Acute pancreatitis associated with pembrolizumab-induced hypertriglyceridemia.

INTRODUCTION: Acute pancreatitis (AP) following drug-induced hypertriglyceridemia is a rare clinical phenomenon. Immune checkpoint inhibitors have revolutionized treatment for a variety of solid organ and hematological malignancies. Pembrolizumab is a programmed cell death receptor-1 (PD-1) inhibitor that has shown promising responses in many advanced cancers. However, a constellation of immune-related adverse events has also been described. There are reports of pembrolizumab-induced hypertriglyceridemia, but AP as a result of this side effect remains an exceedingly rare clinical sequela. CASE REPORT: We delineate a case of a patient with stage IVB non-small-cell lung cancer who developed progressive abdominal pain and nausea following administration of pembrolizumab for four months. Laboratory studies revealed increased serum lipase and triglyceride levels at 12,562 IU/L and 16,901 mg/dL, respectively. The diagnosis of AP was made based on the revised Atlanta classification criteria. After ruling out alternative causes, pembrolizumab-induced hypertriglyceridemia was considered the likely etiology of AP. MANAGEMENT AND OUTCOME: The patient was transferred to the medical intensive care unit for close monitoring. Treatment was initiated with intravenous fluids, pain medications, and an insulin infusion. However, her hypertriglyceridemia levels remained persistently elevated, necessitating therapeutic apheresis. She recovered well with no complications after triglyceride apheresis. DISCUSSION: AP following pembrolizumab-associated hypertriglyceridemia remains a rare clinicopathologic entity. Given the widespread clinical use of immune checkpoint inhibitors, knowledge of such rare adverse events is crucial. Evaluation of serum triglyceride levels before and after initiating pembrolizumab therapy may be mandated, especially in patients with metabolic comorbidities.

Survival Outcomes in Stage IV Gastric Cancer Patients with Krukenberg Tumors: A Systematic Review and Meta Analysis.

BACKGROUND: Stage IV gastric cancer patients with Krukenberg tumors typically exhibit poor survival outcomes, often less than 2 years. The management of this tumor subgroup remains non-standardized, and the impact of oophorectomy on survival remains uncertain. In this study, we systematically analyzed survival outcomes among gastric cancer patients with ovarian metastases who underwent standard chemotherapy, surgical resection of ovarian metastases, or combined chemotherapy and surgery. METHODS: We conducted a systematic review and meta-analysis of randomized controlled trials and observational studies retrieved from MEDLINE (PubMed), Embase, and the Cochrane Library until January 25, 2024, applying the Boolean logic. Participants included individuals with pathologically and radiologically confirmed ovarian metastasis or clinically symptomatic cases with imaging evidence. Statistical analyses were performed using R (v.4.3.2., Vienna). The study was registered with PROSPERO (ID-CRD42023488373). RESULTS: A total of 1502 patients from 17 retrospective studies were pooled for analysis of overall survival (OS) outcomes. The OS in the standard chemotherapy cohort, as determined by the random effects model, was 6.708 months (95% CI 3.867 to 9.548; P<0.0001), with non-significant heterogeneity (I2 = 5.5%). In the surgical resection cohort, OS was 12.786 months (95% CI 6.9 to 18.671; P<0.0001), with low heterogeneity (I2 = 0%). In the combined chemotherapy and surgical resection cohort, OS was 16.228 months (95% CI 12.254 to 20.202), with insignificant heterogeneity (I2 = 0%). CONCLUSION: This meta-analysis offers key insights into survival outcomes associated with different therapeutic modalities in gastric cancer with Krukenberg metastases. It provides valuable evidence for clinical decision-making and future research directions. While the combined approach of chemotherapy and surgery demonstrates the highest effect size for OS, careful consideration of patient-centric approaches is essential in the oncological care landscape.

Nexus between environmental disclosures and top management team characteristics: a systematic review.

Voluntary nature of sustainability disclosures in most of the countries shifts focus of academicians towards discretion of top executives as a major determining force for firms to make their operations environmentally and socially sustainable. Based on two decade literature on the topic available at Scopus database this study aims to present a comprehensive knowledge map of intellectual structure on the relationship of top management characteristics on sustainability spending and disclosures. A bibliometric systematic review of 164 articles from 2002 to 2022 has been conducted with the help of VOSviewer and identified most influential journals, articles, and the countries whose corresponding authors have contributed in the field and influential research clusters in the literature. These research clusters are first, red cluster with 94 articles has discussed the upper echelon's personal and professional characteristics in relation to sustainability disclosures. Second, green cluster with 60 articles has discussed particularly the gender diversity in top executives and board of directors in relationship with sustainability disclosures. Third, blue cluster with 10 articles has elaborated the influence of independent directors on sustainability disclosures of corporate sector. The findings of this study will particularly help the regulators to make regulations regarding critical mass of female on boards and top management, family-owned firms, and politically connected directors. Moreover it will also help consultants, analysts, and investment bankers to differentiate firms with pressure-resistant and pressure-sensitive institutional investors. From this review shareholders can be very much clear in the selection of their representatives and ultimately the appointment of top management team. This study also provides an insight for future direction so that unexplored dimension of this field may further be discovered by upcoming researchers.

Understanding the dynamics of capital structure, corporate governance, and corporate social responsibility in high- and low-leveraged US and Chinese firms.

Corporate social responsibility turned into a global sensation from the inception of the twenty-first century in the corporate world and grabbed immense engrossment from all stakeholders in their decision-making process. Capital structure and corporate governance practices are the well-mellowed facets of corporate finance literature. In this study, the moderating role of corporate social responsibility (CSR) between corporate governance and leverage of the US and Chinese listed firms has been established, with a further extension of analyzing the moderating role of CSR between corporate governance and leverage in high vs low leveraged firms and high CSR vs low CSR firms as the novelty of this study and has never been examined in both economies and globally. The data of 1989 Chinese-listed firms from 28 sectors of the economy and 6640 US-listed firms from 27 sectors of the economy has been taken from 2001 to 2019 and analyzed through fixed effect regression and system generalized method of moment (GMM). Results of the study reveal that CSR and corporate governance are negatively associated with the leverage of both Chinese and US firms. Moreover, the moderating role of CSR has established between corporate governance and leverage negative relationship. The moderating role of CSR in the relationship of leverage and corporate governance is established only in low-leveraged firms whereas it is insignificant in high-leveraged firms. System GMM confirms the signs and significance of the regression results; that is why regression results are robust and reliable, and there is no endogeneity problem in our model. The study also gives an insight for future research on high- and low-leveraged firms and firms with more CSR score than less CSR score with other dimensions such as firm performance and firm value variables.

Understanding the dynamics of natural resources rents, environmental sustainability, and sustainable economic growth: new insights from China.

There is a close relationship between natural resources and production in many sectors, and production and consumption can also have an environmental impact. Low environmental quality affects economic growth and well-being. Environmental protection and economic growth cannot be maximized simultaneously. Choosing the right balance between the two aims is imperative for each country. By moderating the role of merchandise trade and manufacturing value-added from 1970 to 2016, we examine the dynamics of China's natural resource rents, environmental sustainability, and sustainable economic growth. Overall, the results of this study indicate that natural resources improve environmental sustainability at the expense of economic growth. In contrast, financial development, merchandise trade, and urban population growth promote environmental degradation. It is vital to understand governance mechanisms to sustain natural resource policies, considering environmental, social, and governance concerns to benefit society.

Does digitalization matter in green preferences in nexus of output volatility and environmental quality?

The fact is that output volatility and carbon dioxide (CO2) emissions move together over the period. This empirical study examines the dynamic effect of output volatility on CO2 emissions using the advance nonlinear panel autoregressive distributed lag (ARDL) approach. The empirical analysis is executed for ten high emitters Asian countries covering the period from 1990 to 2019. The findings reveal that positive change in output volatility increases CO2 emissions and negative change in output volatility decreases CO2 emissions in the long run in Asia. The results also show that digitization also positively impacts environmental quality in Asia due to green globalization. The findings are also robust and similar in an alternative indicator of the environment. An important policy is that reducing volatility in output is a suitable way of environmental sustainability, particularly for Asian countries.

Acute pancreatitis secondary to cocaine use: a case-based systematic literature review.

Cocaine use continues to be an important global public health problem. As the use of cocaine remains pervasive so have a myriad of adverse events associated with this drug. These deleterious effects are well-studied, but gastrointestinal complications remain esoteric and the existing clinical evidence is scarce. Ischemia of the esophagus and small bowel, perforation, peptic ulceration, gastrointestinal bleeding, and ischemic colitis are among the reported complications. In specific, acute pancreatitis secondary to cocaine use is an exceedingly rare clinicopathologic entity. To date, only 7 cases of this condition have been reported in the English-language literature. We hereby delineate a rare case of a 29-year-old female who developed her first episode of cocaine-associated pancreatitis. The diagnosis was made based on a standard battery of investigations and meticulous exclusion of common etiologies of acute pancreatitis. To our knowledge, this case represents the first report of re-occurrence of acute pancreatitis upon subsequent crack cocaine insufflation, adding a higher level of evidence to a fallible association. We also present a systematic review of the existing literature on acute pancreatitis following cocaine use. An updated knowledge regarding this rare association is of paramount importance for early diagnosis and astute management.