Acute hemorrhagic leukoencephalitis following the first dose of BNT162b2 vaccine against SARS-CoV-2: A case report

Acute hemorrhagic leukoencephalitis (AHLE), is a rare inflammatory demyelinating disorder, variant of acute disseminated encephalomyelitis. The diagnosis of AHLE remains challenging due to the rarity of the disease and the lack of a reliable biomarker. We report here a case of a 73-year-old male patient with a progressive, low-grade febrile confusional syndrome 20 days after receiving the first dose of BNT162b2 vaccine against SARS-CoV-2. Evidence indicative of the underlying condition by an extensive panel of imaging (brain magnetic resonance imaging, computed tomography and digital subtraction angiography), laboratory (complete blood count, biochemistry, coagulation, tests for autoimmune or infectious disorders, tumor markers, hormonal levels, cerebrospinal fluid analysis) and electrodiagnostic tests were scarce, and mainly non-specific. Sequential neuroimaging revealed the appearance of extensive T2 lesions (signs of gliosis) along with multiple hemorrhagic lesions at various cortical sites. The patient was treated with corticosteroids, discontinued due to severe adverse effects, and subsequently with sessions of plasmapheresis and monthly intravenous administration of cyclophosphamide. Considering the rapid aggravation of the patient's neurological status, the MRI findings of cortical lesions and the lack of response to any treatment, a biopsy of a frontal lobe lesion was conducted, confirming the presence of confluent, inflammatory-edematous lesions with scattered areas of necrosis and hemorrhage, and ultimately areas of demyelination, thus confirming the diagnosis of AHLE. After more than 5 months of hospitalization the patient was transferred in a primary care facility and remained in a permanent vegetative state until his death, more than 2 years later.

Calibration and validation of solar radiation-based equations to estimate crop evapotranspiration in a semi-arid climate

The Abtew and Jensen-Haise solar radiation-based equations were used to estimate evapotranspiration, considering the limited climatic data in many locations. Both equations were proven to successfully predict the potential evapotranspiration (ETO) compared with the standard Penman-Monteith (PM) method in two Mediterranean countries. Calibration of the constant coefficient k of the Abtew equation showed substantial differences compared to recommended values (1.22 vs. 0.53), with the highest values observed during September (1.46). Validation of ETO measurements using calibrated Abtew equation against the PM method indicated a high correlation coefficient (r2 = 0.97, RMSE = 0.61). Further, evapotranspiration requirements, using the calibrated empirical equation, were calculated for olives (449 mm) and citrus (807 mm) showing a good agreement with recommended values for dry climate regions. Therefore, the tested equations could be safely used to predict frequencies and doses of irrigation in semi-arid climates, considering limited climatic data availability.

Estimating cucumber crop coefficients under different greenhouse microclimatic conditions

This study aimed to determine cucumber crop coefficients under different greenhouse microclimatic conditions, parameterizing the Priestley-Taylor reference evapotranspiration model. Crop evapotranspiration was directly measured with the use of lysimeters, and crop coefficients were computed following the two-step climate FAO 56 methodology. Greenhouse compartments (i.e., cooled or uncooled) showed reference evapotranspiration differences of up to 12% in an autumn-winter crop. The results presented cucumber crop coefficient values from the initial to the late-season growth stages from 0.45 to 0.94 depending on the greenhouse climate. Based on the greenhouse hourly microclimatic variation of KC, it is recommended not to apply a KC as a constant for transpiration estimation even at greenhouses located within the same region Regression analysis relating crop coefficients with leaf area revealed very high correlation coefficients for the equations tested. The results indicated that evapotranspiration can be modeled satisfactory based on a significant relationship between crop coefficient and simple measurements of the leaf area index (i.e., KC = 0.447 × LAI).

A glycine substitution in the collagenous domain of Col4a3 in mice recapitulates late onset Alport syndrome

Alport syndrome (AS) is a severe inherited glomerulopathy caused by mutations in the genes encoding the α-chains of type-IV collagen, the most abundant component of the extracellular glomerular basement membrane (GBM). Currently most AS mouse models are knockout models for one of the collagen-IV genes. In contrast, about half of AS patients have missense mutations, with single aminoacid substitutions of glycine being the most common. The only mouse model for AS with a homozygous knockin missense mutation, Col4a3-p.Gly1332Glu, was partly described before by our group. Here, a detailed in-depth description of the same mouse is presented, along with another compound heterozygous mouse that carries the glycine substitution in trans with a knockout allele. Both mice recapitulate essential features of AS, including shorten lifespan by 30–35%, increased proteinuria, increased serum urea and creatinine, pathognomonic alternate GBM thinning and thickening, and podocyte foot process effacement. Notably, glomeruli and tubuli respond differently to mutant collagen-IV protomers, with reduced expression in tubules but apparently normal in glomeruli. However, equally important is the fact that in the glomeruli the mutant α3-chain as well as the normal α4/α5 chains seem to undergo a cleavage at, or near the point of the mutation, possibly by the metalloproteinase MMP-9, producing a 35 kDa C-terminal fragment. These mouse models represent a good tool for better understanding the spectrum of molecular mechanisms governing collagen-IV nephropathies and could be used for pre-clinical studies aimed at better treatments for AS.

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Two mouse models were generated that recapitulate essential features of AS patients.

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Glomeruli and tubuli respond differently to mutant collagen IV protomers.

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The mutant colIV protomers in glomeruli probably undergo a cleavage process by MMP9.

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The two AS mouse models represent a good tool for studying collagen-IV nephropathies.

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These models could be used for pre-clinical studies aimed at better treatments.

Surgery as Single-Modality Treatment for Early-Stage Olfactory Neuroblastoma: An Institutional Experience, Systematic Review and Meta-analysis

BACKGROUND

For olfactory neuroblastoma (ONB), the combination of surgical tumor resection and radiation therapy (RT) has been considered the "gold standard" in treatment protocols intended to cure.

OBJECTIVE

To summarize evidence on the treatment of ONB using surgery alone.

METHODS

A retrospective institutional case series, a systematic review of the literature, and an individual patient data (IPD) meta-analysis on only surgically treated ONB patients.

RESULTS

At our institution, a total of 10 patients were treated through surgery alone and remained alive and free of disease at last follow-up. The IPD meta-analysis on 128 patients revealed a disease-free survival (DFS) and overall survival (OS) of 67.7% and 75.4% at 5 years and 57.1% and 71.9% at 10 years, respectively. Univariate analysis showed that Kadish stage C/D and Hyams grading III//IV significantly affected OS (P = 0.000 and P = 0.000) and DFS (P = 0.000 and P = 0.002). For low-risk patients, the DFS was 80.6% at 5 years and 67.8% at 10 years, respectively.

CONCLUSIONS

Surgery alone is an equivalent alternative to combined treatment in carefully selected low-risk ONB patients with better outcome measures than previously reported.

Systemic Evaluation of Chimeric LNA/2'-O-Methyl Steric Blockers for Myotonic Dystrophy Type 1 Therapy

Myotonic dystrophy type 1 (DM1) is a dominantly inherited, multisystemic disorder characterized clinically by delayed muscle relaxation and weakness. The disease is caused by a CTG repeat expansion in the 3′ untranslated region (3′ UTR) of the DMPK gene, which leads to the expression of a toxic gain-of-function mRNA. The expanded CUG repeat mRNA sequesters the MBNL1 splicing regulator in nuclear-retained foci structures, resulting in loss of protein function and disruption of alternative splicing homeostasis. In this study, we used CAG repeat antisense oligonucleotides (ASOs), composed of locked nucleic acid (LNA)- and 2′-O-methyl (2′OMe)-modified bases in a chimeric design, to alleviate CUG^expanded-mediated toxicity. Chimeric 14–18mer LNA/2′OMe oligonucleotides, exhibiting an LNA incorporation of ∼33%, significantly ameliorated the misregulated alternative splicing of Mbnl1-dependent exons in primary DM1 mouse myoblasts and tibialis anterior muscles of DM1 mice. Subcutaneous delivery of 14mer and 18mer LNA/2′OMe chimeras in DM1 mice resulted in high levels of accumulation in all tested skeletal muscles, as well as in the diaphragm and heart tissue. Despite the efficient delivery, chimeric LNA/2′OMe oligonucleotides were not able, even at a high-dosage regimen (400 mg/kg/week), to correct the misregulated splicing of Serca1 exon 22 in skeletal muscles. Nevertheless, oligonucleotide doses were well-tolerated as determined by histological and plasma biochemistry analyses. Our results provide proof of concept that inhibition of MBNL1 sequestration by systemic delivery of a steric-blocking ASO is extremely challenging, considering the large number of target sites that need to be occupied per RNA molecule. Although not suitable for DM1 therapy, chimeric LNA/2′OMe oligonucleotides could prove to be highly beneficial for other diseases, such as Duchenne muscular dystrophy, that require inhibition of a single target site per RNA molecule.

Immunotherapy of Cancer: Developments and Reference Points, an Unorthodox Approach

Oncology is currently a sector of medical science with accelerated progress due to rapid technological development, the advancement in molecular biology, and the invention of many innovative therapies. Immunotherapy partially accounts for this advance, since it is increasingly playing an important role in the treatment of cancer patients, bringing on a sense of hope and optimism through a series of clinical studies and cases with spectacular results. Immunotherapy, after the initial successes it experienced in the early 20th century, was forgotten after chemotherapy and radiotherapy prevailed and developed slowly in the background. Today, it is the new hope for cancer treatment, despite the unorthodox path it has followed. In this article, we study the course and key points of the discovery of immune-oncology from the oncologist's point of view. We also record the questions that have been posed about immunotherapy that sometimes lead to confusion or stalemate.

Clinical value of significance of Hypoxia Inducible Factor-1α, Glucose Transporter-1 and Carbonic Anhydrase IX in rectal cancer after preoperative chemoradiotherapy

PURPOSE

The standard treatment of rectal cancer is surgery along with preoperative radiotherapy, administered alone or in combination with chemotherapy. Preoperative chemoradiotherapy (preCRT) is widely used as it allows better local control and the use of sphincter-saving surgery. Pathological response after preCRT has been shown to be a significant prognostic factor of rectal cancer recurrence and survival. In this review we will assess the value of Hypoxia Induced Factor 1α (HIF-1α), Carbonic Anhydrase IX (CA-9) and Glucose Transporter 1 (GLUT-1) genes as predictive markers of the course of local advanced rectal cancer in patients who underwent pre-CRT.

METHODS

We searched studies, from Pubmed and in English language, obtained the information by using "HIF-1 alpha", "Carbonic Anhydrase IX (CA-9)", "Glucose Transporter 1 (GLUT-1)" and "rectal cancer" as key words.

RESULTS

27 relevant articles were retrieved in initial stage. After full-text review, 13 articles were selected for the final analysis.

CONCLUSIONS

HIF-1α, GLUT-1 and CA-IX may be connected with tumor response to preCRT, however, there is still skepticism towards their clinical use as predictors of outcome. Therefore, there is a need to conduct larger and more extensive cohort studies in order to find whether these predictors can be used in practice.

Hepatobiliary and pancreatic procedures during cytoreductive surgery and HIPEC

PURPOSE

The combination of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has been used as locoregional treatment in selected patients with peritoneal malignancy. The purpose of this study was to report on the outcomes of patients undergoing hepatobiliary and pancreatic procedures during CRS and HIPEC.

METHODS

A prospectively maintained database was used to identify patients that underwent hepatobilliary and/or pancreatic procedures during CRS and HIPEC. Outcome variables included morbidity, 30-day or in-hospital mortality, return to operating theatre, and complications.

RESULTS

Sixty eight patients were included in the study, in whom 67 hepatobiliary and 15 pancreatic procedures were performed. Complete cytoreduction (CC-0/1) was achieved in 64 patients (94.8%). Twelve patients underwent liver resections, 50 underwent resection of Glisson's capsule, 5 underwent procedures of the biliary tree and 15 patients underwent pancreatic procedures. Major complications were encountered in 30/68 patients (44.1%). Pancreatic fistulas (PFs) were observed in 42.8% of the patients that underwent distal pancreatectomy. Reoperation rate was 8.8%, while 2.9% of the patients died during their hospital stay.

CONCLUSION

The need for hepatobiliary procedures bears a significant - but acceptable - rate of morbidity. However, it should not represent a definitive contraindication for CRS and HIPEC.

Hepatocellular Carcinoma Peritoneal Metastasis: Role of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

INTRODUCTION

Peritoneal dissemination of hepatocellular carcinoma (HCC) is a rare presentation with an incidence of 2-6%. The most common cause of peritoneal deposits is a ruptured HCC that results in tumor spillage into the peritoneal cavity. The overall incidence of spontaneous ruptures of HCC ranges from 5 to 15% and carries a high mortality rate of up to 50%. Other factors influencing peritoneal dissemination are the lymph node metastasis and the direct diaphragmatic invasion and there is no significant association with past history of FNAB, or percutaneous RFA or ethanol injection and lung or adrenal metastasis. Clinical Study: We present our experience with 4 patients with localized peritoneal metastases from HCC controlled and managed with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). The mean peritoneal cancer index (PCI) was 10.2. In two cases there is a history of rupture at the onset of diagnosis and in one case dissemination of peritoneal cavity after FNB procedure. All patients after CRS and HIPEC received Sorafenib.

RESULTS

In our study the mean time of onset of peritoneal metastasis was 13.5 months from initial operation and the mean survival was 30 months. Our results are comparable with other studies.

CONCLUSION

Peritoneal metastasis of hepatocellular carcinoma is rare and the benefit of systemic chemotherapy is poor and from Sorafenib is not well described. Surgical resection of extrahepatic HCC metastasis remains challenging. However several case reports and a few case series have provided that surgical resection of HCC peritoneal implants may benefit. We believe from our experience in well-selected patients with peritoneal metastasis from HCC, cytoreductive surgery with HIPEC and Sorafenib may prolong survival compared to systemic chemotherapy alone.

Male breast cancer originating in an ectopic breast tissue in the umbilicus A Case Report

INTRODUCTION

Accessory breast tissue is a rare finding in the general population with an incidence of 1-2%. Carcinomas of accessory breast tissue account for ∼0.3% of breast cancers, 5% of which are arising within a supernumerary breast. They are usually diagnosed at a later stage compared with breast cancer, due to their rarity and low clinical suspicion.

CASE PRESENTATION

We present the case of a 58 years old male who was admitted to our hospital for an umbilical hernia, surgical repair. During surgery a small skin biopsy was excised and sent for pathological examination as routine procedure. The histological report revealed the presence of a poorly differentiated carcinoma. Immunochemical analysis confirmed adenocarcinoma of breast origin.

CONCLUSION

Carcinomas of accessory breast tissue are rare and therefore they are usually of advanced stage in time of diagnosis. Few cases have been reported in literature of accessory breast tissue carcinomas in men. To the best of our knowledge, this is the only case in the literature, of ectopic breast tissue cancer in the umbilicus.

KEY WORDS

Ectopic breast, Male breast cancer, Umbilicus.

Cytoreductive surgery and HIPEC for peritoneal carcinomatosis. A review on morbidity and mortality

PURPOSE

To review morbidity and mortality of cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal carcinomatosis.

METHODS

A literature search was conducted to identify studies from centers that perform CRS and HIPEC, and to collect and analyse data about morbidity and mortality.

RESULTS

Twenty-five articles, published from 2006 to 2014 were reviewed. The studies included 24-1069 patients that had been treated with CRS and HIPEC for peritoneal carcinomatosis. The overall rate of severe perioperative morbidity ranged from 0 to 62% and the mortality rate varied from 0 to 10%. Major morbidity was correlated with age, peritoneal carcinomatosis index (PCI), comorbidities, number of digestive anastomoses and institution where the treatment was performed.

CONCLUSION

Although the resultant morbidity is not negligible, with good patient selection this modality appears to be overall safe and effective in experienced hands. The results indicated that this treatment should be practised by institutions with expertise in the management of peritoneal carcinomatosis.

Salmonella Virchow Infection of the Chicken Elicits Cellular and Humoral Systemic and Mucosal Responses, but Limited Protection to Homologous or Heterologous Re-Challenge

Salmonella enterica serovar Virchow usually causes mild gastroenteritis in humans; however, it is frequently invasive and many isolates are resistant to a broad-range of therapeutic antimicrobials. Poultry meat is considered a major source of human infection. In this study, we characterize the infection biology and immune response to S. Virchow in chickens and determine protection against homologous and heterologous re-challenge, with S. Virchow or S. Typhimurium. Following oral infection of 7-day-old chickens, S. Virchow colonized the gastrointestinal tract and the spleen. Infection elicited an increase in specific IgA, IgG, and IgM antibodies and relative quantitative changes in several leukocyte populations, including CD3, CD4, CD8α, CD8β, MHC II, KuL01, and γδ TCR positive cells, both in the gastrointestinal tract and systemically. Increased expression of pro-inflammatory cytokines IL-1β and IL-6 and the chemokine CXCLi2 was also found. Primary infection with S. Virchow offered limited systemic protection against re-challenge with S. Virchow or S. Typhimurium, but no protection against cecal colonization. In conclusion, S. Virchow exhibits similar infection biology and immune responses in the chicken to that previously described for S. Typhimurium. Unlike S. Typhimurium, S. Virchow infection is poorly protective to homologous and heterologous re-challenge. These findings suggest that S. Virchow is capable of colonizing the chicken well and therefore, presents a risk of entering the food chain in meat production. Furthermore, the development of vaccines that protect effectively against S. Virchow and indeed multivalent vaccines that protect across all Salmonella serogroups in the chicken would appear to remain a challenging proposition.

On the effectiveness of treatment options in epistaxis: an analysis of 678 interventions

BACKGROUND

Epistaxis represents one of the most common emergencies in ENT clinics around the world. It creates great physical and emotional stress to the patient as well as a financial burden on health-care systems. A lot of research has been performed with regard to aetiology and possible treatment, however, not much effort has been put into analysing the effectiveness of common treatment forms. It is the objective of this study to clarify which of these treatment forms is reliable.

STUDY DESIGN

Retrospective cohort study.

LEVEL OF EVIDENCE

2b.

METHODS

Between 03/2007 and 04/2008, all epistaxis therapies including relapses and treatment failures at the University Hospital of Zurich have been documented using a computerised questionnaire. Different treatments were compared to each other.

RESULTS

An analysis of 678 interventions in 537 patients was performed with emphasis on failure proportions and time to occurrence. The estimated failure proportions of coagulation in anterior epistaxis accounts for 14%. Successful treatment of epistaxis in posterior bleedings could be achieved in 62% by packing and in 97% by surgery with a statistically significant difference between the respective groups.

CONCLUSION

Using our treatment options, anterior epistaxis can be cured reliably by cauterisation. Surgical therapies in posterior bleedings are able to successfully salvage failed packing therapies.