Treatment of advanced, recurrent, resistant to previous treatments basal and squamous cell skin carcinomas with a synergistic formulation of interferons. Open, prospective study

<p>Abstract</p> <p>Background</p> <p>Aggressive non-melanoma skin cancer (deeply infiltrating, recurrent, and morphea form lesions) are therapeutically challenging because they require considerable tissue loss and may demand radical disfiguring surgery. Interferons (IFN) may provide a non-surgical approach to the management of these tumors. The aim of this work was to evaluate the effect of a formulation containing IFNs-α and -γ in synergistic proportions on patients with recurrent, advanced basal cell (BCC) or squamous cell skin carcinomas (SCSC).</p> <p>Methods</p> <p>Patients with extensive, recurrent, resistant to other procedures BCC or SCSC received the IFN formulation peri- and intralesionally, three times per week for 3 weeks. They had been previously treated with surgery and/or radiotherapy or chemotherapy. Thirteen weeks after the end of treatment, the original lesion sites were examined for histological evidence of remaining tumor.</p> <p>Results</p> <p>Sixteen elder (median 70 years-old) patients were included. They beared 12 BCC and 4 SCSC ranging from 1.5 to 12.5 cm in the longest dimension. At the end of treatment 47% CR (complete tumor elimination), 40% PR (>30% tumor reduction), and 13% stable disease were obtained. None of the patients relapsed during the treatment period. The median duration of the response was 38 months. Only one patient with complete response had relapsed until today. Principal adverse reactions were influenza-like symptoms well known to occur with interferon therapy, which were well tolerated.</p> <p>Conclusion</p> <p>The peri- and intralesional combination of IFNs-α and -γ was safe and showed effect for the treatment of advanced, recurrent and resistant to previous treatments of BCC and SCSC in elder patients. This is the first report of such treatment in patients with advance non-melanoma skin cancer. The encouraging result justifies further confirmatory trials.</p> <p>Trial registration</p> <p>Current Controlled Trials RPCEC00000052.</p

Rationale, design and protocol of a longitudinal study assessing the effect of total knee arthroplasty on habitual physical activity and sedentary behavior in adults with osteoarthritis

Background: Physical activity levels are decreased and sedentary behaviour levels are increased in patients with knee osteoarthritis (OA). However, previous studies have shown that following total knee arthroplasty (TKA), objectively measured physical activity levels do not change compared to before the surgery. Very few studies have objectively assessed sedentary behaviour following TKA. This study aims to assess patterns of objective habitual physical activity and sedentary behaviour in patients with knee OA and to determine whether these change following TKA. Methods: Patients diagnosed with knee osteoarthritis and scheduled for unilateral primary total knee arthroplasty will be recruited from the Orthopaedic Division at the Charlotte Maxeke Johannesburg Academic Hospital. Eligible participants will have assessments completed one week before the scheduled arthroplasty, six weeks, and six months post-operatively. The primary outcomes are habitual physical activity and sedentary behaviour which will be measured using accelerometry (Actigraph GTX3+ and activPal monitors) at the specific time points. The secondary outcomes will be improvements in osteoarthritis-specific quality of life measures using the following questionnaires: Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee injury and Osteoarthritis Outcome Score (KOOS), Oxford Knee Score (OKS), Knee Society Clinical Rating System (KSS), UCLA activity index; subjective pain scores, and self reported sleep quality.Discussion: The present study will contribute to the field of musculoskeletal health by providing a rich detailed description of the patterns of accumulation of physical activity and sedentary behaviour in patients with knee OA. These data will contribute to existing knowledge using an objective measurement for the assessment of functional ability after total knee arthroplasty. Although studies have used accelerometry to measure physical activity in knee OA patients, the data provided thus far have not delved into the detailed patterns of how and when physical activity is accumulated before and after TKA. Accurate assessment of physical activity is important for physical activity interventions that target special populations

Bispectral fluorescence imaging combined with texture analysis and linear discrimination for correlation with histopathologic extent of basal cell carcinoma

Fluorescence imaging has been shown to be a potential complement to visual inspection for demarcation of basal cell carcinoma (BCC), which is the most common type of skin cancer. Earlier studies have shown promising results when combining autofluorescence with protoporphyrin IX (Pp IX) fluorescence, induced by application of delta-5-aminolaevulinic acid (ALA). In this work, we have tried to further improve the ability of this technique to discriminate between areas of tumor and normal skin by implementing texture analysis and Fisher linear discrimination (FLD) on bispectral fluorescence data of BCCs located on the face. Classification maps of the lesions have been obtained from histopathologic mapping of the excised tumors. The contrast feature obtained from co-occurrence matrices was found to provide useful information, particularly for the ALA-induced Pp IX fluorescence data. Moreover, the neighborhood average features of both autofluorescence and Pp IX fluorescence were preferentially included in the analysis. The algorithm was trained by using a training set of images with good agreement with histopathology, which improved the discriminability of the validation set. In addition, cross validation of the training set showed good discriminability. Our results imply that FLD and texture analysis are preferential for correlation between bispectral fluorescence images and the histopathologic extension of the tumors

Using Scenario Visioning and Participatory System Dynamics Modeling to Investigate the Future: Lessons from Minnesota 2050

Both scenario visioning and participatory system dynamics modeling emphasize the dynamic and uncontrollable nature of complex socio-ecological systems, and the significance of multiple feedback mechanisms. These two methodologies complement one another, but are rarely used together. We partnered with regional organizations in Minnesota to design a future visioning process that incorporated both scenarios and participatory system dynamics modeling. The three purposes of this exercise were: first, to assist regional leaders in making strategic decisions that would make their communities sustainable; second, to identify research gaps that could impede the ability of regional and state groups to plan for the future; and finally, to introduce more systems thinking into planning and policy-making around environmental issues. We found that scenarios and modeling complemented one another, and that both techniques allowed regional groups to focus on the sustainability of fundamental support systems (energy, food, and water supply). The process introduced some creative tensions between imaginative scenario visioning and quantitative system dynamics modeling, and between creating desired futures (a strong cultural norm) and inhabiting the future (a premise of the Minnesota 2050 exercise). We suggest that these tensions can stimulate more agile, strategic thinking about the future

Using Scenario Visioning and Participatory System Dynamics Modeling to Investigate the Future: Lessons from Minnesota 2050

Both scenario visioning and participatory system dynamics modeling emphasize the dynamic and uncontrollable nature of complex socio-ecological systems, and the significance of multiple feedback mechanisms. These two methodologies complement one another, but are rarely used together. We partnered with regional organizations in Minnesota to design a future visioning process that incorporated both scenarios and participatory system dynamics modeling. The three purposes of this exercise were: first, to assist regional leaders in making strategic decisions that would make their communities sustainable; second, to identify research gaps that could impede the ability of regional and state groups to plan for the future; and finally, to introduce more systems thinking into planning and policy-making around environmental issues. We found that scenarios and modeling complemented one another, and that both techniques allowed regional groups to focus on the sustainability of fundamental support systems (energy, food, and water supply). The process introduced some creative tensions between imaginative scenario visioning and quantitative system dynamics modeling, and between creating desired futures (a strong cultural norm) and inhabiting the future (a premise of the Minnesota 2050 exercise). We suggest that these tensions can stimulate more agile, strategic thinking about the future.scenarios; participatory modeling; multiple futures; energy; water