Specific Treatment Plan Research Articles

Using Artificial Intelligence for Personalized Cancer Treatment

The rapid evolution of artificial intelligence and the tools it has created gives rise to significant opportunities for precision oncology and promises a brighter future for the development of the sector. Precision oncology is a modern and advancing branch of cancer treatment and it is a renovated approach which specializes on specific treatment plans rather than “one-size-fits”; with advanced technology including but not limited to genomics, proteomics and bioinformatics, precision oncology focuses on optimizing therapeutic efficacy by targeting the specific molecular and cellular characteristics of a patient's cancer. This review paper explores the sophisticated and complex potential roles of artificial intelligence in cancer treatment, emphasizing on its impact in personalized treatment plans, immunotherapy and diagnostic accuracy. The immense database that AI has access to enables medical professionals to analyze imaging results and detect similarities of symptoms, genetic patterns, offering enhanced prognostic and diagnostic capabilities by eliminating human error and increasing cost effectiveness. This paper also dives into applications such as immune checkpoint inhibitors, digital pathology and demonstrations of the remarkable capability of artificial intelligence in multi-omics integration. Nonetheless, the advent of such advanced artificial intelligence tools, although promising, have not yet become the “gold standard” in oncology due to many rising agitations regarding reliability, since treatment decisions made by opaque AI algorithms are prone to error due to potential biases in AI systems and design errors. By critically examining these points, this paper evaluates both the advantages and disadvantages of the future implementation of artificial intelligence in the field of precision oncology, aiming to devise optimal integration in clinical practice.

Current Status and Progress in Integrative Treatment of Acute Ischemic Cerebrovascular Disease

Acute ischemic cerebrovascular disease (AICD) poses a severe threat to human health, characterized by high incidence and disability rates. Western medicine currently offers multiple treatment methods, such as thrombolysis, anticoagulation, and cerebral circulation improvement, while traditional Chinese medicine demonstrates unique advantages in herbal prescriptions, proprietary Chinese medicines, acupuncture, and massage therapies. Integrative treatment approaches combining Chinese and Western medicine have become widespread in clinical practice, yet challenges remain in optimizing specific treatment plans and elucidating mechanisms of action. This paper aims to comprehensively analyze the current status of integrative treatment for AICD, outline its developmental trajectory, and provide insights for enhancing treatment efficacy.

Efficacy of late-onset antiviral treatment in immunocompromised hosts with persistent SARS-CoV-2 infection.

Four years after the onset of the global coronavirus disease 2019 (COVID-19) pandemic, the immunocompromised are at greatest risk of developing life-threatening severe disease. However, specific treatment plans for this most vulnerable patient group have not yet been developed. Employing a CD4+ and CD8+ T cell-depleted immunocompromised mouse model of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, we explored therapeutic options of persistent infections with standard-of-care paxlovid, molnupiravir, and the experimental therapeutic 4'-fluorouridine (4'-FlU). Late-onset treatment initiated 14 days after infection was efficacious, but only 4'-FlU was rapidly sterilizing. No treatment-experienced viral variants with reduced susceptibility to the drugs emerged, albeit virus replication rebounded in animals of the paxlovid group after treatment end. This study supports the use of direct-acting antivirals (DAAs) for late-onset management of persistent SARS-CoV-2 infection in immunocompromised hosts. However, treatment courses likely require to be extended for maximal therapeutic benefit, calling for appropriately powered clinical trials to meet the specific needs of this patient group.

Knowledge, confidence and clinical reasoning of dental students for diagnosing pediatric periodontal diseases

ObjectiveGiven the importance of diagnosing periodontal diseases in pediatric patients, the objective of this study was to examine knowledge, confidence, and clinical reasoning of third- and fourth-year dental students regarding periodontal diagnosis and treatment planning in pediatric patients. MethodsAn explanatory sequential mixed-method study was conducted in two phases. In the first phase, the survey questions were administered online to the third-and fourth-year dental students. Surveys tested for knowledge, confidence and clinical decision-making using questions and case-studies. Answers from periodontists and the pediatric dentists were used as the gold standard. For the next phase, individual interviews were recorded, transcribed, and coded followed by verbal analysis to assess their clinical reasoning for the specific diagnosis and treatment planning. ResultsWhile there was no overall difference in the knowledge and the confidence level between the students, they differed from the experts for some questions in confidence levels. As measured using the Script Concordance Test (SCT), no significant differences were observed between the participants in their clinical reasoning. The verbal analysis of the interview data showed that the students used three different patterns for searching through the problem space. Most of the students used the forward pattern of search and reported low confidence in diagnosing and treating pediatric periodontal diseases. ConclusionDue to low self-reported confidence in diagnosing periodontal disease in pediatric patients. Providing education solutions will improve the confidence of undergraduate dental students in diagnosing and treating periodontal disease.

The Impact of Molecular and Genetic Analysis on the Treatment of Patients with Atypical Meningiomas.

Meningiomas represent approximately 40% of all primary tumors of the central nervous system (CNS) and, based on the latest World Health Organization (WHO) guidelines, are classified into three grades and fifteen subtypes. The optimal treatment comprises gross total tumor resection. The WHO grade and the extent of tumor resection assessed by the Simpson grading system are the most important predictors of recurrence. Atypical meningiomas, a grade 2 meningioma, which represent almost a fifth of all meningiomas, have a recurrence rate of around 50%. Currently, different histopathologic, cytogenetic, and molecular genetic alterations have been associated with different meningioma phenotypes; however, the data are insufficient to enable the development of specific treatment plans. The optimal treatment, in terms of adjuvant radiotherapy and postoperative systemic therapy in atypical meningiomas, remains controversial, with inconclusive evidence in the literature and existing studies. We review the recent literature to identify studies investigating relevant atypical meningioma biomarkers and their clinical application and effects on treatment options.

Personality disorders in individuals with functional seizures: a systematic review.

https://www.crd.york.ac.uk/PROSPEROFILES/509286_STRATEGY_20240203.pdf, identifier CRD42024509286.

ChatGPT's Gastrointestinal Tumor Board Tango: A limping dance partner?

ObjectivesThis study aimed to assess the consistency and replicability of treatment recommendations provided by ChatGPT 3.5 compared to gastrointestinal tumor cases presented at multidisciplinary tumor boards (MTBs). It also aimed to distinguish between general and case-specific responses and investigated the precision of ChatGPT's recommendations in replicating exact treatment plans, particularly regarding chemotherapy regimens and follow-up protocols. Material and methodsA retrospective study was carried out on 115 cases of gastrointestinal malignancies, selected from 448 patients reviewed in MTB meetings. A senior resident fed patient data into ChatGPT 3.5 to produce treatment recommendations, which were then evaluated against the tumor board's decisions by senior oncology fellows. ResultsAmong the examined cases, ChatGPT 3.5 provided general information about the malignancy without considering individual patient characteristics in 19% of cases. However, only in 81% of cases, ChatGPT generated responses that were specific to the individual clinical scenarios. In the subset of case-specific responses, 83% of recommendations exhibited overall treatment strategy concordance between ChatGPT and MTB. However, the exact treatment concordance dropped to 65%, notably lower in recommending specific chemotherapy regimens. Cases recommended for surgery showed the highest concordance rates, while those involving chemotherapy recommendations faced challenges in precision. ConclusionsChatGPT 3.5 demonstrates potential in aligning conceptual approaches to treatment strategies with MTB guidelines. However, it falls short in accurately duplicating specific treatment plans, especially concerning chemotherapy regimens and follow-up procedures. Ethical concerns and challenges in achieving exact replication necessitate prudence when considering ChatGPT 3.5 for direct clinical decision-making in MTBs.

The Top 100 Most-Cited Publications in Clinical Craniofacial Research.

Craniosynostosis is a birth defect defined as premature closure of sutures leading to possible neurological deficits and cosmetic deformities. Most of the current literature to date focuses on craniosynostosis etiology by analyzing genetics. This paper is a bibliometric analysis of the most influential works related to the clinical management of craniosynostosis to help guide clinicians in their decision-making. Clarivate Web of Science database was used to identify the top 100 most-cited articles addressing the clinical management of craniosynostosis. A bibliometric review was performed to analyze publication metrics and track research trends. The 100 most-cited publications pertaining to craniosynostosis management were cited a cumulative 12,779 times. The highest cited article was Shillito and colleagues' "Craniosynostosis: A Review Of 519 Surgical Patients" with 352 citations. The oldest clinical craniosynostosis article dates back to 1948, and the most recent was published in 2016. The year with the most clinical-focused publications was 2011. The most prolific author was Renier, D. The United States produced 56 of the 100 articles. Most articles (n=52) were level 3 evidence. This bibliometric evaluation of craniosynostosis provides insight into the most impactful literature on this topic. The highest cited articles retrospectively analyze large sample sizes, outline proper evaluation, discuss intervention timelines, and highlight specific treatment plans for this birth defect. By filtering through existing literature, this analysis can guide clinicians on the management of craniosynostosis to maximize patient outcomes.

Effects of eating disorders on the oral cavity

This article focuses on bulimia, also known as an eating disorder disease, but it is not just an eating problem, but a type of preventative compulsion that can have a significant impact on the tissues and symptoms that worsen the entire oral cavity.. It is very important to know these pathologies so that the dentist can manifest these symptoms early and the clinical picture can be treated with an adequate and correct treatment plan depending on the patient. There are poor dietary patterns in the world, one of which is eating disorders (EDs), which cause severe malnutrition with consequences for the development of dental, psychological and social health. Eating disorders, such as anorexia and bulimia, are serious illnesses that arise from both the physical and oral health of sufferers. These disorders can have a significant impact on the tissues and symptoms persist throughout the oral cavity. It is essential that health professionals, including dentists, become more familiar with these pathologies in order to develop symptoms early and provide an appropriate and specific treatment plan for each patient. Next, this study will be deepened, we will address the issue of oral health in people who suffer from eating disorders such as anorexia and bulimia; The most important manifestations that have caused these diseases in budental disease are: dental erosion, caries, periodontal, mucosal alterations, etc. For each one we can find a definition, what are their causes, what sign or symptom they cause.

A multidisciplinary obesity registry for Iranian adults: a protocol.

Obesity is a global health challenge due to its high prevalence and increased related morbidity and mortality. Accordingly, creating a platform to enter data on patients with obesity, treatment process and outcome is mandatory. The objective of this registry is to provide such a database regarding Iranian adults with obesity in order to facilitate future research designs and effective decision making to control this condition. After obtaining informed consent from eligible individuals, a practical questionnaire will be used to gather information about basic characteristics, family history, past medical history, regular medications, dietary intakes and other relevant information of adults with obesity. This data along with the results of laboratory tests, physical examination, and anthropometric measurements will be registered into the registry system by trained members of the team during an in-person visit. Patients will undergo a specific treatment plan based on the multidisciplinary medical team's decision. Then, changeable variables and the outcomes of their treatment process will be registered later in the follow-up sessions. This registry aims to provide a comprehensive dataset on the epidemiology, outcomes and management process of obesity to serve as a foundation for later research projects and improve medical approaches toward this condition.

RESEARCH PROGRESS OF CURCUMIN IN THE TREATMENT OF SEPSIS.

Sepsis is a life-threatening organ dysfunction caused by an unregulated host response to infection. It is an important clinical problem in acute and critical care. In recent years, with the increasing research on the epidemiology, and pathogenesis, diagnostic and therapeutic strategies of sepsis, great progress has been made in clinical practice, but there is still a lack of specific and effective treatment plans. Curcuma longa , a leafy plant of the ginger family, which is a common and safe compound, has multiple pharmacological actions, including, but not limited to, scavenging of oxygen free radicals, attenuation of inflammatory response, and antifibrotic effects. Great progress has been made in the study of sepsis-associated rodent models and in vitro cellular models. However, the evidence of curcumin in the clinical management practice of sepsis is still insufficient; hence, it is very important to systematically summarize the study of curcumin and sepsis pathogenesis.

Detection of Brain Tumour in MRI Images using Deep Belief Network (DBN)

One of the world's deadliest illnesses is brain cancer. It is a cancer that often affects adults as much as children. It is the least likely species to survive, and its diversity is determined by its location, sweetness and structure. The negative effects will stem from the incorrect classification of the tumour brain. Therefore, determining the specific type and rank of the tumour in its early stages is required to select a specific treatment plan. A major concern is the elimination, segmentation and detection of tumour areas infected by magnetic resonance imaging (MRI). Despite the fact that it is a laborious and tedious task done by clinical experts or radiologists whose precision depends entirely on their experience. Computer-aided technology is becoming more and more important for circumventing these limitations. This study investigates a multi-layer Deep Belief Network (DBN) technique for MRI tumour detection. The proposed model is named as Brain Tumour Deep Belief Network (BT-DBN). The BT-DBN was tested with two datasets. The results demonstrate the importance of accuracy parameters relative to the most recent approaches. The results exhibit that the BT-DBN was effective in identifying different types of tumour tissue in MR images of the brain. The precision is 99.51%, the specificity is 94.28%, and the sensitivity is 98.72%.

P26 User experience of a clinical decision support system in the form of a mobile app in supporting antimicrobial stewardship

Abstract Background There are advancements in the use of technology in modern healthcare. Healthcare professionals use various digital platforms such as electronic medical records, e- prescriptions, websites and smartphone apps to enable prompt access to clinical information. Healthcare professionals are likely to refer to their smartphones for prompt clinical information or guidance that are easily accessible in contrast to paper guides, handbooks and desktop computers. Some studies have shown that mobile application guidelines within a smart phone app increase adherence to prescribing guidelines by clinicians. Furthermore, benefits of a smart phone app are the ability to update them more quickly than paper-based information and the ability to improve clinical decision-making within the form of an electronic clinical decision support system (CDSS). Despite the increased use of digital information there are limited studies in this area on the use of CDSS within smart phone antimicrobial apps. More evidence is needed to better understand healthcare usage of such apps in the area of antimicrobial stewardship. Microguide V1 (M1) is a smartphone antimicrobial app currently in widespread use in UK hospitals designed to provide access to local prescribing guidelines. However, M1 does not have a support tool to ‘direct’ or map prescribers to a specific treatment plan for their patients based on symptoms or suspected diagnosis. Microguide V2 (M2) is an updated version that includes an additional decision support tool that helps to identify the correct antibiotic to prescribe based on patient’s clinical symptoms. Objectives To evaluate clinician experiences with both versions of the app within Mid and South Essex University Hospitals (MSE) Trust. In MSE, the M1 is currently in use but M2 is being adopted from November 2023 onwards as part of strategies to improve antimicrobial stewardship, and to help with meeting Commissioning for Quality and Innovation (CQUIN) targets for IV to oral switching of antibiotics). Methods A mixed methods approach was devised utilizing an online survey and interviews pre- and post-introduction of M2. Questions were aligned to the COMB-B behaviour model approach influencing change. Topics covered were awareness, experience, barriers, concerns and prescribing behaviour. All prescribers within the Trust working on adult inpatient wards were eligible for participation. Results A pre-implementation survey of M2 was conducted between January and October 2023. A total of 473 people accessed the online survey, with 24 responses, but only a total of 15 participants fully completed the survey. The roles of the participants were 6 pharmacists, 3 nurses and 6 doctors. In terms of awareness of the app, 87% stated yes and 38% agreed that the app increased their awareness of antimicrobial stewardship. Two-thirds (67%) of participants used the app in supporting prescribing decisions, whilst a third had never used it. Nearly 40% of participants agreed that the app encouraged them to challenge inappropriate prescribing and almost half (46%) agreed that that they felt comfortable accessing the app at patient’s bedside. The interview analysis is still ongoing. Conclusions The results so far provide evidence that M1 is being accessed by prescribers in making clinical decisions and they find it useful. The obvious and major limitation of this study was the small number of responses, and this is partially explained by winter pressures and industrial action by nurses and doctors. This led to reduced availability of participants.

Pilot Project for Observing Efficacy of a Selected Treatment Module in Vaatkantak with Special Reference to Agnikarma

Vaatkantak vis a vis Calcaneal spur/plantar fasciitis is a common problem affecting the quality of life of people. A specific treatment plan was adopted for its treatment in the present study and the results were evaluated. Agnikarma, external application of lepa guti and internal usage of guggulu and kupilu were selected for pacification of Vaat dosha. Marked improvement was seen in all patients.

Advances in understanding the molecular mechanisms of borderline ovarian tumors.

Borderline ovarian tumors (BOTs), which are a special type of epithelial tumor of the ovary, lie between benign and malignant tumors and have low malignant potential. Due to the fact that the early symptoms of these tumors are relatively subtle, they are not easy to diagnose clinically. This study explores advancements in clinical detection methods and provides a comprehensive overview of molecules such as cell migration factors, cell transcription factors, cell damage repair factors, cell cycle regulators, and tumor suppressor genes that are related to the development of BOTs and their related mechanisms in recent years, thus aiming to provide more sensitive, specific, and efficient differential diagnosis and treatment plans for patients to improve their prognosis and survival outcomes.

Perinatal mental health care in the Italian mental health departments: a national survey.

Evidence on the negative outcomes of untreated mental disorders during pregnancy and in the first year after childbirth on women's and children's health has stimulated interest in how to develop and sustain high-quality mental health care during the perinatal period. In Italy, there is a lack of knowledge about how mental health services support women with perinatal mental disorders (PMDs). This study aims to describe the adoption of good practices for the prevention and care of PMDs by the Italian mental health departments (MHDs). This is a nationwide cross-sectional survey conducted online using LimeSurvey. Starting from the Ministry of Health Registry's 127 MHDs were invited to participate between February and March, 2023. Characteristics of the participating MHDs were reported as descriptive statistics. One hundred nineteen MHDs participated, with a response rate of 93.7%. Regarding the prevention of PMDs, 69 (58.0%) MHDs offer preconception counseling, whereas only 6 (5.0%) have information material for this purpose. Written integrated care pathways for PMDs are not available in 94 (79.7%) MHDs. A reference professional for psychopharmacological treatment during pregnancy or breastfeeding is available in 55 (46.2%) MHDs, while a specific treatment plan for women with PMDs is adopted by 27 (22.7%) MHDs. Thirty-four (28.6%) MHDs have established an outpatient clinic for PMDs, whereas there are no inpatient psychiatric facilities designed for mothers and infants (mother-baby units). There is a need to improve the care of women with PMDs in Italy. The provision of pre-conception counseling, integrated care pathways, and specialist skills and facilities for PMDs should be prioritized.

Oral lesions after infection by SARS CoV 2: two case reports

Introduction: The SARS CoV 2 infection has resulted in several health, economic, and social crises in all areas. The disease shows a substantial biological diversity in humans causing a series of sequels in the trans- or post-infection period in the entire organism. Case Report: The manifestations that occur in the oral cavity and pharynx have not been evaluated. In this study, two clinical cases are reported. The first patient, a 67-year-old male, presents erosive lesions on the dorsal surface of his tongue after SARS CoV 2 infection. Results: Therapy consisting of reinforcing oral cleaning, use of antifungal solutions, mouthwashes containing superoxidation solution and B complex was given to the patient. The reported lesions improved satisfactorily. The second case, a 47-year-old male patient, presented vesiculobullous lesions on the lingual and labial mucosa accompanied by severe painful symptoms after SARS CoV 2 infection. An incisional biopsy was performed. The histopathological result was compatible with pemphigus vulgaris, and the treatment protocol was started with 0.1% topical mometasone and 2g miconazole gel, observing adequate involution of the lesions after 20 days. Conclusions: The aim of this study is to report on the lesions affecting the oral cavity and pharynx in post-COVID patients with the aim of carrying out a thorough intraoral examination, establishing a clinical or histopathological diagnosis to implement a specific treatment plan in each case to improve the health and quality of life of the patients. Keywords: SARS-CoV-2; Oral manifestations; Oral ulcer; Pemphigus; Mouth; Mucous membrane.

Dual path sub-type diagnostic model based on the anatomic morphological feature

Intracranial hematoma can compress the brain tissue, resulting in increased cranial pressure and a high fatality rate. Therefore, providing a rapid and accurate clinical diagnosis and treatment plan is a crucial step. Intracranial hematoma can be classified into clinical sub-types such as cerebral lobes, ventricular, basal ganglia, pons, and cerebellum hemorrhage based on the location of the hemorrhage. To accurately identify different sub-types and provide targeted treatment, this paper proposes a dual path sub-type diagnosis model based on the anatomic morphological feature. It extracts anatomic morphological features of hematoma based on clinical prior knowledge to achieve prior feature enhancement. Then, a dual-path input model is constructed, and the dual-path module is used to analyze and integrate various features of different sub-types of intracranial hematoma. The model is validated on the clinical data set of the Second Affiliated Hospital of Dalian Medical University, and the corresponding accuracy can reach 0.993. This model can automatically recognize the sub-type of the clinical intracranial hematoma cases and improve diagnostic efficiency. Besides, it further aid in image analysis and enable specific treatment planning.

Evaluation of occlusal bite force distribution by T-Scan in orthodontic patients with different occlusal characteristics: a cross sectional-observational study

BackgroundThe aim of orthodontic treatment, apart from esthetic and functional corrections, is uniform force distribution. Hence Occlusal analysis using a T scan gives scope for a precisely targeted treatment plan. The T-scan evaluation of occlusal force, time, and location of contacts from initial occlusal contact to maximum intercuspation enables the orthodontist to sequentially balance the occlusal forces on the right and left sides through specific treatment plan options.ObjectiveThe current study aimed to determine the force distribution in the different individuals by using a T-Scan as well as the net discrepancies of forces generated at a maximum intercuspation position in the first molar region between the left and right sides of the mouth.MethodsThis is a descriptive-correlational study that was carried out in Ras Al Khaimah College of Dental Sciences clinics and Ajman University clinics from January 2020 to September 2022 by using the convenience sampling technique. The T-scan III Novus was employed in this investigation to record multi-bite scans for several patients. T-scan was utilised to examine various malocclusions.ResultsThe present study consisted of 158 participants. Analysis of Variance (ANOVA) showed that there is a statistically significant difference in the percentage of force between the three types of malocclusions (I, II, and III) on the right molar side (B-16 and B-46) (p < 0.05). Moreover, the overall discrepancy showed a statistically significant difference in the three types of malocclusion classifications (p < 0.05). On the other hand, there was no statistically significant difference in the percentage of force between B-26 and B-36 (p > 0.05). Post hoc analysis showed a statistically significant difference in the percentage of force between malocclusion classes I and III on the right molar, with a mean difference of 4.11190 (p < 0.05). Similarly, there was a statistically significant difference in B-46 between Malocclusion Classes I and II, 4.01806 (p < 0.05). Additionally, post hoc analysis showed a statistically significant difference between malocclusion classes I and III, with a mean difference of -4.79841 (p < 0.05) on the right molar.ConclusionThe T-Scan is a useful tool for assessing occlusal discrepancies and can be helpful during treatment planning and follow-up, especially for orthognathic surgery patients. A T-scan could be used in orthodontic therapy in a simple and efficient way. Also, it turned out to be a useful tool for diagnosing problems and gave us new information about how therapies work. In this study, T-Scan showed that it can measure occlusal forces in timing in an objective, accurate, and repeated manner. The current study found that T-Scan was better able to report the difference in the percentage of force on the right molar side than on the left side.

HU-based material conversion for BNCT accurate dose estimation

NeuMANTA is a new generation boron neutron capture therapy (BNCT)-specific treatment planning system developed by the Neuboron Medical Group and upgraded to an important feature, a Hounsfield unit (HU)-based material conversion algorithm. The range of HU values was refined to 96 specific groups and established corresponding to tissue information. The elemental compositions and mass densities have an important effect on the calculated dose distribution. The region of interest defined in the treatment plan can be converted into multiple material compositions based on HU values or assigned specified single material composition in NeuMANTA. Different material compositions may cause normal tissue maximum dose rates to differ by more than 10% in biologically equivalent doses and to differ by up to 6% in physically absorbed doses. Although the tumor has a lower proportion of BNCT background dose, the material composition difference may affect the minimum dose of biologically equivalent dose and physically absorbed dose by more than 3%. In addition, the difference in material composition could lead to a change in neutron moderation as well as scattering. Therefore, the material composition has a significant impact on the assessment of normal tissue side effects and tumor control probability. It is essential for accurate dose estimation in BNCT.