhibitory to in vitro mycelial growth of F. acuminatum, F. avenaceum, and F. brachygibbosum. However, our almond branch disease assay did not demonstrate preventive or curative fungicide action against infections by F. acuminatum or F. avenaceum.

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Assessment of the Minimal Targeted Biopsy Core Number per MRI Lesion for Improving Prostate Cancer Grading Prediction

Journal of Clinical Medicine ◽

10.3390/jcm9010225 ◽

2020 ◽

Vol 9 (1) ◽

pp. 225 ◽

Cited By ~ 7

Author(s):

Guillaume Ploussard ◽

Jean-Baptiste Beauval ◽

Raphaële Renard-Penna ◽

Marine Lesourd ◽

Cécile Manceau ◽

...

Keyword(s):

Lesion Size ◽

Targeted Biopsy ◽

Resonance Imaging ◽

Grade Group ◽

Final Grade ◽

Prostate Imaging ◽

Biopsy Core ◽

Mri Characteristics ◽

The Impact ◽

Cancer Grading

Background: To study the impact of MRI characteristics and of targeted biopsy (TB) core number on the final grade group (GG) prediction. Materials and Methods: The cohort was 478 consecutive patients who underwent radical prostatectomy (RP) after positive mpMRI (multiparametric magnetic resonance imaging) followed by fusion TB. Endpoints were the upgrading and concordance rates between TB and RP specimens. Results: Upgrading rate after TB was 40.6%. Patients with upgrading had lower PIRADS (Prostate Imaging-Reporting and Data System) scores (p < 0.001), smaller lesion size (p = 0.017), fewer TB cores (p < 0.001), and lower TB density (p = 0.015) compared with cases with grade concordance. There was a significant continuous improvement in upgrading rate when TB core number per lesion increased from 56.3% to 25.6% when <2 or ≥5 TB cores were taken, respectively (p = 0.002). The minimal TB number per lesion to reduce upgrading risk to approximately 30%was 4 in PIRADS 3, and 3 in PIRADS 4–5 cases. Conclusions: Grade group prediction by TB is significantly improved by higher PIRADS score, larger lesion size, and increased TB per lesion. At least four TB cores should be taken in PIRADS 3 score lesions, whereas three cores seem enough in PIRADS 4–5 cases to improve GG prediction and limit upgrading risk.

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1322Impact of system impedance in ablation-index guided lesion formation in an in vitro model

EP Europace ◽

10.1093/europace/euaa162.038 ◽

2020 ◽

Vol 22 (Supplement_1) ◽

Author(s):

C Lozano-Granero ◽

J Moreno Planas ◽

R Matia Frances ◽

A Hernandez Madrid ◽

I Sanchez Perez ◽

...

Keyword(s):

Contact Force ◽

Lesion Size ◽

Lesion Volume ◽

Application Time ◽

Lesion Formation ◽

Running Water ◽

High Impedance ◽

Ablation Index ◽

The Impact

Abstract Funding Acknowledgements Beca de la Sección de Electrofisiología y Arritmias para formación en investigación post-residencia en centros españoles INTRODUCTION Ablation Index and Lesion Size Index are novel markers of ablation lesion quality that incorporate power (W), contact force (CF), and time (T) in a weighted formula to accurately estimate lesion size. While LSI includes system impedance (I) in the formula, this parameter is not considered for AI calculation. PURPOSE The aim of our study was to analyse the impact of I in lesion formation. METHODS Radiofrequency (RF) lesions were created on porcine myocardial slabs by using an open-tip irrigated catheter with real-time monitoring of CF (a TactiCath™ Quartz Contact Force Ablation Catheter for LSI-guided lesions and a ThermoCool® SmartTouch® Catheter for AI-guided lesions). Catheters were mounted in an articulated arm and manually maneuvered over a platform placed within a tank filled with either a low impedance medium (saline solution) or a high impedance medium (running water) with a heating pump to produce non-pulsatile flow directed perpendicularly to the myocardium surface at a rate of 5 l/min and a temperature of 37ºC. For each catheter and medium, ten lesions were performed with a CF of 20 grams and a W of 25, 30, 35 and 40 watts aiming at a LSI of 5 or a AI of 400 (recommended targets for posterior wall pulmonary vein isolation for each index). After RF delivery, the myocardium was cross-sectioned at the level of each lesion and its blanched zone was measured with a dial calliper with a 0.1 mm resolution (image, panel A). Lesion volume was calculated using width and depth, according to a validated formula (image, panel B). RESULTS No difference in application time was noted in the AI-guided lesions depending on the medium (23.8 ± 1.6s, 17.2 ± 1.4s, 13.7 ± 0.8s and 12.2 ± 0.7s for 25W, 30W, 35W and 40W, respectively) while a significant reduction in application time was noted in the LSI-guided lesions performed in a low I medium (93.8 ± 6.6 ohms; 17.9 ± 1.9s, 11.3 ± 3.7s, 9.1 ± 0.9s and 7.3 ± 0.5s for 25W, 30W, 35W and 40W) compared with those performed in a high impedance medium (132.4 ± 6.6 ohms; 27.3 ± 1.4s, 17.9 ± 2.5s, 15.5 ± 1.4 and 13 ± 1.2 for the same programmed W (p < 0.0001 for all comparisons). Both catheters showed differences in lesion size according to the I, with lower lesion volumes in the low I medium and higher lesion volumes in the high I medium. Although globally smaller in size, higher lesion volumes were noted in the AI-guided lesions compared to LSI-guided lesions in a low I medium (image, panel C). On the contrary, a better performance of the LSI-guided lesions was observed in the high I medium (image, panel D). CONCLUSIONS System impedance affected lesion size both in LSI-guided an AI-guided ablation lesions, with smaller lesions seen in a lower I medium. Further studies are needed to assess the clinical relevance of this findings in an in-vivo scenario. Abstract Figure.

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