Anti-neutrophil cytoplasmic antibodies negative eosinophilic granulomatous polyangiitis glomerulonephritis in children - A diagnostic dilemma

Anti-neutrophil cytoplasmic antibodies (ANCA) associated vasculitis (AAV) refers to small-to-medium vessel vasculitis with multisystemic involvement and is characterized by the presence of ANCA to specifically either proteinase-3 (PR3) or myeloperoxidase (MPO). Eosinophilic granulomatous polyangiitis earlier called as Churg-Strauss vasculitis is a clinicopathological variant of AAV or AAV with granulomatous necrotizing small vessel vasculitis primarily affecting individuals with severe asthma or allergies and rarely reported in the pediatric population. We report a 9-year-old child with pauci-immune crescentic eosinophilic granulomatousglomerulonephritis with heavy eosinophilic infiltration of skin and subcutaneous tissue and negative ANCA. Although he had a recurrent history of cough, there was no history of use of oral or inhalational bronchodilator therapy indicating asthma and no history suggestive history of allergy. He showed significant and rapid clinical as well as biochemical improvement on aggressive immunosuppressive therapy along with plasma exchanges and is under regular follow-up. Diagnosing Eosinophilic granulomatous Polyangiitis glomerulonephritis in children is difficult due to a varied clinical presentation at onset which may evolve over a period of time and due to lack of specific diagnostic tests. High index of suspicion is the key to early diagnosis and successful management

Successful pregnancy outcome in a case of Swyer Syndrome with hypertension and morbid obesity

To report a case of Swyer syndrome with hypertension and morbid obesity with successful pregnancy and live birth after assisted reproductive technology. 27 year old morbidly obese female with essential hypertension who had been on HRT for 10 years with well-developed secondary sexual characters with primary infertility. After adequate development of the uterus and the endometrial preparation, Patients with Swyer syndrome conceive with oocyte donation and ICSI. Caesarean section rate is high due to multiple pregnancies and other obstetric complications. Early detection of these cases would help in timely development of their secondary sexual characters and restoration of menses and gonadectomy for prevention of malignancy as its propensity is high. Multidisciplinary approach is required including counseling and management of long term health problems. Pregnancy is feasible but caesarean rate is high

Optimism as a Prior Belief about the Probability of Future Reward

Optimists hold positive a priori beliefs about the future. In Bayesian statistical theory, a priori beliefs can be overcome by experience. However, optimistic beliefs can at times appear surprisingly resistant to evidence, suggesting that optimism might also influence how new information is selected and learned. Here, we use a novel Pavlovian conditioning task, embedded in a normative framework, to directly assess how trait optimism, as classically measured using self-report questionnaires, influences choices between visual targets, by learning about their association with reward progresses. We find that trait optimism relates to an a priori belief about the likelihood of rewards, but not losses, in our task. Critically, this positive belief behaves like a probabilistic prior, i.e. its influence reduces with increasing experience. Contrary to findings in the literature related to unrealistic optimism and self-beliefs, it does not appear to influence the iterative learning process directly

The third international hackathon for applying insights into large-scale genomic composition to use cases in a wide range of organisms

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Expression of p53 and bcl2 in squamous cell carcinoma of head and neck

Background: Head and neck squamous cell carcinoma (HNSCC) is the sixth-most common malignancy worldwide. Despite advances in radiotherapy and surgical treatment, survival rates have not changed significantly in the last 40 years. Molecular markers are currently being identified that can determine prognosis preoperatively by routine tumor biopsy, lead- ing to improved management of HNSCC patients. Aim: The aim of the present study was to demonstrate the expression of p53 and bcl2 proteins in squamous cell carcinoma of head and neck (HNSCC) and to correlate the expression of p53 and bcl2 with clinical staging (AJCC) and WHO histological grading of SCC. Materials and methods: The study population comprised 50 cases of HNSCC. Tissue sections from these cases were subjected to hematoxylin and eosin (H and E) and immunohistochemical (IHC) staining using p53 and bcl2, and a comparative analysis of the results was performed. Cases of colon carcinoma and benign lymphoid hyperplasia were used as positive controls for p53 and bcl2, respectively. Results: Positivity for p53 was recorded in 30 cases (30/50), while positivity for bcl2 was recorded in 44 cases (44/50). Positivity for p53+/bcl2+ coexpression was seen in 28 cases (28/50). The frequency of p53 expression was associated with tumor histologic grade (p=0.02), increasing lymph node involvement (p=0.01), and clinical stage (p=0.038). The frequency of bcl2 expression was associated with histological grade (p=0.02) and increasing lymph node involvement (p=0.028), but not with clinical stage (p=0.242). Moreover, the combined p53+/bcl2+ expression was significantly associated with histo- logical grade (p=0.02) and lymph node involvement (p=0.01). Conclusion: Study of p53 and bcl2 expression may provide clinicians with more exact information in order to evaluate tumor aggressiveness and survival rates. [Arch Clin Exp Surg 2016; 5(3.000): 160-168

Best-fitting parameters for the Bayesian model summarized per experiment and averaged for the entire group of subjects and per subgroup (optimists and pessimists).

<p>Each column presents the mean value, with the standard deviation between brackets. Significance of the differences is shown on the right of the table: an asterisk in the corresponding column (left to right: LOT-R; α/(α+β) which defines where the prior is centered; γ is the softmax decision parameter) indicates a p value less than 0.05 for a t-test between optimists and pessimists.</p

a) Cartoon of the task: subjects are presented with a sequence of stimuli (here: O₁, O₂, O₁) followed by a decision screen (D₁).

<p>Here the subject needs to choose between the yellow fractal and the square for which the reward probability is given by the number of blue dots (6 dots, indicating a probability of 60%). <u>Inset:</u> Example of a longer sequence of interleaved observation screens and decision screens. <b>b</b>) Performance of the subjects (% trials in which they chose the fractal stimulus) as a function of the difference between the observed reward rate of the fractal being considered and the reward probability of the square. Compared to pessimistic people (red, LOT-R≤mean LOT-R), optimistic people (blue, LOT-R>mean LOT-R) tend to overestimate the probability of reward associated with the uncertain fractal stimulus. Errors bars denote standard deviation. <b>c</b>) Correlation between subjects' LOT-R scores and the mean of their prior distribution p(c) that the fractal stimulus will lead to a reward (r = 0.438, p = 0.001). <b>d</b>) Examples of the prior distributions that were extracted for subjects 10 (pessimistic, LOT-R = 3) and 11 (optimistic, LOT-R = 22) based on their task performance.</p

Reduced uncertainty experiment.

<p><b>a</b>) Performance of the subjects (percentage of trials in which they chose the fractal stimulus) as a function of the difference between the observed reward rate of the fractal being considered and the reward probability of the square. Pessimistic (red, LOT-R≤mean LOT-R) and optimistic people (blue, LOT-R>mean LOT-R) behave similarly. Errors bars denote standard deviation. <b>b</b>) Correlation between subjects' LOT-R scores and the mean of their prior distribution p(c) that the fractal stimulus will lead to a reward (r = 0.009, p = 0.95).</p

Best-fitting parameters for the RL models summarized per experiment and averaged per group.

<p>Each value reported in the column shows mean values for different RL models (left to right: RL_ε; RL₂; RL_2b; RL_b) and X means that the variable is not used in a model. Significance of the differences is shown on the right of the table: an asterisk in the corresponding column indicates a p value less than 0.05 for a t-test between optimists and pessimists. Parameters ε+, ε− denote the learning rates for positive and negative errors respectively, v_o is the initial value of all CS, and τ is the softmax decision parameter.</p

Punishment avoidance experiment.

<p><b>a</b>) Cartoon of the task. The CS can either lead to a punishment (indicated by a sad face) or nothing. <b>b</b>) Performance of the subjects (percentage of trials in which they chose the fractal stimulus) as a function of the difference between the observed reward rate of the fractal being considered and the reward probability of the square. Pessimistic (red, LOT-R≤mean LOT-R) and optimistic people (blue, LOT-R>mean LOT-R) behave similarly. <b>c</b>) Correlation between subjects' LOT-R scores and the mean of their prior distribution p(c) that the fractal stimulus will lead to a reward (r = −0.049; p = 0.74).</p