Individualized Treatment Plans Research Articles

Evolving Standards of Care in the Management of Localized Colorectal Cancer.

The treatment of patients with localized rectal cancer is complex and requires input from a multidisciplinary team. Baseline local staging and mismatch repair protein testing are vital to develop individualized treatment plans. There are multiple options in terms of treatment modalities and sequencing, including transanal excision, short-course radiation, long-course chemoradiation, chemotherapy doublet or triplet, nonoperative management, and immune checkpoint blockade for patients with mismatch repair deficient tumors. While localized colon cancer is typically treated with surgical resection and consideration of adjuvant chemotherapy, emerging data suggest that neoadjuvant chemotherapy may be beneficial in patients with higher-risk disease. Quality-of-life considerations are imperative to prevent potential chronic effects on psychosocial health, neuropathy, fertility, and bowel, bladder, and sexual function. The omission of radiation or surgery can mitigate these toxicities without diminishing oncologic outcomes. The optimal treatment plan and sequence is not a one-size-fits-all approach but rather should be personalized to the patient's disease burden, tumor location, comorbidities, and preferences.

Balancing the mind: The critical role of carbamazepine as a mood stabilizer in bipolar and schizoaffective disorders

This case study explores the therapeutic application and associated challenges of using carbamazepine as a mood stabilizer in the management of schizoaffective disorder. The patient, a 42-year-old male with a history of schizoaffective disorder, exhibited acute manic symptoms exacerbated by substance use and non-compliance with medication. The introduction of carbamazepine initially showed promise in stabilizing mood and reducing psychotic symptoms. However, the treatment course was complicated by a significant adverse dermatological reaction. This necessitated a switch to valproic acid, which was better tolerated. The case underscores the importance of careful monitoring and readiness to adjust treatment in response to carbamazepine-induced side effects. This study highlights the critical need for individualized treatment plans and emphasizes the role of pharmacogenetic testing in predicting adverse drug reactions, ensuring safer and more effective management of psychiatric conditions.

STATISTICAL ANALYSIS OF THE PREVALENCE OF INTERNAL TEMPOROMANDIBULAR JOINT DISORDERS IN FEMALE PATIENTS BASED ON C. H. WILKES CLASSIFICATION

Introduction. Severity levels of temporomandibular joint dysfunction can be assessed by certain parameters based on images obtained using magnetic resonance imaging. In order to assess the condition of the joint and choose the optimal treatment plan depending on the detected changes on the magnetic resonance imaging images, the most common classification according to C. H. Wilkes was chosen. This study aimed to assess the severity of temporomandibular joint dysfunction symptoms in women of child-bearing and post-menopausal age according to the C. H. Wilkes classification. Participants and methods. 63 patients were selected: reproductive period n=45 and post-menopausal n=17. Magnetic resonance imaging is described in detail and the diagnosis according to the C. H. Wilkes classification is made. Statistical analysis was carried out by calculating the χ2 test in order to analyze the independence between categorical variables; Kendall's correlation coefficient was applied to assess the correlation between age and disease stages. Results. Diseases of the temporomandibular joint are more common among women of child-bearing age compared to women of postmenopausal age. This may be related to hormonal changes characteristic of the reproductive period: in the group of child-bearing age, there is a greater variety of stages of the disease, while in the group of post-menopausal age, stage IV prevails. This may indicate the influence of age factors on TMJ development. The relationship between age and diseases of the temporomandibular joint has a statistically significant correlation. The results of the χ2 test show a statistically significant relationship between age and TMJ disease stages. In addition, Kendall's correlation coefficient confirms the presence of a moderate degree of relationship between age and stages of the disease. Conclusion. The results of the analysis of the distribution of temporomandibular joint disease stages between age groups can serve as important data for optimizing clinical practice, improving treatment outcomes, and increasing patients' quality of life. For example, our study indicates that stage Ⅱ according to the classification of C. H. Wilkes is more common in women of reproductive age, and stage Ⅳ is more common in women of postmenopausal age. Clinicians should take this dada into account when developing individual treatment plans.

Imaging of Vaginal Yolk Sac Tumor: 2 Case Reports and Literature Review

Our article reports on two cases of pediatric vaginal yolk sac tumors (YSTs), underscoring the diagnostic challenges posed by their similarities to other vaginal tumors, particularly in differentiating from embryonal rhabdomyosarcoma based on clinical and radiological presentations. Emphasizing the critical role of MRI, histological examination, and alpha-fetoprotein levels in diagnosis, we highlight the complexities of treatment, which has evolved from radical surgeries to more conservative approaches with adjuvant chemotherapy, aiming to preserve future sexual and reproductive functions. Our findings advocate for individualized treatment plans and stress the importance of accurate diagnosis and the potential need for alternative therapeutic strategies in cases of atypical response to treatment.

Individualized strategies for depression: narrative review of clinical profiles responsive to vortioxetine.

Depression is a highly heterogeneous disorder, often resulting in suboptimal response and remission rates. This underscores the need for more nuanced clinical characterization of patients to tailor individualized treatment plans. Emerging evidence highlights the critical role of cognitive and emotional dysfunction in major depression, prompting the exploration of novel therapeutic interventions that target these specific symptom domains. Vortioxetine, a multimodal antidepressant, enhances serotonergic activity while also modulating several other neurotransmitter systems involved in depressive symptoms such as emotional blunting, anhedonia, and cognitive dysfunction. Numerous randomized, placebo-controlled trials have demonstrated vortioxetine's efficacy and safety in treating depression, particularly in specific subgroups of depressed patients, including those with cognitive deficits and comorbid anxiety symptoms or disorders. Although not randomized or placebo-controlled, studies have also shown vortioxetine's efficacy in depressed patients with emotional blunting or anhedonia. Vortioxetine's ability to effectively treat a range of depressive symptoms, including anhedonia, emotional blunting, anxiety, and cognitive dysfunction, provides an individualized treatment solution for depressed individuals suffering from these symptoms. The purpose of this paper is to identify clinical profiles of patients who may benefit from vortioxetine, with the goal of optimizing therapeutic outcomes. Vortioxetine has been shown to be effective for patients with depression and symptoms such as anhedonia, emotional blunting, anxiety, and cognitive dysfunction. Tailoring treatment plans to individual needs and personalizing treatment choices based on the specific symptoms presented by depressed patients improve treatment outcomes.

Clinical Significance of a Novel Vasculogenic Mimicry-Based Prognostic Model in Hepatocellular Carcinoma.

Vasculogenic mimicry, a novel neovascularization pattern of aggressive tumors, is associated with poor clinical outcomes. The aim of this research was to establish a new model, termed VC score, to predict the prognosis, Tumor Microenvironment (TME) components, and immunotherapeutic response in Hepatocellular Carcinoma (HCC). The expression data of the public databases were used to develop the prognostic model. Consensus clustering was performed to confirm the molecular subtypes with ideal clustering efficacy. The high- and low-risk groups were stratified utilizing the VC score. Various methodologies, including survival analysis, single-sample Gene Set Enrichment Analysis (ssGSEA), Tumor Immune Dysfunction and Exclusion scores (TIDE), Immunophenoscore (IPS), and nomogram, were utilized for verification of the model performance and to characterize the immune status of HCC tissues. GSEA was performed to mine functional pathway information. The survival and immune characteristics varied between the three molecular subtypes. A five-gene signature (TPX2, CDC20, CFHR4, SPP1, and NQO1) was verified to function as an independent predictive factor for the prognosis of patients with HCC. The high-risk group exhibited lower Overall Survival (OS) rates and higher mortality rates in comparison to the low-risk group. Patients in the low-risk group were predicted to benefit from immune checkpoint inhibitor therapy and exhibit increased sensitivity to immunotherapy. Enrichment analysis revealed that signaling pathways linked to the cell cycle and DNA replication processes exhibited enrichment in the high-risk group. The VC score holds the potential to establish individualized treatment plans and clinical management strategies for patients with HCC.

Screening and Follow-Up Treatment Practices for Suicide Risk in Adolescent Primary Care: A Retrospective Chart Review.

Universal depression screening in adolescent primary care often encompasses questions about suicide risk. We conducted a retrospective chart review of well-child visits where adolescents (ages 13-17.9) had endorsed self-injurious thoughts and behaviors or suicidal ideation. The goal was to investigate primary care providers' follow-up actions, including documentation, further assessment, and referrals. Over 3-quarters of the progress notes showed evidence of further assessment, and two-thirds documented same-day actions, including mental health referrals, emergency department referrals, safety plans, medication changes, primary-care follow-up, and talking to parents. Actions varied by depression severity. Cases without interventions often had justifications. Owing to the variety of possible meanings and severity underlying positive screens, providers implemented an array of interventions, using clinical judgment to tailor actions to patients' individual needs and preferences. From these observations, we propose that standardized guidelines for suicide risk screening and follow-up should involve a clinical assessment and individualized treatment planning.

Outcomes of mechanical thrombectomy in octogenarians and nonagenarians patients with Acute Ischemic Stroke: A Systematic Review and Network Meta-Analysis

PurposeAcute ischemic stroke (AIS) imposes a major healthcare burden, with the elderly population often underrepresented in clinical trials. This systematic review and network meta-analysis aims to evaluate the safety and efficacy of mechanical thrombectomy (MT) among octogenarians and nonagenarians with AIS due to large vessel occlusion (LVO). MethodsA systematic search was conducted using PubMed, Web of Science, and Scopus databases. Outcomes of interest were modified Rankin Scale (mRS) score of 0–2, thrombolysis in cerebral infarction (TICI) score of 2b-3, 90-day mortality, and symptomatic intracerebral hemorrhage (sICH). The study followed Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. ResultsThe analysis included 47 studies. Significantly lower rates of mRS score 0–2 were observed in nonagenarians (17.4 %) and octogenarians (21.3 %) compared to younger (40.2 %) patients (Odds Ratio (OR) = 3.30, 95 % Confidence Interval (CI):2.35–4.65 and OR = 2.47, 95 % CI: 2.07–2.94). 90-day mortality was significantly higher in nonagenarians (38.9 %) compared to octogenarians (25.4 %) and younger (14.0 %) patients (OR = 0.58, 95 % CI: 0.41–0.83 and OR = 0.31, 95 % CI: 0.21–0.44), and in octogenarians compared to younger patients (OR = 0.52, 95 % CI: 0.41–0.66). No significant differences were observed in TICI 2b-3 and sICH rates across groups. ConclusionsOur findings indicate that MT is a viable treatment option for AIS due to LVO among octogenarians and nonagenarians, albeit with nuanced differences. Specifically, octogenarians had lower 90-day mortality rates compared to nonagenarians. These insights support the need for individualized treatment plans for elderly patients with AIS due to LVO and highlight the importance of including this demographic in future clinical trials.

Clinical application of high-resolution spiral CT scanning in the diagnosis of auriculotemporal and ossicle

Precision and intelligence in evaluating the complexities of middle ear structures are required to diagnose auriculotemporal and ossicle-related diseases within otolaryngology. Due to the complexity of the anatomical details and the varied etiologies of illnesses such as trauma, chronic otitis media, and congenital anomalies, traditional diagnostic procedures may not yield accurate diagnoses. This research intends to enhance the diagnosis of diseases of the auriculotemporal region and ossicles by combining High-Resolution Spiral Computed Tomography (HRSCT) scanning with Deep Learning Techniques (DLT). This study employs a deep learning method, Convolutional Neural Network-UNet (CNN-UNet), to extract sub-pixel information from medical photos. This method equips doctors and researchers with cutting-edge resources, leading to groundbreaking discoveries and better patient healthcare. The research effort is the interaction between the CNN-UNet model and high-resolution Computed Tomography (CT) scans, automating activities including ossicle segmentation, fracture detection, and disruption cause classification, accelerating the diagnostic process and increasing clinical decision-making. The suggested HRSCT-DLT model represents the integration of high-resolution spiral CT scans with the CNN-UNet model, which has been fine-tuned to address the nuances of auriculotemporal and ossicular diseases. This novel combination improves diagnostic efficiency and our overall understanding of these intricate diseases. The results of this study highlight the promise of combining high-resolution CT scanning with the CNN-UNet model in otolaryngology, paving the way for more accurate diagnosis and more individualized treatment plans for patients experiencing auriculotemporal and ossicle-related disruptions.

Patients’ Preferences Regarding Modes of Systemic Psoriasis Treatment – A Qualitative Study

Background Treatment with pathogenesis-directed biologics and oral systemic drugs have made complete clearance of psoriasis a realistic expectation for many patients with psoriasis. Patients’ preferences among these treatments varies. Objective To understand factors impacting psoriasis patients’preferences for injection vs oral medication. Methods Psoriasis patients who receive systemic psoriasis treatment were asked to participate in a semi-structured interview. Sample size was based on achieving saturation with equal number of patients preferring oral vs injectable medications to ensure equal representation of both groups. Qualitative analysis was performed to interpret the results. Results Twenty-two patients participated in the study, 12 males and 10 females. Ten patients were receiving oral medication (apremilast or methotrexate) and 12 patients were receiving injectables (guselkumab, adalimumab, risankizumab, secukinumab, ixekizumab, or tildrakizumab) due to self-reported preference. Five themes resulted from the analysis: patients receiving injectables more frequently discussed the positive impact of the medication on quality of life compared to patients on oral medication; fear of side effects, particularly fear of immunosuppression, is associated with injection medications; avoidance of needles drives patients away from injection medication and towards oral systemic medication; patients prioritize convenience when selecting systemic therapy, though the definition of convenience is subject to perception; and patients value the medication recommendation of the physician, regardless of the route of administration. Conclusion Improving medication adherence and disease outcomes through individualized treatment plans, with an emphasis on patients’ preferences using a shared decision-making approach, may be helpful.

EFFECT OF DAPAGLIFLOZIN ON CARDIOVASCULAR OUTCOMES IN HFREF PATIENTS: IMPACT OF DIABETES MELLITUS TYPE 2 STATUS

Dapagliflozin has shown promise in the treatment of heart failure with reduced ejection fraction (HFrEF), but its effects in patients with and without diabetes remain unclear. Objective: This study aimed to assess the effects of dapagliflozin in HFrEF patients, both with and without diabetes. Methods: From January to July 2023, a six-month case-control study was conducted in the cardiology department of a Tertiary Care Hospital in Peshawar, Pakistan. All patients received an additional dose of dapagliflozin (10 mg) alongside their usual treatment plans. The primary outcome was a composite of heart failure exacerbation or cardiovascular death. Data analysis was performed using SPSS version 22. Results: Patients with diabetes mellitus type 2 (DMT2) exhibited a higher rate of cardiovascular death (22%) and hospitalization for heart failure (14.4%) compared to those without diabetes. The hospitalisation rate for heart failure was also higher in the DMT2 group (12.21%) than in the non-diabetic group (8.6%). Over the trial period, cardiovascular death occurred in 12.44% of patients with DMT2 compared to 7.30% in those without DMT2. Patients with diabetes experienced a significantly higher number of first and recurrent hospitalizations for heart failure and cardiovascular death compared to those without diabetes (32.45% vs. 19.20%, p=0.021). Conclusion: Dapagliflozin therapy in HFrEF patients demonstrated varying effects between those with and without diabetes. The study underscores the importance of personalised management strategies considering comorbid medical conditions. Despite dapagliflozin treatment, patients with both heart failure and diabetes continued to experience cardiovascular complications, highlighting the need for individualised treatment plans that account for a patient's complete medical profile.

An Unusual Case Report of Cotard’s Syndrome with Depressive Delusions

Cotard’s Syndrome, also known as nihilistic delusion or Cotard’s delusion, is an exceptionally rare psychiatric condition characterized by delusional beliefs ranging from a sense of being dead to the conviction of bodily decay or nonexistence. This case report of a male patient, aged 21 years, with Cotard’s Syndrome highlights the difficulties in diagnosis, the course of therapy, and the clinical ramifications of this illness. The patient exhibited symptoms of severe depression along with nihilistic delusions, expressing the belief that he was deceased and experiencing bodily decay. Nihilistic delusions and depressed symptoms compatible with Cotard’s syndrome in the setting of major depressive disorder were found during the patient’s mental state evaluation, despite the absence of a serious physical disease or drug addiction. Treatment consisted of antidepressant and antipsychotic medication, along with individual psychotherapy sessions focusing on cognitive restructuring. Over time, the patient demonstrated gradual improvement in delusional beliefs and depressive symptoms, highlighting the importance of comprehensive psychiatric evaluation and individualized treatment planning.

Abstract PO2-03-01: Personalized 3D tumor models drive shared decision-making in early breast cancer

Abstract Background: Decision-making for early (Stages 1-3) breast cancer (eBC) care is complex and highly personal, requiring discussions between patients and multiple physicians. Shared decision-making (SDM) is an accepted process that combines input from both patients and physicians, although its overall use is low due to a lack of time and incentives, complicated application techniques, and few communication tools. Reviews show that SDM results in “improved affective-cognitive outcomes” but evidence linking to patient outcomes is sparse. Consequently, patients often receive mixed messages and feel anxious when making treatment decisions. SimBioSys (SBS) developed the TumorSight(TM) platform for individualized treatment planning, coordinated care, and SDM. The first application on this platform, TumorSight Viz, rapidly builds 3D computational models from standard breast MRI data, and further integrates deep learning, genomic/genetic testing, metabolomics, and clinical and demographic data to tailor these models for each individual diagnosed with eBC. The platform can also transform acquired data (e.g., prone) to surgical position (e.g., supine) to create realistic images for precision surgical planning and tools for better SDM with eBC patients. We are assessing how surgeons and patient advocates (PA) perceive TumorSight, and how it may support better SDM and treatment implementation. Methods: SBS conducted an exploratory survey with 31 eBC surgeons to assess the utility of TumorSight Viz visualizations across a range of didactic and planning applications and to query preferences for future components like predicted response to chemotherapy and immunotherapy. Questions were developed with input from breast surgeon advisors. More exploration on TumorSight Viz utility is planned with semi-structured qualitative interviews to assess patient advocates’ perceptions of 3D visualizations, surgical planning, and ability to support decision making. PAs will represent geographic, experience, and race/ethnicity diversity. Questions to elicit patient needs, perception of SBS tools, and quality-of-life are being finalized with academic advisors. These will also be used to develop a future eBC patient survey. Results: The SBS surgeon survey revealed that 96% of breast surgeons find visualization important to surgical planning, and these depictions were considered to be critical by a third of breast surgeons surveyed. 96% also listed the conversion of prone to supine visualizations as important (45% critical, 35% valuable, 16% nice to have, 0% not important) for surgical planning value. Surgeons also assigned strong utility for: Graphical 3D rotation to determine tumor shape, size, location, positioning, and landmarks relative to other breast structures – 100% Ability to instantly provide tumor-to-breast volume determination with high accuracy – 96% Ability to instantly provide anticipated tumor extirpation volume to breast volume with high accuracy – 96% Automatic tumor-to-landmark structures measurements (nipple, chest, skin) – 96% Visualization of tumor in the context of other anatomical structures (e.g., skin, blood vessels, chest, heart) – 87% Initial PA discussions (n=3) listed the importance of individualized treatment based on evidence instead of hunches; reasons to avoid prophylactic mastectomies; and ways to lower patient anxiety. Conclusions: Survey-based feedback shows value to eBC surgeons and patients to coordinate care and personalize approaches for optimal outcomes. Computational tools can facilitate patient understanding and patient-tailored treatment. Additional surveys are planned with patients and eBC patient advocacy groups to assess the utility and potential expansion of patient-specific 3D tumor visualizations, both of which will be further discussed. Citation Format: Deborah Collyar, Matthew Biancalana, Anuja Antony, Nicole Liadis, Jyoti Palaniappan, Rebecca Seago-Coyle. Personalized 3D tumor models drive shared decision-making in early breast cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-03-01.

Multi-modal fusion deep transfer learning for accurate brain tumor classification using magnetic resonance imaging images

Early identification and treatment of brain tumors depend critically on accurate classification. Accurate brain tumor classification in medical imaging is essential for clinical decisions and individualized treatment plans. This paper introduces a novel method for classifying brain tumors called multimodal fusion deep transfer learning (MMFDTL) using original, contoured, and annotated magnetic resonance imaging (MRI) images to showcase its capabilities. The MMFDTL can capture complex tumor features frequently missed in analyzing individual modalities. The MMFDTL model employs three deep learning models for extracting features VGG16, Inception V3, and ResNet 50. The accuracy rate improves when combined with decision based multimodal fusion. It produces impressive outcomes of sensitivity 92.96%, specificity 98.54%, precision 93.60%, accuracy 98.80%, F1-score 93.26%, and kappa 91.86%. This research can improve medical imaging and brain tumor analysis through its multi modal fusion approach. It could give healthcare practitioners vital insights for personalized treatment plans and informed decision making.

Machine learning model for prediction of permanent stoma after anterior resection of rectal cancer: A multicenter study

BackgroundThe conversion from a temporary to a permanent stoma (PS) following rectal cancer surgery significantly impacts the quality of life of patients. However, there is currently a lack of practical preoperative tools to predict PS formation. The purpose of this study is to establish a preoperative predictive model for PS using machine learning algorithms to guide clinical practice. MethodsIn this retrospective study, we analyzed clinical data from a total of 655 patients who underwent anterior resection for rectal cancer, with 552 patients from one medical center and 103 from another. Through machine learning algorithms, five predictive models were developed, and each was thoroughly evaluated for predictive performance. The model with superior predictive accuracy underwent additional validation using both an independent testing cohort and the external validation cohort. The Shapley Additive exPlanations (SHAP) approach was employed to elucidate the predictive factors influencing the model, providing an in-depth visual analysis of its decision-making process. ResultsEight variables were selected for the construction of the model. The support vector machine (SVM) model exhibited superior predictive performance in the training set, evidenced by an AUC of 0.854 (95 % CI:0.803–0.904). This performance was corroborated in both the testing set and external validation set, where the model demonstrated an AUC of 0.851 (95%CI:0.748–0.954) and 0.815 (95%CI:0.710–0.919), respectively, indicating its efficacy in identifying the PS. ConclusionsThe model(https://yangsu2023.shinyapps.io/psrisk/) indicated robust predictive performance in identifying PS after anterior resection for rectal cancer, potentially guiding surgeons in the preoperative stratification of patients, thus informing individualized treatment plans and improving patient outcomes.

Development of Tumor Markers for Breast Cancer Immunotherapy.

Although breast cancer treatment has been developed remarkably in recent years, it remains the primary cause of death among women. Immune checkpoint blockade therapy has significantly altered the way breast cancer is treated, although not all patients benefit from the changes. At present, the most effective mechanism of immune checkpoint blockade application in malignant tumors is not clear and efficacy may be influenced by many factors, including host, tumor, and tumor microenvironment dynamics. Therefore, there is a pressing need for tumor immunomarkers that can be used to screen patients and help determine which of them would benefit from breast cancer immunotherapy. At present, no single tumor marker can predict treatment efficacy with sufficient accuracy. Multiple markers may be combined to more accurately pinpoint patients who will respond favorably to immune checkpoint blockade medication. In this review, we have examined the breast cancer treatments, developments in research on the role of tumor markers in maximizing the clinical efficacy of immune checkpoint inhibitors, prospects for the identification of novel therapeutic targets, and the creation of individualized treatment plans. We also discuss how tumor markers can provide guidance for clinical practice.

Primary nasopharyngeal carcinoma with Sjögren's syndrome and positive cerebrospinal fluid Epstein-Barr virus: a case report and literature review

The study presents an analysis of the diagnostic and treatment protocol for a patient with a first episode of nasopharyngeal carcinoma who also has Sjogren's syndrome and Epstein-Barr Virus (EBV) positive cerebrospinal fluid, as detected through metagenomic next-generation sequencing (mNGS). It reviews existing literature to examine the connections between EBV and various conditions including Sjogren's syndrome, encephalitis or meningitis, and nasopharyngeal carcinoma, emphasizing the importance of EBV positive cerebrospinal fluid. The study focuses on a case from the Eighth Medical Center of the General Hospital of the People's Liberation Army, where a patient was admitted with headaches as the primary symptom on March 3, 2021. This patient had a history of Sjogren's syndrome and was later diagnosed with nasopharyngeal carcinoma. The research involved reviewing both domestic and international databases for cases related to cerebrospinal fluid EBV positive encephalitis or meningitis, and nasopharyngeal carcinoma. It aimed to aggregate data on demographics, initial symptoms, treatment methods, and patient outcomes. Findings suggest that positive cerebrospinal fluid EBV is linked to autoimmune diseases, viral encephalitis or meningitis, and nasopharyngeal carcinoma, albeit infrequently in the context of Sjogren's syndrome. Notably, EBV positive cerebrospinal fluid is commonly associated with recurrent nasopharyngeal carcinoma rather than initial episodes. The study concludes that for patients with an immune condition, exhibiting symptoms like headaches or cranial nerve issues, or in cases where nasopharyngeal carcinoma is suspected, early testing through cerebrospinal fluid mNGS or EBV DNA is recommended. This approach facilitates risk assessment, prognosis determination, and the creation of individualized treatment plans.

EXPLORING AYURVEDIC APPROACHES TO LOW BACK PAIN: A COMPREHENSIVE REVIEW

Introduction:Low back pain (LBP) is a common musculoskeletal disorder affecting individuals worldwide, causing significant disability and healthcare burden. While conventional treatments focus on symptomatic relief, Ayurveda, the ancient Indian system of medicine, offers a holistic approach that addresses the root cause of LBP. This comprehensive review aims to explore Ayurvedic perspectives, diagnostic methods, therapeutic interventions, and herbal formulations for managing LBP. Ayurvedic Perspective:Ayurveda views LBP as a manifestation of imbalances in the Tridosha (Vata, Pitta, and Kapha) and the Saptadhatus (seven body tissues). Vata dosha vitiation is predominantly implicated in LBP, leading to symptoms such as stiffness, spasms, and radiating pain. Pitta and Kapha imbalances may exacerbate inflammation and structural degeneration, respectively. Ayurvedic diagnosis of LBP involves assessing the individuals Prakriti (constitutional type), Vikriti (current imbalance), Agni (digestive fire), and Srotas (channels of circulation). Diagnostic Methods:Ayurvedic physicians employ a combination of clinical examination, palpation, and pulse diagnosis (Nadi Pariksha) to assess the underlying doshic imbalances and identify the specific etiology of LBP. Various factors such as lifestyle habits, occupation, dietary patterns, and psychological stressors are taken into account during the assessment. Therapeutic Interventions:Ayurvedic management of LBP is multifaceted, aiming to alleviate pain, reduce inflammation, restore musculoskeletal integrity, and prevent recurrence. Therapeutic interventions include: Panchakarma: Detoxification therapies such as Basti (medicated enema), Abhyanga (oil massage), and Swedana (herbal steam therapy) are utilized to eliminate ama (toxins) and pacify aggravated doshas. Ayurvedic Medications: Herbal formulations containing anti-inflammatory, analgesic, and muscle-relaxant herbs like Ashwagandha (Withania somnifera), Guggulu (Commiphora wightii), and Shallaki (Boswellia serrata) are prescribed to manage pain and inflammation. Yoga and Pranayama: Specific yoga asanas (postures) and pranayama (breathing exercises) are recommended to improve flexibility, strengthen the back muscles, and enhance prana (vital energy) flow to the affected area. Dietary Modifications: Dietary recommendations include consuming warm, light, and easily digestible foods, emphasizing anti-inflammatory spices like turmeric, ginger, and cinnamon, and avoiding cold, heavy, and processed foods that may aggravate Vata dosha. Lifestyle Management: Adopting a balanced daily routine (Dinacharya), practicing stress-reduction techniques such as meditation and mindfulness, and maintaining proper posture and ergonomics are crucial for long-term management of LBP. Clinical Evidence:Several clinical studies have investigated the efficacy of Ayurvedic interventions in LBP management. A randomized controlled trial comparing Ayurvedic treatment with conventional therapy demonstrated significant improvements in pain relief, functional disability, and quality of life among participants receiving Ayurvedic intervention. Furthermore, observational studies have reported favorable outcomes with Panchakarma therapies and herbal formulations in reducing pain intensity and enhancing mobility in patients with chronic LBP. Safety and Considerations:While Ayurvedic interventions are generally considered safe when administered under the guidance of a qualified practitioner, certain precautions should be observed. Individualized treatment plans based on the patients constitution, doshic imbalance, and overall health status are essential to optimize therapeutic outcomes and minimize potential adverse effects. Additionally, close monitoring and periodic reassessment are necessary to track progress and adjust treatment as needed. Conclusion:Ayurveda offers a holistic and individualized approach to managing low back pain, addressing not only the symptoms but also the underlying imbalances contributing to the condition. By incorporating Panchakarma therapies, herbal formulations, dietary modifications, and lifestyle interventions, Ayurvedic treatment aims to restore harmony within the body, promote self-healing, and prevent recurrence of LBP. Further research and collaboration between Ayurvedic and conventional healthcare systems are warranted to validate the efficacy and safety of Ayurvedic interventions and enhance their integration into mainstream healthcare for comprehensive LBP management.

Enhancing Nasopharyngeal Carcinoma Survival Prediction: Integrating Pre- and Post-Treatment MRI Radiomics with Clinical Data.

Recurrences are frequent in nasopharyngeal carcinoma (NPC) despite high remission rates with treatment, leading to considerable morbidity. This study aimed to develop a prediction model for NPC survival by harnessing both pre- and post-treatment magnetic resonance imaging (MRI) radiomics in conjunction with clinical data, focusing on 3-year progression-free survival (PFS) as the primary outcome. Our comprehensive approach involved retrospective clinical and MRI data collection of 276 eligible NPC patients from three independent hospitals (180 in the training cohort, 46 in the validation cohort, and 50 in the external cohort) who underwent MRI scans twice, once within 2months prior to treatment and once within 10months after treatment. From the contrast-enhanced T1-weighted images before and after treatment, 3404 radiomics features were extracted. These features were not only derived from the primary lesion but also from the adjacent lymph nodes surrounding the tumor. We conducted appropriate feature selection pipelines, followed by Cox proportional hazards models for survival analysis. Model evaluation was performed using receiver operating characteristic (ROC) analysis, the Kaplan-Meier method, and nomogram construction. Our study unveiled several crucial predictors of NPC survival, notably highlighting the synergistic combination of pre- and post-treatment data in both clinical and radiomics assessments. Our prediction model demonstrated robust performance, with an accuracy of AUCs of 0.66 (95% CI: 0.536-0.779) in the training cohort, 0.717 (95% CI: 0.536-0.883) in the testing cohort, and 0.827 (95% CI: 0.684-0.948) in validation cohort in prognosticating patient outcomes. Our study presented a novel and effective prediction model for NPC survival, leveraging both pre- and post-treatment clinical data in conjunction with MRI features. Its constructed nomogram provides potentially significant implications for NPC research, offering clinicians a valuable tool for individualized treatment planning and patient counseling.

Factors Influencing Treatment Success in Cholesteatoma Management: A Cross-Sectional Study.

Background/Objectives: Cholesteatoma presents significant management challenges in otolaryngology. This study aimed to delineate the influence of demographic and clinical characteristics, preoperative imaging, and surgical approaches on treatment success in cholesteatoma management. Methods: A cross-sectional analytical study was conducted at the Otolaryngology Department of the University Hospital from January 2021 to December 2022. It included 68 patients diagnosed with cholesteatoma, focusing on three objectives: assessing the impact of demographic and clinical characteristics on treatment outcomes, evaluating the predictive value of preoperative imaging findings, and analyzing the influence of surgical factors. Results: The study population predominantly consisted of male (56%) and Saudi (81%) patients, with an average age of 45 years. Logistic regression revealed that older age (OR: 1.05), male gender (OR: 0.63), and non-Saudi Arab ethnicity (OR: 2.14) significantly impacted treatment outcomes. Clinical characteristics such as severe disease severity (OR: 3.00) and longer symptom duration (OR: 0.96) also influenced treatment success. In preoperative imaging, labyrinthine fistula (Regression Coefficient: 0.63) and epidural extension (Coefficient: 0.55) emerged as key predictors. The surgical factors that significantly affected the outcomes included the extent of surgery (Complete Removal OR: 3.32) and the use of endoscopic approaches (OR: 1.42). Conclusions: This study highlights that patient demographics, clinical profiles, specific preoperative imaging features, and surgical strategies multifactorially determine cholesteatoma treatment success. These findings suggest the necessity for a tailored approach in cholesteatoma management, reinforcing the importance of individualized treatment plans based on comprehensive preoperative assessments.