Wilms Tumor With Raised Serum Alpha-Fetoprotein: Highlighting the Need for Novel Circulating Biomarkers.

Wilms tumor (WT) is the commonest cause of renal cancer in children. In Europe, a diagnosis is made for most cases on typical clinical and radiological findings, prior to pre-operative chemotherapy. Here, we describe a case of a young boy presenting with a large abdominal tumor, associated with raised serum alpha-fetoprotein (AFP) levels at diagnosis. Given the atypical features present, a biopsy was taken, and histology was consistent with WT, showing triphasic WT, with epithelial, stromal, and blastemal elements present, and positive WT1 and CD56 immunohistochemical staining. During pre-operative chemotherapy, serial serum AFP measurements showed further increases, despite a radiological response, before a subsequent fall to normal following nephrectomy. The resection specimen was comprised of ~55% and ~45% stromal and epithelial elements, respectively, with no anaplasia, but immunohistochemistry using AFP staining revealed positive mucinous intestinal epithelium, consistent with the serum AFP observations. The lack of correlation between tumor response and serum AFP levels in this case highlights a more general clinical unmet need to identify WT-specific circulating tumor markers.

The Landscape of Geriatric Fellow Scholarly Activity Participation: Findings From a National Survey of Program Directors.

Introduction As the US population continues to age, there is a critical need for geriatricians to be trained and engaged in research to inform high-quality care for older adults. Our objective was to understand the extent, type, barriers, and facilitators of research training and the attitudes toward research training and scholarly activity among Accreditation Council for Graduate Medical Education (ACGME)-accredited US geriatric fellowship programs. Methods We conducted a cross-sectional survey of geriatric fellowship program directors from September to November 2022. Surveys assessing program characteristics, requirements for scholarly activity, director demographics, and director attitudes toward scholarly activity were distributed via email. We used descriptive statistics to assess fellowship scholarly activity requirements, facilitators, and perceived barriers. Results The survey response rate was 35.3% (41/116 programs). Most programs (82.9%) required participation in scholarly activity and provided protected time (73.2%). Definitions of scholarly activities greatly differed among programs. The most common scholarly activity requirements included participation in a scholarly project (70.7%) or local presentation (46.3%). The short duration of fellowship was the most common major barrier, reported by 70.7% of directors. Lastly, 34.1% of directors indicated satisfaction with the quality of research training provided, while 65.9% of directors reported satisfaction with the opportunities provided to participate in scholarly activities. Conclusions Overall, program requirements, facilitators, and perceived barriers to scholarly activity were heterogeneous among US geriatric program directors. Additionally, only about one-third of directors were satisfied with the research training provided. Our future work will compare the attitudes and reported barriers/facilitators of program director and fellow participants toward participation in scholarly activity.

Geochemical and organic petrographic characteristics of high bituminous shales from Gurha mine in Rajasthan, NW India.

A high bituminous shale horizon from the Gurha mine in the Bikaner sub-basin of the Rajasthan District, NW India, was studied using a collection of geochemical and petrological techniques. This study investigated the nature and environmental conditions of the organic matter and its relation to the unconventional oil-shale resources of the bituminous shale. The analyzed shales have high total organic carbon and total sulfur contents, suggesting that these shale sediments were deposited in a paralic environment under reducing conditions. The dominant presence of organic matter derived from phytoplankton algae suggests warm climatic marine environment, with little connection to freshwater enhancing the growth of algae and other microorganisms. The analyzed bituminous shales have high aquatic-derived alginite organic matters, with low Pr/Ph, Pr/n-C17, and Ph/n-C18 ratios. It is classified as Type II oil-prone kerogen, consistent with high hydrogen index value. Considering the maturity indicators of geochemical Tmax (< 430 °C) and vitrinite reflectance values less than 0.40%VRo, the analyzed bituminous shale sediments are in an immature stage of the oil window. Therefore, the oil-prone kerogen Type II in the analyzed bituminous shales has not been cracked by thermal alteration to release oil; thus, unconventional heating is recommended for commercial oil generation.

Facilitated stent delivery using applied topical lubrication.

OBJECTIVES: The goal of this study was to assess the utility of topical lubrication to aid stent delivery in challenging anatomy and its effects on long-term clinical outcome. BACKGROUND: Failed stent delivery is encountered in up to 5% of percutaneous coronary interventions (PCI). METHODS: The effectiveness of topically applied lubrication to facilitate stent delivery after failed stent placement was evaluated in 20 (2.5%) out of 813 consecutive patients undergoing PCI. Initial attempts at stent delivery failed despite balloon predilatation and use of moderate-to-stiff guidewires in all patients. The lubricious solution used was Rotaglide, a phospholipid emulsion originally designed to reduce catheter friction during rotational atherectomy. Following unsuccessful delivery, stents were removed from the guiding catheters, topically saturated with Rotaglide, and deployment immediately reattempted. Procedural efficacy and long-term clinical outcomes were assessed. RESULTS: The study population included 20 patients aged 69 +/- 10 years, all of whom had complex lesions (ACC/AHA Class B(2) or C). Rotaglide lubricated stents were successfully deployed at the target lesions in 17 of the 20 patients (85%). Patients were followed 19.5 +/- 3.2 months after their index procedure. There were no periprocedural complications or subacute stent thromboses. Of the 14 patients with drug-eluting stents, none had clinical restenosis or target vessel revascularization. Target lesion revascularization secondary to restenosis was required in 1 of 3 patients treated with bare-metal stents. CONCLUSIONS: Topical lubrication is a simple and effective aid for stent delivery in complex lesions. Rotaglide appears safe and biocompatible with drug-eluting stents.