Notes

Grown-up beginning Still's disease in a individual with scleroderma: circumstance statement.
The small or non-existing seasonal variation in sleep and sleep difficulties indicate that extreme seasonal variation in daylight is of little influence on sleep status. The city of Tromsø is a modern city with considerable level of artificial light, which may contribute to the observed rather stabile sleep patterns throughout the year.The aim of this study was to investigate the association between self-reported seasonality, i.e., seasonal variations in mood and related behavior, and chronotype, and between self-reported seasonality and home address' latitude. Data were collected from an online questionnaire with 45,338 participants. Seasonality and chronotype were measured with the Global Seasonality Score (GSS) and the Composite Scale of Morningness, respectively. The participants were categorized into extreme morning types, moderate morning types, intermediate types, moderate evening types, and extreme evening types. Furthermore, participants were categorized depending on home address' latitude. Data were analyzed with chi-square tests and logistic regression analyses adjusting for sex, age, marital status, level of education, and children living at home. Results showed that high seasonality (GSS 11+) was found in 20.9%. The prevalence dose-dependency ranged from 12.2% in extreme morning types to 42.6% in extreme evening types (adjusted OR = 4.21, CI = 3.27-5.41). The prevalence was higher in participants living in North-Norway (latitude from 65 to 71⁰N) versus South-Norway (latitude from 58 to 65⁰N) (23.8% versus 20.7%; adjusted OR = 1.18, CI = 1.08-1.28). When comparing the northernmost (69-71⁰N) to the southernmost (58-59⁰N) counties of Norway, the association was stronger (24.9% versus 18.7%; adjusted OR = 1.37, CI = 1.20-1.56). Among the adjusting variables, high seasonality was associated with female sex, younger age, being unmarried, low level of education, and not having children living at home. In conclusion, about one in five Norwegians reported high seasonality. High seasonality was strongly associated with late chronotype (being an evening type) and weakly associated with living in the north (high latitude).Objectives To investigate the characteristics of margin reflex distance 1 (MRD1) asymmetry in congenital lower eyelid epiblepharon and its resolution after surgical correction of epiblepharon. Methods Among patients who underwent lower eyelid epiblepharon surgery from November 2015 to September 2017, patients with a preoperative MRD1 difference of more than 1.0 mm between the two eyes according to medical photographs were defined as having MRD1 asymmetry. A postoperative MRD1 difference of less than 1.0 mm between the two eyes was regarded as MRD1 asymmetry resolution. The preoperative MRD1 difference was compared between subgroups with resolved or sustained MRD1 asymmetry. Astigmatism and amblyopia were also assessed. Results Among 432 patients, MRD1 asymmetry was observed in 24 patients (5.6%). MRD1 was always lower in the side with more extensive epiblepharon. At 6 months after surgery, the mean MRD1 difference between the two eyes was significantly decreased (1.8 ± 0.7 mm to 0.5 ± 0.8 mm, p less then .001, paired t-test) and MRD1 asymmetry resolution occurred in 19 patients (79%). In the resolved MRD1 asymmetry group, the preoperative MRD1 difference was 2.0 mm or less and was significantly smaller than that in the sustained MRD1 asymmetry group (p = .010, Mann-Whitney U test). Six patients had preoperative aniso-astigmatism ≥ 1.50 D. Unilateral amblyopia presented in nine patients (38%) and improved within 1 year postoperatively. Conclusions MRD1 asymmetry can be resolved after epiblepharon surgery, especially when the preoperative MRD1 difference is 2.0 mm or less. Unilateral amblyopia was frequent, but the treatment outcome was good.Immune checkpoint inhibitors (ICIs) changed management of non-small-cell lung cancer, but resistance usually develops. Today, at ICIs failure, chemotherapy is the treatment of choice, but the chance of immunotherapy rechallenge is appealing. Another challenging issue is whether it is safe to treat HIV-positive patients with ICIs safety and efficacy of immunotherapy have been marginally considered in this subgroup. We report the case of a non-small-cell lung cancer patient treated by PD-1 inhibitors rechallenge despite his HIV-positivity, achieving good partial response with significant clinical benefit and without toxicities. Our experience underlines that HIV-positive patients can be treated similarly to HIV-negative individuals. HIV-positivity should be considered similar to other comorbidities, and not as a sufficient reason to preclude them the best available treatments.Introduction Cystic fibrosis (CF), the most common life-shortening inherited disorder in people of European descent, also occurs in other ethnicities. The identification of the disease, the isolation of the causative gene, termed the cystic fibrosis transmembrane conductance regulator (CFTR) and the improved survival from comprehensive multidisciplinary treatment is one of the success stories of modern medicine. Survival has increased dramatically over the last 50 years, from 10 years in the 1960s to 30 years in the 1990s and approximately 50 years currently. Areas covered This review will examine the development of highly effective modulators for CF which will revolutionize therapy for more than 90% of the people with CF. This review summarizes the development of triple combination CFTR modulator elexacaftor-tezacaftor-ivacaftor. Expert opinion The development of this highly effective CFTR modulator for the majority of people with CF will likely change the landscape of CF care. The challenge is to now find highly effective therapy for the remaining 10% of the people with CF who may need other therapeutic agents to correct their primary defect.
This study aimed to examine a novel microRNA (miR-652-3p) biomarker to improve early diagnosis of acute kidney injury (AKI) in patients with acute decompensated heart failure (ADHF) and to evaluate the survival predictive value of miR-652-3p.

We retrospectively analyzed the data of 196 patients with ADHF, including 65 who developed AKI during hospitalization. Neutrophil gelatinase-associated lipocalin (NGAL) levels were measured in serum and urine samples. Real-time quantitative PCR was applied to evaluate miR-652-3p mRNA expression. The diagnostic performance of miR-652-3p was examined using receiver operating characteristic curve analysis. The prognostic value of miR-652-3p was also analyzed.

Serum and urinary NGAL and miR-652-3p levels were elevated in patients with ADHF and AKI. Serum and urinary miR-652-3p expression had diagnostic value in predicting AKI onset in patients with ADHF, and it had improved diagnostic performance when used with NGAL. Syrosingopine Patients with AKI and high miR-652-3p levels had a high failure rate of renal recovery and poor 180-day survival.

Serum and urinary miR-652-3p may be a candidate biomarker for early diagnosis of AKI in patients with ADHF and for predicting the prognosis of AKI. The combination of NGAL and miR-652-3p may accurately predict AKI onset in ADHF.
Serum and urinary miR-652-3p may be a candidate biomarker for early diagnosis of AKI in patients with ADHF and for predicting the prognosis of AKI. The combination of NGAL and miR-652-3p may accurately predict AKI onset in ADHF.Purposes To investigate the patterns of fundus autofluorescence (FAF) in patients with different grades of myopic atrophy maculopathy (MAM). Methods Patients with MAM who visited Zhongshan Ophthalmic Center from January 2018 to December 2019 were screened. All patients received comprehensive ophthalmologic examinations as well as FAF imaging. The atrophic severity of each eye was identified based on the META-PM classification system, including no myopic retinal lesions (C0), tessellated fundus only (C1), diffuse chorioretinal atrophy (C2), patchy chorioretinal atrophy (C3), and macular atrophy (C4). Results Eighty-nine consecutive patients with 137 affected eyes were included. Four different autofluorescence (AF) patterns were detected unremarkable AF (48 eyes in C1 and 18 eyes in C2, 48.2%), compound AF (2 eyes in C1 and 12 eyes in C2, 10.2%), patchy AF defect (5 eyes in C2 and 34 eyes in C3, 28.5%), and macular AF defect (18 eyes in C4, 13.1%). Moreover, AF patterns were significantly correlated with age (r = 0.419, P less then .001), best-corrected visual acuity (BCVA) (r = 0.592, P less then .001), axial length (AL) (r = 0.529, P less then .001), and subfovial choroidal thickness (SFCT) (r = -0.728, P less then .001). In addition, with the help of FAF, 14.3% (5/35) of eyes initially categorized as C2 merely based on color fundus photographs (CFP) should be categorized as C3. Conclusions The severity of FAF in eyes with MAM was significantly correlated with myopic characteristics. FAF might be beneficial for detecting unremarkable patchy chorioretinal atrophy on CFP of MAM.It is well known that what we eat can influence our physical wellbeing, but interest is also increasing in the relationship between our diet and cognitive health. In recent years, blueberries have risen from relative obscurity to superfood status following a number of published epidemiological studies, rodent trials, and human RCTs, that suggest blueberries may convey benefits to cognition and mood. This commentary explores some of the evidence in humans, particularly during periods of cognitive development in the young and cognitive decline in the elderly. Evidence for possible mechanisms of action are also described. There is little doubt that blueberries convey a small, but tangible, benefit to cognitive function. Effects are seen following dose sizes easily achievable within a normal diet. Nevertheless, further research is needed on the cognitive domains influenced, additional benefits of longer-term supplementation, mechanisms of action responsible, and the real-world relevance of the cognitive benefits attained.
Cytomegalovirus (CMV) infection is widely prevalent but mostly harmless in immunocompetent individuals. In the post hematopoietic stem cell transplant (HSCT) setting unrestricted viral replication can cause end-organ damage (CMV disease) and, in a small proportion, mortality. Current management strategies are based on sensitive surveillance programmes, with the more recent introduction of an effective prophylactic antiviral drug, letermovir, but all aim to bridge patients until reconstitution of endogenous immunity is sufficient to constrain viral replication.

Over the past 25years, the adoptive transfer of CMV-specific T-cells has developed from the first proof of concept transfer of CD 8+T-cell clones, to the development of 'off the shelf' third party derived Viral-Specific T-cells (VSTs). In this review, we cover the current management of CMV, and discuss the developments in CMV adoptive cellular therapy.

Due to the adoption of letermovir as a prophylaxis in standard therapy, the incidence of CMV reactivation is likely to decrease, and any widely adopted cellular therapy needs to be economically competitive. Current clinical trials will help to identify the patients most likely to gain the maximum benefit from any form of cell therapy.
Due to the adoption of letermovir as a prophylaxis in standard therapy, the incidence of CMV reactivation is likely to decrease, and any widely adopted cellular therapy needs to be economically competitive. Current clinical trials will help to identify the patients most likely to gain the maximum benefit from any form of cell therapy.
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