RESUMEN
Adult T-cell leukemia/lymphoma (ATLL) has aggressive clinical behaviors, and improving its prognosis is a great challenge. A disease progression model from asymptomatic human T-cell leukemia virus type 1 carrier to aggressive-type ATLL has been proposed, and indolent ATLL comprising a smoldering or favorable chronic type is located at the midpoint. Even the most favorable smoldering type has a 4-year overall survival rate of <60%. Although watchful waiting is pervasive in patients with indolent ATLL, early therapeutic intervention is discussed among hematologists. Indolent ATLL was once termed T-cell-derived chronic lymphocytic leukemia (CLL). Unlike indolent ATLL, several molecular-targeted agents at the initial treatment have dramatically improved CLL prognosis. Recent studies on CLL have revealed a similar progression model involving premalignant monoclonal B-cell lymphocytosis (MBL). In particular, individuals with high-count MBL have an increased lymphoma risk. Considering the unsatisfactory long-term prognosis of indolent ATLL, further treatment strategies, including precision medicine, are warranted.
Asunto(s)
Antineoplásicos , Leucemia Linfocítica Crónica de Células B , Leucemia-Linfoma de Células T del Adulto , Adulto , Humanos , Leucemia-Linfoma de Células T del Adulto/diagnóstico , Leucemia-Linfoma de Células T del Adulto/etiología , Leucemia-Linfoma de Células T del Adulto/terapia , Leucemia Linfocítica Crónica de Células B/diagnóstico , Leucemia Linfocítica Crónica de Células B/etiología , Leucemia Linfocítica Crónica de Células B/terapia , PronósticoRESUMEN
PURPOSE: The objectives were to evaluate the feasibility of early implementation of a canine-assisted intervention (CAI) for children with neurodevelopmental disorders, and to determine the changes in social functioning and in engagement experienced by the participants. MATERIALS AND METHODS: A CAI consisting of 24 sessions was piloted in an intra-subject quasi-experimental longitudinal design. The outcome measures were the Assessment of Communication and Interaction Skills (ACIS) and Individual Child Engagement Record-Revised (ICER-R). RESULTS: No adverse events or side-effects were noted. The sample consisted of 44 participants (median age 37 months). A total of 33 children (75%) attended all sessions. Main results showed that after completing the intervention, the overall ACIS score improved significantly (p < 0.001); the effect size was large. There was a significant improvement in the scales of the ICER-R from baseline to the final assessment: overall engagement (p < 0.001), frequency of repetitive behaviours (p < 0.001), frequency of interaction between the child and adults (p < 0.001), and the quality of this interaction (p < 0.001); the effect sizes ranged from medium to large. CONCLUSIONS: The early application was feasible. The results in the areas of social functioning and engagement suggest that this CAI may be a useful complementary strategy in early therapeutic intervention with these children. WHAT THIS PAPER ADDS?: The results of implementation of a canine-assisted intervention (CAI) at an early therapeutic intervention unit for children with neurodevelopmental disorders are not known. This research supported the feasibility and positive impact of a CAI in a population consisting of children with neurodevelopmental disorders in the earliest stages of their life, with similar proportions of participants with global developmental delay and autism spectrum disorder. The study was pioneering in the development of this form of actions in an early intervention service for children with these health conditions. The intervention appears feasible and the results extend the existing evidence base for this intervention modality. The findings suggest significant improvements of a medium to large size in the domains of communication skills and social relations, engagement levels, frequency and quality of interaction with adults and repetitive behaviours after 12 and 24 weekly CAI sessions.
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Trastorno del Espectro Autista , Trastornos del Neurodesarrollo , Animales , Trastorno del Espectro Autista/terapia , Comunicación , Perros , Intervención Educativa Precoz , Humanos , Trastornos del Neurodesarrollo/terapia , Interacción SocialRESUMEN
Multiple sclerosis is a complex, autoimmune-mediated disease of the central nervous system characterized by inflammatory demyelination and axonal/neuronal damage. The approval of various disease-modifying therapies and our increased understanding of disease mechanisms and evolution in recent years have significantly changed the prognosis and course of the disease. This update of the Multiple Sclerosis Therapy Consensus Group treatment recommendation focuses on the most important recommendations for disease-modifying therapies of multiple sclerosis in 2021. Our recommendations are based on current scientific evidence and apply to those medications approved in wide parts of Europe, particularly German-speaking countries (Germany, Austria, Switzerland).
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Esclerosis Múltiple , Sistema Nervioso Central , Consenso , Europa (Continente) , Alemania , Humanos , Esclerosis Múltiple/diagnóstico , Esclerosis Múltiple/tratamiento farmacológicoRESUMEN
With the recent advances in spinal muscular atrophy therapies, the complete scenario of standard of care and following up is changing not only in the clinical field with new phenotypes emerging but also with new expectations for patients, caregivers and health providers. The actual evidence indicates that early intervention and treatment is crucial for better response and prognosis. Knowledge of the prenatal and pre-symptomatic postnatal stages of the disease are becoming essential to consider the opportunities of timely diagnosis and to decide the earliest therapeutic intervention.