Phase II trial of a novel chemotherapy regimen CVEP (cyclophosphamide, vinblastine, etoposide and prednisolone) for acquired immunodeficiency syndrome (AIDS)-associated lymphomas.

Management of acquired immunodeficiency syndrome (AIDS)-related diffuse large B-cell (DLBCL) and plasmablastic lymphomas (PBL) poses significant challenges. The evidence supports use of dose-adjusted EPOCH (etoposide, prednisone, vincristine, cyclophosphamide and doxorubicin) with or without rituximab as first-line therapy. The need for central venous access, growth factors and significant toxicities limits its use in resource-constrained settings. To address these challenges, we have developed a novel regimen, CVEP (cyclophosphamide, vinblastine, etoposide, and prednisolone) based on the pharmacodynamic principles of dose-adjusted EPOCH. This single-centre phase II study evaluated the efficacy and safety of CVEP regimen in patients with de novo systemic AIDS-related DLBCL and PBL. The primary objective was complete response (CR) rates as assessed by positron emission tomography-computed tomography. The secondary objectives were incidence of Grade 3/4 toxicities, toxicities requiring hospitalisation, and disease-free survival. From May 2011 to February 2017, 42 patients were enrolled. At the end of therapy the CR rates were 69% (29/42) in the intention-to-treat population and 80.5% (29/36) in evaluable patients. At a median follow-up of 69 months, the 5-year disease-free survival was 65.3%. Out of 217 cycles administered, febrile neutropenia occurred in 19.3% and hospitalisation was required in 18.3% of cycles. There were two treatment-related deaths. The CVEP regimen is an active and safe regimen for AIDS-related DLBCL and PBL.

Factors Influencing Compliance to Radical Treatment of Middle Thoracic Esophageal Cancer: An Audit from a Regional Cancer Centre.

BACKGROUND: The aim of this study is to identify the factors responsible for interruption of planned treatment in patients of carcinoma mid-thoracic esophagus and also discuss the strategies for improving treatment completion rates. MATERIALS AND METHODS: Patients with nonmetastatic mid-thoracic esophageal cancer who received treatment by multimodality approach using chemotherapy, radiation, and/or surgery were retrospectively analyzed. Factors influencing compliance with planned treatment completion were evaluated, and their significance was determined using multivariate Cox regression analysis. RESULTS: Ninety-one patients were reviewed. Median follow-up period was 11 months. Of 15 patients planned with neoadjuvant chemoradiation followed by surgery (Group 1), only 6 (40%) could complete the treatment. Similarly, only 19 out of 36 patients (52.8%) completed the planned definitive chemoradiation (Group 2). Furthermore, of forty patients planned with definitive radiotherapy (Group 3), 29 patients only (72.5%) completed this schedule. The rate of completion of therapy was worst in Group 1. The most common reason for noncompletion of planned treatment was nutritional inadequacy and excessive weight loss in all groups. In addition, chemotherapy-induced myelosuppression (P = 0.05) was the factor leading to treatment interruption in Group 2 and radiation-induced acute mucositis (P = 0.02) and lost to follow-up (P = 0.02) were the factors in Group 3. CONCLUSIONS: Rate of treatment completion significantly impacts survival rates. Nutritional inadequacy was the most common factor for noncompletion of planned treatment. A well-trained management team consisting of oncologist, dietitian, and psychotherapist can help overcome these factors and thereby improve the treatment completion rates.

Effect of silver diamine fluoride application on the microtensile bond strength of three commonly used restorative materials in primary teeth: An ultrastructural study.

INTRODUCTION: Caries in primary teeth rapidly advances owing to its thin structure, thereby requiring restoration. However, restorations often fail due to various causes such as secondary caries and reduced microtensile bond strength (µTBS), which calls for the use of antimicrobial agents such as silver diamine fluoride (SDF). AIM: This study aims to measure and analyse the effect of SDF application on the µTBS of three regularly used restorative materials to dentin of primary teeth as well as compare the types of bond failure interfaces under SEM. MATERIALS AND METHODS: The study comprised 60 samples equally divided into six groups among three restorative materials, namely, glass ionomer cement (GIC, Groups I and II), resin-modified glass ionomer cement (RMGIC, Groups III and IV), and composite resin (Groups V and VI) with subdivisions of A and B, where A represented samples with SDF application and B represented samples without SDF application. RESULTS AND OBSERVATIONS: It was observed that µTBS of RMGIC to sound and carious dentin irrespective of SDF application was found to be statistically significant (P < 0.05), and when GIC, RMGIC, and composite resins were compared to both sound and carious dentin irrespective of SDF application, it was statistically significant (P < 0.05). SEM analysis revealed predominantly cohesive failures among all the groups. CONCLUSION: Based on the results, it was concluded that SDF has no adverse effect on the µTBS of GIC, RMGIC, and composite resin to both carious and sound dentin of primary teeth.

Assimilation of socially assistive robots by older adults: an interplay of uses, constraints and outcomes.

By supporting autonomy, aging in place, and wellbeing in later life, Socially Assistive Robots are expected to help humanity face the challenges posed by the rapid aging of the world's population. For the successful acceptance and assimilation of SARs by older adults, it is necessary to understand the factors affecting their Quality Evaluations Previous studies examining Human-Robot Interaction in later life indicated that three aspects shape older adults' overall QEs of robots: uses, constraints, and outcomes. However, studies were usually limited in duration, focused on acceptance rather than assimilation, and typically explored only one aspect of the interaction. In the present study, we examined uses, constraints, and outcomes simultaneously and over a long period. Nineteen community-dwelling older adults aged 75-97 were given a SAR for physical training for 6 weeks. Their experiences were documented via in-depth interviews conducted before and after the study period, short weekly telephone surveys, and reports produced by the robots. Analysis revealed two distinct groups: (A) The 'Fans' - participants who enjoyed using the SAR, attributed added value to it, and experienced a successful assimilation process; and (B) The 'Skeptics' - participants who did not like it, negatively evaluated its use, and experienced a disappointing assimilation process. Despite the vast differences between the groups, both reported more positive evaluations of SARs at the end of the study than before it began. Overall, the results indicated that the process of SARs' assimilation is not homogeneous and provided a profound understanding of the factors shaping older adults' QE of SARs following actual use. Additionally, the findings demonstrated the theoretical and practical usefulness of a holistic approach in researching older SARs users.

Corrigendum: Assimilation of socially assistive robots by older adults: an interplay of uses, constraints and outcomes.

[This corrects the article DOI: 10.3389/frobt.2024.1337380.].

Diabetes and Anaemia: A Myth or Reality.

Introduction: Chronic diabetes develops when the pancreas does not release enough insulin or the body cannot use it. Anemia is a disorder characterized by reduced hemoglobin or red blood cells. The body needs hemoglobin to transport oxygen. Diabetics with anemia may have micro and macro vascular problems, lowering quality of life and increasing medical costs. Aim and Objectives: To examine the prevalence of anemia among type 2 diabetics, its predictive value, and the connection between anemia and type 2 diabetes. Methodology: A prospective study was conducted on 2000 people with and without type 2 diabetes at the medical and diabetology wards of Punjab's Desh Bhagat University and hospital for medicine and health sciences from June 2022 to June 2023. Results: A statistical significance threshold of 0.005 determined that the mean hemoglobin value was 8.44 in oral hypoglycemics, 7.93 in insulin, and 4.45 in combined insulin and oral hypoglycaemics. Conclusion: Diabetics with type 2 diabetes mellitus and anemia were more likely to have CAD, making anemia a chronic condition that negatively impacts quality of life and accelerates disease consequences.

Health care resource utilization patterns among patients with Parkinson's disease psychosis: analysis of Medicare beneficiaries treated with pimavanserin or other-atypical antipsychotics.

BACKGROUND: Pimavanserin (PIM) is the only FDA-approved atypical antipsychotic (AAP) for hallucinations and delusions associated with Parkinson's disease psychosis (PDP). Comparative real-world analyses demonstrating its benefits are needed. OBJECTIVES: To evaluate health care resource utilization (HCRU) outcomes among PDP patients treated with PIM vs. other-AAPs. METHODS: Retrospective cohort analysis of Parts A, B, and D claims from 100% Medicare sample from 01 January 2013-31 December 2019 was conducted. PDP Patients initiating (i.e. index date) continuous monotherapy (PIM vs. other-AAPs) for ≥12-months during 01 January 2014-31 December 2018 without 12-months pre-index AAP use were selected after 1:1 propensity score matching (PSM) on 31 variables (sex, race, region, age, and 27 Elixhauser comorbidities). HCRU outcomes included: annual all-cause and psychiatric hospitalization (short-term stay, long-term stay, and SNF-stay [skilled nursing facility]) rates, annual all-cause and psychiatric-ER visit rates, mean per-patient-per-year (PPPY) hospitalizations, and average length of stay (ALOS). PIM and other-AAPs were compared using generalized linear models (GLM) controlled for demographic characteristics, comorbidities, coexisting-dementia, and coexisting insomnia. RESULTS: Of 12,164 PDP patients, 48.41% (n = 5,889) were female, and mean age was 77 (±8.14) years. Among 1:1 matched patients (n = 842 in each), 37.8% (n = 319) on PIM vs. 49.8% (n = 420) on other-AAPs (p < .05) reported ≥1 all-cause hospitalizations, respectively. Specifically, short-term and SNF-stay among PIM patients vs. other-AAPs were: 34% (n = 286) vs. 46.2% (n = 389) and 20.2% (n = 170) vs. 31.8% (n = 267) (p < .05), respectively. Similarly, 9.6% (n = 81) of PIM vs. 14.6% (n = 123) of other-AAPs patients had ≥1 psychiatric hospitalization (p < .05). Furthermore, ≥1 all-cause and psychiatric ER visit among PIM vs. other-AAPs were 61.6% (n = 519) vs. 69.4% (n = 584) and 5.2% (n = 43) vs. 10.2% (n = 86) (p < .05), respectively. PIM also had significantly lower ALOS, and mean PPPY short-term hospitalization and SNF-stays. CONCLUSIONS: In this analysis of PDP patients, PIM monotherapy resulted in nearly 12% and 7% lower all-cause hospitalizations and ER visits vs. other-AAPs.

Politeness in Human-Robot Interaction: A Multi-Experiment Study with Non-Humanoid Robots.

We studied politeness in human-robot interaction based on Lakoff's politeness theory. In a series of eight studies, we manipulated three different levels of politeness of non-humanoid robots and evaluated their effects. A table-setting task was developed for two different types of robots (a robotic manipulator and a mobile robot). The studies included two different populations (old and young adults) and were conducted in two conditions (video and live). Results revealed that polite robot behavior positively affected users' perceptions of the interaction with the robots and that participants were able to differentiate between the designed politeness levels. Participants reported higher levels of enjoyment, satisfaction, and trust when they interacted with the politest behavior of the robot. A smaller number of young adults trusted the politest behavior of the robot compared to old adults. Enjoyment and trust of the interaction with the robot were higher when study participants were subjected to the live condition compared to video and participants were more satisfied when they interacted with a mobile robot compared to a manipulator.

Advances in pharmacotherapy for head and neck cancer.

Introduction: Head and neck squamous cell carcinoma (HNSCC) is one of the most common cancers worldwide and is a leading cause for cancer-related mortality. This review attempts to give a comprehensive summary of the recent developments in pharmacotherapeutic options for locally advanced/metastatic HNSCC.Areas covered: In this review, the authors conducted a systematic literature search for published articles on HNSCC in the PubMed database using the keywords 'head and neck squamous cell carcinoma or HNSCC,' 'targeted therapy,' 'immunotherapy.' The search was restricted to meta-analyses, clinical trials, practice guidelines, and abstract presentations at international meetings. The final search encompassed articles published from 2010 to 2021. Articles published in languages other than English were excluded.Expert opinion: Immune checkpoint inhibition has been the most significant advance in the treatment of R/M HNSCC. Oral metronomic therapy has emerged as an important therapeutic option for low to middle-income countries. H-RAS inhibition is one of the most promising areas of research.

Primary Bone Lymphoma: An Experience of a Regional Cancer Center from India.

Background Primary bone lymphoma (PBL) is a rare disease, representing <5% of all extranodal non-Hodgkin's lymphomas (NHLs). The optimal treatment strategy is still unclear. Here, we report our institutional outcome analysis of patients diagnosed with PBL. Materials and Methods From 2007 to 2014, the medical records of 22 patients with PBL were reviewed. Analysis was done for symptom-, patient-, disease-, and treatment-related characteristics. All patients were treated with chemotherapy with or without radiotherapy. Treatment response and impact of different prognostic factors on clinical outcome were analyzed. Results The median age of presentation was 44 years (range: 18-70 years). A total of 19 (86.4%) patients were ≤60 years of age and 3 (13.6%) patients were >60 years. Out of all, 18 were males and 4 were females. Ann Arbor clinical staging at diagnosis was Stage I in 13 (59.1%), Stage II in 3 (13.6%), Stage III in 2 (9.1%), and Stage IV in 4 (18.2%) patients. Spine was the most common site of involvement seen in 12 (54.5%) patients. Diffuse large B cell lymphoma histology was seen in 8 (36.4%) patients and 8 (36.4%) had high-grade NHL. Chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisolone was given to 20 (90.9%) patients, whereas 2 (9.1%) patients received cyclophosphamide, doxorubicin, vincristine, prednisone, and rituximab. Radiotherapy (30-40 Gy) was delivered to 19 (86.4%) patients. The median follow-up period was 40 months (range: 8-105 months). The overall response rate was 86.3% with complete response (CR) in 15 (68.1%) and partial response in 4 (18.2%) patients. Relapses were seen in three (13.5%) patients: two nodal, and one in the bone. Disease-free survival (DFS) and overall survival (OS) at 5 years were 56.6 and 72.7%, respectively. CR after initial treatment was associated with a significant better OS, 80 and 25%, respectively ( p < 0.0001). Age, sex, stage, International Prognostic Index, histologic subtype, and number of sites had no significant influence on OS. Combining radiation therapy with chemotherapy (with or without rituximab) also did not improve the OS or DFS of patients. Conclusion In spite of small number of patients reported in this study, conventional chemotherapy remains an effective treatment option for patients with PBL. OS was found to be affected by the initial response to treatment.

Role of stereotactic body radiation therapy in liver metastasis: A pilot study from tertiary cancer institute in India.

PURPOSE: This trial studies the feasibility and potential utility of stereotactic body radiation therapy in patients with unresectable liver metastasis. AIMS: (1) The aim of this study is to assess the local response of the liver lesions poststereotactic body radiation therapy regarding number and size of lesions and (2) to evaluate the toxicity to organ (s) at risk. MATERIALS AND METHODS: A total of 15 patients were enrolled in this study from November 2014 to October 2015. The inclusion criteria for this study were patients having 1-3 liver metastasis from any solid tumor except germ cell tumor or lymphoma with no evidence of progressive disease (PD) outside the liver. A planning four dimensional-computed tomography (CT) scan was taken. Planning target volume was generated by giving margin of 5 mm. Dose prescribed was 36 Gy in 3#. Response was defined by CT abdomen done at 3 and 6 months poststereotactic body radiation therapy as per RECIST guideline (v1.1). RESULTS: At 3 months poststereotactic body radiation therapy, five patients had partial response, five patients had stable disease, and five patients had PD as per RECIST criteria. Out of 20 assessable lesions, 16 were controlled at 3 months poststereotactic body radiation therapy. The actuarial local control rate was 86% at 3 months and 77% at 6 months poststereotactic body radiation therapy. The median progression free survival was 7 months. Two patients experienced Grade 2 gastric toxicity and one patient experienced Grade 2 small bowel toxicity. No cases of radiation-induced liver disease were observed. CONCLUSIONS: This trial examines the feasibility of stereotactic body radiotherapy to liver metastasis in the Indian scenario. It shows excellent tolerability and is a safe therapeutic option for inoperable patients, showing good local control.

Fractionated Palliative Pelvic Radiotherapy as an Effective Modality in the Management of Recurrent/Refractory Epithelial Ovarian Cancers: An Institutional Experience.

BACKGROUND: The advent of effective chemotherapeutic agents for ovarian carcinoma has made radical abdomino-pelvic radiation redundant. Nevertheless, palliative pelvic radiotherapy still has a role in palliating local symptoms. However, its effect on progression-free survival (PFS) may be debated. AIMS: To study the outcome of fractionated palliative pelvic radiotherapy in relapsed ovarian cancers in terms of symptom control and PFS. METHODS: Twenty-three patients of ovarian cancers, heavily pretreated with chemotherapy and with recurrent or residual pelvic masses, were planned for palliative pelvic radiotherapy to the dose of 46-50 Gy in 23-25 fractions in 4.5-5 weeks. Symptom control and outcomes have been analyzed. RESULTS: Post-radiotherapy, abdominal pain was controlled in 15 out of 17 patients (88.2 %), bleeding per vaginum in all 5 patients and vaginal discharge stopped in 4 out of 5 patients (80 %). On follow-up, of 23 patients, 17 (74 %) had progressive disease post-radiation, and median time to disease progression was 10 months (range 1-49). On univariate analysis, increased PFS was observed in patients who received radiation late in their course of disease, those with serous histology, and with lesser disease bulk in pelvis (≤2 cm) prior to radiation initiation. CONCLUSION: Fractionated palliative pelvic radiotherapy is an efficient method for symptom palliation in relapsed ovarian cancers. Patients who are heavily pretreated with chemotherapy and have a small-volume pelvic disease may show a prolonged PFS with addition of pelvic radiotherapy. Indications of radiotherapy, however, need to be defined.

Comparative evaluation of the effects of xylitol and sugar-free chewing gums on salivary and dental plaque pH in children.

UNLABELLED: This research paper primarily focuses on the importance of use of xylitol among school children. PURPOSE: The purpose of this paper is to evaluate the salivary and dental plaque pH changes after consumption of sugared and sugar-free (xylitol) chewing gums in children. MATERIALS AND METHODS: A total of 30 school children were selected for this study and were divided into two equal groups and given both chewing gums for the experiment. RESULTS: Children consuming the sugar-free (xylitol) chewing gum showed a marked increase in the pH of saliva and plaque when compared to their counterpart. All these values had a significant difference of P ≤ 0.0001. CONCLUSION: Xylitol is a safe all-natural sweetener which helps to reduce tooth decay. It plays a unique role in preventive strategies for better health.

Delayed replantation of an avulsed maxillary premolar with open apex: a 24 months follow-up case report.

Avulsion of permanent teeth is most serious of all dental injuries and accounts for 1-16% of all traumatic injuries, of which maxillary incisors are most commonly involved. However, in this report a rare case of isolated avulsed immature premolar has been described. The patient had reported more than 3 hours after the trauma with a tooth stored in dry condition and soil contamination. The prognosis depends on measures taken at the place of accident or the time immediately after avulsion. Replantation is the treatment of choice, but cannot always be performed immediately. An appropriate emergency management and treatment plan is important for good prognosis. In this report stepwise management of an avulsed immature maxillary premolar with extended period of dry storage has been described followed up for a period of 2 yrs.

Multiple natal teeth: a rare case report.

A rare case report of multiple natal teeth in both maxillary and mandibular dental arches in a 21-day-old baby and its management is being presented here.