Search

Abstract Objective Epilepsy surgery is known to be underutilized. Machine learning‐natural language processing (ML‐NLP) may be able to assist with identifying patients suitable for referral for epilepsy surgery evaluation. Methods Data were collected from two tertiary hospitals for patients seen in neurology outpatients for whom the diagnosis of “epilepsy” was mentioned. Individual case note review was undertaken to characterize the nature of the diagnoses discussed in these notes, and whether those with epilepsy fulfilled prespecified criteria for epilepsy surgery workup (namely focal drug refractory epilepsy without contraindications). ML‐NLP algorithms were then developed using fivefold cross‐validation on the first free‐text clinic note for each patient to identify these criteria. Results There were 457 notes included in the study, of which 250 patients had epilepsy. There were 37 (14.8%) individuals who fulfilled the prespecified criteria for epilepsy surgery referral without described contraindications, 32 (12.8%) of whom were not referred for epilepsy surgical evaluation in the given clinic visit. In the prediction of suitability for epilepsy surgery workup using the prespecified criteria, the tested models performed similarly. For example, the random forest model returned an area under the receiver operator characteristic curve of 0.97 (95% confidence interval 0.93–1.0) for this task, sensitivity of 1.0, and specificity of 0.93. Significance This study has shown that there are patients in tertiary hospitals in South Australia who fulfill prespecified criteria for epilepsy surgery evaluation who may not have been referred for such evaluation. ML‐NLP may assist with the identification of patients suitable for such referral. Plain Language Summary Epilepsy surgery is a beneficial treatment for selected individuals with drug‐resistant epilepsy. However, it is vastly underutilized. One reason for this underutilization is a lack of prompt referral of possible epilepsy surgery candidates to comprehensive epilepsy centers. Natural language processing, coupled with machine learning, may be able to identify possible epilepsy surgery candidates through the analysis of unstructured clinic notes. This study, conducted in two tertiary hospitals in South Australia, demonstrated that there are individuals who fulfill criteria for epilepsy surgery evaluation referral but have not yet been referred. Machine learning‐natural language processing demonstrates promising results in assisting with the identification of such suitable candidates in Australia.

Abstract Introduction Neutralizing antibodies (NAbs) are an important specific defence against viral infections, as these antibodies bind to specific receptor(s) and block the viral entry. NAbs assessments are therefore useful in determining individual or herd immunity to SARS‐CoV‐2. This study aims to deepen the investigation by assessing the positivity rate of neutralizing anti‐spike antibodies to understand the real protection of the studied population against SARS‐CoV‐2. Methods This study involved 260 plasma samples from a larger cohort of 2,700 asymptomatic volunteer donors, enrolled between August and October 2021 in health facilities of N'Djamena. In this study four different kits and techniques including the pseudotype assay have been used and compared with detect the SARS‐CoV‐2 antibodies. Pseudotyped vesicular stomatitis virus (VSV), was used both the identify and measure the NAbs that to evaluate the performance of two cheaper and easy to use commercial kits, specific for the detection of receptor‐binding domain antibodies (anti‐RBD) against the SARS‐CoV‐2 spike protein. Results The VSV spike neutralization assay showed that 59.0% (n = 59) samples were positive for NAbs with titers ranging from 1:10 to 1:4800. While 23 out the 41 negative NAbs samples were detected positive using anti‐RBD (Abbott) test. Furthermore, a direct and significant strong correlation was found between NAbs and anti‐RBD, specifically with Abbott kit. Taken together, the Roche and Abbott methods indicated agreement at the high concentrations of antibodies with the VSV‐pseudovirus method. Abbott and Roche indicated a good sensitivity, but the Abbott system test appeared to have better specificity than the Roche test. Conclusion Our findings indicated a high presence of NAbs against SARS‐CoV‐2 spike protein among asymptomatic individuals in N'Djamena. This could be one of the reasons for the low severity of Covid‐19 observed in this area, given the key role of NAbs in blocking SARS‐CoV‐2 infection.

Abstract Introduction Considering the reported efficacy of monoclonal antibodies (mAbs) directed against the Spike (S) protein of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) in reducing disease severity, the aim of this study was to investigate the innate immune response before and after mAbs treatment in 72 vaccinated and 31 unvaccinated SARS‐CoV‐2 patients. Methods The mRNA levels of IFN‐I, IFN‐related genes and cytokines were evaluated using RT/real‐time quantitative PCR. Results Vaccinated patients showed increased rate of negative SARS‐CoV‐2 PCR tests on nasopharyngeal swab compared with unvaccinated ones after mAbs treatment (p = .002). Unvaccinated patients had lower IFN‐α/ω and higher IFN‐related genes (IFNAR1, IFNAR2, IRF9, ISG15, ISG56 and IFI27) and cytokines (IL‐6, IL‐10 and TGF‐β) mRNA levels compared to vaccinated individuals before mAbs (p

Abstract Introduction Therapy for hypothyroid obese patients is still under definition since the thyrotropin‐stimulating hormone (TSH) level is a less reliable marker of euthyroidism than nonobese patients. Indeed, TSH levels positively correlate with body mass index (BMI), and this increase may be a compensatory mechanism aimed at increasing energy expenditure in obese people. In contrast, the correlation of BMI with thyroid hormone levels is not completely clear, and conflicting results have been obtained by several studies. The L‐T4 replacement dose is more variable in obese hypothyroid patients than in nonobese patients, and a recent study indicated that the L‐T4 replacement dose is related to lean body mass in obese thyroidectomized patients. We aimed to study the correlations of L‐T4‐administered dose, thyroid hormone levels and TSH secretion with basal metabolic rate (BMR) and total calculated deiodinase activity (GD) in obese and nonobese athyreotic patients. We also looked for individualized L‐T4 replacement dose set points to be used in clinical practice. Methods We studied retrospectively 160 athyreotic patients, 120 nonobese and 40 obese. GD was calculated by SPINA Thyr 4.2, the responsiveness of the hypothalamic/pituitary thyrotrope by Jostel's thyrotropin (TSH) index and BMR by the Mifflin‐St. Jeor formula, the interplay of GD and BMR with L‐T4, thyroid hormones and TSH index (TSHI) was also evaluated. Results In our study, the L‐T4 dose was an independent predictor of GD, and approximately 30% of athyreotic patients under L‐T4 therapy had a reduced GD; FT4 levels were higher and negatively modulated by BMR in obese athyreotic patients respect to nonobese, in these patients a T4 to T3 shunt, in terms of TSHI suppression is observed suggesting a defective hypothalamic pituitary T4 to T3 conversion and a resistance to L‐T4 replacement therapy. Conclusions L‐t4 dose is the most important predictor of GD, BMR modulates T4 levels in obese athyreotic patients that are resistant to L‐T4 replacement therapy.

Abstract Thymic carcinoma is an epithelial tumor derived from thymic epithelial cells. Thymic tumors may be associated with other simultaneous and/or metachronous extra‐thymic tumors (e.g., lung cancer). Here, we report a case of simultaneous surgical management of lung and mediastinal neoplasm together with a review of the literature. During radiological follow‐up for prostate and colorectal cancer, an 82‐year‐old man was diagnosed with lung cancer with simultaneous mediastinal suspected neoplasm. Both were surgically removed with a single intervention performed via a uniportal video‐assisted thoracic surgery (uni‐VATS) approach. The literature emphasizes how extra‐thymic cancer can be diagnosed before, concurrently and consecutively with thymic neoplasia. The surgical treatment of such simultaneous cancer is challenging. We succeeded in the excision of both neoplasia with a mini‐invasive surgical technique. This report highlights the feasibility of uniportal VATS in a patient with very unusual clinical and oncological history.

Primary synovial sarcoma is a soft tissue tumor which originates from synovial‐like undeveloped mesenchymal structures. Here, we report the case of a giant mediastinal sarcoma in a 41‐year‐old female patient. After diagnosis, she underwent neoadjuvant chemotherapy. Due to its low efficacy, we collegially decided to undergo cytoreductive debulking surgery. The mass invaded the phrenic nerve bilaterally and its excision caused a severe lesion of the left nerve and a partial impairment of the right one. Thus, plastic surgeons decided to reconstruct the right phrenic nerve employing the contralateral remaining fibers. The invasiveness of this tumor, its difficult removal, histological profile and the peculiar technique to preserve diaphragmatic function classify this case as very rare. The therapeutic strategy was based on interdisciplinary teamwork which comprised several specialists' opinions. Our strategy allowed us to pursue the challenging objective to give a young woman with a severe diagnosis the best possible chance of achieving a good quality of life. To the best of our knowledge, this phrenic nerve reconstructive technique is very rare and has not previously been reported in the literature. The report emphasizes that it is possible to deal with an apparently impossible case through a collaborative approach involving several different medical specialist professionals.

Abstract Bioprosthetic heart valves (BHVs) largely circumvent the need for long‐term anticoagulation compared with mechanical valves but are increasingly susceptible to deterioration and reduced durability with reoperation rates of ≈10% and 30% at 10 and 15 years, respectively. Structural valve degeneration is a common, unpreventable, and untreatable consequence of BHV implantation and is frequently characterized by leaflet calcification. However, 25% of BHV reoperations attributed to structural valve degeneration occur with minimal leaflet mineralization. This review discusses the noncalcific mechanisms of BHV structural valve degeneration, highlighting the putative roles and pathophysiological relationships between protein infiltration, glycation, oxidative and mechanical stress, and inflammation and the structural consequences for surgical and transcatheter BHVs.

T cell suppression is a well established phenomenon, but the mechanisms involved are still a matter of debate. Mouse anergic T cells were shown to suppress responder T cell activation by inhibiting the antigen presenting function of DC. In the present work we studied the effects of co-culturing human anergic CD4+ T cells with autologous dendritic cells (DC) at different stages of maturation. Either DC maturation or survival, depending on whether immature or mature DC where used as APC, was impaired in the presence of anergic cells. Indeed, MHC and costimulatory molecule up-regulation was inhibited in immature DC, whereas apoptotic phenomena were favored in mature DC and consequently in responder T cells. Defective ligation of CD40 by CD40L (CD154) was responsible for CD95-mediated and spontaneous apoptosis of DC as well as for a failure of their maturation process. These findings indicate that lack of activation of CD40 on DC by CD40L-defective anergic cells might be the primary event involved in T cell suppression and support the role of CD40 signaling in regulating both activation and survival of DC.