A Phase 1 Study of Cabozantinib and Trifluridine/Tipiracil in Metastatic Colorectal Adenocarcinoma.

Introduction: This study determined the safety and recommended phase 2 dose (RP2D) of the multikinase inhibitor cabozantinib in combination with trifluridine/tipiracil (FTD/TPI) in refractory metastatic colorectal carcinoma (mCRC).

Patients And Methods: Single institution investigator-initiated phase 1 study using 3+3 design. Eligible mCRC patients had received prior standard regimens.

Plants as vectors for environmental prion transmission.

Prions cause fatal neurodegenerative diseases and exhibit remarkable durability, which engenders a wide array of potential exposure scenarios. In chronic wasting disease of deer, elk, moose, and reindeer and in scrapie of sheep and goats, prions are transmitted via environmental routes and the ability of plants to accumulate and subsequently transmit prions has been hypothesized, but not previously demonstrated. Here, we establish the ability of several crop and other plant species to take up prions via their roots and translocate them to above-ground tissues from various growth media including soils.

A Machine Learning Model for Predicting Mortality within 90 Days of Dialysis Initiation.

Background: The first 90 days after dialysis initiation are associated with high morbidity and mortality in end-stage kidney disease (ESKD) patients. A machine learning-based tool for predicting mortality could inform patient-clinician shared decision making on whether to initiate dialysis or pursue medical management. We used the eXtreme Gradient Boosting (XGBoost) algorithm to predict mortality in the first 90 days after dialysis initiation in a nationally representative population from the United States Renal Data System.

Development of a Visualization Tool for Healthcare Decision-Making using Electronic Medical Records: A Systems Approach to Viewing a Patient Record.

Healthcare delivery systems are widely accepted as socio-technical systems. Unlike other socio-technical systems, healthcare systems leave very little decision-making to technical automation and control. Instead, the healthcare delivery system relies on human healthcare resources for decision-making.

Primary Clear Cell Carcinoma of the Pancreas: A Systematic Review.

Over the years, the world has witnessed many advances in diagnosing and treating multiple types of cancers. These breakthroughs have revolutionized the understanding of the molecular drive behind these neoplasms, leading to tangible therapeutic evolution and promising prognostic implications. However, pancreatic cancer remains a highly lethal disease.

A 64-year-old woman with rapid neurologic decline diagnosed with encephalitis after presumed metastatic cancer.

In an era of fragmented medical care, concurrent clinical features that ultimately lead to a unified diagnosis may not be prioritized appropriately. We present a case of a 64-year-old woman referred to hematology clinic for anemia, with recent memory loss and gait disturbance. Two months later, she developed pneumonia; imaging workup showed a left renal mass.

Heterozygous Alpha-1 Antitrypsin Deficiency Causing Pulmonary Emboli and Pulmonary Bullae.

Alpha-1 antitrypsin deficiency is an autosomal co-dominant disease known for different genetic alterations in the serine protease inhibitor enzyme by which different disease phenotypes can manifest. The lung and the liver are the most common organs involved. The severity of the disease depends on the phenotypes involved.

Primary Refractory Catastrophic Antiphospholipid Syndrome Masquerading as Buerger's Disease.

Catastrophic antiphospholipid syndrome (CAPS) is a lethal disease with up to 30% mortality rate. It can occur as a primary disease or secondary to an underlying autoimmune disease. Current treatment focuses on disease control with anticoagulation and steroids.

Testicular Germ Cell Tumors: Paraneoplastic Syndromes and the Role of Beta-Human Chorionic Gonadotropin.

Choriocarcinoma syndrome is a rare phenomenon that occurs in male patients with testicular choriocarcinoma. Male patients who have a testicular non-seminomatous germ cell tumor (TNSGCT) with at least partial choriocarcinoma histology, and metastases to the lungs and/or other extragonadal sites, as well as a markedly elevated beta-human chorionic gonadotropin (HCG), have been prone to pulmonary bleeding, hypoxia, and acute respiratory distress syndrome (ARDS). The respiratory complications occur immediately after chemotherapy is administered or, in some cases, spontaneously.

Machine learning of EEG spectra classifies unconsciousness during GABAergic anesthesia.

In current anesthesiology practice, anesthesiologists infer the state of unconsciousness without directly monitoring the brain. Drug- and patient-specific electroencephalographic (EEG) signatures of anesthesia-induced unconsciousness have been identified previously. We applied machine learning approaches to construct classification models for real-time tracking of unconscious state during anesthesia-induced unconsciousness.

Small-Cell Lung Cancer Cavities: Primary or Secondary?

Although non-small-cell lung cancer occasionally presents as cavitary lesions, it is rare for small-cell lung cancer (SCLC) to present or progress in such a manner. If a cavitary lesion is seen in the setting of small-cell lung carcinoma, infectious etiologies must be excluded first. We present the case of a 43-year-old man with refractory SCLC that progressed despite two lines of therapy, and who was ultimately found to have recurrent adenopathy and numerous widespread cavitary lung nodules.

Prolonged Treatment Response to Pembrolizumab in a Patient with Pretreated Metastatic Colon Cancer and Lynch Syndrome.

Pembrolizumab and other immunotherapies now play a prominent role in the treatment of metastatic colon cancer. Clinicians have achieved significant response rates even in heavily pretreated patients, particularly those with mismatched repair deficiencies. The endpoint of pembrolizumab treatment for patients who enjoy a strong response remains unclear.

Age-dependent overall survival benefit of androgen deprivation therapy for metastatic prostate cancer.

Background: Androgen deprivation therapy (ADT) remains a standard of care in metastatic prostate cancer. Recent prospective trials have explored addition of chemotherapy to ADT. We retrospectively examined overall survival in metastatic prostate cancer patients treated with ADT, chemotherapy plus ADT (C + ADT), or observation from 2004 to 2010 using National Cancer Database data.

Strategy to reduce bortezomib-induced paralytic ileus in patients with myeloma and impaired renal function.

While bortezomib is known to cause adverse effects involving the autonomic nervous system, gastrointestinal side effects are typically mild. We describe herein a series of patients with myeloma and impaired renal function who developed severe paralytic ileus secondary to bortezomib use. Our patients had other risk factors for paralytic ileus including electrolyte abnormalities and opiate use.

Severe phototoxic reaction secondary to subcutaneous 5-azacitidine.

Phototoxicity occurs when the effects of sunlight and certain drugs converge at the skin level. Various pharmacologic agents have been linked to photosensitivity, including agents used in hematology and oncology. We describe herein a severe phototoxic response to subcutaneous 5-azacitidine.

Audit of anesthetic trainees' 'hands-on' operating room experience in an Australian tertiary children's hospital.

Background: There are no internationally accepted guidelines about what constitutes adequate clinical exposure during pediatric anesthetic training. In Australia, no data have been published on the level of experience obtained by anesthetic trainees in pediatric anesthesia. There is, however, a new ANZCA (Australian and New Zealand College of Anaesthetists) curriculum that quantifies new training requirements.

Late-onset robust curly hair growth in a patient with BRAF-mutated metastatic melanoma responding to dabrafenib.

Development of curly hair has been infrequently described in association with BRAF inhibitors in clinical trials, and usually affects patients between 6 and 24 weeks of therapy. The curly hair is typically preceded by initial hair thinning or even diffuse alopecia. We report herein an occurrence of late-onset robust curly head hair growth in a patient with metastatic melanoma responding well to dabrafenib, without being preceded by hair thinning.