Pancreatic ductal adenocarcinoma: exploring clinicopathological trends and racial disparities in a comprehensive U.S. population-based study.

INTRODUCTION: Pancreatic ductal adenocarcinoma (PDAC) is a highly aggressive malignancy about 50% of PDAC are metastatic at presentation. In this study, we evaluated PDAC demographics, annual trend analysis, racial disparities, survival rate, and the role of different treatment modalities in localized and metastatic disease. METHODS: A total of 144,824 cases of PDAC were obtained from the SEER database from 2000 to 2018. RESULTS: The median age was 69 years, with a slightly higher incidence in males (52%) and 80% of all cases were white. Among cases with available data, 43% were grade III tumors and 57% were metastatic. The most common site of metastasis was the liver (15.7%). The annual incidence has increased steadily from 2000 to 2018. The overall observed (OS) 5-year survival rate was 4.4% (95% CI 4.3-4.6%), and 5 years cause-specific survival (CSS) was 5% (95% CI 5.1-5.4%). The 5-year survival with multimodal therapy (chemotherapy, surgery, and radiation) was 22% (95% CI 20.5-22.8%). 5-year CSS for the blacks was lower at 4.7% (95% CI 4.2-5.1%) compared to the whites at 5.3% (95% CI 5.1-5.4%). Multivariate analysis found male gender and black race associated with worse prognosis. Kaplan-Meier survival analysis found multimodal therapy to have the best outcomes in all three stages. CONCLUSION: PDAC is an aggressive malignancy with male gender and black race are associated with a poor prognosis. Surgery with chemoradiation was associated with the best overall survival. With steadily increasing rates of PDAC, improved treatment modalities are paramount to improving survival in these patients.

Analysis of Medical Malpractice Claims Involving Interventional Radiologists: A Comprehensive Analysis From Two National Legal Databases.

PURPOSE: The nature of lawsuits involving interventional radiologists (IRs) is not well understood. The purposes of this article are to provide an overview of the causes of action underlying medical malpractice lawsuits related to IRs and to characterize the associated factors and outcomes. METHODS: Two large legal databases were used to search for US legal cases in which there were jury awards and settlements involving IRs in the United States. Cases were screened to include only those cases in which the cause of action involved negligence on the part of IRs. RESULTS: A total of 389 published case summaries were identified, of which 93 were eligible to be included in the analysis. In 46% of the cases (43 of 93), medical malpractice was alleged against an individual IR, whereas in 43% (40 of 93), it was alleged against both an individual IR and a health care institution. Thirty-five percent of IR malpractice cases (33 of 93) involved the performance of a vascular procedure, most commonly embolization procedures (30% [n = 10]), stenting or angioplasty (21% [n = 7]), and diagnostic arteriography and angiography (18% [n = 6]). Twenty-six percent of cases (24 of 93) involved IR performance of a biopsy. Eighteen percent of cases (17 of 93) involved a failure to gain informed consent in addition to an allegation of medical negligence during treatment. Eleven percent of cases (10 of 93) were resolved by settlement, with an average settlement amount of $877,500 (range, $200,000-$2,700,000). Among the 72 cases that went to trial, 74% (53 of 72) resulted in judgments for the defendants, and 26% (19 of 72) resulted in judgements for the plaintiffs, with an average award of $2,012,243 (range, $101,667-$6,400,000). CONCLUSIONS: Vascular procedures and biopsies were the most frequent reasons for malpractice lawsuits involving IRs. Failure to gain informed consent in addition to an allegation of medical negligence during treatment was not infrequent. Although the majority of published medical malpractice claims involving IRs resulted in judgments in favor of the defendants, the average amount awarded to plaintiffs was higher compared with previous data reported for all physicians.

Safety, immunogenicity and efficacy of an mRNA-based COVID-19 vaccine, GLB-COV2-043, in preclinical animal models.

Several COVID-19 vaccines, some more efficacious than others, are now available and deployed, including multiple mRNA- and viral vector-based vaccines. With the focus on creating cost-effective solutions that can reach the low- and medium- income world, GreenLight Biosciences has developed an mRNA vaccine candidate, GLB-COV2-043, encoding for the full-length SARS-CoV-2 Wuhan wild-type spike protein. In pre-clinical studies in mice, GLB-COV2-043 induced robust antigen-specific binding and virus-neutralizing antibody responses targeting homologous and heterologous SARS-CoV-2 variants and a TH1-biased immune response. Boosting mice with monovalent or bivalent mRNA-LNPs provided rapid recall and long-lasting neutralizing antibody titers, an increase in antibody avidity and breadth that was held over time and generation of antigen-specific memory B- and T- cells. In hamsters, vaccination with GLB-COV2-043 led to lower viral loads, reduced incidence of SARS-CoV-2-related microscopic findings in lungs, and protection against weight loss after heterologous challenge with Omicron BA.1 live virus. Altogether, these data indicate that GLB-COV2-043 mRNA-LNP vaccine candidate elicits robust protective humoral and cellular immune responses and establishes our mRNA-LNP platform for subsequent clinical evaluations.

Contrast Agent Administration as a Source of Liability: A Legal Database Analysis.

Background Radiology ranks high in terms of specialties implicated in medical malpractice claims. While most radiologists understand the risks of liability for missed findings or lapses of communication, liability for the use of contrast agents in imaging procedures may be underappreciated. Purpose To review the clinical context and outcomes of lawsuits alleging medical malpractice for contrast-related imaging procedures. Materials and Methods Two large U.S. legal databases were queried using the terms "Contrast" and "Radiology OR Radiologist" from database inception to October 31, 2022, to identify cases with published decisions or settlements related to medical malpractice in patients who underwent contrast-related imaging procedures. The search results were screened to include only those cases involving the practice area of health care law where there was at least one claim of medical negligence against a health care institution or provider. Data on the medical complications alleged by patients after contrast agent administration and on the trial were extracted and reported using descriptive statistics. Results A total of 151 published case summaries were included in the analysis. Anaphylactic reaction following contrast agent administration was the most common medical complication observed (30% [45 of 151 cases]), of which failure to diagnose developing anaphylaxis or failure to treat the anaphylactic reaction made up the majority of allegations (93% [42 of 45]). Inappropriate management of contrast media extravasation (27% [41 of 151]) and alleged contrast agent-induced acute kidney injury (13% [19 of 151]) were the next most frequent causes of lawsuits. Of the 11 cases of alleged kidney injury that went to trial, all resulted in a judgment in favor of the defense. Conclusion This study highlights the key reasons for medical malpractice lawsuits associated with use of contrast media and outcomes from these lawsuits. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Trop in this issue.

Prevalence of Colonization With Antibiotic-Resistant Organisms in Hospitalized and Community Individuals in Bangladesh, a Phenotypic Analysis: Findings From the Antibiotic Resistance in Communities and Hospitals (ARCH) Study.

BACKGROUND: Low- and middle-income countries bear a disproportionate burden of antimicrobial resistance (AMR) but often lack adequate surveillance to inform mitigation efforts. Colonization can be a useful metric to understand AMR burden. We assessed the colonization prevalence of Enterobacterales with resistance to extended-spectrum cephalosporins, carbapenems, colistin, and methicillin-resistant Staphylococcus aureus among hospital and community dwellers. METHODS: Between April and October 2019, we conducted a period prevalence study in Dhaka, Bangladesh. We collected stool and nasal specimens from adults in 3 hospitals and from community dwellers within the hospitals' catchment area. Specimens were plated on selective agar plates. Isolates underwent identification and antibiotic susceptibility testing using Vitek 2. We performed descriptive analysis and determined population prevalence estimates accounting for clustering at the community level. RESULTS: The majority of both community and hospital participants were colonized with Enterobacterales with resistance to extended-spectrum cephalosporins (78%; 95% confidence interval [95% CI], 73-83; and 82%; 95% CI, 79-85, respectively). Thirty-seven percent (95% CI, 34-41) of hospitalized patients were colonized with carbapenems compared with 9% (95% CI, 6-13) of community individuals. Colistin colonization prevalence was 11% (95% CI, 8-14) in the community versus 7% (95% CI, 6-10) in the hospital. Methicillin-resistant Staphylococcus aureus colonization was similar in both community and hospital participants (22%; 95% CI, 19-26 vs 21% (95% CI, 18-24). CONCLUSIONS: The high burden of AMR colonization observed among hospital and community participants may increase the risk for developing AMR infections and facilitating spread of AMR in both the community and hospital.

Piriformis Syndrome in Pre-monsoon, Monsoon, and Winter: An Observational Pilot Study.

INTRODUCTION:  Piriformis syndrome (PS) is a rare focal soft tissue rheumatic disease. Due to heavy rural work, we questioned whether PS was more prevalent in the rainy monsoon than in other seasons. In this pilot research, we studied the pattern of PS, the frequency of PS over the seasons, and whether there were typical preceding events.  Methods: In this time-series descriptive study, PS cases diagnosed in a community-based clinic between January 2018 and December 2019 were enrolled. PS was diagnosed by clinical features and a 50% immediate pain relief from ultrasonogram-guided lidocaine (2%) injection in the piriformis muscle (PM). PS mimics were excluded. RESULTS:  A total of 38 PS cases (11 males) were enrolled consecutively. In 2018, during dry winter (November-February), pre-monsoon (March-May), and rainy monsoon (June-October), nine, seven, and one PS cases were diagnosed, respectively; in 2019, the numbers were three, eight, and seven, respectively. Thus, over two years, 12 PS patients were diagnosed in dry winter, 15 in pre-monsoon, and eight in rainy monsoon. There was no correlation with the type of preceding events. There were no differences in the pattern of PS between the seasons. CONCLUSIONS:  In this pilot study, over two years more new PS cases were observed in the pre-monsoon and dry winter than in the rainy season; this was not supporting our research question. There was no association with specific preceding events.

BRASH Syndrome: A Systematic Review of Reported Cases.

The pathophysiology of Bradycardia-Renal Failure-Atrioventricular Nodal Blockade-Shock-Hyperkalemia (BRASH) syndrome involves acute renal injury leading to ineffective clearance of AV nodal agents and potassium. Theoretically, the synergy between AV nodal blockade and hyperkalemic cardiac dysconduction results in circulatory collapse at less-than-expected doses of both. Our study aims to characterize the presentation of BRASH and provide clinical evidence of its risk factors. This systematic review comprises all reported cases of BRASH until February 2022. The average age and Charleston Comorbidity Index at presentation was 69 years and 3.8 respectively - hypertension (71%) was most prevalent followed by diabetes mellitus (48%) and chronic kidney disease (44%). The most frequent presenting complaint was fatigue or syncope (49%). More than half of all patients presented with nonsevere hyperkalemia (less than 6.5 mmol/L) and the mean serum creatinine was 3.6 mg/dL. Beta-blockers (75%) were the most commonly implicated nodal agents. Presenting mean arterial pressure was 62 mm Hg and heart rate averaged 36 bpm; junctional escape rhythm (50%), sinus bradycardia (17.1%), and complete heart block (12.9%) were generally observed on EKG. While most patients responded to medical management, 20% of patients required renal replacement therapy and 33% required transvenous or transcutaneous pacing. No patients underwent permanent pacemaker placement and the in-hospital mortality of BRASH was 5.7%. The diagnosis of BRASH requires a high index of suspicion; its synergistic pathology results in a dramatic clinical presentation that can be easily overlooked. As hypothesized, the degree of renal failure and hyperkalemia are not congruent with the presenting circulatory shock. The significant mortality of this syndrome presents an opportunity for intervention with timely recognition.

A rare case of post-transplant lymphoproliferative disorder (Hodgkins lymphoma) post autologous stem cell transplantation: A case report and review of literature.

Introduction: Post-transplant lymphoproliferative disorders(PTLD) include a mix of rare yet life endangering complications. Case presentation and conclusion: Here, we report a case of a 63-year-old man who was the victim of post-transplant lymphoproliferative disorder (Hodgkin's lymphoma). The patient was initially diagnosed with multiple myeloma, for which chemotherapy and the autologous stem cell transplant was carried out. Post transplant patient was stable but on a follow up visit 6 months after the transplant he presented with generalized lymphadenopathy.His subsequent workup was done including a biopsy of cervical lymph node, which revealed Classical Hodgkin's lymphoma (post-transplant lymphoproliferative disorder (PTLD)) of mixed cellularity type.The patient was started on chemotherapy and received a total of 4 cycles of Chemotherapy (ABVD) before his condition started deteriorating as chemotherapy was poorly tolerated leading to Bleomycin toxicity. The patient regrettably passed away due to an NSTEMI.

COVID-19 Vaccine and Long COVID: A Scoping Review.

As the COVID-19 pandemic progresses, changing definitions and therapeutics regarding the post-acute sequela of COVID-19, particularly long COVID, have become a subject of great interest and study. The study aims to describe the pathophysiology and discuss different therapeutic agents currently available for long COVID. Another objective is to assess comparative efficacy between different types of vaccines on symptoms of long COVID. A preliminary search was conducted using Ovid Medline, Embase, medRxiv, and NIH COVID-19 portfolios. A total of 16 studies were included in our review. Despite some of the data showing variable results, most of the vaccinated patients reported improvement in long COVID symptoms with no significant difference between various types of vaccines. Further trials are needed to better identify the comparative efficacy of vaccines for long COVID and ascertain other therapeutic modalities.

Polymeric membranes for environmental remediation: A product space model perspective.

The development of polymeric membranes from polymers such as polystyrene (PS), polyvinylchloride (PVC), and their associated family has brought great momentum to the environmental remediation universe, mainly due to their surprisingly diverse and multi-purpose nature. Their usage has surged 20 times in the last half-century and is likely to double again in the coming 20 years. As a result, the polymeric materials economy and commercialization of research become increasingly important as a possible option for a country to boost prosperity while decreasing its reliance on limited raw resources and mitigating negative externalities. This transformation demands a systematic strategy, which involves progress beyond improving the existing models and building new avenues for collaboration. In this work, a sophisticated system, i.e., product space model (PSM), has been presented, explicitly appraising the opportunity space for United Kingdom, Italy, Poland, India, Canada, Indonesia, Brazil, Saudi Arabia, Russia and Colombia for their potential future industrialization and commercialization of polymeric membranes for environmental remediation. The results revealed that UK, Italy, Poland and India are at advantageous positions owing to their close proximity of (distance<2) and their placement in Parsimonious policy, which is the most desired quadrant of Policy Map of PSM, Canada and Indonesia have medium level opportunities, while Russia and Saudi Arabia have opportunities with more challenges to fully exploit the unexploited polymers products in terms of membranes for environmental remediation and prove favorable for export diversification, sustainable economic growth, and commercialization.

Assessing the impact of land use land cover change on regulatory ecosystem services of subtropical scrub forest, Soan Valley Pakistan.

This study investigated the effect of land use land cover (LULC) changes on carbon sequestration in the Hayat-ul-Mir subtropical scrub reserve forest, Pakistan. Supervised maximum likelihood classification of Landsat satellite imagery was done to assess spatio-temporal changes in LULC during 2007, 2013 and 2019. The CA-Markov model was used to simulate LULC of 2030. Spatial LULC data and carbon pools data was processed in Integrated Valuation of Ecosystem Services and Tradeoffs (InVEST) carbon model to investigate the effect of LULC on future carbon dynamics. The analysis revealed increase in cover of A. modesta and O. ferruginea and decrease in agriculture, built up and barren area of forest during 2007-2019 and 2030. The analysis also showed that the forest would additionally sequester 111 Mg C with an overall Net Present Value of $4112.05 in year 2030. The analysis revealed LULC changes on 25% area with increase and decrease in the value of ecosystem service (at some location) from carbon storage and loss as CO2 emissions respectively depending on the type of LULC converted. The study is helpful in identifying areas of potential carbon sequestration to maximize net benefits from management interventions.

Fungal burn wound infection caused by Fusarium dimerum: A case series on a rare etiology.

INTRODUCTION: Fusarium dimerum is a filamentous mold associated with poor outcomes in immunocompromised hosts and burn victims. It can be acquired via inhalation or through skin dehiscence. METHODS: Our work presents a Case series of 8 patients from ages 3-57 years who were admitted with multiple burn wounds over the past 6 months. After initial stabilization measures, they all underwent debridement for the lesions after negative initial fungal cultures. The 44-year-old male was the first patient to develop punched-out eruptions on burn areas 7 days after admission; all the other patients experienced similar lesions during the next 6 days. Tissue cultures of the lesions exhibited Fusarium dimerum growth. The patients were managed accordingly with amphotericin B or voriconazoles. All the patients recovered except the 11-year-old boy, who expired on day 9 due to ARDS and sepsis complications. OUTCOMES: Infection with Fusarium dimerum carries a high risk of dissemination in burn infections. Hence, appropriate screening should be carried out via histologic and mycologic diagnostics early in the disease course. CONCLUSION: Considering the sparse literature that is available regarding Fusarium infection in burn victims, this study aims to improve the knowledge surrounding different facets of this disease including its epidemiology, diagnosis, management, and the need to maintain high suspicion of this fungal disease in burn patients.

Percutaneous Transhepatic Bowel Stent Deployment: An Alternative Approach for Malignant Afferent Loop Obstruction Following Whipple's Procedure.

Afferent loop syndrome is an uncommon postoperative complication. Currently, we lack a therapeutic option for treatment of malignant afferent loop obstruction following procedures like Whipple's. Here we present a case of afferent loop obstruction in a known case of pancreatic carcinoma, status after Whipple's procedure, in which we used a percutaneous transhepatic approach to relieve the afferent loop obstruction using a self-expanding bare metal stent.

Sustainable production of diapers and their potential outputs for the Pakistani market in the circular economy perspective.

One of the challenging issues of any country's agenda today is the management of solid waste in the circular economy and eco-efficiency perspective. In this context, there has been much debate about the disposal of diapers, but the current research lacks data for developing countries. Furthermore, the research lacks quantification of data, in terms of output products generated through sustainable waste management practices particularly for diapers. Thus, this research aims to develop a quantitative study based on Life Cycle Assessment (LCA) and Life Cycle Costing Analysis (LCCA) which help to evaluate the overall eco-efficiency of various disposal methods by taking into account their net input and resultant monetary value, in the context of Pakistan. To cover limitations of LCA approach, results have been compared along with the expert's opinion using the well-known multi-criteria method Fuzzy logic and Technique for Order of preference by similarity to ideal solution (TOPSIS) technique. Human health and environment have been used as end-point indicators. The main research result points out that incorporating small scale incineration plants along with recycling using Thermal Pyrolysis Hydrolysis (TPH) plants can help to sustainably dispose-off diapers. The results also indicate the importance for policy makers and industrial sector to find solutions to facilitate implementation of circular economy principles for diapers. In fact, the recycling of diapers using waste-to-energy technologies is a significantly eco-efficient alternative for the Pakistani market, which can be pivotal for Sustainable development and initiation of a circular economy model.

Chitosan reinforced hydrogels with swelling-shrinking behaviors in response to glucose concentration.

Different hydrogels of poly(acrylamide-co-3-acrylamido phenylboronic acid-co-chitosan grafted maleic acid) (P(AM-co-AAPBA-co-CSMA)s) were synthesized using poly(ethylene glycol) diacrylate (PEGDA) as a crosslinker to serve for glucose sensing and insulin delivery. The structure and morphology of the hydrogels, named as CSPBA were studied by FTIR and SEM, while the mechanical properties were tested using dynamic mechanical analysis (DMA) and universal testing machine. The prepared hydrogels shrinked at low glucose concentration due to the 2:1 boronate-glucose binding, and swelled at high glucose concentration because of 1:1 boronate-glucose complexation. Both binding mechanisms are useful for glucose sensing and insulin delivery. The integration of CSMA into hydrogels network not only enhanced the response to glucose at physiological pH, but also improved the mechanical properties and increased the encapsulation efficiency of the prepared hydrogels. These CSPBA may find potential as implantable hydrogels in applications were continuous glucose monitoring and controlled release is beneficial.

Neferine prevents ultraviolet radiation-induced skin photoaging.

The aim of the present study was to evaluate the anti-photoaging effect of neferine upon exposure of mice to ultraviolet (UV) radiation. An in vivo photoaging model was established by repeatedly exposing mouse dorsal skin to UV-A and UV-B radiation for 12 weeks. Through skin photographs, hematoxylin and eosin staining, Masson's trichrome staining, and scanning and transmission electron microscopy, skin wrinkles, epidermal thickness and dermal collagen were analyzed in the UV-irradiated mouse skin. Furthermore, the levels of endogenous antioxidants, namely superoxide dismutase (SOD) and glutathione peroxidase (GPx), were measured to determine the extent of UV-induced oxidative stress that was associated with photoaging. The results demonstrated that the topical application of neferine following UV irradiation reduced oxidative stress by increasing SOD and GPx activities, and attenuated the photoaging process. Histological and ultrastructural examination revealed that neferine delayed skin wrinkle formation by inhibiting epidermal hypertrophy and collagen loss and degradation. In conclusion, the results of the present study indicated that neferine effectively prevents UV-induced skin photoaging and photodamage.

Recent progress in design and preparation of glucose-responsive insulin delivery systems.

Diabetes, as a global threat nowadays, causes the wide usage of exogenous insulin. Subcutaneous injection is the traditional insulin administration in the diabetes treatments and is inconvenient and painful, which results in potential side effects of hypoglycemia. Scientists have made great efforts to develop alternatives. As the promising solutions, smart insulin delivery systems fabricated with glucose- responsive compounds attract considerable attention in the field of diabetes treatments. This review discusses the classifications, properties, response mechanisms of the glucose-responsive compounds, glucose oxidase and concanavalin A and recent progress of glucose-responsive insulin delivery systems.

Recent research progress on polyphosphazene-based drug delivery systems.

In recent years, synthetic polymer materials have become a research hotspot in the field of drug delivery. Compared with natural polymer materials, synthetic polymer materials have more flexible structural adjustability, and can be designed to obtain clinically required delivery vehicles. Polyphosphazenes are one of the most promising biomedical materials in the future due to their controllable degradation properties and structural flexibility. These materials can be designed by controlling the hydrophilic and hydrophobic balance, introducing functional groups or drugs to form different forms of administration, such as nanoparticles, polyphosphazene-drug conjugates, injectable hydrogels, coatings, etc. In addition, the flexible backbone of polyphosphazenes and the flexibility of substitution enable them to meet researchers' design requirements in terms of stereochemistry, nanostructures, and topologies. At present, researchers have achieved a lot of successful practices in the field of targeted delivery of anticancer drugs/proteins/genes, bone tissue engineering repair, cell imaging tracking, photothermal therapy, and immunologic preparations. This review provides a summary of the progress of the recent 10 years of polyphosphazene-based drug delivery systems in terms of of chemical structure and functions.

Mixed matrix membranes incorporated with sonication-assisted ZIF-8 nanofillers for hazardous wastewater treatment.

Mixed matrix membranes (MMMs) provide a unique pathway to treat hazardous industrial effluents. MMMs containing zeolitic imidazolate framework-8 (ZIF-8) as filler in polydimethoxysilane (PDMS) matrix were synthesized. ZIF-8 was prepared using a modified recipe and characterized by different techniques to evaluate its morphology, thermal stability, surface area, pore volume, and other characteristics. The performance of membranes was evaluated for their application in industrial dye-stuff wastewater treatment and solvent-resistant nanofiltration. The results demonstrated that increase in the percentage of ZIF-8 loading in PDMS led to simultaneous increase in the solvent permeability as well as solute rejection from wastewater. The permeability of MMMs increased up to 32% as compared with neat PDMS membrane. The organic dye rejection was achieved more than 87% with MMMs incorporated with 20% loading of nanofillers. Rejection of MMMs was 22% higher than that of unfilled PDMS membrane due to the effect of reduced polymer swelling and size exclusion of the nanofillers. Membrane swelling tests with toluene and isopropanol demonstrated that nanofiller amount has inverse relation with membrane swelling, which implied that nanofillers were in good interaction with polymer and allowed defect free membranes with higher solute rejections and reduced membrane swelling.