Effect of intra-nasal nitrilotriacetic acid trisodium salt in lowering elevated calcium cations and improving olfactory dysfunction in COVID-19 patients.

PURPOSE: An association between COVID-19 and olfactory dysfunction has been noted in many patients worldwide. The olfactory adaptation process leads to an increase in intracellular calcium cation levels. Nitrilotriacetic acid trisodium salt has high selective chelation for calcium cations from olfactory mucus. The aim of this work is to test the effect of an intranasal nitrilotriacetic acid trisodium salt to lower the elevated calcium cations in COVID-19 patients with relevant symptoms of olfactory dysfunction. METHODS: Fifty-eight COVID-19 adult patients with relevant symptoms of olfactory dysfunction were enrolled in a prospective randomized controlled trial. They received a nasal spray containing either 0.9% sodium chloride or 2% nitrilotriacetic acid trisodium salt. Olfactory function was assessed before and after treatment using the Sniffin' Sticks test. Quantitative analysis of calcium cation concentration in nasal secretions was performed using a carbon paste ion-selective electrode. RESULTS: After the application of nitrilotriacetic acid trisodium salt compared to sodium chloride, a significant improvement from functional anosmia to healthy normosmia with significant decrease in calcium cation concentration was observed. CONCLUSIONS: Further collaborative research is needed to fully investigate the effect of an intranasal nitrilotriacetic acid trisodium salt in the treatment of olfactory disorders.

Discontinuation of Transmission Precautions for COVID-19 Patients: Polymerase Chain Reaction Diagnostics, Patient Delays, and Cycle Threshold Values.

BACKGROUND: The decision of when it is safe to discontinue transmission-based precautions for SARS-CoV-2 coronavirus disease 2019 (COVID-19) hospitalized patients has been controversial. The Centers for Disease Control and Prevention offered reverse transcriptase polymerase chain reaction (PCR) diagnostic test- or symptom-based guidelines. METHODS: A retrospective chart review of Vidant Health system, Eastern North Carolina, was conducted. Length of stay, days in isolation unit, and date appropriate for discharge or isolation discontinuation based on the symptom-based strategy were recorded. RESULTS: Of 196 COVID hospitalized patients, 34 had repeated COVID PCR tests 3 or more days from their first positive test result. Half of these patients experienced delays in release from transmission-based precautions because of repeated positive PCR test results and use of the test-based approach. This resulted in an additional 166 days of hospitalization, costing an estimated $415,000. Furthermore, 2 subjects had a combined 16-day delay in necessary medical procedures. Most of the COVID PCR platforms yield quantitative results in the form of cycle threshold (Ct) values, the number of cycles needed to detect the genome. These values have also been used to assess whether patients are likely to remain contagious. None of our patients who met the criteria for symptom-based strategy for transmission-based precaution discontinuation had positive PCR test results with Ct values lower than 25, but 4 had Ct values lower than 30. CONCLUSIONS: Concerns surround immunocompromised patients and those treated with steroids who might be delayed or incapable of stopping viral replication and thus remain contagious. Our results suggest that clinicians use all available data including Ct values to evaluate the safety of discontinuation of transmission precautions.

Thymic Mucoepidermoid Carcinoma: A Systematic Review and Meta-analysis.

Thymic mucoepidermoid carcinoma is a rare tumor that remains poorly characterized and a diagnostic challenge. The aim of this review is to characterize this tumor in a larger cohort of patients using all the available cases in the literature. We systematically searched the PubMed and Scopus database for primary thymic mucoepidermoid carcinoma. A total of 24 studies were included in the final analysis. A total of 41 patients were identified; 23 (56.1%) were male and 18 (43.9%) were female. Mean age was 49.8±21.3 years. Mean tumor size was 7.6±3.5 cm. Twenty (66.7%) were low grade and 8 (26.7%) were high grade. In total, 20 (55.6%) patients were treated with surgery alone. Nodal dissection was performed in 4 cases only. Two patients had MAML2 gene rearrangement and 2 were negative. Follow-up time varied from 2 to 93 months. A total of 13 (44.8%) patients died of disease with a median survival of 12 months. There seems to be a bimodal age distribution with peaks between second and third decades of life, and between sixth and eight decades. Lymph node sampling is frequently not performed; however, we recommend performing it, as it may lead to more accurate staging. There is limited data regarding the utility of MAML2 gene rearrangement in the thymic location. Histologic grade and tumor stage/resectability are the main prognostic factors.

Validation of the Modified Surgeon Periorbital Rating of Edema and Ecchymosis (SPREE) Questionnaire: A Prospective Analysis of Facial Plastic and Reconstructive Surgery Procedures.

Although periorbital edema and ecchymosis are commonly encountered after facial plastic and reconstructive surgery procedures, there is currently no validated grading scale to qualify these findings. In this study, the modified "Surgeon Periorbital Rating of Edema and Ecchymosis (SPREE)" questionnaire is used as a grading scale for patients undergoing facial plastic surgery procedures. This article aims to validate a uniform grading scale for periorbital edema and ecchymosis using the modified SPREE questionnaire in the postoperative period. This is a prospective study including 82 patients at two different routine postoperative visits (second and seventh postoperative days), wherein the staff and resident physicians, physician assistants (PAs), patients, and any accompanying adults were asked to use the modified SPREE questionnaire to score edema and ecchymosis of each eye of the patient who had undergone a plastic surgery procedure. Interrater and intrarater agreements were then examined. Cohen's kappa coefficient was calculated to measure intrarater and interrater agreement between health care professionals (staff physicians and resident physicians); staff physicians and PAs; and staff physicians, patients, and accompanying adults. Good to excellent agreement was identified between staff physicians and resident physicians as well as between staff physicians and PAs. There was, however, poor agreement between staff physicians, patients, and accompanying adults. In addition, excellent agreement was found for intraobserver reliability during same-day visits. The modified SPREE questionnaire is a validated grading system for use by health care professionals to reliably rate periorbital edema and ecchymosis in the postoperative period. Validation of the modified SPREE questionnaire may improve ubiquity in medical literature reporting and related outcomes reporting in future.

A Customizable Quantum-Dot Cellular Automata Building Block for the Synthesis of Classical and Reversible Circuits.

Quantum-dot cellular automata (QCA) are nanoscale digital logic constructs that use electrons in arrays of quantum dots to carry out binary operations. In this paper, a basic building block for QCA will be proposed. The proposed basic building block can be customized to implement classical gates, such as XOR and XNOR gates, and reversible gates, such as CNOT and Toffoli gates, with less cell count and/or better latency than other proposed designs.

CAT-Seg: cascaded medical assistive tool integrating residual attention mechanisms and Squeeze-Net for 3D MRI biventricular segmentation.

Cardiac image segmentation is a critical step in the early detection of cardiovascular disease. The segmentation of the biventricular is a prerequisite for evaluating cardiac function in cardiac magnetic resonance imaging (CMRI). In this paper, a cascaded model CAT-Seg is proposed for segmentation of 3D-CMRI volumes. CAT-Seg addresses the problem of biventricular confusion with other regions and localized the region of interest (ROI) to reduce the scope of processing. A modified DeepLabv3+ variant integrating SqueezeNet (SqueezeDeepLabv3+) is proposed as a part of CAT-Seg. SqueezeDeepLabv3+ handles the different shapes of the biventricular through the different cardiac phases, as the biventricular only accounts for small portion of the volume slices. Also, CAT-Seg presents a segmentation approach that integrates attention mechanisms into 3D Residual UNet architecture (3D-ResUNet) called 3D-ARU to improve the segmentation results of the three major structures (left ventricle (LV), Myocardium (Myo), and right ventricle (RV)). The integration of the spatial attention mechanism into ResUNet handles the fuzzy edges of the three structures. The proposed model achieves promising results in training and testing with the Automatic Cardiac Diagnosis Challenge (ACDC 2017) dataset and the external validation using MyoPs. CAT-Seg demonstrates competitive performance with state-of-the-art models. On ACDC 2017, CAT-Seg is able to segment LV, Myo, and RV with an average minimum dice symmetry coefficient (DSC) performance gap of 1.165%, 4.36%, and 3.115% respectively. The average maximum improvement in terms of DSC in segmenting LV, Myo and RV is 4.395%, 6.84% and 7.315% respectively. On MyoPs external validation, CAT-Seg outperformed the state-of-the-art in segmenting LV, Myo, and RV with an average minimum performance gap of 6.13%, 5.44%, and 2.912% respectively.

Efficient quantum algorithms for set operations.

Analyzing the relations between Boolean functions has many applications in many fields, such as database systems, cryptography, and collision problems. This paper proposes four quantum algorithms that use amplitude amplification techniques to perform set operations, including Intersection, Difference, and Union, on two Boolean functions in O ( N ) time complexity. The proposed algorithms employ two quantum amplitude amplification techniques divided into two stages. The first stage uses the Younes et al. algorithm for quantum searching via entanglement and partial diffusion to prepare incomplete superpositions of the truth set of the first Boolean function. In the second stage, a modified version of Arima's algorithm, along with an oracle that represent the second Boolean function, is employed to handle the set operations. The proposed algorithms have a higher probability of success in more general and comprehensive applications when compared with relevant techniques in literature.

Intravitreal Infliximab for the Treatment of Proliferative Vitreoretinopathy (FIXER): A Randomized Controlled Phase II Trial.

OBJECTIVE: To study the safety and efficacy of intravitreal infliximab administered at the conclusion of pars plana vitrectomy (PPV) in the treatment of proliferative vitreoretinopathy (PVR) associated with rhegmatogenous retinal detachment (RRD). DESIGN: Randomized controlled phase II clinical trial. SUBJECTS: Patients with primary RRD and grade C PVR, according to the updated Retina Society Classification. METHODS: Sixty-six patients were randomized in a 1:1 ratio to undergo PPV and silicone oil (SO) injection with or without intravitreal injection of 1 mg/0.05 mL of infliximab in the air-filled globe before SO injection at PPV conclusion. Surgeons were masked to treatment allocation until PPV conclusion. MAIN OUTCOME MEASURES: The primary outcome measure was anatomic success (defined as complete retinal reattachment without a tamponade at 6 months post SO removal). Secondary outcome measures were final best-corrected visual acuity (BCVA), single-operation success rate (SOSR), rate of recurrent detachment, central macular thickness (CMT) by macular OCT, macular function by multifocal electroretinogram, and macular vascular density (VD) by OCT angiography. RESULTS: Sixty eyes of 60 patients, 30 eyes in each group, completed the study. At baseline, there were no differences regarding age, gender, history of trauma, lens status, duration of RRD, BCVA, intraocular pressure (IOP), intraocular inflammation (IOI), detachment extent in clock hours, number/size of breaks, presence of vitreous hemorrhage, axial length, or grade/extent of PVR between both groups. For the outcome measures, 30 eyes in the infliximab group achieved anatomic success vs. 29 eyes in the control group. The SOSR was higher in the infliximab group (26) vs. the control (23), but this was not statistically significant (P = 0.317). Final logarithm of the minimum angle of resolution BCVA was better in the infliximab group (mean, 0.96; standard deviation [SD], 0.4; Snellen equivalent ≈ 20/180) vs. the control (mean, 1.14; SD, 0.4); Snellen equivalent ≈ 20/280; P = 0.044). There were no differences regarding IOP, IOI, time of SO removal, macular function, CMT, or VD. CONCLUSIONS: Pars plana vitrectomy with SO tamponade with or without intravitreal infliximab is effective in treating PVR-associated RRD. Infliximab may be associated with modest improvement in final visual outcomes but not anatomic outcomes. FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any materials discussed in this article.

Synergism of floated paperboard sludge cake /sewage sludge for maximizing biomethane yield and biochar recovery from digestate: A step towards circular economy.

Anaerobic digestion of floated paperboard sludge (PS) cake suffers from volatile fatty acids (VFAs) accumulation, nutrient unbalanced condition, and generation of digestate with a risk of secondary pollution. To overcome these drawbacks, sewage sludge (SS) was added to PS cake for biogas recovery improvement under a co-digestion process followed by the thermal treatment of solid fraction of digestate for biochar production. Batch experimental assays were conducted at different SS:PS mixing ratios of 70:30, 50:50, 30:70, and 20:80 (w/w), and their anaerobic co-digestion performances were compared to the mono-digestion systems at 35 ± 0.2 °C for 45 days. The highest methane yield (MY) of 241.68 ± 14.81 mL/g CODremoved was obtained at the optimum SS:PS ratio of 50:50 (w/w). This experimental condition was accompanied by protein, carbohydrate, and VFA conversion efficiencies of 47.3 ± 3.2%, 46.8 ± 3.2%, and 56.3 ± 3.8%, respectively. The synergistic effect of SS and PS cake encouraged the dominance of Bacteroidota (23.19%), Proteobacteria (49.65%), Patescibacteria (8.12%), and Acidovorax (12.60%) responsible for hydrolyzing the complex organic compounds and converting the VFAs into biomethane. Further, the solid fraction of digestate was subjected to thermal treatment at a temperature of 500 °C for 2.0 h, under an oxygen-limited condition. The obtained biochar had a yield of 0.48 g/g dry digestate, and its oxygen-to-carbon (O/C), carbon-to-nitrogen (C/N), and carbon-to-phosphorous (C/P) ratios were 0.55, 10.23, and 16.42, respectively. A combined anaerobic co-digestion/pyrolysis system (capacity 50 m3/d) was designed based on the COD mass balance experimental data and biogenic CO2 market price of 22 USD/ton. This project could earn profits from biogas (12,565 USD/yr), biochar (6641 USD/yr), carbon credit (8014 USD/yr), and COD shadow price (6932 USD/yr). The proposed project could maintain a payback period of 6.60 yr. However, further studies are required to determine the associated life cycle cost model that is useful to validate the batch experiment assumptions.

The therapeutic value of Myrtus communis L.: an updated review.

Myrtus communis L. (Family: Myrtaceae) is naturally found in the western part of Asia, Southern Europe, and North Africa. It has been reportedly applied in pharmaceutical industry, traditional medicine, cosmetics, spices, and food. Pubmed, Google scholar, Web of Science, and Scopus were utilized to seek out relevant content concerning the therapeutic potential of M. communis. Subsequently, we conducted a review to identity noteworthy updates pertaining to M. communis. Myrtle berries, leaves, seeds, and essential oils are natural sources of several nutrients and bioactive compounds with marked health effects. The chemical analysis showed that M. communis contained oils, alkaloids, flavonoids, phenolics, coumarins, saponosides, tannins, quinines, and anthraquinones. A pharmacological investigation revealed that M. communis possessed anti-inflammatory, analgesic, antimicrobial, antiparasitic, antioxidant, antidiabetic, anticancer, antimutagenic, immunomodulatory, dermatological, cardiovascular, central nervous system, and gastrointestinal protective effects, among numerous other biological effects. This current review focused on the biochemical, pharmacological, therapeutic effects, and various biological activities of different parts of M. communis. It signifies that M. communis is a therapeutic plant with numerous applications in medicine and could be used as a drug isolate based on its safety and effectiveness.

A Rare Case of a Pancreatic Intraductal Oncocytic Papillary Neoplasm Associated With Invasive Adenocarcinoma Presenting as a Gastric Mass.

The World Health Organization recently recognized intraductal oncocytic papillary neoplasms of the pancreas (IOPNs) as distinct, pre-malignant pancreatic neoplasms. Due to their unique macroscopic and microscopic features, IOPNs are typically easy to diagnose and yield an indolent prognostic outcome. The diagnosis may be more complicated, and the prognosis may differ if an associated invasive carcinoma is present. Owing to the rarity of this entity, the available data is severely limited. Herein, we report a diagnostically challenging case of an IOPN associated with invasive carcinoma, initially presenting as a gastric mass with distinctive radiological and histopathological features.

Heterogeneous porous biochar-supported nano NiFe2O4 for efficient removal of hazardous antibiotic from pharmaceutical wastewater.

Due to the dual issues of antibiotic resistance and bioaccumulation toxicity, antibiotics are ubiquitously present in aquatic environments, and this is causing serious concern. Herein, novel nickel ferrite (NiFe2O4) nanoparticles were successfully loaded onto activated biochar (BC) derived from banana peel (BP) to obtain magnetic nanocomposite (BC-NiFe2O4) as an effective biosorbent for the ciprofloxacin antibiotic (CIP) elimination from pharmaceutical effluent. A facile co-precipitation approach was utilized to construct the heterogeneous BC-NiFe2O4. The synthesized materials were systematically characterized using techniques such as XRD, FE-SEM, EDX, HR-TEM, BET, FTIR, and XPS. In addition, the magnetic measurements indicated the ferromagnetic behavior of the BC-NiFe2O4 sample. The influencing factors (i.e., pH, contact time, initial concentration, dose of adsorbent, ions interference, and solution temperature) of the adsorption process were also well studied. The adsorption capacity of the BC-NiFe2O4 heterostructure was 68.79 mg g-1 compared to the BC sample (35.71 mg g-1), confirming that the loading of magnetically NiFe2O4 nanoparticles onto the surface of porous biochar enhanced its stability and adsorption performance for CIP removal, wherein the metal-antibiotic complex has a significant effect for the removal of CIP. Moreover, the Langmuir adsorption isotherm and the pseudo-second-order model displayed a good fit for the experimental data. The values of △H° and △G° revealed that the adsorption process was endothermic and spontaneous. The coordination affinities, π-π stacking, and H-bonding interactions play a more critical role in the adsorption mechanism that confirmed by FTIR and XPS analysis. To study the stability of BC-NiFe2O4 nanocomposites, desorption and recycling studies were investigated. The results revealed that after three cycles, no significant loss in removal efficiency was detected, reflecting the stability and reusability of the prepared BC-NiFe2O4 nanocomposite.

Impact of chronic kidney disease on in-hospital mortality and clinical outcomes of catheter ablation of ventricular tachycardia: Insights from the national readmission database.

BACKGROUND: Catheter ablation is an effective treatment for ventricular tachycardia (VT), albeit the decision to undergo this procedure is often influenced by underlying comorbidities. The present study aims at evaluating the effects of chronic kidney disease (CKD) on clinical outcomes of VT ablation. METHODS: We identified 7212 patients who presented between 2016 and 2018 and underwent catheter ablation for VT. Their clinical data were retrospectively accrued from the national readmission database (NRD) using the corresponding diagnosis codes. We compared clinical outcomes between patients with chronic kidney disease (CKD group) and patients without. Odds ratios (OR) for the primary and secondary outcomes were calculated, and multivariable regression analysis was utilized to adjust for confounding variables. RESULTS: Compared with patients without CKD, patients in CKD group were older (mean age 67.9 vs. 60.5 years, P < 0.01), had a longer mean length of stay (8.73 vs. 5.69 days, P < 0.01), and higher in-hospital mortality 113 (6.7%) vs. 119 (2.2%) (OR 2.24, 95% confidence interval (CI) (1.29-3.88), P < 0.01). CKD group patients had increased risk of developing acute kidney injury 726 (43%) vs. 623 (11.3%) (3.69 95% CI (2.87-4.74), P < 0.01). CONCLUSION: In patients with CKD, VT ablation is associated with worse clinical outcomes in-hospital mortality, acute kidney injury, mean length of stay, and total hospital charge. This significantly influences the decision-making prior to performing this procedure.

Disparities in Acute Coronary Syndrome Outcomes in Individuals With Intellectual Disabilities: A Propensity-Matched Analysis of National Inpatient Sample.

BACKGROUND: Individuals with intellectual disabilities (IDs) are at similar risk of acute coronary syndrome (ACS) as compared to general population. However, there is a paucity of real-world data evaluating outcomes of ACS in this population. We sought to study ACS outcomes in individuals with IDs using a large national database. METHODS: Adult admissions with a primary diagnosis of ACS were identified from the national inpatient sample of years 2016-2019. Cohort was stratified according to presence of IDs. A 1 to 1 nearest neighbor propensity score matching using 16 patient variables. Outcomes evaluated were in-hospital mortality, coronary angiography (CA), timing of CA (early [day 0] vs. late [>day0]), and revascularization. RESULTS: A total of 5110 admissions (2555 in each group) were included in our matched cohort. IDs admissions had higher rates of in-hospital mortality (9 % vs. 4 %, aOR: 2.84, 95 % CI [1.66-4.86], P < 0.001), and were less likely to receive CA (52 % vs. 71 %, aOR: 0.44, 95 % CI [0.34-0.58], P < 0.001) and revascularization (33 % vs. 52 %, aOR: 0.45, 95 % CI [0.35-0.58], P < 0.001). In-Hospital mortality was higher in the ID admissions whether invasive coronary treatment (CA or revascularization) was performed (6 % vs. 3 %, aOR: 2.34, 95 % CI [1.09-5.06], P = 0.03) or not (13 % vs. 5 %, aOR: 2.56, 95 % CI [1.14-5.78], P = 0.023). CONCLUSION: Significant disparities exist in ACS outcomes and management in individuals with IDs. More research is needed to understand the reasons for these disparities and develop interventions to improve quality of care in this population.

A Rare Case of Synchronous Oncocytoma and Angiomyolipoma of the Kidney.

BACKGROUND The co-occurrence of renal oncocytoma and angiomyolipoma is exceedingly rare. To date, 17 such cases have been reported in the literature. This report describes a unique case of that association that presented as a single renal mass on imaging. CASE REPORT A 75-year-old woman presented with epigastric discomfort. A CT scan of the abdomen revealed a 6.6×5.7×4.7 cm enhancing right renal mass. Gross examination revealed a nodular, well-circumscribed, tan-brown mass located in the lower pole of the kidney that was abutting the renal capsule. Interestingly, superior to this mass, there was an adjacent, pale tan-white, firm, well-circumscribed nodule in the mid-pole, which was not detected on the CT scan and grossly extended to 1.1 cm of the overlying renal capsule. Histologically, the larger tumor showed characteristic features of oncocytoma. The smaller tumor had an admixture of mature adipose tissue, smooth muscle, and vessels, consistent with a renal angiomyolipoma. CONCLUSIONS We present a new case of synchronous renal angiomyolipoma and oncocytoma, which were uniquely adjacent and coexisted with minimal intermingling renal parenchyma. Other "eosinophilic renal tumors" are significant differential diagnosis considerations. Due to the close proximity of these lesions, this association can present clinically and radiologically as a single renal mass. Careful examination of the nephrectomy specimen is essential for the proper detection of small-sized tumors.

Midline Mandibular Cleft Repair: A Case Report.

Midline clefts of the lower lip and mandible are extremely uncommon. Couronne reported the first case in 1819, and fewer than 80 cases have been discovered in the literature to date. This case report describes a female infant who was born having a full midline cleft of the mandible and lower lip, as well as neck flexion contracture that extended from the lower lip to the manubrium sterni. A fenestrated type of acrylic splint was applied over the mandibular arch and fixed by circum-mandibular wiring. Fixation was done using a 0.5 interosseous wire passing through the prepared hole and tightened over a previously harvested rib bone graft.

Safety outcomes of SGLT2i in the heart failure trials: A systematic review and Meta-analysis.

AIMS: Sodium-glucose co-transporter inhibitors (SGLT2i) are emerging as a new treatment for heart failure (HF) after demonstrating favorable clinical outcomes in several randomized controlled trials (RCTs). In this meta-analysis, we assessed the safety of SGLT2i in the trials that prespecified heart failure in their inclusion criteria. MATERIALS AND METHODS: We searched the databases for RCTs comparing SGLT2i to placebo in heart failure patients. The primary outcome was the incidence of serious adverse events (SAEs). A sensitivity analysis according to the class of HF was also performed. RESULTS: The incidence of SAEs was significantly lower in the SGLT2i group (OR, 0.85; 95% CI, 0.77-0.92; P, 0.0002) and SAEs remained significantly lower after performing the sensitivity analysis (OR, 0.82; 95% CI, 0.75-0.89; P, <0.00001). Genital infections, urinary tract infections (UTIs), and hypotension were significantly higher in the SGLT2i group. CONCLUSIONS: SGLT2i remain a safe option for patients with HF with a lower incidence of SAEs. However, since they increase the risk of genital infection, UTIs and hypotension, the risks vs benefits in each patient should be weighed when making a prescribing decision.

Differences According to Sex in Short-term Clinical Outcomes After Supraventricular Tachycardia Catheter Ablation: Insights from the Nationwide Readmission Database.

Catheter ablation is indicated for the management of supraventricular tachycardias (SVTs). We investigated the effect of sex on short-term outcomes after catheter ablation for SVTs other than atrial fibrillation (AF). Using the Healthcare Cost and Utilization Project Nationwide Readmission Database for the years 2016-2018, SVT patients who underwent catheter ablation were identified using the appropriate International Classification of Diseases, 10th Revision, codes. The primary outcome was 30-day readmissions. Secondary outcomes included 30-day readmissions for SVT, postprocedural bleeding, acute myocardial infarction, transient ischemic attack, stroke, hemopericardium, cardiac tamponade, length of stay (LOS) in the hospital, and total hospital charges (in USD). Female sex was not associated with an increased risk of the primary outcome (P = .168) but was associated with a significantly decreased risk of postprocedural revascularization (P = .001), LOS (P = .003), and total hospital charges (P = .002). There were no significant differences in other secondary outcomes. Among patients admitted for catheter ablation for SVTs (other than AF), female sex was associated with decreased LOS and total hospital charges, which may be attributed to increased comorbidity rates in men and gender-based biases.

High Plus Low Dose Radiation Strategy in Combination with TIGIT and PD1 Blockade to Promote Systemic Antitumor Responses.

Tumors deploy various immune-evasion mechanisms that create a suppressive environment and render effector T-cells exhausted and inactive. Therefore, a rational utilization of checkpoint inhibitors may alleviate exhaustion and may partially restore antitumor functions. However, in high-tumor-burden models, the checkpoint blockade fails to maintain optimal efficacy, and other interventions are necessary to overcome the inhibitory tumor stroma. One such strategy is the use of radiotherapy to reset the tumor microenvironment and maximize systemic antitumor outcomes. In this study, we propose the use of anti-PD1 and anti-TIGIT checkpoint inhibitors in conjunction with our novel RadScopal technique to battle highly metastatic lung adenocarcinoma tumors, bilaterally established in 129Sv/Ev mice, to mimic high-tumor-burden settings. The RadScopal approach is comprised of high-dose radiation directed at primary tumors with low-dose radiation delivered to secondary tumors to improve the outcomes of systemic immunotherapy. Indeed, the triple therapy with RadScopal + anti-TIGIT + anti-PD1 was able to prolong the survival of treated mice and halted the growth of both primary and secondary tumors. Lung metastasis counts were also significantly reduced. In addition, the low-dose radiation component reduced TIGIT receptor (PVR) expression by tumor-associated macrophages and dendritic cells in secondary tumors. Finally, low-dose radiation within triple therapy decreased the percentages of TIGIT+ exhausted T-cells and TIGIT+ regulatory T-cells. Together, our translational approach provides a new treatment alternative for cases refractory to other checkpoints and may bring immunotherapy into a new realm of systemic disease control.