Topological data analysis reveals a core gene expression backbone that defines form and function across flowering plants.

Since they emerged approximately 125 million years ago, flowering plants have evolved to dominate the terrestrial landscape and survive in the most inhospitable environments on earth. At their core, these adaptations have been shaped by changes in numerous, interconnected pathways and genes that collectively give rise to emergent biological phenomena. Linking gene expression to morphological outcomes remains a grand challenge in biology, and new approaches are needed to begin to address this gap. Here, we implemented topological data analysis (TDA) to summarize the high dimensionality and noisiness of gene expression data using lens functions that delineate plant tissue and stress responses. Using this framework, we created a topological representation of the shape of gene expression across plant evolution, development, and environment for the phylogenetically diverse flowering plants. The TDA-based Mapper graphs form a well-defined gradient of tissues from leaves to seeds, or from healthy to stressed samples, depending on the lens function. This suggests that there are distinct and conserved expression patterns across angiosperms that delineate different tissue types or responses to biotic and abiotic stresses. Genes that correlate with the tissue lens function are enriched in central processes such as photosynthetic, growth and development, housekeeping, or stress responses. Together, our results highlight the power of TDA for analyzing complex biological data and reveal a core expression backbone that defines plant form and function.

Because you had a bad day: the role of negative affect and justification in self-control failure.

Justification thinking (using excuses to "allow" giving into temptation) has been identified as a potential link between negative affect and self-control failure. We hypothesised that negative affect would prompt greater justification thinking, specifically deservingness thinking (i.e. "I deserve a treat"), and tested this for both inhibitory (temptation is to approach reward; self-control is to inhibit) and initiatory (temptation is to refrain from action, self-control is to initiate action) hypothetical self-control dilemmas. We found that only for inhibitory self-control (Study 1; N = 105) but not initiatory (Study 2; N = 116), negative affect resulted in greater deservingness thinking compared to neutral affect. We also hypothesised that negative mood coupled with justification would prompt greater likelihood of imagined self-control failure. We found that for inhibitory self-control (Study 3; N = 569), participants in negative affect (vs. neutral) and justification (vs. no justification) conditions were independently more likely to report they would fail at self-control. For initiatory self-control (Study 4; N = 321), we found an effect of negative affect on hypothetical self-control failure but no effect of justification. Overall, these studies confirm the role of negative affect in self-control processes and highlight differences between inhibitory and initiatory self-control situations.

Prevalence of eosinophilic esophagitis in a United States military health-care population.

Eosinophilic esophagitis (EoE) is a rapidly emerging chronic immune-mediated condition affecting children and adults, both genders, and all races. A large variation in the prevalence of EoE exists in the literature. The aim of this study is to establish the prevalence of EoE in a military health-care population in the United States using a comprehensive electronic medical record search. Using the International Classification for Diseases-9 code for EoE (530.13), the total number of EoE patients enrolled in the military health-care system from October 1, 2008 to September 30, 2009 including active-duty military, dependents of military personnel, and retirees were identified. For each case of EoE identified, demographic data (age, gender, and race) and geographic location was obtained. The overall prevalence of EoE was calculated as well as the prevalence within subgroups. The geographic regional locations were reported per the U.S. Census Bureau regions (Northeast, South, Midwest, and West). A total of 987 EoE patients were identified from 10,180,515 military health-care beneficiaries, establishing an overall prevalence of 9.7 per 100,000 (95% confidence interval [CI] 9.1-10.3). Seven hundred twenty-eight out of 7,707,372 adult patients were identified, establishing a prevalence of 9.5 per 100,000 (95% CI 8.8-10.1). Two hundred fifty-nine out of 2,473,143 pediatric patients were identified, establishing a prevalence of 10.5/100,000 (95% CI 9.2-11.8). EoE was more prevalent in males (odds ratio [OR] 2.03 [95% CI 1.78-2.32]) and higher in Caucasian versus African Americans (18.1 vs. 5.2/100,000, OR 3.47 [95% CI 2.40-5.03]). EoE was more prevalent in the Western region of the United States compared with the Northeast, South, and Midwest regions, with a prevalence of 11.9 versuss 5.2, 9.6, and 9.2 per 100,000, respectively. When comparing Northern with Southern states, there was an increased prevalence in the North (10.9 vs. 7.2/100,000, P < 0.05). In this large nationwide study, increase in prevalence of EoE was seen in younger adults, with a higher prevalence in Caucasians. Geographically, the western United States had a significantly higher prevalence with a slightly higher prevalence in the Northern latitude.

Safety of dilation in adults with eosinophilic esophagitis.

Esophageal dilation is an effective therapy for dysphagia in patients with stenosing eosinophilic esophagitis (EoE). Historically, there have been significant concerns of increased perforation rates when dilating EoE patients. More recent studies suggest that improved techniques and increased awareness have decreased complication rates. The aim of this study was to explore the safety of dilation in our population of EoE patients. A retrospective review of all adult EoE patients enrolled in a registry from 2006 to 2010 was performed. All patients who underwent esophageal dilation during this time period were identified and included in the analysis. Our hospital inpatient/outpatient medical records, radiology reports, and endoscopy reports were searched for evidence of any complication following dilation. Perforation, hemorrhage, and hospitalization were identified as a major complication, and chest pain was considered a minor complication. One hundred and ninety-six patients (41 years [12]; mean age [standard deviation], 80% white, 85% male) were identified. In this cohort, 54 patients (28%) underwent 66 total dilations (seven patients underwent two dilations, one patient underwent three dilations, and one patient underwent four dilations). Three dilation techniques were used (Maloney [24], Savary [29] and through-the-scope [13]). There were no major complications encountered. Chest pain was noted in two patients (4%). There were no endoscopic features (rings, furrows, plaques) associated with any complication. Type of dilator, size of dilator, number of prior dilations, and age of patient were also not associated with complications. Endoscopic dilation using a variety of dilators can be safely performed with minimal complications in patients with EoE.

Temperature and interspecific interactions drive differences in carbon use efficiencies and biomass stoichiometry among aquatic fungi.

Saprotrophic fungi play important roles in transformations of carbon (C), nitrogen (N), and phosphorus (P) in aquatic environments. However, it is unclear how warming will alter fungal cycling of C, N, and P. We conducted an experiment with four aquatic hyphomycetes (Articulospora tetracladia, Hydrocina chaetocladia, Flagellospora sp., and Aquanectria penicillioides), and an assemblage of the same taxa, to test how temperature alters C and nutrient use. Specifically, we evaluated biomass accrual, C:N, C:P, δ13C, and C use efficiency (CUE) over a 35-d experiment with temperatures ranging from 4ºC to 20ºC. Changes in biomass accrual and CUE were predominantly quadratic with peaks between 7ºC and 15ºC. The C:P of H. chaetocladia biomass increased 9× over the temperature gradient, though the C:P of other taxa was unaffected by temperature. Changes in C:N were relatively small across temperatures. Biomass δ13C of some taxa changed across temperatures, indicating differences in C isotope fractionation. Additionally, the 4-species assemblage differed from null expectations based on the monocultures in terms of biomass accrual, C:P, δ13C, and CUE, suggesting that interactions among taxa altered C and nutrient use. These results highlight that temperature and interspecific interactions among fungi can alter traits affecting C and nutrient cycling.

Exaggerated circulating Th-1 cytokine response in early rheumatoid arthritis patients with nodules.

BACKGROUND: Immunohistochemical studies of the rheumatoid nodule (RN) suggest it is a Th1 granuloma, with focal vasculitis, yet the pathogenesis remains unclear and little is known about circulating cytokines in these patients. OBJECTIVE: We studied circulating cytokines in DMARD-naïve RA patients to investigate associations with subcutaneous RN. METHODS: 149 DMARD-naïve adults with early RA (symptom duration ≤ 2 years) were assessed using the Simplified Disease Activity Index (SDAI), and hand and feet radiographs were scored using the modified Larsen method. Circulating cytokines and growth factors representative of T-helper cell 1(Th1) and Th2 cell, macrophages, and fibroblasts were measured using the Bio-Plex® suspension array system. RESULTS: Of 149 patients, 34 (22.8%) had subcutaneous RN, and these patients had more severe disease with higher mean swollen joint counts (p=0.02), SDAI (p=0.04) and modified Larsen scores (p=0.004). There were no differences in Rheumatoid Factor or anti-cyclic citrullinated peptide antibody positivity between patients with RN and those without RN. Patients with RN showed significantly higher levels of circulating IL-12 (p=0.02), IL-2 (p=0.048), and VEGF (p=0.033) levels, with a trend towards higher levels of IL-7 (p=0.056), IFN-γ (p=0.059) and IL-8 (p=0.074) compared to those without RN. CONCLUSIONS: DMARD-naïve early RA patients with RN had more severe disease than those without RN, and showed an exaggerated circulating Th1 and macrophage cytokine profile.

Functional disability and health-related quality of life in South Africans with early rheumatoid arthritis.

BACKGROUND: The severity and predictors of functional disability and health-related quality of life (HRQoL) in a cohort of South Africans with early rheumatoid arthritis (RA) were investigated. METHODS: Changes in the Health Assessment Questionnaire Disability Index (HAQ) and the 36-Item Short Form Health Survey (SF-36) following 12 months of traditional disease-modifying anti-rheumatic drugs (DMARDs) were studied in previously DMARD-naïve adults with disease duration ≤ 2 years. RESULTS: The majority of the 171 patients were female (82%), Black Africans (89%) with a mean (SD) symptom duration of 11.6 (7.0) months. In the 134 patients seen at 12 months, there were significant improvements in the HAQ and all domains of the SF-36 but 92 (69%) still had substantial functional disability (HAQ > 0.5) and 89 (66%) had suboptimal mental health [SF-36 mental composite score (MCS) < 66.6]. Multivariate analysis showed that female sex (p = 0.05) and high baseline HAQ score (p < 0.01) predicted substantial functional disability at 12 months. Unemployment (p = 0.03), high baseline pain (p = 0.02), and HAQ score (p = 0.04) predicted suboptimal mental health, with a trend towards a low level of schooling being significant (p = 0.08). CONCLUSIONS: Early RA has a broad impact on HRQoL in indigent South Africans, with a large proportion of patients still showing substantial functional disability and suboptimal mental health despite 12 months of DMARD therapy. Further research is needed to establish the role of interventions including psychosocial support, rehabilitation programmes, and biological therapy to improve physical function and HRQoL in this population.

The learning curve and safety of continuous intraoperative vagus nerve monitoring in thyroid surgery.

INTRODUCTION: Continuous intraoperative nerve monitoring allows for continuous feedback on the integrity of the recurrent laryngeal nerve (RLN) and the quality of its induced myogenic potential. The aims of this study were to assess the time requirements and risks associated with vagus nerve electrode placement when learning the technique. METHODS: This is a prospective observational study carried out in a single otolaryngology department at the start of a trainee's placement. A total of 40 vagus nerve dissections in 31 consecutive operations (22 hemithyroidectomies, 9 total thyroidectomies) using automatic periodic stimulation (APS, Medtronic) are included. Of the electrode placements, 10 were performed by the trainer and 30 by the trainee. The time required for each surgical step and complications relating to vagus nerve dissection were recorded. RESULTS: The average (median+IQR) total additional time attributable to vagus nerve dissection, electrode placement and baseline electromyogenic assessment was 3.1mins (2.5-3.3) for the trainer and 4.8mins (4.1-5.3) for the trainee (p<0.0001). There was a downward trend in time requirement for the trainee (not statistically significant, p=0.080). Total operative time was 38min (35-45) for hemithyroidectomy and 56min (53-62) for total thyroidectomy. There was a mix of benign (74%) and malignant (26%) histology, no intraoperative complications relating to autonomic dysfunction and one (2.5%) transient nerve palsy. CONCLUSIONS: Operative time attributable to vagus nerve electrode placement is short and the procedure is easy to learn. Appropriate surgical technique and careful anaesthetic considerations allow monitoring to be performed safely, and may reduce the rate of RLN palsy.

Computational prediction of plant metabolic pathways.

Uncovering genes encoding enzymes responsible for the biosynthesis of diverse plant metabolites is essential for metabolic engineering and production of plant metabolite-derived medicine. With the availability of multi-omics data for an ever-increasing number of plant species and the development of computational approaches, the metabolic pathways of many important plant compounds can be predicted, complementing a more traditional genetic and/or biochemical approach. Here, we summarize recent progress in predicting plant metabolic pathways using genome, transcriptome, proteome, interactome, and/or metabolome data, and the utility of integrating these data with machine learning to further improve metabolic pathway predictions.

Ultrastructural view of astrocyte arborization, astrocyte-astrocyte and astrocyte-synapse contacts, intracellular vesicle-like structures, and mitochondrial network.

The complexity of astrocyte morphology and syncytial coupling through gap junctions are crucial for astrocyte function in the brain. However, the ultrastructural details of astrocyte arborization and interactions between neighboring astrocytes remain unknown. While a prevailing view is that synapses selectively contact peripheral astrocyte processes, the precise spatial-location selectivity of synapses abutting astrocytes is unresolved. Additionally, knowing the location and quantity of vesicles and mitochondria are prerequisites to answer two emerging questions - whether astrocytes have a signaling role within the brain and whether astrocytes are highly metabolically active. Here, we provided structural context for these questions by tracing and 3D reconstructing three neighboring astrocytes using serial block-face scanning electron microscopy. Our reconstructions reveal a spongiform astrocytic morphology resulting from the abundance of reflexive and leaflet processes. At the interfaces, varying sizes of astrocyte-astrocyte contacts were identified. Inside an astrocyte domain, synapses contact the entire astrocyte, and synapse-astrocyte contacts increase from soma to terminal leaflets. In contrast to densely packed vesicles at synaptic boutons, vesicle-like structures were scant within astrocytes. Lastly, astrocytes contain dense mitochondrial networks with a mitochondrial volume ratio similar to that of neurites. Together, these ultrastructural details should expand our understanding of functional astrocyte-astrocyte and astrocyte-neuron interactions.

Using a 4K three-dimensional exoscope system (Vitom 3D) for mastoid surgery during the coronavirus disease 2019 pandemic.

OBJECTIVE: Microscopic surgery is currently considered the 'gold standard' for middle-ear, mastoid and lateral skull base surgery. The coronavirus disease 2019 pandemic has made microscopic surgery more challenging to perform. This work aimed to demonstrate the feasibility of the Vitom 3D system, which integrates a high-definition (4K) view and three-dimensional technology for ear surgery, within the context of the pandemic. METHOD: Combined approach tympanoplasty and ossiculoplasty were performed for cholesteatoma using the Vitom 3D system exclusively. RESULTS: Surgery was performed successfully. The patient made a good recovery, with no evidence of residual disease at follow up. The compact system has excellent depth of field, magnification and colour. It enables ergonomic work, improved work flow, and is ideal for teaching and training. CONCLUSION: The Vitom 3D system is considered a revolutionary alternative to microscope-assisted surgery, particularly in light of coronavirus disease 2019. It allows delivery of safe otological surgery, which may aid in continuing elective surgery.

Pulmonary nodules associated with JAK inhibitor therapy in rheumatoid arthritis: A case report.

Patients with rheumatoid arthritis (RA) may receive Janus kinase (JAK) inhibitors to achieve optimal control of their disease. We report a case of a patient who received a selective JAK1 inhibitor and subsequently developed multiple pulmonary nodules with cavitation. Biopsies confirmed the presence of cryptococcosis and the patient responded well to anti-fungal therapy.

Severity of personality dysfunction predicts affect and self-efficacy in daily life.

According to the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition (DSM-5) alterative model of personality disorders, severity of personality dysfunction theoretically involves deficits in identity, self-direction, empathy, and intimacy. We predicted that people with greater personality dysfunction would experience more problems in daily life, particularly problems associated with self-efficacy for engaging with affect and self-control (i.e., subjective willpower and distress intolerance), along with greater intensity of life stressors and higher perceived invalidation from others. Using ecological momentary assessment, participants (N = 99) were randomly prompted 7 times a day for 1 week, where they were asked questions about momentary affect, their perceived level of momentary distress tolerance, and their momentary willpower. Each night they were also asked about stressors experienced that day and intensity of their subjective response to those stressors and their daily experience of being invalidated. Results found that higher personality dysfunction, assessed at baseline, predicted greater daily negative affect, less daily positive affect, more intensely experienced stressors, and more perceived invalidation. We also found that personality dysfunction interacted with positive affect in predicting momentary self-efficacy and daily invalidation; people with greater personality dysfunction experienced lower momentary willpower, higher distress intolerance and stronger perceived invalidation alongside lower positive affect. These findings provide evidence that personality functioning influences daily life as well as support the use of the alterative model of personality disorders in conceptualizing personality pathology. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

A prospective clinical audit to evaluate postoperative quality of recovery in adults at New Somerset Hospital, Cape Town, South Africa.

BACKGROUND: Recent developments in perioperative medicine increasingly emphasise patient-centred approaches to quality of care metrics. To this end, the 15-item Quality of Recovery (QoR-15) scale is a well-validated and widely applied patient-centred measure of perioperative service quality. OBJECTIVES: To assess quality of recovery in a South African (SA) population by applying the QoR-15 and to identify the local contributors to poor quality of recovery. METHODS: A prospective observational study was performed in all adults undergoing elective and emergency surgery during daytime hours over a 2-week period in February 2019 at New Somerset Hospital, Cape Town, SA. Patients were approached by a qualitative interviewer on day 1 post surgery for consented recruitment, collection of demographic information and application of the QoR-15 questionnaire. RESULTS: Of 193 patients who had surgery, 154 fulfilled our criteria and completed the questionnaire. The median QoR-15 score was 123 out of 150, which is classified as 'good', although most patients (35%) fell into the 'moderate' category (90 - 121); 59% achieved the patient acceptable symptom state score (≥118). The median scores of the most poorly reported QoR-15 items were 5 for 'moderate pain' and 6 for 'able to return to work or usual home activities'. Poor scoring was not related to anaesthetic modality (p=0.088), surgical discipline (p=0.237), timing of surgery (p=0.717) or obstetric as opposed to non-obstetric patients (p=0.472). Construct validity was supported by a negative correlation with duration of anaesthesia (rho=-0.286; p<0.001) and lack of correlation with age (rho=-0.034; p=0.674). CONCLUSIONS: We found the QoR-15 to be a valid, feasible and acceptable tool for clinical auditing of perioperative service quality in SA. The median QoR-15 score was 123, with the majority of patients reflecting a moderate QoR. We have highlighted areas with potential for improvement and provided recommendations to address these aspects.

Prolonged treadmill running in normobaric hypoxia causes gastrointestinal barrier permeability and elevates circulating levels of pro- and anti-inflammatory cytokines.

This study examined the impact of treadmill running in normobaric hypoxia on gastrointestinal barrier permeability and the systemic inflammatory response. Ten recreationally active participants completed two 1-h bouts of matched-workload treadmill exercise (65% normoxic maximal oxygen consumption) in counterbalanced order. One bout was performed in normoxia (NORM: fraction of inspired oxygen (FIO2) = 20.9%) and the other in normobaric hypoxia (HYP: FIO2 = 13.5%). Minute ventilation, respiratory rate (RR), tidal volume (VT), oxygen consumption, carbon dioxide production, respiratory exchange ratio (RER), and heart rate (HR) were measured with a metabolic cart. Peripheral oxygen saturation (SpO2) was measured with pulse oximetry. Absolute tissue saturation (StO2) was measured with near-infrared spectroscopy. Fatty acid-binding protein (I-FABP) and circulating cytokine concentrations (interleukin (IL)-1Ra, IL-6, IL-10) were assayed from plasma samples that were collected pre-exercise, postexercise, 1 h-postexercise, and 4 h-postexercise. Data were analyzed with 2-way (condition × time) repeated-measures ANOVAs. Newman-Keuls post hoc tests were run where appropriate (p < 0.05). As compared with NORM, 1 h of treadmill exercise in HYP caused greater (p < 0.05) changes in minute ventilation (+30%), RR (+16%), VT (+10%), carbon dioxide production (+18%), RER (+16%), HR (+4%), SpO2 (-16%), and StO2 (-10%). Gut barrier permeability and circulating cytokine concentrations were also greater (p < 0.05) following HYP exercise, where I-FABP was shown increased at postexercise (+68%) and IL-1Ra at 1 h-postexercise (+266%). I-FABP and IL-1Ra did not change (p > 0.05) following NORM exercise. IL-6 and IL-10 increased with exercise in both study conditions but were increased more (p < 0.05) following HYP at postexercise (+705% and +127%, respectively) and 1 h-postexercise (+400% and +128%, respectively). Novelty Normobaric hypoxia caused significant desaturation and increased most cardiopulmonary responses by 10%-30%. Significant gut barrier permeability and increased pro- and anti-inflammatory cytokine concentrations could promote an "open window" in the hours following HYP exercise.

The management of laryngeal lipoid proteinosis.

BACKGROUND: Lipoid proteinosis is a rare autosomal recessive disorder caused by mutations in the extracellular matrix protein 1 gene. It is characterised by deposition of hyaline material in the skin and mucous membranes. This paper describes the management of two cases with laryngopharyngeal disease. METHODS: Two patients with a biopsy diagnosis of lipoid proteinosis were identified from the surgical pathology archive covering the period 2004-2016. Their notes were reviewed. RESULTS: An adult male and an adult female were identified. Both had dysphonia and laryngopharyngeal lesions. The patients underwent interval laser microlaryngoscopy to debulk disease but minimise mucosal injury and scarring, using a 'pepper pot' technique. Both had adequate symptom control. CONCLUSION: Lipoid proteinosis is a rare genetic condition, which typically presents in infancy with dysphonia and subsequent skin involvement. Two cases are presented to demonstrate that laryngotracheal symptoms can be controlled with interval laser debulking and the 'pepper pot' technique without causing stenosis.

Evaluation of Simulated Snow and Snowmelt Timing in the Community Land Model Using Satellite-based Products and Streamflow Observations.

The purpose of this study was to evaluate snow and snowmelt simulated by version 4 of the Community Land Model (CLM4). We performed uncoupled CLM4 simulations, forced by Modem-Era Retrospective Analysis for Research and Applications Land-only (MERRA-Land) meteorological fields. GlobSnow snow cover fraction (SCF), snow water equivalent (SWE) and satellite-based passive microwave (PMW) snowmelt-off day of year (MoD) data were used to evaluate SCF, SWE, and snowmelt simulations. Simulated runoff was then fed into a river routing scheme and evaluation was performed at 408 snow-dominated catchments using gauge observations. CLM4 and GlobSnow snow cover extent showed a strong agreement, especially during the peak snow cover months. Overall there was a good correlation between simulated and observed SWE (correlation coefficient, R = 0.6). Simulated and observed SWE were similar over areas with relatively flat terrain and moderate forest density. The simulated MoD agreed (MoD differences (CLM4-PMW) = +/-7 days) with observations over 39.4% of the study domain. Snowmelt-off occurred earlier in the model compared to the observations over 39.5 % of the domain and later over 21.1% of the domain. Large differences of MoD were seen in the areas with complex terrain and dense forest cover. We also found that, although streamflow seasonal phase was accurately modeled (R=0.9), the peaks controlled by snowmelt were underestimated. Routed CLM4 streamflow tended to occur early (by 10 days on average).

Assimilation of MODIS Snow Cover Fraction Observations into the NASA Catchment Land Surface Model.

The NASA Catchment land surface model (CLSM) is the land model component used for the Modern-Era Retrospective Analysis for Research and Applications (MERRA). Here, the CLSM versions of MERRA and MERRA-Land are evaluated using snow cover fraction (SCF) observations from the Moderate Resolution Imaging Spectroradiometer (MODIS). Moreover, a computationally-efficient empirical scheme is designed to improve CLSM estimates of SCF, snow depth, and snow water equivalent (SWE) through the assimilation of MODIS SCF observations. Results show that data assimilation (DA) improved SCF estimates compared to the open-loop model without assimilation (OL), especially in areas with ephemeral snow cover and mountainous regions. A comparison of the SCF estimates from DA against snow cover estimates from the NOAA Interactive Multisensor Snow and Ice Mapping System showed an improvement in the probability of detection of up to 28% and a reduction in false alarms by up to 6% (relative to OL). A comparison of the model snow depth estimates against Canadian Meteorological Centre analyses showed that DA successfully improved the model seasonal bias from -0.017 m for OL to -0.007 m for DA, although there was no significant change in root-mean-square differences (RMSD) (0.095 m for OL, 0.093 m for DA). The time-average of the spatial correlation coefficient also improved from 0.61 for OL to 0.63 for DA. A comparison against in situ SWE measurements also showed improvements from assimilation. The correlation increased from 0.44 for OL to 0.49 for DA, the bias improved from -0.111 m for OL to -0.100 m for DA, and the RMSD decreased from 0.186 m for OL to 0.180 m for DA.

Systemic lupus erythematosus: A possible cause of non-alcoholic Wernicke's encephalopathy.

We report a young woman with systemic lupus erythematosus (SLE) and an acute cerebellar ataxia. A history of poor appetite and vomiting preceded the inco-ordination. Ataxia in SLE has been well described, but is nevertheless uncommon. The clinical triad of mild confusion, ataxia and ophthalmoplegia also raised the possibility of Wernicke's encephalopathy (WE). The diagnosis of WE was further supported by the magnetic resonance imaging features. Owing to overlapping causal factors, this case illustrates the complexity of diagnosing and managing neuropsychiatric syndromes in a patient with SLE. The limited published literature on SLE-related cerebellar syndromes adds to the challenge. Gastrointestinal manifestations of SLE are described as being common in SLE, with nausea and vomiting occurring in >50% of cases in some series. Poor eating habits and vomiting are well-described causes of non-alcoholic WE. This is the first description of gastrointestinal SLE as a possible cause of WE.

Eosinophilic oesophagitis and proton pump inhibitor-responsive oesophageal eosinophilia have similar clinical, endoscopic and histological findings.

BACKGROUND: Some patients with a phenotypic appearance of eosinophilic oesophagitis (EoE) respond histologically to PPI, and are described as having PPI-responsive oesophageal eosinophilia (PPI-REE). It is unclear if PPI-REE is a GERD-related phenomenon, a subtype of EoE, or a completely unique entity. AIM: To compare demographic, clinical and histological features of EoE and PPI-REE. METHODS: Two databases were reviewed from the Walter Reed and Swiss EoE databases. Patients were stratified into two groups, EoE and PPI-REE, based on recent EoE consensus guidelines. Response to PPI was defined as achieving less than 15 eos/hpf and a 50% decrease from baseline following at least a 6-week course of treatment. RESULTS: One hundred and three patients were identified (63 EoE and 40 PPI-REE; mean age 40.2 years, 75% male and 89% Caucasian). The two cohorts had similar dysphagia (97% vs. 100%, P = 0.520), food impaction (43% vs. 35%, P = 0.536), and heartburn (33% vs. 32%, P = 1.000) and a similar duration of symptoms (6.0 years vs. 5.8 years, P = 0.850). Endoscopic features were also similar between EoE and PPI-REE; rings (68% vs. 68%, P = 1.000), furrows (70% vs. 70%, P = 1.000), plaques (19% vs. 10%, P = 0.272), strictures (49% vs. 30%, P = 0.066). EoE and PPI-REE were similar in the number of proximal (39 eos/hpf vs. 38 eos/hpf, P = 0.919) and distal eosinophils (50 vs. 43 eos/hpf, P = 0.285). CONCLUSIONS: EoE and PPI-responsive oesophageal eosinophilia are similar in clinical, histological and endoscopic features and therefore are indistinguishable without a PPI trial. Further studies are needed to determine why a subset of patients with oesophageal eosinophilia respond to PPI.