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Immunotherapy approaches targeting dendritic cells (DCs) are being studied as treatment options in cancer. This project focused on utilizing DCs as a valuable in vitro screening tool for efficacious microparticle formulations containing tumor associated antigens (TAAs) and adjuvants as immunotherapy alternatives. The innate immune system, including DCs, distinctly responds to the particulate matter and adjuvants in these formulations which stimulates the adaptive immune system to eliminate resident cancer cells. We formulated microparticles (MPs) co-loaded with TAAs along with the adjuvants, AddaVax™ and Imiquimod, and measured their effect on DCs in eliciting a cell-mediated immune response towards tumors. The MP zeta potential was measured as -24.0 mV and -26.5 mV for blank and TAA/adjuvant co-loaded microparticles, and the average particle size was 671.2 nm and 854.4 nm respectively. We determined that nitric oxide (NO) secretion was significantly higher in the adjuvant MP treated DCs group and was dose dependent with 1 mg/mL demonstrating the highest secretion levels. TNF-α release was highest in AddaVax™/TAA and Imiquimod/TAA MPs treated DCs, while IL-6 secretion was highest from Imiquimod/TAA MPs as well as from combined AddaVax™/TAA and Imiquimod/TAA MPs. Overall, the cell surface marker expressions of CD80, CD86, CD40, CD54, MHC-I and MHC-II levels were highest with combined AddaVax™/TAA and Imiquimod/TAA MPs. The results of our experiments suggest that a combination of adjuvants targeting different DC receptors loaded with TAA MPs creates an efficient delivery system to T-cells that could improve adaptive immune responses. Our studies also confirm that DCs are potent innate immune cells that can be used successfully as an in vitro tool to screen novel delivery formulations focused on immunotherapy., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Primary hepatic lymphoma (PHL) is a rare variant of non-Hodgkin's lymphoma. Diffuse hepatic involvement is uncommon and therefore presentation as progressive hepatitis or acute fulminant hepatic failure is rare. Acute onset of signs and symptoms can mimic a variety of infectious and inflammatory disorders, thus delaying the diagnosis. A high index of suspicion and liver biopsy early in the course of liver dysfunction may establish the diagnosis and allow rapid initiation of chemotherapy to prevent a fatal outcome. In this report, we describe a rare case of fulminant primary hepatic diffuse large B-cell lymphoma in a 55-year-old woman who died 2 weeks after admission, before the initiation of chemotherapy., Learning Points: Primary hepatic lymphoma (PHL) is a rare yet serious disease which should be suspected in every case presenting as hepatitis with unclear aetiology.A liver biopsy should be performed as early as possible when PHL is suspected.Failure to detect PHL early can result in rapid deterioration and death within 2 weeks of presentation., Competing Interests: Conflicts of Interests: The Authors declare that there are no competing interests.

Vaso-occlusive crisis (VOC) is the primary cause of hospitalization of patients with sickle-cell disease. Treatment mainly consists of intravenous morphine, which has many dose-related side effects. Nonsteroidal antiinflammatory drugs have been proposed to provide pain relief and decrease the need for opioids. Nevertheless, only a few underpowered trials of nonsteroidal antiinflammatory drugs for sickle-cell VOC have been conducted, and conflicting results were reported. We conducted a phase 3, double-blind, randomized, placebo-controlled trial with ketoprofen (300 mg/day for 5 days), a nonselective cyclooxygenase inhibitor, for severe VOC in adults. A total of 66 VOC episodes were included. The primary efficacy outcome was VOC duration. The secondary end points were morphine consumption, pain relief, and treatment failure. Seven VOC episodes in each group were excluded from the analysis because of treatment failures. No significant between-group differences were observed for the primary outcome or the secondary end points. Thus, although ketoprofen was well-tolerated, it had no significant efficacy as treatment of VOC requiring hospitalization. These findings argue against its systematic use in this setting.

Benign cystic lymphangioma is a relatively rare tumor of the human body. It's more frequent in young patients. It is usually localized in the neck but may have mediastinal or intra-abdominal localization. It's usually asymptomatic with good prognosis after total excision. We report in this article the case of a young man with a huge mediastinal cystic lymphangioma which was successfully operated and a review of the literature.

This is a retrospective and descriptive study done at an academic hospital center. It collects data about 143 patients admitted during 10 years at the hospital, between January 1989 and December 2000, to have renal biopsy for suspicion of glomerulopathy. The glomerulonephritides most frequently present were: mesangial proliferative glomerulonephritis (15%), membrano-proliferative glomerulonephritis (13%), chronic glomerulonephritis (13%), membranous glomerulonephritis (8%), proliferative focal and segmental glomerulonephritis (8%) and scleronodular focal glomerulonephritis (8%). Patients with arterial hypertension represented 89% of patients with chronic glomerulonephritis and 54% of patients with scleronodular focal glomerulonephritis. Those with heavy proteinuria represented 82% of patients with primarily membranous glomerulonephritis, 66% of patients with minimal change disease and 44% of patients with membrano-proliferative glomerulonephritis. Those with active urinary sediment have had mostly membrano-proliferative glomerulonephritis, rapidly progressive glomerulonephritis, postinfectious glomerulonephritis and proliferative mesangial glomerulonephritis. High rates of evolution to end-stage renal disease, renal transplantation or dialysis were mostly depicted between patients with scleronodular focal glomerulonephritis (91% of cases), chronic (89% of cases) and membrano-proliferative (72% of cases) glomerulonephritis.

Treatment of acute inflammation contains usually local or systemic anti-inflammatory drugs. These medications, such as corticosteroids or NSAIDs, are not always safe to use. Major side effects are boosting secondary infections due to its immunosuppressive action or masking such as infections by its anti-inflammatory activity. Because of these potential complications, the benefice/risk ratio of anti-inflammatory drugs must be weighed carefully besides its correct patterns of use and the prevention of its side effects. Available recommendations in the literature concerning its use are discussed thereafter.

Objective: Present the epidemiology and clinical characteristics of typhoid fever in the Lebanon., Methods: Retrospective study of 52 patients admitted to a university hospital center between 1995 and 1999. The criteria for inclusion were a positive Salmonella typhi or paratyphi hemoculture and/or Widal serodiagnosis > 1/160 for O agglutinin, in the presence of evocative symptoms., Results: The patients were aged a mean of 31 +/- 24 years. The mean duration between the onset of fever and diagnosis was of 10 +/- 8 days. Fever was observed in 96% of cases and the other predominant symptoms were diarrhea (37%), abdominal pain (31%) and headache (29%). Feverish gastroenteritis is a frequent manifestation in children (61% of cases). Complications were noted in 33% of cases and were predominantly digestive. Leukopenia is not a good diagnostic marker. S. typhi was the cause in 83% of cases. Resistance to ampicillin was noted in 13% of cases, to cotrimoxazole and to chloramphenicol in 10% and to ofloxacine in 3% of cases. One death was reported (2%) of an immunodepressed patient., Conclusion: Typhoid fever is still an endemic disease in the Lebanon and should be systematically evoked in the case of prolonged fever, feverish gastroenteritis and/or headache. The appearance of bacteria resistant to antibiotics makes ceftriaxone or ciprofloxacine the empirical treatment of choice.

In this article, we present two cases of peritoneal pseudomyxoma suspected on abdominal CT Scan and then confirmed on pathologic examination. A mucinus carcinoma was the primary lesion in the two cases, appendicular in the first case and with an undeterminate origin in the second. The prognosis was bad in these cases despite the debulking surgery and the systemic and intraperitoneal chemotherapy.

A 61-year-old man developed an extrapyramidal syndrome 15 days after an episode of carbon monoxide poisoning. Two months later he developed severe deafness. Brain imaging revealed ischemic lesions in the region of the basal ganglia. Audiometric studies disclosed neurosensorial deafness. The patient died nine months later due to respiratory complications.

This is a case report, concerning the endovascular use of N-butyl-2-cyanoacrylate, for treatment of a digestive hemorrhage from a distal branch of the superior mesenteric artery, leading to a successful outcome. This material, usually used in brain angiomas, constitutes an alternative for digestive embolization, which is quick, precise and definitive, without additional risk in experienced hands.

In this article, the case of a 32-year-old man with a paravertebral actinomycosis is discussed. Initially, the diagnosis was not obvious but it was confirmed later with the repetitive radiologic procedures, the elimination of other etiologies (purulent, mycobacterial or mycotic infections and neoplasia) and the biopsy. Treatment with penicillin initially and then with tetracycline for a long term led to a very good outcome at a 3-year follow-up with a radiologic remission. Following the discussion of the case, a review of the literature concerning the paravertebral actinomycosis, its diagnostic clues and treatment is undertaken.