Physiological correlates of a simple saccadic-decision task to extended objects in superior colliculus

Our vision is best only in the center of our gaze, and we use saccadic eye movements to direct gaze to objects and features of interest. We make more than 180,000 saccades per day, and accurate and efficient saccades are crucial for most visuo-motor tasks. Saccades are typically studied using small point stimuli, despite the fact that most real-world visual scenes are composed of extended objects. Recent studies in humans have shown that the initiation latency of saccades is strongly dependent on the size of the target (the "size-latency effect"), perhaps reflecting a tradeoff between the cost of making a saccade to a target and the expected information gain that would result. Here, we investigate the neuronal correlates of the size-latency effect in the macaque superior colliculus. We analyzed the latency variations of saccades to different size targets within a stochastic accumulator model framework. The model predicted a steeper increase in activity for smaller targets compared to larger ones. Surprisingly, the model also predicted an increase in saccade initiation threshold for larger targets. We found that the activity of intermediate-layer SC visuomotor neurons is in close agreement with the model predictions. We also found evidence that these effects may be a consequence of the visual responses of SC neurons to targets of different sizes. These results shed new light on the sources of delay within the saccadic system, a system that we heavily depend upon in the performance of most visuo-motor tasks.

Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study

INTRODUCTION

The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures.

METHODS

In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025.

FINDINGS

Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2-6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p<0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5-5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p<0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4-10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p<0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32-4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3·55 [1·23-11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation.

INTERPRETATION

After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification.

FUNDING

UK Research and Innovation and National Institute for Health Research.

Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study

BACKGROUND

No effective pharmacological or non-pharmacological interventions exist for patients with long COVID. We aimed to describe recovery 1 year after hospital discharge for COVID-19, identify factors associated with patient-perceived recovery, and identify potential therapeutic targets by describing the underlying inflammatory profiles of the previously described recovery clusters at 5 months after hospital discharge.

METHODS

The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study recruiting adults (aged ≥18 years) discharged from hospital with COVID-19 across the UK. Recovery was assessed using patient-reported outcome measures, physical performance, and organ function at 5 months and 1 year after hospital discharge, and stratified by both patient-perceived recovery and recovery cluster. Hierarchical logistic regression modelling was performed for patient-perceived recovery at 1 year. Cluster analysis was done using the clustering large applications k-medoids approach using clinical outcomes at 5 months. Inflammatory protein profiling was analysed from plasma at the 5-month visit. This study is registered on the ISRCTN Registry, ISRCTN10980107, and recruitment is ongoing.

FINDINGS

2320 participants discharged from hospital between March 7, 2020, and April 18, 2021, were assessed at 5 months after discharge and 807 (32·7%) participants completed both the 5-month and 1-year visits. 279 (35·6%) of these 807 patients were women and 505 (64·4%) were men, with a mean age of 58·7 (SD 12·5) years, and 224 (27·8%) had received invasive mechanical ventilation (WHO class 7-9). The proportion of patients reporting full recovery was unchanged between 5 months (501 [25·5%] of 1965) and 1 year (232 [28·9%] of 804). Factors associated with being less likely to report full recovery at 1 year were female sex (odds ratio 0·68 [95% CI 0·46-0·99]), obesity (0·50 [0·34-0·74]) and invasive mechanical ventilation (0·42 [0·23-0·76]). Cluster analysis (n=1636) corroborated the previously reported four clusters: very severe, severe, moderate with cognitive impairment, and mild, relating to the severity of physical health, mental health, and cognitive impairment at 5 months. We found increased inflammatory mediators of tissue damage and repair in both the very severe and the moderate with cognitive impairment clusters compared with the mild cluster, including IL-6 concentration, which was increased in both comparisons (n=626 participants). We found a substantial deficit in median EQ-5D-5L utility index from before COVID-19 (retrospective assessment; 0·88 [IQR 0·74-1·00]), at 5 months (0·74 [0·64-0·88]) to 1 year (0·75 [0·62-0·88]), with minimal improvements across all outcome measures at 1 year after discharge in the whole cohort and within each of the four clusters.

INTERPRETATION

The sequelae of a hospital admission with COVID-19 were substantial 1 year after discharge across a range of health domains, with the minority in our cohort feeling fully recovered. Patient-perceived health-related quality of life was reduced at 1 year compared with before hospital admission. Systematic inflammation and obesity are potential treatable traits that warrant further investigation in clinical trials.

FUNDING

UK Research and Innovation and National Institute for Health Research.

The role of vaccines in combating antimicrobial resistance

Vaccination is one of the most effective measures to reduce antimicrobial resistance in both human and animal pathogens. This presentation reviews the multiple pathways by which vaccines may act to reduce resistance: they can prevent infections by focal pathogens, reducing the need to use antibiotics; they can selectively protect against resistant subtypes of a pathogen; they can reduce infections by other pathogen species which are routinely treated with antibiotics (not necessarily appropriately) thus reducing bystander selection; and they could selectively reduce transmission in settings such as hospitals which may have higher proportions of resistant strains. Because vaccines are highly specific to their targeted pathogens, they are much less likely to induce resistance compared to antibiotics. Hence, they can be delivered to large populations as a preventive measure to reduce transmission. The impact of vaccination on resistance has been demonstrated for vaccines against Streptococcus pneumoniae, Haemophilus influenzae type b and influenza. Current and pipeline vaccines against pathogens such as Vibrio cholerae, Escherichia coli, Salmonella typhi, RSV, diarrhoeal viruses and nosocomial bacteria may also have potential to reduce resistance. Economic evaluations of vaccines need to be expanded to capture their benefits in reducing resistance, in order to incentivize development and introduction of the right vaccines. Accurately doing so will require health systems, epidemiological and economic research.

Relapsed angioimmunoblastic T-cell lymphoma with large pericardial effusion

T-cell lymphomas comprise 10% to 15% of all lymphoid malignancies and affect precursor or mature T cells; the latter are referred to as peripheral T-cell lymphomas. We present a case of a subtype, angioimmunoblastic T-cell lymphoma, in which a patient previously treated with chemotherapy and autologous stem cell transplant relapsed with B symptoms and large pericardial/pleural effusions. Recurrent lymphoma was confirmed on pericardial tissue biopsy. Treatment was trialed with lenalidomide and the effusions resolved. Five months later she died from septic shock and multiorgan failure. Our case highlights the need for rapid evaluation of B symptoms and/or new effusions in patients with a known history of angioimmunoblastic T-cell lymphoma.

Molecular Auger Interferometry

We introduce and present a theory of interferometric measurement of a normal Auger decay lifetime in molecules. Molecular Auger interferometry is based on the coherent phase control of Auger dynamics in a two-color (ω/2ω) laser field. We show that, in contrast to atoms, in oriented molecules of certain point groups the relative ω/2ω phase modulates the total ionization yield. A simple analytical formula is derived for the extraction of the lifetimes of Auger-active states from a molecular Auger interferogram, circumventing the need in either high-resolution or attosecond spectroscopy. We demonstrate the principle of the interferometric Auger lifetime measurement using inner-valence decay in CH_{3}F.

Stratifying risk of recurrence of atrial fibrillation following balloon cryoablation using the CAAP-AF risk scoring system

OBJECTIVE

To determine if the CAAP-AF tool could be applied to a cohort of patients in the United States undergoing cryoablation or AF utilizing second-generation cryoballoons.

BACKGROUND

Atrial fibrillation (AF) is a major source of morbidity and expense, with over 33 million individuals affected worldwide and over 450 000 hospitalizations annually in the United States. Catheter ablation for AF is a class I indication for patients with symptomatic AF. The ability to predict postablation recurrence would have an enormous impact on both patient outcomes and cost to the health care system.

METHODS

Our study was an observational, single-center retrospective study to evaluate the utility of the CAAP-AF risk scoring system in predicting recurrence of AF following second-generation balloon cryoablation for AF.

RESULTS

There were a total of 235 patients. From the initial cohort, 30.2% (71) had a recurrence of AF within 1 year of the cryoablation procedure. There was a statistically significant increase in mean age, left atrial diameter, left atrial volume index, CHADS₂ , CHADS₂ -VASc, and number of antiarrhythmics failed in the group that had recurrence of AF. There was also a statistically significant increase in the CAAP-AF score in patients who had recurrence of AF.

CONCLUSIONS

The CAAP-AF score predicted the freedom from AF 1 year following cryoablation for AF. The CAAP-AF score can aid in selecting patients most likely to benefit from cryoablation, which includes patients with a low CAAP-AF score, as they are most likely to remain AF free at 1 year.

Individual variation in the compromise between social group membership and exposure to preferred temperatures

Group living is widespread among animal species, and comes with a number of costs and benefits associated with foraging, predator avoidance and reproduction. It is largely unknown, however, whether individuals sacrifice exposure to their own preferred or optimal environmental conditions so they can remain part of a social group. Here, we demonstrate that individual three-spine sticklebacks vary in the degree to which they forego exposure to their preferred ambient temperature so they can associate with a group of conspecifics. Individual fish varied widely in preferred temperature when tested in isolation. When the same individuals were presented with a choice of a warm or cold thermal regime in the presence of a social group in one of the environments, fish spent more time with the group if it was close to their own individually preferred temperature. When a group was in a relatively cool environment, focal individuals that were more social deviated most strongly from their preferred temperature to associate with the group. Standard and maximum metabolic rate were not related to temperature preference or thermal compromise. However, individuals with a higher standard metabolic rate were less social, and so energetic demand may indirectly influence the environmental costs experienced by group members. The reduced tendency to engage with a social group when there is a large difference between the group temperature and the individual's preferred temperature suggests a role for temperature in group formation and cohesion that is mediated by individual physiology and behaviour. Together, these data highlight exposure to non-preferred temperatures as a potential cost of group membership that probably has important but to date unrecognized implications for metabolic demand, energy allocation, locomotor performance and overall group functioning.

The Effects of Administration of Ethyl Alcohol to Mice on Megakaryocyte and Platelet Development

The effects of administration to laboratory mice of 5-20% ethyl alcohol (v:v) as drinking water on megakaryocyte and platelet development were studied and compared with data on controls given tap water.

In two separate experiments, mice given 5-15% ethyl alcohol (v:v) for 13 or 11 weeks showed decreases in platelet counts and platelet 35S uptake when compared to the control groups. Mice fed 5-20% alcohol for five weeks showed platelet counts, bone marrow megakaryocyte numbers and diameters that were significantly reduced to 72% (P <0.001), 45% (P <0.001), and 71% (P <0.01), respectively.

The data implied that ethyl alcohol ingestion had a direct inhibitory effect on megakaryocyte and platelet development in mice, which resulted in a marked reduction in the levels of circulating platelets.

Psychiatric disorders among elderly patients admitted to hospital medical wards

A psychiatric investigation was carried out on patients aged 65–80 years who were admitted to the medical wards of six general hospitals in an industrial urban area of West Germany. In all, 626 patients were screened for cognitive and affective disorder using a short standardized interview, and at the second stage all those with abnormal responses, as well as a subsample of the apparently normal patients, were examined in greater detail. After correction for inaccuracies of screening, the frequency of psychiatric illness in this patient population was estimated as 30.2%, made up of 9.1% with organic brain syndromes and 21.1% with functional mental disorders. Comparison with field-study data for the same background population showed that the hospital patients were at increased risk for mental disturbance.

At follow up after one year, outcome in terms of mortality, admission to long-term care and dependency on others was worst for patients with organic mental disorder, even after matching for age and initial severity of physical impairment. Functional mental illness was also associated with a relatively poor outcome in terms of dependency. The mental status of elderly medical patients appears to be important for the prognosis.

Preliminary evidence supports circulating microRNAs as prognostic biomarkers for type 2 diabetes

Background

Circulating microRNAs are emerging as potential prognostic biomarkers for the development of type 2 diabetes. However, microRNAs are also associated with complications from impaired glucose metabolism (e.g. endothelial cell function). Prior studies have not evaluated for associations between trajectories of circulating microRNAs with trajectories of fasting blood glucose over time and the responses to behavioral interventions to reduce risk. This study performed longitudinal assessment of microRNAs and fasting blood glucose and identified relationships between microRNAs and behavioral risk reduction interventions.

Methods

MicroRNAs (n = 353) were measured in subsets (n = 10, n = 8) of participants from previously completed clinical trials that studied behavioral risk reduction interventions. Fasting blood glucose trajectories were associated with changes in 45 microRNAs over 12 months.

Results

Following a 3‐month physical activity and dietary intervention compared with baseline, 13 microRNAs were differentially expressed. Seven microRNAs (i.e. miR‐106b, miR‐20b, miR‐363, miR‐486, miR‐532, miR‐92a and miR‐93) were commonly identified between the two analyses.

Conclusions

Further studies are needed to determine which microRNAs are prognostic biomarkers of risk for type 2 diabetes versus consequences of impaired glucose metabolism. Additional future directions of this research are to differentiate whether microRNAs are prognostic and/or diagnostic biomarkers for risk for type 2 diabetes and predictive biomarkers of responses to risk reduction interventions.

Accurate prediction of X-ray pulse properties from a free-electron laser using machine learning

Free-electron lasers providing ultra-short high-brightness pulses of X-ray radiation have great potential for a wide impact on science, and are a critical element for unravelling the structural dynamics of matter. To fully harness this potential, we must accurately know the X-ray properties: intensity, spectrum and temporal profile. Owing to the inherent fluctuations in free-electron lasers, this mandates a full characterization of the properties for each and every pulse. While diagnostics of these properties exist, they are often invasive and many cannot operate at a high-repetition rate. Here, we present a technique for circumventing this limitation. Employing a machine learning strategy, we can accurately predict X-ray properties for every shot using only parameters that are easily recorded at high-repetition rate, by training a model on a small set of fully diagnosed pulses. This opens the door to fully realizing the promise of next-generation high-repetition rate X-ray lasers.

Genome-Wide Association Study of Spot Form of Net Blotch Resistance in the Upper Midwest Barley Breeding Programs

Pyrenophora teres f. maculata, the causal agent of spot form of net blotch (SFNB), is an emerging pathogen of barley in the United States and Australia. Compared with net form of net blotch (NFNB), less is known in the U.S. Upper Midwest barley breeding programs about host resistance and quantitative trait loci (QTL) associated with SFNB in breeding lines. The main objective of this study was to identify QTL associated with SFNB resistance in the Upper Midwest two-rowed and six-rowed barley breeding programs using a genome-wide association study approach. A total of 376 breeding lines of barley were evaluated for SFNB resistance at the seedling stage in the greenhouse in Fargo in 2009. The lines were genotyped with 3,072 single nucleotide polymorphism (SNP) markers. Phenotypic evaluation showed a wide range of variability among populations from the four breeding programs and the two barley-row types. The two-rowed barley lines were more susceptible to SFNB than the six-rowed lines. Continuous distributions of SFNB severity indicate the quantitative nature of SFNB resistance. The mixed linear model (MLM) analysis, which included both population structure and kinship matrices, was used to identify significant SNP-SFNB associations. Principal component analysis was used to control false marker-trait association. The linkage disequilibrium (LD) estimates varied among chromosomes (10 to 20 cM). The MLM analysis identified 10 potential QTL in barley: SFNB-2H-8-10, SFNB-2H-38.03, SFNB-3H-58.64, SFNB-3H-78.53, SFNB-3H-91.88, SFNB-3H-117.1, SFNB-5H-155.3, SFNB-6H-5.4, SFNB-6H-33.74, and SFNB-7H-34.82. Among them, four QTL (SFNB-2H-8-10, SFNB-2H-38.03 SFNB-3H-78.53, and SFNB-3H-117.1) have not previously been published. Identification of SFNB resistant lines and QTL associated with SFNB resistance in this study will be useful in the development of barley genotypes with better SFNB resistance.

Unrecognized hemoglobin SE disease as microcytosis

Hemoglobin SE disease was first described during the 1950s as a relatively benign microcytosis, but increasing prevalence has revealed a predisposition towards vasoocclusive sickling. Recognition of SE hemoglobinopathies' potential complications is crucial so medical measures can be utilized to avoid multiorgan injury.

Hepatic angiosarcoma associated with disseminated intravascular coagulation

We present a case of hepatic angiosarcoma that presented with disseminated intravascular coagulopathy to highlight the difficulty in diagnosing this disease due its aggressive clinical course, the overlapping features of various coagulopathies, and the nonspecific appearance of angiosarcomas on imaging.

Brief sexuality communication--a behavioural intervention to advance sexually transmitted infection/HIV prevention: a systematic review

BACKGROUND

Throughout the last decade substantial research has been undertaken to develop evidence-based behaviour change interventions for sexual health promotion. Primary care could provide an opportunistic entry for brief sexual health communication.

OBJECTIVES

We conducted a systematic review to explore opportunistic sexual and reproductive health services for sexual health communication delivered at primary health care level.

SEARCH STRATEGY

We searched for studies on PubMed, ProQuest, CINAHL, Jstor, Scopus/Science Direct, Cochrane database of systematic reviews, EBSCO, CINAHL, PsychoInfo, and Web of Knowledge. Both published and unpublished articles were reviewed.

SELECTION CRITERIA

All randomised controlled trials and controlled clinical trials were included. Participants of all ages, from adolescence onwards were included. Brief (10-60 minutes) interventions including some aspect of communication on sexual health issues were included.

DATA COLLECTION AND ANALYSIS

Data were extracted by two reviewers independently using a standardised form. Interventions differed from each other, hence meta-analysis was not performed, and results are presented individually.

MAIN RESULTS

A total of 247 articles were selected for full-text evaluation, 31 of which were included. Sexually transmitted infections (STIs)/HIV were less often reported in the intervention group compared with the control group. Condom use was higher in most studies in the intervention group. Numbers of sexual partners and unprotected sexual intercourse were lower in the intervention groups.

CONCLUSIONS

There is evidence that brief counselling interventions have some effect in the reduction and prevention of STIs/HIV. Some questions could not be answered, such as the effect over time and in different settings and population groups.

Functionality of the three-site ferroxidase center of Escherichia coli bacterial ferritin (EcFtnA)

At least three ferritins are found in the bacterium Escherichia coli : the heme-containing bacterioferritin (EcBFR) and two nonheme bacterial ferritins (EcFtnA and EcFtnB). In addition to the conserved A and B sites of the diiron ferroxidase center, EcFtnA has a third iron-binding site (the C site) of unknown function that is nearby the diiron site. In the present work, the complex chemistry of iron oxidation and deposition in EcFtnA was further defined through a combination of oximetry, pH stat, stopped-flow and conventional kinetics, UV-vis, fluorescence, and EPR spectroscopic measurements on both the wild-type protein and site-directed variants of the A, B, and C sites. The data reveal that although H2O2 is a product of dioxygen reduction in EcFtnA and oxidation occurs with a stoichiometry of Fe(2+)/O2 ∼ 3:1 most of the H2O2 produced is consumed in subsequent reactions with a 2:1 Fe(2+)/H2O2 stoichiometry, thus suppressing hydroxyl-radical formation. Although the A and B sites are essential for rapid iron oxidation, the C site slows oxidation and suppresses iron turnover at the ferroxidase center. A tyrosyl radical, assigned to Tyr24 near the ferroxidase center, is formed during iron oxidation, and its possible significance to the function of the protein is discussed. Taken as a whole, the data indicate that there are multiple iron-oxidation pathways in EcFtnA with O2 and H2O2 as oxidants. Furthermore, our data do not support a universal mechanism for iron oxidation in all ferritins whereby the C site acts as transit site, as has been recently proposed.

Systemic mastocytosis with associated acute myelogenous leukemia

Systemic mastocytosis (SM) is a condition associated with a clonal neoplastic proliferation of mast cells. Approximately 40% of patients with SM present with an associated clonal hematological non-mast cell lineage disorder. Patients presenting with SM-acute myeloid leukemia (AML) have the worst prognosis. We present a case of a 62-year-old woman who was diagnosed with SM-AML. After initial treatment with a standard regimen of cytosine arabinoside (Ara-C)/idarubicin, her bone marrow showed residual blasts. She was subsequently treated with a second induction regimen of clofarabine and high-dose Ara-C, which resulted in remission of AML, although a residual mast cell infiltrate persisted in her bone marrow. After consolidation therapy with clofarabine/Ara-C, the patient received a stem cell allograft. A follow-up bone marrow showed no residual blasts but persistent mast cells occupying about 5% of the marrow volume.

Copper deficiency (hypocupremia) and pancytopenia late after gastric bypass surgery

Hypocupremia, or copper deficiency, is a rare and underrecognized cause of bone marrow dysplasia. Most cases of copper deficiency in adults occurred historically in patients receiving total parenteral hyperalimentation or total parental nutrition. More recently, with the obesity epidemic and the prevalence of gastric bypass, cases of malabsorption-related copper deficiency have occurred. Copper deficiency can lead to significant cytopenias and possible neurologic sequelae, which can be misdiagnosed and mismanaged. Unfortunately, a delay in diagnosis and appropriate treatment may lead to permanent neurologic damage. We describe a woman with previous gastric bypass surgery who presented with pancytopenia and bone marrow biopsy findings consistent with a myelodysplastic syndrome with excess blasts. She was found to be significantly copper deficient. With replacement copper therapy, her cytopenias quickly resolved. We discuss the distinctive clinical and hematologic features of this rare cause of significant cytopenias and provide recommendations for monitoring and treatment of such patients. Moreover, this case is an important reminder that bariatric patients should have routine follow-ups after surgery and continue dietary supplements indefinitely.

T-cell prolymphocytic leukemia

T-cell prolymphocytic leukemia is a rare and unusual malignancy characterized by the proliferation of small- to medium-sized prolymphocytes of postthymic origin with distinctive clinical, morphologic, immunophenotypic, and cytogenetic features. Involvement of the peripheral blood, bone marrow, lymph nodes, liver, spleen, and skin can occur. The clinical course is typically very aggressive with poor response to conventional chemotherapy and short survival rates, and the only potential long-term curative treatment is hematopoietic stem cell transplantation. We report the case of a man with de novo T-cell prolymphocytic leukemia and discuss the distinctive clinical, morphologic, immunophenotypic, and cytogenetic features of this entity.