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EUROPEAN MEDICAL JOURNAL
ISSN 2397-6764 Vol 1.3 • August 2016 • emjreviews.com
CONTENTS
EDITORIAL BOARD...................................................................................................................................... 4
FEATURES
• ETHICAL ISSUES ON AWAKE THORACIC SURGERY FOR SERIOUSLY CHRONICALLY
ILL PATIENTS............................................................................................................................................ 12
Gabor Kiss
• ENDOSCOPIC MANAGEMENT OF SESSILE SERRATED POLYPS OF THE COLON.................. 16
Karen Ma, Joshua Melson
SYMPOSIUM REVIEWS
• REGORAFENIB IN ADVANCED AND REFRACTORY GASTROINTESTINAL CANCERS.......... 21
• OPTIMISING CANCER IMMUNOTHERAPY: CHALLENGES AND OPPORTUNITIES.................. 26
• CHALLENGES A
EUROPEAN MEDICAL JOURNAL ISSN 2397-6764
CONTENTS EDITORIAL BOARD.......................
EUROPEAN MEDICAL JOURNAL • THE EVOLVING BIOSIMI
Editorial Board Editor-in-Chief: Prof Markus P
European Medical Journal Prof Robert Dellaval
SUBSCRIBE TOTHEEMJ NEWSLETTER NwEwwW.newSs.eLmjEr
Welcome Welcome to the third edition of
In asthma and COPD
Foreword Dr Harry Thirkettle BSc Hons MBCh
Information reflects UK marketing authorisation
Now, when you want to give 50% them more help f
ETHICAL ISSUES ON AWAKE THORACIC SURGERY FOR SERI
hospital stays, leading to quick discharge
process and its combination with a higher risk of
A A A U U U S S S T T T R R VI VI VI
ENDOSCOPIC MANAGEMENT OF SESSILE SERRATED POLYPS
found in the proximal colon. Macroscopically thes
mucosal resection (EMR) has become the widely ado
Given the above findings, the US Multi-Society Tas
19. Kahi CJ et al. High colonoscopic preval
REGORAFENIB IN ADVANCED AND REFRACTORY
contribute to the efficacy and side effect profile
70 60 50 40 Proportion of patients (%) 30 2
patients with mCRC in their clinics. The v
Regorafenib in Metastatic Colorectal Cancer in
OPTIMISING CANCER IMMUNOTHERAPY: CHALLENGES A
Squibb, Celgene, GlaxoSmithKline, IQWig, Lilly, N
assess T cell reactivity.6 This type of informati
to overall response rate (ORR) and median p
This calls into question the approach of one-size
antiangiogenic therapy.39 Nivolumab significant
PD-L1 testing has several technical challenges an
patients with melanoma were representative of the
MEDI6469, MEDI6383, MEDI0562, MOXR0916, PF
cell tumour infiltration, total lymphocyte co
PD-1/PD-L1 blockade can then be combined with blo
a humanised murine model has been developed that
into an immunogenic tumour to maximise the anti-
Table 1 continued. Combination approach Targe
Atezolizumab is being investigated in combination
Science. 2015;348(6230):69-74. 6. Kvistborg P et
versus everolimus in advanced renal- cell ca
advanced solid tumors. Abstract TPS3107. ASCO Ann
CHALLENGES AND CONSIDERATIONS IN THE MANAGEME
Pathophysiology and Risk of Hyperkalaemia
(i.e. low glomerular filtration rate [GFR]/protein
alternative (CPS) available in some countries, wh
With regards to the excretion of potassium,
Safety data from the two ZS-9 studies indicated t
cardiovascular risk, and effects of an ACE inhibi
EDITOR’S PICK In t
(FM), chronic fatigue syndrome (CFS), chroni
Table 1: Features of central sensitisation.10,21-
The current hypothesis is that the continuum of C
Consequently, patients with organic rheumatologic
The fibromyalgia/polysymptomatic distress visit In
Table 2: Mayo Clinic fibromyalgia self-management
Table 3: Central sensitisation: Multifactorial ae
age U.S. adults. J Manag Care Pharm. 2012;18(6):4
Outcome. 2014;12:128. 54. Pollard L et al
AVANAFIL: THE SECOND-GENERATION TREATMENT OF
colour Doppler ultrasound, is associated wit
present in the heart), PDE-6 (120-fold, pre
Table 2: Efficacy and safety parameters for avana
Of note, the efficacy of the 100 mg dosage was lo
which is of particular interest for couples seeki
instrument to detect psychological componen
the safety and efficacy of avanafil in subje
dysfunction: a systematic review and meta-ana
NEW EVIDENCE FOR EXOGENOUS GLYCO
(cystitis). Exogenous restoration of the GAG laye
treatment include the adverse effects associated
Steinhoff et al.25 investigated the exogenous CS
in men with post-radiation bladder pain following
Urology. 1996;48(5):817-21. 8. Maggi CA, Meli A.
THE EVOLVING BIOSIMILAR LANDSCAPE: APPROVAL OF TH
INTRODUCTION In 2013, the European Commission (EC
Box 1: How are biosimilars defined? Key characteri
is highly similar for all critical quality attrib
Analytics Physicochemical characterisation
Table 3: European Medicines Agency Guidelines rel
and a prospective observational study to assess t
Immunogenicity is a crucial issue for all biologi
REFERENCES 1. European Medicines Agency. Summary
LATE AND VERY LATE STENT THROMBOSIS IN THE ERA
syndrome), ‘probable’ (any unexplained death ≤30
response.7,15-17 In an autopsy study consisting o
(e, f): a 60-year-old man who received a
Zotarolimus is a semisynthetic derivative
stent thrombosis compared with BMSs (OR: 0.27, 95
However, it is important to note that these trial
limit their widespread usage. Future stent design
(EXAMINATION): 1 year results of a randomise
Have you read the previous editions of the Europe
uropean Medical Journal which are available now t
SPONDYLOARTHRITIS: PATHOGENESIS, CLINICAL MANIFES
ethnicity, and geographical distribution of
Arthritis, enthesitis, or dactylitis plus ≥1 of:
level, there is evidence with TNF and IL23/IL17.
HLA-B27 positivity is an excellent predictor
TREATMENT The main goal of SpA management is to
Immunol Rev. 2010;233(1):162-80. 7. Brown MA e
EVALUATION OF STRESS URINARY INCONTINENCE:
Table 1: Features of urethral biology contributin
Table 3: Preoperative evaluation. History • On
Recently, the American College of Obstetricians a
testing with CST and prolapse reduction alone is
or ‘very much better’. At 12 months, treatment su
5. Clinicians should perform stress testing with
slingplasty (IVS): an ambulatory surgical procedu
CIRRHOSIS: REVIEWING THE LITERATURE A
East Asia and Sub-Saharan Africa. According to th
PSC or PBC.20 Gamma-glutamyl transpeptidase l
gradient to >5 mmHg.38 The haemodynamic
In a study, it was demonstrated that in patients
fumarate for up to 5 years. Hepatol Int. 2015;9(2
49. Mathurin P, Bataller R. Trends in the managem
IN-STENT RESTENOSIS AFTER CAROTID ARTERY S
IN-STENT RESTENOSIS: INCIDENCE AND PATHOPHYSIOLOG
are the most common parameters used for ste
Table 1: Comparison of parameters for defining ste
of HbA1c should be a strong recommendation to the
and stent removal; primary closure of
17. Wasser K et al. Clinical impact and predictor
EUROPEAN MEDICAL JOURNAL provides influential arti
HEPATITIS C: IS REGRESSION OF ADVANCED FIBROSI
the extracellular matrix and the progre
Table 1: Rates of cirrhosis regression measured b
regression of cirrhosis was assessed by performin
70 60 50 40 30 Number of patients 20 10
In cirrhotic patients, SVR improves prognosi
Hepatol. 2013;59(4):675-83. 8. Bruno S et al. Is
CHRONIC TOTAL OCCLUSION IN PATIENTS AFTER
significantly and are carried out in 3% of
compared with the CTOs without a CABG and severe
Currently, the retrograde approach can
the patient experienced angina, particularly duri
CONCLUSION • CTOs after a CABG have worse lesi
equipment delivery from target lesion
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