Interdisciplinary and regional cooperation towards Head and Neck Cancer Interventional Radiotherapy (Brachytherapy) implementation in Southeast Asia

@#We review the evolution of Brachytherapy to interventional radiotherapy and its current and potential roles in HNC management, and the requirements and challenges towards its effective and sustainable implementation in SEA.

Delayed Hemobilia: A Rare Case of Biliary Bleeding One Year After Metallic Stent Placement.

Hemobilia is a rare cause of upper GI bleed. This case report discusses hemobilia caused as a delayed complication of self-expanding metallic stent (SEMS) placement in a 65-year-old male. Our patient had a history of hepatitis C and an unresectable hepatocellular carcinoma, treated with chemotherapy and radiation therapy, which caused obstructive jaundice, which in turn led to the placement of SEMS. This case highlights the challenges in managing late-onset biliary bleeding, especially in patients with underlying malignancies. Detection of bleeding in a timely manner is crucial in devising the treatment plan. Angiographic occlusion is the first line of management to stop the bleed followed by definitive surgery or stent revision. Severe complications can occur in patients with poor general health. This case report addresses the importance of monitoring the patient and the need for collaborative efforts across specialties in managing complex cases. Despite the best efforts of the medical team, this case serves as a reminder of the complex and twisted nature of medical conditions, telling us the importance of developing suitable treatment strategies for each patient's needs and healthcare requirements.

Comprehensive review of diabetic ketoacidosis: an update.

The most frequent hyperglycemic emergency and the leading cause of death in people with diabetes mellitus is diabetic ketoacidosis (DKA). DKA is common in people with type 1 diabetes, while type 2 diabetes accounts for roughly one-third of occurrences. Although DKA mortality rates have generally decreased to low levels, they are still significant in many underdeveloped nations. In industrialized countries, its mortality rate ranges from 2 to 5%, but in underdeveloped nations, it ranges from 6 to 24%. Therefore, it is always lethal if misdiagnosed or improperly treated. According to specific research, DKA can be present at the time of type 1 diabetes onset in 25 to 30% of cases and in 4 to 29% of young people with type 2 diabetes mellitus, and its features include hyperglycemia, metabolic acidosis, and ketosis with its triggering factors commonly being infections, newly discovered diabetes, and failure to start insulin therapy. Less than 20% of DKA patients present comatose, and patients with different levels of consciousness can present at other times. A close association between abnormalities found during a mental status evaluation and osmolality seems to exist. Hospital admission is necessary for vigorous intravenous fluid therapy, insulin therapy, electrolyte replacement, diagnosis and treatment of the underlying triggers, and routine monitoring of the patient's clinical and laboratory conditions to manage DKA properly. Appropriate discharge plans should include actions to prevent a DKA recurrence and the proper selection and administration of insulin regimens.

[Temporal-spatial Distribution and Risk Assessment of Polycyclic Aromatic Hydrocarbons in Soil of Xiangxi Bay in Three Gorges Reservoir Area].

The US Environmental Protection Agency has listed 16 polycyclic aromatic hydrocarbons (PAHs) for priority control. Soil samples from Xiangxi Bay in the Three Gorges Reservoir Area (the water fluctuation zone, WLFZ; upper edge of water fluctuation zone, UEWLFZ; sediments) were analyzed for the concentration of these PAHs, using high performance liquid chromatography (HPLC). The results showed that the soil samples of Xiangxi Bay could be ranked, based on the concentration of PAHs, in the following order:UEWLFZ>WLFZ>sediment. The composition of PAHs varied from the three regions, with 3- and 4-ring PAHs dominating in sediments and 4- and 5-ring PAHs dominating in soil from the WLFZ and UEWLFZ. The composition of PAHs in soil from the WLFZ exhibited a higher coefficient of variation and a weaker correlation with the composition of PAHs in soil from the UEWLFZ and sediment. Soil from the three regions showed varying seasonal distributions of PAHs, which is closely related to the quantity and types of energy consumption in each season. PAHs in sediment from sites at the same altitude showed no evident differences, whereas WLFZ and UEWLFZ soil had higher levels of PAHs at the sites near Xiakou Town and the Yangtze River Estuary. Isomer ratio analysis showed that the sources of PAHs in Xiangxi Bay vary between seasons and regions, with incomplete combustion of fossil fuels and biomass forming the main sources in the soil of Xiangxi Bay. The lifetime carcinogenic risk assessment shows that PAHs in sediment, WLFZ, and UEWLFZ have a potential risk to human through ingestion and dermal contact, with PAHs in the soil of UEWLFZ posing the highest carcinogenic risk. The results provide a theoretical reference for the prevention and control of contamination by PAHs in Xiangxi Bay of the Three Gorges Reservoir area.

Single cell-produced and in vitro-assembled anti-FcRH5/CD3 T-cell dependent bispecific antibodies have similar in vitro and in vivo properties.

Bispecific antibody production using single host cells has been a new advancement in the antibody engineering field. We previously showed comparable in vitro biological activity and in vivo mouse pharmacokinetics (PK) for two novel single cell variants (v10 and v11) and one traditional dual cell in vitro-assembled anti-human epidermal growth factor receptor 2/CD3 T-cell dependent bispecific (TDB) antibodies. Here, we extended our previous work to assess single cell-produced bispecific variants of a novel TDB against FcRH5, a B-cell lineage marker expressed on multiple myeloma (MM) tumor cells. An in vitro-assembled anti- FcRH5/CD3 TDB antibody was previously developed as a potential treatment option for MM. Two bispecific antibody variants (designs v10 and v11) for manufacturing anti-FcRH5/CD3 TDB in single cells were compared to in vitro-assembled TDB in a dual-cell process to understand whether differences in antibody design and production led to any major differences in their in vitro biological activity, in vivo mouse PK, and PK/pharmacodynamics (PD) or immunogenicity in cynomolgus monkeys (cynos). The binding, in vitro potencies, in vitro pharmacological activities and in vivo PK in mice and cynos of these single cell TDBs were comparable to those of the in vitro-assembled TDB. In addition, the single cell and in vitro-assembled TDBs exhibited robust PD activity and comparable immunogenicity in cynos. Overall, these studies demonstrate that single cell-produced and in vitro-assembled anti-FcRH5/CD3 T-cell dependent bispecific antibodies have similar in vitro and in vivo properties, and support further development of single-cell production method for anti-FcRH5/CD3 TDBs and other single-cell bispecifics.

The role of human agents in facilitating clinical and translational science.

The fundamental problem confronting policymakers who desire to facilitate the development of clinical and translational science (CTS) comes in bringing people with disparate interests, vocabularies, cultures, goals, and so forth together for a common purpose. A variety of roles have been suggested for individuals who may play key parts in this overall process: opinion leaders, change agents, boundary spanners, structural hole brokers, and, finally, collaborative knowledge brokers. This essay will systematically review these key roles; focusing on the strengths and weaknesses of each to illustrate their part in approaches to solving this problem. The implications of this perspective will be discussed in terms of the role that human agents can play in facilitating CTS.

Noradrenergic control of cognition: global attenuation and an interrupt function.

It is hypothesized that tonic central noradrenergic activity provides global attenuation, and this system's phasic reactions support an interrupt function. Under normal conditions, these functions enhance vigilance and orienting. Their absence during REM sleep allow greater spontaneous and associative activity and the merging of separate experiences in dreams. An abnormal diminishing of these functions during waking may result in the lack of control and inattentiveness seen in attention-deficit hyperactivity disorder. On the other hand, excessive noradrenergic activity may facilitate the occurrence of panic attacks as these functions undermine processes which normally moderate anxiety.

The interrelationships of Acanthomorph fishes: A total evidence approach using molecular and morphological data.

DNA sequence and morphological data were analyzed for specimens of twenty-five species of acanthomorph fishes and two specimens representing the outgroups Aulopiformes and Myctophiformes. A 572 base-pair (bp) segment of the 12S ribosomal mitochondrial gene, 1112 bp from three regions of the 28S ribosomal nuclear gene, and 38 morphological transformation series were analyzed under the criterion of maximum parsimony. The total evidence analysis resulted in a set of four most parsimonious trees. Relationships common to all trees are largely congruent with the hypothesis articulated by Johnson and Patterson (1993. Bull. Mar. Sci. 52, 554-626).