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Recent studies have described an association between high-risk lipoprotein profiles and anabolic steroid abuse by athletes. However, none have included a comprehensive evaluation of diet as a confounding variable. The risk of cardiovascular disease (CVD) and its associations with drug abuse, dietary patterns, and training regimens were evaluated in 18 steroid-using (SU) and 17 non-steroid-using (NSU; no history of drug use or greater than or equal to 1 year drug-free) male bodybuilders. CVD risk was also evaluated in 10 control males. Fasting serum total cholesterol (TC), high-density lipoprotein cholesterol (HDL) and HDL subfractions 2 and 3, low-density (LDL) and very-low-density (VLDL) lipoprotein cholesterol, apoproteins (APO) A-1 and B, and triglycerides (TG) were analyzed at baseline (greater than or equal to 6 months drug-free) and the peak of steroid self-administration in SU. NSU were tested at similar times. Baseline CVD risk factor ratios (TC/HDL) were elevated (greater than 4.97) in 44% of SU and 24% of NSU. When baseline LDL and HDL values were compared to National Cholesterol Education Program CVD risk guidelines, these percentages stayed the same. At the peak of steroid administration significant changes were observed in LDL (22% increase), HDL (63% decrease), HDL-2 (86% decrease), HDL-3 (54% decrease), and TC/HDL (85% increase). No similar measures were observed among NSU or controls. Diets of all bodybuilders were similar, and included a daily intake of 5739 (+/- 2500) kcal, 324 (+/- 163) g protein, 637 (+/- 259) g carbohydrate, 214 (+/- 109) g fat, 5 (+/- 8) g alcohol, 1413 (+/- 1151) mg cholesterol, and a P/S ratio of 0.6 (+/- 0.3). Significant relationships between dietary fats and serum lipids were observed in the NSU. Polyunsaturated fatty acids were correlated with TG and VLDL (r = 0.69; p = 0.01), and TC/HDL (r = 0.06; p = 0.04). Total fats were correlated with TG (r = 0.57; p = 0.05), HDL-3 (r = -0.62; p = 0.04), and VLDL (r = 0.57; p = 0.05), and saturated fats with HDL-3 (r = -0.59; p = 0.055). Diet was moderately associated with lipoproteins in SU, but steroids had a much greater influence on CVD risk. Despite disease promoting diets NSU had relatively average CVD risk that may be attributed to protective effects of rigorous training.

We describe a patient with Behcet's syndrome who had clinical and angiographic features of widespread cerebral angiitis of small-and medium-caliber vessels. We report the successful treatment of this condition with a combination of cytotoxic agents and steroids, and demonstrate angiographically the resolution of these abnormalities in neuro-Behget's disease.The triad of recurrent aphthous oral and genital ulcers and uveitis was first described by Behqet in 1937 (I). Since then, BehCet's syndrome has been recognized as a multisystem disease that includes neurologic, vascular, articular, and intestinal involvement in addition to the previously described triad (2). Central nervous system (CNS) involvement is a serious complication in Behqet's syndrome, and it most frequently presents as a meningoencephalomyelitic syndrome. Occasionally, it presents as a brain stem syndrome or confusional syndrome (3). Vascular lesions of venous occlusions or aneurysms (4) are characteristically present.We report here a case of Behset's syndrome with clinical and angiographic evidence of CNS vas- culitis. After aggressive therapy with cytotoxic agents and steroids, the patient's condition improved.Case report. The patient, a 39-year-old black woman, first presented to The Cleveland Clinic Foundation in August 1983, with symptoms of pain, swelling, and warmth in both knees. She also described painful "red lumps" on her legs. The lumps were present for days or weeks and then resolved, but left scarring. Her other symptoms included generalized fatigue, a sore tongue, and scotomas of her right eye. Her medical history included mild hypertension of several years duration.Physical examination revealed a 2 x 2-cm tender nodule on the right anterior tibia and multiple areas of hyperpigmentation on the front of her lower legs. At that time, the Westergren erythrocyte sedimentation rate (ESR) was 32 mm/hour. Antinuclear antibody was present at a titer of 1:20, and rheumatoid factor was negative. It was believed that she had postinfectious erythema nodosum. She was given no specific treatment, and the condition subsequently improved.In May 1984, the patient developed acute blindness of her right eye. She was examined at another hospital, and a diagnosis of retinal artery occlusion and retinal detachment was made. She was started on a regimen of prednisone, 20 mglday, for suspected retinal vasculitis. Subsequently, she developed severe cephalgia in the frontal and left temporal areas, but there were no associated visual or neurologic disturbances. A lumbar puncture was performed, and analysis of the cerebrospinal fluid revealed a protein content of 23 mg%; no red blood cells or white blood cells were observed. Computed axial tomography of the patient's head and kidneys showed normal findings, as did renal angiography . Four-vessel cerebral

Question: How can metagenomic next-generation sequencing of cerebrospinal fluid be leveraged to aid in the diagnosis of patients with subacute or chronic meningitis?Findings: Metagenomic next-generation sequencing identified parasitic worms, fungi and viruses in a case series of seven subjects. A database of water-only and healthy patient controls enabled application of a z-score based scoring algorithm to effectively separate bona fide pathogen sequences from spurious environmental sequences. Meaning:Our scoring algorithm greatly simplified data interpretation in a series of patients with a wide range of challenging infectious causes of subacute or chronic meningitis identified by metagenomic next-generation sequencing. AbstractImportance: Identifying infectious causes of subacute and chronic meningitis can be challenging. Enhanced, unbiased diagnostic approaches are needed.Objective: To present a case series of patients with diagnostically challenging subacute and chronic meningitis in whom metagenomic next-generation sequencing (mNGS) of cerebrospinal fluid (CSF), supported by a statistical framework generated from mNGS sequencing of non-infectious patients and environmental controls, identified a pathogen.Design: Case series. Using mNGS data from the CSF of 94 non-infectious neuroinflammatory cases and 24 water and reagent controls, we developed and implemented a weighted scoring metric based on z-scores at the species and genus level for both nucleotide and protein databases to prioritize and rank mNGS results. We . CC-BY-NC-ND 4.0 International license peer-reviewed) is the author/funder. It is made available under aThe copyright holder for this preprint (which was not . http://dx.doi.org/10.1101/213561 doi: bioRxiv preprint first posted online Nov. 7, 2017; performed mNGS on total RNA extracted from CSF of patients with subacute or chronic meningitis and highlight seven cases representing a diverse array of pathogens.Setting: A multi-center study of mNGS pathogen discovery in patients with suspected neuroinflammatory conditions. Participants:Patients with diagnostically challenging subacute or chronic meningitis enrolled in a research study of mNGS performed on CSF.Intervention: mNGS was performed on total RNA extracted from CSF (0.25-0.5 mL). A weighted z-score was used to filter out environmental contaminants and facilitate efficient data triage and analysis.Main Outcomes: 1) Pathogens identified by mNGS and 2) ability of a statistical model to prioritize, rank, and simplify mNGS results.

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