Systemic Therapy

Generalizovaný karcinom prsu je až na vzácné případy nevyléčitelné onemocnění. Díky novým znalostem o biologii nádorů, které přinesly do léčby nové terapeutické možnosti, došlo k signifikantnímu prodloužení přežití u určitých imunofenotypů karcinomu prsu. Především zařazením anti HER2 léčby (trastuzumab, pertuzumab, trastuzumab emtasin, lapatinib) došlo k prodloužení hrubého přežití u pacientek s amplifikací HER2 až na 56 měsíců. Stále se ale jedná o inkurabilní onemocnění a je nutné, kromě snahy o prodloužení přežití, myslet hlavně na zlepšení či alespoň zachování kvality života pacienta.

The general topic of this year’s 17th St. Gallen (SG) International Consensus Conference on the treatment of patients with early breast cancer (SG-BCC) was “Customizing local and systemic therapies for women with early breast cancer.” This topic considers that each treatment decision must also consider the cancer-specific situation of the individual patient. This year, the votes of the SG-BCC were again discussed taking into account the multidisciplinary German S3 Guidelines and the recommendations of the Breast Cancer Working Group of the AGO (Arbeitsgemeinschaft Gynäkologische Onkologie; AGO Mamma). As the international panel of the SG-BCC consists of experts from different countries, the votes do represent an international cross-section of opinions. Therefore, it is useful to discuss the voting results with respect to the German evidence-based treatment guidelines. This publication focuses mainly on systemic treatment.

A German working group of leading breast cancer experts have discussed the votes at the International St. Gallen Consensus Conference in Vienna for the treatment of primary breast cancer with regard to the German AGO (Ar­beitsgemeinschaft Gynäkologische Onkologie) recommendations for clinical practice in Germany. Three of the German breast cancer experts were also members of this year’s St. Gallen panel. Comparing the St. Gallen recommendations with the annually updated treatment recommendations of the Gynecological Oncology Working Group (AGO Mamma 2019) and the German S3 Guideline is useful, because the recommendations of the St. Gallen panel are based on expert opinions of different countries and disciplines. The focus of this article is on systemic therapy. The motto of this year’s 16th St. Gallen Consensus Conference was “Estimating the magnitude of clinical benefit.” The rationale behind this motto is that, for every treatment decision, a benefit-risk assessment must be taken ...

Sekundární mozkové nádory, mozkové metastázy, se vyskytují až u 30-40 % všech onkologických pacientů se solidními nádory, přičemž riziko jejich výskytu a incidence nadále narůstá. Cílem tohoto přehledového článku je poskytnout základní a zároveň aktuální informace o současných léčebných možnostech pacientů s mozkovými metastázami s výjimkou radioterapie, která je diskutována v samostatném, navazujícím, přehledovém článku. Snahou je, v souladu se zaměřením časopisu, poskytnout didakticky a prakticky podané informace o problematice sekundárních mozkových nádorů s důrazem na jejich využitelnost v denní klinické praxi. S rozšiřujícími se léčebnými možnostmi, včetně operačních výkonů a moderní cílené terapie a imunoterapie, lze do budoucna očekávat více personalizovaný přístup v léčbě tohoto onemocnění. Klíčová slova: mozkové metastázy, neurochirurgie metastáz, cílená terapie, imunoterapie. Secondary brain tumors, brain metastases, develop in up to 30-40% of all solid tumor cancer patients, with increasing incidence. The aim of this review is to provide both basic as well as current information on up-to-date treatment options for patients with brain metastases except of radiotherapy, which is discussed in separate, company review. The aim is, in accordance with the focus of the journal, to provide didactical and practical information on the issue of secondary brain tumors with an emphasis on their usefulness in daily clinical practice. With increasing therapeutic options, including surgery and advanced targeted therapy and immunotherapy, a more personalized approach to the treatment of this disease can be expected in the future.

An opportunistic infection is an infection caused by pathogens, such as Toxoplasma gondii, that usually are not pathogenic in a healthy host but may cause an infection in immunocompromised patients. Although the most frequent cause of an opportunistic infection is immunodeficiency due to HIV infection, the immunodeficiency induced by anticancer treatment cannot be ignored. A 56-year old female patient after a comprehensive treatment of breast cancer underwent a stereotactic biopsy of MR-verified multiple brain lesions suspected to be of metastatic aetiology. The histology report unexpectedly concluded that the lesion was brain toxoplasmosis confirmed by detection of IgM specific antibody in cerebrospinal fluid. Immunology examination has proven a deficit of cell-mediated immunity. The symptoms (cephalea, cerebellar symptomatology with vertigo) and MR findings disappeared following 6-month treatment with a combination of pyrimethamin, sulfadiazin and leucovorin. Since neoplastic dupl...

The United Nations General Assembly has officially designated 2025 as the International Year of Quantum Science and Technology (IYQ). This global initiative, supported by UNESCO and co-sponsored by several countries, marks the centenary of quantum sciences, which encompass quantum mechanics, quantum chemistry, and related fields. These disciplines serve as the foundation for fundamental research across the natural sciences. This article explores the complex relationship between quantum mechanics and concepts of traditional chemistry, particularly concerning the microscopic world of atoms and molecules. It highlights how quantum mechanics, a holistic and nonlocal theory, features concepts such as entanglement and the indistinguishability of components that challenge classical chemical notions of distinct interatomic interactions and well-defined molecular structures. While quantum mechanics excels at determining the overall stability and dynamics of the system, the article explains that quantum chemistry relies on the classical Born-Oppenheimer approximation to maintain the view of local interactions and identifiable atoms within a molecule. Then, the article discusses the historical development and limitations of transition state theory in explaining chemical reactions, highlighting chemistry’s specific focus on bond breaking and bond making as a fundamental explanatory principle.

Lung cancer is still a major health problem. In this context, surgical treatment is very important but unfortunately only about a quarter of the patients diagnosed with lung cancer are operable and the overall 5-year survival is unsatisfactory Adjuvant therapies have been investigated in randomized clinical trials to minimize the risk of disease recurrence after surgery. The first meta-analysis published in 1995 about adjuvant systemic therapy brought modest but objective evidence on its benefits. The consolidation of surgical results through systemic adjuvant therapy is important and addressed in this article that describes the main clinical trials that imposed adjuvant chemotherapy as standard of care. New treatments introduced into the therapeutic arsenal of lung cancer, such as targeted therapy and immunotherapy, recently demonstrated a role in the adjuvant settings and were highlighted at the end of this article.

To determine the impact on overall survival with different salvage therapies, including no treatment, reirradiation, systemic therapy, or radiation and systemic therapy, in participants of a phase 3 clinical trial evaluating dose-dense versus standard-dose temozolomide for patients with newly diagnosed glioblastoma. Methods and Materials: This analysis of patients from Trial RTOG 0525 investigated the effect of reirradiation or systemic treatment after tumor progression. Survival from first progression was compared between patients receiving no therapy, systemic therapy alone, radiation alone, and both modalities. The Cox proportional hazards model was used to compare the mortality hazard, controlling for potential confounders. Results: The analysis included 637 patients who progressed and had information on their management, excluding those who died less than half a month after progression. A total of 267 patients (42%) received neither reirradiation nor systemic treatment at progression, 24 (4%) received radiation alone, 282 (44%) received systemic treatment only, and 64 (10%) received both radiation and systemic therapy. Patients who received no treatment had a median survival of 4.8 months, lower than with radiation treatment alone (8.2 months), systemic therapy alone (10.6 months), and both radiation and systemic therapy (12.2 months). In survival models controlling for potential confounders, those who received radiation alone had modestly better survival (hazard ratio HR 0.74, 95% confidence interval [CI] 0.43-1.28), whereas those who underwent systemic therapy either without (HR 0.42, 95% CI 0.34-0.53) or with radiation therapy (HR 0.44, 95% CI 0.30-0.63) had better survival. There was no significant survival difference between patients who received radiation only and those who received systemic therapy (either with radiation or alone). Conclusions: Patients who received no salvage treatment had poorer survival than those who received radiation, chemotherapy, or the combination. However, patient selection for no treatment likely reflects poorer expected prognosis. There was no significant survival difference among those receiving radiation therapy, systemic therapy, or both. Ongoing clinical trials will help define the role of reirradiation after glioblastoma progression.

This paper explores the use of social and mobile technologies on school field trips as means of enhancing the visitor experience. It employs the notion of a 'trajectory'(Ludvigsen et al. 2010; Pierroux et al., 2010; Littleton & Kerawalla, 2012) as appropriate means of connecting learners temporal experiences with informal and formal learning contexts. The focus of the analysis is on a group's trajectory with an aim to examine the meanings made and represented in multimodal 'ensembles' and further, to explore whether artefacts and tools ...

Systemic family therapy has evolved across geographical locations since the early 1950s. Clinically, it developed in the context of a number of therapeutic movements, including child guidance clinics, marriage counselling, and sex therapy. Whilst it is theoretically rooted in the interdisciplinary field of systems theory, or cybernetics, systemic family therapy has prided itself upon its development from practice to theory. It has also been open to influence from a heterogeneous range of other psychotherapeutic approaches and wider intellectual currents. Distinct phases of development are often identified, within which more specific schools have emerged, frequently connected with specific practitioners or clinics. These are outlined in detail elsewhere (e.g., . We present a brief overview of some of these schools before focusing on an integration of enduring systemic ideas that characterises contemporary systemic practice, especially in the UK . We use 'systemic family therapy', 'family therapy', and 'systemic practice' interchangeably to refer to therapeutic practice based upon systemic principles; other therapies delivered to family groups based upon different theoretical principles (for example behavioural family therapy; are not discussed here.

Cel pracyW artykule zaprezentowano rezultaty projektu badawczego poświęconego ocenie zmian w procesie systemowej terapii rodzinnej prowadzonej w grupie klinicznej młodzieżowych pacjentów psychiatrycznych.MetodaDo oceny wykorzystano polską wersję kwestionariusza SCORE–15. Badanie przeprowadzono na grupie 109 rodzin, które wypełniły kwestionariusz przed pierwszą sesją. Przed czwartą sesją ankietę wypełniły 73 rodziny; a po ostatniej sesji ukończyło ją 28 rodzin.WynikiWyniki konsensualnych analiz jakościowych ujawniły zmiany w opisie rodziny, a także w opisie problemu. Analizy statystyczne wyników kwestionariusza SCORE–15 wykazały znaczące zmiany między pierwszą, czwartą i ostatnią sesją. Zmiany zostały zidentyfikowane w skali SCORE Total, a także w skalach VAS. Wskaźnik RCI wykazał 5 popraw i 2 pogorszenia po trzech sesjach oraz brak pogorszeń i 13 popraw pod koniec procesu terapii.WnioskiUzyskane wyniki wskazują na wiele istotnych zmian w badanych obszarach po przejściu rodzin przez ...

‘The Moan Zone’ is a novel intervention that draws inspiration from ‘Worry Time’ - a CBT intervention commonly used to provide relief from excessive anxiety by creating a schedule  that sets aside dedicated time for worrying.
Instead of focusing on and managing anxiety as an individual experience, ‘The Moan Zone’ provides a framework for creating intentional, fulfilling and highly structured interactions between loved ones.

This review examined patterns of systemic anticancer treatment in patients with HR+ /HER2− metastatic breast cancer in real-world clinical practice in Europe since 2016 to assess whether they reflect clinical guidelines and recent changes in available treatment options. We identified 30 publications for inclusion. In studies evaluating
patients up to the end of 2017, endocrine therapy predominated, with endocrine monotherapy typically used in 45–65 % of patients. More recent studies suggested that use of cyclin-dependent kinase 4/6 inhibitor therapy has gained ground since European approval in late 2016, with two studies reporting first-line use in over 55 % of patients. Chemotherapy was typically used first line in 25–45 % of patients, although current guidelines recommend endocrine therapy in the absence of a visceral crisis. In conclusion, our review suggests that the most recent treatment developments for patients with HR+ /HER2 − metastatic breast cancer are being reflected in the changing treatment patterns seen in real-world practice.

BACKGROUND Melanoma is the third most common malignancy that results in brain metastasis and is associated with a median overall survival (OS) of approximately 9 months. In recent years, management of melanoma brain metastases (MBM) by surgery and radiation [stereotactic radiosurgery (SRS) and whole brain radiation therapy (WBRT)] has been bolstered by targeted therapy and immune checkpoint inhibitors (ICI). METHODS 351 patients, treated for MBM at our tertiary care center from 2000–2018, were grouped into: received chemotherapy, ICI, or targeted therapy. 34% of patients treated with ICI had received other systemic therapies as well as part of their management. OS was calculated from the date of diagnosis of the brain metastases. The Kaplan Meier analysis was utilized to determine median OS and difference in OS was determined by utilizing the Cox proportional hazard model. RESULTS The median survival after the diagnosis of brain metastasis was 10.4, 11.96, and 7.06 months in patient...

BACKGROUND: Melanoma brain metastasis is associated with a median overall survival (OS) of approximately 9 months. In recent years, management of melanoma brain metastases (MBM) by surgery and radiation [stereotactic radiosurgery (SRS) and whole brain radiation therapy (WBRT)] has been bolstered by targeted therapy and immune checkpoint inhibitors (ICI). METHODS: 351 patients, who underwent treatment for MBM at our tertiary care center from 2000 to 2018, were grouped into those that received chemotherapy, ICI, or targeted therapy. Thirty-four percent of patients treated with ICI had received other systemic therapies as well as part of their management. OS was calculated from the date of diagnosis of the brain metastases. The Kaplan Meier analysis was utilized to determine median OS and difference in OS was determined by utilizing the Cox proportional hazard model. RESULTS: The median survival after the diagnosis of brain metastasis was 10.4, 11.96, and 7.06 months in patients who re...

Background: Squamous cell carcinomas are tumours originating from keratinocytes and they are among the most commonly encountered skin cancers worldwide. This tumour exhibits various degree of differentiation and subtypes, which is invariably important in prognostication and predictability of aggression and tumour recurrence. The true prevalence of SCC in Nigeria is still debatable. However, The high frequency of cutaneous SCC significantly impacts the health system, making it a public health issue despite its low mortality rates and rare occurrence of metastases Aims: The aim of this study was to examine the proliferative index using ki-67 immuno peroxidase protein among the variants of squamous cell carcinoma diagnosed through routine biopsies at federal medical centre, umuahia, Abia state between 2012 and 2018 Methodology: Archival FFPE blocks were retrieved alongside relevant clinical data. Hematoxylin and eosin as well as immunohistochemistry using monoclonal antibody against Ki-67 (BioCare CRM325C(RM)) for antigen expression on fresh 4-micron sections of tumour specimens was used. The H&E stained slides were interpreted under a light microscope and the immunohistochemical slides were viewed with Olympus CX22LED light microscope and brown nuclear staining was interpreted as positive staining for Ki-67 regardless of staining intensity. While bluish staining of the nucleus was interpreted as negative for Ki-67. The sections were examined at high power (x40) and 10 fields were chosen in the area showing most proliferation (areas showing most positive nuclear staining with Ki-67): Result: In Overall, the Ki-67 index of all the cutaneous SCC in this study ranges from 2.3-80%, with a mean value of 24.7%.The Ki-67 index was variably expressed among the variants of SCC, of which the squamous cell carcinoma NOS have Ki-67 index range from 9.2-35.7% with a mean value of 20.2%, Adenosquamous variant have Ki-67 index range from 40-80% with a mean value of 55.3%, Acantholytic variant, 23.5-45.2% and a mean value of 32.0%, Verrucous squamous cell carcinoma, has Ki-67 index range of 2.3-10.5% with a mean value of 7.7%, that of Keratoacanthoma variant ranges from 2.4-10.7% with a mean value of 7.0% Conclusion: These findings may be helpful in prognostication as well as predictability of SCC tumour recurrence and for the purpose of therapy and

Studies in order to pursue kinetics and mechanism of chemical reactions are a vital component of chemical literature. SATL literature is still not available for promoting this vital aspect of chemistry teaching. A lesson pertaining to this important issue has been developed and various parameters of kinetic studies are explained therein.

Introduction: Breast cancer is the most common tumor in women and represents the leading cause of cancer death. Radiation therapy plays a key-role in the treatment of all breast cancer stages. Therefore, the adoption of evidence-based treatments is warranted, to ensure equity of access and standardization of care in clinical practice. Method: This national document on the highest evidence-based available data was developed and endorsed by the Italian Association of Radiation and Clinical Oncology (AIRO) Breast Cancer Group. We analyzed literature data regarding breast radiation therapy, using the SIGN (Scottish Intercollegiate Guidelines Network) methodology ( www.sign.ac.uk ). Updated findings from the literature were examined, including the highest levels of evidence (meta-analyses, randomized trials, and international guidelines) with a significant impact on clinical practice. The document deals with the role of radiation therapy in the treatment of primary breast cancer, local r...

Leptomeningeal carcinomatosis (LC) is a rare but challenging manifestation of advanced breast cancer with a severe impact on morbidity and mortality. We performed a systematic review of the evidence published over the last two decades, focusing on recent advances in the diagnostic and therapeutic options of LC. Lobular histology and a triplenegative intrinsic subtype are well-known risk factors for LC. Clinical manifestations are diverse and often aspecific. There is no gold standard for LC diagnosis: MRI and cerebrospinal fluid cytology are the most frequently used modalities despite the low accuracy. Current standard of care involves a multimodal strategy including systemic and intrathecal chemotherapy in combination with brain radiotherapy. Intrathecal chemotherapy has been widely used through the years despite the lack of data from randomized controlled trials and conflicting evidence on patient outcomes. No specific chemotherapeutic agent has shown superiority over others for both intrathecal and systemic treatment. Although endocrine therapy was heuristically considered unable to exert significant control on central nervous system metastatic disease, retrospective data suggest a favourable toxicity profile and even a possible positive impact on survival. In recent years, encouraging data on the use of targeted agents has emerged but further research in this field is required. Palliative treatment in the form of whole brain or stereotactic radiotherapy is associated with improvement in clinical manifestations and quality of life, with no proven impact on survival. The most investigated prognostic factors include performance status, non-triple-negative disease and multimodal treatment. Validation of prognostic scores is necessary to aid clinicians in the identification of patient subgroups that are most likely to benefit from an intensive therapeutic approach.

This real-world evidence study assessed the response of patients with locally advanced, surgically unresectable, or metastatic biliary tract cancer who were treated using durvalumab with gemcitabine-cisplatin. The cohort had a median progression-free survival of 8.2 months and an overall survival of 12.7 months. The overall response rate was 29.1% and the disease control rate was 61.2%. Adverse events occurred in 52.3% of patients. The findings align with the TOPAZ-1 trial and other real-world evidence trials and confirm the safety and effectiveness of the treatment regimen in routine clinical analysis.

The Bateson Project and the Haley's own background in communication studies led him to collaborate with Milton Erickson. Haley attended one of Erickson's workshop in 1953 and then trained under his tutelage for 10 years. Haley's book, Uncommon Therapy: The Psychiatric Techniques of Milton Erickson (1973), was a great contribution to the field as it introduced Erickson and his unique and innovative clinical approaches to the psychotherapeutic field and highlighted Erickson's unique way of comprehending family interactions and communications that were being looked upon as dysfunctional and pathological as optimistic information that will help families eventually get unstuck. In 1967, Haley left the MRI to become the Director of Research at the Philadelphia Child Guidance Center with Salvador Minuchin and Braulio Mantalvo. For the next 9 years, Haley's close friendship and collaboration with Minuchin and Mantalvo gave rise to many cutting edge ideas in the practice and training of family therapy. Haley came up with the idea of live supervision for trainees of family therapy and also developed a map for engaging families into therapy and empowering them during their first session. Haley took many of Erickson's ideas to inform his own theory of family therapy, brief strategic therapy that he founded in the 1950s. Along with his second wife, Cloe Madanes, he opened his own training center known as The Family Therapy Institute of Washington in 1976. In the same year, Haley also published one of his most influential books on his clinical approach, problem-solving family therapy. He was known as a renegade of his times who

The Bateson Project and the Haley's own background in communication studies led him to collaborate with Milton Erickson. Haley attended one of Erickson's workshop in 1953 and then trained under his tutelage for 10 years. Haley's book, Uncommon Therapy: The Psychiatric Techniques of Milton Erickson (1973), was a great contribution to the field as it introduced Erickson and his unique and innovative clinical approaches to the psychotherapeutic field and highlighted Erickson's unique way of comprehending family interactions and communications that were being looked upon as dysfunctional and pathological as optimistic information that will help families eventually get unstuck. In 1967, Haley left the MRI to become the Director of Research at the Philadelphia Child Guidance Center with Salvador Minuchin and Braulio Mantalvo. For the next 9 years, Haley's close friendship and collaboration with Minuchin and Mantalvo gave rise to many cutting edge ideas in the practice and training of family therapy. Haley came up with the idea of live supervision for trainees of family therapy and also developed a map for engaging families into therapy and empowering them during their first session. Haley took many of Erickson's ideas to inform his own theory of family therapy, brief strategic therapy that he founded in the 1950s. Along with his second wife, Cloe Madanes, he opened his own training center known as The Family Therapy Institute of Washington in 1976. In the same year, Haley also published one of his most influential books on his clinical approach, problem-solving family therapy. He was known as a renegade of his times who

Objective To evaluate the survival outcomes of patients with local recurrence after radical nephrectomy (RN) and to test the effect of surgery, as monotherapy or in combination with systemic treatment, on cancer-specific mortality (CSM). Methods Patients with local recurrence after RN were abstracted from an international dataset. The primary outcome was CSM. Cox's proportional hazard models tested the main predictors of CSM. Kaplan-Meier method estimates the 3-year survival rates. Results Overall, 96 patients were included. Of these, 44 (45.8%) were metastatic at the time of recurrence. The median time to recurrence after RN was 14.5 months. The 3-year cancer-specific survival rates after local recurrence were 92.3% (± 7.4%) for those who were treated with surgery and systemic therapy, 63.2% (± 13.2%) for those who only underwent surgery, 22.7% (± 0.9%) for those who only received systemic therapy and 20.5% (± 10.4%) for those who received no treatment (p < 0.001). Receiving only medical treatment (HR: 5.40, 95% CI 2.06-14.15, p = 0.001) or no treatment (HR: 5.63, 95% CI 2.21-14.92, p = 0.001) were both independently associated with higher CSM rates, even after multivariable adjustment. Following surgical treatment of local recurrence 8 (16.0%) patients reported complications, and 2/8 were graded as Clavien-Dindo ≥ 3. Conclusions Surgical treatment of local recurrence after RN, when feasible, should be offered to patients. Moreover, its association with a systemic treatment seems to warrantee adjunctive advantages in terms of survival, even in the presence of metastases.

Zusammenfassung Dieser Beitrag untersucht psy-
chotherapeutische Prozesse mit besonderem Augen-
merk auf die therapeutische Beziehung. Konkret geht
es dabei um Überlegungen zur therapeutischen Be-
ziehung aus Sicht von Psychotherapeut:innen sowie
der Wahrnehmung von besonderen, förderlichen oder
hinderlichen Aspekten durch Patient:innen und The-
rapeut:innen. Die qualitativen Daten stammen aus
Interviews einer Studie zu „Prozess und Outcome
in niedergelassener psychotherapeutischer Praxis
(POPP)“ mit Integrativen Therapeut:innen bzw. ihren
Patient:innen. Die Daten wurden mittels qualitativer
Inhaltsanalyse bearbeitet. Aus Sicht der Psychothe-
rapeut:innen lassen sich von Therapeut:innen und
ihren Patient:innen gemeinsam hergestellte Allianz-
faktoren, individuelle Faktoren die diese bzw. ihre
Patient:innen betreffen sowie kontextuelle Faktoren
extrahieren. Die Sicht von Patient:innen und Psycho-
therapeut:innen zu „significant events“ zeigt hohe
Kongruenzen in der Sicht der Dyaden. Die Beziehung
soll durch Empathie und Wertschätzung und ein par-
tizipatives Arbeiten auf Augenhöhe gekennzeichnet
sein. Anhand zweier Studien zur Integrativen Thera-
pie als Beispiel für den humanistischen Ansatz heben
die Ergebnisse die Bedeutung der therapeutischen
Beziehung hervor und identifizieren damit zusammenhängende Faktoren, die sowohl für Patient:innen
als auch ihre Therapeut:innen relevant sind.

Systemic family therapy is an approach to psychological therapy that is increasingly being offered to adults with learning disabilities and their families. To date there has been no published evaluation of the degree to which this is an approach that is effective in alleviating distress for this client group. The present study aimed to explore the experiences of adults with learning disabilities and their family members, who had attended systemic family therapy together. It also aimed to investigate whether it was an experience that had been helpful and in what ways, if any it impacted on their lives. Ten families and six adults with learning disabilities were interviewed about their experiences of attending systemic family therapy. The transcripts were analysed using Interpretative Phenomenological Analysis (IPA). Participants had mixed views about the degree to which systemic therapy had been helpful to them. Some family members saw it as having a positive impact on their views about and ways of approaching particular issues. However, for other families systemic therapy had not offered the kind of help they had expected and the experience was seen as relatively insignificant, vague or confusing. For the participants with learning disabilities there was a general sense that the opportunity to talk about difficulties was seen as valuable. However, the degree to which some of these participants felt they had a voice was limited. A combination of feeling pressure to 'know' what to say, and the presence of other family members in the meetings made it difficult for them to have their say. These findings suggest that although systemic family therapy can be helpful, particular aspects of the process may need to be adapted to ensure it is an approach that is accessible for this client group and their families.

Supervision is fundamental to the social work profession. However, increasing concern has been expressed over the managerial capture of local authority social work and the use of supervision as a way of enabling management oversight (or surveillance) of practice. Despite the importance of supervision, we have little evidence about what happens when managers and child and family social workers meet to discuss casework and less about how supervision influences practice. In this study, 34 supervision case discussions were recorded. Detailed descriptions are given of what happens in supervision. Overall, case discussions operated primarily as a mechanism for management oversight and provided limited opportunity for reflection, emotional support or critical thinking. With reference to organizational context, it is suggested that these deficits result from a system that focuses too much on ‘what and when’ things happen and not enough on ‘how and why’.

In the vast majority of cases, cutaneous melanoma presents as localized disease and is treated with wide excision and sentinel lymph node biopsy, with shared decision making regarding completion lymph node dissection and adjuvant systemic therapy. The treatment of recurrent and in-transit disease is more complex, with further options for regional and systemic therapies and multiple variables to be factored into decisions. Rates of overall and complete response to regional therapies can be quite high in carefully chosen patients, which limits the need for systemic therapies and their inherent side effects. Ongoing trials aim to assess the efficacy of combination regional and systemic therapies and assist in deciding among these options. This review discusses the treatment of primary melanoma and regional nodal disease and offers an in-depth discussion of options for the treatment of recurrent melanoma and in-transit melanoma.

In the history of science, there are individuals who have had a decisive influence on its development by connecting different directions and thus pointing out perspectives for development, and sometimes even working toward the institutionalization of scientific paradigms. In the history of Gestalt theory, Jürgen Kriz is undoubtedly one such important figure.

In recent years there has been a growing spread of psychosocial interventions characterized by the use of multi-family extended groups, whose application is useful in many clinical fields. The adoption of multi-family settings seems to be dictated by the evidence that this working method combines a low cost with high efficiency. In this case, the identification of problematic areas connected with the phenomenology of separation and divorce and the solicitation of possible resources becomes a practice but also an experimental methodology for network support forms. In particular, the configuration of the multi-couple group, specific operational declination of the extended group, is characterized as an optimized version of the clinical application. Hence, the hypothesis of being able to place within it, a plurality of couples, returning from the emotional and relational experience of a marital crisis, but focused on the inevitable task of being able to keep faith in the parental mandate. On the basis of these considerations, we have tried to hypothesize the possibility of starting a multi-family operative programme including separated couples but united with the intention to maintain the parental function, however harshly proven by the dissolution of the conjugal bond.

Gene therapy is perceived as a revolutionary technology with the promise to cure almost any disease, provided that we understand its genetic basis. However, enthusiasm has rapidly abated as multiple clinical trials have failed to show efficacy. The limiting factor seems to be the lack of a suitable delivery system to carry the therapeutic genes to the target tissue safely and efficiently. Therefore, advancements in cancer gene therapy in general depend on the development of novel vectors with maximum therapeutic efficacy at the target site and minimal toxicity to normal tissues. This mini-review highlights both the major fortes and the unique challenges associated with the state-of-the-art gene carriers currently being used in cancer gene therapy.

Being asked a question which enquires into your experiences, ideas or identity is a communication that, in the eyes of the other, you have value, you matter and you are included. In our work with people with learning disabilities, a heterogeneous group of people often at risk of marginalisation, a systemic approach calls into question some taken-for-granted realities of people’s lives.

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El presente artículo nace de la investigación documental de la obra de Humberto Maturana y de sus conceptualizaciones sobre el amor y el lenguaje, así como del análisis de dichas categorías y su posible aplicabilidad y valor para la teorización y práctica de la Terapia Familiar Sistémica.     La investigación documental presenta un examen sobre tres categorías: Amor, Lenguaje y Terapia Familiar Sistémica; dando por resultado descubrimientos que permiten indicar que la Terapia Familiar Sistémica se ennoblece y se beneficia de las concepciones de Maturana. Amor y lenguaje aparecen como elementos centrales, visibles e indispensables dentro del quehacer del terapeuta sistémico. Al punto que se puede decir que no es posible una Terapia Familiar Sistémica sin una búsqueda, emergencia y vivencia del amor y del lenguaje. La Terapia Familiar Sistémica es una forma de lenguaje que permite el reconocimiento del otro y en esa medida, un encuentro amoroso.

e18690 Background: Neoadjuvant chemotherapy (NAC) has been historically reserved for patients with locally advanced breast cancers. The utilization of NAC remains highly variable in clinical practice based on tumor size and receptor status. The decision to pursue NAC is often based on discussions by a multidisciplinary team (MDT). This study aims to look at real-world data describing the contemporary use of NAC in patients with early-stage operable breast cancer in a community cancer center and evaluate the effectiveness of MDT at our institution. Methods: We conducted a retrospective descriptive study at UMass Chan-Baystate between Oct 2018 and Oct 2020. We included patients receiving NAC for early-stage operable or locally advanced breast cancer. We excluded patients receiving neoadjuvant endocrine therapy. Primary outcomes were rates of pathological complete response (pCR) after surgery. Secondary outcomes were referral timeliness back to the breast surgeon and radiation oncologi...

Human epidermal growth factor receptor 2 (HER2)-enriched breast cancers (BC) present the highest rates of pathological response to primary systemic therapy (PST), but they are also the ones that tend to be larger at diagnosis, with microcalcifications and, often, with axillary involvement. If we do not have a reliable method to predict the degree of response, we may not be able to transfer the benefits of PST to surgery. The post-PST surgery planning is guided by the findings in the magnetic resonance imaging (MRI), whose predictive capacity, although high, is far from optimal. Thus, it seems interesting to find other variables to improve it. A retrospective observational study including women with HER2 BC treated with PST and further surgery was conducted. Information regarding clinical, radiological, and histopathological variables was gathered from a total of 132 patients included. Radiological complete response (rCR) was achieved in 65.9% of the sample, and pathological complete...

Endocrine therapy (ET) has established itself as an efficacious treatment for estrogen receptor-positive (ER+) breast cancers, with a reduction in recurrence rates and increased survival rates. The pre-surgical approach with chemotherapy (NCT) has become a common form of management for large, locally advanced, or high-risk tumors. However, a good response to NCT is not usually expected in ER+ tumors. Good results with primary ET, mainly in elderly women, have encouraged studies in other stages of life, and nowadays neoadjuvant endocrine treatment (NET) has become a useful approach to many ER+ breast cancers. The aim of this review is to provide an update on the current state of art regarding the present and the future role of NET.

The treatment of early invasive breast cancer in older patients poses unique challenges due to the distinct biological, clinical, and psychosocial complexities associated with aging. As the population of breast cancer patients aged 70 years and older continues to grow, their persistent underrepresentation in clinical trials remains a major obstacle to evidence-based treatment decision-making. To support the development of a more effective, personalized, and patient-centered approach to systemic therapy, this review outlines the biological features of breast cancer in older women, synthesizes current evidence on neoadjuvant and adjuvant systemic therapies, and discusses strategies for individualized treatment decision-making. Key recommendations include the use of hormonal therapy as the standard of care for hormone receptor positive breast cancer, neoadjuvant therapy primarily when tumor downstaging is desired, and chemotherapy or anti-human epidermal growth factor receptor 2 therapy for relatively fit older patients with high-risk subtypes. Additionally, bisphosphonates may help preserve bone health and reduce recurrence risk. Novel targeted therapies such as cyclin-dependent kinase 4 and 6 inhibitors and immune checkpoint inhibitors show promise, though further studies are needed to confirm their safety and efficacy in older populations. Comprehensive geriatric assessments are essential for identifying patient frailty and vulnerabilities, while predictive tools such as the Cancer and Aging Research Group Breast Cancer model can help assess toxicity risk. In this population, competing risks of non-cancer-related mortality may reduce the absolute benefit of systemic treatment. For patients with elevated risks of other-cause mortality, the potential survival benefit of cancer therapy may be negligible. Predictive models that account for competing mortality, such as the PORTRET tool, can facilitate personalized and shared decision-making.

Το παρόν άρθρο διερευνά τη μεθοδολογική προσέγγιση της Design-Based Research (DBR) στο πλαίσιο της μουσικής εκπαίδευσης, εστιάζοντας τόσο στη φιλοσοφική και θεωρητική της συγκρότηση όσο και στις ερευνητικές πρακτικές που την καθιστούν ιδιαίτερα κατάλληλη για την ανάπτυξη εκπαιδευτικών καινοτομιών. Αρχικά, παρουσιάζονται οι βασικές αρχές της DBR, όπως η συνεργατική φύση του σχεδιασμού, η εφαρμογή σε πραγματικά εκπαιδευτικά περιβάλλοντα και η κυκλική σχέση ανάμεσα στον σχεδιασμό, την εφαρμογή και την αναθεώρηση. Μέσα από αυτή τη διαδικασία, η DBR αναδεικνύεται ως μια προσέγγιση ικανή να συνεισφέρει στην παραγωγή τοπικά έγκυρης αλλά και θεωρητικά τεκμηριωμένης γνώσης για τη μουσική μάθηση και διδασκαλία. Στη συνέχεια, αναδύονται οι διαφορές της DBR από άλλες ερευνητικές μεθοδολογίες, όπως η έρευνα δράσης, οι εθνογραφικές έρευνες και μελέτες περίπτωσης, με στόχο να αποσαφηνιστούν οι αποκλίσεις στις μεθοδολογικές της προοπτικές, καθώς και τα παιδαγωγικά της πλεονεκτήματα. Τέλος, παρουσιάζονται παραδείγματα εφαρμογής στη μουσική εκπαίδευση από τη διεθνή βιβλιογραφία και αναδεικνύονται προοπτικές για μελλοντική έρευνα, τονίζοντας τον ρόλο της DBR στην ανάπτυξη καινοτόμων παιδαγωγικών πρακτικών και στη διαμόρφωση νέων θεωριών για μουσική διδασκαλία-μάθηση.

To evaluate the rate of early breast cancer (EBC) patients treated with neoadjuvant systemic therapy (NAT) in Italy, criteria of patient selection and types of therapies delivered, an analysis of 1276 patients with stage I-II-III was conducted out of 1633 patients enrolled in the multicenter prospective observational BRIDE study. A total of 177 patients (13.9%) were treated with NAT and 1099 (85.9%) with surgery; in multivariate analysis, menopausal status, cT, cN, grade, HER2-positive and Triple negative (TN) subgroups were significantly associated with the decision to administer NAT. The type of NAT delivered was influenced by EBC subtype. NAT was administered to 53.2% of HER2+/HR-negative, 27.9% of HER2+/HR+, 7.1% of HER2-negative/HR+ and 30.3% of TN EBC patients. The pCR rates were similar to the ones reported in the literature: 74.2% in HER2+/HR-negative, 52.3% in HER2+/HR+, 17.2% in HER2-negative/HR+ and 37.9% in TN. In clinical practice, patient and tumor characteristics infl...

E descrito o desenvolvimento da terapia familiar sistémica e a sua relacão corn a mudanca do conheci mento cientIfico no século XX. Depois de definidos os principios gerais da prâtica desta forma de inter vencAo em saüde mental, referem-se as principais indicacOes e contraindicacOes da terapêutica familiar sistérnica, bern como as suas diferencas face a terapia individual tradicional. Considera-se a terapia fami liar sistémica corno enquadrada numa nova episternologia e em fase de crescente desenvolvimento em Portugal.

Systemic corticosteroids are continued to be administered in juvenile idiopathic arthritis (JIA) patients, especially in systemic JIA (sJIA), despite the ability of biologic therapy. One of the complications of long-term CS treatment is delayed hip arthritis development with risk of secondary hip osteoarthritis formation and total hip arthroplasty (THA).We compared different types of hip joint lesions in JIA, especially, secondary hip osteoarthritis development and THA rates in systemic and non-systemic JIA, and evaluate systemic corticosteroids contribution to those complications.The study included 753 JIA patients. They were divided into 2 groups: patients with sJIA and non-systemic JIA (nsJIA). Clinical and demographic characteristics, CS treatment regimens were compared.Results. Hip arthritis was found equally often in both groups, but both secondary hip osteoarthritis (19% vs 5,3%) and THA (8.6% vs 1.6%) prevailed in the sJIA. Patients with sJIA had delayed hip involvement (57....

Colorectal cancer (CRC) is the fourth most frequently diagnosed cancer and the second leading cause of cancer death in the United States. In 2013, an estimated 102,480 new cases of colon cancer and approximately 40,340 cases of rectal cancer will occur. During the same year, an estimated 50,830 people will die of colon and rectal cancers combined. 1 Despite these high numbers, the incidence of colon NCCN

70.6% did not perform a 2 nd TACE. The median PFS of those with an ARTscore of 0-1.5 that performed a 2 nd TACE was 3.6 months, with a median OS of 12.1 months, whereas the median PFS and OS for those who did not perform a 2 nd TACE was 28 days and 2 months, respectively. For patients with an ART-score 2.5 who performed a 2 nd TACE, the median PFS was 3.4 months and the median OS 5.3 months; for those who did not perform a 2 nd TACE, the median PFS was 3.4 months and the median OS was 6.9 months. Thirty-five patients were then evaluated for a 3 rd TACE, according to their ART-scores: 60.0% presented an ART-score of 0-1.5, and 19.0% performed a 3 rd TACE; on the other hand, 40.0% presented an ART-score 2.5 with 28.6% performing a 3 rd TACE. The median PFS of the patients who had an ART-score of 0-1.5 and performed a 3 rd TACE was 4.0 months, with a median OS of 8.4 months, whereas those who did not perform the 3 rd TACE presented a median PFS of 3.3 months, with a median OS of 6.1 months. The median PFS of those with an ART-score 2.5 who performed a 3 rd TACE was 3.3 months, with a median OS of 6.5 months, while those who did not perform a 3 rd TACE, the median PFS was 3.7 months and the median OS was 6.2 months. In this sample, the ART-score seemed to be a valuable tool to evaluate the requirement for retreatment with TACE, since it apparently correlates to the response rate and survival outcomes. No conflict of interest. POSTER Metastatic gastroesophageal adenocarcinoma patients treated with systemic therapy followed by local therapy: A nomogram associated with long-term survivors

Cutaneous squamous cell carcinoma (cSCC), the second most common skin cancer in the US, is usually diagnosed early via biopsy and cured by surgical resection. In rare cases, SCC metastasizes or grows too large for surgical or radiological cure. There were previously limited options for these patients, but the recent approval of cemiplimab, an anti-PD-1 antibody, has shown promise for patients with cSCC who are not candidates for surgery or radiotherapy. 2 Here, we present a 91-year-old patient with advanced cutaneous squamous cell carcinoma (cSCC), misdiagnosed as infection for 9 months, who had an excellent response to cemiplimab.

Cutaneous squamous cell carcinoma (cSCC), the second most common skin cancer in the US, is usually diagnosed early via biopsy and cured by surgical resection. In rare cases, SCC metastasizes or grows too large for surgical or radiological cure. There were previously limited options for these patients, but the recent approval of cemiplimab, an anti-PD-1 antibody, has shown promise for patients with cSCC who are not candidates for surgery or radiotherapy. 2 Here, we present a 91-year-old patient with advanced cutaneous squamous cell carcinoma (cSCC), misdiagnosed as infection for 9 months, who had an excellent response to cemiplimab.

Psoriasis is an immune-mediated inflammatory skin condition affecting 2-3% of the global population, often contributing to various comorbidities. This study aimed to investigate the profile, severity, associations, forms, treatment strategies, and quality of life in psoriasis patients in Oran, Algeria. Data were retrospectively collected over seven years (2016-2022) from two dermatology departments in Oran. Data analysis was performed using IBM SPSS Statistics 20. From 282 patients, 55.3% were female, with disease onset primarily between 18-30 years. Psoriasis was more common in urban residents (83.7%). High blood pressure (16.2%) was the most frequent comorbidity, and 24.2% had a family history of psoriasis. Psychological stress was a triggering factor in 58.9% of cases. Psoriasis vulgaris was most prevalent (70.2%). Topical treatments were the most common (57.4%). The severity index was moderate (10.9±0.40), with a moderate to severe impact on quality of life (11.3±0.48). PASI correlated with family history of autoimmune/metabolic diseases (P=0.046; P=0.043), comorbidities like diabetes and hypertension (P=0.000), and lifestyle factors (P=0.000). PASI was strongly correlated with the quality of life (P=0.000, r=0.604) and inflammation markers (CRP, ESR).Psoriasis significantly influence health, affecting both genders and various age groups. Its etiology and development of comorbidities remain poorly defined.