Microwave ablation is a well-established therapeutic option for percutaneous treatment of lung tumors, however transbronchial microwave ablation remains under investigation. Our study aims to evaluate the safety and feasibility of transbronchial microwave ablation for lung cancer using state of the art bronchoscopy and imaging platforms and a microwave ablation system featuring tumor permittivity feedback control. This study is an investigator initiated multicenter prospective diagnose-stage-treat, then resect, trial designed to evaluate the safety and feasibility of bronchoscopic microwave ablation. Patients with surgically resectable, treatment-naïve primary lung cancer tumors ≤ 3.0 cm will undergo shape sensing robotic assisted bronchoscopy (ssRAB) with cone-beam CT imaging for diagnostic sampling. Following intraoperative pathologic verification of malignancy, transbronchial microwave ablation will be performed. Cone-beam CT imaging will be used for verification of microwave probe position and for evaluation of ablation zone. Dedicated CT chest will be performed two weeks post-ablation. Two to four weeks following ablation patients will undergo standard of care surgical resection. Post-resection histopathologic analysis will evaluate treatment effect. Enrollment began March 2024 as a single-center study. The study will transition to multi-center to increase recruitment and improve generalizability. This study will be a first of its kind using shape sensing robotic assisted bronchoscopy and cone-beam CT for transbronchial microwave ablation. Our treat and resect design will provide short-term clinical safety data and vital treatment effect data. This trial is registered at ClinicalTrials.gov (Identifier: NCT05281237 ). This study was prospectively registered on March 15, 2022.
Doxorubicin remains a cornerstone in sarcoma treatment, but its dose-dependent cardiotoxicity limits its clinical use and therapeutic potential. Dexrazoxane, the only FDA-approved cardioprotective agent, has demonstrated substantial efficacy in preventing doxorubicin-induced cardiotoxicity. However, despite its proven benefits, dexrazoxane remains underutilized not only in clinical practice but also in contemporary trials. This review examines the role of dexrazoxane in recent oncology trials involving sarcoma patients treated with high cumulative doses of doxorubicin. The LMS 04 trial, a contemporary phase 3 sarcoma trial in which dexrazoxane use was prohibited, reported a 5.4
The present paper provides the first integrated assessment of the capacity of the flavonol, fisetin, to induce hormetic dose responses. Fisetin was shown to induce hormetic dose responses in cellular and in vivo animal model systems affecting a broad range of endpoints of potential therapeutic and public health significance across the entire lifespan. Fisetin was effective in slowing aging processes, acting as a senolytic agent in multiple organ systems, in an hormetic fashion. In addition, fisetin was broadly neuroprotective, including during fetal development, and preventing the toxicity of methylmercury. Since these findings indicate that fisetin may have the potential to induce multi-system chemoprotective effects, it indicates the need to better clarify the absorption and bioavailability of fisetin and ways to enhance its efficiency.
e22517 Background: Tracheal, Bronchus, and Lung Cancer (TBL) are the primary causes of death and disability in the United States, accounting for nearly 25% of all neoplasm-related deaths. Among various risk factors, occupational exposure (OE) to carcinogens is a growing concern. Methods: Using Standardized global burden of disease methodologies, we estimated death, disability adjusted life years (DALYs), years lived with disability (YLDs), due to TBL cancer attributable to OC stratified by age, sex, year and location across the USA from 1990-2021. Results: From 1990-2021, the annual percentage change (APC) showed a general decline, with total number of deaths decreasing by -0.35%, DALYs by -0.86%, and YLDs by -0.17%. At the regional level, notable variations were observed: Alaska experienced the highest increase in death APC due to arsenic exposure +0.97%, while all states showed a decrease attributable to asbestos. Nevada recorded the highest increase in death APC from beryllium exposure (+0.09%) with a general increasing trend across all states. Both Wyoming and Nevada observed a +0.02% increase due to cadmium exposure. South Dakota saw a +0.17% increase due to chromium, and Alabama recorded a +0.43% increase from diesel engine exhaust. A declining trend was noted for nickel across all states. Utah had a +0.23% increase due to exposure to polycyclic aromatic hydrocarbons (PAH), and Alaska showed a significant rise of +1.19% from silica exposure. Age-wise, those 55 and older saw reductions in APC for deaths (-0.28%), DALYs (-0.75%), and YLDs (-0.09%). The 20-54 year age group noted more pronounced declines in death (-2.87%), DALYs (-2.95%), and YLDs (-2.28%). Gender analysis revealed that females had increased APC for deaths (+0.92%), DALYs (+0.35%), and YLDs (+1.15%), while males exhibited a declining trend. Conclusions: The study demonstrates an overall reduction in health burdens from 1990-2021, marked by declines in deaths, DALYs, and YLDs. Despite these gains, regional and demographic disparities highlight the continued impact of OE, particularly in states like Alaska and Nevada, and among different age groups and genders. These findings stress the need for targeted policies and improved safety standards to address persistent occupational health risks and achieve equitable health outcomes. Annual percentage of change in total number of deaths, DALYs and YLDs due to TBL cancer attributable to occupational carcinogens from 1990-2021. TBL cancer Attributable to OC APC (%), (1990-2021)Deaths APC (%),(1990-2021), (DALYs) APC (%),(1990-2021), (YLDs) Arsenic -0.43 -0.67 +0.05 Asbestos -0.35 -0.93 -0.22 Beryllium +0.04 -0.19 +0.55 Cadmium -0.35 -0.59 +0.13 Chromium -0.24 -0.48 +0.25 Diesel engine exhaust +0.11 -0.13 +0.61 Nickel -0.55 -0.79 -0.08 Polycyclic aromatic hydrocarbons (PAH) -0.18 -0.42 +0.32 Silica -0.59 -0.83 -0.12
Abstract Background Pre-exposure prophylaxis (PrEP) for HIV is a safe and effective strategy for HIV prevention among high-risk patient groups. Despite consistent experimental and real-world data showing benefit, PrEP is underutilized. There is a dearth of non-specialized providers engaging in PrEP services. The purpose of this project is to increase knowledge and prescribing of PrEP among a cohort of internal medicine (IM) residents. Methods A 3 hour interactive education session was provided to the IM residents of the University of Connecticut Categorical Internal Medicine Residency. Baseline knowledge was assessed with a pre-training survey. This survey was repeated up within six months to assess for a change in PrEP knowledge and prescribing. Results The pre-intervention (pre) survey was completed by 39 IM residents. The post-intervention (post) survey was completed by 25 IM residents from the same cohort. 4 participants from the post group were excluded as they had not completed a pre survey. Similar proportions indicated PrEP awareness pre- and post-intervention 97.4% and 100%, respectively. There was a numeric increase in the proportion of respondents reporting knowledge of PrEP indications from 69.2% pre to 85.7% post. Similar proportions reported prescribing PrEP 15.4% pre and 14.3% post. Those who had prescribed PrEP reported providing it to only 1-5 patients. When assessing for paired differences among a sub-set of participants who had both pre- and post scores, general knowledge of PrEP significantly improved. General knowledge scores averaged 8.6% pre and 22.6% post (p-value 0.001). Of the five general knowledge questions – testing individual domains -- the mean differences between pre and post scores were: 0.6 (95% CI 0.3-1.0), 0.2 (0.04-0.4), 0.05 (-0.1-0.2), 0.2 (0.007-0.4), 0.05 (-0.05-0.1), and 0.3 (0.08-0.5), respectively. Indicating that in all but 2 domains the 95% confidence interval did not include 0. Conclusion Among a cohort of IM residents from a mid-sized, university-based program, general PrEP knowledge was low despite widespread awareness. Knowledge was improved following an educational session; however, prescribing did not increase. Other barriers besides knowledge likely impact the likelihood of generalists, and in particular learners, to prescribe PrEP. Disclosures All Authors: No reported disclosures
