Immune checkpoint inhibitor-associated myocarditis and fulminant type I diabetes in a patient with metastatic non-small cell lung cancer.

A woman in her mid-60s presented to the hospital due to a history of nausea, vomiting, shortness of breath, dyspnoea on exertion and polyuria. She was receiving medical therapy for advanced non-small cell lung cancer and recently initiated immune checkpoint inhibitor (ICI) immunotherapy. Investigations revealed lab results consistent with diabetic ketoacidosis (DKA), elevated cardiac biomarkers, multiple cardiac arrhythmias and reduced ejection fraction on transthoracic echocardiogram. Cardiac catheterisation showed non-obstructive coronary arteries.The patient was diagnosed with an ICI-associated myocarditis and type I diabetes due to recent initiation of the ICI durvalumab. She was treated with the institutional DKA protocol and received corticosteroid therapy for drug toxicity according to guidelines. She was discharged with marked improvement in symptoms. The patient had good recovery after discharge with further investigations showing improvement in her cardiac ejection fraction on cardiac MRI. She remains on medical therapy with an insulin regimen for diabetes management.

Rootstock-induced scion resistance against tobacco mosaic virus is associated with the induction of defence-related transcripts and graft-transmissible mRNAs.

Grafting is a common horticultural practice used to confer desirable traits between rootstock and scion, including disease resistance. To investigate graft-conferred resistance against viral diseases a novel heterografting system was developed using Nicotiana benthamiana scions grafted onto different tomato rootstocks. N. benthamiana is normally highly susceptible to tobacco mosaic virus (TMV) infection. However, specific tomato rootstock varieties were found to confer a range of resistance levels to N. benthamiana scions inoculated with TMV. Conferred resistance was associated with delays in virus accumulation and the reduction in virus spread. RNA sequencing analysis showed the enrichment of transcripts associated with disease resistance and plant stress in N. benthamiana scions grafted onto resistance-inducing tomato rootstocks. Genome sequencing of resistance- and nonresistance-conferring rootstocks was used to identify mobile tomato transcripts within N. benthamiana scions. Within resistance-induced N. benthamiana scions, enriched mobile tomato transcripts were predominantly associated with defence, stress, and abscisic acid signalling when compared to similar scions grafted onto nonresistance-inducing rootstock. Combining these findings suggests that graft-induced resistance is modulated by rootstock scion transcriptional responses and rootstock-specific mobile transcripts.

Cardiac surgery in Indigenous Australians--how wide is 'the gap'?

BACKGROUND: Cardiovascular disease remains the leading cause of mortality in the Indigenous Australian population. Limited research exists in regards to cardiac surgery in the Aboriginal and Torres Strait Islander (ATSI) population. We aimed to investigate risk profiles, surgical pathologies, surgical management and short term outcomes in a contemporary group of patients. METHODS: Variables were assessed for 557 consecutive patients who underwent surgery at our institution between August 2008 and March 2010. RESULTS: 19.2% (107/557) of patients were of Indigenous origin. ATSI patients were significantly younger at time of surgery (mean age 54.1±13.23 vs. 63.1±12.46; p=<0.001) with higher rates of preventable risk factors. Rheumatic heart disease (RHD) was the dominant valvular pathology observed in the Indigenous population. Significantly higher rates of left ventricular impairment and more diffuse coronary artery disease were observed in ATSI patients. A non-significant trend towards higher 30-day mortality was observed in the Indigenous population (5.6% vs. 3.1%; p=0.244). CONCLUSIONS: Cardiac surgery is generally required at a younger age in the Indigenous population with patients often presenting with more advanced disease. Despite often more advanced disease, surgical outcomes do not differ significantly from non-Indigenous patients. Continued focus on preventative strategies for coronary artery disease and RHD in the Indigenous population is required.

Easy come, easy go: a simple and effective orthodontic enamel anchor for endotracheal tube stabilization in a child with extensive facial burns.

Endotracheal tube stabilization in patients with facial burns is crucial and often challenging. We present a simple method of securing an endotracheal tube using two orthodontic brackets bonded to the maxillary central incisor teeth and a 0.08'' stainless steel ligature wire. Our technique is less traumatic, and is easier to maintain oral hygiene than with previously described methods. This anchorage system takes 5 min to apply and can be removed on the ward without the need for a general anaesthetic.