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Nathan Goodyear

Availability of evidence of benefits on overall survival and quality of life of cancer ... - 0 views

  • Although the goal of cancer treatment is to improve the quantity and quality of life,123 clinical trials designed to gain regulatory approval for new drugs often evaluate indirect or “surrogate” measures of drug efficacy. These endpoints show that an agent has biological activity, but they are not reliable surrogates for improved survival4567891011 or quality of life46111213
  • two recent systematic reviews suggest that the strength of association between surrogates in cancer clinical trials and life extension is generally low
  • Available data from the US show that only a small proportion of cancer treatments approved by the US Food and Drug Administration (FDA) unequivocally show benefits on survival or quality of life.30
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  • We sought to systematically evaluate the evidence base for all new drugs and new indications for the treatment of solid tumours and haematological malignancies approved by the EMA in the five year period 2009-13
  • Three investigators (AP, EP, and EG) independently extracted data on and descriptively analysed the following trial features: characteristics of the participant population, study design (randomisation, crossover from experimental to control group, and blinding of investigators and participants), experimental and control groups, enrolment, primary and secondary endpoints, magnitude of benefit on survival and quality of life, and narrative interpretation of the findings
  • Only 18 of the 68 (26%) were supported by a pivotal study powered to evaluate overall survival as the primary outcome
  • From 2009 to 2013, the EMA approved use of 48 oncology drugs
  • Seventeen drugs were approved for treatment of haematological malignancies and 51 for treatment of solid tumours
  • Overall, 72 clinical trials supported the approval of 68 novel drug uses
  • Our scoring was limited to drugs for solid tumours
  • Among 68 cancer drug indications approved by the EMA in the period 2009-13, and with a median of 5.4 years’ follow-up, only 35 (51%) were associated with a significant improvement in survival (26/35) or quality of life (9/35) over existing treatment options, placebo, or as add on treatment
  • Only two of the 26 drugs shown to extend life also showed benefits on quality of life
  • 33 (49%) had not shown any improvement on survival or quality of life
  • This systematic evaluation of oncology drug approvals by the EMA in 2009-13 shows that most of the drugs (39/68, 57%) entered the market without evidence of improved survival or quality of life
  • At a minimum 3.3 years after market entry, there was still no conclusive evidence that 33 of these 39 cancer drugs either extended or improved life
  • What are potential reasons for the paucity of drug approvals with demonstrable survival advantages over existing treatments?
  • Firstly, only 18 (26%) indications for use in our cohort were supported by trials in which extension of life was the primary outcome
  • None of the pivotal studies supporting oncology drug approvals from 2009 to 2013 included quality of life as a primary outcome measure
  • Most new oncology drugs authorised by the EMA in 2009-13 came onto the market without clear evidence that they improved the quality or quantity of patients’ lives
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    New study from European Medicines Agency questions alot of the new cancer drugs brought to the market 2009-2013.  57% of the new drugs (39/68) were brought to the market without evidence of improved survival or quality of life.
wheelchairindia9

Tubular Elastic Bandage - 0 views

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    Tubular Elastic Bandage provides uniform compression and support of the appendages with minimal risk of constriction. It is easy to apply and comfortable to wear, without the need of any clips or tape to hold it in place. Compressive strength remains consistent over a long period of use. This versatile, bandage is an economical and a better substitute for elastic wraps, and other general supports. Holds cold/hot packs or bandages in place. It offers good compression and help to minimize inflammation.The compression can be increased by increasing the layers of the bandage. Washable. Breathable and Hypo allergenic. Remains cool in summers and warm in winters. Uniform compression. Soft to touch, good to feel. Tubular Elastic Bandage Features High Quality Cotton Yarn Is breathable, hypo allergic, dermophilic, remains cool in summers & warm in winters. It is soft to touch, good to feel and is washable. State of Art Knitting Provides uniform compression, long functional life and firm fitting. Tubular Design Quick and easy wearing, without any pins or tapes. Provides complete freedom of movement. Fawn Colored Matches skin color, has better aesthetics. Can be worn inconspicuously under clothing.
Nathan Goodyear

Branched Chain Amino Acid Supplementation for Patients with Cirrhosis | Clinical Correl... - 0 views

  • low level of BCAAs in patients with cirrhosis is hypothesized to be one of multiple factors responsible for development of hepatic encephalopathy
  • supplementation of BCAAs is thought to facilitate ammonia detoxification by supporting synthesis of glutamine, one of the non-branched chain amino acids, in skeletal muscle and in the brain as well as diminishing the influx of AAAs across the blood-brain barrier
  • oral BCAA supplementation is more useful in chronic encephalopathic patients than is parenteral BCAA supplementation in patients with acute encephalopathy
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  • malnutrition progressing to cachexia is another common manifestation of cirrhosis
  • Malnutrition can be mitigated with BCAA supplementation
  • Studies show that administration of amino acid formulas enriched with BCAAs can reduce protein loss, support protein synthesis, and improve nutritional status of patients with chronic liver disease
  • Leucine has been shown to be the most effective of the BCAAs because it acts via multiple pathways to stimulate protein synthesis
  • BCAAs metabolites inhibit proteolysis
  • Patients with cirrhosis have both insulin deficiency and insulin resistance
  • BCAAs (particularly leucine) help to reverse the catabolic, hyperglucagonemic state of cirrhosis both by stimulating insulin release from the pancreatic β cells and by decreasing insulin resistance allowing for better glucose utilization
  • Coadministration of BCAAs and glucose has been found to be particularly useful
  • BCAA supplementation improves protein-energy malnutrition by improving utilization of glucose, thereby diminishing the drive for proteolysis, inhibiting protein breakdown, and stimulating protein synthesis
  • Cirrhotic patients have impaired immune defense, characterized by defective phagocytic activity and impaired intracellular killing activity
  • another effect of BCAA supplementation is improvement of phagocytic function of neutrophils and possibly improvement in natural killer T (NKT) cell lymphocyte activity
  • BCAA supplementation may reduce the risk of infection in patients with advanced cirrhosis not only through improvement in protein-energy malnutrition but also by directly improving the function of the immune cells themselves
  • BCAA administration has also been shown to have a positive effect on liver regeneration
  • A proposed mechanism for improved liver regeneration is the stimulatory effect of BCAAs (particularly leucine) on the secretion of hepatocyte growth factor by hepatic stellate cells
  • BCAAs activate rapamycin signaling pathways which promotes albumin synthesis in the liver as well as protein and glycogen synthesis in muscle tissue
  • Chemical improvement with BCAA treatment is demonstrated by recovery of serum albumin and lowering of serum bilirubin levels
  • long-term oral BCAA supplementation was useful in staving off malnutrition and improving survival by preventing end-stage fatal complications of cirrhosis such as hepatic failure and gastrointestinal bleeding
  • The incidence of death by any cause, development of liver cancer, rupture of esophageal varices, or progression to hepatic failure was decreased in the group that received BCAA supplementation
  • Patients receiving BCAA supplementation also have a lower average hospital admission rate, better nutritional status, and better liver function tests
  • patients taking BCAA supplementation report improved quality of life
  • BCAAs have been shown to mitigate hepatic encephalopathy, cachexia, and infection rates, complications associated with the progression of hepatic cirrhosis
  • BCAAs make up 20-25% of the protein content of most foods
  • Highest levels are found in casein whey protein of dairy products and vegetables, such as corn and mushrooms. Other sources include egg albumin, beans, peanuts and brown rice bran
  • In addition to BCAAs from diet, oral supplements of BCAAs can be used
  • Oral supplementation tends to provide a better hepatic supply of BCAAs for patients able to tolerate PO nutrition as compared with IV supplementation, especially when treating symptoms of hepatic encephalopathy
  • Coadministration of BCAAs with carnitine and zinc has also been shown to increase ammonia metabolism further reducing the encephalopathic symptoms
  • Cirrhotic patients benefit from eating frequent, small meals that prevent long fasts which place the patient in a catabolic state
  • the best time for BCAA supplementation is at bedtime to improve the catabolic state during starvation in early morning fasting
  • A late night nutritional snack reduces symptoms of weakness and fatigability, lowers postprandial hyperglycemia, increases skeletal muscle mass,[25] improves nitrogen balance, and increases serum albumin levels.[26] Nocturnal BCAAs even improve serum albumin in cirrhotic patients who show no improvement with daytime BCAAs
  • Protein-energy malnutrition (PEM), with low serum albumin and low muscle mass, occurs in 65-90% of cases of advanced cirrhosis
  • hyperglucagonemia results in a catabolic state eventually producing anorexia and cachexia
  • BCAAs are further depleted from the circulation due to increased uptake by skeletal muscles that use the BCAAs in the synthesis of glutamine, which is produced in order to clear the ammonia that is not cleared by the failing liver
  • patients with chronic liver disease, particularly cirrhosis, routinely have decreased BCAAs and increased aromatic amino acids (AAAs) in their circulation
  • Maintaining a higher serum albumin in patients with cirrhosis is associated with decreased mortality and improved quality of life
  • the serum BCAA concentration is strongly correlated with the serum albumin level
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    great review of cirrhosis and BCCA supplementation.
wheelchairindia9

Best Tennis Elbow Support - 0 views

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    Tynor Wrist Brace with Thumb is created to reinforce, prevent and partially immobilize the wrist and the palm. This wrist brace allows natural and free activity of the fingers. It keeps the affected area compact and maintains the body heat to lessen the local pain inflammation. Its has high quality striped elastic webbing which provides high modulus of elasticity which gives the comfortable feel. It is made from the strong, durable, porous and a comfortable material which remains for a long time. This Wrist Brace provides excellent compressive strength and support to the wrist. Its Hook loop closures allow easy application and removal. It fits comfortably around the wrist and comes in universal sizing. It also has an anatomical thumb opening which fastens the healing process. It keeps the thumb in relaxed and comfortable position. Its extra porous material allows the proper ventilation to the affected skin. Wrist brace with thumb is designed to support, protect and partially immobilize the wrist and the palm while allowing free and natural movement of the fingers. It compresses the area and retains the body heat to allay local pain and inflammation. Extra grip. Extra porous Controlled compression. Anatomical thumb placement. Tynor Wrist Brace with Thumb Features High quality , striped elastic webbing Strong and durable Porous and comfortable High modulus of elasticity- Retains shape and size for a long time. Excellent compressive strength, better support Hook loop closures Easy to apply and remove Ensures optimal compression Better fitting and universal sizing. Anatomical thumb opening Better pain relief and healing. Thumb in abduction remains relaxed, no fatigue Improves comfort Allows free and natural movement of the thumb and fingers. Tynor tennis elbow support is specially crafted to aid and render relief from generalized pain and tenderness in the forearm and elbow caused by repetitive strain injury due to the firm grip or ac
wheelchairindia9

Wrist and Forearm Splints Causes and Recovery Period | Health | Article Point - 0 views

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    Wrist and forearm splints may be suggested for people with weak wrists or for those that have been previously injured, for tendonitis wrist support and even as a preventative for those who awaken in the morning with pain or numbness after sleeping on their hands at night. The best orthopedic wrist braces for carpal tunnel syndrome, occupational stabilization and relief from the pain of wrist strains and sprains. This Right hand wrist and forearm splint from tynor is meant to be used among patients suffering from any injury or sprain in these regions. The splint is meant to provide controlled compression in various orthopaedic conditions. The splint immobilizes the area that helps in a speedier recovery. It has anatomical thumb opening that allows free movement of the thumb. It provides a lot of comfort and is easily breathable. Forearm splint is the term used to describe the forearm pain similarly the pain of lower leg over the shin is known as shin splints. Forearm splint describes the painful disease of elbow or wrist joint. Continuous pain in forearm is often caused by tendonitis, joint injury or hairline fracture of forearm bones (proximal radius or ulna near elbow joint). Overstretching of the elbow joint often causes forearm injury. Symptoms consist of a dull pain in the forearm. Pain is minor initially but increases as activity continues. Often pin-pointed to the dorsal or back of the hand side of the forearm, mid-way between the wrist and elbow. The patient may experience weakness in the wrist extensor muscles and tenderness deep in the forearm. Pain may be reproduced by attempting to bend the wrist backwards against resistance. They provided wrist splints are used in different medical institutions and hospitals for management of hand fractures. Our offered wrist splints are manufactured by skilled professionals using optimum quality basic material and advanced technology as per the set norms of market. As well, these wrist splints can be availed in v
wheelchairindia9

Chair For Cerebral Palsy Child - 0 views

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    Cerebral palsy (CP) is a group of conditions caused by medical abnormalities in the development of a fetus or the early life of a child. These lead to damage or delayed development in the brain. The disorder is permanent and, though it does not worsen with age, the level of functionality of a person with cerebral palsy varies widely: in some cases, effects may be very minor, while in others, movement is impaired to the extent that a wheelchair is required. Common complications associated with CP vary by the type of CP disorder but can include vision problems, seizures, learning disabilities, and issues speaking, writing, and performing other tasks. Cerebral palsy causes problems with muscle tone, movement, balance and/or coordination. Symptoms and effects range from mild to severe. In some infants, problems are evident soon after birth. In others, diagnosis comes in later infancy or toddlerhood. Cerebral Palsy Wheelchair Description: The model designed for cerebral palsy child only. Ultra light weight aluminium alloy frame. Seat Width 38 cms (15"). Net Weight: 18.5 kgs. Epoxy powder coated frame. Detachable arm rest & foot rest provided. Elevated and swinging foot rest. Elevated foot rest provided to elevate leg angle. Height adjustable and detachable head rest. Hydraulic reclining high back for a comfortable posture. Hydraulic adjustable seat angle. Detachable back and seat pad. Extra cushion upholstery provided to under arm, head & calg Foldable. Lever and paddle brakes provided. Safety belt provided. Maintenance free rear solid wheels. Cloth look like water proof upholstery. Anti wheels for better safety and stability. Extra cushion upholstery provided to under arm, head & leg Folding action. Lever and paddle brakes provided. Safety belt provided. Maintenance free rear solid wheels. Cerebral Palsy Wheelchair Recline system: Recline system provides kids with the most comfortable resting environment. It also allows stretching abdomin
umar111

Body Luxuries Miracle Perfume for Ladies - 0 views

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    Body Luxuries Miracle Perfume for Ladies The Scent That Will Make You Feel Divine. Perfume is an essential part of every woman's beauty regimen. The right scent can lift your mood, boost your confidence, and make you feel divine. But finding the perfect perfume can be a challenge with so many options available in the market. This is where Body Luxuries Miracle Perfume comes in, a fragrance that promises to make you feel like a goddess. What is Body Luxuries Miracle Perfume? Body Luxuries Miracle Perfume is a luxury fragrance designed for women who want to feel confident, alluring, and sophisticated. This fragrance is made from high-quality ingredients, making it long-lasting and ideal for everyday wear. Its unique blend of floral and fruity notes creates a delightful aroma that is sure to turn heads. What makes Body Luxuries Miracle Perfume so special? The scent of Body Luxuries Miracle Perfume is both sensual and captivating. It has a top note of juicy pear and luscious peach that gives it a fruity aroma. The heart notes are a blend of floral scents such as jasmine, lily-of-the-valley, and peony, which give it a feminine touch. The base notes of vanilla, musk, and cedarwood create a warm and inviting aroma, making it perfect for any occasion. The fragrance is long-lasting, so you can wear it all day without having to reapply. This makes it ideal for women who want to smell great throughout the day. Additionally, Body Luxuries Miracle Perfume is affordable, making it accessible to women from all walks of life. How to use Body Luxuries Miracle Perfume To get the best out of Body Luxuries Miracle Perfume, you need to apply it correctly. Start by taking a shower and moisturizing your skin. This will help the fragrance to last longer. Next, spray the perfume onto your pulse points, such as your wrists, neck, and behind the ears. These areas are warmer than other parts of your body, which helps the fragrance to diffuse better. Conclusion Original Body Luxuries Miracle P
Nathan Goodyear

Healthcare | Free Full-Text | The Effects of Resistance Training on Physical Function a... - 0 views

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    Breast cancer survivors (BCS) exhibit decreased physical function and quality of life (QOL) following cancer treatments. Resistance training (RT) may elicit positive changes in physical and mental well-being. This study assessed 27 BCS, pre-and post-intervention (six months) on the following variables: muscular strength (via one repetition maximum (1RM) of chest press and leg extension), physical function (via the Continuous Scale-Physical Functional Performance test) and QOL (via the Short Form-36 survey). RT consisted of two days/week of ten exercises including two sets of 8-12 repetitions at 52%-69% of their 1RM. A repeated measures analysis of variance revealed BCS significantly (p < 0.05) increased upper (71 ± 22 to 89 ± 22 kg) and lower body (74 ± 18 to 93 ± 24 kg) strength, total physical function (65.5 ± 12.1 to 73.6 ± 12.2 units) and the subcomponents of physical function: upper body strength (63.5 ± 16.3 to 71.2 ± 16.8 units), lower body strength (58.5 ± 14.9 to 68.6 ± 16.3 units), balance and coordination (66.5 ± 12.2 to 74.6 ± 11.6 units), and endurance (67.2 ± 12.0 to 75.0 ± 11.6 units). No changes were observed over time for subjective measures of physical function and QOL. Results showed RT could be an effective means to improve objective physical function in BCS. Further research is needed to clarify the effects of RT on subjective physical function and QOL.
wheelchairindia9

Tynor Wrist Brace with Thumb - 0 views

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    Tynor Wrist Brace with Thumb is created to reinforce, prevent and partially immobilize the wrist and the palm. This wrist brace allows natural and free activity of the fingers. It keeps the affected area compact and maintains the body heat to lessen the local pain inflammation. Its has high quality striped elastic webbing which provides high modulus of elasticity which gives the comfortable feel. It is made from the strong, durable, porous and a comfortable material which remains for a long time. This Wrist Brace provides excellent compressive strength and support to the wrist. Its Hook loop closures allow easy application and removal. It fits comfortably around the wrist and comes in universal sizing. It also has an anatomical thumb opening which fastens the healing process. It keeps the thumb in relaxed and comfortable position. Its extra porous material allows the proper ventilation to the affected skin. Tynor Wrist Brace with Thumb Wrist brace with thumb is designed to support, protect and partially immobilize the wrist and the palm while allowing free and natural movement of the fingers. It compresses the area and retains the body heat to allay local pain and inflammation. Extra grip. Extra porous Controlled compression. Anatomical thumb placement. Tynor Wrist Brace with Thumb Features High quality , striped elastic webbing Strong and durable Porous and comfortable High modulus of elasticity- Retains shape and size for a long time. Excellent compressive strength, better support Hook loop closures Easy to apply and remove Ensures optimal compression Better fitting and universal sizing. Anatomical thumb opening Better pain relief and healing. Thumb in abduction remains relaxed, no fatigue Improves comfort Allows free and natural movement of the thumb and fingers. Tynor Tennis Elbow Support Tennis Elbow Support is designed to help provide relief from generalized pain and tenderness in the forearm and elbow caused by repetitiv
wheelchairindia9

Golden Motor Electric Wheelchair - 0 views

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    Powerchairs are generally four-wheeled or six-wheeled and non-folding, however some folding designs exist and other designs may have some ability to partially dismantle for transit. Four general styles of powerchair drive systems exist: front, centre or rear wheel drive and all-wheel drive. Powered wheels are typically somewhat larger than the trailing/castoring wheels, while castoring wheels are typically larger than the castors on a manual chair. Centre wheel drive powerchairs have castors at both front and rear for a six-wheel layout. Angel Wheelchair Electric standing wheelchair Standing up, driving function by power. Head and signal light (controlled by joystick). Adjustable headrest. Adjustable footplate. Detachable backrest Rigid steel framework W/liquid coating Flip-backward armrest Max speed: 9.15KM/H Front castor: 2.80/2.50-4 pneumatic castor (9") Rear wheels: 3.00-8 pneumatic tire (14") Available seat width: A (46 cm), D (42 cm) Max loading: A size: 135 kg Net weight w/o battery: 62.7 kg A powerchairs is a wheelchair that is propelled by means of an electric motor rather than manual power. Power wheelchairs are useful for those unable to propel a manual wheelchair or who may need to use a wheelchair for distances or over terrain which would be fatiguing in a manual wheelchair. They may also be used not just by people with 'traditional' mobility impairments, but also by people with cardiovascular and fatigue based condition. An powerwheelchair powers more than just chair. It gives the power to safely travel long distances on own. It empowers to navigate through home, backyard, school, workplace or local park. It gives power to do the things,want to do. It gives power. When accidents occur that leave permanent leg injuries, or as age sets in and joint pain becomes unbearable, the power chair acts as a gateway to continue living life to the fullest. The powerwheelchairs in our lineup are all battery powered, yet each device fills
spineneuro

Living Life Upright: Kyphosis Treatment and Your Quality of Life - 0 views

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    The medical care provided by the staff at this kyphosis treatment hospital is of high quality, and communication with patients is excellent. As a result, an increasing number of patients are choosing India for their kyphosis treatment and recovery due to the combination of outstanding medical care and cost-effectiveness.
wheelchairindia9

Manual Wheelchairs - 0 views

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    Manual wheelchairs are the type that require people to move them, there are three types of manual wheelchairs namely self-propelled, attendant propelled, and wheelbase. Many manual chairs can be folded wheelchairs for storage or movement into a vehicle. A manual wheelchair is one that is propelled by the user. It is usually done by pushing on round bars that surround the wheels. This wheelchair also has handles on the back so it can be pushed by another person. A manual wheelchair is easy to maintain, is lightweight, and is the least expensive to buy. Manual wheelchairs that cater to many different conditions that a user may have. Manual wheelchairs includes a large selection of high quality chairs that are highly competitive in price. It carry many different categories of wheelchairs, depending on condition can find one that best fits lifestyle. Manual Wheelchairs are the type of device that a person must move themselves without the assistance of a battery. It choose from self-propel, which requires the user to propel with the use of their limbs, and companion propelled, which means that must have a person to push. It believe that users will be able to find the best manual wheelchair available for their specific needs. A lightweight manual wheelchair offers a combination of safety and durability with convenient features such as flip-back armrests and swingaway footrests for easier transfers, and height-adjustable rear wheels. It is available in self-propelled and attendant-assisted versions, and can be quickly demounted for easier transportation. It has quick release rear wheels, swing away and detachable armrests, swing in/out footrests, puncture proof tyres, fitted lap belt, folding backrest and lightweight, padded nylon upholstery. Karma Econ 800 Wheelchair The new multi-adjustable ECON 800 is a quality, lightweight aircraft grade aluminium alloy frame wheelchair. The swing-away and detachable footrest's calf length can be adjusted to fit your bod
wheelchairindia9

Easily Adjust Wrist & Forearm Splint with Thumb - 0 views

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    Wrist and Forearm Splint is designed to immobilize and provide firm and comfortable support to hand and wrist in various orthopedic conditions. It maintains the wrist in the functional position. Tynor's Wrist & Forearm Splint Right/Left Extra Large is made out of very sturdy PUF fused fabric & malleable, anatomically shaped splints. Designed for perfect support & immobilization of wrist & forearm. Tynor Wrist & Forearm Splint Right/Left is designed to provide comfortable and firm support to the wrist as well as to the forearm. It effectively works during various orthopedic conditions. It will keep the wrist in the functional position and speed up the recovery process. It will feel comfortable and relieved after applying this wrist and forearm support. The PUF fused fabric provide comfortable and smooth feel which does not cause any rashes on the skin. It allows proper ventilation system to the skin area and also the skin to breathe properly. It has aluminum splints which are easy to remove and apply as well as offers a better grip and a snug fit. It also has long length that will permit the easy movement. This brace enables free finger movement. It has a hook loop closure system which provides optimal compression and it can easily adjust it as per the requirement. Its brace has an in-built thumb opening which keeps the thumb relaxed and free from pressure. Wrist and Forearm Splint is designed to immobilize and provide firm and comfortable support to hand and wrist in various orthopedic conditions. It maintains the wrist in the functional position. Aesthetically appealing. Customizable splint. Perfect immobilization. Controlled compression. Anatomical thumb opening. Tynor Wrist & Forearm Splint (Right/Left) Features Made out of PUF fused Matty fabric Breathable Excellent aesthetics Improved comfort Enhanced life. Removable, Aluminum Splints Customized fitting Required degree of dorsi-flexion can be achieved Very good grip and immobilizat
wheelchairindia9

Tynor Elbow Support - 0 views

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    Tynor Wrist Brace with Double Lock is designed with a double lock that will make it simple to apply and remove. Its double lock feature gives rigid support to the wrist. It partially keeps the wrist immobilized. It can easily adjust the compression around the affected area as per the desire. It provides the warming feel to the injured area to allay the local pain and inflammation. It has a high modulus of elasticity which works for a long time, even if use this on a regularl basis. It has striped elastic webbing which is of high quality material. This double lock wrist brace is strong, rigid and comfortable to wear. Its material is porous in nature which keeps the affected area air ventilated. It can adjust the compression pressure according to the will. Its double hook loop locking system is easy to apply and remove as well as comes with universal sizing. This wrist brace provides strength and support to the wrist and keep the wrist protected against the further injury or damage. Tynor Wrist Brace with Double Lock Wrist brace with double lock is designed to support, protect and partially immobilize the wrist. It compresses the area and retain the body heat to allay local pain and inflammation. Extra grip. Extra porous Controlled compression. Easy application. Tynor Wrist Brace with Double Lock Features High quality, striped elastic webbing Strong and durable Porous and comfortable High modulus of elasticity- Retains shape and size for a long time. Excellent compressive strength, better support Hook loop Double locking Easy to apply and remove Ensures optimal compression Better fitting and universal sizing. Tynor Elbow Support Elbow support provides firm compression, warmth & support to the forearm and the elbow joint, to allay pain inflammation and stiffness, generally associated with old age, arthritis, sports injury etc. Light weight Four way stretch Freely breathable Soft and comfortable Tynor Elbow Support Features Anatom
Nathan Goodyear

Testosterone deficiency and quality of life in ... [Intern Med J. 2014] - PubMed - NCBI - 0 views

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    Small study in men s/p Testicular cancer found no association between Testosterone levels and quality of life measures.
indian-health

Cardiac Surgeons in Mumbai Opens the Door to Your New Life - 0 views

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    Cardiac surgery in India is available at a fraction of the cost international patients would have to pay elsewhere. The low cardiac surgery cost in India attracts hundreds of cardiac patients from abroad. In comparison to the western nations such as Britain and the US, the cardiac surgery cost in India is just a fraction of what it costs there.Top heart hospitals of Mumbai offer healthcare services at extremely affordable rates, backed with high-quality results as far as global patients all across the world are concerned. The top heart hospitals of Mumbai keep good quality and are equipped with a skilled team of surgeons using robotic surgery in India.
wheelchairindia9

Tynor Ankle Binder - 0 views

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    The boot type walkers can be provided in a fixed mode or with ankle joints to provide articulation. Pneumatic support is also available. The brace has a lightweight, durable, semi rigid shell that will support the limb and provide protection. Incorporated are medial and lateral uprights, heel and rocker sole. Closure is achieved with Velcro. The strapping system provides full circumferential compression of the limb. The breathable fiber liner is washable. The articulated boot allows range of motion (ROM) usually from approximately 20 degrees dorsiflexion to 40 degrees plantar flexion. Tynor Walker Boot is designed by the Tynor to rehabilitate the person after injury or fracture. It allows easy movement as well as supports the ankle and leg. This can be a great substitute for cast and also useful during early cast removal. It can also be used during sprain in the foot and this walker gives great relief to the pain. It can easily do any mild activity. It also works for the persons with a lower leg and will give an equal level of the lower feet as well as reduces the pressure. It effectively enclosed the muscles of the leg or foot during the fracture and gives comfort without disturbing the recovery process. This walker boot is made up from the good quality material. It has Aluminum lateral bars that are corrosion free. It is light in weight and provides enhanced mobility. It gives sturdy support to feet and leg. Its Hook Loop system allows to adjust it according to the comfort. It is also infused with Foam liner and Pad set that gives soft feet and also provides great support. It is available in different sizes. Tynor Walker Boot is designed for rehabilitation after injury, fracture , sprains or surgery of foot, ankle or lower leg. The boots provide support to the ankle and leg without inhibiting mobility. They can be a substitute for cast or can be used in case of early cast removal. With a wider rocker bottom, these boots promote a natural gait, reduced
Nathan Goodyear

Metabolic management of brain cancer - 0 views

  • Glutamine is a major metabolic fuel for both brain tumor cells and tumor-associated macrophages (TAMs)
  • the malignant phenotype of brain tumor cells that survive radiotherapy is often greater than that of the cells from the original tumor.
  • Conventional chemotherapy has faired little better than radiation therapy for the long-term management of malignant brain cancer
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  • most conventional radiation and brain cancer chemotherapies can enhance glioma energy metabolism and invasive properties, which would contribute to tumor recurrence and reduced patient survival [34].
  • We contend that all cancer regardless of tissue or cellular origin is a disease of abnormal energy metabolism
  • complex disease phenotypes can be managed through self-organizing networks that display system wide dynamics involving oxidative and non-oxidative (substrate level) phosphorylation
  • As long as brain tumors are provided a physiological environment conducive for their energy needs they will survive; when this environment is restricted or abruptly changed they will either grow slower, growth arrest, or perish [8] and [19]
  • New information also suggests that ketones are toxic to some human tumor cells and that ketones and ketogenic diets might restrict availability of glutamine to tumor cells [68], [69] and [70].
  • The success in dealing with environmental stress and disease is therefore dependent on the integrated action of all cells in the organism
  • Tumor cells survive in hypoxic environments not because they have inherited genes making them more fit or adaptable than normal cells, but because they have damaged mitochondria and have thus acquired the ability to derive energy largely through substrate level phosphorylation
  • Cancer cells survive and multiply only in physiological environments that provide fuels (mostly glucose and glutamine) subserving their requirement for substrate level phosphorylation
  • Integrity of the inner mitochondrial membrane is necessary for ketone body metabolism since β-hydroxybutyrate dehydrogenase, which catalyzes the first step in the metabolism of β-OHB to acetoacetate, interacts with cardiolipin and other phospholipids in the inner membrane
  • the mitochondria of many gliomas and most tumors for that matter are dysfunctional
  • Cardiolipin is essential for efficient oxidative energy production and mitochondrial function
  • Any genetic or environmental alteration in the content or composition of cardiolipin will compromise energy production through oxidative phosphorylation
  • The Crabtree effect involves the inhibition of respiration by high levels of glucose
  • the Warburg effect involves elevated glycolysis from impaired oxidative phosphorylation
  • the Crabtree effect can be reversible, the Warburg effect is largely irreversible because its origin is with permanently damaged mitochondria
  • The continued production of lactic acid in the presence of oxygen is the metabolic hallmark of most cancers and is referred to as aerobic glycolysis or the Warburg effect
  • We recently described how the retrograde signaling system could induce changes in oncogenes and tumor suppressor genes to facilitate tumor cell survival following mitochondrial damage [48].
  • In addition to glycolysis, glutamine can also increase ATP production under hypoxic conditions through substrate level phosphorylation in the TCA cycle after its metabolism to α-ketoglutarate
  • mitochondrial lipid abnormalities, which alter electron transport activities, can account in large part for the Warburg effect
  • targeting both glucose and glutamine metabolism could be effective for managing most cancers including brain cancer
  • The bulk of experimental evidence indicates that mitochondria are dysfunctional in tumors and incapable of generating sufficient ATP through oxidative phosphorylation
  • Cardiolipin defects in tumor cells are also associated with reduced activities of several enzymes of the mitochondrial electron transport chain making it unlikely that tumor cells with cardiolipin abnormalities can generate adequate energy through oxidative phosphorylation
  • The Crabtree effect involves the inhibition of respiration by high levels of glucose
  • Warburg effect involves elevated glycolysis from impaired oxidative phosphorylation
  • TCA cycle substrate level phosphorylation could therefore become another source of ATP production in tumor cells with impairments in oxidative phosphorylation
  • Caloric restriction, which lowers glucose and elevates ketone bodies [63] and [64], improves mitochondrial respiratory function and glutathione redox state in normal cells
  • DR naturally inhibits glycolysis and tumor growth by lowering circulating glucose levels, while at the same time, enhancing the health and vitality of normal cells and tissues through ketone body metabolism
  • DR is anti-angiogenic
  • DR also reduces angiogenesis in prostate and breast cancer
  • We suggest that apoptosis resistance arises largely from enhanced substrate level phosphorylation of tumor cells and to the genes associated with elevated glycolysis and glutaminolysis, e.g., c-Myc, Hif-1a, etc, which inhibit apoptosis
  • Modern medicine has not looked favorably on diet therapies for managing complex diseases especially when well-established procedures for acceptable clinical practice are available, regardless of how ineffective these procedures might be in managing the disease
  • More than 60 years of clinical research indicates that such approaches are largely ineffective in extending survival or improving quality of life
  • The process is rooted in the well-established scientific principle that tumor cells are largely dependent on substrate level phosphorylation for their survival and growth
  • Glucose and glutamine drive substrate level phosphorylation
  • targeting the glycolytically active tumor cells that produce pro-cachexia molecules, restricted diet therapies can potentially reduce tumor cachexia
  • It is important to recognize, however, that “more is not better” with respect to the ketogenic diet
  • Blood glucose ranges between 3.0 and 3.5 mM (55–65 mg/dl) and β-OHB ranges between 4 and 7 mM should be effective for tumor management
  •  
    Dr Seyfriend presents his metabolic approach to the treatment of brain cancer.
Nathan Goodyear

Vitamin C preferentially kills cancer stem cells in hepatocellular carcinoma via SVCT-2... - 0 views

  • Chen et al. have revealed that ascorbate at pharmacologic concentrations (0.3–20 mM) achieved only by intravenously (i.v.) administration selectively kills a variety of cancer cell lines in vitro, but has little cytotoxic effect on normal cells.
  • Ascorbic acid (the reduced form of vitamin C) is specifically transported into cells by sodium-dependent vitamin C transporters (SVCTs)
  • SVCT-1 is predominantly expressed in epithelial tissues
  • ...41 more annotations...
  • whereas the expression of SVCT-2 is ubiquitous
  • differential sensitivity to VC may result from variations in VC flow into cells, which is dependent on SVCT-2 expression.
  • high-dose VC significantly impaired both the tumorspheres initiation (Fig. 4d, e) and the growth of established tumorspheres derived from HCC cells (Fig. 4f, g) in a time-dependent and dose-dependent manner.
  • Hepatocellular carcinoma (HCC)
  • The antioxidant, N-acetyl-L-cysteine (NAC), preventing VC-induced ROS production (a ROS scavenger), completely restored the viability and colony formation among VC-treated cells
  • DNA double-strand damage was found following VC treatment
  • DNA damage was prevented by NAC
  • Interestingly, the combination of VC and cisplatin was even more effective in reducing tumor growth and weight
  • Consistent with the in vitro results, stemness-related genes expressions in tumor xenograft were remarkably reduced after VC or VC+cisplatin treatment, whereas conventional cisplatin therapy alone led to the increase of CSCs
  • VC is one of the numerous common hepatoprotectants.
  • Interestingly, at extracellular concentrations greater than 1 mM, VC induces strong cytotoxicity to cancer cells including liver cancer cells
  • we hypothesized that intravenous VC might reduce the risk of recurrence in HCC patients after curative liver resection.
  • Intriguingly, the 5-year disease-free survival (DFS) for patients who received intravenous VC was 24%, as opposed to 15% for no intravenous VC-treated patients
  • Median DFS time for VC users was 25.2 vs. 18 months for VC non-users
  • intravenous VC use is linked to improved DFS in HCC patients.
  • In this study, based on the elevated expression of SVCT-2, which is responsible for VC uptake, in liver CSCs, we revealed that clinically achievable concentrations of VC preferentially eradicated liver CSCs in vitro and in vivo
    • Nathan Goodyear
       
      the authors here made similar mistakes to the Mayo authors i.e. under doses here in this study.  They dosed at only 2 grams IVC.  A woefully low dose of IVC.
  • Additionally, we found that intravenous VC reduced the risk of post-surgical HCC progression in a retrospective cohort study.
    • Nathan Goodyear
       
      positive results despite a low dose used.
    • Nathan Goodyear
       
      Their comfort zone was 1mM.  They should have targeted 20-40 mM.
  • Three hundred thirty-nine participants (55.3%) received 2 g intravenous VC for 4 or more days after initial hepatectomy
  • As the key protein responsible for VC uptake in the liver, SVCT-2 played crucial roles in regulating the sensitivity to ascorbate-induced cytotoxicity
  • we also observed that SVCT-2 was highly expressed in human HCC samples and preferentially elevated in liver CSCs
  • SVCT-2 might serve as a potential CSC marker and therapeutic target in HCC
  • CSCs play critical roles in regulating tumor initiation, relapse, and chemoresistance
  • we revealed that VC treatment dramatically reduced the self-renewal ability, expression levels of CSC-associated genes, and percentages of CSCs in HCC, indicating that CSCs were more susceptible to VC-induced cell death
  • as a drug for eradicating CSCs, VC may represent a promising strategy for treatment of HCC, alone or particularly in combination with chemotherapeutic drugs
  • In HCC, we found that VC-generated ROS caused genotoxic stress (DNA damage) and metabolic stress (ATP depletion), which further activated the cyclin-dependent kinase inhibitor p21, leading to G2/M phase cell cycle arrest and caspase-dependent apoptosis in HCC cells
  • we demonstrated a synergistic effect of VC and chemotherapeutic drug cisplatin on killing HCC both in vitro and in vivo
  • Intravenous VC has also been reported to reduce chemotherapy-associated toxicity of carboplatin and paclitaxel in patients,38 but the specific mechanism needs further investigation
    • Nathan Goodyear
       
      so, exclude the benefit to patients until the exact mechanism of action, which will never be fully elicited?!?!?
  • Our retrospective cohort study also showed that intravenous VC use (2 g) was related to the improved DFS in HCC patients after initial hepatectomy
    • Nathan Goodyear
       
      Terribly inadequate dose.  Target is 20-40 mM which other studies have found occur with 50-75 grams of IVC.
  • several clinical trials of high-dose intravenous VC have been conducted in patients with advanced cancer and have revealed improved quality of life and prolonged OS
  • high-dose VC was not toxic to immune cells and major immune cell subpopulations in vivo
  • high recurrence rate and heterogeneity
  • tumor progression, metastasis, and chemotherapy-resistance
  • SVCT-2 was highly expressed in HCC samples in comparison to peri-tumor tissues
  • high expression (grade 2+/3+) of SVCT-2 was in agreement with poorer overall survival (OS) of HCC patients (Fig. 1c) and more aggressive tumor behavior
  • SVCT-2 is enriched in liver CSCs
  • these data suggest that SVCT-2 is preferentially expressed in liver CSCs and is required for the maintenance of liver CSCs.
  • pharmacologic concentrations of plasma VC higher than 0.3 mM are achievable only from i.v. administration
  • The viabilities of HCC cells were dramatically decreased after exposure to VC in dose-dependent manner
  • VC and cisplatin combination further caused cell apoptosis in tumor xenograft
  • These results verify that VC inhibits tumor growth in HCC PDX models and SVCT-2 expression level is associated with VC response
  • qPCR and IHC analysis demonstrated that expression levels of CSC-associated genes and percentages of CSCs in PDXs dramatically declined after VC treatment, confirming the inhibitory role of VC in liver CSCs
  •  
    IV vitamin C in vitro and in vivo found to "preferentially" eradicate cancer stem cells.  In addition, IV vitamin C was found to be adjunctive to chemotherapy, found to be hepatoprotectant.  This study also looked at SVCT-2, which is the transport protein important in liver C uptake.
Nathan Goodyear

Anemia in cancer - 0 views

  • Anemia is a frequent finding in cancer patients, occurring in >40% of cases
  • chemotherapy, the incidence of anemia may rise to 90%
  • Anemia exerts a negative influence on the quality of life
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  • Anemia has also been identified as an adverse prognostic factor
  • mild (10 g/dl—normal), moderate (8–10 g/dl), severe (6.5–8 g/dl) and life threatening (<6.5 g/dl or unstable patient) anemia
  • anemia in cancer patients is often multifactorial.
  • Cancer itself can directly cause or exacerbate anemia either by suppressing hematopoiesis through bone marrow infiltration or production of cytokines that lead to iron sequestration, or by reduced red blood cell production
  • in inflammatory anemia, iron deficiency should be defined by a low transferrin saturation of <20%, ferritin levels of <100 ng/ml and a low reticulocyte hemoglobin concentration of <32 pg
  • anemia to thrombocytosis, as commonly seen in cancer patients
  • TNF-α inhibits hemoglobin production
  • treatment itself may be a major cause of anemia
  • Other cytokines, such as interleukin-6 (IL-6), IL-1 and interferon-γ, have also been shown to inhibit erythroid precursors in vitro [9], albeit to a lesser extent
  • In inflammation, from whatever cause, IL-6 induces the liver to produce hepcidin. Hepcidin decreases iron absorption from the bowel and blocks iron utilization in the bone marrow
  • Numerous in vitro studies have illustrated the central role of TNF-α in the pathogenesis of anemia
  • nephrotoxic effects of particular cytotoxic agents such as platinum salts can also lead to the persistence of anemia through reduced Epo production by the kidney
  • Currently two options are at the disposal of the clinician for the treatment of anemia in cancer patients: transfusion of packed red blood cells and the use of erythropoiesis-stimulating agents (ESAs)
  • The goal of the treatment is to relieve the symptoms of anemia such as fatigue and dyspnea.
  • Transfusion of 1 unit of packed red blood cells has been estimated to result in an increase in the hemoglobin level of 1 g/dl in a normal-sized adult
  • a higher mortality rate in patients receiving ESA treatment
  • Recent concerns regarding the risk of thromboembolism in patients treated with ESA have been corroborated by the meta-analyses conducted by Tonnelli and Bennett
  •  
    Great review of anemia in Cancer:  1)  blood loss 2)  increased RBC loss 3)   decreased RBC production Cancer infiltration of marrow can reduce hematopoiesis.  Inflammatory cytokines can reduce hematopoiesis.  Inflammatory cytokines can block Fe absorption.  Chemo and radiation can cause anemia--particularily platinum based therapies.
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