Case Report: Pulmonary Infarction Following Recent Pulmonary Embolism

A 57-year-old man with chronic obstructive pulmonary disease (COPD), obstructive sleep apnea, and a recent pulmonary embolism (PE) on anticoagulation presented with acute pleuritic chest pain and worsening dyspnea. Computed tomographic angiography (CTA) of the chest revealed a small distal segmental PE in the left lower lobe and an adjacent irregular consolidation, raising concern for pulmonary infarction versus pneumonia. The patient was empirically started on antibiotics for possible pneumonia and admitted for anticoagulation and supportive care. He left the hospital against medical advice (AMA) before completing treatment, but returned days later with exacerbated symptoms. This case highlights the diagnostic challenge of differentiating pulmonary infarction from pneumonia in the context of acute PE. The patient’s course underscores the importance of recognizing imaging and laboratory clues suggestive of infarction, ensuring adequate treatment, and the risks associated with premature discontinuation of care. We discuss the pathophysiology of pulmonary infarction, its clinical and radiologic presentation, and discuss recent literature on management strategies. The case emphasizes the need for high clinical suspicion of pulmonary infarction in PE patients who develop pulmonary opacities, as timely diagnosis can direct appropriate therapy and avoid mismanagement

Aortoduodenal Syndrome: A Rare Case of Duodenal Obstruction Due to Endovascular Aneurysm Endoleak.

Aortoduodenal syndrome results from expansion of an abdominal aortic aneurysm, leading to symptoms of upper gastrointestinal obstruction. Endovascular aneurysm repair of large or symptomatic aortic aneurysms has become an important treatment modality for patients with abdominal aortic aneurysm. However, a large proportion of these grafts are complicated by endoleaks that can lead to a spectrum of significant symptoms. We present a case of rapidly worsening gastrointestinal obstructive symptoms in a patient with an already repaired aortic stent graft and a solitary kidney, found to be due to a type III endoleak that improved after emergent repeat endovascular aneurysm repair

Perioperative Goal-Directed Fluid Therapy in Neurosurgical Patients: A Scoping Review of Current Evidence and Research Gaps

Background: Neurosurgical patients are sensitive to fluid imbalances in postoperative settings. Traditional fluid management has been shown to have variable outcomes. Goal-directed fluid therapy (GDFT) is a tailored approach, but its benefits are not well established in neurosurgery. Hypothesis: The aim of this study is to identify and map the existing literature on perioperative GDFT in neurosurgical patients, including study characteristics, reported outcomes, and knowledge gaps. Methods: This scoping review follows the PRISMA-ScR reporting guidelines and the Arksey and O’Malley six-stage methodological framework. A literature search was performed across three databases from January 2000 to April 23, 2025. Studies evaluating GDFT in adult neurosurgical patients were included, while studies involving pediatric populations, non-English language, case reports, or surgical procedures outside the scope of neurosurgery were excluded. Title and full-text screening were conducted independently by four reviewers. Key study characteristics were extracted and synthesized. Results: Of 62 studies identified, 23 were included after full-text screening: twenty randomized controlled trials, two systematic reviews, and one non-randomized controlled study. GDFT was associated with reduced intraoperative fluid administration, fewer postoperative complications, and shorter hospital stays, demonstrating its value in neurosurgery. Conclusions: Across studies, the protocols for GDFT varied in monitoring tools, fluid thresholds, and intervention algorithms. Limitations of the current evidence include heterogeneity in protocols and comparators, potential publication bias, and a lack of detailed reporting on functional recovery or long-term outcomes. Future research is needed to address these gaps, particularly by standardizing intervention protocols and evaluating long-term clinical outcomes across diverse neurosurgical populations

Effects of Novel Dopamine D4 Receptor-Targeted Compounds on locomotor activity and Anxiety-Like Behavior in Male and Female Sprague Dawley Rats

The consequences of modulating subtypes of G protein coupled dopamine receptors are broadly studied for their role in decision making behavior, specifically in situations involving uncertain risk and reward. The actions of dopamine D4 receptors (D4Rs) on these complex processes are the least understood, particularly due to a lack of available compounds with suitable selectivity for D4Rs. Further, current research often fails to evaluate how modulating specific dopamine receptor subtypes may affect locomotor activity and anxiety-like behavior as confounding factors prior to assessing their function in behavioral assays of higher order decision making. The goal of the current study was to evaluate the extent that D4R modulation contributes to locomotor and anxiety-like behavioral measures and serve as potential confounding variables when evaluated in future experiments that will assay more complex risk/reward decision making behaviors. As such, the current report utilized the open-field test to assess the effects of novel and selective D4 receptor targeted compounds; a full antagonist (FMJ-054), a high-efficacy partial agonist (FMJ-038), and a low-efficacy partial agonist (FMJ-045) on locomotor activity and anxiety-like behavior in male and female Sprague Dawley rats

Exploring Intracellular Signaling Responses to KS18, a Potent Mcl-1 Inhibitor, in Multiple Myeloma

Multiple myeloma (MM), a cancer of plasma B cells, is a hematological malignancy in which patients inevitably relapse and develop drug resistance. Mcl-1, a member of the anti-apoptotic subgroup of Bcl-2 family proteins, plays a critical role in the progression of multiple myeloma and contributes significantly to drug resistance. Elevated Mcl-1 expression is observed in approximately 52% of MM patients at diagnosis, increasing to 81% at relapse. Given its driving role in disease progression and therapy resistance, Mcl-1 inhibition has emerged as a promising therapeutic target, prompting ongoing research into the development and clinical evaluation of Mcl-1 inhibitors, particularly for patients with refractory or relapsed MM. Here, we show that KS18 is a potent and selective Mcl-1 inhibitor in both sensitive and chemo-resistant MM cells in vitro, and it outperforms other clinically tested Mcl-1 inhibitors such as S63845, VU661013, and AZD5991 in resistant cells. Given the many intracellular interactions of Mcl-1, inhibition can result in signaling changes that can either promote or compensate for the intended apoptotic effect. Our research indicates that KS18 causes a decreased p-ERK ½ expression, a kinase which phosphorylates and stabilizes Mcl-1. However, inhibition of p-ERK ½ via Trametinib, an FDA approved MAPK inhibitor, does not affect Mcl-1. Additionally, KS18 upregulates LC3, a key protein of autophagy, and this is not observed in other Mcl-1 inhibitors. Autophagic induced cell death has been observed in response to chemotherapeutic agents. Cells resistant to Mcl-1 inhibitor S63845 still responded to KS18 and exhibited similar upregulation in LC3. These observations provide valuable insights into effects of potent Mcl-1 inhibition and ways to enhance its apoptotic effects while minimizing chemotoxicity in patients

Disparities in Demographics of Patients Presenting to a Student-Run Free Clinic in South Jersey

Medical schools around the country have established free clinics to better serve the underserved patient populations. In this study, we aimed to evaluate demographic characteristics in the patient population at our free clinic, Rowan-Virtua Community Health Clinic (RVCHC), compared to the general population of Camden County. We found a disproportionately higher percentage of black patients at our clinic when compared to the county overall. Addressing these disparities would require targeted outreach to specific patient populations and improved transit access. Future studies should aim to identify RVCHC health outcomes through the management of chronic disease and understanding emergency room utilization

Personalizing Intermittent Fasting: The Role of Microbiome Diversity and Fiber Intake in Shaping Health Outcomes

BACKGROUND: Intermittent fasting (IF) has been linked to improved metabolic health, reduced inflammation, and increased longevity in animal models. These effects are thought to be mediated through changes in the gut microbiome. Murine studies consistently show that IF enhances microbial diversity and promotes beneficial species like Lactobacillus and Bifidobacterium, improving metabolic profiles and gut barrier function. However, human studies reveal inconsistent results, suggesting that individual-level factors such as baseline microbiome composition and fiber intake may influence response to IF. HYPOTHESIS: Baseline gut microbiome diversity and habitual dietary fiber intake modulate the metabolic and inflammatory benefits of intermittent fasting in humans. METHODS: A systematic literature review was conducted to identify peer-reviewed research articles and clinical trials involving intermittent fasting, gut microbiome outcomes, and metabolic parameters in murine and human models. RESULTS: •Murine models: Consistent increase in microbial diversity and improvement in metabolic markers •Human studies: Highly variable outcomes; benefits more likely in individuals with diverse microbiomes and higher fiber intake •Few human trials stratify participants by microbiome composition or diet, limiting interpretation CONCLUSIONS: Individual variability in human IF outcomes may stem from differences in gut microbiome diversity and dietary fiber intake. A threshold model is proposed, in which individuals with favorable gut conditions are more responsive to IF. This supports the need for personalized dietary interventions

Reviewing The Effect of Antiplatelet Therapy on Lumbar Puncture Complications

Reviewing The Effect of Antiplatelet Therapy on Lumbar Puncture Complications aims to assess literature that discusses the possible risks of undergoing lumbar puncture while on antiplatelet therapy. Lumbar punctures offer vital information that can help guide making accurate diagnosis and creating appropriate treatment plans. However, a large portion of the population is on antiplatelet therapy for cardiovascular and cerebrovascular disease prevention. While there are many benefits to being on these medicines, patients are at increased risk for bleeding. Thus the clinical question as to whether or not proceed with lumbar puncture on patients taking antiplatelet therapy involves weighing risks and benefits. This study aims to assess the difference in traumatic lumbar punctures in patients taking antiplatelet therapy and those who are not and how this may contribute to negative outcome such as the development of spinal hematomas. Studies included were all articles published past 2000 involving human subjects that fit the PICO format and provided important background information. Results section analyzed studies comparing participants on antiplatelet therapy and those who were not and the difference in outcomes following lumbar puncture. Differences between groups were minimal and it was seen that antiplatelet therapy before lumbar punctures was not associated with traumatic taps. This review adds to the discussion on whether or not lumbar punctures should be delayed in emergent situations due to risk of bleeding and possible hematoma development. Studies assessed in this review suggest that it may be safe to proceed with lumbar puncture while on antiplatelet therapy

ESU First Gen Community Sprouts Knowledge: Navigating Middle School to College Bound Experiences

The College Bound ESU is a free program designed to connect local middle school students from JT Lambert Intermediate School and Stroudsburg Middle School, whose parents did not complete a 4-year college degree and provide them with the resources to be first generation college students. The program is a school day field trip to ESU campus where they learn about academic departments and college life for a total of 7 experiences. The program is comprised of visits to campus that will engage students by exploring interests and majors. Connecting students with Gen One college student mentors and experience college life. It also reinforces the importance and impact of high school academics. The goal is for the students to gain an appreciation and understand the benefits of a higher education degree. We also discuss how to better prepare students to understand how to get admitted and financial opportunities and pathways. Lastly, we want to demonstrate that college is an achievable goal

EFFICIENCY OF ENZYME INDUCED CARBONATE PRECIPITATION (EICP) BY CRUDE EXTRACT UREASE FOR GEOTECHNICAL AND GEOENVIRONMENTAL APPLICATIONS

Geotechnical engineering is currently facing challenges, including accommodating rapid urbanization, adapting to climate change impacts, and prioritizing sustainability, all while ensuring the safety and stability of critical infrastructure. Biocementation is a recently developed new branch in geotechnical engineering that offers innovative and eco-friendly solutions by leveraging natural processes to enhance soil properties. This dissertation examines the potential of soybean extract urease as a cost-effective substitute for analytical-grade enzymes in Enzyme Induced Carbonate Precipitation (EICP) applications for biocementation. This research examines its effectiveness in various aspects, such as coastal erosion control, desiccation crack remediation, and the removal of heavy metals. Essential parameters of EICP, including pH, temperature, cementation, and enzyme concentration, were evaluated to enhance calcium carbonate precipitation while ensuring cost efficiency. The findings demonstrate that EICP significantly enhances soil strength, decreases soil permeability, improves erosion resistance, and effectively reduces concentrations of heavy metals. The study emphasizes the promise of soybean extract urease as an alternative to traditional soil stabilization techniques, highlighting the viability of EICP as an innovative approach to contemporary engineering challenges by promoting geoenvironmental sustainability through cost-effective soil enhancement and pollution reduction strategies