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Medulloblastoma is a cerebellar tumor classified as primitive neuroectodermal tumor and is prevalent in children, especially male. With regard to histological classification, there are five variations: classical, desmoplastic, anaplastic, large-cell variant and with extensive nodularity. Several studies have reported that medulloblastoma pathogenesis is related to mutations in CNS growth factors, and the main pathways involved are Sonic Hedgehog, NOTCH, WNT, and OTX. Also regarding the immunology, patients with medulloblastoma have a high serum concentration of INF-? and TH17 cells in peripheral blood, and it was observed that TGF-? has been associated with mitogenic stimulation, and possibly associated to the pathogenesis of this disease. The prevalence of a TH1 response related to the survival was also described. The development of therapies for medulloblastoma treatment, though limited, is significant, as they result in an improvement in the patient’s survival. However, a better understanding of the mechanism involved in its immunopathogenesis is still necessary for the development of new drugs and ways of treatment.

Yumi Harano, Lisa Kotajima, Hiroko Arioka Department of General Internal Medicine, St Luke's International Medical Center, Tokyo, Japan Abstract: Cytomegalovirus (CMV) colitis usually occurs in immunocompromised patients after undergoing organ transplantation or chemotherapy. We report the case of a 60-year-old immunocompetent Japanese woman who presented with abdominal pain and bloody diarrhea. She was initially diagnosed as having ischemic colitis with pseudomembranous colitis on the basis of her symptoms, Clostridium difficile antigen positivity, and colonoscopic findings, which showed ulcer formation from the sigmoid colon to rectum. In spite of bowel rest and administration of metronidazole, her symptoms did not improve. On follow-up colonoscopy, ulcerations remained unchanged. Biopsy of the ulceration revealed CMV-infected cells leading to a diagnosis of CMV colitis. CMV colitis is a rare but possible differential diagnosis in immunocompetent patients. We recommend endoscopic biopsy in a case of refractory abdominal pain and bloody diarrhea. Keywords: cytomegalovirus, colitis, immunocompetent, enterocolitis

In patients with triple-negative breast cancer (TNBC), tumor-infiltrating lymphocytes (TILs) are associated with improved survival. Lehmann et al. identified 4 molecular subtypes of TNBC [basal-like (BL) 1, BL2, mesenchymal (M), and luminal androgen receptor (LAR)], and an immunomodulatory (IM) gene expression signature indicates the presence of TILs and modifies these subtypes. The association between TNBC subtype and TILs is not known. Also, the association between inflammatory breast cancer (IBC) and the presence of TILs is not known. Therefore, we studied the IM subtype distribution among different TNBC subtypes. We retrospectively analyzed patients with TNBC from the World IBC Consortium dataset. The molecular subtype and the IM signature [positive (IM+) or negative (IM-)] were analyzed. Fisher's exact test was used to analyze the distribution of positivity for the IM signature according to the TNBC molecular subtype and IBC status. There were 88 patients with TNBC in the dataset, and among them 39 patients (44%) had IBC and 49 (56%) had non-IBC. The frequency of IM+ cases differed by TNBC subtype (p = 0.001). The frequency of IM+ cases by subtype was as follows: BL1, 48% (14/29); BL2, 30% (3/10); LAR, 18% (3/17); and M, 0% (0/21) (in 11 patients, the subtype could not be determined). The frequency of IM+ cases did not differ between patients with IBC and non-IBC (23% and 33%, respectively; p = 0.35). In conclusion, the IM signature representing the underlying molecular correlate of TILs in the tumor may differ by TNBC subtype but not by IBC status.

Caste-specific differences in the dopaminergic systems of social insects assist in maintaining caste-specific behavior. To determine how caste differences in the honey bee occur during metamorphosis, a number of comparative analyses between castes were performed including comprehensive quantification of: levels of dopamine and its metabolite in the brain, the gene expression levels of enzymes involved in dopamine biosynthesis and conversion as well as expression levels of dopamine receptors and a dopamine transporter. Dopamine levels standardized to the protein contents of a whole brain at the day of eclosion in queens were 3.6-fold higher than those in workers. Dopamine levels increased until eclosion (7 days) in queens, whereas those in workers increased until 5-6 days before eclosion and then maintained until eclosion (10 days). These caste-specific dopamine dynamics in the brain were supported by the higher expression of genes (Amddc and Amth) encoding enzymes involved in dopamine synthesis in queens. The distribution of cells expressing Amddc in the brain revealed that soma clusters of dopaminergic cells were similar between castes at 7-8 days after pupation, suggesting the upregulation of Amddc expression in some cells in queens rather than addition of cell clusters. In contrast, genes encoding dopamine receptors were downregulated in queens or showed similar expression levels between castes. The expression of genes encoding dopamine transporters did not differ between castes. These results reveal the developmental process of caste-specific dopaminergic systems during metamorphosis in the honey bee, suggesting caste-specific behavior and division of reproduction in this highly eusocial species.

Introduction: To report eyedrop instillation techniques and factors associated with instillation failure among glaucoma subjects in the Video-Recorded Assessment of Medication Skill and Questionnaire-based evaluation of Perception in Glaucoma Study. Methods: In this cross-sectional observational study, subjects were 60 patients with glaucoma (mean ± standard deviation age, 68.4 ± 11.3 years; 30 men) who required ocular hypotensive medication(s). Subjects completed ophthalmologic examinations and the Mini-Cog cognitive function test; their typical eyedrop instillation technique was video-recorded. Subjects rated their technique as successes/failures by questionnaire and two examiners rated the successes/failures based on video assessment. Discrepancy between self-reported and video-assessed success/failure rates of instillation was the main outcome measures. Multivariate logistic regression identified factors in instillation failure. Results: Of 48/56 (86%) self-reported successes, 27/48 (56%) failed based on video assessment; as a result, 32/56 (57%) were inconsistent between subjective and objective assessments. Overall, 30/56 (54%) failed based on video assessment. In the subject-based data model, older age [odds ratio (OR) 0.93/year, P = 0.025] and lower cognitive function score (OR 2.7/score, P = 0.025) were factors in failed instillations. In the eye-based data model, less myopic objective refractive error (OR 0.77/diopter, P = 0.016) and lower visual field foveal threshold (OR 1.1/decibel, P = 0.041) were factors in failures. Conclusion: In addition to older age, decreased cognitive function, hyperopia, and decreased foveal sensitivity are risks for failed eyedrop instillation. Treating physicians can screen patients who require guidance by checking the risk factors of instillation failure rather than by relying on patient reports. [ABSTRACT FROM AUTHOR]

Background: The goal of this study was to investigate factors associated with 30-day readmission in a multivariate model, including the CDC wound classes "clean," "clean/contaminated," "contaminated," and "dirty/infected." Methods: The 2017–2020 American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database was queried for all patients undergoing total hip replacement, coronary artery bypass grafting, Ivor Lewis esophagectomy, pancreaticoduodenectomy, distal pancreatectomy, pneumonectomy, and colectomies. ACS-defined wound classes were concordant with CDC definitions. Multivariate linear mixed regression was used to determine risk factors for readmission while adjusting for type of surgery as a random intercept. Results: 477,964 cases were identified, with 38,734 (8.1%) patients having experienced readmission within 30 days of surgery. There were 181,243 (37.9%) cases classified as wound class "clean", 215,729 (45.1%) cases classified as "clean/contaminated", 40,684 cases (8.5%) classified as "contaminated", and 40,308 (8.4%) cases classified as "dirty/infected". In the multivariate generalized mixed linear model adjusting for type of surgery, sex, body mass index, race, American Society of Anesthesiologists class, presence of comorbidity, length of stay, urgency of surgery, and discharge destination, "clean/contaminated" (p <.001), "contaminated" (p <.001), and "dirty/infected" (p <.001) wound classes (when compared to "clean") were significantly associated with 30-day readmission. Organ/space surgical site infection and sepsis were among the most common reasons for readmission in all wound classes. Conclusions: Wound classification was strongly prognostic for readmission in multivariable models, suggesting that it may serve as a marker of readmissions. Surgical procedures that are "non-clean" are at significantly greater risk for 30-day readmission. Readmissions may be due to infectious complications; optimizing antibiotic use or source control to prevent readmission are areas of future study. [ABSTRACT FROM AUTHOR]