Anomalous Left Superior Vena Cava Predisposing to Recurrent Brain Abscesses: A Case Report and Review of the Literature.

Brain abscess is a devastating illness, with a high risk of morbidity and mortality. Recurrent brain abscess poses a challenge to diagnosis while treatment options may differ. Right to left shunt is a lesser-explored etiology for recurrent brain abscesses. PubMed literature review was performed to study all published studies with reference to right to left cardiac shunt as a possible etiology for the recurrent brain abscesses. The authors also report a case of a young male who developed recurrent brain abscess after previous resection and treatment. Right to left cardiac shunting of deoxygenated blood is an etiology for recurrent brain abscess formation. Thorough systemic workup and multispecialty treatment is recommended to treat this relatively uncommon presentation.

Metastasectomy for extracalvarial renal cell carcinoma.

Key Clinical Message: Palliative surgical resection of extra-calvarial metastatic lesions from renal cell tumors is crucial for controlling metastatic spread, improving quality of life, and preventing associated morbidity. Careful surgical planning, including selective preoperative embolization and controlled resection around critical structures such as the sagittal sinus, is essential for successful outcomes. Cranioplasty with Titanium mesh and bone cement post-resection can provide symptomatic relief, better cosmesis, and overall improved quality of life. Abstract: Renal cell carcinomas are aggressive tumors with distant systemic disease. The calvarium appears to be an unusual and rare site for distant metastasis. The treatment modalities are challenging and out of the normal realm for the management of these tumors. We report a case of a 63-year-old woman with a previous history of nephrectomy who presented with symptoms of severe headaches, and swelling of bi-frontal and bi-parietal scalp regions due to multifocal extracalvarial disease. Preoperative bilateral superficial temporal artery embolization was performed to control the intraoperative bleeding. Surgical technique has been described with the critical steps involved, and a literature review has been conducted. Palliative tumor resection surgery was performed to improve the patient's quality of life as well as to confirm the histopathological diagnosis. Gross total resection of the extracalvarial metastatic tumor was achieved. Biopsy confirmed renal cell tumor with the clear cell subtype. The patient recovered well from her surgery with slow healing of the scalp wound. At 6-month follow-up, no recurrence of the extracalvarial disease was observed on serial imaging. Extracalvarial metastasis is a rare presentation in renal cell carcinoma. Considering the inherent radioresistant nature of the tumor, palliative surgical resection can be offered to control the metastatic spread, relieve agonizing pain symptoms, and to improve the quality of life. Preoperative embolization helps to decrease intraoperative blood loss. Moreover, palliative surgical resection of extracalvarial diseases helps to treat the metastasis as well as avoiding the associated morbidity that may occur if left untreated.

Paracrine Regulation and Immune System Pathways in the Inflammatory Tumor Microenvironment of Lung Cancer: Insights into Oncogenesis and Immunotherapeutic Strategies.

The intricate interplay between inflammatory processes and the tumor microenvironment (TME) in lung cancer has garnered increasing attention due to its implications for both oncogenesis and therapeutic strategies. In this review, we explore recent advances in understanding the paracrine regulation and immune system pathways within the inflammatory TME of lung cancer. We delve into the molecular mechanisms underpinning oncogenesis, highlighting the role of immune cell populations, cancer-associated fibroblasts, and endothelial cells, as well as their interactions through immune system pathways regulated in a paracrine pattern. Additionally, we discuss emerging immunotherapeutic strategies with a specific focus on the potential of leveraging the inflammatory TME through these pathways to enhance treatment efficacy in lung cancer.

Phosphorus cycling from a coastal upwelling zone in the Southeastern Arabian Sea.

The present study examined the seasonal cycling of phosphorous (P) along the southwest coast of India (SWCI) based on two cruises during the southwest monsoon (SWM) and northeast monsoon (NEM) of 2018. During SWM, the entire SWCI experienced intense upwelling manifested by the incursion of cold, nutrient-rich, and hypoxic waters. During NEM, the region was transformed into a warm, well-oxygenated and nutrient-deplete environment. Dissolved inorganic phosphorus (DIP) was significantly high in the subsurface during SWM due to its release from sediments. The sediment P was high and showed an increasing trend towards the south, principally dependent on the sediment texture, organic carbon, and Fe concentrations. Bioavailable P, the sum of exchangeable (PEx) and reducible (PFe) fractions, was almost consistent (5-20%) over seasons, though PFe showed a marked reduction during SWM. Authigenic fraction (PAut) was the most dominant (46%), followed by detrital (PDet 41%) and residual (PRes 8%) fractions. Principal component analysis (PCA) of geochemical parameters for SWM was indicative of the high dissolution of Fe (oxy)hydroxides under hypoxia releasing P and its complexation with organic matter and Fe. PCA results for the NEM were different, as it indicated increased preservation of P-associated organic matter and Fe, alternately favouring the formation of PAut in sediments. The study's significance is the observation that the bottom water oxygen concentration can significantly influence sedimentary P cycling in tropical coastal upwelling zones.

Distribution, contamination status and bioavailability of trace metals in surface sediments along the southwest coast of India.

This study investigates the influence of upwelling induced seasonal hypoxia in the sediment-water interface on the distribution, bioavailability and geochemical partitioning of selected trace metals in surficial sediments along the southwest coast of India based on two successive cruises. The first cruise was during the southwest monsoon (SWM) season when coastal waters exhibited intermittent bottom hypoxia due to upwelling. The second cruise during the northeast monsoon (NEM) season was characterised by a uniformly warm and well-oxygenated water column in the study region. The results showed that grain size, organic carbon and Fe are the major factors influencing the distribution of trace metals in the surface sediments. Based on the geochemical indices (contamination factor, enrichment factor and geo-accumulation factor), the study region appears to be moderately contaminated by Ni, Cr, and Pb. Based on the ecological risk assessment criteria, the enrichment of Pb, Cr and Ni may cause adverse effects on the benthic organisms. The fractionation studies demonstrated that the major pathway of metal deposition in the sediment is lithogenic. The data also showed that labile and organic fractions are the second dominant forms, while other fractions (exchangeable and carbonate) are insignificant. The consistency in the reactive Fe concentrations during SWM and NEM could be due to the absence of Fe dissolution in sediments under mild reducing condition (intermittent hypoxia). In addition to the above, an enrichment of organic matter also leads to increased deposition of trace metals in sediments. Conversely, the secondary phase enrichment factor and risk assessment code calculated based on the metal fractionation data indicated low risk and contamination along the southwest coast of India except for Zn that showed moderate contamination in some transects. The study provides the need for regular geochemical assessment to control metal pollution in the coastal environment, which is a major resource of the fishery.