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Rev Med Suisse ; 15(660): 1512-1515, 2019 Aug 28.
Artigo em Francês | MEDLINE | ID: mdl-31496176


The emergence of immunotherapy has generated great enthusiasm in oncology improving the prognosis of pathologies such as melanoma, lung cancer, kidney cancer, bladder and head and neck cancers. This enthusiasm concerns also older patients in view of the good tolerance of immunotherapy in young people. However, advanced age is linked to changes in the immune system, called immunosenescence, which could have a negative impact on the efficacy and toxicity of immunotherapy treatment. Knowledge in terms of efficacy and tolerance is limited for geriatric patients, few being included in clinical studies. This article summarizes the experience of immunotherapy in large clinical trials. It appears that the immune checkpoint inhibitors are effective and well tolerated in the elderly.

Imunoterapia , Neoplasias , Fatores Etários , Humanos , Tolerância Imunológica , Imunossenescência , Oncologia/tendências , Neoplasias/terapia
J Geriatr Oncol ; 9(6): 665-672, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29678669


OBJECTIVE: Big Data is widely seen as a major opportunity for progress in the practice of personalized medicine, attracting the attention from medical societies and presidential teams alike as it offers a unique opportunity to enlarge the base of evidence, especially for older patients underrepresented in clinical trials. This study prospectively assessed the real-time availability of clinical cases in the Health & Research Informatics Total Cancer Care™ (TCC) database matching community patients with cancer, and the impact of such a consultation on treatment. MATERIALS AND METHODS: Patients aged 70 and older seen at the Lynn Cancer Institute (LCI) with a documented malignancy were eligible. Geriatric screening information and the oncologist's pre-consultation treatment plan were sent to Moffitt. A search for similar patients was done in TCC and additional information retrieved from Electronic Medical Records. A report summarizing the data was sent and the utility of such a consultation was assessed per email after the treatment decision. RESULTS: Thirty one patients were included. The geriatric screening was positive in 87.1% (27) of them. The oncogeriatric consultation took on average 2.2 working days. It influenced treatment in 38.7% (12), and modified it in 19.4% (6). The consultation was perceived as "somewhat" to "very useful" in 83.9% (26). CONCLUSION: This study establishes a proof of concept of the feasibility of real time use of Big Data for clinical practice. The geriatric screening and the consultation report influenced treatment in 38.7% of cases and modified it in 19.4%, which compares very well with oncogeriatric literature. Additional steps are needed to render it financially and clinically viable.

Neuropsychobiology ; 61(1): 1-9, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-19923860


BACKGROUND/AIMS: Heschl's gyrus (HG) is functionally involved in the genesis of auditory verbal hallucinations (AVH). This dysfunction seems to be structurally facilitated. The aim of the study was to analyze macrostructural features of HG in a group of patients reporting AVH who demonstrated white matter diffusion tensor imaging abnormalities reported previously. METHODS: 3-D anatomical MR scans were obtained (patients with and without history of AVH, controls). HG was delineated by manual segmentation. Cortical folding, absolute and relative volumes, laterality were analyzed. RESULTS: According to the literature, in the collapsed group of patients, the normal left-greater-than-right laterality of HG was attenuated. We found a trend towards a higher number of duplicated HG in hallucinating patients. We also found a bigger volume of HG in the right hemisphere in hallucinating patients. This effect was caused by gray and white matter increase. CONCLUSIONS: This is the first study on manual volumetry of HG in a group of schizophrenia patients with AVH compared to patients without AVH. In a previous analysis of the diffusion tensor imaging data of the here presented sample, we found higher directionality of the arcuate fasciculus in patients with AVH, facilitating abnormal co-activation in the auditory cortices in the hallucinating brain. As these abnormal activations are frequent in hallucinating patients, the here described volume increase of HG might be interpreted as compensatory plastic adaptations of the contralateral regions. We suggest that this volume increase of HG is caused by the symptomatology and not by the underlying disorder of schizophrenia.

Córtex Auditivo/patologia , Alucinações/patologia , Esquizofrenia/patologia , Adulto , Análise de Variância , Feminino , Lateralidade Funcional , Humanos , Processamento de Imagem Assistida por Computador , Imagem Tridimensional , Imagem por Ressonância Magnética , Masculino , Fibras Nervosas Mielinizadas/patologia , Fibras Nervosas Amielínicas/patologia , Tamanho do Órgão