scholarly journals Improving Tumor-Treating Fields with Skull Remodeling Surgery, Surgery Planning, and Treatment Evaluation with Finite Element Methods

2020 ◽  
pp. 63-77
Author(s):  
Nikola Mikic ◽  
Anders R. Korshoej
Keyword(s):  
Brain Cancer ◽  
Treatment Efficacy ◽  
Phase 1 ◽  
Model Development ◽  
Electrode Arrays ◽  
Clinical Phase ◽  
Tumor Treating Fields ◽  
Skull Defects ◽  
Cancer Diseases

AbstractTumor-treating fields (TTFields) are alternating fields (200 kHz) used to treat glioblastoma (GBM), which is one of the deadliest cancer diseases of all. Glioblastoma is a type of malignant brain cancer, which causes significant neurological deterioration and reduced quality of life, and for which there is currently no curative treatment. TTFields were recently introduced as a novel treatment modality in addition to surgery, radiation therapy, and chemotherapy. The fields are induced noninvasively using two pairs of electrode arrays placed on the scalp. Due to low electrical conductivity, significant currents are shielded from the intracranial space, potentially compromising treatment efficacy. Recently, skull remodeling surgery (SR-surgery) was proposed to address this issue. SR-surgery comprises the formation of skull defects or thinning of the skull over the tumor to redirect currents toward the pathology and focally enhance the field intensity. Safety and feasibility of this concept were validated in a clinical phase 1 trial (OptimalTTF-1), which also indicated promising survival benefits. This chapter describes the FE methods used in the OptimalTTF-1 trial to plan SR-surgery and assess treatment efficacy. We will not present detailed modeling results from the trial but rather general concepts of model development and field calculations. Readers are kindly referred to Wenger et al. [1] for a more general overview of the clinical implications and applications of TTFields modeling.

scholarly journals OptimalTTF-1: Enhancing tumor treating fields therapy with skull remodeling surgery. A clinical phase I trial in adult recurrent glioblastoma

2020 ◽  
Vol 2 (1) ◽  
Author(s):  
Anders Rosendal Korshoej ◽  
Slavka Lukacova ◽  
Yasmin Lassen-Ramshad ◽  
Christian Rahbek ◽  
Kåre Eg Severinsen ◽  
...  
Keyword(s):  
Phase I ◽  
Compliance Rate ◽  
Progression Free Survival ◽  
Recurrent Glioblastoma ◽  
Oncological Treatment ◽  
Clinical Phase ◽  
Tumor Treating Fields ◽  
Skull Defects ◽  
Secondary Endpoints ◽  
First Recurrence

Abstract Background Preclinical studies suggest that skull remodeling surgery (SR-surgery) increases the dose of tumor treating fields (TTFields) in glioblastoma (GBM) and prevents wasteful current shunting through the skin. SR-surgery introduces minor skull defects to focus the cancer-inhibiting currents toward the tumor and increase the treatment dose. This study aimed to test the safety and feasibility of this concept in a phase I setting. Methods Fifteen adult patients with the first recurrence of GBM were treated with personalized SR-surgery, TTFields, and physician’s choice oncological therapy. The primary endpoint was toxicity and secondary endpoints included standard efficacy outcomes. Results SR-surgery resulted in a mean skull defect area of 10.6 cm2 producing a median TTFields enhancement of 32% (range 25–59%). The median TTFields treatment duration was 6.8 months and the median compliance rate 90%. Patients received either bevacizumab, bevacizumab/irinotecan, or temozolomide rechallenge. We observed 71 adverse events (AEs) of grades 1 (52%), 2 (35%), and 3 (13%). There were no grade 4 or 5 AEs or intervention-related serious AEs. Six patients experienced minor TTFields-induced skin rash. The median progression-free survival (PFS) was 4.6 months and the PFS rate at 6 months was 36%. The median overall survival (OS) was 15.5 months and the OS rate at 12 months was 55%. Conclusions TTFields therapy combined with SR-surgery and medical oncological treatment is safe and nontoxic and holds the potential to improve the outcome for GBM patients through focal dose enhancement in the tumor.

Defining and Timing of Palliative Opportunities in Children with Central Nervous System Tumors

2021 ◽  
Author(s):  
A McCauley Massie ◽  
Jonathan Ebelhar ◽  
Kristen E Allen ◽  
Nicholas P DeGroote ◽  
Karen Wasilewski-Masker ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
End Of Life ◽  
Phase 1 ◽  
Marrow Transplant ◽  
Cns Tumors ◽  
Do Not Resuscitate ◽  
Intensive Care Admission ◽  
Repeated Events

Abstract Background Children with brain and central nervous system (CNS) tumors experience substantial challenges to their quality of life during their disease course. These challenges are opportunities for increased subspecialty palliative care (PC) involvement. Palliative opportunities have been defined in the pediatric oncology population, but the frequency, timing, and factors associated with palliative opportunities in pediatric patients with CNS tumors are unknown. Methods A single-institution retrospective review was performed on children ages 0-18 diagnosed with a CNS tumor who died between 01/01/2012-11/30/2017. Nine palliative opportunities were defined prior to data collection (progression; relapse; admission for severe symptoms; intensive care admission; bone marrow transplant; phase 1 trial; hospice; do-not-resuscitate (DNR) order). Demographic, disease, treatment, palliative opportunity, and end-of-life data were collected. Opportunities were evaluated over quartiles from diagnosis to death. Results Amongst 101 patients with a median age at death of eight years (Interquartile range, IQR=8.0, range 0-22), there was a median of seven (IQR=6) palliative opportunities per patient, which increased closer to death. PC consultation occurred in 34 (33.7%) patients, at a median of 2.2 months before death, and was associated with having a DNR order (p=0.0028). Hospice was involved for 72 (71.3%) patients. Conclusion Children with CNS tumors suffered repeated events warranting PC yet received PC support only one-third of the time. Mapping palliative opportunities over the cancer course promotes earlier timing of PC consultation which can decrease suffering and resuscitation attempts at the end-of-life.

scholarly journals Dense gas dispersion model development and testing for the Jack Rabbit II phase 1 chlorine release experiments

2018 ◽  
Vol 192 ◽  
pp. 218-240 ◽  
Author(s):  
Simon Gant ◽  
Jeffrey Weil ◽  
Luca Delle Monache ◽  
Bryan McKenna ◽  
Maria M. Garcia ◽  
...  
Keyword(s):  
Dispersion Model ◽  
Phase 1 ◽  
Model Development ◽  
Dense Gas ◽  
Gas Dispersion

Treatment Efficacy

1996 ◽  
Vol 39 (5) ◽  
Author(s):  
Audrey L. Holland ◽  
Davida S. Fromm ◽  
Frank DeRuyter ◽  
Margo Stein
Keyword(s):  
Program Evaluation ◽  
Small Group ◽  
Research Design ◽  
Treatment Efficacy ◽  
Single Subject ◽  
Efficacy Data ◽  
Evaluation Data ◽  
Quality Of Evidence ◽  
Efficacy Of Treatment

This article presents a brief overview of aphasia, followed by a summary of research studies and program evaluation data addressed to answering the question of the efficacy of treatment for aphasia. Selected studies are reviewed in terms of the quality of evidence they present. In addition, a number of questions that remain unanswered are also presented. Several tables, designed to provide clarifying information concerning several aspects of research design (number and types of patients studied, examples of well-designed small-group or single-subject studies, clinical techniques for which efficacy data are available), are included. The conclusion of this review is that, generally, treatment for aphasia is efficacious.

Towards Improving the Quality of Electrophysiological Signal Recordings by Using Microneedle Electrode Arrays

2021 ◽  
pp. 1-1
Author(s):  
Yingying Wang ◽  
Lelun Jiang ◽  
Lei Ren ◽  
Huang Pingao ◽  
Mei Yu ◽  
...  
Keyword(s):  
Electrode Arrays ◽  
Electrophysiological Signal

You Are What You Eat: Affirming Podcast and Subjective Wellbeing among African American Women

2021 ◽  
pp. 002193472110661
Author(s):  
Yatesha D. Robinson
Keyword(s):  
African American ◽  
African American Women ◽  
Subjective Wellbeing ◽  
Phase 1 ◽  
Mixed Methods Design ◽  
American Women ◽  
Competing Demands ◽  
Quality Of Life Index ◽  
Need For Support

The purpose of this exploratory study was to investigate whether intentional exposure to affirming messages via podcast would lead to improvement in subjective wellbeing in a sample of African American women. This two-part study used a mixed-methods design to measure subjective wellbeing using the Multicultural Quality of Life Index and a series of focus groups. During Phase 1, participants rated and discussed culturally relevant affirmations that informed the development of the podcast intervention used in Phase 2. The results revealed that stressors such as microaggressions, mental distress, and competing demands justified the need for support. Participants indicated that the podcast intervention was an enriching experience that illuminated the necessity of restorative practices that heal and revitalize the spirit. The intervention led to positive behavior change; and these results demonstrated the podcast benefits, suggesting that intentional exposure to positive messages may help some African American women cope with life stressors.

scholarly journals QLIF-25. EFFECT OF TUMOR TREATING FIELDS (TTFIELDS) ON HEALTH-RELATED QUALITY OF LIFE (HRQoL) IN NEWLY DIAGNOSED GLIOBLASTOMA. RESULTS OF THE EF-14 RANDOMIZED PHASE III TRIAL

2017 ◽  
Vol 19 (suppl_6) ◽  
pp. vi206-vi206
Author(s):  
Martin J B Taphoorn ◽  
Linda Dirven ◽  
Sophie Taillibert ◽  
Jerôme Honnorat ◽  
Thomas Chen ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Phase Iii ◽  
Newly Diagnosed ◽  
Health Related Quality ◽  
Phase Iii Trial ◽  
Tumor Treating Fields ◽  
Related Quality ◽  
Health Related ◽  
Newly Diagnosed Glioblastoma

A systematic approach for model verification: application on seven published activated sludge models

2010 ◽  
Vol 61 (4) ◽  
pp. 825-839 ◽  
Author(s):  
H. Hauduc ◽  
L. Rieger ◽  
I. Takács ◽  
A. Héduit ◽  
P. A. Vanrolleghem ◽  
...  
Keyword(s):  
Activated Sludge ◽  
Systematic Approach ◽  
Model Development ◽  
Model Verification ◽  
Software Implementation ◽  
Model Description ◽  
Kinetic Rate ◽  
Simulation Results ◽  
Activated Sludge Models

The quality of simulation results can be significantly affected by errors in the published model (typing, inconsistencies, gaps or conceptual errors) and/or in the underlying numerical model description. Seven of the most commonly used activated sludge models have been investigated to point out the typing errors, inconsistencies and gaps in the model publications: ASM1; ASM2d; ASM3; ASM3 + Bio-P; ASM2d + TUD; New General; UCTPHO+. A systematic approach to verify models by tracking typing errors and inconsistencies in model development and software implementation is proposed. Then, stoichiometry and kinetic rate expressions are checked for each model and the errors found are reported in detail. An attached spreadsheet (see http://www.iwaponline.com/wst/06104/0898.pdf) provides corrected matrices with the calculations of all stoichiometric coefficients for the discussed biokinetic models and gives an example of proper continuity checks.

scholarly journals Effects of Climate Change on Grassland Biodiversity and Productivity: The Need for a Diversity of Models

2017 ◽  
Author(s):  
Marcel van Oijen ◽  
Gianni Bellocchi ◽  
Mats Höglind
Keyword(s):  
Climate Change ◽  
Model Development ◽  
Grassland Ecosystems ◽  
Climatic Impacts ◽  
Grassland Productivity ◽  
Climatic Responses ◽  
High Level ◽  
The Impact ◽  
Grassland Biodiversity

There is increasing evidence that the impact of climate change on the productivity of grasslands will at least partly depend on their biodiversity. A high level of biodiversity may confer stability to grassland ecosystems against environmental change, but there are also direct effects of biodiversity on the quantity and quality of grassland productivity. To explain the manifold interactions, and to predict future climatic responses, models may be used. However, models designed for studying the interaction between biodiversity and productivity tend to be structurally different from models for studying the effects of climatic impacts. Here we review the literature on the impacts of climate change on biodiversity and productivity of grasslands. We first discuss the availability of data for model development. Then we analyse strengths and weaknesses of three types of model: ecological, process-based and integrated. We discuss the merits of this model diversity and the scope for merging different model types.

scholarly journals A 40-year-old Woman with Hypercalcemia Crisis Caused by Bone Metastasis in Stage IV Breast Cancer

2021 ◽  
Vol 4 (2) ◽  
pp. 117
Author(s):  
Wiharjo Hadisuwarno ◽  
Merlyna Savitri ◽  
Ami Ashariati ◽  
S. Ugroseno Yudho Bintoro ◽  
M. Noor Diansyah ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Bone Metastasis ◽  
Stage Iv ◽  
Terminal Stage ◽  
Holistic Management ◽  
Stage Iv Breast Cancer ◽  
Laboratory Examinations ◽  
Cancer Diseases

Breast cancer is still global burden especially for woman with 2.3 million cases every year dan 15% mortality among cancer diseases. In developing countries, most of the cases are diagnosed at terminal stage when metastasis already found. Bone metastasis is the highest among other metastasis sites such as: lung, liver and brain. Bone metastasis will cause hypercalcemia and bone pain as complications.  Both will gradually decrease patient’s quality of life. Comprehensive and holistic management for these complications will reduce deterioration and hopefully increase patient’s quality of life even they were at terminal stage. We describe a 40-year-old woman who got hypercalcemia crisis. Hypercalcemia usually manifest as a consequence of other diseases. Epidemiologically, majority come from metastasis, but can be other diseases, such as multiple myeloma. Interestingly, during medical investigation through her medical history, and physical examination, and laboratory examinations, we conclude that her hypercalcemia crisis was caused by bone metastasis from breast cancer.

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