Background: Combining outcomes and the use of standardized effect measures such as effect size and standardized response mean across instruments allows more comprehensive meta-analyses and should avoid selection bias. However, such analysis ideally requires that the instruments correlate strongly and that the underlying assumption of similar responsiveness is fulfilled. The aim of the study was to assess the correlation between two widely used health-related quality of life instruments for patients with chronic obstructive pulmonary disease and to compare the instruments' responsiveness on a study level.

This case report involves an adult patient diagnosed with a rare disease, hemophagocytic lymphohistiocytosis (HLH). We will discuss the patient's clinical presentation, symptoms, and treatment. Due to the rarity of HLH being found in adults, we will break down the essential elements to recognize and diagnose this disease. We present this case to increase physician awareness of HLH occurring in adults. With timely recognition, more patients will be able to receive appropriate treatment, resulting in a decrease in mortality.

Activation of protein kinase C (PKC) by 12-O-tetradecanoylphorbol-13-acetate (TPA) increased steady-state levels of mRNA encoding the major histocompatibility complex (MHC) class II antigen I-A beta and the class II antigen-associated invariant chain (Ii, CD74) in A20 B lymphoma cells and in normal mouse B cells. The increase in Ii mRNA levels appeared to be due to a slight increase in the rate of gene transcription and an increase in the stability of Ii mRNA. The half-life of Ii mRNA increased from 12 h to >24 h following treatment with TPA, as determined by Northern blot analysis following actinomycin D treatment or by the [3H]-uridine pulse-chase method. Interferon-gamma (IFN-gamma), which has been well characterized as a cytokine that induces class II antigens and the Ii, increased Ii expression slightly in A20 cells. However, cotreatment of cells with TPA and IFN-gamma resulted in a block in the TPA-induced increase in Ii expression. Transcription of the Ii gene was minimally affected following treatment with IFN-gamma alone, and cells treated with both TPA and IFN-gamma had the same transcription rate as the control cells. IFN-gamma did, however, block stabilization of Ii mRNA by TPA. Activation of PKC by TPA, which was previously shown to lead to membrane translocation and downregulation, was not inhibited by IFN-gamma. Therefore, IFN-gamma appeared to block a downstream signal transduction pathway activated by PKC that controls stability of Ii mRNA.

Key Clinical MessageRifaximin has only been rarely reported to cause rhabdomyolysis. When physical and nonphysical etiologies have been excluded, thorough review of the patient’s medication list is necessary. In cirrhotics, the potential harm of rifaximin in treatment or prophylaxis of hepatic encephalopathy should be recognized.