Identifying high-risk patients with MALT lymphoma undergoing first-line therapy for disease progression.

Introduction: Marginal zone lymphoma (MZL) is an indolent B-cell non-Hodgkin lymphoma (iNHL) with mucosa-associated lymphoid tissue (MALT) lymphoma being the most common subtype. Typical of other iNHLs, a fraction of patients will experience more aggressive disease marked by early relapse despite effective front-line therapy.

Area Covered: In this review, we discuss existing prognostic scoring systems for patients with MALT lymphoma undergoing first-line therapy, including the MALT-IPI, the Revised MALT-IPI, the MZL-IPI, and the EMZL-MPI.

Preparing the workforce for the non-linear implementation of health information technology.

This article addresses how the dynamic, interdisciplinary, and non-linear nature of health information technology implementations require a workforce equipped with both technical competencies and an understanding of the relationships between healthcare system components. The article identifies key workforce preparation strategies including ongoing education and training for certificates or degrees through universities, professional associations, or health information technology vendors, tuition reimbursement, title changes, paid time off, and increased pay or bonuses. Helping employees to understand how their work is integrated into the overall healthcare data ecosystem creates a more efficient and effective health information technology implementation.

Acute kidney injury after chimeric antigen receptor T-cell therapy is associated with inferior survival in patients with relapsed/refractory large B-cell lymphoma.

Baseline risk factors for acute kidney injury (AKI) during chimeric antigen receptor T-cell (CAR-T) therapy are not well described. Hence, we evaluated the incidence and risk factors associated with AKI among patients undergoing CAR-T for relapsed/refractory large B-cell lymphoma. Among 155 patients, 28 (18%) developed AKI with a median time-to-peak creatinine from CAR-T of 9.

Resistance Mechanism for Zanubrutinib in Marginal Zone Lymphoma.

Marginal zone lymphoma (MZL) is the third most common B-cell non-Hodgkin lymphoma and tends to follow the relapsing course typical of other indolent lymphomas, meaning that many patients receive multiple lines of therapy. Brüton's tyrosine kinase inhibitors (BTKis) have been a promising addition to the treatment landscape of relapsed MZL; however, development of resistance to these agents remains a significant problem that warrants further characterization. This case report presents a patient with relapsed MZL receiving the BTKi zanubrutinib who experienced large cell transformation of their lymphoma in concert with the development of mutations predictive of resistance to BTKi therapy, specifically BTK C481S and PLCG2 D334H.

Evaluating the effect of immune checkpoint inhibitor treatment on chronic obstructive pulmonary disease in lung cancer patients.

Immune checkpoint inhibitors (ICIs) are first line treatment for advanced lung cancer. Tobacco use is a shared risk factor for lung cancer and chronic obstructive pulmonary disease (COPD). Although many patients with COPD and lung cancer receive ICIs, the impact of ICIs on COPD is unknown.

Response to Dabrafenib Plus Trametinib in a Patient With an Uncommon Activating BRAF Mutation: A First in Non-Small Cell Lung Cancer.

Mutations in BRAF are present in 4% of non-small cell lung cancer (NSCLC), of which half are well-characterized activating variants affecting codon 600 (classified as class I). These mutations, most commonly BRAF V600E, have been associated with response to BRAF/MEK-directed small molecule kinase inhibitors. NSCLC with kinase-activating BRAF mutations occurring at other codons (class II variants) represent a substantial portion of BRAF-mutated NSCLC, but use of targeted therapy in these tumors is still under investigation.

Consolidation Osimertinib Versus Durvalumab Versus Observation After Concurrent Chemoradiation in Unresectable EGFR-Mutant NSCLC: A Multicenter Retrospective Cohort Study.

Introduction: Durvalumab improves survival when used as consolidation therapy after chemoradiation (CRT) in patients with stage III NSCLC. The optimal consolidation therapy for patients with EGFR-mutant (EGFRmut) stage III NSCLC remains unknown.

Methods: In this multi-institutional, international retrospective analysis across 24 institutions, we evaluated outcomes in patients with stage III EGFRmut NSCLC treated with concurrent CRT followed by consolidation therapy with osimertinib, durvalumab, or observation between 2015 and 2022.

Surgical management of aphakia.

Despite the safety and efficacy of cataract surgery, intraoperative complications can hamper the ability to place an intraocular lens in the capsular bag. With vast numbers of cataract surgeries performed daily, complications occur often enough that every ophthalmologist should be equipped with techniques to manage aphakia. Medical management of aphakia used to be commonplace but these techniques have their disadvantages including thick bulky lenses, poor cosmesis, and aniseikonia.

Benign Pneumatosis Intestinalis: A Case Report and Review of the Literature.

Background: Pneumatosis intestinalis is the presence of gas within the walls of the intestine on imaging and has variable clinical significance, ranging from an incidental finding to a harbinger of intra-abdominal catastrophe. There are multiple mechanisms by which this radiographic finding develops, including bacterial gas production, increased intraluminal pressure within the gastrointestinal tract, mechanical disruption of the gut mucosa, and tracking of pulmonary gas along the mesenteric vasculature.

Case Presentation: We present the case of a 61-year-old male veteran who had sustained a remote anoxic brain injury resulting in chronic dependence on a gastrostomy tube for enteral nutrition, found incidentally to have pneumatosis intestinalis without signs of intra-abdominal catastrophe.

An estimate of rate of deviation from NCCN guideline recommendations for central nervous system imaging in trials forming basis for drug approval in first line advanced non-small cell lung cancer (NSCLC).

Importance: It is unknown whether and to what degree trials submitted to the US FDA to support drug approval adhere to NCCN guideline-recommended care in their baseline and surveillance CNS imaging protocols.

Objective: We sought to characterize the frequency with which the trials cited in US FDA drug approvals for first line advanced NSCLC between 2015 and 2020 deviated from NCCN guideline-recommended care for baseline and surveillance CNS imaging.

Design, Setting, And Participants: Retrospective observational analysis using publicly available data of (1) list of trials cited by the FDA in drug approvals for first line advanced NSCLC from 2015 to 2020 (2) individual trial protocols (3) published trial data and supplementary appendices (4) archived versions of the NCCN guidelines for NSCLC from 2009 to 2018 (the years during which the trials were enrolling).

Use of Second-line Immunotherapy in Control Arms of Randomized Clinical Trials in Kidney Cancer: A Systematic Review.

Importance: Immunotherapy (anti-programmed death ligand 1 antibodies) is associated with improved survival rates in advanced kidney cell carcinoma (KCC) after progression on first-line tyrosine kinase inhibitor (TKI) treatment. It is unknown whether and to what degree patients in the control arm receive postprotocol immunotherapy in trials comparing combination immunotherapy regimens with TKI in first-line advanced KCC.

Objective: To characterize the proportion of patients in the control arm who received postprotocol immunotherapy in trials comparing combination immunotherapy regimens with TKI in first-line advanced KCC.

Multifarious Functions of Butyrylcholinesterase in Neuroblastoma: Impact of BCHE Deletion on the Neuroblastoma Growth In Vitro and In Vivo.

The physiological functions of butyrylcholinesterase (BChE) and its role in malignancy remain unexplained. Our studies in children newly diagnosed with neuroblastoma indicated that BChE expressions is proportional to MYCN amplification suggesting that pathogenesis of high-risk disease may be related to the persistent expression of abnormally high levels of tumor-associated BChE. BChE-deficient neuroblastoma cells (KO [knockout]) were produced from MYCN -amplified BE(2)-C cells (WT [wild-type]) by the CRISPR-Cas9 targeted disruption of the BCHE locus.

Post-intensive care syndrome following cardiothoracic critical care: Feasibility of a complex intervention.

Objectives: To describe the long-term outcomes of cardiac intensive care unit patients and their primary caregivers, and to explore the feasibility of implementing a complex intervention, designed to support problems associated with post-intensive care syndrome and post-intensive care syndrome-family, in the year following discharge from the cardiac intensive care unit.

Design: A complex multidisciplinary rehabilitation programme, delivered as a quality improvement initiative, in a single centre in the West of Scotland. Outcomes were measured using surveys of health related quality of life, self efficacy, anxiety, depression, pain, caregiver strain, and insomnia.

Fatty Acid Mediators in the Tumor Microenvironment.

Patients with cancer frequently overexpress inflammatory cytokines with an associated neutrophilia both of which may be downregulated by diets with high omega-3 polyunsaturated fatty acids (ω-3 PUFA). The anti-inflammatory activity of dietary ω-3 PUFA has been suggested to have anticancer properties and to improve survival of cancer patients. Currently, the majority of dietary research efforts do not differentiate between obesity and dietary fatty acid consumption as mediators of inflammatory cell expansion and tumor microenvironmental infiltration, initiation, and progression.

Alpha-Particle Therapy for Multifocal Osteosarcoma: A Hypothesis.

Osteosarcoma (OST) is the most common bone tumor in children and adolescents with a second peak of incidence in elderly adults usually diagnosed as secondary tumors in Paget's disease or irradiated bone. Subjects with metastatic disease or whose disease relapses after the initial therapy have a poor prognosis. Moreover, multifocal OST contains tumor-initiating cells that are resistant to chemotherapy.

Effects of novel pyrrolomycin MP1 in MYCN amplified chemoresistant neuroblastoma cell lines alone and combined with temsirolimus.

Background: The activity of MP1, a pyrrolomycin, was studied in MYCN amplified neuroblastoma (NB) alone and combined with temsirolimus (TEM).

Methods: Activity of MP1 was tested in MYCN amplified (BE-2c, IMR) and non amplified (SKN-AS) NB cells. The effect of MP1 on MYCN, MCL-1, cleaved PARP, LC3II/LC3I, bcl-2, BAX, and BRD-4 were determined by western blot and RNAseq.

A Cross-Sectional Study of Return to Work Rate Following Heart Transplantation and the Contributing Role of Illness Perceptions.

Background: Social rehabilitation, including return to work (RTW), is a key indicator of transplant success. However, little is known regarding the RTW rate following heart transplantation or the factors influencing this. The objective of this study was to examine RTW among heart transplant recipients and identify associated predictors.

Surface nano-modification by ion beam-assisted deposition alters the expression of osteogenic genes in osteoblasts.

Biomaterials with enhanced biocompatibility are favored in implant studies to improve the outcomes of total joint replacement surgeries. This study tested the hypothesis that nano-structured surfaces for orthopedic applications, produced by the ion beam-assisted deposition method, would enhance osteointegration by altering the expression of bone-associated genes in osteoblasts. The ion beam-assisted deposition technique was employed to deposit nano-films on glass or titanium substrates.

Immune regulation and anti-cancer activity by lipid inflammatory mediators.

Rodent and clinical studies have documented that myeloid cell infiltration of tumors is associated with poor outcomes, neutrophilia and lymphocytopenia. This contrasts with increased lymphocyte infiltration of tumors, which is correlated with improved outcomes. Lifestyle parameters, such as obesity and diets with high levels of saturated fat and/or omega (ω)-6 polyunsaturated fatty acids (PUFAs), can influence these inflammatory parameters, including an increase in extramedullary myelopoiesis (EMM).

Unforeseen challenges of living with an LVAD.

Background: The implantable left ventricular assist device (LVAD) is being used more commonly, and is associated with improved outcomes physically but can be related to psychological distress.

Key Points: A 28-year-old male of Asian ethnicity who received LVAD implantation for advanced heart failure. Incidents are described wherein the external battery pack for his LVAD was misidentified as an explosive device, and he a security threat.