Intravenous and intracranial GD2-CAR T cells for H3K27M diffuse midline gliomas.

H3K27M-mutant diffuse midline gliomas (DMGs) express high levels of the disialoganglioside GD2 (ref. ). Chimeric antigen receptor-modified T cells targeting GD2 (GD2-CART) eradicated DMGs in preclinical models.

Successful Extracorporeal Cardiopulmonary Resuscitation Despite Aortic Occlusion.

We present the case of a 62-year-old man with severe coronary artery disease who presented to the hospital in refractory ventricular fibrillation cardiac arrest. He showed signs of life despite prolonged resuscitation. We thus decided to initiate extracorporeal cardiopulmonary resuscitation (ECPR).

Sequential intravenous and intracerebroventricular GD2-CAR T-cell therapy for H3K27M-mutated diffuse midline gliomas.

H3K27M-mutant diffuse midline gliomas (DMGs) express high levels of the GD2 disialoganglioside and chimeric antigen receptor modified T-cells targeting GD2 (GD2-CART) eradicate DMGs in preclinical models. Arm A of the Phase I trial NCT04196413 administered one IV dose of autologous GD2-CART to patients with H3K27M-mutant pontine (DIPG) or spinal (sDMG) diffuse midline glioma at two dose levels (DL1=1e6/kg; DL2=3e6/kg) following lymphodepleting (LD) chemotherapy. Patients with clinical or imaging benefit were eligible for subsequent intracerebroventricular (ICV) GD2-CART infusions (10-30e6 GD2-CART).

Venovenous ECMO for Acute Chronic Heart Failure after Bilateral Lung Transplantation.

Venovenous (VV) ECMO is rarely used during decompensated circulatory states. Although VA ECMO is the routine option, VV ECMO may be an option in selected patients. We present a case of pulmonary edema due to acute heart failure in a patient 4- and 12-year post-lung transplantation who received VV ECMO.

Enhancing pediatric access to cell and gene therapies.

Increasing numbers of cell and gene therapies (CGTs) are emerging to treat and cure pediatric diseases. However, small market sizes limit the potential return on investment within the traditional biopharmaceutical drug development model, leading to a market failure. In this Perspective, we discuss major factors contributing to this failure, including high manufacturing costs, regulatory challenges, and licensing practices that do not incorporate pediatric development milestones, as well as potential solutions.

Emergency Clinician Experiences Using a Standardized Communication Tool for Cardiac Arrest.

Introduction Sudden cardiac arrest remains a common and critical disease burden. As post-cardiac arrest care grows in complexity, communication between pre-hospital providers, emergency department personnel, and hospital consultants is increasingly important. Methods This study evaluated the use of a standard handoff tool between pre-hospital personnel and hospital staff, including emergency medical services (EMS), emergency department nurses, physicians, and cardiologists.

Acidemia Detected on Venous Blood Gas After Out-of-Hospital Cardiac Arrest Predicts Likelihood to Survive to Hospital Discharge.

Background: Sudden cardiac arrest is the most common cause of death worldwide, and prognostication after survival remains challenging. Decisions regarding prognosis can be fraught with error in the immediate postarrest period, with guidelines recommending the use of various tests, including blood gas pH, to determine which interventions to perform. Despite these recommendations, the prognostic utility of blood gas pH remains unclear.

Mechanical ventilation of pediatric patients in the emergency department.

When pediatric patients require mechanical ventilation in the emergency department, the emergency clinician should be prepared to select initial ventilator settings and respond to an intubated patient's dynamic physiologic needs to ensure ongoing oxygenation, ventilation, and hemodynamic stability. Pressure-targeted ventilation is generally recommended in pediatric patients, with initial ventilator settings varying depending on age and the etiology of respiratory failure. This issue reviews indications for mechanical ventilation and offers recommendations for ventilator settings and dosing of analgesics, sedatives, and neuromuscular blockers, with a focus on patient populations in whom the approach to mechanical ventilation may be different.

Diagnosis of Rectus Sheath Hematoma by Point-of-Care Ultrasound.

Background: Rectus sheath hematoma is a rare but dangerous cause of undifferentiated hypotension and abdominal pain in the emergency department (ED). Point-of-care ultrasound is a useful tool in its identification.

Case Report: A 75-year-old woman presented to the ED with hypotension of an unclear etiology.

Increasing Awareness on Health Care Access in Florida: A Community-Based Medical-Legal Practicum Project.

Problem: Service learning and experiential coursework has become a requirement for medical students and law students. Advocacy for the underinsured and uninsured is of ethical importance to both the practice of law and medicine, however engaging professional students in meaningful advocacy work with community partners can be challenging.

Purpose: The article describes a partnership between medical and law students in a community-based service learning project to promote health care access.