The Alliance AMBUSH Trial: Rationale and Design

Unlike medulloblastoma (MB) in children, robust prospective trials have not taken place for older patients due to the low incidence of MB in adults and adolescent and young adults (AYA). Current MB treatment paradigms for older patients have been extrapolated from the pediatric experience even though questions exist about the applicability of these approaches. Clinical and molecular classification of MB now provides better prognostication and is being incorporated in pediatric therapeutic trials. It has been established that genomic alterations leading to activation of the sonic hedgehog (SHH) pathway occur in approximately 60% of MB in patients over the age of 16 years. Within this cohort, protein patched homolog (PTCH) and smoothened (SMO) mutations are commonly found. Among patients whose tumors harbor the SHH molecular signature, it is estimated that over 80% of patients could respond to SHH pathway inhibitors. Given the advances in the understanding of molecular subgroups and the lack of robust clinical data for adult/AYA MB, the Alliance for Clinical Trial in Oncology group developed the AMBUSH trial: Comprehensive Management of AYA and Adult Patients with Medulloblastoma or Pineal Embryonal Tumors with a Randomized Placebo Controlled Phase II Focusing on Sonic Hedgehog Pathway Inhibition in SHH Subgroup Patients (Adult & Adolescent MedulloBlastoma Using Sonic Hedgehog Trial). This trial will enroll patients 18 years of age or older with MB (any molecular subgroup and risk stratification) or pineal embryonal tumor. Patients will be assigned to one of three cohorts: (1) average risk non-SHH-MB, (2) average risk SHH-MB, and (3) high risk MB or pineal embryonal tumors. All patients will receive protocol-directed comprehensive treatment with radiation therapy and chemotherapy. Patients with SHH-MB in cohort 1 will be randomized to a smoothened inhibitor or placebo as maintenance therapy for one year.

Heart failure with preserved ejection fraction: recent concepts in diagnosis, mechanisms and management

It is estimated that half of all patients with heart failure (HF) have HF with preserved ejection fraction (HFpEF). Yet this form of HF remains a diagnostic and therapeutic challenge. Differentiating HFpEF from other causes of dyspnoea may require advanced diagnostic methods, such as exercise echocardiography, invasive haemodynamics and investigations for ‘HFpEF mimickers’. While the classification of HF has relied heavily on cut-points in left ventricular ejection fraction (LVEF), recent evidence points towards a gradual shift in underlying mechanisms, phenotypes and response to therapies as LVEF increases. For example, among patients with HF, the proportion of hospitalisations and deaths due to cardiac causes decreases as LVEF increases. Medication classes that are efficacious in HF with reduced ejection fraction (HFrEF) have been less so at higher LVEF ranges, decreasing the risk of HF hospitalisation but not cardiovascular or all-cause death in HFpEF. These observations reflect the burden of non-cardiac comorbidities as LVEF increases and highlight the complex pathophysiological mechanisms, both cardiac and non-cardiac, underpinning HFpEF. Treatment with sodium-glucose cotransporter 2 inhibitors reduces the risk of composite cardiovascular events, driven by a reduction in HF hospitalisations; renin-angiotensin-aldosterone blockers and angiotensin-neprilysin inhibitors result in smaller reductions in HF hospitalisations among patients with HFpEF. Comprehensive management of HFpEF includes exercise as well as treatment of risk factors and comorbidities. Classification based on phenotypes may facilitate a more targeted approach to treatment than LVEF categorisation, which sets arbitrary cut-points when LVEF is a continuum. This narrative review summarises the pathophysiology, diagnosis, classification and management of patients with HFpEF.

Evaluation System of Smart Logistics Comprehensive Management Based on Hospital Data Fusion Technology

With the acceleration of the informatization process, but because of the late start of the informatization construction of logistics management, the current digital system construction of logistics management has not been popularized, and the intelligent logistics integrated management evaluation system is also extremely lacking. In order to solve the lack of existing intelligent logistics comprehensive management evaluation system, this paper introduces the research of intelligent logistics comprehensive management evaluation system based on hospital data fusion technology. This paper analyzes and utilizes the Kalman filter and adaptive weighted data fusion technology in data fusion technology and then analyzes the evaluation index and system design principles of the intelligent logistics comprehensive management evaluation system and then designs the application layer from the application layer. Design the application layer from the application layer. Then design the framework of the intelligent logistics comprehensive management evaluation system at the network layer and the data layer. The system is finally tested, and the test results show that the evaluation accuracy of the system reaches 80%.

Role of Psychology Treatment in "Anxiety Disorder"

In order to manage the emotional and psychological problems in special population such as mental retardation. HIV positive cases and so on. A comprehensive management of this type of cases includes psychotherapy. Here it is necessary to know about this concept and its beauty in various disorders. It is a psychological method which is called psychotherapy (Talking Cure). Psychotherapy is a systematic attempt to manage the mental and emotional disorders with the help of psychological means a variant of this approach came in 1960s. Which was called cognitive behavior therapy. Recent days this approached has been brought revolution in management of psychological, behavioral and emotional problems. This paper will enhance our knowledge regarding status of psychological method in various disorders and mental illnesses.

An Attempt to Evaluate the Green Construction of Large-Scale Hydropower Projects: Taking Wudongde Hydropower Station on the Jinsha River, China as an Example

Huge amounts of energy and resources will be consumed, and a large quantity of environmental pollutants will be produced during the construction process of large-scale hydropower projects. As a core link of green supply chain in hydropower projects, green construction is particularly critical. To objectively evaluate the green construction level of large-scale hydropower projects, an evaluation indicator system was constructed in the study. The evaluation system consisted of 30 quantitative indicators and 7 qualitative indicators from the perspectives of environmental protection, resource saving and comprehensive management on the basis of the construction characteristics of large-scale hydropower projects. The quantitative and qualitative evaluation standards were proposed by combining with relevant laws and regulations, specifications and standards, and the environmental management maturity model. Furthermore, taking the second quarter of 2018 in Wudongde Hydropower Station on the Jinsha River, China, as an example, green construction level was assessed by the analytic hierarchy process fuzzy comprehensive evaluation (AHP-FCE) method. The calculation results indicated that the evaluation value of green construction in Wudongde Hydropower Station was 3.697, at “Good” level. The evaluation values of environmental protection, resource saving, and comprehensive management were 3.681, 3.473, and 3.965, respectively, within the range of 3 to 4, so they were all evaluated to be “Good”. To further improve the green construction level, it was necessary to supervise some aspects of construction process, i.e., treatment of waste slag in construction, economical and intensive utilization of land, publicity and training, soil erosion control, and saving water resources. In particular, management of soil erosion control should be strengthened. The proposed green construction evaluation system is relatively reliable and practical for professionals in the green hydropower industry, and can provide a reference for other large-scale hydropower projects.

Enhanced recovery after surgery: anesthesia-related components

Background: Enhanced recovery after surgery (ERAS) is a multidisciplinary and multimodal evidence-based approach aimed at improving the recovery of surgical patients. Successful implementation of ERAS protocols requires proper perioperative communication and collaboration among surgeons, anesthesiologists, nurses, and other medical personnel.Current Concepts: The anesthesiologist is the clinical leader responsible for the ERAS program. Preoperative patient evaluation, optimization, and patient education are essential components of the ERAS program. The program also involves preoperative fasting and carbohydrate loading to minimize catabolic effects. Selection of an appropriate anesthetic regimen, fluid and temperature management, avoidance of intra/postoperative nausea and vomiting, and multimodal pain management are the key components of ERAS for which the anesthesiologist is responsible.Discussion and Conclusion: Factors that enable the successful implementation of ERAS include the willingness to change to ERAS, formation of multidisciplinary teams to improve cooperation, and support from the hospital management, as well as standardization of order sets and care processes and the appropriate use of audits. As the leader of the ERAS team, the anesthesiologist should be actively involved in comprehensive management of the patient during the perioperative period.