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Better models to identify individuals at low risk of ventricular arrhythmia (VA) are needed for implantable cardioverter-defibrillator (ICD) candidates to mitigate the risk of ICD-related complications. We designed the CERTAINTY study (CinE caRdiac magneTic resonAnce to predIct veNTricular arrhYthmia) with deep learning for VA risk prediction from cine cardiac magnetic resonance (CMR). Using a training cohort of primary prevention ICD recipients (n = 350, 97 women, median age 59 years, 178 ischemic cardiomyopathy) who underwent CMR immediately prior to ICD implantation, we developed two neural networks: Cine Fingerprint Extractor and Risk Predictor. The former extracts cardiac structure and function features from cine CMR in a form of cine fingerprint in a fully unsupervised fashion, and the latter takes in the cine fingerprint and outputs disease outcomes as a cine risk score. Patients with VA (n = 96) had a significantly higher cine risk score than those without VA. Multivariate analysis showed that the cine risk score was significantly associated with VA after adjusting for clinical characteristics, cardiac structure and function including CMR-derived scar extent. These findings indicate that non-contrast, cine CMR inherently contains features to improve VA risk prediction in primary prevention ICD candidates. We solicit participation from multiple centers for external validation.

Background: Chemoimmunotherapy is typically the standard of care for patients with Waldenström macroglobulinemia; however, infectious and hematologic toxic effects are problematic. Acalabrutinib is a selective, potent Bruton tyrosine-kinase inhibitor. The aim of this trial was to evaluate the activity and safety of acalabrutinib in patients with Waldenström macroglobulinemia. Methods: This single-arm, multicentre, phase 2 trial was done in 19 European academic centres in France, Italy, Greece, the Netherlands, and the UK, and eight academic centres in the USA. Eligible patients were 18 years or older and had treatment naive (declined or not eligible for chemoimmunotherapy) or relapsed or refractory (at least one previous therapy) Waldenström macroglobulinemia that required treatment, an Eastern Cooperative Oncology Group performance status of 2 or less, and received no previous Bruton tyrosine-kinase inhibitor therapy. Patients received 100 mg oral acalabrutinib twice per day in 28-day cycles until disease progression or unacceptable toxicity. The primary endpoint was investigator-assessed overall response (at least a minor response) according to the 6th International Workshop for Waldenström Macroglobulinemia (IWWM) and the modified 3rd IWWM workshop criteria. The primary outcome and safety were assessed in all patients who received at least one dose of treatment. This study is registered with ClinicalTrials.gov, number NCT02180724, and is ongoing, but no longer enrolling. Findings: Between Sept 8, 2014, and Dec 24, 2015, 122 patients were assessed for eligibility, of which 106 (87%) patients were given acalabrutinib (14 were treatment naive and 92 had relapsed or refractory disease). With a median follow-up of 27·4 months (IQR 26·0–29·7), 13 (93% [95% CI 66–100]) of 14 treatment naive patients achieved an overall response and 86 (93% [86–98]) of 92 relapsed or refractory patients per both the modified 3rd and 6th IWWM criteria. Seven (50%) of 14 treatment naive patients and 23 (25%) of 92 relapsed or refractory patients discontinued treatment on study. Grade 3–4 adverse events occurring in more than 5% of patients were neutropenia (17 [16%] of 106 patients) and pneumonia (7 [7%]). Grade 3–4 atrial fibrillation occurred in one (1%) patient and grade 3–4 bleeding occurred in three (3%) patients. The most common serious adverse events were lower respiratory tract infection (n=7 [7%]), pneumonia (n=7 [7%]), pyrexia (n=4 [4%]), cellulitis (n=3 [3%]), fall (n=3 [3%]), and sepsis (n=3 [3%]). Pneumonia (n=5 [5%]) and lower respiratory tract infection (n=4 [4%]) were considered treatment related. One treatment-related death was reported (intracranial hematoma). Interpretation: This study provides evidence that acalabrutinib is active as single-agent therapy with a manageable safety profile in patients with treatment-naive, or relapse or refractory Waldenström macroglobulinemia. Further studies are needed to establish its efficacy against current standard treatments and to investigate whether outcomes can be improved with combination therapies. Funding: Acerta Pharma. © 2020 Elsevier Ltd

SummaryChronic inhibition of nitric oxide (NO) synthesis with Nωnitro-L-arginine methyl ester (L-NAME) has become a model of hypertension. The purpose of this study was to evaluate the morphological changes of cerebral arteries in rats with genetic hypertension and hypertension induced by chronic NO deprivation. Spontaneously hypertensive rats (SHR) and normotensive Wistar-Kyoto strain (WKY) were given L-NAME (1 mg·ml-1) from age 5 to 7 or 9 weeks. We assessed vascular remodelling and arteriolar injury score (AIS) in various cerebral arteries using different immunohistochemical staining techniques. In WKY and SHR, L-NAME caused an elevation in tail cuff pressure (TCP). The increase in TCP was larger in SHR than in WKY. L-NAME decreased body weight, but increased heart weight in SHR.The lumen diameter and media cross-section area of internal carotid artery (ICA) in SHR were smaller than those in WKY, and further reduced in SHR and WKY after L-NAME treatment. These findings indicate that cerebral vascular remodelling occurs following chronic hypertension either from genetic origin or NO deprivation. L-NAME increased the media thickness in SHR, but not in WKY. This agent also caused an increase in cell volume density, AIS, and inflammatory cells infiltration in perivascular space with a negative growth index in ICA. The media/lumen ratio was higher in SHR than WKY, and further increased following L-NAME treatment. Diversified vascular remodelling occurred in hypertensive rats, but not in untreated WKY. In summary, these results suggest that NO deprivation and genetic hypertension cause vascular changes in various cerebral arteries.

Botulinum toxin types A through G are potent neurotoxic proteins produced by heterogeneous clostridia.1–5 Conventional testing for botulinum toxin is done by mouse bioassay. Toxin type is determined by the mouse protection assay using specific botulinum toxin antisera.6 The mouse bioassay is a useful test allowing a direct and sensitive determination of LD50 and antibody titers. However the test involves tedious manipulations and the use of live animals. Notermans et al.7 pioneered the development of enzyme-linked immunosorbent assays (ELISAs) for toxins A, B, and E. Since then, numerous radioimmunoassays8 and ELISAs9–18 for detecting botulinum toxins have been published. All are immunoassays, and therefore the results are not strictly comparable to the biological activity measured in the mouse bioassay. Since antibodies and toxin standards needed to perform ELISAs are not generally available, these tests cannot readily be duplicated by other laboratories.

A method was developed specifically to detect naturally occurring Listeria monocytogenes in meat because the traditional cold enrichment procedure was extremely slow and other procedures were ineffective. This method could identify beta-hemolytic Listeria colonies in 3-4 days. The use of a 2-stage enrichment, highly selective LPM agar, and a thin-layer horse blood agar plate for the detection of beta-hemolytic Listeria isolates are the important steps of this method. L. monocytogenes was recovered from 20 of 41 samples of frozen ground beef, 12 of 23 samples of pork sausage, and 7 of 22 samples of poultry. These results indicate that L. monocytogenes is common in raw meat and that this method is effective for its recovery