Scoping review of the recommendations and guidance for improving the quality of rare disease registries.

BACKGROUND: Rare disease registries (RDRs) are valuable tools for improving clinical care and advancing research. However, they often vary qualitatively, structurally, and operationally in ways that can determine their potential utility as a source of evidence to support decision-making regarding the approval and funding of new treatments for rare diseases. OBJECTIVES: The goal of this research project was to review the literature on rare disease registries and identify best practices to improve the quality of RDRs. METHODS: In this scoping review, we searched MEDLINE and EMBASE as well as the websites of regulatory bodies and health technology assessment agencies from 2010 to April 2023 for literature offering guidance or recommendations to ensure, improve, or maintain quality RDRs. RESULTS: The search yielded 1,175 unique references, of which 64 met the inclusion criteria. The characteristics of RDRs deemed to be relevant to their quality align with three main domains and several sub-domains considered to be best practices for quality RDRs: (1) governance (registry purpose and description; governance structure; stakeholder engagement; sustainability; ethics/legal/privacy; data governance; documentation; and training and support); (2) data (standardized disease classification; common data elements; data dictionary; data collection; data quality and assurance; and data analysis and reporting); and (3) information technology (IT) infrastructure (physical and virtual infrastructure; and software infrastructure guided by FAIR principles (Findability; Accessibility; Interoperability; and Reusability). CONCLUSIONS: Although RDRs face numerous challenges due to their small and dispersed populations, RDRs can generate quality data to support healthcare decision-making through the use of standards and principles on strong governance, quality data practices, and IT infrastructure.

Gyrate atrophy of the choroid and retina: Update on diagnosis and treatment.

Gyrate atrophy of the choroid and retina (GACR) is a rare autosomal recessive disease characterised by elevated plasma ornithine levels due to deficiency of the enzyme ornithine aminotransferase (OAT). The accumulation of this amino acid in plasma leads to the development of patches of chorioretinal atrophy in the peripheral retina extending into the macular area. Patients usually present with night blindness followed by constriction of the visual field and, finally, decreased central vision and blindness. The disease is diagnosed by the presence of the characteristic clinical picture, the presence of hyperornithinaemia in plasma and the detection of mutations in the OAT enzyme gene. There is currently no effective gene therapy and the most common therapeutic intervention mainly involves dietary modifications with arginine restriction. This article aims to summarise the pathogenesis, clinical and diagnostic findings and treatment options in patients with GACR.

Proximal balloon-guided catheter with flow inversion vs. distal filter protection during the carotid stent placement, a seven years experience in a Colombian reference center.

BACKGROUND AND PURPOSE: The carotid stent placement as a therapeutic option for carotid stenosis has been increasing among years; therefore, studies are required to evaluate the security and efficacy of its materials. The purpose of this study was to evaluate the distal filter and the proximal balloon-guided catheter with flow inversion as protection devices during carotid angioplasty and stenting. METHODS: This is a retrospective, observational study of patients diagnosed with carotid stenosis treated with angioplasty between January 1, 2014, and June 30, 2020; we analyzed a radiology service database to compare the distal filter and the proximal balloon-guided catheter as protection devices during angioplasty. RESULTS: One hundred seventy-five angioplasties were performed, the distal filter was the most prevalent embolic protection device used (66%), patients baseline characteristics did not differ between groups with different embolic protection devices, except for history of dyslipidemia (p < 0.000). As well, we did not find any significant differences between the groups in the device related complications, intervention time (p = 0.140), unrelated complications (p = 0.693) and functional independence at 90 days (p = 0.096). CONCLUSIONS: In our study the proximal balloon-guided catheter and the distal filter protection device as protection devices during the carotid stenting didn't show significant differences regarding complications related to the system.

Real-time 3D imaging with Fourier-domain algorithms and matrix arrays applied to non-destructive testing.

Real-time 3D ultrasound imaging with matrix arrays remains a challenge in Non-Destructive Testing (NDT) due to the time-consuming reconstruction algorithms based on delay-and-sum operations. Other algorithms operating in the Fourier domain have lower algorithmic complexities and therefore higher frame rates at the cost of more storage space, which may limit the number of reconstruction points. In this paper, we present an implementation for real-time 3D imaging of the Total Focusing Method (TFM) and the Plane Wave Imaging (PWI), as well as of their Fourier-domain counterparts, referred to as k-TFM and k-PWI. For both types of acquisition, the Fourier-domain algorithms are used to increase frame rates, and they are compared to the time-domain TFM and PWI in terms of image quality, frame rates and memory requirements. In order to greatly reduce their memory requirements, a new implementation of k-TFM and k-PWI is proposed. The four imaging methods are then evaluated by imaging in real time a block of stainless steel containing a 3D network of spherical porosities produced by additive layer manufacturing using a powder bed laser fusion process.

A review of the current evidence of fruit phenolic compounds as potential antimicrobials against pathogenic bacteria.

Fruits are among the main natural sources of phenolic compounds (PC). These compounds exert important antioxidant properties primarily associated with the presence of hydroxyl groups in their molecular structure. Additionally, the antibacterial effects of fruit phenolic-rich extracts or individual PC commonly found in fruits have been an emerging research focus in recent years. This review discusses by first time the available literature regarding the inhibitory effects of fruit PC on pathogenic bacteria, including not only their direct effects on bacterial growth and survival, but also their effects on virulence factors and antibiotic resistance, as well as the possible mechanism underlying these inhibitory properties. The results of the retrieved studies show overall that the antibacterial effects of fruit PC vary with the target bacteria, type of PC and length of exposure to these compounds. The type of solvent and procedures used for extraction and fruit cultivar also seem to influence the antibacterial effects of phenolic-rich fruit extracts. Fruit PC have shown wide-spectrum antibacterial properties besides being effective antibiotic resistance modifying agents in pathogenic bacteria and these effects have shown to be associated with interruption of efflux pump expression/function. Furthermore, fruit PC can cause down regulation of a variety of genes associated with virulence features in pathogenic bacteria. Results of available studies indicate the depolarization and alteration of membrane fluidity as mechanisms underlying the inhibition of pathogenic bacteria by fruit PC. These data reveal fruit PC have potential antimicrobial properties, which should be rationally exploited in solutions to control pathogenic bacteria.

Intraspecific and interspecific variation in thermotolerance and photoacclimation in Symbiodinium dinoflagellates.

Light and temperature are major drivers in the ecology and biogeography of symbiotic dinoflagellates living in corals and other cnidarians. We examined variations in physiology among 11 strains comprising five species of clade A Symbiodinium We grew cultures at 26°C (control) and 32°C (high temperature) over a duration of 18 days while measuring growth and photochemical efficiency (Fv /Fm ). Responses to thermal stress ranged from susceptible to tolerant across species and strains. Most strains exhibited a decrease in cell densities and Fv /Fm when grown at 32°C. Tolerance to high temperature (T32) was calculated for all strains, ranging from 0 (unable to survive at high temperature) to 1 (able survive at high temperature). There was substantial variation in thermotolerance across species and among strains. One strain had a T32 close to 1, indicating that growth was not reduced at 32°C for only this one strain. To evaluate the combined effect of temperature and light on physiological stress, we selected three strains with different levels of thermotolerance (tolerant, intermediate and susceptible) and grew them under five different light intensities (65, 80, 100, 240 and 443 µmol quanta m-2 s-1) at 26 and 32°C. High irradiance exacerbated the effect of high temperature, particularly in strains from thermally sensitive species. This work further supports the recognition that broad physiological differences exist not only among species within Symbiodinium clades, but also among strains within species demonstrating that thermotolerance varies widely between species and among strains within species.

Daratumumab, Elotuzumab, and the Development of Therapeutic Monoclonal Antibodies in Multiple Myeloma.

There has been substantial progress in clinical outcomes for patients with multiple myeloma (MM). This encouraging trend derives in large part from the increasing number of effective therapeutic options and the ability because of this to achieve higher quality responses to treatment. The approval of both daratumumab and of elotuzumab in combination with lenalidomide and dexamethasone, in late 2015, was a notable achievement in the field, as daratumumab and elotuzumab represent the first monoclonal antibodies available for use in MM. Given their unique mechanisms of action and favorable side effect profiles, daratumumab and elotuzumab have considerable potential as therapeutic partners with agents in other drug classes and in different clinical settings ranging from newly diagnosed to relapsed disease. This review discusses the development of daratumumab and elotuzumab as well as other monoclonal antibodies currently being evaluated for use in MM.

Neonatal Treatment with a Pegylated Leptin Antagonist Induces Sexually Dimorphic Effects on Neurones and Glial Cells, and on Markers of Synaptic Plasticity in the Developing Rat Hippocampal Formation.

The present study aimed to better understand the role of the neonatal leptin surge, which peaks on postnatal day (PND)9-10, on the development of the hippocampal formation. Accordingly, male and female rats were administered with a pegylated leptin antagonist on PND9 and the expression of neurones, glial cells and diverse markers of synaptic plasticity was then analysed by immunohistochemistry in the hippocampal formation. Antagonism of the actions of leptin at this specific postnatal stage altered the number of glial fibrillary acidic protein positive cells, and also affected type 1 cannabinoid receptors, synaptophysin and brain-derived neurotrophic factor (BDNF), with the latter effect being sexually dimorphic. The results indicate that the physiological leptin surge occurring around PND 9-10 is critical for hippocampal formation development and that the dynamics of leptin activity might be different in males and females. The data obtained also suggest that some but not all the previously reported effects of maternal deprivation on hippocampal formation development (which markedly reduces leptin levels at PND 9-10) might be mediated by leptin deficiency in these animals.

Tomographic diffractive microscopy with agile illuminations for imaging targets in a noisy background.

Tomographic diffractive microscopy is a marker-free optical digital imaging technique in which three-dimensional samples are reconstructed from a set of holograms recorded under different angles of incidence. We show experimentally that, by processing the holograms with singular value decomposition, it is possible to image objects in a noisy background that are invisible with classical wide-field microscopy and conventional tomographic reconstruction procedure. The targets can be further characterized with a selective quantitative inversion.

Evaluation of Clinical Manifestations in Patients with Severe Lymphedema with and without CCBE1 Mutations.

The lymphedema-lymphangiectasia-intellectual disability (Hennekam) syndrome (HS) is characterised by a widespread congenital lymph vessel dysplasia manifesting as congenital lymphedema of the limbs and intestinal lymphangiectasia, accompanied by unusual facial morphology, variable intellectual disabilities and infrequently malformations. The syndrome is heterogeneous as mutations in the gene CCBE1 have been found responsible for the syndrome in only a subset of patients. We investigated whether it would be possible to predict the presence of a CCBE1 mutation based on phenotype by collecting clinical data of patients diagnosed with HS, with or without a CCBE1 mutation. We report here the results of 13 CCBE1 positive patients, 16 CCBE1 negative patients, who were clinically found to have classical HS, and 8 patients in whom the diagnosis was considered possible, but not certain, and in whom no CCBE1 mutation was identified. We found no statistically significant phenotypic differences between the 2 groups with the clinical HS phenotype, although the degree of lymphatic dysplasia tended to be more pronounced in the mutation positive group. We also screened 158 patients with less widespread and less pronounced forms of lymphatic dysplasia for CCBE1 mutations, and no mutation was detected in this group. Our results suggest that (1) CCBE1 mutations are present only in patients with a likely clinical diagnosis of HS, and not in patients with less marked forms of lymphatic dysplasia, and (2) that there are no major phenotypic differences between HS patients with or without CCBE1 mutations.

Characterization of mechanical properties of a hollow cylinder with zero group velocity Lamb modes.

Hollow cylinders used in the industry must be regularly inspected. Elastic guided waves, similar to Lamb modes in a plate, can propagate in the axial direction or around the circumference. They are sensitive to geometrical and mechanical parameters of the cylindrical shell. The objective of this paper is to show that zero group velocity (ZGV) Lamb modes can be used to bring out anisotropy and to measure elastic constants of the material. This study provides experimental and numerical investigations on a Zirconium alloy tube extensively used by the nuclear industry in reactor core components. A non-contact method, based on laser ultrasound techniques and ZGV Lamb modes, demonstrates that the difference observed between axial and circumferential guided waves cannot be explained by an isotropic model. Then, a transverse isotropic model is used for the Zircaloy tube. Four of the five elastic constants are directly extracted from ZGV resonance frequencies. The last one is deduced from the measured dispersion spectra. With this complete set of constants, a good agreement is obtained between theoretical and experimental dispersion curves for both axially and circumferentially propagating guided waves.

Edge resonance and zero group velocity Lamb modes in a free elastic plate.

The local resonances of a free isotropic elastic plate are investigated using laser ultrasonic techniques. Experimental results are interpreted in terms of zero group velocity Lamb modes and edge mode. At a distance from the edge larger than the plate thickness a sharp resonance is observed at the frequency where the group velocity of the first symmetrical Lamb mode vanishes. Close to the edge of the plate, the resonance due to the edge mode dominates. Both zero group velocity and edge resonances appear at the theoretically predicted frequencies. These frequencies do not vary with the distance from the edge of the plate and the transition between the two modes of vibration, at about the plate thickness, is abrupt. Using a laser excitation on the edge, the amplitude profile of the normal displacement at the edge resonance frequency was determined.

Adaptive projection method applied to three-dimensional ultrasonic focusing and steering through the ribs.

An adaptive projection method for ultrasonic focusing through the rib cage, with minimal energy deposition on the ribs, was evaluated experimentally in 3D geometry. Adaptive projection is based on decomposition of the time-reversal operator (DORT method) and projection on the "noise" subspace. It is shown that 3D implementation of this method is straightforward, and not more time-consuming than 2D. Comparisons are made between adaptive projection, spherical focusing, and a previously proposed time-reversal focusing method, by measuring pressure fields in the focal plane and rib region using the three methods. The ratio of the specific absorption rate at the focus over the one at the ribs was found to be increased by a factor of up to eight, versus spherical emission. Beam steering out of geometric focus was also investigated. For all configurations projecting steered emissions were found to deposit less energy on the ribs than steering time-reversed emissions: thus the non-invasive method presented here is more efficient than state-of-the-art invasive techniques. In fact, this method could be used for real-time treatment, because a single acquisition of back-scattered echoes from the ribs is enough to treat a large volume around the focus, thanks to real time projection of the steered beams.

Planos quirúrgicos en cabeza y cuello / Surgical Planes of the Head and Neck

El plano quirúrgico es el plano de disección por el que podemos realizar la exéresis del tumor respetando la mayoría de las estructuras anatómicas neurovasculares. La mayoría de los tumores cutáneos se localizan en la cabeza y el cuello. Por tanto, es importante para el cirujano dermatológico tener un profundo conocimiento de la anatomía quirúrgica de esta área. El temor a dañar estructuras importantes puede llevarnos a no ser suficientemente eficaces en el tratamiento quirúrgico, con el consiguiente riesgo de persistencia o recidiva tumoral. El conocimiento del sistema musculoaponeurótico superficial y sus relaciones con los puntos clave neurovasculares nos permitirá planificar la ejecución de la intervención, guiarnos en la localización del plano adecuado y minimizar las complicaciones posquirúrgicas. El objetivo de este artículo es revisar las características anatómicas claves para el conocimiento de los planos de disección adecuados en la cabeza y el cuello, y con ello, asegurar la supervivencia de los colgajos e injertos (AU)

The surgical plane is a plane of dissection that can be used to excise a tumor while preserving most of the neurovascular structures. The majority of skin tumors are situated on the head and neck, and dermatologic surgeons should therefore have detailed knowledge of the surgical anatomy of this region. Fear of damaging important structures may result in insufficient efficacy of the surgical treatment, with consequent risk of persistence or recurrence of the tumor. Knowledge of the superficial musculoaponeurotic system and its relationship to key neurovascular structures enables the operation to be planned and will help us to locate the appropriate plane and minimize postoperative complications. The objective of this article is to review the key anatomical features defining suitable planes of dissection in the head and neck, the use of which will ensure survival of flaps and grafts (AU)

[Surgical planes of the head and neck]. / Planos quirúrgicos en cabeza y cuello.

The surgical plane is a plane of dissection that can be used to excise a tumor while preserving most of the neurovascular structures. The majority of skin tumors are situated on the head and neck, and dermatologic surgeons should therefore have detailed knowledge of the surgical anatomy of this region. Fear of damaging important structures may result in insufficient efficacy of the surgical treatment, with consequent risk of persistence or recurrence of the tumor. Knowledge of the superficial musculoaponeurotic system and its relationship to key neurovascular structures enables the operation to be planned and will help us to locate the appropriate plane and minimize postoperative complications. The objective of this article is to review the key anatomical features defining suitable planes of dissection in the head and neck, the use of which will ensure survival of flaps and grafts.

Ultrasonic focusing through the ribs using the DORT method.

Thermal ablation induced by high intensity focused ultrasound has produced promising clinical results to treat hepatocarcinoma and other liver tumors. However skin burns have been reported due to the high absorption of ultrasonic energy by the ribs. This study proposes a method to produce an acoustic field focusing on a chosen target while sparing the ribs using the decomposition of the time-reversal operator (DORT method). The idea is to apply an excitation weight vector to the transducers array which is orthogonal to the subspace of emissions focusing on the ribs. A linear array of transducers has been used to measure the set of singular vectors associated with a chest phantom, made of three human ribs immersed in water, and to produce the desired acoustic fields. The resulting propagating fields have been measured both in the focal plane and in the plane of the ribs using a needle hydrophone. The ratio of the energies absorbed at the focal point and on the ribs has been enhanced up to 100-fold, as demonstrated by the measured specific absorption rates.

Neuronal and glial alterations in the cerebellar cortex of maternally deprived rats: gender differences and modulatory effects of two inhibitors of endocannabinoid inactivation.

Adult animals submitted to a single prolonged episode of maternal deprivation (MD) [24 h, postnatal day 9-10] show behavioral alterations that resemble specific symptoms of schizophrenia. Accordingly, this experimental procedure has been proposed as an animal model of schizophrenia based on the neurodevelopmental hypothesis. We have recently reported that MD-induced sex-dependent alterations in the hippocampus of neonatal rats. In view of recent evidence for important implications of the cerebellum in neurodevelopmental psychiatric diseases, we have now addressed possible degenerative changes in the cerebellar cortex of neonatal Wistar rats of both genders. To evaluate the presence of degenerated nerve cells, we used Fluoro-Jade C staining and for the study of astrocytes, we employed glial fibrillary acidic protein. Further, we analyzed the modulatory actions of two inhibitors of endocannabinoids inactivation, the fatty acid amide hydrolase inhibitor N-arachidonoyl-serotonin, AA-5-HT, and the endocannabinoid reuptake inhibitor, OMDM-2 (daily subcutaneous injections during the postnatal period 7-12). The animals were sacrificed at postnatal Day 13. MD induced significant increases in the number of Fluoro-Jade C positive cells (indicative of degenerating neurons) and in the number of glial fibrillary acidic protein positive cells, only in males. The two cannabinoid compounds reversed or attenuated these effects. The present results provide new insights regarding the psychopathological implications of the cerebellum, the role of the endocannabinoid system in neural development, and the possible neurodevelopmental basis of gender differences in schizophrenia.

Vimentin isoform expression in the human retina characterized with the monoclonal antibody 3CB2.

The antigen recognized by the monoclonal antibody 3CB2 (3CB2-Ag and 3CB2 mAb) is expressed by radial glia and astrocytes in the developing and adult vertebrate central nervous system (CNS) of vertebrates as well as in neural stem cells. Here we identified the 3CB2-Ag as vimentin by proteomic analysis of human glial cell line U-87 extracts (derived from a malignant astrocytoma). Indeed, the 3CB2 mAb recognized three vimentin isoforms in glial cell lines. In the human retina, 3CB2-Ag was expressed in Müller cells, astrocytes, some blood vessels, and cells in the horizontal cell layer, as determined by immunoprecipitation and immunofluorescence. Three populations of astrocytes were distinguishable by double-labeling immunohistochemistry: vimentin+/GFAP+, vimentin-/GFAP+, and vimentin+/GFAP-. Hence, we conclude that 1) the 3CB2-Ag is vimentin; 2) vimentin isoforms are differentially expressed in normal and transformed astrocytes; 3) human retinal astrocytes display molecular heterogeneity; and 4) the 3CB2 mAb is a valuable tool to study vimentin expression and its function in the human retina.

Isolation of chick retina cones and study of their diversity based on oil droplet colour and nucleus position.

The chick retina has four morphological cone types that differ not only in shape, but also in the visual pigment in the outer segment, in the colour of the oil droplet in the inner segment and in synaptic connectivity. Neither the type of droplet nor the visual pigment has been definitively established for the four cone types. The main aim of the present work has been the isolation of entire live photoreceptors in order to study the oil droplet colour in each cone type and to quantify each type. We have improved an earlier retinal cell isolation method and obtained large numbers of entire cones. Principal cones (27% of the cones) possess a yellow or colourless droplet. Accessory cones (27% of the cones) all contain a small pale green droplet. Straight cones (44% of the cones) have a red, orange, yellow, or colourless droplet. Oblique cones (1.66% of the cones) all have a colourless droplet. We have found that straight cones with a red, orange, or yellow droplet differ in terms of the position of the nucleus and their percentage and conclude that they are distributed in three rows in the outer nuclear layer (ONL) of the central retina. Our study of 4,6-diamidino-2-phenylindole-stained retinal sections has revealed three rows of nuclei instead of the two currently thought to form the ONL. Together, our results show a larger cone diversity than previously known, suggest a larger functional diversity and provide an efficient method for isolating entire chick photoreceptors.