scholarly journals Microspheres Used in Liver Radioembolization: From Conception to Clinical Effects

Molecules ◽  
2021 ◽  
Vol 26 (13) ◽  
pp. 3966
Author(s):  
Philippe d’Abadie ◽  
Michel Hesse ◽  
Amandine Louppe ◽  
Renaud Lhommel ◽  
Stephan Walrand ◽  
...  
Keyword(s):  
Medical Devices ◽  
Liver Tumors ◽  
Particle Therapy ◽  
Poly Lactic Acid ◽  
Internal Dosimetry ◽  
Endocrine Tumors ◽  
Clinical Effects ◽  
Computational Data ◽  
Local Radiation ◽  
The Relationship

Inert microspheres, labeled with several radionuclides, have been developed during the last two decades for the intra-arterial treatment of liver tumors, generally called Selective Intrahepatic radiotherapy (SIRT). The aim is to embolize microspheres into the hepatic capillaries, accessible through the hepatic artery, to deliver high levels of local radiation to primary (such as hepatocarcinoma, HCC) or secondary (metastases from several primary cancers, e.g., colorectal, melanoma, neuro-endocrine tumors) liver tumors. Several types of microspheres were designed as medical devices, using different vehicles (glass, resin, poly-lactic acid) and labeled with different radionuclides, 90Y and 166Ho. The relationship between the microspheres’ properties and the internal dosimetry parameters have been well studied over the last decade. This includes data derived from the clinics, but also computational data with various millimetric dosimetry and radiobiology models. The main purpose of this paper is to define the characteristics of these radiolabeled microspheres and explain their association with the microsphere distribution in the tissues and with the clinical efficacy and toxicity. This review focuses on avenues to follow in the future to optimize such particle therapy and benefit to patients.

scholarly journals Cardiovascular disease and osteoporosis: is there a link between lipids and bone?

2002 ◽  
Vol 39 (3) ◽  
pp. 203-210 ◽  
Author(s):  
John R Burnett ◽  
Samuel D Vasikaran
Keyword(s):  
Cardiovascular Disease ◽  
Bone Density ◽  
Vascular Calcification ◽  
Cholesterol Biosynthesis ◽  
Hormone Replacement ◽  
Plasma Lipid ◽  
Clinical Effects ◽  
Cardiovascular Morbidity And Mortality ◽  
The Relationship

Atherosclerotic heart disease and osteoporosis are both diseases of old age. Evidence is accumulating for a link between vascular and bone disease. Calcification is a common feature of atherosclerotic plaques, and osteoporosis is associated with both atherosclerosis and vascular calcification. However, the relationship of vascular calcification to the pathogenesis of atherosclerosis remains incompletely understood. Hormone replacement therapy has beneficial effects in the prevention of both atherosclerosis and osteoporosis. Bisphosphonates inhibit bone resorption and are used in the treatment of osteoporosis, whereas the statins inhibit cholesterol biosynthesis and are used for the treatment of atherosclerosis. We have reviewed recent advances in the knowledge of the actions of bisphosphonates and statins at the cellular, molecular and end-organ levels in order to examine the relationship between cardiovascular disease and osteoporosis and to explore the link between lipids and bones. These studies suggest that the mechanism of actions of these two classes of drugs at the cellular level may not be mutually exclusive. There are some early clinical data to complement these findings, suggesting that statins increase bone density and bisphosphonates may have a beneficial effect in vivo on plasma lipid levels and on the atherosclerotic process. Properly designed prospective studies that examine the effect of statins on bone density and fractures, as well as the effects of bisphosphonates on lipid profiles, atherosclerotic progression and cardiovascular morbidity and mortality are needed to define clearly the clinical effects and potential new roles for these agents.

scholarly journals Countrywide survey on utilization of medical devices by GPs in Hungary: advantages of the cluster-practice model

2021 ◽  
Vol 22 ◽  
Author(s):  
Katalin Dózsa ◽  
Fruzsina Mezei ◽  
Tamás Tóth ◽  
Ábel Perjés ◽  
Péter Pollner
Keyword(s):  
Medical Devices ◽  
Point Of Care ◽  
Daily Practice ◽  
Evidence Based ◽  
Self Assessment ◽  
Practice Model ◽  
Practice Models ◽  
Integrate State ◽  
The Relationship ◽  
Further Development

Abstract Background: Expectations towards general practitioners (GPs) are continuously increasing to provide a more systematic preventive- and definitive-based care, a wider range of multidisciplinary team-based services and to integrate state-of-the-art digital solutions into daily practice. Aided by development programmes, Hungarian primary care is facing the challenge to fulfil its role as the provider of comprehensive, high quality, patient-centred, preventive care, answering the challenges caused by non-communicable diseases (NCDs). Aim: The article aims to provide an insight into the utilization of simple, digital, medical devices. We show the relationship between the primary health care (PHC) practice models and the used types of devices. We point at further development directions of GP practices regarding the utilization of evidence-based medical technologies and how such devices support the screening and chronic care of patients with NCDs in everyday practice. Methods: Data were collected using an online self-assessment questionnaire from 1800 Hungarian GPs registered in Hungary. Descriptive statistics, Wilcoxon’s test and χ2 test were applied to analyze the ownership and utilization of 32 types of medical devices, characteristics of the GP practices and to highlight the differences between traditional and cluster-based operating model. Findings: Based on the responses from 27.7% of all Hungarian GPs, the medical device infrastructure was found to be limited especially in single GP-practices. Those involved in development projects of GP’s clusters in the last decade reported a wider range and significantly more intensive utilization of evidence-based technologies (average number of devices: 5.42 versus 7.56, P<.001), but even these GPs are not using some of their devices (e.g., various point of care testing devices) due to the lack of financing. In addition, GPs involved in GPs-cluster development model programmes showed significantly greater willingness for sharing relatively expensive, extra workforce-demanding technologies (χ2 = 24.5, P<.001).

scholarly journals Local Toxicity of Topically Administrated Thermoresponsive Systems: In Vitro Studies with In Vivo Correlation

2018 ◽  
Vol 47 (3) ◽  
pp. 426-432 ◽  
Author(s):  
Sivan Yogev ◽  
Ayelet Shabtay-Orbach ◽  
Abraham Nyska ◽  
Boaz Mizrahi
Keyword(s):  
Block Copolymer ◽  
Ethylene Glycol ◽  
Medical Devices ◽  
Poly Lactic Acid ◽  
Poly Ethylene Glycol ◽  
Thermoresponsive Polymers ◽  
Wide Range ◽  
Poly Ethylene

Thermoresponsive materials have the ability to respond to a small change in temperature—a property that makes them useful in a wide range of applications and medical devices. Although very promising, there is only little conclusive data about the cytotoxicity and tissue toxicity of these materials. This work studied the biocompatibility of three Food and Drug Administration approved thermoresponsive polymers: poly( N-isopropyl acrylamide), poly(ethylene glycol)-poly(propylene glycol)-poly(ethylene glycol) tri-block copolymer, and poly(lactic acid-co-glycolic acid) and poly(ethylene glycol) tri-block copolymer. Fibroblast NIH 3T3 and HaCaT keratinocyte cells were used for the cytotoxicity testing and a mouse model for the in vivo evaluation. In vivo results generally showed similar trends as the results seen in vitro, with all tested materials presenting a satisfactory biocompatibility in vivo. pNIPAM, however, showed the highest toxicity both in vitro and in vivo, which was explained by the release of harmful monomers and impurities. More data focusing on the biocompatibility of novel thermoresponsive biomaterials will facilitate the use of existing and future medical devices.

scholarly journals EXPLORATION AND PREFERENTIAL RANKING OF PATIENT BENEFITS OF MEDICAL DEVICES: A NEW AND GENERIC INSTRUMENT FOR HEALTH ECONOMIC ASSESSMENTS

2017 ◽  
Vol 33 (4) ◽  
pp. 463-471 ◽  
Author(s):  
Eva Lesén ◽  
Ingela Björholt ◽  
Anders Ingelgård ◽  
Fredrik J. Olson
Keyword(s):  
Medical Devices ◽  
Well Being ◽  
Healthcare Personnel ◽  
Clinical Effects ◽  
Patient Benefit ◽  
Swedish Population ◽  
Pilot Studies ◽  
Wide Range ◽  
Patient Reported ◽  
Relative Preferences

Objectives: For medical devices, benefits other than direct clinical effects may have a large impact on the patients’ well-being, but a standardized method for measuring these benefits is unavailable. The objective was to explore potential patient benefits provided by medical devices, and to assess the relative preferences of these benefits in the general Swedish population.Methods: To identify attributes of patient benefit, healthcare personnel within a wide range of disease areas were interviewed. The generalized attributes were then validated among healthcare personnel, patient organizations, and manufacturers; in two pilot studies in the general population; and in two rounds of cognitive interviews. The general population's preferences of the attributes were measured with a usability-tested questionnaire in a final responding sample of 3,802 individuals, representative of the Swedish population.Results: Twenty attributes were identified, encompassing aspects of integrity, sense of security, social participation, and convenience. When measuring the relative preferences, the response rate was 37.0 percent, and the results showed that the attributes with the highest preferences concerned reliability, reduced need for assistance, and sense of control of the illness/disability.Conclusions: A set of twenty attributes of patient benefit relevant to users of medical devices was identified and validated. A questionnaire for patient-reported assessment of the benefits provided by a medical device was developed, based on the attributes. The questionnaire, designated MedTech20, provides a generic measurement method for the evaluation of medical devices used in a wide range of diseases/disabilities.

CYP3A5 is unlikely to mediate anticancer drug resistance in hepatocellular carcinoma

2019 ◽  
Vol 20 (15) ◽  
pp. 1085-1092 ◽  
Author(s):  
Volker M Lauschke ◽  
Åsa Nordling ◽  
Yitian Zhou ◽  
Sara Fontalva ◽  
Isabel Barragan ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Drug Resistance ◽  
Anticancer Drug ◽  
Liver Tumors ◽  
Relative Increase ◽  
Loss Of Function ◽  
Wide Range ◽  
Peritumoral Tissue ◽  
Anticancer Drug Resistance ◽  
The Relationship

Recently, it was published that CYP3A5 contributes to chemotherapeutic drug resistance in a wide range of solid tumors, including hepatocellular carcinoma. However, CYP3A5 is highly polymorphic and 90% of Caucasians are homozygous for the loss-of-function allele CYP3A5*3. Here, we evaluate the relationship between CYP3A5 genotype and expression level of both CYP3A5 transcripts and protein in biopsies from 19 pairs of liver tumors and corresponding peritumoral tissue. We find that CYP3A5 transcript levels are reduced compared with peritumoral controls. Moreover, we do not detect CYP3A5 protein in homozygous CYP3A5*3 carriers and no relative increase of CYP3A5 in tumoral tissue of CYP3A5*1 carriers. We conclude that anticancer drug resistance is unlikely to be caused by increased CYP3A5 expression.

Noninferiority testing in cost-minimization studies: Practical issues concerning power analysis

2006 ◽  
Vol 22 (2) ◽  
pp. 261-266 ◽  
Author(s):  
Mark M. Span ◽  
Elisabeth M. TenVergert ◽  
Christian S. van der Hilst ◽  
Ronald P. Stolk
Keyword(s):  
Power Analysis ◽  
Clinical Effect ◽  
Cost Minimization ◽  
Small Sample ◽  
Sensitivity Analyses ◽  
Absolute Difference ◽  
Clinical Effects ◽  
Treatment As Usual ◽  
The Cost ◽  
The Relationship

Objectives:In cost-minimization studies, it is important to establish noninferiority in the clinical effect of the treatments under investigation. The relationship between the proportion of patients reaching the end point in a study, equivalence limit (δ), and power is investigated in the context of cost-minimization studies with dichotomous clinical end points. Two formulations of the null-hypothesis, absolute and relative formulations of δ, will be explored.Methods:Sensitivity analysis was performed, in which the effect of the predicted proportions and δ on the power in a noninferiority setting was investigated. The patterns found are discussed in terms of the practical relevance within the cost-minimization framework.Results:Sensitivity analyses show different patterns of results for both null-hypotheses. The differences in these results originate from the way δ is expressed. By expressing δ as absolute difference, power grows quite fast when sample proportions are smaller than expected. In the case of a proportional δ at small sample proportions, the power to establish noninferiority remains low.Conclusions:To obtain valid results from a cost-minimization study, care has to be taken to adapt the correct methodology for noninferiority testing in clinical outcomes. Defining δ in terms of absolute differences between treatments can lead to obscured results. Although conservative, the expression of δ as a proportion of the effectiveness of the treatment as usual is found to be closer to clinical practice. The inflated δ, resulting from smaller clinical effects than expected when absolute formulation is applied, thus can be avoided.

scholarly journals Tripping over the other: Could psychedelics increase empathy?

2020 ◽  
Author(s):  
Emily Blatchford ◽  
Stephen Bright ◽  
Liam Engel
Keyword(s):  
Social Connectedness ◽  
Clinical Evidence ◽  
Mechanisms Of Action ◽  
Clinical Implications ◽  
Clinical Effects ◽  
Neural Connectivity ◽  
Psychological Conditions ◽  
Psychedelic Drug ◽  
Prosocial Attitudes ◽  
The Relationship

AbstractThere is increasing evidence that psychedelic-assisted psychotherapy is effective for a range of psychological conditions. There are likely numerous mechanisms of action that contribute to these clinical effects. One such mechanism of action might involve psychedelics increasing levels of empathic functioning. This paper synthesises research concerning the relationship between psychedelics and empathy, emphasising neuroscientific and clinical contexts. We conclude that neuropsychological and clinical evidence imply psychedelics could lead to increased empathic functioning. The effects of psychedelics on the 5-HT system, default mode network, neural connectivity and ego dissolution are implicated in these changes. Changes in empathic functioning also likely relate to increases in the personality trait of openness associated with psychedelic drug use, which is well documented. Increased empathic function likely has clinical implications, leading to increased social connectedness as well as prosocial attitudes and behaviours more broadly.

scholarly journals INCREASED TIBIOFEMORAL ROTATION WITH INCREASING SEVERITY OF PATELLAR INSTABILITY

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0023
Author(s):  
Kenneth M. Lin ◽  
Evan W. James ◽  
Lindsay Schlichte ◽  
Grace Wang ◽  
Daniel Green
Keyword(s):  
Patellar Instability ◽  
External Rotation ◽  
Intraclass Correlation ◽  
Mpfl Reconstruction ◽  
Tibial Tubercle ◽  
Tibial Rotation ◽  
Trochlear Groove ◽  
Clinical Effects ◽  
Tibiofemoral Rotation ◽  
The Relationship

Background: Tibiofemoral rotation (TFR), specifically external tibial rotation, has been recently identified as a potential contributing factor to patellar instability. However, no previous studies have explored the clinical effects of differing degrees of TFR in relation to patellar instability. Purpose and Hypothesis: The purpose of this study is to investigate the relationship between severity of instability with degree of TFR. Our hypothesis is that fixed or obligatory dislocators (FOD) are more likely to have increased external TFR (tibial external rotation compared to femur) than standard patellar instability (SPI) patients requiring medial patellofemoral ligament (MPFL) reconstruction, who will have similar or slightly increased external TFR compared to normal controls. Methods: A retrospective study was performed with patients from 3 cohorts from April 2009 to February 2019: FOD, SPI, and controls with normal magnetic resonance imaging (MRI) of the knee. All FOD patients from the study time frame were analyzed, while controls and SPI patients were randomly selected. Patients were included for age under 18 years and diagnosis corresponding to one of the three cohorts, and excluded for outside institution MRI, and previous MPFL reconstruction or tibial tubercle osteotomy. TFR was measured on preoperative axial MRI using the posterior femoral and tibial condylar lines (Figure 1). Tibial tubercle to trochlear groove distance (TT-TG) was measured. Intraclass correlation coefficient (ICC) was calculated among 3 measurers. Statistical analysis using ANOVA and t-test was performed with significance set at α=0.05. Results: A total of 57 patients were included, 19 in each cohort. Average age was 13.2 years (range 10-17 years), with 31 females (54%). ICC for TT-TG and TFR were 0.90 and 0.72, respectively. TT-TG differed between the controls and SPI patients (both P<0.001), and controls and FOD patients (P<0.001), but not between SPI and FOD patients (P=0.12). TFR differed among the three groups: 8.4° (SD 16.7°) external TFR in FOD, 1.6° (SD 5.4°) external TFR in SPI, and 2.5° (SD 5.8°) internal TFR in controls (P=0.0089). FOD patients had significantly greater external tibial rotation than the SPI group (P=0.047). Conclusions: The degree of TFR is correlated with severity of patellar instability, with greater external tibial rotation seen in FOD than SPI patients, while TT-TG was not different. Further information on the relationship of TFR and patellar instability will not only improve understanding of pathogenesis and prognosis, but may also direct surgical treatment strategies in refractory or severe cases. [Figure: see text][Figure: see text]

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