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Cancer of unknown primary (CUP) represents a significant diagnostic and therapeutic challenge, being the third to fourth leading cause of cancer death, despite advances in diagnostic tools. This article presents a successful approach using a novel genomic analysis in the evaluation and treatment of a CUP patient, leveraging whole-exome sequencing (WES) and RNA sequencing (RNA-seq). The patient, with a history of multiple primary tumors including urothelial cancer, exhibited a history of rapid progression on empirical chemotherapy. The application of our approach identified a molecular target, characterized the tumor expression profile and the tumor microenvironment, and analyzed the origin of the tumor, leading to a tailored treatment. This resulted in a substantial radiological response across all metastatic sites and the predicted primary site of the tumor. We argue that a comprehensive genomic and molecular profiling approach, like the BostonGene© Tumor Portrait, can provide a more definitive, personalized treatment strategy, overcoming the limitations of current predictive assays. This approach offers a potential solution to an unmet clinical need for a standardized approach in identifying the tumor origin for the effective management of CUP.

Coronavirus-19 emerged about 3 years ago and has proven to be a devastating disease, crippling communities worldwide and accounting for more than 6.31 million deaths. The true disease burden of COVID-19 will come to light in the upcoming years as we care for COVID-19 survivors with post-COVID-19 syndrome (PCS) with residual long-term symptoms affecting every organ system. Pulmonary fibrosis is the most severe long-term pulmonary manifestation of PCS, and due to the high incidence of COVID-19 infection rates, PCS-pulmonary fibrosis has the potential of becoming the next large-scale respiratory health crisis. To confront the potentially devastating effects of emerging post-COVID-19 pulmonary fibrosis, dedicated research efforts are needed to focus on surveillance, understanding pathophysiologic mechanisms, and most importantly, an algorithmic approach to managing these patients. We have performed a thorough literature review on post-COVID-19 pulmonary symptoms/imaging/physiology and present an algorithmic approach to these patients based on the best available data and extensive clinical experience.

Byline: Albina. Guri, Lauren. Groner, Joanna. Escalon, Anthony. Saleh Coronavirus-19 emerged about 3 years ago and has proven to be a devastating disease, crippling communities worldwide and accounting for more [...]

Introduction Brain‐computer interfaces (BCIs), functioning as motor neuroprostheses, have the potential to restore the transmission of neural signal from the cerebral cortex to control digital devices and improve functional independence in patients with severe paralysis due to brain, spinal cord, peripheral nerve or muscle dysfunction. Methods COMMAND is an FDA‐approved, NIH‐funded single arm, open‐label, prospective early feasibility study designed to enroll 6 patients with severe quadriparesis to receive an endovascular implantable motor neuroprosthesis (Stentrode, Synchron Inc, Brooklyn, NY). The primary outcome measures include treatment related serious adverse events within 12‐month after device implantation. Secondary outcome measures include restoration of neural signal from the cerebral cortex utilized for neuromuscular control of digital devices, resulting in the successful execution of non‐mechanical digital commands, e.g., for the control of personal computers. The study device comprises of three parts: 1) Endovascular electrode array and lead (StentrodeTM), implanted percutaneously via the jugular vein in the superior sagittal sinus adjacent to the motor cortex using endovascular approach; 2) Implantable Receiver Transmitter Unit (IRTU) implanted in the pectoral region; and 3) Controller, including an External Receiver Transmitter Unit (ERTU), Signal Control Unit (SCU) and Software Application. Results A 67 year‐old patient with complete quadriplegia from amyotrophic lateral sclerosis (ALS) enrolled into the study and completed a screening process, which included CTV and MRV to ascertain normal venous sinus anatomy, with two patent jugular veins and bilateral patent transverse sinuses. Using a right internal jugular vein access, the investigational endovascular Stentrode BCI was implanted in the superior sagittal sinus adjacent to primary motor cortex. Co‐registration to enable accurate anatomical targeting was achieved by fusing structural MRI data with intra‐procedurally acquired 3D‐volume (3D‐DSA). A sub‐clavicular subcutaneous pocket was created to place the IRTU. Then, the lead was tunneled to the pocket and connected to the IRTU. Before closure of the wound, impedance measurement was taken which confirmed functionality of the system. The patient tolerated the procedure very well, was successfully extubated after the procedure and remained neurologically at his baseline. The patient was started on dual antiplatelet therapy 2 weeks prior to the surgery and will be continued on this regimen for 3 months.The participant will undergo machine‐learning‐assisted training to use wirelessly transmitted electrocorticography signals associated with attempted movements to control multiple mouse‐click actions, including zoom and left‐click. Used in combination with an eye‐tracker for cursor navigation, the patient will practice controlling a computer to conduct instrumental activities of daily living (IADL) tasks. Conclusions We describe the first US in‐human experience of a minimally invasive, fully implanted, wireless motor neuroprosthesis using an endovascular stent‐electrode array to transmit electrocorticography signals from the motor cortex for multiple command control of digital devices.

Los cítricos son el cultivo frutal de mayor importancia económica en el mundo. En Nicaragua, la producción de cítricos genera 24.5 millones de dólares anuales. Las enfermedades que se pueden prevenir inoculando micorrizas en porta injertos son la podredumbre radicular causada por Phytophthora sp y el mal seco de los cítricos por Fusarium sp. La introducción de patrones resistentes a enfermedades es una necesidad en la citricultura actual. En las últimas décadas se ha usado los hongos micorrizas arbusculares por el efecto benéfico que producen en sus hospedantes. El objetivo de este estudio fue evaluar el efecto de las micorrizas arbusculares sobre el desarrollo vegetativo de porta injertos Citrange Troyer y Citrange Carrizo. Los hongos micorrizas inoculados fueron aislados de las fincas productoras de cítricos Félix, Marino y San José. El género identificado con mayor porcentaje fue Glomus (97 % a 99 %), mientras que los géneros Scutellospora sp, Gigaspora sp., Septoglomus sp y Acaulospora sp, representaron el 1 % respectivamente. El porcentaje de colonización de raíces con el género Glomus sp, fue del 93 % para el porta injerto Troyer y en Carrizo fue de 83 % a 100 %. El efecto de Glomus sp, se evaluó midiendo las variables altura de planta (cm), número de hojas, diámetro de tallo (mm), longitud de raíz (cm) y biomasa (g). Los resultados del análisis de varianza y separación de medias de Tukey (α=0.05), presentan diferencias significativas para el porta injerto Troyer en las variables diámetro de tallo y longitud de raíces con el aislado de la finca San José, en el caso del porta injerto Carrizo el número de hojas, diámetro de tallo y longitud de raíz mostraron los más altos valores con el aislado de la finca Félix.