associated myositis remains unclear and a multifactorial pathogenicity is likely. In addition to immune dysregulation occurring during Bb infection, such as lymphopenia, decreased suppressor cell activity or polygonal B-cell expansion, direct tissue invasion by Bb also appears to play a role. We propose that the formation of bacterial biofilms, which are known to ensure the survival of bacteria under severe conditions, is a contributing factor. 5 Feng et al. found that aggregated biofilm-like Bb microcolonies were more tolerant to antibiotics compared with other forms of Bb colonies. 3 In addition, alginate-expressing Bb biofilm formations were previously found in skin biopsies from borrelial lymphocytomas and autopsy tissue sections from the heart, brain, liver and kidney of a patient with LD. 2,6 In conclusion, the present case illustrates that biofilm formation in EM lesions may lead to persistent Bb infection and, as a consequence, PTLDS. Potential biofilm formation should be considered in therapy-resistant LD in order to apply early calculated antibiotic treatment and prevent the occurrence of late complications.

Objective: Paradoxical psoriasis has been increasingly reported in adults after exposure to tumor necrosis factor inhibitors (TNFi). Systematic studies in pediatric population are lacking. We aimed to investigate the relationship between TNFi therapy and the onset of new psoriasis in children. Methods: Patients with diagnosis of chronic nonbacterial osteomyelitis (CNO), juvenile idiopathic arthritis (JIA), or inflammatory bowel disease (IBD) treated with TNFi between 2005 and 2015 were identified. Baseline characteristics were compared among those developing psoriasis versus those who did not using t-tests or Wilcoxon Rank Sum tests. Results: A total of 1,092 patients were included with a median follow up of 21-36 months for CNO, JIA and IBD after the initiation of first TNFi. Psoriasis developed after exposure to TNFi in 4 of 28 CNO patients (14%), 3 of 620 JIA patients (0.5%) and 25 of 450 IBD patients (5.6%). There was no significant difference in distribution of age, gender, family history of psoriasis or concomitant medications between psoriasis subset and non-psoriasis subset. Among those who developed psoriasis, 38% had partial and 47% had complete responses to topical therapies or phototherapy. Eleven patients (35%) discontinued, none (0%) switched and twenty (65%) continued TNFi therapies. Conclusion: Cumulative incidence rates of TNFi-associated psoriasis varied in three underlying diseases. Increasing awareness of this unwanted side effect in pediatric community is important to ensure timely diagnosis and treatment. Fortunately , the majority of children affected had a favorable outcome.

Background and Objective Erectile dysfunction (ED) is a prevalent and impactful complication post definitive management of prostate cancer. The mechanism of ED is thought to be secondary to vascular and neural injury as well as corporal smooth muscle damage with resultant fibrosis. The use of penile rehabilitation in ED following treatment for prostate cancer has been studied. Low-intensity extracorporeal shockwave therapy (Li-ESWT) is a novel treatment for ED thought to stimulate neovascularization and nerve regeneration, and as such, has gained interest in treatment of ED related to radical prostatectomy or radiation therapy. Herein, we performed a narrative review on the use of Li-ESWT in management of ED following treatment for prostate cancer. Methods A literature review was performed using PubMed and Google Scholar. Studies evaluating Li-ESWT following prostate cancer treatment were included. Key Content and Findings We identified three randomized controlled trials and two observational studies that assessed use of Li-ESWT for ED after prostate surgery. Use of Li-ESWT across most studies showed improvements in the International Index of Erectile Function-erectile function (IIEF-EF) domain scores, but this improvement was not statistically significant. Additionally, use of Li-ESWT in an early versus delayed fashion does not appear to affect changes in long-term sexual function scores. No data on use of Li-ESWT after radiotherapy were identified. Conclusions There is a paucity of data regarding use of Li-ESWT for penile rehabilitation in treatment of ED post-prostate cancer therapy. Current protocols for Li-ESWT are not standardized and have a limited number of participants with short duration of follow-up. Additional evaluation is needed to determine optimal Li-ESWT protocols. Ideally, studies should have longer follow-up to truly evaluate the clinical significance of Li-ESWT in the treatment of post-prostatectomy ED. Furthermore, the role of Li-ESWT after radiotherapy remains elusive.

ObjectivesTo investigate possible preventive effect of radiographic joint damage, especially RRP by short term treatment with biologics in non-biological disease-modifying ant-rheumatic drugs(non-bio DMARDs) resistant early RA (Clinical registration number; UMIN-CTR 000013614).MethodsFifty early RA patients with extensive BE by hand MRI test despite treatment with non-bio DMARDs were recruited. Among these, 44 patients were diagnosed as RRP. Twenty three patients (male 5, female 18) were treated with combination of non-bio DMARD and biologic DMARDs (Bio group) and 26 patients were treated with enhanced DMARDs therapy using MTX with or without other DMARDs (enhanced DMARDs group). Baseline demographics of both groups were not significantly different (Data not shown). In the Bio group, the following biologics were added: Adalimumab (13 cases), Tocilizumab (3 cases), Abatacept (3 cases), Infliximab (2 cases), Certolizumab (1 case), Golimumab (1 case). In enhanced DMARDs group, mean MTX dose was increased from 7.3 mg/w to 11.3 mg/w or other DMARDs were added. Bone destruction was determined before and 3 or 6 months after treatment by modified total Sharp scoring (mTSS) using by conventional radiography, and expressed as yearly progression of mTSS (ΔmTSS/y). BE score was measured by RAMRIS method using T1 or STIR image of hand MRI (HITACHI, Elis, 0.5T).ResultsSignificant reduction in DAS28-ESR values after 3 or 6 months treatment were observed: from 4.2 to 3.3(p=0.0004) in the enhanced DMARDs group, and 4.37 to 3.0(p<0.0001) in the Bio groups. Similarly, improvement of BE: 7 out of 26 (26.9%) and 14 out of 23 patients (60.9%), mean ΔmTSS/y: 5.8 and 2.4, incidence of RRP: 9 (34.6%) and 9 (34.6%), and structural remission: 5 (21.7%) and 16 patients (69.6%), in the enhanced DRAERDs and the Bio group, respectively. Accordingly, improvement of BE and incidence of structural remission was higher, whereas mean ΔmTSS/y value was significantly lower (p<0.05) in the Bio group compared to in the enhanced DMARDs group (table 1, figure 1).Abstract FRI0124 – Table 1Comparison between the Enhanced DMARDs group and the Bio groupEnhanced DMARDs group (n=23)Bio group (n=26)P ΔmTSS/y5.82.40.0142*% RRP34.6% (9/26)21.7% (5/23)n.s% Structural remission (%)34.6% (9/26)69.6% (16/23)0.0146*% BE improvement26.9% (7/26)60.9% (14/23)0.0166**: significantAbstract FRI0124 – Figure 1Radiographic dataConclusionsResults of this study indicated that short term (3 or 6 months) treatment with biologics is effective in the reducing BE, and consequently prevent further progression of the disease into RRP status in 80% of early destructive RA despite extensive DMARDs therapy. The effect of withdrawal of biologics in RA improving BE are currently under investigation (figure 1). We consider that a short-term treatment with biologics for early RA patients, who are resistant to DMARDs and at high risk to transit to RRP, will be an effective and economical treatment strategy.Disclosure of InterestNone declared

With PSA !3 ng/mL, AUC for fatal PCa increased from 0.41 to 0.65 with addition of % fPSA and AUC for csPCa increased from 0.57 to 0.64. In men 65-72 with PSA >4 ng/mL, AUC for fatal PCa increased from 0.63 to 0.65 by adding %fPSA and AUC for csPCa increased from 0.53 to 0.63. Kaplan-Meier curve (Figure 1) shows clear separation of curves for men with 20% fPSA compared to >20% fPSA in men with !75th percentile of total PSA at baseline. CONCLUSIONS: In a large nationwide screening trial, the addition of free PSA to total PSA in men with PSA >2 (age 57-64) or PSA>3 (age 65-72) improved the prediction of clinically significant and fatal prostate cancer. The use of free PSA to risk-stratify screening could potentially decrease unnecessary prostate biopsies and be used to help determine when to terminate screening.