Combined Treatment Approach Research Articles

Anatomic sub-segmentectomy with single-session combined transcatheter arterial embolization/microwave ablation for the treatment of hepatocellular carcinoma: preliminary results.

This retrospective study aimed to confirm the safety and long-term efficacy of a single-session combined treatment approach with transcatheter arterial embolization (TAE) and microwave ablation (MWA) for inoperable small-to intermediate-sized hepatocellular carcinomas (HCC), focusing on their combined benefits for improving local control. All consecutive patients with up to 2 small-to-intermediate HCC lesions (≤ 5cm) treated with a combined single-session MWA-TAE approach were enrolled between April 2020 and October 2023. All procedures were performed in two stages: TAE and MWA. Clinical and radiological follow-up was performed 3, 6, and 12 months after treatment. In the 21 enrolled patients (15 males, mean age 75.9 years), post-procedural contrast-enhanced CT scans confirmed a satisfactory ablation zone in all patients (100%), with minor peri-procedural complications reported in three patients (14%). At the last 12-month follow-up, one patient (8%) displayed local tumor progression, previously classified as LR-TR equivocal at the 6-month follow-up, and half of the patients (6 patients, 50%) exhibited distant tumor progression, predominantly in the form of intra-hepatic recurrence. The combined approach of TAE and MWA is a promising method to enhance the percutaneous treatment of small to intermediate-sized HCCs with a resulting anatomic ablation area resembling a surgical sub-segmentectomy. This technique can potentially reduce the gap between percutaneous treatment and liver resection outcomes, allowing for a safe and effective option for oncological control in patients with > 3cm lesions.

A novel combination of treatments for acute anterior disc displacement without reduction of temporomandibular joint

This study aimed to evaluate the effectiveness of a new combined treatment approach using arthrocentesis, hyaluronic acid (HA) injection, mandibular manipulation (MM), and the Twin-Block appliance (TBA) for managing acute anterior disc displacement without reduction (ADDwoR). A retrospective cross-sectional study was designed. Thirty-seven patients (38 joints) diagnosed with acute ADDwoR were treated with arthrocentesis plus HA combined with MM and TBA in turn from January 2022 to December 2023. The maximum mouth opening (MMO), visual analogue scale (VAS) pain score, condyle/disc position were measured and comparatively analyzed at baseline and one week, three and six months post-treatment. Analysis of variance, Dunnett’s T3 analysis, and paired samples t-tests were conducted for statistical analyses setting the threshold for statistical significance at P < 0.05. This treatment achieved a success rate of 94.59% (35/37). After one week of treatment, the MMO exhibited a statistically significant improvement, while the VAS pain scores showed a statistically significant decrease (P < 0.001). Magnetic resonance imaging revealed that at six months post-treatment, there was a significant forward shift in the condylar position compared with pre-treatment (P < 0.001),alongside a significant backward movement of the disc on the affected side (P < 0.001).The combination of arthrocentesis plus HA, MM, and TBA can effectively relieve clinical symptoms and restore the disc-condylar relationship in patients with acute ADDwoR.

The Effectiveness of Multimodality Treatment Including Stabilization Splint and Low-Level Laser Therapies on Managing Temporomandibular Disorders: A Pilot Randomized Controlled Trial.

Temporomandibular disorder (TMD) encompasses various clinical issues affecting the temporomandibular joint, masticatory muscles, and surrounding structures. Common symptoms include pain, joint and muscle tenderness, and limited jaw movement. Diverse treatment options have been utilized to manage TMD. However, evidence of the combined modality treatment approach is scarce. This pilot trial aimed to evaluate the effectiveness of combining stabilization splint therapy (SST) with low-level laser therapy (LLLT) in managing TMD. This pilot parallel randomized clinical trial included 30 patients with TMD. Patients were randomly allocated equally into three treatment groups: SST, LLLT, and combined treatment (CT). Outcomes, including pain and functional limitations, were measured at baseline, 1, 2, 3, and 4 weeks after the start of each treatment. CT was significantly more effective in reducing pain in patients with TMD compared to LLLT and SST. Although patients in the LLLT group reported significantly reduced pain, they still had higher pain scores compared to the SST group at certain time points, indicating that LLLT was not as effective as SST. Most functional limitations were improved over time, more consistently within the CT group, but without significant differences between the three groups. Patients were more satisfied with CT compared to LLLT and SST. The superior results of the CT group over the SST and LLLT groups were evident in this pilot trial's outcomes. The combined modality treatment approach seems to yield the greatest improvement for TMD patients.

Assessing the potential of activated carbon and anion-exchange in combination to remove organic micropollutants from wastewater - Long term pilot trials at Kungsängsverket WWTP, Uppsala, Sweden.

Pharmaceuticals and per- and polyfluoroalkyl substances (PFAS) are persistent organic micropollutants (OMPs) posing environmental and health risks due to their bioaccumulative nature and potential toxicity. These OMPs spread to the environment due to the extensive use in today's society. Conventional wastewater treatment plants (WWTPs) are not designed to effectively remove these contaminants, making WWTPs an important pathway, especially for pharmaceuticals, to the aquatic environment. This study investigates the efficiency of combining granular activated carbon (GAC) and anion exchange (AIX) for the removal of OMPs from wastewater. While GAC is a well-established method for removal of pharmaceuticals and AIX for PFAS removal, the combination of GAC and AIX for treating municipal wastewater has not been evaluated before. This research therefore focuses on long-term trials assessing the removal efficiencies of GAC and AIX filters in both bench-scale and pilot-scale setups at Kungsängsverket WWTP in Uppsala, Sweden. The combination of GAC and AIX filters showed over 90% removal efficiency for pharmaceuticals such as diclofenac up to 20,000 treated empty bed volumes (EBV). PFAS removal was primarily achieved by AIX after the initial 5000 EBV by GAC, highlighting the complementary roles of the two technologies. The findings contribute with new insights utilizing GAC and AIX as a combined treatment approach for reducing OMPs in municipal wastewater, contributing to improved environmental and public health outcomes.

Synergistic Anticancer Activity of Quercetin Combined with Luteolin in MCF-7 Breast Cancer Cells via Induction of Apoptosis

Cancer is a major public health problem with its increasing incidence and mortality. The striking role of phytochemicals in the prevention and treatment of cancer is undeniable in studies. In this study, the effects of the combination of quercetin (QUR) and luteolin (LTN) on the MCF-7 human breast cancer cell line were investigated in vitro. WST-1 cell cytotoxicity assay was used to determine cytotoxic activity. The effects on colony survival and cell migration were determined by clonogenic assay and wound scratch assay, respectively. For the determination of apoptosis, AO/EB dual staining, and Caspase-3 ELISA analysis, and genomic analyses revealing p53, Bcl-2, and Bax expression levels were performed. As a result of the analyses, it was seen that especially QUR plus LTN treatment exhibited a great cytotoxic activity in cells. It was determined that the combination treatment suppressed colony survival and significantly inhibited cell migration. Quantitative analysis results show that QUR+LTN treatment triggers cellular apoptosis by upregulating Caspase-3, p53, and Bax, and downregulating Bcl-2. Supporting these findings with further in vitro and in vivo analyses may contribute significantly to revealing the promising efficacy of combined phytochemical treatment approaches on cancer.

P0900 Hyperbaric oxygen therapy downstages refractory perianal fistulizing Crohn’s disease and allows for surgical closure

Abstract Background Hyperbaric Oxygen Therapy (HBOT) has previously shown benefit in treatment-refractory perianal fistulizing Crohn’s disease (PFCD). However, the biological mechanisms underlying therapy response remain poorly understood. In this prospective study, we aimed to assess the feasibility, efficacy, and safety of HBOT followed by surgical closure, while also investigating translational changes associated with HBOT. Methods Patients with active PFCD refractory to 6 months of optimized medical therapy were included. After receiving a seton, patients started HBOT (40 sessions, 110 minutes each with 5-minute air breaks, 100% oxygen at 2.4 atmosphere). Half-way, at week 4, the seton was removed and surgical closure of the internal fistula opening was attempted. All patients continued stable dose of medical treatment during the study. Response was assessed clinically, by pelvic MRI and by patient-reported QoL. RNAseq data of surgical biopsies of the internal fistula opening were explored between patients after completion of HBOT and matched non-HBOT patients. Results Sixteen patients completed HBOT and all of them could undergo a technically successful surgical procedure at week 4 (See Table 1). Clinical remission (no draining fistula openings) was achieved in 43% (W9), 42% (W26) and 70% (W52), and PDAI remission (≤4) was achieved by 31% (W9), 58% (W26) and 70% (W52) (Figure 1). MRI remission (MAGNIFI-CD ≤6) was achieved by 42% (W26) and 57% (W52), and MRI healing (MAGNIFI-CD = 0) was achieved by 8% (W26) and 40% (W52). Quality of Life (CAFQOL) improved significantly with a mean improvement of 10.7 (SE 3.9) by W26 and 22.7 (SE 6.0) by W52. (S)AEs included one patient with a potential oxygen toxicity seizure without long term effects, and one patient reported claustrophobia, no new AEs were reported. Surgical biopsies obtained after HBOT displayed increased expression of cornification markers including CRNN, KRT4, KRT13 and SPRR2B. Pathway analysis confirmed biological activity of ‘keratinization’ and ‘dermal development’ in post-HBOT samples. This is similar to those observed previously in cryptoglandular fistulas. In contrast, patients without HBOT on stable medical treatment mainly showed general immune activation. Conclusion HBOT resulted in downstaging of active PFCD, which became amenable to surgical closure. The combined treatment approach resulted in sustained clinical and MRI remission in patients with refractory disease. HBOT resulted in enhanced activity of pathways associated with keratinization and dermal development. These data support a model where HBOT shifts an active Crohn’s disease fistula towards a more manageable cryptoglandular-like phenotype.

Indirect targeting of MYC and direct targeting in combination with chemotherapies are more effective than direct mono-targeting in triple negative breast cancer

MYC amplification is disproportionally elevated in triple-negative breast cancer (TNBC) compared to other subtypes of breast cancer. Indeed, MYC has long been considered an undruggable oncogene using conventional drug design strategies or small molecules. We hypothesized that targeting MYC using asymmetric siRNA (asiRNA) alone or in combination with chemotherapeutic agents or indirectly via BRD4 and RRM2, may curb its oncogenic behavior. We developed paclitaxel-, doxorubicin-, and cisplatin-resistant MDA-MB-231 cells to study MYC's role in upregulating DNA repair genes during drug resistance development. Our results showed that the knockdown of either MYC or RRM2 downregulated both RAD51 and PARP1 but increased γH2AX. The cytotoxic effect of RRM2 knockdown was significantly (p < 0.05) higher than that of direct MYC knockdown. The knockdown of BRD4 was more effective than the direct knockdown of MYC in downregulating MYC protein. The combined use of asiRNA-VP (Vinylphosphonate) with dacomitinib or talazoparib was synthetic lethal in TNBC cell lines. Compared to chemotherapy-sensitive cells, resistant cells showed overexpression of MYC, RRM2, RAD51, and PARP1 proteins upon chemotherapy treatment, but downregulated in cells treated with asiRNA-VP combination. We confirmed that MYC knockdown upregulated cFLIP, BCL2, STAT1, pSTAT1, STAT2, and cleaved saspase-3 in both TNBC and non-small cell lung cancer (NSCLC) cell lines. Finally, we recommend a combination treatment approach that synergizes with MYC inhibition rather than monotherapy or indirect targeting via upstream regulators such as the BRD4 and RRM2 genes or selective modulation at the protein level to suppress anti-apoptotic genes (cFLIP and BCL2) at the same time.

Active Tumor Targeting by Core-Shell PDMS-HA Nanoparticles with Sequential Delivery of Doxorubicin and Quercetin to overcome P-glycoprotein efflux pump

The therapeutic efficacy of chemotherapy in various malignancies and solid tumors is significantly limited when used as monotherapy. This study explored a combined treatment approach for breast cancer cells involving...

Therapeutic Approaches for Advanced Basal Cell Carcinoma: A Comprehensive Review

Basal cell carcinoma (BCC) accounts for 80% of skin cancer cases. Although mostly curable by simple excision, the treatment of advanced disease can be challenging, as curative surgery or radiotherapy may not always be feasible. The scope of this review is to summarize current knowledge on molecular mechanisms in BCC pathogenesis, to elaborate on the definition of advanced/difficult-to-treat BCC, and to outline systemic treatment options. Particularly, pivotal trial data of the approved hedgehog inhibitors (HHI) sonidegib and vismodegib are compared. Concluding, we provide an overview of novel, particularly neoadjuvant and combined treatment approaches, both with hedgehog and immune-checkpoint inhibitors.

Therapeutic patterns and outcomes in older patients (aged≥65 years) with stage III-IVB inoperable oral cavity squamous cell carcinoma (OCSCC): an investigational study from the SEER database

ABSTRACT Background The aim of this retrospective study is to explore therapeutic patterns and survival outcomes for a cohort of older patients with stage III-IVB inoperable oral squamous cell carcinoma (OCSCC) patients receiving radiation therapy (RT) with or without chemotherapy (CT). Methods This study conducted a retrospective review of 316 patients ≥ 65 aged years with stage III-IVB OCSCC from the Surveillance, Epidemiology, and End Results (SEER) registry (2010–2015). It compared RT alone (n = 109) with RT+CT (n = 207), utilizing Kaplan-Meier and Log-rank tests. Results The estimated overall survival (OS) and cancer-specific survival (CSS) rates at 3 years were 20.6% and 25.9%, respectively. Both univariate and multivariate analyses identified that age and treatment option as independent prognosticators of OS and CSS. Further subgroup analyses showed that the combination of RT and CT significantly improved OS for all OCSCC patients, except those with hard palate tumors. Moreover, this combined treatment approach was linked to enhanced CSS in patients with gingival and tongue squamous cell carcinoma. Conclusion RT+CT significantly enhanced survival in elderly OCSCC patients, particularly those with gingival and tongue cancers, but not in those with hard palate tumors.

Combining Medication With High-Intensity-Focused Ultrasound for Adenomyosis: A Network Meta-Analysis of Randomized Controlled Trials.

This network meta-analysis aims to identify the best possible combination therapy for individuals suffering from adenomyosis. To identify pertinent research for the network meta-analysis, a comprehensive search was conducted across multiple databases, including PubMed, Embase, Cochrane Library, Web of Science, CNKI, WanFang, and VIP, spanning from their commencement to February 21, 2024. The study's focus was on evaluating outcomes including visual analog scale (VAS) scores for dysmenorrhea, measurements of uterine and lesion volumes, menstrual blood loss, and the rate of disease recurrence. The findings from both direct and indirect comparisons, which were quantitatively assessed using weighted mean differences or relative risk along with their respective 95% confidence intervals, were graphically depicted in forest plots. Additionally, the ranking probability was illustrated, which indicated the likelihood of various high-intensity-focused ultrasound (HIFU) combination therapies being the most effective across each measured outcome. In the final analysis, this network meta-analysis encompassed a total of 31 articles. The results showed that HIFU combined with gonadotropin-releasing hormone agonist (GnRH-a) and progestin was more effective to decrease VAS score for dysmenorrhea than other combined therapies. HIFU combined with progestin was superior to other combined therapies in decreasing uterine volume, lesion size, and recurrence rate. HIFU combined with mifepristone was more effective to reduce menstrual volume compared to other combined therapies. The analysis suggests that regimens incorporating HIFU along with GnRH-a and progestin, or HIFU combined with progestin or HIFU combined with mifepristone might offer superior benefits in the clinical management of adenomyosis. These combined treatment approaches could potentially be more effective options for patients suffering from this condition.

Integrative Computational Framework, Dyscovr, Links Mutated Driver Genes to Expression Dysregulation Across 19 Cancer Types.

Though somatic mutations play a critical role in driving cancer initiation and progression, the systems-level functional impacts of these mutations-particularly, how they alter expression across the genome and give rise to cancer hallmarks-are not yet well-understood, even for well-studied cancer driver genes. To address this, we designed an integrative machine learning model, Dyscovr, that leverages mutation, gene expression, copy number alteration (CNA), methylation, and clinical data to uncover putative relationships between nonsynonymous mutations in key cancer driver genes and transcriptional changes across the genome. We applied Dyscovr pan-cancer and within 19 individual cancer types, finding both broadly relevant and cancer type-specific links between driver genes and putative targets, including a subset we further identify as exhibiting negative genetic relationships. Our work newly implicates-and validates in cell lines-KBTBD2 and mutant PIK3CA as putative synthetic lethals in breast cancer, suggesting a novel combinatorial treatment approach.

Current Challenges and Potential Strategies in CAR-T Cell Therapy

Abstract. CAR-T therapy, involves modifying the patient's immune T cells in a laboratory setting to recognize antigens on tumor cells. Significant progress has been made in the treatment of hematologic malignancies, thanks to advancements in cancer treatment, namely the discovery of immunotherapies. Nevertheless, the therapy encounters obstacles such as antigen evasion, effects that target both tumor and non-tumor cells, restricted penetration into tumors, a tumor microenvironment that suppresses immune response, and adverse effects such as CRS and neurotoxicity. This paper analyzes the complexities of CAR-T treatment, its fundamental principles, and potential uses for many forms of cancer, including solid tumors. The primary objective is to improve the effectiveness and safety of the therapy by the manipulation of CAR-T cells, alteration of CAR structures, and investigation of combined treatment approaches. Although CAR-T therapy shows promise in transforming cancer treatment, additional refinement is necessary to optimize its therapeutic efficacy and decrease undesirable side effects. This will facilitate the development of more efficient and individualized cancer treatments.

A Narrative Review on Stress and Itch: What We Know and What We Would Like to Know.

Itch is one of the most prevalent symptoms experienced by patients with inflammatory skin conditions, yet it is also one of the most debilitating. Patients suffering from chronic itch have been found to have significantly higher stress levels compared with those not experiencing itch. In fact, recent studies have revealed a bidirectional relationship between stress and itch, where each condition worsens the other. This is thought to be driven by the vicious itch-scratch cycle, which is fueled by underlying inflammation. The precise molecular pathways and mediators involved, however, remain unclear. This narrative review discusses the existing research on the relationship between stress and itch and outlines future research directions that will be necessary to advance our understanding and treatment of these conditions. Given that the effective management of both symptoms often requires a combined treatment approach, further investigation into their shared mechanisms is essential for identifying successful therapies and improving patient outcomes.

Research progress on the role of bypass activation mechanisms in resistance to tyrosine kinase inhibitors in non-small cell lung cancer.

The clinical application of small molecule tyrosine kinase inhibitors (TKIs) has significantly improved the quality of life and prognosis of patients with non-small cell lung cancer (NSCLC) carrying driver genes. However, resistance to TKI treatment is inevitable. Bypass signal activation is one of the important reasons for TKI resistance. Although TKI drugs inhibit downstream signaling pathways of driver genes, key signaling pathways within tumor cells can still be persistently activated through bypass routes such as MET gene amplification, EGFR gene amplification, and AXL activation. This continuous activation maintains tumor cell growth and proliferation, leading to TKI resistance. The fundamental strategy to treat TKI resistance mediated by bypass activation involves simultaneously inhibiting the activated bypass signals and the original driver gene signaling pathways. Some clinical trials based on this combined treatment approach have yielded promising preliminary results, offering more treatment options for NSCLC patients with TKI resistance. Additionally, early identification of resistance mechanisms through liquid biopsy, personalized targeted therapy against these mechanisms, and preemptive targeting of drug-tolerant persistent cells may provide NSCLC patients with more sustained and effective treatment.

Efficacy of hip abductors exercise training combined with repetitive transcranial magnetic stimulation on knee osteoarthritis: A randomized controlled trial.

Knee osteoarthritis is a common degenerative joint disease where a single treatment method often fails to fully alleviate symptoms. Hence, finding effective non-invasive combined treatment approaches is particularly crucial. The efficacy of treating knee osteoarthritis with hip abductors exercise training combined with repetitive transcranial magnetic stimulation was assessed through functional scales and objective evaluation methods. In this four-week randomized clinical trial, 160 patients meeting inclusion criteria were randomly assigned 1:1 to group A to receive oral celecoxib and group B to receive a combination of hip abductors exercise training and repeated transcranial magnetic stimulation. The primary outcome was the western Ontario and McMaster universities osteoarthritis index. The secondary outcomes include Visual Analogue Scale, knee outcome survey activities of daily living scale, Active Range of Motion, and the Quadriceps Angle, the tibiofemoral angle, peak adductor moment, the integrated electromyography and root mean square of the surface electromyography of the lower extremity muscles. Paired sample t test was used for Within-Group comparison of outcome indicators, and independent sample t test was used for Between-Group comparison. Of the 160 randomly assigned patients, 150 completed the study. After 4 weeks, the WOMAC index decreased from 61 ± 10.83 to 40.55 ± 7.58 in the combined treatment group and from 60.97 ± 10.18 to 47.7 ± 10.13 in the celecoxib group. The effect of the combined treatment group was significantly higher than that in the celecoxib group (P< 0.001). In the combined treatment group, the score of knee joint daily living scale increased (P< 0.001), the active range of motion increased (P< 0.001), the quadriceps angle decreased (P< 0.001), the tibiofemoral angle increased (P< 0.001), and the peak adduction moment decreased (P< 0.001), integrated electromyography and root mean square increased (P< 0.001), and the effect was better than that of celecoxib group (P< 0.001). The visual analog scale score in celecoxib group was lower (P< 0.001) and knee outcome survey activities of daily living scale was higher (P< 0.001). The incidence of treatment-related adverse events was 10% in the celecoxib group and 2.5% in the combined treatment group, all of which were mild. Hip abductors exercise training combined with repetitive transcranial magnetic stimulation can enhance abduction muscle strength, improve mobility, reduce joint pain, and enhance quality of life. This combined approach shows superior clinical effectiveness compared to oral celecoxib.

Combined effect of temporal inundation and aboveground-cutting on the growth performance of two emergent wetland plants, Phragmites australis and Bolboschoenus planiculmis.

Phragmites australis is a common foundation species found in inland and brackish estuarine ecosystems. P. australis stands provide a wide range of habitats for wetland organisms and perform essential functions, such as nutrient cycling, pollutant filtration, wave energy reduction, and soil stabilization. However, excessive growth of P. australis can degrade the quality of wetland habitats, thereby reducing the functions of restored wetlands. In this study, we investigated the effectiveness of vegetation management techniques, such as aboveground cutting and temporal inundation with varying depth and periodicity, in controlling the growth performance of P. australis and adjacent vegetation, Bolboschoenus planiculmis. Differences in growth responses to manipulated inundation stress between P. australis and B. planiculmis were measured. Inundation stress of 10-50 cm caused significantly greater inhibition of growth performance in B. planiculmis compared to P. australis. The combination of aboveground-cutting and inundation treatments resulted in a significant inhibitory effect on the growth performance and survival rate of P. australis. The growth performance of P. australis, including stem volume and biomass, decreased and its mortality rate increased. Our manipulated experiment suggests a combined treatment approach of moderate inundation, such as 5-10 cm for 20-30 days, and aboveground cutting to manage the overgrowth of P. australis in restored brackish wetlands.

Inferior Overall Survival After Haploidentical Donor Lymphocyte Infusions in Relapsed Myeloid Neoplasms.

Allogeneic hematopoietic stem cell transplantation (HSCT) effectively treats high-risk myeloid neoplasms, but relapses post-HSCT, particularly in acute myeloid leukemia (AML) and myelodysplastic neoplasms (MDS), pose significant challenges. Donor lymphocyte infusion (DLI) has been utilized, but its effectiveness, especially in haploidentical settings, remains insufficiently clarified, and graft-versus-host disease (GvHD) poses a substantial risk. In this retrospective cohort study, 57 patients with AML or MDS who received DLI after allogeneic HSCT at our center from 2002 to 2023 were analyzed. Herein, only preemptively or therapeutically applied DLI were included, and endpoints included overall survival (OS), progression-free survival (PFS), and GvHD incidence post-DLI. Median OS after DLI was 517 days, with a 1-year OS of 62.5%. Factors associated with longer OS included patient age, HLA-identical donor, post-HSCT treatment naivety, and preemptive DLI indication. Haploidentical DLI was associated with inferior OS compared to HLA-identical DLI; however, PFS and GvHD incidence post-DLI did not differ significantly. Our study findings indicate that OS rate is inferior in patients with relapsed AML or MDS treated with haploidentical DLI in comparison to those who received HLA-identical DLI. Given the limitations of haploidentical DLI, alternative strategies, such as higher cell doses or combination treatment approaches, warrant further investigation.

Research progress of the SLFN family in malignant tumors.

The Schlafen (SLFN) gene family has emerged as a critical subject of study in recent years, given its involvement in an array of cellular functions such as proliferation, differentiation, immune responses, viral infection inhibition, and DNA replication. Additionally, SLFN genes are linked to chemosensitivity, playing a pivotal role in treating malignant tumors. Human SLFNs comprise three domains: the N-terminal, middle (M), and C-terminal. The N- and C-terminal domains demonstrate nuclease and helicase/ATPase activities, respectively. Meanwhile, the M-domain likely functions as a linker that connects the enzymatic domains of the N- and C-terminals and may engage in interactions with other proteins. This paper aims to present a comprehensive overview of the SLFN family's structure and sequence, examine its significance in various tumors, and explore its connection with immune infiltrating cells and immune checkpoints. The objective is to assess the potential of SLFNs as vital targets in cancer therapy and propose novel strategies for combined treatment approaches.

Surgical Outcomes for Vertebral Body Hemangiomas With Compressive Symptoms: An Institutional Experience.

Background Vertebral hemangiomas (VHs) are benign vascular tumors commonly found within the vertebral bodies of the spine. While most VHs remain asymptomatic and are often discovered incidentally during imaging studies, a subset can become symptomatic, leading to clinical challenges. The optimal treatment approach for symptomatic VHs remains a topic of debate. At our institution, we have managed aggressive VHs through a combination of surgical decompression and intraoperative alcohol ablation. The objective of this research is to evaluate the effectiveness of a combined treatment approach involving intralesional ethanol injection, surgical decompression, and stabilization using titanium polyaxial screws and rods in managing symptomatic VHs with compressive symptoms. Methodology A prospective longitudinal study was conducted at the Indira Gandhi Institute of Medical Science, Patna, in patients with symptomatic VHs associated with compressive myelopathy. The operative plan involved bilateral transpedicular intralesional injection of absolute alcohol (<1% hydrated ethyl alcohol), followed by laminectomy decompression and stabilization of the affected segment using polyaxial titanium pedicle screws and rods. Results A total of 19 patients were included in the study, consisting of 10 females and nine males, all presenting with back pain, myelopathy, and sphincter dysfunction. Preoperative American Spinal Injury Association (ASIA) scores were as follows: A (9), B (5), C (3), D (2), and E (0). The average duration of the surgery was 120 minutes, with a standard deviation of 30 minutes. The average blood loss recorded was 250 cc, with a variability of 50 cc, and the typical volume of absolute alcohol utilized was 6 ml, with a standard deviation of 5 ml. Postoperatively, all patients showed improvement, with follow-up ASIA scores of E (9), D (5), B (3), and C (2). Conclusions The use of intraoperative ethanol as an embolizing agent, laminectomy decompression, and stabilization using screws and rods for symptomatic VHs seems to be ideal treatment modality in resource-poor countries like India.