Current Understanding of PCSK9 and Its Relevance to Cancer Prognosis and Immune Therapy: A Review.

The effectiveness of immunotherapy for most cancer patients remains low, with approximately 10-30% of those treated surviving. Thus, much effort is being put into finding new ways to improve immune checkpoint therapy. Our review concludes that inhibition of proprotein convertase subtilisin/Kexin type 9 (PCSK9), which plays a critical role in regulating cholesterol metabolism, can cause movement of T cells toward tumors, with increased sensitivity to immune checkpoint therapies. We searched PubMed, NCBI, Scopus, and Google Scholar for the published articles without limitations on publication dates. We used the following terms: "PCSK9", "Cancer", "Immune Checkpoint", and "Cancer Prognosis" in the title and/or abstract. Our search initially revealed 600 records on the subject and stored them in the used databases under EndNote X8 management software. A total of 161 articles were selected and through a careful review, 76 were included in our research. We concluded that PCSK9 reduces the number of LDL receptors (LDL-R) on the cell surface, which is linked to its ability to regulate cholesterol levels in the body. Also, we discuss how suppressing PCSK9 leads to the MHC-1 accumulation on the surface of cancer cells, which results in T lymphocyte invasion. Finally, we believe that inhibiting PCSK9 may be an effective strategy for improving cancer immunotherapy.

Physicians' Perspective on a Multidisciplinary Approach to Dysphagia Management.

INTRODUCTION: Professionals need a multidisciplinary approach to manage oropharyngeal dysphagia (OPD). Each team member should be aware of the signs and symptoms of OPD and collaborate with other team members to reach an optimum outcome. This study aimed to evaluate the knowledge and attitude of Iranian physicians regarding dysphagia and speech and language therapy roles in the management of dysphagia. MATERIALS AND METHODS: In this nonexperimental descriptive study, 133 physicians filled a researcher-made questionnaire entailing three sections, each of which recorded the participants' demographic information, OPD knowledge (23 items), and attitude toward OPD (5 items). RESULTS: Iranian physicians correctly answered 70.3% of the questions indicating that they had a moderate level of knowledge on OPD. However, only 53% of the physicians referred their patients to speech-language pathologists, and almost 50% of them reported a significant recovery after speech therapy in their patients. CONCLUSION: It seems that Iranian physicians need to adopt an interdisciplinary approach to manage OPD. Achievement of sufficient knowledge on the pathology of OPD, along with collaboration with other team members, can improve the outcome for patients with OPD.