Two Very Rare Cases of Metastatic Thymic Carcinoma with Sjogren's Syndrome: A Case Series

Thymic tumours are rare thoracic malignancies with thymic carcinoma accounting for approximately 12% of all thymic tumours compared to thymomas which account for approximately 86%. Unlike thymomas, it is very rare for thymic carcinomas to be associated with autoimmune disorders or paraneoplastic syndromes. When these phenomena do occur, the vast majority are myasthenia gravis, pure red cell aplasia, or systemic lupus erythematous. Paraneoplastic Sjogren's syndrome is a rare complication of thymic carcinoma, with only two cases previously reported. Here we present 2 cases of patients with metastatic thymic carcinoma who developed autoimmune phenomena consistent with Sjogren's syndrome without classical symptoms prior to treatment. One patient opted for surveillance of their malignancy, while the other underwent chemoimmunotherapy with favourable results. These case reports describe two distinctive clinical presentations of a rare paraneoplastic phenomenon.

Why Choose a Pathology Career?

CONTEXT.—

There is a global decline in medical graduates pursuing pathology careers, resulting in a broadening gap between workforce demand and supply.

OBJECTIVE.—

To determine causes of low popularity of pathology as a career and develop strategies to avoid a workforce crisis.

DESIGN.—

An online survey was distributed and yielded 1247 responses, including 609 Australian medical students from 10 medical schools, 119 prevocational doctors from 10 major teaching hospitals in New South Wales, 175 residents, and 344 pathologists throughout Australia.

RESULTS.—

Compared with pathology-uninterested peers, students and prevocational doctors interested in pathology careers were more likely to value research opportunities (57 of 166 [34.3%] pathology-interested respondents versus 112 of 521 [21.5%] pathology-uninterested respondents; odds ratio [OR] = 1.91, P < .001), have children (19 of 165 respondents [11.5%] versus 22 of 522 respondents [4.2%]; OR = 2.96, P < .001), and self-identify as introverted (87 of 167 respondents [52.1%] versus 179 of 526 respondents [34%]; OR = 2.1, P < .001). Those uninterested in pathology were more likely to value patient interaction (363 of 524 respondents [69.3%] versus 71 of 166 respondents [42.8%]; OR = 3.02, P < .001). Lack of exposure to pathology was the most-cited reason for rejecting pathology (after lack of patient interaction). There was poor understanding of the role of pathologists and low confidence in the ability to interpret histopathology reports among medical students and prevocational doctors. Negative stereotypes regarding pathologists were identified.

CONCLUSIONS.—

Active interventions increasing exposure of medical students and prevocational doctors to pathology as a career, as well as promotion of research opportunities and potential for work-life balance, are needed to address pending workforce shortages.

Blocking mu-opioid receptors inhibits social bonding in rituals

Religious rituals are universal human practices that play a seminal role in community bonding. In two experiments, we tested the role of mu-opioids as the active factor fostering social bonding. We used a mu-opioid blocker (naltrexone) in two double-blind studies of rituals from different religious traditions. We found the same effect across both studies, with naltrexone leading to significantly lower social bonding compared with placebo. These studies suggest that mu-opioids play a significant role in experiences of social bonding within ritual contexts.

Introducing a post-registration interprofessional learning programme for healthcare teams

INTRODUCTION

Few studies have evaluated interprofessional learning (IPL) and teamworking in active clinical teams. The aim of this study was to evaluate an IPL programme offered to established clinical teams by assessing team climate before, during and after the intervention.

METHODS

A previously validated questionnaire, that explored team members' views of team climate, was administered before the IPL programme, at four months following facilitated meetings, and again at eight months. Responses were analysed using one-sample and independent samples t-tests.

RESULTS

Nine teams, made up of 79 individuals, agreed to join the IPL programme. After four months, during which time the teams were supported by an educational facilitator, the overall team climate increased by 8.0% of the maximum possible score of the questionnaire (95% confidence interval = 7.4% to 8.6%). This difference was highly statistically significant (p-value <0.001) and similar increases in scores were seen in each section of the questionnaire. This significant change was sustained after a further four months when the programme continued without the support of an educational facilitator.

CONCLUSION

An IPL programme, such as the one described in this paper, can improve team climate and raise awareness of professional roles within established clinical teams.

Monoclonal antibody definition of multiple polymorphic epitopes on human leukocyte antigen-DRw52

Monoclonal antibodies have revealed complexity within the human leukocyte antigen class II antigens. We have studied epitopes present on a DR3 homozygous B-lymphoblastoid cell line using five polymorphic monoclonal antibodies produced and characterized in our laboratory. Serological analysis on a panel of B-cell lines revealed that the antibodies have different, but related, specificities (NDS9-anti-DR3, NDS10-anti-DR5, less than 3, less than w6, NDS11-anti-DR3, 5, w6, NDS12-anti-DR3, 5, w6, w8, NDS13-anti-DR3, 5, w6, w8+). Competitive radioimmunoassays and two-dimensional gel analyses demonstrated that whereas the epitopes recognized by the broadly reactive antibodies NDS10, 11, 12, and 13 reside on the same molecule, the epitope detected by NDS9 is present on a molecule with different electrophoretic mobility. Thus, using polymorphic monoclonal antibodies, we have defined multiple epitopes associated with DR3, which have different distributions at the population level.

Aberrant splicing of Drosophila alcohol dehydrogenase transcripts in Saccharomyces cerevisiae

We have investigated the ability of transcripts of the Drosophila melanogaster alcohol dehydrogenase gene to be spliced in Saccharomyces cerevisiae. The alcohol dehydrogenase gene was cloned in S. cerevisiae on a 2 micron DNA-based vector and a hybrid yeast actin-Drosophila alcohol dehydrogenase gene was constructed to demonstrate that transcripts encoded on a 2 micron plasmid could be accurately and efficiently spliced. Transcription of the Drosophila gene occurred in yeast with and without a yeast promoter. The transcripts were polyadenylated and terminated approximately 600 nucleotides distal to the polyadenylation site used in Drosophila. In yeast no splicing of the two introns within the alcohol dehydrogenase coding sequence was detected. However, the leader sequence was apparently spliced using the same 3' splice site as is used in adult flies, but a different 5' splice site. This result may be partly explained by the existence in the Drosophila gene of a sequence which is believed to be required for splicing in S. cerevisiae.