Immunotherapy: A new standard in the treatment of metastatic clear cell renal cell carcinoma

Renal cell cancer (RCC) represents 2%-3% of all adulthood cancers and is the most common malignant neoplasm of the kidney (90%). In the mid-nineties of the last century, the standard of treatment for patients with metastatic RCC was cytokines. Sunititib and pazopanib were registered in 2007 and 2009, respectively, and have since been the standard first-line treatment for metastatic clear cell RCC (mccRCC). Renal cell cancer is a highly immunogenic tumor with tumor infiltrating cells, including CD8+ T lymphocytes, dendritic cells, natural killer cells (NK) and macrophages. This observation led to the design of new clinical trials in which patients were treated with immunotherapy. With the growing evidence that proangiogenic factors can have immunomodulatory effects on the host’s immune system, the idea of combining angiogenic drugs with immunotherapy has emerged, and new clinical trials have been designed. In the last few years, several therapeutic options have been approved [immunotherapy and immunotherapy/tyrosine kinase inhibitors (TKI)] for the first-line treatment of mccRCC. Nivolumab/ipilimumab is approved for the treatment of patients with intermediate and poor prognoses. Several checkpoint inhibitors (pembrolizumab, nivolumab, avelumab) in combination with TKI (axitinib, lenvatinib, cabozantinib) are approved for the treatment of patients regardless of their International mRCC Database Consortium prognostic group and PD-L1 expression. There is no specific and ideal biomarker that could help in selecting the ideal patient for the appropriate first-line treatment.     

Household food insecurity and future orientation of Ghanaian youth and their parents

Food insecurity heightens risk for poor mental health and psychosocial functioning. Higher levels of future orientation influence numerous desirable behaviors. However, limited evidence exists on the association between food insecurity and future orientation, particularly in low-resource settings. The objective of this study was to examine the association between food insecurity and future orientation of Ghanaian youth and their parents. The study included a cross-sectional sample of 2656 youth and 2656 parents from 8 of Ghana’s 10 regions. Food insecurity was measured using the Household Food Insecurity Access Scale. Future orientation in the Ghanaian context was measured using three distinct factors adapted from the School Success Profile and the Consideration of Future Consequences scale. We analyzed our data using hierarchical linear modeling, with a three-level linear random-intercept model with covariates. Results suggest an inverse relationship between food insecurity and future orientation of youth and their parents. Food insecurity was consistently and significantly associated with lower orientation toward success (β = ?0.18, 95% confidence interval [CI] = ?0.22, ?0.14) and higher uncertainty of the future (β = 0.22, 95% CI = 0.17, 0.28) among youth, as well as lower consideration of future consequences (β = ?0.15, 95% CI = ?0.23, ?0.06) among parents. Additionally, severe food insecurity was associated with the lowest future orientation scores for youth and their parents. Our findings indicate that, under conditions of food insecurity, youth and their parents lose sight of the future, which may come at a great cost. Encouraging individuals to engage in thinking about the future or to create future images of their selves may not be meaningful if their basic needs, including access to food, are not met. Programs that provide opportunities to generate income and accumulate assets may have a twofold effect of increasing access to food and improving future orientation.     

Rationale and Methodology of the SARAH Trial: Long-Term Cardiovascular Outcomes in Patients With Resistant Hypertension and Obstructive Sleep Apnea

Introduction

Patients with resistant hypertension (RH) have a high risk of developing cardiovascular events; therefore, new therapeutic approaches to better control blood pressure may be useful in improving cardiovascular outcomes. The prevalence of obstructive sleep apnea (OSA) is very high among patients with RH. Continuous positive airway pressure (CPAP) has been shown to be an effective treatment for reducing blood pressure in patients with RH. Nevertheless, the long-term effect of CPAP treatment on cardiovascular outcomes has not been explored.The main objective of the SARAH study is to assess the impact of OSA and its treatment on cardiovascular outcomes (morbidity and mortality) in patients with RH.

Investigating the time‐lapsed effects of rigid cervical collars on the dimensions of the internal jugular vein

Protocol advocates the use of rigid cervical collars (RCCs) in head trauma patients as they are at risk of concomitant cervical spine injury. Literature has shown RCCs to be a potential cause of venous outflow obstruction, changing internal jugular vein (IJV) cross‐sectional area (CSA), and raising intracranial pressure (ICP). This study aims to investigate the effects of applying a RCC, for a period of four hours, on the dimensions of the IJV, in healthy participants. Seventeen participants (nine male, eight female) took part in this study. Circumference and CSAs of the IJV were measured bilaterally by a single observer using a GE LOGIQ e ultrasound system. Measurements were taken pre‐RCC application, immediately after, every hour over four hours, and five minutes postcollar removal. The CSA of the IJV was 8.3 ±6.0 mm² pre‐RCC application. The CSA of the IJV doubled (18.92 ±10.55 mm²) after four hours and decreased back to 9.36 ±6.8 mm² five minutes postcollar removal. The circumference of the IJV was 17.29 ±6.03 mm pre‐RCC application, increasing to 20.34 ±5.59 mm by the end of the fourth hour and returning to 16.14 ±5.16 mm five minutes postcollar removal. Related‐samples Friedman's ANOVA test showed statistically significant differences for both left and right CSAs and circumferences of the IJV measured across the four hours (P‐value<0.05). Ultrasound assessment of CSA of the IJV may correlate with changes in ICP. Further studies may provide insight into the effects of collar design, and guide future trauma protocol to minimize intracranial pressure fluctuations. Clin. Anat. 32:196–200, 2019. © 2018 Wiley Periodicals, Inc.     

5‐Alpha reductase inhibitors in androgenetic alopecia: Shifting paradigms,current concepts,comparative efficacy,and safety

Androgenetic alopecia (AGA) is a multifactorial disease that carries a significant psychological burden with it. Dihydrotestosterone, the main pathogenic androgen in AGA, is produced by conversion of testosterone, which is catalyzed by the 5‐alpha reductase (5‐AR) isoenzyme family. Finasteride and dutasteride are inhibitors of these enzymes. Finasteride, which is a single receptor 5‐alpha reductase inhibitor (5‐ARI), acts by blocking dihydrotestosterone (DHT). Dutasteride, a dual receptor DHT blocker, has a higher potency than its predecessor, finasteride. This review corroborates the evidence of superiority of dutasteride over finasteride, and its comparable safety profile concerning fertility, teratogenicity, neurotoxicity, and hepatotoxicity.