Paraneoplastic Pemphigus Associated with Bilateral Corneal Perforations in Follicular Dendritic Cell Sarcoma.

PURPOSE: To describe a case of paraneoplastic pemphigus (PNP) presenting as spontaneous bilateral corneal perforations in a patient with follicular dendritic cell sarcoma. METHODS: Retrospective chart reviewResults: A 73-year-old Greek woman with a history of follicular dendritic cell sarcoma (FDCS) presented with bilateral corneal perforations and a cicatrizing conjunctivitis. Her diagnosis was consistent with PNP with corneal and conjunctival involvement after a change in her chemotherapy regimen from intravenous cyclophosphamide to gemcitabine. She was treated with a multilayered amniotic membrane in the right eye and cyanoacrylate glue in the left eye. Systemic intravenous cyclophosphamide and oral prednisone were re-started. Both perforations healed but the patient passed away soon after precluding further follow-up. CONCLUSIONS: Ocular manifestations of PNP can rarely present with spontaneous corneal perforations. This is the first case of FDCS-associated PNP with corneal involvement. Such cases should be diagnosed expediently and managed with aggressive systemic immunosuppressive therapy.

Voxel-wise and spatial modelling of binary lesion masks: Comparison of methods with a realistic simulation framework.

OBJECTIVES: White matter lesions are a very common finding on MRI in older adults and their presence increases the risk of stroke and dementia. Accurate and computationally efficient modelling methods are necessary to map the association of lesion incidence with risk factors, such as hypertension. However, there is no consensus in the brain mapping literature whether a voxel-wise modelling approach is better for binary lesion data than a more computationally intensive spatial modelling approach that accounts for voxel dependence. METHODS: We review three regression approaches for modelling binary lesion masks including mass-univariate probit regression modelling with either maximum likelihood estimates, or mean bias-reduced estimates, and spatial Bayesian modelling, where the regression coefficients have a conditional autoregressive model prior to account for local spatial dependence. We design a novel simulation framework of artificial lesion maps to compare the three alternative lesion mapping methods. The age effect on lesion probability estimated from a reference data set (13,680 individuals from the UK Biobank) is used to simulate a realistic voxel-wise distribution of lesions across age. To mimic the real features of lesion masks, we propose matching brain lesion summaries (total lesion volume, average lesion size and lesion count) across the reference data set and the simulated data sets. Thus, we allow for a fair comparison between the modelling approaches, under a realistic simulation setting. RESULTS: Our findings suggest that bias-reduced estimates for voxel-wise binary-response generalized linear models (GLMs) overcome the drawbacks of infinite and biased maximum likelihood estimates and scale well for large data sets because voxel-wise estimation can be performed in parallel across voxels. Contrary to the assumption of spatial dependence being key in lesion mapping, our results show that voxel-wise bias-reduction and spatial modelling result in largely similar estimates. CONCLUSIONS: Bias-reduced estimates for voxel-wise GLMs are not only accurate but also computationally efficient, which will become increasingly important as more biobank-scale neuroimaging data sets become available.

Spatial distribution and cognitive impact of cerebrovascular risk-related white matter hyperintensities.

OBJECTIVES: White matter hyperintensities (WMHs) are considered macroscale markers of cerebrovascular burden and are associated with increased risk of vascular cognitive impairment and dementia. However, the spatial location of WMHs has typically been considered in broad categories of periventricular versus deep white matter. The spatial distribution of WHMs associated with individual cerebrovascular risk factors (CVR), controlling for frequently comorbid risk factors, has not been systematically investigated at the population level in a healthy ageing cohort. Furthermore, there is an inconsistent relationship between total white matter hyperintensity load and cognition, which may be due to the confounding of several simultaneous risk factors in models based on smaller cohorts. METHODS: We examined trends in individual CVR factors on total WMH burden in 13,680 individuals (aged 45-80) using data from the UK Biobank. We estimated the spatial distribution of white matter hyperintensities associated with each risk factor and their contribution to explaining total WMH load using voxel-wise probit regression and univariate linear regression. Finally, we explored the impact of CVR-related WMHs on speed of processing using regression and mediation analysis. RESULTS: Contrary to the assumed dominance of hypertension as the biggest predictor of WMH burden, we show associations with a number of risk factors including diabetes, heavy smoking, APOE ε4/ε4 status and high waist-to-hip ratio of similar, or greater magnitude to hypertension. The spatial distribution of WMHs varied considerably with individual cerebrovascular risk factors. There were independent effects of visceral adiposity, as measured by waist-to-hip ratio, and carriage of the APOE ε4 allele in terms of the unique spatial distribution of CVR-related WMHs. Importantly, the relationship between total WMH load and speed of processing was mediated by waist-to-hip ratio suggesting cognitive consequences to WMHs associated with excessive visceral fat deposition. CONCLUSION: Waist-to-hip ratio, diabetes, heavy smoking, hypercholesterolemia and homozygous APOE ε4 status are important risk factors, beyond hypertension, associated with WMH total burden and warrant careful control across ageing. The spatial distribution associated with different risk factors may provide important clues as to the pathogenesis and cognitive consequences of WMHs. High waist-to-hip ratio is a key risk factor associated with slowing in speed of processing. With global obesity levels rising, focused management of visceral adiposity may present a useful strategy for the mitigation of cognitive decline in ageing.

Comparison of the Serum Metabolic Fingerprint of Different Exercise Modes in Men with and without Metabolic Syndrome.

Exercise plays a beneficial role in the treatment of metabolic syndrome (MetS). Metabolomics can provide new insights and facilitate the optimization of exercise prescription. This study aimed to investigate whether the response of the human serum metabolic fingerprint to exercise depends on exercise mode or the presence of MetS. Twenty-three sedentary men (nine with MetS and fourteen healthy) completed four trials: Resting, high-intensity interval exercise (HIIE), continuous moderate-intensity exercise (CME), and resistance exercise (RE). Blood samples were collected pre-exercise, immediately after exercise, and 1 h post-exercise for targeted metabolomic analysis in serum by liquid chromatography-mass spectrometry. Time exerted the strongest differentiating effect, followed by exercise mode. The largest changes from baseline were found in the immediate post-exercise samples. RE caused the strongest responses overall, followed by HIIE, while CME had minimal effect. Unlike previous results in urine, no valid model could separate the two groups in serum. Exercise exerted a beneficial effect on prominent serum biomarkers of metabolic risks, such as branched-chain amino acids, alanine, acetylcarnitine, choline, and betaine. These findings contribute to the ongoing research efforts to map the molecular responses to exercise and to optimize exercise guidelines for individuals at cardiometabolic risk.

Median bias reduction in random-effects meta-analysis and meta-regression.

The reduction of the mean or median bias of the maximum likelihood estimator in regular parametric models can be achieved through the additive adjustment of the score equations. In this paper, we derive the adjusted score equations for median bias reduction in random-effects meta-analysis and meta-regression models and derive efficient estimation algorithms. The median bias-reducing adjusted score functions are found to be the derivatives of a penalised likelihood. The penalised likelihood is used to form a penalised likelihood ratio statistic which has known limiting distribution and can be used for carrying out hypothesis tests or for constructing confidence intervals for either the fixed-effect parameters or the variance component. Simulation studies and real data applications are used to assess the performance of estimation and inference based on the median bias-reducing penalised likelihood and compare it to recently proposed alternatives. The results provide evidence on the effectiveness of median bias reduction in improving estimation and likelihood-based inference.

Diurnal variation and reliability of the urine lactate concentration after maximal exercise.

The postexercise urine lactate concentration is a novel valid exercise biomarker, which has exhibited satisfactory reliability in the morning hours under controlled water intake. The aim of the present study was to investigate the diurnal variation of the postexercise urine lactate concentration and its reliability in the afternoon hours. Thirty-two healthy children (11 boys and 21 girls) and 23 adults (13 men and 10 women) participated in the study. All participants performed two identical sessions of eight 25 m bouts of maximal freestyle swimming executed every 2 min with passive recovery in between. These sessions were performed in the morning and afternoon and were separated by 3-4 days. Adults performed an additional afternoon session that was also separated by 3-4 days. All swimmers drank 500 mL of water before and another 500 mL after each test. Capillary blood and urine samples were collected before and after each test for lactate determination. Urine creatinine, urine density and body water content were also measured. The intraclass correlation coefficient was used as a reliability index between the morning and afternoon tests, as well as between the afternoon test and retest. Swimming performance and body water content exhibited excellent reliability in both children and adults. The postexercise blood lactate concentration did not show diurnal variation, showing a good reliability between the morning and afternoon tests, as well as high reliability between the afternoon test and retest. The postexercise urine density and lactate concentration were affected by time of day. However, when lactate was normalized to creatinine, it exhibited excellent reliability in children and good-to-high reliability in adults. The postexercise urine lactate concentration showed high reliability between the afternoon test and retest, independent of creatinine normalization. The postexercise blood and urine lactate concentrations were significantly correlated in all cases, attesting to the validity of urine lactate as an index of anaerobic metabolism. We conclude that urine lactate, after normalization to creatinine, could be used in training practice either in the morning or in the afternoon. Further research is needed to assess the applicability of this novel exercise biomarker.

Effects of Different Exercise Modes on the Urinary Metabolic Fingerprint of Men with and without Metabolic Syndrome.

Exercise is important in the prevention and treatment of the metabolic syndrome (MetS), a cluster of risk factors that raises morbidity. Metabolomics can facilitate the optimization of exercise prescription. This study aimed to investigate whether the response of the human urinary metabolic fingerprint to exercise depends on the presence of MetS or exercise mode. Twenty-three sedentary men (MetS, n = 9, and Healthy, n = 14) completed four trials: resting, high-intensity interval exercise (HIIE), continuous moderate-intensity exercise (CME), and resistance exercise (RE). Urine samples were collected pre-exercise and at 2, 4, and 24 h for targeted analysis by liquid chromatography-mass spectrometry. Time exerted the strongest differentiating effect, followed by exercise mode and health status. The greatest changes were observed in the first post-exercise samples, with a gradual return to baseline at 24 h. RE caused the greatest responses overall, followed by HIIE, while CME had minimal effect. The metabolic fingerprints of the two groups were separated at 2 h, after HIIE and RE; and at 4 h, after HIIE, with evidence of blunted response to exercise in MetS. Our findings show diverse responses of the urinary metabolic fingerprint to different exercise modes in men with and without metabolic syndrome.

Improved reliability of the urine lactate concentration under controlled hydration after maximal exercise.

CONTEXT: Urine lactate may be a novel biomarker of lactate production capacity but its reliability has been unsatisfactory so far. OBJECTIVE: To compare the reliability of urine lactate between controlled hydration and no hydration after maximal exercise. MATERIAL AND METHODS: Athletes performed swimming exercise four times: two followed by consumption of 1 L of water and two followed by no water intake. Blood and urine lactate was measured. RESULTS: The reliability of urine lactate was good and similar to that in blood only after controlled hydration. Blood and urine lactate were correlated under both hydration conditions. DISCUSSION AND CONCLUSION: Controlled hydration after exercise provides satisfactory reliability of urine lactate.