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with the CTL infiltration level to influence patient survival.
Nature Med 2018; 24: 1550
testing how the expression of each gene in tumors interacts
signatures of T cell dysfunction from large tumor cohorts by
infiltration in tumors with low CTL level. The authors identified
of cytotoxic T lymphocytes (CTL) and the prevention of T cell
induction of T cell dysfunction in tumors with high infiltration
two primary mechanisms of tumor immune evasion: the
et al. developed TIDE, a computational method to model
patients respond to treatment. To predict ICB response, Jiang
bring long lasting clinical benefits, but only a fraction of
Cancer treatment by immune checkpoint blockade (ICB) can
Signatures of T cell dysfunction and exclusion predict cancer immunotherapy response
Capsule
pylori infection (Hp-I) has an impact on
We agree with them that Helicobacter
Medical Association Journal (IMAJ).
are published in this issue of the Israel
w leagues for their comments, which
e thank Dr. Kountouras and col-
To the Editor:
Colorectal Cancer
pylori Seropositivity and
The Association of Helicobacter
8: 4088.
syndrome: a large cross-sectional study. Sci Rep 2018;
its related gastroduodenal morbidity with metabolic
Muhsen K. Relationships of H. pylori infection and
4. Refaeli R, Chodick G, Haj S, Goren S, Shalev V,
oncogenesis. Am J Gastroenterol 2013; 108: 625-6.
Impact of Helicobacter pylori infection on colon
3. Kountouras J, Kapetanakis N, Zavos C, et. al.
tract oncogenesis. Metabolism 2018; 87: 18-24.
bolic syndrome on upper and lower gastrointestinal
Potential impact of Helicobacter pylori-related meta-
2. Kountouras J, Polyzos SA, Doulberis M, et al.
undergoing PET/CT scans. IMAJ 2018; 20: 504-8.
3,6
all-cause mortality among colorectal cancer patients
1,5
association of Helicobacter pylori seropositivity with
1. Shmuely H, Brenner B, Groshar D, et al. The
References
[jannis@auth.gr; ancoratus2010@gmail.com]
Military Hospital of Athens, Athens, Greece
4
Department of Gastroenterology, 401 General
Thessaloniki, Greece
School, Aristotle University of Thessaloniki,
First Department of Pharmacology, Medical
3
Switzerland
University Hospital Inselspital Bern, Bern,
2
Department of General Internal Medicine,
Original articles V. Kalamaro, K. Harshkop, R. Lipner and O. Tamir in Diabetes OTZMA, 21 March 2018 Conference on Therapeutic Patient Education healthcare: highlights from the 4th Annual F. Rey, T. Ronchard, J. Chaara and S. Noble the first transcatheter closure still a deadly complication 30 years after I. Levi, M. Zektser, V. Stavi, G. Sebbag and S. Lantsberg N. Hod, R. Anconina, D. Levin, E. Tiktinsky, D. Ezroh K
#
Hoarding among Jewish Holocaust Survivors: Moving tomical changes so modern hybrid imaging demonstrated in a number of papers. In a active infection where biopsy is likely to
Toward a Theoretical Model of PET/CT, which integrates high anatomi- literature review article [5], FDG PET/CT provide the correct diagnosis.
correctly predicted disease progression,
cal resolution with metabolic changes, are
likely to detect these infections at an ear- whereas MRI findings suggested improve- COnCluSIOnS
Bat-Sheva Porat-Katz MD , Teresa W. Johnson DCN , Itai Katz B Med Sc and Shelly Rachman-Elbaum PhD 1 lier stage with higher diagnostic accuracy ment. In another study, after completion This case demonstrated the diagnostic
3,5
1,2
4
rates. Research results have highlighted the of antifungal therapy for hepatosplenic potential of FDG PET/CT in detecting inva-
1 Smith Faculty of Agriculture, Food and Environment, School of Nutritional Sciences, Hebrew University of Jerusalem, Rehovot, Israel advantages of PET/CT in imaging fungal and renal abscess before restarting che-
2 Israeli Ministry of Health, Jerusalem, Israel sive aspergillosis, including guidance for the
3 Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel infections [3-5]. FDG PET/CT frequently motherapy, FDG PET/CT detected lesions most appropriate site for biopsy, detection
4 Department of Kinesiology and Health Promotion, Troy University, Alabama, USA found occult lesions that were not found in the skeletal and cardiac muscles, and in of the true extension of the disease and
5 Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel with other imaging techniques, and the the lungs, that showed antifungal treat- evidence for fungal infection activity, and
results helped to determine treatment ment failure; hence, a different antifungal monitoring the antifungal treatment effec-
length. therapy was given and lesions resolved. tiveness by a series of FDG PET/CT scans.
Clearly it is of invaluable importance to The preliminary papers, however, usually Further investigation with a larger patient
ABSTRACT: Background: Previously described as a subcategory of obses- with possessions, regardless of their actual value.” [1] Affected have a noninvasive whole-body technique involved a limited number of patients [3-5]. cohort is warranted.
sive compulsive disorder (OCD), hoarding disorder was added individuals perceive a need to save items and are distressed at to localize all fungal lesions (even in the CT and MRI depend on structural
to the fifth Diagnostic and Statistical Manual of Mental the thought of discarding them. Without intervention from presence of severe neutropenia) and to have resolution for visualizing disease but Correspondence
Disorders (DSM-V) as a stand-alone diagnosis for the first time. families or third parties, hoarding creates an unhealthy living a way to monitor disease activity to decide nuclear medicine techniques can detect Dr. n. Hod
The first formal research in the 1990s surprisingly found no environment driving the affected person into further social and whether therapy can be stopped, should be in vivo pathophysiological changes before Institute of Nuclear Medicine and Molecular
connection between material deprivation early in life and occupational isolation. The volume of hoarded items sets them prolonged, or should be switched. anatomical changes are observed. Modern Imaging, Soroka University Medical Center, Beer
hoarding; however, later studies linked early traumatic life apart from others. People who collect stamps or coins deliber- Disseminated fungal lesions seen on hybrid imaging modality of PET/CT pro- Sheva 84101, Israel
phone: (972-8) 640-0754
experiences with hoarding. Subsequent familial studies ately seek out objects and organize them. Conversely, people ultrasound, CT, or MRI have been found vides a unique opportunity to combine fax: (972-8) 638-3695
demonstrated a genetic predisposition for hoarding. Emerging with hoarding disorder commonly hoard random items such to persist for a long time after successful the excellent anatomical resolution with email: hod_n@yahoo.com
evidence suggests a link between a post-traumatic stress as newspapers, magazines, paper and plastic bags, cardboard antifungal treatment due to conditions metabolic functional information to diag-
disorder (PTSD) and hoarding in Jewish Holocaust survivors. boxes, photographs, household supplies, food, clothing, toys, such as fibrosis; therefore, these imag- nose, localize, and stage IFIs at a very early References
Objectives: To evaluate the literature on PTSD among Jewish 1. Denning DW, Ribaud P, Milpied N, et al. Efficacy
Holocaust survivors for associations between PTSD and and even animals. Hoarders see potential need for these items ing modalities may have limitations in stage. The overall agreement of the studies and safety of voriconazole in the treatment of acute
hoarding. or attach sentimental value to items they believe are unique and assessing therapeutic effect and guid- is that FDG PET/CT is useful in staging IFIs invasive aspergillosis. Clin Infect Dis 2002; 34: 563-71.
Methods: A systematic search of selected databases, including irreplaceable. They may believe their inventory was obtained ing therapy. In contrast, FDG PET/CT [3-5]. It is helpful to know the extent of the 2. Jamar F, Buscombe J, Chiti A, et al. EANM/SNMMI
guideline for 18F-FDG use in inflammation and
PubMed, Google Scholar, NCBI, Psych Info, and EBSCO Host at a great bargain and too valuable to discard. They may attach provides more accurate information on infection and the organs involved before the infection. J Nucl Med 2013; 54: 647-58. 131118-COHANIM - 131118-COHANIM | 1 - A | 18-11-13 | 11:24:13 | SR:-- | Magenta 131118-COHANIM - 131118-COHANIM | 1 - A | 18-11-13 | 11:24:13 | SR:-- | Yellow
was conducted from 1 March 2017 to 15 July 2018 using the emotional value to items that remind them of events or people therapeutic response, especially for residual onset of therapy, not only to correctly stage 3. Sharma P, Mukherjee A, Karunanithi S, Bal C, #131118-COHANIM - 131118-COHANIM | 1 - A | 18-11-13 | 11:24:13 | SR:-- | Black 131118-COHANIM - 131118-COHANIM | 1 - A | 18-11-13 | 11:24:13 | SR:-- | Cyan
following search terms: hoarding, hoarding disorder, obsessive they do not want to forget. Finally, affected individuals become metabolically active focal deposits in IFIs. it during infection, but also to decide later Kumar R. Potential role of 18F-FDG PET/CT in
compulsive disorder, OCD, compulsive hoarding, Jewish overwhelmed by their inability to organize their trappings so FDG PET/CT allows whole body imaging, if the infection disappeared after comple- patients with fungal infections. AJR Am J Roentgenol
2014; 203: 180-9.
Holocaust survivors, Shoa, post-traumatic stress disorder, and keeping them is easier than sorting and discarding. Hoarding which may detect any uptake throughout tion of the therapy to exclude recurrence. 4. Hot A, Maunoury C, Poiree S, et al. Diagnostic
PTSD. Inclusion criteria included peer reviewed research pub- ranges from mild to severe. In the latter case, affected individuals the body in one imaging session and thus However, histological confirmation must contribution of positron emission tomography
lished on adults in English since 1990. Because no publications may experience emotional, physical, social, financial, and even is likely to pick up infectious foci that may always be performed for a final diagnosis, with [ 18 F]fluorodeoxyglucose for invasive fungal
linking hoarding and PTSD in Jewish Holocaust survivors were legal consequences, such as eviction from their homes. Interest not yet have become clinically apparent as well as for distinguishing between active infections. Clin Microbiol Infect 2011; 17: 409-17.
found, references in retained papers were also searched for any in diagnosis and treatment of hoarding began in the 1990s and and were not detected by other imaging infection and residual local inflammation. 5. Ankrah AO, Sathekge MM, Dierckx RA,
relevant published work. has steadily increased since that time, including demonstrations studies. This phenomenon was consistently FDG PET/CT is able to define the sites of Glaudemans AW. Imaging fungal infections in
children. Clin Transl Imaging 2016; 4: 57-72.
Results: Seven articles linking PTSD and hoarding were of heritability [2].
identified for this review. However, no articles were found Similarly, PTSD diagnosis and treatment are relative new-
linking PTSD and hoarding in Jewish Holocaust survivors. comers to psychotherapy. The DSM-V criteria for a diagnosis Capsule
Conclusions: A relationship between PTSD and hoarding of PTSD includes a direct or indirect exposure to major trauma
in Jewish Holocaust survivors is conceivable and should (e.g., death or near-death, significant trauma, threatened
be explored to effectively diagnose and care for affected or actual sexual violence). The exposure is persistently re- giving antibodies a boost
individuals. experienced through memories, nightmares, and flashbacks. Persistent immune activation during chronic infections is on antigen expression levels. Furthermore, afucosylation of
IMAJ 2018; 20: 670–673 Additional descriptors include difficulty sleeping, hypervigi- often associated with increased generation and deposition antibodies directed against CD4 and CD8α enhanced their
KEY WORDS: hoarding disorder, Holocaust, obsessive compulsive lance, risky behavior, negative feelings, and social and func- of immune complexes. The actions of antibody-based drugs ability to deplete CD4 + and CD8 + T cells in mice persistently
disorder (OCD), post-traumatic stress disorder (PTSD) can thus be severely impaired in individuals with chronic infected with LCMV. Whether afucosylation can be universally
tional impairment [3]. PTSD was not widely investigated until
the 1970s and few people received targeted treatment until the infections. Using lymphocytic choriomeningitis virus (LCMV) used to enhance antibody functions during chronic infections
remains to be seen.
as a model of chronic infection, wieland and colleagues
1980s [4]. For that reason, many affected individuals coped with
ccording to the fifth Diagnostic and Statistical Manual of their symptoms instead of receiving treatment. This situation examined how to enhance antibody functions in this setting. Sci Immunol 2018; 3: eaao3125
The ability of antibodies to deplete target cells was dependent
A Mental Disorders (DSM-V) diagnostic criteria, hoarding was particularly true for Jewish Holocaust survivors who had Eitan Israeli PERFECTOR
disorder is defined as, “persistent difficulty discarding or parting no time to mourn, adjust, or even think about the trauma they
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