Relapsing polychondritis in systemic sclerosis: A rare vasculitic mimic

INTRODUCTION: Relapsing polychondritis is a rare, immune-mediated disease characterised by inflammation of cartilaginous structures. Auricular chondritis, sparing the fatty lobule, is the most typical feature, followed by nose and laryngotracheal involvement. Albeit rare, neurologic involvement is reported with relapsing polychondritis. Cranial nerve involvement is the most frequent neurologic manifestation and is probably due to an underlying vasculitic process. Approximately one-third of relapsing polychondritis patients can overlap with other systemic diseases, including other autoimmune connective tissue diseases, but association with systemic sclerosis has very rarely been described. CASE DESCRIPTION: A 63-year-old woman presented with acute new-onset severe dysphagia, accompanied by hoarseness and preceded by pain, swelling and erythema of the left pinna, unresponsive to antibiotics. She had a history of long-standing limited cutaneous systemic sclerosis. Cranial nerve examination revealed right-sided palatal palsy, and left vocal cord palsy was found on fibreoptic nasendoscopy. Magnetic resonance imaging of the head and neck showed bilateral enhancement of an extracranial segment of the glossopharyngeal and vagus nerves. Clinical features and imaging findings were consistent with relapsing polychondritis, which successfully responded to high-dose steroids. CONCLUSIONS: This is a case of relapsing polychondritis mimicking progression of systemic sclerosis, showcasing its challenging features. It emphasises the importance of early diagnosis and prompt management with potential impact on the outcome, while highlighting the complex interplay between these two disease entities and vasculitic mechanisms, which may reflect the shared network of genetic predisposition across autoimmune rheumatic diseases

Study of EMIC wave excitation using direct ion measurements

With data from Van Allen Probes, we investigate electromagnetic ion cyclotron (EMIC) wave excitation using simultaneously observed ion distributions. Strong He band waves occurred while the spacecraft was moving through an enhanced density region. We extract from helium, oxygen, proton, and electron mass spectrometer measurement the velocity distributions of warm heavy ions as well as anisotropic energetic protons that drive wave growth through the ion cyclotron instability. Fitting the measured ion fluxes to multiple sinm-type distribution functions, we find that the observed ions make up about 15% of the total ions, but about 85% of them are still missing. By making legitimate estimates of the unseen cold (below ∼2 eV) ion composition from cutoff frequencies suggested by the observed wave spectrum, a series of linear instability analyses and hybrid simulations are carried out. The simulated waves generally vary as predicted by linear theory. They are more sensitive to the cold O+ concentration than the cold He+ concentration. Increasing the cold O+ concentration weakens the He band waves but enhances the O band waves. Finally, the exact cold ion composition is suggested to be in a range when the simulated wave spectrum best matches the observed one

Adverse Childhood Experiences and Resilience: Addressing the Unique Needs of Adolescents

Adolescents exposed to adverse childhood experiences (ACEs) have unique developmental needs that must be addressed by the health, education, and social welfare systems that serve them. Nationwide, over half of adolescents have reportedly been exposed to ACEs. This exposure can have detrimental effects, including increased risk for learning and behavioral issues and suicidal ideation. In response, clinical and community systems need to carefully plan and coordinate services to support adolescents who have been exposed to ACEs, with a particular focus on special populations. We discuss how adolescents' needs can be met, including considering confidentiality concerns and emerging independence; tailoring and testing screening tools for specific use with adolescents; identifying effective multipronged and cross-system trauma-informed interventions; and advocating for improved policies

The role and diversity of Pythium and Phytophthora in UK gardens

Gardens are little studied particularly in relation to major plant pathogen genera such as Phytophthora, or the closely related Pythium. UK gardens harbour a wide diversity of plants of worldwide origin, compared to the relatively few native in the UK, and are frequently the endpoint of the worldwide trade in plants and sometimes, as fellow passengers their associated pathogens. Samples from a plant clinic were surveyed for the presence of Phytophthora by three methods. DNA extracted from symptomatic tissue followed by a semi-nested PCR (DEN) gave the highest detection rates with approx. 70% of tests positive. A commercial immunoassay test kit (PocketDiagnositic™) was the fastest; with results in less than 10 min. Apple baiting gave the lowest detection rates (9%), but provided cultures vital for further studies. An unexpected and novel result was the widespread detection of Pythium causing much the same symptoms as Phytophthora. The phylogenetic trees, created using the elision method, of the Phytophthora and Pythium rDNA sequences revealed 46 named or well defined species, 21 and 25 respectively. The phylogeny of both genera was in general accordance with previous publications. Frequently identified species included Ph. cryptogea, Ph. cinnamomi, Py. intermedium and Py. sylvaticum, all ubiquitous with wide host ranges. Occasional occurrences included Ph. ramorum, Ph. tropicalis, Ph. austrocedri and Ph. “niederhauseri”. Twenty putative new species were also detected, based on the Phytophthora and Pythium phylogenies, 11 and 9 species respectively. In pathogenicity tests Phytophthora and Pythium caused root rot, and Py. intermedium caused Hebe death within 3 days of soil inoculation. Not all plants infected with Phytophthora or Pythium died, indicating disease development may involve additional interactions. Pythium foliar blight of mature woody plants was identified. Koch’s postulates were satisfied, indicating new symptoms previously not associated with Pythium infections.Open Acces