Publications by authors named "Usman Khan"

145 Publications

Key Electronic, Linear and Nonlinear Optical Properties of Designed Disubstituted Quinoline with Carbazole Compounds.

Molecules 2021 May 7;26(9). Epub 2021 May 7.

Department of Chemistry, Chemical Engineering and Biotechnology, Donghua University, Shanghai 201620, China.

Organic materials development, especially in terms of nonlinear optical (NLO) performance, has become progressively more significant owing to their rising and promising applications in potential photonic devices. Organic moieties such as carbazole and quinoline play a vital role in charge transfer applications in optoelectronics. This study reports and characterizes the donor-acceptor-donor-π-acceptor (D-A-D-π-A) configured novel designed compounds, namely, -, -, and . We further analyze the structure-property relationship between the quinoline-carbazole compounds for which density functional theory (DFT) and time-dependent DFT (TDDFT) calculations were performed at the B3LYP/6-311G(d,p) level to obtain the optimized geometries, natural bonding orbital (NBO), NLO analysis, electronic properties, and absorption spectra of all mentioned compounds. The computed values of λ, 364, 360, and 361 nm for , , and show good agreement of their experimental values: 349, 347, and 323 nm, respectively. The designed compounds (-) exhibited a smaller energy gap with a maximum redshift than the reference molecules (-), which govern their promising NLO behavior. The NBO evaluation revealed that the extended hyperconjugation stabilizes these systems and caused a promising NLO response. The dipole polarizabilities and hyperpolarizability (β) values of -, -, and exceed those of the reference , , and molecules. These data suggest that the NLO active compounds, -, -, and , may find their place in future hi-tech optical devices.
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http://dx.doi.org/10.3390/molecules26092760DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8125273PMC
May 2021

PRESERVE: Randomized Trial of Intensive Versus Standard Blood Pressure Control in Small Vessel Disease.

Stroke 2021 May 28:STROKEAHA120032054. Epub 2021 May 28.

Oxford University Hospitals NHS Foundation Trust, University of Oxford (G.A.F.).

Background And Purpose: In cerebral small vessel disease, cerebral blood flow and autoregulation are impaired and therefore excessive blood pressure reduction could possibly accelerate white matter damage and worsen outcome. The trial determined, in severe symptomatic cerebral small vessel disease, whether intensive blood pressure lowering resulted in progression of white matter damage assessed using diffusion tensor imaging.

Methods: Randomized, parallel, multicenter controlled, blinded-outcomes clinical trial. One hundred eleven participants with magnetic resonance imaging confirmed symptomatic lacunar infarct and confluent white matter hyperintensities and were recruited and randomized to standard (systolic=130-140 mmHg) (N=56) or intensive (systolic<125 mmHg) (N=55) blood pressure targets. The primary end point was change in diffusion tensor imaging white matter mean diffusivity peak height between baseline and 24 months. Secondary end points were other magnetic resonance imaging markers and cognition.

Results: Patients were mean 68 years and 60% male. Mean (SD) blood pressure reduced by -15.3 (15.4) and -23.1 (22.04) mm Hg in the standard/intensive groups, respectively (<0.001). There was no difference between treatment groups for the primary end point: standard, adjusted mean (SE)=12.5×10 (0.2×10); intensive, 12.5×10 (0.2×10), =0.92. In the whole population over 24 months follow-up, there was a significant deterioration in white matter microstructure but no detectable decrease in cognition.

Conclusions: Intensive blood pressure lowering in severe cerebral small vessel disease was not associated with progression of white matter damage on diffusion tensor imaging or magnetic resonance imaging. In a multicentre study setting over 2 years, multimodal diffusion tensor imaging-magnetic resonance imaging was more sensitive to detecting change than cognitive testing.

Registration: URL: https://www.isrctn.com; Unique identifier: ISRCTN37694103.
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http://dx.doi.org/10.1161/STROKEAHA.120.032054DOI Listing
May 2021

Hub-and-spoke model for thrombectomy service in UK NHS practice.

Clin Med (Lond) 2021 01;21(1):e26-e31

St George's University Hospital NHS Foundation Trust, London, UK.

Mechanical thrombectomy is a highly effective but time dependent treatment for acute ischaemic stroke due to large vessel occlusion. In the UK, the national clinical guidelines for stroke and National Institute for Health and Care Excellence guidance endorses thrombectomy as an acute stroke treatment, and NHS England commissioned thrombectomy services. However, there are no UK 'real-world' data to verify the efficacy of the hub-and-spoke model in thrombectomy. There are currently 24 tertiary neuroscience centres in the UK that can provide thrombectomy treatment and many of these operate only within working hours. This study is the first to demonstrate that a hub-and-spoke thrombectomy service in routine UK 24/7 clinical practice is as effective and safe as in the setting of randomised controlled clinical trials. However, there are 9.3% of patients accepted for transfer to the thrombectomy centre who did not proceed to thrombectomy, mostly due to delays. Fifty-three per cent of thrombectomy cases were performed outside of standard working hours when transfer delays were increased. A 24/7 thrombectomy service is needed to maximise the benefit to all suitable patients. Measures, including improving workflow and optimising work forces, are needed to minimise the delays and continue to improve the service.
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http://dx.doi.org/10.7861/clinmed.2020-0579DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7850178PMC
January 2021

Chemotherapy rechallenge in metastatic colon cancer: A case report and literature review.

World J Clin Oncol 2020 Nov;11(11):959-967

Department of Medical Oncology, Houston Methodist Hospital Cancer Center, Houston, TX 77030, United States.

Background: Colorectal cancer (CRC) is the third leading cause of cancer-related death in males and females in the United States. Approximately, 20%-22% of patients have metastatic disease at the time of presentation, and 50%-60% will develop metastasis over the course of their disease. Despite advances in systemic therapies, there remains a paucity of effective third- and later-line therapies for patients with ongoing disease progression. However, rechallenging chemo-resistant CRC tumors with previously administered therapies is an emerging concept that may be a life-prolonging option for heavily treated metastatic colorectal cancer (mCRC).

Case Summary: A 41-year-old man with no previous medical history initially presented with worsening diffuse abdominal tenderness. Computed tomography was significant for a splenic flexure mass and hepatic lesions concerning for metastatic disease. He underwent a colectomy with anastomosis. Postoperative pathology was diagnostic for moderately to well-differentiated adenocarcinoma (T4bN1bM1a). He received adjuvant 5-fluorouracil, leucovorin, and oxaliplatin (FOLFOX), but therapy was discontinued due to the development of atrial fibrillation. Additional workup indicated a carcinoembryonic antigen level of 508.2 ng/mL, and mutational analysis found that the tumor was microsatellite instability-high and / wild-type. He was started on irinotecan with oxaliplatin (IROX), and bevacizumab (14 cycles), developed disease progression, was transitioned to FOLFOX and cetuximab, and then eventually three cycles of pembrolizumab. Following disease progression, he was rechallenged with IROX therapy, as he previously responded well to oxaliplatin-based therapy. The IROX rechallenge provided this patient with a ten-month survival benefit, decreased metastatic burden, and marked improvement in his clinical condition.

Conclusion: Rechallenge of previous lines of well-tolerated systemic chemotherapy regimens may be a valuable therapeutic strategy in patients with heavily-treated mCRC.
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http://dx.doi.org/10.5306/wjco.v11.i11.959DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7701909PMC
November 2020

Improving the biogas yield of manure: Effect of pretreatment on anaerobic digestion of the recalcitrant fraction of manure.

Bioresour Technol 2021 Feb 20;321:124427. Epub 2020 Nov 20.

Bioproducts, Sciences and Engineering Laboratory, Washington State University, Tri-Cities, Richland, WA 99354, United States; Gene and Linda Voiland School of Chemical Engineering and Bioengineering, Pullman, WA 99163, United States; Biological Systems Engineering, Washington State University, Pullman, WA 99163, United States. Electronic address:

Anaerobic digestion of animal manure show a maximum of ca. 50% conversion of volatile solids due to recalcitrance of lignin and crystalline cellulose under anaerobic conditions. The aim of this study is to evaluate different pretreatments on anaerobic digestion of manure fibers after anaerobic digestion. Physical, chemical, thermal, and thermal combined with alkaline pretreatments using sodium hydroxide were tested on manure fiber fraction separated out after anaerobic digestion of cow manure. The anaerobic digestion after pretreatment along with untreated controls were done in semi-continuous anaerobic bioreactors. All pretreatments showed positive effect and the highest increase in VS conversion (42.4%) and methane yield (ca. 127%) was found for 3% NaOH pretreated sample at 180 °C. Composition analysis showed that cellulose, hemicellulose and lignin in digested manure fibers were optimally reduced by 24.8, 29.1 and 9.5% respectively during pretreatment and 76.5% of cellulose and 84.9% of hemicellulose was converted to methane during AD.
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http://dx.doi.org/10.1016/j.biortech.2020.124427DOI Listing
February 2021

Patient and tumor factors contributing to distant metastasis in well-differentiated thyroid cancer: a retrospective cohort study.

J Otolaryngol Head Neck Surg 2020 Nov 16;49(1):78. Epub 2020 Nov 16.

Division of Otolaryngology - Head and Neck Surgery, University of Calgary, ENT Clinic, 1820 Richmond Road SW, Calgary, AB, T2T 5C7, Canada.

Background: Distant metastasis in thyroid cancer significantly reduces survival in patients with well-differentiated thyroid carcinoma (WDTC). There is limited information available to clinicians regarding pathological features that confer a higher risk of distant metastasis (DM). This study aimed to identify patient and tumor factors that were associated with the development of DM over time in patients with WDTC.

Methods: A retrospective cohort analysis of patients with WDTC (n = 584) at our institution was performed between 2007 and 2017. A total of 39 patients with DM and 529 patients with no DM (NDM) were included. Patient demographics, tumor characteristics and patient survival were compared between the DM and NDM groups using a univariate analysis. Multivariate Cox-proportional hazards model was used to evaluate the risk of developing distant metastasis over time. Kaplan-Meier analysis was used to compare survival between the DM and NDM groups.

Results: Distant metastasis had a substantial impact on disease-specific survival (DSS) at 5 and 10-years in the DM group; 71.0% (SE 8.4%) and 46.9% (SE 11.6%) respectively, compared to 100% survival in the NDM group (p < 0.001). The DM group had significantly higher proportions of males, lymphovascular invasion (LVI), nodal metastasis (NM), large tumor size (TS), extrathyroidal extension (ETE), positive resection margins, multifocality, follicular thyroid cancer (FTC), tall cell variant of papillary thyroid cancer (PTC), and Hurthle cell carcinoma (HCC), when compared to the NDM group (p < 0.05). A TS ≥ 2 cm (Hazard Ratio (HR) 1.370), NM (HR 3.806) and FTC (HR 7.068) were associated with a significantly increased hazard of developing distant metastasis in patients with WDTC.

Conclusions: TS ≥ 2 cm, NM and FTC are associated with a significantly increased propensity for developing DM in our cohort of WDTC patients.
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http://dx.doi.org/10.1186/s40463-020-00469-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7667857PMC
November 2020

Renal Infiltration as a Primary Presentation of Burkitt Lymphoma Secondary to Systemic Lupus Erythematosus: A Rarity Unto a Rarity.

Cureus 2020 Sep 17;12(9):e10512. Epub 2020 Sep 17.

Internal Medicine and Nephrology, University of Oklahoma Health Sciences Center, Oklahoma City, USA.

Burkitt lymphoma (BL) is a highly aggressive non-Hodgkin B-cell lymphoma characterized by the translocation and deregulation of the MYC (MyeloCytomatosis) gene on chromosome 8. Three distinct clinical forms of BL are recognized: endemic (African), sporadic (non-endemic), and immunodeficiency-associated. Bilateral renal infiltration leading to acute kidney injury (AKI) is a rare initial presentation of BL. Diagnosis is usually made after evaluating the histology and immunophenotyping of the affected tissue. We report a case of a 46-year-old male who presented with symptoms of AKI resulting from infiltrative disease, a primary presentation of lymphoma. The patient was a known case of systemic lupus erythematosus (SLE) for the last five years and was referred to the nephrology department due to acute elevation in creatinine, from 0.8 mg/dL to 3.57 mg/dL. On physical examination, there was no lymphadenopathy. Nephrology and SLE workup revealed low complement protein levels and absolute neutrophils, lymphocytes, and metamyelocytes. Renal ultrasound (USG) showed both kidneys with symmetric and edematous appearance. Biopsy affirmed high-grade B-cell lymphoma, positive for BCL-6 (B-cell leukemia/lymphoma) and CD-10 (cell surface marker) and negative for BCL-2 (B-cell leukemia/lymphoma). PET (positron emission tomography) scan showed extensive hypermetabolic lymphadenopathy in multiple areas. The patient was started on chemotherapy and on continuous renal replacement therapy. He improved clinically, and his creatinine lowered down to 0.8 mg/dL. Repeat USG showed decreased edematous appearance of both kidneys. Primary renal infiltration by BL is a rare presentation in adults. Prompt renal biopsy will change the course of treatment and can affect the prognosis. It is thoroughly advised to keep this malignancy in mind when making a diagnosis for AKI.
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http://dx.doi.org/10.7759/cureus.10512DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7571598PMC
September 2020

Composite submental flaps in facial reconstructive surgery involving the zygoma and orbit.

J Otolaryngol Head Neck Surg 2020 Oct 20;49(1):75. Epub 2020 Oct 20.

Division of Otolaryngology - Head and Neck Surgery, Dalhousie University, Dickson Building, QEII Health Sciences Centre, 5820 University Avenue, Halifax, NS, B3H 2Y9, Canada.

Background: The submental island flap (SIF) is a reliable option for reconstructing defects in the facial region and offers several advantages when compared to free-flap alternatives. While the reconstructive applications of the SIF have been demonstrated in the lower face, there are limited reports on its utility as a composite flap for reconstructing defects of the upper facial skeleton. To our knowledge, we report the first cases of composite (osteocutaneous) SIFs used for reconstruction of complex facial defects involving the zygoma and lateral orbit respectively.

Case Presentations: Three consecutive cases are presented. All were performed following resection of skin cancers with invasion of the upper facial skeleton. The first case was a 68-year-old male with a longstanding history of non-melanoma skin cancers who presented with a 7 cm recurrent basal cell carcinoma (BCC) with bicortical invasion of the left zygoma. The second case was an 88-year-old female with several squamous cell carcinomas (SCC), including a dominant 7.1 cm SCC on the right temple with orbital invasion. A third case was a 75-year-old immunosuppressed male with a 6.5 cm SCC of the right cheek with invasion of the orbit and zygoma following prior resection as well as high dose radiotherapy. The operative management of all cases involved harvesting the SIF on its vascular pedicle alongside the inferior portion of the mandible with rigid fixation to address the bony defects. The first case was robust throughout adjuvant radiotherapy with no flap complications after 2 year follow up. The second patient received adjuvant radiation therapy to an area that was previously radiated. Although the flap remained viable for a year, the patient experienced delayed soft tissue loss over the bony segment and eventual devitalization of the distal flap. The third case achieved a satisfactory result with no complications.

Conclusions: Our case series outlines a unique application of the composite (osteocutaneous) submental island flap (SIF) for reconstruction of complex facial defects involving the upper facial skeleton. The osteocutaneous SIF should be used with caution in patients receiving adjuvant radiotherapy who have a history of previous radiation to the same or overlapping field.
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http://dx.doi.org/10.1186/s40463-020-00468-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7574249PMC
October 2020

Metastatic epidural spinal column compression due to pancreatic ductal adenocarcinoma causing subacute Cauda equina syndrome: A case report.

Surg Neurol Int 2020 5;11:279. Epub 2020 Sep 5.

Department of Neurological Surgery, University of California, San Diego, La Jolla.

Background: Pancreatic ductal adenocarcinoma (PDAC) is the most common pancreatic malignancy, which rarely metastasizes to the spine.

Case Description: Here, we present a lytic lumbar metastatic PDAC resulting in severe epidural spinal cord compression (ESCC) with instability. The lesion required preoperative particle embolization, surgical decompression, and fusion.

Conclusion: This case report shows that PDAC may metastasize to the lumbar spine requiring routine decompression with fusion.
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http://dx.doi.org/10.25259/SNI_514_2020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7538966PMC
September 2020

Impact of Coping Veneering Techniques on the Survival of Implant-Supported Zirconia-Based-Crowns Cemented to Hybrid-Abutments: An-In-Vitro Study.

Bioengineering (Basel) 2020 Sep 25;7(4). Epub 2020 Sep 25.

School of Dentistry and Oral Health, Griffith University, Gold Coast, Queensland 4000, Australia.

The objective of this study is to investigate the influence of veneering technique (hand-layering vs. milling) on the fracture resistance of bi-layer implant-supported zirconia-based hybrid-abutment crowns. Mandibular molar copings were anatomically designed and milled. Copings were then veneered by hand-layering (HL) (n = 20) and milling using the Cad-On technique (LD) (n = 20). Crowns were cemented to zirconia hybrid-abutments. Ten samples of each group acted as a control while the remaining ten samples were subjected to fatigue in a chewing simulator. Crowns were loaded between 50 and 100 N for 1.2 million cycles under simultaneous temperature fluctuation between 5 and 55 °C. Crowns were then subjected to static load a to fracture test. Data were statistically analysed using the one-way ANOVA. Randomly selected crowns from each group were observed under scanning electron microscopy to view fractured surfaces. Study results indicate that during fatigue, LD crowns had a 100% survival rate; while HL crowns had a 50% failure rate. Fracture resistance of LD crowns was statistically significantly higher than that of HL crowns at the baseline and after fatigue ( ≤ 0.05). However, fatigue did not cause a statistically significant reduction in fracture resistance in both LD and HL groups ( > 0.05). Copings fractured in the LD crowns only and the fracture path was different in both LD and HL groups. According to the results, it was concluded that milled veneer implant-supported hybrid-abutment crowns exhibit significantly higher fracture resistance, and better withstand clinical masticatory loads in the posterior region compared to the hand-layered technique. Also, fatigue application and artificial aging caused no significant strength reduction in both techniques. Clinical significance: Different veneering techniques and materials (hand-layering or milling) act differently to clinical forces and environment and may be prone to early chipping during service. Therefore, practitioners are urged to consider the appropriate veneering protocol for posterior implant-supported hybrid-abutment restorations.
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http://dx.doi.org/10.3390/bioengineering7040117DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7712862PMC
September 2020

Fractures are common within 18 months following first-line R-CHOP in older patients with diffuse large B-cell lymphoma.

Blood Adv 2020 09;4(18):4337-4346

Department of Haematology, Oxford University Hospitals, Oxford, United Kingdom.

Diffuse large B-cell lymphoma (DLBCL) and osteoporotic fracture are both more common in older patients. Exposure to R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone) is likely to increase the risk of fracture, but evidence is lacking to define fracture incidence in this group. Data on consecutive patients with DLBCL aged ≥70 years treated with 1 to 8 cycles of full or attenuated R-CHOP were retrospectively collected across 10 UK centers (2009-2019). Patients were followed up from starting R-CHOP for a minimum of 6 months and censored at 18 months; at last follow-up if <18 months; or at progression or death. Of 877 patients identified, 148 were excluded: 121 had progression or died before 6 months; 23 had follow-up <6 months. Across 729 remaining patients, the median age was 77 years, and 68% had an Eastern Cooperative Oncology Group performance status of 0 to 1. Eighty-one fractures occurred within 18 months of follow-up; 42 were symptomatic, including 30 requiring hospital attendance or admission. The cumulative fracture incidence was 6.2% (95% confidence interval [CI], 4.7-8.2) at 6 months; 9.7% (95% CI, 7.8-12.1) at 12 months; and 11.4% (95% CI, 9.3-14.0) at 18 months. Multivariate analysis identified a predisposing history (osteoporosis, osteopenia, prior fracture, and rheumatoid arthritis [RhA]), DLBCL bone involvement at baseline, and receipt of prephase steroids as independent risk factors for fracture. There is a clinically relevant fracture risk and significant associated morbidity in older patients receiving R-CHOP. Careful attention to bone health is warranted in older patients receiving R-CHOP. Randomized studies are required to better define the most effective strategies to reduce fracture risk.
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http://dx.doi.org/10.1182/bloodadvances.2020002553DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7509870PMC
September 2020

Urinary Tract Infection Caused by the Novel Pathogen, Lactococcus Garvieae: A Case Report.

Cureus 2020 Jul 29;12(7):e9462. Epub 2020 Jul 29.

Internal Medicine and Nephrology, University of Oklahoma Health Sciences Center, Oklahoma City, USA.

is a part of the genus which was previously a part of the genus . It has been associated with serious diseases in aquaculture. However, human infections are rare. The most common presentation in humans is infective endocarditis. Urinary tract infection (UTI) is a unique presentation of this pathogen. We report the case of a 70-year-old male with a past history of benign prostatic hyperplasia who presented with confusion. Urinalysis confirmed the growth of . A seven-day treatment course of amoxicillin-clavulanate successfully treated the patient. The risk factors for acquiring the infections include contact with seafood or aquaculture. Other risk factors include immunosuppression, gastric acid suppression, and anatomical or physiological defect in the gastrointestinal tract. Special tests, such as VITEK 2, API® 32 strep system, 16S rRNA, or polymerase chain reaction (PCR) testing, are needed for its diagnosis. Hence, we suggest underreporting of the infection may be possible. It is a novel cause of UTI, we suggest a high index of suspicion should be kept, especially in people with associated risk factors or exposure to seafood.
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http://dx.doi.org/10.7759/cureus.9462DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7455392PMC
July 2020

Synthesis of Ultrahigh-Quality Monolayer Molybdenum Disulfide through In Situ Defect Healing with Thiol Molecules.

Small 2020 Sep 2;16(35):e2003357. Epub 2020 Aug 2.

Shenzhen Geim Graphene Center, Tsinghua-Berkeley Shenzhen Institute and Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen, 518055, P. R. China.

Monolayer transition metal dichalcogenides are 2D materials with many potential applications. Chemical vapor deposition (CVD) is a promising method to synthesize these materials. However, CVD-grown materials generally have poorer quality than mechanically exfoliated ones and contain more defects due to the difficulties in controlling precursors' distribution and concentration during growth where solid precursors are used. Here, thiol is proposed to be used as a liquid precursor for CVD growth of high quality and uniform 2D MoS . Atomic-resolved structure characterizations indicate that the concentration of sulfur vacancies in the MoS grown from thiol is the lowest among all reported CVD samples. Low temperature spectroscopic characterization further reveals the ultrahigh optical quality of the grown MoS . Density functional theory simulations indicate that thiol molecules could interact with sulfur vacancies in MoS and repair these defects during the growth of MoS , resulting in high-quality MoS . This work provides a facile and controllable method for the growth of high-quality 2D materials with ultralow sulfur vacancies and high optical quality, which will benefit their optoelectronic applications.
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http://dx.doi.org/10.1002/smll.202003357DOI Listing
September 2020

Gastroduodenal Sarcoidosis With Concomitant Cytomegalovirus Gastritis.

ACG Case Rep J 2020 Jun 11;7(6):e00394. Epub 2020 Jun 11.

Division of Gastroenterology, Department of Medicine, University of Ottawa, Ottawa, ON.

Gastrointestinal sarcoidosis in the absence of pulmonary disease is rare. Likewise, cytomegalovirus (CMV) reactivation in the stomach is also rare. We present a 67-year-old woman with symptomatic CMV gastritis and gastroduodenal sarcoidosis who presented with epigastric pain, nausea, and vomiting. Initial gastric biopsies revealed CMV gastritis. Repeat assessment demonstrated worsening disease requiring antiviral treatment. After this, further investigations into ongoing epigastric pain demonstrated noncaseating granulomas on repeat gastrointestinal biopsies. A diagnosis of sarcoidosis was established and treated with prednisone to resolution.
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http://dx.doi.org/10.14309/crj.0000000000000394DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7304538PMC
June 2020

Comparison of Frenotomy Techniques for the Treatment of Ankyloglossia in Children: A Systematic Review.

Otolaryngol Head Neck Surg 2020 09 2;163(3):428-443. Epub 2020 Jun 2.

Department of Surgery, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.

Objective: To compare the effectiveness of conventional (CF), laser (LF), and Z-plasty (ZF) frenotomies for the treatment of ankyloglossia in the pediatric population.

Data Sources: A comprehensive search of PUBMED, EMBASE, and COCHRANE databases was performed.

Review Methods: Relevant articles were independently assessed by 2 reviewers according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.

Results: Thirty-five articles assessing CF (27 articles), LF (4 articles), ZF (3 articles), and/or rhomboid plasty frenotomy (1 article) were included. A high level of outcome heterogeneity prevented pooling of data. All 7 randomized controlled trials (RCTs) were of low quality. Both CF (5 articles with 589 patients) and LF (2 articles with 78 patients) were independently shown to reduce maternal nipple pain on a visual analog or numeric rating scale. There were reports of improvement with breastfeeding outcomes as assessed on validated assessment tools for 88% (7/8) of CF articles (588 patients) and 2 LF articles (78 patients). ZF improved breastfeeding outcomes on subjective maternal reports (1 article with 18 infants) only. One RCT with a high risk of bias concluded greater speech articulation improvements with ZF compared to CF. Only minor adverse events were reported for all frenotomy techniques.

Conclusions: Current literature does not demonstrate a clear advantage for one frenotomy technique when managing children with ankyloglossia. Recommendations for future research are provided to overcome the methodological shortcomings in the literature. We conclude that all frenotomy techniques are safe and effective for treating symptomatic ankyloglossia.
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http://dx.doi.org/10.1177/0194599820917619DOI Listing
September 2020

Advanced Endoscopy Trainee Involvement Early in EUS Training May Be Associated with an Increased Risk of Adverse Events.

J Can Assoc Gastroenterol 2020 Apr 12;3(2):83-90. Epub 2018 Dec 12.

Division of Gastroenterology, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada.

Background: The quality of endoscopic ultrasound (EUS) involving advanced endoscopy trainees (AETs) is not well understood. In this study, we aimed to examine adverse events (AE) risk and diagnostic yield of EUS procedures involving AETs.

Methods: We conducted a retrospective single-centre review from September 2009 to August 2015. Clinical, procedural, cytological, and hospital visit data within 30 days of the EUS procedure was collected. Primary outcomes were occurrence of an AE and a diagnostic specimen on cytopathology. Each AE was classified as "definitely related," "possibly related," or "not related to the EUS procedure based on a previously defined consensus approach. Advanced endoscopy trainee involvement was established through the operative report.

Results: Our study included 1657 EUS procedures, of which 27% (451 of 1657) involved AETs. Endoscopic ultrasound was most commonly performed to evaluate pancreatic pathology (46% of cases). Overall AE incidence was 3.4%; it was 4.9% when an AET was involved and 2.8% when the EUS was performed without an AET ( = 0.04). The risk of an AE when AETs were involved was greatest in the first three months of training (7.9% versus 2.7%, = 0.04). Multivariate analysis limited to the first three months of training demonstrated AET involvement to be associated with an increased AE risk after adjusting for patient and procedural factors (adjusted OR 3.2; 95% CI, 1.1-8.7; = 0.03). The overall diagnostic yield was 76%. This was not compromised by AET involvement for any quartile of training.

Conclusions: We observed an increased risk of EUS-related AEs when procedures involved AETs during the first three months of training.
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http://dx.doi.org/10.1093/jcag/gwy066DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7165263PMC
April 2020

Pancreatic adenocarcinoma with early esophageal metastasis: A case report and review of literature.

World J Clin Oncol 2020 Feb;11(2):83-90

Department of Oncology, Houston Methodist Cancer Center, Houston, TX 77030, United States.

Background: Pancreatic adenocarcinoma is an aggressive malignancy with a high propensity to metastasize. Esophageal metastasis manifesting as dysphagia is rarely reported in the literature and has not to our knowledge been reported prior to the appearance of the primary disease.

Case Summary: A patient presented with progressive dysphagia to solids and a persistent earache. Computed tomography of the neck and chest revealed a 3.0 cm × 1.8 cm heterogeneous mass originating from the upper third of the esophagus, necrotic cervical and supraclavicular lymphadenopathy, and bilateral pulmonary nodules. She underwent a core needle biopsy of a right cervical node, which suggested a well-differentiated adenocarcinoma of unknown primary. She had an upper endoscopy with biopsy of the esophageal mass suggestive of a well-differentiated adenocarcinoma. Positron emission tomography imaging revealed increased uptake in the esophageal mass, cervical, and mediastinal lymph nodes. She was started on folinic acid, fluorouracil, and oxaliplatin. Prior to initiation of cycle 8, the patient was found to have a pancreatic body mass that was not present on prior radiographic imaging, confirmed by endoscopic ultrasonography and biopsy to be pancreatic adenocarcinoma. CA19-9 was > 10000 U/mL, suggesting a primary pancreaticobiliary origin.

Conclusion: Esophageal metastasis diagnosed before primary pancreatic adenocarcinoma is rare. This case highlights the profound metastatic potential of pancreatic adenocarcinoma.
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http://dx.doi.org/10.5306/wjco.v11.i2.83DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7046924PMC
February 2020

The association of neutrophil-lymphocyte ratio and lymphocyte-monocyte ratio with 3-month clinical outcome after mechanical thrombectomy following stroke.

J Neuroinflammation 2020 Feb 18;17(1):60. Epub 2020 Feb 18.

Department of Neurology, St George's University Hospitals NHS Foundation Trust, London, SW17 0QT, UK.

Background And Aim: Neutrophil-lymphocyte ratio (NLR) and lymphocyte-monocyte ratio (LMR) are associated with clinical outcomes in malignancy, cardiovascular disease and stroke. Here we investigate their association with outcome after acute ischaemic stroke treated by mechanical thrombectomy (MT).

Methods: Patients were selected using audit data for MT for acute anterior circulation ischaemic stroke at a UK centre from May 2016-July 2017. Clinical and laboratory data including neutrophil, lymphocyte and monocyte count tested before and 24 h after MT were collected. Poor functional outcome was defined as modified Rankin Scale (mRS) of 3-6 at 3 months. Multivariable logistic regression analyses were performed to explore the relationship of NLR and LMR with functional outcome.

Results: One hundred twenty-one patients (mean age 66.4 ± 16.7, 52% female) were included. Higher NLR (adjusted OR 0.022, 95% CI, 0.009-0.34, p = 0.001) and lower LMR (adjusted OR - 0.093, 95% CI (- 0.175)-(- 0.012), p = 0.025) at 24-h post-MT were significantly associated with poorer functional outcome when controlling for age, baseline NIHSS score, infarct size, presence of good collateral supply, recanalisation and symptomatic intracranial haemorrhage on multivariate logistic regression. Admission NLR or LMR were not significant predictors of mRS at 3 months. The optimal cut-off values of NLR and LMR at 24-h post-MT that best discriminated poor outcome were 5.5 (80% sensitivity and 60% specificity) and 2.0 (80% sensitivity and 50% specificity), respectively on receiver operating characteristic curve analysis.

Conclusion: NLR and LMR tested at 24 h after ictus or intervention may predict 3-month functional outcome.
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http://dx.doi.org/10.1186/s12974-020-01739-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7026966PMC
February 2020

State, religion and the marginalisation of traditional healing in Gwadar, Pakistan.

Med Humanit 2020 Dec 28;46(4):444-453. Epub 2020 Jan 28.

Anthropology, Sun Yat-Sen University, Guangzhou, China.

This ethnographic encounter explores suppression and domination faced by traditional health seekers in Gwadar, Pakistan. The study aimed to provide an insight into the ways in which practicing traditional healthcare becomes a challenge when it conflicts with the assimilationist project of the state. Qualitative research methods, including in-depth interviews and participant observation, were used to collect data on the encounters of traditional health seekers with the state and dominant religion. The findings show that traditional health seeking behaviour was stereotyped as non-civilised and archaic by medical staff, and labelled as non-religious, and thus, suppressed by radical Islamist groups and other state apparatuses. This situation has further negative effects on the health of traditional health seekers as the national healthcare system does not efficiently provide the services required by this population. State laws, a general environment of fear, and threats have led this population to legal consciousness and contextual awareness; they have further adopted multiple resistance strategies to navigate and circumvent oppressive laws and domination in order to follow their traditional healthcare practices. This study suggests that national cosmopolitan healthcare services provided to the fishing community should be tailored to and not suppress the culturally specific health needs of that population. Members of the fishing community should not be compelled to abstain from their traditional healthcare and health-seeking behaviours; traditional healthcare practices should be merged with cosmopolitan ones in order to address the sociocultural issues and meet the health needs of this marginalised population.
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http://dx.doi.org/10.1136/medhum-2019-011747DOI Listing
December 2020

Activated Carbon Microsphere from Sodium Lignosulfonate for Cr(VI) Adsorption Evaluation in Wastewater Treatment.

Polymers (Basel) 2020 Jan 19;12(1). Epub 2020 Jan 19.

Department of Biological Systems Engineering, Washington State University, Richland, WA 99354, USA.

In this study, activated carbon microsphere (SLACM) was prepared from powdered sodium lignosulfonate (SL) and polystyrene by the Mannich reaction and ZnCl activation, which can be used to remove Cr(VI) from the aqueous solution without adding any binder. The SLACM was characterized and the batch experiments were conducted under different initial pH values, initial concentrations, contact time durations and temperatures to investigate the adsorption performance of Cr(VI) onto SLACM. The results indicated that the SLACM surface area and average pore size were 769.37 m/g and 2.46 nm (the mesoporous material), respectively. It was found that the reduced initial pH value, the increased temperature and initial Cr(VI) concentration were beneficial to Cr(VI) adsorption. The maximum adsorption capacity of Cr(VI) on SLACM was 227.7 mg/g at an initial pH value of 2 and the temperature of 40 °C. The adsorption of SLACM for Cr(VI) mainly occurred during the initial stages of the adsorption process. The adsorption kinetic and isotherm experimental data were thoroughly described by Elovich and Langmuir models, respectively. SL could be considered as a potential raw material for the production of activated carbon, which had a considerable potential for the Cr(VI) removal from wastewater.
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http://dx.doi.org/10.3390/polym12010236DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7023583PMC
January 2020

Zinc oxide‑selenium heterojunction composite: Synthesis, characterization and photo-induced antibacterial activity under visible light irradiation.

J Photochem Photobiol B 2020 Jan 13;203:111743. Epub 2019 Dec 13.

State Key Laboratory of Chemical Resource Engineering, Beijing University of Chemical Technology, No. 15 East Road of North Third Ring, Chao Yang District, Beijing 100029, China.

The designing of new antibacterial agents with high and long-lasting activities are urgently needed in order to cope with the fast-emerging bacterial resistance. Zinc oxide nanoparticles (ZnO) have shown a significant promise as broad-spectrum antibacterial agents, and are efficient material in compromising bacterial membrane stability that leads to an increased cell permeability to nano-products. However, further engineering is required to improve their biological activities and to minimize their toxicity to healthy cells. In an attempt to resolve this issue, two semiconductor materials, ZnO and selenium (Se), were fabricated into a unique structural composite by a newly developed facile green method, and the designed composite was applied as an antibacterial nanomedicine. The developed methodology involves the initial preparation of ZnO, followed by its fabrication with Se at different temperatures (70 °C to 95 °C). Our experimental data showed that well defined interpenetrated crystalline Se network on ZnO (ZnO-Se) can be obtained at 80 °C for 180 min. The as-prepared ZnO-Se showed promising results in inhibiting the challenged bacterial strains under light irradiation (visible light) as compared to free ZnO. The enhanced biocidal property of ZnO-Se could be ascribed to its improved light-harvesting ability for sustainable induction of reactive oxygen species (ROS) and an active contact killing mechanism. Thus, ZnO-Se composite with a novel architecture could be a promising material in the treatment of bacterial infections by a mutual antibacterial synergy from the incorporated elements. Interestingly, the ZnO-Se has the ability to scavenge the overproduction of hydroxyl radicals, thus protecting the healthy cells from oxidative damage.
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http://dx.doi.org/10.1016/j.jphotobiol.2019.111743DOI Listing
January 2020

Anaerobic digestion of biorefinery lignin: Effect of different wet explosion pretreatment conditions.

Bioresour Technol 2020 Feb 2;298:122537. Epub 2019 Dec 2.

Bioproducts, Sciences and Engineering Laboratory, Washington State University, Tri-Cities, Richland, WA 99354, United States; Gene and Linda Voiland School of Chemical Engineering and Bioengineering & Biological Systems Engineering, Washington State University, Pullman, WA 99163, United States. Electronic address:

This study examine ways to make biorefinery lignin accessible for anaerobic digestion. The raw material was the residue after removing carbohydrates by Wet Explosion pretreatment at 190 °C and 7.5% O followed by enzymatic hydrolysis. The residual solid was mainly composed of lignin and was the raw material for a second WEx pretreatment operated at 220 °C with 4% oxygen and variable concentrations of NaOH (0-2%). Lignin B was the residue after pretreated without NaOH, Lignin C was pretreated at 1% NaOH, and Lignin E at 2% NaOH. Anaerobic digestion was carried out on all lignin fractions (Lignin A, B, C and E) at thermophilic conditions (52 °C) by mixing 70% of each lignin fractions with 30% clarified manure. The results showed that the lignin samples were demethoxylated as part of the biodegradation and that the highest severity pretreatment (with oxygen and 2% NaOH) resulted in the highest methane yield.
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http://dx.doi.org/10.1016/j.biortech.2019.122537DOI Listing
February 2020

Unsaturated Single Atoms on Monolayer Transition Metal Dichalcogenides for Ultrafast Hydrogen Evolution.

ACS Nano 2020 Jan 17;14(1):767-776. Epub 2019 Dec 17.

Shenzhen Geim Graphene Center (SGC), Tsinghua-Berkeley Shenzhen Institute (TBSI) & Tsinghua Shenzhen International Graduate School (TSIGS) , Tsinghua University , Shenzhen 518055 , People's Republic of China.

Large-scale implementation of electrochemical water splitting for hydrogen evolution requires cheap and efficient catalysts to replace expensive platinum. However, catalysts that work well at high current densities with ultrafast intrinsic activities is still the central challenge for hydrogen evolution. An ideal case is to use single atoms on monolayer two-dimensional (2D) materials, which simplifies the system and in turn benefits the mechanism study, but is a grand challenge to synthesize. Here, we report a universal cold hydrogen plasma reduction method for synthesizing different single atoms sitting on 2D monolayers. In the case of molybdenum disulfide, we design and identify a type of active site, .., unsaturated Mo single atoms on cogenetic monolayer molybdenum disulfide. The catalyst shows exceptional intrinsic activity with a Tafel slope of 36.4 mV dec in 0.5 M HSO and superior performance at a high current density of 400 mA cm with an overpotential of ∼260 mV, based on single flake microcell measurements. Theoretical studies indicate that coordinately unsaturated Mo single atoms sitting on molybdenum disulfide increase the bond strength between adsorbed hydrogen atoms and the substrates through hybridization, leading to fast hydrogen adsorption/desorption kinetics and superior hydrogen evolution activity. This work shines fresh light on preparing highly efficient electrocatalysts for water splitting and other electrochemical processes, as well as provides a general method to synthesize single atoms on two-dimensional monolayers.
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http://dx.doi.org/10.1021/acsnano.9b07763DOI Listing
January 2020

Primary Cutaneous Nocardiosis: A Rare Presentation of Nocardiosis.

Cureus 2019 Oct 7;11(10):e5860. Epub 2019 Oct 7.

Internal Medicine and Nephrology, University of Oklahoma Health Sciences Center, Oklahoma City, USA.

Nocardia is an uncommon gram-positive, weakly acid-fast bacterium that causes systemic or localized suppurative disease in humans and animals. Nocardiosis is typically regarded as an opportunistic infection, but approximately one-third of the patients are immunocompetent. The most common presentation is pulmonary disease (39%) followed by systemic involvement, defined as involvement of more than two sites; cutaneous presentation constitutes only 8% of the cases. Nocardia is widely distributed geographically; however, in the US, it is mostly found in warm and dry areas of South West and South East. We present a perfect case of cutaneous nocardiosis of a 70-year-old male, who presented with a traumatic splinter injury, leading to pustules formation on the right index finger, along with erythema and induration of the right arm. The patient was empirically diagnosed and treated for cellulitis, with amoxicillin and clavulanic acid, resulting in deterioration of the wound. The patient underwent incision and drainage and wound culture grew nocardia. The index of suspicion should be kept in mind while treating infectious blisters which have failed outpatient cellulitis treatment, immunocompromised hosts, and in nocardia prevalent regions.
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http://dx.doi.org/10.7759/cureus.5860DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6834106PMC
October 2019

Rheumatoid Vasculitis: Is It Always a Late Manifestation of Rheumatoid Arthritis?

Cureus 2019 Sep 28;11(9):e5790. Epub 2019 Sep 28.

Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, USA.

Rheumatoid vasculitis (RV) is an infrequent complication of longstanding severe rheumatoid arthritis (RA). The active vasculitis associated with rheumatoid disease occurs in about 1%-5% of the patient population. RV is a manifestation of "extra-articular" rheumatoid arthritis and involves the small- and medium-sized arteries in the body. Newer RA treatments, including biologic therapies, offer a broader array of potential therapeutic options, although no controlled trials exist to guide treatment. In general, following tissue confirmation of the diagnosis, the severity of organ involvement and disease manifestations can guide treatment decisions. We want to alert clinicians of this unique yet severe complication of RA which has high morbidity and mortality. We describe a thought-provoking case of a 44-year-old male with past medical history (PMH) of hypertension who presented with over three-month history of lower extremity (LE) swelling, discoloration, and ulceration. Arthralgias with constitutional symptoms (fatigue, weight loss), large pericardial effusion, was found to have leukocytoclastic vasculitis along with rheumatoid factor (RF) >650, and anti-cyclic citrullinated peptide (anti-CCP) antibodies >300, low C4 and normal C3. Pericardial fluid appeared serous, exudative, showed histiocytes, multinucleated giant cells and necrotic debris consistent with rheumatoid effusion. Skin, right shin, punch biopsy showed epidermal necrosis from underlying occlusive vasculopathy. Skin, left lower back, punch biopsy showed focal leukocytoclastic vasculitis. The patient was started on high dose steroids with marked improvement in the symptoms, Rituximab was planned awaiting QuantiFERON to be negative. Pan-CT angiography of the whole body was negative for any vascular changes ruling out polyarteritis nodosa (PAN).
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http://dx.doi.org/10.7759/cureus.5790DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6827848PMC
September 2019

Confined van der Waals Epitaxial Growth of Two-Dimensional Large Single-Crystal InSe for Flexible Broadband Photodetectors.

Research (Wash D C) 2019 19;2019:2763704. Epub 2019 Mar 19.

Shenzhen Geim Graphene Center, Tsinghua-Berkeley Shenzhen Institute, Tsinghua University, Shenzhen 518055, China.

The controllable growth of two-dimensional (2D) semiconductors with large domain sizes and high quality is much needed in order to reduce the detrimental effect of grain boundaries on device performance but has proven to be challenging. Here, we analyze the precursor concentration on the substrate surface which significantly influences nucleation density in a vapor deposition growth process and design a confined micro-reactor to grow 2D InSe with large domain sizes and high quality. The uniqueness of this confined micro-reactor is that its size is ~10-10 times smaller than that of a conventional reactor. Such a remarkably small reactor causes a very low precursor concentration on the substrate surface, which reduces nucleation density and leads to the growth of 2D InSe grains with sizes larger than 200 m. Our experimental results show large domain sizes of the 2D InSe with high crystallinity. The flexible broadband photodetectors based on the as-grown InSe show rise and decay times of 140 ms and 25 ms, efficient response (5.6 A/W), excellent detectivity (7×10 Jones), high external quantum efficiency (251%), good flexibility, and high stability. This study, in principle, provides an effective strategy for the controllable growth of high quality 2D materials with few grain boundaries.
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http://dx.doi.org/10.34133/2019/2763704DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6750059PMC
March 2019

Azathioprine and the neurologist.

Pract Neurol 2020 Feb 23;20(1):69-74. Epub 2019 Aug 23.

Neurology, St George's University Hospital, London, UK

Neurologists are very familiar with using corticosteroids and are aware of their considerable risk of adverse effects with prolonged use. Thus, we frequently consider alternative immunosuppression or corticosteroid sparing agents. However, unlike other specialties, such as rheumatology, there are few indications for corticosteroid-sparing agents in neurology and so our experience is less extensive; even these indications may reduce further as more disease-modifying treatments become available for neurological conditions. Azathioprine is perhaps the most commonly used corticosteroid-sparing agent in neurology. This review aims to remind neurologists of important aspects of azathioprine prescribing, focussing on enhancing patient safety and clinician confidence in its prescribing.
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http://dx.doi.org/10.1136/practneurol-2018-002161DOI Listing
February 2020

Percutaneous coronary intervention to left anterior descending artery/right coronary artery bifurcation: this is not a typo! A case report.

Eur Heart J Case Rep 2019 Sep;3(3)

Department of Cardiology, Altnagelvin Hospital, Glenshane Rd, Londonderry BT47 6SB, UK.

Background: Anomalous origin of the right coronary artery (RCA) is a rare congenital anomaly. A single coronary artery arising from the left sinus of Valsalva, with the RCA originating from the left anterior descending artery (LAD), is extremely rare. We report the case of an anomalous origin of the RCA from the mid LAD with a significant bifurcation lesion, in the setting of an acute coronary syndrome, endangering both the RCA and LAD territories.

Case Summary: An 85-year-old female presented with a non-ST elevation acute coronary syndrome. Transradial coronary angiography revealed an anomalous origin of the RCA arising from the mid LAD beyond a large first septal perforator. There was significant stenosis involving anomalous RCA/LAD bifurcation classified as Medina 1, 1, 1. Following discussion at heart team meeting, she underwent successful percutaneous coronary intervention. The LAD/RCA bifurcation was treated using a two-stent culotte technique without any complications. Computed tomography coronary angiogram was performed which confirmed a benign course of the anomalous RCA anterior to aorta and pulmonary artery.

Discussion: This anomaly poses a significant challenge in revascularization due to the large area of myocardium subtended by the LAD and RCA and usually an acute angle of bifurcation. Moreover, CTCA can be useful to ascertain the course of anomalous RCA.
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http://dx.doi.org/10.1093/ehjcr/ytz137DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6764568PMC
September 2019

Association Between Smoking and Survival Benefit of Immunotherapy in Advanced Malignancies: A Systematic Review and Meta-Analysis.

Am J Clin Oncol 2019 09;42(9):711-716

Department of Surgery, Division of Urology, Medical College of Georgia at Augusta University.

Objectives: Smoking is associated with an increased tumor mutational burden. As tumor mutational burden has been shown to correlate with response to immunotherapy (IO), we hypothesized that a history of smoking may be associated with better response to IO.

Methods: We utilized a systematic review with stratified meta-analysis of randomized clinical trials of IO versus standard of care in patients with advanced solid organ malignancies.

Results: Among 9 relevant studies, we found no significant difference in the benefit of IO, compared with other systemic therapies, between ever smokers (hazard ratio [HR], 0.77; 95% confidence interval [CI], 0.58-1.04; P=0.09) and never smokers (HR, 0.75; 95% CI, 0.67-0.86; P<0.0001) (test for difference P=0.83). We also observed no significant difference between current (HR, 0.92; 95% CI, 0.63-1.34; P=0.66; I=67%) and never smokers (HR, 0.74; 95% CI, 0.59-0.93; P=0.01; I=46%) (test for difference P=0.35).

Conclusions: Stratified meta-analysis demonstrates that smoking status is not significantly associated with the response to IO in the treatment of advanced solid organ malignancies.
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http://dx.doi.org/10.1097/COC.0000000000000577DOI Listing
September 2019

Primary cardiac angiosarcoma diagnosed in the first trimester of pregnancy.

Ecancermedicalscience 2019 9;13:922. Epub 2019 Apr 9.

Houston Methodist DeBakey Heart and Vascular Center, Houston, TX 77030, USA.

Primary cardiac angiosarcoma (PCAS) is a malignancy seldom seen in pregnancy. A 23-year-old G1P0 Chinese female was found to have PCAS during her first trimester when she presented with tamponade physiology. The transthoracic echocardiography (TTE) results did not indicate the presence of an intracardiac lesion, and pericardial fluid cytology analysis showed no evidence of malignancy. Cardiac magnetic resonance imaging (CMRI) exhibited a right atrial mass, and tissue biopsy indicated a high-grade angiosarcoma. MRI of the abdomen was suggestive of liver metastasis. She underwent an abortion and was started on combination chemotherapy, with a reduction in both the cardiac and liver masses. In cardiac angiosarcomas, advanced imaging modalities such as MRI should be utilised when there is high clinical suspicion or in the case of pregnancy when trying to minimise foetal harm. Prognosis is poor, and a standardised treatment protocol regardless of pregnancy continues to elude the medical community.
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http://dx.doi.org/10.3332/ecancer.2019.922DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6546259PMC
April 2019