Treatment Protocols Research Articles

Comparative effectiveness of netupitant-palonosetron plus dexamethasone versus aprepitant-based regimens in mitigating chemotherapy-induced nausea and vomiting: a meta-analysis of randomized controlled trials.

Despite guidelines for managing chemotherapy-induced nausea and vomiting (CINV), there remains a need to clarify the optimal use of neurokinin-1 (NK1) receptor antagonists. Comparing the effectiveness of NEPA (netupitant-palonosetron) plus dexamethasone with other NK1 antagonist-based regimens combined with a 5HT3 receptor antagonist and dexamethasone is crucial for informed decision-making and improving patient outcomes. We conducted a systematic review of the literature to assess randomized controlled trials (RCTs) comparing the efficacy, safety, and cost-effectiveness of NEPA plus dexamethasone and other NK1 antagonist-based regimens combined with a 5HT3 receptor antagonist and dexamethasone. PubMed, Embase, and the Cochrane Library databases were systematically searched, with the latest update performed in December 2023. Data on patient demographics, chemotherapy regimen characteristics, and outcomes were extracted for meta-analysis using a random-effects model. Seven RCTs were analyzed. NEPA plus dexamethasone showed superior efficacy in achieving complete response in the overall (risk ratio [RR], 1.15; 95% CI, 1.02--1.30) and delayed phases (RR, 1.20; 95% CI, 1.03-1.41) of chemotherapy. It was more effective in controlling nausea (overall phase RR, 1.20; 95% CI, 1.05-1.36; delayed phase RR, 1.21; 95% CI, 1.05-1.40) and reducing rescue therapy use (overall phase RR, 1.45; 95% CI, 1.07-1.95; delayed phase RR, 1.75; 95% CI, 1.10-2.78). Adverse event rates were comparable (RR, 1.03; 95% CI, 0.96-1.10). Subgroup analysis indicated NEPA's particular efficacy in patients receiving moderately emetogenic chemotherapy (RR, 1.31; 95% CI, 1.07-1.60). NEPA plus dexamethasone regimens exhibit superior efficacy in preventing CINV, supporting their preferential inclusion in prophylactic treatment protocols. Its effective symptom control, safety profile, and cost-effectiveness endorse NEPA-based regimens as a beneficial option in CINV management.

Angioembolization in patients with blunt splenic trauma in Germany -guidelines vs. Reality a retrospective registry-based cohort study of the TraumaRegister DGU®.

Nonoperative management (NOM) for blunt splenic injuries (BSIs) is supported by both international and national guidelines in Germany, with high success rates even for severe organ injuries. Angioembolization (ANGIO) has been recommended for stabilizable patients with BSI requiring intervention since the 2016 German National Trauma Guideline. The objectives were to study treatment modalities in the adult BSI population according to different severity parameters including NOM, ANGIO and splenectomy in Germany. Between 2015 and 2020, a retrospective registry-based cohort study was performed on patients with BSIs with an Abbreviated Injury Score ≥ 2 in Germany using registry data from the TraumaRegister DGU® (TR DGU). This registry includes patients which were treated in a resuscitation room and spend more than 24-h in an intensive care unit or died in the resuscitation room. A total of 2,782 patients with BSIs were included in the analysis. ANGIO was used in 28 patients (1.0%). NOM was performed in 57.5% of all patients, predominantly those with less severe organ injuries measured by the American Association for the Surgery of Trauma Organ Injury Scale (AAST) ≤ 2. The splenectomy rate for patients with an AAST ≥ 3 was 58.5%, and the overall mortality associated with BSI was 15%. In this cohort splenic injuries AAST ≥ 3 were predominantly managed surgically and ANGIO was rarely used to augment NOM. Therefore, clinical reality deviates from guideline recommendations regarding the use of ANGIO and NOM. Local interdisciplinary treatment protocols might close that gap in the future.

Use of growth factor concentrate using derma roller in treatment of androgenetic alopecia: A literature review

Androgenetic alopecia (AGA) is a common cause of hair loss in both men and women. Recent advances in regenerative medicine have led to the use of platelet-rich plasma (PRP) combined with micro-needling as a potential treatment for AGA. However, the clinical effectiveness of this combination therapy remains unclear. To evaluate the efficacy and safety of platelet-rich plasma (PRP) combined with micro-needling for the treatment of androgenetic alopecia through a systematic review and meta-analysis of available clinical studies. A systematic search was conducted in PubMed, Embase, and the Cochrane Library for studies published up to January 2024. Inclusion criteria were randomised controlled trials (RCTs) and cohort studies that assessed hair density, hair thickness, or patient satisfaction after treatment with PRP and micro-needling. Data were extracted and pooled using a random-effects model, and heterogeneity was assessed with the I² statistic. The quality of the studies was evaluated using the Cochrane Risk of Bias tool for RCTs and the Newcastle-Ottawa Scale for cohort studies. A total of 12 studies involving 546 participants were included. Meta-analysis showed that the combination of PRP and micro-needling significantly increased hair density (mean difference: 18.9 hairs/cm², 95% CI: 15.3-22.5, p < 0.001) and hair thickness (mean difference: 0.4 mm, 95% CI: 0.3-0.5, p < 0.01) compared to controls. Patient satisfaction was also higher in the treatment group. The most commonly reported adverse effects were mild scalp irritation and transient erythema, with no serious adverse events. Moderate heterogeneity was observed among the studies (I² = 42%). The combination of PRP and micro-needling is an effective and well-tolerated treatment for androgenetic alopecia, resulting in significant improvements in hair density and thickness. Further large-scale, high-quality trials are needed to confirm these findings and standardize treatment protocols.

Abstract A017: Comprehensive evaluation of the therapeutic effects of whole-body hyperthermia for pancreatic ductal adenocarcinoma (PDAC) and the potential synergy with standard-of-care chemotherapeutics

Abstract Whole-body hyperthermia (WBHT) is a promising therapeutic approach that leverages elevated temperatures to enhance cancer treatment efficacy. By inducing controlled hyperthermia in the range of 39-42.5°C, cellular processes are disrupted and cancer cells can be sensitized to standard-of-care chemotherapies. However, the precise cellular and molecular mechanisms by which WBHT exerts its effects are not fully understood. Elucidating these mechanisms is particularly crucial for optimizing treatment protocols and improving outcomes in aggressive malignancies such as pancreatic ductal adenocarcinoma (PDAC). This study explores the impact of WBHT at 41.5°C on the cell cycle and associated molecular pathways in PDAC cells, providing insights into its therapeutic value and potential for combination regimens. PDAC cell lines, BxPC-3 and AsPC-1, were subjected to WBHT at 41.5°C for 1-6 hours and analyzed immediately, 24h and 48h post-WBHT Cell proliferation was assessed using the 5-ethynyl-2'-deoxyuridine (EdU) base-incorporation assay and proliferating cell nuclear antigen (PCNA) staining for immunofluorescence detection. Morphological changes post-WBHT were monitored using confocal fluorescence microscopy. Total RNA was extracted and sequenced using the Illumina platform. An in-house pipeline was used for QC, alignment and differential expression analysis. Enrichment analysis was performed to identify affected biological processes and pathways. In vivo experiments employed the chorioallantois membrane (CAM) assay per protocol published in STAR protocols. WBHT at 41.5°C significantly disrupted cell cycle progression in PDAC cell lines. The EdU incorporation assay revealed a dose-dependent decrease in DNA synthesis during and following WBHT, indicating cell cycle arrest in the S-phase. Decreases in Ki67, cyclin B1 and PCNA intensities further confirmed this reduction in cell proliferation. Moreover, cells showed notable signs of cellular and mitotic stress, such as the formation of multi-nucleated giant cells, aberrant metaphase morphology and micronuclei. Bulk RNA-seq confirmed alterations in gene expression profiles relating to the cell cycle immediately after HT exposure. Genes associated with the E2F targets and G2/M checkpoint pathways were negatively enriched, whereas genes involved in the Hallmark apoptosis pathway were positively enriched. Preliminary data from in ovo CAM experiments showed a significant inhibitory effect of WBHT monotherapy on growth of BxPC-3 tumors. Our data show that WBHT severely disrupts the cell cycle at the S- and M-phases, via multiple pathways involved in cell proliferation and apoptosis. These cancer hallmarks are targeted by conventional chemotherapeutics, paving the way for combination therapy as one-two punch cancer treatments. The synergy between WBHT with cisplatin and oxaliplatin, but also with gemcitabine and 5-fluorouracil (5-FU) could be optimized based on the improved understanding of the WBHT effects over time, in terms of WBHT duration, sequence of WBHT and chemo and the exact treatment schedule. Citation Format: Robin Colenbier, Tine Logghe, Gaëlle Boulet, Johannes Bogers, Jean-Pierre Timmermans. Comprehensive evaluation of the therapeutic effects of whole-body hyperthermia for pancreatic ductal adenocarcinoma (PDAC) and the potential synergy with standard-of-care chemotherapeutics [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Advances in Pancreatic Cancer Research; 2024 Sep 15-18; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2024;84(17 Suppl_2):Abstract nr A017.

New findings on the incidence and management of CNS adverse reactions in ALK-positive NSCLC with lorlatinib treatment

To explore the presentation and control of CNS adverse reactions in patients with ALK-positive NSCLC treated with lorlatinib. This study includes a retrospective case report from Sir Run Run Shaw Hospital on a lorlatinib-treated patient with CNS adverse reactions and a systematic literature review of similar cases until January 2023. The report detailed a case of a 74-year-old male with Grade III CNS adverse reactions 25 days after starting lorlatinib, which were reversible with dose modification and pharmacotherapy. The review indicated a 19.39% occurrence rate of such reactions, with a 17% improvement rate post-dose adjustment. CNS adverse reactions frequently occur in ALK-positive NSCLC patients on lorlatinib, yet they are reversible with appropriate management. Research should continue to optimize treatment protocols to decrease these reactions' frequency.

Dutasteride for the Treatment of Androgenetic Alopecia: An Updated Review.

Androgenetic alopecia (AGA) is a common skin disease characterized by progressive hair loss, with negative psychological impacts on patients, especially young people. The primary pathogenesis of AGA involves the action of 5α-reductase converting testosterone to dihydrotestosterone, leading to gradual miniaturization of genetically susceptible hair follicles. Finasteride inhibits type II 5α-reductase, while dutasteride simultaneously inhibits type I and type II 5α-reductase. Currently, finasteride is approved by the Food and Drug Administration (FDA) for the treatment of AGA, but its efficacy remains poor in some patients. This article aims to review the treatment of androgenetic alopecia with dutasteride. Oral dutasteride, intradermal injection of dutasteride (mesotherapy) and other related treatment methods are included. We performed a Medical Subject Heading search in the PubMed database using "androgenetic alopecia" and "dutasteride". Compared to finasteride, oral dutasteride has better efficacy and comparable tolerability, and most adverse events are mild and reversible, making it an effective treatment option for AGA. Mesotherapy with dutasteride is a therapeutic option to reduce the systemic adverse effects of the drug, but there are no standardized treatment protocols and large-scale clinical trials. Microneedling combined with dutasteride solution also has its own unique efficacy for treating AGA. Liposomes or nanoparticles of dutasteride are still under development and may become a more optimized topical formulation in the future.

Efficacy and Safety of Alpha-2 Agonists in Autism Spectrum Disorder: A Systematic Review.

This analysis is a systematic literature review assessing efficacy and adverse effects of three alpha-2 agonists for the symptomatic management of autism spectrum disorder (ASD). The present investigation involved an extensive systematic search for eligible studies in PubMed, Embase, Cochrane Library, and Google Scholar. Nine studies, collectively incorporating 226 patients, were assessed. The results demonstrated promising indications for use of alpha-2 agonists in the symptomatic management of autism spectrum disorders, including improvement of hyperactivity, impulsivity, attention deficit symptoms, irritability, and stereotypies in many of the participants studied. The present investigation encourages physicians to consider treatment outcomes of clonidine, guanfacine, and lofexidine to determine the most effective management of ASD-related symptoms and to minimize adverse effects. However, our review cannot provide definitive treatment protocols related to various study limitations.

Histopathological spectrum of ovarian tumours

Background: Ovarian neoplasms include wide spectrum of various tumors, which differ in their histo-morphological features, also in their biological behaviour, tumorigenesis, clinical course, and prognosis. Aim of the study was to study the histopathological features of various ovarian tumors and correlate preoperative serum CA125 tumor marker level with histopathological types. Also to study fallopian tubes for fallopian tube precursor lesions such as serous tubal intraepithelial carcinoma (STIC) in serous carcinoma ovary. Methods: This cross-sectional observational study of the 80 specimens of ovarian tumors was conducted in department of pathology, Netaji Subhash Chandra Bose medical college Jabalpur (M.P.). The relevant data of the patients was collected and analysed as per designed proforma. Results: Out of 80 cases; majority cases 22 (27.5%) were seen in a 31-40 years age group, followed by 41-50 years age group 18 cases (22.5%). Youngest patient was 7 years old and oldest patient was 88 years old, forming the range of 7 years to 88 years. Epithelial tumors were the most common category, followed by germ cell tumors, sex cord stromal tumors and metastatic tumors. Benign tumors were much higher than borderline and malignant tumors mature cystic teratoma was the most common tumor encountered, followed by mucinous cystadenoma. The commonest malignant tumor was serous carcinoma followed by mucinous carcinoma. Conclusions: Ovarian neoplasms constitute a wide spectrum of tumors therefore exact categorization is important to adopt appropriate treatment protocols for the proper management of the patient. Histopathological examination is the gold standard for diagnosis and categorization of ovarian neoplasm.

Isolated gastric Crohn's disease: a growing tendency

Isolated gastric Crohn's disease (IGCD) is a rare manifestation of Crohn's disease confined to the stomach, unlike its more common forms that primarily affect the ileum and colon. We report the case of a 25-year-old female presenting with a one-month history of epigastric discomfort and nausea, with no other significant gastrointestinal or systemic symptoms. Upper endoscopy revealed an aphthous ulceration on the greater curvature of the stomach, with biopsies showing non-caseating granulomas consistent with Crohn's disease. The diagnosis of IGCD was confirmed through a positive ASCA test and negative p-ANCA test, alongside the absence of ileal and colonic involvement. The patient was treated with prednisone for acute symptom management, followed by infliximab for long-term maintenance. Follow-up evaluations showed no significant relapse episodes. This case highlights the diagnostic challenges and management strategies for IGCD, emphasising the need for further research to optimise treatment protocols and improve long-term outcomes.

Potential Advantages of Idarubicin-Loaded Trastuzumab-Coated Liposomes for Combating Head and Neck Squamous Cancer Cells.

Head and neck squamous cell carcinoma (HNSCC) with a high mortality rate is among the most common types of cancer in the world. Human epidermal growth factor receptor 2 (HER2) is expressed higher than normal level in the most HNSCC tumors, making them resistant to chemotherapy and radiotherapy. Therefore, HER2 has been introduced as a suitable target for anticancer drugs. The aim of this study is to examine the efficacy of a treatment protocol involving targeted delivery of idarubicin encapsulated in trastuzumab-decorated liposomes to HNSCC cells. In the current experimental study, efficacies of idarubicin, prepared liposomal idarubicin, and constructed immunoliposomal idarubicin (trastuzumab-decorated) were investigated in killing HN5 cells, a HER2- overexpressing HNSCC-originating cell line. Liposomal content of idarubicin and trastuzumab were qualified by UVVisible spectroscopy and preparations were characterized for shape and size by atomic force microscopy (AFM) and dynamic light scattering (DLS). To clarify role of the missing parts of the available crystal structure (PDB ID: 1n8z) within trastuzumab-HER2 interactions, we used a 40 ns molecular dynamic simulation approach. Based on the obtained results, liposomal idarubicin showed higher toxicity of the encapsulated drug on HN5 cells compared to the traditional free drug formulations. The immunoliposomal form of idarubicin was more effective than the liposomal formulation, in killing of HN5 cells. In addition, simulation of interactions between trastuzumab and HER2 revealed that the missing parts (in the crystal structure) of HER2 have critical interaction with trastuzumab, through salt-bridges and hydrogen bonds. It seems that the prepared immunoliposomes could attach more efficiently to HER2 overexpressing cells, which consequently leads to increasing cellular uptake of idarubicin through a receptor-mediated endocytosis mechanism. Moreover, simulation of the interaction between HER2 and trastuzumab suggested considerable possibilities for increasing trastuzumab affinity to HER2.

Patellar Tendon Ruptures after Total Knee Arthroplasty.

Patellar tendon rupture following total knee arthroplasty (TKA) is a rare, but devastating complication. These injuries occur most frequently in the acute period following TKA due to trauma to the knee. Patellar tendon ruptures that disrupt the extensor mechanism create a marked functional deficit, impacting every facet of daily life. In complete ruptures of the patellar tendon, repair or reconstruction is typically indicated; however, complication rates following intervention remain high, between 25 to 63%. Operative intervention remains the mainstay of treatment, with only certain specific situations where nonoperative intervention is appropriate. Operative treatments include repair with or without augmentation or reconstruction. Augmentation does reduce the high risk of complications, bringing rates down from 63 to 25%. Augmentation options include autografts, allografts, synthetic grafts, or synthetic meshes. Despite advancements, outcomes are unpredictable, and complications are common, highlighting the need for further research to improve treatment protocols. Operative techniques are chosen based on the acuity, location of disruption, and status of the residual soft tissues. This article provides an overview of patellar tendon ruptures following TKA, the various treatment options, and the recommendations of the senior authors for each common type of patellar tendon injury encountered.

Pectoralis Major Muscle Tear – Effectiveness Orthobiologic Nonoperative Treatment with Platet-Rich Plasma (PRP) Injections

Introduction Pectoralis major muscle ruptures, once considered rare, are now more common, especially in young male athletes and weightlifters involved in high-intensity sports. This injury can significantly impair upper limb function, leading to pain, weakness, and potential disability. Exploring and understanding available treatment options, particularly the promising role of orthobiologic therapies like PRP, is essential for optimizing recovery and achieving the best outcomes. Purpose The purpose of this review is to evaluate the effectiveness and the role of orthobiologic treatments such as PRP in enhancing healing and functional recovery for pectoralis major muscle ruptures. Conslusions The treatment of pectoralis major muscle ruptures requires a tailored approach that considers the injury's severity, the patient's activity level, and their goals. Nonoperative treatment can be effective for partial tendinous tears, muscle belly tears, muscle origin tears, and complete tendinous tears in sedentary individuals or when surgery is not feasible. Surgical intervention generally provides superior functional outcomes, particularly for athletes and those with complete ruptures. Orthobiologic treatments, such as ultrasound-guided PRP injections, provide a promising complement to conservative management, with potential benefits in pain reduction and accelerated functional recovery. Studies indicate that PRP-treated patients report higher satisfaction and better outcomes compared to those without PRP treatment. Nevertheless, many questions remain regarding the optimal formulation, dosage, and rehabilitation protocols for PRP. To fully understand PRP's effectiveness and refine its applications in sports medicine, more rigorous and long-term studies are needed. Additionally, further research is required to improve nonoperative treatment and rehabilitation protocols, ensuring optimal outcomes for all patients.

Strategies, detection, and prediction of cardiovascular disease of elderly people in public health

Cardiovascular disease (CVD) is the chronic disease with the highest mortality rate among the elderly in China, and also has a very high prevalence rate, posing a major threat to the health and economy of the elderly. Many improvements are currently underway in China to face the prevention, control and treatment of cardiovascular disease in the elderly. These include measures such as regular medical check-ups at community sites and the popularization of early symptoms of CVD. All these measures have played a positive role in improving CVD among the elderly in China. However, there is a lack of an article to summarize the measures taken in China. This article analyzes the database of studies on CVD in Chinese older adults, summarizes existing CVD prevention, detection, and treatment protocols for older adults in China; and analyzes the strengths and weaknesses of China's current CVD response. Finally, the paper looks at future CVD responses in China and summarizes newly enacted CVD-related policies in China. This paper summarizes the literature on CVD in the elderly in China, which provides a more convenient reference for future research, but it cannot predict China's CVD response or future situation, and future research can make suggestions for improving China's current CVD response based on the literature review.

Hip joint degeneration - not only an issue of the elderly

Introduction: Legg-Calve-Perthes Disease (LCPD) is a condition characterized by ischemia of the proximal femoral epiphysis, leading to pain, limping, and potential hip joint deformities in children. Its etiology remains unclear, with theories implicating repetitive microtrauma, skeletal retardation, and vascular insufficiency. Diagnosis involves radiological assessment and classification systems to monitor disease progression, influencing treatment decisions and long-term outcomes. Material and methods: This study summarizes existing literature and clinical data on LCPD, focusing on etiological theories, diagnostic methods, treatment strategies, risk factors, and prognostic indicators. Information was gathered from medical databases, peer-reviewed journals, and case studies to compile a comprehensive overview of the disease. Aim of study: The aim was to gather current knowledge on LCPD, emphasizing diagnostic approaches, treatment modalities, and factors influencing clinical outcomes. Special attention was given to discussing the efficacy of various treatment options and identifying prognostic factors that impact the disease trajectory. Conclusion: Effective management of LCPD hinges on early diagnosis, appropriate treatment selection, and careful monitoring of disease progression. Prognosis is influenced by factors such as age at diagnosis, extent of femoral head involvement, and maintenance of hip joint congruence. Further research is needed to refine treatment protocols and improve long-term outcomes for affected children.

A DATA DRIVEN APPROACH THROUGH IOMT BASED PATIENT HEALTHCARE MONITORING SYSTEM

The current circumstances underscore the pressing need to accelerate the adoption of Internet of Things platforms in realm of the medical field to improve the health of mankind. Given the present challenges, I propose the development of an Advancing healthcare monitoring system built on the foundation of Internet of Medical Things (IOMT). Advancing patients healthcare IOMT system serves as a communication conduit between patients and doctors, facilitated by the IoMT platform. This platform utilizes various medical sensors connected to a server through technologies such as WiFi and Bluetooth. The data collected and stored in the server is then leveraged to analyse patients' health conditions, guiding subsequent treatment protocols. In this proposed system, the microcontroller serves as an intermediary interface between the sensors and the server. This cutting-edge technology enables remote patient monitoring, eliminating the need for physical presence. Within the prototype, patients' summaries and information is supplied using an online platform. Through the adoption of Advancing Healthcare through Data-Driven IOMT Patient Monitoring, lives can be safeguarded from critical conditions, underscoring the vital importance of embracing such advanced technologies in healthcare.

Compartment Syndrome in Association with Tibial Plateau Fracture: Standardized Protocols Ensure Optimal Outcomes

AbstractThe purpose of this study was to report on the treatment, results, and longer-term outcomes of patients who sustained a tibial plateau fracture with an associated leg compartment syndrome (CS). A total of 766 patients who sustained 766 tibial plateau fractures met inclusion criteria. Fourteen patients (1.8%) were diagnosed with CS in association with a tibial plateau fracture during their initial hospitalization, 13 at the time of presentation and 1 delayed. The treatment protocol consisted of initial external fixation and fasciotomy, followed by irrigation and debridement, and eventual closure. Fasciotomy cases included 2/14 (14.3%) single incision approaches and 12/14 (85.7%) dual incision approaches. Operative treatment of the tibial plateau fracture was performed at the time of final closure or once soft tissues were permitted. One case of CS that developed following definitive fixation was treated with fasciotomy and delayed primary closure after initial stabilization. Ten (71.4%) were available at 1-year follow-up. We compared these 10 cases to the patients with operative tibial plateau fractures without CS to assess for surgical, radiographic, clinical, and functional outcomes. We used a propensity match based on age, body mass index, sex, Charleson comorbidity index, and fracture type to reduce the presence of confounding biases. Standard statistical methods were employed. Those in the CS cohort were younger males (p < 0.05). At latest follow-up, function did not differ between those in the CS group compared with the non-CS cohort (p > 0.05). Clinically, knee flexion (130.7 vs. 126; p = 0.548), residual depression (0.5 vs. 0.2; p = 0.365), knee alignment (87.7 vs. 88.3; p = 0.470), and visual analog scale pain scores (3.0 vs. 2.4; p = 0.763) did not differ between the cohorts. Although infection was higher in the CS cohort, the overall complication rates did not differ between the CS patients and non-CS cohort (p > 0.05). Early identification and standardized treatment protocols for the management of CS that develops in association with a tibial plateau fracture lead to outcome scores that were not significantly different from patients who did not develop CS.

Inhibitory effect of helium cold atmospheric plasma on cariogenic biofilms

ABSTRACT This study aimed to determine the effects of low-temperature plasma jet produced in gas helium (LTP-helium) on cariogenic biofilms composedby Streptococcusmutans, Streptococcus sanguinis and Streptococcus gordonii, and also by the combination of Candida albicans, Lactobacillus acidophilus and S. mutans. Biofilms were treated for 1, 3, 5, and 7 minutes. A 0.12% chlorhexidine solution was used as the positive control and sterile physiologic solution was the negative control. Biofilm viability was analyzed by viable cell recovery, scanning electron microscopy, and confocal laser scanning microscopy. All assays were performed intriplicate in three independent experiments. Multispecies biofilms exposed to LTP-helium had a significant reduction in viability when compared to the negative control (p < 0.0001). For biofilm formedby S. mutans, S. sanguinis, and S. gordonii, LTP treatments for 5 and 7 minutes caused similar reduction of morethan 2 log10. Also, a significant reduction in the viability of biofilms formedby C. albicans, L. acidophilus, and S. mutans was detected (p < 0.0001). In conclusion, LTP-helium reduced theviability of cariogenic biofilms with different microbial compositions, which indicates that LTP-helium is a potential tool for developing new protocols for dental caries prevention and treatment.

Severe Thrombocytopenia from Trastuzumab and Pertuzumab Combination Therapy in a Patient with HER2-Positive Metastatic Rectal Cancer

Introduction: In recent years, trastuzumab and pertuzumab have been used in treatment protocols for patients with HER2-positive colorectal cancer. Although severe thrombocytopenia is an uncommon side effect of anti-HER2 antibody therapy, we present the first patient with HER2-positive metastatic rectal cancer who developed significant thrombocytopenia after trastuzumab and pertuzumab administration. Case Presentation: The condition was identified as drug-induced immune thrombocytopenia associated with trastuzumab and pertuzumab. Despite the discontinuation of anti-HER2 treatment and administration of corticosteroids, and in addition to frequent platelet transfusions, a low platelet count persisted. Consequently, we determined that the patient presented with a condition similar to immune thrombocytopenic purpura (ITP) and selected a treatment approach consisting of eltrombopag, a thrombopoietin receptor agonist. Subsequently, the patient’s platelet count did not decrease further but rather improved. Conclusion: Although uncommon, anti-HER2 antibodies can cause severe thrombocytopenia. Furthermore, if thrombocytopenia persists after treatment discontinuation and the administration of corticosteroids, exploring treatment options aligned with managing ITP is essential.

Development and Management of Avoidant/Restrictive Food Intake Disorder and Food Neophobia in Pediatric Patients with Food Allergy: A Comprehensive Review.

Avoidant/Restrictive Food Intake Disorder (ARFID) and food neophobia present significant challenges in pediatric healthcare, particularly among children with food allergies (FAs). These eating disorders, characterized by the persistent avoidance or restriction of food, can lead to severe nutritional deficiencies and psychosocial impairments. The presence of FAs further complicates these eating behaviors, as the fear of allergic reactions exacerbates avoidance and restrictive patterns. This comprehensive review synthesizes current knowledge on ARFID and food neophobia, focusing on their definitions, characteristics, and the unique challenges they present in the context of FAs. The review explores the critical role of healthcare professionals, especially nurses, in integrating psychological and clinical care to improve outcomes for affected children. A multidisciplinary approach, including Cognitive Behavioral Therapy (CBT) and Family-Based Therapy (FBT), is emphasized as essential in addressing the complex needs of these patients. The review also highlights the need for standardized treatment protocols and further research on the long-term outcomes of these disorders, aiming to enhance therapeutic strategies and family support systems. Effective management of ARFID and food neophobia in the context of FAs requires a holistic and integrated approach to mitigate the profound impacts on a child's growth, development, and overall well-being.

Genetic and Epigenetic Interactions Involved in Senescence of Stem Cells.

Cellular senescence is a permanent condition of cell cycle arrest caused by a progressive shortening of telomeres defined as replicative senescence. Stem cells may also undergo an accelerated senescence response known as premature senescence, distinct from telomere shortening, as a response to different stress agents. Various treatment protocols have been developed based on epigenetic changes in cells throughout senescence, using different drugs and antioxidants, senolytic vaccines, or the reprogramming of somatic senescent cells using Yamanaka factors. Even with all the recent advancements, it is still unknown how different epigenetic modifications interact with genetic profiles and how other factors such as microbiota physiological conditions, psychological states, and diet influence the interaction between genetic and epigenetic pathways. The aim of this review is to highlight the new epigenetic modifications that are involved in stem cell senescence. Here, we review recent senescence-related epigenetic alterations such as DNA methylation, chromatin remodeling, histone modification, RNA modification, and non-coding RNA regulation outlining new possible targets for the therapy of aging-related diseases. The advantages and disadvantages of the animal models used in the study of cellular senescence are also briefly presented.