Hepatobiliary tumors in adolescents and young adults: Site, age and gender distribution.

e16651 Background: Hepatobiliary cancer is one of the common cancers within Asia with 80% of global cases occurring in the continent alone. Currently little is known about the incidence of hepatobiliary cancer in the Adolescent and Young Adults (AYA). In this population, hepatobiliary cancer may present in an insidious manner due to low suspicion and management may result in a higher likelihood of survivors with long-term treatment-related toxicities. We aim to highlight the clinicopathological features and treatment outcomes in this age-group in an Asian high-volume tertiary cancer institution. Methods: Patients diagnosed between the age of 16-39 with hepatobiliary cancers between 1st January 2015 to 31st December 2019 in a single-centre institution in Singapore were included in this study. Results: There was a total of 84 AYA patients with hepatobiliary tumours who were referred to our institution. Median age of diagnosis was 35 years old (n = 84). 32 patients (38.1%) had hepatocellular carcinoma, 22 patients (26.2%) had biliary tract tumours, 11 patients (13.1%) had neuroendocrine cancers while 19 patients (22.6%) had other tumour types (Figure 1). Male incidence was highest in all hepatobiliary AYAs (n = 56, 66.7%, p = 0.002) and hepatocellular carcinomas (n = 25, 78.1%, p = 0.001) (Table). 65 patients (77.4%) remain alive as of 31st December 2019. Conclusions: Patterns of hepatobiliary incidence differ between sexes. In the young AYA population, hepatocellular precursor cells may have sex-specific features affecting malignant potentials. More studies should be done to further elucidate the genomic and epidemiology of hepatobiliary tumours in the younger population of patients to better outcomes in this population. [Table: see text]

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Tissue-specific tregs in cancer metastasis: opportunities for precision immunotherapy

Cellular and Molecular Immunology ◽

10.1038/s41423-021-00742-4 ◽

2021 ◽

Author(s):

Laura A. Huppert ◽

Michael D. Green ◽

Luke Kim ◽

Christine Chow ◽

Yan Leyfman ◽

...

Keyword(s):

Cancer Immunotherapy ◽

Cancer Metastasis ◽

Metastatic Cancer ◽

High Volume ◽

Therapy Resistance ◽

Term Treatment ◽

The Body ◽

Tissue Specific ◽

Tissue Repair And Regeneration ◽

Long Term Treatment

AbstractDecades of advancements in immuno-oncology have enabled the development of current immunotherapies, which provide long-term treatment responses in certain metastatic cancer patients. However, cures remain infrequent, and most patients ultimately succumb to treatment-refractory metastatic disease. Recent insights suggest that tumors at certain organ sites exhibit distinctive response patterns to immunotherapy and can even reduce antitumor immunity within anatomically distant tumors, suggesting the activation of tissue-specific immune tolerogenic mechanisms in some cases of therapy resistance. Specialized immune cells known as regulatory T cells (Tregs) are present within all tissues in the body and coordinate the suppression of excessive immune activation to curb autoimmunity and maintain immune homeostasis. Despite the high volume of research on Tregs, the findings have failed to reconcile tissue-specific Treg functions in organs, such as tolerance, tissue repair, and regeneration, with their suppression of local and systemic tumor immunity in the context of immunotherapy resistance. To improve the understanding of how the tissue-specific functions of Tregs impact cancer immunotherapy, we review the specialized role of Tregs in clinically common and challenging organ sites of cancer metastasis, highlight research that describes Treg impacts on tissue-specific and systemic immune regulation in the context of immunotherapy, and summarize ongoing work reporting clinically feasible strategies that combine the specific targeting of Tregs with systemic cancer immunotherapy. Improved knowledge of Tregs in the framework of their tissue-specific biology and clinical sites of organ metastasis will enable more precise targeting of immunotherapy and have profound implications for treating patients with metastatic cancer.

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Evaluation of the quality composition of micromycetes in the air of the premises of stationary medical institutions

Hygiene and Sanitation ◽

10.47470/0016-9900-2021-100-4-313-317 ◽

2021 ◽

Vol 100 (4) ◽

pp. 313-317

Author(s):

Dariya S. Tupikova ◽

Igor I. Berezin ◽

Alexander V. Zhestkov ◽

Artem V. Lyamin ◽

Andrey V. Kozlov ◽

...

Keyword(s):

Medical Personnel ◽

Allergic Diseases ◽

Term Treatment ◽

Hospital Environment ◽

Quantitative Composition ◽

Fungal Contamination ◽

Air Samples ◽

Study Results ◽

Long Term Treatment ◽

Class B

Introduction. Today, micromycetes are the most common pathogens found in residential and industrial premises and in the hospital environment. At the same time, mold fungi are the cause not only of allergic diseases but also of mycoses of various localization. Mold fungi are hazardous for patients in hospitals on long-term treatment and exposed to immunosuppression factors. Medical personnel who spent a long time in rooms with high contamination by micromycetes in the air can develop mycogenic sensitization. The aim of this work was to show the quantitative and qualitative composition of fungi surrounding the patient and the doctor in multidisciplinary hospitals. Materials and methods. With the help of a microbiological aspirator, air samples were taken in the premises of class B of surgical and therapeutic departments, followed by sowing on Saburo agar. The identified fungi were identified using classical methods and MALDI-ToF mass spectrometry using Microflex LT (Bruker). Results. In the course of the study, the assessment of fungal contamination of class B premises in treatment and prophylactic institutions was carried out to assess the qualitative and quantitative composition. Also, comparing the composition and number of micromycetes between the premises of departments of different profiles was carried out. A high level of contamination of micromycetes in medical premises of class B - 100% of cases was revealed in studies of objects of the hospital environment. The structure of the identified fungi was very diverse. In all air samples were isolated fungi genera Aspergillus, Penicillium, Mucor, Alternaria, and Ulcoladium. Spores of these fungi belonging to opportunistic or saprophytes are found in the air everywhere. Still, a significant increase in microbial load due to micromycetes can cause such typical allergic diseases as bronchial asthma, allergic skin dermatoses, and allergies of other locations. Conclusion. The study results revealed increased fungal contamination in healthcare facilities that require a more careful approach to compliance with the microclimate parameters.

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Determinant factors of depression in beta major thalassemia children

Folia Medica Indonesiana ◽

10.20473/fmi.v57i1.13664 ◽

2021 ◽

Vol 57 (1) ◽

pp. 46

Author(s):

AHMAD SURYAWAN ◽

Hapsari Widya Ningtiar ◽

IRWANTO IRWANTO ◽

I Dewa Gede UGRASENA

Keyword(s):

Serum Cortisol ◽

Cross Sectional Study ◽

Term Treatment ◽

High Serum ◽

Serum Cortisol Level ◽

Mild Depression ◽

Cross Sectional ◽

Determinant Factors ◽

Long Term Treatment ◽

Age Of Diagnosis

Thalassemia is a chronic disease with long-term treatment that increases the potential for impact on physical, cognitive, and psychological conditions. About 80% of patients with major thalassemia have at least one psychiatric disorder, depression is one of the most frequently reported, especially in prepubertal and puberty periods. The aim of this study is to evaluate determinant factors of depression in beta mayor thalassemia children. This was a cross-sectional study on patients aged 9 to 17 years at hematology outpatient clinic in Dr. Soetomo General Hospital from September to Desember 2018. Level of depression determinded by Children Depression Inventory (CDI) questionnaire. The data were collected and analyzed using using the IBM SPSS Statistics version 21. It is statistically significant with p<0.05. Forty-five participants were included in this study, 15 participants with mild depression and 30 participants without depression. Gender (p=0.462), age of diagnosis (p=0.385), frequency of tranfussion (p=0.065), family history of depression (p=0,350), physical change (p=0.711), duration of illness (p=0.674) have no significant value as a determinant factor while complication (p=0.049) and serum cortisol level (p=0.037) had significant value as determinant factors of depression in Beta Major Thalassemia children. Mild depression is more common in thalassemia patients who experience complications and had high serum cortisol levels

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Direct Comparison of the Thickness of the Parietal Peritoneum Using Peritoneal Biopsy and Ultrasonography of the Abdominal Wall in Patients Treated with Peritoneal Dialysis

Peritoneal Dialysis International ◽

10.3747/pdi.2018.00108 ◽

2019 ◽

Vol 39 (5) ◽

pp. 455-464 ◽

Cited By ~ 1

Author(s):

Alferso C. Abrahams ◽

Amélie Dendooven ◽

Jan Willem van der Veer ◽

Rens Wientjes ◽

Raechel J. Toorop ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Abdominal Wall ◽

Morphological Structure ◽

Cadaver Study ◽

Term Treatment ◽

Phantom Study ◽

Peritoneal Fibrosis ◽

Study Results ◽

Long Term Treatment ◽

Peritoneal Biopsy

Background Long-term treatment with peritoneal dialysis (PD) results in peritoneal fibrosis. Peritoneal biopsies have been used to determine the severity of fibrosis. Ultrasonography (US) of the abdominal wall has been used to measure peritoneal thickness non-invasively. However, direct comparison of both methods in the same patient has never been done. Furthermore, the validity of US to measure peritoneal thickness has not been investigated. Methods We performed 3 studies: 1) a human biopsy study to compare US measurement of peritoneal thickness with histological examination; 2) a human cadaver study to investigate the effect of removing the peritoneum on US results; and 3) a phantom study in which we used US to measure the thickness of membrane-like structures with a known thickness to investigate the influence of different US settings. Results The median thickness in biopsies of the peritoneum was 113 μm (interquartile range [IQR] 72 –129 μm), while this was 370 μm (IQR 324 – 458 μm) when measured by US ( p < 0.0001). The mean difference between the 2 measures was -257 μm (limits of agreement -4.6 and -511 μm). In the cadaver study, removal of the peritoneum did not have an effect on the presence or thickness of the hyperechoic line reported to represent the peritoneum. In the phantom study, results were highly dependent on frequency of the transducer, scan depth, and gain settings. Conclusions Ultrasonography results differ markedly from histological measurement using peritoneal biopsies. However, the hyperechoic line generated by US represents the interface between 2 neighboring tissues and not a separate morphological structure. Moreover, its thickness is greatly influenced by user-defined US settings.

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Efficacy of Long-Term Treatment With Thalidomide in Children and Young Adults With Crohn Disease: Preliminary Results

Journal of Pediatric Gastroenterology and Nutrition ◽

10.1097/00005176-200102000-00016 ◽

2001 ◽

Vol 32 (2) ◽

pp. 178-181 ◽

Cited By ~ 45

Author(s):

Sergio Facchini ◽

Manila Candusso ◽

Stefano Martelossi ◽

Mario Liubich ◽

Elisabetta Panfili ◽

...

Keyword(s):

Young Adults ◽

Crohn Disease ◽

Term Treatment ◽

Preliminary Results ◽

Long Term Treatment ◽

Children And Young Adults

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Multicenter extension and switch study evaluating the safety of long-term treatment with abiraterone acetate fine particle formulation (AAFP) in patients with metastatic castration-resistant prostate cancer (mCRPC): The STAAR-E study.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.6_suppl.181 ◽

2018 ◽

Vol 36 (6_suppl) ◽

pp. 181-181

Author(s):

Richard Levin ◽

Robert Given ◽

Paul R. Nemeth ◽

Bill Bosch ◽

Jillian Chapas-Reed ◽

...

Keyword(s):

Clinical Laboratory ◽

Vital Signs ◽

Serum Testosterone ◽

Abiraterone Acetate ◽

Term Treatment ◽

Extension Study ◽

Castration Resistant Prostate Cancer ◽

Laboratory Test Results ◽

Study Results ◽

Long Term Treatment

181 Background: The STAAR-study results showed novel AAFP 500 mg is therapeutically equivalent to originator abiraterone acetate (OAA) 1000 mg in men with mCRPC (Stein et al. Urologic Oncol). This STAAR-extension study evaluates the safety of ≤ 1 year of additional AAFP treatment in men with mCRPC. Methods: Patients were enrolled in the extension if they had: 1) mCRPC; 2) successfully completed 84 days of treatment with either AAFP + methylprednisolone (MP) or OAA + prednisone (PDN) in the STAAR-study; and 3) received their last dose of STAAR-study treatment < 45 days of starting this extension study. All patients continued or switched to AAFP 500 mg QD + 4 mg MP BID. Serum testosterone and PSA levels are measured at 6 and 12 months. Safety evaluations include adverse event (AE) incidence, clinical laboratory test results, and vital signs. Results: 20 patients were enrolled in the ongoing study (11 were switched to AAFP from OAA and 9 continued on AAFP). Median age is 76.5 years, and median AAFP treatment duration (STAAR + STAAR-E) is 178 days as of 8/16/17. Ten patients have been treated with AAFP > 9 months; 3 of these for > 1 year. Three patients discontinued due to progressive disease (n=1), fatigue (n=1), and a fall (non-AAFP related) resulting in death (n=1). No adverse events related to liver enzyme or bilirubin increases have been reported (Table). Conclusions: In this extension study in men with mCRPC, the safety profile of AAFP, regardless of prior treatment with OAA or AAFP, is consistent with that of OAA reported in the literature. Based on these results, longer-term treatment with AAFP + MP has acceptable safety, and patients on OAA + PDN treatment can switch to AAFP + MP successfully. Clinical trial information: NCT02962284. [Table: see text]

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Lentivirus Mediated siRNA against GluN2B Subunit of NMDA Receptor Reduces Nociception in a Rat Model of Neuropathic Pain

BioMed Research International ◽

10.1155/2014/871637 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Feixiang Wu ◽

Ruirui Pan ◽

Jiaying Chen ◽

Megumi Sugita ◽

Caiyang Chen ◽

...

Keyword(s):

Neuropathic Pain ◽

Chronic Constriction Injury ◽

Term Treatment ◽

Prolonged Treatment ◽

Small Interference Rna ◽

Study Results ◽

Long Term Treatment ◽

Mrna And Protein Expression ◽

Promising Treatment

Although neuropathic pain (NP) is still not fully understood by scientists and clinicians alike, studies suggest that N-methyl-D-aspartate (NMDA) receptors play an important role in the induction and maintenance of NP. A promising treatment for NP is through the downregulation of NMDA subunit GluN2B by RNA interference; however, naked siRNA (small interference RNA) is not effective in long-term treatments. In order to concoct a viable prolonged treatment for NP, Lv-siGluN2B (lentivirus carrying siRNA targeting GluN2B subunit) was prepared and the antinociception effects were observed in chronic constriction injury (CCI) rats in the present study. Results showed that Lv-siGluN2B was transduced into spinal cord cells after intrathecal injections and effectively reduced the nociception induced by sciatic nerve ligation while inhibiting the mRNA and protein expression of GluN2B. This antinociception effect lasted approximately 7 weeks. These findings suggest that GluN2B subunit could be a target for NP treatment and Lv-siGluN2B represents a new potential option for long-term treatment of NP.

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THERAPY OF ENDOCRINE DISEASE: Surgery in microprolactinomas: effectiveness and risks based on contemporary literature

Acta Endocrinologica ◽

10.1530/eje-16-0087 ◽

2016 ◽

Vol 175 (3) ◽

pp. R89-R96 ◽

Cited By ~ 20

Author(s):

Metaxia Tampourlou ◽

Raluca Trifanescu ◽

Alessandro Paluzzi ◽

Shahzada K Ahmed ◽

Niki Karavitaki

Keyword(s):

Transsphenoidal Surgery ◽

Young Patients ◽

Cost Effective ◽

High Volume ◽

Term Treatment ◽

Long Term Results ◽

Complication Rates ◽

Management Algorithm ◽

Long Term Treatment

Microprolactinomas are the most common pituitary adenomas. In symptomatic patients, dopamine agonists are the first-line treatment of choice; when cabergoline is used, biochemical control rates between 85 and 93% have been reported. Long-term treatment is needed in most of the cases with compliance, patient convenience, and potential adverse effects representing areas requiring attention. Based on the literature published in the past 15 years, transsphenoidal surgery can lead to normal prolactin in the postoperative period in usually 71–100% of the cases with very low postoperative complication rates. Surgical expertise is the major determinant of the outcomes, and it may be a cost-effective option in young patients with life expectancy greater than 10 years (provided it is performed by experienced surgeons at high volume centers with confirmed optimal outcomes). Larger series of patients with adequate follow-up could further validate the place of transsphenoidal surgery (particularly through the endoscopic approach for which long-term results are currently limited) in the management algorithm of patients with microprolactinoma.

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Long-Term Treatment of Cancer-Associated Thrombosis (CAT) Beyond 6 Months in the Medical Practice: USCAT, a 432-Patient Retrospective Non-Interventional Study

Cancers ◽

10.3390/cancers12082256 ◽

2020 ◽

Vol 12 (8) ◽

pp. 2256 ◽

Cited By ~ 1

Author(s):

Isabelle Mahé ◽

Ludovic Plaisance ◽

Céline Chapelle ◽

Silvy Laporte ◽

Benjamin Planquette ◽

...

Keyword(s):

Colorectal Cancer ◽

Treatment Period ◽

Major Bleeding ◽

Patient Management ◽

Treatment Strategies ◽

Specific Treatment ◽

Term Treatment ◽

Study Results ◽

Long Term Treatment ◽

Cancer Associated Thrombosis

Background: extended anticoagulant therapy beyond the initial 6 months is suggested in patients with cancer-associated thrombosis (CAT) and active cancer. Few data are available on patient management and outcomes on the period between 6 and 12 months after the venous thromboembolism (VTE) event. Objectives: our objective was to document patient management and outcomes beyond 6 months and up to 12 months in CAT patients initially treated for 6 months with tinzaparin. Methods: adult CAT patients with a cancer still alive at the end of an initial 6-month treatment period were eligible to participate in this retrospective non-interventional French multicenter study. Results: a total of 432 patients aged 66.5 ± 12.7 years were available to participate in this study. Out of the patients included in the study, the anticoagulant treatment was maintained in 348 of 422 documented patients (82.5%) while it was discontinued in 74 (17.5%) patients (before the end or at the end of the initial 6-month treatment period). Between 6 and 12 months, 24 patients (5.7%) experienced VTE recurrence, while 21 (5.1%) patients had clinically relevant bleeding, 11 patients (2.7%) had major bleeding and 96 patients (22.3%) died, mostly from cancer. VTE recurrence was more frequent in patients with lung (14.3%) and colorectal cancer (6.0%) while major bleeding was more frequent in patients with colorectal cancer (6.0%). Conclusion: clinical outcomes were consistent with previous observations and variable according to the type of cancer. Further clinical research is required to orient the management of patients with CAT beyond 6 months based on cancer-specific treatment strategies.

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Randomised controlled trial comparing rituximab to mycophenolate mofetil in children and young adults with steroid-dependent idiopathic nephrotic syndrome: study protocol

BMJ Open ◽

10.1136/bmjopen-2021-052450 ◽

2021 ◽

Vol 11 (11) ◽

pp. e052450

Author(s):

Francesca Lugani ◽

Andrea Angeletti ◽

Pietro Ravani ◽

Marina Vivarelli ◽

Manuela Colucci ◽

...

Keyword(s):

Young Adults ◽

Nephrotic Syndrome ◽

Mycophenolate Mofetil ◽

Idiopathic Nephrotic Syndrome ◽

Link Type ◽

Steroid Dependent ◽

Study Results ◽

Long Term Treatment ◽

Children And Young Adults ◽

Steroid Sparing

IntroductionGlucocorticoids induce remission in 90% of children with idiopathic nephrotic syndrome (INS). Some become steroid-dependent (SD) and require the addition of steroid sparing drugs such as calcineurin-inhibitors (CNI) or cyclophosphamide, to maintain remission. Considering the toxicity of these drugs, alternative interventions are needed for long-term treatment. The anti-CD20 antibody rituximab has shown promising steroid-sparing properties, with conflicting results in complicated forms of SD-INS. Mycophenolate mofetil (MMF) resulted effective in maintaining free-steroid remission, however, studies are limited to few uncontrolled trials with reported different dose of MMF.Methods and analysisThis open-label, two-parallel-arm, superiority controlled randomised clinical trial will enrol children with SD-INS maintained in remission with oral glucocorticoids or CNI. Children and young adults will be randomised to either MMF (1.200 mg/m2) or rituximab (375 mg/m2) infusion. After enrolment, glucocorticoids will be tapered until complete withdrawal. We will enrol 160 children and young adults to detect as significant at the two-sided p value of 0.01 with a power >0.8 a reduction in the risk of 1-year relapse (primary end-point). As secondary endpoints, we will compare the amount of glucocorticoids required to maintain complete remission at 6 and 24 months.Ethics and disseminationThe trial was approved by the local ethics boards (Comitato Etico Regione Liguria CER Liguria https://www.portalericerca-liguria.it/). We will publish the study results at international scientific meetings.Trial registration numbersNCT004585152.

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