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Two separate reliability studies were conducted on an observational instrument derived from previous qualitative research and designed for collecting data on teaching behaviors demonstrated by attending physicians during attending rounds. The first study involved five observers coding 17 20-minute, videotaped segments of attending rounds. The second study involved two observers coding 27 two-hour attending round sessions as they occurred live on hospital wards. The reliability estimates from both studies were quite high, indicating that the instrument shows promise for use in both research and evaluation studies. [ABSTRACT FROM AUTHOR]

Human T-cell leukemia virus type 1 (HTLV-1) can cause HTLV-1 Associated Myelopathy/Tropical Spastic Paraparesis (HAM/TSP). Current treatment options for HAM/TSP are limited. We present a woman with rapidly-progressive HAM/TSP with significant, sustained clinical improvement following initiation of mycophenolate mofetil (MMA). Peripheral blood mononuclear cells from the patient, her asymptomatic carrier husband and eight healthy controls were isolated. Frequencies of T-cell populations upon exposure to low and high MMA concentrations and differences in proliferation were analyzed using flow cytometry and a CSFE-proliferation assay. Characterization of T-cell function and proliferation showed higher levels of GranzymeB in HTLV-1+ donors. The improvement and stability of symptoms in this patient with HAM/TSP following MMA initiation requires further study as a potential treatment for HAM/TSP., Competing Interests: Declaration of competing interest The authors have no conflicts of interest relevant to this article to disclose. There are no prior publications or submissions of this article with any overlapping information, including original studies and patients., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Thymomas are tumors of the mediastinum often associated with autoimmune conditions, in particular myasthenia gravis. In contrast, among the fewer than 40 reports of metaplastic thymoma, myasthenia gravis is rarely found. We describe the fourth patient, and first man, with metaplastic thymoma and myasthenia gravis. A 34-year-old had acute onset of double vision with associated dysphagia and was found to have an elevation of serum acetylcholine receptor antibodies. He underwent a transsternal thymectomy. Tissue sections showed a biphasic proliferation of keratin-positive epithelial cells with a complement of spindle cells confirming the diagnosis of metaplastic thymoma. Terminal deoxynucleotidyl transferase (TDT)-positive T lymphocytes were rare and only found in the periphery of the tumor, consistent with thymic remnant. A YAP1::MAML2 gene fusion, with an in-frame fusion between genes YAP1 Exon5 (NM_001130145) and MAML2 Exon2 (NM_032427) was found, supporting further the diagnosis of metaplastic thymoma (Anchored multiplex RNA sequencing [Archer Dx, Boulder, CO] assay). The patient's gender and relatively young age, the presence of an autoimmune condition, and the lack of lymphocytic infiltrate all contribute unusual features to this case and suggest avenues for further exploration., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Henry J. Kaminski, M.D., is a consultant for Roche, Cabeletta Bio, and UCB Pharmaceuticals; and is CEO and CMO of ARC Biotechnology, LLC based on US Patent 8,961,98. He is principal investigator of the Rare Disease Network for Myasthenia Gravis (MGNet) National Institute of Neurological Disorders & Stroke, U54 NS115054, Targeted Therapy for Myasthenia Gravis. R41 NS110331 to ARC Biotechnology, and co-investigator for R43NS124329 MV2C2 antibody as a new therapeutic for myasthenia gravis to Mimivax, LLC. Keith Mortman, M.D., is a consultant for Ethicon & on the advisory board for Guardant Health. We have no other potential conflicts to disclose.

Research in interaction and interviewing behaviors usually has focused on the verbal behaviors exhibited by the interactants. These behaviors have been looked upon and analyzed in isolation, that is, as a single event. There is little or no information on physician-patient interactions that analyzes verbal behaviors as being a series of events related to each other. These behaviors, when seen as a chain of events, provide a different and revealing picture of those who exhibit them. A study was undertaken to gather information on physicians' verbal behaviors and verbal patterns during interactions involving genetic counseling. Physicians who were rated high in communication skills spent more time in the affective dimension of the interaction and exhibited more reflection of feelings, emotional probing, reassurance/support, and silence during the interaction with patients. These differences were found in both the sequential verbal pattern data and the individual verbal behavior data.