Target Nanoparticles Against Pancreatic Cancer: Fewer Side Effects in Therapy

Pancreatic cancer leads the most common lethal tumor in America. This lethality is related to limited treatment options. Conventional treatments involve a non-specific use of chemotherapeutical agents like 5-FU, capecitabine, gemcitabine, cisplatine, oxaliplatine, or irinotecan, that produce several side effects. This review we focus on the use of targeted nanoparticles as an alternative to the standard treatment for the pancreatic cancer. The principal objective of the use of nanoparticles is the reduction in side effects that conventional treatments produce, mostly because of their nonspecificity. Currently, several molecular markets of pancreatic cancer cells have been studied to target nanoparticles and improve the actual treatment. Therefore, properly functionalizated nanoparticles with specific aptamers or antibodies can be used to recognize pancreatic cancer cells and once cancer is recognized, these nanoparticles can attack the tumor by drug delivery, hyperthermia, or gene therapy.

AGO Algorithms for the Treatment of Breast Cancer: Update 2021

Therapy options shown in the algorithms are based on the current AGO recommendations, but cannot represent all evidence-based treatment options, since prior therapies, performance status, comorbidities, patient preference, etc. must be taken into account for the actual treatment choice. In individual cases, other evidence-based treatment options may also be appropriate and justified. Regardless of approval status, the algorithms only take into account drugs that were available in Germany at the time the algorithm was last updated. Here we present the 2021 update of AGO treatment algorithms for early and metastatic breast cancer, which are intended to intensify structured treatment decision by providing reproducible and evidence-based treatment paths and may be helpful for a broad treatment landscape.

Trans-stenotic pressure gradient as derived from CT improves patient management: ADVANCE registry

Background The change in fractional flow reserve derived from CT (FFRCT) value across a coronary stenosis (ΔFFRCT) improves the physiological characterization of coronary artery disease (CAD). The role of ΔFFRCT in guiding risk-stratification and downstream testing in patients with stable CAD is unknown. Purpose To investigate the incremental value of ΔFFRCT at predicting early revascularization and improving efficacy of resource utilization. Methods Patients with CAD on CT coronary angiography (CTCA) were enrolled in an international multicenter registry. Patients with non-evaluable FFRCT analysis were excluded. The CTCA was assessed for: stenosis severity as per CAD-Reporting and Data System (CAD-RADS), lesion length and lesion-specific FFRCT measured 2 cm distal to stenosis. Risk factors and actual treatment (revascularization vs medical therapy) at 90-day follow-up were recorded. Multivariable logistic regression analysis for early revascularization was conducted. The incremental discrimination for revascularization prediction was compared among 3 models (model 1: risk factors + lesion length and location + CAD-RADS; model 2: model 1 + lesion-specific FFRCT; model 3: model 2 + ΔFFRCT). Simulating ICA referral for patients with CAD-RADS ≥3 and lesion-specific FFRCT ≤0.8, the potential impact of ΔFFRCT at reducing ICA referral and improving the ratio of subsequent revascularization was assessed. Results Of 4730 patients (66±10 years; 34% female), 2092 (42.7%) underwent ICA and 1168 (24.7%) underwent early revascularization. With increasing ΔFFRCT, a higher incidence of revascularization (Figure 1A) and an increase in the revascularization to ICA ratio was observed (Figure 1B). ΔFFRCT >0.13 was the optimal cut-off for predicting revascularization as determined by the Youden index. ΔFFRCT remained an independent predictor for early revascularization (odds ratio per 0.05 increase with 95% CI, 1.31 [1.26–1.35]; p<0.0001) after adjusting for risk factors, CAD-RADS, lesion length and location, and FFRCT. Among the 3 models, model 3, which included ΔFFRCT showed the highest AUC and improved discrimination power compared to model 2 (0.87 [0.86–0.88] vs 0.85 [0.84–0.86]; p<0.0001] (Figure 2), with the greatest incremental value for ΔFFRCT observed in patients with lesion-specific FFRCT between 0.71–0.80. In patients with CAD-RADS ≥3 and lesion-specific FFRCT ≤0.8, a diagnostic strategy incorporating ΔFFRCT >0.13 would potentially reduce ICA referral by 32.2% (1638 to 1110) and improve the revascularization to ICA ratio from 65.2% [1068/1638] to 73.1% [811/1110]. Conclusions The characterization of CAD with ΔFFRCT improves the identification of patients requiring early revascularization as compared to a standard diagnostic strategy of CTCA with FFRCT, particularly for those with lesion-specific FFRCT of 0.71–0.80. ΔFFRCT has the potential to aid decision making for ICA referral and improve the efficiency of resource utilization. FUNDunding Acknowledgement Type of funding sources: Private company. Main funding source(s): HeartFlow, Inc., Redwood City, CA, USA ΔFFRCT and actual treatment ROC curve for early revascularization

Effect of Brucine on Three Chondrocyte Apoptosis Models

With the development of people’s application technology of Strychnine, Strychnine is a relatively common type of medicine in the current clinical treatment of arthritis patients. And in the actual treatment, because strychnine has an important effect on the apoptosis of three kinds of chondrocytes. Better results can often be achieved through the use of horse money, which is of great significance to patients. The analysis of the influence of strychnose on the apoptosis of the three types of chondrocytes has become the focus of research in the academic and industry circles. The purpose of this article is to analyze the impact of Strychnoma chinensis on three chondrocyte apoptosis models. In this paper, by establishing a system for culturing rat chondrocytes in vitro, using nitric oxide in vitro cultured rat chondrocytes to induce their apoptosis, and observing the effect of Strychnine, the main monomer component of Chinese medicine Strychnine, on the cellular and molecular levels. The mechanism of SD rat chondrocyte apoptosis is to explore the establishment of a system for culturing rat chondrocytes in vitro. In this paper, rat chondrocytes cultured in vitro were induced by nitric oxide to induce their apoptosis, and the mechanism of strychnine, the main monomer component of Strychnine, was observed in order to explore the mechanism of strychnine on the apoptosis of SD rat chondrocytes in vitro. The experimental results showed that strychnine induced apoptosis of chondrocytes, and the survival rate of cells during 36h and 48h after administration was 99% and 97%, respectively. Its apoptotic rate decreases with the increase of the dose and time of strychnine.

Prevalence of Dental Fear and Anxiety among Orthodontic patients visiting Nobel Medical College

Introduction: Anxiety is the state of feeling nervous or worried that something bad is going to happen. Dental anxiety is defined as a patient’s response to stress that is associated with a dental procedure. The aim of our study is to investigate the anxiety status of dental patients visiting Orthodontic department at Nobel Medical College Teaching Hospital, Biratnagar. Materials and Method: Total 80 ongoing orthodontic patients (M =21 F=59) who completed modified Dental Anxiety Scale questionnaire were included in the study. Result: Majority of patients (65%) had moderate anxiety where as 25% had mild anxiety and around 9% had severe to extreme anxiety. Patients’ age and education level had significant association with the level of dental anxiety. Conclusion: Dental anxiety in orthodontic patients is unavoidable but needs appropriate counseling. Orthodontist’s role is crucial in bridging the gap between patients’ perception towards orthodontic treatment and the actual treatment.

The Pragmatic Turn in Clinical Research

How does knowledge obtained in clinical trials apply to the actual treatment of patients? This question has recently acquired a new significance amidst complaints about the limited ability of trial results to improve clinical practice. Pragmatic clinical trials have been advocated to address this problem. In this article, I trace the emergence of the pragmatic turn in clinical research, starting from the first mention of ‘pragmatic trial’ in 1967, and analyse the changes to how pragmatism has been conceived. I argue that contemporary version of pragmatism risks missing the mark by focusing exclusively on establishing similarity between the trial and the clinic for the purpose of greater generalizability. This focus eclipses the move for carefully aligning medical experimentation with conditions, needs and concerns in the clinic aimed at greater usefulness.

Safety data in randomised real-world evidence studies: Salford Lung Study learnings

Evidence to support clinical decision making must be based on safety data that have been captured, analysed, and interpreted in a robust and reliable way. Randomised real-world evidence (RRWE) studies provide the opportunity to evaluate the use of medicines in patients and settings representative of routine clinical practice. However, elements that underpin the design of RRWE studies can have a significant impact upon the analysis, interpretation, and implications of safety data.In this narrative review, we use data from the Salford Lung Study; two prospective, 12-month, open-label, parallel-group, phase III randomised controlled trials conducted in primary care in the UK; to highlight the importance of capturing treatment modifications when attempting to evaluate safety events according to actual treatment exposure.We demonstrate that analysing safety data by actual treatment received (i.e. accounting for the treatment modifications that occur routinely in the primary care setting) provides additional insight beyond analysing according to randomised treatment strategy only.It is therefore proposed that understanding of safety data from RRWE trials can be optimised by analysing both by randomised group and by actual treatment received.

Strategies to enhance the treatment of lacunar stroke

Lacunar stroke (LS) is caused mainly by pathological changes in the small intracerebral (perforating) arteries, which are typical for arterial hypertension primarily. The current review highlights actual treatment strategies to LS. The management of patients with LS is carried out in accordance with the general approaches for ischemic stroke treatment and includes acute reperfusion and prevention of recurrent stroke. The choice of antithrombotic therapy in patients with LS is based on assessment of intracerebral hemorrhage and systemic bleeding risks. Dual antiplatelet therapy in patients with LS is not provide a significant benefit beyond aspirin monotherapy, increasing intracerebral hemorrhage risk.

Porous graphitic carbon nitride nanomaterials for water treatment

This review summarizes the application of porous g-C3N4 in water treatment and modification to enhance its catalytic performance, showing the potential of porous g-C3N4 for the actual treatment of water bodies.