Complete Response To Tislelizumab In A Muscle-Invasive Urothelial Carcinoma After Surgery Associated With Tumor Mutational Burden High: A Case Report

Muscle-invasive urothelial carcinoma (MIUC) is a highly aggressive urothelial carcinoma. Radical cystectomy (RC) is standard of treatment, but still more than 50% patients with cancer invading the muscularis propria or involving the regional lymph nodes will have metastatic recurrence. In CheckMate274 study, programmed cell death-1 (PD-1) inhibitor nivolumab as adjuvant treatment has shown effective for patients with MIUC. Tislelizumab is an anti-human PD-1 monoclonal IgG4 antibody which was specifically engineered to minimize FcɣR macrophage binding to abrogate antibody-dependent phagocytosis. But there is no report of tislelizumab as adjuvant treatment in MIUC currently. Here, we report a case of MIUC in a patient with PD-L1-negative, microsatellite stable (MSS), high tumor mutational burden (TMB-H) obtained complete response (CR) receiving tislelizumab therapy after surgery. Progression-free survival (PFS) exceeded 6 months since tislelizumab treatment. To our knowledge, this is the first reported case of MIUC patient with PD-L1-negative, MSS and TMB-H who responded well to tislelizumab as adjuvant treatment. However, we still need more studies to assess the efficacy of tislelizumab as adjuvant treatment in MIUC and to confirm that TMB is a predicted biomarker of tislelizumab for efficacy.

Photobiomodulation for the Treatment of Primary Headache: Systematic Review of Randomized Clinical Trials

The purpose of this study was to evaluate the efficacy and safety of photobiomodulation as an adjuvant treatment for primary headache. A systematic review of randomized clinical trials was performed. For such, electronic searches were performed in the MEDLINE, Embase, Cochrane Library, LILACS, PEDro, PsycInfo, Clinicaltrials.gov., and WHO/ICTRP databases, with no restrictions imposed regarding language or year of publication. We included studies that assessed any photobiomodulation therapy as an adjuvant treatment for primary headache compared to sham treatment, no treatment, or another intervention. The methodological assessment was conducted using the Cochrane Risk of Bias tool. The certainty of the evidence was classified using the GRADE approach. Four randomized clinical trials were included. Most of the included studies had an overall high risk of bias. Compared to sham treatment, photobiomodulation had a clinically important effect on pain in individuals with primary headache. Despite the benefits reported for other outcomes, the estimates were imprecise, and the certainty of the evidence was graded as low. These findings are considered insufficient to support the use of photobiomodulation in the treatment of primary headache. Randomized clinical trials, with higher methodological quality, are needed to enhance the reliability of the estimated effects.

A Network Meta-Analysis of the Clinical Efficacy and Safety of Commonly Used Chinese Patent Medicines in the Auxiliary Treatment of Poststroke Depression

Background. Poststroke depression (PSD) is a serious complication of clinical cerebrovascular disease. Patients not only have depression-related emotional symptoms but also have physical symptoms, such as autonomic dysfunction. At the same time, patients with varying degrees of depression will delay the neurological function of stroke patients. The recovery time of cognitive function and limb function will increase the risk of accidental death and even aggravate the mortality of cerebrovascular disease. Through combining data analysis and related literature, seven types of Chinese patent medicines (CPMs) widely used in the clinical treatment of PSD have been screened out. These herbs exhibit some clinical comparability under the conditions that the syndrome type and dosage form are relatively uniform. Therefore, in this study, the network meta-analysis method was used to evaluate the safety and efficacy of the seven CPMs screened out, and the probability ranking was performed to screen the best clinical auxiliary treatment plan of CPM. Methods. We searched the Chinese databases, including CNKI, WANFANG, and VIP, as well as the English databases, including the Cochrane Library, EMBASE, and PubMed, from inception to May 31, 2020, to identify randomized controlled trials (RCTs) on seven kinds of CPMs that were the subjects of the clinical research. The bias risk and quality of the included studies were analyzed with the Cochrane Handbook (version 5.1), ADDIS, and R software, and the results were compared in a network meta-analysis (NMA). Results. In terms of clinical effectiveness, the seven kinds of CPMs all improved clinical curative effects, with Jieyu Anshen capsule adjuvant treatment having the most significant effect [odds ratio (OR) = 5.00, 95% CI (1.72–9.48)]. Wuling capsule AT can effectively reduce the score index of scale factors for the HAMD score, NIHSS score, and TESS score [mean difference (MD) = −3.95, 95% CI (−4.88–3.00); OR = −3.25, 95% CI (−5.46)–1.05); OR = 0.22, 95% CI (0.05–0.79), resp.]. Conclusion. The mechanisms of seven CPMs in the adjuvant treatment of PSD have advantages. In terms of safety and efficacy, the CPMs had better clinical adjuvant treatment performance. Although this study concluded that the Jieyu Anshen capsule is the preferred drug for clinical treatment, a clear conclusion still needs to be verified in a high-quality randomized controlled study. In clinical practice, accurate selection and application can be carried out according to the specific characteristics of patients.

Transtentorial spread of glioblastoma multiforme to cerebellopontine angle – A rare case report

Background: Glioblastoma multiforme (GBM) is the most common central nervous system malignant tumor in adults with 48.3% of cases. Despite it, the presence of transtentorial spread is uncommon, with few patients reported in the literature. In this study, the authors report a case of GBM transtentorial spread to cerebellopontine angle after resection and adjuvant treatment. Case Description: A 55-year-old male patient with GBM, previously submitted to surgical resection and adjuvant treatment with radiotherapy and quemotherapy. Fourteen months after the first surgery, he developed headaches associated with dysphagia and dysphonia. Magnetic resonance imaging showed a recurrence of the left parietal lesion and a new mass in the right cerebellopontine angle. The patient underwent successful surgical resection of both lesions. Chemotherapy was maintained after the surgery. Conclusion: To the best of our knowledge, there are few cases of GBM metastasis to the cerebellopontine angle reported in the literature. Surgical management should be considered in cases of intracranial hypertension and patients with good performance status.

Đánh giá bước đầu ứng dụng tia plasma lạnh trong điều trị hỗ trợ làm lành vết thương phần mềm trên bệnh nhân Covid-19 nặng

TÓM TẮT Đặt vấn đề: Plasma là môi trường chứa các vật chất không còn giữ được cấu trúc phân tử của mình mà bị ion hóa. Thể plasma lạnh được ứng dụng rộng rãi trong Y học với tính an toàn và hiệu quả được khẳng định trong nhiều nghiên cứu. Nghiên cứu này thực hiện tại Trung tâm Hồi sức Tích cực điều trị bệnh nhân COVID-19 của Bệnh viện Trung Ương Huế tại TP.Hồ Chí Minh nhằm mục đích (1) nhận định đặc điểm chung, đặc điểm lâm sàng của bệnh nhân COVID-19 nặng có sang thương phần mềm và (2) đánh giá bước đầu tác dụng tia plasma lạnh trong điều trị hỗ trợ làm lành vết thương phần mềm đối với bệnh nhân COVID-19 nặng Đối tượng, phương pháp: Khảo sát nhanh trong 45 ngày các bệnh nhân bị COVID-19 nặng có sang thương phần mềm đang điều trị tại Trung tâm Hồi sức Tích cực điều trị bệnh nhân COVID-19 trực thuộc Bệnh viện Trung Ương Huế tại TP.Hồ Chí Minh, nghiên cứu mô tả cắt ngang. Kết quả: Trong 915 bệnh nhân bị COVID-19 nặng, có 20 trường hợp bị thương tổn phần mềm được điều trị bằng chiếu tia Plasma lạnh, tỷ lệ nam, nữ 1 : 1, 70% nguyên nhân do loét ép độ I, II, III, 60% tổn thương vùng lưng, mông, cùng cụt. 55,0% thương tổn trước khi chuyển viện đến trung tâm. Sau 14 ngày điều trị 70% vết thương biểu mô hóa hoàn toàn, 90% hết rỉ dịch, sau 3 tuần tất cả vết thương hết đau, hết nổi mẫn hoàn toàn. Kết luận: Tia Plasma lạnh có vai trò tích cực trong hỗ trợ điều trị vết thương phần mềm đối với bệnh nhân COVID-19 mức độ nặng. ABSTRACT COLD PLASMA IRRADIATION AS AN ADJUVANT TREATMENT DIGITAL LESIONS FOR PATIENTS WITH SEVERE COVID-19: INITIAL EVALUATION Background: Plasma is a medium containing substances that no longer retain their molecular structure but are ionized. Cold plasma is widely used in medicine, with safety and effectiveness confirmed in many studies. This study was conducted at the Intensive Care Center for COVID-19 patients of Hue Central Hospital in Ho Chi Minh City to evaluate the general and clinical characteristics in severe COVID-19 patients with digital lesions, to evaluate the effect of cold plasma in the adjuvant treatment of soft tissue wound healing in patients with severe COVID-19 disease initially. Methods: This cross-section descriptive study was conducted on severe COVID-19 patients who undergo digital lesions treated at the COVID-19 Intensive Care Center operated by Hue Central Hospital in Ho Chi Minh, Vietnam, a quick 45 - day survey. Results: In 915 patients with severe COVID-19, 20 cases of digital lesions were experienced with cold plasma irradiation. The male - to - female ratio was 1: 1, 70% of wounds caused by pressure ulcers. 60% of lesions were located on the dorsum, gluteal and sacral region. 55.0% of lesions were discovered before transfer to our center. After 14 days of treatment, 70% of the wounds were completely epithelialized, 90% had no fluid oozing. After three weeks, all the lesions were pain-free, and the redness was completely terminated. Conclusion: Cold plasma Irradiation effectively supports the treatment of digital ulcers in patients with severe COVID-19 disease. Keywords: Cold plasma, COVID-19, pressure ulcers, dermatology, intensive care unit.

Vitreoretinal Surgical Approaches in Intraocular Tumors

Although primary vitreoretinal techniques are rarely used in the primary treatment of intraocular tumors, they are mostly used for differential diagnosis and as an adjuvant treatment for the actual radiotherapy of these tumors. Especially biopsies are taken for masquerading syndromes, biopsies for prognostic evaluation and alternative/adjuvant treatment methods of intraocular tumors have been emphasized in this paper. The principles of vitreoretinal approaches in these cases are evaluated in light of our clinical experience and current literature data.