Podcasts about ldh

Welcome to HCPLive's 5 Stories in Under 5—your quick, must-know recap of the top 5 healthcare stories from the past week, all in under 5 minutes. Stay informed, stay ahead, and let's dive into the latest updates impacting clinicians and healthcare providers like you! Interested in a more traditional, text rundown? Check out the HCPFive! Top 5 Healthcare Headlines for May 12-18, 2025. FDA Approves Once-Daily Roflumilast (ZORYVE) Foam 0.3% for Scalp and Body Psoriasis The FDA approved once-daily roflumilast (Zoryve) foam 0.3% for treating plaque psoriasis on the scalp and body in patients aged 12 and older. This marks the fifth overall indication for roflumilast, adding to its existing approvals in psoriasis and atopic dermatitis. FDA Warns About Rare, Severe Itching After Stopping Cetirizine or Levocetirizine The FDA issued a warning about severe pruritus that can occur after stopping long-term cetirizine or levocetirizine use. Manufacturers will be required to add a label warning noting that symptoms may improve if the medications are restarted. FDA Approves Susvimo for Treatment of Diabetic Retinopathy The FDA approved Genentech's Susvimo, a ranibizumab delivery system, as the first continuous refillable treatment for diabetic retinopathy. Susvimo offers sustained vision maintenance with refills needed only once every nine months. Olezarsen Cuts Triglyceride Levels at 6 Months in Essence Study The Essence study showed olezarsen significantly reduced triglyceride levels in patients with moderate hypertriglyceridemia at ASCVD risk. Monthly doses achieved about 60% reductions, with most patients reaching normal triglyceride levels after six months. Ruxoprubart Shows Efficacy for PNH in Interim Phase 2 Trial Results Interim Phase 2 results showed ruxoprubart met all primary efficacy endpoints in adults with paroxysmal nocturnal hemoglobinuria. The therapy led to transfusion avoidance, improved hemoglobin, reduced LDH, and increased PNH clone size at 12 weeks.

Le 30 avril, trois associations: la LDH, Utopia 56 et le MRAP ont déposé plainte pour diffamation contre Frontières, un média d'extrême droite.Avec Nathalie Tehio (LDH), Yann Manzi (Utopia 56), Bernard Schmid (MRAP) et Paul Elek (Le Média).▶ Soutenez Le Média :

C dans l'air l'invitée du 2 avril 2025 : Evelyne Sire-Marinmagistrate honoraire et vice-présidente de la LDH.Depuis la condamnation pour détournement de fonds de Marine Le Pen, lundi 31 mars, à quatre ans de prison dont deux ans ferme sous bracelet électronique et cinq ans d'inéligibilité avec application immédiate, la juge spécialiste des dossiers financiers Bénédicte de Perthuis fait l'objet d'une surveillance particulière. Le ministère de l'Intérieur confirme que des rondes et des patrouilles sont régulièrement effectuées devant le domicile parisien de la magistrate chargée du dossier, accusée par la droite et l'extrême droite d'avoir rendu un jugement "politique".Les magistrats économiques et financiers ne s'attendaient sans doute pas à être menacés au même titre que ceux qui traitent de criminalité organisée ou de terrorisme. La mise en cause personnelle de leur collègue Bénédicte de Perthuis a poussé des magistrats à prendre la parole. Ils dénoncent une dérive et racontent un quotidien émaillé de menaces et d'intimidations.

Step into a musical adventure celebrating the innovative sounds of female K-pop and J-pop artists who are breaking boundaries and defying expectations. Sarah and Panic take you on a journey through unexpected genre combinations and production techniques that showcase why these groups deserve your undivided attention.Our exploration begins with MADEIN's "SATURN," where sweet harmonies float over grinding bass in a fascinating juxtaposition that left us wondering, "How can they blend acoustic guitars, futuristic synths, and R&B influences so seamlessly?" This genre-defying approach sets the tone for our entire listening session.We then discover f5ve (formerly SG5) and their sparkly synth-pop "Magic Clock," before diving into UNIS's "Curious" – a track that boldly fuses heavy rock guitar with pop vocals and dance beats. But the true revelation comes with LE SSERAFIM's latest EP "Hot," where we explore three distinctly different tracks that showcase incredible versatility: from 70s funk basslines with 50s-style vocal production in "Hot," to the psychedelic rock and Motown influences of "Come Over," culminating in the hypnotic, trance-inducing "Ash" that completely captivated us.What makes these selections so compelling is how these artists reinterpret nostalgic sounds while creating something thoroughly modern. The B-sides particularly impressed us, often containing the most artistic experimentation and vocal showcases. If you really want to do justice to your artist, you need to introduce this type of music.Whether you're already a fan of these groups or completely new to them, this episode will transform how you think about girl group music. Give these boundary-pushing artists a chance – their unexpected sound combinations might just create your next musical obsession.MADEIN info: Instagram  X  YouTube  SATURN (Spotify)F5ve info:  Instagram  X  YouTube  Magic Clock (Spotify)Unis info:  Instagram  X  YouTube  Curious (Spotify)Le Sserafim info: Instagram  X  YouTube   HOT (EP Spotify)Support the showPlease help Music Elixir by rating, reviewing, and sharing the episode. We appreciate your support!Follow us on:TwitterInstagram If have questions, comments, or requests click on our form:Music Elixir FormDJ Panic Blog:OK ASIA

Episode 184: Multiple Myeloma BasicsSub-Interns and future Drs. Di Tran and Jessica Avila explain the symptoms, work up and treatment of multiple myeloma. Written by Di Tran, MSIV, Ross University School of Medicine; Xiyuan Yang, MSIV, American University of the Caribbean. Comments by Jessica Avila, MSIV, American University of the Caribbean. Edits by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Di: Hi everyone, this is Di Tran, 4th year medical student from Ross university.  It's a pleasure to be back.  To be honest, this project is a part of teamwork of two medical students, myself and another 4th year, her name is XiYuan.  She came from the AUC. Unfortunately, due to personal matters she was unable to make it to the recording today which makes me feel really sad. Jessica: My name is Jessica Avila, MSIV, American University of the Caribbean.Di: The topic we will present today is Multiple Myeloma. Multiple myeloma is typically a rare disease and it's actually a type of blood cancer that affects plasma cells in the bone marrow.Jessica: Let's start with a case: A 66-year-old male comes to his family doctor for an annual health checkup. He is not in any acute distress but he reports that he has been feeling tired and weaker than usual for the last 3 months. He also noticed that he tends to bruise easily. He has a history of arthritis and chronic joint pain, but he thinks his back pain has gotten worse in the last couple of months. Upon checking his lab values, his family doctor found that he has a calcium level of 10.8 and a creatinine level of 1.2, which has increased from his baseline. Given all that information, what do you think his family doctor is suspecting? And what kind of tests she can order for further evaluation?Di: Those symptoms sound awfully familiar – are we talking about the CRAB? You know, the diagnostic criteria for Multiple Myeloma.Jessica: Exactly! Those are called “myeloma-defining events.” Do you remember what those are?Di: CRAB criteria comes in 4 flavors.  It's HYPERCALCEMIA with >1mg/dL, RENAL INSUFFICIENCY with serum creatinine >2mg/dL, ANEMIA with hemoglobin value 10% plasma cells, PLUS any one or more of the CRAB features, we can make the official diagnosis of multiple myeloma. Di:  Before we go deeper, let's back up a little bit and do a little background.  So, what do we know about the immunoglobulins, also known as antibodies? Back from years of studying from medical school, we know that the plasma cells are the ones that producing the antibodies that help fight infections.  There  are various kinds that come with various functions.  Each antibody is made up of 2 heavy chains and 2 light chains.  For heavy chains, we have A, D, E, G, M and for light chains we have Kappa and Lambda.Jessica: Usually, the 5 possible types of immunoglobulins for heavy chains would be written as IgG, IgA, IgD, IgE, and IgM.  And the most common type in the bloodstream is nonetheless the IgG. Di: What is multiple myeloma? In myeloma, all the abnormal plasma cells make the same type of antibody, the monoclonal antibody.  The cause of myeloma is unknown, but there are lots of studies and evidence that show a number of potential etiologies, including viral, genetic, and exposure to toxic chemicals, especially the Agent Orange, which is a chemical used as herbicide and defoliant. It was used as a chemical warfare by the U.S. military during the Vietnam War from 1961 to 1971.Jessica: We need to order some specific blood tests to see if there is elevated monoclonal proteins in the blood or urine. So, to begin with we'll need to take a very thorough history and physical exam. Next, we'll do labs, such as CBC, basic metabolic panel, calcium, serum beta-2 microglobulin, LDH, total protein, and some not so common tests: serum protein electrophoresis (SPEP), immunofixation of blood or urine (IFE), quantitative immunoglobulins (QIg), serum free light chain assay, and serum heavy/light chain ratio assay.If any of the results is abnormal, we should consider referring our patient to an oncologist.Di: Interesting! I read that Multiple Myeloma symptoms vary in different patients.  In fact, about 10-20% of patients with newly diagnosed myeloma do not have any symptoms at all.   Otherwise, classic symptomatic presentations are weakness, fatigue, increased bruising under the skin, reduced urine output, weakened bones that is likely prone to fractures, etc. And if multiple myeloma is highly suspected, a Bone Marrow biopsy should be done with testing for flow cytometry and fluorescent in situ hybridization (FISH). Actually, if any of the “Biomarkers of malignancy (SLIM)” is met we can also diagnose multiple myeloma even without the CRAB criteria. Jessica: The diagnosis is made if one or more of the following is found: >= 60% of clonal plasma cells on bone marrow biopsy, > 1 lytic bone lesion on MRI that is at least 5mm in size, or a biopsy confirmed plasmacytoma. Di: Imaging comes in at the final step especially if we able to find one or more sites of osteolytic bone destruction > 5mm on an MRI scan.Jessica: What if the bone marrow biopsy returns > 10% of monoclonal plasma cells, but our patient doesn't have either the CRAB or the Biomarker criteria? Di: That's actually a very good question, since Multiple Myeloma is part of a spectrum of plasma cell disorders. That's when smoldering myeloma comes into play. It is a precursor of active multiple myeloma. Smoldering myeloma is further categorized as high-risk or low-risk based on specific criteria.A less severe form is called Monoclonal Gammopathy of Undetermined Significance, or simply MGUS, with < 10% bone marrow involvement. Those are diagnoses we give once we rule out actual multiple myeloma, which are defined by the amount of M-protein in the serum.Jessica:  When to get started on treatment? Multiple Myeloma is on a spectrum of plasma cells proliferative disorders, starting from MGUS to Smoldering Myeloma, to Multiple Myeloma and to  Plasma Cell Leukemia.  Close supervision/active watching is enough for MGUS and low risk Smoldering Myeloma. But once it has progressed to high-risk smoldering myeloma or to active Multiple Myeloma, chemotherapy is usually required. Some situations may require emergent treatment to improve renal function, reduce hypercalcemia, and to prevent potential infections.Di: As of 2024, treatment of Multiple Myeloma comprises the Standard-of-Care approved by the FDA. In fact, the quadruple therapy is a combination of 4 different class of drugs that include a monoclonal antibody, a proteasome inhibitor, an immunomodulatory drug, and a steroid. Jessica: They are Darzalex (daratumumab), Velcade (bortezomib), Revlimid (lenalidomide) and dexamethasone.  Other treatment plans for Multiple Myeloma include chemotherapy, immunotherapy, radiation therapy (for plasmacytomas) and stem cell transplants. The patient will also be on prophylaxis acyclovir and Bactrim while on chemotherapy. Sometimes anticoagulants are also considered because the chemo increases the risk of venous thromboembolic events.Di: Although the disease is incurable, but with the advancing of novel therapies and clinical trials patients with multiple myeloma are able to live longer.  Problem is the majority of patients diagnosed with Multiple Myeloma are older adults (>65), the risk of falling is adding to multiple complications of the disease itself, such as bone density loss, pain, neurological compromises, distress and weakness.  Palliative care may come in help at any point in time throughout the course of treatment but is most often needed at the very end of the course. Jessica, can you give us a conclusion for this episode?Jessica: Multiple Myeloma may not be the most common cancer, but we have to be aware of the symptoms and keep it in our differential diagnosis for patients with bone pain, easy bruising, persistent severe headaches, unexplained renal dysfunction, and remember the CRAB: HyperCalcemia, Renal impairment, Anemia and Bone lesions.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:International Myeloma Foundation. (n.d.). International Myeloma Working Group (IMWG) criteria for the diagnosis of multiple myeloma. https://www.myeloma.org/international-myeloma-working-group-imwg-criteria-diagnosis-multiple-myeloma Laubach, J. P. (2024, August 28). Patient education: Multiple myeloma symptoms, diagnosis, and staging (Beyond the Basics). UpToDate. https://www.uptodate.com/contents/multiple-myeloma-symptoms-diagnosis-and-staging-beyond-the-basics.University of California San Francisco. (n.d.). About multiple myeloma. UCSF Helen Diller Family Comprehensive Cancer Center. https://cancer.ucsf.edu/research/multiple-myeloma/about Theme song, Works All The Time by Dominik Schwarzer, YouTube ID: CUBDNERZU8HXUHBS, purchased from https://www.premiumbeat.com/.

durée : 00:06:09 - L'invité de 6h20 - La Ligue des droits de l'homme a déposé plainte contre Apple et la collecte d'enregistrements de son assistant "Siri", révèlent ce vendredi la cellule investigation de Radio France et le journal "Le Monde". La présidente de la LDH, Nathalie Tehio, était l'invitée de France Inter pour l'évoquer.

In this JCO Article Insights episode, Rohit Singh provides a summary on "First-Line Nivolumab Plus Relatlimab Versus Nivolumab Plus Ipilimumab in Advanced Melanoma: An Indirect Treatment Comparison Using RELATIVITY-047 and CheckMate 067 Trial Data", by Long et al, published in the November issue of the Journal of Clinical Oncology. The article provides insights into the use of the two dual immune checkpoint inhibitor regimens in patients with untreated advanced melanoma. TRANSCRIPT Rohit Singh: Hello and welcome to JCO Article Insights. I'm your host Rohit Singh, Assistant Professor at the University of Vermont Cancer Center and today we'll be discussing the article “First-Line Nivolumab Plus Relatlimab Versus Nivolumab Plus Ipilimumab in Advanced Melanoma: An Indirect Treatment Comparison Using RELATIVITY-047 and CheckMate 067 Trials,” authored by Dr. Georgina Long from the Melanoma Institute of Australia and her colleagues.  So as we know, nivolumab plus relatlimab and nivo plus ipi, I'm going to refer to as ipi-nivo moving forward, are dual immune checkpoint inhibitors regimens that are approved for treating patients with advanced melanoma based on the phase 2 and 3 RELATIVITY-047 and phase 3 CheckMate 067 trials respectively. Nivo plus relatlimab is the only dual PD-1 and LAG-3 inhibitor regimen approved for treating patients with advanced melanoma and relatlimab is the first in class human IgG4 LAG-3 blocking antibody. Ipi plus nivo is a dual PD-1 and CTLA-4 inhibitor regimen.  So this paper basically is an indirect treatment comparison using a patient level database from these trials and this pretty much was conducted because of the absence of head to head trials looking at different regimens in advanced melanoma in first line setting. In this trial, the authors tried to compare these two trials. However, it's always hard to compare two different trials and we usually don't do cross trial comparisons. The problem is that the groups might be different to begin with. For example, one group might have younger patients, healthier patients, while the other might have older or sicker. These differences can make it hard to tell if the treatment caused improvement or if the groups were different to begin with. In this trial, researchers use inverse probability of treatment weighting to adjust the baseline differences between the two patient groups or between these two trials. Inverse probability of treatment weighting is a method used in research to help make a fair comparison between two groups when studying how a treatment intervention works. Basically, IPTW helps level the playing field between the two groups or like two trials for this paper. So, it calculates the likelihood of receiving a treatment. For each person, for each patient, researchers estimate the chance they would have gotten the treatment based on their characteristics like age, health, condition, their baseline staging, and based on that they create weights. People who are less likely to get the treatment but did are given more weight, and those who are very likely to get the treatment are given less weight. The same is done for the group that didn't get the treatment, and then they rebalance the groups. By applying these weights the group becomes more similar in their characteristics as if everyone had an equal chance of getting the treatment. This way, IPTW helps researchers focus on the effect of treatment itself and other differences between the groups. It's like adjusting the scales to make sure you are comparing apples to apples.  The key outcomes the authors are looking at in this one was progression free survivals, overall survival, confirmed objective response rate, melanoma specific survival, and treatment related adverse events. Looking at the results of this cross comparison trial, first looking at the PFS or progression free survival, both regimens ipi plus nivo and nivo plus relatlimab, showed similar PFS. At 36 months, PFS was 36% in nivo-relatlimab versus 39% in the ipi-nivo regimen with a hazard ratio of 1.08 indicating no significant differences. Looking at the overall survival at 36 months, overall survival was 57% in both the treatment regimens with a hazard ratio of 0.14, again, indicating no significant differences. Now looking at another confirmed objective response rate, confirmed objective rates were similar between both treatment regimens after weighting, 48% versus 50% with an odds ratio of 0.91 suggesting comparable response rates between the two regimens. Looking at melanoma specific survival at 36 months it was 65% versus 62%. Both treatments had similar melanoma specific survival with a hazard ratio 0.86.  An interesting thing in these results was subgroup analysis. Subgroups showed larger numerical differences in efficacy which favored ipi-nivo over nivo-relatlimab that included acral melanoma with a hazard ratio of 1.42 and OS with a hazard ratio of 1.72 in favor of ipi-nivo. Similarly for BRAF mutant melanoma, it showed a confirmed objective response rate with odds ratio 1.54 and same applied to mucosal melanoma with odds ratio of 1.59 and patients who have high LDH more than two times upper level limit. Looking at the safety and adverse side effects, nivolumab plus relatlimab had fewer grade 3 or 4 treatment related adverse effect which is 23% versus 61% and fewer any grade treatment related adverse events leading to discontinuation which was 17% versus 41%, which means 41% of the patients in the ipi-nivo arm lead to discontinuation. However, I would like to add to that that ipi-nivo was conducted much earlier and at that time we were still kind of assessing and trying to understand the immunity adverse effects, how to manage them, which probably could have made discontinuation more common compared to a nivo-relatlimab trial. By that time we definitely had much more experience dealing with immunity adverse effects.A couple of things mentionable in this, notable rates of hepatic and GI grade 3 or 4 treatment adverse events were lower in nivo plus relatlimab than with ipi-nivo, although the onset of any grade endocrine GI hepatic or skin related treatment related adverse events occurred most frequently in both treatment arms and in less than three months from randomization.  So looking at all this data and looking at all this, it definitely seems like both the trials are very comparable in terms of efficacy, though nivo plus relatlimab seems to have a better safety profile. This trial does have some strengths. It does use the patient level data from two large well conducted trials allowing for a robust comparison and inverse weighting which would definitely better help balance baseline characteristics, enhancing the reliability of the results, and it does lead to comprehensive assessment of both efficacy and safety outcomes, and provides a holistic view of the treatments. Given all this, definitely the fact that it's a cross comparison trial which leads to a big limitation, as I already mentioned, like definitely two trials, it's hard to compare two trials which can have its own inherited biases. So it has some differences in trial design, conduct and follow up times. Small size subgroup analysis definitely limits the ability to draw definite conclusions from those groups. There's definitely some inherent uncertainty with direct head to head cross comparison trials.  Looking at the future direction I would take from this trial, if we can have a direct head to head trial because both of the treatments are proven first line setting, it will be comparing these two regimen that can definitely provide more definite evidence and further research is needed to explore the efficacy of these regimens in specific subgroups. As I mentioned in this, some subgroups showed increased benefit in the ipi-nivo regimen, however, they were very small sample size so we need more research exploring those subgroups. One other part in both these trials, patients with active brain mets were excluded. However, there's a phase 2 trial looking at ipi-nivo in active brain mets patients. So I think assessing patients with active brain mets moving forward is also a crucial part looking at, because often, patients with advanced melanoma develop brain mets. It does lead to some unanswered questions like long term survival and quality of life. How do these regimens compare in terms of long term survival and quality of life? While the study provides data on PFS and OS, long term survival and quality of life metrics are essential for understanding the full impact of these treatments. Optimal sequencing strategies: what are the optimal sequence strategies for these patients who progress on one regimen? There is data suggesting that patients may respond to alternative regimens after progression, but more research is needed to establish the best treatment sequence. And real world performance: how do these treatments perform in real world settings outside of clinical trials? Real world data can provide insight into the effectiveness and safety of these regimens in a broader patient population.  So, in summary, nivo plus relatlimab offers similar efficacy to nivolumab plus ipilimumab but a significantly improved safety profile, making it the potentially preferable option for patients with untreated advanced melanoma. However, results should be interpreted with caution due to limitations of cross trial analysis for certain subgroups like acral melanoma, mucosal melanoma, BRAF mutant melanoma, and patients with high LDH more than two times off upper normal limit. The trial showed that there's a trend definitely with ipi-nivo may be more beneficial. Also, today data on the use of nivolumab plus relatlimab in active brain mets has not been reported. Based on these existing data, ipi-nivo remains a standard immunotherapy for patients with active brain mets. Further research, including direct head to head trials is needed to confirm these findings and explore optimal treatment strategies.  Thank you for tuning into today's episode. We hope this detailed summary of the study comparing Nivolumab Plus Relatlimab and Nivolumab Plus Ipilimumab in advanced melanoma has been informative. This is Rohit Singh. Thank you again for listening to JCO Article Insights. Don't forget to give us a rating or review and be sure to subscribe so you never miss an episode. You can find all ASCO shows at asco.org/podcasts. 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. Guest 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.  

〜本日のトピックス〜 1:36 誰かと一緒に買い物するのが苦痛ですか？ 6:43 一緒に買い物したい人の言い分を言わせて！ 9:49 LDHで1位の歯磨きチューブ使ったんですけど… おたよりフォーム「荒山セントラル郵便局」。 Radiotalk以外のプラットフォームからのドスラヂへの質問、感想等はこちらからどうぞ♡ https://forms.gle/Xw34h8hQBimuuQFv6 質問箱「場末ックス」がリニューアルしました。 匿名での質問や感想は是非こちらからお待ちしてます♡ https://querie.me/user/Dosukoi_Radio ソロラヂも極稀に配信中♡ ☆ぺそどコ→ https://radiotalk.jp/program/22542 ☆やしこのぼちラヂ→ https://radiotalk.jp/program/44603 ※「やしこのぼちラヂ」はラジオトークからのみ聴取可能です ☆24/10/26収録 BGM : 「さみしいおばけと東京の月」by しゃろう #2人組 #LGBTQ+ #GayTalker #Thanks5years #収録配信型トーカー #パーキング収録 #ドスラヂの無法痴態 #フリートーク #ドスラヂ2411

A 25-year-old woman gravida 2, para 1 is 24 weeks pregnant and is being seen for an urgent care visit. She reports a constant headache over the past two days along with ankle swelling. Her BP today is 162/86 in, which is a significant elevation from her pre pregnancy blood pressure of 122/68.Laboratory results indicate 2 plus proteinuria as well as elevated ALT and AST. Platelets and LDH are within normal limits, as is fundoscopic and neurological exams. The most likely diagnosis is: A. Health syndromeB. Gestational hypertensionC. PreeclampsiaD. Hypertensive emergencyVisit fhea.com to learn more!

En France, l'Aide sociale à l'enfance du département du Nord est à nouveau pointée du doigt. À côté de Dunkerque, une soixantaine de mineurs étrangers ont été placés sans accompagnement dans un hôtel désaffecté. Sans école, sans formation, sans activités ludiques pour occuper leur journée, ces jeunes exilés sont livrés à eux-mêmes depuis plusieurs mois alors que cet hébergement devait n'être que provisoire. La Ligue des droits de l'homme a saisi la Défenseure des droits pour leur venir en aide.  De l'extérieur, cet ancien hôtel Formule 1, près de Dunkerque, n'a pas beaucoup changé. Certes, l'enseigne qui surplombait la façade a été démontée et les clients n'y viennent plus. Mais les chambres de ce bâtiment en crépi jaune pâle qu'on aperçoit au bord de la route sont toujours occupées.Sur le rebord des fenêtres, des baskets et des vêtements d'adolescents sèchent au soleil. 60 à 80 jeunes mineurs non accompagnés y sont hébergés, selon l'antenne locale de la Ligue des droits de l'homme (LDH). Sabine Donnaint, sa présidente, est allée sur place au mois de mai. « Le premier contact que j'ai eu, c'est deux jeunes, un Afghan et un Malien, qui étaient là depuis quatre mois déjà, donc sans avoir réalisé les tests pour pouvoir aller à l'école, et eux, c'est ce qu'ils voulaient : aller à l'école, pouvoir avoir une formation. On leur disait que ce n'était pas possible parce qu'ils ne savaient pas s'ils allaient rester sur le dunkerquois ou être envoyés aux quatre coins de la France. »L'un des jeunes témoigne via un message WhatsApp envoyé à RFI : « Je ne vais pas à l'école, je ne fais rien... Même la nourriture, c'est un problème, les habits, on ne m'en donne pas, on n'est pas bien vêtus, même les chaussures, on ne nous en donne pas… On souffre ici. »En France, lorsqu'un jeune exilé est évalué mineur, c'est l'Aide sociale à l'enfance qui prend le relais. Elle est pilotée par les départements et se charge de trouver un logement et de l'inscrire à l'école ou en formation. Mais dans cet ancien hôtel, aucun de ces dispositifs n'a été mis en œuvre.  « À chaque fois, ils nous disent qu'ils ne peuvent rien faire tant qu'on n'a pas encore été transférés, qu'on ne peut pas partir à l'école et qu'on ne peut pas s'occuper de nous, témoigne le même jeune, toujours via WhatsApp. Quand on se réveille le matin, on va prendre notre petit-déjeuner à 8 h, dès qu'on a fini de manger, on rentre dans notre chambre, on va se coucher. Nous sommes deux dans la chambre, on ne fait rien ici, on vit très mal ici. »À lire aussiFrance: l'errance des mineurs isolés étrangers cherchant à faire reconnaitre leur minoritéDes jeunes qui redoutent de recevoir une OQTF pour leur 18ᵉ anniversaireL'association Coallia, qui est conventionnée pour accompagner ces mineurs, n'a que partiellement répondu aux questions de RFI. Selon elle, il est « difficile de mobiliser les établissements scolaires » puisque les jeunes ne sont censés rester sur ces dispositifs que pour cinq jours maximum. Pourtant, ceux que nous avons contactés sont là depuis au moins quatre mois et ont loupé la rentrée scolaire. Coallia assure également que « l'équipe encadrante propose des activités aux jeunes », sans préciser lesquelles. Interrogé à ce sujet cette semaine, un autre adolescent dément : « Il y a des cours de français à la Médiathèque, ils ont commencé ça hier », mais rien d'autre. L'association reconnait que les activités sont « délicates à mettre en place, car la convention actuelle est reconduite par période de trois mois », ce qui poserait des problèmes de gestion des effectifs. Pas de réponse sur le nombre de personnels encadrants présents dans l'établissement, mais les mineurs qui y vivent disent ne pas pouvoir compter le nombre d'éducateurs qui se succèdent au quotidien, embauchés pour des contrats très court, parfois à la journée. À lire aussiComment accélérer la scolarisation des mineurs non accompagnés en France ?« Pour ces mineurs, il y a un enjeu qui est totalement déterminant, affirme Bernard Champagne, co-président de la Ligue des droits de l'homme à Dunkerque, très préoccupé par cette situation. Quand ils vont avoir 18 ans, l'obtention de leur titre de séjour est aussi tributaire du parcours scolaire éducatif dans lequel ils sont. S'ils n'y sont pas, il y a une argumentation ouverte par la préfecture en disant qu'ils ne sont pas dans un processus d'intégration et d'insertion et donc, qu'ils n'auront pas de titre de séjour. » Il ironise : « En revanche, avec délicatesse, on leur offre une OQTF. »Et c'est cette OQTF, cette obligation de quitter le territoire, que redoutent certains de ces jeunes, coincés à l'hôtel, alors que leur 18ᵉ anniversaire approche à grands pas.Dans ce département, les travailleurs sociaux estiment que 1 000 enfants sont en attente d'un placement convenable. La Défenseure des droits enquête d'ailleurs sur les dysfonctionnements de l'Aide sociale à l'enfance du Nord, depuis 2022.► Rendez-vous sur notre site Infomigrants pour suivre l'actualité et découvrir des reportages sur les questions de migrations en Europe. 

Les lundi 14 et mardi 15 octobre, la Ligue des droits humains présentera, au Théâtre National dans le cadre du Festival des Libertés, la 5ème édition de son procès fictif "On vous voit" avec l'utilisation de la reconnaissance faciale et les questions de surveillance au centre du procès. Sophie Delacollette, metteuse en scène et Emmanuelle De Buisseret-Hardy, conseillère juridique LDH sont nos invitées. Merci pour votre écoute Tendances Première, c'est également en direct tous les jours de la semaine de 10h à 11h30 sur www.rtbf.be/lapremiere Retrouvez tous les épisodes de Tendances Première sur notre plateforme Auvio.be : https://auvio.rtbf.be/emission/11090 Et si vous avez apprécié ce podcast, n'hésitez pas à nous donner des étoiles ou des commentaires, cela nous aide à le faire connaître plus largement.

Pasaremos un buen rato en Laviana charlando con Mikel de KARMA FEST para que nos presente la X edición que se celebra este próximo fin de semana en 2 días, 2 escenarios, 2 de todo como los pitisuis... y es que estos de Laviana siempre fueron de dir a tope por la vida. Y además, escucharemos y charraremos sobre todas estas bandas y festivales... Baja California, EDEN - Metal Band, Terro-Ria "Horror Show", Pizzeria Moloch, Aresi, Ofensivos, KINKIS GRUÑONES, Maizu Rock, Varillas Punk Rock, Capsula, Teksuo, VENUES, Debler Eternia, Where The Waves Are Born, BOLU2 DEATH, As Life Burns, Heart Of A Coward, LDH - Los Del Humo, Neno y los suyos, Brujeria, Iron Maiden, Nashville Pussy y Bruce Springsteen

Pasaremos un buen rato en Laviana charlando con Mikel de KARMA FEST para que nos presente la X edición que se celebra este próximo fin de semana en 2 días, 2 escenarios, 2 de todo como los pitisuis... y es que estos de Laviana siempre fueron de dir a tope por la vida. Y además, escucharemos y charraremos sobre todas estas bandas y festivales... Baja California, EDEN - Metal Band, Terro-Ria "Horror Show", Pizzeria Moloch, Aresi, Ofensivos, KINKIS GRUÑONES, Maizu Rock, Varillas Punk Rock, Capsula, Teksuo, VENUES, Debler Eternia, Where The Waves Are Born, BOLU2 DEATH, As Life Burns, Heart Of A Coward, LDH - Los Del Humo, Neno y los suyos, Brujeria, Iron Maiden, Nashville Pussy y Bruce Springsteen

Ever wondered how a pre-recording rant session can lighten up your day? Join us as we kick off this episode of Music Elixir, where Sarah and Miss Panic share their hilarious pre-recording rituals and the chaos of juggling new job roles and endless meetings. We celebrate the vibrant support from the Besty and EαRTH fan groups, and discuss the amusing yet frustrating journey of learning a new language amidst our hectic schedules. Laughter truly is the best medicine, and we make sure to stay connected with our listeners, keeping the mood light and engaging.Next, get ready for a musical rollercoaster as we uncover the magic of A.B.C-Z's "Jigsaw" Imagine the nostalgic vibes of Depeche Mode and ABBA, blended into a catchy and emotional track that's impossible not to sing along to. Next we groove to timelesz "Dilemna", and reminisce about the classic sound and past members. Moving on, we dive into SG's "Lucid Dreams," with its dramatic tone shifts and anime-worthy composition. To top it all off, we delve into the solo ventures of BamBam from GOT7! We explore his latest album and catch up on the solo activities of his group mates, especially Jackson Wang's exciting endeavors. From crazy hair aesthetics to speculating on potential collaborations, our discussion is both insightful and entertaining. We wrap up by highlighting standout tracks from BamBam's album and engaging with our listeners through social media. Join us for a fun-filled episode that promises to keep you entertained from start to finish!A.B.C-Z info:InstagramXofficialJigsaw on Spotifytimelesz info:InstagramXYouTubeSG info:InstagramXYouTubeLUCID DREAM on SpotifyBamBam info:InstagramXYouTubeThank You Come Again and Mi Último Deseo on SpotifySupport the showPlease help Music Elixir by rating, reviewing, and sharing the episode. We appreciate your support!Follow us on:TwitterInstagram If have questions, comments, or requests click on our form:Music Elixir FormDJ Panic Blog:OK ASIA

Afin de sensibiliser aux atteintes de la vidéosurveillance sur les droits et libertés des citoyen-nes, une déambulation festive contre la VSA (vidéo surveillance algorithmique) a été organisé le 14 septembre à 14h Croix de Chavaux à Montreuil par la section LDH de Montreuil, la Quadrature du Net avec la présence d'Amnesty international et de l'orchestre du grand Marcel.Notre reportrice Tina est allée les rencontrer.Hébergé par Ausha. Visitez ausha.co/politique-de-confidentialite pour plus d'informations.

ENTRETIEN avec Rémy Cortes et Pierrette Pape, du Labo des histoires EXPOSITION21 septembre – 12 octobre 2024 MANIFESTANTES Pour célébrer la manifestation, dans un contexte de mobilisation citoyenne sans précédent, Le Tetris, la LdH et des autrices indépendantes ont co-construit cet évènement, qui s'inscrit dans une histoire matrimoniale inspirante et engagée. En rendant «femmage» aux femmes qui manifestent et aux artistes qui s'emparent de la contestation, l'exposition retrace l'histoire des actions citoyennes, l'évolution de leurs combats et de leurs solidarités, ainsi que l'impact des manifestations féministes sur la société et le·la politique. LE LABO DES HISTOIRES ATELIER 2 OCTOBRE A 15H : les Havrais dans la guerre, bibliothèque Salacrou / À l'arrière-front ! Écris ton histoire Le Labo des histoires est une association nationale d'intérêt général dont la mission est de démocratiser la pratique de l'écriture chez les jeunes âgés de 6 à 25 ans et d'en faire un moyen d'insertion culturelle et sociale. Il mène chaque année plus de 3000 ateliers d'écriture créative, ainsi que des formations, dans toute la France métropolitaine et ultramarine. Organisés en partenariat avec des structures éducatives, sociales et culturelles, nos cycles d'écriture créative réunissent près de 30 000 jeunes par an, avec une attention particulière aux publics éloignés des pratiques culturelles, et sont animés par des professionnel.les de l'écriture, de la BD au slam, en passant par le roman, la poésie, le scénario, l'écriture de chanson ou encore de podcast.PROJET GENIUS 8 JUiN – 12 OCTOBRECette année, le collectif Les Gens des Lieux revisite le jardin méconnu de la Bibliothèque Armand Salacrou et vous propose de retrouver les traces« archéologiques » de ce lieu conçu à la fin de la Reconstruction par les architectes Jacques Lamy et Jacques Tournant.JARDiN DE LA BiBLiOTHÈQUE ARMAND SALACROU.GENiUS 2024 est une aventure collective mise en oeuvre par LES GENS DES LiEUX (collectif d'architectes, urbanistes, plasticiens et paysagistes havrais)et coordonnée par la Maison de l'architecture de Normandie – le Forum avec le soutien de la CU du Havre Seine Métropole, la ville du Havre, la Région et laDRAC Normandie, en collaboration avec Les Cueilleurs d'Histoires, la compagnie shifts_art in movement, le Labo des histoires, le label Pays d'Art et d'Histoire. SAMEDi 28 SEPTEMBREAtelier d'écriture (1) « Le jardin dans la ville », proposé par le Labo des histoires ( 9h30–12h30 / 12 personnes max. / tout public / gratuit / inscription :Festivalzigzag.fr).SAMEDi 5 OCTOBREAtelier d'écriture (2) « L'envers du décor », proposé par le Labo des histoires ( 9h30–12h30 / 12 personnes max. /tout public / gratuit / inscription : Festivalzigzag.fr).SAMEDi 12 OCTOBREInauguration GENiUS 2024 – PAUSE ! Festival ZiGZAG 12 HApéritif avec Les Cueilleurs d'Histoires Restitution des paroles d'habitants et habitantes12 H 30 à 14 H Tablée festive au grand air (apportez vos victuailles et venez partager un moment de convivialité avecle collectif LES GENS DES LiEUX) Proposition chorégraphique de la compagnie shifts_art' in movement14 H à 15 HLecture au jardin : laissez-vous porter par la lecture de textes issus des ateliers d'écriture, interprétés par un comédien, et d'autres textes choisis par les artistesdu Labo des histoires et les Gens des Lieux. https://www.youtube.com/watch?v=8VCcrRY3PKUHymne des femmes, chanté par 39 femmes au profit de la Maison des femmes

Send us a Text Message.E133: Lonestar Data Holdings (LDH) is DropBox on the Moon, for the ultimate in extraterrestrial data security. By initially placing data storage on Cis Lunar satellites LDH has achieved the ultimate in data security, backup and sovereignty in a way not previously possible. The follow-on is lunar based data storage physically on the Moon's surface in 2026. Founder and CEO Chris Stott explains LDH's data solution to the data security problem, discusses their business model and how LDH  competes with hyperscalers to create a high margin business. (recorded 8/22/24)Follow David on LinkedIn or reach out to David on Twitter/X @DGRollingSouth for comments. Follow Paul on LinkedIn or reach out to Paul on Twitter/X @PalmettoAngel We invite your feedback and suggestions at www.ventureinthesouth.com or email david@ventureinthesouth.com. Learn more about RollingSouth at rollingsouth.vc or email david@rollingsouth.vc.

This week on the podcast, I'm thrilled to welcome Jean-Felix Turcotte, an integrated health practitioner with expertise in blood chemistry, genetics, and lab testing. We delve into the essential blood markers everyone should know about and the importance of personalized health assessments for proactive care.In this episode, you can expect to hear about:- Essential Blood Markers: The top blood tests, including CBC, CMP, GGT, and thyroid panels, that can provide a comprehensive view of your health.- Challenges with Lab Work: The difficulties and challenges in accessing comprehensive blood tests.- Genetic Testing Insights: How genetic mutations like MTHFR impact health and the significance of epigenetics in individualized health plans.- Proactive Health Strategies: The benefits of understanding blood chemistry and genetics in crafting personalized health foundations and lifestyle changes.If you're on the path to proactive and preventative health care, this episode is a must-listen. Together, Jean-Felix and I explore the critical role blood work plays in maintaining optimal health and the steps you can take to tailor your health journey. Tune in to learn how to better approach your health with the right knowledge and tools!Episode Highlight:"It's not just about getting the blood work done; it's about understanding what those markers mean for your proactive and preventative health measures."- Jean-Felix Turcotte Resources:- Find Jean-Felix on Instagram: https://www.instagram.com/jeanfelixturcotte_jft/- Top 10 blood markers to get tested annually: CBC, CMP, GGT, LDH, Lipid panel, Homocysteine, HSCRP, Ha1c, C-peptide, thyroid panel (TSH, T3, T4, rT3, TPO) , uric acid, Iron (ferritin, TIBC, saturation %, Serum Iron)- Book: Dirty genes by Dr Ben Lynch Other helpful resources here for you: - Join The Soul & Wealth Club, my monthly membership: https://vanessagrutman.coach/the-soul-and-wealth-club - Join Femme Biohacker: https://vanessagrutman.coach/femme-biohacker - Join my private Facebook group for free events, challenges and content: https://www.facebook.com/groups/biohackerfemme - 7-day liver detox: https://vanessagrutman.myshopify.com/products/functional-medicine-detox-7-day-protocol 
- My website: https://www.vanessagrutman.com/
- Find me on Instagram: https://www.instagram.com/vgrutman/- Join me on Youtube: https://www.youtube.com/@vanessagrutman
 
Disclaimer: Vanessa Grutman, IHP does not treat, cure or diagnose disease. This show doesn't offer medical advice. Always verify with your physician before undertaking a new protocol or trying a new product.

In this JCO Article Insights episode, Alexandra Rojek provides a summary on "Anti-CD19 Chimeric Antigen Receptor T-cell therapy for Richter's Transformation: An International, Multicenter, Retrospective Study by Kittai, et al published in the Journal of Clinical Oncology March 29th, 2024.  TRANSCRIPT The guest on this podcast episode has no disclosures to declare. Alexandra Rojek: Hello and welcome to JCO Article Insights. I'm your host, Alexandra Rojek, and today we will be discussing an original report published in the June 10th issue of JCO titled, “Anti-CD19 Chimeric Antigen Receptor T-Cell Therapy for Richter Transformation: An International, Multicenter, Retrospective Study,” by Kittai et al. This report addresses the real world efficacy of CAR T-cell therapy for patients with Richter transformation of CLL to large B cell lymphoma, which represents a high risk group of patients with an unmet need for novel and more effective therapeutic agents than are currently available. Richter's represents the transformation of chronic lymphocytic leukemia, or CLL, to an aggressive lymphoma, most often a large B cell lymphoma, most similar to diffuse large B cell lymphoma or DLBCL. Treatment for Richters is often modeled after treatment practices for DLBCL. However, there's no clear standard of care and outcomes for these patients lag behind those of large B cell lymphoma patients otherwise. An important advance in recent years in the DLBCL field is the approval of anti CD19 CAR T-cell therapy in the second and third line settings. However, patients with Richter transformation were largely excluded from these pivotal trials. This study in JCO thus set out to address what the real world outcomes were for patients with Richters who were treated with CAR T-cell therapy across 12 centers internationally. The study included 69 patients across these twelve sites, with a median age of 63 years at diagnosis of Richters and a median of six years after initial CLL diagnosis. Included patients received a median of four prior lines of therapy for either CLL or Richters, with a median of two prior lines of therapy for Richters, although two patients had not received any prior therapy for their Richter transformation. The most recent prior treatments included chemoimmunotherapy in 29% of patients, followed by BTK inhibitors in 19%, as well as combinations of BTK inhibitors and BCL2 inhibitors in 12%. 17% of patients had not received prior therapy for their CLL before their diagnosis with Richters, 58% of cases had known TP53 mutations at time of transformation, and 41% exhibited deletion 17p by FISH. Prior to receiving CAR T-cell therapy, 86% of patients required additional bridging therapy, most commonly with a BTK inhibitor or chemoimmunotherapy. A diverse set of commercial CAR T-cell products were represented in this study, with the majority of patients at 64% receiving axi-cel, 25% receiving tisa-cel, 10% receiving liso-cel, and one patient received brexu-cel in an investigational setting. Median time from apheresis to CAR T infusion was 34 days, and 59% of patients continued on a BTK inhibitor throughout CAR T-cell therapy. When we move on to look at responses, 66 out of 69 patients were available for response. Three patients died related to adverse events after infusion and before response assessment, with the best overall response of complete response or CR in 46% of patients and partial response or PR in 17% for an overall response rate of 63%. With a median follow up time of 24 months, the median PFS in the study was 4.7 months and the median OS was 8.5 months. For those who achieved a CR, the median duration of response was an impressive 27 months, and for those achieving PR, the median duration of response was only two months. The two year PFS rate was thus 28%, and the two year OS rate was 38%. Four patients who achieved a CR went on to receive an allogeneic stem cell transplant. Among those whose disease progressed, 8% had relapse involving the CNS, compared to 10% of patients having CNS involvement prior to CAR T in this study population. The authors were also able to look at minimal residual disease, or MRD testing for CLL in a subset of 27 patients in this study. MRD was undetectable by PCR or flow in either blood or bone marrow in 81% of these 27 patients. However, not all of these patients had paired pre and post CAR T samples available for comparison, thus limiting more detailed interpretation. In an analysis of risk factors linked to adverse outcomes, the study authors found in a multivariable analysis for overall survival that a greater number of prior lines of therapy for Richters, a higher Ki-67 proliferation index, and a higher baseline LDH and CRP were all associated with shorter OS. They did not find an association between patterns of BTK inhibitor use, whether prior to apheresis, as a part of bridging, or concurrent with CAR T-cell therapy, to be associated with either PFS or OS. In evaluating rates of toxicities for patients with Richters treated with CAR T, the authors find that grade 3 or higher cytokine release syndrome or CRS occurred in 16% of patients and grade 3 or higher neurotoxicity or ICANS occurred in 37%. They did not find any baseline features associated with higher risk of severe CRS, however, did find that prior venetoclax exposure was associated with severe ICANS. Overall, the authors find that CAR T-cell therapy is a feasible and effective therapy for Richter transformation of CLL to large B cell lymphoma, thus contributing data to support this additional therapeutic option in a high risk patient population with unmet therapeutic needs. While the PFS and OS rates are lower than those of their large B cell lymphoma counterparts, overall response rate of 63% and particularly the CR rate of 46% with a duration of response of 27 months for this group is quite promising. Those who achieved less than a CR had a much shorter duration of response and progressed quickly, and overall, the median overall survival of the whole study population is only over eight months, which reflects the high risk and poor outcome nature of treatment for Richters with currently available therapies. As the authors discuss, it is likely that the efficacy of CAR T-cell therapy is somewhat overstated in their results by virtue of not being able to include patients who were intended for CAR T-cell therapy but could not receive it in this retrospective study. This represents one of the many real world challenges patients and clinicians treating Richters face. However, the promising results for those who were able to receive CAR T-cell therapy represent a path forward for future investigations for Richters patients. One of the avenues of future pursuit is the addition of BTK inhibitors to CAR T-cell therapy. A subset of patients included in this study received BTK inhibitors for CLL before, during, and after CAR T-cell therapy, and although limited by subgroup analysis and statistical power constraints, this study's authors did not find a difference in outcomes for those who received BTK inhibitors in these settings. Toxicities with severe CRS and ICANS were higher than rates reported in large B cell lymphoma CAR T trials. However, as the authors note, these were comparable to the study of liso-cel toxicity in CLL patients. Higher rates of infection related deaths were also noted compared to large B cell lymphoma patient counterparts, however, in line with comparable CLL patient studies and thus likely related to the unique biology of Richters arising from CLL rather than de novo large B cell lymphoma. In summary, this important work evaluating the outcomes of patients with Richter's transformation treated with anti CD19 CAR T-cell therapy in the commercial setting provides important evidence as to the efficacy of this therapy among patients with an unmet need for efficacious and novel therapies to improve outcomes. As this group of patients is often excluded from clinical trials, this data is particularly important and should drive forward future studies focusing on and or including patients with Richters, given the benefits seen for a subset of patients who achieve a response in the study. While the antecedent CLL distinguishes Richters from de novo large B cell lymphoma biologically along with differences in prior treatment regimens, this study in JCO suggests that future strategies targeting improving baseline disease factors prior to CAR T-cell therapy, including successfully bridging patients to CAR T, reducing risk of CRS and ICANS with treatment, and improving long term efficacy after CAR T with novel constructs, and CAR design, may all be promising next steps in the advancement of CAR T-cell therapy for patients with Richter transformation. This is Alexandra Rojek. Thank you for listening to JCO Article Insights. Don't forget to give us a rating or review, and be sure to subscribe so you never miss an episode. You can find all ASCO shows at asco.org/podcasts.    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. Guest 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 episode, we explore the intricacies of Babesia and Babesiosis, exploring how this protozoan parasite infects red blood cells and evades the immune system. We discuss the various pathological effects of the infection, including impaired blood flow, tissue ischemia, and multi-organ dysfunction syndrome. Additionally, we cover common symptoms, relevant bloodwork indicators, and an overview of anti-malarial herbs/supplements and other strategies often employed in cases of Babesia. Topics: Introduction Recap of previous discussions on Lyme disease and mold Overview of chronic inflammatory response syndrome (CIRS) or biotoxin illness protocols Introduction to the current topic: Babesia and Babesiosis Overview of Babesiosis Definition and cause of Babesiosis Explanation of protozoan parasites Transmission method: tick bites Broad overview of Babesia infection process Babesia Infection Process Entry into the bloodstream via tick bite Infection and multiplication in red blood cells (RBCs) Hemolytic event: rupture of RBCs and hemolytic anemia Babesia's Evasion Mechanisms Avoidance of immune detection and spleen clearance Expression of parasite-encoded proteins on infected RBCs (iRBCs) Adherence to capillary endothelial cells in internal organs Capillary blockage and tissue damage Antigenic variation: changing surface proteins to evade antibodies Pathological Effects of Babesia Impaired blood flow and tissue ischemia Local inflammatory responses Multi-organ dysfunction syndrome Symptoms of Babesiosis Air hunger and low oxygen levels Common symptoms: fever, fatigue, muscle and joint pain, headaches, jaundice, dark urine, nausea, abdominal pain Severe symptoms: organ failure, acute respiratory distress syndrome (ARDS), disseminated intravascular coagulation (DIC), splenomegaly, low blood pressure and shock Bloodwork Indicators for Babesiosis Diagnostic tests: FISH test Hematological markers: hemolytic anemia, thrombocytopenia, leukopenia, hemoglobinuria, hyperbilirubinemia, elevated LDH, reticulocytosis Complement protein C4A and CD57 count Strategies for Babesiosis Importance of working with licensed medical professionals Mention of standard herbs and treatments Anti-malarials (mepron, artemisinin, cryptolepis), antibiotics (azithromycin), methylene blue, lumbrokinase Thank you to our episode sponsor: Liver Medic Use code Chloe20 to save 20% on ⁠"Leaky Gut Repair"⁠ ⁠Brendan's YouTube Channel⁠ ⁠https://x.com/livermedic⁠ Thanks for tuning in! Get Chloe's Book Today! "⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠75 Gut-Healing Strategies & Biohacks⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠" If you liked this episode, please leave a rating and review or share it to your stories over on Instagram. If you tag @synthesisofwellness, Chloe would love to personally thank you for listening! Follow Chloe on Instagram ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠@synthesisofwellness⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Follow Chloe on TikTok @chloe_c_porter Visit ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠synthesisofwellness.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ to purchase products, subscribe to our mailing list, and more! Or visit ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠linktr.ee/synthesisofwellness⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ to see all of Chloe's links, schedule a BioPhotonic Scanner consult with Chloe, or support the show! --- Support this podcast: https://podcasters.spotify.com/pod/show/chloe-porter6/support

For more info on how I can help you visit my site BetterByDrBrooke.com.    What test is the most accurate assessment of your blood sugar, insulin resistance or glucose variability? I cover the lab testing that you would get from your doctor: fasting glucose and Hemoglobin A1C as the most common ones, as well as Fructosamine and Glycomark. As well testing you might not be getting that you could easily request such as fasting insulin or C-Peptide. And there is testing you likely have like LDH that you didn't know was related to blood sugar levels. Lastly, how does at home monitoring play in for you in terms of using a glucometer or a CGM (continuous glucose monitor).   Which test is best? I cover what these tests tell you, why it's key to know what you're looking for, what might be covered by insurance and where you fall on the blood sugar problem spectrum: looking for optimal health and prevention vs. prediabetic or overt insulin resistance.    And the newer question we need to be asking: is it just high blood sugar we need to worry about or is glucose variability where it's at?    Episodes and links referenced in the show that may be helpful:   Get yourself a CGM with my fav app Nutrisense and save $50!   Article I wrote on Do You Need A CGM?   Interview with Carlee Hayes from Nutrisense on using a CGM.    Be sure you connect with me in my FREE PRIVATE Facebook group: Hormones & Happiness with Dr Brooke where other amazing, like minded women like YOU are already hanging out! Join us!   Follow Dr Brooke on Instagram and get signed up for my awesome emails here. Seriously,  I write really great emails, or so 1000s of women tell me and I'd like to send you one too.   To work with Dr Brooke click here and if you loved this episode please leave a review!     Stuff I Know You Will Love (Partners of the Dr Brooke Show) Want to avoid that mid afternoon energy slump and mental fogginess without using caffeine? Or need a preworkout boost to perform your best? Consider exogenous ketones like the ketone diol, no tummy upset, even energy found in KetoneIQ! I have found such a benefit in using KetoneIQ for my midlife brain fog and overall better mental and physical stamina - no fasting or keto diet required!  To learn more about KetoneIQ and save 30% off your first subscription order visit https://KETONE.com/BETTEREVERYDAY (discount automatically applied at checkout).   Did you know that 95% of women taking a prenatal are still nutrient deficient? The founders of Needed saw this as a big problem and I couldn't agree more! But Needed quickly became a bigger solution to a bigger problem by providing more options for moms and moms to be. Women need so much support during the time from thinking about getting pregnant all the way to having little ones and so often they are left with options that don't address their needs (prenatals that have nutrients in the wrong forms or that they can't take due to nausea) or they are left with low energy, anxiety or even colds/flus while they are pregnant or nursing because there aren't natural products that are considered safe during these times. Needed solved all of these problems as well as created a community of no-guilt, education and support for new moms and moms to be. Learn more about Needed and save 20% off your first order with code BETTEREVERYDAY at checkout.  This episode is also sponsored by LMNT Electrolytes! These high sodium, well balanced hydration boosters are perfect for low carb dieters, those doing keto or when employing intermittent or any type of fasting. Skip the brain fog, low energy, cravings and perform better with LMNT electrolytes. Get your FREE sample pack here!

C dans l'air du 21 mai 2024 : Nouvelle-Calédonie : Macron s'en mêle Après plus d'une semaine d'émeutes et six morts, dont deux gendarmes, en Nouvelle-Calédonie, Emmanuel Macron a décidé de se rendre dès ce soir dans l'archipel pour y installer une "mission" dont les contours ne sont pas encore précisés. Hier lors d'un nouveau Conseil de défense, le chef de l'Etat avait salué "de nets progrès dans le rétablissement de l'ordre", tout en décidant de déployer des militaires devant les édifices publics pour soulager les policiers et les gendarmes de ce territoire du Pacifique sud toujours en proie à des blocages. L'Etat d'urgence qui a été déclaré mercredi pour une durée de douze jours, n'est pas prolongé, pour l'instant. "La situation est en voie de se normaliser" et "le sujet [d'une prolongation] n'a pas été adopté ce matin", a expliqué la porte-parole du gouvernement Prisca Thevenot. La fermeture de l'aéroport a, en revanche, été prolongée jusqu'à jeudi, mais sans attendre l'Australie et la Nouvelle Zélande ont entrepris de rapatrier leurs ressortissants bloqués, en affrétant des vols aujourd'hui. Sur place, la situation reste très tendue et la maire de Nouméa Sonia Lagarde, soutien d'Emmanuel Macron, réclame une "pause" dans le projet constitutionnel de dégel du corps électoral. Dans un entretien au Monde, elle assure que ses mises en garde n'ont pas été écoutées et critique le manque de consultation en amont de cette réforme décriée par les indépendantistes qui revient sur le "gel" du corps électoral prévu par les accords de Nouméa en 1998. Le camp des loyalistes, à l'inverse, a appelé ce mardi à ce que la réforme électorale qui embrase l'archipel depuis une semaine aille à son terme. "Ce texte doit poursuivre sa route parlementaire. Le Congrès de Versailles (qui doit encore se réunir avant fin juin, NDLR) ne doit être ni suspendu, ni annulé", a exhorté le député non indépendantiste Renaissance de Nouvelle-Calédonie, Nicolas Metzdorf. Le débat sur la réforme du corps électoral, soutenue par la droite et l'extrême droite, est également relancé en France dans la classe politique. Parallèlement, dans l'Hexagone, le Conseil d'Etat examine ce mardi le recours contre l'interdiction du réseau social chinois TikTok dans l'archipel. Cette décision prise le 15 mai dernier par l'exécutif a été notamment attaquée en justice par la Quadrature du Net et la LDH, qui l'estiment liberticide. Si le gouvernement avait dans un premier temps évoqué un lien avec l'état d'urgence, Matignon mentionne désormais des "circonstances exceptionnelles" pour justifier ce choix. Alors quelle est la situation à Nouméa ? Pourquoi Emmanuel Macron a-t-il décidé de se rendre dans l'archipel ? Comment sortir de la crise ? Quels sont les enjeux autour de l'interdiction de TikTok en Nouvelle-Calédonie ? Enfin pourquoi la fronde sociale gronde-t-elle dans les transports parisiens à l'approche des JO ? Nos experts : - Christophe BARBIER - Editorialiste politique, conseiller de la rédaction - Franc-Tireur - Audrey GOUTARD - Grand reporter spécialisée dans les faits de société - France Télévision - Nathalie SCHUCK - Grand Reporter - Le Point - Jean GARRIGUES - Historien, président du Comité d'histoire parlementaire - Claude MALHURET (en duplex) - Sénateur, rapporteur de la Commission d'enquête du Sénat sur l'utilisation du réseau social DIFFUSION : du lundi au samedi à 17h45 FORMAT : 65 minutes PRÉSENTATION : Caroline Roux - Axel de Tarlé - REDIFFUSION : du lundi au vendredi vers 23h40 PRODUCTION DES PODCASTS: Jean-Christophe Thiéfine RÉALISATION : Nicolas Ferraro, Bruno Piney, Franck Broqua, Alexandre Langeard, Corentin Son, Benoît Lemoine PRODUCTION : France Télévisions / Maximal Productions Retrouvez C DANS L'AIR sur internet & les réseaux : INTERNET : francetv.fr FACEBOOK : https://www.facebook.com/Cdanslairf5 TWITTER : https://twitter.com/cdanslair INSTAGRAM : https://www.instagram.com/cdanslair/

Nante Japan's review of February 2024, featuring segments on Ado's New York concert, Ae! group's impending debut, LDH's rules for fan behavior, Japanese hip hop's big month, and more.

Ever felt the tension while celebrating your favorite artist, cautious not to step on the toes of perplexing copyright laws? Let Panic and Sarah guide you through the labyrinth of LDH's fan rules with a dash of humor, as we untangle the enigma of sharing content online, debating the nuances between fan adoration and intellectual property rights. Amidst our celebrations for International Women's Day, we delve into the puzzling world of official photos and the recent trend of birthday billboards, all while navigating the ever-changing dynamic between artists and their admirers.We analyze the seismic impact of digital engagement on K-pop sensations like BTS and Blackpink, dissecting the nuances of fandom power in the age of viral content. But it's not all glitz and fandom frenzy; we also confront the prickly side of copyright enforcement, pondering the future influence of international fans on entertainment giants. And because no music chat is complete without a little gossip, we bring you the latest buzz from influencers, some barroom karaoke scuffles, and a boy band lineup shuffle.Wrapping up with some candid banter, we speculate on BTS's Jin and Suga's post-military plans and the implications of their social media hush. Our episode is a kaleidoscope of opinions, from the melodramatic squabbles over (G)I-DLE's "Super Lady" to forecasting the shape of K-pop's future. So, whether you're a die-hard fan or just love a hearty debate on the quirks of music culture, tune in as we share our unfiltered take on the symphony of fandom, right down to the last note.Support the showPlease help Music Elixir by rating, reviewing, and sharing the episode. We appreciate your support!Follow us on:TwitterInstagram If have questions, comments, or requests click on our form:Music Elixir FormDJ Panic Blog:OK ASIA

We had the incredible opportunity to talk with Lisa Hamilton Daly, the EVP of Programming at Hallmark Media, about the launch of the new Mystery Channel and what sleuthers can expect. You will definitely want to listen to this episode as she gives some VERY big hints of upcoming mysteries, including Signed, Seal,  Delivered.  There are even some clues to expect in the much-awaited follow-ups to Cut, Color, Murder, Nikki and Nora, as well as Franchesca Quinn.In addition, she lays out Hallmark's plans to slow down releasing new mysteries and get to making the follow-ups to mysteries like Mystery Island and The Cases of Mystery Lane. She may even have hinted that Travis Burke will appear with Goldy and Tom in Curious Caterer. This episode is jam-packed with answers we have all wanted to hear. Enjoy.Follow us on social media: Instagram: @hallmarkmysteriesandmoreYoutubeOr visit our website. This podcast was created by fans for fans and is NOT affiliated with or sponsored by Hallmark or the Hallmark Channel.

【本日のドラマ】「おっさんのパンツがなんだっていいじゃないか！」【トピック】おじさんのアプデ、おじさんにも刺さる、原作者と制作側、LDHのオーディション、vol.660 おっさんのパンツがなんだっていいじゃないか！.MP3※itunes・Spotifyなど各種リンクはこちら！https://lit.link/dassenmovie※Twitter（X）やってます https://twitter.com/dassen_movie@dassen_movie

Ever wondered what it feels like to watch your creative sparks ignite trends across the entertainment industry? Sarah and Panic, your hosts of Music Elixir, pull back the curtain on this very experience. We pride ourselves on our innovativeness, yet we don't shy away from discussing the bittersweet reality of others mirroring our ideas. Our banter takes a turn towards the voiceover realm, highlighting the undeniable power of networking and collaboration in keeping the creative fires burning.This session turns up the heat with a passionate dissection of anthems that scream empowerment from the artists (G)I-DLE, RIKU with MA55IVE THE RAMPAGE and SUPER EIGHT. These tracks, armed with bold harmonies, gritty synths, and heart-pumping beats, are the embodiment of boldness and independence — the kind that fuels your fiercest workout or resurrects any party from the lull. We celebrate these electrifying tunes and the audacious spirit of the phenomenal artists behind them, sharing insights that will have you adding these powerhouses to your playlists in no time. As we gear up for a month-long celebration of Women's History Month, we're putting the spotlight on the powerhouse female musicians who've shaped the industry. The commitment to female representation is not just a March endeavor for us; it's a year-round pledge. Stay tuned for a journey of appreciation and empowerment, as we honor the achievements of women in music.(G)I-DLE info:InstagramXYouTubeRIKU, MA55IVE THE RAMPAGE, LDH info:official LDHSUPER EIGHT info:InstagramXSupport the showPlease help Music Elixir by rating, reviewing, and sharing the episode. We appreciate your support!Follow us on:TwitterInstagram If have questions, comments, or requests click on our form:Music Elixir FormDJ Panic Blog:OK ASIA

Prepare to be whisked away on a musical journey as Sarah and Panic, take you through the dynamic saga of PSYCHIC FEVER from EXILE TRIBE, Japan's latest sensation chasing global stardom. We give you an overview of their story, from the rigorous "Musha Shugyo" shows to time spent in Thailand, along with a bit of the personal with their array of zodiac signs!The pulse of Psychic Fever's music is undeniable, and we can't wait to share our take on tracks like the whimsically worded "Psyfe Cypher" and the sleek "Rocket (Take You Higher)," with its penthouse party ambiance. Jimmy's raspy voice commands attention amidst a symphony of rap battles and melodic harmonies, proving that this group isn't just another pop ensemble—they're trendsetters with a sound that's as diverse as it is catchy. Whether it's the old-school hip-hop vibe or the seductive R&B, the songs of Psychic Fever have a magnetic quality that's sure to resonate.Our episode wouldn't be complete without a candid discussion on how Psychic Fever's tunes influence our personal playlists and daily routines. We share that moment when a potent rap verse caught us mid-task, and the smooth "chocolatey" vocals that ensnared us completely. We also give a nod to JP THE WAVY's impact on the group's sound and the varied energies across their album. So, if you're looking for music that can both soothe and electrify, join us as we celebrate the artistry of Psychic Fever and discover the rich tapestry of sounds that will feed your soul and invigorate your day.Special shout out to @PCF_ThaiForEVER (PSYCHIC FEVER Thai ForEVER) on X-Twitter for requesting this episode.PSYCHIC FEVER from EXILE TRIBE info:InstagramXYouTubeofficial Support the showPlease help Music Elixir by rating, reviewing, and sharing the episode. We appreciate your support!Follow us on:TwitterInstagram If have questions, comments, or requests click on our form:Music Elixir FormDJ Panic Blog:OK ASIA

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 voice of the world's oncology professionals. 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 this 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. Cancer research discussed in this podcast is ongoing, so data described here may change as research progresses. In this podcast, members of the Cancer.Net Editorial Board discuss the latest research, innovations, and discussions taking place across the field of genitourinary cancers, including prostate cancer, bladder cancer, kidney cancer, and testicular cancer. This podcast is led by Cancer.Net Associate Editor for Genitourinary Cancers, Dr. Petros Grivas. Dr. Grivas is the clinical director of the Genitourinary Cancers Program at University of Washington Medicine and a professor in the clinical research division at the Fred Hutchinson Cancer Research Center. He is joined by Dr. Neeraj Agarwal, Dr. Shilpa Gupta, Dr. Tian Zhang, and Dr. Timothy Gilligan. Dr. Agarwal is a Professor of Medicine, and a Presidential Endowed Chair of Cancer Research at the Huntsman Cancer Institute at the University of Utah. He directs the Genitourinary Oncology Program and Center of Investigational Therapeutics at the Huntsman Cancer Institute. He is also the Cancer.Net Specialty Editor for Prostate Cancer. Dr. Gupta is the Director of the Genitourinary Medical Oncology Program at Taussig Cancer Institute and Co-Leader of the Genitourinary Oncology Program at Cleveland Clinic. She is also the Cancer.Net Specialty Editor for Bladder Cancer. Dr. Zhang is an Associate Professor of Internal Medicine at UT Southwestern Medical Center and a medical oncologist at the Harold C. Simmons Comprehensive Cancer Center. She is also the Cancer.Net Specialty Editor for Kidney Cancer. Dr. Gilligan is a Medical Oncologist, Associate Professor of Medicine, and Vice-Chair for Education at the Cleveland Clinic Taussig Cancer Institute. He is also the Cancer.Net Specialty Editor for Testicular Cancer.  View full disclosures for Dr. Grivas, Dr. Agarwal, Dr. Gupta, Dr. Zhang, and Dr. Gilligan at Cancer.Net. Dr. Grivas: Hello. I'm Dr. Petros Grivas. I'm a medical oncologist in Seattle, a professor at the University of Washington and Fred Hutchinson Cancer Center. I'm really excited and thrilled today to host wonderful superstars in the field of GU Medical Oncology who will share insights about the highlights of kidney cancer, prostate cancer, and bladder, urothelial, urinary tract cancers that happened in 2023. And this highlight aims to inform our great audience about what are the clinically relevant insights, what patients should be aware, what patients should ask for when they go to the clinic, or overall, how they can be most well-informed and have the necessary tools to improve their care and feel well-supported in regards to education. So without further ado, we're going to cover in first prostate cancer, a very important update in this year. So all the people out there that are interested in hearing about prostate cancer will find this very, very useful and insightful. I'm very excited to host Professor, Dr. Neeraj Agarwal from University of Utah. Neeraj, do you want to introduce yourself? Dr. Agarwal: Of course. It's such an honor to be here. My name is Dr. Neeraj Agarwal. I'm a professor of medicine and director of genitourinary oncology program at the University of Utah Huntsman Cancer Institute. Dr. Grivas: Neeraj, thank you so much for accepting the invitation and being with us. I would like to ask you, what's your take on the current state of genetic testing in patients with prostate cancer? And when we say genetic testing, maybe you can clarify the distinction between germline and somatic and comment on both if you could. Thank you. Dr. Agarwal: Of course, a very important topic. I must tell you that it is very clear from all the guidelines that in patients with advanced prostate cancer or metastatic prostate cancer, meaning when prostate cancer has spread to different parts of the body, both germline testing to look for hereditary mutations in the DNA repair genes and testing for the same genes inside the tumor tissue are considered standard of care. So, a patient with advanced prostate cancer should have germline testing and somatic tumor tissue testing to look for mutations that can predispose them to have prostate cancer, and if they have genes in the tumor which can be targeted by the current approved drugs, like drugs which are already approved right now or which are in clinical trials. Unfortunately, less than 50% of patients in many areas of the country and in the world, less than 20% of patients are being tested. And even more, unfortunately, patients are less likely to be tested are those who are not well-resourced, who are not living in rich countries, if you will. They are poor- or low-resourced countries. Even with high-income countries, within those countries, patients who are living in relatively not-so-affluent neighborhoods, they are less likely to be tested. From racial perspective, patients who are Black or who are Hispanics are less likely to be tested. Based on how many drugs are out there in the clinic and emerging through clinical trials. And the fact that we can use many of these mutations for prognostication, to inform survival, to inform aggressiveness of the disease. It is not only to treat those patients, but also how to monitor the disease. The genetic testing is very important. Dr. Grivas: Thank you so much, Neeraj. It's very insightful. And I think you did a great job outlining the clinical relevance for both the patient in terms of treatment decision-making and therapy options, especially for advanced prostate cancer, as well as the broader family and implications for cancer prevention and cancer screening for the broader family members. So definitely a very important topic. Neeraj, the other question I have, if you could tell us more about this class of medications called PARP inhibitors. If you can comment on the currently approved PARP inhibitors, either as a single agent, what we call monotherapy or combination therapies for patients with prostate cancer in the United States, and who is eligible to receive those therapies? Dr. Agarwal: And this is such a nice segue to talk about PARP inhibitors as we were just talking about genetic testing of prostate cancer. So, PARP inhibitors are a class of drug which are instrumental, critical in treatment of patients who harbor mutations in those DNA repair genes. And two monotherapies, meaning using these PARP inhibitors as single agents have been already approved in the United States and several other countries. These are olaparib or rucaparib. Olaparib is approved after patients have had disease progression on novel androgen-blocking therapies or androgen blockers such as enzalutamide or abiraterone or apalutamide. And these PARP inhibitors such as olaparib or rucaparib can be used for those patients as single agent if they have these DNA repair mutations. Now, last year, we saw several combinations of PARP inhibitors with these androgen or novel hormonal therapy, as we call them. And these include abiraterone plus olaparib, abiraterone plus niraparib, and talazoparib plus enzalutamide from various phase 3 trials. Now, I'd like to bring to your attention that these PARP inhibitor combinations are approved with different indications in the United States and in the European Union. And they continue to get approved in various other countries. So the combination of abiraterone and a PARP inhibitor, whether it is olaparib or niraparib, they are approved for patients who have new metastatic castrate-resistant prostate cancer, and they have BRCA1 or BRCA2 mutations in the cancer cells or they have germline BRCA1 and BRCA2 mutations. Enzalutamide and talazoparib combination is approved in the United States for patients with metastatic castration-resistant prostate cancer with BRCA1 and BRCA2 mutations, but also several other DNA repair gene mutations. And that's a big difference as far as approval is concerned in the U.S. In the European Union, for our patients who are listening from European Union, the combination of abiraterone and olaparib and enzalutamide and talazoparib are approved for patients with metastatic castrate-resistant prostate cancer where chemotherapy is not clinically indicated, regardless of whether they have mutations in the DNA repair genes or not. And the combination of abiraterone and niraparib is only approved for patients with metastatic castrate-resistant prostate cancer with BRCA1 and BRCA2 mutation. So I just wanted to outline the different indications in the United States and in the Europe. Dr. Grivas: Thank you so much, Neeraj. So eloquent and very relevant to multiple patients globally, as you pointed out, with some differences in terms of the regulatory approval and availability of those agents in different countries. So great insights. Maybe we'll ask you 1 more question again since we are doing the highlights of the year. Another very important area of therapeutic development has to do with these novel agents that target the prostate cancer cells, and we call them theragnostics as a broader term. And I will let you explain what that means maybe in lay terms for our audience. And specifically, if you can comment on the recently presented PSMAforetrial at the ESMO meeting in Madrid with lutetium-177 PSMA. What are the implications of these results for our patients, and what is the role of lutetium therapy in this particular therapy setting? Dr. Agarwal: Of course, very important and pertinent topic indeed. As our patients may know that lutetium-177 therapy, or simply speaking, lutetium therapy, has already been approved for patients with metastatic castrate-resistant prostate cancer who have had disease progression on this novel hormonal therapy and a chemotherapy with docetaxel or cabazitaxel. And this indication is already there in the U.S. and in various other countries. And patients are eligible to receive lutetium therapy as long as their disease has progressed on docetaxel or one of the taxane chemotherapy and a novel hormonal therapy. Now, in the European Society of Medical Oncology meeting, Dr. Oliver Sartor presented the data on PSMAfore trial where lutetium therapy was used before chemotherapy. In this trial lutetium therapy was compared with another novel hormonal therapy after disease progression on 1 novel hormonal therapy. And there was approximately 6-month improvement in progression-free survival, meaning there was a delay in disease progression by 5 to 6 months in patients who were receiving lutetium therapy. And at the time of the report, there was no improvement in overall survival, with the caveat that 84% patients who were receiving novel hormonal therapy, actually, they switched over to lutetium therapy after disease progression. So, overall, survival data may not be met. Having said that, we already know that lutetium therapy is an effective therapy, and it has a definitive role in treatment of our patients with metastatic castrate-resistant prostate cancer. Dr. Grivas: Thank you, Neeraj. That's very, very important data. And I'm so glad we have many more therapy options for our patients with prostate cancer. So involvement and accrual in clinical trials, I'm sure you will agree, is a very important and high priority. And I always encourage people with prostate cancer to ask about clinical trials that are relevant to their situation. Dr. Agarwal: Yeah. I'd just like to add a point regarding lutetium therapy that there was a phase 2 trial in from Australia which compared lutetium therapy with cabazitaxel therapy after disease progression and docetaxel chemotherapy. And efficacy of both agents were not very different. So just wanted to make that point. Dr. Grivas: Thank you, Neeraj. It's a very important point. And obviously, always want to think about pace and preference, convenience, distance from the cancer centers, all the relevant points, how we can individualize suggestions or recommendations for our patients. Thank you so much, Neeraj, for your wonderful input, insights, and all the work you do in the field. Dr. Agarwal: Thank you very much for having me. Dr. Grivas: Of course, of course. And now we're going to transition to a different cancer type. We're going to talk about bladder cancer and urothelial cancer in general, urinary tract cancer. And we're delighted and excited to have Dr. Shilpa Gupta from Cleveland Clinic, who's a professor there of oncology. Shilpa, I want to introduce yourself? Dr. Gupta: I'm Shilpa Gupta. I'm a genitourinary medical oncologist and the director of the GU Program at Cleveland Clinic. I'm really excited to be doing this podcast with you all. Dr. Grivas: Thank you, Shilpa. You have done amazing work in the field, pushing the field forward. You are part of those transformative studies. I will ask you in the beginning where I'm going to focus my first question for people who have advanced or metastatic bladder cancer or urinary tract cancer or upper or lower tract. And we saw really exciting, impressive data at the recent ESMO Congress in Madrid a couple of months ago. And I know you were there and were enjoying to see the improvement in patient outcomes that comes with better quality of life for patients in the last several years. And the question I have for you, if you want to summarize the key data in the first-line treatment, patients who have no prior treatment for metastatic urothelial cancer, what are the key data we showed at the ESMO meeting? Dr. Gupta: Thank you, Petros. As you said, this is a really exciting time for both patients as well as the physicians treating bladder cancer because of all the new developments which we've seen after decades. So at ESMO 2023, we saw the key data from the EV-302 trial, which was a phase 3 trial, which randomized patients to the standard of care, platinum-based chemotherapy, gemcitabine-cisplatin or gemcitabine-carboplatin, versus a novel drug, which is an antibody-drug conjugate called enfortumab vedotin and the immunotherapy pembrolizumab. And the primary endpoint was to see if patients lived longer and this delayed progression. And we saw that in this the progression-free survival, we saw that it was 12.5 months with enfortumab vedotin and pembrolizumab compared to 6.3 months, which means that the risk of progression or death was decreased by 55% with this new combination. And the benefit was seen across all the various factors, especially patients with liver metastases, visceral metastases, whether or not they had contraindications to receiving cisplatin or not or PD-L1 expression. So this is the first time we saw such a remarkable benefit with any treatment that beat platinums. And the overall survival was also doubled: 16 months in chemotherapy versus 31.5 months with this combination. So the risk of death was reduced by 53%. And we also saw that the overall response rates were 68% with this compared to 44% with chemo. And 29% of patients had complete responses. And this was really remarkable because we have not seen such data before. And in the same session, we also saw another phase 3 trial that was presented, which was the Checkmate 901 trial, in which the investigators tested whether the addition of immunotherapy called nivolumab to the standard of care, gemcitabine and cisplatin was better than gemcitabine and cisplatin alone. So this was a study only looking for patients who can receive cisplatin. So patients were randomized to 6 cycles of gemcitabine cisplatin versus nivolumab, gemcitabine cisplatin for up to 6 cycles. And after that, they continued nivolumab maintenance every month for up to 2 years. And in this, the primary endpoint of overall survival was also met, although the difference was not as huge as the other study. It was 18.9 months with chemotherapy versus 21.7 months with the combination. And progression-free survival was also improved by just 0.3 months with the combination. And the objective response rates were higher with the combination, 57% versus 43%, and there were 21% complete responses. So the bottom line is that both these trials showed us that the frontline treatment is not going to be just platinums anymore moving forward. We will have the option of the enfortumab vedotin and pembrolizumab for all comers, patients who can get platinums, and nivolumab and gemcitabine cisplatin for patients who are cisplatin eligible. Dr. Grivas: Thank you, Shilpa. Wonderful summary. Really, really exciting time to see the field moving forward and translate those results to longer life for our patients. In that context, I will also ask you—I asked Neeraj before about genetic testing in prostate cancer. I will ask you a similar question about genetic testing in bladder cancer. Again, reminding the audience about the distinction between germline testing, which is the DNA we are born with, and somatic testing, which is the cancer-specific genomic changes. Could you comment on the importance of genetic testing in bladder cancer? Dr. Gupta: Yes. Absolutely, Petros. Genetic testing in urothelial cancer is very important because for the first time a few years ago, we saw a drug targeting the fibroblastic growth factor receptor or FGFR alterations. This drug is called erdafitinib. It is the first targeted therapy to be approved in urothelial cancer. It is only seen in up to 20% of patients who harbor these alterations for whom this option may be viable. And we saw initially that erdafitinib was approved in patients who harbor these alterations in the phase 2 BLC2001 trial where it showed response rates of 40% and encouraging progression-free survival, and overall survival. And then we also saw in a phase 3 trial called the THOR trial where patients who harbored these alterations by genetic testing, erdafitinib was much better than chemotherapy, prolonged survival by almost 4.2 months compared to chemotherapy. So unless we are testing, we won't find this. So it is really important to test all our advanced disease patients so we are not depriving them of this additional targeted therapy. Dr. Grivas: Thank you, Shilpa. Very important message for our patients to definitely discuss the value of genetic testing. And if we think about therapy implications, specifically genomic changes, DNA changes in these FGFR-2 and FGFR-3 genes are very relevant and important for potential therapy with this agent called erdafitinib. Shilpa, a quick comment. We saw data from THOR cohort 2 comparing erdafitinib with this inhibitor of this FGFR that we just talked about compared to pembrolizumab, which is an immunotherapy drug inhibiting a checkpoint of the immune system. Could you quickly comment on that? And I think both options are available for our patients and sometimes just comes down to the sequence based on a particular patient case. Dr. Gupta: So Petros, as we had thought that patients who harbor these alterations in their tumors, they may benefit from using targeted therapy before immunotherapy. That was the premise of the cohort 2 of the THOR trial, that patients will do better if they received erdafitinib first after progressing on 1 prior line of therapy, which is not an immunotherapy. So patients were randomized to erdafitinib versus pembrolizumab. Of course, all of them had to have the FGFR alterations. The primary endpoint was overall survival. Initially, like I said, the study assumed that there'll be 46% improvement in overall survival with erdafitinib over pembrolizumab. However, the study was a negative study. There was no difference in the overall survival. And what that means for our patients is that erdafitinib right now is positioned for patients who've had prior platinums and immunotherapies. So erdafitinib should not be used before immunotherapy. So I think this is the first study that really settles the question of sequencing for our patients. And I think the message is that in a patient's journey, they should be getting all these therapies. We just now know that it's better to use pembrolizumab before erdafitinib and not vice versa. Dr. Grivas: Thanks, Shilpa. And then really, really interesting to see these trials being reported. And as you said, individual discussion with the patients and the response rate may be another factor to consider. If someone wants to have a more rapid control of the cancer of the disease, we may potentially think about an agent with high response rate and vice versa. So I think to your point, individual decisions. And I think patients asking those questions is very important in the clinic to help select the right patient for the right treatment for the right patient. Dr. Gupta: Yeah. Absolutely, Petros. They did see that the response rates were 40% with the erdafitinib versus 21% with the immunotherapy. So using that information can sometimes guide us if a patient has high disease burden. Dr. Grivas: Thank you, Shilpa. That was very insightful. And thank you for all you are doing for the patients and the field in general. You really, really have helped the field move forward. So congratulations and thank you. And we're going to transition to another superstar in the field of GU cancers. Very excited to host Dr. Tian Zhang. Dr. Zhang is in UT Southwestern in Dallas. Tian, you want to introduce yourself? Dr. Zhang: Hi, Petros. Thank you so much. Tian Zhang, I'm a GU medical oncologist and associate professor at UT Southwestern Medical Center in Dallas. Dr. Grivas: Wonderful. Thanks, Tian. Again, the same comments. All the work you're doing in the field is tremendous. Thanks for joining us today. Tian, we saw some very interesting data at the ESMO meeting. And since we're doing the highlights of the year, I think the predominance of the data we saw at the ESMO meeting was about this drug called belzutifan, where I will ask you to enlighten us what exactly this is. And particularly, we saw 3 different trials. I would probably ask you to focus more on the LITESPARK-005. What was the trial design and what was the primary goal of the study? When patients go on this drug, what they should be aware in terms of side effects? And what was all this discussion that the take-home message at the end of ESMO regarding belzutifan? Thank you. Dr. Zhang: Sure. We'll parse that one at a time. Belzutifan, I hope many of our audience knows is a small molecule inhibitor of the HIF complex, a hypoxia-inducible factor complex, which is implicated in the development of kidney cancers. And this biology actually contributed to the Nobel Prize in 2019. Understanding the structure of the HIF complex and how to target it. For a long time, HIF was thought to be un-targetable. And so the fact that there were small molecules identified actually here in Dallas at UT Southwestern that inhibits the dimerization of the HIF complex is really novel and shows us the bench-to-bedside translatability of these preclinical discoveries. And so there were a couple of molecules that were discovered here on campus and they paved the way for what became molecules that have now made it to clinic, in particular belzutifan. And so we've had belzutifan now approved for Von Hippel-Lindau Syndrome over the last 2 years or so. So many of us are familiar with using this drug in the clinic. It's an oral agent that's able to target the HIF complex and block it and really control the spread of clear cell kidney cancers, in particular in Von Hippel-Lindau disease.  LITESPARK-005, the trial that you're alluding to, there was a registrational trial for belzutifan across other kidney cancer populations. And this trial was the 1 that made, I think, the biggest impact of the 3 trials that were presented at ESMO this year.  LITESPARK-005 was a phase 3 trial of patients who had metastatic or locally advanced clear cell kidney cancer who had progressed after prior systemic therapies, not more than 3 prior lines. And they were randomized to either belzutifan at the 120 milligrams daily dose or everolimus at the 10 milligrams daily dose. And the primary endpoint was delay of progression. So progression-free survival as well as overall survival. So we saw the primary endpoint of these was met for progression-free survival. There was about a 26% risk reduction for progression for patients treated with belzutifan versus those that were treated with everolimus. The objective response rate I would highlight is also significant for the patients treated with belzutifan. There was actually a 3.5% complete response rate and objective responses. So including partial responders was about 23%. I would say that patients who are treated with belzutifan need to be aware of the side effects of anemia and also hypoxia [low levels of oxygen in the body]. And in fact, higher grades of anemia can occur in up to a third of patients and higher rates of hypoxia. So low oxygen saturations can occur in up to 10% or so of patients. And so that's really important when we're thinking about those toxicities and how we might hold or support the side effects with growth factors, for example, for the anemia. Otherwise, it's quite well tolerated as a single agent. As you alluded to, there was 1 controversial aspect of this particular trial because the control cohort was treated with everolimus. And everolimus as a single agent may not be what people use at this point in the refractory setting. But it is an acceptable approved treatment option for patients in the refractory kidney cancer setting, and therefore, it was chosen as the control cohort. And belzutifan did improve compared to a known standard of treatment. So I think that's really important to add to our armamentarium in refractory disease. Dr. Grivas: Wonderful, Tian. Thank you so much for a really, really comprehensive and detailed review. We'll have to see whether it will be available for patients with advanced clear-cell kidney cancer. To your point, it's already available for patients with this condition that you mentioned, the Von Hippel-Lindau genetic condition. So it's great to see more options available for our patients. Maybe I'll ask you another quick trial to comment on Tian, and I'll ask you individual questions to make it easier, to your point, for the audience to follow. And I'm referring to the RENOTORCH trial. This was conducted in China, and I think it was practice-changing there. Could you tell us the study design? Dr. Zhang: RENOTORCH was another phase 3 randomized trial. It was conducted all in China of patients with unresectable metastatic clear cell kidney cancer, no systemic prior therapy, and also intermediate- and poor-risk disease by IMDC criteria. So these were all first-line metastatic disease, and patients were randomized to either toripalimab, which is their PD-1 inhibitor, plus axitinib versus sunitinib. So this is a trial design that mirrors many of our prior trials in the first-line metastatic setting that have led to approvals of VEGF IO [immunotherapy] combinations. But this is the first one that was carried out purely in the Chinese population and important for the Chinese population to gain access to these types of combinations. Dr. Grivas: Thank you, Tian. Very important to see this global approach, as you mentioned, oncology and see trials from different countries. What were the main findings of this trial? Dr. Zhang: Sure. The primary endpoint was progression-free survival of the 2 cohorts. And they randomized about 420 patients. About 80% per cohort had intermediate-risk disease. And the combination of axitinib with toripalimab did improve progression-free survival. So it had a 35% risk reduction for progression over time. So it did meet its primary endpoint. Dr. Grivas: Thank you, Tian. It's great to see progress in the field. As I mentioned, new agents, positive trials. Could you comment a little bit on the side effect profile and the significance of this trial for our patients worldwide? Dr. Zhang: Sure. When we're talking about VEGF IO combinations very similarly as to the prior trials that we've seen in the toxicity profiles, we're thinking a lot about the immunotherapy toxicities of rashes and colitis [inflammation of the colon], endocrinopathies [hormone problems], as well as the rare inflammatory reactions of the liver, lungs, or kidney, but also added in the small molecule effects of hypertension, hand-foot syndrome, and mucositis [mouth sores] and taste changes. So very important to think through those side effect profiles as our patients are being treated with these combinations. Dr. Grivas: Thank you so much, Tian. Great to see, again, this progress made worldwide. And I think it speaks to the idea of how we can have equitable healthcare delivery across the globe, right, and have agents accessible in different parts of the world. Dr. Zhang: Absolutely. In fact, I would just add that the Chinese population haven't actually had access to drugs like cabozantinib. And this is their first phase 3 grade 1 evidence for a combination of VEGF with IO combination. So it's really important that these trials are carried out in the populations where we try to find the effect and see that the consistent benefit is there so that those patients have access to all of these treatment options. Dr. Grivas: Thank you, Tian. I appreciate your wonderful insights and all your amazing contributions in the field and your research. It's really, really inspiring to see. And I'm going to transition now. Last but not least, we're having the honor of hosting professor, Dr. Tim Gilligan, who is in Cleveland Clinic, and Tim is a world-known expert in urinary cancers, including testicular cancer. Tim, would you like to introduce yourself? Dr. Gilligan: Yes. Hi. So I think you just did. Tim Gilligan, an oncologist at Cleveland Clinic. I chaired the NCCN panel on testis cancer and edit the UpToDate sections on testis cancer with their help. Dr. Grivas: Fantastic. Thanks, Tim, for being with us today. And all the work you have done for our patients with GU cancers, testicular cancer, and a lot of work is being done with the NCCN and other guidelines. And you are co-chairing the NCCN guidelines, to your point. Tim, a lot of discussion is happening nowadays across cancer types regarding the role of what we call biomarkers, which are potential features that can help us select patients for the right treatment or help us estimate the prognosis, how long people live. Could you comment a little bit on this biomarker called microRNA in patients with testis cancer? How do you envision this being developed in the future? Is it ready for prime time or not yet? Dr. Gilligan: And that's an important question. It's not ready for prime time yet, but we are making progress. There are a couple of areas where it could be very useful. So for example, in stage I testicular cancer, we tell patients to go on surveillance because they're usually cured with orchiectomy [surgical removal of the tumor and testicle], but there is a risk of relapse, and that risk of relapse is highly variable. And our current risk stratification systems for predicting who's going to relapse, who has stage 1 disease, are helpful, but they're far from perfect. And so there was data presented this year that mRNA may be more accurate at predicting for men with stage I non-seminomas who's destined to relapse. And so the implication of that would be if you are positive for mRNA, this particular mRNA for non-seminoma and you have stage I disease, normal scans, normal markers, you could identify a high-risk group of patients who maybe should get a cycle of BEP chemotherapy rather than waiting. If you know they're going to relapse, you're going to have to get them 3 cycles of BEP, why not just treat them right away? Or maybe RPLND [retroperitoneal lymph node dissection] could be helpful in that setting. We don't know. But we would need to do studies validating that approach. There is data showing that it does predict relapse, but it's not at the point of saying, "Are the patients really going to do better with immediate treatment and which treatment is going to be best for them?" But I thought that was an important finding and really an example of how we think we're going to use it, which is to find relapse a lot earlier and so that we can give a less toxic treatment. And the benefit of that is that we know more and more that chemotherapy is toxic and resulted in second cancers. For men who get multiple cycles of cisplatin-based chemotherapy, or if they get radiation therapy, they're at higher risk of dying of other cancers than the general population. So if this could help us find early relapses, treat it more gently, less aggressively, have late, less toxicity, and the same cure rate. That would be great. So we're not there yet, but I think we're going to get there. Dr. Grivas: Thanks, Tim. Very, very helpful to know. So this microRNA 371 that we talk about is not ready for prime time, but you definitely see promise for the future, and more trials, more studies are being done. Again, illustrating the importance of clinical trials that can help us evaluate the added value of a particular biomarker, including this particular microRNA that we talked about. Dr. Gilligan: Before you change the subject on getting to crude biomarkers, there was also an interesting abstract showing that for stage I seminoma. If we actually use our current markers, we may be able to predict much more accurately. And it'll be interesting to see if that changes. They looked at the variables of lymphovascular invasion, invasion of the hilum of the testis, whether or not preoperative markers were elevated, LDH, and beta HCG. What was interesting to me about that paper was that this is about 900 patients. It was pretty large. That if you had all 4 risk factors, the relapse rate was about 64%. Whereas your average relapse risk for stage I seminoma is about 15%. We put everyone on surveillance. If we started if that model is persuasive to the community and starts getting used, then maybe patients with those 4 risk markers who most of whom are going to relapse, according to this data, maybe you want to treat those people and not put them on surveillance. So that'll be interesting to follow up on too. Dr. Grivas: Thanks, Tim. And you are referring to currently available blood tests, right, that can be used, and we use them in clinical practice. So we just put them together, try to get a sense of the chance of cancer coming back, what we call recurrence, and how long people may live. That can help us make a therapy decision. Thank you, Tim. This is very, very interesting. And I'm glad to see the progress in the field. I think you alluded to that before, but there is a trend discussing when we have a removal of the testicle for a patient with testis cancer, what to do next, depending on the stage, those markers that the blood tests you told us about. What about the role of surgery for removal of lymph nodes, for example? And do you see a trend going forward that in many selective cases, certain scenarios, we may potentially select surgery as opposed to chemotherapy or radiation to avoid these potential complications down the road? And if so, which are those patients who may benefit from surgery? Dr. Gilligan: Yeah, an important question. I think surgery, there's been a growing interest in using surgery rather than chemotherapy in order to avoid late effects. So retroperitoneal lymph node dissection (RPLND) is the most obvious example of that. There is data now showing that most patients with stage II seminoma can be cured with retroperitoneal lymph node dissection. We used to treat those patients with chemotherapy or radiation, but as I've noted, both of those are associated with an increased risk of second cancers down the line. So there are papers on both sides of the Atlantic showing that you can cure most people. However, it is important to note that the relapse rate after surgery is significantly higher than the relapse rate after chemotherapy or radiation. If you take a stage II patient and treat them with chemotherapy or radiation, you're going to cure well over 90% of them. Whereas the relapse risk with surgery, depending on what you find at surgery, is going to be higher. So on average, it's going to be in the realm of 20%, maybe as high as 30%, depending on which paper you look at. And if you take patients who have PN2 disease, so a lymph node is 2 centimeters or bigger, 25% or more of those patients are relapsing after surgery. So it's important for patients to understand that this treatment has the benefit of avoiding chemotherapy for most patients, but it also has a higher risk of relapse than the old treatments. We still think it's attractive because if you can avoid chemotherapy in 3 out of 4 patients or 4 out of 5 patients, that's a benefit to those patients. And also, if you go in and find a significant amount of cancer at surgery, you can give 2 cycles of chemotherapy right away and almost eliminate the risk of relapse, which is less chemo than they would be getting upfront, which would be 3 or 4 cycles. So one of the emphasis now is really trying to avoid late toxicities if we can. You sometimes see that even in the metastatic setting in terms of resecting residual masses and situations where we maybe in the past would have thought about second-line chemotherapy. I think people are more thinking about opportunities to use surgery instead to try to limit the quantity of chemo that we're giving. Those are much trickier decisions than the stage II decisions, but definitely a growing interest in surgery rather than chemo. Dr. Grivas: Thank you so much. It's really, really exciting to see that testis cancer was really transformed in the past with developments of therapies like chemotherapy, radiation therapy, and surgery. And it's great to see this evolving down the road. And I think all of the above that you mentioned evolves through the conduction of clinical trials. And as I mentioned before, I think it's so important to give the opportunity for patients and families to review clinical trial options. I think it's critical to try to help them, but also help other patients, the community, the society in general. So I always try to underline the importance of clinical trials across the board. And on that note, I think we had such a successful year, 2023 across GU cancers. It's so great to see the progress being made. All of us are looking forward for more exciting research being done in 2024 and beyond. And on that note, I want to thank so much Dr. Agarwal, Dr. Gupta, Dr. Zhang, and Dr. Gilligan for wonderful insights and all the great work they're doing in the field of GU cancers. As the editor for the GU Cancers for the wonderful Cancer.Net, I'm so proud of this team and really, really looking forward to further podcasts like this and how we can better serve the educational mission for ASCO, working with the wonderful staff at Cancer.Net. Thank you so much, all of you, for your time today and all you are doing. Dr. Gupta: Thank you, Petros. Dr. Zhang: Thank you, Petros. ASCO: Thank you, Dr. Grivas, Dr. Agarwal, Dr. Gupta, Dr. Zhang, and Dr. Gilligan. You can learn more about new research in genitourinary cancers at www.cancer.net. Cancer.Net Podcasts feature trusted, timely, and compassionate information for people with cancer, survivors, and their families and loved ones. Subscribe wherever you listen to podcasts for expert information and tips on coping with cancer, recaps of the latest research advances, and thoughtful discussions on cancer care. And check out other ASCO Podcasts to hear the latest interviews and insights from thought leaders, innovators, experts, and pioneers in oncology. Cancer.Net is supported by Conquer Cancer, the ASCO Foundation, which funds lifesaving research for every type of cancer, helping people with cancer everywhere. To help fund Cancer.Net and programs like it, donate at CONQUER.ORG/Donate.

La justice internationale est-elle au niveau ? Depuis hier, lundi (8 janvier 2024), se tient en Suisse le procès de l'ex-ministre gambien de l'Intérieur Ousman Sonko pour crimes contre l'humanité. Ce type d‘accusation se multiplie dans le cadre des deux grandes guerres actuelles : à Gaza et en Ukraine. Sur quoi peuvent déboucher les procédures en cours ? Comment faire progresser la justice internationale et prévenir ainsi d'éventuels futurs conflits ? Pour en débattre :- Clara Gérard-Rodriguez, avocate, ancienne juriste à la Cour Pénale Internationale (CPI)- Serge Sur, professeur émérite de Droit public à l'Université Panthéon-Assas, rédacteur en chef de la revue « Questions internationales »- Patrick Baudoin, avocat, président d'honneur de la Ligue des droits de l'homme (LDH).

La justice internationale est-elle au niveau ? Depuis hier, lundi (8 janvier 2024), se tient en Suisse le procès de l'ex-ministre gambien de l'Intérieur Ousman Sonko pour crimes contre l'humanité. Ce type d‘accusation se multiplie dans le cadre des deux grandes guerres actuelles : à Gaza et en Ukraine. Sur quoi peuvent déboucher les procédures en cours ? Comment faire progresser la justice internationale et prévenir ainsi d'éventuels futurs conflits ? Pour en débattre :- Clara Gérard-Rodriguez, avocate, ancienne juriste à la Cour Pénale Internationale (CPI)- Serge Sur, professeur émérite de Droit public à l'Université Panthéon-Assas, rédacteur en chef de la revue « Questions internationales »- Patrick Baudoin, avocat, président d'honneur de la Ligue des droits de l'homme (LDH).

BUFFALO, NY- December 6, 2023 – A new #researchpaper was #published in Oncotarget's Volume 14 on December 1, 2023, entitled, “Plasma levels of BCMA-positive extracellular vesicles correlate to response and side effects in myeloma patients treated with belantamab-mafodotin.” In myeloma patients, high levels of soluble B-cell maturation antigen (sBCMA) can limit the efficacy of BCMA-directed therapies. Belantamab-mafodotin is a BCMA antibody-drug conjugate and shows good overall response rates in heavily pretreated patients, but progression-free survival data are poor. In this new study, researchers Carsten Springer, Jürgen Krauter and Arne Trummer, from Städtisches Klinikum Braunschweig and Heidekreis-Klinikum in Germany, investigated whether sBCMA in blood plasma includes extracellular vesicles (EV) carrying BCMA or other myeloma antigens and if these BCMA-EV levels show a significant change during therapy with belantamab-mafodotin. “As the drug induces apoptosis, we hypothesized that sBCMA includes extracellular vesicles (EV) and thus evaluated numbers of BCMA-EV before and during belantamab therapy in 10 myeloma patients.” BCMA-EV were significantly higher in patients prior to Belantamab (median: 3227/μl; p = .013) than in other myeloma patients before therapy (n = 10; 1082/μl) or healthy volunteers (n = 10; 980/μl). During therapy, BCMA-EV showed a significant increase to a maximum of 8292/μl (p = .028). Maximal changes in BCMA-EV (Δmax = BCMA-EV at C1/maximal BCMA-EV) showed a strong inverse, logarithmic correlation (r = −.950; p < .001) with FLC ratio changes (Δmax = FLC ratio at C1/minimal FLC ratio) and BCMA-EV peaks often preceded FLC progression. Correlating increase of LDH and BCMA-EV levels, together with clinical symptoms, point to a mafodotin-induced eryptosis. In summary, BCMA-EV are a part of sBCMA, peak levels precede progression, and their measurement might be helpful in identifying resistance mechanisms and side effects of BCMA-targeted therapies. “To the best of our knowledge, we demonstrate for the first time that BCMA-positive extracellular vesicles can be found in blood plasma from myeloma patients and that BCMA expression on EV is 10 to 100 times higher than that of other well-known antigens of myeloma cells.” DOI - https://doi.org/10.18632/oncotarget.28538 Correspondence to - Arne Trummer - arne.trummer@heidekreis-klinikum.de Sign up for free Altmetric alerts about this article - https://oncotarget.altmetric.com/details/email_updates?id=10.18632%2Foncotarget.28538 Subscribe for free publication alerts from Oncotarget - https://www.oncotarget.com/subscribe/ Keywords - cancer, myeloma, b cell maturation antigen, extracellular vesicles, belantamab-mafodotin, eryptosis About Oncotarget Oncotarget (a primarily oncology-focused, peer-reviewed, open access journal) aims to maximize research impact through insightful peer-review; eliminate borders between specialties by linking different fields of oncology, cancer research and biomedical sciences; and foster application of basic and clinical science. To learn more about Oncotarget, please visit https://www.oncotarget.com and connect with us: SoundCloud - https://soundcloud.com/oncotarget Facebook - https://www.facebook.com/Oncotarget/ X - https://twitter.com/oncotarget Instagram - https://www.instagram.com/oncotargetjrnl/ YouTube - https://www.youtube.com/@OncotargetJournal LinkedIn - https://www.linkedin.com/company/oncotarget Pinterest - https://www.pinterest.com/oncotarget/ Reddit - https://www.reddit.com/user/Oncotarget/ Media Contact MEDIA@IMPACTJOURNALS.COM 18009220957

While it's true that the majority of people will have a run-in with some kind of cancer in their lifetime, we need to remember that no 2 cancers are the same, and your overall metabolic health has a huge impact on how your body will manage the cancer and what your survival rates will be, plus which treatment path you should go down. To test your body's current metabolic health status when dealing with cancer, there's a number of simple blood tests you can run that will show how well (or poorly) your body is handling the tumor load.  You'll want to run the following tests: CBC and specifically look at WBC, Platelets, and the Neutrophil to Lymphocyte ratio Comprehensive Metabolic Panel - Creatinine, Liver enzymes, Alkaline Phosphatase Inflammatory markers - LDH, ESR, hs-CRP

Have you ever wondered how music can be so diverse yet unite us all? Tantalize your ears today with a journey through the vibrant world of Asian music! We've got you covered with five remarkable singles from artists hailing from Japan, Indonesia, and South Korea. You're sure to move to the rhythm of GENERATIONS from EXILE TRIBE's dance anthem 'Diamonds', you'll groove to the disco beats of U-Know, and get hooked to the catchy track 'Bang' by the Indonesian group StarBe.Now picture this: a Korean rapper with genius lyricism and a heavy bass that gets you thinking and reflecting. BewhY is going to make you marvel at his unique beats and rhythms while exploring how his faith influences his music. His philosophical approach is bound to intrigue you as you explore the depth of his lyrics and the profoundness of his views. You're in for a surprise with HWASA's latest single 'Chili', which begins with an unexpected acapella and soon transitions into a reggaeton beat. If you've been craving for a blend of raw talent and attitude, HWASA is your go-to artist. Her fierce rap delivery and the energy she brings to the track are invigorating. So come join us, as we explore and appreciate the magic of Asian music. It's not just an episode, it's a musical voyage.GENERATIONS from EXILE TRIBEInstagramX/TwitterYouTubeU-KnowInstagramStarBeInstagramX/TwitterYouTubeBewhYInstagramX/TwitterYouTubeHwasaInstagramYouTubeSupport the showPlease help Music Elixir by rating, reviewing, and sharing the episode. We appreciate your support!Follow us on:TwitterInstagram If have questions, comments, or requests click on our form:Music Elixir FormDJ Panic Blog:OK ASIA

About This Episode Dr. Paul Anderson, based in Seattle, shares transformative insights on holistic approaches to cancer.  He emphasizes clean eating's pivotal role in cancer prevention, treatment strategies based on cancer stages, and highlights the importance of monitoring cancer stem cells (CSCs). Diving deep into IV Vitamin C treatment, Anderson notes its unique capability to harm cancer cells while supporting healthy ones.  Furthermore, he discusses the rapidly evolving landscape of Circulating Tumor Cell Tests and their significance in monitoring cancer.  For those navigating the cancer journey or seeking holistic health insights, this interview offers a wealth of knowledge. Dive into the summary or watch/listen for comprehensive understanding. Resources Mentioned: Dr. Paul Anderson's Website "Outside the Box Cancer Therapies" (book) Tests: RGCC CellSearch Biocept Maintrac IvyGene High dose, concentrated mushroom extracts Exogenous ketones Vitamin B3 Nicotinamide riboside Detailed Summary Introduction by Ryan: Dr. Anderson was Ryan's son's naturopathic oncologist. Ryan appreciated Dr. Anderson's vast knowledge and ability to answer difficult questions. Dr. Paul Anderson's Introduction and Background: Based in Seattle, Washington. Met Ryan during the treatment of Ryan's son, Ryder. His practice is divided into two equal parts: Treating patients with cancer, including children (which is uncommon). Treating individuals with complicated chronic illnesses unrelated to cancer. Teaches doctors and emphasizes on sharing knowledge. Co-authored the book "Outside the Box Cancer Therapy" with Dr. Stangler. Working on another book focusing on the emotional aspects and process of being diagnosed with cancer. Comparison between Naturopathic Oncologists and Integrative Medical Doctors: Dr. Anderson emphasizes practical experience, learning from patients. He offers specialized treatments, including IV therapy, hyperbaric oxygen, hyperthermia therapies, etc. Naturopathic oncologists and integrative MDs can both be limited in their treatments by the hospitals or systems they work in. Discussion on IV Vitamin C Treatment: Dr. Anderson is recognized internationally for his expertise on this topic. Benefits can be gained from both low and high doses of IV vitamin C, depending on the application. The amount needed can vary based on body weight and the specific health of the patient. High doses can range from 50-100 grams for most adult-sized individuals. Vitamin C remains in the system for about 24 hours post-IV. Vitamin C is unique in that it harms cancer cells while supporting healthy cells. Lower doses (around 10-15 grams) can provide significant improvements in quality of life for frail or end-of-life patients. Circulating Tumor Cell Tests: Have improved over time; past versions like RGCC and CellSearch were not as accurate. Technology is rapidly changing and affecting the reliability of these tests. Biocept, Maintrac, and IVY gene are currently used tests. These tests are especially useful for: Monitoring cancer in remission or no evidence of disease. Tracking the effectiveness of ongoing treatments. Treatment Strategies Based on Cancer Stage: Late Stage: Urgency in treatment is crucial. Need a holistic approach, addressing dietary habits, toxins, infections, hormones, and overall health. Aim to grab the cancer's attention and slow its progression. Early Stage: There's more flexibility in treatment approaches. Focus can be on non-cancer issues like detoxifying, balancing hormones, improving gut health, and addressing mental health. Treatment options can include concentrated mushroom extracts, metabolic treatments like exogenous ketones, or even dietary shifts such as raw vegan diets. Post-Cancer Treatment: Post chemotherapy and radiation, there's an increased risk for secondary cancers because they can stimulate cancer stem cells. Importance of recovery after initial treatments and secondary prevention to ensure recurrence doesn't occur. Repairing the body and suppressing cancer stem cells is essential. Diet's Impact on Cancer: No single "best" diet for cancer elimination; however, diet plays a pivotal role. Emphasis on clean eating: Avoid processed foods, chemicals, pesticides, and herbicides. A shift in diet can have a noticeable effect on cancer within 1-3 months. Key Dietary Recommendations: Intermittent Fasting (IF): IF for even 13 hours has shown to reduce the recurrence of breast cancer. It activates autophagy (cell cleaning) and has other metabolic benefits. Diet Cleanliness: Remove junk and chemicals from diet. Plant-based Spectrum: High in polyphenols, fiber, dense nutrients, and low in simple carbs. Raw food diets can quickly get the body's attention. Ketogenic Spectrum: Shifts body metabolism and may be beneficial against certain types of cancers. It's crucial to balance protein intake since excess protein can be converted into sugar. Modified Mediterranean Diet: High plant-based with clean protein and fat sources, minimal grains. Diet Adaptability: Initial diet is about getting the body's attention; it might differ from the long-term diet. Both ketogenic and raw food diets have shown positive effects on patients with various cancer types. Adapt the diet based on what a person can do and tolerate. Long-term success requires consistency in dietary habits. Observational Cases: Noted a patient surviving stage 3/4 breast cancer for over 15 years primarily using a ketogenic diet. Other cases showed success with a raw food diet transitioned into a modified vegetarian diet. Regular Monitoring: Emphasizes tracking certain blood work indicators (e.g., LDH, alkaline phosphatase, GGT) regularly. These markers can provide insights into inflammation, oxygen levels, and overall body health. Monitoring helps catch subtle shifts in the body's health, guiding adjustments in treatments and dietary habits. Cancer Stem Cells (CSCs) Insights: CSCs are smarter than regular tumor cells (daughter cells). While treatments like chemotherapy or radiation can reduce tumor size, they might make one prone to relapses because CSCs hide and wait. Many people have dormant CSCs in their bodies. The challenge is to keep these cells inactive. CSCs can recruit normal cells to become cancerous. CSC Triggers & Management: One major trigger for CSCs is inflammation. Inflammation sources include lack of exercise, poor diet, toxins, infections. Healthier lifestyles, such as better diets and regular exercise, produce anti-cancer metabolic triggers. Intermittent fasting and periodic longer fasts can slow CSC activity. Diet, detox, and addressing specific toxic exposures can help maintain an environment less favorable for CSC growth. NAD Therapy Insights: NAD is essential for energy production in mitochondria. High doses of NAD can be problematic for those with cancer because some cancers can utilize excess NAD for growth. For those with a cancer history, lower dose NAD therapy can be considered safe. In active cancer cases, high-dose NAD therapy should be avoided. Oral supplementation with nicotinamide riboside can help, but high doses may pose risks. Resources and Contacts: Book recommendation: "Outside the Box Cancer Therapies" provides practical insights into cancer treatments. Dr. Paul Anderson's clinic: Advanced Medical Therapies, located in Seattle, Washington. ***Get every full two hour call in Going Integrative Plus and ask your questions live directly to the top integrative cancer doctors in the world!***  

A fascinating new study finds common biomarkers predict the odds of living to 100 years of age. This 35-year study in 44,000 adults found high-cholesterol and low blood glucose were linked with higher odds of reaching 100 years of age. Here's a breakdown of these interesting findings: https://bit.ly/3LI6PnM Sponsored: Support your Intermittent Fasting lifestyle with the Berberine Fasting Accelerator by MYOXCIENCE: bit.ly/berberine-fasting-accelerator Save with code Podcast at checkout Show Notes: 03:00 2.7% of participants reached their 100th birthday. 03:30 Non-centenarians had double or triple the rates of common conditions. 04:00 Cardiovascular disease decreases your health span and life span. 05:30 Higher total cholesterol is associated with becoming a centenarian. 07:30 Centenarians had lower levels of blood glucose. 08:20 GGT liver enzyme test reflects the turnover of glutathione and oxidative stress. 10:40 Uric acid is an indirect marker of inflammation, and is low in centenarians. 12:00 Cholesterol may be protective. 15:45 Higher levels of total cholesterol and iron, and lower levels of glucose, creatinine, uric acid, AST, GGT, and ALP, total iron binding capacity and LDH were associated with a greater likelihood of becoming a centenarian. 17:30 Improve GGT levels by improving glutathione health and avoiding drinking alcohol. 18:30 Minimize intrahepatic fat with fasting, exercise, and low carb nutrition. 24:45 ApoB to A1 ratio gives insight into lipoprotein health. 27:50 A short term cold can raise iron levels.

Dr. Michael Atkins and Dr. Vernon Sondak highlight the latest updates to the systemic therapy for melanoma recommendations in this newest guideline. The discussion covers neoadjuvant and adjuvant therapy for resected cutaneous melanoma, options for unresectable and/or metastatic cutaneous melanoma, and therapies for noncutaneous melanoma. They review the importance of this guideline and the most pressing outstanding questions to help inform better treatment strategies for patients with melanoma. Read the full guideline update, "Systemic Therapy for Melanoma: ASCO Guideline Update" at www.asco.org/melanoma-guidelines. TRANSCRIPT This guideline, clinical tools, and resources are available at http://www.asco.org/melanoma-guidelines. Read the full text of the guideline and review authors' disclosures of potential conflicts of interest disclosures in the Journal of Clinical Oncology, https://ascopubs.org/doi/10.1200/JCO. 23.01136 Brittany Harvey: Hello and welcome to the ASCO Guidelines podcast, one of ASCO's podcasts delivering timely information to keep you up to date on the latest changes, challenges, and advances in oncology. You can find all the shows, including this one at asco.org/podcasts. My name is Brittany Harvey, and today I'm interviewing Dr. Michael Atkins from Georgetown Lombardi Comprehensive Cancer Center, and Dr. Vernon Sondak from H. Lee Moffitt Cancer Center and Research Institute, authors on “Systemic Therapy for Melanoma: ASCO Guideline Update.”   Thank you for being here today, Dr. Atkins and Dr. Sondak. Dr. Vernon Sondak: Happy to be here. Dr. Michael Atkins: Yeah, it's a pleasure. Brittany Harvey: Great. Then before we discuss this guideline, I'd like to note that ASCO takes great care in the development of its guidelines and ensuring that the ASCO conflict of interest policy is followed for each guideline. The disclosures of potential conflicts of interest for the guideline panel, including Dr. Sondak and Dr. Atkins, who have joined us here today, are available online with the publication of the guideline in the Journal of Clinical Oncology, which is linked in the show notes. So then, to dive into the content here, Dr. Sondak, what prompted this full update to the Systemic Therapy for Melanoma Guideline, which was initially published in 2018? Dr. Vernon Sondak: Well, the last 10 years or so have seen enormous advances in the management of metastatic melanoma and localized melanoma with systemic therapy, and the last few years haven't slowed up at all. So since 2018, we've seen new approvals, we've seen key pivotal trials that have shown some amazing results that we'll talk about, and all of these things together weighed into the decision to update the systemic therapy guidelines. Brittany Harvey: Great. Thank you for that background on what prompted the update. So then, this guideline provides updated recommendations across four clinical questions. I'd like to review the key updated recommendations for our listeners. So first, Dr. Sondak, what has changed in the updated recommendations regarding neoadjuvant therapy for adults with resectable cutaneous melanoma? Dr. Vernon Sondak: Neoadjuvant therapy is one of the most rapidly evolving and exciting parts of the management of melanoma with systemic therapy. The updated guidelines now include neoadjuvant pembrolizumab as a new recommendation for patients with resectable stage IIIB to IV cutaneous melanoma. This is based on the SWOG S1801 clinical trial, which was a very simple and yet incredibly influential clinical trial. It took patients with resectable metastatic melanoma, either metastatic to the lymph nodes or beyond, as long as it could be removed surgically, and randomized all of the patients to either get surgery, followed by a year of adjuvant pembrolizumab, which is very standard, or the same exact surgery and the same total amount of pembrolizumab, but with three of the doses given before surgery. So that simplicity, that ability to just compare the effect of neoadjuvant or preoperative pembrolizumab to entirely postoperative adjuvant pembrolizumab, made this trial a really pure assessment of the value of neoadjuvant pembrolizumab.  Impressively, this study showed a significant improvement in event-free survival for patients who got those three doses of pembrolizumab upfront. What's event-free survival? That includes relapse-free survival, but also the kinds of events that you can see happening with neoadjuvant therapy, such as progression of the disease prior to surgery that makes the patient unresectable. And the bottom line is that there was really the same number of issues with neoadjuvant pembrolizumab as with surgery, followed by adjuvant therapy, but there were many fewer recurrences among the patients who got neoadjuvant pembrolizumab. So that's why this was put into the guidelines. Brittany Harvey: Excellent. I appreciate you reviewing the evidence behind those recommendations and what's new for neoadjuvant therapy. So then, Dr. Atkins, moving into adjuvant therapy, for patients with resected cutaneous melanoma, what is new in the recommendations regarding adjuvant systemic therapy options? Dr. Michael Atkins: Sure. In the prior version, adjuvant therapy was recommended for patients with stage IIIB, IIIC, and for some patients with stage IV resected to NED. And those were based on studies with adjuvant pembrolizumab, adjuvant ipilimumab, and adjuvant nivolumab compared to ipilimumab. But what's happened since then is some really important adjuvant studies have been carried out in patients with stage IIB, IIC, and IIIA disease who are at slightly lower risk of recurrence, but still have substantial risk of recurrence, and make up a large percentage of the patients who eventually develop stage IV disease. And in these studies, one with pembrolizumab compared to placebo, there was about a 40% to 50% reduction in relapse-free survival observed, leading to the FDA approval of pembrolizumab in that setting. And then recently we saw the results of a similar study involving nivolumab that showed maybe even a slightly better reduction in the risk of relapse in that same patient population. Ultimately, this will lead to FDA approval as well. And we felt it was important to put in the guidelines the results of these studies so that people can have informed discussions with their patients about whether they want to receive this therapy going forward. It's important to point out that we don't have good data yet on overall survival. We just have data on relapse-free survival. So we don't, for sure, know that treating patients early, rather than waiting until a subset of them relapse and treating those late leads to an improved overall survival. That's an important discussion to have with patients to provide them with this option. In addition, we saw the results of the IMMUNED trial, which looked at nivo-ipi or nivo monotherapy versus placebo or observation in patients with stage IV disease that had been completely resected. And we saw dramatic improvement for the nivo-ipi combination compared to nivo or observation in those patients with stage IV NED. And we felt that, therefore, this was also an important patient population where we should offer guidance Brittany Harvey: Absolutely. That shared patient-clinician decision-making is paramount. And then you've both reviewed the options for resected cutaneous melanoma. But Dr. Atkins, what is new regarding systemic therapy options for patients with unresectable and/or metastatic cutaneous melanoma? Dr. Michael Atkins: Yes. For patients with unresectable metastatic cutaneous melanoma, there was a new drug combination that was approved combining nivolumab with relatlimab, which is an anti-lag-3 antibody that showed benefit compared to nivolumab monotherapy across almost all subgroups. In particular, the benefit was similar regardless of BRAF mutation status, regardless of elevated LDH, and regardless of patient stage. That led to FDA approval, and this is now an available treatment option, which is associated with less toxicity and similar efficacy to the standard of care nivo-ipi. In addition, although nivolumab-ipilimumab had been approved and was in our last recommendation for patients with BRAF-mutated melanoma, we didn't really know whether they should receive BRAF/MEK inhibitors, which were also approved, versus nivolumab-ipilimumab as their initial therapy. And so in the past few years, we saw the results of the DREAMseq trial, which randomized patients with BRAF-mutant melanoma to either nivolumab-ipilimumab, followed by BRAF-MEK inhibitor progression, versus the converse sequence. And we saw that at two years, the starting with a nivolumab-ipilimumab had a 20% improvement in two-year overall survival. This prompted the NCCN to change their guidelines to list nivolumab-ipilimumab or other immunotherapies as a preferred frontline therapy. And we thought that this data was important enough and somewhat validated by a randomized phase II trial, the SECOMBIT, which had a lot smaller numbers to encourage us to change the guidelines. Other minor things that we did were to take T-VEC and no longer recommend that as an option for patients with BRAF-wild type disease who had progressed on anti-PD-1 therapy and that ipilimumab and ipilimumab-containing regimens were no longer recommended for patients with BRAF-mutated disease after progression on other immunotherapy. We felt that those patients probably are best served to get BRAF/MEK inhibitors. Brittany Harvey: It's good to have clarity on some of those sequencing options for patients and also on which treatments are working better for patients in these subpopulations. So then, Dr. Sondak, the last set of recommendations. What has changed regarding options available for patients with noncutaneous melanoma?  Dr. Vernon Sondak: There's no question that our patients with noncutaneous melanomas, such as uveal melanoma or mucosal melanoma, have many fewer options and haven't benefited as much from the revolution in treatment that we've seen with our cutaneous melanoma patients, but there have been definite improvements and progress. The full update incorporates new recommendations for uveal melanoma that were published in 2022 as a rapid recommendation update, specifically a new drug called tebentafusp, which is restricted to HLA-A*02:01-positive patients. It's HLA-type restricted, but it is active in patients with metastatic uveal melanoma. And so the new guideline is that previously untreated patients with metastatic uveal melanoma who are HLA-A*02:01-positive should be offered tebentafusp as a treatment option. So that means all our patients with metastatic uveal melanoma should get HLA typed, so they know if they're a person who is eligible for this treatment and it should be considered early on in the treatment paradigm. Brittany Harvey: Well, thank you both for reviewing the updates to these evidence-based recommendations. There's a lot that's new in this field.  So then, Dr. Atkins, what is the importance of this guideline? And in your view, how will it impact clinicians, and also how will these guideline recommendations affect patients? Dr. Michael Atkins: Sure. Well, we have new treatments such as relatlimab and tebentafusp that are available and should be offered to appropriate patients, and new data on how to optimally apply previously approved treatments such as nivolumab-ipilimumab in patients with BRAF-mutated or resected stage IV melanoma, pembrolizumab use in the neoadjuvant setting, and nivo and pembro in earlier stage disease. And with this new information out there and included in the guidelines, hopefully, this will allow practitioners to give the best possible treatments to their patients, and patients to receive treatments which will improve their outcomes. Brittany Harvey: Absolutely. It's great to have new data to better inform treatment options for patients with melanoma.   So then, finally, Dr. Sondak, what are some of the most pressing outstanding questions regarding systemic therapy for patients with melanoma that may need to be addressed in a future guideline update? Dr. Vernon Sondak: Every advance brings up new questions. In neoadjuvant therapy, we have single-agent pembrolizumab with strong data from the randomized trial I spoke about. We anticipate more data about combination immunotherapy, specifically low-dose ipilimumab and nivolumab in the setting of neoadjuvant therapy. There are some trials going on with that. The best neoadjuvant treatment, the best sequence, how long should we treat, and even should we change the surgery based on the results of neoadjuvant therapy, not just the surgery, but the postoperative adjuvant therapy? Those are all questions that are key in the neoadjuvant side.  In the adjuvant therapy side, we have much more clarity now about BRAF versus immunotherapy in unresectable disease, but we still don't know always what's the best adjuvant therapy for our BRAF-mutated patients. That's an area we hope will eventually get more clarity, but I think it's going to take a while for that.   And finally, we'll learn more about the optimum sequencing of patients with metastatic disease, but especially for the patients who've already failed adjuvant or neoadjuvant therapy. So much of the data that Dr. Atkins and I talked about in metastatic disease, whether cutaneous or noncutaneous, involved previously untreated patients. But so many of our metastatic disease patients today have come to us already with some form of treatment in the adjuvant or neoadjuvant setting. We still have a lot of work to do to define the best treatment strategies for those patients.  Brittany Harvey: Definitely. Well, we'll look forward to learning more as new data comes out and as some of that research comes to fruition. So I want to thank you so much for your work to update this guideline and thank you for your time today, Dr. Sondak and Dr. Atkins. Dr. Vernon Sondak: Thank you. Dr. Michael Atkins: You're very welcome. Thanks a lot. Brittany Harvey: And thank you to all of our listeners for tuning in to the ASCO Guidelines podcast. To read the full guideline, go to www.asco.org/melanoma-guidelines. You can also find many of our guidelines and interactive resources in the free ASCO Guidelines app available in the Apple App Store or the Google Play Store. If you have enjoyed what you've heard today, please rate and review the podcast and be sure to subscribe so you never miss an episode. 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. Guest 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.    

Ever had a simple breakfast order turn into a comedy of errors? Well, so did Panic, complete with language barriers and a fiery line cook. While we unravel this hilarious breakfast saga, we also dive into a peculiar incident involving an astrologer and the mysterious disappearance of some of our favorite tunes from Spotify. Curious? Stick around. Now, let's talk music. First, "Tell Me" by FANTASTICS from EXILE TRIBE gives us our disco vibes injection. Followed by the sassy and sweet "Better Things" from girl group aespa! Then we get lost in the global pop sound of IMP.'s debut single, "CRUSIN'." Their unexpected rap adds a unique twist, making it a perfect mood-lifting anthem. Then we journey on to V's soulful ballad "Love Me Again". His captivating voice, combined with dreamy instrumental and sentimental lyrics, makes the song an experience you wouldn't want to miss. And oh! His new blonde hair deserves a mention too. Finally, brace yourself as we delve into the intriguing transitions in the song "DA BOMB" from Snow Man. We analyze Raul's unique vocals, the heavy beats, the Bollywood vibes, and the rap by Miyadate. The song's intensity and transitions are making us wish for a live performance soon. From music insights to food industry quirks and unexpected breakfast drama, our chat has something for everyone. Get ready for an entertaining ride!FANTASTICS from EXILE TRIBE InstagramX (Twitter)YouTubeaespaInstagramX (Twitter)YouTubeIMP. OfficialInstagramX (Twitter)YouTubeV (of BTS) InstagramYouTube (HYBE)Snow Man InstagramX (Twitter)YouTubeTikTokSupport the showPlease help Music Elixir by rating, reviewing, and sharing the episode. We appreciate your support!Follow us on:TwitterInstagram If have questions, comments, or requests click on our form:Music Elixir FormDJ Panic Blog:OK ASIA

Dr. Cochran has a passion for education, guidance and outside the box therapies. Dr. Cochran received his Doctorate in Naturopathic Medicine from Bastyr University. He founded Interactive Health Clinic, with specialty focuses in functional/biological medicine, pain management therapies, integrative oncology, and healthy aging. He is an expert in his field on therapeutic injections and intravenous therapies. He has served as the medical fellow/director of intravenous therapy at the Bastyr Integrative Oncology Research Center (BIORC), Bastyr University's cancer research center. Dr. Cochran is well known worldwide as a lecturer with International IV Therapy for Professionals a group that specializes in educating physicians on intravenous nutrient therapy. He is also an instructor of many therapeutic injections and strong passion for ozone therapies. He has an active consulting business with H.E.R.O.E.S and OCBM where he coaches physicians and professionals on optimized systems for best results. As a keynote speaker and content creator, Dr. Cochran is dedicated to empowering doctors to build successful models in outcome-based medicine. Timestamps: 00:00:00 Trailer and introduction. 00:01:03 Naturopathic doctor with a passion for teaching. 00:03:19 Meat diet improved digestive issues and health. 00:09:18 Dabbled with ketogenic diet.  00:11:36 Not many heard of ketogenic diet. 00:16:16 LDH test detects glucose/carbohydrate consumption, oxygen deficiency.  00:20:56 4 quadrant pain, candida overgrowth, inflammation, alternatives to surgery 00:23:56 The progress of medicine and misunderstood probiotics. 00:26:51 Terrain theory. 00:29:00 Growing licensure, West Coast states most lenient. 00:32:57 Possible chelation therapy benefits. 00:37:55 Pain, diet, metabolic syndrome, cancer, patients. 00:41:51 Carnivore diet gaining popularity due to results. 00:45:04 Naturopaths trained as primary care providers, losing diagnostic skills. 00:48:40 Benefits of ozone therapy. 00:50:07 Cowboy medicine. 00:53:13 Closing. See open positions at Revero: https://jobs.lever.co/Revero/ Join Carnivore Diet for a free 30 day trial: https://carnivore.diet/join/ Carnivore Shirts: https://merch.carnivore.diet Subscribe to our Newsletter: https://carnivore.diet/subscribe/ . ‪#revero #shawnbaker #Carnivorediet #MeatHeals #HealthCreation   #humanfood #AnimalBased #ZeroCarb #DietCoach  #FatAdapted #Carnivore #sugarfree  ‪

Show Notes:0:54, 0:55 and 1:00 - Toronto0:57 - New Brunswick1:01 - Shenzhen 1:45 - Toronto3:48 - Shenzhen 5:44 - Video of LDH Scissors manufacturing process (scroll to bottom of page)7:11 - LDH midnight edition scissors7:13 - LDH traditional scissors7:18 and 7:21 - LDH prism shears7:27 - LDH traditional shears 7:29 - East Asian style handle scissors 11:25 - Sheltersafe.ca13:46 - Shopify15:30 - Toronto17:24 - LDH midnight edition pruning shears17:47 - LDH scissors on Instagram (@ldh_scissors)18:43 - LDH pruning shears20:28 - Carbon steel 20:30 - LDH midnight shears20:31 - LDH traditional shears20:33 - LDH rotary cutter blades20:40 - LDH snips20:42 - LDH prism shears20:47 - Toronto21:11 - LDH Scissor's blog post on how to oil scissors and snips24:54 and 25:39 - ‘Will It Cut?' series27:04 - Barely Finished (@barely.finished)29:02 - Jane Austin29:10 - Flying geese29:29 - LDH midnight edition thread snips29:32 - LDH nine inch midnight edition shears29:36 - LDH one piece thread snip29:40 - LDH imperial snips29:41 - LDH midnight snips29:42 - LDH prism snips29:43 - LDH midnight snips29:43 - LDH Imperial snips29:55 - LDH gift sets30:53 - Heike Handmade (@heike.handmade)31:40 and 32:00 - Natural Habitat Shorts (@naturalhabitatshorts)32:06 - Quilt Buzz (@quilt.buzz)Follow Ursula:Instagram - @ldh_scissors and @barely.finishedhttps://ldhscissors.com/Follow Us:Amanda: @broadclothstudio https://broadclothstudio.com/Wendy: @the.weekendquilter https://the-weekendquilter.com/Quilt Buzz: @quilt.buzzhttps://quiltbuzzpodcast.com/Intro/Outro Music:Golden Hour by Vlad Gluschenko

durée : 00:24:08 - L'invité de 8h20 : le grand entretien - par : Nicolas Demorand, Léa Salamé - Fabien Jobard, sociologue, directeur de recherche au CNRS, centre de recherche sociologique sur le droit et les institutions pénales, Henri Leclerc, avocat, président d'honneur de la LDH, et Camille Chaize, porte-parole du ministère de l'Intérieur, sont les invités du Grand entretien.

Welcome to PICU Doc on Call, a podcast dedicated to intense wisdom in the field of pediatric critical care. In this episode, hosts Pradeep Kama and Rahul Damania, both pediatric ICU physicians, discuss the case of a five-year-old male who presents to the emergency department with unexplained fatigue and fever. The patient's symptoms include fatigue, intermittent fevers, tachycardia, and significantly low hemoglobin levels.The hosts delve into the possible causes of the patient's condition, considering a blood cell disorder and the potential for severe anemia due to aplastic crisis. They explain the physiological adaptations that occur in severe acute anemia, including the shifting of the oxyhemoglobin curve to the right and the increase in cardiac output through tachycardia and increased stroke volume.The podcast episode also covers different forms of hemolytic anemia, including extravascular and intravascular hemolysis, autoimmune hemolytic anemia, and paroxysmal nocturnal hemoglobinuria. The hosts discuss the workup for hemolytic anemias, such as complete blood count, peripheral smear, LDH levels, haptoglobin levels, and Coombs tests. They emphasize the importance of involving hematology and infectious disease specialists for accurate diagnosis and management.The case of the five-year-old with hereditary spherocytosis is explored, highlighting the characteristic spherocytic shape of red blood cells and potential complications like hemolytic crisis, splenic sequestration, and aplastic crisis. The hosts provide insights into the pathophysiology and presentations of these complications, emphasizing the need for prompt recognition and appropriate interventions.In summary, this episode of PICU Doc on Call provides valuable information on the evaluation and management of a pediatric patient with fatigue, fever, and anemia, shedding light on different forms of hemolytic anemias and their associated complications.

EXPERTS PASCAL PERRINEAU Politologue - Professeur des universités à Sciences Po Auteur de « Le populisme » CARL MEEUS Rédacteur en chef - « Le Figaro Magazine » NATHALIE SAINT-CRICQ Éditorialiste politique - « France Télévisions » SOAZIG QUÉMÉNER Rédactrice en chef du service politique - « Marianne » « Le combat syndical contre la réforme des retraites est loin d'être terminé ». La partie n'est pas finie pour Laurent Berger. Présent aujourd'hui dans le cortège parisien de cette douzième journée de mobilisation, le secrétaire général de la CFDT a affirmé qu'il se projetait vers de « grandes manifestations populaires le 1er mai ». « Le mouvement n'est pas fini », a confirmé à ses côtés la numéro un de la CGT Sophie Binet, déterminée à obtenir la non promulgationde la réforme, estimant que le président de la République « ne peut gouverner le pays tant qu'il ne la retire pas ». De son côté, Emmanuel Macron cherche à passer à autre chose, promettant aux syndicats un « échange qui permettra d'engager la suite ». Une proposition froidement reçue par Laurent Berger, qui a plaidé pour un « délai de décence ». « Pour nous, l'ordre du jour est le retrait de cette réforme des retraites », a ajouté Sophie Binet. Une sortie de crise difficile à trouver donc pour le chef de l'Etat, qui voit la contestation le poursuivre jusque dans ses déplacements internationaux, comme cette semaine aux Pays-Bas. En France, la pression ne faiblit pas non plus. Les grèves continuent dans les raffineries et les transports, et des coups d'éclats un peu partout sur le territoire ont lieu dans un climat tendu, parfois violent, qui risque de trouver son paroxysme demain soir si le Conseil institutionnel valide la loi. Une décision cruciale, qui sera scrutée par l'exécutif comme les opposants. Les neuf sages de la rue de Montpensier annonceront en effet si la réforme des retraites est partiellement ou entièrement censurée, ou bien au contraire homologuée. Laurent Fabius, le président du Conseil, a donc lourd sur les épaules. Sa décision, hautement politique, pourrait impacter le reste du quinquennat d'Emmanuel Macron. Le Conseil constitutionnel jugera aussi si la demande de référendum d'initiative partagée (RIP) de la gauche est recevable ou non. De son côté, Laurent Berger appelle le chef de l'Etat à débloquer la situation avec l'article 10 de la Constitution, celui-là même qui permet une nouvelle délibération d'avoir lieu au Parlement. Face à la crise, Elisabeth Borne joue sa survie à Matignon. Et si un début de tension s'est fait sentir ce week-end entre elle et le président de la République, c'est maintenant sa déclaration sur la ligue des Droits de l'Homme qui surprend. Expliquant « ne plus comprendre » certaines positions de l'association, elle emboîte le pas à Gérald Darmanin, qui a déclaré pour sa part que « la subvention donnée par l'Etat à la LDH méritait d'être regardée dans le cadre des actions qui ont pu être menées ». Alors, cette douzième mobilisation de l'intersyndicale est-elle la dernière ? Le Conseil constitutionnel mettra-t-il fin à la crise ? Elisabeth Borne peut-elle encore rester à Matignon ? DIFFUSION : du lundi au samedi à 17h45 FORMAT : 65 minutes PRÉSENTATION : Caroline Roux - Axel de Tarlé REDIFFUSION : du lundi au vendredi vers 23h40 RÉALISATION : Nicolas Ferraro, Bruno Piney, Franck Broqua, Alexandre Langeard, Corentin Son, Benoît Lemoine PRODUCTION : France Télévisions / Maximal Productions Retrouvez C DANS L'AIR sur internet & les réseaux : INTERNET : francetv.fr FACEBOOK : https://www.facebook.com/Cdanslairf5 TWITTER : https://twitter.com/cdanslair INSTAGRAM : https://www.instagram.com/cdanslair/

Hiring associates can be such a pain BUT it's beautiful when it works. I gathered a smart group of managers who have spent years hiring and training associates in their practices. I hope their knowledge can help you anticipate any upcoming transitions for your office. Some highlights: Which traits are a hard pass when interviewing associates? Are new associates really interested in buying in? What are the best ways to introduce an associate to patients? Huge thanks to Curve Dental for sponsoring this episode! Grab a demo with them through this link (no affiliate money to me) and see if they're a fit.  ↪️ CurveDental.com/duncan Full show notes on the podcast home page! https://nobodytoldmethat.libsyn.com/ Connect with the Panelists:  Stacey Singleton, CDA, EFDA, MAADOM - York County Pediatric Dentistry  Barbra Curtis, LDH, CEO - Cambridge Family Dentistry Lynda Davenport, RDA, FAADOM: Endodontic Associates, P.A. ------------- My new insurance course is out! Dental Insurance Design and Management is geared toward those who want to understand the how and why of insurance. As a loyal podcast listener, please use "NTMT" for a $50 courtesy toward your investment.  Don't forget to check out my other podcast Chew on This - A Dental Podcast!  If you like the show then I'd appreciate a good rating. Tell your friends. Even podcasters ask for referrals! ------------- Visit Odysseymgmt.com to check out my book, webinars and courses.    

The Root Cause Medicine Podcast is created by Rupa Health, the best way to order, track & manage results from 30+ lab companies in one place for free. The Root Cause Medicine Podcast is a weekly one-on-one conversation with renowned medical experts, specialists, and pioneers who are influencing the way we look at our health and wellbeing. This week we're joined by Dr. Natalie Underberg, CEO of The PCOS Doc. In this episode, Dr. Natalie Underberg shares the causes, strategies, and lifestyle changes necessary to effectively manage Polycystic Ovarian Syndrome (PCOS). As a seasoned researcher with over a decade of experience studying PCOS, Dr. Natalie is a distinguished expert in her field. In addition to earning her doctoral degree, she has devoted countless hours to advanced functional medicine training through the Institute of Functional Medicine and Apex Energetics, as well as intensive coursework in internal disorders through the American Board of Chiropractic Internists. Dr. Natalie was personally diagnosed with PCOS in 2010, and has since been dedicated to educating, empowering, and advocating for women who also grapple with this complex condition. Alongside her work helping women with PCOS, Dr. Natalie specializes in assisting women with infertility and other hormone-related issues from a holistic perspective. Key Takeaways: What is PCOS? PCOS, which stands for Polycystic Ovary Syndrome, is a hormonal disorder that affects women of reproductive age. Women with PCOS have imbalanced levels of hormones, such as higher levels of androgens and insulin, which can cause a range of symptoms, including irregular menstrual cycles, fatigue, acne, excessive hair growth, weight gain, and even difficulty getting pregnant. Dr. Natalie states that one in seven women are now dealing with PCOS. Challenges of PCOS diagnosis and management When it comes to a PCOS diagnosis, thorough investigations are not being done. There's also a misconception that you need a cyst on your ovaries to qualify for a PCOS diagnosis, which is not true. Many women are being misdiagnosed or mislabeled due to either the presence or lack of polycystic ovarian morphology. If a woman has two of the three Rotterdam criteria, she has PCOS. However, Dr. Natalie believes there is a need for more expansive criteria for diagnosing PCOS than the current Rotterdam criteria. She also mentions that PCOS is a lifelong condition that can be managed well with the proper practices and strategies. Exploring the Rotterdam criteria In order to qualify someone for a PCOS diagnosis, specialists look for two of the three Rotterdam criteria, which are the presence of polycystic ovarian morphology or a cyst, ovulatory dysfunction, and the presence of excess androgens based on labs. However, Dr. Natalie also looks for other signs like inflammation, insulin resistance, chronic stressors, chronic adrenal dysfunction, and more. What causes PCOS? The root causes or drivers of PCOS include inflammation, insulin resistance, environmental toxins, stressors, childhood trauma, sexual trauma, and toxic maternal relationships. Night shift workers, gymnasts, and high-level athletes often have adrenal stress patterns which can lead to hormone dysregulation and PCOS. Additionally, genetics can play a role in PCOS development as well as metabolic issues such as pancreatic beta cell dysfunction and insulin resistance. Dr. Natalie's bits of advice Adopt lifestyle strategies such as getting exposure to natural light within twenty minutes of waking, eating breakfast outside, taking a ten-minute walk after meals, establishing a consistent sleep pattern, eating an anti-inflammatory diet, managing stress through meditation and vagus nerve exercises, using essential oils for self-care, and re-evaluating close relationships. You can also use supplements, herbal therapies, bioidenticals, and natural antimicrobials. Also, check out Dr. Underberg's recommended lab testing: CBC CMP lipid panel, Iron and ferritin panel, DHEA and DHEAS tests, Progesterone test, Pituitary test, LH and FSH tests, Full thyroid panel, Insulin testing, LDH test, A1C test, DUTCH test, GI-MAP test, CDSA test Order tests through Rupa Health - https://www.rupahealth.com/reference-guide

Progress Report: Medicaid Behavioral Health Services: Senior Data Analyst Brent McDougall recaps a new LLA report that evaluates the progress the Louisiana Department of Health has made in addressing issues previously identified in the behavioral health program and that suggests additional analyses LDH could perform to identify risky provider billings. | https://LLA.La.gov/go/podcast

In this Hygiene Chat, Kara Vavrosky, RDHEP, chats with Lori Hall, CDA, LDH, the Senior Hygiene Director of Operations at Heartland Dental, and they discuss how Heartland helped maximize her potential as a dental hygienist. They also discuss mentoring at Heartland Dental and the support systems in place for hygiene providers. Podcast originally posted as a video on Kara RDH's Facebook page on March 1, 2023: https://www.facebook.com/DentalHygieneKaraRDH/videos/852545129152866 This podcast episode is sponsored by Heartland Dental. To learn more about opportunities Heartland Dental has available, head on over to https://rdh.tv/heartland Need CE? Check out the latest courses at https://rdh.tv/ce Get daily dental hygiene articles at https://www.todaysrdh.com Follow Today's RDH on Facebook: https://www.facebook.com/TodaysRDH/ Follow Kara RDH on Facebook: https://www.facebook.com/DentalHygieneKaraRDH/ Follow Kara RDH on Instagram: https://www.instagram.com/kara_rdh/

“Once patients come out on the other side, nursing care involves understanding how to triage their disease: If they call you with concerns, how would you address those concerns? How would you find out if there's something going on? Just given how acute the onset is, a lot of these patients have some post-traumatic stress disorder, so there's a lot of worried-well conversations, and in outpatients you need to figure out how to coordinate future care given their history of thrombotic thrombocytopenia purpura (TTP),” ONS member Amanda Weatherford, MSN, RN, OCN®, clinical nurse coordinator at Fred Hutchinson Cancer Center in Seattle, WA, told Jaime Weimer, MSN, RN, AGCNS-BC, AOCNS®, oncology clinical specialist at ONS in a conversation about nursing considerations to manage TTP. This episode is part of a series about oncologic emergencies; the others are linked in the episode notes. You can earn free NCPD contact hours after listening to this episode by completing the evaluation linked below. Music Credit: “Fireflies and Stardust” by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0 Earn 0.5 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at myoutcomes.ons.org by November 18, 2024. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation. Upon completion of this activity, participants will report an increase in knowledge of thrombotic thrombocytopenia purpura. Episode Notes Complete this evaluation for free NCPD. Previous Oncology Nursing Podcast episodes on oncologic emergencies ONS book: Understanding and Managing Oncologic Emergencies: A Resource for Nurses (third edition) ONS courses: Oncologic Emergencies Treatment and Symptom Management—Oncology RN Essentials in Oncologic Emergencies for the Advanced Practice Provider ONS Huddle Cards™ American Society of Hematology National Organization for Rare Diseases To discuss the information in this episode with other oncology nurses, visit the ONS Communities. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. Highlights From Today's Episode “Immune or acquired thrombotic thrombocytopenia purpura (TTP) is the most common. It's 95% of all the cases. It is what we as nurses are most likely to encounter in our practice.” Timestamp (TS) 03:29 “TTP can show up in cancer and also as the result of chemotherapy and medications. They say it's either a system of malignancy or a consequence of treatment, and it has also shown up in patients who are post allogenic stem cell transplants.” TS 07:05 “Once you suspect that TTP is into play, you would immediately start the patient on plasma exchange or plasma pheresis, daily or twice daily, and also on high-dose steroids. You do that until you start to see improvement in platelet counts and some of the other hemolysis markers, like LDH.” TS 11:26 “Once patients come out on the other side, nursing care involves understanding how to triage their disease: If they call you with concerns, how would you address those concerns? How would you find out if there's something going on? Just given how acute the onset is, a lot of these patients have some post-traumatic stress disorder, so there's a lot of worried-well conversations, and in outpatients you need to figure out how to coordinate future care given their history of TTP.” TS 14:58 “In patients with cancer, TTP is either a symptom of disease or caused by the treatment. So, you could potentially just have a new patient with cancer and, along with this major, acute crisis that they've had, so dealing with a cancer diagnosis and having had TTP. Or trying to figure out if it was medication. How do we resolve that? Are we able to find a different drug and switch to a different regiment, or do we continue to give it because it's the only therapy? And do we have to continue to be on the lookout for relapse?” TS 17:47

In this episode, we invite Dr. Amir Ali, PharmD, BCOP to discuss with us the pathophysiology, risk factors, prevention, and treatment clinical pearls of tumor lysis syndrome TLS). Key Concepts TLS is caused by rapid cell death of cancerous cells that results in intracellular contents “spilling” into the blood – this leads to high serum uric acid, high serum potassium, high serum phosphate, and LOW calcium. These laboratory abnormalities cause acute kidney injury (via crystal formation in the kidney), arrhythmias (from hyperkalemia), and seizures (from high phosphate and low calcium). Patients at highest risk for TLS are those with hematologic malignancies (lymphomas and leukemias), especially if WBC or LDH labs are very high. Prevention is the Key! The primary prevention approach for TLS is hydration, allopurinol, and sometimes a low dose of rasburicase. The treatment of TLS involves more aggressive hydration and rasburicase. References Coiffier B, Altman A, Pui CH, Younes A, Cairo MS. Guidelines for the management of pediatric and adult tumor lysis syndrome: an evidence-based review [published correction appears in J Clin Oncol. 2010 Feb 1;28(4):708]. J Clin Oncol. 2008;26(16):2767-2778. doi:10.1200/JCO.2007.15.0177 Cairo MS, Coiffier B, Reiter A, Younes A; TLS Expert Panel. Recommendations for the evaluation of risk and prophylaxis of tumour lysis syndrome (TLS) in adults and children with malignant diseases: an expert TLS panel consensus. Br J Haematol. 2010;149(4):578-586. doi:10.1111/j.1365-2141.2010.08143.x Jones GL, Will A, Jackson GH, Webb NJ, Rule S; British Committee for Standards in Haematology. Guidelines for the management of tumour lysis syndrome in adults and children with haematological malignancies on behalf of the British Committee for Standards in Haematology. Br J Haematol. 2015;169(5):661-671. doi:10.1111/bjh.13403