Inflammatory bowel disease(IBD)is a chronic intestinal inflammatory disease,and its etiology has not yet been clarified.Recent studies have shown that expressions of microRNA(miRNA)were frequently altered in serum and intestinal tissue of patients with IBD,and the aberrant miRNA expressions are correlated with the disease activity and site of lesion,etc.miRNA plays a role in the diagnosis and exploring disease pathogenesis of IBD,as well as its targeted therapy.This article reviewed the aberrant miRNA expressions in patients with IBD in order to clarify the role of miRNA in the pathogenesis and development of IBD,and to further provide the evidence for its clinical application.
We report 3 cases of durable complete response (CR) in patients with BRAF-mutated metastatic melanoma who were initially treated unsuccessfully with sequential immunotherapies (high dose interleukin 2 followed by ipilimumab with or without concurrent radiation therapy). After progression during or post immunotherapy, these patients were given BRAF inhibitor therapy and developed rapid CRs. Based on the concomitant presence of autoimmune manifestations (including vitiligo and hypophysitis), we postulated that there was a synergistic effect between the prior immune therapy and the BRAF targeting agents. Accordingly, the inhibitors were gradually weaned off beginning at 3 months and were stopped completely at 9–12 months. The three patients remain well and in CR off of all therapy at up to 15 months radiographic follow-up. The institution of the BRAF therapy was associated with development of severe rheumatoid-like arthritis in 2 patients which persisted for months after discontinuation of therapy, suggesting it was not merely a known toxicity of BRAF inhibitors (arthralgias). On immunologic analysis, these patients had high levels of non-T-regulatory, CD4 positive effector phenotype T-cells, which persisted after completion of therapy. Of note, we had previously reported a similar phenomenon in patients with metastatic melanoma who failed high dose interleukin-2 and were then placed on a finite course of temozolomide with rapid complete responses that have remained durable for many years after discontinuation of temozolomide. We postulate that a finite course of cytotoxic or targeted therapy specific for melanoma given after apparent failure of prior immunotherapy can result in complete and durable remissions that may persist long after the specific cytotoxic or targeted agents have been discontinued suggesting the existence of sequence specific synergism between immunotherapy and these agents. Here, we discuss these cases in the context of the literature on synergy between conventional or targeted cytotoxic therapy and immunotherapy in cancer treatment.
Ecthyma gangrenosum is the cutaneous manifestation of bacteremia traditionally associated with Pseudomonas Aeruginosa bacteremia. It classically presents as gunmetal grey bullae with a pink macular margin. To our knowledge, no case reports exist detailing the occurrence of ecthyma gangrenosum in a healthy young woman undergoing treatment for breast cancer. We present such a case to raise awareness of this entity in patients receiving chemotherapy.
“Subacute Synovities of the Hip”, which runs a more fluctuant clinical progress and slower response to treatment than those of acute transient synovitis, is always posing diagnostic and management challenge in children presented with acute hip pain. This study aims to identify the special features of this distinct entity, and the important diagnostic parameters in differentiation of acute transient synovitis, subacute arthritis and also septic arthritis in children presented with acute painful pain. From 1985–1999, 427 children have been admitted into our centre with subsequent diagnosis of acute transient synovitis, subacute synovitis & septic arthritis. 320 cases with full records are available for review, with 270 cases 85%) having acute transient synovitis, 35 cases (10%) of subacute arthritis and 15 cases (5%) of septic arthritis. Statistical results showed that patient having subacute arthritis different significantly from those with acute transient synovitis in terms of age of presentation & duration of symptoms before hospitalization. Moreover, patient having transient synovitis significantly different from those with septic arthritis in terms of temperature on admission, ESR and White Cell Count.
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