T1 mapping and conditional survival in paediatric dilated cardiomyopathy with advanced heart failure.

Myocardial fibrosis is associated with adverse events in idiopathic dilated cardiomyopathy. Cardiac MRI with late gadolinium enhancement can detect myocardial fibrosis. We evaluated the conditional survival of children and adolescents based on native T1 mapping (combined proton signal from myocytes and interstitium prior to contrast administration by the measurement of myocardial and blood relaxation time) as a means to assess myocardial fibrosis. This retrospective case-cohort over a 3-year period included all consecutive patients (aged ≤ 21 years) with advanced heart failure from dilated cardiomyopathy (echocardiographic left ventricular ejection fraction ≤ 45% and NYHA class ≥ 2) who underwent cardiac MRI.Conditional survival (follow-up ≥ 6 months after cardiac MRI) was assessed to include NYHA functional class and time to event (death or heart transplantation). A total of 57 patients (mean age 11.7 ± 6.1 years; 58% male) had a median NYHA Class III (31/57) and median left ventricular ejection fraction 25% (20-38%). Survival data were available in 82% patients (46/57) and the crude mortality rate was 24% (11/46) and one patient (2%) underwent heart transplantation. The median native T1 was elevated at 1351 ms (95% CI 1332, 1394) and it showed no difference between the groups who survived to those who died. Performing a multilevel regression analysis on prognosis failed to predict 6-month conditional survival.

Watson for Oncology and breast cancer treatment recommendations: agreement with an expert multidisciplinary tumor board.

Background: Breast cancer oncologists are challenged to personalize care with rapidly changing scientific evidence, drug approvals, and treatment guidelines. Artificial intelligence (AI) clinical decision-support systems (CDSSs) have the potential to help address this challenge. We report here the results of examining the level of agreement (concordance) between treatment recommendations made by the AI CDSS Watson for Oncology (WFO) and a multidisciplinary tumor board for breast cancer. Patients and methods: Treatment recommendations were provided for 638 breast cancers between 2014 and 2016 at the Manipal Comprehensive Cancer Center, Bengaluru, India. WFO provided treatment recommendations for the identical cases in 2016. A blinded second review was carried out by the center's tumor board in 2016 for all cases in which there was not agreement, to account for treatments and guidelines not available before 2016. Treatment recommendations were considered concordant if the tumor board recommendations were designated 'recommended' or 'for consideration' by WFO. Results: Treatment concordance between WFO and the multidisciplinary tumor board occurred in 93% of breast cancer cases. Subgroup analysis found that patients with stage I or IV disease were less likely to be concordant than patients with stage II or III disease. Increasing age was found to have a major impact on concordance. Concordance declined significantly (P ≤ 0.02; P < 0.001) in all age groups compared with patients <45 years of age, except for the age group 55-64 years. Receptor status was not found to affect concordance. Conclusion: Treatment recommendations made by WFO and the tumor board were highly concordant for breast cancer cases examined. Breast cancer stage and patient age had significant influence on concordance, while receptor status alone did not. This study demonstrates that the AI clinical decision-support system WFO may be a helpful tool for breast cancer treatment decision making, especially at centers where expert breast cancer resources are limited.

First Report of Tobacco streak virus Infecting Guizotia abyssinica from India.

Guizotia abyssinica (L.f.) Cass. (niger), an important oil seed crop grown in India, is used in foods, paints, soaps, and as an illuminant. During a survey conducted in 2004 to monitor Tobacco streak virus (TSV) in Helianthus annuus L. (sunflower) and Arachis hypogaea L. (groundnut), typical symptoms of leaf and petiole necrosis were observed in niger plants from Karnataka State, India. The field-collected samples reacted with TSV-specific polyclonal antiserum in direct antigen coated (DAC)-ELISA. Indicator host species were mechanically inoculated with extracts from symptomatic leaves and grown under greenhouse conditions. The inoculations resulted in local necrotic lesions on Vigna unguiculata cv. C-152 (cowpea), Gomphrena globosa, and Nicotiana tabacum cv. Xanthi (tobacco) at 3 to 4 days postinoculation (dpi) and systemic mosaic mottling on sunflower and G. globosa at 7 to 9 dpi. To identify the virus at the molecular level, total RNA was isolated (RNeasy kit, Qiagen Inc., Chatsworth, CA) from the virus-inoculated cowpea leaf and used for reverse transcription-PCR using TSV CP (coat protein) specific primers (2). The resulting ~720-bp amplicon corresponding to the CP gene of TSV was cloned into pGem-T vector (Promega, Madison, WI) and sequenced. The resulting sequence of the TSV-niger isolate (TSV-NG) comprised 717 nucleotides encoding 238 amino acid residues of the viral coat protein (GenBank Accession No. DQ864458). Comparison of the sequence with those of other TSV CP gene indicated 98.5 to 99.3% nucleotide and 97.9 to 99.6% amino acid sequence identity with TSV isolates from India (1,2; GenBank Accession Nos. AF505073, AY061930, AY061929, AF515823, AF515824, and AF515825). The sequence of TSV-NG had 89.5 and 80.0% amino acid identity with TSV-WC, type strain from the United States (GenBank Accession No. X00435) and TSV-BR, isolate from Brazil (GenBank Accession No. AY354406), respectively. On the basis of symptoms, transmission, and serological and molecular data, the causal agent of necrosis in niger was identified as a strain of TSV widely prevalent in other oil seed and vegetable crops in India. The new report of Tobacco streak virus infecting niger from India, indicated the expansion of host range among oil seed crops. References: (1) A. I. Bhat et al. Indian J Biotechnol. 1:350, 2002. (2) K. S. Ravi et al. Plant Pathol. 50:800, 2001.