Notes

Any retrospective evaluation of radiotherapy in the treatment of external auditory tube carcinoma.
Bleeding manifestations in primary immune thrombocytopenia (ITP) range from skin petechiae to life-threatening intracranial hemorrhage (ICH). However, the relation between these various bleeding manifestations and the platelet count in ITP remains poorly characterized. Using a nationwide database of patients with ITP during the years 2005 to 2014 (10 years) in Japan, we analyzed 19 415 adult patients newly diagnosed with ITP, including 222 with ICH. The frequency of skin purpura was 64.8%, and this increased linearly with thrombocytopenia without a specific platelet count threshold. In contrast, mucosal bleeding (epistaxis and gingival bleeding) and organ bleeding (melena, hematuria, and ICH) increased exponentially with thrombocytopenia at a platelet count threshold of 10 to 15 × 109/L. Age showed a much weaker correlation than platelet count with skin and mucosal bleeding. However, the incidence of organ bleeding increased exponentially above 60 years of age. Multivariate analysis showed that the presence of mucosal bleeding was a risk factor for occurrence of melena and hematuria but not for ICH. The frequency of ICH was 1.1% and risk factors for ICH were age ≥60 years (odds ratio [OR], 3.09; 95% confidence interval [CI], 2.13-4.47; P less then .001), platelet count less then 10 × 109/L (OR, 2.96; 95% CI, 2.11-4.15; P less then .001), and the presence of hematuria (OR, 1.56; 95% CI, 1.04-2.35; P = .033). The relation between ICH and platelet count varied with age. This large-scale analysis of risk factors for bleeding in ITP has revealed distinct characteristics of skin, mucosal, and organ bleeding in adult patients with newly diagnosed ITP, thus indicating those who are at a high risk of severe organ bleeding. © 2020 by The American Society of Hematology.CONTEXT Long-term studies evaluating the treatment of toxic multinodular goitre (TMNG) with fixed activities of radioiodine (RAI) are lacking. OBJECTIVE To describe the effects of 15 mCi on thyroid volume, function and autoimmunity in the long-term. DESIGN and Setting Population-based, retrospective analysis with up to 12 years of follow-up, held in Siena, Italy. PARTICIPANTS Adult patients (n=153) with TMNG, naïve to RAI. METHODS Evaluation of thyroid function, anti-thyroid antibodies and ultrasound scans before and yearly after RAI. MAIN OUTCOME MEASURES Hyperthyroidism cure, hypothyroidism; volume reduction, nadir and regain; antibody titre change. RESULTS The study revealed mean volume reductions ≥50% 3 years after RAI, the greatest annual reduction was observed during the 1st year (30±17.8%; p less then 0.001). Most patients (60%) achieved their volume nadir 3-6 years after RAI. Although 22% patients showed volume regain, the net reduction was statistically significant as late as 9 years after RAI (p=0.005). The mean time to hypothyroidism was 2.7±2.4 years and it was associated with greater reductions in volume (p=0.013). During the 1st 3 years after treatment, hyperthyroid patients decreased approximately by 50%/year without additional RAI. There was no statistically significant association of antibody titres with thyroid function except for TRAb and hyperthyroidism (p=0.004). DL-Thiorphan cost At the end of follow-up there were 61.6% euthyroid patients, 11% hyperthyroid (4.8% overt) and 27.4% hypothyroid patients (2.7% overt). Hyperthyroidism was cured in 89%. CONCLUSIONS The treatment of TMNG with 15 mCi of RAI induced low hypothyroidism rates while providing high cure rates and significant volume reduction, maintained in the long-term. © Endocrine Society 2020. All rights reserved. For permissions, please e-mail [email protected] AND AIMS Hydrological disconnection, especially in a Mediterranean climate, creates coastal saltmarshes with an annual cycle of flooding that are unlike tidally inundated systems. Winter rainfall produces long, continuous hydroperiods, alternating with continuous exposure caused by evaporation in warm, rain-free summers. We aimed to distinguish the effects of elevation, hydroperiod and salinity on annual and perennial halophytes in such a system. METHODS We recorded vegetation and sediment salinity in permanent quadrats on a marsh in the Doñana National Park, Spain, over 7 consecutive years with widely differing rainfall. Elevation was determined from LIDAR data and the duration of the annual hydroperiod from satellite imagery. The independent effects of collaterally varying elevation, hydroperiod and salinity on species distribution were examined using GLMs and hierarchical partitioning. KEY RESULTS Hydroperiod and salinity were both inversely related to elevation but interannual fluctuations in rptible to the more extreme annual cycles of temperature and rainfall predicted for Mediterranean climates. © The Author(s) 2020. Published by Oxford University Press on behalf of the Annals of Botany Company. All rights reserved. For permissions, please e-mail [email protected] Despite the high disease burden of RSV in older adults, there is no approved vaccine. We evaluated the experimental RSV vaccine, Ad26.RSV.preF, a replication-incompetent adenovirus-26 vector encoding the F protein stabilized in pre-fusion conformation. METHODS This phase 1 clinical trial was performed in healthy adults aged ≥60 years. Seventy-two participants received one or two intramuscular injections 12 months apart of Ad26.RSV.preF 5x1010 vp (LD) or 1x1011 vp (HD) or placebo and were followed-up for 2 years for safety and immunogenicity outcomes. RESULTS Solicited AEs were reported by 44% of vaccine recipients, and were transient, and mild or moderate in intensity. No SAE was related to vaccination. After the first vaccination, geometric mean titers (GMTs) for RSV-A2 neutralization increased from baseline (432 LD; 512 HD) to Day 29 (1031 LD; 1617 HD). Pre-F-specific antibody GMTs and median frequencies of F-specific IFN-γ-secreting T cells also increased substantially from baseline. These immune responses were still maintained above baseline levels 2 years post-immunization and could be boosted with a second immunization at 1 year. CONCLUSIONS Ad26.RSV.preF (LD and HD) had an acceptable safety profile and elicited sustained humoral and cellular immune responses after a single immunization in older adults. © The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail [email protected].
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