This study provides insights about the diversity, prevalence and distribution of alpine wild galliformes gastrointestinal parasite community, trying to fill a gap in the scientific information ...currently available in scientific literature. The analysis included three host species: 77 rock partridge (Alectoris graeca saxatilis), 83 black grouse (Tetrao tetrix tetrix) and 26 rock ptarmigan (Lagopus muta helveticus) shot during the hunting seasons 2008-2015. Parasites isolated were Ascaridia compar, Capillaria caudinflata and cestodes. The rock ptarmigan was free from gastrointestinal parasites, whereas the most prevalent helminth (37%) was A. compar in both black grouse and rock partridge. C. caudinflata occurrence was significantly higher in black grouse (prevalence = 10%, mean abundance = 0.6 parasites/sampled animal) than in rock partridge (prevalence = 1.20%, mean abundance = 0.01 parasites/sampled animal). Significant differences were detected among hunting districts. A. compar was found with a significant higher degree of infestation in the hunting districts in the northern part of the study area whereas cestodes abundance was higher in Lanzo Valley. Quantitative analysis of risk factors was carried out using a generalized linear model (GLM) only on the most common parasite (A. compar). Latitude was the only factors associated with infestation risk (OR = 52.4). This study provides information on the composition and variability of the parasite community in the alpine Galliformes species.
Searching for as yet undetected
γ
-ray sources is one of the main stated goals of the
Fermi
Large Area Telescope Collaboration. In this paper, we explore the capability of a filtering method based on ...a finite mixture of von Mises–Fisher distributions. The proposed procedure is specifically designed to handle data with support on the unit sphere. The assumption of a parametric model for each high energy emitting source allows us to derive an explicit expression for both the direction of the sources and their angular resolutions. The corresponding measures are based on the directional mean and the quantiles of the single mixture components. Sound criteria of model selection can provide an automatic way to determine the number of detected sources. Additionally, a likelihood-ratio test is developed to evaluate their significance. The procedure is tested on simulated data sets of photon emissions from high energy sources within the energy range
10
−
1
,
000
GeV
. A real data example consisting of a sample of the
Fermi
LAT data collected over a period of about 7.2 years within the energy range
10
−
1
,
000
GeV
, in a subregion of the
γ
-ray sky, is furthermore provided.
The relationship between the compressive strength of metakaolin-based geopolymer samples and different processing conditions has been investigated for both potassium and sodium based geopolymer ...systems. Cubic geopolymer samples were prepared by mixing the slurry for 1 h in a thermostatic bath at 0 °C. >1200 samples have been tested to gather enough data to carry out a meaningful statistical analysis. All the data evaluation and model development have been carried out extensively using R. The variation of curing and aging time, curing temperature, SiO2/Al2O3 and H2O/Al2O3 molar ratios has been accounted for via the application of statistical models whose reliability has been suitably checked. Curing has been performed in a sealed container at 100% relative humidity. Aging has been conducted in a climate chamber kept at 75% of relative humidity using an oversaturated solution of NaCl. Curing time has proved a positive relationship with compressive strength while aging time does not show evidence of any significant effect. Curing temperature negatively affects compressive strength. Increasing the SiO2/Al2O3 molar ratio results in an increase of the compressive strength within a certain range of values for the ratio; however, above a threshold (3.8 for the potassium-based and 3.4 for the sodium-based geopolymer system) the mechanical properties decrease. The H2O/Al2O3 molar ratio displayed an inverse proportionality with the compressive strength except for the sodium-based geopolymer, where the mechanical properties initially increased. A further comprehensive and statistically sound model has been proposed that allows us to predict the strength of geopolymer samples as a function of process variables and their composition, ranging in a rather wide set of values.
Background and ImportanceThe prognosis for relapsed/refractory(R/R) Mantle cell lymphoma (MCL), a mature B-cell lymphoma, after the failure of Bruton tyrosine kinase inhibitors (BTKi) remains ...unfavourable. Brexucabtagene autoleucel, an autologous anti-CD19 CAR T-cell therapy, represents the first FDA-EMA approved CAR-T treatment for BTKi-refractory R/R MCL. Here, we describe a challenging case of haematologic toxicity associated with immune effector cell-associated syndrome (ICANS).Aim and ObjectivesThe patient is a 59-year-old with refractory mantle cell lymphoma, initially treated with six alternating cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) and R-DAHP (rituximab, cisplatin, cytarabine, and dexamethasone), followed by autologous stem cell transplantation. In the second-line, the patient received ibrutinib, and in the third-line, Brexucabtagene autoleucel.Material and MethodsThe patient experienced grade≥3 cytokine release syndrome (CRS), treated with tocilizumab and steroids, and immune effector cell-associated neurotoxicity syndrome (ICANS), with neurological symptoms such as worsened handwriting, significant attention and orientation decline, necessitating the administration of 20 mg dexamethasone and, for refractoriness, 100 mg anakinra every 6 hours.ResultsThe combined therapy resulted in rapid improvement of the patient‘s toxicity, leading to discharge from the intensive care unit. The therapy was definitively discontinued after 5 days. PET and CT scans showed complete remission of the lymphoma. As the adoption of CAR-T therapy in haematology increases, the management of side effects becomes crucial. ICANS is a common toxicity, particularly in patients treated with axicabtagene ciloleucel and brexucabtagene celeucel, with a median onset time of 6–8 days. In this case, ICANS lasted 25 days, but the combination of dexamethasone and anakinra proved effective. The use of anakinra, an IL-1 receptor antagonist approved for rheumatoid arthritis, was first examined for refractory CRS/ICANS in a murine model before entering clinical practice at various CAR-T centres. The administration of anakinra, in conjunction with dexamethasone, has shown benefits in managing severe ICANS. A phase 2 study (NCT4205838) aims to gather solid evidence for its application. Initial results from the study, based on seven patients, show potential in reducing severe ICANS and corticosteroid use.Conclusion and RelevanceIn conclusion, CAR T-cell therapy offers innovative treatment for B-cell malignancies but introduces unique toxicity. Careful monitoring and interventions are essential to ensure patient safety. Anakinra shows promise in ICANS management and reducing corticosteroid use.References and/or AcknowledgementsConflict of InterestNo conflict of interest.
Background and ImportanceBrexucabtagene autoleucel, an autologous anti-CD19 CAR T-cell therapy with a chimeric antigen receptor (CAR), represents the first FDA-EMA approved CAR-T for ...relapsed/refractory mantle cell lymphoma (MCL). While CAR T-cell therapy is an innovation, it also comes with unique toxicities.Aim and ObjectivesHere, we describe the case of a patient with relapsed-refractory mantle cell lymphoma treated with brexucabtagene autoleucel who experienced Cytokine Release Syndrome (CRS), Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS), evaluated with a Naranjo scale score of 5–8, and intestinal perforation in the days following therapy. This abstract has been written in order to share the clinical difficulties of CAR-T patient management and to highlight the potential role of anti-IL6 medicines in this singular adverse drug reaction.Material and MethodsThe patient received tocilizumab and dexamethasone for CRS, effectively managing it but faced substantial ICANS symptoms. Anakinra and high-dose dexamethasone led to notable improvement. On day +34, acute abdominal symptoms emerged, leading to a CT scan revealing diverticulitis complications, necessitating exploratory laparotomy and colonic resection. Remarkably, histological analysis showed no lymphoma or extensive CAR T-cell infiltration but revealed neutrophilic inflammation and Cytomegalovirus (CMV) presence, treated with antivirals.ResultsWith the increasing adoption of CAR-T therapy in haematology, the accurate management of side effects becomes crucial. A search in our country’s pharmacovigilance database did not reveal other reports of intestinal perforation possibly related to tocilizumab in patients treated with brexucabtagene autoleucel apart from this case, evaluated with a score of 1–4 on the Naranjo scale. Clinical-data and post-marketing surveillance have reported an increased risk of gastrointestinal perforation in patients treated with axicabtagene ciloleucel, but there have been no reports of intestinal perforation associated with brexucabtagene autoleucel. However, the setting remains similar: patients undergo lymphodepleting chemotherapy and receive a high dose of IL-6 receptor inhibitor and corticosteroids.Conclusion and RelevanceIntestinal perforation in CAR-T treated patients is mentioned in the ESMO-guidelines for the management of Immune Effector Cell-Associated Hypersensitivity (ICAH) and a correlation between tocilizumab and intestinal perforations has been suggested (5–8 Naranjo scale score), as observed in clinical trials and post-marketing analysis among patients with rheumatoid arthritis. This case underscores the importance of meticulous monitoring and understanding CAR-T therapy intricacies and toxicity management.References and/or AcknowledgementsConflict of InterestNo conflict of interest.
Summary
Background Children with a shunted hydrocephalus are at highest risk for developing an immediate type allergy to latex. Limited data are available for preventive or therapeutical approaches.
...Objective To evaluate the effectiveness of latex avoidance, with special regard to status of sensitization and compliance.
Methods In 1995, 131 children with a shunted hydrocephalus were screened for sensitization to latex by skin prick test and determination of specific IgE. Patients and parents were instructed on latex‐avoiding strategies. Hospital physicians, family doctors and dentists were advised to perform further surgical and other medical interventions under latex‐free conditions.
In 2000, 100 of these 131 patients were re‐evaluated according to the same testing procedures. Special attention was directed at the extent prophylaxis had been performed.
Results In 1995, 30/100 patients re‐evaluable in 2000 proved sensitized to latex, 70 had negative testing results. In 2000, 64/70 patients were still negative, six had meanwhile developed latex‐specific IgE. Seven out of thirty subjects with former positive testing had changes within the same RAST‐class, 20 showed a decline of at least one RAST‐class, whereas in three cases an increase of latex‐specific IgE was found. However, only 34 patients, mainly those being already sensitized, had thoroughly followed both medical and private prophylaxis. Within this group, 16 subjects (47.1%) had improved and another nine (26.5%) were still negative. Only three (8.8%) already previously sensitized patients presented with a further increase of latex‐specific IgE. Medical prevention contributed more to the outcome than home prevention. No statistically significant correlation with latex‐avoidance was observed, however, in previously unsensitized subjects. Underlying disease, atopy, number of operations, and age did not prove as significant variables.
Conclusion Secondary prevention results in a decrease of specific IgE in latex‐sensitized patients with hydrocephalus. This is due to medical more than home prophylaxis. Sensitization obviously occurs mainly in early childhood, thus primary prevention remains to be the main target.
Between 1991 and 1993, 106 newly diagnosed cases of Hirschsprung's disease (HD) were prospectively analyzed for the association of HD and intestinal neuronal dysplasia (IND) at ten pediatric surgical ...departments in central Europe. Hirschsprung-associated IND (HaIND) was found in 40% of cases. IND was disseminated in one-third and localized in two-thirds of the patients. Initial clinical symptoms were related to the length of the aganglionic segment, but not to the presence of HaIND. An enterostomy performed in 72 cases (67.9%) was located in a segment of pathologically innervated bowel in 50% of all cases, but in 72% of cases of HaIND. The proximal margin of the resected bowel showed pathological innervation in 44% of cases. Supplemental biopsies from the intestine (apart from diagnostic suction biopsies and biopsies at the enterostomy site) led to the first identification or definition of length of associated IND in 17.9% of cases. Postoperatively, the presence of long-segment aganglionosis or associated IND implied a delay in the restoration or normal defecation. Persistent constipation was found in 40% of patients with associated disseminated IND at follow-up at 6 months, compared to 20.6% in patients with isolated HD. These children needed secondary interventions more often than patients with associated localized IND or isolated HD. HaIND thus has clinical implications for the postoperative course if IND is disseminated.
Venous bupivacaine plasma concentrations were measured in six neonates and infants aged 4 days to 3.9 mo (mean, 2.1 mo) and 10 infants and children aged 9 mo to 6 yr (mean, 3.1 yr) after ...administration of an initial bolus of 0.5 mL/kg bupivacaine 0.25%, followed by a continuous infusion of local anesthetic (0.25 mL centered dot kg centered dot h) over a period of 4 h (first hourbupivacaine 0.25%, then reduced to 0.125%). Plasma concentrations of local anesthetic measured at 180 min and 300 min after beginning of bupivacaine administration were significantly higher in younger infants when compared to older infants and children (180 min0.67 +/- 0.24 micro gram/mL 0.25-0.97 vs 0.27 +/- 0.11 micro gram/mL 0.19-0.55, P < 0.01; 300 min0.86 +/- 0.36 micro gram/mL 0.35-1.25 vs 0.34 +/- 0.12 micro gram/mL 0.18-0.57, P < 0.01). The results of our study show that despite applying the same dosage of epidural bupivacaine significantly higher plasma concentrations were seen after short periods of continuous infusion in infants up to 4 mo than in children older than 9 mo.(Anesth Analg 1996;82:231-4)
Objective: The aim of this study was to follow up the 19 infants born in Tyrol province with abdominal wall defects between 1985 and 1996 whose malformation had been diagnosed prenatally, who were ...operated on immediately postpartum and who are alive today. Method: There were seven children in the omphalocele group and 12 in the gastroschisis group; 18 parents of affected infants took part in the study. Results: Four out of seven children with omphalocele had major associated malformations (two Beckwith-Wiedemann syndrome, one porencephalic cyst, one with skeletal defects). These children presented handicaps related to the associated malformations but not to the abdominal wall defect. The three other children with omphalocele are developing normally. Five out of 11 children with gastroschisis had associated intestinal but no extraintestinal malformations. After discharge, ten of 11 children with gastroschisis were developing normally; one child shows signs of mental retardation. Of 14 mothers who had originally planned another pregnancy prior to the birth of the malformed child, nine decided against becoming pregnant again; the others delayed a further pregnancy for several years. Conclusions: In our group, associated malformations were the main factor affecting the long-term quality of life of children with omphalocele and gastroschisis. Although most of the children were developing normally, fear of a repetition of the malformation in a subsequent pregnancy dominated reproductive choices in all couples.
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