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This paper is about the generalized proposition of inflation irrelevance. The weak-form version of inflation irrelevance holds that stock prices are independent of inflation rates. The semi-strong form version is that stock prices are independent of both domestic and foreign inflation rates. The strong, or generalized, version is that stock returns are independent of all three rates, domestic and foreign inflation rates, and changes in foreign exchange rates. Overall, the three forms fail to be rejected separately and jointly under conventional marginal significance levels. The conclusion from this paper is that inflation irrelevance, or nominal neutrality, is a common characteristic in the two countries studied, Japan and the United Kingdom. Therefore, the statistical evidence is mounting manifestly, and is pervasive and applies to diverse economies, among which Japan and UK. This regularity amounts to an international stylized empirical fact that cannot be ignored.

The underlying thesis is that inflation does not impact in a significant way stock returns. A stronger thesis is that both domestic and foreign inflation rates are neutral to stock returns. This joint hypothesis is tested for Canada, using 5 theoretical models that describe the determinants of Canadian stock returns. These models range from the most stripped one to the least constrained. All 5 models produce evidence of the strong inflation irrelevance hypothesis for the two key variables, Canadian and foreign (US) inflation rates. Naturally, the largest theoretical model is to be selected for inference purposes. This model includes 12 explanatory variables: 2 inflation rates, 2 proxies for earnings, 2 local duration effects, 2 foreign (US) duration effects, the Canadian/US dollar foreign exchange rate, the price of oil, and two categorical variables that pick up the effect of foreign (US) stock markets. The results show that the model provides sign and size effects in conformity with expectations from the theoretical macroeconomic interrelationships. Hence, the paper, besides documenting inflation neutrality, models in a meaningful manner the determinants of the stock market. All in all the empirical results are largely supportive.

BACKGROUND: In the 5 years that have passed since the publication of the 2018 International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (ICAR-Allergic Rhinitis 2018), the literature has expanded substantially. The ICAR-Allergic Rhinitis 2023 update presents 144 individual topics on allergic rhinitis (AR), expanded by over 40 topics from the 2018 document. Originally presented topics from 2018 have also been reviewed and updated. The executive summary highlights key evidence-based findings and recommendation from the full document.METHODS: ICAR-Allergic Rhinitis 2023 employed established evidence-based review with recommendation (EBRR) methodology to individually evaluate each topic. Stepwise iterative peer review and consensus was performed for each topic. The final document was then collated and includes the results of this work.RESULTS: ICAR-Allergic Rhinitis 2023 includes 10 major content areas and 144 individual topics related to AR. For a substantial proportion of topics included, an aggregate grade of evidence is presented, which is determined by collating the levels of evidence for each available study identified in the literature. For topics in which a diagnostic or therapeutic intervention is considered, a recommendation summary is presented, which considers the aggregate grade of evidence, benefit, harm, and cost.CONCLUSION: The ICAR-Allergic Rhinitis 2023 update provides a comprehensive evaluation of AR and the currently available evidence. It is this evidence that contributes to our current knowledge base and recommendations for patient evaluation and treatment.

Lymphoproliferative disorders (LPDs) are a group of conditions characterized by excessive production of lymphocytes manifested in various patterns including lymphadenopathy, tumor-like lesions, and lymphomas. LPD may be stimulated by Epstein-Barr virus (EBV) infection that most commonly appears in the setting of immunocompromised status such as long-term use of immunosuppressive medications and in individuals with primary immunodeficiency disorders. EBV mucocutaneous ulcer is a benign LPD reaction that mostly regresses spontaneously but sometimes requires medical or surgical intervention. This article presents a case of oral EBV mucocutaneous ulceration that affected an individual with a history of complex primary immunodeficiency disorders consisted of common variable immunodeficiency disease associated with T-cell dysfunction. This case is unique because the oral lesions led to the diagnosis of concurrent widespread EBV-negative follicular lymphomas, seemingly unrelated to her EBV-positive LPD oral disease. Yet, both occurred in the setting of severe immunosuppression from the primary immunodeficiency disorders.

The novel SARS-CoV-2 virus and resulting COVID-19 global pandemic emerged in 2019 and continues into 2022. While mortality from COVID-19 is slowly declining, a subset of patients have developed chronic, debilitating symptoms following complete recovery from acute infection with COVID-19. Termed as post-acute sequelae of SARS-CoV-2 syndrome (PASC), the underlying pathophysiology of PASC is still not well understood. Given the similarity between the clinical phenotypes of PASC and postural orthostatic tachycardia syndrome (POTS), it has been postulated that dysautonomia may play a role in the pathophysiology of PASC. However, there have been only a few studies that have examined autonomic function in PASC. In this retrospective study, we performed an analysis of autonomic nerve function testing in PASC patients and compared the results with those of POTS patients and healthy controls. Our results suggest that a significant number of PASC patients have abnormal autonomic function tests, and their clinical features are indistinguishable from POTS.

IKZF1/IKAROS is a key transcription factor of lymphocyte development expressed throughout hematopoiesis. Heterozygous germline IKZF1 haploinsufficient ( IKZF1 HI ) and dominant-negative ( IKZF1 DN ) variants in humans cause B cell immune deficiency and combined immunodeficiency. Here, we identified previously unidentified heterozygous IKZF1 variants (R183C/H) located in the DNA binding domain in eight individuals with inflammatory, autoimmune, allergic symptoms, and abnormal plasma cell (PC) proliferation. Leukocytes of patients exhibited specific defects including impaired IL-2 production by T cells, T helper (T H ) skewing toward T H 2, low numbers of regulatory T cells (T reg ), eosinophilia, and abnormal PC proliferation. In contrast to IKZF1 HI and IKZF1 DN , IKZF1 R183H/C proteins showed increased DNA binding associated with increased gene expression of T H 2 and PC differentiation, thus demonstrating that IKZF1 R183H/C behave as gain-of-function (GOF) alleles. In vitro treatment with lenalidomide, known to degrade IKZF1, corrected T H 2 and PC abnormalities caused by IKZF1 R183H/C . These data extend the spectrum of pathological mechanisms associated with IKZF1 deficiencies and highlight the role of IKZF1 in late lymphoid differentiation stages.

IKZF1/IKAROS is a key transcription factor of lymphocyte development expressed throughout hematopoiesis. Heterozygous germline

The purpose of this paper is to verify that discrete statistical distributions of the US stock market are consistent with loss aversion. Loss aversion has the following tenets: an S-shaped valuation function, characterized by diminishing sensitivity, a loss aversion coefficient higher than +1, probability weighting, and reference-dependence. Diminishing sensitivity implies that the exponent of the valuation function is between 0 and +1. It is expected that this exponent be higher for losses. Probability weighting replaces objective with subjective probabilities. Loss aversion is indicated by a coefficient higher than +1 for the valuation of losses. There are three parameters: the two exponents of the valuation function, and the loss aversion coefficient. There is one non-linear equation: the certainty equivalence relation. The procedure is to fix two parameters and find the third parameter by solving the non-linear certainty equivalence equation, using the EXCEL spreadsheet. The program is repeated for more than one case about the fixed parameters, and by enriching the analysis with probability weighting. The calibrations executed point strongly to the conclusion that loss aversion is consistent with six discrete distributions of the first two moments of returns of the US stock markets. The calibration process provides for reasonable estimates of the key parameters of loss aversion. These estimates suggest a more pronounced diminishing sensitivity, and a higher than expected coefficient of loss aversion, especially when probability weighting is imposed.

Background Studies have shown that the albumin-bilirubin (ALBI) grade can be a superior prognosticator for patients undergoing Yttrium-90 (Y90) glass microsphere radioembolization for hepatocellular carcinoma (HCC) compared to the Child-Pugh (CP) scoring system. Less is known about the applicability of this score in non-hepatocellular malignancies using Y90 resin microspheres. This study evaluates the ALBI grade's ability to predict overall survival and biochemical toxicity in patients undergoing resin Y90 radioembolization and body surface area dosimetry (BSA) for non-hepatocellular primary and metastatic liver malignancies compared to the CP class and Model for End-Stage Liver Disease (MELD) score. Methods A retrospective review of patients with intrahepatic metastatic colorectal and neuroendocrine cancers and cholangiocarcinoma undergoing resin radioembolization from 2006-2015 at a single tertiary medical center was performed. ALBI, MELD, and CP scores were compared and correlated with biochemical toxicity and overall survival. Results There was a significant difference in overall survival between CP class A and class B liver function (P=0.04) for the entire patient cohort. ALBI grade (P=0.36) and MELD score (P=0.19) were not independently associated with survival. When stratified by CP class, the ALBI grade revealed a trend for survival difference in CP class B (P=0.05). Baseline ALBI grade was associated with post-procedural albumin reduction (P=0.01) and bilirubin elevation (P=0.007). Conclusions ALBI grade predicted post-procedural biochemical toxicity, but did not predict survival after resin radioembolization of non-hepatocellular liver malignancies using BSA dosimetry. Given the heterogeneity of this study population, dedicated prospective analyses are required.

Sovereign credit rating announcements are usually unexpected events that can affect local financial markets either favorably or detrimentally. In Lebanon, the credit outlook witnessed a deteriorating trend since the mid of the year 2016. The major hypothesis of this paper is that the reaction to the bad credit rating announcements is statistically significant, although ephemeral, delimited to just a few days. It is through the liquidity channel that these announcements create uncertainty and affect the economy. There are two related hypotheses: (1) illiquidity shocks impact undesirably the financial markets, and (2) credit rating announcements are accompanied by a surge in illiquidity. Since the impact of these announcements is ephemeral it should be assessed by high-frequency data, or at most by daily financial data. The domestic foreign exchange market is an ideal place to study this impact. Fortunately, the central bank of Lebanon has lately made available daily foreign exchange rates for six major currencies beginning in 2010. This defines six multiple regressions that are constructed to differentiate between the short-run and the long-run responses to illiquidity. The empirical results show that the above two hypotheses are strongly supported. Moreover, it matters little whether the event window is 3, 4 or 5 days. JEL Classification: G14, F31, C58, C38.

Purpose - The relation between inflation and stock returns has been widely scrutinized. Its importance transcends finding just a simple relation, and has repercussions on the conduct of monetary policy. Theoretically, the relation should be positive and one-to-one. However, early on, the empirical relation was found to be statistically significantly negative. This paper contributes to the theoretical and empirical debate. The null hypothesis is that inflation is irrelevant to stock returns. Therefore, neither a positive theoretical, nor a negative empirical relation, should robustly hold. This position is in accordance to the basic principles of modern corporate finance, which state that the real and nominal equity values are equal.Methodology - The paper starts with simple correlations and presents the probability distributions and histograms of all variables. All distributions are characterized by significant outliers. A theoretical model that excludes inflation is introduced, and the statistical significance of including inflation is tested. The quest covers the 20 Fama-French stock portfolios, classified by their percentiles of equity values. Hence, both bilateral and multilateral regressions are carried out. Findings – Initially bilateral correlations were found to be negative consistent with the early empirical evidence. However, by using robust standard errors, robust least squares, and quantile regressions, the evidence is totally reversed. There is strong support for the irrelevance of inflation. This is true if the investor is sophisticated, i.e. she does not give too much attention to simple bilateral correlations, if she utilizes advanced economic procedures like robust least squares and quantile regressions, if she adjusts for residual autocorrelation and heteroscedasticity, and if she incorporates fundamental variables in the estimation process. Conclusion - Hence the prima facie evidence of non-neutrality is challenged by this paper’s analysis. In opposition to the conviction of many economists, and despite their inherent resistance, the paper argues for inflation irrelevance.

Purpose – This paper aims to develop an equation for the government budget multiplier that does not require the input of the marginalpropensity to consume. In parallel, the paper computes from this equation the actual value of the budget multiplier for the US.Methodology – The paper starts from the premise that taxes and imports are income-driven, and that the level of investment is equal to thelevel of saving. This leads to a theoretical model that is characterized solely by two parameters: the marginal income tax rate, and the marginalpropensity to import. Noteworthy the marginal propensity to consume does not appear in the equation. Subsequently, the paper estimates theempirical marginal income tax rate by regression analysis, and the marginal propensity to import by relying on general import demandfunctions, the latter in order to avoid having an omitted variable bias with a simple linear regression.Findings – The paper finds that the theoretical balanced budget multiplier is nil while the straight multiplier is demonstrated to be equal to theratio of the sum of the marginal income tax rate to the marginal propensity to consume. The analysis shows that the US multiplier is estimatedto be between 2.27 and 3.20, depending upon the empirical results.Conclusion – The paper concludes that the marginal propensity to consume is not needed for identifying the government multiplier. Only themarginal tax rate and the marginal propensity to import are needed. And although the balanced budget multiplier is demonstrated theoreticallyto be zero, the straight fiscal multiplier is found to be higher than the usual in classic models, but more in line with the recent empirical findings.Governments have therefore a powerful policy tool, and investment in infrastructure and in scientific research are forecast to be unequivocallyeffective. At the very least, this is true unmistakably in theory.

This note’s contents depend on three estimates of the Marginal Propensity to Consume (MPC): a high measure, obtained from the long run relation between consumption and income, a low measure, obtained from the intermediate run of the MPC relation, and an actual measure, obtained from current values of consumption and income. The objectives are to find out the actual regularities in the statistical distribution and behavior of steady state consumption, conditional on the way the MPC is estimated. The note computes the implied steady state variables, and from there, high, low, and actual measures of the growth rates of consumption are recovered. A scrutiny of the results reveals 12 stylized facts that are implied by the basic progress of the steady states. These facts encompass level links of the consumption series, their variances, and their growth rates, in addition to their statistical distributions. Therefore the note describes extensively the stylized facts that any model of the permanent income hypothesis needs to explain and corroborate.

This note has the purpose of deriving the balanced budget multiplier for disposable income. Under plausible conditions, it is demonstrated that this multiplier is equal to zero. This might explain the low level of empirical explanatory power of a balanced budget on aggregate output. The paper argues that a debt-financed government spending can be considered, under Ricardian equivalence, as a balanced budget fiscal policy. This also explains why the government spending multiplier is empirically found to be significantly less than one, and closer to zero than to one, while expectations are that it ought to be higher than 2. In addition, the note contends that consumption will be unresponsive to a balanced budget fiscal policy, and may actually fall. This should resonate badly in the assessment of the current stimulus packages embarked by Western nation governments to prop up aggregate demand given the fallouts of the pandemic. The risks are high that the stimulus programs may turn out to be less effective than expected by policy makers.

SARS-CoV-2 vaccination elicited high levels of immunogenicity in immunocompetent people in the original vaccine trials1 2 though recent studies have shown blunted immunogenicity in patients with rheumatic diseases treated with lymphocyte depleting agents.3 4 B-lymphocytes have been implicated in the pathogenesis of anti-neutrophil cytoplasmic antibidy (ANCA)-associated vasculitis (AAV) and B-cell-targeted therapy with rituximab is recognised as an established induction and maintenance strategy in management.5 6 SARS-CoV-2 infection in patients with AAV has been associated with severe outcomes,7 while rituximab has been associated with worse outcomes among patients infected with SARS-CoV-2.8 9 A recent study by Bonelli et al found evidence of an ameliorated humoral response but possible inducible cellular response in five patients treated with rituximab.10 We studied the tolerability and humoral response to the SARS-CoV-2 vaccine series in 48 patients with a diagnosis of AAV. Patients underwent SARS-CoV-2 antispike antibody testing to assess humoral response. Antibody testing was performed using antispike IgG enzyme immunoassay (Roche Elecsys via Quest, DiaSorin Liaison assay via LabCorp or Euroimmun via Hopkins lab). Demographics, clinical information including immunosuppressive therapy were extracted from medical records. Time from last rituximab administration to receipt of the first dose of the vaccine was recorded. We recorded serum creatinine, white blood cell count, serum immunoglobulins, Cluster of CD19 and …

Theory predicts that the optimal foreign exchange rate policy of a central bank, in the presence of perfect capital mobility, and a persistent expansionary fiscal policy, is to fix this rate. Since these fundamentals apply to Lebanon, the Lebanese central bank has judiciously followed the policy of pegging the foreign exchange rate since the end of 1998. However, the actual policy led to a frantic quest for foreign exchange more than the level required or optimal. The behavioral model estimated in this paper worked endogenously from 1994 to 1998, and was actively operated upon afterwards. The model, based on financial engineering concepts, relates the change in the foreign exchange reserves of the central bank to the change in foreign exchange reserves of the banking system, and to the change in the foreign public debt. This model assumes that the central bank swaps government debt, denominated in Lebanese pounds, for a debt in foreign currency, thereby increasing its reserves, and improving the balance of payments. Moreover, the model is based upon the notion that the central bank is able to persuade banks to sell their excess foreign funds abroad for floating notes issued by the central bank, thereby increasing its reserves and improving the balance of payments. Although the central bank has announced publicly that it carried out the financial engineering embodied in the behavioral model discretely, and at specific periods, the paper finds that the same policy was continuously and incessantly undertaken and implemented, but at smaller scales. The crucial evidence comes about from the empirical finding that the change in the net foreign reserves of banks is positively, proportionately and significantly related to the central bank change in foreign exchange reserves. Moreover, part of the increase in foreign debt is funneled to a positive, and significant, relation with the change in foreign reserves of the central bank.

This paper tackles the rather recent weekly period from January 18, 2005 to February 28, 2018, encompassing 523 observations. The portfolio is constructed from the perspective either of a US investor or of a Lebanese one, since the US dollar foreign exchange rate was pegged during the above whole period. The portfolio consists of an investment in the US S & P 500 stock market index and in three Rogers international commodity indexes: agricultural, energy, and metals. The purpose of the paper is to estimate the diversification benefits of the energy commodity index. These benefits arise from the fall in the volatility of the investment portfolio when it is compared to an investment in the energy index only, or in the S & P 500 only. The procedure follows the seminal approach of Markowitz. The inputs of the model are the variance/covariance matrix, the average log returns, and the condition that all investment shares should sum up to 1. The outputs, obtained by matrix manipulation, are the optimal investment shares in the four assets, the volatilities of the optimal portfolios, the characteristics of the efficient frontier, the relation between portfolio shares and the expected, or required return, and finally, the predicted Capital Market Line (CML). The evidence shows that, by holding a portfolio composed of the above four assets, the volatilities are substantially reduced. Moreover, and since short sales are allowed in the model, all optimal investment shares in the energy commodity asset are negative, meaning that in the optimal portfolios the positions in the energy index are short positions. The paper points to the significantly high relative riskiness of the energy index, as a stand-alone asset, or as an aggressive and speculative investment on the CML, and to the substantial portfolio benefits of shorting this index.

Chronic rhinosinusitis (CRS) affects up to 12% of the general population and is traditionally divided into two main phenotypic subsets, based on the presence of nasal polyps (CRSwNP) or their absence. It is well-established that many patients with CRSwNP report poor quality of life (QoL), which is further compromised by comorbidities (eg, asthma, bronchiectasis, aspirin-exacerbated respiratory disease). Chronic rhinosinusitis CRS with nasal polyps is managed with a combination of medical therapy and surgical interventions, and biologics are emerging as a promising new treatment option for patients with inadequate response to the standard of care. A range of patient-reported outcome measures have been used to assess QoL for patients with CRSwNP in clinical trials, including disease-specific questionnaires (eg, Sino-Nasal Outcome Test-22) and generic ones (eg, Short Form-36). Significantly impaired QoL has been identified as a criterion for the indication to use biologics in patients with CRSwNP. This review summarizes clinical evidence (2010-2021) on QoL outcomes with currently available treatments for CRSwNP and assesses the improvement in QoL after biologic treatments, especially for patients with comorbidities reported in interventional studies (randomized controlled trials and real-world experience).

New emerging pulmonary phenotypes associated with antibody deficiency, such as neutrophilic asthma, frequent exacerbations of chronic obstructive pulmonary disease, and unexplained interstitial lung disease, particularly in younger adults, are discussed in this review through a case-based approach. Also discussed in similar fashion are antibody deficiency syndromes that lead to end-stage lung disease and the indications for lung transplantation in primary immunodeficiency disease. These challenging cases require timely and individualized strategies for genetic and immunologic diagnosis, decisions about therapeutic approaches, and long-term monitoring.

Systemic lupus erythematosus (SLE) and common variable immunodeficiency (CVID) are both conditions defined by immune system dysfunction: one hyperactive, the other hypoactive. Although uncommon, these diseases can coexist in the same individual. This review aims to assess the state of the literature on the relationship between SLE and CVID, particularly when workup for CVID should be considered in individuals with SLE and how CVID in individuals with SLE should be treated.

Systemic lupus erythematosus (SLE) patients have a well-established increased risk for cancer. Research from the past 2 decades has identified the specific malignancies that afflict SLE patients at disproportionate rates. Systemic lupus erythematosus patients are at heightened risk for several hematologic malignancies as well as for certain solid tumors, including lung, thyroid, and hepatobiliary cancers. They are at decreased risk for several cancers as well, including prostate and melanoma. Improved understanding of the unique cancer risk profile of SLE patients has led some professional societies to recommend specialized cancer screening and prevention measures for these patients and has enabled clinicians to better serve the SLE patient population.

This book covers a specialized topic in international money and finance which is central bank official intervention in the foreign exchange market. The analysis is applied to an emerging country, Lebanon, in which domestic and foreign assets are imperfect substitutes in contrast to the case in developed nations. This enables the central bank in having another and an additional monetary policy tool. There are five main chapters in our study. The first one is the on the effectiveness of unsterilized official intervention. The second one is on the effectiveness of sterilized official intervention. Sterilized intervention is an open market operation that keeps the monetary base or the high-powered money, and the money supply unchanged. The third one is on the effectiveness of unpredicted, or secret, official intervention. The fourth chapter dwells on an alternative reaction function of the monetary authorities that is more complex than the one assumed earlier. The last chapter provides for an alternative specification of the function of official intervention. My approach necessitates two enquiries. The black market foreign exchange rates need to be computed because Lebanon follows an adjustable peg with unpublished magnitudes and bands. And, due to the absence of direct data on intervention, intervention is imputed by the monthly change in foreign securities held by the central bank. Since the central bank in Lebanon intervenes almost on a daily basis in the financial market, intervention is continuous, and not sporadic like in other countries. Official intervention, whatever its form, is found to be highly effective, and the response of the foreign exchange rate is in accordance and in line with the portfolio balance model. A purchase of foreign currency by the central bank leads to a depreciation of the domestic exchange rate. Moreover, a purchase of one billion US dollars leads to a depreciation of the foreign exchange rate within a range between 0.6% and 2%. This impact is comparable to the empirical results in the literature for other countries. Other inferences are obtained. Unsterilized intervention, whether actual or secret, has a higher explanatory power than sterilized intervention, because of the induced money supply shockwaves that strengthen the effect of unsterilized intervention. And secret intervention has a higher explanatory power than actual intervention. The reaction function of the central bank to the dollar rate is greatly statistically significant, and an alternative relation does not vary by much the results. The reaction functions are specified from a leaning-against-the-wind policy. However, as is already known, fixed and pegged foreign exchange rates are vulnerable to a dollar run, a dearth in foreign exchange balances, recurrent budget and current account deficits, and a bank crisis, coupled with the possibility of civil unrest and dislocation. In such a case the foreign reserves of the central bank will be depleted within a short period. The financial emergency in Lebanon after October 17, 2019, may be due to the threat that foreign exchange reserves will not be enough to back up and to safeguard the domestic currency in times of crisis. Nonetheless the concurrence of more than one catastrophic event, whether economic or social, was generally unexpected. This should no prevent us from studying the relatively calm and prosperous, but peculiar, reckless and corrupt, period before October 2019. The general conclusion from my investigation is that official intervention, whatever its definition, is highly effective, and that it has served well the country during the past mostly tranquil period.

Background Chronic rhinosinusitis with nasal polyps (CRSwNP) can be a severe and debilitating disease associated with significant morbidity, loss of smell, sinus pressure and asthma exacerbations. Eosinophils play a role in the majority (85%) of patients. Benralizumab, an afucosylated monoclonal antibody directed against the IL-5 receptor, has powerful apoptotic effects on eosinophils. Objective We sought to investigate the therapeutic benefit of inhibiting the IL-5 receptor using benralizumab to treat severe rhinosinusitis with nasal polyps. Methods Patients with severe NP (defined by endoscopic grade 5 or more out of 8) with elevated eosinophils and a history of previous surgical or endoscopic polypectomy met entry criteria and were randomized in a double-blind fashion to receive 30 mg benralizumab SC or placebo. Endoscopic NP score was assessed at baseline and at treatment week 20. CT scan, SNOT-22 survey and UPSIT smell test score changes were also evaluated. Results Thirty-three patients were screened, and twenty-four (n = 24) were enrolled in the study. Compared with baseline, benralizumab significantly improved NP score (-0.9 ± 0.2, P = 0.004) whereas placebo did not (-0.3 ± 0.3, P = 0.166). Benralizumab induced polyp size reduction compared with placebo did not reach statistical significance (P = 0.103). Five of 12 benralizumab-treated patients (42%) had improvements in all major outcomes (polyp score, CT, SNOT-22 and smell test) versus 2 out of 12 placebo (17%). The ratio of blood eosinophil count to allergen skin test positivity correlated with polyp reduction. Conclusion Benralizumab was well-tolerated and compared with baseline achieved a statistically significant reduction in nasal polyp size, sinus occupancy, symptoms and improved sensation of smell for most patients (83%).

The ongoing coronavirus disease 2019 (COVID-19) pandemic has increased the need for safe and efficient testing as a key containment strategy. Drive-through testing with nasopharyngeal swab has been implemented in many places in the USA as it allows for expeditious testing of large numbers of patients, limits healthcare workers’ risk of exposure, and minimizes the use of personal protective equipment. We present a case where the aluminum shaft of the nasopharyngeal swab fractured during specimen collection at a drive-through testing facility and was suspected to have remained in the asymptomatic patient. Initial evaluation with a series of radiographs covering the skull base, neck, chest, and abdomen did not reveal the swab. On further clinical evaluation, the swab was found endoscopically, lodged between the left inferior turbinate and nasal floor, and was removed by an otorhinolaryngologist. Using a phantom model, we aimed to delineate an imaging technique to better visualize the aluminum shaft of the nasopharyngeal swab on radiographs to help in identification. A technique using lower tube voltage (kVp) with tight collimation centered at the nasal bones area produced the best visualization of the aluminum shaft of the swab. Recognition that aluminum foreign bodies may be difficult to visualize radiographically and optimization of radiograph acquisition technique may help guide clinical management in unusual cases. Further evaluation with computed tomography or endoscopy should be considered in suspected cases where radiographs are negative.

BACKGROUND. CT attenuation thresholds that accurately distinguish enostoses from untreated osteoblastic metastases have been published. In the Mayo Clinic practices, these thresholds have been applied more broadly to distinguish benign sclerotic bone lesions other than enostoses from osteoblastic metastases. OBJECTIVE. The purpose of this article is to determine if CT attenuation thresholds allow the distinguishing of benign sclerotic bone lesions from osteoblastic metastases in patients undergoing bone biopsy. METHODS. A retrospective search was conducted to identify sclerotic lesions described on CT between October 7, 1998, and July 15, 2018, that underwent subsequent biopsy. Two musculoskeletal radiologists recorded lesions' maximum and mean attenuation. Using previously published attenuation thresholds, sensitivity and specificity for differentiating benign sclerotic lesions from osteoblastic metastases were calculated. ROC curve analysis was performed to determine if more appropriate attenuation thresholds exist. Intraclass correlation coefficients (ICCs) were computed. RESULTS. A total of 280 patients met inclusion criteria. Of those, 162 had malignant biopsy results and 118 had benign biopsy results. Of the 162 malignant lesions, 81 had received prior treatment. Maximum and mean attenuation were not significantly different between benign and malignant lesions for either reader (all p > .05). For reader 1, to distinguish benign from malignant lesions, a maximum attenuation threshold of more than 1060 HU resulted in sensitivity of 23.7%, specificity of 87.0%, and accuracy of 60.6%. A mean attenuation threshold of greater than 885 HU resulted in sensitivity of 19.5%, specificity of 90.7%, and accuracy 60.7%. ROC curve analysis showed AUCs for mean and maximum attenuation thresholds of 51.8% and 54.6%, respectively. Subgroup analyses of benign versus malignant and treated versus untreated lesions had similar results. Similar findings were obtained for reader 2. The two readers' ICC was 0.946 for maximum attenuation and 0.918 for mean attenuation. CONCLUSION. Published attenuation thresholds for distinguishing enostoses from osteoblastic metastases had slightly decreased specificity and markedly decreased sensitivity when applied to the differentiation of benign sclerotic lesions from osteoblastic metastases in our sample of biopsy-proven lesions. ROC analysis showed no high-performing attenuation threshold alternative. CLINICAL IMPACT. Published CT attenuation thresholds intended for distinguishing enostoses from osteoblastic metastases should not be used more broadly. More accurate alternative thresholds could not be derived.