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Selective control of donor-acceptor Stenhouse adduct populations with non-selective stimuli

Selective control of donor-acceptor Stenhouse adduct populations with non-selective stimuli

Leveraging the positives from the pandemic to strengthen infectious disease care in low-income and middle-income countries

Leveraging the positives from the pandemic to strengthen infectious disease care in low-income and middle-income countries

Adjuvant chemotherapy in nasopharyngeal carcinoma

The value of adjuvant chemotherapy after definitive radiotherapy in locoregionally advanced nasopharyngeal carcinoma has been debated since the landmark publication of the Intergroup-0099 trial. 1 Al-Sarraf M LeBlanc M Giri PG et al. Chemoradiotherapy versus radiotherapy in patients with advanced nasopharyngeal cancer: phase III randomized Intergroup study 0099. J Clin Oncol. 1998; 16: 1310-1317 Crossref PubMed Google Scholar The differing views occur for two reasons: (1) early chemoradiotherapy trials in the 2000s investigated various platinum-based regimens of concurrent chemoradiotherapy alone or in combination with adjuvant chemotherapy, with both strategies showing survival benefits over radiotherapy alone; and (2) it was generally observed that platinum doublet adjuvant chemotherapy after concurrent chemoradiotherapy was poorly tolerated. 2 Chua MLK Wee JTS Hui EP Chan ATC Nasopharyngeal carcinoma. Lancet. 2016; 387: 1012-1024 Summary Full Text Full Text PDF PubMed Scopus (934) Google Scholar The resistance towards recommending adjuvant chemotherapy to patients in the clinic was compounded after a phase 3 trial in China showed that adjuvant cisplatin–fluorouracil chemotherapy did not significantly improve failure-free survival after concurrent chemoradiotherapy in locoregionally advanced nasopharyngeal carcinoma compared with concurrent chemoradiotherapy alone. 3 Chen L Hu CS Chen XZ et al. Concurrent chemoradiotherapy plus adjuvant chemotherapy versus concurrent chemoradiotherapy alone in patients with locoregionally advanced nasopharyngeal carcinoma: a phase 3 multicentre randomised controlled trial. Lancet Oncol. 2012; 13: 163-171 Summary Full Text Full Text PDF PubMed Scopus (432) Google Scholar Concurrent chemoradiotherapy followed by adjuvant cisplatin–gemcitabine versus cisplatin–fluorouracil chemotherapy for N2–3 nasopharyngeal carcinoma: a multicentre, open-label, randomised, controlled, phase 3 trialOur findings suggest that concurrent adjuvant cisplatin–gemcitabine could be used as an adjuvant therapy in the treatment of patients with N2–3 nasopharyngeal carcinoma, although long-term follow-up is required to confirm the optimal therapeutic ratio. Full-Text PDF

Predicting clinical outcomes in people with NAFLD: no need for a crystal ball?

A key challenge in the management of non-alcoholic fatty liver disease (NAFLD), one of the most common chronic liver diseases globally, is to identify people at highest risk of progression to advanced liver disease. 1 Younossi ZM Non-alcoholic fatty liver disease—a global public health perspective. J Hepatol. 2019; 70: 531-544 Summary Full Text Full Text PDF PubMed Scopus (1051) Google Scholar Early detection is crucial so that individuals who are at risk can be offered interventions and appropriate care before they develop liver-related complications. The most important predictor of progression to advanced liver disease and mortality in individuals with NAFLD is the extent of liver fibrosis. 2 Dulai PS Singh S Patel J et al. Increased risk of mortality by fibrosis stage in nonalcoholic fatty liver disease: systematic review and meta-analysis. Hepatology. 2017; 65: 1557-1565 Crossref PubMed Scopus (1050) Google Scholar Historically, liver biopsy was the only reliable method to assess liver fibrosis. However, it has a number of limitations (eg, cost, invasiveness, sampling bias, and intra-observer and inter-observer variability) and is not a suitable test for screening or monitoring liver disease progression. In clinical practice, non-invasive tests are increasingly used to provide prognostic information about liver disease severity. 3 Sanyal AJ Castéra L Wai-Sun Wong V Non-invasive assessment of liver fibrosis in NAFLD. Clin Gastroenterol Hepatol. 2023; (published online April 14.)https://doi.org/10.1016/j.cgh.2023.03.042 Summary Full Text Full Text PDF Google Scholar The individual participant data meta-analysis reported by Ferenc E Mózes and colleagues in The Lancet Gastroenterology & Hepatology4 Mózes FE Lee JA Vali Y et al. Performance of non-invasive tests and histology for the prediction of clinical outcomes in patients with non-alcoholic fatty liver disease: an individual participant data meta-analysis. Lancet Gastroenterol Hepatol. 2023; (published online June 5.)https://doi.org/10.1016/S2468-1253(23)00141-3 Google Scholar shows that non-invasive tests can also provide prognostic information about key clinical outcomes. 4 Mózes FE Lee JA Vali Y et al. Performance of non-invasive tests and histology for the prediction of clinical outcomes in patients with non-alcoholic fatty liver disease: an individual participant data meta-analysis. Lancet Gastroenterol Hepatol. 2023; (published online June 5.)https://doi.org/10.1016/S2468-1253(23)00141-3 Google Scholar Their analysis compared the performance of three non-invasive tests and liver biopsy in predicting a composite endpoint of all-cause mortality, hepatocellular carcinoma, liver transplantation, and cirrhosis complications in patients with NAFLD. Non-invasive tests were as good as liver biopsy as predictors of clinical outcomes after adjusting for potential confounders. Performance of non-invasive tests and histology for the prediction of clinical outcomes in patients with non-alcoholic fatty liver disease: an individual participant data meta-analysisSimple non-invasive tests performed as well as histologically assessed fibrosis in predicting clinical outcomes in patients with NAFLD and could be considered as alternatives to liver biopsy in some cases. Full-Text PDF Open Access

Combining next-generation hormonal therapy with PARP inhibition in metastatic castration-resistant prostate cancer

In a paradigm of precision oncology, elegant preclinical work showed that inhibition of poly(ADP-ribose) polymerase (PARP) proteins can exploit a deficiency of cancer cells to repair DNA double-strand breaks through homologous recombination repair (HRR), 1 Lord CJ Ashworth A PARP inhibitors: synthetic lethality in the clinic. Science. 2017; 355: 1152-1158 Crossref PubMed Scopus (1411) Google Scholar and the resulting synthetic lethality was first shown to be clinically effective in ovarian cancer carrying a germline deleterious mutation in BRCA1 or BRCA2, key HRR genes. 2 Banerjee S Moore KN Colombo N et al. Maintenance olaparib for patients with newly diagnosed advanced ovarian cancer and a BRCA mutation (SOLO1/GOG 3004): 5-year follow-up of a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Oncol. 2021; 22: 1721-1731 Summary Full Text Full Text PDF PubMed Scopus (92) Google Scholar For prostate cancer, the discovery of alterations in BRCA2 and other HRR-related genes in up to 20% of advanced disease 3 Robinson D Van Allen EM Wu YM et al. Integrative clinical genomics of advanced prostate cancer. Cell. 2015; 161: 1215-1228 Summary Full Text Full Text PDF PubMed Scopus (2077) Google Scholar led to the development of several biomarker-driven trials of PARP inhibitors in patients with metastatic castration-resistant prostate cancer (mCRPC) 4 Abida W Patnaik A Campbell D et al. Rucaparib in men with metastatic castration-resistant prostate cancer harboring a BRCA1 or BRCA2 gene alteration. J Clin Oncol. 2020; 38: 3763-3772 Crossref PubMed Scopus (309) Google Scholar , 5 de Bono JS Mehra N Scagliotti GV et al. Talazoparib monotherapy in metastatic castration-resistant prostate cancer with DNA repair alterations (TALAPRO-1): an open-label, phase 2 trial. Lancet Oncol. 2021; 22: 1250-1264 Summary Full Text Full Text PDF PubMed Scopus (79) Google Scholar , 6 Hussain M Mateo J Fizazi K et al. Survival with olaparib in metastatic castration-resistant prostate cancer. N Engl J Med. 2020; 383: 2345-2357 Crossref PubMed Scopus (289) Google Scholar , 7 Smith MR Scher HI Sandhu S et al. Niraparib in patients with metastatic castration-resistant prostate cancer and DNA repair gene defects (GALAHAD): a multicentre, open-label, phase 2 trial. Lancet Oncol. 2022; 23: 362-373 Summary Full Text Full Text PDF PubMed Scopus (41) Google Scholar and to the regulatory approval of rucaparib and olaparib as monotherapy for the treatment of mCRPC harbouring mutations in BRCA2 and other HRR genes. Talazoparib plus enzalutamide in men with first-line metastatic castration-resistant prostate cancer (TALAPRO-2): a randomised, placebo-controlled, phase 3 trialTalazoparib plus enzalutamide resulted in clinically meaningful and statistically significant improvement in rPFS versus standard of care enzalutamide as first-line treatment for patients with mCRPC. Final overall survival data and additional long-term safety follow-up will further clarify the clinical benefit of the treatment combination in patients with and without tumour HRR gene alterations. Full-Text PDF

Emerging paradigms in exploring the interactions among diet, probiotics, and cancer immunotherapeutic response

Emerging paradigms in exploring the interactions among diet, probiotics, and cancer immunotherapeutic response

PD-1 Overexpression in Sézary Syndrome Is Epigenetically Regulated

PD-1 Overexpression in Sézary Syndrome Is Epigenetically Regulated

Targeting of biomolecular condensates to the autophagy pathway.

Biomolecular condensates are membraneless compartments formed by liquid-liquid phase separation. They can phase transit into gel-like and solid states. The amount and state of biomolecular condensates must be tightly regulated to maintain normal cellular function. Autophagy targets biomolecular condensates to the lysosome for degradation or other purposes, which we term biocondensophagy. In biocondensophagy, autophagy receptors recognize biomolecular condensates and target them to the autophagosome, the vesicle carrier of autophagy. Multiple types of autophagy receptors have been identified and they are specifically involved in targeting biomolecular condensates with different phase transition states. The receptors also organize the phase transition of biomolecular condensate to facilitate biocondensophagy. Here, we briefly discuss the latest discoveries regarding how biomolecular condensates are recognized by autophagy receptors.

Retraction and republication: 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study

On Nov 24, 2022, The Lancet published an Expression of Concern1The Lancet EditorsExpression of concern: 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study.Lancet. 2022; 401: 90Summary Full Text Full Text PDF Scopus (1) Google Scholar about the Article 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study2Huang C Huang L Wang Y et al.6-month consequences of COVID-19 in patients discharged from hospital: a cohort study.Lancet. 2021; 397: 220-232Summary Full Text Full Text PDF PubMed Scopus (2236) Google Scholar by Chaolin Huang and colleagues, because of the substantive data correction request from the authors following comments from a reader, who was concerned about data and symptom questionnaire inconsistencies between this Article2Huang C Huang L Wang Y et al.6-month consequences of COVID-19 in patients discharged from hospital: a cohort study.Lancet. 2021; 397: 220-232Summary Full Text Full Text PDF PubMed Scopus (2236) Google Scholar and another Article, 1-year outcomes in hospital survivors with COVID-19: a longitudinal cohort study3Huang L Yao Q Gu X et al.1-year outcomes in hospital survivors with COVID-19: a longitudinal cohort study.Lancet. 2021; 398: 747-758Summary Full Text Full Text PDF PubMed Scopus (411) Google Scholar by Lixue Huang and colleagues. We commissioned a series of formal investigations into these alleged data inconsistencies. First, we invited a Chinese statistical reviewer and the former statistical reviewer who provided a review of the original version of the Article by Chaolin Huang and colleagues2Huang C Huang L Wang Y et al.6-month consequences of COVID-19 in patients discharged from hospital: a cohort study.Lancet. 2021; 397: 220-232Summary Full Text Full Text PDF PubMed Scopus (2236) Google Scholar to review the corrected data and the reasons for doing so. Both reviewers agreed that the changes were realistic and reasonable. Second, we contacted a clinical reviewer who saw both Articles on the 6-month2Huang C Huang L Wang Y et al.6-month consequences of COVID-19 in patients discharged from hospital: a cohort study.Lancet. 2021; 397: 220-232Summary Full Text Full Text PDF PubMed Scopus (2236) Google Scholar and the 12-month3Huang L Yao Q Gu X et al.1-year outcomes in hospital survivors with COVID-19: a longitudinal cohort study.Lancet. 2021; 398: 747-758Summary Full Text Full Text PDF PubMed Scopus (411) Google Scholar follow-up to assess whether the symptom questionnaires used in the 6-month and 1-year follow-up visits were different. The clinical reviewer confirmed the differences between the two questionnaires were minimal and did not preclude the comparison of the proportion of COVID-19 survivors with symptoms at 6 months and 12 months. The Chinese versions of the questionnaires have also been reviewed by all the China editors of The Lancet Group, who came to a similar conclusion. Third, we asked the China–Japan Friendship Hospital, the institute of the corresponding author of the Article,2Huang C Huang L Wang Y et al.6-month consequences of COVID-19 in patients discharged from hospital: a cohort study.Lancet. 2021; 397: 220-232Summary Full Text Full Text PDF PubMed Scopus (2236) Google Scholar to assess the validity of the corrected data; the hospital organised a data review committee to go through the data and confirmed the corrected data were valid. Given these results, we invited a resubmission with the corrected data, and organised formal peer review of the fully revised paper with the corrected data by all the previous clinical reviewers and the statistical reviewer. Following the retraction guidelines4Committee on Publication EthicsRetraction guidelines.https://publicationethics.org/retraction-guidelinesDate accessed: June 6, 2023Google Scholar of The Committee on Publication Ethics, we have decided to retract the original published version of the Article and publish a corrected version using the retraction and republication process recommended in cases where substantive changes are required. • View the republished version of the article RETRACTED: 6-month consequences of COVID-19 in patients discharged from hospital: a cohort studyAt 6 months after acute infection, COVID-19 survivors were mainly troubled with fatigue or muscle weakness, sleep difficulties, and anxiety or depression. Patients who were more severely ill during their hospital stay had more severe impaired pulmonary diffusion capacities and abnormal chest imaging manifestations, and are the main target population for intervention of long-term recovery. Full-Text PDF

Right axillopopliteal artery bypass using a combined transiliac and lateral popliteal approach for groin infection and lymph fistula.

Wound infection in the groin is a serious complication after vascular bypass surgery. The combined treatment of critical limb ischemia and recurrent infection presents challenges for vascular surgery(1Lounes Y. Ozdemir B. Alric P. Canaud L. Trans-iliac Bypass for Critical Limb Ischaemia with Groin Necrosis: A Case Report.EJVES Short Reports. 2019; 42: 31-33https://doi.org/10.1016/j.ejvssr.2019.01.002Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar, 2Multon S. Jayet J. Javerliat I. Coscas R. Coggia M. Aortic–tibial transiliac wing extra-anatomic bypass with distal fistula for treatment of an infected deep femoral pseudoaneurysm.J Vasc Surg Cases, Innov Tech. 2022; 8: 201https://doi.org/10.1016/j.jvscit.2022.02.008Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar, 3Engin C, Posacioglu H, Ayik F, Apaydin A . Management of vascular infection in the groin. Texas Hear Inst J (2005) 32:529–534.Google Scholar). In this case, we successfully managed the wound infection in the groin after axillofemoral artery bypass grafting, using a combination of trans-iliac bypass and lateral popliteal approach(4Enzmann F.K. Nierlich P. Eder S. Aspalter M. Dabernig W. Aschacher T. et al.Trans-Iliac Bypass Grafting for Vascular Groin Complications.Eur J Vasc Endovasc Surg. 2019; 58: 930-935https://doi.org/10.1016/j.ejvs.2018.11.003Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar, 5Benzing C. Fellmer P. Lateral Approach to the Distal Femoral Artery in Femoro-Anterior-Tibial Bypass Surgery.Eur J Vasc Endovasc Surg. 2016; 52: 267https://doi.org/10.1016/j.ejvs.2016.04.024Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar). A 74-year-old man, having Buerger's disease and arteriosclerosis obliterans, presented with extensive lymphatic fistula and necrosis of the groin (Fig.1) after right axillary artery to the right deep femoral artery bypass, which had been patented for last five years after the several revascularizations of iliac arteries and femoral arteries. Due to the several open surgeries, such as aorto-right external iliac artery bypass, aorto-left popliteal artery bypass, cholecystectomy and resection of gastric cancer, we chose right axillopopliteal artery bypass grafting, through the iliac wing. The skin incision was made along the iliac crest and the external oblique muscle fascia was separated to reach the pelvis, and a longitudinal incision was made anterosuperior to the greater trochanter to create a gluteal pathway to bypass the infected groin. 10-mm hole was made by shaving the bone about 4 cm from the iliac crest, and the graft was passed through the hole. (Fig 2). A lateral popliteal approach was selected for revascularization owing to extensive groin and medial thigh infective wounds. After that the extensive lymphatic fistula and necrosis were controlled with using negative pressure wound therapy.Figure 2View Large Image Figure ViewerDownload Hi-res image Download (PPT) The postoperative course was uneventful, and contrast-enhanced computed tomography confirmed proper arrangement of the graft, without bending (Fig 3 and Fig 4). He was discharged from the hospital on the 14th postoperative day. The computed tomography which was taken one year later showed the patency of this graft. The combination of trans - iliac bypass and lateral popliteal approach was shown to be effective in this case of extensive groin and medial compartment infection, and can potentially be applied in similar future cases.Figure 4View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Man With Chest Pain After a Traffic Crash.

A 40-year-old man had been involved in a scooter crash and presented to the emergency department with chest pain. His vital signs were blood pressure, 160/84 mmHg; pulse, 109 beats/min; respiratory rate 24 breaths/min, and temperature, 37.5 °C. Physical examination revealed severe local tenderness in the mid-chest region. Plain radiography (Figure 1) and point-of-care ultrasonography of the chest (Figure 2 and Video 1) were performed, and the diagnosis was confirmed by contrast-enhanced computed tomography.Figure 2The point-of-care ultrasound at the site of pain showed a breach in the anterior cortex of the sternal body (arrowhead) and a mass with mixed echogenicity around the fracture indicating hematoma (asterisk).View Large Image Figure ViewerDownload Hi-res image Download (PPT) Sternum fracture. Plain radiography revealed a suspicious mild depression fracture of the sternum. Point-of-care ultrasound imaging, using a high-frequency linear transducer at the site of pain, showed a discontinuous outline of the sternum. A chest computed tomography (Figure 3) image was obtained for confirmation of the diagnosis and to detect possible concomitant associate injuries, such as great vessel disruption, cardiac contusion, and pulmonary contusion. Sternum fracture is characterized by chest pain, which worsens with deep inspiration and shortness of breath. Motor vehicle crashes are the leading cause of sternum fracture, typically due to hitting the steering wheel without an airbag.1Oyetunji T.A. Jackson H.T. Obirieze A.C. et al.Associated injuries in traumatic sternal fractures: a review of the National Trauma Data Bank.Am Surg. 2013; 79: 702-705Crossref PubMed Google Scholar,2Knobloch K. Wagner S. Haasper C. et al.Sternal fractures occur most often in old cars to seat-belted drivers without any airbag often with concomitant spinal injuries: clinical findings and technical collision variables among 42,055 crash victims.Ann Thorac Surg. 2006; 82: 444-450Abstract Full Text Full Text PDF PubMed Scopus (55) Google Scholar Conventional chest radiography has variable diagnosis accuracy, and most sternal fractures may be missed by chest radiography alone.3Perez M.R. Rodriguez R.M. Baumann B.M. et al.Sternal fracture in the age of pan-scan.Injury. 2015; 46: 1324-1327Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar The point-of-care ultrasound can be considered a useful technique in identifying sternum fractures.4You J.S. Chung Y.E. Kim D. et al.Role of sonography in the emergency room to diagnose sternal fractures.J Clin Ultrasound. 2010; 38: 135-137PubMed Google Scholar https://www.annemergmed.com/cms/asset/9b3c776c-e7a2-4271-9e98-27acc23ff9ab/mmc1.mp4Loading ... Download .mp4 (3.14 MB) Help with .mp4 files Video 1The point-of-care ultrasound at the site of pain showed a breach in the anterior cortex of the sternal body (arrowhead) and a mass with a mixed echogenicity around the fracture indicating hematoma (asterisk).

PTEN potentiation of oncolytic HSV therapy for glioblastoma

PTEN potentiation of oncolytic HSV therapy for glioblastoma

Tubarial Salivary Gland – The New Member of Nasopharynx

Tubarial Salivary Gland – The New Member of Nasopharynx

Erythema Ab Igne Associated With Cannabinoid Hyperemesis Syndrome

A woman in her early 50s presented with a chronic rash and abdominal pain. The patient’s pain was relieved by prolonged hot showers. When the patient’s hot water ran out, she found that using a heating pad provided more sustained relief. She subsequently cut off the cover of heating pads to augment the temperature and used this continuously on her abdomen throughout the day. The patient smoked cannabis for 38 years but noticed stomach pain with the introduction of medicinal marijuana within the past 2 years. Physical examination demonstrated reticulated, hyperpigmented, and erythematous patches with desquamative scaling (Figure). A punch biopsy revealed a subepidermal blister with epidermal atrophy and dermal melanophages. Results of direct immunofluorescence were negative, confirming the diagnosis of bullous erythema ab igne. Erythema ab igne is a cutaneous disorder caused by chronic exposure to heat. Typical sources include space heaters, fireplaces, heating pads, and heating blankets. Rarely, squamous cell carcinoma can result. The treatment of choice is discontinuation of the heat source. Cannabinoid hyperemesis syndrome (CHS) is an increasingly reported disorder manifested by cyclical nausea, vomiting, or abdominal pain that is relieved by prolonged and extreme heat.1Chang Y.H. Windish D.M. Cannabinoid hyperemesis relieved by compulsive bathing.Mayo Clin Proc. 2009; 84: 76-78https://doi.org/10.1016/S0025-6196(11)60811-2Abstract Full Text Full Text PDF PubMed Scopus (96) Google Scholar Abstinence from the use of cannabis is the only known therapy to definitively treat the syndrome.2Simonetto D.A. Oxentenko A.S. Herman M.L. Szostek J.H. Cannabinoid hyperemesis: a case series of 98 patients.Mayo Clin Proc. 2012; 87: 114-119https://doi.org/10.1016/j.mayocp.2011.10.005Abstract Full Text Full Text PDF PubMed Scopus (247) Google Scholar In addition to heat, capsaicin topical cream has been used to alleviate abdominal pain. Haloperidol and droperidol may be used for nausea and vomiting symptoms.3Razban M. Exadaktylos A.K. Santa V.D. Heymann E.P. Cannabinoid hyperemesis syndrome and cannabis withdrawal syndrome: a review of the management of cannabis-related syndrome in the emergency department.Int J Emery Med. 2022; 15: 45https://doi.org/10.1186/s12245-022-00446-0Crossref Scopus (0) Google Scholar Use of cannabis (also referred to as marijuana, weed, or pot) among all age groups is rapidly rising. Duration and quantity of cannabis used are risk factors for CHS. The introduction of high-potency cannabis, with increased levels of tetrahydrocannabinol, might also be responsible for increased addiction and the emergence of CHS. The World Health Organization4World Health Organizationwww.who.int/teams/mental-health-and-substance-use/alcohol-drugs-and-addictive-behaviours/drugs-psychoactive/cannabisDate accessed: December 10, 2022Google Scholar and the Centers for Disease Control and Prevention5Centers for Disease Control and Preventionwww.cdc.gov/marijuana/health-effects/ index.htmlDate accessed: December 10, 2022Google Scholar do not specifically list CHS as an acute or chronic health effect of cannabis use. Many physicians are also unsuspecting of this syndrome. Physicians should be aware that abdominal erythema ab igne could be a dermatologic clue to CHS. Our patient was referred to an addiction specialist and directed to use capsaicin 0.1% cream to the abdomen 3 to 4 times daily. The authors report no competing interests.

Live-attenuated Chikungunya vaccine: a possible new era

Chikungunya virus is a mosquito-borne pathogen that causes periodic explosive outbreaks of chikungunya, an illness characterised by severe polyarthralgia and myalgia that can progress to chronic debilitating rheumatic disease. 1 Bartholomeeusen K Daniel M LaBeaud DA et al. Chikungunya fever. Nat Rev Dis Primers. 2023; 9: 17 Crossref PubMed Scopus (0) Google Scholar The pandemic potential of chikungunya virus was best exemplified in 2013, when a major outbreak in South America led to over 1 million infections in a matter of months. 2 Zeller H Van Bortel W Sudre B Chikungunya: its history in Africa and Asia and its spread to new regions in 2013–2014. J Infect Dis. 2016; 214: S436-S440 Crossref PubMed Scopus (22) Google Scholar The pooled incidence of post-chikungunya chronic articular symptoms in the Americas was 52% in studies done between 2014 and 2018, 3 Edington F Varjão D Melo P Incidence of articular pain and arthritis after chikungunya fever in the Americas: a systematic review of the literature and meta-analysis. Joint Bone Spine. 2018; 85: 669-678 Crossref PubMed Scopus (19) Google Scholar leading to the loss of over 150 000 disability-adjusted life-years in Latin America in 2014 alone. 4 Cardona-Ospina JA Diaz-Quijano FA Rodríguez-Morales AJ Burden of chikungunya in Latin American countries: estimates of disability-adjusted life-years (DALY) lost in the 2014 epidemic. Int J Infect Dis. 2015; 38: 60-61 Summary Full Text Full Text PDF PubMed Scopus (27) Google Scholar In 2018, chikungunya virus was listed as a priority pathogen for vaccine development by WHO, 5 Mehand MS Al-Shorbaji F Millett P Murgue B The WHO R&D blueprint: 2018 review of emerging infectious diseases requiring urgent research and development efforts. Antiviral Res. 2018; 159: 63-67 Crossref PubMed Scopus (171) Google Scholar and candidate vaccines have been in various stages of clinical trials for over 60 years. However, no chikungunya virus vaccine has yet met the threshold for regulatory approval based on efficacy or surrogate marker data. Safety and immunogenicity of a single-shot live-attenuated chikungunya vaccine: a double-blind, multicentre, randomised, placebo-controlled, phase 3 trialThe strong immune response and the generation of seroprotective titres in almost all vaccinated participants suggests that VLA1553 is an excellent candidate for the prevention of disease caused by chikungunya virus. Full-Text PDF Open Access

Health outcomes of the G7 Hiroshima Summit: breaking the cycle of panic and neglect and achieving UHC

Health outcomes of the G7 Hiroshima Summit: breaking the cycle of panic and neglect and achieving UHC

Dalpiciclib in advanced breast cancer.

Hormone receptor-positive, HER2-negative advanced breast cancer is largely not curable. Anti-oestrogen agents improve the prognosis of patients with hormone receptor-positive, HER2-negative advanced breast cancer, but resistance eventually occurs. Targeting cyclin-dependent kinase 4 (CDK4) and CDK6 increases endocrine therapy efficacy, leading to the approval of CDK4/6 inhibitors palbociclib, ribociclib, and abemaciclib in the this treatment setting. 1 Spring LM Wander SA Andre F et al. Cyclin-dependent kinase 4 and 6 inhibitors for hormone receptor-positive breast cancer: past, present, and future. Lancet. 2020; 395: 817-827 Summary Full Text Full Text PDF PubMed Scopus (180) Google Scholar Dalpiciclib plus letrozole or anastrozole versus placebo plus letrozole or anastrozole as first-line treatment in patients with hormone receptor-positive, HER2-negative advanced breast cancer (DAWNA-2): a multicentre, randomised, double-blind, placebo-controlled, phase 3 trialOur findings suggest that dalpiciclib plus letrozole or anastrozole could be a novel standard first-line treatment for patients with hormone receptor-positive, HER2-negative advanced breast cancer, and is an alternative option to the current treatment landscape. Full-Text PDF

Transcarotid artery revascularization for the management of blunt cerebrovascular injuries-is it a game changer?

In their 10 patient case series, Walker et al, describe excellent outcomes from the use of transcarotid artery revascularization (TCAR) for the treatment of patients with severe blunt cerebrovascular injuries (BCVI).1Dr. Patrick Walker et al. Transcarotid Artery Revascularization in Blunt Carotid Injury. J Vasc Surg Cases Innov Tech. 20XX, 1(1), XX-XX. doi: XXXX.Google Scholar. For a single center over only 2 years this is a large cohort for a relatively rare problem. It is important to note that the primary treatment for BCVI is antithrombotic therapy with antiplatelets and/or anticoagulation. It has been shown that transfemoral carotid artery stenting for BCVI is rarely necessary or beneficial over antithrombotic therapy and the EAST guidelines recommend against routine stenting of grade II or III BCVI.(2)Burlew C.C. Biffl W.L. Moore E.E. Pieracci F.M. Beauchamp K.M. Stovall R. Wagenaar A.E. Jurkovich G.J. Endovascular stenting is rarely necessary for the management of blunt cerebrovascular injuries.J Am Coll Surg. 2014; 218: 1012-1017https://doi.org/10.1016/j.jamcollsurg.2014.01.042Crossref PubMed Scopus (45) Google Scholar,(3)Kim D.Y. Biffl W. Bokhari F. Brakenridge S. Chao E. Claridge J.A. Fraser D. Jawa R. Kasotakis G. Kerwin A. et al.Evaluation and management of blunt cerebrovascular injury: A practice management guideline from the Eastern Association for the Surgery of Trauma.J Trauma Acute Care Surg. 2020; 88: 875-887https://doi.org/10.1097/TA.0000000000002668Crossref PubMed Scopus (32) Google Scholar The Denver group found an alarmingly high 45% occlusion rate in patients treated with stenting vs. only 5% in those treated with antithrombotic therapy and concluded that stenting for BCVI had an unacceptable risk profile.(4)Cothren C.C. Moore E.E. Ray C.E. Ciesla D.J. Johnson J.L. Moore J.B. Burch J.M. Carotid artery stents for blunt cerebrovascular injury: risks exceed benefits.Arch Surg. 2005; 140 (; discussion 485-486): 480-485https://doi.org/10.1001/archsurg.140.5.480Crossref PubMed Scopus (111) Google Scholar It seems clear that stenting is rarely indicated for BCVI and this is consistent with the experience of the Maryland Shock Trauma study, as the authors point out that their center diagnoses approximately 300 carotid BCVIs per year, of which only 2-3% were selected for TCAR. It's possible that TCAR may be associated with a lower stroke and complication rate in BCVI patients in a similar manner to its benefits for carotid occlusive disease. Namely, by the use of dynamic flow reversal, which was found by Naazie, et al. in their Vascular Quality Initiative study to be the primary mechanism for stroke protection in TCAR.(5)Naazie I.N. Magee G.A. Mathlouthi A. Elsayed N. Dakour-Aridi H. Malas M.B. Primary mechanism of stroke reduction in transcarotid artery revascularization is dynamic flow reversal.J Vasc Surg. 2021; 74: 187-194https://doi.org/10.1016/j.jvs.2020.10.082Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar Although the focus of this series is on the novel use of TCAR in the setting of BCVI requiring stenting, the authors describe another innovation, which is the use of Supera stents (Abbott, Plymouth, MN). The authors state that they prefer Supera stents for this application because of its flexibility and length, as they often stent up to the skull base to treat the entirety of the injury. At first glance, this seems to be an usual choice, but their results suggest that the authors may be on to something. Further study is necessary to determine if TCAR is a gamechanger for the management of BCVI and which of these two innovations is the primary reason for improved outcomes. Transcarotid Artery Revascularization in Blunt Carotid InjuryJournal of Vascular Surgery Cases, Innovations and TechniquesPreviewTranscarotid artery revascularization (TCAR) with flow reversal has substantially changed the management of carotid artery stenosis, enabling an endovascular approach with a periprocedural stroke rate as low or lower than that of open carotid surgery. The use of TCAR in blunt carotid injury has not yet been described. Full-Text PDF Open Access

Response

My colleagues and I thank Professor Chiang1Chiang H.-C. The risk of using antiplatelet and/or anticoagulant treatment for hemorrhagic adverse events during EUS-guided biliary drainage.Gastrointest Endosc. 2023; 97: 1170Abstract Full Text Full Text PDF Google Scholar for his constructive comments regarding our article “Antiplatelet and/or anticoagulant treatment dose not increase hemorrhagic adverse events during EUS-guided biliary drainage,”2Ogura T. Nishioka N. Ueno S. et al.Antiplatelet and/or anticoagulant treatment does not increase hemorrhagic adverse events during EUS-guided biliary drainage.Gastrointest Endosc. 2020; 92: 659-666Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar and we welcome the opportunity to respond. As Professor Chiang mentioned, the sample size was small because bleeding itself was not frequently observed; however, the number of patients who underwent EUS-BD was relatively large. This fact may reflect that bleeding events themselves may be rare. We mentioned this limitation in the text, and we also stated that our results should be evaluated in a large patient cohort. According to Chiang’s analysis, resuming anticoagulant/antiplatelet (AC/AP) may be a risk factor for bleeding.1Chiang H.-C. The risk of using antiplatelet and/or anticoagulant treatment for hemorrhagic adverse events during EUS-guided biliary drainage.Gastrointest Endosc. 2023; 97: 1170Abstract Full Text Full Text PDF Google Scholar However, as we mentioned in the text, the patients’ backgrounds were various; also, other data associated with bleeding were not presented because of the retrospective nature of the study. However, in our study, visible bleeding was observed in only 1 patient who did not receive AC/AP treatment. In clinical practice, a fall in hemoglobin does not matter so much. In addition, a covered self-expandable metal stent was deployed during EUS-BD; therefore, a compression effect was obtained if bleeding occurred as an adverse event. Moreover, according to another recent study,3Okuno N. Hara K. Mizuno N. et al.Outcomes of endoscopic ultrasound-guided biliary drainage in patients undergoing antithrombotic therapy.Clin Endosc. 2021; 54: 596-602Crossref PubMed Scopus (4) Google Scholar EUS-BD can be performed in patients who have undergone AC/AP treatment. Although further study is needed, as Chiang1Chiang H.-C. The risk of using antiplatelet and/or anticoagulant treatment for hemorrhagic adverse events during EUS-guided biliary drainage.Gastrointest Endosc. 2023; 97: 1170Abstract Full Text Full Text PDF Google Scholar points out, we think that EUS-BD can be performed safely. Once again, we would like to thank Professor Chiang for these valuable comments. The author disclosed no financial relationships.

Man With Neck Swelling.

A 53-year-old man with a medical history of hypertension and end-stage renal disease presented to the emergency department with 2 weeks of swelling masses on the right side of the neck. In addition, he experienced a low-grade fever, general malaise, and decreased appetite without weight loss. Physical examination showed multiple enlarged and firm lymph nodes on the neck bilaterally. Laboratory studies revealed a white blood cell count of 14,570 μL and an elevated C-reactive protein concentration of 75 mg/L. Point-of-care ultrasound (Figure 1) and computed tomography (CT) (Figure 2) were performed.Figure 2Computed tomography showing multiple enlarged lymph nodes with central necrosis and peripheral rim enhancement (circles). Left panel, coronal view. Right panel, sagittal view.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Cervical tuberculous lymphadenitis (scrofula). The patient underwent an excisional biopsy of the neck masses, the smear of which showed acid-fast bacilli. The polymerase chain reaction and tuberculosis culture of the specimens were positive for Mycobacterium tuberculosis. The chest radiograph was expected, and the serological testing for HIV was nonreactive. He was initiated on a first-line antituberculosis regimen. Scrofula, known as the “king’s evil” in Europe, was thought to be cured by the royal touch until the 18th century.1Grzybowski S. Allen E.A. History and importance of scrofula.Lancet. 1995; 346: 1472-1474Abstract PubMed Google Scholar Cervical lymphadenitis is the most common form of extrapulmonary tuberculosis. The clinical features are chronic, swollen, and nontender cervical nodes that may fluctuate with fistula formation.2Khalid S.K. Jassim O. Images in clinical medicine. Scrofula.N Engl J Med. 2006; 354: e18Crossref Scopus (0) Google Scholar,3Sharawat I.K. Dawman L. Scrofula.J Pediatr. 2017; 189: 236Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar Ultrasonography is a useful imaging tool in the evaluation of cervical masses, and tuberculous nodes tend to be hypoechoic, round, and without echogenic hilus.4Ahuja A.T. Ying M. Sonographic evaluation of cervical lymph nodes.AJR Am J Roentgenol. 2005; 184: 1691-1699Crossref PubMed Scopus (211) Google Scholar The CT findings of scrofula are multiple low-attenuation lymph nodes with thick and irregular rims of peripheral enhancement.5Hanson R.A. Thoongsuwan N. Scrofula.Curr Probl Diagn Radiol. 2002; 31: 227-229Crossref PubMed Scopus (2) Google Scholar