Pesticides – A Changing Landscape that Demands Close Monitoring

Object The purpose of this study was to assess the efficacy of Gamma Knife surgery (GKS) for treating cavernous sinus dural arteriovenous fistulas (CSDAVFs). Methods Of the 4123 GKSs performed between May 1992 and March 2009, 890 procedures were undertaken to treat vascular lesions. In 24 cases, the vascular lesion that was treated was a dural arteriovenous fistula, and in 6 of these cases, the lesion involved the cavernous sinus. One of these 6 cases was lost to follow-up, leaving the other 5 cases (4 women and 1 man) to comprise the subjects of this study. All 5 patients had more than 1 ocular symptom, such as ptosis, chemosis, proptosis, and extraocular movement palsy. In all patients, CSDAVF was confirmed by conventional angiography. Three patients were treated by GKS alone and 2 patients were treated by GKS combined with transarterial embolization. The median follow-up period after GKS in these 5 cases was 30 months (range 9–59 months). Results All patients experienced clinical improvement, and their improvement in ocular symptoms was noticed at a mean of 17.6 weeks after GKS (range 4–24 weeks). Two patients received embolization prior to GKS but did not display improvement in ocular symptoms. An average of 20 weeks (range 12–24 weeks) was needed for complete improvement in clinical symptoms. There were no treatment-related complications during the follow-up period. Conclusions Gamma Knife surgery should be considered as a primary, combined, or additional treatment option for CSDAVF in selected cases, such as when the lesion is a low-flow shunt without cortical venous drainage. For those selected cases, GKS alone may suffice as the primary treatment method when combined with close monitoring of ocular symptoms and intraocular pressure.

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Anesthesia in Carvajal syndrome; the first case report

Anaesthesia, Pain & Intensive Care ◽

10.35975/apic.v24i1.1233 ◽

2020 ◽

Vol 24 (1) ◽

pp. 105-107

Author(s):

Sedighe Shahhosseini ◽

Reza Aminnejad ◽

Amir Shafa ◽

Mehrdad Memarzade

Keyword(s):

Intensive Care ◽

Case Report ◽

Surgical Resection ◽

Genetic Disorder ◽

Anesthetic Technique ◽

Close Monitoring ◽

Anesthesia Management ◽

Rare Genetic Disorder ◽

First Case ◽

Anesthetic Considerations

Carvajal syndrome is a rare genetic disorder. Patients reporting for surgery pose some difficulties in anesthesia management. In this case report we present the case of a 12-year-old boy, who was a known case of Carvajal syndrome, referred for surgical resection of perianal condyloma. Close monitoring of hemodynamic status is the mainstay of anesthetic considerations in such patients. As in any other challenging scenario, it should be kept in mind that ‘there is no safest anesthetic agent, nor the safest anesthetic technique; there is only the safest anesthesiologist’. Citation: Shahhosseini S, Aminnejad R, Shafa A, Memarzadeh M. Anesthesia in Carvajal syndrome; the first case report. Anaesth pain intensive care 2020;24(1):___ DOI: https://doi.org/10.35975/apic.v24i1.

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Sex and Gender Differences in Rilpivirine based ART - Data from the HIVCENTER Frankfurt

Current HIV Research ◽

10.2174/1570162x17666191104112557 ◽

2019 ◽

Vol 17 (5) ◽

pp. 368-374

Author(s):

G. Schüttfort ◽

K. Philipp ◽

P. de Leuw ◽

E. Herrmann ◽

G. Kann ◽

...

Keyword(s):

Odds Ratio ◽

Virologic Failure ◽

Response Rates ◽

Virologic Response ◽

Close Monitoring ◽

Sex And Gender ◽

Overall Response ◽

Number Of Patients ◽

And Gender ◽

Gender Specific

Objectives: While Rilpivirine has shown high overall response rates in treatment-naïve patients without sex and gender specific differences in clinical trials, Sex and gender specific data in treatment experienced patients receiving rilpivirine are still limited. We conducted a 48 week efficacy and safety analysis in naïve and treatment experienced men and women using retrospective data from the HIVCENTER Frankfurt. Materials and methods: In this retrospective observational study data of all patients who received a rilpivirine based regimen at the HIVCENTER between March 2011 and December 2015 were analyzed. Primary endpoint was the proportion of patients with any discontinuation until week 48. Virologic response rates (FDA snapshot analysis; HIV-1 RNA <50 copies/mL) were assessed at week 48. Results: 194 patients (34% female) were included in the analysis. 74% were treatment-experienced and 26% naïve, respectively. Discontinuations were observed in 31 (15.9%) patients. Regarding sex differences, the proportion of discontinuations was significantly higher in women than in men (24.2% vs. 11.7%; p=0.024; ODDS-Ratio = 2.41; CI 1.12 – 5.18). Virologic failure occurred in 8 PLWHIV (4.1%). Conclusions: While virologic overall response rates to rilpivirine based ART were high for both treatment-experienced and -naïve patients the proportion of discontinuations was significantly higher in women (24.2% vs. 11.7%; p = 0.024; ODDS-Ratio = 2.41; CI 1.12 – 5.18). Although the total number of patients with virologic failure was low (4.1%), the higher rate of ART discontinuations in female patients receiving RPV require close monitoring in the first months of treatment addressing special needs of women living with HIV.

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How Molecular Epidemiology Can Affect Tuberculosis Control in the Middle East Countries: A Systematic Review and Meta-Analysis

Infectious Disorders - Drug Targets ◽

10.2174/1871526520666200106123619 ◽

2020 ◽

Vol 20 ◽

Author(s):

Mohammad Asgharzadeh ◽

Jalil Rashedi ◽

Behroz Mahdavi Poor ◽

Hossein Samadi kafil ◽

Hossein Moharram Zadeh ◽

...

Keyword(s):

Middle East ◽

Molecular Epidemiology ◽

Average Rate ◽

Meta Analysis ◽

Close Monitoring ◽

Drug Resistant ◽

Middle East Countries ◽

Virulent Strains ◽

Recent Transmission ◽

Highly Virulent

: Nowadays, due to the incidence of specific strains of Mycobacterium tuberculosis and also increase the rate of drug resistant-TB mortality rate has elevated by this disease. Identification of common strains in the region as well as sources of transmission are essential to control the disease that this has been possible by using molecular epidemiology. In this survey, studies which have been carried out based on spoligotyping method in Muslim Middle East countries were considered to determine their role in control of TB. All studies conducted from 2005 to June 2016 were considered systematically in three electronic data bases and finally, 23 studies were selected. The average rate of clustering was 84% and the rate of recent transmission was variable from 21.7% to 92.4%. Incidence of Beijing strains was been rising in the considered countries. In Iran and Saudi Arabia which are immigration and labour-hosting countries, respectively, rapid transmittable strains and drug resistant Beijings were higher than other considered countries. Considering the incidence of highly virulent strains, due to the increase of immigration and people infected with HIV, tuberculosis, especially drug resistant form, the lack of close monitoring in the future will be induce trouble.

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Towards CRISP-ML(Q): A Machine Learning Process Model with Quality Assurance Methodology

Machine Learning and Knowledge Extraction ◽

10.3390/make3020020 ◽

2021 ◽

Vol 3 (2) ◽

pp. 392-413

Author(s):

Stefan Studer ◽

Thanh Binh Bui ◽

Christian Drescher ◽

Alexander Hanuschkin ◽

Ludwig Winkler ◽

...

Keyword(s):

Machine Learning ◽

Quality Assurance ◽

Process Model ◽

Practical Experience ◽

Special Focus ◽

Close Monitoring ◽

Machine Learning Applications ◽

Project Organizations ◽

Considerable Impact ◽

Learning Development

Machine learning is an established and frequently used technique in industry and academia, but a standard process model to improve success and efficiency of machine learning applications is still missing. Project organizations and machine learning practitioners face manifold challenges and risks when developing machine learning applications and have a need for guidance to meet business expectations. This paper therefore proposes a process model for the development of machine learning applications, covering six phases from defining the scope to maintaining the deployed machine learning application. Business and data understanding are executed simultaneously in the first phase, as both have considerable impact on the feasibility of the project. The next phases are comprised of data preparation, modeling, evaluation, and deployment. Special focus is applied to the last phase, as a model running in changing real-time environments requires close monitoring and maintenance to reduce the risk of performance degradation over time. With each task of the process, this work proposes quality assurance methodology that is suitable to address challenges in machine learning development that are identified in the form of risks. The methodology is drawn from practical experience and scientific literature, and has proven to be general and stable. The process model expands on CRISP-DM, a data mining process model that enjoys strong industry support, but fails to address machine learning specific tasks. The presented work proposes an industry- and application-neutral process model tailored for machine learning applications with a focus on technical tasks for quality assurance.

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Homogenous overexpression of the extracellular matrix protein Netrin-1 in a hollow fiber bioreactor

Applied Microbiology and Biotechnology ◽

10.1007/s00253-021-11438-0 ◽

2021 ◽

Author(s):

Aniel Moya-Torres ◽

Monika Gupta ◽

Fabian Heide ◽

Natalie Krahn ◽

Scott Legare ◽

...

Keyword(s):

Extracellular Matrix ◽

Hollow Fiber ◽

Mammalian Cells ◽

Matrix Protein ◽

Continuous Production ◽

Extracellular Matrix Protein ◽

Close Monitoring ◽

High Quality ◽

Biolayer Interferometry ◽

Hollow Fiber Bioreactor

Abstract The production of recombinant proteins for functional and biophysical studies, especially in the field of structural determination, still represents a challenge as high quality and quantities are needed to adequately perform experiments. This is in part solved by optimizing protein constructs and expression conditions to maximize the yields in regular flask expression systems. Still, work flow and effort can be substantial with no guarantee to obtain improvements. This study presents a combination of workflows that can be used to dramatically increase protein production and improve processing results, specifically for the extracellular matrix protein Netrin-1. This proteoglycan is an axon guidance cue which interacts with various receptors to initiate downstream signaling cascades affecting cell differentiation, proliferation, metabolism, and survival. We were able to produce large glycoprotein quantities in mammalian cells, which were engineered for protein overexpression and secretion into the media using the controlled environment provided by a hollow fiber bioreactor. Close monitoring of the internal bioreactor conditions allowed for stable production over an extended period of time. In addition to this, Netrin-1 concentrations were monitored in expression media through biolayer interferometry which allowed us to increase Netrin-1 media concentrations tenfold over our current flask systems while preserving excellent protein quality and in solution behavior. Our particular combination of genetic engineering, cell culture system, protein purification, and biophysical characterization permitted us to establish an efficient and continuous production of high-quality protein suitable for structural biology studies that can be translated to various biological systems. Key points • Hollow fiber bioreactor produces substantial yields of homogenous Netrin-1 • Biolayer interferometry allows target protein quantitation in expression media • High production yields in the bioreactor do not impair Netrin-1 proteoglycan quality Graphical abstract

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Acute severe ulcerative colitis: management advice for internal medicine and emergency physicians

Internal and Emergency Medicine ◽

10.1007/s11739-021-02704-0 ◽

2021 ◽

Author(s):

Konstantina Rosiou ◽

Christian Philipp Selinger

Keyword(s):

Ulcerative Colitis ◽

Rescue Therapy ◽

Medical Emergency ◽

Close Monitoring ◽

Surgical Morbidity ◽

Severe Ulcerative Colitis ◽

General Management ◽

Management Measures ◽

Management Advice ◽

Team Setting

AbstractAcute severe ulcerative colitis is a medical emergency that warrants in-patient management. This is best served within a multidisciplinary team setting in specialised centres or with expert consultation. Intravenous corticosteroids remain the cornerstone in the management of ASUC and should be initiated promptly, along with general management measures and close monitoring of patients. Unfortunately, one-third of patients will fail to respond to steroids. Response to intravenous corticosteroid therapy needs to be assessed on the third day and rescue therapies, including cyclosporine and infliximab, should be offered to patients not responding. Choice of rescue therapy depends on experience, drug availability and factors associated with each individual patient, such as comorbidities, previous medications or contra-indications to therapy. Patients who have not responded within 7 days to rescue therapy must be considered for surgery. Surgery is a treatment option in ASUC and should not be delayed in cases of failure of medical therapy, because such delays increase surgical morbidity and mortality. This review summarises the current management of acute severe ulcerative colitis and discusses potential future developments.

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Forearm brachial artery to brachial vein looped arteriovenous grafts: A single center, single surgeon observational study

The Journal of Vascular Access ◽

10.1177/11297298211015095 ◽

2021 ◽

pp. 112972982110150

Author(s):

Jeremy Liu ◽

Josiah Situmeang ◽

Devin Takahashi ◽

Russell Harada

Keyword(s):

Primary Patency ◽

The Body ◽

Secondary Patency ◽

Close Monitoring ◽

Arteriovenous Graft ◽

Inclusion Criteria ◽

Kaplan Meier ◽

Brachial Vein ◽

Arteriovenous Grafts

Background: Long-term hemodialysis (HD) treatment requires the establishment of a cannulatable vascular access (VA) point. While the arteriovenous fistula (AVF) is considered the gold standard, the arteriovenous graft (AVG) is a viable alternative especially in patients with poor superficial venous anatomy. Few studies have assessed the efficacy of the brachial-brachial arteriovenous graft (BB-AVG) for long-term HD access. By analyzing one surgeon’s experience in creating, surveilling and maintaining BB-AVGs, this retrospective study aims to add to the body of literature in assessing patency outcomes of BB-AVGs. Methods: We identified 57 BB-AVGs that met inclusion criteria and were created between October 6, 2005 and May 1, 2019 by a single surgeon in 54 patients. We analyzed primary failures, patency, complications and interventions. Patency rates were calculated by the Kaplan–Meier method. The incidence of complications and interventions were expressed as number of events per person-year. Results: A total of 54 patients (median age of 65 years) were analyzed. Primary patency rates at 12, 24, and 36 months were 20.4% 7.4%, and 5.0%. Primary assisted patency rates at 12, 24, and 36 months were 46.7%, 33.5%, and 15.1%. The secondary patency rates at 12, 24, and 36 months were 81.8%, 63.8%, and 60.1%, respectively. The incidence of complications and interventions was 2.164 per person-year. Most complications and interventions were due to stenosis (1.202 per person-year) or thrombosis (0.802 per person-year). Conclusion: In patients with poor superficial veins, the brachial vein is a reasonable alternative to use as the venous outflow. However, in order to achieve acceptable patency rates, close monitoring of the VA, as well as aggressive treatment of complications within the brachial vein is necessary. Overall, the BB-AVG should be considered in patients who lack adequate superficial veins and require preservation of the more proximal veins.

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