Evaluation of early and late presentation of patients with ocular mucous membrane pemphigoid to two major tertiary referral hospitals in the United Kingdom

PURPOSE: Ocular mucous membrane pemphigoid (OcMMP) is a sight-threatening autoimmune disease in which referral to specialists units for further management is a common practise. This study aims to describe referral patterns, disease phenotype and management strategies in patients who present with either early or established disease to two large tertiary care hospitals in the United Kingdom.\ud \ud PATIENTS AND METHODS: In all, 54 consecutive patients with a documented history of OcMMP were followed for 24 months. Two groups were defined: (i) early-onset disease (EOD:<3 years, n=26, 51 eyes) and (ii) established disease (EstD:>5 years, n=24, 48 eyes). Data were captured at first clinic visit, and at 12 and 24 months follow-up. Information regarding duration, activity and stage of disease, visual acuity (VA), therapeutic strategies and clinical outcome were analysed.\ud \ud RESULTS: Patients with EOD were younger and had more severe conjunctival inflammation (76% of inflamed eyes) than the EstD group, who had poorer VA (26.7%=VA<3/60, P<0.01) and more advanced disease. Although 40% of patients were on existing immunosuppression, 48% required initiation or switch to more potent immunotherapy. In all, 28% (14) were referred back to the originating hospitals for continued care. Although inflammation had resolved in 78% (60/77) at 12 months, persistence of inflammation and progression did not differ between the two phenotypes. Importantly, 42% demonstrated disease progression in the absence of clinically detectable inflammation.\ud \ud CONCLUSIONS: These data highlight that irrespective of OcMMP phenotype, initiation or escalation of potent immunosuppression is required at tertiary hospitals. Moreover, the conjunctival scarring progresses even when the eye remains clinically quiescent. Early referral to tertiary centres is recommended to optimise immunosuppression and limit long-term ocular damage.\ud \u

Endoscopic Submucosal Tunnel Dissection as a Novel Therapeutic Technique in Patients With Barrett’s Esophagus

© 2020 American Federation for Medical Research. With the ameliorated resectability prowess of endoscopic techniques, a myriad of diseases previously treated by major ablative surgeries are now endoscopically curable. Endoscopic submucosal tunnel dissection (ESTD) is a relatively new technique that has diversified endoscopic application. Although ESTD has frequently been used for the resection of esophageal neoplastic lesions, the clinical evidence pertaining to its efficacy in the treatment of circumferential Barrett’s esophagus remains sparse. In this study, we evaluated ESTD as a potential therapeutic technique in patients with Barrett’s esophagus-related high-grade dysplasia. The tunneling strategy helped achieve complete en bloc resection at an increased dissection speed, without any procedural complications. This article illustrates that ESTD can be a feasible, safe, and effective treatment for dysplastic Barrett’s esophagus. Future research should aim to stratify the potential risks and complications associated with this optimization of endoscopic submucosal dissection in patients with superficial esophageal lesions

Implementing a Unification Algorithm for Protocol Analysis with XOR

In this paper, we propose a unification algorithm for the theory $E$ which combines unification algorithms for E\_{\std} and E\_{\ACUN} (ACUN properties, like XOR) but compared to the more general combination methods uses specific properties of the equational theories for further optimizations. Our optimizations drastically reduce the number of non-deterministic choices, in particular those for variable identification and linear orderings. This is important for reducing both the runtime of the unification algorithm and the number of unifiers in the complete set of unifiers. We emphasize that obtaining a ``small'' set of unifiers is essential for the efficiency of the constraint solving procedure within which the unification algorithm is used. The method is implemented in the CL-Atse tool for security protocol analysis

How to prevent type-flaw attacks on security protocols under algebraic properties

Type-flaw attacks upon security protocols wherein agents are led to misinterpret message types have been reported frequently in the literature. Preventing them is crucial for protocol security and verification. Heather et al. proved that tagging every message field with it's type prevents all type-flaw attacks under a free message algebra and perfect encryption system. In this paper, we prove that type-flaw attacks can be prevented with the same technique even under the ACUN algebraic properties of XOR which is commonly used in "real-world" protocols such as SSL 3.0. Our proof method is general and can be easily extended to other monoidal operators that possess properties such as Inverse and Idempotence as well. We also discuss how tagging could be used to prevent type-flaw attacks under other properties such as associativity of pairing, commutative encryption, prefix property and homomorphic encryption.Comment: 16 pages, Appeared in proceedings of Security with Rewriting Techniques (SecRet09), Affiliated to CSF Symposium 2009, Port Jefferson, NY