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Patients with malignant thymomas are susceptible to the development of graft-versus-host disease (GVHD)–like disease known as thymoma-associated multiorgan autoimmunity (TAMA). The proposed mechanism of this paraneoplastic phenomenon is a breakdown in the immune regulatory function of the thymus and subsequent activation of T cells. Here, we report a novel case of a patient with TAMA who, following surgical resection and radiation therapy, successfully underwent treatment with a combination of extracorporeal photopheresis (ECP), intravenous immunoglobulin (IVIg), cyclosporine, and prednisone.

Patients interested in botulinum toxin type A (BTX-A) for wrinkles search for videos on YouTube, but little is known about the quality and reliability of the content.The authors examined the quality, reliability, content, and target audience of YouTube videos on BTX for wrinkles.In this cross-sectional study, the term "Botox" was searched on YouTube. Sixty relevant videos in English were independently categorized by 2 reviewers as useful informational, misleading informational, useful patient view, or misleading patient view. Disagreements were settled by a third reviewer. Videos were rated on the Global Quality Scale (GQS) (1 = poor, 5 = excellent).Sixty-three percent of the BTX YouTube videos were useful informational (GQS = 4.4 ± 0.7), 33% as useful patient view (GQS = 3.21 ± 1.2), 2% as misleading informational (GQS = 1), and 2% as misleading patient view (GQS = 2.5).The large number of useful videos, high reliability, and the wide range of content covered suggests that those who search for antiwrinkle BTX videos on YouTube are likely to view high-quality content. This suggests that YouTube may be a good source of videos to recommend for patients interested in BTX.

Objective To determine whether exaggerating the variations in fundamental frequency (F0) contours of Mandarin-based pitch fluctuations could improve tone identification by cochlear implant (CI) users. Methods Twelve normal-hearing (NH) listeners and 11 CI users were tested for their ability to recognize F0 contours modeled after Mandarin tones, in 4- or 5-alternatives forced-choice paradigms. Two types of stimuli were used: computer-generated complex tones and voice recordings. Four contours were tested with voice recordings: flat, rise, fall, and dip. A fifth contour, peak, was added for complex tones. The F0 range of each contour was varied in an adaptive manner. A maximum-likelihood technique was used to fit a psychometric function to the performance data and extract threshold at 70% accuracy. Results As F0 range increased, performance in tone identification improved but did not reach 100% for some CI users, suggesting that confusions between contours could always be made even with extremely exaggerated contours. Compared with NH participants, CI users required substantially larger F0 ranges to identify tones, on the order of 9.3 versus 0.4 semitones. CI users achieved better performance for complex tones than for voice recordings, whereas the reverse was true for NH participants. Confusion matrices showed that the "flat" tone was often a default option when the tone contour's F0 range presented was too narrow for participants to respond correctly. Conclusion These results demonstrate markedly impaired ability for CI users to identify tonal contours, but suggest that the use of exaggerated pitch contours may be helpful for tonal language perception.

Author(s): Qi, J; Trang, T; Doong, J; Kang, S; Chien, A.L | Abstract: Background Psoriasis patients seek information online, but little is known about their interaction with YouTube. We examined the quality of content in psoriasis-related YouTube videos and investigated their interactions with viewers.Methods YouTube was searched using the term “psoriasis.” Relevant videos in English were independently categorized by two reviewers as useful, misleading, or patient view (regarding experience with psoriasis). Disagreements were settled by a third reviewer. Videos were rated on a Global Quality Scale (GQS) (1=poor, 5=excellent).Results According to our reviewers, 17% of the 47 videos were useful, 21% were misleading, and 62% represented patient views. Mean GQS scores were 4.2 ± 1.3 for useful videos, 1.7 ± 0.7 for misleading videos, and 2.2 ± 1.1 for patient view videos (pl0.001). Video views per day did not differ among the categories (p=0.65), whereas useful videos had fewest “Likes” (useful: 31 ± 55, 33 misleading: 151 ± 218, patient views: 165 ± 325, p=0.06) and comments (useful: 9.8 ± 18.3, misleading: 64.1 ± 89.7, 124.9 ± 34 199.4, p=0.009).Conclusions Useful videos were highest in quality but had similar viewership as misleading and patient view videos, with lower popularity and engagement of users compared to other categories. Physicians and psoriasis patients should be aware of this pattern when pproaching YouTube as a resource.