scholarly journals Nasopharyngeal mucoepidermoid carcinoma: a case report and review of its current management

2021 ◽  
Vol 7 (11) ◽  
pp. 1821
Author(s):  
Purushotman Ramasamy ◽  
Vigneswaran Kumarasamy ◽  
Pathma Letchumanan ◽  
Harvinder Singh Dalip Singh
Keyword(s):  
Mucoepidermoid Carcinoma ◽  
Treatment Options ◽  
Endoscopic Endonasal ◽  
Salivary Gland Tumours ◽  
Sinonasal Malignancies ◽  
Number Of Patients ◽  
Sporadic Cases ◽  
The Right ◽  
Selection Of

<p class="abstract">Salivary gland tumours arising at the nasopharynx is highly infrequent. Among them the commonest is mucoepidermoid carcinoma (MEC). Reports with a larger number of patients are often from Asian countries where nasopharyngeal squamous cell carcinoma is also predominant. Although nasopharyngeal MEC (NMEC) is a disease of adults, sporadic cases amongst children have been reported. We report a case of a 32 years old man presented with complaining of intermittent epistaxis over a year. His nasal endoscopy showed friable polypoid tumour at the right choanae. Histopathology revealed a NMEC and he underwent endoscopic endonasal nasopharyngectomy with adjuvant radiotherapy. The optimal treatment for NMEC is arbitrary due to the lack of evidence. However, unlike most sinonasal malignancies, NMEC has the tendency to manifest itself early and has good response to the treatment. Therefore, in this article we describe the clinical features and justifications for the selection of treatment options including surgical and non-surgical therapies and including the role of neck dissection.</p>

scholarly journals Emerging Role of Immune Therapy in HCC

2021 ◽  
Author(s):  
Stacey M. Stein
Keyword(s):  
Kinase Inhibitors ◽  
Immune Therapy ◽  
Treatment Options ◽  
Single Agent ◽  
Small Subset ◽  
Vascular Endothelial ◽  
Number Of Patients ◽  
Endothelial Growth Factor ◽  
Expected Increase

AbstractHepatocellular carcinoma (HCC) remains a prevalent cancer diagnosis with an expected increase in incidence in the next decade. Treatment options for advanced disease have expanded significantly in the last decade since sorafenib was first approved in 2007. There have been approvals for multiple tyrosine kinase inhibitors (TKIs) with modest improvements in survival. Single-agent PD-1 inhibition has shown responses in ∼15% of patients, with a tail of the curve that is very beneficial to a small subset of patients. Most recently, studies of combination therapy with immune therapy drugs are showing more durable responses in a larger number of patients with unprecedented response rates over 30%. Different strategies have been pursued, including PD-1 and PD-L1 combinations with vascular endothelial growth factor inhibition, TKIs, and anti-CTLA-4 antibodies. This article provides a review of studies both completed and ongoing with immune therapy in advanced HCC.

Impact of treatment line on outcomes with salvage ipilimumab + nivolumab in metastatic renal cell carcinoma (mRCC).

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e17092-e17092
Author(s):  
Ritesh Kotecha ◽  
Chung-Han Lee ◽  
Andrea Knezevic ◽  
Neil J. Shah ◽  
Maria Isabel Carlo ◽  
...  
Keyword(s):  
Treatment Options ◽  
Immune Checkpoint Blockade ◽  
Clinical Progression ◽  
Start Time ◽  
Kaplan Meier ◽  
Number Of Patients ◽  
Time To Treatment Failure ◽  
Treatment Sequencing ◽  
Line Setting

e17092 Background: With the approval of ipilimumab plus nivolumab (I+N) and other immune checkpoint blockade (ICB) based combinations in the first-line setting, the role of I+N for salvage is of high interest for treatment sequencing, yet data is limited. Methods: We conducted a retrospective review of mRCC patients (pts) treated with I+N in the second-line (2L) and beyond settings at MSKCC between 2013-2019. Pt demographics, treatment history and toxicity were compiled. IMDC-risk status was calculated at I+N therapy start. Time to treatment failure (TTF) was defined as earliest date of clinical progression, therapy change or death, and overall survival (OS) was estimated by Kaplan-Meier method. Results: 36 pts received I+N in the 2+L setting, including 31/36 with clear-cell histology. Evaluable IMDC-risk at I+N start was favorable in 1/35 and intermediate-poor in 34/35 pts. The most common 1L therapies were anti-VEGF (22/36) and VEGF + ICB (6/36). 11/36 pts had ICB treatment exposure prior to I+N therapy. I+N therapy in the 2L, 3L and 4L was in 21/36, 8/36 and 7/36 pts, respectively, and 7/36 pts continue I+N at data cut-off. 8/36 pts discontinued I+N due to toxicity, 20/36 pts discontinued therapy due to disease progression, and 1 pt discontinued per pt preference. Cohort median OS was 14.8 months (95%CI: 4.2-44). Overall median TTF was 5.0 months (95%CI: 2.9-14.4), and TTF per 2L, 3L and 4+L was 8.3, 8.9 and 2.5 months, respectively. The number of patients who completed all 4 I+N induction cycles in the 2L, 3L, and 4+L was 11/21 (52%), 5/8 (63%), and 1/7 (14%). The number of patients who subsequently received nivolumab maintenance therapy after induction was 16/21 (76%) in the 2L, 1/8 (13%) in the 3L, and 0/7 (0%) in 4+L. Conclusions: With emerging treatment options for mRCC, this study reveals activity and safety for I+N in 2+L settings. In this limited cohort, completion of induction ipilimumab and use of maintenance nivolumab decline in later-line settings, suggesting limitations as salvage therapy. [Table: see text]

scholarly journals KONSEP ORWELISASI DAN PARKINSONISASI DALAM SISTEM PEMERINTAHAN PUBLIK

2018 ◽  
Vol 3 (2) ◽  
Author(s):  
Yeni Sri Lestari
Keyword(s):  
Good Governance ◽  
Development Effort ◽  
Governance System ◽  
Public Officials ◽  
Strong State ◽  
The World ◽  
Government Bureaucracy ◽  
The Right ◽  
Selection Of

This article discusses the importance of the role of the right government system within a country. One of the determinants of the good governance system is based on the accuracy in the selection of government bureaucracy system. Therefore, to provide a more detailed understanding, this article will discuss about the bureaucratic system. This review will examine two bureaucratic systems currently dominantly applied by most countries in the world, namely Orwell Bureaucracy (Orwellization) and Parkinson's Bureaucracy (Parkinsonization). This article is divided into four studies, first on the backgrounds of Orwell and Parkinson, the two studies on the concept of Orwellization and Parkinsonization framework, the three analyzing the application of both concepts within a country, and the fourth is criticism given by experts to the concept of Orwellization and Parkinsonization. In this study it is found that the concept of Orwellization and Parkinsonization is still relevant in studying the problems of bureaucratic systems in some countries, the concept of Orwellisasi can create a strong state but weaken the issue of Human Rights (HAM), while the concept of Parkinsonization contributed considerably in the development effort but weaken the system of recruitment of public officials. However, there are some experts who give criticism to the concept of  ureaucracy Orwellisasi and Parkinsonisasi this, this is not apart from weakness owned by each bureaucracy concept. Keywords: bureaucracy, Orwellisasi, dan Parkinsonisasi 

The United States and Elections in Africa (2015–2018)

2019 ◽  
pp. 58-98 ◽  
Author(s):  
Andrey Urnov
Keyword(s):  
United States ◽  
Democratic Republic Of Congo ◽  
The United States ◽  
African Countries ◽  
The Us ◽  
Global Leader ◽  
The Usa ◽  
The Right ◽  
Selection Of

As a self-proclaimed “Global Leader” the United States have made “the assertion, advancement, support and defense of democracy” throughout the world one of the pillars of their foreign policy. This aim invariably figures in all Washington’s program documents pertaining to Africa. A major component of these efforts is an assistance to regular, free and fair elections. The selection of arguments cited to justify such activities has been done skilfully. In each specific case it is emphasized that the United States do not side with any competing party, stand “above the battle”, work for the perfection of electoral process, defend the rights of opposition and rank and file votes, render material and technical help to national electoral committees. Sounds irreproachable. However, the real situation is different. The study of the US practical activities in this field allows to conclude that Washington has one-sidedly awarded itself a role of a judge and supervisor of developments related to elections in the sovereign countries of Africa, tries to control the ways they are prepared and conducted. These activities signify an interference into the internal affairs of African states. The scale and forms of such interference differ and is subjected to tasks the USA try to resolve in this or that country on the national, regional or global levels. However, everywhere it serves as an instrument of penetration and strengthening of the US influence, enhancing the US political presence in African countries. The right of the US to perform this role is presented as indisputable. Sceptics are branded as opponents of democracy. The author explores the US positions and activities connected with elections in Africa during the last years of B.Obama and first two years of D.Trump presidencies. He shows how their policy have been implemented on the continental level and in regard to several countries – South Sudan, Libya, Democratic Republic of Congo, Burundi, Rwanda, Nigeria, Somali, Kenya, Uganda.

CASE OF MAXILLARY SINUS FOREIGN BODY REMOVAL

2019 ◽  
Vol 25 (3) ◽  
pp. 73-77
Author(s):  
S.A. Karpishchenko ◽  
◽  
D.A. Usmanova ◽  
E.V. Bolozneva ◽  
E.S. Karpishchenko ◽  
...  
Keyword(s):  
Foreign Body ◽  
Maxillary Sinus ◽  
Foreign Bodies ◽  
Technical Difficulty ◽  
Patient Treatment ◽  
Endoscopic Endonasal ◽  
Foreign Body Removal ◽  
Impression Materials ◽  
The Right ◽  
Selection Of

Maxillary sinus foreign bodies are interrelated with different types of treatment of pathologies of teeth of the maxilla. Foreign bodies can be presented by pins, sillers, impression materials, teeth, dental implants etc. Features of anatomical development of maxilla, degree of pneumatization of it and many other factors promote hit of the foreign body to the maxillary sinus. Detection of the foreign body in the maxillary sinus during the operation sometimes can become a serious technical difficulty and needs a surgeon to be a man of experience. Important part of success of the surgery is selection of access to the maxillary sinus based on the 3D computed tomography data. We represent a clinical case of treatment the patient with the maxillary sinus foreign body after two non-resultative surgeries. After the implantation of dental implant, patient appealed for medical treatment, complaining on the discomfort, passing pain at the right buccal region and secrete from the right part of nose. We know from the anamnesis, that the patient was operated through the anterior maxillary wall under the general anesthesia for two times. The foreign body was removed only during the third surgery, that was done under the local anesthesia under the control of the rigid endoscopes. The patient was conversed to the out-patient treatment at the day of the surgery. The efficacy of the endoscopic endonasal approach to the maxillary sinus through the inferior nasal meatus in case of maxillary sinus foreign body was approved.

scholarly journals Intended arm use influences interhemispheric correlation of β-oscillations in primate medial motor areas

2017 ◽  
Vol 118 (5) ◽  
pp. 2865-2883 ◽  
Author(s):  
Toshi Nakajima ◽  
Haruka Arisawa ◽  
Ryosuke Hosaka ◽  
Hajime Mushiake
Keyword(s):  
Phase Difference ◽  
Phase Synchronization ◽  
Ipsilateral Hemisphere ◽  
Β Phase ◽  
Oscillatory Power ◽  
The Right ◽  
Relationship Of ◽  
Selection Of ◽  
Phase Differences

To investigate the role of interhemispheric β-synchronization in the selection of motor effectors, we trained two monkeys to memorize and perform multiple two-movement sequences that included unimanual repetition and bimanual switching. We recorded local field potentials simultaneously in the bilateral supplementary motor area (SMA) and pre-SMA to examine how the β-power in both hemispheres and the interhemispheric relationship of β-oscillations depend on the prepared sequence of arm use. We found a significant ipsilateral enhancement of β-power for bimanual switching trials in the left hemisphere and an enhancement of β-power in the right SMA while preparing for unimanual repetition. Furthermore, interhemispheric synchrony in the SMA was significantly more enhanced while preparing unimanual repetition than while preparing bimanual switching. This enhancement of synchrony was detected in terms of β-phase but not in terms of modulation of β-power. Furthermore, the assessment of the interhemispheric phase difference revealed that the β-oscillation in the hemisphere contralateral to the instructed arm use significantly advanced its phase relative to that in the ipsilateral hemisphere. There was no arm use-dependent shift in phase difference in the pairwise recordings within each hemisphere. Both neurons with and without arm use-selective activity were phase-locked to the β-oscillation. These results imply that the degree of interhemispheric phase synchronization as well as phase differences and oscillatory power in the β-band may contribute to the selection of arm use depending on the behavioral conditions of sequential arm use. NEW & NOTEWORTHY We addressed interhemispheric relationships of β-oscillations during bimanual coordination. While monkeys prepared to initiate movement of the instructed arm, β-oscillations in the contralateral hemisphere showed a phase advance relative to the other hemisphere. Furthermore, the sequence of arm use influenced β-power and the degree of interhemispheric phase synchronization. Thus the dynamics of interhemispheric phases and power in β-oscillations may contribute to the specification of motor effectors in a given behavioral context.

When Are Designers Willing to Take Risks? How Concept Creativity and Prototype Fidelity Influence Perceived Risk

2018 ◽  
Author(s):  
Elizabeth M. Starkey ◽  
Jessica Menold ◽  
Scarlett R. Miller
Keyword(s):  
Perceived Risk ◽  
Engineering Students ◽  
Risk Attitude ◽  
Individual Risk ◽  
Concept Selection ◽  
The Right ◽  
The Impact ◽  
Different Levels ◽  
Selection Of

Building prototypes is an important part of the concept selection phase of the design process, where fuzzy ideas get represented to support communication and decision making. However, previous studies have shown that prototypes generate different levels of user feedback based on their fidelity and aesthetics. Furthermore, prior research on concept selection has shown that individual risk attitude effects how individuals select ideas, as creative ideas are perceived to be riskier in comparison to less creative ideas. While the role of risk has been investigated in concept selection, there is lack of research on how risk is related to the selection of prototypes at various levels of fidelity. Thus, the purpose of this study was to investigate the impact of prototype fidelity, concept creativity, and risk aversion, on perceived riskiness and concept selection through a between-subjects study with 72 engineering students. The results revealed that there was a “goldilocks” effect in which students choose concepts with “just the right amount” of novelty, not too much and not too little, as long as quality was adequate. In addition, the prototype fidelity of a concept had an interaction with uniqueness, indicating that unique concepts are more likely to be perceived as less risky if presented at higher levels of fidelity.

scholarly journals The Role of the Paramedic Practitioner in the UK

2015 ◽  
Vol 4 (1) ◽  
Author(s):  
Malcolm Woollard
Keyword(s):  
Care Service ◽  
Chronically Ill ◽  
Scope Of Practice ◽  
Unscheduled Care ◽  
Number Of Patients ◽  
Emergency Ambulance ◽  
Job Title ◽  
The Uk ◽  
The Right

The ‘Paramedic Practitioner’ role has developed against a background of change in primary care service provision, apparently resulting in an increasing utilisation of emergency ambulance services. This presents opportunities to extend the scope of practice of paramedics and other health professionals in the diagnosis and management of patients with minor illnesses and injuries. Such patients commonly present via calls to traditional emergency numbers (999) or are referred from other unscheduled care agencies. Paramedic practitioners can reduce the number of patients inappropriately transported to hospital by approximately half, thus meeting an NHS aim of ‘treating the right patients in the right place at the right time’. Other opportunities exist in the form of extended roles in critical care and the management of the chronically ill in the community. Currently, a number of pilot programmes exist but vary considerably with respect to type and duration of training, permitted scope of practice, and even the job title of these new practitioners. To be successful, these major changes in the role of ambulance professionals will require the paramedic profession to take leadership through its own professional body (the British Paramedic Association (BPA) in the establishment of defined standards of practice. A shift from vocational training to university-based education will be necessary to meet the intellectual demands of the autonomous management of these patient populations. Uniformity of job title and legal restrictions on its use are also required. These new opportunities for practice will offer a structured clinical career for ambulance professionals for the first time. The BPA has proposed that Emergency Medical Technicians will have a university Certificate; paramedics a university Diploma; paramedic practitioners an Honours Degree; and advanced paramedic practitioners a Masters Degree. Consultant paramedics holding PhDs will support their peers in furthering professional practice. The ambulance profession is coming of age…

scholarly journals The Perception of Instructors and Learners' in Expertise Building in Vocational Courses in Ghana

2020 ◽  
Vol 7 (2) ◽  
pp. 8-16
Author(s):  
Mustapha Bin Danquah
Keyword(s):  
Sampling Technique ◽  
Simple Random Sampling ◽  
Building Construction ◽  
Technical Institute ◽  
Cape Coast ◽  
The Right ◽  
Vocational Courses ◽  
Descriptive Survey ◽  
Selection Of

The main objective of the study was to ascertain the perception of instructors and learners regarding the role of supervision on expertise building in building construction course in vocational institutes in Ghana. The study adopted a descriptive survey research design and it was carried out at Cape Coast Technical Institute. Utilizing a simple random sampling technique, 90 students were selected while purposive sampling was adopted in the selection of the 10 teachers for the study. This means, in all, 100 participants were selected for the study. A questionnaire was the major instruction for data collection for the study. The result of the study shows that the teachers and several students strongly believe and were convinced that supervision of instruction can be instrumental to the development of expertise in building construction. It facilitates students understanding of valuable aspects of building construction; develop the right attitude and requisite skills. Given the above findings, it is recommended that instructors should be abreast the latest pedagogical approach in building construction to acquaint teachers with a practical yet simple way of imparting requisite skills in building construction students. Also, teachers of building construction should be cooperative with supervisors, be open and willing to adopt the constructive recommendation of supervisors and refrain from teaching student in an autocratic manner. It is also important for building construction teachers to be abreast with the latest information on building construction to build students' expertise valuable for the labour market.

scholarly journals The Role of Islamic Counselling in Pandemic COVID 19: A Conceptual Study for Developing Positive Emotion of Parents and Children

2020 ◽  
Vol 11 (1) ◽  
pp. 18
Author(s):  
Fitriah M. Suud ◽  
Abdul Gaffar ◽  
Kana Safrina Rouzi ◽  
Moh. Toriqul Chaer
Keyword(s):  
Psychological Health ◽  
Empirical Studies ◽  
Mental Condition ◽  
Parents And Children ◽  
Literature Searches ◽  
Number Of Patients ◽  
Phenomenological Studies ◽  
Conceptual Study ◽  
The Right

<p>Pandemic COVID 19 had a global and comprehensive impact. The consequences arising from the epidemic of corona diseases are felt by all religious adherents, countries, and people without the age limit. COVID 19 also comes through economic, political, social, and spiritual space. This virus also not only assaults physical but has disrupted the psychological health of many people.  This study aims to discuss and propose several solutions that can be given related to the response due to COVID 19 through the Islamic counselling approach. This research is a literature review both in concept and the results of empirical studies. Data is collected through artificial intelligent search engines to find the right theme according to the survey within a specific time limit. The results of literature searches and phenomenological studies developed during the pandemic in this community have found that Islamic counselling can reduce the number of patients exposed to the virus. The virus can strike out the weak physical. The brittle physique is affected by a fragile mental condition. Therefore, Islamic counselling strengthens the psychological health that can enhance the body's resistance from corona disease through several stages.</p>

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