Routine childhood immunization in Sub-Saharan Africa: addressing parental vaccine hesitancy.

OBJECTIVES: Parental vaccine hesitancy (VH) is a major barrier to childhood vaccination. We aimed to identify the determinants of parental VH towards routine childhood immunization in 12 Sub-Saharan African countries. STUDY DESIGN: A cross-sectional study was conducted from November 1 to December 15, 2022. METHODS: Parents of children aged 19 months to 6 years and residing in the Sub-Saharan Africa were included. An anonymous online survey and face-to-face interviews were conducted. The Parent Attitude about Childhood Vaccine Scale was used to identify vaccine-hesitant parents. Multivariate regression and mediating analysis were performed. RESULTS: Across the 5032 participants, 21.2% were hesitant towards routine childhood immunization. Urban residents (adjusted odds ratio [AOR] = 1.32, 95% confidence interval [CI]: 1.10-1.58), non-first-born children (AOR = 1.54, 95% CI: 1.19-1.98), and chronically ill children (AOR = 2.00, 95% CI: 1.69-2.37) increased the likelihood of parental VH. Mothers with higher education, attending at least one antenatal care (ANC) visit (AOR = 0.25, 95% CI: 0.19-0.32), and had a healthcare facility-based delivery (AOR = 0.55, 95% CI: 0.44-0.70) decreased the odds of parental VH. Parental VH mediated the effect of ANC and mothers' age on vaccination uptake. ANC increased the odds of vaccination uptake (odds ratio [OR] = 12.49, 95% CI: 9.68-16.13). Parental VH mediated the association between ANC and vaccination uptake, decreasing the likelihood of vaccination uptake (OR = 0.12, 95% CI: 0.10-0.14). Each additional year of the mother's age decreased the odds of vaccination uptake (OR = 0.95, 95% CI: 0.95-0.96). The indirect effect of mother's age on vaccination through parental VH decreased the odds of vaccination uptake (OR = 0.45, 95% CI: 0.44-0.45). Parental VH continued to be a mediator of the combined effect of mother's age and ANC on vaccination uptake, decreasing the likelihood of vaccination uptake (OR = 0.0017, 95% CI: 0.00166-0.00168). CONCLUSIONS: Context-specific interventions are needed to address parental VH and improve vaccine acceptance and coverage.

Neurofeedback and epilepsy: Renaissance of an old self-regulation method?

Neurofeedback is a brain-computer interface tool enabling the user to self-regulate their neuronal activity, and ultimately, induce long-term brain plasticity, making it an interesting instrument to cure brain disorders. Although this method has been used successfully in the past as an adjunctive therapy in drug-resistant epilepsy, this approach remains under-explored and deserves more rigorous scientific inquiry. In this review, we present early neurofeedback protocols employed in epilepsy and provide a critical overview of the main clinical studies. We also describe the potential neurophysiological mechanisms through which neurofeedback may produce its therapeutic effects. Finally, we discuss how to innovate and standardize future neurofeedback clinical trials in epilepsy based on evidence from recent research studies.

Sleep and epilepsy: A clinical and pathophysiological overview.

The interaction between sleep and epilepsy is complex. A better understanding of the mechanisms linking sleep and epilepsy appears increasingly important as it may improve diagnosis and therapeutic strategies in patients with epilepsy. In this narrative review, we aim to (i) provide an overview of the physiological and pathophysiological processes linking sleep and epilepsy; (ii) present common sleep disorders in patients with epilepsy; (iii) discuss how sleep and sleep disorders should be considered in new therapeutic approaches to epilepsy such as neurostimulation; and (iv) present the overall nocturnal manifestations and differential diagnosis between epileptic seizures and parasomnia.

Responses of Eucalyptus globulus and Ficus nitida to different potential of heavy metal air pollution.

The present study aimed to explore the tolerance potential of Cd, Pb and Cu and physiological alterations in two common tree species growing in Minia governorate (Egypt) namely: Eucalyptus globulus and Ficus nitida and to investigate the leaf features [leaf area (LA) and specific leaf area (SLA)] associated with the phytoremediation process. The findings may be useful for future surveillance as preliminary reference values for levels of heavy metals in urban and industrial settings. The levels of cadmium, lead and Cupper in plant leaf were determined. The results showed that heavy metals could inhibit the growth of plants including LA and SLA. The water content (WC) and photosynthetic pigments of Eucalyptus and Ficus decreased with the increased concentration of metals. Contrary to chlorophylls (a) and (b), carotenoids and chlorophyll ratio (a/b) showed a significant increase with increasing metals concentration especially that of Cd and Cu. Proline content was relatively increased and soluble carbohydrate content decreased in plants with high metal accumulation. Eucalyptus showed better tolerance capacity for Cd, Pb and Cu when compared to Ficus. The ability of Eucalyptus to accumulate and tolerate metal stress makes this species a good candidate to recuperate heavy metals-contaminated conditions.

Increased recurrence rates of hepatocellular carcinoma after DAA therapy in a hepatitis C-infected Egyptian cohort: A comparative analysis.

In Egypt, hepatocellular carcinoma (HCC) is the most common form of cancer and direct-acting antivirals (DAA) are administered on a large scale to patients with chronic HCV infection to reduce the risk. In this unique setting, we aimed to determine the association of DAA exposure with early-phase HCC recurrence in patients with a history of HCV-related liver cancer. This was a prospective cohort study of an HCV-infected population from one Egyptian specialized HCC management centre starting from the time of successful HCC intervention. The incidence rates of HCC recurrence between DAA-exposed and nonexposed patients were compared, starting from date of HCC complete radiological response and censoring after 2 years. DAA exposure was treated as time varying. Two Poisson regressions models were used to control for potential differences in the exposed and nonexposed group; multivariable adjustment and balancing using inverse probability of treatment weighting (IPTW). We included 116 patients: 53 treated with DAAs and 63 not treated with DAAs. There was 37.7% and 25.4% recurrence in each group after a median of 16.0 and 23.0 months of follow-up, respectively. Poisson regression using IPTW demonstrated an association between DAAs and HCC recurrence with an incidence rate ratio of 3.83 (95% CI: 2.02-7.25), which was similar in the multivariable-adjusted model and various sensitivity analyses. These results add important evidence towards the possible role of DAAs in HCC recurrence and stress the need for further mechanistic studies and clinical trials to accurately confirm this role and to identify patient characteristics that may be associated with this event.

Immunohistochemical assessment of endothelin-1 axis in psoriasis, basal cell carcinoma and squamous cell carcinoma.

AIM: Endothelin-1 is an autocrine growth factor for keratinocytes, an effect controlled by its A and B receptors, with no previous comparison of endothelin axis expression in inflammatory and neoplastic skin diseases showing keratinocyte proliferation. The aim of the study was to investigate endothelin-1 axis expression in skin lesions of psoriasis, basal cell carcinoma (BCC), and squamous cell carcinoma (SCC). METHODS: This study included 40 subjects (8 patients with SCC, 12 patients with BCC, 10 patients with psoriasis, and 10 healthy controls). Biopsies from lesional skin of patients and normal skin of controls were examined immunohistochemically for endothelin-1 and its receptors A and B frequency and grade of expression. RESULTS: Endothelin-1 and receptor A were detected in all patients with SCC and psoriasis, with a higher frequency and grade of expression than controls and BCC. The frequency of receptor B expression was significantly lower while higher staining grade was found in BCC (8.3%) rather than other studied groups. CONCLUSION: A comparable higher frequency and grade of expression of endothelin-1 and its receptor A are documented in psoriasis and SCC than in BCC and controls denoting their involvement in keratinocyte proliferation in both diseases. Receptor A is the predominately expressed receptor in psoriasis and SCC.

Serum concentration of IL-17, IL-23 and TNF-α among patients with chronic spontaneous urticaria: association with disease activity and autologous serum skin test.

BACKGROUND: Chronic spontaneous urticaria (CSU) is a common skin disorder, which is considered in a subset of patients to be an autoimmune disorder. T helper 17 (Th17) cells are crucially involved in the pathogenesis of some autoimmune diseases. OBJECTIVES: Our aim was to test the association of Th17 with CSU. We examined interleukin (IL)-17, IL-23 and tumor necrosis factor-alpha (TNF-α) serum levels in CSU patients and studied their association with urticaria activity and autologous serum skin test (ASST). SUBJECTS AND METHODS: Serum concentration of IL-17, IL-23 and TNF-α were measured in 75 patients with CSU and 30 healthy control subjects. Disease activity was assessed by using urticaria activity score (UAS) as recommended by EAACI/GA(2)LEN/EDF/WAO Guidelines. RESULTS: Serum concentration of IL-17, IL-23 and TNF-α were significantly higher in CSU patients as compared with the healthy control subjects (mean: 35.51 ± 31.14 vs. 4.60 ± 1.38 pg/mL; P < 0.001, 38.95 ± 27.82 vs. 9.87 ± 4.62 pg/mL; P > 0.001 and 17.93 ± 6.05 vs. 6.87 ± 3.73 pg/mL; P = 0.004, respectively). There were significant positive correlation between serum IL-17, IL-23, TNF-α and disease activity assessed by cumulative UAS for 7 days before blood sampling. The Serum concentration of IL-17, IL-23 and TNF-α were also significantly higher in ASST positive patients than in ASST negative patients. CONCLUSION: Our results showed high serum levels of IL-17, IL-23 and TNF-α among CSU patients which may highlight a functional role of these cytokines in the pathogenesis of this important and common skin disease. It also may provide the rationale for new treatment strategies in chronic urticaria.

A multi-gene phylogeny provides additional insight into the relationships between several Ascosphaera species.

Ascosphaera fungi are highly associated with social and solitary bees, with some species being pathogenic to bees (causing chalkbrood) while others are not, and proper identification within this genus is important. Unfortunately, morphological characterizations can be difficult, and molecular characterizations have only used one genetic region. We evaluated multiple phylogenies of the Ascosphaera using up to six loci: the Internal Transcribed Spacer (ITS) region, 18S rRNA, 28S rRNA, Elongation Factor-1α (EF-1α) the RNA polymerase II largest subunit (RPB1), and the second largest subunit (RPB2). The ITS sequence alone produced an inadequate phylogeny, and the addition of both the 18S and 28S rRNA loci to the ITS sequence produced a phylogeny similar to that based on all six genetic regions. For all phylogenies, Ascosphaera torchioi was in a separate clade that was the most basal, with a strong genetic similarity to Eremascus albus, introducing the possibility of paraphyly within Ascosphaera. Also, based on this new phylogeny, we now suggest that the Apis mellifera (honey bee) pathogens arose within a group of saprophytes, and the Megachile (leafcutting bees) pathogens arose separately.

Pleurotus ostreatus Grown on Agro-Industrial Residues: Studies on Microbial Contamination and Shelf-Life Prediction under Different Packaging Types and Storage Temperatures.

The short shelf-life of mushrooms, due to water loss and microbial spoilage, is the main constraint for commercialization and consumption. The effect of substrate type combined with different temperatures and packaging conditions on the shelf-life of fresh Pleurotus ostreatus is scantily researched. The current study investigated the shelf-life of fresh oyster mushrooms grown on low (0.3, 0.3, 0.17) and high (0.7, 0.7, 0.33) rates of olive pruning residues (OLPR), spent coffee grounds (SCG), and both combined residues (OLPR/SCG) with wheat straw (WS), respectively, at ambient (20 °C) and 4 °C temperatures under no packaging, polyethylene plastic bag packaging (PBP), and polypropylene vacuum bag packaging (VBP). Results showed that at ambient temperature OLPR/SCG mushrooms PBP-bagged had an increased shelf-life by 0.5-1.2 days in comparison with WS ones. The predictive models adopted to optimize mushroom shelf-life at ambient temperature set rates of 0.289 and 0.303 of OLPR and OLPR/SCG, respectively, and PBP as the most suitable conditions (9.18 and 9.14 days, respectively). At 4 °C, OLPR/SCG mushrooms VBP-bagged had a longer shelf-life of 2.6-4.4 days compared to WS ones. Predictive models noted a maximized shelf-life of VBP-bagged mushrooms (26.26 days) when a rate of 0.22 OLPR/SCG is incorporated into the initial substrate. The combination of OLPR and SCG increased the shelf-life of fresh Pleurotus ostreatus by decreasing the total microbial count (TMC) while delaying weight loss and veil opening, and maintaining carbohydrate content, good firmness, and considerable protein, in comparison with WS regardless the storage temperature and packaging type.

Relationship of Imported Fire Ant (Hymenoptera: Formicidae) Integument Coloration to Cuticular Hydrocarbon and Venom Alkaloid Profiles.

Red imported fire ant (Solenopsis invicta Buren; RIFA) and black imported fire ant (Solenopsis richteri Forel (Hymenoptera: Formicidae); BIFA) are considered distinct species with introgression via a reproductively functional hybrid (HIFA). The RIFA and BIFA common names are based on relative coloration. Due to human color perception variation, using color to identify RIFA, BIFA or HIFA is challenging. Fire ant identification traditionally involves molecular or chemical techniques, but a colorimetric test could allow rapid and low-cost identification. In this study, ant integument coloration was measured by spectrophotometer, and color attributes were compared to a combined gas chromatography (GC) index derived from cuticular hydrocarbon and venom alkaloid indices. Significant Pearson Correlation coefficients were found for colony GC index versus color attributes red to green (a*), blue to yellow (b*), chroma (C*), and hue (h*), but not lightness (L*). The RIFA colonies were distinct from BIFA for four of five color attributes and plots of the a*b* and C*h* horizontal axis of the L*a*b* and L*C*h* color spaces. Color attributes for HIFA indices were not distinct from BIFA and RIFA parental species, but HIFA a*b* and C*h* plots were distinct from RIFA and a*b* plots from BIFA. Color attributes a*, b*, and C* increased and h* decreased with GC index in a sinusoidal pattern. In conclusion, most RIFA and BIFA color attributes were distinct and a*b* and C*h* color axes plots had potential to distinguish HIFA from parental species, but coloration of HIFA indices was variable and complicated identifications among HIFA phenotypes, RIFA and BIFA.

Combined effect of olive pruning residues and spent coffee grounds on Pleurotus ostreatus production, composition, and nutritional value.

No previous study assessed the combined effect of olive pruning residues (OLPR) and spent coffee grounds (SCG) on P. ostreatus production and nutritional value. The aim of this study was to determine the capacity of P. ostreatus to degrade lignocellulosic nature of combined OLPR and SCG as well as their resultant nutrient composition. A complete randomized design was adopted with five treatments: S1:100%wheat straw (WS) (control), S2:33%WS+33%SCG+33%OLPR,S3:66%WS+17%SCG+17%OLPR,S4:17%WS+66%SCG+17%OLPR, and S5:17%WS+17%SCG+66%OLPR, and ten replicates per treatment. Substrate's and mushroom's composition were analyzed on chemical scale, including fatty acids and heavy metals profiles, following international standards. Only S1, S2, and S3 were productive, with comparable biological yield, economical yield, and biological efficiency. Organic matter loss decreased with increasing proportions of OLPR and SCG. Percentage lignin loss was higher in S1 than in S2 and S3 (53.51, 26.25, and 46.15% respectively). Mushrooms of S3 had some enhanced nutritional attributes compared to control: decrease in fat, increase in protein, increase in monounsaturated fatty acids, and lower zinc accumulation. Lead was less accumulated in S2 than S1 mushrooms. Sodium content of mushroom decreased in S2 and S3. The latter substrates yielded mushrooms with lower polyunsaturated fatty acids (PUFA) and higher saturated fatty acids (SFA) contents. All mushrooms had a valuable PUFA/SFA. This study suggests using OLPR and SCG in low proportions as nutritional supplements to the commercial wheat straw.

Nano urea effects on Pleurotus ostreatus nutritional value depending on the dose and timing of application.

The work investigated the effect of Lithovit-Urea50 on the composition of Pleurotus ostreatus (Jacq. Ex Fr.) P. Kumm. (1871) cultivated on spent oyster substrate mixed with wheat straw (1:1, w/w mixture). The product was applied in different doses (C1: 3 g kg-1 and C2: 5 g kg-1) at three distinct timings (t1: at spawning, t2: after first harvest, t3: at spawning and after first harvest). Protein and fiber contents increased respectively by 0.64 and 0.2% in C1t1 and by 0.46 and 0.8% in C2t2 compared to control (C0t0). Total carbohydrates increased by 0.48-3.76%. Sucrose and glucose contents decreased in the majority of treatments, while fructose increased in C2t1 (by 0.045%). Essential amino acids were the highest in C1t1, wherein respective improvement of 0.31, 0.10, 0.05, 0.21, 0.18, and 0.09% compared to C0t0. Similarly, C1t1 was superior in non-essential amino acids. Potassium, sodium, calcium, iron, and copper contents decreased in all treatments, with minor exceptions, zinc decreased in C1t1 and C2t1, while nickel and lead increased in all treatments. Conclusively, despite important ameliorations in the mushroom nutritional value, mostly in C1t1, the product should be further tested in lower doses (< 3 g kg-1) to counteract its effect on heavy metal bioaccumulation.

Production and composition of Pleurotus ostreatus cultivated on Lithovit®-Amino25 supplemented spent substrate.

Supplementation of the spent oyster substrate enhances its nutritional properties to produce a new mushroom cropping cycle. The study investigated the potential of a nano-fertilizer (Lithovit®-Amino25) with an admixture of 25% L-amino acids on Pleurotus ostreatus production, proteins, and amino acid contents. The product applied at spawning (t1), after the first harvest (t2), and at both timings (t3), in two doses: 3 g/kg (C1) or 5 g/kg (C2). Compared with control (C0t0), the first harvest was earlier by 2.3-3.3 days in C1t1 and C2t1. The biological yield of the second harvest was improved by 28.0% in C2t2. Superior results were in C1t3 where the number of crops increased to four, biological efficiency was optimized (117.3%) at the third harvest, and biological and economic yields increased by 36.7% and 36.4%, respectively. Lignin was the most degraded in C1t3, while residual cellulose, hemicellulose, neutral detergent fiber, and acid detergent fiber were higher in all treated substrates than in control. In C2t1, mushrooms were the richest in proteins, while in C1t1, they were the richest in the essential amino acids threonine, valine, isoleucine, leucine, and histidine. Lithovit®-Amino25 has a high potential for use in P. ostreatus production.

Valorization of Olive Pruning Residues through Bioconversion into Edible Mushroom Pleurotus ostreatus (Jacq. Ex Fr.) P. Kumm. (1871) of Improved Nutritional Value.

In several Mediterranean countries, olive pruning residues (OLPRs) are abandoned or burned leading to several environmental problems. Valorization of these agrowastes could be a challenge for the primary decomposer Pleurotus ostreatus, turning them into edible biomass. The OLPR was used alone (OLPR), or in mixtures with wheat straw (WS : OLPR 1 : 3 v/v and WS : OLPR 3 : 1 v/v). Mycelial colonization was hastened by 3.7 days in WS : OLPR 1 : 3 (v/v). Yields were comparable to control (WS) in WS : OLPR 3 : 1 (v/v). Organic matter loss decreased with increasing proportions of OLPR in substrates. The nutritional value of mushrooms was improved by lower fat and sodium contents, in WS : OLPR 1 : 3 (v/v) and WS : OLPR 3 : 1 (v/v), and higher total protein, crude fiber, iron, and total carbohydrates contents in WS : OLPR 3 : 1 (v/v), compared with those of control. Polyunsaturated fatty acids, mainly linoleic acid, were the most abundant in mushrooms. Monounsaturated fatty acids increased in mushrooms of the substrates containing OLPR. A good predictive model of partial least square regression analysis showed different relationships of mushroom palmitic, oleic, linolenic, palmitoleic, and stearic acids with substrate composition. Findings suggested the use of OLPR as a supplement to commercial wheat straw and as a tool to reduce the negative impacts of their hazardous disposal on the environment.

Variation of Pleurotus ostreatus (Jacq. Ex Fr.) P. Kumm. (1871) performance subjected to differentdoses and timings of nano-urea.

Supplementation of the growing substrate by nitrogenous additives has been known to improve the production of oyster mushroom (Pleurotus ostreatus (Jacq. ex Fr.) P. Kumm. (1871)). However, the application of nano-additives has not been reported in such cultivation yet. The study investigated the effect of nano-urea added in two different doses (3 g and 5 g per kg substrate), once (at spawning or after first flush) or twice (at spawning and after first flush) to the growing substrate consisting of wheat straw and spent oyster substrate (1:1, w/w). Results showed that the application of nano-urea once has induced the highest number of mushroom flushes (four flushes) despite the dose applied. Contrarily to early findings, where high doses of nitrogen have caused inhibition of mushroom growth and production, nano-urea application has had better effects when applied twice. With 5 g/kg, it induced the shortest period between the first and the third flush (15 days). With 3 g/kg, it resulted in the highest biological and economic yields at the third flush (332.7 g/bag and 283.1 g/bag respectively), in total (973.4 g/bag and 854.0 g/bag respectively), the highest biological efficiency (109.6%), and pileus diameter/stipe length ratio (2.8). Experimental findings of the current study may be potentially applied at commercial scale.

Worker Size, Geographical Distribution, and Introgressive Hybridization of Invasive Solenopsis invicta and Solenopsis richteri (Hymenoptera: Formicidae) in Tennessee.

Worker size and geographical distribution of red imported fire ants (Solenopsis invicta Buren), black imported fire ants (Solenopsis richteri Forel), and their hybrid (S. invicta × S. richteri) (Hymenoptera: Formicidae) were evaluated from colonies sampled across Tennessee. The fire ant species and hybrid status were determined using cuticular hydrocarbon and venom alkaloid indices obtained from gas chromatography and mass spectrometry. Hybrids were the most common fire ant throughout Tennessee. With the exception of a few isolated S. invicta samples, only hybrids were found in east Tennessee, and hybrids predominated in middle Tennessee. In west Tennessee, mixed populations of S. richteri and hybrids were found. Hybrids were more common in west Tennessee than a survey performed a decade earlier. No statistical differences were detected in the average inter-colonial worker size of S. richteri and hybrids. Likewise, average worker size was not related to geographic location in Tennessee. The similarity in average worker size among hybrid colonies with a wide range of cuticular hydrocarbon and venom alkaloid values suggests introgression was not impacting ant size in colonies sampled throughout Tennessee.

Efficacy of Nootka Oil as a Biopesticide for Management of Imported Fire Ants (Hymenoptera: Formicidae).

Recent concerns regarding the impact of traditional synthetic pesticides on nontarget organisms have generated demand for alternative products with lower environmental impact. This demand has led to increasing focus on plant essential oils as sources of new biopesticides. In this study, we demonstrate that the essential oil of the Alaskan yellow cedar, Cupressus nootkatensis (D. Don) Spach, has activity against hybrid imported fire ant workers, Solenopsis invicta Buren × Solenopsis richteri Forel. In digging assays, ants were repelled by nootka oil and digging continued to be suppressed by nearly 50% in nootka oil-treated sand aged 6 mo in the laboratory. Higher worker mortality was also observed in contact and fumigation assays compared to control checks. In a field drench test, mortality of mounds treated with nootka oil lagged behind mounds treated with bifenthrin treatment for 7 wk, but both nootka oil and bifenthrin had higher mortality than the untreated check at the end of the 12-wk evaluation period. In a band application evaluation, nootka oil plots maintained a 90-95% reduction in fire ant mounds from the 2nd to 17th wk, when new mounds began to intrude on the field plots. The quarantine-approved bifenthrin band treatment maintained 100% control from the 2nd to 24th wk. Although the formulation tested here did not perform to Federal Imported Fire Ant Quarantine standards, other formulations may enable this product to reach 100% control. In addition, nootka oil could be beneficial in situations where ant suppression rather than complete quarantine elimination is the management goal.

Is Conduct of Research in Electroconvulsive Therapy Ethical?

INTRODUCTION: Controversy surrounding ECT creates skepticism about the ethics of conducting ECT research. This paper discusses the ethical conduct of clinical research and then focus on the ethics as applied to ECT. METHODS: PubMed was searched for articles related to the ethical conduct of research and that of ECT research published in English. RESULTS: ECT research is ethically justified and should always continue to be conducted with the highest ethical standards. ECT research entails few ethical peculiarities such as involving multiple sessions were capacity to consent can change. It would be unethical not to conduct ECT research. CONCLUSION: ECT research must be based on sound hypotheses in the presence of a clinical equipoise in well-designed studies. ECT studies must select a fair and non-biased sample of participants. It is important that participants represent the broad population of the people that would be receiving ECT for that specific indication. ECT research is ethical; and more research in this field could help decrease stigma and barriers to treatment, and/or reduce side effects and improve efficacy of a potentially life-saving intervention.

Breast inflammatory gigantomastia in a context of immune-mediated diseases.

CONTEXT: Localized breast lesions have been described in lupic or diabetic patients. However, the description of breast gigantomastia in women presenting with autoimmune diseases has not been reported. SETTING: The study took place within the Department of Endocrinology and Reproductive Medicine, Necker Hospital, Paris, France. PATIENTS: We describe eight patients with inflammatory gigantomastia, occurring in a context of immune-mediated diseases: myasthenia, chronic arthritis, or thyroiditis. MAIN OUTCOME MEASURES: Together with hormonal, immunological, and breast magnetic resonance imaging (MRI) evaluation, breast histology enabled us to perform immunocytochemical and indirect immunofluorescence studies. Control sera were obtained from patients with (n = 10) and without (n = 7) antinuclear antibodies. RESULTS: Six of the eight patients developed gigantomastia either at puberty or during pregnancy. Neither a hormonal oversecretion nor a specific immunological pattern was observed. All patients except one presented antinuclear antibodies. Histological study revealed a diffuse, stromal hyperplasia and a severe atrophy of the lobules. A rarefaction of adipocytes was also noted, as previously suggested on MRI. There was a perilobular lymphocytic infiltrate made of CD3+ lymphocytes. Study of sera from five of six cases of gigantomastia showed a nuclear immunofluorescence pattern in normal mammary ductal and lobular glandular epithelium, as well as in kidney and intestine epithelial cells. In control sera, a nuclear signal was observed only when antinuclear antibodies were present. CONCLUSIONS: We suggest that breast tissue may be a target tissue in autoimmune diseases, this process being favored by the hormonal milieu. However, the precise mechanism of such association is not individualized. The fact that stromal hyperplasia is the main histological feature justifies the search for the involvement of growth factors in such a process.