The Evaluation and Management of Visceral Complications in Radiation Fibrosis Syndrome Part 1.

Abstract: External beam ionizing radiation is a fundamental component of cancer treatment and is incorporated into approximately 50% of cancer treatments. Radiation therapy causes cell death directly by apoptosis and indirectly by disruption of mitosis. Purpose of Review: This study aims to inform rehabilitation clinicians of the visceral toxicities of radiation fibrosis syndrome and how to detect and diagnose these complications. Recent Findings: Latest research indicates that radiation toxicity is primarily related to radiation dose, patient co-morbidity, and concomitant use of chemotherapies and immunotherapies for the treatment of cancer. While cancer cells are the primary target, surrounding normal cells and tissues are also affected. Radiation toxicity is dose dependent, and tissue injury develops from inflammation that may progress to fibrosis. Thus, radiation dosing in cancer therapy is often limited by tissue toxicity. Although newer radiotherapeutic modalities aim to limit delivery of radiation to non-cancerous tissues, many patients continue to experience toxicity. Summary: To ensure early recognition of radiation toxicity and fibrosis, it is imperative that all clinicians are aware of the predictors, signs, and symptoms of radiation fibrosis syndrome. Here, we present part 1 of the visceral complications of radiation fibrosis syndrome, addressing radiation-related toxicity in the heart, lungs, and thyroid gland.

A Rare Case of Plasma Cell Leukemia Presenting as Dyspnea.

CASE PRESENTATION: A 74-year-old man presented to the ED with acute chronic exertional dyspnea of 5-day duration. As part of his previous evaluation, 5 months earlier, he had undergone cardiopulmonary stress testing, routine laboratory evaluation, and chest radiography that were unremarkable. Over the subsequent months, he had waxing and waning exercise capacity until his incident hospitalization; the exercise was limited to < 40 meters. He reported associated nonproductive cough, 15-pound unintentional weight loss over the past 5 months, night sweats, easy fatigability, and early satiety. A chest radiograph was performed that showed a left hilar, mass-like consolidation with loss of the left heart border that was associated left-sided pleural effusion and left lower lung zone consolidation. On physical examination, he was afebrile and normotensive with a sinus tachycardia of 125 beats per minute. He was noted to be tachypneic with a respiratory rate of 24 breaths per minute and saturation of 95% on room air. Examination of the chest showed diminished breath sounds over left lower lung fields with scattered end expiratory wheezing.

Robotic radical hysterectomy versus open radical hysterectomy for cervical cancer: a single-centre experience from India.

To compare the disease-free survival (DFS) and overall survival (OS) at 3 years and 5 years in patients undergoing treatment for early-stage cervical cancer with either robotic (RRH) or open radical hysterectomy (ORH). This retrospective study compared all patients with stage IA1 (lymphovascular invasion), IA2, IB1, IB2 and II A cervical cancer in accordance with International Federation of Gynaecology and Obstetrics staging (FIGO 2009) of cancer of the cervix uteri. Patients who underwent Radical Hysterectomy at our centre from January 2011 till January 2018 were included in the study. One hundred and eighty-nine patients ( ORH = 67, RRH = 122) were included. The median follow-up time was 46.3 months in RRH group and 70.0 months in the ORH group. The 3-year DFS was comparable in both the arms, 91.5% in RRH and 91.6% in ORH. The 5-year DFS was 88.9% and 85.9% in robotic and open approaches, respectively (P = 0.258), hazard ratio (HR) 0.616 (CI = 0.266-1.427). The 3-year overall survival for robotic approach was 93.4% and for open was 95%, whereas 5-year overall survival was 84.7% and 87.4% in robotic and open approaches, respectively (P = 0.813). The median estimated blood loss for robotics was lower (100 ml vs 300 ml, P < 0.001) and median operative time was less (162.5 min vs. 180 min, P = 0.005) in robotics. The patients in RRH cohort had shorter median hospital stay (3.9 days vs. 6.3 days, P < 0.001). Robotic radical hysterectomy had comparable survival outcomes to open radical hysterectomy in cancer cervix. RRH is associated with improved peri-operative surgical outcomes and better resource utilisation.

Dual-Purpose CuFe2O4-rGO-Based Nanocomposite for Asymmetric Flexible Supercapacitors and Catalytic Reduction of Nitroaromatic Derivatives.

Energy storage and environmental pollution are two major global concerns in today's scenario. As a result of the momentous exhaustion of fossil fuels, the generation of energy from renewable sources is gaining immense importance. However, the irregular availability of energy from these renewable sources is the major encounter to achieve sustainable energy harvesting technology, yielding efficient but continuous and reliable energy supplies. Apart from the requirement of state-of-the-art heavy-duty technologies such as transportation, defense, etc., in the modern lifestyle to fulfill the demand for flexible electronic devices, the development of high-performance mechanically flexible all-solid-state supercapacitors is increasing massively. On the other hand, to cater to the need for accessibility of clean water for healthy lives, several technologies are evolving to treat wastewater and groundwater. Hence, the development of efficient catalysts for destroying water pollutants is an attractive approach. Considering these two crucial facets, in this paper, we have demonstrated the multifunctional features of a CuFe2O4-rGO nanocomposite, which was exploited to fabricate a high-performance mechanically flexible all-solid-state asymmetric supercapacitor and simultaneously used as an efficient but easily recoverable catalyst for the transformation of different nitroaromatic compounds. We have also demonstrated the conversion of trifluralin (a herbicide), which is present in the water body as a pollutant, to its corresponding amine derivatives, which can be utilized in the preparation of important pharmaceutical products.

A Case of Progressive Dyspnea: Lymphocytic Interstitial Pneumonia in Collagen Vascular Disease.

We describe an interesting rare case of a 61-year-old woman who was admitted to our hospital for exertional dyspnea, non-productive cough, and generalized weakness of six months duration. Her computed tomography was significant for ground-glass opacities combined with bibasilar consolidations and numerous pulmonary cysts. There can be a significant overlap in imaging findings of post-coronavirus disease 2019 (COVID-19) lung disease and interstitial lung disease from autoimmune diseases. We review in extensive detail the differential diagnosis for these imaging findings from a pulmonologist's perspective and discuss investigations required for further workup. Our patient underwent transbronchial biopsy and was eventually diagnosed with lymphocytic interstitial pneumonia with Sjogren predominant mixed connective tissue disease. We also review in detail the current literature and prognosis for this interesting disease.

The Usefulness of Chest CT Imaging in Patients With Suspected or Diagnosed COVID-19: A Review of Literature.

The COVID-19 pandemic has had devastating medical and economic consequences globally. The severity of COVID-19 is related, in a large measure, to the extent of pulmonary involvement. The role of chest CT imaging in the management of patients with COVID-19 has evolved since the onset of the pandemic. Specifically, the description of CT scan findings, use of chest CT imaging in various acute and subacute settings, and its usefulness in predicting chronic disease have been defined better. We performed a review of published data on CT scans in patients with COVID-19. A summary of the range of imaging findings, from typical to less common abnormalities, is provided. Familiarity with these findings may facilitate the diagnosis and management of this disease. A comparison of sensitivity and specificity of chest CT imaging with reverse-transcriptase polymerase chain reaction testing highlights the potential role of CT imaging in difficult-to-diagnose cases of COVID-19. The usefulness of CT imaging to assess prognosis, to guide management, and to identify acute pulmonary complications associated with SARS-CoV-2 infection is highlighted. Beyond the acute stage, it is important for clinicians to recognize pulmonary parenchymal abnormalities, progressive fibrotic lung disease, and vascular changes that may be responsible for persistent respiratory symptoms. A large collection of multi-institutional images were included to elucidate the CT scan findings described.

Solar Light-Irradiated Photocatalytic Degradation of Model Dyes and Industrial Dyes by a Magnetic CoFe2O4-gC3N4 S-Scheme Heterojunction Photocatalyst.

Magnetic CoFe2O4-gC3N4 nanocomposites were successfully synthesized, and their photocatalytic activities toward the decomposition of model synthetic dyes (e.g., methylene blue, methyl orange, and Congo red) in the presence of H2O2 were evaluated under simulated solar light irradiation. The 50CoFe2O4-50gC3N4 nanocomposite exhibited the highest catalytic activity. The catalytic activity of 50CoFe2O4-50gC3N4 toward the photodegradation of some industrially used dyes (such as Drimaren Turquoise CL-B p, Drimaren Yellow CL-2R p, and Drimaren Red CL-5B p) was also examined, and the catalyst exhibited its capability to decompose the industrial dyes completely. An aqueous mixture of these dyes was prepared to mimic the dye-containing wastewater, which was fully photodegraded within 30 min. 50CoFe2O4-50gC3N4 also exhibited facile magnetic separability from the reaction mixture after the accomplishment of photocatalysis reaction and stable performance after five cycles. The high photocatalytic efficiency to degrade several dyes, including dyes used in textile industries, under solar light irradiation makes 50CoFe2O4-50gC3N4 a promising photocatalyst for the treatment of dye-containing wastewater discharged from industries.

A review on the use of DFT for the prediction of the properties of nanomaterials.

Nanostructured materials have gained immense attraction because of their extraordinary properties compared to the bulk materials to be used in a plethora of applications in myriad fields. In this review article, we have discussed how the Density Functional Theory (DFT) calculation can be used to explain some of the properties of nanomaterials. With some specific examples here, it has been shown that how closely the different properties of nanomaterials (such as optical, optoelectronics, catalytic and magnetic) predicted by DFT calculations match well with the experimentally determined values. Some examples were discussed in detail to inspire the experimental scientists to conduct DFT-based calculations along with the experiments to derive a better understanding of the experimentally obtained results as well as to predict the properties of the nanomaterial. We have pointed out the challenges associated with DFT, and potential future perspectives of this new exciting field.

A 58-year-old woman with recurrent pneumonias and a pulmonary abscess.

A 58-year-old female with a history of recurrent pneumonia was evaluated for fevers, right lower back pain, and hematuria. A noncontrast abdominal computed tomography (CT) scan showed air and fluid-filled area in the right lower lobe for which a contrast-enhanced CT chest was performed. The CT of the chest revealed the cystic mass was supplied by an anomalous artery from the descending aorta. The patient was then diagnosed with a superinfected bronchopulmonary sequestration which was treated with surgical resection.

Snowflake-Like Dendritic CoNi Alloy-rGO Nanocomposite as a Cathode Electrode Material for an All-Solid-State Flexible Asymmetric High-Performance Supercapacitor Device.

Flexible all-solid-state supercapacitors having high mechanical stability and foldable features are crucial to meet the growing demands for a large number of portable electronic devices such as wearable electronics, displays, touch screens, detectors, etc. Here, we report the fabrication of such a flexible all-solid-state asymmetric supercapacitor device by using a nanocomposite composed of a snowflake-like dendritic CoNi alloy and reduced graphene oxide ((CoNiD)60-rGO40) as the positive electrode and pure rGO as the negative electrode for the first time. In this device, a polyvinyl alcohol (PVA) gel containing 3 M KOH and 0.1 M K4[Fe(CN)6] was used as the electrolyte cum separator. This supercapacitor device offers a high energy density value of 52.8 Wh kg-1 at a power density of 2000 W kg-1. The values of these two key performance parameters are superior to the many commercially available supercapacitors and reported values in the literature. In addition, this device also exhibits retention of ∼95% of its initial specific capacitance value after 4000 cycles at a current density of 2.5 A g-1, displaying its high cycling stability. This supercapacitor is so flexible that no mechanical deformation occurs even after bending at different angles and folding up to 180°, and its specific capacitance value practically remains unaffected when the device was twisted at different bending angles. This flexible all-solid-state asymmetric supercapacitor device can power a light-emitting diode (LED) and demonstrates its promise to meet the practical applications in energy storage technology.

A "One-Pot" Route for the Synthesis of Snowflake-like Dendritic CoNi Alloy-Reduced Graphene Oxide-Based Multifunctional Nanocomposites: An Efficient Magnetically Separable Versatile Catalyst and Electrode Material for High-Performance Supercapacitors.

In this paper, a simple "one pot" methodology to synthesize snowflake-like dendritic CoNi alloy-reduced graphene oxide (RGO) nanocomposites has been reported. First-principles quantum mechanical calculations based on density functional theory (DFT) have been conducted to understand the electronic structures and properties of the interface between Co, Ni, and graphene. Detailed investigations have been conducted to evaluate the performance of CoNi alloy and CoNi-RGO nanocomposites for two different types of applications: (i) as the catalyst for the reduction reaction of 4-nitrophenol and Knoevenagel condensation reaction and (ii) as the active electrode material in the supercapacitor applications. Here, the influence of microstructures of CoNi alloy particles (spherical vs snowflake-like dendritic) and the effect of immobilization of CoNi alloy on the surface of RGO on the performance of CoNi-RGO nanocomposites have been demonstrated. CoNi alloy having a snowflake-like dendritic microstructure exhibited better performance than that of spherical CoNi alloy, and CoNi-RGO nanocomposites showed improved properties compared to CoNi alloy. The k app value of the (CoNiD)60RGO40-catalyzed reduction reaction of 4-nitrophenol is 20.55 × 10-3 s-1, which is comparable and, in some cases, superior to many RGO-based catalysts. The (CoNiD)60RGO40-catalyzed Knoevenagel condensation reaction showed the % yield of the products in the range of 80-93%. (CoNiD)60RGO40 showed a specific capacitance of 501 F g-1 (at 6 A g-1), 21.08 Wh kg-1 energy density at a power density of 1650 W kg-1, and a retention of ∼85% of capacitance after 4000 cycles. These results indicate that (CoNiD)60RGO40 could be considered as a promising electrode material for high-performance supercapacitors. The synergistic effect, derived from the hierarchical structure of CoNiD-RGO nanocomposites, is the origin for its superior performance. The easy synthetic methodology, high catalytic efficiency, and excellent supercapacitance performance make (CoNiD)60RGO40 an appealing multifunctional material.

A Single Center Experience of Feasibility of a Novel Self-Expanding Metallic Airway Stent (Bonastent): A Case Series.

BACKGROUND: Central airway obstruction (CAO) is defined as obstruction of the airway lumen in the trachea or mainstem bronchi, most commonly due to primary or metastatic malignancy; and is classified as extraluminal, endoluminal, or mixed. The majority of malignant CAO are advanced stage and require a multimodality palliative approach, including stent placement. We describe a retrospective review of a novel self-expandable metallic stent, the Bonastent; a fully covered, nitinol-braided airway stent which conforms to airway tortuosity without loss of diameter in the management of CAO. METHODS: We performed a retrospective chart review of patients with CAO who underwent Bonastent placement at a single center between February 2017 and March 2018. Ease of stent placement, short-term complications (within 24 h of stent placement) and long-term complications (within 3 mo of stent placement) were recorded. RESULTS: Eleven patients were identified, reviewed and included in the study. Thirteen stents in 11 patients were placed for predominantly malignant CAO. One patient had a short-term complication of stent migration. Four patients had long-term complications; of which 3 patients had in-stent mucus impaction requiring bronchoscopy. In our study, the stent-related complication rates were comparable to the reported literature. CONCLUSION: In our experience, Bonastent is an easy to use option which adds to the armamentarium of the self-expandable metallic stent to treat malignant CAO.

Synthesis of multifunctional CuFe2O4-reduced graphene oxide nanocomposite: an efficient magnetically separable catalyst as well as high performance supercapacitor and first-principles calculations of its electronic structures.

Here, we report an 'in situ' co-precipitation reduction based synthetic methodology to prepare CuFe2O4 nanoparticle-reduced graphene oxide (CuFe2O4-RGO) nanocomposites. First principles calculations based on Density Functional Theory (DFT) were performed to obtain the electronic structures and properties of CuFe2O4, graphene and CuFe2O4-graphene composites, and to understand the interfacial interaction between CuFe2O4 and graphene in the composite. The synergistic effect, which resulted from the combination of the unique properties of RGO and CuFe2O4 nanoparticles, was exploited to design a magnetically separable catalyst and high performance supercapacitor. It has been demonstrated that the incorporation of RGO in the composite enhanced its catalytic properties as well as supercapacitance performance compared with pure CuFe2O4. The nanocomposite with 96 wt% CuFe2O4 and 4 wt% RGO (96CuFe2O4-4RGO) exhibited high catalytic efficiency towards (i) reduction of 4-nitrophenol to 4-aminophenol, and (ii) epoxidation of styrene to styrene oxide. For both of these reactions, the catalytic efficiency of 96CuFe2O4-4RGO was significantly higher than that of pure CuFe2O4. The easy magnetic separation of 96CuFe2O4-4RGO from the reaction mixture and good reusability of the recovered catalyst also showed here. 96CuFe2O4-4RGO also demonstrated better supercapacitance performance than pure CuFe2O4. 96CuFe2O4-4RGO showed specific capacitance of 797 F g-1 at a current density of 2 A g-1, along with ∼92% retention for up to 2000 cycles. To the best of our knowledge, this is the first investigation on the catalytic properties of CuFe2O4-RGO towards the reduction of 4-nitrophenol and the epoxidation reaction, and DFT calculations on the CuFe2O4-graphene composite have been reported.

A facile synthesis methodology for preparation of Ag-Ni-reduced graphene oxide: a magnetically separable versatile nanocatalyst for multiple organic reactions and density functional study of its electronic structures.

Here, we report a simple 'in situ' co-precipitation reduction synthesis method for the preparation of nanocatalysts composed of Ag, Ni nanoparticles, and reduced graphene oxide (RGO). First-principles calculations based on Density Functional Theory (DFT) were performed to obtain the electronic structures and properties of Ag-Ni-graphene superlattice and to understand the interfacial interactions which exist at the interface between Ag, Ni, and graphene. The catalytic performance of the synthesized catalysts (Ag x Ni(1-x)) y RGO(100-y) were evaluated for four reactions (i) reduction of 4-nitrophenol (4-NP) in the presence of excess NaBH4 in aqueous medium, (ii) A3 coupling reaction for the synthesis of propargylamines, (iii) epoxidation of styrene, and (iv) 'Click reaction' for the synthesis of 1,2,3-triazole derivatives. For all of these reactions the catalyst composed of Ag, Ni, and RGO, exhibited significantly higher catalytic activity than that of pure Ag, Ni, and RGO. Moreover, an easy magnetic recovery of this catalyst from the reaction mixture after completion of the catalytic reactions and the good reusability of the recovered catalyst is also reported here. To the best of our knowledge, this is the first time the demonstration of the versatile catalytic activity of (Ag x Ni(1-x)) y RGO(100-y) towards multiple reactions, and the DFT study of its electronic structure have been reported.

Newly Diagnosed Idiopathic Liver Abscess: Colonoscopy Required!

Liver abscess is the most common type of visceral abscess reported in the United States. Biliary tract disease is the most common cause of the development of liver abscess. In the last decade, many cases of liver abscesses silently manifesting as colon cancer have been reported in East Asian countries. We herein describe a case of an immunocompetent man who immigrated from East Africa to Unites States and presented with a suspicion of colon mass with metastasis to the liver, and who was later diagnosed to have a colonic malignancy with a concomitant liver abscess. Our aim was to make clinicians aware of the importance of ruling out occult colonic malignancy in patients with idiopathic liver abscess.