What are the experiences of supportive care in people affected by brain cancer and their informal caregivers: A qualitative systematic review.

PURPOSE: To critically synthesise qualitative research to understand experiences of supportive care in people affected by brain cancer and their informal caregivers. METHODS: A qualitative systematic review was conducted according to the Joanna Briggs methodology and has been reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Guidelines. Electronic databases were searched by an expert systematic review librarian for all qualitative studies irrespective of research design. All publications were double screened by two reviewers using a pre-determined exclusion and inclusion criteria. The review was managed using Covidence systematic review software. Methodological quality assessment and data extraction were performed. Qualitative findings accompanied by illustrative quotes from included studies were extracted and grouped into categories, which created the overall synthesised findings. RESULTS: A total of 33 studies were included which represented a total sample of 671 participants inclusive of 303 patients and 368 informal caregivers. There was a total of 220 individual findings included in this review, which were synthesised into two findings (1) caregivers and patients perceived supports which would have been helpful and (2) caregiver and patient experiences of unmet supportive care needs. CONCLUSION: This review highlighted the suffering and distress caused by brain cancer and associated treatments. Both patients and their informal caregivers experienced disconnect from themselves in renegotiating roles, and a profound sense of loneliness as the physical deterioration of the disease progressed. Both patients and informal caregivers reported similar unmet needs within the current service provision for brain cancer. However, what is apparent is that current cancer services are provided solely for patients, with little or no consideration to the support needs of both the patient and their informal caregiver. Service re-design is needed to improve care coordination with individualised informational support, implementation of holistic needs assessments for both the patients and their caregivers, better community support provision, improved opportunities for emotional care with early referral for palliative care services. IMPLICATIONS FOR CANCER SURVIVORS: It is recommended that members of the multidisciplinary brain cancer team reflect on these findings to target holistic needs assessments and develop shared self-management care plans for both the patient and the informal caregiver.

Antioxidant and Anti-Breast Cancer Properties of Hyaluronidase from Marine Staphylococcus aureus (CASMTK1)

This work studied the antioxidant and anti-breast cancer properties of hyaluronidase, extracted from a potential marine strain, Staphylococcus aureus (CASMTK1), isolated from Parangipettai coastal waters in southeast coast of India. The Staphylococcal enzyme production was tested under different carbon and nitrogen sources;and recorded the maximum production when the microbial strain was cultured with starch as the carbon source and ammonium sulphate as the inorganic nitrogen source with the enzyme production of 92.5 U/mL and 95.0 U/mL, respectively. The hyaluronidase enzyme production was also tested in different pH and temperature;and recorded the maximum yield of 102.5 U/mL in pH 5 and that of 95.5 U/mL in 45 °C. The partially purified enzyme was subjected to FTIR and FT Raman technique and found the presence of the amide- I and II, Carboxyl, N-H bending, C-H stretching and α-helices and β-sheet proteins between wave number 1500–1700 cm−1. The partially purified enzyme also exhibited strong antioxidant and in-vitro breast cancer properties. The enzyme showed the highest hydroxyl radical scavenging activity of 79% at the 50 µg/mL concentration, and this activity increased in a dose-dependent manner. The enzyme inhibited proliferation of the breast cancer cell line of MCF-7, and it caused 100% cell death at the concentration of 80 µg/mL. The enzyme generated capacity of producing free radicles that damage the cancer cells, and this effect was very nearer to the standard drug, paclitaxel. The enzyme damaged the cancer cells and induced apoptosis in 78% of cancer cells as evident by condensed or fragmented chromatin at 40 µg/mL. Further purification of the enzyme, analysis of its molecular aspects, and elucidation of exact mechanisms of its biological activities will throw new light on the utility of staphylococcal hyaluronidase in anticancer chemotherapy.

Introduction—Epigenetics regulations in organ specific disorders

Epigenetics is used to explain stable heritable chemical modifications to DNA and histones that affect gene expression without changing nucleotide sequence. The genetic expression of a trait in an organism can be moderated by epigenetics depending on the prevailing environmental conditions and activate different traits from the same genotype via modulating gene expression patterns. Several diseases can control or get influenced by the epigenome. A recent surge in research is focused on decoding such changes as early indicators of diseases. SARS-CoV-2, responsible for the worldwide pandemic, is also suggested to rattle the epigenetic network, impacting the host immune system negatively. While epigenetic drugs have majorly been studied in treating cancer, the increasing funding and interest have paved the way for the researchers to focus on other inflammatory diseases. The primary focus of this book has been to delineate the role of epigenetics in regulating disorders affecting organs in our body. © 2023 Elsevier Inc. All rights reserved.

Efficacy and Safety Analysis of Setmelanotide as a Novel Treatment for Hypothalamic Obesity

Background: Hypothalamic injury and impaired melanocortin-4 receptor (MC4R) pathway signaling, often a result of surgery or radiation for a benign tumor, may lead to hypothalamic obesity (HO). After injury, sudden weight gain and appetite changes unresponsive to existing therapies develop. Setmelanotide, an MC4R agonist, is approved for chronic weight management in patients with certain MC4R pathway-associated diseases. We report interim results of a Phase 2 study of setmelanotide in HO (NCT04725240). Methods: Patients aged 6-40 years with body mass index (BMI) >95th percentile (children 6 to <18 years) or >35 kg/m2 (adults >18 years) and HO caused by structural hypothalamic damage secondary to craniopharyngioma or other benign brain tumor, surgical resection, and/or chemotherapy were enrolled. The setmelanotide dose was initiated by age, with 2-4 weeks of titration to 3.0 mg once daily, followed by 12-14 weeks at the target dose. The primary endpoint was the proportion of patients achieving >5% BMI reduction at Week 16. A key secondary endpoint was the composite proportion of children with >0.2-point reduction in BMI Z score and adults with >5% weight loss. Hunger was assessed daily using a numerical rating scale, where 0 = not hungry at all and 10 = hungriest possible. Results: Eleven patients were included (baseline mean [SD;range] age, 14.6 [4.8;6-23] years and mean [SD] BMI, 38.7 [5.7] kg/m2). All patients (90% CI, 76.2%-100%) had >5% reduction in BMI (p<0.0001);81.8% (90% CI, 53.0%-96.7%) had >10% reduction (p<0.0001). Mean (range) change in BMI was -17.2% (-37.2%, -6.7%). Mean (SD) change in hunger score was -2.7 (2.6). Frequent adverse events included nausea (63.6%), vomiting (45.5%), diarrhea (36.4%), and COVID-19 (36.4%). Two patients discontinued because of adverse events. Conclusions: These early results warrant continued evaluation of setmelanotide in this population with a high unmet medical need and no approved therapies.

Don’t ignore the splinter haemorrhage . . . and other stories

[...]brain tumours after radiotherapy Radiotherapy is sometimes given after surgery for the treatment of pituitary adenomas and craniopharyngiomas, despite the risk of inducing a second brain tumour. Treatment of degenerative meniscal tears Although arthroscopic meniscectomy is frequently performed in people with degenerative meniscal tears, little evidence exists to suggest long term benefit. A randomised controlled trial from the Netherlands finds that self-reported knee function five years after treatment was no better in those receiving surgery than in those randomly assigned to exercise based physical therapy (JAMA Netw Open doi:10.1001/jamanetworkopen.2022.20394).

Transfer Learning from Healthy to Unhealthy Patients for the Automated Classification of Functional Brain Networks in fMRI

Functional Magnetic Resonance Imaging (fMRI) is an essential tool for the pre-surgical planning of brain tumor removal, which allows the identification of functional brain networks to preserve the patient’s neurological functions. One fMRI technique used to identify the functional brain network is the resting-state-fMRI (rs-fMRI). This technique is not routinely available because of the necessity to have an expert reviewer who can manually identify each functional network. The lack of sufficient unhealthy data has so far hindered a data-driven approach based on machine learning tools for full automation of this clinical task. In this article, we investigate the possibility of such an approach via the transfer learning method from healthy control data to unhealthy patient data to boost the detection of functional brain networks in rs-fMRI data. The end-to-end deep learning model implemented in this article distinguishes seven principal functional brain networks using fMRI images. The best performance of a 75% correct recognition rate is obtained from the proposed deep learning architecture, which shows its superiority over other machine learning algorithms that were equally tested for this classification task. Based on this best reference model, we demonstrate the possibility of boosting the results of our algorithm with transfer learning from healthy patients to unhealthy patients. This application of the transfer learning technique opens interesting possibilities because healthy control subjects can be easily enrolled for fMRI data acquisition since it is non-invasive. Consequently, this process helps to compensate for the usual small cohort of unhealthy patient data. This transfer learning approach could be extended to other medical imaging modalities and pathology.

'Communication is key' to reduce suicide risk after cancer diagnosis

A separate meta-analysis of 28 studies by Heinrich and colleagues, published in March in Nature Medicine, showed an 85% higher suicide rate among patients with cancer compared with the general population, with strong correlations of risk with cancer prognosis and stage, time since diagnosis and geographic region. "Suicide is a huge problem in America, and we will most likely see a significant increase since the COVID-19 pandemic began," Nosayaba Osazuwa-Peters, PhD, BDS, MPH, CHES, member of Duke Cancer Institute and assistant professor in head and neck surgery and communication sciences and population health sciences at Duke University School of Medicine, told Healio ;HemOnc Today. Osazuwa-Peters and colleagues reported even larger differences in suicide risk based on area of residence among patients with head and neck cancer. The cross-sectional study, published last year in JAMA Otolaryngology-Head & Neck Surgery, included data from the SEL1 - https://media.proquest.com/media/hms/PFT/1/uf1BN?_a=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%2BgIBToIDA1dlYooDHENJRDoyMDIyMDYwNzEyMjczMzc0NTo3NTEyNTQ%3D&_s=9mfYeas7Ijzr6FwcjkLk0av32yU%3D

A Novel Data Augmentation-Based Brain Tumor Detection Using Convolutional Neural Network

Brain tumor is a severe cancer and a life-threatening disease. Thus, early detection is crucial in the process of treatment. Recent progress in the field of deep learning has contributed enormously to the health industry medical diagnosis. Convolutional neural networks (CNNs) have been intensively used as a deep learning approach to detect brain tumors using MRI images. Due to the limited dataset, deep learning algorithms and CNNs should be improved to be more efficient. Thus, one of the most known techniques used to improve model performance is Data Augmentation. This paper presents a detailed review of various CNN architectures and highlights the characteristics of particular models such as ResNet, AlexNet, and VGG. After that, we provide an efficient method for detecting brain tumors using magnetic resonance imaging (MRI) datasets based on CNN and data augmentation. Evaluation metrics values of the proposed solution prove that it succeeded in being a contribution to previous studies in terms of both deep architectural design and high detection success.

Neuro-Oncologic Care During the COVID-19 Pandemic

The COVID-19 pandemic has shocked health-care systems around the world necessitating profound shifts in resources and alterations to standard therapies. The pandemic’s impact on delivering care to people with cancer is regionally specific and the resultant changes in disease outcomes are not yet known. Neuro-oncologic conditions are often rare diseases with few effective therapies that require coordinated care by a team of specialists organized through a multidisciplinary cancer conference. During this pandemic, additional factors need to be considered such as COVID-19 exposure and therapy-related risks in the setting of a COVID-19 infection. The COVID-19 pandemic has resulted in dramatic changes to therapeutic clinical trials which are a preferred path of care in neuro-oncology due to dismal outcomes and few effective standard therapies. Herein, we discuss plans of care for neuro-oncologic conditions in a pandemic environment where every health-care exposure is considered a risk and standard approaches may not be possible due to limited access to resources such as intensive care units and surgical suites. © 2021 Elsevier Inc. All rights reserved.

COSA's 48th Annual Scientific Meeting Cancer Care and Research: Learning from the Past and Improving the Future

The proceedings contain 333 papers. The topics discussed include: leveraging opportunities of the pandemic: optimal cancer care during and beyond COVID-19;the promise of personalized patient care. from why to how;developing a quality framework for the delivery of immunotherapy;capturing experience of care to inform system and service redesign;using routine patient-reported data to innovate services for people affected by brain cancer;co-designing for patient centered care - examples from practice;what do patients need from a patient organization?!;lung cancer screening ? are we there yet? policy perspective;the evidence behind lung cancer screening;the real risk of lung cancer screening is failure to operate;?user-friendly, highly implementable with rigorous adherence to a clinical pathway?: feasibility of lung cancer screening implementation and rollout in Australia;global advances in prehabilitation;risk stratification and multimodal prehabilitation for modifiable risk to improve surgical outcomes;and multidisciplinary prehab in action: an exercise, nutrition and psychology perspective.

Neurosurgery at the crossroads of immunology and nanotechnology. New reality in the COVID-19 pandemic.

Neurosurgery as one of the most technologically demanding medical fields rapidly adapts the newest developments from multiple scientific disciplines for treating brain tumors. Despite half a century of clinical trials, survival for brain primary tumors such as glioblastoma (GBM), the most common primary brain cancer, or rare ones including primary central nervous system lymphoma (PCNSL), is dismal. Cancer therapy and research have currently shifted toward targeted approaches, and personalized therapies. The orchestration of novel and effective blood-brain barrier (BBB) drug delivery approaches, targeting of cancer cells and regulating tumor microenvironment including the immune system are the key themes of this review. As the global pandemic due to SARS-CoV-2 virus continues, neurosurgery and neuro-oncology must wrestle with the issues related to treatment-related immune dysfunction. The selection of chemotherapeutic treatments, even rare cases of hypersensitivity reactions (HSRs) that occur among immunocompromised people, and number of vaccinations they have to get are emerging as a new chapter for modern Nano neurosurgery.