Mccabebeier8360

513-8.643, pc less then 0.0001), and HLA-DRB1*03 (51.2% vs 27.6%, OR 2.75, 95% CI, 1.495-5.042, pc = 0.0199) compared with controls. CONCLUSIONS The present study demonstrates differences in the immunogenetic background of MOGAD and AQP4-IgG-positive NMOSD. The strong positive association with HLA-A*01, -B*08, and -DRB1*03 is suggestive of a role of this haplotype in the etiology of AQP4-IgG-positive NMOSD in patients with European ancestry, whereas in MOGAD no evidence was found for any HLA association in these disorders. Copyright © 2020 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.A 49-year-old man presented to the nearest emergency department profoundly septic with significantly raised inflammatory markers. He had a background of floor of mouth invasive squamous cell carcinoma for which he underwent complex head and neck surgery followed by adjuvant radiotherapy and insertion of a percutaneous gastrostomy tube for feeding. He experienced 3 weeks of retching, cough and malaise. Imaging revealed both an oesophageal perforation and perforated duodenal ulcer, presumed secondary to oesophageal stricturing from his prior surgery and radiotherapy. © BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.Serous pancreatic cystadenomas are benign tumours and most cases are detected incidentally. Complications are unusual. A patient with a history of a large pancreatic serous cystadenoma (SCA) presented to the emergency department with abdominal pain and haemodynamic shock. After haemodynamic stabilisation, an urgent abdominal CT scan revealed a large hemoperitoneum but the origin of the bleeding was not found. learn more The patient was submitted to an angiography that revealed a bleeding hypervascular pancreatic mass and an embolisation was done successfully. After 3 weeks, the patient underwent a laparotomic left pancreatectomy with en bloc splenectomy. The anatomopathological results were consistent with a microcystic SCA of the pancreas. Despite the high vascularity of pancreatic SCA, haemorrhage is a very rare but life-threatening complication. © BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.This case study reports on the use of intradialytic parenteral nutrition (IDPN) to address severe malnutrition in a 38-year-old woman, redo double lung transplant recipient with a complex medical history including cystic fibrosis and end-stage renal disease (ESRD) on haemodialysis. Gastroparesis and severe postprandial abdominal pain limited oral/enteral nutrition input. The addition of IDPN resulted in a dry weight increase of 13.6% over a 12-month period and an improvement in the patient's malnutrition status from severe (Patient-Generated Subjective Global Assessment (PG SGA) C24) to moderate (PG SGA B7). The patient stated she would recommend IDPN to others in a similar situation. Management of patients with coexisting cystic fibrosis and ESRD with or without haemodialysis requires patient engagement in treatment planning and a multidisciplinary team approach for clinical judgement in the absence of guidelines. As advances in medical care see more patients with these coexisting conditions, IDPN may provide an increasingly useful adjunct therapy. © BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.A 19-year-old girl presented to the rheumatology clinic for left knee monoarthritis for the past 4 months. She also had constitutional symptoms with significant weight loss. On physical examination, she appeared cachexic, her left knee was swollen and tender. MRI of the left knee showed a soft tissue swelling extending into the knee joint. Left knee synovial fluid showed small round cells. Histopathology results were compatible with Ewing's sarcoma. Due to the delay in seeking medical advice, she succumbed to the disease 1 week after the diagnosis was made. Soft tissue/bone tumour causes monoarthritis is not common. A careful history taking, physical examination and investigations should be done in order to identify a sinister cause of monoarthritis such as Ewing's sarcoma. Early treatment should be initiated to ensure a better outcome. © BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.Brucellosis is one of the most frequent zoonotic infections. Cardiac involvement is rare and when involved, affects aortic valve the most. The appearance of a new murmur on clinical examination during sepsis should suspect seeding on valves. Our patient had pulmonary valve endocarditis secondary to brucellosis which was managed with pharmacotherapy as there was no valvular pathology. Triple therapy is standard of care and usually given for months, non-response to pharmacological treatment warrants surgical intervention. Our patient completed the triple-drug regimen at 3 months and is asymptomatic at present. © BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.Several immunotherapy approaches that mobilize CD8+ T cell responses stimulate tumor rejection, and some, such as checkpoint blockade, have been approved for several cancer indications and show impressive increases in patient survival. However, tumors may evade CD8+ T cell recognition via loss of MHC molecules or because they contain few or no neoantigens. Therefore, approaches are needed to combat CD8+ T cell-resistant cancers. STING-activating cyclic dinucleotides (CDNs) are a new class of immune-stimulating agents that elicit impressive CD8+ T cell-mediated tumor rejection in preclinical tumor models and are now being tested in clinical trials. Here, we demonstrate powerful CDN-induced, natural killer (NK) cell-mediated tumor rejection in numerous tumor models, independent of CD8+ T cells. CDNs enhanced NK cell activation, cytotoxicity, and antitumor effects in part by inducing type I interferon (IFN). IFN acted in part directly on NK cells in vivo and in part indirectly via the induction of IL-15 and IL-15 receptors, which were important for CDN-induced NK activation and tumor control.