scholarly journals Evidence-Based Strategies for the Treatment of Peritoneal Malignancies during Health Care Resource Restriction: The COVID-19 Pandemic

2020 ◽  
Vol 28 (1) ◽  
pp. 40-51
Author(s):  
Farhana Shariff ◽  
Danielle Bischof ◽  
Anand Govindarajan ◽  
Rebecca Prince ◽  
Ronald Burkes ◽  
...  
Keyword(s):  
Health Care ◽  
Treatment Options ◽  
Treatment Strategies ◽  
Current Data ◽  
Health Care Resource ◽  
Unique Challenge ◽  
Hospital Capacity ◽  
Number Of Patients ◽  
Hospital Resources ◽  
National Perspective

Background: The COVID-19 pandemic has put enormous pressure on hospital resources, and has affected all aspects of patient care. As operative volumes decrease, cancer surgeries must be triaged and prioritized with careful thought and attention to ensure maximal benefit for the maximum number of patients. Peritoneal malignancies present a unique challenge, as surgical management can be resource intensive, but patients have limited non-surgical treatment options. This review summarizes current data on outcomes and resource utilization to help inform decision-making and case prioritization in times of constrained health care resources. Methods: A rapid literature review was performed, examining surgical and non-surgical outcomes data for peritoneal malignancies. Narrative data synthesis was cross-referenced with relevant societal guidelines. Peritoneal malignancy surgeons and medical oncologists reviewed recommendations to establish a national perspective on case triage and mitigating treatment strategies. Results and Conclusions: Triage of peritoneal malignancies during this time of restricted health care resource is nuanced and requires multidisciplinary discussion with consideration of individual patient factors. Prioritization should be given to patients where delay may compromise resectability of disease, and where alternative treatment options are lacking. Mitigating strategies such as systemic chemotherapy and/or surgical deferral may be utilized with close surveillance for disease stability or progression, which may affect surgical urgency. Unique hospital capacity, and ability to manage the complex post-operative course for these patients must also be considered to ensure patient and system needs are aligned.

scholarly journals Autophagy and salivary gland cancer: A putative target for salivary gland tumors

Tumor Biology ◽  
2020 ◽  
Vol 42 (12) ◽  
pp. 101042832098056
Author(s):  
Evangelos Koustas ◽  
Panagiotis Sarantis ◽  
Margarita Theodorakidou ◽  
Michalis V Karamouzis ◽  
Stamatios Theocharis
Keyword(s):  
Salivary Gland ◽  
Current Knowledge ◽  
Treatment Options ◽  
Treatment Strategies ◽  
In Vivo Studies ◽  
Salivary Gland Cancer ◽  
Number Of Patients ◽  
Salivary Gland Carcinomas

Salivary gland carcinomas are a group of heterogeneous tumors of different histological subtypes, presenting relatively low incidence but the entire variable of types. Although novel treatment options for salivary gland carcinomas patients’ outcomes have improved, the treatment of this type of cancer is still not standardized. In addition, a significant number of patients, with a lack of optimal treatment strategies, have reduced survival. In the last two decades, a plethora of evidence pointed to the importance of autophagy, an essential catabolic process of cytoplasmatic component digestion, in cancer. In vitro and in vivo studies highlight the importance of autophagy in salivary gland carcinomas development as a tumor suppressor or promoter mechanism. Despite the potential of autophagy in salivary gland carcinomas development, no therapies are currently available that specifically focus on autophagy modulation in salivary gland carcinomas. In this review, we summarize current knowledge and clinical trials in regard to the interplay between autophagy and the development of salivary gland carcinomas. Autophagy manipulation may be a putative therapeutic strategy for salivary gland carcinomas patients.

LiverMetSurvey: Analysis of clinicopathologic factors associated with the efficacy of preoperative chemotherapy in 2,122 patients with colorectal liver metastases

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 3521-3521 ◽  
Author(s):  
R. Adam ◽  
T. Aloia ◽  
J. Figueras ◽  
L. Capussotti ◽  
G. Poston ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Preoperative Chemotherapy ◽  
Primary Tumor ◽  
Colorectal Liver Metastases ◽  
Systemic Chemotherapy ◽  
Treatment Options ◽  
Treatment Strategies ◽  
Multimodality Treatment ◽  
Primary Tumor Site ◽  
Number Of Patients

3521 Background: LiverMetSurvey is an international, internet-based registry designed to assess the efficacy of multimodality treatment options for colorectal liver metastases (CLM) by analyzing outcomes following hepatic resection (HR) in a large number of patients. Methods: Data were analyzed for the 2,122 patients entered into LiverMetSurvey by six hepatobiliary centers from inception to August 2004 (HR: 1974 to 2004; 1,306 men: 816 women; mean age: 61 years). The distributions of potential prognostic factors including age, sex, primary tumor site, timing of metastasis diagnosis, tumor number, diameter of the largest metastasis, bilaterality, and treatment with chemotherapy were compared to survivals using univariate and multivariate statistics. Results: Metastases originated in the colon in 69% of patients and were synchronous (diagnosed within 3 mo of primary tumor treatment) in 49% of patients. 34% of patients had ≥ 3 metastases and tumors were distributed bilaterally in 43% of cases. The mean size of the largest metastasis was 41.8 mm. 55% of patients were treated with preoperative systemic chemotherapy. Following resection, 60-day mortality was 1.2% and median, 5-year, and 10-year overall survivals (OS) were 46 mo, 42%, and 26%, respectively. Variables independently associated with poor prognosis included number of metastases > 3 (p<0.0001), bilateral metastases (p=0.0002), and size of the largest metastasis > 5 cm (p=0.03). Preoperative chemotherapy (PC) did not appear to benefit patients with solitary CLM (5-yr OS: PC 45% vs. no PC 58%), but was associated with improved survival in patients with > 5 metastases (5-yr OS: PC 22% vs. no PC 12%). Conclusions: Assessment of outcomes for the first 2,122 registrants to LiverMetSurvey not only confirms the prognostic importance of intrahepatic tumor burden, but also indicates that the ability of preoperative systemic chemotherapy to improve survivals is limited to patients with multiple (> 5) metastases. In addition, this analysis demonstrates the potential for LiverMetSurvey, which is now prospectively enrolling patients from over 40 centers, to determine the therapeutic value of current and future treatment strategies. No significant financial relationships to disclose.

scholarly journals Potential Herb–Drug Interactions in the Management of Age-Related Cognitive Dysfunction

Pharmaceutics ◽  
2021 ◽  
Vol 13 (1) ◽  
pp. 124
Author(s):  
Maria D. Auxtero ◽  
Susana Chalante ◽  
Mário R. Abade ◽  
Rui Jorge ◽  
Ana I. Fernandes
Keyword(s):  
Treatment Options ◽  
Treatment Strategies ◽  
Potential Interaction ◽  
Unique Challenge ◽  
Age Related ◽  
Pharmacological Interactions ◽  
Significant Burden ◽  
Work Interaction ◽  
Middle Aged Adults ◽  
Potential Interactions

Late-life mild cognitive impairment and dementia represent a significant burden on healthcare systems and a unique challenge to medicine due to the currently limited treatment options. Plant phytochemicals have been considered in alternative, or complementary, prevention and treatment strategies. Herbals are consumed as such, or as food supplements, whose consumption has recently increased. However, these products are not exempt from adverse effects and pharmacological interactions, presenting a special risk in aged, polymedicated individuals. Understanding pharmacokinetic and pharmacodynamic interactions is warranted to avoid undesirable adverse drug reactions, which may result in unwanted side-effects or therapeutic failure. The present study reviews the potential interactions between selected bioactive compounds (170) used by seniors for cognitive enhancement and representative drugs of 10 pharmacotherapeutic classes commonly prescribed to the middle-aged adults, often multimorbid and polymedicated, to anticipate and prevent risks arising from their co-administration. A literature review was conducted to identify mutual targets affected (inhibition/induction/substrate), the frequency of which was taken as a measure of potential interaction. Although a limited number of drugs were studied, from this work, interaction with other drugs affecting the same targets may be anticipated and prevented, constituting a valuable tool for healthcare professionals in clinical practice.

Metabolic Syndrome is a Risk Factor for Post-Operative Adhesions: Need for Novel Treatment Strategies

2018 ◽  
Vol 51 (01) ◽  
pp. 35-41 ◽  
Author(s):  
Yair Pilpel ◽  
Guy Pines ◽  
Andreas Birkenfeld ◽  
Stefan Bornstein ◽  
Rafael Miller
Keyword(s):  
Metabolic Syndrome ◽  
Treatment Options ◽  
Treatment Strategies ◽  
Therapeutic Strategies ◽  
Postoperative Adhesions ◽  
Invasive Procedures ◽  
Novel Treatment ◽  
Number Of Patients ◽  
Wide Range ◽  
Novel Treatment Strategies

AbstractMetabolic syndrome is a group of disorders which include obesity, diabetes, dyslipidemias, and hypertension. This condition is rapidly increasing in an aging population. The rates of surgery in older patients is also growing and a wide range of operations including minimally invasive procedures is now available for this segment of the population. The number of patients suffering from postoperative adhesions is therefore correspondingly increasing. In addition to preventing and treating the metabolic disease itself, improved therapeutic strategies for the prevention of surgical adhesions have to be developed. Here we review the existing and novel treatment options.

Update on Interventions in Prevention and Treatment of Pediatric Asthma

2018 ◽  
Vol 25 (16) ◽  
pp. 1909-1919 ◽  
Author(s):  
Elisabetta Calamelli ◽  
Paolo Bottau ◽  
Marcello Lanari
Keyword(s):  
Health Care ◽  
Meta Analysis ◽  
Treatment Options ◽  
Allergic Sensitization ◽  
Pediatric Asthma ◽  
Treatment Strategies ◽  
Treatment And Prevention ◽  
Prevention And Treatment ◽  
Pubmed Search ◽  
The Individual

Background: Asthma represents a worldwide health problem with a strong morbidity and a major impact on the health care system. Multiple efforts have been made towards the development of new strategies for the prevention and treatment of this disorder. In the light of this the present review of the literature aimed at summarizing the latest advances in prevention and treatment of pediatric asthma with a focus on the most effective options of interventions during the first stages of life. Methods: References were identified by searches of PubMed. Search terms used in the search were “pediatric asthma”, “treatment” and “prevention”. We included only meta-analysis, randomized controlled trials, reviews and systematic review articles pertaining to humans and subjects aged 0-18 years. All the interventions have been classified as “non-pharmacological” and “pharmacological”. Results: Non-pharmacological interventions have been focused in identifying the genetic and environmental factors underlying the pathogenesis of this disease, including the individual genetic susceptibility, the early allergic sensitization, the role of the environmental microbiome and the exposure to infections and to pollutants. Moreover, the optimization of the existing pharmacological strategies and the development of new treatment options have improved markedly the management of this disease, thereby reducing the health care costs and ameliorating the quality of life of patients. Conclusion: Childhood asthma prevention and treatment still represents a worldwide challenge. Future efforts should be aimed at identifying high risk target populations, minimizing the costs of each policy of intervention and increasing adherence to treatment strategies.

scholarly journals Recurrent Intrahepatic Cholangiocarcinoma – Review

2021 ◽  
Vol 11 ◽  
Author(s):  
Yuki Bekki ◽  
Dagny Von Ahrens ◽  
Hideo Takahashi ◽  
Myron Schwartz ◽  
Ganesh Gunasekaran
Keyword(s):  
Risk Factors ◽  
Intrahepatic Cholangiocarcinoma ◽  
Treatment Options ◽  
Treatment Strategies ◽  
Early Recurrence ◽  
Current Data ◽  
High Rate ◽  
Locoregional Therapy ◽  
Liver Malignancy ◽  
Term Survival

Intrahepatic cholangiocarcinoma (ICC) is the second-most common primary liver malignancy after hepatocellular carcinoma. While surgical resection with negative margin is the only curative treatment, ICC has very high rate of recurrence, up to 60-70% after curative resection. We reviewed the current data available on risk factors for ICC recurrence, recurrence pattern (location and timing), treatment options, and future directions. The risk factors for recurrence include elevated preoperative CA19-9, presence of liver cirrhosis, nodal metastasis, positive margins, and vascular invasion. Understanding different recurrence patterns, timing course, and risk factors for early recurrence is important to tailor postoperative surveillance and select treatment strategies including systemic or locoregional therapy. Re-resection can be considered for a selected patient population at experienced centers, and can yield long-term survival. ICC remains a dismal disease given the high likelihood of recurrence. Advances in our understanding of the genomic landscape of ICC are beginning to identify targetable alterations in ICC in subsets of patients that allow for personalized treatment.

10: Adults with Overactive Bladder have Significant Health Care Resource Utilization- Evidence from a Large Medicaid Population

2006 ◽  
Vol 175 (4S) ◽  
pp. 4-4
Author(s):  
Gurkirpal Singh ◽  
Smriti Malla ◽  
Huijian Wang ◽  
Harcharan Gill ◽  
Kristijian H. Kahler ◽  
...  
Keyword(s):  
Health Care ◽  
Overactive Bladder ◽  
Resource Utilization ◽  
Health Care Resource ◽  
Health Care Resource Utilization ◽  
Medicaid Population ◽  
Significant Health

New Trends and Developments in Patients with Severe Aortic Stenosis – Towards Optimal Treatment?

2009 ◽  
Vol 5 (2) ◽  
pp. 81 ◽  
Author(s):  
Martijn WA van Geldorp ◽  
Johanna JM Takkenberg ◽  
Ad JJC Bogers ◽  
A Pieter Kappetein ◽  
◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Severe Aortic Stenosis ◽  
Surgical Techniques ◽  
Treatment Strategies ◽  
Tissue Doppler ◽  
Doppler Imaging ◽  
Treatment Modalities ◽  
Diagnostic Tools ◽  
Number Of Patients ◽  
Transcatheter Valve

Over the next few decades the number of patients diagnosed with aortic stenosis is expected to rise as the population ages and the use of several diagnostic tools expands. This will result in a growing need for both medical and surgical treatment and stimulate the development of new diagnostic and surgical techniques. This article briefly describes the prevalence, pathogenesis and clinical presentation of patients with aortic stenosis and focuses on developments in diagnostic tools, treatment strategies and treatment modalities: the use of echocardiography, tissue Doppler imaging, stress testing and biomarkers is discussed, as well as timing of surgery and the role microsimulation can play in prosthesis selection. Furthermore, newly developed transcatheter valve implantation techniques and their possible role in treating ‘inoperable’ or ‘elderly’ patients are discussed.

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