Rectum to Medulla Oblongata: Colorectal Cancer Metastasizing to the Brainstem.

Metastasis with colorectal cancer (CRC) is commonly seen in the liver, lungs and peritoneal cavity. Brainstem involvement with CRC is not studied with no prior reported cases. We report a case of CRC, admitted for apneic spells and dry cough and later found to have metastasis to the left anterolateral medulla oblongata. A 28-year-old male, with a past medical history of asthma, and colorectal adenocarcinoma metastatic to the brain, presented to the emergency department with complaints of a dry cough, altered mental status and shortness of breath. He was seen at urgent care before and was given a week of oral levofloxacin for presumptive pneumonia without any relief. Physical examination was concerning for stridor with clear lung fields. MRI brain showed previously noted post-operative right frontoparietal craniotomy changes and a new 9 x 8 x 8 mm ring-enhancing intra-axial lesion centered at the left anterolateral medulla oblongata indicative of brainstem metastatic disease. The patient was intubated for airway protection and underwent a suboccipital craniotomy for resection of the left pontomedullary mass, and histopathology was positive for metastatic adenocarcinoma, colorectal primary with hemorrhagic necrosis. He had a tracheostomy placed post multiple failed extubation trials and a gastrostomy tube for oral feeds. Goals of care were addressed with the patient and family, and a decision was made for home hospice.

Heart Failure With Stable Mildly-reduced Ejection Fraction: Prognosis and Predictors of Outcomes.

Heart failure with mildly-reduced ejection fraction (HFmrEF) of 40%-49% is an under-recognized type of heart failure. The prognosis and predictors of outcomes of stable mildly-reduced ejection fraction (EF) of 1 year are unclear. This is a retrospective study. Included patients had stable left ventricular ejection fraction (LVEF) for at least 1 year (n = 609) and were classified into 3 groups based on LVEF. Clinical outcome measures were all-cause mortality, cardiac mortality, and HF hospitalization (HFH). In patients with stable HFmrEF of one year, the predictors of clinical outcomes and hospital length of stay (LOS) were studied. Patients with stable HFmrEF had lower HFH rate compared to stable HFrEF with HR = 0.52 (95% CI = 0.39-0.70), P = 0.0001, and a higher HFH rate compared to stable HFpEF with HR = 1.23 (95% CI = 1.01-1.50), P = 0.032. Mortality rates were similar between all groups. In the stable HFmrEF patients, beta-blockers caused lower cardiac mortality, and CKD had fewer HFH. Unfavorable predictors were loop diuretics for mortality, and higher NYHA class for HFH. Smoking and CKD were associated with a longer hospital stay. Stable HFmrEF patients with at least one HF admission had higher mortality. Patients with stable HFmrEF had a lower HFH rate compared to stable HFrEF and higher HFH rate compared to stable HFpEF. In patients with stable HFmrEF, CKD, NYHA class, beta-blockers, and loop diuretics were predictors of clinical outcomes. Smoking and CKD were predictors of hospital LOS.

Portable nanoporous electrical biosensor for ultrasensitive detection of Troponin-T.

AIM: To demonstrate the design, fabrication and testing of a portable, label-free biosensor for ultrasensitive detection of the cardiac Troponin-T (cTnT) from patient blood. MATERIALS & METHODS: The biosensor is comprised of a nanoporous membrane integrated on to a microelectrode sensor platform for nanoconfinement effects. Charge perturbations due to antigen binding are recorded as impedance changes using electrochemical impedance spectroscopy. RESULTS: The measured impedance change is used to quantitatively determine the cTnT concentration from the tested sample. We were successful in detecting and quantifying cardiac Troponin-T from a 40-patient cohort. The limit of detection was 0.01 pg/ml. CONCLUSION: This novel technology has promising preliminary results for rapid and sensitive detection of cTnT.