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We report the case of a 42-year-old female diagnosed with acute promyelocytic leukemia (APL), who developed differentiation syndrome (DS) on day 14 during induction therapy with all-trans retinoic acid (ATRA) and arsenic trioxide (ATO) with sudden-onset dyspnea, abdominal pain, tachycardia, and fever. Her laboratory findings were remarkable for acute kidney injury (AKI), worsening leukocytosis, thrombocytopenia, and lactic acidosis. She was also found to have flash pulmonary edema and a pericardial effusion. Despite immediate dexamethasone and methylprednisolone administration along with cessation of induction therapy, she continued to worsen and suffered a non-shockable cardiac arrest. Return of spontaneous circulation (ROSC) was achieved, but she was in profound shock requiring multiple vasopressors. The patient suffered repeat cardiac arrest later that day and passed away within 24 hours. DS is a potentially life-threatening complication in APL treatment, occurring in about 25% of APL patients and posing significant treatment challenges.

Abstract Objectives The objective of this study is to investigate the association between the use of beta‐adrenergic antagonist atenolol and risk of pathologic upgrade in patients on active surveillance, considering growing literature implicating adrenergic innervation with disease progression mediated through beta‐adrenergic signalling. Patients and Methods Men with low‐risk or favourable intermediate‐risk prostate cancer who were placed on an active surveillance protocol between 2006 and 2020 across three diverse urban hospitals were included. Exposure was duration of atenolol use, and outcome was pathologic grade group upgrading (to GG ≥ 3) on final prostate biopsy. Cox proportional hazard regression models were used to determine the associations between atenolol use and risk of upgrading with time, on a per‐examination basis. Results A total of 467 men with initial GG ≤ 2 were included. Postdiagnosis atenolol use was associated with a decreased risk of pathologic upgrade to GG ≥ 3 on final repeat biopsy (HR 0.81, 95% CI 0.39–0.98). Longer duration of postdiagnosis atenolol use (>2 years) and greater cumulative atenolol dose (>730 defined daily doses) were associated with a more pronounced decreased risk of upgrade to GG ≥ 3 (HR 0.41, 95% CI 0.05–0.88, and HR 0.32, 95% CI 0.15–0.99, respectively). Initiation of atenolol use prior to prostate cancer diagnosis had a slightly greater protective effect than drug initiation postdiagnosis (HR 0.79, 95% CI 0.43–0.98, and HR 0.83, 95% CI 0.30–0.99, respectively). Conclusions Beta‐adrenergic blockade with atenolol use in men on active surveillance is associated with a reduced risk for clinically significant grade group pathologic upgrade.

In this work, we prepared expanded graphite (EG) filler using hydrogen peroxide (H2O2) as an oxidizing agent to study its impact on the thermal conductivity (k) of polyetherimide (PEI) composite, compared to EG prepared using sodium chlorate (NaClO3). Sulfuric acid was used as the primary intercalating agent for both synthesis routes. The use of H2O2 prepared EG (EG-H2O2) led to a remarkable ∼4030% enhancement (9.5 Wm−1K−1) in k of the PEI/EG composite, while the use of NaClO3 prepared EG (EG-NaClO3) led to a much smaller enhancement of ∼2190% (5.3 Wm−1K−1), at 10 wt% EG composition compared to kPEI (∼0.23 Wm−1K−1). Such findings exceed the current state-of-art in EG-based polymer composites. Detailed characterization was performed to understand the properties of EG-H2O2 and EG-NaClO3. Raman analysis revealed that H2O2 resulted in relatively defect-free EG (ID/IG ratio ∼0.04), thus preserving the k of graphite (∼2000 Wm−1K−1). Use of NaClO3, however, led to a large defect density (ID/IG ratio ∼0.25), yielding graphite with significantly diminished k. Furthermore, through-plane thermal diffusivity of EG-H2O2 paper was measured to be 9.5 mm2s-1 while that of NaClO3 case was measured to be 6.7 mm2s-1, thus directly confirming the beneficial impact of H2O2 in preserving the high k of graphene. X-ray photoelectron spectroscopy (XPS) revealed that the higher number of defects in EG-NaClO3 are due to the higher degree of oxidation induced by NaClO3. The results demonstrate the potential of EG-H₂O₂ as an efficient filler for achieving high thermal conductivity polymer composites.

Papillary muscle rupture is commonly linked to ischemic events, occurring typically postmyocardial infarction. However, iatrogenic and nonischemic etiologies can play a role in papillary muscle rupture, including infective endocarditis. The case presented herein is an 85-year-old female with a history of heart failure with preserved ejection fraction (HFpEF), who presented with progressive dyspnea despite furosemide therapy, and was discovered to have a flail posterior mitral valve leaflet secondary to papillary muscle rupture associated with Streptococcus lutetiensis endocarditis. Transthoracic echocardiography revealed flail posterior mitral valve leaflet with newly appreciated severe wide-open mitral regurgitation. Emergent mitral valve repair was performed with a successful MitraClip placement. Patient had an atypical presentation without ischemic symptomology or electrocardiogram (EKG) changes indicative of ischemia. Despite transesophageal echocardiography, not revealing vegetations, infective endocarditis was presumed due to presence of Streptococcus lutetiensis bacteremia, osteomyelitis, elevated inflammatory markers, and clinical presentation. Papillary muscle rupture results in severe mitral regurgitation that is a medical emergency that requires prompt diagnosis and management from a multidisciplinary team. Therefore, it is imperative to ensure clinical insight into the multiple etiologies of papillary muscle rupture to provide timely treatment.

IntroductionThe Brahmaputra, a major transboundary river of the Himalayas flowing predominantly through Northeast India, particularly Assam, is increasingly endangered by contamination due to rapid urbanization and anthropogenic pressures. These environmental changes pose significant risks at the microbial level, affecting nutrient cycling and productivity, and thereby impacting river ecosystem health. The next-generation sequencing technology using a metagenomics approach has revolutionized our understanding of the microbiome and its critical role in various aquatic environments.MethodsThe present study aimed to investigate the structure of the bacterial community and its functional potentials within the sediments of the Brahmaputra River, India, using high-throughput shotgun metagenomics. Additionally, this study sought to explore the presence of antimicrobial resistance genes in the river’s sediment.Results and discussionShotgun metagenomics revealed a diverse bacterial community comprising 31 phyla, 52 classes, 291 families, 1,016 genera, and 3,630 species. Dominant phyla included Pseudomonadota (62.47–83.48%), Actinobacteria (11.10–24.89%), Bacteroidetes (0.97–3.82%), Firmicutes (0.54–3.94%), Cyanobacteria (0.14–1.70%), and Planctomycetes (0.30–0.78%). Functional profiling highlighted significant involvement in energy metabolism, amino acid and central carbon metabolism, stress response, and degradation pathways, emphasizing the microbial community’s role in ecosystem functioning and resilience. Notably, 50 types of antibiotic resistance genes (ARGs) were detected, with resistance profiles spanning multidrug, aminoglycoside, β-lactam, fluoroquinolone, rifampicin, sulfonamide, and tetracycline classes. Network analysis underscored the intricate relationships among ARG subtypes, suggesting potential mechanisms of resistance propagation. Furthermore, plasmid-related genes and 185 virulence factor genes (VFGs) were identified, indicating additional layers of microbial adaptation and potential pathogenicity within the river sediments. This comprehensive microbial and functional profiling of the Brahmaputra’s sediment metagenome provides crucial insights into microbial diversity, resistance potential, and ecological functions, offering a foundation for informed management and mitigation strategies to preserve river health and mitigate pollution impacts.

Background Following international guidelines, communities have deployed automated external defibrillators at train stations without substantive evidence. Methods and Results We geocoded public out‐of‐hospital cardiac arrests (OHCAs) (2016–2020), automated external defibrillators, and train stations. The stations were divided into the following groups according to passenger flow: 1 (0–499), 2 (500–4999), 3 (5000–9999), and 4 (>10 000) passengers per day. Risk ratios (RRs) were calculated using Poisson regression of rates, and odds ratios (ORs) were analyzed through logistic regression. OHCAs at train stations accounted for 102 (2.3%) of 4467 public OHCAs. The incidence rate (IR) and RR for OHCAs were for group 1: IR, 0.02 OHCA per station per year, RR, 1.0 (reference); group 2: IR, 0.07, RR, 4.1 (95% CI, 2.3–7.3); group 3: IR, 0.25, RR, 12.7 (95% CI, 6.2–25.9); and group 4: IR, 0.34, RR, 16.3 (95% CI, 8.6–30.9). Compared with other public OHCAs, OHCAs at train stations were just as likely to receive bystander cardiopulmonary resuscitation (OR, 1.13 [95% CI, 0.60–2.12]). However, they had higher odds of bystander defibrillation (OR, 1.66 [95% CI, 1.06–2.58]), were more likely to achieve return of spontaneous circulation (OR, 1.88 [95% CI, 1.24–2.85]), and survive 30 days (OR, 2.37 [95% CI, 1.57–3.59]). Conclusions The incidence of OHCAs at train stations was associated with passenger flow, with the busiest stations having a 16‐fold higher risk of OHCAs than the lowest. OHCAs at train stations had better outcomes compared with other public OHCAs.

The field of vascular anomalies has seen a rapid paradigm shift from descriptive to molecular diagnoses, with DNA-based next-generation sequencing becoming standard practice in the workup and characterization of lesions. RNA-based panels for fusion transcripts have been less utilized in the field of vascular anomalies. We report a recurrent, infiltrative prevertebral vascular tumor negative for known somatic variants but positive for an Ewing sarcoma breakpoint region 1::nuclear factor of activated T-cells cytoplasmic 2 fusion transcript. This lesion demonstrated intermediate malignant potential with morphologic atypia, novel intraluminal endothelial growth, and atypical mitoses, which have not previously been reported. RNA-based panels for fusion transcripts may represent the next impactful evolution of molecular characterization of vascular malformations and tumors.

Abstract Background Medical cannabis use and public acceptance in the United States have increased over the past 25 years. However, access to medical cannabis remains limited, particularly for underserved populations. To understand how patients experience medical cannabis accessibility, we measured medical cannabis use and barriers to use after medical cannabis certification in an urban safety-net academic medical center. Methods We conducted a retrospective cohort study among patients seen in Montefiore’s Medical Cannabis Program (MMCP) from 2017 to 2019. Patient demographic and clinical characteristics, as well purchase history of medical cannabis, were extracted from electronic medical records. We also administered a phone questionnaire to a subset of patients to assess usage patterns, effectiveness, and barriers to medical cannabis use. Results Among 562 patients who were newly certified for medical cannabis between 2017 and 2019, 45% purchased medical cannabis, while 55% did not. Patients who purchased medical cannabis were more likely to be white and have private insurance or Medicare. Unregulated cannabis use and current tobacco use were less common among those who purchased medical cannabis. In multivariable logistic regression analysis, unregulated cannabis use remained negatively associated with purchasing medical cannabis. Patients reported that affordability and dispensary accessibility were their main barriers to purchasing medical cannabis. Conclusion Among patients certified for medical cannabis use, fewer than half purchased medical cannabis after certification. Improving access to medical cannabis is crucial for ensuring equitable access to regulated cannabis, and to reducing unregulated cannabis use.

Human foot is a biological masterpiece, which is strong enough to support the body weight and flexible enough to adjust to various surfaces. Foot postural deviation can alter the alignment of the entire body. The collapse of the medial longitudinal arch of the foot causes one of the most prevalent deformities i.e. flat foot. Diabetic patients are more prone to have flat foot due to degeneration of posterior tibial tendon over the course of their disease. The aim of this study was to determine the occurrence of adult acquired flat foot and assess the disability of flat foot among diabetic population in Rawalpindi and Islamabad, Pakistan. In this cross-sectional descriptive study, 384 diabetic patients aged 35-60 year were enrolled after obtaining informed consent. Non-probability convenience sampling technique was employed. The data was gathered by performing navicular drop test to determine the presence of flat foot, assessment of posterior tibial tendon dysfunction through single heel rise test and by using foot function index questionnaire to assess pain, disability and activity limitation. Based on results of the study, posterior tibial tendon dysfunction was observed to cause the appearance of low navicular height leading to flat foot in 58.33% of the population. Moreover, there is a moderate tendency of occurrence of flat foot among diabetic population in the absence of other risk factors such as hypertension, obesity, steroids use and previous foot trauma etc. With regard to the functionality measured by foot function index, it was implied that the functional status of the patient was reduced because of the pain, disability and activity restriction in the presence of flat foot.