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Abstract Background The advent of immune checkpoint inhibitors (ICIs) represented a significant breakthrough in cancer therapy. Recently, the combined use of atezolizumab and bevacizumab was approved as first‐line treatment for unresectable hepatocellular carcinoma (HCC). Exposure to a novel and diverse spectrum of immune‐related adverse events (irAEs) has increased with the growing utilization of ICIs, however, a comprehensive understanding surrounding newer agents is still lacking. The incidence of kidney toxicities is rare but rising, often underreported due to the lack of confirmatory biopsies. Here, we present a rare case of biopsy‐proven acute interstitial nephritis (AIN) following atezolizumab‐bevacizumab treatment of advanced unresectable HCC. Case An 84‐year‐old male with T4N0M0 hepatocellular carcinoma was admitted after cycle 5 of atezolizumab due to decreased urine output and dysuria with a serum creatine of 4.7 mg/dL compared to a baseline of 1.3 mg/dL. To confirm the diagnosis of possible intrinsic renal injury, an ultrasound‐guided non‐focal biopsy of the left kidney was performed, revealing AIN. Potential exacerbatory medications, such as proton‐pump inhibitors, were discontinued. The patient was discharged on oral steroids with improvement in serum creatinine. Before completing the steroid taper, the patient developed pneumocystis pneumonia and eventually transitioned to hospice care. Conclusion This case highlights the valuable role renal biopsy can play in accurately capturing irAEs and guiding appropriate management in the setting of ICI‐induced AKI. It also exemplifies important considerations for steroid treatment of irAEs in the setting of comorbidities, such as diabetes.

In this research endeavor, we sought to enhance the efficacy of bamboo fibers through modification with the surfactant cetyltrimethylammonium bromide (CTAB) for the purpose of removing Reactive Blue 235 from effluent. Our investigation encompassed a comprehensive exploration of the impact of crucial parameters, namely, adsorbent dosage (0.25 g–1.25 g), contact time (10–80 min), pH (2–12), initial dye concentration (20–100 mg/L), and temperature (298 K, 308 K, and 318 K) on the dynamics of dye removal. The optimum dye removal efficiency of 94% for Reactive Blue 235 was obtained at an adsorbent dosage of 0.5 g/50 ml of dye solution, initial dye concentration of 40 mg/L, pH of 6, and contact time of 40 min. The experimental framework included the anticipation of data aligned with various isothermal and kinetic models, facilitating a nuanced understanding of the adsorption process. Our findings unveiled that the kinetics of adsorption adhered to a second-order model, while the Langmuir isotherm model aptly described the adsorption behavior. Particularly noteworthy was the monolayer’s adsorption capacity, quantified at an impressive 7.39 mg·g−1 at a temperature of 318 K. The value of Freundlich’s constant, KF, increases with an increase in temperature indicating the endothermic nature of adsorption. The magnitude of E obtained from Dubinin–Radushkevich isotherm varying from 3.92 to 4.66 kJ/mol on increasing temperature from 298 K to 318 K suggests that adsorption of RB235 on BAT is a physisorption (value of E is between 1 and 8 kJ/mol). Delving into the thermodynamic aspects of the process, we calculated ΔH and ΔS to be 54.88 kJ/mol and 184.54 J/mol/K, respectively. The consistently negative values of ΔG (between −0.183 kJ/mol and −3.884 kJ/mol) at all temperatures underscored the feasibility, spontaneity, and entropy-driven nature of the adsorption of RB235 on CTAB-treated bamboo fiber (BAT). What sets our study apart is the deliberate utilization of bamboo fibers sourced from local waste streams, embodying a commitment to sustainable practices. Beyond its effectiveness in effluent treatment, our approach aligns with eco-friendly principles by repurposing indigenous waste materials, contributing to a more sustainable and environmentally responsible future.

In this paper, the Parseval K-g-frames are constructed from a given K-g-frame by scaling the elements of the K-g-frame with the help of diagonal operators, and these frames are named scalable K-g-frames. Also, we prove some properties of scalable K-g-frames and construct new scalable K-g-frames from a given K-g-frame. The necessary and sufficient conditions for a K-g-frame to be scalable are given. Further, equivalent conditions for the scalability of K-g-frames and the K-frames induced by K-g-frames are obtained. Finally, it is shown that the direct sum of two scalable K-g-frames is again a scalable K-g-frame for some suitable bounded linear operator K.

Background Clinical prediction models have been developed for hospitalization for heart failure in type 2 diabetes. However, a systematic evaluation of these models’ performance, applicability, and clinical impact is absent. Methods and Results We searched Embase, MEDLINE, Web of Science, Google Scholar, and Tufts’ clinical prediction registry through February 2021. Studies needed to report the development, validation, clinical impact, or update of a prediction model for hospitalization for heart failure in type 2 diabetes with measures of model performance and sufficient information for clinical use. Model assessment was done with the Prediction Model Risk of Bias Assessment Tool, and meta‐analyses of model discrimination were performed. We included 15 model development and 3 external validation studies with data from 999 167 people with type 2 diabetes. Of the 15 models, 6 had undergone external validation and only 1 had low concern for risk of bias and applicability (Risk Equations for Complications of Type 2 Diabetes). Seven models were presented in a clinically useful manner (eg, risk score, online calculator) and 2 models were classified as the most suitable for clinical use based on study design, external validity, and point‐of‐care usability. These were Risk Equations for Complications of Type 2 Diabetes (meta‐analyzed c‐statistic, 0.76) and the Thrombolysis in Myocardial Infarction Risk Score for Heart Failure in Diabetes (meta‐analyzed c‐statistic, 0.78), which was the simplest model with only 5 variables. No studies reported clinical impact. Conclusions Most prediction models for hospitalization for heart failure in patients with type 2 diabetes have potential concerns with risk of bias or applicability, and uncertain external validity and clinical impact. Future research is needed to address these knowledge gaps.

Abstract Right ventricular (RV) failure remains a major complication after surgical implantation of a left ventricular assist device (LVAD). While the use of a percutaneous RV assist device has been described as a short‐term bridge to recovery in end‐stage heart failure patients with early post‐operative RV failure after index LVAD implant, management of refractory late RV failure remains challenging in these patients. We report the first successful case of extended Impella RP use as a safe and effective bridge to orthotopic heart transplant in an LVAD patient with refractory, haemodynamically significant late RV failure. The Impella RP provided support for 37 days. Haemodynamically intolerant arrhythmia precluded use of inotropic support. No adverse complications related to percutaneous Impella RP support were seen. We also review potential considerations for mechanical circulatory support strategies in this setting: central RV assist device cannulation requires sternotomy incision that can impact subsequent cardiac surgeries, while percutaneous Protek Duo insertion requires adequate vessel size and patency. With an LVAD in situ, veno‐arterial extracorporeal membrane oxygenation was not considered for isolated RV support in this case. The patient is currently over 6 months post‐orthotopic heart transplant.

Abstract Cardiac amyloidosis results in an infiltrative restrictive cardiomyopathy, with a number of characteristic features: biventricular hypertrophy, abnormal myocardial global longitudinal strain with relative apical sparing, biatrial dilation, and small pericardial effusion along with conduction abnormalities. Amyloid deposits leading to hemodynamically significant valvular heart disease are very rare. We describe a rare case of concomitant moderately severe tricuspid and mitral valve stenosis because of ongoing amyloid deposition in a patient with progressive multiple myeloma and fat pad biopsy‐proven light chain amyloidosis. Worsening infiltrative cardiomyopathy and valvulopathy despite evidence‐based chemotherapy and heart failure pharmacotherapy led to end‐stage disease and death. Valvular involvement in cardiac amyloidosis requires early recognition of the underlying disease condition to guide directed medical therapy and prevent its progression. In this instance, valvuloplasty or valve replacement is not a viable option.

Background The acuity and magnitude of the first wave of the COVID‐19 epidemic in New York mandated a drastic change in healthcare access and delivery of care. Methods and Results We retrospectively studied patients admitted with an acute cardiovascular syndrome as their principal diagnosis to 13 hospitals across Northwell Health during March 11 through May 26, 2020 (first COVID‐19 epidemic wave) and the same period in 2019. Three thousand sixteen patients (242 COVID‐19 positive) were admitted for an acute cardiovascular syndrome during the first COVID‐19 wave compared with 9422 patients 1 year prior (decrease of 68.0%, P

Background The effect of implantable cardioverter defibrillators (ICD) in patients with continuous flow left ventricular assist devices (LVADs) on outcomes has not been evaluated in a randomized clinical trial. Methods and Results This is a retrospective single‐center study that included patients who underwent continuous flow LVAD implantation at the Cleveland Clinic between October 2004 and March 2017. Patients were evaluated according to the presence or absence of ICD at the time of LVAD insertion. Among 486 patients in the study cohort, 387 (79.6%) had an ICD before LVAD insertion. Patients with ICD before LVAD were older and had lower use of pre‐LVAD inotropes, extracorporeal membrane oxygenation, and mechanical ventilation. There were 81 patients (21.4% of patients with ICD) who required 93 procedures after LVAD: 74 generator exchanges, 12 lead revisions, and 7 complete system removals because of infection. Of the 99 patients without ICD, 52 (53%) underwent ICD implantation: 29 for primary prevention and 23 for secondary prevention. Patients were followed for a median of 401 (interquartile range 150–966) days. The presence of a pre‐LVAD ICD was not associated with mortality in a multivariable model (hazard ratio 1.19, 95% CI 0.73–1.93, P=0.492), nor was the presence of an ICD at any point when analyzed as a time‐varying covariate (hazard ratio 1.05, 95% CI 0.50–2.20, P=0.907). Conclusions There is no apparent mortality benefit associated with an ICD in a contemporary cohort of patients with continuous flow LVADs to balance considerable morbidity involving ICD‐related procedures and complications.

The study was conducted on skin of 24 buffaloes collected from slaughter house. The skin tissues were collected from dorsal, lateral, and ventral parts of head, neck, thorax, abdomen, and tail regions and fixed in 10% neutral buffered formalin. The tissues were processed for paraffin blocks preparation by acetone benzene schedule. The paraffin sections of 5-6 μm were cut with rotary microtome and stained with hematoxylin and eosin. The sweat glands in buffaloes were of saccular and simple coiled tubular type. Most of the sweat glands were associated with hair follicles and consisted of a coiled secretory portion (body) and a straight duct. The secretory portion was made up of glandular tubules, myoepithelium, and basement membrane. The duct portion had a narrow lumen and was lined by simple cuboidal epithelium. The glandular epithelium was simple squamous, simple cuboidal, or low columnar type depending upon their stage of secretary activity. Two types of sweat glands were observed, i.e., apocrine and merocrine. Large number of blood vessels and nerve fibers were observed in the vicinity of the sweat glands. In head, neck, and tail regions the maximum number of sweat glands/mm2 was observed in dorsal side which did not vary significantly (p

The objective of the present study is to investigate nutritional and antioxidant activity of four types of organic tomato cultivars. The differences in tomato quality are also tested between groups with or without treatment using an organic biostimulator, Stimplex. Total phenolic compounds (TPC), lycopene, β-carotene, DPPH free radical scavenging activity, reducing power, and color parameters were investigated in the current study. The results showed that there was no significant difference in TPC among cultivars regardless of Stimplex treatment. Higher lycopene and β-carotene were obtained in Stimplex treated tomatoes. Lycopene and β-carotene contents were significantly different among cultivars (P

The study was conducted on pancreas of 24 buffalo fetuses collected from abattoir and Veterinary clinics, GADVASU, Ludhiana. The buffalo fetuses were divided into three groups after measuring their CVRL, namely, group I (CVRL between 0 and 20 cm), group II (CVRL above 20 cm and up to 40 cm), and group III (CVRL above 40 cm) and their approximate age was calculated. The tissues were processed for light and ultrastructural studies. In group I, at 1.2 cm CVRL (34 days), the pancreas comprised tubules and solid nest of undifferentiated epithelial cells. At 7.5 cm CVRL (63 days) acinar cells with zymogen granules were observed. These acinar cells varied in shape from columnar to pyramidal. At 12.8 cm CVRL (86 days), parenchyma began to organize into lobes and lobules. The centroacinar cells were observed at 12.8 cm CVRL (86 days). In group II, at 28.3 cm CVRL (137 days), there was extensive branching of tubules that resulted in highly branched ductal tree connecting exocrine secretary units to the duct system. The interlobular and intralobular ducts were well observed at this age yet the intercalated ducts were not completely developed. In group III, exocrine pancreas showed a massive growth at 48 cm CVRL (182 days) with distinct pancreatic lobes and lobules. At 54 cm CVRL (195 days), well developed pancreatic architecture was seen with the presence of extensive development of exocrine part organized in lobes and lobules with interlobular and intralobular ducts whereas the intercalated ducts were observed in 80 cm CVRL (254 days).