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Background: We aimed to develop a publicly shared computational physiologically based pharmacokinetic (PBPK) model to reliably simulate and analyze radiopharmaceutical therapies (RPTs), including probing of hot-cold ligand competitions as well as alternative injection scenarios and drug designs, towards optimal therapies. Results: To handle the complexity of PBPK models (over 150 differential equations), a scalable modeling notation called the "reaction graph" is introduced, enabling easy inclusion of various interactions. We refer to this as physiologically based radiopharmacokinetic (PBRPK) modeling, fine-tuned specifically for radiopharmaceuticals. As three important applications, we used our PBRPK model to (1) study the effect of competition between hot and cold species on delivered doses to tumors and organs at risk. In addition, (2) we evaluated an alternative paradigm of utilizing multi-bolus injections in RPTs instead of prevalent single injections. Finally, (3) we used PBRPK modeling to study the impact of varying albumin-binding affinities by ligands, and the implications for RPTs. We found that competition between labeled and unlabeled ligands can lead to non-linear relations between injected activity and the delivered dose to a particular organ, in the sense that doubling the injected activity does not necessarily result in a doubled dose delivered to a particular organ (a false intuition from external beam radiotherapy). In addition, we observed that fractionating injections can lead to a higher payload of dose delivery to organs, though not a differential dose delivery to the tumor. By contrast, we found out that increased albumin-binding affinities of the injected ligands can lead to such a differential effect in delivering more doses to tumors, and this can be attributed to several factors that PBRPK modeling allows us to probe. Conclusions: Advanced computational PBRPK modeling enables simulation and analysis of a variety of intervention and drug design scenarios, towards more optimal delivery of RPTs. [ABSTRACT FROM AUTHOR]

Literacy is a tool to analyze a problem in different scenarios. A skill that can give a person/business/stakeholders insight to differentiate and explain and how to follow a particular protocol. In the healthcare ecosystem, eHealth literacy is very critical for the promotion of a product/service when it comes to the patient for following or selection of a care plan or doctor level for communication at patient level as well as at a technological level. Young people are more familiar with digital tools. When it comes to an older population, we observe resistance because of weak cognitive skills or suspicious behaviour towards technologies that exist and culture variance. Different stakeholders should consider the level of literacy, deep dig into technological advancement while making policies for the Health care ecosystem and cultural aspects for technological promotion to ensure eHealth solutions to be followed. A business model should be improvised concerning eHealth literacy and culture literacy in different countries in the health care sector for the promotion of a particular assistive technology product/device/service. This paper highlights the various essential aspects concerning eHealth literacy, cultural influences its importance while following a specific plan of care and its adherence at the patient as well as the policy-making level for the healthcare ecosystem. [ABSTRACT FROM AUTHOR]

Extracorporeal membrane oxygenation (ECMO) is becoming more and more clinically important. The extracorporeal circuit for membrane oxygenation consists of a pump, a membrane oxygenator and large volume tubing. The ECMO device forms an additional compartment, which can absorb drugs with high lipophilia and protein binding. Thus, ECMO affects the volume of distribution and the clearance. As a consequence, the pharmacokinetic-pharmacodynamic (pk-pd) target parameters cannot be achieved. The selection of an appropriate substance and the mode of application, combined with therapeutic drug monitoring (TDM), can significantly improve the therapeutic outcome of critically ill patients. [ABSTRACT FROM AUTHOR]

The article cites that immunomodulatory treatment has been proven to reduce relapse and inflammatory magnetic resonance imaging activity in multiple sclerosis (MS) as well as modestly modifying its course, but we are still far away from control of the disease's progress. One major aim is to modify the inflammatory induction of demyelination and axonal damage. Several of the potential routes of axonal damage implicate a role for inflammation, and data from clinical trials support the necessity of a basic anti-inflammatory therapy in MS.