The spine instability neoplastic score (SINS) in the assessment of response to radiotherapy for bone metastases

Abstract

Background

Vertebral metastases are often causing pain and spine instability. Radiotherapy is of significant benefit for painful spine metastases but the response can be very variable. The spine instability neoplastic score (SINS) is a recent classification system for diagnosis of spinal instability caused by vertebral metastases. We analysed the degree of pain relief, the need of drug therapy and the imaging features and the SINS before and after radiotherapy. In particular, we investigated the possible correlation of spine instability defined by pre-treatment SINS with pretreatment pain and with response to radiotherapy.

Material/methods

This study included 121 patients with spine metastases treated with palliative 3D conformal radiotherapy. Pain "at rest" and "breakthrough pain", need for drug therapy in terms of "anti-inflammatory", "weak opioid", "strong opioid", imaging studies and SINS were assessed before and after radiotherapy. Statistical analysis was performed by the correlation coefficient of Spearman and Kruskal–Wallis test.

Results

Pain relief after radiotherapy was observed in 50.4 and 57.8% of patients in terms of pain at rest and breakthrough pain, respectively. The correlation between pain before radiotherapy and SINS was not statistically significant for both pain at rest (p = 0.4) and breakthrough pain (p = 0.49). The correlation between pain response after radiotherapy and SINS was statistically significant for both pain at rest (p = 0.007) and breakthrough pain (p = 0.047).

Discussion/conclusion

The degree of instability, classified according to SINS, resulted to be predictive factor for pain response after radiotherapy. SINS might become a valid tool to identify those patients who can benefit the most from radiotherapy.

http://ift.tt/2szjr9y

Pancreatic ductal adenocarcinoma: metastatic disease

Abstract

The treatment of choice of metastatic PADC is systemic chemotherapy. In the last decade, there have been significant advances in this area. New combination poli-chemotherapy schemes have shown a significant increase in overall survival and progression-free survival without impairing quality of life. In addition, the value of second-line chemotherapy treatment has consolidated and a new concept called "therapeutic sequencing" has also emerged. The aim of this article is to review the different therapeutic options in metastatic PDAC based on patient's characteristics.

http://ift.tt/2t8WCqr

The potential roles of bacteria to improve radiation treatment outcome

Abstract

Many combined therapies have been proposed to enhance radiotherapy outcome, but they have several limitations. As a new feasible strategy, combination of radiotherapy with bacteria showed a significant positive impact on the tumor treatment and metastasis inhibition. Although probiotic bacteria and radiotherapy alone can be effective in the treatment of different cancers, the combination of these two therapies seems to enhance therapeutic outcome and is cost-effective. Bacterial cells can act as therapeutic/gene/drug delivery vehicles as well as theranostic agents. In this communication, we reviewed current evidences, studies, suggestions, and future-based directions on combination of radiotherapy and bacteria. In another sections, an overview on tumor hypoxia, bacteria in cancer therapy, and combination of radiotherapy and bacteria is presented. A brief overview on trials and animal studies which used bacteria to protect normal tissues against radiotherapy-induced complications is also included.

http://ift.tt/2sztDiB

Visiting virtual beach improves patient experiences during dental procedures

Imagine walking along a South Devon beach on a lovely day. The waves are lapping on the shore, rabbits are scurrying in the undergrowth, and the bells of the local church are mingling with the calls...

http://ift.tt/2t93Tq4

Nonintravenous rescue medications for pediatric status epilepticus: A cost-effectiveness analysis

Summary

Objective

To quantify the cost-effectiveness of rescue medications for pediatric status epilepticus: rectal diazepam, nasal midazolam, buccal midazolam, intramuscular midazolam, and nasal lorazepam.

Methods

Decision analysis model populated with effectiveness data from the literature and cost data from publicly available market prices. The primary outcome was cost per seizure stopped ($/SS). One-way sensitivity analyses and second-order Monte Carlo simulations evaluated the robustness of the results across wide variations of the input parameters.

Results

The most cost-effective rescue medication was buccal midazolam (incremental cost-effectiveness ratio ([ICER]: $13.16/SS) followed by nasal midazolam (ICER: $38.19/SS). Nasal lorazepam (ICER: −$3.8/SS), intramuscular midazolam (ICER: −$64/SS), and rectal diazepam (ICER: −$2,246.21/SS) are never more cost-effective than the other options at any willingness to pay. One-way sensitivity analysis showed the following: (1) at its current effectiveness, rectal diazepam would become the most cost-effective option only if its cost was $6 or less, and (2) at its current cost, rectal diazepam would become the most cost-effective option only if effectiveness was higher than 0.89 (and only with very high willingness to pay of $2,859/SS to $31,447/SS). Second-order Monte Carlo simulations showed the following: (1) nasal midazolam and intramuscular midazolam were the more effective options; (2) the more cost-effective option was buccal midazolam for a willingness to pay from $14/SS to $41/SS and nasal midazolam for a willingness to pay above $41/SS; (3) cost-effectiveness overlapped for buccal midazolam, nasal lorazepam, intramuscular midazolam, and nasal midazolam; and (4) rectal diazepam was not cost-effective at any willingness to pay, and this conclusion remained extremely robust to wide variations of the input parameters.

Significance

For pediatric status epilepticus, buccal midazolam and nasal midazolam are the most cost-effective nonintravenous rescue medications in the United States. Rectal diazepam is not a cost-effective alternative, and this conclusion remains extremely robust to wide variations of the input parameters.

http://ift.tt/2svWvHl

Influence of late fluid management on the outcomes of severe trauma patients: a retrospective analysis of 294 severely-injured patients

Publication date: Available online 15 June 2017
Source:Injury
Author(s): Mehdi Mezidi, Mehdi Ould-Chikh, Pauline Deras, Camille Maury, Orianne Martinez, Xavier Capdevila, Jonathan Charbit
BACKGROUNDLiberal late fluid management (LFM) is associated with higher morbi-mortality in critically ill populations. The aim of the study was to assess the association between LFM and duration of mechanical ventilation in a severe trauma population.METHODSA retrospective analysis of consecutive patients with an ISS≥16 and a length of stay in the intensive care unit (ICU)≥7 days was performed. The conservative LFM group included patients with at least 2 consecutive days with a negative fluid balance between day 3 and day 7; other patients were allocated to the liberal LFM group.RESULTS294 severely injured patients were included, 157 (53%) as conservative LFM and 137 (47%) as liberal LFM. The groups did not differ significantly in terms of baseline characteristics, severe injuries, severity criteria or transfusion needs. Liberal LFM was significantly associated with more ventilation days (11 vs 8.5 days; P=0.02), less ventilator-free days at day 30 (19 vs 21 days; P=0.03), longer ICU stay (19 vs 16 days; P=0.03) and longer hospital stay (30 vs 25 days; P=0.04). Mortality rates were comparable between groups (6%). Liberal LFM was significantly associated in multivariable analysis with a reduced number of ventilator-free days at day 30 (β=− 2.14 [95% CI, −4.2 to −0.08], P=0.042).CONCLUSIONSLiberal LFM was associated with higher morbidity in severe trauma patients, longer duration of ventilation, and longer ICU and hospital stays. These results were observed despite similar severity on admission and early fluid management.



http://ift.tt/2s86JgP

Contribution of CARD9-mediated signaling to wound healing in skin

Abstract

The inflammatory response after skin injury involves the secretion of a variety of cytokines and growth factors that are necessary for tissue repair. Caspase recruitment domain-containing protein 9 (CARD9) is an essential signaling adaptor molecule for NF-κB activation upon triggering through C-type lectin receptors (CLRs), which are expressed in macrophages and dendritic cells. However, the role of CARD9 in inflammatory responses at the wound site has not been elucidated. In the present study, we analyzed the role of CARD9 in the healing process of skin wounds. Wounds were created on the backs of wild-type (WT) C57BL/6 mice and CARD9 gene-disrupted (knockout [KO]) mice. We analyzed percent wound closure, and the wound tissues were harvested for analysis of leukocyte accumulation and cytokine and chemokine expression. CARD9KO mice exhibited significant attenuation of wound closure compared with WT mice on days 5, 7, and 10 post-wounding, which was associated with decreased macrophage accumulation and reduced TNF-α, IL-1β, CCL3, and CCL4 expression. These results suggest that CARD9 may be involved in the wound healing process through the regulation of macrophage-mediated inflammatory responses.

This article is protected by copyright. All rights reserved.

http://ift.tt/2ttOccu