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Renal cell carcinoma (RCC) is increasing in incidence as more cross sectional imaging is performed with approximately 20%-30% of cases presenting with metastasis at the time of diagnosis. Small bowel metastatic disease is rare, with RCC to the small bowel being exceptionally rare. We present a case report of metastatic RCC that initially presented as upper gastrointestinal bleeding at time of diagnosis. We also provide a brief discussion of small bowel metastatic RCC disease and literature review.

Understanding the psychological factors that influence people's behavior in using sustainable modes of transportation, e.g., public transport, is crucial for promoting environmentally friendly behavior and mitigating climate change. This study examines the impact of the big-two personality traits (stability and plasticity) on households' auto transport consumption (ATC) and public transport consumption (PTC), and their mediating role in the relationship between socioeconomic factors (e.g., age, income, education, marital status) and transport consumptions (i.e., ATC and PTC). A triple-hurdle model, including two binary logit models and one structural equation model, is developed using a comprehensive national household survey in Australia. Findings reveal that the stability trait is positively related to ATC (b = 0.253, p < 0.10) and negatively to PTC (b = −0.372, p < 0.001), while the plasticity trait shows a positive association with PTC (b = 0.351, p < 0.001) and is negatively related to ATC (b = −0.296, p < 0.001). The developed analytical framework supports policymakers to identify individuals with stability and plasticity traits, using socioeconomic factors, and to design more-targeted interventions to incentivize specific individuals to use public transport, thus contributing to global efforts toward a sustainable future. [ABSTRACT FROM AUTHOR]

OBJECTIVES:. To develop a predictive model using vital sign (heart rate and arterial blood pressure) variability to predict time to death after withdrawal of life-supporting measures. DESIGN:. Retrospective analysis of observational data prospectively collected as part of the Death Prediction and Physiology after Removal of Therapy study between May 1, 2014, and May 1, 2018. SETTING:. Adult ICU. PATIENTS:. Adult patients in the ICU with a planned withdrawal of life-supporting measures and an expectation of imminent death. INTERVENTIONS:. None. MEASUREMENTS AND MAIN RESULTS:. Vital sign waveforms and clinical data were prospectively collected from 429 patients enrolled from 20 ICUs across Canada, the Czech Republic, and the Netherlands. Vital sign variability metrics were calculated during the hour prior to withdrawal. Patients were randomly assigned to the derivation cohort (288 patients) or the validation cohort (141 patients), of which 103 and 54, respectively, were eligible for organ donation after circulatory death. Random survival forest models were developed to predict the probability of death within 30, 60, and 120 minutes following withdrawal using variability metrics, features from existing clinical models, and/or the physician’s prediction of rapid death. A model employing variability metrics alone performed similarly to a model employing clinical features, whereas the combination of variability, clinical features, and physician’s prediction achieved the highest area under the receiver operating characteristics curve of all models at 0.78 (0.7–0.86), 0.79 (0.71–0.87), and 0.8 (0.72–0.88) for 30-, 60- and 120-minute predictions, respectively. CONCLUSIONS:. Machine learning models of vital sign variability data before withdrawal of life-sustaining measures, combined with clinical features and the physician’s prediction, are useful to predict time to death. The impact of providing this information for decision support for organ donation merits further investigation.

OBJECTIVES:. Implantation of venovenous extracorporeal membrane oxygenation as an alternative to invasive mechanical ventilation, an “awake approach,” may facilitate a lung- and diaphragm-protective ventilatory strategies without the associated harms of endotracheal intubation, positive pressure ventilation, and continuous sedation. This report presents the characteristics and outcomes of the patients treated with the awake venovenous extracorporeal membrane oxygenation approach. DESIGN:. Retrospective case series. SETTING:. Monocenter study. PATIENTS:. Severe acute respiratory syndrome coronavirus 2 patients with acute respiratory failure treated with venovenous extracorporeal membrane oxygenation instead of invasive mechanical ventilation from March 2020 to March 2021. INTERVENTIONS:. None. MEASUREMENTS AND MAIN RESULTS:. Physiologic and laboratory data were collected at admission to the ICU, prior to and after venovenous extracorporeal membrane oxygenation implantation, and at decannulation. Seven patients were treated with venovenous extracorporeal membrane oxygenation instead of invasive mechanical ventilation due to hypoxemia with a median Pao2/Fio2 ratio at implantation of 76 (interquartile range, 59–92). Four patients in the awake group subsequently required invasive mechanical ventilation, and only one patient (14.3%) died. There were no significant complications attributed venovenous extracorporeal membrane oxygenation. CONCLUSIONS:. This report demonstrates that in a selected group of patients, an “awake” venovenous extracorporeal membrane oxygenation approach is feasible and may result in favorable outcomes.

Purpose: NRG Oncology's RTOG 0933 demonstrated benefits to memory preservation after hippocampal avoidant whole-brain radiation therapy (HA-WBRT), the avoidance of radiation dose to the hippocampus (using intensity modulated radiation planning and delivery techniques) during WBRT, supporting the hypothesis of hippocampal radiosensitivity and associated memory specificity. However, some patients demonstrated cognitive decline, suggesting mechanisms outside hippocampal radiosensitivity play a role. White matter injury (WMI) has been implicated in radiation therapy–induced neurocognitive decline. This secondary analysis explored the relationship between pretreatment WMI and memory after HA-WBRT. Methods and Materials: Volumetric analysis of metastatic disease burden and disease-unrelated WMI was conducted on the pretreatment magnetic resonance image. Correlational analyses were performed examining the relationship between pretreatment WMI and Hopkins Verbal Learning Test-Revised (HVLT-R) outcomes at baseline and 4 months after HA-WBRT. Results: In the study, 113 patients received HA-WBRT. Of 113 patients, 33 underwent pretreatment and 4-month posttreatment HVLT testing and pretreatment postcontrast volumetric T1 and axial T2/fluid-attenuated inversion recovery magnetic resonance imaging. Correlation was found between larger volumes of pretreatment WMI and decline in HVLT-R recognition (r = 0.54, P

Objective: Fatigue is common in patients with systemic lupus erythematosus (SLE). Fatigue severity scale (FSS) is used to measure fatigue. This study was aimed to develop a culturally adapted Bangla version of the English FSS and to validate it. Methods: English version of FSS was translated into Bangla and adapted in the local sociocultural context, following the recommendations of Beaton et al. One hundred and twenty SLE patients were assessed in the Rheumatology Department of Bangabandhu Sheikh Mujib Medical University. Content validity of the adapted Bangla version was evaluated by item-level content validity index (I-CVI) and scale-level content validity index (S-CVI). Correlation between FSS and health assessment questionnaire-disability index (HAQ-DI) and 12 item short form health survey (SF-12) was measured for the assessment of convergent validity. Internal consistency and test–retest reliability were also assessed. Results: Our procedure had no problem with the content and language. I-CVI and S-CVI for each item was one. FSS showed strong positive correlation (>0.7) with HAQ-DI and strong negative correlation (>−0.7) with SF-12. The scale demonstrated excellent internal consistency (Cronbach's alpha = 0.93) and test–retest reliability (intraclass correlation coefficient = 0.93). Conclusions: The adapted Bangla version of FSS is a reliable and valid instrument and can be recommended for the self-assessment of fatigue in SLE patients. [ABSTRACT FROM AUTHOR]

The relaxation that is known to occur in the crystalline phase of pentachloronitrobenzene (PCNB) and 2,3,4,5,6-pentabromotoluene (PBT) is critically examined using dielectric spectroscopy and differential scanning calorimetry. Findings suggest that the hexasubstituted benzenes or their binaries do not reveal any well resolved secondary relaxation in their plastic crystalline phases within the resolution of the experimental setup and that the T dependence of the relaxation rate deviates from Arrhenius character near [T.sub.g] in PBT, PCNB, and PCT.