A re-challenging case

"Immune Checkpoint Inhibitors (ICI) are associated with multiple cardiotoxic effects. Balancing adverse effects with anti-tumor response poses a challenge to treating advanced cancers. The safety of re-starting ICI therapy after an adverse event is unknown. We present the case of a 58-year-old man with stage IV melanoma ICI-related myocarditis and complete heart block (CHB)."--IntroductionWalter Schiffer (1,2), Kathleen Zhang (1,2), Douglas Kyrouac (1,2), Daniel Lenihan (1,2) ; 1. Washington University School of Medicine. 2. Barnes-Jewish HospitalIncludes bibliographical reference

Pancreaticoportal Fistula Formation as a Consequence of Recurrent Acute Pancreatitis: Clinical and Imaging Considerations

A pancreatic-portal vein fistula (PPVF) is an extremely rare complication of pancreatitis. In this report, we present a patient with a PPVF in the setting of recurrent pancreatitis and portal vein thrombosis diagnosed by cross-sectional imaging and endoscopic retrograde cholangio-pancreatography, who responded to medical management and anticoagulation. A critical review of this disease process is explored to highlight pathology, imaging characteristics, and essential alternative diagnostic considerations. We also discuss potential complications and current treatment strategies. PPVFs pose a unique diagnostic challenge and awareness of its clinical presentation can further improve patient outcomes

Biological Noise Abatement: Coordinating the Responses of Autonomous Bacteria in a Synthetic Biofilm to a Fluctuating Environment Using a Stochastic Bistable Switch

Noise is inherent to single cell behavior. Its origins can be traced to the stochasticity associated with a few copies of genes and low concentrations of protein and ligands. We have studied the mechanisms by which the response of noisy elements can be entrained for biological signal processing. To elicit predictable biological function, we have engineered a gene environment that incorporates a gene regulatory network with the stringently controlled microenvironment found in a synthetic biofilm. The regulatory network leverages the positive feedback found in quorum-sensing regulatory components of the <i>lux</i> operon, which is used to coordinate cellular responses to environmental fluctuations. Accumulation of the Lux receptor in cells, resulting from autoregulation, confers a rapid response and enhanced sensitivity to the quorum-sensing molecule that is retained after cell division as epigenetic memory. The memory of the system channels stochastic noise into a coordinated response among quorum-sensing signal receivers in a synthetic biofilm in which the noise diminishes with repeated exposure to noisy transmitters on the input of a signaling cascade integrated into the same biofilm. Thus, gene expression in the receivers, which are autonomous and do not communicate with each other, is synchronized to fluctuations in the environment