A case of melanoma of the mandibular gingiva with long-term survival: Effect of nivolumab therapy and immuno-radiotherapy for cervical recurrence and nasal metastasis

alexandrossfakianakis shared this article with you from Inoreader A case of melanoma of the mandibular gingiva with long-term survival: Effect of nivolumab therapy and immuno-radiotherapy for cervical recurrence and nasal metastasis Via ScienceDirect Publication: Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology Publication date: Available online 29 April 2022 Source: Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology Author(s): Takehiro Kitabatake, Chihiro Kanno, Tetsuharu Kaneko, Manabu Endo, Morio Yamazaki, Sadanoshin Yaginuma, Tetsuo Akimoto, Hiroshi Hasegawa View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A novel smartphone‐based intervention targeting sleep difficulties in individuals experiencing psychosis: A feasibility and acceptability evaluation

alexandrossfakianakis shared this article with you from Inoreader A novel smartphone‐based intervention targeting sleep difficulties in individuals experiencing psychosis: A feasibility and acceptability evaluation Via Psychology and Psychotherapy: Theory, Research and Practice Abstract Objectives Cognitive Behavioural Therapy (CBT) is an effective psychological intervention for sleep difficulties and has been used successfully in individuals with psychosis. However, access is restricted due to lack of resources and staff training. Delivering CBT for sleep problems using smartphone technology may facilitate wider access. This study aimed to evaluate the feasibility, acceptability and potential usefulness of a guided, smartphone-based CBT intervention targeting sleep disturbance for individuals with psychosis. Design Participants with psychosis spectrum diagnoses were recruited to a single-arm, uncontrolled study and engaged with the seven-module programme via smartphone app for six weeks with therapist support. Method Feasibility was assessed by rates of referral, recruitment and completion. Acceptability was assessed by app usage, a satisfaction questionnaire and qualitative analysis of participants' semi-structured interview. Pre- and post-intervention assessment of sleep, psychotic experiences, mood, well-being and functioning was conducted. Mean change confidence intervals were calculated and reported as an indication of usefulness. Results Fourteen individuals consented to participation, and eleven completed the post-intervention assessment. On average, each participant engaged with 5.6 of 7 available modules. Qualitative feedback indicated the intervention was considered helpful and would be recommended to others. Suggested improvements to app design were provided by participants. Potential treatment benefits were observed for sleep difficulties, and all outcomes considered, except frequency of hallucinatory experiences. Conclusions It is feasible and acceptable to deliver therapist-guided CBT for sleep problems by smartphone app for individuals with psychosis. This method provides a low-intensity, accessible intervention, which could be offered more routinely. Further research to determine treatment efficacy is warranted. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Medicine, Religion, and the Humanitarian Ethos:

alexandrossfakianakis shared this article with you from Inoreader Medicine, Religion, and the Humanitarian Ethos: Walter B. Cannon, Unitarianism, and the Care of Spanish Republican Refugees in France Via Journal of the History of Medicine and Allied Sciences - current issue Abstract Biographies of Walter B. Cannon (1871-1945) usually present two sides of his life: one, where he was an outstanding man of science in the United States during the so-called "Golden Age of Medicine," and the other, where he was a leading humanitarian activist engaged in myriad causes, notably in the defense of Spanish democracy during the Civil War (1936-1939). However, these biographies fail to take into account that the apparent link between these two sides of his life was his religious conviction.This study summarizes the aims and accomplishments of the American Medical Bureau to Aid the Spanish Democracy (AMBASD) of which Cannon was chair between 1937 and 1939. Then, it examines Cannon's inspirational role on the international relief work with Spanish Republican refugees in France, through the case of the Varsovie Hospital of Toulouse that between 1945 and 1949 was jointly managed by the Unitarian Service Committee (USC) and the Joint An ti-Fascist Refugee Committee (JAFRC), and renamed Varsovie Hospital/Walter B. Cannon Memorial in recognition of the Spanish Republicans' debt for his extraordinary contribution during the Spanish Civil War and beyond. Finally, the article investigates the Unitarian roots of Cannon's humanitarian ethos by exploring the historical relations of this religious movement with science and with many major actors at Harvard University as well as the links of Cannon's relatives to Unitarianism.The analysis reveals Unitarianism's influence on Cannon's views about science, democracy, and liberty, as well as on his remarkable involvement in the medical solidarity movement with the Second Spanish Republic and other similar commitments. In sum, it shows how important is to branch out in our studies of medical and scientific practice to include practitioners' broader social and religious communities in order to understand their motivations, achievements, and behavior. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Simulation CT-based radiomics for prediction of response after neoadjuvant chemo-radiotherapy in patients with locally advanced rectal cancer

alexandrossfakianakis shared this article with you from Inoreader Simulation CT-based radiomics for prediction of response after neoadjuvant chemo-radiotherapy in patients with locally advanced rectal cancer Via Radiation Oncology - Latest Articles To report on the discriminative ability of a simulation Computed Tomography (CT)-based radiomics signature for predicting response to treatment in patients undergoing neoadjuvant chemo-radiation for locally ad... View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Rivaroxaban population pharmacokinetic and pharmacodynamic modeling

alexandrossfakianakis shared this article with you from Inoreader Rivaroxaban population pharmacokinetic and pharmacodynamic modeling in Iranian patients Via Journal of Clinical Pharmacy and Therapeutics A population pharmacokinetic/pharmacodynamic (PKPD) model of rivaroxaban was established in Iranian patients. The model consisted of a one-compartment pharmacokinetic model and a direct link linear equation that described the relationship of rivaroxaban concentration with both prothrombin and activated partial thromboplastin times. The selected model for anti-factor Xa activity consisted of a direct link inhibitory E max model with Hill coefficient. Significant differences were seen in the PKPD model parameters in Iranian patients compared to the values reported in other populations. Abstract What is Known and Objective Although predictable pharmacokinetic and pharmacodynamic of rivaroxaban allow fixed dosing regimens without routine coagulation monitoring, there is still the necessity to monitor and predict the effects of rivaroxaban in specific conditions and different populations. The current study was designed and conducted to analyze the rivaroxaban population pharmacokinetics in Iranian patients and establish a pharmacokinetic/pharmacodynamic model to predict the relationship between rivaroxaban concentration and its anticoagulant activity. Methods A sequential nonlinear mixed effect pharmacokinetic/pharmacodynamic modeling method was used to establish the relation between rivaroxaban concentration and anti-factor Xa activity, prothrombin time, and activated partial thromboplastin time (aPTT) as pharmacodynamic biomarkers in a population of sixty-nine Iranian patients under treatment with oral rivaroxaban. Rivaroxaban plasma concentration was quantified by a validated high-performance liquid chromatography-tandem mass spectrometry. Results and Discussion The typical population values (inter-individual variability%) of the oral volume of distribution and clearance for a one-compartment model were 61.2 L (21%) and 3.68 L·h−1 (61%), respectively. Creatinine clearance and Child-Turcotte-Pugh score were found to affect the clearance. A direct link linear structural model best fitted the data for both prothrombin time and aPTT. The baseline estimates of aPTT and prothrombin time in the population were 35.0 (15%) and 12.6 (2%) seconds, respectively. The slope of the relationship between apTT, prothrombin time, and rivaroxaban concentration was 0.033 (28%) and 0.018 (54%) s·ml·ng−1, respectively. The selected model for anti-factor Xa activity consisted of a direct link inhibitory E max model with Hill coefficient. The maximum level of inhibition (E max) was 4 IU·ml−1. The concentration of rivaroxaban producing 50% of the maximum inhibitory effect (EC50) was 180 (24%) ng·ml−1, and Hill coefficient (γ) was 1.44 (108%). No covariates showed a statistically significant effect on PT and activated partial thromboplastin time prolonging properties and anti-factor Xa activity. What is New and Conclusion Our results confirmed that pharmacokinetic/pharmacodynamic models similar to those of the other studies describe the relationship between the rivaroxaban concentration and its anticoagulant effect in Iranian patients. However, considerable differences were observed in the parameters of the pharmacodynamics–pharmacokinetic models with the results of other reports that can explain the unpredictable effects of rivaroxaban in some patients. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Pharmacokinetics, safety and efficacy of intra‐articular non‐steroidal anti‐inflammatory drug injections for the treatment of osteoarthritis: A narrative review

alexandrossfakianakis shared this article with you from Inoreader Pharmacokinetics, safety and efficacy of intra‐articular non‐steroidal anti‐inflammatory drug injections for the treatment of osteoarthritis: A narrative review Via Journal of Clinical Pharmacy and Therapeutics We provide a comprehensive review on intra-articular (IA) non-steroidal anti-inflammatory drug (NSAID) injections for the treatment of osteoarthritis (OA). We found that single doses of IA NSAIDs provided far less total systemic and synovial exposure compared to a one week course of oral NSAIDs, but maximum concentrations to the synovium with IA administration were much higher. Further, single IA NSAID injections appeared to be safe and efficacious compared to courses of oral NSAIDs or single IA corticosteroids in either small animals, large animals or humans. Further research must be conducted, however, IA NSAIDs could be used as an alternative or adjunct therapy to treat OA related pain, especially for patients that are high risk for corticosteroid related adverse effects. Abstract What is known and Objective Osteoarthritis (OA) is a common cause of joint disease and activity limitation in adults. Common therapies to treat OA-related pain are oral and topical non-steroidal anti-inflammatory drugs (NSAIDs) and intra-articular (IA) corticosteroids. However, prolonged courses of oral NSAIDs are associated with systemic adverse effects and repeat IA corticosteroid injections may cause cartilage degeneration. IA NSAIDs may be an alternative therapy possibly minimizing systemic side effects while maintaining efficacy. Therefore, we sought to summarize the pharmacokinetics, safety and efficacy of IA NSAIDs to help providers make a more informed decision on the use of IA NSAIDs. Methods We searched the National Library of Medicine Database with terms "intraarticular and nsaid", yielding 1032 results. Only traditional formulations of NSAIDs were considered for inclusion. Animal studies were included if animals were healthy or if the method of arthritis induction was a reasonable model of osteoarthritis. Human studies were included if humans were healthy or if the primary disease studied was osteoarthritis of a large joint. Of 1032 results, 31 research articles met the inclusion criteria and were summarized in this review. Results and Discussion We found that single doses of IA NSAIDs provided far less total systemic and synovial exposure compared to a one week course of oral NSAIDs, but maximum concentrations to the synovium with IA administration were much higher. IA NSAIDs had an excellent safety profile in small animals, large animals and humans, although these injections were associated with non-specific cartilage inflammation in healthy animals. In animal models, IA NSAIDs had similar efficacy to PO NSAIDs in treating OA-related pain. In humans, IA NSAIDs had similar efficacy to PO NSAIDS and IA corticosteroids in treating OA-related pain; however, many trials did not have a placebo control and outcome measures were heterogeneous. What is new and Conclusion Overall, single doses of IA NSAIDs appear safe and efficacious across animals and humans. The optimal use of IA NSAIDs is still to be determined and further research is needed. However IA NSAIDs may be an additional beneficial therapy to treat OA-related pain. Potential uses may be to augment IA corticosteroids injections, to interrupt multiple IA corticosteroid injections or as an alternative in patients that are high risk for corticosteroid-related adverse events. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A Precision Adjuvant Approach to Enhance SARS-CoV-2 Vaccines Optimized for Immunologically Distinct Vulnerable Populations

alexandrossfakianakis shared this article with you from Inoreader A Precision Adjuvant Approach to Enhance SARS-CoV-2 Vaccines Optimized for Immunologically Distinct Vulnerable Populations Via Clinical Infectious Diseases Advance Access Abstract The SARS-CoV-2 pandemic has caused significant mortality, especially among older adults whose distinct immune system reflects immunosenescence. Multiple SARS-CoV-2 vaccines have received emergency use authorization and or approval from the U.S. Food and Drug Administration, and throughout the world. However, their deployment has heighted significant limitations, such by age-dependent immunogenicity, requirements for multiple vaccine doses, refrigeration infrastructure that is not universally available, as well as waning immunity. Thus, there was, and continues to be a need for continued innovation during the pandemic given the desire for dose-sparing, formulations stable at more readily achievable temperatures, need for robust immunogenicity in vulnerable populations and development of safe and effective pediatric vaccines. In this context, optimal SARS-CoV-2 vaccines may ultimately rely on inclusion of adjuvants as they can potentially enhance p rotection of vulnerable populations and provide dose-sparing effects enabling single shot protection. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Lessons learned from proton vs photon radiation therapy for glioblastoma signal-finding trial

alexandrossfakianakis shared this article with you from Inoreader Lessons learned from proton vs photon radiation therapy for glioblastoma signal-finding trial Via Neuro-Oncology Current Issue We appreciate the astute comments of Drs Vogelius and Bentzen regarding the analyses reported in association with our phase II randomized trial of proton therapy (PT) vs intensity-modulated radiotherapy (IMRT) for patients with newly diagnosed glioblastoma (GBM).1 To address their question about the differences in the reported numbers, the abstract in 2017 reported the intention-to-treat (ITT) analysis of the available patients with completed follow-up whereas the final report presented updated ITT analyses as well as the important per-protocol analysis. The per-protocol analysis included a shift of 2 patients who were assigned to protons but received IMRT due to insurance denial for protons. This raises the learned challenges that were faced within this randomized trial comparing two radiation modalities that relied on insurance approvals eve n within the clinical trial context. We do summarize that although 90 patients consented, the analysis consisted of 67 patients because "the majority of patients were excluded before treatment began due to insurance denial of proton therapy" (p. 1340). There was a further loss of evaluable patients due to loss of follow-up, limiting the evaluable patients who completed neurocognitive function testing, our primary study endpoint. It is possible that further bias may have been introduced in the patients who chose to remain on study vs those who chose to no longer participate or were lost to follow-up. Due to these various competing factors that limited the evaluable patients as well as the primary goal of evaluating the cognitive effects of two treatments, we reported the per-protocol analysis in order to try and associate cognitive toxicity of the treatment received and its related brain dosimetry. When seeking to understand the differences particularly in treatment-related toxic ity between treatments in small phase II signal-finding trials, we argue that there is substantial value to ensuring you are comparing the clinical outcomes relative to delivered treatments, which requires an effective treatment analysis approach. Given the various lessons learned and challenges faced, we congratulate the forethought of the ongoing randomized proton trials that integrated more sophisticated randomization and trial designs to help address some of these challenges. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.