Treatment Modalities Research Articles

Treatment Modalities for Refractory-Recurrent Tenosynovial Giant Cell Tumor (TGCT): An Update

Background and Objectives: Tenosynovial giant cell tumor (TGCT) is a rare, locally aggressive, benign neoplasm arising from the synovium of joints, tendon sheaths, and bursa. There are two main subtypes of TGCT: localized-type TGCT(L-TGCT) and diffuse-type TGCT (D-TGCT). While surgical excision is still considered the gold standard of treatment, the high recurrence rate, especially for D-TGCT, may suggest the need for other treatment modalities. Materials and Methods: This study reviews current literature on the current treatment modalities for refractory-relapsed TGCT disease. Results: The gold standard of treatment modality in TGCT remains surgical excision of the tumor nevertheless, the elevated recurrence rate and refractory disease, particularly in D-TGCT indicates and underscores the necessity for additional treatment alternatives. Conclusions: TGCT is a benign tumor with inflammatory features and a potential destructive and aggressive course that can lead to significant morbidity and functional impairment with a high impact on quality of life. Surgical resection remains the gold standard current treatment and the optimal surgical approach depends on the location and extent of the tumor. Systemic therapies have been recently used for relapsed mainly cases.

Head and Neck Cancer and Sarcopenia: An Integrative Clinical and Functional Review

Sarcopenia is recognized as a crucial factor impacting the prognosis, treatment responses, and quality of life of HNC patients. This review discusses various mechanisms, including common etiological factors, such as aging, chronic inflammation, and metabolic dysregulation. Cancer-related factors, including tumor locations and treatment modalities, contribute to the development of sarcopenia. The clinical implications of sarcopenia in HNC patients extend beyond reduced muscle strength; it affects overall mobility, reduces quality of life, and increases the risk of falls and fractures. Sarcopenia serves as an independent predictor of postoperative complications, chemotherapy dose-limiting toxicity, and treatment outcomes, which affect therapy planning and perioperative management decisions. Methods to assess sarcopenia in HNC patients encompass various techniques. A sarcopenia assessment offers a potentially efficient and readily available tool for clinical practice. Interventions and management strategies for sarcopenia involve exercise interventions as a cornerstone; however, challenges arise due to patient-specific limitations during cancer treatment. A routine body composition analysis is proposed as a valuable addition to HNC patient management, with ongoing research required to refine preoperative exercise and nutrition programs for improved treatment outcomes and survival.

Effect of Contrast Bath on Level of Neuropathic Pain among Patients with Type 2 Diabetes Mellitus

Diabetic neuropathy is a chronic sequela of DM and contrast bath is a non-pharmacological treatment modality which can reduce neuropathic pain among them. The present study was intended to assess the effect of contrast bath on level of neuropathic pain among patients with T2DM. The main objectives of the study were to assess the level of neuropathic pain among patients with T2DM, assess the effect of contrast bath on level of neuropathic pain and to determine the association between the neuropathic pain and socio demographic and clinical variables. The research approach was quantitative and the design adopted was quasi experimental. Sample consists of 60 patients with T2DM having neuropathic pain attending OPDs of Ananthapuri hospital selected by consecutive sampling technique. The conceptual framework adopted for the study was Wiedenbach’s Prescriptive theory. A structured interview schedule was used to collect socio demographic and clinical variables and Galer Neuropathy Pain Scale for assessing the neuropathic pain. Pre-test was done for both groups. After explanation and ensuring safety contrast bath was administered to experimental group for 20 minutes. Post-test was done by using the same tool for both experimental and control group. Mean, frequency, percentage were used to describe the data. Independent t test was used to assess the effect of contrast bath and association of level of neuropathic pain with socio demographic and clinical variables. The results revealed statistically significant (p<0.01) difference in the mean score of neuropathic pain in the experimental and control group after intervention. There was no significant association between level of neuropathic pain and socio demographic and clinical variables. The study infers that contrast bath is a simple non pharmacological home-based cost-effective intervention which can improve the daily functional abilities of patients with DM and thereby enhancing their quality of life.

The Role of Platelet-Rich Plasma Therapy in Treating Sports Injuries

Introduction: Sports injuries are a significant health problem for both professional and recreational athletes. Standard treatment methods, including physiotherapy, pharmacotherapy, and surgical interventions, often fall short in cases of severe soft tissue damage. This has led to a growing interest in alternative therapies, such as platelet-rich plasma (PRP). In recent years, there has been growing interest in platelet-rich plasma (PRP) therapy due to its potential regenerative properties. PRP is increasingly used in the treatment of sports injuries, with the aim of accelerating tissue regeneration and facilitating a return to full physical fitness. This paper attempts to analyze available scientific studies to assess the effectiveness of PRP in the treatment of sports injuries. Purpose of the work: The aim of this study is to assess the effectiveness and safety of platelet-rich plasma (PRP) therapy in treating sports-related muscle, tendon, ligament, and joint injuries, and to compare its efficacy with other established treatment modalities, such as physiotherapy and pharmacotherapy. Results: Platelet-rich plasma (PRP) therapy has been shown to be highly effective in treating sports injuries, particularly muscle and tendon injuries. PRP accelerates tissue regeneration and shortens the time to return to physical activity, but the effectiveness of the therapy depends on the proper preparation protocol and individual patient characteristics. Compared to other treatment methods, PRP has a favorable safety profile and a lower risk of complications. Despite promising results, further studies are needed to better determine the long-term effectiveness and optimal conditions for using this therapy.

Conformal immunomodulatory hydrogels for the treatment of otitis media

Otitis media (OM), a condition stemming from the proliferation of various bacteria within the tympanic cavity (TC), is commonly addressed through the administration of ofloxacin (OFL), a fluoroquinolone antibiotic. Nevertheless, the escalating issue of antibiotic resistance and the challenge of drug leakage underscore the exploration of an alternative, more effective treatment modality in clinical practice. Here, we introduce a simple and easily implementable fluid-regulated strategy aimed at delivering immunomodulatory hydrogels into the TC, ensuring conformal contact with the irregular anatomical surfaces of the middle ear cavity to more effectively eliminate bacteria and treat OM. This innovative strategy exhibits expedited therapeutic process of antibiotic-resistant, acute and chronic OM rats, and significant reductions in the severity of tympanic membrane (TM) inflammation, residual bacteria within the TC (0.12 *105 CFU), and the thickness of TM/TC mucosa (17.63/32.43 μm), as compared to conventional OFL treatment (3.6, 0.76 *105 CFU, 48.70/151.26 μm). The broad-spectrum antibacterial and antibiofilm properties of this strategy against a spectrum of OM pathogens are demonstrated. The strategy is validated to bolster the host’s innate immune response through the stimulation of antibacterial protein synthesis, macrophage proliferation and activation, thereby accelerating bacterial eradication and inflammation resolution within the TC. This facile, cost-effective and in vivo degradable technology exhibits promising prospects for future clinical implementation.

THE FORTH VALLEY ACHILLES MANAGEMENT PROTOCOL FOR ACUTE ACHILLES TENDON RUPTURES: A PROSPECTIVE OBSERVATIONAL STUDY

This prospective study explores the outcomes of the Forth Valley Protocol (FVP) for the management of acute Achilles tendon ruptures. The protocol uses ultrasound as the primary mechanism to guide treatment.All patients presenting with acute tendoachilles rupture over a three-year period were included. Patients under 18 years of age, chronic ruptures, or prior surgery to the Achilles tendon were excluded. Patients with a gap ≤2cm had conservative management following an Early Rehabilitation Protocol (ERP) and >2cm underwent surgery (if an appropriate surgical candidate). Achilles Tendon Rupture Scores (ATRS) were obtained retrospectively. Fischer's exact test was used to determine statistical significance.158 patients were included with a mean age of 53 (range 20–89). Ultrasound scans were obtained for 121 patients (76.5%), demonstrating a mean tendon gap of 1.61cm. 143 patients managed conservatively and 15 surgically. The overall re-rupture rate was 3.8% (n=6). All the re-ruptures occurred in patients treated conservatively, but this was not found to be statistically significant (n=6, P=1.0). The overall complication rate (excluding re-ruptures) was 1.9%. ATRS was comparable between both treatment modalities (P=0.382, 0.422), with a mean score of 86.6 in the conservative group and 81.4 in the surgical group.The FVP demonstrates low re-rupture and complication rates in line with other published studies. Patients with gaps ≤2.0cm on the ultrasound can be successfully treated conservatively with an ERP. This has potential benefits in terms improved patient outcomes, satisfaction, and preservation of resources.

Proton Radiation Therapy: A Systematic Review of Treatment-Related Side Effects and Toxicities

Cancer is the second leading cause of death worldwide. Around half of all cancer patients undergo some type of radiation therapy throughout the course of their treatment. Photon radiation remains (RT) the most widely utilized modality of radiotherapy despite recent advancements in proton radiation therapy (PBT). PBT makes use of the particle’s biological property known as the Bragg peak to better spare healthy tissue from radiation damage, with data to support that this treatment modality is less toxic than photon RT. Hence, proton radiation dosimetry looks better compared to photon dosimetry; however, due to proton-specific uncertainties, unexpected acute, subacute, and long-term toxicities can be encountered. Reported neurotoxicity resulting from proton radiation treatments include radiation necrosis, moyamoya syndrome, neurosensory toxicities, brain edema, neuromuscular toxicities, and neurocognitive toxicities. Pulmonary toxicities include pneumonitis and fibrosis, pleural effusions, and bronchial toxicities. Pericarditis, pericardial effusions, and atrial fibrillations are among the cardiac toxicities related to proton therapy. Gastrointestinal and hematological toxicities are also found in the literature. Genitourinary toxicities include urinary and reproductive-related toxicities. Osteological, oral, endocrine, and skin toxicities have also been reported. The side effects will be comparable to the ones following photon RT, nonetheless at an expected lower incidence. The toxicities collected mainly from case reports and clinical trials are described based on the organs affected and functions altered.

Stereotactic body radiotherapy versus lenvatinib for hepatocellular carcinoma with portal vein tumor thrombosis: a propensity matching score analysis

Background and objectivesThe purpose of this study was to investigate the survival benefit of Stereotactic Body Radiotherapy (SBRT) versus lenvatinib as first-line therapy in the treatment of hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT).Materials and methods147 HCC patients with PVTT were included in this retrospective study, 70 were treated with SBRT and 77 of were treated with lenvatinib. Propensity score matching (PSM) analysis was employed to balance the differences in baseline characteristics between the two groups. Overall survival (OS), progression-free survival (PFS) and objective response rate (ORR) were compared between the two groups. In addition, the safety of patients in both groups was also evaluated.ResultsAfter PSM, 38 patients were matched in each of the two groups. The median OS was 14.5 (95% CI: 10.1–18.9) and 11.1 (95% CI: 9.3–12.9) months in the SBRT and lenvatinib groups, respectively (P = 0.014). The median PFS was 6.8 (95% CI: 5.1–8.5) and 5.0 (95% CI: 3.0–7.0) months, respectively (P = 0.010). The 1-, 2-years OS rates in the two groups were 65.8% vs. 39.5% and 31.6% vs. 10.5%, respectively. The 6-, 12-months PFS rates in the two groups were 57.9% vs. 44.7% and 28.9% vs. 10.5%, respectively. In addition, the SBRT group had a better ORR than the lenvatinib group (52.6% vs. 23.7%, P = 0.009). Patients with good response to SBRT had better survival. Cox proportional hazard model showed that SBRT was an important prognostic factor for OS and PFS. The incidence of hypertension (34.2% vs. 0%) was higher in the LEN group, however, both treatment modalities were well tolerated in the two groups of patients.ConclusionIn HCC patients with PVTT, SBRT had a better survival benefit than Lenvatinib treatment as first-line therapy.

A study to determine the efficacy of intense pulse light in vascular mode for topical steroid damaged facies

Objectives: Misuse of topical corticosteroids on the face has gradually evolved over the years and has now reached phenomenal proportions on account of easy availability, widespread misinformation, and the fairness craze sweeping across the land. Topical steroid-damaged/dependent facies (TSDFs) may present with diffuse erythema, telangiectasia, papules, and atrophy. Current modalities used for the management of TSDF, such as topical tacrolimus and oral antibiotics, have shown a variable response. Intense pulsed light (IPL) systems are economical, have a higher safety margin, and are widely available. The goal of treating vascular lesions with IPL is to raise blood vessel temperature high enough to cause coagulation, leading to destruction and healing with fibrosis. In our study, we exploit these properties of IPL for the management of TSDF. Material and Methods: A total of 15 patients of TSDF were recruited and were treated with three sessions of IPL treatments (vascular mode) 3 weeks apart and were assessed based on a clinical score for TSDF, visual analog scale (VAS) for erythema assessed by the physician and patient at the end of 9 weeks. Results: There was a significant response with a reduction in clinical score of 5.4 points (P > 0.001) and a reduction in physician and patient-assessed VAS for erythema of 3.47 and 3.73, respectively. Conclusion: There is a scarcity of data regarding the efficacy of various treatment modalities for TSDF. Our study establishes IPL (vascular mode) as an innovative emerging modality of treatment.

3D Scaffold-Based Culture System Enhances Preclinical Evaluation of Natural Killer Cell Therapy in A549 Lung Cancer Cells.

Cell-based immunotherapies have emerged as promising cancer treatment modalities, demonstrating remarkable clinical efficacy. As interest in applying immune cell-based therapies to solid tumors has gained momentum, experimental models that enable long-term monitoring and mimic clinical administration are increasingly necessary. This study explores the potential of scaffold-based cell culture technologies, specifically three-dimensional (3D) extracellular matrix (ECM)-like frameworks, as promising solutions. These frameworks facilitate unhindered immune cell growth and enable continuous cancer cell culture. The three-dimensional (3D) cell culture model was developed using tailored scaffolds for natural killer (NK) cell culture. Within this framework, A549 lung cancer cells were cocultured with NK cells, allowing real-time monitoring for up to 28 days. The expression of critical markers associated with anticancer drug resistance and epithelial-mesenchymal transition (EMT) was evaluated in cancer cells within this 3D culture context. Compared to conventional 2D monolayer cultures, this 3D scaffold-based culture revealed that solid tumor cells, specifically A549 cells, exhibited heightened resistance to anticancer drugs. Additionally, the 3D culture environment upregulated the expression of EMT markers namely vimentin, N-cadherin, and fibronectin, while NK and zEGFR-CAR-NK cells displayed anticancer effects. In the two-dimensional (2D) coculture, only zEGFR-CAR-NK cells exhibited such effects in the 3D coculture system, highlighting an intriguing inconsistency with the 2D culture model, further confirmed by in vivo experiments. This in vitro 3D cell culture model reliably predicts outcomes in NK immunotherapy experiments. Thus, it represents a valuable tool for investigating drug resistance mechanisms and assessing the efficacy of immune cell-based therapies. By bridging the gap between in vitro and in vivo investigations, this model effectively translates potential treatments into animal models and facilitates rigorous preclinical evaluations.

Effect of intermittent theta burst stimulation on upper limb function in stroke patients: a systematic review and meta-analysis.

Stroke is a serious health issue that affects individuals, families, and society. Particularly, the upper limb dysfunction caused by stroke significantly reduces the quality of life for patients and may lead to psychological issues. Current treatment modalities are not fully effective in helping patients regain upper limb motor function to optimal levels. Therefore, there is an urgent need to explore new rehabilitation methods to address this issue. The purpose of this meta-analysis and systematic review is to explore the effects of intermittent theta burst stimulation (iTBS) on upper limb function in stroke patients. We searched PubMed, Cochrane Library, Embase, Web of Science, PEDro and China National Knowledge Internet as of April 8, 2024. Retrieved a total of 100 articles. Standardized mean differences (SMDs) and 95% confidence intervals (CI) were calculated. The study included a total of 9 trials and involved 224 patients. The results demonstrate that compared to the control group, iTBS therapy significantly improved Fugl-Meyer assessment-upper extremity (FMA-UE) scores (SMD = 0.88; 95% CI = 0.11-1.66; P = 0.03, I 2 = 84%), Action Research Arm Test (ARAT) scores (SMD = 0.83; 95% CI = 0.16-1.50; P = 0.02, I 2 = 57%), and Barthel Index (BI) scores (SMD = 0.93; 95% CI = 0.53-1.32; P < 0.0001, I 2 = 0%) in stroke patients. The comprehensive evidence suggests that iTBS has superior effects in improving upper limb function and activities of daily living in stroke patients.

Multifunctional Nanoemulsified Clinacanthus nutans Extract: Synergistic Anti-Pathogenic, Anti-Biofilm, Anti-Inflammatory, and Metabolic Modulation Effects against Periodontitis.

This study investigates the therapeutic potential of Clinacanthus nutans extracts, focusing on the 95% ethanol (95E) extract and its nanoemulsified form, against oral pathogens and their bioactive effects. The findings demonstrate potent antibacterial activity against Streptococcus mutans and Staphylococcus aureus, essential for combating periodontal diseases, and significant anti-biofilm properties crucial for plaque management. Additionally, the extracts exhibit promising inhibitory effects on α-glucosidase enzymes, indicating potential for diabetes management through glucose metabolism regulation. Their anti-inflammatory properties, evidenced by reduced nitric oxide production, underscore their potential for treating oral infections and inflammation. Notably, the nanoemulsified 95E extract shows higher efficiency than the conventional extract, suggesting a multifunctional treatment approach for periodontal issues and metabolic disorders. These results highlight the enhanced efficacy of the nanoemulsified extract, proposing it as an effective treatment modality for periodontal disease in diabetic patients. This research offers valuable insights into the development of innovative drug delivery systems using natural remedies for improved periodontal care in diabetic populations.

MicroRNA-582-5p inhibits the progression of gastric cancer cells and their resistance to oxaliplatin by suppressing ATG7 expression.

Gastric cancer (GC) is one of the most common malignant tumors of the digestive tract worldwide. Both environmental and genetic factors contribute to the occurrence and development of GC. Surgery and chemotherapy are the main treatment modalities for gastric cancer; however, some patients show insensitivity to chemotherapeutic agents. Chemotherapy resistance is one of the primary reasons for poor treatment outcomes and the high likelihood of recurrence and metastasis in gastric cancer patients. Numerous studies have confirmed a correlation between the dysregulation of microRNA expression and the development of various malignant tumors, as well as their resistance to chemotherapeutic agents. However, the role of microRNA-582-3p in gastric cancer cells and its mechanism in the resistance of gastric cancer cells to oxaliplatin have not been studied. We first used q-PCR, CCK8, transwell, and scratch assays to validate the expression of microRNA-582-3p in gastric cancer tissues and cells, while also analyzing the relationship between its expression levels and the clinical pathological data of patients. Additionally, we further confirmed the impact of microRNA-582-3p on gastric cancer cell progression and oxaliplatin resistance through knockdown and overexpression experiments. Subsequently, to explore the specific mechanisms of microRNA-582-3p in gastric cancer, we verified the downstream target of microRNA-582-3p, ATG7, using dual-luciferase reporter assays and examined the effect of ATG7 on gastric cancer cell functions. Moreover, we conducted rescue experiments to further validate the interaction between microRNA-582-3p and ATG7. Our experimental results confirmed that microRNA-582-3p is lowly expressed in gastric cancer tissues and cells, and the expression level of miR-582-5p is correlated with the T stage of patients, while showing no correlation with the patients' gender, age, tumor size, degree of differentiation, or N stage. Additionally, we found that microRNA-582-3p functions as a tumor suppressor in gastric cancer cells, as its overexpression inhibits the biological functions of gastric cancer cells and increases their sensitivity to oxaliplatin. Furthermore, we identified binding sites between microRNA-582-3p and the autophagy-related gene ATG7, observing that knockdown of microRNA-582-3p increases ATG7 expression, while its overexpression reduces ATG7 levels. Moreover, ATG7 is overexpressed in gastric cancer cells; knockdown of ATG7 inhibits the biological functions of gastric cancer cells and increases their sensitivity to oxaliplatin, whereas overexpression of ATG7 reverses the inhibitory effect of miR-582-5p on gastric cancer. Our study confirms that microRNA-582-3p acts as a tumor suppressor in gastric cancer cells, and its role may be mediated through the regulation of ATG7 expression levels. MicroRNA-582-3p may serve as a potential target for gastric cancer treatment and a predictive biomarker.

Glucose metrics and device satisfaction in adults with type 1 diabetes using different treatment modalities: a multicenter, real-world observational study.

To evaluate glucose metrics, device satisfaction and diabetes impact in adults with type 1 diabetes using different treatment modalities in a real-life setting in Italy. This was a multicentre, nationwide, cross-sectional study. Candidates were consecutively evaluated for eligibility during their routine medical visit at the diabetes centre. Researchers collected comprehensive demographic, socioeconomic, anamnestic and clinical data, and administered the Diabetes Impact and Device Satisfaction scale. From 2021 to 2022, a total of 428 subjects, 45% males, with a median age of 32 years (IQR 23-47) were recruited in 11 participating centres from all over Italy. No differences in age, physical activity, and diabetes impact were found for the different treatment modalities. HCL/AHCL and SAP groups reported higher device satisfaction vs. MDI + SMBG and MDI + CGM (p < 0.001). Subjects treated with HCL/AHCL exhibited significantly higher TIR and significantly lower time spent in hypoglycemia level 1, time spent in hyperglycemia, CV and GMI compared to MDI + CGM, and significantly higher TIR and significantly lower time spent in hypoglycemia level 2, time spent in hyperglycemia, and CV compared to SAP. Significant reduction in hypoglycemia level 2 was also found with PLGM compared to SAP. High education attainment was associated with optimal metabolic control. Real-life use of advanced technologies for type 1 diabetes is associated with improved glucose metrics and device satisfaction. Education level also contributes to success of treatment.

Laryngeal mask airway or high flow nasal cannulaversusnasal cannula for advanced bronchoscopy – a randomized controlled trial

Research QuestionAdvanced bronchoscopic procedures became a widely prevalent evaluation and treatment modality. These procedures require appropriate sedation and respiratory support. This study directly compares three respiratory support methods during advanced bronchoscopy.MethodsThis 3-arm, prospective, block randomized trial included 60 consenting adult patients that were referred for advanced bronchoscopy involving endobronchial ultrasound with transbronchial needle aspiration (EBUS – TBNA) and met inclusion / exclusion criteria. Patients were randomized to undergo a bronchoscopy through a laryngeal mask airway (LMA), or with a high-flow nasal cannula (HFNC) or low flow nasal cannula (NC), with bronchoscopy performed through a bite block. Demographic, procedural and clinical parameters were compared between the 3 groups, including complications, oxygenation, ventilation and need for intervention.ResultsAnalysis according to intention to treat was made for the 20 patients in each arm. There were no significant differences in demographic parameters, pre-morbidities, and procedure type and duration between groups. Hypoxia was significantly more common in the NC group (90%) compared with the LMA (45%) and HFNC (26%) groups (p&lt;0.01). Need for interventions and their number was also lower in the LMA (40%) and HFNC (52.6%) groups compared to the NC group (90%, p&lt; 0.01). A multivariate analysis confirmed both HFNC and LMA as independent predictors of lower rate of recurrent desaturation events and fewer complications in general compared to NC.

Comparison of traditional and next-generation oral anticoagulants in the etiology of epistaxis

Background/Aim: There is a dearth of studies addressing the effects of next-generation anticoagulants on epistaxis. The aim of this investigation was to determine whether there are any differences between traditional and next-generation anticoagulants in the etiology of epistaxis. Methods: This retrospective cohort study focused on a total of 7,110 individuals (3,278 females (46.1%) and 3,832 males (53.9%)) diagnosed with epistaxis between 2018 and 2022; the mean age of the patients was 37.7 years. Patient data (age, gender, outpatient and inpatient treatments, relevant laboratory parameters, and treatment evidence) were retrospectively reviewed from a hospital database. The severity of epistaxis was assessed based on treatment notes. Patients with hypertension and those undergoing antiaggregant therapy were excluded from the study. International Classification of Diseases (ICD) codes from the automated system were examined retrospectively. The data were used to establish three patient groups: the first group consisted of individuals taking next-generation oral anticoagulants, the second group consisted of individuals taking traditional oral anticoagulants, and the third group consisted of healthy controls. Results: We found statistically significant differences among the groups in terms of age, the severity of epistaxis, the treatment modality, and laboratory findings (P&lt;0.001); no statistically significant difference was found in terms of gender (P=0.954). Group 2 contained the largest number of hospitalized patients and patients with severe active nosebleeds. Conclusion: Next-generation anticoagulants are more reliable than traditional anticoagulants in terms of the severity of epistaxis, the need for hospitalization, and laboratory results.

Study Protocol and Mission for the Tohoku Registry of Acute Aortic Dissection (TRAD).

Acute aortic dissection (AAD) is a life-threatening condition that imposes a significant socioeconomic burden on society. The Tohoku Registry of Acute Aortic Dissection (TRAD) is a collaboration of 13 tertiary referral hospitals in the Tohoku region of Japan designed to investigate all aspects of AAD treatment in this district, and to address significant clinical questions to help understand its dynamic pathology and develop optimal strategies for treating AAD. Comprehensive cases developing type A and type B AAD, including those with prehospital cardiopulmonary arrest transported to TRAD centers, over 5 years from 2017 to 2022 are registered. The TRAD dataset encompasses prehospital information, diagnostic imaging findings, treatment modalities, and outcomes for each case. After discharge, patients will be followed up for 10 years for survival, aortic events and inspection data. We believe that this multicenter registry of AAD analyses will clarify the current short-term outcomes of recent surgical, endovascular, and medical treatments in the Tohoku region, and provide insights into the long-term outcomes of different treatment modalities to achieve extended life expectancy in reasonably good health.

SLIM-assisted automatic cartography of cell death types and rates resulting from localized photodynamic treatment

We report a spatial light interference microscopy (SLIM)-based methodology aimed at automatic monitoring and analysis of changes in cellular morphology within extended fields of view in cytological samples. The experimental validation was performed on HeLa cells in vitro subjected to localized photodynamic treatment. The performed long-term noninvasive monitoring using the SLIM technique allowed us to estimate quantitative parameters characterizing the dynamics of average phase shift in individual cells and to reveal changes in their morphology specific for different mechanisms of cell death. The results obtained evidenced that the proposed SLIM-based methodology provides an opportunity for identification of cell death type and quantification of cell death rate in an automatic mode. The major sources of potential errors that can affect the results obtained are discussed. The developed methodology is promising for automatic monitoring of large ensembles of individual cells and for quantitative characterization of their response to various treatment modalities.

The association between change in temporal muscle mass and treatment of acromegaly

PurposeWe aimed to evaluate the relationship between temporal muscle thickness and GH/IGF-1 elevation and the effect of acromegaly treatment on temporal muscle thickness. MethodsPatients with acromegaly and healthy controls were included in the study. While laboratory parameters, clinical findings and temporal muscle thickness of acromegaly patients at the time of diagnosis and one year after treatment were evaluated, laboratory parameters and temporal muscle thickness of healthy controls were evaluated only during the period when they were included in the study. Temporal muscle thickness was measured using pituitary MRI. Temporal muscle thickness of patients with acromegaly was compared with healthy controls. We also evaluated how temporal muscle thickness changes with treatment in patients with acromegaly and the association between laboratory parameters and temporal muscle thickness. ResultsIn patients with acromegaly, measurements of left, right, and mean temporal muscle thickness at the time of diagnosis were found to be significantly higher than those of healthy controls' measurements at the time of their inclusion in the study (p = 0.007, p = 0.014 and p = 0.018, respectively). However, no significant difference was found when comparing the temporal muscle thickness of the 1st year of acromegaly treatment with the temporal muscle thickness of healthy controls at the time of their inclusion in the study (p = 0.155, p = 0.189, p = 0.198, respectively). In addition, a significant decrease was detected in the left, right and mean temporal muscle thicknesses of patients with acromegaly before and after treatment. While the temporal muscle thickness at the time of diagnosis was thicker in patients with acromegaly receiving surgical + medical treatment than in patients receiving exclusively surgical treatment, statistical significance was only found in the left temporal muscle thickness (p = 0.042). ConclusionTemporal muscle thickness was found to be associated with treatment modalities in patients with acromegaly.

Malignant Transformation in Porokeratosis Ptychotropica: A Systematic Review.

Porokeratosis ptychotropica (PP) is a rare and unusual variant of porokeratosis. There is a dearth of information on the natural history, epidemiology, and optimal treatment options. This study aimed to characterize the worldwide distribution, epidemiology, clinical features, and treatments attempted for all reported cases of porokeratosis ptychotropica. A total of 59 cases of porokeratosis ptychotropica have been reported, with most cases originating from the United States. The median age of patients affected with porokeratosis ptychotropica was 49 years. The most involved body locations are the buttocks and gluteal cleft. The risk of malignant transformation in porokeratosis ptychotropica is approximately 1.7% but there is significant bias in estimating rare occurrences in rare diseases. In conclusion, PP is an important but under-recognized variant of porokeratosis, with a likely low risk of malignant transformation. The best available treatment modality remains uncertain; however, the use of topical lovastatin/cholesterol cream appears promising. Long-term surveillance appears prudent for porokeratosis ptychotropica due to a risk of cancerization.