Search

Objective: Comorbid post-traumatic stress disorder in patients with anorexia nervosa may negatively affect the course of anorexia nervosa treatment, which is already challenging. There are currently no guidelines or recommendations on concurrent treatment approaches for both anorexia nervosa and post-traumatic stress disorder. This systematic scoping review aims to explore the feasibility, acceptability and effectiveness of psychological trauma-focused treatment concurrently offered to underweight patients receiving anorexia nervosa treatment. Method: A multi-step literature search, according to an a priori protocol was performed. Databases PubMed, Embase, APA PsycINFO, Web of Science, Scopus and Cochrane Central were searched up to September 19th 2022, and the search was rerun June 19th 2023. For quality assessment, Risk of Bias in Nonrandomised Studies-of Interventions tool was used. Results: The extensive search yielded 1769 reports, out of which only three observational pilot studies, both English and German, published between 2004 and 2022, could be included. The included studies reported on a total of 13 female participants between 16 and 58 years old, with anorexia nervosa or otherwise specified feeding or eating disorder, baseline BMI ranging between 14.6 and 16.5, who received concurrent anorexia and post-traumatic stress disorder treatment. In all participants, the emotional and cognitive functioning was sufficient to process the offered trauma-focused interventions, despite their significantly low body weight. Discussion: The findings of this review identify a dearth of treatment research on knowledge of concurrent trauma-focused treatments for patients with anorexia nervosa. Refraining patients with anorexia nervosa from trauma-focused treatment may not be warranted. [ABSTRACT FROM AUTHOR]

ObjectiveComorbid post-traumatic stress disorder in patients with anorexia nervosa may negatively affect the course of anorexia nervosa treatment, which is already challenging. There are currently no guidelines or recommendations on concurrent treatment approaches for both anorexia nervosa and post-traumatic stress disorder. This systematic scoping review aims to explore the feasibility, acceptability and effectiveness of psychological trauma-focused treatment concurrently offered to underweight patients receiving anorexia nervosa treatment.MethodA multi-step literature search, according to an a priori protocol was performed. Databases PubMed, Embase, APA PsycINFO, Web of Science, Scopus and Cochrane Central were searched up to September 19th 2022, and the search was rerun June 19th 2023. For quality assessment, Risk of Bias in Non-randomised Studies-of Interventions tool was used.ResultsThe extensive search yielded 1769 reports, out of which only three observational pilot studies, both English and German, published between 2004 and 2022, could be included. The included studies reported on a total of 13 female participants between 16 and 58 years old, with anorexia nervosa or otherwise specified feeding or eating disorder, baseline BMI ranging between 14.6 and 16.5, who received concurrent anorexia and post-traumatic stress disorder treatment. In all participants, the emotional and cognitive functioning was sufficient to process the offered trauma-focused interventions, despite their significantly low body weight.DiscussionThe findings of this review identify a dearth of treatment research on knowledge of concurrent trauma-focused treatments for patients with anorexia nervosa. Refraining patients with anorexia nervosa from trauma-focused treatment may not be warranted.

Cardiovascular and cerebrovascular diseases are the leading causes of death worldwide and interact closely with each other. Danhong Injection (DHI) is a widely used preparation for the co-treatment of brain and heart diseases (CTBH). However, the underlying molecular endotype mechanisms of DHI in the CTBH remain unclear. To elucidate the underlying endotype mechanisms of DHI in the CTBH. In this study, we proposed a modular-based disease and drug-integrated analysis (MDDIA) strategy for elucidating the systematic CTBH mechanisms of DHI using high-throughput transcriptome-wide sequencing datasets of DHI in the treatment of patients with stable angina pectoris (SAP) and cerebral infarction (CI). First, we identified drug-targeted modules of DHI and disease modules of SAP and CI based on the gene co-expression networks of DHI therapy and the protein–protein interaction networks of diseases. Moreover, module proximity-based topological analyses were applied to screen CTBH co-module pairs and driver genes of DHI. At the same time, the representative driver genes were validated via in vitro experiments on hypoxia/reoxygenation-related cardiomyocytes and neuronal cell lines of H9C2 and HT22. Seven drug-targeted modules of DHI and three disease modules of SAP and CI were identified by co-expression networks. Five modes of modular relationships between the drug and disease modules were distinguished by module proximity-based topological analyses. Moreover, 13 targeted module pairs and 17 driver genes associated with DHI in the CTBH were also screened. Finally, the representative driver genes AKT1 , EDN1 , and RHO were validated by in vitro experiments. This study, based on clinical sequencing data and modular topological analyses, integrated diseases and drug targets. The CTBH mechanism of DHI may involve the altered expression of certain driver genes (SRC, STAT3, EDN1, CYP1A1, RHO, RELA) through various enriched pathways, including the Wnt signaling pathway. [Display omitted] • A modular-based disease and drug-integrated analysis strategy was proposed to reveal the co-treatment mechanisms of diseases. • Drug-targeted modules of Danhong injection and disease modules of stable angina pectoris and cerebral infarction were identified. • Co-module pairs and drive genes of Danhong injection were screened using proximity-based topological analyses. • The representative drive genes were validated by in vitro experiments. • The endotype driven co-module mechanisms of Danhong Injection for cardiovascular and cerebrovascular diseases were explained. [ABSTRACT FROM AUTHOR]

This literature review examines research on co-occurring substance use disorders (SUDs) and post-traumatic stress disorder (PTSD) among the veteran population. Authors share the prevalence of co-occurring SUD and PTSD and highlight how integrated treatment of SUDs and PTSD may be beneficial within this population. The Seeking Safety Model Integrated treatment model is explored, along with other recommended evidence-based practices. The benefits of recovery-oriented psychiatric rehabilitation approaches to treatment that include integrated SUD and PTSD treatment, peer support, and Individual Placement and Support (IPS) model supported employment strategies are shared. Future recommendations are suggested based on current literature. [ABSTRACT FROM AUTHOR]

Abstract Extracorporeal cardiopulmonary resuscitation (ECPR) can be associated with increased survival and neurologic benefits in selected patients with out-of-hospital cardiac arrest (OHCA). However, there remains insufficient evidence to recommend the routine use of ECPR for patients with OHCA. A novel integrated trauma workflow concept that utilizes a sliding computed tomography (CT) scanner and interventional radiology (IR) system, named a hybrid emergency room system (HERS), allowing emergency therapeutic interventions and CT examination without relocating trauma patients, has recently evolved in Japan. HERS can drastically shorten the ECPR implementation time and more quickly facilitate definitive interventions than the conventional advanced cardiovascular life support workflow. Herein, we discuss our novel workflow concept using HERS on ECPR for patients with OHCA.

Posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) frequently co-occur. Integrated treatments are effective, but not all patients respond and predicting outcome remains difficult. In this study, latent class analysis (LCA) identified symptom-based subgroups of comorbid PTSD/AUD among 119 veterans with PTSD/AUD from a randomized controlled trial of integrated exposure therapy (I-PE) versus integrated coping skills therapy (I-CS). Multilevel models compared subgroups on PTSD severity and percentage of heavy drinking days at post-treatment and 3- and 6-month follow-up. LCA revealed three subgroups best fit the data: Moderate PTSD/Low AUD Impairment (21%), High PTSD/High AUD Impairment (48%), and Low PTSD/High AUD Impairment (31%). There was a three-way interaction between time, treatment condition, and subgroup in predicting PTSD outcomes (p <.05). For the Moderate PTSD/Low AUD Impairment class, outcomes at post-treatment and 3-months were similar (ds = 0.17, 0.55), however I-PE showed greater reductions at 6-months (d = 1.36). For the High PTSD/High AUD Impairment class, I-PE demonstrated better post-treatment (d = 0.83) but comparable follow-up (ds = −0.18, 0.49) outcomes. For the Low PTSD/High AUD Impairment class, I-PE demonstrated stronger outcomes at every timepoint (ds = 0.82–1.15). Heavy drinking days declined significantly through follow-up, with an effect of subgroup, but not treatment, on timing of response. This was the first study modeling how PTSD and AUD symptoms might cluster together in a treatment sample of veterans with PTSD/AUD. Symptom-based subgroups show promise in helping understand variability in treatment response among patients with PTSD/AUD and deserve further study. • Veterans with PTSD/AUD received integrated coping skills or exposure therapy. • Latent class analysis explored subgroups of comorbid PTSD/AUD. • PTSD/AUD subgroups differed based on PTSD severity and AUD-related impairment. • PTSD/AUD subgroups moderated treatment response to integrated interventions. [ABSTRACT FROM AUTHOR]

Abstract Background The outcomes of multiple injury patients with concomitant torso hemorrhage and traumatic brain injury (TBI) are very poor. The hybrid emergency room system (HERS) is a trauma management system designed to complete resuscitation, computed tomography (CT), surgery, angioembolization, and intracranial pressure (ICP) monitoring all in one trauma resuscitation room without patient transfer. We aimed to review the outcomes of polytrauma patients who underwent concurrent bleeding control and ICP monitoring using the HERS. Methods In this retrospective observational study, we enrolled patients who underwent concurrent bleeding control and ICP monitoring using the HERS between August 2011 and June 2018. Initial data on vital signs, Injury Severity Score (ISS), probability of survival (Ps) calculated by the Trauma and Injury Severity Score (TRISS), intervention type, 28-day mortality, and Extended Glasgow Outcome Scale at 6 months after injury were collected. Continuous variables were expressed as the median (25th and 75th percentiles) and categorical variables as numbers (%). Results Ten patients were included in the analysis. The injury severity of the patients was as high as an ISS of 58 (50–64) and TRISS Ps of 0.15 (0.02–0.36). Seven of the 10 (70%) patients had hemodynamic instability within 30 min from arrival. The recorded durations from arrival to events were CT examination 9 (6–16) min, bleeding control procedure 29 (22–42) min, and neurosurgical intervention 39 (31–53) min. Four of the 10 patients (40%) survived to discharge, and two of them (20%) were able to live independently at 6 months after injury. Conclusions The concurrent performance of bleeding control procedure and ICP monitoring would be feasible in HERS settings among polytrauma patients with exsanguinating hemorrhage and TBI.

Extracorporeal cardiopulmonary resuscitation (ECPR) can be associated with increased survival and neurologic benefits in selected patients with out-of-hospital cardiac arrest (OHCA). However, there remains insufficient evidence to recommend the routine use of ECPR for patients with OHCA. A novel integrated trauma workflow concept that utilizes a sliding computed tomography (CT) scanner and interventional radiology (IR) system, named a hybrid emergency room system (HERS), allowing emergency therapeutic interventions and CT examination without relocating trauma patients, has recently evolved in Japan. HERS can drastically shorten the ECPR implementation time and more quickly facilitate definitive interventions than the conventional advanced cardiovascular life support workflow. Herein, we discuss our novel workflow concept using HERS on ECPR for patients with OHCA. [ABSTRACT FROM AUTHOR]

Previous literature has explored parents' perceptions of their involvement in treatment for stuttering and/or speech sound disorder (SSD) in isolation. However, no studies have documented these perceptions when children have co-occurring disorders. The aim of this study was to explore parents' experiences of their involvement in their children's treatment for co-occurring stuttering and SSD. Semi-structured interviews were conducted with four parents whose children had undergone concurrent, direct treatment for co-occurring stuttering and SSD in a previous research trial. Interviews were conducted around 40 months after entry into the original trial. Data were analysed using thematic analysis. Thematic analysis identified three core themes. The data revealed important clinical considerations, including provision of accessible information and support to parents around their roles in treatment, and barriers and facilitators to this form of service delivery. Identified facilitators included structured clinic and home sessions, tangible reward systems, and parental/child motivation. Parents' experiences were largely positive, and evaluation of caregiver perspectives allows more holistic investigation of treatment approaches. [ABSTRACT FROM AUTHOR]

Nobiletin and β-lactoglobulin were previously demonstrated to suppress mast cell de-granulation in vitro and in vivo. In this study, the multiple anti-allergic effects of both substances by simultaneous treatment were examined in order to determine if they could further mitigate allergic symptoms. Concurrent treatment with nobiletin and β-lactoglobulin effectively suppressed de-granulation of RBL-2H3 cells by inhibiting increases in intracellular Ca2+ concentration. Immunoblot analysis showed that phosphorylation of phosphoinositide 3-kinase, Akt, and Syk in RBL-2H3 cells was all inhibited by the concurrent presence of nobiletin and β-lactoglobulin. Moreover, concurrent administration of nobiletin and β-lactoglobulin reduced passive cutaneous anaphylaxis (PCA) reaction in mice compared with nobiletin or β-lactoglobulin administered alone. In addition, the concurrent administration of freeze-dried Citrus unshiu peel powder and yogurt whey containing these bioactive substances also reduced PCA reaction and allergic symptoms of a murine model of Japanese cedar pollinosis.

Purpose: There is a paucity of evidence to guide treatment for children with co-occurring stuttering and speech sound disorder. Some guidelines suggest treating the two disorders simultaneously using indirect treatment approaches; however, the research supporting these recommendations is over 20 years old. In this clinical case series, we investigate whether these co-occurring disorders could be treated concurrently using direct treatment approaches supported by up-to-date, high-level evidence, and whether this could be done in an efficacious, safe and efficient manner. Method: Five pre-school-aged participants received individual concurrent, direct intervention for both stuttering and speech sound disorder. All participants used the Lidcombe Program, as manualised. Direct treatment for speech sound disorder was individualised based on analysis of each child’s sound system. Result: At 12 months post commencement of treatment, all except one participant had completed the Lidcombe Program, and were less than 1.0% syllables stuttered on samples gathered within and beyond the clinic. These four participants completed Stage 1 of the Lidcombe Program in between 14 and 22 clinic visits, consistent with current benchmark data for this programme. At the same assessment point, all five participants exhibited significant increases in percentage of consonants correct and were in alignment with age-expected estimates of this measure. Further, they were treated in an average number of clinic visits that compares favourably with other research on treatment for speech sound disorder. Conclusion: These preliminary results indicate that young children with co-occurring stuttering and speech sound disorder may be treated concurrently using direct treatment approaches. This method of service delivery may have implications for cost and time efficiency and may also address the crucial need for early intervention in both disorders. These positive findings highlight the need for further research in the area and contribute to the limited evidence base. [ABSTRACT FROM PUBLISHER]

This is preliminary study assessing the efficacy and safety of concurrent use of radiation therapy (RT) and T-DM1 for the treatment of brain metastases (BM) in patients with HER2-positive metastatic breast cancer (BC). We retrospectively studied 12 patients treated for BM at the Institut Curie in 2014-2015 with T-DM1 and concurrent (4) or sequential (8) radiosurgery with or without whole brain irradiation. The following variables were studied: local control, clinical and radiological response as well as early and late side effects. The mean age of the population was 38 years at the time of diagnosis of BC and 46 years at of BM. All patients were with good PS. The response rate of the concurrent treatment group was 75 % with 1 complete response, 1 partial response, one stable disease and 1 progression. Comparatively, the response rate in the sequential group was as follows: two complete responses, two partial responses, six cases of stable disease and two cases of local progression. No patient experienced interruption of irradiation because of side effects. About 50 % of patients were asymptomatic after treatment. Radiation necrosis was observed in 50 % of patients in the concurrent group and 28.6 % of patients in the sequential group with a similar rate of oedema in the two groups. We found that the combination of T-DM1 and radiosurgery was feasible but can increase the incidence of radiation necrosis. Larger prospective studies with longer follow-up are needed to more clearly evaluate this association. [ABSTRACT FROM AUTHOR]

Background: Lung cancer combined by chronic obstructive pulmonary disease (LC-COPD) is a common comorbidity and their interaction with each other poses significant clinical challenges. However, there is a lack of well-established consensus on the diagnosis and treatment of LC-COPD., Methods: A panel of experts, comprising specialists in oncology, respiratory medicine, radiology, interventional medicine, and thoracic surgery, was convened. The panel was presented with a comprehensive review of the current evidence pertaining to LC-COPD. After thorough discussions, the panel reached a consensus on 17 recommendations with over 70% agreement in voting to enhance the management of LC-COPD and optimize the care of these patients., Results: The 17 statements focused on pathogenic mechanisms (n=2), general strategies (n=4), and clinical application in COPD (n=2) and lung cancer (n=9) were developed and modified. These statements provide guidance on early screening and treatment selection of LC-COPD, the interplay of lung cancer and COPD on treatment, and considerations during treatment. This consensus also emphasizes patient-centered and personalized treatment in the management of LC-COPD., Conclusions: The consensus highlights the need for concurrent treatment for both lung cancer and COPD in LC-COPD patients, while being mindful of the mutual influence of the two conditions on treatment and monitoring for adverse reactions., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tlcr.amegroups.com/article/view/10.21037/tlcr-23-339/coif). Yong Song serves as an Editor-in-Chief of Translational Lung Cancer Research from September 2020 to August 2022. RB reports payment from AZ, BI, NOVARTIS, EISAI, MSD, OTSUKA, LILLY, ROCHE, Amgen, GSK, Seagen, Pierre Fabre Italfarmaco, outside the present manuscript. Nicolas Girard reports receiving research grants or support from Abbvie, Amgen, AstraZeneca, Beigene, Boehringer Ingelheim, Bristol-Myers-Squibb, Daiichi-Sankyo, Eli-Lilly, Gilead, Hoffmann-La Roche, Janssen, LeoPharma, Merck, Merck Sharp & Dohme, Novartis, Sivan; receiving payment from Abbvie, Amgen, AstraZeneca, Beigene, Bristol Myers Squibb, Daiichi-Sankyo, Eli-Lilly, Gilead, Hoffmann - La Roche, Ipsen, Janssen, LeoPharma, Medtronic, Merck Sharp & Dohme, Novartis, Pierre Fabre, Pfizer, Sanofi, and Takeda; having participation on a data safety monitoring board for Roche; having leadership role in the International Thymic Malignancy Interest Group; and having employment of a family member with AstraZeneca. AP received consulting or advisory role from Roche/Genentech, Bristol Myers Squibb, AstraZeneca, MSD Oncology, Pfizer, Boehringer Ingelheim, Janssen, Novartis, Daiichi Sankyo Europe GmbH, Bayer; payment or honoraria for speakers’ bureau form AstraZeneca, Janssen, Boehringer Ingelheim, Daiichi Sankyo Europe GmbH, MSD Oncology. The other authors have no conflicts of interest to declare., (2023 Translational Lung Cancer Research. All rights reserved.)

People with substance-use disorders have elevated rates of tobacco use compared with the general population, yet rarely receive tobacco-dependence treatment within substance-use treatment settings (SUTS). One barrier to delivering evidence-based interventions in SUTS is providers' misconception that treating tobacco use and non-nicotine substance use concurrently jeopardizes clients' substance-use recovery, although research indicates that it enhances support for recovery and relapse prevention. A total of 86 treatment providers employed in SUTS (i.e., 9 Federally Qualified Health Centers, 16 Local Mental Health Authorities (LMHAs), 6 substance-use treatment programs in LMHAs, and 55 stand-alone substance-use treatment centers) in Texas, USA, answered survey questions about their (1) thoughts about treating tobacco during substance-use treatment, and (2) delivery of the 5A's tobacco-use intervention (Ask, Advise, Assess, Assist, Arrange). Twenty-six providers and leaders were interviewed about attitudes toward tobacco-free workplace policies and tobacco dependence and the relative importance of treating tobacco (vs. other substance-use disorders) at their center. Providers who did not believe tobacco use should be addressed as soon as clients begin treatment (i.e., endorsed responses of after 1 year, it depends on the client, or never) had lower odds of Asking clients about their tobacco use (OR = 0.195), Advising clients to quit smoking (OR = 0.176), and Assessing interest in quitting smoking (OR = 0.322). Qualitative results revealed barriers including beliefs that clients need to smoke to relieve the stress of substance-use recovery, are disinterested in quitting, fears that concurrent treatment would jeopardize substance use, and limited resources; additional training and education resources was the key facilitator theme. The results demonstrate a critical need to eliminate barriers to tobacco-treatment provision for clients in SUTS through education to correct misperceptions, specialized training to equip providers with knowledge and skills, and resources to build center capacity. Integrating evidence-based smoking interventions into routine care is key to support the recovery efforts of clients in SUTS.

Background Chemo-radiotherapy is standard of care in the treatment of unresectable stage III NSCLC. We aimed at assessing whether the addition of concurrent taxane-chemotherapy to thoracic irradiation following chemotherapy was able to improve treatment outcome. Material and methods In PITCAP trial, patients with unresectable stage III NSCLC were randomized to receive 2 cycles of platinum-paclitaxel followed by 60–61.2 Gy thoracic irradiation (control arm) or by same radiotherapy with concomitant weekly paclitaxel (experimental arm). A literature-based meta-analysis including all studies with same design was also performed. Results At the time of the second interim analysis, when 151 patients were randomized, accrual was terminated. With a median follow-up of 6.1 years, median survival was 13.2 vs 15.1 months, with a 3-year survival rate of 19.5 vs 21.2% in the control and experimental arm, respectively (HR: 0.97; 95% CI 0.69–1.36; p = 0.845). Treatment toxicity was manageable in both arms. The meta-analysis of 5 trials (n = 866) confirmed the lack of a meaningful effect on 1-year overall survival of a taxane added concurrently to radiotherapy. Conclusions These results do not support a meaningful survival benefit with the addition of single agent taxane given concurrently to radiotherapy after platinum-based induction in locally advanced NSCLC. [ABSTRACT FROM AUTHOR]

Speech sound treatment in the public schools is often conducted in small groups, but there are minimal data on the efficacy of group treatment. This study evaluated the efficacy of a motor learning-based treatment (Concurrent Treatment) provided to elementary-school students in small groups. Concurrent Treatment incorporates the randomized sequencing of various practice tasks (e.g., words, sentences, or storytelling) and can result in rapid speech sound acquisition during individual treatment settings. Twenty-eight 6- to 9-year-old children participated in a randomized pretest--posttest control group design. The experimental group received Concurrent Treatment, while the control group received treatment (if needed) after the study. Participants in the experimental group acquired their target speech sounds within 40 30-minute sessions in groups of up to four participants (effect size, d=1.31). [ABSTRACT FROM AUTHOR]

Nobiletin and β-lactoglobulin were previously demonstrated to suppress mast cell de-granulation in vitro and in vivo . In this study, the multiple anti-allergic effects of both substances by simultaneous treatment were examined in order to determine if they could further mitigate allergic symptoms. Concurrent treatment with nobiletin and β-lactoglobulin effectively suppressed de-granulation of RBL-2H3 cells by inhibiting increases in intracellular Ca 2+ concentration. Immunoblot analysis showed that phosphorylation of phosphoinositide 3-kinase, Akt, and Syk in RBL-2H3 cells was all inhibited by the concurrent presence of nobiletin and β-lactoglobulin. Moreover, concurrent administration of nobiletin and β-lactoglobulin reduced passive cutaneous anaphylaxis (PCA) reaction in mice compared with nobiletin or β-lactoglobulin administered alone. In addition, the concurrent administration of freeze-dried Citrus unshiu peel powder and yogurt whey containing these bioactive substances also reduced PCA reaction and allergic symptoms of a murine model of Japanese cedar pollinosis. [ABSTRACT FROM AUTHOR]

Background: To compare the efficacy of concurrent and sequential administration of radiotherapy and chemotherapy on patients with operable breast cancer after breast.conserving surgery. (BCS).Materials and Methods: We searched MEDLINE (National Library of Medicine, Bethesda, Maryland) and EMBASE (Elsevier, Amsterdam, Netherlands) databases for eligible studies. Clinical outcomes (such as overall and locoregional recurrence-free survival, toxicity related complications) used as evaluation indexes of efficacy. Odds ratios (ORs) with 95% confidence intervals (CI) of each index was calculated and analyzed with the RevMan Version 5.2 software.Results: Three articles (two trials), which compared the clinical efficacy of concurrent and sequential administration of radiotherapy and chemotherapy for operable breast cancer patients, were eligible in this meta-analysis. There were significant differences between concurrent and sequential treatments in 5-year loco-regional recurrence free survival (OR: 0.39, 95% CI: 0.20-0.75, P = 0.005) and late skin toxicity of telangiectasia (OR: 2.00, 95% CI: 1.39-2.87, P = 0.0002). However, no significant difference was discovered in five-year overall survival (OR: 0.62, 95% CI: 0.35-1.11, P > 0.05), acute skin toxicity (OR: 1.73, 95% CI: 0.98-3.04, P > 0.05) and late skin toxicity of lymphedema (OR: 1.27, 95% CI: 0.88-1.83, P > 0.05).Conclusion: Our study demonstrated that the concurrent administration of chemotherapy (anthracycline-based) and radiotherapy was superior to the sequential administration in locoregional recurrence-free survival for the operable node positive breast cancer patients. However, choose of treatment for operable breast cancer patients must be cautious due to high risk of lymphedema. [ABSTRACT FROM AUTHOR]

Background. Left ventricular ejection fraction (LVEF) is used routinely to monitor cardiac dysfunction associated with breast cancer treatment. In this study the prevalence of early left ventricular diastolic dysfunction (LVDD) and its relationship to the dose-volume of the heart irradiated were evaluated in HER2-positive breast cancer patients undergoing concurrent trastuzumab and adjuvant radiotherapy (RT). Materials and Methods. Data from 40 breast cancer patients treated with concurrent trastuzumab and left-sided adjuvant RT between September 2011 and October 2012 were collected prospectively. For comparison, 32 patients treated with concurrent trastuzumab and right-sided adjuvant RT and 71 patients treated with left-sided RT alone were collected retrospectively. Echocardiography was obtained before RT, immediately following RT, and 3 and 6 months after RT. Doses to the heart and left ventricle (LV) were quantified. Results. Prior to RT with concurrent trastuzumab, 11 of 29 (left) and 8 of 25 (right) patients with normal baseline left ventricular diastolic function (LVDF) developed LVDD. In patients receiving left-sided RT alone, 12 of 61 patients with normal baseline LVDF developed LVDD. Dmean, D15-D40, D60-D70, and V3-V10 of the LV were significantly higher in patients who developed LVDD after concurrent trastuzumab and left-sided RT. In contrast, only two patients developed grade 1 LVEF decrease after both concurrent treatment and left-sided RT alone. Conclusion. Changes in LVDF compared with LVEF are more sensitive for early detection of cardiotoxicity. The dose-volume of the heart contributes significantly to the risk of LVDD in patients with left-sided breast cancer treated concurrently with trastuzumab. [ABSTRACT FROM AUTHOR]

ABSTRACT Case A 64 year-old woman suffering from atopic dermatitis refractory to standard treatment presented for treatment of severe skin eruptions on the whole body. Outcome On her first visit, white blood cell count including eosinophils (3310/μL), serum lactate dehydrogenase ( LDH; 460 IU/L), serum immunoglobulin E (19 694 IU/mL), and thymus and activation-regulated chemokine ( TARC; 58 250 pg/mL) were elevated. Oral treatment with fexofenadine hydrochloride and topical steroids were started, but the eruptions and itching did not significantly improve. On day 18, concurrent treatment with Unseiin 7.5 g/day was started. On day 81, remission of skin eruption, and normal TARC (396 pg/mL), eosinophils (200/μL), and LDH (187 IU/L) were confirmed. Conclusion Concurrent treatment with Unseiin and standard treatment may provide an effective treatment option for patients with atopic dermatitis refractory to standard treatment. [ABSTRACT FROM AUTHOR]

This single-center prospective study aims to assess the outcomes and the toxicities related to the concurrent administration of trastuzumab (T) with adjuvant locoregional radiotherapy (RT) in localized breast cancer. Data of 308 patients were analyzed. T was delivered every 3 weeks (loading dose of 8 mg/kg, then 6 mg/kg) for 1 year. Left ventricular ejection fraction (LVEF), measured by echocardiography or myocardial scintigraphy, was considered as impaired when below 55 %. Toxicities were assessed according to the Common Terminology Criteria for Adverse Events version 3.0. Univariate and multivariate analyses were carried out using the Cox model. Median follow-up was 50.2 months (13.0-126.0). Median age at diagnosis was 52 years (25-83). Internal mammary node (IMN) RT was performed in 227 patients (73.7 %). After completion of RT, 26 patients (8.4 %) presented an impaired LVEF: 17 (5.5 %) of grade 1, 7 (2.3 %) of grade 2, and 2 (0.6 %) of grade 3. At 48 months, locoregional control rate was 95 % [95 % CI 92; 98], and overall survival rate was 98 % [95 % CI 96; 100]. In univariate analysis, neither the treated breast side ( p = 0.655) nor IMN RT ( p = 0.213) exposed patients to LVEF alteration. In multivariate analysis, clinical lymph node involvement was associated with an increased risk of locoregional and distant recurrence ( p = 0.016 and p = 0.007, respectively). In this prospective study, the toxicities of concurrent T with locoregional breast RT were acceptable and the outcomes favorable. Longer follow-up is warranted to confirm these results. [ABSTRACT FROM AUTHOR]

The purposes of the present study were to evaluate the hepatocarcinogenicity of concurrent treatment of 2-amino-3,8- dimethylimidazo[4,5-f ]quinoxaline (MeIQx) and diethylnitrosamine (DEN) in rats and to determine whether no effect levels of combinations of these two different structural categories of genotoxic hepatocarcinogens exist. Two 16-week rat hepatocarcinogenesis assays were performed using a total of 790 male F344 rats. In experiment 1, we evaluated the effects of concurrent treatment of a subcarcinogenic dose of DEN on rat hepatocarcinogenesis induced by various doses of MeIQx. In experiment 2, we determined hepatocarcinogenicities of combinations of MeIQx and DEN at subcarcinogenic doses, low carcinogenic doses and high carcinogenic doses. Quantitative analyses of glutathione S-transferase placental form (GST-P)-positive foci, a preneoplastic lesion of the liver in rats, revealed that concurrent treatment with subcarcinogenic doses of DEN did not enhance MeIQx-induced rat hepatocarcinogenicity. We also found that concurrent treatment with combinations of subcarcinogenic doses of DEN and MeIQx was not hepatocarcinogenic, indicating that the combined effects of subcarcinogenic doses of DEN and MeIQx were neither additive nor synergistic. Moreover, concurrent treatment with low carcinogenic doses of these 2 carcinogens did not show additive or synergistic effects. Synergetic effects were observed only in rats coadministered high carcinogenic doses of the 2 carcinogens. These results demonstrate the existence of no effect levels of combinations of these 2 genotoxic hepatocarcinogens, and provide new evidence supporting our idea that there is a threshold, at least a practical threshold, that should be considered when evaluating the risk of genotoxic carcinogens. [ABSTRACT FROM AUTHOR]

Background & Aims: Transarterial chemoembolization (TACE) is an important palliative treatment for unresectable hepatocellular carcinoma (HCC), but TACE-induced ischemic injury can upregulate angiogenic factors and is associated with poor prognosis. The aim of this study was to evaluate the safety and efficacy of concurrent conventional TACE and sorafenib in patients with unresectable HCC. Methods: The primary objectives of this prospective, single-arm, phase II study were to evaluate safety and time to progression (TTP). Sorafenib was given 3days after TACE and was administered for up to 24weeks. Repeated TACE was performed on demand. Tumor response was assessed every 8weeks. Results: Fifty patients were treated and followed from July 2009 to May 2011. All patients were in Barcelona Clinic Liver Cancer (BCLC) stage B (82%) or C (18%). The median time of follow-up was 14.9months and a median of 1 TACE session was given (range, 1–4). The median dose intensity of sorafenib was 68.7% (range, 37.3–100) of 800mg daily. The most common reasons for dose reduction were hand–foot syndrome and thrombocytopenia. Thirty patients completed the study and 17 patients discontinued sorafenib due to disease progression. The overall median TTP was 7.1months (95% confidence interval (CI), 4.8–7.5months): 7.3months in BCLC stage B; 5.0months in BCLC stage C. The 6-month progression-free survival rate was 52% (95% CI, 37.3–66.1). Conclusions: Concurrent treatment of unresectable HCC with conventional TACE and sorafenib demonstrates a manageable safety profile and a possibility of promising efficacy. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to define the maximum tolerated dose (MTD) by describing the doselimiting toxicity (DLT) of weekly cisplatin concurrently with conventional plus 3-dimensional conformal radiotherapy (CT + 3DCRT) in patients with loco-regionally advanced nasopharyngeal carcinoma (NPC). Methods: Patients with loco-regionally advanced NPC (III/IVa stage) were enrolled into a dose-escalating study. Toxicity was graded according to Common Terminology Criteria for Adverse Events version 3.0 (CTCAE v3.0). MTD was defined when 2 of 6 patients developed DLT. The starting dose of cisplatin was 15 mg/m/w, with a subsequent dose escalation of 5 mg/m/w in cohorts of 3 new patients. CT + 3DCRT was given to the nasopharynx and the upper neck; the lower neck was treated by a single anterior field irradiation. The prescription dose was 70-80 Gy by 35-40 fractions to the nasopharynx gross tumor, and 66-70 Gy by 33-35 fractions to the positive neck lymph nodes. Results: From Jun. 2008 to Sep. 2009, 24 patients received complete chemoradiotherapy, and all of them were eligible for toxicity evaluation. On the first five dose levels of 15 mg/m/w and 35 mg/m/w, no patient experienced DLT. On the next dose level of 40 mg/m/w, 1 patient experienced DLT of grade 3 myelosuppression for 1.4 weeks, and among the additional 3 patients, no one developed DLT. On the seventh dose level of 45 mg/m/w, all the patients developed grade 3 myelosuppression for more than 1 weeks, and the dose-escalating trial stopped. The 23 (95.8%) patients achieved clinical complete remission (CR) in the local site; 22 (91.7%) achieved CR in the regional site, and all patients got CR 3 months later. After a median follow-up of 16.4 months, 1 patient developed liver metastases 2 months later, 1 patient developed bone metastases 10 months later and 22 kept disease-free survival. Conclusion: The MTD of cisplatin weekly with concurrent CT + 3DCRT for local advanced NPC is 40 mg/m/w, with myelosuppression as DLT. [ABSTRACT FROM AUTHOR]

The aim of osteoporosis treatment is to prevent future fractures. Although concurrent treatment has been used very frequently for osteoporosis in clinical practice, there are no data on accurate and verified effectiveness of concurrent treatment for fracture prevention in patients with osteoporosis. To clarify the clinical usefulness of concurrent treatment, the Japan Osteoporosis Society has authorized the establishment of the A-TOP (Adequate Treatment of Osteoporosis) research group. The objective of this research is to establish a design for a clinical trial to prove whether concurrent treatment using both alfacalcidol (1-alpha-hydroxycholecalciferol) and alendronate is more effective as compared to treatment using alendronate alone in terms of fracture prevention. The present study was named JOINT (Japanese Osteoporosis Intervention Trial) and is based on a method using national, prospective, randomized, open-labeled, blinded endpoints focusing on postmenopausal osteoporosis with a high risk for fracture. The patients were mainly selected by practitioners and allocated randomly by a central registration system into two groups, of which one received 5 mg/day of alendronate alone, and the other received 1 μg/day of 1-alpha-hydroxycholecalciferol (alfacalcidol) in addition to the alendronate. The endpoints focused primarily on fracture prevention, and the patients' quality of life (QOL) and change in body height, as well as adherence and the adverse events of the treatments were evaluated secondarily. To obtain sufficient statistical power in the events during a 2-year observation period, the patients who are expected to have higher risk were selected to participate in this study, and it was decided that the final plan would involve 890 patients per group (two-sided alpha = 0.05, power = 0.8). Data collection began in November 2003. Correspondence regarding the registration of the investigator and the progress of the study was conducted through a web system from the Public Health Research Foundation to practitioners. [ABSTRACT FROM AUTHOR]

Abstract: Patients in substance abuse treatment frequently smoke cigarettes and often die of tobacco-related causes. Substance abuse treatment programs too often ignore tobacco use. Many patients have expressed interest in stopping smoking, although they may be ambivalent about smoking cessation during substance abuse treatment. This article provides a review of tobacco cessation literature and successful methods of intervention. Research supports two key findings: (a) smoking cessation during substance abuse treatment does not impair outcome of the presenting substance abuse problem and (b) smoking cessation may actually enhance outcome success. We will discuss how to incorporate smoking cessation. [Copyright &y& Elsevier]

The article presents a study examining the differences in demographic and clinical characteristics of smokers and how diagnostic grouping predicts short-term abstinence. Three diagnostic groups are provided including the conduct of chart reviews of the treatment records of male veterans. Results are discussed per diagnostic group and across groups. Pharmacotherapy combined with intensive group counseling are recommended to achieve smoking abstinence.

Cigarette smoking is highly prevalent among people with alcohol use disorders. Although several studies have demonstrated the feasibility of treating nicotine dependence in people with substance use disorders, researchers and clinicians continue to debate whether nicotine dependence treatment should be delivered simultaneously with or subsequent to alcohol treatment. Evidence suggests that alcohol-dependent individuals prefer sequential treatment and that simultaneous treatment can negatively impact alcohol use outcomes, although the literature is not conclusive. This review includes recommendations of considerations for treatment timing decisions and future research directions. [ABSTRACT FROM AUTHOR]

Background: Improving services and treatment outcomes for individuals with cooccurring alcohol and drug use disorders and psychiatric conditions has been a critical challenge to clinicians and policy makers. This study examined 1-year outcomes for individuals entering chemical dependency (CD) treatment with and without cooccurring psychiatric diagnoses targeted by California parity legislation. Among those with cooccurring conditions (i.e., dual-diagnosis patients), we examined a model including individual characteristics, treatment services, and extratreatment characteristics to understand CD outcome predictors in this population. We hypothesized that longer CD treatment duration and receiving psychiatric services would predict higher abstinence levels. In particular,patterns of psychiatric services (amount of services, receiving a critical dose, or receiving services concurrently with CD treatment) were assessed in relation to outcome. Methods: We examined abstinence rates 1 year after intake for 747 adults with and without cooccurring conditions. Among dual-diagnosis patients, logistic regression was used to examine predictors of abstinence. Results: At baseline, dual-diagnosis patients ( N=104) had higher levels of medical, family, and employment problems than others. They had similar CD retention and received more psychiatric services during the year after intake and had comparable CD outcomes at 1 year. Length of stay in CD treatment, hours of psychiatric services, number of months with concurrent CD and psychiatric services, and number of 12-step meetings attended were independent predictors of abstinence for dual diagnosis patients. Conclusions: Chemical dependency outcomes in patients with cooccurring psychiatric conditions were positively associated with the number and patterning of services. Receiving psychiatric services concurrently with CD treatment may be beneficial for dual-diagnosis patients. Future studies should examine how best to integrate services to optimize treatment outcomes. [ABSTRACT FROM AUTHOR]

Phonologic treatments have traditionally been designed to teach a target speech sound starting with presumed easy teaching tasks and progressing to harder tasks. This investigation evaluated the effects on single-phoneme acquisition, generalization, and maintenance of Concurrent Treatment, which randomly intermixed presumed easy and hard teaching tasks were utilized. A multiple-baseline-across-subjects design was used with 4- to 7-year-old participants with /s/ misarticulations. All four participants rapidly acquired /s/ and showed generalization to untaught exemplars ranging from syllables to connected speech. Two participants showed generalization to within-clinic conversations and across settings. Results suggested that an easy-to-hard task sequence may be unnecessary for successful treatment outcomes and that the concurrent sequence may be beneficial. Implications for treatment design and future research are discussed.: Learning outcomes(1) As a result of this activity, the participant will be able to explain the difference between incremental and concurrent task sequence. (2) As a result of this activity, the participant will be able to explain the procedures of Concurrent Treatment. (3) As a result of this activity, the participant will be able to explain the results of the experimental investigation of Concurrent Treatment. [Copyright &y& Elsevier]

Tobacco dependence is prevalent among alcohol dependent patients, and causes increased morbidity and mortality. Concurrent treatment for these disorders may be advantageous, but there are concerns about adverse effects on alcohol treatment outcomes. The Timing of Alcohol and Smoking Cessation (TASC) Study is a randomized controlled clinical trial to compare the effectiveness of smoking cessation treatment offered concurrently or six months following intensive rehabilitation for alcohol dependence. This paper describes the study design and baseline characteristics of the study population. Participants were current smokers in intensive alcohol dependence treatment, with willingness to consider quitting smoking. Smoking intervention offered behavioral and pharmacological treatment. One thousand nine hundred forty-three patients were screened for enrollment; 499 were eligible and participated (26%). We describe demographic characteristics, smoking behavior and attitudes among participants and nonparticipants toward smoking cessation and drinking. We conclude that there is considerable interest in smoking cessation in alcohol dependent treatment populations, and recruitment to research studies is feasible. [ABSTRACT FROM AUTHOR]

As commonly used, adjuvant paclitaxel after doxorubicin in high-risk breast cancer patients results in a prolonged delay of the onset of radiation therapy after breast-conserving surgery. Concurrent delivery of breast irradiation with paclitaxel would allow for earlier initiation of radiation. We report on the toxicity of concurrent paclitaxel and breast irradiation after doxorubicin and cyclophosphamide. Twenty-four patients were treated with concurrent breast radiation and paclitaxel. All patients received four cycles of doxorubicin and cyclophosphamide followed by four cycles of paclitaxel, 175 mg/m2 every 3 weeks. The radiation therapy started after the first cycle in 3 patients, after the second cycle in 16, and after the third in 5. The breast received 4680–5040 cGy external beam irradiation, followed by a boost of 1000–2000 cGy. Fifteen patients received supraclavicular irradiation, and a posterior axillary supplement was used in five patients. Median follow-up after completion of irradiation was 11.5 months (range 2–29 months) with 21 patients followed ≥6 months, 12 followed ≥12 months, and 7 followed ≥18 months. Using Radiation Therapy Oncology Group (RTOG) acute toxicity scoring criteria, 7 patients experienced grade 1 skin and/or soft tissue reactions and 17 patients had grade 2 reactions. The average total duration of radiation treatment was 49 days (range 41–57 days). Only eight patients had radiation therapy interruptions for a median of 3.5 days (range 2–8 days): two more than 5 days. None had a chemotherapy dose reduction. One patient discontinued paclitaxel after the third cycle due to bilateral upper extremity neuropathy. No cases of pneumonitis or brachial plexopathy were seen. Concurrent treatment with every 3-week paclitaxel and breast irradiation was well tolerated. Additional study is needed to determine optimal timing, long-term toxicity, and potential benefits of... [ABSTRACT FROM AUTHOR]

Lung cancer is the most frequent form of malignant tumours. The prognosis is poor with a 5-year cure rate which increased from approximately 6% in the sixties to only 15% in the nineties. Surgery remains the reference treatment but only a small minority of patients (about 25%) present with operable disease. The post-surgical 5-year survival is only 25%, providing the rationale for the current research on adjuvant treatments for control of both local and metastatic disease. In that context, the combination of radiotherapy and chemotherapy, commonly referred to as chemo-radiotherapy, has assumed considerable importance : either exclusively in inoperable patients (inoperable tumour or patients inoperable for medical reasons), or pre-operatively. This article reviews the results of the pivotal definitive chemoradiotherapy studies in non-metastatic non-small-cell lung cancer. With exclusive chemoradiation, the concomitant scheme seems to be the most favourable, results issued from randomised studies are expected to confirm that point. An increased toxicity is observed, and the advent of conformal therapy may allow another survival gain. Optimal treatments integration will be necessary. [Copyright &y& Elsevier]

[Display omitted] • Current standard treatments for locally advanced NSCLC. • Focus on treatments for locally advanced NSCLC in elderly patients. • Main issues for multimodality approach in elderly patients. Treatment of locally advanced NSCLC (LA-NSCLC) is focused on multimodal strategy, including chemotherapy and radiotherapy (in combination or as alternative treatments), followed by surgery in selected cases. Recently, durvalumab consolidation after definitive chemo-radiation has shown a meaningful overall survival benefit. However, it is important to note that elderly patients represent a high proportion of NSCLC population and frailty and comorbidities can significantly limit treatment options. Indeed, elderly patients are under-represented in clinical trials and data to drive treatment selection in this category of patients are scanty. Available data, main issues and controversies on multimodal treatment in elderly LA-NSCLC patients will be reviewed in this paper. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the influence of concurrent trastuzumab on the cardiotoxicity in patients receiving left-sided adjuvant radiotherapy., Materials and Methods: Medical records of stage I-III left-sided breast cancer patients, including 64 receiving concurrent trastuzumab with radiotherapy and 73 receiving radiotherapy alone were retrospectively reviewed. All of the patients had normal LVEF after adjuvant chemotherapy. Information of doses volume to cardiac structures was collected. Cardiac events were assessed according to CTC 2.0., Results: Median follow-up of LVEF and clinical assessment of cardiac function from the initiation of radiotherapy was 6.7 months (range 3-60.9) and 26 months (range 6.4-60.9), respectively. Grade 1 LVEF dysfunction occurred in 5 (7.8%) and 3 (4.1%) patients of the concurrent-trastuzumab and radiotherapy alone cohort, respectively. Trastuzumab was the only significant factor influencing absolute LVEF decrease in univariate analysis. In multivariate analysis of concurrent-trastuzumab cohort, IMC radiotherapy and start trastuzumab during radiotherapy were independent risk factors. For concurrent cohort, mean heart dose, as well as D10-D30, D50-D55, V5-V20 of the heart and D30-D45, D65-D75, V6-V15 of the LV were significantly higher in patients developing LVEF dysfunction., Conclusions: Concurrent trastuzumab and left-sided radiotherapy is well tolerated in terms of cardiotoxicity in patients with normal baseline cardiac function after adjuvant chemotherapy. However, increases in mean dose and low-dose volume of cardiac structures are associated with a higher risk of acute LVEF dysfunction.