Search

Gliomas are the most common primary neoplasm of the central nervous system. A promising frontier in the definition of glioma prognosis and treatment is represented by epigenetics. Furthermore, in this study, we developed a machine learning classification model based on epigenetic data (CpG probes) to separate patients according to their state of immunosuppression. We considered 573 cases of low-grade glioma (LGG) and glioblastoma (GBM) from The Cancer Genome Atlas (TCGA). First, from gene expression data, we derived a novel binary indicator to flag patients with a favorable immune state. Then, based on previous studies, we selected the genes related to the immune state of tumor microenvironment. After, we improved the selection with a data-driven procedure, based on Boruta. Finally, we tuned, trained, and evaluated both random forest and neural network classifiers on the resulting dataset. We found that a multi-layer perceptron network fed by the 338 probes selected by applying both expert choice and Boruta results in the best performance, achieving an out-of-sample accuracy of 82.8%, a Matthews correlation coefficient of 0.657, and an area under the ROC curve of 0.9. Based on the proposed model, we provided a method to stratify glioma patients according to their epigenomic state.

Background The introduction of a transapical transcatheter beating heart replacement system has significantly expanded therapeutic options for patients with severely diseased mitral valves, particularly those ineligibles for traditional surgery or transcatheter repair. However, challenges, such as left ventricular outflow tract obstruction (LVOT-O) and the risk of dynamic systolic anterior motion (SAM) in cases with elongated anterior mitral leaflet (AML) post-prosthesis implantation, impede the widespread adoption of transcatheter mitral valve replacement (TMVR). Case summary In 2022, a 75-year-old male with severe mixed-genesis mitral regurgitation (MR) underwent Carillon Mitral Contour System annuloplasty. Recurrent heart failure admissions (New York Heart Association IV) and prohibitive risk for open-heart surgery (European System for Cardiac Operative Risk Evaluation II 8.27%) prompted evaluation for Tendyne TMVR with the MitraCut technique. This beating heart transapical approach involved scissor-mediated splitting of the elongated 27 mm AML, essential for mitigating LVOT-O risk and dynamic SAM. The screening echocardiogram revealed the poorly tethered AML near the thickened septum at the simulated neo-LVOT site. Discussion This case underscores the intricate management challenges associated with severe MR, highlighting the successful application of the MitraCut technique as a viable alternative in high-risk scenarios. The imperative for further research and clinical studies is emphasized to comprehensively elucidate outcomes and safety parameters, providing valuable insights for refining TMVR applications within this context. [ABSTRACT FROM AUTHOR]

Extracorporeal photopheresis (ECP) is used by few lung transplant centers to treat chronic lung allograft dysfunction (CLAD). Although reported results suggest a beneficial effect on CLAD progression, evidence is limited to single center experiences. The aim of this study is to analyze outcomes of ECP in a large multicenter European cohort. The primary endpoint was patient survival after initiation of ECP. This study included 631 patients, 87% suffered from bronchiolitis obliterans syndrome (BOS), and 13% had restrictive allograft syndrome (RAS). Long-term stabilization was achieved in 42%, improvement in 9%, and no response in 26%. Within the first 12 months of therapy, 23% of patients died. Patients' survival after initiation of ECP at 5 years was 56% in stable, 70% in responders, and 35% in nonresponders (p = 0.001). In multivariable Cox regression, both stabilization (HR: 0.48, CI: 0.27-0.86, p = 0.013) and response (HR: 0.11, CI: 0.04-0.35, p < 0.001) to ECP were associated with survival. Absolute FEV1 at baseline was also protective (HR: 0.09, CI: 0.01-0.94, p = 0.046). RAS phenotype was the only risk factor for mortality (HR: 2.11, 1.16-3.83, p = 0.006). This study provides long-term outcomes of ECP use in CLAD patients in the largest published cohort to date. Two-thirds of the cohort had a sustained response to ECP with excellent long-term results. [ABSTRACT FROM AUTHOR]

Copyright of Rivista Italiana di Educazione Familiare is the property of Firenze University Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This article discusses the outcomes of minimally invasive mitral valve surgery (MIMVS) in patients with mitral valve endocarditis compared to patients with other indications for MIMVS. The study found that MIMVS was feasible in patients with endocarditis and had a low early postoperative mortality rate. Although patients with endocarditis had a higher preoperative incidence of stroke and neurological symptoms, the incidences of postoperative stroke and intracerebral bleeding remained low. The study suggests that MIMVS is a viable option for patients with mitral valve endocarditis. [Extracted from the article]

This article examines the outcomes of minimally invasive mitral valve surgery (MIMVS) in obese patients. The study compared the postoperative results of obese patients (BMI ¿30 kg/m2) who underwent MIMVS to those of non-obese patients (BMI <30 kg/m2). The study found that there was no significant difference in age, gender, preoperative renal insufficiencies, and chronic lung diseases between the two groups. While the surgery time was longer in the obese group, there was no difference in time on cardiopulmonary bypass and clamping time. The study also found that the postoperative ventilation time and incidence of wound healing disorder were slightly higher in the obese group. However, there was no significant difference in postoperative complications such as bleeding, renal insufficiency, stroke, myocardial infarction, pacemaker implantation, and mortality between the two groups. The study concludes that MIMVS in obese patients is feasible and should not be considered a contraindication. [Extracted from the article]

This article examines the impact of reduced forced expiratory volume in one second (FEV1) on early postoperative outcomes after minimally invasive mitral valve surgery. The study compared patients with FEV1 <80% and ¿80% who underwent the surgery. The primary endpoint was 30-day mortality, and secondary endpoints included intubation time, length of stay in the intensive care unit, and incidences of postoperative respiratory insufficiency and pneumothorax. The study found that despite a slightly longer intubation time and time on the ICU, reduced FEV1 did not significantly affect the early postoperative outcomes of patients undergoing this surgery. [Extracted from the article]

This article presents a 13-year retrospective single-center study on lung transplantation (LTx) in patients with severe pulmonary hypertension (PH). The study focuses on patients who required extracorporeal membrane oxygenation (ECMO) as a bridge to LTx. The results show that while ECMO bridging did not affect graft survival after LTx, bridged patients experienced more complications during the peri-transplant period. The authors suggest that prioritizing high-risk patients for organ allocation and performing transplantation before the need for ECMO bridging can help prevent unnecessary complications and save hospital resources. [Extracted from the article]

Free heme is released from hemoproteins during hemolysis or ischemia reperfusion injury and can be pro‐inflammatory. Most studies on nephrotoxicity of hemolysis‐derived proteins focus on free hemoglobin (fHb) with heme as a prosthetic group. Measurement of heme in its free, non‐protein bound, form is challenging and not commonly used in clinical routine diagnostics. In contrast to fHb, the role of free heme in acute kidney injury (AKI) after cardiopulmonary bypass (CPB) surgery is unknown. Using an apo‐horseradish peroxidase‐based assay, we identified free heme during CPB surgery as predictor of AKI in patients undergoing cardiac valve replacement (n = 37). Free heme levels during CPB surgery correlated with depletion of hemopexin (Hx), a heme scavenger‐protein. In mice, the impact of high levels of circulating free heme on the development of AKI following transient renal ischemia and the therapeutic potential of Hx were investigated. C57BL/6 mice were subjected to bilateral renal ischemia/reperfusion injury for 15 min which did not cause AKI. However, additional administration of free heme in this model promoted overt AKI with reduced renal function, increased renal inflammation, and reduced renal perfusion on functional magnetic resonance imaging. Hx treatment attenuated AKI. Free heme administration to sham operated control mice did not cause AKI. In conclusion, free heme is a predictor of AKI in CPB surgery patients and promotes AKI in transient renal ischemia. Depletion of Hx in CPB surgery patients and attenuation of AKI by Hx in the in vivo model encourage further research on Hx therapy in patients with increased free heme levels during CPB surgery. [ABSTRACT FROM AUTHOR]