Short- and Long-Term Prognosis in Hemodynamically Stable Pulmonary Embolism With Unresectable or Metastatic Malignancies: The Role of Performance Status.

BACKGROUND: The simplified Pulmonary Embolism Severity Index (sPESI) has limitations when evaluating acute pulmonary embolism (PE) in patients with concurrent malignancy. Despite its utility in predicting outcomes among cancer patients, the role of the Eastern Cooperative Oncology Group Performance Status (ECOG PS) in acute PE remains underexplored. This study aims to assess the prognostic significance of ECOG PS ≥ 3 on short- and long-term mortality in acute PE with malignancy, correlating it with the sPESI. METHODS AND RESULTS: We retrospectively analyzed 44 hemodynamically stable acute PE patients with unresectable or metastatic malignancies ineligible for curative treatment at Kameda Medical Center, a tertiary medical facility in Japan, from April 1, 2019, to March 2, 2023. Of these patients, 16 (36.4%) had ECOG PS ≥ 3. No 30-day mortality occurred in patients with ECOG PS ≤ 2, compared to 18.8% in those with ECOG PS ≥ 3 (p = 0.04). Groups were similar in the sPESI scores, hospital-onset PE proportion, and initial treatments. Post PE diagnosis, 92.9% of ECOG PS ≤ 2 patients and 50% of ECOG PS ≥ 3 patients received chemotherapy (p = 0.002). Cox regression analysis revealed ECOG PS ≥ 3 was independently associated with increased overall survival hazard (adjusted HR = 4.0; P = 0.002). CONCLUSIONS: ECOG PS ≥ 3 suggests a poorer short-term prognosis and independently predicts a worse long-term prognosis in hemodynamically stable acute PE patients with advanced malignancies.

Task-specific relationships between error-related ERPs and behavior: Flanker, Stroop, and Go/Nogo tasks.

Performance monitoring has been widely studied during different forced-choice response tasks. Participants typically show longer response times (RTs) and increased accuracy following errors, but there are inconsistencies regarding the connection between error-related event-related brain potentials (ERPs) and behavior, such as RT and accuracy. The specific task in any given study could contribute to these inconsistencies, as different tasks may require distinct cognitive processes that impact ERP-behavior relationships. The present study sought to determine whether task moderates ERP-behavior relationships and whether these relationships are robustly observed when tasks and stimuli are treated as random effects. ERPs and behavioral indices (RTs, accuracy) recorded during flanker, Stroop, and Go/Nogo tasks from 180 people demonstrated a task-specific effect on ERP-behavior relationships, such that larger previous-trial error-related negativity (ERN) predicted longer RTs and greater likelihood of a correct response on subsequent trials during flanker and Stroop tasks but not during Go/Nogo task. Additionally, larger previous-trial error positivity (Pe) predicted faster RTs and smaller variances of RTs on subsequent trials for Stroop and Go/Nogo tasks but not for flanker task. When tasks and stimuli were treated as random effects, ERP-behavior relationships were not observed. These findings support the need to consider the task used for recording performance monitoring measures when interpreting results across studies.

Pulmonary hypertension-related deaths in patients with acute pulmonary embolism in the United States, 2003 to 2020.

BACKGROUND: Data regarding the mortality trends in pulmonary embolism (PE)-related mortality in patients with concomitant pulmonary hypertension (PH) are lacking. We assessed the trends in PE-related mortality in patients with concomitant PH in the United States (US) over the past 2 decades and during the first year of the COVID-19 pandemic using data from the Centers for Disease Control and Prevention's (CDC) Wide-ranging ONline Data for Epidemiologic Research (WONDER) dataset. METHODS: Mortality data were retrieved from the publicly available CDC WONDER mortality dataset from 2003 to 2020. Age-adjusted mortality rates (AAMRs), per 100,000 population, were assessed using Joinpoint regression modelling and expressed as estimated average annual percentage change (AAPC) with relative 95% CIs and stratified by urbanicity, sex, age, and race/ethnicity. RESULTS: Over the study period, the AAMR for PE/PH-related mortality linearly increased (AAPC: +4.3% [95% CI: 3.7 to 4.9], p < 0.001) without sex differences. The AAMR increase was more pronounced in White individuals (AAPC: +4.8% [95% CI: 4.1 to 5.5], p < 0.001) and in subjects living in rural areas (AAPC: +5.1% [95% CI: 3.8 to 6.4], p < 0.001) compared to those living in urban areas. During the first year of the COVID-19 pandemic there was a significant excess in PE/PH-related mortality among women, older than 65 years and living in rural areas. CONCLUSIONS: The rate of PE/PH-related mortality in the US is increasing. Although the early diagnosis of PH in patients with acute PE has become easier with improved diagnostic modalities, the mortality rate of these patients remains high.

Fauna - Microplastics interactions: Empirical insights from benthos community exposure to marine plastic waste.

Microplastic deposition in soft marine sediments raises concerns on their role in sediment habitats and unknown effects on resident macrobenthic communities. To assess the reciprocal influence that MPs and macrobenthos might have on each other, we performed a mesocosm experiment with ambient concentrations of environmental Polyethylene (PE) and a non-manipulated, natural macrobenthic community from the Belgian part of the North Sea (BPNS). Our results show that PE fragments increase mortality of abundant bivalves (specifically Abra alba) after 30 days of exposure but not for the most abundant polychaete Owenia fusiformis, possibly due to its predominant suspension feeding behavior. Fast burial of surface MPs exposes deep-dwelling burrowers to the pollutant, however reducing the amount of MPs interacting with (sub) surface living fauna. We conclude that macrobenthos promotes the sequestration of deposited MPs, counteracting resuspension, and can have cascading effects on biodiversity due to their effect on abundant and functionally important species.

Impact of connective tissue diseases on inpatient outcomes in gastrointestinal bleeding: insights from a national database analysis.

Background: Connective tissue diseases (CTDs) are characterized by immune system dysregulation, which can profoundly impact the gastrointestinal (GI) system. While GI bleeding is a well-recognized cause of mortality and morbidity in the USA, its occurrence in patients with CTD remains documented but underexplored in terms of inpatient outcomes. GI bleeding in CTD is attributed to factors such as vasculopathy and drug-related risks, notably steroids and non-steroidal anti-inflammatory drugs (NSAIDs). This research seeks to conduct a comprehensive national-level analysis, utilizing the National Inpatient Sample (NIS), to compare GI bleeding outcomes between patients with CTD and those without this condition. Methods: Utilizing the extensive NIS database covering 2020, we conducted a retrospective analysis of GI bleeding patients with CTD, identified through the International Classification of Diseases, 10th Revision (ICD-10). The primary outcome was in-hospital mortality. The secondary outcomes included rate of urgent esophagogastroduodenoscopy (EGD) and colonoscopy-endoscopy in 1 day or less, total rate of EGD and colonoscopy, rate of EGD and Colonoscopy with intervention, rate of complications including acute kidney injury (AKI), blood transfusion, sepsis, pneumonia, pulmonary embolism (PE) and healthcare utilization. Employing Stata software, we utilized multivariate logistic and linear regression analyses to adjust for confounders. Results: There were 455,494 hospitalizations for GI bleeding and 19,874 involved patients with CTDs. The in-hospital mortality rate was significantly lower for CTD patients at 2.1%, compared to 2.4% for non-CTD patients [adjusted odds ratio (aOR): 0.79, 95% confidence interval (CI): 0.63-0.99, P=0.04]. CTD patients showed increased odds of total EGD, urgent colonoscopy, and total colonoscopy; however, these changes were not statistically significant. CTD patients had higher odds of complications, including PE (6.87% vs. 4.12%, P=0.009). However, there were no significant differences in mean length of hospital stay and total hospital charges (THCs) compared to non-CTD patients. Conclusions: Patients with CTD exhibited a lower in-hospital mortality rate compared to those without CTD. The elevated risk of PE underscores the importance of implementing prophylactic measures for these patients.

Factor V Leiden Heterozygous: Complicated by Recurrent Venous Thromboembolism and Bilateral Pulmonary Embolism.

Factor V Leiden (FVL) is a hypercoagulable disorder that puts patients at increased risk of initial venous thromboembolism (VTE). However, those with heterozygote status are not usually susceptible to recurrent VTE. This is a case of a 35-year-old Caucasian male who presented to the emergency department with shortness of breath and chest pain. He had a past medical history of superficial thrombophlebitis and deep vein thrombosis (DVT) and was known to be FVL heterozygous. His home medications did not include anticoagulation medications at the time of presentation to the emergency department. The patient was diagnosed with bilateral pulmonary embolisms (PEs) secondary to a recurrent DVT. Initial treatment included a pulmonary thrombectomy and a lower extremity thrombectomy. Despite the patient being placed on heparin, there was a recurrence of the PE three days later, requiring a repeat pulmonary thrombectomy. This case of recurrent VTE in a heterozygous FVL patient is unusual and should lead to new considerations on the approach to lifelong anticoagulation in these patients.

Evaluation of efficacy and safety of Botulinum toxin-A injection at three deferent sites in treatment of premature ejaculation.

BACKGROUND: Premature ejaculation (PE) is a common sexual problem, resulting in adverse effects on the quality of life, of both the patient and the partner. The idea of muscular contraction inhibition during the ejection phase of ejaculation by Botulinum toxin-A injection may delay ejaculation. AIM OF STUDY: This study was performed to assess the efficacy and safety of Botulinum toxin-A injection in PE treatment. MATERIAL AND METHODS: This study included 45 married male patients diagnosed with primary PE. All included patients were injected with 75 units of Dysport equal efficacy of 25 units of Botulinum toxin-A (Botox) into three sites: the root of the penis (Group 1), glans penis (Group 2), and each side of the ischiocavernosus muscle (Group 3). All patients were subjected to an assessment of intravaginal ejaculation latency time (IELT) using a stopwatch and answering the Premature Ejaculation Diagnostic Tool (PEDT) Questionnaire before and after treatment. RESULTS: There was a statistically significant improvement in IELT after treatment in all groups. The most significant improvement was shown in Group 3 (average 108% increase), followed by Group 1 (74%) and Group 2 (40%), respectively. There was a positive correlation between age and the improvement in improved IELT. There was a statistically significant improvement in PEDTq scores in Group 1 and Group 3. CONCLUSION: Botulinum toxin-A injection into the root of the penis and ischiocavernosus muscle could be recommended in the treatment of premature ejaculation.

Characteristics of Corynespora cassiicola, the causal agent of tobacco Corynespora leaf spot, revealed by genomic and metabolic phenomic analysis.

Corynespora cassiicola is a highly diverse fungal pathogen that commonly occurs in tropical, subtropical, and greenhouse environments worldwide. In this study, the isolates were identified as C. cassiicola, and the optimum growth and sporulation were studied. The phenotypic characteristics of C. cassiicola, concerning 950 different growth conditions, were tested using Biolog PM plates 1-10. In addition, the strain of C. cassiicola DWZ from tobacco hosts was sequenced for the using Illumina PE150 and Pacbio technologies. The host resistance of tobacco Yunyan 87 with different maturity levels was investigated. In addition, the resistance evaluation of 10 common tobacco varieties was investigated. The results showed that C. cassiicola metabolized 89.47% of the tested carbon source, 100% of the nitrogen source, 100% of the phosphorus source, and 97.14% of the sulfur source. It can adapt to a variety of different osmotic pressure and pH environments, and has good decarboxylase and deaminase activities. The optimum conditions for pathogen growth and sporulation were 25-30 °C, and the growth was better on AEA and OA medium. The total length of the genome was 45.9 Mbp, the GC content was 51.23%, and a total of 13,061 protein-coding genes, 202 non-coding RNAs and 2801 and repeat sequences were predicted. Mature leaves were more susceptible than proper mature and immature leaves, and the average diameter of diseased spots reached 17.74 mm at 12 days. None of the tested ten cultivars exhibited obvious resistance to Corynespora leaf spot of tobacco, whereby all disease spot diameters reached > 10 mm and > 30 mm when at 5 and 10 days after inoculation, respectively. The phenotypic characteristics, genomic analysis of C. cassiicola and the cultivar resistance assessment of this pathogen have increased our understanding of Corynespora leaf spot of tobacco.

Competitive coordination assisted scalable fabrication of FITC­nickel frameworks anchored nanofiber paper for colorimetric/fluorescent monitoring of shrimp freshness.

A novel type of colorimetric/fluorescent nanopaper indicator has been developed from the melt-extruded poly (vinyl alcohol-co-ethylene) nanofibers with surface anchored metal-organic frameworks (MOFs) by an interfacial coordination strategy. Specifically, the fluorescein isothiocyanate molecules could be anchored to the nanofiber surface by nickel ions and co-assembled into a hydrophilic nanocoating via a dynamic water/alcohol solvent evaporation method. Interestingly, this hydrophilic surface enables fast adsorption of moistures and interaction with biological amine vapors, resulting a saffron cake-layer of MOF nanocrystals with ultra-sensitive colorimetric/fluorescent responses based on an alkaline pH/ammonia induced competitive coordination mechanism. Finally, these porous nanofibrous matrix and active nanocoating make the nano-paper an ultra-sensitive optical platform for in-situ monitoring of the shrimp freshness from mins to weeks. Therefore, this composite film shows great potential into advanced paper-based indicators for food quality control and safety in processing industry.

Comparison of Tenecteplase Versus Alteplase for the Treatment of Pulmonary Embolism and Cardiac Arrest with Suspected Pulmonary Embolism.

High-risk pulmonary embolism (PE) is a life-threatening disease state with current guidelines recommending reperfusion therapy with systemic thrombolytics in addition to anticoagulation. This was a prospective observational cohort study with a historical control group comparing tenecteplase to alteplase for the treatment of PE or cardiac arrest with suspected PE. The primary outcome was the incidence of institutional protocol deviations defined as incorrect thrombolytic dose administered or the incorrect product compounded. Secondary outcomes included any bleeding event, major bleeding event, all-cause mortality, and for patients with a cardiac arrest, successful return of spontaneous circulation (ROSC). Fifty-four patients were included in the study. Protocol deviations occurred in one patient receiving tenecteplase and one patient receiving alteplase (4.0% vs 3.4%; P = 1.0). There was no difference in all-cause mortality (80% vs 86.2%; P = .72), any bleed (12% vs 13.8%; P = 1.0), major bleed (8.0% vs 6.9%; P = 1.0), or ROSC achievement (22.2% vs 28.6%; P = .73) when comparing tenecteplase to alteplase. Our study demonstrates that tenecteplase may be an alternative thrombolytic to alteplase for treatment of PE or cardiac arrest with suspected PE. Further studies comparing the different systemic thrombolytic agents for PE or cardiac arrest with suspected PE are needed.

Durvalumab plus platinum-etoposide chemotherapy for extensive-stage small cell lung cancer: a retrospective real-world study.

Background: Immune checkpoint inhibitor plus platinum-etoposide (PE) improved overall survival (OS) in patients with extensive-stage small cell lung cancer (ES-SCLC). While the CASPIAN trial demonstrated the efficacy of durvalumab plus PE, the clinical trial results may not be representative of the general, real-world population because clinical trials often have strict inclusion and exclusion criteria. We herein report the efficacy and safety of durvalumab plus PE in patients with ES-SCLC in real-world, clinical practice. Methods: The present, monocentric, retrospective study evaluated patients with ES-SCLC or recurrent, limited-stage SCLC who received durvalumab plus PE between September 2020 and February 2023. The efficacy and incidence of adverse events (AEs) were also evaluated. Results: The study included 40 patients, of whom 17 were elderly (age >70 years), and 15 had performance status (PS) 2 or 3. The median follow-up time was 13.0 months [95% confidence interval (CI): 8.0-22.2 months]. The objective response rate was 80.0% (95% CI: 63.1-91.6%), and the disease control rate was 88.6% (95% CI: 73.3-96.8%). The median progression-free survival (PFS) was 5.9 months (95% CI: 4.9-6.9), and the median OS was 25.4 months (95% CI: 4.6-46.2). Factors such as advanced age, poor PS, and presence of brain metastases were not associated with lower PFS and OS. Twenty-six patients (65.0%) experienced grade 3 or higher AEs, mainly hematological toxicity. AEs leading to treatment discontinuation occurred in three patients (8%). Conclusions: Durvalumab plus PE in patients with ES-SCLC showed good efficacy and safety according to our real-world data, suggesting that this treatment is well tolerated in clinical practice, even in elderly patients and those with poor PS.

Paraneoplastic Syndrome in Adrenocortical Carcinoma: The Unexpected Mime.

Adrenocortical carcinoma (ACC) is a malignancy of the adrenal cortex with a high morbidity and mortality. More than half of the cases are functional tumors. As different hormones can be co-secreted above physiologic levels, it causes a very broad variety of symptoms and makes differentiating from more common entities hard. Here we present a case of a patient with a newly diagnosed ACC who initially presented with acute pulmonary embolism and recurrent deep vein thromboses (DVT) in the setting of hypercortisolism. Imaging showed a left adrenal mass invading adjacent structures including a nonocclusive thrombus in the left renal vein. Intravenous anticoagulation and thrombectomy were initially performed, followed by removal of the tumor and adjacent metastatic disease. Pathology confirmed ACC. The patient underwent left adrenalectomy, left nephrectomy, splenectomy, distal pancreatectomy, and caval thrombectomy with inferior vena cava (IVC) filter placement. Intravenous anticoagulation and glucocorticoid replacement were also administered as part of the treatment plan. Unfortunately, the patient had multiple episodes of bleeding and thrombosis and was eventually discharged to hospice care. DVT in the setting of ACC can be caused by increased hypercoagulability from hypercortisolism, direct venous thrombosis, or vascular invasion. Thrombosis, especially in the inferior vena cava, has been associated with poor prognosis and survival rates. Clinicians should be aware of this rare complication given its immediate therapeutic repercussions and prognostic value.

Simultaneous Material and Chemical Recycling of Waste PET/PE Multi-layer Films under Hydrothermal Conditions.

Multi-layer plastic films are widely used in various fields especially for packaging, but due to complex composition, it is very difficult to recover single-material polymers or high-purity monomers from them after usage. In this study, we proposed a hydrothermal process for recycling PET/PE (PET: Polyethylene terephthalate; PE: Polyethylene) films. PET can be hydrolyzed to monomers of terephthalic acid (TPA) and ethylene glycol (EG). Using a hydrothermal system equipped with two filters, PE, TPA, and EG were collected separately, indicating the simultaneous material and chemical recycling of PET/PE films was firstly achieved. At 300 °C and 10 MPa for 60 min, PET conversion reached around 100%, and TPA yield of 83.0% was obtained with a high TPA purity of 96.1%. In addition, the effect of the holding time on PET conversion, TPA yield, EG yield, and TPA purity was studied. This research opened up a new and sustainable pathway to recycle multi-layer plastic films in both lab and industry.

A Superior Squeeze: Superior Vena Cava Syndrome Secondary to Small Cell Lung Cancer.

Superior vena cava (SVC) syndrome is an uncommon yet potentially fatal syndrome occurring after intrinsic or extrinsic compression to the SVC. While there are multiple emerging etiologies for this phenomenon, malignancy remains the most common. It is characterized by several symptoms including facial swelling, extremity swelling, shortness of breath, and headaches. We present the case of a 59-year-old female with a past medical history of cocaine abuse who was admitted for upper extremity swelling and facial edema. Imaging revealed a right suprahilar mass compressing a branch of the right pulmonary artery and SVC, in addition to bilateral segmental and subsegmental pulmonary emboli. She underwent an emergent biopsy and SVC stenting, with immunostaining revealing small cell lung cancer (SCLC). This case highlights a severe presentation of SVC syndrome caused by previously undetected SCLC.

No association between error-related ERPs and trait anxiety in a nonclinical sample: Convergence across analytical methods including mass-univariate statistics.

Enhanced error monitoring, as indexed by increased amplitude of the error-related negativity (ERN) event-related potential (ERP) component, has been suggested to reflect a vulnerability neuro-marker of anxiety disorders. Another error-related ERP component is the error positivity (Pe), which reflects late-stage error processing. The associations between heightened ERN and Pe amplitudes and anxiety levels in the nonclinical population have been inconsistent. In this preregistered study, we examined the association between anxiety, ERN, and Pe, using different analytical methods (mass-univariate analyses, MUAs and conventional analyses), self-reported anxiety scales (STAI and STICSA), and trial numbers (all correct trials and equal numbers of correct and error trials). In a sample of 82 healthy adults, both conventional and MUAs demonstrated a robust enhancement of the ERN and Pe to errors relative to the correct-response ERPs. However, the mass-univariate approach additionally unveiled a wider array of electrodes and a longer effect duration for this error enhancement. Across the analytic methods, the results showed a lack of consistent correlation between trait anxiety and error-related ERPs. Findings were not modulated by trial numbers, analyses, or anxiety scales. The present results suggest a lack of enhancement of error monitoring by anxious traits in individuals with subclinical anxiety and those with clinical anxiety but without a clinical diagnosis. Importantly, the absence of such correlation questions the validity of the ERN as a neural marker for anxiety disorders. Future studies that investigate neuro-markers of anxiety may explore alternative task designs and employ robust statistics to provide a more comprehensive understanding of anxiety vulnerability.

PE6c greatly enhances prime editing in transgenic rice plants.

Prime editing is a versatile CRISPR/Cas-based precise genome-editing technique for crop breeding. Four new types of prime editors (PEs) named PE6a-d were recently generated using evolved and engineered reverse transcriptase (RT) variants from three different sources. In this study, we tested the editing efficiencies of four PE6 variants and two additional PE6 constructs with double-RT modules in transgenic rice (Oryza sativa) plants. PE6c, with an evolved and engineered RT variant from the yeast Tf1 retrotransposon, yielded the highest prime-editing efficiency. The average fold change in the editing efficiency of PE6c compared with PEmax exceeded 3.5 across 18 agronomically important target sites from 15 genes. We also demonstrated the feasibility of using two RT modules to improve prime-editing efficiency. Our results suggest that PE6c or its derivatives would be an excellent choice for prime editing in monocot plants. In addition, our findings have laid a foundation for prime-editing-based breeding of rice varieties with enhanced agronomically important traits.

The role of 3D printing in chest wall reconstruction.

Technology is advancing fast, and chest wall surgery finds particular benefit in the broader availability of three-dimensional (3D) reconstruction and printing. An increasing number of reports are being published on the use of these resources in virtual 3D reconstructions of chest walls in computed tomography (CT) scans, virtual surgeries, 3D printing of real-size models for surgical planning, practice, and education, and of note, the manufacture of customized 3D printed implants, changing the fundamental conception from a surgery that fits all, to a surgery for each patient. In this review, we explore the evidence published on simple chest wall reconstruction, including the use of 3D technology to assist in the improvement of the repair of the most frequent chest wall deformities: pectus excavatum and carinatum. Current studies are oriented to the automatization and customization of transthoracic implants, as well as education on real-size models. Next, we investigate the implementation of 3D printing in the repair of complex chest wall reconstruction, comprised of infrequent chest wall deformities such as pectus arcuatum and Poland syndrome. These malformations are very heterogeneous resulting in a high degree of improvisation during the surgical repair. In this setting, 3D technology plays a role in the standardization of a process that contemplates customization, concepts that may seem contradictory. Finally, 3D printing with biocompatible materials is rapidly becoming the first choice for the reconstruction of wide chest wall oncological resections. In this work, we review the first and most important current publications on the subject.

Electrocardiographic abnormalities and NT-proBNP levels at long-term follow-up of patients with dyspnea after pulmonary embolism.

OBJECTIVES: Electrocardiogram (ECG) and measurement of plasma brain natriuretic peptides (BNP) are established markers of right ventricular dysfunction (RVD) in the setting of acute pulmonary embolism (PE) but their value at long-term follow-up is largely unknown. The purpose of this prospective study was to determine the prevalence of ECG abnormalities, describe levels of N-terminal proBNP (NT-proBNP), and establish their association with dyspnea at long-term follow-up after PE. DESIGN: All Swedish patients diagnosed with acute PE in 2005 (n = 5793) were identified through the Swedish National Patient Registry. Surviving patients in 2007 (n = 3510) were invited to participate. Of these, 2105 subjects responded to a questionnaire about dyspnea and comorbidities. Subjects with dyspnea or risk factors for development of chronic thromboembolic pulmonary hypertension were included in the study in a secondary step, which involved collection of blood samples and ECG registration. RESULTS: Altogether 49.3% had a completely normal ECG. The remaining participants had a variety of abnormalities, 7.2% had atrial fibrillation/flutter (AF). ECG with any sign of RVD was found in 7.2% of subjects. Right bundle branch block was the most common RVD sign with a prevalence of 6.4%. An abnormal ECG was associated with dyspnea. AF was associated with dyspnea, whereas ECG signs of RVD were not. 61.2% of subjects had NT-proBNP levels above clinical cut-off (>125 ng/L). The degree of dyspnea did not associate independently with NT-proBNP levels. CONCLUSIONS: We conclude that the value of ECG and NT-proBNP in long term follow-up after PE lies mostly in differential diagnostics.

Heparin-Induced Hemorrhagic Bullous Dermatosis: A Rare Complication of Unfractionated Heparin.

We present a case of an 82-year-old female with a significant medical history of hypertension and Alzheimer's disease who developed heparin-induced hemorrhagic bullous dermatosis during treatment for a subsegmental pulmonary embolism. The patient was admitted with lower extremity edema and cyanosis, diagnosed with a subsegmental pulmonary embolism, and started on therapeutic doses of unfractionated heparin. On the sixth day of heparin therapy, she developed abdominal bloating and a diffuse exanthematous rash, which progressed to hemorrhagic bullae on the plantar and dorsal aspects of her feet, alongside extensive purpura on her legs. Laboratory findings revealed thrombocytopenia. Multidisciplinary consultations confirmed the diagnosis of heparin-induced hemorrhagic bullous dermatosis. Management included continuing unfractionated heparin with close monitoring, supportive topical treatments, and a subsequent transition to rivaroxaban. The patient's condition improved significantly, and she was discharged in stable condition. This case highlights the importance of recognizing rare adverse reactions to heparin and raises the question of preventive measures or risk factors related to this manifestation.

A Rare Case of Right Atrial Thrombus in a Patient With Recurrent Classical Hodgkin Lymphoma.

Patients with cancer are at risk for thrombotic complications due to a hypercoagulable state. However, the benefit of prophylactic anticoagulation is unclear in many subsets of these patients. For the first episode of acute thromboembolic disease (VTE) in patients with active cancer, anticoagulant therapy is administered for at least three to six months. Herein, we present a 31-year-old female with active, recurrent stage IIIa classical Hodgkin lymphoma (CHL) (nodular sclerosis), previously treated for proximal upper extremity deep vein thrombosis (DVT), presenting for evaluation of shortness of breath and eventually diagnosed with bilateral pulmonary embolism (PE) secondary to a right atrial thrombus. The patient was successfully treated with surgical resection of the thrombus. With this case report, we hope to encourage physicians to use prophylactic indefinite anticoagulation in patients with active cancer and previous DVT, including patients with upper extremity DVT.