Relapsed Multiple Myeloma Presenting as Intracranial Plasmacytoma and Malignant Pericardial Effusion following Recent Allogeneic Stem Cell Transplantation

Although rare, both central nervous system and pericardial involvement of myeloma have been well described in the literature. Their simultaneous occurrence in relapsed disease, however, has not been previously reported. This case describes a 54-year-old female who was treated for high-risk multiple myeloma with multiregimen chemotherapy and allogeneic hematopoietic stem cell transplantation. Four months after transplant, she was found to have relapsed disease manifesting as an extraosseous, intracranial plasmacytoma and simultaneous malignant pericardial effusion. Her disease characteristics, treatment course, radiologic and pathologic findings are described in detail, and we review the previous literature to determine the various aspects of her disease that may have contributed to her aggressive clinical course.
Case Rep Oncol 2017;10:582–587

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DrugECs: An Ensemble System with Feature Subspaces for Accurate Drug-Target Interaction Prediction

Background. Drug-target interaction is key in drug discovery, especially in the design of new lead compound. However, the work to find a new lead compound for a specific target is complicated and hard, and it always leads to many mistakes. Therefore computational techniques are commonly adopted in drug design, which can save time and costs to a significant extent. Results. To address the issue, a new prediction system is proposed in this work to identify drug-target interaction. First, drug-target pairs are encoded with a fragment technique and the software "PaDEL-Descriptor." The fragment technique is for encoding target proteins, which divides each protein sequence into several fragments in order and encodes each fragment with several physiochemical properties of amino acids. The software "PaDEL-Descriptor" creates encoding vectors for drug molecules. Second, the dataset of drug-target pairs is resampled and several overlapped subsets are obtained, which are then input into kNN (-Nearest Neighbor) classifier to build an ensemble system. Conclusion. Experimental results on the drug-target dataset showed that our method performs better and runs faster than the state-of-the-art predictors.

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The microbiota revolution: Excitement and caution

Scientific progress is characterized by important technological advances. Next-generation DNA sequencing has, in the past few years, led to a major scientific revolution: the microbiome revolution. It has become possible to generate a fingerprint of the whole microbiota of any given environment. As it becomes clear that the microbiota affects several aspects of our lives, each new scientific finding should ideally be analyzed in light of these communities. For instance, animal experimentation should consider animal sources and husbandry; human experimentation should include analysis of microenvironmental cues that might affect the microbiota, including diet, antibiotic and drug use, genetics. When analyzing the activity of a drug, we should remember that, according to the microbiota of the host, different drug activities might be observed, either due to modification or degradation by the microbiota, or because the microbiota changes the immune system of the host in a way that makes that drug more or less effective. This minireview will not be a comprehensive review on the interaction between the host and microbiota, but it will aim at creating awareness on why we should not forget the contribution of the microbiota in any single aspect of biology.

This article is protected by copyright. All rights reserved

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PulmCrit- The gag reflex shouldn’t be tested in living patients

As a medical student I rotated through an elite hospital where it was believed that every patient admitted to the medicine service needed a rectal exam.  The rationale was to avoid ever missing a case of rectal or prostate cancer.  Eventually, the utility of digital rectal examination as a cancer-screening tool was debunked.  Thankfully, this practice has fallen out of favor.

EMCrit by Josh Farkas.

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Role of sialendoscopy in juvenile recurrent parotitis (JRP).

Role of sialendoscopy in juvenile recurrent parotitis (JRP).

Eur Ann Otorhinolaryngol Head Neck Dis. 2017 Jun 29;:

Authors: Berta E, Angel G, Lagarde F, Fonlupt B, Noyelles L, Bettega G

Abstract
Juvenile recurrent parotitis (JRP) is a rare disease of childhood occurring between the ages of 3 and 5 years, characterized by recurrent non-suppurative parotitis, spontaneously evolving towards parotid gland dysfunction. Clinically, JRP presents in the form of unilateral or bilateral, usually asynchronous, swelling of the parotid gland. The diagnosis is based on ultrasound characteristics. Widespread use of sialendoscopy has opened up new prospects for the management of this disease. This review of the literature evaluates the role of sialendoscopy in the management of JRP. A Medline search retrieved 68 articles, 18 of which concerned JRP. Standard treatment consists of antibiotics for at least 10 days at the acute phase of the disease. All studies demonstrated the diagnostic value of sialendoscopy by visualizing strictures, hypovascularization and whitish intraductal debris. Sialendoscopy is also useful for treatment, by allowing intraductal lavage and, when possible, dilatation of strictures. Lavage is performed with saline solution, hydrocortisone, antibiotics or a combination of these solutions, with no significant differences in terms of efficacy. The mode of administration with or without sialendoscopy also appears to provide similar results. Sialendoscopy appears to be a diagnostic and therapeutic option, although it has not been shown to be more effective than simple lavage. All lavage solutions appear to be effective.

PMID: 28669808 [PubMed - as supplied by publisher]

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The Adult Deformity Surgery Complexity Index (ADSCI): a Valid Tool to Quantify the Complexity of Posterior Adult Spinal Deformity Surgery and Predict Postoperative Complications

Publication date: Available online 4 July 2017
Source:The Spine Journal
Author(s): Ferran Pellisé, Alba Vila-Casademunt, Susana Núñez-Pereira, Montse Domingo-Sàbat, Juan Bagó, Xavier Vidal, Ahmet Alanay, Emre Acaroglu, Frank Kleinstück, Ibrahim Obeid, Francisco J S Pérez-Grueso, Virginie Lafage, Shay Bess, Christopher Ames, Anne F. Mannion
Background ContextIn 2008, Mirza et al. designed and validated the first and only index capable of quantifying the complexity of spine surgery. However, this index is not fully applicable to adult spinal deformity (ASD) surgery, since it does not include the surgical techniques most commonly used and most strongly associated with perioperative complications in ASD patients.PurposeThe objective of this study is to develop an "Adult Deformity Surgery Complexity Index" (ADSCI), to quantify objectively the complexity of the ASD posterior surgery.Study Design/SettingExpert consensus (Delphi process) and retrospective analysis of prospectively collected data using multiple regression models.Patient SamplePatients prospectively enrolled in two comparable multicentric ASD databases sharing same inclusion criteria.Outcome MeasuresInternal and external validation of ADSCI using R² for intraoperative bleeding and length of surgery. Receiver Operating Characteristics (ROC) and Area Under the Curve (AUC) analysis to assess ADSCI sensitivity and specificity.MethodsADSCI development and validation was based on the construction and comparison of three different tools: ADSCI score constructed by three rounds of expert consensus (ADSCI-Delphi) and two multiple regression models (ADSCI-RM-Simple and ADSCI-RM-Mixed). Their predictive capability was compared by means of R² values in the same subrogated of surgical complexity as in the Mirza index validation: intraoperative bleeding and duration of surgery. Sensitivity and specificity were evaluated using Receiver Operating Characteristics (ROC) curves and area under the curve (AUC) analysis. The external validity was also examined by evaluating its predictive capability in another multicenter ASD database of comparable patients in the USA.ResultsAt the time of the study, the database included 1325 patients. 475 of these were eligible for the study, having been treated surgically using a posterior approach only (52.2y SD20; 77.7% female; 85.4% ASA I/II). 51 international experts participated in the Delphi-consensus process. The surgical variables selected by consensus and included in the equation were divided into actions and factors. Actions selected were: number of fused segments, decompressions, interbody fusions and cemented levels; number and type of posterior osteotomies and use of pelvic fixation. The factors included were: implant density, revision surgery and team experience. ADSCI-RM-Mixed (Regression model with Delphi formula interactions), provided the best estimates and predictive value, well above Mirza's invasiveness index. The ADSCI-RM-Mixed, with greater AUCs (>0.70), was also the most sensitive and specific for both of the dependent variables studied and for complications prediction. ADSCI-RM-Mixed obtained also the highest R² values in the validation cohort in predicting blood loss (R²=0.34) and surgical time (R²=0.26) with similar effect sizes to those for the derivation cohort.ConclusionsADSCI is the first tool to be specifically developed for the preoperative assessment of the complexity of ASD surgery. This study confirms its validity, specificity and sensitivity and shows it has greater predictive capability than the more generic Mirza invasiveness index. ADSCI should be useful for quantitatively estimating the increased risk associated with more invasive surgery and adjusting for surgical case-mix when making safety comparisons in ASDS.



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Introduction to the 2nd Meeting on Immunity and Inflammation in Epilepsy (IIE2016)

Summary

We report about the main topics presented during this meeting which was devoted to discuss the new emerging evidence for a role of immune- and inflammation-related mechanisms in various autoimmune and nonautoimmune forms of epilepsy. Major emphasis was given to novel immune/inflammatory mechanisms contributing to seizures and neurological comorbidities as well as to the discovery and validation of noninvasive biomarkers of brain inflammation which may be used to monitor epileptogenesis and predict the therapeutic effects of treatments. The key question was whether our scientific community is ready for the translation of the results of laboratory research to clinical studies, and how to best design clinical trials of anti-inflammatory drugs with potential disease-modifying effects.

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