Voice Therapy: Racial Disparities in Adherence and Clinically Significant Outcomes

Voice therapy is evidence-based, behavioral intervention that can reduce functional and organic voice disorders. Despite its proven effectiveness, non-adherence to voice therapy is still an issue. Research shows that an estimated 65% of patients who initiate voice therapy drop out before reaching therapeutic goals. Voice therapy outcomes are largely dependent on patients’ adherence to treatment regimens, but there is limited information concerning factors that may be associated with voice therapy adherence and therapeutic outcomes for patients who successfully complete voice therapy. The purpose of this study was to investigate which demographic factors could be associated with higher adherence rates to voice therapy and whether adherent patients reported greater positive change in vocal quality than non-adherent patients. The study consisted of a retrospective chart review of 287 patients diagnosed with various voice disorders who attended voice therapy at the outpatient Our Lady of The Lake Voice Center in Baton Rouge, Louisiana. Using a Microsoft Excel spreadsheet, the following demographic information was collected for this study: race/ethnicity, age, gender, and vocal pathology. Vocal pathologies and disorders observed were vocal fold atrophy, benign lesions, chronic laryngitis, vocal fold edema, vocal fold leukoplakia, muscle tension dysphonia (MTD), vocal cord dysfunction (VCD), sulcus vocalis/vocal fold scarring, and vocal fold paralysis. The following information was also collected: discharge status (whether the subject was discharged from therapy by the SLP or discontinued therapy without a recommendation for discharge) and pre- and post-therapy Voice Handicap Index (VHI, Jacobson et al.1997) responses to determine the clinical significance of subject-perceived improvement in voice quality upon successfully completing voice therapy. Results indicated an overall adherence rate of 33.8% and a non-adherence rate of 66.2%. These results are consistent with literature published in other behavior change fields that examine adherence rates to behavioral therapies. Demographic factors associated with higher adherence rates occurred among subjects who were white, female, and older (65+ years in age). Non-white subjects, however, reported higher rates of clinically significant improvement in voice quality after completing voice therapy

Pleural Fluid Resolution Is Associated with Improved Survival in Patients with Malignant Pleural Effusion

Malignant pleural effusion is associated with a poor prognosis and, while risk stratification models exist, prior studies have not evaluated pleural fluid resolution and its association with survival. We performed a retrospective review of patients diagnosed with malignant pleural effusion between 2013 and 2017, evaluating patient demographics, pleural fluid and serum composition, and procedural and treatment data using Cox regression analysis to evaluate associations with survival. In total, 123 patients were included in the study, with median survival from diagnosis being 4.8 months. Resolution of malignant pleural fluid was associated with a significant survival benefit, even when accounting for factors such as placement of an indwelling pleural catheter, anti-cancer therapy, pleural fluid cytology, cancer pheno/genotypes, and pleural fluid characteristics. Elevated fluid protein, placement of an indwelling pleural catheter, and treatment with targeted or hormone therapies were associated with pleural fluid resolution. We conclude that the resolution of pleural fluid accumulation in patients with malignant pleural effusion is associated with a survival benefit possibility representing a surrogate marker for treatment of the underlying metastatic cancer. These findings support the need to better understand the mechanism of fluid resolution in patients with malignant pleural effusion as well as the tumor–immune interplay occurring with the malignant pleural space

Concert recording 2019-11-20

[Track 1]. Quatour pour saxophones. I. Gaiete Villageoise / F. & M. Jeanjean -- [Track 2]. Memory from Nepomuk\u27s dances / Marcelo Zarvos -- [Track 3]. Quatour pour saxophones. II. Doloroso III. Spirituoso / P.M. Dubois -- [Track 4]. Danza 2016 / Lucky Chops -- [Track 5]. Howler back / Zack Browning -- [Track 6]. Dusk / Steven Bryant -- [Track 7]. Oileain reel / Craig Richards

Integrated genomic characterization of pancreatic ductal adenocarcinoma

We performed integrated genomic, transcriptomic, and proteomic profiling of 150 pancreatic ductal adenocarcinoma (PDAC) specimens, including samples with characteristic low neoplastic cellularity. Deep whole-exome sequencing revealed recurrent somatic mutations in KRAS, TP53, CDKN2A, SMAD4, RNF43, ARID1A, TGFβR2, GNAS, RREB1, and PBRM1. KRAS wild-type tumors harbored alterations in other oncogenic drivers, including GNAS, BRAF, CTNNB1, and additional RAS pathway genes. A subset of tumors harbored multiple KRAS mutations, with some showing evidence of biallelic mutations. Protein profiling identified a favorable prognosis subset with low epithelial-mesenchymal transition and high MTOR pathway scores. Associations of non-coding RNAs with tumor-specific mRNA subtypes were also identified. Our integrated multi-platform analysis reveals a complex molecular landscape of PDAC and provides a roadmap for precision medicine

Concert recording 2019-11-24b

[Track 1]. Sonata. I. Andante, Allegro moderato [Track 2]. II. Adagio non troppo [Track 3]. III. Allegro con brio / James Di Pasquale -- [Track 4]. Epitaph de Jean Harlow / Charles Koechlin -- [Track 5]. Divertimento. I. Allegro ma non troppo [Track 6]. II. Andante III. Presto / Roger Boutry -- [Track 7]. Ulla in Africa / Heiner Wilberny

Long-term safety and efficacy of patisiran for hereditary transthyretin-mediated amyloidosis with polyneuropathy: 12-month results of an open-label extension study

© 2020 Elsevier Ltd. All rights reserved.Background: Hereditary transthyretin-mediated amyloidosis is a rare, inherited, progressive disease caused by mutations in the transthyretin (TTR) gene. We assessed the safety and efficacy of long-term treatment with patisiran, an RNA interference therapeutic that inhibits TTR production, in patients with hereditary transthyretin-mediated amyloidosis with polyneuropathy. Methods: This multicentre, open-label extension (OLE) trial enrolled patients at 43 hospitals or clinical centres in 19 countries as of Sept 24, 2018. Patients were eligible if they had completed the phase 3 APOLLO or phase 2 OLE parent studies and tolerated the study drug. Eligible patients from APOLLO (patisiran and placebo groups) and the phase 2 OLE (patisiran group) studies enrolled in this global OLE trial and received patisiran 0·3 mg/kg by intravenous infusion every 3 weeks with plans to continue to do so for up to 5 years. Efficacy assessments included measures of polyneuropathy (modified Neuropathy Impairment Score +7 [mNIS+7]), quality of life, autonomic symptoms, nutritional status, disability, ambulation status, motor function, and cardiac stress, with analysis by study groups (APOLLO-placebo, APOLLO-patisiran, phase 2 OLE patisiran) based on allocation in the parent trial. The global OLE is ongoing with no new enrolment, and current findings are based on the interim analysis of the patients who had completed 12-month efficacy assessments as of the data cutoff. Safety analyses included all patients who received one or more dose of patisiran up to the data cutoff. This study is registered with ClinicalTrials.gov, NCT02510261. Findings: Between July 13, 2015, and Aug 21, 2017, of 212 eligible patients, 211 were enrolled: 137 patients from the APOLLO-patisiran group, 49 from the APOLLO-placebo group, and 25 from the phase 2 OLE patisiran group. At the data cutoff on Sept 24, 2018, 126 (92%) of 137 patients from the APOLLO-patisiran group, 38 (78%) of 49 from the APOLLO-placebo group, and 25 (100%) of 25 from the phase 2 OLE patisiran group had completed 12-month assessments. At 12 months, improvements in mNIS+7 with patisiran were sustained from parent study baseline with treatment in the global OLE (APOLLO-patisiran mean change -4·0, 95 % CI -7·7 to -0·3; phase 2 OLE patisiran -4·7, -11·9 to 2·4). Mean mNIS+7 score improved from global OLE enrolment in the APOLLO-placebo group (mean change from global OLE enrolment -1·4, 95% CI -6·2 to 3·5). Overall, 204 (97%) of 211 patients reported adverse events, 82 (39%) reported serious adverse events, and there were 23 (11%) deaths. Serious adverse events were more frequent in the APOLLO-placebo group (28 [57%] of 49) than in the APOLLO-patisiran (48 [35%] of 137) or phase 2 OLE patisiran (six [24%] of 25) groups. The most common treatment-related adverse event was mild or moderate infusion-related reactions. The frequency of deaths in the global OLE was higher in the APOLLO-placebo group (13 [27%] of 49), who had a higher disease burden than the APOLLO-patisiran (ten [7%] of 137) and phase 2 OLE patisiran (0 of 25) groups. Interpretation: In this interim 12-month analysis of the ongoing global OLE study, patisiran appeared to maintain efficacy with an acceptable safety profile in patients with hereditary transthyretin-mediated amyloidosis with polyneuropathy. Continued long-term follow-up will be important for the overall assessment of safety and efficacy with patisiran.info:eu-repo/semantics/publishedVersio