Graft-versus-Host Disease-Like Pattern in Mycophenolate Mofetil Related Colon Mucosal Injury: Role of FISH in Establishing the Diagnosis

Mycophenolate mofetil (CellCept®), a commonly used immunosuppressive drug in solid organ transplantation, has recently been shown to cause graft-versus-host disease (GVHD)-like changes in the gastrointestinal tract. On rare occasions, true GVHD has also been documented in the gastrointestinal tract of solid organ transplant patients. Because the treatment for these two entities is different, i.e. removal of the offending agent versus the administration of steroids, proper identification of the cause is imperative. We present a case of mycophenolate mofetil colitis mimicking grade I GVHD of the gut. In our study, we used fluorescence in situ hybridization for the Y chromosome to document the lack of male donor lymphocytes in the female recipient colon biopsy. We suggest that molecular techniques including fluorescence in situ hybridization could be used to discriminate between MMF-related colitis and true GVHD in order to help guide therapy

Intra-tumor heterogeneity of MLH1 promoter methylation revealed by deep single molecule bisulfite sequencing

A single tumor may contain cells with different somatic mutations. By characterizing this genetic heterogeneity within tumors, advances have been made in the prognosis, treatment and understanding of tumorigenesis. In contrast, the extent of epigenetic intra-tumor heterogeneity and how it influences tumor biology is under-explored. We have characterized epigenetic heterogeneity within individual tumors using next-generation sequencing. We used deep single molecule bisulfite sequencing and sample-specific DNA barcodes to determine the spectrum of MLH1 promoter methylation across an average of 1000 molecules in each of 33 individual samples in parallel, including endometrial cancer, matched blood and normal endometrium. This first glimpse, deep into each tumor, revealed unexpectedly heterogeneous patterns of methylation at the MLH1 promoter within a subset of endometrial tumors. This high-resolution analysis allowed us to measure the clonality of methylation in individual tumors and gain insight into the accumulation of aberrant promoter methylation on both alleles during tumorigenesis

Randomized elimination and prolongation of ACE inhibitors and ARBs in coronavirus 2019 (REPLACE COVID) Trial Protocol

Severe acute respiratory syndrome coronavirus 2 (SARS- CoV- 2), the virus responsible for coronavirus disease 2019 (COVID- 19), is associated with high incidence of multiorgan dysfunction and death. Angiotensin- converting enzyme 2 (ACE2), which facilitates SARS- CoV- 2 host cell entry, may be impacted by angiotensin- converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), two commonly used antihypertensive classes. In a multicenter, international randomized controlled trial that began enrollment on March 31, 2020, participants are randomized to continuation vs withdrawal of their long- term outpatient ACEI or ARB upon hospitalization with COVID- 19. The primary outcome is a hierarchical global rank score incorporating time to death, duration of mechanical ventilation, duration of renal replacement or vasopressor therapy, and multiorgan dysfunction severity. Approval for the study has been obtained from the Institutional Review Board of each participating institution, and all participants will provide informed consent. A data safety monitoring board has been assembled to provide independent oversight of the project.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/163400/2/jch14011_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/163400/1/jch14011.pd

Myths and misconceptions about hypnosis and suggestion: Separating fact and fiction

We present 21 prominent myths and misconceptions about hypnosis in order to promulgate accurate information and to highlight questions for future research. We argue that these myths and misconceptions have (a) fostered a skewed and stereotyped view of hypnosis among the lay public, (b) discouraged participant involvement in potentially helpful hypnotic interventions, and (c) impeded the exploration and application of hypnosis in scientific and practitioner communities. Myths reviewed span the view that hypnosis produces a trance or special state of consciousness and allied myths on topics related to hypnotic interventions; hypnotic responsiveness and the modification of hypnotic suggestibility; inducing hypnosis; and hypnosis and memory, awareness, and the experience of nonvolition. By demarcating myth from mystery and fact from fiction, and by highlighting what is known as well as what remains to be discovered, the science and practice of hypnosis can be advanced and grounded on a firmer empirical footing

Ben Edmonston to "My Dear father and mother," June 25, 1863

In a letter of June 25, 1863, Ben Edmonston writes to his parents describing conditions and reporting on the illness and possible discharge of his brother. He also dscribes a recent Union raid in eastern Tennessee that destroyed railroad bridges and stations.Cumberland Gap June 25th 1863 My Dear father & Mother I seat myself today to Answer your very kind letter of date 15 th which came to hand last night. I was exceeamgly glad to hear from you, as a kind letter from Any friend in this dreary region is regarded as a treat but to rec ieve a letter from the old homestead from the kind parents of my childhood. & my more more advanced age, is a treat worthy of lasting memory. I was much pleased to hear that you were Still in the Land of the Living. though truly sorry to hear that you were Suffering with Rheumatism. for I am well prepared to Sympathize with any one in such a condition these mortal limbs of mine are continual sufferers from its dreadful effects. I am truly sorry for the declining Sight of your eye, but hope it will soon be Restored. Father, you labor too hard, do take more rest, as it is Indespensable to your well being in your declining days. The Boys have all pretty well recovered from their shock. Except John Cooper. who was sent to the Hospital at Knoxville. I dont know how he is but hope he is improoving. Thom is in a very delic ate situation. he has had a very heavy seat of cold on his lungs for more than a month, but is still able to go about. The Col ordered him not to go on duty another time. and said that If he had have known his situation he would have had him discharged long ago. The Col told me this morning to have the Dr to Examine him to day or tomorrow which I will do If it does not rain too hard. Thom is a bout one half mile from here. I have not seen him for two days. Thom would I have had his certificate of Discharge from the Dr before this had not Dr Rogers took down sick. he Examined him once and said he would Examine him the next day but was not able. Our surgeon is now in and I will have him Examined to day or tomorrow and will use my influence to get him off. I know of no news reliable. The Yanks made a raid into East Tenn last week, and burned the Depot at Lenoirs Station below Knoxville and burned the Bridges at, Strawberry Plains, Mopey creek & flat Creek. The Extent of the damage I dont know. they made their Escape. what damage we done them I dont know. I could give you the rumors but they may not be correct. Therefore I withold them. I woul