Whom should we treat with novel agents? Specific indications for specific and challenging populations

A relative wealth of new therapies for acute myeloid leukemia (AML) have led to a rapid shift in treatment paradigms for this disease. Understanding whom, when, and how to treat is more complex than ever before. Here we explore whom to treat with these available new therapies, focusing on special patient populations that include older adults, those with relapsed disease, and those with TP53-mutated AML. These high-risk subgroups are some of the most challenging to care for, but novel treatments are providing them with new hope.

Clinical implications of concentration of alveolar nitric oxide in asthmatic and non-asthmatic subacute cough

Background and objective: Asthma is one of the important causes of subacute cough. Concentration of alveolar nitric oxide (CANO) is a sensitive inflammatory indicator of peripheral airways, which has received much less attention than fraction of exhaled nitric oxide (FeNO50). The main objective of this study was to explore the correlation between CANO and clinical parameters in asthmatic and non-asthmatic subacute cough, which might promote understanding the clinical utility of CANO in these special patient population. Materials and methods: 155 patients with subacute cough were included consecutively, of which 25 were diagnosed as asthma. Data for demographic characteristics, FeNO50, CANO, baseline spirometry, bronchial provocation test (or bronchodilation test) and response dose ratio (RDR) was collected. Differences between asthmatic and non-asthmatic group were analyzed. Spearman’s correlation coefficient (rho) was used to evaluate the correlation between FeNO50, CANO and other clinical parameters. Results: In patients with subacute cough, baseline CANO values did not differ between asthmatic and non-asthmatic patients (4.4(1.3, 11.4) versus 4.0(2.1, 6.8) ppb, P>0.05). Besides, CANO exhibited stronger association with pulmonary function parameters when compared with FeNO50. For asthmatic subacute cough, CANO was inversely correlated with FEV1/FVC (rho=-0.69, P<0.01) and small airway parameters including MEF25 (rho=-0.47, P<0.05) and MMEF (rho=-0.45, P<0.05). For non-asthmatic subacute cough, CANO was inversely correlated with MEF25 (rho=-0.19, P<0.05) and RDR (rho=-0.21, P<0.05). Conclusion: In subacute cough, asthmatic and non-asthmatic patients had similar values of baseline CANO. In both asthmatic and non-asthmatic subacute cough, CANO exhibited stronger association with pulmonary function parameters when compared with FeNO50. A low CANO value in non-asthmatic subacute cough corresponded to a higher value of RDR, which implied stronger tendency towards airway responsiveness.

Breast Cancer and Pregnancy: A Review

Breast cancer is one of the most commonly encountered types of malignancy during pregnancy. Here, we review the most recent data with regards to this special patient population. Current evidence shows that it is appropriate for oncologists to treat these patients carefully with a coordinated multidisciplinary approach.

Treatment of a Critically Ill COVID-19 Patient with the Seraph 100 Microbind Affinity Filter

The coronavirus disease 2019 (COVID-19) pandemic has a serious impact on health and economics worldwide. Even though the majority of patients present with moderate and mild symptoms, yet a considerable portion of patients need to be treated in the intensive care unit. Aside from dexamethasone, there is no established pharmacological therapy. Moreover, some of the currently tested drugs are contraindicated for special patient populations like remdesivir for patients with severely impaired renal function. On this background, several extracorporeal treatments are currently explored concerning their potential to improve the clinical course and outcome of critically ill patients with COVID-19. Here, we report the use of the Seraph 100 Microbind Affinity filter, which is licensed in the European Union for the removal of pathogens. Authorization for emergency use in patients with COVID-19 admitted to the intensive care unit with confirmed or imminent respiratory failure was granted by the U.S. Food and Drug Administration on April 17, 2020.A 53-year-old Caucasian male with a severe COVID-19 infection was treated with a Seraph Microbind Affinity filter hemoperfusion after clinical deterioration and commencement of mechanical ventilation. The 70-minute treatment at a blood flow of 200 mL/minute was well tolerated, and the patient was hemodynamically stable. The hemoperfusion reduced D-dimers dramatically.This case report suggests that the use of Seraph 100 Microbind Affinity filter hemoperfusion might have positive effects on the clinical course of critically ill patients with COVID-19. However, future prospective collection of data ideally in randomized trials will have to confirm whether the use of Seraph 100 Microbind Affinity filter hemoperfusion is an option of the treatment for COVID-19.

Practical Experience of Humanistic Care Among Medical Staff in Stroke Wards: A Qualitative Research Study Conducted in China

BackgroundAs a special patient group, stroke patients have a significant attachment to humanistic care. There are, however, still many problems in clinical practice. Medical staff in stroke wards are the main providers of humanistic care. Finding out the opinions of staff that provide the medical service is vitally important for stroke patients that need access to curative and humanistic care.ObjectiveThe aim of the study was to explore the psychological experiences of doctors, nurses and physiotherapists during the implementation of humanistic care in a stroke ward.MethodMedical staff including doctors, nurses and physiotherapists were selected from stroke wards in general hospitals (minimum level two) from 13 cities within six provinces in China. A purposive sampling method was used until no new data were generated (n=18). Semi-structured interviews were conducted by using a phenomenological research method. The Colaizzi seven-step method was used for analysis.ResultThe end user’s experience incorporated four themes: (1) Gradually improving the perception of humanistic caring in a stroke ward. (2) Required improvement of consciousness and ability of humanistic care implementors in a stroke ward. (3) Main problems and contradictions associated with implementing humanistic care in stroke wards. (4) Critical needs of staff in a stroke ward.ConclusionSteady advances have been made in the prevention and treatment of stroke in China. Care behaviour of staff in stroke wards has gradually improved. Nevertheless, while implementing humanistic care in stroke wards, the consciousness and ability of medical staff needs to be improved, in addition to the practical problems and contradictions affecting the development of humanistic care. In order to improve the level of humanistic care in stroke wards, attention should be paid to the overall improvement of the personal qualities of medical staff in stroke wards and the integration of a humanistic management mode.