Advancements in Pancreatic Cancer Detection: Integrating Biomarkers, Imaging Technologies, and Machine Learning for Early Diagnosis.

Artificial intelligence (AI) has come to play a pivotal role in revolutionizing medical practices, particularly in the field of pancreatic cancer detection and management. As a leading cause of cancer-related deaths, pancreatic cancer warrants innovative approaches due to its typically advanced stage at diagnosis and dismal survival rates. Present detection methods, constrained by limitations in accuracy and efficiency, underscore the necessity for novel solutions. AI-driven methodologies present promising avenues for enhancing early detection and prognosis forecasting. Through the analysis of imaging data, biomarker profiles, and clinical information, AI algorithms excel in discerning subtle abnormalities indicative of pancreatic cancer with remarkable precision. Moreover, machine learning (ML) algorithms facilitate the amalgamation of diverse data sources to optimize patient care. However, despite its huge potential, the implementation of AI in pancreatic cancer detection faces various challenges. Issues such as the scarcity of comprehensive datasets, biases in algorithm development, and concerns regarding data privacy and security necessitate thorough scrutiny. While AI offers immense promise in transforming pancreatic cancer detection and management, ongoing research and collaborative efforts are indispensable in overcoming technical hurdles and ethical dilemmas. This review delves into the evolution of AI, its application in pancreatic cancer detection, and the challenges and ethical considerations inherent in its integration.

Dense Cover, but Not Allelopathic Potential, of Naturalized Alien Cenchrus echinatus L. Threatens the Native Species in Urban Vegetation.

Exotic plants usually exhibit problems for native species where they coexist. This study evaluated the effect of naturalized alien Cenchrus echinatus L. on native plants in urban vegetation. A field trial was conducted to assess the effect of this species on the cover and diversity of the native vegetation. The allelopathic potential of such species was examined. Sites comprising C. echinatus had a lower cover than some native species. Lower floristic diversity was observed at higher densities of this plant. The soil under this plant attained lower N, P, and K contents. This soil had no effect on the germination and growth of native species. It also comprised germinable seeds of some species which were absent from the standing vegetation. Exotic C. echinatus may exert negative effects on the native vegetation of the urban plant communities. A dense cover of this species may inhibit the germination of native species, leading to a reduction in their cover. Reduction in cover and diversity of native species may not be attributed to allelopathy. These results suggest that naturalized C. echinatus may be more competitive than the native ones, particularly at higher densities. Furthermore, it may represent a threat to the native plants in the urban vegetation.

LPWAN Cyber Security Risk Analysis: Building a Secure IQRF Solution.

Low-power wide area network (LPWAN) technologies such as IQRF are becoming increasingly popular for a variety of Internet of Things (IoT) applications, including smart cities, industrial control, and home automation. However, LPWANs are vulnerable to cyber attacks that can disrupt the normal operation of the network or compromise sensitive information. Therefore, analyzing cybersecurity risks before deploying an LPWAN is essential, as it helps identify potential vulnerabilities and threats as well as allowing for proactive measures to be taken to secure the network and protect against potential attacks. In this paper, a security risk analysis of IQRF technology is conducted utilizing the failure mode effects analysis (FMEA) method. The results of this study indicate that the highest risk corresponds to four failure modes, namely compromised end nodes, a compromised coordinator, a compromised gateway and a compromised communication between nodes. Moreover, through this methodology, a qualitative risk evaluation is performed to identify potential security threats in the IQRF network and propose countermeasures to mitigate the risk of cyber attacks on IQRF networks.

Method validation and risk assessment for sulfonamides and tetracyclines in bees' honey from Egypt, Libya and Saudi Arabia.

Several studies worldwide have reported contamination of bees' honey by antibiotics, which may pose a hazard to consumers' health. The present study was thus established to: (1) introduce a validated multi-residue method for determining sulfonamides (SAs) and tetracyclines (TCs) in honey; and (2) characterize the potential risk due to the exposure to SAs and TCs in honey samples from Egypt, Libya, and Saudi Arabia. SAs and TCs were simultaneously extracted using solid-phase extraction and matrix solid phase dispersion methods. SAs and TCs were screened using HPLC-MS/MS and HPLC-DAD. The results confirmed detection limits for SAs and TCs by HPLC-MS/MS of 0.01 and 0.02-0.04 (ng g-1), respectively. The limits were 2.5-5.6 and 12.0-21.0 (ng g-1) for SAs and TCs by HPLC-DAD, respectively. The obtained accuracy rates were in the ranges of 83.07-86.93% and 86.90-91.19%, respectively, for SAs and TCs, with precision rates lower than 9.54%. Concerning the occurrence of antibiotics, the positive samples constituted 57.6%, 75%, and 77.7% of the Egyptian, Saudi Arabian, and Libyan samples, respectively. Notably, SAs antibiotics were the most prevalent in the Egyptian and Saudi Arabian samples; in contrast, TCs were the most dominant in Libya. Calculated parameters of risk assessment, concerning the aggregated exposure to SAs and TCs, showed no potential adverse effects from the exposure to contaminated honey in studied countries.

Myocardial recovery in a patient with dilated cardiomyopathy after short-term biventricular assist device support.

Management of patients with end-stage heart failure is still challenging. We report a case of idiopathic dilated cardiomyopathy who went through a challenging course. The case was presented as acute heart failure syndrome, which rapidly declined into cardiogenic shock and cardiac arrest that required an extracorporeal membrane oxygenator, then biventricular assist device implantation for circulatory support. The course was complicated with severe gastrointestinal bleeding and multiorgan failure until achieving full cardiac and organ recovery. The left ventricle ejection fraction improved from 10% to 50% at discharge.

Assessing Cyber Risks of an INS Using the MITRE ATT&CK Framework.

Shipping performed by contemporary vessels is the backbone of global trade. Modern vessels are equipped with many computerized systems to enhance safety and operational efficiency. One such system developed is the integrated navigation system (INS), which combines information and functions for the bridge team onboard. An INS comprises many marine components involving cyber threats and vulnerabilities. This study aims to assess the cyber risks of such components. To this end, a methodology considering the MITRE ATT&CK framework, which provides adversarial tactics, techniques, and mitigation measures, was applied by modifying for cyber risks at sea. We assessed cyber risks of 25 components on the bridge by implementing the extended methodology in this study. As a result of the assessment, we found 1850 risks. We classified our results as 1805 low, 32 medium, 9 high, and 4 critical levels for 22 components. Three components did not include any cyber risks. Scientists, ship operators, and product developers could use the findings to protect navigation systems onboard from potential cyber threats and vulnerabilities.

Growth responses and genetic variation among highly ecologically diverse spring wheat genotypes grown under seawater stress.

Most of the freshwaters worldwide are used for agriculture. Freshwater sources are expected to decline and will not suffice to support the food production needed for the growing population. Therefore, growing crops with seawater might constitute a solution. However, very little work has been done on the effect of seawater stress on wheat, an important cereal crop. The present study aimed to determine whether particular wheat genotypes provided better resistance to seawater stress. A set of 80 highly diverse spring wheat genotypes collected from different countries in Europe, Asia, Africa, North and South America was exposed to 50% seawater stress at the early growth stage. Four seeding shoot and root traits were scored for all genotypes. High genetic variations were found among all genotypes for the epicotyl length (EL), hypocotyl length (HL), number of radicles (NOR), and fresh weight (FW). Eight genotypes with high-performance scores of seedling traits were selected. The correlation analyses revealed highly significant correlations among all traits scored in this study. The strongest correlation was found between the NOR and the other seeding traits. Thus, the NOR might be an important adaptive trait for seawater tolerance. The genetic diversity among all genotypes was investigated based on genetic distance. A wide range of genetic distances among all genotypes was found. There was also a great genetic distance among the eight selected genotypes. In particular, the genetic distance between ATRI 5310 (France) and the other seven genotypes was the greatest. Such high genetic diversity might be utilized to select highly divergent genotypes for crossing in a future breeding program. The present study provides very useful information on the presence of different genetic resources in wheat for seawater tolerance.

Changes in Carbon and Nitrogen Metabolites before, at, and after Anthesis for Wheat Cultivars in Response to Reduced Soil Water and Zinc Foliar Application.

Water deficit stress is one of the major constraints for commercial agriculture, as it disturbs the metabolic processes in plant. Identification of carbon and nitrogen receptors that act on drought resistance helps in breeding for drought resistance varieties. Zn fertilizer can regulate multiple antioxidant defense systems at the transcriptional level in response to drought. Two field experiments were conducted in 2018-2019 and 2019-2020 seasons to explore the effectiveness of foliar application of zinc oxide on soluble sugar, soluble proteins, and free amino acids under normal irrigation and drought-stressed environments. Three Egyptian wheat cultivars (Triticum aestivum L.) were used. The experimental design was split-plot in RCBD with three replications, applying zinc oxide levels to the whole plot and the split plots. Leaf samples were taken for analysis before anthesis, at anthesis, and after anthesis. Application of Zn increased soluble sugars. However, the free amino acids were higher under irrigation, reached the maximum at anthesis, and decreased sharply after 2 weeks from anthesis. The ranking of cultivars for the three metabolites differed according to plant stage, reflecting the response to Zn and years. Correlations between metabolites according to Zn were positive. The findings suggest the potential of foliar application of Zn to alleviate drought stress.

The combined effect of water deficit stress and TiO2 nanoparticles on cell membrane and antioxidant enzymes in Helianthus annuus L.

Nanotechnology has become one of the several approaches attempting to ameliorate the severe effect of drought on plant's production and to increase the plants tolerance against water deficit for the water economy. In this research, the effect of foliar application of TiO2, nanoparticles or ordinary TiO2, on Helianthus annuus subjected to different levels of water deficit was studied. Cell membrane injury increased by increasing the level of water deficit and TiO2 concentration, and both types of TiO2 affected the leaves in analogous manner. Ord-TiO2 increased H2O2 generation by 67-240% and lipid peroxidation by 4-67% in leaves. These increases were more than that induced by Nano-TiO2 and the effect was concentration dependent. Proline significantly increased in leaves by water deficit stress, reaching at 25% field capacity (FC) to more than fivefold compared to that in plants grown on full FC. Spraying plants with water significantly decreased the activities of enzymes in the water deficit stressed roots. The water deficit stress exerted the highest magnitude of effect on the changes of cell membrane injury, MDA, proline content, and activities of CAT and GPX. Nano-TiO2 was having the highest effect on contents of H2O2 and GPX activity. In roots, the level of water deficit causes highest effect on enzyme activities, but TiO2 influenced more on the changes of MDA and H2O2 contents. GPX activity increased by 283% in leaves of plants treated with 50 and 150 ppm Nano-TiO2, while increased by 170% in those treated with Ord-TiO2, but APX and CAT activities increased by 17-197%, in average, with Ord-TiO2. This study concluded that Nano-TiO2 didn't ameliorate the effects of drought stress on H. annuus but additively increased the stress, so its use in nano-phytotechnology mustn't be expanded without extensive studies. Supplementary Information: The online version contains supplementary material available at 10.1007/s12298-022-01153-z.

Does ramadan fasting affect the therapeutic and clinical outcomes of warfarin? a systematic review and meta-analysis.

BACKGROUND: Warfarin's therapeutic effect is affected by many factors, including diet modifications. The impact of Ramadan fasting on warfarin is controversial. The aim of this systematic review and meta-analysis was to investigate the effect of Ramadan fasting on patients taking warfarin. METHODS: A literature search was done in PubMed, WOS, Scopus, and Embase from inception to May 24, 2021. All relevant studies measuring the international normalized ratio (INR), time in therapeutic range (TTR), or the number of patients within therapeutic range before, during, and after Ramadan were assessed by full-text screening for achieving all of the inclusion criteria. We used the Newcastle-Ottawa Scale for quality assessment and RevMan 5.4 software for meta-analysis. RESULTS: A total of five studies with 446 patients were included in the meta-analysis. The patients served as their own control. Our pooled analyses showed no significant difference during Ramadan compared to pre-Ramadan (MD: 0.08; 95% CI: - 0.00, 0.15; P = 0.06) and post-Ramadan (MD: - 0.00; 95% CI: - 0.14, 0.14; P = 1.00, respectively). There was only a significant increase in the risk ratio of supratherapeutic INR when comparing post-Ramadan vs. pre-Ramadan (RR: 1.69; 95% CI: 1.22, 2.33; P = 0.001). However, there was no significant risk for supratherapeutic INR during Ramadan compared to pre-Ramadan or post-Ramadan; the number of patients within the therapeutic range of INR during Ramadan compared to pre-Ramadan; and TTR during Ramadan, pre-Ramadan, and post-Ramadan. CONCLUSION: Ramadan fasting did not affect INR level, TTR, or the number of patients within the therapeutic range before, during, and after Ramadan. However, there was a possibility of achieving a supratherapeutic INR post-Ramadan compared to pre-Ramadan. Therefore, INR monitoring and warfarin dose adjustments accordingly are recommended after Ramadan.

New antimicrobial and cytotoxic benzofuran glucoside from Senecio glaucus L.

The ethyl acetate fraction of the dried aerial parts of Senecio glaucus L. exhibited significant antimicrobial activity against some of selected bacteria and fungi. Also, it showed potent cytotoxicity against PANC-1 cancer cell lines under glucose deficient medium. The ethyl acetate fraction was subjected to different chromatographic techniques for isolation of the bioactive compounds. A new benzofuran glucoside; 2,3-dihydro-3ß-hydroxyeuparin 3-O-glucopyranoside (1) was isolated. Additionally, two known flavonoid compounds isorhamentin 3-O-ß-D-glucoside (2), and isorhamentin 3-O-ß-D-rutinoside (3) were first identified in S. glaucus. Compound 1 exhibited potent antimicrobial activities against two Gram-positive bacteria, one Gram-negative bacteria, and two fungi. Also, it displayed potent cytotoxic activity against PANC-1 cancer cell lines under glucose deficient medium (IC50 7.5 µM). However, the isolated flavonoid glycosides (2 & 3) showed moderate antimicrobial activities against two Gram-positive bacteria, two Gram-negative bacteria, four fungi, and did not show any cytotoxic activity against PANC-1.

Recovery From COVID-19 Pneumonia in a Heart Transplant Recipient: A Case Report.

Solid-organ transplant patients have a high risk of severe infection related to acute respiratory syndrome coronavirus-2 (SARS-Cov-2). This case represents a 54-year-old woman known as a diabetic, hypothyroidism, and a recent heart transplant recipient who presented with a 1-week history of cough and fatigue. She was hypoxic on presentation to the hospital and progressively declined and required invasive mechanical ventilation. She had respiratory distress and hypoxia and chest x-ray showed progressive bilateral chest infiltrates. She had leukopenia of 3.5 cells *109/L and lymphopenia of 0.2 cells *109/L. The inflammatory markers were increased: C-reactive protein, 25 mg/L; ferritin, 1106 ng/mL; lactate dehydrogenase, 632 U/L; and interleukin-6, 87 pg/mL. She was treated for severe coronavirus disease 2019 (COVID-19) pneumonia. Her treatment involved supportive care with mechanical ventilation, convalescent plasma transfusion, antiviral therapy with favipiravir, intravenous dexamethasone, and reduction of immune suppression medication. This case had a successful recovery through multidisciplinary team management. Solid-organ transplant recipients are a high-risk population who need an individualized care plan for the optimization of immunosuppressive medication and treatment of the COVID-19 infection.

A Comprehensive Systemic Literature Review of Pericardial Decompression Syndrome: Often Unrecognized and Potentially Fatal Syndrome.

BACKGROUND: Pericardial Decompression Syndrome (PDS) is defined as paradoxical hemodynamic deterioration and/or pulmonary edema, commonly associated with ventricular dysfunction. This phenomenon was first described by Vandyke in 1983. PDS is a rare but formidable complication of pericardiocentesis, which, if not managed appropriately, is fatal. PDS, as an entity, has discrete literature; this review is to understand its epidemiology, presentation, and management. METHODOLOGY: Medline, Science Direct and Google Scholar databases were utilized to do a systemic literature search. PRISMA protocol was employed. Abstracts, case reports, case series and clinical studies were identified from 1983 to 2019. A total of 6508 articles were reviewed, out of which, 210 were short-listed, and after removal of duplicates, 49 manuscripts were included in this review. For statistical analysis, patient data was tabulated in SPSS version 20. Cases were divided into two categories surgical and percutaneous groups. t-test was conducted for continuous variable and chi-square test was conducted for categorical data used for analysis. RESULTS: A total of 42 full-length case reports, 2 poster abstracts, 3 case series of 2 patients, 1 case series of 4 patients and 1 case series of 5 patients were included in the study. A total of 59 cases were included in this manuscript. Our data had 45.8% (n=27) males and 54.2% (n=32) females. The mean age of patients was 48.04 ± 17 years. Pericardiocentesis was performed in 52.5% (n=31) cases, and pericardiostomy was performed in 45.8% (n=27). The most common identifiable cause of pericardial effusion was found to be malignancy in 35.6% (n=21). Twenty-three 23 cases reported pre-procedural ejection fraction, which ranged from 20%-75% with a mean of 55.8 ± 14.6%, while 26 cases reported post-procedural ejection fraction which ranged from 10%-65% with a mean of 30% ± 15.1%. Data was further divided into two categories, namely, pericardiocentesis and pericardiostomy. The outcome as death was significant in the pericardiostomy arm with a p-value of < 0.00. The use of inotropic agents for the treatment of PDS was more common in needle pericardiocentesis with a p-value of 0.04. Lastly, the computed recovery time did not yield any significance with a p-value of 0.275. CONCLUSION: Pericardial decompression syndrome is a rare condition with high mortality. Operators performing pericardial drainage should be aware of this complication following drainage of cardiac tamponade, since early recognition and expeditious supportive care are the only therapeutic modalities available for adequate management of this complication.

Tricuspid Valve Regurgitation After Heart Transplantation: A Single-Center 10-year Experience.

BACKGROUND: Tricuspid valve regurgitation may affect the outcomes after heart transplantation. There is a paucity of data reporting the outcomes of heart transplants in our region. The objectives of this study were to report the occurrence of tricuspid regurgitation after heart transplantation, its course, and its effect on survival. METHODS: From 2009 to 2019, 30 patients had heart transplantation at our cardiac center. Their age was 36.73 ± 13.5 years, and 25 (83.33%) were males. Indications for transplantation were dilated cardiomyopathy (n = 21; 72.41%), ischemic cardiomyopathy (n = 8; 26.67%) and hypertrophic cardiomyopathy (n = 1; 3.45%). Cardiopulmonary bypass time was 157.24 ± 34.6 min, and ischemic time was 138 ± 73.56 min. All patients had orthotopic heart transplantation with a bi-caval technique. RESULTS: Eleven patients had severe tricuspid regurgitation postoperatively (37%). The degree of tricuspid regurgitation decreased significantly after 6 months (p = 0.011) and remained stationary during the follow-up. Pre-transplant dilated cardiomyopathy was significantly associated with severe tricuspid regurgitation post-transplant (p = 0.017). The mean follow-up was 39.43 ± 50.57 months. Survival at 10 years was 90% in patients with less than moderate tricuspid regurgitation postoperatively compared to 43% for patients with moderate and severe tricuspid regurgitation (log-rank p = 0.0498). CONCLUSION: Tricuspid regurgitation is a common problem after heart transplantation. Despite the improvement of the degree of tricuspid regurgitation after 6 months, survival was negatively affected by postoperative moderate or severe tricuspid regurgitation. Patients with dilated cardiomyopathy may benefit from concomitant tricuspid valve repair at the time of heart transplantation. Further larger studies are warranted.

Detailed Genetic Analysis for Identifying QTLs Associated with Drought Tolerance at Seed Germination and Seedling Stages in Barley.

Drought induces several challenges for plant development, growth, and production. These challenges become more severe, in particular, in arid and semiarid countries like Egypt. In terms of production, barley ranks fourth after wheat, maize, and rice. Seed germination and seedling stages are critical stages for plant establishment and growth. In the current study, 60 diverse barley genotypes were tested for drought tolerance using two different treatments: control (0-PEG) and drought (20%-PEG). Twenty-two traits were estimated for seed germination and seedling parameters. All traits were reduced under drought stress, and a significant variation was found among genotypes under control and stress conditions. The broad-sense heritability estimates were very high under both control and drought for all traits. It ranged from 0.63 to 0.97 under the control condition and from 0.89 to 0.97 under drought, respectively. These high heritabilities suggested that genetic improvement of drought tolerance in barley at both stages is feasible. The principal component analysis revealed that root-related parameters account for the largest portion of phenotypic variation in this collection. The single-marker analysis (SMA) resulted in 71 quantitative trait loci (QTLs) distributed across the seven chromosomes of barley. Thirty-three QTLs were detected for root-length-related traits. Many hotspots of QTLs were detected for various traits. Interestingly, some markers controlled many traits in a pleiotropic manner; thus, they can be used to control multiple traits at a time. Some QTLs were constitutive, i.e., they are mapped under control and drought, and targeting these QTLs makes the selection for drought tolerance a single-step process. The results of gene annotation analysis revealed very potential candidate genes that can be targeted to select for drought tolerance.

Operator-Controlled Comparison Between 5 French and 6 French Guiding Catheters for Percutaneous Intervention Using Transradial Approach.

Objective To compare 5 French (Fr) and 6 Fr guiding catheters regarding the volume of contrast administered, fluoroscopy time, and total procedure time during transradial percutaneous coronary intervention (PCI). Background Previous studies had compared 5 Fr and 6 Fr catheters and deemed 5 Fr catheters safe and effective. In this study, we retrospectively compared the 5 Fr catheter to 6 Fr catheter with an attempt to eliminate the effect of inter-operator skill level variability. Methods In a single-center, retrospective cohort study, we randomly selected patients who had received PCI through transradial access using 5 Fr or 6 Fr catheters. The study involved two groups of 100 patients each. These groups were comprised of an equal number of cases from each operator. The primary endpoint was contrast medium volume. Secondary endpoints were fluoroscopy time and procedure time. Results Less contrast was used in the 5 Fr group vs. 6 Fr catheter group (140.2 ± 45.7 mL vs. 158.2 ± 66.7 mL, p=0.004). PCI using 5 Fr catheters was associated with shorter fluoroscopy time (13.7 ± 7.3 mins vs. 15.2 ± 8.2 mins, p=0.584) and shorter procedure time (43.7 ± 22.2 mins vs. 46.5 ± 19.7 mins, p=0.890), but this was not statistically significant. Conclusion Transradial PCI using 5 Fr guiding catheters was associated with less contrast medium usage, but there was no advantage regarding procedure time or fluoroscopy time when compared to 6 Fr catheters. Similar to 6 Fr catheters, 5 Fr catheters achieved high PCI success rates through radial access when compared in the treatment of coronary lesions with the same level of complexity.

Brugada Phenocopy Type 1 Secondary to Synthetic Cannabinoids.

Brugada phenocopies (BrP) are clinical entities that have EKG tracings similar to the congenital Brugada syndrome (BrS) but without ventricular tachyarrhythmias or sudden cardiac death. BrP is caused by various factors such as metabolic disturbances (electrolyte imbalance), drugs, mechanical compression of the mediastinum, and inflammatory conditions such as myocarditis or pericarditis. We present a very rare case of a young patient who had a Brugada phenocopy Type 1 suspected to be secondary to synthetic cannabinoids.

Habitat variations affect morphological, reproductive and some metabolic traits of Mediterranean Centaurea glomerata Vahl populations.

Centaurea glomerata Vahl is an annual, monoecious and herbaceous member of Asteraceae, found in some localities of different topographic features/habitat conditions along the Mediterranean coastal region of Egypt. This study aimed to investigate some environmental gradients including edaphic and climate criteria on morphological, reproductive traits as well as phenolic and flavonoid metabolites in this species. Three distinct populations were selected. Two of them were located in coastal sand dunes (found in Rosetta region in Egypt); one was located on flat sand dunes, whereas the other grown on sloping ones. Meanwhile, the third population was represented in the rocky hillside of Burg El Arab region. The population detected in the sloping sand dunes showed best morphological and reproductive features, whilst the opposite was true for that represented on the rocky hillside. Moreover, the free phenolic and flavonoid compounds prevailed in the later. The meteorological data revealed that the rocky hillside received relatively lower minimum temperature and higher solar irradiance, while the sand dunes of Rosetta showed more warmer conditions. Light intensity and wind speed were reduced on the sloping sand dunes. The Canonical Correspondence Analysis (CCA) exhibited a clear correlation between most of metabolites detected and the population found on the rocky hillside along with higher solar irradiance prevails. The morpho-reproductive traits were related to climatic gradients and some soil criteria. These results revealed that the changes in micro-topography, that may lead to change in soil and climate variables, is the most important environmental gradient that controls the morphological and biochemical features of C. glomerata. Solar irradiance and/or light intensity are key factors playing a role influencing the measured traits of this species. These findings suggest that accumulation of secondary metabolites could be a biochemical strategy and an adaptational criterion for such species under stress conditions.

Elastofibroma Dorsi: A Rare Connective Tissue Tumor.

Elastofibroma dorsi (ED) is a benign connective tissue tumor that most commonly occurs on the inferior pole of the scapula. It can be found incidentally on radiologic imaging or due to clinical symptoms. Patients may become apprehensive due to it mimicking new malignancy or recurrence of prior malignancy. Treatment is only recommended in symptomatic cases and biopsy is usually unnecessary. We present a case of a 70-year-old female status-post lung cancer resection who was found to have a lump at the inferior pole of her right scapula. She was seen by multiple different specialties and subsequently, a biopsy confirmed her mass to be consistent with ED. Since ED is a benign soft tissue tumor, educating physicians is of utmost importance to avoid pursuing unnecessary diagnosis and to thereby decrease the cost of care to the patient. Therapeutic excision should only be performed in symptomatic patients and observing these lesions in asymptomatic patients would be sufficient.

Kounis Syndrome Induced by Protamine Sulfate.

Protamine sulfate is considered a "life-saving" antidote for heparinized patients with major bleeds. Although the beneficial attributes and application of protamine sulfate in various clinical settings cannot be argued, it also has an impressive side-effect profile. Kounis syndrome (KS) is an acute coronary syndrome in the setting of an allergic reaction, which can be induced by numerous allergens. Herein, we report a case of KS secondary to the use of protamine sulfate after cryoablation for atrial fibrillation.