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Journal of Integrative Oncology

ISSN: 2329-6771

Open Access

Current Issue

Volume 9, Issue 1 (2020)

    Editorial Pages: 1 - 1

    Oncology 2020 conference scheduled at Paris, France during February 20-21, 2020

    Abdalla Abotaleb

    Hilaris Conferences feel delighted to announce our forthcoming event “ONCOLOGY 2020” which is going to be held during February 20-21, 2020 in Paris, France with the theme “Fearless commitment for a Cancer free world”.

    Editorial Note Pages: 1 - 1

    Editorial Note on Journal of Integrative Oncology

    Annabel Rose

    Journal of Integrative Oncology (JIO) is an open access, peer reviewed scientific journal which believes to promote and publishes novel findings in the subject area of Cancer Biology, Integrative Medicine, Stem Cell Research, Immunology, Chemotherapy etc. and its related field.

    Special Issue on Oncology and Cancer Therapy (2020)

      Editorial Pages: 1 - 1

      Market analysis on Oncology

      Ria Silva

      After the successful completion of the Oncology conference we are pleased to welcome you to the “Global Summit on Oncology and Cancer Therapy.” The congress is scheduled to take place on November 23-24, 2020 in the beautiful city of New York, USA. This 2020 Oncology Conference will give you exemplary experience and great insights in the field of research. The global Oncology/Cancer drugs market was valued at $97,401 million in 2017, and is estimated to reach at $176,509 million by 2025, registering a CAGR of 7.6% from 2018 to 2025. Cancer is a disease, which involves the abnormal growth of cells that result in the formation of a tumor. However benign tumors are not Cancers. The abnormal tumor cells have the tendency to spread to other local tissues and may also spread to different parts of body through blood and lymphatic system. Different types of Cancers such as lung Cancer, colorectal, breast Cancer and others are predominant among the populace. Treatment of Cancer depends upon the stages of the disease progression. Chemotherapy is majorly used in the earlier stages whereas other therapy options such as targeted therapy drugs, immunological therapy drugs are used in late stage. Cancer has a widespread prevalence worldwide, which has led to rise in demand for Cancer drugs. The key factors that are responsible for the growth of the Oncology/ Cancer drugs market are surge in Cancer research, rise in geriatric population worldwide, and increase in number of collaborations between pharmaceutical companies. In addition, rise in healthcare expenditure worldwide is expected to boost the market expansion. Moreover, high market growth potential in developing nations, rise in number of pipeline products, and upsurge in demand for personalized medicines are expected to create new opportunities for the market players during the forecast period. However, adverse effects associated with the use of Cancer drugs and high costs related with Cancer drug development are the major factors that impede the growth of the market. According to drug class type, the targeted therapy segment occupied the largest Oncology/Cancer drugs market share in 2017. This is due to the ability of targeted therapies to kill only malignant cells, higher efficacy and higher survival rates associated with their use. The immunotherapy segment is expected to show fastest growth during the forecast period, registering a CAGR of 10.4%. This is attributed to surge in incidence of Cancer worldwide and high unmet medical needs in some countries. Immunotherapy drugs are widely accepted as an ideal treatment option as these drugs are potentially harmless to the other living cells of the body which makes them less toxic as compared to other modes of Cancer therapies. Moreover, continuous efforts in R&D to design and develop new immunotherapeutic for the treatment of various Cancer types serves as a key factor for the growth of the Oncology/Cancer drugs market. According to indication, the prostate Cancer segment occupied the largest Oncology/Cancer drugs market share in 2017. This is due to presence of huge geriatric population. The lung Cancer segment is expected to show fastest growth during the forecast period. This is due to technological developments in the field of Cancer diagnostics and rise in the awareness related to the early diagnosis of Cancer. translation. This will be possible due to the fact that the computer will begin to understand and analyse the meaning of the text. Our Mission • To provide the best platform were various ideas can be shared and information can be discussed. • To conduct conferences annually in each and every field of life science in various parts of the world to target maximum audiences. • To conduct outstanding events with our hard work. • To create some value worldwide.

      Value Added Abstracts Pages: 2 - 2

      Lung cancer SBRT calculation algorithm dosimetric comparison between AAA and AcurosXB in intensity modulated radiation therapy IMRT

      Ahmed Ali Bakr

      Background: This paper purpose is to assess the accuracy of two Algorithms, Anisotropic Analytical algorithm (AAA) and Acuros XB (AXB) used for dose calculation in treatment planning system Eclipse TPS (Varian Medical Systems, Palo Alto, CA). Estimating conformity (CI) and homogeneity index (HI) using 6 MV photon energy implemented in true beam linear accelerator Material and methods: CT series of 27 non-small cell lung cancer (NSCLC) patients treated with intensity modulated radiation therapy (IMRT) technique. Complex cases planned for stereotactic radiation body radiosurgery (SBRT) treatment, using (AAA) algorithm. Then recalculate the same plans using Acuros XB algorithm estimating the conformity index (CI) and Homogeneity index (HI) for PTV using dose volume histogram (DVH) for both calculation algorithms were calculated. Results: The results of the part of clinical study showed no significant differences for the mean dose but different noticed in conformity index for the planning target volume (PTV) for both algorithms that was between (1.45±0.55)for AAA and (2.17±0.7) for Acuros XB however the Homogeneity Index difference (0.15±0.07) for AAA and (0.1±0.08) for acuros XB, the maximum dose for PTV are significantly differ about 2.3% to 4.5% between them.

      Value Added Abstracts Pages: 3 - 3

      Program against Cancer in Niger

      El Hadji Seydou Mbaye

      Worldwide, one in eight deaths is due to cancer. Projections based on the GLOBOCAN 2012 estimates predict a substantive increase new cancer cases per year by 2035 in developing countries if preventive measures are not widely applied. According to the World Health Organization (WHO), millions of lives could be saved each year if countries made use of existing knowledge and the best cost-effective methods to prevent and treat cancer. Therefore, the aim of this study is to estimate a provisional budget against cancer in low and middle incomes countries, according the GNI-PPP, the cancer incidence and the number of population.Economically country classification is determining with the Gross national income (GNI), per capita, Purchasing power parity (PPP), according the administrations of the International Monetary Fund (IMF), the World Bank (WB) and the Central Intelligence Agency (CIA). Cancer incidence data presented are based on the most recent data available at IARC. However, population compares estimates from the US Bureau of the Census. The provisional budget is establishing among the guidelines developed by WHO for regional and national cancer control programs according to national economic development. Provisional budget against cancer is estimated to 21,824.998 (thousands of U.S $) for a population of 19,245,344 persons in Niger.

      Value Added Abstracts Pages: 4 - 4

      COVID 19 and laboratory diagnosis during a time of supply chain concerns.

      JM Blondeau

      Clinical Microbiology laboratories are continuing to be impacted particularly hard by the COVID 19 global pandemic and the urgent needs to increase testing capacity for both COVID 19 and for other infectious diseases – particularly hospitalized and critical care patients. As an example, blood culture collections have increased. With this increased testing capacity demand, were the coincidental requirements for technology (i.e. instruments), reagents, plastics (i.e. assay trays, pipette tips) and additional technical laboratory staff. A shortage of trained medical laboratory technologists (MLT) remains a challenge and this will likely continue as retirements will outpace new graduates. Technology is promoted as an alternative to staffing shortages with a transition from “traditional” bench microbiology and microscopy to automated and semi-automated platforms including multiplex polymerase chain reaction (PCR), automated Gram staining and total lab automation. Matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) has already revolutionized bacterial/yeast identification in labs with this technology. Such technology advances offer exciting opportunities but have negative consequences related to loss of traditional microbiology skill sets. Clinically, however, clinicians are anxious for accurate results within shorter turn-around-times (TAT) that influence therapeutic decisions and/or patient flow and favor these technological advances. Currently there is a disconnect between availability of equipment (weeks to months for delivery) and availability of the necessary supplies/assays to operate these instruments. Supply chain has been frequently cited as a concern during the COVID 19 pandemic. In some instances, the limiting factor might be availability of a specific pipette tip or reagent. To meet testing demands in our diagnostic laboratory, we are operating similar technology from different vendors in an attempt to secure necessary supplies but this is not a guarantee. This presentation will focus on testing for COVID 19 and other infectious diseases during a time of supply chain issues.

      Value Added Abstracts Pages: 5 - 5

      Low Doses of Radiation Promote Cancer-capable Cells

      Michael Shaib

      The world is naturally radioactive and approximately 82% of human absorbed radiation doses, which are of control, arise from natural sources such as cosmic, terrestrial and exposure from inhalation or intake radiation sources. In recent years several international studies have been carried out on the effects of low radiation dose. Gamma radiation emitted from natural sources is largely due to primordial radionuclides, mainly 232Th and 238U series and their decay products as well as 40K, which exist at trace levels in the earth’s crust. Their concentration in soils, sands, and rocks depends on the local geology of each region of the world. Naturally occurring radioactive materials generally contain terrestrial-origin radionuclide, left over since the creation of the earth. The present review article was carried out to consider all of natural radiation and some device emitting ionizing radiation such X-rays, CT scans used in Nuclear Medicine, and some equipment in our building today e.g. smoke detector emitting alpha radiation (Americium Beryllium), can promote cancer-capable cells.

      Value Added Abstracts Pages: 6 - 6

      Photobiomodulation in CIPN treatment for breast cancer patients: a case report

      Milena Trudes de Oliveira Caires

      Peripheral neuropathy is a side effect that often occurs in patients under cancer treatment with Taxanes denominated Chemotherapy-Induced Peripheral Neuropathy (CIPN). It usually affects sensitive nerves, and the symptoms anatomically extend over the extremities (gloves and socks). This condition can cause the reduction or discontinuation of therapy, leading to the increasing use of non-drug strategies which has demonstrated many effective procedures in symptom reduction. Photobiomodulation (PBM) is a non-invasive treatment that has been applied to prevent or manage cancer treatment side effects and is used, among other actions, for peripheral nerve regeneration; however, best parameters must be established. Considering the pathophysiology and the prevalent symptom localization of CIPN, we intend to use the beneficial effects of FBM with red low power laser (LLT) in soles and toes. This study aims to evaluate the efficacy of red LLT applied to soles and toes in symptom relief and quality of life improvement of breast cancer patients with CIPN treated with Taxanes. One patient was selected to receive eight red LLT (660 nm) applications, and its efficacy was measured by using Visual Analysis Scale (VAS) and the DN4 and EORTC QLQ- C30 (version 3.0) questionnaires. This female patient received neoadjuvant treatment with docetaxel due to triple-negative breast cancer and symptoms of CIPN during eight months. After the intervention, the score of DN4 was from 3 to 0, the Symptom Scales EORTC QLQ-C30 was from 45 to 10, the Functional Scales EORTC QLQ-C30 was from 49 to 91, the Global Health Status was from 50 to 83,33, VAS was from 8 to 2, and the subjective improvement was of 80%. This case report showed positive results in the symptom reduction and quality of life improvement of a breast cancer patient treated with red LLT in soles and toes.

      Special issue on Critical Care and Cancer Treatment (2020)

        Editorial Pages: 1 - 1

        2021 Conference Announcement on Pharmacology & Drug Discovery

        Cathrine Lewis

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        Short Communication Pages: 2 - 2

        Critically caring for Spatial Computing

        Bradley R Chesham

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        Short Communication Pages: 3 - 3

        Dunning-Kruger Effect and it is meaning at critical care and emergencies.

        Evangelia Michailidou

         

         BACKGROUND: The Dunning-Kruger effect is a kind of cog­nitive bias in which people think that they are smarter and more capable than they are. Essentially, low-skilled people don’t have the skills needed to understand their own incom­petence. The combination of poor self-awareness and low cog­nitive ability leads to their own abilities being overestimated.

        OBJECTIVE: While work analyzing Dunning-Kruger metrics clearly identifying the presence or absence of the test, the mag­nitude of the outcome has not been determined. Doctors can also try to address their own Dunning-Kruger impact by mov­ing on to further study. “The result is due to the lack of exper­tise, and the answer to the lack of competence is to learn more abilities. “Young doctors should also be mindful of the Dun­ning-Kruger influence to be conscious of maintaining a sense of humility. “, as they achieve a preliminary understanding of functioning, always hang on to it like the tree of life because it’s so much work going through and overhauling. Experience teaches us to keep certain idling options in the past.

        CONCLUSION: Doctors who want to be as effective as possible during a crisis and have their team effectively can develop the skills needed to manage the Dunning-Kruger phenomenon when times are calm and operations are nor­mal. Further studies are needed to define education, explain variable results, and confirm clinical benefit through further analysis of the phenomenon targeted at critical care and emergencies.

        Short Communication Pages: 4 - 4

        Latest developments and new challenges for Cancer patient in Intensive Care Unit

        Evangelia Michail Michailidou*

        It has been believed for years that cancer patients have not been referred to the Intensive Care Unit (ICU) because they have serious and potentially reversible acute illnesses. Fortunately, a variety of tests have shown that this is not the case. Today, the number of cancer patients in ICUs around the world is rising every year, and both longevity and quality of life are growing in the same way.

        This progress is due to several causes, from progress in anti-tumour therapy to improved patient care in the ICU. We are working towards an individualized and dynamic approach that will be tailored to the form of tumor and the immune response of the patient. The prognosis of vital cancer patients is time-dependent and so ICU-intensive patients must face the difficulty of making a successful selection of patients for early admission and efficient diagnosis and care. Oncological and haematological disorders are one of the major causes of morbidity and mortality worldwide.

        In view of the reality that cancer therapies have improved their effectiveness, correlated with stronger prognosis and increased life expectancy, it is foreseeable that the amount of cancer patients needing admission to ICU would continue to rise in the coming years, constituting an area of compulsory continuing education for intensive care staff.

        Observational findings have demonstrated an increase, not only in terms of survival but also in terms of the quality of life of cancer patients seeking admission to the ICU. However, this is also notably worse than that of the general public at 3 and 12 months post-hospital discharge, particularly in haematological patients. Ageing, low functional status prior to ICU entry, and higher levels of multi-organ loss during ICU stay are independent predictors of lower quality of life.

        A research published in France revealed comparable health results, with hospital mortality rates, 3-month mortality and 1-year mortality of 39%, 47% and 57% respectively (Azoulay et al. 2013). These findings are well away from classical research, which posed unacceptably high mortality rates that did not warrant intensive control of these populations.

        There is no question that the change in the prognosis of cancer patients in ICU is multifactorial. Awareness of these variables is important for patient management and a challenge for sustainable change. Five primary elements can be highlighted:

        New anti-tumor treatments

        Health and surgical care of cancer patients have improved dramatically. Chemotherapy in ICU, which is unimaginable until reasonably recently, can be a therapeutic alternative in selected critical patients. Treatment of tumor cells gradually targeted as shown by immunotherapy is usually successful and well tolerated. Laparoscopic surgeries reduced the duration and postoperative complications of several tumors. Also the most extreme procedures, such as cytoreductive surgery and heated intraperitoneal chemotherapy, involve a brief ICU stay when conducted by experienced teams.

        Requirements for entry to the ICU

        We provide a better variety of patients who will benefit from access to the ICU. This is attributed, among other factors, to better cooperation between oncologists, haematologists and intensifiers in the creation of management guidelines and admission requirements agreements. The decision whether or not to admit a cancer patient to the ICU is complicated and both the possible advantage and the risk of therapy being ineffective should be taken into account. Admission to the ICU of an oncology patient should be based on three principles:

        • The rationale for admission needs to be reversible

        • The patient has demonstrated an adequate quality of life and a prognosis of oncological illness and its treatment options support the use of extreme interventions.

        • The patient or members of his or her families do not deny entry.

        The prognosis of cancer patients in the ICU, as well as those with nononcological disorders, depends on their performance status, the severity of acute disease and the number of organ systems that malfunction. Oncological diagnosis, tumor cycle, neutropenia, aplasia or the presence of metastases has little or no relation to the short-term prognosis of an ICU cancer patient.

        In general, cancer patients have a worse prognosis than non-cancer patients in ICU, particularly those with haematological malignancies. This is presumably due to being an immunocompromised patient and not developing cancer of its own. If we could assess the immunosuppression condition of critical patients in normal clinical practice, we would find a strong link with the condition and the prognosis. Over the next five years, improved awareness of the immune response in vital cancer patients, the potential to collect real-time evidence and the prospect of therapeutically modulating this response would represent an unprecedented step forward in enhancing survival.

        Common prognosis ratings have very little utility in cancer patients and only ratings that measure organic function,Sequential Organ Loss Assessment (SOFA), Logistic Organ Dysfunction Score (LODS), better estimate mortality and are helpful in decision making. The short-term prognosis is mainly related to the number of defective organs (especially if more than 3), the need for intrusive mechanical ventilation (IMV) and the need for renal replacement therapy.

        Rate and precision

        Cancer patients have different degrees of immunosuppression, making them more likely to have conditions, not just contagious ones, during their disease, and to respond adversely to these complications. Also small organ dysfunctions have been associated with an increase in mortality, making early ICU entry a better predictive determinant. It is highly important when an oncologist is admitted to an ICU with sepsis or acute respiratory failure. The risk / benefit of preventive admission to ICU should be considered in high-risk patients.

        The pace at which effective care is placed in motion will have a direct effect on the prognosis. The implementation of extra-ICU rapid response teams, extra-ICU patient evaluation teams or specialized initiatives for some pathologies (sepsis code) has contributed to improvement in this area.In a significant percentage of vital cancer cases, we have no reliable diagnosis and these cases have a poorer prognosis.

        Non-invasive or minimally invasive diagnostic methods such as computed tomography ( CT), lung and cardiac ultrasound, thermodilution and/or pulse wave tracking and early examination of bronchoscopy samples (bronchoalveolar lavage and tracheal suction) should be the foundation of early diagnosis. There are also complex oncology patients in the category of acute time-dependent pathologies who have been shown to improve prognosis with immediate intervention protocols: code myocardial infarction, code stroke or code sepsis. Why not code cancer if we need to be extremely reliable and fast in our diagnostic and therapeutic response to cancer patients?

        Strengthening service measures in the ICU

        This is particularly true for respiratory assistance, both non-invasive mechanical ventilation (NIMV) and high-flow nasal cannula oxygen (HFNC). The requirement for tracheal intubation and IMV was found to be the key risk factor for short-term mortality in onco-haematological patients admitted to ICU. Given the increase in longevity due to the use of protective artificial ventilation, based on various clinical trials), NIMV has been prescribed as an initial therapy for respiratory failure in these patients as it greatly decreases the need for tracheal intubation and IMV, prevents related complications and increases prognosis. It is important to remember that in patients who choose a non-invasive ventilation strategy and subsequently require tracheal intubation, both short-term and longterm mortality is significantly higher; therefore, invasive support should not be delayed if permitted.

        Trial of the ICU

        In the group of patients we've questions on the attitude to be taken, it might be advisable to hold out an ICU trial, that's to mention, admission to the ICU without therapeutic restrictions for a minimum of 72 hours, with frequent and periodic re-evaluations, with a view to not perpetuating unnecessary treatments and prolonging the suffering of patients and their families. The ICU trial is predicated on a study published by Lecuyer et al. (2007) which found no statistically significant variation at the time of admission to the ICU that differentiated between survivors and nonsurvivors.

        However, none of the patients who required increased organ support measures survived after 72 hours. Thus, if, at that point, the patient experiences a failure of three or more organs or a worsening of the previous multi-organ failure, vital expectations are minimal and it might be advisable to need action to limit the therapeutic effort (Prieto del Portillo et al. 2014). During this way, not only can we avoid unnecessary treatment or suffering of patients and relatives, but we'll also participate within the prevention of conflict between ICU staff and burnout.

        Admission to ICU does not necessarily involve taking all the necessary measures for as long as possible. We need to take into account a wide range of options. Patients may be admitted with the intention of providing unrestricted treatment for at least five days and reassessed on the basis of their evolution. It is possible to enter for haemodynamic or renal support and to limit IMV. We can even sign up to optimize comfort measures or reduce high-flow nasal goggles or IMV dyspnoea in patients with poor prognosis.Decisions must even be taken here in amultidisciplinary way (intensivists, oncologists and hematologists) and in agreement with the patient and also the members of the family.

        All therapeutics alternatives might indeed be considered and individualized, counting those customarily considered restricting variables like ICU chemotherapy or extracorporeal layer oxygenation (ECMO) in patients with extreme headstrong respiratory failure. Another issue is how early oncologists or intervists ask support and help from ICU. Unfortunately, experience has shown that valuable time is lost, which is to the detriment of the patient, until he would transferred to the ICU. Unfortunately, this ascertainment goes beyond the scope of this text. We reserve that we'll analyze it plus its extension in another article.

        Short Communication Pages: 5 - 5

        Management of cancer pain and opioid epidemic

        Evangelia Michailidou

         

         The opioid crisis affects people with cancer who depend on opioids to help them relieve their pain. It can be caused by cancer, by its treatment or by a combination of factors. While some pain lasts for a relatively short period and recovers on its own, cancer or its treatment may also lead to long-lasting, chronic pain. Opioid medications are an important compo­nent of the treatment of many forms of unreliable cancer pain.

        Types of medications or other approaches used to manage pain in cancer patients and survivors

        Any prescription opioid drug can be used in people with can­cer. Non-opioid agents are often used, including drugs such as acetaminophen (Tylenol) and ibuprofen (Motrin or Advil). Antiseizure drugs such as gabapentin (Neurontin or Gralise) or antidepressant drugs such as duloxetine (Cymbalta) can be used for nerve pain. Oncology services rely heavily on opi­oids, but we never rely exclusively on opioids. We always use many treatments that operate in a number of ways. This covers other pharmacological (drug) treatment and, as far as possi­ble, non-pharmacological treatments such as physical therapy, occupational therapy, orthotics, cognitive behavioral therapy, massage and other integrative therapy.

        How the opioid crisis has impacted cancer patients, cancer sur­vivors and their family members

        It has heightened fear — especially the fear of addiction — that some patients might be reluctant to take opioid medication for pain. Often it’s not a patient, it’s a family member who’s thinking about addiction. As a consequence, family members may withhold treatment for a loved one who is in pain, or may doubt the need for opioid medication even when that person is at the end of life. Another big consequence is the decrease in access to prescription pain medications. The latest findings from a report released by the American Cancer Society Cancer Action Network and the Patient Quality of Life Alliance indi­cate that one-third or more of cancer patients and survivors have trouble obtaining their prescription opioid medicines.

        Short Communication Pages: 6 - 6

        Non-Drug Approaches for cancer patient

        Evangelia Michail Michailidou*

        Non pharmacological treatments are valuable adjuncts to the treatment modalities for patients with cancer pain. Variety can be used to minimize pain and concomitant mood disturbance and improve quality of life. Physicians may feel relatively uninformed about the approaches used and scientific support for cancer patients. This article discusses a variety of non-pharmacological and complementary and alternative approaches widely used in patients with cancer pain. It focuses on those with scientific support or encouraging preliminary evidence, with the intention of familiarizing physicians with therapies that may supplement routine oncological treatment.

        Pain is a multi-faceted condition involving biological , psychological and social effects. The incidence of pain in cancer patients has been reported to be between 46% and 79% during cancer care and 65% for those with advanced disease. Etiological causes for cancer pain include disease progression, treatment strategies for stopping cancer (e.g. surgery, chemotherapy, or radiotherapy), inactivity musculoskeletal pain, and cancer-related infections that cause neuropathic pain.

        A mixture of pharmacological and non-pharmacological treatment approaches for cancer pain is the standard of care as set out in the latest recommendations of the World Health Organization (WHO).

        Model of Biopsychosocial

        This model incorporates the biological , psychological and social aspects of treatment and has been extended to patients with cancer pain.10 There is also a metaphysical or existential component of pain in cancer patients , particularly those diagnosed with terminal illness. Pain- related quality of life has been categorized into three well-being variables according to biopsychosocial representation:

        • Physical wellbeing;

        • psychological well-being (i.e., cognition, affect, moral causes, coping, communication, and the sense of pain and cancer);

        • interpersonal well-being (e.g. social support, working roles)

        The prevalent model of pain, Gate Control Theory,postulates a spinal cord control mechanism in the dorsal horn that receives ascending and descending signals from the nervous system and balances their integration. In the end, the experience of pain is decided by the biological assessment of these inputs.

        Cognitive-Behavioral Therapy

        Cognitive behavioral ( CBT) can be helpful for patients with cancer pain.19 These strategies usually include telling patients to perform one of the following alone or in combination:

        • To monitor their pain

        • Monitor thoughts and feelings during the prescribed duration of the day;

        • Follow pain exacerbations.

        Patients then explore with the psychiatrist the content of these feelings and their connection to subsequent emotions. Maladaptive coping, often attributed to impaired unconscious reasoning and belief, may be recognized and changed by psychological intervention. Catastrophizing is one of the most important maladaptative adaptive coping mechanisms for pain relief. This is a propensity to make pessimistic perceptual and emotional judgments about discomfort or situations (e.g., "This discomfort is terrible, and I can't bear it." Or, "This pain means I'm going to die soon"). Catastrophication is associated with depression, elevated pain severity, and life-related pain and anxiety interference. The expectations of pain control and high self-efficacy that cancer survivors may do anything to affect their pain are associated with d iminished pain in these survivors.

        Adjuvant methods

        Together with effective pharmacological and interventional modes of care, include non-pharmacological and complementary medicine approaches. A comprehensive review of all non-pharmacological and alternative treatment approaches used in the treatment of cancer pain is beyond the scope of this Report. The emphasis is therefore on non- pharmacological treatments and complementary medicine commonly used to treat patients with cancer pain.

        The significance of gate control theory for the treatment of patients with cancer pain is that downward cortical inputs that influence pain perception include neurological and psychosocial variables such as pain, emotions, stress responses, and cognition. Interventions aimed at changing these variables may also alter the perception and understanding of pain.

        Psychological interference

        Attention of social problems such as emotional anxiety, coping, and cancer belief is an important component of pain management services. Cancer pain can be aggravated by psychological distress, particularly mood disturbance, depression, panic, and anxiety, as shown by the vast majority of studies. Panic of disease deterioration and painful death is normal, but the degree of psychological distress varies among patients.

        Psychological conditions with which patients need care are normal in cancer but tend to be more prominent in certain patients that often experience clinically severe pain.Thus, early intervention with mental health providers who can identify and manage psychological disorders ( e.g. serious affective disorders, attachment disorders, and anxiety disorders) is essential.

        Behavioral interference

        This treatment requires an exploration of the behaviour that has been learned or conditioned to assess and prevent suffering and to treat people with suffering or psychological distress. Psychophysiological techniques such as biofeedback and calming have been classified as behavioural. Other such techniques include modeling suitable actions, performing tasks in a "ranked" or structured way that encourages achievement and affirmation, practicing tasks ( e.g. sometimes to minimize fear) and controlling praise or incentives offered to significant others. Other strategies involve modeling acceptable behavior, executing tasks in a "ranked" or organized fashion that promotes accomplishment and affirmation, practicing tasks ( e.g. often mitigating fear) and managing appreciation or rewards given to significant others. The hybrid technique involves mediation, hypnosis, music therapy, and systemic desensitization. The last approach incorporates stimulation with sensitivity to conditions that induce fear; it can contribute to fear regulation.

        Hypnosis is a particularly intense state of concentration that can be used to change unpleasant sensations. It has been found to be highly effective in the management of pain after invasive operations or surgery.

        Physical Modality

        Unique non-pharmacological physical modalities are also used to increase pain management plans. For example, rehabilitative therapy, such as optimizing range of motion, stamina, agility and neuromuscular function, can minimize instability and disuse-related pain. Another common physical therapy option, transcutaneous electrical stimulation (TENS), provides mild electrical stimulation to painful regions. The use of heat or cold or a mixture of both is another widely prescribed physical modality. The first technique is most commonly used to ease postoperative pain and pain from cancerrelated inflammatory processes. Caution must be taken while using heat in patients with insensate tissue, arterial insufficiency, metastatic cancers, diathesis bleeding, or cognitive deficits; such conditions can preclude a patient from hearing alerts of too much heat.

        Finally, therapeutic movement and massage should be used to enhance the range of motion and relieve muscle pain. Physical therapy trained in the treatment of chronic or cancer pain also have the expertise to motivate certain patients to exercise, particularly though they observe limited improvement.

        Psychosocial interference

        Cancer suffering also impacts the psychological well-being of individuals. Keefe et al identify many broad types of treatments intended to treat patients with cancer pain, including cancer education, hypnosis and imaging, and instruction in coping skills. Educational engagement is based on helping people to understand the assessment of discomfort and address obstacles to pain management.

        A National Institutes of Health (NIH) Consensus Declaration on cancer symptom treatment details barriers to pain control. Casts, role playing, counseling, workshops and didactic sessions have been examined. While some of these approaches have positive outcomes, others do not; further research is required to determine the effectiveness of educational approaches.While some of these interventions have promising results, others do not; more analysis is needed to assess the feasibility of instructional approaches to critical potential directions in the study of biopsychosocial aspects of cancer pain. The reference to a psychologist is more an anomaly than the rule for patients with disease-related pain.

        At times, access to facilities is still challenging. Subsequently, Keefe et al suggest that future investigate be coordinated toward down to earth procedures for integration, counting including medical caretakers in cognitive-behavioral preparing that can be fulfilled amid therapeutic arrangements, andusing phone or Web frameworks to convey self- management preparing.These techniques have been used in back pain and osteoarthritis trials with good results.

        Therapeutic massage

        Therapeutic massage goes back thousands of years to ancient civilizations of China , Japan and India. It is characterized as the systematic manual or mechanical manipulation of the body's soft tissues by movements such as rubbing, kneading, pushing, rolling or clapping, or a combination of movements for therapeutic purposes, including pain relief, muscle relaxation and circulation promotion.

        Massage increases the pleasure and reduces levels of cortisol and anxiety. Psychosocial problems for survivors include discomfort, exhaustion, cognitive changes, body appearance, sexual functioning, infertility, financial challenges, and anxiety to the caregiver. Individuals can also experience medical and neurological disorders that include signs of traumatic stress, depression , anxiety, and recurrence.

        The need for greater attention and randomized psychosocial treatments for cancer survivors' problems has recently been demonstrated. No epidemiological data exists for chronic pain in cancer patients, while post-treatment pain syndromes are well established. Surgery, amputation, radiation therapy, and chemotherapy are also possible causes of nerve damage arising from chronic pain. Slow improvement of cancer will also lead to persistent suffering. Recognizing and treating those with chronic pain in the same multidisciplinary way as those used during primary cancer care and those with nonmalignant pain was essential to improving the quality of life of cancer survivors.

        Complementary medications

        Complementary medicine (CAM) treatment modality has risen since 1993, when Eisenberg et al disclosed in a first nationwide survey that one in three respondents had used an unorthodox or CAM treatment modality in the previous year. However, studies have shown that patients frequently do not disclose their use of CAM to their doctors, often because of assumptions that their doctors are not responsive to CAM care. High- quality empiric results on CAM methods are emerging from expanded study due to the establishment of the National Center for Complementary and Alternative Medicine (NCCAM) by the National Institutes of Health; however, comprehensive research on a wide variety of approaches is not yet available.

        Several alternative therapy approaches have some convincing scientific research or positive preliminary data: traditional Chinese medicine, mind-body medicine, and therapeutic massage. Several alternative therapy approaches have some convincing scientific research or positive preliminary data: traditional Chinese medicine, mind-body medicine, and therapeutic massage.

        Chinese Traditional Medicine

        Traditional Chinese medicine dates back more than 4000 years and considers wellbeing as an equilibrium between the person and the environment. According to traditional Chinese medicine, qi or ch'I is a life energy force that flows in characteristic patterns (meridian) corresponding to five elements (earth, wood , metal, water , and fire). Physical and psychological disease is conceived as an inappropriate flow or blockage of qi around a meridian. The goal of traditional Chinese medicine is therefore to maintain an equilibrium in opposite meridian poles, referred to as yin and yang. Three elements of traditional Chinese medicine are acupuncture, qigong and neuro-emotional technique (NET).

        Acupuncture

        Acupuncture, acupuncture, and electroacupuncture are types of conventional Chinese medicine in which the physical signs of meridians (e.g. joint pain) are measured and qi is encouraged or rebalanced. Pressure on meridian points can be exerted by inserting small gage needles (e.g. acupuncture) or a mixture of needles and low-frequency electrical current (electroacupuncture) or by manual finger pressure (acupuncture).

        Physicians educated in Western medicine and acupuncture are most likely to follow a pragmatic approach to activate target points, tender points or a combination of segmental points suitable to a distressed location, while these referral patterns also mimic conventional meridian lines. Some research suggests that the benefits of acupuncture are related to the release of multiple endogenous compounds.

        Acupuncture has been shown to better relieve a wide spectrum of pain disorders. Evidence is especially good for the use of this procedure in acute pain with little support for the management of post-process pain in cancer patients.

        In addition to alleviating cancer pain, acupuncture has been used to treat patients with radiation-induced xerostomia, cancer-related complications such as shortness of breath due to primary or secondary malignancy, lower extremity edema secondary to intrapelvic lymph node dissection due to malignant gynecological tumors, and women with menopausal symptoms due to tamoxifen.

        Side effects of acupuncture, acupuncture, and electroacupuncture are usually restricted to mild bruising or pain at the point of touch. Acupuncture is contraindicated in the immediate region of the unstable spine, in people with serious clotting problems or neutropenia, and in limbs with lymphedema. In comparison, semi-permanent needles, which have been taped for days at a time, are contraindicated in patients with valve heart disease.

        Qigong

        Qigong is an ancient method to harness energies by gradual body movements and meditation, with or without visualization and breathing exercises. Like acupuncture and other traditional Chinese therapies, the aim of qigong is to open blocked energy pathways and promote qi.

        While often taught in isolation for healing and health reasons, qigong is part of a cultivation method or lifestyle framework in Buddhism and Taoism directed at spiritual liberation and longevity.

        Neuroemotional Technique

        Neuroemotional Technique (NET) is an intervention focused on conventional Chinese medicine and involves measuring and physically holding corresponding meridian pulse points, thus promoting cognitive andemotional processing and resolution of previous stressful or anxietyproducing events. A preliminary NET analysis of female cancer survivors with associated traumatic stress symptoms compared with a postintervention exposure to a cancer-related case. Decreases in physiological reactivity and subjective scores of event-related pain were observed in addition to reduced levels of pro-inflammatory cytokines in response to the event.

        Mind-body therapies

        The word mind-body therapies is rather vague and refers to a collection of therapeutic modalities that include the awareness of the two-way influence of both systems. Any of these modalities are commonly classified as more traditional forms of care, such as gradual muscle relaxation. Hypnosis and meditation services are commonly considered to be CAM techniques and are reviewed here.

        1. Hypnosis is a dynamic mechanism of attentive, receptive focus marked by a changed sensorium, altered psychological condition, and limited motor function. NIH Technology Appraisal Panel found good support for the use of hypnosis in reducing pain, even cancer-related pain. Pressure relief is believed to occur by cognitive distraction, muscle relaxation, and modification of vision. Hypnosis has been used to successfully alleviate chemotherapy-related nausea and vomiting. This use of hypnosis focuses on the suppression of discomfort and physical reactions associated with hospital-associated reactions.

        2. Meditation and Mindfulness – Based Stress Reduction — Meditation is a technique adapted from more systematic conventional Eastern programs. Yoga, for example, is an ancient Eastern Indian method that prescribes a way of life that requires healthy diet, actions, physical exercise, and sleep hygiene. Mindfulness-based stress reduction (MBSR) is one such technique that has demonstrated clinical benefits to people with a wide variety of medical problems, including cancer. This process promotes moment-to - moment consciousness through routine meditative practice. Participants learn to respond to their perception, including negative emotional feelings and non-judgmental states, embrace and relax.

        MBSR has been shown to enhance patients' ability to deal with prostate cancer and to alleviate depression and mood problems in a population of patients with mixed forms of cancer. Shifts in immune system markers (reduction in T1 pro-inflammatory lymphocyte to T2 anti-inflammatory lymphocyte ratio) have also been reported in patients with breast cancer and prostate cancer following an 8-week MBSR program.

        3.Mindfulness-based art therapy (MBAT) is a recently designed curriculum for cancer patients that incorporates MBSR into a supportive- expressive group model. A randomized clinical trial of MBAT showed substantial decreases in psychiatric pain and improvement in the quality of life of women living with mixed cancer relative to those on the waiting list.

        4. MBAT differs from MBSR in that it is primarily tailored for cancer patients, offers a non-verbal creative-expressive aspect by art therapy, and is tailored for small groups.

        Pediatrics and Neonatology (2020)

          Editorial Pages: 1 - 1

          Longdom Group LLC Global Summit on Pediatrics and Neonatology

          Elena Smith

          Conferences Series LLC has successfully concluded its Global Summit on Pediatrics and Neonatology from November 23-24, 2020 at Madrid, Spain. More than 40 distinguished scientists, researcher, academician participated for sharing research advance, knowledge and expertise related to the Healthcare worldwide. The 2 days conference, held on July 22 through July 23 provides the leading academic scientists, researchers and scholars to share their experiences and research results about all aspects of Pediatrics & Neonatology. Upcoming Conferences on Global Summit on Pediatrics and Neonatology during November 23-24, 2021 at Madrid, Spain. Longdom Group LLC take great pleasure in inviting the scientific community across the globe to the Global Summit on Pediatrics and Neonatology during November 23-24, 2021 at Osaka, Japan. Osaka is a designated city in the Kansai region of Honshu in Japan. Japan is considered as one of the best venue for conducting conferences due its favourite tourist destinations. This meeting will explore advances in the Pediatrics & Neonatology. The upcoming Pediatrics & Neonatology, 2021 focus on Pediatrics and Neonatology, issues, prevention and study of Infectious diseases and Pediatrics issue . This conference will also present the advanced research, advanced techniques for treatment for better Health and diseases related to the Epidemiology and Infectious diseases The participants can exchange and share their research results covering the scientific aspect of Epidemiology ,Digital & Dental Healthcare, Nutritional Health & Epidemiology, Diabetes & Public Health, Oncology & Public Health, Infectious Disease Epidemiology, Healthcare Nursing, Public Health & Nutrition, Sexually Transmitted Diseases, Environmental Health Sciences, Obesity & Health Disorders, Maternal, Infant, and Child Health, Mental Health and Mental Disorders, Healthcare-Associated Infections, Occupational Safety and Health, Educational and Community Based Programs, Modern Public Health Practice, Social and Behavioural Sciences, Social Determinants of Health, Disaster Management & Emergency Preparedness, General Public Health in the Pediatrics and Anesthesia , 2021. Conference will encourage Young Researcher’s Forum, scientists and the researchers in their early stage of career graph to widely discuss their outcome so as to enrich and develop the idea. The ‘Best Poster Award’ is meant to encourage students in taking active part in the International Science platform to sharpen their skills and knowledgebase. The Sponsor in the Pediatrics and Neonatology, 2021 can reach and get exposure to new clients, customer, business, brand awareness and media exposure. The sponsorship has different levels Premium Sponsorship Packages: Elite Sponsor, Silver Sponsor, Gold Sponsor, Exhibition, Additional Sponsorship Packages and Advertisements.

          Value Added Abstracts Pages: 2 - 2

          DOLF Method - The use of multisensory teaching strategies in reading and writing learning (on Portuguese people)

          Ana Severino

          Multisensory teaching: Multisensory teaching means that when information is presented, the learner is simultaneously using multiple senses. Visual (what we see), auditory (what we hear) and kinesthetic/tactile (what we feel) are the 3 primary senses that students use, and these correspond to the visual, auditory and motor (or muscle) memory. The more pathways and connections a student use for learning a new item of knowledge, the more pathways they have for retrieval of this information, enhancing memory and the learning of written language. This multisensory teaching strategies also increases listening, speaking, reading and writing skills development. It’s through multisensory methods, involving touch and movement, that the child is able to bridge the gap between oral and written language, facilitating the learning process. Teachers or therapists who use this approach teach children to link the sounds of the letters with the written symbol. In this way, multisensory learning is used as a form of prevention and/or intervention in children with learning difficulties and/or dyslexia, phonological and/or phonetic disorders. Método DOLF - Desenvolvimento Oral Linguístico e Fonológico: The DOLF Method stands for Oral, Linguistic and Phonological Development. It was created by two speech language pathologists with the purpose of establishing an effective technique to support their daily practice with children with learning difficulties. It´s an auxiliary tool in the learning of speech, language, reading and writing and uses multisensory teaching strategies, allowing the child to see, hear, speak, make the gesture and write. The DOLF method associates a gesture to each phoneme in the Portuguese language (sound), subsequently making the connection to its respective grapheme (letter. It draws attention to the movements of the mouth, the way they are articulated or how sounds are produced. The use of the gesture supports the auditory and visual memory triggering a supplementary memory: the motor memory (articulatory-motor). It’s a flexible method that can be applied according to the objective and through each student. The DOLF method can be applied by speech-language pathologists, teachers, psychologists or any technician who works with children with learning difficulties in reading and writing.

          Value Added Abstracts Pages: 3 - 3

          Analgesia and peri-operative practice in fractured neck of femurs at York Teaching Hospitals NHS Foundation Trust

          Dr Sarah Easby

          Fractured neck of femurs are a significant public health issue. NICE recommends that healthcare professionals should deliver care that minimises the patient’s risk of delirium and maximises their independence and pain control is a vital component of this [1]. Prompt assessment and response to pain as per NICE guidelines aids speedy recovery and helps to prevent complications such as delirium in and already high risk, elderly population. Previous audits have found poor documentation of the assessment of pain and the rate of nerve blocks in A+E and theatres. This completed cycle audit will assess the interventions made in response to these audits including adding pain scores to e-observations and training staff to perform nerve blocks. The aim of this audit was to assess current anaesthetic and analgesic practice. Method: This was a retrospective review of 32 case notes and electronic prescribing over November – December 2019. Data collected included documentation of pain assessment, which analgesia was prescribed as per NICE guideline CG124 [1] and rate of nerve block in A+E and theatres. Results: The audit found that 100% of patients received analgesia as per NICE guidelines. In all settings, documenting the assessment of pain scores has improved from 44% to 63% in A+E, 64% to 81% on the ward pre-operatively and 0 to 100% post op. However, a small number of patients had blanket pain scores of zero which questions the validity of some assessments. On admission, 41% of patients received a nerve block and 94% intra-operatively, up from 22% and 55% respectively, the majority of patients received a fascia iliaca block (FIB). Conclusions: The large increase in post op pain assessment is likely credited to mandatory input as part of e-observations and overall practice has improved significantly. A refresher training session will be provided for ward nursing staff to re-iterate the importance of accurately assessing of and responding to pain. The Hip Fracture Specialist Nurse is now competent to perform FIBs which may further increase the number performed on admission.

          Value Added Abstracts Pages: 4 - 4

          Regenerative Medicine in Paediatric Age

          Eduardo Serna Cuéllar

          Actual indications of PRP, lipofilling and SVF therapies to reconstruct defects in children. Biocompatibility and disponibility have guaranteed the frequent use of adipose tissue as graft to reconstruct soft tissue defects of the face, above all, in paediatric patients, in wich survival was apreciated superior and in wich implantation of other materials may origin complications and secuelae at very early ages. A survival analysis has been realized with the stereologic method in order to quantify the grafts take tax and to study differences between adult and childhood groups. This volumetric analysis evidenced a high survival of fat grafts in infants (93%), significantly superior than in adults (63%) in fifteen months follow-up, allowing us to conclude that these regenerative techniques offer a real guaranty of success, although partial and non-ever lasting, with good clinical results in selectioned paediatric patients.

          Value Added Abstracts Pages: 5 - 5

          Uniform practice for the prevention of healthcare associated infections and occupational therapy in pediatry & neonatology

          Guylaine HENRY LAMY

          Hygiene rules and practices for preventing healthcare-associated infections evolve with the readjustments in line with advances in science and technology The awareness that basic health principles are, in some cases, difficult or even impossible to put into practice for various reasons is shown by the current global health crisis caused by Coronavirus strains Management of political authorities, lack of information, difficulties of access to training, fake news, popular beliefs, individual defensive reactions, individual characteristics of the population and professionals, including patients and their families in pediatrics and neonatology, equipment and procedures that are still not appropriate to prevent the cross transmission of healthcare-associated infections. For example, equipment used for occupational therapy care is very often shared without the possibility of disinfection between patients. The architectural environment of structures, workshops and liberal occupational therapy practices (differentiation of public reception, care, cleaning, disinfection and waste disposal areas, and finally clean storage) do not always allow basic hygiene tasks to be carried out (and when they are carried out, in the right order) There is a real obstacle to the change in practices that is necessary to provide the care that the public expects from professionals.

          Value Added Abstracts Pages: 6 - 6

          Botulinum Toxin Usefulness in the Treatment of Drooling in Childhood

          Paola Diaz Borrego

          Introduction: Drooling is a common and severe problem in different kind of disorders. It affects both adults and children and it is the cause for respiratory infections or dermal complications as minor social participation. Ultrasound botulinum toxin injections could be a successful option to reduce excessive sialorrhea in children independently whose origin it has. Methods: Retrospective-descriptive survey. Period study: 2010- 2019. Inclusion criteria: patients under 18 on severe drooling. Measure units: demographic data, glands injected, botulinum toxin dosage, side effects, intensity and frequency drooling scale (IFDS), and daily changes of bibs/tissues before and 1 month after ultrasound guided injection, use of sedation during procedure and feeding mode. Intervention was performed with ultrasound guidance of salivary glands (10 MHZ linear transducer: submental acoustic window of submaxilar glands and transverse scans of parotid glands) Results: 67 patients, 58,2% females. Mean age 9,03 (limits: 4-14 years). 46,3% were Cerebral Palsy patients. The most frequently gland infiltrated was submaxilar (53,7%). They showed severe drooling (65,7%) or profuse drooling (26,9%) and 88,1% constantly drooled pre treatment. Botulinum toxin total dosage average used, was 53,78 IU (Parotids/ submaxilar mean dosage: 23,06 IU/ 19,49 IU respectively). 30 day post treatment assessment: 6% no drooling and 68,6% mild or moderate drooling, 34,1 % occasionally drooled. Statistical significative difference (p <0,05%) pre-post infiltration. Daily bibs changes post-injection reduction: 48%. Non-response to toxin injection in ten of the treatment sessions: 14,9% cases. Side-effects: 2,98% (hematoma/ mild dysphagia). No differences observed by glands number injected, sedation procedure or underlying disease. Conclusions: Ultrasound botulinum toxin injections in children with severe drooling, demonstrated clinical improvement in reduction on saliva. The usefulness didn´t depend on the disease that originated the sialorrhea. Some children failed to respond to the treatment due probably to insufficient dosage, inadequate diagnosis or uncontrolled secondary drooling factors. Good results were possible with injections of two glands (instead of four), reducing side effects possibility.

          Special issue on Solid Tumor (2020)

            Editorial Pages: 1 - 1

            Conference Announcement on Artificial Intelligence and Robotics

            Ria Silva

            We are pleased to welcome you to the “2nd International Conference on Automation and Artificial Intelligence” after the successful completion of the series of Artificial Intelligence 2020. The congress is scheduled to take place in the beautiful city of London, UK, on June 15-16, 2021. This Artificial Intelligence 2021 conference will provide you with an exemplary research experience and huge ideas. The perspective of the Artificial Intelligence Conference is to set up transplant research to help people understand how treatment techniques have advanced and how the field has developed in recent years. Conferenceseries proffers our immense pleasure and honour in extending you a warm invitation to attend Artificial Intelligence 2021 on June 15-16, 2021 in London, UK. It is focusing on “Innovations and Advancements in Automation and Artificial Intelligence”, to enhance and explore knowledge among Artificial Intelligence community and to establish corporations and exchanging ideas. Providing the right stage to present stimulating Keynote talks, Plenary sessions, Discussion Panels, B2B Meetings, Poster symposia, Video Presentations and Workshop Artificial Intelligence anticipates over 200 participants around the globe with path breaking subjects, discussions and presentations. This will be a splendid feasibility for the researchers, delegates and the students from Global Universities and Institutes to interact with the world class scientists, speakers, Analyst, practitioners and Industry Professionals. Conference Series invites all the experts and researchers from the Automation and Artificial Intelligence sector all over the world to attend “International Conference on Automation and Artificial Intelligence (Artificial Intelligence 2021) which is going to be held on June 15-16, 2021 in London, UK. Artificial Intelligence 2021 conference includes Keynote presentations, Oral talks, Poster Presentations, Workshops, and Exhibitors. Artificial Intelligence is a region of software engineering that emphasises the production of intelligent machines that work and respond like people. Artificial Intelligence is expert in studying how human brain thinks, learn, decide, and work while trying to solve a problem, and then using the products of this study as a source of increasing smart software and systems. In the real life, the knowledge has some undesirable properties. In the modern world, Artificial Intelligence can be used in many ways to control robots, Sensors, actuators etc., An Automation system is a system that controls and displays building organisation. These systems can be established in a few typical ways. In this segment, a general construction frame work for a structure with complex requirements due to the action such as a consulting room will be described. Actual scheme frequently have some of the features and components described here but not all of them. The Automation level consists of all progressive controls that regulate the field level devices in actual time. Online transaction is broadly utilized nowadays. This is one of the best example of Automation. In online shopping the imbursement and checkout are through online conversation system. The most other engineering majors work with Artificial Intelligence, but the heart of Artificial Intelligence is Automation and Automation Engineering across all the disciples. Artificial Intelligence 2021 conference is also comprised of Best Post Awards, Best Oral Presentation Awards, Young Researchers Forums (YRF) and also Video Presentation by experts. We are glad to welcome you all to join and register for the “International Conference on Automation and Artificial Intelligence” which is going to be held during June 15-16, 2021 at London, UK.

            Short Communication Pages: 2 - 2

            The Tyler Robinson Foundation: Providing Financial and Emotional Support for Pediatric Cancer Families

            Kimberly Gradisher

            Statement of the Problem: Families of children who are diagnosed with pediatric cancer are at a high risk of financial toxicity, which also causes an increase in emotional distress. Families must manage childcare, travel, and food during and after their children’s treatments. The stresses of these factors on top of the tragedy of dealing with a pediatric cancer diagnosis can be devastating to the financial and emotional well-being of a family. These families require financial and emotional support during and after a child’s treatment to attempt to reduce these stresses. Researchers have reported that 1/5 of cancer patients’ families reported losing more than 40% of their annual income due to work disruptions. Financial and emotional resources for families dealing with pediatric cancer beyond research are not as common as is required considering the need that exists. Methodology & Theoretical Orientation: The mission of The Tyler Robinson Foundation is to strengthen families financially and emotionally as they cope with the tragedy of a pediatric cancer diagnosis by offsetting out-of-pocket life expenses. We have provided financial resources in the form of grants and other programs to more than 1,500 families across the world, concentrating on the United States and Canada, since our founding in 2013. Interaction between staff and families also provide much needed emotional support. Our families have let us know that the financial relief that they receive have had positive effect on their families and the amount of focus that they can place on their children. Conclusion and Significance: The Tyler Robinson Foundation has assisted families for 7 years to focus on the care of their children during pediatric cancer treatment while reducing financial stresses, which in turn provides some relief for their emotional distress. We intend to continue in our mission and expand beyond our current reach.

            Short Communication Pages: 3 - 3

            Perioperative use of NSAID might prevent early relapses in breast and other cancers

            Michael Retsky

            A bimodal pattern of hazard of relapse among early stage breast cancer patients has been identified in multiple databases from US, Europe and Asia. We are studying these data to determine if this can lead to new ideas on how to prevent relapse in breast cancer. Using computer simulation and access to a very high quality database from Milan for patients treated with mastectomy only, we proposed that relapses within 3 years of surgery are stimulated somehow by the surgical procedure. Most relapses in breast cancer are in this early category. Retrospective data from a Brussels anesthesiology group suggests a plausible mechanism. Use of ketorolac, a common NSAID analgesic used in surgery was associated with far superior disease-free survival in the first 5 years after surgery. The expected prominent early relapse events in months 9-18 are reduced 5-fold. Transient systemic inflammation accompanying surgery (identified by IL-6 in serum) could facilitate angiogenesis of dormant micrometastases, proliferation of dormant single cells, and seeding of circulating cancer stem cells (perhaps in part released from bone marrow) resulting in early relapse and could have been effectively blocked by the perioperative anti-inflammatory agent. If this observation holds up to further scrutiny, it could mean that the simple use of this safe, inexpensive and effective anti-inflammatory agent at surgery might eliminate early relapses. We suggest this would be most effective for triple negative breast cancer and be especially valuable in low and middle income countries. Similar bimodal patterns have been identified in other cancers suggesting a general effect.

            Short Communication Pages: 4 - 4

            The effectiveness of systemic treatment of breast cancer depending on the body weight index using levocarnitine

            Hojouj Mohammad

            The prevalence of breast cancer (BMD) in the world in general and in Ukraine is steadily increasing. Epidemiological, experimental and clinical studies have shown that metabolic disturbances associated with body mass index (BMI)> 30 kg / m2 increase the risk of occurrence and worsen the clinical course of breast cancer. Thus, in patients with obesity, a decrease in the sensitivity of the tumor to systemic antitumor therapy, an increase in the frequency of postoperative complications and a decrease in the rates of general and non-recurrent survival. The aim of the study was to improve the results of neoadjuvant systemic antitumor therapy in breast cancer patients with abdominal obesity (BMI greater than 30 kg / m2) by administering levocarnitine in combination with NSAT for the correction of metabolic disorders as the main pathogenetic part of obesity. For the study used a retrospective study between 2010 and 2014 three hundred patients (prevalence of 12.4% which is 100 thousand. population in the Dnipropetrovsk region) with BMI> 30 kg / m2, morphologically verified diagnosis of different forms of breast cancer and all stages (I- IV). Subsequently, a group of comparisons with abdominal obesity BMI> 30kg / m2 with a definite molecular subtype of tumor, levels of expression of estrogen receptor ER, progesterone PgR, Her-2 / neu, Ki-67 proliferation index was formed. The observation group of patients with breast cancer and BMI> 30kg / m2 was formed in the period from 2014 to 2018 due to prospective observation of “case-control”. Thus, the study involved 108 patients aged 32 to 76 years (mean age (58 ± 2). With nodal breast cancer II-III stage. As a result of randomization of all patients (n = 108) on breast cancer with BMI> 30 kg / m2, depending on the appointment of levocarnitine during NSAT, were divided into 2 groups: comparison and observation. In the comparison group, patients (n = 58) with BMI> 30 kg / m2 patients with breast cancer who did not receive levocarnitine during NSPT, and in the, observation group - patients (n = 50) on breast cancer with BMI> 30 kg / m2 who received levocarnitine during NIST.

            Short Communication Pages: 5 - 5

            Combination Targeted and Immunotherapies in Solid Tumor Brain Metastases

            Morganna Vance

            An estimated 20% of all patients with cancer will develop brain metastases, with the majority of those occurring in patients with lung, breast and colorectal cancers, melanoma, and renal cell carcinoma. Brain metastases are thought to occur via seeding of circulating tumour cells into the brain microvasculature; within this unique microenvironment, tumour growth is promoted and the penetration of systemic medical therapies is limited. Development of brain metastases remains a substantial contributor to overall cancer mortality in patients with advanced-stage cancer, as prognosis remains poor despite multimodal treatments and advances in systemic therapies, which include a combination of surgery, radiotherapy, chemotherapy, immunotherapy and targeted therapies. This has driven continued development of novel immunotherapies and targeted therapies that have higher bioavailability beyond the blood–tumour barrier, to further advances in radiotherapies and minimally invasive surgical techniques. As these discoveries and innovations move from the realm of basic science to preclinical and clinical applications, future outcomes for patients with brain metastases are almost certain to improve. In this virtual presentation, we will explore combination trials in solid tumor brain metastases, highlighting the unmet needs in this patient population and underlining promising combination strategies.

            Short Communication Pages: 6 - 6

            State of the art management of Radioactive-Iodine Refractory Differentiated Thyroid Cancer (RAI-R DTC)

            Naiyarat Prasongsook

            Introduction: The treatment options for patients with radioactive-iodine refractory differentiated thyroid cancer include observation, multi-tyrosine kinase inhibitors (MTKIs), and traditional chemotherapy. An appropriate initial treatment with MTKI is challenging in clinical practice that the benefits outweigh the risk of any adverse events. Treatment strategies for Radioactive-Iodine Refractory Differentiated Thyroid Cancer: The activation of multiple downstream VEGFR signaling pathway, oncogenic mutated kinases (e.g. BRAF mutations), rearrangements of RET ,ALK, NTRK, and TERT promoter mutation are molecular mechanisms involved in RAI-R DTC. MTKIs demonstrated the clinical benefits either progression-free survival (11 to 18 months) or response rate (24-63%). Sorafenib and lenvatinib were approved by FDA for treatment of RAI-R DTC. However, up to 60% of patients with MTKIs required a dose reduction due to adverse events (AEs). The most frequent AEs are hypertension, diarrhea, weight loss, musocitis, fatigue,hand-foot syndrome, alopecia, and diarrhea. Therefore, close monitoring for disease progression and TSH-suppressive therapy are appropriate treatment for those patients with asymptomatic metastatic disease, or slow growing tumor. Initiation of treatment with MTKIs should be considered in symptomatic disease or rapid growing tumor. Conclusions: MTKIs demonstrate a promising approach. Sorafenib and lenvatinib have been approved by the FDA for the treatment of RAI-R DTC. However, multidisciplinary evaluation for adjustment made in order to take account of clinical benefit and risks should be performed before initiating MTKIs regarding to potential toxicities.

            Special Issue on Cancer Treatment and Prevention (2020)

              Opinion Article Pages: 3 - 4

              Management of cancer pain and the opioid epidemic

              Evangelia Michail Michailidou*

              The opioid crisis affects people with cancer who depend on opioids to help them relieve their pain. It can be caused by cancer, by its treatment or by a combination of factors. While some pain lasts for a relatively short period and recovers on its own, cancer or its treatment may also lead to long-lasting, chronic pain. Opioid medications are an important component of the treatment of many forms of unreliable cancer pain.

              Opinion Article Pages: 5 - 8

              Non-Drug Approaches for cancer patients

              Evangelia Michail Michailidou*

              Non pharmacological treatments are valuable adjuncts to the treatment modalities for patients with cancer pain. Variety can be used to minimize pain and concomitant mood disturbance and improve quality of life. Physicians may feel relatively uninformed about the approaches used and scientific support for cancer patients. This article discusses a variety of non-pharmacological and complementary and alternative approaches widely used in patients with cancer pain. It focuses on those with scientific support or encouraging preliminary evidence, with the intention of familiarizing physicians with therapies that may supplement routine oncological treatment.

              Pain is a multi-faceted condition involving biological , psychological and social effects. The incidence of pain in cancer patients has been reported to be between 46% and 79% during cancer care and 65% for those with advanced disease. Etiological causes for cancer pain include disease progression, treatment strategies for stopping cancer (e.g. surgery, chemotherapy, or radiotherapy), inactivity musculoskeletal pain, and cancer-related infections that cause neuropathic pain.

              A mixture of pharmacological and non-pharmacological treatment approaches for cancer pain is the standard of care as set out in the latest recommendations of the World Health Organization (WHO).

              Short Communication Pages: 9 - 9

              Breast cancer screening barriers from the women???s perspective: A meta-synthesis

              Ahmad Moosavi , Sepideh Garh sheiklou

               

               Background: The principal aim of health service providers in the field of breast cancer is to detect and treat lesions at an appropriate time. Therefore, identification of barriers to screening can be very helpful. The present study aimed to systematically review the qualitative studies for extracting and reporting the barriers of screening for breast cancer from the women’s perspective. Materials and Methods: In this systematic review; Pubmed, Google Scholar, Ovid Scopus, Cochrane Library, Iranmedex, and SID were searched using the keywords: screening barriers, cancer, qualitative studies, breast and their Persian equivalents, and the needed data were extracted and analyzed using an extraction table. To assess the quality of the studies, the Critical Appraisal Skills Program me (CASP) tool was used. Results: From 2,134 related articles that were found, 21 articles were eventually included in the study. The most important barriers from the point of view of 1,084 women were lack of knowledge, access barriers (financial, geographical, cultural), fear (of results and pain), performance of service providers, women's beliefs, procrastination of screening, embarrassment, long wait for getting an appointment, language problems, and previous negative experiences. Articles' assessment score was 68.9. Conclusions: Increasing women's knowledge, reducing the costs of screening services, cultural promotion for screening, presenting less painful methods, changing beliefs of health service providers, provision of privacy for giving service, decreasing the waiting time, and providing high quality services in a respectful manner can be effective ways to increase breast cancer screening.

              Short Communication Pages: 10 - 10

              Sonography of the Neoplastic Diseases in the Gastro-Intestinal Tract

              Vikas Leelavati Balasaheb Jadhav

              Sonography of the Gastro-Intestinal Tract can reveal intra-mural tumours, Intra-mural haematoma, Lesions of Ampulla of Vater like benign & infiltrating mass lesions. Neoplastic lesion is usually a segment involvement, & shows irregularly thickened, hypoechoic & aperistaltic wall with loss of normal layering pattern.It is usually a solitary stricture & has eccentric irregular luminal narrowing. It shows loss of normal Gut Signature. Enlargement of the involved segment seen.Shouldering effect at the ends of stricture is most common feature. Enlarged lymphnodes around may be seen. Primary arising from wall itself & secondary are invasion from peri-Ampullary malignancy or distant metastasis. All these cases are compared & proved with gold standards like surgery & endoscopy.

              Some extra efforts taken during all routine or emergent ultrasonography examinations can be an effective non-invasive method to diagnose primarily hitherto unsuspected benign & malignant Gastro-Intestinal Tract lesions, so should be the investigation of choice.

              Editorial Pages: 11 - 11

              2021 Conference Announcement on Pharmacology and Drug Discovery

              Ahmad Moosavi, Sepideh Garh sheiklou

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              Cancer Treatment and Prevention (2020)

                Value Added Abstracts Pages: 1 - 1

                Global Summit On Oncology and Breast Cancer | March 05-06, 2020 | Vienna, Austria

                N. Senhou

                 

                 We’re pleased to bring you exciting news about next year’s “Global Summit On Oncology and Breast Cancer ”.Which is going to held on March 05-06, 2020 | Vienna, Austria . We have set a date and location that we hope for the foundation of a productive and enjoyable gathering.

                Oncology 2020 regards each one of the individuals to go to the “Oncology 2020” amidst March 05-06, 2020. which melds brief keynote presentations, speaker talks, Exhibition, Symposia, Workshops, Speaker sessions.

                Oncology 2020 will join world-class professors, scien­tists, researchers, students, Perfusionists, Oncologists to discuss methodology for ailment remediation for Cancer diseases, Breast Cancer and health disorders. Oncology 2020 are planned to give various information that will keep helpful specialists next to each other of the issues impacting the expectations, finding and treatment of Cancer diseases. The assembling of this event will be dealt with around the subject “Oncology 2020”.

                Value Added Abstracts Pages: 2 - 2

                Beam Quality Measurement and Verification in Radiation Therapy

                Barrington Brevitt

                The aim of all radiotherapy treatment is to precisely deliver a prescribed dose of radiation to a tumour volume while simultaneously sparing the organs at risk (OARs) surrounding this tumour. Radiation therapy has evolved and the method of radiation generation varies, ranging from the controlled emission of gamma rays from a Cobalt 60 source to the production of particles such as; photons, electrons and protons produced in linear accelerators. The high energy photons employed during tumour treatment can interact with components of the gantry such as lead jaws, and produce particles that may contaminate the treatment beam. These contaminants are produced through various interactions with the photons and the absorbing medium such as; Compton Interaction, Photoelectric Effect and Pair Production. Photons have more penetrating power than charged particles of similar energy, and as they traverse a medium there is energy transformation to electron energy(1). The prospect of an interaction per unit distance travelled is denoted by the principle N= N_0 e^(-μx), where μ is dependent on the energy of the photon and the materials through which it travels(2). The aim of this paper is to conduct beam quality measurements and verification for treatment plan quality assurance in radiation therapy. An IBA Pharma type ion chamber (FC65-G) and electrometer (IBA Dose 2) were used to obtain ionization charges for an 18MV and a 6MV photon beam from a C-Series linear accelerator. These measurements were taken using a 1D water phantom, dimensions 40cm* 35cm*34.5 cm at a source to detector distance (SDD) of 100cm with the chamber 10cm beneath the water surface. The “K” (quality conversion factor) was calculated using the TPR20, 10 method. Two sets of measurements were taken at a depth of 20 cm and 10 cm beneath the water surface at a source to detector distance of 100cm. Three measurements were taken for both photon energies at polarities of +300, -300 and +100 on the electrometer. Ka values were calculated using the TPR20, 10 principles outlined in the TRS 135 protocol. The Ka value for the 6MV photon was determined to be 0.996 Gy while that for the 18MV was 0.973 Gy. These Ka values were then used to determine the tabulated percentage depth dose (PDD) for the photon energies. The tabulated PDD’s were 0.665 and 0.788 for the 6MV and 18MV beam respectively. From equation 2, Dw (10cm) for 6MV photon was calculated to be 0.68 Gy and that for the 18 MV photon was 0.81 Gy. The absorbed dose of the treatment unit at Dmax (Eq. 3) was calculated to be; (18MV) 1.03 Gy and (6MV) 1.03 Gy

                Value Added Abstracts Pages: 3 - 3

                The Male Breast Cancer Coalition (MBCC).

                Cheri ambrose

                February 13, 2019 marked the 5th anniversary of The Male Breast Cancer Coalition (MBCC).  This non-profit and awareness foundation was established with the objectives of saving lives through advocacy, education and a complete resource access of any and all support facilities and clinical information leading to the diagnosis, treatment and prevention of Male Breast Cancer. Origins of the MBCC came from the partnership between MBCC President and Co-founder, Cheri Ambrose of New Jersey and co-founder Bret Miller of Kansas City who is recorded as the youngest male worldwide to contract breast cancer. Bret was just 17 years old when he found a lump during a high school sports physical. For six years he was told by various doctors that it was nothing to worry about, just calcium that would dissipate as he got older. Bret underwent a mastectomy for breast cancer at the age of 24.  He promised his doctor that if cured, he would become the face of breast cancer for me. He started his own awareness foundation, the Bret Miller 1T Foundation with his mother Peggy Miller as his manager and was attending many of the local 5k races and breast cancer events in Kansas City in an effort to bring awareness to the risk men face. Cheri had been working at her own organization in New Jersey known as the Blue Wave.  The Blue Wave was born out of a need for awareness after a very dear friend had been diagnosed with breast cancer.  He went from being a vibrant, outgoing person into a virtual hermit, shutting himself off from everyone due to embarrassment of having a women’s disease. Once connecting, through social media and an hour-long phone call with Peggy Miller, Bret’s mother and foundation manager, the two knew there was so much more they could do together and joined forces and never looked back.  To date touching the lives of over 500 men diagnosed with breast cancer around the world.

                Value Added Abstracts Pages: 4 - 4

                Efficacy of oral immunotherapy in a case of metastatic breast cancer.

                Tarang Krishna

                Breast cancer is one of the most common cancers in women. World Health Organization estimated the number of diagnosed breast cancer cases at approximately 2.1 million in 2018. This equals to about 11.6% of the total cancer incidence burden1. Globally, the incidence rates of breast cancer are much higher as compared to other cancers. Such high prevalence of breast cancer calls for an effective treatment that is able to resolve the condition permanently. Although the best form of resolution is early diagnosis but an assured treatment should be sought as most of the cases get detected in advanced stages. The potential side effects of chemotherapy and radiotherapy make them a non viable option in the treatment of breast cancer. The treatments of hormone therapy and targeted therapy are also not devoid of side effects. The treatment should be such that relieves the ailment of the patient rather than augmenting it. Another form of treatment that has emerged to treat various forms of cancer including breast cancer is immunotherapy and it is still in the stage of clinical trials. Many studies have been conducted in relation to the treatment of metastatic breast cancer with immunotherapy but none has been plausible in removing the disease entirely from the body and the possibility of emergence of alternate effects has also not been entirely ruled out. This case report aims to establish the efficacy of oral immunotherapy treatment in a patient of metastatic breast cancer in terms of the following: 1) Relieving the patient of her presenting complaints. 2) Removing the evidence of the disease completely from the body. 3) Ruling out relapse of the disease. 4) Ensuring a normal life to the patient.

                Value Added Abstracts Pages: 5 - 5

                PROGNOSTIC IMPORTANCE OF MOLECULAR GENETIC MARKERS: Ki67, Bcl2, and p53 IN PATIENTS WITH LOCALLY ADVANCED CERVICAL CANCER

                Karimova N.S

                Summary. In biopsy preparations, there are 30 patients with cervical cancer at the IIb-IIIb clinical stages. A study in patients with locally advanced cervical cancer showed that a high expression level of Ki67 proliferation in primary patients, elevated levels of p53 protein before carrying out correlate with an unfavorable prognosis, which makes it possible to use these indicators in monitoring the course of the disease. It was shown that prior to the initiation of antitumor treatment, the expression level of Ki67 was as high as possible in those patients who subsequently showed progression of the disease, and reached 85%. The expression level of Ki67 and p53 protein was shown to correlate with indicators of tumor progression. The aim of the study was:  In accordance with the purpose of the study outlined above, the expression level of molecular biological markers Ki67, Bcl2, p53 and their prognostic value in patients with locally advanced cervical cancer who received complex treatment were assessed. Material and methods: 30 patients with locally advanced cervical cancer with IIB – IIIA-B stage who received chemoradiotherapy in ССncer center from 2014 to 2017 were examined. The stages of the disease before the start of treatment were carried out in accordance with the international classification of TNM (seventh revision 2009) and in accordance with the classification of the International Federation of Obstetricians-Gynecologists classification (FIGO, 2011). The diagnosis of the disease in all cases verified histological. Morphologically, all women were diagnosed with squamous cell carcinoma. The possibilities of the proliferative activity marker Ki67, p53 protein, Bcl2 in determining the prognosis of the disease, locally advanced cervical cancer were studied. The material of the study was cervical

                All patients underwent 3 courses of neoadjuvant polychemotherapy with 21 day intervals, according to the scheme: Cisplatin 100 mg 1 day, Fluorouracil 1000 mg 1-4 days.Then, after computerized topometry of the pelvic organs, planning of combined radiation therapy was carried out, including remote gamma therapy and intracavitary brachytherapy. Remote irradiation was carried out on a gamma therapeutic apparatus (TERABALT type 80 model SCS 2012 Czech Republic) in the standard fractionation mode (daily 5 times a week Single Focal Dose 2 Gy to Total Focal Dose 46 Gy). Intracavitary radiotherapy was performed on a BEBIG brachytherapy device - MULTISOURSE Co60 2013. (Germany) in fractional mode Single Focal Dose 5 Gy, eq Total Focal Dose to point A up to 70-90 Gy, to point B 50-58 Gy. The initial expression of the listed immunohistochemical markers in the tumor and prior to chemo-radiotherapy was evaluated. The immunohistochemical study was carried out according to a standard procedure on dewaxed sections of cervical tissue blocks obtained from resection specimens or cervical biopsies. A pathologist to clarify the histological diagnosis and the correspondence of the blocks to the selected sections reviewed all drugs.

                Value Added Abstracts Pages: 6 - 6

                Gut microbiota behavior, low carbohydrate dietary intake and cancer.

                Leo Nissola

                Gut microbiota is a key intermediary between diet and host physiology, modulating several metabolic and neurological signaling pathways. Microbiota plays a key role in digestion, metabolism and behavior as well as microbial response to diet. Dysbiosis of gut microbiota has been strongly related to cancer. Ketogenic diet alters the gut microbiota and protects against multiple chronicle diseases and recent studies have linked ketogenic diet with cancer prevention. It is known that over 30 percent of all cancers can be prevented by lifestyle and dietary measures. Obesity, nutrient sparse foods such as concentrated sugars and refined flour products impairs the glucose metabolism. The hypothesis that cytotoxicity induced by glucose deprivation in cancer cells is mediated by mitochondrial superoxide and H2O2 was confirmed by exposing glucose-deprived transformed human fibroblasts to electron transport chain blockers (ETCBs), known to increase mitochondrial superoxide and H2O2 production by a wide number of researchers. Therefore, glucose deprivation in the presence of ETCBs enhanced oxidative stress as well as cell death in several different human cancer cell lines (PC-3, DU145, MDA-MB231, and HT-29). Low fiber intake, consumption of red meat, and imbalance of omega 3 and omega 6 fats contribute to an increase in overall cancer risk in both genders. Studies have show that when a diet is well balanced, it is likely that there would be at least a 60 percent decrease in breast, colorectal, and prostate cancers. Improving metabolites and immunological

                anticancer profile by k-PBD. There’s robust evidence that shows prolonged fasting, fastingmimicking diet (FMD) and ketogenic diet demonstrates a strong usefulness as adjuvants in cancer therapy.

                Value Added Abstracts Pages: 7 - 7

                Evaluation of predictors for behavioral intentions to adhere to cervical cancer treatment among aged 25-49 years in Botswana.

                Major, T.E., Koyabe, B., Ntsayagae, E., Molwane, B., and Monare, B

                There is evidence of ongoing research and investment in Africa to improve vaccination, screening, and treatment for cervical cancer (Finocchario-Kessler , Wexler , Maloba , Mabachi , Ndikum-Moffor , Bukusi; 2016). However, the majority (54.6 %) of cervical cancer research in Africa focused on secondary prevention (i.e., screening). This is followed by studies focusing on primary prevention (23.4 %) of cervical cancer, particularly HPV vaccination. Finocchario-Kessler, etc (2016) records that research focusing on tertiary prevention, which is the treatment of cervical cancer, is at the lowest (17.6 %). It is vital that research focusing on tertiary prevention for women diagnosed with abnormal cervical tissue is given equal attention as a matter of urgency for the overall survival (OS) for women with locally advanced cervical cancer. Studies on adherence to treatment regimen and schedule for cervical cancer will inform the innovation and improvement efforts towards treatment adherence and follow-up of women diagnosed with abnormal cervical tissue.

                Value Added Abstracts Pages: 8 - 8

                Role of Vitronectin as a potential Serum Biomarker for Breast Cancer Prognosis

                Meera Srivastava*, Alakesh Bera

                Introduction: Breast Cancer is the most common form of cancer in women worldwide, impacting nearly 2.1 million women each year. In 2018, nearly 627,000 women died of breast cancer, which accounts for 15% of all cancer deaths. Identification of new biomarkers could be key for early diagnosis and therefore, increase the survival.  Vitronectin, a glycoprotein that is abundantly found in serum, extracellular matrix, and bone, binds to integrin alpha V beta 3, and promotes cell adhesion and migration. Current studies indicate that patients with amplified Vitronectin copy-number have lower survival rates than patients without amplified Vitronectin. In this study, we focused on the role of vitronectin in breast cancer survival and its functional role as a non-invasive biomarker for early stage and stage specific breast cancer detection. Materials and Methods: To confirm that the expression of vitronectin is amplified in breast cancer, a total of 240 serum samples (n=240) from breast cancer patients were analyzed using the Reverse Phase Protein Array (RPPA) technique. Of the 240 samples, 120 samples were of African American descent, while the other 120 were of Caucasian American descent.

                Value Added Abstracts Pages: 9 - 9

                Breast cancer risk factors, prevention and patients empowerment

                Míriam Algueró Josa

                Breast cancer was the most common cancer in women worldwide in 2018, contributing 25.4% of the total number of cases diagnosed. Evidence says that less than 10% (between 6% and 7%) of the total is due to genetic missfailiures. Some mutations, particularly in BRCA1, BRCA2 and p53 might induce an increase of breast cancer. However, these mutations are rare and account for a small portion of the total breast cancer burden. (1) Risk factors Lifestyle is also determinant when it comes to cancer. Several researches have proven that unhealty diets, obesity (2), smoking (3), alchool intake (4) and a sedentary life style (5) might translate in an increase of all types of cancer risk, including breast cancer (6) Breast cancer prevention According to reserch there are several things that patients can do to prevent all types of cancer, including breast cancer (7),(8), (9) Patient empowerment Research has shown that a healthy lifestyle increases chances to overcome breast cancer. Passing this information on to patients is crucial for them to take an active part in their illness and improve their quality of live as well as their chances to recover health. (10)

                Value Added Abstracts Pages: 10 - 10

                Radiation protection during PRRT therapy in NGHA

                N. Senhou

                Radiation protection in medicine covers in principle, medical exposure, occupational exposure, and public exposure in association with various clinical circumstances. Medical exposure involves not only patients but also their relatives and medical staff. Peptide receptor radionuclide therapy (PRRT) is a molecular targeted therapy used to treat neuroendocrine tumors (NET). In National Guard Hospital in Saudi Arabia the PRRT therapy is kind of new treatment and the radioprotection for such treatment was unknown because of the lack of reference or lectures, in some cases it may be considered as a low contamination treatment because it’s a beta emission, PRRT delivers high doses of radiation to tumors in the body to destroy or slow their growth and reduce disease side effects, Therapeutic procedures with beta emitters are growing. The purpose of this topic is to report on the current state of PRRT, to clarify the issues of radiation protection associated with PRRT, and to show future prospects. Medical staff is often not aware of the high risk of exposure to beta radiation, inappropriate dose meters available or used can make it more complicated, the

                personal dose meters used often are not worn properly. Skin dose of staff during labelling(preparation) and infusion (administration) should be done carefully because extremity exposure of technicians during preparation may exceed dose limit if safety standards are not strictly kept. PRRT requires deliberate radiation protection standards as it uses unsealed radionuclides and gives therapeutic radiation doses in humans. the goal of this topic is the proposal of large variations of individual practices during preparation and administration and to imply options for improving radiation safety

                Value Added Abstracts Pages: 11 - 11

                Knowledge on colorectal cancer prevention among adults attending at a tertiary level hospital

                Sachita Budhathoki, J.Pokharel

                Colorectal cancer ranks among the third most common cancer worldwide, second in terms of mortality due to cancer and has shown an increasing trend of incidence in Asian region lately.    In Nepal, It is among the top five most common cancers in both males and females. Over the next ten years, countries in the low- income Asia pacific region including Nepal are projected to have the highest colorectal cancer  growth rates of 70%. Owing to the growing burden, there is demand for more research in the field and hence strategies to increase the knowledge on colorectal cancer. The American cancer society asserts that colorectal cancer is common after age 50 and its screening should start after age 45. This study aimed to assess the level of knowledge on colorectal cancer including knowledge on preventive lifestyle and screening tests among adults. A cross sectional descriptive study was conducted from 2018 october- 2019 January among 110 non- cancer patients and adults aged 40-75 years attending Nepal Medical college Teaching Hospital. Non-probability purposive sampling was done. Structured interview questionnaire adopted from standard bowel cancer awareness measure (CAM) developed by cancer research UK was used for data collection. Frequency distribution, mean values and chi-square value were computed for statistical analysis. Results show that 81.8% had heard of colorectal cancer in their lifetime while 18.2% had never heard of it before. The main source of information was friends (47.7%)  Of those who had heard of colorectal cancer, 92.2% believed colorectal cancer is preventable while 23.3% had in fact heard about colorectal cancer screening tests and mean knowledge percentage on the domain was only 14.44%. Mean knowledge percentage was found highest (74.6%) for knowledge regarding preventive lifestyle practices. Majority (65.6%) had moderate level of knowledge, 24.4% had inadequate knowledge while only 10% had adequate level of knowledge. Significant statistical association was

                not found between level of knowledge and selected demographic variables like age, sex, education, occupation (p<0.05) There is need of extensive public awareness programs on colorectal cancer with a focus on screening tests to fill the gaps of knowledge and promote utilization of early screening methods for prevention. Health care professional should be able to provide planned, structured health teaching on colorectal cancer to disseminate authentic information on the topic.

                Value Added Abstracts Pages: 12 - 12

                Effect of Topical Anesthetic Cream on Pain During Periareolar Injection of Technetium Tc99m Sulfur Colloid for Sentinel Lymph Node Biopsy in Breast Cancer: A Randomized Control Trial

                Sarah Canning

                Background: Injection of Tc99m to localize nodes for sentinel lymph node biopsy is reported by patients as very painful. The purpose of this study was to determine if anesthetic cream reduces pain associated with periareolar injection of Tc99m and to help elucidate conflicting literature regarding the efficacy of anesthetic cream for this procedure. Methods: A randomized, double-blind, placebo-controlled methodology was used for adult females with breast cancer undergoing periareolar injection of Tc99m for sentinel lymph node biopsy. Pain levels were compared using anesthetic cream (2.5% lidocaine/2.5% prilocaine) vs. placebo. Patient exclusion criteria included use of opioids or adjuvant pain medication or injecting Tc99m the day before surgery. The Numerical Rating Scale was used to assess pain levels immediately after the injections. Results: Comparing 23 experimental and 26 control pa

                tients, there was no significant difference between the experimental (median = 4) and the control group (median = 5) on level of pain experienced U=0.492, P > .05. Conclusions: The experimental group had a slightly lower median pain score; however, there was no statistically significant difference between those who used the cream compared with those who used a placebo, supporting the conclusion that anesthetic cream does not reduce pain during Tc99m injections. This study adds to the current literature to provide a stronger position that there is no benefit to using anesthetic cream for this procedure.

                Value Added Abstracts Pages: 13 - 13

                Increasing Risk of Breast Cancer in IVF Cases

                Dariush D. Farhud

                the increase rate of infertility, the referral rate to infertility treatment centers has also increased. Nowadays, assisted reproductive technology (ART) is used to treat this problem. Considering the possible future implications for mothers who are treated with in-vitro fertilization (IVF) and the offspring as the end product of this method, extensive researches have been conducted in this regard. According to some researches, there is speculation about the increased risk of cancer in mothers and their offspring. In in-vitro fertilization (IVF), drugs such as Clomiphene citrate and gonadotropins are used to stimulate and mature follicles and thus increase ovulation. Based on studies, the long-term use of these drugs can increase estrogen hormones and cause excessive expression of genes, resulting in an increased risk of breast cancer. Breast cancer is one of the most common cancers among women, which is mostly hereditary and afflicted with high and growing severity. In this article, we are referring to and collecting more than one hundred articles worldwide, which followed the hypothesis that the use of IVF drugs can lead to breast cancer, and our findings completely confirm this. With this in mind, mothers who are going to have infertility treatments should be individually evaluated “personalized medicine” and family history of breast cancer, must be considered prior to treatment.

                Value Added Abstracts Pages: 14 - 14

                The T cell Repertoire as a biomarker for breast cancer detection

                Miri Gordin and Hagit Philip

                To study the T-cell repertoire during tumor progression, we followed 10 female mice of a transgenic mouse strain that expresses the un-activated rat neu (Erbb2) oncogene, along with 5 control mice. These mice develop mammary tumors spontaneously over 5-8 months. To quantify the peripheral T cell repertoire, we extracted T cells from blood, every month, over the period of 9 months. Cells from these samples were sorted and later processed through a cDNA TCR С and С library preparation protocol using single-molecule barcoding and then NGS sequenced. We were able to use the repertoire to classify tumor and non-tumor mice, using their immunological repertoire. Using feature selection algorithms, we were able to provide superior classification using a small subset (3 to 6 clones) of the T cell repertoire. Thus, machine learning

                and feature selection allowed us to reduce the hundreds of thousands of TCR alpha and beta sequences obtained during repertoire sequencing, to a set of six clones, with which we can identify the source of a blood sample as tumor or control. We can further stratify older transgenic mice (older than 5 months) and those of older control mice, using the same small T cell clones’ subset. This latter classification has been obtained with as little as three T cell clones.

                Value Added Abstracts Pages: 15 - 15

                Health Beliefs on the Behavioral Adoption of Mammography Screening: A Path Analytic Model

                Soo Foon Moey

                Despite the effectiveness of mammography for early breast cancer detection, its’ utilization among Malaysian women remains low. This is possibly due to mammography screening being still opportunistic in nature. Conceptualizing screening behavior intentions utilizing Health Belief Model (HBM) is appropriate in understanding behavioral changes. As such, the study utilized HBM constructs in predicting the variance in adaptive behavior of mammography while controlling for moderating effects of knowledge and socio-demographic factors and mediating effects of self-efficacy using structural modeling fit analysis. Materials and methods A multi-stage, stratified random sampling method was utilized to select the polyclinics in Kuantan, Pahang. Five hundred and twenty Malaysian women aged between 35 and 70 years were selected randomly using sample size calculation at 5% type 1 error, p < 0.05, absolute error at 2%.  Sets of the copyrighted, validated questionnaire were used to obtain the data. Structural equation modeling using Mplus was used to test the model. Indirect effects were included iteratively to the path model for evaluating moderating and mediating effects significance.

                Volume 9, Issue 3 (2020)

                  Brief Report Pages: 4 - 6

                  Pelvic Pain is Correlated with Vitamin D Serum Levels in Ovarian Endometriosis

                  Manuel García Manero*, Juan Luis Alcazar and Patricia Diaz Ortega

                  Objective: To determine whether Vitamin D serum levels are correlated with pelvic pain in patients with ovarian endometriomas.  

                   

                  Design: Prospective study.

                   

                  Setting: Tertiary-care university hospital.

                   

                  Patient(s): vitamin D serum levels were prospectively analyzed in 43 patients (group A, asymptomatic patients or patients with mild dysmenorrhea; group B, moderate dysmenorrhea and group C, severe dysmenorrhea and/or chronic pelvic pain and/or dyspareunia) who were diagnosed for cystic ovarian endometriosis to assess whether a correlation exists between Vitamin D serum levels and pelvic pain.

                   

                  Intervention(s): Vitamin D serum levels determination.

                   

                  Main outcome measure(s): Vitamin D serum levels and pelvic pain.

                  Result(s): From 43 patients, five cases were ultimately excluded because patients didn´t continuous). The mean (± SD) vitamin D serum levels in group A were 26,9 ± 04.17 pg/mL in group B were 16,2 ±1,4 pg/mL. and group C 10,4 pg/ml ± 2,4 pg/ml

                  Conclusion(s): Pain symptoms in ovarian endometriosis is correlated with vitamin –D serum levels.

                   

                  Opinion Article Pages: 7 - 9

                  Latest developments and new challenges for Cancer patients in Intensive Care Unit

                  Evangelia Michail Michailidou

                  It has been believed for years that cancer patients have not been referred to the Intensive Care Unit (ICU) because they have serious and potentially reversible acute illnesses. Fortunately, a variety of tests have shown that this is not the case. Today, the number of cancer patients in ICUs around the world is rising every year, and both longevity and quality of life are growing in the same way.

                  Short Communication Pages: 10 - 10

                  Horizontal mitochondrial transfer and dihydroorotate dehydrogenase function in recovery of tumorigenic capacity in mtDNA deficient cancer cells

                  Lanfeng Dong

                  Recently, we showed that cancer cells devoid of mitochondrial DNA (mtDNA) refered to as ρ0 cells recover their tumour formation ability in syngeneic mice only after the acquisition of the host mtDNA.1 Thus, ρ0 cancer cells are unable to form tumour unless mitochondria with mtDNA are acquired from normal cells in the tumour microenvironment to reconstitute their respiratory function.2 Therefore, mtDNA and mitochondrial respiration is needed for tumorigenesis.

                   

                  We explored the functional consequences of horizontal transfer of mitochondria, and found that pyrimidine biosynthesis, which is dependent on respiration-linked dihydroorotate dehydrogenase (DHODH), is essential for overcoming cell-cycle arrest and hence for promotion of tumour formation3. DHODH is present and primed in mtDNA-devoid cells, and it is fully re-activated by complex III/IV respiration and coenzyme Q (CoQ) redox-cycling recovered as a consequence of mitochondrial transfer. Moreover, respiration recovery, which is necessary for tumour cell proliferation allowing for tumour formation and progression, is associated with efficient de novo pyrimidine synthesis. We propose that re-activation of DHODH, a rate-limiting enzyme in the de novo pyrimidine synthesis, is the key event for triggering tumour growth following horizontal transfer of mitochondria into mtDNA-compromised cancer cells and that it is intimately linked to mitochondrial respiration.

                   We therefore propose that DHODH is the critical link between de novo pyrimidine synthesis and respiration. We conclude that the CIII/CIV-CoQ-DHODH axis is the major promoter of tumour formation, making DHODH a potential broad-spectrum target for cancer therapy.

                  Short Communication Pages: 11 - 11

                  The generation of anti-tumour bystander killing by genetically engineered ovarian tumour cells and the influence of ?-irradiation: implications for clinical use as Cancer Vaccines

                  Jehad Zweiri

                  Breast cancer makes up approximately 25% of all newly diagnosed cancers in women globally and is the second most common cancer in the world today. With the rates of newly diagnosed cancer cases, increasing globally and cancer being amongst the world???s leading cause of death, the question arises, what must the global community do to win the fight against cancer? In order to tackle the issue at hand, the field of oncology care is rapidly evolving with many organizations and institutions investing heavily in various advancing technologies and treatment modalities. With the availability of knowledge and information on different treatment modalities readily available online, many patients are well informed of the treatment options available. However, not all cancer centers are able to provide the most up to date treatment due to financial constraints and often times lack of expertise in niche treatment deliveries. Our industry has reached a point of inflection and the need for integrated collaboration across facilities is more important today than it has ever been. The issue for many facilities is the fear of loss of revenue to competing centers and the lack of ability to invest in the ever-evolving treatment modalities, which can lead to sub-optimal clinical outcomes for the patients. This presentation focuses on the need for integrated collaboration and the importance of working together across facilities as opposed to competing against one another. The discussion centers around three key areas are: (1) Understanding the various treatment modalities, (2) fostering an environment for each group of physicians and their specialties, and (3) building an integrated care network. The various successful models that have been implemented in order to ensure the best clinical outcomes for the patients, giving them access to the latest cutting edge treatment throughout the world will be a part of the presentation.

                  Short Communication Pages: 12 - 12

                  Attempts in Development of Early Diagnostics of Ovarian Carcinoma

                  Umarova N.A

                  Ovarian carcinoma (OC) is one of the most difficult localizations, from the perception of early diagnostics, in malignant process.
                  The studies, we have been conducting since 2006 and data based on results of 1368 patients, have shown that dynamic monitoring of СА-125 possesses low
                  sensitivity (52,8 %) and specificity (64,2 %) when dealing with I-II stage of the disease

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