Spinal tumours: recommendations of the Polish Society of Spine Surgery, the Polish Society of Oncology, the Polish Society of Neurosurgeons, the Polish Society of Oncologic Surgery, the Polish Society of Oncologic Radiotherapy, and the Polish Society of Orthopaedics and Traumatology.

PURPOSE: The purpose of these recommendations is to spread the available evidence for evaluating and managing spinal tumours among clinicians who encounter such entities. METHODS: The recommendations were developed by members of the Development Recommendations Group representing seven stakeholder scientific societies and organizations of specialists involved in various forms of care for patients with spinal tumours in Poland. The recommendations are based on data yielded from systematic reviews of the literature identified through electronic database searches. The strength of the recommendations was graded according to the North American Spine Society's grades of recommendation for summaries or reviews of studies. RESULTS: The recommendation group developed 89 level A-C recommendations and a supplementary list of institutions able to manage primary malignant spinal tumours, namely, spinal sarcomas, at the expert level. This list, further called an appendix, helps clinicians who encounter spinal tumours refer patients with suspected spinal sarcoma or chordoma for pathological diagnosis, surgery and radiosurgery. The list constitutes a basis of the network of expertise for the management of primary malignant spinal tumours and should be understood as a communication network of specialists involved in the care of primary spinal malignancies. CONCLUSION: The developed recommendations together with the national network of expertise should optimize the management of patients with spinal tumours, especially rare malignancies, and optimize their referral and allocation within the Polish national health service system.

Exposure to Secreted Bacterial Factors Promotes HIV-1 Replication in CD4+ T Cells.

Microbial translocation is associated with systemic immune activation in HIV-1 disease. Circulating T cells can encounter microbial products in the bloodstream and lymph nodes, where viral replication takes place. The mechanisms by which bacteria contribute to HIV-associated pathogenesis are not completely deciphered. Here, we examined how bacteria may impact T cell function and viral replication. We established cocultures between a panel of live bacteria and uninfected or HIV-1-infected activated peripheral blood CD4-positive (CD4+) T cells. We show that some bacteria, such as Escherichia coli and Acinetobacter baumannii, sustain lymphocyte activation and enhance HIV-1 replication. Bacteria secrete soluble factors that upregulate CD25 and ICAM-1 cell surface levels and activate NF-κB nuclear translocation. Our data also demonstrate that CD25 polarizes at the virological synapse, suggesting a previously unappreciated role of CD25 during viral replication. These findings highlight how interactions between bacterial factors and T cells may promote T cell activation and HIV-1 replication. IMPORTANCE People living with HIV suffer from chronic immune activation despite effective antiretroviral therapy. Early after infection, HIV-1 actively replicates in the gut, causing the breakage of the intestinal epithelial barrier and microbial translocation. Microbial translocation and chronic immune activation have been proven linked; however, gaps in our knowledge on how bacteria contribute to the development of HIV-related diseases remain. Whether T cells in the peripheral blood react to bacterial products and how this affects viral replication are unknown. We show that some bacteria enriched in people living with HIV activate T cells and favor HIV-1's spread. Bacteria release soluble factors that cause the overexpression of cellular molecules related to their activation state. T cells overexpressing these molecules also replicate HIV-1 more efficiently. These results help us learn more about how HIV-1, T cells, and bacteria interact with each other, as well as the mechanisms behind chronic immune activation.

Type I interferon response and vascular alteration in chilblain-like lesions during the COVID-19 outbreak.

BACKGROUND: The outbreak of chilblain-like lesions (CLL) during the COVID-19 pandemic has been reported extensively, potentially related to SARS-CoV-2 infection, yet its underlying pathophysiology is unclear. OBJECTIVES: To study skin and blood endothelial and immune system activation in CLL in comparison with healthy controls and seasonal chilblains (SC), defined as cold-induced sporadic chilblains occurring during 2015 and 2019 with exclusion of chilblain lupus. METHODS: This observational study was conducted during 9-16 April 2020 at Saint-Louis Hospital, Paris, France. All patients referred with CLL seen during this period of the COVID-19 pandemic were included in this study. We excluded patients with a history of chilblains or chilblain lupus. Fifty patients were included. RESULTS: Histological patterns were similar and transcriptomic signatures overlapped in both the CLL and SC groups, with type I interferon polarization and a cytotoxic-natural killer gene signature. CLL were characterized by higher IgA tissue deposition and more significant transcriptomic activation of complement and angiogenesis factors compared with SC. We observed in CLL a systemic immune response associated with IgA antineutrophil cytoplasmic antibodies in 73% of patients, and elevated type I interferon blood signature in comparison with healthy controls. Finally, using blood biomarkers related to endothelial dysfunction and activation, and to angiogenesis or endothelial progenitor cell mobilization, we confirmed endothelial dysfunction in CLL. CONCLUSIONS: Our findings support an activation loop in the skin in CLL associated with endothelial alteration and immune infiltration of cytotoxic and type I IFN-polarized cells leading to clinical manifestations.

Patency and flow response in endarterectomized coronary arteries.

Ninety patients, operated on from May, 1978, through June, 1979, underwent coronary endarterectomy and early recatheterization. Patency of grafts to endarterectomized arteries was 103 of 118 (87.3%) and patency of conventional vein grafts in the same patients was 217 of 233 (93.1%). Myocardial blood flow using xenon 133 washout, at rest and with isoproterenol-induced stress, was measured in 7 normal coronary arteries, 28 conventional saphenous vein grafts, and 33 saphenous vein grafts to endarterectomized coronary arteries. The increase in myocardial blood flow, from rest to isoproterenol-induced stress, was comparable for the three groups. The endarterectomized group was divided further by separating out the 10 patients with heavy scarring or residual disease. The remaining patients had a flow response identical to those with conventional saphenous vein grafts. The rate of perioperative infarction in patients receiving endarterectomy was 3 of 113 (2.6%), as measured by appearance of new persistent Q waves on the serial postoperative electrocardiogram. Positive pyrophosphate scans were noted in 12 of 105 (12.4%) patients. It is concluded that, in the early stages at least, grafts to endarterectomized coronary arteries stay open and perfuse the myocardium as well as conventional saphenous vein grafts unless the myocardium is heavily scarred or unless residual disease remains.

[Results of studies on the use of psychotropic drugs in the treatment of encephalopathies following early childhood brain damage]. / Ergebnisse eigener Untersuchungen über die Anwendung psychotroper Heilmittel zur Behandlung von Encephalopathien mach frühkindlicher Hirnschädigung.

Results are reported of three years' experiments on the use of psychotropic drugs in the treatment of 240 encephalopathic children between the ages of 6 and 15 years, who received 322 treatments in the clinic or ambulatory. The authors consider psychotropic drugs a good symptomatic medicament, helping to remove, alleviate or correct symptoms like psychomotor disturbances, distractability of attention, restlessness, tension, anxiety, night enuresis, explosivity, irritability, disturbed sleep etc. Effects of treatment are much better owing to the fact that patients are made more accessible to psychotherapy and psychagogic measures. Chlorpromazine, glutaminic acid and vitamins of the B group were particularly effective in the treatment of motorically excited encephalopaths with a passive attitude towards their surroundings.