Hyperbaric Medicine in Pediatrics — reality of a Portuguese reference center / Medicina Hiperbárica em Pediatria — realidade de um centro de referência português

ABSTRACT Objective: To identify and characterize the population of Pediatric patients referred to our hyperbaric oxygen therapy center. Methods: Retrospective and observational study, including pediatric patients treated with hyperbaric oxygen therapy, from 2006 to 2021, at the hyperbaric medicine reference center in the north of Portugal. Variables of interest were extracted from electronic medical records. Results: Our study included 134 patients. The most frequent reasons for referral were carbon monoxide poisoning (n=59) and sudden sensorineural hearing loss (n=41). In 75 cases (56%), treatment was initiated in an urgent context. Symptom presentation at Emergency Department varied among patients, the most frequent being headache and nausea/vomiting. Concerning carbon monoxide poisoning, the most common sources were water heater, fireplace/brazier, and boiler. Regarding adverse effects, it was identified one case of intoxication by oxygen and four cases of middle ear barotrauma. Conclusions: The most frequent cause for referral was carbon monoxide poisoning. All patients evolved favorably, with few side effects being reported, emphasizing the safety of this therapy. While most pediatricians may not be aware of the potential benefits arising with hyperbaric oxygen therapy, it is of upmost importance to promote them, so that this technique is increasingly implemented.

RESUMO Objetivo: Identificar e caracterizar a população de casos pediátricos encaminhados para o nosso centro de oxigenoterapia hiperbárica. Métodos: Estudo retrospetivo e observacional, que incluiu doentes pediátricos tratados com oxigenoterapia hiperbárica, de 2006 a 2021, no centro de referência de medicina hiperbárica do norte de Portugal. As variáveis de interesse foram extraídas dos processos clínicos eletrônicos. Resultados: O nosso estudo incluiu 134 casos. Os motivos de encaminhamento mais frequentes foram intoxicação por monóxido de carbono (n=59) e surdez súbita neurossensorial (n=41). Em 75 casos (56%) o tratamento foi iniciado em contexto de urgência. Os sintomas de apresentação à admissão variaram entre os diferentes casos, sendo os mais frequentes cefaleias e náuseas/vômitos. No que diz respeito à intoxicação por monóxido de carbono, as fontes mais comuns foram o aquecedor, lareira/braseiro e caldeira. Com relação aos efeitos adversos, foram identificados um caso de intoxicação por oxigênio e quatro casos de barotrauma do ouvido médio. Conclusões: A causa mais frequente de encaminhamento foi a intoxicação por monóxido de carbono. Todos os pacientes evoluíram favoravelmente e foram registrados poucos efeitos adversos, o que enfatiza a segurança desta terapia. Uma vez que a maioria dos pediatras pode não estar informada sobre os potenciais benefícios da oxigenoterapia hiperbárica, é de extrema importância promovê-los para que esta técnica seja cada vez mais implementada.

Cura por vacío (VAC), a propósito de un caso en Atención Primaria / Vacuum assisted closure (VAC), about a case in primary care

El síndrome compartimental agudo requiere de la descompresión quirúrgica, mediante fasciotomía, esta técnica debe ser urgente y será clave para evitar la instauración de graves secuelas. El posterior abordaje de estas heridas de difícil y lenta cicatrización suponen un reto para los profesionales de la salud y un problema para la salud pública debido a los altos costes y elevada morbilidad. La terapia de presión negativa (TPN) o cura por vacío (VAC, "vacuum assisted closure") es un tratamiento no invasivo que consigue la curación de las heridas favoreciendo la vascularización, la aparición del tejido de granulación y eliminación del exceso de exudado[AU]

Acute compartment syndrome requires surgical decompression by fasciotomy, this technique must be urgent and will be key to avoid the establishment of serious sequels. The subsequent approach to these wounds, which are difficult and slow to heal, is a challenge for health professionals and a problem for public health due to high costs and high morbidity. Negative pressure therapy (NPWT) or vacuum assisted closure (VAC) is a non-invasive treatment that achieves wound healing by promoting vascularization, the appearance of granulation tissue and elimination of excess exudate[AU]

A síndrome compartimental aguda requer descompressão cirúrgica, por fasciotomia, esta técnica deve ser urgente e será fundamental para evitar o estabelecimento de sequelas graves. O tratamento subsequente destas feridas difíceis e de cicatrização lenta é um desafio para os profissionais de saúde e um problema desaúde pública devido aos elevados custos e à elevada morbilidade. A terapia por pressão negativa (NPWT) ou o encerramento assistido por vácuo (VAC) é um tratamento não invasivo que permite a cicatrização de feridas através da promoção da vascularização, do aparecimento de tecido de granulação e da remoção do excesso de exsudado[AU]

Yoga como terapia complementaria para el Adulto Mayor / Yoga as a complementary therapy for older adult

Introducción: El yoga es una actividad que trata de un ejercicio el cual contiene una intensidad baja a moderada, la cual no se centra exclusivamente en el entrenamiento físico, sino que también en el desarrollo de la mente y el espíritu de uno mismo. El yoga puede obtener un mayor impacto en el equilibrio y en la ganancia de fuerza de la parte superior del cuerpo, además, demuestra mejora en la aptitud cardiorrespiratoria y flexibilidad. Metodología: El enfoque de desarrollo fue de tipo cuantitativo en donde se realizó una revisión sistemática como metodología de búsqueda de información, relacionada al yoga como una terapia complementaria y los beneficios que éste aportaba al bienestar de las personas mayores. Resultados: En cada uno de los ensayos controlados aleatorizados que fueron recabados para fines de esta revisión sistemática. Se destaca la importancia y los beneficios del yoga en la movilidad, fuerza, flexibilidad y espiritualidad de los usuarios que practican esta terapia. Discusión: Los artículos analizados pertenecen a ensayos clínicos o estudios aleatorizados, los cuales permitieron responder de manera efectiva a nuestra pregunta de investigación, la cual consiste en reconocer si el yoga es efectivo para disminuir el riesgo de dependencia funcional y eliminar hábitos que no son saludables para las personas mayores, además de mejorar la calidad de vida actual. Gracias a ello se pudo evidenciar que esta terapia en adultos mayores genera cambios positivos respecto a estado y condición física, la ejecución de esta práctica mejora la calidad de vida en un 80% Conclusión: La yoga como terapia complementaria si entrega beneficios en la calidad de vida de la población adulta mayor, dado que, que hubo una mejora tanto en la movilidad, calidad de vida y autovalencia de los adultos mayores[AU]

Introduction: Yoga is an activity that deals with a low to moderate intensity exercise, which is not exclusively focused on physical training, but also on the development of the mind and spirit itself. Yoga may have a greater impact on balance and upper body strength gains, and have shown improvements in cardiorespiratory fitness and flexibility. Methodology:the development approach was of a quantitative type where a systematic review was carried out as a methodology for searching for information related to yoga as a complementary therapy and the benefits that it brought to the well-being of the elderly. Results:The importance and benefits of yoga on the mobility, strength, flexibility and spirituality of users who practice this therapy are highlighted in each of the randomized controlled trials that were collected for the purposes of this systematic review. Discussion: The articles analyzed belong to clinical trials or randomized studies, which allowed us to effectively answer our research question. The activity of yoga in older adults generates positive changes regarding state and physical condition, the execution of this practice improves the quality of life by 80% Conclusion: Yoga as a complementary therapy delivers benefits in the quality of life of the adult population elderly, it can be said that there was an improvement in mobility, quality of life and self-valence of the elderly[AU]

Introdução: O Yoga é uma atividade que trata de um exercício de intensidade baixa a moderada, que não se foca exclusivamente no treino físico, mas também no desenvolvimento da mente e do espí-rito. A ioga pode ter um impacto maior no equilíbrio e nos ganhos de força da parte superior do corpo e mostrou melhorias na apti-dão cardiorrespiratória e flexibilidade. Metodologia: a abordagem de desenvolvimento foi do tipo quantitativo onde foi realizada uma revisão sistemática como metodologia de busca de informações re-lacionadas ao yoga como terapia complementar e os benefícios que trouxe para o bem-estar dos idosos. Resultados: A importância e os benefícios do yoga na mobilidade, força, flexibilidade e espiri-tualidade dos usuários que praticam esta terapia são destacados em cada um dos ensaios clínicos randomizados que foram coletados para fins desta revisão sistemática. Discussão: Os artigos analisa-dos pertencem a ensaios clínicos ou estudos randomizados, o que nos permitiu responder de forma eficaz à nossa questão de inves-tigação. A atividade de yoga em idosos gera mudanças positivas quanto ao estado e condição física, a execução desta prática mel-hora a qualidade de vida em 80% Conclusão: o yoga como terapia complementar traz benefícios na qualidade de vida da população adulta idosa, pode-se dizer que houve melhora na mobilidade, qualidade de vida e autovalência dos idosos[AU]

Doença falciforme: cuidado com pessoas com úlcera da perna nos serviços de atenção à saúde / Sickle cell disease: caring for people with leg ulcers in heal-thcare services / Enfermedad falciforme: cuidado de personas con úlcera de pierna en los servicios de atención a la salud

Objetivo: identificar o local e os cuidados diretos recebidos por pessoas com úlceras da perna por doença falciforme nos serviços de atenção à saúde. Método: estudo transversal, realizado em 11 centros, no período de agosto de 2019 a abril de 2020. Fizeram parte do estudo 72 pessoas com úlcera da perna ativa. O estudo foi aprovado pelo Comitê de Ética em Pesquisa. Resultado: apresentavam anemia falciforme 91,7% dos participantes, com mediana de três anos de existência da úlcera; 77,8% eram redicivantes; 40,3% compravam os insumos; 66,7% trocavam o próprio curativo no domicílio; 52,8% realizavam uma ou mais trocas diárias; 45,8% dos tratamentos foram prescritos pelo médico; 37,5% eram pomada (colagenase ou antibiótico); 89% não utilizavam compressão para o manejo do edema. Conclusão: a maioria dos participantes não estava inserida na Rede de Atenção à Saúde para o tratamento da úlcera, e não recebia assistência sistematizada e nem insumos apropriados.

Objective: to identify the location and direct care received by people with leg ulcers due to sickle cell disease in health care services. Method: a cross-sectional study carried out in 11 centers from August 2019 to April 2020. The study included 72 people with active leg ulcers. The study was approved by the Research Ethics Committee. Results: a total of 91.7% of the participants had sickle cell anemia, with a median of three years of ulcer existence; 77.8% were recurrent; 40.3% bought the supplies; 66.7% changed their own dressings at home; 52.8% did one or more changes a day; 45.8% of the treatments were prescribed by physician; 37.5% were ointments (collagenase or antibiotics); and 89% did not use compression to manage edema. Conclusion: most of the participants were not included in the Health Care Network for ulcer treatment and did not receive systematized care or appropriate supplies.

Objetivo: identificar el lugar y los cuidados directos recibidos por personas con úlceras de pierna por enfermedad falciforme en los servicios de atención a la salud. Método: estudio transversal, realizado en 11 centros, en el período de agosto de 2019 a abril de 2020. Participaron 72 personas con úlcera de pierna activa. El estudio fue aprobado por el Comité de Ética en Investigación. Resultado: presentaban anemia falciforme 91,7% de los participantes, con una mediana de tres años de existencia de la úlcera; 77,8% eran recidivantes; 40,3% compraban los insumos; 66,7% cambiaban su propio vendaje en el domicilio; 52,8% realizaban uno o más cambios diarios; 45,8% de los tratamientos fueron prescritos por el médico; 37,5% eran pomada (colagenasa o antibiótico); y 89% no utilizaban compresión para el manejo del edema. Conclusión: la mayoría de los participantes no estaba integrada en la Red de Atención a la Salud para el tratamiento de la úlcera, y no recibía asistencia sistematizada ni insumos apropiados.

Efficacy of anti-suppression therapy in improving binocular vision in children with small-angle Esotropia

Purpose: To evaluate the efficacy of anti-suppression exercises in children with small-angle esotropia in achieving binocular vision. Methods: A retrospective review of patients aged 3–8 years who underwent anti-suppression exercises for either monocular or alternate suppression between January 2016 and December 2021 was conducted. Patients with esotropia less than 15 prism diopters (PD) and visual acuity ≥ 6/12 were included. Patients with previous intra-ocular surgery or less than three-month follow-up were excluded. Success was defined as the development of binocular single vision (BSV) for distance, near, or both (measured clinically with either the 4 prism base out test or Worth four dot test) and maintained at two consecutive visits. Qualified success was defined as the presence of diplopia response for both distance and near. Additionally, improvement in near stereo acuity was measured using the Stereo Fly test. Results: Eighteen patients with a mean age of 5.4 ± 1.38 years (range 3–8 years) at the time of initiation of exercises were included in the study. The male female ratio was 10:8. The mean best corrected visual acuity was 0.18 LogMAR unit(s) and the mean spherical equivalent was +3.8 ± 0.14 diopters (D). The etiology of the esotropia was fully accommodative refractive esotropia (8), microtropia (1), post–operative infantile esotropia (4), partially accommodative esotropia (1), and post-operative partially accommodative esotropia (4). Patients received either office-based, home-based, or both modes of treatment for an average duration of 4.8 months (range 3–8). After therapy, BSV was achieved for either distance or near in 66.6 % of patients (95 % CI = 40.03–93.31 %). Binocular single vision for both distance and near was seen in 50 % of children. Qualified success was observed in 38.46% of patients. Persistence of suppression was observed in one patient (5.5 %)... (AU)

Terapia de Aceptación y Compromiso en conducta suicida: una revisión sistemática / Acceptance and Commitment Therapy on suicidal behavior: a systematic review

El suicidio se ha convertido en un problema social y de salud pública a nivel mundial. En este sentido, la Terapia de Aceptación y Compromiso (ACT) podría ser eficaz en su abordaje, existiendo evidencia sobre la relación entre algunos de sus componentes y la conducta suicida. Así, el presente estudio tuvo por objetivo realizar una revisión sistemática sobre la eficacia de ACT en conducta suicida. Para ello se siguió el protocolo PRISMA, empleando las siguientes bases de datos: PsycInfo, PubMed, Scopus y PsicoDoc. Inicialmente se obtuvieron 108 publicaciones potencialmente relevantes, de las cuales, finalmente, 13 fueron incluidas en la revisión. La calidad de los estudios se analizó a través de un instrumento de evaluación de riesgo de sesgos. Como resultados, a nivel general se observaron disminuciones estadísticamente significativas en ideación suicida (IS) y factores de riesgo de suicidio. Además, algunos estudios señalaron relaciones estadísticamente significativas entre un aumento de flexibilidad psicológica y la disminución de IS. Si bien los datos apuntaron a una posible eficacia de ACT en la reducción de IS, es necesario llevar a cabo mayor número de estudios experimentales que contemplen la complejidad de la conducta suicida y exploren los procesos de cambio implicados.(AU)

Suicide has emerged as a pressing global issue affecting both so-ciety and public health.In this context, Acceptance and Commitment Therapy (ACT) could prove effective in its approach, supported by evi-dence of the relationship between certain components of ACT and suicidal behavior. Thus, the present study aims to conduct a systematic review on the efficacy of ACT in suicidal behavior. For this, the PRISMA protocol was followed, using thefollowing databases: PsycInfo, PubMed, Scopus and PsicoDoc. Initially, 108 potentially relevant publicationswereobtained,13ofwhichwerefinallyincludedinthereview.Weanalyzedstudy qualityus-ingariskofbiasassessmentinstrument.Asaresult,statisticallysignificantdecreases in suicidal ideation (SI) and suicide risk factors were observed. In addition, some studies indicated statistically significant relationships be-tween increased psychological flexibility and decreasedSI.WhilethedatasuggestedthepotentialeffectivenessofACTinreducingsuicidal ideation (SI), more experimental studies are needed to consider the complexity of suicidal behavior and explore the processes of changeinvolved.(AU)

Transitioning to peritoneal dialysis: it does not matter where you come from / Transição para diálise peritoneal: não importa de onde

Introduction: Patients with end-stage renal disease (ESRD) frequently change renal replacement (RRT) therapy modality due to medical or social reasons. We aimed to evaluate the outcomes of patients under peritoneal dialysis (PD) according to the preceding RRT modality. Methods: We conducted a retrospective observational single-center study in prevalent PD patients from January 1, 2010, to December 31, 2017, who were followed for 60 months or until they dropped out of PD. Patients were divided into three groups according to the preceding RRT: prior hemodialysis (HD), failed kidney transplant (KT), and PD-first. Results: Among 152 patients, 115 were PD-first, 22 transitioned from HD, and 15 from a failing KT. There was a tendency for ultrafiltration failure to occur more in patients transitioning from HD (27.3% vs. 9.6% vs. 6.7%, p = 0.07). Residual renal function was better preserved in the group with no prior RRT (p < 0.001). A tendency towards a higher annual rate of peritonitis was observed in the prior KT group (0.70 peritonitis/year per patient vs. 0.10 vs. 0.21, p = 0.065). Thirteen patients (8.6%) had a major cardiovascular event, 5 of those had been transferred from a failing KT (p = 0.004). There were no differences between PD-first, prior KT, and prior HD in terms of death and technique survival (p = 0.195 and p = 0.917, respectively) and PD efficacy was adequate in all groups. Conclusions: PD is a suitable option for ESRD patients regardless of the previous RRT and should be offered to patients according to their clinical and social status and preferences.

Introdução: Pacientes com doença renal em estágio terminal (DRET) frequentemente mudam de modalidade de terapia renal substitutiva (TRS) por razões médicas ou sociais. Nosso objetivo foi avaliar desfechos de pacientes em diálise peritoneal (DP) segundo a modalidade anterior de TRS. Métodos: Realizamos estudo retrospectivo observacional unicêntrico, em pacientes prevalentes em DP, de 1º de janeiro de 2010 a 31 de dezembro de 2017, acompanhados por 60 meses ou até saírem de DP. Pacientes foram divididos em três grupos de acordo com a TRS anterior: hemodiálise prévia (HD), transplante renal malsucedido (TR) e DP como primeira opção (PD-first). Resultados: Entre 152 pacientes, 115 eram PD-first, 22 transitaram da HD e 15 de TR malsucedido. Houve tendência à maior ocorrência de falência de ultrafiltração em pacientes em transição da HD (27,3% vs. 9,6% vs. 6,7%; p = 0,07). A função renal residual foi melhor preservada no grupo sem TRS prévia (p < 0,001). Observou-se tendência à maior taxa anual de peritonite no grupo TR prévio (0,70 peritonite/ano por paciente vs. 0,10 vs. 0,21; p = 0,065). Treze pacientes (8,6%) tiveram um evento cardiovascular maior, cinco dos quais haviam sido transferidos de um TR malsucedido (p = 0,004). Não houve diferenças entre PD-first, TR prévio e HD prévia em termos de óbito e sobrevida da técnica (p = 0,195 e p = 0,917, respectivamente) e a eficácia da DP foi adequada em todos os grupos. Conclusões: A DP é uma opção adequada para pacientes com DRET, independentemente da TRS anterior, e deve ser oferecida aos pacientes de acordo com seu status clínico e social e suas preferências.

Aplicação clínica da laserterapia de baixa potência na atenção primária à saúde / Clinical praxis of low-level laser therapy in primary health care

LASER é um acrônimo que sumariza a amplificação da luz por emissão estimulada de radiação (eletromagnética). O Programa Saúde em Ação equipou diversas Unidades Básicas de Saúde com aparelhos de laser diodo. Cirurgiões Dentistas têm aplicado a laserterapia de baixa potência para acelerar a remissão de várias condições clínicas, sem necessidade de encaminhamento imediato para Atenção Secundária. O objetivo deste artigo é apresentar protocolos de laserterapia de baixa potência empregados por Cirurgiões Dentistas da Atenção Primária à Saúde de Campinas-SP, por meio da ilustração com casos clínicos atendidos em consultas de urgência. Aplicações para ulceração traumática e desordem temporomandibular foram realizadas em uma senhora de 60 anos de idade, que aguardava a substituição das próteses totais. Irradiou-se por laser vermelho (660nm) com energia de 1J as margens da ulceração. Após palpação da articulação e dos músculos mastigatórios para mapeamento, os pontos álgicos foram irradiados por laser infravermelho (808nm) com energia de 4J. Um homem de 50 anos de idade queixava-se de paralisia hemifacial havia 10 dias. A tentativa de recuperação do nervo facial ocorreu com irradiação por laser infravermelho com energia de 8J por ponto, em 22 pontos dos ramos do nervo facial. Em ambos os casos, a regressão do quadro clínico desconfortável foi observada. Os Profissionais do Sistema Único de Saúde (SUS) que são aptos ao uso dos equipamentos para laserterapia de baixa potência podem utilizar este recurso de modo seguro e bem sucedido, observando comprimento de onda do laser e doses protocolares para cada alteração a ser tratada.

LASER is an acronym which means light amplification by stimulated emission of radiation (electromagnetic). Many Primary Health Care Units received diode laser devices from the Brazilian Health in Action Program. Dental practitioners have applied low-level laser therapy for accelerating the resolution of several clinical problems, without the need to prompt referral for Secondary Attention. This manuscript aimed at presenting low-level laser therapy protocols, used by Dentists in Primary Health Care Units from Campinas-SP, illustrated with case reports of urgency consultations. Applications for traumatic ulcers and temporomandibular disorder were performed in a 60-year-old woman who was waiting for dental prosthesis replacement. Red laser irradiation (660nm) with 1J energy was delivered at the margins of the ulcer. Upon articular and masticatory muscles palpation for mapping, trigger points were irradiated with infrared laser (808nm), 4J energy. A 50-year-old man complained of hemifacial paresis for 10 days. The recovery attempt of the facial nerve was carried out by infrared laser irradiation with 8J energy per point in 22 points of the facial nerve branches. In both case reports, regression of the uncomfortable clinical problem was noted. Professionals from the Unified Health System (SUS) who are able to use a low-level laser device may safe and successfully operate this equipment, selecting the appropriate laser wavelength and protocol doses for managing each clinical problem.

Changes in mindfulness facets across yoga, CBT and stress education in individuals with generalized anxiety disorder.

Improving mindfulness is an important treatment target for generalized anxiety disorder (GAD). However, less is known about how different treatments impact specific aspects of mindfulness. In a clinical trial (Simon et al., 2021), 226 individuals with GAD were randomized to 12 weeks of Kundalini Yoga (KY), cognitive behavioral therapy (CBT) or stress education (SE). To examine whether specific facets of mindfulness, as measured by the Five Facet Mindfulness Questionnaire (FFMQ) change more than others across treatment and between treatments, we ran a multi-variate multilevel growth curve model (MMLM). Results indicated that while the Non-judge, Act with Awareness, and Non-react facets increased significantly during treatment, the Observe and Describe facets did not. Improvement in the Acting with Awareness facet during treatment was significantly greater for KY than CBT. These findings reveal the need to better understand how behavioral treatments can influence specific components of mindfulness for those with anxiety.

Characterization of the novel broad-spectrum lytic phage Phage_Pae01 and its antibiofilm efficacy against Pseudomonas aeruginosa.

Introduction: Pseudomonas aeruginosa is present throughout nature and is a common opportunistic pathogen in the human body. Carbapenem antibiotics are typically utilized as a last resort in the clinical treatment of multidrug-resistant infections caused by P. aeruginosa. The increase in carbapenem-resistant P. aeruginosa poses an immense challenge for the treatment of these infections. Bacteriophages have the potential to be used as antimicrobial agents for treating antibiotic-resistant bacteria. Methods and Results: In this study, a new virulent P. aeruginosa phage, Phage_Pae01, was isolated from hospital sewage and shown to have broad-spectrum antibacterial activity against clinical P. aeruginosa isolates (83.6%). These clinical strains included multidrug-resistant P. aeruginosa and carbapenem-resistant P. aeruginosa. Transmission electron microscopy revealed that the phage possessed an icosahedral head of approximately 80 nm and a long tail about 110 m, indicating that it belongs to the Myoviridae family of the order Caudovirales. Biological characteristic analysis revealed that Phage_Pae01 could maintain stable activity in the temperature range of 4~ 60°C and pH range of 4 ~ 10. According to the in vitro lysis kinetics of the phage, Phage_Pae01 demonstrated strong antibacterial activity. The optimal multiplicity of infection was 0.01. The genome of Phage_Pae01 has a total length of 93,182 bp and contains 176 open reading frames (ORFs). The phage genome does not contain genes related to virulence or antibiotic resistance. In addition, Phage_Pae01 effectively prevented the formation of biofilms and eliminated established biofilms. When Phage_Pae01 was combined with gentamicin, it significantly disrupted established P. aeruginosa biofilms. Conclusion: We identified a novel P. aeruginosa phage and demonstrated its effective antimicrobial properties against P. aeruginosa in both the floating and biofilm states. These findings offer a promising approach for the treatment of drug-resistant bacterial infections in clinical settings.

Proton Therapy Reduces the Effective Dose to Immune Cells in Mediastinal Hodgkin Lymphoma Patients.

Purpose: Effective dose to circulating immune cells (EDIC) is associated with survival in lung and esophageal cancer patients. This study aimed to evaluate the benefit of intensity-modulated proton therapy (IMPT) for EDIC reduction compared with volumetric modulated arc therapy (VMAT) in mediastinal Hodgkin lymphoma (mHL) patients. Materials and Methods: Ten consecutive mHL patients treated with involved-site IMPT after frontline chemotherapy were included. The mean dose to the heart, lung, and liver and the integral dose to the body were obtained, and we calculated EDIC based on these variables. The effective dose to circulating immune cells was compared between IMPT and VMAT schedules. Results: The median EDIC was reduced from 1.93 Gy (range: 1.31-3.87) with VMAT to 1.08 Gy (0.53-2.09) with IMPT (P < .01). Integral dose reduction was the main driver of EDIC reduction with IMPT, followed by lung sparing. Conclusion: Intensity-modulated proton therapy significantly reduced EDIC in mHL patients undergoing consolidation involved-site radiation therapy. Integral dose reduction combined with improved lung sparing was the main driver of EDIC reduction with IMPT.

The value of intervention with radiotherapy after first-line chemo-immunotherapy in locally advanced or metastatic esophageal squamous cell carcinoma: A multi-center retrospective study.

Background: Chemotherapy plus immunotherapy has become the standard first-line treatment of advanced or metastatic esophageal squamous cell carcinoma (ESCC), but median duration of response is only 7.0-8.3 months and progression-free survival (PFS, ∼6 months) is still far from satisfactory. We aim to evaluate whether early involvement of radiotherapy might improve the treatment outcome if objective response to first-line chemo-immunotherapy was observed in locally advanced or metastatic ESCC. Methods: Patients were retrospectively collected from 3 institutions in China. Patients with histopathologically confirmed diagnoses of locally advanced or metastatic ESCC were identified, who objectively responded to first-line chemo-immunotherapy (complete or partial response, or stable disease) and also received radiotherapy of primary lesions with radiation dose of over 40 Gy, with or without radiotherapy of metastatic lesions before the first disease progression. Results: A total of 72 eligible patients were identified. With median follow-up duration of 14.6 (range, 7.1-34.8) months, median progression-free survival (PFS) and overall survival (OS) were 13.5 (95 % CI,10.4-NA) months and 31.8 (95 % CI, 23.0-NA) months, respectively. Median duration from initiation of chemo-immunotherapy to radiotherapy was 2.9 (range, 0-15.1) months. Besides lower tumor burden as a significant factor of better treatment outcome, radiation dose ≥ 50 Gy was associated with superior PFS, while OS might be mainly related to tumor response to the induction chemo-immunotherapy. A low incidence of Grade 3 or above treatment-related adverse events were observed (19 %), and no treatment-related death occurred. Conclusion: Our multi-center retrospective study showed survival benefit brought by early involvement of radiotherapy after first-line chemo-immunotherapy for patients with locally advanced or metastatic ESCC. However, further investigation is warranted in future prospective, controlled trials to assess the value of radio-immunotherapy in advanced or metastatic ESCC.

CAR-T lymphocyte-based cell therapies; mechanistic substantiation, applications and biosafety enhancement with suicide genes: new opportunities to melt side effects.

Immunotherapy has made significant strides in cancer treatment with strategies like checkpoint blockade antibodies and adoptive T cell transfer. Chimeric antigen receptor T cells (CAR-T) have emerged as a promising approach to combine these strategies and overcome their limitations. This review explores CAR-T cells as a living drug for cancer treatment. CAR-T cells are genetically engineered immune cells designed to target and eliminate tumor cells by recognizing specific antigens. The study involves a comprehensive literature review on CAR-T cell technology, covering structure optimization, generations, manufacturing processes, and gene therapy strategies. It examines CAR-T therapy in haematologic cancers and solid tumors, highlighting challenges and proposing a suicide gene-based mechanism to enhance safety. The results show significant advancements in CAR-T technology, particularly in structure optimization and generation. The manufacturing process has improved for broader clinical application. However, a series of inherent challenges and side effects still need to be addressed. In conclusion, CAR-T cells hold great promise for cancer treatment, but ongoing research is crucial to improve efficacy and safety for oncology patients. The proposed suicide gene-based mechanism offers a potential solution to mitigate side effects including cytokine release syndrome (the most common toxic side effect of CAR-T therapy) and the associated neurotoxicity.

A future directions of renal cell carcinoma treatment: combination of immune checkpoint inhibition and carbon ion radiotherapy.

Renal cell carcinoma (RCC) is considered radio- and chemo-resistant. Immune checkpoint inhibitors (ICIs) have demonstrated significant clinical efficacy in advanced RCC. However, the overall response rate of RCC to monotherapy remains limited. Given its immunomodulatory effects, a combination of radiotherapy (RT) with immunotherapy is increasingly used for cancer treatment. Heavy ion radiotherapy, specifically the carbon ion radiotherapy (CIRT), represents an innovative approach to cancer treatment, offering superior physical and biological effectiveness compared to conventional photon radiotherapy and exhibiting obvious advantages in cancer treatment. The combination of CIRT and immunotherapy showed robust effectiveness in preclinical studies of various tumors, thus holds promise for overcoming radiation resistance of RCC and enhancing therapeutic outcomes. Here, we provide a comprehensive review on the biophysical effects of CIRT, the efficacy of combination treatment and the underlying mechanisms involved in, as well as its therapeutic potential specifically within RCC.

Case Report: The effect of automated manual lymphatic drainage therapy on lymphatic contractility in 4 distinct cases.

Introduction: Automated manual lymphatic drainage therapy (AMLDT) is available for home use in the form of a pneumatic mat of 16 pressurized air channels that inflate and deflate to mimic the stretch and release action of manual lymphatic drainage therapy. Four cases (a patient with complex regional pain syndrome and lymphedema, a healthy patient, a breast cancer survivor with chronic pain, and a patient with a history of abdominal surgery) underwent near-infrared fluorescence lymphatic imaging (NIRFLI) with AMLDT to evaluate the effect of AMLDT on lymphatic pumping and pain. Methods: Each patient received 32-36 injections of 25 µg indocyanine green (ICG) on the anterior and posterior sides of their body and underwent 1 h of NIRFLI to assess the drainage of ICG laden lymph toward regional nodal basins at baseline. Each patient lay supine on the mat for 1 h of AMLDT with NIRFLI to assess lymphatic flow during treatment. A final NIFRFLI assessment was done 30-60 min posttreatment with the patient in the supine and prone position. Patients reported baseline and posttreatment pain using the Visual Analogue Scale. An imager analyzed NIRFLI images using ImageJ (US National Institutes of Health). Using time stamps of the first and last images to determine time lapsed and the number of pulses observed in a timeframe, pulsing frequency (pulses/min) was obtained to assess lymphatic function. Results: All 4 cases completed the NIRFLI and AMLDT without complications; all 3 patients with baseline pain reported reduced pain posttreatment. AMLDT appeared to alter lymphatic contractility, with both increased and decreased pulsing frequencies observed, including in nonaffected limbs. Pulsing frequencies were very heterogeneous among patients and varied within anatomic regions of the same patient. Discussion: This proof-of-concept study suggests that AMLDT may impact lymphatic contractility. Further research on its effect on lymphatic function is warranted.

Navigating Aspirin Hypersensitivity in Patients Undergoing Percutaneous Coronary Intervention.

Aspirin hypersensitivity continues to be a major clinical challenge in patients with coronary artery disease (CAD), particularly in those requiring percutaneous coronary intervention (PCI) in the absence of a validated alternative antiplatelet regimen. Although true aspirin allergies are uncommon, they can manifest with severe reactions such as angioedema or anaphylaxis, highlighting the critical role of diagnostic challenge tests and tolerance induction strategies. Here, a 61-year-old female with end-stage renal disease (ESRD) on hemodialysis presented with new-onset heart failure and elevated troponins in the setting of a hypertensive emergency. A subsequent left heart catheterization revealed severe multivessel disease, but PCI was deferred due to her history suggestive of aspirin-induced angioedema and the absence of a known optimal approach in this scenario. Given the feasibility of completing a desensitization protocol, aspirin desensitization was pursued, facilitating the successful placement of a drug-eluting stent. This case highlights the need for validated protocols to manage aspirin hypersensitivity, as the current treatment paradigm necessitates a highly individualized approach by the treating clinician.

Analysis of surgical complexity and short-term prognostic indicators in NSCLC patients: neoadjuvant targeted therapy versus neoadjuvant chemoimmunotherapy.

Background: Neoadjuvant therapy improves survival benefits in patients with locally advanced non-small cell lung cancer but increases tissue density, presenting challenges for surgeons. Objectives: To compare the differences in surgical complexity and short-term prognostic outcomes between neoadjuvant targeted therapy (NTT) and neoadjuvant chemoimmunotherapy (NCI). Design/methods: This study enrolled 106 patients underwent curative surgery after neoadjuvant therapy between January 2020 and December 2023 at the National Cancer Center of China. Differences in surgical complexity and short-term prognostic outcomes between the two neoadjuvant therapy cohorts were evaluated. The pathological indicators such as pathological response rate and lymph node upstaging/downstaging were then analyzed. Results: In total, 33 patients underwent NTT and 73 underwent NCI preoperatively. Patients who received NTT showed a higher minimally invasive surgery rate (84.8% versus 53.4%, p < 0.01), shorter operative time (144 versus 184 min, p < 0.01), lower conversion rate (3.3% versus 17.8%, p = 0.03), less postoperative drainage (day 3: 140 versus 200 mL, p = 0.03), and lower incidence of postoperative complications including arrhythmias (6.1% versus 26%, p = 0.02). The pathological response rate in the NTT and NCI groups was 70% and 75%, respectively, with the latter group showing a higher complete pathological response rate. The two groups had no significant differences in major pathological response and lymph node pathological response rate. Conclusion: Patients who received NTT presented fewer surgical challenges for surgeons and had better surgical outcomes than those who received NCI therapy, with comparable pathological response rates between the two cohorts. Accordingly, NTT is the preferred induction regimen for patients harboring mutation status.

Research progress and future directions of immune checkpoint inhibitor combination therapy in advanced gastric cancer.

In recent years, with the continuous development of molecular immunology, immune checkpoint inhibitors (ICIs) have also been widely used in the treatment of gastric cancer, but they still face some challenges: The first is that only some people can benefit, the second is the treatment-related adverse events (TRAEs) that occur during treatment, and the third is the emergence of varying degrees of drug resistance with long-term use. How to overcome these challenges, combined therapy based on ICIs has become one of the important strategies. This article summarizes the clinical application of ICIs combined with chemotherapy, targeted therapy, radiotherapy, photodynamic therapy, thermotherapy, immune adjuvant, and dual immunotherapy and discusses the mechanism, and also summarizes the advantages and disadvantages of the current combination modalities and the potential research value. The aim of this study is to provide more and more optimized combination regimen for ICI combined therapy in patients with advanced gastric cancer and to provide reference for clinical and scientific research.

The efficacy of the novel "wall pierce" technique for common femoral access in endovascular therapy.

Under challenging common femoral artery access scenarios, the "wall PIERCE" technique, which utilizes a larger puncture needle to pierce the vessel wall along the guidewire, facilitates sheath insertion. This method proved successful in two cases without any complications, presenting a valuable addition to strategies for addressing challenging sheath insertion scenarios.