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Effectiveness of Pelvic Floor Muscle and Education-Based Therapies on Bladder, Bowel, Vaginal, Sexual, Psychological Function, Quality of Life, and Pelvic Floor Muscle Function in Females Treated for Gynecological Cancer: A Systematic Review.

Gynecological malignancies are prevalent in females, and this population is likely to experience symptoms of pelvic floor disorders and sexual dysfunction. Non-surgical, non-pharmaceutical conservative therapies, namely pelvic floor muscle (PFM) therapies and education-based interventions, could be beneficial for this population. The purpose of this systematic review was to examine the evidence regarding their effectiveness on bladder, bowel, vaginal, sexual, psychological function, quality of life, and PFM function in gynecological cancer populations. Six databases were searched to identify studies employing any interventional study design, except case studies, to investigate the effect of PFM therapies, education-based interventions, or combined therapies on any outcome of interest. The search yielded 4467 results, from which 20 studies were included. Of these, 11 (55%) were RCTs, two (10%) were non-RCTs with two groups, and seven (35%) were non-RCTs with a single group. Findings suggest that combined (multimodal) therapies, specifically PFM (active > passive) + education therapies, appear more effective for vaginal, overall pelvic floor, sexual, and PFM function. PFM therapies (active and/or electrostimulation) may improve bladder outcomes. Limited evidence suggests PFM (active) + education therapies may improve bowel function. Conservative therapies may improve psychological function, although available data do not appear to favor a particular therapy. Given the conflicting findings regarding quality of life, no clear conclusions can be made. Interpretation of findings highlighted the importance of intervention dosage, adherence, and supervision for optimal effectiveness. Despite the limitations of the included studies, this review provides new and valuable insights for future research and clinical practice.

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Unveiling the Hidden Links: Periodontal Disease, Fusobacterium Nucleatum, and Cancers.

Fusobacterium nucleatum (F. nucleatum), an anaerobic, gram-negative microbe, commonly found in human dental biofilm and the gut flora. It has long been known to have a higher concentration in periodontal disease and has recently been implicated in bothoral and distant cancers such as colorectal,gastrointestinal, esophageal, breast, pancreatic hepatocellular,and genitourinary cancers.However, the mechanism of its involvement in the development of cancer has not been fully discussed. This review aims to cover biological molecular and clinical aspects of F. nucleatumand cancers. Studies indicate F. nucleatum promotes tumor development through chronic inflammation, immune evasion, cell proliferation activation, and direct cell interactions, as in oral squamous cell carcinoma (OSCC). In colorectal cancer (CRC), F. nucleatum contributes to tumorigenesis through β-catenin signaling and NF-κB activation. It also induces autophagy, leading to chemoresistance in CRC and esophageal cancers, and enhances tumor growth and metastasis in breast cancer by reducing T-cell infiltration. F. nucleatum is linked to carcinogenesis and increased bacterial diversity in OSCC, with improved oral hygiene potentially preventing OSCC. F. nucleatum triggers cancer by causing mutations and epigenetic changes through cytokines and reactive oxygen species. It also promotes chemoresistance in CRC. F. nucleatum may potentially serve as a diagnostic tool in various cancers, with non-invasive detection methods available. Further investigation is needed to discover its potential in the diagnosis and treatment of OSCC and other cancers.

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Telehealth Utilization in Neuro-Oncology: Commentary on a Single Institution Experience After the COVID-19 Pandemic.

During the COVID-19 pandemic, regulatory and reimbursement policy changes provided patients improved access to neuro-oncology by telehealth. Here we discuss benefits and limitations of telehealth use in neuro-oncology. We review utilization of telemedicine services following the COVID-19 pandemic. Utilization of telemedicine by neuro-oncology during the COVID-19 pandemic was 52%, compared to 27-29% for other solid tumors groups. Following the pandemic, between January 2021 and April 2024, telehealth utilization has remained high in neuro-oncology with approximately 30% of all visits completed by telemedicine, compared to 10-15% for other solid tumor groups. The striking difference between telehealth visit utilization in neuro-oncology and general medical oncology even after expiration of the COVID-19 Public Health Emergency expiration and end of pandemic-related restrictions, underscores the potential value of convenient access to care for patients with central nervous system tumors. Given widespread use of telehealth in neuro-oncology, prospective evaluation to determine the safety, usability, and acceptance of video-enabled, telehealth visits is critical. Such data may lead to broader adoption of telehealth, lead to regulatory and reimbursement reform for telehealth sustainability, and improve clinical trial access and accruals.

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