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were generally well-tolerated. The nine enrolled individuals
antibody at 0, 3, and 6 weeks. Infusions of the two antibodies
Participants received three infusions of 30 mg/kg −1 of each
was administered during analytical treatment interruption.
that target independent sites on the HIV-1 envelope spike,
the intended movement. Within 1 week, this spatiotemporal
potent monoclonal anti-HIV-1 broadly neutralizing antibodies
the lumbosacral spinal cord with timing that coincided with
trial in which a combination of 3BNC117 and 10-1074, two
authors delivered trains of spatially selective stimulation to
Mendoza and colleagues reported on a phase 1b clinical
pulse generator with real-time triggering capabilities, the
interruption of treatment leads to rapid rebound viraemia.
paralysis despite extensive rehabilitation. Using an implanted
(HIV)-1 require lifelong antiretroviral therapy because
and presented with permanent motor deficits or complete
Individuals infected with human immunodeficiency virus
had sustained a spinal cord injury more than 4 years before
enabled voluntary control of walking in individuals who
Combination therapy with anti-HIV-1 antibodies maintains viral suppression
targeted spinal cord stimulation neurotechnologies that
complete leg paralysis. wagner and colleagues introduced
Capsule
Spinal cord injury leads to severe locomotor deficits or even
Targeted neurotechnology restores walking in humans with spinal cord injury
Using heterozygous TSC2 hPSCs with a conditional mutation
of TSC1 or TSC2 in human pluripotent stem cells (hPSCs).
cellular models of TSC by CRISPR-Cas9-mediated gene editing
origin of tuber cells, Blair and colleagues established human
are linked to epileptogenesis. To determine the developmental
aggregated forms of α-synuclein, analogous to those found
dysmorphic, disorganized neurons and glia in the cortex that
PD and healthy individuals contained abnormally cleaved and
pathologies of TSC are cortical tubers, which are regions of
risk of developing PD. The appendixes of both individuals with
mechanistic target of rapamycin complex 1 signaling. Hallmark
α-synuclein and that removal of the appendix decreases the
TSC2 gene. Their protein products are negative regulators of
the human appendix contains an abundance of misfolded
opmental disorder caused by mutations in the TSC1 or
kinson’s disease (PD). Killinger and co-authors reported that
Tuberous sclerosis complex (TSC) is a multisystem devel-
Misfolded α-synuclein is a pathological hallmark of Par-
genetically engineered human cortical spheroid models of tuberous sclerosis
The benefits of a missing appendix
Capsule
has frequently been indicated. Recently,
these symptoms, removal of the implants
other diseases. In an attempt to relieve
Universitetsforlaget, New York, Humanity Press, 1973.
breast implants, it is important to rule out
3 (1): 52-8.
complaints may be related to the silicone
compulsive and hoarding symptoms. Obsessive Compuls Relat Disord 2014;
When attempting to establish whether the
hoarding symptoms, obsessive-compulsive symptoms, and comorbid obsessive-
131118-COHANIM - 131118-COHANIM | 2 - B | 18-11-13 | 11:24:13 | SR:-- | Cyan
and more often non-specific, symptoms.
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131118-COHANIM - 131118-COHANIM | 2 - B | 18-11-13 | 11:24:13 | SR:-- | Yellow
J Anxiety Disorders 2013; 27 (3): 328-39.
implants, they may present with various,
131118-COHANIM - 131118-COHANIM | 2 - B | 18-11-13 | 11:24:13 | SR:-- | Magenta
patients that after getting silicone breast
200 (1): 35-4.
to be defined, clinicians should warn
differ from individuals with obsessive compulsive disorder? Psychiatry Res 2012;
While the optimal choice still remains
Disorders 2011; 25 (2): 192-202.
clinical response.
Stressful life events and material deprivation in hoarding disorder. J Anxiety
chose not to. Both of them had good overall
breast implants removed, while patient 2
hoarding and its relationship to life events. Depress Anxiety 2010; 27 (9): 829-38.
nosuppressants, patient 1 chose to have the
and Psychotherapy 2010; 2: 61-9.
courses of glucocorticosteroids and immu-
been reported as well [2]. Following several
trauma. J Loss Trauma 2001; 6 (3): 197-218.
without any evidence of granuloma has
but interstitial and membranous nephritis
directions. Dialogues in Clin Neurosci 2010; 12 (2): 233-40.
to the tubule-interstitial compartment,
#
Original articles Original articles Eitan Israeli Eitan Israeli Nature 2018; 563: 65 Sci Transl Med 2018; 10: eaar5280 PLoS One 2017; 12 (6): e0179541. symptoms across adolescence and young adulthood: a longitudinal twin study. in 15-year olds. PLoS ONE 2013; 8 (7): e69140. heritability of hoarding symptoms in adolescence: a population based twin study Neuropsychiatr Genet 2013; 162B (4): 380-7. discarding possessions: implications for hoarding disorder. A
ent from a combined result of fine needle aspiration (FNA) infectious pathogens [1]. Intravenous pulse most commonly of intra-abdominal origin, Given the rarity of AA and the lack
Table 3. Histology of surgical lymph node biopsy
and FNB. methylprednisolone was initiated on 4 con- negative infectious workup, lack of a clini- of clear diagnostic criteria, the correct
Diagnosis n (%) The median time from starting the investigation until secutive days, followed by oral 1.3 mg/kg cal response to antibiotics, and a dramatic diagnosis and appropriate treatments are
Lymphoma 48 (40.7) obtaining final diagnosis was 3 months in patients who had prednisone with a concomitant cyclospo- response to steroids [2,3]. Excluding the frequently delayed. Greater knowledge of
Nonspecific lymphadenopathy 32 (27.1)
Specific nontuberculous lymphadenitis* 29 (24.6) undergone percutaneous biopsy, but only 1.25 months in rine 5 mg/kg. Given the lack of an adequate latter, which could not be assessed as AA AA among physicians will promote early
Tuberculous lymphadenitis 3 (2.5) patients who were referred directly for surgery (P < 0.0001). clinical response and elevation of inflam- was surgically treated, our patient met all diagnosis and effective treatment.
Metastatic lymphadenopathy 2 (1.7) matory markers when steroid tapering was of the criteria. Similar to our patient, in the
Non-diagnostic 1 (0.8) attempted, intravenous immunoglobulins largest cohort to date of 30 patients with Correspondence
Total leukemia 118 (100) DISCUSSION 3 gr/kg were added. Over 3 weeks, the AAs, most patients (n=21) had IBD fol- Dr. I. Snast
*sarcoidosis, toxoplasmosis, systemic lupuserythematosus lymphadenopathy, Dept. of Dermatology, Rabin Medical Center
(Beilinson Campus), Petah Tikva 4941492, Israel
foreign body reaction, abscess, infectious mononucleosis, cat scratch disease, In common practice it is rare to base a diagnosis on the thigh ulcer healed completely and the chest lowed by neutrophilic dermatosis (n=6),
granulomatous inflammation (nondiagnostic), toxoplasmosis results of excisional biopsy of ELN. This practice is due to necrolysis ceased with granulation tissue and relapsing polychondritis (n=3) [2]. phone: (972-3) 937-6653
email: snastigor@gmail.com
the development of new methods of percutaneous biopsy and filling wound-bed. Two weeks later, the Although most cases of AA were
SEnSITIVITy AnD SpECIfICITy the advent of more accurate techniques. Nevertheless, surgical patient underwent reconstructive surgery. shown to involve the spleen. Our case References
The sensitivity and specificity of percutaneous biopsy for diag- biopsy allows for the extraction of lymph nodes to permit a Exposed ribs were covered with a muscular demonstrates that AAs can potentially 1. Ahronowitz I, Harp J, Shinkai K. Etiology and
management of pyoderma gangrenosum: a com-
nosis of lymphoma in all subgroups of patients were 67.8% and more detailed pathological analysis. Preserving lymph node flap of the remaining pectoralis major so appear anywhere in the body. Our patient prehensive review. Am J Clin Dermatol 2012; 13 (3):
79%, respectively, with a false positive rate in 21% (5/24) and microarchitecture and harvesting large samples aids in the that the entire wound was covered with a presented with the typical appearance of 191-211.
false negative rate in 32% (9/28) of patients [Table 4] final pathological diagnosis as well as permits thorough tissue split-thickness skin. Prednisone and cyclo- PG, another rare dermatosis mediated by 2. André MFJ, Piette J-C, Kémény J-L, et al. Aseptic
Fifty-four patients (46%) were referred for surgical biopsy workup. Excisional biopsy presented a diagnosis in 71% of sporine were slowly tapered. Subsequently, neutrophils, concurrently with AA. The abscesses: a study of 30 patients with or without
inflammatory bowel disease and review of the
due to lymphadenopathy only. Of this group, a histological the patients in our data sample. This result is in line with the adalimumab was initiated due to IBD exac- overlap between the two conditions was literature. Medicine (Baltimore) 2007; 86 (3): 145-61.
result of lymphoma from excisional biopsy occurred in 18 cases overall diagnostic yields of surgical biopsy of 70.4% and 63% erbation without skin lesion recurrence. also evident in a recent literature review 3. Bollegala N, Khan R, Scaffidi MA, et al. Aseptic
(35% of all patients). The sensitivity and specificity of percutane- that were first described 30 years ago by Doberneck [5] and of IBD-associated AA, in which 2 of 37 abscesses and inflammatory bowel disease: two cases
and review of literature. Can J Gastroenterol Hepatol
ous biopsy for diagnosis of lymphoma, in patients who were sent Margolis and their teams [6], respectively. patients (5.5%) presented with both dis- 2017; 2017: e5124354.
for examination due to lymphadenopathy only, were 53.8% and In the general population, the incidence of malignant COMMEnT orders [3]. This finding suggests that com- 4. Butler D, Shinkai K. What do autoinflammatory
70%, respectively, with a false positive rate in 30% and a false neoplasms that are determined following a presentation of AA represents a new clinical entity char- mon immunologic pathways may mediate syndromes teach about common cutaneous diseases
such as pyoderma gangrenosum? A commentary.
negative rate in 46% of patients. lymphadenopathy is very low [7-9]. However, this is not the acterized by deep neutrophilic abscesses, both disorders [4]. Dermatol Clin 2013; 31 (3): 427-35.
Overall, 31 patients (26.3%) had a previous history of lym- case among patients undergoing investigation at medical
phoma. Eighteen of these patients (58%) underwent percutane- centers where the proportion of patients receiving a diagno- Capsule
ous biopsy. In seven patients (22%), the biopsy revealed a recur- sis of malignant tumors reaches 40–60% [10]. In our study,
rence of lymphoma. Surgical biopsy confirmed the diagnosis lymphoma was the most common diagnosis obtained by gut check for a promising HIV treatment
of lymphoma in only five patients (71.4%). The sensitivity and both percutaneous biopsies (in 46% of patients) and surgical
specificity of percutaneous biopsy for diagnosis of recurrence of biopsies (in 40.7% of patients). Morris-Stiff and colleagues Eradicating human immunodeficiency virus (HIV) in infected against α4β7 as a treatment for their mild inflammatory
lymphoma were 62.5% and 80%, respectively, with a false posi- [11] found that lymphoma is a common cause of lymphade- patients likely requires disrupting the reservoir of infected bowel disease. Longitudinal colonoscopies revealed that the
tive rate of 28.5% and a false negative rate of 27%. The results nopathy, representing the histological diagnosis in 21% of T cells in the gastrointestinal tract. One approach may be anti-α4β7 therapy disrupted local lymphoid aggregates. The
did not reach statistical significance due to the small numbers all lymph node biopsy specimens. Moor et al. [12] reported targeting cells expressing the integrin α4β7, which has been treatment was well tolerated, but long-term effects on the HIV
of patients in these two groups. a surgical diagnosis of lymphoma in 19% of all cases includ- tested in simian immunodeficiency virus models and is an reservoir remain to be determined.
The sensitivity and specificity of the fine needle biopsy ing adults and children. The higher percentage of lymphoma approved therapy for inflammatory bowel disease. uzzan and
(FNB) was tested separately for identifiable lymphoma diagnoses by surgical pathology in the present study is likely colleagues studied a small cohort of HIV-infected individuals Sci Transl Med 2018; 10: eaau4711
on antiretroviral therapy who began receiving an antibody
pathology in all groups of patients and were found to be 63% explained by the high number of patients who were referred Eitan Israeli
and 82%, respectively. The results were thus not much differ- already with a previous history of lymphoma and the clinical
suspicion of disease recurrence. This finding may also suggest
Table 4. Sensitivity and specificity of percutaneous biopsy for lymphoma a reflection of a very busy hematological diseases center, as Capsule
in our institution.
Sensitivity Specificity false positive negative predictive p gene editing and muscular dystrophy
(%) (%) (%) value (%) value A substantial proportion of patients undergoing surgical
All patients* 19/28 (67.8) 19/24 (79) 5/24 (21) 9/28 (32) 0.0009 biopsy show findings that do not require treatment. Indeed, Duchenne muscular dystrophy (DMD) is characterized by model of DMD that exhibits many features of the human
N=52 our study found that 21.7% of all lymph node biopsies showed progressive muscle weakness and a shortened life span. disease. Intramuscular or systemic delivery of the gene editing
Lymphoma patients** 5/8 (62.5) 8/10 (80) 2/7 (28.5) 3/11 (27) 0.15 non-specific lymphadenopathy not requiring further treatment. The disease is caused by mutations that reduce or prevent components resulted in a substantial increase in dystrophin
n=18 Moor’s team [12] recorded 45% of cases with non-specific expression of dystrophin, an essential structural protein protein levels in skeletal and heart muscle. Restoration of
Lymphadenopathy*** 7/13 (53.8) 7/10 (70) 3/10 (30) 6/13 (6) 0.40 lymphadenopathy not requiring further treatment, raising the
patients n=23 in skeletal and heart muscle. The gene editing technology dystrophin expression was accompanied by improved muscle
*All patients who underwent a percutaneous biopsy prior to surgery question about whether this diagnosis could have been made CRISPR-Cas9 can correct disease-causing mutations and has histology.
**Patients with lymphoma history who underwent a percutaneous biopsy prior to surgery on other, non-surgical grounds. yielded promising results in mouse models of DMD. In a small, Science 2018; 362: 86
***Patients with lymphadenopathy in presentation who underwent a percutaneous biopsy prior to Surgical biopsy is considered a minor procedure involving short-term study, Amoasii et al. tested this strategy in a dog Eitan Israeli
surgery
procurement and study of tissue for the purpose of diagnosis,
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