Types Of Treatment Modalities Research Articles

Awareness about Prosthodontic Treatment Modalities Based on Socioeconomic Status among Patients Visiting Dental Colleges in Jharkhand, India – A Patient Survey

Introduction: The questionnaire-based survey was carried out to evaluate about different types of prosthetic treatment modalities specifically removable prosthesis, fixed teeth supported prosthesis and implants in relation to different socioeconomic factors. Materials and Methods: A close–ended questionnaire-based study was carried out between January 2021 to February 2022 and a total of 1000 patients between 18 to 80 years were selected who were satisfying the inclusion criteria. Results: Females were more aware about removable prosthesis (41.86%) and dental implants (11.99%). Patients with primary level of education were more aware about removable prosthesis (41.25 %). Patients with elementary occupation were least aware (46.61%) about different types of treatment modalities. Professionals had more knowledge about FPD (66.66%). Tendency of fixed teeth supported prosthesis and overall awareness were significantly higher among the patients with monthly income more than Rs.6000/-. Conclusion: Females were more aware about different prosthetic treatment options. Patients with higher education and income were more aware about fixed prosthetic treatment. Patients who were in service and skilled workers were almost equally aware about removable and fixed prosthesis treatment.

CLINICAL STUDY OF CHRONIC FISSURE-IN-ANO AND COMPARATIVE STUDY OF DIFFERENTMODALITIESOF ITS TREATMENT IN NMCH&RC

Anal fissure is a most common painful condition whichcauses considerable morbidity and affects the patients quality of life to a greater extent. The majority of acute anal fissures heal spontaneously. However, some of the acute anal fissures do not resolve but become chronic. Thiswarrantsprompttreatmentof the condition with appropriatemethods.Selecting a better method of treating this condition that can achieve optimal clinical results and getting the least pain and inconvenience to the patient has always posed a challenge to the surgeons. This has led to the innovation of a number of surgical and pharmacological methods that relaxes the anal sphincter. Aimof The Study:To study the different clinical presentations and etiological factors of the fissure in ano& different modalities of treatment of fissure in ano i.e., application of 2% Diltiazem ointment, Lords Anal Dilatation and Subcutaneous Lateral Internal Sphincterotomy. &to evaluate the efficacy Subcutaneous Lateral Internal Sphincterotomyas a treatment modality in the management of chronic anal fissure in comparison with application of 2% Diltiazem ointment & with Lords Anal Dilatation. Materials & Methods: The material for the study was taken from the cases attending thesurgery OPD and admitted In-patients of all the units of the Department of General Surgery, Navodaya Medical College Hospital & Research Centre,whowerediagnosed to haveChronicanal fissure. This study was a prospective study which included 90 patients presenting with chronic anal fissure over a period of 18 months from November 2019 to May 2021.Thesepatientswererandomly selectedandclassifiedintothree groups(A,B,C) eachconsistingof30 patients & each group with one type of treatment modality, like group A for 2% diltiazem, B for lords anal dilatation & C for LIS. Follow-up of the patients was done by history and per-rectalexamination to assess the efficacy of the treatment and the complications like pain,bleeding,sphincter spasm, dischargeperanum and incontinence. Results :This study showed the results in favour of Lateral Internal Sphincterotomywith a healing rate of 100% with faster pain-relief and minimal or no complications ifperformedbythehands of an experienced surgeon, whereas latency in the clearance of symptoms and lesions was seen with 2% Diltiazem and Lords Anal Dilatation with adverse effects as well. With the healingrate of 100% of Fissure-in-ano in LIS therapy group, 81% in Lords Anal Dilatation and 71% with topical 2% Diltiazem therapy, & adverse effects or complications being maximum in 2% Diltiazem therapy group, 13 patients (46%) when compared to Lords Anal Dilatation (41% , 11 patients) and LIS group (32%, 09 patients), weconcludethatLateralinternalsphinterotomy(LIS) appearstobethebetterlineoftreatmentasthereis 100%healingrate, minimal complications and no recurrence.

CLINICAL STUDY OF CHRONIC FISSURE-IN-ANO AND COMPARATIVE STUDY OF DIFFERENTMODALITIESOF ITS TREATMENT IN NMCH&RC

Anal fissure is a most common painful condition whichcauses considerable morbidity and affects the patients quality of life to a greater extent. The majority of acute anal fissures heal spontaneously. However, some of the acute anal fissures do not resolve but become chronic. Thiswarrantsprompttreatmentof the condition with appropriatemethods.Selecting a better method of treating this condition that can achieve optimal clinical results and getting the least pain and inconvenience to the patient has always posed a challenge to the surgeons. This has led to the innovation of a number of surgical and pharmacological methods that relaxes the anal sphincter. AimofThe Study:To study the different clinical presentations and etiological factors of the fissure in ano& different modalities of treatment of fissure in ano i.e., application of 2% Diltiazem ointment, Lords Anal Dilatation and Subcutaneous Lateral Internal Sphincterotomy. &to evaluate the efficacy Subcutaneous Lateral Internal Sphincterotomyas a treatment modality in the management of chronic anal fissure in comparison with application of 2% Diltiazem ointment & with Lords Anal Dilatation. Materials & Methods: The material for the study was taken from the cases attending thesurgery OPD and admitted In-patients of all the units of the Department of General Surgery, Navodaya Medical College Hospital & Research Centre,whowerediagnosed to haveChronicanal fissure. This study was a prospective study which included 90 patients presenting with chronic anal fissure over a period of 18 months from November 2019 to May 2021.Thesepatientswererandomly selectedandclassifiedintothree groups(A,B,C) eachconsistingof30 patients & each group with one type of treatment modality, like group A for 2% diltiazem, B for lords anal dilatation & C for LIS. Follow-up of the patients was done by history and per-rectalexamination to assess the efficacy of the treatment and the complications like pain,bleeding,sphincter spasm, dischargeperanum and incontinence. Results :This study showed the results in favour of Lateral Internal Sphincterotomywith a healing rate of 100% with faster pain-relief and minimal or no complications ifperformedbythehands of an experienced surgeon, whereas latency in the clearance of symptoms and lesions was seen with 2% Diltiazem and Lords Anal Dilatation with adverse effects as well. With the healingrate of 100% of Fissure-in-ano in LIS therapy group, 81% in Lords Anal Dilatation and 71% with topical 2% Diltiazem therapy, & adverse effects or complications being maximum in 2% Diltiazem therapy group, 13 patients (46%) when compared to Lords Anal Dilatation (41% , 11 patients) and LIS group (32%, 09 patients), weconcludethatLateralinternalsphinterotomy(LIS) appearstobethebetterlineoftreatmentasthereis 100%healingrate, minimal complications and no recurrence.

The Comparison of Electroacoustic and Subjective Voice Quality in Type 3 and 4 Transoral Laser Cordectomy for Early-Stage Glottic Carcinoma.

One of the main issues in early-stage glottic carcinoma management is the voice quality following different types of treatment modalities. In type 3 and 4 transoral laser cordectomies, the voice outcomes can show significant differences due to the extent of the vocal muscle resection. This study aims to compare the voice quality in patients who underwent type 3 and 4 laser cordectomy for early-stage glottic carcinoma. A total of 30 patients who underwent type 3 (15 patients) and type 4 (15 patients) laser cordectomy for T1a glottic carcinoma between May 2018 and 2020 were included in this retrospective comparative study. Electroacoustic voice analysis and Voice Handicap Index-10 were performed in the postoperative twelfth month and the outcomes were compared between two laser cordectomy groups. The mean age of all patients was 48.6 ± 4.2 years. Noise-to-harmonic ratio, jitter, shimmer, pitch perturbation quotient and amplitude perturbation quotient values were significantly different between two groups (p < 0.05). Fundamental frequency and Voice Handicap Index-10 scores showed no statistically significant difference (p > 0.05). This study reports significantly better results for type 3 against type 4 laser cordectomy by means of objective voice analysis outcomes, except fundamental frequency. On the other hand, self-reported subjective analysis showed very similar results for both groups. Further studies combining data with multiple objective and subjective analyses with larger patient series and longer follow-up are warranted.

Health-related quality of life among breast cancer patients in India.

This study evaluated the health-related quality of life (HRQoL) among breast cancer patients during various phases of treatment and with different treatment modalities, which helps in monitoring treatment outcomes, assessing the well-being of patients, and conducting health technology assessments. A total of 534 interviews were conducted among the patients of breast cancer recruited at different stages of disease and with different treatment modalities. HRQoL was determined using EuroQoL five dimensions questionnaire with five levels (EQ-5D-5L), EuroQoL Visual Analogue Scale (EQ VAS), and the EORTC QLQ-BR23 instrument. The utility values were determined based on the Indian EQ-5D-5L value set. The socio-demographic and clinico-therapeutic determinants of HRQoL were evaluated using multiple linear regression. The mean utility value of breast cancer patients was 0.602 (SD = 0.311) and mean EQ VAS score was 75 (SD = 12.3). The mean utility value at diagnosis was 0.628, whereas utility value was 0.55, 0.595, and 0.64 for post-surgery, post-chemotherapy, and post-radiotherapy treatment groups, respectively. The most frequently reported problem was pain/discomfort (in 84.3% patients), followed by anxiety/depression (83.5%). On EORTC QLQ-BR23, the maximum symptom scale scores for systemic therapy side effects were reported in the post chemotherapy group. The body image score and future perspective score were better in patients undergoing breast conservative surgery (BCS) compared to patients undergoing modified radical mastectomy. Age, education, and employment status of the patient, type of treatment modality, and use of taxanes are the determinants of HRQoL in breast cancer patients. Clinical interventions should focus upon management of pain and anxiety. BCS should be offered to all eligible patients as it is associated with better HRQoL. Addressing the factors that independently affect the HRQoL will help in improving the treatment compliance and outcomes.

Endovascular and Medical Management of Cerebral Venous Thrombosis: A Systematic Review and Network Meta-Analysis

Management of cerebral venous thrombosis (CVT) involves minimizing expansion of the thrombus and promoting the recanalization of the venous sinus. While current guidelines include indications of endovascular management and anticoagulation with heparin and warfarin, the use of direct-acting oral anticoagulants (DOACs) has increased. In this study, we aim to conduct a network meta-analysis comparing these 3 therapeutic options: standard anticoagulation, DOACs, and endovascular treatments (EVTs). Seventeen of 2265 studies identified from 4 publication databases met inclusion criteria for this network meta-analysis. Outcomes analyzed included modified Rankin Scale score, complications, mortality, and 6-month recanalization rates using a frequentist network meta-analysis approach. For each outcome, the preferential order of each intervention was ranked hierarchically based on P-score calculations used for frequentist network meta-analyses. Modified Rankin Scale outcomes were not significantly different based on the type of treatment modality (i.e., standard anticoagulation, DOACs, or EVT). Evaluation of complications demonstrated that patients treated with EVT were significantly more likely to experience a worse outcome than individuals treated with standard anticoagulation (odds ratio [OR]=1.83, P=0.04). Other comparisons did not demonstrate a significant difference in adverse events. For all-cause mortality outcomes, EVT demonstrated significantly greater odds of mortality than standard anticoagulation (OR=1.89, P=0.02). Mortality between DOACs and standard anticoagulation was not significantly different. When comparing 6-month recanalization rates, DOACs and EVT were significantly more effective than standard anticoagulation (OR=1.93, OR=2.2, P < 0.05). EVT followed by DOACs was preferred over standard anticoagulation for 6-month recanalization rates. This network meta-analysis evaluates the outcomes in CVT treatment, comparing standard anticoagulation, DOACs, and EVT, with evidence that DOACs have similar outcomes to standard anticoagulation in the treatment of CVT. EVT resulted in an increased risk of overall mortality but improved 6-month recanalization rates.

Gender-Specific Care for Women in Psychiatric Units.

Structural inequalities in health care often result in female patients' not receiving care tailored to their needs. Women with mental illness in the peripartum period are no exception. Caan and colleagues delve into the benefits of breastfeeding in psychiatric units, highlighting the scarcity of appropriate resources due to the lack of mother-baby units in the United States. They also offer practical solutions and a legal analysis to address this problem. This commentary aims to broaden the scope of the article and emphasize how psychiatric care in the United States needs to address much more than lactation to provide gender-specific care. Elements of care to consider include types of treatment modalities offered, perinatal psychotropic choices, access to co-hospitalization options, lactation resources, and posthospitalization support. Pursuing a holistic and multi-disciplinary approach will allow psychiatric facilities in the United States to provide gender-appropriate care that will not only benefit women with mental health needs in the peripartum period, but also their infants and families as a whole.

PERIAPICAL LESIONS: CURRENT MODALITIES

In cases with periapical lesions, there are two types of treatment modalities: noninvasive and invasive. The first one noninvasive is also known as nonsurgical or endodontic treatment. The second one – invasive method is surgical approach. In some cases, there is a need for combination of both aproaches. In everydays clinical treatment, the first choice is less invasive method and has better outcomes. Treatment of some periapical lesions (like cysts) are a theme of discussion and we do not have best option to treat them. The patient should make the definitive decision about the treatment. The doctor should inform him about the advantages and disadvantages of endodontic-noninvasive and surgical-invasive procedure. The therapeutic modalities for these pathologies are a wide range of treatment from endodontic treatment to different surgical options. We like to find out and present the best way about healing the periapical lesion. We wanted to know whenever surgical or non-surgical approach is better, and if using them might improve healing of those pathologies. The aim was clear and to reach it, we make an electronic search of medical and dental literature. We searched the following electronic databases: PubMed and Embase Ovid. Inclusion and exclusion criteria were used to reach the aim of this review study. We place restriction about language (only those articles that are written on English) and publication date (articles that are not older than 2010 year). We excluded duplicate article. We searched the references of the studies that we included for those review. We searched by hand the reference list of the studies and journals in the fields of endodontics and oral surgery. Every periapical lesion should firstly begin with good performed endodontic treatment. In some cases, there is a need for surgical approach of periapical pathologies because the endodontic treatment is not successful. Some cases might fail because of multipurpose factors such as: foreign body reaction, the size of the periapical lesion, biofilm, oral health and oral hygiene. A surgical approach is an option in cases when periapical lesion is large. Marsupialization might be the adequate option of treatment for those lesions in some cases. In cases with postoperative periapical lesion there is a need for surgical retrograde treatment. The procedure can be performed with hand endodontic instruments to make mechanical treatment of the root canal especially the part that is untreated. The advantages, disadvantages and modalities of treatment of periapical lesions are discussed in this review. According to these review there is no evidence that the first approach leads to better results compared to the second approach. This conclusion is based on electronic research of the literature database and clinical trials. There are several options for treatment to eliminate the clinical problems of periapical lesions but furder research is necessary. This review article is about the benefits of both approaches, and to determinate the best treatment modalities of cases with periapical pathologies, healing and postoperative quality of dental life.

Elevation of depressed (pond) fracture in infant using a vacuum-assisted device: Technical note

Abstract Introduction: Pond fracture also called ping-pong fracture in children is caused due to direct impact on the skull. It is rare and many types of treatment modalities have been described. In this report, we describe a makeshift vacuum-assisted device to elevate the fracture, which is both cost-effective and efficient. Case presentation: A 5-month-old infant was brought to the emergency department with a history of fall of heavy object on the head resulting in pond fracture over the left parietal area and an episode of focal motor seizures. After ruling out an intracranial injury with a computer tomogram, we elevated the depressed fracture by a makeshift vacuum suction device using a plastic funnel connected to vacuum chamber. Post-procedure child had one episode of focal seizure and was discharged after a brief period of observation. Conclusion: Plastic funnel vacuum suction can be effectively used to elevate the Pond fractures in infants with appropriate precautions.

Cervical cancer in the era of precision medicine: A perspective from developing countries

Cervical cancer (CC) constitutes about 70%–80% of squamous cell carcinoma and 10%–15% of adenocarcinoma. In about 90% of CC cases the Human papillomavirus (HPV) infection appears to be the main culprit. Other risk factors include smoking, compromised immune system, birth control pills, starting sex at a young age, and having many sexual partners. It is also important to note that CC is one among the few completely preventable cancers. It can be reverted or completely cured if detected in early stages or prevented by healthy lifestyle habits, safe sex, regular screening, and vaccination. It is worth mentioning that, with recent advances in medicine, early detection is now possible by affordable, self-sampling and simple procedures and have significantly reduced the mortality rate, however the rate of incidences has not decreased significantly, especially in older women. Commitments and initiatives by governmental and non-governmental entities through screening and vaccinations for CC are nearly reaching to total protection of girls and women. By raising the awareness on early detection and treatment of CC we can not only eliminate cervical cancer but also ensure reproductive health of the women. Hence, the present review is focused to build the awareness regarding CC by presenting an update of the latest medicinal advancements; building the basics of CC such as its causes, types of treatment modalities, advanced treatment modes, opportunities for prevention, latest technology including clinical trials and financial scenario for the treatment of this deadly disease.

Evaluation of Malnutrition and Quality of Life in Patients Treated for Oral and Oropharyngeal Cancer.

Background Oral and oropharyngeal cancer is a debilitating disease with high morbidity and mortality. Depending on the site and extent of the involvement of the cancer and the type of treatment modality, these patients can develop pain, trismus, xerostomia, dysphagia, and taste disturbances, compromising them socially and nutritionally. The aim of the study was to evaluate malnutrition and quality of life in patients treated for oral and oropharyngeal cancer. Methodology. A cross-sectional study was conducted which included 97 patients treated for oral and oropharyngeal cancer. The quality of life of the selected patients was assessed by using a validated European Organization for the Research and Treatment of Cancer's Quality of Life Questionnaire, Head and Neck and Mandibular Function Impairment Questionnaire. Pre- and posttreatment weight of the patients were assessed, and weight loss of ≥10% of pretreatment weight was considered as malnutrition. The chi-square test was used to correlate the symptoms with the quality of life. A paired t test was used to assess the differences in weight before and after treatment, and a p value of <0.005 was considered as significant. Results The most commonly reported symptoms were xerostomia (93.81%), pain (81.44%), and dysphagia (76.3%). A total of 40.2% of the individuals in the study had malnutrition. Malnutrition was comparatively lower in the group who had nutritional supplements. Conclusion The quality of life in patients treated for oral and oropharyngeal cancer deteriorates immediately after the treatment; however, it significantly improves over time.

Post-Treatment Adverse Health Correlates among Prostate Cancer Survivors in a Sample of Men Residing in Atlantic Canada.

Background: Recent large population-based studies have shed light on an association between prostate cancer (PCa) survivorship and mental health, which emerged when the comparison group was either men without a history of cancer or those with any other type of cancer except prostate. Here we examine the role of surgery alone, compared to other types of treatment modalities in this association in a population-based sample of men with prostate or other types of cancer. Methods: A cross-sectional analysis was conducted on a subsample of 632 male participants aged 36–69 from the 2009–2015 survey cycle of the Atlantic PATH cohort study. The primary outcomes were the presence of mild, moderate or severe depression or anxiety indicators and were assessed using the seven-item generalized anxiety disorder (GAD-7) scale and the nine-item Patient Health Questionnaire (PHQ-9), respectively. The presence of a lifetime history of PCa or other form of cancer (except PCa) was the main predictor variable and was assessed in cancer treatment modality (surgery or other types of treatment modalities) stratified analyses. Covariates included age, marital status, household income, comorbidity, and survivorship time. Results: The presence of depression in this sample was prevalent among 17.7% of men, and of anxiety among 9.3% of men. Survivors who were treated with surgery for their PCa diagnosis had 7.55 statistically significantly higher odds of screening positive for current depression symptoms compared with those of other forms of cancer in controlled analyses. These differences were not observed for anxiety. Conclusions: These findings emphasize the need for multidisciplinary survivorship care plans among PCa patients, especially those who undergo surgery. Targeted programming aimed at prioritizing and delivering comprehensive mental health support to PCa survivors early in the survivorship journey is justified.

Abstract 1063: Effectiveness of Tumor Treating Fields (TTFields) in combination with sorafenib for treatment of hepatocellular carcinoma in vitro and in vivo

Abstract Purpose/Objective(s): Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer and it is one of the leading causes of related mortality worldwide. Sorafenib is an oral multikinase inhibitor that targets the Raf/MEK/ERK signaling pathway, thus inducing autophagy and blocking angiogenesis. Sorafenib is approved for advanced HCC and is the main first-line chemotherapy, yet its survival benefits are limited. Tumor Treating Fields (TTFields) therapy is an anticancer treatment that is non-invasively and locoregionally delivered to tumor bed via low intensity (1-3 V/cm), intermediate frequency (100-500 kHz), alternating electric fields. Since HCC is a complex, heterogeneous tumor with exhibited aberrant signaling pathways, sorafenib combined with additional chemotherapy agents and other types of treatment modalities, such as TTFields, may be a feasible option for targeting HCC. The purpose of this study was to explore the use of TTFields, alone and in combination with sorafenib, for HCC treatment. Materials/Methods: HCC cell lines (HepG2 and Huh-7D12) were treated for 72 hours with TTFields at various frequencies. Efficacy of TTFields and sorafenib combination was tested by applying optimal frequency TTFields in the presence of various concentrations of sorafenib. Cytotoxicity, apoptosis, and clonogenicity were determined, and overall effect was calculated as the product of the cytotoxic and clonogenic effects. Changes in autophagy levels were also examined. In vivo, N1S1 HCC cells (50,000) were orthotopically injected into the left hepatic lobe of SD rats. After 1 week, TTFields at the optimal frequency were continuously applied for 6 days to the abdominal region of rat torsos, and sorafenib (10 mg/kg/day) was injected daily. Tumor volume growth was determined by MRI. Results: The TTFields frequency assessed for optimally treating HCC cell lines was 150 kHz. Cells were sensitive to sorafenib in a dose-dependent manner, and concomitant addition of TTFields augmented this effect. The effect of TTFields, like that of sorafenib, was demonstrated to be related to increases in autophagic flux. In the animal model, tumor growth was significantly reduced in the combination group compared to other treatment groups. Conclusion: These results demonstrate that TTFields are effective for the treatment of HCC and may further enhance effectiveness in combination with standard of care chemotherapy. The ongoing phase 2 HEPANOVA (NCT03606590) clinical trial will investigate the safety and efficacy of TTFields plus sorafenib combination in patients with unresectable, locally advanced HCC. Citation Format: Shiri Davidi, Anna Shteingauz, Sara Jacobovitch, Karnit Gotlib, Catherine Tempel-Brami, Mijal Munster, Einav Zeevi, Eyal Dor-On, Rosa S. Schneiderman, Tali Voloshin, Adi Haber, Moshe Giladi, Adrian Kinzel, Uri Weinberg, Yoram Palti. Effectiveness of Tumor Treating Fields (TTFields) in combination with sorafenib for treatment of hepatocellular carcinoma in vitro and in vivo [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 1063.

Safety and Efficacy of Convalescent Plasma Therapy for the Management of COVID-19: A Systematic Review

Introduction: Till date, no proven therapy exists for coronavirus disease (COVID-19), though different types of treatment modalities are being practiced around the world. Different studies regarding Convalescent Plasma (CP) therapy from COVID-19 recovered donors have shown favorable results with fewer adverse consequences. In this systematic review, we aimed to determine the safety and efficacy of CP as a therapy for COVID-19. Methods and Materials: The English language databases of PubMed, Google Scholar, and ScienceDirect were searched up to 22 May 2020. Eligibility for inclusion, risk of bias assessment, and data extraction from the included studies were determined and a narrative synthesis was conducted. Results: A total of 12 studies were selected for review. The overall risks of bias were moderate to high. The results revealed significance in the initiation of CP therapy during the early stages of viremia from a safety and efficacy viewpoint. The patients also received concomitant drugs and other supportive therapies in most cases. Some cases of mortality were reported in 3 studies. Viral loads were documented to decrease and become negative in 8 studies within 3-26 days post-transfusion. The improvement in clinical symptoms following CP therapy was demonstrated in 9 studies. Most of the patients experienced very few adverse effects. Conclusions: The rational practice of CP therapy based on a risk-benefit judgment can prove to be an efficacious therapeutic option as a last resort until the approval of any therapeutic and/or prophylactic agent(s). The substantial randomized controlled trials (RCTs) are necessary to validate the effectiveness of such therapy.

The Impact of IDH1 Mutation and MGMT Promoter Methylation on Recurrence-Free Interval in Glioblastoma Patients Treated With Radiotherapy and Chemotherapeutic Agents.

The aim of this study is to investigate the relationship between isocitrate dehydrogenase-1 (IDH1) mutation and O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation with recurrence-free interval in glioblastoma patients treated with chemoradiotherapies. Clinical data were collected from 82 patients with totally resected glioblastoma and treated with adjuvant therapies from 2014 to 2019. IDH1 mutation was assessed by immunohistochemistry and MGMT promoter methylation was assessed by different sequencing methods. IDH1 mutation was present in 32 cases and 50 cases were IDH1 wildtype; 54 and 28 patients had unmethylated and methylated MGMT promoter, respectively, Of the 82 patients, 62 patients received chemoradiotherapy while 20 patients only received radiation. Approximately, 61% of patients had a tumor recurrence after 1 year, and 39% showed a recurrence before 1 year of treatment. There was no significant relationship between IDH1 mutation and MGMT promoter methylation (p-value = 0.972). Patients with IDH1 mutation and their age <50 years showed a significant difference in recurrence-free interval (p-value = 0.014). Difference in recurrence-free interval was also statistically observed in patients with unmethylated MGMT promoter and treated with chemoradiotherapies (p-value = 0.031), by which they showed a late tumor recurrence (p-value = 0.016). This revealed that IDH1 mutation and MGMT methylation are independent prognostic factors in glioblastoma. Although IDH1-mutant glioblastomas showed late tumor recurrence in patients less than 50 years old, the type of treatment modalities may not show additional beneficial outcome. Patients with unmethylated MGMT and IDH1 mutation, treated with different chemoradiotherapies, showed a late tumor recurrence.

Locoregional Combined With Systemic Therapies for Advanced Hepatocellular Carcinoma: An Inevitable Trend of Rapid Development.

Despite the application of antiviral drugs and improved surveillance tools, the number of patients diagnosed with hepatocellular carcinoma (HCC) at an advanced stage and with a dismal prognosis is still on the rise. Systemic treatment with multiple multitargeted tyrosine kinase inhibitors (TKIs), such as sorafenib, has been a widely utilized approach for a decade. In addition, the use of a combination of TKIs with other types of compounds, including immune checkpoint inhibitors (ICIs) and antiangiogenic inhibitors, has shown efficacy in treating advanced HCC. However, the presence of intolerable adverse events, low disease response and control rates, and relative short overall survival of such combinatory therapies makes novel or optimized therapies for advance HCC urgently needed. Locoregional therapy (transarterial chemoembolization, and thermal ablation) can destroy primary tumors and decrease tumor burden and is widely used for HCC management. This type of treatment modality can result in local hypoxia and increased vascular permeability, inducing immunogenic effects by releasing tumor antigens from dying cancer cells and producing damage-associated molecular patterns that facilitate antiangiogenic therapy and antitumor immunity. The combination of systemic and locoregional therapies may further produce synergistic effects without overlapping toxicity that can improve prognoses for advanced HCC. In preliminary studies, several combinations of therapeutic modes exhibited promising levels of safety, feasibility, and antitumor effects in a clinical setting and have, thus, garnered much attention. This review aims to provide a comprehensive, up-to-date overview of the underlying mechanisms of combined systemic and locoregional therapies in the treatment of advanced HCC, commenting on both their current status and future direction.

Abstract PO-033: Papaverine derivative smv-32 alleviates tumor hypoxia and radiosensitizes tumors by inhibiting mitochondrial metabolism

Abstract Radiation therapy is a standard type of treatment modality used to achieve local control in more than 50% of all cancer patients. However, tumor hypoxia reduces the effectiveness of radiation therapy by limiting the biologically effective dose. We identified that FDA-approved phosphodiesterase 10A (PDE10A) inhibitor papaverine (PPV) has an off-target effect inhibiting mitochondrial oxygen consumption (OCR) leading to acute reduction of tumor hypoxia and significant radiosensitization of model tumors. Our data suggests that PDE10A does not contribute to the radiosensitizing effect. Based on PPV’s structure, we used biomedicinal chemistry approach to engineer its novel derivative SMV-32 with reduced PDE10A inhibition. We used Seahorse metabolic flux analyzer to determine the effect of PPV and SMV-32 on mitochondrial OCR in vitro. Near-infrared optical spectroscopy and pODD-luciferase in vivo reporter system was used for pharmacodynamics analyses and dose response evaluation. Local radiation therapy was delivered using Small Animal Radiation Research Platform (SARRP). We compared intraperitoneal (IP) and intravenous (IV) delivery and optimized dosing using pODD luciferase reporter system. SMV-32 showed superior OCR inhibition in vitro and enhanced hypoxia reduction in vivo compared to PPV. A single clinically relevant dose of PPV or SMV-32 significantly reduced the hypoxic fractions of heterotopic and orthotopic tumors in mice and sensitized the tumors to radiation therapy. PPV and SMV-32 appear to be ideal candidates for clinical radiosensitization. PPV is already in phase I clinical trial for treatment of non-small cell lung cancer combined with stereotactic body radiation therapy. Citation Format: Martin Benej, Jinghai Wu, McKenzie Kreamer, Sandip Vibhute, Ioanna Papandreou, Nicholas C. Denko. Papaverine derivative smv-32 alleviates tumor hypoxia and radiosensitizes tumors by inhibiting mitochondrial metabolism [abstract]. In: Proceedings of the AACR Virtual Special Conference on Radiation Science and Medicine; 2021 Mar 2-3. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(8_Suppl):Abstract nr PO-033.

Factors that Affecting the Skin Necrotic due to Extravasation Injury and Modality Theraphy at Pediatric Inpatient Ward dr. Soetomo Hospital Surabaya (Januari - Desember 2019)

Background: Extravasation injury is the most common complication of intravenous therapy in children. Research in the NICU at UK, found extravasation injury caused skin necrotic 38/1000 neonates, 70% of preterm neonates. Extravasation injuries and their sequels can be more serious morbidity than the underlying disease, potentially for amputation. The research objective was to determine the factors that influence the incidence of skin necrotic due to extravasation injury and the types of treatment modalities in the pediatric hospital Dr. Soetomo Hospital Surabaya for the period January - September 2019.Methods: This research is descriptive analytic with cross sectional approach with collected data from medical records. The medical records of 44 pediatric patients undergoing treatment at the pediatric inpatient ward of Dr. Soetomo Hospital Surabaya with skin necrotic due to extravasation injury which was brought to the Reconstructive and Aesthetic Plastic Surgery Dr. Soetomo Hospital Surabaya for the January - December 2019 period was reviewed retrospectively. We analyzed patient characteristics, risk factors, types of wound care therapy modalities, and case outcomes.Results: There were 44 cases of skin necrotic injury due to extravasation injury, with the largest percentage of neonates group (34%), male gender (66%), hypertonic fluids / drugs (73%), most regions of dorsum and wrist dextra (17%) and the most used therapeutic modality was autolytic debridement (45%).Conclusions: From this study, several conclusions can be drawn regarding the prevalence of skin necrotic due to extravasation injury, there was a relationship between the incidence of skin necrotic injury due to extravasation injury with age, types of fluid/drug given, and the location of the peripheral venous line, whereas the incidence was not related to gender. The initial treatment modality that is still frequently used today is autolytic debridement.

Outcome of combined surgical and intralesional steroids injection therapy for management of ear keloid

Background: Ear keloid is one of the challenging problems that affect people of different races with substantial aesthetic outcomes. Various types of treatment modalities, including intralesional corticosteroid injection are advocated to lower recurrence following excision.&#x0D; Objectives: To investigate the efficacy of a combined excision and postoperative intralesional triamcinolone acetonide (TA) injection for treating ear keloid patients.&#x0D; Methodology: This was a descriptive study done to observe the outcome of combined approach of surgical and intra-lesional steroids injection therapy for ear keloids. Age, sex, site, size, duration, recurrence, and aesthetic outcome were evaluated.&#x0D; Results: A total of 18 patients representing 19 ear keloids, with one case having bilateral and 3 pediatric cases were included from February 2018 to January 2019.The mean age was 22 years with female to male ratio of 5:1, site were left sided 9 (50%), right 8 (44%) and 1(6%) bilateral. About 10 (53%) cases were at helix, and 9(47%) at ear lobule. Mean length of ear keloid was 1.53 cm with range of 0.5-3cm and mean breath 1.39cm with the range of 0.5-2.5 cm. The mean duration of ear keloid was 9.47 months. 2 (11%) cases showed a history of recurrence. Injection triamcinolone acetonide hypersensitivity was noted by 1 (5.3%) patient. Evaluation for all patients with aesthetic outcome was mean ± standard deviation (4.38±1.025).&#x0D; Conclusion: Management of ear keloid using the combination of surgical excision and intra-lesional steroids injection therapy can be a good alternative option with low recurrence rate.

Cost-effectiveness of pain management services for chronic low back pain: a systematic review of published studies

BackgroundChronic low back pain (CLBP) is a highly prevalent condition that has substantial impact on patients, the healthcare system and society. Pain management services (PMS), which aim to address the complex nature of back pain, are recommended in clinical practice guidelines to manage CLBP. Although the effectiveness of such services has been widely investigated in relation to CLBP, the quality of evidence underpinning the use of these services remains moderate. Therefore the aim is to summarize and critically appraise the current evidence for the cost effectiveness of pain management services for managing chronic back pain.MethodsElectronic searches were conducted in MEDLINE, EMBASE and PsycINFO from their inception to February 2019. Full economic evaluations undertaken from any perspective conducted alongside randomized clinical trials (RCTs) or based on decision analysis models were included. Cochrane Back Review Group (CBRG) risk assessment and the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist were used to assess the methodological quality of eligible studies.ResultsFive studies fulfilled eligibility criteria. The interventions varied significantly between studies in terms of the number and types of treatment modalities, intensity and the duration of the program. Interventions were compared with either standard care, which varied according to the country and the setting; or to surgical interventions. Three studies showed that pain management services are cost effective, while two studies showed that these services are not cost effective.In this review, three out of five studies had a high risk of bias based on the design of the randomised controlled trials (RCTs). In addition, there were limitations in the statistical and sensitivity analyses in the economic evaluations. Therefore, the results from these studies need to be interpreted with caution.ConclusionPain management services may be cost effective for the management of low back pain. However, this systematic review highlights the variability of evidence supporting pain management services for patients with back pain. This is due to the quality of the published studies and the variability of the setting, interventions, comparators and outcomes.