Membranoproliferative glomerulonephritis after intravitreal vascular growth factor inhibitor injections: A case report and review of the literature.

Systemic administration of agents that inhibit vascular endothelial growth factor (VEGF) and therefore vascular proliferation is often used to treat various cancers. However, these agents are associated with a number of side effects, including proteinuria and renal injury. Intravitreal injection of anti-VEGF agents has become the cornerstone of macular disease treatment. Since these agents cross the blood-retina barrier and enter the circulation, systemic side effects have been reported. We report the novel case of a 57-year-old patient who presented with macular oedema secondary to central retinal vein occlusion, underwent three monthly loading-dose injections with the anti-VEGF agent ranibizumab, and 2 weeks after the second injection presented with biopsy-verified membranoproliferative glomerulonephritis. Twelve weeks after presenting with renal failure and 10 weeks after his last anti-VEGF injection, the patient demonstrated spontaneous recovery of his kidney function. The patient had a history that promoted renal fragility, including hypertension, liver transplantation 6 years earlier for alcohol-related cirrhosis and new-onset diabetes mellitus after transplant. Our literature review and case suggest that although adverse renal events after intravitreal anti-VEGF injections are very rare, ophthalmologists and nephrologists should be aware of this risk.

The association between regional guidelines compliance and mortality in severe trauma patients: an observational, retrospective study.

BACKGROUND AND IMPORTANCE: Trauma is a major cause of mortality and morbidity. Regional trauma systems are the cornerstones of healthcare systems, helping to improve outcomes and avoid preventable deaths in severe trauma patients. OBJECTIVES: The goal of this study was to evaluate the association between compliance with the guidelines of a regional trauma management system and survival at 28 days of severe trauma patients. DESIGN, SETTINGS AND PARTICIPANTS: We conducted a retrospective observational study from 1 January 2019 to 31 December 2019. All adult patients admitted for trauma at the University Hospital of Marseille (France) and requiring a pre-hospital medical team were analysed. Compliance with a list of 30 items based on the regional guidelines for the trauma management was evaluated. Each item was classified as compliant, not compliant or not applicable. The global compliance was calculated for each patient as the ratio between the number of compliant items over the number of applicable items. OUTCOME MEASURES AND ANALYSIS: The primary aim was to measure the association between compliance with the guidelines and survival at 28 days using a logistic regression. Secondary objectives were to measure the association between compliance with the guidelines and survival at 28 days and 6 months according to the severity of the patients, using a cut-off of the injury severity score at 24. MAIN RESULTS: A total of 494 patients with a median age of 35.0 (25.0-50.0) years were analysed. Global compliance with guidelines was 63%. Mortality at 28 days and 6 months was assessed at 33 (6.7%) and 37 (7.5%) patients, respectively. The level of compliance was associated with reduced mortality at 28 days [odds ratio (OR) at 0.94 and 95% confidence interval (CI) at 0.89-0.98]. In the subgroup of 122 patients with an injury severity score above 23, the level of compliance was associated with reduced mortality at 28 days [OR: 0.93 (95% CI: 0.88-0.99)] and 6 months [OR: 0.93 (95% CI: 0.87-0.99)]. CONCLUSION: Increased levels of compliance with the guidelines in severe trauma patients were associated with an increase in survival, notably in the most severe patients.

Postural balance in frequent lucid dreamers: a replication attempt.

STUDY OBJECTIVES: Early research suggests that the vestibular system is implicated in lucid dreaming, e.g. frequent lucid dreamers outperform others on static balance tasks. Furthermore, gravity-themed dreams, such as flying dreams, frequently accompany lucid dreaming. Nonetheless, studies are scarce. METHODS: We attempted to: (1) replicate previous findings using more sensitive static balance measures and (2) extend these findings by examining relationships with dreamed gravity imagery more generally. 131 participants (80 F; Mage=24.1 ± 4.1 yrs) estimated lucid dreaming frequency then completed a 5-day home log with ratings for dream lucidity awareness, control, and gravity sensations (flying, falling). They then performed balance tasks on a sensitive force plate, i.e. standing on one or both feet, with eyes open or closed. Center of pressure (CoP) Displacement and CoP Velocity on each trial measured postural stability. RESULTS: Findings partially support the claim of a vestibular contribution to lucid dreaming. Frequent lucid dreamers displayed better balance (lower CoP Velocity) than did other participants on some trials and lucid dreaming frequency was globally correlated with better balance (lower CoP Velocity). Lower CoP Velocity was related to flying sensations in men's dreams and with more dream control in women's dreams. However, body height-possibly due to its relationship to sex-and levels of sleepiness confound some of these effects. CONCLUSION: While findings only provide a partial replication of previous work, they nonetheless support an emerging view that the vestibular system underlies basic attributes of bodily self-consciousness, such as feelings of self-agency and self-location, whether such consciousness occurs during wakefulness or dreaming.

"Wanting" versus "needing" related value: An fMRI meta-analysis.

Consumption and its excesses are sometimes explained by imbalance of need or lack of control over "wanting." "Wanting" assigns value to cues that predict rewards, whereas "needing" assigns value to biologically significant stimuli that one is deprived of. Here we aimed at studying how the brain activation patterns related to value of "wanted" stimuli differs from that of "needed" stimuli using activation likelihood estimation neuroimaging meta-analysis approaches. We used the perception of a cue predicting a reward for "wanting" related value and the perception of food stimuli in a hungry state as a model for "needing" related value. We carried out separate, contrasts, and conjunction meta-analyses to identify differences and similarities between "wanting" and "needing" values. Our overall results for "wanting" related value show consistent activation of the ventral tegmental area, striatum, and pallidum, regions that both activate behavior and direct choice, while for "needing" related value, we found an overall consistent activation of the middle insula and to some extent the caudal-ventral putamen, regions that only direct choice. Our study suggests that wanting has more control on consumption and behavioral activation.

COPPS, a composite score integrating pathological features, PS100 and SDHB losses, predicts the risk of metastasis and progression-free survival in pheochromocytomas/paragangliomas.

Current histoprognostic parameters and prognostic scores used in paragangliomas and pheochromocytomas do not adequately predict the risk of metastastic progression and survival. Here, using a series of 147 cases of paraganglioma and pheochromocytoma, we designed and evaluated the potential of a new score, the COPPS (COmposite Pheochromocytoma/paraganglioma Prognostic Score), by taking into consideration three clinico-pathological features (including tumor size, necrosis, and vascular invasion), and the losses of PS100 and SDHB immunostain to predict the risk of metastasis. We compared also the performance of the COPPS with several presently used histoprognostic parameters in risk assessment of these tumors. A PASS score (Pheochromocytoma of the Adrenal gland Scaled Score) ≥ 6 was significantly associated with the occurrence of metastases (P < 0.0001) and shorter PFS (P = 0.013). In addition, both MCM6 and Ki-67 LI correlated with worse PFS (P = 0.004 and P < 0.0001, respectively), and MCM6, but not Ki-67, was significantly higher in metastatic group (P = 0.0004). Loss of PS100 staining correlated with the occurrence of metastasis (P < 0.0001) and shorter PFS (P < 0.0001). At a value of greater or equal to 3, the COPPS correlated with shorter PFS (P < 0.0001), and predicted reproducibly (weighted Kappa coefficient, 0.863) the occurrence of metastases with a sensitivity of 100.0% and specificity of 94.7%. It thus surpassed those found for either PASS, SDHB, MCM6, or Ki-67 alone. In conclusion, while validation is still necessary in independent confirmatory cohorts, COPPS could be of great potential for the risk assessment of metastasis and progression in paragangliomas and pheochromocytomas.