Salem Hospital

Patient: Female, 13-year-oldFinal Diagnosis: Lymphangioma circumscriptumSymptoms: Multiple, reddish and pigmented papules located in medial scapular regionClinical Procedure: Combined laser approach (Erbium: Glass and CO2)Specialty: DermatologyObjective: Rare diseaseBackgroundLymphangioma circumscriptum (LC) is a rare condition characterized by a lymphatic malformation primarily affecting the cutaneous region. Although surgical excision has historically been the first-line treatment, it may be associated with substantial complications and recurrence. This case report presents the first documented use of a simultaneous combination of erbium glass (1540 nm) and CO2 (10 600 nm) lasers as a targeted therapeutic strategy for LC in a patient with a dark phototype.Case ReportA previously untreated 13-year-old Asian girl presented with a 5-month history of multiple reddish and pigmented papules located in the right medial scapular region. After histopathological confirmation, the lesions were simultaneously treated with an erbium glass (4.0 W, 1 millisecond, 4 mJ) and CO2 (15 W, 0.25 milliseconds, 3.8 mJ) laser system, followed by topical tacrolimus (0.03%). The protocol was well tolerated, with moderate procedural pain and transient effects that resolved within 2 months. Clinical observation suggested a notable reduction in vesicles, reaching near-total clearance at the 2-month follow-up.ConclusionsThese results suggest that the simultaneous combination of erbium glass and CO2 lasers represents a feasible therapeutic option for LC in patients with pigmented skin. Further investigation in larger studies with extended follow-up is required to establish long-term efficacy and safety compared with conventional surgical or laser-based standards.

Abstract This study aims to evaluate the incidence and persistence of systemic hypertension following embolization of renal angiomyolipomas with particles. Retrospective review of patients who underwent particle embolization of angiomyolipomas was conducted at a single institution from 2010 to 2021. Blood pressure measurements were obtained at three time points: before treatment, within 30 days following treatment, and greater than 30 days following treatment. Patients were excluded for lack of follow-up blood pressure data. Hypertension was defined as systolic pressure ≥ 130 mm Hg or diastolic pressure ≥ 80 mm Hg. Fifty-four renal embolization procedures in 38 patients were included in the final cohort. An initial increase in blood pressure by at least 10 mm Hg was noted following 23/54 (43%) procedures. Some cases were transient, but persistently increased blood pressure after 30-days was seen following 13/49 (27%) procedures. New-onset hypertension ≥ 130/80 was detected in 12/38 (32%) patients and persisted beyond 30-days in 8/34 (24%) patients. Anti-hypertensive medications were initiated in 14/38 (37%) patients following the procedure. Of 9/54 (17%) procedures with evidence of nontarget embolization on angiography, 4/9 (44%) had transient hypertension, and one had persistent hypertension. The incidence of postprocedural hypertension following particle embolization of renal angiomyolipomas may be unexpectedly high in this patient population.

Introduction: Advancements in extracorporeal membrane oxygenation (ECMO) have reshaped the landscape of critical care, enabling lung rest and support in severe respiratory failure. However, ventilator management during ECMO remains an area of evolving practice with no universally accepted standard. While traditional lung-protective strategies dominate, novel approaches aimed at further minimizing ventilator-induced lung injury (VILI) and enhancing lung recovery are gaining traction. This review highlights new and rising ventilation strategies in the management of ECMO-supported patients. Methods: A literature review was conducted using PubMed, Embase, and Cochrane databases for studies published between January 2012 and March 2024. Search terms included “ECMO,” “mechanical ventilation,” “ultraprotective ventilation,” “awake ECMO,” “spontaneous breathing,” and “adjunctive strategies.” Included studies were clinical trials, cohort studies, case series, and expert guidelines addressing novel ventilator approaches in adult patients receiving either veno-venous (VV) or veno-arterial (VA) ECMO. Results: Emerging ECMO ventilation strategies include ultraprotective (≤4 mL/kg) and near-apneic ventilation, as well as spontaneous breathing protocols. Early mobilization and awake ECMO allow lower sedation, preserved diaphragm function, and earlier weaning. Advanced modes like Neurally Adjusted Ventilatory Assist (NAVA) and Proportional Assist Ventilation (PAV) aim to synchronize effort while limiting lung stress. Adjuncts such as prone positioning, permissive hypercapnia, and variable ventilation may improve recruitment and oxygenation. These approaches may enhance recovery and reduce VILI, though high-quality data are limited. Conclusions: Ventilation management in ECMO is shifting beyond traditional lung-protective frameworks toward individualized, dynamic approaches that emphasize lung rest, patient interaction, and early recovery. Novel strategies such as ultraprotective ventilation, awake ECMO, and synchrony-promoting modes are redefining care paradigms. Further randomized trials are needed to establish the safety, efficacy, and long-term outcomes of these rising approaches.

Forest harvests are a significant part of disturbance regimes in many temperate forest landscapes. However, variability in biodiversity between early seral stands originating from harvest versus natural disturbances like wildfire is not well understood. We used a chronosequence sampling design to compare diversity, composition, and traits of ground and tiger beetles (Coleoptera: Geadephaga, hereafter “ground beetles”) between early seral stands regenerating within 20 years after clearcut harvest or stand-replacing wildfire in southwest Oregon, USA. Clearcut stands were managed with planting and herbicides whereas fire-origin stands received minimal post-fire management. We also compared ground beetle communities 6–9 years after post-fire salvage logging. Compared to young clearcut stands (2–5 yr), ground beetle communities in young fire-origin stands had 30 % higher species richness (90 % CI: 0, 60 %), distinct composition, and disturbance-adaptive traits, including small body size (90 % CI for trait-environment interaction: −1.72, −0.63) and flight ability (90 % CI: 0.39, 1.47). Communities converged in the oldest age class (16–20 yr). Salvage logging favored flight-capable species to a greater degree than unlogged fire-origin stands (90 % CI: 0.12, 1.02) up to 9 years after disturbance, suggesting prolonged early seral conditions. Ground beetle composition varied with vegetation and deadwood structure but was also likely influenced by unobserved processes, such as fire-induced beetle mortality exceeding that of timber harvest. Our results indicate an ephemeral ground beetle community inhabiting post-fire stands that differs from post-harvest environments, suggesting that fire effects on the forest floor have a distinctive role in shaping early seral forest biodiversity. • Comparisons to natural disturbance provide useful context for understanding conservation implications of forest harvests • We compared ground beetle biodiversity after timber harvest, wildfire, and post-fire salvage logging • Ground beetles were more diverse and had more disturbance-adapted traits in the short-term after fire than harvest • Ground beetle communities converged by 16–20 years after disturbance

Abstract Background Whole-genome sequencing (WGS) has revolutionized Public Health Microbiology and has been used routinely for identification, epidemiological surveillance and monitoring antimicrobial resistance (AMR). In this study, in silico gene detection and clonality analysis identified the presence of multidrug-resistant Salmonella enterica serovar Infantis isolates with extended-spectrum β-lactamase AMR determinants harbored on a megaplasmid (pESI-like plasmid) called IncFIB (K)_1_Kpn3 in the Ecuadorian population.Heatmap of multidrug-resistant strains of Salmonella enterica serovar Infantis.Red = Resistance and yellow = Susceptibility.Plasmid IncFIB (K)_1_Kpn3 diagram in Ecuadorian strains Methods Twelve S. Infantis strains were obtained from urine cultures of patients aged 9 months to 95 years (11 female, 1 male) between 2022-2024. WGS was performed using Oxford Nanopore MinION (Rapid Barcoding Kit 24 V14 (SQK-RBK114.24). Data were processed using Galaxy Australia: Porechop for trimming, Flye for de novo assembly, and Abricate (Virulence Factor Database, ResFinder, and PlasmidFinder). Results The presence of blaCTX-M-65, amongst other resistance determinants conferring resistance to β-lactams, macrolides, aminoglycosides, tetracycline, sulfonamide, phenicol and fosfomycin were identified (Figure 1). Analyses of the genome indicated that the resistance were located on a 322518 bp plasmid that showed 99 % sequence similarity to an IncFIB plasmid (CP016409) (Figure 2). Clonality analysis showed that 100% isolates were belong to clone ST32 and all harbored the IncFIB plasmid. Furthermore, this plasmid contained genes associated with virulence, such as ybt (iron uptake), fae (fimbriae) which enhance the colonization capability and fitness of the bacterium. Conclusion The emergence of the multidrug-resistant (MDR) ESBL-producing S. enterica serovar Infantis has been linked to the presence of a unique pESI or pESI-like megaplasmid that enhances bacterial adaptation. The presence of pESI-like plasmids has demonstrated the emergence of a stable, resistant ST32 clone that has been circulating in the Ecuadorian population for some time, probably since 2014 (first reports). Disclosures All Authors: No reported disclosures

Weekly dose-dense paclitaxel may have immunomodulatory effects, enhancing immune responses via cytotoxic T-cell infiltration. Therefore, we assessed the combination of weekly dose-dense paclitaxel with pembrolizumab in patients with platinum-resistant ovarian cancer that persisted or recurred within 6 months of previous platinum chemotherapy. A multi-center open-label, single-arm study was conducted and participants received weekly intravenous paclitaxel 80 mg/m2 and every 3-week intravenous pembrolizumab 200 mg until progression or toxicity. The primary objectives were to determine the progression-free survival at 6 months and safety. Secondary analyses included objective response rate, disease control rate, duration of response, median progression-free survival, and overall survival. All patients receiving any drug were included in the toxicity evaluation. Exploratory analysis of programmed cell death ligand 1 in archival tissue was performed. Of the 42 patients enrolled, 37 had Response Evaluation Criteria in Solid Tumors (RECIST)-evaluable disease, and 41 were assessable in the intention-to-treat analysis. In the RECIST-evaluable cohort, the progression-free survival at 6 months was 58.6% (95% confidence interval 41.0 to 72.7), the overall response rate was 51.4% (range; 34.4-68.1), disease control rate was 86.5% (range; 75.5-97.5), and the median progression-free survival was 7.23 (range; 4.54-11.00) months. In the intention-to-treat analysis, the progression-free survival at 6 months was 55.3% (range; 38.8-69.1), overall response rate was 46.3% (range; 30.7-62.6), disease control rate was 78.0% (range; 62.4-89.4), and median progression-free survival was 6.87 (range; 4.37-8.9) months. The median duration of response for responders was 8.8 (range; 4.4-13.0) months. The median overall survival for the RECIST-evaluable and intention-to-treat groups were 26.3 (13.4 to not reached) and 25.9 (range; 13.3-27.1) months, respectively. Most common adverse events were anemia (69.1%), fatigue (52.4%), lab abnormalities (50.0%), decreased neutrophils (23.8%), and edema (47.6%). The combination of weekly dose-dense paclitaxel and pembrolizumab demonstrated promising activity and was well tolerated, although edema may be increased.

Operative intervention with multimodal therapy, including systemic therapy and radiation, is routinely used in the curative-intent treatment of patients with pancreatic ductal adenocarcinoma (PDAC). Occasionally, patients are unable to undergo multimodal therapy. However, contemporary data on the benefit of operation alone for patients with resectable PDAC are limited. The National Cancer Database was queried for patients diagnosed with resectable (clinical stage II or less) PDAC between 2010 and 2016. Patients who underwent upfront resection without additional treatment were compared with those who refused operation, to determine the comparative role of isolated surgical intervention for PDAC. Propensity score matching was used to account for selection bias. A total of 2,391 (6.1%) underwent upfront curative-intent resection without further treatment and 485 (1.2%) refused recommended operation. Propensity matching resulted in 471 well-balanced pairs. In the surgery group, 30- and 90-day mortality was 7% (33) and 17% (81), respectively. Median overall survival (OS) was 14.09 months (95% CI 12.39 to 16.72) compared with 6.34 months (95% CI 5.72 to 6.9) in the no-treatment group (log rank test p < 0.001). Estimated 1-year OS rates were 56% (95% CI 51.7 to 60.8) vs 26% (95% CI 22.3 to 30.6), respectively. For patients who underwent operation with R0 resection, median OS was 17.87 months (95% CI 14.7 to 21.3) compared with 7.56 months (95% CI 6.5 to 11.5) for non-R0 resection (log rank test p < 0.001). This national study of patients with early-stage PDAC affirms that surgical resection, in the absence of multimodal therapy, is associated with improved outcomes compared with no resection. However, the association with improved survival is clinically annulled in the absence of a negative-margin resection.

Racial inequities in substance use disorder treatment, and specifically buprenorphine treatment, contribute to overdose inequities. Bridge Clinics are a low-threshold, transitional treatment model that may improve treatment access. This report assesses the change in visit volume for Black and Hispanic patients and those with limited English proficiency (LEP) after the implementation of the Bridge Clinic expansion across 4 distinct sites. Between October 2021 and 2023, 3 hospital-based Bridge Clinics were expanded, and a community-based Bridge Clinic was established, all in regions with high racial and language inequities in overdose mortality. Implementation included creating Bridge Clinic performance measures, which were reviewed with clinic leadership monthly, developing a toolkit, and launching mobile services. We present Bridge Clinic visit volume aggregated by calendar year for Black-non Hispanic, Hispanic (any race), and LEP patients. We calculated the percent of total visits for each patient group and assessed the change over time. Comparing 2021 to 2023, total visits increased from 5323 to 10,350, and unique patients increased from 1893 to 3316. Annual visits increased from 437 to 1151 visits for Black patients; 566 to 1609 for Hispanic patients; and 96 to 265 for LEP patients. The percent of visits grew significantly for Black (8.21% vs. 10.24%, P<0.001), Hispanic (10.63% vs. 15.55%, P<0.001) and LEP patients (1.80% vs. 2.56%, P=0.003) from 2021 to 2023. Expanding low-barrier Bridge Clinics may increase substance use disorder (SUD) treatment visits for Black and Hispanic patients and those with LEP.

This article addresses the genetic and genomic determinants that influence susceptibility or resistance to human infections, whether caused by bacteria, viruses, fungi, parasites or even prions. A large number of genes are involved in susceptibility or resistance, and this is because Homo sapiens sapiens evolutionarily acquired key DNA modifications adaptable to defence as a result of the interaction of infectious agents with their genetic properties, natural selection and mutations. This article provides a description of the methods used in the investigation of this evolution and mutual host-infectious agent adaptation. The genes involved in susceptibility and resistance are presented, as well as the polymorphic variants that provide greater or lesser reaction capacity. The high number of genes, which produce specific defence proteins, have intricate relationships among them. Relationships among these genes have been analysed. A list of variants, and even mutations of the 70 to 153 proteins/genes that are involved in the immune response to infectious diseases has been compiled. Additionally, we designed a network of physical interactions as predictable, with BioGrid data and enrichment data obtained by the g:Profiler platform, finding 57 of the 70 genes with protein-to-protein interactions. The network detected is composed of 1,049 interacting genes (in total 1,106 genes and 1,910 interactions). This analysis shows the importance of immunity genes in the defence against infectious agents, as well as the effects of the genes involved such as HLA, immunoglobulins, interleukins, immune cells, among others. Based on the functional analysis of genes involved in susceptibility and resistance to infections, we compiled a list of genetic disorders that increase an individual’s risk of developing infectious diseases. It is known that infectious diseases manifest general clinical characteristics, which are a good guide to suspect a disease. Furthermore, we describe general clinical signs that may suggest underlying genetic immunodeficiency and highlight specific infectious diseases—such as HIV/AIDS, amebiasis, malaria, Chagas disease, tuberculosis, and COVID-19—where genetic susceptibility factors have been well-characterised.