Simultaneously assessing intended and unintended treatment effects of multiple treatment options: a pragmatic “matrix design”

2011 ◽  
Vol 20 (7) ◽  
pp. 675-683 ◽  
Author(s):  
Jeremy A. Rassen ◽  
Daniel H. Solomon ◽  
Robert J. Glynn ◽  
Sebastian Schneeweiss
Keyword(s):  
Treatment Effects ◽  
Treatment Options ◽  
Multiple Treatment ◽  
Matrix Design

scholarly journals Update on the role of pembrolizumab in patients with unresectable or metastatic colorectal cancer

2021 ◽  
Vol 14 ◽  
pp. 175628482110244
Author(s):  
Vanessa Wookey ◽  
Axel Grothey
Keyword(s):  
Colorectal Cancer ◽  
Immune Checkpoint ◽  
Checkpoint Inhibitors ◽  
Treatment Options ◽  
Standard Of Care ◽  
Cancer Type ◽  
Cancer Therapies ◽  
Multiple Cancer ◽  
Multiple Treatment

Colorectal cancer (CRC) is the third most common cancer type in both men and women in the USA. Most patients with CRC are diagnosed as local or regional disease. However, the survival rate for those diagnosed with metastatic disease remains disappointing, despite multiple treatment options. Cancer therapies for patients with unresectable or metastatic CRC are increasingly being driven by particular biomarkers. The development of various immune checkpoint inhibitors has revolutionized cancer therapy over the last decade by harnessing the immune system in the treatment of cancer, and the role of immunotherapy continues to expand and evolve. Pembrolizumab is an anti-programmed cell death protein 1 immune checkpoint inhibitor and has become an essential part of the standard of care in the treatment regimens for multiple cancer types. This paper reviews the increasing evidence supporting and defining the role of pembrolizumab in the treatment of patients with unresectable or metastatic CRC.

scholarly journals Beyond the guidelines management of juvenile idiopathic arthritis: a case report of a girl with polyarticular disease refractory to multiple treatment options and Leri Weill syndrome

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Vana Vukić ◽  
Ana Smajo ◽  
Mandica Vidović ◽  
Rudolf Vukojević ◽  
Miroslav Harjaček ◽  
...  
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Case Report ◽  
Treatment Options ◽  
Janus Kinase ◽  
Musculoskeletal Symptoms ◽  
Multiple Treatment ◽  
Number Of Patients ◽  
Systemic Glucocorticoids ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Abstract Background The last two decades brought new treatment options and high quality guidelines into the paediatric rheumatologic practice. Nevertheless, a number of patients still present a diagnostic and therapeutic challenge due to combination of vague symptoms and unresponsiveness to available treatment modalities. Case presentation We report a case of sixteen years old girl suffering from polyarticular type of juvenile idiopathic arthritis refractory to multiple treatment options. She first presented at the age of 4 with swelling and contractures of both knees. Her symptoms were initially unresponsive to nonsteroidal anti-inflammatory drugs and progressed despite treatment with intraarticular and systemic glucocorticoids and methotrexate. Throughout the years, she received several biologics together with continuous administration of nonsteroidal anti-inflammatory drugs and disease modifying anti-rheumatic drugs as well as intraarticular and systemic glucocorticoids in disease flares. However, none of this options  provided a permanent remission, so various other modalities, as well as other possible diagnoses were constantly being considered. Eventually she became dependent on a daily dose of systemic glucocorticoids. In 2018, the treatment with Janus kinase inhibitor tofacitinib was initiated, which led to gradual amelioration of musculoskeletal symptoms, improvement of inflammatory markers and overall well-being, as well as to the weaning of systemic glucocorticoids. As the swelling of the wrists subsided for the first time in many years, Madelung’s deformity was noticed, first clinically, and later radiographically as well. Genetic analysis revealed short-stature homeobox gene deficiency and confirmed the diagnosis of Leri Weill syndrome. Conclusions This case report emphasizes the need for reporting refractory, complicated cases from everyday clinical practice in order to build-up the overall knowledge and share experience which is complementary to available guidelines. Individual reports of difficult to treat cases, especially when additional diagnoses are involved, can be helpful for physicians treating patients with common rheumatological diseases such as juvenile idiopathic arthritis.

Response of Deeproot Sedge (Cyperus entrerianus) to Herbicide and Prescribed Fire in Texas Coastal Prairie

2015 ◽  
Vol 8 (1) ◽  
pp. 15-31 ◽  
Author(s):  
Jonathan R. King ◽  
Andrew J. Bennett ◽  
Warren C. Conway ◽  
David J. Rosen ◽  
Brian P. Oswald
Keyword(s):  
Prescribed Fire ◽  
Treatment Options ◽  
Rapid Expansion ◽  
Coastal Prairie ◽  
Multiple Treatment ◽  
Exotic Invasive Species ◽  
Plant Groups ◽  
Exotic Invasive ◽  
Dormant Season ◽  
In Fire

AbstractIntroduced accidentally from South America, deeproot sedge is rapidly expanding in a variety of habitats throughout the southeastern United States. Of particular concern is its rapid expansion, naturalization, and formation of monocultures in Texas coastal prairie, one of the most imperiled temperate ecoregions in North America. The objective of this research was to examine how deeproot sedge responds to prescribed fire, to the herbicide imazapic, and to treatment combinations of both. Combinations of prescribed fire and imazapic treatments and imazapic-only treatments effectively reduced deeproot sedge cover and frequency. However, plots exposed to dormant season fires (with no imazapic) had greater deeproot sedge cover after burn treatments were applied, indicating that coastal prairie management using only dormant season prescribed fire will not work toward reduction or management of this exotic invasive species. Although deeproot sedge cover was often reduced in fire–imazapic treatment combinations, it was still present in treatment plots. Moreover, desirable functional plant groups (i.e., native bunchgrasses) did not respond positively to the fire–imazapic treatments, but in some instances, woody plant coverage increased. Repeated, long-term approaches using integrated and coordinated efforts with multiple treatment options will be necessary to restore community structure to desired compositional levels. Such integrated approaches should be effective in reducing deeproot sedge frequency, cover, and extent to more manageable levels throughout its introduced geographic range.

Understanding relevant immune mechanisms in gastrointestinal oncology

2021 ◽  
pp. 107815522199286
Author(s):  
Bulent Cetin ◽  
Ozge Gumusay
Keyword(s):  
Checkpoint Inhibitors ◽  
Treatment Options ◽  
Checkpoint Inhibition ◽  
Immune Checkpoint Inhibition ◽  
Gastrointestinal Cancers ◽  
Therapeutic Approaches ◽  
Cancer Treatments ◽  
Multiple Treatment ◽  
Gi Cancers ◽  
The Many

Rapid and successful drug development has resulted in multiple treatment options for gastrointestinal cancer, requiring careful decision making for individual patients. The general theme in modern immunology is that the field is moving beyond establishing the fundamental principles of immune response mechanisms to applying these propositions to understand human diseases and develop new therapies. Immunotherapy has contributed enormously to cancer treatments with a virtual explosion in novel therapeutics including checkpoint inhibitors and other recently developed immunomodulators and the development of novel therapeutic approaches. Although the majority of gastrointestinal (GI) cancers are generally considered poorly immunogenic, clinical trials have revealed that some of the patients with various gastrointestinal cancers are highly responsive to immune checkpoint inhibition-based therapies. We paid special attention to the clinical relevance of immunology and emphasized how newly developed therapies work, including what their strengths and pitfalls are. This review aims to enhance the interest of practitioners in the many specialties and subspecialties that the discipline influences and to assist them in understanding this increasing complexity.

Suffocated Maxillary Central Incisors (Surgical and Orthodontic Management): A Report of Two Cases

2021 ◽  
Vol 11 (1) ◽  
pp. 55-60
Author(s):  
Barun Kumar Sah ◽  
Jamal Giri ◽  
Bandana Koirala ◽  
Mamta Dali ◽  
Sneha Shrestha
Keyword(s):  
Orthodontic Treatment ◽  
Treatment Options ◽  
Self Esteem ◽  
Permanent Tooth ◽  
Mixed Dentition ◽  
Dental Practice ◽  
Central Incisor ◽  
Supernumerary Teeth ◽  
Multiple Treatment ◽  
Maxillary Incisors

Clinically, supernumerary teeth are able to cause different local disorders and the most common one is impaction of maxillary incisors. Impacted maxillary incisors substantially affect esthetics, function, and self‑esteem of patients. Impaction of maxillary permanent incisor is a rare clinical entity in dental practice. Although impaction of a permanent tooth is rarely diagnosed during the mixed dentition period, an impacted central incisor is usually diagnosed accurately when there is delay in the eruption of tooth. Multiple treatment options are available for impacted incisors. Surgical-orthodontic treatment is one of the alternative option for the correction. Early diagnosis and management of supernumer¬ary teeth is important to prevent the need for more complex surgical and orthodontic treatment. Here, we present a report of two cases of impacted maxillary incisors and its management

scholarly journals Introducing the leapfrog design: A simple Bayesian adaptive rolling trial design for accelerated treatment development and optimization

2018 ◽  
Author(s):  
Simon Edward Blackwell ◽  
Marcella Woud ◽  
Jürgen Margraf ◽  
Felix D. Schönbrodt
Keyword(s):  
Treatment Options ◽  
Science Research ◽  
Clinical Translation ◽  
Psychological Treatments ◽  
Multiple Treatment ◽  
Accelerate Development ◽  
New Variant ◽  
Research Findings ◽  
Treatment Research ◽  
New Treatment

The application of basic science research to the development and optimization of psychological treatments holds great potential. However, this process of clinical translation is challenging and time-consuming, and the standard route by which it proceeds is inefficient. Adaptive rolling designs, which originated within cancer treatment research, provide an alternative methodology with potential to accelerate development and optimization of psychological treatments. In such designs, multiple treatment options are tested simultaneously, with sequential Bayesian analyses used to remove poorly performing arms. Further, new treatment arms informed by the latest research findings can be introduced into the existing infrastructure as the trial progresses. These features drastically reduce the sample sizes needed and offer a means for more rapid and efficient clinical translation. This paper outlines the utility of such designs to clinical psychological science, focusing on a new variant termed the ‘leapfrog’ design, and discusses their potential uses to accelerate clinical translation.

scholarly journals Non-Surgical Management and Post-Surgical Rehabilitation of Carpal Tunnel Syndrome: An Algorithmic Approach and Practical Guideline

2020 ◽  
Vol 11 (3) ◽  
Author(s):  
Mahshid Nazarieh ◽  
Azadeh Hakakzadeh ◽  
Shima Ghannadi ◽  
Faezeh Maleklou ◽  
Zahra Tavakol ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Surgical Management ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Treatment Options ◽  
Operative Management ◽  
Functional Improvement ◽  
Therapeutic Effects ◽  
Multiple Treatment ◽  
Tunnel Syndrome

: One of the most common forms of entrapment neuropathy is Carpal Tunnel Syndrome (CTS). There are various treatment options for CTS. However, there are no clear and structured guidelines. This review classified the existing treatments and developed an algorithm to help physicians to choose the best option for their patients. Treatment options were summarized in three sections: non-surgical management of CTS, post-operative management of CTS, and practical open carpal tunnel release post-op protocol. The physicians can prescribe multiple treatment options to CTS patients. Corticosteroid in oral or injectable form has strong evidence in pain control and functional improvement in the short term. Shockwave therapy and nocturnal wrist splints display moderate therapeutic effects. Post carpal tunnel release rehabilitation can be started a few days after the operation.

scholarly journals Management of Crossbite in Anterior Region Due to Over-retained Deciduous Teeth in an Adolescent – a Case Report

2021 ◽  
pp. 39-44
Author(s):  
Niharika Gahlod ◽  
Arun Sajjanar ◽  
Surykant Singh ◽  
Milind Wasnik ◽  
Sneha Khekade
Keyword(s):  
Case Report ◽  
Treatment Options ◽  
Normal Growth ◽  
Permanent Dentition ◽  
Anterior Region ◽  
Congenital Absence ◽  
Deciduous Teeth ◽  
Primary Tooth ◽  
After Effects ◽  
Multiple Treatment

The deciduous teeth which are retained beyond the age of exfoliation are termed as over-retained deciduous teeth. There are numerous reasons for such teeth which include congenital absence or impaction or translation or transmigration of successor teeth or maybe because of existence of some kind of pathology, such as cysts, tumours, and odontoma under the primary tooth that results in the impaction of successor teeth. It may also be due to partial or total microdontia of permanent dentition. This leads to malalignment in permanent dentition which indirectly hampers the normal growth of the jaws. This case report shows several after-effects of over retained teeth along with the concerned multiple treatment options.

Idiopathic condylar resorption in orthodontics

2021 ◽  
Vol 14 (2) ◽  
pp. 82-88
Author(s):  
Salwa El-Habbash ◽  
Timothy McSwiney
Keyword(s):  
Risk Factors ◽  
Orthognathic Surgery ◽  
Mechanical Load ◽  
Systemic Disease ◽  
Treatment Options ◽  
Open Bite ◽  
Mandibular Movement ◽  
Anterior Open Bite ◽  
Surgical Risk ◽  
Multiple Treatment

Condylar resorption (CR) can be categorized into functional and dysfunctional remodelling of the temporomandibular joint (TMJ). The literature describes dysfunctional remodelling of the TMJ as idiopathic condylar resorption (ICR). Idiopathic condylar resorption (ICR) is a well-documented but poorly understood pathological entity that can occur spontaneously or post-orthognathic surgery. It predominantly affects young women, with other risk factors including Class 2 malocclusion with steep mandibular plane angles. It is distinguished by a decreased condylar head volume and ramus height, progressive mandibular retrusion and an anterior open bite. Its aetiology can be categorized into surgical and non-surgical risk factors. These include hormones, systemic disease, trauma, mechanical load and surgical risk factors, such as magnitude and direction of mandibular movement, type of surgical fixation and length of post-operative maxilla-mandibular fixation. ICR is a diagnosis of exclusion, and identified by a combination of clinical, radiographic and haematological findings. Multiple treatment options have been described in the literature, including medical management, orthodontics, orthognathic surgery, TMJ surgery, TMJ and orthognathic surgery combined, and total joint prosthesis reconstruction. Further research is required to better understand the aetiology of ICR and more long-term, controlled, multicentre clinical studies are needed to evaluate the outcomes of surgical and non-surgical management of CR patients. CPD/Clinical Relevance: Idiopathic condylar resorption has many presentations and potential causes that can greatly impact the decisions and outcomes for orthodontic/orthognathic treatment.

Sign in / Sign up

Export Citation Format

Share Document