Background Sepsis is one of the most frequent reasons for acute intensive care unit (ICU) admission of very old patients and mortality rates are high. However, the impact of pre-existing physical and cognitive function on long-term outcome of ICU patients ≥ 80 years old (very old intensive care patients (VIPs)) with sepsis is unclear. Objective To investigate both the short- and long-term mortality of VIPs admitted with sepsis and assess the relation of mortality with pre-existing physical and cognitive function. Design Prospective cohort study. Setting 241 ICUs from 22 European countries in a six-month period between May 2018 and May 2019. Subjects Acutely admitted ICU patients aged ≥80 years with sequential organ failure assessment (SOFA) score ≥ 2. Methods Sepsis was defined according to the sepsis 3.0 criteria. Patients with sepsis as an admission diagnosis were compared with other acutely admitted patients. In addition to patients’ characteristics, disease severity, information about comorbidity and polypharmacy and pre-existing physical and cognitive function were collected. Results Out of 3,596 acutely admitted VIPs with SOFA score ≥ 2, a group of 532 patients with sepsis were compared to other admissions. Predictors for 6-month mortality were age (per 5 years): Hazard ratio (HR, 1.16 (95% confidence interval (CI), 1.09–1.25, P < 0.0001), SOFA (per one-point): HR, 1.16 (95% CI, 1.14–1.17, P < 0.0001) and frailty (CFS > 4): HR, 1.34 (95% CI, 1.18–1.51, P < 0.0001). Conclusions There is substantial long-term mortality in VIPs admitted with sepsis. Frailty, age and disease severity were identified as predictors of long-term mortality in VIPs admitted with sepsis.

Human papillomavirus-positive (HPV + ) oropharyngeal squamous cell carcinoma (OPSCC) has increased in incidence and has a much better prognosis than HPV-negative (HPV -) OPSCC with radiotherapy alone, but exactly why is unknown. The present study therefore aimed to further examine the sensitivity and possible changes in gene expression of several HPV + and HPV -OPSCC, including various novel cell lines, upon ionizing irradiation (IR). Previously established HPV + UM-SCC-47, UPCI-SCC-90, CU-OP-2, CU-OP-3 and HPV -UM-SCC-4, UM-SCC-6, UM-SCC-74a, UM-SCC-19 and newly established CU-OP-17 and CU-OP-20, characterised here, were subjected to 0-6 Gy. Surviving fractions of each cell line were tested by clonogenic assays, and irregularities in cell cycle responses were examined by flow cytometry, while changes in gene expression were followed by mRNA sequencing. HPV + OPSCC cell lines showed greater variation in sensitivity to ionizing irradiation (IR) and tended to be more sensitive than HPV -OPSCC cell lines. However, their IR sensitivity was not correlated to the proportion of cells in G2 arrest, and HPVcell lines generally showed lower increases in G2 after IR. Upon IR with 2 Gy, mRNA sequencing revealed an increase in minor HPV integration sites in HPV + cell lines, and some changes in gene expression in OPSCC cell lines, but not primarily those associated with DNA repair. To conclude, HPV + OPSCC cell lines showed greater variation in their sensitivity to IR, with some that were radioresistant, but overall the HPV + OPSCC group still tended to be more sensitive to IR than the HPV -OPSCC group. In addition, HPV + OPSCC lines were more frequently in G2 as compared to HPVcell lines, but the increase in G2 arrest upon IR in HPV + OPSCC was not correlated to sensitivity to IR. Increases in minor HPV integration sites and changes in gene expression were also demonstrated after irradiation with 2 Gy.

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We describe an unsuccessful treatment of Balo concentric sclerosis (BCS), review the current evidence directing therapy, and propose next steps for exploring this rare and commonly fatal condition. Case Report A 52-year-old left-handed engineer reported three weeks of progressive left leg weakness. Examination revealed pyramidal weakness, hyperreflexia and spasticity in the left leg. An MRI head scan showed concentric sclerosis in the right frontoparietal region ( Figure 1A). He was diagnosed with J Neurol Neurosurg Psychiatry 2013;84:e2 73 of 95 ABN Abstracts group.bmj.com on August 18, 2015 -Published by