Recent advances in the control of volatile organic compounds emissions from indoor wood-based panels: A comprehensive review.

Wood-based panels provide efficient alternatives to materials such as plastics derived from traditional petroleum sources and thereby help to mitigate greenhouse gas emissions. Unfortunately, using indoor manufactured panel products also results in significant emissions of volatile organic compounds including olefins, aromatic and ester compounds, which negatively affect human health. This paper highlights recent developments and notable achievements in the field of indoor hazardous air treatment technologies to guide future research toward environmentally friendly and economically feasible directions that may have a significant impact on the improvement of human settlements. Summarizing and synthesizing the principles, advantages, and limitations of different technologies can assist policymakers and engineers in identifying the most appropriate technology for a particular air pollution control program based on criteria such as cost-effectiveness, efficiency, and environmental impact. In addition, insights into the development of indoor air pollution control technologies are provided and potential areas for innovation, improvement of existing technologies, and development of new technologies are identified. Finally, the authors also hope that this sub-paper will raise public awareness of indoor air pollution issues and promote a better understanding of the importance of indoor air pollution control technologies for public health, environmental protection, and sustainable development.

Remediation and recovery of Kariba weed as emerging contaminant in freshwater and shellfish aquaculture system via solvothermal liquefaction.

Fast growing Kariba weed causes major problems and pollution on freshwater and shellfish aquaculture systems by interfering with nutrient uptake of crops, restricting sunlight penetration, and decreasing water quality due to massive biomass of Kariba weed remnants. Solvothermal liquefaction is considered an emerging thermochemical technique to convert waste into high yield of value-added products. Solvothermal liquefaction (STL) of Kariba weed as an emerging contaminant was performed to investigate the effects of different types of solvents (ethanol and methanol) and Kariba weed mass loadings (2.5-10 % w/v) on treating and reducing the weed via conversion into potentially useful crude oil product and char. Up to 92.53 % of Kariba weed has been reduced via this technique. The optimal conditions for crude oil production were found to be at 5 % w/v of mass loading in methanol medium, resulting in a high heating value (HHV) of 34.66 MJ/kg and yield of 20.86 wt%, whereas the biochar production was found to be optimum at 7.5 % w/v of mass loading in methanol medium, resulting in 29.92 MJ/kg of HHV and 25.38 wt% of yield. The crude oil consisted of beneficial chemical compounds for biofuel production such as hexadecanoic acid, methyl ester (65.02 peak area %) and the biochar showed high carbon content (72.83 %). In conclusion, STL as a remediation for emerging Kariba weed is a feasible process for shellfish aquaculture waste treatment and biofuels production.

The National Clinical Care Commission Report to Congress: Recommendations to Better Leverage Federal Policies and Programs to Prevent and Control Diabetes.

The National Clinical Care Commission (NCCC) was established by Congress to make recommendations to leverage federal policies and programs to more effectively prevent and treat diabetes and its complications. The NCCC developed a guiding framework that incorporated elements of the Socioecological and Chronic Care Models. It surveyed federal agencies and conducted follow-up meetings with representatives from 10 health-related and 11 non-health-related federal agencies. It held 12 public meetings, solicited public comments, met with numerous interested parties and key informants, and performed comprehensive literature reviews. The final report, transmitted to Congress in January 2022, contained 39 specific recommendations, including 3 foundational recommendations that addressed the necessity of an all-of-government approach to diabetes, health equity, and access to health care. At the general population level, the NCCC recommended that the federal government adopt a health-in-all-policies approach so that the activities of non-health-related federal agencies that address agriculture, food, housing, transportation, commerce, and the environment be coordinated with those of health-related federal agencies to affirmatively address the social and environmental conditions that contribute to diabetes and its complications. For individuals at risk for type 2 diabetes, including those with prediabetes, the NCCC recommended that federal policies and programs be strengthened to increase awareness of prediabetes and the availability of, referral to, and insurance coverage for intensive lifestyle interventions for diabetes prevention and that data be assembled to seek approval of metformin for diabetes prevention. For people with diabetes and its complications, the NCCC recommended that barriers to proven effective treatments for diabetes and its complications be removed, the size and competence of the workforce to treat diabetes and its complications be increased, and new payment models be implemented to support access to lifesaving medications and proven effective treatments for diabetes and its complications. The NCCC also outlined an ambitious research agenda. The NCCC strongly encourages the public to support these recommendations and Congress to take swift action.

The National Clinical Care Commission Report to Congress: Leveraging Federal Policies and Programs to Improve Diabetes Treatment and Reduce Complications.

The Treatment and Complications subcommittee of the National Clinical Care Commission focused on factors likely to improve the delivery of high-quality care to all people with diabetes. The gap between available resources and the needs of people living with diabetes adversely impacts both treatment and outcomes. The Commission's recommendations are designed to bridge this gap. At the patient level, the Commission recommends reducing barriers and streamlining administrative processes to improve access to diabetes self-management training, diabetes devices, virtual care, and insulin. At the practice level, we recommend enhancing programs that support team-based care and developing capacity to support technology-enabled mentoring interventions. At the health system level, we recommend that the Department of Health and Human Services routinely assess the needs of the health care workforce and ensure funding of training programs directed to meet those needs. At the health policy level, we recommend establishing a process to identify and ensure pre-deductible insurance coverage for high-value diabetes treatments and services and developing a quality measure that reduces risk of hypoglycemia and enhances patient safety. We also identified several areas that need additional research, such as studying the barriers to uptake of diabetes self-management education and support, exploring methods to implement team-based care, and evaluating the importance of digital connectivity as a social determinant of health. The Commission strongly encourages Congress, the Department of Health and Human Services, and other federal departments and agencies to take swift action to implement these recommendations to improve health outcomes and quality of life among people living with diabetes.

Microwave processing of oil palm wastes for bioenergy production and circular economy: Recent advancements, challenges, and future prospects.

The valorization and conversion of biomass into various value-added products and bioenergy play an important role in the realization of sustainable circular bioeconomy and net zero carbon emission goals. To that end, microwave technology has been perceived as a promising solution to process and manage oil palm waste due to its unique and efficient heating mechanism. This review presents an in-depth analysis focusing on microwave-assisted torrefaction, gasification, pyrolysis and advanced pyrolysis of various oil palm wastes. In particular, the products from these thermochemical conversion processes are energy-dense biochar (that could be used as solid fuel, adsorbents for contaminants removal and bio-fertilizer), phenolic-rich bio-oil, and H2-rich syngas. However, several challenges, including (1) the lack of detailed study on life cycle assessment and techno-economic analysis, (2) limited insights on the specific foreknowledge of microwave interaction with the oil palm wastes for continuous operation, and (3) effects of tunable parameters and catalyst's behavior/influence on the products' selectivity and overall process's efficiency, remain to be addressed in the context of large-scale biomass valorization via microwave technology.

Utilization of current pyrolysis technology to convert biomass and manure waste into biochar for soil remediation: A review.

Traditional disposal of animal manures and lignocellulosic biomass is restricted by its inefficiency and sluggishness. To advance the carbon management and greenhouse gas mitigation, this review scrutinizes the effect of pyrolysis in promoting the sustainable biomass and manure disposal as well as stimulating the biochar industry development. This review has examined the advancement of pyrolysis of animal manure (AM) and lignocellulosic biomass (LB) in terms of efficiency, cost-effectiveness, and operability. In particular, the applicability of pyrolysis biochar in enhancing the crops yields via soil remediation is highlighted. Through pyrolysis, the heavy metals of animal manures are fixated in the biochar, thereby both soil contamination via leaching and heavy metal uptake by crops are minimized. Pyrolysis biochar is potentially use in soil remediation for agronomic and environmental co-benefits. Fast pyrolysis assures high bio-oil yield and revenue with better return on investment whereas slow pyrolysis has low revenue despite its minimum investment cost because of relatively low selling price of biochar. For future commercialization, both continuous reactors and catalysis can be integrated to pyrolysis to ameliorate the efficiency and economic value of pyrolysis biochar.

Transforming municipal cotton waste into a multilayer fibre biocomposite with high strength.

We analyzed the problematic textile fiber waste as potential precursor material to produce multilayer cotton fiber biocomposite. The properties of the products were better than the current dry bearing type particleboards and ordinary dry medium-density fiberboard in terms of the static bending strength (67.86 MPa), internal bonding strength (1.52 MPa) and water expansion rate (9.57%). The three-layer, four-layer and five-layer waste cotton fiber composite (WCFC) were tried in the experiment, the mechanical properties of the three-layer WCFC are insufficient, the five-layer WCFC is too thick and the four-layer WCFC had the best comprehensive performance. The cross-section morphology of the four-layer WCFC shows a dense structure with a high number of adhesives attached to the fiber. The hardness and stiffness of the four-layer cotton fiber composite enhanced by the high crystallinity of cellulose content, and several chemical bondings were presence in the composites. Minimum mass loss (30%) and thermal weight loss rate (0.70%/°C) was found for the four-layer WCFC. Overall, our findings suggested that the use of waste cotton fiber (WCF) to prepare biocomposite with desirable physical and chemical properties is feasible, and which can potentially be used as building material, furniture and automotive applications.

Product spectrum analysis and microbial insights of medium-chain fatty acids production from waste biomass during liquor fermentation process: Effects of substrate concentrations and fermentation modes.

Substrate toxicity would limit the upgrading of waste biomass to medium-chain fatty acids (MCFAs). In this work, two fermentation modes of electro-fermentation (EF) and traditional fermentation (TF) with different concentration of liquor fermentation waste (20%, 40%, 60%) were used for MCFAs production as well as mechanism investigation. The highest caproate (4.04 g/L) and butyrate (13.96 g/L) concentrations were obtained by EF at 40% substrate concentration. TF experiments showed that the substrate concentration above 40% severely inhibited ethanol oxidation and products formation. Compared with TF mode, the total substrates consumption and product yields under EF mode were significantly increased by 2.6%-43.5% and 54.0%-83.0%, respectively. Microbial analysis indicated that EF effectively alleviated substrate toxicity and enriched chain elongation bacteria, particularly Clostridium_sensu_stricto 12, thereby promoting ethanol oxidation and products formation. Caproiciproducens tolerated high-concentration substrates to ensure normal lactate metabolism. This study provides a new way to produce MCFAs from high concentration wastewater.

Environment impact and bioenergy analysis on the microwave pyrolysis of WAS from food industry: Comparison of CO2 and N2 atmosphere.

The alarming output of waste activated sludge (WAS) from industries requires proper management routes to minimize its impact on the environment during disposal. Pyrolysis is a feasible way of processing and valorizing WAS into higher-value products of alternate use. Despite extensive research into the potential of WAS through pyrolysis, the technology's long-term viability and environmental impact have yet to be fully revealed. In addition, the environmental effects of utilizing different pyrolysis atmosphere (N2 or CO2) has not been studied before, although benefits of CO2 reactivity during pyrolysis have been discovered. This study evaluates the process's environmental impact, carbon footprint, and bioenergy yield when different pyrolysis atmospheres are used. The global warming potential (GWP) for a functional unit of 1 t of dried WAS is 203.81 kg CO2 eq. The heat required during pyrolysis contributes the most (63.7%) towards GWP due to high energy usage, followed by the drying process (23.6%). Transportation contributes the most towards toxicity impact (59.3%) through dust, NOx, NH3 and SO2 emissions. The initial moisture content of raw WAS (65%) greatly impacts overall energy consumption and environmental impact. Pyrolysis in an N2 atmosphere will result in a higher overall bioenergy yield (833 kWh/tonne) and a lower carbon footprint (-1.09 kg CO2/tonne). However, when CO2 was used, the specific energy value within the biochar is higher (22.26 MJ/kg) due to enhanced carbonization. The carbon content of gas derived increased due to higher CO yield. From an energy perspective, the current setup will achieve a net positive bioenergy yield of 561 kW (CO2) and 833 kW (N2), where end products like biochar, bio-oil and gas can be used for power production. Despite the energy-intensive process, microwave pyrolysis has excellent potential to achieve a negative carbon footprint. The biochar used for soil amendment served as a good carbon sink. The utilization of CO2 as carrier gases provides a pathway to utilize anthropogenic CO2, which helps reduce global warming. This work demonstrates microwave pyrolysis as a negative emission, bioenergy-producing approach for WAS disposal and valorization.

A bibliometric analysis on the tribological and physicochemical properties of vegetable oil-based bio-lubricants (2010-2021).

Vegetable oil-based bio-lubricants possess potential as an alternative to mineral oil-based lubricants due to their biodegradability and renewability. However, a detailed examination of the publication focus, trend, and future direction related to these bio-lubricants' tribological and physicochemical properties is scarce. Therefore, the study presents a bibliometric analysis of vegetable oil-based bio-lubricant. One hundred sixty-five publications were extracted from Web of Science (WoS) from 2010 to 2021. During this period, the total citation was 2,240, recording an average citation per publication of 13.58. Proceedings of The Institution of Mechanical Engineers, Part J: Journal of Engineering Tribology was the top productive journal, publishing 10.3% of the publications selected on the studied topic. From 2010 to 2021, India was the most productive country working on bio-lubricants due to its abundance of coconut products, followed by Malaysia due to its abundance of palm products. The keyword analysis indicated that a significant amount of work emphasised the derivation of bio-lubricants with an increasing shift towards tribological performance characterisation. From the analysis, palm is the most studied bio-lubricant, followed by castor oil. The reported viscosity and viscosity index values cover an extensive range, allowing these bio-lubricants to be adopted for a wide range of applications. For different vegetable oil-based bio-lubricants, the coefficient of friction is reported from 0.001 to 0.78, with the wear scar diameter being reported from 0.075 µm to 4.59 mm. Even though these bio-lubricants' friction and wear performances can be tabulated, the dataset is still unreliable for lubricant-selection purposes because of the varying test conditions. Such a scenario also limits the ability to correlate the role of fatty acid composition in the vegetable oil-based bio-lubricants in fulfilling their various application-specific potentials. Therefore, this study recommends that a unified correlation between the fatty acid composition and its tribological performance be attained consistently to better elucidate the potential of vegetable oil-based bio-lubricants.

Acute pleiotropic effects of dapagliflozin in type 2 diabetic patients with heart failure with reduced ejection fraction: a crossover trial.

AIMS: This study aimed to explore the rapid effects of dapagliflozin in heart failure with reduced ejection fraction (HFrEF). METHODS AND RESULTS: We studied the functional, echocardiographic, electrophysiological, lung ultrasound, ambulatory blood pressure (BP), microvascular and macrovascular function, and biochemical effects of 2 week treatment with dapagliflozin in 19 type 2 diabetic HFrEF patients in a double-blind, crossover, placebo-controlled trial. Dapagliflozin had no significant effect on clinical, functional, or quality of life parameters. Dapagliflozin reduced systolic BP [114 (105, 131) vs. 106 (98, 113) mmHg, P < 0.01] and diastolic BP [71 (61, 78) vs. 62 (55, 70) mmHg, P < 0.01]. There was no effect on cardiac chamber size, ventricular systolic function, lung ultrasound, or arterial wave reflection. Dapagliflozin increased creatinine [117 (92, 129) vs. 122 (107, 135) µmol/L, P < 0.05] and haemoglobin [135 (118, 138) vs. 136 (123, 144) g/L, P < 0.05]. There was a reduction in ventricular ectopy [1.4 (0.1, 2.9) vs. 0.2 (0.1, 1.4) %, P < 0.05] and an increase in standard deviation of normal heart beat intervals [70 (58, 90) vs. 74 (62, 103), P < 0.05]. Unexpectedly, dapagliflozin increased high-sensitivity troponin T [25 (19, 37) vs. 28 (20, 42) ng/L, P < 0.01] and reduced reactive hyperaemia index [1.29 (1.21, 1.56) vs. 1.40 (1.23, 1.84), P < 0.05]. CONCLUSIONS: After 2 weeks, while multiple parameters supported BP reduction and haemoconcentration with dapagliflozin, reduction in cardiac filling pressure, lung water, and functional improvement was not shown. Reduced ventricular ectopic burden suggests an early antiarrhythmic benefit. The small increase in troponin T and the reduction in the reactive hyperaemia index warrant further mechanistic exploration in this treatment of proven mortality benefit in HFrEF.

The Living-Related Kidney Transplant Program in Brunei Darussalam: Lessons Learnt from a Nascent National Program in a Small, Muslim, and Asian Country.

Brunei Darussalam commenced its living-related renal transplant program in 2013, with subsequent attainment of independent local capacity and proficiency in 2019. The preliminary outcome from the program has already begun to shape the national nephrology landscape with a 36% increment in transplant rate and mitigation of commercialized transplantations. The blueprint for the program was first laid out in 2010 and thereupon executed in four phases. The first phase involved the gathering of evidence to support the establishment of the national program, through researches investigating feasibility, public opinion, quality of life, graft survival, and cost-effectiveness. The second phase focused on laying the foundation of the program through grooming of local expertise, implementation of legal-ethical frameworks, religious legitimization, and propagation of awareness. The third phase worked on facilitating experiential exposure and strengthening local infrastructure through the upgrading of facilities and the introduction of subsidiary services. The fourth phase was implemented in Brunei in 2013 when foreign personnel worked together with the local team to perform the transplants. Between 2013 and 2019, ten kidney transplants were performed, with two being done in 2018 and three in 2019. We hope to inspire other similar countries to develop their own self-sustainable and independent local program.

The Role of the Pharmacist in Optimizing Cancer Immunotherapy: A Retrospective Study of Nivolumab Adverse Events.

BACKGROUND: Immune checkpoint inhibitors (ICIs) are an emerging treatment in cancer therapy for prolonging life, minimizing symptoms, and selectively targeting cancer. Program death 1 (PD-1) inhibitors, such as nivolumab, fall within this class, enabling the patient's immune system to detect and destroy cancer. The introduction of ICIs is changing cancer therapy, with new drugs and new toxicities-an evolving area encountered by pharmacists. OBJECTIVE: This study aims to compare the pattern of nivolumab-induced adverse events observed in practice, when compared with clinical trial and literature data. The secondary aim of the study is to identify the presentation and treatment modalities initiated in practice. METHODS: We performed a retrospective case note review across 2 South Australian hospitals to identify the common toxicities and symptomatic treatments experienced by patients receiving nivolumab. Results were compared with clinical trial data from product innovator Bristol-Myer Squib and other published literature. RESULTS: Seventy patients were included in the study; of these, 60 (86%) experienced any grade adverse event(s). A total of 59 (84%) of 70 experienced mild to moderate grade 1 to grade 2 adverse events and 10 (14%) of 70 patients experienced severe grade 3 to grade 4 adverse events, displaying some consistencies with clinical trial and published literature data. Together, the prevalence of adverse events with details on presentation and treatments illustrates possible pharmacy practice strategies and areas for intervention. CONCLUSIONS: The listed prevalence of adverse events and practice strategies identified throughout this study highlights how pharmacists may assist in the identification of predictable ICI toxicities associated with gastrointestinal, endocrine, dermatological toxicities, and fatigue.

Fournier Gangrene Associated With Sodium-Glucose Cotransporter-2 Inhibitors: A Review of Spontaneous Postmarketing Cases.

Background: Use of sodium-glucose cotransporter-2 (SGLT2) inhibitors has been associated with Fournier gangrene (FG), a rare urologic emergency characterized by necrotizing infection of the external genitalia, perineum, and perianal region. Objective: To describe and compare reported cases of FG in diabetic adults receiving treatment with SGLT2 inhibitors or other antiglycemic agents. Design: Descriptive case series. Setting: U.S. Food and Drug Administration (FDA) Adverse Event Reporting System and published case reports. Patients: Adults receiving SGLT2 inhibitors or other antiglycemic agents. Measurements: Clinical and laboratory data. Results: The FDA identified 55 unique cases of FG in patients receiving SGLT2 inhibitors between 1 March 2013 and 31 January 2019. The patients ranged in age from 33 to 87 years; 39 were men, and 16 were women. Time to onset after initiation of SGLT2-inhibitor therapy ranged from 5 days to 49 months. All patients had surgical debridement and were severely ill. Reported complications included diabetic ketoacidosis (n = 8), sepsis or septic shock (n = 9), and acute kidney injury (n = 4). Eight patients had fecal diversion surgery, 2 patients developed necrotizing fasciitis of a lower extremity that required amputation, and 1 patient required a lower-extremity bypass procedure because of gangrenous toes. Three patients died. For comparison, the FDA identified 19 FG cases associated with other antiglycemic agents between 1984 and 31 January 2019: metformin (n = 8), insulin glargine (n = 6), short-acting insulin (n = 2), sitagliptin plus metformin (n = 2), and dulaglutide (n = 1). These patients ranged in age from 42 to 79 years; 12 were men, and 7 were women. Two patients died. Limitation: Inability to establish causality or incidence, variable quality of reports, possible underreporting, and confounding by indication. Conclusion: FG is a newly identified safety concern in patients receiving SGLT2 inhibitors. Physicians prescribing these agents should be aware of this possible complication and have a high index of suspicion to recognize it in its early stages. Primary Funding Source: None.

Tunnel Dielectrophoresis for Tunable, Single-Stream Cell Focusing in Physiological Buffers in High-Speed Microfluidic Flows.

A novel tunnel dielectrophoresis (TDEP) mechanism is demonstrated for continuously tunable, sheathless, 3D, and single-stream microparticle and cell focusing in high-speed flows in regular physiological buffers. Particles and cells showing negative DEP responses can be focused at the electric field minimum location regardless of their types and sizes.

Prostate Artery Embolization (PAE) in the Management of Refractory Hematuria of Prostatic Origin Secondary to Iatrogenic Urological Trauma: A Safe and Effective Technique.

INTRODUCTION: Incidence of refractory hematuria of prostatic origin (RHPO) is extremely rare, with an iatrogenic etiology even rarer. When conservative methods fail to control bleeding, more invasive surgical methods are needed. In this article we describe our experience with prostatic artery embolization (PAE) as a minimally invasive alternative treatment option in patients with RHPO secondary to iatrogenic urologic trauma. TECHNICAL CONSIDERATIONS: Three patients presented with RHPO. The etiologies were transurethral resection of prostate surgery, Foley catheter removal with a supratherapeutic international normalized ratio and self-traumatic Foley catheter removal respectively. Stepwise management with conservative and medical methods failed to control bleeding. Under local anesthesia and moderate sedation, bilateral PAE was performed via a right common femoral artery access and using cone beam computed tomography. An embolic mixture containing 300-500 um Embosphere® Microspheres (Biosphere Medical, Rockland, MA) was injected under fluoroscopic guidance until stasis was achieved. PAE using the described technique was a technical and clinical success in all three patients. Hematuria resolved within a period of 24 hours. There were no intra- or periprocedural complications. CONCLUSION: PAE offers a reasonable option in treatment of RHPO, regardless of the cause and may be attempted prior to surgical techniques or sometimes in conjunction. Being minimally invasive and performed under local anesthesia, PAE is especially useful when excessive bleeding prevents adequate visualization of a bleeding source during cystoscopy and in the elderly age group with several comorbidities. An added advantage is the prostatic parenchymal ischemia leading to significant prostate volume reduction and alleviation of the obstructive symptoms.

Outcomes of Renal Transplantation in Brunei Darussalam over a Twenty-Year Period (1993-2012).

Objectives. Brunei Darussalam has a high prevalence and incidence of end stage renal disease (ESRD). Up until 2012, all renal transplantations were performed in overseas centres, either as government-sponsored (living-related transplantation) or as self-sponsored (commercialized transplantation) ones. We hypothesize that graft and patient survival of Brunei renal transplant patients are on a par with international standards. Materials and Methods. Data of all renal transplant patients in Brunei were analysed over a twenty-year period from registry records and case notes. Comparative survival data from other countries were obtained from PubMed-listed literature. Results. A total of 49 transplantation procedures were performed in foreign centres between 1993 and 2012. 29 were government-sponsored and 20 were self-sponsored transplantations. The 5- and 10-year overall patient survival rates were 93.3% and 90.1%, respectively. The 5- and 10-year overall graft survival rates were 91.1% and 81.2%. There is no difference in the survival outcomes of government-sponsored and self-sponsored patients. Living-related (government-sponsored) and commercialised (self-sponsored) grafts had equivalent survival to those reported in the literature. Conclusion. Our survival data was on par with those achieved in many countries. We hope to use this information to convince local stakeholders and patients to favour transplantation as the preferred modality of RRT.

Aberrant presentation of self-lipids by autoimmune B cells depletes peripheral iNKT cells.

Invariant natural killer T (iNKT) cells provide cognate help via CD1d to lipid antigen-presenting B cells for antibody production, but whether B cells reciprocally regulate iNKT cells remains largely unexplored. Here, we found peripheral, but not thymic, iNKT cells to be numerically reduced in autoimmune mice lacking Fas specifically in B cells. The residual iNKT cells were antigenically overstimulated, had altered cytokine production, and manifested enhanced proliferation and apoptosis. B cell-specific ablation of CD1d ameliorated these iNKT defects, suggesting that inappropriate presentation of CD1d-restricted self-lipids by autoimmune B cell-depleted peripheral iNKT cells. CD1d(+) autoimmune B cells have reduced α-galactosidase A expression and, as revealed by lipidomic profiling, altered lipidome with aberrant accumulation of certain self-lipids and reduction of others. These findings unveil a critical link between autoimmunity, B cell lipidome, and the maintenance of peripheral iNKT cells and highlight an essential homeostatic function of B cells beyond antibody production.

Successful treatment of tumor-induced osteomalacia due to an intracranial tumor by fractionated stereotactic radiotherapy.

CONTEXT: Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome, characterized by tumor secretion of fibroblast growth factor-23 (FGF23) causing hypophosphatemia due to renal phosphate wasting. TIO is usually caused by small, benign, difficult-to-localize, mesenchymal tumors. Although surgery with wide excision of tumor borders is considered the "gold standard" for definitive therapy, it can be associated with considerable morbidity depending on the location. To date, radiation therapy has not been considered as an effective treatment modality in TIO. OBJECTIVE: A 67-year-old female presented with multiple nontraumatic fractures, progressive bone pain, and muscle weakness for 4 years. She was found to have biochemical evidence of urinary phosphate wasting with low serum phosphorus, low-normal serum calcium, normal 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D, and high serum FGF23 levels. TIO was diagnosed. Selective venous sampling for FGF23 confirmed that a 1.7-cm left frontal mass, radiographically similar to a meningioma, was the causative tumor. She declined surgery due to fear of complications and instead underwent fractionated stereotactic radiotherapy for 6 weeks. RESULTS: In less than 4 years after radiation therapy, she was successfully weaned off phosphorus and calcitriol, starting from 2 g of oral phosphorus daily and 1 µg of calcitriol daily. Her symptoms have resolved, and she has not had any new fractures. CONCLUSIONS: Stereotactic radiotherapy was an effective treatment modality for TIO in our patient. Fractionated stereotactic radiation therapy represents an alternative to surgery for patients with TIO who are not surgical candidates or who decline surgery.