scholarly journals An Update for UK Podiatrists Performing Toenail Surgery on Patients Who Are Taking Antithrombotic Medications: It’s About Bleeding Time

2021 ◽  
Author(s):  
Ian Reilly ◽  
Toby Blandford
Keyword(s):  
Bleeding Time ◽  
Treatment Strategies ◽  
General Rule ◽  
Standard Of Care ◽  
Limited Evidence ◽  
The United Kingdom ◽  
The Matrix ◽  
Ablative Techniques ◽  
Nail Surgery ◽  
Antithrombotic Medication

Nail surgery for the permanent removal of all or part of the nail unit can be performed via incisional or physically ablative techniques for conditions such as ingrown, mycotic, or dystrophic toenails. In the United Kingdom podiatric community, where phenol techniques are the standard of care for ablation of the matrix, there remains confusion about the management of patients undergoing nail surgery who are concurrently taking antithrombotic medication(s). The aim of this paper was to review the literature describing treatment strategies for antithrombosed patients undergoing nail surgery. However, having found limited evidence, the authors considered relevant and associated literature in the field of cutaneous/dermatological surgery and extrapolated those findings for patients undergoing nail avulsion surgery. A case-by-case risk assessment is warranted in all patients but as a general rule, the podiatrist can perform nail surgery without the patientceasing their antithrombotic medication.

scholarly journals Immunmodulatory Treatment Strategies of Hepatocellular Carcinoma: From Checkpoint Inhibitors Now to an Integrated Approach in the Future

Cancers ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 1558
Author(s):  
Matthias Ocker ◽  
Christian Mayr ◽  
Tobias Kiesslich ◽  
Sebastian Stintzing ◽  
Daniel Neureiter
Keyword(s):  
Hepatocellular Carcinoma ◽  
Clinical Trials ◽  
Immune Checkpoint ◽  
Checkpoint Inhibitors ◽  
Treatment Strategies ◽  
Human Tumor ◽  
Standard Of Care ◽  
Immune Checkpoints ◽  
Published Data ◽  
Ablative Techniques

Background: Hepatocellular carcinoma (HCC) still represents a human tumor entity with very limited therapeutic options, especially for advanced stages. Here, immune checkpoint modulating drugs alone or in combination with local ablative techniques could open a new and attractive therapeutic “door” to improve outcome and response rate for patients with HCC. Methods: Published data on HCC experimental to pre-(clinical) treatment strategies from standard of care to novel immunomodulatory concepts were summarized and discussed in detail. Results: Overall, our knowledge of the role of immune checkpoints in HCC is dramatically increased in the last years. Experimental and pre-clinical findings could be translated to phase 1 and 2 clinical trials and became standard of care. Local ablative techniques of HCC could improve the effectivity of immune checkpoint inhibitors in situ. Conclusions: This review demonstrates the importance of immunomodulatory treatment strategies of HCC, whereby the “best treatment code” of immune checkpoint drugs, combination with ablative techniques and of timing must be evaluated in coming clinical trials.

scholarly journals Updated Insights on EGFR Signaling Pathways in Glioma

2021 ◽  
Vol 22 (2) ◽  
pp. 587
Author(s):  
Alexandru Oprita ◽  
Stefania-Carina Baloi ◽  
Georgiana-Adeline Staicu ◽  
Oana Alexandru ◽  
Daniela Elise Tache ◽  
...  
Keyword(s):  
Signaling Pathways ◽  
Treatment Strategies ◽  
Growth Factor Receptor ◽  
Standard Of Care ◽  
Egfr Signaling ◽  
Current Standard ◽  
Egfr Amplification ◽  
Epidermal Growth ◽  
New Diagnosis ◽  
Clear Clinical Benefit

Nowadays, due to recent advances in molecular biology, the pathogenesis of glioblastoma is better understood. For the newly diagnosed, the current standard of care is represented by resection followed by radiotherapy and temozolomide administration, but because median overall survival remains poor, new diagnosis and treatment strategies are needed. Due to the quick progression, even with aggressive multimodal treatment, glioblastoma remains almost incurable. It is known that epidermal growth factor receptor (EGFR) amplification is a characteristic of the classical subtype of glioma. However, targeted therapies against this type of receptor have not yet shown a clear clinical benefit. Many factors contribute to resistance, such as ineffective blood–brain barrier penetration, heterogeneity, mutations, as well as compensatory signaling pathways. A better understanding of the EGFR signaling network, and its interrelations with other pathways, are essential to clarify the mechanisms of resistance and create better therapeutic agents.

scholarly journals Intratumoural Cytochrome P450 Expression in Breast Cancer: Impact on Standard of Care Treatment and New Efforts to Develop Tumour-Selective Therapies

Biomedicines ◽  
2021 ◽  
Vol 9 (3) ◽  
pp. 290
Author(s):  
Smarakan Sneha ◽  
Simon C. Baker ◽  
Andrew Green ◽  
Sarah Storr ◽  
Radhika Aiyappa ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cytochrome P450 ◽  
Treatment Strategies ◽  
Standard Of Care ◽  
Therapeutic Index ◽  
Cancer Cell Proliferation ◽  
Selective Treatment ◽  
Standard Of Care Treatment ◽  
Future Work ◽  
Treat Breast Cancer

Despite significant advances in treatment strategies over the past decade, selective treatment of breast cancer with limited side-effects still remains a great challenge. The cytochrome P450 (CYP) family of enzymes contribute to cancer cell proliferation, cell signaling and drug metabolism with implications for treatment outcomes. A clearer understanding of CYP expression is important in the pathogenesis of breast cancer as several isoforms play critical roles in metabolising steroid hormones and xenobiotics that contribute to the genesis of breast cancer. The purpose of this review is to provide an update on how the presence of CYPs impacts on standard of care (SoC) drugs used to treat breast cancer as well as discuss opportunities to exploit CYP expression for therapeutic intervention. Finally, we provide our thoughts on future work in CYP research with the aim of supporting ongoing efforts to develop drugs with improved therapeutic index for patient benefit.

scholarly journals Non-infectious uveitis affecting the posterior segment treated with fluocinolone acetonide intravitreal implant: 3-year fellow eye analysis

Eye ◽  
2021 ◽  
Author(s):  
Carlos Pavesio ◽  
Carsten Heinz
Keyword(s):  
Cataract Surgery ◽  
Treatment Strategies ◽  
Standard Of Care ◽  
Fluocinolone Acetonide ◽  
Posterior Segment ◽  
Recurrence Rates ◽  
Intravitreal Implant ◽  
Infectious Uveitis ◽  
Dose Corticosteroid ◽  
Fellow Eyes

Abstract Background Prevention of non-infectious uveitis of the posterior segment (NIU-PS) recurrence using 0.2 μg/day fluocinolone acetonide implant (FAi) was assessed over 3 years (NCT01694186). Outcomes for FAi-treated and fellow eyes with NIU-PS were compared, to evaluate FAi versus conventional treatment strategies. Methods Eligible subjects had >1-year recurrent NIU-PS history and either ≥2 separate recurrences requiring treatment, or corticosteroid therapy (systemic or ocular) in the 12 months preceding study entry. Bilateral disease was present and analysed in 59/87 FAi-treated participants. Recurrence rates, best-corrected visual acuity (BCVA) changes, cataract surgery, intraocular pressure (IOP) events and adjunctive medication use were compared for FAi-treated and fellow eyes. Results Over 36 months, more FAi-treated than fellow eyes remained recurrence-free (28.8% vs. 5.1%, P = 0.001; mean 1.9 vs. 4.7 recurrences, respectively, P < 0.0001). FAi-treated eyes gained +9.6 letters BCVA, versus a loss of −4.4 in fellow eyes (P < 0.0001). Systemic medications were given to 42.4% of subjects. Intra/periocular adjunctive injections were lower in FAi-treated than fellow eyes (20.3% vs. 66.1%, P < 0.0001); topical corticosteroid use was also lower in FAi-treated than fellow eyes (27.1% vs 52.5%, P = 0.0041). IOP-related events occurred at similar rates in both FAi-treated and fellow eyes, excepting IOP-lowering surgery (5.1% vs. 15.3%, respectively; P = 0.1251). Cataract surgery occurred in 72.0% of FAi-treated and 37.0% of fellow eyes. Conclusions In subjects with bilateral NIU-PS, continuous, low-dose corticosteroid with 0.2 μg/day FAi reduced recurrence and adjunctive medication requirements, and improved vision over 36 months, providing greater protection against ocular inflammation than a reactive approach using standard of care.

822 Apnea every 5 minutes

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A321-A321
Author(s):  
Anupamjeet Sekhon ◽  
Ambrose Chiang ◽  
Kingman Strohl ◽  
Eric Yeh
Keyword(s):  
Treatment Strategies ◽  
Standard Of Care ◽  
Lithium Carbonate ◽  
Apnea Hypopnea Index ◽  
Refractory Depression ◽  
Maxillomandibular Advancement ◽  
Respiratory Events ◽  
Perceived Benefit ◽  
Caucasian Female ◽  
Do So

Abstract Introduction Vagal Nerve Stimulators (VNS) are used in refractory epilepsy and depression. VNS are known to decrease airflow, oxygen saturation, and respiratory amplitude during sleep. We present a case of VNS induced OSA that was overlooked for 6 years. Report of case(s) A 63-year-old Caucasian female with refractory depression, hypothyroidism, and obesity presented with snoring and excessive daytime sleepiness (EDS). She had VNS implanted in a research trial for depression. She was on bupropion, duloxetine, lithium carbonate, lamotrigine, olanzapine, and levothyroxine. Polysomnography (PSG) showed moderate OSA with apnea-hypopnea index (AHI) of 25.8 and SpO2 nadir of 83%, and was titrated to bi-level positive airway pressure (PAP). She tried different masks and pressures but her leak and PAP intolerance persisted. There was no improvement in her EDS, and Armodafinil was prescribed for wake promotion. She struggled with bi-level PAP therapy for five years before being considered for hypoglossal nerve stimulator. But was turned down because of VNS presence. She was then recommended maxillomandibular advancement (MMA) but decided against it. She continued PAP therapy until a repeat PSG revealed mild to moderate OSA (AHI 10.9, RDI 17.8, and SpO2 nadir 79%), and it was noted that most of her respiratory events appeared in a regular fashion at 300-second intervals corresponding with the firing of VNS. PSG performed with VNS turned off showed no OSA (AHI 0.8 and SpO2 nadir 85%). PAP therapy was discontinued and subsequent nocturnal pulse oximetry showed normal oxygenation (ODI 15, RDI 17.8, SpO2 &lt;88% for only 1.7 minutes). Her EDS resolved and VNS was eventually removed as per patient’s preference. She was started on a new medical therapy for depression. She continues to be asymptomatic. Conclusion Ascertainment bias led to delay in recognition of the cause of OSA as focus was on treatment only. Lowering the VNS frequency, increasing cycle time, turning it off during sleep or removal can improve respiratory events. The decision to do so depends on perceived benefit and harm of continuing VNS therapy. This case highlights the importance of re-evaluation of causes and treatment strategies when the standard of care is ineffective. Support (if any):

New treatment strategies for diabetic eye disease

2020 ◽  
pp. 179-184
Author(s):  
Sobha Joseph ◽  
Ramesh R. Sivaraj
Keyword(s):  
Treatment Strategies ◽  
Diabetic Macular Oedema ◽  
Argon Laser ◽  
Fluocinolone Acetonide ◽  
Drug Molecules ◽  
The United Kingdom ◽  
Anti Vegf ◽  
Diabetic Eye Disease ◽  
Control Of Diabetes ◽  
New Treatment

Argon laser treatment was the mainstay of treatment for diabetic retinopathy (DR) and maculopathy up to the last decade. However, with the better understanding of pathophysiology of DR, newer medications have become available. Anti-vascular endothelial growth factors (anti-VEGF) and steroid implants for vision-threatening diabetic macular oedema have been widely adopted in clinical practice with several longer-acting drug molecules in the pipeline. In the United Kingdom, ranibizumab and aflibercept are licensed anti-VEGF drugs. Dexamethasone and fluocinolone acetonide implants are the steroids that are available. The emphasis on systemic control of diabetes and blood pressure remains very relevant even in the era of these newer drugs.

scholarly journals Towards Personalization in the Curative Treatment of Gastric Cancer

2020 ◽  
Vol 10 ◽  
Author(s):  
Astrid E. Slagter ◽  
Marieke A. Vollebergh ◽  
Edwin P. M. Jansen ◽  
Johanna W. van Sandick ◽  
Annemieke Cats ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Treatment Options ◽  
Treatment Strategies ◽  
Standard Of Care ◽  
Molecular Characteristics ◽  
Perioperative Chemotherapy ◽  
Current Standard ◽  
Common Cancer ◽  
Resectable Gastric Cancer

Gastric cancer is the fifth most common cancer worldwide and has a high mortality rate. In the last decades, treatment strategy has shifted from an exclusive surgical approach to a multidisciplinary strategy. Treatment options for patients with resectable gastric cancer as recommended by different worldwide guidelines, include perioperative chemotherapy, pre- or postoperative chemoradiotherapy and postoperative chemotherapy. Although gastric cancer is a heterogeneous disease with respect to patient-, tumor-, and molecular characteristics, the current standard of care is still according to a one-size-fits-all approach. In this review, we discuss the background of the different treatment strategies in resectable gastric cancer including the current standard, the specific role of radiotherapy, and describe the current areas of research and potential strategies for personalization of therapy.

scholarly journals Study protocol: optimising newborn nutrition during and after neonatal therapeutic hypothermia in the United Kingdom: observational study of routinely collected data using propensity matching

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e026739 ◽  
Author(s):  
Cheryl Battersby ◽  
Nick Longford ◽  
Mehali Patel ◽  
Ella Selby ◽  
Shalini Ojha ◽  
...  
Keyword(s):  
United Kingdom ◽  
Therapeutic Hypothermia ◽  
Late Onset ◽  
Standard Of Care ◽  
Blood Stream ◽  
Research Database ◽  
Population Database ◽  
Scientific Publications ◽  
Link Type ◽  
The United Kingdom

IntroductionTherapeutic hypothermia is standard of care for infants born ≥36 weeks gestation with hypoxic ischaemic encephalopathy (HIE); consensus on optimum nutrition during therapeutic hypothermia is lacking. This results in variation in enteral feeding and parenteral nutrition (PN) for these infants. In this study, we aim to determine the optimum enteral nutrition and PN strategy for newborns with HIE during therapeutic hypothermia.Methods and analysisWe will undertake a retrospective cohort study using routinely recorded electronic patient data held on the United Kingdom (UK) National Neonatal Research Database (NNRD). We will extract data from infants born ≥36 weeks gestational age between 1 January 2008 and 31 December 2016, who received therapeutic hypothermia for at least 72 hours or died during therapeutic hypothermia, in neonatal units in England, Wales and Scotland. We will form matched groups in order to perform two comparisons examining: (1) the risk of NEC between infants enterally fed and infants not enterally fed, during therapeutic hypothermia; (2) the risk of late-onset blood stream infections between infants who received intravenous dextrose without any PN and infants who received PN, during therapeutic hypothermia. The following secondary outcomes will also be examined: survival, length of stay, breast feeding at discharge, hypoglycaemia, time to full enteral feeds and growth. Comparison groups will be matched on demographic, maternal, infant and organisational factors using propensity score matching.Ethics and disseminationIn this study, we will use deidentifed data held in the NNRD, an established national population database; parents can opt out of their baby’s data being held in the NNRD. This study holds study-specific Research Ethics Committee approval (East Midlands Leicester Central, 17/EM/0307). These results will help inform optimum nutritional management in infants with HIE receiving therapeutic hypothermia; results will be disseminated through conferences, scientific publications and parent-centred information produced in partnership with parents.Trial registration numberNCT03278847; pre-results,ISRCTN47404296; pre-results.

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