This randomized clinical trial assessed the use of the anti-inflammatory agent Taurolidine in attenuating peri-operative inflammation in 60 patients with non-metastatic colon cancer undergoing surgery. Patients received either Taurolidine or placebo intravenously for 4 days beginning at anesthesia induction. The primary outcome was difference in mean IL-6 levels on postoperative day 1, with secondary outcomes including differences in other inflammatory markers over 7 days and clinical outcomes. IL-6 levels were equivalent on day 1 but were significantly attenuated over 7 days in the Taurolidine group. Surgical site infections were reduced in the Taurolidine group, though tumor recurrence was similar between groups. Perioperative Taurolidine significantly reduced circulating IL-6 levels in
Antibiotics in the ICU - when, what and how?scanFOAM
A presentation by Fredrik Sjövall at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All available content from SSAI2017: https://scanfoam.org/ssai2017/
Delivered in collaboration between scanFOAM, SSAI & SFAI.
PEPTIC (Holden Young - Roseman University College of Pharmacy)HoldenYoung3
PEPTIC (Holden Young - Roseman University College of Pharmacy)
Effect of stress ulcer prophylaxis with proton pump inhibitors vs histamine-2 receptor blockers on in-hospital
mortality among ICU patients receiving invasive mechanical ventilation (PEPTIC).
JAMA . 2020; 323(7):616-626
Fungal infections can occur due to the increasing use of broad-spectrum antibiotics and patients with immunodeficiency. Some pathogens, such as Cryptococcus, Candida,and Fusarium, rarely cause serious diseases in the normal host, while other endemic fungi, such as Histoplasmosis, Coccidiodes,and Paracoccidiodes can cause disease in a normal host, but has a tendency to be aggressive on immunocompromise.
Candida species are normal flora that may be an apportunistic pathogen. Candidiasis occurs in some diseases such as gastrointestinal mucosal esophagitis, a fungal disease associated with the use of catheters and in - patients who have mucosal damage or obtain broad – spectrum antibiotics. Other candidiasis consist of skin candidiasis, funguria candidiasis, disseminated candidiasis and endocarditis candidiasis. Candidemia is the fourth most common cause of nosocomial bloodstream infections in the United States and in many of the developed country. Invasive candidiasis has a significant impact on patient outcomes, and it has been estimated that the mortality of invasive candidiasis is as high as 47%. The mortality rates are 15%-25% for adults and 10%-15% for neonates and children. Diagnostic approach to fungal infection is a priority. The knowledge of the changes in epidemiology and risk factors for fungal infections, has become the main reference to measure optimal treatment of fungal infections.
Journal club presentation: by RxVichuZ!! ;)RxVichuZ
My 97th powerpoint... deals with the comparative study of efficacy of piperacillin-tazobactam, as compared to meropenem in the treatment of ESBL(Extended spectrum beta-lactamases) infections.
A summarized insight has been provided, using research article from JAMA.
Convalescent Plasma and COVID-19: Ancient Therapy Re-emergedasclepiuspdfs
Convalescent plasma has again re-emerged as a therapy during coronavirus disease (COVID-19) outbreaks currently use as a prophylactic or an interventional treatment in infected patients. Convalescent plasma has been used in the 20th century confronting different infectious diseases where there was no other therapy available. Conceivably, this convalescent plasma therapy tends to be proving a game-changing treatment in some COVID-19 patients and could support treatment, in addition to the current interventions before other developed therapies are available for the population.
NUTRIREA-2 (Holden Young - Roseman University College of Pharmacy)HoldenYoung3
NUTRIREA-2 (Holden Young - Roseman University College of Pharmacy)
Enteral versus parenteral early nutrition in ventilated adults with shock: a randomised,
controlled, multicentre, open-label, parallel-group study (NUTRIREA-2).
Lancet. 2018;391:133–43
Antibiotics in the ICU - when, what and how?scanFOAM
A presentation by Fredrik Sjövall at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All available content from SSAI2017: https://scanfoam.org/ssai2017/
Delivered in collaboration between scanFOAM, SSAI & SFAI.
PEPTIC (Holden Young - Roseman University College of Pharmacy)HoldenYoung3
PEPTIC (Holden Young - Roseman University College of Pharmacy)
Effect of stress ulcer prophylaxis with proton pump inhibitors vs histamine-2 receptor blockers on in-hospital
mortality among ICU patients receiving invasive mechanical ventilation (PEPTIC).
JAMA . 2020; 323(7):616-626
Fungal infections can occur due to the increasing use of broad-spectrum antibiotics and patients with immunodeficiency. Some pathogens, such as Cryptococcus, Candida,and Fusarium, rarely cause serious diseases in the normal host, while other endemic fungi, such as Histoplasmosis, Coccidiodes,and Paracoccidiodes can cause disease in a normal host, but has a tendency to be aggressive on immunocompromise.
Candida species are normal flora that may be an apportunistic pathogen. Candidiasis occurs in some diseases such as gastrointestinal mucosal esophagitis, a fungal disease associated with the use of catheters and in - patients who have mucosal damage or obtain broad – spectrum antibiotics. Other candidiasis consist of skin candidiasis, funguria candidiasis, disseminated candidiasis and endocarditis candidiasis. Candidemia is the fourth most common cause of nosocomial bloodstream infections in the United States and in many of the developed country. Invasive candidiasis has a significant impact on patient outcomes, and it has been estimated that the mortality of invasive candidiasis is as high as 47%. The mortality rates are 15%-25% for adults and 10%-15% for neonates and children. Diagnostic approach to fungal infection is a priority. The knowledge of the changes in epidemiology and risk factors for fungal infections, has become the main reference to measure optimal treatment of fungal infections.
Journal club presentation: by RxVichuZ!! ;)RxVichuZ
My 97th powerpoint... deals with the comparative study of efficacy of piperacillin-tazobactam, as compared to meropenem in the treatment of ESBL(Extended spectrum beta-lactamases) infections.
A summarized insight has been provided, using research article from JAMA.
Convalescent Plasma and COVID-19: Ancient Therapy Re-emergedasclepiuspdfs
Convalescent plasma has again re-emerged as a therapy during coronavirus disease (COVID-19) outbreaks currently use as a prophylactic or an interventional treatment in infected patients. Convalescent plasma has been used in the 20th century confronting different infectious diseases where there was no other therapy available. Conceivably, this convalescent plasma therapy tends to be proving a game-changing treatment in some COVID-19 patients and could support treatment, in addition to the current interventions before other developed therapies are available for the population.
NUTRIREA-2 (Holden Young - Roseman University College of Pharmacy)HoldenYoung3
NUTRIREA-2 (Holden Young - Roseman University College of Pharmacy)
Enteral versus parenteral early nutrition in ventilated adults with shock: a randomised,
controlled, multicentre, open-label, parallel-group study (NUTRIREA-2).
Lancet. 2018;391:133–43
Antibiotics are prescribed in daily base to ICU critically ill patients
it needs understanding to PK, PD of these group of drugs to achieve a desirable outcome
NUTRIREA-2 (Holden Young - Roseman University College of Pharmacy)HoldenYoung3
Presentation
NUTRIREA-2 (Holden Young - Roseman University College of Pharmacy)
Enteral versus parenteral early nutrition in ventilated adults with shock: a randomised,
controlled, multicentre, open-label, parallel-group study (NUTRIREA-2).
Lancet. 2018;391:133–43
SEPSIS IS MOST FATAL DISEASE WORLD WIDE. EARLY DETECTION OR PREDICTION OF SEPSIS IS A CHALLENGE
SEPSIS BIOMARKERS ARE OUR WEAPON TO EARLY DETECT SEPSIS. WE HAVE TO UNDERSTAND IT WELL
Currently efficacy of therapy of patients with
MDR ТВ does not exceed 48.7% worldwide and in Russian
Federation. One of the reason is a frequent development of
adverse drug reactions during the use of combination of
antituberculosis drugs. Since 2013 after registration of
tioureidoiminomethylpyridinium perchlorate (Pecrhlozon®) in
Russian Federation, opportunities appeared for further study
of its efficacy and safety in treatment of tuberculosis with
multiple drug resistance (MDR). In the present study we
applied monitoring of adverse drug reactions during complex
therapy by Perchlozon in combination with five other drugs
with the use of international 5-grade scale. We used Common
Terminology Criteria for Adverse Events (version 3.0). In the
study only mild (grade 1) and moderate (grade 2) adverse drug
reactions were observed except single case when severe (grade
3) adverse drug reaction happened. Mild adverse reactions that
during receiving Perchlozon therapy in complex with other
drugs for MDR-TB did not require its cessation.
Neoadjuvant rh-endostatin, docetaxel and epirubicin for breast cancer: effica...Enrique Moreno Gonzalez
Recombinant human endostatin (rh-endostatin) is a novel antiangiogenesis drug developed in
China. Previous experiments have shown that rh-endostatin can inhibit the proliferation and
migration of endothelial cells and some types of tumor cells. In this study, we evaluated the
efficacy and safety profiles of combination therapy of rh-endostatin and neoadjuvant
chemotherapy for breast cancer patients in a prospective, randomized, controlled, phase II
trial.
Colorectal cancer (CRC) has potential to spread within the peritoneal cavity, and this transcoelomic
dissemination is termed “peritoneal metastases” (PM).The aim of this article was to summarise the current
evidence regarding CRC patients at high risk of PM. Colorectal cancer is the second most common cause of cancer
death in the UK. Prompt investigation of suspicious symptoms is important, but there is increasing evidence that
screening for the disease can produce significant reductions in mortality.High quality surgery is of paramount
importance in achieving good outcomes, particularly in rectal cancer, but adjuvant radiotherapy and chemotherapy
have important parts to play. The treatment of advanced disease is still essentially palliative, although surgery for
limited hepatic metastases may be curative in a small proportion of patients.
Antibiotics are prescribed in daily base to ICU critically ill patients
it needs understanding to PK, PD of these group of drugs to achieve a desirable outcome
NUTRIREA-2 (Holden Young - Roseman University College of Pharmacy)HoldenYoung3
Presentation
NUTRIREA-2 (Holden Young - Roseman University College of Pharmacy)
Enteral versus parenteral early nutrition in ventilated adults with shock: a randomised,
controlled, multicentre, open-label, parallel-group study (NUTRIREA-2).
Lancet. 2018;391:133–43
SEPSIS IS MOST FATAL DISEASE WORLD WIDE. EARLY DETECTION OR PREDICTION OF SEPSIS IS A CHALLENGE
SEPSIS BIOMARKERS ARE OUR WEAPON TO EARLY DETECT SEPSIS. WE HAVE TO UNDERSTAND IT WELL
Currently efficacy of therapy of patients with
MDR ТВ does not exceed 48.7% worldwide and in Russian
Federation. One of the reason is a frequent development of
adverse drug reactions during the use of combination of
antituberculosis drugs. Since 2013 after registration of
tioureidoiminomethylpyridinium perchlorate (Pecrhlozon®) in
Russian Federation, opportunities appeared for further study
of its efficacy and safety in treatment of tuberculosis with
multiple drug resistance (MDR). In the present study we
applied monitoring of adverse drug reactions during complex
therapy by Perchlozon in combination with five other drugs
with the use of international 5-grade scale. We used Common
Terminology Criteria for Adverse Events (version 3.0). In the
study only mild (grade 1) and moderate (grade 2) adverse drug
reactions were observed except single case when severe (grade
3) adverse drug reaction happened. Mild adverse reactions that
during receiving Perchlozon therapy in complex with other
drugs for MDR-TB did not require its cessation.
Neoadjuvant rh-endostatin, docetaxel and epirubicin for breast cancer: effica...Enrique Moreno Gonzalez
Recombinant human endostatin (rh-endostatin) is a novel antiangiogenesis drug developed in
China. Previous experiments have shown that rh-endostatin can inhibit the proliferation and
migration of endothelial cells and some types of tumor cells. In this study, we evaluated the
efficacy and safety profiles of combination therapy of rh-endostatin and neoadjuvant
chemotherapy for breast cancer patients in a prospective, randomized, controlled, phase II
trial.
Colorectal cancer (CRC) has potential to spread within the peritoneal cavity, and this transcoelomic
dissemination is termed “peritoneal metastases” (PM).The aim of this article was to summarise the current
evidence regarding CRC patients at high risk of PM. Colorectal cancer is the second most common cause of cancer
death in the UK. Prompt investigation of suspicious symptoms is important, but there is increasing evidence that
screening for the disease can produce significant reductions in mortality.High quality surgery is of paramount
importance in achieving good outcomes, particularly in rectal cancer, but adjuvant radiotherapy and chemotherapy
have important parts to play. The treatment of advanced disease is still essentially palliative, although surgery for
limited hepatic metastases may be curative in a small proportion of patients.
Establishment of a Rehabilitation Clinic for Colorectal Cancer. Will it End P...daranisaha
Colorectal cancer (CRC) is the third most common diagnosis and the second most lethal malignancy in both men and women.
To establish a rehabilitation clinic in the oncology department in hospitals and address its positive effect on colorectal cancer patients’ need.
A prospective study of breast lump andclinicopathologicalanalysis in relation...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Chemosensitivity Testing of Circulating Epithelial Tumor Cells (CETC) in Vitr...Peter Pachmann
ABSTRACT
Background: Chemotherapy is a mainstay of tumor therapy, however, it is predominantly applied according to empiri- cally developed recommendations derived from statistical relapse rates occurring years after the treatment in the adju- vant situation and from progression-free interval data in the metastatic situation, without any possibility of individually determining the efficacy in the adjuvant situation and with loss of time and quality of life in the metastatic situation if the drugs chosen are not effective. Here, we present a method to determine the efficiency of chemotherapeutic drugs using tumor cells circulating in blood as the part of the tumor actually available in the patient’s body for chemosensitiv- ity testing. Methodology/Principal Findings: After only red blood cell lysis, omitting any enrichment (analogous to other blood cell enumeration methods, including rare CD34 cells), the white cells comprising the circulating epithelial tumor cells (CETC) are exposed to the drugs in question in different concentrations and for different periods of time. Staining with a fluorescence-labeled anti-epithelial antibody detects both vital and dying tumor cells, distinguishing vital from dying cells through membrane permeability and nuclear staining with propidium iodide. Increasing percent- ages of dying tumor cells are observed dependent on time and concentration. The sensitivity can vary during therapy and was correlated with decrease or increase in CETC and clinical outcome. Conclusions/Significance: Thus, we are able to show that chemosensitivity testing of circulating tumor cells provides real-time information about the sensitivity of the tumor present in the patient, even at different times during therapy, and correlates with treatment success.
Cord Blood Mesenchymal Stem Cells Conditioned Media Suppress Epithelial Ovari...ijtsrd
Background and objective: Treatment of epithelial ovarian cancer (EOC) is a major challenge with only 30% 5-year survival rate. The outcome of the different therapeutic modalities is still poor, and there is an urgency to find new treatment lines. The effect of mesenchymal stem cells on different tumors is greatly variable. The present work shows the effect of cord blood mesenchymal stem cells conditioned media (MSC CM) in different concentrations on epithelial ovarian cancer stem cells (CD44+ cells) in vitro. Methodology: Ovarian cancer stem cells were subjected to MSC CM of (100%, 75%, 50%, 25%) concentrations for 72 hours followed by investigation of cell morphology, proliferation, apoptosis, cell cycle and expression of certain genes (Oct-4, Sox-2, and Nanog). Results: Cell shrinkage and cell debris was observed with all cancer cell lines by contrast with control. MTT assay showed a reduction in proliferation, in a concentration-dependent manner. The annexin-v results demonstrated a significant early and late apoptosis. There was an increase in the sub-G1 phase of the cell cycles indicating apoptosis. There was a progressive suppression of embryonic stemness genes in all cell lines compared to control. Conclusion: Based on these results, it was concluded that MSC CM may be a potential ovarian cancer inhibitor that may create a new modalities of treatment in ovarian cancer patients. Maher E. Elgaly | Mohamed E. El Ghareeb | Mohamed H. Bedairy | Ahmed M. Badawy | Abeer Shaaban | Farha El shennawy"Cord Blood Mesenchymal Stem Cells Conditioned Media Suppress Epithelial Ovarian Cancer Cells in Vitro" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-2 | Issue-5 , August 2018, URL: http://www.ijtsrd.com/papers/ijtsrd18182.pdf http://www.ijtsrd.com/other-scientific-research-area/other/18182/cord-blood-mesenchymal-stem-cells-conditioned-media-suppress-epithelial-ovarian-cancer-cells-in-vitro/maher-e-elgaly
Gastric cancer
Second most common cancer-related death.
4th most common cancer
Korea, Japan, China, Taiwan high rates.
with 875,000 injured annually person in the world.
Palliative chemotherapy with:
Irinotecan and cisplatin.
Folic acid, 5-FU, and irinotecan (FOLFIRI).
Leucovorin, 5-FU, and oxaliplatin (FOLFOX).
Phase II studies evaluating irinotecan-based or oxaliplatin-based regimens demonstrate similar response rates
Correlation between vascular endothelial growth factor-A expression and tumor...UniversitasGadjahMada
Vascular endothelial growth factor-A (VEGF-A) has been observed as the predominant angiogenic factor in colorectal cancer (CRC) and the assessment of microvessel density (MVD) has been used to quantify tumor neoangiogenesis. This study aimed to determine clinicopathological and prognostic significance of both angiogenic markers in the local CRC patients. We analyzed tissue samples obtained from 81 cases with CRC. VEGF-A expression and MVD counts were immunohistochemically detected using anti VEGF-A and CD31. The assessments of both markers were classified as low and high. Correlation between VEGF-A expression and MVD value and clinicopathological characteristics were examined using Chi-square test. The overall survival (OS) was plotted using the Kaplan-Meier method. The results indicated a high VEGF-A expression was found more frequently in the rectal location (P=0.042) and T4 tumors (P=0.041) compared to their counterparts. Older patients tended to show a higher MVD value compared to younger cases (P=0.062). In addition, survival analysis showed that males had a worse OS compared to females (P=0.029), and VEGF-A expression and MVD count did not correlate with patients’ survival. In conclusion, there were significant differences of VEGF-A expression according to tumor location and T invasion. Sex, but not angiogenic markers, had an influence on the survival of CRC patients.
Current evidence for laparoscopic surgery in colorectal cancersApollo Hospitals
The article lays an emphasis on the laparoscopic surgical method used to treat colorectal cancer. It reviews the current status of the laparoscopic colorectal surgeries and recommendation of evidences for short- and long-term outcome. The early results were against laparoscopic approach. There was a need of properly designed study to validate or invalidate these findings. Seven large-scale trials compared laparoscopic and open colectomy for colon carcinoma and examined short-term and long-term outcomes. These trials included the Clinical Outcomes of Surgical Therapies (COST) trial funded by the National Cancer Institute in the United States, the Conventional versus Laparoscopic-Assisted Surgery in Colorectal Cancer (CLASICC) trial in the United Kingdom, the Colon Cancer Laparoscopic or Open Resection (COLOR), a multicenter European trial.
For the validation of the argument that laparoscopy is safe, meta-analysis was performed. Certain conclusions of meta-analysis are also presented in this article. The individual merits and weaknesses of laparoscopic surgery as compared with open surgery as the primary treatment of colorectal cancer are being highlighted in this article.
Similar to Neoadjuvant NSAIDs in colon cancer (13)
A child with ARFID will display a range of physical and behavioural warning signs. Behavioural signs include a sudden refusal to eat, a fear of choking and difficulty eating meals with others. Physical signs include delayed growth and, depending on your child's age, weight loss or failure to gain weight.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
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5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
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Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
2. Background
Peri-operative inflammation is a phenomenon that has
been extensively highlighted in cancer patients as a po-
tential therapeutic target [1–3]. Strong links have been
demonstrated between the pro-inflammatory compo-
nents of the peri-operative inflammatory milieu and
their effects locally on residual tumor cell deposits and
systemically on disseminated tumor cells [4–9].
However, treatment strategies aimed at potentially im-
proving survival for cancer patients by targeting
peri-operative inflammation have yet to be devised, with
the majority of treatment strategies aimed only at the
neoadjuvant and adjuvant period.
The peri-operative inflammatory response itself is vital
for the healing process, however several components of
the inflammatory cascade initiated by surgical trauma
confer accelerant effects on residual tumor deposits [10–
15]. In particular, the pro-inflammatory cytokine IL-6 has
been demonstrated to act as a key mediator in tumor cell
growth by upregulation of metastatic gene expression and
further stimulation of down-stream pro-inflammatory cy-
tokines and growth factor release [16]. Tumor derived
IL-6 also acts as a chemoattractant to circulating tumor
cells and facilitates self-seeding of disseminated tumor
cells [17, 18]. Moreover, elevated levels of IL-6 carry prog-
nostic implications in certain tumor phenotypes including
colon cancer, with elevated IL-6 levels closely associated
with increasing tumor size, tumor stage, presence of meta-
static disease and reduced survival [19].
Up to 30% of non-metastatic colon cancer patients can
develop distant metastases. In particular, 70% of metastases
will occur within 2 years of the initial ‘curative’ operation.
This pattern is thought to relate to the effects of surgical in-
flammation [20, 21]. The best illustration of this cause-effect
relationship is demonstrable where complications such as
anastomotic leakage occur or where conversion from lap-
aroscopic to open surgery is necessary [22]. In these scenar-
ios patients experience a more exaggerated inflammatory
response and ultimately have a worse outcome [23, 24].
Thus, colon cancer offers an ideal model to investigate the
potential therapeutic effects of targeting inflammation.
To explore the concept of attenuating inflammation
safely in cancer patients undergoing major surgery we
chose the ubiquitously active agent Taurolidine which
has been extensively studied in a variety of clinical states
involved in inflammation and cancer with a remarkable
safety record [25]. Taurolidine itself possesses both
anti-inflammatory and anti-neoplastic properties and has
an excellent safety profile [26–28]. Our pre-clinical ex-
perience of the anti-inflammatory effects of Taurolidine
were in an experimental pancreatitis model where Taur-
olidine reduced the endotoxin levels in an animal model
[29]. Other groups have shown a reduction in
pro-inflammatory mediators including IL-1 and TNF-α
associated with Taurolidine administration [30]. In
addition, our group has demonstrated previously in the
setting of a randomised clinical trial that peri-operative
IL-6 can be safely and successfully targeted using this
anti-inflammatory agent in patients undergoing coronary
artery bypass surgery [31].
On this basis we hypothesised that peri-adjunctive
utilisation of a dual anti-inflammatory and anti-neoplas-
tic agent, Taurolidine, could potentially reduce immedi-
ate peri-operative inflammation which may confer
survival benefits for colon cancer patients. Thus, to test
this hypothesis, we performed a randomised, controlled
clinical trial to examine the efficacy of using an
anti-neoplastic agent on peri-operative inflammation in
non-metastatic colon cancer patients undergoing resec-
tion of their primary tumor. We conceptualised the term
‘surguvant’ to define therapeutic modification used in
combination with surgical treatment during the
peri-operative period. We also sought to examine patient
safety peri-operatively and observe the effects of this
treatment strategy on disease free survival.
Methods
Trial design
A randomised, multicentre, placebo controlled, open
label clinical trial was performed. Three centres re-
cruited patients including Cork University Hospital,
Bons Secours Cork and Mercy University Hospital. Pa-
tients were randomised on a 1:1 allocation ratio to 2%
Taurolidine infusions or to a placebo, given 4 times a
day for a total of 4 days. A sealed envelope method was
used for randomisation. Randomisation codes were gen-
erated from www.randomization.com.
The investigational medicinal product was an intra-
venous formulation of 2% Taurolidine (C7H16N4O4S2)
manufactured by Geistlich-Pharma AG, CH 6110
Wolhusen/Luzern, Switzerland. The comparator pla-
cebo was 0.9% saline. The Taurolidine solution required
central administration and all patients randomised to
receive Taurolidine had either a central line or a periph-
eral long line inserted prior to the operation. First dose
of Taurolidine or Placebo was administered at induc-
tion of anaesthesia. Trial bloods were performed
pre-operatively, and at 3 h, 6 h, day 1, day 2, day3, day
5 and day 7 (only if still an inpatient) post-operatively.
Human IFN-γ, IL-1β, IL-2, IL-6, IL-10, TNF-α, Human
VEGF, Human CRP levels were measured using a cus-
tomised ELISA kit manufactured by MSD (Meso Scale
Discovery)® (Gaithersburg, Maryland, US).
Inclusion/exclusion criteria
Inclusion criteria included males and females between
18 and 85 years of age with non-metastatic colon cancer.
Patients undergoing elective surgery only were included.
Redmond et al. BMC Cancer (2018) 18:794 Page 2 of 8
3. Exclusion criteria were as follows - Rectal cancers
(defined as a tumor < 15 cm from the anal verge), pa-
tients with a known allergy to taurolidine / taurine,
pregnant and lactating women, evidence of underlying
liver disease (abnormal LFT’s (> × 2 normal), INR > 1.5),
evidence of underlying renal disease (creatinine > 180 for
women, > 150 for men), blood dyscrasia (neutropenia < 1500
cells /cm3, thrombocytopenia < 100,000 cells/cm3),
evidence of intestinal obstruction, metastases (M1:Distant
spread or Dukes D), morbid obesity (body mass index
> 40 kg/m2
), operative risk > ASA – III, previous can-
cer / malignant disease other than non-melanoma
skin cancer, coexisting active inflammatory disorder
(including active RA, IBD, SLE), corticosteroids usage,
immunosuppressive drugs, previous diagnosis of HIV,
chronic active Hepatitis B or C (testing not required
for study), active infection at the time of surgical
intervention.
Endpoints
The primary endpoint for the study was the difference in
mean plasma IL-6 levels on day 1 in Taurolidine as com-
pared to placebo group, adjusted for pre-operative IL-6,
age and gender. Secondary laboratory endpoints included
the difference in mean IL-6, IL-10 and CRP measured on
post- operative days 2, 3, 5 and 7 in the Taurolidine as
compared to the placebo group, adjusted for baseline
measurement, age, gender and procedure type.
Exploratory analyses were conducted examining levels of
TNF-α, VEGF, IL-1β, IFN-γ, surface expression of CD14
and CD11b on neutrophils/monocytes, and plasma levels
of C-reactive protein at the above time points.
Secondary Clinical Endpoints included a comparison
of Taurolidine to control group with regard to occur-
rence & severity of post-operative infections, time to
bowel functional recovery, post-operative pain control
and recurrence (defined as local or metastatic growth) of
tumor growth.
Trial oversight
All patients provided full written informed consent.
Trial participation was approved in all 3 study sites
by the Cork Research Ethics Committee and the Irish
Medicines Board and was registered with EudraCT
(registration number = 2008–005570-12) and ISRCTN
(registration number = 77,829,558). The trial was con-
ducted in accordance with the provisions of the
Declaration of Helsinki. A trial monitor was utilised
to ensure the accuracy of the data collected and the
case report form from each patient.
Sample size
Precise sample size and power estimation for the trial
was limited by lack of data within available literature de-
scribing expected baseline and follow-up levels of the
various biochemical outcome parameters in the
Fig. 1 Consort diagram
Redmond et al. BMC Cancer (2018) 18:794 Page 3 of 8
4. proposed study population and lack of available evidence
regarding the efficacy of the intervention within this set-
ting. Based on the changes in IL-6 levels following co-
lonic resection observed by Salvadora Delgado, M.D. et
al. [32], we estimated that 28 patients in each arm would
allow us to detect a 0.75 SD difference in study arms
with 80% power, given a type 1 error rate of 5%, using a
two sample t-test with equal samples sizes and a shared
variance.
Statistical analysis
Categorical data were described by their counts and per-
centages in each category. Continuous variables were de-
scribed by their medians and inter-quartile ranges. All
continuously measured laboratory endpoints were log
transformed. Differences between study arms for labora-
tory endpoints, at each time point specified in the proto-
col, were estimated using ANCOVA, with adjustment
for baseline measurement, age, sex, and procedure. Dif-
ferences between study arms in linear trajectories of la-
boratory endpoints across all time-points (days 1–7)
were estimated using linear mixed effects models using a
treatment arm by Time interaction term. These models
were adjusted for age, sex, and procedure type. The stat-
istical significance of the interaction was tested using the
p-value from the likelihood ratio chi-squared test.
Differences between study arms for categorical clinical
endpoints were assessed using the chi-squared test. Dif-
ferences between study arms for time-to-recurrence and
mortality were estimated using the Cox proportional
hazards model, adjusted for age, sex, and procedure.
All analyses were conducted on an intent-to-treat
basis, using the R Project for Statistical Computing
(version 3.2.2 R Foundation for Statistical Computing,
Vienna, Austria. www.r-project.org/).
Results
A total of 293 patients were screened for trial inclusion.
Two hundred thirty three patients were excluded, thus
60 patients were randomised to either study group
(Fig. 1). Twenty-eight patients were randomised to pla-
cebo and 32 patients to Taurolidine. The patient, tumor
and operative characteristics are summarised in Table 1.
There was no significant difference in these characteris-
tics between the two study arms.
Primary endpoint and post-hoc analysis
A peak in IL-6 levels in both study groups was evident
at 24 h post surgery. The overall trend for this IL-6 peak
was to settle over the remaining study days. IL-6 levels
at 24 h were equivalent in the Taurolidine and placebo
group (p = 0.89). Post-hoc analysis was performed to
analyse the selected study cytokines in both study groups
over the entire 7 day study period (Fig. 2). IL-6 levels
were found to be significantly attenuated in the Tauroli-
dine group compared to the placebo group over the
course of the study period (p = 0.04). In addition, the
mean levels of IL-6 were significantly attenuated in the
Taurolidine group compared to placebo at 7 days (p = 0.04).
Secondary laboratory end-points
TNF-α levels demonstrated a peak at 24 h post surgery.
The rate of TNF-α attenuation in Taurolidine treated pa-
tients compared to placebo over the 7 days approached
Table 1 Patient, surgery and tumor characteristics, reported as
n(%), or median[IQR]
Total
(n = 60)
Saline
(n = 28)
Taurolidine
(n = 32)
p-value
Sex
F 21 (35%) 6 (21.4%) 15 (46.9%) 0.07
M 39 (65%) 22 (78.6%) 17 (53.1%)
Age 69 [59.8,
72.2]
67 [58.8,
72]
69.5 [65.2,
72.2]
0.49
Surgery
Anterior
resection
27 (45%) 12 (42.8%) 15 (55.6%) 0.55
Right
hemicolectomy
23 (38.3%) 12 (42.8%) 11 (40.7%)
Total
colectomy
1 (1.7%) 0(0%) 1 (3.7%)
Other 9 (15%) 4 (14.2%) 5 (15.6%)
Procedure
Converted 6 (10%) 3 (10.7%) 3 (9.4%) 0.59
Lap 47 (78.3%) 23 (82.1%) 24 (75%)
Open 7 (11.7%) 2 (7.1%) 5 (15.6%)
Primary tumor
T1 4 (6.7%) 1 (3.6%) 3 (9.3%) 0.59
T2 8 (13.3%) 5 (17.8%) 3 (9.3%)
T3 34 (56.6%) 16 (57.1%) 18 (56.2%)
T4 8 (13.3%) 2 (7.1%) 6 (18.8%)
T4a 4 (6.7%) 3 (10.7%) 1 (3.2%)
T4b 1 (1.7%) 1 (3.5%) 0 (0%)
Carcinoid 1 (1.7%) 0 (0%) 1 (3.2%)
Regional lymph nodes
N0 31 (51.6%) 12 (42.8%) 19 (59.4%) 0.37
N1 9 (15%) 5 (17.8%) 4 (12.5%)
N1a 7 (11.6%) 4 (14.2%) 3 (9.4%)
N1b 6 (10.0%) 3 (10.8%) 3 (9.4%)
N2 5 (8.4%) 3 (10.8%) 2 (6.2%)
N2b 2 (3.4%) 1 (3.6%) 1 (3.1%)
Lymph node yield 17 16 18 0.58
Follow-up
(months)
34 32 37 0.23
Redmond et al. BMC Cancer (2018) 18:794 Page 4 of 8
5. significance (p = 0.07). At the 7 day time point, IL-2
demonstrated a trend towards attenuation in the
Taurolidine treated group compared to placebo (p = 0.06).
The remaining cytokines and growth factors did not show
any significant changes over the study period between the
two study groups.
Secondary clinical end-points
The median length of stay was 6 days for the entire
study cohort. There were 11 cases of post-operative in-
fective complications. Six of the infective complications
were surgical site infections, 5 cases were in the placebo
group and 1 in the Taurolidine group (p = 0.09) (Table 2).
Three post-operative infections were anastomotic leaks,
2 in the placebo and 1 in the Taurolidine treated group
(p = 0.41). The remaining 2 infective complications con-
sisted of a lower respiratory tract infection in a patient
with underlying COPD and cellulitis at the site of PICC
line insertion. Both of these infective complications were
in the Taurolidine group.
The mean time to return of bowel function was 39 h
in the placebo group and 34 h in the Taurolidine group
(p = 0.32). Pain scores demonstrated no difference be-
tween the two study groups (p = 0.39).
Survival end-points
At the 2 year follow-up time point there were 3 recurrences
in total, 2 in the placebo group and 1 in the Taurolidine
group (p = 0.38) (Table 3). The overall median follow-up at
the time of data analysis was 34 months (range 24 months
to 5 years). The median follow-up time in the placebo
group was 32 months (range 24–76 months). The median
follow-up time in the Taurolidine group was 37 months
(range 24–76 months). In this time period 6 patients had
experienced a recurrence, with 3 in the placebo treated
group and 3 in the Taurolidine group (p = 0.64). In these
patients the median time to recurrence was 19 months in
the placebo group and 38 months in the Taurolidine group
(p = 0.27). The 3 placebo group patients developed
Fig. 2 Seven-day linear trends in laboratory endpoints. Differences in the 7-day linear trend between treatment arms were tested using linear
mixed effects models and treatment X time interaction term. The p-values in the plot are from the likelihood ratio test for a model including that
interaction term vs. a model without it
Table 3 A comparison of survival outcome data
Total
(n = 60)
Saline
(n = 28)
Taurolidine
(n = 32)
p-value
Overall recurrence 6 3 3 1
Recurrence at 2 years 3 2 1 0.389
Mean time to recurrence
(months)
16.3 28.6 0.4
Median time to recurrence
(months)
19 38 0.268
Table 2 A comparison of clinical end-point data
Placebo
(n = 28)
Taurolidine
(n = 32)
p-value
Pain Day 1 2.5 1.8 0.391
Day 2 1.9 2 0.873
Day 3 1.9 1 0.179
Time to bowel function (hrs) 39 34 0.32
Infective complication 8 4 0.19
Surgical site infection 5 1 0.09
Anastomotic leak 2 1 0.59
Other 0 2 0.49
Redmond et al. BMC Cancer (2018) 18:794 Page 5 of 8
6. loco-regional recurrence. The 3 Taurolidine patients devel-
oped distant metastatic disease.
Discussion
This multi-centre, randomised clinical trial was specific-
ally designed to address the question of the potential ef-
fects of surgically induced inflammation on
perioperative tumor kinetics using IL-6 as a surrogate
marker. We used the agent Taurolidine to therapeutic-
ally modify these effects during the peri-operative time
period. Although there was no difference seen at the
early 24 h time-point, post hoc analysis demonstrated a
significant trend for IL-6 attenuation over the 7 day
post-operative period in Taurolidine versus the control
group, with levels being significantly different at
post-operative day 7. Thus whilst we do not demonstrate
an immediate post-operative effect, in post hoc analysis
we see a delayed effect from Taurolidine on circulating
Il-6 levels.
The levels of circulating colon cancer cells and circulating
colon cancer stem cells are significantly higher
peri-operatively, particularly within the portal venous sys-
tem [33, 34]. Together with a surge in circulating
pro-inflammatory cytokine and growth factor levels, this is
a significant and completely understudied phenomenon
that potentially has detrimental implications for cancer pa-
tients in both the short and long term. This trial provides
evidence, at least in part, that targeting the inflammatory
response in particular can potentially reduce post-operative
tumor metastatic growth resulting in improved patient sur-
vival outcome. In particular it can reduce inflammation and
ultimately may improve patient outcome.
Circulating levels of IL-6 were attenuated in response
to Taurolidine administration in a time dependent man-
ner. It is possible that earlier administration of Tauroli-
dine a number of days pre-operatively might result in a
more immediate attenuation of IL-6 post-operatively.
Furthermore, post-operative administration over an ex-
tended period of time may also have an added benefit in
the presence or absence of chemotherapy [35].
IL-6 can propagate colon cancer cell growth and un-
surprisingly circulating levels of IL-6 are prognostic in
colon cancer [36]. The present study was not powered
for a formal survival analysis so it is not possible to as-
sess the clinical impact of IL-6 attenuation, however in-
teresting trends are emerging from this data in relation
to survival outcome. The median time to tumor recur-
rence was longer, though not significantly different in
patients who were treated with Taurolidine versus those
that were treated with placebo (38 months versus
19 months). However, these are only trends and would
require an appropriately powered trial in order to draw
solid conclusions.
Surgical patients are dependent upon components of in-
flammation to heal safely. Compromise of the healing
process can lead to life-threatening complications, for ex-
ample an anastomotic leak. Unsuccessful attempts at uti-
lising the peri-operative period for adjunctive therapies
have failed in the past due to compromise of safety. The
present trial demonstrates that the anti-inflammatory
agent Taurolidine can target key pro-inflammatory cyto-
kines without compromising patient safety.
Several key points now need to be addressed. Firstly,
does extension of the period of Taurolidine administration
help to further attenuate pro-inflammatory responses to
surgical trauma. Careful attention to patient safety and
safety outcomes will be required if further extension of
the administration period is considered. Secondly, does
the attenuation of the inflammatory response translate
into a survival benefit? We hypothesise that the attenu-
ation of Il-6 levels over the initial post-operative week
may lead to a clinically relevant improvement in patient
outcomes as the peri-operative interaction of disseminated
tumor cells and the pro-inflammatory milieu of cytokines/
growth factors will occur in a less favourable environment.
However this needs to be further addressed in a large, ad-
equately powered clinical trial.
Conclusions
Peri-operative use of Taurolidine attenuated circulating
IL-6 levels in a progressive manner post-operatively. We
believe that further investigation of such ‘surguvant’
therapies during this under-investigated period could
lead to significant improvements in surgical patient out-
comes in a safe manner.
Abbreviations
ANCOVA: Analysis of covariance; ASA: American society of anaesthesiologists;
CD-11b: Cluster of differentiation 11b; CD-14: Cluster of differentiation 14;
COPD: Chronic obstructive pulmonary disease; CRP: C-reactive protein;
HIV: Human immunodeficiency virus; IBD: Inflammatory bowel disease; IFN-
γ: Interferon gamma; IL-10: Interleukin 10; IL-1β: Interleukin 1-beta; IL-2: Interleukin
2; IL-6: Interleukin-6; INR: International normalised ratio; LFTs: Liver function tests;
RA: Rheumatoid arthritis; SLE: Systemic lupus erythematous; TNF-α: Tumour
necrosis factor-α; VEGF: Vascular epithelial growth factor
Acknowledgements
A number of individuals contributed to this study and should be acknowledged
for their efforts including Professor Michéal Ó'Ríordáin, Mr. Colm O’Boyle,
Mr. David Gough, Professor Joe Eustace, Mr. Darren Dahly, Mr. Emmet
Andrews, Mr. Morgan McCourt, Professor Mark Corrigan, Dr. Derek Power
and Dr. Patrick Hallihan,
Funding
The trial was funded by Geistlich Pharma AG, Wolhusen, Switzerland. The
funding body had no role in data collection. Data analysis and interpretation
was performed by a statistician who received support from the funding body.
Accuracy of trial data was overseen by an independent trial monitor who was
supported by the funding body. Study design and manuscript preparation was
performed independent of the funding body.
Availability of data and materials
Trial data is available from authors at request.
Redmond et al. BMC Cancer (2018) 18:794 Page 6 of 8
7. Authors’ contributions
HPR was involved in trial conception, design, manuscript preparation and
final approval for publication. PN contributed to trial design and data collection.
MJ contributed to data collection and data analysis. EOC contributed to data
collection and data analysis. NF contributed to data collection and data analysis.
RP contributed to trial design and manuscript preparation. JHW contributed to
trial design, data analysis and manuscript preparation. DPOL contributed to trial
design, data collection, data analysis and manuscript preparation. All authors
read and approved the final manuscript.
Ethics approval and consent to participate
Trial participation was approved in all 3 study sites by the Cork Research Ethics
Committee and the Irish Medicines Board and was registered with EudraCT
(registration number = 2008–005570-12) and ISRCTN (registration number
= 77,829,558). Written consent to participate was given by each patient.
Consent for publication
Participating patients gave full written informed consent to allow for patient
data to be included in any subsequent publication.
Competing interests
The authors declare that they have no competing interests.
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published
maps and institutional affiliations.
Received: 19 February 2018 Accepted: 27 June 2018
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