Podcasts about Hematology

Dr. Steven attended medical school at Philadelphia College of Osteopathic Medicine and completed his medical oncology and hematology fellowship at Georgetown University Medical Center. He's triple-board certified in Internal Medicine, Medical Oncology, and Hematology and sees patients at a private practice called cCare in San Diego. Dr. Steven is also known as "the singing oncologist" and is the host of the Dr. Steven Show. He's a married father of three and author of Love is the Strongest Medicine: Notes from a Cancer Doctor on Connection, Creativity, and Compassion. Dr. Steven and I had a chance meeting at midnight at a health and wellness conference and had an immediate connection. I've wanted to interview him for years and we finally made it happen. Dr. Steven Eisenberg is an incredible human. You're gonna love him. Show Notes: https://www.chrisbeatcancer.com/dr-steven-eisenberg-love-is-the-strongest-medicine/ Enjoy!

Welcome to Ask Stago, the podcast dedicated to provide expert answers to your expert questions in hemostasis. In today episode, our expert guest, Dr Caroline Vayne from Tours University Hospital in France, gives us an overview on heparin induced thrombocytopenia. As usual, don't forget to send any question you may have to ask@stago.com, we will be glad to answer to it.   Learn more: Gruel Y, Vayne C, Rollin J, Weber P, Faille D, Bauters A, Macchi L, Alhenc-Gelas M, Lebreton A, De Maistre E, Voisin S, Gouilleux-Gruart V, Perrin J, Tardy-Poncet B, Elalamy I, Lavenu-Bombled C, Mouton C, Biron C, Ternisien C, Nedelec-Gac F, Duchemin J, De Raucourt E, Gouin-Thibault I, Rugeri L, Tardy B, Giraudeau B, Bejan-Angoulvant T, Pouplard C. Comparative Analysis of a French Prospective Series of 144 Patients with Heparin-Induced Thrombocytopenia (FRIGTIH) and the Literature. Thromb Haemost. 2020 Jul;120(7):1096-1107. doi: 10.1055/s-0040-1712957. Epub 2020 Jun 22. PMID: 32572863. Gruel Y, De Maistre E, Pouplard C, Mullier F, Susen S, Roullet S, Blais N, Le Gal G, Vincentelli A, Lasne D, Lecompte T, Albaladejo P, Godier A; Members of the French Working Group on Perioperative Haemostasis Groupe d'intérêt en hémostase périopératoire GIHP. Diagnosis and management of heparin-induced thrombocytopenia. Anaesth Crit Care Pain Med. 2020 Apr;39(2):291-310. doi: 10.1016/j.accpm.2020.03.012. Epub 2020 Apr 13. PMID: 32299756. Arepally GM. Heparin-induced thrombocytopenia. Blood. 2017 May 25;129(21):2864-2872. doi: 10.1182/blood-2016-11-709873. Epub 2017 Apr 17. PMID: 28416511; PMCID: PMC5445568. Rollin J, Pouplard C, Gruel Y. Risk factors for heparin-induced thrombocytopenia: Focus on Fcγ receptors. Thromb Haemost. 2016 Oct 28;116(5):799-805. doi: 10.1160/TH16-02-0109. Epub 2016 Jun 30. PMID: 27358188. Pishko AM, Cuker A. Diagnosing heparin-induced thrombocytopenia: The need for accuracy and speed. Int J Lab Hematol. 2021 Jul;43 Suppl 1:96-102. doi: 10.1111/ijlh.13564. PMID: 34288442. Tardy B, Lecompte T, Mullier F, Vayne C, Pouplard C. Detection of Platelet-Activating Antibodies Associated with Heparin-Induced Thrombocytopenia. J Clin Med. 2020 Apr 24;9(4):1226. doi: 10.3390/jcm9041226. PMID: 32344682; PMCID: PMC7230370. Cuker A, Arepally GM, Chong BH, Cines DB, Greinacher A, Gruel Y, Linkins LA, Rodner SB, Selleng S, Warkentin TE, Wex A, Mustafa RA, Morgan RL, Santesso N. American Society of Hematology 2018 guidelines for management of venous thromboembolism: heparin-induced thrombocytopenia. Blood Adv. 2018 Nov 27;2(22):3360-3392. doi: 10.1182/bloodadvances.2018024489. PMID: 30482768; PMCID: PMC6258919. Vayne C, Rollin J, Gruel Y, Pouplard C, Galinat H, Huet O, Mémier V, Geeraerts T, Marlu R, Pernod G, Mourey G, Fournel A, Cordonnier C, Susen S. PF4 Immunoassays in Vaccine-Induced Thrombotic Thrombocytopenia. N Engl J Med. 2021 Jul 22;385(4):376-378. doi: 10.1056/NEJMc2106383. Epub 2021 May 19. PMID: 34010527; PMCID: PMC8174029. Pavord S, Scully M, Hunt BJ, Lester W, Bagot C, Craven B, Rampotas A, Ambler G, Makris M. Clinical Features of Vaccine-Induced Immune Thrombocytopenia and Thrombosis. N Engl J Med. 2021 Oct 28;385(18):1680-1689. doi: 10.1056/NEJMoa2109908. Epub 2021 Aug 11. PMID: 34379914. Kizlik-Masson C, Vayne C, McKenzie SE, Poupon A, Zhou Y, Champier G, Pouplard C, Gruel Y, Rollin J. 5B9, a monoclonal antiplatelet factor 4/heparin IgG with a human Fc fragment that mimics heparin-induced thrombocytopenia antibodies. J Thromb Haemost 2017; 15: 2065–75. Related podcast: Understand the sensitivity and specificity https://www.podcastics.com/podcast/episode/8-what-are-sensitivity-and-specificity-performances-of-a-diagnostic-assay-37747/   Content is scientific and technical in nature. It is intended as an educational tool for laboratory professionals and topics discussed are not intended as recommendations or as commentary on appropriate clinical practice.

Dr. Kimberly McGregor, MD is a Director of Clinical Development at Foundation Medicine. She received a medical degree from the University of California Santa Barbara. She is board-certified in Medical Oncology and Hematology. Currently, she is the VP of Medical Affairs at Oncocyte.  

Behind the Knife ABSITE 2022 - high yield learning to help you DOMINATE the exam. Don't forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/0578802767/ref=sr_1_2?keywords=behind+the+knife+podcast&qid=1639489872&sr=8-2 If you like the work that Behind the Knife is doing please leave us a review wherever you listen to podcasts.    Visit behindtheknife.org to access podcasts, videos, CME, and more.  

About this episode Today Amy introduces a new member to the ITB crew: Alex Carter. Alex is a MS4 at The Ohio State College of Medicine and is looking to go into Internal Medicine. He has written articles for In-Training and enjoys being active and outdoors in his free time. Study on the go for free! Download the Audio QBank by InsideTheBoards for free on iOS or Android. If you want to upgrade, you can save money on a premium subscription by customizing your plan until your test date on our website! Our other podcasts: Crush Step 1 Step 2 Secrets Physiology by Physeo Step 1 Success Stories The InsideTheBoards Study Smarter Podcast The InsideTheBoards Podcast Beyond the Pearls The Dr. Raj Podcast The Health Beat Produced by Ars Longa Media To learn more about us and this podcast, visit arslonga.media. You can leave feedback or suggestions at arslonga.media/contact or by emailing info@arslonga.media. Produced by: Christopher Breitigan and Madison Linden. Executive Producer: Patrick C. Beeman, MD Legal Stuff InsideTheBoards is not affiliated with the NBME, USMLE, COMLEX, or any professional licensing body. InsideTheBoards and its partners fully adhere to the policies on irregular conduct outlined by the aforementioned credentialing bodies. The information presented in this podcast is intended for educational purposes only and should not be construed as professional or medical advice. Learn more about your ad choices. Visit megaphone.fm/adchoices

In this week's episode, we'll review a research article that provides the first description of a targeted gene insertion approach to correct the genetic mutation underlying XMEN disease. Next, we'll cover results of a phase 2 study that provides proof-of-principle that the JAK/STAT pathway is a promising target for the treatment of peripheral T-cell lymphomas. We'll close with a study providing precise and up-to-date estimates on the incidence of intracranial hemorrhage in patients with hemophilia that could have important implications for preventive strategies.

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez, is joined by Dr. Andreina Fernandes to discuss HPV-independent Cervical Cancers. Dr. Fernandes is a Molecular Biologist, Doctor of Science, and author of “Human papillomavirus-independent cervical cancer,” the Lead Article for the January 2022 issue of IJGC. Dr. Fernandes is a Researcher of the Molecular Genetics Laboratory at the Institute of Oncology and Hematology, and Professor of the Faculty of Dentistry, at Universidad Central de Venezuela in Caracas, Venezuela. (https://ijgc.bmj.com/content/early/2021/12/08/ijgc-2021-003014) Highlights: -The percentage of HPV-independent tumors is very variable, around 5 and 10%. -HPV-independent tumors are characterized by a differentiated molecular profile with lower proliferative activity, a p53 immunostaining, and alterations in PTEN, p53, KRAS, CTNNB1, ARID1A and ARID5B. -Most HPV-independent tumors are adenocarcinomas, however, there have been reports of HPV-independent cases with squamous histology. -HPV-independent tumors are associated with early lymph node involvement, accelerated tumor growth, distant metastasis, and a more aggressive biological behavior, related to a worse disease free survival and overall survival. -The hit and run mechanism could explain the absence of the viral genome in the HPV-independent cervical cancer cases. Andreina Fernandes (@AndreFernandes2)

In this week's episode, we'll review a research article demonstrating that some platelet-derived extracellular vesicles harbor proteasomes that can process and present antigens via MHC class I molecules. Next, we'll review results of a phase 1 study of a fibril-reactive monoclonal antibody that was well tolerated and led to rapid, sustained organ responses in patients with AL amyloidosis. We'll close with a research article suggesting that the pore-forming protein gasdermin D, which plays a crucial role in the release of neutrophil extracellular traps, is a promising drug target in sepsis.

At the 2021 Annual Meeting of the American Society of Hematology, researchers presented more data on additional risks faced by patients who have acute leukemia or myelodysplastic syndrome and have become infected with COVID-19. In a key study presented at ASH, Dr. Pinkal Desai from New York's Weill Cornell Medical College has identified clinical predictors of outcome among these patients. Oncology Times reporter Peter Goodwin talked with Dr. Desai about her findings and clinical recommendations.

Guest: Daniel O. Persky, MD From updates in combination therapy to developments in novel agents, Dr. Daniel Persky shares what he expects to see for chronic lymphocytic leukemia and mantle cell lymphoma from the American Society of Hematology's 63rd Annual Meeting and Exposition.

Guest host, Dr. John Sweetenham, associate director for Clinical Affairs at the UT Southwestern Harold C. Simmons Comprehensive Cancer Center, and Dr. Derek Raghavan, President of the Levine Cancer Center at Atrium Health in North Carolina, discuss some of the major issues ahead for the oncology community in 2022, including tension caused by the COVID-19 pandemic, achieving true equity of care, how to use molecular testing in an optimized fashion, and the future of the oncology workforce. Transcript  Dr. John Sweetenham: Hello, and welcome to ASCO Daily News podcast. I'm John Sweetenham, the associate director for Clinical Affairs at UT Southwestern's Harold C. Simmons Comprehensive Cancer Center and guest host of the podcast. Today, we'll be discussing the challenges ahead for the oncology community in 2022 with Dr. Derek Raghavan, President of the Levine Cancer Institute at Atrium Health in North Carolina. Our full disclosures are available in the show notes, and disclosures relating to all episodes of the podcast can be found on our transcripts at asco.org/podcasts. Derek, always a pleasure to have you here, and great to have you back on the podcast again.   Dr. Derek Raghavan: Hey, John. Always enjoy chatting together.   Dr. John Sweetenham: Derek, we're interested today to get your insights into what you think are going to be the major challenges facing the oncology community in 2022. I think each of us could come up with a pretty substantial list, but very interested to hear what you think are going to be those issues which are going to be uppermost in our mind as we move into the new year.   Dr. Derek Raghavan: Well, I think there are a number of important issues, John. I think everybody in clinical practice, medical or nursing, or whatever, have been brutalized somewhat by the COVID-19 pandemic, and I think everyone's tired and a bit cranky, and they're upset with a schism between the fringe and the science-based clinicians. So, I think that underscores everything. And there's an anxiety and a tension that I think is just new.   From the practical standpoint, which is where I think your question is directed, yeah, I think there will be issues that relate to achieving true equity of care. And I think hopefully, the focus will move from analysis paralysis to actually doing things and measuring outcomes. I think there will be the tension between value, price, and cost. People are spending an awful lot of money on health care. That's going to be an issue.   We have very good information on molecular prognostication, but a lot of the data that are coming out are from technologies that are not fully validated and not even standardized. There's a lot of disinformation and misinformation coming out, and I think we're going to have to address that. I think those are 3 themes that could keep us talking for quite a while.   I think the other thing, which is more up your alley than mine, is we've been watching CAR T[-cell therapy] emerge. I think we've got a beginnings of a pretty good handle on how CAR T[-cell] relates to hematological malignancy. It's much less clear in the solid tumors, and there is a bit of a tendency to do what used to happen in the 1970s and '80s, which is here's a new treatment. Let's give it a whack and see what happens.   But this is very expensive. We don't want to fall into the trap of how bone marrow transplant was introduced as a standard of breast care management for nearly a decade, based on somewhat flimsy evidence. So, we need to be a little more thoughtful about how we introduce CAR T[-cells] into the solid tumors.   Dr. John Sweetenham: Thanks. Yeah, plenty to discuss there, as you say. And what I'd like to do just because it is such a topical issue and continues to be at the moment is just pick up a little on the COVID-19 theme. I think that we've all seen a great deal of discussion in recent months about many of the consequences of COVID-19, including delayed screenings, late diagnosis, clinician burnout, and so on. But I'm interested in your insights on a couple of things.   Number 1, since we're now seeing the emergence of further new variants, what do you think that this is going to mean for the oncology community in terms of handling these new variants within the context of our patients with cancer? And then secondly, because I'm intrigued by one of the things you mentioned in our discussions about this podcast, you mentioned the changed relationship between health professionals and parts of the community as a consequence of COVID-19. And interested to hear you expand just a little bit on that. So, kind of 2 questions wrapped up in 1 there.   Dr. Derek Raghavan: Yeah. Well, I think the 2 are connected. The old style of physicians has always liked to be sure of their ground and to have a firm database when they talk about things. Particularly with the new variants, while it's completely appropriate to be transparent about the fact that they knew that they seemed different and so on, I think there is the problem that there are a lot of physicians who are now becoming TV personalities as much as physicians and who are talking all the time.   I'm not critical of that, but the problem is that they're being honest in saying we don't really know this, but this is what I think, and then they have to change direction. So, what's happening is, for the first time in a long time, physicians are regularly being quoted and being seen as saying things that are not necessarily correct, and that reduces confidence by the community and the physicians. At the same time, COVID-19, in my view, highly, inappropriately became a political football.   You have people who have absolutely no training, so radio hosts, football quarterbacks, basketball stars making extraordinary statements about COVID-19 and their approach to vaccination, masking, and other things where they have absolutely no business doing it. But they are people who are believed. They're high profile. And so, there's now a schism emerging between patients who listen to people who have no medical training at all and no basis for what they say and those particularly in the political domain who have politicized this and created a situation where, once upon a time, a physician was at least seen as coming from the right place and with good intent.   But we've both seen so many of these public demonstrations where physicians and public health physicians are being castigated for simply espousing good practice. Now, with respect to managing the variants, I think the fact is we have some basic principles that I have believed now for 2 years. Masks reduce the chance of getting any type of COVID-19. They just do. If you wear a mask most of the time when you're out and about, you're going to cut your chances down. Vaccination reduces the chance of ending up in the ICU unless you have some sort of immunological deficit.   Dr. John Sweetenham: Yeah. I'm going to switch gears now and return to the first thing that you mentioned right up front, which is the issue of equity and how we are going to address equity issues in the coming year. I think that in many ways, 2020, going into 2021, has been 2 years where issues of equity in health care have really come to the fore. And of course, there's been a great deal of discussion around this.   And I think you'd agree with me that we've seen, at the same time, that some of the strategies that we have been using during the COVID-19 pandemic, including telehealth, which one would have hoped would be a great equalizer, actually has the potential to exacerbate some of the disparities that we've been seeing in health care. But you mentioned analysis paralysis, and just to pick up on that theme, despite the huge amount of coverage that equity has received in medical journals and the media, where do you think we actually are in finally truly addressing some of the cancer care disparities that we see?   Dr. Derek Raghavan: Well, I think, John, you know that I was one of the early chairs of the ASCO Task Force. Otis Brawley and I chaired that task force together. Very early in the piece, I'm going to say probably 15 years ago, we wrote really quite a strong position paper on this whole issue. And so, we got started early in doing stuff on what we thought would be important, and we did, with support from the Komen Foundation, was to start training people of color in the oncology space and keeping them working in underserved communities by paying off their college loans for the period of time that they did that.   So, people have been doing stuff for a while. I think what's happened in the last decade, and it has been a slow change, is that there's been more a move to saying, let's get started. So, if you look at Chris Lathan up at Harvard, at one of their underserved hospitals, if you look around the country, consider the Bristol Myers Squibb Foundation, which puts money into active projects that are about doing stuff rather than having meetings to consider doing stuff. I think there's been that swing.   Dr. John Sweetenham: When we think about equity and disparities of care, we're often drawn towards the cost of cancer care and how much that plays into disparities and inequity in the delivery of cancer care. And picking up on that theme that you mentioned around value, cost and price, and maybe we could think about linking that with the use of CAR T-cell therapy and the application of CAR T-cells in the solid tumor world, if that is going to happen, what do you think we can do during 2022 to confront some of the cost and price issues that we're seeing within our cancer care environment right now?   Dr. Derek Raghavan: Well, I sometimes think in a utopian fashion, which doesn't get me very far, I have to say. What I'd love to see in the United States, because we spend far more money on everything health-wise than any other country in the civilized or uncivilized world, but what I'd like to see is a bipartisan initiative run by people who actually understand health care and health care economics that would go to the issue of, how do you get better bang for your buck? And it would include doing some tough things.   We waste money outrageously. We'll treat third-line metastatic pancreas cancer off trial. Nothing works in third-line metastatic pancreas cancer off trial. It's worth maybe a clinical trial to help the next person in line. That's how we make progress. But just to keep giving the same old litany of drugs in the hope that it might work is a waste of money. As I talked about before, BMT for breast cancer turned out to be a huge waste of money over a long period of time. So, if you can actually create a scenario where government set some rules and took the courageous, and this why it would have to be bipartisan, it would actually start to rationalize health care.   You know, John, the Oregon experiment many years ago, where one party started to rationalize care, and the other party accused them of rationing care. I mean, you can't have that happen. We've also seen both sides allocate the task of developing health care algorithms to people who are great politicians but know nothing about health care or economics. So, I mean, there are easy ways to do it. What we can do ourselves is be honest. Tell people what bang they'll get for their buck.   The person who is likely to have, say, an 80% chance of being dead within 4 months may not wish to mortgage his house if he's told that. On the other hand, he might well want to mortgage his house if he thinks that a very expensive treatment will give him the chance of being alive in 5 years. So, we, as physicians, shouldn't make that decision. It's the patient's right to be able to choose life versus the life of their offspring and spouse and future generations. So, I think it's not that complex, and I think if we brought more transparency about good expectations versus poor expectations, gave a better reason for patients getting more involved in trials, we're still at less than 15% of patients with cancer in the USA getting involved in trials, and that's a tragedy.   Dr. John Sweetenham: Yeah, I think also, the other thing that's occurred to me in this context, is the fact that while we tend to hone in on costs of treatment when we get into these discussions, I've been seeing some emerging literature around the cost of follow-up and unnecessary follow-up and imaging and so on in those patients who are in survivorship part of their cancer journey. And there's a huge opportunity there, I think, for us to reduce costs of care with no impact whatsoever on survival, no difficult treatment decisions to be made because we're simply doing an enormous amount of unnecessary testing in these patients who have completed treatment that we know doesn't impact survival. So, I do think that we could take a really serious look at that and make very significant savings. So, I think there's lots of potential there too.   Dr. Derek Raghavan: Yes. I agree, John. And I'd actually give kudos to ASCO in this space because they were early adopters of the Choosing Wisely campaign. They wrote two sets of guidelines about stupid things that we do that make no difference. And to be honest, I think that--I was on that committee, and the committee got tired.   I was one of the few people that actually felt we should keep going and very actively keep issuing guidelines of things that just aren't worth doing and having symposia at the ASCO ASM say that the symposia that are entitled “How to Waste Money” or alternatively entitled “How to Stop Doing Dumb Stuff” would be really quite important. And it would give the basis for sensible medicine to people who do medical legal protection work. So, most people who do multiple PET scans on lymphoma where the patient is completely well and blah, blah, blah are doing it for medical-legal reasons. They're not doing it because they think it will make a huge difference.   And I, of course, am not talking about the people where they're following PET scans as markers of response. So, I think we can do this work. I'd love to see a presidential campaign which is about not doing dumb stuff and where ASCO takes the bully pulpit and says, “we're spending a year policing ourselves, talking about all the things we do that don't actually make things better for patients.”   Dr. John Sweetenham: So, let's extend this theme of expensive therapies. And you mentioned CAR T-cell therapy. And in the hematologic malignancy world, we're now just beginning to see 1 or 2 results, which will be presented at the American Society of Hematology meeting in a couple of weeks from now, positive results from a couple of randomized clinical trials in hematologic malignancy with CAR T-cell therapy. So, what are your thoughts on the application of this treatment in the solid tumor world, and where do you think we are, what do you think we might see during 2022?   Dr. Derek Raghavan: Well, let's talk strategy first. I think a good place to begin is with a good scientific hypothesis. So, we both know how CAR T[-cells] work. We don't have to have a long discussion here about them. It would be patronizing to the audience. But you might think about, what solid tumor is actually going to benefit from immunological manipulation? Where have the checkpoint inhibitors been helpful, and where have they not been helpful? And so, you might focus the initial part of CAR T[-cells] and solid tumor work on those where there's a hypothesis that makes sense.   Then the second thing you could do would be to actually come to the companies that make all their money from CAR T[-cells] and say, perhaps you could invest in this research with us, and we'll do a couple of Hail Mary passes. So, let's look at the tumors where there isn't a good hypothesis, but nothing works, and see if we can get an experience. So, that'd be a nice, simple, easy way to do it. And then measure tight outcomes, have very robust entry criteria so you don't get confused about various toxicities because you're actually starting with patients in reasonable shape and then expanding to all populations.   So, the first part would be phase 1 and 2. Then you, early in the piece, make sure that you have inclusiveness so that you know all the population groups that might benefit from the treatment. I think that'd be a reasonable way to go.   Dr. John Sweetenham: Talking about identifying targets appropriately and target populations for treatment, you had mentioned as one of your other challenges for 2022 the concept around identifying molecular subgroups and molecular prognostication as a way of patient selection. So, could you say a little bit more about that and what you think we're going to need to do in the coming year in terms of refinement of targets?   Dr. Derek Raghavan: Well, John, this is an area of your expertise as well, coming from the hematological malignancy world. Now, I hope we would both agree that having robust reproducible technology is important. The fact that there are so many molecular diagnostic companies that hype their product doesn't necessarily mean that the product is good. So, there needs to be standardization of approaches to using technology, to measuring outcomes.   We need to have comparative sets of data, looking at different technologies to see how they work, and those sorts of studies need to be funded by government because there's no particular reason for the companies to agree to perhaps show that their diagnostic technology is not as good as somebody else's. But this would be a good initiative for the government to actually start to rank order of the products that are out there. I, frankly, think when you think of the impact of all of these molecular diagnostic tests, I've never understood why so many of them are out there without tight U.S. Food and Drug Administration (FDA) regulation. So, I think that's a place to begin.   If you think back to the old breast cancer days when there was immunohistochemistry and a bunch of molecular technologies, the outcomes were so varied when compared on common tumor samples. So, we just seem to be quite comfortable to make the same set of mistakes again. I do think there are responsible investigators doing excellent work in the space, so I'm not critical of the space. I'm answering the question, which is we need now to bring some regulation in to ensure that the quality of the work, reproducibility of the work. You'll even see, and I know you and I have talked about this in the past, there'll be Mr. X who has prostate cancer and gets his PSA measured, which is Prostate-Specific Antigen, looking at how active the cancer is regularly in different labs. That makes absolutely no sense. There's no common standard. PSA in my lab is going to be different from PSA in your's. And so there just should be some nice, simple rules of how to use molecular testing in an optimized fashion.   Dr. John Sweetenham: Yeah, and I wonder also whether we need to be looking a little bit more closely at point of care clinical decision support for some oncologists who may not be as molecularly literate as others because I do think that's another real challenge at the moment is giving guidance to everyone who might see these patients in terms of treatment selection.   Dr. Derek Raghavan: Well, I agree with you completely. I mean, kudos to the major companies because most of them provide pretty good decision support. One with which we worked tended to be a little too positive about its product, and we worked to change that. And now they're actually very useful. We have a big series from our molecular tumor board here that runs over I think a 5-year period that Carol Farhangfar, PhD, has just submitted for publication, which shows that you can heavily influence people who are out in the community by providing centralized support for their use of molecular diagnostic tests. But again, we only deal with the major companies so that we think there's good quality control there. And we don't flip back and forth in an individual patient between one company and another.   Dr. John Sweetenham: Right. Well, I think we're almost out of time, Derek, but I did want to ask you one more question, and it's a real change of gear. But over the last year or so, I think that probably largely because of the COVID-19 pandemic, we have seen some exacerbation of workforce issues in the oncology workforce that we knew already existed. I think there is undoubtedly more burnout being reported than there was before. Certainly, within our own organization, we have seen some increased staff turnover and a number of people who I think, frankly, have realized that they want to move closer to their families.   And so, there's been a certain amount of churn, which I think many of us in cancer centers are experiencing. Interested to know whether you've seen anything similar and what strategies you're using in terms of staff retention and oncology clinician burnout at your center.   Dr. Derek Raghavan: I think this is a difficult problem. The morale at the Levine Cancer Institute, much like the Simmons Cancer Center, is high, and that's driven by the leadership cadre being out there with their troops, visible and actively engaged so that the troops on the line feel that the bosses are part of the deal. And we do silly little things that matter, which is parties and celebrations and thank yous and all that sort of stuff. We get the staff to thank each other. We encourage the patients to thank the staff just with an attaboy or something that just says we appreciate the care.   So, I think this is a challenge. I do think work-life balance in old geezers like you and me has been a slightly different thing from some of the younger physicians who are spending, I think sensibly, more time with their families and don't want to spend these long hours. I think the other thing is there is still a town-gown issue where there are people who can make a lot more money much more quickly in some parts of non-academic practice, and it's getting harder to publish in academic practice, so the rewards for that are slipping a little.   I actually don't really have a solution. I think that the august colleges drawing to the attention of the world that this is a big deal and engaging bipartisan support from the political machinery will be important. I think ASCO can, through its government relations people (ASCO Advocacy), continue to prosecute these issues, which they do. I think there is the mistake that we make in the cancer space is we do still tend to compete between societies.   I've always thought it would be much healthier to have ASCO, ASTRO, ACS, SUO, SSO and all those people having a common council that speaks on this sort of issue with one voice and draws to attention of the people out there that this is a big issue. The best of the doctors (docs) are getting older. The younger docs come through the Taylor laws are less experienced and less well-trained and have a different ethos. So, we're going to lose an aspect of practice that's been part of the tradition of medical practice since the time of Osler, and it's definitely going away.   I have a superb physician fellow working with me at the moment who I would rate as one of the best 3 in 10 years. The reason she's one of the best 3 in 10 years is she practices the style of medicine that my fellows did 25, 30 years ago, most of whom are now professors of medicine somewhere. And good with patients, knows her staff, does research, and somehow manages to have reasonable time for a family. That tradition is starting to go away, and I don't think there is a simple change. And then the final point, the people who run health care today see it as a business. I was in a meeting recently outside my own domain where someone said, you know, I have to figure out whether medicine is really importantly a health care business or whether it's an IT business focused on health care. And that's going to start to lose the human side of medicine. We spent some time on that today. The outcomes will go down if this is just a business.   Dr. John Sweetenham: Well, thanks, Derek. Really appreciate all of your insights today. I think there's no doubt that 2022 is going to be a year of many challenges for those of us in the oncology community and for our patients, but I think it's also inevitably going to be a very exciting year in terms of new developments.   And hopefully, if we're recording another podcast like this in a year from now, the COVID-19 pandemic will be a little bit more in the rearview mirror, and we will be able to focus on many of the other important issues that face us. So again, really appreciate your sharing your insights with us, and wish you all the best for 2022.   Dr. Derek Raghavan: John, always a pleasure chatting, and the same to you and Caroline and the family.   Dr. John Sweetenham: Thank you. And thanks to our listeners for your time today. If you enjoyed this episode, please take a moment to rate, review, and subscribe wherever you get your podcasts.   Disclosures: Dr. John Sweetenham: Consulting or Advisory Role: EMA Wellness   Dr. Derek Raghavan: Consulting or Advisory Role: Gerson Lehrman Group, Caris Life Sciences   Disclaimer: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guests' statements on the podcast do not express the opinions of ASCO.  The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.

In this week's episode, we'll talk about the functional properties of mesenchymal stromal cells in sickle cell disease, learn more about CAR T-cell-mediated hematotoxicity in relapsed/refractory B-cell lymphoma, and discuss dual cytokine blockade in graft-versus-host disease.

On today's episode meet Dr. Chad Pecot. Dr. Pecot is a Thoracic Medical Oncologist and Associate Professor at the UNC Lineberger Comprehensive Cancer Center, where he specializes in solid tumor malignancies. Since August 2013 he has been an independent investigator at UNC-Chapel Hill. Chad has a degree in Biomedical Engineering. He got his medical degree from the University of Miami, did his residency at Vanderbilt University Medical Center, Fellowship at MD Anderson Cancer Center in Hematology and Oncology and Chief Fellowship in Thoracic Medical Oncology. He is a self-described lung cancer slayer.

In this week's episode, we'll learn about a new approach for targeting Janus kinases in CRLF2-rearranged ALL, discuss risk stratification for myeloid leukemia in children with Down syndrome and learn more about how sialic acid alterations on megakaryocyte antigens regulate immune cells and platelet production.

We're back with a hematology/oncology heavy episode! We talk about oral azacitidine for acute myeloid leukemia (AML) and nelarabine for T-cell acute lymphoblastic leukemia (T-ALL) with Dr. Bernie Marini, a Clinical Pharmacist Specialist in Hematology and Associate Professor at University of Michigan Medicine. Back us on Patreon! www.patreon.com/plenarysession Check out our YouTube channel: www.youtube.com/channel/UCUibd0E2kdF9N9e-EmIbUew

First on today's podcast, we'll review results of a randomized phase 2 study demonstrating that inhibition of ROCK2 with belumosudil is well tolerated and effective in patients with steroid-refractory graft-versus-host disease. Next, we'll review the work of researchers who have uncovered new insights into the immunopathogenesis of vaccine-induced immune thrombotic thrombocytopenia. And we'll close with a report of a prospective longitudinal analysis that elucidates the dynamics of mutated hematopoietic stem and progenitor cells during therapy with interferon-alpha in patients with BCR-ABL1 negative myeloproliferative neoplasms.

All four studies included in this podcast present preliminary data with modest numbers of patients, and therefore, the findings should be interpreted with these limitations. Likewise, the impact of specific strains and waning antibody levels after COVID-19 vaccination will require further follow-up, since the Delta variant was not the dominant strain in circulation at the time of this research. The first two studies assess the immune responses to vaccination in two specific high-risk populations, namely, patients with lymphoma and multiple myeloma. The last two studies, one from a large European consortium and the other based on nationwide data from Israel, report on the incidence, risk factors and short-term outcomes of COVID-19 breakthrough infection in vaccinated patients with hematologic malignancies.

In this week's episode, we'll learn more about the efficacy of asciminib in patients with chronic myeloid leukemia who are resistant or intolerant to two or more tyrosine kinase inhibitors, discuss the role of dopamine signaling in hematopoietic stem and progenitor cell function, and learn more about elevated plasma concentration of complement factor C5 as a risk factor for venous thromboembolism.

Host: Jacob Sands, MD Guest: Joseph Tuscano, MD While lymphoma can sometimes be difficult to treat, emerging therapies and clinical developments are on the horizon. But could they help improve patient outcomes? Dr. Jacob Sands is joined by Dr. Joseph Tuscano, Physician and Professor of Hematology and Oncology at UC Davis Comprehensive Cancer Center to talk about updates in Lymphoma treatment.

Not exactly one of the ologies of the Christian system, and not quite the scientific study of blood, John Buck explores the significance of blood in the Scripture.

In this week's episode, we'll review results of a phase 2 study showing the beneficial effects of a first-in-class factor D inhibitor as add-on therapy in PNH patients who remain anemic and are transfusion-dependent despite C5 inhibition. Next, we'll review the work of researchers who have developed a neural network that they say is highly accurate in differentiating between bone marrow cell morphologies. We'll close with a report demonstrating that RNA editing of antizyme inhibitor 1, or Azin1, is a novel regulator of hematopoietic cell fate that can influence self-renewal and differentiation.

50 High Yield Hematology Questions to help you prepare for your Pance, Panre, and Eor's. ►Paypal Donation Link: https://bit.ly/3dxmTql  (Thank you!) --- Support this podcast: https://anchor.fm/scott--shapiro/support

In this week's episode, we'll learn more about the application of machine learning in molecular subclassification and prognostication of acute myeloid leukemia or AML, discuss the role of aging bone marrow in leukemia progression, and learn more about the challenges in treating bleeding disorders of unknown cause.

In this week's episode, we'll review a research article showing beneficial effects of prenatal immunotherapy in a mouse model of anti-CD36-mediated fetal and neonatal alloimmune thrombocytopenia. Next, we'll look at results of a simulation analysis suggesting that gene therapy for hemophilia B is more cost-effective than on-demand or prophylactic factor treatment. We'll conclude with a report which provides important new insights into regulation of terminal erythroid maturation at the transcriptional level that may help improve our understanding of normal and abnormal erythropoiesis.

Joanne, Kauê e Iago debatem sobre o manejo no PS da crise álgica aguda em pacientes com Anemia Falciforme. Além da conduta na analgesia, abordamos alguns diagnósticos diferenciais importantes e um guia para casos de dores refratárias e para a prescrição de analgesia domiciliar. Tem alguma dúvida ou sugestão? Mande mensagem no @tadeclinicagem no instagram ou twitter. Este episódio foi realizado em parceria com o Whitebook! Acesse o link e inscreva-se para saber mais sobre a MEDFRIDAY, a Black Friday do Whitebook que vai trazer ofertas imperdíveis para você - https://medfriday.pebmed.com.br?utm_source=podcast&utm_medium=cpc&utm_campaign=medfriday-2021-tdc&utm_content=tdc Referências: 1) Goddu, P. et al. Do Words Matter? Stigmatizing Language and the Transmission of Bias in the Medical Record. J GEN INTERN MED 33, 685–691 (2018). 2) Haywood C Jr. et al. A video-intervention to improve clinician attitudes toward patients with sickle cell disease: the results of a randomized experiment. J Gen Intern Med. 2011 May;26(5):518-23. Epub 2010 Dec 23. 3) Vichinsky E. Evaluation of acute pain in sickle cell disease. Acesso em uptodate.com em outubro/2021 4) DeBaun M. Acute vaso-occlusive pain management in sickle celldisease. Acesso em uptodate.com em outubro/2021 5) Brandow AM, Carroll CP, Creary S, et al. American Society of Hematology 2020 guidelines for sickle cell disease: management of acute and chronic pain. Blood Adv. 2020;4(12):2656-2701. 6) Sins JWR, Mager DJ, Davis SCAT, et al. Pharmacotherapeutical strategies in the prevention of acute, vaso-occlusive pain in sickle cell disease: a systematic review. Blood Adv 2017; 1:1598. 7) Brookoff D, Polomano R. Treating sickle cell pain like cancer pain. Ann Intern Med 1992; 116:364. 8) Smith WR, McClish DK, Dahman BA, et al. Daily home opioid use in adults with sickle cell disease: The PiSCES project. J Opioid Manag 2015; 11:243. 9) van Beers EJ, van Tuijn CF, Nieuwkerk PT, et al. Patient-controlled analgesia versus continuous infusion of morphine during vaso-occlusive crisis in sickle cell disease, a randomized controlled trial. Am J Hematol 2007; 82:955.

Tonight we're going to look at what the COVID-19 vaccines do to the human body. We'll look at how it effects the central nervous system, the cardio-vascular system, the body organs, the respiratory system and how it affects the blood.

CLICK HERE to listen to episode audio (4:53).Sections below are the following: Transcript of Audio Audio Notes and Acknowledgments Image Sources Related Water Radio Episodes For Virginia Teachers (Relevant SOLs, etc.). Unless otherwise noted, all Web addresses mentioned were functional as of 10-29-21. TRANSCRIPT OF AUDIO From the Cumberland Gap to the Atlantic Ocean, this is Virginia Water Radio for Halloween 2021.  Besides focusing on autumn's festival of fun and fright, this episode is part of a series this fall about water connections to the human body and human biology. SOUND – ~9 sec That eerie sound of a tree creaking in October wind sets a seasonal stage for a Halloween challenge: exploring how Halloween, water, and human biology all connect.  Sound like quite a trick?  Well, have a listen to some Halloween music for about 50 seconds, and then we'll treat you to some examples. MUSIC - ~50 sec – instrumental You've been listening to “A Little Fright Music,” by Torrin Hallett, a graduate student at the Yale School of Music.  And here are six matches of Halloween creatures or images with water in the human body. 1.  Skeleton images rattle around everywhere for Halloween, and in living skeletons water is a significant component of bones and cartilage.  2.  Pretend blood covers many-a Halloween costume, and over half of the volume of blood is plasma, which in turn is over 90 percent water, and water is also a major component of blood cells. 3.  A muscular costume is part of pretending to be a super-strong character like Wonder Woman or Superman; and water plays a significant role in muscle structure and function; in turn, muscle is an important water-storage area for the body. 4.  The monster in movie versions of “Frankenstein” was brought to life by electricity, and the cells of our nervous system transmit messages though electrochemical impulses, using sodium and potassium ions in a water-based solution. 5.  If fiery or icy creatures need some temperature regulation, water's the body fluid that does it. And 6.  Flashing and watching from many creatures on Halloween night are eyes, either scary, suspenseful, or super-powered; and eyes have chambers containing aqueous humor and vitreous humour, two fluids that consist mostly of water and that maintain the shape of the eyes. This Halloween, imagine being a creature that's about 60 percent composed of an amazing substance with unique powers to dissolve other substances, absorb and release heat, and withstand being compressed.  What would you be?  Why, the water-based human being that you are! Thanks to Torrin Hallett for composing this week's music for Virginia Water Radio, and we close with another listen to the last few seconds of “A Little Fright Music.” MUSIC - ~13 sec – instrumental SHIP'S BELL Virginia Water Radio is produced by the Virginia Water Resources Research Center, part of Virginia Tech's College of Natural Resources and Environment.  For more Virginia water sounds, music, or information, visit us online at virginiawaterradio.org, or call the Water Center at (540) 231-5624.  Thanks to Ben Cosgrove for his version of “Shenandoah” to open and close the show.  In Blacksburg, I'm Alan Raflo, thanking you for listening, and wishing you health, wisdom, and good water. AUDIO NOTES AND ACKNOWLEDGEMENTS The wind and creaking tree sounds were recorded by Virginia Water Radio in Blacksburg, Va., on October 5, 2014.  “A Little Fright Music” is copyright 2020 by Torrin Hallett, used with permission.  Torrin is a 2018 graduate of Oberlin College and Conservatory in Oberlin, Ohio; a 2020 graduate in Horn Performance from Manhattan School of Music in New York; and a 2021 graduate of the Lamont School of Music at the University of Denver.  He is currently a graduate student at the Yale School of Music.  More information about Torrin is available online at https://www.facebook.com/torrin.hallett.  Thanks very much to Torrin for composing the piece especially for Virginia Water Radio.  This music was previously used in Episode 548, 10-26-20. Following are other music pieces composed by Torrin Hallett for Virginia Water Radio, with episodes featuring the music. “Beetle Ballet” – used in Episode 525, 5-18-20, on aquatic beetles.“Chesapeake Bay Ballad” – used in Episode 537, 8-10-20, on conditions in the Chesapeake Bay.“Corona Cue” – used in Episode 517, 3-23-20, on the coronavirus pandemic.“Flow Stopper – used in Episode 599, 10-28-21, on the “Imagine a Day Without Water” campaign.“Geese Piece” – used most recently in Episode 440, 10-1-18, on E-bird. “Ice Dance” – used in Episode 556, 12-21-20, on how organisms survive freezing temperatures.“Lizard Lied” – used in Episode 514, 3-2-20, on lizards.“New Year's Water” – used in Episode 349, 1-2-17, on the New Year. “Rain Refrain” – used most recently Episode 559, 1-11-21, on record rainfall in 2020.“Runoff” – in Episode 585, 7-12-21 – on middle-school students calling out stormwater-related water words.“Spider Strike” – used in Episode 523, 5-4-20, on fishing spiders.“Tropical Tantrum” – used most recently in Episode 580, 6-7-21, on the 2021 Atlantic tropical storm season preview.“Tundra Swan Song – used in Episode 554, 12-7-20, on Tundra Swans.“Turkey Tune” – used in Episode 343, 11-21-16, on the Wild Turkey.  Click here if you'd like to hear the full version (2 min./22 sec.) of the “Shenandoah” arrangement/performance by Ben Cosgrove that opens and closes this episode.  More information about Mr. Cosgrove is available online at http://www.bencosgrove.com. IMAGE Water uses in the human body.  Illustration from the U.S. Geological Survey, “The Water in You: Water and the Human Body,”  https://www.usgs.gov/special-topic/water-science-school/science/water-you-water-and-human-body?qt-science_center_objects=0#qt-science_center_objects. SOURCES Used for Audio Peter Abrahams, ed., How the Body Works: A Comprehensive, Illustrated Encyclopedia of Anatomy, Metro Books, New York, 2007. American Red Cross, “Blood Components,” online at https://www.redcrossblood.org/donate-blood/how-to-donate/types-of-blood-donations/blood-components.html. Erin Blakemore, “How Twitching Frog Legs Helped Inspire ‘Frankenstein,'” Smithsonian Magazine, December 4, 2015, online at https://www.smithsonianmag.com/smart-news/how-twitching-frog-legs-helped-inspire-frankenstein-180957457/. Fandom, “Monster Wiki/Frankenstein's Monster,” online at https://monster.fandom.com/wiki/Frankenstein%27s_Monster. Mayo Clinic Health System, “Water: Essential to your body,” online at https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/water-essential-to-your-body. Science Direct:“Aqueous Humor,” online at https://www.sciencedirect.com/topics/medicine-and-dentistry/aqueous-humor;“Vitreous Humour,” online at https://www.sciencedirect.com/topics/veterinary-science-and-veterinary-medicine/vitreous-humour. University of Michigan Health, “Eye Anatomy and Function,” as of August 31, 2020, online at https://www.uofmhealth.org/health-library/hw121946. U.S. Geological Survey, “The Water in You: Water and the Human Body,” https://www.usgs.gov/special-topic/water-science-school/science/water-you-water-and-human-body?qt-science_center_objects=0#qt-science_center_objects. U.S. National Institutes of Health/National Cancer Institute, SEER Training Modules:“Composition of the Blood,” online at https://training.seer.cancer.gov/leukemia/anatomy/composition.html;“Skeletal System,” online at https://training.seer.cancer.gov/anatomy/skeletal/. For More Information about Human Biology, Including Water Aspects American Society of Hematology, “Blood Basics,” online at https://www.hematology.org/education/patients/blood-basics.Cleveland [Ohio] Clinic:“Heart & Blood Vessels: How Does Blood Travel Through Your Body,” online at https://my.clevelandclinic.org/health/articles/heart-blood-vessels-blood-flow-body;“Lymphatic System,” online at https://my.clevelandclinic.org/health/articles/21199-lymphatic-system. Eric Cudler, “Neuroscience for Kids,” online at https://faculty.washington.edu/chudler/neurok.html. The Franklin Institute of Philadelphia, Penn., “Blood Vessels,” online at https://www.fi.edu/heart/blood-vessels. Isabel Lorenzo et al., “The Role of Water Homeostasis in Muscle Function and Frailty: A Review,” Nutrients, Vol. 11, No. 8 (August 2019, accessed online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6723611/(subscription may be required for access). Memorial Sloan Kettering Cancer Center, “Facts About Blood and Blood Cells,” online at https://www.mskcc.org/cancer-care/patient-education/facts-about-blood-and-blood-cells. Science Direct, “Synovial Fluid: Structure and Function,” excerpted from Textbook of Pediatric Rheumatology, 5th Edition, Elsevier, Amsterdam, Netherlands, 2005; accessed online at https://www.sciencedirect.com/topics/medicine-and-dentistry/synovial-fluid(subscription may be required for access). University of Bristol (England), School of Medical Sciences, “Brain Basics: The Fundamentals of Neuroscience,” online at http://www.bris.ac.uk/synaptic/basics/basics-0.html. U.S. National Institutes of Health/National Cancer Institute, SEER Training Modules:“Blood, Heart and Circulation,” online at http://www.nlm.nih.gov/medlineplus/bloodheartandcirculation.html;“Muscular System,” online at https://training.seer.cancer.gov/anatomy/muscular/;“Nervous System,” online at https://training.seer.cancer.gov/anatomy/nervous/. RELATED VIRGINIA WATER RADIO EPISODES All Water Radio episodes are listed by category at the Index link above (http://www.virginiawaterradio.org/p/index.html).  See particularly the “Science” subject category. Following are links to other episodes on connections of water to human biology (much of the information in this week's episode was taken from these previous episodes). Overview of water's roles in the body – Episode 592, 8-30-21.Disease: COVID-19 – Episode 517, 3-23-20 and Episode 519, 4-6-20.Disease: influenza – Episode 393, 11-6-17.Disease: viruses – Episode 600, 10-25-21.Circulatory system connections to water – Episode 593, 9-6-21.Muscular system connections to water – Episode 596, 9-27-21.Neurological system connections to water – Episode 594, 9-13-21.Skeleton system connections to water (with a Halloween theme) – Episode 595, 9-20-21.Water intake and exercise – Episode 466, 4-1-19.Water thermodynamics – Episode 195, 1-6-14. Following are links to other Halloween-themed episodes. Episode 238, 10-31-14 – focusing on the plant Witch-hazel.Episode 548, 10-26-20 – focusing on water-related readings that are supernatural, mysterious, or imaginative. FOR VIRGINIA TEACHERS – RELATED STANDARDS OF LEARNING (SOLs) AND OTHER INFORMATION Following are some Virginia Standards of Learning (SOLs) that may be supported by this episode's audio/transcript, sources, or other information included in this post. 2020 Music SOLs SOLs at various grade levels that call for “examining the relationship of music to the other fine arts and other fields of knowledge.” 2018 Science SOLs Grades K-3 plus 5: MatterK.4 – Water is important in our daily lives and has properties.3.3 – Materials interact with water. Grades K-4: Living Systems and Processes4.2 – Plants and animals h

Host: Charles Turck, PharmD, BCPS, BCCCP Guest: Elizabeth A. Brem, MD Guest: Ehab L. Atallah, MD Dr. Elizabeth Brém, an Assistant Professor in the Division of Hematology/Oncology at the University of California Irvine School of Medicine and Dr. Ehab Atallah, a Professor of Medicine and Section Head of Hematological Malignancies in the Medical College of Wisconsin's Division of Hematology and Oncology join Dr. Charles Turck to explore collaborative approaches and share best practices in the management of chronic lymphocytic leukemia.

In this week's episode, we'll discuss an analysis of genetic risks for CMV infection after an allogeneic hematopoietic stem cell transplant, learn more about a new multiplex gene editing approach to reactivate fetal hemoglobin in thalassemia, and discuss transcriptional rewiring of normal plasma cell development in light-chain amyloidosis and myeloma.

In this week's episode, we'll review results of a phase 3 randomized study demonstrating shorter time to neutrophil and platelet recovery with an ex vivo expanded hematopoietic progenitor cell product called omidubicel as compared to standard umbilical cord transplantation. Next, we'll look at preliminary data on the development of lymphomas originating from piggyBac-modified CD19 CAR T-cells, sounding a note of caution for researchers exploring new gene modification methodologies for CAR T-cell production. We'll conclude with a report suggesting that the vesicular protein CD63 may orchestrate the transfer of iron-rich ferritin among cells.

O uso da Varfarina é extremamente comum na nossa prática clínica e precisamos saber como manejar sua intoxicação. Kaue e Rapha conversam sobre essa intoxicação em 3 situações - Paciente com sangramento grave, sangramento leve e o paciente com RNI (ou INR) alterado mas sem sangramento. Referências: Crowther MA, Ageno W, Garcia D, et al. Oral vitamin K versus placebo to correct excessive anticoagulation in patients receiving warfarin: a randomized trial. Ann Intern Med 2009; 150:293. Witt DM, Nieuwlaat R, Clark NP, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: optimal management of anticoagulation therapy. Blood Adv 2018; 2:3257. Ansell J, Hirsh J, Hylek E, et al. Pharmacology and management of the vitamin K antagonists: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133:160S. Leissinger CA, Blatt PM, Hoots WK, Ewenstein B. Role of prothrombin complex concentrates in reversing warfarin anticoagulation: a review of the literature. Am J Hematol 2008; 83:137. Gunther KE, Conway G, Leibach L, Crowther MA. Low-dose oral vitamin K is safe and effective for outpatient management of patients with an INR>10. Thromb Res 2004; 113:205. Farrow GS, Delate T, McNeil K, et al. Vitamin K versus warfarin interruption alone in patients without bleeding and an international normalized ratio > 10. J Thromb Haemost 2020; 18:1133. Refaai MA, Goldstein JN, Lee ML, et al. Increased risk of volume overload with plasma compared with four-factor prothrombin complex concentrate for urgent vitamin K antagonist reversal. Transfusion 2015; 55:2722. Goldstein JN, Refaai MA, Milling TJ Jr, et al. Four-factor prothrombin complex concentrate versus plasma for rapid vitamin K antagonist reversal in patients needing urgent surgical or invasive interventions: a phase 3b, open-label, non-inferiority, randomised trial. Lancet 2015; 385:2077. Hylek EM, Regan S, Go AS, et al. Clinical predictors of prolonged delay in return of the international normalized ratio to within the therapeutic range after excessive anticoagulation with warfarin. Ann Intern Med 2001; 135:393. Kuijer PM, Hutten BA, Prins MH, Büller HR. Prediction of the risk of bleeding during anticoagulant treatment for venous thromboembolism. Arch Intern Med 1999; 159:457.

In this week's episode, we will review a study that prospectively followed tuberculosis patients after treatment initiation to evaluate iron handling during the resolution of inflammatory anemia. We will also examine clinical benefit and long-term safety of gamma-retroviral gene therapy in patients with adenosine deaminase deficient severe combined immunodeficiency.

In this week's episode, we'll review a study providing new insights on megakaryocyte diversity and function, including a unique subpopulation that may act as immune cells. Next, we'll review research that intriguingly reveals a putative role for the PD1 gene in cutaneous T-cell lymphoma. Lastly, we'll conclude with a report demonstrating a lack of cross-reaction between the antibodies that cause vaccine-induced thrombocytopenia and thrombosis, and the COVID-19 spike protein.

Dr. Gabrielle Rocque, chair of the 2021 ASCO Quality Care Symposium, breast oncologist and health services researcher at the University of Alabama at Birmingham, and symposium chair-elect, Dr. Stephanie Wheeler, professor in the Department of Health Policy and Management at the University of North Carolina at Chapel Hill, discuss key interventions in quality care and compelling patient perspectives presented at #ASCOQLTY21. Transcript ASCO Daily News: Welcome to the ASCO Daily News podcast. I'm Geraldine Carroll, a reporter for the ASCO Daily News. On today's episode, we'll discuss promising interventions to improve the quality of care for patients and survivors and other key takeaways from the 2021 ASCO Quality Care Symposium. I'm delighted to welcome the chair and chair-elect of the [ASCO Quality Care] Symposium, Dr. Gabrielle Rocque and Dr. Stephanie Wheeler, for this discussion. Dr. Rocque is a breast oncologist and health services researcher. She is also associate professor of medicine in the Division of Hematology and Oncology and Gerontology, Geriatrics, and Palliative Care at the University of Alabama at Birmingham. Dr. Wheeler is a professor in the Department of Health Policy and Management at the University of North Carolina at Chapel Hill. She also serves as associate director of community outreach and engagement at the UNC Lineberger Comprehensive Cancer Center. My guests' full disclosures are available in our show notes, and disclosures relating to all episodes of the podcast are available on our transcripts at asco.org/podcasts. Dr. Rocque and Dr. Wheeler, thanks for being on the podcast today. Dr. Gabrielle Rocque: Thank you for having us. ASCO Daily News: Dr. Wheeler, it was wonderful to have a hybrid event this year, with people participating in person in Boston and virtually. This is surely a sign of things to come. Can you tell us about some of the most important interventions in quality improvement that were presented at the [ASCO Quality Care] Symposium? Dr. Stephanie Wheeler: Absolutely, and thank you so much for hosting us. It was a really terrific [ASCO Quality Care] Symposium. And the fact that we had hybrid engagement from investigators all over the country and internationally was really exciting. There's a couple of intervention classes, if you want to call it that, that I think were particularly inspiring and interesting to me. The first were sets of interventions that focused on strategies to improve goals of care conversations and advanced care planning directives for patients with cancer or people with terminal illness in particular. And I just wanted to highlight a couple of those that I thought were particularly innovative. One was Abstract 8, which focused on using computer modeling and care coaches to increase advanced care planning conversations for people with advanced cancer. And this was presented by Dr. Divya Gupta. And it was just a wonderful example of how we can utilize technology and also care coaches. And in many cases, these don't necessarily have to be clinicians. They sometimes can be community health workers and others who can help direct those conversations and make it more comfortable for people living with advanced disease, and also their families, to consider next steps. In a similar vein, there were two other presentations--Abstract 1 delivered by Dr. Manali Patel and Abstract 2 delivered by Dr. Divya Parikh--that also utilized a similar model in a different care setting. And in those cases, the care settings ranged from VA to integrated health care settings. And we even had a conversation about how to do this work in community rural oncology practices. And I think that this kind of intervention has the potential for translation across a variety of settings. And the next steps are going to be figuring out exactly how to implement it in these settings. So, that's one class that I thought was particularly interesting. And I just want to highlight another group of interventions and studies that I found really innovative. And those were the presentations about hospital at-home models and how we can better deliver oncology care in the comfort of individuals' homes. And I thought Dr. Cardinale Smith did a great job from Mount Sinai describing the landscape of those interventions and the future for this kind of care delivery (“Overview of Programs and Ethics”). ASCO Daily News: Excellent. Great to hear about those promising new approaches. Dr. Rocque, the [ASCO Quality Care] Symposium captured many trends in quality care, including patient-reported outcomes measurement as an important way to monitor quality of care and patients' experiences. Can you highlight the studies that will help inform our listeners about how to integrate patient-reported outcomes into real-world settings? Dr. Gabrielle Rocque: Yeah. This was a major topic of the conference this year to think about how patient-reported outcomes are informative both in traditional research settings and in real-world settings. So, I was really intrigued by the Abstract 154 by Joy Jarnagin. And that abstract talked about how the changes in patient-reported outcomes actually had a very strong association with patients' treatment response, and in fact, was even more informative than those patients' tumor markers and I think show a novel way that patient-reported outcomes can be used. We also saw some more traditional abstracts on patient-reported outcomes. I'd like to highlight Abstract 152 by Valerie Lawhon, which really used patient-reported outcomes to identify patients' experience and their mental health outcomes during the COVID-19 pandemic, and I think provided us some really important insight into the experiences of our patients. And then as you mentioned, there is a lot of focus on real-world settings and how to transition from typical research patient-reported outcomes to a more broad scale implementation. And the session implementing PROs in oncology practice was really outstanding in terms of considering how this can be done. So, Dr. Terry Mulvey from Massachusetts General Hospital presented their experience on how to get these patient-reported outcomes into routine care, and what are some of the challenges associated with that, and how did they have to adapt to make sure that this was doable in real-world settings (“Challenges to Getting Started in a Practice Setting”). I was also impressed with the study by Dr. Raymond Osarogiagbon on the potential populations where there can be barriers of care and their study looking at an intervention in which they're implementing patient-reported outcomes over a wide variety of different practice types across the country (“Potential Populations Where This Can Be a Barrier to Care”). And I think these early insights also pointed us to future questions. Dr. Wynne Norton did a wonderful job of outlining some of the future questions that are likely to come up as we move into an era where patient-reported outcomes are a part of standard of care, and really think about how do we refine these for maximal benefit (“Overview of Current Strategies”). So, I think all of these sessions were highlighting the promise of patient-reported outcomes, as well as the future questions in this space. ASCO Daily News: Excellent. As a specialist in gerontology, geriatrics, and palliative care, please tell us about new approaches that oncologists should be aware of as they strive to provide high quality care for older patients and those receiving palliative care. Dr. Gabrielle Rocque: Absolutely. So, we've talked a bit about the patient-reported outcomes. And I think we'd be remiss in not highlighting the presentation on geriatric assessment--the presentations on the geriatric assessments into clinical practice by Dr. [Rawad] Elias (“Incorporating Geriatric Assessments Into Practice”). And I think this highlights another opportunity for us to move the field forward and take better care of our older adults. In terms of palliative care, there were multiple very informative abstracts. Dr. Wheeler has highlighted a few in the space of care guides or lay health coaches providing support in advanced care planning. In addition, we saw an interesting discussion of caregiver interventions for patients that are receiving--with cancer treatment by Dr. Nick Dionne-Odom (“Caregiver Interventions”). And I think it's important that we remember both the patients and the caregivers who are affected by cancer and by the amount of work that has to be done to support a patient with cancer going through their journey. ASCO Daily News: Absolutely, so important to remember caregivers and their needs and resources that could be available to them as well. Dr. Wheeler, financial toxicity is an enormous concern for many patients and their families, and the oncology care community has been trying for some time to figure out how best to address the concerns of patients and the health care system. Are there any new interventions that we should be aware of? Dr. Stephanie Wheeler: Yes, and I think that the [ASCO Quality Care] Symposium was an opportunity to hear about several of those. And some of them didn't make it onto the main stage but were featured in abstract sessions and poster sessions. So, as we're all well aware, financial toxicity is a multidimensional set of constructs that includes patients and their family's material out-of-pocket burden, as well as the psychological distress and potentially harmful care altering behaviors that financial hardship induces. And so, we continue to hear at the [ASCO Quality Care] Symposium multiple talks about the strain that patients are undergoing, including the non-medical hardship that's introduced by a cancer diagnosis. And that was really interesting, and I think important to document. But I think that where the field is moving is more towards interventions, both behavioral interventions and systems interventions, multilevel approaches to dealing with the hardship itself as well as the importance of policy. So, there were several abstracts that talked about the introduction of biosimilars and generics and how that affected price of many of the oncologic drugs available on the market. And frankly, the message is a bit discouraging. Prices continue to rise. And in some cases, the price increases are not limited to pharmacologic products. In some cases, we saw abstracts presenting the increased cost of surgery, of outpatient care appointments, and things like that as well. So, we're not going to fix the problem by managing drug pricing alone. In terms of patient and family-directed interventions, I thought that there were some interesting abstracts. I want to highlight a number 53--or excuse me, Abstract 43 by Melissa Beauchemin that focused on the existence of hospital specialty pharmacies and partnering with freestanding care coordination organizations to improve access to oncology medications, as well as Abstract 96 presented by Ms. Rachel Marquez which was focused on resolving transportation disparities and access to cancer treatments. These kinds of interventions are obviously patient directed but have tremendous potential. And then I also want to just note a couple of additional studies that are ongoing that are important to recognize in this field. There are at least five National Cancer Institute (NCI)-funded R01 trials underway right now investigating the role of financial navigation and various iterations of it in different care settings. So, I think we will want to look to this meeting as an opportunity to hear about that work as it moves forward. And how that work is implemented is going to be vital, because the types of care settings where it's being done--ranging from AYA populations in Utah, to urban populations in Washington state, to integrated care organizations in Northern California, all the way to parts of rural North Carolina--we're going to see a diversity of outcomes and different ways in which those types of interventions can manifest in those different studies. I also want to note that the NCI has funded a series of supplements through its Cancer Center Core Grant Initiative that are all focused on identification, timely identification of financial toxicity in practice. And many of the investigators leading that work were attending the [ASCO Quality Care] Symposium, and so that will be important to keep an eye on as we move forward as well. ASCO Daily News: Excellent. Dr. Rocque, let's focus on health equity and access. I'd like to ask you about the session on eliminating barriers to clinical trial access. The presenters of this session shared strategies to directly address inclusion and diversity in cancer care. Can you tell us about approaches that caught your attention? Dr. Gabrielle Rocque: Absolutely. So, this was a really great session talking about clinical trial access and barriers, and particularly as it relates to health equity. And so, in Abstract 74, Dr. Joe Unger presented a really interesting conceptual model that highlighted that the barriers to clinical trial access are not necessarily always at the patient level, but they are at the system level, the provider level. And this framework for considering how do we target in the future our ability to engage patients in clinical trials was really important, and I think was complemented well by the patient perspective from Rick Bangs, who's worked closely with SWOG, in thinking about how do patients view clinical trials and how can we better engage them. And I think folding together these different experiences and models to develop future interventions. I also thought the Abstract 75 looking at survival in the real-world analysis was noteworthy. And in particular, the ability to consider patients who are typically excluded from clinical trials based on their laboratory criteria and potentially having something like chronic kidney disease, and how little data there is on those patients who actually, in this study, had different outcomes after chemotherapy for breast cancer. I think when you think about clinical trial access and inclusion, I also think you need to think about how we collect our data and how we consider race and other social determinants of health. So, there were a few other abstracts that, although not in this session, I think were incredibly important for us to consider. The first is Abstract 78 by Ms. Niveditta Ramkumar that talked about the association between rurality and race and surgical treatment and outcomes for non-metastatic colon cancer. And so, she talked a bit about the intersectionality between race and rurality, and I think brings up an important topic that we need to think about these constructs, not only as individual constructs but how they impact each other as we consider analysis in the future. And also Abstract 80 by Dr. Kekoa Taparra, which was a really interesting abstract that talked about the disaggregation of Pacific Islanders in major Asian subpopulations to reveal hidden cancer disparities. So, in this abstract, he discussed how we often lump together different populations, potentially because of small numbers, who really may have very different experiences and characteristics. And I think challenges us to move the field forward by identifying populations in groups that are, in fact, very similar to each other and not just pulling this together. And I think that will have an impact on how we view engaging patients in clinical trials, as well as reporting those clinical trial results that allows our providers to understand how the trial results fit for the patient that is sitting in their clinic for whom they're making their decisions. ASCO Daily News: Indeed. Dr. Wheeler, is there anything that you'd like to add on the issue of access to clinical trials? Dr. Stephanie Wheeler: So, there was an abstract that particularly sparked my attention, [Abstract] 79 presented by Dr. Jenny Xiang about the VA Connecticut Cancer Experience, where universal pre-screening and using computer algorithms to identify patients who might be eligible for clinical trials was used. And I think that this is an important approach that can help us rely less on the assumptions and the biases that exist in clinical care practice about whether a patient may or may not participate in a clinical trial, and instead use the vast amounts of information that we know about them in their electronic health record to try to preemptively identify them and approach them. We know that when patients are asked and invited to be part of trials, they are much more likely to say yes than people assume. And this could be a more unbiased way of assessing that eligibility, and then proactively identifying people, ideally, with a trial navigator. I think that would enable us to potentially overcome some of the barriers that exist and that are, frankly, institutionally biased in many cases. ASCO Daily News: Thank you, Dr. Wheeler. Dr. Rocque, the [ASCO Quality Care] Symposium featured an excellent keynote address by Dr. Ben Corn of Hebrew University of Jerusalem (“Integrating Hope – Real Hope! – Into Clinical Oncology”) and a wonderful lecture by Dr. John Cox, who was honored with the Joseph V. Simone award for advancing quality cancer care (“Reshaping Practice: Necessary Trouble”). Can you share some highlights from their talks? Dr. Gabrielle Rocque: Definitely. So, the keynote address by Dr. Ben Corn was perfectly timed for this meeting. I think everyone has had a difficult past 2 years with the pandemic. And his message of the importance of hope really struck a chord with me and many of the attendees, and how this is something that we can strategically work to improve, and that hope is something we can modify and train for. And so, I'm really excited to both hear this lecture and then also see what's to come in the future in this domain of hope-related research. Another session that I would like to highlight as well is Dr. Cox's talk after receiving the Joe Simone Achievement Award. And his lecture highlighted that change is coming. And he emphasized the importance of changing payment structures to be able to improve the quality of care that patients receive and to be able to leverage those changes for infrastructure that allows us to enable our health system to have a more patient-centered approach with many of the types of interventions that we've been talking about here today. So, I think both of those sessions are really must-watch sessions that I would like to highlight today. ASCO Daily News: Excellent. Well, the [ASCO Quality Care] Symposium also heard some compelling patient perspectives. Dr. Wheeler, can you share some of these messages with us? Dr. Stephanie Wheeler: One of the most powerful sessions in the entire meeting was the very first one, which was focused on the metavivor experience (“The Patient Voice: “Metavivors” and Long-Term Survivorship Care”). And I think because part of the intention of the planning committee was to proactively feature patients' voices at this meeting, this particular session was almost entirely comprised of patients and survivors. And living with advanced disease, as we know now, is very different than it was in the past. And we know that patients living with incurable disease may sometimes go on to live 15, 20, 25 years. And their needs are quite different than patients who have early-stage cancer. And so, this session was impactful because it represented a range of experiences. We heard from a caregiver. We heard from a young woman who's living with stage four melanoma, Dr. Tarlise Townsend (“An AYA Perspective”). And one of the things that I took away from this session in particular was that our approaches in the way that we talk to metavivors has to be fundamentally different, that they want providers to be truthful, they want providers to acknowledge the uncertainty and prognosis and the sometimes complex and rapidly changing regimens that may be available for them in terms of dealing with their disease. But they don't want to be condescended to, they don't want to feel like there's information that is being withheld. One of the things that Dr. Townsend shared that was very powerful was that she talked about how her providers, in many cases, outlined an optimistic future for her and would give her maybe unfair expectations about what the future might hold and think about it in terms of the outlier effect. But that's not the case for many people with her condition. And so, she talked about having to do her own death work--and that's her term--and how much time she spent really trying to understand for herself what the future looked like. And it just resonated so much with me. And everybody on this panel had similar stories to share about their experiences. And it reminded me that at the end of the day, we're all human. None of us deal with uncertainty well. None of us deal with death well, or the prospect of death. But the best that we can do in these situations is to be open and honest and straightforward and recognize the fear and the hope and all of that being intermingled, and really respect the person's autonomy and the person's experience and their ability to make plans for themselves going forward. ASCO Daily News: Thank you, Dr. Wheeler. We will have links to these important patient perspectives in the transcript of this episode, as well as the other abstracts discussed today. Dr. Rocque and Dr. Wheeler, thank you very much for sharing these important highlights from the 2021 ASCO Quality Care Symposium. Dr. Stephanie Wheeler: Thank you for having us. Dr. Gabrielle Rocque: Thank you so much. ASCO Daily News: And thank you to our listeners for your time today. If you enjoyed this episode, please take a moment to rate, review, and subscribe wherever you get your podcasts. Disclosures: Dr. Gabrielle Rocque: Consulting or Advisory Role: Pfizer, Flatiron Research Funding: Carevive Systems, Genentech, Pfizer Travel, Accommodations, Expenses: Carevive (an immediate family member) Dr. Stephanie Wheeler: Research Funding (institution): Pfizer Foundation Travel, Accommodations, Expenses: Pfizer Disclaimer: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.    

ASCO: You're listening to a podcast from Cancer.Net. This cancer information website is produced by the American Society of Clinical Oncology, known as ASCO, the world's leading professional organization for doctors who care for people with cancer. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Cancer research discussed in this podcast is ongoing, so the data described here may change as research progresses. In the Research Round Up series, members of the Cancer.Net Editorial Board discuss the most exciting and practice-changing research in their field and explain what it means for people with cancer. In today's episode, Cancer.Net Associate Editors discuss new research in brain tumors and gastrointestinal cancers presented at the 2021 ASCO Annual Meeting, held virtually June 4-8. First, Dr. Glenn Lesser will discuss new research in 2 types of brain tumors, craniopharyngioma and glioblastoma. Dr. Lesser is the Louise McMichael Miracle Professor and Associate Chief in the section on Hematology and Oncology in the Department of Internal Medicine at Wake Forest University, and is the Director of Medical Neuro-Oncology at the Atrium Health Wake Forest Baptist Comprehensive Cancer Center. He is also the Cancer.Net Associate Editor for central nervous system tumors. View Dr. Lesser's disclosures at Cancer.Net. Dr. Lesser: Hello. My name is Glenn Lesser, and I'm a professor of medical oncology and the Director of Medical Neuro-oncology at the Wake Forest Baptist Comprehensive Cancer Center in Winston-Salem, North Carolina. I'm also the editor of the brain tumor section for ASCO's Cancer.Net. And today, I would like to briefly discuss 2 clinically relevant research studies involving patients with brain tumors that were presented at this year's ASCO's Virtual Scientific Program. I have no disclosures or relationships relevant to the second abstract I'll be discussing today. But by way of full disclosure, I have enrolled patients and I'm a co-investigator on the first study I'll describe. As an introduction to those listeners not familiar with the current treatment options for patients with brain tumors, it's important to remember that patients with primary tumors of the brain have not seen the recent rapid advances in effective treatment strategies that patients with other malignancies have experienced. Thus, those of us who treat these patients really actively await the research results, which are presented and highlighted annually in several of our key national meetings, including ASCO, or the American Society of Clinical Oncology, Annual Meeting, which was, again, held virtually this year in light of the pandemic. I have selected several abstracts whose results, I believe, have immediate clinical relevance and can be used to modify our current standard of care therapies for the subgroups studied. First abstract of interest was the presentation by Dr. Brastianos, who is the principal investigator of the Alliance A071601 study, which is a phase II trial of BRAF/MEK inhibition in patients with a tumor called a newly diagnosed papillary craniopharyngioma. A craniopharyngioma's a very uncommon tumor that can occur in both adults and children. And it typically arises in the region of the optic chiasm, a very important structure related to vision, and the pituitary gland, which is responsible for the production of a variety of hormones or compounds which stimulate other glands in the body to produce key hormones. These tumors often have cystic and solid components. And, as they grow, they compress the optic chiasm and the pituitary gland to produce symptoms, including loss of bilateral peripheral vision. Standard therapy for these lesions has included 1 or more surgeries and treatment with radiation therapy, including both external beam radiation and stereotactic radiosurgery.  Although these tumors are generally not felt to be malignant, their continued growth and compression of surrounding structures leads to significant morbidity and symptoms, which dramatically worsen the quality of life of patients who have them and which, rarely, can be fatal. In adults, the most common variant of these tumors is called a papillary craniopharyngioma. And Dr. Brastianos and others have previously shown that these papillary tumors almost always have a driver mutation known as a BRAF V600E mutation. Now, a driver mutation is a specific mutation in the DNA, the instruction manual of the tumor cells, that gives those cells a selective growth advantage and, thus, promotes the cancer's development and spread. In contrast, passenger mutations are mutations that may be present in the cancer cells but don't directly promote their growth or survival. The tumors that contain these driver mutations have the potential to be selectively targeted and effectively controlled by drugs which have been developed against that particular characteristic mutation. So this study builds on earlier case reports showing fairly dramatic regressions of these tumors with the use of agents that have been developed to target the BRAF V600E mutation, which is a characteristic of the more common aggressive melanoma skin cancer. Over the last decade, 3 sets of drugs have been developed and brought to market, which have great efficacy in killing cells with this specific mutation. These drugs include a BRAF inhibitor, which targets the BRAF gene, and a MEK inhibitor, which essentially blocks an escape mechanism that the tumor cells try to use when confronted by the BRAF inhibitor. This is the only example I know of in oncology where giving 2 drugs leads to actually fewer side effects than if only the BRAF inhibitor was given by itself. But this trial had 2 cohorts of patients, 1 where it involves 16 patients with newly diagnosed craniopharyngiomas and a second arm enrolled patients whose craniopharyngioma recurred after radiation plus or minus surgery. The drugs used in this trial were vemurafenib and cobimetinib. And the goal was to give patients at least 4 months of this oral combination therapy. Dr. Brastianos presented the results of the newly diagnosed cohort, or Cohort A, at this year's ASCO. Remarkably, 15 of the 16 treated patients, or 94% of those treated, had a volumetric response, meaning a significant shrinkage of the tumor based on a central, independent review of their brain MRI scans. In fact, the only patient who didn't respond only received 2 days of treatment before they had to stop the medications due to some drug-related toxicity. So not only did these patients respond, but the median reduction in their tumor size was about 91%. And, furthermore, these responses appeared to last a long time, with only 1 patient recurring at the time the data was analyzed for ASCO. The estimated overall survival of the patients on Cohort A at 2 years was 100%, while their estimated progression-free survival at 2 years was 93%. Phenomenal results. These drugs do have a variety of side effects which can occur to someone commonly and may lead to drug discontinuation in as many as a third of patients, although not nearly that many discontinue these drugs due to toxicity on this particular trial. These results, I believe, really establish combination-drug therapy with BRAF and MEK inhibitors as an effective standard-of-care option for selected patients with these newly diagnosed papillary craniopharyngiomas that contain a BRAF mutation. We're anxiously awaiting both longer-term follow-up of this study to determine the durability of these responses as well as the presentation of the results of Cohort B, which treated patients with recurrent disease after radiation. The second study I'd like to highlight was presented in the oral poster session by Dr. Domenech on behalf of her colleagues in the GEINO, the Spanish Neuro-oncology Cooperative Group Trial 14-01. She presented the long-term results of this prospective trial, which randomized patients with newly diagnosed glioblastoma to 6 cycles of adjuvant temozolomide versus continuing the temozolomide for up to 12 monthly cycles of therapy. But since the publication of Dr. Roger Stupp's landmark trial in the New England Journal of Medicine in 2005, the standard therapeutic approach around the world for patients with newly diagnosed glioblastoma has included concurrent radiation and temozolomide chemotherapy for about 6 weeks, so both given at the same time, followed by monthly adjuvant temozolomide for 6 to 12 months with the drug being given for 5 days in a row each month. We have learned much about the molecular subgroups of glioblastoma and the characteristic molecular findings that may predict a given patient's responsiveness to this therapy since this publication. To date, however, clinical trials have not convincingly determined whether the benefits seen by adding chemotherapy to radiation stem from the concurrent phase of therapy, the adjuvant or post-radiation phase of therapy, or the entirety of the concurrent followed by adjuvant temozolomide. Furthermore, although the initial pivotal study described only 6 months of adjuvant monthly temozolomide to patients, many practitioners have felt that, frankly, more is better, particularly with a well-tolerated drug like temozolomide. And many physicians routinely give up to 12, or even more, monthly cycles of the drug. As a result, many clinical trials over the last 15 years have allowed investigators to treat to the duration of their choice. Those in favor of this approach believe that more anti-cancer therapy is better, while those who limit temozolomide to only 6 months cite the increased cost, the increased rate of side effects or toxicities, as well as the mutational stress that prolonged alkylating therapy might put on tumors, which can theoretically lead to a more resistant tumor at the time of recurrence. GEINO 14-01, which enrolled 159 patients, is the only large, prospective attempt to randomize patients to 6 or 12 cycles of adjuvant temozolomide therapy. The presented findings clearly show that adding 6 cycles of temozolomide after the first 6 adjuvant cycles produced no additional benefit in overall survival. With a median follow-up of about 20 months, there was no difference in the percent of patients surviving at 2 years between the arms, nor was there a difference in the percent of long-term survivors defined as survival of at least 30 months from the diagnosis. Patients in the extended therapy arm did experience an increase in hematologic or blood count toxicities in addition to the added cost and additional doctor visits the extended treatment generated. The authors, somewhat respectfully, concluded that the results of this trial should be corroborated in a prospective phase III trial. However, it's unlikely that such a trial will ever be mounted. And these results are likely going to be the best data we have to guide our approach in the future. Although more data will be provided in the full publication of the results of this trial, the presented results indicate that in most patients with newly diagnosed glioblastoma, the standard of care should involve a maximum of 6 months of adjuvant temozolomide chemotherapy. In conclusion, the investigative teams behind both of these studies I've just described are to be commended on their efforts, which provide guidance on how best to care for patients with craniopharyngiomas and newly diagnosed glioblastoma. These studies are also outstanding examples of why well-done clinical trials that carefully test and evaluate the beneficial effects, as well as the toxicities of new cancer treatments, are critical to our goal of optimizing the treatment of our patients with cancer. Thanks so much for listening today. ASCO: Thank you Dr. Lesser. Next, Dr. Jeffrey Meyerhardt will discuss new research in esophageal and colorectal cancer. Dr. Meyerhardt is the Douglas Gray Woodruff Chair in Colorectal Cancer Research, Clinical Director and Senior Physician at the Gastrointestinal Cancer Center at the Dana-Farber Cancer Institute, Deputy Clinical Research Officer at the Dana-Farber Cancer Institute, and Professor of Medicine at Harvard Medical School. He is also the Cancer.Net Associate Editor for gastrointestinal cancers. View Dr. Meyerhardt's disclosures at Cancer.Net. Dr. Meyerhardt: My name is Jeffrey Meyerhardt. I'm a gastrointestinal oncologist at the Dana-Farber Cancer Institute in Boston, Massachusetts. I'm an Associate Editor of Cancer.Net, ASCO's patient information site. Today, I'm going to discuss research on gastrointestinal cancers that were presented at the 2021 ASCO Annual Meeting. I do not have any relationships to disclose related to these studies. I'm going to focus on some studies related to esophageal and gastric cancer as well as studies in colorectal cancer. For esophageal and gastric cancer, we saw a variety of studies for immunotherapy in different settings. I think some important background information in considering esophageal and gastric cancer is that there are similarities and differences between the 2 cancers. Esophageal cancers can be squamous cell or adenocarcinomas. Gastric cancers that'll be discussed here are adenocarcinomas. In between the esophagus and the stomach is the gastroesophageal junction, one of the cancers with increasing incidence overall. They are also typically adenocarcinomas. For non-metastatic disease, the location of disease is treated differently. But for metastatic disease, most standard chemotherapy trials lump all of these sites together and have mixed squamous cell carcinoma and adenocarcinoma of the esophagus together. However, with immunotherapy, there are differences emerging to rethink this concept. While there are challenges in finding reliable markers to determine efficacy of immunotherapy in all cancer types, 2 markers have emerged relevant to gastro and esophageal cancer, PD-L1, or the combined positive score, and tumor mutational burden, which signals immunogenicity of a cancer. While there were a wealth of studies of immunotherapy, 1 study that was noteworthy at this year's ASCO was CheckMate 648. The CheckMate studies have focused on the PD-1 inhibitor nivolumab. Checkmate-648 was a randomized study comparing unresectable advanced, recurrent, or metastatic esophageal squamous cell carcinoma, previously untreated, randomized to 1 of 3 treatments. Nivolumab with 2 standard chemotherapies, 5-FU and cisplatinum, versus nivolumab and ipilimumab, a no-chemotherapy, just-immunotherapy arm, or chemotherapy only with 5-FU and cisplatinum. Nivolumab and ipilimumab was superior to chemotherapy only alone for overall survival and progression-free survival, particularly in patients with PD-L1 scores greater than or equal to 1%. Of note, there are some patients that don't benefit early on, which has been seen in other studies comparing chemotherapy to immunotherapy. There was similar overall and progression-free survival for immunotherapy alone compared to nivolumab, 1 immunotherapy with chemotherapy. More immunotherapy-related toxicities were seen with the combined immunotherapy arm, but more GI toxicities were seen with nivolumab plus chemotherapy. Overall, this study provides a non-chemotherapy option for patients as initial therapy for esophageal squamous cell carcinoma. Turning to colorectal cancers, there are 2 studies that I wanted to highlight. The first study was the DESTINY-CRC01 study. This was a phase II study of trastuzumab deruxtecan, T-DXd, which is an antibody-drug conjugate of humanized anti-HER2 antibody bound to a chemotherapy, a topoisomerase I inhibitor. A phase II study means all patients got the same drug. The study focused on a limited population of metastatic colorectal cancer patients who overexpressed a protein called HER2. As with other cancer types, it is important to have molecular testing of colorectal cancer that may determine certain treatment options for patients. The several molecular features in colorectal cancer that are proven most important in treatment decisions include microsatellite instability, a feature that predicts effectiveness of immunotherapy; KRAS and RAS mutations that the lack of efficacy of a class of drugs called epidermal growth factor inhibitors like cetuximab and panitumumab; BRAF, which has specific drugs that target this mutation; and HER2. HER2 overexpression was first targeted in breast cancer. And there are also overexpressing stomach cancers that benefit from HER2-directed therapy. Approximately 3 to 4 percent of metastatic colorectal cancers overexpressed HER2. The DESTINY trial focused on patients who had progressed on at least 2 prior lines of therapy. So a heavily-pretreated population, 45% of patients with significant overexpression had a response to therapy. And 83% had disease control with a median of greater than half a year. Interestingly, the drug was meaningfully active in patients who had prior HER2-directed therapy. While the drug had some expected toxicities, 9% of patients also experienced something called interstitial lung disease, inflammation of the lungs, which would need to be monitored. However, this drug does show promise in the armamentarium of targeted therapies for metastatic colorectal cancer. The last trial I wanted to focus on is FOCUS4. This trial compared maintenance therapy with capecitabine, an oral form of 5-FU, versus active monitoring for patients with metastatic colorectal cancer. This is a topic that I found so important over the years and have not received as much attention I think it deserves. Fortunately, there are multiple trials in this field. And I think it's important to highlight them when new ones result. The basic principle is that when treating colorectal cancer these days with combinations of different chemotherapies, it is not uncommon to have a patient experience good disease control for prolonged periods of time. Initially, trials for metastatic colorectal cancer decades ago just continued therapy for as long as the disease was controlled for undue toxicities. However, with more effective therapies, there also have been increasing cumulative toxicities that catch up with patients over time. And there has been interest in continuing and considering changing at some point from multiple combination regimens to either maintenance therapy, some people call “chemotherapy light,” or giving a full holiday off therapy. And there have been multiple trials over the years that have looked at these strategies. What is clear from those trials is that patients don't do better just staying on combination therapy. However, maintenance therapy is still chemotherapy. And a key to understand, is that even necessary? Are patients compromising outcomes by taking periods off of treatment? FOCUS4 was a trial in the U.K. that randomized patients with metastatic colorectal cancer whose disease was controlled after 16 weeks of first-line combination therapy. They received either capecitabine with a usual 2 weeks of pills followed by 1-week break--or active monitoring with scans every 8 weeks. While the time till this tumor grew was shorter fully off of chemotherapy, the overall survival was not different between the 2 arms. This lack of overall survival has proven out in other trials. It was recently seen in a meta-analysis published in the Journal of the American Medical Association of Oncology recently. Active monitoring may not be the best option for every patient. But I think it is an important discussion between patients and their oncologists to balance quality of life and continued disease control. Thank you for listening to this brief summary of new research in gastrointestinal cancers from the 2021 ASCO Annual Meeting. ASCO: Thank you, Dr. Meyerhardt. You can find more research from recent scientific meetings at www.cancer.net. And if this podcast was useful, please take a minute to subscribe, rate, and review the show wherever you listen to podcasts. This Cancer.Net podcast is part of the ASCO Podcast Network. This collection of 9 programs offers insight into the world of cancer care, covering a range of educational, inspirational, and scientific content. You can find all 9 shows, including this one, at podcast.asco.org. Cancer.Net is supported by Conquer Cancer, the ASCO Foundation, which funds lifesaving research for every type of cancer, helping patients everywhere. To help fund Cancer.Net and programs like it, donate at CONQUER.ORG/Donate.

Spark Therapeutics' Clinical Development Lead, Hematology, Dr. Tiffany Chang explains the company's data from its ongoing Phase 1/2 clinical trial of investigational SPK-8011 for hemophilia A, the largest gene therapy trial in this disease to date as well as the misconceptions and unknowns about the disease.

CLICK HERE to listen to episode audio (4:09).Sections below are the following: Transcript of Audio Audio Notes and Acknowledgments ImageExtra Information Sources Related Water Radio Episodes For Virginia Teachers (Relevant SOLs, etc.). Unless otherwise noted, all Web addresses mentioned were functional as of 9-24-21. TRANSCRIPT OF AUDIO From the Cumberland Gap to the Atlantic Ocean, this is Virginia Water Radio for the week of September 27, 2021.  This episode is part of a series this fall on water connections to the human body and human biology.  This week, we start with some mystery sounds.  Have a listen for about 25 seconds, and see if you know the body system you can hear at work in all of these sounds.  And here's a hint: it'll be a show of strength if you guess this. SOUNDS  - ~23 sec If you guessed the muscular system, you're right!  Walking, dribbling a basketball, lifting weights, and jumping rope all involve some of the over 600 skeletal muscles in the human body.  Skeletal muscles, also called striated or voluntary muscles, are one of three muscle types in the body.  The other two are smooth, or involuntary muscles, found in internal organs; and cardiac muscle in the heart.  Whatever their location or function, muscles have several important connections to water, including the following six. First, water is a major component of muscles, making up over 70 percent of muscle mass. Second, cell volume, that is, the space within cells, is affected by the amount of water that cells contain, or the cells' hydration state.  This is believed to be related to muscle strength and contraction capacity by affecting the shape and function of muscle proteins. Third, water is the medium containing all the dissolved biochemicals that the body needs to function, including those involved in muscular contraction and in nourishing muscle cells. Fourth, water is involved in reactions that release energy from the molecule ATP, and water is associated with the important energy-storage molecule glycogen. Fifth, water helps regulate body temperature, including the heat generated by muscular activity. And sixth, water helps lubricate moveable joints, the structures upon which skeletal muscles act to move parts of the body. Overall, water plays a significant role in muscle strength and function, and muscle, in turn, is an important area of water storage for the body. We close with some music whose title speaks of one of the most common uses of our muscles.  Here's the closing 25 seconds of “Walk This Way For Awhile,” by the Harrisonburg and Rockingham County, Va.-based band, The Steel Wheels. MUSIC - ~25 sec – Lyrics: “…you walk this way for awhile; will you walk this way for awhile?  I think you will, I know you still, I hope you will.” SHIP'S BELL Virginia Water Radio is produced by the Virginia Water Resources Research Center, part of Virginia Tech's College of Natural Resources and Environment.  For more Virginia water sounds, music, or information, visit us online at virginiawaterradio.org, or call the Water Center at (540) 231-5624.  Thanks to Stewart Scales for his banjo version of Cripple Creek to open and close this show.  In Blacksburg, I'm Alan Raflo, thanking you for listening, and wishing you health, wisdom, and good water. AUDIO NOTES AND ACKNOWLEDGEMENTS The sounds heard in this episode were recorded by Virginia Water Radio in Blacksburg, Va., on September 23, 2021. “Walk This Way for Awhile,” by The Steel Wheels, is from the album “Live at Goose Creek,” recorded October 14, 2010, at Franklin Park Performing Arts Center, Purcellville, Va., and produced by Goose Creek Music; used with permission of The Steel Wheels.  The song is also on The Steel Wheel's 2010 album, “Red Wing.”  More information about The Steel Wheels is available online at http://www.thesteelwheels.com/.  More information about Goose Creek Music is available online at http://www.goosecreekmusic.com/.  More information about the Franklin Park Arts Center is available online at http://www.franklinparkartscenter.org/.  This music was used previously by Virginia Water Radio in Episode 286, 10-19-15. Click here if you'd like to hear the full version (1 min./11 sec.) of the “Cripple Creek” arrangement/performance by Stewart Scales that opens and closes this episode.  More information about Mr. Scales and the group New Standard, with which Mr. Scales plays, is available online at http://newstandardbluegrass.com. IMAGE Structure of a representative human skeletal muscle.  Illustration from National Institutes of Health/National Cancer Institute, SEER Training Module, “Muscular System/Structure of Skeletal Muscle,” online at https://training.seer.cancer.gov/anatomy/muscular/structure.html. EXTRA INFORMATION ABOUT THE HUMAN MUSCULAR SYSTEM The following information is quoted from the National Institutes of Health/National Cancer Institute, SEER Training Module, “Muscular System/Introduction” online at https://training.seer.cancer.gov/anatomy/muscular/. “The muscular system is composed of specialized cells called muscle fibers.  Their predominant function is contractibility.  Muscles, attached to bones or internal organs and blood vessels, are responsible for movement.  Nearly all movement in the body is the result of muscle contraction.  Exceptions to this are the action of cilia, the flagellum on sperm cells, and amoeboid movement of some white blood cells. “The integrated action of joints, bones, and skeletal muscles produces obvious movements such as walking and running.  Skeletal muscles also produce more subtle movements that result in various facial expressions, eye movements, and respiration. “In addition to movement, muscle contraction also fulfills some other important functions in the body, such as posture, joint stability, and heat production.  Posture, such as sitting and standing, is maintained as a result of muscle contraction.  The skeletal muscles are continually making fine adjustments that hold the body in stationary positions.  The tendons of many muscles extend over joints and in this way contribute to joint stability.  This is particularly evident in the knee and shoulder joints, where muscle tendons are a major factor in stabilizing the joint.  Heat production, to maintain body temperature, is an important by-product of muscle metabolism.  Nearly 85 percent of the heat produced in the body is the result of muscle contraction.” SOURCES Used for Audio Ann Baggaley, ed., Human Body, Dorling Kindersley Publishing, New York, N.Y, 2001. Cedric Bryant and Daniel Green, eds., Essentials of Exercise Science, American Council on Exercise, San Diego, Calif., 2017. Michael Houston, Biochemistry Primer for Exercise Science, 3rd Edition, Human Kinetics, Champaign, Ill., 2006. Isabel Lorenzo et al., “The Role of Water Homeostasis in Muscle Function and Frailty: A Review,” Nutrients, Vol. 11, No. 8 (August 2019, accessed online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6723611/(subscription may be required for access).  National Institutes of Health/National Cancer Institute, SEER Training Modules, “Muscular System,” online at https://training.seer.cancer.gov/anatomy/muscular/. Science Direct, “Synovial Fluid: Structure and Function,” excerpted from Textbook of Pediatric Rheumatology, 5th Edition, Elsevier, Amsterdam, Netherlands, 2005; accessed online at https://www.sciencedirect.com/topics/medicine-and-dentistry/synovial-fluid(subscription may be required for access). Scott Powers and Edward Howley, Exercise Physiology: Theory and Application to Fitness and Performance, 8th Edition, McGraw-Hill, New York, N.Y., 2012.U.S. Geological Survey, “The Water in You: Water and the Human Body, online at https://www.usgs.gov/special-topic/water-science-school/science/water-you-water-and-human-body?qt-science_center_objects=0#qt-science_center_objects. For More Information about Water and the Human Body American Society of Hematology, “Blood Basics,” online at https://www.hematology.org/education/patients/blood-basics. Cleveland [Ohio] Clinic, “Heart & Blood Vessels: How Does Blood Travel Through Your Body,” online at https://my.clevelandclinic.org/health/articles/heart-blood-vessels-blood-flow-body. Cleveland [Ohio] Clinic, “Lymphatic System,” online at https://my.clevelandclinic.org/health/articles/21199-lymphatic-system.Eric Cudler, “Neuroscience for Kids,” online at https://faculty.washington.edu/chudler/neurok.html. Franklin Institute of Philadelphia, Penn., “Blood Vessels,” online at https://www.fi.edu/heart/blood-vessels. Mayo Clinic Health System, “Water: Essential to your body,” online at https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/water-essential-to-your-body. Memorial Sloan Kettering Cancer Center, “Facts About Blood and Blood Cells,” online at https://www.mskcc.org/cancer-care/patient-education/facts-about-blood-and-blood-cells. National Institutes of Health/National Cancer Institute, SEER Training Modules, “Nervous System,” online at https://training.seer.cancer.gov/anatomy/nervous/. National Institutes of Health/National Cancer Institute, SEER Training Module, “Skeletal System,” online at https://training.seer.cancer.gov/anatomy/skeletal/.National Institutes of Health/National Library of Medicine, “Blood, Heart and Circulation,” online at http://www.nlm.nih.gov/medlineplus/bloodheartandcirculation.html. University of Bristol (England), School of Medical Sciences, “Brain Basics: The Fundamentals of Neuroscience,” online at http://www.bris.ac.uk/synaptic/basics/basics-0.html. RELATED VIRGINIA WATER RADIO EPISODES All Water Radio episodes are listed by category at the Index link above (http://www.virginiawaterradio.org/p/index.html).  See particularly the “Science” subject category. Another episode related to human exercise is Episode 483, 7-29-19.  It focuses on buoyancy and drag in the water and is designed for middle school and high school students. Following are links to other episodes on connections of water to human biology.  Please note that some of these episodes are being redone in fall 2021; in those cases, the respective links below will have information on the updated episodes.  Episode 195, 1-6-14 – Water thermodynamics.Episode 393, 11-6-17 – Disease: Influenza.Episode 466, 4-1-19 – Water intake and sports.Episode 517, 3-23-20 and Episode 519, 4-6-20 – Disease: Water connections to COVID-19.Episode 592, 8-30-21 – Overview of water's roles in the body.Episode 593, 9-6-21 – Circulatory system connections to water.Episode 594, 9-13-21 – Neurological system connections to water.Episode 595, 9-20-21 – Skeletal system connections to water. FOR VIRGINIA TEACHERS – RELATED STANDARDS OF LEARNING (SOLs) AND OTHER INFORMATION Following are some Virginia Standards of Learning (SOLs) that may be supported by this episode's audio/transcript, sources, or other information included in this post. 2020 Music SOLs SOLs at various grade levels that call for “examining the relationship of music to the other fine arts and other fields of knowledge.” 2018 Science SOLs Grades K-3 plus 5: Force, Motion, and Energy5.2 – Energy can take many forms.5.3 – There is a relationship between force and energy of moving objects. Grades K-4: Living Systems and Processes4.2 – Plants and animals have structures that distinguish them from one another and play vital roles in their ability to survive. Grade 66.6 – Water has unique physical properties and has a role in the natural and human-made environment. Life ScienceLS.2 – All living things are composed of one or more cells that support life processes, as described by the cell theory.LS.4 – There are chemical processes of energy transfer which are important for life. BiologyBIO.2 – Chemical and biochemical processes are essential for life.BIO.3 – Cells have structure and function. Virginia's SOLs are available from the Virginia Department of Education, online at http://www.doe.virginia.gov/testing/. Following are links to Water Radio episodes (various topics) designed especially for certain K-12 grade levels. Episode 250, 1-26-15 – on boiling, for kindergarten through 3rdgrade.Episode 255, 3-2-15 – on density, for 5th and 6th grade.Episode 282, 9-21-15 – on living vs. non-living, for kindergarten.Episode 309, 3-28-16 – on temperature regulation in animals, for kindergarten through 12th grade.Episode 333, 9-12-16

Dr. Sanjay Juneja is a triple board certified hematologist and medical oncologist and Chief Medical Officer of the Cancer Channel on the online health and wellbeing platform Doctorpedia. Better known online as ‘TheOncDoc', he prides himself as a social media educator and medical influencer with over 500,000 followers. He's also a regular guest on TV news channels and podcasts, and has partnered with several cancer organizations to support awareness initiatives. During his time at Louisiana State University (LSU) School of Medicine, Dr Juneja developed a strong appreciation of the pivotal role of education in supporting patients through medical challenges, including cancer, by empowering them with a solid understanding of their diagnosis and treatment. After completing residential training in Internal Medicine at LSU's Health Sciences Center, Dr Juneja served as a Chief Fellow in Hematology/Oncology at the Feist-Weiller Cancer Center in Shreveport, LA. In 2019 he returned to his native city of Baton Rouge to work with the Hematology/Oncology Clinic, an American Oncology Network division. He was certified by American Board of Internal Medicine in Internal Medicine, Hematology and Medical Oncology. https://passiveincomemd.com/podcast74/

Jennifer Maynard spent over twenty years in the field of Biotechnology and Pharmaceuticals, where she focused mainly in Oncology, Ophthalmology and Hematology, working to try to make a change for the better in human health. She left her career as a Pharma Executive to pursue her passion for “Food as Medicine,” as she believes that only by addressing what we put on our plates can we begin to truly combat chronic illness. In this pursuit she founded Greater Greens, a regenerative farming operation that combines modern Ag technology, like vertical aquaponics, with regenerative farming practices to harvest the greatest benefits of nature, while still preserving and regenerating it.  She focuses on the connectivity of soil health, plant health and human health. Once the farm was fully operational, she co-Founded Nutrition for Longevity (www.nutritionforlongevity.com) with L-Nutra (www.L-Nutra.com) to provide clean, healthy, farm fresh produce, precisely tailored meal kits, and lifestyle programs that follow the Longevity Diet and bring Food as Medicine to life.Recently Jennifer founded United4Longevity (www.United4Longevity.com), a non-profit focusing on Food as Medicine and in collaboration with Nutrition for Longevity, provides nutritional solutions to address chronic illnesses to the most underserved communities across the US.In this conversation Jennifer talks about the basics of longevity diet - focusing on whole, minimally processed foods, with high nutritional density and in optimal proportion of macronutrients. Should you eat raw? Is portion control important, or should we pay more attention to calories? Can you be full on plant-based diet? Can you get enough protein? How important is knowing where our food comes from? Tune in to get answers for all of these questions and more!This podcast is brought to you by Emory Lifestyle Medicine & Wellness. To learn more about our work, please visithttps://bit.ly/EmoryLM

Title of episode: 099 Leukemia: Canine Blood Cancer   Join Yvonne Brandenburg, RVT, VTS SAIM and Jordan Porter RVT, LVT, VTS SAIM as we talk about: The other type of leukemia… but no, it is not like the feline version; remember that is a virus. Leuk stands for white, and emia stands for blood. That is right, this is a white blood cell disease.    Question of the Week What is your experience with canine leukemia?  Leave a comment at https://imfpp.org/episode99   Resources We Mentioned in the Show  VIN: Canine Leukemia:  https://veterinarypartner.vin.com/default.aspx?pid=19239&catId=102899&id=4952613  EclinPath: Hematology; leukemia types:  https://eclinpath.com/hematology/leukemia/leukemia-types     Thanks so much for tuning in. Join us again next week for another episode!  Want to earn some RACE approved CE credits for listening to the podcast? You can earn between 0.5-1.0  hour of RACE approved CE credit for each podcast episode you listen to.    Join the Internal Medicine For Vet Techs Membership to earn and keep track of your continuing education hours as you get your learn on!   Join now! http://internalmedicineforvettechsmembership.com/   Get Access to the Membership Site for your RACE approved CE certificates Sign up at https://internalmedicineforvettechsmembership.com  Get Access to the Technician Treasure Trove  Sign up at https://imfpp.org/treasuretrove    Thanks for listening!  – Yvonne and Jordan     

Some mission experts estimate that up to 90% of young people who consider missions cease to pursue it because of various fears and obstacles, including the fear of fundraising. This session will help participants: 1. Identify various obstacles and fears relating to fundraising 2. Consider ways that God can help us overcome these barriers 3. Become aware of best resources and training materials used to help missionaries build and maintain a full and engaged prayer and financial support team 4. Know what questions to ask about support raising with possible mission agencies when evaluating where and how God will have you serve

Dr. Bart Biemond, a hematologist joins the podcast to discuss topics in sickle cell anemia in this PV Roundup specialist spotlight podcast.

This session focuses on women in mission and will highlight the role of women in missions, challenges faced, and some practical ways to overcome those challenges.

CLICK HERE to listen to episode audio (4:19).Sections below are the following: Transcript of Audio Audio Notes and Acknowledgments Images Sources Related Water Radio Episodes For Virginia Teachers (Relevant SOLs, etc.). Unless otherwise noted, all Web addresses mentioned were functional as of 9-3-21. TRANSCRIPT OF AUDIO From the Cumberland Gap to the Atlantic Ocean, this is Virginia Water Radio for the week of September 6, 2021.  This revised episode from October 2017 is part of a series this fall of episodes on water connections to the human body and human biology. SOUND - ~3 secHow is a human heartbeat part of a water story?  Have a listen for about 25 seconds to the following mystery sounds, and see if you can guess the heart-and-water connections they represent.  And here's a hint: if you have the energy, you could follow many branches to this solution.SOUNDS - ~21 secYou've been listening to sounds from a platelets donation at the American Red Cross' New River Valley Donor Center in Blacksburg, Virginia.  The sounds—a blood-pressure measurement, a needle stick into an arm vein, and the machine separating blood components and recirculating fluid to the patient—illustrate three connections between the human circulatory system and water.First, the heart provides a force—measured by blood pressure—to keep blood circulating around the body, like the sun's energy powers evaporation and winds that help keep water circulating around the earth.  Second, arm veins are part of an intricately branched system of arteries, veins, and capillaries, resembling a watershed's branching pattern as one travels uphill from ocean to river to headwater streams.   Humans have an estimated 60,000 to 100,000 miles of blood vessels, compared to Virginia's approximately 100,000 miles of rivers and streams.  Finally, blood's components are mostly water: blood plasma is a solution of water and many biochemicals, mixed with water-based red and white blood cells and with platelets.  As a result, blood in the human system has water's physical and chemical properties for transporting materials and regulating heat.Cells and transported substances make blood “thicker” than water, just as the saying goes.  But the water we borrow temporarily from the global water cycle is at the chemical and physical heart of blood and the circulatory system's vital functions.Thanks to staff at the New River Valley Donor Center for participating in this episode, and thanks to Soundbible.com for the heartbeat sound. We close with some music inspired by the action of the human heart.  Here's about 20 seconds of “Heartbeat,” by the Harrisonburg and Rockingham County, Va.-based band, The Steel Wheels. MUSIC - ~23 sec –Lyrics - “Feel my heartbeat comin' in next to you; heartbeat, yes you do.” SHIP'S BELL Virginia Water Radio is produced by the Virginia Water Resources Research Center, part of Virginia Tech's College of Natural Resources and Environment.  For more Virginia water sounds, music, or information, visit us online at virginiawaterradio.org, or call the Water Center at (540) 231-5624.  Thanks to Ben Cosgrove for his version of “Shenandoah” to open and close the show.  In Blacksburg, I'm Alan Raflo, thanking you for listening, and wishing you health, wisdom, and good water. AUDIO NOTES AND ACKNOWLEDGEMENTS This Virginia Water Radio episode revises and replaces Episode 392, 10-30-17, and Episode 236, 10-20-14. The human heartbeat sound was recorded by Mike Koenig and made available (9/14/09 upload) online at the Soundbible.com Web site, http://soundbible.com/1001-Heartbeat.html, for public use under the Creative Commons license “Attribution 3.0”; for more information on Creative Commons licenses, please see https://creativecommons.org/licenses/; information on the Attribution License specifically is online at https://creativecommons.org/licenses/by/3.0/. Other sounds heard in this episode were recorded at the American Red Cross New River Donor Center in Blacksburg, Virginia, during an October 19, 2014, platelet donation by Virginia Water Radio host Alan Raflo.  Thanks to the staff at the Donor Center for their help and for allowing the sound recording.  For information about blood and platelet donations, please visit the American Red Cross' “Donating Blood” Web site at http://www.redcrossblood.org/donating-blood.

When I arrived in Nigeria I thought my main role would be taking care of my 6-month-old daughter. When people asked before we left, “What are you going to do?” I almost apologetically said I would be a “homemaker.” Shortly after arriving I struggled to know my role as “an accompanying spouse.” I was not prepared for this undefined role and sometimes felt like a “second class missionary” because I was not in a specific ministry. It did not take long before the Lord opened up for me amazing opportunities for ministry, some in our home and others in our community. During this workshop I will share my journey, the many wonderful doors of significant opportunity God opened for me to serve using my past experiences, education and gifts to eventually serve many unreached women and children in our community and in Nigeria. We will also explore ways in which male “accompanying spouses” also got involved and had an impact in their own unique ways and the significance of culture on these decisions.

Iago e Pedro discutem um caso de Plaquetopenia apresentado pelo Fred! Como confirmar a plaquetopenia? O que pedir de exame? Tudo isso nesse episódio! Referências Thachil J, Fitzmaurice D. Thrombocytopenia in an adult. Bmj. 2013 Jun 10;346. Bradbury C, Murray J. Investigating an incidental finding of thrombocytopenia. BMJ. 2013 Jan 11;346. Stasi R. How to approach thrombocytopenia. Hematology 2010, the American Society of Hematology Education Program Book. 2012 Dec 8;2012(1):191-7. Swain F, Bird R. How I approach new onset thrombocytopenia. Platelets. 2020 Apr 2;31(3):285-90. Donald M Arnold, MD, MSc, Adam Cuker, MD, MS. Diagnostic approach to the adult with unexplained thrombocytopenia. uptodate.com acesso em agosto/2021

CLICK HERE to listen to episode audio (3:34).Sections below are the following: Transcript of Audio Audio Notes and Acknowledgments ImageExtra Information Sources Related Water Radio Episodes For Virginia Teachers (Relevant SOLs, etc.). Unless otherwise noted, all Web addresses mentioned were functional as of 8-27-21. TRANSCRIPT OF AUDIO From the Cumberland Gap to the Atlantic Ocean, this is Virginia Water Radio for the week of August 30, 2021.  This week, we introduce a series episodes on water connections to the human body and human biology.  We start with some mystery sounds.  Have a listen for about 10 seconds, and see if you know what action these sounds have in common.  And here's a hint: I'm not joking when I say the answer “in jest.” SOUNDS  - ~10 sec If you guessed taking water into the body, or ingesting water, you're right!  You heard sounds of sipping water from a glass, slurping water through a straw, and a crunching into an apple.  Taking in water as liquid or in food is, of course, the first part of the human body's use of water.  Once it's inside of us, water's got a lot to do.  As the Mayo Clinic Health System has stated it, “nearly all of your body's major systems depend on water to function and survive.” Here are eight key aspects and functions of water in human biology. Water constitutes a large percentage of body organs and tissues, including over 70 percent of the brain and heart, over 80 percent of the lungs. It's a major component of blood and lymphatic fluid, which transport materials throughout the body. It's the medium for the body's biochemical reactions. It cushions and protects body organs and tissues. It helps the body regulate its temperature. It's involved in the breakdown and transport of foods and the nutrients they provide. It lubricates joints. And it transports waste products out of the body. Water can perform these life-sustaining functions because of its unique physical and chemical properties that allow it to dissolve many substances, absorb and release heat, and withstand being compressed. We'd be nowhere without it, so we close with some music for the body part that's crucial for all of water's functions.  Here's about 15 seconds of “The Mouth Reel,” by No Strings Attached. MUSIC – ~15 sec - instrumental SHIP'S BELL Virginia Water Radio is produced by the Virginia Water Resources Research Center, part of Virginia Tech's College of Natural Resources and Environment.  For more Virginia water sounds, music, or information, visit us online at virginiawaterradio.org, or call the Water Center at (540) 231-5624.  Thanks to Stewart Scales for his banjo version of Cripple Creek to open and close this show.  In Blacksburg, I'm Alan Raflo, thanking you for listening, and wishing you health, wisdom, and good water. AUDIO NOTES AND ACKNOWLEDGEMENTS “The Mouth Reel,” from the 1999 album “In the Vinyl Tradition – Volume I,” is copyright by No Strings Attached, used with permission.  More information about No Strings Attached—a long-time Blacksburg- and Roanoke-based band which is no longer performing—is available online at http://www.enessay.com/index.html. Click here if you'd like to hear the full version (1 min./11 sec.) of the “Cripple Creek” arrangement/performance by Stewart Scales that opens and closes this episode.  More information about Mr. Scales and the group New Standard, with which Mr. Scales plays, is available online at http://newstandardbluegrass.com. IMAGE Water uses in the human body.  Illustration from the U.S. Geological Survey, “The Water in You: Water and the Human Body,”  https://www.usgs.gov/special-topic/water-science-school/science/water-you-water-and-human-body?qt-science_center_objects=0#qt-science_center_objects EXTRA INFORMATION ABOUT WATER IN THE HUMAN BODY The following information is quoted from the U.S. Geological Survey, “The Water in You: Water and the Human Body,” https://www.usgs.gov/special-topic/water-science-school/science/water-you-water-and-human-body?qt-science_center_objects=0#qt-science_center_objects. “According to H.H. Mitchell, Journal of Biological Chemistry 158, the brain and heart are composed of 73% water, and the lungs are about 83% water.  The skin contains 64% water, muscles and kidneys are 79%, and even the bones are watery: 31%. “Each day humans must consume a certain amount of water to survive.  Of course, this varies according to age and gender, and also by where someone lives.  Generally, an adult male needs about 3 liters (3.2 quarts) per day while an adult female needs about 2.2 liters (2.3 quarts) per day.  All of the water a person needs does not have to come from drinking liquids, as some of this water is contained in the food we eat. “Water serves a number of essential functions to keep us all going.*A vital nutrient to the life of every cell, [it] acts first as a building material.*It regulates our internal body temperature by sweating and respiration.*The carbohydrates and proteins that our bodies use as food are metabolized and transported by water in the bloodstream.*It assists in flushing waste mainly through urination.*[It] acts as a shock absorber for brain, spinal cord, and fetus.*[It] forms saliva.*{It] lubricates joints.” SOURCES USED FOR AUDIO AND OFFERING MORE INFORMATION American Society of Hematology, “Blood Basics,” online at https://www.hematology.org/education/patients/blood-basics. Cleveland [Ohio] Clinic, “Lymphatic System,” online at https://my.clevelandclinic.org/health/articles/21199-lymphatic-system. Mayo Clinic Health System, “Water: Essential to your body,” online at https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/water-essential-to-your-body.  This is the source of the quote used in the audio of this episode. U.S. Geological Survey, “The Water in You: Water and the Human Body,” https://www.usgs.gov/special-topic/water-science-school/science/water-you-water-and-human-body?qt-science_center_objects=0#qt-science_center_objects. RELATED VIRGINIA WATER RADIO EPISODES All Water Radio episodes are listed by category at the Index link above (http://www.virginiawaterradio.org/p/index.html).  See particularly the “Science” subject category. Following are links to other episodes on connections of water to human biology.  Please note that some of these episodes are being redone in fall 2021; in those cases, the respective links below will have information on the updated episodes.  Episode 195, 1-6-14 – Water thermodynamics.Episode 287, 10-26-15 – Skeleton system connections to water.Episode 392, 10-30-17 – Circulatory system connections to water.Episode 393, 11-6-17 – Disease: Influenza.Episode 450, 12-10-18 – Neurological system connections to water.Episode 466, 4-1-19 – Water intake and sports.Episode 517, 3-23-20 and Episode 519, 4-6-20 – Disease: Water connections to COVID-19. FOR VIRGINIA TEACHERS – RELATED STANDARDS OF LEARNING (SOLs) AND OTHER INFORMATION Following are some Virginia Standards of Learning (SOLs) that may be supported by this episode's audio/transcript, sources, or other information included in this post. 2020 Music SOLs SOLs at various grade levels that call for “examining the relationship of music to the other fine arts and other fields of knowledge.” 2018 Science SOLs Grades K-3 plus 5: MatterK.4 – Water is important in our daily lives and has properties.3.3 – Materials interact with water. Grades K-4: Living Systems and Processes1.5 – Animals, including humans, have basic life needs that allow them to survive. Grade 66.6 – Water has unique physical properties and has a role in the natural and human-made environment. Life ScienceLS.4 – There are chemical processes of energy transfer which are important for life BiologyBIO.2 – Chemical and biochemical processes are essential for life.Virginia's SOLs are available from the Virginia Department of Education, online at http://www.doe.virginia.gov/testing/. Following are links to Water Radio episodes (various topics) designed especially for certain K-12 grade levels.Episode 250, 1-26-15 – on boiling, for kindergarten through 3rdgrade.Episode 255, 3-2-15 – on density, for 5th and 6th grade.Episode 282, 9-21-15 – on living vs. non-living, for kindergarten.Episode 309, 3-28-16 – on temperature regulation in animals, for kindergarten through 12th grade.Episode 333, 9-12-16 – on dissolved gases, especially dissolved oxygen in aquatic habitats, for 5thgrade.Episode 403, 1-15-18 – on freezing and ice, for kindergarten through 3rd grade.Episode 404, 1-22-18 – on ice on ponds and lakes, for 4ththrough 8th grade.Episode 406, 2-5-18 – on ice on rivers, for middle school.Episode 407, 2-12-18 – on snow chemistry and physics, for high school.Episode 483, 7-29-19 – on buoyancy and drag, for middle school and high school.Episode 524, 5-11-20 – on sounds by water-related animals, for elementary school through high school.Episode 531, 6-29-20 – on various ways that animals get water, for 3rd and 4th grade.Episode 539, 8-24-20 – on basic numbers and facts about Virginia's water resources, for 4th and 6th grade.

Rene Hoet is working for over 20 years in Biotech and Pharma Industry focusing on Antibody Research and development.Since April 1 2021 Rene works as Chief Scientific Officer at Montis Biosciences, Leuven, Belgium to develop the next generation Immuno-Oncology drugs using a novel approach interfering in the Tumor Endothelial Cell and Perivascular Macrophage Interactions to restore a immunocompetent tumor microenvironment.From Oct. 2018 till 26 March 2021 Rene worked as Chief Scientific Officer at Imcheck Therapeutics (Marseille, France) reporting to the CEO where he built up a successful mAb research & development group on first in class mAbs (and bispecifics) in immune-oncology targeting butyrophilins and immune modulating gammadelta T cell and macrophage subsets. In Nov. 2019, Rene together with the CEO raised 48 M euro series B investment and moved ICT01 an antibody to BTN3A1, the first activating gammadelta T cell mAb, from preclinical stage into the clinic (start clinical trial March 2020).From 2010-2018 Rene worked for Bayer AG as Vice President Biologics Research (Cologne, Germany), part of the Biologics Research & Development leadership team at Bayer reporting to the Sr. VP. Biologics Research & Development. His group was responsible for Antibody Discovery and Optimization for all therapeutic areas in Bayer (incl. Cardiovascular Diseases, Oncology, Gynecology,Hematology and Autoimmunity) and during this period a number of antibodies from Bayer´s  internal pipeline entered into the clinic. Anetumab (Mesothelin-ADC), FXIa  (phase II), C4.4.a-ADC, FGFR2-ADC, PRLR, TIFPa, CD22-TTC, CEACAM6 (all phase I). In addition Rene was appointed in 2012 to extraordinary Prof. Biopharmaceutics at the University of Maastricht, The Netherlands to guide researchers to use antibodies to Bridge the Gap between academic research and pharma applications.Between 2008-2010 Rene worked at Genmab as Sr. Director Research and was heading up Product Related Research, Scientific Communication & Translational Research. His team was driving new Antibody Discovery Programs and was also actively supporting Clinical Antibody Programs of Ofatumumab (CD20) (FDA approved 2009) and Daratumumab (CD38) (FDA approved 2015). From 1997-2008 Rene had various positions at Dyax and became V.P. Research and Operational Manager of Dyax sa. Rene and his team were driving internal Antibody Lead Discovery (in Dyax Liege Belgium and Cambridge US) as well as external collaborations and supporting out-licensing of Dyax antibody phage libraries. From the antibody phage libraries he developed at Dyax now 4 antibodies have been approved Ramucirumab (KDR), Lilly, 2014, Necitumumab (EGFR), Lilly, 2015, Avelumab (PDL-1) EMD Serono/Pfizer, 2017, and lanadelumab (kallikrein), Shire, 2018). In addition over 10 antibodies from this mAb library from various companies are still in clinical trial. Rene obtained his PhD at the Un. Nijmegen, the Netherlands and performed a post-doctoral study at the Un. Cambridge U.K.with Prof. G. Winter (nobel prize winner 2018). He contributed to over 40 scientific papers and is inventor on 20 patent /patent applications.

Guest Sansea Kaphan Jacobson, Dartmouth '96, was assured of herself when she arrived at college, pre-med bound. But then she found Sanborn Library and let her love of literature guide her studies and put the pre-med dreams to bed. She took advantage of the corporate recruiting process to find her first job after college in the IT consulting world. She found, however, that she was more interested in impacting the people she served than the project outcomes. She decided to get back on track to the helping professions.After completing the post-bac courses necessary for med school, she had the opportunity to work in a hematology lab at the NIH. An astute mentor told extrovert Sansea that she would likely prefer clinical oncology than the pathology in the lab. So, she pursued this line of work in medical school and found herself bedside with dying patients. The psychiatry rotation showed her that it was really the psychology that had drawn her to that work.Her career now encompasses clinical work with teen experiencing anxiety and suicidal thoughts, but she also advises residents and fellows and mentors them through the psychiatric program. When one student asked about her medical center's wellness education efforts for her fellow practitioners, Sansea realized that it was up to her to lead the program and model what wellness looks like. In this episode, find out from Sansea how listening to the narrative and reacting with empathy can create meaningful linkages on ROADS TAKEN with Leslie Jennings Rowley.About This Episode's GuestSansea Jacobson is Associate Professor of Psychiatry at the University of Pittsburgh School of Medicine, Co-Chair of the UPMC Graduate Medical Education Wellness, Environment, Learning, and Living Committee and program director of child and adolescent psychiatry fellowship at Western Psychiatric Institute & Clinic of UPMC, where her clinical and advocacy efforts are focused on the prevention of suicide in youth through her work at the Services for Teens at Risk (STAR) Center. Through her multi-faceted work, she has become one of the pioneers in a field devoted to reforming our relationship with media in order to promote positive mental health messaging for our nation's youth. Executive Producer/Host: Leslie Jennings RowleyMusic: Brian Burrows Find more episodes at https://roadstakenshow.comEmail the show at RoadsTakenShow@gmail.com

Straight from lymphoma and leukemia into Clotting diseases Hematology is not an easy section, but here we go. Today we're covering blood clotting or coagulation.   Through this process blood transforms from a liquid into something more like jello. Why would we want this? We want this to prevent excessive blood loss.  This process also […] The post S2 E080 Clotting overview appeared first on Physician Assistant Exam Review.