Encephalitis, acute renal failure, and acute hepatitis triggered by a viral infection in an immunocompetent young adult: a case report

<p>Abstract</p> <p>Introduction</p> <p>Cytomegalovirus generally causes self-limited, mild and asymptomatic infections in immunocompetent patients. An aggressive course in immunocompetent healthy patients is unusual.</p> <p>Case presentation</p> <p>We report the case of an immunocompetent 16-year-old Egyptian boy with encephalitis, acute renal failure, and acute hepatitis triggered by viral infection with a complete recovery following antiviral treatment.</p> <p>Conclusion</p> <p>We believe that this case adds to the understanding of the molecular biology, clinical presentation and increasing index of suspicion of many viral infections.</p

Improved Efficacy of First-Line Imatinib in Advanced Gastrointestinal Stromal Tumors (GIST):The Dutch GIST Registry Data

BACKGROUND: Patients with unresectable and metastasized gastrointestinal stromal tumor (GIST) experienced a remarkable improvement of progression-free survival (PFS) and overall survival (OS) after the introduction of imatinib. Our hypothesis is that the outcomes of treatment with imatinib are even better nowadays compared with the registration trials that were performed two decades ago. To study this, we used real-life data from a contemporary registry.METHODS: A multicenter, retrospective study was performed by exploring clinical data from a prospective real-life clinical database, the Dutch GIST Registry (DGR). Patients with advanced GIST treated with first-line imatinib were included and PFS (primary outcome) and OS (secondary outcome) were analyzed. Results of our study were compared with published results of the European Organisation for Research and Treatment of Cancer (EORTC) 62005 trial, which marked the first era of imatinib in the treatment of GIST.RESULTS: Overall, 420 of the 435 patients treated with imatinib in the DGR had recorded response evaluation and were included in the analysis. During a median follow-up of 35.0 months (range 2.0-136.0), progression of GIST was eventually observed in 217 patients (51.2%). The DGR cohort showed a longer median PFS (33.0 months, 95% confidence interval [CI] 28.4-37.6) compared with the EORTC 62005 trial (an estimated PFS of 19.5 months). Additionally, the median OS of 68.0 months (95% CI 56.1-80.0) was longer than the exposed median OS (46.8 months) published in the long-term follow-up results of the EORTC 62005 trial (median follow-up duration 10.9 years).CONCLUSION: This study provides an update on outcomes of imatinib in the treatment of advanced GIST patients and demonstrates improved clinical outcomes since the first randomized studies of imatinib 2 decades ago. Furthermore, these results represent outcomes in real-world clinical practice and can serve as a reference when evaluating effectiveness of imatinib in patients with advanced GIST.</p

Immobilisation of Candida rugosa lipase on aminated polyethylene/polypropylene microfibrous sheet modifieded with oxirane group

An active microfibrous substrate containing aminated brush obtained by radiation-induced grafting of glycidyl methacrylate (GMA) onto a polyethylene/polypropylene (PE/PP) microfibrous sheet followed by amination reaction was prepared and used for immobilisation of Candida rugosa lipase under various conditions. The aminated microfibrous sheet was characterised by Fourier-transform infrared spectroscopy (FTIR-ATR) and field emission scanning electron microscope (FESEM). The amine group density on the aminated micro-fibrous sheet was found to be 3.33mmol/g. Response surface methodology (RSM) was applied to model and optimise the immobilisation conditions including immobilisation time (2-6 h), medium pH (pH 7-9) and enzyme/support ratio (5.0-9.0mg/cm2). The model generated from RSM was significantly correlated with the studied parameters for the residual activity of the immobilised lipase. The optimum values for immobilisation time, medium pH, and enzyme/support ratio were found to be 4.24h, pH 8, and 8.51mg/cm2 respectively. The enzymatic activity using p-nitrophenyl palmitate (pNPP) as substrate was 1.4588U/cm2 under optimum conditions. The pH endurance, storage, and thermal stability of the immobilised lipase were remarkably enhanced. The immobilised lipase can be readily recovered and more than 50% of its activity was retained following 10 cycles. The results of this study suggested that the aminated microfibrous sheet of PE/PP grafted with poly(GMA) is a promising polymer support for enzyme immobilisation with high potential for broad biocatalytic applications

Integrating Science and Policy Through Stakeholder-Engaged Scenarios

Scenario development for integrated analysis focuses on adopting an interdisciplinary approach covering key elements of the biophysical environment as well as changes in livelihoods, education, economics and governance both locally and internationally. Most importantly, the development of these scenarios generates a dialogue across institutions, stakeholders and sectors, with the use of common data and agreement on shared qualitative and quantitative futures. The scenarios adopted combine three alternative future climates and three socio-economic development pathways. Quantification of these issues included estimation based on published data, expert knowledge and stakeholder engagement, particularly where data are most uncertain or unknown. This chapter demonstrates this approach for coastal Bangladesh

Gastrointestinal Stromal Tumours (GIST) in Young Adult (18-40 Years) Patients:A Report from the Dutch GIST Registry

Gastrointestinal stromal tumour (GIST) is a disease of older adults and is dominated by KIT/PDGFR mutations. In children, GIST is rare, predominantly occurs in girls, has a stomach location and generally lacks KIT/PDGFR mutations. For young adults (YA), aged 18 to 40 years, the typical phenotypic and genotypic patterns are unknown. We therefore aimed to describe the clinical, pathological and molecular characteristics of GIST in in YA. YA GIST patients registered in the Dutch GIST Registry (DGR) were included, and data were compared to those of older adults (OA). From 1010 patients in the DGR, 52 patients were YA (54% male). Main tumour locations were stomach (46%) and small intestine (46%). GIST genetic profiles were mutations in KIT (69%), PDGFRA (6%), SDH deficient (8%), NF1 associated (4%), ETV6-NTRK3 gene fusion (2%) or wildtype (10%). Statistically significant differences were found between the OA and YA patients (localisation, syndromic and mutational status). YA presented more often than OA in an emergency setting (18% vs. 9%). The overall five-year survival rate was 85%. In conclusion, YA GISTs are not similar to typical adult GISTs and also differ from paediatric GISTs, as described in the literature. In this series, we found a relatively high percentage of small intestine GIST, emergency presentation, 25% non-KIT/PDGFRA mutations and a relatively good survival

Degradation, infection and heat effects on polypropylene mesh for pelvic implantation: what was known and when it was known

Many properties of polypropylene mesh that are causative in producing the complications that our patients are experiencing were published in the literature prior to the marketing of most currently used mesh configurations and mesh kits. These factors were not sufficiently taken into account prior to the sale of these products for use in patients. This report indicates when this information was available to both mesh kit manufacturers and the Food and Drug Administration