A Rapid and Satisfactory Outcome with Combined Immunosuppressive Therapy in Acquired Haemophilia A with Underlying Tuberculosis

Acquired haemophilia A (AHA) is a rare disorder with an incidence of 1.5 cases per million per year in the United Kingdom. The incidence could be underestimated due to difficulty in diagnosis and also due to the fact that people with low titre inhibitor levels are asymptomatic. It is usually a disease affecting elderly but a disease peak in the younger population is known. The common underlying diseases are autoimmune disorders, malignancies, infections, and drugs. However, approximately 50% of the cases do not have a specific aetiology and about 10% will not have bleeding manifestations. Therefore, an isolated prolongation of APTT should be evaluated, especially prior to any haemostatic challenges. We report a case of a middle-aged man who presented with bleeding due to AHA associated with high inhibitory titres and active pulmonary tuberculosis. He was treated with both antituberculous and combined-aggressive immunosuppressive therapy which resulted in satisfactory disease remission.

Single-ring suspended fiber for Bragg grating based hydrostatic pressure sensing

We present a novel optical fiber composed of a suspended core, a supporting ring and an outer ring. To establish a large holey region, a germanium-doped core is suspended by a silica ring and the entire structure is enclosed by another silica ring. By monitoring the Bragg wavelength shift of an FBG written in such a fiber with an air filling fraction of 65%, a hydrostatic pressure sensitivity of -43.6 pm/MPa was achieved experimentally. The high-pressure sensitivity is in good agreement with the numerically calculated value of ~40 pm/MPa. Due to the significant impact of the fiber core suspended in the large holey region inside the fiber, the pressure sensitivity improved by approximately eleven times compared to a Bragg grating inscribed in a standard single-mode fiber. To the best of our knowledge, it is the highest pressure sensitivity obtained for a FBG-based sensor experimentally, when compared to other FBG-based pressure sensors reported up to date. The large air hole region and the suspended core in the center of the fiber not only make the proposed fiber sensor a good candidate for pressure measurements, especially in the oil industry where space is at a premium, but also allow the detection of substances, by exploiting interaction of light with liquids or gases.

Optofluidics in Microstructured Optical Fibers

In this paper, we review the development and applications of optofluidics investigated based on the platform of microstructured optical fibers (MOFs) that have miniature air channels along the light propagating direction. The flexibility of the customizable air channels of MOFs provides enough space to implement light-matter interaction, as fluids and light can be guided simultaneously along a single strand of fiber. Different techniques employed to achieve the fluidic inlet/outlet as well as different applications for biochemical analysis are presented. This kind of miniature platform based on MOFs is easy to fabricate, free of lithography, and only needs a tiny volume of the sample. Compared to optofluidics on the chip, no additional waveguide is necessary to guide the light since the core is already designed in MOFs. The measurements of flow rate, refractive index of the filled fluids, and chemical reactions can be carried out based on this platform. Furthermore, it can also demonstrate some physical phenomena. Such devices show good potential and prospects for applications in bio-detection as well as material analysis.

Why are patients with progressive nonfluent aphasia nonfluent?

OBJECTIVE

To investigate the cognitive and neural basis for nonfluent speech in progressive nonfluent aphasia (PNFA).

BACKGROUND

Nonfluent speech is the hallmark feature of PNFA, and this has been attributed to impairments in syntactic processing, motor-speech planning, and executive functioning that also occur in these patients. Patients with PNFA have left inferior frontal atrophy.

METHODS

A large semi-structured speech sample and neuropsychological measures of language and executive functioning were examined in 16 patients with PNFA, 12 patients with behavioral-variant frontotemporal dementia (bvFTD), and 13 age-matched controls. Speech fluency was quantified as words per minute (WPM) in the semi-structured speech sample. Stepwise linear regression analyses were used to relate WPM to grammatic, motor-speech planning, and executive aspects of patient functioning. These measures were then related to cortical thickness in 8 patients with PNFA and 7 patients with bvFTD using structural MRI.

RESULTS

WPM was significantly reduced in patients with PNFA relative to controls and patients with bvFTD. Regression analyses revealed that only grammatic measures predicted WPM in PNFA, whereas executive measures were the only significant predictor of WPM in bvFTD. Cortical thinning was significant in PNFA relative to controls in left inferior frontal and anterior-superior temporal regions, and a regression analysis related this area to reduced WPM in PNFA. Significant cortical thinning associated with limited grammatic processing also was seen in the left inferior frontal-superior temporal region in PNFA, and this overlapped with the area of frontal-temporal thinning related to reduced WPM.

CONCLUSION

Nonfluent speech in PNFA may be due in part to difficulty with grammatic processing associated with left inferior frontal and anterior-superior temporal disease.

Neurocognitive contributions to verbal fluency deficits in frontotemporal lobar degeneration

OBJECTIVE

To test the hypothesis that different neurocognitive networks underlie verbal fluency deficits in frontotemporal lobar degeneration (FTLD).

METHODS

Letter ("FAS") and semantic ("animal") fluency tests were administered to patients with a behavioral/dysexecutive disorder (bvFTLD; n = 71), semantic dementia (SemD; n = 21), and progressive nonfluent aphasia (PNFA; n = 26). Tests measuring working memory, naming/lexical retrieval, and semantic knowledge were also obtained. MRI voxel-based morphometry (VBM) studies were obtained on a subset of these patients (bvFTLD, n = 51; PNFA, n = 11; SemD, n = 10).

RESULTS

Patients with SemD were disproportionately impaired on the semantic fluency measure. Reduced output on this test was correlated with impaired performance on naming/lexical retrieval tests. VBM analyses related reduced letter and semantic fluency to anterior and inferior left temporal lobe atrophy. Patients with bvFTLD were equally impaired on both fluency tests. Poor performance on both fluency tests was correlated with low scores on working memory and naming/lexical retrieval measures. In this group, MRI-VBM analyses related letter fluency to bilateral frontal atrophy and semantic fluency to left frontal/temporal atrophy. Patients with PNFA were also equally impaired on fluency tests. Reduced semantic fluency output was correlated with reduced performance on naming/lexical retrieval tests. MRI-VBM analyses related semantic fluency to the right frontal lobe and letter fluency to left temporal atrophy.

CONCLUSIONS

Distinct neurocognitive networks underlie impaired performance on letter and semantic fluency tests in frontotemporal lobar degeneration subgroups.

Systemic humoral immunity to non-typeable Haemophilus influenzae

Non-typeable Haemophilus influenzae (NTHi) is a major cause of respiratory but rarely systemic infection. The host defence to this bacterium has not been well defined in patients with chronic airway infection. The aim of this study was to assess the effect of humoral immunity in host defence to NTHi. Responses were measured in control and bronchiectasis subjects who had recurrent bronchial infection. Antibody and complement-mediated killing was assessed by incubating NTHi with serum and the role of the membrane-attack complex and classical/alternate pathways of complement activation measured. The effect of one strain to induce protective immunity against other strains was assessed. The effect of antibody on granulocyte intracellular killing of NTHi was also measured. The results showed that both healthy control subjects and bronchiectasis patients all had detectable antibody to NTHi of similar titre. Both groups demonstrated effective antibody/complement-mediated killing of different strains of NTHi. This killing was mediated through the membrane-attack complex and the classical pathway of complement activation. Immunization of rabbits with one strain of NTHi resulted in protection from other strains in vitro. Antibody activated granulocytes to kill intracellular bacteria. These findings may explain why NTHi rarely causes systemic disease in patients with chronic respiratory mucosal infection and emphasize the potential importance of cellular immunity against this bacterium.

Churg-Strauss syndrome in patients receiving montelukast as treatment for asthma

STUDY OBJECTIVES

We previously reported eight patients who developed Churg-Strauss syndrome in association with zafirlukast treatment for asthma and postulated that the syndrome resulted from unmasking of a previously existing condition due to corticosteroid withdrawal and not from a direct drug effect. The availability of montelukast, a new leukotriene receptor antagonist with a different molecular structure, permitted us to test this hypothesis. Our goals were to ascertain whether the Churg-Strauss syndrome developed in patients taking montelukast and other novel asthma medications, and to describe potential mechanisms for the syndrome.

DESIGN

Case series.

SETTING

Outpatient and hospital practices of pulmonologists in the United States and Belgium.

PATIENTS

Four adults (one man, three women) who received montelukast as treatment for asthma; two women who received salmeterol/fluticasone therapy, but not montelukast.

RESULTS

Churg-Strauss syndrome developed in the four asthmatic patients who received montelukast. In each case, there was a long history of difficult-to-control asthma characterized by multiple exacerbations that had required frequent courses of oral systemic corticosteroids or high doses of inhaled corticosteroids for control. Two other asthmatics who received fluticasone and salmeterol but not montelukast therapy developed the same syndrome with tapering doses of oral or high doses of inhaled corticosteroids.

CONCLUSIONS

The occurrence of Churg-Strauss syndrome in asthmatic patients receiving leukotriene modifiers appears to be related to unmasking of an underlying vasculitic syndrome that is initially clinically recognized as moderate to severe asthma and treated with corticosteroids. Montelukast does not appear to directly cause the syndrome in these patients.