Influence of entomopathogenic fungus, Metarhizium anisopliae , alone and in combination with diatomaceous earth and thiamethoxam on mortality, progeny production, mycosis, and sporulation of the stored grain insect pests

Abstract

The stored grain insects cause great damage to grains under storage conditions. Synthetic insecticides and fumigants are considered as key measures to control these stored grain insect pests. However, the major issue with these chemicals is grain contamination with chemical residues and development of resistance by insect pests to these chemicals. Biological control is considered as a potential alternative to chemical control especially with the use of pathogens, alone or in combination with selective insecticides. The present study was conducted to evaluate the synergism of Metarhizium anisopliae with diatomaceous earth (DE) and thiamethoxam against four insect pests on the stored wheat grains. In the first bioassay, the M. anisopliae was applied at 1.4 × 10⁴ and 1.4 × 10⁶conidia/ml alone and in integration with two concentrations (250 and 500 ppm) of tested DE. The tested fungus when combined with DE and thiamethoxam possessed synergistic impact as compared to their individual efficacy. Adult mortality increased with respect to increased exposure interval and doses. In the second bioassay, M. anisopliae was applied at 1.4 × 10⁴ conidia/ml individually and in combination with three concentrations (0.50, 0.75, and 1.00 ppm) of thiamethoxam. Results concluded that M. anisopliae integrated with DE and thiamethoxam provides more effective control of stored grain insect pests.

Comparison of virtual monoenergetic and polyenergetic images reconstructed from dual-layer detector CT angiography of the head and neck

Abstract

Objectives

To compare the image quality of virtual monoenergetic images and polyenergetic images reconstructed from dual-layer detector CT angiography (DLCTA).

Methods

Thirty patients who underwent DLCTA of the head and neck were retrospectively identified and polyenergetic as well as virtual monoenergetic images (40 to 120 keV) were reconstructed. Signals (± SD) of the cervical and cerebral vessels as well as lateral pterygoid muscle and the air surrounding the head were measured to calculate the CNR and SNR. In addition, subjective image quality was assessed using a 5-point Likert scale. Student's t-test and Wilcoxon test were used to determine statistical significance.

Results

Compared to polyenergetic images, although noise increased with lower keV, CNR (p < 0.02) and SNR (p > 0.05) of the cervical, petrous and intracranial vessels were improved in virtual monoenergetic images at 40 keV and virtual monoenergetic images at 45 keV were also rated superior regarding vascular contrast, assessment of arteries close to the skull base and small arterial branches (p < 0.0001 each).

Conclusions

Compared to polyenergetic images, virtual monoenergetic images reconstructed from DLCTA at low keV ranging from 40 to 45 keV improve the objective and subjective image quality of extra- and intracranial vessels and facilitate assessment of vessels close to the skull base and of small arterial branches.

Key points

• Virtual monoenergetic images greatly improve attenuation, while noise only slightly increases.

• Virtual monoenergetic images show superior contrast-to-noise ratios compared to polyenergetic images.

• Virtual monoenergetic images significantly improve image quality at low keV.

Folliculocystic and Collagen Hamartoma of Tuberous Sclerosis: A New Case in a Female Patient and Review of Literature

Abstract

Folliculocystic and collagen hamartoma (FCCH) of tuberous sclerosis is a rare entity described in 2012 by Torrelo et al with only eight cases described predominantly in males. It presents since birth or early infancy and in the majority of cases is associated with tuberous sclerosis. The hamartoma presents as an exophytic plaque and has distinctive histopathological features including hair follicles, intact or ruptured epidermal cysts, and an increased number of collagen fibers extending to the subcutaneous tissue.

Herein we present an additional case of this rare entity in an 18 year old female who met clinical criteria for tuberous sclerosis. The patient had an exophytic mass in the left temporal area for many years and wanted surgical excision due to its cosmetic appearance. Histopathology of the surgical specimen showed a hamartomatous lesion with multiple large intact epidermal cysts, hairs, and increased thickened collagen. The patient has followed up for one year after the excision, with no recurrence.

Additionally, we provide a literature review of known cases of folliculocystic and collagen hamartoma as well as its clinical and histopathological differential diagnosis.

TNFα and IL-17A are differentially expressed in psoriasis-like vs. eczema-like drug reactions to TNFα antagonists

Abstract

Background

Tumor necrosis factor α (TNFα) blocking drugs are in use for a wide range of autoimmune disorders. In up to 5% of patients, this class of drugs produces puzzling cutaneous side effects that are the subject of this investigation, namely psoriasiform and eczema-like skin inflammation. These side effects can occur after any time of treatment and regardless of the underlying disorders. The exact pathophysiology is as yet unknown.

Methods

33 patients (19 female, average age 52 years) who had a cutaneous reaction to infliximab, adalimumab or etanercept were included. The type of inflammatory reaction was determined, and the corresponding cytokine expression was evaluated by immunohistochemistry for TNFα, IL-1β, IL-22, IL-6, IL-17A, IL33, IL-8 and IL-36α (semi-quantitative grading system from - to ++++). In addition, RNA expression levels of IL-17A and TNFα were confirmed by quantitative real-time PCR.

Results

IL-17A (p < 0.039) and TNFα (p < 0.008) were expressed at significantly higher levels in psoriasis or pustular like reactions (PPR) compared to eczematous-like reactions (ELR). There was no significant difference in the expression of IL-1β, IL-22, IL-6, IL-33, IL-8 and IL-36α between PPR and ELR.

Conclusion

TNFα and IL-17A are both cytokines known to be involved in psoriasis but less so in non-psoriasiform dermatitis or eczema. Therefore, their overexpression in PPR is plausible and suggests that the pathogenesis of PPR mirrors at least in part those of psoriasis. Further investigations will define the exact role of these cytokines in rare cutaneous side effects of anti-TNFα therapy. Our results suggest that IL-17A inhibition could be a therapeutic option in patients with anti-TNF induced psoriasis.

Correction to: Digestive system in psoriasis: an update

In the original publication, the data labels are incorrect in Fig. 3. The corrected Fig. 3 is given here.

Proper land use for heavy metal-polluted soil based on enzyme activity analysis around a Pb-Zn mine in Feng County, China

Abstract

Enzymes in the soil are useful for assessing heavy metal soil pollution. We analyzed the activity of a number of enzymes, including urease, protease, catalase, and alkaline phosphatase, in three types of land (farmland, woodland, and grassland) to evaluate soil pollution by heavy metals (Pb, Zn, and Cd). Our results showed that the tested soil was polluted by a combination of Pb, Zn, and Cd, but the primary pollutant was Cd. An ecological dose analysis demonstrated that urease was the most sensitive enzyme to Pb and Cd in the farmland, and catalase and phosphatase were the most sensitive enzymes to Pb, Zn, and Cd in the woodland and grassland. The ecological risk of Cd (E _Cd ) was the smallest in all three types of land, suggesting that Cd was the major metal inhibiting enzyme activity. Electrical conductivity (EC) was shown to be a negative regulator, while nitrogen, phosphorus, and clay contents were positive regulators of soil enzyme activity. The total enzyme index (TEI) inhibition rates in the woodland were 22.2 and 38.6% under moderate and heavy pollution, respectively, which were lower than those of the other two types of land. Therefore, woodlands might be the optimum land use choice in relieving heavy metal pollution. Taken together, this study identified the key metal pollutant inhibiting soil enzyme activity and suitable land use patterns around typical metal mine. These results provide possible improvement strategies to the phytomanagement of metal-contaminated land around world.

Validation of a Metastatic Assay using biopsies to improve risk stratification in patients with prostate cancer treated with radical radiation therapy

Abstract

BackgroundRadiotherapy is an effective treatment for intermediate/high-risk locally-advanced prostate cancer, however, >30% of patients relapse within five years. Clinicopathological parameters currently fail to identify patients prone to systemic relapse and those whom treatment intensification may be beneficial. The purpose of this study was to independently validate the performance of a 70-gene Metastatic Assay in a cohort of diagnostic biopsies from patients treated with radical radiotherapy and androgen deprivation therapy (ADT).Patients & MethodsA bridging cohort of prostate cancer diagnostic biopsy specimens was profiled to enable optimization of the Metastatic Assay threshold prior to further independent clinical validation in a cohort of diagnostic biopsies from patients treated with radical radiotherapy and ADT. Multivariable Cox proportional hazard regression analysis was used to assess assay performance in predicting biochemical failure-free survival (BFFS) and metastasis-free survival (MFS).ResultsGene expression analysis was performed in 248 patients from the independent validation cohort and the Metastatic Assay applied. Ten year MFS was 72% for Metastatic Assay positive patients and 94% for Metastatic Assay negative patients (HR = 3.21, [1.35-7.67]; p=0.003). On multivariable analysis the Metastatic Assay remained predictive for development of distant metastases (HR = 2.71, [1.11-6.63]; p=0.030). The assay retained independent prognostic performance for MFS when assessed with the Cancer of the Prostate Assessment Score (CAPRA) (HR = 3.23 [1.22-8.59]; p=0.019) whilst CAPRA itself was not significant (HR = 1.88, [0.52–6.77]; p=0.332). A high concordance (100% [61.5-100]) for the assay result was noted between two separate foci taken from 11 tumours, whilst Gleason score had low concordance.ConclusionsThe Metastatic Assay demonstrated significant prognostic performance in patients treated with radical radiotherapy both alone and independent of standard clinical and pathological variables. The Metastatic Assay could have clinical utility when deciding upon treatment intensification in high-risk patients. Genomic and clinical data are available as a public resource.

Liquid biopsy: another tool towards tailored therapy in colorectal cancer

From hepatitis C virus infection to B-cell lymphoma

Abstract

In addition to liver disorders, Hepatitis C virus (HCV) is also associated with extrahepatic immune manifestations and B-cell non-Hodgkin lymphoma (NHL), especially marginal zone lymphoma, de novo or transformed diffuse large B-cell lymphoma and to a lesser extent, follicular lymphoma. Epidemiological data and clinical observations argue for an association between HCV and lymphoproliferative disorders. The causative role of HCV in NHL has been further supported by the response to anti-viral therapy. Pathophysiological processes at stake leading from HCV infection to overt lymphoma still need to be further elucidated. Based on reported biological studies, several mechanisms of transformation seem however to emerge. A strong body of evidence supports the hypothesis of an indirect transformation mechanism by which sustained antigenic stimulation leads from oligoclonal to monoclonal expansion and sometimes to frank lymphoma, mostly of marginal zone subtype. By infecting lymphocytes, HCV could play a direct role in cellular transformation, particularly in de novo large B cell lymphoma. Finally, HCV is associated with follicular lymphoma in a subset of patients. In this setting, it may be hypothesized that inflammatory cytokines stimulate proliferation and transformation of IgH-BCL2 clones that are increased during chronic HCV infection.Unraveling the pathogenesis of HCV-related B-cell lymphoproliferation is of prime importance to optimize therapeutic strategies, especially with the recent development of new direct-acting antiviral drugs.

Patient and tumor characteristics and their influence on early therapy persistence with letrozole in postmenopausal patients with early breast cancer

Abstract

Background

Patients' compliance and persistence with endocrine treatment has a significant effect on the prognosis in early breast cancer (EBC). The purpose of this analysis was to identify possible reasons for non-persistence, defined as premature cessation of therapy, on the basis of patient and tumor characteristics in individuals receiving adjuvant treatment with letrozole.

Patients and methods

The EvAluate-TM Study is a prospective, multicenter, noninterventional study in which treatment with the aromatase inhibitor letrozole was evaluated in postmenopausal women with hormone receptor-positive EBC in the early therapy phase. Treatment persistence was evaluated at two pre-specified study visits after 6 and 12 months. As a measure of early therapy persistence the time from the start to the end of treatment (TTEOT) was analyzed. Cox regression analyses were performed to identify patient characteristics and tumor characteristics predicting TTEOT.

Results

Out of the total population of 3941 patients with EBC, 540 (13.7%) events involving treatment cessation unrelated to disease progression were observed. This was due to drug-related toxicity in the majority of cases (73.5%). Persistence rates were 92.2%, 86.9% and 86.3% after 6, 12 and 15 months, respectively. The main factors influencing premature treatment discontinuation were older age (HR 1.02 per year), comorbidities (HR 1.06 per comorbidity), low body mass index, and lower tumor grade (HR 0.85 per grade unit).

Conclusions

These results support the view that older, multimorbid patients with low tumor grade and a low body mass index are at the greatest risk for treatment discontinuation and might benefit from compliance and support programs.

Clinical Trials Number

CFEM345DDE19

Reproductive potential and performance of fertility preservation strategies in BRCA -mutated breast cancer patients

Abstract

BackgroundPreclinical evidence suggests a possible negative impact of deleterious BRCA mutations on female fertility. However, limited and rather conflicting clinical data are available. This study assessed the reproductive potential and performance of fertility preservation strategies in BRCA-mutated breast cancer patients.Patients and MethodsThis was a retrospective analysis of two prospective studies investigating oocyte cryopreservation and ovarian tissue cryopreservation in newly diagnosed early breast cancer patients. In the current analysis, baseline anti-mullerian hormone (AMH) and performance of cryopreservation strategies were compared between patients with or without germline deleterious BRCA mutations.ResultsOut of 156 patients included, 101 had known BRCA status of whom 29 (18.6%) were BRCA-mutated and 72 (46.1%) had no mutation. Median age in the entire cohort was 31 years (interquartile range [IQR] 28-33).Median AMH levels were 1.8 µg/L (IQR 1.0-2.7) and 2.6 µg/L (IQR 1.5-4.1) in the BRCA-positive and BRCA-negative cohorts, respectively (P=0.109).Among patients who underwent oocyte cryopreservation (N=29), women in the BRCA-positive cohort tended to retrieve (6.5 vs. 9; P=0.145) and to cryopreserve (3.5 vs. 6; P=0.121) less oocytes than those in the BRCA-negative cohort. Poor response rate (i.e. retrieval of ≤ 4 oocytes) was 40.0% and 11.1% in the BRCA-positive and BRCA-negative cohorts, respectively (P=0.147).Among patients who underwent ovarian tissue cryopreservation (N=72), women in the BRCA-positive cohort tended to have a numerically lower number of oocytes per fragment (0.08 vs. 0.14; P=0.193) and per mm² (0.33 vs. 0.78; P=0.153) than those in the BRCA-negative cohort. Two BRCA-mutated patients were transplanted after chemotherapy and one delivered at term a healthy baby.No difference between BRCA1- and BRCA2-mutated patients was observed in any of the above-mentioned outcomes.ConclusionA consistent trend for reduced reproductive potential and performance of cryopreservation strategies was observed in BRCA-mutated breast cancer patients. Independent validation of these results is needed.

Okulokutaner und okulärer Albinismus

Zusammenfassung

Albinismus wird unterteilt in die okulokutane (OCA) und die okuläre Form (OA). Differenzialdiagnostisch abzugrenzen sind seltene, häufig mit Infektanfälligkeit und neurologischen Symptomen assoziierte Syndrome mit partiellem Albinismus. Der OCA ist eine autosomal-rezessiv vererbte Erkrankung der Melaninbiosynthese, die zu vollständigem oder partiellem Verlust von Melanin in Haut, Haarfollikeln und Augen führt. Von den heute bekannten 7 Subtypen (OCA 1–7) sind 4 (OCA1–4) gut charakterisiert. Ihnen liegen Mutationen in Genen zugrunde, die für Tyrosinase – Schlüsselenzym der Melaninsynthese – und für weitere Proteine codieren. Diese spielen eine wichtige Rolle für die katalytische Aktivität der Tyrosinase sowie die Struktur und die Funktion von Melanosomen. Klinische Symptome und Krankheitsverlauf bei Vorliegen dieser Subtypen, insbesondere Art und Ausmaß der Pigmentierung von Haut und Haaren sowie Schwere der Augenbeteiligung, zeigen eine ausgeprägte Variabilität, die die phänotypische Klassifizierung erschwert. In der Therapie stehen konsequenter UV-Lichtschutz zur Hautkrebsprophylaxe und regelmäßige Vorsorgeuntersuchungen im Vordergrund. Die albinismustypischen Augenveränderungen erfordern die frühzeitig einsetzende Diagnostik und Betreuung durch spezialisierte ophthalmologische Einrichtungen. Neue Strategien zur systemischen Behandlung von Subtypen des Albinismus sind in präklinischer Erprobung. Der OA ohne Hautbeteiligung wird X‑chromosomal vererbt, ist wesentlich seltener und durch reduzierte Pigmentierung von Retina und Iris mit Bildung von Makromelanosomen und Makulahypoplasie mit z. T. erheblicher Visusverschlechterung gekennzeichnet. Die typischen Augensymptome des OA wie Nystagmus und Blendempfindlichkeit können in unterschiedlicher Ausprägung bei allen OCA-Formen auftreten.

Optimisation of window settings for traditional and noise-optimised virtual monoenergetic imaging in dual-energy computed tomography pulmonary angiography

Abstract

Objectives

To define optimal window settings for displaying virtual monoenergetic images (VMI) of dual-energy CT pulmonary angiography (DE-CTPA).

Methods

Forty-five patients who underwent clinically-indicated third-generation dual-source DE-CTPA were retrospectively evaluated. Standard linearly-blended (M_0.6), 70-keV traditional VMI (M70), and 40-keV noise-optimised VMI (M40+) reconstructions were analysed. For M70 and M40+ datasets, the subjectively best window setting (width and level, B-W/L) was independently determined by two observers and subsequently related with pulmonary artery attenuation to calculate separate optimised values (O-W/L) using linear regression. Subjective evaluation of image quality (IQ) between W/L settings were assessed by two additional readers. Repeated measures of variance were performed to compare W/L settings and IQ indices between M_0.6, M70, and M40+.

Results

B-W/L and O-W/L for M70 were 460/140 and 450/140, and were 1100/380 and 1070/380 for M40+, respectively, differing from standard DE-CTPA W/L settings (450/100). Highest subjective scores were observed for M40+ regarding vascular contrast, embolism demarcation, and overall IQ (all p<0.001).

Conclusions

Application of O-W/L settings is beneficial to optimise subjective IQ of VMI reconstructions of DE-CTPA. A width slightly less than two times the pulmonary trunk attenuation and a level approximately of overall pulmonary vessel attenuation are recommended.

Key Points

• Application of standard window settings for VMI results in inferior image perception.

• No significant differences between B-W/L and O-W/L for M70/M40+ were observed.

• O-W/L for M70 were 450/140 and were 1070/380 for M40+.

• Improved subjective IQ characteristics were observed for VMI displayed with O-W/L.

God meets Satan’s Apple: the paradox of creation

Abstract

It is now the majority view amongst philosophers and theologians that any world could have been better. This places the choice of which world to create into an especially challenging class of decision problems: those that are discontinuous in the limit. I argue that combining some weak, plausible norms governing this type of problem with a creator who has the attributes of the god of classical theism results in a paradox: no world is possible. After exploring some ways out of the paradox, I conclude that the classical theist should accept Marilyn Adams's view that no norms (of morality or of rationality) apply to gods.

Does Caesarean Section Affect Breastfeeding Practices in China? A Systematic Review and Meta-Analysis

Abstract

Objectives To ascertain the association between caesarean delivery and breastfeeding practices in China. Methods We conducted a systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines. Electronic databases of CNKI, Medline, EMBASE, CINAHL, ProQuest and Science Direct were searched and screened to identify relevant articles from January 1990 to June 2015. Both fixed and random effect meta-analysis techniques were used to estimate the pooled effect size between caesarean delivery and breastfeeding outcomes at different time points. Sensitivity analysis and publication bias test were also conducted. Results Forty six studies were eligible for the qualitative synthesis of systematic review; among them, 27 studies were included for the meta-analysis. At the early postpartum period, the odds of exclusive breastfeeding after caesarean section was 47% (pooled OR 0.53, 95% CI 0.41, 0.68) lower than that after vaginal delivery. At 4 months postpartum, the odds of breastfeeding was similarly lower (pooled OR 0.61, 95% CI 0.53, 0.71) for caesarean mothers. Substantial heterogeneity among studies was detected for both breastfeeding outcomes. Subgroup analyses stratified by study design, time points of breastfeeding outcomes and definitions of breastfeeding all confirmed the negative association between caesarean section and breastfeeding prevalence. Conclusions In China, breastfeeding practices were affected adversely by caesarean delivery. Therefore, health policy to improve breastfeeding outcomes should take this into consideration.

Concealing a shiny facial skin appearance by an Aerogel-based formula. In vitro and in vivo studies

Abstract

Objective

To explore, in vitro and in vivo, the potential interest of an Aerogel-based formula, in concealing a naturally shiny facial skin.

Methods

In vitro, various formulae and ingredients were applied as a thin film onto contrast plates and studied through measuring the shine induced following pump spraying of a mixture of oleic acid and mineral water as a sebum/sweat mix model. In such a test, an Aerogel ingredient led to very positive results. In vivo, two different formulae with various concentrations of Aerogel were randomly tested on half side of the face vs. bare side of Chinese women, under some provocative environmental conditions, known to enhance facial shine. These conditions comprised a normal activity under a hot and highly humid summer time followed -or not- by a hamam session. Both studies included comparative evaluations using a half-face procedure (treated/untreated or vehicle. In the first case, evaluations were quantitatively carried out whereas the second one was based on a quantitative self-evaluations from standardized full-face photographs

Results

In vitro, the tested Aerogel, incorporated at 1% or 2% concentration in a common O/W cosmetic emulsion, shows an immediate light scattering effect, thereby masking shine. Such effect appears of much higher amplitude than that of two other tested particulate ingredients (Talc and Perlite). A noticeable remanence of anti-shine effect was confirmed in vivo in extreme conditions. The latter was self-perceived by all participants in the second study. This results is likely related to the super hydrophobic behavior of the Aerogel.

Conclusion

As cosmetic ingredient, this new Aerogel appears as a highly promising ingredient for concealing the facial skin shine, a source of complaint from many consumers living in hot and humid regions.

This article is protected by copyright. All rights reserved.

Naturally Occurring ω-Hydroxyacids

Abstract

ω-Hydroxyacids are fatty acids bearing a hydroxyl group on the terminal carbon. They are found in mammals and higher plants and are often involved in providing a permeability barrier, the primary purpose of which is to reduce water loss. Some ω-hydroxyacid derivatives may be involved in water proofing and signaling. The purpose of this review is to survey the known natural sources of ω-hydroxyacids.

ω -Hydroxyacids are produced by two different P450-dependent mechanisms. The longer (30 – 34 carbons) ω-hydroxyacids are produced by chain extension from palmitic acid until the chain extends across the membrane in which the extension is taking place, and then the terminal carbon is hydroxylated. Shorter fatty acids can be hydroxylated directly to produce C16 and C18 ω-hydroxyacids found in plants and 20-eicosatetraenoic acid (20-HETE) by a different P450.

The C16 and C18 ω-hydroxyacids are components of polymers in plants. The long-chain ω-hydroxyacids are found in epidermal sphingolipids, in giant ring lactones from the sebum of members of the equidae, as a component of meibum and in carnauba wax and wool wax.

This article is protected by copyright. All rights reserved.

Methotrexate-induced pneumonia: A dermatologist wake up call

Newer treatments of psoriasis regarding IL-23 inhibitors, phosphodiesterase 4 inhibitors, and Janus kinase inhibitors

Abstract

The rapid progress of genetic engineering furthermore opens up new prospects in the therapy of this difficult-to-treat disease. IL-23 inhibitors, phosphodiesterase 4 (PDE4) inhibitors, and Janus kinase (JAK) inhibitors are currently encouraging further research. Two drugs which are IL-23 inhibitors are now in phase III of clinical trials. The aim of the action of both drugs is selective IL-23 inhibition by targeting the p19 subunit. Guselkumab is a fully human monoclonal antibody. Tildrakizumab is a humanized monoclonal antibody, which also belongs to IgG class and is targeted to subunit p19 of interleukin 23 (IL-23). Phosphodiesterase inhibitors exert an anti-inflammatory action and their most common group is the PDE4 family. PDE4 inhibits cAMP, which reduces the inflammatory response of the pathway of Th helper lymphocytes, Th17, and type 1 interferon which modulates the production of anti-inflammatory cytokines such as IL-10 interleukins. The Janus kinase (JAK) signaling pathway plays an important role in the immunopathogenesis of psoriasis. Tofacitinib suppresses the expression of IL-23, IL-17A, IL-17F, and IL-22 receptors during the stimulation of lymphocytes. Ruxolitinib is a selective inhibitor of JAK1 and JAK2 kinases and the JAK-STAT signaling pathway. This article is a review of the aforementioned drugs as described in the latest available literature.

Pulmonary arteriovenous malformations in hereditary haemorrhagic telangiectasia: Correlations between computed tomography findings and cerebral complications

Abstract

Objectives

Computed tomography (CT) is the modality of choice to characterise pulmonary arteriovenous malformations (PAVMs) in patients with hereditary haemorrhagic telangiectasia (HHT). Our objective was to determine if CT findings were associated with frequency of brain abscess and ischaemic stroke.

Methods

This retrospective study included patients with HHT-related PAVMs. CT results, i.e. PAVM presentation (unique, multiple, disseminated or diffuse), the number of PAVMs and the largest feeding artery size, were correlated to prevalence of ischaemic stroke and brain abscess. All CTs were reviewed in consensus by two radiologists.

Results

Of 170 patients, 73 patients had unique (42.9 %), 49 multiple (28.8 %), 36 disseminated (21.2 %) and 12 diffuse (7.1 %) PAVMs. Fifteen patients presented with brain abscess; 26 patients presented with ischaemic stroke. The number of PAVMs was significantly correlated with brain abscess (11.5 vs. 6.2, respectively; p=0.025). The mean diameter of the largest feeding artery was significantly correlated with ischaemic stroke frequency (4.9 vs. 3.2 mm, respectively; p=0.0098).

Conclusions

The number of PAVMs correlated significantly with risk of brain abscess, and a larger feeding artery significantly with more ischaemic strokes. These findings can lead to a better recognition and management of the PAVMs at risk of cerebral complications.

Key Points

• Chest CT helps clinicians to facilitate appropriate PAVM management strategies.

• Pulmonary arteriovenous malformation CT findings are correlated with risk of cerebral complications.

• Risk of brain abscess is significantly correlated with number of PAVMs.

• Risk of ischaemic stroke is significantly correlated with large feeding artery PAVMs.

• Prevalence of observed of brain abscess and ischaemic stroke is 26 %.