scholarly journals Relapsed Medulloblastoma in Pre-Irradiated Patients: Current Practice for Diagnostics and Treatment

Cancers ◽  
2021 ◽  
Vol 14 (1) ◽  
pp. 126
Author(s):  
Rebecca M. Hill ◽  
Sabine L. A. Plasschaert ◽  
Beate Timmermann ◽  
Christelle Dufour ◽  
Kristian Aquilina ◽  
...  
Keyword(s):  
Residual Disease ◽  
Primary Tumour ◽  
Treatment Resistance ◽  
Signs And Symptoms ◽  
Treatment Modalities ◽  
Diagnostic Process ◽  
Liquid Biopsies ◽  
Early Therapy ◽  
Paediatric Tumours ◽  
Molecular Group

Relapsed medulloblastoma (rMB) accounts for a considerable, and disproportionate amount of childhood cancer deaths. Recent advances have gone someway to characterising disease biology at relapse including second malignancies that often cannot be distinguished from relapse on imaging alone. Furthermore, there are now multiple international early-phase trials exploring drug–target matches across a range of high-risk/relapsed paediatric tumours. Despite these advances, treatment at relapse in pre-irradiated patients is typically non-curative and focuses on providing life-prolonging and symptom-modifying care that is tailored to the needs and wishes of the individual and their family. Here, we describe the current understanding of prognostic factors at disease relapse such as principal molecular group, adverse molecular biology, and timing of relapse. We provide an overview of the clinical diagnostic process including signs and symptoms, staging investigations, and molecular pathology, followed by a summary of treatment modalities and considerations. Finally, we summarise future directions to progress understanding of treatment resistance and the biological mechanisms underpinning early therapy-refractory and relapsed disease. These initiatives include development of comprehensive and collaborative molecular profiling approaches at relapse, liquid biopsies such as cerebrospinal fluid (CSF) as a biomarker of minimal residual disease (MRD), modelling strategies, and the use of primary tumour material for real-time drug screening approaches.

A Study on Frozen Shoulder and its clinical management through Nasaapana and Nasya

2016 ◽  
Vol 1 (1) ◽  
Author(s):  
Praveenkumar H. Bagali ◽  
A. S. Prashanth
Keyword(s):  
Medical Science ◽  
Frozen Shoulder ◽  
Signs And Symptoms ◽  
Treatment Modalities ◽  
Animal Kingdom ◽  
Shoulder Joints ◽  
Group A ◽  
Group B

The unique position of man as a master mechanic of the animal kingdom is because of skilled movements of his hands and when this shoulder joints get obstructed, we call it as Apabahuka (Frozen shoulder), we do not find satisfactory management in modern medical science. Various effective treatment modalities have been mentioned which reverse the pathogenesis, Shodhana is advised initially followed by Shamana therapies. In the present study 30 patients were selected incidentally and placed randomly into two groups A and B, with 15 subjects in each group. Group A received Amapachana with Panchakola Churna, Jambeera Pinda Sweda and Nasya Karma. Group B received Amapachana with Panchakola Churna, Jambeera pinda Sweda and Nasaapana. In both the groups two months follow up was done. Both groups showed significant improvement in the signs and symptoms of Apabahuka as well as the activities of daily livings, thereby improving the quality of life of the patients. Nasya Karma and Nasaapana provided highly significant results in all the symptoms of Apabahuka. In the present study as per the clinical data, Nasaapana is found to be more effective than Nasya Karma.

scholarly journals Emerging Lab-on-a-Chip Approaches for Liquid Biopsy in Lung Cancer: Status in CTCs and ctDNA Research and Clinical Validation

Cancers ◽  
2021 ◽  
Vol 13 (9) ◽  
pp. 2101
Author(s):  
Ângela Carvalho ◽  
Gabriela Ferreira ◽  
Duarte Seixas ◽  
Catarina Guimarães-Teixeira ◽  
Rui Henrique ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Liquid Biopsy ◽  
Residual Disease ◽  
Lab On A Chip ◽  
Microfluidic Devices ◽  
Early Recurrence ◽  
Circulating Tumor Dna ◽  
Clinical Validation ◽  
Liquid Biopsies ◽  
Lung Cancer Patients

Despite the intensive efforts dedicated to cancer diagnosis and treatment, lung cancer (LCa) remains the leading cause of cancer-related mortality, worldwide. The poor survival rate among lung cancer patients commonly results from diagnosis at late-stage, limitations in characterizing tumor heterogeneity and the lack of non-invasive tools for detection of residual disease and early recurrence. Henceforth, research on liquid biopsies has been increasingly devoted to overcoming these major limitations and improving management of LCa patients. Liquid biopsy is an emerging field that has evolved significantly in recent years due its minimally invasive nature and potential to assess various disease biomarkers. Several strategies for characterization of circulating tumor cells (CTCs) and circulating tumor DNA (ctDNA) have been developed. With the aim of standardizing diagnostic and follow-up practices, microfluidic devices have been introduced to improve biomarkers isolation efficiency and specificity. Nonetheless, implementation of lab-on-a-chip platforms in clinical practice may face some challenges, considering its recent application to liquid biopsies. In this review, recent advances and strategies for the use of liquid biopsies in LCa management are discussed, focusing on high-throughput microfluidic devices applied for CTCs and ctDNA isolation and detection, current clinical validation studies and potential clinical utility.

scholarly journals Long Covid-19: Proposed Primary Care Clinical Guidelines for Diagnosis and Disease Management

2021 ◽  
Vol 18 (8) ◽  
pp. 4350
Author(s):  
Antoni Sisó-Almirall ◽  
Pilar Brito-Zerón ◽  
Laura Conangla Ferrín ◽  
Belchin Kostov ◽  
Anna Moragas Moreno ◽  
...  
Keyword(s):  
Primary Care ◽  
Disease Management ◽  
Signs And Symptoms ◽  
Diagnostic Process ◽  
Press Releases ◽  
Expert Opinions ◽  
Number Of Patients ◽  
Patient Groups

Long COVID-19 may be defined as patients who, four weeks after the diagnosis of SARS-Cov-2 infection, continue to have signs and symptoms not explainable by other causes. The estimated frequency is around 10% and signs and symptoms may last for months. The main long-term manifestations observed in other coronaviruses (Severe Acute Respiratory Syndrome (SARS), Middle East respiratory syndrome (MERS)) are very similar to and have clear clinical parallels with SARS-CoV-2: mainly respiratory, musculoskeletal, and neuropsychiatric. The growing number of patients worldwide will have an impact on health systems. Therefore, the main objective of these clinical practice guidelines is to identify patients with signs and symptoms of long COVID-19 in primary care through a protocolized diagnostic process that studies possible etiologies and establishes an accurate differential diagnosis. The guidelines have been developed pragmatically by compiling the few studies published so far on long COVID-19, editorials and expert opinions, press releases, and the authors’ clinical experience. Patients with long COVID-19 should be managed using structured primary care visits based on the time from diagnosis of SARS-CoV-2 infection. Based on the current limited evidence, disease management of long COVID-19 signs and symptoms will require a holistic, longitudinal follow up in primary care, multidisciplinary rehabilitation services, and the empowerment of affected patient groups.

scholarly journals A pilot study to establish non-invasive biomarkers for higher-grade meningioma

2019 ◽  
Vol 21 (Supplement_4) ◽  
pp. iv6-iv6
Author(s):  
Daniele Baiz ◽  
Caterina Negroni ◽  
Emanuela Ercolano ◽  
Claire L Adams ◽  
Kathreena M Kurian ◽  
...  
Keyword(s):  
Ex Vivo ◽  
Tumour Progression ◽  
Primary Tumour ◽  
Regulation Of Gene Expression ◽  
Diagnostic Tools ◽  
Malignant Tumours ◽  
Liquid Biopsies ◽  
Benign Meningioma ◽  
Non Invasive ◽  
Serum Exosomes

Abstract Introduction Meningioma brain tumours are the most common primary tumour in adults. Despite surgery and/or radiation therapy, meningioma may recur. The 5-year recurrence rate in benign meningioma is estimated in about 10% while much greater in atypical and malignant tumours. MicroRNAs (miRNAs) represent a large class of small RNAs driving regulation of gene expression and playing a role in tumour progression and therefore proposed as diagnostic tools. Moreover, miRNAs can be released from tumour cells into the blood stream via exosomes, showing potential to be used as liquid biopsies. Methods Identification of novel circulating biomarkers was conducted by performing an unbiased Cancer MicroRNA qPCR Array, followed by bioinformatics analysis. In parallel, we conducted a biased in silico analysis of the miRNAs targeting Cyclin D1 and E1, recently proposed as immunohistochemical meningioma biomarkers. Validation studies performed using TaqMan® reagents. Results Stringent unbiased (p<0.01) miRNA profiling followed by validation in ex vivo samples revealed that the miR-9-1 is upregulated in higher-grade meningioma tissues and serum exosomes, controlled by the EGFR/AP-1 axis and correlated with lower levels of E-Cadherin, a proposed biomarker for malignant meningioma. On the contrary, biased analysis, followed by validation in vitro and ex vivo, showed that the miR-497~195 cluster is downregulated in higher-grade meningioma tissues and serum exosomes, correlating with the overexpression of GATA-4, a novel meningioma tissue biomarker. Conclusion Our data demonstrated that both miR-497~195 and miR-9-1 show potential to become promising non-invasive biomarkers for higher-grade meningioma, reflecting their expression status in tissues. (DB and CN contributed equally).

scholarly journals Rationale for Early Detection of EWSR1 Translocation-Associated Sarcoma Biomarkers in Liquid Biopsy

Cancers ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 824
Author(s):  
Felix I. L. Clanchy
Keyword(s):  
Early Detection ◽  
Liquid Biopsy ◽  
Residual Disease ◽  
Surgical Excision ◽  
Molecular Techniques ◽  
Rt Pcr ◽  
Liquid Biopsies ◽  
Societal Burden ◽  
Recent Developments ◽  
Mesenchymal Tumours

Sarcomas are mesenchymal tumours that often arise and develop as a result of chromosomal translocations, and for several forms of sarcoma the EWSR1 gene is a frequent translocation partner. Sarcomas are a rare form of malignancy, which arguably have a proportionally greater societal burden that their prevalence would suggest, as they are more common in young people, with survivors prone to lifelong disability. For most forms of sarcoma, histological diagnosis is confirmed by molecular techniques such as FISH or RT-PCR. Surveillance after surgical excision, or ablation by radiation or chemotherapy, has remained relatively unchanged for decades, but recent developments in molecular biology have accelerated the progress towards routine analysis of liquid biopsies of peripheral blood. The potential to detect evidence of residual disease or metastasis in the blood has been demonstrated by several groups but remains unrealized as a routine diagnostic for relapse during remission, for disease monitoring during treatment, and for the detection of occult, residual disease at the end of therapy. An update is provided on research relevant to the improvement of the early detection of relapse in sarcomas with EWSR1-associated translocations, in the contexts of biology, diagnosis, and liquid biopsy.

scholarly journals A CASE STUDY ON AYURVEDIC MANAGEMENT OF VATAHATA VARTMA (PTOSIS)

2021 ◽  
Vol p5 (4) ◽  
pp. 2955-2959
Author(s):  
Sangeeta Neelannavar ◽  
Vijayamahantesh Hugar ◽  
Varsha Kulkarni
Keyword(s):  
Surgical Intervention ◽  
Medical Condition ◽  
Medical Science ◽  
Signs And Symptoms ◽  
Treatment Modalities ◽  
Upper Eyelid ◽  
Contemporary Science ◽  
Functional Deterioration

Vatahata Vartma is a condition of Vartma where in the Vartma-Shuklagata Sandhi is afflicted by vitiated Vata leading to Vimukta Sandhi (functional deterioration of the Shuklavartmagata Sandhi which facilitates the movement of eyelids), Nischeshta (no or reduced eyelids activity), Nimilayati (unable to close the eyelids). The signs and symptoms of Vatahata Vartma can be corelated to Ptosis in modern medical science. Ptosis is a medical condition in which there will be drooping or falling of upper eyelid. The condition worsens when there is exhaustion of the extra ocular muscles. This condition can be either uni-ocular or binocular. If the condition is left untreated, it can lead to complications. Surgical intervention is the only line of treatment mentioned for ptosis in contemporary science. Ayurveda has mentioned different treatment modalities for similar conditions. This paper highlights a case study of Vatahata Vartma (ptosis) managed with Ayurvedic line of treatment with Mukhabhyanga, Sweda, Nasya, Akshipindi and Akshi Tarpana. Keywords: Vatahata Vartma, Ptosis, Nasya, Akshitarpana, Akshipindi

scholarly journals TO EVALUATE THE EFFECT OF UPANAHA SWEDA IN JANUSANDHIGATA VATA WITH VACHADI AND KOLADI YOGAS A COMPARATIVE CLINICAL STUDY

2021 ◽  
Vol 9 (8) ◽  
pp. 1675-1682
Author(s):  
Desai Sucheta ◽  
Desai Ananta ◽  
Borannavar Shaila
Keyword(s):  
Clinical Study ◽  
Elderly Population ◽  
Functional Disability ◽  
Signs And Symptoms ◽  
Walking Distance ◽  
Treatment Modalities ◽  
Age Factor ◽  
Comparative Clinical Study ◽  
Group A

The present scenario of lifestyle is prone to cause many lives deteriorating conditions. Sandhigatavata is one among the Vatavyadhi and the commonest articular disorder affecting the middle-aged, obese, and elderly population. The advancement in working pattern, lifestyle & age-factor, all together have become a prime cause for aggravation of Vata, which accelerates Dhatukshaya (depletion of tissues). Sandhigatavata can be correlated with osteoarthritis (OA) which is one such chronic, degenerative, inflammatory disease that has a great impact on the quality of the life of an individual. OA poses a huge hindrance in the day-to-day activities of the sufferer like walking, dressing, bathing etc. As per Ayurveda, it is caused due to localized accumulation of aggravated Vata in joints, which leads to Shula, Sotha, Vatapoornadritisparsha and functional disability of affected Sandhis. If not treated in time, the disease makes man disable. According to epidemiology the prevalence of osteoarthritis in India is 22-39%. Different treatment modalities like Snehana, Swedana, Lepa, Bandhana, Agni Karma and Raktamokshana are emphasized in Ayurveda to provide better relief from the pain and swelling and restore mobility; for the management of these symptoms, Swedana is the most convenient & best procedure. So, the present study was aimed to assess clinically the effect of Upanaha Swedas in the management of Janusandhigatavata. Objectives: To evaluate and compare the efficacy of Vachadi Upanaha Sweda and Koladi Upanaha Sweda in the management of Janusandhigatavata. Materials and Methods: It was a randomized comparative clinical study; total 40 patients were divided into 2 groups as 20 in each. In Group A, patients were treated with only Vachadi Upanaha Sweda and other group patients were treated with Koladi Upanaha Sweda. Results: Statistical analysis revealed that both the interventions wereeffective in reducing all the signs and symptoms of Janusandhigatavata, however in parameters Shotha, tenderness and walking distance, Koladi Upanaha Sweda showed better response than Vachadi Upanaha Sweda. Conclusion: There is a significant effect of Koladi Upanaha Sweda over Vachadi Upanaha Sweda in Janusandhigatavata both clinically and statistically. Keywords: Janusandhigatavata, knee osteoarthritis, Koladi Upanaha, Vachadi Upanaha, Swedana.

Irritable Bowel Syndrome with Diarrhea

2018 ◽  
Author(s):  
Judy Nee ◽  
Jacqueline L. Wolf
Keyword(s):  
Irritable Bowel Syndrome ◽  
Differential Diagnosis ◽  
Abdominal Pain ◽  
Treatment Options ◽  
Clinical Manifestations ◽  
Signs And Symptoms ◽  
Treatment Modalities ◽  
Dietary Advice ◽  
Emerging Therapies ◽  
Irritable Bowel

Irritable bowel syndrome (IBS) is a complex, functional gastrointestinal condition characterized by abdominal pain and alteration in bowel habits without an organic cause. One of the subcategories of this disorder is IBS with diarrhea (IBS-D). Clinically, patients who present with more than 3 months of abdominal pain or discomfort associated with an increase in stool frequency and/or loose stool form are defined as having IBS-D. This review addresses IBS-D, detailing the epidemiology, etiology and genetics, pathophysiology and pathogenesis, diagnosis, clinical manifestations and physical examination findings, differential diagnosis, treatment, emerging therapies, complications, and prognosis. Figures show potential mechanisms and pathophysiology of IBS, IBS-D suspected by clinical assessment and Rome III criteria, pharmacologic and nonpharmacologic treatment options, potential mechanisms of action of probiotics, and potential treatment modalities. Tables list the Rome criteria for IBS, alarm signs and symptoms suggestive of alternative diagnoses, IBS criteria, differential diagnosis of IBS-D, dietary advice options for IBS-D, and alternative and emerging therapies in IBS-D. This review contains 5 figures, 6 tables and 42 references KEYWORDS: IBS-D, eluxadoline, rifaximin, probiotics, bloating, antidepressants, bile acid malabsorption, microscopic colitis, celiac

732 TUMOR INFILTRATING NEUTROPHILS ARE A POOR PROGNOSTIC MARKER FOR ESOPHAGEAL CANCER PATIENTS RECEIVING NEOADJUVANT CHEMORADIOTHERAPY

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Carlos Cabalag ◽  
Owen Prall ◽  
John Ciciulla ◽  
Laurence Galea ◽  
Niko Thio ◽  
...  
Keyword(s):  
Immune Cell ◽  
Residual Disease ◽  
Neoadjuvant Chemoradiotherapy ◽  
Treatment Resistance ◽  
Tumor Infiltrating Lymphocytes ◽  
Disease Recurrence ◽  
Expression Of Genes ◽  
Inflammatory Chemokines ◽  
Pre Treatment ◽  
Immune Related Genes

Abstract   Significant advances have been made in our understanding of the tumor immune microenvironment (TIM) and tumor infiltrating lymphocytes (TILs). Nevertheless, there is little understanding of the changes in the TIM in response to neoadjuvant chemoradiotherapy (CRT). Thus, our aim was to investigate the changes in the TIM with neoadjuvant CRT in EC by assessing the immune cell infiltrate, the expression of immune related genes, and their association with treatment response and prognosis. Methods To decipher the effects of neoadjuvant CRT on the TIM, we obtained 58 paired pre-treatment and post neoadjuvant CRT treated EC specimens. TILs and tumor infiltrating neutrophils (TIN) were quantified in pre-treatment biopsies and surgical resection specimens following neoadjuvant CRT. To evaluate the immune transcriptomics, RNA was extracted from these specimens and gene expression was assessed using the Nanostring Platform based on the PanCancer Immune Profiling Panel. Immunohistochemistry (IHC) was performed to validate findings from the immune transcriptomics. Results TIL counts were not prognostic for disease specific survival (DSS). We observed higher expression of immune-suppressive inflammatory chemokines (TGFß-1 and IL-16) in post-neoadjuvant treated samples compared to pre-treatment biopsies. In samples collected after neoadjuvant CRT, low expression of genes related to anti-tumor T cell cytotoxic activity1 was significantly associated with disease recurrence. In patients with residual disease, multivariate analysis revealed a high neutrophil count, but not TIL count, was significantly associated with inferior DSS (HR 3.8 [1.3– 10.8]; p = 0.01). Conclusion In EC, the tumor microenvironment after neoadjuvant CRT remains largely immune-suppressive. We discovered that the presence of TINs in patients with residual disease post neoadjuvant CRT is an independent adverse prognostic factor. Collectively, our results suggest that an inflammatory pro-tumoral microenvironment associated with TINs may contribute to treatment resistance and progressive disease in EC.

scholarly journals Using nanobiopsy of single brain tumour cells to investigate transcriptional reprogramming during standard treatment.

2019 ◽  
Vol 21 (Supplement_4) ◽  
pp. iv7-iv8
Author(s):  
Marilena Elpidorou ◽  
Paolo Actis ◽  
Lucy Stead
Keyword(s):  
Standard Treatment ◽  
Primary Tumour ◽  
Treatment Resistance ◽  
Treatment Resistant ◽  
Transcriptional Reprogramming ◽  
Cytoplasmic Material ◽  
Novel Technology ◽  
Transcriptional Changes ◽  
Transcriptional Reprogram ◽  
Selection Of

Abstract Glioblastoma (GBM) is an incurable brain cancer because, despite aggressive standard treatment (consisting of surgery, radiation and Temozolomide chemotherapy), 100% of tumours recur. GBM tumours are characterised by significant intratumour heterogeneity, with genotypically or phenotypically distinct subpopulations of cells co-existing within each tumour. However, it is not yet known whether the inevitable recurrence of GBM is owing to Darwinian selection of inherently treatment resistant cells within the primary tumour, or the ability of cells to transcriptional reprogram and acquire treatment resistance properties. Knowing this is fundamental to developing more effective treatment for GBM: should we therapeutically target existing cells or their ability to reprogram? The only way to know this is to profile individual cells longitudinally, which has not been possible until now. Here we present a pioneering technology, known as nanobiopsy, which can longitudinally track the transcriptional profile of single GBM cells through standard treatment. The nanobiopsy allows injection or extraction of cytoplasmic material by electrowetting. We have proved that this technique is able to sample cytoplasmic fractions from cells without killing them, giving us the advantage to capture the transcriptional changes occurring through treatment using optimised scRNA sequencing protocols. We are applying this novel technology to help us identify treatment resistance modes and mechanisms to reveal novel targets for drug development.

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