Single Treatment Modality Research Articles

Awake bruxism in temporomandibular disorders patients referred to tertiary care: A retrospective study on its assessment and TMD management.

Bruxism is defined as a repetitive jaw-muscle activity characterised by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible. Bruxism can occur during sleep (sleep bruxism, SB) or during wakefulness (awake bruxism, AB). To date, the effect of AB on the purported negative consequences of bruxism has remained unclear. The assessment of AB, its relation to temporomandibular disorders (TMD) treatment modalities, and their possible outcomes were investigated among TMD patients resistant to treatment in primary care and referred to a tertiary care clinic. The records of 115 patients were studied. Patients were referred to the Head and Neck Centre, Department of Oral and Maxillofacial Diseases, Helsinki University Central Hospital, for TMD treatment between 2017 and 2020. The data derived from the eligible patients' records included the following: background data (age and sex), referral data (reason and previous treatment), medical background (somatic and psychiatric), clinical and possible radiological diagnoses at a tertiary care clinic, treatment modalities for masticatory muscle myalgia, bruxism assessment, its possible treatment modalities and their outcomes, and overall management outcome. We analysed the outcomes of single treatment modalities and combined groups of modalities. For the demographic data, the Chi-squared test and Fischer's Exact test were used to determine the associations between the categorical variables. A Sankey-diagram was used to describe the flow of treatment. Temporomandibular joint-pain-dysfunction syndrome (K07.60) was the most frequent single reason to refer a patient to tertiary care (17.4%). At referral, men had myalgia (M79.1) significantly more often (p = .034) than women. Similarly, men had depression (p = .002) more often and other psychiatric diagnoses (p = .034). At tertiary care, the presence of AB was assessed in 53.9%, and self-reported AB was recorded in 48.7%. In patients with possible AB, those who were prescribed neuropathic pain medication showed significantly less improvement in symptoms (p = .021) than those who underwent splint therapy (p = .009). Overall, half of the patients showed overall improvement in their TMD symptoms from the treatment combinations. Despite several treatment modalities, only half of the patients showed improvement in their symptoms in the present study. A standardised assessment method encompassing all factors contributing to bruxism behaviours and their consequences is suggested.

Comparing the role of different treatment modalities in locoregionally advanced olfactory neuroblastoma: The 20-year clinical experience of a single institution.

The clinical value of different treatment modalities, especially systemic chemotherapy (CT) in patients with locoregionally advanced olfactory neuroblastoma (LA ONB) remains unclear. Patients with LA ONB from 2000 to 2020 at our center were collected retrospectively. The entire cohort was divided into combined systemic and local therapy (CSLT) versus local therapy (LT) groups (grouping method 1), and the same cohort was divided into neoadjuvant chemotherapy (NAC) versus non-NAC groups (grouping method 2). CSLT group included patients treated with CT + LT. LT group included patients treated with surgery (SG), radiotherapy (RT), concurrent chemoradiotherapy (CCRT), or any combination of the above methods. LT group was further divided into mono-modality local therapy (MOLT) group and multi-modality local therapy (MULT) group. MOLT group included patients treated with RT alone or SG alone. MULT group included patients treated with SG + RT/CCRT, or CCRT alone. NAC group included patients treated with NAC + LT ± adjuvant chemotherapy (ADC). Non-NAC group included patients who received LT ± ADC. A total of 111 patients with LA ONB were included. The median follow-up was 80.2 months (range, 2.1-254.9). The 5- and 10-year OS rates were 70.2% and 61.3%, respectively. In univariate analysis, patients treated with NAC (n = 43) had significantly better overall survival (OS) compared with those without NAC (n = 68) (p = 0.041). Patients in MULT group (n = 45) had significantly improved OS (p = 0.004) and PFS (p = 0.003) compared with those in MOLT group (n = 15). Multivariate analysis identified NAC and CSLT (n = 51) were independent prognostic factors for superior OS (p = 0.020, p = 0.046). Our study suggested that CSLT, especially a combination of NAC and LT, improved the survival of patients with LA ONB. Multiple treatment modalities yielded better PFS and OS compared to single-modality treatment.

Abstract 94: Utilization of MGMT Promoter Methylation Status to Guide Treatment in Elderly Patients With Glioblastoma

Abstract Purpose: Glioblastoma is the most common primary malignant brain tumor in adults. In younger patients, the standard of care is chemoradiation. However, due to the increased risk of chemotherapy-associated toxicity in older patients, monotherapy is instead recommended. O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation has been found to be a prognostic indicator, with methylated MGMT (mGMT) patients having better response to chemotherapy (temozolomide) than unmethylated MGMT (uMGMT) patients. In this study, we compared the overall survival (OS) of different treatment modalities in mMGMT and uMGMT glioblastoma patients older than 60 years. Methods: Patients diagnosed with glioblastoma (ICD-O-3 histology code 9440) after the age of 60 (N = 8356) were identified in the National Cancer Database (2004-2020). Effects of MGMT methylation status and treatment modality (chemotherapy, CT; radiation therapy, RT; chemoradiation, CRT) on OS were analyzed using Kaplan-Meier curves, log-rank tests, and Cox proportional hazards modeling. Results: The average age of this sample was 70.8 ± 6.8 years, with nearly half of the sample being under the age of 70. Regardless of MGMT status, most patients received CRT (63.7% uMGMT, 65.1% mMGMT). uMGMT patients treated with CRT had better OS (14.0 months) than those receiving RT (8.2 months; p < 0.001), but there was no difference compared to those receiving CT (12.3 months; p = 0.247). A similar trend was seen in mMGMT patients (CRT: 16.9 months, RT: 9.3 months, CT: 11.8 months). However, among all patients receiving CRT, those with mMGMT survived significantly longer than their uMGMT counterparts (p < 0.001). After adjusting for all other variables, Cox regression analysis remained significant, with a decreased hazard ratio in mMGMT patients (HR = 0.631, p < 0.001). Conclusion: mMGMT patients older than 60 years of age demonstrated better survival outcomes when treated with chemoradiation. While mMGMT patients had a better response to CRT than uMGMT patients, uMGMT patients experienced improved OS with CRT than single modality treatment. Therefore, combination therapy should be considered not only in younger patients but also in older patients who otherwise have no medical contraindications. Citation Format: Tiffany Chu, Ting Wang, Peter Silberstein. Utilization of MGMT Promoter Methylation Status to Guide Treatment in Elderly Patients With Glioblastoma [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 94.

Clinical characteristics of patients with non-small cell lung cancer eligible for biology-guided radiotherapy.

e20523 Background: Biology-guided radiotherapy (BgRT) is a novel radiotherapy modality that uses real-time positron emission tomography (PET) to guide radiotherapy beamlets. BgRT recently received FDA clearance for clinical use using the 18F FDG radiotracer for the treatment of tumors in lung and bone. We sought to identify non-small cell lung cancer (NSCLC) patients who may be candidates for BgRT based on diagnostic FDG PET/CT imaging. Methods: We conducted an IRB-approved retrospective assessment of NSCLC patients diagnosed between 01/01/2006 and 12/31/2013 at a tertiary care center in the United States. Patient and tumor characteristics were verified by an institutional data repository team and through electronic medical record review. Patients were excluded from analysis when documentation of clinical/ imaging findings was insufficient. Frequency of characteristics were interpreted with and without tumor diameter and maximum standardized uptake value (SUVMax) parameters, to confirm eligibility for BgRT on this novel radiotherapy device. Results: Of the 686 patients eligible for analysis, 523 presented with tumor SUVMax of ≥6 on diagnostic PET imaging and 360 presented with tumor diameters of at least 2 cm and below 5 cm. Of the 277 patients who met both SUVMax and size parameters, respectively, 75 (27.1%), 145 (52.3%), and 57 (20.6%) presented with squamous, adenocarcinoma, or other/unknown histology, and 77 (27.9%), 29 (10.5%), 92 (33.3%), and 78 (28.3%) presented with stage I, II, III, or IV tumors (AJCC 7th edition). Conclusions: Theoretical applicability of biology-guided radiotherapy was observed in our NSCLC patient cohort. Therefore, despite current limitations of radiotracer uptake thresholds and tumor size restrictions, there is broad potential applicability of this treatment modality, either as a single modality treatment or in conjunction with active systemic therapy. [Table: see text]

Comparing the role of different treatment modalities in locoregionally advanced olfactory neuroblastoma: The 20-year clinical experience of a single institution.

e18055 Background: There are few studies on different treatment modalities, especially systemic chemotherapy (CT) for locoregionally advanced olfactory neuroblastoma (LA ONB) with only a few small-sample studies reported. We retrospectively analyzed the treatment patterns and explored the factors affecting the prognosis of patients with LA ONB at our center over the past 20 years in the present study. Methods: LA ONB patients from 2000 to 2020 at our center were collected retrospectively. The entire cohort was divided into combined systemic and local therapy (CSLT) vs. local therapy (LT) groups (grouping method 1), and the same cohort was divided into neoadjuvant chemotherapy (NAC) vs. non-NAC groups (grouping method 2). CSLT group included patients treated with CT + LT. LT group included patients treated with surgery (SG), radiotherapy (RT), concurrent chemoradiotherapy (CCRT), or any combination of the above methods. LT group was further divided into mono-modality local therapy (MOLT) group and multi-modality local therapy (MULT) group. MOLT group included patients treated with RT alone or SG alone. MULT group included patients treated with SG + RT/CCRT, or CCRT alone. NAC group included patients treated with NAC + LT ± adjuvant chemotherapy (ADC). Non-NAC group included patients who received LT ± ADC. Results: A total of 111 patients with LA ONB were included. The median age was 40 (range, 10–82) years old. The median follow-up duration for the entire cohort was 80.2 (range, 2.1-254.9) months, while 88.5 (range, 4.0-240.7) months for the CSLT group, 77.2 (range, 2.1-254.9) months for the LT group, 86.0 (range, 4.0-240.7) months for the NAC group, and 78.7 (range, 2.1-254.9) months for the non-NAC group. Thirty-five patients (31.5%) died, among which 30 patients died of tumor progression, 3 patients died of other diseases, and 2 patients’ causes of death were not available. The estimated 5-year overall survival (OS), progression-free survival (PFS), local recurrence-free survival (LRFS) and distant metastasis-free survival (DMFS) rates for the entire cohort (n = 111) were 70.2%, 53.1%, 73.6%, and 74.1%, respectively. The estimated 10-year OS, PFS, LRFS, and DMFS rates were 61.3%, 37.7%, 60.1%, and 68.0%, respectively. In univariate analysis, patients treated with NAC (n = 43) had significantly better overall survival (OS) compared with those without NAC (n = 68) ( P = 0.041). Patients in MULT group (n = 45) had significantly improved OS ( P = 0.004) and PFS ( P = 0.003) compared with those in MOLT group (n = 15). Multivariate analysis identified NAC and CSLT (n = 51) were independent prognostic factors for superior OS ( P = 0.020; P = 0.046). Conclusions: Our study suggested that CSLT, especially a combination of NAC and LT, improved the survival of patients with LA ONB. Multiple treatment modalities yielded better PFS and OS compared to single modality treatment.

Immuno-chemotherapy as single treatment modality for larynx preservation (ICoLP): Co-primary endpoints and safety results.

6008 Background: Optimal treatment of larynx squamous cell carcinoma (LC) maximizes functional outcomes and survival. Surgery and radiotherapy (RT) may lead to significant morbidity, notably dysphonia and dysphagia. Our group published durable pathologic complete response (pCR) with normal function in 33% of patients (pts) with stage II-IV LC treated with single modality chemotherapy. We hypothesized that pembrolizumab (P), cisplatin (C), and docetaxel (D) will cure a subset of LC pts and preserve larynx function. Methods: Eligible pts had stage II-III LC measurable per RECIST 1.1. Treatment consisted of P 200 mg, C 75 mg/m2 or carboplatin AUC 6, and D 75 mg/m2 IV Q3W. After 2 PCD cycles, pts with radiological response (complete [CR], partial [PR], or stable disease [SD]) received 2 additional PCD cycles. After 4 cycles, pts underwent larynx biopsy. Those with pCR received 4 doses of consolidation P; those without pCR received local therapy (LT; RT or surgery). Co-primary endpoints are disease control rate (DCR; CR+PR+SD) after 2 PCD cycles and pCR rate after 4 cycles. Secondary endpoints include safety, laryngeal preservation rate, relapse-free survival, and swallow function. Per Bayesian design (H0: 65% DCR, 15% pCR; H1: 85% DCR, 30% pCR), we reject H0 if of 25 pts, 19 have DCR or > 7 achieve pCR (10% alpha, 88% power). Results: 24 pts enrolled from 8/9/19-12/15/22, 62.5% were stage III (54.2% were T3 and 16.7% were N1); 23 were evaluable for the efficacy endpoints. DCR was 100% with 74% (17/23) being objective responses and 52% CR; pCR rate to date is 77.3% (17/22; 1 pt is on-treatment). 6 of 17 (35%) pts with pCR developed recurrence, mostly (4/6) within 4 months of pCR, and were salvaged with LT. 5 pCR lasted ≥ 1 y; 2 additional pCR pts unable to perform serial laryngoscopy or imaging due to loss of insurance (n = 1) or moving to another state (n = 1) have not had clinical recurrence for ≥ 2 ys. The median follow-up is 17.2 mos (range: 1.4 – 39.4 mos). One patient who refused LT at early recurrence was lost to follow-up and eventually underwent a total laryngectomy and RT then recurred locally and died of disease. An additional patient who had pCR with early recurrence received definitive RT with CR, but subsequently developed a solitary lung metastasis treated with RT; 2 pts remain on trial treatment. The most common treatment-related adverse events (TRAE) were fatigue (91.6%), anemia (79%), diarrhea (45.8%), and nausea (41.6%). 10 grade 3-4 TRAE were reported in 5 (20.8%) pts with the most common being neutropenia (3/24, 12.5%) and anemia (2/24; 8.3%). 2 pts discontinued PCD treatment due to toxicity. Conclusions: The study reached its primary endpoint with a DCR of 100% (23/23) and a pCR in 77.3% (17/22) of evaluable patients; 5 pCR last ≥ 1 y. Recurrences after pCR occurred stressing the importance of close follow-up. Updated efficacy and swallow function results will be presented at the meeting. Clinical trial information: NCT04030455 .

Microbiota-gut-brain axis and related therapeutics in Alzheimer's disease: prospects for multitherapy and inflammation control.

Alzheimer's disease (AD) is the most common type of dementia in the elderly and causes neurodegeneration, leading to memory loss, behavioral disorder, and psychiatric impairment. One potential mechanism contributing to the pathogenesis of AD may be the imbalance in gut microbiota, local and systemic inflammation, and dysregulation of the microbiota-gut-brain axis (MGBA). Most of the AD drugs approved for clinical use today are symptomatic treatments that do notimprove AD pathologic changes. As a result, researchers are exploring novel therapeutic modalities. Treatments involving the MGBA include antibiotics, probiotics, transplantation of fecal microbiota, botanical products, and others. However, single-treatment modalities are not as effective as expected, and a combination therapy is gaining momentum. The purpose ofthis review is to summarize recent advances in MGBA-related pathological mechanisms and treatment modalities in AD and to propose a new concept of combination therapy. "MGBA-based multitherapy" is an emerging view of treatment in which classic symptomatic treatments and MGBA-based therapeutic modalities are used in combination. Donepezil and memantine are two commonly used drugs in AD treatment. On the basis of the single/combined use of these two drugs, two/more additional drugs and treatment modalities that target the MGBA are chosen based on the characteristics of the patient's condition as an adjuvant treatment, as well as the maintenance of good lifestyle habits. "MGBA-based multitherapy" offers new insights for the treatment of cognitive impairment in AD patients and is expected to show good therapeutic results.

Multiagent Intratumoral Immunotherapy Can Be Effective in A20 Lymphoma Clearance and Generation of Systemic T Cell Immunity

The use of immunotherapies has shown promise against selective human cancers. Identifying novel combinations of innate and adaptive immune cell-activating agents that can work synergistically to suppress tumor growth and provide additional protection against resistance or recurrence is critical. The A20 murine lymphoma model was used to evaluate the effect of various combination immunotherapies administered intratumorally. We show that single-modality treatment with Poly(I:C) or GM-CSF-secreting allogeneic cells only modestly controls tumor growth, whereas when given together there is an improved benefit, with 50% of animals clearing tumors and surviving long-term. Neither heat nor irradiation of GM-CSF-secreting cells enhanced the response over use of live cells. The use of a TIM-3 inhibitory antibody and an OX40 agonist in combination with Poly(I:C) allowed for improved tumor control, with 90% of animals clearing tumors with or without a combination of GM-CSF-secreting cells. Across all treatment groups, mice rejecting their primary A20 tumors were immune to subsequent challenge with A20, and this longstanding immunity was T-cell dependent. The results herein support the use of combinations of innate and adaptive immune activating agents for immunotherapy against lymphoma and should be investigated in other cancer types.

Effects of multimodal pain management strategies on acute physiological and behavioral response to cautery disbudding in neonatal goat kids

Dairy goat kids are commonly disbudded in the United States without pain relief. Our objective was to identify an efficient pain management strategy by monitoring changes in plasma biomarkers and behavior of disbudded goat kids. A total of 42 kids (5-18 d old at the time of disbudding) were randomly allocated to 1 of 7 treatments (n = 6/treatment): sham treatment; 0.05 mg/kg i.m. xylazine (X); 4 mg/kg subcutaneous buffered lidocaine (L); 1 mg/kg oral meloxicam (M); xylazine and lidocaine (XL); xylazine and meloxicam (XM); and xylazine, meloxicam, and lidocaine together (XML). Treatments were administered 20 min before disbudding. One trained individual, blinded to treatment, disbudded all kids; sham-treated kids were handled similarly except the iron was cold. Jugular blood samples (3 mL) were obtained before (-20, -10, and -1 min) and after (1, 15, and 30 min, and 1, 2, 4, 6, 12, 24, 36, 48 h) disbudding and analyzed for cortisol and prostaglandin E2 (PGE2). Mechanical nociceptive threshold (MNT) testing was performed at 4, 12, 24, and 48 h after disbudding, and kids were weighed daily until 2 d post-disbudding. Vocalizations, tail flicks, and struggle behavior during disbudding were recorded. Cameras were mounted over home pens; continuous and scan observations over 12 periods of 10 min each, in the 48 h after disbudding, captured frequency of locomotion and pain-specific behaviors. Repeated measures and linear mixed models assessed treatment effects on outcome measures during and after disbudding. Models accounted for sex, breed, and age as random effects, and Bonferroni adjustments accounted for multiple comparisons. At 15 min after disbudding, XML kids had lower plasma cortisol concentrations compared with L (50.0 ± 13.2 vs. 132.8 ± 13.6 mmol/L) and M kids (50.0 ± 13.2 vs. 145.4 ± 15.7 mmol/L). Cortisol was also lower in XML kids over the first hour after disbudding compared with L kids (43.4 ± 9 vs. 80.2 ± 9 mmol/L). Change from baseline PGE2 was not affected by treatment. Behaviors observed during disbudding did not differ by treatment group. Treatment affected MNT such that M kids were more sensitive overall compared with sham kids (0.93 ± 0.11 kgf vs. 1.35 ± 0.12 kgf). None of the recorded post-disbudding behaviors were affected by treatment, but study activities did influence behavior over time, with kid activity levels declining in the first day after disbudding but largely recovering thereafter. We conclude that none of the drug combinations investigated here appeared to fully attenuate pain indicators during or after disbudding, but triple modality seems to have offered partial relief compared with some of the single-modality treatments.

Radiosurgery for Cerebral Arteriovenous Malformations

Arteriovenous malformations (AVMs) are the most common intracranial vascular malformation that we encounter in our clinical practice. Patients may present with either headaches, seizures, or bleed. There are several classification systems described in literature to aid in management. Most of them look into the size of the nidus and the status of the draining veins. Any nidus which is compact, superficial, and in a surgically safe area are offered surgery. Most of the other AVMs are managed by radiosurgery or embolization either as a single treatment modality or in combination.

Fe-MnO2 nanosheets loading dihydroartemisinin for ferroptosis and immunotherapy

Ferroptosis has emerged as a therapeutic tactic to trigger cancer cell death driven by abnormal accumulation of reactive oxygen species (ROS). However, a single ferroptosis treatment modality is often limited. In this work, a combination therapy of ferroptosis and immunotherapy for cancer was proposed. Specifically, a versatile nanodrug was designed for the multiple treatment of hepatocellular carcinoma (HCC) by loading dihydroartemisinin (DHA) on Fe3+-doped MnO2 nanosheets (Fe-MnO2/DHA). Firstly, Fe-MnO2/DHA was degraded by glutathione (GSH) in the tumor microenvironment (TME) to release Fe2+, Mn2+ and DHA, leading to aberrant ROS accumulation due to Fenton/Fenton-like reaction. Secondly, breakage of endoperoxide bridge from DHA was caused by Fe2+ to further induce oxidative stress. Thirdly, the depleted GSH promoted the inactivation of glutathione peroxidase 4 (GPX4), resulting in lipid peroxide (LPO) accumulation. The resulting LPO and ROS could induce ferroptosis and apoptosis of liver cancer cells. Furthermore, Fe-MnO2/DHA mediated three-pronged stimulation of oxidative stress, resulting in high levels of targeted immunogenic cell death (ICD). It could enhance the infiltration of CD4+ T and CD8+ T cells, and promote macrophage polarization. DHA also acted as an immunomodulator to inhibit regulatory T cells (Tregs) for systemic antitumor. Overall, Fe-MnO2/DHA presents a multi-modal therapy for HCC driven by ferroptosis, apoptosis and immune activation, significantly advancing synergistic cancer treatment.

Function Preservation in Head and Neck Cancers

The treatment of head and neck cancers can have a significant impact on function and appearance, which results in impairment of quality of life. Various long-term sequelae of treatment include speech and swallowing difficulty, oral incompetence, trismus, xerostomia, dental caries and osteoradionecrosis. Management has evolved from single modality treatment of either surgery or radiation to multimodality treatment to attain acceptable functional outcomes. Brachytherapy, also known as interventional radiotherapy, with its ability to deliver high doses centrally to the target, has been shown to improve local control rates. Due to the rapid fall-off of the dose of brachytherapy there is better organ at risk sparing as compared with that of external beam radiotherapy. In the head and neck region, brachytherapy has been practiced in various sites, including the oral cavity, oropharynx, nasopharynx, nasal vestibule and paranasal sinuses. Additionally, brachytherapy has also been considered for reirradiation as a salvage. Brachytherapy can also be considered as a perioperative technique together with surgery. Close multidisciplinary cooperation is required for a successful brachytherapy programme. In oral cavity cancers, depending on the location of the tumour, brachytherapy has been shown to preserve oral competence, maintain tongue mobility, maintain speech, swallowing and the hard palate. Brachytherapy in oropharyngeal cancers has been shown to reduce xerostomia and also reduce dysphagia and aspiration post-radiation therapy. For the nasopharynx, paranasal sinus and nasal vestibule, brachytherapy preserves the respiratory function of the mucosa. Despite such an incomparable impact on function and organ preservation, brachytherapy is an underutilised technique for head and neck cancers. There is a strong need to improve brachytherapy utilisation in head and neck cancers.

An Overview of Drug Delivery Nanosystems for Sepsis-Related Liver Injury Treatment.

Sepsis, which is a systemic inflammatory response syndrome caused by infection, has high morbidity and mortality. Sepsis-related liver injury is one of the manifestations of sepsis-induced multiple organ syndrome. To date, an increasing number of studies have shown that the hepatic inflammatory response, oxidative stress, microcirculation coagulation dysfunction, and bacterial translocation play extremely vital roles in the occurrence and development of sepsis-related liver injury. In the clinic, sepsis-related liver injury is mainly treated by routine empirical methods on the basis of the primary disease. However, these therapies have some shortcomings, such as serious side effects, short duration of drug effects and lack of specificity. The emergence of drug delivery nanosystems can significantly improve drug bioavailability and reduce toxic side effects. In this paper, we reviewed drug delivery nanosystems designed for the treatment of sepsis-related liver injury according to their mechanisms (hepatic inflammation response, oxidative stress, coagulation dysfunction in the microcirculation, and bacterial translocation). Although much promising progress has been achieved, translation into clinical practice is still difficult. To this end, we also discussed the key issues currently facing this field, including immune system rejection and single treatment modalities. Finally, with the rigorous optimization of nanotechnology and the deepening of research, drug delivery nanosystems have great potential for the treatment of sepsis-related liver injury.

Cancer Diagnoses and Use of Radiation Therapy Among Persons Experiencing Homelessness

Persons experiencing homelessness (PEH) have low rates of cancer screening and worse cancer mortality compared with persons not experiencing homelessness. Data regarding cancer diagnosis and treatment in PEH are limited. We investigated cancer prevalence and use of radiation therapy (RT) in PEH. Patients presenting between January 1, 2014, and September 27, 2021, at a large metropolitan hospital system were assessed for homelessness via intake screening or chart search. PEH data were cross-referenced with the institution's cancer database to identify PEH with cancer diagnoses. Demographic, clinical, and treatment variables were abstracted. Of a total of 9654 (9250 evaluable) PEH with a median age of 42 years, 81 patients (0.88%) had at least 1 cancer diagnosis and 5 had multiple diagnoses, for a total of 87 PEH with at least 1 cancer diagnosis. The median age at diagnosis was 60 years. In total, 43% were female and 51% were Black, and 43% presented with advanced or metastatic disease. Lung (17%), prostate (15%), leukemia/lymphoma (13%), and head/neck (9%) were the most common diagnoses. In total, 17% of patients underwent surgery alone, 13% received chemotherapy alone, 14% received RT alone, and 6% received hormone therapy alone. A total of 8% of patients underwent no treatment, and 43% underwent multimodality therapy. In total, 58% of treated patients never achieved disease-free status. Of the 31 patients who received RT, 87% received external beam RT. Most patients (70%) received hypofractionated regimens. For patients who had multifraction treatment, the treatment completion rate was 85%, significantly lower than the departmental completion rate of 98% (P < .00001). In a large cohort of PEH in a metropolitan setting, cancer diagnoses were uncommon and were frequently in advanced stages. Most patients underwent single-modality treatment or no treatment at all. Despite the use of hypofractionation, the RT completion rate was low, likely reflecting complex barriers to care. Further interventions to optimize cancer diagnosis and treatment in PEH are urgently needed.

The Evolving Landscape of Leptomeningeal Cancer from Solid Tumors: A Systematic Review of Clinical Trials.

Leptomeningeal carcinomatosis (LMC) is a fatal but uncommon complication occurring in 5-15% of patients with stage IV cancer. Current treatment options are ineffective at managing leptomeningeal spread, with a median overall survival (mOS) of 2-6 months. We aimed to conduct a systematic review of the literature to identify past and future therapies for LMC from solid tumors. Forty-three clinical trials (CTs) published between 1982-2022 were identified. Of these, 35 (81.4%) were non-randomized CTs and 8 (18.6%) were randomized CTs. The majority consisted of phase I (16.3%) and phase II CTs (65.1%). Trials enrolled patients with LMC from various primary histology (n = 23, 57.5%), with one CT evaluating LCM from melanoma (2.4%). A total of 21 trials evaluated a single modality treatment. Among CTs, 23.7% closed due to low accrual. Intraventricular (ITV)/intrathecal (IT) drug delivery was the most common route of administration (n = 22, 51.2%) vs. systemic drug delivery (n = 13, 30.3%). Two clinical trials evaluated the use of craniospinal irradiation for LMC with favorable results. LMC continues to carry a dismal prognosis, and over the years, increments in survival have remained stagnant. A paradigm shift towards targeted systemic therapy with continued standardization of efficacy endpoints will help to shed light on promising treatments.

Management of silicone granuloma: A systematic review

Management of silicone granuloma: A systematic review

Yoga: unraveling the internal pharmacy – Impact on genome and epigenome

Complex and chronic lifestyle disorders have become the leading cause of death and disability worldwide. They involve multiple morbidities necessitating the attention of numerous healthcare facilities as well as community-based care too. Stress and anxiety brought on by the fast-paced life, unhealthy eating habits, sedentary lifestyle, poor quality of life, polypharmacy, and high medical costs have significantly influenced the development of such multimorbid conditions. Most chronic complex diseases share a similar underlying pathology including high levels of stress, inflammatory immune response, persistent activation of the hypothalamo-pituitary-adrenal axis, oxidative stress, accelerated immune-aging, dysregulated blood flow, enhanced apoptosis and accelerated aging with shorter telomeres and DNA damage. These are modifiable factors which can impact disease progression and no single treatment modality in modern medicine can alone impact all these factors. As a result, the treatment must involve an integrated approach that targets both mind and body and each of these factors which form an architectural framework which supports the onset of these complex lifestyle disease and thus though we may enjoy longer lifespan, but it is accompanied by shorter health span. Yoga, a mind-body intervention with Indian roots, strives to bring about the synchronization of physical and mental health by unraveling and switching on the internal pharmacy and maintenance of homeostasis at cellular and molecular level.

Academic progress research on the prevention of surgical incision scar during surgical treatment of benign breast tumors

Objective: This article summarizes the progress of surgical treatment of benign breast tumors and the prevention of incision scars during surgery. Methods: In this paper, the relevant research literature on the surgical treatment of benign breast tumors in China and the world was consulted, analyzed, and summarized. Conclusion: Many methods in this article can be used for scar treatment during the recovery period of surgery, and the success rate of these methods varies with different body constitutions. Since no single treatment modality is ideal for scarring, clinical management varies from individual to individual. The point of view of this article is that based on the basic principles of wound care, doctors need to be familiar with the problems that should be paid attention to in the process, from incision to scar, and handle the details of the operation preparation stage, operation process, and operation recovery period, and strive for ideal wound surface during the operation recovery period.

Clinical evaluation of Laser-Assisted New Attachment Procedure® (LANAP®) surgical treatment of chronic periodontitis: a retrospective case series of 1-year results in 22 consecutive patients.

Treatment for periodontitis has evolved over the years as new technologies have become available. Currently, lasers seem attractive as a treatment modality, but their effectiveness needs to be verified. The purpose of this project was to evaluate Laser Assisted New Attachment Procedure® (LANAP®) surgery as a single treatment modality. As part of a mandatory training program for periodontists and other dentists, 22 consecutive patients diagnosed with moderate to severe periodontitis (probing depth [PD] up to 11 mm) were treated with the LANAP® surgical approach using a 1064-nm Nd:YAG laser as part of a multi-step protocol. Following single-session active therapy, they were entered into a maintenance program. Their clinical status was re-evaluated at 12-18 months following surgery. All 22 patients completed the 12- to 18-month follow-up. PD, clinical attachment level, and furcation (FURC) showed substantial improvement. Recession was minimal (mean, 0.1 mm), while 93.5% of PD measurements were 3 mm or less at re-evaluation. Furthermore, 40% of grade 2 FURC closed clinically. Within the limits of this case series, LANAP® was found to be an effective, minimally invasive, laser surgical therapy for moderate to advanced periodontitis.

A Case of Soft Tissue Eosinophilic Granuloma in the Ear Canal

Soft tissue eosinophilic granulomatosis (Kimura’s disease) is a benign disease with a chronic course that manifests as painless soft tissue masses or enlarged lymph nodes. These masses frequently occur in the head and neck region, especially around the parotid gland, while there are few reports of involvement of the ear canal.We encountered a case of soft tissue eosinophilic granulomatosis of the ear canal. Surgical resection and oral administration of suplatast tosilate proved effective and no recurrence was observed. Soft tissue eosinophilic granulomas have a propensity to recur after single-modality treatment. In this case, combined surgical and drug treatment proved effective and no recurrence was observed.