Canadian Rheumatology Association Recommendations for the Screening, Monitoring, and Treatment of Juvenile Idiopathic Arthritis-Associated Uveitis.

OBJECTIVE: To develop Canadian recommendations for the screening, monitoring, and treatment of uveitis associated with juvenile idiopathic arthritis (JIA). METHODS: Recommendations were developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE)-ADOLOPMENT approach. A working group of 14 pediatric rheumatologists, 6 ophthalmologists, 2 methodologists, and 3 caregiver/patient representatives reviewed recent American College of Rheumatology (ACR)/Arthritis Foundation (AF) recommendations and worked in pairs to develop evidence-to-decision (EtD) tables. A survey to assess agreement and recommendations requiring group discussion was completed. EtD tables were presented, discussed, and voted upon at a virtual meeting, to produce the final recommendations. A health equity framework was applied to all aspects of the adolopment process including the EtD tables, survey responses, and virtual meeting discussion. RESULTS: The survey identified that 7 of the 19 recommendations required rigorous discussion. Seventy-five percent of working group members attended the virtual meeting to discuss controversial topics as they pertained to the Canadian environment, including timing to first eye exam, frequency of screening, escalation criteria for systemic and biologic therapy, and the role of nonbiologic therapies. Equity issues related to access to care and advanced therapeutics across Canadian provinces and territories were highlighted. Following the virtual meeting, 5 recommendations were adapted, 2 recommendations were removed, and 1 was developed de novo. CONCLUSION: Recommendations for JIA-associated uveitis were adapted to the Canadian context by a working group of pediatric rheumatologists, ophthalmologists with expertise in the management of uveitis, and parent/patient input, taking into consideration cost, equity, and access.

The role of radiotherapy for T4 non-melanoma skin carcinoma.

INTRODUCTION: To review outcomes of patients treated with radiotherapy (RT) for T4 non-melanoma skin cancer (NMSC). METHODS: A retrospective chart review was performed of 21 patients who received RT for T4 NMSC from 2004 to 2010. Outcomes of treatment efficacy, RT technique and patient morbidity were analysed. Twelve patients (57.1%) were treated definitively without prior treatment, five (23.8%) were recurrent lesions and four (19.1%) were treated postoperatively. Ten patients (47.6%) had evidence of bony erosion at presentation, and four (19.1%) had nodal disease. Intensity-modulated radiotherapy (IMRT), three-dimensional conformal RT and electron treatment were included RT techniques. RESULTS: Median follow-up was 12 months (range, 5-48 months). Twelve patients (57.1%) following RT required no further treatment and had no disease recurrence. Three patients (14.3%) required salvage treatment and are disease-free following all treatment. Tumours treated initially or postoperatively had improved control rates following RT compared with recurrent lesions (58.3% and 100% vs. 20%). Sixty percent of patients treated with IMRT achieved local control following RT, and 80% were disease-free following surgical salvage treatment. Squamous cell carcinoma (SCC) histology, presence of bony erosion and/or nodal disease was associated with a higher incidence of disease recurrence. CONCLUSIONS: Patients presenting with untreated lesions, smaller tumour volumes (<70 cm(3)) postoperatively, basal cell histology and absence of bone erosion or nodal disease have improved local control and outcomes. Basal cell carcinoma and SCC should be staged and treated as two separate disease entities. The use of IMRT for advanced skin cancer warrants further investigation.

Adult depression-like behavior, amygdala and olfactory cortex functions are restored by odor previously paired with shock during infant's sensitive period attachment learning.

Maltreatment from the caregiver induces vulnerability to later life psychopathologies, yet attraction and comfort is sometimes provided by cues associated with early life maltreatment. We used a rat model of early life maltreatment with odor-0.5 mA shock conditioning to produce depressive-like behaviors and questioned whether stimuli associated with maltreatment would restore emotional neurobehavioral function to control levels. Pups received daily novel odor-0.5 mA shock conditioning from postnatal day 8 to 12. This procedure produces a new maternal odor that controls pups' attachment behaviors. In adulthood, either with or without the infant odor, animals received a Forced Swim Test, Sucrose Preference Test or assessment of amygdala and olfactory system functioning using field potential signal evoked by olfactory bulb paired-pulse electrical stimulation. Following neonatal odor-shock pairings, but not unpaired controls, adults without the odor present showed increased depression-like behavior in the Forced Swim Test and Sucrose Preference Test and a deficit in paired-pulse inhibition in amygdala and piriform (olfactory) cortex. All effects were brought to control levels when the infant conditioned odor was presented during behavioral and neural tests. The ability of cues associated with early life maltreatment to normalize behavior and amygdala activity suggests these cues provide adaptive value in adulthood.