Sister Mary Joseph’s nodule from primary endometrial carcinoma: a case report

Sister Mary Joseph’s nodule (SMJN) refers to umbilical metastases is rare and is likely be the first manifestation of an underlying malignancy likely gastrointestinal or genital in origin. The incidence reported is about 1-3% and has a poor prognosis with an overall survival (OS) of 2-11 months from the initial diagnosis. The ovarian location is incriminated the most common site followed by endometrium in gynaecological cancers. Only 32 cases of SMJN from endometrium with have been reported in the published literature. A 57-year-old postmenopausal woman, presented with a large bleeding and infected umbilical mass and symptomatic anaemia. A diagnosis of SMJN was made following biopsy of the mass which revealed metastasis of an endometrial adenocarcinoma. She underwent 6 cycles of neoadjuvant chemotherapy. Subsequent laparotomy including full resection of the umbilical lesion, abdominal wall reconstruction with composite mesh, and a total abdominal hysterectomy with bilateral salpingo-oophorectomy, omentectomy and bilateral lymph nodes excision. Histological diagnosis revealed metastasis from primary endometrial carcinoma.  Currently patient condition is stable and is on follow up. This is the 33rd case as reported in the literature of SMJN originating from endometrial carcinoma from authors knowledge. Our approach was multimodal with neoadjuvant chemotherapy followed by surgery and adjuvant radiotherapy. Currently there is no specific recommendation and management should be individualised

Perception of preparedness among primiparous on self-care and infant care before discharge in a private hospital in Malaysia

Primiparous refers to a woman who has given birth for the first time to an infant or infant, alive or stillborn. These primiparous mothers have concerns pertaining to their self-care and their newborn infants' care. These expectations and concerns of Primiparous mothers are unlikely to be met due to a lack of preparedness for information about self-care and infant care. This study aimed to identify the perception of preparedness for self-care and infant care among the primiparous before discharge and the information needs, after delivery in a private hospital in which this study was conducted. This study adopted a cross-sectional and descriptive design to achieve the research objective. The target population was primiparous who had given birth to a healthy baby in a private hospital in Penang. There was a total of 72 participants in this study. Data was collected using a self-develop questionnaire with a 5-point Likert scale to generate quantitative data. Data was analyzed using SPSS version 23.0. The findings of this study revealed that the perception and understanding of primiparous towards the information provided before discharge from the hospital has not reached a satisfactory level as primiparous were not confident enough with some of the information provided and the needs to be prepared themselves before discharge. Hence, this study concludes that future studies are needed to explore new practices to enhance the quality of maternal health care and promote positive maternal experience and well-being for mother and infant

Pharmacological Effects of Asiatic acid in Glioblastoma Cells under Hypoxia

Glioblastoma multiforme (GBM) is the most common and malignant primary brain tumor in adults. Despite current treatment options including surgery followed by radiation and chemotherapy with temozolomide (TMZ) and cisplatin, the median survival rate remains low (<16 months). Combined with increasing drug resistance and the inability of some compounds to cross the blood brain barrier (BBB), novel compounds are being sought for the treatment of this disease. Here, we aimed to examine the pharmacological effect of Asiatic acid (AA) in glioblastoma under hypoxia. To investigate the effects of AA on cell viability, proliferation, apoptosis and wound healing, SVG p12 fetal glia and U87-MG grade IV glioblastoma cells were cultured under normoxic (21% O2) and hypoxic (1% O2) conditions. In normoxia, AA reduced cell viability in U87-MG cells in a time and concentration-dependent manner. A significant decrease in viability, compared to cisplatin, was observed following 2hrs of AA treatment with no significant changes in cell proliferation or cell cycle progression observed. Under hypoxia, a significantly greater number of cells underwent apoptosis in comparison to cisplatin. While cisplatin showed a reduction in wound healing in normoxia, a significantly greater reduction was observed following AA treatment. An overall reduction in wound healing was observed under hypoxia. The results of this study show that AA has cytotoxic effects on glioma cell lines and has the potential to become an alternative treatment for glioblastoma

Adding 6 months of androgen deprivation therapy to postoperative radiotherapy for prostate cancer: a comparison of short-course versus no androgen deprivation therapy in the RADICALS-HD randomised controlled trial

Background Previous evidence indicates that adjuvant, short-course androgen deprivation therapy (ADT) improves metastasis-free survival when given with primary radiotherapy for intermediate-risk and high-risk localised prostate cancer. However, the value of ADT with postoperative radiotherapy after radical prostatectomy is unclear. Methods RADICALS-HD was an international randomised controlled trial to test the efficacy of ADT used in combination with postoperative radiotherapy for prostate cancer. Key eligibility criteria were indication for radiotherapy after radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to radiotherapy alone (no ADT) or radiotherapy with 6 months of ADT (short-course ADT), using monthly subcutaneous gonadotropin-releasing hormone analogue injections, daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as distant metastasis arising from prostate cancer or death from any cause. Standard survival analysis methods were used, accounting for randomisation stratification factors. The trial had 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 80% to 86% (hazard ratio [HR] 0·67). Analyses followed the intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov, NCT00541047. Findings Between Nov 22, 2007, and June 29, 2015, 1480 patients (median age 66 years [IQR 61–69]) were randomly assigned to receive no ADT (n=737) or short-course ADT (n=743) in addition to postoperative radiotherapy at 121 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 9·0 years (IQR 7·1–10·1), metastasis-free survival events were reported for 268 participants (142 in the no ADT group and 126 in the short-course ADT group; HR 0·886 [95% CI 0·688–1·140], p=0·35). 10-year metastasis-free survival was 79·2% (95% CI 75·4–82·5) in the no ADT group and 80·4% (76·6–83·6) in the short-course ADT group. Toxicity of grade 3 or higher was reported for 121 (17%) of 737 participants in the no ADT group and 100 (14%) of 743 in the short-course ADT group (p=0·15), with no treatment-related deaths. Interpretation Metastatic disease is uncommon following postoperative bed radiotherapy after radical prostatectomy. Adding 6 months of ADT to this radiotherapy did not improve metastasis-free survival compared with no ADT. These findings do not support the use of short-course ADT with postoperative radiotherapy in this patient population

Duration of androgen deprivation therapy with postoperative radiotherapy for prostate cancer: a comparison of long-course versus short-course androgen deprivation therapy in the RADICALS-HD randomised trial

Background Previous evidence supports androgen deprivation therapy (ADT) with primary radiotherapy as initial treatment for intermediate-risk and high-risk localised prostate cancer. However, the use and optimal duration of ADT with postoperative radiotherapy after radical prostatectomy remains uncertain. Methods RADICALS-HD was a randomised controlled trial of ADT duration within the RADICALS protocol. Here, we report on the comparison of short-course versus long-course ADT. Key eligibility criteria were indication for radiotherapy after previous radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to add 6 months of ADT (short-course ADT) or 24 months of ADT (long-course ADT) to radiotherapy, using subcutaneous gonadotrophin-releasing hormone analogue (monthly in the short-course ADT group and 3-monthly in the long-course ADT group), daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as metastasis arising from prostate cancer or death from any cause. The comparison had more than 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 75% to 81% (hazard ratio [HR] 0·72). Standard time-to-event analyses were used. Analyses followed intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov , NCT00541047 . Findings Between Jan 30, 2008, and July 7, 2015, 1523 patients (median age 65 years, IQR 60–69) were randomly assigned to receive short-course ADT (n=761) or long-course ADT (n=762) in addition to postoperative radiotherapy at 138 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 8·9 years (7·0–10·0), 313 metastasis-free survival events were reported overall (174 in the short-course ADT group and 139 in the long-course ADT group; HR 0·773 [95% CI 0·612–0·975]; p=0·029). 10-year metastasis-free survival was 71·9% (95% CI 67·6–75·7) in the short-course ADT group and 78·1% (74·2–81·5) in the long-course ADT group. Toxicity of grade 3 or higher was reported for 105 (14%) of 753 participants in the short-course ADT group and 142 (19%) of 757 participants in the long-course ADT group (p=0·025), with no treatment-related deaths. Interpretation Compared with adding 6 months of ADT, adding 24 months of ADT improved metastasis-free survival in people receiving postoperative radiotherapy. For individuals who can accept the additional duration of adverse effects, long-course ADT should be offered with postoperative radiotherapy. Funding Cancer Research UK, UK Research and Innovation (formerly Medical Research Council), and Canadian Cancer Society

IoT-enabled digital revolution of the healthcare system

In modern civilization, healthcare is a significant problem. The Internet of Things (IoT) technology is appealing to everyone because it has the ability to change the present healthcare system and address the problems that the aging population and the steady rise in chronic sickness are posing for the healthcare system. This chapter focuses on the conventional healthcare system that has been used in the past to deliver healthcare services as well as the integration of IoT, a new technology, into the healthcare system to modernize patient care. To provide services more quickly and effectively, this chapter illustrates how IoT has changed the conventional approach to monitoring healthcare. Finally, a study on different IoT-based healthcare monitoring systems will be conducted, along with a comparison of numerous IoT-based healthcare systems to show their advantages and disadvantages. The industry's digital transformation is piquing the curiosity of academics and healthcare practitioners alike. In this work, we attempt to examine the research question about the management and commercial uses of digital technology by different stakeholders. This chapter examines IoT applications for medical purposes, the different ways it is affecting the healthcare industry, and some potential future routes for its growth, such as Bio-IoT and Nano-IoT or the Internet of Nano Things. From the perspective of monitoring patients' vital signs, wireless body area networks (WBANs) are crucial components of a system. The WBANs consist of tiny smart devices that communicate wirelessly and are implanted within or on top of the patient. We analyze the literature on digital transformation in healthcare to answer this question. According to our findings, previous research can be grouped into five clusters: organizational characteristics, patient-centered approaches, operational efficiency of healthcare providers, and research techniques. These clusters are linked to illustrate how various technology adoption approaches enhance service providers' operational effectiveness. Research in a variety of directions is recommended, with implications for management as well

Analysis of Pharmacokinetics, Pharmacodynamics, and Pharmacogenomics Data Sets Using VizStruct, A Novel Multidimensional Visualization Technique

Purpose. Data visualization techniques for the pharmaceutical sciences have not been extensively investigated. The purpose of this study was to evaluate the usefulness of VizStruct, a multidimensional visualization tool, for applications in pharmacokinetics, pharmacodynamics, and pharmacogenomics. Methods. The VizStruct tool uses the first harmonic of the discrete Fourier transform to map multidimensional data to two dimensions for visualization. The mapping was used to visualize several published pharmacokinetic, pharmacodynamic, and pharmacogenomic data sets. The VizStruct approach was evaluated using simulated population pharmacokinetics data sets, the data from Dalen and colleagues (Clin. Pharmacol. Ther. 63:444–452, 1998) on the kinetics of nortriptyline and its 10-hydroxy-nortriptyline metabolite in subjects with differing number of copies of the CYP2D6, and the gene expression profiling data of Bohen and colleagues (Proc. Natl. Acad. Sci. US